Da Costa-Deaver debate over routine use of blood counts for patients with appendicitis (Howell VI, 207-221)

Da Costa advocated routine use of; John Deaver championed immediate appendectomy for acute appendicitis. “Da Costa did not feel that one ought to use a low count as a signal not to operate. . . much of Da Costa’s discussion had to do with using blood counts to follow a patient’s recovery after surgery. After an abdominal operation there existed the possibility that not all of the infected material had been removed. If the white count remained high . . . that would be a reason to go back in and clean out more pus, to do more surgery rather than less. . . So, one wonders, why Deaver’s fervent, sustained opposition to blood counts” (211). . . . The very success of surgeons such as Deaver could support a strong argument for general practitioners to use blood counts to diagnose appendicitis, as a crutch to make up for their lack of clinical experience and skills. . . . The meaning of the blood count as a technology was thus twofold. On the one hand, it was a mark of scientific progress, a technique using microscopes, creating numbers and graphs, and defining the practice of medicine as scientific. On the other hand, it was a crutch, a means to make up for the absence of other, more subtle clinical skills” (217).