Speaking broadly, cholecystitis is a disease which begins in youth but is first recognized and properly treated in old age. As we shall see later, in a group of men and women coming to operation at an average age of 44 years, the duration of symptoms averaged nineteen years, an interval during which there were many courses of treatment, most of them directed against such vague disorders as "nervous indigestion," "flatulent dyspepsia," and "intestinal autointoxication." Now, we might say with Naunyn 1 that the "process of gallstone formation does not give rise to any symptoms," and that those which appear are "merely the manifestation of chronic dyspepsia;" or we may more logically assume that the symptoms observed do represent the earlier stages of cholecystitis. If that be the case, surely the sensible thing to do is to analyze very carefully the early histories of the persons who now undoubtedly have
ALVAREZ WC, MEYER KF, RUSK GY, TAYLOR FB, EASTON J. PRESENT-DAY PROBLEMS IN REGARD TO GALLBLADDER INFECTIONSA STATISTICAL INQUIRY. JAMA. 1923;81(12):974–980. doi:10.1001/jama.1923.02650120006003
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