The evening times. [volume] (Washington, D.C.) 1895-1902, 1902-09-17
Physicians in Conference
Discuss Subject Of
Appendicitis,
EARLY OPERATIONS FAVORED
American Association of 0bstetTicians
and Gynecologists Takes Up Malady
of the Day-EIection Of officers aud
Banquet to Be Held This Evening.

Appendicitis, was the subject dis
eussed at the second days session this
morning of the fifteenth annual meet
ing Of the American Association OF OBJ
stetricians, and Gynecologists, held in
the convention hall at the Hotel Ra-
leigh. The subject was taken up IN its
different phases in treatises prepared
and read by several authorities and then
discussed at length by all present.
One paper read by Dr. John B, Deay-
CT, OF Philadelphia, and entitled Star
vation, irrational treatment of appendi-
citis,' was Of particular interest
Dr.. Beaver drew two leading deduc-
tions from his experience in the treat
ment Of the disease:
First that an early operation. prefer
ably in the stage OF aDDendiceaI collie,
is the only rational procedure, and is
the only treatment ~hich viii reduce
the mortality in acute appendicitis to
Insignificant figures
Second, that the so-caIled rest
treatment Of appendicitis fails TO check
peritoneal Inflammation. and viii IN the
majority Of instances harm the patient.
Removal of Appendix.
Were it possible" said Dr.. Beaver,
TO be as cock sure Of the degree and
archaeological type Of the peritoneal in
fiammation as We are Of the good re-
suits following the early removal Of the
appendix, then and then only. might
there be ground for urging in favor Of
delay To claim to foresee the degree.
type. and extent Of the peTiJoneal in
hammauon is. 10 say the least, absurd.
Il Is the privilege CT the gentlemen who
make these pretensions TO claim SO
great knowledge, but to possess this
knowledge I do not think any sane NOR
tai viii admit I have no sympathy for
those deceiving themselves IN this way,
but great sympathy for the poor suf-
ferers who unfortunately come under
their care
Sc9rss the crest Cure"
I'VE clam 10 be able TO recognize a
grave tyr e oeritonitis. but beyond this
We maRe ID pfetensions and have but
little conf, nee in statements made as
to tie degree. type. and extent of the
peritons4I infection Bearing this in
mind - wish to sound a note OF warn
ing against The advocates Of the So
called rest or starvation treatment Of
appendicitis not, however, against the
practice IN certain cases OF washing out
the stomach and giving of all nourish-
me1t PEI Tectum. For this method, it
is claimed that, By Withdrawing all
nourishment and cathartics By the
mouth. by rectal feeding, gastric Iavage
and the use Of small doses Of opium and
local antiphlogistics, particularly anti
phIogistine whatever that may be)
which ! have seen used, the extension Of
the peritoneaI Inflammation in the pres
enee OF gangrenous and perforative
appendicitis viii regularly remain cir
cuRscribed.
1T is further claimed that these pa
tients recovering come TO the operating
table with their abdominal cavities
practically in a normal condition ex-
cept occasionally a small abscess at the
site of the origin of the trouble, or the
presence Of adhesions- Lastly, il is
claimed by the use of this method Of
treatment the mortality of acute appen-
dieitis may be markedly reduced.
Against these statements il is the
object Of this paper TO protest and TO
make a firm stand against any form Of
treatment, other than early operation,
aiming 10 restore the peritoneaI cavity
10 the condition which exists in the
early hours Of an appendiceaI infamma-
ton.
Operation Versus Rest
The authors experience for the PAST
two and half months mas furnished
the lesson from which the objection TO
the rest treatment is drawn
From June Is 10 September / there
were operated upon in the German He's
pitaI ninety-eight cases Of appendicitis.
not including the cases occurring IN
children. CThese statistics we're com
piled By my senior house surgeon, Dr.
AulieT-J Twenty-seven cases weHre Of
the type called chronic and all recov-
cred. The remainder. seventy-one. were
acute IL character and twelve died, 4
mortality Of 16-9 per cent"
Instances Cited.
Dr. Beaver then proceeded to instance
particular cases as illustrating the ne
cessity in general Of an operation at an
early stage Of the disease.
'Thirty-two patients" he said. '-suf-
fering from acute appendicitis, were
sent 10 the hospital early in the course
OF the disease and in whom the infective
process was limited TO the appendix or
TO the tissues Immediately contiguous
These cases were operated upon imme-
diayely after cleansing the digestive
tract with a gentle cathartic or after
the giving OF an enema They were
typical OF the acute type Of appendicitis,
with the sudden onset. the usual symp-
toms and swollen edematous and con
gested appendix
IN a few cases there was q small alb
esss Immediately about a necrotfc focus
il the appendix.
With the exception of one case they
all made a nice and uueyentfuI recovery.
The single death was E1an Of sixty
four years o. age, whose appendix was
removed twf.lv5 hours after the onset
OF the attack His abdomen was closed
with silk tier sutures. and he made a
good. recovery from the effects OF the
operation Nine days later he collapsed
and suddenly died from cardiac diluta-
ton Autopsy showed a healthy peri
tcneum and the wound in the eecum
healed and in good condition.
Loss Of the Appendix.