CHILLS OCCURRING EARLY IN APPENDICITIS BEFORE OPERATION AND THEIR INDICATION OF AN OPERABLE STAGE OF PYLEPHLEBITIS

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Abstract
Gerster,1 twenty years ago, made the following statements: It seems clear that, as regards purulent pylephlibitis caused by appendicitis, an early diagnosis of the primary trouble and prompt operation offer the only reliable safeguards. The occurrence of a chill is of the gravest import and should be considered to constitute a more urgent indication to operate than even the signs of local peritonitis. Where much necrosis is found, it would be very desirable to expose and evacuate thrombosed veins. The evacuation of septic thrombi from the jugular vein in mastoid disease has yielded such excellent results that the application of the principle to the portal vein would be natural and logical. Gerster's observations in his series of cases definitely proved his point, and in another series to be presented here it will be proved again, with the addition of convincing studies of the pathologic anatomy of pylephlebitis secondary to

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