PROTECTION AND REPAIR OF THE PERINEUM

lie patient was placed on alkalies for lus byperchlorhydria for three months without any benefit.An appendectomy was advised.Operation showed that the appendix was intact, but unusually long and clironically inflamed.There was u stric¬ ture 4 cm.(l'A inches) from the distal end.Another path¬ ologic tenture of the case was the kinking of the ileum by a short, firm fold of mesentery opposite the true mesentery.Division of this gave a looseness to the ileum and freedom of drainage which hud not existed before.After the removal of 'he appendix the patient made a complete recovery.Casi: 2.-Mr.'I'., aged -11, complained for live years of digestive disturbance.Two or three hours after meals he experienced epigastric distress, belching sour gus.He was easily tired, hud backache and was quite nervous, Bowels wen» normal.Physical examination proved absolutely nega¬tive.An examination of the stomach contents showed that '"' had hypcrchlorhydria.Palpation over the whole abdomen elicited no pnin.Continuous deep pressure over the appen- diceal region induced n feeling of distress in the epigastrium which the patient asserted to be similar to his digestive dis¬ turbance, complained of two or three hours after meals.!>n 'enioval of the pressure, the distress experimentally produced snlisidcd.Diagnosis, chronic appendicitis.The patient was placed on alkalies for his hypcrchlorhydria, which seemed to keep Iiim comfortable, .lustas soon us he discontinued the Rlkali .hisdigestive Bymptoms recurred. 1advised the removal "' the appendix.At operation the appendix was found to be 8'"i. (.'! inches) long and rctrocecally adherent.The meso-appen- dlx was very short, rendering ligation difficult, The appendix llil|l a sharp kink in the middle; the distal end showed marked change, with thickening and infiltrated walls.The case proved to bo one of chronic interstitial appendicitis with thickening ol the walls.The patient made a complete recovery, all "'«much symptoms entirely and permanently subsiding.Case '>.Miss D" aged 4().had complained of indigestion 'Or fourteen years, »'she belched gas, had backache, tired T'ickly.slept poorly and was very much const ¡paled.I'h.vsi- ' ul examination was negative.A continuous pressure over ii l"e appendix induced distress iu the left liypochonilriuni.At n°t ime during the past fourteen years had she been well.At operation it was found that the appendix looked quite "orinal, but that it was somewhat confined by old adhesions.Ihe main pathologic showing wns Ihe evidence of long-stand-' ""g adhesive inflammation, confining the ascending colon from 11 » me cecal extremity past tin» hepatic flexure.Not only was ''"' intestine confined by the membrane, thus limiting its mobility, hut it was also divided by several bands of this laudative membrane Into what might he called compartments.'ne operative mensures consisted in removing the appendix »lid freeing the ascending colon antl hepatic flexure.The P&tient has mude a complete recovery.Case A.-Mrs.K" nged :i(i.hail had stomach trouble all her "''• Her appetite was reported to be poor; there was severe '''stress immediately after meals, belching of gas.flatulency, ""'kachc ¡md nausea anil headaches: she tired quickly; bowels were constipated,.Physical examination proved negative.By ,l arm continuous pressure over the appendiceal region a pain *8 induced in the epigastrium; the harder the pressure, the ""iic severe the pain, inasmuch as the patient hud been under'"' care» of several good physicians, 1 explained that it was 'seless to endeavor (o relieve the difficulty by medication.* ' operation the appendix was readily exposed; it was found to '**' 11 cm.(4 inches) iu length und somewhat thicker than nor-'