The development of paratyphlitis and perityphlitis will demand, in addition to the measures already specified, local ap plications, preferably of cold, or, if that be badly borne, of heat; and counter irritation and sorhefacient ointments when the process manifests a tendency to become chronic.
Medical treatment of perityphilitis de fended against surgical interference. The plan of treatment is rest, free evacuation of the bowels, hot fomentations, or ice bags, with the addition, in chronic cases, of repeated blistering over the tumor. Saundby (Birmingham Med. Review, Sept., '91).
In cases of indolence of the cmcum external treatment, friction and massage of the abdomen, with the continuous current, if necessary, are employed, and if there is any congestion of the cmcum or periesecal ganglia the parts are painted with tincture of iodine or small blisters applied. The diet is of great im portance, and no solid foods should be taken, but meats, fish, etc., be reduced to a fine pulp, and vegetables be given in the form of a puHe. Jules Simon (Revue Gin. de Clin. et de Th6r. Jour. des Prat., Jan. 19, '95).
Experiment to ascertain whether or not the external application of the sub stance, and in particular of the essence of turpentine, might not influence favor , ably suppurative processes. One in vestigation in this field, in a case of purulent pleurisy. was crowned with success, and then on several occasions the author used the essence of turpen tine as a resorbent and antiphlogistic. It is, however, in perityphlitis, before the stage of exudation, that the med icine in question appears to give most excellent results. It was used in twelve such cases, either in the form of the essence, or of the essential oil, in a dose of 3 drops, repeated two or four times a day. It may be given in ether or incor porated in the yelk of an egg, or, better, since the stomach does not bear it well, as an emulsion in the yelk of an egg. If there is an exudate around the ap pendix, it is well to combine internal and external exhibition of turpentine. The internal use of this remedy must be stopped if any trouble appears with the kidneys or lungs. M. Mayer (Semaine Mi2dieale, No. 34, 1902).
Suppuration will and peritonitis may demand surgical intervention. (See AP PENDICITIS, volume 1.) When there is severe localized pain, tenderness, and a tumor present in the right iliac region, with the constitu tional symptoms of suppurative inflam mation, an early operation is demanded to evacuate the pus. This should be done as early as the third day when possible. Delay is more dangerous than operation. R. Winslow (Va. Med. Monthly, May, '91).
One ought not to seize on and explore every perityphlitic abscess, more par ticularly when the proof of its existence is doubtful and only a mere suspicion. When general peritonitis sets in as a complication, surgical treatment is nec essary. Ewald (Berliner klin. Woch., No. 1S, '91).
Resection of the mourn recommended when it is perforated. Von Winiwarter (Ann. de la Soc. Med.-chir., June, '92).
Colon, Dilatation of.
Symptoms.—Apart from the symp toms of any primary condition that may be operative, dilatation of the colon is characterized especially by distension of the abdomen of varying degree, yielding a tympanitic note on percussion. Con stipation, further, is a prominent feature.
and may be marked. Sometimes there occur in association numerous small, liquid stools, together with ungratified desire for or ineffectual effort at defeca tion. There is also general discomfort in proportion to the degree of distension and the resulting displacement and in terference with function of adjacent or gans. Bladder, uterus and appendages may be crowded into the pelvis; lungs, liver and heart pushed high up into the thoracic cavity. Digestion is naturally deranged, nutrition suffers, weight is lost, and the quality of the blood de teriorates.
The symptoms of atony of the intes tions are marked constipation, headache, vertigo, nausea, and pains in the back and loins. Nervous symptoms are often present. The signs are marked tympany and sometimes the ability to detect the distended colon and fined' masses by pal pation. By giving an enema of 6 7, to fluidounces of water, splashing can be heard, while normally 1 pint will be required to produce the sound. Frieden wald (bled. News, Aug. 11, '94).