membranes toward the left margin of its circumference seemed unusually dense, feeling like a smooth, thick, folded fibrous mass, thus making the os much thicker at that point than else where. The gravid organ was low down in "the pelvis," the hard surface of the presenting part (vertex) being more readily discerned through the uterine structures on the right side than on the left, where it could not with certainty be detected. The woman stated that the hemorrhage had ceased since the labor commenced.

Knowing that she could not possibly be beyond seven months pregnant, and hoping to arrest this third attempt at miscarriage, a full dose of opium was prescribed, and I left, with instructions to be sent for, if the pains became more active during the night. At 3 o'clock A. M. was called again, and found the os fully dilated, the second stage of labor having commenced; vertex presentation; right occipito-posterior position. There had been no hæmorrhage of moment during the night. At 4 A. M. a premature infant, weighing about two pounds (attached by a remarkably small, short cord) was born, which made feeble efforts at respiration. The hand placed upon the abdomen showed little reduction in the size of the womb, and an examination, per vaginam, that the placenta was not detached, the insertion of the aforesaid cord being readily felt at the left side just within the os, and above was the pouch of membranes enveloping another child. Abdominal frictions and a dose of ergot brought on pains, with a descent of the presenting part, the vertex also, and in fifteen minutes the birth of this occurred, enveloped in its membranes. This, the largest and most vigorous, was attached by a long, large gelatinous cord that encircled its neck. The uterus contracted well, expelling the placenta immediately, with little loss of blood. Both children died within an hour. The conformation of the placenta was peculiar; while preserving the ordinary circular outline, one part of its margin was thin, beveled off, and composed chiefly of duplicated folds of membranous structure entirely destitute of what is known as the parenchyma of the after-birth. Into

the free margin of this attenuated portion the small cord of the first child was inserted, the vessels composing it wending their way quite prominently through its translucent folds towards the more material part. It was about one-third the size of the other, which was implanted midway between the centre of the placenta and the opposite thick, fleshy, border; the first, with the corresponding infant, resembled a dwarfed, stunted growth from an impoverished soil; the second as pointedly indicated the superiority of its vascular connections. This is in harmony with the remark of Dr. Toner, "that the child having the cord attached nearest to the centre of its placenta will be the best nourished, and therefore the largest."

Surveying the case now in its details, it becomes quite clear that the position of the placenta determined the uncontrollable and (in a certain sense) ceaseless hæmorrhage for four months, or longer. Its peculiar form and implantation upon the cervix so near the os, served to impress upon the case the combined features of accidental and unavoidable hæmorrhage. This peculiarity of structure rendered it, perhaps, liable to an easy compromise of its uterine attachments at their weakest point, which was, in all probability, near the os uteri. Rest ordinarily favors arrest of hæmorrhage, but under these circumstances the pressure of the contents of the organ upon this attenuated portion of the placenta when in the erect position restrained the flow, precisely as the presenting part arrested it when labor fairly began; hence the greater loss of blood at night, when this pressure was diminished or removed.

ART. III.-REPORT OF A VERY FATAL FORM OF DISEASE OCCURRING IN BLACK SWAMP, DALLAS COUNTY, ALA., WITH AN ACCOUNT OF AN AUTOPSY. Reported by BENJ. H. RIGGS, M. D., Selma, Ala.

I avail myself of your popular journal to call the attention of

your readers to a remarkably fatal series of cases that have occurred within the last ten days at the farm of Mr. John McIlvain, about four miles from Selma, among the colored people living there. Within this time eight persons have died, two men, two women, and four children. The history of the cases, as far as I can learn, is as follows: Without any previous disturbance or admonitory symptoms of note, the patient is seized with a chilliness, which increases to an aggravated ordinary chill, passing into congestion, coma, and death in from eight to twenty hours. Dr. C. D. Parke, the usual medical attendant, saw three of these cases in the confirmed stage shortly before death; the others died before he could reach them. This is about what he states to be a typical case: Patient stupid or intellect wandering at intervals; answers when loudly called; pupils somewhat contracted; no rigidity of the dorsal or post-cervical muscles; no spasms as a rule; slight in one case however; feet and hands cold; skin of extremities high up and of body warm and relaxed, and bathed with warm perspiration; respiration fifty-two, labored and much mucous rales; pulse weak and increased in frequency; tongue not very heavily coated; not much thirst. Dr. Parke invited Dr. H. S. Hudson, Dr. J. S. Peterson, and myself, to go out on Saturday, April 1st, to make an autopsy of the body of a middle-aged negro woman; this woman was taken sick on Friday afternoon, and was dead at 3 o'clock Saturday morning; she, her husband, and three of their children, all living in the same house, were the first taken-all died. To illustrate how sudden in its onset and rapid in its course is the disease, I will give the following statement: We dined with Mr. McIlvain, after the post mortem, at about 3 o'clock P. M.; we observed a well-developed, robust, young black woman waiting on us around the table; she was taken sick as above an hour or two afterwards—say, 5 P. M. of the same afternoon, and was dead before next morning's sun was up. An old, healthylooking mulatto man, turning gray from age, assisted us in the examination; in fact, he loaned us his hand-saw to aid us in making section of the skull; he also was dead before next morn

ing. Before next morning, also a child living in another house from the infected locality, as did the house-girl also, was moribund, and died since, making the eighth case. Mr. McIlvain had a slight seizure the same fatal afternoon (Saturday) like the others, but under timely assistance, vigorous stimulants, and revulsives, was relieved.

Autopsy: Made nine hours after death. Dr. Peterson, the junior member of our party, deserves credit for cheerfully and zealously doing the most of the work. Rigor mortis not great; body not very cold; expression of countenance placid and natural; plumpness good; no shrinking or shriveling of skin or muscles; pupils not much dilated; abdomen not distended. In turning the body partially on the side and drawing up the head, a quantity of slimy, pea-green fluid ran out of the stomach per orem. We removed the calvarium and examined the brain; there was no evidence of inflammation; the membranes were natural; the brain was normal in consistence, color, and the quantity of its fluids, except there was a slight excess in the quantity of dark blood contained in its sinuses. The spinal cord the medulla spinalis and theca-was not perceptibly abnormal. The spleen was dense and hypertrophied. The lower lobe of the left lung was of a dark slate-red color, and filled with a frothy mucus or serum; the greater part of the upper lobe of this lung was in the same state, but not to such a degree; the lower and middle lobes and lower part of the upper lobe of the right lung were congested, mottled, and irregular on the surface, and filled with a crepitating fluid; the upper part of the upper lobe of this lung looked natural and healthy. Here seems to be the seat of the disease; it is a congestion, not yet an inflammation. The liver and kidneys were sound.

The question of importance is, what was the disease of which these people, all negroes, died? The farm is situated in Beach Creek Swamp, a famously malarial locality; within the last four years there has been much clearing up of undergrowth, and felling and belting of timber, and causeways built of young green timbers, which are now beginning to rot. There is also a

large pen of rotten, offensive cotton-seed in a field near by.. The houses are situated on narrow ridges of land, and the surrounding low grounds are and have been through many months partially covered with water.

The Winter here has been unusually mild and wet; we have had no freeze since early in December last.

May not these cases be the explosive or "fulminant" form of malarial disease, in which the immediate cause of death is a congestion or drowning of the lungs? Due to the depressing or quenching effect of that poison on the great sympathetic system. I would like to hear from the experience of others on this head. The settlement, by advice of the physicians, has been broken up; hands to return and work during the days.

P. S., April 5th-I have just learned that two more have died, in manner as above, since they moved away. Probably they carried the disease with them. This makes ten deaths. I append a note by Dr. C. D. Parke.

"I saw two cases; in one the pulse was what I would call a good pulse of ninety, until some hours before death; skin in a moist pleasant state, even to the ends of the fingers and toes. The other was cold to knees and elbows, and no pulse at wrist; in temple ninety. I saw one case in the chill, two hours after the attack, and after a careful examination thought it of a very mild type: the same impression was made on Mr. McIlvain in the commencement of the other cases. The delirium came on from six to fourteen hours after attack.

"I would also state that the answer to a prompt call seemed mechanical, and only existed up to five hours before death, after which they were completely comatose."

ART. IV.-OPERATIONS FOR STRICTURE AND STONE PERFORMED SIMULTANEOUSLY WITH SUCCESSFUL RESULT. BY DR. DAVID CUMMINS. W. DOUGLAS MORTON, M. D., Louisville, Ky.

J. M., aged 63 years and eight months at the time of opera