Feb. 24, z877.] THE BRITISH MEDICAL 7OURNAL. 223 of Bright's disease in that spirit, thoughthe measures must be graduated according to the depth and amount of the poison. Following out this principle, these patients ought to be roused by means of strong coffee or tea; interested by the society of friends and the business of everyday life; directed to take exercise briskly, and, so as to stir their circulation, keep tlhemselves warm and earn their digestion, at the same time that they avoid fatigue and exhaustion. They ought, indeed, to live, so to speak, within the income of their organs ; but they ought, at the same time, to live almost up to that income. The many exercises of life increase the powers of life, just as the oarsman or the mountaineer,
Multifocal endometriosis found outside of the pelvis is very rare. We present here a case of endometriosis found in the pelvis, appendix and umbilicus. A 52-year-old female had a previous umbilical hernia repair, and years later started to develop a recurrent umbilical mass. After a full work-up, it was decided the patient have a diagnostic laparoscopy with wide local excision of umbilical mass to rule out any underlying malignancy. Findings during the procedure included an umbilical mass, dilated appendix and ovoid mass abutting the appendix. Pathology of the umbilical mass was found to be consistent with endometriosis. Umbilical and pelvic endometriosis is a rare condition. Options for diagnosis prior to surgical interventions are limited in endometriosis. In this case, ruling out underlying malignancy took priority, and the mass was removed and she will have less chance of recurrence.
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