Appendicitis

“ Mynter does not deny the possibility of complete recovery from appendicitis without removing the organ, but considers it an exception or almost an impossibility, and I find that this view is shared by a majority of clinical observers of wide experience."
"It is rare for an acute attack of appendicitis to subside unoperated without leaving one or more of the pathological conditions briefly described above, and it is plain that with these present the patient must be much more liable to a future attack than he was primarily. ”

“ It does not matter whether the patient suffers from catarrhal appendicitis, with or without a foreign body in the appendix, or whether the appendix be gangrenous or perforated, he will almost invariably recover if from the beginning of the disease absolutely no food is given by mouth. ”

“ In conclusion I will say that the most important lesson my experience has taught me is the fact that more harm is done to the patient suffering from acute appendicitis by the administration of any kind of nourishment or cathartics by mouth than in any other way, and that more lives can be saved by prohibiting this and by removing any food which may be in the stomach at the beginning of the attack by gastric ravage than by all the other methods of medical and surgical treatment combined. ”

“ If a case has been medicated and fed to death—abused to the extent of causing a rupture into the peritoneal cavity—surgery must be resorted to as the only hope.
If a case survive an operation the patient is no wiser than he was before, and knows nothing about avoiding another attack, for let it be said loud enough to be heard by all, and with no fear of successful contradiction, that if every child at birth should have the appendix removed there would not be one case less of appendicitis than there is with the appendix intact. ”

“ People died of inflammation of the bowels and peritonitis then; and as the appendix was not known as the origin of the trouble, the fateful name was not the spectre that it is now. Practically all abdominal colic—and this means 90 per centum of all the acute pain which follows gastro-intestinal disturbance in young or middle-aged adults—is due to appendicitis. It comes on, as a rule, in the midst of good health. It is very treacherous, and when the patient is apparently but slightly ill, a sudden turn for the worse may assert itself, and an intensely painful and prostrating condition develop. ”

“ You Americans are too fond of the knife! It is not always necessary to cut out an inflamed appendix. In my hospital we have had four hundred cases of appendicitis within the last ten years, and have operated just forty times! ”

“ The pathology of appendicitis is necessarily touched upon more or less in going over the etiology, symptoms, and treatment of the disease, and variation is the rule, for how could it be otherwise when subject and environment must always vary?
As soon as an inflammation starts, the first thing that nature does is in the line of enforcing the _first law of cure, _namely: _rest. _To bring this about the musculature is set, rigidly contracted, thus fixing the parts. The contraction, of course, will be in keeping with the irritation of the parts; great pain means great rigidity, and _vice versa. ”

“ Apart from the fact of the more frequent occurrence of appendicitis, the disease is now better understood and more promptly recognized. It was formerly included under the term “perityphlitis”—that is, inflammation connected with the caecum or blind portion of the large intestine. But in the vast majority of cases the inflammation begins in the appendix, not in the intestine proper. It is apt to extend and set up a localized peritonitis, which in the worst cases may become general.
Appendicitis is more often met with in the young than the old, and in boys rather than girls ”

“ If, in a case of appendicitis, for one reason or another operation is to be delayed, what treatment should be resorted to? The patient should be put to bed with his knees resting over a pillow, and a large fomentation under oil silk should be laid over the lower part of the abdomen. No food should be given beyond an occasional sip of hot water. ”

“ In many of the ordinary surgical operations it is not necessary to follow out the details with any great degree of accuracy, because failure to do this will at most result in confining the patient to bed a little longer than usual or necessary, while in the appendicitis operation it is likely to result in the death of the patient. ”

“ In the surgical treatment of appendicitis the American profession has taken the lead, and the mention of this disease brings to mind such names as McBurney, whose name is given to an anatomical point—McBurney's Point—midway between the right anterior superior spine of the ileum and the umbilicus, Deaver of Philadelphia, and Ochsner and Murphy of Chicago. Those who are interested in the surgical treatment of the disease can look into the methods of these men, and many others. ”

“ Of course, technically there could be no appendicitis without an appendix, but the cecum would become inflamed just as readily.
No amount of forcing drugs given by the mouth can induce a movement from above the constriction, but a great amount of pain can be produced by attempting to force a passage. No one comprehending the true state of affairs would be foolhardy enough to try to force the bowels to move. The reader can readily imagine the great pain and danger liable to follow cathartic drugs, for they stimulate severe peristaltic contractions. ”

“ A foreign body is the exciting cause in many cases, though less commonly so than was formerly imagined. The inflammation in the appendix varies in intensity from a very slight catarrhal or simple form to an ulcerative variety, and much more rarely to the acute fulminating appendicitis in which necrosis of the appendix with abscess formation occurs. It is always accompanied by more or less peritonitis, which is protective in nature, shutting in the inflammatory process. ”

“ The pull exerted by the heavy loaded cæcum upon such of the proximal portion of the appendix as is fixed by acquired adhesions to the abdo­minal wall produces a kinking of the appendix at the junction of the fixed and mobile portions. In consequence of this secretion tends to accumulate in the distal portion of the appendix and concretions form in it, or it may become more or less acutely inflamed, producing varying conditions of what is called appendicitis. ”

“ We will remove the appendix, on general principles, and that will probably be all that is needed to cure the trouble in her head.”
Under the circumstances, it was excellent advice. [259] But how much better it would have been for the unfortunate woman, whose life was thus endangered by the surgeon’s knife, if it had been recognized from the beginning that her malady was only a “hysterical simulation” of the symptoms of appendicitis. ”

“ If the symptoms and signs, namely, pain, vomiting, fever, tenderness, and rigidity are interrupted, the diagnosis of acute appendicitis may be considered doubtful. Leucocytosis is of value as a confirmatory symptom when the patient reacts well to 123the infection. The most important point in the differential diagnosis is the distinction between acute cholecystitis and acute appendicitis. Acute pancreatitis, perforated ulcer, or perforated gall bladder, present symptoms so much more intense than those of acute appendicitis that they should not give rise to confusion. ”

“ If there were any way to prove that so-called appendicitis is more common to-day than in former times, it is reasonable to believe that the irritating effect of the pretty general habit of taking cathartic medicine has had more to do with bringing it about than any other one thing. ”

“ My knowledge of anatomy had betrayed me.
The old doctor then gave me this homely advice, which may or may not be correct. At any rate I never forgot it. He said:—
“You’ve been eating too much and have a little indigestion and stomach-ache. But like thousands of others who have fertile imaginations, you have appendicitis—on the brain. People rarely had this disease thirty years ago. Why should they have it so frequently to-day? Is the human body so radically different from what it was a few years ago? ”

“ In man it is a rudimentary structure, but in some of the lower animals it plays an important part in digestion. Inflammation of the vermiform appendix, or, more shortly, appendicitis, is not an uncommon disease, and of later years has received more attention than formerly; the dangerous illness of King Edward in 1902 especially brought this malady into prominent notice. Appendicitis is more commonly met with in children and young adults. ”

“ There is, however, a tendency to exaggerate the place that this organ holds in the pathology of chronic cases. Many women who suffer from nothing more than hysterical abdominal conditions are told by someone that they have recurrent attacks of appendicitis, though there is nothing except their suggestive complaints of pain on which to found such a diagnosis, and then it becomes extremely difficult to remove this idea from their minds, and contrary suggestion applied over a long period is the only therapeutics that favorably affects them. ”

“ Acute Appendicitis. John B. Deaver says the important points that have to be learned about this disease are that it is the most common intra-abdominal inflammation; that indigestion is often a forerunner, preparing the soil for the infection; that being an infectious disease and the most common infectious disease of the abdominal cavity, the appendix constitutes the avenue by way of which infection most commonly invades the upper abdomen. ”

“ Therefore, the best thing to do in the way of taking precautions against the occurrence of appendicitis is, in the language of the day, to "forget it" as completely as possible, reassuring ourselves that, in spite of its extraordinary notoriety and popularity, it is a comparatively rare disease in its fatal form, responsible for not more than one-half of one per cent of the deaths, and that the older we grow, the better become our chances of escaping it. ”

“ Jones.
“—become insane from automobiling. He has lately developed appendicitis, and now he fancies that he is an automobile with his boiler burned out. Dr. Cutler thinks that this idea has been suggested by pain in the region of the appendix. He is a wonderful diagnostician.” ”

“ It is sound surgery, in dealing with abscesses, to find, if possible, the direction nature is taking to evacuate pus and be guided by this suggestion in evacuating a pus cavity.
In order to cure appendicitis you must remove the cause. Cutting off the appendix, opening an abscess, withholding food till the acute symptoms have passed; such treatment is not removing the cause. Nothing short of changing the eating habits of the patient will cure, so the surgeon who knows nothing about food and its action—what part improper eating has to do with bringing on the disease—will never be able to cure. ”

“ The disease called appendicitis has either [pg 280] in our times become wonderfully frequent or else the improved methods of diagnosis have made us acquainted with what has long been one of the principal maladies of mankind. The appendix vermiformis seems to be a useless remnant of anatomical structure transmitted to us from a lower animal condition. At least such is the interpretation which scientists generally give to this hurtful and dangerous tube-like blind channel in connection with the bowels. ”

“ Then we have to fight nature. We have to go against the workings of nature by surgery, in order to get the person right.
In suppurative disease, such as appendicitis, it is often difficult to decide when nature is doing better than we can do, and when we can do better than nature. The appendix is a hollow tube the size of one's little finger, and hangs off from one part of the large bowel. When it gets inflamed nature at once begins the defences which I have described in the lung, namely, the walling-off process, which tends to make the bacteria harmless. ”

“ In chronic dysentery large patches of the bowel, and even the ulcers themselves, may be pale and anæmic, whilst at the same time other patches of the gut are congested. Some parts may be thickened and contracted; others, again, may be thinned and dilated, the glandular structures being atrophied. Lesions of the appendix are often found in amœbic dysentery. Symptoms of appendicitis occurring in countries where appendicitis and consequently appendicectomy are common should incite the tropical practitioner to examine the stools for amœbæ and to apply the appropriate treatment. ”

“ As his sensitive fingers passed over the place under which the appendix is located, he felt something that broke the smoothness of the perfect skin. It was a surgical scar. That fact alone should almost certainly rule out a present attack of appendicitis! ”

“ It is true that recurrences can usually be prevented by careful attention to diet, by securing daily free evacuations of the bowels, by avoiding over-work and above all things by abstaining from eating too freely, especially of indigestible food when tired. Notwithstanding these facts most patients will never be entirely well after recovering from an attack of appendicitis, and if this is the case I believe that the best treatment consists in the removal of the diseased appendix. ”