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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    necessary to ascertain how much violence was used, and to associate this factor with the previous condition of the appendix, as seen at opei'ation or postmortem, according to the statement made by the physician. In view of the grave conse- quences to the defendant involved in an action for damages, the physician who examines the appendix and neighboring structures in such a case ought to note carefully the presence or absence of any old adhesions (evidences of pre^•ious attacks), of peritonitis, of rupture, of perforation, or of acute strangulation of the appendix. The appendix itself should be most carefully preserved, and preferably in formalin or in Kaiserling fluid, in order to demonstrate any ulcers of the mucous surface, any old scars, or strictures. If the appendix shows signs of old disease, if it contains a large concretion, or if the patient had had pre- vious attacks and it can be shown that but slight force was used, and that with- out intent of injury, the status of the defendant will be different from what it would be in a case of disease, or one in which much violence was used. The question of trauma as it affects the liability of life insurance companies becomes somewhat different, since the injury giving rise to appendicitis in these cases is due to exertion on the part of the patient himself, rather than to force in the hands of another. In the absence of a specific exception in the policy, the company ought to own its lia]')ility for appendicitis, as for any other internal disease. The only instance in which such a company could escape liability would be where it could show that the plaintiff had knowledge of previous attacks or weakness, which he concealed, or failed to state in applying for his insurance, and which information, under the terms of his policy, he was bound to furnish. In the case of accident insurance, the company should be held liable when the appendicitis sets in <liroetly after a blow or a strain. Medico-legal Complications.—As an instance of legal complications re- lating to an appendicitis, I cite the following case (No. 47), for which I am indebted to A. E. Malloch, of Ontario, Canada: A young man was attempting to lift a heavy cheese down from a shelf, while standing on a step-ladder, and the added weight causing the ladder to shift its posi- tion, forced him to exert himself, and occasioned a violent strain of the abdominal muscles; he remarked at once to those present that he had strained himself seriously. He began to have pain in his side almost immediately, severe enough to keep him in bed, more or less, for three days, after which he improved. On the tenth day, however, he was seized with symptoms of collapse, and died the day afterward. The postmortem examination made by Malloch showed general purulent peri- tonitis with a ruptured abscess sac, containing a hard, sloughing appendix (see Fig. 399). The patient, having taken out an accident policy in the Commercial Travel- ler's Insurance Company, the family presented a claim, which the company refused to pay, because there was no external lesion discoverable. On receiving a letter, however, signed by Dr. Mullin, the physician in charge, as well as by Drs. Malloch and Olmstead, who attended in consultation, testifying as follows, they paid the claim: The deceased immediately after lifting the weight stated that