Excerpt from Lectures on Appendicitis and Notes on Other Subjects
There has been little to add to a contribution on the subject of the pathology of appendicitis which I offered to the profession at the meeting of the Pan-American Medical Congress in 1893 and published in the first edition of these lectures in 1895. Students of the subject of appendicitis in this country and in Europe have corroborated the testimony then offered without making addition to the principles or opposing the theories advanced. We may assume that the pathology of appendicitis is thoroughly understood, and that we need not look for many further additions to our knowledge upon that subject in the future.
In operative methods I have adopted the McBurney blunt dissection operation for entering the abdominal cavity, but have made no other changes from the methods described in the second edition of the lectures. My statistics continue to show the advantages of leaving out of the technique of operation, features which have a special death-rate of their own. It is apparent to many observers of methods that gauze packing has a special death-rate of its own, that iodoform gauze packing has a special death-rate of its own, that the plans of ligating the appendix like an artery, of making long and multiple incisions, of leaving infected or concretion-bearing appendices among adhesions after opening one abscess, all have special death-rates of their own. At the time of publication of this edition I am firm in the conviction, based upon practical results, that the principles of treatment that were laid down in the first edition taught the avoidance of methods which make appendicitis operations unpopular with physicians in some parts of this country and in other countries.
In this edition I have added several brief features which seemed to be to the point, namely: A note on the frequency of the occurrence of appendicitis. A series of summaries to facilitate an easy review of matters of leading importance. The testimony of ten consecutive appendicitis patients on their views of the comparison between medical and surgical treatment. A note on the attitude of ten physicians on the subject of appendicitis; and, A description of the formalin preparation of catgut.
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