A treatise on appendicitis / by George R. Fowler.

  • Fowler, George R. (George Ryerson), 1848-1906.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on appendicitis / by George R. Fowler. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    rudimentary remnant of the lengthened cecum found in all mammalia except man, and some of the higher quadrumana. It is also found in the wombat. It is usually attached to what was originally the apex of the cecum, close to the ileo-cecal valve on the inner and posterior side of the bowel (Fig. 3). Excep- tionally the fetal type persists, in which case the appendix may become a continuation of the long axis of the colon (Fig. 4). In another form, the appendix appears between two bulging sacculi (Fig. 5) ; or, in still another, the root of the appendix is posterior to the inferior angle of junction of the ileum with the cecum (Treves), (Fig. 6).1 Instances of non-descent of the cecum result in a corres- ponding abnormal situation of the appendix; the latter has even Fig. 5. Fig 6. been found lying to the left of the median line. Lennander men- tions having observed in a dissection of a sixteen-year-old boy, the cecum, together with an appendix nine inches long, lying against the spleen in the left hypochondriac region.2 The length of the appendix varies from one to nine and a half inches ; the average length is three and one-half inches. Its diameter is that of a goose quill. When a meso-appendix is pre- sent, this comes off from the left layer of the mesentery of the ileum, with which, together with the points of its attachment to the appendix, it forms two sides of a triangle ; the third side of the triangle is formed by the free border of the meso-appendix. In 200 cadavers examined by Ferguson, of Toronto,3 the appendix 1 These variations depend upon the greater or lesser relative development of the dextral wall of the cecum. 2 Sammlung klinischer Vortrage, No. 75, August, 1893. 3 American Journal of the Medical Sciences, January, 1891.