Four operations for appendicitis : three recoveries, one death from a very small concealed abscess / by W.W. Keen.
- William Williams Keen
- Date:
- 1891
Licence: Public Domain Mark
Credit: Four operations for appendicitis : three recoveries, one death from a very small concealed abscess / by W.W. Keen. 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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![[Reprinted from the Transactions of the Philadelphia County Medical Society.] FOUR OPERATIONS FOR APPENDICITIS : THRE RECOVERIES, ONE DEATH FROM A VERY SMALL CONCEALED ABSCESS. By W. W. KEEN, M.D., PROFE8SOR OF PRINCIPLES OF SURGERY, JEFFERSON MEDICAL COLLEO [Special meeting, September 28, 1891.] Case I. Recurrent appendicitis; operation, after the fifth attack {with perforation and general peritonitis), by median and lateral incisions; recov- ery.—Miss B., aged thirty years, a slender, frail woman. A year ago she developed a moderate lateral curvature of the spine through muscular weak- ness. Her father died of cancer of the bowels ; her mother is living and is even more delicate than herself. About fifteen years ago she had her first attack of perityphlitis. A few years later a second occurred, and about six years ago a third, which was the first in which I saw her. The attack was not severe, no suppuration followed, and after its subsidence she seemed as well as u>ual. On May 31, 1890, she was suddenly taken with severe paroxysmal pain in the lower part of the abdomen, accompanied by vomiting. The attack was attributed to the eating of some strawberries, and when the bowels were subsequently moved by small doses of calomel a quantity of strawberry seeds was passed. The pain was relieved by morphia. There was slight general tenderness, not limited to the right iliac fossa. The temperature only rose to 101°. The attack gradually passed away, and in two weeks she was able to return home. For the account of this attack I am indebted to Dr. W. H. Morrison, who attended her. The symptoms rather pointed in his mind to an ordinary intestinal colic from the fruit, though as there had been prior attacks of perityphlitis the right iliac fossa was watched W'th some care ; but no special dulness or tenderness existed there, nor was there any induration. There had been no chill. The summer of 1890 was passed in comparatively good health. As soon as I returned from my summer holiday I was asked to see her by my assistant, Dr. W. J. Taylor. He had diagnosticated not only a renewed attack, but also a probable perforation of the appendix on the day of my return. She had been constipated for several days, and a slight movement of the bowels on September 30, 1890, due to divided doses of Epsom salt given the previous evening, was followed by symptoms of peritonitis over the entire lower abdomen, the tenderness in the left iliac fossa being possibly even more marked than in the right. The induration was only moderate. Exploration by the rectum revealed general tenderness of the pelvic viscera](https://iiif.wellcomecollection.org/image/b22304861_0005.jp2/full/800%2C/0/default.jpg)
