Treatment : Part 2

Appendicitis
by John Henry Tilden

(Page 7 of 18)

An opium tympanites causes many physicians to mistake it (a drug-action, or a symptom induced by drug-action) for the tympanites caused by peritonitis. The great disadvantage of thus masking and perverting symptoms, which should be natural so that the physician can know at any hour of the day just exactly where his patient is, must certainly present itself even to a lay mind.

It surely is important to know that an opium-induced, phantom peritonitis causes pressure upon the diaphragm, which in turn crowds the lungs and heart, inducing precordial oppression - smothering sensations and simulating important symptoms which should be understood at once so that a proper remedy may be applied.

"In the following forty-eight hours, with irregular variations and a slight tendency to rise, the temperature ranged between 102.2 degree F., and 105.3 degree F. The pulse became more frequent but remained strong and uniform; the respirations were unaltered in character but increased in frequency to 48."

Unnatural and brought about by opium.

"The patient, unless under the influence of opium, was sleepless, his mind was clear, and he gave the impression of being extremely ill, although not in collapse."

This is peculiar to opium; it was too early for these symptoms to develop in this case; hence drugs brought them on.

"The pains, eructations and vomiting were decidedly relieved by the opium;"

A relief that was bought at a tremendous cost, for a time came in a very few days when it was hard to tell whether the vomiting was from the disease or from the drug. The increase in respirations was due to opium.

"but ice-bags for a time were not well borne and cold Priessnitz compresses were substituted. Vomiting was rare, was invariably bilious and coarse-grained; neither feces nor flatus were discharged; the urine was as before the diazo-reaction negative.

"Distention of the abdomen and the area of diffuse resistance increased; sensitiveness to touch appeared to be dulled by the opium; in the ileo-cecal region, however, it was constantly severe and lancinating. The liver dullness below decreased;"

Why not? Extending tympanites caused it - insignificant at most.

"the pulmonary-liver border extended to the upper border of the fifth rib; on the right side of the abdomen between the navel and the anterior, superior spine of the ileum a circumscribed slight dullness was observed."

This could have been taken for granted without unnecessary palpation.

"There was great nausea and burning thirst."

Already the opium was getting in its work. Great nausea and burning thirst were not due to the disease, and the crowding upward of the liver border was caused by the gas distention.

Diagnosis: Acute diffuse appendicular peritonitis, probably also perforation; circumscribed perityphlitic abscess.

The diffuse peritonitis was apparent to the eye but not to the reason as the course of the disease proves before many days.

"Operation was considered but not performed. Removal to the hospital for the purpose of an operation was absolutely declined by the patient."

"I saw him upon the following day, the fourth of the disease."

Undoubtedly this case had advanced to the seventh day when the description began.

"In general the severity of the clinical picture had increased, especially some of the individual symptoms: Severe, markedly febrile general condition; pulse 120 to 136, moderately full, regular."

Drugs and food caused the increase in the severity of the symptoms, for if the increase in pulse and temperature had been due to toxic infection, there would have been no amelioration of these symptoms, which we find takes place later.

"There was insomnia with occasional opium slumber; otherwise the mind was clear but anxious. The tongue was thickly coated, the lips were dry, there was tormenting thirst."

Ice and opium were getting in their work, increasing the nervousness and of course the fever.

"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.