The appendix does not, unfortunately, hang out from the surface of the
body, where it could peacefully decay and drop off without prejudice to
the rest of the body, or be quickly lopped off in the event of its
giving trouble. On the contrary, it projects its stubby and
insignificant length right into the midst of the most delicate and
susceptible cavity of the body, the general cavity of the abdomen, or
peritoneum. The thin, sensitive sheet of peritoneum which lines this
cavity covers every fold and part of the food-tube, from the stomach
down to the rectum. And when once infection or inflammation has occurred
at any point in it, there is nothing to prevent its spreading like a
prairie fire, all over the entire abdominal cavity from diaphragm to
pelvis. If this wretched little remnant were a coil of explosive fuse
within the brain-cavity itself, which any jar might set off, it could
hardly be richer in possibilities of danger.
A redeeming feature of appendicitis is that the appendix lies--so to
speak--in a corner, or wide-mouthed pouch, of the great peritoneal
cavity; and if the inflammation set up in it can be "walled off" from
the rest of the peritoneal cavity, and limited strictly to this little
corner or pouch, all will be well. This is what occurs in those cases of
severe appendicitis which spontaneously recover. If, however, this
disturbance bursts its barriers, and lights up an inflammation of the
entire peritoneal cavity, then the result is likely to be a fatal one.
Just how far nature can be trusted in each particular case to limit and
stamp out the process in this manner is the core of the problem that
confronts us, as attending physicians.
In the majority of cases, fortunately, the peritoneal fire brigade acts
promptly, pours out a wall of exudate, and locks up the appendix in a
living prison, to fight out its own battles and sink or swim by itself.
But unfortunately, in a minority of cases, by a wretched sort of
"senatorial courtesy" which exists in the body, the appendix is given
its ancestral or traditional rights and allowed to inflict its petty
troubles upon the entire abdominal cavity, and include the body in its
downfall.
Lastly come the two most pertinent and appealing questions:--
What is the outlook for me if I should develop appendicitis? And what is
to be done?
Public-domain text, read in full here on John Shaqi.
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