condition, insensible, extremities cold, pulse and breathing scarcely perceptible, and her whole appearance completely blanched. By the persevering help of stimulants and artificial heat, she gradually revived.

"I learned from the family that, previous to her insensibility, she had complained of an agonizing pain in her left side, and an increase of sickness at the stomach, and in a few moments after went into convulsions.

"So forcibly was I struck with her bloodless condition at this time, I remarked to her husband that she had all the appearance of one who had lost a great amount of blood from flooding.

"Being comfortably restored, before I left, I ordered her brandy and water; ice in small and repeated doses, with essence of beef; and to repeat the enema of laudanum and flaxseed tea if the pain returned, together with the following prescription in doses of twenty drops every hour:

"During the three following days, the vomiting continued with very little abatement. Every attempt to administer nourishment or medicine was indomitably resisted by the stomach, with the exception of the brandy and the morphine solution. On each successive day an anodyne injection was given, to subdue the attacks of pain in the left side. Her pulse, in the mean time, was feeble and frequent, her countenance blanched, and her whole condition so much exhausted as to afford but slight hope of her recovery. On Tuesday, 24th, however, there was an apparent amendment in her case; her pulse began to react, she was able to retain a little nourishment, the vomiting had in a great degree subsided, and her expression was, 'I feel comfortable." Her bowels not having been open for several days, I ordered her a turpentine enema, to which they responded readily, though not freely. Wednesday, Aug. 25th. Had passed an easy night, but without much sleep; upon the whole she had improved, was cheerful, had taken a cup of tea, and had eaten some calf's-foot jelly; the tenseness and tenderness of the abdomen had subsided. I could make considerable pressure without causing either pain or sickness, and for the first time I was able to detect a tumor in the left iliac region, upon which spot, however, she could not allow pressure without acute pain.

แ

"I felt quite encouraged with her appearance and the improvement in her symptoms, as did also her friends. Feeble hope was given that

she might be restored. She asked for a peach, which was allowed her, and I left her in good spirits.

"It was near 3 o'clock P. M., when I was summoned by a hasty messenger, that Mrs. was dying. On approaching her bedside, which was surrounded by weeping friends, I found her lifeless.

"I learned that she continued as well and as cheerful as when I left her in the morning, up to 3 o'clock, when she was suddenly attacked with violent pain, followed by a convulsion, which in a few minutes ended in death."

Having inserted the foregoing account of Mrs. N's case, by Drs. Yardley and Jewell, it only remains for me now to say, that the necroscopic examination of the body of this unfortunate lady was made by Dr. Ellerslie Wallace, in presence of Dr. Jewell and the author of this article, on Friday, August 27, 1847. Upon exposing the contents of the abdomen by a crucial dissection, and looking downwards into the excavation of the pelvis, there was discovered a great quantity of coagulated blood and serum, which being removed, the uterus was observed to extend across the pelvis from front to rear, lying horizontal in the excavation, and covered by the left Fallopian tube, which was turned over from left to right quite across the pelvis coincidently with the transverse diameter. The tube was enormously enlarged, having been converted into a sac which contained a foetus of near three months, developed in a tubarian gestation.

The uterus being measured, was a little more than four inches long, and at the broadest part three and three-quarter inches wide. The child-bearing Fallopian tube could be lifted up from where it lay upon the front surface of the womb-no inflammatory attachment having as yet been formed to bind them together. Upon lifting the tube-sac off the uterus, and then attempting to raise the fundus uteri out of its retroverted position, it was not possible to succeed, in consequence of the adhesive bands and bridles that bound it to the lower part of the sacrum. When these adhesions had been divided by the scalpel, Dr. Wallace could lift the fundus out of its bed, and reposit the womb. This I had been unable to effect during Mrs. N-'s lifetime, either with the hand or with Hervez de Chegoin's caoutchouc pessary. I was not surprised to find the fundus glued in this manner to the lower part of the sacrum, for I had, in June, announced to Dr. Yardley my belief that it was adherent-an opinion founded upon the firm resistance of the tumor against all my attempts to reposit it. I may remark here, that I believe the womb might have been got out of its false and adherent position by means of the caoutchouc pessary, or by slow and cautious proceeding with colpeurysis, had not the tubal preg

nancy unhappily supervened. I suppose that the adhesions might have been gradually broken or absorbed under the elevating power of M. Braun's method.

The rupture of the tube had occurred near its outer end, which, from its being turned over and laid upon the prostrate womb, was found nearer the right than the left ischium. Through the edges of laceration in the tube-sac, one of the feet of the embryon was protruding. The uterus and its appendages were removed, with consent of the friends.

Upon laying the uterus open, it was found to be filled with a deci

duous mass and with bloody slime. The cavity was somewhat enlarged, but the paries of the uterus was very thick, like that of a uterus contracted after delivery. The tube was now laid over to the left, its natural position, and opened; whereupon it disclosed the embryon, as in the figure, which was taken by Mr. M'Ilvaine ad vivum. The deciduous membrane is seen in the cavity of the uterus, its edges being laid over on the cut surfaces.

I regard the case as an interesting one, from its showing the presence of its decidua in utero in a tubal pregnancy, and more especially as presenting an example of adherent retroversion; and, perhaps not less so, as exhibiting tubal pregnancy in a woman with adherent retroversio uteri. Since Dr. Braun's invention of the colpeurynter, described in a future page, I have used his instrument as a means of repositing the organ in the following case, and conceive that I have been the first person to make that application of it.

CASE. In the month of June, 1856, a medical gentleman, practising in one of the interior towns of Pennsylvania, came to me to say that he had a case of retroversion in a woman, past four months pregnant, which he had in vain attempted to relieve. Nothing that he had done had in the least changed the posture of the womb, and he had accompanied his patient to the city for my advice and aid. On proceeding to the hotel, I took my colpeurynter with me, and found that I could barely reach the os uteri, by pushing the index finger as far as it could possibly be thrust upwards behind the symphysis pubis. I am sure the point of the finger was three and one-eighth inches within the orificium; so that, as the symphysis is but one inch and a half long, the os was situated very far above the top of the symphysis, and close behind the anterior abdominal paries. The pelvis was quite full of a fluctuating mass, which was the womb, distended with something, but whether with an ovum, I dare not now say. I prevailed upon the woman to lie on the back near the foot of the bed, with the limbs flexed, and, upon introducing and gently distending the colpeurynter, she complained of some uneasiness. In a short time, additional portions of water were thrown in, and I again desisted to let her rest. I soon afterwards allowed the sac to collapse, by letting the water escape into a bowl, and then repeated the injections, begging her to decide for me as to what amount she could, on trial, easily endure. It was not long before she, with a start, exclaimed: "What's that?" My reply was: "I suppose it is your cure;" and truly, on withdrawing the colpeurynter from the vagina, I found, to my great satisfaction, that the uterus was completely reposited, the os being in its true nor

mal position, and the fundus, that had long been turned over into the recto-vaginal cul-de-sac, being now above the plane of the superior strait. The woman was so overjoyed with this entire relief, as to signify her happiness, by the wildest expressions of delight, to her husband, who stood by her couch.

I have made use of the colpeurysis in a great many cases of retroversion of the womb, and I am free to say that I cannot now conceive of any such case that would not readily admit of repositing by the colpeurynter, excepting always those cases in which adhesions have taken place, so as to confine the fundus low down in the cavity, and even in some of these, if the adhesions should not be very strong and old, repeated, gentle, and persevering colpeurysis might enable one either to elongate the adhesive bridles, or even break them, and force the fundus to rise up to its place.

Mr. Gemrig, surgeons' instrument maker, in Eighth Street, Philadelphia, prepares a most convenient colpeurynter. It consists of a vulcanized rubber bag, which, when collapsed, is not much bigger than a black walnut. To the sac is attached a hose, or tube, of the same material, about fourteen to eighteen inches long. A small brass stopcock is secured on the end of the hose, and fitted to receive the fistula of the syringe, by means of which water or air may be injected, and the bag distended at will. The great length of the hose permits one to use the apparatus in a way less shocking to the woman's delicacy, as the stopcock can be brought out from beneath the bedclothes, and the sac filled and emptied by turns.

In my practice, I am in the habit of teaching the patient to perform the colpeurysis with her own hands, first showing her how to adjust the colpeurynter, and then teaching her how to force the air or the water into the caoutchouc. This I have done for such persons as, having a chronic retroversion with considerable hypertrophy, I did not choose to attempt to cure by one violent operation; and I do believe, that in the bad cases, it would be, in general, for the interest of the sick woman to first teach, and then trust her as to the mode and degree of the colpeurysis.

I am very glad to have an opportunity to recommend the employ ment of the colpeurynter for the treatment of retroversion, particularly as such an application of the instrument appears to have wholly escaped the attention of its author, Dr. Braun, who, at p. 126, op cit., gives us a list of the affections for which he advises its employ. ment, and which consist in cases No. 1. Metrorrhagia during dilatation of the cervix in labor; 2, bad presentations, as preparation for turning; 3, deformed pelvis; 4, bringing on, or hastening labor in eclampsia;