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Appendicitis by John Henry Tilden
page 82 of 107 (76%)
"The point of rupture formed adhesions, the natural drainage of the
peritoneal ichorous focus ceased, perhaps a new influx of
inflammatory material from the perforated appendix also took; place.
There was a fresh relapse of the local peritonitis which extended
beyond the boundaries of the limiting adhesions, and permitted the
invasion by bacteria of the free abdominal cavity. This, time the
severe toxic picture of collapse immediately followed, and with
marked decrease in cardiac strength led to death.

"Doubtless the patient might have been saved in the first stages of
the disease by the evacuation of the abscess; the incision would at
first have acted similarly to spontaneous rupture into the
intestine, but the relapse would have been prevented by permanent
drainage, and a radical cure might have been brought about by the
immediate or subsequent removal of the appendix.

"Opium, no doubt, had a favorable effect upon the affection. By
relieving intestinal irritability, and by bringing about a mild
degree of narcosis, the patient was kept quiet and this materially
assisted in limiting the severe perityphlitic suppuration in the
first stage of the disease."

[All of which is positively not true, as I have witnessed for
years.]

"If, as it unfortunately happened, the point of rupture had not
immediately closed again, if it had remained open until suppuration
ceased and contraction and healing of the perforated appendix had
taken place, opium would have been regarded as instrumental in
saving the patient, and unquestionably, at least to some extent,
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