The farmer had learned from experience that the less he put in his stomach the better he felt; hence, for a day or two before he left his home to consult me, he had refused food and drugs and had taken very little water.

After giving the sick man a rest in my office I had his wife take him to the home of a friend with whom they had arranged to stay while in the city.  In a few hours I visited him and made the following prescriptions and proscriptions:  Positively no food, not one teaspoonful of anything except water.  An enema of half a gallon of tepid water to be used once each day for the purpose of clearing out the bowels below the constriction, and I advised against violence—­rough handling.  A hot water jug to the feet, fee to the abdomen, all the fresh air possible in his bedroom and absolute quiet.  If nauseated, enough water to control thirst was to be used by enema; if the stomach was all right all the water desired by mouth.

I called the second day; the patient had slept some—­he thought about three hours of broken rest—­feeling fairly comfortable; pulse 120, temperature 101 degree F. at 9:00 a.m.; 102 degree F. at 5:00 p. m.  Third day:  Temperature 100 degree F. at 9:00 a. m.; 101 degree F. at 5:00 p. m.; one-third of the tympanites gone; slept six hours; hungry and demanding food.  I said, “No, you get no food until the bowels move.”  The ice was taken off the bowels; hot cloths were substituted.

The fourth day the temperature in the morning was 100 degree F.; in the afternoon 101 degree F., pulse 100; slept well, hungry, bowel distention reduced fifty per cent.  I touched him very lightly and found enough to confirm my diagnosis of typhlitic abscess; this was the first time I had felt that I was justified in attempting to confirm my suspicions, and even this examination could not be called a palpation, for I put no weight upon the abdomen.  The patient was very dissatisfied because I would not allow him food.  I said, “No. you can’t eat until your bowels move.”  “How soon will they move!” he asked in an irritating and ungracious manner, to which I replied, “Your God only knows, and He won’t tell.”

Fifth day about the same, a little better; very ugly because I would not allow him food.  He said:  “I don’t believe there is anything the matter with me; you are holding me down.”

Sixth day about the same, feeling fine, sleeping fine and starving to death. He made himself so unpleasant by his clamoring for food that I permitted his wife to give him a half dozen Tokay grapes.  He had scarcely swallowed the sixth when he had all the pain he wanted.  His wife came to my office in great excitement:  “Doctor, please come at once to see my husband; he is much worse, he is in agony with his bowels.”  My answer was:  “Go back and renew your hot applications to the bowels and tell your husband I permitted him to eat the grapes because he had been so unkind and ungrateful for the comfort that had been given him; tell him that I knew the grapes would give him pain and that the pain will not wear off entirely for twelve hours, and that I will not see him before tomorrow morning.”