In view of the scant mention in text-books of surgery and anatomy of the anomalous and rare situation of the appen¬ dix in the postcascal retroperitoneal tissue, and the natural inference that the appendix is congenitally absent if at least part of it is not found intimately covered with peritoneum, this case is of interest. The clinical history of the case presents no unusual features. S. A. M" dentist, male, single, birthplace and residence in Wis¬ consin, twenty-five years old; alcohol,

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... co, and venery nega¬ tive; began in February, 1903, to have attacks of abdominal pain, nausea, tenderness localized over appendix area, and moderate distention of abdomen, with irregularity of bowels. Between attacks, patient tired easily, and did not fully recover his health. When seen first, December 6, 1903, with Dr. J. M. Lewis, of Bloomington, Wisconsin, patient was just recovering from an attack which had been more severe than any previously expe¬ rienced, during which he vomited once. On examination, the appendix area still gave localized tenderness. The abdomen was otherwise negative, as was the urine. Diagnosis of chronic catarrhal appendicitis was made and opera¬ tion recommended, in view of the progressively increasing sever¬ ity and number of attacks, and the patient's failure to recuperate fully in the intervals. The abdomen was opened by the usual muscle-splitting procedure, and the caecum identified and brought into the wound. The longitudinal bands and ilcocrecal junction were easily made out, but no appendix could be seen. (Fig. 1.) Starting at the point where the longitudinal bands should meet, search was systematically made in all directions for any trace of the appendix, without success. Also there were no signs of 721