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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    varies with the character of the attack, rarely running above 101° in tlie mild cases; in an acute localised abscess the temperature at first is often very high, but it is not at all unusual to see it drop in a few days, probably as a result of toxa3mia; in patients with diffuse peritonitis there isfrequently but little pyrexia, the temperature not rising much above 101°. On palpation one frequently finds a mass occupying the right iliac fossa, which consists of coils of intestine matted together over and around the inflamed appendix. It is sometimes tympanitic, but may be quite dull. The outline of this mass is likely to be blurred and indistinct if there is much concurrent distension of the small intestine, and iu cases where the appendix lies behind the caecum there may be neither dulness nor tumour to be detected. The formation of an abscess is not necessarily associated with any increase either of the local or of the general dis- turbance, and one must never be tempted to Avait for fluctuation before determining as to the necessity of an operation. Thus in one of the cases I have already alluded to, the patient Avas taken ill on tlie Friday night; the tem- perature was high, and there was continuous vomiting and constipation. He was carefully treated, and when I saw him on the following Wednesday the temperature had fallen to the normal, the vomiting had ceased, and a natural motion had been passed. The abdomen was tense and tympanitic, but not particularly tender ; the only symptom that caused much trouble Avas hiccough. Naturally one concluded that the stress of the inflammatory mischief Avas over, and that the distension Avould be relieved by evacuation of the bowels. This Avas undertaken by means of enemata and calomel, and the hiccough ceased, although the distension continued, and on Saturday, Avhen I saw him again, Avas as marked as ever. Operation Avas then decided ou, and on raising the ccecum from its bed an abscess of some size was found, connected Avith a kinked and perforated appendix. The direction taken by the pus necessarily varies consider- ably with the position of the appendix ; if it is situated on the anterior aspect of the cmcurn, the abscess tends to point through the anterior abdominal wall, causing it to become red and oedematous. If, however, the appendix is located