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the fatal effects of false passages made in attempting to sound bladder, and still surgeons continue to perform this operation. have heard of several fatal results of false passages made with uterine sound, and still most practitioners feel themselves justified using an instrument of which Dr. Simpson has well indicated utility. For the same reason, I feel justified in advocating the use the uterine curette, notwithstanding accidents, which will impr upon you the necessity of using it with intelligent gentleness. will, moreover, doubtless observe that the plan of treatment I ha shown to be useful in some rare instances is not more dangerous th that proposed by others for similar cases. Velpeau advocates inj tions and cauterization of the internal cavity of the womb; and Bennet, in his notice of internal metritis, says "that he has carr the solid nitrate of silver into the cavity of the womb in inter metritis, or else the acid nitrate of mercury as a last resort, and son times without success."

I must not omit mentioning that you will find the curette, as presented in Fig. 1, very useful to remove portions of retained placer from the womb, when its size and sensibility, as well as continu flooding subsequent to confinement, lead to such a diagnosis. Recam first used it for this purpose, I and others have imitated his examp Vidal de Cassis, Hourmann, and other French practitioners, ha tried injections of a solution of nitrate of silver in what they te uterine catarrh. Acute peritonitis occurred in some of their cas several of which ended fatally; but I have already shown that Fren pathologists have confounded some half-dozen different diseases und the name of uterine catarrh.

To give an idea of the kind of cases in which the French have tri uterine injections, I shall relate what Bequerel did at La Pitié 1850. He chose seven women, in all of whom the neck of the won was more or less acutely inflamed; the orifice of the womb was larg than it ought to have been, and surrounded by erosions; the dischar was muco-purulent. An india-rubber sound was introduced into t womb to the depth of an inch and a half, and by means of a syring a solution of nitrate of silver of two grains to the ounce of water w injected. Three out of the seven patients were suddenly seized wit symptoms of severe metro-peritonitis, from which it is true they r covered, but without even being cured of the original uterine diseas of which only one out of the seven was cured. These cases could no have been worse chosen, for while the neck of the womb was acutel inflamed, the body of the womb was most likely in a healthy state and although the india-rubber sound did not penetrate into the cavit of the womb, the solution of nitrate of silver did, and coming in con tact with a surface, the sensitiveness of which had not been blunte by long-continued morbid action, metro-peritonitis ensued.

The fatal results of uterine injections in such cases does not impl that they would not be useful in well-selected cases. Although suc

is my opinion, I have never employed injections into the womb, for I have been deterred from their employment by the knowledge of the uncertainty of their action. Sometimes a strong solution of the nitrate of silver can be injected into the womb without much reaction; at others, a decoction of nut-leaves brings on acute peritonitis. This uncertainty of action is met with even in the same patients: thus, in one of Recamier's cases, the vegetations had been removed from the womb, its cavity had been twice cauterised without determining any reaction, when it was thought advisable to inject a little tepid water into the womb, but this was very soon followed by violent symptoms of peritonitis. In three of Becquerel's cases peritonitis ensued after a second, a third, and a fourth injection, the previous injections having produced no ill effects.

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In case uterine injections should be deemed useful, a weak solution of tincture of iodine would be the best fluid to be used, and the best instrument, that which was suggested to Dr. Mackenzie by the sight of Mr. Coxeter's ingenious instrument for laryngeal injections. should, however, caution those who might use it to press lightly on the fundus of the india-rubber receptacle, otherwise the fluid would be projected with too great force. In two instances I have removed the vegetations from the internal cavity by means of the curette, and nature did the rest.

In another case, after applying the speculum, and removing as much as possible of uterine mucus, I covered the extremity of the uterine sound with cotton wool, which, when saturated with tincture of iodine, I introduced into the cavity of the womb. The neck of the womb took up part of the tincture; so, removing the sound, I again saturated it, and re-introduced and pressed it about in various directions. This was not followed by much pain. Three days afterwards some of the vegetations came away, with a sero-purulent discharge. Ten days after, I repeated the operation with similar results, and then the case did well.

In the wards of Baudeloque, at the Hôpital des Enfants at Paris, I had been often struck by the good effects which followed the application of caustic iodine to the ulcerated surfaces of scrofulous patients, and I was led to try the same application, according to the strength indicated by the Pharmacopoeia, or diluted with water, to various morbid lesions of the mucous membrane of the womb.

The benefits to be derived from the topical applications of iodine to the womb are little known to the profession, and are well deserving of more extensive trial than has hitherto been given to them, not only on account of the favourable results of their application in the cases under consideration, but also from the well-known fact of the innocuity of the introduction of iodine into our tissues. Within the last few years, in France, tincture of iodine has not only been injected into the tunica vaginalis, to cure hydrocele, but also into fistulous passages of acutely-inflamed extensive mammary abscesses, into large ovarian

and other cysts, and even into the peritoneal cavity to cure ascites, and without determining those symptoms of violent inflammation that might have been expected.

Having thus briefly sketched what is known relative to uterine catarrh and internal metritis, it may be well to state some of the points in which they differ, as the last complaint has but little i occupied the profession of this country.

Uterine catarrh is very frequent; internal metritis very rare. Uterine catarrh almost exclusively affects the neck of the womb; internal metritis, its body. Uterine catarrh is as frequently observed in the single as in the married; internal metritis seems to affect almost exclusively those who have borne children. In uterine catarrh the discharge is viscous; in internal metritis, serous or sanguineous, and very abundant. Uterine catarrh gives rise to no abnormal growths; internal metritis frequently does. In uterine catarrh life is never compromised; it is not unfrequently so in internal metritis. Injections have been found useless and often dangerous in uterine catarrh, but are sometimes serviceable in internal metritis.-Lancet, Jun. 21, 1854, p. 63.

150.-ON THE DIMINUTION AND DISAPPEARANCE OF UTERINE TUMOURS.

By Dr. SAMUEL ASHWELL, late Obstetric Physician and Lecturer at Guy's Hospital.

[There is something very extraordinary in the spontaneous diminution of some uterine tumours, without any coincident breaking-down of their structure. A few striking cases of this kind are here recorded. The alarm on discovering the presence of large tumours of the uterus is by no means so great as it was some years ago.]

The exact pathology, however, of certain of these uterine tumours is still a vexed question-one certainly admitting of further elucidation -whether, for instance, a fibrous tumour is ever capable of being absorbed, is yet a matter of dispute; for while Lisfranc regards the absorption of any tumour as satisfactory proof that it is not fibrous, there are, as I shall show, distinguished pathologists, both in this country and abroad, who believe they have witnessed the melting down and disappearance of both fibrous and cancerous growths. It is therefore right, where we can only form a doubtful diagnosis as to the nature of any uterine tumour, to treat it as though it were curable; for if malignant, judicious treatment can do no harm; whereas, if it be of unspecific and benign character, the treatment will generally prove curative. I state then, at once, that the pathology of these large and hard tumours, to the very occasional diminution and disappearance of which, without coincident breaking-down and discharge of their structure, I am now soliciting attention, is not the object of

this paper, my aim being, to show that tumours of the uterus so large as to attract attention by their great size, so hard as to resemble, in some examples, the hardness of true carcinoma, and giving rise to alarming hemorrhages and frequently-recurring pain, do very occasionally, when all treatment has been abandoned, present the following results:

First. A slow but progressive diminution of bulk and of hardness, unaccompanied by any appreciable breaking-down of their

structure.

Second. A lessening at least, and sometimes a cessation of the bleedings, profuse menstruation and discharges, and, where it has existed, of the pain.

Third. A gathering of flesh, and a restoration of the general health. As tending to confirm these statements, I shall adduce the opinion of some eminent pathologists, to prove that the absorption even of scirrhous tumours may be effected by appropriate treatment.

Sir Charles Clarke (vide 'Ashwell on Female Diseases,' p. 297) mentions a case "where a tumour as big as a child's head could be felt through the parietes of the abdomen; just above the pubes, upon its surface, could be felt two smaller tumours-one the size of a man's fist, and the other twice this size. The patient had laboured for some time under a very profuse discharge of blood from the vagina. A variety of means were employed for the relief of this case for two years. Upon examining the abdomen at the end of this period, the tumours could not be discovered, and after death the uterus was found as large as that of a woman at the end of the fifth month of pregnancy. Upon the anterior part of it, near the fundus, were found two tumours, as large as peas, which were probably the same tumours before felt, as there was no other vestige of them. The tumours were of a hard and resisting nature, and were lying between the muscular part of the uterus and the peritoneum covering it."

Dr. Walshe (in one of the most invaluable text-books of our profession, 'On the Nature and Treatment of Cancer,' p. 134) says, in reference to the termination of cancer, by resolution and absorption,66 one of the most essential attributes of cancerous substance is an unswerving tendency to grow, or at least to sustain itself unimpaired, by the influence of surrounding parts; its nature is opposed to resolution. Nevertheless, there would be temerity in denying the possible occurrence of this unfortunate change." Weller affirms, that he observed a medullary fungus of the eye of an infant, which eventually disappeared, aud was followed by dropsy and atrophy of the ball. Mr. Travers relates, that "the solution of chloride of lime effected the absorption of a large tumour (in the course of some months), regarded by competent authorities as scirrhus, in a lady whose other breast had been extirpated for that disease. Not long after she died of asthma, from diseased lungs; the scirrhous tubercle appearing not only in the chest, but in several of the abdominal viscera."

lants should be avoided, and all drinks should be as cold as possible. Water, or cream ices, flavoured according to the patient's taste, may be advantageously given between meals. Should the complaint determine continued insomnia and hysterical symptoms, acetate of morphine must be given, and the doses progressively increased until such symptoms abate. In the interesting case I related in a previous paper, the patient for many days took from two to three grains of acetate of morphine, and I believe that it not only brought on sleep and diminished hysterical phenomena, but was also instrumental in curing the uterine disease, for the manifest improvement only set in when the patient was brought under the influence of opium.

When the violence of the disease has abated, and instead of flooding, there remains amongst other symptoms, a moderate discharge of serum, sanguineous or not, then benefit will be derived from the application of a seton or issue above the pubis, either of which should of course be kept open for several months. This is a disagreeable remedy, and therefore seldom proposed, but it will be found beneficial not only in cases of internal metritis, but also when dysmenorrhoea is attended by uterine exfoliation; indeed we have found nothing so useful in this obstinate complaint.

If it has been ascertained by means of the uterine curette that the internal surface of the womb is free from all morbid products, all further instrumental interference would be objectionable, inasmuch as it could do no good, and must do harm. Should the curette, on the contrary, detect roughness, and bring away some of the morbid growths previously described, their removal from the womb is an indication of first-rate importance, since a rapid cure has sometimes followed the operation, and no improvement can take place so long as they remain.

As this method of treatment is almost unknown amongst us, and as it is also applicable to the cure of menorrhagia when caused by retained portions of placenta, or by hydatid growths in the early stage of their formation, I shall enter into some details. Recamier, in one case, finding the neck of the womb much dilated, introduced his finger into the cavity of the womb, and scraped of the vegetations with his nail. This suggested to him, some forty years ago, the idea of doing the same with an uterine sound made of pewter or steel, and he called it a Curette, because it was destined to remove morbid growths from the cavity of the womb. The curette is an uterine sound, blunt, somewhat curved at its extremity, and hollowed out on its curved side, Fig. 1.

as it is shown in figure No 1, the extremities of which are represented as more pointed than they really are. It should be introduced into the