On July 13, 1900, I was asked to see a married woman 28 years of age. She was confined to bed with a temperature of 101 F., irregularly enlarged abdomen, nodular in form, but with some elasticity, circumscribed peritonitis on the left side with pain and great tenderness, so much tenderness in fact as to make abdominal palpation almost valueless. Ten years ago the patient complained of a lump in her side; it remained stationary, however, or increased very little in size. Eighteen months before my visit she had married, and thirteen months later gave evidence of pregnancy, i. e., suppression of menses, morning sickness, etc. At this time this tumor—so long known to exist—began to grow rapidly and becamevery painful, so much so that she was finally forced to keep her bed and accept the daily use of anodynes to secure rest.
At the time of my visit she