. A practical treatise on medical diagnosis for students and physicians . Even with a mild degree of pain the skin is hot and the temperatureslightly raised. In the cases in which the pain is more severe the generalreaction is greater, the temperature rises rapidly to 102° or 103° skin is hot and dry, the face flushed. The pulse is full and strongand in a young adult rises to 90 and 95. In some cases the patient com-plains more of the fever than of the pain after the first severity of theattack has subsided. The tongue is coated and the appetite is lost. On physical examination the area
. A practical treatise on medical diagnosis for students and physicians . Even with a mild degree of pain the skin is hot and the temperatureslightly raised. In the cases in which the pain is more severe the generalreaction is greater, the temperature rises rapidly to 102° or 103° skin is hot and dry, the face flushed. The pulse is full and strongand in a young adult rises to 90 and 95. In some cases the patient com-plains more of the fever than of the pain after the first severity of theattack has subsided. The tongue is coated and the appetite is lost. On physical examination the area which was the seat of pain is foundto be tender. When examined with the tip of the finger pressing firmly,more marked tenderness can usually be found at a point midway betweenthe anterior superior spine of the ilium and the umbilicus, known asMcBurneys point, which corresponds to the site of the diseased appen-dix. The swollen tender appendix may occasionally be palpable. Oninspection the affected area is slightly or may be considerably enlarged. Fig. 37-4. Fig. 375. Some positions of appendix and relation to peritoneum. Comparison must be made with the opposite side. It will be seen thatthe usual depression in front of the anterior spine, or the cavity towardthe loin, is not so deep as on the opposite side. In front the surface maybe even with the plane of the ilium. On palpation, in addition to ten-derness and pain at the point previously indicated, fulness and enlarge-ment can be distinguished. There are resistance to pressure and more orless rigidity of the abdominal muscles. On careful measurement thesemi-circumference will be found in most instances to be larger than thesemi-circumference of the opposite side. When bimanual palpation isperformed, the left hand being placed in the loin behind and the rightover the abdominal surface, resistance, induration, and rigidity can moreeasily be detected. On percussion there is change in the note comparedwith that of the opposite
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