Appendicitis : its pathology and surgery . ea semilunaris. Theappendix was very hard to find. At last, it was found bounddown by tough and vascular adhesions to the peritoneum ofthe iliac fossa. It sprang from the outer side of the csecum,and was constricted close to its base. It was removed inthe usual manner and the wounds closed. This operation was rapidly performed, and on the follow-ing day he seemed rather better, with a lower temperature. As STENOSIS AND ITS COMPLICA TIONS I was leaving home my friend and colleague, Mr. Bruce Clarke,took charge of the case. The patient became worse with
Appendicitis : its pathology and surgery . ea semilunaris. Theappendix was very hard to find. At last, it was found bounddown by tough and vascular adhesions to the peritoneum ofthe iliac fossa. It sprang from the outer side of the csecum,and was constricted close to its base. It was removed inthe usual manner and the wounds closed. This operation was rapidly performed, and on the follow-ing day he seemed rather better, with a lower temperature. As STENOSIS AND ITS COMPLICA TIONS I was leaving home my friend and colleague, Mr. Bruce Clarke,took charge of the case. The patient became worse withcontinuously high temperature. Mr. Bruce Clarke reopene<ithe upper wound and again explored the liver. A soft spotwas discovered, and an abscess full of odourless pus opened anddrained. The shock of this was more than could be borne,and death ensued in five or six hours. Unfortunately, thepus from the abscess was not examined. At the post-mortem examination other small found in the liver. Xo evidence of pylephlebitis was. Fig. 32.—Streptococci in lymph on peritoneum of appendix. Xotc thatstreptococci out of focus look like bacilli. x 1000. discovered. There was slight localised peritonitis in the rightiliac fossa. The histological specimens made from the proximal anddistal ends of the appendix are almost alike. To the nakedeye the sections of the appendix look unaltered; its coats areof the usual thickness, and its lumen of the usual size andshape. Most of the peritoneum has been torn off, but thatwhich remains is very vascular, and engorged with surface is covered with lymph, which is crowded with cocci, APPENDICITIS diplococci, and streptococci. The chains consist of fromthree to eight cocci. Small clumps of cocci, probably en-tangled chains, are also present. The cocci vary in size from•5 jx to -75 fi (Fig. 32). The lymph contains no bacilli. The outer muscular coat is thin and irregular, the inner ofthe usual thickness, but oedematous and pen
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