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). ❋ John Henry Tilden (1895)
The first abscess is typhlitic, the second is perityphlitic. ❋ John Henry Tilden (1895)
How was it possible with meteorism as described, to say that there was a sharply circumscribed perityphlitic abscess? ❋ John Henry Tilden (1895)
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. ❋ 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. ❋ John Henry Tilden (1895)
Please note particularly: The appendix was found in a pus cavity -- a perityphlitic abscess. ❋ 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. ❋ 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. ❋ 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." ❋ 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. ❋ John Henry Tilden (1895)
_ In regard to the dejecta, the two passages at the onset of the disease pointed to increased peristalsis; this was of short duration, soon changing to the opposite condition, and until the rupture of the perityphlitic abscess absolute constipation existed. " ❋ John Henry Tilden (1895)
[It is an evidence of professional officiousness to say positively that there was a "sharply circumscribed perityphlitic abscess." ❋ John Henry Tilden (1895)
I fear our German friend of "Die Deutsche Klinik" had "booze" in his logic when he was explaining how his patient came to die.] "Moreover, the bacterial finding of streptococci and cold bacilli in the perityphlitic abscess is typical, and the limitation of the diffuse peritonitis to areas below the omentum is also instructive. ❋ John Henry Tilden (1895)
By relieving intestinal irritability, and by bringing about a mild degree of narcosis, the patient was kept quiet and this materially assisted in limiting the severe perityphlitic suppuration in the first stage of the disease. " ❋ John Henry Tilden (1895)
"After the appearance of these symptoms, a more or less firmly adherent but limited perityphlitic abscess, and a less intense although well developed peritonitis in this region, were assumed; the latter, notwithstanding the painful meteorism, was not necessarily diffuse in the strict sense of the term; the omentum often protects the upper abdominal cavity from infection, as was proven in this case at the autopsy. ❋ John Henry Tilden (1895)
This, I assume, would have been the ending if the vigorous examination that was given the patient the day before the collapse had not prematurely ruptured the abscess both into the gut and into the subperitoneal region converting an appendicular abscess into a perityphlitic one.] "Upon the next day there were several hemorrhagico-purulent stools, the urine was profuse and voided without pain. ❋ John Henry Tilden (1895)
