the old, and in
boys rather than girls; and in some families there is a strange
predisposition towards it. It is often started by a chill, or by
over-exertion, and sometimes the attack follows a blow or strain, or
some other direct injury, after which the virulent micro-organisms seize
on the mucous membrane and involve the appendix in acute inflammation.

The appendix is a narrow tube, about the size of a goose-quill, with an
average length of 3 in. It terminates in a blunt point, and from its
worm-like shape is called _vermiformis_. It is an appendage of the large
intestine, into which it opens, and is regarded as the degenerate relic,
surviving in man and other mammals, of an earlier form of intestine.
Foreign bodies passing down the intestinal canal may find their way into
the appendix and lodge there. Frequently the diseased appendix is found
blocked by hard faeces or undigested particles of food, such as nuts,
fibrous vegetable matter, and other imperfectly masticated substances;
inflammation may occur, however, without the presence of any impacted
material. The appendix may be twisted, bent, or otherwise strangulated,
or its orifice may be blocked, so that the tube is distended with mucus
which can find no outlet; or ulceration of tuberculous or malignant
origin may occur. Inflammation started in the appendix is liable to
spread to the peritoneum, and herein lies the gravity of the affection
and the indication for treatment. The symptoms vary from "indigestion,"
and slight pain and sickness, which pass off in a few short days, to an
exceedingly violent illness, which may cause death in a few hours. Pain
is usually first felt in the belly, low down on the right side or across
the region of the navel; sometimes, however, it is diffuse, and at other
times it is scarcely complained of. There is some fever, the temperature
rising to 101 deg. or 102 deg. F., with nausea, and very likely with
vomiting. The abdomen is tender to pressure, and the tenderness may be
referred to the spot mentioned above. Some swelling may also be made out
in that region. The attack may last for two, three or four days, and
then subside. 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 violent
stage. In some chronic cases the trouble continues, on and off, for
months or even for years.

[Illustration: L