CHAPTER XII
APPENDICITIS, OR NATURE'S REMNANT SALE
We were not made all at once, nor do we go to pieces all at once, like the "one-hoss shay." This is largely because we are not all of the same age, clear through. Some parts of us are older than other parts. We have always felt a difficulty, not to say a delicacy, in determining the age of a given member of the human species—especially of the gentler sex. Now we know the reason of it. From the biologic point of view, we are not an individual, but a colony; not a monarchy, but a confederacy of organ-states, each with its millions of cell-citizens. It is not merely editors and crowned heads who have a biologic right to say "We." Therefore, obviously, any statement that we make as to our age can be only in the nature of an average struck between the ages of our heart, lungs, liver, stomach; and as these vary in ancientness by thousands of years, the average must be both vague and misleading. The only reason why there is a mystery about a woman's age is that she is so intensely human and natural. The only statement as to our age that the facts would strictly justify us in making must partake of the vagueness of Mr. A. Ward's famous confession that he was "between twenty-three summers."
As we individually climb our own family-tree, from the first, one-celled droplet of animal jelly up, none of our organs is older than we are, but a number of them are younger. The appendix is one of these. Now, by some curious coincidence, explain it as we may, some of our oldest organs are youngest, in the sense of most vigorous, elastic, and resisting, while some of our youngest are oldest, in the sense of decrepit, feeble, and unstable. It is perhaps only natural that an organ like the stomach, for instance, which has a record of honorable service and active duty millions of years long, should be better poised, more reliable, and more resourceful than one which, like the lung or the appendix, has, as it were, a "character" of only about one-tenth of that length. However this may be, the curious fact confronts us that scattered about through the body are structures and fragments, the remains of organs which at one time in our ancestral career were, under the then existing circumstances, of utility and value, but have now become mere survivals, remnants,—in the language of the day, "back numbers." Some of these have still a certain degree of utility, though diminished and still diminishing in size and functional importance, like our third molars or "wisdom" teeth, our fifth or "little" toes, our gall-bladder, our coccyx or tail-bone, the hair-glands scattered all over the now practically hairless surface of our bodies, and our once movable ears, which can no longer be "pricked," or laid back. These, though of far less utility and importance than they obviously were at one time, still earn their salt, and, though all capable of causing us considerable annoyance on slight provocation, seldom give rise to serious trouble or inconvenience. There are, however, a few of these "oversights" which are of little or no known utility, and yet which, either by their structure or situation, may become the starting-point of serious trouble.
The best known members of this small group are the openings through the abdominal wall, which, originally placed at the strongest and safest position in the quadrupedal attitude, are now, in the erect attitude, at the weakest and most dangerous, and furnish opportunity for those serious and sometimes fatal escapes of portions of the intestines which we call hernia; the tonsils; and our friend the appendix vermiformis.
For once its name expresses it exactly. It is an "appendix," an afterthought; and it is "vermiformis," a worm-like creature,—and, like the worm, will sometimes turn when trodden on. Its worm-likeness is significant in another sense also, in that it is this very diminutiveness in size—the coils into which it is thrown, the spongy thickness of its walls, and the readiness with which its calibre or its circulation is blocked—that is the fundamental cause of its tendency to disease.
The cause of appendicitis is the appendix.
"Despise not the day of small things" is good pathology as well as Scripture. Here we have a little, worm-shaped tag, or side branch, of the food-tube, barely three or four inches long, of about the diameter of a small quill and of a calibre that will barely admit an ordinary knitting needle. And yet we speak of it with bated breath. When we remember that this little, twisted, blind tube opens directly out of one of the largest pouches of the intestines (the cæcum), and that it is easy for anything that may be present in the large pouch—food, irritating fragments of waste matter, or bacteria—to find its way into this fatal little trap, but very difficult to find the way out again, we can form some idea of what a literal death-trap it may become.
How did such a useless and dangerous structure ever come to develop in a body in which for the most part there is mutual helpfulness, utility, and perfect smoothness of working through all the great machine? To attempt to answer this would carry us very far back into ancient history. But to make such backward search is absolutely the only means of reaching an answer.
"But," some one will object, "how perfectly irrational, not to say absurd, to propose to go back hundreds of thousands of years into ancient history, to account for a disease which has been discovered—according to some, invented—within the past twenty-five years!"