Factors in Appendicitis

To the Editor:  —In The Journal, May 8, 1915, p. 1584, a quotation is made from Rosenow to the effect that Heyde, Aschoff and others have called attention to the fact that the anatomy of the appendix favors strangulation of its circulation. These two authors are probably chosen for quotation because they are "made in Germany." One of them published his theory in 1911 and the other published his theory in 1912. Among "the others" one will find a complete description of this mechanical theory in a book entitled "Lectures on Appendicitis" by an American author, published in 1896. This book is to be found in medical libraries. It contains the statement that the serious complications of. acute infective appendicitis are dependent on swelling of the internal coats of the appendix within the outer constricting sheath of peritoneum. When, for any reason, the inner coats of the appendix become compressed