THE MICROSCOPE 
IN 
GYNAECOLOGY. 
BY 
A. Mead Edwards, M. D., 
NEWARK, N. J. 
Extracted from the Transactions of the Medical Society of New Jersey. 
NEWARK, N . J .: 
Jennings <k Hardham, Steam Printers and Bookbinders, 
153 arid 155 Market Street. 
1 875. THE MICROSCOPE 
IN 
GYNAECOLOGY.- 
by j y 
A. MEAD EDWARDS, M. D., 
NEWARK, N. J. 
Extracted from the Transactions of the Medical Society of New Jersey. 
NEWARK, N. J.: 
Jennings & Hakdham, Steam Printers and Bookbinders, 
153 and 155 Market Street. 
1 87 5. THE MICROSCOPE IN GYNAECOLOGY. 
When the various and continually multiplying applications of the modern 
compound achromatic microscope, in its present almost perfected condition, 
to the various branches of biology are taken into consideration, it becomes 
a matter of some surprise that the practitioner of medicine has not more 
frequently availed himself of the assistance of that important instrument of 
research, in augmenting the limited powers with which he has been gifted, 
and thereby enabling him the more certainly to arrive at correct diagnoses in 
cases of disease. We ought hardly, however, to wonder that the already 
overburdened busy man of practice cannot steal a few more hours from his 
time of necessary rest, to look still deeper into the tissues of his patients. 
But there are always men, and they are perhaps to be found amongst the 
specialists, who do have the time to devote to researches of a scientific char- 
acter. Many of these, doubtless, lack the desire or ability to use an instru- 
ment, such as the microscope, which requires for its intelligent employment 
a long period of schooling, of a severe and thorough description. To 
those who have not used its searching eye to assist and guide the labors 
of the mind, the microscope appears to be, doubtless, either a mere plaything, 
or, at best, an instrument the use of which is as easy as seeing with the eyes 
alone. To such the microscopist seems little better than an idler, or, even 
worse, a wild enthusiast. But they forget how many years it took them to 
learn to see as well as they can with their unassisted eyes; how many still 
longer years were required before they could interpret what they saw and 
thought they could comprehend. The manifold difficulties attendant upon 
microscopic research, are not known to such persons, and can only be appre- 
ciated from experience. It would be out of place to dwell upon them at 
the present time; but it will be my endeavor to call attention to a field of 
research which has been but little cultivated, but which would yield to the 
earnest student ample returns of interest and profit. The application of the 
microscope to practical medicine has been fully recognized by a few men, 
and treatises in English, German and French are to be found which treat 
more or less completely of the subject; but its use, as specially applied to 
Gynaecology, has not, as yet, been sufficiently set forth, although Gynaecology 
itself is rapidly becoming, if it has not already become, a science. There- 4 
fore, it is my intention, in this paper, to present some suggestions pointing 
in the direction in which, I am of opinion, this means of physical research 
might be applied to investigations in this branch of medicine. Every day, 
more and more, the profession are coming to recognize and depend upon 
physical methods as applied to diagnosis. Instrumental observation and 
registration are so sure and reliable, so exact and ready, that the errors aris- 
ing from the personal equation are almost, if not entirely, in many cases re- 
moved. The Stethoscope occupies a well-deserved position in the practi- 
tioner’s tool-chest; the Thermometer is now loudly asserting its rights to 
recognition as an indispensable adjunct at the bed-side, and the Test-tube 
and Hydrometer have long since found a home on the office-table. Why, 
then, should not the more delicate, exact, and therefore valuable Microscope 
be more often appealed to for assistance in unravelling knotty points in 
pathology ? It has been more for the purpose of claiming the right of the 
microscope to be called upon to do its part in scientific diagnosis, than to 
show what it has already done for medicine, that this paper has been 
written. Therefore it will necessarily be to a very great extent of a sketchy 
character, and, as I have just said, suggestive even if it does not convey any 
very valuable information to the readers. 
Although the list of Gynaecologists is a long one, and many eminent names 
adorn it, yet those who have employed the microscope to assist them in 
their investigations are very few. Thus we find the names of Donn6, Tyler, 
Smith, Kollicker and Scanzoni, Sims, Eichwald, Drysdale, Waldeyer and 
Martin as among the most prominent who have written much on the sub- 
ject; whilst a few others have contributed scattered papers to the journals 
on matters relating to it. I shall make no attempt herein to review all that 
has been done by the investigators just enumerated, but shall merely allude 
to some of their discoveries, whilst I point out the direction in which I 
consider that future studies should be pushed. At the same time, I shall 
briefly describe a few observations of my own, illustrating them by means 
of drawings from nature made by means of the microscope. These are but 
samples of many, which I have made from time to time, and the results 
have been so promising that it is my intention to follow them up, as time 
and opportunity offers; at the same time, I would ask those who have the 
opportunity of so doing to follow out the hints I shall give, and see if the 
microscope, truthfully and conscientiously employed, will not yield fruit as 
profitable as that bestowed by the other instruments of physical research 
used by the practitioner of medicine. 
At the outset, and before going any farther, I wish it to be distinctly under- 5 
stood that I merely claim for the microscope the position of an assistant—a 
valuable and trustworthy assistant in diagnosis. That it is always reliable, 
I claim, as reliable in its place as the thermometer in its position; no more 
so. The careless observer, using the thermometer, may make absurd diag- 
noses ; the unlearned owner of a microscope may easily do more. It is true 
that many accomplished diagnosticians do not depend upon any instruments 
of physical research to aid them in making their examinations. With them 
the practiced ear does not require the stethoscope; the sensitive finger can 
almost dispense with the thermometer; but no human eye, however practiced 
or sensitive, can unaided see what the microscope reveals. There are those 
who think that the microscope is not reliable, and point to the confused 
history of cancer-cells in justification of their doubts. But it must be re- 
membered that in such cases it is not the instrument, but the observer that 
we are trusting, and it will be well, also, not to forget that the instrument 
does not see, but the eye which is behind it; that the instrument cannot 
misinterpret, but the uninformed user of it may do so. Therefore, if at any 
time erroneous deductions have been drawn from observations made by 
means of the microscope, the instrument should not be held responsible 
therefor, but they should rather be set down to the credit of the careless or 
unpracticed observer who employs it. Microscopists are plentiful, but stu- 
dents are rare; and to use the microscope intelligently requires that its 
possessor should be both an earnest and patient student. 
To illustrate what I have to say, I shall, as I have already remarked, in 
the first place detail a few original observations which I have made, and 
which, although they may at first sight not appear to point to very imme- 
diate practical results in either pathology or therapeutics, yet to the scientific 
student of medicine they will, I trust, prove of interest as throwing some 
light upon the etiology of certain conditions of a portion of the human 
mucous-membrane. My attention was first called to this subject some few 
years since, when I was making a series of experiments connected with the 
life history of certain minute forms of vegetables belonging to the group 
Fungi, and which experiments I had undertaken in the expectation that 
they would assist in unravelling a few knotty points bearing upon the so- 
called spontaneous generation theory. And although it would perhaps be 
thought that this same spontaneous generation theory can have very little 
to do with practical medicine, yet when it is applied to the beginning of 
pathological conditions affecting the human economy and the origin of dis- 
ease, spontaneous or otherwise, be looked for, it at once becomes interesting 
and extremely important to the working practitioner. To this end I shall 6 
enumerate one or two cases in which I employed the microscope in the ex- 
amination of discharges from the vaginal mucous-membrane of patients un- 
der treatment at that time; and, after pointing out what I found therein of 
interest, I shall briefly allude to the observations of others in this field. 
Thereafter, and in conclusion, I shall indicate the direction in which it ap- 
pears to me that further observations of this character should be made. 
The first case is that of a young married woman, afflicted apparently with 
no more serious disease than simple coryza. “ A cold ” having been caught, 
nothing was done for it, and seemingly it had passed off, without leaving 
any bad effects. This lady had always been remarkably healthy, and not 
subject to abnormal discharges of any kind from her genitals. When, 
she found ttyat after the cold in the head had passed off, and the enrprh of 
the catarrhal mucous-membrane had ceased, a discharge was occurring from 
the vagina, she became alarmed and applied for advice, fearing that some- 
thing serious was the matter with her. I made a vaginal examination to 
see if there was any serious cause for alarm, and more for the purpose of allaying 
her anxiety, when I found that the leucorrhoea was, as I had supposed, 
mostly vaginal, but to a certain extent uterine likewise. This uterine leu- 
corrhoea, as is usually the case, passing over the congested mucous-mem- 
brane of the lip of the os externum, had produced one or two slight so-called 
“ ulcerations.” For be it remembered that this uterine leucorrhoeal dis- 
charge, inore especially when it is for the most cervical, is with certain consti- 
tutions of a jmrticularly icchorous character; so much so that when coming in 
contact with a membrane of the nature of that covering the lips of the uterus, 
it will abrade and remove the epithelium to a very great extent, and produce 
the condition known to the older practitioners as “ ulceration.” In persons 
of this type, a discharge from the nasal mucous membrane will in like man- 
ner produce similar abrasions of the cuticle, below the nostrils and cover- 
ing the upper lip. To treat the ulcerations upon the uterine mouth alone, 
would be unscientific, and as unsatisfactory as to treat the solution of con- 
tinuity found upon the face; and to cure either condition we must go to the 
root of the evil, and finding that, treat it. 
It is not my intention, at the present time, to say anything in connection 
with the treatment of conditions, such as I found in this patient, as it is 
only my desire to detail what a microscopic observation revealed in the dis- 
charge itself. When examined by means of a sufficiently high power, it 
was found to present the appearance I have depicted in the first of the 
plates accompanying this paper. And here let me say how much I regret 
that I have been unable, as yet, to preserve specimens of vaginal discharges, 7 
so as to be able to exhibit them at any length cf time after they have been 
obtained. I do not. however, despair of succeeding in so doing, and am at 
present engaged in experimenting on this subject. In the drawing I have 
represented the squamous vaginal epithelial scales with their nuclei and nu- 
cleoli. I adopt these terms nucleus and nucleolus provisionally, as making 
the matter understandable to those who are not informed with regard to 
the later revelations of microscopic histology, as bearing upon the cell 
theory of the older observers, whilst at the same time I recognize the fact 
that our knowledge on this point is, at the present time, most markedly in 
a transition state, so much so that it becomes extremely difficult for a writer 
to express himself at the same time clearly and truthfully, without going 
into what would prove tedious details. In the plate will be seen certain 
fine filaments. These are of a mycelial character, resembling very closely 
what C. Robin has figured in his Histoire Naturelle des Veg6taux Parasites 
(Planche I., Fig. 1 et 2) as Leptothrix buccalis. In fact, leaving out what he 
calls “ globules purulents (globules muqueux)” and the curious organism to 
be presently described; my second plate which shows this organism more 
plainly and represents a specimen obtained at a later period from the same 
patient, and his fig. 1, are almost identical in appearance. This specimen 
was taken from the surface of the tongue and contains the squamous epi- 
thelium found there, and which is the same in all particulars as that occur- 
ring in the vagina along with the Leptothrix filaments and granular, matter. 
As it may, at first sight, appear strange that we should find the same organ- 
ism, namely, the Leptothrix in the mouth and in the vagina, it may be of in- 
terest to say something on this point at the present time. Al. Donn6, in his 
Cours de Microscopie, 1844, when describing vaginal mucus, says thai under 
certain circumstances this secretion becomes so modified as to have dissemi- 
nated amongst its epithelial scales, or “ epidermic vesicles,” as he calls them, 
numerous delicate filaments whose origin or meaning he is at loss to account 
for. The figure he gives in his Atlas of these organisms, is extremely crude, 
and by no means to be compared to that of Robin, just mentioned. In 1843, 
Kiitzing founded the genus Leptothrix with a large number of species; 
one of which, namely, L. bitccalis, was founded by Ch. Robin in his Histoire 
Naturelle des V6getaux Parasites, 1853, page 345. He mentions it as being 
found upon the surface of the tongue, in the matter which accumulates be- 
tween the teeth, or in the cavities of decayed teeth, from whence it passes 
into the liquids of the stomach and intestines, and makes its appearance in 
the dejections of diarrhoea. This plant was seen long before Robin’s time, 
but he was the first one to make a scientific study of it and name it. He 8 
nowhere mentions having found it in the mucous of the genital organs ; but 
the form mentioned and figured by Donn6 is, without doubt, the same plant 
which I have found in that locality. Robin says that along with the fila- 
ments of Leptothrix, he always found Vibrions belonging to various species. 
This point it is important to bear in mind, as I intend to show presently 
the relation existing between the filaments and the Vibrions. 
The most remarkable constituent of this particular specimen of lucor- 
rhceal discharge was an organism which was in this particular specimen rather 
rare. I at once perceived that it was a member of the heterogenous 
group termed “ Infusoria,” and which contains both animals and plants, as 
well as things which are neither one nor the other. It is, in fact, the 
Trico-monas vaginale of Donn6, which he first described and figured in 1837, 
in his “ Recherches Microscopiques sur la nature des Mucus et la mati6re des 
divers 6coulemens des organes genito-urinaires.” Since this time the ortho- 
graphy of the name of this creature has been remodelled so that we now 
know it as Trichomonas Vaginalis. The individuals I saw in this specimen 
were extremely lively in their motions, so much so that my attention was 
immediately attracted by them, and I was at once able to identify them as 
the organisms first seen by Donn6, although I had never seen them before. 
Of course, I was naturally anxious to learn what their presence indicated. 
Donn6, when he first saw them, did not believe them to be indicative of 
any pathological condition of the parts whereupon they were found, 
although later writers have fallen into the error of supposing that he con- 
sidered them to be present only during disease. This mistake has, doubt- 
less, arisen from Kuchenmeister having stated in his Manual of Animal and 
Vegetable Parasites, (Eng. Ed., 1857, Vol. I., page 7,) that it “only occurs 
in women with gonorrhreal discharge, or with anabundant vaginal secretion 
mixed with mucous and pus-corpuscles; never in a normal and healthy 
secretion, but only in pathological secretions.” Beale, who is singularly 
careless in his quotations, says (Kidney Diseases, 3d Ed., 1869, page 326), “ it 
was found in the urine of females suffering from leucorrhoea,” and he goes 
on to say that “ they are probably ordinary monads, or pus-corjmscles with 
a projecting filament. I have met with both, but have never seen any- 
thing exactly resembling the figures of the so-called Trichomonas vaginae.” 
(It will be noticed that Donne does not call them “Vaginas'' but “ Vagin 
ale." Now what Donn6 really does say (Cours de Microscopie, 1844, page 
157) is that he found this creature “in the vaginal mucous of certain women, 
affected with a discharge sometimes of a suspicious character, some- 
times resulting from want of cleanliness of the genitals.” The fact would 9 
seem to be that the Trichomonas vaginalis is the result of the retention 
of an abundant mucous discharge within the vaginal canal; for I shall 
show, farther on, that they may, at least, multiply outside the human 
body. As to how they originate in the vaginal mucous, either by 
“ spontaneous generation ” or otherwise, I leave for future investigation to 
decide. 
As I have quoted Donn6, an author whose investigations are, I think, 
insufficiently known or appreciated, it may be of interest to say that his 
inaugural thesis was on Physiological and Chemico-Microscopical Researches 
on the Blood Globules, Pus, Mucus, and the Humors of the Eye,” and that 
in it he makes the following remark: “ The globules which are found in 
mucus or rather in saliva, have the same aspect as the last mentioned (pus 
globules), and I consider that they have the same origin.” This was in 
1831, and it is of interest, when considered in connection with the later ob- 
servations of Waller, Conheim and others, which go to prove the identity 
of the leucocytes and pus and mucus corpuscles. 
Two days after I had examined the specimen of vaginal mucus I have 
just been describing, I was enabled to procure another of a similar charac- 
ter from the same patient, who continued to have some leucorrhoea; and at 
that time, not knowing the import of either of the microscopic forms which 
I had detected, I had determined to keep her under observation. At this 
time, I found the Trichomonas and Leptothrix rarer than at first. Four days 
thereafter another specimen was taken and examined. In this no Tricho- 
monas was seen, but the Leptothrix was in patches attached by one end of 
the filament to the epithelial plates. At the point of attachment was a 
mass of granular matter. Robin has well figured this mode of growth, in 
his Atlas, Planche I., fig. 1, of Leptothrix buccalis from the mouth. Separate 
filaments of this plant are shown in the drawing, as are filaments taking on 
the form and possessed of the movements of Vibriones. There are separate 
segments of the same, identical with what have been called Bacteria, both 
in form and movements. Monads were seen in active motion, and there w7as 
a form made up of three joints, one of which was bent, and showing one 
of the stages of transition, as was afterwards proved, from the Vibrione to 
the Leptothrix. The rest of the field of vision was filled up with minutely 
granular matter, as was the case with the first specimen. 
From the observations which I had been engaged upon for some time, 
connected with the development of certain fungi, and which I have already 
alluded to, I was induced to seal some of this discharge up in what is 
known to microscopists as a “ cell,” where it was entirely excluded from the 10 
air, and wherein it could be examined from time to time, or even watched 
under the microscope for hours at a time, and any changes which might 
take place in it be studied. It was thus watched carefully and observed fre- 
quently during the next three days. At the end of that period a marked 
change had occurred. The Bacteria forms and Monads had increased in 
numbers, whilst the filaments of Leptothrix had dropped off from the epi- 
thelial scales, showing that these shorter forms were derived from the longer 
ones. Chains made up of two and three Monads were also to be seen. 
Such chains, in which the bead-like portions number two to five, have had 
bestowed upon them the name of Bacterium triloculare, and where they are 
still more numerous and are arranged in the form of an open spiral they 
have been called Spirillum. 
It was whilst watching this and other similar specimens, during severa, 
consecutive hours and days, that I saw certain changes actually take place 
which it will be well here to describe. The granular matter, which was 
always present in greater or less quantity, was at first immovable, and under 
a power of one thousand diameters did not appear to have any definite form, 
although, doubtless, if a still higher power had been used in its study it 
would have been seen to be globular. Soon its individual particles en- 
larged considerably, and taking upon themselves the spherical form, became 
true Monads with rapid trembling movements. These then attached them- 
selves one to the other, until the chains constituting Bacterium trilocalare 
were formed. Gradually the little bead-like portions melted one into the 
other and rod-like Bacteria appeared. Now the Bacteria elongated into 
longer rods, which, in turn, would adhere end to end until chains of two or 
more rods were seen. At the point of union of these rods a certain amount 
of mobility often existed, and such zig-zag forms sailed about in a lively 
manner. These have been called Vibriones. But, at times, the contents of 
the long rods would grow out lengthwise, and Leptothrix filaments would be 
the result. It would seem that the granular matter adhering to epithelium 
might thus develop into groups of filaments like those I have depicted in 
the plate. But these filaments themselves undergo a change, either when 
attached and long, or free and short. Then their contents are transformed 
to such an extent that they refract light very strongly and appear almost 
opaque. Soon they enlarge in every direction, and growing rapidly, develop 
into a true fungoid mycelium. From this mycelium true sporangia—i. e., 
seed-vessels—grew up into the air above the fluid. These I have drawn. 
One is a Muco?\ whilst the other I cannot fipd described or figured any- 
where. And to show its novelty, I may say that I sent a drawing of it to 11 
Mr. M. C. Cooke, of London, the celebrated authority on fungi, and in re- 
ply he wrote me that he could not guess what my plant might be, and said, 
“ are you sure that it is not an alga ? It seems to me more of an algoid 
than a fungoid fruit.” The Mucors, I may say for the information of those 
who are not up in fungi, are the moulds so common on animal and vegeta- 
ble substances everywhere, and although numerous species and even genera 
have been described, there is good reason to believe that they are trans- 
mutable one into the other. Thus, Dr. Tilbury Fox has shown that many of 
the fungi peculiar to different skin diseases are thus transmutable ; and he 
considers Leptothrix allied to Torula (yeast fungus), which he places in his 
diagram of the relations of these minute forms of life, as the centre around 
which are grouped Aspergillus, Penicillium, Puccinia, a fungus parasite found 
in the vagina by Dr. Bennett, and others. The mass of fungoid mycelium 
I speak of constituted a tough membrane closely resembling that developed 
on mucous and other surfaces in Diphtheria ; in fact, there is good reason 
to believe that in this case there was developed exteriorly to the living 
body a true diphtheritic membrane. The reasons for this belief will be 
pointed out hereafter. 
It may be as well to state here that Cohn has lately been investigating 
these minute forms of existence, and has cleared up the synonomy to such 
an extent, that we may hereafter be somewhat more clear as to what writers 
mean when they are speaking of them. Thus, the single spherical forms I 
have called Monads, he prefers to call Micrococus; the straight rod-like form 
he calls Bacterium; when it is jointed, Bacillus; when it is motile, Vibrio; 
and when it is corkscrew in form, Spirillum. 
The second case to be mentioned in which the vaginal discharge was ex- 
amined by means of the microscope, is that of a lady, forty years of age, and 
unmarried. This patient had been under treatment for some time, and 
came to me from another physician with the following history : For six or 
eight years she had had prolapsus in the first degree, accompanying, if not 
resulting from chronic endometritus, as well as ante-version, which, at times, 
was very marked. When I first saw her the uterus could be readily re- 
placed, but as she was unable to wear a support of any kind, after a while 
it seemed to have formed adhesions, fixing it low in the pelvis, so that I 
could not, at the time I am speaking of, readily move it. At times she had 
considerable leucorrhoea accompanied by severe bearing-down pains and 
frequent and painful micturition. The urethra was slightly inflamed, and 
this condition continued until it was treated with a mixture of carbolic acid 
and glycerine, in the proportions of one to twenty, introduced on cotton 12 
wool wrapped around a probe. The anterior wall of the vagina was very 
sensitive, referable to the urethral trouble. The cervix was difficult to en- 
gage for some time, until the uterus had been somewhat replaced. When 
she came under my care I found the endometritis existing in a very slight 
degree, but still there was sufficient to account for the leucorrhoea, which often 
produced redness and a stinging sensation of the external parts. The re- 
sults of the examination, by means of the microscope, of the discharge 
from this patient, showed the presence, besides the vaginal epithelium, of 
nothing but innumerable Monads in extremely active motion. I fully ex- 
pected, from my previous experience, that these Monads would develop into 
Leptothrix, or even still more complex vegetable forms. Therefore, five days 
after the first examination, another specimen was obtained and examined. 
Therein I found several specimens of Trichomonas, and, in fact, in the 
vaginal discharge, which was abundant at this time, they were plentiful. In 
the drawing, I have depicted a group of three individuals, as well as a single 
one with one of its extremities attached to an epithelial plate in the form 
of a stalk. There is also one with this stalk-like appendage drawn out into 
a fine filament. This individual was watched for a long time, and was seen 
to first fix itself to the epithelial plate, and, thereafter, move its body 
somewhat away, leaving a portion of its substance attached to the scale, 
constituting a stalk. Gradually this stalk became thinner and thinner as 
the creature moved farther away. Then it detached itself from the epi- 
thelial plate with a jerk and swam away, with a Iqng stalk trailing after it 
like a tail. This was soon absorbed into the general substance and the indi- 
vidual presented the same character as its neighbors. I have also shown 
what has never been hitherto described—that is to say, a Trichomonas sub- 
dividing longitudinally into two new individuals; and this act I observed 
taking place on several occasions. I call this subdivision, although I am some- 
what in doubt if it were that process or true copulation; but as no one 
has seen generative organs in Trichomonas, the matter must remain some- 
what uncertain. It is true that since Balbiani’s observation of copulation 
in hermaphrodite Kolpoda, the existence of fissiparous subdivision in these 
creatures is considered by many as doubtful. It would be hardly worth 
while for me to detail here all I have seen connected with the life-history of 
these creatures; but one fact had better be placed upon record. I have 
proved, to my own satisfaction at least, that it has no investing membrane, 
but consists merely of a mass of sarcode, differentiated at the point where 
something like a nucleus is seen, and where the cilliae and terminal filament 
are found ; but its structure is in every respect so extremely delicate, that 13 
its study even with the high power that I used, which magnified it one 
thousand diameters, or one million times, and which was a fine one-tenth 
immersion lens, made by R. & J. Beck, of London, did not reveal any more 
than I have detailed. On several occasions the vaginal discharge from this 
patient was examined, and the same organism was always found in it, some- 
times being present in enormous quantities, so that fifteen or twenty would 
be within the field of view of the microscope at one time. At no time was 
Leptothrix to be seen. On one occasion, when the discharge from this pa- 
tient was examined, it was found to be very markedly changed in charac- 
ter. The epithelmium was smaller than that found previously, and rounder 
in outline. Hence, I judged that it could hardly be vaginal, or if it were, that 
it came from deeper layers. And this would seem to be confirmed by the 
presence of numerous pus corpuscles. Along with these elements were many 
large animals like Trichomonas, except that they were about three times as 
large as that creature and of almost spherical outline. They possessed 
cillise, which they kept in active motion, and terminal filaments exactly like 
the ordinary form of Trichomonas, but they did not change their position in 
the liquid. 
This was the only time I ever saw these creatures. In another case of pro- 
lapsus Leptothrix filaments were found on more than one occasion, and they 
were observed in other cases; so that we must believe that as Leptothrix 
luccalis is certainly a normal inhabitant of the mouth, so the same form of 
vegetation is of common occurrence in the vagina. In fact, I found Leptothrix 
in the vaginal mucus of all women where that fluid was normal in quantity, 
and where no severe uterine disease existed or no washes had been used. It 
would seem, then, that Leptothrix is a normal inhabitant of vaginal mucus, 
and that when the mucus is secreted in extra quantity, and therefore accum- 
ulates in that canal, Trichomonas is apt to be developed. I cannot, as yet, 
persuade myself that the presence of this organism indicates any uterine or 
ovarian disease. 
We come now to consider whether these facts, which I have detailed, pos- 
sess anything more than a scientific interest; that is to say, whether they 
may, in any way, be made useful as applicable to practical gynseology. It 
was in the year 1860, that the eminent Professor of Medical Midwifery in 
the University of Berlin, first put forth the theory that that pathological 
condition which has commonly gone by the name of puerperal fever depends 
upon a diphtheritic process set up in the female genital organs, and which, 
in cases which prove fatal, spreads therefrom to more vital parts. Unfor- 
tunately, the views held by the different members of the medical profession 14 
with regard to this condition, are extremely various, but this has most likely, 
in a considerable degree, arisen from the different amounts of thoroughness 
in diagnosis brought to bear upon the subject. At all events, the applica- 
tion of a new means of research, namely, the microscope, in the hands of 
Professor Martin, has brought forth facts of extreme value and interest, and 
the important bearings of which can hardly be over-estimated. In a late lec- 
ture on this subject, he points out that “febrile conditions may be met with 
in lying-in women as well as in pregnant women, whether as a consequence 
of inflammation in almost any organ, (but which has no connection with the 
puerperal condition, or in connection with various contagious diseases, as 
scarlatina, variola, &c. There may even be febrile affections consequent 
upon inflammatory action in the genitals of lying-in women, but which are 
not essentially different from puerperal fever in the alarming sense of the 
word. Entirely unconnected with this, lying-in women may have very se- 
vere fever from inflammation of the breasts or nipples, after contusion or 
laceration of the uterus or vagina, as well as consequent on abscesses or ulcer- 
ation which may ensue from effusion of blood into the connective tissue. 
Such fever, neither in its course, symptoms or issue, resembles the puerperal fe- 
ver as limited and distinguished by Prof. Martin. In fact, if fever can arise 
during the period of confinement, from these causes and from others, as is of 
course the case, we can readily understand, as Prof. Byford remarks, “ the term 
puerperal fever has been applied by different authors and practitioners to 
almost every form of fever and inflammation incident to the puerperal con- 
dition.” Prof. Martin shows that there is a distinct condition occurring in 
the lying-in women, which is characterized by the diphtheritic process, 
which he regards as essential to it. He then says, “ what are we to under- 
stand by the diphtheritic process ? ” You are aware that recent investiga- 
tions have thrown most important light on the nature of diphtheria affecting 
other organs, especially the pharynx, where it has been shown to consist of a 
fungus formation, the spores of which are seen under the microscope to 
penetrate not only into the tissues, but within the blood-vessels—producing 
in this way a generalized disease. In diphtheria of the genital organs inves- 
tigations have as yet not been extended thus far, and it remains a question 
calling for further examination. Admitting, however, that the diphtheria is 
here due to a fungus formation, other questions arise. Is the fungus in ques- 
tion specifically different ? Since we are familiar with various fungi which 
germinate in the vagina of both pregnant and non-pregnant women without 
giving rise to any dangerous affection—is the fungus the mere carrier of the 
contagion ? or is the puerperal fever produced in consequence of the special 15 
condition of lying-in women favoring the production of certain fungi, by 
reason of changes taking place in the organic substances and fluids ? ” What 
he calls “ the microscopico-anatomical basis of puerperal fever ” is found as a 
diphtheritic deposit covering those wounded spots on the external genitals, 
as well as the walls of the vagina, which, in the form of larger or smaller 
lacerations of the mucus membrane, so frequently occur during labor. 
This lesion is then a true traumatic diphtheria. “ The circumference of 
these spots is more or less considerably swollen. In many cases the diph- 
theritic deposit is thus confined to the external genitals, and the disease 
pursues its course by casting off the deposit without any or with very little 
general disturbance. But in the majority of cases coming under medical 
recognition, the diphtheritis is not confined to the entrance of the vagina, 
but is found deep within the canal, covering the large or small lacerations of 
the os uteri, and within the cavity of the uterus itself. There it occupies 
both the site of the placenta and the upper parieties of the organ; and it is 
sometimes formed exclusively here, and in no places accessible to the eye.” 
Without going further into the consideration of this condition it may be 
remarked, that the diphtheritic deposit, growing and increasing as fungi 
usually grow and increase, by means of its mycelium as well as by distribu- 
tion of its spores, as a general rule is found to extend rapidly from the 
genital organs to the skin of the thigh, nates, &c. “ These, then, exhibit an 
erythema (which has been well named puerperal scarlatina) or pass into ul- 
ceration.” More frequently it spreads to and into the urethra and rectum, and 
still more commonly by means of the connective tissue and fallopian tubes, 
upwards and onwards to the peritoneum, or even to the great glandular or- 
gans of the abdomen, the kidneys, liver and spleen. Finally the lower lobes 
of the lungs may be implicated, and pleuritic adhesions be associated with 
those lesions found in the peritoneum. In conclusion, Prof. Martin recom- 
mends a symptomatic treatment along with the use of such substances as 
have been considered anti-zymotic, as creosote water, carbolic acid, chlorine, 
and nitrate of silver. The alkaline bromides he does not speak of, but 
their internal and local application in pharyngeal diphtheritis has been 
found to be so useful, that it would seem that in the puerperal form of the 
affection they would certainly prove of use. Sulphurous acid in the form 
of hot spray, I have found to answer so nicely in diphtheritic affections of 
external parts, that I think it worthy of trial in the puerperal diphtheritis. 
The alkaline permanganates might likewise be tried; but of all remedies that 
seem to promise the best results in affections of this character, Salicylic acid 
evidently stands preeminent, and I shall presently, in another paper, detail 
the results of the trials to which others, as well as myself, have put it. 16 
In connection with this subject of the occurrence of a diphtheritic mem- 
brane, consisting of the mycelium of a fungus upon the mucus membrane 
of the female genital organs, it will be of importance to note that Dr. Tyler 
Smith, in his treatise on Leucorrhoea, calls attention to the resemblance of 
the mucus membrane in these situations to the cutaneous structures. He 
says that this is more markedly the case with this than with the mucus 
membrane of more internal parts. “ This is particularly the case,” he says, 
“ with respect to the dense epithelial layer of the vagina and os uteri; and 
and the villi of the os uteri are perhaps more nearly allied to the papillae of 
the skin than to the villi of the intestinal mucus membrane,” and “ these 
analogies are strongly confirmed by what is observed of the pathological 
lesions to which these parts are liable, and by the effects of therapeutical 
applications. Several of the common skin affections are closely imitated on 
the vaginal surface and the vaginal portion of the cervix uteri, and give 
way to treatment adapted for genuine skin disease.” From this we can 
readily comprehend that, notwithstanding the dissimilarity existing between 
the mucus membrane of the vagina and the more internal parts, and, of 
course, of the serous membranes, that yet a mycosis which spread from the 
skin to the vagina would be liable to travel still farther and involve deeper 
tissues. Prof. Waldeyer, of Breslau, has examined the diphtheritic deposit 
found upon the mucous membrane of the uterus as well as the puriform mass 
from the lymphatics of that organ, and the broad ligament, and the peritoneal 
exudation, which is partially fluid and partially fluid and partially made up 
of whitish-yellow prominent fibrinous flakes, and iu all of them the microscope 
has shown him Bacteria. Haussmann had formerly found these organisms 
aleng with Yibriones in the lochial discharge. Waldeyer tells us 
that in the diphtheritic exudation the Bacteria lie between the pus- 
cells and those of the partly decomposed tissue elements. The puri- 
form contents of the lymphatics consist, besides the pus-cells, for 
the most part of Bacteriae, and they are also found in the peritoneal 
exudations and flakes, mixed with pus-cells, young-cells, and masses 
of fibrin, and even in the interior of the pus-cells. In the main they were 
the globular Bacteria of Cohn, or what we would be disposed to call Monads, 
though in part they were the rod-like micro-bacteria. Orth, also, considers 
fungi to be the essence of puerperal fever. In the January (1875) number 
of the American Journal of the Medical Sciences, Dr. John S. Parry, of the 
Philadelphia Hospital, has published a paper on a form of Puerperal Fever, 
charcterized by diptheritic deposits on wounds of the genital passages, and 
by other peculiar phenomena, wherein he points out that “ various affections 17 
have been described under the general term puerperal fever.” He considers 
that these various affections may be classified under three heads, as follows: 
Local inflammatory diseases, including Perimetritis, Parametritis and general 
Peritonitis; Septic diseases, including Pyaemia and Septicaemia, Diphtheria 
of wounds and Erysipelas of the genitals and internal organs in puerperal 
women, and idiopathic fevers in the puerperal female. All of which shows 
how hasty we have been in considering almost every febrile condition of a 
grave character, when occurring in the puerperal female, to belong to a dis- 
tinct and distinguishable disease. The natural consequence has been that a 
mixture of many, if not all of the symptoms of these various forms of dis- 
ease which have been mentioned, have been from time to time thrown together 
and called puerperal fever. It is not for me at the present time and in a paper 
of the character of this one, to consider the pros and cons of the question, as to 
whether there be a distinct disease entitled to the name puerperal fever; I have 
already said that Prof. Martin thinks that there is; but it would appear to 
me from my knowledge of the manner in which diphtheritic deposits, con- 
sisting of Bacteria and their resultant fungoid mycelium fibres make their 
appearance, that there must be a peculiar condition of the membrane upon 
which they appear, produced by some distinct pathological metamorphosis, 
honestly entitled to consideration when classifying disease. Bacteria and 
fungus mycelium may be the result of Diphtheria, but as certainly they will 
develop all of the conditions and symptons which go to make up the dis- 
ease we call diphtheria. And if we do find diphtheritic membrane accom- 
panying febrile conditions in puerperal women, the state which produces 
that Diphtheria must be present. As to whether Diphtheria, as commonly 
recognized, be a disease in itself, or only a condition resulting from a dis- 
ease, is another question well worth considering, but not at the present time, 
as is likewise that question which has not sufficiently occupied the minds of 
scientific physicans—namely, are diseases, so-called, specifically distinct in 
the acceptance of the term as employed in modern scientific language ? At 
some future day I may return to a consideration of this point. 
To the practitioner who has not made himself acquainted with the laws 
governing the growth and reproduction of the more minute forms of exist- 
ence, it is difficult to understand how it comes about that a disease like 
Diphtheria spreads with such rapidity as to involve large surfaces of mucous 
membrane, and endanger life in a few hours; but his wonder at perceiving 
such things to actually take place ceases when he is told that botanists have 
determined that some of the obscure fungi, and those forms which probably 
belong to the very groups whose mycelium constitutes the diphtheritic mem- 18 
brane, multiply with the marvelous rapidity of ninety-six million in a single 
minute. In this connection, it will be well to note that Dr. L. Mayer, in 
1862, published a memoir in which he considered the subject of vegetable 
parasites in relation to uterine and vaginal diseases; but his observations, as 
well as those of Prof. Martin, just referred to, do not seem to have attracted 
the attention they deserved, in this country, at least, or, at all events, their 
observations have not been availed of and applied by the profession at 
large. In short, perhaps we have no more striking illustration of the fact that 
it requires often many years before the results arrived at by scientific diag- 
nosticians and pathologists, working with all the modern appliances of in- 
struments for investigation are assimilated and made use of by the everyday 
working practitioner. In the paper in question, Dr. Mayer describes a species 
of fungus which he found spreading over the inner surface of the labia, the 
nymphaj, clitoris, along the vagina to the uppermost portion of the cervix 
uteri, in cases under his charge. He says that he never found this growth 
to extend beyond these limits, but as his observations were drawn from only 
six cases, and when the difficulty of exploring the uterine cavity is taken 
into consideration, we may believe that it might be found elsewhere, as in 
the cases mentioned by Prof. Martin, and the one presently to be described 
in England. In the six cases alluded to, there was usually observed spots in 
size varying from that of a pin’s head to smaller, of a bright yellowish color, 
of a roundish or irregular outline, and generally loosely attached to the mu- 
cous membrane. More rarely, true diplitheritic-like membranes are formed, 
which, on removal, leave shallow ulcers. The basis on which these fungi 
grow is always liyperannic, as we would expectto be the case, and an increased 
secretion is found to occur. This secretion is mucous, opalescent, and of a 
milky or creamy character, but sometimes of a still greater consistency, not 
unlike potato-paste. The six individuals thus affected with vaginal mycosis, 
were of various ages and of different conditions of health. Five of them 
suffered from diseases of the sexual organs, whilst the remaining one was 
pregnant at the time of the examination. In the first five there existed 
a more or less severe inflammatory condition of the mucous membrane of 
the genital organs, and all complained as soon as the mycosis was well estab- 
lished, of intense burning, itching and pricking in the vulva and vagina, 
which occurred paroxysmally, and destroyed rest and sleep. The pregnant 
woman, however, did not suffer from inflammation or the peculiar burning 
and itching of which the otheis complained. Frequent injections of water 
were used, by which the fungoid patches being removed, all the troublesome 
symptoms disappeared. There is one point of great interest and importance 19 
connected with one of these cases, which Dr. Mayer unfortunately has failed 
to record, and that is whether the pregnant woman, during her subsequent 
confinement, suffered any return of the malady for which he had treated her. 
Neither are we told whether or not there were any abrasions of the mucous 
membrane in any of the cases; but it is not likely that there wras, or we would 
have heard, if any of the cases were followed up, of more alarming symp- 
toms like those to which Prof. Martin has called our attention. 
In the London Lancet, for 1849, we have a paper entitled “ Some remarks 
upon the development of Epiphytes, with the description of a new vegeta- 
ble formation found in connection with the human uterus, by Dr. J. Stuart 
Wilkinson.” Therein is described a case of a woman, who was suffering 
from a troublesome pruritis accompanied by considerable tumidity of the 
labia majora. Small sores were seen, caused, as she thought, by the friction 
employed to relieve the distressing sensations. Her attention was attracted 
to vaginal discharge of a yellow color and foetid odor, which gradually in- 
creased in quantity. This discharge presented to the eye a very unusual ap- 
pearance, such as might be produced by mixing up a large quantity of hairs 
of extreme tenuity and softness with purulent matter. Under the micro- 
scope this was found to consist of filaments of well-defined vegetable struc- 
ture along with corpuscles, oval and spherical in form, some with and 
others apparently without nuclei, and granules and molecules. Robin men- 
tions (page 366) and figures (PI. V., fig. 1, a, b, c, d, e, f, g, h,) a vegetable 
from the human uterus, the drawings and particulars of occurrence of which 
were sent to him by Lebert, and which he considers an alga belonging to 
the genus Leptomitus. The figures he gives, however, would seem to prove 
it to be a fungus, or, at least, the mycelium of such a plant. It was taken 
from the mucous membrane of the cervix of a women in the Lourcine hos- 
pital, and Lebert thought it probable that the spores of the plant may have 
been introduced in vaginal injections which had been used. I have found 
still one more example of a vegetable within the human female genital or- 
gans recorded by Kiichenmeister, in his Manual of Animal and Vegetable 
Parisites (Sydenham Society Edition, 1857. Vol. II., page 235). This case 
is as follows : “ A case of diphtheritic inflammation of the intestines was ob- 
served at the Lying-in Hospital, at Dresden, in Professor Dr. Genser. A 
similar process occurred afterwards in the vagina, forming a membranous 
layer on the mucous membrane of the vagina, which wTas thrown off in sin- 
gle pieces. A slight improvement wras noticed. Prosecutor Dr. F. A. Zen- 
ker recognized in these masses scanty pavement-epithelium, and entangled, 
fungous filaments and spores, which were entirely surrounded by mucus cor- 20 
puscles. Dr. Zenker was kind enough to send me some of these broken 
pieces, and I obtained, on addition of strong vinegar, the partly articulated 
filaments of which I have given an illustration in Tab. V., fig. 8. In order 
better to recognize the shape and articulations of the very diaphanous fila- 
ments, I added Syrupus Rubi Idcei, which answered its purpose, and which I 
would recommend for the purpose of examining vegetable parasites by 
means of ascetic acid. I use, however, a red ink when I employ potassa, 
since the Syrupus Rubi Ideal would change its color in alkalies. The above 
parasites remind us of those which Hannover found on the ulcerated mucus 
membrane of the oesophagus, and in cases of typhus. They very much re- 
semble Leptomitus Hannoveri (Tab. I., fig. 8), and ought accordingly be class- 
ified with the algai of Robin. This parasite resembles slightly the fungus 
given in Tab. V., fig. 2, which Bennett found in the lungs. It appears to 
me, however, that we have to deal with a LeptomitusKiichenmeister tells 
us in his appendix, that Kolliker and Scanzoni also found spare, thin, and 
short ferment-fungi in the secretions of the cervix uteri.” (Vol. II., page 
256). He does not refer us, however, to the original account of this discov- 
ery. He also says that “ first Donn6 and after him Kolliker and Scanzoni 
found in vaginal mucous fine, stiff threads, 0.04—0.06"; in length, exactly 
resembling Leptothrix buccalis, from which they are only distinguished in 
that they are always isolated, are not bound together by a fine granular ma- 
terial, and are never situated on epithelial cells. Although often very num- 
erous, they are still not so abundant as Trichomonas vaginalis, and are never 
met with like these without the coexisting presence of mucus-corpuscles.” 
(Page 256.) I cannot find that Donn6 says anything on this subject, at least 
in any of his writings that I have seen or heard of, and we are not told 
where Kolliker and Scanzoni’s paper is to be found. If such observations 
have been made and recorded, it is of interest, for they accord in the main 
with what I had observed long before I had seen Ktichenmeister’s remarks, 
and which I have described in this communication. It would seem, then, 
that fungoid growths are found within the human female genital organs, 
both in health and in disease, and it is not difficult to believe that the ap- 
parently innocent Leptothrix of the healthy mucous membrane may become 
the dangerous diphtheritic membrane of puerperal fever. To prove this 
true or false farther investigations are needed, and it is my intention, as op- 
portunity offers, to make them. 
In this connection, and as assisting us in arriving at a somewhat more 
complete acquaintance with the condition of our knowledge of the connec- 
tion of fungi with disease, it will be well to briefly glance at the following 21 
facts: “ Fuchs mentions having found a fungus in Bronchitis maligna, in the 
sputa and bronchi,” (Kiiclienmeister, Yol. II., page 257). This he considered 
to be identical with Leptomitus Hannoveri, which Hannover found on the 
tongue and pharynx in various diseases, as typhus (typhoid ?) fever, pneu- 
monia, pleuritis, phthisis, delirium tremens, apoplexy, diabetes and chronic 
gastritis (Muller Archiv., 1842, page 280: Valentin’s Reportorium, 1843, 
page 84 : Robin Hist. Nat. Veg. Par., page, 363.) These diseases are so 
different in character one from the other, that the fungus formed can hardly 
be believed to have any direct connection with any of them, and when we 
come to examine the figure of it given by Robin, we see that it is most likely 
an extension of growth of the form which goes by the name of Leptothrix 
buccalis, so common in the mouth and due to certain conditions of the mu- 
cus membrane in those parts incidental to the febrile state. For it will 
be seen that I have now a precisely similar form from Leptothrix buccalis in 
vaginal mucous, which was diluted with water, and kept from becoming dry 
by means of a cover, as I have described. 
I might follow up this subject to a much greater length were I treating 
of the pathology of diseases in which so-called fungi make their appearance, 
and I might even continue this disquisition to its inevitable conclusion with 
regard to the abiogenetic origin of these minute forms, but I refrain, for this 
paper is merely meant as a sketch pointing the way in which those disposed 
and properly qualified must proceed if they are to solve the problem of what 
is disease and how is it to be arrested. Within the space of a composition 
of the character of the present this vast subject of the application of the 
microscope to the investigation of disease, cannot of course, have due justice 
done to it. Therefore I shall rest after recording one or two more facts of 
interest. Allusion must, at least, be made to the fact that this instrument 
has been called into requisition in the diagnosis of ovarian tumors. Thus 
Dr. Atlee in his treatise on the General and Differential Diagnosis of Ova- 
rian Tumors, has a chapter contributed by Dr. Thomas M. Drysdale on this 
branch of the subject. This gentleman considers that in fluids drawn from 
ovarian cysts is to be found a peculiar structure of which he says “ no mat- 
ter what other cells may be present or absent, the cell which is almost in- 
variably present in the fluids is the granular cell,” ( page 458.) So also Dr. 
Peaslee, in his treatise on Ovarian Tumors, when speaking of the applica- 
tion of the microscope to their diagnosis says, “ a still more striking charac- 
teristic when met with of the ovarian cystomata is the ovarian glomerulus, 
or ‘ gorged granule,’ spoken of by Mr. Nunn, though he does not attach 
much diagnostic importance to it, and which is recognized by Keberl6 and 22 
Dr.W. L. Atlee, and described as found in some of the ovarian cysts recently 
removed by the latter,” (page 117.) He then goes on to describe and figure 
this glomerulus, but says that he has “ not been able to detect them in the 
fluid of all cysts known to be ovarian,” and he considers that “ further ob- 
servation is necessary in order to determine their precise diagnostic value.” 
Eichwald has published in the Wurzburg Medicinische Zeitschrift for 18C4, 
elaborate reports on the chemical composition and microscopic characters 
of the elements of ovarian cysts; and Spencer Wells, in his treatise on 
Diseases of the Ovaries, gives the results arrived at pietty fully. This inves- 
tigator evidently does not think that the microsope detects anything mark- 
edly peculiar in this fluid, and points out that “ chemical examination has 
proved these highly refracting granules which occur in all ovarian fluids to 
be fat globules or fatty granules.” These refracting granules constitute the 
contents of the supposed “ ovarian cell.” Dr. II. F. Walker has contributed 
an article to the American Journal of Obstetrics, (Yol. III., 1870, page 
120,) entitled “ The Hypodermic Syringe a means of diagnosis in Ovarian 
Disease,” wherein he says that he considers that “by the aid of the micro- 
scope, with never so small an amount of the fluid contents of the tumor, a 
diagnosis can be made in every case,” and quotes a case in which, when a 
small portion of the fluid drawn by the means of the syringe from a tumor 
was examined “ the microscope showed that it contained a multitude of the 
ovarian corpuscles.” It would seem however that though we may find that 
the microscope will at some future time prove of value in the diagnosis of 
ovarian tumors, that those who have relied upon the “ ovarian corpuscles,” 
“ globules,” or “ cells,” as diagnostic, have been apparently led astray, for we 
are told by Dr. T. II. Green in his “ Introduction to Pathology and Morbid 
Anatomy,” that when fatty degeneration takes place and the albumenoid 
constituents of the tissues are transformed into fat, that the fat makes its ap- 
pearance as minute granules and molecules within the cells, and, gradually 
increasing in number, at last fill the cell; “ as they increase many of them 
coalesce, and so form distinct drops of fat; this, however, is not common, 
the fat usually remaining to the last in a granular form.” These granules of 
fat may remain in a coherent form for some time after the cell wall and nu- 
cleus are destroyed ; then these constitute the so-called “ inflammatory,” or 
“ exudation corpuscles,” or “ corpuscles of Gluge,” which are so common in 
chronic cerebral softening and in other forms of fatty degeneration.” So 
the colostrum corpuscles are but such aggregations of minutely granular 
fatty matter, and “ other examples are afforded by the formation of the se- 
baceous matter of the skin, the cerumen of the ear, and the corpus luteum 23 
of the ovary.” Under these circumstances it would seem that we must 
abandon the “corpuscles of Gluge,” as diagnostic of cystic degeneration of the 
ovary, and find something more characteristic to rest our verdict upon, for 
they are the “ ovarian corpuscles” so-called, or at least cannot be distinguish- 
ed from them by chemical or microscopical means. 
To make the microscope practically applicable, then to Gynaecology, or any 
other branch of medicine, a thorough knowledge of the optical principles in- 
volved in the construction of the instrument is necessary, that is to say, the 
observer must be a thorough microscopist, so that what is seen by means of 
it may be rightly interpreted ; as well as an intimate acquaintance with the 
various tissues of the body in health and in disease, together with morbid 
growths and the results of acting upon them with various chemical reagents. 
To arrive at this amount of knowledge necessitates many hours labor and a 
vast deal of research, so that we can hardly expect that the practitioner of 
medicine will ever become an accomplished microscopist. But it is to be 
hoped that there will speedily spring up a sufficient number of skilled work- 
ers with the instrument, to whom the practitioner may go for assistance, 
and on whom he may with full confidence lean to aid him in making his 
diagnosis. 
120 Belleville Avenue, 
Newark, N. J., April 6, 1875.