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June 8, 1940


JAMA. 1940;114(23):2300. doi:10.1001/jama.1940.62810230003007b

History.—  A man aged 41 when seen March 16, 1939, gave a history of having been in perfect health on retiring the night before. He was awakened at 1 a. m. with severe abdominal pain about the umbilicus. The pain was constant but there was no nausea or vomiting. The hotel physician was called; he diagnosed the condition as acute appendicitis and advised immediate operation. He gave the patient one-fourth grain (0.016 Gm.) of morphine for the pain. When seen by me, the patient had had the hypodermic and the pain had been greatly relieved, but he looked acutely ill and was perspiring freely. He vomited once half an hour after the morphine had been administered. The temperature was 99 F. by mouth. The abdomen had a boardlike rigidity, and slight pain on pressure was elicited just to the left of the umbilicus. The patient was removed to the

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