When shall we operate for appendicitis? / by Willy Meyer.

  • Meyer, Willy, 1858-1932.
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: When shall we operate for appendicitis? / by Willy Meyer. 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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    amount of pus through the rectum. According to the history of the case, this surely had originally been a diffuse purulent exudation due to perforative appen- dicitis. In 1891 I operated on an athletic young man of eighteen, who four days previous had been suddenly stricken down with symptoms of a most acute peritonitis. He was taken home in a wild delirium. For three days and nights it required the steady watch of a number of attendants to keep him in bed. On the fourth day I was called in by the attending phy- sician, and when I opened the abdomen, the incision, made in the loin, evacuated a large abscess with the gangrenous appendix and two faecal concretions. On gentle palpation the finger could feel the anterior and posterior surfaces of the liver, and enter between the coils of the intestines in many directions. The patient recovered. A similar third case was successfully ope- rated upon by me last January. Of course, under proper treatment and care these patients get well. But the course of their disease has been exceptionally fortunate. Perhaps five out of a hundred have such luck. But exceptions cannot and shall not guide us in drawing our conclusions. It is a fact that patients with acute perforative appendicitis generally die if not operated upon in the very first hours. Dr. Mc- Burney saved fourteen out of twenty-four patients.1 In my hands, three out of four of the patients operated upon within the first twelve hours after the perfora- tion have recovered. Those operated upon later, five in number, died. This is not the place to give a his- tory of these most interesting cases. I shall publish them at the proper time. Only one I should like to mention very briefly, a case which, I believe, shows beyond doubt that the clinical symptoms of a true perforative appendicitis can rapidly develop without a macroscopical defect in the walls of the vermiform. The case is embodied in those four operated upon within the first twelve hours that I have just men- 1 N. Y. Medical Record, March 30, 1895.