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JAMA. 1910;LIV(24):1941-1942. doi:10.1001/jama.1910.02550500027011.
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Patient.  —A white woman, aged 30, born and raised in South Florida; married, and having one child aged 3. When I first saw her in December, 1908, she had had a menorrhagia for six weeks, the flow being irregularly profuse, but without pain. The patient was badly nourished, almost emaciated. Although very weak she was able to move about the room. She was markedly melancholic, or rather in varying stages of hysteromelancholia, with occasional suicidal tendencies. There was no rise of temperature or pulse and there were no definite points of pain or tenderness. She gave a history of having had dysmenorrhea for years, and of having temporarily lost her mind twice.

Examination.  —I found a relaxed vaginal outlet, uterus in extreme retroflexion, marked endometritis, with both ovaries enlarged and tender. At times she talked rationally and gave me a fairly clear history of her troubles. There was no apparent


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