If the child is left alone, given no food, and ice put on the sensitive parts if the temperature is 103 degree F., or hot applications if the temperature is less, the tenderness will probably go away in two or three days; if it does not, an abscess will form and empty into the cecum.  If the child is fed, and the tumor manipulated—­subjected to unnecessary examinations—­the abscess may be made to burrow down toward the groin, which should be avoided for it is a very undesirable complication.  The first abscess is typhlitic, the second is perityphlitic.  The first may form without the aid of bruising in the manipulation of repeated examinations, but the second must be forced by bad management.  The latter abscess, I have reason to believe, is the former abscess driven, by repeated manipulations, to burrow downwards instead of opening into the cocum.

Fecal abscess, arising from ulceration of the colon, may be mistaken for appendicitis.  There is a localized swelling, immovable in breathing or when pressed upon, and having a tympanitic sound on percussion over it with dull sound on pressure and heavy stroke.

The symptoms of appendicitis are:  Pain in the front, lower, right side of the abdomen.  It is paroxysmal and caused in the main by peristalsis—­the regular action characteristic of the sewer function of the bowels, which is for the purpose of forcing the contents of the intestines onward to the outlet, and which ordinarily is carried on without pain; but, in bowel obstructions of any kind, the onward flow of the bowel contents is cut off resulting in great pain where there is much irritability, for irritation of any kind always increases this expulsive movement.  Food, taken in health, stimulates this contraction and if taken when there is inflammation—­enteritis, colitis or inflammation of any part—­the contraction is increased and necessarily painful.  Think of the pain that the subject of diarrhea has, then imagine what that pain must be if there should be obstruction so that the fecal matter could not pass.  That is as near as I can describe what the pain of appendicitis is.  Anything that will stimulate these contractions will throw the patient into great distress.  Food or drugs will cause pain, and water, the first few days of the illness, will do the same.

In inflammation of the cecum, where the inflammatory process remains local and there is no obstruction more than constipation will make, the patient will be troubled with occasional attacks of pain which will pass as colic; or there may be a diarrhea, lasting for a day, every few weeks or months with constipation between the attacks.  These cases may lead in time to ulceration, then to fecal abscesses and they are often diagnosed chronic appendicitis.