Notes on appendicitis / by Albert Carless.

  • Carless, Albert, 1863-1936.
Date:
[1896?]
Catalogue details

Licence: Public Domain Mark

Credit: Notes on appendicitis / by Albert Carless. 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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    to the subdivisions of the portal vein in the liver, leading to portal vein pyaemia or pylephlebitis, as evidenced by high fever with recurrent rigors and distinct hepatic ten- derness ; true general pyaemia may subsequently develop. Another venous complication that may arise is thrombosis in the iliac veins, leading to the so-called “white leg;^’ this is probably due to pressure of an inBammatory mass upon the venous trunks in the iliac fossa. In addition to all these phenomena it must not be forgotten that toxaemic symptoms of a marked character manifest themselves, and that a considerable depreciation of the general powers quickly ensues from this cause, and may render an opera- tion fatal which, undertaken under more favorable auspices, would have been successful. Some months back 1 was called in to operate on a young lady who had been allowed to remain in a febrile state for six weeks with a large abscess in the iliac fossa; at the time of operation there were additional symptoms of peritoneal invasion, but although the proceeding was a simple one, and the abscess easily found and opened, yet the shock was sufficient to produce a fatal issue from cardiac failure. At any time during the preceding six weeks an operation would have been justiBable and probably successful, but the condition of general asthenia from continued toxic poisoning sufficed to turn the balance in the wrong direction. Into the symptomatology of appendicitis space forbids me to enter at all fully, but a few points suggested by some of my cases must bo alluded to. The general features of an attack are sufficiently well known, and the usual clinical picture is very characteristic. The sudden onset of pain referred to the right iliac fossa, as also fever, vomiting, and constipation, are the cardinal phenomena. On careful exa- mination patients usually refer their pain to what is now known as McBurney’s spot, i. e. a point inches inwards from the anterior superior iliac spine along a line drawn from it to the umbilicus, and corresponding with fair accuracy to the attachment or base of the appendix. The pain is increased on any movements of the abdominal parietes, and hence the right leg is usually kept well flexed, and the overlying muscles rigidly contracted. The fever necessarily