tion of the intestinal tube to fall over the front aspect of the womb, and, when once engaged there, to be driven down by the expulsive force of the belly, as low as, or even lower than the umbilicus, where it is pinched, or compressed, or perhaps in a sense strangulated, by the contraction of the abdominal muscles in the labor throes. The Student will readily conclude that so distressed a condition of an important organ could not but introduce modifications in a labor. In such a case, his attention will be drawn to the extreme suffering of his patient during her pains, which, instead of propelling the child rapidly, as might be expected in view of the intenseness of her distress, cause it not to advance even one tittle; while cries, jactitation, and the most disheartening expressions leave him at a loss to imagine the cause of delay, the more particularly when he finds not, in the position, the presentation, or the state of the soft parts, causes that might arrest the progress of the parturition. He ought to inquire as to the existence of such possible causes, and if he find them not by his vaginal exploration, let him ask questions as to the place and kind of pain, and he will discover that the woman has intestinal pain, and that that pain is situated between the womb and the integument.

CASE.-Without making further special observation on this accident, it will suffice me here to say, that, about fifteen years since, I was in attendance upon a primipara lady occupying a high social rank in this city. The labor had proceeded without any untoward circumstance to almost complete dilatation of the cervix uteri, when my patient began suddenly to complain most unaccountably of her pains. She became excessively agitated, and being a person possessed of great self-control, I was much astonished and alarmed by her moans and agitation. I could discover in the condition of the presenting parts and the textures within the pelvis, no grounds of great distress; but after careful inquiry, learned that the pain was in the uterine tumor, just above the umbilicus. She had not been affected with rheumatismus uteri during her gestation or the antecedent part of her labor; I was obliged, therefore, to fall back upon the painful apprehension that the texture of the uterus was about to give way at the seat of this pain, for that is what the practitioner ought to apprehend under such circumstances. Approaching the lady's bedside, I requested permission to examine the abdomen, for which the nurse prepared her by uncovering her of all save the under garment. Upon touching the abdomen, I found an irregular eminence in the place complained of. Gently percussing it, I discovered from its sonorousness that it was a loop of intestine fallen down there, and

which, being compressed between every uterine and abdominal contraction, had given rise to the agitation and pain. As the integuments were thin, I was enabled by a sort of taxis to push the loop upwards from its dangerous position, whereupon the labor pains became again normal, and the parturition thenceforth proceeded steadily and towardly to a happy conclusion. I have never met with a similar example. This was altogether an unnatural state for a woman in labor, and therefore I consider this woman's labor altogether a preternatural one.

Carcinoma Uteri.-Carcinomatous degeneration of the cervix and os uteri does not, unhappily, always obviate the power of fecundation and conception. A lip of the os tincæ may be far gone into carcinomatous degeneration without exciting suspicious discharges of mucus, sanies, or blood, and even without developing such a degree of sensibility of the part as to preclude cohabitation. The development of heterologue tissue in the cervix uteri is, in some instances, as slow and torpid as the development of similar tumors in other parts of the body. To become pregnant under such circumstances is a great misfortune indeed, for gestation changes the whole life-activity of the uterus, which becomes altered in form and density, and fatally tends to augment the heterologue life which has established itself upon the vaginal portion of the organ. Hence where the torpid and sleepy carcinoma takes upon it the life of the open cancer, and the foetus has attained its full growth, and labor has begun, let the Student imagine the awful condition of the patient, one-half of the circumference of whose cervix uteri has become a mass of heterologue tissue, filled with the caudate cells and silvery bands of the cancerous mass, utterly unsusceptible of dilatation, and exquisitely sore and painful. If such a womb should ever be opened, the dilatation of the mouth of it must be effected at the expense of the unaffected half, its only dilatable portion. If the circle of the os uteri must in labor become a circle of twelve or thirteen inches in circumference, in order to permit the escape of the head, what must be the unspeakable agony of the patient, half the circumference of whose os uteri has become perfectly undilatable through carcinomatous degeneration?

CASE.-I saw, in the early part of the year 1847, a wretched human being, whose cervix uteri and vagina, the seat of a frightful ulcerated carcinoma, had just been torn to pieces by the escape of a full-sized foetus at term.

CASE. On the 18th of March, 1848, I was called at 11 P. M. in consultation, to a pregnant lady. She was thirty-three years of age. She has not had a child during the last fourteen years, having previously given birth, I believe, to two children.

Throughout the whole course of the present gestation, she has suffered with distressing, most distressing, nausea and vomiting. She is pale and emaciated. Has had frequent bloody vaginal discharges from the beginning of the pregnancy until now-expects her accouchement about the tenth proximo.

At six P. M. she was attacked with flooding, since which time she has lost probably more than eight ounces of blood, which still continues to ooze slowly away. They showed me a hard vaginal coagulum, larger than the whole thumb. Figure 93, annexed, represents the size of the os uteri and the thickness of its edges: the posterior lip, which is much thicker than the remainder of the circle, is seen on the left side of the plan; this lip is prolonged into a tumor that bleeds at the slightest touch, and is evidently a mass of carcinomatous tissue

Fig. 93.

in open ulceration. The figure, half size of nature, gives a correct notion of the profile of this tumor, and of the degree of the aperture of the os uteri, in which the child's head is represented as pressing

upon the cervix and os. The tumor is seen in profile descending into

Fig. 94.

the vagina. Figure 94 gives a front view of it. The tumor is hard, wholly undilatable, so that the whole of the dilatation hitherto effected, has been effected at the expense of three-fifths of the circle, the remaining heterologue two-fifths not having furnished anything to the dilatation, or, if anything, an uncomputable proportion.

. Agreeably to the decision in consultation, she got an enema of forty five drops of laudanum mixed in a fluidounce of clear starch. March 19th, 12 M. She slept well after the enema, and has had no pain to-day.

21st. Has continued well up to 3 P. M. to-day, when she was seized with the pains of labor, attended with inconsiderable hemorrhage. I

Fig. 95.

was again summoned to the consultation at 5 P. M. The os uteri was dilating. The tumor was now found nearer to the left ischium, as if the womb had been rolled upon its axis. As the pains in

creased, her distress became very great indeed,-I may say unspeakably great. The child had attained to within twenty days of term, and it was apparent that full two-fifths and more of the cone of the cervix uteri could not furnish any material for the necessary dilatation. Hence there must be the greatest danger of rupturing the tissue; and accordingly at six o'clock in the afternoon, the whole projecting mass of the tumor came away into the hand of the gentleman in attendance who handed it to me, and of which a good representation is given in Figure 95.

The lady was a person of admirable temper and manners, but the greatest courage and the utmost stretch of her Christian fortitude and patience could not conceal from the anxious spectators the extremity of her agony.

There was no great increase of hemorrhage after the separation and escape of the tumor, but the bag of waters was thrust down far outside of the ostium vaginæ, soon after which, at 6 P. M., the child was expelled. A solution of morphia was administered to her, and she became composed. At one o'clock in the morning, she was seized with a rigor, which soon became a violent ague, that lasted more than an hour, whereupon febrile reaction ensued, with a pulse at 180 beats per minute. This febrile condition was attended with violent pain and intense sensibility of the abdomen to pressure. There had been very little discharge since the expulsion of the child, and the mass of the uterus was well and firmly contracted. Upon the establishment of the febrile reaction, she was bled to the amount of twenty-two ounces, with great relief to her distress, and without the least appearance of syncope.

Wednesday, March 22d. At one o'clock to-day, she suddenly began to sink. She was in the full possession of her intellectual powers, and had not the slightest pain. She died in the afternoon. Upon examining the body about twenty-four hours after death, there was no trace of hemorrhage in the belly, nor any marks of peritonitis. These figures were drawn by Mr. Gihon, and represent the tumor correctly.

I have met with some examples of carcinoma of the cervix in pregnancy, which did not prevent the patients from recovering from the lying-in; but I lately saw a woman who was delivered while affected with carcinoma of the cervix and vagina. The parts gave way, and she died.

Smallpox.-There can scarcely be a more disturbing cause of parturition than smallpox existing in a woman in labor.