Page:1902 Encyclopædia Britannica - Volume 25 - A-AUS.pdf/551

 APPALACHIAN- -APPENDICITIS he also wrote the spurious Ignatian epistles • he was likewise probably a semi-Arian of the school of Lucian of Antioch. His date is given by Harnack as a.d. 340-360, with a leaning to 340-343; by Lightfoot as the latter half of the 4th century; by Brightman, 370-380; and by Funk as the beginning of the 5th century. The present writer holds to the first-named of these—i.e., 340-360. Authorities.—Uelten. Constitutiones Apostolicae. Suerini, 1853.—Lagarde. Didascalia Apostolorum Syriace. Lips. 1854.— Bunsen. Christianity and Mankind, vi. { = Analecta ante-nicaena ii.) Lond. 1854. An unsatisfactory attempt to reconstruct the original Greek text of the Didascalia by means of the Syriac text and the Apostolical-Constitutions.—Lagarde. Constitntiones Apostolorum. Lips, et Lond. 1862.—J. B. Pitra. Juris Ecclesiastici Graecorum Historia et Monumenta, i. Romae, 1864.—Hauler. Didascaliae Apostolorum Fragmenta Ueronensia Latina. Lipsiae, 1900.—See also Bickell. Geschichte des Kirchenrechts, i. Giessen, 1843.—F. X. Funk. Die apostolischen Konstitutionen. Rottenb. 1891.—Harnack. Geschichte d. altchristl. Litteratur, i. 515 ff. Leipz. 1893.—Brightman. Liturgies Eastern and Western, I. xvii. ff. Oxford, 1896.—Achelis in Hauck, Real-Enkyklopddie, i. 734 f., Art. “Apostolische Konstitutionen und Kanones.” Leipz. 1896. (w. E. Co.) Appalachian Mountains. See America, North. Appendicitis.—In medical nomenclature the termination “itis” is used to signify inflammation, and is arbitrarily tacked on to the end of any word, whether of Greek or Latin origin. On this principle “ appendicitis ” has been coined to designate inflammation connected with that part of the intestine which is known as the “appendix.” There is no reason to suppose that the affection is more common than it used to be ; but it is now better understood and more frequently recognized, and the development of modern abdominal surgery has brought it into prominence. It was formerly included under the term “ perityphlitis”—that is, inflammation connected with the “caecum,” a portion of the large intestine,—and some authorities still prefer that term as more scientifically accurate; but it is now generally recognized that in the vast majority of cases the inflammation begins in the appendix, not in the intestine proper. From the appendix it extends to the surrounding peritoneum and sets up a localized peritonitis, which in the worst cases may become general. The appendix is a narrow tube, normally about the size of a goose quill, and from 1 inch to 5 or 6 inches in length. The average length is 3 inches. It terminates in a blunt point, and from its worm-like shape is called the appendix vermiformis. It is an appendage of the large intestine, into which it opens. It is not known to perform any functions, and is regarded as the degenerate relic, surviving in man and other mammals, of an earlier form of intestine. Owing to its shape, character, and situation the appendix is frequently the seat of morbid changes. They have been observed in one-third of a Large Intestine showing Vermiform number of bodies examined Appendix (u.a.) and C^eccm (c). ,, ,• x n post mortem. Inflammation is set up in various ways. Foreign bodies passing down the intestinal canal may find their way into the appendix and lodge there. This was formerly believed to be the chief cause of mischief; hence the warning, familiar to every child, against the danger of swallowing cherry stones and other small, hard objects. Extended knowledge, how-

503

ever, has shown that such foreign bodies are only present in a small minority of cases. More frequently the tube is found blocked by hardened faeces or undigested particles of food, such as nuts, cheese, fibrous vegetable matter, and other imperfectly masticated substances. Sometimes calcareous concretions are formed round a nucleus furnished by some small body. Inflammation may occur, however, without any of these things. The tube may be twisted or otherwise strangulated, leading to gangrene; or the orifice may be closed in a similar manner, so that the tube becomes greatly distended with mucus, which can find no outlet; or ulceration of tuberculous origin may occur. In all cases inflammation started in the appendix is liable to spread to the surrounding membranes, and herein lies the gravity of the affection. For clinical purposes several varieties of appendicitis may conveniently be distinguished according to the degree and course of the inflammation : (1) simple inflammation, commonly called “ catarrhal ” ; (2) ulcerative ; (3) perforative ; (4) relapsing ; (5) chronic. The symptoms vary accordingly within wide limits, ranging from slight pain and sickness, which pass off in a day or two, to an exceedingly violent illness, which may cause death in a few hours. (1) Simple inflammation. In a well-defined case the onset is sudden. Pain is felt in the belly, low down on the right side (the right iliac fossa), or across the front; it is often described as “ radiating.” There is some fever, the temperature rising to 101° or 102° F., with constipation, nausea, and very likely vomiting. The abdomen is tender to pressure, and the tenderness may be referred to a particular spot. Some swelling may also be made out. The attack lasts for two, three, or four days, and then subsides. There are, however, other cases less well defined, in which the mischief pursues a latent course, producing little more than a vague abdominal uneasiness, until it suddenly advances into a more violent stage. (2) The illness assumes a more acute form, and all the symptoms are more severe. There may be an initial rigor; the temperature rises to 104° or higher, with great prostration, severe pain, and complete loss of appetite. An unpleasant taste in the mouth is often observed; vomiting may persist and become faecal. Abdominal tenderness is more marked and general, and swelling more obvious. The patient lies with legs drawn up, so as to ease pressure on the abdomen and lessen pain. The attack may subside or go on to the suppuration and the formation of an abscess. (3) If the abscess break into the general abdominal cavity, there is sudden and violent pain with collapse. The condition is one of extreme gravity. Death usually follows within fortyeight hours, and recovery is very rare. (4) Some persons are subject to recurrent attacks of appendicitis, and to this variety of the disease the term “ relapsing ” is applied. Such attacks do not differ in character from those previously described. They are no doubt due to some standing condition of the appendix coupled with imperfect performance of the digestive functions, but they only occur at intervals, and between the attacks the patient is well. (5) The chronic form of appendicitis differs from the relapsing in that the patient is never well, but always suffers from more or less uneasiness, which is liable to develop into an acute attack. With regard to treatment it is obvious that, however mild an attack may be, an affection liable to assume such grave forms is not to be trifled with and demands early medical assistance. In the milder cases the measures indicated are rest in bed, hot fomentations or poultices to the abdomen, and opiates to relieve pain and keep the intestine quiet. Leeches over the abdomen give much relief. Food should be hot, fluid, and given in small