Peri-caecal inflammation.

  • John Herr Musser
Date:
1888
Catalogue details

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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    resist peritonitis, should it occur, whilst at the same time the mere draining of fluid from the intestines and surrounding parts would influence for the better the peri-csecal inflammation? or shall Ave paralyze and congest, and inflate the bowels by the old-fashioned splinting treatment, and thus beckon on peritonitis? Pain of intense character would often be as much an indication for operative relief as for morphia. Prompt resolution should take place in cases which are not to go on to the stage of pus formation ; and very long continuation of symp- toms, or relapses, or recurrences, would be strong indications for surgical interference. The presence of such tedious recovery, relapse, or recurrence would point to the probable presence of conditions exceedingly dangerous to the patient from liability to general peritonitis or perforation at any time; they further would point, as a rule, to the appendix as the ' source of irritation and danger. Indeed, in man, that worse than useless appendage must be regarded as the root of most evil in the reg;ion under consideration. To illustrate this point by a single impressive instance, let me quote a case which was reported for me in the Philadelphia Medical Times of June 11, 1887. It was that of a woman who, for a long time, had been having mild attacks of abdominal pain, located in the region of the caecum, which had usually yielded with great promptitude to anodynes. During the course of the last attack of that nature, violent symptoms of perforation and general peritonitis came on. I did not see her until two days after this unfortunate accident; but, though she was then in a most desperate condition, I advised operation as her only chance, and forthwith performed abdominal section. The appendix was found perforated in two places, and violent general purulent peritonitis going on. She died a few hours afterward, but I felt better satisfied that the operation had been performed. Coming now to our second division, suppose the process to have gone beyond the simple, inflammatory .stage, and the presence of pus, even a few drops, to have been diagnosed. In the great majority of instances, the presence of even a minute amount of pus so near to the peritoneum would be of vastly more risk to the patient than abdominal section for its relief. Hence, I should operate whenever the diagnosis of pus had been made—occa- sionally even without positive diagnosis. But in this paper diagnosis of distinct conditions is presumed, and I am expected simply to out- line treatment for those defined conditions; hence, without qualifica-
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