and lancinating. The liver dullness below decreased;"

[Why not? Extending tympanites caused it--insignificant at most.]

"the pulmonary-liver border extended to the upper border of the
fifth rib; on the right side of the abdomen between the navel and
the anterior, superior spine of the ileum a circumscribed slight
dullness was observed."

[This could have been taken for granted without unnecessary
palpation.]

"There was great nausea and burning thirst."

[Already the opium was getting in its work. Great nausea and burning
thirst were not due to the disease, and the crowding upward of the
liver border was caused by the gas distention.]

_"Diagnosis:_ Acute diffuse appendicular peritonitis, probably
also perforation; circumscribed perityphlitic abscess."

[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."