R. S. INGERSOLL, M. D by R. S. Ingersoll

Review and Herald Publishing Association · Washington, D. C. · Apr 13, 1911

R. S. INGERSOLL, M. D

By R. S. Ingersoll

Appendicitis

R. S. INGERSOLL, M. D

A LITTLE more than a score of years ago this disease was practically unrecognized. The disorder existed, but it was left to a later time to be studied and properly labeled. To-day, when a man has pains in his abdomen, they are not all monotonously denominated by a single term.

But there is more to the study of this affection than merely giving it a name. There is a practical importance in understanding its nature, so that we can to a certain extent guard against it.

The word appendicitis means an inflammation of the vermiform appendix, which is a blind pouch opening into the head of the large bowel, called the cæcum. The small intestine enters the large not at the very end, but about two and one-half inches above, and this portion below is the cæcum. To this the troublesome appendix is attached as a small, finger-like projection. From the head of the colon, situated in the lower part of the right side of the abdomen, the course of the bowel is up toward the liver, then across, and down on the left side. These three parts are called the ascending, transverse, and descending portions of the colon. When the contents of the small intestine are carried into the colon, there would be a tendency to accumulate matter in this pouch, or cæcum, were there no force to lift it up and carry it on.

This is a wise provision of the Creator, and is so arranged for a definite purpose. As the food passes through the small intestine, the process of digestion is being carried on, and it is thus prepared for absorption. By the mechanism above described, the progress of the intestinal contents is slowed; and thus the more complete absorption of the nutritive material is facilitated.

If all goes well, the intestinal contents are passed on without producing any trouble. But if from any cause they remain in this absorption chamber too long, the watery portion is absorbed; the dry material remaining is handled by the bowel with difficulty; and finally it acts as a foreign body, and irritates the delicate lining membrane. Thus is begun a mild inflammation, which readily extends to the appendix.

When in a healthy condition, the appendix can expel its contents by muscular contractions; but when its vitality is lowered by repeated irritation or inflammation, it is not able properly to force along even normal intestinal contents. When to these is added the embarrassment of dealing with hard, dry, and irritating substances, it gives up the task; and the particles remain within its lumen, soon causing ulceration of the surface against which they lie. The way is now open for the entrance of the germs which inhabit the intestine, but

under ordinary conditions do no harm. They set up active inflammation, and produce poisons which are absorbed into the circulation, causing fever. The sufferer has severe pain, with vomiting, and we say he has appendicitis.

Fortunately, in the majority of cases, by the combined action of the muscles of bowels, stomach, and even abdomen, the irritating material is removed, the ulcer heals, and the attack is over.

But this is not always the end of the trouble. When tissues of the body have been damaged by ulceration, the repair material is quite different from the normal. It contracts more or less, and produces deformity just as it does after a burn on the surface of the body. So if the ulcer in the appendix has been close to the bowel, there is a contraction of its lumen after healing; and if material accumulates even in small amounts, it is very difficult for it to be forced out. Repeated irritation, lowered resistance, new offending material in position, cause other attacks probably more serious than the first. This may go on even to the formation of an abscess, and then the pus must be removed. This sometimes occurs by rupturing into the bowel; but often surgical interference is necessary.

How to Guard Against Appendicitis

From the foregoing it is obvious that we must—

Avoid irritation of the sensitive mucous membrane by irritating foods.
Keep the bowels active.
Use every means possible to keep up the general tone of the entire digestive system.

We should of course avoid condiments, indigestible foods of all kinds, and especially anything cooked in grease. Rich pastries cause torpidity of the bowel.

On the other hand, the bowels may be kept active by the use of whole-wheat bread and biscuits, thoroughly cooked porridge, or prepared cereal food, as flakes, which, after the digestible portion is absorbed, leave a residue acting as a healthy stimulus to the muscular action of the intestine. Plenty of fruit also may be used; but acid fruits should not be taken with coarse vegetables, as the combination may cause acidity of the stomach. Acid fruits are best eaten with cereal foods only.

If the above precautions do not secure regular daily action of the bowels, one might make one meal of the day entirely of fruit,—apples, pears, etc. Either the morning or the evening meal may be of this nature, preferably the latter. A glass of cold water taken early in the morning before breakfast is also helpful.

As to means of a general nature, regular, systematic exercise is of great value to those who lead a sedentary life. Various exercises help to strengthen the abdominal muscles, affecting those of the intestinal wall also. Again, all exercise should be taken in the open air. If this is impracticable, let the windows and doors be opened wide, so as to get the benefit of the outside air.

Suggestions as to Treatment

Severe pains in the abdomen, associated with vomiting and fever, always suggest conditions which should influence the sufferer to call a competent physician without delay, as in these cases early attention often means the saving of life.

For the relief of the pain there is nothing of a simple nature better than the use of hot fomentations, applied frequently over the painful part. These may be used with perfect safety at any time during the illness. Take a flannel cloth, fold it to the desired shape, wring out of boiling water, and spread over two thicknesses of dry flannel upon the abdomen of the patient, a little more to the right side than the left. The fomentation should be covered with a dry flannel, and allowed to remain three or four minutes, when it should be reheated and again applied. Repeat the treatment three times. When the flannels are removed, the skin should be cooled for a moment by rubbing lightly with the hand, or a cloth, first dipping in cold water. Then dry thoroughly with a coarse towel.

By means of rest, liquid diet, and the use of the enema, and by vigorous fomentations in the early stages of the disease, the necessity for an operation may be avoided.

Takoma Park, D. C.