Cases of simple catarrhal appendicitis with adhesive peritonitis almost invari ably get well.
Cases in which extraperitoneal perfo ration occurs generally recover, unless the abscess opens into the bladder or the pleura, when recovery is doubtful.
Cases in which invasion of the general peritoneal cavity by septic material has occurred usually ends fatally.
Surgery has sometimes been successful even where there has been (a) general suppurative peritonitis; (b) septic pare sis of the intestines; (e) multiple ab scesses in the peritoneal cavity. Price (Buffalo Med. and Surg. Jour., Dec., '91).
Diffuse peritonitis the cause of 70 per cent. of the deaths from appendicitis. Haenel (Miinchener med. Woch., Mar. 26, '95).
Recovery in a ease of acute gangre nous appendicitis with general suppu rative peritonitis. Parker Sims (N. Y. Med. Jour., May IS, '95).
Recovery in a ease of profuse septic peritonitis. The protecting wall of the inflammatory adhesion was incomplete, and the septic process extended to the liver and the whole right abdominal cavity. The pelvis was filled with puru lent fluid and faces. Appendix gan grenous and left in. Kakeles (N. Y. Med. Jour., July 6, '95).
Case of fulminating appendicitis. The patient, a girl aged 25 years, was oper ated upon at 5 P.m., twenty-four hours from the beginning of the active symp toms. The peritoneal cavity was found to contain about two quarts of pus, the intestines being coated throughout with thick layers of lymph. Although at first the prognosis was exceedingly bad, the patient was convalescent at the time the report was published. McCosh (An nals of Surg., Feb., '97).
Pa in.—lf violent, sudden, and persist ent, it indicates probable seriousness of the attack, but nothing as to the natural defenses for limiting infection. On the other hand, absence of pain is undecisive between the gangrene and resolution.
Pnl.se and Temperature.--While a rapid pulse and high temperature favor the de structive process, their absence affords no assurance of recovery. Referring to this, Tyson remarks that too much stress cannot be laid upon the fact that there may be gangrenous appendicitis in the presence of normal temperature.
Shoek.—The presence of shock, if un doubted, is a very grave symptom, gen erally indicating perforation. On the other hand, the most deadly attacks often occur without it.
Sensitiveness.—If persistent and highly developed, it generally indicates destruc tive inflammation, but gives no clue con cerning the limitations of infection.
The Expression.—This is of material value before the development of grave conditions.
Perforation.—This can no more be foretold than the perforation of the in testine in typhoid fever or the rupture of all aneurism. Howard Crutcher (Can ada Lancet, May, '9S).
Tendency to recurrence is one of the marked features of appendicitis. The danger to life increases with each suc cessive attack.
Study of 104 cases of recurring appen dicitis in which operation between the attacks was performed, without a death. Examination of the appendices removed showed that in not one case had the organ become normal after the attack. Every specimen showed inflammatory conditions. Clinical symptoms are not certain, and one cannot positively deter mine from them the stage which the in flammation has reached nor the variety to which it belongs. Hermann Rummell (Berliner Min. Woch., Apr. 11, '9S).
Medical Treatment. — Medical treat went is indicated when the signs of ab scess formation are not present and even then only during the incipient stage of the disease.
Saline aperient, sulphate of magnesia in small doses every two or three hours, combined with copious warm enemata or irrigation of the bowels with Hegar's funnel syringe, the patient being in the knee-chest position, are of value to re duce the infectious secretions and dis charges.
Early employment of salines is useful for the removal of toxins and on account of the derivative action. S. C. Gordon (Amer. Jour. Med. Sciences, Jan., '93). For distension salines are of no use Gradual remission of the active symp toms, especially in the size of the tumor, is a favorable sign. The contrary is the case when the remission is sudden.