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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    previous history of the patient, the seat and character of the pain, the period of occurrence of the fever, and the date ot the appearance of the tumor are necessary for an eliminative diagnosis. A primary perforating inflammation of the caecum is extremely rare even in chronic dysentery or in chronic tuberculosis. In an extensive research into the literature of the subject hut three cases of acute primary perforation of the caecum have been found: one from a fish- bone, another from a pin, and the third from strangulation of the bowel. Two cases of rupture of the caecum are recorded. So rare is the affection in question that the possibility of a primitive, perforating caecitis may be disregarded. Bartholow’s1 communication on this subject relates rather to the secondary perforation of the caecum from without. Stercoral caecitis, on the contrary, is exceedingly common, and is, perhaps, the most important of all the conditions with which the per- forating appendicitis may be confounded. The history of this affection usually makes evident a period of protracted constipation in a person not especially young, vigorous, and apparently healthy, who may have had similar attacks. The pain is trifling for a long time, and the sensitiveness slight. Fever is absent, or of late occurrence. The tumor is present at the beginning as a distinct nodular or doughy mass, elongated, and in the lumbar region. It is unnecessary to say that from a stercoral caecitis may arise a perforative appendicitis which may end in perforation. Many of the so-called cases of typhlitis ter- minating in resolution, associated with fecal retention, and persisting after the removal of the feces, are undoubtedly of this nature. Intestinal obstruction from intussusception or strangulation is char- acterized by the frequent absence of a suggestive previous history. The pain is not so localized or intense, and the fever is not conspicu- - ous at an early stage. The abdomen is distended and tympanitic at the outset, and is, at the same time, unusually sensitive. Borboryg- mus and perceptible movements of the intestine are associated with or followed by fecal vomiting. Obstinate constipation and the retention of flatus are noticeable. The tumor is absent when the intestine is strangulated, and it is elongated, sausage-like, usually following the course of the colon when intussusception is present. Tenesmus and 1 American Journal of the Medical Sciences, 18G6, N. 8., lii. 351.