Diagnosis.—The diagnosis of typh litis is to be made from the mildness of the symptoms, and the readiness with which they yield to appropriate treat ment, and the absence of evidences of constitutional disturbance. As has al ready been intimated, the differentiation from appendicitis is exceedingly difficult and oftentimes impossible, by reason of anatomical peculiarities. Appendicitis, comparatively, may be looked upon as the graver of the two conditions, and its symptoms may be considered the more marked and the less yielding to treat ment. Under favorable conditions it may be possible to distinguish by palpa tion between an inflamed cmcum and an inflamed appendix. It is doubtful if paratyphlitis and perityphlitis are to be differentiated from para-appendicitis and periappendicitis. (See APPENDI CITIS, volume i.) Etiology.—Isolated inflammation of the crecum is probably an uncommon condition, if it occur at all. On the other hand, typhlitis will be found, as a rule, to accompany enteritis and colitis, and also appendicitis, with the symptoms of each of which its own symptoms are likely to be blended.
Cause of all typhlitis and perityphlitis and paratyphlitis assigned to an inflam matory process in the appendix, due to its occlusion either by faeces, fcal cal culi, stricture, or, more seldom, foreign bodies. Sehede (Deut. med. \Voch., June S, '92).
Perityphlitis is unusually common in America, due to two of our natural fail ings: eating too much and chewing too little, the result of which is constipation.
Lange (N. Y. Med. Jour., June 6, '91).
The mcum may, with the adjacent bowel, be the seat also of tuberculous, syphilitic, typhoid, or dysenteric infil tration, and perhaps secondary ulcera tion. The symptomatology attributed in the past to syphilis was largely con strutted from the manifestations of what we have learned to recognize as appendicitis. At the same time, the pos sibility of catarrhal inflammation of the mum cannot be denied. Such a condi tion may arise in consequence of the presence of irritants, either introduced from without or generated within the body; but, as has been stated, the re sponsible agencies do not confine their activities to the head of the colon. The long-continued presence of hardened ftecal masses in the mcum may cause irritation and give rise to ulceration, with the development of either paratyph litis, inflammation of the connective tis sue surrounding the cfecum; or peri typhlitis, inflammation of its peritoneal covering; and these may be responsible in time for more remote complications. This train of events, it may be concluded from the experience of recent years, is like typhlitis itself, rather uncommon, so-called paratyphlitis being in the vast preponderance of cases para-appendicitis and periappendicitis.
Prognosis.—The prognosis of simple catarrhal typhlitis is favorable. Recov ery is the rule under judicious treatment, though recurrence may take place on re newal of the provocative conditions. The prognosis is rendered grave by the development of paratyphlitis and graver by that of perityphlitis, both of which may lead to fatal suppurative peritonitis.
Treatment.—The treatment of typh litis is essentially an eliminative and antiphlogistic one, and will be partly medicinal and partly dietic. It is best, even in mild cases, for the patient to go to bed, and be placed under conditions of rest and quiet. The diet should be bland and unirritating, and so constituted as to give rise to the least residuum possible. A suitable dietary can be constructed with milk as a basis, and including soft boiled eggs. Vegetables and solid food in general had better be avoided. If the stomach be irritable, food may be with held entirely for twenty-four or even forty-eight hours. As constipation is the rule, the bowels are to be moved, and preferably by means of enemata given with the aid of a fountain-syringe. For this purpose, a quart or two quarts of simple warm water may be used; or soap suds may be added; or 1 or 2 ounces of castor-oil, or olive-oil, or cotton-seed oil, or oil of turpentine, perhaps emulsified with the yelk of an egg. If the constipa tion prove obstinate, irrigation of the bowel with larger quantities of water may be practiced.
The best treatment of perityphlitis is removal of the intestinal contents in every possible way, especially by wash ing out the stomach. If the stomach is washed out soon after the onset of fecal stoppage, the faecal masses removed, and this done two or three times daily, the intestines may be relieved, and the de composition of their contents and ab sorption of toxic substances prevented. Good effects from this treatment re peatedly observed. Ewald (Berliner kb». Woch., No. 18. '91).
When the constipation has been over come small closes of calomel, grain hourly for six doses, followed by a saline —magnesium sulphate, sodio-potassium tartrate, sodium phosphate, from 2 to 4 drachms, may be given; or, if the con stipation was aggravated originally, the saline may have been given at the outset, preceded or not by 5 grains of calomel. If the bowels be loose and pain be a prominent symptom, opium may be in dicated, though deceptive masking of the symptoms by the anodyne is to be guarded against.