born October 30, 1837, which reproduced the relaxation. She soon got over this, and in the next pregnancy and confinement felt nothing of it: this labor was on the 2d of September, 1843. When the child was three months old, the relaxation took place, and was long troublesome. She was again pregnant in 1845, but had no return of the inconvenience in the gestation or lying-in, which occurred January 20, 1846. The joint gave way again soon after her last accouchement, August 17, 1847: she discovered it on the 20th day of the month, and it was so movable, that a cracking sound was produced by turning in bed.

The Student will readily perceive that a considerable relaxation of the pubal joint cannot fail to coincide with a relaxation, more or less considerable, of at least one of the sacro-iliac junctions, and that in such case the pain, weakness, or constitutional disturbances developed by the accident are readily accounted for, and can be treated wisely at least, if not fortunately. It appears to me that in articular maladies or accidents of this sort, there is but one sound principle of cure, and that is absolute rest in a recumbent position. A woman could hardly fail to recover if kept quiet in bed for a long time. She could hardly recover while taking usual exercise, which is wholly incompatible with the cure of the injured articulation. In those cases in which the joint has become positively inflamed and painful, it would be useful to apply leeches, cups, or blisters, or use anæsthetic topicals, as chloroform, belladonna, opium, or aconite. I have found every attempt at bandaging a failure, on account of the impossibility of well adjusting and properly retaining a bandage in place in this particular part of the body, so that I am obliged to conclude that the best thing that can be done is to go to a protracted rest in bed.

Diameters of the Pelvis.-As every woman's hand, foot, or chin is not like every other woman's, so there are, perhaps, no two pelves that are exactly alike. For the utilitarian purposes of clinical midwifery, it is enough, therefore, to know that as children's heads and trunks are supposed to be of a mean weight and bigness, so ought the pelvic canal to be of an average capacity for their transmission. Different authors give us different means of these pelvic diameters, and it is, perhaps, of no very great importance that they should exactly agree together in their several estimates of size. In order to reach what would be the average of ten different pelves, I measured ten of those in my collection at Jefferson College, and the result was as follows in this tabular view, which I subjoin:—

For the ten antero-posterior diameters in this table, the mean was a little more than four inches and two-tenths; the ten transverse diameters gave me 4.79 inches, and the oblique diameter 4.45 inches and one-tenth; and these may be taken as correct, because those diameters do not change much in drying. As to the inferior strait, which I measured from the point of the coccyx to the crown of the pubal arch, less correct results can be expected, because in drying it generally happens that the shrinking or contraction of the sacro-sciatic ligaments draws the point of the coccyx forwards towards the arch. Even with this consequence, the ten antero-posterior diameters gave a mean length of 3.7, whereas the true expression ought to be, as it is in the recent subject, more than four inches-say four and a half in some subjects, though rarely. The ten transverse diameters of the lower strait were 4.32. I shall not cite from the authors the collected tables of pelvic diameters, because I prefer not to load the Student's memory with such matters, feeling sure he will know how large a pelvis is, and ought to be, when he knows how large a child's head is or ought to be. For my own part, I do know that an American child's head ought to be three inches and eighty-eight hundredths wide, measured through the parietal protuberances; and such is its transverse diameter. Its occipito-frontal diameter should be four inches and ten-twelfths, and its occipito-mental diameter five inches and a half.

In order then that an American should be born in quite a normal way, his mother's superior strait ought to be four inches in anteroposterior, four and a half inches in transverse, and five inches in its oblique diameters. Such a pelvis as that is proper for easily transmitting any properly developed fœtus, provided it should present itself aright in the labor.

Let the Student then learn that the superior strait has four diameters to be measured; one from the pubis to the promontory, which is four inches; one from the middle of the brim to the opposite brim, which is four inches and a half; and two others, called oblique diameters,

from each sacro-iliac junction to the opposite acetabulum, which are five inches long in each. For the inferior strait let him measure two diameters only, one from the pubal arch to the point of the coccyx, four and a half inches; and the other across the outlet from one tuberosity to its opposite fellow, which is four inches in length.

It is of great importance to have correct views of the depth of the female pelvis, and nothing is easier than to obtain them by considering that a symphysis pubis is from top to bottom an inch and a half long, which gives the depth of the pelvis behind its anterior wall as one inch and a half. The planes of the ischia are three and a half inches high, and, therefore, the depth of the pelvis at the side and all across to the other side—that is to say, its middle depth-is three inches and a half. The sacrum is four inches long, and the coccyx is an inch and a half, which equal five inches and a half, the depth of the pelvis on its posterior wall; so that the pelvis is an inch and a half deep in front, three and a half at the sides and in the middle, and five and a half inches deep behind. The magnitude or dimensions of all the things that are within the pelvis may be estimated by comparing them with these diameters, and as an object that is four inches high cannot be vertically placed within the pelvis except it be near its posterior wall, so, one only two and a quarter inches high can be, like the nongravid womb, completely within the pelvis, no part of it rising or projecting above the plane at the strait.

The recent pelvis, which is represented in Fig. 18, is exhibited as a cross section, the body being cut in two from front to rear to show the relative positions and forms of the viscera.

The drawing has been reduced for this work from the admirable engraving that accompanies Dr. Kolrausch's work, entitled Zur Anatomie und Physiologie der Beckenorgane.

It appears to me that this is the most instructive illustration that I have ever met with in books on midwifery, and it is to be entirely confided in for its correctness. The subject was a young girl of 21 years of age, who committed suicide while menstruating. The specimen was prepared in such a way as to enable Dr. Kolrausch to see it while lying in a bath of alcohol covered with a glass plate. Looking downward through a diopter firmly fixed 24 inches above the glass plate, Dr. Kolrausch, using a pen dipped in printer's ink softened with oil of turpentine, drew every one of the lines with the utmost exactness on the intervening plate of glass-seeing them through the diopter; so that they could not, perhaps, be more correctly taken by a photograph. The copper-plate was copied from the drawing.

To the right is the buttock covering the bisected sacrum, in front of

which is the rectum, which has been opened by the incision. On the left, behind the os pubis, is the bladder of urine with its urethra.

Between the bladder and the rectum is the tube of the vagina surmounted by the uterus, whose summit or fundus does not rise quite so high as the plane of the superior strait. The womb rests upon the upper end of the vagina, which incloses its cervical or neck portion and keeps it up in its place by means of its connection with the bladder in front and the rectum behind, and more than all by means of two utero-sacral ligaments which tie the upper ends of the vagina and the womb to a certain place about an inch and a half in front of the apex of the sacrum. I may here say, that as long as the utero-sacral ligaments remain in a healthy state, preserving by their tone a due length, the womb cannot fall downwards or prolapse, because the cervix, being inclosed within the upper end of the canal of the vagina, it cannot

move down unless that upper end of the vagina move down also, which, as above said, it cannot do except the ligamenta utero-sacralia give way first. The length of the vagina determines the height of the womb's place in the pelvis. All these intro-pelvic organs are covered up beneath the serous peritoneal membrane as if they were enveloped in a napkin, but still exhibit their magnitudes and forms beneath its foldings.

In front the peritoneum covers the anterior hemisphere of the bladder, its top and part of its posterior surface, but not all of it. The lower or posterior part of the bladder lies in contact with the vagina, and is united to it by what is called the vesico-vaginal septum or partition. After leaving the vagina the peritoneum proceeds to invest about one-half of the anterior aspect of the womb, its fundus, and the whole of its posterior wall, as far down as to about the middle of the cervix, where it leaves it to continue its downward course, in which it invests about one-third of the uterine extremity of the vaginal canal; then turning upwards it mounts on the rectum to inclose that intestine in its serous coating, and so passes up above the brim or strait. In investing the bladder, the womb and vagina and the rectum, as above, the peritoneum sends off to the left side of the pelvis, and also to the right side, its two ligamenta lata or broad ligaments which serve to steady the uterus and keep it from falling against the sides of the excavation when the woman lies on this side or on that.

The same peritoneum sends two folds that serve as ligaments backwards from the upper and lateral parts of the vagina to be inserted into the face of the sacrum on either side of the rectum. Now, as the peritoneum, after covering the hinder surface of the womb, goes on to and rises up along the rectum and the face of the sacrum, these two peritoneal folds or utero-sacral ligaments form the sides of a cul-de-sac, that looks like a deep pocket between the gut and the womb, and which is called Douglas' cul-de-sac, a thing of much import because it is the place into which the fundus uteri falls when it is quite turned over backwards, or retroverted. Let the Student, therefore, comprehend that the hinder wall of Douglas' cul-de-sac is the rectum and sacrum; its front wall is the womb and upper posterior end of the vagina, and its right and left walls the right and left utero-sacral ligaments. I wish him to know this point well, on account of its concern in retroversio uteri and in prolapsion of the bowels; but more particularly because I wish him to bear it in constant remembrance whenever he may be thrusting the blade of a forceps upwards at the risk of bursting a way into it; for when passing the forceps upwards, in a labor, he is very liable to force its point through the thin and dis