[The diffuse peritonitis was apparent to the eye but not to the reason as the course of the disease proves before many days.]

“Operation was considered but not performed.  Removal to the hospital for the purpose of an operation was absolutely declined by the patient.”

“I saw him upon the following day, the fourth of the disease.”

[Undoubtedly this case had advanced to the seventh day when the description began.]

“In general the severity of the clinical picture had increased, especially some of the individual symptoms:  Severe, markedly febrile general condition; pulse 120 to 136, moderately full, regular.”

[Drugs and food caused the increase in the severity of the symptoms, for if the increase in pulse and temperature had been due to toxic infection, there would have been no amelioration of these symptoms, which we find takes place later.]

“There was insomnia with occasional opium slumber; otherwise the mind was clear but anxious.  The tongue was thickly coated, the lips were dry, there was tormenting thirst.”

[Ice and opium were getting in their work, increasing the nervousness and of course the fever.]

“The cheeks were red.  The patient maintained the dorsal decubitus with feebly flexed legs and hushed voice; the hands moved but slightly and trembled.”

[Narcotism.]

“Occasionally there were spontaneous attacks of severe, tearing, abdominal pain, starting posteriorly in the lower right side.”

[Why not?  Food was being given, stimulating peristalsis.]

" The abdomen was very tympanitic and tense, and could scarcely be touched; nevertheless, it was possible to determine upon the right side low down an area of dullness about the size of a hand with increased resistance; otherwise the note was tympanitic upon percussion.”

[The reader will notice the frequency of the reports regarding the area of dullness and extension of tympanites.  These frequent examinations are wearing on patients in this condition, and are of no consequence whatever; they start at nothing and end nowhere, except in the discomfort and often the death of the patient; they are practiced by too many physicians and should be discouraged for they represent a very bad habit and are harmful; they are pushed to a pernicious extent in some cases, for without doubt abscesses are ruptured by them.  If the physicians were not satisfied by this time without the need of laying on of hands, observation and analysis were lacking.]

“The diaphragm was raised; except for a small zone liver dullness was absent.”

[Of what possible benefit was this knowledge under the circumstances?]

“Now and then there was grass-green vomitus which, the last time, contained a few brownish granules and had a fecal odor.  Urine unchanged; micturition very painful; no feces.”

[Proof positive that there was no peritonitis yet, and the indicating symptoms were those of opium.]