IN a preliminary study,10 reported two years ago, from observations made upon the exteriorized, unobstructed appendix, evidence was presented which suggested that the vermiform appendix of man secreted fluid. It was also shown, at that time, that obstruction of the cecal appendage of the rabbit was followed consistently by evidence of rapid fluid secretion. During the time that has intervened since then, these studies have been extended considerably. In the present communication evidence of the secretory capacity of the vermiform appendix of man will be cited.The behavior of the appendix when obstructed temporarily will be described and factual proof of the reproduction of the pathologic picture of spontaneous appendicitis through the agency of obstruction will be presented.Method.-From studies made upon the obstructed cecal appendage of the rabbit and the vermiform appendix of the chimpanzee," it was apparent that in order to adduce convincing proof of the secretory capacity of the appendix of man it was necessary to incannulate the obstructed exteriorized appendix. Unobstructed appendicostomies permitting incannulation had been established incidentally when colostomy was performed for malignant disease of the colon. Exteriorization of the appendix in this manner had been accomplished readily through a button-hole incision and did not complicate the operative procedure.10In a patient presenting a carcinoma of the ascending colon, it was possible to exteriorize, with the blood supply intact, after the Bloch-Mikulicz principle, the greater portion of the right half of the colon and the terminal ileum. A few days later, when the exteriorized bowel had become fairly well covered with fibrin and effectual sealing of the wound had occurred, the base of the appendix was ligated securely. The attachment of a closed water system connected to a recording manometer permitted determination of the ensuant increase in intraluminal pressure. The manometer used required addition of 0.58 cc. of fluid to raise the pressure reading IOO cm. of water.It was obvious that this type of case, permitting determination of the secretory capacity of the vermiform appendix, would not be encountered frequently. After considerable deliberation the method depicted in Figure I was worked out. When preliminary colostomy was being performed for malignancy of the large bowel or rectum prior to excision of the lesion, the appendix

a large and pruritic patch of papular dermatitis at the site of the test.Schulmann and Détouillon,46 in 1932, pointed out that dermatitis in wooded districts is probably much more common than is supposed, perhaps affecting 2 per cent of the population employed as woodcutters, saw¬ mill workers, cultivators, fuel woodcutters, charcoal burners and hunters. This type of dermatitis develops slowly, is localized to contact regions, but may gradu¬ ally become generalized, and can be cured readily, often without recurrences if the patients avoid that type of work.

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No explanation is offered for the appearance of acrodynia in our experiments in contrast to the usual freedom in mice from acrodynia during pyridoxine deprivation. By inspection of the conditions of previous studies of BG deficient mice together with the variables introduced in our experiments, no definite correlation could be established relating the composition of the diet, age or sex of the mice, the probable pyridoxine content of the diet, levels of other vitamins, etc., to the protection from, or appearance of, acrodynia. The syndrome has appeared in the mice without fail on 3 different occasions that were so spaced in time (February, May, and September) that suclh factors as season and humidity were prob-was tested, and it may be that strain differences play an important role in the appearance of acrodynia.Summary. 1. Pyridoxine deficiency was produced in weanling male and in young adult female mice fed (a) a purified diet containing 9 other crystalline B vitamins, and (b) GL semipurified diet containing a low level of liver powder. 2. Acrodynia appeared among both the weanling and young adult mice fed these 2 diets. 3. As little as 0.166 mg of added crystalline pyridoxine-HC1 per kg of the purified diet protected the mice from acrodynia and resulted in a good growth response by the weanling mice.

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