hemorrhage after parturition, by causing contractions of the muscular walls of the uterus.

The bowels, if necessary, should be regulated by gentle aperients, such as the following:

Misce; et divide in pilulas xij.,

B. Pulveris rhei, balsami copaibæ, àã 3 ss. quarum capiat duas horâ somni pro re natâ. Turpentine and the secale cornutum have also been found efficacious in restraining menorrhagic discharge.

The best local remedy is the sulphate of alum hip-bath, which may be made in the proportion of twelve ounces of alum to two gallons of water. It may be used daily for about twenty minutes, first tepid, thence gradually reducing it to the normal temperature.

Should the discharge continue unabated, notwithstanding the use of the above remedies, a polypous growth or some morbid condition of the uterus is to be suspected; and the uterus must then be examined.-Association Med. Journal, May 6, 1853, p. 394.

147.-ON THE USE OF CINNAMON IN CERTAIN EXAMPLES OF

MENORRHAGIA.

By DR. T. H. TANNER.

[We frequently meet with cases of menorrhagia where no satisfactory explanation can be given of the increased discharge.]

The symptoms usually presented are briefly these: the catamenia appear regularly every twenty-eight days, and are at first only of the proper quantity; but, instead of ceasing after a duration of three or four days, they continue unabated for ten or fourteen, and occasionally even for three weeks. The general symptoms which arise from this debilitating discharge are just such as might be expected. There is general weakness, languor, mental depression, with pains in the head, loins, and so on the patient suffering, it is to be remembered, not from any diseased condition, giving rise to the hemorrhage, but merely from the loss of blood itself. In other instances the discharge continues a less time, but the flow is more abundant, clots being frequently discharged; this variety is generally followed by leucorrhoea. My own experience tends to show that these forms of menorrhagia occur more frequently in unmarried than in married women; but for many reasons, and especially because of the class of patients from whom my observations are for the most part deduced, I would not say positively that such is the case.

Ailments of this class are at all times troublesome to cure, but those I am considering are particularly so, from the absence of any special indications for treatment. In some of them, indeed, it appears, at first sight, only necessary to keep the patient quiet, to administer astringents, especially such as act particularly upon the uterus, and to regulate the diet, in order to give the desired relief. But it will often be found that these means are quite inefficient, and the acetate of lead, gallic acid, the ergot of rye, oxide of silver, sulphuric acid, tincture of sesquichloride of iron, and similar remedies may be employed without any avail. In thinking over these cases I was led, from a remark made by Dr. Pereira, to try the use of cinnamon. In the last edition of the Elements of Materia Medica,' this gentleman says, when speaking of cinnamon, that "some writers regard it as acting specifically on the uterus" (vol. ii. p. 1307), and reference is then made to the writings of Sundelin and Wibmer. As far as I know, these are the principal authors who have recommended the use of this agent; for I am not aware that mention is made of it by gentlemen who have written on obstetrics and diseases of women in this country. Having thus been led to try the effects of this agent, and having derived the most beneficial effects from its employment, I have felt desirous of making its value more generally known, that its utility may be tested on a large scale.

That its beneficial action is really due to some specific effect which cinnamon exercises upon the uterus, and not any astringent property it may possess from the tannic acid which the bark and leaves of it contain in common with all the lauraceæ order of plants, is, I think, certain; and partly in confirmation of this view, it may be mentioned, that in a case of labour in which I employed it, it appeared not only in a marked manner to increase the severity and rapidity of the pains, but the patient,

who had in her previous labours suffered severely from flooding after the birth of the placenta, on this occasion lost only a very small quantity of blood. That this fortunate circumstance was due to the administration of the cinnamon I do not of course pretend positively to assert; the case is merely mentioned to give some colour to the opinion expressed that this agent acts specifically upon the uterus. Much clearer evidence of its value in such cases of menorrhagia as I have described, is, however, easily obtained. The principal points I would now refer to are, that it acts after the failure of other astringents; that it is most efficacious given alone, uncombined with other medicines; that if its employment be discontinued too soon, the discharge of blood returns; while, in a few instances, it has been found necessary, after an apparent cure, to resort to its employment for the two succeeding catamenial periods, when the menstrual flow, after continuing for three or four days, has not given any signs of abatement, and when the patient has begun to suffer from mental depression and the early symptoms of general debility. The form usually employed, and which appears to be the best, is that of the tincture, in drachm doses, using cinnamon water as the vehicle; it should be taken about every six hours, but not more frequently, as it is apt to give rise to nausea and vomiting. It is also better to continue its administration for about fourteen days after the symptoms which called for its employment have disappeared; and even then, if the case has been an obstinate one, a draught composed of it should be taken once daily for a month.-Lancet, Oct. 15, 1853, p. 363.

148.-CASE OF FIBROUS TUMOUR OF THE WOMB REMOVED BY INCISION AND ENUCLEATION.

Under the care of T. P. TEALE, Esq., F.L.S., Surgeon to the Leeds General Infirmary.

[The patient in this case was fifty-six years old. She was extremely fat and anæmic. Since her last child, which was born nine years ago, she had been subject to profuse uterine hemorrhages. The pelvis was filled with a smooth rounded elastic tumour, descending as low as, and resting upon the perineum. It could not be ascertained whether it was pedunculated or closely attached to the surface of the womb. Mr. Teale says:]

The first step in the operation was to grasp the tumour by a pair of fenestrated forceps, as used in midwifery. By firm traction of the mass downwards, and movements of it from side to side, a great portion of it was gradually brought outside of the vulva; but, as soon as the forceps was removed, it receded within the pelvis. This was repeated two or three times, until at length I brought it so low down that Mr. Haymes could retain it by the grasp of both his hands, until I had applied around its upper part a strong whipcord, by the aid of Gooch's double canula. By this ligature, which was applied for the purpose of retention, and not for strangulation, the tumour was held downwards, and prevented from receding; and I was thus able to determine, without difficulty, the relations of the upper part of the tumour to the body of the womb. It was then found that the tumour was not pedunculated, but was imbedded at its upper part, by a broad base, in the substance of the posterior wall of the womb, which was now partially inverted by the traction which had been employed. By means of long curved probe-pointed scissors, I made a transverse incision through the investing membrane of the tumour, a little above the ligature that had been applied, large enough to admit the tips of three fingers, by which I was enabled, slowly and cautiously, to enucleate the imbedded portion of the tumour from the uterine wall; so that it only remained attached by the undivided portion of the investing membrane, which was now divided by the scissors, and the entire mass was removed. The process of enucleation resembled much the turning out of a fatty tumour from its cellular bed. I now examined the vagina, and found it occupied by an elongated mass, as thick as the wrist, which was immediately recognised as the inverted womb. By compressing this mass with the fingers, and pushing it steadily upwards, the womb slowly receded, and at length suddenly resumed its naturul position; after which the parts presented the ordinary characters which are observed in a person recently delivered of a child; but the womb felt of rather smaller size. XXVIII.-19.

The operation was completed at 8 p.m. In two hours afterwards the patient was perfectly easy, free from hemorrhage, and her pulse 80.

On the following morning, she felt quite comfortable, having slept well, and her pulse was 80. So slight was the loss of blood, that during the night she had only soiled moderately one napkin.

The tumour weighed a pound and a half. Its length was seven inches; circumference at the broadest part, eleven inches; and at the line of incision ten and a quarter inches.

Remarks.-1. The practicability of enucleating some fibrous tumours of the womb, previously established, and further confirmed by this case, is a fact of great importance in the treatment of those fibrous masses which protrude from the interior of the womb, without having a peduncle or a well-defined neck. Although enucleation has been previously practised, I am not aware of the modification of the process by incision having been hitherto adopted. By the transverse incision of the investing membrane at its upper part, the trouble of enucleation is greatly diminished. I may also remark, that the process adopted in this case, as compared with the incomplete separation of the mass by ulceration consequent upon the application of a ligature, was a great saving of constitutional effort, as well as a much more complete removal of the disease.

2. In cases of large tumour of this kind, where it is impossible to determine by the fingers its mode of attachment, we may, by traction downwards, even beyond the external parts, accurately determine the nature of its connexion, and easily reach the site of operation. But, when inversion has been thus produced, it is important that the operator should, without delay, attempt the replacement of the womb; and he may do this, as in the present case, with the greatest hope of success, as the mouth of the womb, from long distension, is not disposed at the moment to contract with great force.-Med. Times and Gazette, Aug. 20, 1853, p. 194.

149.-Case of large Cyst in the Labium Pudendi analogous to Hydrocele of the Spermatic Cord. Under the care of T. P. TEALE, Esq., F.L.S., Surgeon to the Leeds General Infirmary.-[For the notes of this case, and for the examination of the contents of the cyst, we are indebted to Mr. Scattergood, formerly an assistant surgeon at the Infirmary.]

Esther Gilbert, aged 55, married, was admitted into the Leeds Infirmary, June 24, 1847, on account of a tumour occupying the right labium pudendi. The tumour was of oblongo-oval form. It commenced at the lower part of the inguinal canal, which was apparently occupied by it, and extended downwards, distending the labium, and forming a pendulous mass hanging down between the thighs; fluctuation was distinct throughout its whole extent. She stated, that more than a year ago she perceived a lump, as large as a pullet's egg, in the upper part of the labium. Since that time it had gradually enlarged, but had never been painful. The bowels were generally costive, but never obstructed; her general health was pretty good; menstruation ceased three or four years ago. On puncturing the tumour with a grooved needle, a fluid issued, resembling in appearance thin dirty cream.

[On June 26, Mr. Teale tapped the tumour, and removed three pints of a dirty milky fluid, sp. gr. 1026. It had a slightly acid reaction, and was not rendered viscid by boiling with liq. potassæ. The microscope showed the presence of a large quantity of oil globules. The sac subsequently refilling, Mr. Teale, after tapping it, injected 3ij. each of tincture of iodine and rectified spirit of wine. As it refilled, it was again tapped, and double the quantity of the injection used. The cyst did not now distend so rapidly as on former occasions, but the patient soon afterwards died of some disease unconnected with the tumour. Mr. Teale suspected it to be a cyst developed in connexion with the round ligament, analogous to hydrocele of the spermatic cord in the male. No opportunity, however, was afforded of a post-mortem examination.] -Med. Times and Gaz., July 30, 1853, p. 113.

150.-On the Diet of Infants.-We have had a considerable experience in direct

ing and observing minutely the rearing of infants upon a substitute for mother's milk. We never allow a healthy infant, for the first two months, to have any other food as a substitute for its mother's milk than cow's milk diluted with two-thirds of water, and well sweetened with fine sugar. Of this fare we sanction an unlimited supply, at intervals of from one and a half to two hours during the day, and three or four hours at night, provided it be sucked from a teat. Upon this simple fare, we have seen children grow up in the plenitude of health and strength. If the food be as thin as we have described, no evil can arise from over-feeding; and by allowing an interval to elapse between the times of feeding, digestion goes on better, and fretfulness is averted. To weak or scrofulous infants, the addition of a little mutton suet is good, or the same benefit may be obtained by giving two teaspoonfuls of cod-liver oil daily. Oatmeal, and all farinaceous foods, are unsuitable and unnatural for the first two months, and are certain to induce fits of feverishness and griping pains. After the second month, rusk, melted down in the sweetened milk and water, is useful; but the food must still be thin, and sucked from a teat by the infant. The exertion of sucking is, for many reasons, very salutary.-Association Med. Journal, Aug. 12, 1853, p. 714.

151.-Dissection of a Portion of the Uterus and Placenta. By Drs. WINN and GALL. [These gentlemen were enabled to make this dissection through the kindness of Mr. Edward Snell. By this investigation the theories of Goodsir and other modern observers, and to a great extent that of the immortal Hunter, with regard to the placental circulation, would seem to be established.]

Under a power magnifying 270 times, the following facts were clearly manifested: 1. That the falciform duplicatures of the sinuses contained not only parallel, but transverse muscular striæ, indicating a high degree of contractile euergy. As these bodies are situated at the openings of the sinuses, they must exert a powerful influence in arresting the flow of blood when the placenta is separated from the uterus. 2. That many of the delicate filaments which are seen passing from the placenta to the uterus, when these bodies are gently separated, are composed of looped capillaries, enclosed in a fine nucleated membrane. This membrane is probably a continuation of the chorion. These loops form, as it were, villi, and project, but do not open into the sinuses. They corresponded exactly with the description given of them by Goodsir. 3. That the tissues of the placenta presented numerous oil-globules, showing that the organ had fulfilled its destiny, and that it was, in fact, effete, and soon about to be thrown off in the same manner as a ripe seed-vessel is separated from the parent plant. Dr. Winn, in conclusion, stated that the placental circulation was a difficult question, and had given rise to a variety of conflicting opi. nions; he, however, considered that modern research had established many facts, and that it could now be safely inferred that the maternal blood entered the placental cells by the curling arteries of the uterus, and that into these cells the placental tufts projected. From these cells the blood is returned by the uterine veins without having left the maternal blood vessels. The foetal tufts are therefore merely bathed in the blood of the sinuses, and the blood of the foetus is purified by a sort of action similar to that which takes place in the brancheæ of fishes.-Lancel, June 11, 1853, p. 547.

152. ON THE PATHOLOGY AND TREATMENT OF LEUCORRHOEA, BASED UPON THE MICROSCOPICAL ANATOMY OF THE OS AND CERVIX UTERI.

By DR. W. TYLER SMITH, Physician Accoucheur to St. Mary's Hospital. [Dr. Smith believed that a microscopical examination of the various leucorrhoeal secretions in different cases would account for the many discrepancies upon the subject. The results of the examination were not so satisfactory as could have been wished.]

The opaque, curdy, and creamy discharge found lying upon the surface of the vagina and the external portion of the cervix uteri, seems to the naked eye widely different from the viscid, transparent secretion seen issuing from the cervix uteri.

Yet, under the microscope, both were found to consist of nearly the same elements, namely, mucus or pus globules and epithelial particles, involved in a thick tenacious plasma. The only difference appeared to be in the relative quantity of squamous epithelium and mucous corpuscles. In the vaginal secretion the epithelium was in greatest abundance, while mucous corpuscles were in excess in the secretion from the canal of the cervix. It was evident, however, that the physical qualities of the discharges did not depend upon these variations, as the opaque, curdy, and the transparent viscid secretions were sometimes quite identical in their microscopical appearances. It became, therefore, an object to ascertain the precise structures which secreted these discharges, and the causes which modified their sensible and microscopical appearances.,

[Dr. Smith lays great stress upon the value of the assistance he has received from Dr. Hassall and Dr. Handfield Jones, the former assisting him in the examination of the anatomy of the os and cervix uteri, and the latter in that of a large number of specimens of leucorrhoeal discharges. The os and cervix uteri present a very large surface for the purpose of glandular secretion. Dr. Smith regards the cervix uteri to be an open gland, and supposes it to be the principal seat of leucorrhoea.]

I may here refer to a point which should not be lost sight of, bearing as it does upon the pathology and treatment of leucorrhoeal affections, namely, the great similarity which exists between the skin and the mucous membrane of the vagina and the external portion of the os and cervix uteri. The resemblances of the mucous membrane in these situations are certainly much nearer to the cutaneous structures than to the mucous membranes of the more internal parts. This is particularly the case with respect to the dense epithelial layer of the vagina and os uteri; and the villi of the os uteri are, perhaps, more nearly allied to the papillæ of the skin than to the villi of the intestinal mucous membrane. These analogies are strongly confirmed by what is observed of the pathological conditions to which these parts are liable, and by the effects of therapeutical applications. It is well known that when inversion of the vagina occurs, as in procidentia uteri, the secretion of mucus is arrested, and the epithelial layer of the vagina becomes hard and similar to epidermis. The epithelium found upon the follicular surface of the canal of the cervix uteri is cylindrical or dentated, like the epithelium just within the os. It is also ciliated low down in the cervix, and this character is continued into the cavity of the fundus uteri. The villi found in this portion of the cervix are covered by the dentated epithelium, just as in the case of the villi of the lowest part of the cervix. Mixed with the epithelium of the follicular surface of the cervix, a considerable number of caudate corpuscles are frequently found, each of them having a distinct central nucleus. Thus it appears that the epithelium of the os uteri and external portion of the cervix is constantly squamous; that the epithelium just within the os uteri is cylindrical but not ciliated; and that in the rugous portion of the cervical canal the cylindrical epithelium becomes ciliated. Various opinions have been held respecting the situation in which the squamous epithelium becomes changed for the cylindrical, and also respecting the point at which cilia are first found. The above is the result, however, of the examination of the numerous uteri, made as early as possible after death, so as to anticipate the alterations of the cilia and epithelium by post-mortem changes.

The normal mucus secreted by the glandular portion of the cervix is extremely viscid and almost transparent. It adheres to the crypts and rugæ so as to fill the canal of the cervix. It consists chiefly of mucous corpuscles, caudate corpuscles, minute oil globules, and occasionally dentated epithelium, all entangled in a thick tenacious plasma. The tenacity of this plasma is so great that the mucous corpuscles and epithelial debris are arranged in strings within the fluid, and even individual corpuscles may be elongated by pressure upon the plasma, under the microscope. The mucus found at the lowest part of the canal of the cervix is thinner than that belonging to the glandular portion of the cervix, a circumstance which may perhaps be owing to the secretory action of the large number of villi within the margin of the os.

The mucus found in the upper part of the vagina, as the proper vaginal secretion, is no doubt chiefly secreted by the villi and epithelium of the upper extremity of the wagina and of the os uteri and external portion of the cervix.

The vaginal mucus, as first secreted, is pearly and semi-transparent, containing