The subcutaneous saline infusion is another ridiculous habit.  It would really be amusing if it were not so tragic, to see patients driven to the edge of the great divide and then see the innocent doctor throw out an impotent life line.

The absolute innocence displayed by this professional man, from first to last, his belief in himself and the mechanism of his theory and practice exculpate him from the charge of carelessness, neglect of duty or even that he didn’t know what he is doing.  He does know what he is doing in a way.  He works as exactly as a Waltham watch and he thinks about as much as the stem that winds the watch.

I cannot agree to the summing up of this case.  There was not at any time, previous to the relapse and death of this patient, what we understand as peritonitis.  A post-mortem examination might have shown the intra-peritoneal covering, of that portion of the cecum involved in the inflammation, slightly inflamed, but it is not reasonable to believe that the inflammation was of a toxic character unless adhesive inflammations can be so called.

Inflammation is always the same, it matters not what the exciting cause may be.  It is an exaggerated physiological process.  If there is inflammation of any part of the body it means that there is an exaggeration of function.  Its intensity will be in keeping with the exciting cause.  If the cause is intense heat or cold, or a corroding acid or alkali, the local action may be great enough to destroy the part; the inflammation following will be of the contiguous structure outside of the killing range of the cause, and it will be a simple—­non-toxic—­inflammation unless the secretions thrown out in excess of the reparative need are retained by dressings or prevented in some other way from draining away.  If these secretions are kept bound on the raw surface by dressings until they decompose—­yes, until the fermentation causes germs—­the wound will become infected, and to what extent will depend upon the amount of malpractice—­carelessness or ignorance—­to which the case is subjected.

If the inflammation is caused by decomposition or a toxic agent, the extent of the process will depend upon the integrity of the part infected and the state of the general health, also upon the local environment—­such as pressure interfering with the circulation of the blood.

In this fatal case there was the constitutional derangement and the toxic state of the alimentary canal; then there was the exciting cause, sufficient to create a local infection the symptoms of which were given at the beginning of this description, and which lasted for a few days; during which time the patient, no doubt, was eating and possibly taking home remedies to move the bowels, etc.  These preliminary symptoms were followed by a severe pain in the right lower abdominal region, followed with chills, fever, nausea, vomiting and later by painful movements from the bowels, small in character, and soon after this distention of the bowels from gas.