DEVELOPMENT IN NINETEENTH CENTURY 347 



methods, has pointed out new ways, and has discovered new facts, all 

 of which tend to reduce the mortality. It seems now the only thing 

 that is left is to combine the various views of experienced surgeons 

 into some uniform plan of treatment, in order to produce the best 

 results. The mortality in appendicitis in all cases under medical 

 treatment is about 16%, with 30% of relapses, while in diffuse 

 suppurative peritonitis it is almost uniformly fatal. 



The mortality in appendicitis in all cases under surgical treatment 

 is about 4%, and with no relapses, and in diffuse suppurative peri- 

 tonitis the mortality in published statistics is from 31 %, the lowest, 

 to 91 %, the highest, and in my 11 consecutive cases of diffuse sup- 

 purative peritonitis the mortality was zero. 



Ochsner has recently contributed some statistics from his own op- 

 erations during one year, which reflect great credit upon his excellent 

 work. In the acute there was a mortality of 3 %, and in the chronic 

 cases there was a mortality of 1 %. In the entire number of cases, 

 both acute and chronic, there was a mortality following the opera- 

 tion of 2 %. Deaver has also recently contributed some statistics 

 from his own operations extending over a period of one year, which 

 likewise reflect great credit upon his surgical skill. In the cases of 

 general diffuse peritonitis there was a mortality of 31 %. In the 

 cases in which there was abscess there was a mortality of 12 %. In 

 the cases in which the disease was confined to the appendix, with 

 stricture, ulceration, and necrosis of the mucous membrane, there was 

 a mortality of 0.8%, and finally, in all the cases operated upon, the 

 total mortality was 5 %. Richardson's published statistics are prac- 

 tically the same, and the result of these various operators gives an 

 idea of what surgery has accomplished. In a study of the last 119 

 cases of appendicitis occurring in my practice up to April 1, 1903, 

 the mortality of the disease, irrespective of operation or of any 

 special plan of treatment, was a little over 1.5 %. In the cases treated 

 without operation in which the attack was a mild, catarrhal one, 

 and in which the patients were not operated upon during the attack, 

 the mortality was zero. In this group of cases in which conservatism 

 was employed for special reasons, the appendix was in many cases 

 subsequently removed owing to repeated attacks, and the mortality 

 was zero. In the group of cases in which the appendix was gangrenous 

 and had ruptured into the peritoneal cavity with a general peritonitis, 

 of which there were 11 cases, the mortality was zero. In the cases in 

 which there was an acute perforative appendicitis, and in which the 

 appendix was gangrenous, and found in a circumscribed abscess 

 cavity, the mortality was 7 %. If now, in this group, all the operative 

 cases are collected, both acute and chronic, the death-rate was 2%. 

 If the two fatal cases in the entire list of 119 cases are eliminated, 

 which were hopeless from the start, but which were operated upon 



