or there is more obstruction than can be accounted for by such
diseases as suppurative inflammation of the cecum or appendix.

It will be well to remember that diseases of the cecum or appendix
or both never cause complete obstruction, except in exceedingly rare
cases where adhesive bands are formed, completing the cut-off. In
this connection it will be well to also remember that in absolute
obstruction the symptoms of nausea and vomiting, or retching, will
continue, while those of appendicitis will stop in three days. In
addition to the continued nausea of complete obstruction, the pulse
grows weaker and more frequent and the patient shows great anxiety
of expression, there is a sickness that can not be accounted for
with a diagnosis of appendicitis or typhlitis, and the patient has
the appearance of being desperately sick. The great pain at the
beginning subsides, the temperature falls, the pulse grows rapid and
weak, the skin becomes leaky, the mind becomes dull, drowsy and
comatose, then a little wandering and death relieves the suffering
in a short time.

These symptoms are of collapse and they may come on in the course of
a typhoid fever, or other diseases of the alimentary canal; they
always mean a fatal toxemia either from obstruction or perforation,
and occasionally the only forerunning symptom is sudden abdominal
pain. Circumstances must guide in making a diagnosis. If, during a
run of typhoid fever, there should be sudden abdominal pain followed
with symptoms of collapse and nothing to account for it, it means
perforation; an immediate operation may save the patient; nothing
else will.

A sudden pain in the abdomen of a woman during menstrual life, with