_acute, diffuse peritonitis, _be drugged and fed, and go through the
daily physical examinations such as he was put through, and on the
day before the abscess breaks into the bowels show a temperature of
101.3 degree F. The pulse counts for nothing in such a case as this;
I did not look upon the farmer's pulse as indicative of any serious
state, for I knew the opium had caused it. If the pulse of either
the merchant or the farmer had been due to peritonitis death would
have ended either one before his abscess had broken. In fact diffuse
peritonitis comes from perforation with discharge of the abscess
contents into the peritoneal cavity, and it always spells death.

When vomiting recurs, or continues after the third day, there is
malpractice, or there is a serious complication, or there is a
mistaken diagnosis.

It is well to get this one fact well in mind, namely, appendicular
and typhlitic abscesses are not accompanied with complete
obstruction; hence, when the symptoms are so profound as to point to
absolute obstruction, no delay should be made in having the abdomen
opened and the obstruction, whatever it is, should be removed at
once.

The fact that the bowels do not move in from twelve to twenty-one
days should not be looked upon as total obstruction. What
obstruction there is is due to fixation of the parts and is truly a
physiological rest--it is on the order of the fixation of an
inflamed joint--the joint appears to be anchylosed, but as soon as
the pain is gone it becomes as movable as ever.

Again, if the case is really obstruction it will grow worse daily