84 IMMUNITY IN HEALTH 



resolution, and the patient completely recover. Some- 

 times, however, although the parts afterwards are 

 normal in appearance to the naked eye, some injury to 

 the lymph follicle remains, rendering it unduly prone 

 to further attacks of appendicitis. I have repeatedly 

 seen an appendix removed in the fourth or fifth attack 

 of inflammation, or in a quiescent period between un- 

 doubted attacks of appendicitis, which showed no ad- 

 hesions, stenosis, nor obvious sign of previous inflam- 

 mation. Probably, in such cases, the permanent injury 

 consists of some microscopical lesion to the lymph folli- 

 cles. That one attack of appendicitis predisposes to 

 another is surely true. And the same can be said of 

 inflammations of the tonsil. Theoretically, this might 

 be due to a prolonged lowered resistance of the patient 

 or to the continued presence of virulent organisms in 

 the alimentary canal, but since most of the cases of 

 recurrence of these diseases can be shown to be due to 

 the cicatricial effects of previous attacks, it is likely 

 that the fewer cases of recurrence where no such cica- 

 tricial effects are seen with the naked eye are also due 

 to permanent but microscopic lesions. 



In view of the constant ingestion of bacteria by the 

 subepithelial lymphatic glands, there is no need to 

 assume any primary lesion of the epithelium. Small 

 glandular lymphocytes return from the lumen of the 

 alimentary canal, laden with some exceptionally viru- 

 lent bacteria. 



The small glandular lymphocytes die, and the toxins 

 of the bacteria repel the efforts of the large glandular 

 lymphocytes to engulf and destroy the smaller cells 

 and the bacteria together. The bacteria then com- 

 mence to multiply extracellulary ; the arterioles of the 

 gland dilate and polymorphonuclear cells migrate to 

 the scene of the conflict. 



Should resolution not occur, the initial lymphadenitis 



