Notwithstanding the clear points which are presented in a diagnosis of appendicitis, it is by no means easy in all cases to make a diagnosis and feel positive concerning it.
Among the conspicuous points in the diagnosis is the location of the disorder at McBurney's point. Morris, in a recent article, called attention to the location of tenderness over the right lumbar ganglia, one and one-half inches outside of the umbilicus, in line with the anterior superior spine.
He says that in the early stages of an acute infection, there is persistent aching in this location opposite the appendix. The right lumbar ganglia are tender, while the left ganglia are not at all sensitive. Later on when the acute inflammation of the appendix has subsided, leaving a mucous inclusion or scar tissue, the tenderness at McBurney's point has disappeared, perhaps entirely, but there is yet tenderness over the right lumbar ganglia, with an absence of tenderness over the left lumbar ganglia.
Still later on, when the appendix is undergoing infection with replacement of the lymphoid coats with connective tissue, digestive disturbances and various local neuralgias may be present, due to the fact that the nerve filaments may be entrapped into new connective tissue.
There may be no return of tenderness at McBurney's point, but there is persistent tenderness over the right lumbar ganglia. Again when a movable kidney is to blame for irritation and infection of the appendix, there may be no tenderness at McBurney's point, but there is persistent tenderness over the right lumbar ganglia.
The author further concludes that where the right lumbar ganglia alone is tender, the difficulty is in the appendix. Where the right and left both are tender, the difficulty is due to pelvic disorders. The author is a man of experience and close observation and his statements carry weight.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.