MISCELLANEOUS DISORDEES.—Accord ing to Deaver, movable kidney is to be differentiated as follows: In appendicitis there is more apt to be fever and in creased pulse-rate, the rigidity of the abdominal wall does not involve such a large area, there is a circumscribed and acutely-tender point, the tenderness is more superficial, and there is an absence of a movable tumor which readily slips from between the examiner's fingers.
Chronic appendicitis is present in from SO to 90 per cent. of women with symp tom-producing movable right kidney. This frequency constitutes chronic ap pendicitis one of the chief, if not the chief, symptoms of movable kidney. Twenty per cent. of all women have movable kidney or kidneys; 4 per cent. of all women have symptom-producing movable kidney or kidneys; 4 per cent. of all women have appendicitis, while per cent. of all women have both symptom-producing movable kidney and appendicitis; only per cent. of all women have appendicitis and well anchored kidneys. A movable left kid ney never produces appendicitis. Mov able right kidney probably produces chronic appendicitis by indirect pressure upon the mesenteric vein, the return circulation of the appendix being ham pered by compression of the vein between the head of the pancreas and the spinal column. George - M. Edebohls (Post graduate, Feb., '99).
Infectious catarrhal 'inflammation of the bile-ducts and ulceration of these ducts may occasionally simulate appen dicitis. Biliary colic is to be differen tiated by jaundice, absence of fever, peculiar color of the stools, finding of gall-stones in the passage, and by the more severe and continuous pain, radiat Diagnosis is not easy when inflamma tion of the right tube and ovary and of the appendix occur at the same time. We have in both rapid pulse, rise of temperature, pain, vomiting, and tym panites. However, appendicitis begins more acutely. If a chronic case, there is a history of one or more former sharp and sudden attacks. Lesions of tubes and ovaries are of older date and have a history of menstrual disorder. Pain of
appendicitis is acute, frequently violent, beginning over the solar plexus, radi ating over the whole belly, and finally settling in the right iliac region. In ad nexal disease the pain is dull and heavy, and never sharp and lancinating until the peritoneum is involved. Patient is more alarmed in appendicitis than in dis ease of the adnexa. Location of tender ness is different: in appendicitis it is on a level with the anterior spine; in ad nexa, trouble is in the pelvis. In the latter, vaginal examination reveals the site of tenderness; in the former, one can touch and move the organs in the pelvis without producing pain. Vomit ing is more common in appendicitis. Rigidity of the muscles of the abdomi nal wall over the right iliac region is almost always present in appendicitis, and generally absent in inflammation of the tubes and ovaries. In case of doubt chloroform should be given, and by its aid the enlarged and tortuous appendix can be felt or by a bimanual examination disease of the adnexa may be discovered. Hunter McGuire (Southern Med. Record; Canada Lancet, May, '98).
Neuralgia in the region of the appen dix, renal colic, particularly when pro tracted and febrile, cholecystitis, per foration of duodenal or other ulcers along the gastrointestinal tract and diseases of the internal genitalia may simulate this affection. E. G. Janeway (Med. Record, May 26, 1900).
Appendicitis is much more common in women than is supposed, because of the frequency with which it is mistaken for ovaritis of the right side. Several per sonal patients had been treated for a prolonged period. The pain of appendi citis is more sudden in its onset, and much more acute and is often accom ing usually from the chest-margin to the ' umbilicus.
Simple empyenia of the gall-bladder is diagnosed by the onset, the location and character of the pain and tenderness, and by the area and degree of rigidity.