Bedside Interpretation of Laboratory Findings

c complete epitomie of their symptolls woul he impossible on the present an~f ile notesaecaipssbe -th oprerate occasoiil, )Ut I slhall giVe you MI outline of thie otes of a case recenitly operated uiponi in my wvard (kindly supplie(i by my mu0LISe-SUI-geon, Dr. George Kane) Mrs. J., aged 34, miarri-ed. TwoD childrle-ni dlive and wvell. Pleurisy eight years ago. Bilious attacks as a chil(l and since. For thie last one-and-a-half v-ears (lrigginig pain in the r-ight side close to the umilbilicus. Attackls begini with v-oImitinig. Pain has no relationl to food, anid is niot elifeved by it. Alkalies (1o not relieve. Appetite good. Bowels constipated. Micturition anid menstr-uaitionl ii-inoal. Loss of veiglit r-ecently. On examination, patienit is pale and(1 anwnmic. t onigue imoist. Teeth-uppers artificial, lowerilncisors good. Fauces infected. Abodo(mien-outline normal, movements good. No suIperficial tend(lerness, bLtL on deep) palpation t tenll(lr spots 11ir fouLndl corresponiding to P-ayr's points as alreadyv descrilbd. Liver, slpleen, and kidneys showitothling abnormal. Heart, lunigs, and cenitral ner-'i-vous systemn niormal. X-ray examnililontin aftert 1 at o)pac aitt-l shltX\. i(notiinig abnornial, and tlt test-nlleal figues lii, within nior-miial limilits. Operation ttrouglh a righlt paranttedlial inlcisioot slhowvs thIe gall-bladder--, stomaoch, and dul(olettumI1 oritrmal. Appenidix seemiled fibr-otic aindi distenided(l t tlte til), but no sigin of inflanititioon-it wvas remioved. Thto glanids of the superior miesenteric gr-oup) wvere nmlr.kedlY enlarged, both tihose of the internitediate zoine as well as tltose within the r-oot of the miesentery. TItle glands ini the lesser omientumll were also enlarged. That these glands ar-e enlargedl to a pathological (legree I have nlo doubt whatsoever; tlhact the enlargement is frequently tuberculous ill origill is also beyond (loubt; but tlhere are other enlargements which have not )-et been adequately accounited for. Suclh cases form-i ani appreciable proportioni of the chronic abdlominal problems occurrinig int practice. Out of 275 cases of this type, including appendicitis, duodenal tilcer, and mesenlteric glandular enlargemenit, I finid the following, all proved by operation:Appendicitis 82 Duodenal Ulcer 240 Enlarge(d Lymph-glaitds 53 \With the exceptionl of Heusser's wvork, I can find( iut tie literature no complete reports on the histology, the bacteriology, or inoculationi examinatioit of these cases. TIhe clinical side of the plrobleml has been studied, antl many papers have beeni published, but the subject awvaits fuller investigation bythe labor-atorwvorker.