It is most important in all severe cases to give subcutaneous injec tions of normal salt solution (Friedrich) every three to four hours, 100 to 200 Gm. (3 to 6 ounces). By this means there is an increase in the number of blood corpuscles, rise of the blood pressure, irrigation of the blood, etc., and a favoring of resolution of the severe and general symp toms, Especially do the symptoms of shock and of intoxication dis appear. By this method the most severe cases begin to improve under the infusion alone, and after some (lays thc most hopeless cases sometimes assume a condition favorable for an operation. While under this treatment for one or two clays a positive diagnosis and prognosis can be made. In the quickly extending perityphlitie conditions, in which the local and severe general symptoms slimy no abatement, one does not hesitate to operate as long as the general picture, espec ially the lowering of the leucocyte count, does not show a too hope less case. From this position of operating in children during the first forty-eight hours, have weakened because of the severe shock, and symptoms of poisoning which are present.. One operates under the most favorable auspices after previous treatment with normal salt solution (compare Fig. 32).
For the remaining milder eases the expectant treatment should be tried for the first few days. Also absolute rest, ice packs or poultices,
and opium. In place of a strict hunger (Het, more fluid food can be given slowly in small quantities (each quarter hour one swallow of milk). After the treatment by normal salt infusion more liquid diet by mouth can be given according as the general symptonis abate. The liquid diet should be gradually increased for some eight days; then comes a careful emptying of the bowels (oil enema) and where possible, the lightest, softest, and most easily swallowed food. The hot poultices are now applied only for a few hours in the day, the bowels are emptied daily by mean.s of small enemas, and absolute rest should be enforced. For some weeks, with few deviations, this is the plan and general rule of conservative treatment. After some weeks most careful attention should be paid to dietetics. Surgical aid is to bc sought, if at the end of the first few days a perityphlitic tumor can be palpated which increases in size, and when the symptoms are yet uncertain and the temperature does not abate.
An interval operation is: indicated when small inflammatory nodules remain after the attack and ft thickened appendix can be palpated himanually and when intestinal pain is present after some months.