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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    its base by a foreign body or by infection of its wall, destroying the vitality of the tissue, or by contortion, shutting off its circulation, if an early operation is performed the appendix will be found black, non- adherent, surrounded by omentum, which is adher- ent to the wall of the bowel, and without pus infec- tion of the peritoneum. It looks as though it were a miniature gall-bladder with extremely thin walls. The dangers of this variety with early operation before it has perforated, one can readily see would be small, as the cecum can be lifted into the wound, the appendix ligated, excised in the absence of pus in the peritoneal cavity, with very little danger of subsequent infection. When the appendix has per- forated, as in subdivision a, the contrary is the case. A greater or lesser accumulation of the products of infection and gangrene of the appendix, the micro- phytes, pus, etc., are liberated into the peritoneal cavity. These produce a peritonitis which may be- come localized by the formation of limiting adhes- ions ; or, in the absence of the latter, a general peritonitis may result, with a tendency similar to that found following gangrenous destruction in other- portions of the body from infection, in which there is an absence of the effort of limitation and a non- restricted advancement of infection. Peritoneal Infections.—The first variety of infections without perforation I have mentioned under the head of ulceration of the mucous membrane. The second variety is the most common in diseases of the appendix, a small circumscribed abscess as a result of perforation. The effect of this abscess in its sub- sequent course depends on : 1, whether there follows necrosis of the wall of the adherent intestine which protects the peritoneal cavity and the admission of the contents of the abscess into the intestine; or 2, whether the abscess is retained within the constantly dilating sac, producing a large accumulation always separated from the general peritoneal cavity, which can be treated surgically by a lateral incision without