whose mind, for the time, is abolished, and her body is, as you see, tortured by these violent spasms; now, I'm going to make her swallow fifteen grains of the powdered root of valerian, and do you look on, to observe what strange powers are possessed by certain medicinal articles over the human body. You shall see that, in about fifteen minutes, this great storm shall become a great calm." The woman could not swallow, but I made her swallow the fifteen grains. "Now," said I,-"look at her." In two or three minutes, her spasms became less, and in a quarter of an hour, she was perfectly well. "Now, what do you think of that, my dear?"-said I. "I don't know what to think of it, doctor, but it surprises me very much.'

I have said nothing about opium; what need have I to mention the name of opium in connection with such circumstances? It commends itself, by its very name, in all such cases; provided that you can render yourself sure, that there is not connected with the paroxysmal manifestations, some element of meningitis, or cerebritis, which you have not deprived of its mischievous nature, by the salutary interposition of your lancet.

With regard to the treatment of persons in the intervals of the hysterical paroxysms, to which they are liable, I should be guilty of the fault of iteration, were I to say much upon that subject, since I have so clearly expressed the conviction of my mind, that hysteria is truly hysteria, and not merely nervous sur-excitation. But, if hysteria be truly hysteria, it follows that, in the intrahysterical periods, you should address your inquiries and your remedies to the condition of the reproductive organs, and those morbid states which are the "ipsissima causa morbi."

But I have spoken so much at length, in these letters, upon these morbid conditions, that I shall here close the present one, referring you to many of the antecedent pages of this volume.

C. D. M.

LETTER XXXVII.

GENTLEMEN :-The change in the condition of the reproductive organs brought about by pregnancy, is too great to fail, in the majority of instances, to produce phenomena approaching perhaps to the nature of disease.

It is necessary that the physician should render himself familiar with these phenomena. The pregnant state, in fact, is one full of interest to the medical student or the practitioner of physic. I feel it a duty, therefore, to say in these letters something to you of the state of pregnancy, and the maladies and the inconveniences with which it is accompanied.

The fecundated germ, in attaching itself to the lining surface of the uterus, may affix itself to any part of the internal superficies of that organ. I say the fecundated germ, because I wish to express the opinion, that the germ may become fecundated without being followed by pregnancy. The germ is fecundated by the contact of the male sexual element, which imparts to it the power to develop the organisms, and the whole nature of the animal in question. But pregnancy cannot be deemed to take place, until the germ has established a mesenteric connection with the living surface of the mother. When, then, the mesenteric attachment takes place, the woman has conceived. Doubtless, thousands and millions of germs become fecundated, but which never form mesenteric attachments, and are, consequently lost; the womb is only pregnant when the mesenteric attachment is made. No matter where this mesenteric attachment is, the woman is pregnant when it is made. It may be effected in some part of the tractus of the Fallopian tube; or it may be made upon the surface of the ovary, the ovary being covered at the time by the fimbria of the tube. If the porule of the Graafian cell have been formed, and the male sexual element have been translated through the channel of the tube, and come in contact with the exposed ovule, still contained within the Graafian crypt, the ovule may be there fecundated, and may form its mesenteric attachment within the crypt, and then you will have an ovarian pregnancy, and there

is not another way in which you can have one. It is probable that the germ may be fecundated within the grasp of the fimbria, and being thus endowed with the development power, it may fall into the peritoneal sack, and there form its mesenteric attachment; thus constituting a ventral pregnancy. An ovule, on its passage from the fimbria to the uterus, may become fecundated; it may be arrested in the narrowest part of the tube, where it passes through the thickness of the uterus; the delay and the pressure are probably the causes why it sometimes forms its mesenteric attachment there, and develops itself in the substance of the uterus outside of its cavity, thus constituting what is called interstitial preg

nancy.

Conception is never natural, never right, never safe, except when it takes place in the cavity of the womb. Please not understand me as stating, that fecundation always takes place out of the uterine cavity; it is probable that it most frequently takes place outside of the cavity, but it may take place within the cavity of the womb. The fecundation takes place in whatever place the contact of the sexual element happens to be made. When a woman has conceived, the womb begins to increase in size; the increase taking place at first in the body and fundus, and not affecting the neck. This growth of the womb is so rapid, that it passes from the non-gravid state to the condition of the organ at full term of utero-gestation, in the short space of two hundred and eighty days; a space of time in which the most remarkable changes occur in the character of the organ, and in the influence of the organ upon the living economy. The non-gravid womb is about two and a half inches long, one and a half in the widest part, and one half an inch in thickness; and its weight shall scarcely be found to exceed two ounces. The gravid womb at full term, is often twelve inches in length, and its transverse diameter is equal to eight or nine inches; its weight, freed from its contents, is scarcely less than one pound, or a pound and a half. It exceeds by from eight hundred to twelve hundred per cent. its normal weight.

The space occupied by it in the non-gravid state, is, as you have seen, very small; in the gravid condition it constantly intrudes itself among the other organs, pushing them aside, distending some, and compressing others, interfering with the flow of blood in the vessels and the ascent of the lymph in the tubes;

and calling out of the general source of the circulation vast torrents of arterial blood, which it returns to the venous circulation, after having deprived it of its oxygen, and of much of its elements of assimilation.

Under such a view of the changes taking place in the womb, you have little reason to be surprised that the health of the woman is often disturbed. Do you imagine that the womb, when twelve inches in length by nine in breadth, and weighing a pound and a half, is the same organ that it was in the non-gravid condition? You call it, it is true, by the same name, uterus. But, if you inspect it, if you touch it, if you weigh it, if you analyze it, you will find it a totally different material.

Why is it that the womb undergoes these wonderful changes of form, of dimensions, of weight? These changes are compulsory. The uterus has received the fecundated germ; that germ is an animal, and was before it came into the uterus wholly independent of it; and will be while it remains in the womb, equally independent of that organ. That is to say, it will be as independent of the uterus as the plant is of the soil in which it grows; if the plant be torn from the soil, it will perish, because it can nowhere find the materials for its development; and if the ovum is torn from its attachment, it will perish for a similar reason.

The ovum grows by its own force; it finds on the surface of the womb, the assimilative elements, which it knows how to assimilate for its own purposes. That assimilation, increasing constantly its weight and dimensions, it is inevitable that, if it is to reside in the womb, that organ must yield to the pressure of the growing ovum; and in yielding to that pressure, it is not destroyed; on the contrary, it is developed; it is augmented in size and in weight; its uterine arteries and its nerves, and its absorbent vessels, all are increased, not in number, but in length and in diameter; greater quantities of blood furnish the material out of which this new growth takes place; and thus the womb under the constant pressure of the augmenting ovum, is stimulated or excited to new efforts of uterine development force,-augmentation.

You know this to be true, because you know that the uterus at any period of utero-gestation has a constant tendency, I had almost said a constant desire, to return to its non-gravid repose. You know that it will begin to return to that non-gravid condition,

whenever with the point of a bougie or other instrument you rupture the membranes of the ovum, and allow the watery contents to flow off. You also know, that it occasionally happens, that the uterus refuses to yield to the distention of the growing ovum, which is ruptured and expelled, or is even expelled unruptured by the action of the muscular womb.

I don't know what better argument I can present to you in favor of the opinion I have expressed, of the compulsory nature of the uterine development in pregnancy, than the one above stated. If you remove the cause, the effect ceases, is an axiom in philosophy: I say, that the cause of the growth of the uterus resides in the ovum, and I prove it by stating that whenever the ovum is destroyed, the effect of its growth, to wit, the growth of the womb, ceases ipso factô.

I wish to make this statement to you, simply because it is a physiological truth, but more than that, because it contains the most important chirurgical principle, a principle which you will apply a thousand times perhaps in your practice; a principle which, if you understand it properly, shall give you the gratification of rescuing multitudes of people from an untimely grave, save you from the grossest errors in practice, and enable you to do honor to the divine art that you profess, by showing its might and its beneficence, upon the most interesting and important occasions.

When the womb first begins to develop itself under the influence of the growing ovum, it grows healthfully engorged, and of course grows broader, longer, and offers a larger surface of pressure to the superincumbent viscera. Both its augmented weight and volume, therefore, give it a tendency to descend toward the floor of the pelvis, and as it is attached to the bladder by the utero-vesical septum, and presses upon the rectum, which is both behind it and below it, the woman will scarce fail to have some symptoms of a prolapsus or descent of the uterus, evinced by a more frequent desire to pass urine, and a tenesmic feeling of weight and dragging about the loins, and in the two iliac regions. Such symptoms, therefore, in married women, or women exposed to the risk of conception, you should regard as rational or inferential signs of the gravid state; symptoms not absolutely to be relied upon, but still of no little value, when collated with those hereafter to be mentioned.