Ilis breath vas foul, and his tongue tbickly coatedl. There wvas a slight rigidity over the righlt ectusīelow. Boyd, whlo folund that lie complained of pain in the left P., a -outhl age(d 19, was taken suddenly ill oilĭecember 28th withl a verv severe pain in his stomiiach, amld lie The thlird dlay, and the remiainder at a later date. Tlhree were seen during tlle first twelve hours,ĥ otlhers witlhlin the first forty-eiglht hours, 12 Yvere seen on I liave comiie across 25 cases of acute appenidicular obstruction. Subplhrenie, abscess, portal pyaemia, etc., increase inįrequency and gravity witlh delay in operation. Tllirdly, serious complications, suchl as general peritonitis, Layers, there is little risk of bulging apart -from drainage. Witlh mnodernl mlietlhods of closing tlle abdominal wall in Therefore drainage, witlh all its disastrous sequelae of discomnfort, delay, and stubsequent liernia, will be avoided, for Secondly, in anĮ.arly operation we are less likely to encounter pus, and In -tlle first place, in ani early operation it is practicallyĪlways possible to remove the appendix. Btut cau we, for these reasons,ĭelay or postpone operation? I tllihli not, and for tlle It is safely limilited in its extravasation, and can readilyīe dealt wvitlh surgically. Pusįormiation, wuhen it occuIs, is usually not unannounced. Sigus, and pathological changes keep close com-pany. Judging from thle history of theseĬases of true acute appendicitis, it would seem to beĬapable of argumiient that they do not constitute a veryįatal form of illness, even when operated upon in the later Walls of the appendix arc tllick anid fleshy, alnl there is noĭistensioil of its cavity. Wlhicli are adherent to the appendix and tlle caeccun. Iot troublesome, and if pus be present it is small inĪmIllount, and well walled off by the surrounding organs, ln tllese cases, too, vomiting and constipation are Tvpe as in tlle cases about to be quoted, and even from itsįirst beginnings is definitely localized to tlle right iliacįossa. These are examlples of acute appendicitis in wlhich,įrom the onset, the temperature and pulse are elevated,Īild in wllicll pain, tlhouglh present, is not of such a severe Gave little trouble the wounid wvas drainied, aild the patient lhad
The walls of the appendix were very much thickened, but there Perforatioln and a small amiount of pus-about a teaspoonful. This consisted of the appendix, buried inĪ mass of coagulum, and bent at an acute angle, with a small On opening the abdomenl a swelling, lay on the outer side of andīelow the caecuin. The riglht side,just above Poupart's ligament. When seen the 8th, the temperature was 99° and the pulse 120. The patienit lha(l h-ad several similar attacks, but they hadĪlwa,vs passe(d off in a few days. A probable diagnosis of supputrative appendicitis wvas made, and Dr. Of the 7th, wheni the temperatuire rose to 102°, and the The temperature an(d pulse varied little til l the evening 'T'he temperature at the onset was 1010 and( the pulseġ10. The abdomeni, which gradually settled dowii towards the riglht She had taken ill on the 5th with paini inl Many of these cases, hlowever, go, on to suppurationi. Interrupted, the patient's temperatuire never reaching higher Removal of the appendix was comparatively easy, aindI thiu A long' appenldix with thlickened walls, wvhicli wereĪdherent to the surrounding struettures, was founid.
I was aske(d to see the patien-t next day, anid The temperature was 101cĪnd the pulse 115. She ha(l taken ill the lpreviou's niighit wvithpain L)eenl sub)ject to dyspepsia, and( this wvas the third attack ofĪppendicitis during which she had beeii under Dr. R., a single lady, aged 39, seen witlh the lateĭr. To the absence of any great pain as the initial symiiptom,Īnd to the absernce of trouLblesomue constipation. I would speciallydirect attelition to the indefinite onts.et, Read before the North of Ireland Branch of the Britislh Medical There was nlo pus, anld tile abdomelen was tlherefore closed iii All acute diseases of tileĪppendix lhave been included under the general termīuried in plastic lymph, oil the outer side of the caecumii. Of tlle living" has failed to receive due consideration,Ĭases has Ilitllerto existed. In Sirīerkeley Moynihan s picturesque words, 'the patlhology Patlhological findings of tile operation room. Views about diagnosis, prognosis, or treatment, oli the Scientific treatment still rulns to from 5 to 25 per cent.,Īccording to its type, demiiands vigorous investigation.įew of tile niumerouLs wiiters on tlle subject base tlleir Uttpwarcds of 1,500 people, and whose nmortality under modern SUR GEON, ULSTER HOSPITAL FOR CHILDIREN AN'D WOMIEN Ī DISEASE wliicll anllually kills in Englalnd andl W'ales
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