the operation of the diaphragm and abdominal muscles. For twenty minutes I continued pressing the belly, and compressing the uterus betwixt my hands. The wound of the integuments was dressed; stitches were introduced, the intervals strengthened by adhesive straps; compresses were put on the abdomen, and the belly swathed. But that happened which I foresaw would be the consequence of ceasing to compress the uterus: the woman became more faint, and at last insensible; she lived only to the gratification of her wish, to become, at all hazards, the mother of a living child.

Dissection.

It was fully three weeks before I could procure the body for dissection, yet as this was during a severe winter, the demonstration of the cause of death, and of the state of the uterine contraction, was perfect. On opening the belly, I saw the uterus lying contracted; but the wound of it was gaping, the lips everted, and it now appeared as if the uterus had been cut from the fundus to the neck. This singular appearance and deception I attributed to the contraction of the body of the uterus, while the edges of the incision remained paralysed and uncontracted.* The thickness of the womb was increased to four times the diameter it presented during the operation: but what most deserved attention was the appearance of the large vessels, now with open mouths, which during the operation were not apparent. From the mouths of those vessels the streaming blood had been coagulated, and now formed strings, reaching from the mouths of the vessels to the great cakes of coagulated blood which lay on each side of the abdominal ca

* Precisely the same appearance presented in the case communicated by Dr. Hunter, Med. Obs. and Enq. v. 4. Mr. Thomson's incision was six inches in length of the gravid uterus: on dissection the uterus was found contracted to the size of a common melon; and the wound appeared nearly the whole length of its body.

vity. Besides the coagulated blood which lay in the cavity of the abdomen, a large clot was in the cavity of the uterus.*

From this case we see, that when the substance of the uterus is cut, either the muscular fibres do not fully contract, or in their contraction in consequence of being cut across, they do not constringe the blood-vessels. The misfortune in the case was, that the placenta was attached to the lower and fore part of the uterus; and this, with the defect of action in the muscular fibres, was the occasion of the death of the woman by hæmorrhage.

The circumstances of this case suggest very material improvements in the manner of performing the operation. Instead of cutting into the womb, as was done in the preceding case, I would recommend that a very small incision should be made, such only as would enable a finger to be introduced; by boring, aided by the disposition which the uterus has to dilate, another finger might be passed, and then a third, and at length the whole hand, in a conical form, might be forced into the womb. I further venture to suggest, that this should be done as far down upon the lower part of the uterus, as the urinary bladder and the reflection of the peritoneum will permit; for at the lower part the uterus is least vascular, and most disposed to dilate. In the further prosecution of the operation, the child should not be suddenly extracted, but the feet being brought out by the opening, the body should be slowly delivered by the spontaneous action of the womb; and the whole operation performed as much as possible in imitation of the gradual progress of a natural labour: the only apology for hurry in the operation would be the separation of the placenta, or the compression of the cord in the narrow wound; but the

* This corresponds with the dissection in the case communicated by Dr. Hunter.

In the operation by Mr. Hunter, Med. Obs. and Enq. V. V, p. 227, the womb strongly contracted round the neck of the child, so as to retard the delivery of the head and press the funis; it is added, that Mr. Hunter soon overcame this stricture sufficiently to let the head be extracted.-By passing VOL. V.

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No. 17.

placenta could not possibly be detached in the method now proposed, and it would be possible to guard against the compression of the cord.

The muscular structure of the womb becomes a subject of very great interest in connection with that of flooding; it has been proved by the sections of the uterus, made in different states of its contraction, that the order of the muscular fibres. is calculated so as to close the vessels; that where nature has provided for the attachment of the placenta, there the broken vessels are guarded by the provision of the surrounding muscular texture; but we know also, that during this contraction of the superior part of the womb, the lower part dilates and relaxes. Now if the contraction of the womb be essential to the safety of the mother, what will be the effect of the attachment of the placenta to a part of the womb which must relax during the labour! Every one knows the peculiar danger of the case of placenta previa, that each labour pain, as it returns, increases the violence of the flooding, instead of checking it. In common cases, breaking the membranes and accelerating the labour, checks the flooding, and secures the safety of the patient; but when the placenta is attached to the orifice of the uterus, the reverse of this takes place.

From attention to the muscular structure of the uterus I have been led to conclude, that in common cases of flooding, during labour, the hæmorrhage is not accidental, in any other meaning of the term, than as it proceeds from the place of the uterus to which the placenta is accidentally attached; that the placenta cannot be partially separated if it be attached in a regular circle to the fundus of the uterus; and that flooding on the commencement and during the progress of labour, is

the fore and middle fingers into the womb, so that a finger might lie on cach side of the cord, the pulsation of the cord would be free, however powerful the contraction of the uterus. But in truth there is no disposition in the wound to contract.

owing to an irregularity in the shape and attachment of the placenta.

When the placenta is attached in a regular circle to the fundus uteri, it cannot be partially separated, and cannot be separated bodily, until the uterus is permitted to have a great degree of contraction by the delivery of the child; the circular muscles of the fundus being agents in a double capacity, that is, both in expelling the child, and in constringing the uterine vessels; by the time that the child is expelled, the vessels of the fundus are greatly diminished in diameter. Further, the place and strength of these muscles being perfectly regular and uniform, their action must have the effect of equally drawing the surface of the uterus, which is in correspondence with the margin of the placenta, towards the center of the fundus, and consequently of separating the surface of the uterus from the placenta; but no one part of it will be separated until the general restriction is nearly completed. This will not be the case when the margin of the placenta extends irregularly, or when the placenta is attached to the side of the uterus. After the delivery of the child in cases of flooding, it is not uncommon to find a portion of the placenta low down in the uterus, and separated, while the greater portion remains attached to the fundus. In examining the inner surface of the uterus by dissection, I have seen the part corresponding with the pla centa irregular in its form, and extending towards the side and neck of the uterus. In such circumstances of the attachment of the placenta, the retraction on the lower part of the womb being to a greater extent than the fundus, will account for the too early separation of that margin of the placenta which stretches towards the orifice, and also for the hæmorrhage, which is a consequence of this partial separation; but in the progress of the labour, and after the discharge of the waters, the more powerful efforts of the uterus draw the muscular fibres more closely around the blood-vessels, and then the flooding ceases.

The flooding which attends the torpor of the uterus in any

circumstances, when the connection with the placenta is broken, will be very easily accounted for on recurring to the details of the anatomy given in the first part of this paper.

On the Effects of Evacuating the Aqueous Humour in Inflammation of the Eyes; and in some Diseases of the Cornea. By JAMES WARDROP, F.R.S. Ed.

[From the London Medico-Chirurgical Transactions for 1813.]

In January, 1807, some cases of Ophthalmia were published in the Edinburgh Medical and Surgical Journal, in which the evacuation of the aqueous humour was attended with beneficial effects-but at that time, the practice was to be considered only in its infancy, the number of cases in which it had been tried were very limited, and I was unable to point out, with any degree of precision, the particular species of ophthalmia, and the peculiar symptoms of the disease which could be relieved by this mode of treatment. I had, however, sufficient experience to be convinced, that the operation could be performed, in almost every case, without aggravating, if it did not arrest the progress of the inflammatory symptoms; and I therefore embraced that channel of laying my observations before the public, that both the application and the utility of the practice might be established by the additional experience of others.

The subsequent successful result of this mode of treatment in a series of cases of ophthalmia, and its utility in some affections of the cornea, have induced me to bring the subject before the public in this Memoir; being now enabled to point out, with some confidence, the particular species of the disease, and those symptoms, which the evacuation of the aqueous humour is best calculated to remove, and, at the same time, to recommend it as a mode of practice, from which very