A Few Cases of Mild Mental Disturbance

1893 Boston Medical and Surgical Journal  
it should be picked up with the forceps and at first nicked through by the kuife, to avoid wounding any underlying gut. For those who cau recognize the large intestine when they see it (and those who cannot do so can readily learn by a little careful study at an autopsy) there is not much difficulty in finding the appendix. The longitudinal bands ou the colon and coicum run straight down to the base of the appendix. In cases where the surgery is delayed, it may be impracticable for an
more » ... le for an inexperienced surgeon, or even for an adept, to remove the appeudix. But in cases of immediate operation the appendix cau easily be brought up out of the belly wound and cut off by a V-shaped incision, which will allow the inversion of its edges aud the approximation by Lembert sutures of their peritoneal coats. If there is any gangrene of the outside of the appendix, it is uot safe to close the abdomiual wound : some gauze must be loosely stuffed into the cavity where the orgau lay, which can be removed on the second or third day. But if the appendix has no gangrenous surface, then, after careful wipiug out the region involved, the abdominal walls cau be safely closed by layers, with buried sutures. Such, in brief outliuo, is the operation by which patients suffering with appendicitis may be surely saved not ouly from death but from the chances of recurrence and of long-suffering. I now beg to offer the following conclusions : (1) Appendicitis itself is not a serious disease, for it is the inflammation of a worthless part of the body. It is, however, apt to recur. And any attack if left to nature or to medical management may cause a fatal puruleut peritonitis or a localized abscess. (2) Appendicitis can be as readily recognized as can any other local internal inflammation. This diagnosis, however, is easiest iu the earliest stage of the disease. (3) No rules cau be formulated for differentiatiug the varieties of appendicitis, and of thus foretelling which cases will recover and which will cause dangerous or even fatal consequences. For there is no known way, except by abdominal section, of ascertaining the rate of progress or the extont of the inflammation iu auy given case ; nor of determining the virulence of the couteuts of the orgau, or its anatomical situation. (4) The only rational treatment of the disease is its immediate ending, by excising the organ, before its own death or damage causes like results to its owner. This, at the beginning of the attack, is a feasible aud an absolutely safe operation. (5) The mortality in properly treated cases of appendicitis is nil. -m
doi:10.1056/nejm189311301292204 fatcat:kt4dlllqfnd6dbmgrzm2gd7jjq