An Address ON THE MORTALITY OF APPENDICITIS

J. E. Adams
1925 BMJ (Clinical Research Edition)  
THE incidence of a disease and its mortality are the two criteria by which the capacity of the medical profession should be judged. To prevent we must eliminate cause. The cause or causes of appendicitis have been a subject for both speculation and research for more than thirty years, but little has been established beyond the fact that the appendix is a dangerous possession. Its removal is therefore the surest method of preventing appendicitis, and the practice of removing an appendix which is
more » ... n appendix which is to all appearances healthy, when the abdomen is opened for some other operative procedure, is quite sound provided it does not delay matters and add to the difficulty of the operation in hand. There has been talk of a function for the appendix, but as far as I am aware no one really knows what it is, and, surgically speaking, it is not an organit is a nuisance. Unfortunately the risk of an abdominal operation can never be reduced to that of having one's hair cut, and therefore preventive appendicectomy is customarily limited to those cases where there is evidence of a present or past attack. Unless an epidemic occurs it is difficult to be dogmatic concerning the incidence of any particular disease. The increase or decrease can be gauged by personal impressions on the part of practitioners, by the collected statistics of institutions, and, lastly, by the returns of the Registrar-General. The last mentioned are certainly the most reliable source of information, but, unfortunately, they deal only with fatal cases. Mortality is not a fair criterion of incidence.' If it be accepted that where mortality figures show an increase this must mean a rise in incidence, then much of what I wish to say becomes pointless. The chief value of the Registrar-General's statistics is that they cover the whole of England and Wales, bearing relation to some forty million inhabitants. Institutional figures are not easy to obtain so that they can all be massed in one total, and the impressions of practitioners, so far as I have been able to benefit by them, do not support the view that appendicitis is noticeably on the increase. The question has been carefully studied by Rendle Short.' He states that 'appendicitis did not become a separately notifiable and recorded cause of death until 1901." This was about the ;time of King Edward's historic operation for appendicular absces' on the eve of his coronation. The figures Rendle {Short quotes end with 1918. His conclusions are important, and those which bear most directly on our subject are as follows: 1. Appendicitis was present, but was relatively rare in this and other countries until the end of the nineteenth century. Since then it has become very common in most highly civilized countries. 2. The rise in Bristol, and probably throughout England, was beginning in 1895, and was pronounced between 1895 and 1905, since when it has been fairly stationary. 3. This rise was most marked at first in towns, in the male sex, and probably amongst the better-off class. 4. The privations of war did not reduce it.
doi:10.1136/bmj.1.3355.723 fatcat:4fccct47svdlfeeehqu5k3oaqq