Excerpt from The Medical News, Vol. 66: A Weekly Medical Journal, January-June, 1895
The symptoms of appendicitis are (1) a sudden pain in the abdomen; (2) shortly followed by nausea and, perhaps, vomiting; (3) local tenderness over the site of the appendix, and most frequently in the right iliac region; (4) elevation of temperature. These symptoms, occurring in this order, without a previous history of genito-urinary infection, or of a lesion of the gall-tracts, or Pott"s disease, indicate with almost uniform regularity appendicitis. They do not indicate that the appendix is gangrenous, or that there is a simple catarrhal appendicitis. They do not indicate whether it has perforated or has not perforated; nor whether the cause is an infection with the staphylococcus, the streptococcus, or the bacillus coli commune, or the presence of a fecal stone, or of a foreign body. They do not indicate whether it is a stenosis of the appendix or an appendicitis obliterans, but merely that it is an appendicitis or acute disease of the appendix.
The physical manifestations, the presence or absence of induration, tumefaction, edema of the wall, tympanites, etc., aid in the differentiation of the various pathologic conditions present in the more advanced stage; but all of these are absent or comparatively worthless in the early stage.
The etiology, which was for a long time a subject of contention, is now practically agreed upon. It was very difficult to eradicate from the professional mind the deep-rooted erroneous belief that in a great majority of cases appendicitis was due to foreign bodies admitted into and retained in the appendix, as grape-seeds, cherry-stones, fragments of bone. Only 2 percent, are cases with foreign bodies, and fecal stone in 38 percent. To indicate the causes of appendicitis I will use the same classification employed in ray article of March 3, 1893:
1. Simple pus-infection, producing the catarrhal variety.
2. Extensive infection by the bacillus coli commune or by pyogenic microbes, producing gangrene of a greater or lesser portion of the appendix.
3. Pressure-atrophy with infection of the appendix (a) by fecal concrement, and (b) by foreign bodies.
4. Retention-accumulations (a) from cicatricial contractions, stenosis, and obliteration, and )from occlusion by an enterolith or foreign body.
From the reports of autopsies collected I find that in 70 percent, of the cases there were perforations of the appendix. Of my own cases in which the appendix was removed there was 87 percent. Simple primary catarrhal appendicitis, if it exists, is rarely brought to the attention of the physician and still less frequently to that of the surgeon. Of 194 cases reported we had but one of this variety. A catarrhal inflammation in which the more serious form of appendicitis had previously existed is not uncommon. The question of greatest practical importance to the surgeon and physician is the diagnosis. Can we determine when appendicitis is present, and can we determine the pathologic conditions that exist in the abdomen at any given time in the progress of the disease? To the former we must with positiveness answer in the affirmative; to the latter an equally forcible negative must be given; that is, we can say from the symptoms that a lesion of the appendix exists; but we cannot say, in most cases, how extensive, how dangerous, and how far-reaching the effects of that appendicitis may be, and still less can we say in any given case how soon the life of the patient may be greatly jeopardized by the disease which at the moment has apparently no grave danger.
If we were able to determine in the early stage, from the symptoms, physical signs or clinical history of a given case that it is going to take a favorable or an unfavorable course, we would regulate our treatment accordingly. Unfortunately, there are no symptoms present in the dangerous cases admonitory of their fat. Это и многое другое вы найдете в книге The Medical News, Vol. 66 (George M. Gould)