ACUTE INFLAMMATIONS 88 



The rarer occurrence of tuberculosis and actinimy- 

 cosis also perhaps indicates that the micro-organisms 

 of these diseases may be the causal factor in excep- 

 tional instances.* 



The ulcers in dysenteric colitis appear to start at 

 the solitary follicles (Dalafield and Prudden). One 

 may even speculate that the rare disease — mesosig- 

 moiditis — may commence in the solitary follicles of the 

 pelvic colon. 



Without wishing to see subepithelial lymphadenitis 

 in all diseases, one may yet assert that it is the pro- 

 bable commencement of sore throats, peptic ulcers, 

 typhoid fever and appendicitis. 



The interesting fact has often been noticed that more 

 than one set of subepithelial lymphatic glands may be 

 contemporaneously affected. Thus, tonsilitis will be 

 occasionally accompanied or shortly followed by appen- 

 dicitis (Pybus, 1915). One may imagine that the causal 

 micro-organism is capable of multiplying in these cases 

 in the differing environments of throat and caecum. In 

 certain specific fevers — e.g., scarlatina, all the sub- 

 epithelial lymphatic glands may be seen inflamed at a 

 post-mortem examination (Eustace Smith). All such 

 cases may be rather clumsily described under the name 

 of poly-suhepithelial lymphadenitis. 



This initial lymphadenitis may, of course, undergo 



* Tlie morbid anatomy of appendicitis may be summarised as 

 follows : — 



The gross changes in the early stages are increased vascularity, 

 thickening, hardening and unusual lacerability. Later, ulceration, 

 gangrene and perforation may be found, and calculi, adhesions and 

 irregularities of calibre may succeed. 



The microscopic appearances include : — ^ 



• (1) The presence of polymorphonuclear leucocytes in all the ooats. 



(2) The presence of e.vtra-cellnlar bacteria in the lymph nodes. 

 (This is of little practical value owing to the difficulty of staining 

 gram-negative bacteria in tissues.) 



(8) Necrosis of lymph nodules. 



(4) Destruction of the epithelium . 



(5) Later, fibrosis. 



