but rarely the case) is perhaps one of the least equivocal indications of previous inflammatory action. But thick mucus sometimes assumes a good deal the appearance of coagulable lymph; and the existence of a coloured coagulum, may occasionally be confounded with a coagulated portion of extravasated blood, adhering (as in the case of Nicholson) to the villous coat; which may the more readily occur, when the former is not in quantity, sufficiently great, to produce well marked thickening. It is also to be observed, that in cases where mineral poisons have been given, the deleterious operation (as appears from the experiments of Mr. Brodie) is generally upon the brain and nervous system; and in this case the inflammation, produced on the stomach itself may be short of that which would produce effusion of lymph.

It is exceedingly likely, that in inflammation of the stomach, the redness is less distinctly referable to vessels, and the florid colour more permanent, than in mere turgescence: but it is not to be forgotten, that it sometimes happens in cases of natural death, that the vascularity of that organ is partly fiorid and distinct, and partly diffused; circumstances which may create a little embarrassment, when they are to be considered with reference to a certain supposed cause.

In every case of death from poison, the appearances which dissection may offer, must be modified by the state of the blood-vessels after death, and by the very vascular nature of the stomach, and the disposition to accumulation in its veins, which occur at the close of life. We may therefore not unreasonably expect such venous accumulation to be often superadded to the proper and necessary effects of inflammation.

If well marked erosions were the frequent effects of severe inflammations, they would materially assist in forming a ground of discrimination. As Mr. Brodie and Dr. Jaegar, however, represent erosions to be very uncommon effects of arsenic, it is important, that the frequent thinness of the fundus of the stomach, and the occasional inequalities of the villous coat, either there, or in other parts of that viscus, should not be VOL. V. No. 17.

F

mistaken for them. These inequalities are by no means unfrequent, and I have often seen them to a considerable degree, where they were unquestionably mere peculiarities of struc

ture.

In judging of the existence of external inflammation in the living, body, it is not by mere redness, or by turgescence of vessels, that the opinion is guided; but by those circumstances, in conjunction principally with pain, heat and swelling. It does not therefore appear to be less necessary, for the purpose of enabling us to judge of the existence of internal inflammation, that something unequivocal in the symptoms should be superadded to the appearances submitted to our consideration, than that there should be assistance required in judging of external affections, in addition to mere colour or vascularity.

But on the subject of symptoms, it is important to recollect, not only that genuine gastritis is extremely rare, but that affections of some neighbouring parts, which may sympathize much with the stomach, may be confounded with original affections of the stomach itself. This organ, too, is liable to many very painful or uncomfortable sensations, which there is no reason to consider as marking it with any particular character of disease.

In offering these remarks, I may, perhaps be regarded as having somewhat aggravated the difficulty of forming a judgment, after death, as to the existence of inflammation of the stomach during life. It does not appear to me, however, that I have done so; and I should be happy, if, by calling the attention of professional men to the subject, a more correct, and more practical diagnosis should be established, than is at present possessed, relative to the operation of inflammation in that organ, from whatever cause it may have proceeded.

Before I conclude this paper, it is necessary that I should advert to the appearances of inflammation, which are gene

rally stated to be found in the stomachs of hydrophobic patients, and which have been, by many, thought to prove that hydrophobia is a species of gastritis.

I have seen five cases of hydrophobia, and have been present at the dissection of three of them; but I am unable to say, that there was any palpable difference, between the vascular appearance of the villous coat of the stomach in those cases, and that which is ordinarily seen, in the human subject, where there was no affection of the stomach during life.

In some of the cases which are upon record, the stomach is stated to have been entirely free from disease;* and most of the other examples to be found in authors, particularly those which are published in the Memoirs of the Royal Society of Medicine of Paris for 1783, and by Dr. Hunter, in the 1st volume of the Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge, afford no appearances in that viscus, which are not referable to fulness of vessels only.

The appearances observed in the stomach of the dog, are rather more diversified. The principal number of cases reported, exhibit marks of redness and fulness, or slight extravasations of various extent, in the villous coat; but there are some mentioned, where this coat presented nothing morbid in its aspect.t

When we compare the descriptions given of the state of the stomach, in most of the cases of hydrophobia recorded as occurring in the human subject (for I do not take into account any extraordinary, or anomalous cases) with the series of dissections presented in this paper, the resemblances are striking, and certainly tend to throw some degree of doubt on the idea very commonly entertained, that the usual vascular appearance

See VAUGHAN'S Cases and Observations on Hydrophobia, Cases 1st and 3d. Also two cases by Dr. BABINGTON, the first in Medical Communications, vol. I. p. 215; the second in Medical Records and Researches, p. 117; and several cases quoted in Hamilton's Work on Hydrophobia

GILMAN'S Dissertation on the Bite of a Rabid Animal, sect. I. &c. &c.

observed in hydrophobic stomachs, is inflammation; and that it is connected with the production of the symptoms which existed during life. It is very difficult to conceive, that the cause of one of the most formidable and distressing maladies of the human body, can be such an affection of a part, as is, in many cases, so slight, as not to be an object of attention or remark at all; and in most, does not exceed what is very generally met with, where no symptoms, referable to disease of the stomach, or spasmodic affection of the esophagus or pharynx, were pre

sent.

The appearances mentioned in some of the dissections given of dogs, deviate more from the character of simple turgescence, than most of those stated to have been observed in the human subject; inasmuch as there was frequently effusion of blood seen between the villous and muscular coat of the stomach, or in the substance of the former. The mere action of vomiting will, however, as I have in one case particularly observed, materially increase the redness to be seen, after death, in the stomach of a healthy dog. In attempting, therefore, to establish the pathology of this disease, it is important to discriminate between the effects of inflammation, and the influence which the violent spasmodic affection of the œsophagus and pharynx will have, not only upon the mucous membrane covering those parts, but upon the villous coat of the stomach itself, by being propagated downwards within the cardiac orifice. For it is very probable, that violent spasmodic action of muscles, may produce a well marked influence on a superincumbent mucous coat, particularly when such coat is extremely lax and vascular, as is that of the stomach.

With regard to the employment of blood-letting in hydrophobia, I would observe, that if its utility were even confirmed by the most irrefragable evidence, it would not be conclusive as to the inflammatory nature of this disease. The effects of this remedy are not to be limited to the mere removal of inflammation, or inflammatory disposition. It is not employed with this view in apoplexy, where it is often of the most de

cided benefit; and there may be effects produced in the body, particularly on the nervous system, by the copious abstraction of blood, for which the present state of pathological knowledge is not qualified to account.

On the Muscularity of the Uterus.

By CHARLES BELL, Esq. F.R.S. Ed.; and Teacher of Anatomy in Great Windmill Street.

[From the London Medico-Chirurgical Transactions for 1813.] As midwifery makes no part of my occupations, I intend, in this paper, to confine my attention to the anatomical structure of the womb; or to such points of the pathology as are directly connected with the anatomy. But some facts have been forced upon my observation which have not hitherto been laid distinctly before the public. They have induced me to resume the examination of the muscular structure of the womb; and comparing what I have seen in the dead body, with what I have observed in the living, I shall endeavour to lay a connected account of this subject before the Society.

I have dissected the gravid uterus in all conditions-in women who, in consequence of fever, had died undelivered; in women who had died from flooding; and in women who had died in consequence of distortion of the bones: I have had two opportunities of examining the uterus ruptured by its spontaneous action; and one, in which the uterus had been ruptured by violence; and, finally, I have examined the state of the uterus after death in consequence of the Cæsarian section.*

*I wish that my present subject permitted me also to state what I have found on dissecting the parts after the use of the crotchet, and in particular where the forceps had been used, as I must presume, in a case improper for them. The injury which the seeming harmless instrument, the forceps, is capable of doing might then be proved, and a wholesome admonition given to the young surgeons.