There have been eight cases reported since .1901. Including in the conservative treatment of these cases those in which there was no surgical interference and those in which simple incision and drainage was done, we get apparently the largest number of recoveries. However, the proper treatment in these cases is a disputed point, Keen3 stating that in the most cases an exploratory operation should be done. In our opinion, death would have followed an immediate operation in our case, and it seems

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... to us that no fixed rule should be laid down; each case should be treated on its own merits. It should be borne in mind that only eases of subcutaneous rupture of the kidney are considered in these reports and remark*. AN Patient.\p=m-\Awoman, aged 35, was sent into the Clara Barton Hospital, Dec. 4, 1908, with the tentative diagnosis of ruptured ectopic pregnancy. Condition on Admission.\p=m-\Whenseen by us she was in a state of collapse with weak, thready, and intermittent pulse; rapid respiration, and a temperature of 98 F. She was not particularly anemic, however. Her abdomen was very much distended and she complained of pain over the enlarged uterus. No fetal heart could be heard and no movement of the child could be detected. History.\p=m-\Thepatient gave a history of an uneventful pregnancy of seven months duration. At about five months she began to notice fetal motion which continued irregularly up to her present illness. At 3 a. m., Wednesday, Dec. 2, 1908, she was taken with a sudden pain in the lower abdomen and collapsed. Since when she had noticed no fetal motion and her bowels had not acted. Her attending physician had treated her expectantly until a consultation had decided the presence of a surgical phase, and she was sent into the hospital for observation. Ectopic pregnancy was ruled out owing to the patient's history, and the normal, symmetrical enlargement of the uterus. Rupture of the uterus seemed .most probable with rupture of some of the other viscera as a possible alternative. However, the fact that the woman was not in labor and had not been; had sustained no accidents, and had been perfectly well throughout her pregnancy made us hesitate in making a positive diagnosis. Termination of Case.-It was clearly a surgical case, but the woman was practically moribund and operation was out of the question. Four hours later she died. Autopsy.-The peritoneum showed signs of inflammation. About 500 c.c. of blood and exudate was taken from the pelvic cavity. The tubes were folded behind the uterus, enlarged and adherent and at the fundus the fetal head was protruding. Careful questioning of the husband elicited the fact that the woman had had an instrumental delivery several years previous, after which she was ill for several weeks. She probably then had a severe infection which produced tbe adherent tubes and the fixed uterus which the autopsy disclosed. 2. Florchen-Beitr. z. klin.