Welcome to Stuff you should know, a production of I Heart Radio. Hey you, welcome to the podcast. I'm Josh Clark. There's Charles w Chuke Bryant's willing away in some champagne. You're sorry, sparkling my shando and so it's from NAPA. And there's Jerry over there, Jerry Scudder champagne too. We're all just hanging out. We're gonna talk to you guys while we wait for the shrimp cocktail with aw literally and that makes this stuff you should know. That's right. Uh, we're back in the same room everybody for the first time in about fourteen months. And Jerry brought in champagne and frozen shrimp cocktail. There's a story behind that. Go ahead and say it. You go ahead and say, I don't remember you were the shrimp you first started it, Like I feel like twelve years ago we we we were tracking to hit number one on iTunes in like two thousand and eight, I think at the beginning of two thousand no nine maybe whatever, and um, I was like, I want a shrimp cocktail in the in the recording studio when we hit number one. We hit number one, came and went stayed number one, hit number one again. No shrimp cocktail. This is the shrimp cocktail from two thousand nine. Yeah, finally has made an appearance, and it's frozen. It might literally be from two thousand It might be. It's turning. The veins are turning kind of purple as it thaws. I can't wait to eat the shrimp cocktail. Yeah, we're having shampagne. Jerry classed it up basically, I feel I feel it was a nice homecoming she did. But the three of us are fully backs. Were in a room together. The microphones don't have fake years attached to them. Yeah, I mean that joke won't make sense to you now, But we recorded another episode before this one, but it was getting released later, so this technically our second episode. It just put that in your button and smoke it in your hat. What do you talk about? Have a weird urged a curse? I don't know why. I think you just did so, Jerry Beppe bp P p peep. But it's it's great to be back together in a little weird um, but not as weird as I thought it would be. That first one was weird because we're in a different room. Yeah, we got all the weirdness out in a weird situation, it would have been weird regardless. But now we're back in in Studio one A. That was a really good move. Jerry, did you plan it like that to get the jitters out? Jerry thumbs up. Jerry's real. Everybody she chooses not to talk. Jerry's let her hair grow out. I know she got a ponytail, but the first time I've ever seen it's got an even more peppery, no salty in a salt and pepper way. It doesn't get more peppery unless you make a you know, a move to make it so. And she looks like a wealthy retiree who drives a Maseratti and knows their way around the club. You know what I mean, That's what Jerry looks like. She looks distinguished but also foxy. Yeah. So I spent my last January of losing twenty five pounds and then COVID hit and now I have gained backunds. I'm exactly where I was. Is that right? Exactly to the pound? And it makes me really angry. Oh no, just go with you. Oh I know, but I just, you know, let me get back together. I was like, man, I'm doing so good. I'm so good pandemic And I was like, well, now I can eat and drink all I want because it's sad. So you lost the weight before the pandemic hit, Yeah, I hit it hard in January to junior March January one probably, yeah, okay, And like I was working with a trainer, like you know, so I was having to go to her every like three days a week, and just you know, I was making the right decisions and tracking and and the weight disappears. And then COVID hit and I just started making all the wrong decisions and let myself do that. Yeah, that happened to all of us, myself included. I went through what you went through where I lost a bunch of weight and I managed to keep it off. And then COVID hit and I was still doing okay, doing okay, maybe eating a little more than usual, like I'm not gonna let it happen though, and I was. I wasn't. And then our book hit, and that's what got me. When we were writing it and working on a two hours a day every day, I was eating so much weight. I gained book weight, and I actually I have not been this big since I don't know when. Man, but I still got it. So I'm I'm doing what I can. You look the same? I do? Well? Then I what I started two weeks ago was kicked in. I guess if I look the same, well, you look great. Great, everyone looks and feels great. Yeah, let's talk about the appendix, the Rodney Dangerfield of organs. This is one of my favorite articles that we've done in a while. Yeah, and you know how I often complain about science. This is a kind of science I love. Yeah. Understandable, Yeah, body science, understandable. Super cool. This factors into our hygiene hypothesis episode, our human microbiome episode, digestive system episode. Yeah, it all sort of fits together. In that little worm like organ, it's an organ, right, yeah, it's an organ. Yeah. A lot of people thought it was a vestigial organ. They're wrong, right, But that weird little thing, uh, hanging out there, just going just wiggling around like a little worm is really kind of cool and fascinating. And I love that it has a great story behind its lack of usefulness and then turns out usefulness. And it's just agreed, this is really good stuff. It's smashed bang stuff. You should know. That's right. Let's talk about it. So um, like you said, the appendix is like this little worm like thing that dangles off the bottom of the ascending coal and large intestine. Coal in large intestine and large bowl are the one and the same. So when you hear people say bowl, they're typically talking about that colon large intestine. It's all the same thing, which I found confusing until I looked it up and found okay, it's all that um two to four inches long the appendix right generally, although the biggest one was pulled out of a seventy two year old Croatian man named Sofranco August during his autopsy, and his was ten inches or twenty six centimeters long. What do you think they were like in that autopsy? They're like, wow, I think that the medical examiner's staff had a T shirt made up that Sofranco August was buried in that said, I've got the biggest appendix ever. Maybe, I mean that's crazy because when you, like I encourage you look up a picture of the appendix, it is it looks like a little worm and it's hanging there on this little bulbous pouch called the sikum, and the Sikim is kind of like where it's it's the part in between this all Intestine and Large Intestine where there there's an agreement that takes place, basically where the small Intestine it is like, all right, listen, I'll take all this food and I'll make it into clime, but I am not going into the fecal zone. Now you handle the fecal stuff, colon, And the colon says, fine, here's my buddy, the secum. It'll it'll service a little halfway house. You can pass everything along to me. I will broke rate, you won't get any poop on you Small Intestine, and I'll send it to the Large Intestine. But off of that Secum is dangling this this little dude yeah, which as far as anybody could ever tell, had nothing to do with digestion, which makes it really weird because everything else around here has to do with digestion. That's just what they do, that's their their their trade. And the appendix is just hanging out and people just thought, Okay, this this thing doesn't make any sense. But the fact that is attached there and doesn't seem to have to do with digestion, made people for a very long time think that it was a vestigial organ right, which we'll get into the specifics of one man who really championed that idea in a way that frankly made a lot of sense, and you can see why it took that many years for anyone to really poke around further into it. Yeah, because you're just like, yeah, you just explained it's sure. But there are other mammals that have secums, uh, and in some mammals, especially herbivores, that can be really big relative to their body size, because in herbivores it acts as the the predigestion house for plants, and since they're eating tons of plants, they have large secums. Yeah, plant fiber is really really good for you, but it's also really hard to digest a lot of cellulose um. And that's that large intestine coming into play again, because in the stomach and the small intestine there's um, a microbiota, a microbiome, which we talked about in that one episode the Human Microbiome Project. Um. There's some in the small intestine. I think there's far far less even in the stomach, but in the large intestine. That's where it really shines. And those microbes, the pathogens, the virus is the fung guy all of the and the bacteria most of all. They all kind of work or fight or play and digest this stuff. They break it down so that we can absorb it. They turn it into fiber. Um dietary fiber uh keeps you from absorbing a lot of sugar or fats or whatever at once. Um insoluble fiber bulks your stool up, so it really kind of gets everything out of the coal and really cleanses it when you finally poop. Hand gestures. Yeah, I've missed you seeing my hand gestures now that I think, even when we're recording at home, Um, I forgot what it's like to be seeing so um. So the large intestine has this microbiome that that lives in there, and just just remember that. That's a big important point. Yeah, put a pin in that, but not literally because that would be dangerous. Um. Out of the three sixty one mammal species, only about fifty of us have an appendix or something like an appendix. Obviously, the great apes do, rabbits, possums, wombats weirdly square poop. Did they really comes out in cubes? Really? Yes? I can't tell if you're messing with me right now? Wait, hold on, keep talking. You're thinking of the square watermelons in Japan, maybe thinking of all of bees. I'm pretty sure wombats have square all right, a rare in show check. But dogs and cats don't have appendix, cows don't, oranges don't, sheep don't. Oh yeah, little poop poop cubes square. Yeah, it looks like those ice cube chocolates. How do they? How does that happen? How do they? Yeah? How does that work? Um? I don't have time to read that, but it looks like there's a science alert from January that says wombats are the only animals that poop cubes and now we know how Okay, well that's a definite short stuff. Okay, we'll do it. Look for that soon. Uh So, back to the vestigial organ aspect. Charles Darwin is the person who came out and said, hey, I've been looking at these And by the way, that was named officially by an anatomous named Phelippe Verhan in seventeen ten. Appendix vermiformists, which means worm shaped detachment, and I think the first appendix removals in seventeen thirty five. But Darwin was the one who said, hey, everybody, I've been looking at these herbivores and they've got these really big Secum's giant for this, for this reason that Josh just described future Josh and he said, so, here's the deal is, when we see a bunch of plants, we had humongous secombs as well. And as our diet changed and we got away from plants, you know, our body started to change along with it, and that seek them just kind of shrank. And the appendix is just a little shriveled up piece of that formerly large secum and it's just dangling. They're doing nothing. Isn't that amazing? And everyone until two thousand seven said it sounds right to me. Darwin's got it right. It does. I mean, it totally makes sense and seems completely believable. Yes, But now that I know it was wrong, I questioned every single thing he ever thought of or set. Welcome to our world, Darwin, So you guys messed up that one thing. I just don't know I believe anything. May we hear that like every week too? Don't we it's fun so um. But yeah, it went for We went for well over a hundred and fifty years of just everyone believing that the appendix was a totally useless fastigial organ that had no function whatsoever any longer. And so it was fine if you just took it out, which is we'll see like people do a lot actually and it is fine for the most part, which we're lucky that it's fine. But also I think if if it weren't fine, we would have figured out very quickly, like, oh wait, this is you're not supposed to do that. So the fact that we were able to remove the appendix later on, um without a problem, um, just kind of lent to this, let's support to the idea that it was a Vista gi organ. Right. Um, But it turns out it does serve some function. We'll start talking about that. I think after a break, what do you think, Chuck? That was so smooth? Thank you so much smoother in person? All right, we're back from our break. Um, who knows what amazing as you guys just heard. But I'm envious of you because we didn't hear it. We just have a moment of silence in between that's right. Uh, And now we can talk about the microbiome a little more. And if you want to look into our Human Microbiome Project works show that was it's when fourteen there are trillion cells in the body. About thirty trillion of those are human cells with DNA and the rest of those hundred trillion are the microbiome. That isn't just amazing and it's really there's something about the digestive system that just frankly turns us both on a little bit. Yeah, there were these animations that can I remember who made them? Um many many years ago? Yes, but the animator just understood us on a level that even I'm like, I'm like, oh, I didn't know myself. Just little shorts from clips show. They did one about a four and a half minute clip from how the digestive system works, which is worth looking up on YouTube. It's where I watched it the other day. They are they were just gifted and talented. It's one of my favorite little things that we ever that someone ever did for us. I want to say, Nick Nick sounds right? Okay, I think it was Nick. I hope it's Nick Nick. Please like right in if you still listen. Nick moved on. Okay, well, anyway, they were really great. What Nick's work, and if it wasn't Nick, Nick's new nickname is Nick. That's right, Okay, So um, Yes, the digestive system does get us jazz, and in particular the microbiome, which we wouldn't have a digestive system, or at least one that functions, because again, those bacteria help us break down stuff that we would normally have trouble breaking down, help us form poop all of that stuff. And there's a it's a symbiotic relationship because in breaking those those things down, like that plant fiber for instance, they're eating, they're happy, they're reproducing, but then the byproducts and the stuff that they break open make that stuff bioavailable for us, so we can kind of get the nutrients and all that stuff from it as well. It's a beautiful relationship. Not all bacteria is good, though, No, there's the bad stuff. And we should point out that most of this bacteria is in that large intestine, uh, the in the stomach and the small intestine. Most of it's killed off by gastric acid. But the bad bacteria is if you eat some bad chicken or if you have you ever done that? Yes, yeah, you know me. I've had all manner of stomach issues over the years. Where where did you get your bad chicken? I don't remember. I don't remember specifically, but I know I've had bad food before that made me sick. And in my case in Guatemala, if you remember, you and Jerry both well, it was not me. You know what, we were even closing our mouth in the shower. We're being so careful. But on that last night it was the ice, the mixed drinks. I forgot the ice is made from water, and that water was not good for Americans. And I stayed home that night so I didn't get diarrhea. It was worth it though, Jerry and I had such a good time. So yeah, I got bad sick after our guatte trip. But that's the bad bacteria, and and that's how it can get into your body. And your body is solution to this, uh as Jerry can affirm, is is diarrhea. It's your body's way of saying, we're just gonna flush you out human being. Just get rid of everything, get rid of all the stuff. But that's gonna take a lot of the good stuff with it, and that's no good because if you have all the good bacteria or a large amount of good bacteria leaving your body, then that can leave you very vulnerable to nutritional deficiencies and other bad stuff. Sure, yeah, because I mean, like a lot of the neurotransmitters that make your brain function correctly or produced in your gut from the function of the bacteria. Like, there's a lot of bad things that can happen if you don't have a balanced microbiome in your gut. Right. So Interroduke University in two thousand seven, I guess someone was staring at a picture of the human body from the inside out and locked in on that appendix and they're like, it's just sitting there attached to the scumb It's got to do something right. And they did some studying and testing I know exactly you like me, and they figured out this theory that this is a safe house essentially for that good bacteria. It's got a really rich uh biofilm, which is we've talked about biofilm in a bunch of episodes. I feel like it's like coating on the inside of the blindings of all kinds of things. Yeah, it keeps bacteria from being destroyed. It's like a protective mucus get exactly, which is you know that sounds gross, but it's a really a good thing. And the appendix is just lousy with this great biofilm. And they said, I think we think the Duke University blue devils think that this is a safe house for that good bacteria. Because when the body is being flushed out with diarrhea from his illness, the appendix is down there at the end of the cul de sact. It's not even getting affected, basically, right. And so when that bacteria leaves and takes the good with it, the appendix says, hi, I'm here, look at all my good bacteria friends, go forth and do your work. Exactly, goes bloop and pushes all like a big hunk of mucasy bacteria or bacteria ridden mucus into your large intestine to recallonized, which is amazing. And and all of a sudden, the science world was turned upside down because they thought they and it turns out they did find a use for the appendix. Yeah. Um, and not only uh is it a storehouse they found for bacteria, the good bacteria that make up our microbio. It's also a place where um lymphocytes and other immune cells are produced. Like it's called limphoid tissue, where like T cells, B cells. I think there's one called T natural killer cells, which you don't want to mess with the iced tea. Yeah, or um the uh Woody Harrelson and Julia Juliet lewis of immune cells. Um, they're produced in the appendix right. Um, So when the recollonization process is going on, you could still have bad bugs in are but to prevent them from taking hold, those immune cells come in and just wipe them out while the good stuff comes back in and recolonizes. So the appendix is a really apparently a very useful organ It has a use after all. Yeah, but you can still live without it. That's the weird thing. Why why if it produces this really important function, why would we still be able to live without it? I don't know. Oh, well, well we'll talk about it later. Well, now, what I didn't see anywhere was like if you have if you live you know in an adverse way because you don't have your appendix, Like does that make you more susceptible to certain things? If you have that food borne illness or right, okay, So here's the other thing. Um, the there was more support from the fact that you can have your appendix remove so there's more support for the idea that the appendix plays a role um and isn't vestigial, from the fact, weirdly that if you remove it, at least in the developed world, you're you're still gonna be okay without it. Okay, it makes no sense. It's a paradox. But then when they looked into the paradox there, like, actually, this does make sense because of that hygiene hypothesis that you mentioned earlier. Should we dive into it? All right? Uh? Well, hygiene hypothesis in a nutshell, And I recommend you listen to that episode because it was really good, but is sort of it goes a little something like this, uh and developing. I'm sorry. In the developed world are immune systems can be overactive, and that's why we have things like allergy allergies, especially food borne allergies to like peanuts and trimp that's sitting here in front of us thawing out slowly because our immune system really wants to do something. It is not good at Netflix and chill it likes to really be act of and if you've got clean water and really good fresh food and you know your body didn't have to worry about that kind of stuff, it starts to attack your body in other ways just because it wants something to do. Right. It's like one of those people at work who, like, you know, break something and then fixes it just to show they're working. Do people do that? There's gotta be some people out there we like nudge of vase off their desk or what right at the at the base putting back together plane? Okay, but there haven't been any breaks for a while, so I'm just trying to see how that would happen at our office, Like how does somebody break a podcast? Uh, you can break in RSS feed or something like that, or maybe an I T person who like screws up the system, so everyone's like, you gotta help us fix it, right, kind of like that? What about this? What about somebody who organizes things when they're already a certain way, but they just have too much idle time, so they organize stuff and all of a sudden there's a problem. That's kind of what I'm talking about. So um with the hygiene hypothesis. The idea as far as it relates to the appendix is that because we live in this very sanitary version of the world where we don't get hookwork, because we don't wear bare feet and poop outside, are drinking water is clean, we don't have like giardia in it typically um. Because we're not exposed to this stuff, our immune system is on high alert. So it attacks not just peanuts, but also potentially the appendix too, because it's just sitting there. It is just sitting there, but also remember it's a storehouse of bacteria. It's also a storehouse of um. The lymph system, so it's producing immune cells. And apparently, if you're a kid and you get appendicitist, which we'll talk about in a minute, all that whole thing, the number one cause of that is overproduction of limp cells. So it's possible that your immune system says, uh, this, this part of the body is producing a lot of weird immune cells are way more than it should. There's a lot of bacteria here. I hadn't noticed before. Let's go attack it. That your immune system attacks your appendix and causes inflammation and then that creates the Appendicitis that can be dangerous later. That sounds very weird. Why would anybody say that, Well, Chuck, turns out that there's a paradox that goes hand in hand with developing countries. Huh. Well, yeah, I mean they've seen this kind of proven out in developing countries is as they've become more developed and more industrialized, their rate of appendicitis has gone way up, and their body previous to that industrialization is maybe getting water that's not great for them or food that might carry some sort of food born illness. So their immune system is like, we're we we love this person in this culture because we're always busy flushing this system out with with diarrhea and we're just hard at work and we don't have time to to create some fake peanut allergy or to go after the appendix is not sitting there around do and anything. So they're it's just it's busy, and they've seen as they become more industrialized, Uh, appendicitiss have gone up and sort of lock step with that. Yeah, it happened in the United States and Europe in the beginning of the twentieth century. There was a big spy Like before that, there was no such thing. As appendicitis basically, Um, there was, but it was very very rare, and then huge, an enormous spike, and then it plateaus and stabilizes. I think in both Western and Eastern Europe and the US were hovered around a hundred cases per hundred thousand people of appendicitis these days UM over in like I think uh, South Korea UM around that time, no appendicitis. Later in the twentieth century, early twenty one century, as their development just went through the roof huge cases, a huge increase of appendicitis UM and there you can just kind of follow it around the world. As development comes, appendicitis goes up, and they think that it's this hygiene hypoths that explains it. So you've got the safe house theory that the pendix actually does have a purpose and a role, and then you have the hygiene hypothesis that explains, um, why appendicitis is a thing in developed countries. Well, should we take a break and dig into appendicitis? I think we should. It's going to be awfully painful and gross. I'll bet the ads everyone heard were just astounding. So we've been dancing around the appendicitis kind of this whole episode It was identified for the first time in six by Reginald Fitz and before that they just said, you know, if you've got an abdominal illness and you die because of it, it's you know, it's just you had a bad stomach ache that killed you. Sorry. Yeah. So sad Dave wrote one of my favorite lines in the history of stuff you should know articles. He said, fits was the first to finger the appendix is the culprit. I was like, man, finger the appendix. That's a that's a spinal tap record. That's gross. But you actually probably could finger the appendix because it is like it's like a little pouch. Just to just think about finger sized. Yeah, you can figure a whole forearm into uh. So Franco August appendix. Oh man, that's an intr so uh appendix, everyone the appendix. Everybody grow up, Calm down, calm down. Um. So the appendicitis happens because basically I mentioned it was a cul de sac. It's a it's the end of the road situation once you get to the far end of the appendix. But that other end that connects to the sikum is very narrow and the opening is not that bigg and it can get clogged up with bacteria. It can get clogged up with certain kinds of seeds to go through your body undigested hay seeds. Hay seed. Sure, it can get this is really gross. But it can get clogged with vecaliths, which are stone like pieces of petrified feces. My friend I saw that. That is the number one reason appendicitis and adults. Uh, it's a hard word to say, but they you know, that's what happened. The opening blocks, bacteria builds up, it gets inflamed, and inflammation is that sort of enemy of all the human body. And you start to get fever and nausea, you've got pain. You might get a pain in your sort of lower right side of your gut. Yeah, because that's where your appendix is. Like if you make a L shape with your thumb and forefinger, like the loser put exactly. I didn't want to say it, but okay, we're gonna get some email about that. Um the if you take the thumb and put it in your navel and point your finger to your hip, Okay, that is like in the little um. The is where your appendix is. Okay, where your thumb and yeah, the little webbing. Yeah, all right, Well that's if you get a pain there and you are nauseous and you might have a fever, then get thee to a hospital emergency room because you might have advanced appendicitis. At that point, you might have an appendectomy quick like they can do them super fast. Um, if you get it really really early, they might concure it with just antibiotics, which is great. But I think eighteen eighty seven, the very year after FITS identified the disease in six is when they had their first appendex tomy, which means they had been happening the whole time. They finally just said, oh wait a minute, I think it's the appendix is why all these people are dying from the stomach pains. So maybe we can start removing this little useless dangle. Yeah. I think it was a guy named Thomas Morton. Yeah, Thomas Morton was the surgeon who looks like he lost his brother and son. It was from mysterious stomach ailments, but it was probably ruptured appendixes and that's what happens at ruptures and then leaks bad stuff into your intestines and your your toast. Yeah. So so when the appendix is infected and it leaks that stuff. It perforates is what they called burst is another way to put it, depending I think on how bad it is. All of the infected pus. If there's fecalists in there, that whatever bacteria they have with them, um, all that stuff it bills, right, it spills into your abdomen, and your abdomen has an inner has an abdominal wall, and it has an inner coating called the peritonium. And the peritonium um is not to be infected with anything. It's very delicate. It doesn't like gross stuff. Keep all that and the appendix and the intestines and all that large intestine. But when your appendix bursts and releases all that stuff, it gets your paritonium infect and your paritonium is like a highway straight to your blood vessels, straight into your organs. And so all of a sudden, your infection goes from your appendix, which you can deal with, to your piritonium being infected, which means your blood and then your organs are infected, which means you can go into shock and you're you have a like cascading system failure. That's why it's such an emergency when you when you have like a pendicitis, because it may rupture and that can be problematic. Yeah, and you can still die from that. I think the surgery itself in the mortality rate from an appendectomy was now it's down to point well, it's one tenth of one percent whatever that is. That's pretty low, and that was since the mid fifties. But that's the that's the mortality rate for the appendectomy, right, for appendicitis. I think overall, maybe worldwide it's um I think point two to point eight percent, which means to between two and eight of every to and eight people who get appendicitis, out of every thousand people who get a pendicitis. There's kind to be an easier way to say this. Uh, they die from it, they buy the farm. Not many, but that's significant. If you're you know, eight people out of a thousand, that's one. I wanted that to be point eight. And I think the mortality rate is lowest in young people obviously, although young people between ten and thirty are the most likely to have an ependectomy, I think, right, yes, which is interesting, that's weird. Um, the reason that it's lowest and very young people is The common knowledge among um doctors and in the medical field is that the appendix has played a role for a long time, but it's just part of your immune system when you're very young. I have the impression that that is old school thinking, That is pre bacteria safe house thinking. What that young kids don't get it because they just have killer immune systems. Yeah, And that the appendix is just on fire and it's just happily working, and that it can become problematic after it stops providing it its function. The idea is that the younger you are, the more vulnerable you are to dying from diarrheal diseases, for infections, and so you would have a healthier immune system. And kids do have like just as hopped up immune system. But I think the medical understanding up until recently is that that the appendix plays a part of that, right, but that it stops functioning as you get older, and then you're vulnerable to appendicitis, and then after you make it out of the danger zone, you can just basically coast and get fecal with all day long blocking up your appendix and it doesn't matter. The new thinking is that, no, it's the storehouse for stuff. We just don't need it anymore because we don't really get diarrheal infections here in the developed world. Right, yeah, okay, that makes sense. But appendicitis is a thing, and if you do go to if you do have symptoms that seems weird, generalized pain around your navel or where your appendix is, you should go to the doctor. The thing is, as this new idea that the appendix actually does serve a function um has has, at least in some quarters, created this call for doctors to stop doing what are called negative appendectomies, where it's like, oh, you got stomach pain, let's take your appendix out and right, because supposedly a non perforated appendix may actually resolve itself, like it may go and like spit that set out and like go back to normal or whatever. Right, um, And you don't want to just lose your appendix willy nilly, for no. For one, you're undergoing surgery. There's always complications in rest of the point is, though, don't just stay home the the this one paper I read was like, you're better off for the physician to wait and see in the hospital. Keep you in the hospital under observation. So that if do need emergency surgery, you're there, um and then it may resolve itself on its own if it hasn't perforated already or um, and that that's that's preferable to just removing the appendix. Don't be like I can still play my street hockey game later, right. Yeah. I think they were saying, like, it's not up to you the patient, like just go to the hospital. I'm talking to the doctors right now. The paper was saying, of course, you know, don't remove the appendix if it if it doesn't need removing. Are we at Harry Yudini? Yeah, so this is a little addendum. Uh. I kind of think it's like an appendix. I kind of think we should do uh Harry Judini episode at some point, you bet, don't you think? Yeah, should we talk about this now at all? I think we should do Houdini around HALLOWEENI okay, okay, that sounds fantastic. I tried to think it's something to rhyme with Weenie. No, it's like a thumbs up like Magnafini. Oh that's great. That was Yeah, all right, I'm gonna stop it right there by using good Well, people really don't know that. I just left the room for like fifteen minutes trying to think of something and keep the magic of editing. Jerry didn't do like the star wipes. Uh. So there have been a few people who have died from a ruptured appendix. They believe that bring him young. The Mormon prophet did Um Charles Floyd the only person that Lewis and clark journey expedition to die. I didn't remember that, did you. I think I remember just mentioning. I do remember one person die and we're like, what was his problem? Why did he screw everything up? And it's hiss appendix. So Harry Houdini did die of an appendicitis. And I don't think we even said, uh, Perry and IDAs, Yeah we did, did we say that was the actual words? That's the Oh I don't know. But that's the affection of the peritonium. Yeah, that's the name of it. Though. Yeah, and that's what you do. You're like, you don't die from your appendix, person, because again, like, yeah, it provides a funk, but it's not it doesn't keep you alive. It's not like your heart bursting, right, It's it's the parent of the paratoneum getting infected that kills you. So Houdini did die of that. But you know, the old story is that he had come off stage. He was backstage in his green room and uh, presumably having smart food and beef jerky. If you're at the stuff, you should know show everywhere from opening the bottle. Oh, man, I can't wait to do that again. Uh, but I can't wait because I'm not doing that anytime soon. Still want to get on a plane, you know, not quite yet, but we're looking forward to that for sure. But you know, there are these college students came backstage and one of them was like, I heard that anyone can put you in the stomach and that you, uh, you can make your stomach strong and it won't even hurt you. And I'm a pretty good stomach puncher. He goes, well, that is sort of true. And the guy punches him before he even has a chance to really prepare and say, sure, bring it, and uh that the sucker punch and that burst as appended, and that's how he died. And that story is just a little blurry around the edges as how that went down exactly right. Yeah, So there there were there were eyewitnesses, and they did say that this guy um did punch Houdini. It's conflicting whether or not Houdini gave the guy permission to punch him. And I were the guy just started punching um. But there was a young man named Joscelyn Gordon white Head, white Head, Whodini's last words were done in by it guy named Jocelyn. I didn't see that. One account was that he was still laying on the couch and the and the guy started wailing on his stomach. Well, yeah, because he he had injured his ankle the the I think night before, a couple of days before, so he was reclining on the couch. I guess somebody was sketching him. Was basically like that scene in Titanic. Yeah, he was like and um and the guy started drawing right Uh, and then the guy punches him while he that happened. Uh. The question the thing that's that's that's sketchy is whether or not that guy punched Udini. In the appendix and Jodie's appendix ruptured where otherwise wouldn't have they think that that happened. Very very rarely appendicitis prodom by blood trauma. Um, they think that he probably had appendicitis already. This guy punched Harry Houdini in his inflamed appendix, and that that created problems. So the guy definitely killed Houdini one way or the other. It's just did Houdini already have appendicitis or not? And he probably did? Most most scholars say yes, there's just no way this this little guy from McGill University. I mean, come on, the Canadian Harvard, give me a break. Yeah. Um, that that he burst Houdini's appendix. Yeah. I was had a weird brief Houdini obsession when I was a little kid. Oh yeah, I think I did a you know, some sort of visual report, you know when you would just do not even maybe it was a book report, an interpretive dance. Is that what you're saying. Yeah, that's what it was. But yeah it was on Judini, and I was just for a little while, I just was really Hudini obsessed and then kind of magic obsessed. Oh yeah, and then you have one of those kids at a magic phase. Did you have a kid. I may have had a kid. Did you go to like the trick shops magic shops? Yeah, there was one called Eddie's Trick Shop here in the Stone Mountain. Then I went to That's awesomes were great deck of fake cards or some nice fake vomit or yeah, and you always looked up to the person behind the counter and then you grew up and you're like, oh, that's a used to work. They're kind of thing. Yeah, it was the magic shop and then the place that sold sold old mad magazines. Those were the two greatest places on the planet. When you're a certain age, you know, yeah, you got anything else about Appendix appendicitis Judini, this is a good I quite enjoyed this experience. I did too, Thanks to you guys for listening. And uh, since we don't have anything else about the appendix, that means it's time for a listener mail. I'm gonna call this great idea from a ten year old listener and this one, this one is genuinely going in the two do file. Uh, dear, and this is short and sweet deer Chuck Bryant and Josh Clark. Hi, my name is Jack and I'm ten years old and from hi Watha, Iowa. And I listen to your podcasts while I'm mo. My dad introduced me to your podcast and they've been great. My favorite one so far was probably Titanic. It's really interesting. Before I listened to that one, I wasn't really interested in the Titanic, but when I listen, I got more interested. I was wondering if you ever thought doing one on child labor It was after am the Grass, So okay, yeah, I learned about it in school and want to know more about it. Thank you for all your great podcast. And then it's from Jack and that is is on brand of stuff you should know episode as I've ever heard. Yeah, but also coming from child Laborer, it really kind of has a certain like glow to it, you know. Yeah, I think, uh, that's a great idea. I wonder if this kid is just like, I'm gonna get my parents back for this maybe because do you remember wanting to mow the grass when you were ten? Totally and then you started to about the third or fourth time, You're like, I've made a terrible mistake. Well, it'll depend that, but it also depended on the kind of mo word that your parents stuck you with. We did have a writer for a short time, so that was kind of pre go card car driving. Yeah, it's like driving, Yeah, but with it blade spinning at thousands of RPMs right beneath like sure, just put that nine year old in the sea right, Who is that again? That was Jack? Jack? Thank you, great name, great idea, great person all around, Coming soon like you can. You can count on that one, Jack. If you want to get in touch with this like Jack did with the Great Idea, we are always open for those. Take your idea, wrap it up, spank it lightly on the bottom, and send it off to Stuff podcast at i heeart radio dot com. Stuff you Should Know is a production of I Heart Radio. For more podcasts my heart Radio, visit the i heart Radio app, Apple Podcasts, or wherever you listen to your favorite shows. H

Welcome to Stuff you should know, a production of I Heart Radio. Hey you, welcome to the podcast. I'm Josh Clark. There's Charles w Chuke Bryant's willing away in some champagne. You're sorry, sparkling my shando and so it's from NAPA. And there's Jerry over there, Jerry Scudder champagne too. We're all just hanging out. We're gonna talk to you guys while we wait for the shrimp cocktail with aw literally and that makes this stuff you should know. That's right. Uh, we're back in the same room everybody for the first time in about fourteen months. And Jerry brought in champagne and frozen shrimp cocktail. There's a story behind that. Go ahead and say it. You go ahead and say, I don't remember you were the shrimp you first started it, Like I feel like twelve years ago we we we were tracking to hit number one on iTunes in like two thousand and eight, I think at the beginning of two thousand no nine maybe whatever, and um, I was like, I want a shrimp cocktail in the in the recording studio when we hit number one. We hit number one, came and went stayed number one, hit number one again. No shrimp cocktail. This is the shrimp cocktail from two thousand nine. Yeah, finally has made an appearance, and it's frozen. It might literally be from two thousand It might be. It's turning. The veins are turning kind of purple as it thaws. I can't wait to eat the shrimp cocktail. Yeah, we're having shampagne. Jerry classed it up basically, I feel I feel it was a nice homecoming she did. But the three of us are fully backs. Were in a room together. The microphones don't have fake years attached to them. Yeah, I mean that joke won't make sense to you now, But we recorded another episode before this one, but it was getting released later, so this technically our second episode. It just put that in your button and smoke it in your hat. What do you talk about? Have a weird urged a curse? I don't know why. I think you just did so, Jerry Beppe bp P p peep. But it's it's great to be back together in a little weird um, but not as weird as I thought it would be. That first one was weird because we're in a different room. Yeah, we got all the weirdness out in a weird situation, it would have been weird regardless. But now we're back in in Studio one A. That was a really good move. Jerry, did you plan it like that to get the jitters out? Jerry thumbs up. Jerry's real. Everybody she chooses not to talk. Jerry's let her hair grow out. I know she got a ponytail, but the first time I've ever seen it's got an even more peppery, no salty in a salt and pepper way. It doesn't get more peppery unless you make a you know, a move to make it so. And she looks like a wealthy retiree who drives a Maseratti and knows their way around the club. You know what I mean, That's what Jerry looks like. She looks distinguished but also foxy. Yeah. So I spent my last January of losing twenty five pounds and then COVID hit and now I have gained backunds. I'm exactly where I was. Is that right? Exactly to the pound? And it makes me really angry. Oh no, just go with you. Oh I know, but I just, you know, let me get back together. I was like, man, I'm doing so good. I'm so good pandemic And I was like, well, now I can eat and drink all I want because it's sad. So you lost the weight before the pandemic hit, Yeah, I hit it hard in January to junior March January one probably, yeah, okay, And like I was working with a trainer, like you know, so I was having to go to her every like three days a week, and just you know, I was making the right decisions and tracking and and the weight disappears. And then COVID hit and I just started making all the wrong decisions and let myself do that. Yeah, that happened to all of us, myself included. I went through what you went through where I lost a bunch of weight and I managed to keep it off. And then COVID hit and I was still doing okay, doing okay, maybe eating a little more than usual, like I'm not gonna let it happen though, and I was. I wasn't. And then our book hit, and that's what got me. When we were writing it and working on a two hours a day every day, I was eating so much weight. I gained book weight, and I actually I have not been this big since I don't know when. Man, but I still got it. So I'm I'm doing what I can. You look the same? I do? Well? Then I what I started two weeks ago was kicked in. I guess if I look the same, well, you look great. Great, everyone looks and feels great. Yeah, let's talk about the appendix, the Rodney Dangerfield of organs. This is one of my favorite articles that we've done in a while. Yeah, and you know how I often complain about science. This is a kind of science I love. Yeah. Understandable, Yeah, body science, understandable. Super cool. This factors into our hygiene hypothesis episode, our human microbiome episode, digestive system episode. Yeah, it all sort of fits together. In that little worm like organ, it's an organ, right, yeah, it's an organ. Yeah. A lot of people thought it was a vestigial organ. They're wrong, right, But that weird little thing, uh, hanging out there, just going just wiggling around like a little worm is really kind of cool and fascinating. And I love that it has a great story behind its lack of usefulness and then turns out usefulness. And it's just agreed, this is really good stuff. It's smashed bang stuff. You should know. That's right. Let's talk about it. So um, like you said, the appendix is like this little worm like thing that dangles off the bottom of the ascending coal and large intestine. Coal in large intestine and large bowl are the one and the same. So when you hear people say bowl, they're typically talking about that colon large intestine. It's all the same thing, which I found confusing until I looked it up and found okay, it's all that um two to four inches long the appendix right generally, although the biggest one was pulled out of a seventy two year old Croatian man named Sofranco August during his autopsy, and his was ten inches or twenty six centimeters long. What do you think they were like in that autopsy? They're like, wow, I think that the medical examiner's staff had a T shirt made up that Sofranco August was buried in that said, I've got the biggest appendix ever. Maybe, I mean that's crazy because when you, like I encourage you look up a picture of the appendix, it is it looks like a little worm and it's hanging there on this little bulbous pouch called the sikum, and the Sikim is kind of like where it's it's the part in between this all Intestine and Large Intestine where there there's an agreement that takes place, basically where the small Intestine it is like, all right, listen, I'll take all this food and I'll make it into clime, but I am not going into the fecal zone. Now you handle the fecal stuff, colon, And the colon says, fine, here's my buddy, the secum. It'll it'll service a little halfway house. You can pass everything along to me. I will broke rate, you won't get any poop on you Small Intestine, and I'll send it to the Large Intestine. But off of that Secum is dangling this this little dude yeah, which as far as anybody could ever tell, had nothing to do with digestion, which makes it really weird because everything else around here has to do with digestion. That's just what they do, that's their their their trade. And the appendix is just hanging out and people just thought, Okay, this this thing doesn't make any sense. But the fact that is attached there and doesn't seem to have to do with digestion, made people for a very long time think that it was a vestigial organ right, which we'll get into the specifics of one man who really championed that idea in a way that frankly made a lot of sense, and you can see why it took that many years for anyone to really poke around further into it. Yeah, because you're just like, yeah, you just explained it's sure. But there are other mammals that have secums, uh, and in some mammals, especially herbivores, that can be really big relative to their body size, because in herbivores it acts as the the predigestion house for plants, and since they're eating tons of plants, they have large secums. Yeah, plant fiber is really really good for you, but it's also really hard to digest a lot of cellulose um. And that's that large intestine coming into play again, because in the stomach and the small intestine there's um, a microbiota, a microbiome, which we talked about in that one episode the Human Microbiome Project. Um. There's some in the small intestine. I think there's far far less even in the stomach, but in the large intestine. That's where it really shines. And those microbes, the pathogens, the virus is the fung guy all of the and the bacteria most of all. They all kind of work or fight or play and digest this stuff. They break it down so that we can absorb it. They turn it into fiber. Um dietary fiber uh keeps you from absorbing a lot of sugar or fats or whatever at once. Um insoluble fiber bulks your stool up, so it really kind of gets everything out of the coal and really cleanses it when you finally poop. Hand gestures. Yeah, I've missed you seeing my hand gestures now that I think, even when we're recording at home, Um, I forgot what it's like to be seeing so um. So the large intestine has this microbiome that that lives in there, and just just remember that. That's a big important point. Yeah, put a pin in that, but not literally because that would be dangerous. Um. Out of the three sixty one mammal species, only about fifty of us have an appendix or something like an appendix. Obviously, the great apes do, rabbits, possums, wombats weirdly square poop. Did they really comes out in cubes? Really? Yes? I can't tell if you're messing with me right now? Wait, hold on, keep talking. You're thinking of the square watermelons in Japan, maybe thinking of all of bees. I'm pretty sure wombats have square all right, a rare in show check. But dogs and cats don't have appendix, cows don't, oranges don't, sheep don't. Oh yeah, little poop poop cubes square. Yeah, it looks like those ice cube chocolates. How do they? How does that happen? How do they? Yeah? How does that work? Um? I don't have time to read that, but it looks like there's a science alert from January that says wombats are the only animals that poop cubes and now we know how Okay, well that's a definite short stuff. Okay, we'll do it. Look for that soon. Uh So, back to the vestigial organ aspect. Charles Darwin is the person who came out and said, hey, I've been looking at these And by the way, that was named officially by an anatomous named Phelippe Verhan in seventeen ten. Appendix vermiformists, which means worm shaped detachment, and I think the first appendix removals in seventeen thirty five. But Darwin was the one who said, hey, everybody, I've been looking at these herbivores and they've got these really big Secum's giant for this, for this reason that Josh just described future Josh and he said, so, here's the deal is, when we see a bunch of plants, we had humongous secombs as well. And as our diet changed and we got away from plants, you know, our body started to change along with it, and that seek them just kind of shrank. And the appendix is just a little shriveled up piece of that formerly large secum and it's just dangling. They're doing nothing. Isn't that amazing? And everyone until two thousand seven said it sounds right to me. Darwin's got it right. It does. I mean, it totally makes sense and seems completely believable. Yes, But now that I know it was wrong, I questioned every single thing he ever thought of or set. Welcome to our world, Darwin, So you guys messed up that one thing. I just don't know I believe anything. May we hear that like every week too? Don't we it's fun so um. But yeah, it went for We went for well over a hundred and fifty years of just everyone believing that the appendix was a totally useless fastigial organ that had no function whatsoever any longer. And so it was fine if you just took it out, which is we'll see like people do a lot actually and it is fine for the most part, which we're lucky that it's fine. But also I think if if it weren't fine, we would have figured out very quickly, like, oh wait, this is you're not supposed to do that. So the fact that we were able to remove the appendix later on, um without a problem, um, just kind of lent to this, let's support to the idea that it was a Vista gi organ. Right. Um, But it turns out it does serve some function. We'll start talking about that. I think after a break, what do you think, Chuck? That was so smooth? Thank you so much smoother in person? All right, we're back from our break. Um, who knows what amazing as you guys just heard. But I'm envious of you because we didn't hear it. We just have a moment of silence in between that's right. Uh, And now we can talk about the microbiome a little more. And if you want to look into our Human Microbiome Project works show that was it's when fourteen there are trillion cells in the body. About thirty trillion of those are human cells with DNA and the rest of those hundred trillion are the microbiome. That isn't just amazing and it's really there's something about the digestive system that just frankly turns us both on a little bit. Yeah, there were these animations that can I remember who made them? Um many many years ago? Yes, but the animator just understood us on a level that even I'm like, I'm like, oh, I didn't know myself. Just little shorts from clips show. They did one about a four and a half minute clip from how the digestive system works, which is worth looking up on YouTube. It's where I watched it the other day. They are they were just gifted and talented. It's one of my favorite little things that we ever that someone ever did for us. I want to say, Nick Nick sounds right? Okay, I think it was Nick. I hope it's Nick Nick. Please like right in if you still listen. Nick moved on. Okay, well, anyway, they were really great. What Nick's work, and if it wasn't Nick, Nick's new nickname is Nick. That's right, Okay, So um, Yes, the digestive system does get us jazz, and in particular the microbiome, which we wouldn't have a digestive system, or at least one that functions, because again, those bacteria help us break down stuff that we would normally have trouble breaking down, help us form poop all of that stuff. And there's a it's a symbiotic relationship because in breaking those those things down, like that plant fiber for instance, they're eating, they're happy, they're reproducing, but then the byproducts and the stuff that they break open make that stuff bioavailable for us, so we can kind of get the nutrients and all that stuff from it as well. It's a beautiful relationship. Not all bacteria is good, though, No, there's the bad stuff. And we should point out that most of this bacteria is in that large intestine, uh, the in the stomach and the small intestine. Most of it's killed off by gastric acid. But the bad bacteria is if you eat some bad chicken or if you have you ever done that? Yes, yeah, you know me. I've had all manner of stomach issues over the years. Where where did you get your bad chicken? I don't remember. I don't remember specifically, but I know I've had bad food before that made me sick. And in my case in Guatemala, if you remember, you and Jerry both well, it was not me. You know what, we were even closing our mouth in the shower. We're being so careful. But on that last night it was the ice, the mixed drinks. I forgot the ice is made from water, and that water was not good for Americans. And I stayed home that night so I didn't get diarrhea. It was worth it though, Jerry and I had such a good time. So yeah, I got bad sick after our guatte trip. But that's the bad bacteria, and and that's how it can get into your body. And your body is solution to this, uh as Jerry can affirm, is is diarrhea. It's your body's way of saying, we're just gonna flush you out human being. Just get rid of everything, get rid of all the stuff. But that's gonna take a lot of the good stuff with it, and that's no good because if you have all the good bacteria or a large amount of good bacteria leaving your body, then that can leave you very vulnerable to nutritional deficiencies and other bad stuff. Sure, yeah, because I mean, like a lot of the neurotransmitters that make your brain function correctly or produced in your gut from the function of the bacteria. Like, there's a lot of bad things that can happen if you don't have a balanced microbiome in your gut. Right. So Interroduke University in two thousand seven, I guess someone was staring at a picture of the human body from the inside out and locked in on that appendix and they're like, it's just sitting there attached to the scumb It's got to do something right. And they did some studying and testing I know exactly you like me, and they figured out this theory that this is a safe house essentially for that good bacteria. It's got a really rich uh biofilm, which is we've talked about biofilm in a bunch of episodes. I feel like it's like coating on the inside of the blindings of all kinds of things. Yeah, it keeps bacteria from being destroyed. It's like a protective mucus get exactly, which is you know that sounds gross, but it's a really a good thing. And the appendix is just lousy with this great biofilm. And they said, I think we think the Duke University blue devils think that this is a safe house for that good bacteria. Because when the body is being flushed out with diarrhea from his illness, the appendix is down there at the end of the cul de sact. It's not even getting affected, basically, right. And so when that bacteria leaves and takes the good with it, the appendix says, hi, I'm here, look at all my good bacteria friends, go forth and do your work. Exactly, goes bloop and pushes all like a big hunk of mucasy bacteria or bacteria ridden mucus into your large intestine to recallonized, which is amazing. And and all of a sudden, the science world was turned upside down because they thought they and it turns out they did find a use for the appendix. Yeah. Um, and not only uh is it a storehouse they found for bacteria, the good bacteria that make up our microbio. It's also a place where um lymphocytes and other immune cells are produced. Like it's called limphoid tissue, where like T cells, B cells. I think there's one called T natural killer cells, which you don't want to mess with the iced tea. Yeah, or um the uh Woody Harrelson and Julia Juliet lewis of immune cells. Um, they're produced in the appendix right. Um, So when the recollonization process is going on, you could still have bad bugs in are but to prevent them from taking hold, those immune cells come in and just wipe them out while the good stuff comes back in and recolonizes. So the appendix is a really apparently a very useful organ It has a use after all. Yeah, but you can still live without it. That's the weird thing. Why why if it produces this really important function, why would we still be able to live without it? I don't know. Oh, well, well we'll talk about it later. Well, now, what I didn't see anywhere was like if you have if you live you know in an adverse way because you don't have your appendix, Like does that make you more susceptible to certain things? If you have that food borne illness or right, okay, So here's the other thing. Um, the there was more support from the fact that you can have your appendix remove so there's more support for the idea that the appendix plays a role um and isn't vestigial, from the fact, weirdly that if you remove it, at least in the developed world, you're you're still gonna be okay without it. Okay, it makes no sense. It's a paradox. But then when they looked into the paradox there, like, actually, this does make sense because of that hygiene hypothesis that you mentioned earlier. Should we dive into it? All right? Uh? Well, hygiene hypothesis in a nutshell, And I recommend you listen to that episode because it was really good, but is sort of it goes a little something like this, uh and developing. I'm sorry. In the developed world are immune systems can be overactive, and that's why we have things like allergy allergies, especially food borne allergies to like peanuts and trimp that's sitting here in front of us thawing out slowly because our immune system really wants to do something. It is not good at Netflix and chill it likes to really be act of and if you've got clean water and really good fresh food and you know your body didn't have to worry about that kind of stuff, it starts to attack your body in other ways just because it wants something to do. Right. It's like one of those people at work who, like, you know, break something and then fixes it just to show they're working. Do people do that? There's gotta be some people out there we like nudge of vase off their desk or what right at the at the base putting back together plane? Okay, but there haven't been any breaks for a while, so I'm just trying to see how that would happen at our office, Like how does somebody break a podcast? Uh, you can break in RSS feed or something like that, or maybe an I T person who like screws up the system, so everyone's like, you gotta help us fix it, right, kind of like that? What about this? What about somebody who organizes things when they're already a certain way, but they just have too much idle time, so they organize stuff and all of a sudden there's a problem. That's kind of what I'm talking about. So um with the hygiene hypothesis. The idea as far as it relates to the appendix is that because we live in this very sanitary version of the world where we don't get hookwork, because we don't wear bare feet and poop outside, are drinking water is clean, we don't have like giardia in it typically um. Because we're not exposed to this stuff, our immune system is on high alert. So it attacks not just peanuts, but also potentially the appendix too, because it's just sitting there. It is just sitting there, but also remember it's a storehouse of bacteria. It's also a storehouse of um. The lymph system, so it's producing immune cells. And apparently, if you're a kid and you get appendicitist, which we'll talk about in a minute, all that whole thing, the number one cause of that is overproduction of limp cells. So it's possible that your immune system says, uh, this, this part of the body is producing a lot of weird immune cells are way more than it should. There's a lot of bacteria here. I hadn't noticed before. Let's go attack it. That your immune system attacks your appendix and causes inflammation and then that creates the Appendicitis that can be dangerous later. That sounds very weird. Why would anybody say that, Well, Chuck, turns out that there's a paradox that goes hand in hand with developing countries. Huh. Well, yeah, I mean they've seen this kind of proven out in developing countries is as they've become more developed and more industrialized, their rate of appendicitis has gone way up, and their body previous to that industrialization is maybe getting water that's not great for them or food that might carry some sort of food born illness. So their immune system is like, we're we we love this person in this culture because we're always busy flushing this system out with with diarrhea and we're just hard at work and we don't have time to to create some fake peanut allergy or to go after the appendix is not sitting there around do and anything. So they're it's just it's busy, and they've seen as they become more industrialized, Uh, appendicitiss have gone up and sort of lock step with that. Yeah, it happened in the United States and Europe in the beginning of the twentieth century. There was a big spy Like before that, there was no such thing. As appendicitis basically, Um, there was, but it was very very rare, and then huge, an enormous spike, and then it plateaus and stabilizes. I think in both Western and Eastern Europe and the US were hovered around a hundred cases per hundred thousand people of appendicitis these days UM over in like I think uh, South Korea UM around that time, no appendicitis. Later in the twentieth century, early twenty one century, as their development just went through the roof huge cases, a huge increase of appendicitis UM and there you can just kind of follow it around the world. As development comes, appendicitis goes up, and they think that it's this hygiene hypoths that explains it. So you've got the safe house theory that the pendix actually does have a purpose and a role, and then you have the hygiene hypothesis that explains, um, why appendicitis is a thing in developed countries. Well, should we take a break and dig into appendicitis? I think we should. It's going to be awfully painful and gross. I'll bet the ads everyone heard were just astounding. So we've been dancing around the appendicitis kind of this whole episode It was identified for the first time in six by Reginald Fitz and before that they just said, you know, if you've got an abdominal illness and you die because of it, it's you know, it's just you had a bad stomach ache that killed you. Sorry. Yeah. So sad Dave wrote one of my favorite lines in the history of stuff you should know articles. He said, fits was the first to finger the appendix is the culprit. I was like, man, finger the appendix. That's a that's a spinal tap record. That's gross. But you actually probably could finger the appendix because it is like it's like a little pouch. Just to just think about finger sized. Yeah, you can figure a whole forearm into uh. So Franco August appendix. Oh man, that's an intr so uh appendix, everyone the appendix. Everybody grow up, Calm down, calm down. Um. So the appendicitis happens because basically I mentioned it was a cul de sac. It's a it's the end of the road situation once you get to the far end of the appendix. But that other end that connects to the sikum is very narrow and the opening is not that bigg and it can get clogged up with bacteria. It can get clogged up with certain kinds of seeds to go through your body undigested hay seeds. Hay seed. Sure, it can get this is really gross. But it can get clogged with vecaliths, which are stone like pieces of petrified feces. My friend I saw that. That is the number one reason appendicitis and adults. Uh, it's a hard word to say, but they you know, that's what happened. The opening blocks, bacteria builds up, it gets inflamed, and inflammation is that sort of enemy of all the human body. And you start to get fever and nausea, you've got pain. You might get a pain in your sort of lower right side of your gut. Yeah, because that's where your appendix is. Like if you make a L shape with your thumb and forefinger, like the loser put exactly. I didn't want to say it, but okay, we're gonna get some email about that. Um the if you take the thumb and put it in your navel and point your finger to your hip, Okay, that is like in the little um. The is where your appendix is. Okay, where your thumb and yeah, the little webbing. Yeah, all right, Well that's if you get a pain there and you are nauseous and you might have a fever, then get thee to a hospital emergency room because you might have advanced appendicitis. At that point, you might have an appendectomy quick like they can do them super fast. Um, if you get it really really early, they might concure it with just antibiotics, which is great. But I think eighteen eighty seven, the very year after FITS identified the disease in six is when they had their first appendex tomy, which means they had been happening the whole time. They finally just said, oh wait a minute, I think it's the appendix is why all these people are dying from the stomach pains. So maybe we can start removing this little useless dangle. Yeah. I think it was a guy named Thomas Morton. Yeah, Thomas Morton was the surgeon who looks like he lost his brother and son. It was from mysterious stomach ailments, but it was probably ruptured appendixes and that's what happens at ruptures and then leaks bad stuff into your intestines and your your toast. Yeah. So so when the appendix is infected and it leaks that stuff. It perforates is what they called burst is another way to put it, depending I think on how bad it is. All of the infected pus. If there's fecalists in there, that whatever bacteria they have with them, um, all that stuff it bills, right, it spills into your abdomen, and your abdomen has an inner has an abdominal wall, and it has an inner coating called the peritonium. And the peritonium um is not to be infected with anything. It's very delicate. It doesn't like gross stuff. Keep all that and the appendix and the intestines and all that large intestine. But when your appendix bursts and releases all that stuff, it gets your paritonium infect and your paritonium is like a highway straight to your blood vessels, straight into your organs. And so all of a sudden, your infection goes from your appendix, which you can deal with, to your piritonium being infected, which means your blood and then your organs are infected, which means you can go into shock and you're you have a like cascading system failure. That's why it's such an emergency when you when you have like a pendicitis, because it may rupture and that can be problematic. Yeah, and you can still die from that. I think the surgery itself in the mortality rate from an appendectomy was now it's down to point well, it's one tenth of one percent whatever that is. That's pretty low, and that was since the mid fifties. But that's the that's the mortality rate for the appendectomy, right, for appendicitis. I think overall, maybe worldwide it's um I think point two to point eight percent, which means to between two and eight of every to and eight people who get appendicitis, out of every thousand people who get a pendicitis. There's kind to be an easier way to say this. Uh, they die from it, they buy the farm. Not many, but that's significant. If you're you know, eight people out of a thousand, that's one. I wanted that to be point eight. And I think the mortality rate is lowest in young people obviously, although young people between ten and thirty are the most likely to have an ependectomy, I think, right, yes, which is interesting, that's weird. Um, the reason that it's lowest and very young people is The common knowledge among um doctors and in the medical field is that the appendix has played a role for a long time, but it's just part of your immune system when you're very young. I have the impression that that is old school thinking, That is pre bacteria safe house thinking. What that young kids don't get it because they just have killer immune systems. Yeah, And that the appendix is just on fire and it's just happily working, and that it can become problematic after it stops providing it its function. The idea is that the younger you are, the more vulnerable you are to dying from diarrheal diseases, for infections, and so you would have a healthier immune system. And kids do have like just as hopped up immune system. But I think the medical understanding up until recently is that that the appendix plays a part of that, right, but that it stops functioning as you get older, and then you're vulnerable to appendicitis, and then after you make it out of the danger zone, you can just basically coast and get fecal with all day long blocking up your appendix and it doesn't matter. The new thinking is that, no, it's the storehouse for stuff. We just don't need it anymore because we don't really get diarrheal infections here in the developed world. Right, yeah, okay, that makes sense. But appendicitis is a thing, and if you do go to if you do have symptoms that seems weird, generalized pain around your navel or where your appendix is, you should go to the doctor. The thing is, as this new idea that the appendix actually does serve a function um has has, at least in some quarters, created this call for doctors to stop doing what are called negative appendectomies, where it's like, oh, you got stomach pain, let's take your appendix out and right, because supposedly a non perforated appendix may actually resolve itself, like it may go and like spit that set out and like go back to normal or whatever. Right, um, And you don't want to just lose your appendix willy nilly, for no. For one, you're undergoing surgery. There's always complications in rest of the point is, though, don't just stay home the the this one paper I read was like, you're better off for the physician to wait and see in the hospital. Keep you in the hospital under observation. So that if do need emergency surgery, you're there, um and then it may resolve itself on its own if it hasn't perforated already or um, and that that's that's preferable to just removing the appendix. Don't be like I can still play my street hockey game later, right. Yeah. I think they were saying, like, it's not up to you the patient, like just go to the hospital. I'm talking to the doctors right now. The paper was saying, of course, you know, don't remove the appendix if it if it doesn't need removing. Are we at Harry Yudini? Yeah, so this is a little addendum. Uh. I kind of think it's like an appendix. I kind of think we should do uh Harry Judini episode at some point, you bet, don't you think? Yeah, should we talk about this now at all? I think we should do Houdini around HALLOWEENI okay, okay, that sounds fantastic. I tried to think it's something to rhyme with Weenie. No, it's like a thumbs up like Magnafini. Oh that's great. That was Yeah, all right, I'm gonna stop it right there by using good Well, people really don't know that. I just left the room for like fifteen minutes trying to think of something and keep the magic of editing. Jerry didn't do like the star wipes. Uh. So there have been a few people who have died from a ruptured appendix. They believe that bring him young. The Mormon prophet did Um Charles Floyd the only person that Lewis and clark journey expedition to die. I didn't remember that, did you. I think I remember just mentioning. I do remember one person die and we're like, what was his problem? Why did he screw everything up? And it's hiss appendix. So Harry Houdini did die of an appendicitis. And I don't think we even said, uh, Perry and IDAs, Yeah we did, did we say that was the actual words? That's the Oh I don't know. But that's the affection of the peritonium. Yeah, that's the name of it. Though. Yeah, and that's what you do. You're like, you don't die from your appendix, person, because again, like, yeah, it provides a funk, but it's not it doesn't keep you alive. It's not like your heart bursting, right, It's it's the parent of the paratoneum getting infected that kills you. So Houdini did die of that. But you know, the old story is that he had come off stage. He was backstage in his green room and uh, presumably having smart food and beef jerky. If you're at the stuff, you should know show everywhere from opening the bottle. Oh, man, I can't wait to do that again. Uh, but I can't wait because I'm not doing that anytime soon. Still want to get on a plane, you know, not quite yet, but we're looking forward to that for sure. But you know, there are these college students came backstage and one of them was like, I heard that anyone can put you in the stomach and that you, uh, you can make your stomach strong and it won't even hurt you. And I'm a pretty good stomach puncher. He goes, well, that is sort of true. And the guy punches him before he even has a chance to really prepare and say, sure, bring it, and uh that the sucker punch and that burst as appended, and that's how he died. And that story is just a little blurry around the edges as how that went down exactly right. Yeah, So there there were there were eyewitnesses, and they did say that this guy um did punch Houdini. It's conflicting whether or not Houdini gave the guy permission to punch him. And I were the guy just started punching um. But there was a young man named Joscelyn Gordon white Head, white Head, Whodini's last words were done in by it guy named Jocelyn. I didn't see that. One account was that he was still laying on the couch and the and the guy started wailing on his stomach. Well, yeah, because he he had injured his ankle the the I think night before, a couple of days before, so he was reclining on the couch. I guess somebody was sketching him. Was basically like that scene in Titanic. Yeah, he was like and um and the guy started drawing right Uh, and then the guy punches him while he that happened. Uh. The question the thing that's that's that's sketchy is whether or not that guy punched Udini. In the appendix and Jodie's appendix ruptured where otherwise wouldn't have they think that that happened. Very very rarely appendicitis prodom by blood trauma. Um, they think that he probably had appendicitis already. This guy punched Harry Houdini in his inflamed appendix, and that that created problems. So the guy definitely killed Houdini one way or the other. It's just did Houdini already have appendicitis or not? And he probably did? Most most scholars say yes, there's just no way this this little guy from McGill University. I mean, come on, the Canadian Harvard, give me a break. Yeah. Um, that that he burst Houdini's appendix. Yeah. I was had a weird brief Houdini obsession when I was a little kid. Oh yeah, I think I did a you know, some sort of visual report, you know when you would just do not even maybe it was a book report, an interpretive dance. Is that what you're saying. Yeah, that's what it was. But yeah it was on Judini, and I was just for a little while, I just was really Hudini obsessed and then kind of magic obsessed. Oh yeah, and then you have one of those kids at a magic phase. Did you have a kid. I may have had a kid. Did you go to like the trick shops magic shops? Yeah, there was one called Eddie's Trick Shop here in the Stone Mountain. Then I went to That's awesomes were great deck of fake cards or some nice fake vomit or yeah, and you always looked up to the person behind the counter and then you grew up and you're like, oh, that's a used to work. They're kind of thing. Yeah, it was the magic shop and then the place that sold sold old mad magazines. Those were the two greatest places on the planet. When you're a certain age, you know, yeah, you got anything else about Appendix appendicitis Judini, this is a good I quite enjoyed this experience. I did too, Thanks to you guys for listening. And uh, since we don't have anything else about the appendix, that means it's time for a listener mail. I'm gonna call this great idea from a ten year old listener and this one, this one is genuinely going in the two do file. Uh, dear, and this is short and sweet deer Chuck Bryant and Josh Clark. Hi, my name is Jack and I'm ten years old and from hi Watha, Iowa. And I listen to your podcasts while I'm mo. My dad introduced me to your podcast and they've been great. My favorite one so far was probably Titanic. It's really interesting. Before I listened to that one, I wasn't really interested in the Titanic, but when I listen, I got more interested. I was wondering if you ever thought doing one on child labor It was after am the Grass, So okay, yeah, I learned about it in school and want to know more about it. Thank you for all your great podcast. And then it's from Jack and that is is on brand of stuff you should know episode as I've ever heard. Yeah, but also coming from child Laborer, it really kind of has a certain like glow to it, you know. Yeah, I think, uh, that's a great idea. I wonder if this kid is just like, I'm gonna get my parents back for this maybe because do you remember wanting to mow the grass when you were ten? Totally and then you started to about the third or fourth time, You're like, I've made a terrible mistake. Well, it'll depend that, but it also depended on the kind of mo word that your parents stuck you with. We did have a writer for a short time, so that was kind of pre go card car driving. Yeah, it's like driving, Yeah, but with it blade spinning at thousands of RPMs right beneath like sure, just put that nine year old in the sea right, Who is that again? That was Jack? Jack? Thank you, great name, great idea, great person all around, Coming soon like you can. You can count on that one, Jack. If you want to get in touch with this like Jack did with the Great Idea, we are always open for those. Take your idea, wrap it up, spank it lightly on the bottom, and send it off to Stuff podcast at i heeart radio dot com. Stuff you Should Know is a production of I Heart Radio. For more podcasts my heart Radio, visit the i heart Radio app, Apple Podcasts, or wherever you listen to your favorite shows. H