Early pregnancy, that is, the first eight to ten weeks of gestation, is sometimes complicated by a set of symptoms the most prominent of which are sudden very acute pains in the lower part of the abdomen, followed by intense prostration, and then by the symptoms of internal bleeding,--namely, a soft pulse, pallor with cold extremities, sighing respiration, and marked tendency to faintness. When symptoms like these occur during the first three months of pregnancy, they signify, almost without exception, rupture of an extrauterine gestation-sac. Except where operation can be performed at once, these cases are almost invariably fatal. Extrauterine pregnancy occurs with greatest frequency in women who, having had one or more children, then have a period of five or more years without children, followed by pregnancy. Undoubtedly, extrauterine pregnancy, the knowledge of which is the result of medical advance in very recent years, and appendicitis, which is the growth of the last twelve years, were prominent factors in the production of many inexplicable deaths in history. These were not infrequently set down as due to poison. Acute indigestion in elderly people is sometimes followed by sudden death. Observations in this matter have somehow become much more frequent of late years, and many of the so-called cases of heart failure belong to this group. The important nerve trunk that carries nervous fibres to the heart bears fibres to the digestive tract, the oesophagus, the stomach, the intestines, the liver as well, and also to the larynx and lungs. There is a certain intercommunication between the impulses which pass along these various nerve fibres. Intense irritation of the nerve endings in any one of these organs may be reflected back upon the heart. Curiously enough the nerve fibres to the heart that run in this trunk are many of them inhibitory; that is to say, they lessen the function of the heart or cause it to stop beating entirely. If an intense nervous irritation is set up in the stomach, reflex nervous impulses may cause the heart to stop completely and never resume its work. Typical cases of this kind often occur during the first cold days of the winter time. Elderly people come to their meals cold and chilly, yet with appetite increased by the bracing air. They sit down at once, take a larger meal than usual, and then develop severe gastritis during the night. This is {155} relieved by purging and vomiting, and the pain yields to the administration of morphine. Their condition improves and all danger seems past, when, on sitting up suddenly the next day, or, if left alone, getting up to get something for themselves, they collapse and are dead before help can come to them. Deaths like this sometimes occur in dysentery also, the reason being the intense nervous reflex from the irritated intestinal nerve endings which exerts its influence upon the heart nerves.