By the 29th the pulse was below 100, the abdomen free from pain, and our patient was able to be removed to the sofa: since the last report, she had occasionally suffered from diarrhoea, which yielded to the usual remedies. As both Bark and the Sulphate of Quinine did not agree with the bowels, she began yesterday to take Gentian, with some Sp. Ammoniæ Comp.

August 2d.-Pulse 90; no abdominal pain or distention. There is still a circumscribed hardness to be distinguished: the discharge has ceased, and the urine consequently is not offensive.

19th. Mrs. H. has taken Bark three times a day since the 7th, has been progressively improving, and has to-day taken an airing; and on the 23d she removed from home for change of air.

March 23d, 1826.-Mrs. H. continues as well as before her last confinement.

REMARKS.

THE severity, shortness, and frequency of the pains caused by the unusual resistance of the os uteri, would probably have been alleviated, if blood could have been taken from the arm, and thus have

allowed more time for the natural dilatation of the os uteri, and possibly have prevented the accident. I am aware that the os uteri, although partially thickened and indurated by disease, or other cause, will dilate sufficiently to allow a common sized child to pass at the full period. An instance of this kind occurred to me when residing in Sloane Street.

Mrs. about 27 years of age, was taken in labour of her second child, at the full period, in September, 1813. On examination I found the os uteri partially dilated to the size of a crown piece, but one portion of it was hard, thickened, and unyielding, having a small excrescence growing from it. The pains were severe, and of regular recurrence, and had the effect of gradually dilating the healthy part of the os uteri, but the scirrhous portion remained unaltered.

It appeared probable that the natural efforts would be sufficient to complete the delivery, by the dilatation of the healthy part of the os uteri; con- . ceiving, however, that the disease would be hurried on by the effects of the labour, and become eventually cancerous, I requested the opinion of an eminent accoucheur, who advised a small bleeding; and in about thirty-six hours from the commencement of the labour, the child was born by the natural efforts, and the patient recovered without any unusual symptoms.

In October, 1814, I was requested again to visit this lady. She considered herself nearly six months gone with child; she complained of sickness and considerable pain, which she attributed to piles. Suspecting that the disease of the os uteri was going on, I made an examination, and found it thickened, hard, and irregular, nearly throughout its whole extent. An eminent accoucheur met me in consultation, and our patient was kept tolerably easy by occasional opiates; she experienced however, now and then, slight bearing-down pains for two days; the pains then suddenly became violent, and after three or four hours excessive suffering, the child was expelled. The cancerous disease of the os uteri rapidly extended, and the poor lady died, completely worn out by suffering, about six weeks after her delivery.

In Mrs. H.'s case immediate delivery appeared to be the only chance of saving her life; there was no time to wait for the natural dilatation of that part of the os uteri which was not thickened and contracted, and we found the dilatation could not be safely effected by common means: the only alternative therefore appeared to be the Cæsarian Section, or the dilatation of the contracted and hardened part of the os uteri by an incision of sufficient extent to allow the hand to pass into the uterus. The former is so dreadful, and generally so fatal an operation, that the latter was without hesitation adopted.

It may be observed that our patient derived marked benefit from the free use of aperients and opiates, and the application of the cold lotion was always particularly grateful to her. I have found a similar application of decided advantage, in one or two cases of obscure abdominal inflammation, as recommended by Dr. Sutton.

I am inclined to think the rupture of the uterus is not of so rare occurrence as generally believed, and that the almost sudden deaths which we occasionally hear of taking place during, or immediately after labour, occasionally arise from this cause.

I have heard of three or four instances of this accident having occurred among my medical brethren in the neighbourhood; and a few weeks since I met a gentleman in consultation, who informed me that he had been called in the day before, by a midwife, to a woman in labour, who died before he could deliver her. On enumerating some of the symptoms, I told him I suspected the uterus had given way, and advised him to examine the body; he did so, and wrote me word that there was a rent in the uterus large enough to thrust his fist through.

COMPLETE dislocations of the vertebræ without fracture, whether produced by accident or disease, are so uncommon, if we except the first and second bones of the neck, that the possibility of the occurrence has been doubted, and even denied by some of the highest authorities. In the "Traité des Maladies Chirurgicales", which contains the valuable results of his long experience, Baron Boyer points out the circumstances which prevent the displacement of the bodies of the vertebræ, and, without expressly denying it, appears clearly to disbelieve its possibility*. He asks the question, whether the bodies of the vertebræ can be luxated? alludes

* Tom. IV. Chap. IV. Article 4.