146 The Philippine Journal of Science 1918 



which was relieved by bring-ing up considerable amounts of gas between 

 meals. The constipation has grown progressively worse for a period of 

 two years, in spite of various diets, exercises, and increasing doses of 

 purgatives. 



The result of a general examination was negative with the exception of 

 a slight increase in the rigidity of the wall of the right lower quadrant 

 of the abdomen over that of the opposite side and a slight tenderness on 

 deep palpation over the caecal region not due to the pelvic viscera, as 

 determined by bimanual examination. No definite attacks of pain referable 

 to this region of the abdomen were remembered by the patient. 



Removal of the appendix was advised, and at operation an appendix 

 nearly obliterated, patent, and of increased diameter for only the distal 

 half-centimeter was found. The proximal portion of the organ was largely 

 represented by a mass of fibrous tissue with evidences of the original 

 layers occurring- in but one or two places. There was atrophy of the 

 lining of the distended distal portion. The patient recovered promptly, 

 and within three months of the operation suff'ered no more from nervous- 

 ness, indigestion, or constipation. 



Case II. — Physician, age 30, single, complained of recurring jaundice of 

 very slight grade, accompanied by attacks of hyperacidity and constipation. 

 Following one of these attacks, in which there had been a slight febrile 

 reaction unaccompanied by any leucocytosis, the gall bladder had been 

 explored and drained, it being thought that here lay the cause of the 

 trouble. The patient recovered from this attack about as quickly as 

 he had from the previous ones, but, after a period of freedom from 

 jaundice lasting only a little longer than the previous intervals, he again 

 became yellow and had a low fever. During this attack, the intestinal 

 manifestations were more marked than usual, and examination showed 

 on deep palpation a very tender appendix region. An appendix with 

 thickened wall, well surrounded by adhesions and plastered posteriorly 

 to the lower end of the caecum, was removed through a low incision. During 

 the past five years the patient has been free from all jaundice and digestive 

 disturbances. 



Case III. — American clerk, age 28 years, single. This patient com- 

 plained of a slight yellow color of the eyeballs, sour stomach, constipation 

 alternating with diarrhoea, and increasing nervousness. The jaundice and 

 the attacks of diarrhoea were to the patient the most annoying symptoms. 

 At no time was there any tenderness elicited by pressure over the region 

 of the gall bladder, although even light palpation over the appendix pro- 

 duced discomfort and a sickening sensation which, although never entirely 

 absent, was most marked during acute exacerbations of the symptoms. 



At the time of operation the advisability of exploring the gall bladder 

 was discussed, and, as it was found possible completely to empty this 

 organ with the finger introduced through a McBurney incision, the opera- 

 tion included merely the removal of the appendix, which was chronically 

 inflamed, adherent, with signs of acute engorgement. It is now over 

 three years since the operation, and the patient has had no further jaundice 

 nor other manifestation of a gastrointestinal disturbance. 



Case IV. — American woman, aged 42, married, has had several children, 

 and has lived in tropical countries for over twelve years. For the past 

 three years or more the patient has lost weight slowly but steadily, and 

 has had numerous attacks of jaundice of a mild grade with no special 



