Among the many serious aspects in which that protean disease, appendicitis, is presented to the surgeon, there is none more alarming than the types in which diffuse peritonitis is attended with intestinal paralysis and distention of the abdomen. Here we have in addition to the already severe septicemia due to absorption from the peritoneum, a toxemia from absorption of the poisonous products of stagnating feces in the intestine, and the great depression produced by gaseous distention of the bowel. The mechanical interference with the descent of the diaphragm renders respiration feeble and shallow, interferes with the aëration of the blood, and adds the grave complication of asphyxia to tax the failing strength of a patient already almost exhausted. It is hard to conceive of a more certainly fatal form of assault on the organism.
We all, as surgeons, are familiar with the insidious and dangerous character of those cases of