From a Country Hospital

Kai Tiaki : the journal of the nurses of New Zealand, Volume IV, Issue 1, 1 January 1911, Page 36

From a Country Hospital

On 26th August a male patient was admitted to this hospital with symptoms of general peritonitis — due to perforation of an appendicular abscess.

While at work he was seized with acute abdominal pain, during the night the pain became worse, and diarrhoea and vomiting commenced. This condition continued for three days ; on the fourth day he suddenly became much worse, when the doctor m charge ordered his removal to hospital.

Two hours after admission he was operated on by the medical superintendent. The incision was made over right rectus, on opening into peritoneal cavity, pus — very offensive — was present. This was mopped up as thoroughly as possible, swabs being passed into pelvis and both iliac fossae.

The appendix was found bound down by adhesions behind the caecum, the tip extending up towards liver. The adhesions were separated and appendix removed. Two fsecal concretions were found m appendix, and perforation about one quarter of inch from tip.

Drainage tubes were passed into pelvis to region of appendix, the wound being closed with through-and-through sutures ; dressings were applied and patient removed to bed. After regaining consciousness the patient was put into Fowler's position, and continuous saline per rectum commenced.

The dark colouied and foul-smelling vomit that had been so troublesome before opera-

tion still continued. Twenty-four hours after operation the stomach tube was passed, and stomach washed out with warm water. This gave relief for some hours, when the persistent vomiting commenced again, necessitating the washing out of stomach a second time. The vomiting ceased after that, and the patient was able to take and keep down, whey, barley water, and albumen water.

After the third day the continuous saline per rectum was discontinued.

Owing to the septic condition it was necessary to have the wound dressed twice a day from date of operation. Six days after operation the patient had a severe haemorrhage from wound ; after being tightly plugged with gauze the haemorrhage ceased. This left the patient very weak, and it was thought he would not recover ; however, there was no recurrence of haemorrhage, and he steadily gained ground.

With treatment the septic condition of wound improved, and 24 days after operation the wound was almost healed, when the medical superintendent performed a second operation for repair of wound, this being necessary as little time or trouble was spent over the wound at the first operation, owing to the collapsed condition of patient. After having made a marvellous recovery the patient was well, and able to leave the hospital on 28th October — nine weeks from date of admission.

(January, 1911).