Licence: Public Domain Mark
Credit: Peri-caecal inflammation. 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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![Appendix. The following notes are presented explanatory in a measure of the text. They are based on the appearance of the specimens the wri'-er had on exhi- bition at the meeting, collected from private sources and from hospitals. Some twenty specimens were obtained for this purpose. The writer's best thanks are due to Drs. Pepper, Edwards, Bernardy, Willard, Woodbury, Loug- streth, Hinsdale, Seltzer, Daland, Bodaraer, and others, for notes and speci- mens. Some excellent descriptions may be found in the Catalogue of the Museum of the Pennsylvania Hospital. I. Strictly speaking, we should say the sequence of typhlitis, perityphlitis, and peri-C8ecal abscess occurs but rarely. A typhlitis and perityphlitis, no doubt, are seen clinically, but the cases do not come to the post-mortem table unless perforative appendicitis occurs conjointly. For this reason, and because a similar sequence of lesions does not obtain in similar inflammations of the large bowel under like circumstances, as fecal impaction from stricture, or from paresis in the aged or after typhoid fever, the pathologist may well doubt the existence of perityphlitis and succeeding peri-csecal abscess without con- joint primary appendicitis. In the more violent inflammations of the gastro- intestinal tract, in gastritis, enteritis, or in dysentery, such sequential lesions moreover are not found. II. Case I.—Matilda Thomas, aged one hundred and four years. Cause of death, exhaustion from strangulated hernia. Abstract from autopsy record, Philadelphia Hospital. Abdominal cavity: no effusion; adhesion of large and small intestine; appendix dilated to size of first finger, end of it incarce- rated in inguinal canal, with portion of mesentery and small intestine; so much post-mortem discoloration, could not determine color of parts ; local peri- tonitis ; in canal and layers of muscles and fasciae considerable amount of greenish pus; the portions outside of canal adherent to the bladder, uterus, and ovary, the latter being included in the inflammatory mass. Organs occupy normal position. (Musser.) Cose//.—Philadelphia Hospital. Female, aged twenty-two years. Appendix four inches long, dilated to size of finger, contained mucoid fluid, adherent to a large pyosalpinx. (Musser.) III. From Museum of Pennsylvania Hospital, described by Wistar. (See a Catalogue of Pathological Museum, 1869.) IV. Cranberry seeds (Mears). Fecal concretions (Hartshorne, Daland, Hinsdale, Seltzer, Musser). Grape seeds (Edwards, W. A.). A concretion one-half inch long and one-quarter inch thick, cone-shaped, apex pointing toward the perforation in the appendix, base concave, firm, fecal color and odor, in mass of which black bodies, size of cranberry seed, were found. It completely occluded the canal, causing retention of the natural secretion, inflammation, ulceration, etc. The perforation was one-eighth inch from the apex of the concretion (Musser). A phosphatic concretion in Matter Museum (Woodbury). V. General peritonitis (Woodbury, Willard, Hall (Mutter Museum), Boda- mer [Case I.], Seltzer, Pepper [1637 Pennsylvania Hospital Museum], Long-](https://iiif.wellcomecollection.org/image/b22273414_0010.jp2/full/800%2C/0/default.jpg)
