which are most commonly found in asphyxiated persons, renders it probable that such was not the cause of their death, and heightens the probability of its having acted as a narcotic poison. We cannot urge the similarity of the morbid appearances found, to those produced by the narcotic poisons, for, according to the observations which have as yet been made upon the subject, they are so various that no reliance can be placed upon them. We may add however, that if the gas had acted simply by excluding the due proportion of oxygen, and thence as an asphyxiating one, most probably one of the individuals would have suffered some unpleasant sensation, that would have awakened them, and thus have prevented the fatal effects, or at least have caused some disturbance; whereas there was no indication of their having moved much: which we would readily expect, upon the supposition of their having respired a narcotic poison, producing stupor and insensibility.

6.-Case of Imperforate Uterus. By Alexander Tweedie.

In the fourth number (vol. ii, p. 258,) of these Reports, is given the early history of this case, together with an account of her first delivery, and the treatment then employed. With regard to that part of the history of this patient, it is sufficient for our present purpose to say: that she was a rather small woman, but had always enjoyed robust health-had menstruated regularly from her fourteenth year, up to the time of her marriage, which was in February, 1836, in her 23d year— that she never menstruated after she was married-that in November, 1836, she was admitted into Guy's Lying-in Charity-shortly afterwards had a slight sanguineous discharge from the vagina, which continued a day or two-that in about twenty-four or thirty-six hours from its cessation, she felt the

early symptoms of approaching labor-that soon the pains. became pretty severe, and continued so but ineffectual, for some hours-that a smooth globular body was discovered to descend into the vagina at each contraction of the uterusthat no os uteri could be found-that the vagina could be traced throughout its whole extent, and was ascertained to be reflected from this globular body just as it commonly is from the neck of the uterus-that during the absence of pains, this body could be distinctly felt to be the head of the child with the relaxed coats of the uterus intervening-that a point was discovered, which seemed to be thinner than the rest, and an incision was made through it antero-posteriorly, to the extent of an inch and a half-that the waters immediately escaped-that subsequent pains caused a considerable extension of the opening by laceration, extending from the reflexion of the vagina at the ileo-pubic junction on the right side, obliquely across towards the sacro-iliac symphysis of the left-that after a protracted labor and considerable exhaustion, the patient was delivered of an asphyxiated child, which however was resuscitated-and that finally she recovered without any very unfavorable symptoms, leaving a small opening at the top of the vagina, with several cicatrized lines radiating from it, and without any cervix uteri.

The present article gives an account of her second confinement, which took place in January, 1838. Her health after her first delivery, had been tolerably good-she had miscarried twice, once at the second month, and the second time at the third month of utero-gestation—and she menstrated regularly during the whole period of lactation, when not pregnant. In this, her second confinement, when she had been in labour 8 hours, the uterine contractions became "intensely powerful," and on examination, there was found at "the ute

rine extremity of the vagina, an irregular opening, which posteriorly and laterally seemed continuous almost with the vagina, but anteriorly was bounded by a strong, firm, unyielding, rigid edge, upon which at each pain the child's head was forcibly impelled." The opening was about "the area of a penny," and a cicatrized line was distinctly perceptible, running towards the left ilio-pubic junction. The uterine contractions having continued very powerful for twelve hours, without augmenting the size of the opening, it was determined to enlarge it; which was accordingly done to the extent of an inch with a probe-poined bistoury, after the manner of dividing a hernial stricture. Scarcely any blood followed the incision-the uterine contractions almost ceased for a time, and she felt faint. Upon the exhibition however of some weak brandy she revived, the contractions returned, and in less than an hour from the operation, she was delivered of a full grown child, which was asphyiated but restored after some difficulty. As in her former confinement she recovered without any difficulty-suffering only for a few days some tenderness upon pressure over the pubes-and some inconvenience from distention of the left breast by milk, there being in this case the singular coincidence of the imperforate state of the os uteri and absence of the neck of the uterus, with the want of a nipple upon the left breast.

In his remarks upon the probable explanation of this case, Mr. Tweedie observes:

"There being thus no cervix, it is evident that the glandular or follicular structure of the part cannot exist; but it does not therefore follow that there was no opening into the womb prior to impregnation. We believe there was an opening, but not surrounded by the glandular structure which naturally exists here: hence, when impregnation took place, the ordinary mucous secretion could not be found, to seal it up; and is it very unreasonable to imagine, that, under this malforma

tion of parts, adhesive matter, instead of mucus, might have been poured forth, and thus, by adhesion, as pregnancy advanced, the orifice have become entirely obliterated?"

For the probability of such a state of things having existed in this case, he relies upon the facts of it, as already detailed: and in support of the possibility of such an adhesion's taking place, he quotes first: a case by Dr. A. S. Thomson, of a woman aged 65—who died of dry gangrene-in whom the uterus was found containing 8 quarts of dark brown fluidits mucous membrane healthy-and the os uteri interiorly "as completely obliterated as if it had never existed”—and internally, or upon its vaginal face, but "faintly marked." Secondly, a case, in which a woman died in labour, from rupture of the cervix uteri, there being no trace of a normal os uteri, save something like a dimple at its ordinary site. Thirdly, a case by professor Hamilton of Edinburgh, of a healthy young woman, who had menstruated regularly up to the time of her first pregnancy-who went to the full termhad severe labour pains, which were ineffectual from an adhesion of the vagina to the extent of an inch, about two inches from its external orifice, which was opened by an incision, when shortly after the labour terminated favourably.

We have thus given all of the important facts connected with this most interesting case.

7.-On Incision in cases of Occlusion and Rigidity of the Uterus. By Samuel Ashwell, M. D.

The object of this paper of Dr. Ashwell's is to show

"Ist. That incision is the safest remedy, where the os is in a state of firm and complete closure; or, in other words, where the uterus, so far as its lower orifice is concerned, is imperforate and

2dly. That in examples of such extreme rigidity of the os, where, after hours of strong uterine effort, the power of dilatation is entirely absent, whether such rigidity arise from disease in the structural organization of the part, or has resulted from previous laceration and ulceration, incision is the best and safest treatment; far preferable to protracted and powerful dilatation of the os by the finger; or, on the principle of non-interference, to leaving the case to the natural efforts."

Complete closure of the os uteri may result from adhesive inflammation, in cases where the aperture is unusually small, and as a consequence of "morbid deposit about the os and cervix, produced either by chronic inflammation or occurring as the result of former laceration or ulceration."

The only condition with which occlusion may be confounded, is obliquity of the uterus; particularly ante-version, in which the os is thrown far upwards and backwards; towards or at the promontory of the sacrum. In regard to the practicability and mode of distinguishing occlusion from obliquity, the Doctor observes—

"There can be but little difficulty in the diagnosis of instances of complete and firm closure of the os. When parturient effort is really established, the lower portion of the uterus, in the form of a tense and large globular mass, is generally forced down very low, sometimes so far, as nearly to reach the external entrance of the vagina. Thus a fingerat all practised in these inquiries-must detect an aperture, if there be one; and, if not, the spot where the os uteri, at the time of conception, had been.

A repetition of uterine action will afford abundant opportunities for careful re-examination; so that no apology for indiscreet and dangerous delay can exist. If, too, a spot shall be discovered-more depressed, and of different structure to the surrounding parts, indicating the site of the os uteri at the time of impregnation, it is impossible then to doubt about the nature of the case; and the only question remaining to be determined, is the precise method of relief."