The Canadian journal of medicine and surgery . ant cells. The tuberculous process in the lymph glands hashere and there advanced to caseation. The following points merit attention in this case: 1. The total absence of definite symptoms until a few hoursbefore operation. 2. The presence of symptoms identical with those of acuteappendicitis. 3. Marked contraction of the stricture. 18 Canadian Journal of Medicine and Surgery. 4. Ilic udvisahility of alwjiys cxpldi-in^ the i-ii^lii IL-iial [»eration, and then thei-c wasmoderate pain over the appculix, accompanied bv i-ii:idity of therif2,ht rectus
The Canadian journal of medicine and surgery . ant cells. The tuberculous process in the lymph glands hashere and there advanced to caseation. The following points merit attention in this case: 1. The total absence of definite symptoms until a few hoursbefore operation. 2. The presence of symptoms identical with those of acuteappendicitis. 3. Marked contraction of the stricture. 18 Canadian Journal of Medicine and Surgery. 4. Ilic udvisahility of alwjiys cxpldi-in^ the i-ii^lii IL-iial [»eration, and then thei-c wasmoderate pain over the appculix, accompanied bv i-ii:idity of therif2,ht rectus. Examination of the blood showe<l a total absence of eosiuo-philes. Tile only way in which wc can account for the lack ofsymptoms is that for some reason there occurred an acute contrac-tion of the stricture, which, up to that time, had p;riniite<l the. FKil I^K VI. TLUKUCULOIS STKICTUUE OF THE ASCENDING C(JLn.\ W ITHPERFOHATIOX OF THE fECTM. Dirc-ctly opposite the ileocecal valve is a small perforation with slightly ragged short distance above this i>oint the intestinal walls grow thicker and then form anannular constriction. The liiiiieri of the ascending colon at the stricture has been sonarrowed that a small bird-shot, when introduced, lodged therein iind pluggedthe gut. free passage of feces. The possible existence of such a conditionsup])lies another indication for early operation whenever troubleexists in the appendiceal region. Already peritonitis had devel-oped, although the symptoms had existed for so short a time; andhad we delayed until morning there would have been little chanceof saving the patient. After having- removed the a]i])endix and wiped the ]nis fromthe pelvis, the abdominal cavity appeared normal, and I probablyshould not have explored the right renal pocket had I not beenfamiliar witli
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