THE HARVEY MEMORIAL AT HEMPSTEAD CHURCH
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720 post-war delay is being overcome. The officers’ death-rate increased from 3 93 (in the previous year) to 4.44 per 1000, that from injuries dropped from 1-85 to 1.42, but that from " diseases of the digestive system, except liver and tonsillitis " rose from 0-39 to 0’91. The death-rate of other ranks was 2-35 (previous year 2-80) ; from injuries 0-62 (0-90), from pneumonia 0-33 in both years, from digestive diseases 0-25 (0-21), and from influenza only 0-02 (0-09). The striking feature of the year is the increase in gastric and duodenal ulcer recently noticed ; last year there were 25 and 29 cases, but this year 11 and 53. Appendicitis is also on the increase. We shall return to the consideration of this Report. THE HARVEY MEMORIAL AT HEMPSTEAD CHURCH. Two years ago the Royal College of Physicians of London took the initiative in an appeal for the rebuilding of the tower of Hempstead Church, Essex, where lies the body of William Harvey. A marble sarcophagus had been provided by the College in 1883 just after the old battlemented tower with its fire bells had fallen to the ground, and the appeal was directed to medical men of all nations to erect a tangible memorial of one of the great men of their profession. The probable cost was estimated at JE5000, of which about one-tenth had already been contributed locally. ’ At a meeting of the Committee of the Restoration ’, Fund held at the College on March 9th, the following report was received:- ’ Receipts. £ s. d. Donations received ........ 431 10 fi , Interest on Investments, &c..... 32 2 8 £463 13 2 Expenditure. Expenses of Appeal ...... 5 1-1 10 Purchase of £360 5 per cent. War Stock.. 363 6 9 Balance in hand and at Hank .... 41 1 7 £463 13 2 This is in addition to the sum of £515 collected locally previous to the appeal, and invested in 5 per cent. War Stock. It was resolved to keep the fund open in the hope of receiving sufficient further support to commence the rebuilding of the tower. Subscrip- tions may be sent to Dr. Sidney Phillips, Joint Hon. Sec. of the Fund, Royal College of Physicians of London, Pall Mall East, S.W.1. A SCHEME OF DISTRICT NURSING.—At the College of Nursing on March 24th a number of district nurses met the Directors of the Mutual Property Insurance Company, Ltd., to discuss the nursing service recently organised by the company. Miss Dorsey, R.N., of the Nursing Division, League of Red Cross Societies, briefly described from the chair her experience when cooperating with the Metropolitan Life Insurance Company of New York. In 17 years the nursing service of this Company paid more than 27,000,000 visits, 3,000,000 in 1926 ; during this time the mortality-rate of the population fell by one-half, and that of typhoid by 82 per cent. Miss Dorsey urged district nursing associations to cooperate with the M.P. Insurance Company. Dr. J. A. H. Brincker spoke of the new arrangement between public health authorities and the Metropolitan Asylums Board, whereby, in a measles epidemic, preference in admission to hospital would be given to severe measles over mild scarlet fever, and thus a new field for service would be opened to the district nurse. In the ensuing discussion an almost unanimous desire was expressed for the development of ’, public health nursing in this country on general rather than on special lines. Miss Wilmshurst, S.R.N., superintendent of the Metropolitan District Nursing Association, spoke of the preventive side of district nursing and the opportunities it affords for health teaching in the home. Modern Technique in Treatment. A Series of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions CCXVII.—THE TREATMENT OF CHRONIC APPENDICITIS. THE term " chronic appenditicis " in its widest sense includes all those cases which are not acute, and therefore includes the interval appendix. In cases which have been tided over an acute attack by means of expectant treatment, the appendix should be removed after infection has subsided and before recurrence is likely. Commonly the time selected is about three months after convalescence from the acute attack ; a longer interval subjects the patient to the risk of another acute attack. especially in young patients. It is estimated that 80 per cent. of patients of all ages relapse within two years after an initial attack of acute appendicitis without appen- dicectomy. In these cases a definite diagnosis has presumably been made, and therefore, unless any other lesion is suspected, a gridiron incision gives suitable exposure. As a rule surprisingly little, pathological change is found in an appendix which was known to have been acutely inflamed or even the cause of an abscess a few months previously. A few limited adhesions, a stricture or a fihrutic tip are commonly the only legacies of the acute attack. Chronic appendicitis may present as one of two more or less definite clinical entities-i.e.. the inter- mittent, and the chronic dyspeptic type. The Intermittent Type. The intermittent type is characterised by recurrent attacks of pain, sometimes colicky in nature, which originate in the neighbourhood of the epigastrium or umbilicus, and are later referred to the appendicular region. Vomiting may occur, but is not a marked feature. After an interval varying from a few hours to a few days the symptoms abate. leaving a tem- porary local soreness in their wake. On examination some deep tenderness can usually be elicited in the lower right quadrant, and occasionally a thickened or concretion-containing appendix can be palpated through a thin abdominal wall. On removal the appendix is found to contain a concretion or possess a stricture, the symptoms presumably being due to spasmodic efforts of the organ to overcome the resultant obstruction. The Dyspeptic Type. The dyspeptic type of chronic appendicitis is less definite in its symptomatology, and may mimic almost any chronic abdominal condition. Generalised abdominal discomfort is more or less constant and may be aggravated by exercise. Haematemesis and even melæna may occur, but the periodic remissions of symptoms so characteristic of gastric or duodenal ulcer are not marked. Symptoms are not relieved by recumbency or pregnancy, which fact may assist in the differential diagnosis of visceroptosis. Neurosis is a commonly associated condition, being partly due to prolonged ill-health, and sometimes aggravated by injudicious treatment. The discomfort associated with renal conditions is usually limited to the side of the lesion, whereas, although the tenderness of chronic appendicitis is commonly localised to the right iliac fossa, the actual pain is referred more centrally. Suspicions of pelvic disease may be aroused by the history of the case, pain is commonly referred to the lower part of the back, and routine examination usually reveals the cause of the trouble. On removal this type of appendix may show generalised or local fibrosis, especially of the tip. In other cases the organ may be transformed into mucocele, or even an empyema.
Transcript of THE HARVEY MEMORIAL AT HEMPSTEAD CHURCH
720
post-war delay is being overcome. The officers’death-rate increased from 3 93 (in the previous year)to 4.44 per 1000, that from injuries dropped from1-85 to 1.42, but that from " diseases of the digestive system, except liver and tonsillitis " rose from 0-39to 0’91. The death-rate of other ranks was 2-35(previous year 2-80) ; from injuries 0-62 (0-90), frompneumonia 0-33 in both years, from digestive diseases0-25 (0-21), and from influenza only 0-02 (0-09).The striking feature of the year is the increase ingastric and duodenal ulcer recently noticed ; lastyear there were 25 and 29 cases, but this year 11 and53. Appendicitis is also on the increase. We shallreturn to the consideration of this Report.
THE
HARVEY MEMORIAL AT HEMPSTEADCHURCH.
Two years ago the Royal College of Physiciansof London took the initiative in an appeal for therebuilding of the tower of Hempstead Church, Essex,where lies the body of William Harvey. A marblesarcophagus had been provided by the College in1883 just after the old battlemented tower with itsfire bells had fallen to the ground, and the appeal wasdirected to medical men of all nations to erect atangible memorial of one of the great men of theirprofession. The probable cost was estimated at JE5000,of which about one-tenth had already been contributedlocally. ’
At a meeting of the Committee of the Restoration ’,Fund held at the College on March 9th, the followingreport was received:- ’
Receipts.£ s. d.
Donations received ........ 431 10 fi ,
Interest on Investments, &c..... 32 2 8
£463 13 2
Expenditure.Expenses of Appeal ...... 5 1-1 10Purchase of £360 5 per cent. War Stock.. 363 6 9Balance in hand and at Hank .... 41 1 7
£463 13 2
This is in addition to the sum of £515 collectedlocally previous to the appeal, and invested in 5 percent. War Stock. It was resolved to keep the fundopen in the hope of receiving sufficient further supportto commence the rebuilding of the tower. Subscrip-tions may be sent to Dr. Sidney Phillips, Joint Hon.Sec. of the Fund, Royal College of Physicians ofLondon, Pall Mall East, S.W.1.
A SCHEME OF DISTRICT NURSING.—At the Collegeof Nursing on March 24th a number of district nurses met theDirectors of the Mutual Property Insurance Company, Ltd.,to discuss the nursing service recently organised by thecompany. Miss Dorsey, R.N., of the Nursing Division,League of Red Cross Societies, briefly described from thechair her experience when cooperating with the MetropolitanLife Insurance Company of New York. In 17 years thenursing service of this Company paid more than 27,000,000visits, 3,000,000 in 1926 ; during this time the mortality-rateof the population fell by one-half, and that of typhoid by82 per cent. Miss Dorsey urged district nursing associationsto cooperate with the M.P. Insurance Company. Dr. J. A. H.Brincker spoke of the new arrangement between publichealth authorities and the Metropolitan Asylums Board,whereby, in a measles epidemic, preference in admission tohospital would be given to severe measles over mild scarletfever, and thus a new field for service would be opened tothe district nurse. In the ensuing discussion an almostunanimous desire was expressed for the development of ’,public health nursing in this country on general rather thanon special lines. Miss Wilmshurst, S.R.N., superintendentof the Metropolitan District Nursing Association, spokeof the preventive side of district nursing and the opportunitiesit affords for health teaching in the home.
Modern Technique in Treatment.A Series of Special Articles, contributed by invitation,on the Treatment of Medical and Surgical Conditions
CCXVII.—THE TREATMENT OF CHRONICAPPENDICITIS.
THE term " chronic appenditicis " in its widestsense includes all those cases which are not acute,and therefore includes the interval appendix. Incases which have been tided over an acute attack bymeans of expectant treatment, the appendix shouldbe removed after infection has subsided and beforerecurrence is likely. Commonly the time selected isabout three months after convalescence from theacute attack ; a longer interval subjects the patientto the risk of another acute attack. especially inyoung patients. It is estimated that 80 per cent. ofpatients of all ages relapse within two years after aninitial attack of acute appendicitis without appen-dicectomy. In these cases a definite diagnosis haspresumably been made, and therefore, unless anyother lesion is suspected, a gridiron incision givessuitable exposure. As a rule surprisingly little,pathological change is found in an appendix whichwas known to have been acutely inflamed or eventhe cause of an abscess a few months previously. Afew limited adhesions, a stricture or a fihrutic tip arecommonly the only legacies of the acute attack.
Chronic appendicitis may present as one of twomore or less definite clinical entities-i.e.. the inter-mittent, and the chronic dyspeptic type.
The Intermittent Type.The intermittent type is characterised by recurrent
attacks of pain, sometimes colicky in nature, whichoriginate in the neighbourhood of the epigastrium orumbilicus, and are later referred to the appendicularregion. Vomiting may occur, but is not a markedfeature. After an interval varying from a few hoursto a few days the symptoms abate. leaving a tem-porary local soreness in their wake. On examinationsome deep tenderness can usually be elicited in thelower right quadrant, and occasionally a thickenedor concretion-containing appendix can be palpatedthrough a thin abdominal wall.On removal the appendix is found to contain a
concretion or possess a stricture, the symptomspresumably being due to spasmodic efforts of theorgan to overcome the resultant obstruction.
The Dyspeptic Type.The dyspeptic type of chronic appendicitis is less
definite in its symptomatology, and may mimicalmost any chronic abdominal condition. Generalisedabdominal discomfort is more or less constant andmay be aggravated by exercise. Haematemesis andeven melæna may occur, but the periodic remissionsof symptoms so characteristic of gastric or duodenalulcer are not marked. Symptoms are not relieved byrecumbency or pregnancy, which fact may assist inthe differential diagnosis of visceroptosis. Neurosisis a commonly associated condition, being partly dueto prolonged ill-health, and sometimes aggravated byinjudicious treatment. The discomfort associatedwith renal conditions is usually limited to the side ofthe lesion, whereas, although the tenderness of chronicappendicitis is commonly localised to the rightiliac fossa, the actual pain is referred more centrally.Suspicions of pelvic disease may be aroused by thehistory of the case, pain is commonly referred to thelower part of the back, and routine examinationusually reveals the cause of the trouble.On removal this type of appendix may show
generalised or local fibrosis, especially of the tip.In other cases the organ may be transformed into mucocele, or even an empyema.
