abscess forms, the walls of which surround the appendix which is
inflamed and often gangrenous. About this time, on account of the
gradual increase in swelling, the pressure brings obstruction,
partial or complete, causing the symptoms to become suddenly very
dangerous; then if vigorous examinations are made to determine the
exact status of the disease, don't be surprised if rupture of the
pus sac takes place! This then demands an immediate operation which
if performed will show a gangrenous appendix that had ruptured! This
is quite common and is looked upon as proof positive that an
operation was justified; in fact, the proper and only thing to be
done, and it should have been done earlier!

This is the opinion of the majority of the profession. It really
appears that surgeons are innocent of the part they play in
rupturing unsuspected abscesses and otherwise complicating this
disease by much rough handling.

The paroxysmal pain which is characteristic of the early stages of
appendicitis may be accompanied by fever, sometimes low and
sometimes high, nausea, vomiting and diarrhea. The vomiting may be
severe and there may only be nausea. If there is much vomiting there
will usually not be much diarrhea for the excessive vomiting is an
indication that there is obstruction. In other cases there is both
nausea and diarrhea; then the obstruction is either not established,
for the trouble is as yet a local inflammation of the mucous
membrane, or the diarrhea is from the bowels below the cut-off.

It is safe to prognose obstruction when the vomiting is severe; but
if the nausea continues longer than three days, it must be due to
eating or to drugs, to taking too much water while there is nausea,