I scarcely touched the abdomen, for I knew I dare not press, in
percussing, enough to distinguish any sound except the tympanitic.
It has never been my custom to allow my curiosity to run away with
my judgment, and cause me to make needless examinations.

All examinations are needless when, it matters not what the
diagnosis can or must be, the treatment will be the same. All
possible bowel troubles which present the same general symptoms of
the disease I am here describing, must receive a like general
treatment. This being true, it matters not what the difference is,
there cannot be a variation requiring a bimanual examination to
differentiate it that will justify the risk. All examinations are
needless and criminal when there is a possibility of rupturing an
abscess. Especially is this true when it is a_ positive fact _that
all typhlitic and appendicular abscesses will open into the bowels
if allowed to do so.

In this ease I reasoned as follows: This must be a case of abscess,
for the signs of obstruction are not those of complete obstruction,
such as are seen in hernias, volvulus, constricting bands and many
other causes not necessary to mention. If there were complete
obstruction there would be increasing nausea and vomiting, ending in
collapse and death. This tympanites cannot be from peritonitis for
perforation would be necessary to cause it and nothing would stop
the progress after it had once started except to open the cavity
wash and drain. Hence this cannot be peritonitis, for there has been
no operation and the patient still lives. It can be distention from
the effects of morphine, but there must be more than morphine
paralysis, for there is a temperature of 102 degree to 103 degree
F., and there has been, so the wife says, a temperature of 104