pulsory efforts of that organ, when the brain has become preternaturally inactive.

It appears, then, to the writer, that the appropriate stimuli of the motor fibrils of the womb, which are the impulses of the nerves of impressibility, are not exclusively received in the spinal marrow, but may be received in the brain itself. But it is not in these two parts only that the writer believes the impulse of the nerves of impressibility may be received, for he thinks these may be communicated to the motor fibrils in the womb itself. In this opinion, he is countenanced by the movements which take place in muscular organs after separation from the body, upon the application of stimuli. And though he is not certain that the womb has contracted under such circumstances, he doubts not that this organ, as well as the heart and stomach, might exhibit these phenomena. A fact has been adduced by some physiologists, to prove that the spinal marrow or the ganglia retain some nervous power, or even elaborate it after death; and this is the occasional expulsion after death of the contents of the uterus. But this fact is as strong for the brain or for the nerves of the womb, as for the ganglia or the spinal marrow. Why is it not adduced to prove the same of the brain, which we have no right to assume is more dead than they? This fact, as well as the alleged contractions of the separated organ, go to show, that the nervous system may retain, or even elaborate nervous force, after the circulation and the respiration have ceased.

When muscular organs contract, after separation from the body, the phenomenon is referred to contractility of the organ itself, and altogether independent of the nervous system; but it is difficult to conceive how any vital act can take place independently of the nervous influence. The present writer prefers referring the movement to impressions made upon the nerves of impressibility, and communicated to the motor fibrils ere they have left the organs in question.

When movements in muscular organs take place, when severed from all connection with the ganglia and neighbouring nerves, they are usually very imperfect, and of very short duration, doubtless in consequence of the amount of the nervous force remaining in the organ, being small, or in consequence of the quantity of nervous energy which may be elaborated by the ganglia in the organs being inconsiderable, and, perhaps, by its being im perfect in quality. There is reason to suppose, that complete death or inaction of the nervous system, in all its parts, may take place at one and the same moment, with stoppage of the respiration and circulation, which is vulgarly called death.

not

When movements take place in the womb, when it is connected with the spinal marrow and the ganglionic system only, the

brain being separated, they are not strong, nor so long continued, as when it is connected with the whole nervous system. Strong contractions of the womb have occurred after the brain has been separated, but this is comparatively rare, and they are never continued for any length of time. In this instance, the contractions are more powerful and complete than the alleged movements in the womb, separated from the body; and this depends, doubtless, upon the larger amount of nervous influence which the ganglia and the spinal marrow can contain, and also, probably, on these parts elaborating nervous influence themselves. These movements are much less powerful than when the womb is connected with the whole nervous system, as happens in natural labour; and this latter circumstance is to be accounted for on the principle, that the brain elaborates originally part, or, perhaps, nearly all the nervous influence subservient to the contraction of the uterus.

Anatomical account of the nerves of the Uterus.-The womb, both in its impregnated and unimpregnated condition, is supplied by nervous filaments, proceeding from the sacral nerves forming the sciatic plexus, and from the ganglionic system, in that part called the hypogastric plexus. In the unimpregnated condition, the nerves are remarked to be about the same size and the same number, as go generally to other organs of a similar size: in short, nothing remarkable is observable. But ere the uterus has been impregnated a few weeks, the nerves are found to be larger and more numerous than previously; with the growth of the uterus these nerves grow, and ganglia increase in size. About the sixth month a wonderful change has taken place, thousands of filaments appearing, and spreading themselves over the uterus and vagina. At the ninth month, the ganglia have attained an enormous size; the filaments are innumerable, spread over the uterus, and resemble fascia, for which, indeed, they were long mistaken, until the distinguished Dr Robert Lee pointed out their real nature. To this distinguished obstetrician, the profession is indebted for this important and highly interesting discovery, which throws so much light upon the phenomena of utero-gestation and of labour, and which, moreover, goes so far to support the views of the humble writer of this paper. The writer has had the advantage of examining the beautiful preparations of the nerves of the uterus, prepared by Dr Lee, to whose liberality and kindness the profession is not less indebted, than science is, to his meritorious exertions in this field of labour.

The nerves of the uterus, at the ninth month of utero-gestation, are not much less than the whole ganglionic system of all the other parts of the body. Doubtless, many of these nerves are engaged in the various offices of nutrition, of secretion, and absorption, both in respect to the uterus and to its contents; and

there is every reason to believe, that many of them, viz. the nerves of impressibility and of involuntary motion, are now attaining that perfection, which is to fit them for the performance of the expulsory efforts, so important to the welfare both of the mother and the offspring.

The only season during health, at which the uterus is called into contractile or expulsory efforts, is the ninth month of uterogestation. At this season the condition of the womb is fitted for the effort, and the embryo is now present, and more than ever calculated to impress the organ, by its size, weight, movements, and other qualities.

But there are other occasions, on which the contractile efforts of the uterus are made, and these occur when certain morbid conditions are present. These unseasonable contractions may take place in the impregnated or in the unimpregnated uterus. They vary much in their character, according to the nature of the conditions on which they depend; and for the most part, they are less and less complete, the more remote the condition of the uterus is from its usual state at the ninth month of uterogestation.

In the unimpregnated uterus, contractile efforts are occasionally induced by disease of the organ, by the presence of false membranes, moles, and hydatids, within its cavity.

In the impregnated uterus, the morbid conditions leading to preternatural contractile efforts of this organ, are referrible to two different parts, to the stimulus, viz. the embryo, and to the impressed organ, including its nerves of impressibility and of organic motion.

The conditions of the embryo leading to preternatural contractions of the womb, are, preternaturally large size of fœtus, a multiplicity of foetuses, putrefaction of foetus, convulsions and great movements of the child, large volume of liquor amnii, the contact of the foetus upon the uterus, by violence, or by the premature discharge of the liquor amnii.

When the morbid condition, leading to preternatural contractile movements, exists in the womb, it is for the most part referrible either to the nerves of impressibility or to the nerves of motion. The morbid affection of the nerves of impressibility is invariably one of over-activity, and the seat of the affection may comprise their whole course or only a part, as in the uterus, in the medulla spinalis, or, perhaps, in the brain itself. The whole course of the nerves of impressibility is most commonly the seat of the disease, when the patient is the subject of a peculiarly excitable nervous system; and this is usually evinced by general excitability.

The medulla spinalis is a common seat of the affection, and most frequently occurs in patients affected with disease of spine.

The brain is the seat of the affection very commonly, when preternatural contraction attends the early stage of fever, mania, delirium tremens, concussion, and the like.

The ramifications of the nerves in the uterus, is most frequently the seat of the morbid affection, when the woman is affected with diseases characterised by increased vascular action and irritation, and when foreign bodies or irritating agents are applied to the uterus itself, as the finger, or instruments, occasionally employed by the accoucheur or others, to induce premature labour.

When the morbid condition resides in the motor nerves of the uterus, the seat of it may comprise their whole extent, or a part only, as was mentioned in connexion with the nerves of impressibility.

It most commonly happens, that these two sets of nerves are affected at the same time. The nerves of impressibility convey strong impulses, and the motor nerves respond to these impressions with preternatural force.

Insufficient action of the contractile fibres of the uterus is frequently remarked in labour, or at the proper season of labour; and the conditions on which this depends, may be referred either to the stimulus or to the womb, including the nervous system subservient to it.

The conditions of the embryo leading to inert action are—the death of the foetus some time before the full period-large amount of liquor amnii, over-distending the uterus-the sudden and premature withdrawal of the waters at an early stage of labourthe impinging of the angular parts of the infant on particular spots of the uterus, causing partial action only,-the sudden withdrawing of the body of the child by manual force, after the head has been born, in the absence of contractile efforts,-the extraction of the placenta during inaction of the uterus, and without adopting steps to promote its contraction. These causes lend some countenance to the supposition, that the embryo is the stimulus of the womb's action; as the stimulus is removed, so we find the organ less disposed to contract. Some examples of delayed delivery are recorded; but when the period of delay has been considerable, not amounting even to a few weeks, much doubt has hung over the accuracy of the facts. The possibility of labour being delayed as well as hastened, forms a very important consideration; and if the view of the present writer, that the embryo brings on delivery, by being a stimulus to an impressible organ, be correct, it does not appear difficult to suppose that certain conditions may arise, both in the embryo and in the womb, which may delay the expulsive process.

The conditions of the womb itself which lead to inefficient action, are rigidity of the os uteri, imperfect development, scirrhous

and fibrous tumours, preventing the usual action of the motive power supplied by the nerves.

The nerves subservient to the uterus are frequently the seat of conditions unfavourable to the action of the organ. The most common condition is inaction. This is the opposite condition to that which induces preternatural activity of the uterus. It depends on many different circumstances; on the exhibition of narcotics, on congestion, on effusion of blood, infiltration of serum; the presence of purulent matter within the head; general debility; derivation to some other organs; ramollissement of the medullary structures; the inaction of hysterical women, such as is observed in trance, syncope, uterine hemorrhage, and mental emotions, such as sorrow, and apprehension; and protracted labour. The morbid condition usually extends both to the nerves of impressibility and of motion, and may be noted throughout their whole extent, or may be confined to one or more parts, as in the case of preternatural action, already referred to. But the most common seats of this condition of the nervous structures, subservient to the contractions of the uterus, are the brain and medulla spinalis.

ARTICLE III.-Remarks on the Diagnosis of some Valvular Diseases of the Heart. By ANDREW ANDERSON, M.D., Professor of the Institutes of Medicine in Anderson's University, Glasgow.

The following case appears to me to assist in explaining the cause of the first sound of the heart.

Margt. Gordon, aged 29, has for some years had occasional palpitations, which have latterly increased in frequency. There is much oppression, cough, and frequent paroxysms of orthopuca; oedema of legs.

Percussion over heart natural; impulse weak. The sounds have quite changed character with one another, the first being short, quick, and abrupt, and followed by a pause; the second loud, and accompanied by a prolonged, coarse, rasping sound, audible only to the left side, and ending without interval in the next first sound. But for the coincidence with the impulse and arterial pulse, the latter would have been mistaken for the second, the other for the first sound.

Inspection, ten days after report.-Heart of natural size, right cavities healthy. Left auricle a good deal dilated, left ventricle natural bulk, small in capacity; in short, in the state which has been called concentric hypertrophy. Muscular substance firm; aorta and its valves natural. Mitral valve contracted, the centre of the membrane thin, though opaque; but its roots and edges, as well as the chorda tendineæ, were stiff, cartilaginous, and