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.

CHAPTER V

Symptoms:  An acute attack is ushered in with severe pain.  At first this is felt over the entire abdomen, but it is more marked near the navel than elsewhere.  After about twenty-four hours it becomes localized in the region of the cecum.

The pain is colicky or spasmodic in character, showing that it is due to peristalsis; food of any kind increases the peristalsis; hence the pain becomes more severe after feeding.  Do not make the mistake of thinking that liquid food, such as milk, can be given, for a teaspoonful is sometimes sufficient to make the patient miserable for a whole day.

The abdomen is tender, especially over the cecum, and should therefore be manipulated as little as possible, for it causes the patient unnecessary pain, and if an abscess has formed there is danger of breaking the walls which nature has thrown up.

Nature’s tendency appears to be to fix the inflamed portion so as to secure rest and this is accomplished by the muscles of the abdominal wall becoming rigid, especially over the cecum.  These muscles are contracted to such an extent that the right thigh is often drawn up in order to relieve the tension.