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