[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."
[Undoubtedly this case had advanced to the seventh day when the description began.]
"In general the severity of the clinical picture had increased, especially some of the individual symptoms: Severe, markedly febrile general condition; pulse 120 to 136, moderately full, regular."
[Drugs and food caused the increase in the severity of the symptoms, for if the increase in pulse and temperature had been due to toxic infection, there would have been no amelioration of these symptoms, which we find takes place later.]
"There was insomnia with occasional opium slumber; otherwise the mind was clear but anxious. The tongue was thickly coated, the lips were dry, there was tormenting thirst."
[Ice and opium were getting in their work, increasing the nervousness and of course the fever.]