tube gives evidence of severe functional disturbance, if not of anatomical lesion.

I

It is very commonly the case that the "Sore Mouth" does not occur until after delivery, and sometimes not until after lactation has been, for a length of time, fully established. It then, together with the gastric disturbance, (and I believe the two are inseparable), constitutes the chief evidence of the morbid state. The affection of the mouth cannot, however, as supposed by Dr. Hale, be "dependent upon some peculiar state of the system, produced by the secretion in the mammæ.” have recently attended a lady, who in the last month of her pregnancy, and for the first time, suffered very much from the "Sore Mouth,” but who has not felt it since her delivery, being a period of three months, and, notwithstanding, she nurses her child, and has an abundant secretion of milk. The following case, which I shall briefly relate, and to which I have before referred, also militates forcibly against such a supposition.

Mrs. pregnant with her first child, passed through all the pe riods of gestation in remarkable health. During the period of lactation, she suffered from the affection of the mouth. In less than a year she became again pregnant, and as the event proved, with twins. About the seventh month, she began to show the primary symptoms of the puerperal anæmia. She soon became cedematous; the cedema was general, and accompanied by the alarming symptoms which I have previously mentioned. She had also at this time the "Sore Mouth," subsequent, however, to the first appearance of the oedema. Immediately after delivery, there was an exaggeration of all the symptoms, and her life appeared in imminent danger. There was no secretion of milk whatever, and her infants were nourished by other means. After a period of some months she recovered her usual health. Upon her next pregnancy, at the same period, she presented the same train of symptoms, though in a minor degree. She had, however, a more or less profuse diarrhoea, during the whole of the last month. The affection of the mouth was as severe as in her former pregnancy; the œdema much less. After delivery no immediate change in her symptoms. There was a slight secretion of milk, but it was thin and watery, and her infant appeared to suffer from its ingestion. She ceased to suckle it, in two weeks after its birth. This lady has recently been again delivered of a healthy child, after passing through her pregnancy in good health, and is now suckling it, without suffering any particular inconvenience. She says, she occasionally feels the symptoms of "Sore Mouth."

I have never observed in this complaint any decided febrile symptoms. The pulse has appeared to me very similar to that of chlorotic anæmia. I have not practised auscultation in these cases, with a view to discover the cardiac and arterial bruits usually found in chlorosis. No case has ever occurred under my immediate observation, which progressed to a fatal termination, and I can, consequently, give no accurate account of the ultimate effects of the disease. Dr. E. P. Bennett, of Danbury, (to whom I am indebted for many observations of this peculiar form of anæmia), has, however, recently seen two fatal cases, in both of which, he informs me, there was profuse hemorrhage from the mouth and nose, as well as from the bowels. One of these

females had been in perfect health previous to conception. She died in a few weeks after her accouchement.

From the observations which I have made of this condition of puerperal females, I am led to consider it a disease, consisting primarily in a lesion of the circulating fluids; a lesion followed by symptoms known only to the puerperal state. For while this possesses some of the appreciable characters common to all anæmic conditions, yet it differs from them all in certain of its more prominent features, and especially in that of the inflammatory affection of the mouth.

The modern researches upon the blood have shown conclusively, that pregnancy exercises a marked influence upon the composition of this fluid, the most notable characters of which are diminution of the red globules, increase of the proportion of water, slight increase of fibrine, diminution of the albumen of the serum, &c. From the analyses made by Drs. Becquerel and Rodier, of the blood of pregnant females, those gentlemen derive, among others, the following conclusions: that, "in a certain number of cases of pregnancy, when it is not yet advanced, and has exercised no very sensible influence upon the organism, the composition of the blood is not altered; in proportion as pregnancy approaches its termination the blood is in general modified," (Gazette Medicale de Paris, 1844). The modifications observed by them, are those just mentioned. It is an exaggeration of these modifications which, I suppose, constitutes the primary pathological condition, and thus the physiological state of the pregnant woman, becomes the transition to the pathological one, the symptoms of which I have endeavored to describe. But these changes in the proportion of the constituent principles of the blood, considered isolatedly, differ very little from those which occur in other circumstances; in fact, they are very similar to those occurring in every anæmic state. Why then the symptomatic differences, and special anatomical expressions of puerperal anæmia? It is reasonable to suppose they are the result of the specific impression, made by the process of reproduction, through the medium of the nervous system, upon the entire organism, and more especially upon the assimilating organs. This view seems the more rational, when we consider that, while it is the stomach which suffers, the greatest sympathetic and indeed functional disturbance in the early periods of pregnancy, it is also this organ and its dependencies, which manifest the most prominent lesions from the disease in question. The fact that there is frequently no appearance of this difficulty, until a certain period after the commencement of lactation, is to my mind, only another evidence that its primary cause is the impoverishment of the blood from the establishment and continuation of a function consequent to that of gestation. The vital fluids already somewhat exhausted in the nutrition of the fœtus, and by the losses consequent to delivery, are unable to sustain any further drain, without inducing true pathological changes in the solids; and modified by the specific impression of the reproductive process upon the economy, which is continued even in lactation, these changes still retain a special stamp.

As this paper has already reached some length, I shall defer the consideration of treatment to a future number, when I may also refer to some facts which further illustrate the pathology of the disease.

ART. X.-Case of Hydatids of the Uterus. By WM. H. HANCHITT, M. D., of Cold Water, Michigan.-(Communicated by Professor C. B. Coventry, M. D.)

MRS. C., of Cold Water, Michigan, aged twenty-five, of a sanguine temperament, and firm constitution, had always enjoyed good health from infancy, with the exception of an occasional attack of intermittent fever, of short duration, which left her free from organic or func tional derangement. She is the mother of three children. I attended her in the delivery of the last two. These labors were natural and easy, as also was the first, as I was informed. She always had a good getting up after each confinement. She never had a premature birth; never suffered any derangement of the menses, except from pregnancy. There is a difference of about two years between the birth of each of her children.

She had a return of the menses when her youngest child was about a year old, still nursing it, as she had with her former children. About the middle of February, 1844, she had a full and natural flood of the menses, which was the third or fourth time since her last labor; her youngest child being about fifteen months old. Two weeks from her last menstrual period, she jumped from a low broad fence, and immediately on alighting, she was taken with severe distress in the back, which extended to the hips and through the whole pelvis, and nearly produced syncope. She however, soon recovered, so as not to suffer any particular inconvenience, only some slight pain and uneasiness, which made her pass a restless night, but she slept well in the morning, and arose feeling perfectly well, and did not recollect suffering any from the injury after. Two weeks after the injury, making four weeks after the last menstrual period, she was slightly feverish; had morning sickness; no return of the menses; and considered herself pregnant. She noticed nothing in her symptoms different from those in former pregnancies, excepting in degree, being more severe, and continued bad up to the end of the third month, having formerly sub. sided in a few weeks. She does not recollect of having pain, or tenderness, in the region of the uterus.

August 7, 1844. Summoned to visit her in haste, found her flooding severely, but sitting up; slight pain in the back; no bearing down, or periodic pains. (I had not been advised with regard to her pregnancy before this, but considered her so, as I had seen her frequently; did not know of the injury she received in February.) Considered herself in the 6th month of gestation, having menstruated the last time about the middle of February. Her pulse was full, not compressible; face flushed, and heat moderately increased. She had been making a bed an hour before, and was seized with flooding immediately after lifting the feather bed, which she said strained her back, and left a constant but slight distress across her loins. I took sixteen ounces of blood, advised her to keep her bed, and not to leave it on any occasion. Morphine and acetate of lead, once in two hours; cold drinks and low diet.

August 8. Found her comfortable; pulse natural, skin cool, flooding stopped, having ceased a few hours after first visit. No pain in her back, or distress across her loins. Prescribed salts and senna; after

the operation of which a powder of the morphine and lead, and discontinue if the flooding did not return.

August 9. Found her sitting up; cathartic had operated well; had taken one powder of the morphine and lead, and slept well during the night. Pulse natural, skin cool; no pain, soreness, or flooding, or any inconvenience, save slight debility. Advised low diet; very little or no exercise; allowing her to walk about her room, and to keep her bowels soluble with an occasional Seidlitz powder.

September 14. I was called to visit her in haste; found her flooding freely. She had taken considerable exercise the past month, and had eaten heartily of nourishing diet. Her pulse was moderately increased in frequency and force; hands cool; face flushed; chest and abdomen hot. Attempted to open a vein, but she fainted from excitement, while I was ligating the arm. She is always much ex. cited about being bled. Have had to abandon it at other times from the same cause. Gave full doses of acet. lead and morphine; ten grs. of the former, and one-half gr. of the latter, once in two hours. Called again in a few hours; flooding had ceased; pulse slow, soft, and skin cool and dry; stomach slightly nauseated. The distress she complained of in her back on my first visit to-day, entirely relieved. Abdomen more enlarged than usual for her at this period of gestation, and had been larger from the commencement than at similar times in former pregnancies. Ordered quiet, cool drinks, recumbent position, a Seidlitz powder once in two hours till the bowels were freely moved; and then, if the flooding returned, give the powders of lead and morphine in half doses, once in two hours till it ceased.

September 15. Found her up and walking about the house, giving directions to the servants; flooding has not returned; Seidlitz had operated freely; felt quite well, had eaten some breakfast. I have here stated that during these attacks, and indeed through the whole period of the case to its final termination. I could not discover that there was the slightest propulsive effort of the uterus, though I had frequently questioned her on the subject. I urged the necessity of her keeping quiet, to avoid even lifting a pail of water, making her bed, or sweeping her room.

October 16. Was requested to visit her, and found her flooding moderately, and had had several light attacks of hemorrhage since my last visit. Notwithstanding my injunctions, she had exercised considerably about her domestic affairs, eaten heartily, walked some distance to her neighbors and to church. Found her pulse feeble, skin cool, face pale, and slight distress in her back, but subsided some during the last month, but as large now as usual for her at this period of gestation. I now learned from her that she had discovered no motions since she considered herself pregnant. This led me to suppose that there might be some thing unnatural. I now learned, for the first time, of the injury she received in jumping from the fence two weeks after her last menses, but I could not attribute much to that, as she did not suffer much inconvenience from it. On questioning particu. larly, I found she had suffered much during the first three months, with acid stomach, headache, and severe morning sickness. Through the fourth and fifth months, up to the time of her first attack, she had felt well, being entirely free from the above supposed symptoms of pregnancy.

I now made a thorough examination of the abdomen; found no tenderness on firm pressure; could feel a large mass of an oval form which presented a uniformness on every part; stated to the patient my fears that she was not pregnant, and proposed an examination per vaginam, but was urged to delay a short time, advised perfect rest, mild diet, and to obviate costiveness with an occasional Seidlitz powder, and use injections, per vag., of sulph. zinc, twice a day, previously cleansing with warm soap and water.

From this time I knew little of her till Jan. 9th, 1845, when I was requested to visit her. I found her very feeble, with a cool skin, feeble, frequent pulse, very easily compressible, face pale, countenance sunken, stomach irritable, appetite poor, and bowels costive; no soreness of uterus but a constant aching distress in the back. There was some discharge from the uterus, without color, in the forenoon; but about 4 o'clock, P. M., the skin would become hot; face somewhat flushed, and pulse increased in force and fulness, and the discharge entirely stop. I found she had had a slight discharge every day since my last visit, October 16, 1844, sometimes quite free and considerably colored; at others scanty and without color. She was only able to be dressed in the morning, moved to a lounge in her sitting room, and spend the day in a recumbent position. Eleven months had elapsed since she supposed herself pregnant. I insisted on an examination per vag., to which she consented. I found the os uteri a little open, but not enough to admit the end of my finger. The neck of the uterus was partially obliterated, and very firm and unyield. ing. By pressing on the abdomen, I could pass my finger quite a distance around the mouth of the uterus externally, but could not enter it with firm pressure. There was not the slightest tenderness on pressure. I could discover nothing but a uniform, solid, slightly elastic substance in the uterus. My hand was not colored in the least by the discharge, which consisted of transparent mucus-like matter, without any particular odor. I told her that I thought there was a semi-organized mass in the uterus, nourished by a vascular connection, but could not say at that time it was of the nature of hydatids.

My friend Dr. Sprague, of Cold Water, was now called in council, and after deliberation, we concluded to administer the ergot in order to excite the action of the uterus to throw off the mass, and a day was set for the trial. Previous to this time, however, I had another exami nation per vaginam. The os uteri was firm and unyielding. I told the friends I feared the result; we should probably separate the mass, and should not be able to force it through the mouth of the womb, and fatal hemorrhage might be the consequence. I would propose a palliative course, and wait the result; that ultimately the case would come to a state in which the os uteri would be dilated or dilatable, and the uterus take on action to expel its contents, and then we might use such remedies to assist as the nature of the case might indicate. This was consented to.

In addition to the symptoms mentioned above, I should have stated that she has symptoms of torpid liver, as icterode skin, jaundiced eye, and costiveness, showing that her other symptoms are influenced more or less from this cause.

Ordered grs. x. calomel in a tablespoonful of oil, to be taken at six P. M., that it may operate during the fever, after the operation