Ellsworth American. [volume] (Ellsworth, Me.) 1855-current, 1910-03-30

seiote insieuincAnt, and in conse-
quence from this point OF view there is no
objection to its removal by operation.
VARIOUS TYPES OF APPENDICITIS.
In order to appreciate the value Of the
treatment Of q case OF appendicitis, it is
necessary to consider what course a case
may run when left to itself, and this il. it
is scarcely necessary to add, not the
same In every instance. In one case al
Inflammation sets in, runs its course, sub
sides, and leaves nothing Of . serious kind
behind it. The patient gradually RECEIVERS
completely, and some never have any
more attacks, and some have repeated at
tacks Of the same kind or OF more seri-
GUS kind
In the second place, sometimes things
do not go quite so simply, bat the infiam-
nation goes on to the formation of pus or
matter-that is, the case Is of the suppurs-
tive type. There is danger here; for, al
though the abscess so formed in connec-
ton with the bowel may burst out
through the skin and all 90 well, or may
burst into one Of the internal organs and
find escape by natural passages and all 20
well, yet the abscess may burst into the
cavity OF the abdomen, and then all will
go wrong; for peritonitis, ending in
death, will be the sure result.
In the third place, the Inflammation
may be SO intense from the start that
almost immediate modification or death
of the appendix may take place, and an
opening is thus formed for she escape of
some OF the contents of the bowel into the
cavity OF the abdomen, and an immediate
peritonitis is set up, with death in q few
days as its only possible result; and these
cases are unfortunately only too common.
There is, therefore, a real danger OF death
in case OF appendicitis, q death which is
often only preventible by a recourse to the
knife As soon as the illness begins. Indeed,
the operating surgeon soon gets to view
the appendix as a veritable death trap.
METHODS OF TREATMENT.
This being the kind OF trouble which
is called appendicitis, the views reported
as having been expressed at the recent
international medical congress st Buda-
pest may be recalled. 1t is reported that
there were three views expressed by
those who took part in the discussion
First, there was the view that cases of
appendicitis should not be operated upon;
second, the view was expressed that all
cases should be operated upon, and third,
there was the view that some cases should
be subjected and that others should not be
subjected to operation.
In consideration of the fact that rapid
death can occur in certain cases and that
death in cases of the same kind is
regularly prevented by timely operation,
the first view, il indeed it was ever seri-
ously advocated by people competent to
discuss the subject, may be confidently set
aside as an absolutely erroneous and
dangerous doctrine.
Also, in view OF the fact that many
cases OF appendicitis are of trivial nature,
pass OF and never again give trouble, it
is evident that to have operated upon
these would have been quite wrong, and
therefore the second reported view that all
cases should be operated upon indiscri...-
inately may also be set aside as in
correct. 1t may be erring on the safe side
to operate on such cases for fear they
should be more serious than they look,
but it is nevertheless erring.
And, lastly, the third view, that some
cases require and others do not require
operation, is undoubtedly the exact one;
and this is the doctrine which ought to be
followed in appendicitis.
On consideration OF the best view, it is
seen, however, that it implies more than
the other two, for il means that the dis
elimination as to when to operate and
when not is left TO the judgment of the
surgeon, and requires, therefore, q surgeon
capable Of judging.
II the surgeon were regarded as a man
incapable of judging, as a mere machine
to be applied by the public, then the
second view would be the one for the pub
lie to adopt. e., every case should be
operated upon; but where the surgeon is
looked upon as q man able to discrimi-
nate, then the third view is undoubtedly
the correct one.
1t has been claimed that, il an "expe-
ton should go on or be ssrisked'', but that,
il an "tnexperienced surgeon only could
be commanded, that the operation should
not go ON and the disease be "risked".
But it is necessary to inquire what is
meant by an experienced" surgeon. A
strict disciple of modern surgery, provided
that he does not destroy an organ whose
function is necessary to life, can, as rule,
do almost anything in the body without
death following as q result Of his work,
given q moderately healthy individual free
from the deleterious effects OF indulgence
in alcohol. In the hands of such the
patient in undergoing the operation runs
practically no risk, as far as the operation
is concerned. Were the operation unnec-
essary, he will recover. Were the opera
ton necessary. il he dies, he dies not from
the operation, but because the operation
has been unavailing.
- L. Id