Perforating inflammation of the vermiform appendix : with special reference to its early diagnosis and treatment / by Reginald H. Fitz.

  • Fitz, Reginald H. (Reginald Heber), 1843-1913.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: Perforating inflammation of the vermiform appendix : with special reference to its early diagnosis and treatment / by Reginald H. Fitz. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    In one of the cases in which this symptom appeared on the first day death occurred on the fourth day. It was stated that there was no perforation of the appendix, although this structure presented a deep purple color and contained a fecal concretion. General peritonitis was present and a considerable quantity of pus was found in the pelvis and vicinity of the appendix. In the other case the general abdominal pain came on three hours after moderate pain in the bowels. It radi- ated from the right iliac region. In sixty-six hours the patient was dead. The intestines were glued together by a butter-like lymph, but there was no serous or seropurulent exudation. It was thought desirable to ascertain the date at which tympanitic distention of the abdomen appeared. At the same time it is recog- nized that this sign of a general peritonitis is of considerably less value than that already stated. Tympanites was present on the 1st day 2d “ 3d “ 4th “ 5th “ 6th “ Appendicitis. Typhlitis and perityphlitis. 0 cases. 1 case. 7 “ 5 cases. 13 “ 8 “ 14 “ 2 “ 3 “ 2 “ 1 “ 1 “ CO I GO | 19 “ It is evident, from the above tables, that the majority of cases of resulting general peritonitis begin on the second, third, and fourth days after the inflammation of the appendix is established. This is inferred from the date of the occurrence of the general abdominal pain in sixty per cent, of the cases of appendicitis, and from that of tympanites in nearly ninety per cent, of these cases. The source of this early peritonitis is to be found, in most instances, in the escape into the peritoneal cavity of the inflammatory product encysted near the appendix. Although usually small in quantity at this early period, its quality is exceedingly acrid. The speedy death of the patient almost invariably results from the occurrence of the general peritonitis. In 176 cases the day of death was as follows: