Cases of shock have been reported, said to be due to compression of the ovaries, when Credé's method of expressing the placenta has been employed.

cases.

3. Typhoid.-Rare. Premature labor occurs in 65 per cent. of Labor unfavorably influences the disease, often causing profound shock after delivery. Active stimulation should be employed during labor, and forceps used in the second stage.

4. Pneumonia or other Adynamic Diseases.—Require stimulants. Whiskey, digitalis, carbonate of ammonium administered in the first stage, and labor terminated in the second.

5. Valvular Defect in Heart.-Extensive mitral disease frequently causes death; mortality 53 per cent. The heart is embarrassed during pregnancy or labor, and manifests its weakness directly after the expulsion of the child or placenta. When the discharge of blood is profuse, cardiac failure is rare in these cases, thus indicating the treatment: Venesection, removing 8-16 oz., if there is not much blood lost after labor. Nitrite of amyl directly after labor has given very good results. Digitalis should be given in the first stage, and forceps or extraction by the feet (in breech cases) resorted to in the second. Sudden Death during or directly after Labor.

Causes.-1. Profound Mental Impressions, as sudden joy, grief, fear, exaggerated shame, excessive pain.

2. Shock.

3. Heart Failure.-It may be due to advanced kidney disease, fatty degeneration, fibroid patch, rupture of aneurism, myocarditis, etc. So small a matter as an intrauterine injection has caused death in these cases.

4. Accidents of Labor, as accidental, unavoidable, or postpartum hemorrhage, rupture or inversion of uterus.

5. Rupture of Hæmatoma, externally or internally.

6. Syncope. This is not usually fatal. It is favored by the determination of blood from the brain, as by hemorrhage. Thromboses in the heart may form, and those in the uterine sinuses may be prolonged and embolism result. Prolonged syncope, associated with air hunger and other symptoms of profuse internal hemorrhage, is almost always fatal.

7. Embolism and Thrombosis, especially of Pulmonary Artery.

May be the result of syncope, or it may possibly be caused by entrance of air. Embolus of fat from pelvic connective tissue has occurred.

Symptoms. Sudden shock, heart failure, rapid respiration, air hunger, followed usually by death, although not invariably fatal. 8. Rupture of Gastric Ulcer.

9. Acute Purpura Hæmorrhagica.
10. Rupture of Peritoneal Adhesions.

11. Rupture of Aorta.

12. Rupture of Cyst in Auricular Septum.

13. Angina Pectoris.

Effect of Maternal Death upon the Foetus.-The fœtus survives rarely more than a few minutes. It has lived for two hours.

When making an autopsy on a parturient woman, it is convenient to split the symphysis and remove the genital tract in one piece.

Post-mortem Delivery.—Accumulated gases have caused delivery of foetus, giving rise to the suspicion of burial before death.