The vermiform appendix and its diseases / by Howard A. Kelly and E. Hurdon.

Date:
1905
Catalogue details

Licence: In copyright

Credit: The vermiform appendix and its diseases / by Howard A. Kelly and E. Hurdon. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    favor the invasion of pathogenic organisms, giving rise to an attack of appendic- itis in nowise differing from the common forms of tlie disease. If the patient strains, or makes active use of the abdominal muscles at the time of the receipt of the blow, these factors may act conjointly in causing the attack. The more violent the blow or the greater the strain, the greater is the like- lihood of an injiuy to the appendix. A blow acts more efficiently upon a person with a shallow or a scaphoid abdo- men where the walls are thin, than upon one who is stout or strongly built. The blow acts as the inmiediate cause in producing the attack, which, while it might have occurred soon without such intervention, might also not have occurred for some years; the mediate cause is usually a foreign body. Whenever a physician is called to a case the history of which is suggestive of traumatic origin, he will do well to make careful notes at the time, quoting as far as possible the patient's own language and expressions relating to the follow- ing facts: 1. The nature of the injury, Avhether a blow, a fall, or a strain. 2. The agent producing the injury. 3. The exact point and manner of impact, and whether the patient was en- gaged in active exertion or straining himself at the time the injury was received. 4. The expressions used by the patient at time and the the nature of his imme- diate complaints. 5. The length of time elapsing between the injury and the call for medical aid. 6. Any external evidence of violence (to be noted most carefully). 7. If an interval of some weeks has elapsed, an inquiry into the condition of the patient during this period should be made, it being stated whether he was .able to resume his ordinary occupations, and with or without distress. 8. If death ensues or an operation is performed, it is of the highest impor- tance to record the exact condition of the peritoneum and the viscera underlying the injured area, a minute and careful statement regarding the presence or ab- sence of fecal concretions being always recorded. The following case, in which a concealed trauma and infection were suspected, is of great medico-legal interest. It was reported by H. M. Biggs to the New York Pathological Society as an instance of suspected criminal abortion which proved to be appendicitis. The patient, an unmarried servant, was suddenly seized with severe pain dur- ing a menstrual period. The attending physician discovered a general peritonitis, and associating this fact with the occurrence of an excessive menstrual flow, and some evidence of a circumstantial character, concluded that the case was one of criminal abortion, and so reported it to the Board of Health. The woman died, and the autopsy revealed a general peritonitis resulting from a perforation of the appendix about one and a half inches from its base; a small, hard mass of fecal matter was found in the peritoneal cavity.