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September 4, 1886


JAMA. 1886;VII(10):264-266. doi:10.1001/jama.1886.04250090012004

On the 17th of October, 1884, I was called to see Mrs. R. M., 40 years of age. She had been a tailoress until her marriage, six years before. She told me that three years previous to this visit she had rheumatism, for which she was treated about one year. She fancied that the remedies given her then, increased the menstrual flow very much at first, and finally arrested it altogether. This so alarmed her that she refused to take any more medicine, and had had no further treatment up to the time that I saw her, although she had suffered greatly with her heart in the meantime. She was a slender woman, rather over medium height. Her face was very pale, her lips bluish, cheeks sunken. She seemed very nervous and her voice was tremulous.

Her pulse was 108, very irregular in volume and rhythm, and frequently intermitted. The

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