Primary peritonitis in children may mimic acute appendicitis, with fever, abdominal pain, nausea, vomiting, diarrhea, diffuse abdominal tenderness, rebound tenderness, and hypoactive or absent bowel sounds. In cirrhotic patients, the presentation is often atypical and may present insidiously with no signs of peritoneal irritation. The most frequent symptoms are fever (69%) and abdominal pain (59%). Other signs and symptoms include hepatic encephalopathy (54%), abdominal tenderness (49%), diarrhea (32%), ileus (30%), shock (21%), and hypothermia (17%). Approximately 10% of patients with SBP have no signs or symptoms. Because of the variable clinical picture, patients with cirrhosis who have unexplained deterioration, especially hepatic encephalopathy, should undergo a diagnostic paracentesis.Tuberculous peritonitis usually appears gradually, with fever, malaise, weight loss, night sweats, and abdominal distension. The abdomen is often described as being “doughy” on palpation. Surgery or laparoscopy typically reveals multiple nodules over the peritoneal and omental surfaces with adhesions. C. immitis causes a granulomatous peritonitis and manifests variably.*88/348/5*

But unlike colds, there are many fewer viruses that cause the flu, and despite their fickle nature, it is possible to prevent the flu by an annual vaccine taken weeks before the flu season. Researchers worldwide monitor the changes in the flu virus, and before each flu season, manufacturers are usually able to produce a revised vaccine that incorporates protection against the newest virus variants.
Chances are you’ve heard recommendations that flu vaccine be given annually to people over sixty-five, to people like the police and firefighters who perform essential services, and to anyone with a chronic illness like heart or lung disease or an immune deficiency that can turn even a mild flu into a deadly disease. Being a younger, healthy person in a “nonessential” occupation, perhaps you think the flu vaccine is not for you. Perhaps you view a bout with the flu as a mini-vacation, an excuse to escape from your normal duties. Or perhaps friends told you that when they took the vaccine, they got a reaction that was almost as bad as the flu itself.
Well, if any of these “perhapses” applies to you, think again. Anyone, regardless of age or health status, is entitled to and can benefit from flu vaccine, assuming the person can afford it. The public health recommendations about who should be immunized are designed to protect those at highest risk of suffering life-threatening complications from the flu. They were issued primarily because there simply isn’t enough flu vaccine to go around if every young, healthy person got the shot too. But times are changing, and new technologies and an increased number of vaccine producers have helped to expand the supply, which would no doubt grow larger if the demand for the vaccine were greater.
Having the flu is no fun, and chances are you’ll feel too ill to do any of those housebound projects you’ve been meaning to get around to. If you can’t afford to be flattened by the flu for a week or more, and debilitated for weeks longer, you’d be wise to get the vaccine in October or early November every year. Waiting until the flu hits your community is not wise; it usually takes two to three weeks after you receive the vaccine for your body to build up an immunity to the viruses. However, public health officials advise that high-risk individuals who were not previously immunized should get the vaccine even if a flu outbreak is already under way.
Vaccine side effects have been greatly exaggerated. It is biologically impossible to get the flu from the vaccine because the viruses in the vaccine are dead and incapable of invading and reproducing in your cells. All they can do is rev up your body’s immune system and prompt it to produce antibodies that would knock out the live flu viruses should you encounter them. If you do suffer a flulike reaction from the vaccine, chances are you are extremely susceptible to the viruses the vaccine is designed to protect against. If you were unprotected and contracted the flu from one of those live viruses, you would undoubtedly become extremely ill. It’s better by far to have a brief flulike vaccine reaction than the full-blown flu. The most common vaccine reaction is not illness at all but rather some minor redness and soreness at the site of the injection that goes away in a day or two.
There are, however, a few people who should not take flu vaccine. Since the vaccine is produced from viruses that are grown in eggs, those with a severe allergy to eggs should avoid it. People who are already suffering from an infectious illness had best let themselves recover before getting a flu shot. The vaccine can be given safely to very young children, although they commonly get more side effects than adults do. Babies over age six months who have ailments that place them in a high-risk category for serious complications of the flu can be given a so-called split-virus vaccine to minimize side effects.
Flu vaccine is effective, but it is not perfect. In general it is 70 to 90 percent effective in preventing the flu that is going around that year. Unfortunately, it is more effective in younger people than in the elderly, who most need its protection. Also, it has a time-limited benefit. Even if the flu viruses don’t change from one year to the next, the immunity induced by the vaccine only lasts about one year. So you would need to get an annual shot no matter how the virus behaves.
*18\296\2*

Pneumonia was once one of the most feared of all human diseases. Its death rate was about a third of all those whom it attacked. The germ that caused it is one called a “pneumococcus” which lives ordinarily in the noses and throats of anywhere from five to sixty per cent of people. The condition comes on most often in the winter months and can affect people of all ages.
The pneumococcus gets down into the lungs and there sets up a severe infection which follows a typical course. For a few days the symptoms are like those of an ordinary respiratory disease. Then comes the sudden hard, shaking chill, rapid rise in temperature and pulse rate, with a severe pain on one side of the chest that the doctor recognizes as the beginning of pneumonia. The cough comes on painfully and with small amounts of pink or rust-colored sputum. Breathing is rapid, shallow and painful. There may be blueness because the blood is not getting enough oxygen.
The doctor, by the use of his stethoscope and by watching the motion of the chest, by thumping to discover areas of consolidation, recognizes that the lung is congested and unable to function. Usually after seven to ten days a crisis occurs. The body temperature falls to normal in from six to twelve hours, accompanied by profuse sweating, and the pneumonia as such is over.
The development of the new antibiotic drugs has changed the whole picture. Now, following the administration of penicillin, the pain in the pleura which lines the chest disappears in a few hours and the temperature, pulse, and respiration fall to normal in twelve to thirty-six hours. The spread of the inflammation can be stopped even before a single lobe is involved. This change in the nature of pneumonia is one of the most dramatic occurrences that has ever taken place in medicine and represents one of the greatest accomplishments of the present century.
For the treatment of pneumonia nowadays the chief reliance is on the drugs. The patient is kept in bed in a position in which he is most comfortable. He is given considerable rest but is permitted to sit up for examinations and for any other necessary procedure. He usually has little appetite and need not be urged to eat, but within a half a day after the specific treatment has been begun, he may be hungry and can take a soft diet. Formerly great efforts were made to keep the bowels moving; that too is no longer a serious problem for the doctor. If there is a real shortage of air and the person seems blue, oxygen can be given. It is customary to give oxygen now as soon as it is needed and not to wait until the patient seems actually to suffer from oxygen lack.
The pain in the chest can be controlled with suitable drugs. It is also possible to relieve severe pain by the injection of local anesthetic drugs or by strapping or wrapping the chest wall to prevent unnecessary motion.
The doctor is alert for complications. If penicillin is not as effective as seems to be desirable, aureomycin, the sulfonamides, such as sulfadiazine, and other methods may be tried. Particularly, however, the doctor must look out for complications such as secondary formation of pockets of infected material at the bottom of the lung.
The former fatality rate of 25 to 30 per cent has now dropped to less than 7 per cent. Pneumonia is stiff a particularly serious disease to those who have been long weakened by some other disease such as cancer or alcoholism or malnutrition, or some other serious complication involving the heart.
*15/318/5*