In regard to the first of these, it is safe to say that our answer is
much less alarming than it was in the earlier stage of our knowledge.
Naturally enough, in the beginning, only the severest and most
unmistakable forms of the disease and those which showed no tendency to
localization, were recognized, or at least came under the eye of the
surgeon; and as a large percentage of these resulted fatally, the
conclusion was reached, both in the medical profession and by the laity,
that appendicitis was an exceedingly dangerous disease, with a high
fatality in all cases. As, however, physicians became more expert in the
recognition of the disease, it was discovered to be vastly more common,
while side by side came the consoling knowledge that a considerable
percentage of cases got well of themselves, in the sense of the
inflammation being limited to the lower right-hand corner of the
abdominal cavity, though, of course, with the possibility of leaving a
smouldering fuse which might light up another explosion under any stress
in future.
Further, as the attention of the post-mortem investigators at our large
hospitals was directed to the subject, it was found that a very
considerable percentage of all bodies, ranging from twenty to--according
to some estimates--as high as sixty per cent, showed changes in the
appendix and its neighborhood which were believed to be due to old
inflammations; so that, while it is possible to speak only with great
caution and reserve, the balance of opinion among clinicians and
pathologists of wide experience and the more conservative surgeons
appears to be that from one-half to two-thirds of all cases of
appendicitis will recover of themselves, in the sense of subsiding more
or less permanently, without causing death.
On the other hand, it must be remembered that the appendix is an organ
which, so far as any evidence has been adduced, is entirely without
useful function; that it is in process of shriveling and disappearance,
if left entirely alone, and that the best result which can be expected
from a self-cured attack of appendicitis is the destruction of the
appendix and its elimination as a further possible cause of mischief. By
avoiding an operation in appendicitis, we may be practically certain
that we save nothing that is worth saving--except the fee. Moreover,
even though only from one-fourth to one-third of all cases develop
serious complications, you never can be quite sure in which division
your particular case will fall.
Public-domain text, read in full here on John Shaqi.
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