to move them both together to the same side; to effect which, she was, and still is, obliged to flex the knees, by drawing up the feet towards the pelvis, and then incline both the limbs towards the right or the left, as in incipient paraplegia.

"On several occasions I expressed to the family my desire to be assisted by the advice of some of my brethren, and especially of those who had formerly had charge of the patient, and who still saw her from time to time.

"Consequently, at the beginning of April, 1834, I met MM. Magendie and Amussat. After an attentive examination, these gentlemen who had observed the case during the first confinement, ascertained that there was an enormous increase of the mobility and separation of the symphyses.

"It was agreed at the consultation, that, as a basis of treatment, the lady should be sent to the country, to a dry and elevated situation, where she should be exposed upon her bed, to the influence of pure air and solar light; and that she should take saline, alkaline, sulphurous or aromatic baths; that she should make use of an animal diet, which should be tonic without being too stimulating; and that above all, she should return to the use of a mode of constriction of the pelvis, which should be strong, methodical and permanent.

"My colleague M. Amussat, who took charge of the treatment, and gave the most assiduous attention to the patient, was kind enough to see that the bandage should be prepared by a careful artist; a sort of mechanical girdle, which should embrace the hips, taking as its point d'appui the trochanters; the pressure to be regulated by means of screws. When the apparatus was applied, the patient could bear it only for a quarter of an hour at a time, although the buckles and the screws were not much tightened. The result did not answer the expectations that had been indulged, for, as soon as the machine was applied, she was attacked by slight fever, accompanied with very decided nervous spasms; symptoms that were reproduced upon every repetition of the experiment. It was necessary to give up the means as too energetic, and to recur to the use of the simple bandage furnished with buckles and strong straps, which the patient could tighten at will.

"Notwithstanding the most careful attention,-in spite of the perseverance with which the above treatment has been carried out for two years; in spite of the employment of other therapeutical

means, which we shall omit, with many other interesting details to mention, the lady remains very nearly in the state in which she was in the month of April, 1834.

"Having been called to her five or six weeks since, to take care of her in a new pregnancy, which began at the end of November, 1835, I find her in the following condition:

"In the course of the two years during which I had lost sight of her, she has grown thin; the digestive functions are torpid, and often performed with pain; the alvine and urinary excretions are voluntary and easy; the sexual organs retain the free exercise of their functions; the sensibility of the legs and thighs natural, but they have sensibly diminished in size, are more flaccid, softer, and have almost entirely lost the power of motion; flexion and extension are still difficult; it is impossible for her to lift up her limbs, and she cannot quit the horizontal posture. Upon exploring the symphysis of the pubis, either internally or externally, the bones are found more separate than in the ordinary condition. Upon lifting up one pubis, and pushing the other in the opposite direction, I thought I could perceive a vacillation of the bones which the patient said she also could perceive.”

I have nowhere met with a more interesting detail of the effects of the relaxation of the symphysis of the pubis, than the one which I have now laid before you. Nor have I seen one attended with so total a loss of power, as this described by Prof. Moreau.

I long had charge of the case of a lady, laboring under a strange susceptibility of the nervous system, accompanied with a loss of innervative power, so that, although she was at ease, and apparently well in a state of recumbent repose, a slight, even a very slight muscular effort was often observed to be followed by a severe attack of lypothymia. The digestive powers were not particularly affected, nor were the assimilative functions much interrupted by these strange maladies. It seemed at times that she was greatly benefited by the pelvic bandage, and I doubt not, that the motion of the lower extremities was much more possible, and much less painful, when the bones of the pelvis were held in contact by the aid of the girdle. She has recovered and lost again, two or three times, the power of voluntary exercise; she has given birth to several children, and is now in the possession of comfortable health. I always supposed that her maladive condition took its radiating point from an affection of the pelvic symphyses, which

came on during fatiguing journeys, while pregnant with a heavy male child. I could also produce pain in the symphysis pubis, by pulling the crista of the ilia apart with my two hands; I could never give any pain by pressing the pubes together by placing my hands on the exterior of the pelvis.

I believe that these cases ought to be regarded as cases of rheumatism of important articulations; and whether they be rheumatic or not, in their incipiency, the sprain, and injury done to the joint, by gestation and labor, are sufficient to invite attacks of rheumatism, which, having once effected a lodgment in the tissue, can be with difficulty, or not at all displaced.

In cases of relaxation of the pubic symphysis refusing to yield. to a treatment consisting of an absolute rest of the articulation, effected through recumbency and bandaging, there will also, I think, be good reason to accuse the part of rheumatism, provided we exclude from the diagnostic any possible condition of active inflammation tending to produce suppuration or caries of the joint.

In the case which I have cited at such length from Prof. Moreau, you see that the patient suffered for many consecutive years, and that the last note of the case left her in still very ill health. Do you think that such grave disorders of the health, and so great a persistence in them, could possibly depend upon mere relaxation of the fibro-cartilage that binds the ossa pubis together? Do you not rather concur with me, in the opinion just now expressed, that there must be some disorder over and above the state of relaxation in which the articulations are known to be? And is it not likely that the disorder is arthritic? I should think that if you should come across a case such as that of Prof. Moreau, you would resort to an anti-rheumatic treatment; and that for the subduction of the arthritic disorder, you would at least come to the conclusion that the use of a powerful counter-irritation and derivation like that of the seton, might assist to restore the patient's health. I should think that such a seton as that of Dr. Grauiex would scarcely be objected to by the patient herself, as it would afford some reasonable ground of hope to relieve a torturing and disabling disorder.

I have proposed such a seton to a young lady at present under my care, who has suffered for years from manifest relaxation of the interpubic ligaments, whose general health, however, has not

been deeply mined, but who declines to admit of the application of the remedy.

C. D. M.

LETTER XXXIX.

GENTLEMEN:-Among the diseases and accidents of pregnancy, none are more common and more vexatious than those connected with miscarriage and abortion.

The full term of pregnancy extends, as I have stated, to about the two hundred and eightieth day from the fecundation of the ovum; it is more prudent, in making the calculation for the term, to begin the computation from the day of the last catamenial show: two hundred and eighty days from this date, the woman ought to expel the child. It is in this manner that I have made the computation for my patients for many years past, and as yet have found no reason for changing my method or habit. It is true that the Jewish women, as I mentioned in a former letter, begin their computation after the eighth day subsequent to the disappearance, and they say that the calculation serves them well; but the other method has also served me well.

Some years ago there was a trial in England involving the question of the duration of pregnancy. It was called the Gardiner Peerage Case, and was instituted for the purpose of settling the title of a claimant to that peerage. Many eminent medical men in England were examined on the occasion, and the result was, that no absolute term of pregnancy was ascertained. Moved by the interest excited in that case, Dr. Merriman, of London, took the greatest pains to ascertain the duration of pregnancy in many women, and he succeeded in satisfying his mind of the great correctness of the computation for one hundred and fourteen cases of mature children. The results of these inquiries he published in the Lond. Med. Chir. Trans., vol. xviii. part ii., at p. 338. He gave a tabular statement as follows: There were born at

From the foregoing table it appears that the term, or the duration of a pregnancy, is not absolutely fixed, or that there is a considerable latitude as to the number of days that the foetus may remain in utero; some of them being rendered "mature" sooner, and some later, according to the amount of vital force they are endowed with. It is relative, perhaps, also to the strength and ability of the maternal constitution, and in some degree, probably, according to the placental attachment and connection, as more or less extensive and perfect.

But, while the natural term of a pregnancy is about 280 days, such is the delicacy of the attachment by which the fœtus is united to its parent, that many causes are found sufficient to separate it from the lining surface before its time; and numerous diseases, to which its frail nature renders it liable, serve to bring its life to a premature conclusion. By its death, the ovum becomes a foreign body, and is expelled by the womb which it now irritates pathologically, and thereby excites the contractile force of its muscles, so as to give rise to the pains or contractions of a miscarriage, as well as the bloody discharge that usually attends the contractions.

It should be considered, that though the fœtus is contained within the cavity of the womb, it is prevented from all direct contact with that organ, except at one point. It floats in the water of the amnios, and the interior of the womb is lined every