<h3>Patient.</h3> —Mrs. A., aged 22, married, with one child 14 months old, is anemic, has had no illness since childhood, but suffers from dysmenorrhea, which she has had since the beginning of menstruation. <h3>History of Illness.</h3> —The latter part of November, 1904, she had a severe attack of cramps, which lasted three or four days, the exact cause or nature of which was not determined. Two weeks previous to the present attack she had a similar attack, severe in character. The present illness began suddenly Jan. 7, 1905, with a sharp, spasmodic, colicky pain in the right side, with nausea and vomiting. January 8, the pain became so excruciating that she fell in collapse. I found her in a condition of profound shock. She was pulseless at the wrist and the heart sounds were very indistinct; temperature, 95.8, skin moist with cold, clammy perspiration; semi-delirious. Three-quarters of a grain of morphin given hypodermically gave very little relief. She was removed to the hospital. <h3>Examination.</h3> —January 9, examination revealed pronounced tympanitis, with tenderness on pressure on right side, extending from the margin of the rib to the right groin; the pain radiated from a point over the right kidney toward the bladder. The point of greatest tenderness and distension was in the region of the right kidney and of the gall bladder. The great distension of the abdomen and the severe pain made a
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