. Medical communications of the Massachusetts Medical Society. n there is of your carrying life in-surance or of your abstaining from liquor or of avoidingover work and over worry or of over speeding your auto-mobile; but you will still probably do all of these thingsand will still submit yourself or members of your family tosome eminent consultant for his opinion as to whether or notthe occasional belly-ache is due to the appendix. The con-sultant may look wise but in a hundred cases he cannot showthe wisdom of the doctrine of chances, unless there has beena previous definite attack of the sy
. Medical communications of the Massachusetts Medical Society. n there is of your carrying life in-surance or of your abstaining from liquor or of avoidingover work and over worry or of over speeding your auto-mobile; but you will still probably do all of these thingsand will still submit yourself or members of your family tosome eminent consultant for his opinion as to whether or notthe occasional belly-ache is due to the appendix. The con-sultant may look wise but in a hundred cases he cannot showthe wisdom of the doctrine of chances, unless there has beena previous definite attack of the symptom complex — gen-eral abdominal or epigastric pain, right iliac localizationand tenderness persisting at McBurneys point for a day ortwo after the pain has disappeared. If he wishes to make no positive mistakes he will add tothis sequence, on the second day, slight fever and vomitingor nausea. He cannot avoid negative mistakes for many cases withdefinite appendiceal lesions give no history of previousattacks. 242 OBSERVATIONS ON A SERIES OF NINETY-EIGHT. KinKe Potential appendix Fig. 1. This class includes kinks, bends, twists, short mesenteries, congenital ad-hesions and misplacements or other causes which render a partial obstructionof the lumen probable. Such conditions predispose to retention of fecesand bacteria and later prevent the exit of infected secretions. They represent the next most dangerous condition to stenosis from postinflammatory stricture. CONSECUTIVE OPERATIONS FOR CHRONIC APPENDICITIS. 243 We all agree that No. 2 should be removed because itis really dangerous. We all agree that No. 1 at times, and perhaps always,presents the same dangers in minor degree as No. 2. Most surgeons seem satisfied and regard their operationas successful when they can demonstrate No. 3 to the patientor to the attending physician, but is it not more logicalto remove No. 4 which has all the possibilities of the others?For it would save No. 3 the attack which caused his oblite
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