whether the inflammation of the serosa quickly spreads or remains
local. Peritoneal meteorism is peculiar. The abdomen is uniformly
distended, balloon-like; the muscles as well as the rest of the
abdominal walls are tense. It must be added, how ever, that in spite
of the excruciating pain upon touch there is no sign of contraction
of the abdominal muscles, of the "muscular resistance" _(defense
musculaire) _which is so common on pressure in other forms of
abdominal pain, particularly when circumscribed."

[Distention from any cause--or stretching of muscular fiber--causes
paralysis for the time being.]

"The same is true of the diaphragm; it is forced upward, the muscles
are therefore elongated and tense; but there is no evidence of
active contractions. Abdominal respiration ceases; gradually then,
as may be recognized by the limits of percussion, increasing loss
of _muscle tonus_ is added. In this case the autopsy showed that the
peritonitis had not advanced up to the serosa of the diaphragm."

[The muscle tonus when a patient is under the influence of opiates
cannot be reckoned with, for that drug paralyzes the muscles, and
the bowels fill with gas as was seen in this case up to the day
before the abscess ruptured; on that day feeding had been suspended,
resulting in a decrease of gas and an amelioration of all the
symptoms.]

"Among these signs pain, either spontaneous or upon touch, a rise in
temperature, increased frequency of the pulse and, in general, the
signs of severe illness, are to be looked upon as the local and
general symptoms of a severe septic inflammation; vomiting, at least