proportion to the increasing bulk of its contents, the rate of accommodation is liable to be outstripped by the distending force. The uterus becomes thinned out, stretched, therefore weakened. If the thinning happen to be more marked at one part, rupture at that part is very likely to happen if a sudden contraction occur. And especially is this likely if the tissues have undergone morbid change. This is the more likely to happen because distension of the uterine fibre is very apt to cause vomiting; and vomiting has been noted as a factor in the production of rupture. That the expulsive action of the auxiliary muscles may conduce to rupture, the following considerations show. Tyler Smith says: "In cases where the uterus is feebly developed or weakened by disease and exhausted action, the contractions of the abdominal muscles must contribute to the rupture of the organ, by urging the head or presenting part of the child through the os uteri." In the lecture on "Retroversion" (see p. 267) cases are cited showing that the vagina may be ruptured by the pressure upon it of the retroverted uterus, gravid or after labour. And so an ovarian tumour, as in Mr. Berry's case already referred to, and in Dr. Dunn's (see p. 368), may be so driven into Douglas' pouch as to tear through the posterior wall of the vagina. Reasoning from the observation of some cases in which the uterine tissue was altered by disease, and partly from the the he the opinion has lately found |