PER1TYPHUTIS AND PERIPROCTITIS. GO 7 



tation as possible. Castor-oil seems to suit best, and, according to 

 HenocKs observation, after it has been used a long time, the disgust 

 which most patients have for it subsides. For other points we refer 

 to the treatment of stricture of the intestine as described in Chapter II. ; 

 and for operative procedures, to works on surgery. 



CHAPTEK VI. 



INFLAMMATION" OF THE CONNECTIVE TISSUE IN THE VICINITY OF TUB 

 INTESTINES J PEKITYPHLITIS AND PEEIPKOCTITIS. 



BY perityphlitis we understand the inflammation of the connective 

 tissue which attaches the ascending colon to the iliac fascia. In far 

 the greater number of cases this inflammation is propagated from the 

 ccecum and ascending colon ; in other cases it is an independent dis- 

 ease ; it is then usually called rheumatic perityphlitis ; lastly, it occurs 

 late in typhus, septicaemia, puerperal fevers, etc., and then belongs 

 to the so-called metastatic inflammations. The exudation deposited 

 may be absorbed, and the disease end in recovery ; but more frequent- 

 ly the inflammation leads to diffuse necrosis of the inflamed connective 

 tissue, and large abscesses form which may extend upward to the kid- 

 neys, and downward even below Poupart's ligament, to the inner part 

 of the thigh. Lastly, the posterior wall of the ccecum and of the as- 

 cending colon, the anterior wall of the abdomen or the skin of the 

 thigh, may be perforated ; or the contents of the abscess may escape 

 into the abdomen and cause peritonitis. 



If the disease develops from a typhlitis, after the superficial tumor 

 due to the inflamed ccecum has disappeared, there remains a painful 

 tumor lying farther back. This is covered by the inflated ccecum, and 

 hence gives a clear percussion-sound. Frem the pressure of the tumor 

 on the nerve-trunks, there is often pain, or a dull feeling in the corre- 

 sponding leg, and from the pressure on the veins there is oedema. If 

 there be resolution of the inflammation, the tumor becomes smaller, 

 the pain less, and the patient quickly recovers. If it leads to suppura- 

 tion and formation of abscesses, the tumor increases ; in favorable cases, 

 fluctuation appears sooner or later in the abdomen or thigh ; when the 

 abscess opens, purulent masses, mixed with mortified connective tissue, 

 are evacuated, and if the strength of the patient hold out, cure may 

 result in these cases also ; in other cases death results from exhaus- 

 tion. If the contents of the abscess escape into the ascending colon 

 after perforation of its posterior wall, the result is usually favorable ; 

 out if, on the contrary, they break through into the abdominal cavity, 



