Waterbury evening Democrat., 1895-03-04

Ill AilC tttl N tiS iloG CNOlN Ollb Ol CA- i>tenCo and in ccasiug to bo useful it be- samo very troublesome In surviving its function q portion of the intestinal S2nal it became q menace to health and n constant source of danger. The dangor was also much increased by the circum- stance that tho symptoms accompanying disorders of the appendix would direct tho attention of tho physician and patient to other portions uf tho body rather than to the seat of tho trouble. In this disease tho pain is usually felt in tho noighborhood If tho umhilicuS, next in frequency is Iumrlainrd of in the cpigastrium, very in- lrrlUrntly in tho region below the um- 'lliruS, and least often of all is it felt in the appendix itself This circumstance has hrcn responsible for many errors which have been mado in determining the character aNd location of tho trouble.
 The intiaInluHtOry lCSiOnS of tho appen- dix were formerly cnmprehendcd under the terms typhlitis, pcrityphlitiS and para tYphlitis Tho first was defined by Albcrs as inflammation of the Ciecum itsolf, the sccuud as inflammation of the parts inn mediatrly surrounding tho crcum and tho third as inflammation of the postpcritoncaI tissue of the Cocum. Grisollo understood | the true pathology of the disease and pub | lishCd his views in 1889, but those of Al bUrs got into tho medical textbooks, and | tho correct view was disrcgarded for over half century until brought to light and verified by Dr. Fitz of Boston and Dr. McBurncy of Now York.
 Acute appendicitis is characterized from | the outset by soVoro abdominal pain. Co | incidCntly with the attack of pain or soon | after it begins nausea and vomiting ire quently occur. In cases where these arc produced by indigestion and intestinal | collie the nausea is moro apt to prcCcdo the pain than tu follow il, as in appendicitis. l The sudden occurrence of sharp, coliCky l pains should always dir,ct the attention of the suirvr,r and Jho physician to tha | appendix NcrmiIoCmiS, and watchful l carr should la kept over this troaCheruus organ, As sonn as the diagnosis of prOgrcss- | i've appendicitis Is assured the abdominal cavity should be opened and the appendix | rcmOvcd. To operate too early may bo to | operate unnecessarily, but it is better to do so than to operate too late and hence | unsuccv~sfully NunO but surgeons of re- 1 putr and uf assured skill should bc cnl- ployed to operate, for, though to remove | the appendix iS not fraught with great | danger when the operator is skillful, 1t may well become sowhcn tho surgeon en- pluycd tluv,s not understand his business properly,
 | Peculiarities of the Trouble. l MlIu cases or hpptnulSlllS may FICOVSE without surgical treatment, but quito of ten mild casus develop into acute and are of course much more difficult to euro than if operated upon hoforD the trouble became l intvnSiird in its character. Tho disease may purSuo a rapid cuurso in somo cases 1 "a q fatal termination in S6 hours from the beginning uf the attack. In casos which have byrn successfully operated upon con vulrSccncr will usually occupy about thrco weeks.
 | Appendicitis Is much moro frequent among men than women, though tho con trAry is generally held to be tho casc. Tho reason that women arc less liable to tho diS,,asy is probably owing to the fact that in them the appendix has an additional source of blood supply in the artery of the l RppCndicular ovarian liEamunt and Is in consequence l1'tter prepared to resist in- lection than the less libcrally supplied ap- peudiN of the male
 In former times appendicitis was sup | posed to bc caused hy tho presence within the V,rmifUrn appendix of cherry stoncs
 grape s,,ds, lemon and orange pits, date | stones, fish honcS pins, etc. So firmly was | this idea fixed in the lay and professional
 minds that children were carefully watch
 cd while eating fruit to prevent them i from swallowing a stone seed which would lodge in this ''dCathtrap," as the
 appendix was popularly called, and pro ducc what was at that time regarded as
 an almost necessarily fatal malady. The
 same fallacy is still very prevalent among
 nonmCdical people, and to assign such an
 origin tn tho disease is much moro com
 mon than to attribute it to its real causes. No doubt tho presence of such foreign sub
 stances in tho appendix might cause trou-
 blu thcrC aS they would in other parts oi
 the intestinal canal where they found lodgnont and could not be expelled. The instances i'll which appendicitis has been
 induced by such Judgments in the appen- dix have been so raro that they may be with
 safety excluded in any consideration oi : the trouble. Another view-that the pain . in the appendix Is produced by an attempt !. 1 on the part of the appendix to rid itsel
 Of fccal mattcr-is proved to be wrong by
 the fact that fccal matter and even copro l liths have been found in the organ wheI there was no pain or trouble with the ap j, pcndix at all.
 4 Home For Microbes.
 The generally received opinion now i 5 that appendicitis is caused by micro or
 ganisms which are conveyed into the ap ), pondix by fecal matter or otherwise
 These organisms may be and probably ar }, the same as those usually found in the in
 testinal canal, where their being presen }. Is not regarded as source of danger
 When they enter the appendix, however tt Is supposed to be altogether different
 as the lower resisting power of the orgal makes 1t peculiarly subject to infection.
 Among the evolutionary changes talk , ing place in the appendix and tending t B its ultimate disappearance may bo altera
 tiQns in the character of its epithelpl lin '' ing, which distinguishes it from the lin
 ing of the csecum and render it liable t |. bacterial infection. So far as the tissues O - the appendix are concerned, n progressive
 Iy lowered vital resisting power would b
 the first and most obvious change, result
 ing from the disusags of the organ an
 its downward tendency toward final elimi
 nation from the body as useless append
 age.
 Tho conclusion is now regarded by med
 ical men ns being almost irresistible tha
 infection is not only the principal an
 necessary cause of appendicitis, but tha
 1t is also the primary cause. Some infeS , tious material enters the appendix an y becomes fixed there, owing to the very ir
 efficient expulsive power possessed by th
 part. The low vitality and weak resistin = power possessed by the organ constitut 10 it a good field for propagating bacteria an
 developing those conditions constitutin w the disease of appendicitis.
 Not a New Trouble.
 e'l ElssRsss of tha anpendix asArrnhahi