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The full force of the peristaltic waves from the small intestine with its onrush of fluid or semifluid contents subjects the cecum to great distention and strain.
In this case the point of infection was walled in, as all such cases are, with exudates and whether the appendix was primarily affected or not doesn't matter; it was within this enclosure and found to be ruptured, which is common; but its rupture was of no consequence because the escaped contents were in the abscess cavity that finally emptied into the cecum, the natural outlet in all these cases if they are left to nature and not officiously fingered thumbed and punched to death.
A post-mortem examination might have shown the intra-peritoneal covering, of that portion of the cecum involved in the inflammation, slightly inflamed, but it is not reasonable to believe that the inflammation was of a toxic character unless adhesive inflammations can be so called. Inflammation is always the same, it matters not what the exciting cause may be.
Death was caused by a well-defined round perforation at the cardiac curvature the size of a sixpence. Anomalies of the Intestines. The Ephemerides contains the account of an example of double cecum, and Alexander speaks of a double colon, and there are other cases of duplication of the bowel recorded. There is an instance of coalition of the jejunum with the liver, and Treuner parallels this case.
The abdomen is tender, especially over the cecum, and should therefore be manipulated as little as possible, for it causes the patient unnecessary pain, and if an abscess has formed there is danger of breaking the walls which nature has thrown up.
Its only real and permanent cure is through exercise in the open air, sleep, and proper ventilation of bedrooms, with abundance of nourishing food, including plenty of green vegetables and fresh fruits. The beginning of the large bowel, where the small bowel empties into it, is the largest part of it, and forms a curious pouch called the cecum, or "blind" pouch.
The opening of the appendix is so very small that inflammation of the cecum soon closes it and then we have a mucous surface without drainage, which means obstruction opposition to the requirements of nature for one of the functions of the mucous membrane is to secrete and this secretion must have an outlet or the part becomes diseased.
The symptoms and course of the malady up to that time should have told the real diagnostician that there was an abscess and that the abscess would rupture into the cecum if it were not meddled with. No one with a proper understanding of his responsibility in such a case would have thought of undertaking an operation with a patient in the physical condition that this man was reported to be in.
"The point of rupture closed!" How could a rupture into a distended gut close, The distention was greater after the rupture than before. Fresh infection could not take place without a power to force the putrefaction greater than the force that existed before the abscess broke into the cecum. Let us reason together: Nature fought successfully against heavy odds before the rupture.
Nature's tendency appears to be to fix the inflamed portion so as to secure rest and this is accomplished by the muscles of the abdominal wall becoming rigid, especially over the cecum. These muscles are contracted to such an extent that the right thigh is often drawn up in order to relieve the tension.
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