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September 24, 1938


Author Affiliations

Neenah, Wis.

JAMA. 1938;111(13):1231. doi:10.1001/jama.1938.02790390087031

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To the Editor:—  In reply to Dr. Royal H. Fowler (The Journal, July 30, p. 466) and to add to the voluminous literature on this subject I will report this case:A farmer lad aged 21 with absolutely no history of gastrointestinal trouble, was kicked by a cow, while milking. The blow was an indirect one, as the rim of the pail was forcibly driven across the region of the umbilicus and right lower quadrant. Immediately after the trauma he suffered abdominal pain, felt weak and nauseated and was unable to eat. For the next six days, anorexia was present with abdominal pain referable to the middle and right lower quadrant. Nausea was present but he had not vomited. His parents brought him to my office after the end of the sixth day. He appeared pale and very ill. A cursory examination of the abdomen revealed a mass the size

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