ACUTE INFLAMMATIONS 87 



whereas it is unknown in the child." These figures show 

 the surprising frequency of inflammation of this 

 structure. 



The tendency to early recurrence of inflammation 

 after a sufliciently severe initial attack is most strongly 

 marked in the case of the vermiform process, but is 

 also frequently noticeable with the lymphoid tissues 

 of the throat. Indeed, the more complex the structure 

 of the subepithelial lymphatic glands the more surely 

 does it exhibit this tendency. Apart from persistence 

 of the original virus in all its intensity, the tendency 

 to recurrence is probably due in general to undue stag- 

 nation from cicatricial contraction. 



This section cannot be closed without a serious con- 

 sideration of the question of hsematogenous infection. 

 Inflammation of the appendix has been experimentally 

 induced in a few cases by the injection subcutaneously 

 of certain bacteria. 



It has been suggested that the subepithelial 

 lymphatic glands therefore become infected from the 

 blood stream and not through the overlying epithelium. 

 Perhaps the best clinical evidence in favour of haema- 

 togenous infection is the ulceration of the tonsils in 

 secondary syphilis. In this stage of syphilis the 

 organism is undoubtedly circulating in the blood 

 stream. 



One may add that other lymphoid tissue is often 

 excited by general infections of the blood stream. 



Neither the experimental nor the clinical evidence 

 are conclusive, however, for it must be borne in mind 

 that possibly in subcutaneous inoculations, and cer- 

 tainly in secondary syphilis, the micro-organisms pass 

 out in large quantities in the secretions into the alimen- 

 tary canal, and may thence be ingested by the sub- 

 epithelial lymphatic glands, and in them may then give 

 rise to morbid processes. 



