PAIN, LAUGHTER AND WEEPING 325 



this hypothesis is well illustrated by the following 

 case histories : 



Several years ago, a man, 78 years old, whose chief 

 complaint was obstinate constipation was admitted to 

 the medical ward. The abdomen was but slightly 

 distended ; there was no fever ; no pain; no increased 

 leucocytosis ; no muscular rigidity; and but slight 

 general tenderness. The patient said he had lost in 

 weight and in strength during several previous months. 

 A tentative diagnosis of malignant tumor of the large 

 intestine was made, but free movements were secured 

 rather easily and we abandoned the idea of an explora- 

 tory operation. The patient gradually failed and died 

 without a definite diagnosis having been made by 

 either the medical or the surgical service. At autopsy, 

 there was found a widespread peritonitis arising from a 

 perforated appendix. 



An infant was taken ill with some indefinite disease. 

 Several of the ablest medical and surgical consultants 

 of a leading medical center thoroughly investigated 

 the case. Although they could make no definite 

 diagnosis, they all agreed that surely it could not be 

 appendicitis, because there was no muscular rigidity 

 and no tenderness. The autopsy showed a gangrenous 

 appendix and general peritonitis. 



These two cases are illustrations of the principle 

 that underlies the freedom from pain which results 

 from the use of narcotics and anesthetics. It is the 

 same principle that explains the fact that cholecys- 

 titis may occur in the aged without other symptoms 

 than the presence of a mass and, perhaps, very slight 

 tenderness. It accounts, in general, for the lack of 



