“In regard to the fulminant symptoms at the onset of the disease, however, it is more likely that even then perforation had already occurred, and I that the final and fatal exacerbation was in consequence of adhesions formed in the first period which were powerless to resist the entrance of organisms producing inflammation.  The pus finally broke through the adhesions, and produced diffuse peritonitis.”

[It is a technical point unnecessary to raise whether the adhesions formed in the first or the last period; they were formed without question; I and if they were formed in the beginning, as doubtless they were, they withstood the most severe and trying period of their existence, which was before the abscess broke into the bowels, and so far as being able to resist to the very last, there has been no evidence to prove that the last infection was because of any lack of power of resistance on their part for the autopsy showed them intact.  It is doubtful if anything but sound tissue could have withstood the strain that was put upon this man’s diseased cecum from gas distention.  The infection-laden gas could find a way anywhere in diseased tissue and broken continuity.  Why should the pus break through the adhesions and find its way into the peritoneum after they had been able to make an effectual resistance till the bulk of it had forced a passage into the bowel?  Why should the adhesions have less power to resist when there is less strain upon them and also a patent outlet for the pus?  I fear our German friend of “Die Deutsche Klinik” had “booze” in his logic when he was explaining how his patient came to die.]

“Moreover, the bacterial finding of streptococci and cold bacilli in the perityphlitic abscess is typical, and the limitation of the diffuse peritonitis to areas below the omentum is also instructive.  This simultaneously prevented the invasion of organisms producing inflammation into the serous surfaces above.”

[There is nothing strange about this for nature works for the purpose of preventing “serous surface” invasion, and it takes a deal of malpractice to force such an infection.  If nature’s provisions against peritoneal inflammation were not as great as they are, few people with intestinal putrefactive diseases, from cholera infantum in babyhood to proctitis in old age, would get well, for most of the treatment for one and all of these diseases is obstructive rather than conservative and helpful.]

“This strong man, aged 31, had previously regarded himself as perfectly well.  Nothing indicated the danger in which he found himself and which had existed since the appearance of the fecal calculus. the time when this had formed being impossible to determine.  The disease appeared acutely with fulminant symptoms.”

[He was, indeed, unfortunate, but his greatest misfortune, as I see it, was his treatment.  Every acute disease is fulminant, even indigestion is fulminant, but the force of the warring elements is soon expended and unless reinforced by fresh elements the fulmination must end.