perityphlitic

Just why diagnosing a perityphlitic abscess should have cleared the diagnostic atmosphere to such an extent as to justify one in declaring that, _since the discovery of the abscess there could be no doubt of diffuse peritonitis, _is hard to understand.

Appendicitis John Henry Tilden 1895

The fact that a diagnosis was made in spite of the tympanitic distention is proof that a dangerous force was used in doing so, converting a typhlitic abscess into a perityphlitic one, and doubtlessly causing premature rupture into the bowel.

Appendicitis John Henry Tilden 1895

The first abscess is typhlitic, the second is perityphlitic.

Appendicitis John Henry Tilden 1895

The perityphlitic pus appeared to be sacculated by adherent intestinal coils, but beyond the adhesions in the free abdominal cavity below the omentum there was diffuse, fresh, fibrinous peritonitis and distributed here and there small quantities of thin, putrid pus (many bacteria, large quantities of streptococci and cold bacilli).

Appendicitis John Henry Tilden 1895

Please note particularly: The appendix was found in a pus cavity -- a perityphlitic abscess.

Appendicitis John Henry Tilden 1895

How was it possible with meteorism as described, to say that there was a sharply circumscribed perityphlitic abscess?

Appendicitis John Henry Tilden 1895

I am not inclined to accept the diagnosis, for within twenty-four hours the abscess broke into the cecum, and if the case had advanced to perityphlitic abscess, the pus would have burrowed downward towards the groin and would not have terminated as early as it did.

Appendicitis John Henry Tilden 1895

Of course if the unfortunate patient has fallen into the hands of some one who believes it the prerogative of a physician to manipulate in season and out of season, and who has converted a typhlitic abscess into a perityphlitic one, or forced the pus to burrow towards the groin, then a free opening with a let-alone after treatment, except thorough drainage, may be followed in time by restoration to health; however, if the patient fully recovers it will be more from luck than from the usual management.

Appendicitis John Henry Tilden 1895

Great nausea and burning thirst were not due to the disease, and the crowding upward of the liver border was caused by the gas distention.] _ "Diagnosis: _ Acute diffuse appendicular peritonitis, probably also perforation; circumscribed perityphlitic abscess."

Appendicitis John Henry Tilden 1895

Foods and drugs were the cause of the discomfort.] "With a sharply circumscribed perityphlitic abscess there could be no doubt of the diagnosis of diffuse peritonitis nor of the indication for operation on account of the long continuance of the severe symptoms.

Appendicitis John Henry Tilden 1895