Elmer D. Twyman, M.D.
JAMA. 1919;73(24):1840. doi:10.1001/jama.1919.26120500001011.
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History.  —Mr. H. C., aged 22, white, American, a coast guard, permit No. 1,574, was admitted to the U. S. Marine Hospital, Port of New York, Nov. 9, 1918, complaining of a dull pain in the right iliac fossa. The complaint had lasted for four days; he was nauseated but he had not vomited. The dull ache, which had no connection with eating, was continuous. The patient complained of diarrhea.There was nothing significant in his past illnesses or family history. He denied venereal disease. His parents and three sisters were living and well.

Physical Examination.  —The only abnormalities noted were diffuse tenderness in the right hypogastric region and a slight rigidity of the rectus muscle. No signs of tenderness were elicited by pushing gas around in the colon; moderate tenderness was noted in both lumbar regions posteriorly. There was gross abdominal distention; but deep palpation revealed a mobile mass,


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