Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Appendicitis

Episode Date: February 14, 2023

People have been dying of the inflammation of the appendix long before anyone even knew what this little finger-like organ was good for. Dr. Sydnee goes through the history of the first accidental appendix removal, to the long journey to figuring the true cause of abdominal distress. And most importantly: What's the one place where you MUST have your appendix removed before visiting?Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talkies about some books. One, two, one, of misguided medicine. for the mouth. Wow. Hello everybody and welcome to Salt Bones, a marital tour of Miss guided medicine.

I'm your co-host Justin McAroy. And I'm Sydney McAroy. It sounded like you weren't sure what podcasts you were on when we started. Honey, would that be so hard to believe? I do a lot of these in a given way. You're not usually there. Oh, so this is just another podcast.

Just one more podcast for you. Does the pilot think special about your wife, the love of your life, your soulmate sitting across from you? Does the pilot know where he's flying to or is he just flying? You know? No, he knows where he's flying. Well, to where he is flying. The point that like a surgeon doesn't think about what they're gonna take out before they just start cutting, you know what I mean? Oh, this is a lead-in. Yeah, that's it.

I wrote this on note cards. Surgeons know what they're taking out before they take it out. I mean, if they're taking something out, they know if and what they are taking out before they do so. Okay. I stand by that surgeons. I'll defend you to the end. We never do this, but I wanted to break in before we actually start the episode proper and mention that we're going to be doing a max fund bonus episode where we answer questions from kids. So if you have a kid that would like to ask us a question for this special episode, you can email that

with the kids name and age if you like, or pronouns if that's something you wanna send along with their question. It's some of the weird medical questions, but it's just stuff for kids. Yeah, still not medical advice. Yeah. For that, please go to their doctor for provider.

That email address is sawbonesatmaximumfund.org. Please send those along. Anyway, Sid, you had already scrubbed in and you were all ready to start hacking weight this episode. I broke your Fiesneed right on your gloves. Susie emailed us. Thank you Susie and asked if we'd cover to Pindasitis. And I don't believe, gosh, I hope we haven't,

because I'm worried about too. We've hit on lots of things around the appendix. I think we have talked about it in the self-surgery episode. I know. I think we've had some questions and question-and-answer episodes about the appendix, but I could not find a whole episode devoted to that strange little organ the appendix. The appendix. Yeah. Do you know what the appendix is Justin?

Honey, I don't. I know it's I think it's vestigial. Not necessarily. No, okay. That is a theory. It's a muscle. Not necessarily, no. Okay, that is a theory. It's a muscle in your body. Well, it's an organ. Do you know what it, okay, do you know what it's connected to? No, I mean, the breast of the stuff, the tubes and the tubes and blood and stuff. The tubes and blood and stuff. Yeah, the other tubes and blood.

We have been doing this show for so long. You have to know something, like not even a system, like what? They're just. Okay, well that's something. Yes, it is a small, it looks like a little finger. It's like a hollow tube. Your fingers aren't hollow per se.

They got stuff in them. There's a little hollow outpouching finger-like projection is what we always say. It's a small finger-like projection off the side of the first part of a large intestine, the seacum. The seacum. The seacum. It just sticks off the side of the seacum, a little finger of tissue. It's usually, it can be anywhere from five to 35 centimeters long for those of you who like centimeters.

And I do. It's usually around nine. It can be anywhere from five to 35 centimeters long for those of you who like centimeters. And I do. It's usually around nine. Okay. It's the average, but length doesn't matter when it comes to the appendix. Absolutely not. It's just an appendix. It can stick out in different positions, most are like behind your seeker.

That's unexpected. Retrocycle, if you will. That's not expected. I don't only like the thing of the things in there just kind of stay and put. So that was unexpected that you said that. No, no, like they don't, I'm not saying it moves. I'm saying that in different humans, it's in different positions. Still again, honey, that's weird.

It's just weird. Some, in some people, everything's reversed, like everything's mirror image, what it generally is. And a fourth grade science teacher, like that. Scythus and verses. Yeah. But with the appendix, most are like behind the see-comsum,

extend down into the pelvis. There's lots of different directions. You can see a whole little diagram, if you want. If you look it up, a little like shadow ghost appendixies sticking off the see-comin different directions. Imagining all the positions the appendix could take if it wanted, but it knows it's stuck in a rut and it's just gonna stay right there behind the see-com because it's safe. Because it's safe.

Safe there. Until some money-grubbing surgeon comes in and tries to pluck it out like a fig, like a right fig. Generally, it lives in the right lower quadrant of your abdomen. So when we talk about the abdomen and medicine, that's the stomach area. Well, stomach is an organ, so it's not the abdomen, but that's probably what you would call your belly.

Your tummy. Just say tummy, yeah. We divide it into four quadrants, and that helps us know these organs are in this quadrant. So it's like, ish. Yes. Justin has gestured to the right lower quadrant of his abdomen since you can't see that. That's typically where it is at a place called McBernie's point, we'll get to McBernie. This is where you have pain if it gets inflamed. That's why it's important is because if you come in and you're like, oh, it hurts down here, then we get worried.

It is lymphoid tissue, like immune type tissue. Basically, it's also got a lot of good bacteria in it that's supposed to help us, which is why we think it might not be a sigil, because like maybe it has good stuff in there that your body needs. You need it the whole time. Yeah. But in the sense that can you live without it? Why yes? Many do.

That is definitely true. When it gets inflamed, it could be from like blockage. That's the common thought is that it's getting blocked off by poop, feces, blocking it. Or just general inflammation of the tissue inside. If the lining gets inflamed enough, it can block off the entrance and exit. There's only one way and one way out And then you get pain It's the pain will start in the middle of your abdomen like it you're around your belly button

And then sort of migrate down to that right lower quadrant and you can get nausea and vomiting fever's chills diarrhea constipation if it ruptures Which a lot of people think about the appendix rupturing is like, like a big explosion. I didn't, that didn't, that is the same. It got like a little, like a water balloon that gets a poke in it, that kind of rupture.

Yeah, it's a, yes, a perforation, a whole forms. And like that is bad because now infectious material is seeping into your abdominal cavity, right? We don't love that. But it usually will like wall off into an abscess. So now you have a whole pocketopus. Pocketopus. From the same people that brought you Johnny Vagaglass. It's Johnny Switchblade. Johnny Switchblade, DaVinciRPunk. When we did discover it, when did we discover it? That's the question, when did we discover it? The appendix?

Yeah. We had to find it, we had to cut people open to find it. 14, 20, 30. Not quite. It took us a while to be comfortable. We've talked about this in our dissection episodes with the idea of like cutting people open. Why did you make me guess any time from all of time? You knew I wasn't going to get that right?

I was set up to fail. For a long time, people were certainly having an appendicitis, like having issues with their appendix, and you wouldn't have known what was happening. Like we have found mummies who have adhesions in that area, meaning like the appendix probably ruptured here and caused like infection. And then we can see all these places where like the tissue got all matted together with this abscess that formed, and I mean, ostensibly the person probably died of sepsis.

We don't know. But obviously people were having an appendicitis and unfortunately probably succumbing to it for a long time before we knew what that was. Galen wrote about the condition appendicitis. We didn't call it that because we didn't know about the appendix, but he wrote about the syndrome

that would be associated with it, that this sort of pain down there and all of the symptoms that would go with it and the fact that then you probably died. And that was bad, but he didn't know why. He mainly dissected animals and depending on what animal you dissect, you might not find independence. Some got him some don't.

Exactly. He did write, so like I said, he wrote about the condition and it could cause death, but nobody was ever going to do surgery. Why don't you say ever? Commonly. Obviously, people have attempted surgery as long as there have been people. But commonly, you wouldn't want to do a surgery because you would probably die, right?

We didn't have anesthesia. We didn't have any understanding of infection as a concept and all the bleeding. So, and you didn't want to be the one to kill somebody, right? Like, you don't, you think they're gonna die, but you don't know they're gonna die. And then you cut them open and they die while you probably kill them. The best course of action was thought to be to either one, just wait until a fist jala would form. They would call this pointing. It would point me, like come to a head, is a good

way to think about it. So like you would get a head there and then like a tract. So basically, there'd be so much infection that it would like start burrowing its way through a little path through your abdominal wall and then pop out and now you have this tract from inside to outside through which a pus can drain, but which is like a good thing though. Okay. Because then it's draining. Good, and you want it out of there. All right. Right.

Where there is pus. There's pus there's a what? Let it out. Yeah. Evacuate it. Or you could just let the patient die. That is. That is the other option you have.

That's always an option. It's not when you guys tend to deploy or. No, no, but at the time the thought was like, we don't understand what's happening. We know this, when this happens, it's usually pretty bad. And sepsis, people would usually like fall asleep, like become delirious, drift off to sleep, and then die peacefully.

There are anatomical drawings that date back to the 15th and 16th centuries that show the appendix. So that's about when we started like dissecting humans and going, hey, look at this little weird thing. Look at this worm This weird little worm. We don't know. It's either good or bad. We don't know anything about it, but it's there Like Da Vinci drew it now. We didn't see that until like the 18th century, but he drew it a long time before so he knew it was there He didn't tell us but he knew he knew it was there Borhov of of a suffig, of course, you know.

Yes. Borhov's Asophagus. Sure, the classic. You know all about that. Yeah. Like when an Asophagus ruptures, it's called Borhovs. Oh, of course. So Borhov of Asophagus fame.

He wrote that the best management for what he termed Iliac passion, that's the region, like the iliac region, think about like lower abdomen hip area down there, a passion of that region. What does that mean? Well, this is what, like you get a bunch of pain and some problem down there.

So we call it iliac passion. We didn't know, we didn't know there was an appendix in there. So his treatment was, you bleed the patient, always bleed the patient. That's your most human history, right? Bleed the patient. Give them enemas, give them laxatives, give them opiates, because,

hey, why not? And then you could also add a fomentation to the skin. Now what is a fomentation? A fomentation is something you would put on the outside with the intention of it being absorbed through the skin. It could be made of herbs, like some sort of paste, basically. So what do you still do?

Kind of like a poultice. You'll have foam intations. It's just like a fancy medical word for something that doesn't just anymore. No, I mean, because you could like make them out of animal stuff and put it on there too. I'd say the closest approximation to that today, like what do we put on the skin in order to manage an

infection inside? If the skin is closed, there's not a lot, right? If you have an infection in your stomach, I'm not going to put something on top of your stomach, but the only thing that's similar is when we apply heat to things, we'll say that if you have an abscess, apply heat to it to draw it. A lot of people say it's drawing it out. It's bringing it to a head causing spontaneous strainage. But no, we don't use that sort of, we don't use a fermentation in this sense anymore. But it would be absorbed in. So that's how Borhov recommended it. The first time an appendix was removed was not for an appendicitis. The first time somebody actually chants going in there cut out.

In 1735, Claudius Amiond removed the appendix of an 11 year old boy who had swallowed a pin. A straight pin. He had swallowed a pen. And then also this boy had an inguinal hernia. So like down in the groin region he had a defect in the muscles in the abdominal wall, a little hole there and through that hole had poked some intestinal tissue down into his scrotum. And then the pen poked a hole in the intestine in the scrotum and Then a fistula formed with the scrotum. Oh, it's like a hole to the outside world. Oh, oh, no via scrotum and you don't want that. No, no, I mean, I don't have one, but I wouldn't want it. I think that's gonna be passed for me

Yeah, so anyway, so because of the hernia, he gets this fish, so they go in, he does surgery and actually removes the appendix, and it gets better. Yay. But we didn't sort of prove with this. That would be, as back as 7035, he takes out an appendix and the kid lives. It would be kind of a tense few weeks for that doctor where he's like, I don't know, I just took it. I don't really, I don't know if we need everything in there,

but um. There's a lot of it though, so it feels like we could do without. So since there's a lot of it in there, maybe we don't need all of it. There's just so many loops of that intestine test and we'll just take some out. Maybe. Anyway.

But I will say, I kept looking it up this story over and over and over again. He did live, right? Like the kid lived, the kid lived, and everybody just calls it a successful operation. So I am in turp. I'm choosing to remember that as the kid lived. And he's still alive today? I'm not using it. This was in 1735. Okay. Yes, I remember that as the kid lived. And he still lived today? I'm not using it.

This was in 1735. Okay. But again, the entity of the appendicitis. So just because we had removed an appendix successfully, does not necessarily mean that we understood the concept of inflammation of cetopendix called an appendicitis that leads to these symptoms that we mentioned, that leads to the need for possible surgery.

A lot of surgeons thought that when this happened, the seacum was the issue. So the part of the large intestine that the appendix is attached to, much larger part, that's the problem. That's wherein lies the issue, and you can see where it would be a lot harder to remove a big chunk of the large intestine than what it would be to remove this tiny little worm,

the appendix. One surgeon who believed that it was a problem with the seachum was John Hunter. You may remember him from our self-experimentation episode. He was the guy who infected himself accidentally with syphilis angonorea. He did mean to infect himself with one thing, but he accidentally infected himself with both things,

conflating these two separate entities into one disease process. They're by setting back that research. I think you estimated like a century. Yeah, about a century. Also, Dr. Dupatrin of contracture fame, Dupatrin's contracture. Wow, they're getting all the heavy hitters.

This is like the travel enrol brace. Dr. Dupatren, who, and I mentioned, if you know, if you're in medicine, you know, the contracture, I'm talking about, but it's, you get this thickened band of tissue in the palm of the hand and it can cause your fingers to start to sort of curl down in like claw-like. Right.

Dupatren's contracture, that's what it's named for. Anyway, Dupatren said, I have been mistaken, but I have been mistaken less than other surgeons, which I love that specific brag, because it's like, I'm still recognizing. I'm flawed.

I'm just flawed less than others. So that could be like a surgical motto for you surgeons out there. I'm kidding. I'm a family doctor. I'm supposed to give surgeons a hard time. It's like a thing. You know, like they're going to give me a hard time for seeing Kumbayaon wearing Berk and Stocks. And we all here in the Laman camp love this sort of back and forth and can really engage and appreciate it. I was going to say, you know who you are, my surgeons, but you're not listening to a podcast. You're way too busy for that. Yeah, you're

listening to, I feel like Bruce Springsteen music. Like, cut open people, right? That seems like it's surgeons. I don't know. I, we live in West Virginia. So most of the surgeons I worked with listened to country music, but we had a few like ACDC fans. Okay.

Yeah. The tracks. Um, anyway, before I tell you about like, how do we move on from here? We think it's the Seekam. We've got to get better. We need to realize the appendix can be a problem. And I'm going to tell you about that after do we move on from here? We think it's the Seacum. We've got to get better. We need to realize the appendix can be a problem And I'm gonna tell you about that after we go to the billing department. Let's go I'm Jordan Morris and I'm Jesse Thorne. On Jordan Jesse Go, we make pure, delightful nonsense.

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Oh, all answers are final for all people for all time. We got this. Can I tell you my appendicitis story? Before we begin, back in the second half, it's a little embarrassing. So I'm a little embarrassed to share it. Is this for the show? Yes, for the show.

Okay. Yeah, it's for the show. I don't mind their friends. They're not gonna tell anybody. Well, don't lean too far away from the mic there. Just tell them you're sorry. Don't be afraid. So when I was a kid, I would probably have been 10, 11 years old,

my stomach started hurting really, really bad. And I was like bent over and doubled in pain. And my mom waited and waited and it didn't get better. I just kept hurting and hurting and hurting. And so she eventually took me to the walk-in clinic and when I went in, the doctor was like, can you jump up and down for me? And when I jump up and down the first time,

I farted and my stomach immediately stopped hurting, but I was, it's really through embarrassed. Does that say what it is? Right, so I just started like gradually tamping down the symptoms until the bitch is like, I'm not sure, I was like, actually, it's starting to feel better now. And I left and we left.

But that was the closest I've come to having a dentist. You know, it was very instructive, though, that story for me, because I can't use my doctor brain with our children. We've established this. When they are sick, I either completely disregard it and go out of your fine, or I go to the other extreme and think, this is the worst thing ever.

We need 18 specialists in a emergency room. That story has come in handy many times because neither of our children seem to understand what gas is. And both of them, when they get gas, treat it like an emergency. Yeah. But it is in fact gas. Yeah. And both of them, when they get gas, treat it like an emergency. Yeah. But it is in fat gas.

Yeah. So it's been helpful. Look, we've benefited from your humiliation. Yeah. In the mid-1800s, surgeons started attempting, as a way to handle this condition, draining the abscesses that would form. So as I said, if your appendix ruptures an abscess will form, I mean, assuming you're still alive,

and you haven't, it's a common to sepsis. And you could, like initially, there was this thought of just wait till it drains on its own if it does. But in 1848, there was a surgeon Hancock who said, let's do this a little earlier. Like we know that you've got something going on down in this part of your stomach. We can't really look and see what it is.

But why don't we go ahead and make a cut and drain whatever's in there out? Don't wait for it to drain on its own. This was a big advance. I know it sounds like a simple thing. This actually was a big advance. I've seen this before. These things will pop. Let's take it out before it can pop.

Yeah, and what you're trying to do there then is avoid the patient becoming septic. Because no longer it's just in there, the more likely it is to spread to the bloodstream, and then you can get this systemic reaction that can make you super sick and you can die. So like, we're draining it as a way to try to avoid that, even if we don't know what we're doing.

Hey, notably, he also was able to use chloroformate as anesthesia at this point. So this was a big, obviously, move forward for all surgery. And as surgeons started doing that following suit, they were able to reduce mortality. And the other things with that moved us forward too. Like I said, chloroform was now available, so the idea of some sort of agent to put you to sleep made the concept of surgery a lot more possible. Semmelvice of handwashing fame had entered the picture and told us all that washing our

hands was a good idea. Of course, he was ostracized from all of medical science as a result for telling us to wash your hands. It was a good time for surgery though. There's a lot of things moving in our favor towards surgery. Exactly. Anisepsis, the concept of anisepsis was catching on Lister was promoting that, that if we try to keep things clean, more people will survive the surgical procedure.

And then there was a big breakthrough in 1886. There was the first meeting of the American Association of Physicians in DC in June of that year. And there was a pathologist present who stood up and gave a report basically saying, listen, this thing that happens in the right lower quadrant of the abdomen that we're all blaming on the Seacum is not the Seacum. It's the appendix's fault.

I am telling you all, this thing that's happening should be called appendicitis because it's inflammation anditis of the appendix. What was the name before the one with was there a see-comsitis? They had lots of different. I mean, a lot of basically like abdominal pus collections and a variety of things you would call that, right? Like for some reason, you've got a big collection of pus and you're in your abdomen, what's the thought?

But what caused it, what happened inside your body wasn't always well known. Anyway, so he was the one who said, this is an appendicitis. And it's a lost opportunity in my mind because the guy's name was a Reginald Heber Fitz. And he could have named it Fitzitis. Fitzitis is bad, try again.

Fitz condition. Fitz condition, Fitz syndrome. Fitz, Fitz. Fitz disease. Fitz, Fitz. Fitz, Fitz. Fitz abdomen. Fitz, Fitz appendix. I doubt I'm all Fitz Fitz. Fitz abdomen. Fitz ad. Fitz appendix. Adopt them with

it's like this. You've got an a a Fitz appendix. Uh oh. Your appendix fits. Hey, your appendix is on the Fitz. Ah, there's on the Fitz. There's such a missed opportunity. It could be named for him. But inside of he was he was it just stood up inside it's an

appendix. It's going to be like, I got it. We're going to call it on the Fitz and everyone's like, a pen of five. It's said we'd be like, I got it, we're gonna call it on the fits. And everyone's like, we barely have electricity. We do not know. We do not get the joke. We don't understand. In 1887, very soon after that, so the next year,

Thomas Morton, physician encountered a 26 year old man. He was sick and he had already been treated with a number of different things. He'd been tried with some pepsons, some quinine, soda water, calamel, stimulants, poltuses. He'd been blood, right? I mean, we're already up to 1887. Are we bleeding people still? Sure. Sure. We don't know what else to do. Leach is all over and he was still no better. He was getting worse, probably succumbing slowly to sepsis. And Thomas Morton said, I'm going to open you up and I'm going to drain this abscess

and he took out the appendix. Just like that. And the 26 year old patient survived. Fantastic. Really sort of proving what Fitz had said the year previously. This is an appendix problem. Is the appendix people? It was the appendix all along, not that poor seeker. Observing that patients seem to fare just fine without the appendix,

because that was a big thing, right? Like, if we're going to cut an organ out of the body, and this was a gamble, I don't know, I don't have like a charting of how many times we tried this with other things in the body. But that's a real, that's a risky prospect. It's like this., it's like this, but like if you try it with your liver bad bad bad bad bad negative outcomes. We can get rid of one kidney but not both yeah, I'm in without doing other things. Yeah, you get rid of the spleen. There are consequences, but you could get rid of it So you know, I don't know how many times we could try that before, but it was a big deal to take out an organ and then just cross your fingers and go, well, I hope that wasn't

one we needed. So, people seem to do just fine, and the idea that the appendix was vestigial became pretty popular as we're moving into the late 1800s, early 1900s. Dr. Chapman in 1887 pointed out that only six animals have an appendix. Man, gorilla, chimpanzee, orangutan, gibbon, and wombat. Meaning it must be being phased out. Mother Nature has decided we do not need this. Slowly we are evolving away from it.

And we are the last remaining six creatures with appendices, meaning that, you know, they're going away. Was there ever a push to like take these things out as a precautionary measure, just like, hey, we found out we don't need them, so we're just gonna always, we're just gonna take them. Well, I mean, there's something. I know that it kinda got to that point with tonsils for a while, and like when I was a kid,

where it's like anything else that they're in there for, they'll just go ahead and take the tonsils. Well, I mean, with the tonsils, you wouldn't be in there for much else though. Yeah, but like, you know. But like, no, I know what you're saying. And I think, I think you're not like, not like you're just already in the throat.

It's just like it, it was a lot more. Yes, I think your point is valid that there was a point where. Wait, can you say it again? I want to get that from my ringtone. Mm-hmm. I think your point is valid that there was a point where we can you say it again, I want to get that from my ring tone. Mm hmm. I think your point is valid that there was a point where, especially with tonsils, our criteria for removing tonsils, we would do it a lot quicker, right? We wouldn't need so many documented cases of strep throat or whatever.

We would say like, oh, that's enough evidence. We do think you need your tonsils out. I know that, I mean, there was a time where if you were in the abdomen doing another procedure, you might take the appendix out. Sure. Generally speaking, we don't, if you are healthy and well, we would not cut open your abdomen to remove an appendix. Thanks.

I think there are very specific cases where they do that, though. Like people who are going on specific trips, like if you're gonna go work in certain places and things. Yeah. Oh wow. You know, I don't, it's interesting. This may be a myth. We need to bust this myth,

that's something we need to look into. But like, especially at this point in history, you wouldn't have done that, because surgery was still a very risky prospect. We're still pre-annabiotic era. Oh, sure, okay, yeah, that's completely different. Right, so like you definitely wouldn't have, and then by the time you get to a point

where we have antibiotics, we understand antiseptic, we have our clean sterile ORs where you can safely have anesthesia and surgery and all that. By then, the thought of doing something just cause, I mean, we really had developed a system of ethics surrounding medicine where we wouldn't do that, right? We'd have to have a compelling indication. He called it,

I thought you would appreciate this. Chapman called it a trap to catch cherry stones. So the appendix was, I don't know that cherry stones have ever been caught in the appendix. But in 1889, there was a New York doctor Charles McBernie who wrote about the splitting of the specific procedure to remove the appendix where you separate the muscles in a certain way. And you remove the appendix through this incision that he dubbed the McBernie incision. There we go. Now we're talking. McBernie's point. You know what's interesting is he was not the first guy to do that. There was a doctor, a Lewis MacArthur in Chicago, who actually had written about this procedure that he had done a few months previously.

But there was a delay in publishing that paper. So because of this delay in publication, McBernie got his out first. So even though MacArthur did it first, it is forever known as McBernie's point. That's what I was taught in med school. McBernie's point is where you worry about pain. If you're worried about an appendicitis, McBurnie's incision is the incision.

No, of course we've replaced that with other procedures, but that is, it is McBurnie's enomic authors a few months. In 1897, Dr. Harvey Cushing of disease fame. There was lots of famous guys in this one. Yeah, that's like all the time. Developed an appendicitis three weeks after he lost a patient following an appendectomy. It must have been pretty scary, right?

He had somebody come in, needed an appendectomy, he performed it, the patient still died, and now he needs one. He convinced another surgeon, Hall stood to operate on him. This was like, people did not want this to happen. Everybody's really freaked out. They were like, no, no, no, we don't want to lose Dr. Cushin.

He was a very famous physician, very talented surgeon. Anyway, even Osler was like, no, no, no, no, don't do this. And Hallstead did it, and of course, he survived and documented his whole course, what it was like to be the patient with the appendicitis to have the surgery to survive it. We talked about this in our yellow fever episode, but Dr. Walter Reed actually succumbed to an appendicitis in 1902. Why were we still losing people to it at this point when we had to figure it out? A lot of it was if you were able to remove the appendix before it perforated, you probably

could contain the infection. If it perforated and you had an abscess formation, then you're fighting sepsis. And this is 1902. We still don't have antibiotics. We really take for granted antibiotics. And so that was still a risk if sepsis had set in prior to removing it,

or if after the surgery infection happened, because that can happen, right? After you do an incision, infection can occur. After Queen Victoria died in 1901, Prince Albert Edward, who was heir to the throne, also developed an appendicitis 12 days before his coronation. Oh, so embarrassing. And the story is that he tried to delay it. He told the surgeon, we got to wait, just wait till I get crowned, okay, and then we'll deal with this. But it ruptured, and he was so sick that two days before the crowning, he finally had to say, okay, we'll have to postpone. So. So you got it in for the beginning?

He did survive, though. He did survive. They delayed the coronation by six weeks, but he survived. Over time, we have moved on from an open surgical procedure, meaning we cut an incision in your abdomen and pull the appendix out. Well, I mean, cut it out. We can just rip it out. That sounds rough. We've moved on to laparoscopic procedures where we use a camera.

We make very tiny incisions. We use tools called trocars when we go in and make cuts. And remove things so it's less invasive. It's less risky. The recovery period is much faster. So we can do things that way. And most recent years, we've even moved in the direction of managing some cases, like pre-rupture, so not after they've ruptured, certainly. But some cases of appendicitis, we've begun to

manage with antibiotics alone, the idea that there may be a way that we could treat these with just IV antibiotics or even oral antibiotics by mouth and prevent the need for surgery. There were some interesting cases that even compared patients who were treated with antibiotics to patients who weren't even given antibiotics just like fluids in some time and they both got better kind of giving rise to this question of, sometimes is it not in factions? Sometimes is it just the appendix is inflamed and it needs some time to cool off, so to speak.

All that being said, we still take an appendicitis very seriously. Sure, yeah. If for no other reason than it is a known entity throughout a lot of medical history that we can treat effectively and save your life. So there's no need to delay care. If you think you have an appendicitis, if you think someone you love has an appendicitis, please go seek care immediately. Don't wait to see if it cools off. Don't just

take antibiotics that are left over in your house. I know you've got antibiotics left over in your house. So many people do. Please don't take them. Please go go be seen. But it is interesting that we are moving to a day where not all appendicitis sees may need to be managed with surgery, which is unfortunate because in the house of God, they say the chance to cut is a chance to cure about the appendicitis. It was so simple. But of course if you don't need to have surgery, why do you want? Yeah, sure. Oh, folks, what's wrong? I need to know, do you really have to have your appendix taken out for certain?

You know what, you looked that up and I'll wrap the show up, okay? Thank you so much for listening to our podcast. Thanks to the taxpayers for using their song Medicines as the intro and outro of our program. Thank you for your questions from kids. Another reminder there that is solbons at maximumfund.org. Just send along those questions with the kids info and we would be happy to attempt to answer those. So just keep us informed. We have a book. It's called the Salman's book. You can get it wherever there's books. I'm just kind of talking until

Sydney looks up at me in a way that says she found her answer. That's it's an it's an Arctic Antarctica. If you are a doctor, wintering at Australian Antarctic stations, you do have to have your appendix removed before you go because there's usually only one doctor at the station during winter. So you're the only one. And evacuation back to medical care in Australia is impossible for at least a part of the year. So you do have to have in that dates back

to remember the episode we did about self-surgery, where the guy, the Russian doctor, removed his own appendix. I remember that. Yes, so that's it. I knew I wasn't making that up. Thank you, Sydney, for never giving up and thanks to you for listening. That's going to do it for us until next time.

My name is Justin McRoy. Hi, Sydney McRoy. And as always, don't drill a hole in your head. Alright! Maximumfun.org Comedy and Culture Artist Oat? Audience Supported