(W. F. C.)
APPEARANCE (from Lat. apparere, to appear), in law, the coming into court of either of the parties to a suit; the formal act by which a defendant submits himself to the jurisdiction of the court. The defendant in an action in the High Court of England enters his appearance to the writ of summons by delivering, either at the central office of the Supreme Court, or a district registry, a written memorandum either giving his solicitor’s name or stating that he defends in person. He must also give notice to the plaintiff of his appearance, which ought, according to the time limited by the writ, to be within eight days after service; a defendant may, however, appear any time before judgment. The Rules of the Supreme Court, orders xii. and xiii., regulate the procedure with respect to the entering of an appearance, the giving of notice, the limit of time, the setting aside and the general effect of default of appearance. In county courts there is no appearance other than the coming into court of the parties to the suit. In criminal cases the accused appears in person. In civil cases infants appear by their guardians ad litem; lunatics by their committee; companies by a solicitor; friendly societies by the trustee or other officer appointed to sue or be sued on behalf thereof.
APPENDICITIS, the modern medical term for inflammation of that part of the intestine which is known as the “appendix.” Though not a new disease, there can be no doubt that it is far commoner than it used to be, though the explanation of this increased frequency is not yet forthcoming. Amongst the virulent micro-organisms associated with the disease no one specific germ has hitherto been found. It may be remarked that the theories that influenza, or the use of preserved foods, may be connected with the disease as cause and effect, have supporters. Sometimes the disease is due to the impaction of a pin, shot-corn, tooth-brush bristle, or fish-bone in the appendix, which has set up inflammation and ulceration. In many cases a patch of mortification with perforation of the appendix is caused by the presence of a hard faecal concretion, or “stercolith,” which from its size, shape and appearance has been mistaken by a casual observer for a date-stone or cherry-stone.
Apart from the fact of the more frequent occurrence of appendicitis, the disease is now better understood and more promptly recognized. It was formerly included under the term “perityphlitis”—that is, inflammation connected with the caecum or blind portion of the large intestine. But in the vast majority of cases the inflammation begins in the appendix, not in the intestine proper. It is apt to extend and set up a localized peritonitis, which in the worst cases may become general.
Appendicitis is more often met with in the young than the old, and in boys rather than girls; and in some families there is a strange predisposition towards it. It is often started by a chill, or by over-exertion, and sometimes the attack follows a blow or strain, or some other direct injury, after which the virulent micro-organisms seize on the mucous membrane and involve the appendix in acute inflammation.
The appendix is a narrow tube, about the size of a goose-quill, with an average length of 3 in. It terminates in a blunt point, and from its worm-like shape is called vermiformis. It is an appendage of the large intestine, into which it opens, and is regarded as the degenerate relic, surviving in man and other mammals, of an earlier form of intestine. Foreign bodies passing down the intestinal canal may find their way into the appendix and lodge there. Frequently the diseased appendix is found blocked by hard faeces or undigested particles of food, such as nuts, fibrous vegetable matter, and other imperfectly masticated substances; inflammation may occur, however, without the presence of any impacted material. The appendix may be twisted, bent, or otherwise strangulated, or its orifice may be blocked, so that the tube is distended with mucus which can find no outlet; or ulceration of tuberculous or malignant origin may occur. Inflammation started in the appendix is liable to spread to the peritoneum, and herein lies the gravity of the affection and the indication for treatment. The symptoms vary from “indigestion,” and slight pain and sickness, which pass off in a few short days, to an exceedingly violent illness, which may cause death in a few hours. Pain is usually first felt in the belly, low down on the right side or across the region of the navel; sometimes, however, it is diffuse, and at other times it is scarcely complained of. There is some fever, the temperature rising to 101° or 102° F., with nausea, and very likely with vomiting. The abdomen is tender to pressure, and the tenderness may be referred to the spot mentioned above. Some swelling may also be made out in that region. The attack may last for two, three or four days, and then subside. There are, however, other cases less well defined, in which the mischief pursues a latent course, producing little more than a vague abdominal uneasiness, until it suddenly advances into a violent stage. In some chronic cases the trouble continues, on and off, for months or even for years.
| Large Intestine showing Vermiform Appendix (v.a.) and Caecum (c). |
On paper it is easy to arrange cases of appendicitis into three classes—catarrhal, ulcerative and mortifying—but in actual practice this is neither desirable nor possible. Such classification is based upon the symptoms, and in appendicitis symptoms may be actually misleading. The three conditions to which the surgeon chiefly looks for guidance are the aspect of the patient, the rate of his pulse and the degree of fever as shown by the thermometer. But in certain cases of appendicitis, though the surgeon knows intuitively, or, at least, suspects, that the general condition is extremely serious, the patient looks fairly well and says that he is not in pain, his pulse-rate being but little quickened and his temperature being but slightly above normal. Nevertheless, when the surgeon has opened the belly in the appendix region, he finds the appendix swollen, perforated and mortified, and lying in a stinking abscess, whilst inflammation has already spread to the neighbouring coils of intestine. Unfortunately, the surgeon can no more tell what he is going to find at his operation in some of these cases than he can foretell the course which any particular case is going to run.