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August 11, 1945


JAMA. 1945;128(15):1123. doi:10.1001/jama.1945.02860320065025

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To the Editor:—  The great discrepancy that exists between the clinical diagnosis of chronic appendicitis and many apparent nonpathologic appendixes subsequently reported by some pathologists as chronic appendicitis presents a serious and challenging problem to all clinicians and especially to surgeons.In no other field of surgery is there tolerated so flagrant a violation of diagnostic and pathologic fundamentals. The growth of this pernicious practice is due to three errors: First, inadequate and hasty study by the clinician. All too frequently we find the first and easiest diagnosis to be chronic appendicitis, whereas the correct approach would be to proceed on the basis that this is the last possible diagnosis and should be arrived at only after all studies and adequate consultations have ruled out other diseases which may easily simulate chronic appendicitis. Only after this are we justified in subjecting the patient to surgery. The wisdom of the phrase

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