Appendicitis in France and in America

From the discussion regarding appendicitis by the Paris Surgical Society (Bull. et m ém. de la Soc. de Chir. de Paris, T. xviii), it is evident that unanimity of opinion upon some points as to treatment is not yet established in France, and that the French are somewhat behind the progress of American surgeons. The discussion as brought out in the society includes the etiology and p athology, the expectant opium treatment and early and late operations upon the inflamed vermiform, and is based upon the histories of cases presented and the results of operations performed. The adherents of the opium treatment (Berger, Moty, Marchant) thought that it was most advisable because they had obtained good results from its use even in cases where suppuration was highly suspected, and because recurrence of an attack is not always avoided by an operation. All are agreed that the indications for operation are positive when there is a large abscess that threatens to rupture into the per itoneal cavity, or when peritonitis has already commenced. The indications for an early operation are only relative and are dependent upon the presence of a positive swelling (Reclus, Schmit). A swelling it is thought always indicates suppuration, even though the general symptoms have improved or th e swelling decreased somewhat in size. Decision is not to be made until the swelling is positive, and then the indications would simply be those of an abscess.
Source: JAMA - Category: General Medicine Source Type: research