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 Content s vii

Concern for Welfare 30

Benefits for Participants and Society 30
Research Risks 31
Justice 31
Why Ethics Matter 32
MEDIA MATTERS: David Reimer 32
Research Ethics Boards 34
Categorizing Research Risk 34
Conflict of Interest 35
Examples of Ethical Violations in Psychology 36
Ethical Considerations for Research with Non-human Animals 38
Why Use Animals in Research? 39
What Animals Are Used in Research? 40
How Are Animals Protected? 40

CHAPTER 3 Starting Your Research 43

INSIDE RESEARCH: Christopher Green 43
Choose a Research Topic 46
Take a Variety of Psychology Classes 46
Hit the Books 47
Search for Research Articles 47
The Art of Reading Research Articles 48
Get Involved in an Ongoing Research Project 50
Let Theory Guide Your Research 51
The Role of Theory in Forming Research Questions 51
MEDIA MATTERS: Being Mindful in the MindUP program 52
Theory May Shape Hypotheses 53
Theory and Methodology Reinforce One Another 53
Interplay between Theory and Analysis Strategy 54
Avoid Common Problems in Starting Your Research 55

CHAPTER 4 Focusing Your Question and Choosing a Design 57

INSIDE RESEARCH: Tony Vernon 57
Define Your Goal 60
Define the Research Question 61
MEDIA MATTERS: Baby Geniuses 62
Operationally Define Your Variables 62
viii Contents

Choose a Research Methodology 63

Quantitative Research Approaches 64
Qualitative Research Approaches 67
Advantages of Multiple Approaches and Methods 68
Reliability and Validity 69
Raising Children’s Intelligence: What Works? 74

CHAPTER 5 Developing Your Research Proposal 79

INSIDE RESEARCH: Jayne Gackenbach 79
Obtain Your Sample 82
Populations versus Samples 82
Representative Samples 83
Labelling Populations 84
MEDIA MATTERS: WEIRD Science 85
Probability Samples 86
MEDIA MATTERS: The $1 Million Netflix Prize 87
Non-probability Samples 88
Online Samples 88
Choose Your Measures 89
Scales of Measurement 90
Select Your Scale 92
Reliability and Validity 93
Conduct a Power Analysis 93
Prospective versus Retrospective Power Analysis 94
Why Does Power Matter? 94
Formulate an Analysis Plan 94
The Art of Juggling Choices 96
Participant Recruitment Issues 96
Time Constraints 96
Money Constraints 96
Equipment Constraints 97
Make the Best Choices 97

CHAPTER 6 Survey and Interview Approaches 101

INSIDE RESEARCH: M. Gloria González-Morales 101
The Pervasiveness of Surveys 104
MEDIA MATTERS: The Profligate Tooth Fairy 105
Surveys versus Interviews 106
 Content s ix

The Pros and Cons of Surveys 107

Advantages of Surveys 108
Disadvantages of Surveys 109
The Pros and Cons of Interviews 113
Advantages of Interviews 113
Disadvantages of Interviews 114
Focus Groups 115
Using an Existing Survey versus Creating a New One 115
Steps to Building Your Own Questionnaire 117
Question Wording 117
Response Types 120
Evaluating Your Survey 122

CHAPTER 7 Experimental Designs 127

INSIDE RESEARCH: Patrick McGrath 127
The Uniqueness of Experimental Methodology 130
Experimental Control 130
Determination of Causality 131
Internal versus External Validity 132
Key Constructs of Experimental Methods 132
Manipulation of the Independent Variable 133
Experimental and Control Groups 133
Placebo Effect 134
MEDIA MATTERS: The “Sugar Pill” Knee Surgery 135
Random Assignment 135
Types of Experimental Designs 136
Between-Subjects Designs 137
Within-Subjects Designs 138
Matched-Group Designs 140
Extraneous and Confounding Variables 142
Participant Characteristics 143
The Hawthorne Effect 143
Demand Characteristics 144
Other Confounds 144
Strategies for Dealing with Confounds 144
Ceiling and Floor Effects 145
What Dwyer, Kushlev, and Dunn Found 147
Ethical Considerations in Experimental Design 147
Placebo/Control Group and Denial of Treatment 147
Confederates and Deception 148
x Contents

CHAPTER 8 Variations on Experimental Designs 151

INSIDE RESEARCH: Colleen MacQuarrie 151
Quasi-experimental Designs 154
Advantages of Quasi-experimental Designs 156
Disadvantages of Quasi-experimental Designs 156
Factorial Designs 157
Basic Factorial Designs: The 2 × 2 157
MEDIA MATTERS: Almighty Avatars 158
Higher-Order Factorial Designs 163
Single-Case Experimental Designs 164
Advantages of Single-Case Experimental Designs 169
Disadvantages of Single-Case Experimental Designs 169

CHAPTER 9 Observation, Case Studies, Archival Research, and Meta-Analysis 173

INSIDE RESEARCH: Martin Daly 173
Observational Methods 176
Naturalistic Observation 176
MEDIA MATTERS: An American Family 179
Structured Observation 183
Video Recording 184
Coding of Observational Data 184
Case Studies 185
Drawing Insight from the Exceptional Drawing of Nadia 186
The Memorable Case of H. M. 186
Advantages of Case Studies 187
Disadvantages of Case Studies 187
Archival Research 188
Advantages of Archival Research 188
Disadvantages of Archival Research 188
Meta-Analysis 189
Advantages of Meta-Analysis 191
Disadvantages of Meta-Analysis 191

CHAPTER 10 Research over Age and Time 195

INSIDE RESEARCH: Erin Barker 195
Defining Developmental Terms 198
MEDIA MATTERS: An Aging and Able Workforce 199
 Content s xi

Designs to Study Change over Age and Time 200

Cross-Sectional Designs 200
Longitudinal Research Designs 201
Cross-Sequential Designs 205
Microgenetic Designs 207
Additional Challenges to Consider in Developmental Designs 208
Determining the Underlying Cause of Changes 209
Finding Equivalent Measures 209
Determining the Appropriate Sampling Interval 210
Summary of Research Investigating Change over Time 210

CHAPTER 11 Analyzing Your Data I: An Overview 215

INSIDE RESEARCH: Kyle Matsuba 215
The Steps of Data Analysis 218
Checking and Cleaning Data 218
Calculating Scale Means and Reliabilities 219
Computing Descriptive Statistics 220
Creating Visual Displays for Univariate Descriptive Statistics 221
Computing Bivariate Descriptive Statistics and Creating Visual Displays 223
Computing Effect Sizes 225
Confidence Intervals 227
Inferential Statistics and Null Hypothesis Significance Testing 227
Example 1: Assessing the Fairness of a Coin 228
Example 2: Comparison of Two Means 230
Criticisms of NHST 234
Misuse of p as an Indicator of Importance 234
Arbitrary Nature of Reject/Fail-to-Reject Decisions 235
A Culture of Low-Power Studies 235
MEDIA MATTERS: Publication Bias and a Possible Solution 237
Going beyond NHST: Effect Size and Confidence Intervals 237
Focus on Effect Size 238
Use Confidence Intervals 238

CHAPTER 12 Analyzing Your Data II: Specific Approaches 243

INSIDE RESEARCH: Scott Ronis 243
General Approach to Data Analysis 246
MEDIA MATTERS: The Power of the p Value 247
xii Contents

Comparing Means 249

One-Sample t Test 250
Independent-Samples t Test 251
Matched-Pairs t Test 253
Comparisons of More Than Two Means: ANOVA 254
Independent-Groups One-Way ANOVA (Between Subjects) 254
Multiple Comparisons 256
Repeated-Measures One-Way ANOVA (Within Subjects) 257
Two-Way ANOVA (Factorial ANOVA) 258
Comparing Counts/Frequencies 261
2 × 2 Tables 262
χ2 Test of Independence for R × C Contingency Tables 263
Tests of Association: Correlation 264
Assumption Violations 265
Random Sampling and Independence of Observations 265
Non-normal Distributions 266
Unequal Variances 266
Unequal Cell Sizes in Factorial ANOVA Designs 267
Lack of Sphericity with Repeated Measures 268
Robust Statistical Methods 268

CHAPTER 13 Writing Up Your Results 273

INSIDE RESEARCH: Patricia Coburn 273
Determining Your Audience 276
Elements of Good Scientific Writing 277
Clear 277
Concise 277
Compelling 278
Overall Manuscript Flow and Organization 279
Hourglass Organization 279
The Right Level of Detail 280
Basic Sections of a Quantitative Research Paper 280
Title Page 281
Abstract 282
Introduction 284
Methods 286
Results 290
Discussion 292
MEDIA MATTERS: When Research Is Misrepresented 294
 Content s xiii

References 294
Figures and Tables 295
Common Issues to Consider 296
Variations from a Single-Experiment Paper 297
Multiple-Experiment Papers 297
Qualitative Research Reports 297
Alternative Ways to Communicate Research Results 298
Poster Presentations 298
Oral Presentations 299

CHAPTER 14 Publishing Your Research [Online]

INSIDE RESEARCH: Sherry Beaumont
The Paper Is Done! Now What?
Presenting Research at Conferences
Types of Conferences
Choosing the Right Conference
Presentation Formats
Choosing the Right Presentation Format
Writing Up Research for Publication
The APA-Style Manuscript
Types of Journals
Choosing the Proper Home for Your Research
The Review Process
Paper Submission
Editorial Review
Publication
MEDIA MATTERS: The Rise in Retractions

CHAPTER 15 Neuroscience Methods [Online]

INSIDE RESEARCH: Merlin Donald
The Importance of Understanding Neuroscience
Neuroimaging Techniques
Electroencephalography
Magnetic Resonance Imaging
Functional Magnetic Resonance Imaging
MEDIA MATTERS: Helping the Blind to See
Diffusion-Weighted Imaging
Near-Infrared Spectroscopy
xiv Contents

Ethical Issues in Neuropsychology

Safety Concerns
Finding Incidental Brain Abnormalities
Bias in Participant Selection
Using Neuroscience in Conjunction with Other Methods

Appendix 304
Glossary 305
References 315
Author Index 329
Subject Index 333
Preface
Research Methods in Psychology: From Theory to Practice is designed primarily for students
who want to or will be expected to conduct research or for those who want to understand
research as it occurs from the “inside.” As its name suggests, this text guides students
through the entire research process—from learning about the wide range of current meth-
ods to the first step of developing a research question and through the final stage of writing
up and presenting or publishing results.
Our first goal for this book is to provide beginning researchers with the knowledge and
skills they need to begin ethical, creative research. Although this book focuses primarily on
psychological research, its content is relevant for anyone interested in doing research in the
social and behavioural sciences. Our second and closely related goal for this book is to help
students become not only producers of research, but also educated consumers of the re-
search they encounter daily in online news sources, blogs, social media, and printed news-
papers and magazines. These reports often provide brief snippets from actual research, but
with an unstated marketing bias. We believe that every educated adult in our society should
know when to trust these accounts and how to evaluate them.
Given the large number of research methods books on the market, someone could rea-
sonably ask why another book on this topic is necessary. Because three of us have taught
research methods and helped redesign the research methods classes at our universities, we
feel there is a need for a novel approach to this course. In our experience, we have found that
the majority of current research methods texts are not written with the notion that students
will conduct their own research projects, nor do they provide beginning students with
much guidance about becoming involved in research.
In contrast, Research Methods in Psychology: From Theory to Practice delves into the
­practical challenges that face new researchers. We start at the beginning with practical tips
on how to select a research topic and find relevant research articles and then guide students
through each stage of the research process, ending with detailed information on writing up
your research results, presenting research at conferences, and finding the right publication
outlet for research, a topic we think will be particularly valuable as more and more under-
graduates work toward these goals.
We also include two chapters on statistics. This may seem odd given that most colleges and
universities require a separate statistics course prior to a research methods course. However,
we have seen that many students taking research methods need at least a refresher, if not a
more comprehensive review, of statistical material. Additionally, a number of colleges and
universities are moving toward an integrated sequence of statistics and research methods
courses, an approach we feel is quite productive. These statistics chapters provide up-to-date
information about current controversies regarding the continued use of null hypothesis test-
ing with a view to what the future might hold for data analysis, while also providing students
with a requisite understanding of the traditional model. We also present material on research
over time (or developmental approaches), neuroscience, qualitative research, case study ap-
proaches, single-case experimental designs, and meta-analysis. Although we acknowledge
that few undergraduates will use these methods in their undergraduate careers, we feel this
information will make them better critical consumers of research wherever they encounter it.
xvi Preface

FEATURES
Research Methods in Psychology: From Theory to Practice contains a number of distinct fea-
tures. Each chapter begins with an Inside Research section that highlights research that is
being conducted by researchers across Canada. Their shared experiences about their research
studies, struggles, and career choices help demystify and personalize the research process
and capture some of its inherent excitement for students. A Chapter Abstract presents an
overview of what will be covered in the chapter, along with a list of Learning Objectives
specific to the chapter. A Flowchart depicts the organization of the research process and im-
portant choice points. The flowchart in Chapter 1 provides an overview of the entire research
process, emphasizing iterative aspects of research. Flowcharts in subsequent chapters zoom
in on sections of the initial flowchart relevant to the material covered in the chapter.
Each chapter includes at least one Media Matters section that analyzes and evaluates
how a particular research study or general topic relevant to the chapter is portrayed in the
mass media. Practical Tips boxes highlight central concepts introduced in each chapter,
and a Chapter Summary recaps the key issues. Two pedagogical elements conclude each
chapter. The first is End-of-Chapter Exercises, which offer a series of questions that read-
ers can use to test their understanding of the content presented in the chapter and to push
themselves beyond the text to consider wider applications of the material. The second is a
list of Key Terms defined in the Marginal Glossary within each chapter. Although many
terms are specific to research methods and analysis, others come from diverse areas of
­psychology to broaden students’ understanding of the field.
Our Accompanying Instructor’s Manual not only presents standard material such as
chapter outlines, slides, and exam questions, but also includes details and examples regard-
ing how to conduct data analysis in SPSS and R . These analyses are based on the examples
provided in the chapters.

ORGANIZATION
Whereas many instructors like to assign chapters in a textbook in the order in which they
appear, our own experience has taught us that this can be difficult in a research methods
class, especially one that requires students to conduct mini research projects. In a sense, to
be a skilled researcher and critical consumer of research, you need to know all of the m ­ aterial
covered in this book to start with. This is clearly not practical or possible. For this reason, we
have designed chapters to stand alone as references for a particular method or issue, so that
they might be used in an order that best fits an instructor. We have also placed a chapter on
ethics early in the book and presented material on ethics throughout the text to reflect our
belief that ethical concerns should be considered throughout the research process. In our
own research methods courses, we include in almost every class a brief discussion of ethical
issues relevant to a particular method or gleaned from a recent press account.

ACKNOWLEDGEMENTS TO THE US EDITION

A book like this takes some time and a lot of help! We are particularly thankful for Jane
Potter at Oxford University Press for convincing us that we should write this book. We are
grateful to Lisa Sussman at Oxford University Press for her careful editing of the text and
 Pref ace xvii

for guiding us through the entire process. We also thank the many reviewers and students
who read drafts of chapters, as well as the many students who have taken our research meth-
ods classes. Your thoughts and comments have undoubtedly made this a better book! We
thank the following reviewers:

Michael D. Anes, Wittenberg University Marina Klimenko, University of Florida

Suzette Astley, Cornell College
Jodie Baird, Swarthmore College
Levi R. Baker-Russell, University of
Tennessee
Cole Barton, Davidson College
Timothy Bickmore, Northeastern
University
Caitlin Brez, Indiana State University
Kimberly A. Carter, California State
­University, Sacramento
Janessa Carvalho, Bridgewater State
University
Herbert L. Colston, University of
Wisconsin–Parkside
Elizabeth Cooper, University of
­Tennessee, Knoxville
Katherine Corker, Kenyon College
Randolph R. Cornelius, Vassar College
Amanda ElBassiouny, Spring Hill College
Catherine Forestell, The College of
­W illiam & Mary
Judith G. Foy, Loyola Marymount
University
Ronald S. Friedman, University at Albany,
State University of New York
Kathleen Geher, State University of New
York, New Paltz
Frank M. Groom, Ball State University
David Haaga, American University
William Indick, Dowling College
Mark A. Jackson, Transylvania University
Kulwinder Kaur-Walker, Elizabeth City
State University
Victoria Kazmerski, Pennsylvania State
University, Erie
Nate Kornell, Williams College
Rebecca LaFountain, Pennsylvania State
University, Harrisburg
Huijun Li, Florida A&M University
Stella G. Lopez, University of Texas at
San Antonio
William McKibbin, University of
­M ichigan, Flint
Lindsay Mehrkam, University of Florida
Kathryn Oleson, Reed College
Bonnie Perdue, Agnes Scott College
Bill Peterson, Smith College
Thomas Redick, Purdue University
Monica Riordan, Chatham University
Melissa Scircle, Millikin University
Elizabeth Sheehan, Georgia State
University
Angela Sikorski, Texas A&M University
Texarkana
Meghan Sinton, College of William and
Mary
Mark Stellmack, University of Minnesota
Janet Trammell, Pepperdine University
Andrew Triplett, Loyola University,
Chicago
Laura Butkovsky Turner, Roger Williams
University
Barbara J. Vail, Rocky Mountain College
Luis A. Vega, California State University,
Bakersfield
John L. Wallace, Ball State University
Mark Whiting, Radford University
Ryan M. Yoder, Indiana University–
Purdue University, Fort Wayne

Finally, we thank all of our families. Ben thanks Amy for her endless patience with the
length and scope of this project and her invaluable help in designing several of the figures in
the chapter on experimental methods. He also thanks his daughters, Emma and Sophie, for
their love and for providing the motivation to push through this project. Karl thanks Sarah for
listening to many crazy research ideas and helping to turn them into more practical ones, as
well as providing support on a daily basis. Karl also thanks his daughters, Emily and Julia, for
xviii Preface

their love and support. Lisa thanks Daniel for his constant encouragement, invaluable IT sup-
port, and take-out dinners and Madeline, Emma, and Owen for making everything worth-
while. Kevin thanks Carol, Lauren, and Megan for their love, encouragement, and support.

WHY A CANADIAN EDITION?

The Canadian edition of Research Methods in Psychology: From Theory to Practice offers a
Canadian perspective on conducting research in psychology. This has two key advantages.
First, by emphasizing Canadian-specific content and language, most notably in regard to
Canadian research ethics, this text will be more relevant to students and instructors in
Canada. Second, by highlighting Canadian researchers and incorporating Canadian re-
search examples throughout the text, it exposes students to the amazing work that is being
conducted in our own country.

ACKNOWLEDGEMENTS TO THE
CANADIAN EDITION
Even adapting an existing book takes a considerable amount of time and effort by many. I am
thankful for Dave Ward at Oxford University Press for the opportunity to adapt this book into
a Canadian edition. I am also grateful to Elizabeth Ferguson and Mariah Fleetham for their
editing of the book and assistance through the entire process of this adaptation. I would also
like to thank two student assistants, Kyla Javier and Thomas Hughes, for their help in identi-
fying potential Canadian researchers to profile in this book and for searching out Canadian
research to use as examples throughout the book. I am very grateful to each of the researchers
who agreed to be profiled in the Inside Research boxes at the start of each chapter. I would like
to thank the students in my research methods classes, who through their successes and strug-
gles helped me identify particular content areas to expand on and include in this adaptation.
I would also like to thank the reviewers who read drafts of chapters. Your thoughts and com-
ments have undoubtedly made this a better book! We thank the following reviewers:

Kelly Arbeau, Trinity Western University Stephen W. Holborn, University of

Craig Blatz, MacEwan University
Connie Boudens, University of Toronto
Michael Emond, Laurentian University
Ken Fowler, Memorial University of
Newfoundland
Manitoba
Guy Lacroix, Carleton University
Harvey Marmurek, University of Guelph
Jennifer Ostovich, McMaster University
Kendall Soucie, University of Windsor

Finally, I would like to thank Chris for his support and encouragement through this pro-
cess, and my children, Evan, Kaylee, and Amy, for their love and support.
Introduction to Research
Methods
1
Chapter Contents
Why You Should Care about Research How Cognitive Biases and Heuristics Affect Your
Methods 4 Judgment 11
Methods for Evaluating Claims 5 Conducting Your Own Research to Evaluate Claims 14
The Extraordinary Coffee Bean 5 Distinction between Science and Pseudoscience 14
Trust the Experts 7 The Goals of Science 15
Read and Evaluate Past Research 9 The Scientific Method 15
Search for Convergence 9 Distinction between Applied and Basic Research 17
How to Evaluate the Quality of Reported The Research Process and Organization of This
Research 9 Book 17

INSIDE RESEARCH: Carla MacLean

As an undergraduate at the University of Victoria, I was not initially
charmed by the research process. Like anything that is difficult to
master, conducting good research is challenging. However, as my
interest in psychology grew, so too did my research skills, and

Courtesy of Carla MacLean

now working with others to conduct research is one of the things
I enjoy most in my career. My interests are diverse, yet at the core
of my research pursuits is a quest to understand how we might
maintain accuracy or reduce bias in people’s assessments of situ-
ations, information, and one another. I typically pursue these core
interests in the applied areas of eyewitness memory and profes- Instructor, Department of Psychology, Kwantlen
sional decision making (e.g., industrial incidents, forensic events, Polytechnic University
the legal system).
My goal is to explore topics that are interesting to both psychologists and the broader public, to stim-
ulate discussions, and to generate psychologically based strategies for issues found in the world outside
the lab. It is not difficult to find such topics. In collaboration with talented colleagues and students, I have
continued
2 CHAPTER 1 Int rod uc tion to Re searc h Met hod s

researched such things as the effect of knowledge and expectation on professionals’ and witnesses’
­observations of people, places, and events, as well as psychologically based incident report forms and
investigation tools.
Over the years, conducting research has taught me to be measured and organized in how I approach
new problems, both inside and outside of the lab—this is a powerful life skill. I encourage you to embrace
the challenge of research, think critically, and enjoy the process!

Carla MacLean has interests in the strengths and weaknesses of human memory, as well as judgment
and decision making. Much of her research has real-world application, focusing on eyewitness memory
as well as context effects and motivation on professionals’ judgments. Her research methods include
both experiential and computer-based designs.

Research Focus: Professional experience and judgment, as well as eyewitness memory

 Introduc tion to Re s earc h Method s 3

THE RESEARCH PROCESS

Complete ethics training This flowchart provides an overview of
the research process, emphasizing the
iterative aspects of research. Flowcharts
in subsequent chapters zoom in
Formulate a research
question on ­s ections of this flowchart relevant
to the covered material.

Generate testable
hypotheses

Choose a research
method

Develop a research
proposal

Obtain REB approval

Collect pilot data

(optional)

Collect actual data

Analyze data

Write up study

Publish or present study

4 CHAPTER 1 Int rod uc tion to Re searc h Met hod s

Chapter Abstract
In this chapter, we discuss the importance of research methods and their relevance not only to
the scientific process but also to daily life. We explore various approaches to evaluating the
constant stream of reports of research findings in the media and advertising, as well as results
published in scholarly journals. We present examples of fraudulent and questionable ethical
practices to help develop a healthy skepticism of all research findings. Finally, we introduce the
fundamental distinction between science and pseudoscience and present a flowchart depict-
ing the research process that will guide the organization of subsequent chapters.

LEARNING OBJECTIVES
By the end of this chapter, you should be able to:
• Explain the importance of understanding research methods.
• Describe methods for evaluating the quality of research-based claims.
• Provide examples of cognitive biases and explain how they can influence our decision
making.
• Identify the three goals of science.
• Differentiate between the scientific method and pseudoscience.
• Describe the difference between applied and basic research.

WHY YOU SHOULD CARE ABOUT

RESEARCH METHODS
There are three main reasons why you should know something about research methods.
First, such knowledge helps you better understand how we come to know the truth of the
information we are presented with on a daily basis, ranging from claims that it is better to
buy organic food to claims that listening to music while studying will not improve your exam
scores. How can you tell whether the results of research studies or claims made in the media
are justifiable and believable? In the past few years alone, companies and researchers have
claimed that listening to Mozart boosts IQ; wearing magnetic bracelets reduces pain and
motion sickness and promotes better balance; drinking coffee and red wine promotes
health; drinking pomegranate juice reduces cholesterol and boosts heart health; and drink-
ing diet soda may increase women’s risk for depression. Are any of these claims true? How
would you find out?
Second, understanding research methods will be directly applicable to many of your other
psychology courses. The content of these courses (e.g., social, personality, or clinical psychol-
ogy) have advanced from years of research that have developed the theories and current trends
you will learn about in those fields. Further, you will be required to read and interpret research
studies conducted in these fields as part of your studies.
Finally, understanding research methods can aid in many of your everyday decisions.
In terms of both physical and psychological well-being, a deeper knowledge of methods
can help you make good healthcare decisions. In terms of being a consumer, this knowledge
 Method s for Evaluating Claim s 5

can help you evaluate advertising claims made about a new car, television, or computer so that
you can make the best possible choice.
Another good reason to know about research is so that you can conduct your own research.
Doing research can be a fun, creative, and rewarding experience, but becoming a skilled re-
searcher requires a certain amount of knowledge. Our hope is that by reading this book, you
will acquire the knowledge you need to be a better consumer of research and to conduct your
own research project.

METHODS FOR EVALUATING CLAIMS

One way to evaluate research claims made by researchers, reporters, or healthcare-related
websites is to simply accept them at face value because they are based on the opinions of ex-
perts. After all, the claim must be supported by some expert for it to appear in the news or on
the Internet, right? However, increasing numbers of individuals are getting their news online
or through social media, and this has allowed for increasing instances of fake news—made-up
content that is presented as real news.
Do you blindly trust experts cited in a newspaper or online? Can you tell whether an image
you are seeing is authentic or fabricated? How do you know who you can trust? Many reports
do not even mention a specific expert, so how can you determine whether the report and re-
porting provide an accurate description of trustworthy results?
A second approach for evaluating claims is to read and evaluate the actual research. But
often you will find competing accounts that are difficult to interpret without extensive
knowledge of a particular field of study. How, then, do you evaluate the claims found in
different sources and come to your own conclusion? This evaluation process becomes
easier as you gain experience and learn to judge the quality of the research and
conclusions.
A third method for evaluating claims is to search for similar results, or converging evidence,
about claims made in news releases (in print or online) and original research. Converging converging evidence
evidence refers to results from multiple research investigations that provide similar findings. Results from multiple
But when you begin to search for converging results, you may be confronted with a diverse set research investigations
of facts and opinions that can be difficult to sort out. that provide similar
findings.
Finally, you could conduct your own research project to test the claims, but many individu-
als do not have the knowledge or resources to conduct such tests. Much of this book is tar-
geted to help you design and conduct your own research project.

The Extraordinary Coffee Bean

As an introduction to evaluating particular claims that appear in the media, we present
two reports about coffee and consider how you might evaluate their accuracy. We exam-
ine issues of expertise, reading, and evaluating past research; the importance of finding
convergent evidence; and particular aspects to look for in a report of a research
finding.
For many years, reports about the health benefits of caffeine have circulated in the media.
A New York Times article highlighted in Figure 1.1 suggests that caffeine consumers have a
lower death rate than individuals who abstain from caffeine. Should we trust Jane Brody and
6 CHAPTER 1
Yvetta Fedorova
skepticism The process
of applying critical
thinking in evaluating
the truth of a claim.
Int rod uc tion to Re searc h Met hod s
Having Your Coffee and Enjoying It Too
By JANE E. BRODY [NY TIMES, June 25, 2012]
A disclaimer: I do not own stock in
Starbucks nor, to my knowledge, in
any other company that sells coffee or
its accoutrement. I last wrote about
America’s most popular beverage four
years ago, and the latest and largest
study to date supports that earlier
assessment of coffee’s health effects.
Although the new research, which
involved more than 400,000 people in
a 14-year observational study, still
cannot prove cause and effect, the
findings are consistent with other recent large studies. The findings were widely reported, but
here’s the bottom line: When smoking and many other factors known to influence health and
longevity were taken into account, coffee drinkers in the study were found to be living somewhat
longer than abstainers. Further, the more coffee consumed each day—up to a point, at least—the
greater the benefit to longevity. The observed benefit of coffee drinking was not enormous—a
death rate among coffee drinkers that was 10 percent to 15 percent lower than among abstainers.
But the findings are certainly reassuring, and given how many Americans drink coffee, the
numbers of lives affected may be quite large.
FIGURE 1.1 The benefits of coffee.
her reporting? How can we know whether the research she reported really supports the claim
that is being made?
There are multiple ways to evaluate the report. First, you could try to find out who
conducted the original research. Was it a trained, objective researcher or someone hired
by Starbucks or some other coffee supplier? The blurb in Figure 1.1 does not contain
this information, but if you look at the original press report (Brody, 2012), you will find
that Dr. Neal Freedman and his colleagues conducted the study. Dr. Freedman is listed
as an epidemiologist at the National Cancer Institute, and the research was published in
the New England Journal of Medicine. He seems like a trained researcher, so perhaps we
should accept the findings. But s­ kepticism is a good trait when reading newspapers or
websites, and we will explore in the next section why trusting the experts may or may not
be a good thing.
Second, you could dig for converging evidence from other websites or news outlets. Do
multiple sites provide converging evidence? Unfortunately, not all of them will cover the
same aspects of a story. The media story “Should You Swap Your Regular Coffee for
Green Coffee Extract? (Stieg, 2019) suggests that green coffee beans (beans that are un-
roasted and unprocessed, as is typically done for regular coffee) contain high levels of
chlorogenic acid, which acts as an antioxidant, and can help you lose weight and poten-
tially protect against diabetes and heart disease. The compound has been extracted from
the bean and turned into a powder or supplement that can be taken orally. The story cites
a Dr. Luis Cisneros-Zevallos throughout the article. Is he an expert on caffeine and weight
loss? Should we automatically accept his claims because he is a doctor? How should we
evaluate these two reports, and should we drink coffee or take green coffee bean supple-
ments, or both?
Another random document with
no related content on Scribd:
on the further side, then on the near side of the opening, after which
the serous membranes are accurately sutured around the opening
by continuation of the first row of silk sutures. The actual opening
made for the purpose should be at least an inch in length, preferably
an inch and a half or more, while when the lower bowel is attached
to the colon such an opening may well have a length of at least 2¹⁄₂
inches, for if successful it will be followed by a certain degree of
cicatricial contraction and will never remain of its original size (Figs.
566, 567, 568 and 569). The suture may be combined with the
elastic ligature, the method again being similar to that for uniting the
jejunum with the stomach, already described. The rubber ligature
used for the purpose is of the same size, and there is no difference
to be made in the directions already given. The elastic ligature,
however, can not be relied upon in emergency cases where it is
necessary to effect a communication at once. It is serviceable only in
instances where there is a leeway of at least three or four days. This
method has for one of its advantages the fact that in its performance
it is not necessary to clamp or secure the bowel by any instrument,
simply to empty it for the moment with the fingers, it not being
opened during the operation by anything save the needle puncture,
which is promptly filled with the rubber. It does require, however, that
the rubber used for the purpose shall be reliable and new, it being
unfortunately the case that pure rubber which will last for a long time
is seldom found in the market.
 Fig. 566 Fig. 567

Entero-anastomosis of intestinal Suture of the distal edges of the

loops which have been resected and mucosa.
the bowel ends closed; the first row
of sutures has been applied and the
line of opening indicated. (Lejars.)
 Fig. 568 Fig. 569

Insertion of the last (fourth) row of Resection of intestine with lateral

sutures. (Lejars.) anastomosis. Posterior suture inserted.
The free ends of the bowel inverted and
sutured. (Richardson.)

The button method depends for its success upon a mechanical

device of Murphy, known everywhere as the “Murphy button,” or
upon one of its modifications. Fig. 570 illustrates the component
parts of this device, which is made in various sizes and, in fact, in
various shapes for different purposes, though the circular forms
suffice for practically all cases. In Fig. 572 it is seen in actual use,
while Figs. 573 and 574 illustrate the method of its insertion and
securement.
 Fig. 570

The Murphy button.

 Fig. 571

End-to-end union of intestine by means of the Murphy button: the two portions of
the Murphy button, held in position by purse-string sutures, are ready to be
pressed together. (Richardson.)

Fig. 572

Union—end to end—with the Murphy button.

The underlying principle of the Murphy button is that each half can
be inserted separately and that then, by pressing these halves
together, an opening is at once afforded from one part of the bowel
to the other. If the halves be pressed together with the proper degree
of firmness they produce, first, adhesion between considerable areas
around their circumference, followed in the course of a few days by a
necrosis of the central portion, which sloughs because deprived of its
circulation by the pressure. So soon as this separation or sloughing
is complete the button drops into the intestinal canal, being
completely loosened, and is now carried along by peristalsis and by
the fecal current from above, its position shifting as would that of a
scybalous mass or a fecal concretion, until it finally emerges from the
intestinal tube, being passed from the anus. How soon it will thus
appear will depend in large measure upon the point of the intestinal
canal into which it is thus intruded. If this be high up it will be slower
in appearing. If low down it may be expected sooner. While it usually
appears within ten days or two weeks it may, however, be longer
retained, and in one case of my own was not passed for three
months, although the anastomosis was made with the ascending
colon, into which it must have dropped.
Fig. 573 shows one of the halves held in the grasp of a forceps,
being inserted into a small buttonhole opening just large enough to
receive it, around which there has been passed a buttonhole or
purse-string suture of silk. This portion once thus inserted should not
be lost within the bowel, it being necessary to retain control of it by
the forceps until its application to the other half. Both halves being
inserted and brought opposite to each other, as in Fig. 574, the
smaller is introduced into the larger, and they are then pressed
together until the included serous surfaces are brought into contact,
with sufficient pressure inflicted to bleach them, in order that their
subsequent necrosis may be ensured. A circular row of sutures
should now be placed around the surfaces thus applied, in order to
more widely secure them in contact. The procedure being completed
in this way, the parts are dropped back into the abdomen and the
abdominal wound closed.
 Fig. 573

Introduction of one-half of a Murphy button. (Bergmann.)

 Fig. 574

Intestinal anastomosis with a Murphy button, showing the halves in position ready
to be pushed together. (Bergmann.)

End-to-end reunion can be accomplished by the same method, or

the end of the small intestine may be applied to the side of the large,
after a method which will be best understood by reference to Fig.
571, it being necessary here to draw the squarely cut end of the
intestine around the button with a circular suture, and, at the same
time, to so grasp the button that it shall not recede into and be lost in
the bowel.
Small buttons have been made for the purpose of uniting the gall-
bladder to the upper bowel and extra large ones are made for the
large intestine.
The particular advantage of the button method is the shortness of
the time required for its performance, as it can be conducted in a few
moments by one who might take four times as many minutes in
using sutures. The disadvantages attaching to it are these: (1) That it
depends for its success upon necrosis, i. e., of the part of the bowel
included within its grasp; (2) that it might itself serve as a foreign
body and produce acute obstruction, a not unknown event; (3) that it
is not always at hand, especially in emergency cases, and that to
rely upon it is to be limited in one’s abilities.
There is but little question that, when properly performed, the
simple suture methods are the best of all, and the operator who has
never seen a button used should abstain from its use. Still it has
given many good results. My belief is that the better the surgeon’s
judgment, and the more developed his skill, the less he will rely upon
any mechanical expedient of this character, and the more upon what
he can accomplish with the needle in his own fingers.
End-to-side anastomosis is in no essential respect different from
resection, only it may be done for the purpose of exclusion when
nothing is absolutely removed. Thus in case of cancer of the cecum
a lateral implantation can be made of a lower loop of the ileum upon
the side of the ascending colon, using for this purpose a button,
having divided the ileum on the proximal side of the ileocecal valve,
and turned in both ends and invaginated the stumps. Here one
resects nothing, but makes a direct communication between the
bowel above and below the cancer, short-circuiting the intestinal
canal, as electricians would say, and all for the purpose of giving
temporary relief. Thus end-to-side or end-to-end anastomosis may
be made, according as circumstances dictate, and, if one chooses,
with the Murphy button.
Resection of some portion of the large or small intestine is
required under a variety of different circumstances. Thus after
certain injuries, contusion and rupture, or numerous punctures or
gunshot perforations, it may be decided to remove a considerable
length of bowel rather than be compelled to give special attention to
a number of distinct lesions, believing it a time-saving measure, and,
therefore, for the welfare of the individual. The same measure will be
indicated when, either by injury or disease, the blood supply of any
portion of the bowel is apparently compromised or certainly shut off.
Here necrosis is so certainly to be expected, or perhaps has already
occurred, in such a way as to necessitate removal of whatever
length of bowel may thus be involved. Several of those cases,
already mentioned, which produce obstruction of the bowel will
demand resection, as, for instance, when reduction of an
invagination is impossible, with gangrene threatening. In a few
instances extensive gangrene, precipitated by embolism or
thrombosis of the mesenteric vessels, has been successfully treated
by resection of considerable lengths of bowel. Again, the bowel is
resected for closure of fecal fistula or artificial anus, as well as for
relief of stricture due to various causes. Finally, nearly all of the
tumors of the intestine itself, and especially all of the malignant
forms, will require removal of at least a few inches of gut, save in
those cases where this is shown to be impracticable because of the
presence of cancer elsewhere, in which case it may be sufficient to
make an anastomosis.
When intestinal resection is not an emergency measure there
should be as much preparation as the case will permit, including
lavage of the stomach, the ingestion of sterilized food, the use of
antiseptics and the most thorough emptying of the bowel which can
be accomplished.[58]
[58] Sanderson has suggested a new method of sterilization of the
interior of the bowel at the time of operation. He injects a solution of
acetozone through a hypodermic needle, or, after opening the bowel, freely
irrigates with the same.

One of the greatest difficulties attendant upon the operation is the

avoidance of all contamination by contact of peritoneum with
intestinal contents. Against this the most minute precautions should
be taken. This is never an easy matter, and in the presence of
distended bowels and the emergency of acute obstruction it
sometimes taxes every resource at hand. A variety of clamps have
been devised by different operators, the intent being to so clasp the
bowel beneath their blades as to completely occlude it. These blades
are covered with sterilized rubber tubing to keep them from acting
too harshly, and it is necessary to use pressure upon the handles
with great discretion, lest permanent injury be done to the
bloodvessels. The bloodvessels of the bowel are essentially
terminal, and the blood supply should be kept sufficient for every part
which is not removed. These vessels are, moreover, numerous and
relatively large, and hemorrhage is not always easy of control,
especially when clamps are not at hand. As a substitute for clamps
tapes of sterilized gauze may be used, being tied around the bowel,
or the fingers of a reliable assistant may be substituted. Such use of
the fingers is not easy nor simple, not only because they become
tired and relax their grasp, but since they slip so easily, and because
the escape of one drop of fecal matter may cause a fatal
contamination.
Resection of the bowel may imply in one case a removal of but
two or three inches of its length, while the other extreme is not
reached until several feet of bowel have been removed. I have been
able to successfully remove eight feet and nine inches of intestine,
the lower part including the cecum and a portion of the ascending
colon, and there are now on record nearly twenty cases where over
200 Cm. of bowel have been resected, nearly all of them recovering.
Success in this procedure depends partly upon the condition
necessitating the operation, as well as the general condition of the
patient, but in no small measure hangs upon the perfection of the
operator’s technique.
 Fig. 575 Fig. 576

End-to-end or circular anastomosis Completion of last row of sutures, begun

by enterorrhaphy. First row of distal as shown in Fig. 575. (Lejars.)
sutures in serosa. (Type of needle
differs from that used in this
country). (Lejars.)

Whatever be the condition which requires such resection it should

be made sufficiently extensive to completely include and permit the
total removal of the diseased or injured portion. The abdominal
incision should be large enough to permit the delivery upon the
surface of the body of all that portion to be removed. Unless this be
done the difficulties are greatly enhanced. Save where there is some
distinct indication for opening elsewhere, this incision is made in the
middle line. The compromised bowel having been sought and thus
delivered and one having decided exactly where to divide it, clamps
are so placed both above and below each line of division as to
prevent leakage. Underneath the bowel to be thus divided gauze is
placed in such a way as to receive the small amount of discharge
which will escape from the portion between the clamps. The exposed
bowel surfaces should then be thoroughly cleaned, the contaminated
gauze removed, fresh pieces substituted for it, and the other division
of bowel made in the same way. While in some cases it may be well
to tie off the mesenteric border and secure all its vessels before
dividing the bowel, this may at other times be delayed until after the
division. At all events it is the next step. Whether the mesentery shall
be simply separated along the intestinal border and tied off in small
portions, one after another, or whether a triangular resection of a
portion of the mesentery itself should be made, securing the larger
vessels nearer to its root, will depend on the nature of the case and
upon whether the mesentery itself be involved in the disease. In
dealing with cancer it is often necessary to remove, at the same
time, every enlarged lymphatic. It may be inferred that no incision or
tear, no matter how short, can be made in these tissues without
danger of subsequent hemorrhage unless the parts be secured
against it. A series of ligatures and sutures is therefore called for
here which may consume no small proportion of the entire time of
the operation. (See Figs. 575 and 576.)
All that portion of bowel which has been condemned having been
removed and a careful toilet of the parts having been made the
surgeon next proceeds to restore the bowel lumen. A V-shaped
defect in the mesentery should be united with sutures. The line of
former mesenteric border left after removal of bowel should be not
only carefully protected with ligatures, but the whole margin should
be overcast and so folded in or drawn together in tucks as to make it
easy to bring the bowel ends together without undue stress.
 Fig. 577 Fig. 578

Circular anastomosis of portions of the bowel having different lumina. (Bergmann.)

The sutures by which the divided bowel is restored should begin at

the mesenteric border, and every care should be taken to make the
joint at this point absolutely water-tight. Suture methods have been
described. To unite bowel ends of the same diameter it is an easy
matter to suture together first the mucosa and then the outer layer,
so long as the intestine is on the outside of the body and equally
accessible on all sides (Fig. 578). The surgeon is sometimes
compelled to do this work within the body cavity, as in resection of
the rectum for cancer. It may be advisable to first place a row of
sutures between the serosa and muscularis on the further side of the
margins to be united, then to close the mucosa completely around,
and then to finish the outer layer of sutures. So long as differences of
size are not conspicuous, end-to-end approximation can be made
almost anywhere. When, however, it is necessary to attach small
bowel to large, the size of the larger opening should be reduced to fit
the smaller, or one or both ends may be closed, turning in the stump,
as already described, and then making lateral or end-to-side
anastomosis. Any such anastomotic opening should be so placed,
and bowel so directed, that there shall be no interference in the
direction of the natural bowel stream, failure to observe this
precaution producing not only added immediate danger but more or
less permanent obstruction (Figs. 579 and 580).

Fig. 579 Fig. 580

Isoperistaltic lateral apposition. Antiperistaltic lateral apposition (bad).

All that has been said above with regard to the Murphy button and
its use in anastomotic operations holds equally good here with
regard to its usefulness after resection.
Numerous devices, either instruments for the purpose of holding
the bowel together while it is sutured, or of affording substitutes for
the Murphy button, have been planned by operators all over the
world. There are few of them, however, which give any better results
than the simple methods above described, to which I prefer to limit
description here because of their very simplicity.
Intestinal suture or any other method of completing the resection
having been finished, a careful toilet of all exposed parts should be
made, by which bowel may be dropped back into the abdominal
cavity and the latter closed without drainage.
The subsequent management of these cases will consist in two or
three days’ starvation, in order that peristalsis may be reduced to a
minimum, the patient being meanwhile fed by the rectum. Then will
come a time when both fluid food, and cathartics a little later, should
be gently and discriminately administered. Any satisfactory suture
method will rarely give way after forty-eight hours. Buttons, on the
contrary, may break loose after many days or even weeks, and this
fact affords another argument against their use.

Fig. 581 Fig. 582

Enterostomy; preliminary fixation of a Enterostomy; fixation of margins of

loop of bowel to the peritoneum. opened gut to skin. (Lejars.)
(Lejars.)

Enterostomy.—Enterostomy for establishment of fecal fistula, or

artificial anus, is performed for relief purposes and
sometimes as an emergency measure. It consists in attaching some
portion of the bowel, naturally that above the constriction or disease
which compels the operation, to the parietal peritoneum through a
small wound in the abdominal wall. When the large intestine is
opened for this purpose the operation is usually referred to as a
colostomy, and this preferably is done in the left iliac region. When
enterostomy of the smaller bowel is preferable it may be done at any
point on the abdominal surface. Thus if through a median incision a
condition be found necessitating it the bowel should be attached at
the lower end of the abdominal opening, for here drainage will be
better and contamination less likely. When enterostomy is done for
acute obstruction, it is preferable to place the opening in one iliac
fossa or the other.
Enterostomy consists essentially of the following steps: opening
through the abdomen, recognition of the parietal peritoneum, which
is seized with forceps on either side, opened and secured with these
forceps, after which the first tensely distended loop of bowel which
presents is taken, and, with a series of fine sutures in a round
needle, the serous surface of the gut is attached to the margins of
the parietal peritoneum (Figs. 581 and 582). In the more desperate
cases a portion of the bowel may be brought out through the wound
and fixed there in such a way that it cannot recede. If the emergency
is great the bowel may be immediately punctured, the patient so
placed and so protected that fecal contents shall escape away from
the body rather than over it. If one can take a little time he may wait
a few hours for the adhesion which is sure to take place between the
peritoneal surfaces and the consequent shutting off of the abdominal
cavity from the outer wound. Thus after twelve hours the surface of
bowel exposed through the wound may be punctured either with a
knife, scissors, or the actual cautery, and this may be done without
causing pain to the patient. Escape of bowel contents will instantly
ensue after puncture. After permitting all to escape that will,
abundant protection should be provided for the reception of the
discharges, which will continue at reduced rate. The best way to do
this is to pass into the bowel in the proper direction a rubber tube, as
large as it can accommodate, or a glass tube, bent at an angle,
which shall connect with a flexible tube, and thus conduct away all
discharge.
Another method of performing the operation is to bring out the loop
of bowel, open and empty it, then to introduce a glass or rubber tube,
around which is snugly fastened the bowel margin. The intestine is
then stitched in place and the tube so arranged as to conduct away
all discharge.
Just how much may be expected of such a relief opening will
depend upon the case. These operations, especially for cancer of
the rectum or the lower bowel, may prolong life for two or three
years. An emergency opening into the small bowel for relief of acute
obstruction may need to be kept open for but a few days, after which
the tube may be removed and the fecal fistula be allowed gradually
to contract. According to the case an intestinal resection may be
made or the opening may be closed by one of the plastic methods.
Appendicostomy.—Appendicostomy is the more complete form
of carrying out a suggestion first made by Hale
White, of opening the colon on the right side in cases of intractable
colitis. Gibson suggested to accomplish this by a method similar to
Kader’s for gastrostomy, making a valvular colostomy through which
the colon might be irrigated, without escape of feces. In 1902, Weir,
intending to do this operation, found the appendix rising so invitingly
into the wound that the inspiration occurred to him, and was promptly
acted upon, to utilize it for the purpose.
In performing the operation the smallest possible incision should
be made through which the appendix may be delivered, its
mesenteric artery is tied, and its mesentery stripped down to its
origin. At the latter the cecum is fastened to the parietal peritoneum
by a suture on either side, avoiding the appendicular artery itself.
The balance of the wound is then closed as usual, the appendix
being fastened to the lower angle by suture, the protruding part then
wrapped with gutta-percha tissue and included in the dressing. At
the end of two days the external portion may be divided about 1 to 4
inches from the skin, after which a catheter is passed along its lumen
and the stump tied around it. This serves the double purpose of
preventing leakage and severing the appendix flush with the skin.
The catheter is introduced from 2 to 4 inches, and its external portion
left open to allow escape of gas, or doubled and fastened to prevent
leakage, as circumstances may require. Irrigation may be begun on
the third or fourth day.
 When the appendix is used for the purpose of forming an artificial
anus it will be probably in instances where there is more of the
emergency element present, and it may be sufficient then to simply
utilize it for the purpose of anchoring the cecum to the abdominal
wall, or with the purpose of dilating it after the expiration of a few
hours. In other words, the method may be modified to meet the
indication.
It is scarcely necessary to devote space to any other operative
procedures upon the small intestine. Consequently it will simply be
mentioned here that the upper part of the jejunum can be used for
artificial feeding and jejunostomy made to take the place of
gastrostomy under those rare circumstances which may demand it.
Upon the large intestine colopexy may be practised, attaching it to
the anterior abdominal wall or to the border of the liver or the
gastrohepatic omentum. Andrews’ suggestion to attach the colon to
the lower border of the liver, after certain operations upon the biliary
passages, will be described in connection with the latter. In cases of
extreme dilatation, with loss of muscular tone, etc., involving
especially the colon, an enteroplication may be practised
corresponding to gastroplication, and having the same purpose, with
a technique practically identical with the other. Thus when the
sigmoid flexure is so dilated as to largely fill the abdominal cavity,
with an enormous S-shape, much can be done by thus reducing its
dimensions, the only objection being the fear that the causes which
produced the condition will conspire to reproduce it even after
enteroplication.
 CHAPTER XLIX.
[59]
THE APPENDIX AND ITS DISEASES.
[59] The laity, as well as part of the profession, having not yet ceased to
wonder at the great importance attaching today to appendicitis, when
twenty years ago it was practically unknown, it is worth while to insert here
the following brief historical account: The term “appendicitis” was coined by
Fitz for a condition which had not been hitherto unknown, but to which he
gave a classical description. That the appendix might be primarily diseased
had been known for one hundred and fifty years; that peri-appendicular
abscesses were frequent may be seen by reference to works of the middle
and latter part of the past century on perityphlitis and perityphlitic abscess,
Willard Parker, of New York, being the most prominent writer of his day
upon this subject. In the Transactions of the Medical Society of the State of
New York for 1875, Gouley reports a case of so-called perityphlitic abscess
due to perforation of the appendix, with remarks upon its surgical treatment.
The curious feature attaching to this case was that two years previous to its
occurrence the patient had swallowed one of his teeth. Although this tooth
was not found at the time Gouley alluded to the possibility of it or any other
small body lodging in the appendix and finally causing ulceration. He
referred also to the case published in 1856 by Dr. Lewis, of New York, who
reported an individual dying at the age of eighty-eight, whose appendix was
found to contain one hundred and twenty-two deer shot, it appearing that he
had been exceedingly fond of game; he supposed that the shot found in the
appendix were contained in meat which he had eaten. Lewis also referred
to forty-seven cases of foreign bodies which he tabulated, all but one of
which died.
Fitz’s article appeared in 1886. In it he claimed that operation should be
done much earlier than was then the custom, and he showed that 34 per
cent. of these cases died during the first five days of illness. But the first real
operation for appendicitis as such was done by Krönlein, of Zurich,
according to a suggestion made by Mikulicz in 1884. The second was done
by Symonds, in England, in 1885, this being an interval operation. The first
operation in the United States was done by Hall, of New York, in May, 1886,
although to Morton, of Philadelphia, the credit must be given of the first
operation in this country on a case deliberately diagnosticated. This was in
April, 1887, Sands doing the next one in December of the same year.