rOLUMBIA LIBRARIES OFFSITE 
 
 *^"eALTH SCIENCES STANDARD 
 
 HX64067106 
 RD542 Ed22 A review of the hist 
 
 Compliments of the Auih^ 
 
 A Review of the History and 
 Literature of Appendicitis 
 
 BY 
 
 GEORGE M. EDEBOHLS, A.M., M.D. 
 
 NtW YimK 
 
 Reprint from the Medical Record, November 2^, jSgg 
 
 NEW YORK : 
 
 THE PUBLISHERS' PRINTING COMPANY 
 
 32, 34 Lafayette Place 
 
 iSqq 
 
1?JD64:^ 
 
 '^'1 <^.7 
 
 Columbia ®nit)ersttp 
 
 COLLEGE OF 
 
 PHYSICIANS AND SURGEONS 
 
 LIBRARY 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/reviewofhistorylOOedeb 
 
A Review of the History and 
 Literature of Appendicitis 
 
 BY 
 
 GEORGE M. EDEBOHLS, A.M., M.D. 
 
 NEW \OKfi 
 
 Reprint from the Medical Record, November 2j, '^99 
 
 NEW YORK : 
 
 THE PUBLISHERS' PRINTING COMPANY 
 
 32, 34 Lafayktte Place 
 
 iSgg 
 

A REVIEW OF THE HISTORY AND LITERA- 
 TURE OF APPENDICITIS. 
 
 By GEORGE M. EDEBOHLS, A.M., M.D., 
 
 NEW YORK. 
 
 During the early part of the present year the writer 
 had occasion to look up one or two points in connec- 
 tion with the subject of appendicitis. He became in- 
 terested and more and more deeply involved in the 
 literature, until after a number of months, during 
 which all his spare moments were devoted to the task, 
 he found that he had read and passed in review about 
 all that has ever been written upon appendicitis. The 
 magnitude of the labor becomes apparent when it is 
 stated" that the literature of appendicitis, up to and in- 
 clusive of the year i8g8, embraces more than twenty- 
 five hundred journal articles, dissertations, and books, 
 all but a very small fractional part of which the writer 
 has consulted in the original. As illustrating the 
 rapid growth of the literature it may be stated that 
 more than one-half of the twenty-five hundred journal 
 articles, dissertations, and books have appeared within 
 the past five years. 
 
 Upon the conclusion of the task, and at the sugges- 
 tion of the editor of the Medical Record, who thought 
 that a historical review of the subject of appendicitis 
 might interest some of the readers of his journal, the 
 following notes were arranged for publication. 
 
 Nomenclature. — Epityphlitis, ecphyaditis, and sco- 
 lecoiditis have been proposed by Kuester, Morris, and 
 Gerster, respectively, as synonyms for appendicitis. 
 The term appendicitis, however, though a barbarism, 
 is too firmly established by long and universal usage, 
 
both among the profession and the laity, to be displaced 
 at this late day. We bow to the inevitable, and, for 
 reasons which have been well set forth by Ellis,""* ac- 
 cept the term appendicitis. 
 
 General Historical Data. — The early history of ap- 
 pendicitis is merged with and emerges from that of 
 iliac phlegmon, typhlitis, paratyphlitis, and perityph- 
 litis. Saracenus, in a letter dated August 28, 1642, 
 published by Roussel,^"* describes an abscess in the 
 right iliac region with discharge of fecal matter and 
 fourteen lumbricoid worms, possibly the most ancient 
 clear case of perityphlitic or appendicular abscess on 
 record. A number of similar cases were published 
 during more than a hundred years following, before 
 Mestivier,"^ in 1759, recognized appendicitis as a dis- 
 tinct entity. Mestivier incised an abscess in the right 
 groin, in a woman far advanced in pregnancy, and on 
 autopsy found at the bottom of the abscess the appen- 
 dix vermiformis perforated by a pin. Toward the end 
 of the eighteenth and during the early half of the nine- 
 teeth century, appendicitis with perforation and abscess 
 formation was often found in the dead-house and de- 
 scribed by numerous writers. Yet, as late as 1838, so 
 learned a man as Albers,' writing at length on typhlitis 
 and perityphlitis, does not even mention the appendix — • 
 proof that a knowledge of the existence of appendi- 
 citis was by no means general at that time. The com- 
 pl ications and sequelas of appendicitis, especially those 
 fatal in character, were also noted during the early 
 half of the present century. In 1846 Landsberg"" re- 
 ported two cases of hernia, one inguinal and one fem- 
 oral, containing the appendix. Hall,'" Zdekauer,"'* 
 Monks,^'' Ohlmacher,"^-"* PoUosson,-'' Rotter,'"^' Rou- 
 tier,'"" Kayser,''' Ginnard,'" and Gross'-" iiave since 
 reported like experiences. In 1847 ^^^'^ diagnosis of 
 appendicitis began to be made during life by Cless,'" 
 Hancock,"" and others. In the fifties Cless,''" Bam- 
 berger," and Leudet'""' reported large numbers cf per- 
 
sonal observations of perforative appendicitis \vith 
 autopsies; Leudet, for example, reporting tliirteen 
 cases of perforation and seventeen cases of simple 
 ulceration of the appendix observed by him in three 
 years. Skoda, ""^ in 1862, noted the spontaneous cure 
 of appendicitis by obliteration, and advises a " harden- 
 ing process " treatment with that end in view. V\ith,'" 
 in 1879, fully described peritonitis appendicularis, and 
 Bierhoff,^^ in 1880, gave an excellent, full, and elabo- 
 rate description of the pathology of appendicitis, mod- 
 ern in every respect except as to bacteriology. The 
 classic of Fitz,'"^ which appeared in 1886, may fairly 
 be said to have given the impetus to the intense and 
 practical study of appendicitis of latter years. 
 
 The bacteriology of appendicitis first received atten- 
 tion in 189 1, chiefly at the hands of the Frenchmen 
 Adenot ^ and Gouillioud,'^® soon followed by Ecke- 
 horn,'"^ Weir,='^° Robb,"' Hodenpyl,'^' and others. 
 
 The diagnosis of acute appendicitis was advanced 
 more* than by all previous knowledge combined, by 
 McBurney,^'^ when, in 1889, he discovered and estab- 
 lished the value of *' McBurney's point." The intro- 
 duction and elaboration, in 1894, by Edebohls,^" of 
 palpation of the vermiform appendix finally placed us 
 in a position to diagnose clearly and positively every 
 case of chronic, and nearly every case of acute, appen- 
 dicitis. 
 
 The history of the origin and development of the 
 operative treatment of perityphlitic abscess and of ap- 
 pendicitis will receive full attention later on under a 
 special heading. 
 
 Frequency of Appendicitis As regards both the 
 
 frequency of appendicitis and its relative frequency in 
 the two sexes, the most remarkable and apparently 
 irreconcilable statements are made by various investi- 
 gators. While the belief is current that appendici- 
 tis affects males in larger proportion than females, 
 Einhorn,'" in eighteen thousand successive autopsies, 
 
found perforating appendicitis in 0.55 per cent, of 
 males and 0.57 per cent, of females, and Robinson^'* 
 in one hundred and twenty-eight autopsies as they 
 came found evidences of past peritonitis on and about 
 the appendix in sixty-six per cent, of female and fifty- 
 six per cent, of male bodies. 
 
 With "" quotes Toft as finding in three hundred 
 autopsies one hundred and ninety entirely normal 
 appendices and one hundred and ten appendices pre- 
 senting more or less evidences of disease. Wallis/'^ 
 on the contrary, in autopsies extending over nearly five 
 years found only 1.7 per cent, of all appendices pre- 
 senting evidences of disease. Fitz,"*"' in 1886, reports 
 two hundred and fifty-seven cases of perforative appen- 
 dicitis observed by him post mortem, and comments 
 upon the frequency with which autopsy shows long- 
 standing chronic inflammation without acute attacks. 
 Ribbert '" and Zuckerkandl ^'^ have given us post-mor- 
 tem statistics of obliterating appendicitis. The for- 
 mer, in four hundred autopsies, found the appendix 
 partially obliterated in 21.5 per cent, and completely 
 obliterated in 3.5 percent.; the latter, in two hundred 
 and thirty-two examinations, found 9.9 per cent, of 
 partial and 13.8 per cent, of complete inflammatory 
 obliteration of the lumen of the appendix. Clinically^ 
 Edebohls'"' finds that four per cent, of all women have 
 appendicitis. 
 
 Anatomy of the Vermiform Appendix. — Accord- 
 ing to Kelynack,'" the existence of the appendix does 
 not appear to have been recognized previous to the 
 sixteenth century, when it was described by Carpi, 
 Estienne, and Vidus Vidius, the latter of whom applied 
 the qualifying term "vermiform." Santorini and Sa- 
 batier described it quite satisfactorily in the seven- 
 teenth century. But it is only since the appearance of 
 the classic of Lieberkiihn,^"^ in 1739, and that of 
 Vosse,^" in 1749, that a description of the vermiform 
 appendix has found its way into every text-book of 
 anatomy. 
 
Finnell,"^ in 1S69, measured fifty male and fifty 
 female appendices, and found the appendix averaged 
 one-half inch longer in women than in men. Mott,"" 
 Biggs, '^ Dade,'"* and others have put on record excep- 
 tionally long appendices. The general anatomy of 
 the appendix has received consideration at the hands 
 of Hewson,'"' Ribbert,"' and many others. Ribbert's 
 macro- and microscopical examinations of four hun- 
 dred appendices deserve special mention. The varia- 
 tions of position observed post mortem have been 
 minutely investigated by Bryant.^" The peritoneal 
 folds and fossae in the immediate neighborhood of the 
 appendix are fully described and pictured by Lock- 
 wood and Rolleston,'""^ Kelynack,'"' and Jonnesco.'^' 
 Swan^"" records the only well-authenticated case of 
 congenital absence of the appendix. 
 
 Etiology of Appendicitis. — The causative factors 
 in the production of appendicitis are universally ad- 
 mitted by all writers to be very generally local in 
 character. Fox,'"^ in 1885, called attention to the 
 analogy between quinsy and appendicitis, in both of 
 which lymphoid tissues identical in structure were in- 
 volved. Atkinson'^ and Bloomfield,^'" in 1895, dis- 
 cussed heredity as a cause, and "family appendicitis" 
 was again brought forward by Faisans"' in 1896. In 
 1891 Adenot^ and Gouillioud '^''' developed the impor- 
 tant role played by bacteria in the etiology of appen- 
 dicitis. In 1895 and 1896 quite a crop of general 
 causes of appendicitis sprang up in the literature. 
 Frazer'-" writes of uratic typhlitis, Matthieu""' of la 
 lithiase appe?idiculaire, and Simons'" describes a case 
 of gouty appendicTtis. Rheumatism was advanced as 
 a cause by Sutherland,"' followed by Beverley Robin- 
 son. ■"■' Byron Robinson"*** finds the chief exciting 
 cause of appendicitis in the action of the psoas mus- 
 cle. La grippe is considered by a number of New 
 York physicians of prominence and large experience a 
 frequent cause of attacks of appendicitis. The etiol- 
 
8 
 
 Ogy of relapses has been carefully and minutely 
 studied by von Miyer.^^^ Goluboff "'^ calls appendi- 
 citis an epidemic infectious disease. Edebohls'"" has 
 pointed out the role played by movable right kidney 
 in the production of appendicitis. 
 
 Pathology of Appendicitis. — The general gross 
 pathglogy of appendicitis has received full attention in 
 the writings of Leudet,'"' With,"' Bierhof,='' Porter,''^' 
 Fitz,''® and numerous others. Thd microscopical ap- 
 pearances have been carefully studied by Craig," 
 Ribbert,'""" Letulle and Weinberg.^"" The spontaneous 
 cure of appendicitis by obliteration was noted by 
 Skoda*"* in 1862. and the cure of perforation of the 
 appendix by the same process was recorded by Pep- 
 per^*'^ in 1857. Later, Senn,"" Zuckerkandl, '" and 
 Piersol"'" wrote on " appendicitis obliterans," the last- 
 named author designating it nature's cure. Catarrhal 
 appendicitis, though generally recognized, has received 
 but scant description, the only noteworthy contribu- 
 tion, perhaps, being that of Deaver.'" The pathology 
 of interval cases is well described and pictured by 
 Abbe.' "Appendicite sous-he'patique " is considered 
 worthy of special description by Glantenay."*^ The 
 homology of appendicitis with salpingitis is insisted 
 upon by Delbet."* A solitary case of intramural ab- 
 scess of the appendix is recorded by Pilliet,"'" and a 
 solitary observation cf suppurative typhlitis with a 
 normal appendix by Lop.'*'* 
 
 Foreign Bodies in the Appendix. — In former years 
 foreign bodies in the appendix were considered under 
 the head of etiology of appendicitis. In the light of 
 modern views the permanent lodgment of foreign 
 bodies in the appendix is probably more frequently 
 the result than the cause cf appendicitis. In the fol- 
 lowing list, by no means complete, of foreign bodies 
 found in the appendix, reference to publication is 
 omitted. 
 
 Entozoa have been found in the appendix in the 
 
following varieties : Ascarides lumbricoides (Becque- 
 rel, Patterson, Lang, Buck, Cuthbertson) ; Oxyuris 
 vermicularis (Bierhof ) ; Tricocephalus dispar (Bier- 
 hof). 
 
 Coproliths have been found by everybody who has 
 had much to do with post-mortem investigations or 
 with the surgery of the appendix. Next to coproliths, 
 pins have been the foreign bodies most frequently met 
 in the appendix (Mestivier, Hewitt, Joffroy, Legg, 
 Boussi, Ashby, Shoemaker, McPhaedran, Calmer, Van- 
 derveer, Park). 
 
 Other foreign bodies found in the appendix are: 
 grape seeds (Briske, Pepper, Noyes, Kebb) ; melon 
 seeds (Tavignot, Malespine, Edebohls) ; a chocolate 
 nut (Prescott); a grain of oat (Price, Howe); cherry 
 stones (Theurer, Werner, Reignier, Ferguson, For- 
 mad) ; raspberry seeds (Vedder, Craig) ; prune stones 
 (Vidal, Stuetzle) ; a date seed (Leaman) ; orange seeds 
 (Thornton, Service) ; a bean (Cliquet, Haeker, Wy- 
 man) ; tomato seeds (Edebohls); a fruit stone (Fir- 
 ket) ; huckleberry seeds (Brundage) ; blackberry seeds 
 (Vanderveer, Wilson) ; shell of hazelnut (Southam) ; 
 a piece of chestnut (Owens, Formad) ; peanuts (Rosen- 
 heimer) ; hair (Peterson, Hildebrandt) ; a bristle 
 (Ward, Gibbons, Ulloa y Geralt); a glazier's point of 
 zinc (Bartlett) ; a globule of solder (Morton) ; a gela- 
 tin capsule (Roberts) ; a piece of bone (Ferguson, 
 Coleman); apiece of screw nail (Ferguson); a rifle 
 cartridge (Ransohoff); fin of a fish (Ashton); knot of 
 a heavy silk ligature from a tubo-ovarian pedicle (Ede- 
 bohls). 
 
 Pathological Conditions Other than Inflammation 
 Affecting the Vermiform Appendix. — For the sake 
 of completeness I append a list of various diseased 
 conditions of the appendix other than inflammatory, 
 which I have found recorded in the literature: Pro- 
 lapse of mucous membrane of appendix (Rolleston^""); 
 invagination of appendix (^McKidd '^'^) •, intussuscep- 
 
TO 
 
 tion of the appendix (McGraw,"^" Wright and Ren- 
 shaw,^'' Waterhouse"') ; cystic dilatation of appendix 
 (Gruber/''' Slioemaker/-^' Hawkins/^' Coats"); reten- 
 tion cyst of appendix (Maylard,'^'' Sonnenburg^'^-') ; 
 mucocele of appendix (Fe're,'" Vimont,"""" Baillet ") ; 
 hydrops of vermiform appendix (Combemarle,"'' Gutt- 
 mann,"" Ribbert ^^') ; tuberculosis of appendix (Apert '" 
 and numerous others) ; echinococcus of appendix 
 (Bierhof,^^ Birch-Hirschfeld "); actinomycosis of 
 appendix (Ekehorn,'"° Gangolph and Duplant/^^ 
 Czerny^^); cystic degeneration or alveolar carcinoma 
 of appendix (Rokitansky'^'"^); primary colloid cancer 
 of appendix (Draper^") ; primary cancer of appendix 
 (Mosse and Daunic^^'); cancer of appendix (Stim- 
 son"^") ; primary adenocarcinoma of appendix 
 (Wright "^) ; primary endothelial sarcomata of appen- 
 dix (Glazebrook '''). 
 
 Bacteriology of the Appendix. — Clarke" has felic- 
 itously entitled the appendix a culture tube. Since 
 Adenot ^ and Gouillioud,"" in 1891, began the study of 
 the bacteriology of the appendix and showed appendi- 
 citis to be due, in practically every case, to bacterial 
 invasion of the appendix walls, most frequently by the 
 bacterium coli commune, researches in this direction 
 have been continued with uninterrupted zeal and en- 
 thusiasm by a number of workers. Ekehorn,'"" in 
 
 1892, proved that the bacterium coli manifested dif- 
 erent degrees of virulence in different cases, and that 
 it is present in every form of appendicitis, from the 
 catarrhal onward. Robb,"'^" in 1892, reported a case 
 of associated streptococcus infection of the vermiform 
 appendix and right Fallopian tube. Morris,'^"*'* in 
 
 1893, published the first article with the distinct title, 
 "Infectious Appendicitis."' Weir,""'" in 1893, found 
 the diplococcus pneumonias in nearly pure culture in 
 the appendix in a case of purulent appendicitis, and 
 Ohlmacher,"" in the same year, found the proteus vul- 
 garis. Hodenpyl,'^' in 1893, contributed a most im- 
 
I T 
 
 portant bacteriological study of appendicitis based 
 upon an examination of thirty-five cases. Achard and 
 Broca/ in 1897, presented a noteworthy resume of the 
 bacteria found in the peritoneal exudate in twenty 
 cases of appendicitis. Beaussenat" has given us the 
 most important paper on experimental appendicitis. 
 His experiments, supplemented by those of Josue',''* 
 prove that germs may invade the lymphoid tissue of 
 the appendix by way of the blood and by way of the 
 lymphatics, as well as through the mucous membrane. 
 Hartmann and Reymond '^" report an observation of 
 the passage of the bacterium coli from an appendix 
 abscess through the intact bladder wall, causing infec- 
 tious cystitis. 
 
 Complications of Appendicitis. — The complications 
 of appendicitis are impressive by reason of both their 
 number and their gravity. Mortier,^" Little,""" Shef- 
 fey,''' Bennett," Lincoln,'"*^ Perry,-'^' Andrews,^' Pi- 
 tres,"' Hendricks,^'' Englisch,'^*^ Dale,'* Bierhof,'' 
 Murray,"^ Weiss,^®'^ and Morris-'" have recorded cases 
 of intestinal strangulation, the result of appendicitis. 
 Death from hemorrhage has resulted from perforative 
 ulceration, due to appendicitis, (a) of the small in- 
 testine (Osier''") ; (^) of the sigmoid (Stedman^'=^) ; (c) 
 of the right external iliac artery (Powell, '^'^ Sour- 
 dille'"); {d) of the right iliac vein (Fowler,'"* 
 Lewis""') . 
 
 Other complications or sequelce noted are: Pro- 
 lapse of the mucous membrane of the appendix into the 
 caecum (Rolleston^"") ; invagination of the appendix 
 (McKidd ""') ; discharge of the gangrenous appendix 
 per rectum. (Jackson,^" Long"'") ; faecal fistula (Long,"" 
 Rioblanc,"' and numerous others') ; appendiculo-intes- 
 tinal fistula through a suppurating mesenteric gland 
 (Packard"^'); vesico-intestinal fistula (Keen''"); per- 
 foration of the colon, rectum, and bladder (Roches- 
 ter^'') ; perforation of the bladder (Clark,'" Boardman,'" 
 Cameron") ; perforation into the bladder with forma- 
 
12 
 
 tion of stone (Fowler''^^) ; localized and general peri- 
 tonitis, by almost every writer; obliteration of the 
 right crural artery by arteritis (Be'rard "'■') ; embolism 
 of the left anterior tibial artery, with gangrene of the 
 leg (Scheibenzuber^'') ; embolism of the pulmonary 
 artery (McGregor) ; phlebitis of the right iliac-, phle- 
 bitis of the left leg (Freeman'"); thrombosis of the 
 right femoral vein (Legg''"*^) ; phlebitis and thrombosis 
 of the vena mesenterica magna and portal pylephlebitis 
 (Aufrecht," Ssawostjc^n' w'*^") ; purulent inflammation 
 of the portal vein (Bacrnhoff,'^' Moers,"^ Machell,'^* 
 Mynter,*"^ Carless^^); portal pylephlebitis and hepatic 
 abscess (Traube,^" Pierson,''' Davat,'" Boussi,'" Jo- 
 rand ''") ; hepatic abscess, " la foie appendiculaire ^' of 
 Dieulafoy'^' (Krakowitzer,'^=^ Ashby,'' De Gennes,^' 
 Shoemaker,'" Harte,"" Achard,' Nuding,'^" Pillietand 
 Costes,''" Sheen, ^'^ Morton"^''); left perinephritic ab- 
 scess, perforation of the diaphragm, left purulent pleu- 
 ritis (Coats"^) ; right perinephritic abscess, perforation 
 of the diaphragm, right empyema (Ardouard," Shiels,^''"* 
 Rioblanc^''^) ; the same, with perforation of the lung 
 (Thacher^"); the same, with gangrene of the lung 
 (Mader-'^) ; right pleuro-pneumonia (Dupre "*) ; sub- 
 phrenic abscess (Sachs,'" Freiberg'"*); perforation of 
 the eighth intercostal space and right lung (McCal- 
 lum,""' McPhaedran'"'"") ; purulent cystitis, due to mi- 
 gration of the bacterium coli commune through the 
 intact bladder wall (Hartmann and Reymond '"") ; pre- 
 vesical abscess (Tuffier^^'); ureteritis, pyelonephritis 
 (Hectoen'") ; scrotal abscess and purulent pleuritis 
 (Lemariey"*'); multiple distant abscesses (Pirard^^'); 
 glycosuria (Leidy'^'') ; fusion of the appendix to the 
 gall bladder (Czerny," Edebohls). Beurnier,^*' Czer- 
 ny,'" and Shoemaker^"^" have devoted special attention 
 to the coexistence of appendicitis and membranous 
 colitis. 
 
 Herniae Containing the Appendix. — The appen- 
 dix has frequently been found among the contents 
 
13 
 
 of a hernial sac. Landsberg,"^ Hall,"^ Zdekauer,"' 
 Monks,-"^ Ohlmacher,'"^ Kayser/^* and Gross"' have 
 recorded cases of inguinal hernia containing the ap- 
 pendix. The case of Hall is historical from the fact 
 that it represents the first removal of the appendix 
 with survival of the patient. Landsberg,'^' Polios- 
 son, "\ Rotter,'"' Routier,'"' Ginnard,'^" and Vander- 
 yggj.a47bis have found the appendix as part of the con- 
 tents of a femoral hernia. 
 
 Appendicitis Associated with Diseased Conditions 
 of the Pelvic Organs. — The association of an inflamed 
 appendix with every variety of diseased conditions of 
 the pelvic organs, more especially of women, is a mat- 
 ter of almost daily observation in the practice of ab- 
 dominal surgery. In some cases the appendix is the 
 starting-point of the diseased action, in others it be- 
 comes involved secondarily to disease affecting pri- 
 marily the pelvic viscera. Baldy," Richelot,'"' Mix- 
 ter"\ Robb,"-" Jr^ggard,"" Binckley,'" McGuire,'-'*' and 
 Deaver'^' have, among others, given special attention 
 in their writings to this aspect of our subject. 
 
 Appendicitis Complicating Pregnancy, Labor, and 
 the Puerperal State. — The classical case of Mesti- 
 vier,"^ the first in which a diseased appendix, in this 
 case containing a pin, was recognized at autopsy as 
 the cause of an abscess in the right iliac fossa, oc- 
 curred in a woman eight months pregnant. The case 
 of Hancock,'"^ no less historical as representing the 
 first successful operation for deep-seated perityphlitic 
 abscess, also occurred in a woman eight months preg- 
 nant. The patieni miscarried four days after opera- 
 tion. The next case recorded is that of Porcher,"" 
 whose patient miscarried at five months, died suddenly 
 and unexpectedly fourteen hours afterward, and was 
 found on post-mortem to have purulent appendicitis 
 and peritonitis. Hirst,'^® in 1890, operated upon a 
 woman six months pregnant for supposed acute sup- 
 purative appendicitis. He found chronic appendicitis 
 
14 
 
 with a few adhesions. The patient died two days 
 after the operation ; there was no autopsy. Mixter,"* 
 in 1 89 1, reports a case of appendicitis originating in 
 the seventh month of pregnancy; successful operation 
 was performed two months after the termination of 
 pregnancy. Wigging" in 1892, reports an autopsy 
 upon a woman three months pregnant, who died ls the 
 result of perforative appendicitis. Petersen,"' in 
 1893, records a case of appendicitis on the seventh 
 day following a l?hor at term, with rupture of the ab- 
 scess into the bowel and recovery without operation. 
 Krafft ""^ reports a successful operation for purulent ap- 
 pendicitis, performed January 29, 1893, upon a woman 
 aged twenty-five years, four and a half months advanced 
 in pregnancy. The patient had double pleuritis and 
 acute endocarditis immediately preceding the appen- 
 dicitis. The pregnancy proceeded to term without 
 interruption, and terminated in the birth of a boy 
 whom the mother, in memory of her experience, chris- 
 tened Malgretout. Grandin,'" in 1893, reports a case 
 of acute catarrhal appendicitis six days after delivery 
 at term ; recovery without operation. Also a case of 
 miscarriage at three months complicated with acute 
 catarrhal appendicitis. Munde,"" in 1894, reports the 
 successful evr,,:uation of a peri-appendicular abscess in 
 a woman eight months pregnant. A dead child was 
 born one week after operation. 
 
 From this time onward reports of cases of appendi- 
 citis occurring in pregnant women become more numer- 
 ous. Hind,'"^ in 1895, reports a case having medico- 
 legal bearings. A woman, pregnant near term, was 
 violently assaulted. Labor set in, and death followed 
 two days after delivery. Autopsy showed an abscess 
 due to perforation of the appendix. Bayley,^^ in the 
 same year, records an attack of appendicitis during the 
 sixth month of pregnancy; recovery took place without 
 operation, followed by delivery at term. McArthur,^"^ 
 also in 1895, reports two operations for acute appen- 
 
15 
 
 dicitis in pregnant ^vomen, both fatal. Johnson/^* in 
 1896, reports a successful operation for non-suppura- 
 tive appendicitis in a woman three and a half months 
 pregnant, followed by confinement at term. Robson,*"' 
 in the same year, records a successful operation for 
 appendicitis thirty-six hours after accouchement at the 
 eighth month. McCosh,"-^ in 1S97, reports a success- 
 ful operation for appendicitis during the sixth month 
 of pregnancy, with subsequent delivery at term. Abra- 
 hams," in 1897, collected the more recent cases of ap- 
 pendicitis during pregnancy from the literature, giving 
 cases of his own together with additional cases of 
 Munde, Harrison, Thomason, Crutcher, and Hirst. 
 For details of these the reader is referred to the de- 
 scriptions and abstracts of Abrahams, Deaver,'^* in 
 1S9S, wrote a valuable paper on appendicitis in rela- 
 tion to disease of the uterine adnexa and pregnancy. 
 Finally Gerster,'^' in 1899, contributes three personal 
 observations of appendicitis successfully operated upon 
 during the eighth, second, and fifth months, respec- 
 tively, of pregnancy, with premature labor in the first 
 and delivery at term in the second and third cases. 
 
 The Diagnosis of Appeudicitis. — The symptoms 
 and signs of perityphlitic abscess^ especially in the 
 later stages of the disease, have been pretty clearly un- 
 derstood by the profession ever since the time of Mes- 
 tivier. Beginning with 1S47, the diagnosis of perfora- 
 tion of the appendix, or of its involvement in the in-, 
 flammatory process, began to be made more frequently, 
 among the first by Cless"' and Hancock.*" Gibney,'^^ 
 in 1 88 1, wrote a very creditable paper on the differ- 
 ential diagnosis between appendicitis and hip-joint 
 disease. Valuable modern contributions have been 
 presented by Morton,''' Deaver,'" Meek,-'" Fowler,'"'^ 
 Murphy ,'"'' and numerous others. Fowler*'^'^ has gone 
 very fully into the differential diagnosis of appendi- 
 citis in the female. 
 
 The greatest advance in the diagnosis of acute ap- 
 
i6 
 
 pendicitis v/e owe to the keen observations of McBur- 
 ney,^*^ which, in 1889, gave us that valuable aid in 
 diagnosis now known the world over as "the McBur- 
 ney point." Rosenthal ^" makes a weak priority claim 
 for Traube in relation to the discovery of the point. 
 
 The elaboration and publication by Edebohls,®^ in 
 1894, of his method of palpation of the vermiform 
 appendix finally made those who have become con- 
 versant with the method masters of the situation as 
 regards the diagnosis of both acute and chronic appen- 
 dicitis. It is true a thickened, inflamed appendix had 
 previously now and then been felt through the ab- 
 dominal walls. Treves,^" in 1889, and Cameron, ^^ in 
 1893, each reported such an experience, and Duncan,^' 
 in J892, says that the position of an inflamed appen- 
 dix may often be felt. The positive determination of 
 the health or otherwise of the appendix, however, by 
 direct examination and palpation of the organ in each 
 and every case presenting, was considered an impossi- 
 bility and never attempted previous to the publication 
 of Edebohls. 
 
 Among those who have adopted Edebohls' method 
 of palpation of the appendix, and who depend upon it 
 for the diagnosis of appendicitis, may be mentioned 
 Deaver,'« Long,'^" Halsted,^'' Shrady,''' Morris,"" 
 Noble,''' Mynter,"" Murphy, Beck," and Kelly.'" 
 
 The Medical Treatment of Appendicitis. — Vol- 
 umes have been written upon the medical and surgical 
 treatment of appendicitis. The history of the origin 
 and development of the surgical treatment of the affec- 
 tion will receive attention presently. The medical 
 treatment has received full consideration at the hands 
 of all the older and many of the more recent clinicians, 
 and the principles supposed to underlie it are well 
 known to every practitioner. Few physicians advo- 
 cate, with With, ^" medical treatment only for all cases. 
 A large number of prominent internists, with Eliot,'" 
 Fitz,"" and others, consider appendicitis essentially a 
 
I? 
 
 surgical affection. As Ipng ago as 1848, Smith ^^^ ex- 
 pressed doubt as to the efficacy of all local applica- 
 tions, including leeches, saying of the latter: "If you 
 are going to use leeches in typhlitis apply them at the 
 anus, not over the swelling." The only recommenda- 
 tion of electricity in the treatment of appendicitis is 
 by Williams.''' 
 
 The Surgical Treatment of Appendicitis. — The 
 earliest recorded case of operation for appendicitis is 
 generally credited to Mestivier,"^"^ who, in 1759, incised 
 and drained an abscess in the right inguinal region. 
 The patient died, and the autopsy disclosed an appen- 
 dix perforated by a pin. A few operations for so- 
 called perityphlitic abscess, which had slowly per- 
 forated the abdominal parietes and become, in part at 
 least, subcutaneous, were reported between 1759 and 
 1848. Dupuytren'^ operated thus in 1815 and 1828; 
 Ahrt** in 1832, and Parker""" in 1843. ^^- ^^^ o^- these 
 cases fluctuation was distinctly made out, and pus was 
 encountered in the subcutaneous tissues of the abdom- 
 inal wall. 
 
 Hancock,'" on April 17, 1848, performed the first 
 deliberate operation for deep-seated suppuration of 
 appendicular origin. He operated on the fifteenth day 
 of illness, and before fluctuation became apparent, 
 reaching the pus collectiqn by a font-inch incision 
 extending from just above the right anterior superior 
 spine of the ilium downward and inward along Pou- 
 part's ligament. His patient recovered. On the 
 strength of this case Hancock proposed to operate 
 early in these cases before fluctuation appeared, re- 
 marking that patients do not usually live to fluctua- 
 tion. His teaching, however, found no echo in medi- 
 cal literature until reiterated by Lewis'""^ in 1856. 
 His example was first imitated after eighteen years by 
 Parker, ■■*''■ the publication of whose case, in 1867, may 
 fairly be said to have directly inaugurated the modern 
 surgical treatment of abscesses of appendicular origin, 
 
i8 
 
 and indirectly to have led to the modern surgery of the 
 appendix. 
 
 By many writers Parker is credited with the first 
 operation for perityphlitic abscess in 1843. Parker, 
 in 1867, reported four cases of perityphlitic abscess 
 operated upon, the first operation being performed in 
 1843. In his first three cases, however, subcutaneous 
 fluctuation or phlegmon invited the incision, as it had 
 done in the cases already cited as previously reported. 
 Parker's first operation for deep-seated suppuration, 
 prior to fluctuation, was performed in 1866, nearly 
 eighteen years after the original operation of Hancock. 
 His patient also recovered. 
 
 From 1867 to 1884 the initiative taken by Hancock 
 and Parker in opening and draining so-called peri- 
 typhlitic abscesses before fluctuation was evident was 
 enthusiastically taken up and followed, especially by 
 American surgeons. New York being at first the chief 
 focus of the new surgical activity. Buck, Sands, 
 Weber, Bontecou, Burge, Whitall, Ward, Kelsey, Hol- 
 den, Clarke, Ely, Raub, Bacon, Clay, North, Beach, 
 Chamberlain, Koehler, Mynter, Weir, Byrd, Pierson, 
 were among the earliest performers or reporters of 
 operations for the evacuation of deeply seated abscesses 
 of appendicular origin. Noyes,'" in 1883, collected 
 the reports of one hundred operations for perityphlitic 
 abscess. 
 
 Nearly all of the perityphlitic abscesses operated 
 upon during this period were opened by the original 
 classical incision of Hancock. Weber^^^ at first con- 
 tented himself with incising down to, but not through, 
 the fascia transversalis, and this method was even 
 advocated as the routine procedure by Whitall. '"^^ 
 Kolb,""^ in i860, practised puncture of the abscess by 
 the trocar and dilatation of the opening with sponge 
 tents. Muenchmeyer,^" in i860, was the first to prac- 
 tise a counter-opening in the loin to obtain better 
 drainage, a procedure which has since found many 
 
19 
 
 imitators. Buck/^ in 1861, evacuated a pelvic ab- 
 scess, presumably of appendicular origin, by puncture 
 through the rectum. Bartholow,'' in 1866, credits 
 Buck with approaching a pentyphlitic abscess from 
 beneath Poupart's ligament by an incision carried 
 through the fascia lata of the right thigh, thence work- 
 ing his way upward beneath Poupart's ligament to the 
 abdomen. I have been unable to find the original 
 account by Buck of this procedure. Barlow and God- 
 lee,*" in 1885, operated upon a case of appendicular 
 abscess by two incisions, one median, exploratory in 
 character, and one lateral, over the abscess, to evacu- 
 ate the pus. This procedure has been followed in a 
 number of cases by various operators. Kroenlein,"^ 
 in 1887, reported the first case of operation for peri- 
 typhlitic abscess under Listerism. Homans,'^'' in 1886, 
 took a decided step in advance in the case of an ap- 
 pendicular abscess deeply situated against the pos- 
 terior abdominal wall. He opened the abdomen 
 through the usual incision above and parallel to Pou- 
 part's ligament, and evacuated the abscess across the 
 free peritoneal cavity while protecting the latter against 
 infection by suitably placed packing. This has be- 
 come and remained standard modern practice. Not 
 so the procedure of Edebohls,''^ who in 1889, in a 
 similar case, closed the peritoneum by suture, dissected 
 it up, and opened the abscess retroperitoneally. 
 Byrd,'* in 1881, in a case of perforative appendicitis 
 with two additional, ulcerative perforations of the 
 caecum, adopted the procedure, nothing less than bril- 
 liant for that day, of converting the three openings 
 into one large one, establishing an artificial anus by 
 stitching the bowel opening to the wound, and irri- 
 gating and draining the free peritoneal cavity. His 
 patient recovered. Mention should, finally, be made 
 of Kottmann's'"' plan of opening the abscess by 
 Vienna paste, the only advocacy or practice of this 
 method which I have found recorded in the literature. 
 
20 
 
 The above data all refer to operations for the evacu- 
 ation of perityphlitic abscesses of appendicular origin 
 undertaken before the time at which operations upon 
 the appendix itself came into vogue. The history of 
 the surgery Df the appendix itself, and data in connec- 
 tion therewith, will presently receive attention. Be- 
 fore proceeding to this chapter of the history of ap- 
 pendicitis, however, two subjects, that of aspiration, 
 exploratory or curative, of perityphlitic abscesses, and 
 that of so-called left-sided appendicitis, deserve a mo- 
 ment's consideration. 
 
 Exploratory Puncture. — Bontecou,"' in 1873," re- 
 ported two cases of operation for perityphlitic abscess 
 in which he employed previous aspiration to determine 
 the presence of pus. Prior to that time we find re- 
 corded, now and then, a crude attempt to establish the 
 presence of pus by an oblique puncture with a narrow 
 knife, a grooved needle, or a trocar. Potter, -^'^ in 1879, 
 reported a cure of perityphlitic abscess following a 
 single aspiration of the contained pus. Peltzer,'*''^ in 
 1882, observed a cure following two aspirations of the 
 pus, followed each time by irrigation of the abscess 
 cavity with a solution of salicylic acid. Bull,^*^ in 
 1886, advocates dropping all time limits and operating 
 as soon as pus can be discovered by the needle. At 
 about this period exploratory punctures for diagnostic 
 purposes were much in vogue. Gradually, however, 
 they yielded place to the increasing positiveness with 
 which diagnosis could be reached without their aid, 
 until at the present day probably no surgeon of any 
 prominence either employs or recommends the needle 
 for diagnosis. 
 
 Left-Sided Appendicitis. — As regards ieft-sided 
 appendicitis the only genuine case thereof on record 
 is that of Biegi,^^ which occurred in a soldier who 
 died of appendicitis and was found on autopsy to have 
 a complete transposition of all the viscera. The case 
 of Bontecou/' in which death resulted from ulcerative 
 
21 
 
 perforation of the small intestine into the left iliac 
 fossa; that of Traube,^^^ of a perityphlitic abscess 
 pointing on the left side; and the three cases reported 
 by Fowler/''^ in which the caecum and appendix were 
 displaced to the left, all originated primarily in the 
 right iliac fossa. So did the case of Coats/^ in which 
 empyema of the left chest followed perforation of the 
 diaphragm by pus from an abscess of appendicular 
 origin. 
 
 Surgery of the Appendix. — We have finished with 
 the history of the era when operations for the evacua- 
 tion and drainage of perityphlitic abscesses consti- 
 tuted, with the few exceptions mentioned, the sole surgi- 
 cal resource in the treatment of appendicitis, or rather 
 of its results. We come now to the period which saw 
 the birth of the surgery proper of the appendix itself. 
 We will consider the surgery of the appendix as ap- 
 plied, first, to the treatment of acute appendicitis, and, 
 secondly, to the treatment of chronic, relapsing, and 
 interval cases. 
 
 The first recorded operation upon the appendix itself 
 was planned by Dr. Mahomed and executed on August 
 24, 1883, by Symonds."" Mahomed diagnosticated a 
 stone in the appendix. Symonds removed the stone, 
 three-fourths by one-half inch in size, through the 
 ordinary incision for tying the external iliac artery, 
 approaching the appendix from behind, through peri- 
 toneal adhesions, opening the appendix, extracting the 
 stone, and closing the opening in the appendix by 
 Lembert sutures. The patient recovered and was 
 cured of all his s.ymptoms. In connection with this 
 case Symonds becomes prophetic in relation to the 
 future removal of the appendix in similar cases. I 
 have found but three other instances of operation upon 
 the appendix stopping short of its removal. INIorton,'*'^ 
 on April 27, 1887, removed the larger part of an appen- 
 dix containing a perforation, between two ligatures, 
 one applied near the base and one near the distal free 
 
341 
 
 22 
 
 end of the appendix. Sands, ^°^ on December 31, 1887 
 closed a perforation of the appendix by suture. Tait 
 in 1889, slit open and drained an appendix. All three 
 patients recovered. 
 
 Excision of the Appendix. — Kroenlein,''* on Feb- 
 ruary T4, 1884, performed the first removal of the ap- 
 pendix for acute appendicitis. He was followed in 
 1886 by Weir,'"' Bryant,^' and one or two others. 
 These earliest appendicectomies for acute appendicitis 
 had one discouraging feature in common; they were 
 all fatal. 
 
 The first successful removal cf the appendix was 
 performed by Hall,'" on May 8, 1886, in an operation 
 for the relief of a strangulated hernia. The appendix, 
 with an abscess around it, was found among the con- 
 tents of the hernial sac, tied off, and removed. 
 
 Morton,'^- on March 19, 1888, and Sands,^°^ on 
 April 17, 1888, performed the first successful appen- 
 dicectomies for acute appendicitis, the correct diag- 
 nosis having been made in both cases before operation. 
 To Morton belongs priority of performance, to Sands 
 priority of publication. Other successful appendicec- 
 tomies for acute appendicitis were performed during 
 1888, in the order named, by Hoffmann,'^'* McBur- 
 ney,"" Cutler," and VVeir.^*^' Hoffmann removed the 
 appendix through a median incision, and the case of 
 McBurney was the first in which an acutely inflamed 
 appendix, full of pus, was removed entire and without 
 rupture. 
 
 Thereafter removal of the appendix in acute appen- 
 dicitis rapidly became a recognized and oft-undertaken 
 procedure. As early as 1889, McBurney'"'^ reported 
 seven appendicectomies of his own with six recoveries 
 and one death, and Morton'"" four appendicectomies 
 with two recoveries and two deaths. Since that time 
 scores of operators number their appendicectomies for 
 acute appendicitis by the hundreds. 
 
 Treves,'*' on June 29, 1888, performed the first ap- 
 
23 
 
 pendicectomy for relapsing appendicitis. The opera- 
 tion as described would be classed as modern even at 
 this day, the stump end being closed by suture instead 
 of ligated, the abdominal wall closed for primary 
 union, and the patient recovering. The rapidity with 
 which operations for relapsing appendicitis, or inter- 
 val operations, were adopted, and the success with 
 which they were practised by surgeons the world over, 
 are best evidenced by the fact that Bull," as early as 
 1894, was able to collect four hundred and forty-four 
 interval operations with eight deaths. It is safe to 
 say that at the present day several thousand such cases 
 could be collected from the literature alone. 
 
 The Technics of Appendicectomy. — The various 
 surgical procedures for the simple evacuation and 
 drainage of a peri-appendicular abscess have already 
 been considered. It remains to record the history of 
 the development of the technics of the operation for 
 the removal of the appendix. 
 
 Appendicectomy for Acute Perforative or Gan- 
 grenous Appendicitis. — During the two or three years 
 immediately following the first removal of the appen- 
 dix for acute perforative appendicitis by Kroenlein,"* 
 in 1884, and the early, equally unsuccessful imitations 
 of his example, the advocates of appendicectomy in 
 pus cases were few indeed. The first successful cases, 
 reported in 1888, furnished a new stimulus to surgical 
 activity in this direction, and within two or three 
 years thereafter the number of cases reported slowly 
 increased. Since 1890 the large majority of surgeons 
 with a name advocate removal of the appendix in acute 
 appendicitis as the routine procedure, always to be 
 attempted save under m.ost exceptional conditions. A 
 few surgeons claim that it is always both possible and 
 better to remove the appendix in acute appendicitis. 
 This advice and practice are based upon the fact that 
 a second operation for appendicitis has become neces- 
 sary in some cases in which the appendix was left at 
 
24 
 
 the first operation. Comparatively, however, the cases 
 in which such a secondary operation was called for or 
 performed are very few, Morton,'" Patel,'"' Romans,"^" 
 and Wolf ^''"* among others have put on record such sec- 
 ondary onerations. The expedient adopted by Wyeth "* 
 of operating at two sittings represents an unnecessary 
 compromise. 
 
 In direct opposition to the modern tendency to re- 
 move the appendix whenever feasible, and vainly 
 attempting to stem the tide, we find Barton,''^ as late 
 as 1894, and a few others even more recently, preach- 
 ing the doctrine of leaving the appendix in operations 
 for acute appendicitis, claiming better results from this 
 practice. That this claim does not hold good in the 
 work of the better operators goes without saying. 
 
 The Incision in Acute Appendicitis. — The early 
 incisions employed in operations for acute appendi- 
 citis, when abscesses were emptied and drained 
 <{)nly, as well as when the appendix was removed, 
 always divided all the various anatomical layers of 
 the abdominal wall in one and the same directions: 
 either a little above and parallel to Poupart's liga- 
 ment, or nearly vertically, just external and parallel 
 to the outer border of the right rectus abdominis mus- 
 cle. Aside from the counter-opening in the back more 
 or less frequently practised by a number of surgeons, 
 Dejace "^ in one case practised lumbar incision of a 
 perityphlitic abscess, and Gerster'^° speaks of Lange 
 as in one instance having to abstain from removing 
 the appendix through an anterior incision, later on 
 removing the organ successfully through a posterior 
 wound. Vischer,'°° in 1897, proposed a new site for 
 the incision, placing it above and parallel to the iliac 
 crest and running from the outer edge of tlie external 
 oblique inward to the anterior superior iliac spine. 
 The median incision has also been practised, now and 
 then, by Hoffmann''' and others, but has found no en- 
 thusiastic advocates. 
 
25 
 
 The gridiron incision of McBurney,"-^ published in 
 
 1894, represents the most modern thought and fully 
 satisfactory technics in regards to the incision of the 
 anterior abdominal wall practised anywhere between 
 the outer borders of the recti and the erector spinae 
 muscles on either side, not only for appendicitis, either 
 acute or chronic, but also for other intra-abdominal 
 conditions exceptionally best approached within the 
 limits stated. McBurney at first thought his incision 
 unsuitable for pus cases calling for gauze packing. 
 This judgment, however, has been reversed by the fur- 
 ther experience of a number of American operators, 
 among them the writer, who constantly use this incision 
 in cases of acute appendicitis, and consider all the other 
 incisions already mentioned as antiquated and out of 
 place in up-to-date surgery. The slight modification of 
 the gridiron incision proposed by Elliot, ^^'^ who cuts the 
 fascia of the external oblique horizontally, while at- 
 tempting to refine on the principle enunciated by Mc- 
 Burn"ey, is of no practical importance. 
 
 The Incision in Chronic Appendicitis. — The com- 
 ments made anent the first incisions practised for acute 
 appendicitis hold good also for those made for the 
 removal of the appendix in interval cases, with this 
 important exception: that, beginning with the very 
 first removal of the appendix for recurrent inflamma- 
 tion by Treves, the abdominal wound has been very 
 generally closed for primary union without attempts at 
 drainage. The gridiron incision, originally devised 
 and brought forAvard by McBurney for cases of appen- 
 dicitis not requid_ng drainage, but equally applicable 
 to pus cases, represents the first giant stride forward 
 in the surgery of the incision made for the removal of 
 the appendix in chronic appendicitis. Battle, ''' in 
 
 1895, gave us the incision through the right rectus 
 abdominis muscle, which in chronic appendicitis has 
 become the successful rival of the gridiron incision of 
 McBurney. The rectus incision of Battle may be 
 
26 
 
 found admirably pictured and described as the simple 
 incision by Deaver'" in 1896. Curiously enough, in 
 1897, Jalaguier,'"*^ Kammerer,"' and Lennander''" pub- 
 lished the Battle incision, each apparently urder the 
 impression that the incision was original with himself. 
 The lumbar incision for chronic appendicitis was 
 brought forward by Edebohls/"" in 1898, as applicable 
 to cases in which right nephropexy and appendicec- 
 tomy were called for in the same patient. 
 
 About ten centimetres seems to be the length of in- 
 cision usually accepted as required in acute appendi- 
 citis. In the surgery of chronic appendicitis Mor- 
 ris, "° in 1893, first recognized that such long incisions 
 were unnecessary, and loudly called for the one-and-a- 
 half-inch incision. He has since been outdone in this 
 direction by Scott, ^^* who writes on "the incision less 
 than one and a half inches long in appendicitis." 
 The writer'"^ has recently recorded his views on the 
 subject, and will close with the statement that the 
 only incisions necessary and permissible in the mod- 
 ern surgery of the appendix are the gridiron incision 
 of McBurney, the rectus incision of Battle, and, per- 
 haps, the lumbar incision of Edebohls. 
 
 Technics of the Stump. — The treatment of the 
 stump left after amputation of the appendix has occu- 
 pied a great deal of the attention of surgeons. In 
 some cases of acute appendicitis, with gangrenous de- 
 struction and disintegration of the entire appendix and 
 even of greater or less areas of the csecal walls, the 
 question of a stump and its treatment does not arise. 
 In such cases the damage must be repaired by suture, 
 and the danger must be minimized by the usual gauze 
 packing and drainage, or by suture of the damaged 
 bowel to the abdominal wall as practised by Byrd,^'^ 
 Bunner," and others. Simple ligation of the stump, 
 though still very generally practised, cannot be consid- 
 ered a perfectly safe procedure. Dock '^ has put on 
 record a death from simple ligation, and the writer 
 
27 
 
 knows of another unpublished case in which intestinal 
 leakage and fatal peritonitis followed the slipping of 
 a ligature placed around an appendix stump. 
 
 The example of Lautard/''^ who amputated the tip 
 of the appendix and sewed the long stump to the ab- 
 dominal walls, has found no imitators. 
 
 Invagination of the ligated stump has been attempted 
 by Smith '"" and many others since his time. All such 
 attempts are illogical and have necessarily met with 
 failure, as complete invagination of a ligated. stump is 
 an impossibility. The most that can be accomplished 
 is to depress a ligated stump and cover it over with 
 peritoneum, a procedure which Stimson^^^ was the first 
 to condemn as ''bottling up" of the appendix. 
 
 Closure of the open ends of the appendix by suture 
 was practised by Treves^^° in the very first case of re- 
 moval of the appendix for recurrent appendicitis, the 
 mucous and muscular coats being united by suture. 
 Treves, however^ found it impossible in his case to 
 sew the peritoneum over the free end of the stump, 
 which procedure appears to have been first accom- 
 plished by Allingham. Monks,'"'' in 1890, im.proved 
 this step of the technique by first inverting the cut 
 end of the appendix and then closing the inverted edge 
 by suture. Ruth,^"'' in 1895, sutured the cut edges of 
 the appendix stump, inverted the stump, and approxi- 
 mated the peritoneum by suture. 
 
 Inversion of the appendix stump without previous 
 ligation and suture was practised by Dawbarn'*^ as far 
 back as 1890 or 1891. The correct principle underly- 
 ing Dawbarn's method was clumsily imitated by Plum- 
 mer,'^"^ who slits the appendix stump upward at two 
 opposite points, trims and inverts the flaps, and sutures 
 the serosa — and by Bloch," who uses a temporary 
 suture through the lips of the appendix stump, passes 
 the threaded suture through the csecal wall opposite 
 the appendix, from within outward, withdraws the 
 suture, and closes the peritoneum over the inverted 
 stump. 
 
28 
 
 Price^"^ and Eastman^^ do away entirely with a 
 stump by excision of the entire appendix and suture 
 of the resultant hole in the bowel wall. Edebohls^" 
 originated inversion of the entire, uncut appendix, the 
 only procedure which does away with the necessity of 
 opening the bowel and with the resultant risk of infec- 
 tion. His procedure, so far as I am aware, has found 
 but one imitator, Fowler,'"^ whose first and only case 
 of inversion of the entire appendix for chronic appen- 
 dicitis ended fatally as the result of the operation. 
 Against this, however, stand considerably more than 
 one hundred cases of inversion of the entire, uncut 
 appendix for chronic appendicitis, at my own hands, 
 without a single death. 
 
 Septic Peritonitis ; Drainage ; Accidents. — The 
 treatment of the diffuse septic peritonitis accompany- 
 ing appendicitis has received attention at several 
 hands. McBurney,^"^ in 1895, wrote the most impor- 
 tant clinical contribution to this aspect of appendicitis, 
 advocating free flushing of the peritoneum with drain- 
 age, procedures practised by Byrd ^^ as early as 1881. 
 Pond"'" added to these resources, in extremely bad 
 cases, incision of the intestine and suture of the inci- 
 sion lips to the abdominal wound, permitting of the 
 direct introduction of salines, stimulants, etc., into 
 the intestine. 
 
 Gauze drainage is all but universally used in pus 
 cases, either alone or combined with rubber or glass 
 drainage tubes. Morris^" first employed an iodoform 
 wick, and later a special device consisting of a slen- 
 der piece of gauze wrapped about with perforated rub- 
 ber tissue. As regards the use of iodoform gauze, 
 opinions of experienced men vary widely. Morris, for 
 instance, in 1897, published a tirade against the use 
 of gauze, iodoform and plain, while Murphy, in the 
 same year, returns to the use of iodoform gauze after 
 having completely discarded it for a time. 
 
 Very recently a tendency to close immediately the 
 
29 
 
 abdominal wall for primary union in some cases of 
 appendicitis with pus is becoming manifest. Schuel- 
 ler,"' in 1S89, was the first, I believe, successfully to 
 close the abdomen at once and entirely after an appen- 
 dicectomy at which he found turbid serum in tl">e peri- 
 toneal cavity. Clark,'" in 1897, alludes to instances 
 of similar practice, and Boldt informs me that he has 
 several times operated successfully in the same man- 
 ner in cases in which a small amount of pus was 
 present. 
 
 A curious accident, tearing off of the distal end of 
 the appendix during enucleation of the latter, and fail- 
 ure to find again the distal end, is recorded by Hunt- 
 ington.'" The writer has had a similar experience; 
 both cases ended in recovery, without drainage. 
 Hutchinson'"'" reports an operative case in which he 
 found the appendix at some distance from the caecum, 
 from which it had entirely separated by sloughing. 
 
 Statistical. — i^utopsy statistics of appendicitis, 
 large "and important for the time at which they were 
 presented, have been given by Leudet,""^ Finnell,^'^ 
 Toft,''' Fitz,"'' Einhorn,'^' Wallis,^^' Ribbert,-^'' and 
 Robinson.-"^ Kleinwaechter'" and With''" have fur- 
 nished statistics regarding the duration of appendicitis 
 under medical treatment, while Sands'"^ and Fitz'^^ 
 investigated the mortality under medical and under 
 surgical treatment. McBurnev"'"' presents personal 
 statistics of operations for appendicitis in the pres- 
 ence of diffuse septic peritonitis. Von Mayer^^* gives 
 us a very unique, practical, and interesting study of 
 seventy-five operative cases of chronic appendicitis. 
 Of these, thirty-three presented clinical symptoms 
 corresponding to the lesions found, thirty-two pre- 
 s-^nted no clinical symptoms, and ten had severe symp- 
 toms with no lesions. Statistics of operative cases, 
 with mortality, have been published by Clay,^" Bull," 
 MacDonald,-'^ Murphy,''"'' Johnson,'"'' Kuemmeii,'®' 
 Sonnenburg,"" Deaver,"" Halliday,'^* and very numer- 
 ous others. 
 
30 
 
 Illustrations. — Appendicitis has furnished a favor- 
 ite subject for the artist's pencil and brush, and it is 
 not too much to say that perhaps upon no other sub- 
 ject in the entire range of pathology has such wide- 
 spread, profuse, elaborate, and beautiful illustration 
 been lavished. I call attention in the following to 
 those illustrations which have struck me as particu- 
 larly noteworthy; they constitute, however, only a 
 modicum of the whole. 
 
 The anatomy of the appendix and its vicinity has 
 been thoroughly illustrated by Little,'"* Schueller,^'^ 
 Lockwood and Rolleston,'"^ Levings,""" Kelynack,^'^ 
 and Jonnesco,'^** The general pathology has been 
 well pictured by Fenger,''^ Fowler,'-^ Jessop,'" Plum- 
 mer,'"'" Lannelongue,''^ Smith, ^■'^ and Sonnenburg^'^ 
 among others, while the histo-pathology has been espe- 
 cially well delineated by Letulle and Weinberg.'"" 
 Chronic appendicitis has received the artistic atten- 
 tions of Foges"" ; interval appendicitis those of Abbe' ; 
 appendicitis obliterans those of Senn^'^ and Zucker- 
 kandl"*"'; and the location of abscesses those of Har- 
 ris. ^^^ Intestinal strangulation following appendicitis 
 has been pictured by most of those already enumerated 
 as having described cases, while some of the operative 
 sequelae have been delineated by Peck.""* Cysts and 
 cystic degeneration of the appendix have been well 
 pictured by Gruber,''' Gouillioud,"' Shoemaker,'"' 
 Sonnenburg,^" and Coats."' 
 
 Among illustrations of other pathological conditions 
 affecting the appendix the following may be men- 
 tioned : Invagination of the appendix, by McKidd '"^ ; 
 prolapse of mucous membrane of the appendix, by 
 Rolleston'""; thrombosis of appendicular vessels, by 
 Dieulafoy"; tuberculosis of the appendix, by Apert '"; 
 and primary cancer of the appendix, by Mosse and 
 Daunic.'*^ The technics of the operation for appen- 
 dicitis have been abundantly illustrated by many 
 writers, among others by Ruth,'"^ Deaver,'' Fowler, 
 
 124 
 
31 
 
 and Morris.-" The article of Ruth contains beautiful 
 illustrations detailing the technics of the stump. 
 Deaver's admirable plates are the only ones I have 
 found illustrating the rectus incision. Five cuts de- 
 tailing post-operative sequelae in a very interesting 
 case are given by Peck,"" 
 
 Literature. — ^The entire literature of appendicitis, 
 complete to the beginning of the year 1899, and in- 
 cluding, in addition, about fifty numbers appearing 
 during the present year, has been consulted in the 
 preparation of this article. This vast literature em- 
 braces, as already stated, more than twenty-five hun- 
 dred journal articles, dissertations, and books, A 
 complete bibliography, prepared by the author, may 
 be found in the library of the New York Academy of 
 Medicine, where it is at the disposal of any one who 
 may wish to consult it. 
 
 The appended bibliography of three hundred and 
 seventy-six references is believed to include nearly all 
 of real value that has been published upon the sub- 
 ject of appendicitis. It includes papers and books » 
 important and valuable for the time at which they 
 were published, together with a number of articles to 
 which reference became necessary in the preparation 
 of this historical review. 
 
 BIBLIOGRAPHY. 
 
 1. Abbe, R. : Medical Record, New York, 1897, Hi., 37-39. 
 
 2. Abrahams, R. : Anier. Jour, of Obst. , 1S97, xxxv. , 205- 
 225. 
 
 3. Achard, C: Mfrcredi med., Paris, 1894, v., 569-572. 
 
 4. Achard, C. , et~Broca, A.: Bull, at mem. soc. med. des 
 hop. de Paris, 1897, s. 3, xiv. , 442. 
 
 5. Adenot : Compt. rend. soc. de biol., Paris, 1S91, s. g, iii., 
 740-742. 
 
 6. Ahrt : Jour. d. Chir. u. Augenh., Berlin, 1S35, xxiii., 140- 
 14S. 
 
 7. Albers, T. F. H.: Beobacht. a. d. Gebiete d. Pathol., 8vo, 
 Bonn, 1S3S, pt. 2, 1-37. 
 
32 
 
 8. Allen, D. P. : Rev. de gyne'col. et de chir. abd. , Paris, 
 1897, i., 665-690. 
 
 9. Andrews, T. H. : Proceedings of the Path. Soc. of Phila- 
 delphia, 1866, ii., 238-240. 
 
 10. Apert, E. : Presse med. , Paris. i8g8, ii., 343. 
 
 11. Ardouard : Progres med., Paris, 1876, iv. , 416. 
 
 12. Ashby, H.: Lancet, London, 1879, ii., 649. 
 
 13. Atkinson, G. A.: British Med. Jour., London, 1895,!., 
 
 1439- 
 
 14. Aufrecht, E. : Berlin, klin. Wochenschr. , 1869, vi., 308. 
 
 15. Baernhof, A.: Beitr. z. Heilk., Riga, 1854-55, iii., 147- 
 150. 
 
 16. Baillet : Bull. soc. anat. de Paris, 1891, Ixvi. , 67. 
 
 17. Baldy, J. M.: Medical News, Philadelphia, 1S89, Iv., 
 
 579-581. 
 
 18. Bamberger: Verhandl. d. phys.-med. Gesellsch. in 
 "Wiirzb., 1859, ix. , 123. 
 
 19. Bartholow, R. : Amer. Jour, of Med. Sci., Philadelphia, 
 1866, n. s. , Hi., 351-362. 
 
 20. Barlow and Godlee : Trans. Clin. Soc. of London, 1885-86, 
 xix. , 8S-94. 
 
 21. Barton, J. M. : Philadelphia Polyclinic, 1894, iii., 173-175. 
 
 22. Battersby, F. : Dublin Quarterly Jour, of Med. Sci., 1847, 
 
 iii., 516-539- 
 
 23. Battle, W. H.: British Med. Jour., London, 1S95, ii. , 
 1360. 
 
 24. Battle, W. H. : British Med. Jour., London, 1897, i. 965- 
 967. 
 
 25. Bayley, N. B.: Medical Record, New York, 1895, 
 xlvii. , 342. 
 
 26. Beaussenat, M. : Rev. de gynec. et de chir. abd., Paris, 
 1897. i. 283-312. 
 
 27. Beck, C.: New York Med. Jour., 1898, Ixviii., 685, 727, 
 
 757. ?"^ 
 
 28 B ;nnett, R. : Trans. Path. Soc. , London, 1852-53, iv., 146. 
 
 29. Bjrard : Gaz. des hop., Paris, 1840, 2mes., ii,, 145. 
 
 30. Beurnier, L.: Jour, de med. de Paris, 1898, 2mes. ,x. , 
 
 546. 
 
 31. Biegi : Med. moderne, Paris, 1897, viii. , 643. 
 
 32. Bierbaum, J.: Jour. f. Kinderk. , Erlangen, 1867, xlviii., 
 
 26-55. 
 
 33. Bierhoff, C. : Ueber die Krankheiten des Wurmfortsatzes, 
 8vo, Ludenscheid, 1878. 
 
 34. Bierhoff, C.: Deutsches Arch. f. klin. Med., Leipzig, 
 1880-81, xxvii., 248-267. 
 
 35. Biggs, H. M.: Medical Record, New York, 1888, 
 xxxiii. , 720. 
 
33 
 
 36. Binkley, J. T.: Amer. Jour, of Obst., New York, 1894, 
 xxix., 474. 493- 
 
 37. Birch -Hirschf eld, F. v.: Arch. d. Ileilk., Leipzig, 1871, 
 xii,, 191. 
 
 3S. Bloch, A. J. N.: New Orleans Med. and Surg. Jour., 
 1896-97, xlix , 75-7S. 
 
 39. Bloomfield, J. E. : British Med. Jour., London, 1S95, ii., 
 65S. 
 
 40. Boardman. C. H.: Northwest. Med. and Surg. Jour., St. 
 Paul, 1873-74, iv. . 8-12. 
 
 41. Bontecou R. B. ; Trans. Med. Soc. of New York, Albany, 
 1873. Ixvii., 137-139. 
 
 42. Boussi, R.: France med., Paris, 187S. xxv., 154-156. 
 
 43. Buck, G. : Amer. Med. Times, New York, 1S61, iii., 
 258-260. 
 
 44. Buck, G. : Trans. New York Acad, of Med. (1S74-76), 
 1876, 2d s , ii., 1-14. 
 
 45. Bull, W. T.: New York Med. Jour., 1S73, xviii., 240-264. 
 
 46. Bull, W, T. : Medical Record, New York, 18S6, xxix., 
 265. 
 
 47. Bull, \Y. T. : Medical Record, New York, 1S94, xlv., 
 
 385-359- 
 
 48. Burne. E. : Gaz. med. de Paris, 1838, 2me s. , vi. , 3S5-401. 
 
 49. Brenner. A.: Wien. klin. \Vochenschr. , 188S, i , 216-219. 
 
 50. Bryant, J. D. : Annals of Surgery, Philadelphia, 1S93, 
 xvii., 1 64-1 So. 
 
 51. Bryant, J. D.: Gaillard's Med, Jour.. New York, 1887, 
 xliv , 134-^36- 
 
 52. Byrd. W. A.: Trans, Amer. Med. Assoc, Philadelphia, 
 1881, xxxii., 433-437- 
 
 53. Cameron, H, C: Glasgow Med, Jour., 1894, xlii., 143- 
 
 147. 
 
 54. Carless, A,: Kings College Hosp. Rep,, 1894-95, London, 
 1896, ii.. 93, 
 
 55. Clark, J, G, : Amer. Jour, of Obst., 1897, xxxv. , 672. 
 
 56. Clark, A,: Amer. Med. Times, New York. 1861, ii.. 258. 
 
 57. Clarke, E, W, : Med. Press and Cir. , London. 1894, n. s. , 
 Ivii., 386-388. 
 
 58. Clarke and Smith : Lancet, London, 1890, i., 956-958, 
 
 59. Clay, D. M, : New Orleans Med, and Surg. Jour,, 1878- 
 79, vi,, 196-214. 
 
 60. Clemens, T,: Deutsche Klinik, Berlin, 185T, iii,, 85. 
 
 61. Cless : Med, Cor. -Bl. d. wurttb. arztl. Yer., Stuttgart, 
 1847 xvii., 27, 
 
 62. Cless, Jr.: Med, Cor,-Bl, d, wurttb, arztl. Ver., Stuttgart, 
 1857, xxvii,, 25, 33, 
 
 63. Coats, J.: Manual of Pathology, third edition, 1895, 
 
34 
 
 Longmans, Green & Co., London, 8vo, p. 1 130 (pp. 863 and 
 876). 
 
 64. Coe, H. C: New York Polyclinic, 1894, iv. , 73. 
 
 65. Combemarle : Bull. med. du Nord, Lille, i8gi, xxx. , 
 223-225. 
 
 66. Courtney, W. : Northwestern Lancet, St. Paul, 1897, xvii. , 
 443-446. 
 
 67. Craig, C. F. : New England Medical Monthly, 1897, xvi., 
 407-417. 
 
 68. Crutcher, H. : Medical Era, Chicago, i8g6, xiii., 312. 
 
 69. Crutcher, H.: International Journal of Surgery, New 
 York, iSg6, ix , 99. 
 
 70. Crutcher, H.: Hahnemannian Advocate, Chicago, 1896, 
 XXXV., 277-2S3. 
 
 71. Cutler, E. R. : Boston Med. and Surg. Jour., 1S89, cxx. , 
 
 554-556. 
 
 72. Czerny and Heddaeus : Beitrag z. klin. Chir., Tubingen, 
 1898, xxi.. 513-618. 
 
 73. Dade, W. H. : Medical News, New York, 1898, Ixxii., 
 
 439- 
 
 74. Dale : British Med. Jour., London, 1879, ii , 655. 
 
 75. Davat . Bull. soc. anat. de Paris, 1873, xlviii., 577- 
 
 76. Dawbarn. R. H. M. : Medical Record, New York, 
 
 1895, xlviii., 289-294. 
 
 77. Deaver, J. B. : Medical News, Philadelphia, 1894, Ixiv. , 
 533. 566. 
 
 78. Deaver, J. B. : Trans. Med. Soc. of Pennsylvania, Phila- 
 delphia, 1894, XXV., 110-118. 
 
 79. Deaver, J. B. : A Treatise on Appendicitis, Philadelphia, 
 
 1896, P. Blakiston, Son & Co., 16S pages, 32 plates, 8vo. 
 
 80 Deaver, J. B. ; New Orleans Med. and Sur. Jour., 1898- 
 99. li., 443-445. 
 
 81. Deaver, J. B. : Trans. Amer. Assoc, of Obstet. and 
 Gynaecologists, 1897, Philadelphia, 1S97, x., 362-372. 
 
 82. De Gennes, P.: Bull. soc. anat. de Paris, 1883, lyiii., 
 168-172. 
 
 83. Dejace, L. : Ann. soc. med. -chir. de Liege, 1894, xxxiii., 
 282-285. 
 
 84. Delbet, P.: Le9ons de clinique chirurgicale, Paris, 1899, 
 G. Steinheil, 8vo. 376 pages. 
 
 85. Dennis, F. S. : Trans. Amer. Surg. Assoc, Philadelphia, 
 1890, viii., 135-166. 
 
 86. Diagnosis (The) and Treatment of Inflammation of the 
 Appendix ; a discussion. Med. Communications of the Massa- 
 chusetts Med. Soc, Boston, 1891, xv. , 529-560, 
 
 87. Dieulafoy : Clin. med. de I'Hotel-Dieu de Paris (1897- 
 98), 1899, 2, 167. 
 
35 
 
 88. Dieulafoy, G. : Presse me'd., Paris, iSgS, ii., 2S1-284. 
 
 89. Dock, G : Medical Age, Detroit, iSg2. x., 397-402. 
 
 90. Draper, F. W. : Boston Med. and Surg. Jour., 1SS4, ex., 
 
 131- 
 
 91. Duncan. J.: Trans. Med.-Chir. Soc. . Edinburgh, 1892- 
 93, n. s , xii., 227-237. 
 
 92. Dupre, E.: F"rance med . Paris, 1SS8, i., 25-31. 
 
 93. Dupuytren : Clinique chirurgicale, Paris, 1S39, iii., 8vo, 
 520. 
 
 94. Eastman, J.: Western Med. Rec, 1S99, iv. , 43-48. 
 
 95. Edebohls, G. M.: Mediz, Monatsclir. . i8go. ii., 220. 
 
 96. Edebohls, G. M.; Amer. Jour, of Med. Sci. , 1894, n. s., 
 cvii., 4S7. 
 
 97. Edebohls, G. M. : Post-Graduate, 1894, ix., 154. 
 
 98. Edebohls, G. ]\I.: Amer. Jour, of Obst., 1S95, xxxi. , 164. 
 
 99. Edebohls, G. M.: Amer. Jour, of Med. Sci , 1S95, n. s. , 
 cix. . 650. 
 
 100. Edebohls, G. M.: Centralbl.- f. Gyn., iSgS, xxii., 1084- 
 1090. 
 
 loi. Edebohls, G. M. : Post Graduate, 1899, xiv., 85-98. 
 
 102. Edebohls, G. M.: Medical Record, New York, 1899, 
 Iv. , 341-345- 
 
 103. Edebohls, G. M.: Medical Record, New York, 1S99, 
 Iv. , 665-667. 
 
 104. 'Edson, B. : Proceedings of Med. Soc. of County of 
 Kings, Brooklyn, 1879-S0, iv., 45-49. 
 
 105. Einhorn, H.: Munchner med. Wochenschr. , 1S91, 
 xxxviii , 1 31, 140. 
 
 io5. Ekehorn, G. : Upsala Laekaref. Foerh. , 1S92-93, xxviii. , 
 113-150. 
 
 107. Eliot, G. : Proceedings of Conn. Med. Soc , Bridgeport, 
 1893, 194-199- 
 
 133. Elliot, J. W.: Boston I\Ied. and Surg. Jour., 1896, 
 cxxxv., 433, 441-445. 
 
 I 35 Ellis, R. ; New York Med. Jour., 1899, Ixxv., 90-92. 
 
 no. Englisch : Bericht d. k. k. Krankenanst. Rudolfstift. 
 in Wien, 1878, 391 
 
 111. Faisans : Bull et mem. soc. med. des hop. de Paris, 
 iSg^j, 3m2 s , xiii , 228:::239. 
 
 112. Fenger, C. ; Amer. Jour of Obst., New York, 1893, 
 xxviii , 161-109. 
 
 113. Fenwick, S. : Lancet, London, 1S84, ii., 9S7, 1039. 
 
 114. Fere : Progres med., Paris, 1877, v., 73. 
 
 115 Finnell. T. C. : Medical Record, New York, 1869, 
 iv. , 66. 
 
 116. Fitz, R. H.: Amer. Jour, of Med. Sci., Philadelphia, 
 1886, n. s. , xcii., 321-346. 
 
36 
 
 iiy. Fitz, R. H.: Boston Med. and Surg. Jour., 1890, cxxii., 
 619. 
 
 118. Foges, A.: Wien. med. Wochensch., 1896, xlvi., 2169, 
 2227, 2281, 2329. 
 
 119. Fowler, G. R. : Medical News, Philadelphia, 1893, Ixiii., 
 604. 
 
 120. Fowler, G. R. : Annals of Surgery, Philadelphia. 1894, 
 xix., 4, 146, 327, 474, 546. 3 plates. 
 
 121. Fowler, G. R. : Amer. Jour, of Med. Sci., Philadelphia, 
 1897, n. s. , cxiii., 152-157. 
 
 122. Fowler, G. R. : Brooklyn Med. Jour., 1807, xi., 243- 
 
 259- 
 
 123. Fowler, G. R.: Jour. Amer. Med. Assoc, Chicago, 
 1897, xxix , 933-940. 
 
 124. Fowler. G. R. : Meth. Episcop. Hosp. Rep., 1887-97, 
 New York, 1898,!., 164-211. 7 plates. 
 
 125. Fox. R. H : Lancet. London, 1885, ii., 1166. 
 
 126. Frazer, J. E. : British Med. Jour., London, 1895, i., 
 1320. 
 
 127. Freeman, C.: Canada Lancet, Toronto, 1871-72, iv. , 268. 
 
 128. Freiberg, A. H. : Ohio Med. Jour., Cincinnati, 1896, 
 vii , 220 227 
 
 129 Gangolph et Duplant : Rev. de chir. , Paris, 1897, xvii., 
 503-518. 
 
 130. Gerster, A. G. : New York Med. Jour., 1890. lii., 6-14. 
 
 131. Gerster, A. G.: Philadelphia Monthly Med. Jour., 1899, 
 i., 170-174- 
 
 132. Gibney, V. P.: Amer. Jour, of Med. Sci., Philadelphia, 
 1881, n. s , Ixxxi., 119-128. 
 
 133. Glantenay : Presse med., Paris, 1899, i., 9. 
 
 134. Glazebrook, L. W.: Virginia Med. Monthly, Richmond, 
 1895-96, xxii. , 211. 
 
 135. Goluboff : Berlin, klin. Wochenschr., 1897, xxxiv., 9-1 1. 
 
 136. Gouillioud : Lyon medicale, i8gi, Ixvii. , 245-254, I 
 plate. 
 
 137. Grandin, E. H. : Amer. Gynaec. Jour., Toledo, 1893, 
 iii., 544-54S. 
 
 138. Gross, H. : Deutsche Zeitschr. f. Chir., Leipzig, 1898, 
 xlvii., 260-265. 
 
 139. Gruber, W. : Arch. f. pathol. Anat. , etc., Berlin, 1875, 
 Ixiii. , 97-99- 
 
 140. Guinard, A. : Gaz. des hop., Paris, 1896, Ixix. , 1350- 
 1352. 
 
 141. Guttmann, P.: Deutsche med. Wochensch., Leipzig, 
 1891, xvii., 260. 
 
 142. Habershon: Observation on Diseases of the Alimentary 
 Canal, London, 1857, 
 
37 
 
 143- Hall. R. T-: New York Med. Jour., 1886, xliii., 662. 
 
 144. Halliday, J. C. : British Med. Jour., London, 1S98, i., 
 
 II95- 
 
 145. Halsted, W. S. : Johns Hopkins Hosp. Bull., Baltimore^ 
 
 1894, v., 113. 
 
 146. Hancock H.: London Med. Gazette, 1848. n. s., vii., 
 547-550. 
 
 147. Harris, ^L L.: Jour. Amer. !Med. Assoc, Chicago, 
 
 1895. XXV., 1085-10S8. 
 
 148. Harte, R. H. : American Lancet, Detroit, 1894, n. s., 
 xviii., 294. 
 
 J49. Hartley, F. : Medical Record, New York, iSgo, 
 xxxviii., 169-174. 
 
 150. Hartmann et Reymond : Assoc, franc, d'urol. , Proc- 
 verb., 1897, Paris, iSg8, ii. , 324-330. 
 
 151. Hawkins, H. P.: On Diseases of the Yermiform Ap- 
 pendix, etc., London, 1895, Macmillan & Co., 146 pages. 8vo. 
 
 152. Hektoen, L. : Amer. Jour.' of Obst., New York, 1893, 
 xxviii., 272-2?o. 
 
 153. Hendricks, H. ^V. : Medical Record, New York, 1876, 
 
 xi., 764- 
 
 154. Hewson, A.: Amer. Jour, of Med. Sci., Philadelphia, 
 1893, n. s , cvi., 185-190. 
 
 155. Hind, W. : Prov. Med. Jour., Leicester, 1895, xiv.,489. 
 156! Hirst, B. C. : Amer. Jour. Gyn. and Peed., 1890-gi, 
 
 iv. , 39- 
 
 157. Hodenpyl, E. : New York Med. Tour., 1S93, Iviii , 777- 
 
 785. 
 
 158. Hoffmann, J.: Amer. Jour, of Obst., New\ork, 18S8, 
 xxi., 1185-118S. 
 
 159. Homans, J.: Boston Med. and Surg. Jour., 1S86, cxiv., 
 388. 
 
 160. Homans, J. : Boston Med. and Surg. Jour., 1S90, cxxii., 
 
 54. 77- 
 
 161. Homans, J.: Boston Med. and Surg. Jour., 1899, cxl., 
 
 112. 
 
 162. Hutchinson, J. A. : Montreal Med. Jour., 1S99, xxviii., 
 205. 
 
 163. Huntington, --T. ^Y.: Occidental Med. Times, Sacra- 
 mento, 1894, viii., 12-17. 
 
 164. Jackson : Extr. Rec. Bost. Soc. Med. Improvement, 
 1859, iv., 49-52. 
 
 165. Jaggard, W. : Amer. Jour, of Obst., New '^ ork, 1893, 
 xxviii., 265-2*^9. 
 
 166. Jalaguier, A.: Presse medicale, Paris, 1897, v , 53. 
 
 167. Jessop, T. R. : British Med. Jour. , London, iS94,» i. , 627- 
 637, I plate. 
 
38 
 
 i68. Jonnesco and Juvara: Progres medical, Paris, 1894, xix. , 
 273. 303. 321, 353. 369. 4 plates. 
 
 169. Johnson, M. M. : Jour. Amer. Med. Assoc, Chicago, 
 1896, xxvi , 1202-1206. 
 
 170. Jorand, A.: Bull. soc. anat. de Paris, 1894, Ixix. , 300- 
 
 303- 
 
 171. Josue : Compt. rend. soc. de biol. , Paris, 1S97, lome 
 s. , iv. , 280-2S2. 
 
 172. Kammerer, F. : Annals of Surgery, Philadelphia, 1897, 
 xxvi., 225-228. 
 
 173. Karewski, F. : Deutsche med. Wochenschr. , Leipzig and 
 Berlin, 1897, xxiii. , 294, 312, 331 ; Ver.-Beil. 67 (Discussion), 
 Ver.-Beil. 69-72. 
 
 174. Kayser, F. : Hygiea, Stockholm, 1896, Iviii. , pt. 2, 557- 
 560. 
 
 175. Keen, W. W, : Philadelphia Med. Jour., 1898, i., 764. 
 
 176. Keen, W. W.: Trans. Amer. Surg. Assoc, Phila- 
 delphia, 1898, xvi. , 243-252. 
 
 177. Kelynack, T. N. : The Pathology of the Vermiform Ap- 
 pendix. London, 1893, H. K. Lewis, 223 pages, Svo. 
 
 178. Kelly, H. A.: Operative Gynaecology, New York, D, 
 Appleton & Co., vol. i., p. 123. 
 
 179 Kleinwaechter : Mitt. a. d. Grenzgeb. d. Med. u. Chir., 
 Jena, 1896,1., 717-728. 
 
 180. Kolb : Med. Cor. -Bl. d. wurttemb. arztl. Ver., 
 Stuttgart, i860. XXX., 103. 
 
 181. Kottmann, A.: Cor.-Bl. f schweizer Aerzte, 1871,1., 8. 
 
 182. Krafft, C. : Rev. med. de la Suisse rom., Geneve, 1893, 
 xiii. , 764-772. 
 
 1S3. Krakowitzer, E. ; New York Medical Jour,. 1871, xiii., 
 733-736. 
 
 184. Kroenlein, R. U. : Arch. f. klin. Chir., 1886, xxxiii., 
 
 514- 
 
 185. Kroenlein, R. U. : Arch. f. klin. Chir., Berlin, 1877, 
 xxi. (Suppl.-Heft), 165. 
 
 186. Kuester : Centralbl. f. Chir., Leipzig, 1898, xxv. , 1241- 
 
 1243 
 
 187. Kuemmell, H. : Arch. f. klin. Chir., 1890, xl., 618. 
 1S8. Kuemmell, H. : Berlin, klin. Wochenschr., 1898, xxxv., 
 
 321-328. 
 
 189. Kuemmell, H. : Deutsche med. Wochenschr., Leipzig 
 u. Berlin. 1898, xxiv. , V. B 181 
 
 190. Lang: Med. Corresp.-Bl. d. wurttemb. arztl. Ver., 
 Stuttgart, i860. XXX., T03. 
 
 191. Landsberg : Allg. med. Centr.-Ztg., Berlin, 1S46, xv., 
 809-814. 
 
 192. Lannelongue : Gaz. hebdom. de med., Paris, 1SS3, 2me 
 s. , XX. , 33-46, I plate. 
 
39 
 
 193- Lautard : Arch. prov. de chir. , Paris, 1895, iv. , 712-717. 
 
 194. Legg, J. W.: St. Bartholomew's Hospital Report, Lon- 
 don. iSSo, xvi. , 259. 
 
 195. Leguen, F. : De I'appendicite, Paris, 1S97, jNIasson et 
 Cie. , 40 pages, Svo. 
 
 196. Leidy, J.: Medical News, Philadelphia, 1894, Ixv., 357. 
 
 197. Lemariey : Gaz. deshop., Paris, 1S93, Ixvi., 131S-1320. 
 19S. Lennander, K. : Upsala Laekaref. Foerh., 1S9S, xxvii. , 
 
 87-103. 
 
 199. Lennander, K. G. : Centralb. f. Chir., 1S9S, xxv. , 90. 
 
 200. Letulle, M., et jNL Weinberg: Arch, des sc. med. de 
 Bucarest, Paris, 1S97, ii., 360-510. 
 
 201. Leudet, T. E. : Arch. gen. de med., Paris, 1S59, ii., 
 
 139- 315- 
 
 202. Levings, A. H. : Trans. Wise. Med. Soc, Madison, 
 1892, xxvi, 60-82. 
 
 203. Lewis, G. : New York Jour, of Med., 1856, 3 s., i., 328- 
 
 353- 
 
 204. Lewis, J. C: Medical Record, New York, 1894, 
 xlvi., 463. 
 
 205. Lieberkiihn, J. N.: De Yalvula coli usu Processus Yer- 
 micularis, Ludg. Bat., 1739. 
 
 206. Lincoln, H. M. : Amer. Jour, of Med. Sci., Phila- 
 delphia. 1S53, n. 5., xxvi., 364. 
 
 207. Little, T. E. : Dublin Quar. Jour. Med. Sci., 1871, Hi., 
 237-241. 
 
 208. Little : Lancet, London, 1S47, i., 389. 
 
 209. Lockwood, C. B. and RoUeston, H. D. : Jour, of Anat. 
 and Physiolog}', London, i8qi-92, xxvi., 130-148, i plate. 
 
 210. Long, W. J.: Intercolonial Med. Jour. Australasia, 
 Melbourne. 1896, i., 708. 
 
 211. Long, J. W. : Medical Review, St. Louis, 1894, xxx., 
 
 441-445- 
 
 212. Lop: Rev. demed., Paris, 1897, xvii., 64S-652. 
 
 213. MacDonald, W. G. : Trans. Assoc. Amer. Obst. and 
 Gynec. , Philadelphia, 1895, vii. , 131-144. 
 
 214. Machell, H. T. : Canadian Practitioner, Toronto, 1890, 
 XV., 537-543. 
 
 215. Mader, J. : ~Ber. d. k. k. Krankenanst. Rudolfstift. in 
 Wien (iSr76). 1877, 382. 
 
 216. Matthieu, A.: Gaz. des hop., Paris, 1S96, Ixix., 402- 
 404. 
 
 217. Maylard : Trans. Glasgow Pathol, and Clin. Soc, 1S91- 
 93, iv., III. 
 
 218. McArthur, L.L. : Amer. Jour, of Obst., New York, 
 1895, xxxi , 1S1-185. 
 
 219. McBurney, C. : New York Med. Jour., 1S89, L, 676- 
 684. 
 
40 
 
 220. McBurney, C. : Medical Record, New York, 1892, 
 xli., 421-427. 
 
 221. McBurney, C. : Medical Record, New York, 1895, 
 xlvii., 385-390. 
 
 222. McBurney, C : New York Med. Jour., 1888, xlvii., 
 719-721. 
 
 223 McBurney, C. : Annals of Surgery, Philadelphia, 1894, 
 XX., 38-43- 
 
 224. McCallum, H. A.: Medical News, Philadelphia, 1892, 
 Ixi.. 681. 
 
 225. McCosh and Hawkes :. Amer. Jour, of Med. Sci. , 1897, 
 cxiii. , 513. 
 
 226. McGraw, T. A.: British Med. Jour., London, 1897, ii., 
 956-958. 
 
 227. McGuire, H. : Virginia Med. Monthly, Richmond, 1895— 
 96, xxii,, 885-903. 
 
 22S. McKidd, J.; Edinburgh Med. Jour., 1859, iv. , 2, 793, 
 2 plates. 
 
 229. McPhedran, A.: Canada Lancet, Toronto, 1896-97, 
 xxix., 115-117. 
 
 230. Meek, H.: New York Polyclinic, 1S95, v.-vi., 210. 
 
 231. Merling, F. : Diss, sistens processus vermiformis anato- 
 miam pathologicam, Heidelbergse, 4to, 1S56. 
 
 232. Mestivier, M. : Jour, de med., chir. , phar. , etc., Paris, 
 1759, x 441- 
 
 233. Mikulicz, T. : Volkmann's Samml. klin. Vortr., 18S5, 
 No. 262, p. 2313. 
 
 234. Mixter, S. J.: Boston Med. and Surg. Jour., 1891, 
 cxxv , 697. 
 
 235. Moers : Deutsches Arch. f. klin. Med., Leipzig, 1868, 
 iv., 251-256 
 
 236. Monks, G. R.: Boston Med. and Surg. Jour., 1890, 
 cxxii., 543. 
 
 237. Monod, C.: Assoc. fran9. de chir., Proc-verb. (etc.), 
 1894, Paris, 1895, viii. , 206-212. 
 
 238. Moore, C. 11.: Lancet, London, 1S64, ii., 512-515. 
 
 239. Morris, R. T.: Trans. Pan-American Medical Congress, 
 1893, i. , pt. i., 1095-1100. 
 
 240. Morris, R. T.; Lectures on Appendicitis, 1899, G. P. 
 Putnam's Sons, 181 pages. 
 
 241. Mortier : Jour, compl. du diet, de sc. med., Paris, 1819, 
 iii., 241-243. 
 
 242. Morton, T. G. : Jour. Amer. Med. Assoc, 1888, x., 
 
 733-739- 
 
 243. Morton, T. G. : Maryland Med. Jour., Baltimore, 1889- 
 90, xxii., 484 ; 1890, xxiii . 8, 89. 
 
 244. Morton, T. G. : Trans. College of Physicians, Phila- 
 delphia, i8yo, 3 s., xii., 1-36. 
 
. 41 
 
 245- Morton, T. G. : Jour. Amer. Med. Assoc, Chicago, 
 189X, xvii., 125-136. 
 
 246. Morton, C. A.: Bristol ^led.-Chir. Jour., iSgy, xv., 
 319-321. 323 
 
 247. Mosse et Daunic : Eull. soc. anat. de Paris, 1897, Ixxii. , 
 814. 
 
 24S. Mott, F. W. : Trans. Pathol. Soc, London, 1888-89, 
 xl., 105. 
 
 249 .Muenchmeyer . IDeutsche Klinik, Berlin, 1S60, xii., 43, 
 
 56, 81. 93- 
 
 250. Munde, P. F. : Medical Record, New York, 1894, 
 xlvi. , 678. 
 
 251. Murohy, J. B.: Medical News, Philadelphia, 1S95, Ixvi., 
 1-8. 
 
 252. Murphy, J. B : Jour. Amer. Med. Assoc, Chicago, 
 1894, xxii., 302, 347, 3S7, 423. 
 
 253. Murray, R. W.: British Med. Jour., London, 1896, ii., 
 
 747- 
 
 254. Mynter, H.: Appendicitis and its Surgical Treatment, 
 Philadelphia and London, 1S97 ; J. B. Lippincott Company, 303 
 pages, Svo 
 
 255. Mynter, H. : Trans of Med. Soc. of New York, 1896, 
 166-171. 
 
 256. Noble, C. P. : Amer. Gyncec. and Obst. Jour., New York, 
 1895, "vii.. 115-117; disc , 14L-153. 
 
 257. Noyes, R F.: Trans. Rhode Island Med. Soc, 1882, 
 Providence. 1883, ii., pt. 6, 495-539. 
 
 258. Nuding, W. H. : Ohio Med. Jour., Cincinnati, 1895, 
 
 ^i.. 30-33- 
 
 259. Ohlmacher, A. P.: Cleveland Med. Gazette, 1893-94, 
 
 ix., 511-519. 
 
 260. Osier, W.: Montreal Gen. Hosp. Rep., 1S80, i., 
 
 313- 
 
 261. Packard: Proceedings of Pathol, Soc, Philadelphia, 
 1858, i., 170. 
 
 262. Parker, W. : Medical Record, New York, 1867, ii., 
 
 25-27- 
 
 263. Patel. M.: Lyon medicaie, 1898, Ixxxix., 189-197. 
 
 264. Peck, G. S.r^JTrans. Assoc Amer. Obst. and Gynec. 
 (1894), Philadelphia, 1895, vii,, 1 1 5-130, 5 plates, 
 
 265. Peltzer : Deutsche mil.-arztl, Ztschr,, Berlin, 18S2, xi., 
 411. 
 
 266. Pepper, W. : Amer. Jour, of Med. Sci., Philadelphia, 
 1867, n. s., liv., 145-147- 
 
 267. Pepper, W.: Trans. Med. Soc. of Pennsylvania, Phila- 
 delphia, 1883. XV,, 226-246, 
 
 268. Perry, J. W. : Memphis Medical Recorder, 1857, v. , 659. 
 
42 
 
 269. Peterson, R. : Medical News, Philadelphia. 1893, Ixii., 
 
 515-517 
 
 270. Piersol, G. A.: Univ. Med. Mag., Philadelphia, 1894- 
 95, vii , 893-899. 
 
 271. Pierson, W. : Trans. Med. Soc. of New Jersey, Newark, 
 1871, 279-2S1. 
 
 272. Pilliet and Costes : Bull. soc. anat. de Paris, 1895, Ixx., 
 19-38. 
 
 273. Pilliet, A. H. : Progres medical, -Paris, 1898 3mes.,cii., 
 
 65-67. 
 
 274. Piard, E. : Arch. gen. de med.. Paris, 1896,, ii. , 290, 
 436, 560. 
 
 275. Pitres, A.: Mem. et bull. soc. med.-chir. des hop. de 
 Bordeaux, 1869, iv. , 43-49. 
 
 276 Plummer, R. H. : Trans. Pan-Amer Med. Congress, 
 1893, Washington, 1895, pt. ii , 1166-1168, 3 plates 
 
 277. Pollosson, M. : Mem. et compt. rend soc. de sci. med. 
 de Lyon (1893), 1894, xxxiii. , 135-142. 
 
 273. Pond, E. M. : Amer. Jour, of Obst. New York, 1898, 
 xxxviii , 829-832. 
 
 279 Pond, E.M. : Medical Record, New York, 1898, liii., 
 582-587 
 
 2S0. Porcher, F. P.. North Carolina Med. Jour., Wilming-^ 
 ton. 1879, iv., 375. 
 
 281. Porter, W. H.: New York Med. Jour., 1S90, Ii. , 88-94. 
 
 282. Potter, H. C. : Medical Record, New York, 1879, 
 XV., 371. 
 
 283. Powell, J. B.: New Orleans Tvled. and Surg. Jour., 1855, 
 xi., 468-470. 
 
 284. Price, J.: Amer. Jour, of Surg, and Gynec, Wellston, 
 Mo., 1895-96, viii. , 115-117. 
 
 285. Quenu ; Bull, et mem. soc. de chir. de Paris, 1893, n. s., 
 xix , 678-680. 
 
 286. Reclus. P.: Bull, et mem. soc. de chir. de Paris, 1892, 
 n. s. , xviii., 125-132. 
 
 287. Ribbert : Arch. f. path. Anat. (etc.), Berlin, 1893, 
 cxxxii.. 66—90. 
 
 288. Richardson, M. H. : Boston Med. and Surg. Jour., 
 1892, cxxvi , 261-263; cxxvii., 105-111. 
 
 2S9 Richardson, M. H.: Amer. Jour, of Med. Sci., Phila- 
 delphia, 1S94, n. s., cvii., 1-25. 
 
 290. Richeloc, L G : Bull, et mem. soc. de chir. de Paris, 
 1890, n. s , xvi., 625-630. 
 
 291. Richelot, L. G.: Bull. med.. Paris, 1897, xii., 441-443. 
 
 292. Rioblanc : Gaz. des hop. . Paris, 1S97, Ixx., 1235. 
 
 293. Robb, H. : Johns Hopkins Hosp. Bull., Baltimore^ 
 1892, iii., 23-25. 
 
4 
 
 '> 
 
 2g4- Robinson. B, : Medical Record, New York, 1S95, 
 xlviii., 757-762. 
 
 295. Robinson, B. : Medical Record, New York, 1895, 
 xlviii., 373 
 
 296. Robson, M.: British ^led. Jour., London, 1S96, ii., 
 1761-1763. 
 
 2-57. Rochester, T. : Buffalo Med. and Surg. Jour., 1S78, 
 xviii., 124. 
 
 298. Roger, H., et Josue, O.: Rev. demed., Paris, 1896, xvi. , 
 
 433-45 7- 
 
 299. Rokitansky, C: Med. Jahrb. , ^^ ien 1867, xiii., 179— 
 
 183. 
 
 300. RoUeston, H. D. : Edinburgh Med. Jour., 1898, n. s., 
 iv , 21-26. 
 
 3H. Rosenthal, A.: Medical Record, New York, 1898, 
 
 liii , 359- 
 
 302. Rosenstirn, J.: Arch. prov. de chir. , Paris, 1898, vii., 
 643-570. 
 
 303. Rotter, J.: Ueber Perityphlitis, Berlin 1S96, S. Karger, 
 8vo, 103 pages, 3 plates. 
 
 304.. Roussel. A.. Loire med., St. Etienne. 1897. xvi., 114. 
 
 305. Routier : Bull, et mem. soc. de chir. de Paris, 1896, 
 n. s , xxii., 435. 744-747- 
 
 306. Ruth, C. E. : Mathews' Med. Quarterly, Louisville, 
 1S95, ii , 234-236. 
 
 307. Sachs, W. : Arch. f. klin. Chir., 189^,!., 16-74. 
 
 30S. Sands, Ii. B. : Ann. Anat. and Surg Soc, Brooklyn, 
 N. Y , 18-0, ii., 249-270. 
 
 309 Sands, H. B. : New York Med. Jour., 1S88, xlvii. , 197- 
 205. 607. 
 
 310. Scheibenzuber, A.: Ohio Med. and Surg. Jour., Colum- 
 bus, 1877, n. s., ii., 259. 
 
 311. Schooler, E. : Trans. Iowa IMed. Soc, Dubuque, 1886— 
 89, vii., 300-304. 
 
 312. Schlafke : Munchner med. ^Yochenschr, , 1895, xlii., 
 752-776. 
 
 313. Schueller, M. : Arch. f. klin. Chir., Berlin, 18S9, xxxix., 
 
 845-359- 
 
 3T4 Scott, N. S.: -Trans. Ohio Med. Soc, Cleveland, 1S98, 
 
 153-162. 
 
 315 Senn, N. : Jour. Amer. Med. Assoc, Chicago, 1S89, 
 xiii. , 63C-636. 
 
 316. Senn, M. • Jour. Amer. Med. Assoc, Chicago, 1894, 
 xxii.. dO-X-AII. 
 
 317. Sheen, A. : Practitioner, London, 1896, Ivi., 607-611. 
 
 318. Sheffey, L. B. : South. Med. and Surg. Jour., Augusta, 
 Ga. , 1S49, n. s. , v. , 654. 
 
44 
 
 319- Sliiels, G. F. : Occidental Med. Times, Sacramento, 
 189b, X., 592-595- 
 
 320. Shoemaker. G. E. : Annals of Surgery, Philadelphia, 
 1898, xxvii , 7:- 3-740. 
 
 321. Shoemaker, G. E. : Trans. College of Physicians, Phila- 
 delphia, 1892, 3 s., xiv. , 214-216. 
 
 322. Shrady, G. F. : Medical Record, New York, 1894, 
 xlv , 1-4 
 
 323. Simons, M. H.: Report of Surg. -Gen. of the Navy, 
 Washington, 1S96, 204. 
 
 324. Skoda: Allg. Wien. med. Zeitg. , 1S62, vii., 445-451. 
 
 325. Smith, S. H.: Western Lancet, Cincinnati, 1848, vii., 
 I34-M2 
 
 326. Smith, J. : Edinburgh Med. Jour., 1895-96, xli , 402- 
 413, I plate 
 
 327 Sonnenburg : Deutsche Zeitschr. f. Chir. , Leipzig, 1893— 
 94, xxxviii , 155-295. 
 
 328. Sonnenburg, E : Verhandl d. deutsch. Gesellsch. f. 
 Chir , I>erlin, 1896. xxv., pt. ii., 42-67. 
 
 329. Sonnenburg, E.: Pathologic u. Therapie d. Perityph- 
 litis, 3 Aufl., Leipzig, 1897, F. C. Vogel, 8vo, 395 pages, 6 
 plates. 
 
 330. Sonnenburg, E. : Mitt. a. d. Grenzgeb. d. Med. u. Chir., 
 Jena, 1898, iii , 1-21. 
 
 331. Sourdille, G. : Bull. soc. anat. de Paris, 1894, Ixix., 447- 
 
 451- 
 
 332. Ssawostjanow, A. I.: Med. Obozr., Moscow, 1893, 
 xxxix. , 938-943. 
 
 333. Stedman, O.: Lancet, London, 1S93, i. , 1061. 
 
 334. Stiegele : Med. Cor.-Bl. d. wurtt. arztl. Ver. , 1870, 
 xl. , 203 
 
 335. Stimson, L. A.: New York Med. Jour., 1S90, Hi., 449- 
 
 456. 
 
 336. Stimson, L. A. : Annals of Surgery, Philadelphia, 1896, 
 xxiii , 186. 
 
 337. Stimson, L. A.: Trans. Med. Soc, New York, Phila- 
 delphia, 1S91, 235-245. 
 
 338. Sutherland, G. A : Lancet. London, 1895, il., 457-459. 
 
 339. Swan, J. M. : Univ. Med. Mag., Philadelphia, 1895-96, 
 viii. , 194-196. 
 
 340. Symonds, C. J. : Trans. Clin. Soc. of London, 1884-85, 
 xviii. , 285-291. 
 
 341. Tait, L. : British Med. Jour., 1889, ii., 763. 
 
 3.^2. Talamon, C. : Appendlcite et perityphlite, i2mo, Paris, 
 1892. Translated by E. P. Kurd, i6mo, Detroit, Mich., 1893. 
 
 343. Thacher, T. H.: Proceedings New York Pathol Soc. 
 (1891), 1892, 71. 
 
45 
 
 344- Toft : Dissertatio de fabrica et functione processus vermi- 
 formis, Groningue. 1S40 p 24 
 
 345. Traube : Deutsche K linik, 1S59, xi , 505-507. 
 
 346. Treves, F., and Swallow, J. D.. Lancet, London, 1SS9, i., 
 267-269. 
 
 347. Tuffier : Semaine medicale, Paris, 1S94, xiv. , 5-7. 
 
 347 bis. Vanderveer, A.: Medical Review of Reviews, iSgg, 
 v., 672. 
 
 348. Vimont : Bull. soc. anat de Paris, 1SS7, Ixii., 60S. 
 
 349. Vineberg, H. N.: Charlotte (X. C) Med. Jour., 1895, 
 vii., 17-26. 
 
 350. Vischer. C. V.: Annals of Surgery, Philadelphia. 1S97, 
 xxvi., 624. 
 
 351. Vols. A : Die durch Kothsteine bedingte Durchbohrung 
 des Wurmfortsatzes die haufige verkannte Ursache einer 
 gefahrlichen Peritonitis, und deren Behandlung mit Opium. 
 8vo, Carlsruhe. 1S46 
 
 352. Von liochstetter, A. F.: Colica processus vermiformis 
 (Breuer) Beitr. z. Chir. Festschr. Theodor Billroth, Stuttgart, 
 1S92, 135-143- 
 
 353. Von Mayer, Ch. : Rev. med. de la Suisse rom. , Geneve, 
 
 1897, xvii., 209-255. I plate. 
 
 354. Von Mayer, Ch. ; Rev. med. de la Suisse rom., Geneve, 
 
 1898, xviii. , 2S5-299. 
 
 355- Vosse, J : De intestino cseco ejusque appendice vermi- 
 formi, sm. 4to, Goettingae. 1749. 
 
 356. Wallis, C : Hygiea, Stockholm, 1892, liv. , 578-595. 
 
 357. Waterhouse, H. F. : British Med. Jour., London. 1S97, 
 ii., 1505. 
 
 355. Weber, L. : Bull New York Acad, of Med., 1871, iv., 83. 
 
 359. Weeks, S. H. : Trans. Amer. Surg. Assoc, Philadelphia, 
 1892, X. , 179-182. 
 
 360. Weir. R. F. : Medical Record, New York, 1893, xliv., 
 348. 
 
 361. Weir. R. F. : Medical Record, New York, 1889, 
 XXXV. , 449. 
 
 ';62. Weiss et Fevrier : P^ev. de chir., Paris, 1898, xviii., 596, 
 1 1 66. 
 
 363. Whitall, S. ; i^EDiCAL Record, New York, 1874, ix., 
 
 255-257- 
 
 364. Wiggin, F. H. : Medical Record, New York, 1892, 
 xli., 109 
 
 365. Williams, H.: Medical News, Philadelphia, 1S95, Ixvi., 
 4.8-^-480. 
 
 366. With, C. E. : Peritonitis appendicularis. Festskr. d. 
 Laegevidensk. Fak. v. Kjobenh. Univ., Kjobenh., 1879, No. 5, 
 1-84. 
 
46 
 
 367- With, C. E. : Peritonitis appendicularis, etc, , K jobenh. , 
 1897, 8vo. 
 
 368. With, C. : Congr. period, intern, des sc, med., compt. 
 rend., 18S4, Copenh., 18S6, ii., Sect, de med., 133-141. 
 
 369. Wolf, H. J.: New York mediz. Monatschr. , 1899, ^i'» 
 275- 
 
 370. Worcester, A.: Boston Med. and Surg. Jour., 189I, 
 cxxv. , 84. 
 
 371. Wright, G. A., and Renshaw, K. : British Med. Jour., 
 London, 1897, i., 1470. 
 
 372. Wright, J. H.: Boston Med. and Surg. Jour., 1898, 
 cxxxviii., 150. 
 
 373. Wyeth, J. A.: New York Polyclinic, 1S93, i., 63-70. 
 
 374. Wyeth, J. A.: Jour. Amer. Med. Assoc, Chicago, 1894, 
 xxiii., 928. 
 
 375. Zdekauer, A.: Prag. med. Wochenschr., i8go, xv. , 340. 
 
 376. Zuckerkandl, E. : Anat. Hefte, Wiesb. , 1894, iv., 99- 
 124, 4 plates. 
 
 59 West Fortv-Ninth Street. 
 
COLUMBIA UNIVERSITY LIBRARIES 
 
 This book is due on the date indicated below, or at the 
 expiration of a definite period after the date of borrowing, 
 as provided by the rules of the Library or by special ar- 
 rangement with the Librarian in charge. 
 
 DATE BORROWED 
 
 DATE DUE 
 
 DATE BORROWED 
 
 DATE DUE 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 C28(1 140)M10O 
 
 
 
 
RD542 
 E deb oh Is 
 
 Ed22 
 
 '^'''TlH,..°,L!S.^..&L?r:d.!iteratureo 
 
 200228585^