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B. O. C. Pribram, M.D.
JAMA. 1952;149(3):245-250. doi:10.1001/jama.1952.02930200031008.
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Recent discussions of surgical indications for so-called silent as well for acute and fulminant lithiasis reveal that the opinions of both physicians and surgeons are still widely divergent. The existence of a silent stone has been denied by many surgeons. W. Mayo called it a myth. Other surgeons, while admitting its existence, usually fail to give an explanation. However, the complete absence of clinical signs and symptoms despite the presence of stones in an organ of known sensitivity is not so mysterious as it may seem. Indeed, there is a pathologic basis providing an entirely satisfactory explanation. The following observations in a clinical experiment may serve to illustrate this statement.

THE SILENT ZONE IN THE GALLBLADDER  In a patient with a cholecystostomy the following experiment was made. A flexible probe was introduced through the opening, and the mucosa was scratched in all parts of the fundus of the gallbladder without


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