By Eric Graf von der Goltz, M.D., New York
The biochemical treatment of appendicitis in its cures, not only temporary but lasting, against the general and perseverance assertion of surgeons to be purely surgical disease, causes the publication of the present paper.
My appendicitis cases have seldom come from the start of the disease under my care. Generally one, two or more physicians have had charge of them successively, all concurring in their diagnosis and the final proposition to have the operation performed soon as possible.
In the biochemical treatment and further in the cellular-therapeutical one, the following remedies will be called pre-eminently into action:
Kalium muriaticum exudations, second state of a fully established case of appendicitis.
Magnesia phosphorica existing tympanitis; pains; rigidity of the abdominal muscles.
Often these two remedies will be found indicated from the moment of taking charge of the case. (In case of any especially high fever without as yet the formation of any infiltration, or only in the first onset of the same ferr. Phos. instead of mag. Phos. must be used alternately with Kali mur.) In most cases coming out of the hands of other physicians Kali mur. And Mag. Phos. seem to be indicated; as an undeniable harm has most frequently been done by the in-discretely used ice bag. In the eventual differentiation between the ice bag (so-called freezing methods) and warm application in appendicitis, like in all other diseases, I am guided by the individual instinct of the patient.
Under the use of the foregoing remedies we will observe either a speedy cure of a simple form not too far gone (the real feature of appendicitis up to 95 per cent.), or we will find that if the whole habitues, etc., not contraindicated, our next change of the remedies will be to Silicea.
It is remarkable how a few doses of this tissue salt in a high trituration, respectively in high potency, will change the whole picture; I prefer the 30th centennial potency in this disease.
These three remedies: Kali mur., Mag. Phoos. And Sil. Form the nucleus for the biochemical treatment of appendicitis.
Inter currently we must often use the following:
Kalium Sulfuricum – evening aggravations.
Natrum sulfuricum – hard, continuous constipation; nausea
Kalium Phosphoricum – intervening high temperature in the later time of the course of the disease with eventual alarming symptoms.
Other remedies must also be called in at times for help, but those cases are very rare – and ominous; in those case a certain suspicion of early neglect either from side of the patient or from the side of the treatment could not be denied.
If now alarming symptoms of early beginning sepsis are present – Kali phos. and Sil. In alternation, here in 12x trituration will save the patient in cases where even great surgeons have met unexpected failures, also where a second operation as a last attempt to help had proved fruitless, as the annales of the appendicitis operations have shown in an alarming and surprising number between rich and poor patients, private residence and charitable institution.
My observation regarding the necessity of an operation will be only in cases of a large tumor without any improvement of objective and subjective symptoms in about 10-12 hours after the introduction of the biochemical treatment in the individual case.
The harmless dissolution of pus and its final disposition by the physiological means of the organisms through the helpful action of Sil. (later Calc. Sulf. And Calc. Sulphide) combined with the antiseptic action of Kali Phos., Ars. iod., etc., can be learned and observed only in cases where the family declares that no operation will be allowed.
The following case gives the best illustration of a case of this kind:
S.S., nine years old, a girl of slight stature, etc., was sick since November 2, 1899, with clear and characteristic symptoms of appendicitis, and had been treated for such a disease from the beginning of her malady.
As the disease proceeded further and further and the physicians finally all concurred, one after the other, that the operation was the only thing to be done, I was called in November 6.
The patient showed the following characteristic picture: A localized pain, an irregularly shaped distension of the abdomen, fever 1030 , constipation, right thing flexed, the tumor at the lower border of the ileum.
The physicians expected very soon (if nothing was done) a perforation. As the parents declared that no operation would be allowed I began the biochemical treatment. The pulse was 130-160, small and irregular. Medication: Kali mur. 6x, five grains (powder) every hour.
November 7th – Pains undiminished; temperature, 1010 ; pulse, 100. Besides Kali mur. I prescribed for the pains Mag. Phos., as alternating remedy, 6x, five grains (powder) every hour.
9th – Patient had the first quiet night since November 2d. Same medicines.
10th. – The tympanists diminished. The tumor now visible, hard – Silicea 12x, one three-grain powder every two hours.
11th. – Renewed attack of pains and tympanists; tongue brown and dry; temperature, 1020 ; pulse, 100. Kali phos. 6x, one powder (five grains) every two hours.
12th. – Patient had a good night; temperature, 98.50 at 7 A.M. and 1000 at 7 P.M.; pulse, 100 (both times). Same medication.
13th. – Patient free from pain; temperature, 990 ; pulse, 100. Tympanists nearly gone; patient can extend her right leg slowly without pain. Same medication.
14th. – Patient on the way to recovery. Kali phos. 30x, one dose of one-grain powder every four hours.
15th. – Patient continues to improve. Same medication.
16th. to 18th – Continued improvement. No medication.
19th. – Last visit – Patient cured.
On account of other diseases in the family I had occasion to see the patient December 10th. I was not able to find any tumor or even any painful spot under the most rigid examination. Patient has never had a relapse to the present day.
In such a manner I have had different cases of equal severity; also one complicated with pregnancy. Especially this case must be mentioned for the reason that after curing the appendicitis (also treated previously by other physicians who recommended surgical interference) I attended the confinement. Mrs. K. to day is in perfect health, a year since her confinement.
More or less it must be stated the without any great variation the described treatment must be regarded as the typical one.
It is self-evident that perforative cases must be operated. But it has also been proved in my experience that appendicitis treated biochemically never will present the perforative (gangrenous, etc.) climax if taken in charge in reasonable time. It results therefore that the only possible difficulty for the treating physician will be to decide the question it the appendicitis case has been taken in charge early enough or not. To differentiate in this question I follow the advice of Dr. Willy Meyer, of New York City, in observing the pulse – a continuous high-rated pulse without lowering tendency speaks for operation and the reaction of the pulse to the treatment – even the slightest but sure decline in beats confirms the expectative, respectively, the medical here biochemical treatment.
The relapsing form of appendicitis is easily cured permanently by two remedies Kali mur. And Sil., according to circumstances, that means Sil. For any hard tumor, Kali mur. For those forms more of a certain elastic softness, resembling a catarrhal exudation.