98 IMMUNITY IN HEALTH 



the appendix. But experience has shown that when 

 this inflammation has proceeded to such a degree that 

 the symptoms and signs point definitely to appendicitis, 

 appendicectomy without delay gives distinctly the 

 best results. A mild catarrhal appendicitis, giving rise 

 to an attack of abdominal pain, at first general, but 

 after a few hours localised in the right iliac fossa, with 

 slight rise of temperature, some nausea or even vomit- 

 ing, a tendency to constipation, and tenderness or 

 rigidity with diniinished reflexes in the right iliac 

 region, demands immediate excision of the appendix 

 as, of course, do severer forms of the disease with 

 complications. 



The routine removal of the tonsils in cases of tubercu- 

 lous disease in the glands of the neck, has been advo- 

 cated on the grounds that the tonsils act as "portals 

 of entry" to the tlibercle bacilli. It is probable that 

 the tonsils have so acted in such cases, but to remove 

 them in all cases of tuberculous cervical glands is to 

 be on a par with the wealthy merchant who returned 

 home to find that malefactors had broken into his 

 house through the front door and damaged his property. 

 * 'Remove the door," cried the angry merchant. 



The oral or rectal administration of bacterial cultures 

 has sometimes been attempted with some degree of 

 success. Some immunity to typhoid fever and to tuber- 

 culosis has thus been attained. The difficulties that 

 may be apprehended are the destruction of the dead 

 bacilli by alimentary juices, and the considerable 

 dilution of the fluid in which they are suspended, so 

 that but few ever reach the surface of the subepithelial 

 lymphatic glands. On the other hand the administra- 

 tion of too virulent a strain might yield such a violent 

 reaction as to open the way for a mixed infection and 

 an acute inflammation. Perhaps these difficulties will 

 some day be overcome. 



