SHOTS IN APPENDIX

Southland Times, Issue 19771, 20 February 1923, Page 6

SHOTS IN APPENDIX

DUE TO EATING GAME. TWO CHRISTCHURCH CASES. Although the popular notion that appendicitis is caused by the presence of foreign bodies, such as fruit stones and chips of enamel, in the appendix has long since been disproved, three cases of appendixes filled with shot have been reported within the past six weeks—two of them in Christchurch and the third in Australia, states the Christchurch Sun. The hospital surgeon at Nhill, a small Victorian town, operated on an aboriginal for appendicitis, and found the appendix to be fully loaded with shot, so that it resembled a miniature old-fashioned shot pouch. The aboriginal had been in the habit of shooting and eating game since boyhood, and it was not hard to tell whence the shot had come. The Christchurch cases occurred within about a week of each other in the practice of two leading surgeons. About 600 appendixes are removed every year in Christchurch—approximately two every day, excluding Sundays. At the Christchurch Hospital alone the annual number exceeds 400, and 200 is a moderate estimate for the operations of this class performed in the different private hospitals. A very large quantity of game is eaten by the people of Christchurch, yet no other cases of shotladen appendixes can be recalled by the doctors. The occurrence of three within such a short time is considered a remarkable coincidence.

In one case the number of shot recovered was 17, and in the other it was seven or eight. Some information about the former case was given to a representative of The Sun by the Surgeon, who wishes to remain anonymous. The patient, he said, was suffering from severe chronic digestive trouble, accompanied by jaundice, and it was decided to give him a meal containing bismuth (which is opaque to X-rays) and makes an examination. The photographs, to everybody’s surprise, showed the appendix as an opaque body, perfectly straight, about seven inches in length, and hanging vertically. An operation was performed, and the appendix was removed. It was found to be packed with leaden shot.

A remarkable point, said the doctor, was that all the shot were covered with small depressions, or facets, caused by the force with which the walls of the appendix had pressed them together. The facets were brightly polished, and an examination under a lens showed them to have been made by the pressure of other spherical bodies. It was evident that they had not been made when the shot had been fired. The shot must have been in the appendix for a number of years, and their presence appeared to have caused the whole of the man’s trouble, for since the removal of his appendix his digestion had become almost normal.

Faceting, such as that found upon the shot, was usually to be noticed upon gallstones, which had been believed at one time to be the cause of the man’s condition. The appendix, in the ordinary course of nature, made violent efforts to get rid of the foreign bodies, and in doing so upset the whole system of rhythmical movements by which the digestive organs carried out their work. Evidently the gall-bladder ceased to function properly, with the result that the patient absorbed large quantities of bile, developing the jaundice already mentioned. When the cause of the disturbance had been got rid of. the normal cycle resumed.

Speaking from a wide experience of appendicitis operations, the doctor said that only very rarely was a foreign body found in the appendix. Sometimes a bristle from a tooth brush was discovered, but it was doubtful if the patient s condition was any the worse for that. Appendicitis was caused by the accumulation of fecal matter in the appendix. Generally this matter was found to have become compressed into a hard mass very like a date-stone, but the mass, when cut across, showed itself to be made up of concentric layers, clearly indicating its origin. Its presence in the appendix caused such pressure on the walls of the latter that the tube beyond the obstruction was deprived of normal circulation, and virtually died, making immediate removal necessary. A contributory cause was chronic constipation, which blocked the blind end of the large intestine, and tended to make the products of digestion enter the appendix. Except in such exceedingly rare cases as the three mentioned, foreign bodies had nothing to do with appendicitis