TOPOGRAPHY AND DEVELOPMENT OF THE CECUM-APPENDIX

Abstract

The appendix is frequently one of the mobile viscera of the abdomen. Its position at any given time depends largely on the cecum, which latter varies in contour and even in position, as a result not only of type but also of peristaltic activity, state of filling and other physiologic conditions. Three general types of ceca, (1) the infantile; (2) that prevailing in early childhood; and (3) the adult, may be regarded as a developmental sequence. The factors of intrinsic growth and of gravity (weight-bearing of cecal contents) are considered in the evolution of the cecum from infantile to adult types. The directions taken by the appendix are not regarded as significant, when the appendix itself is mobile. From this it follows that but two general categories of appendix are proposed, the fixed and the mobile. Two historic events are recounted in connection with the diseased appendix, viz., the first use of the word appendicitis, proposed by Fitz, in 1886; the designation of the point of greatest tenderness in appendicitis by McBurney, in 1889. The futility of defining McBurney''s point is recognized, especially in reference to the highly variable topography of the junction between appendix and cecum.