than with an operation. Of course, patients have occasionally
recovered, by accident, in the hands of most incompetent surgeons,
but the death rate after appendicitis operations in the hands of
incompetent surgeons is absolutely frightful.

"My experience and personal observation have taught me that
physicians and surgeons, as a rule, are absolutely conscientious,
and that when they perform this operation, notwithstanding the fact
that they themselves know they are incompetent (and they alone must
necessarily be their own judges as to their competency), they do it
because they have been taught that this is the only right treatment,
and that the patient is entitled to an effort on the part of the
physician or surgeon to save the life which is in danger. I believe
that this is extremely bad teaching, and that many hundreds of lives
have been sacrificed unnecessarily on account of this. I say this
because I am confident that with proper non-operative treatment
almost all of the cases which are diagnosed reasonably early may be
carried through any acute attack, no matter what its character may
be.

"I would then say, primarily, that no case of appendicitis should be
operated upon unless a competent surgeon is available. This, of
course, does not apply to cases in which a circumscribed abscess has
formed which anyone can open with safety provided he has
sufficiently good judgment not to do anything further."

Here I must differ. If the case has not been complicated by overmuch
handling, digging, punching, thumping and otherwise manipulating in
the name of bimanual diagnosis, no one has any right to put a knife
into the pus sac for it matters not how well it is done the drainage