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in 28 out of the 34 instances. Shock is not often met with, but may be severe and fatal. Peritoneal symptoms rapidly develop, with a tendency in some cases to be localized in the upper part of the abdominal cavity and in the right side ; when these signs show themselves mostly to the right and at or below the level of the umbilicus, an appendicitis is necessarily simulated. When the liver dulness has disappeared nearly up to the mammary line, air extravasation may be suspected, and when it isdoi:10.1056/nejm190105091441908 fatcat:x73wabbyvrhj3jg2our5z6d3zq