Appendicitis : its pathology and surgery . li, short, thick bacilli,with rounded ends, long, thick bacilli, leptothrix, spores, andspore-bearing bacilli. Where the bacterial mass is in contact with the ulceratedmucosa, the cocci and bacilli have penetrated its lymph canal-icular system. The bacteria have also penetrated intothe mucosa by growing along the tracts of the tubularglands. This penetration occurs in three stages. First, theepithelium of the mucous gland is shed, leaving a hollowTtubular space, or socket, as Dr. Hawkins calls it, in thelymphoid tissue; second, the bacteria fill this
Appendicitis : its pathology and surgery . li, short, thick bacilli,with rounded ends, long, thick bacilli, leptothrix, spores, andspore-bearing bacilli. Where the bacterial mass is in contact with the ulceratedmucosa, the cocci and bacilli have penetrated its lymph canal-icular system. The bacteria have also penetrated intothe mucosa by growing along the tracts of the tubularglands. This penetration occurs in three stages. First, theepithelium of the mucous gland is shed, leaving a hollowTtubular space, or socket, as Dr. Hawkins calls it, in thelymphoid tissue; second, the bacteria fill this hollow (seeFig. 13); and third, they spread thence into the lymph 58 APPENDICITIS canalicular The next case shows another manner ofinvasion, and that the lumen of the tubular gland may bechoked with bacteria as a preliminary to the destruction ofits epithelium. The distal end of the appendix possesses no trace of alumen or of a mucosa. The centre of the section is occupiedby connective tissue and inflammatory corpuscles. The sub-. Fig. 13.—Bacteria invading mucosa along tract of tubular gland. A little of theepithelium still remains below. The lumen is above. x 200. mucous, muscular, and peritoneal coats are the same as in theproximal end. This specimen is so clear that hardly any comment isneeded. Penetration of bacteria by way of the tubular glandsis, I believe, quite common. The contents of the lumen aresuch as one commonly meets with in chronically inflamedappendices, and, as we shall presently see, are such as usuallylead to the formation of a concretion. Evidently, it wasquite time that this appendix was excised. I believe the 1 This last point is not well shown in the part of the section , as the magnification is too low. been vi ULCERATION OF THE MUCOSA 59 operation had been deferred because the patient had valvulardisease of the heart. When removing this appendix, I was much struck by thegreat size and mobility of the csecum. The immediate
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