Perityphlitis and its varieties : their pathology, clinical manifestations, and treatment / by Frederick Treves.

  • Treves, Frederick, 1853-1923.
Date:
1897
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Licence: Public Domain Mark

Credit: Perityphlitis and its varieties : their pathology, clinical manifestations, and treatment / by Frederick Treves. Source: Wellcome Collection.

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    have been f0Ulld ai'0UDd aPPendiC6S ^!hich not \' nly L not visibly perforated, but which contain no pus, and are simnlv in a state of chronic catarrh. The material in the abscess varies. There may be merely a scanty, thin turbid, greenish liquid with a very ill odour. There may be a sero- ient exudation. There may be laudable pus The pus has usual y an offensive smell; it may have an odour actually fecal, or it may contain fecal matter; but the last-named condition is uncommon. The most usual matter evacuated from the abscess is very ill-smelling pus of a dirty colour, somewhat thin, and often mixed with clots of fibrinous matter ' The quantity of pus found in the abscess varies. It is usually some three or four ounces ; but it may contain some pints. In one case which had been long neglected I evacuated an abscess which contained two ^The abscess cavity is apt to contain gas, the result probably of decom- position. In rare instances the gas is excessive m amount, and the swelling caused by the abscess may be as resonant as the surrounding intestines. Morton reports a case of a perityphlic abscess from which on puncture gas only escaped, but a deeper puncture revealed pus. In one case, in my own practice, I cut down upon an iliac abscess following upon perityphlitis, and opened a large cavity containing gas, and pre- senting in its depths so very minute a quantity of pus.that I could not help thinking that the matter might have escaped by an opening into the bowel; there was no evidence, however, of such an opening, and the cavity healed rapidly and well. In a case reported in the Med. Neivs (U.S.A., December 17, 1892) the abscess cavity contained not only gas and pus but some fecal matter also. The relation between the size of the swelling found in the right iliac fossa and the amount of. pus which is discovered in the abscess is not always direct; the swelling may be extensive, and yet the amount of pus small. The swelling is made up of the caecum and sundry coils of small intestine which are adherent, and the walls of which are con- gested and cedematous. Between and around the coils are much adherent lymph, much effusion, and most probably a considerable mass of thickened and adherent omentum ; in not a few instances there is also a collection of fecal matter in the caecum. The swelling is apparently in- creased again by swelling in the protecting parietes, and by contraction of the muscle over it. In the majority of abscesses which are evacuated by operation the appendix does not come into view; it is obscured and indeed buried by recent adhesions. It may, however, present itself and be found per- forated or gangrenous, as a whole or in part. It may be found actually detached—as a result of gangrene of its base—and lying free in the abscess cavity. Calcareous or fecal concretions or, in rare instances, foreign bodies may be found in the abscess cavity, such substances B