Theories aside, we must to-day accept the classic division, and say that in the vast majority of cases death results' under the following conditions: 1. Lesions of the circulatory system: a. Lesions of the heart or of its envelopes ; alteration in the valves; myocarditts ; hydatid cysts of the septum of the heart ; pericarditis ; rupture of the heart. In this sub division belong the cases of P. Dubois, MacCorvan, Corvisart, Hervieux. Depaul, McClintock, McNichol, Spiegelberg, Simpson, Despeaux, Ader, Peleyo, Danyau, Coste, etc.
b. Hemorrhages.—The cases of Elsasser, Lachapelle, Dubois, Quesnel, Johnson, Matice, Zenker, Besniors, 011ivier d'Angers, Hervieux. In all these cases death has been rapid, but not sudden, in the true sense of the word.
c. Thrombosis of the Pulmonary Artery. Cases of Dionis, McClintock, Hervieux, Gosselin, Prestat, Hawer, Charcot and Ball, Hoogeweg, Simp son, Pajot, Jacquemet, Playfair, Peter.
d. Presence of Air in the Heart and the large Vessel&—Lachapelle, Baudelocque, Lionnet, Bessens, Olshausen, Litzmann, Depaul, Berry, Leven, Smith, Walford, Schroeder, Hervieux, etc.
2. Lesions of the Respiratory System (congestion, pulmonary apoplexy, pleurisy, pleuro-pneumonia).—Cases of Mordret, Moynier, Charpentier,
Delamotte, Campbell, Devilliers, Verrier, 011ivier d'Angers.
3. Lesions of the Nervous Centres (hemorrhage, traumatic shock, moral emotions).—Cases of Meniere, Schedel, Lachapelle, Moynier, Mordret, Villeneuve (Marseilles), Writan, Blum, Playfair, Burdel, Travers, Mor gagne, Robert, McClintock.
4. Puerperal Poisoning, Septiccemia.—Hervieux, Lachapelle, Dubois, Keith, Challier, Schroeder, Larrey, Meritan, Charpentior (two cases.) 5. Acute Such are the usual causes of sudden death in the puerperium. In many instances, it is apparent, there existed a lesion which predisposed to this sudden end, and from this standpoint phlegmasia alba dolens, by causing the formation of a thrombus in the crural vein, should hold the first place. Happily this fatal sudden termination is rare, and must be considered exceptional.
As for the belief that the property of the blood of puerperal women of coagulating spontaneously plays a part, for our' part we would reject it absolutely, for since this property exists in all, puerperal women, we should be astonished not at the accident, but at the infrequency with which it occurs.