ACUTE INFLAMMATIONS 79 



Payer's patches become inflamed and swollen with- 

 out ulceration in many cases of enteritis. Even in 

 typhoid fever ulceration is by no means an essential 

 part of the disease. Eustace Smith (1909) writes : " In 

 children there is less tendency to ulceration of the in- 

 testine than at a later period of life. In many cases 

 even when the fever has lasted its full period, Peyer's 

 patches are seen as soft, non-ulcerated swellings," and 

 Dreschfeld states : " In a few cases the lesions of enteric 

 fever have been found with the exception of intestinal 

 ulcers ; the Peyer's patches in these cases presented 

 swelling and congestion only. Death in the cases re- 

 ported had occurred at a date (after the 21st day), when 

 the ulceration ought to have been well marked." Else- 

 where, he says : " In a section [of Peyer's patches in 

 early typhoid fever] stained with aniline dyes for the de ■ 

 tection of micro-organisms, large numbers of typhoid 

 bacilli are seen, most numerously in the centre of the 

 follicle, where the nuclei appear less stained." 



Appendicitis has been ascribed to many factors, some 

 highly fanciful, others perhaps acting as predisposing 

 causes. The first part of the claim that the appendix 

 is vestigial and therefore prone to inflammation, has 

 already been refuted. So far from the appendix being 

 the shrinking caecum of a vegetarian turning carni- 

 vorous, we find it best developed in association with a 

 huge caecum in the purely herbivorous rodents. Chronic 

 constipation seems to predispose to the disease, whether 

 owing to generally lessened resistance of the body, to 

 altered bacteriological content of the caecum, or to in- 

 terference with the mobility or circulation of the appen- 

 dix by peritoneal adhesions about the large bowel. The 

 wavy contortion of the vermiform process has been said 

 to lead to congestion and consequent lowering of the 

 local resistance of the mucous membrane. Certain it 

 is that the free border of the meso-appendix is so short 



