The sun. [volume] (New York [N.Y.]) 1833-1916, 1907-05-05


tSlsst hlS BAN, bdkisI e Sbsttds
ing hid pain does not mean renewing Il
souTcs. Whsneytf 3 Conplsle recovery
IL Witnessed without operation 1t is nattul
that cures.
It Is far better when there 10 good grount
for believing that appendicitis exists Il
u the risks Of operation than 70 run th'
riaks Of peritonitis. $50 Impressed am T.
l'says DR.. osler. shat we physicians Loo,
lives by ~tempoziSfng with certain oases d
appendicitis that I prefer In hospital wora
TO have suspected pasaa admitted directly
to the surgical side.' In that variety oI
the disease marked by regular recurrence,
Of slight attacks 10 IL the better part oi
valor for the patient 70 60 TO q hospttAl
during an interval between them apd
50 have his c~antankerous appendix eut
out under the best possible conditions.
Such at least 10 the opinion Of the ma
jority OF the worlds most eminent physi-
cians--Amedpsn. English, German and
French-to-day. But 1t must be said In
all fairness that there 10 also q respectable
minority which holds that surgery is
reSorted to with too great Frequency. and
that nature and proper nursing are capable
OF curing q large proportion OF cases. Prof
Dieulafoy. b F~renchman, insists that opera
tions for appendicitis are often performed
upon people who are really in the first stages
Of typhoid fever u have nothing worse than
a simple colo, Doyen and other dissentsr
make even more serious allegations.
This recalls the story OF the American
who was subject TO Ats and feared that
while unconscious he would be hustled to a
hospital and relieved Of his appendix. To
guard himself against this he carried In bis
pocket a paper reading: If I am picked
up on the street please don't cut out my
appendix; il has been removed twice al
ready" Another American, after recov-
'ering from an operation for appendicitis,
had the following tattooed over the soar:
Keep out; there's nothing inside"
Those who oppose surgical Interference
base. THAR chief argument upon the fact
that appendicitis ia a self- Limiting and SELF
curing disease, The le~uoooytes of the
blood, as we have seen, engage in a battle
with the germs In the appendix as soon az,
they appear, and under proper conditions
this battle is likely to be successful.
In such cases the patients pain lessons,
his temperature falls, bis nausea dfsap-
pears, and in a short while he is we'll again
Sometimes the germs are wiped out en-
tirely; at other times they spend them
selves in forming some sort Of a ttumor,
which in the course OF time will be alb
sorbed. But it Is plain that q man who
has once had appendicitis has proved that
his appendix Is liable to the disease and
that in consequence his chances Of having
it again are above the average. The only
who is certainly protected against
it lie he who has lost his appendix.
When the leucooytes are defeated in their
battle and there is no surgical interference
the diseased appendix becomes mors and
more infamed and the number Of germs in
it increases enormously. Finally they
break through it's walls and are scattered
broadcast through the abdominal cavity.
Here they find immediate Judgment in the
peritoneum, the thin membrane which
encloses, like a bag, the whole contents Of
the cavity.
The membrane begins TO grow infiamed
and the condition that results may be com
pared roughly to that observable in the
membranes of the nose during a very bad
cold. The germs, being thus well nourished
and housed, give forth their characteristic
In immense quantities. These
p~oisons then disable the heart and brain
and the patient dies.
A pathologist named Fitz was the first to
make an exhaustive study Of appendicitis.
This was In 1888. Since then q large number
of eminent m~en-Kelly, Hurdon, osler,
Dupuytren, Addison, Bright, Hodg-
kin, latham, Nothnagel, Elnhorn and
others-have studied it's varied aspects. At
such centres of medical research as Vienna,
London. Hamburg, Berlin, Paris, Balti-
more, Chicago and Philadelphia it has led
10 elaborate experiments. AS a result
is one OF the comparatively
diseases which the modern physician
approaches with confidence. He knows
what causes it and how 10 cure il.
The death rate from the disease lie slight.
In the United States each year about one
hundred and forty persons in every million
die Of it. In certain large cities the per-
10 higher and in other districts
It IL lower. In Germany, Austria and Eng
and it is decidedly less prevalent.
A few years @ 1t was the universal
among the laiety that appendicitis
vas alwa Us caused by grape seeds or other
lard substances. Recent research scarcely
out this notion. True enough, II
s common TO find foreign bodies In dis
,ased appendices, but whether these things
rave actually caused the preliminary irri-
alton. or have merely had their entry |
nto the appendix facilitated by condi-
ions already existing, is q matter for de-
,ate.
1t Is known, however, that severe blows
'ver the appendix occasionally cause APP
'endioitis. The resultant injury affords
tray germs a lodgment, just as a scratch
the face affords a chance for germs 20
ettle down and produce a boil, and after
while a general Inflammation is in prog
ess and the surReons have another task