Appendicitis : its pathology and surgery . membrane are gone. A small piece of the meso-appendix is cut in the surface has a little lymph upon it, and this contains vessels are engorged with blood, and some of its intersticesare filled with old blood extravasation. A small vein con-tains a clot of some age, and its endothelial lining is activelyproliferating. This clot probably has streptococci in it. Ispeak with reserve, because mistakes are easily made whenthe bacteria are few. STENOSIS AND ITS COMPLICATIONS [23 No traces of tubercle or of tubercle bacilli are to be fou
Appendicitis : its pathology and surgery . membrane are gone. A small piece of the meso-appendix is cut in the surface has a little lymph upon it, and this contains vessels are engorged with blood, and some of its intersticesare filled with old blood extravasation. A small vein con-tains a clot of some age, and its endothelial lining is activelyproliferating. This clot probably has streptococci in it. Ispeak with reserve, because mistakes are easily made whenthe bacteria are few. STENOSIS AND ITS COMPLICATIONS [23 No traces of tubercle or of tubercle bacilli are to be found. It is unnecessary to comment at length upon this presence of streptococci accounts for the appendicitis andthe inflamed mesenteric glands. The phlebitis of the smallvein in the meso-appendix, shows the way by which the liverbecame infected. The cessation of the pain in the appendix is very remark-able. I can recall another case in which a similar absence ofpain occurred. Case 32.—Appendicitis—Peri-appendicular Abscess —. -Streptococci in contents of the lumen of the vermiform appendix, x 1000. Portal Pyaemia — Subdiaphragmatic Abscess. — In February,1896, I was requested by my colleague, Dr. (lee, to open ahepatic abscess. The patient was a young man, and somepus and bile had been obtained by aspirating through theeighth intercostal space behind. His condition was verycritical, with a continuously high temperature. There wasnothing that pointed to the cause of the abscess. I madean incision parallel to the lower margin of the twelfth rib,and managed to open the abscess by pushing a drainagetube along the back of the right lobe of the liver. The abscess [24 APPENDICITIS was full of fcetid pus. A large drain was inserted, and theabscess washed out with biniodide of mercury lotion 1 in 1000—the general peritoneal cavity having been shut off withgauze packing. The patient improved for a time, but died ofsepticemia on March 1; the fourth day after the operat
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