Spare the Knife?

In acute appendicitis, physicians and surgeons have been almost unanimous for more than half a century that the thing to do was to cut out the diseased and apparently useless organ as fast as possible. In the last dozen years, many have wondered whether antibiotics might do the job as well as the scalpel, but few have dared to take a chance. In the British Medical Journal, Surgeon Eric Coldrey reports that, in three years at Rotherham Hospital in Yorkshire, he has taken this chance in 137 cases of acute appendicitis and has lost only one patient (a feeble man of 78, who succumbed to pneumonia).

Up to now, Surgeon Coldrey has drawn a line between patients admitted within 24 hours after the onset of acute appendicitis and those admitted later. With the early admissions, for whom surgery offers the least risk, he follows tradition and operates promptly; the later admissions, for whom surgery would be more hazardous, he treats with drugs. He lets these rest in bed in any position they find comfortable, allows no food and only water to drink, gives them penicillin injections (250,000 units) every six hours, and in severe cases adds another antibiotic or one of the sulfas. To relieve pain, he gives meperidine or morphine.

Some patients were operated on later, when the infection had subsided. The operation then was easier and recovery was smoother, Surgeon Coldrey believes, than if the patients had gone under the knife while acutely ill. In other cases, operations were avoided for patients either pregnant or suffering such ailments as bronchitis, heart disease or influenza. A prime indication for avoiding an operation, Surgeon Coldrey thinks, is when acute appendicitis develops aboard ship, "away from skilled surgery and adequate surgical surroundings." In fact, Surgeon Coldrey is now beginning to wonder whether it is even necessary to operate automatically in the first 24 hours of an attack.

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