In diseases such as typhoid fever, appendicitis and typhlitis, we have first of all a constitutional derangement brought on by errors of life.  The general resistance is lowered from nerve-exhausting habits; the general tone of digestion is below par and the bowel contents are maintaining a higher toxic state than usual; we have added to this condition an unusual tax in a long run of hot weather, business worries or unusual mental, physical or digestive strain, following which acute intestinal indigestion manifests with a sudden explosion; or there takes place a transformation of the contents of the bowels into an intense putrefaction which infects a portion of the mucosa that has been rendered susceptible by pressure from fecal impaction, concretions, or any cause capable of devitalizing.  If the infection takes place in Peyer’s patches, typhoid fever is the consequence; if the local trouble is of the cecum, typhlitis will result, and if the local devitalization is in the appendix, brought on from the irritating effects of a fecal calculus, appendicitis will result.

These diseases may start in a fulminant manner as suggested—­with an acute intestinal indigestion, which will die down as soon as all the elements that combine to set off this fulmination l eve expended their force and unless fresh material be added everything must settle down to a local trouble.  Or if the primary irritation is subjected to a light form of toxic infection the development of the disease will be much more insidious and will require much more time to come to its maturity, or its fulminating stage.

The reason for this is that each person has a cultivated immunity to a given toxic state of the intestinal contents, and when from pressure or the irritation caused by a calculus. there is a denudation of the mucosa the infection that takes place has not the power to arouse a systemic resistance’ but can cause only a local inflammation; this inflammation may end in ulceration, or it may cause a thickening of the parts and interfere with drainage from mucous or glandular pockets; then the locked up secretions become intensely toxic, and this sets up a new infection much greater then l the first and powerful enough to cause the system to call out its militia to put down the rebellion.  Now we have fulmination, but if food and drugs are withheld it ends soon.]

“Severe abdominal pain with tense abdominal walls, fever and vomiting form the characteristic triad in the first phase of the disease; less rapidly does meteorism appear.  This depends upon whether the inflammation of the serosa quickly spreads or remains local.  Peritoneal meteorism is peculiar.  The abdomen is uniformly distended, balloon-like; the muscles as well as the rest of the abdominal walls are tense.  It must be added, how ever, that in spite of the excruciating pain upon touch there is no sign of contraction of the abdominal muscles, of the “muscular resistance” (defense musculaire) which is so common on pressure in other forms of abdominal pain, particularly when circumscribed.”