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Acute appendicitis is one thing; relapsing appendicitis is another. The latter condition is very manageable. Inasmuch, then, as it is impossible to know what direction the disease will take, whether to quiescence or to disaster, it is for the greatest good in the greatest number of cases that the inflamed appendix be removed by operation whilst the disease is still limited to the appendix. It is highly probable that if every available hospital surgeon were asked if he had ever had cause to regret having advised early operation in a case of appendicitis the answer would be "No"; on the other hand, every surgeon would be able to recall cases in which delay had been followed by disaster--which an early resort to operation would, in all probability, have prevented. If the disease is going to assume the severe form, all the symptoms, as a rule, increase in severity. The facial expression becomes more anxious, and the accumulation of gas in the paralysed intestine causes an increase in the abdominal distension, so that the patient lies with his knees drawn up. The vomiting continues. The pulse quickens to 120 or 140 a minute, and the temperature rises, perhaps to 104 deg. F. The swelling and tenderness increase on the right side of the abdomen, and if the abscess does not find escape externally it probably bursts into the general peritoneal cavity, and the patient becomes bathed in profuse sweat, the result of blood-poisoning. Death is likely to follow within two days, the result of blood-poisoning and exhaustion. _Catarrhal and Relapsing Appendicitis._--Some cases of appendicitis run a mild course, giving rise to no worse symptoms, perhaps, than those of "indigestion" and nausea, with a feeling of general discomfort in the abdomen, and, probably, some local tenderness. The attack may be preceded or accompanied by constipation. The administration of a mild aperient or an enema, rest, starvation and fomentation will probably put matters right again--at any rate for a time. This form of the disease may be due to the presence of "bolted," unchewed or indigestible food in that part of the large intestine into which the appendix opens. And these mild recurrent attacks may sometimes be got rid of altogether by having the teeth put in order, and by inducing the individual to choose his food with discretion, to chew it carefully, to take his meals regularly and to eat slowly. Obviously, these attacks are very different from
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