must likewise admit that I had a hope, in removing the colon, to be able to preserve it for subsequent demonstration, in which I was disappointed by unexpected circumstances. Is it not, however, more than probable, that the contraction of the aorta, and consequent dilatation of that part of the vessel immediately above the contraction, and flattened state of the spine, were occasioned by long-continued pressure of the enormous colon, the contraction being precisely in the situation where the transverse arch of that bowel had lain across the spine? The lungs, though subject to pressure and to preternatural circulation for a long period (I imagine to a degree, from the first commencement of the cough, more than sixteen months), evinced no disorganization, some muco-purulent fluid only being to be detected in the bronchia. The head, I regret to say, I had not an opportunity of examining, but its state may be clearly inferred from the obstruction of the descending aorta, and the symptoms long before death.

So far I have plainly related a succession of facts, simply transcribed from my notes, with the impression they created upon occurrence. I shall now state some incidental circumstances which may throw material light upon the physiology of the cases before us. Both these young ladies had enjoyed uninterrupted good health till within about twelve months antecedent to the period they were placed under my care. Each of them distinctly traced the derangement of their health to have commenced with constipated bowels. The first, Miss L. evidently accelerated the march of disease by having, a few weeks previously to my seeing her, made frequent use of the cold bath, into which, from timidity, I found she invariably entered by immersing the lower extremities first, and was generally several minutes before she could be prevailed upon to proceed to submersion.

This family, consisting of four, benevolently disposed, amiable, and affectionate sisters, had, for many months, indiscreetly confined themselves to the house, in the sedentary occupation of needle-work for the poor. Two of them fell sa

crifices, I have no doubt, to their philanthropy: a third, who was the eldest, has recently escaped with difficulty the same catastrophe, having suffered a sudden total obstruction in the colon, which produced peritoneal inflammation, that was not subdued without the most decided depletion; one hundred and sixty ounces of blood having been abstracted in five days, upon repeated recurrence of the inflammatory symptoms. And the fourth has an enlargement of the thorax of the left side, an indescribably distressing feel about the chest, a pulse that strongly indicates mischief about the source of the circulation, and an incipient stricture of the oesophagus.

The prominent symptoms in the two fatal cases bore the most marked analogy, with this difference, that in the first case the cerebral affection was one of the first symptoms; in the second, it was most decided at the termination of the disease. In the first case, the increased circulation of blood through the lungs rapidly produced disorganization, and an extensive suppuration of the parenchymatous substance, long before she expired; while in the second, we had no evidence, while living, of any destruction having taken place in the organs of respiration, and the dissection proved the capacity occasionally inherent in the lungs to resist disease.

The cough in the first case soon assumed a phthisical character; while in the second, it was only to be compared to that spasmodic cough which is invariably produced by the lodgment of foreign bodies in the substance of the lungs. And though this cough had continued to the most distressing degree for full sixteen months, it had evidently effected no mischief abstractedly. In both instances there were attacks, which I have candidly stated I imagined to be hepatic, and they were both after the apparently total evacuation of the long-retained contents of the colon. Both had the same unequal balance of the circulation, as evinced by the preternatural determination to the head, and cold lower extremities.

In the first case, the effect was extravasation, I have little doubt, into one or both ventricles in the early part of the dis

ease; and in the second, that event occurred at the conclusion. Each had the same peculiar feel across the spine (which was precisely opposite the spot where the loss of substance in the bodies of the vertebræ was discovered in the second case), and each drew the same comparison, that it was like a cold heavy hand placed across the back bone. In the first case I had concluded there was organic affection of the heart, and we had direct evidence of an almost total obstruction of the circulation to the lower extremities. That the disease was essentially the same in both instances, I have not now the smallest doubt, though the effects were, in some measure, varied. The first cause, I have little hesitation in concluding, was in the obstruction of the colon at the sigmoid flexure, and all the succeeding symptoms were merely a chain of successive effects. I hope I am reasoning from sound pathology when I say, there cannot be a doubt but that the enormously distended colon had pressed upon the aorta so long and so forcibly, that it had caused a contraction of its calibre; that the force of the circulation meeting with this obstruction had caused that distention of the vessel above the diaphragm; that the coats of the artery began to lose their elasticity and dilate, which dilatation went on progressively increasing till it involved the heart itself in its morbid effects. The column of blood being obstructed in its descent, was forced in larger quantities through the lungs and along the course of the carotids. The heart must have been long embarrassed by the obstruction in the aorta, and was no doubt ultimately overloaden, or, as it were, overpowered by its own blood. Two peculiar circumstances, which I have but cursorily mentioned in the statement of appearances on dissection, I have deemed of sufficient importance to merit separate notice. First, the sacrum, I have observed, formed an unusually acute angle with the last lumbar vertebra. The spinal column at its base was nearly straight, the lumbar vertebræ projecting much less into the pelvis, than I ever saw them. The superior margin of the sacrum stood nearly at right angles with the last lumbar vertebra, its dorsum abruptly protruding

posteriorly, where, at the lower part, it formed another considerable angle, throwing the os coccygis directly in upon the rectum; thus nearly describing a triangle, instead of an ellipsis. How far the sharp ridge, thus formed by the supesior margin of the sacrum, across which the colon was firmly bound by peritoneum, influenced the formation of the contraction, I leave others to decide. And how much a sitting posture, constantly indulged in, may distort the os coccygis and sacrum of a young delicate female, I profess myself ignorant.

Secondly, the colon, though so amazingly distended, was void of fæces, and filled only with flatus; this I imagine may be satisfactorily accounted for from the long-continued distention of the bowel having destroyed the elasticity of the muscular fibres, and the constant state of gastric and enteric irritation creating an extrication of gas, which filled the vacuum.

I have several times heard my much-respected friend Dr. Armstrong, insist upon an accumulation in the colon being a frequent but unsuspected cause of many anomalous complaints. Valuable as I have ever considered any remark made from his professional experience, I think this one truly inestimable, not only from its justness, but from the irreparable mischief the obscurity of the disease frequently produces. The cases here related are not the only ones that have impressed me with this conviction, but several others have subsequently fallen under my observation, where unloading the colon has produced surprising effects. In truth, such has been the relief I have witnessed in some affections of the head, of the chest, and of the stomach, where there was no inconvenience directly referrible to the abdomen, that, without the elucidation of this dissection, I should have been utterly at a loss to account for it.

AN

UNUSUAL CASE

ОР

TWIN CONCEPTION AND LABOUR;

ALSO

A CASE OF BLIGHTED OVUM,

WHICH WAS RETAINED IN THE UTERUS ELEVEN MONTHS:

WITH

Practical Observations; and Remarks on the Doctrine of

Superfœtation.

BY JOHN POWELL, ESQ.

Surgeon and Accoucheur to the Lying-in Institution, Newman Street, London.

Y. Z. aged thirty-three, engaged me to attend her, with her ninth child; she had always had favourable and speedy accouchements, and to the period of her present confinement was in good health. Feb. 26, 1820, after having had many severe pains, she sent for me: on examining per vaginam, I found the os uteri gradually dilating, but the recurrence of pains taking place only at considerable intervals, I left her, and repeated my visit in the evening; a progressive advancement was observable, but the intervals betwixt the pains being still long, I again left her, requesting to be sent for when the pains became more frequent. On the following morning, and throughout the day, the pains were violent, and produced ́a regular dilating effect upon the os uteri, yet not so urgent as