ACUTE DIVERTICULITIS OF THE ASCENDING COLON.

Signs, but on the fourth day the patient began to complain of pain in the right lumbar region high' up in the neighbourhood of the kidney: A perinephric abscess was thought ofisthis time, as the pain, was quite acute. At no time did she vomit or lose her appetite for fluids, nor was there any interference with Formal' bowel movements. Under the influence of prontylin the temperature in three days was reduced to 14Y1; but the pulsehad risen to 112 and thewhite blood count was 37,000. Examination per vaginam was still negative. The facial aspect remained the same, except that *the patient was .obviously very tired. At this juncture the prontylin was stopped beause she had had heavy dosage and a slight cyanosis had begun. On the morning of the seventh day the temperature had risen again to 104.50 and the white blood count to 40,000. No localization of the inflammatory process could be' made out and the pain had ceased in both lumbar regions. The pulse had risen to 130; the'urine still showed only an occasional pus cell and a few red blood cells. It was quite obvious that this woman was in a desperate state. Despite stimulation and intravenous therapy she' became comatose at 8 p.m. and death occurred two hours later on March 3rd. Post mortem.-Post-mortem examination revealed the following important points. There was no inflammation within the peritoneal cavity, simply about 20 c.c. of clear peritoneal fluid in the pouch of Douglas. The uterus and adnexa were normal. The eccum occupieda low position in the right iliac fossa and the appendix was wholly extra-peritoneal, extending over the right iliac artery across the back of the true pelvis into the root of the sigmoid mesentery. It was nothing but a gangrenous mass with a bulbous tip, which had ruptured at this point. Absorption from this had apparently spread up into the aortic glands on both sides of the vertebral column through the trunk lymphatics, and on the left side every gland was nothing but a pus sac. The 'perirenal fat contained multiple abscesses,, and this condition reached as high as the diaphragm. On the right side a similar condition was present and had reached as high as the perirenal fatty tissue. All of this inflammatory process was therefore behind the posterior parietal peritoneum. The remainder of the examination was essentially negative.