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June 2, 1945


JAMA. 1945;128(5):326-329. doi:10.1001/jama.1945.02860220008003

In patients with symptoms of intra-abdominal disease the difficulties of precise anatomic diagnosis are often greatly increased by clinical manifestations due to a wide variety of extra-abdominal lesions. Hematologic, allergic, orthopedic, respiratory, endocrinologic, infectious or urologic disease frequently leads to erroneous diagnosis and mistaken surgical intervention. The diagnostic problem is usually difficult enough in adults but is notoriously more difficult in children, and in the very young the clinical approach must be largely objective. It is recognized that in infants and children with symptoms of acute abdominal surgical disease laparotomy is often the urgent indication even though the differential diagnosis may be in doubt. Only by this method will the mortality of acute appendicitis, for example, be reduced.

Abdominal pain commonly results from a localized intraperitoneal disease, as appendicitis, cholecystitis or diverticulitis, or is widespread, as in general peritonitis. The abdominal projection of pain through the vagus from an acute

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