The vermiform appendix and its diseases / by Howard A. Kelly and E. Hurdon.

Date:
1905
Catalogue details

Licence: In copyright

Credit: The vermiform appendix and its diseases / by Howard A. Kelly and E. Hurdon. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    length and thickness, resembUng a firm cord to the touch; its cavity was filled by a large lunibricoid worm, with its tail projecting into the cecum. No other worms were found in the intestine, and there was no inflannnation. Blackadder considered that the irritation produced by the worm caused, either directly or reflexly, a spasmodic contraction of the abdominal muscles, impeding the action of the already diseased heart. He mentions two other cases in which he had found lumbricoids or fecal concretions in the appendix at autopsies, death having occurred from causes altogether distinct from that organ. In 1827 another Frenchman, Melier, published an article so full of thought and insight that it might well have marked an historical epoch in the subject had the author possessed the courage of his convictions, and had he been able to combat Dupuytren, the greatest surgical authority of his time. Melier begins by noting that pathological anatomy had taught almost nothing in regard to disease of the appendix. Some recent observations, how- ever, he says, show that disease of the organ ma}^ assume a role of the highest importance, for under certain conditions it can become the seat of a rapidly fatal disease. He then cites Louyer-Villermay's cases, and adds another from his own experience, in which a patient, when apparently on the road to recovery, after a self-administered enema had a sudden return of agonizing pain in the lower abdomen, followed by an acute peritonitis, and died eighteen hours after the onset of the secontl attack. At the autopsy the vermiform appendix was found gangrenous and perforated in several places. Melier's analysis of the situation is this: In my opinion, the fecal matter accumulated in the appendix, which then dilated little by little, becoming first inflamed, then gangrenous, and finally perforated. The earliest symptoms, appearing in the form of colic, are probably accounted for by the inflammation and distention of the appendix; its rupture occasioned the effusion, which was responsible, in turn, for the peritonitis. The perforation was determined, or at any rate hastened, by the patient's exertion in taking an enema, since it was at this moment that the intense pain began, and immediately afterward that peri- tonitis set in. He then cites two other cases, of lesser interest, in regard to which his own remarks are noteworthy. This disease, he says, is considered e x t r e m e 1 }' rare; observe, however, that the fix e cases which form the basis of this p a p e r h a v e been collected in a short space of time, and that two among them were reported by the same physician; these facts entitle us to b e 1 i e e that if such affec- tions have not been more frequently observed, it is because the appendix has not received sufficient attention, and because lesions situated in it have been overlooked at a u t o ]) s i e s. In regard to diagnosis, I will say, further, that when my friend Monsieur Sevestre was called to the second of the cases, which he reported to me, he was able to state posi-