Henry B. Sands / [Charles North Dowd].

  • Dowd, Charles North, 1858-1931.
Date:
[1924]
Catalogue details

Licence: In copyright

Credit: Henry B. Sands / [Charles North Dowd]. Source: Wellcome Collection.

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    2 SURGERY, GYNECOLOGY AND OBSTETRICS nasopharyngeal polypi, tracheotomy, laryngectomy, excision of cords of the bra- cheal plexus, internal oesophagotomy, intussusception, perityphlitis, peritonitis, various forms of urethral lesions and rupture of veins. His most notable contribution to surgery was in the study of what we now call appendicitis. It is difficult for present-day surgeons to realize the problems of our surgical forefathers with regard to this disease. The pathological process existed then as it does now; but it had been studied late, either at autopsy after fatal general peritonitis had resulted, or at operation after so-called perityphlitic abscesses had formed. Hence, strangely enough, attention had been centered on the head of the colon and not on the appendix. The secret of the real pathology was only hidden by the thickness of the ab¬ dominal wall, but the fear of penetrating the peritoneum prevented early operation. Dr. Sands, however, reasoned out the pathology and then did an operation which at that time seemed early. He had long been familiar with the work of Willard Parker, who in 1856 had introduced a definite line of procedure in the treatment of perityphlitic abscesses; and in 1880 Sands wrote a valuable article on the sub¬ ject and gave histories of 15 cases. About 7 years ]ater he stated that he had ob¬ served a large number of additional cases and announced his belief that the appendix was really the offending organ. As evidence of this he cited the exist¬ ence of appendiceal concretions in perityphlitic abscesses and also stated that the attacks of pain in “perityphlitis ” varied in their position much as the appendix varies in its position. With these observations in mind he was called by Dr. Baruch on December 30, 1887, to see a case of acute peritonitis localized in the region of the perforated appendix. He saw the case 45 hours after the onset of symptoms, advised immediate laparotomy and performed the operation 3 hours later. The appendix had ruptured at its base, three concretions lay outside the place of rupture, and local peritonitis was present. He closed the opening, drained the local abscess, and the patient recovered. In reporting this case to the New York Surgical Society on February 8, 1888, he stated that he believed that it was the “first in¬ stance in which an early operation had been done for localized peritonitis due to a perforation of the vermiform appendix in which the operation had ended in recovery,” and substantiated this belief by referring to Weir’s recent tabulation of operations for perforating lesions of the intestine. The publication of this case by Sands proved a tremendous incentive to prompt operation in cases of so-called perityphlitis, which were as common then as cases of appendicitis are now. If Sands could cure a case by an operation at a time which then seemed early, other operators believed that they could do the same; and McBurney, Bull, and others immediately followed his example. The pathology was found to be as Sands had stated it. The word appendicitis was coined and the modern conception of the disease was promptly accepted. In