Appendicitis : its pathology and surgery . further outthan usual. Inflamed and adherent omentum was first en-countered. A large portion was ligatured and excised; itshistological characters will be presently described. No puswas seen until the caecum was raised, when about two ouncesof foetid pus escaped from a cavity which also contained theinflamed and perforated appendix. No concretion was dis-covered. The pus was thoroughly washed out with 1 in 1000biniodide of mercury lotion, and the appendix removed in theusual way. A rubber drainage tube was placed in the outer TREATMENT, EXPECTANT AND
Appendicitis : its pathology and surgery . further outthan usual. Inflamed and adherent omentum was first en-countered. A large portion was ligatured and excised; itshistological characters will be presently described. No puswas seen until the caecum was raised, when about two ouncesof foetid pus escaped from a cavity which also contained theinflamed and perforated appendix. No concretion was dis-covered. The pus was thoroughly washed out with 1 in 1000biniodide of mercury lotion, and the appendix removed in theusual way. A rubber drainage tube was placed in the outer TREATMENT, EXPECTANT AND OPERATIVE 243 part of the wound, and the remainder was closed. The patienlmade an uninterrupted recovery, and was quite well threemonths afterwards. The excised omentum is intensely inflamed, very vascular,and swollen. Its surface is covered with inflammatory exuda-tion which consists of fibrin and nucleated corpuscles. Itssubstance is very (edematous, penetrated by dilated blood-vessels, and crowded with nucleated cells. The appearances. Fig. 50.—Inflamed omentum, x 1000. Acute appendicitis with perforation andlocalised foetid abscess. The omentum was not involved in the abscess, butapart from it. in hsernatoxylin stained sections are almost the same as in themicrophotograph made from a case without suppuration(Fig. 49). In specimens stained by Weigerts method, the lymph onthe surface and the peritoneal covering of the omentum, for adepth of 1 mm., is full of cocci, diplococci, short chains ofcocci and bacilli. The latter are by far the most numerous(Fig. 50). They vary in length from -75 /j, to 2 //,; their usualwidth is 5 /x. They doubtless belong to the groups of bacteriawhich are included in the terms bacterium coli commune orbacillus coli communis. These bacteria were numerous on the APPENDICITIS surface of the omentum and probably absent from its have referred elsewherel to this circumstance, and. pointedout how it influences the curability of the peritonitis
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