THE LANCET,] "VERY LIKE A-TAIL."-MEDICINE AND THE PULPIT. of the self-respect and independence of the poor; and that it will be necessary that help, hitherto given indiscriminately, should in future be either largely curtailed, or, at least, surrounded by restrictions at present unknown. We feel strongly that there can be no real improvement as regards public relief until out-door pauperism is placed under an improved form of the official inspection that is at present confined to workhouses. "VERY LIKE A TAIL." THE statement made in a paragraph that appeared in The Times with the above heading is in no way unworthy of credit. As every anatomist is aware, the coccyx represents an abortive tail; and if, instead of forming a curve with its concavity directed forwards, the concavity should be directed backwards, the appearance described by "B' without a Tail" would be at once produced. The case, however, is a remarkable one; and we trust that a scientific description may be elicited from the surgeon who saw it. It would be interesting, for instance, to ascertain whether the appendage consisted of an hypertrophy of a single bone, or was composed of a series of separate bones; and, in the latter case, whether these were articulated with one another or not. The length of the tail in some of the apes, we may remark, does not materially exceed the dimensions ascribed to the appendage in question. MEDICINE AND THE PULPIT. LAST week we noticed the fact that a Sanitary Association had been formed in Newcastle-on-Tyne on the suggestion of the Rev. J. H. Rutherford, who is a dissenting minister, and has, comparatively lately, obtained the licences of the Colleges of Surgeons and Physicians of Edinburgh. Newcastle-on-Tyne has been on various occasions distinguished for its unhealthiness, and nothing can be more proper than the formation of a Sanitary Association. But there are some peculiarities in Mr. Rutherford's way of teaching truth on sanitary questions to which he will excuse us for objecting. [JAN. 9, 1869. 59 crowded church or other place, and especially if the patient be a lady, it may be considered a mere fainting; and the best way of relieving that is, to lay the patient down if possible, use a fan and the smelling-bottle, and as soon as the patient has recovered a little remove her into the open air. The case of a man found insensible is altogether of a graver complexion. Even here the generally safe thing is, to lay him down on his side, keeping the head a little raised; to loosen anything about the neck; allow air to play about the patient; and send for the nearest doctor. If the patient is quiet and pale, and can swallow, a little wine and water, or spirit and water, may be given, pending the doctor's arrival. If he is in violent convulsion, with foaming at the mouth, the great duty of bystanders is to control the movements of the patient so that he do not injure himself; to loosen the neckerchief; allow plenty of air to circulate, and await the arrival of a doctor. The patient cannot swallow in this condition, and the fit will in all probability pass off in a few minutes. THE MEDICAL CORONER OF MELBOURNE ON Of all unflattering doctrines recently stated, the doctrine of the inability and unfitness of ordinary medical men to make a post-mortem examination is one of the most offensive; and of all the offensive statements of the doctrine, none is so insulting to our profession as that of Dr. Youll the medical coroner of Melbourne. He seems to combine I with the most complete distrust of other medical men the We We gather from a local paper that he has delivered a course of lectures on these questions in his church, one of them being entitled, "What about Cholera ?" Now, we shall not be suspected of any indifference to this question, and we think it proper that medical men should in fit places enlighten the public by answering the question. But surely a church is not the place for such a discussion. That is a place for the treatment of spiritual questions. If Mr. Rutherford is to continue the double duty of a minister and a general practitioner, he should above all things not talk "shop" in the chapel. We know that an eminent American preacher has lately sanctioned by his example this kind of thing by allowing a physiological lecturer the use of his pulpit on a Sunday night. He himself was not the lecturer. If the old themes of the pulpit are true, they are worthy of the exclusive use of the church. Mr. Rutherford's case is worse than Mr. Beecher's, for, being a medical practitioner as well as a minister, the vulgar may suppose that he is using his ministerial position for the dis-established in the Presidency of Madras. Lord Napier is play of his medical learning. And it is above all things necessary that a minister should be, like a certain illustrious lady, "above suspicion." WHAT TO DO IN CASES OF SUDDEN ILLNESS. A CORRESPONDENT wishes us to give some directions for the guidance of the public in cases of sudden attacks of illness. It is not easy in a short space to lay down instructions of this kind. But the following principles may, in most cases, be safely acted on. If the case occurs in a THE CONTAGIOUS DISEASES ACT IN MADRAS. Report for 1867 of the working of the several Lock Hospitals enabled to report to the Secretary of State for India that there has been a considerable diminution in the total number of admissions into hospital for this class of diseases number of women treated amounted to 1349, being a deamong the European troops during the year. The total crease of 222 on the number of the previous year. Among the troops the percentage of admissions to strength has been reduced from 21.1 in 1866 to 184 in 1867. The reductions at some of the military stations have been strikingas, for example, at Secunderabad, where the number of ad missions has sunk from 24.6 to 12-72; and at Wellington, where the percentage treated in 1866 amounted to 278, but now only amounts to 13:47. Most of the medical officers call attention to the far milder character assumed by these affections among the patients of both sexes. They complain, as we do, of the difficulties arising from a limited application of these measures. The excess of this class of affections among the men of one European regiment was found to be due to the fact that they had contracted their disease at a station in which the Act was not enforced. The obvious remedy for this state of things is to introduce and extend the legislative measure all over India. HYGIENE AFLOAT. offspring but to get the most they can out of them. If, as FRIENDLY SOCIETIES AND THEIR SURGEONS. THE new year has found the battle of the clubs still undecided. Both sides have suffered in the conflict, but the steady and united resistance of the friendly societies has WE took occasion last month to refer briefly to a report lately presented to the Commissioners of Sewers by Dr. Letheby, in which the defective sanitary condition of vessels moored in the Thames was duly and properly noticed. In the autumn of 1866, when the epidemic of cholera commenced, Dr. Rooke, surgeon to the Dread-given them an advantage over the less combined action of nought hospital ship, recommended the Committee of the Seamen's Hospital Society to institute a ship-to-ship visitation on the river between London Bridge and Gravesend. The very complete organisation of that business by Dr. Rooke, the able manner in which it was performed by Mr. Johnson Smith, and the other professional visitors engaged in the work, formed a subject of comment in most of our leading journals, and a very decided opinion was expressed by those journals that, in the interests of the floating population, a unity of sanitary supervision should be established in the port of London. The Thames Conservancy is, as the governing body of the river, most competent to deal with this important question, and there can be no doubt that legislative powers might be granted whereby the sanitary, as well as the administrative, jurisdiction of the Thames could be placed under its care and control. Many of the members of that body hold also high positions in the Corporation of the City of London. Dr. Letheby has done good service in representing to the Commissioners of Sewers the urgent necessity that exists for prompt and immediate interference. We trust that this will form one of the many important questions of internal reform that should be discussed and settled in the forthcoming session of Parliament. THE FACTORY EXTENSION ACT. A CORRESPONDENT of the Standard calls attention to two letters which appeared recently in the Birmingham Daily Post, animadverting upon the duties of the medical pro-, fession under the Factory Extension Act, and attempting to show that the services of the certifying surgeons are both costly and useless, since the certificates of birth are much more reliable evidence of age than any skilled opinion. The manufacturing interest is so well known to resent all interference with its supposed vested rights in human life and health, that we are not surprised to find a Birmingham writer inclined to kick against the pricks, and (vote all medical interference a bore and a sham, particularly since the manufacturer has to pay for the very inspection of which he complains. Fortunately for humanity, the "strength and healthy` appearance of every child under thirteen employed in a factory must be certified by a medical man under the Acts, 3 and 4 Wm. IV., c. 103, and 7, 8, and 9 Vict. To suppose that birth certificates may be usefully employed instead of medical inspection, displays a total ignorance of the manner in which birth certificates can he manipulated by parents who have no thought of their the surgeons. Still the contest is an open one, and there are many instances in which the five shilling rate has been accepted. In Oldbury, Wednesbury, and Darlaston, and some other places in the Black Country, the surgeons are firm, and hold frequent meetings, at which the various incidents of the contest are considered, and resolutions passed to meet the exigencies of the position as they arise. By this organisation a tone has been given to the movement in South Staffordshire which renders the contest hopeful. In Birmingham the Cannon-street Provident Institution has abandoned its two and sixpence, and now asks by advertisement in the public papers for seven surgeons, offering the remuneration of three shillings per head per annum. There can be no doubt as to the course which ought to be pursued, and it is to be hoped that the absence of any application from the more respectable members will teach the members of this Society that their offer is grossly inadequate. After the last annual meeting the Cannon-street Society found itself almost without surgeons; the 28th instant should find it without a single medical officer. As the Society which resisted the first demand for increased remuneration, it is now again testing for its fellows the firmness of the profession, and the response which is returned to its advertisement will carry with it victory or disaster to the movement in Birmingham. STREET ACCIDENTS. DURING the year 1868 the deaths of 203 persons resulted from horse or carriage accidents in the streets of London; 65 of these occurred to children under ten years of age, and 120 to adults. Injury from horses caused 7, omnibuses 12, cabs 21, vans or waggons 45, drays 7, carts 53, and other vehicles not described 58 deaths. To the Registrar-General's inquiry whether heavy waggons and the like should be allowed to be driven as recklessly as they are now in the streets of London, we have no hesitation in saying, No, nor light ones either. At present, drivers are, as a rule, not only sublimely indifferent to the fate of pedestrians who may happen to cross their path, but are equally careless about collisions with other vehicles; and the consequences are partly seen in the statistics of death above quoted, but they are much more fully known to hospital surgeons, as well as in private practice, by effects of which the public at large know very little. We hope, that under a new Police Commissioner, the modern prototypes of that Jehu who was recognised of old by his "driving furiously," will find themselves constrained to become more mindfui of life and limb. THE LANCET,] THE DANGERS OF ENAMELING.-BAD DRAINS. THE DANGERS OF ENAMELING. THAT the dangers to which enamelers of cards and other articles are exposed are not imaginary, was proved in the instance of two cases brought under the notice of the Medical Society of London, on Monday last, by Dr. Oppert. One case was that of a man of middle age, who had been in the trade for twenty-six years, and exhibits at the present time decided and severe symptoms of lead-poisoning. There is the unmistakable blue line along the gums, and, in addition, loss of sensibility and mobility of the left arm and leg, so that the gait is unsteady. The second case was that of a man who used a compound of white lead and sulphur for the purpose of glazing the straw hats that are imported from Florence. He also possesses the blue line along the gums; but the absence of any severe symptoms of poisoning is due to the use of the antidote with the poison. The materials used by the former of the two patients have been placed in our hands by Dr. Oppert, and they consist of arsenite of copper (the employment of which is stated to be followed by bleeding from the nose) and oxide of lead. Here, at any rate, are two undoubted instances of metallic poisoning in the case of men employed in the glazing of cards and straw hats. It is, of course, impossible to say how much mischief of a similar kind escapes detection. We have known enough for some time to feel that some protection should be afforded to workmen engaged upon the use of dangerous colorants in manufactures. THE BIRMINGHAM BOARD OF CUARDIANS. Ar a recent meeting of the Birmingham Board of Guardians the following important resolution was carried, on the motion of Professor Clay: "That the Board take into consideration the whole question of out-door medical relief of this parish, with a view to revising the same; that the matter be referred to a committee, and that the committee be empowered to have the several district medical officers examined thereon." We are glad to find so able a member of the profession moving in this matter, and we trust that the deliberations of the committee will result in an improved method of administering out-door medical relief, as well as in a more adequate remuneration of the medical officers. For the appointment of resident medical officer to the workhouse, rendered vacant by Dr. Robinson's election as public vaccinator, there are several local candidates in the field. PROPOSED FREE HOSPITAL FOR SICK [JAN. 9, 1869. 61 sick little children without being so identified with the shibboleths of religious party; and we put it to the promoters, who, we are sure, are moved by the most benevolent motives, whether they cannot make their scheme yet nobler by making it wider, and detaching it from all sectarianism. 66 BAD DRAINS. A CORRESPONDENT describes in the Daily News of Monday a disgraceful arrangement of drains "in a good house in one of the best squares on the Bedford estate," which was fortunately discovered and remedied ere much damage was done. Smells came from the upper stories, and it was found that the rain gutters on the roof discharged into a broad open pipe which also received the soil from two waterclosets. Necessarily therefore the pipe conducted to the roof of the house the foul gases from the common sewer. The writer remarks,- Talk of fever and pestilence creeping through the drains into our kitchens; here they were nestling in the roof over my sleeping children." That, under similar circumstances, fever will attack the inmates of a household, has been shown by Dr. Buzzard, who describes in THE LANCET of Nov. 7th, 1868, how seven persons were attacked with typhoid in a house where the rain-pipe was employed as the soil pipe of a watercloset. We are tired of inveighing against the ignorance of builders on these points. When the public generally has succeeded in acquiring a faint idea of the dangers, as well as the unpleasantness, attaching to the entrance of sewage gas into their dwellings, we may expect a gradual improvement in the first requisite of health in a civilised community. LEAD-POISONING ON THE TYNE. A VALUED correspondent reminds us of a fact of which we were not altogether ignorant-that there is a great amount of lead-poisoning involved in the various works on the Tyne. He says "it is pitiful to see the number of young girls suffering from lead." It is not improbable that this subject of lead-poisoning will be brought before Parliament. It is of sufficient importance to be a matter of inquiry, whether we consider the suffering involved in lead-poisoning, or the frequently early disablement of the sufferer in various ways. It is about the height of injustice to see a poor man or girl first in the course of their employment poisoned with lead, so as to be rendered unfit for work, and then quickly and heartlessly discharged when unequal to the work which has poisoned them. THE NAVAL MEDICAL SERVICE. THE official Navy List for January shows some addition to the members of the naval medical profession since the corresponding period of last year. Only one promotion to the rank of Inspector has taken place during the past year Ir is proposed to have an hospital for sick children in Nottingham. Such hospitals are a necessity in most towns, and especially in large manufacturing towns like Nottingham. There is one detail of this scheme which we highly-that of Dr. Salmon. The two vacancies in the list of approve the admission is to be free, on application, according to the room and the means provided by gifts and subscriptions. The worst cases are to be admitted first; and the propriety of admission and the urgency of the case are to be decided by the medical officers. This last rule cannot be too highly praised, as securing the best use of the beds of the hospital. Another feature of this proposal, however, we cannot so highly commend. It bears the impress, on the very face of it, of a sectarian scheme. The nursing is to be by religious sisterhoods; and we gather from the advertisement that even the medical officers have been selected by the promoters, and not elected by the votes of the general public of Nottingham. It says little for our Christianity if it cannot act for the relief of Deputy Inspectors, caused by the sudden death of Dr. Beith and the promotion of Dr. Salmon, have been filled by the promotion of Drs. Nelson and Pottinger, the number remaining at 15 as before. The list of Staff Surgeons has only grown in the year from 85 to 91, although 13 Surgeons have been promoted during the year, the balance being struck by promotion, retirement, and death. There are now 177 Surgeons, against 183 last year; and of these only seven have been promoted during the year-a smaller number than has occurred within the memory of the oldest “salt.” The Assistant-Surgeons, who numbered 240 last year, have increased to 245; but as the Admiralty appears to have entrapped thirty-two youths during the twelve months, and has promoted but seven of their seniors, there remains a balance of twenty assistant-surgeons, who appear to have been "expended," to use the correct nautical expression. We know that, unfortunately, some of these vacancies have been caused by death on duty; but the majority have resulted from that tendency to resignation which leads to the active rather than the passive conjugation of the verb "resign," on the part of gentlemen who have had one or two years' experience of the Royal Navy. LIGATURE OF THE LINGUAL ARTERY. On the evening of Friday, January 1st, Mr. Christopher Heath tied the left lingual artery in a patient in University College Hospital, for hæmorrhage from a cancer involving the left half of the tongue, which resisted ordinary treatment. The ligature was applied in the digastric triangle by cutting through the hyo-glossus muscle, and the artery was reached with comparative ease. There has been no recurrence of the bleeding, and the growth has considerably diminished since the operation. THE MEDICAL BENEVOLENT FUND SOCIETY OF IRELAND. DR. R. M'DONNELL, with a generosity which does him infinite credit, and shows his unselfishness, has intimated his intention of paying over, in the future, the pension assigned him by Government as late medical superintendent of the Mountjoy Prison to the Royal Medical Benevolent Fund Society of Ireland, and has forwarded a cheque for the first instalment to the secretary of the Society, expressing a regret that the sum is not larger than it is. A sum of £121 19s. 2d., left under the will of Dr. Kingsley, the founder of the Society, has been handed to the treasurer. THE CAS EXAMINERSHIP OF THE CITY THE election of a Gas Examiner for the City of London, in consequence of the resignation of Dr. Letheby, is now exciting considerable attention; the more so as the salary offered has recently been increased from £200 to £500 a year. A great number of candidates already exist, among whom are Dr. Whitmore, Dr. Septimus Gibbon, and Prof. Redwood. It appears to us that the last-named gentleman is specially fitted for this important post, inasmuch as his well-known reputation is an all-sufficient guarantee that the work would be skilfully and properly performed; and we believe that the Corporation would be most fortunate in securing the services of so distinguished a chemist. THE RECENT EPIDEMIC OF TYPHUS IN THE epidemic of typhus which recently prevailed in Naples has now almost completely died out. The Italian journals give the following statistics of the havoc which was created, and show how dearly the non-observance of sanitary laws is paid for by a neglectful population. Our readers need not be informed of the filth and foulness which pollute Naples. Up to the date of August 31st, at which time the epidemic had lost its intensity, the various hospitals had received 5151 patients, of whom 603 died, making a proportion of 113 per cent. The number of cases observed in the town amounted to 2708 cases, of which 683 terminated fatally, thus giving a proportion of about 25 per cent. The total number of cases amounted to 7859, with 1283 deaths; in other words about 161 per cent. mortality. It is curious to note that the mortality in the town was double that which occurred in the hospitals. AT the monthly meeting of the Committee of the Medical Benevolent Fund held on Dec. 29th the amount distributed was £70, the number of recipients being ten. On Tuesday next (Jan. 12th) the annual general meeting of subscribers will be held, after which the report will be issued, and an appeal made to the profession for further support. The following donations are thankfully acknowledged: James Paget, Esq., F.R.S., D.C.L., £25; Mr. Stocker (by Dr. J. S. Stocker), £5 5s. AN important sanitary measure has just been adopted by the municipal authorities of Paris. Hitherto, new-born children were obliged to be taken to the respective mairies to have their names inscribed on the register of births. This was a fruitful cause of disease and infant mortality. The baneful custom is now done away with, and the French Government has directed that in future medical men attached to the État Civil, or municipal institutions in Paris, shall, on being informed by the parents, repair to the children's domicile, and there register their birth. MR. GENTLES, medical officer for the south district of the Derby union, has reported to the guardians that during the last half year scarlatina has been very prevalent and fatal, causing 15 out of 39 deaths. The chairman expressed the opinion of the Board that Mr. Gentles' report was a most excellent one, and that they quite agreed with the remarks he had made on the means necessary to diminish disease. We may anticipate, of course, that something opinion on the part of the Board and their medical officer. practical will follow from this satisfactory coincidence of We are happy to notice that Liverpool no longer occupies the unenviable position of lowest on the Registrar-General's returns. Thanks to the efforts of the Health Committee, the death-rate has so diminished that it is able to take a fifth or sixth place. The last return] of Dr. Trench gave 248 deaths within the borough in the week, 101 being of children under five years of age. THE number of the medical profession in the colony of Victoria is on the decrease. During the past year only sixteen names were added to the register. Of these about half are re-registrations; and as there have been at least half a dozen deaths, and as many leaving the colony, the present number is something less than it was at the beginning of the year. In 1867, on the contrary, there were thirty-five additions, and the deaths were not more numerous than in the past year. This lessening of the number of medical practitioners is indicated by the fact that at the present moment there are six houses to let in Collins-street, the medical quarter of Melbourne. Four years ago houses were at a premium in this street, one gentleman having given £100 to become the tenant of one of the more eligible residences. The dearth of unemployed medical men has been further instanced by the Committee of the Melbourne Hospital having elected on the resident staff two of the senior students of the university. THE Pall Mall Gazette states that the Poor-law Board have in contemplation the introduction of certain reforms in the present system of relieving casuals, and have solicited by circular an expression of opinion from the various boards of guardians upon the proposed alterations. It is intended to make uniform the dietary and amount of task-work in all the unions in the country, and the Board have submitted for the consideration of the local guardians a not too liberal scale of diet and a fair average task. The Board insist upon THE LANCET,] THE PATHOLOGY AND TREATMENT OF UTERINE FLEXIONS. the enforcement of the bath, recommend the system of separate sleeping cells, and make various suggestions for the curtailment of the comforts of casuals. A MEETING of the Salisbury Medical Society was held in the committee-room of the Salisbury Infirmary on Wednesday last. A paper was read by Mr. Coates on the Treatment of Desquamative Nephritis, by Mr. Davis on Suppression of Urine, and by Mr. Marshall on a case of Puerperal Convulsions. MEASURES are now under consideration at Liverpool for enforcing a stricter compliance with the provisions of the Vaccination Act, both as regards vaccinations and their due registration. THE PATHOLOGY AND TREATMENT OF We have received numbers of the California Medical Gazette for October and November, 1868; and find in them, among much interesting matter, two papers under the above title, by Dr. John Scott, of San Francisco, Surgeon to the California State Women's Hospital. The recent discussions in this country impart additional interest to these papers, and the views and practice of Dr. Scott seem to us to be sufficiently original and important to deserve the attention of our readers. We therefore give a summary of what he has written on the subject. [JAN. 9, 1869. 63 to pessaries, describes his own methods of proceeding in language which we will quote at length. "In entering on the treatment of retroflexion, the first and most important point to determine-a point which I have not seen insisted on-is, the existence or non-existence of adhesions; for in one case, where the uterus is free, we can confidently hold out the hope of a perfect restoration of the organ to its normal position and integrity, as the result of the treatment; whereas, in the other, our prognosis nust be guarded, and while we anticipate such a marked and permanent improvement in the general health, and such a relief from local suffering, that the patient will cease to suffer from the affection, yet we may entirely fail to rectify the malposition itself. Taking, therefore, a case of simple retroflexion, we shall find the uterus bent on itself, ble of being lifted up into its natural position by the cautious generally enlarged, more or less tender on pressure, capause of the sound in its cavity, but gradually falling back into its position on its withdrawal. The cervical canal is in the form of a bent tube or syphon, and at the point of flexure behind, an inch and a half from the os, the induration previously noticed will be found. Dr. Scott is of opinion that some malposition of the uterus exists in nearly all chronic uterine affections, especially in cases of erosion of the os, with hypertrophy of the cervix; and he attributes the discomfort and impaired health of the patient, which often continue after all visible disease is removed, to the effects of the displacement. He points out that the speculum and the posi-patient lying on the left side, with the knees drawn up, and tion used by Dr. Marion Sims are the only ones that render it possible to determine exactly what is the shape and direction of the uterus; and leads up finally to the conclusion that "the true pathology of uterine displacements will be found in the existence of chronic inflammation of the organ, and the results it entails; and, if this opinion is correct, the treatment based on it will embrace at one and the same time the removal of the malposition which exists and the affection which has produced it.......In this way we can perceive how the effusion of fibrin in either wall of the uterus will lead to an ante- or a retro-version, while a more uniform enlargement of the organ will tend to its prolapse." After discussing at some length the differences of opinion, about the importance of flexions, that prevail, it seems, in the New World as well as in the Old, Dr. Scott expresses his own opinion as follows: "In recent cases, and before the uterus has become fixed in its position, it is quite possible, by rest, local depletion, and saline aperients, with tonics, to effect a restoration of the uterus to its natural position; but when the affection has become chronic, and effusion of fibrin into the parenchyma of the organ has taken place, the malposition remains and perpetuates itself till measures of a more radical and comprehensive nature are adopted for its removal. "If a uterine version is not a dislocation of the organwhether produced gradually or suddenly,-I know not what it is; and to leave it in a position where, by its pressure on adjacent organs, it interferes with their proper functions, while its own circulation and nutrition are at the same time injuriously affected, is to sanction a practice which can scarcely be called either scientific or rational." The author next proceeds to the consideration of treatment; and, after giving an opinion very decidedly adverse "The treatment must be both general and local. While the functions of all the abdominal viscera are seriously interfered with, the portal circulation is especially deranged, as evidenced by the frequent occurrence of rectal disease in the form of hæmorrhoids, prolapsus ani, fissures and ulcerations; and, as a consequence, the secretions of the liver are not only seriously disordered, but that viscus is constantly influence on the health and spirits of the patient. To the seat of a passive congestion, which exerts an important remedy this state of things, mercurial alteratives, and aperients, such as castor oil, or compound jalap powder, should be given at intervals during the first month; afterwards, small doses of bichloride of mercury, with vegetable tonics, will be found all that is needed till convalescence has such as calumba or cascarilla, with muriate of ammonia, advanced, when the preparations of iron and quinine will be found of the utmost value. To assist nature in restoring the uterus to its normal position, the following operation is then performed, and the proper time for its execution is the first week after the cessation of the catamenia, the patient's bowels having been freely acted on the day before. The the left arm behind the back, Sims's speculum is introduced and firmly held by the nurse. The anterior lip of the os is then seized by Sims's tenaculum, and with the long elbow scissors described by Emmet, it is divided to the extent of troduced, and the organ having been with its aid restored about half an inch. The ordinary uterine sound is then into its natural position, it is withdrawn, and replaced by the small silver probe, which is handed to an assistant, who is directed to retain it in situ, with its concavity forward. And if the patient is directed to lie with the body inclined Sims's knife (as improved by Emmet), with the blade in a forward, the organ will readily gravitate in that direction. line with the shaft, is then introduced, with the edge backwards, through the os and above the flexure, and this latter is divided by an incision which extends along the back wall of the cervix clean out to the os externum. The knife is again passed in with the edge reversed, and another incision is made along the front wall, beginning opposite the commencement of the first incision, and terminating in the division of the anterior lip made previously by the scissors. In the absence of woodcuts, too expensive for a young journal to furnish, I feel it difficult to convey a correct idea of the depth to which these incisions are carried, but I hope it will suffice to say that they must be regulated by the exist, and which vary in almost every case. They must be amount of adventitious deposit and hypertrophy which sufficiently free to accomplish the object in view, while such a division of the uterine tissues as would interfere with the future integrity of the organ must be carefully avoided. But little bleeding may be expected; but what does occur should be encouraged to the extent of four or six ounces, as a salutary depletion from the engorged tissues. Future hæmorrhage may, however, occur; and to provide against it, and prevent the premature closure of the incision, small pledgets of cotton, dipped in a solution of perchloride of iron and glycerine, in the proportion of one of the former to two of the latter, should be introduced in succession within the cut surfaces till all bleeding has ceased. The |