Opium paralyzes the nervous tone and resistance to microbic proliferation, and masks symptoms. It is doubtful whether it has ever checked peritonitis. Old fashioned laudanum poultice is sufficient in parietal cases. Surgical measures are required only in one-third of the eases and should always be preceded by med ical treatment. Talamon (Med. Mod., No. 31, '97).
Proper expectant treatment: Put the patient to bed and keep him there. Ap ply over the whole iliac region a soap "poultice," consisting of a thick layer of green soap, spread on a single layer of muslin or lint. Over this apply an ice bag or ice-coil. Relieve bowels by soap and-water enema. Keep the stomach at rest while vomiting exists. Restrict the patient to milk or clear broths. Note the temperature, pulse, and respirations every four hours. Give no drugs. Never give opium or morphine in cases of ap pendicitis, except in eases of abdominal shock from rupture of appendix or ab scess. Syms (N. Y. Med. Jour., May 15, '97).
Fifteen cases of appendicitis in private practice, all of whom have recovered without operation. Patients were all put to bed and kept quiet. All food was withheld for twenty-four or forty-eight hours—even water was given sparingly. A saturated solution of Epsom salt in peppermint-water was given in teaspoon ful doses, one in three hours, until one or two movements of the bowels were obtained in twenty-four hours. When stomach was too irritable to retain the Epsom salts, calomel was given in di vided doses until there were one or two movements of the bowels. No opiates were employed. When patient began to eat, food was given cautiously: a tea spoonful of milk and lime-water, or small quantity of beef-juice or some animal broth, once in two or three hours. Tur pentine dupes and the hot-water bags are of use in overcoming pain. Opiates are to be avoided. Many cases, how ever, are surgical from the beginning. The result of medical treatment is doubt ful, if within the first twenty-four hours after the patient is seen, or after the bowels have been sufficiently moved, there has not been a decided improve ment in pain, vomiting, and fever. H. B. Allyn (Thee. Gaz., Jan. 15, '99).
The treatment in the early stages of appendicitis should be as follows: 1. copious warm soap and water enemata should be given, with the object of evacu ating the lower bowel. 2. The hourly administration, until the bowels move freely, of small teaspoonfuls of sulphate of magnesia dissolved in about 2 wine glassfuls of warm water. It usually
takes from six to eight doses before the bowels commence to move. 3. Hot lin seed poultices should be applied to the right iliac region for the relief of pain. Opium should be avoided on account of its tendency to mask symptoms and con fine the bowels. 4. Whey, chicken-tea, meat-jellies, etc., may be given. Milk only encourages constipation. Ernest Maylard (Glasgow Med. Jour., Mar., '99).
The prophylactic diet treatment re solves itself into the avoidance of large, heavy meals, and particularly those which are hastily devoured. Milk is to be speeially avoided, for it is a vehicle for bacteria of primary importance. and. further, produces bulky and scybalous stools. On the whole, a liquid and vegetable diet is the best to advise. Sey mour Taylor (W. London "Med. Jour., Apr., '99).
Nourishment only by the rectum dur ing the acute stage of appendicitis pre vents peristalsis and consequent irrita tion of the efneum and its environment. This method enhances the patient's op portunity for recovery. If vomiting is present, gastric lavage will usually quiet it. A. J. Ochsner (Berliner kiln. Woch., Sept. 24, 1900).
Opium is sometimes used in light cases where we are certain that no aggravation of the condition present it to take place. But this no one can foretell with cer tainty, and it seems best to protect the patients against increased chances of death by only employing local anodyne measures that will not mask the advance of complications.
A large number of catarrhal cases are cured by medical treatment; but when the disease advances to pus-formation surgical treatment is needed. "If we err, let it be on the side of too early, rather than on that of too long delayed operation." Da Costa (Med. News, May 26, '94).
The surgeon is brought face to face with a condition which has a recognized mortality of about 5 to S per cent.: too high a percentage. We first have to contend with the presence of a suppura tion. In 450 eases I do not think there has been an entire absence of pus in one single instance. I am satisfied there are some cases which can be cured by medi cine, but can they be differentiated? By medical treatment we have a mor tality of 10 per cent., and, if we have 3 per cent. by the knife, then we mast operate to save the other 7 per cent. J. B. Murphy (Amer. Medico-Surg. Bull., Oct. 10. '96).