HEALTH COLUMN.

Otago Witness, Issue 3112, 5 November 1913, Page 68

HEALTH COLUMN.

Appendicitis. Although inflammation of the appendix had been described by a. number of observers during the last century, it was not until 1836 that the importance and frequency of this condition began to bo appreciated. It was in that year that a Boston doctor prepared his classical paper on the subject. —Causes.— The appendix is a vestige of what was a largo and important portion of the alimentary canal in our early evolutionary ancestry, and, like most vestiges of this character, its tissues are possessed of less vital resistance than are those of active organs. Th's is the first reason why severe inflammatory processes so often arise in it. Again, the appendix is a sac the neck of which is usually narrower than the rest of its cavity, and as a consequence it happens that, infecting germs find their way. into it, and when imprisoned there by swelling of the lining membrane rapidly attack and destroy that lining and migrate into its walls. As is well known, nothing is more favourable for the growth of .germs than the presence of warmth, moisture, and a condition in which drainage is impossible. Nothing is loss favourable to the vital resistance of a part than swelling, with pressure upon the blood vessels and lymphatic channels. Finally, the fact that the appendix lies near, or on, a certain muscle called the ilco-psoas, aids in provoking appendicular irritation, and this is probably one of the reasons why appendicitis so often follows violent rowing, golfing, and bicycling. Among the causes which exist in the appendix itself is the presence of faecal concretions, and rarely foreign bodies, of which a multitude have been recovered, such as pins, tacks, seeds, and other objects accidentally swallowed. Occasionally intestinal worms and other parasites have been found.

—Contributory Causes.— Errors in diet may be a productive factor, for in a certain number of cases of the disease there is a history that the patient has, a few hours before the attack or immediately before it, eaten heartily of ordinary or indigestible food. The ago of the patient is undoubtedly an important factor in the development of the malady. Although it is met with in young children and in old persons that ■ is, after 60 years of age—appendicitis is certainly very much more rare at these periods of life than in the interval. For this there is no adequate explanation. The period of greatest frequency is from 15 to 30 years, and some maintain that more than half the cases occur before the twentieth year. Another predisposing factor is sex. About six times as many men as women have appendicitis. This is in part duo not only to creator physical activity, but to the more frequent causes of intestinal catarrh in males. The disease is more frequent among the well-to-do than in the poorer classes’, although it might ho supposed that the greater muscular exertion in the latter class would predispose its members to the malady. —Symptoms.—

The most constant symptom is the presence of pain in the abdomen. The pain may I>e diffuse, or at least the patient nyay not bo able to localise it. Not rarely, if tire patient is asked to localise it, ho will generally describe it as being in the pit of the stomach. If this is pressed upon the pain may be, increased. In some caeca the pain is referred to the left side of the lower abdomen, and it is only when pressure is applied to the corresponding right area that the patient appreciates that that is the real centre of his suffering, and by manifestations of unquestionable character shows that the source of pain has boon discovered.

The pain of appendicitis is usually severe and sharp, and in some cases agonising. It is usually sudden in onset, and for this reason it may be confused at first with renal or gallstone colic. Occasionally cases are met with in which the pain is loss .spasmodic and more dull in character, but they are the exception. Next to pain, the mosi important symptom in appendicitis is rigidity or fixation of the muscle which overlies the appendix. This is a sign of great reliability, and its degree often measures the severity of the inflammatory process. Vomiting is very commonly present in these cases. In some of them it occurs so early as to seem to usher in the attack. This is particularly apt to l>e the ease if the stomach has been overloaded with food just before the attack. If the stomach is empty at the time of onset, vomiting is often absent.

The temperature in a case of this disease is rarely very high. It varies from 99deg to lOldeg, and occasionally reaches 102 deg in adults. In children it may be higher. The pulse is quick, but not very rapid, unless serious abdominal disturbance has already developed. It ranges from 90 to 110 per minute. If it goes higher than this general peritonitis is probably present. Distension of the abdomen with gas is usually a late symptom, indicative of the same complication, and generally a grave symptom. —Prognosis.— This depends largely upon the severity of the condition. A scries of mild catarrhal cases will give a recovery percentage of 100; whereas a series of severe gangrenous cases will give a mortality of 100. The prognosis in an ordinary attack of appendicitis is good for recovery from that attack. but a recurrence is likely. _ In the gangrenous type the prognosis is always grave, and often fatal. Much depends upon prompt surgical interference. It this is delayed, death is the result in the majority of cases of this type. Taking all the cases of all types, wo find that the percentage of mortality is only alxnit 15 per cent, under , medical treatment. Treatment.— Tliore is perhaps no more difficult point for decision in medical practice than that as to tha treatment of appendicitis. The

two questions to be decided are —“ Is it a real case of appendicitis, and, if so, when should the surgeon operate?” Some are strongly in favour of immediate operation; others are equally in favour of the interval operation. It has been shown that when the operation h performed within 48 hours 83 per cent, recover, whereas if left to the ninth or tenth days only a third of the patients recover. It is necessary to warn patients w’ho have had rec irrent appendicitis not to expect perfect comfort by operation, for not rarely, while they recover from the operation, they continue to have tenderness and pain in the right groin for years.