During the few days of preliminary symptoms nature was going through the usual preparation of fixing the parts.  The muscles were becoming rigid, which is one of nature’s plans for protecting an inflamed part; the infection was striking deeper and arousing all the defenses.  Possibly there had been a local inflammation of long standing, gradually degenerating into a fecal ulcer, which means that there was a spot of ulceration deep enough for fecal accumulation and the accumulation created fresh infection, which lighted up an active inflammation setting all the parts into defensive activity.  The muscles of the abdomen—­the bowels and all involved and contiguous parts—­became set or fixed; and when this rigid state became established, the bowels below the cecum refused to receive the contents of the small intestine; hence when the peristaltic movement started at the head of the small intestine it found that an embargo had been laid on the cecum and lower bowels so that nothing could pass.  This embargo took effect “about midday; he was seized with very severe pain.”  What was this pain?  What is the pain that always attends obstruction of any kind?  It is the desire for the bowels to move when they are unable, on account of the stoppage, to do so.  Is there a reader who can’t conceive of the terrible suffering that must come from such a state of the bowels, The pain is not from the spot inflamation, or ulceration, or the forming abscess, whichever is the exciting cause of all this trouble; for, if it wore, the pain would not stop in three days, or after the patient has been fasted long enough for the peristaltic movements to subside side.  No, the local inflammation is not sufficient within itself to cause any more pain than this patient had the few days before he went to bed; it takes obstruction to bring suffering, and even obstruction will not cause pain per se, for this is proven in all cases rightly treated.  As soon as the stomach and upper bowels are rested from food and drugs, all pain is gone and will never return unless the patient is badly handled.

In this case opium and morphine were given; this was very bad treatment, for these drugs always produce nausea and vomiting, exactly what was not desired because of the evil effect the retching had on the forming abscess.  It is true that these cases frequently vomit the first three days after the obstruction, but there is practically no danger from retching that early in the disease.  Again, the opium masked the case dreadfully; for it produced vomiting at that stage of the case when there should have been no trouble with the stomach at all, and induced a tympanites that was mistaken for the same state brought on by peritonitis.

In this case the doctor was in a mental mist from the beginning to the end; notwithstanding he was so confident that he knew all about his patient, that he has given the case a careful summing up so that it may be put with the medical classics.