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Royal H. Fowler, M.D.
JAMA. 1938;111(5):466-467. doi:10.1001/jama.1938.02790310088025.
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To the Editor:—  "Trauma and Appendicitis" is the subject of an editorial in The Journal, June 4, in which my recent article, "The Rare Incidence of Acute Appendicitis Resulting from External Trauma" is mentioned. The strict criteria demanding actual proof of direct trauma to the appendix, which I have laid down to meet the requirements of primary traumatic appendicitis, are not accepted by the editorial writer. He does accept, however, the purely theoretical and indirect mechanism in this class of case, sponsored by Luddington and others, to which I cannot subscribe, i. e., the expulsion of cecal contents into the normal appendix, the result of a direct blow on the abdomen. The case of primary traumatic appendicitis, the result of this pathogenesis, is a weak one, if one accepts the statement of the editorial writer, namely, "A normal appendix with a free lumen would empty itself of the material forced


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