clysters, each containing three ounces of sulphate of magnesia and six drops of croton oil, to be administered.

In the evening I found that several doses of calomel had been taken, occasionally ten and fifteen grains at a time, but rejected (as was always the case, she said, when she took calomel), and that the clysters had brought away no fæces. I therefore ordered a drop of croton oil to be given by the mouth every four hours till the bowels yielded, and an injection to be administered containing twelve drops.

On Thursday morning-the fourth day, I found that the clyster had been given, and that three pills, each containing a drop of the oil, had been taken and had remained on the stomach, and that, since the exhibition of the last, a motion had taken place. Her constant pain was infinitely less, and she now bore pressure pretty well except at the epigastrium but the pulse was a hundred and forty, and she was restless, and said her strength was greatly reduced. She had several motions in the course of the day, and expired at five o'clock in the afternoon, perfectly sensible.

From the dreadful agony which was felt from the first; its sudden commencement, and that at the pit of the stomach, and its greater intensity there throughout the disease than in any other

part of the abdomen; the ghastliness of the countenance and her icy coldness even when I first saw her; the absence of fulness and all hardness in the pulse, even during the evident existence of intense abdominal inflammation; and the rise of this at the epigastrium and its diffusion all over the abdomen, I apprehended the stomach was ruptured, and I very earnestly requested permission to examine the body. The inspection took place on Saturday morning.

The abdomen was prodigiously distended, and, on opening the peritonæum, a large quantity of very fetid gas escaped. On the whole parietal

portion of the peritoneum was a layer of fibrine, as also on the whole convex surface of the liver, the anterior surface of the stomach and of the omentum, and on much of the intestines. It was for the most part readily peeled off, but had effected adhesions between some portions of the small intestines, and between some portions of the peritoneum and omentum. A good deal of yellowish fluid with white flakes was collected in the upper part of the abdomen, such as is the mere product of inflammation, but I could discover no effusion of the contents of the stomach. In the anterior part of the cardiac half of the stomach, a little below the small curvature, was a perfectly circular aperture, with a smooth edge, large enough to admit the end of the little finger, and the surrounding part was of a dark colour to some extent. The stomach con

tained a good deal of soft dark matter, which readily escaped on moving or pressing the organ. On examining the interior, a large ulcer was discovered, two inches in length, broad at one extremity and gradually narrower towards the other, with smooth edges, and the surrounding parts were greatly thickened, and very red and hard. The ulceration was gradually deeper from the narrow extremity to the other where the rupture had occurred.

I was informed that for several months she had been greatly troubled with dyspepsia, was observed to be continually putting her hand to the pit of the stomach, where she complained of an uneasiness which she was in the habit of relieving by copious draughts of hot water, and that she had lately grown thinner.

In an interesting paper on cases of this kind, published in the eighth volume of our Transactions*, Mr. Travers has stated the chief diagnostic symptoms to be, First, Sudden, most acute, peculiar and unremitting pain, radiating from the pit of the stomach or navel to the circumference of the trunk

* The indefatigable pathologist, Dr. Abercrombie, of Edinburgh, has just published some cases of this kind that occurred to himself, with references to others in various authors. Edinburgh Med. and Surg. Journal. Jan. 1824. A case that lately happened in the practice of the writer of one of the most original, laborious, and important pathological works ever published, M. Laennec, will be found in the Revue Medicale. Mars 1824.

and even to the limbs; Secondly, Coeval rigidity of the abdomen; and, Thirdly, A natural pulse for some hours, till the symptoms of peritonitis begin.

In this case, the pain did remit:-after the fifth dose of opium she became comparatively easy, and remained so for twenty-four hours*. The rigidity of the abdomen did not strike me. The pulse was 120 from the first.

The grounds of my diagnosis have been already mentioned.

* In Dr. Laennec's case, alluded to in the last page, the pain lessened in the evening after the rupture, and on the third day scarcely any was felt.

Dr. Carmichael Smyth recorded, between thirty and forty years ago (Medical Communications, Vol. II. p. 467 et seq. 1790), the case of a young lady whose stomach suddenly burst to an extent sufficient to admit a quill, in a round ulcer, about the size of a sixpence, that had destroyed all but the peritoneal coat of the organ. The rupture occurred on her going to bed, and instantly caused violent pain which lasted great part of the night, but she complained of none in the morning when Dr. C. Smyth was summoned to her, and passed the day tolerably well. She expired suddenly in the evening.

In his short but excellent narrative, this distinguished physician so well described the symptoms and the appearances on dissection, and gave so correct a view of the nature of the case, that I should have judged it superfluous to make the present communication, but for the illustration that our diagnosis (nor indeed our prognosis as far as it depends upon the diagnosis) must not be influenced by the continuance or remission of pain.

ON A

NEW VARIETY

OF

EXTRA-UTERINE PREGNANCY.

BY GILBERT BRESCHET, M.D.

CHEF DES TRAVAUX ANATOMIQUES DE LA FACULTE DE MEDECINE DE PARIS, CHIRURGIEN EN CHEF DE L'HOSPICE DES ENFANS-TRouves, professeur agrege A LA FACULTE DE MEDECINE, PROFESSEUR PARTICULIER D'ANATOMIE, MEMBRE TITULAIRE DE L'ACADEMIE ROYALE DE MEDECINE, DE LA SOCIETE PHILOMATIQUE, ETC.

Read Feb. 23d, 1824.

IT is agreed by modern anatomists that the product of generation passes from the ovarium into the fallopian tube, before entering the uterus where it is to acquire its full developement. The ovum, however, does not invariably follow this regular course, but may be impeded at some point in its passage; is then termed extrathe pregnancy uterine, and of this there are three varieties. In the first variety, graviditas abdominalis, or ventral pregnancy, the embryo is in the abdominal cavity, and its involucra form adhesions to the viscera and the peritoneum. In the second, graviditas ovariana, ovarian pregnancy, the foetus is developed in the ovarium; and in the third, graviditas tubaria, or tubal pregnancy, the ovum does not pass the tube, but acquires a certain growth, varied by circumstances, in that canal. I am of opinion that a