The gravity of appendicitis is consider ably increased when that disease is com plicated by pregnancy. One author esti mates the mortality of appendicitis dur ing pregnancy at 31.2 per cent. and that of appendicitis in general at 12.8. Rue (La Mid. ?od., Mar. 12, '98).
The prognosis depends upon the char acter of any given case, whether it be one of the appendix perforating into the genera] peritoneal cavity or perforating with limiting adhesions; or, again, whether the appendix remains without perforation; but chiefly the prognosis depends upon the stage at which the disease is seen and recognized, and upon the treatment adopted. If the case belong to either group of the perforat ing class, is seen within six, eight, or twelve hours from the occurrence of perforation, and proper treatment is adopted. the prognosis is good. If the case is a non-perforating one. is seen early, and appropriate treatment is car ried out, the prognosis is excellent.
On the other hand, if two or more days have elapsed since perforation of the appendix into the general peritoneal cavity, and as a consequence general septic peritonitis has existed for this length of time, with genera] septicaemia as an inevitable result, death will occur in a large proportion of such cases as long as there are no more potent means of treatment than are known at the present time.
In the class of eases which are treated in the interim, again, the prognosis is excellent. J. C. Davie (Dominion Med. Monthly, Nov., 1901).
Improved methods of treatment, espe cially the early evacuation of pus and a better understanding of the symptoms, have brought the mortality down from 30 per cent. to S per cent.
Statistics of four hundred and fifty reported operations during the interval between the attacks showing eight deaths, which would give a mortality percentage of 1.77. If all cases were reported, 5 or 6 per cent. would be a fairer estimate. We need more carefully recorded cases. Bull (N. Y. Med. Rec ord, Mar. 31, '94).
The surgical death-rate in acute and chronic appendieeal cases, without ab scess, is a fraction of 1 per cent. at the hands of several American surgeons, and it is believed from classified data that the eventual death-rate in appendicitis cannot be much less than twenty-five per cent. The loss of time and sufferings
are also much less under proper surgical treatment than under the best medical treatment. Robert T. Morris (Med. Times, Apr., '9S).
Seven hundred and fifty cases of ap pendicitis personally observed show that out of 464 acute cases, 2S4 were oper ated on, with 63 deaths, giving a mor tality of 21 per cent.; 149 cases recovered without operation, and 31 cases were moribund when first seen by the surgeon.
One hundred and fifty-one cases were operated on in the "interval" (i.e., after an acute attack had subsided, or be tween two - acute attacks in chronic cases). All of these recovered.
Out of 1S0 cases treated medically, 31 died, giving a mortality of only 17 per cent., as against 21 per cent. in the acute cases operated on by the authors. But it must be observed that some of the 31 cases might have recovered by operation; on the other hand, it may be argued that, of the 03 fatal cases operated on, some might have recovered under med ical treatment only. If all cases were seen by the surgeon on the first or sec ond day, every fatal ease would be oper ated on at a time most favorable for Cure.
Seven per cent. of all cases treated by other than surgical means when first at tacked will die, and the mortality of all cases treated in this way which pass to a second attack is 14 per cent. On the other hand, chances are three to one against a recurrence. Operation by ex perts is practically without mortality; but those who are inexperienced in ab dominal surgery take great risks. Every case requires consultation. M. C. McCan non (Med. and Surg. Bull., Aug. 9, '9S).
The more frequent complications that may thwart all plans of treatment even in the presence of the most careful tech nique: 1. General septic peritonitis. 2. Intestinal obstruction, due to kinking of the recently separated intestine or to adventitious bands. 3. Retroperitoneal abscess. 4. fistula. 5. Multiple abscess of the liver. 0. Gangrene of the encum. 7. Phlebitis of the femoral vein. S. Communication of the abscess with the rectum, vagina, or bladder. 9. Ven tral hernia. 10. Fatal hmmorrhage. 11. Parctitis. 12. Empyema. 13. Pericar ditis. R. A. Sterling (Intereol. Med. Jour. of Australasia, Aug. 20, '9S).