Several years ago a man who was a very good friend of mine developed appendicitis. His wife was a Christian Scientist, and because of her peculiar beliefs she prevailed on him to keep away from medical doctors and trust in the healing powers of Divine Providence.
Now Divine Providence is a kindly soul and if properly used certainly puts the patient in a good frame of mind to withstand operative procedures. In this case, though, my friend developed a ruptured appendix and when he applied to me for treatment the case had gone too far. However, I operated on him at once and found the abdomen saturated with pus. I removed the appendix, swabbed out the peritoneal cavity and put in drainage.
For two days following the operation I felt greatly encouraged because drainage was quite free and remaining in the sitting position did not tire him. On the third day ileus developed and with it vomiting and great pain with peritonitis and tympanitis. In spite of our best efforts the patient died on the fifth day.
Since that time the sulfa drugs have been highly eulogized as a cure for nearly every disease which flesh is heir to. I have seen some of the most terrible results following the use of these drugs and have been so prejudiced against them that I have refused to use them.
Two years ago a boy ten years old was brought to me because of severe abdominal pains. On examination I found the appendix had ruptured and that the condition undoubtedly was one of gangrene. I felt the boys chances of recovery were very poor indeed, but I operated on him at once and in spite of my prejudice against the drug (sulfanilamide) I removed the gangrenous appendix, sprinkled perhaps a dram of powdered sulfanilamide in the pocket in the bowel and inserted drainage.
It has always been my custom to give a high potency of the indicated remedy, which is usually Aconite, Ipecac or Arnica, as soon as the patient is able to take the medicine following the operation. In this case Aconite was indicated and one powder was given on the morning of the second day to be repeated if restlessness and high fever occurred.
I found the Aconite acted with just as much influence as though the sulfanilamide had not been used, and I found it necessary to use only a very small amount of morphine.
Because I had used sulfanilamide locally I watched the case with a great deal of interest, and whereas without its use in pus cases a very penetrating and disagreeable odor emanated from the wound, with the use of the sulfa drug locally no odor was given off. The boy did not develop any peritonitis or any tympanitis and the tube was removed on the eighth day and he went home on the ninth day.
Since that time I have used sulfanilamide locally in a number of cases and have formulated the following rules for my use of it:.
1. Sulfanilamide may be used locally in a gangrenous or suppurating wound with great benefit in the healing process providing drainage is used. Its action seems to be local and because of the drainage there is very little absorption in to the system. It is just an active local antiseptic.
2. Its localized action when used as above seems to have very little effect in antagonizing the indicated remedy, because most of its dilatory action is drained off.
3. I do not use any of the sulfa drugs in a wound which I close, but only when drainage is inserted. In my cases where I have used the sulfa drugs locally and closed the would, absorption of the drug took place and interference with action of the indicated remedy resulted, also the wound did not heal kindly. Very frequent sloughing around the stitches occurs and general healing and the well being of the patient is slowed down considerably.
4. I have used very little sulfa drugs either by mouth or by injection, for the reason that the indicated remedy has a better and a more prolonged action and cooperated with nature in the way I like.
I am convinced now, however, that sulfanilamide is of great benefit as a local antiseptic if not confined, and in surgical cases where infection and pus endanger the patients life I use it when drainage is inserted.
FORT MORGAN, COLO.