continued with exacerbations upon motion, after eruetations, and on
talking; the entire abdomen was very sensitive. Strangury with the
frequent discharge of scant urine was observed.

"Toward evening the physician found the patient extremely ill,
immovable in the active dorsal decubitus, with an anxious facial
expression, reddened cheeks, cautious, superficial respiration with
a low, hushed voice; he complained of continuous, also occasionally
of marked tearing and contracting pains in the entire abdomen, most
severe upon the right side low down; the temperature was 103.2
degree F., the pulse was 112, full, somewhat tense, regular and
even.

"The lips were dry, the tongue markedly coated; _foetor ex ore _was
present; painful eructations were frequent, also singultus, complete
anorexia and extreme thirst. The respirations were superficial,
quite rapid, and purely thoracic; the diaphragm was slightly raised;
the pulmonary-liver border was, in the right mammillary line, at the
lower border of the fifth rib; upon anterior examination the
thoracic organs appeared normal; the examination of the back was not
then undertaken.

"The entire abdomen was uniformly tympanitic, everywhere very
sensitive to the slightest pressure, but more so upon the right side
than upon the left. There was also pain upon pressure in the lumbar
region.

"Signs of abdominal respiration were absent. Careful palpation
showed a uniform, drum-like resistance, otherwise nothing abnormal.
The percussion note over the abdomen upon light tapping (and only