he walked a half block to the street car; then from the car to my
office he was obliged to walk one block and at last climb one flight
of stairs. When they came into my office the wife was almost
carrying him. I saw at a glance that he was a desperately sick man,
and before I attempted to examine him I had him lie down for a
while.

He had no history of any previous sickness; he had always been very
healthy, and his life had been spent in hard work in the open air.

The general appearance of the man was that of one suffering from
diffuse peritonitis. The abdomen was enormously distended; this
symptom more than any other caused me to fear and wonder--fear that
rupture would take place before he could be put to bed, and wonder
how it was possible for a man to be out of bed and go through what
he had gone through that morning without causing a fatal injury of
some kind. The distention, I was informed, had been gradually coming
on from the first, and he had been given morphine to control the
pain from the first day of his illness. When they gave me this
information I knew that the tympanites was due to narcotic
paralysis, instead of coming from perforative, septic peritonitis,
as the general appearance and symptoms indicated. This reasoning
gave me hope in spite of the formidable appearance of the case.

The pulse was 130, temperature 102 degree F., in the forenoon; he
had been troubled with nausea a great deal, but with the exception
of one or two vomiting spells, the first and second day, the nausea
did not often cause retching. The mouth and lips were dry, tongue
coated, bad taste in mouth and breath very offensive.