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that appears between his writings and the facts of the present day. Boerhaave first mentions the appendix to con- tradict his master, Vesalius. "We cannot agree," he says, "with the modern anatomists, Vesalius and others, that the appendicula vermiformis should b.' reckoned one of the large intestines." Again, he says: "There is a considerable quantity of feces found in the large intestine of the fetus and in buy prednisone online purchase prednisone prednisone price the appendix, which at the time of birth is found full of feces representing the juice of poppies, and which is called meconium." With Boerhaave, an- atomy was the handmaid of physiology, as it was with all the older writers up buy prednisone to the time of Win- slow, and though he confines himself to a few- words on the anatomy of the appendix, he goes at length into a fantastic explanation of its physi- ology'. This is his anatomy of the part: "The reservoir or prednisone tablets diverticulum of the cecum is furnished with a small vermicular appendix or little intes- tine." prednisone 10mg This meagre account is reinforced bv a note which says : "This is a small slender process of the cecum, arising usually from the bottom or sides, and at some distance from the colon, in that August .-3, 1913-] llll-.I.SCHliK: rill. .irPENDIX .l.\D ITS l)lSi:.ISHS. 375 jiart generic prednisone which is opposite to llic ihiim. This process, or nifiiihraiious bii};, is furnished witli glandular tissue, vviiich discharj;es mucus to tiie feces;" Then follows order prednisone his physiology : 'The cheap prednisone appendix is larger ill the fetus, which serves to increase the si)ace (lesliued for the reception of the meconium, but when the feces are accumulatetl in these parts to such a degree that tlv.-y cannot easily he con- tained, by distending and irritating the intestines, it occasions pain and causes the infant to struggle; whereby the natural birth is promoted." To go back to his anatomy, the term membranous bag is prednisone mg hardly descriptive of the appendix of the present day. As a clue to the changes that have taken place order prednisone online in the appendix, let us follow Boerhaave's description of other parts of the intestine: "Fol- lowing the Ancients," he writes in Irtstitutcs and Cdiiimciits, "we call that part of the colon the ce- cum, which is large and globular at its end or be- ginning, and so capacious as at times to be e<|ual to two span (?). and in it the feces are collected as they prednisone online slip through the ilium." Xow a span is a unit of measurement based on the distance between the tips of the thumb and little finger of the ex- tended hand, and is reckoned at nine inches. buy cheap prednisone A cecum of the present time measuring eighteen inches would be very extraordinary indeed. Boerhaave's description of the duodenum also affords matter for thought. In his lectures on an- atomy, while teaching that science in the Univer- sity of I^eyden, he says. "The duodenum, the first part of the small intestines, has this ])eculiar to itself, that it is disposed in a straight direction." There is a note appended, which reads, "It is re- markable that this is the only part of the intestine with the beginning of the jejunum, that is dis- posed in a straight course, all the rest being sur- prisingly convoluted into various turnings and windings." Further, he states. "The duodenum arises at the pylorus and terminates at its incurva- tion immediately below the insertion of the biliary duct : . . . there are few instances of the biliary or jiancreatic duct opening into the upper part of the duodenum." Here he cites the cases of rav- enous fishes and liirds. such as the ostrich, whose bile ducts open directly into the stomach. His de- ductions are not the result of a cursory examina- tion, for he can describe minutely how the bile duct passes "first a little way between the external and muscular coats, and then for about an inch between the muscular and villous," and it does not escaue him how "the fibres of the muscular coat serve for valves to prevent regurgitation from the intes- tines." In speaking of the muscular coats of the intestines he says : "There are three strong liga- ments detached from the appendix on each side throughout the length of the colon, which contract prednisone cost it prednisone 20mg like so many muscles and terminate in the rec- tum. These ligaments are six times shorter than the colon itself, so that on separating them from the intestine it becomes much elongated, thinner and narrower." In comparing these statements with the facts of the present day. we are forced to the conclusion that either Boerhaave and other anatomists of that time were very careless observers, or that the an- atomy of the parts has undergone considerable change even in the past three centuries. The ap- pendix certainly seems to be contracted, since \esalius classified it wdth the great intestines, or even since Boerhaave described it as a "mem- branous bag." The muscular fibres of the appen- dix are arranged more like tlujse of the stomach than the intestines, and its nnicous surface is still supplied with gl.inds. The muscular fibres sug- gest a capability for emptying itself, which presup- |)oses that it was used as a rece])tacle of some kind, such as the stomach, while the glands suggest some form of secretion analogous to that of the stomach, where the main use of the mucus glands is to pro- tect the walls of the stomach from the highly irri- tating i)roduct of the oxyntic cells. If the stomach were to become atrophied we would expect such an order in its recession, that is to say, the disap- pearance of the glands whose secretion assists purchase prednisone online in digestion pari passu with a failure of the supply of material to be digested, with a persistence of the mucous or protective agent. If the appendix ever was an organ connected with digestion it is Cjuite reasonable to suppose that

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