APPENDICITIS. The appendix is not uncom monly the seat of processes accompanied by in flammation, perforation, a ml abscess. Attacks of this kind are termed appendicitis. The excit ing causes arc mechanical or chemical irritation and bacteria.
The disease is most common in individuals be tween ten and thirty years of age, though it has been seen in an infant under one year and in patients over seventy. About SO per cent. of the cases occur in males, because of their greater ex posure to weather and injury, and because the female appendix has a greater arterial supply. The disease appears to he more common in the States than in other countries. It is slightly more frequent in summer and autumn than during other seasons. The varieties of this ailment are generally classified as follows: Acute appendicitis, including catarrhal, intestinal, ul cerative, and gangrenous forms; and chronic ap pendicitis. including catarrhal, intestinal, and obliterating forms. In most varieties the ap pendix is larger. longer, and firmer than normal, oedematous and filled with fluid or semifluid secre tion, the lumen opening into the circuit) heing closed. In the interstitial form there is a dense cellular infiltration of the retiform tissue of the mucous membrane, pathologic alterations involv ing also the submucous. muscular, and subserous coats, and dilatation of the blood-vessels existing. Abscesses may develop in the submucous and subserous layers. The lymphoid follicles arc the seat of serous infiltration, and new lymphoid cells develop in small collections, afterwards be coming necrotic. Iu the severer forms the final process is ulcerative, following extensive dis tention and necrosis, and the purulent contents of the appendix fall into the peritoneal cavity, together with final material in many cases. In the chronic forms ulceration does not take place. Attacks may recur during life from time to time and be unrecognized. One-third of all adult bodies reveal diseased appendices at autopsy.
The three principal symptoms of appendicitis are pain, tenderness, and rigidity of the lower part of the abdominal wall on the right side.
The pain resembles that of colic and is generally referred to the neighborhood of the umbilicus, yet it may be felt in any part of the abdomen. A special diagnostic corroborative sign for the physician is at \leIiurney's point, midway between the anterior superior spine of the ilium and the navel. There are also gastrointestinal
disturbances, elevation of temperature, increased rapidity of pulse and of respiration,- vomiting, nausea, hiccup, and either diarrhoea or consti pation. The last-named is usually present after the first. Difficulty in swallowing, chills, cya nosis, profuse perspiration, and distention of the abdomen may occur. The physician can some times find the appendix by palpation. Ulceration and perforation with peritonitis may occur in three mr four days or may occur on the first day upon ?vhich any symptoms have been noticed by the patient. Or ten days to two weeks of mild symptoms may elapse, and the patient may nearly regain his health when a relapse occurs. The interval may lie a half-year or a year and than a recurrence may take place. In the chronic forms the most constant symptom is pain in the right iliac fossil, moderate at times, frequently recurring, and at times of great severity. The danger in these cases lies in the possibility of a sudden acute exacerbation going on to laceration, gangrene, and fatal peritonitis. Various other disorders present similar symptoms and condi tions to those of appendicitis, and it is impos sible for the layman to diagnose it.
The treatment of appendicitis is determined by the fact that it is a surgical affection from the start. Removal of the appendix as early as diagnosis is made is the only conservative, safe, and justifiable treatment. To await the prob able formation of 1)115 is generally to sacrifice the patient. The medical treatment of the case is confined to the periods before and after the operative procedure, and includes attention to diet, local applications, laxatives, rest, and stimu lation. An early use of a laxative in suspected appendicitis is imperative, whether diarrlifert be present or not. Opium should never be given under any circumstances.
It is commonly thought that fruit seeds nat urally gravitate into the intestine. Such is not the ease. Foreign bodies of that sort are ex tremely rare in cases of appendicitis. Fircal con cretions or appendicular calculi are frequently met. Consult :eBurney, "indications for Early Operation for Appendicitis." in Annals of Surgery, xiii. (1891) ; Kelly, "The Pathogenesis of Appendicitis." in Philadelphia Med/cot Journal, iy. ( 1899) Deaver, A Treatise on Appendicitis (Philadelphia, 1900).