The Salt Lake herald. [volume] (Salt Lake City [Utah]) 1870-1909, 1902-06-09
CAUSE oF APPENpICITIs.
Mierobe Theory Advanced by Prom
inent Pathologist.
philadelphia Medical Journal)

philadelphia Medical JOurnaL)
Despite the numerous clinical 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 is the case
in other diseases of obscure origin,
various theories have been advanced
from time to time, only TO be ADAM
dOned when found wanting in evidence.
The grape seed, focal concretions and
even the street car and golf have been
each in turn held up as the causatiVe
agent. 1t 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 connections and other for
eign bodies found with sufficient fire.
QuenCy to account for all cases of ap-
pendicitis. IT is sufficient to reflect on
the frequency with which foreign
bodies, large and small, pass through
the ahmentary canal without lodging
in the appendix to reject the foreign
BODY theory as explaining fully the
causation of appendicitis. We must
admit at the same time that n 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 Geological factor in appended
tbs. According to this theory dle PAR
asites enter the appendix and, by their
presence OF their eggs, injure the walls
and establish a locus MINORS resis-
tantiae, which is then attacked by
pathogenic organisms. This theory is
certainly a plausible one. Here we
deal not with a foreign body which is
propelled along a smooth mucous mem
brane, but an active parasite pos
sessing 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 appendix.
As a matter of fact. it seems IN
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 be-
come d prey to pathOgeniC organisms
which are ever present in this particu-
lar location. In short, appendicitis is
often an infectious disease, having its
primary seat in the appendix, and as
its direct cause any Of the several
pathOgenic micro organisms, such as
4 the yirulent bacillus coll communis.
staphylOcOccus, streptOcoccus, etc. This
disease is in a measure analogous TO
diphtheria, on the one hand, and to
! typhoid enteTitis on the other, the anal
! Ogy Of the latter being made still closer
by the fact that in the appendix, as in
the ileum, the lynphoid tissue is pri-
narily involved and there is the same
tendency to necrosis and perfOratiOn.
/ Whether the disease becomes a septice-
mia, tOxemia or terminates in local
suppuratiOn depends entirely on the
nature Of the offending micrO-Organism.