A B C D E F G H I J K L M N O P R S T U V W X Z

Appendicitis: The Etiology, Hygenic and Dietetic Treatment

J >> John H. Tilden, M.D. >> Appendicitis: The Etiology, Hygenic and Dietetic Treatment



Created by Steve Solomon (ssolomon@soilandhealth.com)

APPENDICITIS

THE ETIOLOGY, HYGIENIC AND DIETETIC TREATMENT

BY JOHN H. TILDEN, M.D.

Author of

"Impaired Health," 2 Vol.; "Cholera Infantum," "Typhoid Fever,"
"Diseases of Women and Easy Childbirth," "Venereal Diseases,"
"Appendicitis," "Care of Children," "Food," 2 Vol.; "Pocket
Dietitian."

=====================NOTICE*===================

You have recently purchased some of my earlier writings, hence the
following suggestion:

As my regular readers know, I do not favor the use of _protein_ and
starchy foods in the same meal. The only exceptions that I ever made
to this combination was the use of potatoes with meat in the same
meal and the serving of milk with starch. I still allow the
occasional use of potatoes with meat for well people, for the potash
content of the potato helps with the digestion of these two foods.
_But the combination of milk with starch I discontinued some years
ago._

In some of my former writings this correction has not yet been made,
therefore we are asking our readers to keep this in mind when
studying those particular works. Where you find milk in combination
with starch, change the milk to teakettle tea, which means hot water
with a little cream (which is fat, not protein) and a small amount
of sugar.

In some of my former writings this correction has not yet been made,
therefore we are asking our readers to keep this in mind when
studying those particular works. Where you find milk in combination
with starch, change the milk to teakettle tea, which means hot water
with a little cream (which is fat, not protein) and a small amount
of sugar.

*(This notice was slipped inside the book, printed on a small,
glossy sheet. Editor)





THE ROAD OF ILL HEALTH




To understand the cause of appendicitis we must go back to the
beginning, and when we do we find that it starts just where all
diseases start, namely, _where health leaves off! _When the laws of
health are broken for the first time, it can be said that the
individual has started on the road of ill health. How fast he will
travel and just what will be the character of the disease he meets
with will depend upon his constitution, inheritance, environment and
education.





APPENDICITIS





CHAPTER I.




This cut represents the back view of the cecum, the appendix, a part
of the ascending colon, and the lower part of the ileum, with the
arterial supply to these parts.

"A, ileo-colic artery; B and F, posterior cecal artery; C,
appendicular artery; E, appendicular artery for free end; H, artery
for basal end of appendix; 1, ascending or right colon; 2, external
sacculus of the cecum; 3, appendix; 6, ileum; D, arteries on the
dorsal surface of the ileum."--Byron Robinson.

The reader will see how very much like a blind pouch the cecum is,
2. The ileum, 6, opens into the cecum, all of the bowel below the
opening being cecum, the opening of the appendix, 3, is in the lower
part of the cecum.

The arterial supply to these parts is great enough to get them into
trouble in those people who are imprudent eaters, and it is also
great enough to save the parts when diseased if the patient has the
proper treatment.

For the benefit of the lay reader I will say that the blood-vessels
represented in the cut are the arteries; there are also veins,
nerves, and lymphatics imbedded in the folds of the peritoneum,
accompanying and paralleling the arteries, but they are not shown in
the cut.

The peritoneum is the lining membrane of the peritoneal cavity. It
is well to remember that there is nothing in the peritoneal cavity
except a little serum. The layman will say that the bowels are in
this cavity, but they are not; they project into the cavity, and
their outside covering is the lining membrane of the peritoneal
cavity, but they are truly on the outside of the cavity, and to
enable the layman to understand the anatomy so that he can apply it
when reading of the disease, I shall describe the course of an
ulcer: If an ulcer starts in the bowel it first eats through the
mucous coat which is the lining membrane of the bowel then through
the submucous coat, which is the second layer or coat of the bowel,
then through the muscular coat, which is the third layer of the
bowel; this brings the ulcer to the serous coat or peritoneum. When
the peritoneum is eaten through it is called perforation, for it
means that there is an opening into the peritoneal cavity, and,
unless the cavity is cut into, cleaned and properly drained death
will take place in a very short time. I say death is inevitable
without surgical treatment. In this I appear to be more radical than
the most radical, for the best authors have much to say about
perforation, diffuse peritonitis, and of patients who live after
perforation, as though it were a common occurrence; I say they are
mistaken.





CHAPTER II




_History: _Appendicitis did not become popularly known until about
twenty years ago--not till it was christened and baptized in the
blood of the surgical art. Of course the appendix has always been
subject to inflammation, just as it is now, but in former years the
disease we call appendicitis bore various names, depending upon the
diagnostic skill of the attending physician. Typhlitis and
perityphlitis were the names used to designate the disease now
covered by the word appendicitis.

The diseases that appendicitis may be confounded with and must be
differentiated from are obstruction, renal colic, hepatic colic,
gastritis, enteritis, salpingitis, peritonitis due to gastric or
intestinal ulcer, enterolith, obstipation, invagination or
intussusception, hernia, external or internal, volvulus, stricture
and typhoid fever.

The old text-book description of typhlitis and perityphlitis is so
similar to the description of the present day appendicitis that it
is not necessary to reproduce it. The symptoms given show
conclusively that they are really one and the same.

In the surgical treatment of appendicitis the American profession
has taken the lead, and the mention of this disease brings to mind
such names as McBurney, whose name is given to an anatomical
point--McBurney's Point--midway between the right anterior superior
spine of the ileum and the umbilicus, Deaver of Philadelphia, and
Ochsner and Murphy of Chicago. Those who are interested in the
surgical treatment of the disease can look into the methods of these
men, and many others. The medical literature of the day abounds in
exhaustive treatises on the subject of appendicitis and its surgical
treatment.

We are living in an age that will not be properly recorded unless it
be entered as _The Age of Fads._

Following immediately on the announcement of Lord Lister's
antiseptic surgical dressing which rendered the invasion of the
peritoneal cavity comparatively safe, came the laparotomy or
celiotomy mania. When it was discovered that opening the abdomen was
really a minor operation, it was soon legitimatized by professional
opinion, and rapidly became standardized as a necessary procedure in
all questionable cases--in all obscure cases of abdominal
disease--where the diagnosis was in doubt. The result of
popularizing and legitimatizing the exploratory incision, was to
cause those who failed to resort to it, in doubtful eases, to be in
contempt of the court of higher medical opinion, and to license
those of a reckless, selfish, savage nature to play with human life
in a manner and with a freedom that would make a barbarian envious.

The wave of abdominal operations that swept the country in the last
quarter of the nineteenth century was appalling. The slightest pain
during menstruation, or in the lower abdomen, in fact every pain
that a woman had from head to toes was put under arrest and forced
to bear false witness against the ovaries. It was a very easy matter
to trump up testimony, when real evidence was embarrassing, to
foregone conclusions; hence pains in obscure and foreign parts took
on great importance when analyzed by minds drilled in the science of
nervous reflexes, sympathies and metastases.

Normal ovariotomy (removing normal ovaries for a supposed reflex
disease) swept the whole country during the eighties and threatened
the unsexing of the entire female population. The ovaries had the
reputation of causing all the trouble that the flesh of woman was
heir to. Oophorectomy was the entering wedge, since then everything
contained in the abdomen has become liable to extirpation on the
slightest suspicion.

Those surgeons of greater dexterity or savagery, I can't tell which,
prided themselves in operating on the more difficult cases. Taking
the ovaries out was a very tame affair compared to removing the
uterus, tubes and ovaries; hence the surgical adept embraced every
opportunity for an excuse to remove everything that is femininely
distinctive.

About 1890 appendicitis began to attract the attention of those
surgically ambitious. The ovariotomy or celiotomy expert began to
feel the sting of envy and jealousy aroused by those who were making
history in the new surgical fad--appendectomy--and they got busy,
and, as disease is not exempt from the economic law of "supply
always equals demand," the disease accommodatingly sprang up
everywhere; it was no time before a surgeon who had not a hundred
appendectomies to his credit was not respected by the rank and file,
and an aspirant for entrance to the circle of the upper four hundred
could not be initiated with a record of fewer than one thousand
operations.

Thanks to the law of supply and demand the ovaries retired and gave
women a much needed rest. If they had continued to misbehave as they
had been doing before the appendix got on the rampage, the demand
for surgical work would have exceeded the supply of surgeons.
Diseases of all kinds are very accommodating; as soon as a
successful rival is well introduced they retire without the least
show of jealousy, showing that they are not strangers to the highest
ethics, their associations to the contrary notwithstanding.

There are many well written articles on appendicitis, but I believe
the monograph by A. J. Ochsner, M. D., is decidedly the best, and
when I refer to the best professional ideas on etiology, pathology,
symptomatology and treatment I have in mind the opinions set down by
Ochsner, for he has taken more advanced grounds in the medical
treatment of this disease than any other physician I know anything
about in this or any other country. If his "A Handbook on
Appendicitis" brought out in 1902, had come out three years before,
I should give him credit for being the first man on record to
proscribe the taking of food in appendicitis, but as my first
written advice on the subject was in the July, 1900, number of A
Stuffed Club,* two years before his book, I shall give myself the
credit for being the first physician to announce to the world _the
only correct plan of treating the disease and suggesting the
probable cause _which the intervening time has proven to be correct
The only reason I have for making this announcement is that in all
probability no one else will ever do so, and, as it is just and
right that I should have the credit, I do myself the honor. The
general rule is that if a new method of treatment comes out, or a
discovery of importance is made other than in the regular
professional channels, it will either be ignored or adopted (cribbed
is more expressive) and no credit given. This is a small matter, and
of no special consequence, yet it carries a meaning.

*(Editor's note: "A Stuffed Club" was the newsletter or journal
published by Dr. Tilden for many years.)

Previous to 1890 the most popular treatment was probably the giving
of opium; although this was far from ideal, "it had the advantage of
taking away the patient's appetite, relieving pain, and putting the
bowels to rest."--Ochsner. If there were any way to prove it, we
should find that next to surgery opium is still the most popular way
of treating the disease.

To-day there is no other disease which brings surgery so quickly to
mind as does appendicitis, especially if the victim can stand for a
good, large fee. It is only human I presume, for surgeons to defend
the operation. They believe in it, and are not willing to
investigate, for they are satisfied. They know or should know that
ninety per cent of all the surgery practiced to-day has no excuse
for its existence--no more right to be protected by the laws that
weld society together than has any other graft that exists by the
grace of public ignorance and credulity. This operation has for some
time been the largest single item of revenue for the profession.

Thirty-four years ago I was called in consultation to see my first
case of what was then generally recognized as perityphlitis or
typhlitis--inflammation of the connective tissue about the cecum. It
was a typical case of what is today called appendicitis. I advised
the doctor to cease his fruitless endeavors at securing relief by
giving drugs, and give the patient nothing but water. As I remember
now, it took about four weeks for this patient to recover. This
plan--positively nothing but water--has since been a part of my
treatment in all such diseases.





CHAPTER III




_Etiology: _To understand the cause of appendicitis we must go back
to the beginning, and when we do we find that it starts just where
all diseases start, namely, _where health leaves off! _When the laws
of health are broken for the first time, it can be said that the
individual has started on the road of ill health. How fast he will
travel and just what will be the character of the disease he meets
with will depend upon his constitution, inheritance, environment and
education. I do not mean by education, school or book education; I
mean intuition--that knowledge which evolves from home life and
habits. I mean, has he any self-discipline? Does he know anything
about self-denial? Has he any conception of a control higher than
impulse? Has he been brought up to know that there is a limit to the
gratifying of wants and desires beyond which, if he goes, he must
make good with laws that are as exacting as they are invariable?
Does he know that nature shows no favoritism? Does he know that
there are laws regulating his intercourse with men--with
everything--that exact absolute justice from him? And that, if he
takes advantage of weakness or ignorance because he can, or if he
secures an advantage through credulity or trickery, he must settle
for the crime before a judge who is absolutely just! If he has this
education, which is a constitutional ingrafting from the mother's
blood, fructified by a like potential father, he will be almost
immune from all diseases. This is an education that can not be
secured unless the individual has the prenatal and environing
influences to differentiate these static attributes of his nature,
and, if he has, the result will be that all these qualities will
come to him because "like attracts like." In an atmosphere where
others attract evil this individual attracts good. The same is true
on the physical plane. Those who have diseased bodies always have
disease making habits, hence they attract from a given environment
all the disease making impulses, while those of healthy bodies have
health imparting habits, and attract from the same environment the
health impulses for which they have an affinity.

The constitution, inheritance and education of all mankind will vary
from the highest to the lowest types. As we go down the scale from
those with ideal physical and mental health, we see man becoming
more and more the victim of disease.

It is no uncommon thing to find people of seeming intelligence who
appear surprised when told that they have brought upon themselves
such a vulnerable state of health from wrong eating and care of
their bodies that they are in line for appendicitis, pneumonia,
typhoid fever, bowel obstruction, or blood poisoning. In such types
blood poisoning would surely follow a complicated fracture of a
bone--a fracture where the ends of the bone cut through the flesh
causing an open wound.

Pregnant women belonging to this class go into confinement with
their blood so heavily charged with the by-products of an imperfect
metabolism that they are very liable to have septicemia.

People who think they must have "three square meals a day" must
have catarrh, rheumatism, tonsilitis, quinsy, pneumonia, typhoid
fever, and all sorts of bowel trouble including appendicitis. Why!
Because three meals a day consisting of bread, potatoes, eggs, meat,
fish, butter, milk, cheese, beans, etc., overwork the metabolic
function and as a consequence organic functioning is impaired, cell
proliferation falls below the ideal, bodily resistance falls lower
and lower, the intestinal secretions lose their immunizing power
more and more, until at last the body becomes the victim of every
adverse influence. At first fermentation--indigestion--shows
occasionally; the intervals between these attacks of acid stomach,
or fermentation, grow shorter and shorter until they are of daily
occurrence; accompanying this fermentation there is gas distention
of the bowels, and this inflation in time interferes with their
motility and weakens them so that sluggishness is succeeded by
obstinate constipation.

Every step of this evolution shows an increasing toxic state of the
fluids in the bowels. After constipation is established the efforts
at securing evacuations are of such a nature as to irritate the
cecum. Drugs to force movement cause painful distentions of this
portion of the bowels. The drugs stimulate peristalsis of the small
intestine; each wave from the small intestine breaks on the walls of
the cecum, for the colon is loaded with fecal accumulations so that
the onrushing contents of the small intestine can not be received by
the colon; hence the force of the whole peristaltic impact is spent
on the cecum, which must endanger the integrity of the mucosa as
well as the musculature.

This point of the bowels, the cecum is more endangered from diarrhea
than any other. The toxic ptomaines are especially liable to create
a local infection if nothing more.

This state of the intestines--toxic state--is a constant menace to
health; in fact the organism is heavily taxed to maintain its
defense.

The overcrowding of metabolism, as explained above, the chronic
constipation and toxic bowel secretions, I recognize as the chief
factors--the necessary and leading factors--in the building and
maintaining of that constitutional state which I am pleased to
denominate _Constitutional Catarrh. _When this state is established,
it can be said that the individual is ready to develop any phase of
disease that circumstance, accident, or caprice of fortune or
environment may offer.

The constant presence of gas in the bowels becomes more and more
menacing to the cecum as the constipation increases. The filled-up
condition of the bowels--the colon and rectum--prevents the easy
passage of gas from the bowels, hence it accumulates in the
ileo-cecal region and keeps the cecum distended.

The constant dilating of the cecum from gas accumulations and the
forced dilations from diarrheas made either from drugs or irritating
foods, must not only damage the cecum but the appendix as well; for
the appendix opens into this part of the intestine and it is
reasonable to believe that it suffers distention from gas and that
toxic secretions are driven into it. When its function is not
interfered with by an unusual pressure as from constipation, no
doubt it can empty itself and does do so.

When it is understood first of all that appendicitis--the
inflammation known as appendicitis--is a local manifestation of a
general or constitutional derangement, the cause for this local
manifestation may be taken up.

In order to understand why the disease localizes we must refer the
reader to the peculiar anatomical construction of the cecum and the
appendix, and their relation to other parts. The cecum is a large,
blind pouch, one of the shortest of the several divisions in the
continuity of the intestinal canal, which begins where the small
intestine ends, and ends where the large intestine begins. Its blind
end or pouch is down; this dependent position makes it peculiarly
liable to impaction and the injuries which are disposed to come from
distention; for, as the colon ascends from its connection with the
cecum, the force of gravity must be reckoned with.

The colon is very liable to be more or less distended with
accumulations, and especially is this true of those of sedentary
habits, for a call to evacuate the bowels is frequently postponed.

This postponing of duty to nature has evolved, in all these years of
civilized life, a weakened functioning so that man is more subject
to constipation than any other animal. The bowels are educated to
tolerate a great accumulation and the pretty general habit of taking
drugs to force action has grown a weakened state which is the
natural sequence of overstimulation and as this has been going on
generation after generation it has become more or less
transmissible.

The cecum, situated as it is, must bear the brunt of the evil
effects of constipation. When the large intestine is full or
distended, as it usually is in cases of chronic constipation, so
that nothing can pass out of the cecum this organ becomes a jetty
head, so to speak, against which the peristaltic waves from the
small intestine break. The full force of the peristaltic waves from
the small intestine with its onrush of fluid or semifluid contents
subjects the cecum to great distention and strain.

If there were any way to prove that so-called appendicitis is more
common to-day than in former times, it is reasonable to believe that
the irritating effect of the pretty general habit of taking
cathartic medicine has had more to do with bringing it about than
any other one thing.

Distention, with the straining of the walls from peristaltic
onrushes as described above, and the infection that this part of the
alimentary canal is subjected to because of the decomposition of
food that is going on to a greater or less extent in all victims of
constipation, are the causes of inflammation in the cecum. If the
inflammation involves the appendix or the cecal location of the
appendix, it may be called appendicitis, but the appendix is
involved the same as any other contiguous part. Any mind capable of
reasoning should have no trouble in rightly assigning the
responsibility of this disease, if sufficient attention be given to
anatomism.

There is not any very good reason for one capable of analyzing, to
jump at the conclusion that the appendix is the cause of the disease
because it is frequently found in the field of inflammation. The
same reasoning would make Peyer's glands the cause of typhoid fever.

The unwholesome condition of the intestinal tract which is the
immediate or exciting cause of appendicitis and other diseases
peculiar to this location, is brought on by improper life; not one
cause, nor a dozen special causes, but anything and everything that
break down the general health create this condition; then add the
accidental eating of decomposition, or add decomposition,
auto-generated, and we have the necessary data.

The opening of the appendix is so very small that inflammation of
the cecum soon closes it and then we have a mucous surface without
drainage, which means obstruction--opposition to the requirements of
nature--for one of the functions of the mucous membrane is to
secrete and this secretion must have an outlet or the part becomes
diseased.

According to the theory of bacteriology a micro-organism is to blame
for appendicitis. If this were true it would relieve humanity of all
responsibility. There is a disposition on the part of man to shirk
responsibility and the germ theory is not the first theory of
vicarious atonement that he has spun. Those who wish to shirk all
kinds of responsibility by adopting the germ theory and by making
micro-organisms the scape-goat may do so, but I would advise all
sensible people to keep in mind the following truth: _Violated
hygienic laws predispose to disease; _then, when resistance is
broken down, the immediate and exciting cause may be anything
capable of laying on the "last straw."

The micro-organisms are present wherever there is life and are as
necessary to life as they are to death.

Ochsner states that in nearly all instances the disease can be
traced to the common colon bacillus, which is always present when
the intestine is normal. The three pus cocci are sometimes blamed,
and so are the bacilli of typhoid fever, tuberculosis and the ray
fungus (so-called cause of lumpjaw).

Other causes given are: Edema and congestion closing the lumen of
the appendix, thus preventing drainage; constipation; digestive
disturbances; traumatism; eating too freely while in an exhausted
condition.

"Whatever the predisposing causes may be in any given case, the
exciting cause is always some infectious material. The colon
bacillus is always present in the lumen of the alimentary canal and,
although it is harmless under normal conditions, when these
conditions arc changed and there is an abrasion, an abnormal
condition of the circulation, or a lack of drainage, it becomes at
once actively pathogenic. With a perfectly normal peritoneum a
considerable quantity of a pure culture of colon bacilli may be
injected into the abdominal cavity without causing any harmful
effect, as has been shown by the experiments of Ziegler, but if
there is any disturbance in the circulation or nutrition of the
peritoneum, the same quantity taken from the same culture will give
rise to a dangerous peritonitis."--Ochsner. [This goes back to the
constitutional derangement. First of all low resistance, then any
exciting cause is sufficient.]

Copyright (c) 2007. famouswriterz.com. All rights reserved.