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March 2, 1907


JAMA. 1907;XLVIII(9):801. doi:10.1001/jama.1907.02520350059008

The history of most cases shows that the atypical forms become well known long after the typical ones are generally recognized. This is true of appendicitis, in which disease the classical picture with acute onset, localized pain and tenderness over McBurney's point is now known to every physician, but certain chronic forms are less often recognized. The fact that there are chronic cases in which there are no definite attacks and but few symptoms directly referable to the appendix has been recognized for some years. Ewald spoke of this type of appendicitis as "appendicitis larvata," but the term has not come into general use. There is little doubt that cases of this character are frequently overlooked and diagnosed as intestinal indigestion or dyspepsia. They do not belong to the class of cases which reach the surgeon early, and, as a rule, the surgeon is more expert at detecting the atypical

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