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The two things I thought I knew about appendicitis were that it was rare and mainly affects children and teenagers. A doctor friend on a recent visit had confirmed these points, but I was able to disabuse her. By
then I had just come out of hospital after having an appendectomy.
It had struck without warning, the abdominal pain so severe that I
developed acute urinary retention, which necessitated my admission
to hospital at 1.30am. I was lucky. The appendix was gangrenous, already
leaking and only hours away from perforation and consequent peritonitis.
Two days after my operation, l was visited by John, my good friend and
neighbour. John said that he had just delivered his wife Sheila to the
surgeon for an appendectomy. It was some decades ago since Sheila and
I were teenagers. My views on appendicitis needed revising, and I made
some enquiries of my surgeon. No, appendicitis is not rare, neither is
it confined to the young. In his hospital, with a catchment population
of 150,000, appendectomies average 11 a week of all ages. Scaled up to
the UK population of 56 million, this works out at 370 appendectomies
a week. This does not take into account the innumerable “grumbling” appendices
which do not necessitate an operation.
Until the mid-1800s, appendicitis was only encountered at post-mortems.
This was due to the unwritten law of surgery, accepted since the time
of Hippocrates, that the three body cavities, the head, the thorax and
the abdomen, were not to be touched by the surgeon’s knife, except
of course on the battlefield. With the advent of anaesthesia and antisepsis — and
then aseptic techniques — the moratorium on surgery within the
body cavities became unnecessary. Inflamed appendices could now be diagnosed “live” by
pain in the lower right abdominal quadrant, high temperature and an elevated
white blood cell count. Many appendectomies
had been performed by the end of the 19th century, but the general public
was unaware of the operation until 1902, when the coronation of King
Edward VII had to be postponed due to royal appendicitis. Sir Frederick
Treves, who had pioneered appendectomy in the UK, operated on Edward
and found an abscess on his appendix that merely needed draining, and
did not need to remove the organ. But the press drew no such fine distinctions,
and blazoned to the nation that the king had been saved by an appendectomy.
In those more innocent days, when royalty were emulated, there was an
upsurge in pains in the lower right abdomen and, for a time, appendectomy
was the fashionable operation. In fact, appendectomy is one of the few
operations that is justified as a preventive measure. When I worked in
the Far East, most American personnel who were sent there to work in
outstations far from hospital facilities had had their appendixes removed
in the US before arrival.
The original purpose of the appendix was to help in the digestion of
cellulose during the million or more years when the hunter-gatherer diet,
richer than now in fruit and vegetables, was standard. Today the appendix
has become a largely ignored appendage, and appendectomy overshadowed
by more glamorous transplants, heart bypasses and joint replacements.
However, pharmacists dealing directly with the public need to be aware
that appendicitis is still relatively common in all age groups, and to
be alert to the possibility of encountering the condition in daily practice.
— Contributed
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The Pharmaceutical Journal