WHAT IS APPENDICITIS? Appendicitis, inflammation of the appendix, more properly known as the vermiform appendix, a fingershaped sac three to six inches long which projects from the large bowel, in the lower right quarter of the abdomen. Infection and inflammation of the appendix are potentially serious because the infection may spread to the peritoneum, the membranous tissue which lines the abdomen. Acute peritonitis, or inflammation of the peritoneum, is a grave development and may be fatal unless treated promptly. Peritonitis may result from appendicitis in at least two ways. The peritoneum is shaped to fit over the appendix, just as a glove covers a finger, and is thus in close contact with it. Accordingly infection of the appendix may spread to the Peritoneum simply by contact. Moreover, if an inflamed appendix is left untreated, it may rupture or develop gangrene. In either case, masses of infected matter will be discharged into the peritoneal cavity. These possibilities demand that the condition be accorded immediate attention by a physician. Delay often unnecessarily permits the development of complications, renders treatment more difficult, and may possibly endanger life. Attempts to diagnose and treat the symptoms of appendicitis without a physician, by ascribing the symptoms to a gastrointestinal disturbance and administering a cathartic or laxative, may have serious consequences. Abdominal pain should never be treated with a cathartic or laxative without the cause of the pain being first established. Appendicitis usually begins with a sick feeling, accompanied by nausea, lack of appetite, and at first a rather diffuse abdominal soreness. Vomiting may occur, and a rise in temperature is likely. Gradually the pain tends to concentrate on the right side of the abdomen below the navel and the muscles in that region tighten when pressed in examination. Symptoms indicative of appendicitis can actually arise from nothing more serious than accumulation of gas or solid matter in a part of the bowel. However, ordinarily these symptoms disappear with elimination from the bowel. If they persist, the doctor should be promptly consulted. He will determine whether or not appendicitis has actually occurred. Examination of the blood will usually show abnormal numbers of white cells if the appendix is infected. Diagnosis is not always easy because of the variety of difficulties which may manifest similar symptoms. This is especially true of the resemblance between the early stages of appendicitis and, in some cases, of early pneumonia. In early pneumonia, inflammation in the lower lungs may spread to the diaphragm, the large breathing muscle which walls off the chest and abdominal cavities from each other. Pain is present in the same part of the abdomen as in appendicitis, and is also accompanied by rigidity on touch. Because of the danger presented by an inflamed appendix, surgery is a common and satisfactory means of eliminating the condition. Appendectomy is so completely standardized that recovery will usually be normal, if the operation takes place before the appendix ruptures. If the appendix has ruptured, or has become gangrenous, however, the situation is much more serious. Ordinarily, in a simple appendectomy, the patient will be up in two or three days, and sent home from the hospital in a week. When complications occur, the condition demands different considerations and may involve much more time. Fortunately the antibiotic drugs such as penicillin, terramycin, aureomycin, and others control peritonitis so that death from this complication is now rare. The precise way in which appendicitis develops is not fully understood. Doctors once believed that it was the result of food lodging in the appendix. Many appendices removed and examined were found to contain a variety of unexpected objects and materials, such as stones, hair, seeds, pins, bones, lead shot, and sometimes worms. Many other appendices, however, did not contain anything foreign. It is now felt that inflammation and infection are commonly caused by germs. The structure of the appendix, with its long slender tube, narrow opening at one end only, and lining of lymphatic tissue, makes it susceptible to inflammatory swelling and the resulting closure. The organ then cannot empty its contents. An abscess forms, the swelling increases, and the accumulating infected and lymphatic matter within the tube cannot escape. The appendix may then burst or become gangrenous. Gangrene is the atrophy of the tissues locally affected. Sudden relief after a period of pain should be considered a potential danger signal rather than a sign of improvement, for it may signify that perforation has occurred or that gangrene has begun.