The John B. Murphy Hall - The Diagnosis of Appendicitis

john b murphy

John Benjamin Murphy, M.D. (1853-1923)

The art of diagnosis of disease is central to the practice of medicine. It can be enormously challenging to take a person with a set of symptoms, to sort through all of their individual confounding and conflicting stories, and then arrive at a unifying theory of disease. There is an old rule, termed "Osler's Law" in common use:

"The Doctor should strain and squeeze to give the patient one disease."

But then there is a rejoinder:

"No matter how the Doctor squeezes, the patient will have what he damn well pleases."

In other words, as physicians we are on a continual search for a unifying diagnosis for each patient - one disease or syndrome that explains it all. But sometimes a patient will have two or three or more unrelated diseases at the same time.

Normally, appendicitis occurs by itself in an otherwise healthy young person who abruptly becomes sick. But it can occur in anyone, very young, very old, pregnant, sick with other things. Another old adage - "The hardest diagnosis in the world is appendicitis in someone hospitalized for something else."

A wonderful friend of mine, a family doctor, called me early one Saturday morning and told me of a pregnant woman hospitalized two days before for an inflammation of the pancreas gland. He told me the story and finished with, "but I think she has appendicitis." Now, he's a very good doctor, but this seemed a little far fetched. I came in and examined the nice lady, and agreed with him that she probably had appendicitis. The two of us took our her gangrenous, not ruptured appendix that morning. Mother and baby did just great. I mention this as an example of a great Doctor who was willing to think outside of the reports, examine the patient, and come to his own conclusions. Very impressive.

In Murphy Hall, we have a number of exhibits on the diagnosis of appendicitis.

The first exhibit answers the question you may have in the middle of the night - "Do I have appendicitis" and which speaks to how appendicitis is diagnosed, and which presents the Alvarado score, a simple, well validated scoring system for diagnosing appendicitis. We also have a brief blurb for the best medical textbook ever written, "Cope's Early Diagnosis of the Acute Abdomen."

We also have an exhibit on imaging studies for appendicitis - does a CT scan help.

In "how often is the Doctor wrong?" we talk about having surgery when the appendix is found to be normal.

We have a specal ehibit on the extraordinary life of Dr. John B. Murphy.

Finally, I want to make a special pitch for a great book, "Every Patient Tells a Story," by my friend, Dr. Lisa Sanders, a lovely person and great Doctor, who lives on another plane than the rest of us mere mortals. She is a Doctor, mother, writer, and the Medical Adviser and model for TV's House. If put a link to Amazon, because it would be a great addition to your library, and because in the book Lisa talks about a contest I once ran with Surgical residents in Connecticut challenging them to diagnose appendicitis by physical examination rather than an immediate CT scan.