Vol. XXIV. No. i3.] 
POPULAR SCIENCE NEWS. 
191 
matter bv the mysteiioiis and untrustworthy 
statements pinportin-^ to emanate from Koch's 
laboratory, and one cannot help recalling to 
lind Brown-Sequard's "Elixir of Life" in 
Fthis connection ; but for this lie cannot be held 
I in any way responsible. It is pitiful to read the 
dispatches from ]?erlin which state tiiat the 
hotels of that city are fast filling up with 
LConsumptive invalids from all parts of Eu- 
tope, in anticipation of the announcement 
Mof the remedy which is to give them relief 
from their suflerings, and readv to submit at 
the first opportunitv to the treatment which 
is to give them a renewed lease of life ; 
and the whole civilized world would share in 
the disappointment if the remedy should fail 
to meet the expectations of its discoverer. 
But if a cure or preventive for con- 
sumption has really been discovered, with 
the possibility of its application to other 
diseases, then Doctor Koch will certainly 
take the highest rank in the scientific and 
medical woild, and no honors or emoluments 
will be too great for one who has conferred 
such an immeasurable blessing upon human- 
ity- ... 
APPENDICITIS. 
Analysis of seventy-two cases seen in the last 
four years leads to the following conclusions : 
1. Many cases of appendicitis are so mild as not 
to demand medical treatment. Although one-third 
of all post-mortem examinations may show lesions 
indicative of an appendicitis at some period of the 
patient's life, the clinical history will frequently be 
negative. 
2. A personal experience, if sufficiently large, is 
likely to afford conclusions which may have a greater 
value than those derived from a much larger num- 
ber of selected cases. In Dr. Bridge's paper it was 
stated that four-fifths of the patients were males. 
In my personal experience there are only twice 
as many males as females. The diagnostic value 
of sex is then distinctly less than the collective 
experience claimed. 
3. In general the diagnosis of appendicitis is 
easy. It is based upon a localized tenderness, and 
the exclusion of ail causes for such tenderness but 
the appendix. Still it has been my misfortune to 
malce a diagnosis of appendicitis when it did not 
exist, and to fail to recognize its presence until after 
death in a patient upon whom laparotomy was per- 
formed for the relief of a supposed acute mechanical 
intestinal obstruction. The following are the cases 
in which appendicitis was supposed to be present : 
A circumscribed peritonitis was recognized in the 
right lumbar and iliac region, and from its seat, 
sudden origin and rapid progress was thought to be 
due to an appendicitis. The cavity was successfully 
drained, but the patient died of acute pneumonia in 
the course of a fortnight. The peritonitis had origi- 
nated from an abscess in the liver, and this was 
attributed to a catarrhal colitis of long standing. 
In a second case ot erroneous diagnosis there was a 
spreading peritonitis of the lower abdomen of sudden 
onset. The abdomen was opened and drained, but 
the appendix was found to be free from disease 
After death the peritonitis was found to have resulted 
from a suppurating sub-peritoneal inguinal lymph- 
fgland, the result of a gonorrhoea. Information 
Iconcerning the latter disease was withheld until 
|«fler the autopsy. A third case gave such a mis- 
leading history that a pyosalpinx was mistaken for 
an appendicitis. The tubes were removed and the 
patient cured. Lastly, a girl of ten years, suffering 
from a sudden and spreading hypogastric perito- 
nitis, with a deep-seated tumor below the naval, 
was seen by Dr. Homans. Although some doubt 
was entertained as to the appendicular source of the 
disturbance a laparotomy was considered urgent. 
Dr. Ilomans successfully removed an ovarian cys- 
toma, the pedicle of wliicli had become recently 
twisted and its vessels strangulated. 
4. Recurrence proved to be much more frequent 
than was found in the collective experience — 44 per 
cent, in many cases against 11 per cent, in the 
larger series. It is interesting to note that the fre- 
quency of the recurrence was about the same in 
those cases which were subsequently treated medi- 
cally as in those which were operated upon. So far 
as this evidence goes, a recurrent attack makes no 
more urgent a demand for surgical treatment than 
does an original attack. 
5. With regard to the duration of the disease, it 
may be said that although more cases recovered 
during the first three weeks under purely medical 
than under surgical treatment, this fact must be 
attributed to their mildness. Of the severe cases 
quite as many demanded from four to eight weeks 
for complete recovery, whether the treatment was 
medical or surgical. It cannot be claimed, there- 
fore, for the surgical treatment of appendicitis that 
it has shortened the period of recovery. At least 
such a claim would not be justified by the results 
found in the cases which have come under my 
observation. 
6. The rate of mortality in appendicitis is by no 
means clearly established. The physician who sees 
chiefly the mild cases says that it is very low, while 
the surgeon who is called upon for aid in the gravest 
cases considers the mortality to be very high. So 
far as I am aware, the cases observed by me form 
the largest number reported in the experience of a 
single individual, and they may be considered as 
establishing, for the present, the rate of mortality. 
Of these cases 74 per cent, recovered and 26 per 
cent died. About one-half of them were treated 
medically, the other half receiving surgical treat- 
ment. Among those treated surgically 40 per cent, 
died, while of those under medical treatment 11 per 
cent. died. 
The spontaneous evacuation of pus, an event to 
be anticipated and guarded against, took place in 7 
per cent. Of the cases treated medically 11 per 
cent, died, and in 14 per cent, there was spontaneous 
evacuation of pus'; thus in one-fourth of these cases 
the treatment should have been surgical. Since 
these medical cases were about half of the whole 
number seen, it follows that the treatment should 
have been surgical in about five-eighths of the 
cases. The percentage of the cases ending in reso- 
lution was 36, which is practically the same as 
previously found. 
It is evidently desirable to make the rules for the 
surgical treatment of appendicitis as simple as pos- 
sible. I would advise surgical treatment for urgent 
symptoms, rising pulse and temperature, increasing 
distension and spreading pain with or without a 
tumor, and for a tumor with or without urgent 
symptoms. Recurrent attacks should be treated as 
first attacks. If recurrence is so frequent as to 
debar the patient from the enjoyment of life or the 
ability to earn, removal of the appendix between 
the attacks should be advocated. — Dr. R. H. Fitz, 
in Boston Mtdical and Surgical Journal. 
I Specially Compiled for Popular ScuTUie News. I 
MONTHLY SUMMARY OF MEDICAL 
PROGRESS. 
BY MAURICE D. CLARKE, M I). 
Some New Bacterial Poisons. —Dr. V. C. 
Vaughan sums up the present state of our know- 
ledge on the above subject as follows : 
1. Man is attacked by the infectious diseases 
either through the alimentary canal or through the 
blood or lymph. 
2. The gastric juice is a physiological guard 
against infection by the way of the intestines. 
3. Additional guards against infection by the 
intestines are probably to be found in the absorbing 
cells of the stomach and intestines. 
4. Susceptibility to the intestinal infectious dis- 
eases is increased when for any reason these physio- 
logical guards are defective. 
5. All toxicogenic germs are dangerous when 
introduced into the intestines, and their capability 
of doing injury lies in their production of chemical 
poisons. 
6. Many of these poisons are proteid in char- 
acter. 
7. These poisonous proteids most probably act 
by catalysis. 
8. In the splitting up of complex molecules into 
simpler ones, heat is liberated and fever manifests 
itself. 
9. The physiological guard against infection 
through the blood or lymph lies in the germicidal 
action of the proteids of these fluids. 
10. Susceptibility to infection through the blood 
or lymph is increased by impoverishment of these 
fluids. 
11. We can continue to treat consumption and 
other systemic diseases by the employment of lib- 
eral diet, exercise in the open air, and constitutional 
remedies without being unscientific in our practice. 
12. Filth, without being the bearer of a specific 
germ, is a cause of disease. 
13. Wherever man pollutes the soil about him, 
the air which he breathes, and the water which he 
drinks with his own excretions, there enteric fever 
will be found. 
14. In their causal relation to disease, germs 
cannot be classified without a knowledge of the 
chemical changes which they induce. 
15. While certain bacterial poisons can result 
only from the growth of certain germs, other 
poisons similar to one another in their action, 
though probably not identical, may result from any 
one of a number of organisms. In the former case 
we have such diseases as anthrax and small-pox, 
with their practically constant symptoms and well- 
marked course; in the latter case we have such 
diseases as the summer diarrhoea of infancy and 
enteric fever, with their varying symptoms.— J/erf. 
News. 
The use of the salts of iridium in photography is 
likely to, come into vogue, the metal iridium being 
at present somewhat cheaper than platinum. 
Pneumonia and Bloodletting.— M. Crocq, who 
has frequently written and spoken in favor of the 
revival of venesection, made a powerful speech 
dealing with this subject at a recent meeting of the 
Belgian Academic de Medecine. Speaking of pneu- 
monia, he declared his disbelief in the cause of the 
disease being either Friedlander's bacillus or the 
diplococcus of Fraenkel and Weichselbaum. Inocu- 
lation of this latter microbe, he remarked, is said to 
procure immunity from subsequent inoculations, 
which is exactly contrary to the eflect gf an attack 
of pneumonia, for it rather predisposes the subject 
to subsequent attacks. Again, M. Crocq injected 
sputum from pneumonic patients, in which the 
diplococcus had been found, into the lungs of four 
rabbits, but none of them contracted pneumonia. 
