Auscultation of the lungs and heart sometimes affords information.
Examination through the rectum is of value in determining the presence of pus in advanced cases. In the earlier stages this procedure is of no value.
Examination of the urine may assist in the location of the inflammatory proc ess and in determining the activity of metabolic processes. Glycosuria was also found present in three cases examined by Leidy.
In 228 consecutive cases of appendicitis in which there was an operation there were 7 errors in diagnosis; these include 1 each of old typhoid-fever complications, peritoneal tuberculosis, cancer of appen dix, congestion of appendix, hysteria, pneumonia, and seqiielre of measles. As the number of errors is small compared with the total number of cases, it is con cluded that appendicitis is one of the most readily diagnosed of all diseases. In 4 of the cases in which an incorrect diagnosis was made the operation was of benefit to the patient. Robert T. Morris (N. Y. Med. Jour., Apr. S, '99).
The youngest patient on record oper ated on was sixty-one days old. Chil dren seem to bear general septic infec tion better than adults. The two con ditions from which infantile appendi citis must be differentiated are intus susception and tuberculous peritonitis. The most reliable source of information lies in the careful examination of the abdominal wall, which, in a child, is very easily accomplished. Abdominal disten sion, frequent and shallow respiration are common. T. II. Manley (Jour. Amer. Med. Assoc., June 1, 1901).
Every death from appendicitis,- in an individual otherwise well, excepting those of the fulminating type, could have been prevented by the use of the knife at the proper time. If one is to
operate early, an early diagnosis is necessary. If the three cardinal symp toms of appendicitis are kept in mind, the early diagnosis is, in nine cases out of ten, very simple. The three cardinal symptoms are pain, tenderness, and rigidity. J. B. Deaver (New York Med. Jour., Dee. 7, 1901).
We can hest diagnose the locality of the disease by the following method: Ask the patient to point the finger quickly to the spot where there is the most pain without looking at the abdo men. Repeat this proceeding a number of times until you are certain that the right point has been obtained. Then the course of the appendix will lie be tween the base of the organ and this point. Where no mass can be felt in the region it is impossible correctly to diagnose a perforation or gangrene. Where the mass can be felt and persists longer than two or three days without diminishing in size or indeed even in creasing, it always has pus for a nu cleus. C. A. Elsberg, (Med. Record, April 5, 1902).
There are a certain number of cases in which the diagnosis of appendicitis is so evident that no one questions the propriety of operation. There are other eases in which the symptoms remain permanently, subjecting the patient to frequent exacerbations. There is a third class in which the symptoms abate never to return, on the one hand, or to return at intervals, on the other hand, until relieved or until death oc curs. In any case of appendicitis in which the diagnosis is undoubted and the services of a competent surgeon can he secured, operation should be done. James Tyson (Proceedings Amer. Med. Assoc.; Phila. Med. Jou•., June 21, 1002).
Diagnosis, Differential.