82 IMMUNITY IN HEALTH 



throughout all the coats. All these observations support 

 the view that appendicitis commences as a lymphaden- 

 itis, and we are led to the supposition that the exciting 

 cause of the first attack in most cases is the presence of 

 some virulent bacterial strain. Perhaps some variety of 

 streptococcus is most often responsible,. because in the 

 most fulminating types of the disease the early peri- 

 toneal exudate yields a growth of virulent streptococci. 

 Of course, as in all intestinal cases, these organisms are 

 soon overgrown by the prevalent bacillus coli communis. 

 Perhaps the infecting organism is more likely to occur 

 in meat, if there is really any truth in the belief that 

 appendicitis is less frequent amongst the more vege- 

 tarian Chinese and Japanese than amongst the more 

 meat-eating Europeans.* Certainly, one would im- 

 agine that micro-organisms flourishing in dead animal 

 tissues would be more attune^ to living in animal tissues 

 than would most bacteria which might be present in 

 vegetable fibres. 



It is noteworthy here to recall that appendicitis may 

 occur early in typhoid fever. Anyone with a wide ex- 

 perience of abdominal cases has seen the child who 

 develops rose spots and a tender spleen, after removal 

 of an obviously inflamed appendix. McKillop (1912) 

 recorded such a case in a girl of 19. The tip of the 

 appendix was congested and swollen, and contained a 

 fa3cal concretion. Undoubted symptoms of typhoid 

 fever declared themselves after appendicectomy. 



* I am not satisfied on this point. I have seen cases of appendicitis 

 amongst Soutliern Chinese snbsisting largely on rice, and liave often 

 noticed in the dissecting room adlierent appendices in Chinese coolies 

 on a principally vegetarian diet. Perhaps one reason for the relative 

 infrequence of severe appendicitis amongst the Chinese may be the 

 method of treatment. The native practitioners in China are very 

 averse to the indiscriminate use of purgatives for all abdominal pains. 



Treves, in 1902, pointed out what is indeed the usual experience, 

 that Europeans living in the Tropics are more liable to appendicitis 

 than in Europe. The risk of having to eat decomposing or diseased 

 meat is much greater, of course, in tropical countries. 



