enter into an argument to disprove the so untenable theories, or to establish the theory of the entrance of air, as a cause of death. But so changed have been some of the pathological facts, and so persistently have the other theories been urged, and so emphatically has it been said that this theory could not be sustained by the facts in the case: and from the fact too that the possibility of its truth has been denied by some eminent members of our profession, and its great improbability asserted by others: I have determined, as far as I am able, to remove all doubt in this case, and if possible to establish its truth, that it may shed light upon a subject of the greatest pathological interest and importance.

A. First, then, let us consider in detail all the other theories that have been proposed to account for this death, in relation to their consistency with all the real post-mortem facts.

1st. "Excessive uterine hemorrhage."-This theory was based upon the very unusual bloodlessness of the extremities, the placenta and uterus, and the condition of those organs. Its chief use in this place is to re-establish some post-mortem facts that have been denied.

This theory was carried from the first post-mortem examination by DR. MOTTRAM, notwithstanding there was not a single bloodstain on the clothing of the deceased, or the bedding, seen by any one. With such prima facie improbability of the truth of this theory, it would seem that there must have existed and been undeniably recognized, facts, not only consistent with it, but actually suggesting, and compelling its reception.

What did the entertainment of this theory imply?

(a.) An absence of blood in the system. This seemed to be apparent; but at the second examination was disproved.

(b.) It emphatically implied and demanded, for its intelligent reception, that the mind so receiving it, and believing it, should have either known that the conditions of the uterus and placenta rendered it possible, or at least should have believed that such conditions might have existed.

Those conditions were, of course, injury of the inner wall of the uterus, injury of the placenta, or injury of the connection of the

two.

The evidence seems to show that there was no injury of the inner surface of the uterus. But the memorandum made at the time of the examination concerning the placenta was "softened and broken down.”

Here we have the recognized positive existence of the facts necessary to the theory. And if we had not, certainly the manner in which the placenta and ovum were emptied out of the divided uterus would at least render possible their existence, though they had not been observed. This possibility, yes, probability, or certainty, of such an ante-mortem separation of the placenta must have been the basis of the theory.

Now this theory was abandoned after the second post-mortem examination.

An abandonment of the theory, however, would not change the positive existence of the facts necessary to the theory. It was remarkable, then, that when the theory was abandoned the facts should have, by some means, been changed.

The memoranda of the facts made at the first post-mortem examination were not admitted in evidence after the coroner's inquest. But we have, in place of the simple statement, "placenta softened and broken down," the following, viz: "No traces of any separation of the placenta from the inner wall of the uterus."

DR. MOTTRAM. "I did not make a very minute examination of the placenta."

"In the condition I found that uterus and placenta, a condition of integrity, I should say air could not have been forced into the uterine sinuses."

The very conditions necessary to an intelligent belief that there had been uterine hemorrhage are here positively asserted not to have existed.

2d. "Simple syncope from shock."-The few symptoms we have that preceded the death of this woman are not indeed symptoms usually attendant upon simple syncope. 66 A scream,' " "throwing up of the hands," "striking with the hands," "blueness of the face," and "rigidity of the muscles," are certainly not the recorded. symptoms of fainting fits.

Nor are the post-mortem appearances any more consonant with this theory.

Is it possible that "emptiness of all the cavities of the heart" and "extreme congestion of the lungs" can be evidences of paralysis of the heart? But is not paralysis of the heart a necessary pathological condition in syncope?

3d. "Spasm of the muscles of respiration." This theory appears to have been suggested by the fact, developed at the second post

mortem examination, that the obstruction to the circulation was at the pulmonary capillaries.

Suppose this theory to have been true, and the muscles of respiration by some unknown excitant had instantly been thrown into permanent and strong contraction, fixing the chest immovably as in some cases of poisoning by strychnia. What then would have been the manner of death, and what the pathological appearances of the heart and lungs? (In this case we suppose the heart not involved in the spasm). Most certainly the manner of death would have been that of asphyxia. The lungs would have been extremely congested, but the right cavities of the heart would have been filled with venous blood crowding in from both venæ cavæ.

4th. "Spasm of the heart."-If this theory had been true, the obstruction to the circulation would have been at the heart. The lungs should have been as devoid of blood as other parts, or, at least, should not have been "extremely congested." For at any given moment when the circulation is healthy there is in the pulmonary structures, in transitu, at least as much blood as is contained in the right ventricle at once, the contraction of the two sides of the heart being synchronous. When an organ is extremely congested, does it not contain many times its normal amount of blood? Is it not plain, then, that a spasm of the heart instantly shutting, and holding shut all its cavities, could not "extremely congest" the lungs?

Besides, the post-mortem appearances indicated that the obstruction in the circulation was at the pulmonary capillaries; and that at the heart there was a condition of things very unusual. In ordinary asphyxia the circulation is obstructed at the pulmonary capillaries, but the right heart and vena cava are crowded with. blood.

Moreover, at the instant of the spasm, the pulmonary veins would be full of arterial blood, on its way from the lungs to the left heart; this would be increased by blood passing through the capillaries after the spasm had occurred. This arterial blood should have been found either in the pulmonary vein or in the left auricle. Both were empty.

B. Let us, secondly, consider for a moment the reasonableness of the three last theories, in respect to the proximate or exciting cause of this death.

Certainly, in forming a theory of the manner of death, some regard should have been paid to the conditions, circumstances, and

acts preceding and attending the death, for in them, if known, was to be found an adequate cause for the death. The following appear to be those conditions, circumstances, and acts. A young woman in her usual health, or at least attending to her household duties up to the hour of her death-of unusual nerve and self-possession, subject only to hysteria and that seldom--not subject nor liable to fainting or spasms, when examined per vaginam in a previous metro-peritonitis, or at her confinement-with deliberation and forethought in the act she was about to enter on. An abortionist went to her house to procure an abortion-went into the bedroom with her for that purpose. Said he used an instrument which did not hurt her until just as he was about to withdraw it, when he blew in it, and immediately the woman. screamed out, threw up her hands, struck at him, became insensible, and was soon dead.

By the gentlemen holding the theories now in question no weight at all could have been given to the act of blowing through an instrument, although this fact was admitted by the defence. It is true they endeavored to show by the respondent himself that he was in the act of using a simple speculum to ascertain if this woman was really pregnant; and that he blew in it to clear the mucus out of the os tincæ; a pretence so ridiculous and absurd to any one at all accustomed to the use of the speculum, as at once to prove its

untruth.

Were there any conditions in this case that predisposed to spasms? Had she had puerperal convulsions, the theory of spasms might have been reasonable; but she had not.

Was there anything in the attendant circumstances that would predispose a healthy woman of "unusual nerve and self-possession," bent on the accomplishment of her object, to spasm? and such a spasm? Can a reasonable and unprejudiced mind answer this question otherwise than "no"?

Was there any act aside from the "blowing" that could have produced such a spasm in such a woman?

Two of the gentlemen testify (after the coroner's inquest, indeed) that "there were no marks of mechanical injury," and that "they should have observed them if there had been any." But this testimony, it will be remembered, was given by men who emptied the placenta and ovum out of the uterus, just as one would skin a squirrel, by cutting the skin open upon the back and stripping it

off at each end-by men who recorded upon the spot that the "PLACENTA WAS BROKEN DOWN."

Dr. Johnson, indeed, says: "The spasm might have been produced by the introduction of a speculum or even the finger into the vagina." And all the other gentlemen say it might have been produced "by the operation," which, if they are to be believed, "left no marks."

Is not such an hypothesis utterly preposterous? been, "within the memory of man," a case analogous?

Has there

No such case was adduced or referred to upon the trial.

C. We will now turn our attention to the theory of "death by forced entrance of air into the circulation through the uterine sinuses."

Let us try this theory also by the acts performed, the antemortem symptoms, the post-mortem appearances, and the objections urged against it.

1st. By the acts performed.-The abortionist, through an instrument,' then within the uterus, or at least within the vagina, "blew," and the woman "screamed," "threw up her hands," "struck at him,” "fainted," was found in a minute or two, by the husband, “blue in the face," "insensible," and with the arms and muscles about the face and neck in a "trembling motion."

This act, surely, will be acknowledged to be an adequate cause of death if the air entered the sinuses. Has any other act been brought to light that would be an adequate cause of the death under the existing conditions and circumstances?

2d. Moreover, see how exactly the symptoms correspond to the symptoms in those cases where death is undoubtedly due to the accidental entrance of air during surgical operations, in the "espace dangereuse."

[I am indebted for much that immediately follows, to an admirable résumé of the facts and literature upon the subject of "air in the veins as a cause of death," by James S. Greene, M. D., published in the American Journal of the Medical Sciences, Jan. 1864].

From the symptoms reported in sixty-seven cases, Dr. Green gives us the following as characteristic symptoms: "The patient

1 By reference to the husband's testimony it will be seen that he described very well a flexible catheter with its attendant wire as the instrument seen by him upon the bed.