Seventeen cases of chronic (relapsing) appendicitis, treated by operation / by Hunter McGuire.

  • McGuire, Hunter Holmes, 1835-1900.
Date:
[1895]
Catalogue details

Licence: Public Domain Mark

Credit: Seventeen cases of chronic (relapsing) appendicitis, treated by operation / by Hunter McGuire. 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.

    4/20 (page 2)
    after suppuration has taken place, or during the quiescent stage, between the attacks. There are some cases of appendicitis so slight that I am satis- fied they belong to the doctor and not to the surgeon; very often they are not recognized by the practitioner as appendicular trou- ble, but put down as bilious colic, localized peritonitis, kidney colic, etc. Under rest, purgation, hot applications, rigid diet, leeches, and the very moderate use of opium, these cases recover, and, in very many instances, sta}'^ well. In some of these cases, if, after the attack, you could look at the appendix and struc- tures around it, you would see evidences of inflammation in the shape of slight thickening, induration, and adhesions. If you will examine subjects in any large dissecting-room you will find frequent specimens of this kind. These slight cases of appen- dicular trouble are not cases for operation. A man’s usefulness is not impaired, nor is his life usually shortened by it; indeed, he often gets on through life better than the man with a crip- pled leg, or the poor fellow who lives for years with a crippled heart. I wish my voice was strong enough, just here, to call a halt to the men who say that, in all cases of appendicitis, you must operate. They say, “ Operate at once, not this afternoon or to-morrow, but now,” in all cases where the disease is recog- nized. There are'cases, however, when the disease, instead of abating, grows worse, the temperature gets higher, the pulse more rapid, the lump in the iliac region is larger, the belly is more tender, and possibly a rigor comes on. A slight pitting oedema in the skin over the region of the appendix is sometimes seen. The fluctua- tion tells us that pus has formed, and the whole aspect of the case is changed. I know I subject myself to severe criticism when I say that, even now, I am not in all cases in a hurry to operate. Possibly the disease has been going on for some days, as is often the case, before the consulting surgeon is called ; the symptoms are not so urgent, fluctuation not very distinct, and the barrier of lymph containing the pus is probably strong. I am not in a hurry to operate, because a certain proportion of these cases may get well without it. Recovery is not always impossible, even after some matter is supposed to be present, or is actually there.