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JAMA. 1890;XIV(10):344-345. doi:10.1001/jama.1890.02410100020001e.
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This case is a beautiful illustration of what Senn says in his masterly article on "Ulcerative Appendicitis" (in Vol. xiii, No. 18 of THE JOURNAL): "Many patients suffer from well-defined symptoms indicative of the presence of an inflammatory lesion of the appendix for months and years before it gives rise to a perityphlitis or perforati ve peritonitis."

Peter R., æt. 27, student, consulted me at my office December 14, for a vague recurring pain in the lower part of the abdomen of four years' duration. He attributed it to running one day, when he felt something give way in the ilio-cæcal region. He was a strong, muscular young man with a good family history, and besides those pains had never been sick. The pains had never caused vomiting except once, two years ago. His pulse was 82; temp. 37.7° C.

Examination revealed no tympanitis, no swelling in ileo-cæcal region, and


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