has become thin and yielding; whereas, in the early months, the whole cervix, as well as the os uteri, is of an almost cartilaginous hardness and rigidity.

At the beginning of the effort to miscarry, the womb is shaped like Figure 69. The egg lies in the cavity made out of the expanded corpus

Fig. 71.

et fundus; but, before the ovum can be expelled, the long cylindrical neck must first be converted into a cone, like Fig. 70. But, after the cervix has been altered in shape, so as to become a cone, the ovum cannot escape until by a further process of dilatation that cone is turned into a wide open cylinder, whereupon the ovum is thrust forth and falls into the vagina, as in Fig. 71.

Abortions sometimes take place very easily, with little pain, and almost without hemor rhage; but the quantity of blood lost in some instances of miscarriage is enormous; probably on account of the extreme degree of uterine irritation or sanguine molimen which the act of abortion develops. The hemorrhage is apt to continue until the contents of the womb are expelled; and it is, therefore, highly important to expedite that occurrence by all reasonable means. fortunately, these means are few.

Un

Upon taking charge of a case of abortion, it is the student's duty to ascertain which of two indications he ought to pursue. First, he should decide whether he will attempt to save the pregnancy, by pre

serving the vitality of the ovum; and second, he should determine whether any moral probability now exists of the death of the ovum. In the latter case, it may demand his respect no longer; in the former, he will act against duty if he fails to do whatever may hopefully tend to the conservation of the fruit of the womb. The quantity of blood lost already may serve in some degree to enable him to decide both these questions; for, if the pregnancy be not much advanced, the loss of a considerable quantity of blood is evidence of so incurable a detachment of the fixed ovum as to preclude any reasonable expectation of its continuing to live in the womb.

Besides his inquiries and observation as to the quantity and force of the hemorrhage, he should carefully ascertain by touching the existing condition of the os and cervix uteri. Therefore, whenever the flow becomes so considerable as to affect the pulse and the complexion of the patient, it is imperatively required that the medical man should ask for an examination per vaginam; and he will sometimes find that the ovum is sticking in the cervix, and needs only a little aid to escape from it—but, while it remains, it cannot but keep up the hemorrhage. The fore-finger may, in such instances, be pushed as far as practicable within the canal of the cervix, alongside of the ovum, and then bent so as to resemble a blunt crotchet. By the aid of the finger, used in this way, and the assistance of powerful bearing down on the part of the woman, the offending cause is without much difficulty removed, and the effect ceases. When the finger cannot be employed, Dr. Dewees's placenta-hook may be employed.

I annex a figure (Fig. 72) of Dr. Dewees's placenta hook or crotchet,

Fig. 72.

which is on some occasions a convenient instrument for pulling down the ovum when merely held by the cylindrical grasp of the cervix.

Fig. 73.

Dr. Henry Bond, an eminent practitioner of this city, has proposed a placenta forceps for the delivery of the secundines in abortion, of which Fig. 73 is a representation.

Dr. Bond's instrument is ten inches in length, and so rounded that it is difficult to conceive of an operator awkward enough to pinch with it any of the parts of the mother. An inspection of the drawing suffices, without further explanation, to give an idea of its usefulness.

While I lay before the Student these instruments for the extraction of the dead ovum, I ought to warn him against too facile a disposition as to the employment of them, and to assure him they will often dis'appoint his expectations, and sometimes, where they do succeed, lead to evil consequences as to the mother. The ovum, in abortions, inhabits the body and fundus uteri. The cervix stands guardian as facultas retentrix over the deposit, and reluctantly yields it a passage. In doing so, the conical neck of the womb must become a cylindrical canal, into which the fundus and corpus uteri thrust their intolerable burden. When this cylindrical canal hath received into its calibre a small ovum, or the remains of one, it has, of itself, little or no power of expulsion, but merely grasps the ovum and holds it fast. It holds it sometimes for many days. I have found it to hold the ovum in this manner for many consecutive days, because the very os uteri would not let it escape, failing to yield, chiefly perhaps because no dilating pressure was applied. In the long run it yields, the os tincæ becoming wide open, and then a bearing-down effort, a fit of coughing, or straining at stool or urine, drives it forth into the vagina. (Vide Fig. 71.) Now, until the canal has become truly cylindrical, Dr. Bond's forceps and Dr. Dewees's hook are not to be employed without much care and gentleness. For the most part, it is better to wait until all is prepared, and then remove the object with the index finger.

In those cases in which a proper attempt to extract the debris of the ovum has failed, those who like the support of high authority may console themselves by referring to Puzos, who at page 193 says that "cette terminaison est bien moins effrayante; mais elle est bien plus longue; j'ai vu de ces fontes durer six semaines à deux mois; et pendant tout le temps, où les vuidanges sont si fœtides, j'ai vu ces femmes tourmentées de fièvres irrégulières de dégoûts et d'inquiétudes." He thinks these cases ought to be left to nature.

If, upon making examination in abortions, the state of the cervix is found to be unfavorable to the speedy expulsion of the offending cause, and the hemorrhage be not too threatening, recourse may be had to the application of napkins, wrung out of cold vinegar and water, to the hypogastrium and pudenda; to the administration of dilute aromatic sulphuric acid; to the acetate of lead, with opium; or to the preparations of secale cornutum-as the powder, in doses of five to ten grains repeated pro re natâ, or its vinous tincture, of which a teaspoon

ful may be given every half hour, or at intervals of one or more hours, according as the events of the case seem to demand. A powder consisting of five grains of alum and one grain of nutmeg may be given as a hemostatic every half hour or hour. The lancet may be resorted to, to aid both in diminishing the hemorrhagic nisus and in favoring the dilatation of the cervix, to which nothing contributes more powerfully than venesection. This, however, should be used with great and good discrimination.

Colpeurysis is a process or method of treatment used in certain sexual disorders, the employment of which is daily becoming more general in Europe and America. The instrument by which colpeurysis is effected was proposed and introduced into practice by Dr. Carl Braun, assistant physician at the Lying-in Clinic at Vienna. An account of the matter is contained in a work in three parts entitled Klinik der Geburtshilfe und Gynækologie, published in the course of the years 1852 to 1855, by Messrs. Chiari, Spaeth and Braun. In part I. p. 126, is an article on colpeurysis by Dr. Braun, with a figure of Braun's colpeurynter, of which I annex a copy, Fig. 74. Colpeurysis is from the Greek xoλpos and usw. The compound word is intended to express the idea of vagina and dilater. Previously to Dr. Braun, physicians and surgeons were accustomed to the use of various methods

Fig. 74.

of dilating the vagina or the cervix uteri, such as sponge tent, the tampon, &c., but the apparatus delineated in Fig. 74 is found so convenient that it will doubtless become much in vogue in practice. The colpeurynter is a vulcanized gum-elastic bag fitted into a small hollow cone of horn. There is fitted to the apparatus a ring for holding a strap and buckle which serves to secure it from falling away when duly adjusted. There is also a stopcock, as seen in the drawing. The vulcanized rubber bag when empty may be introduced into the vagina, and then filled

with air or tepid or cold water in quantity sufficient to distend the bag at discretion, so that the walls of the vagina may be made to expand as much as they do when distended by the foetal head in labor. This colpeurysis may be carried on so slowly and gently as to give no distressing pain, and if it be continued for a certain length of time it inevitably causes the neck of the womb to dilate. Hence it is a neck dilater as well as a vagina dilater, and is used daily for hastening the dilatation in abortions, in hemorrhagic labor, and other cases in which it is desirable to precipitate the delivery of the woman.

This colpeurynter makes a very good tampon, and possesses the great advantage of being employed warm or cold, as it may be distended with water of any desirable temperature. I have used it as a tampon in placenta prævia in a case that required speedy dilatation to enable me to turn and deliver by the feet, and I have used it in various other states of the female genitalia which I propose to speak of on the proper occasion; for the present I mention its use as both a tampon and dilater very appropriate in abortion cases. The Student doubtless understands that if the vagina should be very much distended with a colpeurynter, the cervix uteri must sooner or later yield to the force, or be pulled open by the upper end of the vagina which arises from the whole outer circumference of the neck.

Tampon.-But among the various means of putting an end to troublesome hemorrhage, I ought to name the tampon, or plug. This tampon may be composed of a sponge; or, what is far better, of pieces of cotton or linen cloth or patent lint, torn into squares of from two to three inches, which may be pressed into the vagina, one at a time, until the entire canal is filled and distended with them. They should be kept there by a napkin, worn as for the menstrua, or by pressure with the hand of a nurse, a napkin being interposed, until the flow is effectually checked, at least. The tampon may be allowed to remain in sitû from six to twelve, or even twenty-four hours in winter. When removed, it is generally followed by the ovum or its remains, which are frequently found attached by a coagulum to the upper part of the tampon. Should any dysury be caused by its presence, the bladder may be readily relieved by the catheter while the woman preserves a horizontal posture, which should never give place to a vertical one until all probability of a return of the hemorrhage has disappeared.

I do not understand how a woman can be permitted to die with hemorrhage, in an abortion, while a colpeurynter or the materials for a tampon are at hand, since the discharge may always be effectually controlled. The remedy gives no pain, if properly used; and, so far