The St. Louis Republic. [volume] (St. Louis, Mo.) 1888-1919, 1901-02-03
Appendicitis
Not a Fad.

Surgeons are often asked whether appen-
dicitis Is not a fad. and whether our grand
fathers ever had appendicitis. etc. AS a
matter of fact. in my early professional
days, appendicitis was well known. But 1t
was called localized peritonitis' or local.
lied "abscess": but. while the disease was
very frequent. its relation to the appendix
was not recognized until from his study Of
its pathology an American pointed 1t out.
Even now European surgeons. with a few
exceptions. are not alive to the need for
operation in such cases.
There is little doubt that the great preva-
lence of grip during the last few years
has increased the number of cases of a.p-
pendicitis. both Of them being catarrhal
conditions Of the lining membrane OF the
same continuous tract of the lungs, the
mouth. the stomach and the intestines.
One OF the most fatal accidents that can
befall a patient Is to have an ulcer of the
stomach perforate so that the contents OF
the stomach escape into the general alb
dominal cavity. Until 1855 no one ventu-ed
to operate In such a case. In an inaugural
dissertation by Tinker OF Philadelphia S3
cases OF such perforatipg ulcers OF the
stomach were reported. Of which 13 recov-
cred. a mortality Of 1881 per cent. In not
a few of them. IL prompt instead OF late
surgical help had been invoked. even a
still better result would have been reported.
II no operation had been done the mortality
would have been 100 per cent.
In cancer of the stomach itself we ere
able. as a rule. to make a positive diagnosis
only when a perceptible tumor Is found. By
that time so many adhesions have formed
and the infection has involved the neigh
boring glands to such an extent tina it is
impossible to remove the tumor. but the
statistics even here are not without en-
enlargement. at least for comfort II not for
life. In many cases the tumor has been re-
moved and the stomach and intestines
Joined together by various devices. and the
mortality. which is necessarily great. and
the mortality. which il necessarily great.
has been reduced by Czerny to u per cent
and by Carrie to I per cent. Even the en-
tire stomach has been removed in several
cases and recovery has followed in alb ,ut
one-half. Most of these patients. however.
have died from a return of the disease.
When. as a result of swallowing caust;c
I've or other similar substances. the outlet
Cthe oesophagusl becomes contr acted to
such an extent that no food can be swal-
lowed we now establish an opening into
the stomach through which a tube is In
serted at meaitime and the patient has his
breakfast. dinner and supper poured into
his stomach through the tube. II the stric-
ture OF the oesophagus Is from malignant
Z disease. Of course this only prolongs life
by preventing a horrible death by starva-
ticn. but in cases in which it is nonmaiig-
ndnt lie II lnueinltciy prolonged. The NOR.
tality OF such an operation Is very small.
BY a freak of nature or disease the ston-
ach sometimes Is narrowed In the middle.
forming what Is called an 'hour-glas as
stomach" In such a case We open the abb
domen. make an opening Into the parts Of
the stomach and unite the two SO that We
re-establish the single cavity OF the stom-
ach. The mortality of the operation Is very
slight. s per cent.
Again, sometimes the stomach be-
comes unduly diiatcd, thus Interfering
seriously with Its function. A number Of
surgeons in such cases have simply folded
over the wall OF the stomach upon itself
and have sewed 1t together. taking a plat
or tuck" in the stomach wall and have
restored 1t to its normal capacity and
function.
One of the most important advances has
been made in the treatment Of gall stones.
The bile in the sail bladder is In q state
of Quiescence which In favorable to a de-
posit of crystals from the bile. These crys-
tails become agglutinated together into
larger or smaller solid masses. called gall
stones. Sometimes the number Of these IL
very small, from one to four or I'VE; some
times they accumulate In enormous num-
bers, several hundreds having been report
ed in a number Of instances. Where they
are small they can escape through the duct
Of the gall bladder into the bowel and create
no disturbance but Uhsso tha1 are large