A CASE OF APPENDICITIS


Since it is a medicinal case and should not be allowed to migrate into a surgical one, what shall be done? Shall we argue that, because of her advanced age and that she has passed the milestone of earthly travels, we should resort to palliatives and turn the case over to some good neighbour lady? No! We dont do business that way.


(From The Homoeopathic Recorder, August, 1905)

IN February of this year, early one morning, I was called to see a lady, 84 years of age, who was said to be very sick. On arrival I found her trying to vomit, each paroxysm causing most excruciating pain in the region of the appendix vermiformis; there was some effort at purging, but of no volume; there was a rise of one degree of temperature, great anxiety, death-like pallor of the face, cold hands and feet, a heavily coated tongue (white), and very severe pain across the abdomen, scanty and highly-coloured urine-in short, a very sick woman.

On enquiring learned from her that she had been in this condition nearly all night, was not able to lie down, but was a widow and alone and had no one to call in help.

I aided her to her bed, made a careful physical examination, found a very hard tumorous something in the region of caecum, great sensitiveness through the entire abdomen, and thought I had a case of appendicitis. A neighbour lady was called and I again looked over my case carefully, found a very weak heart, great dyspnoea on attempting to move, chronic rheumatic arthritis and a history of constipation and dysuria. An operation was impossible and much encouragement would compel a violation of present prognosis. But I have learned that in severe cases never to hurry, so I sat down and talked a little longer.

The abdomen was hard, but not tympanitic, tendency to bloating in lower abdomen soon after eating, the pains were all worse on the right side, the patient had for several days always felt worse toward evening, even this attack began on the evening before; there was a sallow complexion that looked like an approaching icterus; the pains in the right side of the abdomen were spasmodic and very sharp, and on the whole things looked discouraging. Then this question arose, as it seems to me natural: Is this a case for the surgeon or for the physician? Surgery was at once ruled out of the question.

(a) Because of age.

(b) Because of organic heart trouble.

Since it is a medicinal case and should not be allowed to migrate into a surgical one, what shall be done? Shall we argue that, because of her advanced age and that she has passed the milestone of earthly travels, we should resort to palliatives and turn the case over to some good neighbour lady? No! We dont do business that way.

While sitting by her bedside we saw that she was worse toward evening, for she emphasized this point, that the trouble was largely on the right side, that the urine we have just seen in the vessel was turbid, full of brick-dust sediment and very scanty, that for several days she felt a sense of satiety as soon as she attempted to eat, and since these points appeared to us as cardinal we put a few granules of Lycopodium 1m, in one-half glass cold water and ordered a teaspoonful every three hours until our return in the evening.

At 6 p.m. she was somewhat better in some ways, but it was the time of day to feel worse and she did so, and yet felt much better than she had expected to feel. The remedy was continued during the night, with hot cloths applied to parts affected. The following morning she had a stool of very large, lumpy faeces that caused her much pain on evacuation. Treatment continued.

At 6 p.m. was better; had a second stool of large lumps and the pain in the right side was lessening. The remedy was given every four hours, and the following morning more stool of the same nature, so that the poor old woman wondered where it all came from. During this time she had nothing but a liquid diet with all the water she cared to drink. The temperature became normal as soon as this large quantity of stool was expelled. After the third day she received no more medicine and made a splendid recovery in ten days. She has been in good health since then.

George E. Dienst