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The diagnosis of appendicitis is now generally made without difficulty by the general practitioners. Still sometimes a mistake is made and the diagnosis not easy on account of obscure symptoms.
The first symptom is pain and this varies in location. It is seldom in the region of the appendix at first, but most frequently is referred to the umbilicus. In a smaller number of cases, the pain is first located in the region of the stomach, especially in cases accompanied by vomiting; and in a very small proportion of cases only, is it located by the patient in the region of the appendix. The pain is generally spasmodic, colicky, hence the expression, "appendicular colic." Sometimes, however, the pain is not so sharp and acute, but is dull and constant. Remember, I am referring to the very first symptoms.
In the acute fulminating kind, when the appendix is ruptured and diffuse
CARSTENS JH. DIAGNOSIS AND SYMPTOMS OF APPENDICITIS.. JAMA. 1897;XXVIII(13):594–595. doi:10.1001/jama.1897.02440130020001d
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