JAMA Revisited January 18, 1902

Appendicitis and Infectious Diseases The pre-eminently local character of appendicitis and its successful surgical treatment have undoubtedly served to distract the attention from its possible relations to infectious diseases in general. In the large majority of the cases local conditions appear to Related article page 2340 explain satisfactorily the development of appendicitis and its consequences, but there are also forms of appendicitis in which the etiology is not quite so simple, and it is to these forms that Finney and Hamburger1 direct attention. “Propagated appendicitis” is the term applied by M. Reclus to appendicitis developing from extension of enterocolitis. The nature of the appendix favors stagnation and increased bacterial virulence, which result in greater intensity of the resulting lesions of this part of the intestine. Then there are cases in which appendicitis seems to be a “local expression of a general infection.” Finney and Hamburger cite three cases associated with rheumatic polyarthritis, and they also refer to similar observations by previous writers not only in the case of rheumatic polyarthritis but also in other infectious diseases, such as measles, typhoid fever, scarlet fever, influenza, etc.

Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted. 2384

Experiments by Adrian and others indicate that the lymphoid tissues of the appendix favor the arrest and growth of bacteria circulating in the blood, because the lesions become manifest here earlier than elsewhere in the intestines. Attention is also called to the apparent relation between influenza and appendicitis, and Adrian has demonstrated the presence of the bacillus of influenza in appendicitis developing in the course of influenza, indicating that the latter disease may stand in direct causal relation to appendicitis. The probable “rheumatic nature” of some cases of appendicitis associated with joint affections is strengthened when one considers the analogy between the tonsils and the appendix, especially in their richness of lymphoid tissue. Bland Sutton has called the appendix “the abdominal tonsil,” and as there is a rheumatic tonsillitis why should there not also be a rheumatic appendicitis, using the word rheumatic in its ordinary broad sense. Finney and Hamburger are not willing that these suggestions as to the probable nature of some cases of appendicitis in any way should modify the present views as to its treatment. The peculiar local conditions of the appendix render all inflammations of this little blind tube liable to extension to the general peritoneum, a menace that by most surgeons and physicians is considered as adequately removed only by surgical treatment. 1. American Medicine, Dec. 14, 1901. JAMA. 1902;38(3):181.

Section Editor: Jennifer Reiling, Assistant Editor.

JAMA June 16, 2015 Volume 313, Number 23 (Reprinted)

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Appendicitis and Infectious Diseases.

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