Volume 1

An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott.

Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of the diseases of children ... / edited by Louis Starr ; assisted by Thompson S. Westcott. Source: Wellcome Collection.

    553/652 (page 509)
    DISEASES OF THE (LECUM AND APPENDIX. By JOHN ASHHUBST, Jr., M. D., Philadelphia. Inflammatory Affections of the O^icum and Appendix. Under the names of typhlitis, perityphlitis, appendicitis, caecitis, perityph- litic abscess, etc. are included by systematic writers certain cases of inflam- mation, usually severe and sometimes ending in suppuration or in general peritonitis, met with in the right ilio-lumbar region. While these cases are met with at all ages, they are sufficiently common in children to make their consideration proper in a work devoted to the maladies of childhood, and they are so often attended with danger and lead to such serious consequences that their importance can hardly be overestimated. The terms typhlitis and ccecitis are strictly applicable to inflammation, catar- rhal or parenchymatous, affecting the caecum (blind gut) or caput coli; peri- typhlitis to an inflammation of the areolar or connective tissue behind the caecum, where this portion of bowel is usually uncovered by peritoneum ; peri- typhlitic abscess to a collection of pus occurring in the same region; and the somewhat barbarous term appendicitis to an inflammation of the pouch or diverticulum known as the appendix vermiformis. Without denying that the caput coli itself may be primarily the seat of inflammation, as indeed may any portion of the intestines, constituting the grave condition enteritis, and while acknowledging at least the possibility of a true perityphlitis, per- haps leading to extra-peritoneal suppuration, there can, I think, be no doubt that in the large majority of instances the appendix vermiformis is the part primarily involved, and that the resulting abscess, when pus is formed, is intra-peritoneally situated, though fortunately, in most cases, walled off by adhesions which prevent the general infection of the peritoneal cavity. Morbid Anatomy.—The pathological lesions found in cases of inflamma- tion of the caecum and appendix are quite variable. In the majority of cases the inflammation does not advance beyond the stage of lymph-formation, and even after repeated attacks (for the disease is often recurrent) the parts will be found indurated and thickened, and matted together by dense adhesions; but there will be no abscess. In other instances, and particularly when the patient is tuberculous, pus will form at an early period, usually as the result of ulcer- ation and perforation of the intestinal wall, but sometimes without perforation, simply from the intensity of the inflammation. Foreign bodies, such as grape- seeds, etc., are occasionally found lodged in the caecum or appendix, or loose in the surrounding abscess; but more commonly what are supposed to be foreign bodies are really concretions of earthy phosphates with faecal matter and inspis- sated mucus, or of inspissated mucus alone. The caecum from its shape and position is apt to become the lodging-place for concretions of this character, which set up irritation and may lead to ulceration of the caecal wall, while small