Perityphlitis and its varieties : their pathology, clinical manifestations, and treatment / by Frederick Treves.

  • Treves, Frederick, 1853-1923.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Perityphlitis and its varieties : their pathology, clinical manifestations, and treatment / by Frederick Treves. Source: Wellcome Collection.

    12/70 (page 8)
    PERITYPHLITIS the appendix. It may bo safe to conclude that simp], and uncomplicated catarrh of the appendix leads to no symptoms, and cannot be clinically recognised. There is evidence that it may be acute or chronic, and that it may bo entirely recovered from. Its origin is due, no doubt, to the same causes which lead to catarrh in other parts of the intestine. Yet now and then it appears to be induced by a minute fragment of ftecal matter retained in the appendix which, as a solid and decomposing foreign body, sets up irritation. Very often, indeed, I believe the catarrh extends to the appendix from the caecum. It is most common to observe that mischief in the appendix, leading to perityphlitis, is set up by constipation, by a lodgment of faecal matter, or of a mass of undigested food in the caecum. It is reasonable to conclude that some catarrh or even ulceration of the caecum may be induced by such accumulation, and that the inflammation may spread to the appendix, which seems to be peculiarly susceptible to catarrh. In a few instances a minute foreign body is the cause of the catarrh. Such instances will be alluded to later. _ The morbid changes produced by the catarrh are precisely the same as in other parts of the intestinal canal. The epithelium of the surface, as well as that which lines the crypts of Lieberkuhn, is shed, the retiform tissue becomes infiltrated with leucocytes, and the whole mucous mem- brane is thickened. The process may end in complete recovery, no doubt; but, if long continued, it may lead to one or other of the follow- ing results :— (a) The watery discharge, produced by long-continued catarrh, may lead to an inorganic concretion. These concretions are no doubt formed from the salts contained in the catarrhal fluid. A precisely similar for- mation of a stony concretion, as a result of long-continued catarrh, is met with in the nose as a rhinolith. The rhinolith appears in all cases to be the product of long-continued nasal catarrh. Occasionally a minute speck of foreign matter, such as a piece of nutshell, forms the nucleus of the concretion. The concretions are usually of a mortary consistence moderately friable, and are composed of phosphates of lime and mag- nesia and of carbonate of lime, mixed or stained with a little fecal matter. ■ Some have been found to contain cholesterin. Owing to the slight admixture of fecal matter they are often called fecal concretions. I do not know that the common assertion that they contain inspissated mucus is well founded. Some of them are veritable stony concretions, and can be evenly divided with a fine saw. The firmer stones are much like the rhinoliths on section. I have never satisfied myself that, as some affirm, the actual nucleus of these concretions is composed of fecal matter. I have found bodies in the appendix with a putty-like interior, resembling faecal matter with a casing of lime salts. The real concretions must be clearly distinguished from the little pellets of moulded and often hard and brittle faecal matter which are often met with in the appendix. The real concretions vary greatly in size. They are generally of even and symmetrical outline. Some are very minute, others are over an inch