Case of appendicitis due to trauma tism, the patient, a boy of 16 years, hav ing been struck in the right iliac region by the handle of a push-cart. Distinct tumor in the right iliac region, marked tenderness most acute over McBurney's point, and some pyrexia. The tip of the appendix found gangrenous. W. S. Coley (Med. Record, Feb. 15, '96).
A strain may apparently originate an attack: a point of medico-legal impor tance. An already damaged appendix is especially susceptible to such injury. Many acute attacks of appendicitis com mence during sleep. Rutherford Mor ison (Edinburgh Med. Jour., Mar., Apr., May, '97).
The disease is of growing medico-legal importance, as many eases are of trau matic origin, and may therefore give rise to proper suits for damage or valid claims against accident-insurance companies. W. B. Small (Med. Record, Sept. 10, '98).
In three hundred male and one hun dred and eighteen female adult autop sies the appendix was found so fre quently adherent to the psoas muscle while free from adhesions when situated elsewhere that the conclusion that trauma of the psoas muscle is most pro ductive of appendicitis is inevitable. Byron Robinson (Annals of Surg., Apr., 1901).
Three cases showing that a slight in jury may give rise to a fatal attack of appendicitis. A small deposit of hard faecal matter in the appendix may, after prolonged retention, set up localized necrosis, which is not likely to cause mischief so long as it involves only the inner layers of the appendical wall. Any injury inflicted on the abdomen may rupture the intact external coat, and cause the infected contents of the appendix to penetrate the abdominal cavity. Direct or indirect traumatism may produce an attack of appendicitis in a healthy subject, but in most trau matic cases a laceration caused by a confined enterolith is the starting-point of the infla mina tion. Schottmuller (Mitt. aus der Gren. der Med. and Chir., B. vi, H. 1 and 2, 1901); Neumann (Archly f. klin. Chir., B. lxxii, H. 2).
2. Irritating faecal matter, which fre quently forms hard egg-shaped fEecal con cretions of various sizes; foreign bodies, —cherry-stones, orange-seeds, buttons, spicules of bone, etc.,—which penetrate into the interior of the appendix through deficient action of a valve which usually closes its opening, or on account of ex cessive patency of the latter. Grape seeds were at one time thought to play an important role as etiological factors, but a painstaking investigation by Ed mund Andrews showed that this was not based on facts. Indeed, it is quite prob
able that foreign bodies play a very small part in the production of attacks of appendicitis, hardened fecal masses be ing excluded.
Study of four hundred specimens of the vermiform appendix. Faecal stones found thirty-eight times; equally fre quent in both sexes. The appendix un dergoes a process of retrogression, in length, in its histological structure, and spontaneous obliteration of the lumen. The average length is eight and one fourth centimetres; greatest length at tained between the ages of 10 and 30; the shorter the appendix, the more fre quent the obliteration. Ribbert (Vir chow's Archiv, B. 132, H. 1, '93).
Of one hundred and forty-six adult cases recorded by Matterstock sixty three had fmcal concretions and but nine had foreign bodies. J. O. Affieck (Int. Med. Mag., Oct., '93).
Two hundred cases of appendicitis ex amined for seeds. In one case a few strawberry-seeds found, while none of the others contained more than a fmcal concretion in the form of a foreign body. Gallant (Med. Record, Feb. 15, '96).
Investigation as to the question of the part played by grape-seeds in the eti ology of appendicitis, based upon all cases found in the Chicago hospitals dur ing a period of fourteen years: 3709 in number. Instead of finding that a large number of cases had occurred during August, September, October, and No vember,—the grape-eating months,—it was actually found that a smaller num ber of cases had been observed during these months each year. Edmund An drews (Jour. Amerr. Med. Assoc., vol. xxvii, p. 1193, '96).
Appendicitis caused by a full-sized Ascaris lunibricordcs in the appendix. J. Price (Va. Med. Semimonthly, Jan. 29, '98).
The vermiform appendix is a common habitat of thread-worms; very probably they breed there. In 200 autopsies on children under twelve years of age thread-worms were present in the intes tines in 38, or 19 per cent., and in those children over twelve years of age the percentage was much higher, viz.: 32 per cent. In no less than 25 out of the 38 cases the worms were found in the appendix, and in 6 the appendix was the only part of the alimentary canal where the worms were found. In 1 case where pain had been complained of in the right iliac fossa the appendix contained 111 worms, and was in a catarrhal condition.