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April 10, 1909

A New Sign of Perforation in Typhoid Fever

JAMA. 1909;LII(15):1194-1195. doi:10.1001/jama.1909.02540410042012

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To the Editor:  —In The Journal, February 27, page 695, in the article entitled a "New Sign of Perforation in Typhoid Fever," the following statement occurs: "A small area of tenderness was found low down in the right iliac fossa. The patient was turned on his left side and in half an hour the area of tenderness had moved toward that side about two inches."This seems such bad teaching that it should not be allowed to pass unchallenged.Patients with perforation in typhoid fever die from general peritonitis. With the vast improvement in results from Fowler's position, based on Muscatello's finding as to regions of absorption, a surgeon of to-day can scarcely justify his position if he treats his patients otherwise. No one would dream of using Clark's position. It would seem equally indefensible to place the patient in any position whatsoever, merely to make him worse in order

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