ABDOMINAL VISCERA IN MAN. 279 



33, and 27 the appendix was directed upwards into a retro- 

 colic pouch; in the other cases it passed upwards outside an 

 ascending meso-colon. In case 38 the appendix was unusually 

 large, and reached outside the ascending colon to the under 

 surface of the liver. 



In seven cases the root of the appendix was more than 5 cm. 

 below CD., and was associated in all cases with a distended 

 caecum. In four of these cases (Nos. 7, 20, 22, and 30) the 

 Ccecum was prolapsed into the pelvic cavity. 



In four cases the root of the appendix was less than 4 cm. 

 from the middle line, being associated in cases 7, 22, and 30 

 with the prolapsed cseca. 



In six cases it was more than 8 cm. from the middle line. 

 The chief feature in these cases was distension of the caecum. 



The alterations in the position of the appendix as a whole, 

 whether very high up or very low down, seem, therefore, 

 specially associated with a distended condition of the caicum, 

 and the appendix is most likely to be found directed upwards 

 when the peritoneal attachments of the caecum are loose. 



The position of the appendix in 7'elation to the ccecum is 

 chiefly regulated by the degree of absorption of its mesentery 

 by the caecum or colon, and by the state of distension of the 

 caecum ; and this latter may move the appendix up or down. 

 The tenseness of the peritoneum in the iliac fossa no doubt 

 chiefly determines the degree of possible prolapse of the 

 cfecum. 



By some writers manifold classifications of the position of 

 the appendix are adopted. If we are, however, guided by the 

 state of its mesentery, the following divisions are natural 

 enough. 



The appendix generally hangs either partly or wholly over 

 the margin of the psoas into the pelvic cavity. The direction 

 of its free end is evidently a matter of small importance, as it 

 will vary from time to time. Because of their clinical 

 importance, those cases in which the root and body of the 

 appendix lie wholly within the pelvic cavity should be given 

 separately. 



There are also the cases of an appendix wholly in the iliac 



