vegetable matters on fifteen of those days, or thirty days in sixty, which, for many cases, will be found a sufficient degree of absti

nence.

Certainly, I have cured some very unpromising forms of diseased os and cervix uteri, by such a course. And now I shall desist from further remarks on this painful subject, referring you to the publications already mentioned, where you may find greater details, but little more encouragement; and I am very truly, &c. C. D. M.

LETTER XXIII.

GENTLEMEN:-If you will look into the books, or listen to the relations of your patients, you will, perhaps, be led to believe that the womb is occasionally to be found distended with air, which, after having caused it to expand, until it attains the size of a womb six months gone with child, more or less, suddenly escapes; whereupon the signs of the woman's pregnancy disappear to the great astonishment of the hopeful patient, as was the case in the celebrated instance of Mrs. Commodore Trunnion, of whose baby the author said, "tenues in auras evadit." These ventose pregnancies are nonsense, and no thoroughly-bred and close thinking physician ought to be for a moment misled by such a story. It is against physiology; it is against pathology, and it flies in the face of common sense, to talk of collections of wind distending a material like the womb, a material which creaks under the edge of the bistoury, and expanding it like a normal ovum, whose gentle slowness of growth is the sole reason for the deployment of the gravid uterus.

Air is too subtle to remain quietly locked up in a bottle that has no cork in it; and you all know very well, there is no womb into whose cavity you could not thrust a large quill, or male catheter; how, then, is air to remain in the womb, and blow it up like a Freshman's football, not only against the resistance of the womb itself, but against all the succussions of the abdo

minal muscles and diaphragm, and the resistance of the skin of the trunk of the body to boot! It is an idle conceit.

What! is there no such thing, then, as physometra and tympanites uteri; or a discharge of wind from the womb? Has it never been heard? Yes, I have heard it many times, both in child-bed women, and in others. Yet I repeat, that inflation and distention of the womb with gas, the ventose pregnancy, the pet vaginal are not diseases, but pure accidents. Madame Boivin and Dugés, at page 134, say, "We have never known the existence of an aeriform body in the uterus, except in obstetric cases, as in retention of the membranes, or of portions of the dead fœtus, or of putrid coagula, causing gaseous exhalations, found in the uterus after death, or escaping per vaginam during life."

Let me explain this matter to you, for I cannot patiently endure to think that a pupil of mine, be he settled in Maine or Wiscon-' sin, at the Sault St. Marie, or Monterey, should admit to a patient that the womb can become filled and distended with gas, as a result of diseased secretion, for such secretion is impossible, and to admit it ridiculous.

I have often been present at the discharge of large quantities of gas from the genitalia. A woman shall be seized with her last labor-pain, and bearing down with great violence, thrust not the child only, but the placenta also forth upon the bed; and, in bearing down with the violent force of the labor-tenesmus, she pushes the very womb itself to the bottom of the pelvis, shortening the vagina in so doing, wrinkling and crushing it down to the os magnum. As soon as the tenesmus is over, the resiliency or elasticity of the tissues recovering its power, the womb rises again to a certain height within the excavation of the pelvis; but, as it is a cul-de-sac that rises, it is natural for air to follow it, and the vagina, and the womb itself, may thus contain air that has been drawn up within them, upon the same principle as that which makes it follow the movement of a piston in a cylinder. Then comes a new pain-an after-pain; or else I apply my hand to the hypogastrium to make sure of a good contraction of the womb. If I compress the womb with my hand, and particularly if I push it downwards in the pelvis, I am very apt to cause a quantity of air to rush out at the ostium vaginæ, with considerable noise. This I have heard a great many times. So, in making

the examination per vaginam, when the uterus is very low down, or when in making use of the speculum I push the os tincæ far away from the os magnum, air enters the passage, and follows the retreating womb. If it be left there, and the woman is seized with a fit of coughing, or if she moves quickly, or changes her position, the air is pressed out with the sound of the pet-vaginal. And there is no other way to account for it, that is reasonable. So, also, a woman has a heavy womb, with a large loose vagina; she lies on the couch or bed; and the uterus retreats, as La Motte says, drawing air after it; but she rises, or coughs, or turns, and the air is expelled. These occurrences give you no colorable ground to suppose that she secretes air from her genital mucous membrane; did you ever hear of air being secreted by the bladder of urine? Never. Air is not secreted. The bubbles of it that you see upon the skin, are not bubbles of secreted air; they arise from the vaporization, or from the transformation of fluid products on the skin.

A fish even does not secrete the air of his swimming bladder. He comes to the surface for it.

If a woman sends for you, with a distended abdomen, with suppression of her catamenia and other signs of pregnancy, and complaining also of the pet-vaginal, I pray you be not so thoughtless as to tell her that her womb is distended with air, for it is not.

Auscult the patient, and percuss the abdomen, and explore it by means of palpation, and if she be not pregnant, you may say she has a tympany, or ascites, &c.; but do not say she has a flatulent womb. I would as lief hear you had told her she has a flatulent right ventricle of the heart or ventricle of the brain.

If, as Madame Boivin says, there be a putrid placenta corrupting and rotting within a lately delivered womb, or lying in the vagina like a huge putrescent tampon, you would not be surprised, upon taking it away, to find it followed by a gush of foul air, which, it is said, has even been found to be inflammable. In extracting the putrid placenta, I have not only had to submit to the horrible offence of this putrid blast from the womb, but I have found the decaying mass of the after-birth crepitating under my hand like a putrid piece of emphysematous lung.

But in these cases the passage has been closed by the decaying mass; and you might suppose that a very firm clot or a quantity of chorion and amnion left in the womb after labor, could so

shut up and close the orifice as to detain within the globe the putrid or other gases formed or extricated within.

It might even happen that an ulceration of the canal of the cervix with luxuriant granulations, should shut up the mouth of the womb; and that some of the fluids detained above the obturation might extricate gases: but that they could expand the uterus so as to make it large as the womb at five months, is what I cannot conceive of, and if I should, like Frank, meet with such a case, I would not believe it. I would rather believe I had made a mistake in my diagnostic.

A woman might well have an escape of air from the os uteri, who had had a utero-rectal fistula, a thing quite possible after adhesion of the utero-rectal peritoneal cul-de-sac.

Well, then, as I do not believe in a physometra as a disease, but only as an obstetric accident, I have nothing more to say about it, except that when your patient complains of it to you, and is disquieted and alarmed about it, I hope you will make her understand that she is not the subject of any sickness, but only of an accident.

Although I have nothing more to say about physometra, I have something to observe about those supposed pregnancies that consist merely of wind-wind in the bowels.

Certain nervous women, of child-bearing age, and certain women about the change of life, are liable to suppose themselves pregnant because the abdomen is enlarged and the catamenia have not returned.

A young lady of my acquaintance was married, and went to another city to reside with her husband; there she became pregnant, as she supposed, and when about seven months gone, came to see her family. Her physician, who had seen her in her new residence, had pronounced her pregnant, and all the charming prospects and tender sentimentalities connected with these new scenes for the newly married, were hers.

Soon after her arrival here, I was hastily called on account of a threatened premature labor, as she had a considerable show. Upon reaching the apartment, the scene of much anxiety, and after making inquiries as to the stage of the gestation, the amount of the hemorrhage, &c., I placed my hand upon the abdomen to discover whether the womb was condensed, and found the belly so uniformly distended up to the scrobicle, and so soft and so

free from any hard uterine outline or delimitation, that I pushed the bunch of my fingers gently down to the plane of the superior strait, and could almost carry them to the promontorium without encountering any obstruction from womb or child. Next I obtained permission to examine by the Touch, and discovered the uterus to be non-gravid. What did I do next?—or what do you think I ought to have done? My patient was already sufficiently agitated and nervous with all these palpations and explorations. If I had at once communicated to her the result of my researches, I should have had a scene. I reassured her-I told her there was no danger; and then, in another apartment, I communicated to her mother the disappointing intelligence, warning her to break it gently to the young lady, which was judiciously effected.

My patient, after having some treatment adapted to the morbid innervations of her alimentary canal, recovered, and returned to her home. The symptoms, after a few months, returned, and at six or seven months of the gestation, the medical man, who declared on this occasion that she was not pregnant, resolved to bring her doubts to a final term; whereupon he gave her a strong dose of physic, which brought away a young dead fœtus. The same patient crossed the Atlantic, and became pregnant in Europe. Her medical men permitted her to embark for the United States at an advanced period of gestation, and she reached her native place in safety. When she came here I discovered it to be another attack of tympany. After this, her health being better, she again conceived, and had an abortion of about two months' gestation.

Now these were not examples of physometra, but of tympanitis. A lady twenty miles from town was pregnant-her physician agreed that she was;-her monthly nurse was engaged here, and near the term was conveyed to the country residence to be in readiness for the accouchement. The accouchement came not: the nurse remained six weeks in waiting. The physician at length wrote me a letter giving an account of the case, and sent the lady to town. I percussed the abdomen with flatulent resonance on the whole superficies of the belly, which was a uniform tympanitic tumour, and not a uterine tumour. "You are not pregnant,' said I; "you are resonant upon the whole abdomen, down to the very hypogastrium, and there is no click of the foetal heart. The motions you have felt and the distention you have suffered were