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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    have been caused by the passage of loops of small intestine through an opening bounded by the appendix, ileum, and cecum. The appendix, which was much thickened at the tip, adhered to the ileum above the cecum, forming a complete ring, with the cecum on the right, the appendix in front, and the ileum on the left side. The small intestines below the seat of constriction and the whole of the large intestine were contracted, nearly empty, and healthy, but above the constricted portion the ileum was greatly distended, and its coats intensely inflamed, being in places quite black, or sloughing. Some distended convolu- tions of the small intestine overlying the cecum had yielded the dulness on percussion in the right iliac fossa. The operation was manifestly undertaken to relieve one of the sequela? of an old appendicitis, and is, I believe, the first celiotomy in which the abdomen was opened and the diseased appendix exposed to view. WiLLARD Parker, of New York, took the next step in the development of the surgery of the appendix, in 1867. His name is so intimately associated with this subject in America that the method he pursued became widely known, and is still called the Willard Parker operation. It was in this year, 1867, that Parker published four cases in which he had treated abscess in the right iliac fossa, consequent on inflammation of the appendix, by incision and evacuation, one dating as far back as 1847. In the intervening years he gradually became convinced that it was not necessary, nor even desirable, to await fluctuation before making an incision, and the last case afforded him the opportunity of putting his theory to a successful test. The important object of his writing, therefore, was to declare what good results were likely to attend an early incision, and to counsel its wider adoption. He declares that: The matter of local treatment [of disease of the appen- dix] has attracted my attention for j^ears. These questions presented them- selves: Are the efforts of nature exerted in behalf of such a case, and if so, in what way? Observation indicates the reply and experience verifies its truth. Nature does labor in behalf of life in two ways: (1) by means of the wall of false membranes which she builds around the abscess; and (2) by the ulceration which gives exit to the escape of its contents. This being settled, it becomes a question whether surger}^ might be able to render assistance to nature in this work; and if so, at what period would assistance best come in To be successful it is necessary that it should be made neither too early nor too late— not before adhesions are fully formed, nor, after a short period, before the maxi- mum formation of pus has been reached, that is, the incision should be made after the fifth day and before the twelfth If no abscess has already formed, in case one should be in process of formation, an external opening would tend to make it point in a safe direction. And even if no abscess should form, a free incision would relieve tension, thus adding to the comfort of the patient and in no way prejudicing his safety. One other question remains: Would the operation bring about a cure? Judging from the three cases reported