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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    In some parts, hardly any but micrococci can be seen. These are single, in pairs, in short chains of three or four, or in little groups. In other parts, the cocci are mixed with bacilli, amongst which are small ovoid bacilli, often in pairs, rather slender bacilli, about the size and shape of tubercle bacilli, and short thick bacilli. The bacteria are growing everywhere, but perhaps most are to be seen towards the lumen and upon the peritoneal surface. In short, the con- cretion contained a preponderance of bacilli; the inflamed appendix and peritoneum a preponderance of micrococci, probably streptococcus pyogenes. A search was made for tubercle bacilli, but with negative results. The kind of infection which may be associated with the presence of a concretion, is also illustrated in the following case. Case 16.—Appendicitis with Concretion—Perforation and Gangrene—Streptococcic Peritonitis.—A schoolboy, aged ten, was quite well on April 4, 1899. Until then, he had had no symptoms whatever which pointed to appendicular disease. In the early morning of April 5, he awoke feeling very ill, vomited four times, and afterwards complained of pain in the right iliac region. Later, castor-oil was given, and the bowels were moved five times. The vomiting continued. In the even- ing, he walked to the hospital. At 11 p.m. the same day (April 5), his temperature was 101° F. and pulse 145. Vomiting had become persistent. The abdomen moved freely, except over the right iliac fossa, where it was almost still, and rather tender. No tumour could be felt, although the abdominal walls were not rigid, nor could any tumour be felt per rectum. Digital pressure caused pain in the recto-vesical pouch. I performed laparotomy, through the usual oblique incision, less than twenty-four hours after the onset of the symptoms. ' The vermiform appendix lay in front of the ca'cum, wrapped in a cap of inflamed omentum. A quantity of thin, odourless pus was found beneath and around the csecum. It was not con- fined by adhesions, but free in the peritonea] cavity. The fact of the pus being so thin, odourless, and without adhesions, led me to diagnose streptococcic peritonitis. The appendix, which contained two small faecal concretions, was perforated in two places, and gangrenous throughout. Mr. B. Rowe, the house-
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