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.

CHAPTER VI

Surgical Treatment:  Appendicitis is quite generally thought of as an exclusively surgical disease.  Osler recommends that such cases be operated upon, and most of the prominent physicians agree with him.  The surgeons are a unit for the operative treatment.

Many surgeons are in accord with Prof.  L. ID.  Russell of Cincinnati, O., namely, that it is not a question of “when to operate, but how much to operate,” meaning that all cases should be operated upon as soon as possible after the diagnosis has been made, but the extent of the operation is to be decided by the conditions found after the incision has been made.  If the appendix is surrounded with pus and hard to get at, the indication is merely for drainage at this operation, but if the appendix is accessible, it should be removed.