Patient.
—M. J., colored, primipara, aged 23, was taken sick suddenly, Jan. 21, 1909, with pain in the lower ahornen, followed by chills, restlessness, and vomiting. No information of importance was elicited from her family history.
History.
—For some time before her present illness began, her appetite had been poor; she had suffered pain in her lower abdomen, and nausea after eating; ner bowels usually moved twice daily.
Examination.
—Jan. 23, 1909, she was admitted to Garfield Memorial Hospital. Her tongue ý as coated with a grayish white fur; facial expression was drawn; she was in dorsal deoubitus position with knees flexed. Pulse was 132; temperature, 103; leucocyte count, 20,560. The abdominal muscles were rigid, especially the left rectus; there was tenderness on pressure over both ovarian regions; on the left side a mass was outlined as big as a hen's egg. Vaginal examination revealed double salpingitis and a large mass.