280 PROFESSOR CHRISTOPHER ADDISON. 



fossa, where it may either be free, — often in a retro-colic 

 pouch, — or partly or wholly behind the peritoneum, these 

 last cases being clinically very important. Finally, there are 

 irregular cases made up chiefly of those in which the appendix 

 is situated outside an ascending colon. 

 In this series there were — 



1. Wholly in the pelvic cavity, 6 cases, or 15 per cent. 



2. Free, hanging more or less over the pelvic brim, 16 cases, 



or 40 per cent. 



3. Wholly in the iliac fossa, 14 cases, or 35 per cent. 



Of these, 



a. 7 were quite free, being 17*5 per cent, of the whole 



series. 

 h. 4 were partly free, and recurved into a retro-colic 



pouch, being 10 per cent, of the whole series. 

 c. 3 were behind the peritoneum (Nos. 14, 15, 34), or 



7 '5 per cent, of the whole series. 



4. Irregular cases, 4, or 10 per cent. 



In three of the irregular cases the appendix was situated 

 outside an ascending meso-colon, and in one case (No. 39), it 

 was bound to the back of the caecum. 



The last case exemplified well the condition of an appendix 

 adherent to the c«cum, without an apparent mesentery (see 

 fig. 11, PI. XXII., Pt. III.). One of the three cases in group 3 c 

 was the seat of a small appendicular abscess (No. 34). 



It is not necessary, after what has been said in Part III., to 

 discuss further the various positions of the appendix. 



The Ocecum. — The lowest point of the caecum was situated, as 

 a rule, 61 cm. from the middle line, and 1*23 cm. below the 

 level of the anterior superior iliac spine ; in other words, in the 

 left lateral line, about h an inch below the level of the anterior 

 superior ihac spine. In 20 cases, or 50 per cent., the variation 

 was from the level of the spine to not more than 3 cm. below. 

 The innermost point reached 3*4 cm. from the middle line, at a 

 height of 21 cm. above the anterior superior iliac spine. The 

 inner border of the large intestine at the right, in the plane of 

 CD., was 5*5 cm, from the middle line, and the outer border 

 11-3 cm. 



