TYPIILITIS. — This disease is charac terized by a gradual onset, a typhoid course, and a prolonged convalescence.
The pain on pressure in typhlitis is dull, while in appendicitis it is sharp, Typhlitis is more a disease of corpulent aged individuals leading a sedentary life; appendicitis is an affection of young adult males. Benoit, (L'Union Med. du Canada, Mar., '94).
Faecal distension of the cazeum some times causes irritation of the mucous membrane, and presents symptoms sim ilar to those of appendicitis. This con dition may be excluded by the fact that the tumor preceded the pain, by the ab sence of vomiting and rigidity of the abdominal wall, and by the small amount of pain and tenderness. Typhoid fever is to be excluded by gradual rise and higher temperature range, by the absence of tumor and rigidity of the muscles in the right iliac region, and by the nervous phenomena and spots. In typhoid fever the characteristic stools will probably be found, and in appendicitis constipation, or, if diarrhoea, it is not characteristic. Intestinal obstruction presents the symp toms of shock from the first, if it is acute, and there is no elevation of tem perature. The constipation is more marked than in inflammation of the ap pendix, save in those cases where paresis of the intestine is present. Vomiting is a characteristic symptom of intestinal obstruction. In renal calculus the pain radiates from the right lumbar region to the hypogastrium and is very severe, but disappears after the lapse of some hours as quickly as it came. The testicle is
retracted and the patient is without fever. The absence of fever by no means excludes appendicitis, however. Gall stones may be simulated by an abnor mally located appendix which is in flamed. In the female inflammation of the Fallopian tube and extra-uterine pregnancy can usually be excluded by a bimanual examination in connection with the clinical history of these conditions. J. Garland Sherrill (Louisville Jour. of Surg. and Med., Apr., '99).
A number of cases of chronic colitis seen in which the question was raised as to whether the condition was not really a chronic appendicitis, but no case of acute appendicitis of so grave a nature had been seen as to make it unsafe to give a laxative or injection for fear of producing perforation where the question was raised as to whether the condition was really an acute ap pendicitis or acute colitis. When per foration is threatened in acute ap pendicitis, the diagnosis is usually not difficult to make. One or two cases of unmistakable chronic colitis personally seen which were entirely cured by re moval of a diseased appendix. This would seem to indicate that the inflam mation in these cases had begun in the appendix and extended to the colon, the primary and chief lesion, however, being in the appendix. McBurney (Med. Rec ord, April 19, 1902).