Faecal Abscess. Typhlitis.
At the end of the small intestines above the right groin, just before the large intestines commence, there is an enlargement of the intestine called the cæcum, and running out from this pouch-like enlargement is a small appendage, called the vermiform appendix on account of its worm-like appearance. This appendix has a small canal in a portion of it, with an orifice in the cæcum. The exact use of the vermiform appendix has not yet been definitely agreed upon. By the accumulation of faecal material and rarely of small seeds, etc.[1], in the cæcum, or in the canal of the appendix, or by inflammation extended from other parts, the cæcum and vermiform appendix may become inflamed, causing a condition termed typhlitis. Inflammation of the peritoneum about the cæcum is called perityphlitis, that of the cæcum's connective tissue is known as paratyphlitis, and inflammation of the vermiform appendix is termed appendicitis. The last term being most generally used and representing the most frequent form of the trouble.[1] Causes of appendicitis also include intestinal parasites.
Symptoms. — First of all will be very sharp pain in the region just above the right groin and intense suffering upon pressure or movement. At that point examination will reveal tenseness and soon considerable swelling, beneath which may be found an oval tumor, and the whole abdomen will become enlarged. The patient will be found on the right side with the limbs drawn up to relieve all tension of the muscles of the affected region. Constipation is marked, and the urine is partially suppressed; often there is vomiting of offensive material having a faecal odor, the pulse is wiry and frequent, the countenance distressed and the voice feeble.
If the appendix alone is inflamed, there will be no faecal odor to vomited material and the swelling and tumor will be less pronounced, although the pain will be intense. The danger in these cases lies in the liability of suppuration and perforation into the abdominal cavity. Sometimes there may be suppuration and evacuation outward, or through the bowels, or the suppurative materials may be absorbed.
Treatment. — If the inflammation is caused by accumulations of faeces in the cæcum, large injections of warm water or infusion of spearmint (three or four quarts in amount) should be given, and repeated if necessary until free evacuations are obtained. When inflammation of the appendix exists place over the affected region a large and hot mullein-leaf poultice, containing considerable lobelia herb and sprinkled lightly with ginger; and administer by the mouth teaspoonful doses of an infusion of lady slipper, one teaspoonful, and lobelia, half a teaspoonful, to a cup of boiling water, every half hour. Sustain the strength by broths or malted milk or other liquid foods. Enjoin perfect quietude in bed, and move the bowels by injections, never using cathartics.
The surgical operation for appendicitis is frequently resorted to, but in nearly all cases needlessly; the removal of the vermiform appendix being a fad[2], very remunerative to the surgeon who can persuade others to submit to his desires. Persons who eat heartily after long abstinence or while the intestines are empty after catharsis or otherwise, are especially liable to be attacked by appendicitis.
[2] The removal of an inflamed appendix is still very common due to the risk of peritonitis.