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

  • Treves, Frederick, 1853-1923.
Date:
1897
Catalogue details

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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    PERITYPHLITIS Definition and Names.—By perityphlitis is understood a peritonitis localised in the region of the caecum. Many names have been applied to this condition, which serve to perpetuate current views of its pathology. The fact that the effusion in this form of peritonitis is nearly always circumscribed, led early to the belief that it is extraperitoneal and located in the connective tissue behind the caecum. In early days, there- fore, this affection was known as iliac phlegmon, and later the more prec'ise term paratyphlitis conveyed the same view of the position of the inflammatory changes. When these names were in use it was erroneously assumed that the caecum had a non-peritoneal surface which brought it in contact with the connective tissue of the iliac fossa, and when the etiology of the trouble came to be investigated it was assumed that the mischief started in the caecum itself. Upon this belief was based the term typhlitis; that is to say, an inflammation of the caecum itself. This name appears to have been first used by Albers in 1838. In Copland's Dictionary of Medicine, published in 1834, although the caecum and the supposed connective tissue around it are still pre-eminent in the pathology, yet it is recognised that the trouble may start in the appendix vermiformis. Burne seems to have been the first to develop the modern doctrine of the predominant part played by the appendix in this affection. Fitz in 1886 (9) placed the pathology of perityphlitis upon a sound basis, and demonstrated the part of the appendix in its production. Finally, the uncouth name appendicitis has been given to this disease. The name perityphlitis does not denote the seat of origin of the malady, but indicates with sufficient clearness the predominant pathological feature of an affection which may arise in more ways than one, and which has no precise clinical individuality until the peri- toneum in the caecal region has become inflamed. The literary history of perityphlitis is well given by Dr. Kelynack in his work on the Pathology of the Vermiform Appendix (Manchester, 1893). NORMAL ANATOMY.—The caecum is that part of the large intestine which lies below the level of the ileo-caecal valve—that is to say, below