This paper is only available as a PDF. To read, Please Download here.
- 1.1. A vague midline sensation of gas stoppage characterizes the onset of acute appendicitis.
- 2.2. It induces the patient (a) to seek the toilet (b) to take laxatives.
- 3.3. During the time of onset, a period from one to more than twenty-four hours, few patients are able to pass gas or to defecate without catharsis or enemas. Those able to pass gas or to defecate obtain little or no relief thereby. Hence, the sensation is a symptom and not a physical sign.
- 4.4. This bowel consciousness is an urge downward rather than an upward urge of nausea or vomiting.
- 5.5. The sensation of gas stoppage ends when pain localizes over the appendix, usually in the right iliac fossa. The features described are then altered. There is a definite pain which is different.
- 6.6. The gas stoppage sensation is present at onset irrespective of whether localization later is “typical,” “atypical,” or absent.
- 7.7. The sensation is particularly valuable in fulminating cases.
- 8.8. Three questions have been devised to elicit it. To find it, the examiner should carefully focus the patient's mind on the time prior to localization of pain, to the time not when he first felt sick, but when he last felt perfectly well.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Diagnostic Features of the First Pain of Acute Appendicitis.J. Missouri M. A. 1944; 41: 30-33
- Diseases of the Appendix, Small Intestine, and Colon.in: Ed. 5. Surgical Diagnosis. Vol. II. W. B. Saunders Company, Philadelphia, London1930
- Textbook of Surgery. Charles C. Thomas, Publisher, Springfield, Ill., Baltimore1940
Fitz, R.: Quoted by Homans.3
- Surgery of the Appendix Vermiformis.in: Surgery. W. B. Saunders Company, Philadelphia and London1908
Received: July 12, 1944
☆The author's father, E. L. Keyes, M.D., of New York, helped in preparing this paper.
© 1945 Published by Elsevier Inc.