cauterizer, and also to allow the internal wires to pass out. Within the catheter are placed the two conducting wires, insulated, they being at one end connected with the wires of the battery, and at the other with a piece of platinum wire, which is coiled round the porcelain cauterizer. The battery employed is Groves', of four or five cells, and of these two are required to heat the porcelain to whiteness, which degree of heat is essential. From this simple contrivance the instrument derives its principal value, the heat being thus both intense and permanent. When ready for use it is entirely under the control of the surgeon, a matter of vast importance in its application. The patient to be operated upon should be in the usual obstetric position, and the batteries and wires concealed from her, so that she should not have any idea of the nature of the remedy. A good light and speculum are essential, and the speculum best suited is the common circular glass one, or one of glass coated with gum-elastic. Neither ́ the two-bladed metallic nor the conical glass forms are at all suited; the former because it allows all the heat from the blades of the speculum to be concentrated on those portions of the vagina which bulge between them, and the latter because it is liable to be easily expelled by the vagina. A full view of the os and cervix uteri having been obtained, the os should be cleansed with a piece of cotton or wool, and when the cautery has become intensely heated, it should be steadily introduced and quenched in the diseased tissue, the duration of the application and the depth of its introduction depending upon the effect required. The eschars thus produced are marked with a whitish-yellow border, and the cervix often visibly contracts under the application of the cautery. The author insisted upon heating the porcelain to whiteness, otherwise slight hemorrhage may occur, from the instrument dragging off a portion of mucous membrane, which invariably adheres to the instrument under such circumstances; the surgeon should also remember that the degree of the eschar is entirely under his control. He then stated that the cases where it was applicable were those of induration of the os and cervix uteri, of ulceration of the os, and in prolapsus uteri, and also in prolapsus of the anterior wall of the vagina.-Lancet, Nov. 26, 1853, p. 503.

156.-SPONTANEOUS CURE OF POLYPUS UTERI.
By DR. F. H. RAMSBOTHAM.

[Three cases of this description have been lately published, one by Mr. Canney detailed in the succeeding article (157) and two others by Dr. Ramsbotham in the 'Med. Times and Gazette' for Jan. 22 and Feb. 5, 1853 (vide Retrospect, vol. xxvii, p. 254). Dr. Ramsbotham relates another instance as follows:

Dr. R. was called to a case under Mr. Stephenson, of Dalston. The patient, aged 33, was the mother of three children, and had been lately the subject of menorrhagia and leucorrhoea.]

From the time the menorrhagia began to annoy her she has been subject at intervals to what she then considered a descent of the womb. She was in the habit of returning the protruded substance, allowing herself two or three days' rest, when the inconvenience was for a time suspended. On any exertion, however, it recurred, and on each such occasion she treated herself in the same manner. She now believes this substance was the tumour; and of this, indeed, I think there can be little doubt. She states also, that, on the fourth day after her last labour, the womb came down, remained external a whole day, and was returned by the medical gentleman then in attendance. Whether this substance was really the uterus, or the polypus enlarged by the growth of pregnancy, I have had no opportunity of learning, but I suspect the latter was the case.

Mr. Stephenson was first called to her about a year ago, when she was suffering from common continued fever, being much debilitated, and greatly blanched. In a week she was free from fever, and continued to follow her ordinary mode of life, until the end of last September, when an attack of diarrhoea induced her to seek his advice again. The hemorrhage was now almost incessant; she complained of a distressing sense of weight at the vertex, much pain in the lumbar region and groins, particularly the left, and a sensation, when she sat down, as though the whole of the lower part of her bowels was being pressed upwards. She suffered also from violent bearing-down pains when she stood, and was far more easy in the recumbent position. In the early part of October she became again the subject of continued fever, attended by hemorrhage, headache, and severe vomiting. During one of her attacks of sickness, a fleshy mass was protruded from the genitals, but without pain; this she took to be the uterus, and passed it up again. Mr. Stephenson was summoned to her in haste, and the following I give in his own words:

"On examination I found a soft, smooth, loose, membranous body, occupying very nearly the whole length of the vagina, of a pyriform shape, free at the lower end, and attached to the uterine structure above, at about half-an-inch beyond the mouth. I could pass my finger completely round it, within the hard projecting uterine neck, and trace its narrow root. By gentle traction I found it give a little, and was able to bring it down till its free end reached about two inches external to the vulva. That part of the abnormal growth external to the body presented the appearance of a pale, glossy, membranous bag, not unlike prolapsus vesica; and, then rolled between the thumb and index finger, felt very like thick layers of mucous membrane. The woman expressed no sense of pain when it was pinched. There was no hemorrhage at this time. Having concluded that it was a case of polypus, and that nature was making an effort to cast it off, I resolved upon leaving it in her hands for a short time, and waiting the result, unless symptoms arose calling for active measures.

"In 24 hours, the mass external to the body had assumed a shrivelled appearance, was dusky in colour, and had begun to emit a gengrenous odour. On traction, it was brought down about an inch further. On the next day it had become perfectly black, and the odour it exhaled was almost intolerable. As the patient evinced symptoms of great exhaustion, I recommended a consultation with Dr. Ramsbotham."

I saw her at 3 p.m. on the 25th. The tumour had then been down nearly three days; the part external was as large as a man's fist; it was highly putrid, and very readily torn; the attachment by the stem within the cervix uteri still remained perfect. The woman was of waxy paleness; her countenance bore a distressed, cadaverous expression; the pulse was quick, jerking, and easily compressible: tongue and lips moist and pale; and altogether she displayed unequivocal marks of having been for a long time the subject of copious losses of blood. I passed two fingers of my left hand well within the os uteri, carried their points up to the attachment of the tumour, and with very little trouble separated the diseased mass from the healthy structures, by tearing it away. When brought away it was about seven inches in length and five in breadth, having the ordinary appearance of the fleshy polypus, partially destroyed by putrefaction. The removal occasioned neither pain nor loss of blood. "About four hours after the operation," says Mr. Stephenson, "the patient expressed herself as being greatly relieved, and seemed to mend and rally from the moment of its removal."

The bowels had not acted for six days, in consequence of the medicine having been invariably rejected by vomiting. On the separation of the tumour, however, the sickness ceased, and the sulphate of magnesia, dissolved in infusion of roses, was speedily efficacious. The tinctura ferri sesquichloridi was afterwards administered, and she was ordered a generous diet and a pint of porter daily. For the first fortnight there was a pale straw-coloured discharge, along with which some shreddy membranous portions came away, evidently the remains of the neck of the tumour.

Four days after the removal the menses returned, at the regular period, but in so small a quantity as "scarcely to stain the linen." On November 23, they again appeared, and continued flowing only three days, though copiously while they lasted. In the interval there was a small quantity of pale yellow discharge. Mr. Stephenson made an examination on November 16. The os uteri was then sufficiently open to admit the passage of the first joint of the finger, but "nothing like the remains of a polypus could be detected." She came down stairs on that day, is rapidly gaining strength and colour, and says herself she has not felt so well for more than two years.-Med. Times and Gazette, Dec. 24, 1853, p. 648.

157.-A Case of Large Polypus of the Uterus Complicated with Inversion. By GEORGE CANNEY, Esq., late House-Surgeon to University College Hospital.-M. H., a stout, fair-complexioned woman, many years married, but without family, has suffered severely during the last seven years from uterine disease, attended with severe pain, floodings, and extremely offensive vaginal discharges. On the 6th of of October, 1848, she was seized, while in bed, about seven o'clock in the morning, with violent expulsive pains, which in a short time, as she thought, protruded the whole mass of the diseased womb through the os externum. Her midwife was sent for, and for many hours made fruitless attempts to return the mass. About five in the evening, I was requested to see her, and found her faint from loss of blood, the surface of the body, and the external genitals, being quite blanched. Protruding from the os externum there was an enormous pear-shaped mass, of a red colour, and smooth, shining surface, which was a perfect cast of the body and neck of an enlarged uterus, (the narrow portion or neck of the tumour being the lowest,) having a dark sloughy appearance; and, to complete the deception, the finger could be passed for nearly an inch into a depression in the lower portion of the tumour. As a catheter, however, passed into the bladder in the usual course, I at once pulled down the mass until the forefinger could be passed over its large extremity into the vagina, when the large end of the polypus could be distinctly felt connected with the inverted fundus of the uterus by a short thick pedicle. A ligature having been applied, the pedicle was divided with a pair of scissors, and the surface of the uterus being found free from any further growth, the inverted fundus was carefully replaced. As soon as the womb was restored to its natural condition, the ligature came away; nevertheless, there was no further flooding; the patient never had a bad symptom; and the gentleman under whose care she was placed reported to me, at the end of a week, that she had resumed her household duties.

The tumour was of a simple fibrous texture, and weighed twentyfour ounces.-Med. Times and Gazette, Nov. 12, 1853, p. 498.

158.-On the Extraction of Polypi from the Uterus. In a paper by Mr. GEORGE CANNEY, of Bishop Auckland, on this subject, read before the Royal Medical and Chirurgical Society, various opinions were elicited on the different modes of extracting these growths from the uterus. Mr. Canney recommends excision rather than the ligature when the polypi are not large. DR. TYLER SMITH prefers the ligature. Mr. HODGSON says that torsion is sometimes both better and safer than either excision or the ligature. DR. COPLAND gives us an interesting case to show the effects of biborate of soda. He says]

Polypi, or fibrous tumours, on the inner surface of the uterus, were occasionally thrown off without resorting to the ligature, or any other

operation. Some years ago he had been called in consultation to the case of a lady suffering from constantly recurring uterine hemorrhage. A tumour was protruding from the os uteri. The question of removal was discussed, and it was decided that biborate of soda should be given, with a view of producing the contraction of the uterus, by which the growth might be thrown off. The medicine was given in large doses, and continued for two or three days. The uterus contracted powerfully, and the tumour was expelled. All the symptoms abated for three or four days, when a second tumour presented itself. Dr. R. Lee then joined the consultation, and it was determined that the use of the soda should be persevered in. The result was, that this second tumour, like the first, was thrown off, and the patient recovered. He could speak from his own knowledge, that she was alive and well 13 or 14 years afterwards. This might not have been a case, strictly speaking, of polypus of the uterus, but it was certainly one of a tumour under the villous coat of that organ, which was thrown off by the contractions of the uterus.-Lancet, April 8, 1854, p. 389.

159.-ON THE SOURCE OF HEMORRHAGE IN PARTIAL SEPARATION OF THE PLACENTA.

By DR. F. W. MACKENZIE. (Read before the Medical Society.) There are few subjects in obstetric medicine of greater scientific interest and none of greater practical importance, than that of the anatomical source of hemorrhage in cases of partial separation of the placenta. Upon its right understanding may be said to depend not only the whole question of the extraction of the placenta, in cases of placenta prævia, but also the general treatment of uterine hemorrhage in all its several forms; and yet there is probably no subject upon so much diversity of opinion prevails, or in regard to which mere speculative notions have been more freely allowed to take the place of original observation. With the view of aiding in the solution of this question, I am induced to submit to the Society some investigations which were specially undertaken for the purpose of elucidating it.

On referring to the published writings of various obstetric authorities, it will be found that three different opinions prevail at the present day respecting the anatomical source of hemorrhage in cases of partial separation of the placenta. The first affirms, that it is principally or wholly uterine; the second, that it is principally or wholly placental; the third, that it is both uterine and placental, the blood escaping partly from the exposed uterine, and partly from the detached placental surfaces.

Further, it will be found that uterine hemorrhage, whether occurring in connection with partial or entire separation of the placenta, is generally considered to be principally venous. "Uterine hemorrhage," says Dr. Simpson, "after the separation of the placenta, in any of the stages of labour, is not arterial in its character. The utero-placental