APPENDICITIS (from Latin, appen dere, to hang on; and itis, inflammation).
Definition. — An inflammation of the vermiform appendix, frequently compli cated with ulceration and perforation of its coats, caused by microbic infection, which may originate from irritation pro duced by hardened fmcal masses, foreign bodies, or traumatism.
Symptoms. — Whether catarrhal or ulcerative, the attack presents itself usu ally in a previously healthy person and begins with sudden intense pain in the right iliac fossa, frequently localized at a spot one and one-half to two inches from the anterior superior spine of the ileum toward the umbilicus (McBurney's point), and increased by pressure. This is the most important diagnostic sign when associated with the other symp toms. The pain may radiate from this point toward the umbilicus, the epigas trium, the groin, and the testicles, and be attended by exacerbations. It may be felt in other parts, especially the epigastrium and the umbilicus, and may even be located in the left iliac fossa.
One of the most significant symptoms of inflammation of the appendix, as distinguished from other pathological conditions that may develop in the right iliac fossa, is undoubtedly the tender ness over McBurney's point. Too often it is assumed by the practitioner that there must be spontaneous pain in the right iliac fossa whenever acute ap pendicitis develops. It is perfectly pos sible, however, for an active inflamma tion of the appendix to be dangerously progressive without the slightest pain in this region, or with only some pass ing discomfort on movement. Yet a touch over the point midway between the anterior superior spine and the um bilicus may reveal the existence of ex quisite tenderness. This is the signifi cant value of the diagnostic symptom discovered by the New York surgeon, and the real reason why McBurney's point has attracted the attention of the medical world. Editorial (Jour. Amer. Med. Assoc., Aug. 16, 1902).
Nausea and vomiting are present in the majority of cases, but it does not furnish any information as to the seri ousness of the case.
Vomiting present in 203 out of a series of 306 cases; it bodes neither good nor ill. Hood (Lancet, Sept. 18, '97).
Fulminating appendicitis observed in three cases. In each case there was a premonitory stage lasting a few hours, during which the patient experienced abdominal malaise. The acute symp toms which somewhat subsided after several hours, followed in twenty-four hours by violent and sudden increase of all symptoms. A few hours later pus, with a perforated and non-adherent appendix, was found. Gauze was used for drainage in preference to a tube. The three cases recovered. Richardson (Lancet, Mar. 23, 1901).
The pulse is usually high, but the tem perature-chart shows but little, if any, rise.
The most important point to bear in mind in the diagnosis of appendicitis is the fact that the temperature of the patient is a matter of no consequence as giving any clue to the condition of the appendix. R. T. Morris (Med. Rec ord, Dec. 26, 'K.
Anorexia and digestive disorders are rarely absent. Diarrhoea and constipa tion alternate, but either symptom may be a prominent one during the entire course of the attack.
Rigidity of the right abdominal wall is generally present, but circumscribed rigidity over the region of the appendix is present in about one-half of the cases.
Circumscribed muscle-tension was ob served one hundred and twenty times in three hundred cases. Shrady (N. Y. Med. Record, June 6, '94).
If the case be one of simple catarrhal appendicitis, the above symptoms con tinue two or three days and the patient gradually recovers.
Leucocytosis has recently been sug gested as an important sign.
Method of differential diagnosis more accurate than the ordinary clinical meth ods available, viz.: examination of the blood. In appendicitis with pus-forma tion there exists a typical abscess, and in abscess-formation there is an increase in the number of leucoeytes, the increase be ing proportionate to the amount of pus formation. If there is no leucocytosis, the ease is either not one of appendicitis or one of the catarrhal form, and ex tremely mild, or very severe and gan grenous, the patient being in a moribund condition. This means of diagnosis and prognosis should be given a trial. H. Stuart MacLean (Virginia Med. Semi monthly, Sept. 22, '99).