_Pathology: _Formerly very little was written about the pathology of
the appendix, the writers describing more the lesions of the cecum
and surrounding structures. After the birth of the surgical craze,
the exciting cause was located, or supposed to be located in the
appendix, and the abnormal condition of the cecum was and is
considered to be secondary or due to the lesions found in the
appendix. The profession must evolve beyond its present tendency to
look for cause in the organ. First understand the general then the
special will be apparent.
The pathology of the appendix has now grown exceedingly voluminous,
and if it were as valuable in quality as it is great in quantity the
necessity for more investigation would be removed.
Appendicitis means inflammation of the appendix. This inflammation
may affect the whole structure or merely a part. Catarrhal
appendicitis affects only the mucous membrane.
The appendix may be gangrened, wholly or in part. At times only the
mucous membrane is gangrenous. The mucous membrane may be ulcerated
and the pus penned in because of a closure of the mouth from
swelling.
Concretions are found in the organ at times. These are evidently
formed inside the appendix, for they arc often too large to enter in
the form in which they are found.
When there is perforation of the appendix the result is peritonitis
according to some authors, and, according to others just as great,
this is disputed I belong to the latter class in belief.
The pathology of appendicitis is necessarily touched upon more or
less in going over the etiology, symptoms, and treatment of the
disease, and variation is the rule, for how could it be otherwise
when subject and environment must always vary?
As soon as an inflammation starts, the first thing that nature does
is in the line of enforcing the _first law of cure, _namely: _rest.
_To bring this about the musculature is set, rigidly contracted,
thus fixing the parts. The contraction, of course, will be in
keeping with the irritation of the parts; great pain means great
rigidity, and _vice versa. _This being true, the harm that must come
from keeping the stomach and bowels irritated by giving drugs and
food should be plain to any mind capable of reasoning and willing to
think.
The more food given the more gas, pain and rigidity, and the more
rigidity the more complete the obstruction, and the more complete
the obstruction the more retention of gas. I need not enumerate the
evils due to gas distention, for they should be apparent.
If the obstruction caused by the swelling incidental to the
hyperemia and inflammation is not already complete, the fixing or
muscular rigidity completes it. After the obstruction is complete,
if there is diarrhea, which is frequently one of the first symptoms,
it comes from below the cut-off.
The inflammation of the cecum and appendix is similar to
inflammations elsewhere; the capillary blood vessels become
engorged, the circulation becomes sluggish, and this causes
swelling; the tissues then grow dark from the congestion. This
condition is similar to tumefaction in general. which is favorable
to abscess formation.
When the local irritation and inflammation start with enough impetus
to evolve an abscess the parts become fixed, as stated above, and
the environing structures assume an attitude of alligated defense.
There is a drawing together of neighboring tissue; the momentum,
which should be recognized as the brood mother and care-taker of
everything vital in the abdominal cavity, joins with contiguous
structures and all become welded together by a friendly adhesive
inflammation. When this defense is complete the abscess is walled in
so completely and with such thoroughness that all possibility of
intraperitoneal rupture rests with the blundering, heavy-handed,
trouble-hunting profession; and if nature _ever fails to complete
the building of this wall of defense it will be because she has been
interfered with by officious meddling in the name of scientific
healing._
There is no question but that many of these patients are seriously
handicapped and others positively killed by unskillful, overzealous,
superfluous examinations. A heavy-handed attendant should never be
allowed to manipulate swellings in the right iliac fossa, nor in any
other suspected region, for fear of destroying nature's defenses,
and possibly rupturing an abscess, the contents of which will be
emptied into the peritoneal cavity, causing peritonitis and death.
Seeds are seldom found in the appendix and the fear of swallowing
them because they may lodge in it is not well founded. There is no
question but that this organ has the power, when normal, of taking
care of itself. It has a peristaltic action and can expel anything
that is capable of gaining entrance.