SURGEON AND PATIENT.

New Zealand Herald, Volume XLV, Issue 13583, 12 September 1908, Page 2 (Supplement)

SURGEON AND PATIENT.

HOW TO DEAL WITH THE USELESS APPENDIX.

Some radical suggestions for the prevention of appendicitis were made at tho meeting of the British Medical Association at Sheffield by Mr. R. J. Pye-Smith, F.R.C.S., professor of surgery in the University ot Sheffield. Mr. Pye-Smith dismissed the suggestion that everyone should get rid of his appendix early in life as rather radical, but he favoured the practice of removing the appendix whenever it was exposed in the course of another operation. On the subject of appendicitis Mr. PyeSmith said:— , "Inflammation of tho appendix is now so prevalent and so frequently of a dangerous type that serious suggestions have been made for its universal removal. USELESS. ORGAN. -~~ "Were its uselessness beyond question, were the operation for its removal attended ! with no more risk, expense,.and other inconveniences than ordinary vaccination, and were the incidence on the, population of appendicitis anything approaching that of smallpox among the unvaccinated, the suggestion might deserve our careful consideration. " Two other suggestions of definitely restricted applicability have been made for the removal of the uninflamed appendix. One it that it should, as a rule, bo amputated whenever in the course of an operation it is exposed, and it is judsred, from its appearance or from its proximity to diseased structures or to parts being operated on, to be in more than ordinary danger of becoming inflamed. " The other is that its removal should be effected during the quiescent or interval stage, when an attack of appendicitis has been recovered from without operation. Both these suggestions seem very reasonable, and I, in common with others, have frequently acted on them, but with regard to the second suggestion let us note that i in order that this line of treatment may be carried out, it is necessary that the patient should survive the illness. PROBLEM OF RECOVERY. "Herein lies the chief weakness of the position; not, indeed, the sole weakness, for another weak point is not infreauently found in the unwillingness of the patient who has gone more or less favourably through a first attack to face again, and this time in cold Wood, the loss of time and money, the discomfort, and inevitable though very small risk attaching to the operation. But the chief weakness of this plan of treatment is that it is quite problematical at the beginning of an attack whether or not the subject of it will ever reach the interval stage. "If a positive diagnosis of .appendicitis can be made sufficiently early to allow of an operation being performed within twenty-four hours of the onset of the .symptoms, the patient, I am convinced, has the best possible chance of a rapid and permanent recovery, while by this early removal of the offending appendix he is safeguarded from any attack m the future.