Surgery for appendicitis

The story of Phyllis is a particularly sad one. Her father, who had worked on a farm, died of heart failure caused by over-exertion and exhaustion. This was in 1903 when Phyllis was three years old. Her mother was left with six children and another on the way. They were living in Kenton in Middlesex.

A month and a half later and Phyllis’ mother was struggling. Phyllis’ eldest sister, Dolly, was working as a servant and living away from home. Another of Phyllis’ siblings went to live with relatives, but this still left four children for Phyllis’ mother to provide for.

The shock of her husband’s death had made Phyllis’ mother unwell, so much so that the family’s doctor thought she would need to have a serious, and potentially fatal, operation. She wasn’t working and the family was living in temporary accommodation, which they would soon be forced to leave. For all these reasons an application was made for Phyllis and her elder sister, Ida, to enter the care of The Children’s Society (then known as the Waifs and Strays Society).

One month later, both Phyllis and Ida entered The Society’s Lampson Home in Dulwich, London. Here they both stayed until 1908 when Ida returned back to their mother. At this time their mother was unwell again, as was their grandmother who had been helping her. Ida was 15 years old by this point; she returned home to help her mother, and the intention was for Ida to go to work in domestic service once her mother was well again and no longer needed assistance.

As she was only eight years old, Phyllis remained in the Lampson Home. We don’t hear anything more about her until a year later, when there is the following letter:

Letter from case file 10143, giving the news that Phyllis had died of appendicitis following an operation, 1909

500 Lordship Lane. S.E.
May 13/09

Lampson Home

Dear Mr. Rudolf,

It will grieve you to hear that
Phyllis [surname] [died] on the 9th. inst. [instant] at Guy’s
Hospital after an operation for Appendicitis.
She was a very good girl, and we are all much
saddened by her loss. We have arranged for
the funeral at Honor Oak Cemetery at 11.30
on Saturday next.

Yours sincerely
 Ths [Thomas] Douglas.

Another letter tells us something about Phyllis’ character:

… she was one of the nicest little Girls in the Home & a great favourite with us all & also with her teacher & her school-fellows, her teacher was particularly fond of her.

Sadly for Phyllis, it seems that the operation wasn’t able to save her, despite having been treated at the prestigious Guy’s Hospital in London. The causes of her death are given as appendicitis, peritonitis (inflammation of the lining of the abdomen) and heart failure.

Appendicitis was first named in 1886 and surgery to treat the disease started to become more common after that point. Most famously King Edward VII had to postpone his coronation in 1902 in order to have urgent surgical treatment for appendicitis. Edward VII’s operation was successful but, sadly, not everybody survived the new surgical technique. From what we have found so far in the Unexplored Riches in Medical History project, appendicitis was fatal in 40% of cases of the disease. These figures only come from a small sample, so they are likely to change as the project continues, but it does suggest that surgery to treat appendicitis over one hundred years ago was not any way near as successful as it is today.

In many cases, it was not the surgery itself but complications of the disease that proved to be fatal. Mortality rates were high for people, like Phyllis, who were also suffering from peritonitis, which is an infection of the lining of the abdomen. Surgery to treat appendicitis would remove the infected appendix, but if the infection had already spread to the rest of the abdomen, there was little that could be done. Mortality rates only began to drop when antibiotics started to be used alongside surgery in the 1940s and 1950s.

Unfortunately for Phyllis, in 1909, with her complications her prognosis wouldn’t have been good. Surgery would have been her only hope for treatment, but it seems that her disease was so far gone that even that wasn’t enough to help her.

Burning books, toys and clothes?

Diphtheria can be fatal, and before 1940 it was one of the leading causes of death in children. It’s an infectious bacterial disease that affects the upper respiratory tract and instances of it were common in the early-20th Century before vaccination against it became widespread.

Due to the infectious nature of the diphtheria, it could spread quickly through children’s homes if any of the residents caught it, and a number of our records mention outbreaks of the disease.

The letter below sent to head office from St Nicholas’ and St Martin’s Orthopaedic Hospital and Special School in Pyrford, Surrey, dated 1927, shows some of the measures taken to try to combat outbreaks of diphtheria.

Letter discussing the need to burn school books thought to cause an outbreak of diphtheria at St Nicholas' and St Martin's Orthopaedic Hospital and Special School, Pyrford, Surrey, 1927

Dear Dr. Westcott

Dr. Hardy is of the opinion that
all suspect school books & material should also be
burnt at S. Martins, in view of Diptheria [sic] which
is still going on there. Miss Hutchinsons estimates
that to replace these would cost from £30-£35.

As we are £15. in hand, on the £35. sanctioned
by you at your last meeting, on S. Nicholas School,
may we please be allowed to add £15.0.0
to our expenditure for S. Martins.

My Cttee. [Committee] recommend this for your approval.

Yrs sincerely
K.A. Tringham. Hon Sec

Other letters in the file show that it was thought, in this instance, that the disease had entered the home through books and toys that had been donated by the public for the children to use. As they were thought to be the cause of the outbreak, the books and toys were burned in an attempt to stop the disease from spreading further. The rest of the letter asks The Children’s Society (then known as the Waifs and Strays Society) for further funding for new replacement books and toys to be bought; which later letters show was granted.

As a result of the incident, it was decided that used toys and clothes should no longer be donated to St Nicholas’ and St Martin’s due to the risk of infection. At first glance, this may seem like a strong reaction, but things become more clear when you realise that St Nicholas’ and St Martin’s specialised in looking after children with conditions such as tuberculosis, polio and rickets. These children would have been very susceptible to diphtheria and other infectious diseases and the managing committee didn’t want to put their health at further risk.