Dr. BANTOCK believed the specimen to be one of cyst of the par-ovarium. He had recently removed from a patient a specimen which, in addition to its showing an admirable instance of prolapsus of the ovary (left), indicated the pathology of these cases very clearly. It shows a cyst of the par-ovarium as large as a small walnut, encroaching on the ovary, and it is easy to perceive how its enlargement must necessarily involve the ovary, and, perhaps, lead to cystic disease of that organ. On the opposite side is another about one eighth the size. His observation of a large number of ovariotomies led him to believe that when the disease originated in the ovary, such tubercular disease is always found, to a greater or less extent, while in the cases under consideration a single cyst, with the ovary at the base, is the most frequent if not invariable condition, the ovary retaining its functional activity to some extent.

The PRESIDENT suggested that cysts originating from the par-ovarium would probably always be simple, and yet the Fallopian tube is found passing round the half of the tumour, both in compound and single cysts. He thought the explanation given by Dr. Meadows the most probable one; at any rate, in the compound cysts.

CASE OF VAGINAL THROMBUS.

By ROBERT JALLAND, M.R.C.S., Horncastle.

On the 22nd of September, 1871, I was called to a young girl in her confinement. She was about 20 years of age, a primipara, unmarried, and had been in labour ten hours.

On examination I found the head low in the pelvis, and the os fully dilated, but the pains were weak and inefficient. I also noticed some enlargement of the right labium, and a fulness at the posterior part of the vagina, which latter I attributed at the time to a loaded condition of the rectum.

Finding after a full dose of ergot that the pains did not improve; and, as my patient was becoming exhausted, I applied the short forceps, and extracted the child without the slightest difficulty.

A second child now presented (breech presentation), which was expelled quickly in a few pains, and was shortly followed by the two placenta. Up to this time no hæmorrhage had occurred.

Upon making an examination to remove any portion of membranes or clot which might have remained in the vagina, I was surprised to find the vagina occupied by a globular tumour the size of my fist, projecting from its posterior wall; it was firm, smooth, and unyielding, and I was endeavouring to make out its extent and attachments when, to my horror, it appeared to suddenly burst in my hand, and in a moment the bed was deluged with dark venous blood, in such profuse quantity that my patient almost immediately became pulseless and unconscious. I at once gave a dose of ergot, and applied cold wet napkins to the abdomen and vulva, but the hæmorrhage continued as profuse as ever, though the uterus itself was firmly and perfectly contracted. I then introduced my fingers into the vagina, and found a rent in the posterior surface about two inches and a half long, from which the blood continued to flow in a stream; on each side of the rent the inner coat of the vaginal wall appeared to be separated for half an inch. Finding that I could restrain the hæmorrhage by pressure upon the parts, I kept my fingers firmly applied for upwards of half an hour, after which no further bleeding occurred, and my patient gradually rallied. The following day I found her cheerful and comfortable. There had been no return of the hæmorrhage, and she was already suckling her two infants.

On inquiry I learned that she had been suffering from a varicose condition of the veins of the right labium, and superficial veins of right thigh, and had felt a fulness and sense of weight in the lower part of the vagina for some weeks before her confinement, which at times prevented her from taking exercise; but, concluding it was nothing unusual, she had not made it known to her friends.

I am pleased to say she has continued to make a good recovery.

As is well known, a varicose condition of the labia and

nymphæ during pregnancy is not uncommon, but there are peculiarities in this case which seem to make it worthy of recording.

1st. The moderate size of the varicose tumour, and the absence of further enlargement during the progress of labour. 2ndly. That it offered no hindrance to the expulsion of the child. 3rdly. That there was no apparent increase in its size until the placenta were expelled. 4thly. The rapid enlargement and spontaneous rupture which followed the final contractions of the uterus, due probably to the sudden influx of blood from the uterine into the vaginal plexus of veins.

On examining the patient about a month afterwards, I felt a roughness where there had been a rent in the vagina, the rent had healed up, and nothing abnormal could be detected.

ON RETROFLEXION OF THE UTERUS AS A FREQUENT CAUSE OF ABORTION.

By J. J. PHILLIPS, M.D. Lond.,

ASSISTANT OBSTETRIC PHYSICIAN TO GUY'S HOSPITAL; ASSISTANT PHYSICIAN
TO THE HOSPITAL FOR SICK CHILDREN; AND PHYSICIAN TO
THE ROYAL MATERNITY CHARITY.

THE object of this short paper is to elicit discussion on a cause of abortion which I believe to be a very common one, and which appears to be insufficiently noticed in most of the ordinary text-books on Midwifery. Reference will also be made to some cases of retroflexion of the uterus in which repeated pregnancies had terminated in abortion, but in which the recurrence of this accident was prevented in a subsequent pregnancy by simply restoring the uterus to, and maintaining it in, its natural position during the early months of gestation.

The subject of retroversion of the gravid uterus appears to have first attracted attention in consequence of the patient's inability to empty the bladder; and the existence

of this displacement is now familiar to most practitioners in connection with retention of urine about the third or the fourth month of pregnancy. There probably is no obstetrical writer who does not refer to this complication, and the statement is added by many authors that, if the uterus remain in this position, it becomes strangulated in the pelvis, and abortion may result. This last is doubtless a common termination in those cases where the uterus does not regain its normal position, though it must be admitted that many exceptional cases are on record in which the displacement continued to a late period of pregnancy, and a few even in which it was persistent to the full time of gestation.1 Cases of retroversion of the uterus with retention of urine and terminating in abortion are therefore well recognised; but it seems to me that a still larger number of cases of pregnancy is met with, resulting in repeated early abortions from the retroflected state of the uterus, but whose true nature is apt to be overlooked, as they are not necessarily accompanied by any severe or well marked urinary troubles.

My attention was first directed to this subject by observing the large number of women attending as out-patients who gave the history of frequent abortions; and although I was not sanguine enough to expect (considering the various and frequently complicated causes which lead to the premature expulsion of the ovum) that the cause of the accident could in all cases be made out, either from the history furnished by the patients, or from their condition when coming under observation, still, I have made it a practice among my out-patients to ascertain by a vaginal examination whether any marked disorder of structure, or of position of the uterus could be found to exist in such cases. The result of this practice has been very strongly to impress me with the belief that the chief factor in the production of a large proportion of the cases here referred to is a displacement of the uterus backwards. I am well aware that a source of fallacy

Merriman, Dissertation on Retroversion of the Womb,' 1810; Oldham, Obstet. Trans.,' Vol. I, &c.

is very liable to creep in here, and that among those who attend the out-patient departments of hospitals, it is a common practice to walk about soon after an abortion, and that the enlarged uterus, under such circumstances, is very liable to descend in the pelvis, and in its descent to become then, for the first time, retroflected; and, further, that this displacement after an abortion, as, indeed, after labour at full term, may, under favorable circumstances, become spontaneously rectified with the completion of the process of involution. These, however, are not the cases here referred to, but rather those in which the retroflexion is a permanent condition, existing before the supervention of pregnancy, and continuing during the earlier months.

It is not intended to be implied by these remarks that abortion is believed to be the almost invariable termination of pregnancies complicated with a retroflected state of the uterus, for it is not very uncommon to notice the ascent above the pelvic brim about the third or fourth month of a previously completely retroflected uterus, especially when certain precautions are observed by the patient, and, indeed, occasionally under conditions apparently most unfavorable for its restitution. Nevertheless, making due allowance for cases terminating thus favorably, retroflexion of the uterus appears to be so efficient a predisposing cause of abortion that it should occupy a leading position in an enumeration of the local disorders tending to the production of this accident.

I cannot find any reference to this displacement as a cause of abortion in the well-known text-books of Churchill, Murphy, Milne, Miller, or Cazeaux.

Dr. Ramsbotham, Dr. Tyler Smith, and Dr. Meadows, in their works on Midwifery, state that displacements of the uterus may lead to abortion, and retroversion is noticed by them, though not prominently, among the local causes, the following extracts will show.

as

After enumerating various causes, Dr. Ramsbotham says: "Prolapsus or retroversion of the uterus may cause premature expulsion of the ovum, so also may constipation if it exist