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.

The history that the patient and his wife gave me from memory was
that the urine had been scant, and at times painful to pass. There
had been from the start severe pain in the lower bowels, but neither
the patient nor his wife could remember if there had been more pain
on right, lower frontal region than anywhere else; they both
declared that the pain was all through the bowels and that there was
much bearing down like unto the pain of a diarrhea.

Breathing was shallow, of course; it never is otherwise in severe
abdominal distention.