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July 9, 1927


Author Affiliations

Durham, N. C.

JAMA. 1927;89(2):140. doi:10.1001/jama.1927.02690020064029

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To the Editor:  —I have received from Dr. Emil Bogen an interesting reprint and copy of a letter to you relative to a case reported by me (The Journal, April 30, p. 1395) as one of bilateral diaphragmatic pleurisy simulating perforated gastric ulcer. Dr. Bogen suggests that it was a case of arachnidism. Such a diagnosis was considered before operation and the history of spider bite included as relevant. The day following operation, however, the appearance was that of a respiratory infection, with leukocytosis of 19,000; and this appearance became more marked as the respirations rose from 30 to 48 per minute. The later occurrence and persistence of definite, clear and unmistakable dry pleural friction rubs anteriorly, posteriorly and in the axilla on both sides at the level of the diaphragm just about indisputably establish a diagnosis of bilateral diaphragmatic pleurisy. To suppose an arachnidism also would necessitate the supposition

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