unable to lie down or to swallow, with a very rapid pulse, a warm moist skin and perfect mental composure. Various efforts were made to ascertain the seat of her difficulty. There was no swelling to account for it, no appearance of disease about the throat internally, nor any cerebral symptoms, and yet our patient was evidently in a condition of great danger; the respiration was unobstructed, though the voice had again sunk to a nearly inarticulate whisper. There was no sound like that of croup in respiration, and no evidence of effusion about the larynx; there was no hemorrhage nor other cause of exhaustion. Stimulating and nutricious enemata were given freely, and the stomach tube at the suggestion of Dr. Hodge was procured, with the intention of support ing her by food injected into the stomach-we were, however, deterred from its use by an apprehension lest it should bring on a sudden spasm of the glottis, and cause immediate death. We all saw her repeatedly from this time until Friday morning at eleven o'clock, when she expired.

The interesting points in this case are the intensity of the arterial excitement, the dysphagia and aphonia, without a corresponding difficulty of respiration, or sufficient swelling and inflammation in those parts of the throat within sight, and commonly affected, to account for these symptoms. It was not laryngitis, nor bronchitis, nor pharyngitis, nor tonsillitis. The examination of the body revealed the whole mystery. Upon opening the trachea and larynx the traces of inflammation were so slight as hardly to be recognised; and we were disposed at one time to seek the causes of death in the brain, or some other organ. It was, however, determined to remove entirely the pharynx, together with the base of the tongue, in order to look at them carefully from behind; in doing this an abscess was opened, situate between the esophagus and the vertebra, containing about half an ounce of purulent matter, and so immediately behind the glottis as to account most satisfactorily for the difficulty of swallowing and dread of strangulation expressed by the patient, from the time the disease first assumed a serious character. There were also minute depositions of pus between the arytenoid and cricoid cartilages, shewing the cause of the difficulty of speaking.

Dr Ashmead communicated the following history of "a case of death from over-distension of the bowels, producing pressure upon the diaphragm, to such an extent as to prevent respiration." W. Wyre, aged 40 years, of large robust frame aud in full health, was attacked with violent abdominal pain, vomiting and constipation, about 3 o'clock A. M., on the 27th of August last. At 3 P. M., I saw him; he had then feeble and frequent pulse, shrivelled skin, covered with a cold, clammy sweat; hands and face blue, as in the last stage of Asiatic Cholera; respiration short and hurried; abdomen enormously inflated with gas, tense as a drum, and rising

high above the level of the sternum. He was suffering under great distress and uneasiness, but had no acute pain. His intellect was perfectly clear. I found on enquiry that the patient had arrived here on the 26th, from England, after a long voyage, during the few last days of which, he had been on short allowance. The night previously to his attack, he had eaten voraciously of watermelon, and drank freely of small-beer and cider just before retiring to bed. On first entering the room, and seeing the patient in the condition described, the thought instantly crossed my mind, that here was an obstruction of the bowels, causing immense distention, by which the lungs, heart and blood-vessels were compressed, and their actions impeded; that the patient was actually moribund, asphyxied, and could only be saved by an immediate evacuation of the gas. Acting too on the wise maxim of my estimable Preceptor, (the late Dr. Parrish,) always to suspect hernia, in cases of cholic, I at once enquired "Have you hernia ?" The answer was, yes, and on examining, I found a large scrotal hernia on the left side, in a state of strangulation. This was readily reduced and an injection of Spts. Teribinth, in water,every five minutes afterwards, brought away a large fluid evacuation, but no flatus. I now attempted to pass a large tube into the bowels, but failed-another enema was given, during the operation of which, the patient, contrary to my positive orders, rose from his bed, and was near fainting from the exertion; he was laid back in bed, and some brandy and Spts. of Teribinth, given to hasten peristaltic action from above, and to stimulate the general system, which was now still farther prostrated. I stepped aside, with my back toward the patient, to prepare another injection; when in an effort to vomit, he turned upon his abdomen: aware of the imminent danger of this position, I seized him, and turned him over as quickly as possible on the side; but his respiration was now irregular and gasping, and in less than two minutes ceased altoge ther. In the act of expiring he had a feculent evacuation, from the bowels, with some flatus. During his last moments I proposed tapping the cæcum, an operation which may be done without penetrating the peritoneum; to this the patient consented, but unfortunately no instrument, not even a pen-knife could be procured, until it was too late.

The whole time I was with him, was not more than half an hour, and every thing had to be done by myself; could I have had fifteen minutes longer the life of the patient might have been saved.

August 28th, at 74 o'clock, A. M., I made an Autopsy-Corpse less livid than before death-muscles very rigid-lungs crepitated naturally, not inflamed but greatly compressed, and congested with dark blood-Pleura natural-Heart natural, containing 1 ounces coagulated blood-Pericardium contained a small quantity of dark colored serum-Peritoneum of abdominal parieties healthy. Its cavity contained about a quart of dark, bloody serum, with a few albuminus flocculi, floating in the left iliac fossa. Peritoneum of intestines, exhibited slight injection over the stomach, duodenum,

and upper half of the jejunum; over the lower portion of the jejunum, and the ilium, the injection was much higher, approaching to a dark color, and over the whole of the large intestines, the color was so dark, that it might have been mistaken for gangrene, had there been any odour, or softening of the structure, which, however, was not apparent. A small portion of coagulable lympth was observed on the portion of the bowels which had been strangulated. Omentum natural, and pushed far up in the hypochondriac region-stomach, liver, spleen and kidnies all healthy; bladder contracted.

The position of the diaphragm was particularly remarked. The highest point of its peritoneal surface (ascertained by thrusting an iron stile, through the chest, perpendicular to the spine,) after the removal of the bowels, was, on the right side three inches above the nipple, or half way between the nipple and the lower edge of the clavicle; on the left side one inch above the nipple-Bowels greatly distended, their mucous membrane throughout of a healthy texture -the duodenum and upper half of the jejunum empty, and compressed together-the lower half of the jejunum and the ilium, greatly distended with gas, and loaded with yellowish fluid fæces, and small pieces of undigested vegetable substance of the size of beans the distension increased towards the cæcum.

On passing an iron stile through the abdominal parieties one inch above, and one inch to the left, of the anterior, superior spine of the ilium, it penetrated the cæcum about an inch without the reflection of the peritoneum, from the intestine to the abdominal parieties. This is the point for the performance of the operation, mentioned in the history of the case. On the anterior surface of the ascending colon, two or three inches above the iliocæcal valve, its peritoneal coat was lacerated, making a tear two or three inches long and about one and a half inches wide. The longitudinal band of muscular fibres at this point was also torn across and retracted, so as to obliterate the pouches which exist at this place. So great was the distension of the cæcum, that on cutting off the ilium two inches above it, a violent gush of fluid fæces and gas took place, attended with a loud noise; the contents of the bowels being propelled to the distance of at least four feet from the body. The ascending, transverse, and descending colon were also enormously distended, the latter passing very high up, into the left hypochondriac region. The distension gradually lessened from the transverse colon downwards. The sigmoid flexure with its mesocolon, were highly injected and eccymosed, the dark color terminating above and below in abrupt lines, showing the exact extent of the stricture. The part which had been strictured was attached to the internal abdominal ring by elongated old adhesions. The low. er portion of the sigmoid flexure, and the rectum were perfectly natural.

Dr. Meigs remarked that he was glad to hear the very interesting communication of Dr. Ashmead, as it confirmed an opinion

which he had long held and taught, that deathoften occurred in puerperal peritonitis from the same cause, which produced it in Dr. A.'s case. He thought the use of the tube, in this disease, a matter of great practical importance, and one upon which he had dwelt with emphasis in his work on midwifery. He had frequently known patients to be greatly and suddenly relieved by it, when no other means appeared available.

It is a well known fact, that inflammation of the serous covering of the intestine, will paralyze its muscular coat, and that then the peristaltic actions will be suspended, hence the great accumulation of flatus which occurs in Peritonitis, and the necessity of purgatives to produce muscular contraction, and of a resort to mechanical measures, to relieve distension.

Dr. Meigs considered the passage of the sigmoid flexure of the colon, to be the chief object in the introduction of the tube; it was here that the main difficulty existed; the muscular bands at this point, were in a state of spasm, affording oftentimes an insuperable obstruction to the passage of flatus; the moment this spasni is relieved by the introduction of the tube, a violent rush of gas from above takes place, the tympanitis rapidly subsides, and the respiration of the patient becomes free.

Dr. Meigs enforced these views by a reference to a case of Colica Pictonum which had fallen under his observation some years since. The patient was a robust man who was violently seized with this disease. When Dr. M. was called he found him cold and nearly pulseless, with enormous distension of the bowels, difficult respiration, hypocratic countenance, and such decided evidences of approaching dissolution, that he considered him moribund, and thought he could not survive fifteen minutes. He determined however, to attempt his relief by the introduction of a tube into the bowels-he succeeded in passing the sigmoid flexure-a violent rush of gas followed, with immediate relief to the patient. The abdomen fell, the respiration became less oppressed, the pulse revived, and to the surprise of Dr M. the patient finally recovered. He must have died very speedily had not the escape of flatus been effected.

Dr. Morris stated that the reference made by Dr. Ashmead, to the importance of suspecting hernia, in cases of Cholic (so frequently insisted upon by his and Dr. A.'s preceptor,) brought to his mind a case which occurred to him within a year, in which this caution was especially applicable. A lady sent for Dr. M. in the absence of her usual medical attendant, complaining severely of pain in the abdomen, with vomiting, constipation, &c.; he prescribed bleeding, castor oil, &c., and left her for a few hours. On his return no improvement was manifest, and he was induced to suspect hernia; on enquiry, however, the patient was not aware of the existence of a herniary tumor. Dr. M. now left the case in the hands of the attending physician, who continued his attendance for some time,

without producing any alleviation of the distressing symptoms. At the end of several days the patient called the attention of her medical attendant to a small indurated tumor in the groin, which on examination appeared more like an enlarged lymphatic gland, than a hernial sac. There was no elasticity or fluctuation, such as is generally felt in hernia, and yet the symptoms of strangulated bowel existed. A consultation of surgeons was now called, when it was concluded to cut down upon the tumor, and ascertain its character. On laying off the skin and superficial fasciæ, a small knucle of bowel, covered by its peritoneum, was found strangulated. Scarcely any fluid existed in the sac, and the bowel was closely impacted in its unnatural position, which circumstances accounted for the hardness and tension of the tumour, causing it to feel like an indurated gland. The bowel was restored to the abdomen, and the patient recovered.

Dr. Meigs, stated that he had in his hand yesterday, a placenta of ordinary size and structure of a child born at full period; attached to the edge of this placenta, was another much smaller, but of an indurated structure like a gland. To the latter was attached an umbilical chord, and the two inner membranes enclosing a fœtus of about two months and a half, shrivelled and looking like a mummy. He learned from the medical friend, who brought him the specimen, that the woman from whom it had been discharged, had given birth to a still-born child at full term, with the placenta, &c., attached as usual, but with it this peculiar structure was thrown off. The female had been subject for several months prior to her accouchment to attacks of uterine hemorrhage. Dr. Meigs considered it a case of twins, in which one had died at 24 months, the other continuing to live to full term. There was a death of one fœtus without abortion. He had seen a case some years since in which a fœtus of four and a half months, had followed the birth of a child at full term. But such cases were very rare.

Dr. Johnston was anxious to hear whether the experience of Dr. Meigs would bear out the theory of Serres in reference to the formation of double monsters. The idea of Serres of the formation of the fœtus and its organs by two lateral halves, would account readily for all cases of monstrosity from deficiency of parts; by supposing an arrest of developement, and that a condition, which at one time of intrauterine life was natural, had become permanent. But Serres not content with this explanation, endeavors to account for monstrosities with a redundancy of parts on the same principle of symmetrical developement. Double monsters being explained by the primary developement of two distinct foetuses, which, if each be provided with a separate placenta and distinct membranes, may be regularly developed and twins be born; but if one of the placenta should become atrophied, its fœtus will remain undeveloped and be delivered as a monster at the period of the birth of the well formed child. But suppose two ova to be simultaneously