Worm-Shaped Trouble

Appendicitis is no longer the killer it was a dozen years ago. Since sulfa drugs began to be used to control the complication of peritonitis, the annual toll of U.S. lives lost to appendicitis has been cut from about 17,000 to 5,000. But, says Dr. Frederick Fitzherbert Boyce of New Orleans, the success of the wonder drugs has given both doctors and laymen a false sense of security.

Hoping to "sound the alarm" about the continuing seriousness of appendicitis, Dr. Boyce has written a book, Acute Appendicitis and Its Complications (Oxford, $8.75). The first essential, he says, is still accurate diagnosis. And unfortunately, appendicitis does not always cause the textbook symptoms: e.g., nausea, pain and tenderness in the lower right-hand quarter of the belly. Pain may be felt anywhere in the abdomen, often above the navel, or even in the right shoulder. And appendicitis may hide under the symptoms of many other diseases.

For patients, Dr. Boyce gives time-honored advice: go to the doctor as soon as appendicitis is suspected. Above all. do not take a laxative; it may cause a disastrous rupture of the appendix. For doctors, Dr. Boyce also has a suggestion: tell patients in advance what to do if they think they have appendicitis. For keepers of vital statistics, he has this criticism: don't lump together all deaths from appendicitis, whether caused by the chronic or the acute form of the disease. This obscures the seriousness of the acute form, he says, which, with its complications, actually causes 99% of all appendicitis deaths.

Like all researchers before him, Dr. Boyce is at a loss to explain why man is born with an appendix. It serves no known purpose. But he has gathered a lot of odd facts about the useless, troublesome appendage:

P: The appendix, popularly believed to be on the right side, is sometimes found on the left.

P: Instead of being vermiform (worm-shaped), it may be S-shaped, U-shaped, or even split into two branches. P: Some people have two appendices; there are 28 known cases of people who had none.

P: Inside patients' appendices, surgeons have found: pins, needles, nails, screws, bird shot, bullets, iron filings, solder, stones, buttons, seeds, beans, oat hulls, chestnuts, pieces of bone and wood, straw, bristles, eggshell, hair and teeth.

Although acute appendicitis spares no age, social group, sex or race, it is far more common among civilized than primitive peoples, and more common in the U.S. and Canada than anywhere else. Dr. Boyce does not know the answer to that, either. Apes in captivity apparently become susceptible to the disease. But, says Dr. Boyce, that is no help--because nobody knows whether apes at large in the jungle get it too.

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