1212

" XBD=300 XHG=118 YBD=329 YHG=298>involved " XBD=361 XHG=321 YBD=327 YHG=298>in " XBD=447 XHG=381 YBD=328 YHG=298>the " XBD=726 XHG=469 YBD=334 YHG=297>pathological " XBD=903 XHG=746 YBD=335 YHG=298>change. " XBD=1080 XHG=957 YBD=327 YHG=297>When " XBD=1149 XHG=1100 YBD=327 YHG=308>no " XBD=1275 XHG=1171 YBD=328 YHG=300>trace" XBD=157 XHG=116 YBD=367 YHG=338>af " XBD=334 XHG=182 YBD=368 YHG=338>normal " XBD=481 XHG=358 YBD=374 YHG=346>ovary " XBD=623 XHG=504 YBD=367 YHG=338>tissue " XBD=720 XHG=649 YBD=367 YHG=347>can " XBD=792 XHG=745 YBD=366 YHG=337>be " XBD=951 XHG=817 YBD=372 YHG=337>found, " XBD=1044 XHG=977 YBD=367 YHG=338>the " XBD=1215 XHG=1070 YBD=374 YHG=338>growth " XBD=1274 XHG=1242 YBD=367 YHG=338>is" XBD=238 XHG=119 YBD=407 YHG=377>called " XBD=286 XHG=262 YBD=406 YHG=387>a " XBD=332 XHG=311 YBD=389 YHG=377>&dquo; " XBD=514 XHG=350 YBD=407 YHG=376>diffused " XBD=740 XHG=539 YBD=409 YHG=376>fibroma,&dquo; " XBD=842 XHG=766 YBD=407 YHG=378>and " XBD=934 XHG=867 YBD=407 YHG=377>the " XBD=1066 XHG=958 YBD=414 YHG=378>great " XBD=1275 XHG=1087 YBD=414 YHG=378>majority" XBD=181 XHG=120 YBD=447 YHG=426>are " XBD=284 XHG=201 YBD=447 YHG=416>said " XBD=347 XHG=304 YBD=447 YHG=418>to " XBD=416 XHG=368 YBD=446 YHG=417>be " XBD=476 XHG=436 YBD=446 YHG=416>of " XBD=573 XHG=496 YBD=447 YHG=416>this " XBD=744 XHG=595 YBD=447 YHG=418>nature. " XBD=838 XHG=799 YBD=447 YHG=417>It " XBD=887 XHG=857 YBD=446 YHG=417>is " XBD=949 XHG=908 YBD=446 YHG=417>in " XBD=1045 XHG=968 YBD=447 YHG=417>this " XBD=1163 XHG=1068 YBD=447 YHG=418>class " XBD=1274 XHG=1184 YBD=448 YHG=417>that" XBD=222 XHG=117 YBD=486 YHG=465>some " XBD=365 XHG=242 YBD=486 YHG=458>assert " XBD=474 XHG=384 YBD=487 YHG=456>that " XBD=630 XHG=493 YBD=487 YHG=456>ascites " XBD=681 XHG=650 YBD=486 YHG=457>is " XBD=768 XHG=703 YBD=487 YHG=457>the " XBD=883 XHG=791 YBD=492 YHG=458>rule, " XBD=976 XHG=904 YBD=487 YHG=456>but " XBD=1037 XHG=997 YBD=486 YHG=466>as " XBD=1153 XHG=1059 YBD=494 YHG=457>they " XBD=1272 XHG=1173 YBD=488 YHG=457>form" XBD=183 XHG=120 YBD=527 YHG=496>the " XBD=393 XHG=205 YBD=533 YHG=496>majority " XBD=454 XHG=415 YBD=525 YHG=496>of " XBD=595 XHG=479 YBD=532 YHG=506>cases, " XBD=713 XHG=619 YBD=526 YHG=496>then " XBD=792 XHG=736 YBD=526 YHG=506>we " XBD=943 XHG=815 YBD=526 YHG=496>would " XBD=1105 XHG=967 YBD=534 YHG=499>expect " XBD=1169 XHG=1127 YBD=528 YHG=499>to " XBD=1273 XHG=1193 YBD=527 YHG=497>find" XBD=254 XHG=120 YBD=567 YHG=537>ascites " XBD=434 XHG=280 YBD=573 YHG=538>present " XBD=498 XHG=457 YBD=565 YHG=536>in " XBD=588 XHG=522 YBD=567 YHG=536>the " XBD=811 XHG=612 YBD=574 YHG=536>majority, " XBD=961 XHG=836 YBD=567 YHG=536>which " XBD=1017 XHG=985 YBD=566 YHG=537>is " XBD=1273 XHG=1043 YBD=574 YHG=538>apparently" XBD=186 XHG=114 YBD=607 YHG=579>not " XBD=273 XHG=206 YBD=607 YHG=576>the case-Hellman " XBD=783 XHG=636 YBD=613 YHG=576>stating " XBD=893 XHG=803 YBD=607 YHG=576>that " XBD=946 XHG=913 YBD=607 YHG=576>it " XBD=1058 XHG=966 YBD=613 YHG=577>only " XBD=1210 XHG=1079 YBD=607 YHG=586>occurs " XBD=1273 XHG=1232 YBD=606 YHG=577>in" XBD=138 XHG=117 YBD=645 YHG=617>5 " XBD=237 XHG=168 YBD=653 YHG=626>per " XBD=384 XHG=263 YBD=647 YHG=616>cent. 2 " XBD=526 XHG=436 YBD=646 YHG=616>This " XBD=671 XHG=553 YBD=653 YHG=615>figure " XBD=792 XHG=698 YBD=654 YHG=626>may " XBD=865 XHG=818 YBD=646 YHG=616>be " XBD=976 XHG=892 YBD=652 YHG=617>low, " XBD=1077 XHG=1006 YBD=647 YHG=616>but " XBD=1270 XHG=1106 YBD=648 YHG=617>Doran’s" XBD=192 XHG=116 YBD=687 YHG=656>and " XBD=447 XHG=214 YBD=687 YHG=656>Fairbairn’s " XBD=531 XHG=469 YBD=687 YHG=666>are " XBD=631 XHG=552 YBD=686 YHG=657>also " XBD=718 XHG=652 YBD=687 YHG=658>too " XBD=812 XHG=738 YBD=687 YHG=657>low " XBD=861 XHG=831 YBD=686 YHG=656>if " XBD=947 XHG=880 YBD=687 YHG=657>the " XBD=1047 XHG=968 YBD=687 YHG=658>rule " XBD=1098 XHG=1067 YBD=686 YHG=657>is " XBD=1159 XHG=1118 YBD=688 YHG=659>to " XBD=1271 XHG=1181 YBD=687 YHG=657>hold" XBD=226 XHG=116 YBD=735 YHG=698>good. " XBD=404 XHG=279 YBD=728 YHG=697>When " XBD=516 XHG=424 YBD=736 YHG=698>only " XBD=559 XHG=536 YBD=727 YHG=707>a " XBD=668 XHG=579 YBD=735 YHG=699>part " XBD=728 XHG=688 YBD=727 YHG=697>of " XBD=815 XHG=748 YBD=728 YHG=697>the " XBD=959 XHG=836 YBD=735 YHG=706>ovary " XBD=1009 XHG=977 YBD=728 YHG=697>is " XBD=1211 XHG=1029 YBD=728 YHG=697>involved " XBD=1272 XHG=1232 YBD=728 YHG=698>in" XBD=232 XHG=114 YBD=768 YHG=738>the &dquo; " XBD=542 XHG=250 YBD=770 YHG=737>fibromatous &dquo; " XBD=722 XHG=572 YBD=776 YHG=747>process " XBD=782 XHG=749 YBD=769 YHG=738>it " XBD=838 XHG=807 YBD=768 YHG=737>is " XBD=1045 XHG=868 YBD=768 YHG=747>common " XBD=1113 XHG=1072 YBD=769 YHG=739>to " XBD=1221 XHG=1140 YBD=768 YHG=737>find " XBD=1272 XHG=1249 YBD=768 YHG=748>a" XBD=269 XHG=116 YBD=816 YHG=780>capsule " XBD=333 XHG=292 YBD=810 YHG=781>to " XBD=424 XHG=356 YBD=810 YHG=779>the " XBD=607 XHG=447 YBD=817 YHG=779>growth, " XBD=749 XHG=631 YBD=808 YHG=778>hence " XBD=842 XHG=776 YBD=809 YHG=778>the " XBD=1271 XHG=868 YBD=816 YHG=779>name &dquo; encapsuled" XBD=313 XHG=114 YBD=850 YHG=818>fibroma&dquo; " XBD=450 XHG=338 YBD=856 YHG=820>given " XBD=517 XHG=476 YBD=850 YHG=821>to " XBD=616 XHG=540 YBD=851 YHG=819>this " XBD=747 XHG=642 YBD=850 YHG=819>third " XBD=870 XHG=775 YBD=849 YHG=820>class " XBD=956 XHG=902 YBD=857 YHG=819>by " XBD=1097 XHG=980 YBD=850 YHG=828>some. " XBD=1271 XHG=1150 YBD=849 YHG=819>These" XBD=346 XHG=116 YBD=898 YHG=859>encapsuled " XBD=534 XHG=367 YBD=897 YHG=860>growths " XBD=619 XHG=555 YBD=890 YHG=869>are " XBD=782 XHG=640 YBD=897 YHG=861>always " XBD=997 XHG=802 YBD=896 YHG=859>innocent, " XBD=1096 XHG=1019 YBD=890 YHG=859>and " XBD=1270 XHG=1117 YBD=890 YHG=859>accord-" XBD=180 XHG=114 YBD=938 YHG=900>ing " XBD=246 XHG=204 YBD=931 YHG=902>to " XBD=378 XHG=273 YBD=930 YHG=910>some " XBD=517 XHG=405 YBD=931 YHG=900>are &dquo; " XBD=679 XHG=535 YBD=930 YHG=900>seldom " XBD=751 XHG=707 YBD=930 YHG=910>or " XBD=893 XHG=775 YBD=931 YHG=909>never " XBD=1191 XHG=917 YBD=937 YHG=900>accompanied " XBD=1272 XHG=1218 YBD=937 YHG=899>by

ascites.&dquo;7 " XBD=414 XHG=361 YBD=971 YHG=941>As " XBD=504 XHG=428 YBD=971 YHG=941>will " XBD=565 XHG=518 YBD=970 YHG=940>be " XBD=668 XHG=580 YBD=970 YHG=950>seen " XBD=792 XHG=683 YBD=976 YHG=941>later, " XBD=996 XHG=808 YBD=977 YHG=940>however, " XBD=1080 XHG=1010 YBD=978 YHG=950>my " XBD=1178 XHG=1094 YBD=971 YHG=950>case " XBD=1270 XHG=1193 YBD=971 YHG=939>had" XBD=139 XHG=115 YBD=1010 YHG=990>a " XBD=424 XHG=163 YBD=1011 YHG=981>well-marked " XBD=613 XHG=460 YBD=1019 YHG=982>capsule " XBD=724 XHG=647 YBD=1012 YHG=981>and " XBD=784 XHG=760 YBD=1010 YHG=990>a " XBD=1077 XHG=819 YBD=1011 YHG=981>considerable " XBD=1271 XHG=1108 YBD=1011 YHG=982>amount" XBD=154 XHG=117 YBD=1051 YHG=1021>of " XBD=331 XHG=182 YBD=1053 YHG=1022>ascites. " XBD=528 XHG=385 YBD=1052 YHG=1021>Clark’s " XBD=641 XHG=557 YBD=1052 YHG=1031>case " XBD=747 XHG=669 YBD=1052 YHG=1021>had " XBD=789 XHG=765 YBD=1051 YHG=1031>a " XBD=1103 XHG=808 YBD=1052 YHG=1021>&dquo;well-marked " XBD=1269 XHG=1126 YBD=1052 YHG=1021>fibrous" XBD=308 XHG=118 YBD=1101 YHG=1062>capsule,&dquo; " XBD=405 XHG=329 YBD=1093 YHG=1063>and " XBD=529 XHG=424 YBD=1093 YHG=1071>some " XBD=697 XHG=548 YBD=1099 YHG=1062>ascites, " XBD=866 XHG=717 YBD=1100 YHG=1062>though " XBD=951 XHG=884 YBD=1094 YHG=1063>the " XBD=1088 XHG=970 YBD=1094 YHG=1063>latter " XBD=1181 XHG=1104 YBD=1093 YHG=1072>was " XBD=1270 XHG=1200 YBD=1093 YHG=1064>not" XBD=334 XHG=117 YBD=1141 YHG=1103>recognised clinically. 2 " XBD=743 XHG=624 YBD=1134 YHG=1104>These " XBD=927 XHG=760 YBD=1141 YHG=1104>growths " XBD=992 XHG=944 YBD=1134 YHG=1104>do " XBD=1079 XHG=1008 YBD=1135 YHG=1106>not " XBD=1270 XHG=1094 YBD=1141 YHG=1104>separate" XBD=180 XHG=116 YBD=1175 YHG=1144>the " XBD=335 XHG=210 YBD=1181 YHG=1145>layers " XBD=406 XHG=366 YBD=1174 YHG=1144>of " XBD=503 XHG=436 YBD=1175 YHG=1144>the " XBD=654 XHG=534 YBD=1175 YHG=1144>broad " XBD=895 XHG=685 YBD=1182 YHG=1145>ligament ; " XBD=1037 XHG=942 YBD=1182 YHG=1145>they " XBD=1214 XHG=1067 YBD=1182 YHG=1154>possess " XBD=1270 XHG=1247 YBD=1173 YHG=1153>a" XBD=261 XHG=116 YBD=1222 YHG=1184>pedicle " XBD=411 XHG=286 YBD=1215 YHG=1184>which " XBD=468 XHG=437 YBD=1214 YHG=1184>is " XBD=628 XHG=496 YBD=1216 YHG=1184>rather " XBD=760 XHG=651 YBD=1216 YHG=1185>short " XBD=863 XHG=787 YBD=1215 YHG=1185>and " XBD=1010 XHG=890 YBD=1217 YHG=1185>broad " XBD=1079 XHG=1038 YBD=1215 YHG=1194>as " XBD=1129 XHG=1107 YBD=1215 YHG=1194>a " XBD=1270 XHG=1156 YBD=1215 YHG=1184>rule. 1

" XBD=230 XHG=114 YBD=1255 YHG=1225>Their " XBD=480 XHG=247 YBD=1256 YHG=1225>consistence " XBD=622 XHG=499 YBD=1256 YHG=1225>varies " XBD=739 XHG=640 YBD=1256 YHG=1226>from soft-when " XBD=1269 XHG=1015 YBD=1263 YHG=1225>degenerated-to " XBD=447 XHG=222 YBD=1296 YHG=1264>bone-hard. " XBD=593 XHG=500 YBD=1295 YHG=1265>Like " XBD=759 XHG=610 YBD=1296 YHG=1266>uterine " XBD=946 XHG=776 YBD=1302 YHG=1265>fibroids, " XBD=1059 XHG=963 YBD=1304 YHG=1266>they " XBD=1138 XHG=1076 YBD=1296 YHG=1276>are " XBD=1269 XHG=1155 YBD=1296 YHG=1265>liable

" XBD=155 XHG=117 YBD=1337 YHG=1307>to " XBD=445 XHG=177 YBD=1343 YHG=1305>degenerative " XBD=630 XHG=468 YBD=1344 YHG=1306>changes " XBD=691 XHG=652 YBD=1336 YHG=1307>of " XBD=836 XHG=712 YBD=1337 YHG=1306>which " XBD=924 XHG=857 YBD=1338 YHG=1307>the " XBD=1185 XHG=947 YBD=1338 YHG=1309>commonest " XBD=1269 XHG=1206 YBD=1337 YHG=1316>are" XBD=235 XHG=115 YBD=1384 YHG=1346>cystic " XBD=353 XHG=265 YBD=1384 YHG=1347>(due " XBD=423 XHG=381 YBD=1378 YHG=1349>to " XBD=724 XHG=449 YBD=1385 YHG=1349>myxomatous " XBD=945 XHG=751 YBD=1385 YHG=1347>softening " XBD=1015 XHG=969 YBD=1378 YHG=1357>or " XBD=1081 XHG=1040 YBD=1379 YHG=1349>to haemor-" XBD=259 XHG=115 YBD=1424 YHG=1387>rhage), " XBD=504 XHG=277 YBD=1424 YHG=1388>calcareous, " XBD=598 XHG=522 YBD=1418 YHG=1387>and " XBD=867 XHG=616 YBD=1419 YHG=1388>oedematous. " XBD=1000 XHG=921 YBD=1418 YHG=1384>The " XBD=1161 XHG=1016 YBD=1426 YHG=1388>pedicle " XBD=1269 XHG=1176 YBD=1426 YHG=1398>may" XBD=270 XHG=114 YBD=1459 YHG=1427>become " XBD=479 XHG=305 YBD=1461 YHG=1428>twisted and, " XBD=678 XHG=639 YBD=1458 YHG=1429>of " XBD=858 XHG=714 YBD=1465 YHG=1438>course, " XBD=960 XHG=893 YBD=1460 YHG=1428>the " XBD=1142 XHG=996 YBD=1466 YHG=1429>growth " XBD=1269 XHG=1176 YBD=1467 YHG=1439>may" XBD=290 XHG=112 YBD=1500 YHG=1468>obstruct " XBD=454 XHG=307 YBD=1501 YHG=1468>labour.

" XBD=541 XHG=476 YBD=1557 YHG=1526>An Illastrative " XBD=908 XHG=806 YBD=1557 YHG=1525>Case.

" XBD=197 XHG=163 YBD=1605 YHG=1575>A " XBD=318 XHG=233 YBD=1605 YHG=1584>case " XBD=380 XHG=361 YBD=1604 YHG=1575>I " XBD=569 XHG=420 YBD=1606 YHG=1575>treated " XBD=785 XHG=616 YBD=1612 YHG=1576>recently " XBD=871 XHG=826 YBD=1610 YHG=1575>is, " XBD=931 XHG=913 YBD=1604 YHG=1575>I " XBD=1099 XHG=974 YBD=1610 YHG=1574>think, " XBD=1268 XHG=1143 YBD=1605 YHG=1574>worth" XBD=324 XHG=114 YBD=1652 YHG=1615>recording." XBD=189 XHG=159 YBD=1696 YHG=1670>A " XBD=351 XHG=204 YBD=1696 YHG=1669>married " XBD=512 XHG=366 YBD=1700 YHG=1677>woman, " XBD=614 XHG=528 YBD=1703 YHG=1669>aged " XBD=682 XHG=631 YBD=1701 YHG=1668>52, " XBD=776 XHG=698 YBD=1696 YHG=1670>sent " XBD=843 XHG=791 YBD=1696 YHG=1669>for " XBD=911 XHG=858 YBD=1695 YHG=1677>me " XBD=971 XHG=927 YBD=1696 YHG=1678>on " XBD=1065 XHG=988 YBD=1696 YHG=1669>Jan. " XBD=1154 XHG=1084 YBD=1700 YHG=1669>5th, " XBD=1268 XHG=1175 YBD=1700 YHG=1669>1920," XBD=159 XHG=114 YBD=1732 YHG=1714>on " XBD=336 XHG=188 YBD=1731 YHG=1706>account " XBD=400 XHG=364 YBD=1731 YHG=1704>of " XBD=509 XHG=428 YBD=1738 YHG=1706>pain " XBD=608 XHG=539 YBD=1731 YHG=1705>and " XBD=789 XHG=637 YBD=1738 YHG=1705>swelling " XBD=851 XHG=816 YBD=1730 YHG=1705>in " XBD=940 XHG=881 YBD=1732 YHG=1704>the " XBD=1149 XHG=969 YBD=1731 YHG=1705>abdomen. " XBD=1269 XHG=1198 YBD=1731 YHG=1705>The" XBD=276 XHG=115 YBD=1767 YHG=1740>duration " XBD=336 XHG=300 YBD=1767 YHG=1740>of " XBD=419 XHG=358 YBD=1767 YHG=1740>her " XBD=576 XHG=442 YBD=1768 YHG=1740>trouble " XBD=658 XHG=599 YBD=1767 YHG=1740>she " XBD=746 XHG=683 YBD=1773 YHG=1742>put " XBD=808 XHG=769 YBD=1766 YHG=1740>at " XBD=939 XHG=830 YBD=1766 YHG=1739>about " XBD=1029 XHG=961 YBD=1767 YHG=1741>two " XBD=1162 XHG=1054 YBD=1773 YHG=1748>years. " XBD=1270 XHG=1209 YBD=1773 YHG=1740>My" XBD=212 XHG=114 YBD=1803 YHG=1778>notes " XBD=286 XHG=248 YBD=1803 YHG=1777>at " XBD=379 XHG=320 YBD=1803 YHG=1776>the " XBD=497 XHG=414 YBD=1802 YHG=1776>time " XBD=635 XHG=531 YBD=1802 YHG=1776>read : *’-Nfeiises |>" XBD=1005 XHG=889 YBD=1802 YHG=1776>19-51. " XBD=1165 XHG=1053 YBD=1802 YHG=1768>Never " XBD=1269 XHG=1198 YBD=1809 YHG=1768>anv" XBD=336 XHG=115 YBD=1839 YHG=1811>disturbance " XBD=399 XHG=364 YBD=1838 YHG=1811>of " XBD=495 XHG=426 YBD=1839 YHG=1811>this " XBD=690 XHG=523 YBD=1838 YHG=1811>function. " XBD=844 XHG=739 YBD=1843 YHG=1811>Eight " XBD=1022 XHG=872 YBD=1837 YHG=1811>children " XBD=1265 XHG=1045 YBD=1844 YHG=1803>living-two" XBD=171 XHG=114 YBD=1874 YHG=1855>are twins---says she " XBD=609 XHG=548 YBD=1874 YHG=1847>has " XBD=708 XHG=640 YBD=1873 YHG=1847>had " XBD=822 XHG=740 YBD=1873 YHG=1854>over " XBD=904 XHG=852 YBD=1878 YHG=1845>20, " XBD=1036 XHG=937 YBD=1873 YHG=1846>twins " XBD=1166 XHG=1068 YBD=1873 YHG=1847>twice " XBD=1265 XHG=1196 YBD=1873 YHG=1846>and" XBD=247 XHG=113 YBD=1916 YHG=1883>triplets " XBD=348 XHG=265 YBD=1909 YHG=1891>once " XBD=411 XHG=367 YBD=1915 YHG=1882>(?) " XBD=447 XHG=429 YBD=1893 YHG=1882>&dquo;

Coi,iditioit ozz E.TanLi)?alio;t.---Nfouiitainous swelling " XBD=1267 XHG=1232 YBD=1950 YHG=1924>of" XBD=285 XHG=113 YBD=1987 YHG=1960>abdomen " XBD=374 XHG=308 YBD=1986 YHG=1960>due " XBD=434 XHG=398 YBD=1986 YHG=1961>to " XBD=527 XHG=458 YBD=1987 YHG=1961>free " XBD=633 XHG=551 YBD=1986 YHG=1960>fiuid " XBD=726 XHG=656 YBD=1987 YHG=1960>and " XBD=835 XHG=749 YBD=1986 YHG=1959>hard " XBD=1002 XHG=853 YBD=1990 YHG=1961>tumour, " XBD=1113 XHG=1020 YBD=1986 YHG=1967>more " XBD=1172 XHG=1129 YBD=1985 YHG=1967>on " XBD=1264 XHG=1190 YBD=1986 YHG=1958>left." XBD=274 XHG=114 YBD=2028 YHG=1994>Mobility " XBD=450 XHG=306 YBD=2022 YHG=1995>difficult " XBD=519 XHG=482 YBD=2023 YHG=1997>to " XBD=652 XHG=552 YBD=2022 YHG=1996>make out-so " XBD=964 XHG=861 YBD=2022 YHG=1995>much " XBD=1090 XHG=997 YBD=2021 YHG=1994>fiuid. P.V.-" XBD=237 XHG=115 YBD=2058 YHG=2030>Cervix high " XBD=429 XHG=371 YBD=2064 YHG=2039>up, " XBD=608 XHG=457 YBD=2063 YHG=2030>jammed " XBD=770 XHG=635 YBD=2063 YHG=2031>against " XBD=885 XHG=797 YBD=2057 YHG=2030>back " XBD=947 XHG=911 YBD=2057 YHG=2031>of " XBD=1091 XHG=973 YBD=2063 YHG=2030>pubes. " XBD=1265 XHG=1140 YBD=2057 YHG=2030>Uterus" XBD=221 XHG=113 YBD=2092 YHG=2073>seems " XBD=404 XHG=247 YBD=2099 YHG=2067>separate " XBD=516 XHG=427 YBD=2092 YHG=2066>from " XBD=680 XHG=541 YBD=2092 YHG=2067>tumour " XBD=778 XHG=706 YBD=2097 YHG=2066>(she " XBD=880 XHG=803 YBD=2098 YHG=2074>says " XBD=1010 XHG=906 YBD=2092 YHG=2066>latter " XBD=1150 XHG=1034 YBD=2093 YHG=2073>moves " XBD=1265 XHG=1177 YBD=2092 YHG=2065>from" XBD=185 XHG=113 YBD=2127 YHG=2101>side " XBD=255 XHG=218 YBD=2127 YHG=2101>to " XBD=384 XHG=287 YBD=2133 YHG=2101>side). " XBD=484 XHG=432 YBD=2127 YHG=2101>No " XBD=650 XHG=517 YBD=2127 YHG=2101>oedema " XBD=783 XHG=681 YBD=2127 YHG=2101>lower " XBD=925 XHG=813 YBD=2132 YHG=2101>limbs, " XBD=1063 XHG=958 YBD=2128 YHG=2101>vulva " XBD=1133 XHG=1095 YBD=2128 YHG=2110>or " XBD=1266 XHG=1163 YBD=2128 YHG=2101>lower" XBD=312 XHG=113 YBD=2162 YHG=2135>abdominal " XBD=434 XHG=348 YBD=2162 YHG=2135>wall. " XBD=536 XHG=483 YBD=2161 YHG=2134>No " XBD=713 XHG=571 YBD=2162 YHG=2136>nodules anywhere. " XBD=1093 XHG=988 YBD=2162 YHG=2136>Small " XBD=1264 XHG=1129 YBD=2163 YHG=2137>ventral" XBD=346 XHG=113 YBD=2197 YHG=2170>hernia-had " XBD=398 XHG=369 YBD=2196 YHG=2170>it " XBD=473 XHG=419 YBD=2197 YHG=2169>for " XBD=603 XHG=496 YBD=2203 YHG=2178>years. and " XBD=1089 XHG=920 YBD=2202 YHG=2171>cachexia, " XBD=1180 XHG=1115 YBD=2198 YHG=2171>but " XBD=1263 XHG=1201 YBD=2199 YHG=2172>has" XBD=260 XHG=112 YBD=2232 YHG=2205>suffered " XBD=337 XHG=282 YBD=2232 YHG=2205>for " XBD=379 XHG=358 YBD=2231 YHG=2213>a " XBD=485 XHG=402 YBD=2231 YHG=2206>time " XBD=596 XHG=506 YBD=2232 YHG=2205>from " XBD=711 XHG=618 YBD=2238 YHG=2206>pain, " XBD=928 XHG=736 YBD=2238 YHG=2206>dyspepsia, " XBD=1020 XHG=952 YBD=2233 YHG=2206>and " XBD=1262 XHG=1044 YBD=2239 YHG=2207>palpitation," XBD=197 XHG=113 YBD=2266 YHG=2241>with " XBD=439 XHG=230 YBD=2273 YHG=2242>consequent " XBD=535 XHG=469 YBD=2268 YHG=2241>loss " XBD=603 XHG=567 YBD=2267 YHG=2241>of " XBD=734 XHG=633 YBD=2274 YHG=2241>sleep. " XBD=882 XHG=781 YBD=2268 YHG=2240>Pulse " XBD=1011 XHG=913 YBD=2274 YHG=2241>rapid " XBD=1111 XHG=1042 YBD=2268 YHG=2242>and " XBD=1261 XHG=1141 YBD=2268 YHG=2242>feeble." XBD=149 XHG=112 YBD=2301 YHG=2275>T. " XBD=311 XHG=167 YBD=2302 YHG=2276>normal. " XBD=464 XHG=360 YBD=2303 YHG=2274>Urine " XBD=611 XHG=478 YBD=2303 YHG=2276>normal " XBD=746 XHG=630 YBD=2308 YHG=2276>(never " XBD=831 XHG=761 YBD=2309 YHG=2284>any " XBD=1011 XHG=848 YBD=2309 YHG=2276>dysuria). " XBD=1262 XHG=1060 YBD=2310 YHG=2277>Diagnosis :" XBD=167 XHG=115 YBD=2337 YHG=2310>On " XBD=331 XHG=184 YBD=2337 YHG=2311>account " XBD=382 XHG=347 YBD=2337 YHG=2311>of " XBD=531 XHG=398 YBD=2342 YHG=2311>ascites, " XBD=634 XHG=549 YBD=2338 YHG=2311>solid " XBD=791 XHG=651 YBD=2338 YHG=2312>tumour " XBD=842 XHG=806 YBD=2338 YHG=2311>of " XBD=917 XHG=858 YBD=2338 YHG=2304>the " XBD=1042 XHG=934 YBD=2344 YHG=2319>ovary " XBD=1226 XHG=1058 YBD=2345 YHG=2312>probably " XBD=1262 XHG=1243 YBD=2339 YHG=2321>a" XBD=279 XHG=112 YBD=2378 YHG=2345>fibroma ; " XBD=348 XHG=304 YBD=2372 YHG=2354>on " XBD=508 XHG=360 YBD=2373 YHG=2347>account " XBD=555 XHG=519 YBD=2373 YHG=2347>of " XBD=694 XHG=567 YBD=2374 YHG=2347>certain " XBD=852 XHG=707 YBD=2374 YHG=2348>amount " XBD=898 XHG=864 YBD=2374 YHG=2347>of " XBD=1070 XHG=910 YBD=2373 YHG=2347>cachexia present-" XBD=265 XHG=112 YBD=2414 YHG=2381>possibly " XBD=448 XHG=285 YBD=2408 YHG=2390>sarcoma. " XBD=514 XHG=497 YBD=2408 YHG=2382>I " XBD=676 XHG=536 YBD=2409 YHG=2381>advised " XBD=850 XHG=699 YBD=2409 YHG=2382>removal " XBD=907 XHG=872 YBD=2409 YHG=2382>of " XBD=986 XHG=928 YBD=2409 YHG=2382>the " XBD=1147 XHG=1008 YBD=2410 YHG=2383>tumour " XBD=1206 XHG=1169 YBD=2410 YHG=2392>or " XBD=1262 XHG=1227 YBD=2409 YHG=2383>in" XBD=254 XHG=111 YBD=2448 YHG=2417>default, " XBD=415 XHG=270 YBD=2450 YHG=2417>tapping " XBD=465 XHG=430 YBD=2444 YHG=2417>of " XBD=539 XHG=480 YBD=2444 YHG=2417>the " XBD=734 XHG=553 YBD=2444 YHG=2417>abdomen. " XBD=880 XHG=782 YBD=2445 YHG=2418>After " XBD=987 XHG=894 YBD=2445 YHG=2425>some " XBD=1188 XHG=1002 YBD=2445 YHG=2417>hesitation " XBD=1263 XHG=1203 YBD=2445 YHG=2418>the" XBD=246 XHG=109 YBD=2485 YHG=2453>patient " XBD=447 XHG=264 YBD=2480 YHG=2453>consented " XBD=504 XHG=468 YBD=2479 YHG=2454>to " XBD=566 XHG=525 YBD=2479 YHG=2452>be " XBD=724 XHG=585 YBD=2485 YHG=2453>tapped." XBD=493 XHG=157 YBD=2521 YHG=2494>Paracentesis.-On " XBD=624 XHG=508 YBD=2522 YHG=2494>March 1st, " XBD=759 XHG=721 YBD=2522 YHG=2496>at " XBD=832 XHG=773 YBD=2522 YHG=2495>the " XBD=1020 XHG=847 YBD=2522 YHG=2495>Aberdare " XBD=1102 XHG=1034 YBD=2521 YHG=2495>and " XBD=1263 XHG=1120 YBD=2522 YHG=2494>District" XBD=256 XHG=113 YBD=2557 YHG=2528>General " XBD=452 XHG=281 YBD=2563 YHG=2530>Hospital, " XBD=496 XHG=480 YBD=2556 YHG=2530>I " XBD=713 XHG=522 YBD=2563 YHG=2531>performed " XBD=966 XHG=739 YBD=2563 YHG=2531>paracentesis " XBD=1061 XHG=992 YBD=2557 YHG=2531>and " XBD=1262 XHG=1086 YBD=2557 YHG=2531>withdrew " XBD=1284 XHG=1280 YBD=2568 YHG=2517>I

7 " XBD=304 XHG=176 YBD=2598 YHG=2565>gallons " XBD=362 XHG=327 YBD=2592 YHG=2566>of " XBD=473 XHG=385 YBD=2592 YHG=2566>clear " XBD=647 XHG=494 YBD=2599 YHG=2566>greenish " XBD=762 XHG=669 YBD=2592 YHG=2566>fiuid. " XBD=881 XHG=811 YBD=2592 YHG=2566>The " XBD=1042 XHG=903 YBD=2592 YHG=2567>tumour " XBD=1164 XHG=1064 YBD=2592 YHG=2566>could " XBD=1262 XHG=1185 YBD=2592 YHG=2574>now" XBD=153 XHG=110 YBD=2626 YHG=2600>be " XBD=244 XHG=180 YBD=2627 YHG=2601>felt " XBD=306 XHG=268 YBD=2627 YHG=2609>as " XBD=355 XHG=335 YBD=2627 YHG=2609>a " XBD=479 XHG=382 YBD=2632 YHG=2600>hard, " XBD=672 XHG=508 YBD=2631 YHG=2601>rounded, " XBD=887 XHG=703 YBD=2628 YHG=2601>ballotable " XBD=1005 XHG=914 YBD=2628 YHG=2609>mass " XBD=1139 XHG=1033 YBD=2633 YHG=2600>filling " XBD=1213 XHG=1166 YBD=2633 YHG=2608>up " XBD=1263 XHG=1242 YBD=2626 YHG=2608>a" XBD=341 XHG=110 YBD=2662 YHG=2635>considerable " XBD=437 XHG=358 YBD=2667 YHG=2637>part " XBD=489 XHG=453 YBD=2662 YHG=2636>of " XBD=564 XHG=504 YBD=2662 YHG=2636>the " XBD=761 XHG=580 YBD=2662 YHG=2636>abdomen. " XBD=855 XHG=809 YBD=2663 YHG=2637>As " XBD=893 XHG=873 YBD=2661 YHG=2644>a " XBD=1045 XHG=910 YBD=2668 YHG=2636>general " XBD=1262 XHG=1061 YBD=2662 YHG=2635>anaesthetic" XBD=177 XHG=109 YBD=2697 YHG=2678>was " XBD=397 XHG=206 YBD=2702 YHG=2670>employed, " XBD=486 XHG=426 YBD=2697 YHG=2670>the " XBD=649 XHG=513 YBD=2702 YHG=2671>patient " XBD=778 XHG=677 YBD=2702 YHG=2671>being " XBD=889 XHG=805 YBD=2703 YHG=2678>very " XBD=1174 XHG=916 YBD=2703 YHG=2670>apprehensive, " XBD=1262 XHG=1203 YBD=2696 YHG=2669>the" XBD=333 XHG=108 YBD=2737 YHG=2704>separability " XBD=400 XHG=365 YBD=2731 YHG=2705>of " XBD=492 XHG=432 YBD=2731 YHG=2705>the " XBD=664 XHG=525 YBD=2731 YHG=2706>tumour " XBD=785 XHG=695 YBD=2732 YHG=2706>from " XBD=877 XHG=817 YBD=2731 YHG=2705>the " XBD=1025 XHG=909 YBD=2732 YHG=2706>uterus " XBD=1127 XHG=1059 YBD=2731 YHG=2713>was " XBD=1260 XHG=1160 YBD=2731 YHG=2704>made" XBD=328 XHG=109 YBD=2771 YHG=2739>abundantly " XBD=453 XHG=355 YBD=2766 YHG=2739>clear. " XBD=553 XHG=501 YBD=2765 YHG=2738>No " XBD=722 XHG=581 YBD=2766 YHG=2740>nodules " XBD=837 XHG=751 YBD=2766 YHG=2747>were " XBD=927 XHG=864 YBD=2765 YHG=2740>felt " XBD=1143 XHG=952 YBD=2772 YHG=2739>anywhere. " XBD=1262 XHG=1192 YBD=2765 YHG=2739>The" XBD=246 XHG=109 YBD=2806 YHG=2774>patient " XBD=329 XHG=265 YBD=2800 YHG=2774>felt " XBD=386 XHG=348 YBD=2801 YHG=2782>so " XBD=553 XHG=408 YBD=2800 YHG=2774>relieved " XBD=633 XHG=574 YBD=2801 YHG=2775>she " XBD=767 XHG=655 YBD=2800 YHG=2774>would " XBD=852 XHG=789 YBD=2800 YHG=2776>not " XBD=1014 XHG=873 YBD=2801 YHG=2776>consent " XBD=1071 XHG=1034 YBD=2801 YHG=2776>to " XBD=1114 XHG=1093 YBD=2800 YHG=2782>a " XBD=1263 XHG=1135 YBD=2801 YHG=2774>radical" XBD=288 XHG=109 YBD=2842 YHG=2810>operation " XBD=373 XHG=304 YBD=2835 YHG=2809>and " XBD=459 XHG=390 YBD=2836 YHG=2817>was " XBD=675 XHG=477 YBD=2842 YHG=2809>discharged " XBD=736 XHG=693 YBD=2835 YHG=2818>on " XBD=813 XHG=754 YBD=2835 YHG=2808>the " XBD=923 XHG=832 YBD=2835 YHG=2809>19th." XBD=277 XHG=156 YBD=2877 YHG=2850>Course " XBD=335 XHG=299 YBD=2882 YHG=2850>of " XBD=510 XHG=355 YBD=2877 YHG=2849>Case.-I " XBD=602 XHG=532 YBD=2877 YHG=2858>saw " XBD=712 XHG=622 YBD=2876 YHG=2851>little " XBD=769 XHG=734 YBD=2876 YHG=2850>of " XBD=851 XHG=790 YBD=2877 YHG=2850>her " XBD=959 XHG=871 YBD=2876 YHG=2850>until " XBD=999 XHG=983 YBD=2876 YHG=2850>I " XBD=1089 XHG=1021 YBD=2877 YHG=2859>was " XBD=1189 XHG=1111 YBD=2878 YHG=2851>sent " XBD=1264 XHG=1209 YBD=2876 YHG=2850>for" XBD=209 XHG=108 YBD=2918 YHG=2886>again " XBD=273 XHG=228 YBD=2912 YHG=2894>on " XBD=371 XHG=292 YBD=2912 YHG=2885>Jan. " XBD=484 XHG=390 YBD=2916 YHG=2884>25th, " XBD=599 XHG=506 YBD=2911 YHG=2884>1921. " XBD=713 XHG=647 YBD=2911 YHG=2885>She " XBD=800 XHG=730 YBD=2911 YHG=2885>had " XBD=903 XHG=819 YBD=2911 YHG=2885>been " XBD=1083 XHG=921 YBD=2918 YHG=2885>suffering " XBD=1152 XHG=1099 YBD=2912 YHG=2886>for " XBD=1263 XHG=1169 YBD=2912 YHG=2893>some" XBD=192 XHG=108 YBD=2946 YHG=2920>time " XBD=311 XHG=221 YBD=2947 YHG=2921>from " XBD=420 XHG=339 YBD=2952 YHG=2920>pain " XBD=518 XHG=448 YBD=2946 YHG=2920>and " XBD=752 XHG=546 YBD=2947 YHG=2920>intractable " XBD=902 XHG=783 YBD=2946 YHG=2919>bilious " XBD=1101 XHG=933 YBD=2952 YHG=2920>vomiting " XBD=1196 XHG=1131 YBD=2946 YHG=2920>due " XBD=1262 XHG=1225 YBD=2946 YHG=2920>to" XBD=275 XHG=109 YBD=2988 YHG=2962>pressure, " XBD=405 XHG=294 YBD=2982 YHG=2955>which " XBD=492 XHG=424 YBD=2982 YHG=2955>had " XBD=612 XHG=511 YBD=2981 YHG=2955>made " XBD=691 XHG=631 YBD=2981 YHG=2955>her " XBD=767 XHG=709 YBD=2981 YHG=2956>life " XBD=987 XHG=786 YBD=2986 YHG=2953>miserable ; " XBD=1079 XHG=1019 YBD=2982 YHG=2955>she " XBD=1166 XHG=1098 YBD=2982 YHG=2963>was " XBD=1263 XHG=1185 YBD=2981 YHG=2963>now" XBD=274 XHG=108 YBD=3022 YHG=2990>prepared " XBD=329 XHG=293 YBD=3016 YHG=2990>to " XBD=437 XHG=347 YBD=3016 YHG=2989>have " XBD=623 XHG=453 YBD=3022 YHG=2990>anything " XBD=732 XHG=635 YBD=3016 YHG=2990>done. " XBD=847 XHG=781 YBD=3016 YHG=2989>She " XBD=933 XHG=865 YBD=3016 YHG=2998>was " XBD=1021 XHG=946 YBD=3016 YHG=2989>thin " XBD=1103 XHG=1034 YBD=3015 YHG=2989>and " XBD=1261 XHG=1121 YBD=3020 YHG=2989>wasted," XBD=174 XHG=110 YBD=3051 YHG=3024>but " XBD=254 XHG=190 YBD=3051 YHG=3026>not " XBD=308 XHG=270 YBD=3050 YHG=3025>to " XBD=386 XHG=327 YBD=3050 YHG=3024>the " XBD=525 XHG=406 YBD=3050 YHG=3025>extent " XBD=560 XHG=544 YBD=3050 YHG=3024>I " XBD=700 XHG=577 YBD=3051 YHG=3024>should " XBD=807 XHG=718 YBD=3051 YHG=3025>have " XBD=990 XHG=826 YBD=3056 YHG=3025>expected " XBD=1098 XHG=1009 YBD=3050 YHG=3025>after " XBD=1199 XHG=1115 YBD=3050 YHG=3024>such " XBD=1262 XHG=1217 YBD=3050 YHG=3032>an" XBD=255 XHG=107 YBD=3086 YHG=3058>interval " XBD=340 XHG=270 YBD=3084 YHG=3059>had " XBD=416 XHG=356 YBD=3085 YHG=3058>the " XBD=564 XHG=432 YBD=3091 YHG=3059>growth " XBD=665 XHG=580 YBD=3084 YHG=3059>been " XBD=885 XHG=682 YBD=3090 YHG=3059>malignant. " XBD=1039 XHG=933 YBD=3084 YHG=3059>There " XBD=1124 XHG=1054 YBD=3084 YHG=3058>had " XBD=1225 XHG=1140 YBD=3084 YHG=3059>been " XBD=1263 XHG=1242 YBD=3084 YHG=3066>a" XBD=398 XHG=109 YBD=3120 YHG=3093>reaccumulation " XBD=457 XHG=422 YBD=3119 YHG=3093>of " XBD=580 XHG=488 YBD=3123 YHG=3092>fluid, " XBD=670 XHG=607 YBD=3118 YHG=3093>but " XBD=729 XHG=693 YBD=3119 YHG=3094>to " XBD=897 XHG=751 YBD=3124 YHG=3093>nothing " XBD=985 XHG=918 YBD=3118 YHG=3093>like " XBD=1067 XHG=1008 YBD=3119 YHG=3093>the " XBD=1263 XHG=1099 YBD=3125 YHG=3093>quantity" XBD=249 XHG=111 YBD=3159 YHG=3129>present " XBD=401 XHG=286 YBD=3154 YHG=3127>before " XBD=592 XHG=437 YBD=3160 YHG=3128>tapping. " XBD=711 XHG=640 YBD=3153 YHG=3127>The " XBD=888 XHG=748 YBD=3154 YHG=3129>tumour " XBD=992 XHG=923 YBD=3154 YHG=3127>had " XBD=1144 XHG=1031 YBD=3159 YHG=3135>grown " XBD=1262 XHG=1184 YBD=3153 YHG=3135>con-" XBD=304 XHG=108 YBD=3195 YHG=3161>siderably ; " XBD=349 XHG=332 YBD=3188 YHG=3161>I " XBD=512 XHG=363 YBD=3195 YHG=3161>thought " XBD=554 XHG=525 YBD=3188 YHG=3162>it " XBD=712 XHG=567 YBD=3194 YHG=3162>roughly " XBD=789 XHG=725 YBD=3188 YHG=3170>one " XBD=872 XHG=802 YBD=3188 YHG=3162>and " XBD=907 XHG=886 YBD=3187 YHG=3170>a " XBD=993 XHG=920 YBD=3188 YHG=3162>half " XBD=1106 XHG=1006 YBD=3188 YHG=3162>times " XBD=1157 XHG=1120 YBD=3188 YHG=3170>as " XBD=1263 XHG=1172 YBD=3194 YHG=3162>large" XBD=145 XHG=108 YBD=3222 YHG=3203>as " XBD=262 XHG=166 YBD=3223 YHG=3196>when " XBD=341 XHG=281 YBD=3223 YHG=3196>she " XBD=428 XHG=360 YBD=3223 YHG=3204>was " XBD=482 XHG=446 YBD=3222 YHG=3197>in " XBD=660 XHG=500 YBD=3228 YHG=3196>hospital. " XBD=885 XHG=709 YBD=3228 YHG=3196>Vomiting " XBD=970 XHG=903 YBD=3223 YHG=3204>was " XBD=1263 XHG=991 YBD=3222 YHG=3196>extreme-cold" XBD=215 XHG=109 YBD=3257 YHG=3231>water " XBD=333 XHG=232 YBD=3262 YHG=3231>being " XBD=496 XHG=347 YBD=3262 YHG=3230>rejected " XBD=549 XHG=511 YBD=3257 YHG=3239>as " XBD=648 XHG=565 YBD=3257 YHG=3238>soon " XBD=701 XHG=665 YBD=3256 YHG=3238>as " XBD=834 XHG=719 YBD=3256 YHG=3230>taken. " XBD=952 XHG=882 YBD=3256 YHG=3230>The " XBD=1064 XHG=969 YBD=3262 YHG=3231>pulse " XBD=1147 XHG=1080 YBD=3257 YHG=3238>was " XBD=1262 XHG=1165 YBD=3262 YHG=3230>rapid" XBD=178 XHG=109 YBD=3291 YHG=3264>and " XBD=301 XHG=192 YBD=3290 YHG=3264>feeble " XBD=384 XHG=315 YBD=3290 YHG=3264>and " XBD=504 XHG=399 YBD=3297 YHG=3265>temp. " XBD=727 XHG=520 YBD=3291 YHG=3264>subnormal. " XBD=847 XHG=776 YBD=3290 YHG=3265>The " XBD=1051 XHG=861 YBD=3290 YHG=3265>maximum " XBD=1263 XHG=1064 YBD=3290 YHG=3264>abdominal" XBD=200 XHG=109 YBD=3330 YHG=3298>girth " XBD=284 XHG=216 YBD=3325 YHG=3307>was " XBD=378 XHG=300 YBD=3325 YHG=3306>now " XBD=433 XHG=394 YBD=3323 YHG=3298>55 " XBD=495 XHG=448 YBD=3324 YHG=3299>in. " XBD=614 XHG=544 YBD=3324 YHG=3298>The " XBD=757 XHG=629 YBD=3324 YHG=3298>similar " XBD=876 XHG=772 YBD=3331 YHG=3298>figure " XBD=1049 XHG=892 YBD=3330 YHG=3299>previous " XBD=1102 XHG=1066 YBD=3324 YHG=3299>to " XBD=1264 XHG=1119 YBD=3331 YHG=3299>tapping" XBD=126 XHG=110 YBD=3357 YHG=3331>I " XBD=222 XHG=144 YBD=3360 YHG=3333>lost. " XBD=377 XHG=270 YBD=3359 YHG=3332>There " XBD=481 XHG=396 YBD=3359 YHG=3341>were " XBD=543 XHG=498 YBD=3359 YHG=3341>no " XBD=660 XHG=562 YBD=3359 YHG=3332>other " XBD=752 XHG=676 YBD=3359 YHG=3341>new " XBD=922 XHG=769 YBD=3365 YHG=3333>physical " XBD=1040 XHG=940 YBD=3366 YHG=3333>signs." XBD=497 XHG=155 YBD=3406 YHG=3373>Laparotomy.-She " XBD=596 XHG=529 YBD=3400 YHG=3382>was " XBD=798 XHG=628 YBD=3399 YHG=3373>admitted " XBD=867 XHG=830 YBD=3400 YHG=3375>to " XBD=958 XHG=899 YBD=3399 YHG=3373>the " XBD=1082 XHG=989 YBD=3400 YHG=3381>same " XBD=1263 XHG=1113 YBD=3406 YHG=3374>hospital" XBD=209 XHG=109 YBD=3439 YHG=3408>again " XBD=283 XHG=239 YBD=3434 YHG=3416>on " XBD=394 XHG=312 YBD=3433 YHG=3407>Feb. " XBD=496 XHG=425 YBD=3436 YHG=3408>9th, |>" XBD=623 XHG=530 YBD=3438 YHG=3408>1921, " XBD=722 XHG=652 YBD=3434 YHG=3408>and " XBD=795 XHG=751 YBD=3433 YHG=3416>on " XBD=883 XHG=824 YBD=3434 YHG=3408>the " XBD=994 XHG=914 YBD=3434 YHG=3407>12th " XBD=1041 XHG=1024 YBD=3433 YHG=3407>I " XBD=1262 XHG=1070 YBD=3439 YHG=3408>performed" XBD=326 XHG=105 YBD=3474 YHG=3441>laparotomy " XBD=422 XHG=338 YBD=3468 YHG=3442>with " XBD=504 XHG=445 YBD=3468 YHG=3442>the " XBD=605 XHG=527 YBD=3474 YHG=3442>help " XBD=656 XHG=622 YBD=3468 YHG=3442>of " XBD=732 XHG=672 YBD=3474 YHG=3450>my " XBD=932 XHG=746 YBD=3474 YHG=3442>colleagues " XBD=1005 XHG=948 YBD=3468 YHG=3442>Dr. " XBD=1118 XHG=1022 YBD=3467 YHG=3441>Isaac " XBD=1262 XHG=1132 YBD=3472 YHG=3442>Banks," XBD=184 XHG=109 YBD=3501 YHG=3476>who " XBD=363 XHG=207 YBD=3507 YHG=3476>assisted, " XBD=453 XHG=384 YBD=3502 YHG=3476>and " XBD=536 XHG=479 YBD=3502 YHG=3476>Dr. " XBD=591 XHG=559 YBD=3501 YHG=3476>J. " XBD=648 XHG=615 YBD=3501 YHG=3477>C. " XBD=813 XHG=673 YBD=3507 YHG=3476>Ogilvie, " XBD=910 XHG=835 YBD=3502 YHG=3476>who " XBD=1021 XHG=935 YBD=3507 YHG=3484>gave " XBD=1130 XHG=1043 YBD=3508 YHG=3484>open " XBD=1261 XHG=1156 YBD=3502 YHG=3477>ether." XBD=139 XHG=109 YBD=3533 YHG=3508>A " XBD=258 XHG=160 YBD=3535 YHG=3510>small " XBD=358 XHG=278 YBD=3536 YHG=3510>nick " XBD=413 XHG=377 YBD=3536 YHG=3510>in " XBD=493 XHG=434 YBD=3536 YHG=3510>the " XBD=728 XHG=515 YBD=3540 YHG=3510>peritoneum " XBD=890 XHG=749 YBD=3536 YHG=3510>allowed " XBD=952 XHG=911 YBD=3534 YHG=3509>22 " XBD=1067 XHG=976 YBD=3542 YHG=3511>pints " XBD=1124 XHG=1089 YBD=3536 YHG=3510>of " XBD=1262 XHG=1143 YBD=3537 YHG=3511>ascitic" XBD=204 XHG=111 YBD=3573 YHG=3541>fluid, " XBD=364 XHG=236 YBD=3571 YHG=3544>similar " XBD=430 XHG=394 YBD=3571 YHG=3545>to " XBD=520 XHG=462 YBD=3570 YHG=3544>the " XBD=710 XHG=552 YBD=3576 YHG=3545>previous " XBD=927 XHG=741 YBD=3576 YHG=3544>discharge, " XBD=995 XHG=958 YBD=3570 YHG=3545>to " XBD=1103 XHG=1026 YBD=3570 YHG=3544>flow " XBD=1284 XHG=1132 YBD=3577 YHG=3545>slowly.,

" XBD=1391 XHG=1321 YBD=329 YHG=302>The " XBD=1557 XHG=1413 YBD=330 YHG=302>incision " XBD=1648 XHG=1579 YBD=329 YHG=310>was " XBD=1754 XHG=1671 YBD=329 YHG=302>then " XBD=1936 XHG=1778 YBD=336 YHG=300>enlarged " XBD=2032 XHG=1958 YBD=328 YHG=302>well " XBD=2190 XHG=2054 YBD=334 YHG=300>beyond " XBD=2272 XHG=2212 YBD=327 YHG=300>the umbilicus." XBD=1388 XHG=1319 YBD=364 YHG=337>and " XBD=1476 XHG=1417 YBD=363 YHG=337>the " XBD=1645 XHG=1504 YBD=364 YHG=338>tumour " XBD=1751 XHG=1671 YBD=364 YHG=345>seen " XBD=1970 XHG=1779 YBD=370 YHG=337>occupying " XBD=2057 XHG=1997 YBD=363 YHG=337>the " XBD=2217 XHG=2085 YBD=369 YHG=337>greater " XBD=2322 XHG=2244 YBD=369 YHG=336>part " XBD=2383 XHG=2349 YBD=363 YHG=336>of " XBD=2472 XHG=2410 YBD=364 YHG=337>the-" XBD=1501 XHG=1319 YBD=399 YHG=372>abdomen. " XBD=1584 XHG=1549 YBD=399 YHG=372>It " XBD=1680 XHG=1611 YBD=399 YHG=380>was " XBD=1854 XHG=1710 YBD=399 YHG=372>covered " XBD=1966 XHG=1883 YBD=398 YHG=372>with " XBD=2016 XHG=1994 YBD=397 YHG=379>a " XBD=2342 XHG=2044 YBD=404 YHG=371>greenish-yellow, " XBD=2470 XHG=2370 YBD=399 YHG=372>semi-" XBD=1511 XHG=1319 YBD=440 YHG=406>glistening, " XBD=1667 XHG=1530 YBD=433 YHG=408>smooth " XBD=1817 XHG=1684 YBD=434 YHG=407>surface " XBD=1918 XHG=1834 YBD=439 YHG=414>very " XBD=2062 XHG=1933 YBD=433 YHG=406>similar " XBD=2113 XHG=2077 YBD=432 YHG=406>in " XBD=2340 XHG=2129 YBD=438 YHG=413>appearance " XBD=2391 XHG=2356 YBD=433 YHG=406>to " XBD=2475 XHG=2409 YBD=434 YHG=407>the-" XBD=1566 XHG=1317 YBD=469 YHG=442>non-sensitive " XBD=1668 XHG=1596 YBD=469 YHG=442>side " XBD=1735 XHG=1699 YBD=468 YHG=442>of " XBD=1810 XHG=1765 YBD=468 YHG=450>an " XBD=2077 XHG=1842 YBD=474 YHG=441>undeveloped " XBD=2355 XHG=2110 YBD=474 YHG=441>photographic " XBD=2465 XHG=2385 YBD=469 YHG=441>film." XBD=1440 XHG=1319 YBD=504 YHG=476>Flakes " XBD=1490 XHG=1455 YBD=503 YHG=476>of " XBD=1524 XHG=1503 YBD=503 YHG=485>a " XBD=1666 XHG=1537 YBD=504 YHG=477>similar " XBD=1803 XHG=1678 YBD=503 YHG=477>nature " XBD=1852 XHG=1816 YBD=502 YHG=477>to " XBD=1926 XHG=1867 YBD=503 YHG=476>the " XBD=2100 XHG=1941 YBD=508 YHG=476>covering " XBD=2147 XHG=2113 YBD=502 YHG=476>of " XBD=2219 XHG=2161 YBD=503 YHG=476>the " XBD=2369 XHG=2233 YBD=503 YHG=477>tumour were-

" XBD=1461 XHG=1319 YBD=544 YHG=510>floating " XBD=1572 XHG=1480 YBD=539 YHG=512>loose " XBD=1628 XHG=1592 YBD=537 YHG=512>in " XBD=1709 XHG=1650 YBD=537 YHG=510>the " XBD=1848 XHG=1730 YBD=538 YHG=511>ascitic " XBD=1952 XHG=1870 YBD=537 YHG=511>fluid " XBD=2172 XHG=1973 YBD=544 YHG=510>remaining, " XBD=2230 XHG=2194 YBD=537 YHG=519>as " XBD=2278 XHG=2251 YBD=537 YHG=510>if " XBD=2379 XHG=2298 YBD=544 YHG=511>they " XBD=2472 XHG=2399 YBD=538 YHG=511>had" XBD=1404 XHG=1318 YBD=572 YHG=545>been " XBD=1554 XHG=1423 YBD=573 YHG=546>rubbed " XBD=1621 XHG=1573 YBD=572 YHG=546>off " XBD=1686 XHG=1639 YBD=579 YHG=546>by " XBD=1852 XHG=1703 YBD=573 YHG=545>friction. " XBD=2007 XHG=1900 YBD=573 YHG=546>There " XBD=2111 XHG=2025 YBD=573 YHG=553>were " XBD=2172 XHG=2128 YBD=572 YHG=554>no " XBD=2378 XHG=2191 YBD=577 YHG=545>adhesions, " XBD=2463 XHG=2396 YBD=573 YHG=546>and" XBD=1377 XHG=1317 YBD=607 YHG=580>the " XBD=1548 XHG=1398 YBD=610 YHG=582>tumour, " XBD=1680 XHG=1570 YBD=608 YHG=581>which " XBD=1770 XHG=1702 YBD=607 YHG=589>was " XBD=1900 XHG=1792 YBD=608 YHG=581>found " XBD=1958 XHG=1922 YBD=608 YHG=582>to " XBD=2023 XHG=1980 YBD=607 YHG=581>be " XBD=2078 XHG=2043 YBD=607 YHG=581>of " XBD=2157 XHG=2099 YBD=607 YHG=580>the " XBD=2240 XHG=2177 YBD=607 YHG=579>left " XBD=2375 XHG=2260 YBD=613 YHG=588>ovary, " XBD=2463 XHG=2396 YBD=609 YHG=589>was" XBD=1478 XHG=1295 YBD=648 YHG=616>removed " XBD=1603 XHG=1495 YBD=643 YHG=616>whole " XBD=1668 XHG=1622 YBD=649 YHG=615>by " XBD=1829 XHG=1683 YBD=649 YHG=616>ligating " XBD=1904 XHG=1845 YBD=643 YHG=615>the " XBD=2006 XHG=1922 YBD=649 YHG=624>very " XBD=2119 XHG=2022 YBD=643 YHG=616>short " XBD=2203 XHG=2134 YBD=642 YHG=615>and " XBD=2326 XHG=2221 YBD=643 YHG=615>broad " XBD=2472 XHG=2339 YBD=648 YHG=615>pedicle-" XBD=1365 XHG=1295 YBD=685 YHG=650>by " XBD=1492 XHG=1381 YBD=678 YHG=651>which " XBD=1539 XHG=1510 YBD=677 YHG=651>it " XBD=1625 XHG=1557 YBD=678 YHG=659>was " XBD=1808 XHG=1644 YBD=677 YHG=651>attached " XBD=1861 XHG=1826 YBD=678 YHG=651>in " XBD=2008 XHG=1881 YBD=678 YHG=651>chains. " XBD=2126 XHG=2055 YBD=676 YHG=650>The " XBD=2259 XHG=2144 YBD=678 YHG=651>uterus " XBD=2349 XHG=2281 YBD=677 YHG=651>and " XBD=2465 XHG=2375 YBD=684 YHG=651>right" XBD=1435 XHG=1295 YBD=719 YHG=686>ovary, " XBD=1562 XHG=1451 YBD=713 YHG=685>which " XBD=1746 XHG=1576 YBD=719 YHG=686>appeared " XBD=1904 XHG=1760 YBD=718 YHG=687>normal, " XBD=2006 XHG=1920 YBD=714 YHG=694>were " XBD=2162 XHG=2020 YBD=713 YHG=686>allowed " XBD=2213 XHG=2177 YBD=712 YHG=686>to " XBD=2364 XHG=2227 YBD=712 YHG=686>remain. " XBD=2462 XHG=2410 YBD=713 YHG=685>No" XBD=1461 XHG=1315 YBD=748 YHG=721>nodular " XBD=1513 XHG=1475 YBD=748 YHG=730>or " XBD=1793 XHG=1526 YBD=755 YHG=722>papillomatous " XBD=1956 XHG=1808 YBD=755 YHG=721>growths " XBD=2057 XHG=1971 YBD=748 YHG=729>were " XBD=2149 XHG=2070 YBD=748 YHG=729>seen " XBD=2198 XHG=2162 YBD=748 YHG=721>in " XBD=2272 XHG=2213 YBD=747 YHG=720>the " XBD=2461 XHG=2284 YBD=754 YHG=721>abdomen," XBD=1426 XHG=1316 YBD=784 YHG=756>which " XBD=1511 XHG=1443 YBD=784 YHG=765>was " XBD=1641 XHG=1529 YBD=784 YHG=757>closed " XBD=1693 XHG=1657 YBD=783 YHG=757>in " XBD=1769 XHG=1710 YBD=783 YHG=757>the " XBD=1884 XHG=1786 YBD=784 YHG=758>usual " XBD=1986 XHG=1901 YBD=791 YHG=766>way. " XBD=2145 XHG=2036 YBD=783 YHG=756>When " XBD=2338 XHG=2162 YBD=784 YHG=756>examined " XBD=2388 XHG=2353 YBD=784 YHG=756>in " XBD=2465 XHG=2405 YBD=784 YHG=756>the" XBD=1404 XHG=1316 YBD=819 YHG=792>bowl " XBD=1547 XHG=1437 YBD=819 YHG=792>which " XBD=1734 XHG=1580 YBD=819 YHG=792>received " XBD=1797 XHG=1767 YBD=818 YHG=792>it " XBD=1896 XHG=1836 YBD=819 YHG=792>the " XBD=2077 XHG=1938 YBD=819 YHG=793>tumour " XBD=2293 XHG=2109 YBD=819 YHG=790>resembled " XBD=2345 XHG=2324 YBD=819 YHG=800>a " XBD=2465 XHG=2375 YBD=826 YHG=791>huge" XBD=1485 XHG=1316 YBD=860 YHG=827>pumpkin " XBD=1535 XHG=1500 YBD=854 YHG=827>in " XBD=1668 XHG=1552 YBD=860 YHG=827>shape, " XBD=1788 XHG=1686 YBD=860 YHG=826>being " XBD=1967 XHG=1803 YBD=859 YHG=827>rounded, " XBD=2053 XHG=1984 YBD=854 YHG=828>and " XBD=2234 XHG=2069 YBD=854 YHG=825>flattened " XBD=2336 XHG=2248 YBD=854 YHG=827>from " XBD=2409 XHG=2350 YBD=860 YHG=827>top " XBD=2463 XHG=2425 YBD=854 YHG=828>to" XBD=1462 XHG=1316 YBD=889 YHG=862>bottom. " XBD=1546 XHG=1511 YBD=889 YHG=862>It " XBD=1644 XHG=1575 YBD=890 YHG=871>was " XBD=1778 XHG=1674 YBD=889 YHG=863>much " XBD=1917 XHG=1807 YBD=897 YHG=863>larger " XBD=2032 XHG=1946 YBD=889 YHG=863>than " XBD=2083 XHG=2062 YBD=888 YHG=870>a " XBD=2221 XHG=2112 YBD=889 YHG=862>man’s " XBD=2348 XHG=2250 YBD=889 YHG=861>head. " XBD=2464 XHG=2393 YBD=888 YHG=861>The" XBD=1441 XHG=1314 YBD=930 YHG=897>largest " XBD=1724 XHG=1461 YBD=925 YHG=897>circumference " XBD=1812 XHG=1743 YBD=925 YHG=906>was 41! " XBD=1962 XHG=1916 YBD=924 YHG=898>in. " XBD=2046 XHG=2011 YBD=925 YHG=898>It " XBD=2215 XHG=2065 YBD=931 YHG=897>weighed 19t " XBD=2373 XHG=2316 YBD=927 YHG=896>lb., " XBD=2460 XHG=2394 YBD=924 YHG=897>and" XBD=1383 XHG=1315 YBD=960 YHG=941>was " XBD=1491 XHG=1420 YBD=960 YHG=932>soft " XBD=1594 XHG=1525 YBD=959 YHG=933>and " XBD=1881 XHG=1633 YBD=966 YHG=932>compressible. " XBD=2000 XHG=1929 YBD=959 YHG=933>The " XBD=2195 XHG=2037 YBD=966 YHG=933>covering " XBD=2265 XHG=2229 YBD=959 YHG=932>of " XBD=2465 XHG=2298 YBD=965 YHG=932>greenish-" XBD=1436 XHG=1315 YBD=1002 YHG=968>yellow " XBD=1587 XHG=1469 YBD=995 YHG=968>tunica " XBD=1803 XHG=1621 YBD=1002 YHG=968>albuginea " XBD=1874 XHG=1836 YBD=995 YHG=977>or " XBD=2055 XHG=1908 YBD=1001 YHG=968>capsule, " XBD=2179 XHG=2090 YBD=995 YHG=968>after " XBD=2361 XHG=2210 YBD=999 YHG=966>incision, " XBD=2467 XHG=2394 YBD=995 YHG=975>was" XBD=1468 XHG=1314 YBD=1036 YHG=1001>stripped " XBD=1529 XHG=1482 YBD=1030 YHG=1002>off " XBD=1600 XHG=1542 YBD=1030 YHG=1003>the " XBD=1722 XHG=1613 YBD=1030 YHG=1003>whole " XBD=1769 XHG=1734 YBD=1030 YHG=1004>of " XBD=1841 XHG=1782 YBD=1030 YHG=1004>the " XBD=1994 XHG=1853 YBD=1031 YHG=1005>tumour " XBD=2088 XHG=2005 YBD=1030 YHG=1003>with " XBD=2160 XHG=2102 YBD=1030 YHG=1003>the " XBD=2319 XHG=2173 YBD=1036 YHG=1002>greatest " XBD=2365 XHG=2330 YBD=1029 YHG=1002>of " XBD=2462 XHG=2377 YBD=1031 YHG=1010>ease." XBD=1386 XHG=1315 YBD=1065 YHG=1037>The " XBD=1579 XHG=1409 YBD=1071 YHG=1038>collapsed " XBD=1685 XHG=1600 YBD=1066 YHG=1039>shell " XBD=1743 XHG=1707 YBD=1066 YHG=1039>of " XBD=1824 XHG=1764 YBD=1065 YHG=1038>the " XBD=1995 XHG=1846 YBD=1070 YHG=1040>tumour, " XBD=2108 XHG=2019 YBD=1066 YHG=1039>after " XBD=2307 XHG=2128 YBD=1072 YHG=1037>stripping, " XBD=2459 XHG=2327 YBD=1065 YHG=1037>showed" XBD=1353 XHG=1314 YBD=1101 YHG=1073>at " XBD=1443 XHG=1378 YBD=1100 YHG=1081>one " XBD=1546 XHG=1470 YBD=1107 YHG=1074>pole " XBD=1593 XHG=1572 YBD=1100 YHG=1082>a " XBD=1797 XHG=1620 YBD=1101 YHG=1074>knob-like " XBD=2013 XHG=1824 YBD=1108 YHG=1074>projection " XBD=2149 XHG=2040 YBD=1101 YHG=1074>which " XBD=2295 XHG=2175 YBD=1101 YHG=1073>looked " XBD=2356 XHG=2320 YBD=1101 YHG=1082>as " XBD=2407 XHG=2381 YBD=1101 YHG=1073>if " XBD=2461 XHG=2432 YBD=1101 YHG=1074>it" XBD=1426 XHG=1314 YBD=1143 YHG=1108>might " XBD=1527 XHG=1438 YBD=1136 YHG=1109>have " XBD=1627 XHG=1541 YBD=1136 YHG=1108>been " XBD=1700 XHG=1641 YBD=1137 YHG=1109>the " XBD=1860 XHG=1714 YBD=1138 YHG=1109>remains " XBD=1910 XHG=1875 YBD=1137 YHG=1110>of " XBD=1983 XHG=1924 YBD=1137 YHG=1110>the " XBD=2115 XHG=1997 YBD=1143 YHG=1118>ovary, " XBD=2194 XHG=2130 YBD=1136 YHG=1109>but " XBD=2460 XHG=2206 YBD=1143 YHG=1109>unfortunately" XBD=1383 XHG=1314 YBD=1172 YHG=1144>this " XBD=1538 XHG=1401 YBD=1178 YHG=1145>portion " XBD=1624 XHG=1556 YBD=1173 YHG=1153>was " XBD=1705 XHG=1641 YBD=1172 YHG=1146>not " XBD=1902 XHG=1722 YBD=1172 YHG=1145>examined " XBD=2218 XHG=1919 YBD=1179 YHG=1145>microscopically. " XBD=2317 XHG=2267 YBD=1171 YHG=1144>On " XBD=2477 XHG=2333 YBD=1172 YHG=1145>section ." XBD=1374 XHG=1315 YBD=1207 YHG=1179>the " XBD=1537 XHG=1398 YBD=1207 YHG=1181>tumour " XBD=1629 XHG=1560 YBD=1207 YHG=1188>was " XBD=1920 XHG=1661 YBD=1214 YHG=1181>honeycombed " XBD=2020 XHG=1936 YBD=1208 YHG=1181>with " XBD=2144 XHG=2045 YBD=1208 YHG=1181>small (} " XBD=2267 XHG=2222 YBD=1207 YHG=1180>in. diameter" XBD=1475 XHG=1316 YBD=1249 YHG=1215>cyst-like " XBD=1628 XHG=1510 YBD=1249 YHG=1223>spaces " XBD=1776 XHG=1664 YBD=1243 YHG=1216>which " XBD=1947 XHG=1813 YBD=1243 YHG=1216>exuded " XBD=2088 XHG=1984 YBD=1243 YHG=1215>blood " XBD=2228 XHG=2124 YBD=1249 YHG=1216>freely " XBD=2342 XHG=2275 YBD=1243 YHG=1215>and " XBD=2463 XHG=2377 YBD=1243 YHG=1223>were" XBD=1491 XHG=1315 YBD=1284 YHG=1250>evidently " XBD=1599 XHG=1504 YBD=1278 YHG=1259>areas " XBD=1649 XHG=1613 YBD=1278 YHG=1251>of " XBD=1915 XHG=1663 YBD=1285 YHG=1251>degeneration." XBD=1582 XHG=1358 YBD=1325 YHG=1292>Pathological " XBD=1813 XHG=1603 YBD=1326 YHG=1293>Report.-A " XBD=1973 XHG=1836 YBD=1327 YHG=1293>portion " XBD=2032 XHG=1996 YBD=1320 YHG=1293>of " XBD=2114 XHG=2055 YBD=1320 YHG=1293>the " XBD=2274 XHG=2137 YBD=1321 YHG=1294>tumour " XBD=2361 XHG=2295 YBD=1321 YHG=1301>was " XBD=2464 XHG=2384 YBD=1321 YHG=1294>sent" XBD=1351 XHG=1314 YBD=1356 YHG=1329>to " XBD=1442 XHG=1383 YBD=1356 YHG=1328>the " XBD=1614 XHG=1475 YBD=1356 YHG=1328>Clinical " XBD=1817 XHG=1648 YBD=1357 YHG=1329>Research " XBD=2073 XHG=1848 YBD=1361 YHG=1329>Association, " XBD=2175 XHG=2106 YBD=1356 YHG=1329>and " XBD=2263 XHG=2205 YBD=1356 YHG=1329>the " XBD=2463 XHG=2292 YBD=1362 YHG=1328>following" XBD=1429 XHG=1314 YBD=1398 YHG=1366>report " XBD=1518 XHG=1450 YBD=1392 YHG=1373>was " XBD=1719 XHG=1541 YBD=1392 YHG=1365>received : " XBD=1862 XHG=1757 YBD=1391 YHG=1364>&dquo; The " XBD=1989 XHG=1884 YBD=1392 YHG=1365>tissue " XBD=2038 XHG=2011 YBD=1392 YHG=1365>is " XBD=2205 XHG=2061 YBD=1398 YHG=1365>entirely " XBD=2369 XHG=2224 YBD=1393 YHG=1364>necrotic " XBD=2460 XHG=2391 YBD=1392 YHG=1365>and" XBD=1451 XHG=1314 YBD=1427 YHG=1400>cellular " XBD=1631 XHG=1468 YBD=1427 YHG=1400>elements " XBD=1705 XHG=1647 YBD=1427 YHG=1408>are " XBD=1821 XHG=1720 YBD=1427 YHG=1400>made " XBD=1900 XHG=1838 YBD=1427 YHG=1402>out " XBD=1998 XHG=1915 YBD=1427 YHG=1400>with " XBD=2111 XHG=2015 YBD=1434 YHG=1401>great " XBD=2301 XHG=2127 YBD=1434 YHG=1400>difficulty. " XBD=2381 XHG=2348 YBD=1427 YHG=1399>It " XBD=2421 XHG=2395 YBD=1428 YHG=1400>is " XBD=2457 XHG=2437 YBD=1427 YHG=1409>a" XBD=1555 XHG=1314 YBD=1468 YHG=1435>fibro-myoma " XBD=1609 XHG=1580 YBD=1468 YHG=1435>(? " XBD=1780 XHG=1626 YBD=1467 YHG=1436>fibroma, " XBD=1837 XHG=1798 YBD=1462 YHG=1436>A. W. 0.) " XBD=2035 XHG=1999 YBD=1462 YHG=1436>of " XBD=2117 XHG=2058 YBD=1462 YHG=1436>the " XBD=2247 XHG=2140 YBD=1468 YHG=1443>ovary " XBD=2333 XHG=2261 YBD=1462 YHG=1435>into " XBD=2454 XHG=2350 YBD=1463 YHG=1436>which|>" XBD=1545 XHG=1313 YBD=1504 YHG=1471>haemorrhage " XBD=1630 XHG=1568 YBD=1498 YHG=1471>has " XBD=1760 XHG=1656 YBD=1499 YHG=1471>taken " XBD=1882 XHG=1787 YBD=1504 YHG=1472>place " XBD=1987 XHG=1906 YBD=1498 YHG=1471>thus " XBD=2159 XHG=2011 YBD=1505 YHG=1471>forming " XBD=2240 XHG=2182 YBD=1498 YHG=1471>the " XBD=2366 XHG=2265 YBD=1504 YHG=1471>cysts, " XBD=2456 XHG=2389 YBD=1498 YHG=1471>and" XBD=1560 XHG=1313 YBD=1540 YHG=1506>subsequently " XBD=1649 XHG=1589 YBD=1533 YHG=1506>the " XBD=1788 XHG=1679 YBD=1534 YHG=1507>whole " XBD=1958 XHG=1818 YBD=1533 YHG=1508>tumour " XBD=2048 XHG=1987 YBD=1534 YHG=1506>has " XBD=2272 XHG=2079 YBD=1540 YHG=1507>undergone " XBD=2451 XHG=2300 YBD=1534 YHG=1506>necrosis." XBD=1421 XHG=1314 YBD=1571 YHG=1542>There " XBD=1462 XHG=1435 YBD=1569 YHG=1543>is " XBD=1522 XHG=1478 YBD=1569 YHG=1551>no " XBD=1700 XHG=1539 YBD=1569 YHG=1542>evidence " XBD=1751 XHG=1716 YBD=1569 YHG=1542>of " XBD=1882 XHG=1766 YBD=1569 YHG=1543>recent " XBD=2069 XHG=1895 YBD=1569 YHG=1542>infection. " XBD=2223 XHG=2118 YBD=1570 YHG=1542>There " XBD=2265 XHG=2237 YBD=1569 YHG=1538>is " XBD=2323 XHG=2279 YBD=1568 YHG=1549>no " XBD=2410 XHG=2338 YBD=1576 YHG=1542>sign " XBD=2464 XHG=2424 YBD=1569 YHG=1542>of" XBD=1531 XHG=1313 YBD=1611 YHG=1578>malignancy " XBD=1586 XHG=1548 YBD=1605 YHG=1586>or " XBD=1638 XHG=1601 YBD=1604 YHG=1578>of " XBD=1817 XHG=1652 YBD=1604 YHG=1578>innocent " XBD=2006 XHG=1833 YBD=1610 YHG=1577>epithelial " XBD=2288 XHG=2024 YBD=1610 YHG=1577>proliferation.&dquo;" XBD=1428 XHG=1357 YBD=1640 YHG=1613>The " XBD=1578 XHG=1444 YBD=1646 YHG=1614>patient " XBD=1661 XHG=1593 YBD=1640 YHG=1621>was " XBD=1878 XHG=1680 YBD=1646 YHG=1613>discharged " XBD=1982 XHG=1894 YBD=1639 YHG=1613>from " XBD=2146 XHG=1998 YBD=1645 YHG=1613>hospital " XBD=2263 XHG=2162 YBD=1640 YHG=1613>much " XBD=2458 XHG=2286 YBD=1646 YHG=1612>improved" XBD=1356 XHG=1313 YBD=1674 YHG=1656>on " XBD=1465 XHG=1370 YBD=1682 YHG=1649>April " XBD=1572 XHG=1480 YBD=1676 YHG=1648>30th. 1921.

" XBD=1379 XHG=1361 YBD=1722 YHG=1691>I " XBD=1569 XHG=1399 YBD=1729 YHG=1692>recently " XBD=1788 XHG=1586 YBD=1722 YHG=1691>examined " XBD=1982 XHG=1815 YBD=1722 YHG=1691>her---on " XBD=2114 XHG=2006 YBD=1728 YHG=1691>April " XBD=2235 XHG=2130 YBD=1727 YHG=1691>20th, " XBD=2359 XHG=2256 YBD=1728 YHG=1690>1923, " XBD=2456 XHG=2376 YBD=1729 YHG=1690>just" XBD=1356 XHG=1310 YBD=1760 YHG=1731>26 " XBD=1532 XHG=1375 YBD=1763 YHG=1732>months " XBD=1652 XHG=1551 YBD=1763 YHG=1732>after " XBD=1839 XHG=1669 YBD=1763 YHG=1733>removal " XBD=1896 XHG=1857 YBD=1762 YHG=1732>of " XBD=1980 XHG=1914 YBD=1763 YHG=1732>the tumour-and " XBD=2414 XHG=2297 YBD=1762 YHG=1732>found " XBD=2456 XHG=2432 YBD=1762 YHG=1742>a" XBD=1596 XHG=1310 YBD=1810 YHG=1772>rosy-cheeked, " XBD=1783 XHG=1630 YBD=1809 YHG=1773>smiling " XBD=1891 XHG=1815 YBD=1803 YHG=1773>and " XBD=2019 XHG=1924 YBD=1810 YHG=1782>very " XBD=2162 XHG=2049 YBD=1803 YHG=1772>obese " XBD=2342 XHG=2193 YBD=1803 YHG=1781>woman (her-

obesity. " XBD=1569 XHG=1503 YBD=1843 YHG=1813>she " XBD=1741 XHG=1600 YBD=1849 YHG=1814>stated, " XBD=1845 XHG=1768 YBD=1843 YHG=1823>was " XBD=2033 XHG=1874 YBD=1843 YHG=1813>marked " XBD=2179 XHG=2051 YBD=1844 YHG=1812>before " XBD=2275 XHG=2207 YBD=1844 YHG=1813>her " XBD=2454 XHG=2300 YBD=1850 YHG=1813>illness)," XBD=1384 XHG=1309 YBD=1884 YHG=1853>and " XBD=1490 XHG=1412 YBD=1892 YHG=1863>any " XBD=1658 XHG=1515 YBD=1884 YHG=1853>doubts " XBD=1704 XHG=1686 YBD=1883 YHG=1854>I " XBD=1808 XHG=1731 YBD=1884 YHG=1853>had " XBD=1876 XHG=1835 YBD=1883 YHG=1863>as " XBD=1943 XHG=1903 YBD=1884 YHG=1856>to " XBD=2037 XHG=1971 YBD=1885 YHG=1853>the " XBD=2140 XHG=2064 YBD=1884 YHG=1855>real " XBD=2300 XHG=2165 YBD=1884 YHG=1855>nature " XBD=2364 XHG=2325 YBD=1884 YHG=1853>of " XBD=2457 XHG=2388 YBD=1885 YHG=1854>the" XBD=1466 XHG=1308 YBD=1925 YHG=1895>tumour " XBD=1576 XHG=1479 YBD=1925 YHG=1903>were " XBD=1774 XHG=1591 YBD=1932 YHG=1894>dispelled " XBD=1856 XHG=1790 YBD=1925 YHG=1894>the " XBD=2042 XHG=1870 YBD=1925 YHG=1896>moment " XBD=2076 XHG=2059 YBD=1923 YHG=1894>I " XBD=2169 XHG=2092 YBD=1924 YHG=1904>saw " XBD=2260 XHG=2183 YBD=1924 YHG=1894>her. " XBD=2331 XHG=2312 YBD=1923 YHG=1893>I " XBD=2453 XHG=2346 YBD=1925 YHG=1894>could" XBD=1387 XHG=1307 YBD=1964 YHG=1933>find " XBD=1457 XHG=1409 YBD=1965 YHG=1945>no " XBD=1661 XHG=1481 YBD=1965 YHG=1934>evidence " XBD=1733 XHG=1693 YBD=1965 YHG=1935>of " XBD=1981 XHG=1764 YBD=1965 YHG=1944>recurrence " XBD=2043 XHG=2003 YBD=1964 YHG=1935>of " XBD=2129 XHG=2063 YBD=1965 YHG=1934>the " XBD=2307 XHG=2151 YBD=1965 YHG=1937>tumour " XBD=2368 XHG=2325 YBD=1965 YHG=1944>or " XBD=2450 XHG=2386 YBD=1966 YHG=1935>the" XBD=1456 XHG=1308 YBD=2006 YHG=1975>ascites. " XBD=1588 XHG=1509 YBD=2005 YHG=1975>The " XBD=1713 XHG=1610 YBD=2013 YHG=1976>large " XBD=1809 XHG=1735 YBD=2005 YHG=1976>size " XBD=1870 XHG=1830 YBD=2005 YHG=1975>of " XBD=1958 XHG=1892 YBD=2005 YHG=1975>the " XBD=2122 XHG=1979 YBD=2005 YHG=1975>former " XBD=2217 XHG=2141 YBD=2005 YHG=1975>and " XBD=2303 XHG=2237 YBD=2006 YHG=1975>the " XBD=2453 XHG=2324 YBD=2006 YHG=1977>extent" XBD=1347 XHG=1307 YBD=2046 YHG=2015>of " XBD=1449 XHG=1383 YBD=2046 YHG=2016>the " XBD=1604 XHG=1486 YBD=2046 YHG=2017>latter " XBD=1703 XHG=1640 YBD=2046 YHG=2025>are " XBD=1779 XHG=1739 YBD=2046 YHG=2016>of " XBD=1985 XHG=1815 YBD=2046 YHG=2016>interest. " XBD=2058 XHG=2041 YBD=2044 YHG=2015>I " XBD=2207 XHG=2096 YBD=2046 YHG=2015>could " XBD=2370 XHG=2243 YBD=2046 YHG=2015>detect " XBD=2453 XHG=2404 YBD=2045 YHG=2025>no" XBD=1583 XHG=1306 YBD=2093 YHG=2055>hydrothorax. " XBD=1954 XHG=1638 YBD=2094 YHG=2056>Unfortunately, " XBD=2058 XHG=2006 YBD=2093 YHG=2055>by " XBD=2130 XHG=2108 YBD=2085 YHG=2065>a " XBD=2340 XHG=2178 YBD=2086 YHG=2055>mistake " XBD=2455 XHG=2387 YBD=2087 YHG=2056>the" XBD=1464 XHG=1306 YBD=2127 YHG=2098>tumour " XBD=1561 XHG=1483 YBD=2126 YHG=2106>was " XBD=1789 XHG=1583 YBD=2134 YHG=2096>destroved " XBD=1834 XHG=1811 YBD=2126 YHG=2106>a " XBD=1927 XHG=1855 YBD=2126 YHG=2096>few " XBD=2044 XHG=1949 YBD=2134 YHG=2096>days " XBD=2167 XHG=2066 YBD=2126 YHG=2096>after " XBD=2363 XHG=2186 YBD=2126 YHG=2096>removal. " XBD=2454 XHG=2414 YBD=2127 YHG=2096>It" XBD=1444 XHG=1305 YBD=2168 YHG=2137>would. " XBD=1490 XHG=1472 YBD=2166 YHG=2136>I " XBD=1643 XHG=1516 YBD=2169 YHG=2137>think, " XBD=1768 XHG=1668 YBD=2166 YHG=2127>have " XBD=1890 XHG=1795 YBD=2166 YHG=2136>been " XBD=1940 XHG=1916 YBD=2166 YHG=2146>a " XBD=2088 XHG=1964 YBD=2167 YHG=2127>useful " XBD=2287 XHG=2114 YBD=2167 YHG=2136>addition " XBD=2351 XHG=2311 YBD=2167 YHG=2138>to " XBD=2455 XHG=2377 YBD=2174 YHG=2145>any

gynaecological " XBD=1800 XHG=1612 YBD=2207 YHG=2187>museum.References.

1. Maclean, E. J.: A Case of Fibroma of the Ovary, Jour.Obst. and Gynæcol. Brit. Emp., November, 1903.

2. Clark, E. D., and Gabe, W. E.: Amer. Jour. Obst. andGynecol., March, 1921.

3. Eden and Lockyer: Gynæcology, p. 684. J. and A. Churchill,London, 1916.

4. McCann, F. J. : Brit. Med. Jour., 1903, i., 127.5. Fairbairn: Jour. Obst. and Gynæcol. Brit. Emp., ii., 128.6. Doran: Trans. Obst. Soc. Lond., 1896, xxxviii., 187.7. Williamson and Barris : Diseases of the Ovary, New System

of Gynæcology, 1917, ii., 808.

TWO SPORADIC CASES OF INFECTIONBY B. AERTRYCKE.

BY DOUGLAS FIRTH, M.D. CAMB., F.R.C.P. LOND.,JUNIOR PHYSICIAN, KING’S COLLEGE HOSPITAL;

AND

E. FF. CREED, B.M., B.CH., D.P.H. OXF.,DIRECTOR OF THE PATHOLOGICAL DEPARTMENT,

KING’S COLLEGE HOSPITAL.

TllB connexion " XBD=1907 XHG=1737 YBD=3176 YHG=3145>between " XBD=1994 XHG=1949 YBD=3175 YHG=3146>B. aetti-yeke " XBD=2326 XHG=2250 YBD=3175 YHG=3145>and " XBD=2454 XHG=2365 YBD=3175 YHG=3145>food" XBD=1503 XHG=1304 YBD=3222 YHG=3186>poisoning " XBD=1549 XHG=1517 YBD=3215 YHG=3186>is " XBD=1650 XHG=1562 YBD=3215 YHG=3194>now " XBD=1706 XHG=1665 YBD=3215 YHG=3194>so " XBD=1806 XHG=1722 YBD=3214 YHG=3185>well " XBD=2054 XHG=1823 YBD=3215 YHG=3185>established " XBD=2158 XHG=2069 YBD=3215 YHG=3187>that " XBD=2248 XHG=2172 YBD=3215 YHG=3186>this " XBD=2448 XHG=2264 YBD=3222 YHG=3187>organism" XBD=1336 XHG=1303 YBD=3254 YHG=3226>is " XBD=1430 XHG=1359 YBD=3253 YHG=3234>one " XBD=1494 XHG=1454 YBD=3254 YHG=3225>of " XBD=1583 XHG=1517 YBD=3253 YHG=3225>the " XBD=1691 XHG=1607 YBD=3253 YHG=3225>first " XBD=1756 XHG=1715 YBD=3253 YHG=3225>to " XBD=1887 XHG=1783 YBD=3253 YHG=3233>come " XBD=2036 XHG=1913 YBD=3253 YHG=3225>under " XBD=2246 XHG=2058 YBD=3262 YHG=3226>suspicion " XBD=2377 XHG=2271 YBD=3255 YHG=3225>when " XBD=2451 XHG=2403 YBD=3254 YHG=3233>an" XBD=1493 XHG=1304 YBD=3293 YHG=3264>outbreak " XBD=1549 XHG=1510 YBD=3293 YHG=3265>of " XBD=1657 XHG=1567 YBD=3293 YHG=3264>food " XBD=1875 XHG=1675 YBD=3300 YHG=3265>poisoning " XBD=2037 XHG=1892 YBD=3298 YHG=3272>occurs, " XBD=2127 XHG=2055 YBD=3293 YHG=3264>but " XBD=2330 XHG=2145 YBD=3301 YHG=3264>difficulty " XBD=2448 XHG=2347 YBD=3293 YHG=3264>often" XBD=1420 XHG=1304 YBD=3332 YHG=3304>arises " XBD=1483 XHG=1443 YBD=3332 YHG=3303>in " XBD=1575 XHG=1508 YBD=3331 YHG=3303>the " XBD=1835 XHG=1601 YBD=3339 YHG=3303>recognition " XBD=1901 XHG=1861 YBD=3331 YHG=3303>of " XBD=1990 XHG=1924 YBD=3331 YHG=3303>the " XBD=2189 XHG=2016 YBD=3339 YHG=3304>sporadic " XBD=2310 XHG=2215 YBD=3339 YHG=3312>case, " XBD=2456 XHG=2336 YBD=3332 YHG=3303>either" XBD=1401 XHG=1304 YBD=3371 YHG=3343>from " XBD=1673 XHG=1450 YBD=3371 YHG=3343>anomalous " XBD=1948 XHG=1721 YBD=3378 YHG=3342>symptoms, " XBD=2040 XHG=1997 YBD=3370 YHG=3351>or " XBD=2183 XHG=2086 YBD=3371 YHG=3343>from " XBD=2453 XHG=2230 YBD=3372 YHG=3342>insufficient

pathological " XBD=1881 XHG=1606 YBD=3417 YHG=3382>investigation " XBD=2039 XHG=1929 YBD=3410 YHG=3381>when " XBD=2307 XHG=2089 YBD=3410 YHG=3381>abdominal " XBD=2452 XHG=2353 YBD=3418 YHG=3382>signs" XBD=1592 XHG=1304 YBD=3458 YHG=3413>preponderate.

’

The " XBD=1553 XHG=1470 YBD=3488 YHG=3460>tirst " XBD=1674 XHG=1590 YBD=3488 YHG=3468>case " XBD=1799 XHG=1711 YBD=3487 YHG=3459>here " XBD=2015 XHG=1836 YBD=3489 YHG=3458>recorded " XBD=2142 XHG=2050 YBD=3495 YHG=3468>may " XBD=2223 XHG=2177 YBD=3488 YHG=3459>be " XBD=2373 XHG=2259 YBD=3488 YHG=3459>taken " XBD=2453 XHG=2410 YBD=3487 YHG=3467>as" XBD=1564 XHG=1306 YBD=3535 YHG=3499>representing " XBD=1654 XHG=1587 YBD=3527 YHG=3499>the " XBD=1790 XHG=1680 YBD=3527 YHG=3498>usual " XBD=1921 XHG=1815 YBD=3534 YHG=3498>type, " XBD=1984 XHG=1946 YBD=3526 YHG=3498>in " XBD=2132 XHG=2010 YBD=3526 YHG=3497>which " XBD=2303 XHG=2158 YBD=3526 YHG=3498>sudden " XBD=2449 XHG=2330 YBD=3532 YHG=3498>onset," XBD=1476 XHG=1304 YBD=3575 YHG=3539>pyrexia, " XBD=1694 XHG=1502 YBD=3566 YHG=3537>diarrhoea " XBD=1810 XHG=1733 YBD=3564 YHG=3536>and vomiting, " XBD=2213 XHG=2063 YBD=3570 YHG=3535>general abdominal

1213

pain, and marked tenderness on palpation over thewhole abdomen are the usual features. These are,however, by no means pathognomonic, and as a ruleit is only by a process of exclusion, and with thehelp of the pathologist, that a correct diagnosis isreached. This case was sent to hospital as an " acuteabdomen " and reached the medical wards with aprovisional diagnosis of atypical typhoid fever, butclinical evidence and pathological investigation sooncorrected this error. In the second case, no suspicionof the causative agent was roused, although someform of poisoning was suspected, and it was onlyafter the examination of cultures from the cadaverthat B. aertrycke was implicated. In neither instancewas any other member of the household affected, norwas the source of the infection traced.CASE I.-Male, aged 23, admitted to King’s College

Hospital on August 1st, 1922, complaining of severe

abdominal pain, with vomiting and diarrhoea which hadstarted suddenly 24 hours previously. The abdominal painwas sharp and stabbing in character, but not definitelylocalised. It remained a prominent feature throughout thefirst week. Vomiting was frequent at the onset and did notfinally cease until the seventh day ; diarrhoea persisted forabout the same time. The tongue was dry and the dorsumfurred. The abdomen was moderately distended, and therewas marked general abdominal tenderness without rigidity.Headache was severe for the first few days. The tempera-ture was 102° F. on admission and gradually fell, becomingnormal on the eighth day. The pulse-rate never rose above100 and for most of the febrile period was between 80 and 90.The atropine test was performed on the third day, and themaximum increase in pulse-rate under the influence of1/33 gr. of atropine was 14. A blood count on the thirdday showed a total leucocyte count of 14,400 per c.mm., withpolymorphonuclears 67-6 per cent., lymphocytes 31-2 percent., eosinophiles 1-2 per cent. The pyrexia and symptomsall subsided by the end of the first week, and convalescencewas uninterrupted.

Bacteriological ZMgsMyMott.—A blood culture was takenon the day after admission, Douglas and Colebrook’s trypsin-broth culture-medium being used, but the cultures remainedsterile. A Widal test on the patient’s serum to B. typhosusand B. paratyphosus A and B was performed with negativeresults. On the third day a specimen of faeces was plated out,and from this B. aertrycke was isolated and identified. About50 per cent. of the colonies developing on MacConkey’smedium proved to be B. aertrycke. The organism gave allthe cultural reactions of the Salmonella group ; it was notagglutinated by a B. paratyphosus B or a B. gaertner serumeven at one-tenth of the full titre of the serum ; but gavestandard agglutination with a B. aertrycke serum at doublethe titre of the serum. These agglutination reactions remainedunchanged after the organism had been grown on artificialmedia for four months. Attempts were made to isolate theorganism from the stools during the second and third weeksof the disease both by direct plating and by brilliant-greenenrichment methods, but without success. Unsuccessfulefforts were also made to recover the organism from theurine.The agglutination reactions of the patient’s serum gave

the following results :—

There was throughout no development of agglutinins toB. paratyphosus A or to B. gaertner. All agglutination testswere performed by Dreyer’s method, with standard culturesand sera issued by the Oxford University PathologyDepartment.CASE 2.-Female, aged 8, admitted to hospital at 9 P.M.

with the following history : The day previous to admissionthe child seemed quite well, but at 3 A.i. had been rousedwith an attack of vomiting, soon followed by diarrhoea,which became severe and was accompanied by great painin the abdomen and back, and marked restlessness. Duringthe afternoon the child became unconscious, in which stateshe was admitted to hospital. On examination, thetemperature was 10-t° F., respirations 60. and the pulseuncountable, but no abnormal physical signs could bedetected. At 10.30 r.M. there was a generalised convulsion

with twitching of the arms and legs. A second occurred at12.40 A.M., during which head retraction was marked, theopisthotonos being so severe that the head nearly touchedthe heels. The pupils were widely dilated and immobileduring the fit, but became normal soon after the attack hadceased. A third fit occurred at 5.30 A.31., in which theopisthotonos was again marked ; the respirations thenbecame rapid and irregular, and the child died at 5.40 A.M.,some 28 hours after onset of illness. Post mortem a markedinjection of the mucosa was found in the stomach andduodenum ; this subsided in the jejunum, became moreintense in the ileum, and reached a maximum in the lowerileum and cascum, where the appearance was haemorrhagic.The inflammation died away in the descending colon. Thespleen was large and soft, and the mesenteric glands wereincreased in size. Apart from some congestion of the lungsand brain, no other lesions were found. Dr. J. G.Ledingham isolated B. aertrycke from the spleen and intestinalcontents.

We are indebted to Sir Humphry Rolleston forpermission to publish the notes of the second case.

A. CASE OF

ENCEPHALITIS LETHARGICARECOGNISED BY CHANGE IN BEHAVIOUR.

BY JESSIE H. GELLATLY, M.D. EDIN., D.P.H.,ASSISTANT MEDICAL OFFICER OF HEALTH, CAMBRIDGESHIRE

COUNTY COUNCIL.

FOLLOWING the publication in THE LANCET ofProf. A. J. Hall’s Lumleian lectures, notes of thefollowing case were sent to him. He was kind enoughto give his opinion that it was undoubtedly anexample of encephalitis lethargica, and suggested itspublication as illustrating particularly the seriousmedico-legal aspects of these cases.

Family History and Circumstances.-The child, a girl,aged 10 years and 10 months, is illegitimate, born when themother was 17 years old. The mother is of average intelli-gence for her class ; no abnormalities are known in herfamily nor in that of the child’s father. The motherthasmarried since the birth of this child ; the step-father,hasalways rather resented the latter’s presence in the home,and has never treated her kindly. The home is a very poorone in every respect.

Previous Personal History.-Until early in 1920 the child,although described afterwards by her teacher as rathernervous and excitable, was never noted as in any wayabnormal, and her general intelligence was certainly quiteup to the average of her age and class.

Present Illnes8.-Early in 1920 the child was suddenlyseized with what was then diagnosed as a violent attack ofchorea. I did not see her until some months afterwards,when an accurate history was a little difficult to get from therelatives, but one fact had struck them very much, andcan be relied upon-namely, that for the first 24 hours thechild saw everything double. The illness was said to havecome on through a fright-seeing a favourite uncle fall offa horse. The night after this fright she was very excitedand hardly slept at all ; the choreiform movements developednext day, and on (I think) the following day a doctor wascalled in who sent her to Addenbrooke’s Hospital, Cam-bridge. She remained there, under treatment for chorea forabout a week, but was discharged at the end of that time as"

nobody could get any sleep in the ward, she made so muchnoise all night." She was treated as an out-patient for somemonths : the choreiform movements gradually subsided, butthe child has remained in a verv markedlv abnormal mentalstate ever since.

Condition on Examirzatiozz.-I saw her first in February,1921, when she had returned to school. The parents hadhad no medical advice for some months. The child was thennearly nine years old ; her general intelligence was good, andher school work nearly equal to the average for her age inspite of her long absence. She was, however, very restless,talkative, excitable, and emotional. the teacher said,

"

quitedifferent from what she used to be." The parents com-plained that she gave them. no rest at night, and that shewas very spiteful towards the other children. Definitestatements were made that as bedtime approached shebecame very excited. and although sent to bed sat upshouting and singing most of the night. She would fallasleep about breakfast-time, and often sleep until midday.The parents were utterly out of patience with the child, andhad treated her with considerable severity on account of

1 THE LANCET, April 14th, 1923, p. 731.