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VAGINAL EXPLORATORY PUNCTURE AND CELIOTOMYTHEIR ADVISABILITY IN DOUBTFUL DIAGNOSIS IN DISEASES OF THE FEMALE GENITAL ORGANS; REPORT OF CASES.

C. O. THIENHAUS, M.D.
JAMA. 1903;XLI(23):1404-1406. doi:10.1001/jama.1903.92490420022002e.
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When some time ago in a discussion on the differential diagnosis of appendicitis, pyosalpinx, extra-uterine pregnancy, tuberculosis of the right tube and exudates in the right iliac region, I heard the opinion expressed by a teacher of gynecology : "What is the use of going into minute details of differential diagnosis in such cases? The abdomen has to be opened anyhow," I was unwillingly reminded of the general who without sufficient reconnoitering led his troops into an unknown valley, and afterward, encountering insurmountable difficulties, met terrific defeat. Though without question the advancements of modern surgery in the last twenty-five years have made an exploratory laparotomy a relatively safe procedure, so far as the immediate and probably the remote safety of the patient is concerned, yet it must not be forgotten that all therapeutic actions ought in every medical as well as surgical case to be based on a strict and

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