APPENDICITIS, inflammation of that part of the in testine known as the "appendix." It has no single cause. Fre quently its origin is quite obscure, but the starting point may be the impaction of a pin, shot-corn, tooth-brush bristle, or a fish bone in the appendix. In many cases a patch of mortification with perforation of the appendix is caused by the presence of a hard faecal concretion, or "stercolith," which from its size, shape and appearance has been mistaken by a casual observer for a date-stone or cherry-stone. The condition is more often met with in the young than the old, and in boys rather than girls; and in some fam ilies there is a strange predisposition towards it. Inflammation started in the appendix is liable to spread to the peri toneum, and herein lie the gravity of the affection and the indication for treat ment. The symptoms vary from "indi gestion," and slight pain and sickness, which pass off in a few short days, to an exceedingly violent illness, which may cause death in a few hours. Pain is usually first felt in the belly, low down on the right side or across the region of the navel ; sometimes, however, it is diffuse, and at other times it is scarcely complained of. There is some fever, the temperature rising to 1010 or F., with nausea, and very likely with vomit ing. The abdomen is tender to pressure, and the tenderness may be referred to the spot mentioned above. Some swell ing may also be made out in that region. The attack may last for two, three or four days, and then subside. There are, however, other cases less well defined, in which the mischief pursues a latent course, producing little more than a vague abdominal un easiness, until it suddenly advances into a violent stage. In some chronic cases the trouble continues, on and off, for months or even for years.
Many valuable lives are needlessly lost from appendicitis every year, chiefly due to ignorance and delay in diagnosis and treat ment. The significance of abdominal pain, especially in children, is not sufficiently recognized by the public. Time is wasted on purgatives and sedatives, both of which do much harm, for the former precipitate perforation and hasten the spread of the dis ease ; and the latter, by relieving pain, mask the symptoms and often lead to fatal delay in treatment. No one can tell whether an attack is going to subside under medical treatment or proceed with great rapidity to a fatal issue. The risk of immediate opera tion is practically negligible, whereas that of waiting is great and uncertain. The experience of surgeons all over the world shows that there is practically no mortality from operations for appen dicitis undertaken within 12 or even 24 hours of the onset of the attack, whereas the death-rate for operations delayed until the third or fourth day is about I o%.
Palliative symptoms suggestive of acute appendicitis develop it is of vital importance to put the patient to bed and give him nothing but water until the diagnosis has been made and an operation can be performed. When, for some reason, an operation cannot be performed, complete rest and careful diet must be continued until the attack has subsided. Only liquids are given by the mouth, and purgatives and sedatives are entirely avoided ; but local sedatives may be applied to the ab domen.
is a common mistake that the patient needs elaborate preparation for an operation for appendicitis, but f or tunately this is not the case, and the rapid progress of an acute attack will not allow of it. A valvular incision, which should leave no weakness of the abdominal wall, is made over the site of the appendix; the latter is removed and the wound completely closed except in late cases, when abscess or peritonitis has de veloped, in which temporary drainage may be necessary. In very late grave cases with abscess formation, the surgeon has some times to be content with mere drainage, deferring the removal of the appendix to a later date. Appendicitis usually recurs with increasing frequency and severity, therefore it is generally agreed that when an attack has subsided it is wise to remove the appendix soon, in a quiet interval, in order to prevent the recurrence of a grave or fatal attack. It is, however, a foolish policy to defer operation when an opportunity offers of having it performed early in an attack.