These symptoms are of collapse and they may come on in the course of a typhoid fever, or other diseases of the alimentary canal; they always mean a fatal toxemia either from obstruction or perforation, and occasionally the only forerunning symptom is sudden abdominal pain.  Circumstances must guide in making a diagnosis.  If, during a run of typhoid fever, there should be sudden abdominal pain followed with symptoms of collapse and nothing to account for it, it means perforation; an immediate operation may save the patient; nothing else will.

A sudden pain in the abdomen of a woman during menstrual life, with positively no unusual menstrual symptoms and no trouble in the right ileo-cecal region, indicates perforation of the stomach or of the gall-bladder.  If there have been a menstrual period or two gone over with a slight showing, and some uneasiness, perhaps nausea, perhaps a flow with pain somewhat simulating abortion, a sharp, severe abdominal pain followed with quickening of the pulse and an exceedingly anxious facial expression, ectopic pregnancy with rupture of the tube may be suspected.  One must also keep in mind renal calculus in determining bowel diseases.

Authors pretty generally unite in declaring that appendicitis is a dangerous disease.  In his late book, “The Abdominal and Pelvic Brain,” Dr. Byron Robinson of Chicago says, “Appendicitis is the most dangerous and treacherous of abdominal diseases—­dangerous because it kills and treacherous because its capricious course can not be prognosed. . . .  For years I have made it a rule to recommend appendectomy to patients having experienced two attacks.  Fifty per cent of subjects who have had one attack experience no recurrence.”

In Keating’s Cyclopedia of the Diseases of Children, Dr. John B. Deaver of Philadelphia makes the following statements: 

“Appendicitis, whether acute or chronic, is essentially a surgical affection, and should be placed at once under the care of a skillful surgeon.  The truth of this statement is becoming recognized in direct proportion to the general knowledge of the course and uncertainties of the disease, and at the present time only those who have but a limited idea of the course of the affection and have seen but a few cases, attempt to treat appendicitis without the advice of a surgeon.”

“Operation is the only procedure by which we can be certain of curing our patient.  It is true that some cases do recover from an attack of appendicitis without an operation, but the percentage of those that recover from the disease is almost nil.”

“The main reason, however, why the appendix should be removed as soon as possible is that no one can state positively what course the disease is taking.”