those of the acute
septic form of the disease described above, though there is no telling
that one of them may not develop into the acute form. Some of the mild
attacks are due to a kink in the appendix, or to some other condition
which temporarily prevents the secretions of the appendix from finding
their way into the large intestine. Others of them are caused by a
passing catarrhal inflammation of the lining of the appendix and have a
distant resemblance to a recurring "sore throat."

After undergoing one or two of these mild attacks the patient would be
well advised to have his appendix removed when it has once more got into
the "quiet stage." Experience abundantly shows that the operation can
then be performed with but slight disturbance of the patient, and with
the smallest possible amount of risk. And until his vulnerable appendix
has been removed he is never safe.

In the _chronic_ form of the disease though the patient is never
desperately ill he is never quite well. He has pains and discomfort in
the abdomen, with slight tenderness and nausea, with "indigestion," as
he may call it. And as one can never tell when the smouldering
inflammation may break out into conflagration, he is well advised to
submit himself to operation without further delay. To carry about a
diseased appendix is to run the constant risk of being laid up at a time
most inconvenient, as when travelling or when staying in some place
where skilled assistance is far distant or absolutely unobtainable. But
having made up his mind that the appendix had better be removed, the
patient can choose time, place and surgeon, and, having undergone a
week's careful training for the ordeal, can safely count on being back
at work again in a month or six weeks' time.

As regards _treatment_, the greatest safety consists in the prompt
removal of the inflamed appendix, and statistics show that if the
operation can be done in the first or second day of even an acute
attack, the result is generally favourable--that is to say, if the
appendix can be removed whilst the disease is still shut up within its
tissues. But in some cases ulceration and perforation, or mortification,
may have taken place over a hard faecal concretion within the first
twenty-four or forty-eight hours, and, the septic germs having been let
loose, peritonitis may have already set in, and operation may be
followed by disappointment. Still, if the case had been left unoperated
on, no other r