Appendicitis: The Etiology, Hygenic and Dietetic TreatmentTilden, J. H. (John Henry)
Science
Appendicitis: The Etiology, Hygenic and Dietetic Treatment
Tilden, J. H. (John Henry)
Appendicitis
"The cheeks were red. The patient maintained the dorsal decubitus
with feebly flexed legs and hushed voice; the hands moved but
slightly and trembled."
[Narcotism.]
"Occasionally there were spontaneous attacks of severe, tearing,
abdominal pain, starting posteriorly in the lower right side."
[Why not? Food was being given, stimulating peristalsis.]
" The abdomen was very tympanitic and tense, and could scarcely be
touched; nevertheless, it was possible to determine upon the right
side low down an area of dullness about the size of a hand with
increased resistance; otherwise the note was tympanitic upon
percussion."
[The reader will notice the frequency of the reports regarding the
area of dullness and extension of tympanites. These frequent
examinations are wearing on patients in this condition, and are of
no consequence whatever; they start at nothing and end nowhere,
except in the discomfort and often the death of the patient; they
are practiced by too many physicians and should be discouraged for
they represent a very bad habit and are harmful; they are pushed to
a pernicious extent in some cases, for without doubt abscesses are
ruptured by them. If the physicians were not satisfied by this time
without the need of laying on of hands, observation and analysis
were lacking.]
"The diaphragm was raised; except for a small zone liver dullness
was absent."
[Of what possible benefit was this knowledge under the
circumstances?]
"Now and then there was grass-green vomitus which, the last time,
contained a few brownish granules and had a fecal odor. Urine
unchanged; micturition very painful; no feces."
[Proof positive that there was no peritonitis yet, and the
indicating symptoms were those of opium.]
"Opium at first decidedly influenced the condition; the patient took
daily 0.5 to 1.8, and since yesterday morphin subcutaneously 0.02 at
a dose."
[Of course, anyone acquainted with opium knows that it loses its
effect, but it never fails to do its damage. The daily intake of
7-3/4 grains to 27.5 grains must lead to trouble.]
"Ice bags were not well borne, and Priesslitz compresses were used
continuously. The intake of food was reduced to almost nothing."
[Not one teaspoonful of food should have been given; under such
treatment this case would have been very comfortable. Foods and
drugs were the cause of the discomfort.]
"With a sharply circumscribed perityphlitic abscess there could be
no doubt of the diagnosis of diffuse peritonitis nor of the
indication for operation on account of the long continuance of the
severe symptoms. But neither this proposition nor that of an
exploratory laparotomy, the result of which might have induced the
patient to yield, was accepted."
Public-domain text, read in full here on John Shaqi.
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