It has already been indicated that certain localities are more liable to inflammation than others, and as the inflammations of certain of these regions present special points of importance they have received special names.

Duodenitis is usually an extension of a catarrh of the stomach, and it would not warrant any special reference except from the fact that the Common bile duct often takes part in the catarrh, and we have obstruction and Icterus sometimes resulting from this simple cause.

Typhlitis and Perityphlitis designate conditions which require very special notice. These two terms mean respectively inflammation in and around the caecum, but they are frequently used so as to include inflammations in connection with the vermiform appendage.

In some cases the caecum is very seriously inflamed and ulcerated, •especially when large masses of hard faeces lodge in it. Under these circumstances the ulcers may increase in depth, and extend, in the posterior part of the wall where the gut is not covered by peritoneum, through the entire thickness of the intestine so as to penetrate into the retro-peritoneal connective tissue. The result is acute inflammation in this region, often going on to the formation of Abscess, a condition designated Perityphlitis.

Inflammations In Connection With The Vermiform Appendage. Appendicitis

Acute inflammations in this region much more frequently arise in connection with the appendix than with the caecum. Inflammations are frequently caused by the presence of Foreign bodies in the appendage. Any hard substance lying in the caecum may, if small enough, pass into the vermiform appendage. In this way apple, grape, cherry, or orange seeds are said to get into it. But much more frequently pieces of hardened faeces are met with, and as these become dry and frequently assume the shape and appearance of cherry or orange stones, they are frequently mistaken for them. This occurs all the more because the inspissated faeces are often coated with phosphates which form a kind of rind.

The presence of the foreign body causes inflammation of the mucous membrane, and this, from the continued pressure and confined space, readily results in ulceration. To these conditions the term Appendicitis is properly given, but it is often extended to the resulting lesions, which are much more important than those of the appendage itself. The ulcers frequently penetrate through the appendage and lead to peritonitis. As a general rule the appendage has acquired adhesions before actual perforation occurs, and so the peritonitis is limited by the adhesions. But the inflammation is apt to return, and not infrequently results in the formation of recurring abscesses. The bursting of one of these into the cavity of the peritoneum often leads to Fatal peritonitis. Sometimes the suppuration in connection with the venni form appendage is in the Subperitoneal tissue. An abscess so produced may extend long distances beneath the peritoneum. The result is not infrequently a chronic peritonitis with considerable matting around.

The author met with a case in which an abscess connected with the vermiform appendage extended across the brim of the pelvis to the left side of the abdomen, and thence upwards beneath the peritoneum till it reached the diaphragm. It then penetrated the diaphragm and discharged itself into the pleural cavity.

Proctitis and Periproctitis are inflammations in the rectum and around it, of an equivalent character to those in and around the caecum. If the ulceration leads to perforation and the formation of abscess, then the disease may have a very chronic course with fistulae discharging into the rectum. Sometimes these open externally, or into the vagina, and they may retain their communication with the rectum, so forming false passages for the faeces and flatus; or the internal aperture may close, leaving merely an external fistula.

Literature

Catarrh - Nothnagel, Phys. u. Path, des Darmes, 1884; Goodhart, (Casts from intestine) Path, trans., 1872, xxiii., 98; Woodward, Med. and surg. hist, of war of rebellion, Part 2, vol. i., 1879; Baur, (Perityphlitis) Ziemssen's Encycl., viii., 1878; Steineh, Path Anat. des Wurmfortsatzes, 1882; Cornil, Arch, de Phys., iii., 1873; Coats, Brit. Med. Jour., 1875, i.; Barker, ibid., 1893, i., 993 -r Kelynack, Path, of the Vermif. Append., 1893; Hawkins, Diseases of the Vermif. Append., 1895.