Appendicitis : with original report and analysis of one hundred and forty-one histories and laparotomies for that disease under personal observation : read before the Pan-American Medical Congress / by J.B. Murphy.

  • Murphy, J. B. (John Benjamin), 1857-1916.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Appendicitis : with original report and analysis of one hundred and forty-one histories and laparotomies for that disease under personal observation : read before the Pan-American Medical Congress / by J.B. Murphy. 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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    opening the unaffected portion of the peritoneal cavity; or 3, whether the abscess suddenly ruptures into the peritoneal cavity; or 4, whether the abscess opens into other of the neighboring viscera or cavi- ties, as kidney, bladder (Case 82) or pleura. The local, circumscribed peritoneal abscess is a source of danger: 1, from absorption ; 2, from necro- sis of the bowel forming part of its wall, followed by hemorrhage which may prove fatal (Case 54); 3, danger of rupture into the general peritoneal cavity (Case 108); 4, thrombo-phlebitis, secondary abscesses. (See Cases 10 and 26.) General Suppurative Peritonitis—as a result of dis- ease of the appendix is produced: a, by a direct per- foration and emptying of contents of the appendix into the peritoneal cavity (many cases); b, by a rup- ture of a small circumscribed abscess that had pre- viously formed around the appendix (Case 108); c, by infection through wall of appendix (Cases 85 and 86), and also through the wall of an unruptured abscess (Case 134); d, by a rupture of gangren- ous appendix into peritoneal cavity. The result of the infections of the peritoneum, or general suppurative peritonitis, depends upon the pathologic changes produced by the infection on the surface of the peritoneum. We have, 1, a dry septic variety of peritonitis with more or less complete exfoliation of the endothelium of the peritoneum, which terminates fatally in a very short period of time, as in Cases 25 and 43. We have, 2, where the quantity of pus is considerable, a ptomaine poisoning from the imme- diate absorption of the quantity of pus poured into the peritonea] cavity, where the patient at the end of four to twelve hours after the rupture will die with the most profound symptoms of collapse from toxines. (See Cases 102 and 104.) We have, 3, an escape of a quantity of pus into the peritoneal cavity, generating a suppurative peritonitis. Of this variety there were thirty-six cases, with twelve deaths. In all of these the patient had no immediate manifes-