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Robert A. Noble, M.D.
JAMA. 1912;LVIII(10):691. doi:10.1001/jama.1912.04260030091007.
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The following case is reported because of the unusual size of the specimen.

Patient.  —N. T., a woman aged 42, single, patient of Dr. G. R. Smith, was seen in consultation at St. Joseph Hospital, Jan. 4, 1912. During the past six years she had experienced repeated attacks of abdominal pain of general distribution, with occasionally more localized pain in the right iliac region. These attacks of pain were accompanied usually by nausea and vomiting. Increase in the pulse-rate or temperature elevation was rarely observed. She complained of excessive bloating and that abdomen was frequently painful to pressure. There was chronic constipation; menstruation fairly regular, at no time painful.

Examination.  —At the time I saw the patient she had been confined to her bed about one week, during which time she had had violent pain throughout the abdomen localizing in right lower quadrant. The abdomen was painful to pressure


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