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February 1, 1913


Author Affiliations

Professor of Gastro-Enterology and Adjunct Professor of Dietetics in the Detroit College of Medicine; Consulting Gastro-Enterologist to Harper Hospital DETROIT

JAMA. 1913;60(5):350-351. doi:10.1001/jama.1913.04340050020007

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The condition I am about to describe has often been found, but I present it in order to induce other observers to assist in coming to some conclusion as to its value in the diagnosis of chronic appendicitis. Chronic concealed appendicitis without active inflammation is difficult to diagnose. Ewald has well named this condition "appendicitis larvata." Exploratory operation in these cases frequently reveals an obliterative appendicitis.

In 1898 a patient consulted me for an obstinate hyperchlorhydria. She gave a history of repeated attacks of appendicitis. On examination I found that a continuous firm pressure with the ends of the first three fingers over McBurney's point induced a referred distress or pain in the epigastrium or precordial region. Later on the patient had a recurrent attack of acute appendicitis which necessitated immediate operation. The appendix was found to have sloughed off and the wound was simply packed. The patient made a

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