perforation which would have ended the case in death very soon.

In this case the point of infection was walled in, as all such cases
are, with exudates and whether the appendix was primarily affected
or not doesn't matter; it was within this enclosure and found to be
ruptured, which is common; but its rupture was of no consequence
because the escaped contents were in the abscess cavity that finally
emptied into the cecum, the natural outlet in all these cases if
they are left to nature and not officiously fingered--thumbed and
punched to death.

The distinction drawn by this author between toxic and bacterial
peritonitis is, to my mind, a distinction without a difference.

In this case the tympanites following the obstruction was due to the
fact that the gas in the bowels was retained for a few days because
of the completeness of the obstruction, and would have passed off in
three days had it not been for the paralyzing effect of the opium;
hence the distention that came from gas was succeeded by the
distention peculiar to opium and caused the doctor to believe that
he had a case of diffuse peritonitis when, in fact, he had a case
of gas distention due to morphine paralysis. The morphine directly
and indirectly weakened the heart. The distention of the bowels was
a constant interference. The pulse at the start was fine at 112, but
in six days it had increased to 140 and finally reached 160.