"This improvement continued for several days and even became more marked The abdomen returned to the norm with the exception of the ileo-cecal region; there was a small stool daily without recognizable pus; no fever.
"Upon the_ twelfth day of the disease vomiting _suddenly recurred with severe diffuse abdominal pain, marked meteorism, and fever to about 102.2 degree F.;"
[True, diffuse peritonitis set in at this time.]
"the symptoms increased in severity, and changed during the collapse, his temperature 97.3 degree F., pulse 160, thready, uneven; conspicuous facies hippocratica; no pain; a slight comatose condition, moderate meteorism, no movement of the bowels. Stimulants were without effect; subcutaneous saline infusion revived the patient but only for a short time? and death occurred the following morning upon the fourteenth day of the disease."
[Meteorism! What at is it? A blown-up condition of tile bowels. Gruel caused gas to form the gas was driven into the abscess cavity, reinfection took place? which ended in diffuse peritonitis. The patient's resistance was used up and, being exhausted he died. He had made a brave fight a against all sorts of odds but the second round was too much for him.]
"Autopsy: Normal condition of the scrosa above the omentum: the appendix surrounded by adhesions embedded in fecal pus? gangrenous toward its terminal portion, and showing perforation; fecal calculus in the pus; appendix movable toward the cecum."
[Just what may be expected in all cases! Nature is always busy reinforcing weak points, but the modern physician and surgeon is too wily and artful for her; she can't always anticipate his moves, hence she can't always fortify successfully.]
"Agglutinated point of rupture at the median periphery of the cecum near the ileo-cecal valve. The perityphlitic pus appeared to be sacculated by adherent intestinal coils, but beyond the adhesions in the free abdominal cavity below the omentum there was diffuse, fresh, fibrinous peritonitis and distributed here and there small quantities of thin, putrid pus (many bacteria, large quantities of streptococci and cold bacilli). The peritoneum was injected. of a delicate rose-red color, here and there covered with fine, mucus-like pseudo-membranes. Heart flabby."
[The autopsy showed nothing more than would be expected. The fresh peritonitis confirms what I say that a reinfection was forced because of the character of the food. The meteorism opposed relaxation and rest, two conditions positively necessary and without which healing can not take place. What was to hinder the heart from being flabby, Drugs and systemic infection are quite enough.
In proper hands this young man would not have been very sick; possibly his trouble would have been thrown off and the inflammation passed off by resolution.