Perforating inflammation of the vermiform appendix : with special reference to its early diagnosis and treatment / by Reginald H. Fitz.

  • Fitz, Reginald H. (Reginald Heber), 1843-1913.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Perforating inflammation of the vermiform appendix : with special reference to its early diagnosis and treatment / by Reginald H. Fitz. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    his death, yet the appendix was converted into a solid fibrous band intimately united by firm adhesions to the posterior wall of the ctecum. The severity of these lesions suggests the probability that apparently slight disturbances of digestion were overlooked. The diarrhoea, con- stipation, or abdominal pain, especially when occasionally recurrent, were regarded as characteristic of a feeble digestion. There can be little doubt that a diagnosis of bilious attack, colic, gastritis, enteritis, gravel, ovaritis, congestion of the womb and the like, may not unfre- quently conceal the existence of an inflamed appendix. The latency of the symptoms in certain cases of appendicitis is such that the eventual diagnosis is obscured, and the desirable method of treatment hopelessly postponed. Buck1 reports that a sailor was at work rolling barrels of flour till the day of his admission to the hospital. He then had a prominent iliac tumor extending along the outer half of Poupart’s ligament. Fluctuation was transmitted from it to below the inner half of the ligament. Another sailor left Portland for New York, April 12, 1886, and arrived five days later. In the meantime he purged himself in consequence of a right iliac pain. Although suffering, he kept at work during the following week. He then left for Boston, where he arrived on the thirteenth day after the beginning of the pain. Symptoms of general peritonitis were evident, and he died the next day. General peritonitis was present, the result of an encysted inflammation about the appendix. This organ formed a gangrenous slough lying in the cavity of the abscess. The latency, as well as the frequent obscurity, of the symptoms of appendicular inflammation is thus apparent. The presence, there- fore, of the symptoms noAV to be mentioned, in individuals from whom the history of one, and particularly of several such attacks is to be obtained, is of marked importance in aiding diagnosis. Sudden, severe abdominal pain is the most constant, first, decided symptom of perforating inflammation of the appendix. It occurred in 216 out of 257 cases, 84 per cent. In most instances it is present in apparently healthy individuals, in a few it follows an attack of diarrhoea. The pain is usually intense, rarely slight, and is occasionally accom- panied by a chill, or nausea and vomiting. 1 New York Medical Journal, 18G6, ii. 40.