The record-union., 1897-02-26

does the opening of the abdominal cav
lty with all the attendant dangers.
There seems to be popular but
wholly ~unwarranted impression that
Inflammation of the appendix means
certain death unless removed by the
surgeon. The appendix is a vital or
gan, but not necessary to life. Other
more vital organs-as the lungs, stom-
ach, liver, etc.-are essential to life,
consequently when attacked by inf1am-
nation no attempt is made to remove
them, but they are treated medically,
and as a general rule the disease is
moved. Why not treat the inf1amma-
ton of the less vital organ in sim
liar manner, and avoid the dangers of
surgical measures? For Inflammation
of the appendix is no more serious, and
usually less serious, than Inflammation
of other organs.
There are certain distinct, wellde-
fined symptoms, the manifestation of
which justify surgical measures, and
these are such as clearly indicate to
the skilled surgeon that suppuration
has occurred in the appendix. and that
the pus has broken through the inclos-
ing wall of the appendix and entered
the abdominal cavity. Then, and
without unavoidable delay, should the
surgeon open the abdomen, cleanse the
peritoneal cavity, remove all diseased
tissue, and if skillfully done the
chances are even that he will save his
patient While delaying operative
measures, nature, which always strives
to remove disease and restore health.
may succeed in esta blishing resolution,
reabsorbing all extravasated fluids, or
pus having formed, may provide adhe-
siOnS between the appendix and adJa-
cent intestine. through which 1t may
discharge, or it may establish adhe-
sions with the abdominal wall, where
the pus will point and on resulting
distinct f1uctuation the surgeon can
lance the tumor and give free exit to
the pus.
This last result has occurred in my
own experience, the patient fully re-
covering, never having suffered re-
currence to my knowledge.
AS to recognized symptoms demand
ing operation, l quote extracts from
recent article in a standard medical
journal, giving rules for operating in
"Of all symptoms indicating danger,
consideration of the pulse is the most
important A 'snappy,' inflammatory
pulse continuously accelerated, or in
creasing in frequency indicates the
necessity for operative interference
Localized pain is an important element
in diagnosis, but not reliable as guide
for operation. Sudden increase of pain
is a leading symptom of perforatlon'
meaning but little in itself, in estimat-
ing the time for operation, but taken IN
connection with other symptoms be-
comes corroborative. Increase of three
elements in the order of their impor-
tance, pulse rate first, pain localized
and progressive second and tempera-
ture last constitute the cardinal symp-
toms for operation. The gradual sub
sidence of these symptoms is leglt-
mate reason for postponing operative
interference. In the case of abceSS IN
the absence of frequent symptoms 1t
is better to wait until adhesions have
formed a protective wall. One attack
does not of necessity mean that sub
sequent ones are to follow, and each
case should be treated according to its
indications at the time, whether an
acute condition. or the lighting up OF
an appendix which had previously
been the seat of an Inflammation"
The attack of appendicitis suffered
by Madam Modjeska in Los Angeles
quite recently which received such gener-
al notice in the public press was treated
strictly in accordance with the rules
as above quoted. Resolution took
r,Ic advocated
by some of the consulting surgeons was
avoided, and complete recovery is the
reward and no doubt Madam Nodes
ka is duly thankful for her escape
from the surgical ordeal.
The appendix, like several other or
gans of the body, has no known func-
ton or use, but because We do not
know it's Use does not prove that the
Creator had no purpose in its creation,
and a human being with the appendix
removed is not a complete or perfect
individual physically and there is no
justification whatever for the reckless,
indiscriminate removal of the organ,
as practiced by some surgeons of the
day who, taking advantage of the con-
fiding credulity of the public, are prac-
tically guilty in many cases of surgical
murder.
The work of the surgeon Is truly
fascinating, and he loves to operate,
but no true surgeon permits his ambi-
ton to dull his sense of duty, or lessen
his respect for the rights of his con-
fiding patient. Don't understand me
to mean that the fascination, while
great incentive. is the only reason for
operating, for the large and very lib
eral fee usually charged is, l regret to
say, a very important consideration.
Does any person believe that if no
greater fee was received for surgical
interference than for proper and skill
full medical treatment that oper-
ative measures would be so indis
criminately advised and such unjusti-
fable risks taken?
A patients dependence rests entirely
upon the skill, honor and integrity of
his physician or surgeon, and usually
is not misplaced, but when two or
more surgeons, bound closely together
by professional ties, are alone present
during an operation and find that a
grieVous error of diagnosis has been
made, is it natural to expect them to
reveal the mistake and retire in dis
grace, or to gloss the affair over and
make such report to the patient or
friends as will best ease their anxious
hearts?
There are instances reported where
physicians have cut open the abdomen
al cavity in so called appendicitis and
utterly failed to find the appendix, and
closing the incision have reported to
the friends that the offending organ
was removed and the patient could not
have survived many hours without the