Acute phlegmonous cholecyslitis and gangrene of the gall-bladder may usually be diagnosed by the existence of more acute symptoms, more general perito nitis, by the rapid and shallow respira tion, location of the pain and tenderness, and by the greater tendency to a rapidly fatal issue.
Perforated gastro-intestinal ulcers are diagnosed by predisposing age, history of previous gastric or intestinal disturb ances, sudden acute pain in the epigas trium, followed by collapse,. and last by the presence of bloody vomiting, or, in the case of intestinal ulcers, by the limmorrhage from the bowel. Perfora tion occurring in typhoid may be very difficult to tell from a concurrent ap pendicitis.
Extra-uterine pregnancy is to be rec ognized by the existence of the usual subjective signs of pregnancy, by vaginal examination, and by the absence of in flammatory symptoms prior to the rupt ure. (Annals of Surg., Mar., '98.) Etiology and General Characteristics. —Young adults, especially males, consti tute the majority of cases. Appendicitis occurs at all ages, however, though very rarely during infancy.
Among 4S9 eases found in literature 392 were males and 97 females. I'ravaz (These de Lyon. 'SS).
Of 90 eases, 73 per cent. were under thirty years of age; 76 per cent. were males, 24 per cent. females. Bigelow (Vis Medicatrix,'Oct.. '91).
Report of 517 eases seen in the leading Montreal hospitals showing the condi tion to be most common between the ages of twenty and thirty, and to occur twice as often in males as in females. G. A. Armstrong (Lancet, Sept. 18, '97).
Study of SO cases treated by 13roca; 70 not previously published. Propor tion of boys to girls, 58 to 21; 5 were aged between 2 and 5, 25 between 5 and 10, and 41 between 10 and 13 years. Mlle. Gordon (These de Paris, No. 101, '07).
Heredity seems to act as a predispos ing factor in connection with an arthritic diathesis.
Three cases in which appendicitis seemed to follow family lines. The first patieut had lost a daughter one year before from peritonitis, resulting from appendicitis. She had had three pre vious attacks. The second, a child, 11 years of age, had a first cousin, 12 years of age, operated on for appendicitis. The third, a boy aged 13 years, had lost an elder brother, who had died of general peritonitis. A gangrenous appendix also
found in this case, W. T. Smith (Med. Record, Sept. 12, '96).
Heredity as a predisposing cause.
The author refers to the fact that for- j eign writers have reported a number of families in which this disease was fre quent. Talamon says that the reason this subject has been overlooked in medicine is due to the fact that the clinical forms and methods of treatment of appendicitis have been discussed, to the neglect of the etiology. The author reports three family histories in which appendicitis and bowel disturbance were very common. In the first family there was a train of symptoms going through all the members of the second genera tion. These refer to gastro-intestinal disorders associated with nervous symp toms and circulatory disturbance. In the third generation there was appen dicitis. Tit the second family the father probably had appendicitis, and he as well as the mother had constipation All the members of the second genera tion had some gastro-intestinal disturb ance. Three of the members of this P family had appendicitis. In the third generation of the same family constipa tion was the rule, and in the fourth A generation there were two eases of gas treetasis. F. Forschheimcr (Amer. Med., Oct. 5, 1901).
The local inflammation may be caused by the intrusion of:— 1. Micro-organisms, specific, and non specific, of which constipation, dietetic indiscretions; neighboring catarrhal, ty phoid, and tubercular processes; constric tion, torsion, or strain are the primary etiological factors. Cases due to actino mycosis are occasionally observed. Trau matism, blows upon the abdomen, etc., sometimes produce inflammation of the appendix.
The great frequency of this affection is due to the fact that the appendix is a functionless structure of low vitality, removed from direct fcal current; bacterium coil commune is always present and is capable of great virulence when constriction of the appendix or lesions of its mucous membrane or other coats are present. J. William White (Therapeutic Gazette, p. 385, '94; Brit. Med. Jour., Feb. 9, '95).