respects abnormal, either in the large intestines or their contents. The peritoneum was highly inflamed. The bladder was contracted; and on its posterior wall were two spots of well-defined inflammation. The spleen and kidneys were healthy. About two ounces of bloody serum were found in the cavity of the abdomen. The upper part of the larynx and lower part of the pharynx were inflamed; and there were traces of inflammation at the bifurcation of the trachea. The veins of the head were very full, as well as those on the surface of the brain. The brain was of large size, and well developed: its vessels were congested; but there was no morbid change of structure."

No trace of poison could be detected in the contents of the stomach and viscera. The suspicion of poisoning, however, was entertained, and it was strengthened by the fact, that the man and his wife lived somewhat unhappily together. The husband, himself, who was a shepherd, kept by him a quantity of arsenic and bichloride of mercury, which he was in the habit of using for the purpose of destroying the fly in sheep. It was therefore suspected that one or other of these irritant poisons, or some preparation of barytes, had been administered by him designedly; or that the poison might have become accidentally mixed with the food, and have thus given rise to the illness of all the parties, and to the death of the child.

But there was another explanation of the symptoms. "The mutton which the family had had for dinner on the Monday was part of the body of a sheep which had been affected with the staggers,' and which, in consequence, had been killed, and the meat distributed among many poor families in the neighbourhood. It was therefore not unreasonably considered that the very unwholesome nature of this food might sufficiently account for the serious consequences which had followed the meal. It is however worthy of remark, that no other persons of other families, who had freely partaken of the mutton from this sheep, were attacked, or experienced any ill consequences whatever."

The meat could not be procured for examination, but a tin plate which covered it presented no poisonous contamination.

A medical opinion was required of Mr. Taylor, on the cause of death in the child. It might be ascribed to three causes.

1. To some mineral irritant poison mixed with the food.

2. To the poisonous nature of the food itself; either from the animal having been killed while in a diseased state, or from the flesh having become partially decayed.

3. To natural causes.

These hypothetical cases are examined with much ability by Mr. Taylor. The curious we must refer to the original. The pros and cons under each head are carefully weighed, and Mr. Taylor comes to the conclusion that there is no evidence of there having been a mineral poison at work-nor of death from natural causes-but that the meat was at the bottom of the mischief. He conceives that there are only three ways in which the features of the case can be explained.

(1.) That the effects were due to idiosyncrasy; the diseased mutton not possessing any injurious properties, but being rendered poisonous by peculiarity of constitution in this family.

(2.) Admitting that there was no such peculiarity of constitution, that the disease in the sheep had especially affected and rendered poisonous that particular portion of the flesh which had been taken by this family.

(3.) That the effects did not depend on idiosyncrasy, or on the disease with which the sheep was affected; but that decay had commenced in the portion of it assigned to this family, and that thereby an animal irritant poison had become generated.

Of these hypotheses, he is inclined to adopt the third; and, in the course of the paper, he cites some striking facts, in support of this opinion. One or two may not be out of place even here.

"At a public festival at Zurich, in the year 1839, upwards of 600 persons partook together of a repast, consisting chiefly of veal, roasted or in cutlets. At variable periods afterwards, nearly all of these individuals were taken ill; and in a week most of them were confined to their beds. They were affected with rigors, vertigo, headache, intense fever, diarrhoea, vomiting, and, in some instances, delirium. At a later period, an abundant flow of fetid saliva occurred, the interior of the mouth being covered with ulcers; and in many cases, after involuntary discharges of the fæces, great prostration of strength, and death, ensued. In these cases, the mucous membrane of the digestive canal was found softened, the intestinal follicles ulcerated, and the veins empty. It was afterwards ascertained that the veal, when eaten, had been in an incipient state of putrefaction."

In another case related by Dr. Christison, the putrefaction of veal had gone farther, so far indeed as to have converted it into something approaching to adipocere. Several persons who ate of it were all seized with pain in the stomach, efforts to vomit, purging and lividity of the face, succeeded by a soporose state, like the stupor caused by opium, except that when roused the patients had a peculiar wild expression. One patient died comatose in the course of six hours. The rest, being freely purged and made to vomit, eventually got well; but for some days they required the most powerful stimulants, to counteract the exhaustion and collapse which followed the sopor.

After partaking of a roebuck, killed in a state of excessive terror and exhaustion, several persons experienced a violent gastro-intestinal inflammation, with other symptoms like those already detailed. Here the flesh was not in a putrefying state.

But we need not pursue this subject. We strongly recommend our readers to peruse the original paper, which, like all of Mr. Taylor's on matters connected with medical jurisprudence, is distinguished by sound sense and correct reasoning.

II. OBSERVATIONS ON PELVIC TUMORS OBSTRUCTING PARTURITION; WITH CASES. By JOHN C. W. LEVER, M.D.

In a former paper, Dr. Lever made some remarks on those tumors which implicate the pelvis itself, as well as those organs and structures concerned in the birth of the child. He now turns to those tumors which belong to or implicate the parts in the neighbourhood of the birth passages. This division includesA. Tumors of the ovaries. B. Tumors of the Fallopian tubes. C. Tumors of the rectum. D. Tumors of the bladder. E. Tumors in the cellular tissue of the pelvis and, F. Those varieties of pelvic hernia which may and do occasionally offer an obstruction to the course of natural parturition.

A. Tumors of the Ovaries.

The ovaries are liable to various diseases and displacements: thus, there may be inflammation and its consequences; there may be encysted dropsy; the ovary is liable to be affected with specific and malignant tumors; and lastly, it may be displaced or dislocated. Inflammation of the ovary may be either acute or chronic; and may cause induration, softening, or suppuration of the organ. The ovary is also liable to the encysted form of dropsy-to osseous, cartilaginous, and scrofulous and tuberculous tumors-to cancer and melanosis.

The ovary is subject to displacement within or without the pelvis. This may be a consequence of displacement of the uterus. Inflammation may fix the ovary in its morbid position.

The ovary may become displaced, when it may remain within the pelvic cavity, or escape from it. Displacement of the uterus may disturb the ovary; inflam

The en

mation supervening on its malposition may glue it in its new place. larged ovary falling into the recto-vaginal pouch may form a serious obstacle to the progress of labour.

In extra-pelvic displacement, the ovary may be found in an umbilical, ischiatic, femoral, or inguinal hernia.

"When pregnancy is complicated with enlargement or misplacement of the ovary, it is of great importance to ascertain the extent, situation, size, shape, density, and connexions of the obstruction. The enlarged ovary may be seated above the brim of the pelvis, or it may descend into that cavity occupying the side corresponding to the ovary affected: in other cases, although the ovary descends into the pelvic cavity, its mobility is so great, that there is no difficulty in lifting it up, and in placing it above the brim, as was done in Cases 34 and 35. "Where the tumor is of the congested form, large, and confined to the abdomen, it may produce lateral obliquity of the uterus; and so render the labour tedious, preventing the presentation from entering into the brim, as in Case 34."

Ovarian tumors, complicated with pregnancy, vary, as might be supposed, very much in size. They have been known to occupy the whole pelvic cavity. It is of consequence to ascertain the consistence of these tumors. If fluctuation is indistinct, Dr. L. approves of an exploratory puncture. In short, he is of opinion, that, in all tumors of this kind, impeding labour, we are justified in assuring ourselves of the nature of the tumor before proceeding to perform the operation of embryotomy.

The diagnosis of ovarian tumor, when complicated with labour, is not always easy, particularly when the patient is not seen till she is in labour.

" In forming our diagnosis, we must be guided by the history, situation, and shape of the tumor. If an examination be made before the child's head has descended into the pelvis, or if there be no adhesions and the tumor be moderate in size, its displacement and reposition may enable us to determine its nature. If the tumor be encysted, it is elastic, soft, and fluctuating, becoming more tense during the uterine efforts; or by them it is urged into the pelvic cavity, or the child's head is pressed against it, which took place in Case 38. But otherwise, whether it be of a non-malignant or malignant nature, uterine pains will not increase its tensity, neither will it become flaccid when the efforts cease; in short, the only effect produced by the pain is a forcing down of the tumor en masse; so that, in order to arrive at a correct diagnosis, we should examine the tumor both during and in the absence of pains. Exploration already referred to should be made in every case in which doubt exists, before we proceed to destroy or even risk the child's life. The history of the examination of the case, both per vaginam and per anum, will, I think, in every case, enable us to decide the obstruction to be ovarian; for if due caution be employed, it can neither be mistaken for disease of the uterus nor vagina. The cases which are most likely to be confounded with ovarian tumors are those in which encysted or other tumors are developed in the cellular tissue, between the rectum and the vagina; but this is but of little consequence, as the treatment in both cases is founded upon the same principles."

Prognosis. This must be considered in reference to the mother, and the child. It must mainly depend upon the size, seat, mobility, and nature of the ob

struction.

"If the tumor be small, if it chiefly consist of fluid, or if we are able to return it above the brim of the pelvis, there is little or no danger to be apprehended, either to the mother or the child; but if the tumor be large, solid, firmly adherent, and if it occupy the cavity of the pelvis, the operation of craniotomy will very probably be necessary; and the difficulty in performing that operation, as well as the injury the parts may sustain during the delivery, will render the re

covery of the mother a question of great uncertainty: or, lastly, the labour may be so protracted, that the patient may die of exhaustion. Puchelt, who has collected together thirty-one cases, mentions but one (that related by Busc) in which the woman died undelivered, although he alludes to several which proved fatal after delivery, either from exhaustion or inflammation. Our prognosis, therefore, must be based upon the nature, size, and mobility of the obstructing tumor. Of the thirty-one cases related by Puchelt,

1 died without being delivered;

14 died soon after delivery;

3 died from other causes; and 13 recovered.

With regard to the child, our prognosis will depend on the same causes that influence us in determining that of the mother.

Puchelt states, that—

21 children died before delivery;

after delivery;

were born alive;

while in 2, the result is not stated.

In Dr. Merriman's cases, the still-born children amounted to 16, and those born alive to 4."

Treatment. If the tumor, from its site, offers little obstruction to the birth of the child, or if it be so compressible as to let the head pass, labour may be naturally completed. Sometimes, where the tumor is caused by encysted dropsy, it is quite above the pelvis, and, so soon as the head is engaged in the pelvic cavity, the labour goes on naturally: but owing to the obliquity of the uterus caused by the tumor, the first stage of labour is lingering, as the head, or presenting part of the child, does not enter the brim of the pelvis in the most favourable manner. In all cases, whether the tumor is above the pelvis or within it, we should give full trial to the natural efforts; at the same time taking care not to defer our assistance too long, as the injury the soft parts may sustain may lead to fatal results.

Reposition. In some cases, the tumor may be placed above the brim of the pelvis, out of harm's way, until the head has entered the pelvic cavity, when no obstruction is then to be apprehended. All accoucheurs concur in recommending this, when it can be effected, and there are many recorded instances of success under great difficulties.

Puncture or Incision.-" Dr. Merriman states, that in six cases, out of those recorded by him, the tumors were opened; in three, the labour was left to Nature to complete. Two of the women recovered, but the other remained for a long time in an ill state of health: two of the children were preserved. In the remaining three cases in which the tumors were opened, the use of the perforator was afterwards necessary: one of the women died, one remained in an ill state of health for eighteen months and then sank under her sufferings, while the third recovered. Dr. Ingleby is an advocate for the operation; and the case recorded at p. 126, which I have previously referred to, shews how likely even experienced

medical men are to be deceived by the mere feel of the tumor. In this case, the sensation conveyed to the finger was that of an osteo-sarcomatous tumor : it felt precisely like a large mass of cartilage: it was not softer in one part than another there was no fluctuation; and it was not harder during the pains than during their absence; but still, when a long curved trocar was introduced into the tumor through the rectum, about seven ounces of a clear straw-coloured viscid fluid, which proved to be albuminous, escaped through the canal: and although this was not followed by the natural expulsion of the child's head, still it rendered the operation of artificial delivery much more easy and in Case 36, the tumor was supposed to be a solid body. I have before stated that, in my opinion, in every case, we ought to perform the operation of puncture before we have recourse to the more serious operation of embryotomy."

If the contents of the tumor are too thick to pass through a canula, an incision may be made. Some advise this to be made per rectum-others per vaginam. To this latter more natural opinion, Dr. Lever inclines.

Extirpation of the Tumor.-The following are Dr. Lever's sentiments on this

head.

"If the tumor be of such a size or nature that its contents may be evacuated or lessened by the operation of puncture or incision, the operation of extirpation should not be entertained; neither, in my opinion, are we justified in resorting to extirpation, if we can deliver the child with the aid of the embryospastic instruments. But if they are inadmissible-if the tumor be so large, firm, and adherent, that, by its bulk, it prevents the descent of the child's head-by its incom pressibility, it does not yield to pressure-by reason of its solidity, its contents cannot be discharged, either by the operation of puncture or incision—and by its confined and fixed position in the pelvis, it cannot be replaced-then I am of opinion that the operation for extirpation is called for, and justifiable." He cites Dr. Merriman in support of this opinion.

Turning. This Dr. Lever condemns. For, he argues, "if the tumor be so compressed that the hand can be readily introduced for this purpose, it is far better to wait, and trust to the natural efforts, or to evacuate the fluid contents of the obstructing tumor: for the operation of version must be attended with some degree of violence and risk; and indeed, should we succeed in passing our hand and bringing down the feet, the greatest difficulty will be experienced in the delivery of the shoulders and head. In five cases related by Dr. Merriman, the labour was terminated by turning the child: all the children were lost, and but one of the mothers recovered."

Delivery by Embryospastic Instruments.-Dr. Lever conceives that these cases are not generally suited for this mode of delivery. If instruments are required, they are usually those which evacuate the tumor, or remove at once, or those which lessen the size of the child and reduce it to the size of the contracted opening through which it has to pass.

Cephalotomy." Six cases are recorded by Puchelt in which the operation of cephalotomy has been had recourse to. Of these six, but three women recovered. Dr. Merriman states, that in his eighteen cases the perforator was used five times, after a longer or shorter duration of labour.' Of these women, three died; another recovered very imperfectly; and one got well. The perforator was had recourse to also in three cases after the tumor had been opened, one of these women died, one remained in an ill state of health for eighteen months and then sank under her sufferings, while the third recovered."

Cæsarean Section.-Dr. Lever knows of no case in which this has been performed.