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July 18, 1966

The 'Silent' Gallstones: A Therapeutic Dilemma

JAMA. 1966;197(3):24-25. doi:10.1001/jama.1966.03110030022010

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When the President of the United States felt the sharp pains of cholelithiasis last September, he joined a centuries-old fraternity of persons who have known this problem.

But there are other stone-bearers who go about without pain. They live with "silent" gallstones. And for the physician, they represent a therapeutic dilemma.

"The physician's dilemma," Robert J. Bolt, MD, suggested in a Gastroenterology Section symposium, "occurs because he cannot predict which of the patients will, and which will not, encounter difficulty as a result of their stones."

In effect, added Jonathan E. Rhoads, MD, the therapeutic dilemma encompasses "a relatively small number of patients who, for one reason or another, have had their stones discovered, but who seem to have no symptoms directly attributable to them."

Dr. Bolt, who is professor of internal medicine at the University of Michigan and soon will be chairman of the Internal Medicine Department, University of

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