Appendicitis in children / by John B. Deaver.

  • John Blair Deaver
Date:
[1893]
Catalogue details

Licence: Public Domain Mark

Credit: Appendicitis in children / by John B. Deaver. 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.

    9/22
    reveal dullness and later flatness. Deep rectal as well as vaginal examination I do not think of much diagnostic value, earl)7 in the disease at least. In those cases where the appendix projects into the pelvis it may be of some as- sistance. If a mass can be felt through the rectum or the vagina, palpation of the abdominal walls at the same time may elicit fluctuation. Suppuration is not always readily detected, as fluctuation is difficult to elicit on ac- count of the unyielding abdominal wall. Yet I have seen it well pronounced many times. (Edema of the overlying abdominal walls is of great diagnostic value as indicating the presence of deep suppuration. If, associated with the presence of a mass in the right iliac fossa, there are decided chills, or even chilly sensations with sweating, it is quite evident that pus is present. Diagnosis.—The establishment of a diagnosis depends on the character of the symptoms, the clearness of the his- tory, the duration of the disease, and the previous treat- ment, as the administration of opiates to relieve distressing- pain may mask many symptoms which would otherwise be prominent. The affections with which appendicitis is most likely to be confounded in children are enteritis, in- volving all the coats of the intestine (entero-peritonitis); acute mechanical intestinal obstruction ; perinephritic ab- scess ; abscess of the kidney, and especially so if the kid- ney be a floating one, as I have once observed ; psoas abscess ; iliac abscess ; abscess of the abdominal parietes ; hip disease ; hepatic and renal colic. In enteritis involving- all the coats of the intestine the disease is ushered in by a diarrhnea of a more or less severe type, in which the stools are watery and mucoid in character. This is accom- panied by pain of a colicky nature referred to that portion of the abdomen corresponding to the situation of the affected coils of intestine, also by the absence of abdominal
    digitised image 1
    digitised image 2
    digitised image 3