I need to ask something...

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tags: story vermiform appendix duke university charles darwin hygiene hypothesis parkinson's disease harry houdini



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Early in my story I mentioned that in "wealthy" countries, it is standard to surgically remove an inflamed appendix. What I did not mention was: If you don't live in a wealthy country, you are less likely to come down with appendicitis in the first place. And no, this isn't because in a less developed nation an inflamed appendix is less likely to recieve medical care. (Though that is probably true.) It is because of this paradox: Appendicitis is a first world problem.

It seems, the cleaner your enviroment, the more likely you are to come down with certain medical issues. This phenomenon has been termed the "hygiene hypothesis", and was originally linked to allergies, eczema and asthma:

"According to the hygiene hypothesis, those of us in developed nations have effectively sanitized our way to poorer health by systematically eliminating nature’s lush microbial wilderness from our homes. That microbe stew, the theory goes, plays a vital role in stimulating and training a young child’s immune system to recognize real threats -- and not overreact to false ones."
-- https://centerforhealthjournalism.org/2015/02/25/it%E2%80%99s-been-big-week-bamba-and-dirty-dishes

For many cases of appendicitis, it seems our bodies turn on themselves, and regard the appendix itself as a threat. This isn't always the case, but in first world countries, which have much higher incidents of inflamed appendixes, it may often be the case. Other causes of appendicitis are: blockages, and rarely, physical trauma. (Regarding the latter, the illusionist Harry Houdini died after a stunt that saw him punched repeatedly in his abdomen¹. The event took place before he was suitably prepared, and resulted in a ruptured appendix. There is some debate today about whether the injury itself caused him to have appendicitis (that led to an eventual rupture), or if he already may have had an undetected, low grade appendicitis, making a rupture more likely at the time of the assault.)

Blockages can be from food (especially seeds), foreign objects, petrified poop (called a fecalith), tumours, and parasitic worms. (In the case of worms, this cause is more likely to occur in a third world country.)

The appendix itself, whose full name is "vermiform appendix", is a small tube, that hangs near the junction of your small and large bowel. It is usually about the width of an adult pinky finger, and 2-4 inches long. It is a one-way pouch, that can release stuff into your large bowel; nothing you are digesting ever passes through it. Until very recently, it was thought to be "vestigial". (That is, something that was of use to our ancestors, that became unnecessary as we evolved; like wisdom teeth. Charles Darwin himself championed this idea.)

Despite Darwin's belief, on the fringes of medicine there has been speculation that in humans, the appendix does serve a purpose. In 2007 this belief was brought into the main stream by scientists from the Duke University Medical Centre. They wrote a paper positing that the appendix acts as a "safe house for good bacteria.²" In the event of dysentery or cholera, or other gut infections, which cause the bowel to flush out (both bad and good) bacteria, the appendix can repopulate the large bowel with healthy biome, kickstarting a healthy gut, after a depleting illness. It is worth noting, dysentery and cholera occur rarely in first world nations, which supports how people in the developed world appear to function just fine after appendectomies. Function just fine, that is, with one small exception: There is a correlation between having your appendix removed, and having a higher chance of getting Parkinson's disease³. If my memory is correct, I do not think this small risk was ever mentioned to me by the Surgery Team, or anyone else, at Mount Sinai Hospital. I came across this detail while doing my googling, late at night, after I had already signed the surgery consent papers.

  1. https://en.wikipedia.org/wiki/Harry_Houdini
  2. https://www.abc.net.au/news/2007-10-10/scientists-discover-true-function-of-appendix-organ/693946
  3. https://www.webmd.com/parkinsons-disease/news/20190509/is-appendix-removal-linked-to-parkinsons-disease

This writing above is one chapter from the long form article "3 Days and 2 Nights".
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