Pain in the shoulders is associated, as a rule, with disorders of the shoulder joint and in the proximity; and with various intrathoracic and subdiaphragmatic lesions, such as angina pectoris, pleurisy, pneumonia, new growths and lesions of the gallbladder, liver, stomach and intestine. While I was engaged in studying the significance of shoulder pains in uterine insufflation, my attention was called to the occurrence of shoulder pains in patients with ruptured ectopic pregnancy. The first observation was made on a ward patient in October, 1921. The patient presented the history characteristic of tubal pregnancy. There was a fulness in the pouch of Douglas, tenderness, moderate abdominal distention, and shifting dulness in the flanks. The patient stated that she had severe darting pains in the shoulders, which had begun two days before her admission to the hospital. On further questioning, this pain was said to follow an attack of fainting. She