The Harvard Medical Unit.

115 in the treatment is early operation, for the rate of mortality rapidly increases with delay, and few of the cases in which the appendix has given way end in recovery. Mr. IRWIN rightly insists that the remedy for the high mortality in cases belonging to this category lies in the earlier operation, and the possibility of this depends mainly on the doctor who is first called to see the patient. In only too the alimentary canal, that repeaued observations many cases is the surgeon told that the doctor has should be made to determine whether the con. not urged the need for an operation, that he has ditions indicated are temporary or permanent. By tried soothing remedies which sometimes succeed these means they have found it possible to say in masking the serious nature of the attack-even the cessation of pain, which not rarely occurs on whether there are constrictions or kinks in the the onset of gangrene, has been mistaken for real appendix, whether concretions are present or not, amelioration. With the medical profession lies the whether the appendix is dilated, and whether onus of impressing on the patient and his friends adhesions exist. If the appendix always occupies the necessity for an early operation if the patient’s the same position, if manipulation with the hand life is to be saved in these cases. Correct diagnoses cannot induce it to move, then we may be sure should be made in cases where the symptoms are that adhesions exist which chain it down to well marked and the history is clear. The illusIn one case brought forward by the trations accompanying Mr. IRWIN’S paper show. one place. authors the appendix gave all the indications appendices in varying conditions immediately after and illustrate appearances which are, of of being healthy and empty, yet at a subsequent removal, course, completely lost in preserved specimens. examination two small shot were seen in it; but they gave rise to no symptoms, though the appendix The Harvard Medical Unit. emptied itself more slowly than before, for it was found to contain some barium sulphate 24 hours AFTER three years of friendly cooperation with after the caecum had discharged its contents. The the British Army Medical Corps in France, the appendix was examined every week, and three Harvard Medical Unit is passing through London weeks later the shot had gone. This interesting on its way back to the United States. In 1915 observation shows us that foreign bodies may Colonel HUGH CABOT gave up his assistant pronot only enter but may also leave the appendix. fessorship of genito-urinary surgery at Boston, with Dr. G. C. SHATTUCK and a group of colleagues, That the diagnosis made by the X rays may be determined to offer us any help they could during considered trustworthy we learn from Dr. SPRIGGS, the war and to see the business through to for in all the cases in which a subsequent opera- the bitter end. The Harvard Unit consisted tion was performed the condition found was that of American medical officers and nurses with which had been recognised on the skiagram. Thus English personnel, at first under the command there can be no doubt that we have in the use of of Sir ALLAN PERRY, and from October, 1915, on the X rays a valuable aid in the diagnosis of chronic with Colonel CABOT as chief. A most excellent feeling has prevailed throughout amongst appendicitis, just as there can be no doubt that the friendly the members of the unit and between them and information needs highly skilful record. The work their British helpers, and has been no mean factor of Dr. SPRIGGS and Mr. MARXER has been very in that close professional relationship which has thorough, and must have entailed great expenditure been springing up between American and British of time and pains well directed. The illustrations officers. The position of the unit has enabled it to showing the actual skiagraphic appearances are form independent views on the important topics of sufficient guarantees of the practical worth of the war-time surgery. Their experience, Colonel CABOT to the belief that any of research, for by the methods adopted information tells us, gives no support the new antiseptics and ingenious methods of applycan be obtained that is otherwise unavailablewill have any permanent place in information which may either render operative ing antiseptics No antiseptic has yet been produced surgery. measures unnecessary or much reduce their which may not do as much damage to the human duration. tissues as it does to the micro-organisms. AntiIn this issue of THE LANCET, also, Mr. S. T. septic, in distinction to aseptic, surgery has not, IRWIN, of Belfast, gives a careful classification in the opinion of the unit, gained strength by the of the forms of acute appendicitis, supported by experiences of the war. Direct blood transfusion, on the other hand, Colonel CABOT thinks, would gain some effective coloured drawings, and he claims that it is possible to discriminate definitely between the by more frequent use, the simple method practised in America being preferred. The permanent record several varieties before the abdomen is opened, of the Harvard Medical Unit is still to come, but though many surgeons will hesitate to concur. He whatever the value of the scientific work it conpoints out that in the obstructive form the attack tains, the contribution made by the unit to a always begins with the sudden onset of pain, and friendly feeling and a sympathetic understanding he believes that this suddenness is characteristic between the two Armies will be no less permanent. of the obstructive form, certainly the most The war has done much to draw the two Englishpeoples together, and we warmly endorse dangerous of all the varieties. He shows that it speaking is the obstructive form which on rupture gives Colonel CABOT’S expressed desire to make this more intimate by the interchange rise to widespread peritonitis, for the pus which rapprochement of students, both before and after graduation, prothe appendix contains is at high tension, and only viding for the purpose a large scholarship fund rarely is it that adhesions exist to confine the available for promising students on either side of infection. In these obstructive cases the essential the water.

has been acquired and when adequate care is taken it is found that very great reliance can be placed on the appearances presented by the skiagrams, and Dr. SPRIGGS and Mr. MARXER are to be heartily congratulated on their work. They found that it is often necessary, as in the case of the X ray diagnosis of disease in other parts of

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