THE DIGESTIVE SYSTEM. 



565 



appendix. ' Both the fsecal concretions and the foreign bodies may act 

 as important predisposing agents of inflammation and perforation of the 

 appendix, through pressure, erosion, etc., of the mucous membrane, af- 

 fording portals of entry to various forms of pathogenic micro-organisms. 

 The bacteria most commonly found associated with the lesions of acute 

 appendicitis and its accompanying peritonitis are Streptococcus pyo- 



FIG. 341. APPENDIX WITH OBLITERATION OF THE LUMEN BY FIBROUS TISSUE. 



genes, Staphylococcus pyogenes, the Bacillus coli commums, and Bacillus 

 protons. 1 



TUMORS OF THE INTESTINE. 3 



Fibroma and Lipoma may be developed from the submucous coat and 

 grow inward, or from the subserous coat and project outward into the 

 peritoneal cavity. 



Myoma may originate in the muscular coat and project inward, ob- 

 structing the intestine. In the duodenum such tumors may obstruct the 

 common bile duct. Less frequently these tumors project outward into 

 the peritoneal cavity. 



1 For a study of foreign bodies in appendix see Mitchell, Johns Hopkins Hospital 

 Bulletin, vol. x., p. 35, 1899. 



2 Hodenpyl, "Etiology of Appendicitis, "New York MedicalJournal, December 30th, 

 3. Consult also Kelynack, "Pat 



Berry, Jour, of Path, and Bact., vol. iii., p. 160, 1895 

 Arch., Bd. cxxxii., p. 66. 

 Ser. 11, 1900, p. 173. 



thology of the Vermiform Appendix," London, 1893. 

 ii., p. 160, 1895 (bibliography). Ribbert, Virch. 

 For bacterial report see Low, Reports Boston City Hospital, 



For a study of congenital tumors of the intestines consult Hueter, Ziegler's Bei- 

 trage zur path. Auat., Bd. xix., p. 391, 1896. 



