32 CROWELL. 



was a globular swelling 2 centimeters in diameter and raised 

 1.5 centimeters above the surface of the appendix. This swelling 

 was covered with peritoneum continuous with that clothing the 

 appendix, its surface was perfectly sipooth, and the mass was 

 slightly fluctuating. The tip of the appendix seemed to have a 

 somewhat thinner wall than the remainder of the organ, and the 

 intermediate portion was thicker than normal. These features 

 are illustrated in Plate I, fig. 1, a photograph taken after opening 

 the appendix and removal of some of the contents, thus account- 

 ing for the shrunken appearance of the cyst. The appendix, cyst, 

 and adjacent portion of the csecum were preserved in toto. On 

 opening the appendix longitudinally (after fixation), the picture 

 as seen in Plate I, fig. 2, was disclosed. The hypertrophic base of 

 the appendix projected a few millimeters into the lumen of the 

 csecum much as the cervix uteri projects into the vagina; its 

 orifice was practically occluded, allowing the passage of only a 

 very fine strand of catgut. The proximal and distal thirds of 

 the appendix were dilated, while the middle third was almost 

 obliterated by the approximation of its walls. External to the 

 proximal half of the appendix was the cyst, the inner wall of 

 which was formed by the muscular tunic and the outer wall by 

 a thin membrane covered by peritoneum. No direct commu- 

 nication of this cyst with the lumen was discovered on gross 

 examination. The cyst and the proximal and distal thirds were 

 distended by a thick, pearly-white, translucent mucoid material 

 of about the consistence of gelatine, showing flecks of a whiter 

 substance embedded in it. 



Description of the microscopic details must include a study 

 of practically the entire appendix, and for the purpose of clear 

 orientation the different localities will be studied separately. 



1. The proximal portion of the appendix. This shows a 

 marked inflammatory hypertrophy which has led to the pro- 

 jection of the appendix into the csecum, and the practical 

 obliteration of the lumen of this part of the appendix. The 

 inflammatory condition is manifested by fibrosis with . round- 

 celled infiltration and a muscular atrophy, along with a marked 

 mucoid degeneration of the mucosa. The glandular' tubules of 

 the mucosa are separated by masses of round cells and are 

 probably diminished in number, whereas the individual epithe- 

 lial cells of the glands are almost entirely transformed into 

 large goblet cells with basal nuclei surmounted by large cup- 

 shaped cavities just emptied of their mucus contents. This 

 condition exists for about 4 millimeters within the appendix. 



