144 ANATOMY AND PHYSIOLOGY 



patches (or agminated glands) the largest of which may measure 

 three inches in length. 



Clinical note. The solitary glands (more especially the Peyer's 

 patches) become inflamed and ulcerated in typhoid fever. 



The Large Intestine 



The large intestine is about five feet long and two and one-half 

 inches wide in the widest part. It begins where the small intestine 

 ends (in the right iliac region), ascends through the right lumbar, 

 crosses the abdomen in front of the small intestine, descends to 

 the left iliac region, and thence down through the pelvis, ending in 

 front of the coccyx. (See Regions of the Abdomen, p. 366.) 



The mucous coat is smooth and rather pale. No folds are 

 present; and no villi, but the solitary and tubular glands are 

 numerous, like those of the small intestine. 



The circular fibers of the muscular coat are evenly distributed, 

 but the longitudinal fibers of the cecum and colon are arranged in 

 three bands, placed at even distances apart. These bands are 

 shorter than the tube itself, therefore they gather it into puffs 

 which give the bowel a sacculated appearance. By this, the large 

 bowel may be recognized at once, even should it be really small 

 in actual size in some portion of its extent. 



The serous coat covers the greater part of the large intestine; 

 the exceptions will be noted later. (See p. 146, Surgical Note, 

 The Rectum?) 



The four divisions of the large intestine are the cecum, the 

 colon, the sigmoid loop, and the rectum (Figs. 106, no). 



The cecum, or first division, is a short pouch hanging below the 

 level of the ileocolic valve and presenting the opening of the appen- 

 dix vermiformis or appendix ceci. The three longitudinal bands 

 of the muscular coat meet at the base of the appendix, which is a 

 small tube three or four inches long, attached to the posterior wall 

 of the cecum. It often turns upward, quite as often downward, 

 and may lie transversely. It has all four coats, with intestinal 

 and solitary glands, but is of no use. 



Clinical note. Owing to its small size any substance which enters the 

 appendix is apt to be retained, and if it is of an injurious character it will 

 cause appendicitis. This disease is more often caused by the action of 



