Management of acute suppurative appendicitis in the small rural hospital: A report of one hundred consecutive cases

The history of appendicitis has been briefly reviewed and a plea made for a renewed interest in this disease on the part of all physicians.A series of one hundred consecutive cases of acute suppurative appendicitis, with two deaths, has been presented. In twenty-five of these the appendix had perforated with one death—a mortality rate of 4.0 per cent. In the seventy-five cases without perforation there was one death—a mortality rate of 1.33 per cent. The mortality rate for the entire series was 2.0 per cent.These attacks occurred for the most part in young and middle aged patients, 70 per cent being less than thirty years old and 80 per cent less than forty.The symptoms as seen in this series have been presented as follows: pain, tenderness, rigidity, vomiting, rapid pulse, fever, leucocytosis, diarrhea and constipation. The constant presence of pain, although not usually severe, and the overwhelming frequency of tenderness and rigidity have been pointed out. Nausea and vomiting in association with abdominal pain have been emphasized as of major significance.The importance of early diagnosis and operation and their relationship to mortality and morbidity has been stressed.The danger of laxatives has been reiterated.Treatment has been discussed with a plea for early operation.The advantages of certain points in technic have been mentioned.A frank statement of the need for more and earlier consultations in suspected appendicitis and a discussion of the responsibilities of both physician and surgeon have been presented.