52 PKOFESSOR A. BIRMINGHAM. 



the caecum begins to expand, the inner aspect is prevented by 

 its connection with the termination of the ileum from enlarging 

 as freely as the rest of this wall ; in consequence of this, the 

 outer part grows and expands much more rapidly, producing the 

 characteristic lop-sided appearance of the organ, and soon comes 

 to form the lowest part or fundus of the caecum, and the greater 

 part of its sac; whilst the original apex, with the vermiform 

 appendix springing from it, anchored, as it were, to the end of 

 the ileum, is thrust to one side, and finally lies on the inner or 

 inner and posterior aspect of the cascum, a little way below, and 

 usually posterior to, the end of the ileum. 



Although the opening of the appendix is usually between 

 1 and 1^ inches below the ileo-c£ecal orifice when seen from the 

 interior, viewed from the exterior the appendix comes off from 

 the inner and posterior aspect of the caecum about f inch below 

 the inferior margin of the ileo-caecal junction. The readiest 

 guide to the appendix is the anterior taenia coli, which is always 

 distinct. 



My experience agrees with that of Berry as regards the 

 mesentery of the appendix, which usually extends to the tip of 

 the process, and connects this latter to the under surface of that 

 part of the mesentery proper which goes to the lower end of the 

 ileum. 



The appendix is stated to be relative to the rest of the large 

 intestine, much longer in the child at birth than in the adult, 

 iiibbert makes the proportions 1 to 10 at birth, and 1 to 20 in 

 the adult. This difference is, I believe, excessive ; the proportion, 

 in my experience, has been as 1 to 16 or 17 at birth and 1 to 19 

 or 20 in the adult. 



Structure of the appendix. — The submucosa, which is thick, is 

 almost entirely occupied by large masses of lymphoid tissue, 

 surrounded by sinus-like lymph spaces. Owing to the large 

 size of these lymphoid nodules, the areolar tissue of the 

 submucosa is compressed against the inner surface of the 

 muscular coat, and forms a well marked fibrous ring, which sends 

 processes at intervals between the lymphoid masses towards the 

 mucous membrane. The inner portion of this fibrous ring 

 seems to have been mistaken for the muscularis mucosae, 

 which lies internal to the chief masses of lymphoid tissue, 



