Further observations upon the etiology, diagnosis and treatment of acute and chronic appendicitis : with the report of sixty-one chronic cases operated upon, with one death / by John B. Deaver.

  • Deaver, John B. (John Blair), 1855-1931.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Further observations upon the etiology, diagnosis and treatment of acute and chronic appendicitis : with the report of sixty-one chronic cases operated upon, with one death / by John B. Deaver. 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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    The acute cases that go on to suppuration, and in which there is the greatest tendency for the pus to become circumscribed, are those in which the ap- pendix points toward the northern end of the appendiceal compass and lies between the layers of the mesocolon. The palpation of the appendix in chronic cases is a valuable and reliable means of diagnosis. Of course, in those cases in which the organ lies behind the cecum the method is less valuable, although it is even then of service,because when the cecum is dis- tended the condition is due to flatus and not to feces. This has been my experience in the sixty-one chronic cases upon which I have operated, to say nothing of a much greater number of acute cases. I have been able to diagnosticate and demonstrate by operation a thickened appendix, giving its direction and location and its depth from the anterior wall of the abdomen. Women are better subjects, but the method is ap- plicable to men, especially if they have been the victims of repeated attacks of appendicitis. In chronic cases I have noted that upon palpation over the base of the appendix the pain is referred in a direction corresponding to the long axis of the organ, i. «?., when the pain is referred to the liver the appendix points north, and so on, corresponding to the different positions that the appendix holds. The difficulty attending the differential diagnosis between chronic appendicitis and incipient psoas- abscess, that is before the pus has passed any distance down the psoas-sheath, I have had forcibly brought to my mind recently in two cases. The chief points in favor of a forming psoas-abscess are the appear-