Appendicitis : its pathology and surgery . ed theinnermost part of the circular muscular coat; the latter,together with the longitudinal, is penetrated by numeroussmall blood-vessels. The peritoneal coat is moderately in-flamed, and, together with the meso - appendix, containsnumerous small granular cells, like pus cells. Many of thesmall lymphatic spaces and channels of the peritoneum arefull of these granular cells. This description also applies tothe distal end of the appendix, except that its lymph follicleshave not disappeared. Three lymph follicles, with their basilar 136 APPENDICITIS ly
Appendicitis : its pathology and surgery . ed theinnermost part of the circular muscular coat; the latter,together with the longitudinal, is penetrated by numeroussmall blood-vessels. The peritoneal coat is moderately in-flamed, and, together with the meso - appendix, containsnumerous small granular cells, like pus cells. Many of thesmall lymphatic spaces and channels of the peritoneum arefull of these granular cells. This description also applies tothe distal end of the appendix, except that its lymph follicleshave not disappeared. Three lymph follicles, with their basilar 136 APPENDICITIS lymph spaces, were counted in one section. In all thesections little haemorrhages had occurred. The blood cells hadalmost disappeared, leaving the pigment, which was mostabundant in the peritoneal coat. No trace of tubercle or oftubercle bacilli could be found; nor could bacteria be seenin specimens stained by Weigerts method. It is clear that this microscopical examination throws nolight upon the repeated acute attacks of appendicitis. In-. 2s^:- -^ will 11 -! Fig. 37.—Inflammatory obliteration of the lumen of the vermiform appendix, x 45. asmuch as the lumen had disappeared, they could hardly beattributed to pent-up bacterial contents. It is, of course, notquite right to assume that all the lumen has gone withouthaving seen a series of sections cut with a microtome. Never-theless, its obliteration is almost a Case 39.—The Mucosa of the Apperidix destroyed, and itsLumen obliterated by one Attack of Appendicitis.—The mucosaof the appendix may be destroyed, and the lumen obliterated 1 MBurney has also mentioned a case similar to these two. Evidentlyobliteration of the lumen does not bring the disease to an end {Annals ofSurgery, vol. xxvii. p. 319). IX COMPLETE OBLITERATION OF THE LUMEN 137 by a single severe attack of appendicitis. Mr. X., aged twenty-four years, was suddenly seized with an awful pain in theright iliac fossa. This was followed by vomitin
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