Abdominal Trauma in Acute Appendicitis

Abstract

CENTRALIZED GONOCOCCUS CULTUREThe evidence presented in this paper of trichomonad infestation will not increase clinical belief in the pathogenic importance of this parasite. The very high incidence of the organism in the female genital tract without any inflammation or discharge may suggest very legitimately that its presence in inflammatory exudates is coincidental rather than causative. It may also be pointed out that the detection of Trichomonas was merely incidental to this investigation and that the specimens were not those generally considered best for the purpose. It is quite possible that in some women vaginal irritation may be caused by T. vaginalis, but to ascribe to it the importance it commonly gets because of its frequent presence in leucorrhoea is an example of post hoc ergo propter hoc reasoning which cannot be substantiated by the facts at present available. Further investigation of its occurrence in normal women is obviously desirable. The transport method described allows the investigation to be carried out more leisurely and conveniently than has hitherto been regarded possible. SummaryA method of transporting specimens for the diagnosis of gonorrhoea is described. By its use facilities for culture can be made available to all clinics within a " time distance" of 24 hours from a laboratory.The method is at the same time applicable to the detection of T. vaginalis.In the above investigation of gonorrhoea 139 positives out of 184 were found by smear examination alone and 158 by culture. The combination of smear and culture discovered 24% more positives than smear examination alone, and culture alone 10% more than smear.T. vaginalis was found in approximately 50% of women with vaginal discharges and in almost 40% of women in whom no evidence of inflammatory disorder was evident and who were examined as a test for cure cf gonorrhoea.FooTNoTE.-Since this paper was written an alteration in technique has been found necessary owing to the bactericidal action on Neisseria of certain later batches of agar used in preparing the transport medium. This property is apparently the same as that described by Ley and Mueller (1946), and is particularly prominent in the absence of nutrient material which is a feature of the medium described. The inhibitory effect can be neutralized by charcoal (Stuart, 1947), but charcoal cannot be incorporated in the medium without absorbing the methylene-blue reduction indicator. Accordingly, swabs are prepared as described above and then dipped in a 1 % water suspension of finely ground charcoal (B.D.H. blood charcoal and "norit" have been found equally suitable) before being dried and sterilized. Results from a year's experience with these charcoal-impregnated swabs are significantly better than those given above, and suggest that even when the agar is apparently free from inhibitor this alteration in technique is desirable.

Parents, Family Doctors, and Acute Appendicitis in Childhood

“…In the present series there did not appear to be any increased liability of the younger children to have coexisting illness, though eight children had specific infective fevers, four had severe respiratory infections, and infective hepatitis and acute nephritis were among the other illnesses present at the same time. Seven children had'a history of preceding injury: the possible role of trauma in acute appendicitis has been discussed by Black (1948).…”