The uterus is peculiarly situate in this respect, that it is liable to two different states,-the unimpregnated and the impregnated, and also that its condition, in the period before puberty and in old age, is very different from its state in the period of puberty, and in that which may be termed the puerperal period of female life. Previous to puberty and in old age the uterus is small, and its organization is much less distinct than in the puerperal period. It is natural to think, that, in the immature or impuberal time of life, the nerves of the womb may be small and indistinct. It is natural also to think, that these nerves, if they exist, become larger and more distinct in the mature than in the impuberal state; and that, if the womb be not excited by the function which it is intended to accomplish, these nerves may either remain stationary, or they shrink and become small, until old age advances, when they return, it may be inferred, to a state analogous to that which is observed previous to the period of puberty.

It seems uncertain whether any person has examined the womb in females previous to puberty, with the view of ascertaining the existence and condition of its nervous system. The state of that system in the virgin uterus of the mature female has been first carefully examined and described by Dr Lee. In the body of a young woman who had never been pregnant, and in whom the uterus was of the ordinary size, Dr Lee found the spermatic nerves on both sides chiefly derived from the renal plexus, the most of these nerves distributed not upon the spermatic arteries but on the veins, some branches going to the Fallopian tubes and ovaries, and others passing to the uterus into the great transverse plexuses beneath the peritoneum, on the posterior or dorsal or sacral surface of the uterus.

"The aortic plexus, hypogastric nerves, and plexuses are considerably larger than in the last dissection. [This was in the unimpregnated uterus of a female beyond the middle period of life.] The arteries of these nerves and plexuses have been successfully injected, and it is evident that they are much smaller, than the arteries in the gravid uterus at the fourth month. The ganglia are large and distinct, and the branches sent off to the bladder, vagina, and rectum are all accompanied by arteries filled with injection. Numerous branches of nerves are seen accompanying the uterine blood-vessels to the fundus, and the plexuses on the body of the uterus, before and behind, are continuous with the branches proceeding from the hypogastric plexuses, and the ganglia at the cervix.”—P.8.

From the appearances found in another instance, in which Dr Lee dissected and exposed the nerves of the unimpregnated uterus, in the body of a woman beyond the middle period of life, it results that the aortic plexus, the hypogastric nerves, and plexuses were much smaller than in any of the gravid uteri examined by Dr Lee. There seems, therefore, to be little doubt that the or

gasm of pregnancy has the effect of enlarging not only the bloodvessels, but the nerves of the womb. In this case the description of the nerves is the following.

"From the fore and middle part of the left hypogastric plexus, a small branch passed down on the inside of the ureter to the trunk of the uterine artery and vein, which were surrounded with a plexus of nerves as in the gravid uteri before examined. From this branches passed upward to the fundus uteri, and a communication between these and the spermatic nerves was quite evident. From the left hypogastric plexus numerous branches also passed directly into the uterus without entering the ganglion at the cervix, which ramified under the peritoneum behind, and on the muscular coat. Branches from the posterior part of the hypogastric plexus communicated with some branches of the sacral nerves behind the ganglion. The trunk of the left hypogastric nerve was easily traced through the plexus to the upper part of the ganglion, which was remarkably large and distinct, and consisted of white and grey matter. Into the posterior part of the ganglion, the third sacral nerve sent numerous small branches. From the anterior margin of the ganglion, a broad band of white and grey nerves passed round the outer surface of the ureter, and after uniting with a similar band on the inside, sent branches to the plexus surrounding the uterine artery and vein, and also branches to the anterior surface of the uterus. Large flat nerves were seen passing off from the anterior border of the ganglion to the bladder and vagina, and from its inferior and posterior borders to the vagina and rectum. A great number of nerves likewise passed off from the inner surface of the ganglion into the cervix uteri. The nerves sent off from the ganglion were both larger and more numerous than those which entered it. A great web of nerves was seen under the peritoneum, both on the anterior and posterior surface of the uterus, intimately connected with the nerves sent off by the ganglion and the hypogastric plexus."-P. 7, 8.

We must turn now to the state of the nerves during pregnancy; and it appears from the dissections of Dr Lee, that in this state the nervous plexuses and branches become large and distinct, so as to seem much more numerous than in the unimpregnated organ.

First, in the third month, and it may be added the fourth, the utero-cervical ganglion is large, thick, and distinct, of an oblong shape, about three-quarters of an inch in diameter, and consisting of white and gray matter. Into this ganglion pass the hypogastric and sacral nerves, at this time smaller than in the ninth month; and from its lower margin issue three bundles or masses of nervous fibres, which present an appearance like the pes anserinus of the portio dura or the seventh or facial nerve. This is perhaps a little less distinct in the third than in the fourth month. The posterior of these is subdivided into numerous small branch

es, which, accompanied with arteries, supply the rectum and the back wall of the vagina. The branches of the middle bundle likewise accompanied with arteries, are ramified on the side of the vagina. The anterior branches are ramified upon the bladder and the entrance of the ureter.

From the hypogastric plexus, before it enters the ganglion, and from the inner surface of the ganglion, are sent to the neck of the womb numerous large and small branches of nerves, some of which accompany the blood-vessels to the fundus, and others are spread out beneath the peritoneum. From the inner border of the ganglion issue two nervous bands, one broad, passing on the outside of the ureter, another on the inside, when they unite and surround the ureter. From these united bands many considerable branches are sent to the back part of the bladder, and into the anterior part of the cervix uteri.

On the lower and anterior part of the cervix, over the mesial line, is a thick membranous expansion, into which these nerves are received from both the hypogastric plexuses and the ganglia. From the sides and upper part of this membrane are sent numerous filaments, apparently nervous, which are afterwards lost in the round ligaments.

The state of the nervous system of the womb is described at the sixth month of pregnancy, in the seventh month, and in the ninth month; and it appears that the arrangement now mentioned is the most usual; and that the principal change effected consists in the circumstance, that the nervous branches become larger and more distinct as pregnancy advances. Thus it appears that there is an utero-cervical ganglion on each side of the cervix uteri; that from this branches are sent to the bladder, rectum, and vagina; that from the hypogastric plexus and utero-cervical ganglion conjointly, branches sink into the cervix uteri (Fig. 2. 6.), and are also made to unite with those of the opposite side, beneath the peritoneum; that in the latter periods of pregnancy, viz. the ninth month, similar unions are observed over the posterior surface of the body of the uterus; and that the whole of these nerves become larger at this period than previously.

The conclusions which the author deduces from the whole of these dissections, may be understood from the following extract: "These dissections prove that the human unimpregnated uterus possesses a great system of nerves, which enlarges with the coats, blood-vessels, and absorbents during pregnancy, and which returns after parturition to its original condition before conception took place. It is chiefly by the influence of these nerves, that the uterus performs the varied functions of menstruation, conception, and parturition, and it is solely by their means, that the whole fabric of the nervous system sympathises with the different morbid affections of the uterus. If these nerves of the uterus could not be demon

strated to exist, its physiology and pathology would be completely inexplicable."-P. 8.

These views are ingenious, and seem well founded. But they do not throw so much light on the sympathies and actions of the womb, as might have been expected from an exposition of the nervous system of the womb so elaborate and complete. We believe that Dr Lee wished to confine the present publication to the mere description of anatomical facts; and that he felt, that to go more into detail than is done in the preceding sentence, might have been entering on a subject which is at once uncertain, and upon which, without a full discussion of its multiplied questions, it would have been idle to enter at all.

At the same time it may not be improper to notice shortly one or two points connected with the anatomico-pathological relations of this subject.

It may be inferred that the presence, the formation, and the connections of the utero-cervical ganglions afford a satisfactory explanation of many of the morbid sensations, and uneasy feelings of which females labouring under uterine disorder, and utero-vaginal disorder, complain. Thus, the gnawing pain in the back, and in the lumbo-sacral region, so frequent in females labouring under disordered menstruation, suppressed menstruation, painful menstruation, and utero-vaginal catarrh or leucorrhoea, is doubtless dependent on the turgid and vascular state of the os and cervix uteri acting upon the ganglions and their branches, and reflected backwards to the spinal connections of the nerves from which the uterocervical ganglion is formed.

Many of the uneasy and very excruciating sensations and symptoms at present classed under the comprehensive and convenient abstraction of spinal irritation, are evidently to be referred not so much to irritation primarily seated in the spinal chord, as to irritation, which, if seated there, derives its first origin from causes which act on the uterus, and on its nervous system. By far the greatest proportion of sufferers from the disorder are females; in almost the whole, if not the whole, the uterine circulation and the uterine functions are in various modes and degrees disordered. In one, there is chronic inflammation of the orifice and neck of the uterus, with leucorrhoea. In another, there is amenorrhoea, with an inflammatory state of the inner membrane of the womb. In a third, there is amenorrhoea with an anæmial condition of the womb, or a flaccid, but enlarged, tumid and softened state of the neck and orifice of the organ. In a fourth, there is dysmenorrhoea, with excessive pain in the uterus, vagina, and adjoining parts, at each menstrual period. In no case of this kind, in short, is the uterus or its circulation, quite healthy. These morbid states cannot take place without causing more or less irritation in the uterine extremities of the nervous system of the

womb; and they may, as in other cases, take place, and cause the irritation, without, however, giving indications of the existence or degree of that irritation, at the precise and original locality where it is greatest. But the morbid state of the uterine nerves is reflected backwards to their spinal connection, and there, probably, by the orgasm being propagated to their sensitive roots, gives rise to the peculiar acute, or the gnawing and uneasy pain in the back, or, in short, the excruciating suffering, of which females with deranged uterine action so often complain.

Finally, from the extensive and intimate connections which exist between the utero-cervical ganglion, and the nerves which contribute to form it, on the one hand, and the nerves of the splanchnic system on the other, with which these are associated, we can understand the occurrence of gastric symptoms, as acidity, pica, heartburn, flatulence, gastrodynia, especially the severe pains often felt in the site of the stomach; the intestinal pains, and other morbid phenomena felt in the course of the bowels; the pains in the splenic region; those in the region of the heart, together with the abnormal and often violent action of that organ; the palpitation; the blowing sounds in its contractions; and the rapid motion which it often presents; the pains in the mammæ ; and, in short, many of those neuralgic and painful sensations felt in organs very remote from that which is the seat of the evil.

A therapeutic practical inference deducible from these considerations, is, that in many of the painful diseases of females, careful inquiry into the state of the womb and its secretions, and its appendages, ought to be made, and that in either giving a prognosis, or concerting therapeutic measures, attention should be paid to the state of the womb; and those remedies ought to be exhibited which are most likely to restore that organ to its healthy state, in order to relieve or assuage the other symptoms.

This work is illustrated by two good lithographic delineations of the nerves of the gravid uterus. In the explanation of the first figure in Plate first, there is some mistake, as there is no explanation to the cypher figure 12.

ART. IV.-Abhandlung über Perkussion und Auskultation. Von JOSEPH SKODA, D. der Medicin, Mitglied der Medicinischen Fakultät und der k.k. Gesellschaft der Arzte in Wien. Wien, 1839. 8vo, pp. 271. Treatise on Percussion and Auscultation. By JOSEPH SKODA, M. D., Member of the Medical Faculty and of the Royal-Imperial Society of Physicians in Vienna. Vienna, 1839.

SINCE the year 1819, when Laennec first published his views on the diagnosis of the diseases of the lungs and heart, by means of auscultation and percussion, that method of observing the na