Causation

Appendicitis is mainly interesting from the dietetic standpoint on account of the possible causative relation of certain food residues. In about one third of the cases fecal concretions are found in the appendix, and in one thirteenth foreign bodies have been discovered. It is a popular belief that the disease is often established by the presence in the intestine of grape seeds or skins, lemon, orange, or mustard seeds, cherry pits, bits of chicken bone or clam shell, etc., but such is not the case. Substances of this nature are no doubt often swallowed, but they seldom make their way to the appendix or do any harm; and it is now known that the disease, while it may exceptionally be produced by such irritants, is commonly caused in other ways, and is often of bacterial origin. I have known of one fatal case resulting from eating a large number of soft-shell crabs, but such accidents are very rare. On the other hand, both overeating and overdrinking may indirectly cause appendicitis as well as the consumption of too highly seasoned foods, for these factors provoke catarrh of the intestine, distending the bowel with feces and gas, and making it easy for the catarrhal process or for bacteria of various sorts to enter the appendix and set up local inflammation there.

The recurrent cases are more apt to be excited directly by overeating and improper food.

Dietetic Treatment

The dietetic treatment of appendicitis which has not yet passed into the surgeon's hands should consist in giving only such food as will be thoroughly absorbed, leaving as little residue as possible to irritate the lower bowel and excite peristalsis. Until the outcome of the attack is decided it is best to put the patient upon a fluid diet, consisting chiefly of nutritive broths. Beaten eggs may be allowed, and a moderate quantity of pancreatinised milk, whey, or buttermilk. Cocoa may be given, and strained gruels of rice or barley.

In recurrent cases the patient should be cautioned to eat moderately and avoid all coarse or hard food, such as grits, coarse oatmeal, tough meats, fibrous vegetables, the skin of fruits or potatoes - in short, everything likely to overload the intestine with accumulated waste.

The operative cases should have the diet recommended after laparotomy. Usually the digestive organs require almost absolute rest for twenty-four hours after the operation, and hot water may be sipped. No food at all should be given for fully six hours before operation.

Acute Peritonitis

Acute peritonitis, if due to causes within the alimentary canal, demands absolute rest of the stomach and intestines, and this is secured by giving all nourishment, stimulants, and medicines in the form of nutrient enemata (p. 414). Any food in the stomach is likely to excite vomiting and aggravate the pain and other symptoms.

Most cases of acute peritonitis demand laparotomy, and the dietetic treatment is given under that heading.

In other cases a very little fluid nourishment may be cautiously administered per os, such as peptonised milk, light gruels of pearl barley or arrowroot, plain meat juice squeezed from a fresh steak, or one of the forms of peptonised meat or egg albumin in sherry should be tried. Only one or two teaspoonfuls should be given once in fifteen minutes or half an hour, and every effort must be made to prevent the occurrence of vomiting or meteorism. Twelve or fifteen ounces per diem of predigested food given by the mouth is all that should be prescribed in such cases. The resumption of a full diet should be extremely gradual, occupying several weeks.

It is well to avoid the use of aerated waters of all kinds on account of their tendency to increase meteorism and render the patient still more uncomfortable. Alcoholic stimulation is usually required in severe cases, and if the stomach is intolerant it should be given in the form of dry champagne or dilute whisky or brandy. The latter may be added to rectal enemata.

The reader is referred to the section upon the diet for convalescent typhoid-fever patients (p. 441) for hints as to selection of a menu for convalescents from peritonitis.

Chronic Peritonitis

In chronic peritonitis the outcome of chronic tuberculosis, or other disease, plainly cooked animal food agrees best. Starches and sugars, from their tendency to ferment and dilate the bowels with gas, should be avoided. Broiled tender chop, steak, chicken, or white meat of fish may be given. Eggs, milk, and cream are permitted when they do not cause dyspepsia. Bread should be eaten sparingly, and must always be stale or toasted. Zwieback and crackers are given for variety. All food should be eaten very slowly and in very moderate quantities at a time.