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I send the following notes in view of the interesting questions raised by the case. CLINICAL HISTORY I was called early one morning to see a man aged 66, who had been in great abdominal pain all night. The pain was widely diffused all over the abdomen, the bowels had been well opened twice the previous day, the temperature was normal, and the pulse 96 and rather weak.doi:10.1136/bmj.2.4411.85 fatcat:njvofrls3rdtjfqnpd6oxloc4e