sinuses and veins, some of which are large enough freely to admit a finger within their cavities.

In the development of the superficial veins of the gravid womb, the fibrous coats of them do not appear to undergo much change or addition. It is the lining membrane, the endangium, that is to say, the vein that runs in the substance of the organ that is chiefly increased, so that, in examining the gravid womb, one sees rather great holes and channels lined with a smooth endangium, running among the tissue, than ordinary veins. In this respect there is nothing peculiar to the womb, since it has been long known that the veins within a viscus consist only of the endangium, as must indeed have been the case in the earliest stages of development, even of the aorta itself, for the blood makes its own channel. It makes, therefore, its endangium first, and the more tough, fibrous, and elastic parts of its tubes afterwards. (See Raciborski's paper on the Veins, in the Transactions of the Roy. Acad. Medicine.)

From the foregoing, it appears that the augmentation in weight, volume, and capacity of the gravid womb, is a compulsory process under an antagonistic force applied and sustained by the self-developing ovum. The ovum may be compared to a powerful acephalocyst that, attaching itself by means of its placental mass, that serves as a suctorial organ, to the living wall of the womb, absorbs, and compels it to yield in every dimension for its growing wants of accommodation. I beg the Student to see, in this great change of the womb from its non-gravid weight of two ounces to its gravid weight at term of one pound, or even one pound and a half, the proof of what I said a little while ago, videl., that the uterus is subject to a physiological hypertrophic evolution, from which it recovers as soon as the cause is removed; for, when the womb becomes emptied by the act of parturition, it returns within thirty or forty days to its non-gravid weight and size. The Student, in this, will see an example of an enormous hypertrophy or evolution, produced in the course of two hundred and eighty days, and recovered from by involution in the course of one month after the termination of the pregnancy. Let him reflect, therefore, that, if this is the law of the womb, it ought not to surprise him to learn that irritations, displacements, and various other causes may excite in the vacant womb this same disposition to hypertrophy under which it grows rapidly larger and larger for a certain time, but ceases to grow and returns speedily to its normal size and weight very soon after the irritation, displacement, &c., are removed.

Though the womb increases in weight as pregnancy proceeds, the means of its suspension in the cavity of the pelvis are still the same

in the gravid as in the non-gravid state. It is to be expected, then, that, as the uterus becomes heavier, it shall sink somewhat lower down, and that the woman shall, if she be a susceptible creature, perceive some symptoms like those of a falling of the womb: although the womb is growing larger, the lower part of the abdomen does not, at first, become larger. On the contrary, the early sinking downwards of the womb causes the hypogastrium to be less protuberant than before the conception, and hence the French proverb: "A ventre plât, enfant il y a," or, as an old English midwifery states it,

"In a belly that is flat

There's a child, be sure of that."

These signs of falling of the womb in women who are married, should be ever held as suspicious until there is full reason to believe that they are not results of an early pregnancy; and there is frequently no little embarrassment in coming to a positive conclusion; even the vaginal taxis cannot, in all instances, give an assured ground of opinion, since the engorgements of the uterus, so frequently coincident with prolapsions, are with difficulty to be distinguished from the aug. mented volume of the same organ arising from gravidity.

The reproductive organs have a direct connection with the cerebrospinal, and the ganglionic system of innervations. There is, therefore, no part nor parcel of the economy, into relation with which it cannot, under certain states of health, be brought; they are among the most powerful disturbers of the complacency of the organisms. They constitute an imperium in imperio, whose behests are not to be disobeyed. These organs can disturb the brain-the respiration-the digestion— the circulation-the secretions-the nutrition.

When the womb has become the seat of an advancing gestation, and feels the impulse of development, the complacency of the other innervations is, generally, discomposed. The stomach is one of the organs earliest to be called into sympathetic distress. The sympathy of the stomach is, in general, independent of any marked change of the animal heat, and of the rate of the arterial pulse. It is expressed by anorexia, by nausea, and ofttimes by vomiting. Probably the salivation, which is also a common symptom in pregnancy, is one of the same category of disturbances, as is also the sore-mouth of pregnant and suckling women.

Multitudes of women suffer from nausea only in the morning hours; the sympathy being interrupted by the business, the preoccupation, and the fatigues of the day, to return again on the following morning and follow the same course. In some, the nausea is perpetual, and attended with the most obstinate vomiting.

In most of the cases the nausea is gone before the quickening takes place; yet a young woman, under my care, vomited very soon after the conception, and vomited every day, and many times daily, during the whole course of her pregnancy. When her labor came on, which was a hard one, her disposition to vomit was greatly aggravated with every renewal of the contractions. To such a height did this symptom rise, that I found it seriously to contravene the intent and purpose of the labor pains. It is not a good practice, in general, to rupture the membranes of a primipara; but in this instance I concluded that, if the ovum could be allowed to discharge the waters, the condensation of the womb, that would follow, might put an end to the vomiting. I thrust my index finger through the distended bag of waters at the next pain. From that moment the nine-month's vomiting ceased, and returned no more. The labor, no longer delayed and contravened by the troublesome vomiting, hastened to a favorable conclusion.

I attended a lady in Spruce Street, a few years since, who, during nearly three consecutive months, appeared to vomit up every particle of her ingesta. It was her own opinion, coincided in by her friends and attendants, that the total amount of all her food and drinks returned very soon after they were swallowed. Although she felt much weakened, I could not perceive that, under this process, she lost her flesh; and, in the end, she gave birth to a healthy daughter. It is apparent that she must have been nourished during this time; but the manner, and the quantity, have remained ever since a mystery that I cannot explain. I cite this as one case only out of a great number that have occurred in my practice.

Many of these troubles vanish while the woman takes exercise in her carriage or on foot; because, as before said, the powers of the constitution, when devoted to the purposes supposed in every case of active employment of them, are not liable to be checked and diverted by a morbid consent of the stomach with the womb. Hence such women should be advised to walk or ride, or to busy themselves with their affairs, and avoid a sedentary and slothful life.

The acidity and eructations, and the diarrhoea or costiveness of pregnancy, may be obviated by the use of alkalies, whether soda or potash, magnesia, lime, or ammonia. Some vigor may be communicated to the gastric innervations by means of champagne; or by brandy and water, rum and water, or by certain of the bitter spirituous tinctures, combined with aperients.

I readily cured a case of this sort, in the spring of 1848, in a person who had suffered great distress from vomiting, cardialgia, flatulency, and constipation. She had a mixture composed of sweet tincture of

rhubarb two ounces, and tincture of gentian one ounce. A dessertspoonful of this medicine, taken once a day, dissipated all the symp toms; and I assure the Student that, in many instances of severe distress from this vomiting, I have found the patients promptly relieved by its use. Two drops of tincture of aconite, in a tablespoonful of water, may be given for the dose, in certain of the cases, with marked relief.

Many of those examples that consist of nausea and vomiting during the early part of the day, but which cease after the meridian hour, may be set aside by the following method:

Let a cup of coffee, with a toast, be brought to the bedside at the earliest morning hour. The patient should be called from her sleep to take this preliminary breakfast, without rising from bed. As soon as it is taken, let her lie down to sleep again, if possible. It appears useless to offer a rationale of this method. I am very confident, however, that, in a considerable number of persons, it will be found to put a sudden stop to the vomiting, as well as to the nausea. Certainly, many of my patients have been speedily, as well as permanently cured by it, and that in very distressing instances of the nau

sea.

Inasmuch as pregnancy enables the womb to disturb the alimentary organs in the manner above mentioned, it might reasonably be inferred that the rest of the nervous mass is also liable to interruption of its regular action, from similar causes. Considerable modifications are sometimes observable even in the temper and disposition of the woman. Those who are by nature amiable and gentle, sometimes becomes peevish, and fretted by trifles-full of false alarms and idle fears; while persons naturally ill-tempered become charitable, and kind, and courageous. Strange desires, longings, wishes for extraor dinary, unprocurable, or disgusting kinds of aliment, are said to arise in pregnant women; but in a long clinical practice I have never met with any examples of the sort; which leads me to infer that these longings are more frequent in the books than in the practice of

our art.

Quickening. The embryo acquires a power of slight muscular motion at an early stage of pregnancy; but, as it is inclosed within the decidua and the membranes, and floats in an abundant liquor amnii, the first feeble motions of its body or limbs cannot make themselves felt through so many coverings, by the living tissue of the womb. In general, it attains the age of four months and a half before it becomes sufficiently large and strong to make itself felt by the

mother when thrusting with its feet or hands, or when suddenly redressing its body from the usually flexed position. When the child hath first acquired this power to make its motion felt by the mother, it is said to be quick with life, or to have quickened, and the event is called the quickening. Quickening is the first perceived motion of the child.

The lawyers have looked upon a child quick with life as worthy of the protection of the laws; for it is felony, maliciously and with evil intent, to kill a child that is quick with life in the womb, but not felony to kill one that is not quick with life. It appears to me that this is a distinction without a difference; for the child of six weeks, or of two months, is as essentially quick with life as one of five or seven, or even nine months. The only difference is, that the child at four or four and a half months is strong enough to make itself felt, while at two or two and a half months its movements are so feeble as not to be perceptible by the mother. It is to be hoped that this barbarous and ignorant distinction, a remnant of early superstition, may be done away with by our modern legislatures, and that the wretches who for hire lend our art to the detestable baseness teneros avellere fœtus may be made liable to condign punishment for the crime, committed at whatever stage of the gestation.

Form of the Belly in Pregnancy.-As the ovum grows larger day by day, so doth the womb continue to expand, adding molecule to molecule, weight to weight, and mass to mass. The lower belly becomes a little protuberant, and the swelling is fashioned upon the pear-shaped womb that lies beneath, and pushes the belly outwards. The Student should remember that other bodies besides the womb may cause the abdomen to enlarge, but that no object save the uterus itself can give to the hypogaster its peculiar gravid shape. The form of the hypogastric tumor dependent on the state of gravidity furnishes to the physician, therefore, a very useful means of diagnosis, which ought not to be neglected in some of the difficult cases, cases in which it is a matter of extreme consequence to individuals that no mistake should be made as to the real nature of the symptoms.

Pouting of the Navel.-The navel in the non-gravid woman is a deep depression or dimple. This depression is caused by the contraction or shortening of the remainders of the two umbilical arteries and veins, which, after birth, draw the skin inwards and downwards to make the pit of the navel. In the gravid woman, when the six months are past, the navel rises to the general level of the skin, and,