The Medical Treatment of Appendicitis.

Notwithstanding the tidal wave of argument presented by the faculty of the dominant school in favor of almost invariable operation for appendicitis, the patients are still dying under operation with alarming frequency, and many of the cases are showing but few pathological changes, on the opening of the abdomen, when every symptom apparently demanded an operation before the opening was made. I have had an unusual number of deaths brought to my attention lately, following immediate operation.

At the same time the arguments in favor of a rational medical treatment were never so many, nor so frequently presented as at the present time. There are actually hundreds of physicians who depend upon medicines rather than the knife, and who have learned how to correctly use the tools they depend upon, who have attended and have cured many cases of appendicitis of the more or less severe form, and who have lost no larger proportion of cases than those who operate. Scientific data to the contrary, I am more and more convinced every day, that the conservative method is the safest method, and the most satisfactory to the patient.

I have had under my observation in the past year, several cases who came to me from other physicians after having been operated on for appendicitis more or less remotely, who were suffering from the direct results of the operation, to such an extent as to render existence almost unbearable.

One young lady of eighteen is approaching a condition of despondency which is most sorrowful to contemplate, with constant and increasing distress which medicine does not seem to be able to relieve, which followed an operation for appendicitis which was performed, because there was some dysmenorrhea which was supposed to depend upon adhesions involving the appendix. Slight adhesions were found and that was all, and the appendix was removed, not because it was diseased, but because it was then convenient to do so, but every symptom has been aggravated by the operation. Another case in nearly every way similar to this has suffered for seven years. And still another young lady, the incision revealed a healthy appendix, with an ovarian cist, intestinal inflammation occurred and death followed within a week.

Dr. William Gregory writing to The American Journal of Clinical Medicine claims to cure his cases with medicine. He presents a clear diagnosis in 23 cases out of which only one was a surgical case. None of the others died.

His method is similar to that course which is popular with all those who succeed in curing these cases. It consists of persistent heat applied if necessary for days over the diseased organ; a mild but thorough irrigation of the intestinal tract, with avoidance of an intestinal irritation; avoidance of opium or morphin; avoidance of cold applications; an avoidance of food for at least the first twenty-four hours; the use of bryonia for its specific influence on serious inflammations, and those of the underlying structures; aconite for the fever, and belladonna to overcome hyperemia.

Another physician in the same journal presents a similar course of treatment with similar results. He has been in practice nearly thirty-five years, has not lost a patient or had one operated on. Such a statement as this is sneered at and jeered by surgeons, as has been done in my presence many times, and yet I am acquainted with a large number of conscientious men who will swear that this has been their experience also.

My method is similar to the above with the addition of echinacea to antagonize the formation of pus at any stage, and olive oil for its nutritional and lubricating influence.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.