The Anderson intelligencer. [volume] (Anderson Court House, S.C.) 1860-1914, 1899-08-09

the beginning Of the disease. This
later Investigation has shown to be
not SO, but rather that the outward
manifestations of the disease is, so to
speak, the beginning of the end. The
old theory is held to still in many
quarters, and the great authorities arc
emphatic in pointing out this differ
ence, as it is Of vital Importance in
treating the disease. DR.. Willy
Meyer, the attending surgeon to the
German aud New York skin and can
Ger hospitals. and one of the leading
surgeons of the day, in paper read
! before the Metropolitan Society ON
December %, 1895, discussed the time
when it is necessary to operate for
appendicitis, and brought out his
point very clearly as follows:
1T would, no doubt, be very wrong
to believe that the first attack Of in
fammation really is the first patholog-
ical symptom which befalls the ap-
pcndix. First explosion would better
express, it seems to me, the actual
occurrence. We all know that the
faecal concretions 80 often found in
the appendix dc not form over night;
a structure which shuts off upwardly
an abscess within the tip of the organ
sometimes found on cutting open an
appendix which was removed during
the first inflammation does not develop
within a few days. Thus It is clear
that explosive material slowly accu-
'mulates within the lumen of the ap-
pcndix; that important changes slowly
set in within the different structures
OF its wall, also often of the nourish-
ing vessels in its mesenteciolum. At
last it comes to climax; the conha-
Observation-Disclosures out"
DR.. Robert Able, the attending sur
geon at St. Luke's Hospital, and the
New York Concer Hospital, and assist
ant attending surgeon at Roosevelt
Hospital, is also impressive in max
ing the same point. DR.. Able is a
firm believer in the value of operation,
and in the Medical Record of July 10,
1897, says:
''But who can afford to wait the
perilous delay when the surgery of
the day offers safe and speedy relief?
It is now possible by recently per-
fected methods to remove these dan
gerous chronically infamed organs
through small incision. USUALLY one
inch long,) and leave the abdominal
wall practically normal in both appear
ance and function
In the paper above referred to DIR.
Willy Meyer exhaustively treats of
the subjec.. He says, among other
things
First-In cases Of diffuse perfora-
tive appendicitis the operation must
always be done at once. Patients
have the best chance TO recover if
operated upon within tho first twelve
hours. Exceptionally, patients get
we'll without an operation.
Second-In cases Of acute appen-
dicitis the patients always need care
full observation. IF the pulse goes up
above 116 to 120 and has the tendency
to stay there, the indication for an
operation is given.
In case Of doubt, the operation IS
better than waiting. ~.
Third--In cases of sub-acute (mild)
attack Of appendicitis, also after the
first severe attack from which the
patient recovers without Immediate
operation, the appendix should be re-
moved. The appendix, once inflamed,
has to be looked upon as diseased
organ, which is very apt to give re-
peated and more serious, even fatal
trouble in the future.
When done at this time we can al
most always perform the blunt divis-
ion of the abdominal muscles ac-
cording to the direction Of their fbres,
and thus save the patient the probable
appearance Of ventral hernia.
TIE KNIFE IN APPENDICITIS.
To the Editor Of the Tribune The
letter published in your issue of July
13 relating TO operations for appen-
dicits calls for the. endorsement Of
maoy members Of the profession who
feel that the knife is being used much
too freely 10. these cases, aud that
Lives are needlessly sacrificed in con-
sequence. Typhlitis, or perityphlitis,
the name by which appendicitis was
formerly known. has never been con-
sidered as an especially dangerous
disease, and never until the operation
eArfs& noxyx :, srA<. s,nr.,- :, - 4 Fxl !.