This is one of the so called modern diseases, not that it has not existed for a long time, but that not till lately has it been recognized as a distinct ailment. Formerly it fell under the general category of peritonitis or inflammation of the bowels. American physicians have done more toward discovering its characteristics than others. It is an inflammation of the appendix vermiform is, which is situated at the end of the large bowel, in the right flank, close to the junction of the colon with the small bowel (see manakin). This organ is a small, round, tail like body, about the size of a slate pencil, and aver. ages some three inches in. length. It is hollow, lined with mucous membrane, and covered like the bowel proper with a peritoneal membrane. It secretes mucus. Its use is as yet unknown, being thought by many to be a rudimentary organ like the uvula, without function, and possibly analogous to the herbivorous stomach. Whenever small seeds enter the cavity of this organ (which is in reality a rare occurrence) or whenever, from any cause, a catarrhal inflammation is developed in it, the secretion increases, and being confined, aggravates the trouble. This catarrhal inflammation is generally mild and the trouble often subsides either for good or to start up again sooner or later.
The inflammation may, however, become purulent, the germs penetrating the walls of the appendix and causing a general inflammation of the peritoneal coat of the bowel. In these cases nature fights hard to resist the invasion of the germ and throws out a large amount of lymph and serum, which, when it hardens, often acts as a barrier to the further progress of the peritonitis which has begun about the appendix. These cases are characterized by a hard lump in the appendicular region, the inside of which contains pus as a rule, which has escaped from the bursting appendix. Cases of this class are extremely dangerous and require the immediate aid of a surgeon, as they are bound to give trouble sooner or later, even if the first attack does not prove fatal.
There is still a third class of cases, called fulminating, because from the very first they seem to be purulent, and spread rapidly into a general peritonitis, death occurring within a few days from the appearance of the first symptoms. These cases are the most hopeless of all, and must be operated on without the slightest delay, since immediate evacuation of the pus, before a general infection of the abdominal cavity supervenes, is the only possible hope of saving the patient.
Symptoms. The disease, as generally observed, begins with languor and pain in the abdomen, with special soreness on the right side, oftentimes nausea and vomiting, constipation, a slight rise of temperature, and headache. As the disease progresses the tenderness amounts to pain, a bunch may be felt by the medical attendant: the temperature gets a little higher and symptoms of pus formation set in. The case may hang in this initial stage (up to the point of pus formation) for several days and finally subside, it being a more or less catarrhal inflammation; but when pus has once formed the patient cannot escape without an operation for the removal of the offending body. Many surgeons at the present day even take the ground that every inflamed appendix should be removed.
Treatment. The medical treatment consists in giving magnesia in form of the solution of the citrate, with a light diet, and keeping the patient in bed. Poultices may be of some benefit. Opium should not be used unless pain is extreme.
The operation for appendicitis, when performed between the attacks, is a comparatively safe one in competent hands; but it becomes a very grave one if pus forms rapidly and invades the general abdominal cavity. Between these two classes of cases there are all grades of difficulty and danger.
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