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

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

The Patient does not remember, when he swallowed the Pin which had perforated the Gut within the Rupture. But as this Rupture was from his Infancy, fixed and unreducible, so it is likely the Pin had then made its way into the Appendix Coeci prolapsed; and that an Inflammation ensuing thereon, had occasioned an Adhesion, whereby the Increase of the Tumour had been checked, and the Reduction of the Parts prolapsed thereby, rendered impracticable. The Surgeons who constantly dressed the Patient before the Operation, did observe then, as they have since, that the Humour discharged formerly at the Fistula, had frequently the Appearence, and, as they thought the Smell of Excrements, so that there is no Doubt that the Cause of it was the Wound made in the Gut, by the Pin giving way occassionally to such a Discharge. The Patient also perfectly remembers, that the Impostumation or Gathering preceding [sic] the fistulous Discharge was attended with very little Pain, or much less than generally attends Suppuration. Which shews that the Extravasation of the Excrements from the Gut into the Hernial Bag, and the bursting of this Bag, were the Cause of the fistulous Discharge, and of the continuance of it outwardly. As to the Pin found in the Rupture at the Time of the Operation, it is observable, that two Thirds of it, incrusted with a chalky Matter, were confined and concealed within the Gut; the other Third next the Point, had made its way through it, the Point of which was so lodged in the Omentum wherein it was fixed, as to leave a free Passage for the Excrement from the perforated Gut outwardly, whenever the Perforation in the Gut, upon shifting the Position of the inclosed Pin, could open, and afford a Passage for the Discharge of the Faeces this way, which was as oft as this conical or pyramidal Pin did alter its Place, or did not exactly obturate the Aperture in the Appendix Coeci, it exactly fitted. I have already observed, that the Aperture made in the Gut by the Pin, lay concealed, the Point being lodged in the Omentum, lying parallel with the Gut, which was here duplicated; where it was so secured, that it seemed almost impossible it could ever make its way out of this Place, and its other Confinement in the Gut, as the Aperture was callous, and so resisting that it was with some Violence it was forced out of its Confinement through an Aperture fitted for the Point only and so streight, that the Report upon its coming out was like that of a Cork out of a Bottle; for though it appeared the Opening had occasionally been inlarged, as the incrusted Part of the Pin was pressed forward into it, yet it is plain Nature's Attempts to get rid of it had been fruitlefs, and might possibly have been so during all the Patient's Life. Sir Hans Sloane has furnished the Curious with Instances of Bodies incrusted in the Guts with Stone, and of some making their way out. when there was little Probability of it. Daily Experience shews, how far Nature will struggle to free herself, so that it is always most eligible to trust them to her Care: This may appear from the Difficulties that have attended the Cure of this Case, which at last did not prove so succesful as it was first hoped for; for the Patient having been remiss in the wearing of his Truss, upon some Effort the Guts found a way into the Inguen again, six Months after the healing of the wound. This Case also shews, that the best Operation, and the utmost Care, is no Security against the Relapse of a Rupture. This is the 3d or 4th Instance I have met with, of the Insufficiency of this Operation to effectuate a Cure of Ruptures; and yet it is plain, this is by far more likely to prove effectual, than the Caustick or any other Method cried up for the Cure of this Evil. In a growing Age, a good Spring Truss is an effectual Remedy; and in an Adult, this should be the ultimate one. though it is no more than a Palliative Cure. N. B.