[The symptoms were those of intestinal putrefaction with local inflammation of the cecum and, as the history of the ease has pointed out, was located in that part of the cecum giving attachment to the appendix, for the autopsy showed that the appendix was surrounded by adhesions and imbedded in fecal pus.  Please note particularly:  The appendix was found in a pus cavity—­a perityphlitic abscess.  Why shouldn’t the appendix be necrosed?  Located in a field of inflammation, blown up, distended beyond its vital integrity; why should it not become gangrenous, It doesn’t matter when the perforation of the appendix took place for it is quite evident that there was not enough disease of the appendix to cause its perforation until after it had become encased in the abscess cavity, and if the young man could have been freed from the treatment he received and could have been given the necessary rest the abscess cavity would have emptied itself, necrosed appendix and all, into the bowel and he would have made a perfect recovery.

“The point of rupture closed!” How could a rupture into a distended gut close, The distention was greater after the rupture than before.  Fresh infection could not take place without a power to force the putrefaction greater than the force that existed before the abscess broke into the cecum.  Let us reason together:  Nature fought successfully against heavy odds before the rupture.  There was gas distention of bowels interfering by pressure with the circulation and increasing the area of destruction of tissue; frequent retching and vomiting interfering by stretching and probably tearing, threatening disruption to the plastic process that was going on to close in the disorganizing and necrosing processes; the frequent examinations, and manipulations for diagnostic purposes, etc., but, in spite of all this opposition, fatal infection was successfully resisted; then, after the rupture and discharge, the relaxation, the calling off by nature of all her defenses, showed that the battle was won.  All the defense yet left was the hard induration, “firm, flat resistance.”  This induration was quite sufficient to prevent reinfection, had there not been something out of the regular order to interfere.  In this case there was a prostrated muscular system.  The narcotic had left the patient without muscular power.  The starchy food created gas, and the bowels, not having their natural tone, gave way to the gas until there was "Meteorism," not tympanites but meteorism which means to blow up or distend all that is possible.

Such a state as that means mechanical interference with every organ in the thoracic, abdominal and pelvic cavities, and, besides the pressure and interference in drainage and the blowing into the abscess cavity and into the pyogenic membrane gas loaded with infection, there was an almost fatal interference with the action of the heart and lungs.  The prostrating effect on the muscular system of the septic or putrefactive poison was nothing to be compared to the paralyzing effect of opium.  I believe this man would have survived every interference if the milk gruel had been left out, but acting as it did, it proved to be the last straw.]