ABDOMINAL VISCERA IN MAN. 281 



Lolu positions of the Caecum. — There were 7 cases in which the 

 c'secum was prolapsed within the pelvis, and 3 other cases in 

 which it was partly so ; making 25 percent, of the cases in which 

 the caecum was more or less completely in the pelvic cavity. 



In case 6 there was a caecum 8 cm. long, the lowest 6 cm. of 

 which hung into the pelvic cavity. Cases 7, 8, 20, 22, 26, 30, and 

 36 presented instances of complete, and cases 6, 35, and 38, of 

 partial, prolapse. These cases include amongst them all those in 

 which the lowest point of the caecum was more than 3 cm. below 

 the level of the anterior superior iliac spine. In conjunction 

 with these cases should be mentioned those of low level of the 

 lower border of the ileo-colic junction, which had an average 

 position of 2-3 cm. below CD. There were 10 cases in which it 

 was 4 cm. or more below CD. Five of them, Nos. 7, 20, 22, 30, 

 and 36, were cases of prolapse of the caecum. In three others 

 (Nos. 11, 21, and 40) the caecum very much distended, and in 

 the remaining two cases, Nos. 28 and 29, it was distended. 



The chief characteristic of these cases of prolapse of the caecum 

 seems to be a distended, and in most cases a generally convoluted 

 condition of the large intestine. Given distension of the ca?cum, 

 the tension of its various peritoneal attachments would seem to 

 determine, in the main, the subsequent position, excepting in 

 such a case as No. 36, in which the pressure of the liver must 

 have prevented the distended caecum from passing upwards. 



High positions. — There were 6 cases (Nos. 12, 17, 18, 23, 

 31, and 37) in which the caecum was displaced more or less 

 completely above the level of CD., and the common feature 

 in nearly all of them was great distension of the ctecum. 

 These cases include those in which the ileo-colic junction 

 occupied its highest position. 



It will be seen, on reference to the tables, that the chief 

 lateral displacements of the ileo-colic junction and the inner- 

 most point of the caecum were likewise associated with bowel 

 distension. 



The averages given in the tables, and the outline in fig. 3, 

 Part I., would appear, in the absence of obvious distension, to be 

 a fair representation of a non-prolapsed caecum. 



If the outlines on the plates be studied, it will be seen that, in 

 many of the cases of distension of the ciecum, especially when it 



