86 IMMUNITY IN HEALTH 



1. 

 of the ileum, the deepening of the ulcers may breach 

 the wall of an artery and lead to severe and even fatal 

 haemorrhage. 



If recovery takes place after suppuration has oc- 

 curred, some degree of cicatrisation remains. Much — 

 rarely even perhaps all^ — the lymphoid tissue of the in- 

 flamed organ may be destroyed. The epithelium may 

 be extensively removed. This may cause a localised 

 stenosis of the tonsillar crypt or of the vermiform pro- 

 cess, thus predisposing to the inspissation of retained 

 material and concretion formation (in vermiform ap- 

 pendix and faucial tonsil) or to cystic dilatation beyond 

 (mucocele of appendix, cyst of faucial tonsil, and per- 

 haps Thornwaldt's cystic adenoids), or to subsequent 

 suppuration under pressure beyond the block. 



The crypts and the appendicular lumen may indeed 

 be completely blotted out after repeated inflammation 

 of the tonsil and the appendix respectively. 



Inflammation of the intestinal lymphatic structures 

 may be followed by peritoneal adhesions. In the case 

 uf the vermiform process such adhesions may interfere 

 with the blood supply of the organ. Similarly cica- 

 trices in the meso-appendix, consequent upon 

 lymphangitis or lymphadenitis (for the meso-appendix 

 contains one or more lymphatic glands) may cause 

 sharp kinking of the appendix, interfering with the 

 blood supply or the free passage of material along its 

 lumen. 



Such ~ strictures and adhesions undoubtedly predis- 

 pose to further attacks of inflammation, though the 

 presence of the latter probably lessen the risks to life of 

 such subsequent attacks. 



Birmingham writes (Shennan, 1912) that " partial 

 occlusion (of the vermiform appendix) is present' in 

 25 per cent, of all cases (of post-mortem examinations 

 of adults), and in more than half those sixty years old. 



