DISORDERS OF THE UTERUS, adnexa, and pelvic cellular tissue, especially sal pingitis, are conditions which may cause confusion, especially the latter. Exam ination of the genito-urinary organs sometimes establishes the differential diagnosis.
By placing the patient on her left side with the shoulders low and the legs drawn up, it is much more easy to de tect the position and condition of the appendix and also to differentiate it from the uterine adnexa than by palpa tion of the patient lying on her back. Even when no great intestinal distension is present, the depth at which the appen dix might lie is greater, and the tension of the abdominal walls is likely to be more marked in the dorsal position than when this lateral method is employed, if no intestinal adhesions are present. (J. C. Simpson.) In appendicitis the pains are more violent, but more strictly localized, and radiating pains are absent. In catarrhal salpingitis, especially if the ovaries share in the inflammation of the tubes, the pains radiate toward the thigh; the alarming symptoms also show a notice able remission toward the third or fourth day. (Vineberg.) In an acute progressive case the ab domen is so rigid that deep palpation is difficult and dangerous. A rigid abdo men is the principal differential sign between acute appendicitis and salpin gitis. (R. T. Morris.) Simple appendicular colic or parietal inflammation of the appendix may be accompanied, in hysterical persons, espe cially women, by nervous symptoms, simulating severe diffuse peritonitis. Talamon (Mad. Mod., No. 24. '97).
Three cases of tubo-ovarian congestion diagnosed as appendicitis. Colicky pains in the right iliac region fire days after the end of the menstrual period; simi lar attack a year previously. A rectal and vaginal examination revealed a re troflexed uterus, with enlarged tender ovary and tube on the right side. J. C. MacEvitt (Brooklyn Med. Jour., Apr., '97).
Six cases of appendicitis in the female in which it was impossible to positively establish the diagnosis before opening the abdomen. If the pain and the tumor are high up in the region of the right tube and ovary, appendicitis probably present. If the hymen is intact an in flammatory enlargement on the right side is probably due to appendicitis. Richelot (Le Gynec., June, '97).
Acute puerperal parametritis may be gin in the same manner as perforation of the appendix, but the symptoms are less severe, those of diffuse peritonitis being absent.
It is more difficult to distinguish be tween perforation of the appendix and the rupture of a pus-tube or ovary. If recovery takes place, the parametritis and paratyphlitis exudates can usually be diagnosticated by their characteristic shape and position. Kruger (Deut. Zeit. f. Chin, B. 45, H. 3 and 4).
panied with nausea. Muscular spasm is usually marked; the general dis turbance is greater, and the progress more rapid. An intact hymen points to appendicitis. F. W. McRae (N. Y. Med. Jour., Feb. 2, 1901).