The Norfolk weekly news-journal., 1909-07-16
A SMALL BLIND TUBE
The vermlform Appendix and Its
Probable Function.
PROBLEM OF APPENDICITIS.

Appendicitis Is not a disease OF mod
ern times, though its nature and meth
DDS Of treatment are the result of
careful observation by one Of our well
known modern surgeons while engaged
In postmortem work.
1t may be safe to say that append
citis Is as old as mankind, for In
studying very old histories wherein
are given the diagnoses OF the physi-
clans we read OF cases OF inflammn-
ton Of the bowels. intestinal disorders
and like ailments the symptoms of
which prove that they must have been
appendicitis.
Appendicitis Is Inflammation OF the
vermiform appendix, small blind
tube, averaging two and half inches
In length and a quarter Of an inch In
diameter, attached to the coecum at
its inner and posterior part It Is
made Of very sensitive mucous mem
brane containing several glands.
The appendix is part of the digestive
tract, its function, 1t Is believed. being
to lubricate that part OF the intestines.
though as yet there is no absolute
proof Of this. Careful study Of child
from whom the colon has been re-
moved until he reaches the age Of
ties Of any nature.
The causes Of this disease may be
grouped under four heads-etenosis,
which means closing up: impaction,
the entrance of foreign bodies. not nee.
essarily seeds; exposure and injury.
In fighting this disease nature takes
three methods Of dlsposing Of the toxic
NEUTRALITY-SUSPICIOUS. them into the
peritoneal cavity, sending them into
the bowels and discharging them
through an external wound. In the
first, If the discharge be not too rapid
while the peritoneum is taking them
up, nature again makes an effort to
ward off the threatened danger by
walling the poisonous matters In. thus
locallzing them and so aiding the ply
sician or surgeon In his work. II.
however. the discharge be sudden, as
Is the case when the mass bursts, the
whole Of the peritoneum becomes in
volved, which Is called septic perito-
nitis, and this is generally fatal.
After the diagnosis has revealed the
disease the doctor decides whether the
case be one for medicine or external
treatment or for separation In the
latter case the greatest Of care Is de-
handed, as sometimes an immediate
operation is necessary. while at other
times 1t must be delayed. often for
hours, until the condition Of the pa
tent has been brought to that point at
which the surgeon can feel 1t Is safe tn
so ahead.
The operation determined upon, the
most careful arrangements to secure
perfect antisepsis are made, and the
patient Is placed in a full state Of an
aesthesia.
The operating surgeon then draws
an imaginary line from the navel to
the anterior superior spine of the right
hip bone, dividing that line into three
parts. Under the inner side Of the
middle third the appendix in normal
cases will be found, though in rare
cases it has been found on the left side
and In extremely rare cases otherwise
displaced.
Having satisfied himself Of the exact
spot under which it will be found, an
incision from two to FIVE inches long
Is made in the skin. (Some Of the best |
surgeons pride themselves on the |
Of their incisions in this op-
eration) The fatty tissues are then |
cut through, the small blood vessels |
are secured, and then the muscular /
walls Of the abdomen are separated,
bringing into view the peritoneum.
This is a Serious secretive lining COM
posed OF two layers. On cutting
through this the edges OF both layers
are clamped so as to enable the sur
geon to reunite them when the opera
ton shall have been completed.
The intestines are now visible, and
the affected section Is very tenderly
drawn through the opening. where the
nature and extent Of the infection are
made known. Hot towels moistened
with salt water are kept applied to the
while 1t is exposed. The
word ''tenderiy'' characterizes the
whole Of this operation, as the surgeon
must be more than careful to prevent
any rupture Of the appendix. for should
this happen while he is operating the
pus would be quickly taken up by the
and other mucous mem
branes, and the resulting complications
would make the outcome very uncer-
tain.
The mesentery, large vessel ad1Utn-
Ing the appendix, Is next ligated, and
then the colon Is tied OF. after which
the diseased organ Is cut away. Tho
stump Is pushed back into the intes-
tine and the ligature Is tightly drawn,
this to prevent the forming Of pouch
The removal safely accomplished.
the intestine is replaced, the edges OF
the peritoneum are carefully approx
mated and the muscular walls. fatty
tissue and skin are brought together
by subcutaneous and cutaneous So
lures.
In the majority OF cases, no COM
plications ensuing, the patient Is ready
For discharge IN two weeks.-Jpmes NJ.
Smyth, NJ. D.. In New York World.