It has been very truly said that acute diseases are the sudden exaggerations of chronic disturbances of the vital forces. Manifestly it is also true, that the acute disease is more immediately dangerous to life than the deep-seated diseased condition, which is the starting point for the acute attack, in itself so alarming. Doubtless it is the duty of the true physician to endeavor to eradicate the chronic condition before it gives rise to the violent attack of acute trouble which we all dread to see. No physician, however skilful he may be, is always able to do this. Many times his first call to the patient is made, when an attack of terrible pain has made the attendance of a physician necessary.
The acute diseases of the abdomen are noted for their sudden onslaught and their rapid development. This is easily explained. In the abdomen we have an ideal field for rapid growth, heat, moisture and gases. This combination, unless quickly cured, leads to the formation of pus and gangrene, and when these end-products have formed, they very quickly become a terrible menace to life. The young and vigorous person is more prone to develop these acute states of disease than the older, more mature person, therefore the dire result of a failure to recognize and cope with the situation seems more tragic.
This is true Hahnemannian teaching, for in paragraphs III and Iv of the Organon Hahnemann says:.
“When the physician knows the obstacles to recovery in each case and how to remove them, he is prepared to act thoroughly and to the purpose, as a true master of healing.
“He is at the same at preserver of health when he knows the causes that disturb health, that produce and maintain disease, and when he knows how to remove them from healthy persons”.
Not all cases of acute abdominal trouble proceed to suppuration. How then can we tell definitely when pus is forming: by determining the amount of leucocytosis in each individual case. It has been discovered that leucocytosis always takes place in the formation of pus.
If we find by a process of careful elimination of every other locality, which is a possible seat for trouble, that the acute manifestation is confined to the abdomen, we know where the origin of the disease is.
The normal number of leucocytes is about 6000 to 7000; when inflammation is present they increase rapidly to 12,000, and from that point the red flag of danger is out. If the count goes above 16,000 we know that pus is localizing and the higher the count above 16,000 the more urgent the case becomes. Before this discovery, the physician was often deceived into thinking his patient was improving, for with the localizing of the pus, the temperature would drop and the pain become less, but with this seeming improvement, the danger of a fatal result increases. Then it is that we should exercise good surgery, for we know as the Organon before quoted says “the obstacle to recovery and how to remove it” and should operate and thereby preserve the life until we have time to cure the patient.
The following cases which have come under my care during the past winter, will illustrate my feeling in regard to these dangerous cases. Upon our alertness and ability to direct the preservation of life, depends our success as general practitioners of medicine.
PATIENT NO. 1.
Walked into my office, having come from a wedding; a large, well-framed man, fifty years of age, whom I have known for years, now very much stooped and apparently in acute pain. He told me this pain had come on very suddenly, and was located in the left side of the abdomen, when it first began three hours before. It was paroxysmal in type; was relieved by bending over upon it. His temperature was one degree below normal.
The right rectus muscle was under very rigid tension. He had vomited and complained of a severe headache. A blood count was taken and the leucocytes were 25,000. He was immediately removed to the hospital and operated upon when we found a ruptured appendix and quite a quantity of pus walled off in a pocket by itself. He made an uneventful recovery with drainage tubes, after which I was able to find his constitutional remedy, which has greatly helped him.
CASE NO. 2.
The next case was a child seven years old. Awoke in the morning with very acute pain, paroxysmal in type. The pain was largely confined to the right ilio-caecal region; the right rectus muscle was very tense. She was very tender to touch. She had vomited twice. Her temperature was 102. The blood count showed 25,400 leucocytes. I found this condition on my first call. She was removed to the hospital and operated upon when we found a large pocket of pus as the appendix was removed, and drained. She was in the hospital two weeks. Since then I have had her under my care and we are able to report that the homoeopathic remedy has done very much for her, in building up her general health.
CASE NO. 3.
The next case is a boy twelve years of age. I was called three days after the former one, the first time I had ever seen the patient. He was complaining of practically the same symptoms. The leucocytes count 20,000. We operated on the boy and found pus and a gangrenous appendix which had ruptured. He has made a good recovery and we are able to care for him now in a purely homoeopathic way.
CASE NO. 4.
In the next case I was called to one of the factories to examine a boy twenty years of age, who had been taken sick after dinner, with acute pain in the abdomen, centralizing in the right side. I could see that he was a very sick boy. I took a blood count and found a leucocytosis of 26,000. We operated on him at the hospital, and found an appendix very much swollen and filled with pus, which we removed without rupturing, so that we were able to close the wound entirely, and we removed him to his home in just one week.
CASE NO. 5.
The next case I want to report is that of my own son, who was attending class in college at 1 P.M. His professor stopped him to inquire how he was feeling, as he had noticed that he was not well, and advised him to come home immediately. I saw him at 7.30 that evening, and found a typical “acute abdomen”, except that there was no rigidity of the rectus muscle, but tenderness upon pressure. He had a temperature of 100; a blood count of 18,000 white cells.
He was immediately operated upon and we were able to remove without rupturing. This was located very deep, back of the caecum and extending into the pelvis, which accounted for the lack of rigidity of the rectus muscle. Following this operation he developed a very loose, rattling cough, with a great many coarse rales in the lungs. He had the typical dilation of the alae nasi. This brought to my mind his constitutional remedy, which has been his remedy for a number of years, viz., Lycopodium.
CASE NO. 6.
The next case I report because it illustrates the lack of proper attention on my part, as the physician. I was called one night after midnight, to see a colored man about twenty-two years of age, who was in very great distress from pain in the abdomen which was very tender to touch. Pain was paroxysmal; his temperature was 100; he had vomited. There was great urging to stool, but inability to accomplish the act. He reported that he had been operated upon for appendicitis two months before, and had that evening eaten three bananas. I administered Nux vomica and stayed with him for a half hour, when the pain had largely subsided. I left orders that if the pain returned, to let me know.
I heard nothing through the next day from the patient, so concluded that it was a case of acute indigestion, but the next morning the medical examiner called me at eight oclock and asked me whether I had attended this man and whether I thought he had heart trouble. He had died during the night.
I investigated the case afterward, and found the pain had been quiescent for two hours after I left and then had come on severely again the patient had neglected to call me. The undertaker reported to me that he had removed about two quarts or blood and pus from the abdomen. This undoubtedly was a case of strangulation of the gut, and I really believe, that had I known of the condition and taken a blood count, that we could have saved the man by an immediate operation.
My object in writing this paper and reporting these cases, is to show how we come upon suddenly and with no warning, very dangerous states, where there is no time to do aught but render the patients condition temporarily safe, after which we will be able to give the patient the full benefit of the curative action of the homoeopathic remedy.