S. W., a woman, aged 22, married, nullipara, weight, 110 pounds, admitted to the Western Maryland Hospital, March 23, 1919, had been operated on for pus tubes in September, 1917, drainage being required. This operation was followed by an uneventful recovery and good health until March 15, 1919, at which time she consulted her physician for the relief of abdominal pain associated with vomiting and preceded by constipation. Her condition increased in severity and, March 22, the vomitus assumed a fecal character. Small semisolid bowel evacuations occurred, March 17 and 18. On the night of March 22, she was placed on a train and brought to the hospital, a distance of 159 miles.
On admission the vomitus was of a distinct fecal character; the temperature was 97 by mouth; pulse, 120, and respiration, 20. The abdomen was greatly distended, and was very tender and rigid. Peristalsis was absent. There was