แ

prevent infection. If she could do so, the mortality might, in his opinion, be absolutely stopped. But other means might be taken, and they were precautions on the part of the attendants. He believed fully that the great majority of cases arose from the transmission of the disease by medical students; if the

risk of infection to many women be multiplied by the number of students, the wonder was that the mortality was not greater. He said that the class of students who now attended lying-in women were quite different from those who did so long ago, and the mortality had increased with the thirst for practical dissection. He would have the education in midwifery put off until after all other study had been concluded, and no student permitted on any account to enter a ward after contact with diseased or decomposed structures.

On the conclusion of Dr. Beatty's remarks, Dr. Stokes and Dr. Henry Kennedy addressed the meeting. We are compelled to postpone publication of their remarks.

founded on insufficient, and, in some respects, erroneous, data, would prove a failure; and that, while it was easy for him to point out the defects of certain institutions, it was far from certain that the new plan would have fewer. You say, "It will be a lasting regret and reproach if this debate goes forth from the Society without_a_word ask what is meant by "independent opinion?" Now, I would of independent opinion on the matter." Are not those eminent men whose names I have mentioned both independent, impartial, and above the suspicion of being actuated by unworthy motives? Has not the discussion been perfectly free? Has any impediment been thrown in the way of any member addressing the Society? Nay, more has not the President on every occasion invited visitors to take part in the discussion? What greater But if all the speakers freedom of discussion is possible? have agreed in condemning some of the salient and novel propositions put forward in Dr. Kennedy's essay, or in exposing some inaccuracy, does it therefore follow that

Correspondence.

THE DEBATE AT THE DUBLIN OBSTETRICAL

SOCIETY.

TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.

SIR,-The comments which appeared in your last impression relative to the proceedings of the Dublin Obstetrical Society call for some notice. Without doubt, the prestige of the Society was seriously damaged by the extraordinary oration which occupied the entire of the last evening; but it is most unjust to condemn the Society because one member is found capable of handling so serious a subject in a jocular manner. Surely you cannot accuse any one of the previous speakers of treating the subject in any but a becoming manner. This is, however, of comparatively little consequence compared with the insinuation conveyed in the assertion that the discussion had taken the form of "an overwhelming organisation for the defence of individual hospitals, and for the extinction of Dr. Kennedy." This I believe to be a most unjust insinuation, and one wholly without founda

tion. Is it likely that such men as Churchill, Beatty, M'Clintock, or Denham would be capable of joining in such a proceeding as the foregoing paragraph implies? the two former of whom were never in any way connected with either of the hospitals in question, but, on the contrary, were attached for years to small lying-in charities; while the two latter have no greater interest in them than Dr. Kennedy has himself-namely, that of being Gover

nors and former Masters. The fact that such names as the foregoing must be included in "the organisation," if it existed, is, I think, sufficient proof of the incorrectness of the insinuation, but further, from my knowledge of the facts, I can without hesitation assert that no organisation" exists or ever did exist; on the contrary, I believe that the great majority of the members of the Society have approached the subject with the most sincere desire of arriving at the truth. It was the duty of those gentlemen, who were practically acquainted with the working of lying-in charities, to express their opinion. Doubtless those opinions differ in many material points from Dr. Kennedy's; but, though almost every speaker proved some portion of Dr. Kennedy's statistics to be incorrect, and some of his conclusions erroneous, there was not one who attempted to say, as you would lead us to suppose, "that his facts and arguments had nothing in them." On the contrary, everyone admitted the truth of some of his "facts" and " arguments." Without doubt all the speakers were of opinion that Dr. Kennedy overrated the evils and under-estimated the good of lying-in hospitals, while some feared that the remedy he proposed,

mity "suspicious?" I regret trespassing thus on your space, but feel constrained to vindicate a Society, in the welfare of which I take a great interest, from what I believe to be unjust in your comments.

I am, Sir,

Your obedient servant,

A MEMBER OF THE OBSTETRICAL SOCIETY. May 29.

[Although we cannot see that our correspondent's vindication of the Obstetrical Society was called for by any comments we have made, yet we insert his letter with satisfaction, because an opportunity is afforded us of repudiating his interpretation of our remarks. Our assertion that "the debate took the form of an overwhelming organisation" has been read by nine out of ten of our should be,-in the sense that the general tenor of the subscribers, we are convinced, as we intended that it discussion, the deliberate mode in which it was conducted, and the very remarkable unanimity of the speakers, was calculated to convey to the independent reader the impression that the speakers were biassed pro Rotundo and contra Dr. Evory Kennedy's views.

Whether this statement be or be not justified, it is equally unfair to us that our correspondent should attempt

to apply our objection to the style of the debate to the speeches of individuals.

We can give expression to an opinion as to the tone of a lengthened discussion without charging any speaker with anything more than involuntarily contributing to that tone, and without in the least implying the existence of any organisation as it has been, we cannot swerve from our opinion, formed not without a patient study of the debate.

At the time when our comments were penned, eight obstetric members of the Society had, as far as we can recollect, spoken, of whom all but one were ex-Masters or ex-Assistant-Masters of the Rotundo Hospital, and of whom all, without exception, strongly condemned Dr. Evory Kennedy's opinions. Most of them were, we are convinced, unconscious of even a prejudice in the matter; yet, without doubt, the fact would be capable of an interpretation which it would have been better, if possible, to have avoided.--ED. M. P. and C.]

DR. DRYSDALE'S THEORY OF OVER.

POPULATION.

TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.

SIR,-In Dr. Drysdale's paper (in your number of May 5th) on the above subject, he speaks of preventing the miseries of over-population and starvation "by the prudent and commonsense practices of the French people." What are these

66

Finally, the title of this essay ought to have been, "Overpopulation, and how to prevent it," for that is what its author writes about. Among causes of disease and early mortality" over-population ranks high, but so does intemperance, and so (inter alia) does the disgraceful state of the dwellings in which the poorer classes are compelled to live. While talking of over-population, let us not forget the two latter, which operate in a leading degree to sap and destroy the vital power of so many of our people, and which, if not speedily altered, must impair our national vigour.

I am, Sir,

Your obedient servant,

H. E. C. NOURSE, F.R.C.S.,

Surgeon to the Brighton Hospital for Sick Children. Brighton, May 31st, 1869.

Medico-Parliamentary Intelligence.

THE House of Commons resumed its labours the day after the Derby. Nothing of particular interest to our readers transpired on that day, and the attendence was small. On Friday last however, the Poor Act was on the orders of the day and Mr. Goschen moved the second reading of the Bill which he brought in some time back to amend Mr. Hardy's MetroAfter explaining at some length all politan Poor Act of 1867. that had been done under that Act, he went on to particularize numerous considerations which made it imperative to proceed with the policy then commenced, costly though he admitted it to be. But the Bill, while giving greater facilities for amalgamation and classification, on the advantages of which, he expatiated very earnestly, would vary Mr. Hardy's progamme so far as to save the metropolis about £460,000. Among the most important points in the Bill he mentioned that it would give power to the Poor Law Board to dissolve small Unions and unite them with large ones, also to dissolve sick asylums and school districts in order to amalgamate them for other purposes. It would repeal all local Acts as far as the collection of rates goes, but its main feature was to obtain the great object of classification of paupers, not only sick but able-bodied, by amalgamation and exchange between different workhouses, rather than by new buildings.

At the close of Mr. Goschen's speech, the debate was adjourned until next Friday.

Medical Gleanings.

ON VACCINATION.

TO THE EDITOR OF THE MEDICAL PRESS AND CIRCULAR.

SIR,-We are aware from statistics, as from other experience, that since the discovery of the protective influence of vaccination, the fatality of small-pox has been considerably diminished; and it is now most probable that efficient vaccination confers a degree of immunity from that disease quite equal to that obtained by inoculation, while it is much safer, and by far less disgusting.

Though few physicians doubt the efficacy of vaccination in acting as a preventative against the contagion of small-pox, we should be loth, least, through carelessness in its operation (not being fully aware of the genuineness of the virus, and the healthiness of the party from whom it be taken), we should introduce into the system a disease equally as destructive. I think it may form a subject for discussion, whether or not phthisis and other diseases may not in this way be introduced into the blood of a healthy child. We know how diseases which lie latent in the system are brought out by vaccination. For my own part, as medical officer of a large district, I have taken lymph from children whom I believed at the time to have been perfectly healthy, but who had been previously affected with cutaneous diseases, and exactly the same eruptions were afterwards produced in healthy children who had been vaccinated with the virus. This has put me on my guard, having occurred in more instances than one, and in cases where (without previous knowledge) any one would say that the children from whom the matter was taken were in a

perfectly healthy condition. It is also doubtful to me if the lives of one or two children were not caused by the introduction of tubercular matter, through the medium of vaccination, into their blood.

I must apologise for offering these few hurried remarks. I do not pretend to offer any theory of my own, my object being merely to elicit some observations on the subject from dispensary medical officers (more particularly from those located in country districts, who have more opportunities of judging of the after-effects of vaccination), with a view to understanding more thoroughly the dangers consequent on the introduction of unhealthy virus into the system, and whether or not hereditary diseases, such as phthisis, may not in this way be introduced into the blood.

I remain yours faithfully,

RICHARD AMBROSE O'KELLY, L. R.C.P. Edin., Medical Officer of Dromleigh and Coolmountain. May 15, 1869.

IN a paper addressed to the French Academy of Sciences, M. E. Faivre examines the part played in the white mulberry tree by the latex or descending sap. Physiologists are very much divided as to the real nature of its action. Is it a secretion? Does it constitute an alimentary residue, destined to undergo a new manipulation, so to say? Is it to be considered in the light of a serous liquid containing matter capable of assimilation, or is it a mixed compound, containing not only the latter, but likewise excretory substances? Such are the questions that are agitated, and in order to arrive at a reasonable conclusion, M. Faivre has very wisely confined his observations to a single plant, the white mulberry tree; and in this pursuit he has been engaged five years. Within the limits assigned he has arrived at the following conclusions:-1. The latex is not a transitory formation of the vegetable organism. In the mulberry tree it is found at every time of the year in the trunk, the roots, and the twigs. If any one of these parts be diseased or mortified, if it cease its functions normally, as is the case with the leaves, the latex diminishes and disappears. It abounds in the inner layers of the bark, where great vegetable activity prevails; it accumulates in large proportions at the base of each incipient bud, in the limbus of the leaves during their growth. 2. It is ascertained that, when cuttings are planted in winter in a hotbed, those which have wood-buds and containing a large quantity of latex, scarcely contain any as soon as the buds have opened; so that their development coincides with a diminution of that sap. The effects produced by the striking of the cutting become especially perceptible when the twigs just treated are compared with others taken on trees at the same period, and as much as possible in the same condition. The same results are not perceived in such

cuttings as are laden with fruit-buds. 3. The connexion between active vegetation and the diminution of latex is also proved by the following experiment :-Let an annular excision be effected in spring on a ligneous twig, the buds being removed above the cut, and the existence of latex in the parts subjected to the operation being ascertained. All the buds or new leaves sprouting out above the excision should be carefully removed as often as any appear, and before their complete development. This done, on cutting off the twig, it is found that the latex has disappeared, and that the amylaceous deposit, the existence of which has been shown in the ligneous strata, has likewise, at least partly, disappeared. From all this and other experiments, M. Faivre arrives at the conclusion that the latex, though it may contain excretory principles, certainly plays a part in nourishing the plant.—Galignani. THE TERMINATION OF THE SENSIBLE NERVE OF THE URINARY

BLADDER. BY DR. M. PFLAUM.

EXAMINATIONS about the relations of the nerve in the mucous membrane of the urinary bladder, which I made last winter session under the direction of Professor Chryonsczewsky, were of the following results :

I. The little nerve trunks of the sub-mucous membrane send

off fine nervous twigs, or more frequently single nerve fibres, which pierce the mucous membrane in different directions, and finally terminate in the following double way:

1. Either the nerve fibres go directly to the deeper epithelial layer, where they change into piriform nuclei containing structures, or

2. They unite in the upper part of the mucous membrane to a horizontally arranged plexus, and from this are eliminated those fibres which unite with the piriform structure.

II. Against the epithelial nature of these piriform structures speaks besides their form the following:

1. In a solution of carmine they get more intensely coloured than the neighbouring epithelial cells, and

2. They adhere more strongly to the mucous membrane than the common epithelial cells.

III. They are on the contrary of nervous nature, which appears from the following:

1. Chloride of gold gives them, in the same way as to the nerve fibres, a dark brown or even black colour, whilst the surrounding connective tissue and the epithelial cells are not at all changed by it.

2. Every one of these structures is anatomically a continuation of the axis cylinder of a nerve fibre. This continuation became evident by the isolated preparations.

IV. Before the junction with these terminal apparatuses, the axis-cylinder often undergoes a dichatomous division. V. The nerve shears disappears for the most part, still before the concerned fibre has reached the epitheial layer.

By this examination I availed myself of a solution of carmine, a solution of chloride of gold, and a solution of chronic acid (for isolating). I also made use of pencil and needle.

IRON SUGAR.

A NEW preparation of iron has been recently introduced into medicine by M. C. Chautrand, under the name of Sucre Ferrugi neux. It is in the form of small distinct cubical crystals of cane sugar, having a reddish-brown colour due to the presence of a portion of peroxide of iron in a soluble condition diffused in and upon each crystal. When introduced into cold water it dissolves, forming a deep red solution, only a trace of the oxide of iron remaining insoluble. If the solution be boiled or kept for some time, the oxide is precipitated.

This preparation appears to contain nothing but a pure hydrate of peroxide of iron associated with the cane sugar. The proportion of iron present is not large, but the compound is pleasant to the taste, and is intended to be taken in doses of two to four teaspoonfuls half an hour after meals.

NOTE ON DISPENSING.

Medical News.

SOCIETY FOR RELIEF OF WIDOWS AND ORPHANS OF MEDI. CAL MEN.-At the annual meeting of this society, Thomas Hammerton, Esq., M.P., in the chair, Henry Sterry, Esq., was elected a vice-president, and the following gentlemen directors, viz., Nathaniel Grant, M.D.; Francis Bisset Hawkins, M.D.; Henry Pye L. Drew, Esq.; Erasmus Wilson, Esq.; James Hinton, Esq.; and Frederick G. Reed, M.D. The statement of accounts read showed a total of £2,504 10s. granted in relief during 1868, an increase of £261 over that of the preceding year. At the end of the year 52 widows and 27 children were receiving relief in sums from £50 to £20 per annum for the widows, and from £25 to £5 for the children. During the year 6 widows and 11 children had been added to those already on the books; 6 widows receiving grants had died, and 2 children had become ineligible. The secretary stated that already, during the present year, applications for assistance had been received from 5 widows and 18 children. The meeting was brought to a close by an unanimous vote of thanks to the Court of Directors for their trouble and zeal in managing the affairs of the society.

OXFORD UNIVERSITY AND THE RADCLIFFE INFIRMARY.— The subjoined paper has been circulated :-" It has been sug gested that a short printed explanation should be laid before Convocation as to the grant of £500, which the University has been asked to make towards the provision of accommodation for fever cases upon the grounds of the Radcliffe Infirm ary. The following statement has in consequence been drawn up by the undersigned, who had the duty of asking the Coun cil to recommend the making of this grant entrusted to them. The governors of the Radcliffe Infirmary, having decided to provide certain accommodation for fever cases, have determined to draw largely upon their own resources in furtherance of this object. They have also sought aid from other sources besides the University, and as they have reason to believe, with good hope of their application being success. ful. The peculiar interest which the University has in the establishment of such an addition to the Radcliffe Infirmary as the one contemplated has not been overlooked. This will be seen from the following extract from a resolution passed at a special court of the Governors of the Infirmary, held May 12, 1869-That these, or some other beds, be also available for use by patients whose friends are willing to remunerate the infirmary, to the extent at least of the whole course of their treatment, whenever such beds are not likely to be in requisition for the poor.' 'It has been decided to provide upon the present occasion accommodation for sixteen fever cases; and the powers given by a recent resolution to the committee of management as to the application of the capital of the infirmary in aid of the undertaking furnish a sufficient guarantee for the completion of the work.'-John Slatter, Henry W. Acland, George Rolleston."

NOTICES TO CORRESPONDENTS.

In all cases when proofs are sent, it is of the utmost importance for them to be immediately returned.

DR. JONES.-The subject has been fully discussed in our columns. MR. GASCOYNE.-Thanks. It shall have early attention.

J. D.-The paragraph in question is simply untrue.

DR. MOUDON.-The letter, like several others, is unavoidably postponed.

J. L.-Messrs. Churchill and Sons.

DR. WARING-CURRAN's address has been mislaid. He would oblige by forwarding it.

DR. WUCHERER, Bahia, Brazil.-Your communication upon worms of a species not yet described, met with in the urine of patients suffering from Intertropical Hæmaturia in Brazil has come to hand, and shall receive early attention.

DR. WILLIAMS. The letter on Legally-qualified Midwives shall appear in our next.

DR. J. WILLIAMS, America.-Вy next mail, you will receive the 29 volumes of this journal, as per your order for which we tender our

B Potass. Chlorat. 3ss. ; Soda Hypophosphit. 3j. ; Syrup. Simpl. 3ss.; Aquæ ad 3vj.

The salts, owing to pressure with regard to time, were mixed energetically together in a mortar. Explosion ensued with no other dangerous result than whirling the pestle to a distance, and slightly injuring the dispenser. The mode of compounding this and similar formula is to dissolve the salts separately, when no accident can happen.-Pharmaceutical Journal.

amalgamation of the MEDICAL PRESS and the MEDICAL CIRCULAR. During the past fortnight we have been favoured with several very flattering letters from America and Canada, as to the high position this journal has attained in those countries. Our friends will please acc. pt our best thanks for their congratulatory communications. COMMUNICATIONS, Enclosures, &c., received from Mr. Summers, Haverfordwest; Mr. J. Finlayson, Manchester; Mr. J. G. Wilkinson, London; Mr. Tichborne, Dublin; Dr. Palfrey, London; Dr. W. H. Wilkinson, Owestry; Mr. Cadbury; Mr. J. Cope, Manchester; Mrs. Williams, London; The Secretary, Anthropological Society; Mr. T.L. Baines, London; Messrs. Willmer and Rogers, New York; Dr. CalMaw; Mr. H. E. C. Nourse, Brighton; Dr. Holman, America square lenette, Guernsey; Mr. H. P. Sawyer, New York; Mr. Grace; Mr. C. Mr. R. Freeman; Dr. Wurcherer, Brazil; Mr. J. Lade, Bury; Dr.

Lecture.

PAGE

Epidemic of Cholera in Gambia 476 The Sea as a Motive Power University of Oxford

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484

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Education of the Deaf and Dumb

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Royal College of Surgeons of England.. Vaccination in Bombay..

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Infanticide....

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The Health of Dublin..

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The Order of the Bath

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The Loyalty of the Medical Club

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ON FIBROUS TUMOURS OF THE UTERUS.

BY JAMES PALFREY, M.D., M.R.C.P. (Lond). Assistant Physician, Accoucheur to, and Lecturer on Diseases of Women at the London Hospital; formerly Obstetric Physician to the Farringdon Lying-in Charity, and to the Metropolitan Free Hospital, and to the Surrey Dispensary, &c., &c.

LECTURE V.-PART I.

GENTLEMEN,-Resuming to-day the consideration of the treatment of these fibrous tumours of the uterus, I wish, before speaking of the management of the separate forms of the disease, to make a remark or two upon a plan of treatment which for many years has been very much in fashion, and which by the sufferers is frequently regarded with implicit faith and confidence. I refer to the periodical resort of patients suffering from fibroid disease to places possessing waters impregnated with various salts, and these waters, taken internally, combined with the daily use for some hours of tepid hip, or entire baths, have long had the reputation of curing these growths of the uterus. The waters of Kreuznach, a town of Rhenish Prussia, have, above all others, enjoyed the reputation of being efficacious in reducing uterine fibroids. The springs of this place are found to be impregnated with the salts of bromine. I have patients who have for several years travelled to these places, and who have returned to their homes at the close of the season certainly in far better general condition than when they left us; but in no case have I seen a real diminution of the uterine growth from which they suffered, and I have long ago arrived at the conclusion that the improvement that takes place in these patients results from the careful general management to which they are subjected by the physician who, residing on the spot, usually takes charge of, and presides over, every movement of each visitor during the period of her visit to "the Baths." Should

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483 Notices to Correspondents, &c.

491

any of you be sufficiently interested in this subject to wish to pursue it further, I can refer you to the account published by Dr. Prieger, of Kreuznach, as also to the analysis of the waters of that place given by Dr. Sutro in his work on the "German Mineral Waters " (London, 1851). And now let us make a remark or two upon the few special points of treatment that will demand your attention in the first or subperitonial variety of fibroids. It is not often that patients suffering from this form of disease will require much attention. The principal complaint for which you will be consulted will be the inconvenience arising from the weight of the tumour, and in those cases in which it has attained a large size, and exerts pressure upon neighbouring organs (if the pedicle be long enough to admit of its moving freely about in the abdominal cavity), pain in, or disturbance of, the functions of the organ so interfered with, you will find both these conditions relieved by the use of a silk elastic abdominal belt, so made as to be drawn over the patient's legs and envelop her abdomen and pelvis. I have long discarded the use of those belts, which being fastened behind (in many cases, by almost innumerable laces, buckles, straps, and other contrivances), fail, in consequence of the unequal pressure they exert, to be of the slightest use. A simple elastic belt, slightly stiffened by some thin whalebone slips in front, and an under strap and pad to keep it in position, suffices to give support to the abdominal parietes, and removes the pressure which the growth causes upon the abdominal viscera. Here I must mention a condition you will not unfrequently be called upon to treat. In my first lecture I said that although I had never seen true inflammation of a fibrous body, yet active inflammation of the peritoneum covering these growths was not a rare occurrence, and it is in these cases of sub-peritoneal tumours that this limited peritonitis most often takes place. The attack, as I have seen it, usually begins in much the same way as simple peritonitis, rigors, heat of skin, and a rapid, but not the usually small, hard pulse of peritonitis are conditions soon followed by acute pain of greater or less severity in the region of the growth. This pain is always increased on pressure. The patient lies on her back with the thighs drawn up and flexed; the countenance, however, is never

expressive of that intense anxiety and suffering which is so characteristic of puerperal inflammation. The tongue is white and coated, the tip and edges being red; vomiting is generally present, and increases the patient's distress; there is also constipation from the beginning, and often tympanitis. The attack usually runs its course in seven, or eight, or ten days. The treatment I have adopted has not been heroic; usually eight or ten leeches to the painful spot, followed by the constant use of spongio piline, soaked with hot poppy decoction; this followed in a few hours by the hypodermic injection of some quarter or third of a grain of morphia in solution. The internal administration of solid opium in one or two grain doses, every four or six hours, to relieve pain and stay peristaltic action, a cradle over the abdomen to prevent pressure of the bedclothes, the daily use of the warm vaginal douche, and about the sixth or seventh day the exhibition of a warm gruel and turpentine enema, perfect mental and bodily rest, ice in various forms, such as iced milk, orange or lemon water ices, iced beef tea, administered at short intervals in very small quantities, are the means I have seen sufficient to conduct the patient safely through the attack I have described. There is one fact concerning this limited inflammation I must record, and it is that these attacks are very likely to recur. I have seen on three or four separate occasions a most interesting example of this acute inflammation with Mr. Joseph Loane, of Whitechapel; it occurred in a woman the subject of a sub-peritoneal fibroid weighing many pounds. On each occasion the patient has been to all appearances dangerously ill, and in considerable peril, the pain and vomiting on the first occasion inducing very considerable exhaustion. From each attack this patient has wholly recovered, and been able to resume her usual duties. I may observe that I have abstained in the majority of these cases that I have had to treat from giving any form of alcohol during the attack, and the patients have done well without the exhibition of any form of stimulant. I have never yet seen a fatal result follow an attack of this circumscribed and limited peritonitis. I must tell you that these tumours have been removed on various occasions by opening the abdominal cavity, as is done in ovariotomy-the pedicle of the growth being ligatured or divided by the écraseur. The success that has attended the operation has been very small indeed, deaths from hæmorrhage, peritonitis, or pyæmia, following the removal of the tumour in the majority of the cases in which it has been performed. Several times I have been urged by the subjects of these sub-peritoneal growths to undertake their removal in this way, but I have in every instance refused, because I believe the occasions are very rare indeed that this form of the disease destroys, or even shortens life, and seeing that at all times, and under the most favourable circumstances, the abdominal incision is an operation attended with very grave and serious risks, I consider that I am not justified in placing a woman's life in great and severe peril for the advantage of ridding her of a growth which, at the worst, is but an inconvenience and disfigurement. It is but fair to tell you, however, that Dr. Atlee, of Philadelphia, has opened the abdomen, and removed these out-growths on many occasions. You will find a very interesting account of his operations, and the results that have attended them, in a paper he published in the transactions of the American Medical Association for 1853, entitled "The Surgical Treatment of Certain Fibrous Tumours of the Womb." Now and then also it has happened, and that too in the hands of some of our most experienced and accomplished obstetricians, that these sub-peritoneal fibroids have been mistaken for ovarian tumours, and their removal has been effected after the parietes have been divided, and the mistake made apparent. In conclusion upon this first form of Fibroid, I will remark, that should any special symptom present itself, or any accident occur in the progress of the case, you must treat that symptom or accident in exactly the same way you would if it were to occur in the course of disease in any other organ of the body.

Bring, I say, your general principles of therapeutics to bear upon the conditions, and you will act wisely. In treating the interstitial form of Fibroids the symptoms that will most frequently demand your attention are:-1st. Congestive tumefaction of the whole uterus, which will manifest itself not only in increased sensibility of that portion of the uterine wall in which the tumour is situated, but by a general tenderness of, and increase in the volume of, the womb, and more especially will this hypertrophy, be noticed just before each menstrual period. No treatment is so successful for the relief of this congestive state as repeated local blood-lettings by means of leeches applied to the os uteri, this proceeding followed by a warm hip bath, and a full dose of the tincture of hyoscyamus, has never in my hands failed to relieve the troublesome and distressing symptoms I have just mentioned, and I know of but one contra-indication to the adoption of the plan above proposed, and that is the presence of profound anæmia. Of course, should this latter condition be present in this, or any other form of the disease, you will pause before abstracting even the smallest quantity of blood. Do your best in this case by a generous diet and the judicious administration (in the intervals of the menstrual periods) of some form of iron, combined with the observance of every hygienic means calculated to improve and restore the healthy character of the blood, and having succeeded in this then you may resort carefully to the local abstraction of blood from the congested uterus. The second important symptom in this variety of fibrous tumour will be pain as I have before told you, sometimes it will be lumbar, at other times it will be hypogastric pain that will call for relief. Now, without doubt, the most speedy manner of relieving these various pains is the administration of opium or some of its salts. My experience has taught me that the patients in every class of life very soon become accustomed to the use of this drug, and before long by the gradual increase in the quantity taken, they tolerate its use to such an extent that the quantities they take is, in many instances, enormous. Hence it is that I ask you to put off as long as possible the habitual administration of this drug, patiently try the various sedatives; give in turn for the relief of these pains--hyoscyamus conium, the extract and tincture of cannabis indica, aconite, and the other remedies of this class, and when at last you are driven, as you will be, to commence the use of opium, begin by using a vaginal pessary composed of one half a grain of sulphate of morphia made into a suitable form with the butter of cacao, and let this be carried to the upper part of the vagina (the patient being at the time in bed) as often as the severity and duration of the pain demands; should this after a time fail to give ease and relief from suffering, I then advise you to commence the administration of morphia by the hypodermic method, a quarter of a grain or even less than this quantity injected in the neighbourhood of the pain is always followed by many hours of freedom from distress. The instrument I have for some years used, is one made for me by Mr. J. Banks, of the firm of Maw and Son. I send it round to you, and you will see that each turn of the screw represents the injection of a drop of the solution of morphia, one grain of the salt being contained in Mxxiv of the solution. (To be continued.)

FOREIGN OBJECTS IN THE LUNG.

A METALLIC tube composed of zinc and copper, one half an inch long, and weighing eleven grains, was recently in a fit of coughing expelled from the lungs of a girl twelve years of age, living in New York City. The tube, being the whistle of an india-rubber air ball, was two years ago accidentally forced into the upper part of the larynx, and thence in the attempts to remove it by emetics, was lodged in the lungs. During the whole of the period mentioned, the girl suffered from an oppressive senation on the chest and from continued coughing. During one of the paroxysms the tube was ejected. This occurrence gives a strong illustration of the remedial force of nature which is sometimes successful in affording relief when all the resources of surgery and medicine have been tried and failed.