_Symptoms: _An acute attack is ushered in with severe pain. At first
this is felt over the entire abdomen, but it is more marked near the
navel than elsewhere. After about twenty-four hours it becomes
localized in the region of the cecum.
The pain is colicky or spasmodic in character, showing that it is
due to peristalsis; food of any kind increases the peristalsis;
hence the pain becomes more severe after feeding. Do not make the
mistake of thinking that liquid food, such as milk, can be given,
for a teaspoonful is sometimes sufficient to make the patient
miserable for a whole day.
The abdomen is tender, especially over the cecum, and should
therefore be manipulated as little as possible, for it causes the
patient unnecessary pain, and if an abscess has formed there is
danger of breaking the walls which nature has thrown up.
Nature's tendency appears to be to fix the inflamed portion so as to
secure rest and this is accomplished by the muscles of the abdominal
wall becoming rigid, especially over the cecum. These muscles are
contracted to such an extent that the right thigh is often drawn up
in order to relieve the tension.
When the cecum is inflamed it is common for the colon to be loaded;
this colon obstruction prevents the onward passage of the contents
of the small intestine, and when they cannot free themselves and the
peristaltic movements meet with sufficient obstruction to force a
halt, the pain and suffering become intense. When the peristaltic
movement has met with a few disappointments it reverses and empties
the contents of the small intestine into the stomach. The result is
nausea and vomiting which at times are both severe and persistent.
But when it lasts beyond three days it is an indication of a
complication or mistake in diagnosis, providing the patient has been
properly treated.
The abdomen becomes distended with gas if drugs and food are given;
as regards the pulse, there is nothing characteristic about the
pulse rate and the temperature in this disease. Sometimes the
temperature does not go over 100 degree F., but at times it reaches
105 F. The pulse is sometimes so rapid that it is hard to count--due
usually to drug influence--and again it may not go above 100 or 110
beats per minute during the entire attack.
As these patients are nearly always constipated, and suffering from
indigestion, they generally have a coated tongue.
The above symptoms are those relied upon in making a diagnosis, and
especially the first four--pain, tenderness, rigidity, and nausea
with vomiting--which are generally referred to as the four cardinal
symptoms. Some authors give a "characteristic triad," namely: pain
with tenderness of the abdominal wall, fever, and vomiting.
A patient may have pain with tenderness, fever and vomiting, and be
very far from having appendicitis. There is a world of difference in
the importance of pain, the range being from no danger at all to
absolutely no hope. Tympanites may mean a very simple state or an
absolutely hopeless state. To be able to interpret the exact worth
of symptoms means observation, study, reflection--labor and
experience running over years--and a love of work that is not the
good fortune of a very large percentage of mankind.
Before we get through with this subject the reader will be shown how
it is possible for highly educated men to be wholly unable to
interpret the worth of symptoms.