Varga Benedek szerk.: Orvostörténeti közlemények 149-157. (Budapest, 1996)

ADATTÁR / DOCUMENTS - Balogh János: Appendektómia 1735-ben. Claude Amyand beszámolója az első sikeres vakbélműtétről

lodged in it and the Omentum suffered, upon the Separation of these from each other. The Gut forming a double Tube, like a double-jointed Syphon, continuing in the Curve as it passed over the Testicule and Spermaticks, was separated one part from the other and from the adjacent Parts, as far as the Aperture in the Abdominal Muscles, where the unperforated End of it was separated therefrom, and thence stretched out and unfolded, which brought in View the Aperture made in it by the Pin hitherto concealed, through which that Part of it, which was incrusted with Chalk, had just made its way out upon an occasional Pressure, as a Cork out of a Bottle. It was the Opinion of the Physicians and Surgeons present, to amputate this Gut: To which End a circular Ligature was made about the sound Part of it, two Inches above the Aperture, and this being cut off an Inch below the Ligature, was replaced in the Abdomen, in such a Manner that an artificial Anus might be made there, if the Patient's Case should require it. Afterwards so much of the Hernial Bag as had been detached from the Skin, the Spermaticks, etc. was cut off, which, as they appeared in a sound State, were preserved in Situ. The Fistulous Opening adjoining to the Thigh, and answering to the Aperture in the Gut, was opened; some Angles of Skin in the way removed; The Aperture in the Muscles, which had been inlarged by Incision, was stopped up with a Tent; and the rest of the Dressings and the Situation of the Patient ordered so, as to remove from the Wound all such Pressure from within as might disturb the Cure. 'Tis easy to conceive that this Operation was as painful to the Patient as laborious to me: It was a continued Dissection, attended, with Danger on Parts not well distsinguished: It lasted near half an Hour, and the Patient bore it with, great Courage. During it the Patient vomited largely, and had several Stools, but was soon composed by half an Ounce of Diacodium, and Emollient Embrocations and Fomentations, frequently applied warm on the Belly: He was blooded, and an Emollient Carminative oily Clyster was ordered to be applied in the Evening; but as he was easy, and the Belly not Tense, that was omitted. He was confined to a very sparing Diet, and his Body kept open by Clysters, injected every 2d Day, when Stools were wanted, to prevent straining. When dressed upon the 4th Day after the Operation, every thing appeared well, and we had good reason to hope for a Cure, especially as the Discharge by the anus was Natural. The Tent put into the Abdominal Aperture was not removed till the 8th. Upon the 10th the Ligature round the Appendix Coeci, where it had been amputated, dropt off, and no Faeces followed it; and as it was then plain they had taken the natural Course, from that Time the Wound was treated like an ordinary one, saving it was observed to keep a strong and constant Pressure over the Abdominal Aperture, as well to fence against the Intrusion of the Viscera into the Wound, as by a strong Incarnation and Cicatrix effectually to secure the Patient against a Rupture. During the Time of the Cure he was confined to his Bed, always kept to sparing Diet, and ordered never to go to Stool but in a Bed-pan; by these means the Wound was completely healed up in less than a Month, and, the Patient soon after discharged with a Truss, which he was ordered to wear some Time, to confirm the Cure. That the Appendix Coeci should be the only Gut found in this Rupture, is a Case singular in Practice: This was full of Excrements, and occasionally could be distended with an additional Quantity, which upon Pressure was returned into the Colon, with that kind of Noise which Guts relaced generally give. This had occasioned a Diminution of the Tumour when compressed, before the Operation was performed, as the Patient was lying backwards with his Head downwards, and an Increase of it as he stood erect, when the Faeces from the Colon could get into it gain.