arge Intestine showing Vermiform Appendix (v.a.) and
Caecum (c)]

On paper it is easy to arrange cases of appendicitis into three
classes--catarrhal, ulcerative and mortifying--but in actual practice
this is neither desirable nor possible. Such classification is based
upon the symptoms, and in appendicitis symptoms may be actually
misleading. The three conditions to which the surgeon chiefly looks for
guidance are the aspect of the patient, the rate of his pulse and the
degree of fever as shown by the thermometer. But in certain cases of
appendicitis, though the surgeon knows intuitively, or, at least,
suspects, that the general condition is extremely serious, the patient
looks fairly well and says that he is not in pain, his pulse-rate being
but little quickened and his temperature being but slightly above
normal. Nevertheless, when the surgeon has opened the belly in the
appendix region, he finds the appendix swollen, perforated and
mortified, and lying in a stinking abscess, whilst inflammation has
already spread to the neighbouring coils of intestine. Unfortunately,
the surgeon can no more tell what he is going to find at his operation
in some of these cases than he can foretell the course which any
particular case is going to run.

We may most usefully give here the symptoms as they are likely to be
found in an ordinary case of appendicitis, and as they may be observed
by one who is not a member of the medical profession, in a way that may
prove helpful to him when circumstances have awakened his interest in
the disease.

The case taken shall be that of a boy at school, for, as already stated,
boys are more prone to the disease than girls. The boy has had, may be,
occasional attacks of "indigestion" which have duly passed away under
the influence of aperient medicines, and, being heated at play, he has
sat down upon the cold ground. Or he has got wet through or over-tired
during a long walk or ride. At any rate, his vital powers have been
suddenly lowered, and the micro-organisms teeming in his bowel have
seized upon the lining membrane of the appendix. He feels out of sorts,
and if he manages to eat a meal he very likely vomits it soon after, for
the whole nervous system of his abdomen is disturbed by the local
inflammation. The act of vomiting gives slight relief, however, and
probably he begins to complain of pains in his head as well as in his
abdomen, and possibly he has an attack of shivering--the result o