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.

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    somewhat boggy, but there was no especial tenderness. The temperature was 99.5° F.; the leucocyte count was 5600. The hyperplastic form of tuberculosis develops very insidiously. Colicky abdominal pain, at first occurring at long intervals, but becoming progressivel}' more acute and more frequent, is the most constant symptom. The later symptoms are usually those of gradually advancing obstruction, accompanied with evening pyrexia, emaciation, and loss of strength. In some cases recm*- rent acute attacks, closely simulating recurrent appendicitis, are the most prominent features in the clinical history. As a rule, how^ever, the patient does not entirely recover in the intervals. The most conspicuous physical sign is the presence of a tumor in the right iliac fossa. This may be so prominent as to be noticeable on mere inspection. It is more or less cylindrical, somewhat nodular, and as a rule possesses slight or no mobility. It is somewhat tender, but rarely acutely so. The disease may closely simulate a new-growth of the cecal region, or a peri-appendical exudate. The age incidence of the disease corresponds with that of carcinoma. The most distinctive features in the diagnosis are the gradual development and the character of the tumor, which is more sharply outlined and less tender than a perityphlitic mass, while it is less nodular than a carcinoma and more nearly preserves the normal contour of the bowel. The shape may strikingly resemble that of a sarcoma. The latter condition, however, is too rare to complicate the diagnosis frequently. The detection of tubercle bacilli in the stools is of positive value, pointing directly to intestinal tuberculosis, because, as mentioned above, this localized tubercular process is seldom complicated with active tuberculosis elsewhere, so that the possibility of other sources for the organisms need not be considered. ACTINOMYCOSIS. Actinomycosis h o m i n i s has only recently come to be regarded as anything more than a pathologic curiosity. Murphy in 1885 reported the first case in America, but since then over 100 cases have been reported in this country by W. S. Erving (Johns Hopkins Hospital Bull, 1902), while Illich {Beit. z. klin. Akt., Wien, 1892) collected 421 cases from the literature. In about 20 per cent, of these cases the disease was localized in the abdomen, and in the majority, the infection atrium was the vermiform appendix. Four cases of actinomycosis affecting the right side of the abdomen have been observed in the Johns Hopkins Hospital, 3 in the surgical department and 1 in my own clinic. The clinical histories of these cases were so strikingly similar that only one case will be cited as an example. J. H. H., Gyn. No. 6961. A negress, twenty-eight years old, had spent most of her life on a farm. Five months before admission, while in good health and hav- ing had no symptoms of intestinal trouble, she was suddenly seized with intense