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Show CAUSE OF APPENDICITIS. Philadelp"nia Medical Journal.) Despite the numerous clinicar observations obser-vations and the many opportunities for exhaustive investigations , afforded by operations and autopsies, we are still' in the dark concerning the cause and effect of appendicitis. As to the case in other diseases of - obscure origin, various theories have been advanced from time to time, only to be abandoned aban-doned when found wanting in evidence. The grape seed, fecal concretions and even the" street par and golf have been each in turn held up as the causative agent. It is needless to say that the disease attacks equally the one who carefully rejects the seeds and the one who swallows . them Indiscriminately; nor are fecal concretions and other for- KitU0 .Oiling ifttVi sufficient frp- quency to account for all cases of appendicitis. ap-pendicitis. It is sufficient to reflect on the frequency with which foreign bodies, large and small, pass through "the alimentary canal without lodging in the appendix to reject the foreign-body foreign-body theory '.is explaining fully the causation . of . appendicitis.. We must admit at the same time that in some cases a smalL foreign body, such as a pin, may lodge in the appendix and set up an irritation. Recently Metchnikoff advanced the theory, supported 'by a considerable number of clinical observations, that the intestinal parasites form the most frequent etiological factor in appendicitis. appendici-tis. According to this theory, the par-asitis par-asitis enter the appendix and, by their presence or their eggs, injure the walls and establish a locus minor.is resistance resis-tance organisms. This theory is certainly cer-tainly a plasible one. Here we deal not with a foreign body which is propelled pro-pelled along the smooth mncous membrane, mem-brane, but an active parasite possessing possess-ing independent motion a parasite which is fully capable of setting up severe irritation. But here, again, the parasite only serves as a predisposing factor, the main cause residing in the pathogenic organism which attacks the "Injured abpeniix. ; j' As a matter of fact, it seems unnecessary un-necessary to invoke the aid of a foreign body in every case of appendicitis. An organ so rudimentary as the appendix is certain to lack in vital resistance and may under certain conditions become be-come a prey to pathogenic organisms which are ever present in this particu- I lar location. In short, appendicitis" is often an infectious disease, having its primary seat ;n the appendiv, and as its direct cause any of the several pathogenic micro-organisms, such as the virulent bacillus coil communis, f staphylococcus, streptococcus, etc. This disease is -in a measure analogous -to diphtheria-on the one hand, and : to j typhoid enteritis on the other, the anal-I anal-I ogy of the latter being made still closer ! by the fact that in the appepndix. as in the lTeum, the lymphoid tissue is primarily pri-marily involved and there is the same tendency to necrosis and perforation. Whether the disease becomes a septicemia.', septice-mia.', a toxemia, or terminates Jn .local suppuration -depends entirely --on- the nature of the offending micro organ-Ism. organ-Ism. WWWWW " ! WWll,l!,JWW, mBrWm iliMWHMil.iu J.lf.lJIH!!HlWI'UIJlimjJl,', |