A contribution to the surgical treatment of diseases of the appendix vermiformis / by William Henry Battle.

  • Battle, William Henry, 1855-1936.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the surgical treatment of diseases of the appendix vermiformis / by William Henry Battle. 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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    was quite clear, and he talked intelligently, being fre- quently interrupted in his replies to questions by pa- roxysms of pain in the abdomen, which caused him to throw back his head, hold his breath for a few moments, and grind his teeth. He was lying on his back with his legs and thighs flexed, and complained only of the con- stant pain in the abdomen, which at times became much worse. Examination of the abdomen showed no move- ment of the abdominal wall, respiration being entirely thoracic. The skin was reddened as the result of the former application of hot fomentations. There was no fulness in any particular part of the abdomen, which was slightly distended. The muscles were held very rigidly, so that the abdominal wall was very hard; it was so exces- sively tender that he complained of the slightest touch; this tenderness was not localised, but extended all over the abdomen. On percussion there was resonance, with the exception of a small area above the pubes; this was about an inch and a half in extent from below upwards in the middle line, did not extend far to the left, and gradually diminished towards the right, until it ceased about the middle of Poupart’s ligament. There was no fluid thrill. The hepatic and splenic regions were normal. The urine was clear and contained no blood. His tongue was dry and furred. Pulse 125. Temperature I02'2°. There had been no vomiting. The bowels,had acted normally. Mr. Thurston, the house surgeon, and Mr. C. S. Wallace, who was on duty for the resident assistant surgeon, re- cognised the condition as one of acute purulent peritonitis, and sent for me to see the patient. We thought the cause was disease of the appendix vermiformis. As soon as possible operation was undertaken. The abdomen was opened in the middle line, above the pubes after the surface had been thoroughly cleansed. On incision of the peritoneum a quantity of offensive pus escaped, and when the finger was introduced the pelvis was felt to be full of thick pus. The intestines were slightly matted together, but easily separated on touch. A small quantity of lymph came away, and a small area of one coil of intestine had some lymph adherent to it, but generally the peritoneal coat of the bowel was very little changed. No gut protruded through the wound. The abdomen was well washed out with sterilised water, passed through the Berkfeldt filter, and search made for the