is such an action as this that constitutes the hour-glass contraction of the womb, which takes place in consequence of the non-separation of the placenta from the uterine surface-thus disabling that placentouterine quarter from contracting equally with the rest of the organ. When this happens, the placenta is, of course, shut up within a cell, above the hour-glass contraction.

Obliquity. The gravid uterus commonly occupies the middle of the abdomen, in hale young women, notwithstanding both the projec tion of the sacrum and the intrusion of the spinal column tend to give to it an oblique direction; hence, we generally find it to be inclined towards one side of the abdomen in persons of a lax and flaccid habit of body. So far as my observation enables me to speak, it is oblique to the left more frequently than to the right side.

Great degrees of obliquity are scarcely met with in first pregnancies, in consequence of the vigorous contractility of the symmetrical abdominal muscles, which constrain the gravid womb to remain in the mesian line; whereas, in women who have borne many children, those muscles acquire such a laxity and want of tone, as to allow the organ to librate from side to side, or fall to the front, according to the attitude of the patient for the time being.

A right or a left lateral obliquity becomes very evident if the woman stands on her feet. In general, if the organ bears over to the right side, its faulty direction will be corrected by turning upon the left, and vice versa. In anterior obliquity, the fundus falls so far forward as to make the patient seem more lusty or larger than she really is. The figure is greatly improved, in such cases, by wearing a suspensory bandage, which assists the recti and obliqui abdominis to hold the gravid organ up nearer to the back bone. When a patient suffers herself to be annoyed by what she supposes to be an inordinate ⚫ development of the womb, her fears may sometimes be allayed by showing her that, notwithstanding she is apparently enormously large, she is, in reality, not more lusty than common, and that the false appearance depends upon an anterior obliquity of the womb, which causes the belly to protrude unnaturally.

Pressure of the Womb on the Vessels.-Interference of the gravid womb with the functions of the kidneys, is now universally conceded to give rise to a convulsive disposition in pregnant women, that exhibits itself under the form of eclampsia, commonly known as puerperal convulsions. When the uterus has become inordinately large and heavy, and when the woman is at the same time affected

with costive and overloaded bowels, it can scarcely be supposed that the great emulgent veins should not suffer more or less from pressure, obstructing the course of the blood returning from the interior of the kidneys. One could easily imagine that this pressure upon the emulgent veins should have an obstructing power almost equal to that of a ligation of the vessel. Under such circumstances, the Bowman's capsules, which contain the essential secretory apparatus of the kidneys, would be so distended as to suspend, in a good measure, their offices, and so the azotized elements appointed to be carried off by the urine would remain, and continue to accumulate in the blood. The nervous disorders consequent on this vitiated condition of the circulating fluid, are signs of the uræmia; and the convulsions, and other signs—as paleness, weakness, delirium, &c., are symptoms of an uræmic intoxication. Any woman approaching the period of her confinement, who has a swelled, or oedematous leg, may well be suspected as prone to uræmic intoxication, and, provided she is vexed with headache, nervous twitchings, or any disorder of the senses of sight, hearing, &c., she should be at once taken care of, and all proper measures should be adopted to prevent the explosion of an uræmic convulsion.

Women in whom the abdominal muscles have not lost their tone, by repeated extensions in pregnancy, compress the uterus strongly, in a direction towards the back; whereas, those whose abdominal muscles have become weakened by repeated gestations, carry the child very low, to use a common term, allowing the enlarged womb to rest upon the muscles in front of it. In the former case, the pressure of the organ against the spine must, to a greater or less degree, interfere with the current of blood in the great vessels of the abdomen. Hence the aorta and iliac arteries, and some of their branches, will pass on their contents with less freedom than is natural, whereby the upper parts of the body become supplied with more than their due proportion of the arterial blood. Headache, vertigo, flushings of the face, and tendency to paralysis and convulsions, may fairly be attributed to excessive momentum of the blood thus distributed to the superior parts, and rendered doubly noxious by an accompanying uræmia. Sighing, præcordial distress, dyspnoea, and coughs are also found to depend upon the same principles, and are to be treated with a view to lessen this vicious distribution and sur-accumulation of the vital fluids. Venesection, looseness of the bowels, light diet, warm baths, and whatever tends to produce moderate relaxation of the muscular forces, are in general employed with signal success in these circumstances. Dr. Collins, App. 199, remarks, that "Puerperal convulsions occur almost invariably in strong plethoric young women, with their first chil

dren, more especially in such as are of a coarse, thick make, with short necks." He adds, at p. 201, "that of thirty cases occurring during his Mastership, twenty-nine were in women with their first children."

Can this excess of propensity to eclampsia in primiparæ be attributed to any other cause than those excessive sanguine determinations to the head, above indicated, and the disordered function of the kidneys, above spoken of? Ought we not to expect convulsions in women in the first labor, when we reflect upon the tendency to hyperæmia of the brain, caused by the above mentioned restraints of the downward circulation? My experience in Midwifery having long since taught me to be watchful of the signs of any excess in such determination of the blood, I rarely permit my patients to lie on the back to be confined; for I have been for some time impressed with the opinion, that women who lie on the back in labor, especially in first labors, are more liable to convulsion on account of the greater pressure against the large vessels within the belly; a pressure which, at least, is always relaxed during the absence of pain, in such as lie on the side.

I have frequently met with coughs in the latter weeks of pregnancy, which proved rebellious against all treatment, until the delivery of the patient; after which they yielded to the common means of cure: the pressure of the womb on the abdominal vessels being removed, the pulmonary engorgement and hyperæmic irritation previously sus tained and reinforced thereby proved no longer indomitable.

The same pressure of the enlarged womb, above spoken of, interrupts the return of the venous blood from the extremities, and the transit of the contents of the lymphatic absorbents. Hence, when that pressure has reached its maximum, the feet and legs become oedematous, or anasarcous; the veins of the feet and legs acquire an enormous size, become permanently varicose, and in certain instances burst, so as to cause effusions of blood to take place. In like manner, as has been stated of the superior or arterial engorgements, this inferior or venous engorgement ceases upon the abstraction of its cause; limbs, when swelled even enormously, are observed to recover their natural size in three or four days after the accouchement.

That worthy old author, M. Puzos, whose Traité des Accouchemens was published in 1755, gives, at page 84, a sensible account of the causation of this oedema gravidarum: "On sçait que cette enflure ne vient que de la difficulté que les liqueurs ont à remonter de bas en haut, et à entrer dans le ventre; parceque le poids de l'enfant se fait bien plus sentir lorsque la femme est deboût que couchée, et s'oppose plus fortement au retour de la lymphe, dans cette situation, que lorsqu'elle est horizontale."

Puzos, it is true, makes a just discrimination betwixt this accident in Midwifery and a true dropsy; but the Student will be misled, should he not be convinced that the vast majority of the cases of infiltration, no matter how extensive, are owing to pressure on veins and absorbents, and not to a true hydropic diathesis. This accidental dropsy from mechanical obstruction requires no treatment by drugs. Puzos's explanation as to position ought to be remembered, and a confident expectation should be indulged as to a cure, a spontaneous cure, as soon as the obstructing cause shall have been removed, by the birth of the child.

Women sometimes grow apparently very fat in the last weeks or days of pregnancy; but the appearance of embonpoint is false-the delusion arising from an insensible watery infiltration of the whole of the superficial cellular tela: instead of increasing her embonpoint, she is really losing flesh by the constant waste of the elements of her blood, and when she comes to her lying-in she complains, a few days afterwards, of growing thin, whereas she may be in reality growing fatter. The deception consists in the elimination of the water of infiltration, which lets her contour down to the true state and expression of her real embonpoint.

Hydatid Degeneration of the Ovum.-A woman who has conceived in the womb, and in whom the pregnancy may have gone on for several weeks, or even for some months in the most regular and orderly manner, is nevertheless liable to subsequent faulty progress in the development of the ovum. For example, the whole mass of the placenta may become the seat of an hydatid degeneration. Hydatids are transparent vesicles or bullæ, colorless, and distended with water resembling pure water. They are supposed by many authors to be independent animals, and were by Laennec denominated as the cysticercus. Mr. Milne Edwards, in his Elémens de Zoologie-Animaux sans Vertèbres, speaks of them as belonging to the class of the Helminths or Entozoars. Under the order Cystoid Helminths, genus Hydatins, he says: "Finally, the Hydatids are generally considered as the last link in the series of intestinal worms; but the bodies described under this title are perhaps not real animals, and seem rather to be mere pathological products."

M. Pouchet, also, in his Zoologie Classique, p. 537, tom. ii., says:— "It sometimes happens that women, affected with all the symptoms of pregnancy, discharge a considerable quantity of delicate vesicles filled with an aqueous liquor, that are perfectly analogous to the cysticercus, and that have hitherto been regarded as hydatids. The

vesicles seem to adhere by a pedicle to the organ that produces them. Bremser looks upon them as helminths, and says they are really endowed with individual life, and constitute a peculiar species of animals. But several French physicians do not partake of this opinion of the celebrated German helminthologist, and think that these pretended entozoars are commonly nothing more than a pathological degeneration of the product of conception. Such are the opinions of Messrs. Désormeaux, Velpeau, and Orfila, &c."

I have translated the above passages from Milne Edwards, and Pouchet, in order to confirm the opinion I have to express as to the pathological and accidental nature of the placental hydatids. I am inclined to regard them as depending upon an hydropic state of the villi of the chorion, which, by a process of endosmose, under some maladive condition of the life-force of the ovum, is able to convert them into cysts, to the ruin of the product of the fecundation.

When a villous chorion begins to be generally subject of this hydatid generation, it is to be deemed that the embryo must necessarily perish in consequence of the destruction of its branchial organ, the placenta, which, after all, is nothing more than a cellulo-vascular process from the chorion. I have seen many examples in which the placenta, at healthful term, has exhibited several of these hydatidvesicles without harm to the foetus-while in others, the embryo has been prematurely discharged, accompanied with the debris of a placenta filled with innumerable small bullæ resembling white grapes in bunches.

Let the Student observe that the ovum, when invaded and conquered by this attack, continues to augment in size, its progress being governed by no ascertained law of rate. The healthy ovum has an exact rate-it is finished in nine months; but the hydatid has no certain rate-it compels the womb to distend for its accommodation, and that at a rate which is uncertain. I have seen a young woman, at the fourth month after conception, as large as she ought to have been at the sixth month. It is easy to infer that such a rapid deploy. ing of the womb, one so different from the gentle and lawful rate of a true pregnancy, must have the effects of a pathological, rather than those of a physiological force.

The term to which the development of placental hydatids may attain in any special case cannot be foreseen. The uterus may cease even in the 7th month

to tolerate their presence in the 3d, 4th, 5th, or of gestation.

The signs by which they are known are either inferential or positive. We infer that the womb contains hydatids whenever we discover it to