38 Trans. Acad. Sct. of St. Louis 
dient that has been determined as existing and as flow- 
ing progressively, ever distally, over the stomach and 
intestines resulting in the onward propulsion of their 
contents. This, just as a ripple in water, once broken 
cannot progress beyond the point of break. So in chronic 
appendicitis the stomach may be secondarily delayed in 
emptying with resulting feeling of pressure, or gas, as 
people call it, because they can relieve this tension dis- 
comfort by belching. Now successful surgical treatment 
of the appendix will, so to speak, clear the track so 
that traffic may go on again in more nearly orderly 
and timely fashion. 
And now ensues another factor vastly portentous and 
regarding which our comparison of the traffic on a rail- 
road will not hold. With increasing congestion behind 
a diseased and delaying point, there results slight dila- 
tation of such congested parts of the intestines in front 
of it. Not only do their contents move on less rapidly 
than normally, but the bowel actually undergoes a slight 
stretching as the result of its constant heavy load. Let 
me drop this point for a moment and consider another 
necessary to understand before one can appreciate what 
finally occurs. There are in our stomachs and intestines 
a series of four sphincters. One of these, the cardia, is 
at the point where the esophagus joins the stomach; 
another, the pylorus, is the gate-way from stomach to 
intestine, and the fourth, the recto-sigmoid, is between 
the lower bowel and the rectum. These valves are soft 
mouth-like structures, of great delicacy in sensibility 
and action. Now if the bowel is slightly stretched local 
to them, these sphincters will be stretched in common, 
so that they no longer close completely, in other words, 
they remain constantly open and are incompetent, or as 
one might say, leak. So if we have a congested condition 
