Pinching the appendix in the diagnosis of chronic appendicitis / by Anthony Bassler.

  • Bassler, Anthony, 1874-
Date:
1913
Catalogue details

Licence: In copyright

Credit: Pinching the appendix in the diagnosis of chronic appendicitis / by Anthony Bassler. 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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    Extracted from the Ameri August, 19 Medical Sciences, PINCHING THE APP CHRONIC DIAGNOSIS OF ICITIS. By Anthony Bassler, M.D., PROFESSOR OF CLINICAL MEDICINE, NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL; VISIT- ING PHYSICIAN, NEW YORK POLYCLINIC HOSPITAL; CHIEF GASTRO-ENTEROLOOIST, GERMAN POLIKLINIK; VISITING GASTRO-ENTEROLOGIST, people’s HOSPITAL, NEW YORK. Nothing in medicine in the way of examination seems to have been better learned than McBurney’s point and its significance in connection with the diagnosis of appendicitis. It is rare indeed among the students of my postgraduate teaching experience to ask the question “What is McBurney’s point?” and not receive an intelligent and capable answer. There is no doubt that the sign is of much value in the diagnosis of appendicitis, but that it fails at times is the purpose of this article. In the average case of pain in the lower right quandrant of the abdomen, some rise in temperature, increase in the pulse rate, a spasm of the abdominal muscles over the area, and perhaps pain and tightening when the thigh is straightened on the pelvis, the diagnosis is easy. In these cases the area of tenderness upon pressure is so much larger than the area which corresponds to the appendix itself that pressure midway between the umbilicus and superior spine of the ileum in a backward direction serves the purpose. But there are frank cases, usually subacute or those with a small abscess, wherein the tenderness on pressure is lower than would correspond sharply to McBurney’s point. In the average person when the head of the cecum is in normal position, an inch or so above the brim of the pelvis, the base or length of the appendix is slightly outside or midway on the spine and umbilical line, and there are many individuals in whom the cecum is much lower, and in them pressure upon what is McBurney’s point may not elicit the ten- derness that would come from pressure lower down over what would then correspond to the site of the appendix. This is particularly true in cases of chronic appendicitis where all that may be useful in the way of physical examination is a tenderness localized to the appendix. Not considering those cases that give a history of