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.
11/26 (page 7)
![stretli [Pennsylvania Hospital Museum Catalogue, No. 1368], Meigs [Penn- sylvania Hospital, 136G], Bernardy, Musser). Local peritonitis (Mears, Pep- per, Hinsdale, Bodamer [Case II.], Hartshorne, Musser). VI. Two inches of the appendix necrosed, slate-gray color, soft, floated in the pus, attached slightly to the healthy stump (Musser). Appendix sloughed off. Male, forty years. Peritonitis fourth day (Bodamer, Case I.). Appendix one and a half inches long, ulceration one inch from bowel, a few lines in diameter. No communication between appendix and caecum. Gelatinous mass in appendix (Bodamer, Case II.). Appendix removed by amputation, was attached by its blind extremity to omentum, also removed. Length two inches, one inch occluded by concretions, and one dilated and empty (Wood- bury, Mutter Museum). Appendix two and a half inches long. Ulceration three lines in length and two inches in Avidth, half an inch from extremity. Canal not dilated. Walls not thickened (Willard). Mutter Museum, College of Physicians of Philadelphia, A. D. Hall. Vermiform appendix, caecum and portions of ileum, perforation, peritonitis; death. When recently examined a perforating ulcer of the appendix was found, through which a grooved director could be passed, communicating freely with the peritoneal cavity. There are two perforations, one, 2.5 centi- metres, from the caput coli; the muscular coating of the appendix appeared to have been destroyed by ulcerations, and then the peritoneal coat had given way in three small openings about 2 millimetres in line. These were arranged in a triangular manner. The second was a solitary perforation, 4 centimetres from the end of the appendix. Although thick patches of lymph had been thrown out, no attempts to limit the effusion of foreign material by lymph barriers was discoverable. There was nothing to show that any foreign body or concretion or impaction had been the origin of the lesion. Fluid pus was found in the interspace between liver and stomach, and about six ounces of turbid serum were in the pelvic cavity. The intestines were glued together. Mrs. C, aged twenty-five years, mother of two children, youngest four months old. Death on fifth day of idiopathic peritonitis, with characteristic symptoms. Catalogue of Mutter Museum, College of Physicians, E. Hartshorne. Appendix, gangrene and perforations. Eecently observed the appendix was inflamed and greatly enlarged, and intimately adherent to surrounding parts; was distended to a sac 5 centimetres long and 2 centimetres broad, and com- municated by a small opening with the cavity of head of colon; walls thick- ened, infiltrated with dark blood and serum ; its peritoneal coat highly injected and covered with exudation, and the mucous lining showing traces of exten- sive inflammation, which had run into a superficial gangrene. The latter had produced a honeycombed appearance of the inner surface, and had covered it with a dark greenish,-pulpy, and extremely fetid matter. On its side, about two-thirds of the distance from the caecal extremity, an ulcerated perforation, some 6 lines in length and 3 lines in width, was found, from which fluid fecal and other matter had been flowing in small quantities. Immediately behind this opening, and encased by the appendix, a peculiar, moderately hard con- cretion, of the shape and color of an elongated olive stone, presented itself, having been apparently moulded by the cavity by which it was contained.](https://iiif.wellcomecollection.org/image/b22273414_0011.jp2/full/800%2C/0/default.jpg)
