New-York tribune., 1899-07-18
FASHIONABLE APPENDICITIS
DOCTORS STILL DISCUSSING THE BEST
METHOD OF TREATING THE DISEASE
ToN1r1s-NoT PROBABLY MORE FREQUENT.
II Is SAID. THAN YEARS AGO

I
ferers. has led TO renewed interest in this sub
ject. and In the ever constant discussion the
I best method OF treating the disease whether as
many eminent surgeons and others hold Il is wisest
to adhere TO the early operation originally ad-
Vised by Dr. McBurney to stick to the timely
/ operation" that has come into vogue through the
/ nsistence OF the general practitioner One
traordnary thing concerning IT all is that science
mas been bic 10 account with any degree OF GER
tanty for the vermiform appendix The most gen.
orally accepted theory now seems TO be that II Is
rudmentary stomach or intestine. and that in
prehistoric time II actively useful organ OF
| the body but that in process OF time it became
longer useful, and from II has dwindled TO
its present proportions Certain IL is that Mother
Nature never works ir vain. and that while often
| the reason for what she does may not appear on
superficial observation closer examination invaria-
bly, reveals good for all she does
! DR.. Wynkoop. In speaking OF the disease yester-
day. said:
! AT the present time appendicitis Is fashionable
disease. You hear Of a hundred cases OF IL to-day
where twenty years ago you did not hear OF one.
and yet I believe II Is not more prevalent
than then. The is that the disease Is
/ ognized now, where formerly It not. In past
| times what know 10 be appendicitis was
known peritonitis because peritonits Is OF
the most prominent symptoms OF appendicitis. and
is secondary 10 appendicitis The relationship be-
tween peritonitis and appendicitis and the causa-
tion Of the latter lying within the former. not
| formerly known Peritonitis idopathlc dis
ease. is believed rarely to occur. It is almost
wholly secondary to infammatory or perforative
I diseases of Of the abdominal organs and in
! the causatlon Of It the appendix vermiforms'
stands In the very front rank
SUDDEN ONSET OF THE DISEASE.
The vermform appendix is outgrowth from
the intestine the point OF junction Of the large
| and small intestines II varies in length from
three to six inches. and is about the thickness OF
| HEEL
and the intestine but the free end is cu de sac
Appendicitis consists Of an Inflammation OF this
organ. This Inflammation may be catarrhal.
| caused by the lodgment Of some foreign body
which has passed from the intestine into II and
been unable to escape. Appendicitis from what
ever cause, has a sudden onset person in seem
ingly perfect health within three or four hours
may become seriously I'll. the chief symptoms being
pain in the right side Of the abdomen, low down,
accompanied by fever and often by vomiting.
Some cases rapid course. and fatal with
in twenty-fou thirty-six hours Some last for
several weeks. A small proportion OF the
| tend TO recovery without surgical assistance but
by far the largest portion without such assistance
are fatal In those which without operative
interference. recover. there is tendency 10 re-
lapse, a second. third fourth recurrence appear
ing intervals OF from or three months TO
! two three years. As rule. those cases which
! tend TO natural recovery easily recognized By
! signs. and in such cases naturally. no operative
| interference IS advised practised at the time
The tendency TO relapse. which Is now recognized.
has led 10 the belief among the best surgeons that
| In a period between relapses. when the patient is
| in thoroughly good health the safest is 70
| remove the appendix. In those severe cases which
| 90 not tend to natural recovery. operation is not
| only the best. but It is the only safe course 70
| pursue Operation Will not every OF these
| severe cases but IT will the OF them.
and those cases which prove fatal with operation
| will be equally without It,"
DIR. MAX MYER AGAINST OPERATIONS.
Dr. Max Myer the microscopist Of the Board Of
| Health. said:
symptoms Of appendicitis are generally a Pc
! cunarly piercing pain or right side OF the alb
| domen toward the hip bone, generally accompanied
| by constipation and localized pain. and II there is
suppuration It is sometimes necessary TO have an
operation. I think that many times where an op-
GRAFTON is performed a counter irritation would
| answer the purpose as well think operations are
! overdone There are more operations performed in
this country than in Europe. which would indicate
a fondness for operations on the part Of our doc
! tors and surgeons I have known OF cases where
| Il was found after removing the appendix that
there Inflammation at ah'
| Formerly Il was generally supposed that the first
outward manifestation Of the presence Of append
! ctls was the beginning of the disease This later
| investigation has shown tC be not So but rather
that the outward manifestation OF the disease is,
| theory is held to still in many quarters and the
great authorities are emphatic in pointing out this
difference. 1t is OF vital importance in treating
| the disease Dr. Willy Meyer. the attending sur
| geon to the German and New-York Skin and can
! Ger hospitals and Of the leading surgeons OF
| the dav in paper read before the Metropolitan
Medical Society on December 3. 1895. discussed the
time when II Is necessary operate FOR append
ctis and brought out this point very clearly as
| follows:
It would, no doubt, be very wrong 70 believe that
pafboiocicai symptom which befalls the appendix.
First explosion" would better express seems 70
faecal concretons so often found In the appendix
do not form over night structure wnen SHUTS o on
! upwardly an abscess within the tip OF the organ
sometimes found on cutting K osea sst n Ia aPBeHan
S6ss Taeh NOV wa deveop Within few days Thus it
/ clear that explosive material slowly accumulates
WINGS snn sloViv set in within the different struct-
ures OF wall also often OF the nourishing yes
| climax: the ammation-breaks
! out
ADVOCATES OF OPERATIONS
DR.. Robert Able the attending surgeon at St.
Luke's Hospital and the New-York Cancer Hospital
and assistant attending surgeon ar Roosevelt Hos
! pital IS also impressive in making the same point
! rr Abbe is a firm believer In the value OF opera
ton and in The Medical Record" OF July 10. 1897,
| says:
put 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 perfected
rethods 70 remove these dangerous chronically in
famed organs through small incison (usually one
| inch Iong) and leave the abdominal wall practically
| normal in both appearance and function"
In the paper above referred 10 DR.. Willy Meyer
eyhaustvely treats OF the subject. He says, among
other things:
First-In cases OF difruse perforative appendicitis
! the operation must always be done at once. Pa
tisnts nave the best chance 70 recover II operated
! unon within the first twelve hours Exceptionally,
| nstients get well without an operation
| secondeIn case OF acute appendicitis the patients
iwsvs need careful observation II the pulse goes
IN sbove lI6 10 l20 and has the tendency TO stay
there the indication for an operation Is given
| In csse OF doubt the operation Is better than
| waiting. .- ,--us, ...o.L ., a.
Thrd-In cases OF subacgte 'miog attacS i OF ZAP, ap,