THE FUNCTION OF THE APPENDIX AND THE ORIGIN OF APPENDICITIS

I have long since made up my mind what I shall do if I, in my turn, become the subject of appendicitis-I shall forthwith call in a surgical friend, and if he says "Yes, I think that the appendix is at fault," I shall ask him if he would mind my getting another surgeon (not a physician) to come and see me with him for the purpose of confirmation; and on the diagnosis being confirmed, I shall beg him at once to operate. And if these principles were adopted in all cases of appendicitis, would not the mortality of the disease be lowered by more than 90 per cent.? I think so. I have not hurriedly formed the opinion that the greatest safety in appendicitis is in the early operation. And certainly I did not start with that opinion: I have been steadily driven to it. I have seen a fair share of cases of appendicitis, with some of which I have been associated from the beginning of the attack; to more I have been called in when the disease had already made considerable headway, and for others my help has been asked only towards the close of the chapter. And my deliberate opinion is that if it were generally recognized that safety lay in prompt operation, the present high death-rate in the disease, as I have already said, would be greatly lowered. At various times in our professional life we have to study our bearings, take soundings, and re-shape our course. How greatly thus has our treatment of cancer of the breast, for instance, improved in recent years, for even if there is a slight margin of doubt in that diagnosis we now urge immediate and complete operation. There is no waiting for the appearance of signs which shall render the diagnosis so clear that there is no chance of mistaking a chronic inflammatory thickening for a malignant infiltration; the patient and not the tumour is now given the benefit of the doubt, and the improvement in our results has, in consequence, been most remarkable. In diphtheria, too, antitoxin is injected without a moment's delay; and in the case of suspected renal calculus the kidney is explored for a likely stone even if the x rays fail to reveal its presence.