Medicine: More Appendicitis

Whenever life insurance companies notice that their clients are dying in increasing numbers of some affliction, The Spectator, insurance publication, sounds an alarm. Investigations are started and remedies devised. It is good business for the insurance companies, a good deed for the public.

Last week’s cause for corporate alarm was appendicitis. From 18,000 to 20,000 people in the U. S. are dying each year from this cause. The national mortality record, like the mortality record for women in childbirth, is, according to Frederick Ludwig Hoffman, consulting statistician for Prudential Insurance Co., the worst in the world. The U. S. appendicitis death rate per 100,000 inhabitants in 1929 was 15.2. Now the rate may be still higher. For in 1920 it was 13.4, from which it rose to the 1929 level.

The comparable death rates from appendicitis among other peoples are: Prussia 6.8; Irish Free State 5.2; Scotland 10.0; New Zealand 7.2; Mexico City 9.1; Italy 3.7 (lowest in the world); England & Wales 7.7. Canada, where living habits are very much as in the U.S., has almost as high a death rate as the U.S.

A noteworthy feature of the death statistics on appendicitis is that most victims are in their early 30’s, tip-top age for earning power and economic value to the community.

Demanded Dr. Hoffman: “The American public is entitled to an explanation of the extraordinary difference in the appendicitis death rates. … If there is a lack of surgical skill … the matter imperatively demands consideration. For it goes without saying that most of the deaths follow operations, since it is a safe assumption that three-fourths of the appendicitis cases find their way into hospitals for more skillful treatment.”

Diagnosticians as well as surgeons doubtless will be vexed with Dr. Hoffman’s blame. Appendicitis is not always easy to diagnose. The surgeon usually gets the case at the last minute, when the appendix is about to burst or has already burst and scattered its pus. It is almost always peritonitis which causes death.

Infection is the essential cause of appendicitis. The appendix is a taggle to the intestines, on the right side of the abdomen. It doubtless is the remnant of some organ useful to a primitive creature from which man evolved. But what that use was, anatomists have never agreed. It has no known use to present man. and it is often a nuisance. Feces, seeds, fruit stones, other digestive debris may pack into the appendix, set up an inflammation. Or the inflammation may represent an infection which originated in some distant part of the body.

Often it is difficult to distinguish the pains of appendicitis from those of tuberculosis, pneumonia or pleurisy. Actinomycosis, a fungus infection which causes abscesses, may simulate appendicitis. A mistake in diagnosis may result from the presence of colic of the bile or of the kidneys, inflammation of the kidneys, stricture of the right ureter (through which the right kidney drains into the bladder). Diseases of women’s sexual apparatus may act like appendicitis. Especially confusing in this respect is menstrual colic, from which many a flabby and nervous woman suffers. And infections of the intestines may spread to the appendix.

Appendicitis should be suspected if a person, especially one under 30, has a sharp pain and a tender spot a few inches to the right of and a little below his navel; if he has fever and a furred tongue.

An appendix pain may pass away. But it is almost sure to return some day. There is no medicine to cure an infected appendix. It must be cut out. the sooner the better, agree most physicians and surgeons. Deaths are almost always due to delayed operations.