An appendicular inflammatory proc ess is almost invariably started by the bacillus coli communis. In a certain proportion of cases other micro-organ isms,- especially the staphylococcus py ogenes and streptococcus, are also found..
Experiments in rabbits showing that any obstruction of the mouth of the ap pendix is sufficient to cause appendicitis. The bacillus eoli found in pure culture remain inoffensive until obstruction of the opening causes their multiplication. Roger and Josue (Jour. des Practiciens Feb. S, '96).
The coli bacillus, undoubtedly, may exist in the exudate. In 20 casesexamined, all purulent, 10 were asso ciated with other bacteria, the most im portant of which in 6 cases was the streptococcus. It is probable that in appendicitis the coli bacillus is aided by other bacteria, which it soon out numbers and destroys. Aehard and Broca (Gaz. Heb. de Med. et de Chir., Apr. 1, '97).
New method of studying the removed appendix. Within a few hours after re moval the appendix should be distended with 95-per-cent. alcohol, through a con ical nozzle of a small syringe tied tightly into its cut end by a ligature, which is tightened as the syringe is withdrawn. The distended organ is then immersed twenty-four hours or more in alcohol of the same strength. It is then ready for section. If it is sliced centrally from end to end, its interior will be a revela tion to the surgeon. Whereas the out side may preserve the cylindrical form of a normal appendix, and may give little or no evidence of inflammation, the interior (if the patient has had one or more attacks) will show one or sev eral of the conditions illustrated by the annexed cuts. Robert Abbe (lled. Rec ord, July 10, '97).
Histological study of the various forms of follicular appendicitis: 1. Recurrent formed from the faeces and contain no food-remnants, they are derived from the mucous secretion of Lieberkulm's glands; the latter are hypertrophied from their activity. 3. The obliteration of the vermiform process is a pathological pros appendicitis has its principal location in the follicles. 2. Frecal concretions, which are frequently found in appendicitis, are a result of the appendicitis; they are not ess which follows follicular appendicitis. 4. Gangrenous appendicitis in which all the coats of the organ are destroyed simultaneously is fortunately of rare oc currence. fillet (Le Prog. :MM., Jan. 29, '98).
There are at least four distinct vari eties of appendicitis obliterans: an exu dative variety; a variety characterized by mucosal hyperplasia, and sclerosis; a variety characterized by submucous hy pertrophy; a reparative variety. In all
varieties there may be and generally is localized peritonitis; endarteritis and periartcritis are almost constant phe nomena in the disease. The vermiform appendix, in health, is distinctly muscu lar; in disease the muscles often hyper trophy. J. F. Binnie (Annals of Surg., May, '98).
Appendicitis should be regarded as an inflammation of the vermiform process due to infection. The streptococcus lanceolatus, the bacillus pyogenes, the bacillus subtilis, the staphylococci, the bacterium colt commune may each be responsible for the infection, but in the large majority of instances the culture will be found to contain either the bac terium coli commune alone or in con junction with one of the other afore mentioned organisms. It is a well known fact that these organisms may exist in the intestinal tract without pro voking infection, but that when there is any circulatory disturbance or injury to the mucous membrane their virulence in creases, and infection is apt to follow. Carl Beck (N. Y. Med. Jour., Nov. 19, '98).
Virulence of the bacillus eoli in experi mental appendicitis. Increased virulence of the 13. colt and appendicitis can occur without occlusion of the cavity of the appendix; suppurative appendicitis can occur as a result of nutritional changes in the appendicular parietes, and this without an increased virulence of the B. soli contained in the pus. Charles de Klecki (Ann. de l'Institut Pasteur, June 25, '99).
Of all the etiological factors that enter into the pathogenesis of appendicitis, im perfect drainage of the organ plays the most conspicuous part. Whenever this is present, and exists for only a brief period of time, there are bound to arise very definite and at times serious conse quences. As a result of the interference with drainage, the bacillus colt communis is changed into a virulent organism. Next in importance to the part played by insufficient drainage and increased ac tivity of micro-organisms is the question of circulatory disturbances. The insig nificance attached to the presence of foreign bodies in the human appendix was well borne out by the experimental work. C. H. Frazier (William Pepper Laboratory of Clin. Med., 1900; Mcdi chic, Aug., 1900).