Appendicitis : its pathology and surgery / by Charles Barrett Lockwood.

  • Lockwood, Charles Barrett, -1914.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Appendicitis : its pathology and surgery / by Charles Barrett Lockwood. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    incision. The appendix was free and about 10 cm. (4^ in.) long, and had a meso-appendix for about half its length. As I have remarked, it presented no appearance of disease to the naked eye, but felt very hard. The right ovary and tube were normal. The patient made an uninterrupted recovery, the wound healed by first intention, and she was quite well some months after the operation. The proximal and distal sections are not quite alike. They both measure 4 mm. in diameter, about the size of the ulnar artery, but the proximal has very thin walls (1 mm.), and a wide circular lumen, 2 mm. across: the distal lumen is a mere slit, 1 mm. long, narrowed by the swollen lymphoid follicles of the mucosa, The peritoneal coat is normal and about 1 mm. thick. The longitudinal muscle coat is hardly any thicker, and its fibres are scattered. The circular muscular coat is also very thin, being about '25 mm. thick. These coats are otherwise quite normal. The submucosa is cedematous and its lymphatics dilated; it is, however, barely more than -25 mm. thick. Its blood-vessels are slightly dilated. In its thickest parts, the mucosa is not more than 25 mm. thick, but, in places, it is ulcerated almost as far down as the submucosa. The lymphoid tissue of the mucosa is so crowded with cells that the stroma is hidden. The remains of three or four lymphoid follicles can be traced ; one is ulcerated and infil- trated with the purulent and bacterial contents which fill the lumen. The ulceration and infiltration have begun in the centra] medullary portion of the follicles. The follicular lymph sinuses are not dilated. The tubular glands are dilated, and most have lost the epithelium at their mouths. They contain rather an excess of mucous cells. The epithelial lining of the lumen is de- tached, with the exception of a few small patches. The lumen is full of purulent and fsecal material. It contains masses of granules, yellow pigment, fibres, epithelial cells, mucus, pus cells, large nuclei, red blood corpuscles, and a great variety of bacteria, including cocci, diplococci, streptococci in chains of six or seven elements, small ovoid bacilli in pairs and swarms,
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