Alexandria gazette. [volume] (Alexandria, D.C.) 1834-1974, 1902-06-26
THE KINGS MALADY.

I
living surgeons and specialists upon alb
dominal troubles, says the New York
Times, the chances of death in cases OF
perityphltis where abscesses form, as IN
that of King Edward, are about one in
three
Sir Frederick also declares that the pc
riod when death is most likely to occur,
if at all, is from the fifth to the eighth
day. He expresses the opinion that the
knife should not be resOrted to until sew
cral days have elapsed from the appear
ance of the symptoms, unless the case Is
especially acute, in which surgical inter
ference is necessary Immediately.
Judging from the opinions of this dis
tinguished physician, it may be assumed
that either the Kings condition has de
veloped suddenly-in which case mortal
itv is probable-cr else he has been Il
very sick man for several days and the
physicians have been attempting TO
patch up their patient for the week 5
ceremonies.
What physicians regard as one Of the
most exhaustive essays written on the
subject of perityphlitis is that of Sir
Frederick, published in Thomas Clifford
Allbutt's System of Medicine" Every
phase of the malady is treated in that
essay and many of the typical cases cited
bear remarkable similarity to that of
King Edward. The following are some
extracts from the essay:
Perityphlitisrepre the commonest
variety of peritonitis and the remarkable
frequency of Inflammation in this posi-
ton is due to the fact that the appendix
is one of the weakest points within the
abdomen. Perityphlitis may be met
with in patients cfall ages. The greater
proportion of cases occur i'll young
adults, and the period of greatest fire.
ouency is between 10 and 20 years.
Long-impacted masses in any part
of the colon give rise to catarrh. This
catarrh often passes on to liberation.
If the ulcer acquires sufficient depth
to allow the perit0ncum to lie infected
perityphlitis results. The primary
ulcer may be due to the presence Of a
foreign body, to septic infection, to
typhoid liberation or TO tuberculosis.
I" 4 large proportion Of the subjects OF
perityphlitis-especially the subjects
above the age of 20-arc chronic dySpep-
ties. They bolt their food, or their
meals are irregular, or they begin active
work as soon az their repast is finished.
Many of these people have morbid ap-
petite; many of them are aware that an
attack is generally preceded by an ag-
gravation of the dyspeptic symptoms.
Certain Of the patients are nervous per-
sons, who seem to be victims Of a kind
of nervous dyspepsia.
"The general features of an attack are
sudden severe abdominal pain, more or
less defnitele located in the right illiac
fossa. The pulse may be thready and
the tongue is furred. There is much
prostration. The onset is generally sud
den. The attack often comes on at
night or in the early morning. The pa
tient may be in perfect health at the
time of the attack
"The abdominal pain may be de-
scribed as all over the abdomen, and
NAV go back to the loins 1t is describ-
ed as burning, tearing or aching.
1t is very acute, and has paroxysms
of greater intensity. 1t is not like the
pain of collie, although it may be spoken
of as 'cramp-like' 1t is not of kind
to bend the patient double, nor is it re-
lievod, except at the very beginning, by
pressure.
"The pain, if severe, may produce
some degree of collapse. Even in mild
examples, the patient feels faint, a clam
my sweat breaks out over his forehead,
his hands and feet become cold, and he
is soon quite prostrated
"Fever is constant and prominent
symptom. 1t begins as soon as the in
itial collapse, if any, has passed off, and
is usually of high grade. 1t may run
up to 1899 or 1912. Most often it
reaches its highest point at the begin
ming of the case. The temperature,
after subsiding a little, may rise again to-
ward the middle period or the end of the
case, The temperature may keep up for
nine or ten or twelve days. The fever
NAV continue for three or even four
weeks. 1t then disappears as mysteri-
ousy as it was maintained.
'In attacks of the most intense and
acute type the symptoms soon become
marked by their severity Death may
take place very rapidly. A very large
proportion of the fatal and severe cases
are first attacks, Those who have had
MANY attacks seem to be better able to
bear a widespread peritonitis. The
main feature of the treatment of an
acute attack consists Of an urgent advice
that a free incision should be made down
to the iuAamed area as soon as there Is
evidence that suppuration has taken
place To this rule there is practically
no exception. 1t may be laid dowu as a
rough rule that the use of the knife Will
very seldom be called before the fifth
day. Indeed, | would venture to think
that surgical interference before the fifth
day should not be undertaken except in
the presence of emphaticsymptOms. In