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February 12, 1910


JAMA. 1910;LIV(7):519-525. doi:10.1001/jama.1910.92550330001001f

This subject is of interest to every one called to make a diagnosis in acute abdominal affections. My remarks shall be confined to conditions simulating early tubal pregnancy. The cardinal symptoms of early tubal pregnancy are (1) a missed menstruation, (2) sudden onset of pain (with or without shock), (3) bloody vaginal discharge, (4) a tender mass beside the uterus, (5) only slight fever, and (6) exacerbations of the pain and enlargement of the mass without corresponding elevation of temperature. In atypical cases, there may be decided fever or onset of pains without missed menstruation or other variations from the rule. Again, the internal hemorrhage may be very severe at first, requiring a diagnosis at once before the appearance of later confirmatory evidences. It may be impossible to feel a mass, for the liquid blood itself gives no well-marked resistance and yet causes so much tenderness that the enlarged tube

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