[Reprinted from The Medical News, October i, 1892.] 
PEANUTS IN THE VERMIFORM APPENDIX; 
OPERATION; COMPLETE REMOVAL OF 
THE APPENDIX; RECOVERY. 
By M. ROSENHEIMER, M.D., 
OF MILWAUKEE, WIS. 
Emma J., an American, twenty-three years old, was 
first seen on May 5, 1892, at 5 p.m. She had had a 
slight chill and pain in the abdomen since early in the 
morning. She had been feeling well the day before, 
when she came from her home in the country to friends 
in the city. She had always been constipated, but had 
had two slight bowel-movements in the forenoon. On 
inquiry, I learned that she had eaten some cherries the 
evening before, but she was positive that she had not 
swallowed any of the stones. It was only at a later 
questioning that the fact was elicited that she had eaten 
peanuts two days previously. She felt nauseated, and 
had vomited once or twice. I prescribed a mixture con- 
taining the fluid extract of opium, but without relief. 
The pain gradually became localized to the right iliac 
region, and increased in intensity. The temperature 
was 100.50, the pulse 96. I made a diagnosis of appen- 
dicitis, and administered half a grain of morphine hypo- 
dermatically, and ordered warm local applications. 
I saw the girl again on the following day at 8 a m. 
She had rested several hours during the night, but the 
pain gradually returned, and was again controlled by the 
administration of quarter grain doses of morphine. The 
lower limbs were flexed on the abdomen, and there was 2 
great tenderness over the cecum. There was consider- 
able nausea and frequent retching. The temperature 
was 99.50, the pulse 96. The warm applications were 
continued, as well as morphine administered at intervals. 
At 5 p.m. of this day there was much pain, in spite of the 
anodyne, and the abdomen was tympanitic, excepting 
in the region of the cecum, where there was flatness. 
The right groin was at this time also a little more ele- 
vated than the left groin. Nausea became extreme, and 
the slightest attempt to move or to raise the head was at- 
tended with retching. The temperature was 102°, the pulse 
108. The bowels had not been moved since the morning 
of the preceding day ; nor had the patient taken any 
nourishment. Thirst was marked, but only small quan- 
tities of lemonade were retained. The family had been 
advised of the girl's illness, and some members having 
arrived, a consultation was proposed. 
At 9 p.m. I saw her again, in consultation with Dr.W. 
H. Earles, who concurred in my diagnosis. The patient 
was having great pain, with almost constant nausea and 
retching. The temperature was ioi°, the pulse 108. 
Operation was advised, but it was decided to wait until 
morning. 
The girl rested some during the night, after full doses 
of anodyne, but the pain returned. It was now decided 
to operate, and the conditions being explained to the 
patient, an intelligent young woman, her consent was 
obtained. A full dose of morphine was administered, 
and she was transported to Trinity Hospital. The opera- 
tion was performed at 11.30 A.M., Drs. Earles and Hoyer 
assisting. The patient took chloroform badly, and ether 
was substituted. She ceased breathing several times, 
and became deeply cyanosed, so that it became neces- 
sary to resort to artificial respiration. While under the 
anesthetic, a circumscribed induration in the right iliac 
region could be plainly mapped out. An incision was 
made parallel with, and about an inch and a half inter- 3 
nal to, Poupart's ligament, extending from the level of 
the anterior superior iliac spine downward for three or four 
inches, and the seat of the trouble exposed. On open- 
ing the peritoneum, some brownish, slightly fecal-smell- 
ing fluid escaped. After some search, the appendix was 
found. It contained two large bodies, and was gangre- 
nous for an inch of its length, having perforated at three 
points. After the appendix had been removed, it was 
found to contain two good-sized peanuts. The abdom- 
inal cavity was irrigated with sterilized water, the wound 
plugged with sterilized iodoform-gauze, and an antisep- 
tic dressing applied. The patient's condition at the 
close of the operation, which occupied about forty min- 
utes, was critical, but improved after the administration 
of several hypodermatic injections of brandy. She was 
placed in bed, and heat applied to the extremities. Mor- 
phine was given hypodermatically, in sufficient quantity 
to keep her comfortable. 
The temperature for two days varied between ioo° and 
102°; the pulse ranged at about 132, and was feeble. 
The wound was dressed after twenty-four hours, quite a 
quantity of fecal-smelling fluid having saturated the 
dressings. On the fourth day the temperature and 
pulse became permanently normal. Absolutely nothing 
was given for the first twenty-four hours, although the 
thirst was distressing. After this, lemonade in dram- 
doses was administered, and, later, milk and lime water. 
She improved rapidly, and made a complete recovery. 
At the date of writing, five weeks after the operation, the 
girl had left the hospital, and returned to her home in 
the country, a distance of fifty miles. 
My supposition is that the peanuts were shrivelled and 
small when swallowed, and found their way into the ap- 
pendix, where, absorbing moisture, they swelled, and, 
giving rise to strangulation, caused the subsequent 
trouble. 
802 Third St.