Page:The New International Encyclopædia 1st ed. v. 20.djvu/101

VEBMIFOBM APPENDIX. 75 VERMIGLI. cKCtim found in all mammals excepting some of the higher apes and the wombat. In structure it resembles closely that of the large gut. It is hallow to its tip, and its cavity com- municates with that of the large bowel. It is entirely covered by the peritoneum, being fre- nuently attached by a fold of this membrane to the back of the large intestine, iiarely it has its own mesentery. Its functions are probably unimportant. Situated in the right side of the abdominal cavity, in the right iliac region, it hangs sus- pended from the large gut and after describing a few slight turns terminates in a blunt end. It normally projects in a direction upward and in- ward. Sometimes, however, it is greatly elon- gated and projects far out into the jieritoueal cavity; sometimes it is found bound down by ad- hesions to comparatively distant points, and sometimes it hangs down into the cavitj' of the true pelvis in close relation to the bladder and other pelvic viscera. Its blood supply in the male is a twig from the mesenteric arterial s.ysteni. In the female, besides the mesenteric supply a branch of the right ovarian artery is distriljuted to its distal extremity. Appendicitis. The appendix is not uncom- monly the seat of processes accompanied by in- flammation, perforation, and abscess. Attacks of this kind are termed appendicitis. The excit- ing causes are mechanical or chemical irritation and bacteria. The disease is most common in individuals be- tween ten and thirty years of age, though it has been seen in an infant under one year and in patients over seventy. About 80 per cent, of the cases occur in males, because of their greater ex- posure to weather and injury, and because the female ajipendix has a greater arterial supply. The disease appears to be more common in the United States than in other countries. It is slightly more frequent in summer and autumn than during other seasons. The varieties of this ailment are generally classified as follows: .Ich^c appendicitis, including catarrhal, intestinal, ul- cerative, and gangrenous forms; and chronic ap- pendicitis, including catarrlial, intestinal, and obliterating forms. In most varieties the ap- pendix is larger, longer, and firmer than normal, (Edematous and filled with fluid or semifluid secre- tion, the lumen opening into the ca;cum being closed. In the interstitial form there is a dense cellular infiltration of the retiform tissue of the mucous membrane, pathologic alterations involv- ing also the submucous, muscular, and subserous coats, and dilatation of the blood-vessels existing. Abscesses may develop in the submucous and subserous layers. The lymphoid follicles are the seat of serous infiltration, and new lymphoid cells develop in small collections, afterwards be- coming necrotic. In the severer forms the final process is ulcerative, following extensive dis- tention and necrosis, and the purulent contents of the appendix fall into the peritoneal cavity, together with fneeal material in many cases. In the chronic forms ulceration does not take place. Attacks may recur during life from time to time and be unrecognized. One-third of all adult bodies reveal diseased appendices at autopsy. The three principal symptoms of appendicitis are pain, tenderness, and rigidity of the lower part of the abdomiilal w'all on the right side. Vol. .X.— 6. The pain resembles that of colic and is generally referred to the neighborhood of the uudiilicus, yet it may be felt in any part of the abdomen. A special diagnostic corroborative sign for the physician is pain at Meliurney's point, midway between the anterior superior spine of the ilium and the navel. There are also gastro-intestinal disturbances, elevation of temjieniture, increased rapidity of pulse and of respiration,- vomiting, nausea, hiccuj), and either diarrhoea or consti- pation. The last-named is usually present after the first. Difficulty in swallowing, chills, cya- nosis, profuse jierspiration, and distentiim of the abdomen may occur. The jihysician can some- times find the appendix by palpation. Ulceration and perforation with peritonitis may occur in three or four days or may occur on th(.' first day upon which any symptoms have been noticed by the patient. Or ten days to two weeks of mild sym])toms may elapse, and the patient may nearly regain his health when a relapse occurs. The interval may be a half-year or a year and then a recurrence may take place. In the chronic forms the most constant synii)toni is pain in the right iliac fossa, moderate at times, frequently recurring, and at times of great severity. The danger in these cases lies in the possibility of a sudden acute exacerbation going on to ulceration, gangrene, and fatal peritonitis. Various other disorders present similar symptoms and condi- tions to those of appendicitis, and it is impos- sible for the layman to diagnose it. The treatment of appendicitis is determined by the fact that it is a surgical affection from the start. Removal of the appendix as early as diagnosis is made is the only conservative, safe, and justifiable treatment. To await the prob- able formation of pus is generally to sacrifice the patient. The medical treatment of the case is confined to the periods before and after the operative procedure, and includes attention to diet, local applications, laxatives, rest, and stimu- lation. An early use of a- searching laxative in suspected appendicitis is imperative, whether diarrhoea be present or not. Opium should never be given under any circumstances. It is commonly thought that fruit seeds nat- urally gravitate into the intestine. Such is not the case. Foreign bodies of that sort are ex- tremely rare in cases of appendicitis. Faecal con- cretions or appendicular calculi are frequently met. Consult: McBurney, "Indications for Early Operation for Appendicitis," in Annals of Surijer;/, xiii. (1891); Kelly. "The Pathogenesis of Appendicitis," in Philudeljthia Medical Journal, iv. (1S09) : Deaver, A Treatise on Appendicitis (Philadelphia, I'JOO). VERMIFUGE. See Anthelmintic. VERMIGLI, ver-me'lye, Pietro Martire (Peter Martyr) (1500-G2). A Protestant Re- former. He was born in Florence; became an Augustinian monk at Fiesole in 1510; rose to be visitor-general of the Order ( 1541 ) , but adopted the views of the reformers. Having avowed his conversion at Lucea, he was compelled to fiee to Switzerland, whence he passed to Strassburg, and became professor of theology there (1542). In- vited by Cranmer to England, he was. in 1547, appointed by Edward VI. regius professor of divinity at Oxford. Driven from England under Queen Marv, he resumed his chair at Strassburg