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Updated: June 22, 2025
A redeeming feature of appendicitis is that the appendix lies so to speak in a corner, or wide-mouthed pouch, of the great peritoneal cavity; and if the inflammation set up in it can be "walled off" from the rest of the peritoneal cavity, and limited strictly to this little corner or pouch, all will be well. This is what occurs in those cases of severe appendicitis which spontaneously recover.
As I have said for years: The physician who gives drugs can't possibly know where his patient is. "Peritoneal collapse!" If there had been no narcotism there would have been no appearance of collapse. Every symptom giving the appearance of collapse was due to opium and morphine.
Hulke reports a case remarkable for the immense size of the rupture which protruded from a spot weakened by a former abscess. There was a partial absence of the peritoneal sac, and the obstruction readily yielded to a clyster and laxative. The rupture had a transverse diameter of 14 1/2 inches, with a vertical diameter of 11 1/2 inches.
Of course, the surgeon declares that pus should be let out by cutting into it, or it is liable to break into the peritoneal cavity and cause death This is positively not the truth, for when an abscess threatens, nature at once proceeds to throw a wall around in order to avoid accidents.
The Fallopian tubes, which penetrate and are attached to the peritoneal sack, together with the uterine broad ligaments, are designed to hold the womb in place, but if the womb and ovaries are crowded down into the pelvic cavity and the womb doubled upon itself, dysmenorrhea or painful menstruation, or amenorrhea, with convulsions, is the result.
For if there had been intra-peritoneal infection in the first place, it would have indicated perforation, and then, without the opening up of the peritoneal cavity, washing and draining, there would have been a funeral. The following is a similar case except that the woman came into my hands the first day of her sickness.
If, however, this disturbance bursts its barriers, and lights up an inflammation of the entire peritoneal cavity, then the result is likely to be a fatal one. Just how far nature can be trusted in each particular case to limit and stamp out the process in this manner is the core of the problem that confronts us, as attending physicians.
Some of the others are so stated as to render it probable that they may have been of the same nature. Five other cases were of peritoneal inflammation; three in males. Three were what was called enteritis, in one instance complicated with erysipelas; but it is well known that this term has been often used to signify inflammation of the peritoneum covering the intestines.
In the majority of cases, fortunately, the peritoneal fire brigade acts promptly, pours out a wall of exudate, and locks up the appendix in a living prison, to fight out its own battles and sink or swim by itself.
There were some indications of excitement about her, though whether from mental or physical causes I could not tell, but nothing to awaken concern. This morning I found her in a most critical condition. Puerperal fever had set in, with evident extensive peritoneal involvement. The case was malignant, all the abdominal viscera being more or less affected. I learned from the nurse that Mr.
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