APPENDICITIS- 5

CHAPTER V

    Symptoms: An acute attack is ushered in with severe pain. At first this is felt over the entire abdomen, but it is more marked near the navel than elsewhere. After about twenty-four hours it becomes localized in the region of the cecum.

    The pain is colicky or spasmodic in character, showing that it is due to peristalsis; food of any kind increases the peristalsis; hence the pain becomes more severe after feeding. Do not make the mistake of thinking that liquid food, such as milk, can be given, for a teaspoonful is sometimes sufficient to make the patient miserable for a whole day.

    The abdomen is tender, especially over the cecum, and should therefore be manipulated as little as possible, for it causes the patient unnecessary pain, and if an abscess has formed there is danger of breaking the walls which nature has thrown up.

    Nature's tendency appears to be to fix the inflamed portion so as to secure rest and this is accomplished by the muscles of the abdominal wall becoming rigid, especially over the cecum. These muscles are contracted to such an extent that the right thigh is often drawn up in order to relieve the tension.

    When the cecum is inflamed it is common for the colon to be loaded; this colon obstruction prevents the onward passage of the contents of the small intestine, and when they cannot free themselves and the peristaltic movements meet with sufficient obstruction to force a halt, the pain and suffering become intense. When the peristaltic movement has met with a few disappointments it reverses and empties the contents of the small intestine into the stomach. The result is nausea and vomiting which at times are both severe and persistent. But when it lasts beyond three days it is an indication of a complication or mistake in diagnosis, providing the patient has been properly treated.

    The abdomen becomes distended with gas if drugs and food are given; as regards the pulse, there is nothing characteristic about the pulse rate and the temperature in this disease. Sometimes the temperature does not go over 100° F., but at times it reaches 105 F. The pulse is sometimes so rapid that it is hard to count--due usually to drug influence--and again it may not go above 100 or 110 beats per minute during the entire attack.

    As these patients are nearly always constipated, and suffering from indigestion, they generally have a coated tongue.

    The above symptoms are those relied upon in making a diagnosis, and especially the first four-- pain, tenderness, rigidity, and nausea with vomiting--which are generally referred to as the four cardinal symptoms. Some authors give a "characteristic triad," namely: pain with tenderness of the abdominal wall, fever, and vomiting.

    A patient may have pain with tenderness, fever and vomiting, and be very far from having appendicitis. There is a world of difference in the importance of pain, the range being from no danger at all to absolutely no hope. Tympanites may mean a very simple state or an absolutely hopeless state. To be able to interpret the exact worth of symptoms means observation, study, reflection--labor and experience running over years--and a love of work that is not the good fortune of a very large percentage of mankind.

    Before we get through with this subject the reader will be shown how it is possible for highly educated men to be wholly unable to interpret the worth of symptoms. 

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