The vermiform appendix and its diseases / by Howard A. Kelly ... and E. Hurdon ... With 399 original illustrations, some in colors, and 3 lithographic plates.

  • Kelly, Howard A. (Howard Atwood), 1858-1943.
Date:
[1905], [©1905]
Catalogue details

Licence: In copyright

Credit: The vermiform appendix and its diseases / by Howard A. Kelly ... and E. Hurdon ... With 399 original illustrations, some in colors, and 3 lithographic plates. 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.

    707/898 (page 643)
    the pulse-rate may remain nearly normal. One of the most important signs is the persistent, distressing nausea and vomiting which generally characterize the affection from first to last, although they sometimes cease toward the end, the cessation producing an illusory impression of improvement. A further most important sign, which is associated with the cessation of peristalsis, is the cessation of fecal movement and the passage of gas. The distended abdomen is fixed, and the respiration becomes superior thoracic in type. There is often a dry, typhoid tongue, and later on a mild or marked delirium. As the infection spreads the system becomes dried out for want of water and the excretion of urine is much diminished. There is sometimes an accumu- lation of ascitic fluid. One of the most marked signs in advanced cases is the facial expression, which is distressed and anxious, the patient having a collapsed look, with hollow eyes and a dusky skin, the expression alone being often sufficient to indicate the nature of the malady to an experienced eye. V. H. Williams graphically says of one of his cases: He had that gray, hard, sal- low, anxious look of sepsis, which means much to the eye of the surgeon (Trans. Amer. Surg., 1893, p. 261). The first step in the differential diagnosis is to distinguish between these cases of diffuse peritonitis and cases of a circumscribed abscess still limited to the neighborhood of the appendix, in which the local inflammation has called forth a marked reactive disturbance of the entire peritoneum. In a localized peritonitis there may be fever, quickened pulse, vomiting, and a general tym- pany of the abdomen, associated with more or less general discomfort. A care- ful exa,mination, however, will usually show that the tenderness is pretty well localized, and that there is a well-defined mass shut off in the iliac fossa. Furthermore, the effect on the general condition of the patient is not that of the profound depression associated with the more extensive disease. It is in just these cases, however, in which a local affection is passing into a general one, that the most serious mistakes are made, and, where there is doubt, it is better to operate than to wait for the extension of the disease. The differential diagnosis between intestinal obstruction and peritonitis accompanied with tympany, nausea, and pain, is sometimes even more difficult. In intestinal obstruction, however, fever, at first, is lacking, there is no such widespread sensitiveness to pain as in peritonitis, and the distention is limited to the loops of intestine which lie near to the obstruction. These loops can often be seen and felt as they contract, and roll their gaseous contents under the fingers in the effort to force a passage through the barrier, the pain being associated with the attacks of peristalsis. Moreover, in intestinal obstruction there is no increasing leucocytosis. In either case relief is to be sought in operative measures. Prognosis.—The prognosis in cases of diffuse peritonitis depends upon the character of the infection, as well as upon its extent. Where it has spread very rapidly, and there is a profound depression, as in cases of peritoneal