His wife was a large, strong woman and gave him valuable assistance, but I never have understood how it was possible for so sick a man to make the journey from his home to my office.  He was obliged to help himself a great deal in climbing in and out of ordinary conveyances to reach the train and, when in Denver, with his wife’s assistance, he walked a half block to the street car; then from the car to my office he was obliged to walk one block and at last climb one flight of stairs.  When they came into my office the wife was almost carrying him.  I saw at a glance that he was a desperately sick man, and before I attempted to examine him I had him lie down for a while.

He had no history of any previous sickness; he had always been very healthy, and his life had been spent in hard work in the open air.

The general appearance of the man was that of one suffering from diffuse peritonitis.  The abdomen was enormously distended; this symptom more than any other caused me to fear and wonder—­fear that rupture would take place before he could be put to bed, and wonder how it was possible for a man to be out of bed and go through what he had gone through that morning without causing a fatal injury of some kind.  The distention, I was informed, had been gradually coming on from the first, and he had been given morphine to control the pain from the first day of his illness.  When they gave me this information I knew that the tympanites was due to narcotic paralysis, instead of coming from perforative, septic peritonitis, as the general appearance and symptoms indicated.  This reasoning gave me hope in spite of the formidable appearance of the case.

The pulse was 130, temperature 102 degree F., in the forenoon; he had been troubled with nausea a great deal, but with the exception of one or two vomiting spells, the first and second day, the nausea did not often cause retching.  The mouth and lips were dry, tongue coated, bad taste in mouth and breath very offensive.

The reason there had not been more vomiting in this case was because there was diarrhea at first and not quite so much locked up fecal matter as common.  The bowels had been relieved of the usual accumulation more than is common to the majority of such diseases before the swelling and fixation had become established.

There is a small percentage of people who are not quite so irritable as others; in these the contraction, constriction or fixation—­the embargo laid on these parts by nature in her conservative effort at preventing movement—­is not established quite so early, and the efforts on the part of doctors to force a movement are more successful in cleaning out a part of the accumulation; or there may come a diarrhea from the putrefactive poisoning which is causing the infection of the cecum or appendix and leading to abscess, and this causes a partial cleaning out before fixation is established; in these cases there is never so much vomiting nor nausea, neither do they suffer so much pain for there is not the usual accumulation in the alimentary canal to excite the peristaltic movement.