_History: _Appendicitis did not become popularly known until about
twenty years ago--not till it was christened and baptized in the
blood of the surgical art. Of course the appendix has always been
subject to inflammation, just as it is now, but in former years the
disease we call appendicitis bore various names, depending upon the
diagnostic skill of the attending physician. Typhlitis and
perityphlitis were the names used to designate the disease now
covered by the word appendicitis.
The diseases that appendicitis may be confounded with and must be
differentiated from are obstruction, renal colic, hepatic colic,
gastritis, enteritis, salpingitis, peritonitis due to gastric or
intestinal ulcer, enterolith, obstipation, invagination or
intussusception, hernia, external or internal, volvulus, stricture
and typhoid fever.
The old text-book description of typhlitis and perityphlitis is so
similar to the description of the present day appendicitis that it
is not necessary to reproduce it. The symptoms given show
conclusively that they are really one and the same.
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. The medical literature of the day abounds in
exhaustive treatises on the subject of appendicitis and its surgical
treatment.
We are living in an age that will not be properly recorded unless it
be entered as _The Age of Fads._
Following immediately on the announcement of Lord Lister's
antiseptic surgical dressing which rendered the invasion of the
peritoneal cavity comparatively safe, came the laparotomy or
celiotomy mania. When it was discovered that opening the abdomen was
really a minor operation, it was soon legitimatized by professional
opinion, and rapidly became standardized as a necessary procedure in
all questionable cases--in all obscure cases of abdominal
disease--where the diagnosis was in doubt. The result of
popularizing and legitimatizing the exploratory incision, was to
cause those who failed to resort to it, in doubtful eases, to be in
contempt of the court of higher medical opinion, and to license
those of a reckless, selfish, savage nature to play with human life
in a manner and with a freedom that would make a barbarian envious.
The wave of abdominal operations that swept the country in the last
quarter of the nineteenth century was appalling. The slightest pain
during menstruation, or in the lower abdomen, in fact every pain
that a woman had from head to toes was put under arrest and forced
to bear false witness against the ovaries. It was a very easy matter
to trump up testimony, when real evidence was embarrassing, to
foregone conclusions; hence pains in obscure and foreign parts took
on great importance when analyzed by minds drilled in the science of
nervous reflexes, sympathies and metastases.
Normal ovariotomy (removing normal ovaries for a supposed reflex
disease) swept the whole country during the eighties and threatened
the unsexing of the entire female population. The ovaries had the
reputation of causing all the trouble that the flesh of woman was
heir to. Oophorectomy was the entering wedge, since then everything
contained in the abdomen has become liable to extirpation on the
slightest suspicion.
Those surgeons of greater dexterity or savagery, I can't tell which,
prided themselves in operating on the more difficult cases. Taking
the ovaries out was a very tame affair compared to removing the
uterus, tubes and ovaries; hence the surgical adept embraced every
opportunity for an excuse to remove everything that is femininely
distinctive.
About 1890 appendicitis began to attract the attention of those
surgically ambitious. The ovariotomy or celiotomy expert began to
feel the sting of envy and jealousy aroused by those who were making
history in the new surgical fad--appendectomy--and they got busy,
and, as disease is not exempt from the economic law of "supply
always equals demand," the disease accommodatingly sprang up
everywhere; it was no time before a surgeon who had not a hundred
appendectomies to his credit was not respected by the rank and file,
and an aspirant for entrance to the circle of the upper four hundred
could not be initiated with a record of fewer than one thousand
operations.
Thanks to the law of supply and demand the ovaries retired and gave
women a much needed rest. If they had continued to misbehave as they
had been doing before the appendix got on the rampage, the demand
for surgical work would have exceeded the supply of surgeons.
Diseases of all kinds are very accommodating; as soon as a
successful rival is well introduced they retire without the least
show of jealousy, showing that they are not strangers to the highest
ethics, their associations to the contrary notwithstanding.
There are many well written articles on appendicitis, but I believe
the monograph by A. J. Ochsner, M. D., is decidedly the best, and
when I refer to the best professional ideas on etiology, pathology,
symptomatology and treatment I have in mind the opinions set down by
Ochsner, for he has taken more advanced grounds in the medical
treatment of this disease than any other physician I know anything
about in this or any other country. If his "A Handbook on
Appendicitis" brought out in 1902, had come out three years before,
I should give him credit for being the first man on record to
proscribe the taking of food in appendicitis, but as my first
written advice on the subject was in the July, 1900, number of A
Stuffed Club,* two years before his book, I shall give myself the
credit for being the first physician to announce to the world _the
only correct plan of treating the disease and suggesting the
probable cause _which the intervening time has proven to be correct
The only reason I have for making this announcement is that in all
probability no one else will ever do so, and, as it is just and
right that I should have the credit, I do myself the honor. The
general rule is that if a new method of treatment comes out, or a
discovery of importance is made other than in the regular
professional channels, it will either be ignored or adopted (cribbed
is more expressive) and no credit given. This is a small matter, and
of no special consequence, yet it carries a meaning.
*(Editor's note: "A Stuffed Club" was the newsletter or journal
published by Dr. Tilden for many years.)
Previous to 1890 the most popular treatment was probably the giving
of opium; although this was far from ideal, "it had the advantage of
taking away the patient's appetite, relieving pain, and putting the
bowels to rest."--Ochsner. If there were any way to prove it, we
should find that next to surgery opium is still the most popular way
of treating the disease.
To-day there is no other disease which brings surgery so quickly to
mind as does appendicitis, especially if the victim can stand for a
good, large fee. It is only human I presume, for surgeons to defend
the operation. They believe in it, and are not willing to
investigate, for they are satisfied. They know or should know that
ninety per cent of all the surgery practiced to-day has no excuse
for its existence--no more right to be protected by the laws that
weld society together than has any other graft that exists by the
grace of public ignorance and credulity. This operation has for some
time been the largest single item of revenue for the profession.
Thirty-four years ago I was called in consultation to see my first
case of what was then generally recognized as perityphlitis or
typhlitis--inflammation of the connective tissue about the cecum. It
was a typical case of what is today called appendicitis. I advised
the doctor to cease his fruitless endeavors at securing relief by
giving drugs, and give the patient nothing but water. As I remember
now, it took about four weeks for this patient to recover. This
plan--positively nothing but water--has since been a part of my
treatment in all such diseases.