In several other cases the appendix was in a similar condition. The idea that thread-worms are chiefly found in the lower part of the colon is therefore erro neous, and injections, in order to be effective, must be sufficiently bulky to reach the cmcum, as much as 16 to 20 ounces being often tolerated by children of from six to twelve years of age. Still (Brit. Med. Jour., vol. i, p. 898, '99).
One thousand four hundred cases col lected from various sources in the last ten years, and only about 7 per cent. found of true foreign bodies. In 700 of these cases in which definite statement was made as to the nature of the for eign bodies, 45 per cent. were fmcal con cretions. The only foreign body observed in 250 cases of appendicitis at the Johns Hopkins Hospital was a segment of a tape-worm. J. F. Mitchell (Johns Hop kins Hosp. Bull., Jan., Feb., Mar., '99).
As previously shown, appendicitis may be caused by ova of the ascaris lumbricoides and trichocephalus dispar. This view sustained by five other cases. Hence, in all cases of appendicitis the stools should be examined for worms or their ova. When possible, santonin and thymol should be given. Raw veg etables, salads, strawberries, etc., and unboiled or unfiltered water should be prohibited those with appendicitis, or subject to it, and their stools examined from time to time. Metchnikoff (Jour. des Prat., Mar. 23, 1901).
Notwithstanding the frequency of worms (ascarides and trichocephali) among the Chinese and Europeans liv ing in China, not a single case of ap pendicitis met with in the European population, some 120 persons, under per sonal care. Yet in a young Russian woman and in two missionaries abdom inal pains suggesting appendicular colic seemed to depend on the presence of a trenia; they ceased on the expulsion of the parasite. The rarity of appendi citis in the Chinese appears to confirm the opinion of Keen and Lucas-Cham Pionniere as to the predisposing influ ence of meat diet, meat in China being a luxury within the reach of few. Matignon (Bull. de l'Acad. de MM.,. Mar. 26, 1901).
General Pathogenesis. — The vermi form appendix is a glandular organ pre senting a certain analogy to the tonsils and liable, as well, to follicular, mucous, submucous, infectious, exudative, and ulcerative disorders.
The appendix is rather a glandular organ than an organ of absorption; its mucous glands and lymphoid tissue are greatly developed. In the angle formed by the appendix, the cmcum, and the small intestine there is a lymphatic gan glion not before described. Clado (Bull. de la Soc. de Biol., Jan. 30, '92).
Like the tonsil, the appendix abounds in closed adenoid follicles, and, like ton sillitis, appendicitis recurs in patients who are predisposed to it. Since ton sillitis is one of the most frequent mani festations of influenza clue to a change in the seasons, it is not to be wondered at that appendicitis should occur under the same conditions. Three illustrative cases. P. Merklen (Univ. Med. Jour., Apr., '97).
An absolutely healthy appendix is never attacked by appendicitis, but may become involved by continuity from catarrhal inflammation of the cncum. Appendicitis has always a gradual begin ning without symptoms, followed by signs of sudden acute inflammation. A pointed foreign body in the appendix may give similar symptoms rapidly fol lowed by perforation. The appendix is predisposed to attacks by chronic ill ness. While f meal concretions are usually found in a healthy appendix, they may occur in granular or tuber cular appendicitis. Stricture or stenosis of the appendix may occur. Non-puru lent appendicitis rarely contains a fecal concretion. Gangrene occurs earlier in purulent than non-purulent appendi citis; gangrene is more rare with strict ure or stenosis of the appendix than with granular appendicitis. Minute haemorrhages occur and the infection reaches the lymph-channels. Periap pendicu]ar abscess may develop without perforation, rarely even at some dis tanee from the appendix, and may be wholly absorbed, with recovery. Ste nosis of the appendix rarely heals spon taneously, and the presence of a con cretion usually causes suppuration, though it may reach the cmcum. Only about one-third of all cases run a mild course. Of 282 patients with appendi citis, but S4 were non-purulent. Riedel (Archiv f. klin. Chin, vol. lxvi, Nos. 1 and 2, 1902).