B47lr 18564 Sas.'sssjj^c.'craHn^^ !!raji|X.-*''".v~ ;s.~ T?~zs,~szzrzr.'TiX7^ 45025901 A REVIEW OF THE PRESENT STATE OF UTERINE PATHOLOGY. f A REVIEW PRESENT STATE UTERINE PATHOLOGY. BY JAMES HENRY BENNET, M. 1). MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS ; PHYSICIAN-ACCOUCHEUR TO THE ROYAL FREE HOSPITAL \ LY HOUSE PHYSICIAN (BY CONCOURS) TO THE HOSPITALS ST. LOUIS, LA PITIE, AND LA SALPETRIERE, PARIS ; " A TREATISE ON INFLAMMATION OF THE UTERUS," ETC. ETC. PHILADELPHIA: BLANCHARD AND LEA 185 6. I Wp i pHILADBr,pHlA. PBEFACE. In the successive editions of my "Practical Treatise on Uterine Inflammation," I have studiously avoided controversial discussions; and the present Essay has been partly written to obviate the necessity of entering the polemical arena in a future edition. Time and experi- ence have proved the correctness of the facts I have advanced: as will ever be the case when facts—albeit novel and startling—are really true, and can be easily demonstrated. Various doctrinal explanations of these facts have, however, been brought forward or reproduced dur- ing the last few years—explanations at variance with the views which I profess. I have endeavored, in the following pages, to analyze and answer these antagonistic doctrines, and most sincerely do I trust, that I may be deemed to have accomplished the rather ungracious task in a spirit of courteous scientific inquiry. Several of the writers whose views I criticize are esteemed and valued friends, the opinions of whom I would fain have respected; but science admits not such distinctions. In the defence of what we conscientiously consider to be the truth, all considerations of private friendship must be laid aside; and may be laid aside, provided the discussion be carried on in a strictly honorable and truthful spirit. This I have endeavored to do; and it remains with the profession to decide how far I have succeeded. 60 Grosvenor Street, May, 1856. CONTENTS. CHAP. PAGE I.—Preliminary Remarks.......1 The Pathology of the Uterine Mucous Membrane, formerly ignored, now definitively elucidated ..... 9 II.—A Sketch op Uterine Pathology.....13 III.—Objections..........18 The Existence of Inflammatory Ulceration of the Neck of the Uterus Denied by Dr. Robert Lee; Proved by the recent Researches of Dr. West ....... 18 Dr. West's Denial of its Pathological Importance 23 Dr. Tyler Smith's Recognition and Microscopical Description of Ulceration of the Uterine Neck......29 Its Existence generally Recognized in Edinburgh, Dublin, France, and America ......... 34 IV.—The Leucorrho3A Theory—The Syphilis Theory—The Ovarian Theory........36 V.—The Displacement Theory.......45 Historical Considerations .......45 Anatomical and Physiological Facts bearing on Displacement of the Uterus......... 49 The Pathology and Therapeutics of Displacements of the Uterus 54 VI.—Summary..........62 The Double Medico-Chirurgical Character of Uterine Pathology 62 viii CONTENTS. PAGE Appendix...........(>,(' I. A Table containing a Memorandum of the Condition of the Genital Organs in the Bodies of Fifty Native Indian Women who had died of various Diseases. By Madoosudun Goopta, S. A. S. Contributed by Dr. Stewart, H. E. I. C, late Professor of Midwifery in the Medical College of Cal- cutta ..........07 II. The Use and Abuse of the Stronger Caustics, and of the Actual Cautery in the Treatment of Uterine Disease . . 68 A REVIEW OF THE PRESENT STATE OE UTERINE PATHOLOGY. CHAPTER I. PRELIMINARY REMARKS. THE PATHOLOGY OF THE UTERINE MUCOUS MEMBRANE FORMERLY IGNORED NOW DEFINITIVELY ELUCIDATED. Unfortunately for the medical community, and still more so for the numerous females suffering from uterine symptoms whom its mem- bers are called upon to treat, the greatest diversity of views respecting uterine disease still obtains amongst those who are looked up to as authorities. Not only is this the case in England, but also in France, where uterine pathology has occupied so much of the attention of the profession during the last twenty years; as is proved by the late dis- cussion at the Paris Academy of Medicine. That my writings have contributed to this diversity of opinion, both at home and abroad, is more than probable, and I can only hope and trust that they have, even in so doing, exercised a beneficial influence, by directing the current of professional research in & sound and true direction. It is now more than ten years since I first made known, in The Lancet, the opinions and doctrines I entertain with reference to uterine diseases. These doctrines have been favorably received, adopt- ed, and acted upon by very many practitioners in nearly all parts of the world, and I now feel that it has become a duty incumbent upon me to state what influence or change, time, additional experience, and the labors of those who have followed me in the field of scientific investigation, have produced in my mind. I feel the more called upon so to do, as I have been for many years a silent, although certainly not an indifferent, observer of all that has been written and said in favor of or in opposition to the views I advocate. I have endeavored to learn from my opponents the weak points of my own doctrines. I have tried to think that they might be right and that I might be wrong, and year after year have repeated my observations on large masses of 10 PRELIMINARY REMARKS. sufferers. I have tried to divest myself of all prejudice or precon- ceived opinions, and endeavored to arrive at conclusions, as if all were doubt and obscurity in my mind; as was the case before I had accom- plished the unravelling of the confused web of uterine pathology, such as I found it in my earlier days. All these experimental researches and investigations have, however, invariably led me to the same results—to the confirmation of the doc- trines brought forward in my papers published in The Lancet in 1844-45, and in the successive editions of my work on Uterine In- flammation. Had I not already arrived at these doctrines, the obser- vation of any one year might have led me to the erection of the scientific edifice which the work alluded to contains. How could it be otherwise when all the cases I meet with, in their previous history, in their progress, and in their results, corroborate them ? May I also be allowed to add, incidentally, that I have constantly been receiving corroborative testimony from men practising in the most distant parts of the globe, whose intellect, powers of observation, and sincerity, I cannot but respect, and who appear to have studied the question con- scientiously, and without any other bias than the one, decidedly inimi- cal to my opinions, of former professional convictions. The views I have propounded may be said to be the result of the progressive improvement of medical science, which has been taking place since the close of the last century. They flow naturally, inevit- ably, from the direction which pathologists since that epoch have given to medical investigations. From the moment that theories, that pre- conceived general views, were more or less laid aside, and that Nature herself was questioned — from the moment that pathologists began minutely to examine the changes that occur in our organs during life, or are found after death—all the discoveries which my predecessors and I have made with reference to the uterus became inevitable, and merely a question of time. It was impossible that every organ in the eco- nomy, however minute, however physiologically obscure, should be examined, probed, analyzed, in health and disease, and that the uterus alone should escape investigation. I and those who preceded me have merely endeavored to accomplish for the uterus what the crowd of modern investigators have done or are doing for other organs. We are men of our time, contributing to the scientific structure which is now rising by degrees on a basis unknown to the votaries of science in the darker ages of the human intellect — that of faithful, conscientious observation, and careful, accurate induction. Medical men of all ages have observed an intimate connection between the train of symptoms to which the generic term "uterine" is given, and morbid conditions of innervation, digestion, and nutrition. The connection, however, which so constantly exists between these general morbid states and chronic inflammatory conditions of the neck and body of the uterus was universally ignored until the beginning of the pre- sent century, when it was rediscovered by M. Recamier the late dis- tinguished physician of the H6tel Dieu at Paris. I say rediscovered because, as I have elsewhere proved, traces of a knowledge of these local morbid uterine states are to be found in the writings of the Greek THE PATHOLOGY OF THE UTERINE MUCOUS MEMBRANE. 11 and Roman physicians of antiquity. M. Re'camier, and subsequently M. Iiisfranc, who labored actively in this new direction, whilst endea- voring to connect general symptoms with local disease, merely followed m the wake of the pathologico-physiological or Broussaian school, in the palmy days of which they lived and flourished. Their labors are certainly amongst the most valuable that we owe to this school, which, during the early part of this century, contributed so much to our posi- tive knowledge of disease and of the anatomical changes which it pro- duces during life in the human economy. Previous to these eminenti men, the knowledge of uterine pathology, as it existed in the Paris school, was limited to a more or less perfect acquaintance with fibrous tumors, polypi, cancer, acute and chronic metritis and displacements. Functional derangements, such as amenorrhoea, dysmenorrhea, monor- rhagia, sterility, abortions, &c, were attributed to vital uterine states, to irritability, or to want of tone of the uterus, or to the debility and disordered state of general health, which so frequently accompanies these functional derangements. The leucorrhoeal discharges, which are also so frequently observed along with these conditions, were con- sidered to be merely symptomatic in the great majority of cases. Such, I may safely say, was also the view taken of uterine pathology in our most esteemed works on the subject up to the time when my first contributions to uterine pathology appeared. Moreover, such are still the views of a large portion of the medical profession in this country at the present time. In uterine pathology, thus viewed, there are many errors, many oversights, but there is one especially which not only weakens, but totally destroys it—the pathology of the uterine mucous membrane is ignored, is passed over all but as if it did not exist; although the mucous membrane which lines the two cavities of the neck and body of the uterus is a most highly organized and a most important one. Its liability to inflammation and to inflammatory lesions, and the influence with such inflammation exercises over all other morbid uterine condi- tions, with the exception of cancer, is so great as to render an intimate knowledge of its diseases absolutely indispensable for the understanding and successful treatment of uterine affections, and of disordered func- tional uterine conditions. Nor is it surprising that such should be the case. If we go back to general pathology, if we refer to the laws which regulate disease in each of the separate tissues which, by their combination, constitute the animal economy, we shall find that wherever there is a highly organized mucous membrane, the inflammatory lesions, acute or chronic, to which that mucous membrane is liable, constitute the principal feature in the pathology of the organ to which it belongs. Morbid growths, cancer- ous degenerescence, and mere functional derangements, are everywhere infinitely more rare than these mucous membrane lesions. Thus, in the lung, how infinitely more frequent are bronchitis and the emphysemat- ous or asthmatic conditions which it often entails, than pneumonia or pleurisy—that is, than inflammation of the substance and of the serous covering of the lungs; or than morbid growths, or cancerous degene- rescence ; or than mere functional derangement. The same may be said 12 PRELIMINARY REMARKS. of the throat, of the eye, of the intestines, &c. In each organ, the mucous membrane has its own individual peculiarities^ and liabilities, depending on structure, on functions, and on physiological exposure to offending causes, but still the general law is the same in all, as regards the comparative frequency of its diseases. We might also, d priori, conclude that this particular mucous mem- brane would be more than usually liable to inflammation, and to in- flammatory ulceration, and that these morbid conditions, once estab- lished, would be more than usually difficult to remove, when we reflect that it presents important structural and physiological predisposing conditions. Thus it contains, scattered throughout its texture, a vast number of mucous follicles, and these follicles, in all mucous membranes, are very liable to take on inflammatory action, and, as a sequela, to ulcerate. The physiological predisposing causes of inflammation, also, are numerous; the principal one being the menstrual congestion to which the uterus is periodically exposed for about one week in four during the entire duration of uterine life. And such, in reality, modern research has proved to be the case, by the employment of physical or instrumental means of investigation. Inflammatory lesions of the uterine mucous membrane are as frequent, indeed, even more frequent, than the laws of general pathology would have led us to expect. Moreover, they are perhaps more liable to pass into the chronic stage, and more difficult to eradicate than in any other mucous membrane. What general pathology, however, could not discover, although it might foreshadow it—what could only be brought to light and proved by experience — is, that permanent functional derangements of the uterine system, and the general conditions of dyspepsia, debility, and morbid cerebro-spinal innervation, which generally accompany such functional derangements, are mostly occasioned by these mucous mem- brane lesions and their sequelae, and are only to be permanently got rid of by their entire removal. This is one of the most important lights that modern science has thrown on the uterine pathology of former days. I, for my part, think I may claim the credit of having sifted the data furnished by those who preceded me; of having still further pursued their investigations, and accumulated fresh materials; of having pursued the local history of uterine inflammation throughout all the ages and phases of female life ; and of having built up in my work on Uterine Inflammation a scientific edifice, founded on the faithful observation of Nature, sufficiently prac- tical and comprehensive to explain nearly all that is obscure in the observation of uterine diseases, and calculated to afford a true guide to the practitioner in his attempt to restore the health of his patients. I will now give a concise and at the same time complete view of the doctrines I profess, and, having done so, I intend to examine the objec- tions that have been raised to these views, and the opinions respecting uterine pathology generally that clash with them; thus giving my readers an opportunity of judging for themselves. A SKETCH OF UTERINE PATHOLOGY. 13 CHAPTER II. A SKETCH OF UTERINE PATHOLOGY. I admit, to the fullest extent, that the nutrition, vitality, and func- tions of the uterus are susceptible of being modified by general causes, or by general morbid conditions, without the existence of any descrip- tion of local mischief, inflammatory or other, of the uterus or ovaries. So fully, indeed, do I admit this fact, that I believe few women can have their health profoundly modified by any disease or by any morbid state, without the uterine functions being modified. At the same time I believe, as a result of lengthened experience, that the great majority of instances of confirmed uterine suffering that come under the observa- tion of the medical practitioner, are cases in which the primary and principal evil, the morbid centre, is inflammation of the mucous mem- brane or of the proper tissue of the neck or body of the uterus, with their varied sequelae. Around this inflammatory disease, when accurate physical examination has proved its existence, may generally be grouped the principal symptoms the patient presents, both local and general. The expression confirmed, which I have used in speaking of uterine suffering, is of vast importance; for in it lies the distinction between morbid conditions of uterine vitality and of uterine functional activity the reflex of general pathological states, and the same morbid conditions the result of actual local disease, inflammatory or other. When these morbid conditions are the indications of local disease, they are con- firmed, varying in intensity but constant. When they are the reflex of general pathological states they are changeable—arriving and depart- ing with the "general" cause, and giving way under the influence of the appropriate treatment of the general states of the system to which they owe their existence. Although thus fully admitting the influence of general pathological causes in disturbing the vital and functional activity of the uterus, it will be seen, by what precedes, that I consider such modifications as essentially temporary, and as remediable by the general treatment of the disease or diseased state of which they are the symptom. On the other hand, it must be equally evident that I consider confirmed uterine suffering, confirmed derangements of vital and functional uterine action, which resist the treatment of the general morbid conditions that accom- pany them, as the decided result, generally speaking, of local disease, and in the great majority of cases, of chronic inflammatory lesions. From the dawn of menstruation until a very advanced period of fe- male existence, the uterine mucous membrane may be attacked by in- 14 A SKETCH OF UTERINE PATHOLOGY. flammation, and is very frequently so attacked ; more especially between the ages of twenty and fifty. The inflammation may be limited to the cervix, but most generally it passes into the cervical canal, where it has a great tendency to perpetuate itself, owing partly to the numerous folli- cles which the cervical mucous membrane contains, and partly to men- strual influences. It may also pass into the uterine cavity, but this comparatively seldom occurs, as I believe I first pointed out. Inflam- mation may exist for months or years without ulceration ensuing, but in a very large proportion of cases ulceration does ensue at an early period, and has also a tendency to perpetuate itself indefinitely, if not treated. By ulceration I mean the result of destructive inflammation, characterized by the destruction of the epithelium, and the exposure of a muco pus-secreting surface. The characteristics of the ulceration vary from those of a mere abrasion, to those of a bleeding, fungous, foul- looking sore. Inflammation and inflammatory ulceration of the mucous membrane lining the cervix and its canal are generally attended in their early stages by swelling and enlargement of the cervix. If the disease is not discovered and treated, the swollen cervix may remain indefinitely soft, but it more frequently becomes hardened, indurated, and consequently larger and heavier than in the normal state. The hypertrophy may be confined to the cervix alone, or extend to the body of the uterus. These enlargements of the cervix and of the uterus give rise to a train of im- portant secondary symptoms—viz: to displacements. If the enlarged and heavy cervix remains in a normal position, it drags the womb down, and produces prolapsus. In the married female it is frequently thrust backward, and retroverted on the rectum and sacrum, the uterus being at the same time more or less anteverted. The recumbent position or its own weight produces occasionally the same result in the non-married female. This tendency to hypertrophy, owing to physiological causes easily appreciated, is greater in the married than in the unmarried— greater in women who have had children than in those who have not. Acute and chronic inflammation of the proper tissue of the body of the uterus and of the cervix are not unfrequently met with, quite inde- pendently of mucous membrane inflammatory conditions. They are, however, of very much less frequent occurrence than these latter lesions. Both the cervix and body of the uterus may become enlarged and heavier, as a result of acute and chronic metritis, and be second- arily displaced, without the existence of inflammation or of inflamma- tory ulceration of the mucous membrane. Chronic enlargement of the uterus posteriorly, and its retroversion on the rectum, are frequently thus produced. The tendency of the neck and body of the uterus to become hyper- trophied under the influence of chronic mucous membrane inflammation or of acute and chronic inflammation of the uterine proper tissue is explained by the extreme physiological facility with which the uterus enlarges under the influence of physiological and morbid uterine stimuli Passive hypertrophy of the cervix and uterus, in women who have had children, is often merely the result of the powers of transformation and absorption—which, after confinement, reduce the uterus from forty A SKETCH OF UTERINE PATHOLOGY. 15 ounces to two in four or five weeks—flagging, from some cause or other, before entire resolution is obtained. This arrest is often owing to the presence of some mucous membrane lesion of the neck of the uterus, either existing before the confinement, or occasioned by it. Hypertro- phy of the neck and body of the uterus may also occur as a result of mere modified functional activity. Whatever the cause of the hypertrophy, it is attended with displace- ments, which are merely the result of gravity, in the great majority of cases, the womb being prolapsed, retroverted, or anteverted, according to the region of the uterus or its cervix which is the seat of enlarge- ment. These displacements I consider to be only curable, generally speaking, by the removal of the conditions which produce them—that is, the enlargement, induration, or hypertrophy. If the latter cannot be removed, I believe that mechanical means of replacement or susten- tation nearly always proves useless as means of effecting a permanent cure. Displacements may, however, it must be remembered, be pro- duced by other causes, such as laxity of the vagina and vulva, or of the ligaments, pressure of surrounding organs, tumors, &c. These local morbid conditions, inflammation, ulceration, hypertrophy, and displacements, are generally found connected in practice with local or uterine symptoms, such as intractable leucorrhoeal discharges, ova- rian sacro-lumbar, and hypogastric pains, bearing down, and inability to stand or walk with ease; with functional uterine derangements, such as amenorrheas, dysmenorrhcea, monorrhagia, sterility, abortions, ute- rine inertia, &c. ; and with general symptoms, such as disordered states of the chylopoietic viscera, of the nutritive and assimilative functions, and of the cerebro-spinal system, as indicated by dyspepsia, debility, anaemia, hysteria, &c. I have no hesitation in stating as a fact, in my mind fully established, that when females present the above enumerated local or uterine symp- toms, in a chronic, confirmed manner, even without the general symp- toms, the local diseased conditions described will be generally found, on examination, in a more or less developed state. Conversely, when weak, debilitated, dyspeptic, hysterical females do not recover their health under judicious medical and hygienic treatment, and when they present habitually any of the uterine symptoms before mentioned, there is generally local uterine disease; its existence being generally the key to their ill health, and its removal a necessary preliminary to their per- manent recovery. In the first class of females, viz: those who have local uterine symp- toms without a general break-down of health, the test as to their having, or not having actual structural uterine disease, is to be found in the nature and duration of the uterine symptoms. If they are recent, fugitive, and give way to general treatment, we may conclude that the cause is also recent, fugitive, and that there is merely functional derangement; but if, on the contrary, they are chronic and confirmed, and obstinately resist ordinary treatment, we may conclude that there is some chronic, confirmed, local mischief existing, which ought to be thoroughly investigated and treated. With them the general health remains good, because the constitution is vigorous, and resists the local 16 A SKETCH OF UTERINE PATHOLOGY. disease, so that the usual visceral and cerebro-spinal sympathetic reac- tions are not roused. In the second class of females, viz: those who are weak and debili- tated, and have but little local evidence of disease, the test again is general treatment. If they are merely dyspeptic, chlorotic, anaemic, rheumatic, gouty, &c, the uterine symptoms ought to improve, and eventually disappear, under the usual treatment of these morbid condi- tions. If they do not, we must look out for some other cause, and it will frequently be discovered in the uterine organs themselves. To this class belong a large proportion of the population of sofa, bath-chair, nervous, debilitated, dyspeptic females, who wander from one medical man to another, and who crowd our watering-places in summer; most of them are suffering from chronic uterine inflammatory disease, unre- cognized and untreated, and most of them would, if their disease were only discovered and cured, become amenable to the resources of our art, and eventually recover their health, spirits, and powers of locomotion. It is a singular and instructive fact that amongst the male part of the community there is no similar invalid population, always ill, unable to walk or ride, constantly requiring medical advice, and yet living on from year to year, without their friends or themselves knowing what is amiss with them, beyond the evident weakness, dyspepsia, &c. When both the local and general symptoms are combined, there is really no element of error left for those who are acquainted with these forms of disease, and there must come the day when such cases will be recognized and properly treated, by all educated medical practitioners, as surely as a case of pneumonia or rheumatism. As I have before stated, inflammation and the lesions which accom- pany and follow it, may occur at any period of female life, from the dawn of menstruation until old age. As the female progresses through the various phases of her existence, the position in which she is physio- logically and socially placed, varies with reference to the uterine organs. In the unmarried state, she is spared all the dangers to which marriage renders her sex liable; but she is still exposed to perturbations of the menstrual function, and to mental influences, which combine to produce, occasionally, even early in life, aggravated forms of uterine inflamma- tion, and of mucous membrane ulcerative disease, as was first pointed out by myself. Many of the worst cases of hysterical convulsions, spinal irritation, dysmenorrhoea, dyspepsia, debility, &c, observed in young unmarried females, may be traced to this cause. In the married, inflammatory affections of the uterus, but more espe- cially of the cervical mucous membrane, are very frequent • and in addition to the symptoms and conditions above enumerated, are amongst the most frequent causes of sterility, miscarriages, false conceptions and premature confinements'; of sickness, uterine pain, and hemorrhage during pregnancy ; of non-dilatation of the cervix during labor • and of puerperal metritis, hemorrhage, &c, after labor. Even after the cessation of menstruation, inflammatory and ulcerative disease of the uterine mucous membrane may persist, and be the prin- cipal cause of that agonizing backache of which elderly women some- A SKETCH OF UTERINE PATHOLOGY. 17 times complain, and which resists every means of treatment, unless its true cause be discovered and removed. Inflammatory affections of the uterus, but more especially of the cer- vical mucous membrane, often complicate polypi, both vascular and fibrous, and fibrous tumors of the uterus—an important fact, which I believe I was also the first to discover. Functional derangements of the uterine system, existing indepen- dently of uterine lesions, inflammatory or other, occur, as I have already stated, in every-day life, but they seldom come under the cog- nizance of the consulting medical practitioner. Being essentially fugitive and temporary in their existence, like the causes which produce them, and being unattended with confirmed sympathetic reactional symptoms, they are not complained of in a general way, or are viewed as mere epiphenomena of the disease the course of which they checker. Ovarian inflammatory lesions, thickening, hardening, &c, are fre- quently met with in the dead, and consequently we may presume that they not very unfrequently exist in the living. That they may and do occasion all the symptoms of deranged vital and functional uterine action above enumerated is certain ; and I occasionally see cases which illustrate and prove this fact. Judging, however, from careful obser- vation and lengthened experience, I do not believe that these morbid uterine symptoms are generally, or, indeed, very frequently, occasioned by actual ovarian disease, notwithstanding the all but constant existence of ovarian pain when they are present. What proves that in these cases it is not really the ovaries that are, generally speaking, the seat of disease, is, that however long and actively you may treat the ovarian pain, tenderness, &c, they persist; whereas, if you leave the ovaries entirely alone, and treat and remove the uterine lesions which coexist, the ovarian symptoms rapidly subside. A partial key to this practical fact is probably to be found in the absence of a mucous membrane ele- ment in the ovaries. Consequently its pathology is likewise absent. Although fibrous tumors of the uterus and polypi frequently coexist with inflammatory lesions, we cannot connect them as cause and effect. Polypi appear to develop themselves as a result of erratic nutrition quite independently of inflammation. Cancer in the uterus, as elsewhere, is a disease per se, and has in my opinion, no link or connection whatever with inflammation, which neither leads to it, nor usually complicates it. If the view3 which I have here briefly developed are correct, the therapeutics of uterine pathology must necessarily be totally altered. If, in confirmed uterine suffering, existing alone or along with general derangement of health, the cause is mostly to be found in chronic uterine inflammatory lesions, it is clear that the paramount and primary duty of the medical attendant is to get rid of these lesions once their existence has been ascertained. If general therapeutic treatment, com- bined with dietetic and hygienic management, rest, functional repose, &c, fail, or have failed, to remove such confirmed inflammatory lesions (and this is usually the case), recourse must be had, simultaneously, to more energetic means of treatment. The more energetic means of treatment then required are those which surgery resorts to in the treat- 18 OBJECTIONS. ment of chronic local inflammatory disease in other accessible parts of the body — the throat, the eye, the anus, &c. — viz:_ local depletion, emollient, sedative, and astringent injections, counter-irritants, the use of stimulating vitality-modifying agents, such as caustics of variable strength, &c. From what precedes, it must have become clear to my readers that uterine pathology, as I have interpreted it, in its more aggravated and confirmed forms, passes, in a great measure, from the domain of medi- cine into that of surgery. Instead of having to rely on drugs, on the agencies of general therapeutics, and on skill in their administration, we are called upon to have recourse to surgical instruments and agen- cies ; and we want in the medical attendant skill in their use, a know- ledge of local diseases, of the treatment local diseases require, and an acquaintance with their reactions on the economy at large. So true is this, that in France, since the new light broke on uterine pathology, it has fallen, by general consent, into the domain of surgery to such an extent that the leading authorities have principally been surgeons. I have only to mention Lisfranc, Marjolin, Yelpeau, Jobert de Lamballe, Ricord, Huguier, &c, to corroborate this assertion. No class of maladies, indeed, more aptly illustrates how artificial is the barrier between medicine and surgery than uterine disease, as illu- minated by modern research. In their earlier stage, and in their sim- pler forms, they are medical, and fall all but necessarily under the eye of the physician ; but, in their later stage, and in their more aggravated form, they are essentially surgical. No medical practitioner, therefore, who is not at the same time a sound physician and a good practical sur- geon, is competent successfully to struggle with the difficulties which have to be encountered in their treatment. CHAPTER III, OBJECTIONS. THE EXISTENCE OF INFLAMMATORY ULCERATION OF THE NECK OF THE UTERUS DENIED BY DR. ROBERT LEE; PROVED BY THE RECENT RE- SEARCHES OF DR. WEST. In the last chapter I have given a rapid sketch of uterine pathology or at least of the debatable ground in this department of medical science based on my own experience and researches. In this sketch inflamma- tion and inflammatory lesions occupy the most prominent position and by their presence are explained most of those forms of confirmed vital and functional uterine derangement which were formerly considered to be morbid entities, and described under the names of leucorrhcea arne- norrhoea, dysmenorrhoea, menorrhagia, &c. &c. These views have now been many years before the medical public THE EXISTENCE OF ULCERATION DENIED BY DR. LEE. 19 and although adopted and acted upon by numerous eminent practi- tioners, whose approbation has been my greatest and most valued reward, they have been denied or severely criticised and opposed by others. The opponents to this doctrine may be classed in two catego- ries : Firstly, those who deny entirely the existence of inflammatory and ulcerative lesions of the neck of the uterus, and consequently the expediency of instrumental uterine treatment under any circumstances; and those who, although not going so far, inasmuch as they admit the possibility of inflammatory changes occurring in the mucous membrane of the neck of the uterus, yet deny their ulcerative nature, and con- sider instrumental examination unnecessary or even prejudicial. Se- condly, those who admit all the lesions of the cervix and body of the uterus which I have described, yet differ from me as to their causes, symptoms, and pathological importance; denying that they exercise the influence over the general health which I have ascribed to them, or denying that they require the surgical treatment which I have stated to be so frequently indispensable. Thus there are still some practitioners to be found who totally reject the correctness and accuracy of modern researches into uterine patho- logy. In their eyes, inflammatory affections of the cervix uteri are a mere delusion—a thing that is not, a creation of the imagination. I can- not call these opponents "false observers," for they have not observed at all, and therein lies their strength. Had they "looked at Nature," they could not speak with the confidence which they evince. As yet, however, none have ventured to give utterance to their opinions in print; they are merely enunciated in private, and are the result of preconceived ideas. In close proximity to, but a step in advance of, these men of a past day, we find others on whose unwilling senses a certain amount of evidence has been absolutely forced, but? who still explain away and try to ignore what they have actually seen. Fore- most among these, I regret to say, is a physician of great and deserved eminence, who has contributed much to medical literature, whose talents all respect, and whose character all esteem, but who, in this department of science, has unfortunately done much to retard the pro- gress of truth. I allude to Dr. Robert Lee, whom I am unfortunate enough to number amongst my antagonists; I say unfortunate, inas- muclfas his weight and authority, in and out of the profession, have been a great barrier, in London, even to the investigation of my views. Dr. Lee denies entirely the existence of inflammatory ulceration of the cervix uteri, as will be seen in the following extracts from his paper read before the Medico-Chirurgical Society in 1850 {Transactions, vol. xxxiii. p. 270):— " In cases of obstinate leucorrhoea, I have often employed the specu- lum in married women, after I had failed to detect the existence of disease by the ordinary mode of examination. In some of these cases, there has been seen an unusual degree of redness of the os uteri, sometimes affecting the whole, and at other times limited to the inner margin, with or without swelling. The white, viscid discharge has been seen issuing from the os uteri. I have never seen ulceration of the orifice of the uterus in such a case." 20 OBJECTIONS. Again, page 275, he says emphatically: uXeither in the living nor in the dead body have I ever seen ulceration of the os and cervix, except ot a specific character, and especially scrofulous and cancerous. And yet that Dr. Lee has seen one of the conditions, to which the term ulceration has been applied by nearly all the pathologists who have latterly written on this subject, is evident from the first few lines of the following description, which I find also on page 270 :—- " At other times, both the lips are swollen, nodulated,_ and fissured, and the mucous membrane covering them intensely red, with an appear- ance of superficial excoriations or granulations, which are elevated above the surrounding surface. These apparent granulations are usually considered and treated as ulcers of the os and cervix uteri, but they do not present the appearances which ulcers present on the sur- face of the body, or in the mucous membranes lining the viscera, and they are not identical with the granulations which fill up healthy ulcers. They present the appearances often observed on the tonsils, which are said to be ulcers, and are not." The above extracts show that although Dr. Lee states he has never seen inflammatory ulceration of the orifice of the uterus, he has seen some of those conditions which I and my predecessors and successors term ulcerative—that is, pus-secreting, granular surfaces, denuded of epithelium by destructive inflammation. The difference between us, therefore, is partly one of words, Dr. Lee recognizing and describing at least one of the forms of inflammatory ulceration that we recognize and describe. That Dr. Lee should consider such a state as the one he depicts in these extracts as unimportant, as not demanding any local surgical treatment which requires the agency of instrumental examina- tion, that he should think it perfectly curable by general treatment, is another matter. For the present, I am satisfied with having thus demonstrated, by Dr. Lee's own testimony, the existence of these cer- vical lesions. Dr. Lee teaches that the conditions are rare, and I am afraid that my testimony has but little weight in his eyes ; but what will he say to that of Dr. West, of St. Bartholomew's Hospital ? Dr. West, in his Croonian Lectures for 1854, " On the Pathological Im- portance of Ulceration of the Os Uteri,"1 to which I shall presently allude more at length, states that out of 268 patients examined by him, at the Middlesex and St. Bartholomew's Hospitals, he found ulceration in 125. This testimony as to the frequency of inflammatory ulceration, is of the more value, as Dr. West all but agrees with Dr. Lee in con- sidering these lesions, although of so frequent occurrence, to be of little or no pathological value. We now come to the second category of my opponents, to those who have investigated the question of uterine disease, armed with the same means of physical examination as myself and my predecessors • and whose testimony is of a mixed character, corroborating some of the results at which we have arrived, and invalidating others; but who finally announce totally different conclusions. Foremost amongst these more formidable antagonists is Dr. West, to whose lectures I have just [' American edition, Philadelphia, 1854.] THE EXISTENCE OF ULCERATION PROVED BY DR. WEST. 21 alluded. Before proceeding, however, I must be allowed to pay a tribute to the scientific spirit in which Dr. West's researches have been conducted, and to express my regret that I cannot reply to his ob- jections, and at the same time extend to him the courtesy which he appears to have shown to me in not alluding to my name, although com- bating many of my opinions and assertions. Dr. West's lectures are founded, as I have stated, on the instrument- al examination of 268 females, presenting uterine symptoms of suffi- cient importance in his eyes to warrant such an investigation. The lectures are written with a view to elucidate the pathological importance of ulceration of the uterine neck. In 125 cases, he found ulceration slight, or the reverse; in 143, there was no ulceration. Of the 143 cases in which no ulceration existed, in 29, the uterus was apparently healthy ; in 110, it was not healthy in one respect or other. In the 110 cases of unhealthy uterus, the morbid conditions were either displace- ments, enlargements, indurations of the body or cervix of the uterus, or congestion of the cervix: all more or less variously combined. These varied morbid changes and conditions, it should be remembered, are ge- nerally the result of acute or chronic inflammatory action, existing in the mucous membrane, or in the proper tissue of the neck or body of the uterus. Dr. West's deductions and conclusions are principally drawn from the comparison of these two groups of females: those who present symptoms of uterine ailment with ulceration, and those who present the same symptoms without ulceration; and the pith of these deductions may be said to be, that as the symptoms and morbid results are nearly the same in both groups, ulceration can have no decided pathological importance, and is not a condition that requires special attention or treatment. I would, firstly, draw attention to the important corroborative testi- mony given by Dr. "West as to the correctness of my statements respect- ing the frequency of inflammatory ulceration of the cervix uteri. Dr. West does what I have constantly implored all who presume to give an opinion on the subject to do—he looks, he examines for himself; and what does he find ? 125 cases of ulceration in 268 women examined. If we eliminate the cases of healthy uterus, we find the proportions as follows : Ulcerated, 125 ; non-ulcerated, 110 ; that is, more than half the patients examined presented ulceration. In the 300 cases examined by myself at the Western General Dispensary, and reported in my work, the proportions were: Ulcerated, 222 ; non-ulcerated, 78 ; that is, not quite three-fourths presented ulceration. The difference between more than half and less than three-fourths is not one which, in a statis- tical inquiry of this nature, invalidates results. Dr. West's figures prove the extreme frequency of ulceration in women suffering from symptoms of uterine ailment just as forcibly as mine. The slight dis- crepancy would admit of easy interpretation were it desirable to enter into the subject. Amongst other causes, it may depend on the less de- gree of severity with which symptoms were scanned and weighed, before an instrumental examination was decided on. What more conclusive answer than the above facts can be made to 2-2 OBJECTIONS. Dr. Robert Lee, when he states that he has never seen an inflammatory ulceration of the uterine neck ? Surely I need not pursue any further the refutation of this remarkable assertion. The frequency of inflammatory ulceration of the uterine neck is cor- roborated by several striking and important facts mentioned by Dr. West, as brought to light in the course of his inquiry, although, singu- larly enough, he does not appear himself to see that such is the neces- sary inference. Thus he examined 40 females affected with venereal diseases on the day of their admission into the venereal wards of St. Bartholomew's Hospital: 18 were suffering from gonorrhoea alone ; 10 from gonorrhoea and syphilis ; and 12 from syphilis only. Of these 40 patients, thirteen presented ulceration ; " in 10 it was mere excoria- tion ; in 3 the ulceration was more extensive." Dr. West draws also from the above facts the conclusion that, " be the causes of ulceration of the os uteri what they may, sexual excesses, at any rate, have no great share in their production." Now it appears to me that when, out of forty women possibly, not certainly, exposed to this influence, one-third (13 in 40) present ulcerative lesions in a more or less marked degree, and that the presence of these ulcerative lesions is not satisfactorily explained by the existence of syphilis, or by that of gonorrhoea, we are quite warranted in coming to a totally different conclusion. I would remind my readers, that the periodical examinations made by the Parisian medical police have proved the fre- quency of inflammatory lesions of the cervix uteri amongst the females most exposed to such excesses. Again, Dr. West gives the result of a careful examination of the uteri of 62 females who died in the medical wards of St. Bartholomew's Hospital of other than uterine disease. Of the whole number, 43 were married, or were presumed to be so; and 19 were believed to be virgins. The uterus was healthy in 33, diseased in 29. Of the latter, there was ulceration in 17 ; induration of walls of uterus without ulceration, in 5; disease of lining of uterus without ulceration, in 7. Dr. West sees in this startling and very unexpected result of his ' post-mortem researches, evidence of the non-importance of these lesions in a pathological sense ! " The very frequency of their occurrence," he remarks (p. 36), " instead of substantiating the opinion that they are of great importance, rather militates against that supposition." I on the contrary, see in it positive proof of what I have often stated, viz: that the existence, unrecognized and untreated, of a large amount of uterine disease in the female population, is an indirect cause of death. Inflammatory diseases of the uteru3 and of its neck are essentially debilitating affections, through their reactions on the functions of diges- tion and nutrition. When, therefore, as so generally occurs, they are not treated, they gradually induce a state of debility and anaemia and of deficient vital energy, which may render the female unable to resist the attack of intercurrent disease, to which she becomes an easy prey Such at least is my interpretation of this pathological revelation. Whether pathologically important or not, the facts brought forward by Dr. West remain. Out of 62 miscellaneous uteri examined by him there were inflammatory lesions, more or less severe, in 29, nearly one DR. WEST'S DENIAL OF ITS PATHOLOGICAL IMPORTANCE. 23 half, and in 17 there was ulceration. Thus does Dr. West himself blow to the winds and utterly destroy the value of the statistical state- ments made by Dr. Robert Lee, in the paper I have already quoted. According to Dr. Lee (p. 273), Dr. Boyd examined 708 uteri, at the Marylebone Infirmary, without finding a single case of inflammatory ulceration. He found 21 cases of cancer, 31 of bony or fibrous tumor, 13 dropsies of the ovaries, 24 puerperal cases, 3 of enlargement, but nothing else. Therefore, Dr. Boyd concludes " that ulceration of the neck of the womb is an exceedingly rare disease, else," he observes, "I must have observed it; having cut up and weighed many hundred (uteri), it could have scarcely escaped my notice." Dr. Lee adds (p. 274), that Mr. Hewett and Mr. Pollock have examined 900 uteri at St. George's Hospital, and that they " did not observe a single example of simple ulceration of the os and cervix in the 900 uteri they examined, which confirms the accuracy of the opinion given by Dr. Boyd—that ulcera- tion of the neck or mouth of the womb is a very rare disease." At the time these statements were first published, and were brought forward as a proof that pathological anatomy gave no evidence even of the existence of a morbid condition said by me to be of such frequent occurrence during life, my reply was: that mucous membrane lesions had not been found after death, because they had not been sought for ; as had often before been the case in the history of pathological anat- omy. The observers whose results were so confidently appealed to by Dr. Lee—observers whose talents and integrity I esteem greatly—were looking for bony and fibrous tumors—for dropsies and cancerous degenerescence—and they found them. They were not looking for inflammatory ulcerations, and they did not find them. I could bring other valuable testimony forward to corroborate the results arrived at by Dr. West, who being alive to the existence of ulceration, ivas looking for it and found it; but I prefer leaving to him, for the present, the refutation of Dr. Lee on this point, as on others. Certainly no one will accuse Dr. West of a favorable bias towards the views I defend. I must, however, be allowed to call attention to the rather remarkable fact, that Dr. Lee comes to the conclusion that ulceration of the neck of the uterus does not exist and is of no pathological importance, because he does not find it after death; whilst Dr. West also concludes that it is of no pathological importance, because, on the contrary, he does find it very frequently after death. DR. WEST'S DENIAL OF THE PATHOLOGICAL IMPORTANCE OF INFLAMMA- TORY ULCERATION OF THE NECK OF THE UTERUS. In the preceding remarks, my principal object has been to show, that the researches of one of my scientific opponents, Dr. West, so far from invalidating the statements I have published respecting the fre- quency of inflammatory ulceration of the neck of the uterus during life and after death, powerfully confirm them, and constitute the best refu- tation I can adduce (apart from my own personal experience) of the negative assertions of Dr. Robert Lee. It now behooves me to analyze 24 OBJECTIONS. more fully the train of erroneous reasoning which has led so conscien- tious and accurate an observer as Dr. West to differ entirely with me, and with those who adopt the same views as myself, as to the patho- logical importance of the lesions we both recognize. The key to Dr. West's lectures, the explanation of the frame of mind under the influence of which his researches were carried out, and the re- sume of the results to which they have led him, are to be found in a para- graph at the foot of page 27, which runs as follows : " The really import- ant question is, whether ulceration of the os uteri is to be regarded as the first in a train of processes which are the direct or indirect occasion of by far the greater number of the ailments of the generative system; or whether, on the other hand, it is to be considered as a condition of slight pathological importance, and of small semeiological value—a casual con- comitant, perhaps, of many disorders of the womb, but of itself giving rise to few symptoms, and rarely calling for special treatment ?" The first part of this paragraph may be considered a concise statement of the views Dr. West attributes to his antagonists, of the scientific error he thinks he has to encounter. The second part may be considered a con- cise enunciation of the opinions with which he rises from the investiga- tion. Dr. "West wrestles with an imaginary enemy—combats a foe of his own creation. No pathologist, to my knowledge, as I have already stated, at home or abroad, has described ulceration of the os uteri as a morbid entity—as a disease existing per se. On the contrary, all who have written on the subject have spoken of ulceration, and described it as a result of the inflammation which invariably, necessarily, precedes and accompanies it, and which may exist without it for years, in the uterus as elsewhere. Dr. West has been apparently misled by the discussion to which Dr. Lee's extraordinary assertions gave rise. Dr. Lee, in his anxiety to crush the modern views of uterine pathology, boldly denied the existence of ulceration. He thereby thought to de- stroy doctrines which announced inflammation and inflammatory lesions as of constant occurrence, and ulceration as the most frequent secondary lesion of all, and the one that more especially necessitates instrumental interference. Thence it was that the discussion took place on this one point: Is there, or is there not, such a condition as ulceration ? Thence also, I presume, the origin of Dr. West's error in thinking that his antagonists impute to ulceration alone all the pathological influences which they ascribe in reality to inflammation and to inflammatory lesions generally. At least, I can most assuredly say, that I have never in my writings for a moment attempted such a separation. This is evident from the very title of my work, which I call " A Practical Treatise on Lnflammation of the Uterus, its Neck, and Appendages." If Dr. West will substitute, in the paragraph I have quoted the words —" inflammation of the neck and body of the uterus and their sequelae " for the words " ulceration of the os uteri"—I will accept his proposi- tion as a true exposition of my opinions ; but as long as it remains as it is, I cannot possibly thus accept it. This fundamental error made at the very threshold of Dr. West's inquiry, appears to me to thoroughly negative its value. It has induced DR. WEST'S DENIAL OF ITS PATHOLOGICAL IMPORTANCE. 25 him to establish a comparison, which runs throughout his essay, and on which his statistical tables are based, between two groups of patients who, in reality, do not admit of being compared. This is at once appa- rent, when we reflect that one group contains 125 females, presenting inflammatory ulceration of the cervix, and the other group 110, who present morbid uterine conditions, by far the greater part of which are also the result of inflammation. Thus, the uterus was displaced in 36 cases; in 28 it was lower than natural; in 3 it was retroverted; in 5 anteverted ; the body was enlarged in 20; the os or cervix was also enlarged, or indurated, in 10; the cervix, or os, was enlarged or indu- rated in 44; the orifice of the os was more or less congested, with the uterus healthy, enlarged, or misplaced, or with the os or cervix indurated in 58. I cannot myself see what scientific advantage can possibly accrue from the minute comparison of the symptoms, local and general, pre- sented by 125 women having ulcerated uteri, and by 110 women in whom the cervix uteri is not ulcerated, it is true, but who are mostly suffering from other modes of manifestation of the same inflammatory disease. It can only make confusion worse confounded, and so far from clearing up the subject, involve it in impenetrable darkness. Indeed, to me it appears incomprehensible that a pathologist, of Dr. West's powers of observation and analysis, should, in studying a disease, have thus isolated one of its morbid conditions; should have laboriously com- pared the cases in which it is present, with those of the same generic nature, in which it is absent; and because he could find no real, sub- stantial difference between them, have denied its pathological import- ance. I renounce, therefore, following Dr. West, on this ground; and shall only deal with the unfortunate and unwarrantable conclusion to which the abve error has led him, viz: "That ulceration of the cervix is to be considered as a condition of slight pathological importance, and of small semeiological value .... rarely calling for special treatment (p. 27) .... that it does not appear to exercise any special influence, either in causing sterility, or in inducing abortion," &c. (p. 61). Dr. West bases these conclusions on his .statistical analysis of the cases seen and treated; and what I consider his failure to discover the truth, is another illustration of the danger of trusting too implicitly to results obtained by numerical calculations. I profess a great respect for statistics, and am well aware that they have done much for medical science; but there is always a danger in resorting to them. If there is the slightest flaw in the basis, the whole superstructure will probably be false, and yet it may present the appearance of demonstration, and by many be accepted as such ; the mind has surrendered itself to figures —has abdicated its powers of observation, and has accepted, in advance, the results they give, whatever they be. Nothing, consequently, sur- prises ; nothing shocks. It is possible, however, always to add up the fugitive elements of disease—always to operate numerically with success, on such ever-varying elements as those which manifest their influence in the loss and recovery of health ? Thus, Dr. West states that he has ascertained, by statistical researches, 3 26 OBJECTIONS. that inflammatory ulceration of the cervix uteri has no influence in pro- ducing sterility or abortions. Now if 1, as a practitioner, have found, during a long'series of years, that I have constantly been consulted by young sterile married women, in whose history I can trace the evidence of uterine mischief, dating from the earliest period of their married life, or even from an epoch antecedent to it; if, on examination, I find some chronic inflammatory uterine lesion, say ulceration, if I treat the local disease, and cure it, and if a considerable proportion of these women subsequently become fertile, am I not warranted in considering the local disease as the cause of their sterility ? If, again, I find married women who have had children, often becoming sterile for years after a tedious or instrumental labor, which has left traces of uterine suffering—if, dis- covering this condition to be connected with local inflammatory mischief, I remove it by treatment, and they, subsequently, in very many instances, again become pregnant, am I not warranted in considering the temporary sterility of these women as occasioned by the temporary local disease ? If, on the other hand, I find that women who are con- tinually aborting or miscarrying, are generally suffering from symptoms of uterine ailment, and present, on examination, local inflammatory lesions, mostly inflammatory ulceration, and if, on thoroughly removing these lesions, I find that a large proportion at once go to the full time, and are delivered of live children, am I not warranted in concluding that in these females the existence of the inflammatory disease was the cause of the abortions, and of the premature termination of the preg- nancies ? Such being the case—and it has been the case in my practice for many years—am I to suspend the exercise of my observing faculties, to question the experience of the past, and to acknowledge that inflam- matory lesions of the cervix have nothing to do with sterility or with abortions, because some statistical researches, based on the enumera- tion of the number of children which one group of women has had, as compared with the number that another group has had, decide the question on one side or the other ? My answer is—certainly not. I know that I am right, and that the figures are wrong. I know that there must be some fallacy, some source of error, and I repudiate numerical results, which, were I to put faith in them, would evidently lead me astray. And here is the real danger of the numerical method when incautiously applied to vital symptoms and conditions, and to the results of treatment. There may be such a fallacy, such a source of error, which misleads the unwary, and which can only be detected by those who have had extensive experience, and who are led by this ex- perience to question what the figures announce, and to look for the source of error. The doctrine which Dr. West teaches with reference to the treatment of inflammatory ulceration of the neck of the uterus__viz: " that it rarely calls for special treatment," appears to me most deplorable fo- if it were adopted, most of the pathological discoveries made in'this direction would become positively fruitless, and women would be left to Buffer as of old. I cannot, however, discuss the question on the con- fined basis on which Dr. West has placed it; I must be allowed to DR. WEST'S DENIAL OF ITS PATHOLOGICAL IMPORTANCE. 27 throw into the scale all the inflammatory lesions which constitute so large a part of what he makes his antagonistic group. I must have the inflammatory congestions, the chronic inflammatory indurations of the os, of the cervix, and of the uterus, &c, and this will leave but little behind. That given, the questions to examine will be—Firstly, are these lesions connected with the general break-down of the health so constantly observed in the patients presenting them ? Secondly, is their removal necessary for the recovery of health ? Thirdly, can they be removed without resorting to instrumental and surgical mer.ns of treatment ? I have not the slightest hesitation in answering the first two ques- tions affirmatively, and the third negatively, on the ground both of my own individual experience and of that of other pathologists. That the local lesions and the break-down of health are connected is evident from their very general co-existence; and that the entire re- moval of the local mischief is necessary for the permanent recovery of health, is a fact of which I every day become more convinced. For many years I have been living amongst a population of invalids, pre- senting the two conditions. Before they apply to me they have gene- rally exhausted, during years, all the resources of medical science, and have enjoyed every advantage that social means and the affection and kindness of relatives can contribute; but all in vain, because the local uterine mischief has been overlooked. That once discovered and reme- died, they gradually rally, and are eventually restored to health. Such, also has been the experience of very many talented practitioners whom I could name, were it desirable. Nor can it be said, as Dr. West sur- mises (p. 81), that these patients recovered—owing to the rest and the correct medical and hygienic management which was combined with the local treatment, the latter being a useless concomitant of such general treatment.—All these means have generally been tried for years, in the cases to which I allude, by the most skilful practitioners, but in vain. As to the third question, I have no hesitation, either, in saying, that if chronic inflammatory lesions of the cervix, ulceration, thickening, in- duration, &c, are to be removed, in very many cases, it can only be effectually accomplished by persevering surgical treatment. It is a per- fect delusion to suppose that these lesions, in a confirmed state, can be got rid of merely by attention to the general health, and by rest of body and mind, hip-baths, lotions, &c. Such treatment only alle- viates, only enables sufferers to get on ; it only temporarily takes the sting out of their ailments; it does not cure them. However much better they may feel under it, as soon as they resume the ordinary du- ties of life, all their sufferings, local and general, return. If the medical practitioner makes up his mind that these lesions are insignificant, mere concomitants of the general ill health, and that their removal is not necessary for the patient's well-doing, of course he feeta warranted in discarding surgical means of treatment. But if, on the contrary, he knows that they constitute the pivot of the case; that their existence has probably been the cause of the patient's falling into bad health, that as long as they remain there is not a chance of a per- 25 OBJECTIONS. manent recovery; and that the slightest residue of local disease will all but inevitably, in the course of time, reproduce the entire mischief, he will not shrink from exacting from his patients the necessary submission to surgical treatment, and he will do his duty to them, however painful that duty. The surgical agents which I recommend in the treatment of chronic inflammatory lesions of the cervix uteri are the same as those which are used for the treatment of similar conditions in other parts of ^the body. They are local antiphlogistic remedies, such as local depletion, emollients, sedatives, astringents, counter-irritants, and vitality-modify- ing agents, such as caustics of variable intensity. There are few sur- gical agencies, the knife excepted, which cannot be classed under the above heads. The object in resorting to their use is, firstly, to subdue subacute or chronic inflammatory action, and thus to promote the healing of the excoriations, abrasions, or deep ulcerations, and to favor the softening and absorption of the sub-mucous inflammatory indura- tions. Whilst these means of treatment are being resorted to, expe- rience has pointed out that the greatest assistance can be derived from the use of caustics ; indeed, that they are often indispensable. The object in view is to modify the vitality of the diseased tissues, and to substitute healthy, manageable inflammation to morbid inflammation. This treatment of chronic, obstinate, intractable, inflammatory con- ditions—ulcerations of mucous membrane, induration, and hypertrophy of sub-mucous and proper tissue—is strictly consonant with the recog- nized doctrines of surgery. It is merely the application of the laws which regulate the therapeutics of surgery to the diseased conditions of this peculiar region. Moreover, I have no hesitation in saying that those who, having recognized these local morbid states, shrink (through convictions, timidity, or ignorance) from the use of surgical agents, and are contented to treat their patients generally, and by the use of lotions and injections, <&c, must very frequently remain satisfied with their non-cure. They must, and do, often dismiss their patients with the morbid states described still existing. It is to this result, indeed, that the conclusions to which Dr. West has arrived directly tend—viz : the imperfect treatment and cure of uterine disease, and the consequent reproduction or perpetuation of the patient's sufferings. The above analysis of Dr. West's lectures may be summed up as follows : Firstly, Dr. West's testimony, founded on accurate re- searches, carried out at two of the large metropolitan hospitals, estab- lishes in the most peremptory and undeniable manner, the oft-disputed accuracy of my pathological statements respecting the existence and frequency in the living and in the dead, of inflammatory lesions of the cervix uteri; such as ulcerations, indurations, &c. This testimony therefore, utterly invalidates and destroys, were it still necessary the scientific value of Dr. Robert Lee's negation of the existence of in- flammatory ulcerative disease in this region of the body. Secondly, Dr. West's negative conclusions as to the pathological im- portance of inflammatory ulceration of the os uteri, are, even^in argu- ment, quite valueless^ owing to the singular fact of his having drawn them from the statistical comparison of two groups of patients, laboring? DR. TYLER SMITH'S RECOGNITION OF ULCERATION. 29 in a great measure, under identically the same disease, only manifesting its existence in one group by one mode of expression, in the other group by another mode of expression. DR. TYLER SMITH'S RECOGNITION AND MICROSCOPICAL DESCRIPTION OF ULCERATION OF THE UTERINE NECK. In the preceding remarks I have shown the utter fallacy of Dr. Robert Lee's denial of the existence of inflammatory ulceration of the neck of the uterus, by referring to the testimony of Dr. West, of St. Bartholomew's Hospital. Thus, on the authority of Dr. West, it is evi- dent that when Dr. Lee writes—" Neither in the living nor in the dead body have L ever seen ulceration of the os and cervix, except of a specific character, and especially scrofulous and cancerous" (Medico-Chirurgi- cal Transactions, vol. xxxiii. p. 275)—he must either have taken upon himself to contradict my statements without due investigation of the subject, or his mental vision must have been so obscured by prejudice, that he was incapable of recognizing the truth when placed before him. That Dr. Robert Lee is open to one or other of these imputations, is also undeniably proved by the recent evidence of Dr. Tyler Smith in his work on Leucorrhcea. Dr. Tyler Smith's testimony as to the existence of non-specific ulcerations of the cervix uteri, and consequently as to the soundness and correctness of the descriptions of the more severe forms of inflammatory ulceration, contained in the successive editions of my work on Uterine Inflammation, is even more emphatic and more conclusive than that of Dr. West, inasmuch as it is based on minute microscopical investigation. It also carries with it the additional weight of emanating from a physician who, only a few years ago, publicly ad- vocated and supported many of Dr. Lee's assertions. Dr. Tyler Smith's first contribution to. uterine pathology was a memoir, which was read at the Westminster Medical Society, and sub- sequently published in The Lancet, April 20th, 1850, under the title of " Observations on the supposed Frequency of Ulceration of the Os and Cervix Uteri." In this essay, Dr. Smith supported most of the opin- ions and views contained in Dr. Lee's memoir, although in a much more guarded manner. Thus he admitted the frequent existence of abrasions and excoriations of the cervix uteri, but denied their ulcerative nature, or their claim to be called forms of ulceration. Then, without denying, as Dr. Lee did, the existence of inflammatory ulcerations of the cervix uteri of a more marked type, he argued against their existence, both in the living and the dead, using the same arguments as Dr. Lee with reference to the living, appealing to the same negative testimony—that of the curators of St. George's Hospital—with reference to the dead. In order to show that I am not misrepresenting the views brought forward, by Dr. Tyler Smith in the essay to which I allude, I must be allowed to give the following extract (The Lancet, vol. i. 1850, p. 474) :— " The granulations which are sometimes found surrounding the os uteri—which may secrete mucus or pus abundantly, and which may 30 OBJECTIONS. bleed on being roughly handled—are, I have no doubt, the result of in- flammation ; but they resemble the granular state of the conjunctiva (Dr. Tyler Smith's Italics), rather than the granulations of a true ulcer, the granular os uteri offering no edges or signs of solution of continuity, by which we might satisfactorily declare it to be an ulcer. The granu- lar os uteri would be a more correct designation, in such cases, than ' ulceration' of the os uteri. Some of the so-called ulcerations appear to be nothing more than patches of thickened epithelium, or portions of the os and cervix from which the epithelium has been melted away by acrid and irritating secretions. ... It appears to me that we can neither receive the existence of excoriation, or abrasion ; of granulation or of fungous growths ; the secretion of pus or muco-purulent matter; as affording undeniable evidence of the existence of ' ulceration' of the os and cervix uteri. We must try ulceration in this part of the body by the same test which we apply to ulcers in other parts of the economy. We must look for a solution of continuity, with 'a secreting surface, separated from the healthy structures, having defined edges, everted or inverted—for an ulcer, in fact, in the common pathological meaning of the term." Such were Dr. Tyler Smith's views of the pathology of ulceration of the uterine neck in 1850. Even after the elimination of abrasions and excoriations,—the result of morbid action, not of accident, be it remembered,—Dr. Smith refused to admit that " bleeding granular sur- faces, secreting mucus and pus abundantly," were ulcerations, because, apparently, they had not (like old skin ulcers) "defined edges, everted or inverted." The very enunciation of such views as the above im- pressed me at the time with the conviction that they originated in want of practical experience, and in the controversy which followed between myself and Dr. Smith I said as much. The following year Dr. Tyler Smith was appointed physician-accoucheur to St. Mary's Hospital, where a wide field of practical observation was opened to him. What has been the result ? Dr. Smith has recently published a work on "Leucorrhoea,"1 in which the granular, bleeding, muco-pus-secreting surfaces, described above as not constituting ulceration, as not deserv- ing that appellation, are now carefully and minutely depicted as super- ficial ulcerations of the os and cervix uteri, and are distinctly stated to be the morbid change that immediately follows abrasions or excoriations of the mucous membrane (vide pp. 91, 92). The following paragraphs are verbatim extracts from Dr. Smith's work:— " Epithelial Abrasion of the Os and Cervix Uteri.—The next mor- bid change (to vascular injection of the os and cervix uteri) consists of loss of epithelium, and partial or entire denudation of the villi. To the naked eye a red eircle of excoriation surrounds the os uteri...... It sometimes involves the whole surface of the os uteri, and extends to the upper part of the vagina, and also ascends within the canal of the cervix. The denuded surface does not generally secrete pus, but an abundance of mucous plasma and epithelial scales is produced, and the surface frequently bleeds upon slight irritation. To the naked eye the 1 [Tyler Smith on the Pathology and Treatment of Leucorrhoea. Am. ed., Phila., 1855.1 DR. TYLER SMITH'S RECOGNITION OF ULCERATION. 31 abrasion appears rough, and to the touch it feels erectile and 'velvety' —a term which has very commonly been applied to what has been con- sidered ulceration of the os and cervix uteri. The villi do indeed in this condition stand out somewhat like the pile of velvet, and in some cases the villi themselves are considerably enlarged. When such cases are examined microscopically after death, the villi are seen with their vascular loops, but with entire loss of their epithelial covering. The naked villi are sometimes so large as to be visible, and they look like an irregular fringe skirting the uterine aperture. This state has been con- sidered one of superficial ulceration, but epithelial abrasion is the only morbid change which exists in cases of this kind, and it is nothing like that state which is considered ulceration in other parts of the body. If this were to be considered genuine ulceration, we must apply the same term to the simple loss of the epidermis after the application of a blis- ter to the skin. In leucorrhoea, it is, I believe, caused, like the super- ficial redness, chiefly by the irritation of the os uteri from the alkaline cervical discharges. This loss of epithelium is the most frequent change which I have met with upon the surface of the os uteri in cases of ordinary leucorrhoea."—pp. 86, 87. " Superficial Ulceration of the Os and Cervix Uteri.—When these changes have proceeded a step further, there is found not merely loss of the dense layer of epithelium covering the os uteri, but the villi both of the external surface of the os uteri, and of the mucous surface within the labia uteri, are destroyed entirely or in patches. It is this condition which constitutes the granular condition of the os uteri. In that state of the os uteri, which upon examination after death would be pronounced to be undoubtedly superficial ulceration, the condition which generally obtains is a partial or entire loss of the epithelial layer around the os uteri in circumscribed patches, and here and there the partial or entire destruction of the villi. This loss of the villi gives an eaten, corroded appearance to the surface of the os. Such a condition of the os uteri may be limited in extent, or it may spread over the whole of the os uteri and external portion of the cervix, and pass within the labia. In this state there is a free secretion of purulent or muco- purulent fluid.....On the surface of the os uteri superficial ulceration does not go beyond the removal of the epithelium and villi, but I have seen a portion of the rugae in the lower part of the cervical canal itself eaten away in very severe cases."—pp. 87, 88, 89. What can be more graphic, and at the same time more minute, more accurate, and more conclusive than this description of ulceration of the uterine neck ? And yet it is from the pen of a pathologist who, when he wrote the memoir from which is taken the first extract, considered these identical mucous-membrane lesions to be merely granular, con- junctiva-like states, of a non-ulcerative nature. It is from the pen of one who, if he did not repudiate the very existence of ulceration in this region, like Dr. Lee, appeared to accept it principally on the faith of others, and more through cautious reserve than because he had ever himself met with any lesion of the kind. At the time that Dr. Robert Lee's memoir and that of Dr. Tyler Smith were simultaneously brought forward, the one at the Medico- 32 OBJECTIONS. Chirurgical Society, and the other at the Westminster Society, the one denying the very existence of inflammatory ulceration of the uterine neck, and the other, if not its existence, its frequency—at the time that the archives of St. George's Hospital were ransacked for post-mortem arguments—it was currently reported that the result of this combined effort would be the annihilation of the views I upheld. The unsound- ness of doctrines so pernicious in their tendency, it was said, was to be demonstrated, their progress arrested, and those who supported them placed under general professional ban. I must be pardoned if I here briefly state what has been the result of the efforts thus made to crush the pathological truths of which I had made myself the interpreter. Finding that my appeals to facts and to experience were received with incredulity, and met by counter-assertions—the thorough fallacy of which I have now proved by other testimony than my own—I chal- lenge my opponents to meet me in the field of observation. I proposed to assist a committee of the Medico-Chirurgical Society to investigate the state of fifty, or more, new patients, presenting symptoms of uterine suffering, in any hospital,or dispensary in London, and to abide by the result. My challenge was not accepted ; but my views and assertions have since then been tacitly and unintentionally submitted to the very ordeal I courted, at St. Mary's Hospital, and that by one of my " then" opponents, Dr. Tyler Smith himself. The results of the investigation, in his hands, I have just laid before my readers. In the above extracts, it will have been remarked that Dr. Tyler Smith still denies that the condition which he describes under the head of epithelial abrasion constitutes ulceration. Am I not, however, justi- fied in saying that it is merely a discussion of words to deny the generic term ulceration to the conditions of abrasion, excoriation, epithelial' denudation—whatever it may be called—which Dr. Smith himself de- scribes as the first stage in the destructive process, which ends by giving rise to what he now admits is really " ulceration ?" In sound logic, does not the term ulceration apply just as rationally to the first stage of the destructive process, that which destroys the epithelium, and exposes the fringe-like villi, as to the second stage, that which corrodes and destroys the surface of the villi themselves ? In both, the difference is merely one of degree. Whether the epithelium alone be destroyed, or the epithelium and a portion of the villi, there is equally destruction of one at least of the elements, which, by their combination, constitute the healthy mucous membrane. The morbid cause, also, is confessedly the same in both, whether that cause be inflammation or leucorrhoea. As regards mere pathological facts, it does not appear to me,' taking into consideration the above passages, and the general tenor of his work, that there is now much difference of opinion between Dr. Tyler Smith and myself. The experience of the last few years, in the verv field where I was long engaged (Paddington), has led Dr. Smith at last to recognize and describe the same lesions that I have observed taught and described ever since 1837—that is, thirteen years before the publi- cation of his first memoir. He now admits that vascular injection of the os and cervix uteri, epithelial abrasion of the os and cervix uteri and superficial ulceration of the os and cervix uteri, are all stages, decrees DR. T. SMITH'S RECOGNITION OF INFLAMMATORY LESIONS. 33 of the same morbid process. That I should call these conditions in- flammatory conditions, the result of inflammation, and that he should simply describe them, attributing their presence to "leucorrhoea," does not prevent his agreeing with me, that they are of great pathological importance; which Dr. West denies, as we have seen. Thus, in addi- tion to his recognition of their frequent existence, Dr. Smith admits that they produce hypertrophy of the subjacent tissues by their long- continued presence ; that they often cause abortion and sterility ; and that they are constantly connected with deranged conditions of general health, which can only be effectually and permanently remedied by their removal. If any further evidence were required to show how greatly a few years of practical hospital experience, on his part, have narrowed the gulf which formerly separated Dr. Tyler Smith and myself, and have, necessarily, inevitably led him to the results at which I had in a great measure arrived before I even wrote my thesis on this subject, in 1843, I would refer to the rules he now lays down to guide the practitioner in the surgical examination of patients. In the memoir to which I have repeatedly alluded, and in the discussion which followed, Dr. Smith fully admitted the necessity of resorting to instrumental examination in ute- rine disease. From the severity, however, of his criticisms on those who, holding contrary opinions to himself, frequently looked for, and treated ulcerative disease, it is very clear that he was then far from considering instrumental examination as necessary, in the investigation and treatment of confirmed uterine disease, as he now evidently thinks it. These rules will be found at page 197 :— " The rule I adopt, with respect to examination, is as follows—In all married persons suffering from uterine disease, where the symptoms are severe, I make a careful examination digitally, and with the speculum, if necessary, at the first time I am consulted. The frequency of sub- sequent examinations depends upon the nature of the case. With respect to unmarried women, I never make a physical examination, unless ordi- nary means fail of curing the uterine disorder. I then examine in the fir3t instance digitally, and only use the speculum in cases where the finger detects disease of the os or cervix uteri, such as loss of surface, enlargement of the labia uteri, induration, or gaping of the os uteri, with purulent or muco-purulent discharge," &c. Assuredly I have never gone further, indeed scarcely as far, either in the instructions I have given to others, or in my own practice. The advice I have always given to practitioners has been, even with married women, to resort only to digital and instrumental means of examination, when general treatment has failed, unless the symptoms be very marked and decided. In my own practice I am, and have ever been, so scrupu- lous, that it does not occur to me once in six months, to examine a patient without finding sufficient disease to warrant the examination. When, perchance, it has occurred to me to make a fruitless examination, I have always felt that I had committed a grievous error of diagnosis, by which my patient had suffered; and I have reproached myself greatly for so doing. Thence, probably, it is, that in my published statistics the proportion of severe cases is large. 34 OBJECTIONS. THE EXISTENCE OF INFLAMMATORY ULCERATION OF THE OS UTERI, GENE- RALLY RECOGNIZED IN EDINBURGH, DUBLIN, FRANCE, AND AMERICA. It will be admitted, I think, by all, that in the preceding strictures, I have proved, in the most peremptory and incontrovertible manner, both the existence and the frequency of inflammatory lesions of the ute- rine neck, including inflammatory ulceration. My readers must also bear in mind that I have proved my position, not by appealing to my own personal experience, but by recording that of other London physi- cians, opposed to me in their general views of uterine pathology. I should not have considered this demonstration worth either the time or the space which I have devoted to it, had it not been for the paralyzing influence which Dr. Robert Lee's unreserved denial of these pathological facts has had over the medical profession in London. Coming, as this extraordinary denial has come, from one of the oldest, most scientific, and most esteemed of our body, the effect has been to imbue the minds of the leading members of the profession, medical and surgical, with a scepticism which has tended to stifle even inquiry, and has marred the progress of doctrines of inexpressible value to the wel- fare of the female community. Fortunately, the blighting influence of Dr. Lee's negation of these vitally important facts has not extended beyond the metropolis. In the provinces, many experienced practitioners, and principally hospital sur- geons practising midwifery, have examined for themselves. They have found, as all have done who have conscientiously investigated Nature, that my descriptions of diseased uterine conditions are taken from life, and are strictly accurate and true ; and they have adopted the doctrines which I defend. Whilst speaking of provincial inquirers, I must not omit to mention Dr. Whitehead, of Manchester, who was one of the earliest in the field, and whose labors and researches place him in the foremost ranks of uterine pathologists. In Edinburgh, our celebrated fellow-practitioner, Dr. Simpson, has for many years taught and demonstrated the correctness of these views. The great and deserved authority which surrounds him, and the talent and energy with which he upholds his opinions, have borne down all opposition ; and although difference of opinion may be entertained on other points, I am not aware that the existence and frequency of in- flammatory and ulcerative lesions of the uterine neck have even been questioned in modern Athens since the publication of the first edition of my work in 1845. I may say the same of Ireland, where these morbid conditions have been long recognized, and treated surgically, as a matter of course by the most eminent uterine pathologists of the day, amongst whom I may name Dr. Montgomery, Dr. Evory Kennedy, and Dr. Beatty. In France, their existence and frequency, and the necessity of treat- ing them on surgical principles, have been generally recognized ever since the publication of Lisfranc's lectures, more than twenty years ago. In America, the change that has taken place within the last ten years THE EXISTENCE OF ULCERATION GENERALLY RECOGNIZED. 35 in the opinions of the medical profession with reference to uterine dis- ease is, I believe, even still more decided than in England. The exist- ence and frequency of inflammation and of inflammatory ulceration of the neck of the uterus and of its canal is now, I am told, all but uni- versally recognized. I think I may fairly lay claim to the honor of having contributed to this change, the reprint of my work "On Uterine Inflammation" having been received with favor in the United States, and having gone through four editions. Dr. Meigs himself has recently testified to the frequency of inflammation and of inflammatory lesions of the neck of the uterus, as the cause of obstinate leucorrhoeal dis- charge, and of confirmed uterine suffering, in his work " On Acute and Chronic Diseases of the Neck of the Uterus," published at Philadelphia in 1854. Dr. Meigs has so long most deservedly held the highest posi- tion amongst obstetric and uterine authorities in the United States, that his adhesion to the views advanced by modern pathologists, as to the local inflammatory cause of leucorrhoea accompanied by confirmed Uter- ine ailment and constitutional disturbance, I consider to be very valua- ble. Thus (page 37) we find the following paragraph : " We should cure a much greater number of leucorrhceas if we would not misin- terpret the disorder, calling that a vaginal which is really a cervical malady, and vice versd......We repeat, the serious cases (of leu- corrhoea) are cases of disease of the cervix; but a vaginal injection for inflammation of the canal of the neck is simply ridiculous. The albuminous leucorrhoea is a sign of inflammation of the cervix, in which is included the canal, with its copious muciparous apparatus. It is as much a surgical disease as an ulcer of the leg, as an anthrax, or con- junctivitis. WThen the surgical disorder is cured, the sign disappears. Hence we desire to express the opinion that such leucorrhceas are to be held as acute or chronic inflammations of the canal of the neck, and ought to be treated accordingly. Although Dr. Meigs thus recognizes the existence and frequency of inflammatory lesions of the cervix uteri, attributes due importance to them, and teaches that they are surgical conditions which must be dis- covered and treated by surgical means if we wish to cure the leucor- rhoeal discharges, and the local and general disturbance which they occasion, he denies that the term ulcer or ulceration can be applied to them. The disagreement, however, is clearly one of words only; his book itself contains several very good colored figures, which most gra- phically represent the different stages of inflammatory ulceration. With Dr. Meigs it is a mere fastidiousness of phraseology, which a little thought and the knowledge of the labors of others will no doubt modify. He is so convinced, indeed, of the frequency of these diseased conditions, of their importance, and of the necessity of their surgical treatment, that he impresses most strenuously on all family practitioners, the neces- sity of becoming acquainted with the true pathology and treatment of these diseases, that they may afford real relief to their patients without the latter being obliged to apply to special practitioners. Having thus established the soundness and correctness of the patho- logical facts on which the doctrines I advance are, in a great measure, founded, I shall briefly examine the various theories which are more or 36 THE LEUCORRHOEA THEORY less current in uterine pathology, and which are invalidated by these doctrines. In speaking of Dr. West's researches, I have already re- ferred to the views of those who, although admitting the existence of inflammatory lesions, most unaccountably and illogically deny their pathological importance. I shall now briefly examine various other opinions and doctrines, which I shall class under the following heads: The Leucorrhoea Theory, the Syphilis Theory, the Ovarian Theory, and the Displacement Theory. CHAPTER IV. THE LEUCORRHOEA THEORY—THE SYPHILIS THEORY—THE OVA- RIAN THEORY. THE LEUCORRHCEA THEORY. Dr. Tyler Smith's recent work appears to have been principally written in order to bring before the profession the peculiar views which he professes with reference to the morbid states, general and local, to which we have alluded as characterizing conditions of uterine ailment. The germ of these views is to be found in his Memoir of 1850. He therein observed, that the abrasions, granular conditions, &c, which are found at the os uteri, are probably " the result of irritation, pro- duced by secretions depraved by some change in the innervation or nutrition of the uterus." This is the idea which Dr. Smith has de- veloped, and on which he has based a theory of uterine pathology, in opposition to what he terms the " Inflammation Theory." Calling to his assistance the microscopical talents of Dr. Hassall and of Dr. Hand- field Jones, he has submitted the mucous membrane of the vagina, cervix, and cervical canal, to a minute microscopical examination, and the results thus obtained are interesting. It would appear that the vaginal and cervical mucous membranes, which are covered with pavement epithe- lium scales, contain few, if any, mucous follicles. The mucous mem- brane of the cervical canal, on the contrary, which is covered with cylindrical epithelium scales, presents even more mucous follicles dis- seminated over its surface than was previously supposed. The draw- ings of this mucous membrane, and of its follicular structure, are very beautiful, and the description of their structure and disposition given by Dr. Tyler Smith is more minute than that of any previous anatomist. Numerous as we thought them, it appears that they are even still more numerous, amounting to many thousands. Adopting the researches of M. Donn6 and of Dr. Whitehead, Dr. Tyler Smith draws attention to the fact, that the ropy, mucous secretion of these follicles is alkaline and remains transparent in the cervical canal. On reaching the vagina' and meeting with the acidal vaginal secretion, its albumen becomes coagu- ESSENTIALLY UNSOUND. 37 lated, if not very abundant, and it is thus transformed into the white, creamy fluid therein found. Starting from these anatomical and physiological considerations, and extending his former idea, Dr. Tyler Smith assumes (p. 85) that a mor- bidly augmented secretion from the mucous glands of the cervical canal, occurring under the influence of general or local causes, is " the most essential part of the disorder," in women presenting symptoms of uterine ailment, and is the cause of the mucous membrane lesions, and of their sequelae, which are observed in practice. To this morbid con- dition, which he terms Leucorrhoea, Dr. Tyler Smith attributes the mor- bid changes which I and others have described as the evidence and result of inflammation—that is, congestion, erosion, well-marked ulcera- tion, hypertrophy, induration, the functional derangements of the uterus, and the secondary sympathetic reactions which are observed in the cases presenting them. The word inflammation is so sedulously avoided, that a careful perusal of Dr. Tyler Smith's work leaves in the mind a doubt as to whether he admits its existence even as a secondary result of this mysterious entity, " Leucorrhoea." Thus, at page 89, we- find the following paragraph :— "In maintaining the important part played by the cervical secretions in inducing morbid conditions of the os uteri, I do not wish to be under- stood as saying that they are the only causes of these conditions. What I contend for is, that in the majority of cases in which leucorrhoea is present, in combination with non-malignant disease of the os and cer- vix, the morbidly active condition of the cervical glands is the primary and essential disorder. Amongst the other causes of morbid change in the os and cervix uteri, the varying vascular and mechanical conditions of these parts in menstruation, coitus, pregnancy, and parturition, must of course be enumerated. Eruptive conditions of the cutaneous cover- ing of the os uteri, in the shape of aphtha, herpes, or eczema, form another class of cervical discharge. Vaginitis may also extend upwards, and involve the os and cervix.'' In the above extract it will be observed that the morbidly increased cervical secretion is not given as the cause of inflammation, which secondarily induces ulceration, induration, &c, but as the essential dis- order of which these lesions are the morbid conditions. _ Neither is the intervention of inflammation recognized in the enumeration of the other causes which produce morbid changes in the os and cervix, except in the case of vaginitis extending to the cervix. Dr. Tyler Smith seems to have endeavored to establish an union be- tween the pathology of former days and the results of modern expe- rience. Thus formerly it was thought that the discharges, be they mucous, purulent, or bloody, which issued from the female organs, were in a great measure the mere reflex of general and functional morbid conditions. The modes of investigation which are now adopted show the all but constant existence, in such cases, of local lesions. Dr. Smith evidently tries to combine the two by thus stating that, under the in- fluence of both general and local causes, the cervical secretions become morbidly exaggerated and modified, without the intervention of inflam- mation, thus establishing what he terms Leucorrhoea. This new entity, 38 THE LEUC0RRH03A THEORY this peculiar morbid state once admitted, it becomes the source of all evil, producing congestion, erosion, ulceration, hypertrophy, abortions, sterility—indeed, whatever mischief subsequently occurs, local or gene- ral, in the uterine organs ! Thus it is that we find him describing erosions, ulcerations, &c, not as inflammatory lesions, but merely as symptoms of leucorrhoea. This attempt to unite past and present pathology does not certainly appear to me calculated to overturn what Dr. Smith calls " The inflam- mation Theory." What are the lesions described in the extracts I have given—the congestions of the capillary villi or network, the subsequent erosions, ulcerations, and hypertrophies ? Are they not inflammatory lesions ? To say that they are symptoms of leucorrhoea is merely to evade the question, to answer by a word which thus used has no rational meaning; and yet, if Dr. Smith admits that they are in their inti- mate essence inflammatory conditions, why does he not frankly say so ? In every part of the.economy, in every tissue, they are considered by pathologists to be the symptoms, conditions, and sequelae of inflamma- tion, and to ignore this fact is to ignore the established laws of general pathology. Indeed, it would be just as rational to call inflammation, ulceration, and thickening of the mucous membrane of the throat "leu- corrhoea," as to give that appellation to these identical changes in the cervical and vaginal mucous membrane. The unsoundness of Dr. Tyler Smith's fundamental doctrine is at once detected if we refer to the laws of general pathology. Mere morbid hypersecretions, fluxes, as they have been called, from mucous or glandular organs, do not produce irritation and morbid changes in the structures with which they come in contact, apart from inflamma- tion. It requires the existence of inflammation to endow these hyper- secretions with acrid irritating properties. Thus, a mucous flux or discharge may exist from the bowels for months or years, to an enor- mous extent, without the anus or adjacent parts ever being irritated. The nasal secretion may be greatly increased, for a considerable space of time, without irritation of the alae of the nose or of the lips. But let the inflammation be the cause of the hypersecretion or flux, and at once the scene changes. If the mucus from the bowels is occasioned by inflammation of the intestinal mucous membranes, it becomes irri- tating, and excoriates the anus. If the hypersecretion from the nasal mucous membrane is occasioned by coryza or inflammatory cold in the head, the alse of the nose and the lips are excoriated. Moreover in all these instances, the morbid changes themselves produced on the anus, the lips, the cheeks—erythema, excoriation, &c, are inflamma- tory changes, produced by an acrid inflammatory secretion. Inflamma- tion has supervened both as cause and as effect. Such being the pathological law in other parts of the economy it must also hold good in the uterus. The morbid hypersecretions of the cervical canal, and of the vagina, are in themselves innocuous and only acquire irritating properties through the intervention of inflamma- tion. They may and do increase, and diminish in the different phases of the female's pathological state, under the influence of menstruation pregnancy, over-exertion, mental emotion, &c, without any local mor- ESSENTIALLY UNSOUND. 39 bid change occurring. This, indeed, Dr. Tyler Smith himself acknow- ledges and develops. When, however, their increase is accompanied with the ordinary local evidences of inflammation—swelling, redness, heat, pain, ulceration, and thickening of diseased tissues—it is because inflammation co-exists, here as elsewhere, has changed the character of the discharge, and developed the whole train of morbid changes that characterize inflammation, &c. To say that the primary cause of these morbid conditions, the essential disorder, is the morbidly increased mucous secretion, is a mere assertion which cannot be proved; and is contrary, as we have seen, to the laws of general pathology, our only safe guide in such questions. This doctrine of " leucorrhoea," as developed by Dr. Tyler Smith, appears to me a mystical, unpathological doctrine, unworthy of the present state of science. It is a doctrine that substitutes words for facts. What, I will ask, is the intimate nature, the cause of this mor- bid hypersecretion which, according to his views, is the " essential dis- order ;" which creates morbid changes that are not inflammatory, although they present all the characteristics of inflammatory lesions ? Dr. Tyler Smith cannot tell us, for he ignores inflammation, and does not soar above the idea of a "morbidly exaggerated secretion." But the profession will tell him that the essential disorder is inflammation, neither more nor less. Much might be added, but I believe I have said enough to show that the new "Leucorrhoea" theory is but a poor substitute for the one Dr. Tyler Smith attacks. This, the " inflammation theory," as he calls it, is founded on the recognition of the positive fact, that most of the morbid lesions observed in patients suffering from confirmed uterine ailment are inflammatory lesions, the result of inflammation. Those who adopt it believe that, in these cases, inflammation is the primary condition, as in other mucous membranes, and that the hypersecretions are, generally speaking, quite secondary, mere symptoms. At the same time, we believe that the inflammatory disease itself, and the lesions it produces, including the hypersecretions, are completely sub- servient to the general pathological laws which regulate inflammation in its origin, progress, and termination, in all parts of the animal economy. Before I pass to another subject, I would remark, that Dr. Smith, throughout his work, corroborates a very important practical fact, which I was, I believe, the first to point out and elucidate—viz: that the discharges, mucous or purulent, which issue from the cervical canal are generally secreted by the cervical canal, and not by the uterine cavitv. In other words, I believe that I was the first to demonstrate that nearly all that had been previously written by French and English pathologists on endo-metritis, or inflammation of the lining membrane of the uterine cavity, had been written in error as to the seat of disease, and as to the origin of the morbid discharges. Instead of proceeding from the uterine cavity, as was generally supposed, in the great majority of cases, they proceed from the cervical cavity or canal only, the uterine mucous membrane being, comparatively, seldom the seat of disease and of morbid secretions. These views were developed at great 40 THE LEUCORRHCEA THEORY, ETC. length in the second edition of my work on " Uterine Inflammations, 1^49 ; and it is gratifying to me to find them so thoroughly corrobo- rated by Dr. Tyler Smith's more recent researches. Recognizing, as Dr. Tyler Smith does, fully, the pathological im- portance of uterine lesions, ulcerative and other, he agrees with me as to the absolute necessity of their removal by local as well as by general treatment. He adopts the more simple means of local treatment which I recommend—astringents, injections, local depletion, applications of the nitrate of silver, &c, but repudiates and strongly condemns the more energetic surgical agencies, such as the acid nitrate of mercury, and other mineral acids, potassa fusa, the actual cautery, &c. Dr. Tyler Smith must not think me discourteous if I once more appeal to time and to his own increased experience. These will, in my opinion, inevitably do away with all disagreement between us, by proving to him the absolute necessity of the more potent surgical agencies which he now repudiates. Dr. Tyler Smith is too sensible a man, too clever a physician, to leave in the hands of his fellow-practitioners means of treatment which are occasionally indispensable in order to entirely re- move important morbid conditions. When additional experience has shown him that there are patients, especially in private practice, where cases can be followed, who can only be restored to health by the in- strumentality of the vitality-modifying agents which he now condemns ; and that if he does not therewith cure them, others will; I predict that he will pass the "rubicon," and become a convert to the vitality- modifying doctrine, as he has become a convert to the ulcerative doc- trine. Should that day come, however, as I believe it will, I shall have a right to ask Dr. Tyler Smith to publicly acknowledge his conversion, and not in a second or third edition of his work, to act by this ques- tion, as he has done in the first, by the ulceration one. Although compromised, as we have seen by the expression of very decided opinions, in the controversy on the existence and frequency of ulcera- tion of the neck of the uterus, Dr. Smith, in his work on Leucorrhoea, never even alludes to his having formerly entertained other opinions than those which he enumerates; but quietly describes ulceration as if its pathology had never been questioned, either by himself or by any one else. I may be allowed to add, that many practitioners who for- merly denounced me loudly for using too energetic surgical means in the treatment of uterine disease, have, since then, taught by experience and by my example, adopted these very means, and are now quietly and tacitly employing them, thereby gaining credit and honor in prac- tice. Such a course may be admissible in a private practitioner but it is certainly not justifiable in a public man, in one who claims to teach and to lead professional opinion. The term leucorrhoea, if retained at all, ought, in sound pathologv it appears to me, to be reserved for those forms of passive mucous hypersecretion of the vaginal, cervical, and intra-cervical mucous mem- brane which often temporarily exist independently of inflammatory lesions, and independently of uterine ailment. These passive and fleet- THE SYPHILIS THEORY. 41 ing conditions of hypersecretion, really and truly, are the reflex of general conditions of health, and seldom come under the eye of the profession as distinct morbid states. THE SYPHILIS THEORY. One of the first explanations that were given in Paris, many years ago, of the presence of inflammatory and ulcerative lesions of the uterine neck, was, that they were frequently, if not principally, secondary syphilitic conditions. This explanation of no longer deniable patholo- gical facts has found, of late, advocates and supporters in England. Amongst others, I may mention Dr. Tyler Smith, who, in his work " On Leucorrhoea," states " that far too little importance has hitherto been given to the connection between Secondary Syphilis and obstinate Leucorrhoea with disease of the os and cervix uteri" (p. 99). A few pages further on, after discussing my opinions on the subject, he adds, " I have always been of opinion that there is a large amount of unde- tected syphilis in the works of Dr. Whitehead and Dr. Bennet." The careful perusal of the arguments brought forward by Dr. Tyler Smith and others has not, however, in any respect modified the opin- ions which I laid before the profession in 1845, in the first edition of my work on " Uterine Inflammation." My firm impression, indeed, is that Dr. Tyler Smith, and those who formerly defended, or now defend, similar ideas, very greatly exaggerate the part that syphilis, primary or secondary, plays in the production of inflammatory lesions of the neck of the uterus. Their view of the subject appears to be the natural re- sult of a transition state of opinion. First, inflammatory lesions of the uterine neck are ignored or denied. Second, it being no longer possi- ble to deny their existence, they are considered to be often syphilitic. Third, their inflammatory nature is recognized as the rule, and their syphilitic nature is taught to be an occasional but rare occurrence. May I be allowed to add, that I have a strong conviction, that when the pathologists who now see syphilis everywhere have had as much ex- perience of local uterine disease as I have had, their ideas will undergo considerable modification. The opinions which I hold on this subject have not been adopted without considerable study, experience, and research. In the year 1840, I became attached as interne (house-surgeon) to the Hopital St. Louis, the celebrated Parisian Skin Hospital, to which are sent most of the cases of secondary syphilis that apply for admission to the Bureau Central. I was then told by several of the medical officers that ulcera- tive affections of the neck of the uterus were very common amongst these patients, and that they were considered to be mostly of a secondary syphilitic character. I remained at this hospital two years, and during nearly the entire time I had under my charge several wards of women suffering under secondary cutaneous syphilis. I invariably examined the state of the uterine organs, and found, as I had been told, that ulcerative lesions of the uterine neck were of very common occurrence. At first, I was 4 12 THE SYPHILIS THEORY. quite prepared to accept their secondary nature ; indeed, I may say that the bias in my mind was such as would have naturally led me to thi> conclusion. But before I came to St. Louis I had had much experience of uterine disease in non-syphilitic hospitals, and especially at La Pitie, where vast numbers of females are received who have recently left the Maternite, the largest lying-in hospital in Paris, and in whom the ute- rine lesions are undeniably of an inflammatory nature. Thus fore- warned, I was at once struck by the similarity between the ulcerative states I saw amongst the syphilitic patients at St. Louis and the ulcera- tive states I had seen amongst the non-syphilitic patients atLa Pitie. This induced me to question the secondary nature of the uterine disease in the former, and to investigate narrowly the entire subject. The researches which I then commenced were carried on throughout my lengthened residence in this hospital, and soon showed me that not only the morbid characters presented by the ulcerations were, generally speaking, quite different from those which are observed in the throat in secondary syphilitic disease, but that they did not yield to anti-syphili- tic treatment, like the secondary cutaneous and throat affections. If the uterine ulceration was left untouched, and the patient was only treated anti-syphilitically, the syphilitic cutaneous eruption got well, as also the throat, when the latter was affected; but the uterine disease generally remained the same. Thus it became evident to me that in the majority of cases the ulcerative conditions observed were not the result of syphilis ; that they were, on the contrary, generally speaking, mere inflammatory lesions, the existence of which was in a great mea- sure to be accounted for by the abandoned life most of the patients had led previous to their entrance into the hospital. These views will be found explained at length in the chapter on Syphilis, in my work on " Uterine Inflammation." If chronic inflammatory and ulcerative conditions of the uterine neck are, generally speaking, non-syphilitic, even in those who are actually suffering from secondary syphilis, they are, a fortiori, still more likely to be non-syphilitic in women who are to all appearance free from any syphilitic taint; and such I believe to be the case. During the last sixteen years, I have constantly kept this question in view when analyz- ing the nature and cause of uterine disease, and the result has been the confirmation of the opinions arrived at when at St. Louis. I occasion- ally meet with inflammatory and ulcerative disease of the cervix, which presents all the characteristics of secondary throat syphilis, but it is all but invariably in women who present other evidences of confirmed constitutional syphilis—cutaneous eruptions, throat and nasal mucous membrane disease, &c. As to secondary syphilis localized in the uterus alone, I am as much as ever convinced that it is extremely rare and that consequently it is an error in pathology, to attribute to it any but a very minute proportion of the cases of uterine cervical disease met with in practice. In expressing this opinion, it must be understood that I speak of syphilis proper, and not of gonorrhoea. I believe in the totally distinct nature of these diseases, and in the impossibility of simple gonorrhoea giving rise to secondary syphilitic symptoms. Gonor- rhoea itself, in its chronic neglected form, I consider to be a frequent THE OVARIAN THEORY. 43 although often non-recognizable cause of chronic inflammatory disease of the uterine neck—ulcerative and non-ulcerative, especially in the lower classes. THE OVARIAN THEORY. What may be termed the Ovarian Theory of Uterine Pathology has evidently originated in physiological prepossessions. It may be traced to the great progress made during the last twenty years, in the physio- logy of the female organs of generation. The discovery of the fact that menstruation, and all the healthy phenomena connected with it, arc completely subordinate to the existence, and monthly maturation of ova in the ovaries, has led to the idea that morbid menstrual conditions must be also subordinate, in the great majority of cases, to morbid ova- rian conditions, and principally to subacute ovaritis. This mode of reasoning, perfectly logical in theory, is apparently substantiated in practice by the clinical fact that, in cases of morbid menstruation, com- plicating uterine ailment—and, indeed, even in cases of uterine ailment without morbid menstruation, there is, all but constantly, tenderness, pain, and fulness in the ovarian regions, and principally in the left. When the patients who present these ovarian symptoms are instru- mentally examined, the ovarian pain and tenderness, the morbid men- strual states, and the constitutional disturbance, are all but invariably found complicated by the inflammatory uterine lesions so often described; but the latter, in the "ovarian theory," are considered to be generally the result of secondary uterine irritation, to be sympathetic of ovarian disease. Nothing can be more lucid, more apparently logical than this theory. The sequence in the reasoning appears perfect: subacute ovarian inflammation, as demonstrated by pain and tenderness in the ovarian region; disturbance in the menstrual functions, with sympathetic inflam- matory lesions of the uterus; and lastly, constitutional sympathetic reactions. Unfortunately, the ovarian theory does not bear the test of expe- rience. If the ovarian pain and tenderness are symptomatic of suba- cute ovaritis, and the subacute ovaritis is the cause, through sympathetic reaction, of all the uterine and general disturbance, it follows as a neces- sary consequence that, by treating the ovaritis, we ought to subdue, remove all the secondary disturbances and lesions, and general morbid reactions, and thus restore the patient to health. But, alas, this is not the case, in the very great majority of instances. We may blister, leech, and otherwise treat the supposed ovaritis indefinitely, without either permanently subduing the ovarian pains, or removing the uterine lesions and symptoms. If, on the contrary, ignoring entirely the ovarian symptoms, looking upon them as mere neuralgic sympathetic pains, we treat the uterine mischief only, we find that, in the very great majority of cases all is gradually restored to order. The menstrual and other uterine functions return to a normal state, the sympathetic general 44 THE OVARIAN THEORY. symptoms subside, and the ovarian pains and tenderness themselves permanently disappear. Thus does experience prove the fallacy of an apparently rational theory. Thus does it show that the disease is really uterine, and that the ovarian pains, tenderness, and fulness must, generally, be con- sidered merely sympathetic, and not necessarily indicative of ovarian disease. I have said necessarily, because, in some exceptional cases, these very symptoms really do indicate morbid ovarian conditions, the result of subacute or chronic inflammatory disease. In these exceptional cases, either there are no uterine lesions, or if there are such lesions, the ovarian and morbid menstrual symptoms persist after their entire removal. Often, also, in these cases, the ovaries, one or both, are very perceptibly enlarged to the touch. It must be remembered likewise, that the two conditions, chronic inflammation of the ovaries and of the uterus, may co-exist, and may give way to the same means of treat- ment. We must not, however, forget that, as I stated in a former chapter, a key to this apparent discrepancy between physiology and pathology is to be found in the anatomy of the female generative organs. The uterus has a mucous membrane, the ovary has none. Thus the uterus is predestined, by its anatomical structure, by the laws of general pathology, to be very much more frequently the seat of inflammatory disease than the ovaries, which are purely parenchymatous. Thence it is that, in practice, we find the ovaries so much more frequently manifesting sympathetic disturbance, owing to the reaction of uterine disease, than we find the uterus manifesting sympathetic disturbance owing to the reaction of ovarian disease. It will be seen by what precedes, that I fully and entirely admit the physiological and pathological consensus between the ovaries and the uterus—consensus which makes it all but impossible for the one to be diseased without the other suffering more or less sympathetically. But it will also be seen that I consider clinical experience undeniably proves that, in the immense majority of cases of uterine ailment, the uterus, and not the ovaries, is the actual seat of disease. The uterus is not a mere receptacle, a mere bladder, as has been asserted. Hippocrates was much nearer the truth when he called the uterus " animal in ani- mali." To me, as to the older writers, its influence over the female organization, in health and in disease, is a constant source of wonder and admiration. In health, it is the womb that stamps on woman her peculiar impress—that makes her what she is sexually and even indi- vidually. In disease, there are scarcely any limits to the morbid influ- ences over body and mind which it is capable of producing. The frequency, in post-mortem examinations, of morbid ovarian states, thickening, induration, cystic development, &c, in persons who have died from other diseases, does not invalidate the above facts. It merely proves what may be recognized during life, that chronic in- flammatory and other changes may occur in the ovaries__as in other parenchymatous organs—without giving rise to symptoms of any very marked character. Moreover, as the ovaries are two in number even HISTORICAL CONSIDERATIONS. 45 when one is obliterated, as it were, by morbid changes, if the other remains healthy, and ova are regularly matured in its structure, all the phenomena of normal menstruation may take place under its single influence. This we frequently see in the early stages of ovarian cystic disease. I think, therefore, that I am quite warranted in saying, that the morbi'd ovarian changes discovered after death cannot be the origin and cause of the ovarian pains which so frequently accompany uterine ailment and uterine lesions, for in that case the latter would not so constantly disappear on the removal of the uterine lesions, and so con- stantly persist, whatever the amount and duration of merely ovarian treatment. The part which the ovaries play in uterine pathology has been ably described by my friend Dr. Tilt, in his work on " The Diseases of Females and on Ovarian Inflammation." Dr. Tilt authorizes me here to state "that whatever maybe exaggerations of those who have adopt- ed his views, he himself repudiates all exaggeration ; that he views as I do the majority of cases which occur in practice; that he treats them as I do; and that he only admits subacute ovaritis as the sole disease or as a complication of uterine affections, in a limited number of in- stances." CHAPTER V. THE DISPLACEMENT THEORY. HISTORICAL CONSIDERATIONS. By the expression Displacement Theory, I refer to the opinion held by those practitioners who consider that the displacements of the uterus so frequently recognized in females presenting symptoms of uterine disturbance and suffering, are the principal and often the sole cause of these conditions. The questions raised by the consideration of these opinions are by far the most difficult to solve of all that I have had to examine in the course of this review, and have now for many years exercised the minds of the most eminent uterine pathologists, both in this country and in France. In the latter country, the pathological im- portance and the treatment of uterine displacements was discussed for three consecutive months, during the year 1854, at the Acaddmie de Mddecine, and most of the more eminent Paris uterine pathologists took a part in the debate. It would indeed be vanity for me to pretend to accomplish what they failed to do—to clear up the obscurity which surrounds this vexata qusestio, entirely to solve its difficulties, and such a pretension is far from me. Without aspiring, however, to so much, I hope to be able, by appealing this time to my own personal expe- rience, to contribute to the defence of the doctrines which observation has led me to adopt, from the vigorous attacks which they have had to sustain. 46 THE DISPLACEMENT THEORY. The existence of uterine displacements, other than prolapsus, has long been noticed by writers on the Diseases of Females, but the atten- tion of the profession does not appear to have been more than casually directed to them, until Recamier, by his minute researches into uterine pathology, roused a new spirit of inquiry amongst bis countrymen. It would appear, from the recent discussion at the Paris Academy, that as far back as 1826, thirty years ago, M. Amussat, impelled to investi- gation by M. Rdcamier's example, recognized the clinical fact, that falling or prolapsus of the uterus is not the only displacement to which that organ is liable; and that displacements, forwards and backwards, anteversion and retroversion, are also very common. M. Amussat made in that year many attempts to replace the uterus, and to keep it re- placed by mechanical means. He states that he invented and tried various kinds both of extra-uterine and of intra-uterine sounds, and pessaries, specimens of which he presented to the Academy at the late debate. His researches in the direction of intra-uterine support were arrested, however, by the death of a young lady, suffering from ante- version, into whose uterus he had introduced an ivory stem pessary, with the view of permanently straightening it. She went home, was attacked with inflammation, and died "promptly." Discouraged by this sad event, M. Amussat ceased to make any effort to straighten the uterus by mechanical agents applied to the inte- rior of the organ, and directed his attention merely to cervical and vaginal means of treatment and support. A few years later, M. Velpeau commenced a series of experiments with the same view, that of straightening the womb mechanically, through the agency of intra-uterine sounds. He invented a metallic spring stem, which he first introduced curved into the uterus through a gum-elastic canula, and then straightened by touching the spring. Finding, however, that although the intra-uterine sound temporarily restored the uterus to its natural direction, its presence occasioned severe accidents, M. Velpeau likewise discarded its use, and, from that time forward, principally relied on bandages of various kind, and especially on abdominal bandages. My own personal knowledge of Parisian uterine opinions and prac- tice dates from the year 1836, in the early part of which I joined the medical schools of that city. During nearly eight years that I remained there, I was, without interruption, connected with the hospitals as pupil, dresser, clinical clerk, house-surgeon, or house-physician, and thus became acquainted with the views and practice of most of the surgeons and accoucheurs who have taken part in the recent debate • for it is worthy of passing remark, that surgeons and accoucheurs only spoke on the subject under discussion, not a single physician having joined in it. I was, from the first, thrown in contact with M. Velpeau^ to see whom I had visited Paris, and who, then and since, has ever shown himself to me the kindest of teachers and friends. I can thus bear testimony to the fact, that he was, at that epoch, constantly lec- turing on anteversion and retroversion. Indeed, during the year 1838 when I officiated under him at la Charite, as dresser and clinical clerk' I took down many cases of this description, in his female wards. At HISTORICAL CONSIDERATIONS. 47 that time he was not using, for treatment, any mechanical means of support, but depended on rest, general treatment, and the use of bandages. The speculum was also but seldom resorted to, and inflam- matory lesions were but little talked of. He was clearly then, even more than now, under the influence of the mechanical views of uterine pathology—that is, he then attributed, as he still does, principal im- portance to displacements of the uterus. He thought that they often existed independently of inflammatory action, as a cause, and con- sidered them to be the main origin of the uterine suffering which so often accompanies them. I was the more struck with these views, as at the same time I had become acquainted with the doctrines and practice of Lisfranc and Gen- drin at la Pitie. These practitioners both used the speculum constantly, considered the lesions, which it brought to light, as of primary -im- portance, and the displacements—deviations they are called in Paris— which accompany them as secondary phenomena; generally speaking, the result of inflammatory engorgement or enlargement. Since then, in Paris, uterine pathology has obeyed these two direc- tions. Some have followed Amussat and Velpeau, and inclined to what I have called the " displacement theory"—that is, to the inter- pretation of uterine suffering by uterine displacement; whilst others, on the contrary, following Recamier, Lisfranc, and Gendrin, have inclined to the inflammation theory. I need not tell my readers that I myself belong completely to this latter school. The more I have studied and observed, the more convinced have I become that the true key to by far the largest part of the field of uterine pathology is to be found in the accurate knowledge of inflammation in the different tissues and regions of the uterus. Although uterine pathologists have been thus, in Paris, separated, as it were, theoretically, into two schools, I may say that the actual treat- ment of uterine disease has not so essentially differed as might have been expected until the recent researches and publications of our coun- tryman, Dr. Simpson, became known. All, or nearly all, admitted the frequent existence of inflammatory lesions, and taught that they ought, once recognized, to be treated and removed. Only those who con- sidered these lesions the "fons et origo mali" were satisfied that they had done all that was necessary for the local treatment of their patients when they had removed them; whereas those who thought the displace- ments of the uterus the principal mischief, and the inflammatory lesions mere epiphenomena, often overlooked their presence, and trusted from the first to pessaries, bandages, &c. In the late discussion at the Academy of Medicine, these two schools were very fairly reproduced. Singularly enough, the surgeons repre- sented by Velpeau, Amussat, Malgaigne, Huguier, &c, principally took the displacement view of the subject. Whereas the inflammation view was supported by the physician-accoucheurs, Paul Dubois, Depaul, and Cazeau. This fact, which struck me at once on reading the report of the discussion, renders it all the more difficult for an impartial observer to judge between conflicting opinions, as it shows the existence of a mental bias, corresponding with the general tenor of studies and of 48 THE DISPLACEMENT THEORY. professional preoccupation. Is it not possible, however, that practi- tioners, whose pursuits, like those of accoucheurs, are not purely either medical or surgical, and whose position in the healing art is, conse- quent! v, a double one, may be the best qualified to judge a question which evidently lies on the frontier ground between medicine and sur- gery? . <, In Great Britian, displacements of the uterus, with the exception ot prolapsus, were but little thought of until the publication of Dr. Simp- son's paper on the Uterine Sound, in 1843, and more especially that of his essay on Retroversion of the Unimpregnated Uterus, in the Dublin Quarterly Journal for May, 1848. In this latter able and lucid me- moir, Dr. Simpson described at length retroflexion and retroversion of the uterus. Finding the replacement of the retroverted uterus by means of the uterine sound totally inefficient, he proposed for their treatment his fixed stem pessary. This pessary comprises, as every one knows, three parts; the stem two inches and one-third long, which occupies the cervical canal, and enters the uterus terminating in a bulb, on which the cervix rests ; and the vaginal and external parts, by means of which it is fixed on the pubis. It thus mechanically straight- ens the uterus, and maintains it all but immovable. In his essay, Dr. Simpson merely alludes to anteversion, on which French pathologists lay great stress, and he does not speak of lateral displacements, or latero-versions. He enters, however, at length into the pathology of retroversion, and ascribes to it most of the symptoms of uterine disturb- ance and suffering which I and others ascribe to inflammatory lesions. The intra-uterine mode of treatment is also brought forward by Dr. Simpson, in the essay in question, as one which he had tried for some time, found free from risk or danger, and pre-eminently successful. The intra-uterine, or stem pessary, thus revived—simplified and im- proved no doubt, and guaranteed as a safe and efficacious agent by a pathologist of great weight and authority—was received with favor, both in this country and abroad, by the followers of the mechanical or displacement school. To them, the deviations of the uterus were still the principal cause of uterine suffering, and yet they were miserably deficient in means of treatment. M. Amussat was reduced to propose to establish adhesion between the posterior surface of the cervix uteri and the vagina by means of potassa fusa! M. Velpeau seemed to rely on abdominal and other bandages; M. Hervey de Chegoin and others, on vaginal pessaries of various forms and materials: and all to little or no purpose, for the displacements were obstinate, and the womb would not be replaced or straightened by such means. This favor was greater even in Paris than in England, owing to the greater hold that these doctrines had over the medical mind. The late M. Valleix, like myself an old pupil of M. Velpeau, more especially distinguished himself by his ardent and uncompromising advocacy of the displacement theory, and of the treatment of uterine displacements by the use of the intra- uterine stem pessary. It would be vain to attempt to reproduce the various arguments that have been adduced on both sides, at home and abroad; it would take a volume. I shall, therefore, confine myself to recording my own opin- ANATOMICAL AND PHYSIOLOGICAL FACTS. 49 ions, and the data on which they are founded. Seven years' additional personal experience, and an attentive study of all that has been done and said during that time, have only confirmed the views which I advanced in the second edition of my work on "Uterine Inflammation," in 1849. I then said, and still believe, that the displacement theory, as an explanation of the morbid uterine and general symptoms of those who present uterine displacements, is an error. I also stated that most (not all) of these uterine displacements had their origin in modifications of volume, the result of inflammatory lesions, directly or indirectly; and that the rational treatment of these displacements consisted in the treatment of the inflammatory lesions which produce them. I have myself had little experience of the fixed intra-uterine stem pessary: firstly, because, holding the above views, I did not often see its applicability, or the necessity for its use; and secondly, because I was afraid of it, for reasons which I shall give hereafter. The expe- rience of others, however, now obliges me to say that its use is attended with considerable risk and danger. Although Dr. Simpson has himself, I believe, had no fatal accident in his practice, several fatal cases have occurred in England ; and in Paris seven deaths from the use of the intra-uterine pessary have been published; the one of M. Amussat, which occurred in 1826, and six recent cases. Of the latter, three have taken place in the practice of M. Valleix—two from acute peritonitis, ana" one from secondary pelvic abscess; one in that of M. Nedaton; one in that of M. Maisonneuve; and one in that of M. Aran. The three last were also cases of acute peritonitis. The discussion, at the Aca- demy of Medicine, on uterine displacements, and on their treatment by the intra-uterine pessary, originated in the communication, to the Academy, of two of these fatal cases. I shall now take into consideration the facts which have led me, indi- vidually, to repudiate the doctrine of uterine displacement as the prin- cipal cause of uterine suffering, and which have prevented my resorting, unless in exceptional cases, to mechanical means for the treatment of these displacements. ANATOMICAL AND PHYSIOLOGICAL FACTS, BEARING ON DISPLACEMENT OF THE UTERUS. In order to appreciate correctly the intricate question of uterine dis- placements, there are various facts, anatomical and physiological, which should be known and borne in mind. The principal anatomical feature to which I would draw attention is, the extreme mobility of the healthy unimpregnated uterus. This extreme mobility may be proved experimentally. If the index finger is passed into the vagina—the patient lying on her back, the pelvis elevated, and the knees flexed—and if pressure is made on the cervix with the finger, it will be found that the healthy uterus yields with the greatest readiness to the slightest impulsion. It affords so little resist- ance to the finger that, if the bladder and rectum are empty, it may be either raised directly upwards, towards the upper pelvic outlet, or 50 THE DISPLACEMENT THEORY. depressed posteriorly, anteriorly, or laterally, and that with the great- est ease, and without the patient experiencing even discomfort. The anatomical explanation of this great freedom of motion of the healthy uterus is to be found in the smallness of its size, and in the laxity of its connections with the pelvic organs and cavity. In the female who has not borne children, the uterus only weighs an ounce or an ounce and a half; even in the one who has borne children, it does not weigh more than two ounces in the healthy state. This smallness in size of the uterus is evidently a provision of nature. A. small, light organ could be supported and kept in situ without the necessity of strong, unyielding bands or ligaments; whereas such means of support and retention would have been indispensable, had the uterus been large and heavy, and at the same time would have been quite incompatible with the changes which it is destined to undergo in pregnancy. On examining minutely the means of support which the uterus pre- sents, we find that they are very slight. The lateral ligaments are not so much means of sustentation as peritoneal folds, enveloping the uterine appendages—the ovaries, Fallopian tubes, and round ligaments. The latter, by their passage through the inguinal canal, and their firm cuta- neous attachment, are really means of sustentation; but the support which they give to the uterus is very much like that given to a swing by the two ropes which suspend it, and which allow great freedom of motion in every sense. The insertion of the vagina on the neck of the uterus, and the closure of the vaginal canal on the lower extremity of the cervical cone, evidently constitute another important means of sus- tentation. It is at the insertion of the vagina on the neck of the uterus that the neck, or lower segment of the uterus passes out of the pelvic cavity through the inferior pelvic fascia, which probably assists the vagina to support it. The connection between the fundus of the bladder and the neck of the uterus also contributes, no doubt, to fix the uterus in its normal state; as does the pressure of the surrounding organs, the pelvic cavity being full, and more or less closely packed during life. If the walls of the abdomen are removed, and the uterus is examined in situ, it will be found that the uterus and the lateral ligaments extend across the pelvic cavity, and divide it into two sub-cavities ; one smaller —the anterior, which contains the bladder; the other larger—the pos- terior, which contains the rectum. The uterus and the bladder are generally in juxtaposition; but the uterus and rectum, especially when the latter is empty, are separated by portions of the small intestines, which fill up the pelvic cavity, and form a posterior support to the uterus. The healthy uterus, in its normal condition and position, is generally, I believe, if not always, slightly inclined forwards, that is, slightly ante- flexed. This fact is not mentioned by anatomists; but if true as I believe it to be, is of importance, from its direct bearing on the patho- logy of one of the forms of uterine displacement—anteflexion and ante- version. I became acquainted with the existence of this normal ante- flexion accidentally, a few years ago. Finding, as I have elsewhere stated, that the vital contraction of the os internum, during life, often opposes considerable resistence to the introduction of the sound into the ANATOMICAL AND PHYSIOLOGICAL FACTS. 51 uterus, I tried small wax or gum-elastic bougies, which generally pass with comparative ease. If these bougies are left a minute or two in the uterine cavity, the uterus being perfectly healthy and normal in size, on withdrawal they invariably present a slight anterior curve, as in the accompanying wood-cut. The degree of the curve varies, as in the engraving, which represents two bougies that had been allowed to remain a couple of minutes in the uteri of two young sterile patients, perfectly free from uterine disease. One I had treated successfully, by dilatation, for dysmenorrhcea, the result of congenital narrowness of the cervical canal; the other I had treated for an inflammatory affection of the neck of the womb, and she had quite lost all morbid symptoms. Every precaution was taken to insure correctness; the bougies being introduced by means of the speculum. This slight curve I find so constantly as I describe and portray it, in the healthy uterus, that I cannot but consider it to be a natural one. Its existence, moreover, is corroborated by the researches of M. Boul- lard, a young Paris surgeon, Prosector to the Faculty, who, after numerous and extended cadaveric investigations, has arrived at the same conclusion. Thus, his researches tend to establish by the examination of the dead, what mine tend to establish by the examination of the liv- ing, viz : the existence of a slight degree of anteflexion as a natural ana- tomical state. M. Boullard's statements were discussed, and partly substantiated, partly negatived, at the Academy of Medicine, but prin- cipally on data furnished by the digital examination of living patients. The least consideration, however, will show that such a slight curve as the one indicated in the wood-cut above can be scarcely appreciable to the touch, although pathologically very important, as a predisposing cause of morbid anteversion. The axis of the unimpregnated healthy uterus is generally considered to be that of the upper pelvic outlet; but if the slight anterior curva- ture which I describe is recognized, we must admit that the axis of the upper portion of the uterus only, corresponds to the upper pelvic outlet, whereas that of the lower portion or neck would partly correspond to that of the lower pelvic outlet. M. Cruveilhier says that the uterus has " no axis"—meaning thereby that its changes of position are so variable and constant that it can scarcely be said, anatomically speak- ing, to have any normal axis. In speaking of the axis and normal position of the uterus, it is neces- sary to call to mind the fact that congenital modifications of form and axis are occasionally found. The uterus may be anteflexed, retroflexed, 52 THE DISPLACEMENT THEORY. or lateroflexed as a congenital state, the inflexion varying from a scarcely perceptible degree to one in which the uterus is completely bent on itself, so that the cervix and body of the uterus correspond. Ihese congenital malformations were ably described by M. Huguier a tew years ago; and I have repeatedly met with illustrations of this form of deviation of the uterus from its normal standard. The position of the uterus, and consequently its axis, is often changed or modified, owing to a physiological cause—marriage—which acts independently of disease of any kind or description. This really phy- siological displacement is of such constant occurrence, that it ought to be taken seriously into consideration, and I am much surprised that none of the speakers at the French Academy mentioned it. Under the influence of congress, in a great number of women entirely free from any morbid uterine state, sterile or not, the cervix is thrown mecha- nically backwards, and the body of the uterus forwards, that is in ante- version. This is more especially the case when the vagina is short, or when the cervix is long from the vagina being inserted high up on the uterus, so as to expose in the vaginal cul-de-sac a considerable por- tion of the uterine neck. This frequent existence of deviation or dis- placement of the cervix backwards and of the uterus forwards, as a really post-marital physiological state, independently of any morbid uterine condition, or of any kind of pelvic change or influence, must be considered an important element in the appreciation of the pathological importance of anteversion of the uterus. Indeed, its non-recognition, in my opinion, renders to a great extent valueless the conclusions of many who have spoken and written on the subject. Owing to the laxity and freedom of the anatomical connections which I have above described, the uterus moves, as we have seen, with the greatest freedom in the pelvic cavity, readily adapting itself to the ever-varying positions which it is called upon to assume. Thus, if the bladder is full, it presses on the uterus and retroverts it, a fact which can easily be ascertained. If the rectum is loaded with feces, it dis- places the small intestines, presses on the uterus from behind, and ante- verts it. In walking and riding the uterus sways to and fro, more or less, according to the degree of tightness with which the pelvic viscera are packed, and according to the degree of support it receives. Both in walking and in standing it falls slightly; indeed, I much question whether, in every woman, however healthy, the uterus is not always lower when she retires to rest at night, than when she rises in the morn- ing. Moreover, in the married condition, it is constantly exposed to physiological displacements. The freedom of motion which its ligaments and modes of attachment allow to the uterus is, however, most forcibly illustrated by the change of position which occurs in pregnancy. After the first few months of pregnancy, the enlarged uterus ascends and leaves its former position and connections in the pelvic cavity, becoming for the time an abdomi- nal organ. To admit of this entire change of position, the lateral liga- ments unfold, and the round ligaments are elongated as the uterus in- creases in size. At the termination of the pregnancy, the uterus which in a primipara has increased from one ounce to thirty or forty ounces ANATOMICAL AND PHYSIOLOGICAL FACTS. 53 rapidly returns to all but its former size—to about two ounces—passing through a series of vital changes. This marvellous return to all but the original size and weight no doubt takes place, in order that the means of support which we have enumerated may again be sufficient to support the uterus, and to maintain it in situ. These changes, from small to large, and from large to small, moreover, are capable of being reproduced an indefinite number of times, during the period of ovarian activity. It is to this end that the uterus is made an organ apart from all others ; that it is endowed with vital powers which no other either requires or possesses. From what precedes—and the facts which I have advanced cannot be denied—it is evident that even the unimpregnated uterus, in health, is by no means destined to remain constantly in the same anatomical po- sition, to preserve constantly the same axis. It is also equally evident that the healthy uterus bears changes of position, and considerable pressure from surrounding organs, &c, without either pain, discomfort, or inconvenience. The explanation of this fact is to be found in a physiological law, which, although well known, appears to me to have been all but entirely lost sight of in the discussion of uterine displacements. All our organs, internal and external, when in a healthy state, are capable of bearing, without pain or inconvenience, considerable pressure, and any degree of displacement of which their means of fixity can admit. Thus, if a healthy person lies on the side—say the right side—the heart, the left lung, the stomach full of food, obey the laws of gravity, fall more or less, and press on the organs beneath them; and that, as I have said, without occasioning pain or inconvenience. Were any of these organs inflamed, however, the result would be far different: great pains would be experienced. Thence it is that patients suffering from inflammation of any thoracic or abdominal organ lie on the back, to avoid the pres- sure of the surrounding viscera on the diseased organ, pressure which it can no longer bear. It may be objected that physiological pressure, the result of change of position and of functional conditions, is essentially temporary, and that, were it permanent, it would not be so easily borne. Here, how- ever, general pathology comes to our assistance, and teaches us that non-inflammatory morbid growths and tumors, slowly developing themselves, may exercise considerable permanent pressure on the organs which surround them, in any part of the economy, without the super- vention of any symptoms of distress or inconvenience. This fact, which has not received the attention it deserves, I developed at con- siderable length in the third edition of my work ; and I shall conclude this rapid survey of the anatomy and physiology of the uterus, with reference to its mobility, by the following extract, page 405 :— " The impunity with which pressure may be exercised on viscera and organs by tumors, the growth of which is very gradual, may be ob- served in every part of the economy. Even the brain, the most sensitive of all to pressure, will bear it if very gradually applied. Thus, we often see exostosis and tubercular formations greatly compressing the cerebral substance without the supervention of any symptom until the 54 TnE DISPLACEMENT THEORY. growths have reached a considerable size, or until inflammation super- vene. It may, indeed, be considered an axiom in pathology, that all organs will largely accommodate themselves to pressure, provided such pressure be gradually applied, not carried to the extent of seriously interfering with their functions, and be unaccompanied by inflamma- tory action.....The history of fibrous growths (of the uterus) permits no room for doubt on this question. These growths almost invariably attain a considerable size, and deeply modify the position of the uterus, giving rise to retroversion, or anteversion, and exercising considerable pressure on the pelvic viscera, before they occasion any appreciable symptoms. In fact, my experience shows that patients thus suffering seldom complain at all, unless there be some concomitant inflammatory affection of the cervix or of its cavity, until either the external ap- pearance of the abdomen be modified by the size of the tumor, or until hemorrhage supervene. The first period of the existence of the tumor, and the displacement which it occasions, pass unperceived and unnoticed by the patient herself, and by her medical attendant." THE PATHOLOGY AND THERAPEUTICS OF DISPLACEMENTS OF THE UTERUS. In my preceding remarks I have drawn attention to the smallness of size and lightness of weight of the uterus; to the great laxity of its means of support and fixity; to the extreme mobility which it conse- quently evinces ; to the ease with which it obeys the many physiological causes of displacement to which it is subjected; and to the complete immunity from pain, or even inconvenience, with which these displace- ments are borne. I have explained the immunity from pain evinced by the uterus when displaced under the influence of physiological causes, by referring to the law through which all our viscera bear, without inconvenience, any amount of displacement compatible with their means of fixity, and any amount of pressure to which they can be exposed from the proximity and functional activity of surrounding organs. I have pointed out that this capability of our organs to bear considerable pressure without incon- venience is not only observed in the temporary physiological conditions described, but is also found to exist under the permanent pathological pressure of non-inflammatory morbid growths, such as tumors, aneur- isms, &c. I have laid stress on the very important fact, that when once inflammation supervenes, this immunity from pain and inconvenience on pressure ceases ; as evidenced by the inability of patients suffering from inflammation of the abdominal or thoracic viscera to lie otherwise than on their back: or as evidenced by the pain which is experienced on the pressure of an inflamed finger. Finally, I have recalled the rapidity with which the uterus increases in size and weight under the influence of the physiological stimulus of pregnancy, and reverts to its natural size and weight when that stimulus is removed. This brief recapitula- tion is necessary, as in the above facts is found the key to the history of uterine displacements or deviations, as I have interpreted them. PATHOLOGY AND THERAPEUTICS. 55 The uterus may be displaced or deviated in various ways. Its posi- tion and form may be modified with reference to its own axis, or with reference to its conventional anatomical pelvic axis, which corres- ponds, as we have seen, to that of the upper pelvic outlet. When the axis of the uterus itself is modified, the uterus is said to be flexed, ante- riorly, posteriorly, or laterally; and we have thus antero-flexion, retro- flexion, and latero-flexion. When the uterus is displaced in toto, with- out any abnormal bend or flexion taking place, so that its axis is changed with reference to that of the upper pelvic outlet, it is said to be antero- verted, retro-vcrted, or latero-verted. Practically, these two forms of uterine displacement are so often met with in the same uterus, and are often so evidently stages, degrees, of the same morbid state, that Dr. Simpson has merged them into one, and only recognizes, practically, three forms of uterine displacement— antero-version, retro-version, and latero-version. Theoretically, how- ever, we must accept the two ; for if these displacements really do exer- cise an important influence in the production of morbid uterine and general symptoms, the modus operandi in both, or at least in the more simple cases of both, must be quite different. In simple flexion, unac- companied by uterine enlargement, the pressure is merely intra-uterine —is only felt, in an appreciable degree, by the walls, vessels, and nerves of the bent uterus. In actual displacement of the uterus in mass, the uterine structures themselves remain as they are ; the pressure is on the surrounding organs, and the strain is extra-uterine ; on the liga- ments and extra-uterine vessels and nerves. Simple or combined, these morbid conditions of uterine position—to which we must add prolapsus, more or less complete, of the entire organ—are generally found to c'o-exist with the uterine suffering or ail- ment to which I have so repeatedly alluded, and with the inflammatory lesions which so usually accompany it. The extreme partisans of "The Displacement Theory" attribute to the existence of these displacements primary importance, and think that, in the majority of cases, they are the real cause of the mischief existing; that they constitute the morbid condition which principally requires treatment. In their eyes the co- existing inflammatory lesions, the ulcerations, hypertrophies, and indu- rations, are, in many, if not in the majority of cases, epiphenomena, either occasioned by the displacement, or merely complicating it. The reasons which have led me to the conclusion that these views are erroneous, that the displacement is, on the contrary, in most in- stances, really the epiphenomenon, and that it does not require, gene- rally speaking, actual treatment of any kind, may be divided into physiological, pathological, and therapeutical. Physiologically, we have seen that the uterus bears pressure and displacement, when perfectly healthy, without pain or inconvenience. We have seen also, that in the married state the neck of the uterus is very frequently mechanically retroverted ; thrust on the rectum, into the* sacral cavity—the body of the uterus being, at the same time, ante- verted—and yet that all goes on normally, without either distress or discomfort being experienced. We have seen that slight anteflexion, or anteversion, is probably a natural condition during life, and that 56 THE DISPLACEMENT THEORY. very decided flexions of the uterus may exist congenitally, or be pro- duced by accidental causes, such as violent efforts, habitual rectal con- stipation, or even menstruation, and remain for a time or for life, with- out producing any morbid symptoms. Such being the case, on what reasonable grounds can we be called upon to attribute to a slight flexion or to a slight displacement of the uterus the symptoms of uterine suf- fering presented by a female in whom one or the other co-exists with inflammatory lesions ? Is it sound logic—is it rational, so to do ? Is it not much more consistent with physiological observation and com- mon sense to attribute the uterine and general disturbance to the inflam- mation, and to consider the displacement as the epiphenomenon—as the secondary, comparatively unimportant, element? And if this reasoning applies to slight displacements, does it not also apply, by extension, although in a minor degree, to the more decided uterine dis- placements when connected with inflammatory lesions ? Pathologically, there are many valid reasons for considering moderate displacement of the uterus a phenomenon of secondary, and not of pri- mary, importance, in the cases of uterine suffering in which it is ob- served. The inflamed uterus, instead of bearing, without inconvenience, as the healthy uterus does, pressure and displacement, often becomes extremely tender, and, like the inflamed finger, suffers not only from pressure, but from mere contact. Thus, even when there is no devia- tion or displacement of any kind, we frequently find that females who are laboring under slight uterine inflammation, complain greatly of weight, heaviness, and bearing-down, and are unable to stand or walk with ease. The mere physiological weight of the inflamed uterus or cervix uteri, its mere contact with, and pressure against, the surround- ing organs when in the erect position, becomes all but unbearable, and the recumbent position is sought with eagerness. Why, therefore, should we attribute uterine suffering to displacement only, or even prin- cipally, if, on the one hand, we constantly find all the symptoms, local, functional, and general, that characterize such suffering existing in cases where there are inflammatory lesions only, without either devia- tion or displacement; whilst, on the other hand, mere displacement unattended with inflammatory disease fails to produce these symptoms ? This train of reasoning becomes the more cogent when we consider that—setting aside the physiological and accidental displacements to which I have alluded—uterine displacements are generally the imme- diate result of enlargement of the uterus or of its cervix, and that en- largement of the uterus is generally the result, direct or indirect, of inflammation. Both these propositions have been contested, and yet it appears to me that they admit of easy demonstration. We have seen that the uterus is physiologically endowed with a vital property that no other organ possesses. Under the influence of its normal stimulus, a fecundated ovum, it increases to twenty or thirty times its usual weight in the course of nine months; and once freed of the ovum it rapidly diminishes, so as to return in a few weeks to its natural size. This property is capable of being roused by other than physiological stimuli. Almost any morbid stimulus is followed by the same vital result. Thus all kinds of morbid growth, which originate in the sub- PATHOLOGY AND THERAPEUTICS. 57 stance of the uterus, are attended with the development and aggran- dizement of the uterine structures. Inflammation of the uterus also, wherever situated, is usually attended with enlargement, as in other organs, but more readily than in other organs. If the inflammation is general, the entire uterus enlarges; if it is local, the part affected in- creases, either alone or principally. This form of uterine enlargement is the direct result of inflammation acting on tissues vitally prone to develop themselves. There is, how- ever, another form of uterine enlargement, indirectly the result of inflam- mation, which is of great importance, and which does not appear to me to have received the attention that it deserves—viz: enlargement from the premature arrest of the absorption or transformation process, which physiologically reduces the uterus to its normal size after parturition. This pathological arrest frequently occurs as a result of metritis, and, more frequently still, as the result of inflammatory lesions of the cervix uteri, existing before labor, or produced by contusions or lacerations during labor. Under the influence of uterine irritation thus induced, instead of diminishing—as it ought, until it reaches a weight of two ounces—the uterus stops short at three, four, five, &c. When the arrest is connected with actual metritis, the enlarged uterus is sensitive to pressure, and all the symptoms of chronic metritis are present. When, on the other hand, it is the mere indirect result of cervical disease, the uterus is in a passive state of enlargement only, and is neither sensitive nor painful on pressure. As the uterine cavity enlarges along with the walls when the uterus is generally enlarged, we have in the uterine sound a valuable means of estimating, indeed of positively measuring, the size of the enlarged uterus. Should there be any difficulty in passing the sound, a. small wax bougie may be used, as I have stated, and if left a couple of minutes will give a model of any incurvation that may exist. The means of sustentation which the uterus possesses are adapted, as we have seen, to support an organ one or two ounces in weight only. If the uterus enlarges regularly, through the presence of a morbid growth in its cavity—a fibrous tumor, for instance—it may gradually rise out of the pelvis, as in pregnancy ; but when the enlargement and increase of weight are partial or concentric, and limited, the tendency is for the uterus to follow the laws of gravity, and to fall either back- wards in retroversion, or forwards in anteversion, or downwards in pro- lapsus. The direction which the uterus takes depends on various cir- cumstances. If the enlargement or increased weight is principally in the posterior wall of the uterus, as is often the case, or if the patient lies much in the recumbent position, the tendency is for the weighted uterine fundus to fall backwards in retroversion. If the anterior wall is the seat of enlargement, the uterus may fall forwards in anteversion. Anteversion also very frequently occurs as a direct result of the mecha- nical post-marital displacement backwards of the neck of the uterus, which I have described; especially when the cervix itself is hypertro- phied and indurated. The natural anteflexion which I have described is likewise, no doubt, a predisposing cause of this displacement. When the uterine enlargement is general, not very great, and the patient is 5 53 THE DISPLACEMENT THEORY. obliged to stand and walk much, the uterus falls directly, giving rise to prolapsus. Partial prolapsus is one of the commonest of all uterine displace- ments, and the study of the conditions under which it takes place throws considerable light on the displacements of the body of the uterus. Pro- lapsus of the uterus, as distinguished from anteversion and retroversion, is most frequently the result of the increase in size and weight of the lower or cervical segment of the organ. The cervix uteri becomes en- larged as a result of metritis, or of the arrest of post-partum absorption ; or, as is much more frequently the case, of local inflammatory disease of the cervical mucous membrane. Its weight being increased, it drags down the uterus, like a piece of lead affixed to the bottom of a cork floating in water would drag down the cork. This displacement is more especially prone to occur if the floor of the pelvis, the vagina, the vulva, and perineum, and the uterine ligaments generally, have been relaxed and over-distended by frequent parturition or from idiosyncrasy. When the cervical or vaginal mucous membranes, or both, are inflamed and tender, prolapsus is attended with considerable distress ; but when these conditions are absent, the cervix may be very low in the vagina without either pain or discomfort being experienced. This is a pathological illustration of the fact which we have already seen physiologically demonstrated—viz : that a considerable degree of uterine displacement, of any description, may exist without distress, provided there be the absence of inflammatory action. The latero-versions which are not occasioned by adhesions, the result of pelvic abscesses, peritonitis, &c, are, I believe, nearly always con- genital. In some women, the healthy normal uterus lies diagonally in the pelvis, the cervix being directed to the groin, and the fundus towards the ilium. This congenital deviation is generally observed from right to left—that is, the uterus lies so that the cervix is directed towards^the left groin. As I observed in my work, page 11, "This fact, which is not mentioned by anatomists, should be borne in mind, as ignorance of it may lead to error in the diagnosis of disease. Most of the lateral deviations of the uterus described by pathologists are merely exaggerations in a diseased and hypertrophied organ of this natural position or direction." M. Huguier, I may mention, attributes congenital latero-version to congenital shortness of one of the round ligaments. Therapeutically, the secondary nature and importance of uterine dis- placements, when not carried to an extreme degree, may be undeniably proved by the results of practical experience. For very many years I have completely ignored, as far as direct treatment is concerned, the existence of displacement in the numerous cases of uterine ailment which I have been called upon to treat. Looking upon the displace- ment as a mere congenital, physiological, or pathological concomitant of the inflammatory disease which I all but invariably find to exist when uterine suffering is present; or considering it to be the direct result of enlargement of the body or neck of the uterus, inflammatory or other, I have generally looked upon it as a mere symptom, and acted on this view. Thus, as a rule, I have thrown aside pessaries,' bandages PATHOLOGY AND THERAPEUTICS. 59 and all artificial or mechanical agencies for the sustentation or straight- ening of the prolapsed or deviated uterus; accepting these conditions, and the distress they may occasion, as symptoms not in themselves requiring any particular treatment beyond partial rest. My great aim has been to remove what I consider the cause of the pathological pro- lapsus, retroversion, or anteversion; be that cause relaxation or dis- ease of the vagina, congestion, induration and hypertrophy, or passive enlargement, either of the body or neck of the uterus. I find that when these morbid conditions can be thoroughly and completely removed by treatment, and when time has been allowed to Nature to restore the integrity and functional activity of the recently diseased organs, one of two things occurs—either the displacement ceases—the uterus ascending to its natural position if prolapsed, and returning to its normal intra-pelvic situation if retroverted or ante- verted, or it does not. In either case, however, in the immense majority of instances, the patient is perfectly freed from pain, or even discomfort, and ceases to complain of the symptoms of uterine suffering. When the uterus returns to its physiological position as a result of the removal of the morbid condition which produced the displacement, the subsidence of pain and discomfort is a fact which may be explained either by appealing to the displacement, or to the inflammatory lesions which accompanied it. This alternative, however, is no longer admis- sible when the displacement—prolapsus, anteversion, or retroversion— remains after the removal of the inflammatory lesions; all pain and discomfort at the same time disappearing; and this I am constantly witnessing. I speak within very reasonable limits when I say that scores and scores of my former patients, who had for years suffered from uterine ailments before they were treated by me, are now living like other people, perfectly free from inconvenience of any kind, walking, stand- ing, running, and going through all the ordinary ordeals of life, al- though the uterus has remained displaced. It has either remained lower than normal, or has kept in anteversion or retroversion, and in some to a considerable extent. These women are, however, otherwise sound, free from any inflammatory lesion, and the displacement con- sequently gives them no more trouble, than do the congenital and phy- siological displacements described above. Thus taught, thus enlightened by anatomical and physiological data, and by therapeutical experience, when women who are wearing band- ages, pessaries, &c, for displacements apply to me, I commence by re- moving them—temporarily, as I tell the patients. I then study mi- nutely the state of the uterine organs, and generally find a very tangible cause for this painful displacement in the shape of some of the diseased conditions which I have enumerated. These I make it my object to remove, at the same time carefully regulating the general health, treat- ing all local complications of bladder, bowels, &c, and enjoining partial rest and repose. I tell the patients to bear the annoyance and pain occasioned by the displacement as a temporary symptom of their dis- ease as they would bear the pain and discomfort of a sprained ankle or of a broken leg. All disease removed as far as possible, I ask for 60 THE DISPLACEMENT THEORY. time—for three, six, or twelve months passed at home under general hygienic and dietetic discipline, in order that Nature may be enabled to come to the patient's assistance, to fine down swelling, and to restore healthy tone and action. That period passed, if the displacement still persists and still proves a source of discomfort, I myself am re*(]y to sanction the return to the bandages and pessaries. Not one out of fifty, however, of my patients has ever occasion to resume these mechanical means of treatment when they have gone through the above ordeal. The necessity ceases with the diseased condition that occasioned it, and the bandages, abdominal and other, as also the pessaries, are all but in- variably thrown aside forever. In the preceding remarks I have purposely excepted severe cases of displacement. There are cases of prolapsus or procidentia uteri, in which all the means of sustentation which the uterus naturally presents have been so strained and weakened, and in which the vaginal outlet is so loose and open, that the uterus will fall when the patient is in the erect position, and no treatment can restore the healthy tone of the parts involved so as to admit of the uterus being retained in situ. When this is the case, like other practitioners, I resort to mechanical agencies, but principally to extra vulvar pressure and support. All intra-vaginal pessaries, in my experience, give rise to irritation, and are consequent^7 objectionable, and to be dispensed with, if possible. Com- plete procidentia uteri is principally observed in the lower classes, and is evidently the result, generally speaking, of their being up and about too soon after their confinements, when the uterus is much too heavy. Retroversion, when extreme, and attended with considerable non- reducible enlargement of the uterus, is also a most unmanageable form of ailment, and must likewise be excepted from the above remarks. It may remain as a serious morbid condition when all inflammatory dis- ease has been removed, blocking up the rectum, and occasioning con- siderable distress by pressure; as does retroversion in pregnancy when the displaced uterus has attained a certain size. The mention of this intractable morbid condition leads me back to the consideration of Dr. Simpson's fixed intra-uterine stem pessary. Holding, as I do, the views above enunciated, my readers will at once understand that I see no occasion whatever for the use, either of the stem pessary or of any other, in the more ordinary cases of retrover- sion and anteversion. Thinking, as I do, that these displacements are often met with as mere temporary results of removable morbid condi- tions; or that they are either physiological conditions, or non-important traces—remains of past pathological states, why should I torment my patients with mechanical remedies, the presence of which is often at- tended with suffering and accidents, and occasionally with dangerous, or even fatal, consequences? In the more severe forms of retroversion however, to which I have just alluded, I would gladly avail myself of the stem pessary, other means failing, had I any confidence in its effi- cacy, and were I convinced that its use was free from danger. I have seldom, however, resorted to it, because I think I have reason even from my own limited experience, to believe it to be inefficacious in such cases, the displacement returning as soon as it is removed; and because PATHOLOGY AND THERAPEUTICS. 61 the experience of others shows that it is a dangerous remedy ; especially, I should say, in this very class of cases, in which the strain on the intra-uterine extremity must be very great. This remark, however, it must be remembered, does not apply to the bulb-ended metallic dilators which Dr. Simpson has introduced and recommended for the dilatation of the cervical canal. I have very often used them, and believe them to be free from risk of any kind, if prudently and carefully employed. Not being fixed, and moving with the uterus as they do, there is no strain or pressure on the walls of the uterine cavities. I have always treated the uterine cavity with great respect, owing partly, no doubt, to a painful lesson which I received long ago, whilst house-surgeon to M. Jobert de Lamballe at the Hopital St. Louis. A fine young woman, twenty-six years of age, died under my charge from acute metro-peritonitis, the result of an injection into the uterine cavity. She was suffering from enlargement of the womb, and it was only discovered after death that the cause was the presence of a small fibrous tumor. The os internum being thereby opened, the injection pene- trated freely into the uterus, and caused the inflammation which rapidly destroyed her. When, also, I began to use the uterine sound, at Dr. Simpson's suggestion, I soon found that as long as it occupied only the cervical canal there was usually no pain ; but that as soon as it passed the os internum, and touched the uterine mucous membrane, there was always pain, sometimes faintness, and often a discharge of blood. These facts, combined with my theoretical and practical views, have contributed to make me very cautious in the experimental use of the fixed stem pessary. Nor do I regret that it has been so, seeing the fatal results which have recently attended the practice of the Paris surgeons. With their experience before me, and the knowledge that other fatal cases have occurred in England, I am inclined to think that I shall henceforth be even still less disposed than formerly to resort to the intra-uterine method of treating retroversion of the uterus. It is for- tunate, therefore, for me that the experience of many years has led me to the conclusions which I have embodied in the course of this Review, viz: — That uterine displacements, in the immense majority of cases, require no special treatment; that in those extreme cases of anteversion and retroversion in which it really would be desirable to straighten the uterus by mechanical means, the intra-uterine pessary, when borne, is of but little, if of any use, as the displacement usually returns as soon as it is extracted; and that in complete prolapsus vulvar bandages afford the support the easiest borne, and the most efficacious; combined occasionally with an abdominal bandage, with a view to take off intesti- nal pressure. 62 SUMMARY. CHAPTER VI. SUMMARY. THE DOUBLE MEDICO-CHIRURGICAL CHARACTER OF UTERINE PATHOLOGY. My aim in writing the review of the opinions and theories more or less current respecting uterine pathology, which I have now concluded, has been twofold. Firstly, I have wished to show that the frequent existence of inflammatory lesions of the uterine neck, ulcerative and other, which I, and those who preceded me in the surgical investioration of uterine diseases have announced, is a truth. That it really is a truth, an undeniable truth, I have proved, not by my own experience, or by that of the pathologists who agree with me, but by appealing to the observation and writings of practitioners who hold totally opposite opin- ions as to the pathological importance, and even as to the cause and nature of these lesions. Henceforth, this fact must be accepted as one established on an incontrovertible basis, and to question it will merely expose those who do so to the smile of the more enlightened members of the profession. Secondly, I have wished to show that the various theories which have been brought forward with a view to explain uterine ailment and uterine lesions, without referring to idiopathic uterine inflammation as, generally speaking, their direct cause, are untenable on scientific and practical grounds. This I have proved by demonstrat- ing that these theories are founded on the endeavor to give a general application to facts which, in reality, only admit of a very partial appli- cation. Thus, cases may, and do occur in which inflammatory lesions of the neck of the uterus, including ulceration, exist without presenting any pathological importance. In some women, the organic sensibility of the womb, and its sympathetic connection with the rest of the economy are so slight, that severe uterine disease, inflammatory or other, may exist for months or years, as in other organs, without producing either iriuch local discomfort or much general disturbance; but these are exceptional cases. To conclude, from them, that inflammatory lesions in this region are, as a general rule, of no pathological importance, is to state what is, on the one hand, contrary to experience, and, on the other contrary to the laws of general pathology, to which I have so often and so con fidently appealed in the course of this review. What would be thought of a pathologist who gravely asserted that ulceration of the eye the nose, the mouth, the throat, the larnyx, the stomach, the rectum' the anus, the vulva, &c, were of no pathological importance?__and if the are of importance, why should.the uterus, the sensitive centre of so SUMMARY. 63 many affinities and sympathetic reactions, be the solitary exception to a general pathological law ? Thus, leucorrhoea often exists as a mucous membrane and follicular hypersecretion, the result of physiological or pathological congestion, and may, in some rare cases, exercise a morbid reaction on health, and require treatment. But to consider this hypersecretion as the essential disease that generally produces the symptoms of uterine ailment, local and constitutional; and to look upon the recognized inflammatory lesions and reactions of uterine mucous membrane, which are so constantly found in cases of uterine ailment, as mere symptoms of this essential disease, is to ignore entirely the laws of general pathology. It is, indeed, to mingle together in inextricable confusion the cause, nature, symptoms, and sequelae of uterine disease. Thus, ovaritis exists both in the acute, subacute, and chronic forms; and when it is present reacts, of course, on the uterine functions, giv- ing rise to a regular sequence of symptoms; but to attribute to subacute ovaritis the cases in which tenderness, pain, and fulness of the ovarian region are found, and to look upon the coexisting uterine lesions and symptoms as merely sympathetic conditions, is simply a pathological error, the result of physiological prepossessions. It is giving to the ovaries, pathologically, the same pre-eminence in the female genital system that they really do exercise physiologically—a pre-eminence to which they have no real claim. Thus, primary and secondary syphilis are both observed in the neck of the womb, but their presence is, in reality, so rare, that even in the wards of a syphilitic hospital they are seldom observed, and they have very little to do with the uterine disease observed in town practice. Thus, displacements of the uterus are constantly met with; but ex- cept in extreme cases, they are, in reality, of secondary importance. They often exist in the healthy without being recognized or complained of; and they often remain after the removal of disease without distress or inconvenience being experienced. Whilst in those who suffer from the symptoms of uterine ailment, they generally coexist with decided inflammatory lesions ; their presence may be generally explained by these lesions; and they generally disappear by degrees, as the inflam- matory lesions are cured and removed. If I have succeeded in establishing the truth of these two proposi- tions, the correctness of the doctrines which I have so long and so strenuously defended, and which I briefly exposed in my second chap- ter, must be acknowledged ; and the inflammation theory, as it has been termed, must be accepted as the key to the greater part by far of the field of uterine pathology. My readers, however, are now in possession of the principal data, anatomical, physiological, and therapeutical, on which my own convictions are founded, and it remains for them to examine Nature herself, to use their own powers of observation and judgment, and thus to arrive at personal conclusions and opinions on the°subject. Most sincerely do I trust that the arguments which I have adduced may lead many who have hitherto been supine to throw off the trammels of preconceived opinions, to think and observe for themselves, and thus to assist in establishing on a firm basis a branch 64 SUMMARY. of medicine of such vital importance to the whole community. At present it is in a transition state, many conflicting opinions and doc- trines, as we have seen, dividing the medical mind. Such a state of things, however, is not destined to last. The sound common sense of the practical members of the medical profession will before very long discern the truth, winnow the grain from the chaff, and definitively settle these disputed questions, as it has settled many others. This, the future verdict of the profession may give the palm to the opinions which I defend, or it may possibly give it to those which I criticize or condemn. In the latter case, I should only be able to excuse my error by claiming to have conscientiously brought to the study of the subject all the powers of observation and reasoning which I possess. But if, on the contrary, as I hope and believe, the views I defend are eventu- ally triumphant, my great reward will be the knowledge that I shall have contributed, under difficulties of no ordinary kind, to the advance- ment of true science, and to the welfare of the human family. Before concluding, there is one fact which I am anxious to again bring forcibly before my readers ; and that is, the double, medico- chirurgical character of uterine pathology. If the views which I have developed are correct, confirmed uterine disease generally passes out of the domain of medicine into that of surgery, and requires surgical means of investigation and surgical means of treatment. The prac- titioner, therefore, who would successfully grapple with the difficulties of uterine pathology must, on the one hand, be thoroughly imbued with medical knowledge; and on the other, he must be well acquainted with the doctrines of surgery, and accustomed to its manipulations and ope- rations. The publication of this essay in the pages of The Lancet has given rise to a discussion which illustrates and substantiates this fact, and also shows what are some of the difficulties against which the ration- al therapeutics of uterine disease have to contend. It has been stated that to use the more powerful surgical agents which I recommend to modify morbid vitality in chronic, intractable, or suspicious forms of inflammatory and ulcerative disease of the cervix, is to mutilate that organ. I can, for my part, scarcely understand how any one conver- sant with the doctrines and operations of surgery can apply such a term to the cautious and prudent use of the mineral acids, of the potassa cum calce, or of the actual cautery, employed, not to destroy but to modify morbid vitality. Nor can I understand how any such practi- tioner can write with absolute horror and dread of the actual cautery, or "white iron," which is an acknowledged, accepted surgical ao-ent, still used and prized by many surgeons, and which would be more em- ployed, were it not that it alarms patients. I have often seen it used and used it myself in my early surgical days, for various diseases, and have always found it a safe and manageable agent. Indeed this fear of the actual cautery, and of the more powerful caustics, appears to me quite puerile in a surgical point of view, if these agents really are required to cure disease. What is surgery, but the application of the knife, of caustics, of the actual cautery, or of whatever powerful agent may be required to remove or to destroy disease, or to modify vitality't Why, therefore, in plain common sense, should the application of these SUMMARY. 65 agents to the occasional treatment of uterine disease, be spoken of with "unsurgical horror and alarm," if they really are occasionally required? and why should they not be required in exceptional cases of uterine disease, as well as in exceptional cases of disease of the bowel, vulva, meatus urinarius, &c. ? Here again we may appeal to the laws of general pathology. Once it is admitted that the neck of the uterus is liable to inflammation, ulceration, thickening, hypertrophy, and induration ; that it may become the seat of unhealthy, suspicious disease, ulcerative and other; and that these diseased conditions may exist uncured an indefinite number of years—every well-informed surgeon will allow that there must be cases which will not give way to the nitrate of silver, to astringents, leeches, &c. And if so, what is to be done with them ? Are we to leave the patients to their fate, and confess ourselves impotent to cure, whilst we have more powerful surgical agents in our hands—agents which can cure these very morbid states? To the surgically-educated practitioner there is but one solution of this question : as long as there is a fair chance of cure, he will keep to the milder means of treatment; it is his imperative duty so to do. As soon, however, as he has ascertained that these means are insufficient, he will at once, prudently and cautiously, but without fear or trepidation, resort to the more powerful means of treatment at his command. APPENDIX. i. During the publication of this Review, I have received a valuable communication from an Indian practitioner, a thorough stranger to me, which so fully bears out the truth of an assertion elsewhere made, that I think I cannot do better than here append it. I allude to the state- ment contained in the preface to the second edition of my treatise on " Uterine Inflammation," to the effect that " the descriptions of uterine disease which I have given are the expression of facts truly observed and faithfully reproduced, and will hold good alike in all climes, in all lands, and in all grades of social life." I may add that Dr. Stewart's testimony, as to the frequent existence of inflammatory and ulcerative disease of the neck of the uterus amongst the native women of India, is thoroughly corroborated by the experience of Dr. Scott, formerly Phy- sician to the Hospital for Native Women at Madras, and now practising at Ootacamund. Dr. Scott has repeatedly informed me that he has found these diseased conditions to be quite as frequent amongst the native women at Madras as I have done in Paris and London. I merely transcribe Dr. Stewart's communication, which is as follows:— " Warley Barracks, Brentwood, Essex, 19th March, 1856. " Dear Sir—It may perhaps interest you and the readers of The Lancet to know that your views and observations regarding the frequency and importance of ulceration of the cervix and os uteri are amply borne out in India, as every- where else. In proof of this, I take the liberty of sending you a somewhat curi- ous memorandum, drawn up for me by one of my late esteemed associates in the Calcutta Medical School, Baboo Madoosudun G-oopta, of the appearances observed in these parts on the post-mortem examination of fifty native Indian females whose deaths occurred in hospital from other casual diseases. " A long and extensive experience amongst native families in Calcutta, from the highest to the lowest classes, fully satisfied me that the particular affections which you have so ably described and brought to the notice of the profession are of immense frequency, and that the plan of treatment which you so ably advo- cate is the only right one. " I am, Sir, yours truly, " D. S. Stewart, M. J)., " Surgeon Hon. E. I. Co.'s Dep6t, Warley." CONDITION OF THE GENITAL ORGANS. 67 Memorandum of the Condition of the Genital Organs in the Bodies of Fifty Native Indian Women, who had Died of various Diseases. By Madoosudun Goopta, S.A.S. No. Uterus. 46 50 35 40 24 34 45 50 25 27 50 30 42 40 30 27 30 Cervix and Os Uteri. | Natural . . Small, hard Natural . . Ditto . . Ditto . . 18 28 19 50 20 30 21 50 22 36 23 27 24 45 25 46 26 40 27 25 28 30 29 29 30 30 31 30 32 50 33 40 34 45 35 45 36 65 37 65 38 60 39 50 30 30 41 19 42 50 43 40 44 35 45 2S 46 42 47 32 48 13 49 26 50 22 Ditto .... Ditto .... Ditto .... Ditto .... ( Enlarged by re- < cent pregnan- ( cy, inflamed Swollen and soft . Natural .... Ditto .... Ditto .... Largo and inflamed Natural . . . Gravid . . . Natural . . . Prolapsed . . Natural . . . Ditto .... Sloughing . . . Natural .... Ditto .... Ditto .... Fatty degeneration Natural .... Ditto .... ( Displaced fundus < adherent to rec- ( turn .... Natural .... Ditto Ditto Ditto Ditto Ditto Natural...... Os rigid and contracted. f Os irregular, a tumor { on one side . . . Healthy...... f Cervix much inflamed,' { os ulcerated . . Os and cervix ulcerated Os closed..... Fungous tumor . . . Os widely open . . . Inflamed Os ulcerated..... Os scirrhous, deep ulcers . Cervix swollen . . . . Os ulcerated..... Lacerated ulcers . . . . Cervix inflamed, os ulc'ated ( Cervix inflamed, os ex-) { tensively ulcerated J Cervix swollen, soft . . . Not unhealthy f Cervix ulcerated, os { raw and open Os irregular, hard Cancerous ulcers . . . Cervix and os inflamed . Ditto....... Os obliterated .... Cervix and os ulcerated Tubercles in cervix Natural...... os | (Displaced to' « 1 enlarged, altered, and improved, that it can scarcely We are firmly of opinion that in^portion " a be considered the same work.-J>r. Ranking', Ac- knowledge of uterine diseases becomes more appre- s elated this work will be proportionably established stract- as a text-book in the profession.—The Lancet. Also, just ready, by the same author, and for sale separate, A REArIEW OF THE PRESENT STATE OF UTERINE PATHOLOGY. 1 small vol. Svo. 50 cents, in flexible cloth. In this little work, which can be had either in connection with the "Practical Treatise," or separate the author presents his latent views with regard to the various doctrines which have re- cently been brought forward on this interesting question, under the following heads :— r j preliminary. II. Sketch of Uterine Pathology. III. Objections. IV. The Leucorrhoea Theory —the Syphilis Theory —the Ovarian Theory. V. The Displacement Theory. Vi. Summary. BLANCHARD & LEA'S MEDICAL BROWN (ISAAC BAKER), Surgeon-Accoucheur to St. Mary's Hospital, Ac. m-nTT1 A T ON SOME DISEASES OF WOMEN ADMITTING OF SURGICAL TRBjAi- .MENT. With handsome illustrations. One vol. Svo, extra cloth. (Now Ready.) ■» l ^-^ Mr. Brown has earned for himself a high reputa- and merit the careful "tte,lti"" °/ eVefy SUrgC tion in the operative treatment of sundry diseases i accoucheur.—Association journ . and injuries to which females are peculiarly subject. ' '.„ . n() nPSjtation in recommending this book We can truly say of his work that it is an important . ' ful attention of all surgeons who make addition to obstetrical literature. The operative r" ™ je C(,n,plaints a part of their study and practice. (•ingestions and contrivances which Mr. Brown de- \_Dublin Quarterly Journal. scribes, exhibit much practical sagacity and skill, , ^ BENNETT (J. HUGHES), M.D., F. R. S. E., Professor of Clinical Medicine in the University of Edinburgh, etc. THE PATHOLOGY AND TREATMENT OF PULMONARY TUBERCU- LOSIS, and on the Local Medication of Pharyngeal and Laryngeal Diseases frequent v mistaken for or associated with, Phthisis. In one handsome octavo volume, extra cloth, with beautiful wood-cuts. pp. 130. (Lately Issued.) SI 25. BUDD (GEORGE), M. D., F. R. S., Professor of Medicine in King's College, London. ON DISEASES OF THE LIVER. Second American, from the second and enlarged London edition. In one very handsome octavo volume, extra cloth, with four beauti- fully ^colored plates, and numerous wood-cuts. pp.468. $3 00. For many years, Dr. Budd's work must be the I the subject has been taken up by so able and experi- authority of the great mass of British practitioners enced a physician.—British and Foreign Medico- on the hepatic diseases ; and it is satisfactory that I Chirurgical Review. by the same author. (Now Ready.) ON THE ORGANIC DISEASES AND FUNCTIONAL DISORDERS OF THE STOMACH. In one neat octavo volume, extra cloth, f 1 50. A new work, 1856. W hile special treatises have been multiplying upon almost all the different classes of diseases, there has long been felt the want of an authoritative work on the disorders of the stomach, which con- stitute, perhaps, a larger proportion of the daily practice of the physician than any other class of maladies. To supply this want has been the object of the author, and his reputation is an ample ' guarantee of the value of his labors. From the high position occupied by Dr. Budd as style, the subjects are well arranged, and the practi- a teacher, a writer, and a practitioner, it is almost cal precepts, both of diagnosis and treatment, denote needless to state that the present book may be con- the character of a thoughtful and experienced phv- sulted with great advantage. It is written in an easy sician.—London Med. Times and Gazette, Dec. 1855. BIRD (GOLDING), A. M., M. D., &c. URINARY DEPOSITS: THEIR DIAGNOSIS, PATHOLOGY, AND THERAPEUTICAL INDICATIONS. A new and enlarged American, from the last improved London edition. With over sixty illustrations. In one royal 12mo. vol, extra cloth, pp.372. $130. extension and satisfactory employment of our thera- It can scarcely be necessary for us to say anything of the merits of this well-known Treatise, which so admirably brings into practical application the re- sults of those microscopical and chemical researches regarding the physiology and pathology of the uri- nary secretion, which have contributed so much to the increase of our diagnostic powers, and to the peutic resources. In the preparation of this new edition of his work, it is obvious that Dr. Golding Bird has spared no pains to render it a faithful repre- sentation of the present state of scientific knowledge on the subject it embraces.— The British and Foreign Medico-Chirurgical Review. BY THE SAME AUTHOR. ELEMENTS OF NATURAL PHILOSOPHY; being an Experimental Intro- duction to the Physical Sciences. Illustrated with nearly four hundred wood-cuts. From the third London edition. In one neat volume, royal 12mo., extra cloth, pp.402. $125. BILLING'S PRINCIPLES OF MEDICINE.— Second American, from the Fifth and Improved London edition. In one handsome octavo volume, extra cloth. 250 pages. SI 25. BLAKISTON'S PRACTICAL OBSERVATIONS ON CERTAIN DISEASES OF THE CHEST, and en the Principles of Auscultation. In one vol., cloth, Svo pp.384. SI 25. BURROWS ON DISORDERS OF THE CERE- BRAL CIRCULATION, and on the Connection between the Affections of the Brain and Diseases of the Heart. In one 8vo. vol., extra cloth, with colored plates, pp. 216. SI 25. BEALE ON THE LAWS OF HEALTH IN RE- LATION TO MIND AND BODY. A Series of Letters from an old Practitioner to a Patient. In one volume, royal 12mo., extra cloth, pp. 296. 80 cents. BUSHNAN'S PHYSIOLOGY OF ANIMAL AND VEGETABLE LIFE; a Popular Treatise, on the 1- unctions and Phenomena of Orgunic Life In one handsome royal 12mo. volume, extra cloth, with over 100 illustrations, pp. 234. 80 cents. BUCKLER ON THE ETIOLOGY, PATHOLOGY TISD AN DEK «rFl^ nSE F^RO-BRONCHI-' TIS AND RHEUMATIC PNEUMONIA In one 8vo. volume, extra cloth, pp. 150. $ 1 25. BLOOD AND URINE (MANUALS OM RV J°HN WILLIAM GRIF PITH G OWFN REESE AND ALFRED MARKWlblf ™ thick volume, royal 12tno., extra cloth with plates, pp. 460. $1 25. ' W,th BRODIF/S CLINICAL LECTURES ON SUR GERY. 1 vol. 8vo., cloth. 350 pp. $125 UR" AND SCIENTIFIC PUBLICATIONS. 5 BARLOW (GEORGE H.), M. D. Physician to Guy's Hospital, London, &c. A MANUAL OF THE PRACTICE OF MEDICINE. With Additions by D. F. Condie, M. D., author of "A Practical Treatise on Diseases of Children," &c. In one hand- some octavo volume, leather, of over 600 pages. (A new work, just ready, 1856.) $2 75. The position of the author as physician to Guy's Hospital and other large public institutions, is a sufficient guarantee of the extent and value of the experience which is here systematically re- corded and condensed. His aim throughout has been to produce a practical work, on which the student can rely as a guide, and to which the practitioner can refer with confidence. The additions by the editor comprise chapters on Cerebro-spinal Meningitis, Cholera Infantum, and Yellow Fever, besides numerous notes wherever the diseases or practice of this country seemed to render them necessary or desirable. We most emphatically commend it to the attention of the profession, as deserving their confidence—a depository of practical knowledge, from which they may draw with great benefit.—Cincinnati Med. Ob- server, Mar. 1856. The student has long been in want of a good ele- mentary work on the Practice of Medicine. In Dr. Barlow's Manual that want is supplied ; and we have no question that it will at once be installed as the favorite text-book in all Medical Schools.— Medical Times and Gazette. We recommend Dr. Barlow's Manual in the warm- est manner as a most valuable vade-mecum. We have had frequent occasion to consult it, and have found it clear, concise, practical, and sound. It is eminently a practical work, containing all that is essential, and avoiding useless theoretical discus- sion. The work supplies what has been for some time wanting, a manual of practice based upon mo- dern discoveries in pathology and rational views of treatment of disease. It is especially intended for the use of students and junior practitioners, but it will be found hardly less useful to the experienced physician. The American editor has added to the work three chapters—on Cholera Infantum, Yellow Fever, and Cerebro-spinal Meningitis. These addi- tions, the two first of which are indispensable to a work on practice destined for the profession in this country, are executed with great judgment and fi- delity, by Dr. Condie, who has also succeeded hap- pily in imitating the conciseness and clearness of style which are such agreeable characteristics of the original book.—Boston Med. and Surg. Journal, Feb. 1S56. We have looked through this volume with very great satisfaction; it is written in an easy and plea- sant style, and the short though lucid expositions of disease, clearness of description, and soundness of precept will make it a welcome visitor in the library of every practitioner. It combines the simplicity of old Cuxlen, with the elegance of Watson, and al- though not so copious as other works we might men- tion, it will, nevertheless, become a standard autho- rity.—American Lancet, Mar. 1856. BARTLETT (ELISHA), M. D. THE HISTORY, DIAGNOSIS, AND TREATMENT OF THE FEVERS OF THE UNITED STATES. A new and revised edition. By Alonzo Clakk, M. D., Prof. of Physiology and Pathology in the N. Y. Coll of Physicians and Surgeons, &c. In one octavo volume, of six hundred pages, extra cloth. (Nearly Ready.) The masterly and elegant treatise by Dr. Bartlett is invaluable to the American student and practi- tioner.—Dr. Holmes's Report to the Nat. Med. Asso- tiation. We regard it, from the examination we have made of it, the best work on fevers extant in our language, and as such cordially recommend it to the medical public.—St. Louis Medical and Surgical Journal. ' Take it altogether, it is the most complete history of our fevers which has yet been published, and every practitioner should avail himself of its con- tents.—The Western Lancet. BOWMAN (JOHN E.), M.D. PRACTICAL HANDBOOK OF MEDICAL CHEMISTRY. Second Ame- rican, from the third and revised English Edition. In one neat volume, royal 12mo., extra cloth, with numerous illustrations, pp. 288. (Now Ready, 1856.) $1 25. Presenting, in a condensed and convenient form, at a very low price, the applications of Chemistry to the practical purposes of Clinical Medicine, this work supplies a want which has long been felt bv the physician. The numerous editions which have been called for both in England and this country, sufficiently attest the success with which the author has carried out his plan. BY THE SAME AUTHOR. INTRODUCTION TO PRACTICAL CHEMISTRY, INCLUDING ANA- LYSIS. With numerous illustrations. Inoneneatvol.,royall2mo.,extracloth. pp.350. $125. CURLING (T. B.), F. R.S., Surgeon to the London Hospital, President of the Hunterian Society, &c. A PRACTICAL TREATISE ON DISEASES OF THE TESTIS, SPERMA- TIC CORDr AND SCROTUM. Second American, from the second and enlarged English edi- tion In one handsome octavo volume, extra cloth, with numerous illustrations, pp. 420. (Now Ready, 1856.) 82 00. In the revised English edition, of which this is a reprint, the author, for want of space, omitted the Anatomical Introduction. By a more condensed style of printing, room has been found in the present volume to retain this important portion without rendering the work inconveniently large. Some of the notes of the former American editor have also been incorporated, and a number of new illustrations introduced. With these improvements, and the thorough revision which it has enjoyed at the hands of the author, it will be found fully worthy to retain the authoritative position which it has acquired with regard to this class of affections. We now take farewell, for the present, of this ex- cellent treatise, placing it on our book shelves by the side of Cooper on Fractures and Dislocations, and other similar standard and valuable works — Asso. Med. Journal, Jan. 1656. We shall not devote any further space to the work under notice, as it is so well known to the profession already. We can only say that it should be in the library of every practical surgeon. The present edi- tion is much improved, contains numerous wood- cuts, and several accounts of cases illustrating the various diseases of the testicles.—Med. Times and Gazette, Feb. 1856. 6 BLANCHARD & LEA'S MEDICAL CARPENTER (WILLIAM B.), M. D., F. R. S., &c, Examiner in Physiology and Comparative Anatomy in the University of Loudon. PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief applications to Psychology, Pathology, Therapeutics, Hygiene, and Forensic Medicine. A new American, irora the last and revised London edition. With nearly three hundred illustrations. Ldited, 'wiinaciu tions, bv Francis Gurney Smith, M. D., Professor of the Institutes of Medicine in t be■* *n"f£- vania Medical College, &c. In one very large and beautiful octavo volume, of about nL"e n"""rea lar-e paires, handsomely printed and strongly bound in leather, with raised bands. (Just issuea, 1v30.) $4 *5 -if In the preparation of this new edition, the author has spared no labor to render it, as heretofore, a complete and lucid exposition of the most advanced condition of its important subject, i ne amount of the additions required to effect this object thoroughly, joined to the former large size o the volume, presenting objections arising from the unwieldy bulk of the work, he has omitted all those portions not bearing directly upon Human Physiology, designing to incorporate hem in hi* forthcoming Treatise on General Physiology. As a full and accurate text-book on the 1 hy- moIo"v of Man, the work in its present condition therefore presents even greater claims upon the -uident and physician than those which have heretofore won for it the very wide and distin- guished favor which it has so long enjoyed. The additions of Prof. Smith will be found to supply whatever may have been wanting to the American student, while the introduction of many new illustrations, and the most careful mechanical execution, render the volume one of the most at- tractive as yet issued. For upwards of thirteen years Dr. Carpenter's | To eulogize this great work would be superfluous. work has been considered by the profession gene- ' We should observe, however, that in this edition rally, both in this country and England, as the most | the author has remodelled a large portion of the valuable compendium on the subject of physiology , former, and the editor has added much matter of in- in our language. This distinction it owes to the high terest, especially in the form of illustrations. AVe attainments and unwearied industry of its accom plished author. The present edition (which, like the last American one, was prepared by the author him- self), is the result of such extensive revision, that it may almost be considered a new work. We need hardly say, in concluding this brief notice, that while the work is indispensable to every student of medi- cine in this country, it will amply repay the practi- tioner for its perusal by the interest and value of its contents.—Boston Med. and Surg. Journal. This is a standard work—the text-book used by all medical students who read the English language. It has passed through several editions in order to keep pace with the rapidly growing science of Phy- siology. Nothing need be said in its praise, for its merits are universally known ; we have nothing to say of its defects, for they only appear where the science of which it treats is incomplete.— Western Lancet. The most complete exposition of physiology which any language can at present give.—Brit, and For. Med.-Chirurg. Review. The greatest, the most reliable, and the best book on the subject which we know of in the English language.—Stethoscope. may confidently recommend it as the most complete work on Human Physiology in our language.— Southern Med. and Surg. Journal, December, 1855. The most complete work on the science in our language.—Am. Med. Journal. The most complete work now extant in our lan- guage.—N. O. Med. Register. The best text-book in the language on this ex- tensive subject.—London Med. Times. A complete cyclopaedia of this branch of science. —N. Y. Med. Times. The profession of this country, and perhaps also of Europe, have anxiously and for some time awaited the announcement of this new edition of Carpenter's Human Physiology. His former editions have for many years been almost the only text-book on Phy- siology in all our medical schools, and its circula- tion among the profession has been unsurpassed by any work in any department of medical science. It is quite unnecessary for us to speak of this work as its merits would justify. The mere an- nouncement of its appearance will afford the highest pleasure to every student of Physiology, while its perusal will be of infinite service in advancing physiological science.—Ohio Med. and Surg. Journ. BY the same author. (Lately Issued.) PRINCIPLES OF COMPARATIVE PHYSIOLOGY. New American, from the Fourth and Revised London edition. In one large and handsome octavo volume, with over three hundred beautiful illustrations, pp. 752. Extra cloth, $4 80; leather, raised bands, $5 25. The delay which has existed in the appearance of this work has been caused by the very thorough revision and remodelling which it has undergone at the hands of the author, and the large number of new illustrations which have been prepared for it. It will, therefore, be found almost a new work, and fully up to the day in every department of the subject, rendering it a reliable text-book for all students engaged in this branch of science. Every effort has been made to render its typo- graphical finish and mechanical execution worthy of its exalted reputation, and creditable to the mechanical arts of this country. This book should not only be read but thoroughly studied by every member of the profession. None are too wise or old, to be benefited thereby. But especially to the younger class would we cordially commend it as best fitted of any work in the English language to qualify them for the reception and com- prehension of those truths which are daily being de- veloped in physiology.—Medical Counsellor. Without pretending to it, it is an encyclopedia of the subject, accurate and complete in all respects— a truthful reflection of the advanced state.at which the science has now arrived.—Dublin Quarterly Journal of Medical Science. A truly magnificent work—in itself a perfect phy- siological study.—Ranking's Abstract. This work stands without its fellow. It is one few men in Europe could have undertaken; t is one no man, we believe, could have brought to so suc- cessful an issue as Dr. Carpenter. It required for its production a physiologist at once deeply read in the labors of others, capable of taking a general critical, and unprejudiced view of those labors and of combining the varied*, heterogeneous materials at his disposal, so as to form an harmonious whole. We feel that this abstract can give the reader a verv imperfect idea of the fulness of this work, and no idea of its unity, of the admirable manner in which material has been brought, from the most varioui sources, to conduce to its completeness, of the lucid- ity of the reasoning it contains, or of the clearness of language in which the whole is clothed Nor the profession only, but the scientific world at lar** must feel deeply indebted to Dr. Carpenter for thi« great work. It must, indeed, add largely even to his high reputation— Medical Times. AND SCIENTIFIC PUBLICATIONS. 7 CARPENTER (WILLIAM B.), M. D., F. R. S., Examiner in Physiology and Comparative Anatomy in the University of London. (Now Ready, June, 1856.) THE MICROSCOPE AND ITS REVELATIONS. With an Appendix con- taining the Applications of the Microscope to Clinical Medicine, &c. By F. G. Smith, M. D. Illustrated by four hundred and thirty-four beautiful engravings on wood. In one large and very handsome octavo volume, of 724 pages, extra cloth, $4 00 ; leather, §4 50. Ur. Carpenter's position as a microscopist and physiologist, and his great experience as a teacher, eminently qualify him to produce what has long been wanted—a good text-book on the practical use of the microscope. In the present volume his object has been, as stated in his Preface, " to combine, within a moderate compass, that information with regard to the use of his ' tools,; which is most essential to the working microscopist, with such an account of the objects best fitted for his study, as might qualify him to comprehend what he observes, and might thus prepare him to benefit science, whilst expanding and refreshing his own mind " That he has succeeded in accom- plishing this, no one acquainted with his previous labors can doubt. The great importance of the microscope as a means of diagnosis, and the number of microsco- pists who are also physicians, have induced the American publishers, with the author's approval, to add an Appendix, carefully prepared by Professor Smith, on the applications of the instrument to clinical medicine, together with an account of American Microscopes, their modifications and accessories. This portion of the work is illustrated with nearly one hundred wood-cuts, and, it is hoped, will adapt the volume more particularly to the use of the American student. Every care has been taken in the mechanical execution of the work, which is confidently pre- sented as in no respect inferior to the choicest productions of the London press. The mode in which the author has executed his intentions may be gathered from the following condensed synopsis of the CONTENTS. Introduction—History of the Microscope. Chap. I. Optical Principles of the Microscope. Chap. II. Construction of the Microscope. Chap. III. Accessory Apparatus. Chap. IV. Management of the Microscope Chap. V. Preparation, Mounting, and Collection of Objects. Chap. VI. Microscopic Forms of Vegetable Life—Protophytes. Chap. VJI. Higher Cryptoga- mia. Chap. VIII. Phanerogamic Plants. Chap. IX. Microscopic Forms of Animal Life—Pro- tozoa—Animalcules. Chap. X. Foraminifera, Polycystina, and Sponges. Chap. XI. Zoophytes. Chap. XII. Echinodermata. Chap. XIII. Polyzoa and Compound Tunicata. Chap. XIV. Molluscous Animals Generally. Chap. XV. Annulosa. Chap. XVI. Crustacea. Chap. XVII. Insects and Arachnida. Chap. XVIII. Vertebrated Animals. Chap. XIX. Applications of the Microscope to Geology. Chap. XX. Inorganic or Mineral Kingdom—Polarization. Appendix. Microscope as a means of Diagnosis—Injections—Microscopes of American Manufacture. Those who are acquainted with Dr. Carpenter's previous writings on Animal and Vegetable Physio- logy, willfully understand how vast a store of know- ledge he is able to bring to bear upon so comprehen- sive a subject as the revelations of the microscope ; and even those who have no previous acquaintance with the construction or uses of this instrument, will find abundance of information conveyed in clear and simple language.—Med. Times and Gazette, May, 1856. BY THE SAME AUTHOR. ELEMENTS (OR MANUAL) OF PHYSIOLOGY, INCLUDING PHYSIO- LOGICAL ANATOMY. Second American, from a new and revised London edition. With one hundred and ninety illustrations. In one very handsome octavo volume, leather, pp. 566. $3 00. In publishing the first edition of this work, its title was altered from that of the London volume, by the substitution of the word " Elements" for that of " Manual," and with the author's sanction the title of "Elements" is still retained as being more expressive of the scope of the treatise. Those who have occasion for an elementary trea- tise on Physiology, cannot do better than to possess themselves of the manual of Dr. Carpenter.—Medical Examiner. The best and most complete expose" of modern Physiology, in one volume, extant in the English language.—St. Louis Medical Journal. To say that it is the best manual of Physiology now before the public, would not do sufficient justice to the author.—Buffalo Medical Journal. In his former works it would seem that he had exhausted the subject of Physiology. In the present, he gives the essence, as it were, of the whole.—N. Y. Journal of Medicine. by the same author. (Preparing.) PRINCIPLES OF GENERAL PHYSIOLOGY, INCLUDING ORGANIC CHEMISTRY AND HISTOLOGY". With a General Sketch of the Vegetable and Animal Kingdom. In one large and very handsome octavo volume, with several hundred illustrations. Thp subiect of eeneral physiology having been omitted in the last editions of the author's « Com- narative Physiology" and''Human Physiology," he has undertaken to prepare a volume which shall present it more thoroughly and fully than has yet been attempted, and which may be regarded as an introduction to his other works. BY THE SAME AUTHOR. A PRIZE ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH AND DISEASE. New edition, with a Preface by D. F. Condie, M. D., and explanations of scientific words. In one neat 12mo. volume, extra cloth, pp. 178. (Just Issued.) 50 cents. CHELIUS (J. M.), M. D., Professor of Surgery in the University of Heidelberg, &c. A SYSTEM OF SURGERY. Translated from the German, and accompanied with additional Notes and References, by John F. South. Complete in three very large octavo volumes, of nearly 2200 pages, strongly bound, with raised bands and double titles. §10 00. 8 BLANCHARD & LEA'S MEDICAL CONDIE (D. F.), M. D., &c. A PRACTICAL TREATISE OX THE DISEASES OF CHILDREN. Fourth edition, revised and augmented. In one large volume, 8vo., leather, of nearly 750 pages. S?-'> 00. From the Author's Preface. The demand for another edition has afforded the author an opportunity of again subjecting the entire treatise to a careful revision, and of incorporating in it every important observation recorded since the appearance of the last edition, in reference to the pathology and therapeutics of the several diseases of which it treats. In the preparation of the present edition, as in those which have preceded, while the author has appropriated to his use every important fact that he has found recorded in the works of others, having a direct bearing upon either of the subjects of which he treats, and the numerous valuable observations—pathological as well as practical—dispersed throughout the pages of the medical journals of Europe and America, he has, nevertheless, relied chiefly upon his own observations and experience, acquired during a long and somewhat extensive practice, and under circumstances pe- culiarly well adapted for the clinical study of the diseases of early life. Every species of hypothetical reasoning has, as much as possible, been avoided. The author has endeavored throughout the work to confine himself to a simple statement of well-ascertained patho- logical facts, and plain therapeutical directions—his chief desire being to render it what its title imports it to be, a practical treatise on the diseases of children. Dr. Condie:s scholarship, acumen, industry, and practical sense are manifested in this, as in all his numerous contributions to science.—Dr. Holmes's Report to the American Medical Association. Taken as a whole, in our judgment, Dr. Condie's Treatise is the one from the perusal of which the practitioner in this country will rise with the great- est satisfaction.—Western Journal of Medicine and Surgery. One of the best works upon the Diseases of Chil- dren in the English language.—Western Lancet. Perhaps the most full and complete work now be- fore the profession of the United States; indeed, we may say in the English language. It is vastly supe- rior to most of its predecessors.—Transylvania Med. Journal. We feel assured from actual experience that no physician's library can be complete without a copy of this work.—N. Y. Journal of Medicine. A veritable pediatric encyclopaedia, and an honor to American medical literature.—Ohio Medical and Surgical Journal. "We feel persuaded that the American medical pro- fession will soon regard it not only as a very good, but as the very best "Practical Treatise on the Diseases of Children."—American Medical Journal. We pronounced the first edition to be the best work on the diseases of children in the English language, and, notwithstanding all that has been published, we still regard it in that light.—Medical Examiner. CHRISTISON (ROBERT), M. D., V. P. R. S. E., &.C. A DISPENSATORY; or, Commentary on the Pharmacopoeias of Great Britain and the United States; comprising the Natural History, Description, Chemistry, Pharmacy, Ac- tions, Uses, and Doses of the Articles of the Materia Medica. Second edition, revised and im- proved, with a Supplement containing the most important New Remedies. With copious Addi- tions, and two hundred and thirteen large wood-engravings. By R. Eglesfeld Griffith, M. D. In one very large and handsome octavo volume, leather, raised bands, of over 1000 pages. $3 50. It is not needful that ws should compare it with the other pharmacopoeias extant, which enjoy and merit the confidence of the profession : it is enough to say that it appears to us as perfect as a Dispensa- tory, in the present state of pharmaceutical science, could be made. If it omits any details pertaining to this branch of knowledge which the student has a right to expect in such a work, we confess the omis- sion has escaped our scrutiny. We cordially recom- mend this work to Buch of our readers as are in need of a Dispensatory. They cannot make choice of a better.—Western Journ. of Medicine and Surgery. COOPER (BRANSBY B.), F. R. S. LECTURES ON THE PRINCIPLES AND PRACTICE OF SURGERY. In one very large octavo volume, extra cloth, of 750 pages. $3 00. COOPER ON DISLOCATIONS AND FRAC- TURES OF THE JOINTS —Edited by Bransbt B. Cooper, F. R. S., &c. With additional Ob- servations by Prof. J. C. Warees. A new Ame- rican edition. In one handsome octavo volume, extra cloth, of about 500 pages, with numerous illustrations on wood. $3 25. COOPER ON THE ANATOMY AND TREAT- MENT OF ABDOMINAL HERN I A. One large volume, imperial 8vo., extra cloth, with over 130 lithographic figures. $2 50. COOPER ON THE ANATOMY AND DISEASES OF THE BREAST, with twenty-five Miscellane- ous and Surgical Papers. One large volume, im- perial 8vo., extra cloth, with 252 figures, on 36 plates. S2 50. COOPER ON THE STRUCTURE AND DIS- EASES OF THE TESTIS, AND ON THE THYMUS GLAND. One vol. imperial 8vo., ex- tra cloth, with 177 figures on 29 plates. $2 00. COPLAND ON THE CAUSES, NATURE, AND TREATMENT OF PALSY AND APOPLEXY In one volume, royal 12mo., extra cloth, po. 326. 80 cents. CLYMER ON FEVERS: THEIR DIAGNOSIS, PATHOLOGY, AND TREATMENT In one octavo volume, leather, of 600 pages. $1 50. COLOMBAT DE L'ISERE ON THE DISEASES OF FEMALES, amfon the special Hygiene 'of their Sex. Translated, with many Notes and Ad- ditions, by C. D. Meigs, M. D. Second edition, revised and improved. In one large volume oc- tavo leather, with numerous wood-cuts. pp. 720. CARSON (JOSEPH), M. D., Professor of Materia Medica and Pharmacy in the University of Pennsylvania SYNOPSIS OF THE COURSE OF LECTURES ON MATERIA' MEDICA AND PHARMACY, delivered in the University of Pennsylvania. Second and revised elii tion. In one very neat octavo volume, extra cloth, «f 20S pages. (Now Ready.) $1 50. AND SCIENTIFIC PUBLICATIONS. U CHURCHILL (FLEETWOOD), M. D., M. R. I. A. ON THE THEORY AND PRACTICE OF MIDWIFERY. A new American, from the last and improved English edition. Edited, with Notes and Additions, by D. Francis Condie, M. D., author of a "Practical Treatise on the Diseases of Children," &c. With 139 illustrations. In one very handsome octavo volume, leather, pp. 510. S3 00. To bestow praise on a book that has received such marked approbation would be superfluous. We need only say, therefore, that if the first edition was thought worthy of a favorable reception by the medical public, we can confidently affirm that this will be found much more so. The lecturer, the practitioner, and the student, may all have recourse to its pages, and derive from their perusal much in- terest and instruction in everything relating to theo- retical and practical midwifery.—Dublin Quarterly Journal of Medical Science. A work of very great merit, and such as we can confidently recommend to the study of every obste- tric practitioner.—London Medical Gazette. This is certainly the most perfect system extant. It is the best adapted for the purposes of a text- book, and that which he whose necessities confine him to one book, should select in preference to all Others.—Southern Medical and Surgical Journal. The most popular work on midwifery ever issued from the American press.—Charleston Med. Journal. Were we reduced to the necessity of having but one work on midwifery, and permitted to choose, we would unhesitatingly take Churchill.—Western Med. and Surg. Journal. It is impossible to conceive a more useful and elegant manual than Dr. Churchill's Practice of Midwifery.—Provincial Medical Journal. Certainly, in our opinion, the very best work on the subject which exists.—N. Y. Annalist. No work holds a higher position, or is more de- serving of being placed in the hands of the tyro, the advanced student, or the practitioner.—Medical Examiner. Previous editions, under the editorial supervision of Prof R. M. Huston, have been received with marked favor, and they deserved it; but this, re- printed from a very late Dublin edition, carefully revised and brought up by the author to the present time, does present an unusually accurate and able exposition of every important particular embraced in the department of midwifery. * # The clearness, directness, and precision of its teachings, together with the great amount of statistical research which its text exhibits, have served to place it already in the foremost rank of works in this department of re- medial science.—N. O. Med. and Surg. Journal. In our opinion, it forms one of the best if not the very best text-book and epitome of obstetric science which we at present possess in the English lan- guage.—Monthly Journal of Medical Science. The clearness and precision of style in which it is written, and the greatamount of statistical research which it contains, have served to place it in the first rank of works in this department of medical science. —N. Y. Journal of Medicine. Few treatises will be found better adapted as a text-book for the student, or as a manual for the frequent consultation of the young practitioner.— American Medical Journal. by the same author. (Now Ready, 1856.) ON THE DISEASES OF INFANTS AND CHILDREN. Second American Edition, revised and enlarged by the author. Edited, with Notes, by W. V. Keating, M. D. In one large and handsome volume, extra cloth, of over 700 pages. $3 00, or in leather, $3 25. In preparing this work a second time for the American profession, the author has spared no labor in giving it a very thorough revision, introducing several new chapters, and rewriting others, while every portion of the volume has been subjected to a severe scrutiny. The efforts of the American editor have been directed to supplying such information relative to matters peculiar to this country as might have escaped the attention of the author, and the whole may, there- fore, be safely pronounced one of the most complete works on the subject accessible to the Ame- rican Profession. By an alteration in the size of the page, these very extensive additions have been accommodated without unduly increasing the size of the work. A few notices of the former edition are subjoined :— We regard this volume as possessing more claims to completeness than any other of the kind with which we are acquainted. Most cordially and ear- nestly, therefore, do we commend it to our profession- al brethren, and we feel assured that the stamp of their approbation will in due time be impressed upon it. After an attentive perusal of its contents, we hesitate not to say, that it is one of the most com- prehensive ever written upon the diseases of chil- dren, and that, for copiousnessof reference, extent of research, and perspicuity of detail, it is scarcely to be equalled, and not to be excelled, in any lan- guage.—Dublin Quarterly Journal. After this meagre, and we know, very imperfect notice of Dr. Churchill's work, we shall conclude by saying, that it is one that cannot fail from its co- piousness, extensive research, and general accuracy, to exalt still higher the reputation of the author in this country. The American reader will be.particu- larlvpleased to find that Dr. Churchill has done full justice throughout his work to the various A mencan authors on this subject. The names of Dewees, Eberle Condie, and Stewart, occur on nearly every Daee, and these authors are constantly referred to by the author in terms of the highest praise, and with the moat liberal courtesy.—The Medical Examiner. The present volume will sustain the reputation acquired by the author from his previous works. The reader will find in it full and judicious direc- tions for the management of infants at birth, and a compendious, but clear account of the diseases to which children are liable, and the most successful mode of treating them. We must not close this no- tice without calling attention to the author's style, which is perspicuous and polished to a degree, we regret to say,not generally characteristic of medical works. We recommend the work of Dr. Churchill most cordially, both to students and practitioners, as a valuable and reliable guide in the treatment of the diseases of children.—Am. Joum. of the Med. Sciences. We know of no work on this department of Prac tical Medicine which presents so candid and unpre- judiced a statement or posting up of our actual knowledge as this.—N. Y. Journal of Medicine. Its claims to merit both as a scientific and practi- cal work, are of the highest order. Whilst we would not elevate it above every other treatise on the same subject, we certainly believe that very few are equal to it, and none superior.—Southern Med. and Surgical Journal. BY THE SAME AUTHOR. ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PE- CULIAR TO WOMEN. Selected from the writings of British Authors previous to the close of the Eighteenth Century. In one neat octavo volume, extra cloth, of about 450 pages. $2 50. 10 BLANCHARD & LEA'S MEDICAL CHURCHILL (FLEETWOOD), M. D., M. R. I. A., &.C. ON THE DISEASES OF YYOMKN; including those of Pregnancy and Child- bed. A new American edition, revised by the Author. With Notes and Additions, by D J Ran- cis Condie, M. D., author of " A Practical Treatise on the Diseases of Children. in one lur^e and handsome octavo volume, with wood-cuts, leather, pp. 6\S4. *:! 00. larity. This fifth edition, before us. is well calcu- lated7 to maintain Dr. Churchill'i high repotation. It was revised and enlarged by the author for nil ^Ye now regretfully take leave of Dr. Churchill's book. Had our typographical limits permitted, we Bhould gladly have borrowed more from its richly stored pages. In conclusion, wr heartily recom- mend it to the profession, and would at the same time express our firm conviction that it will not only add to the reputation of its author, but will prove a work of great and extensive utility to obstetric practitioners.—Dublin Medical Press. Former editions of this work have been noticed in previous numbers of the Journal. The sentiments of high commendation expressed in those notices, have only to be repeated in this; not from the fact that the profession at large are not aware of the high merits which this work really possesses, but from a desire to see the principles and doctrines therein contained more generally recognized, and more uni- versally carried out in practice.—N. Y. Journal of Medicine. We know of no author who deserves that appro- bation, on "the diseases of females," to the same extent that Dr. Churchill does. His, indeed, is the only thorough treatise we know of on the subject; and it may be commended to practitioners and stu- dents as a masterpiece in its particular department. The former editions of this work have been com- mended strongly in this journal, and they have won their way to an extended, and a well-deserved popu- American publishers, und it seems to us that there is scarcely anv species of desirable information on its subjects that may not be found in this work.—Ihi Western Journal of Medicine and Surgery. We are gratified to announce a new and revised edition of Dr. Churchill's valuable work on the dis- eases of females We have ever regarded it as one of the very best works on the subjects embraced within its scope, in the English language; and the present edition, enlarged and revised by the author, renders it still more entitled to the confidence of the profession. The valuable notes of Prof. Huston have been retained, and contribute, in no small de- gree, to enhance the value of the work. It is a source of congratulation that the publishers have permitted the author to be, in this instance, hig own editor, thus securing all the revision which an author alone is capable of making.—The Western Lancet. Asa comprehensive manual for students, or a work of reference for practitioners, we only speak with common justice when we say that it surpasses any other that has ever issued on the same sub- ject from the British press.—The Dublin Quarterly Journal. DICKSON (S. H.), M. D., Professor of Institutes and Practice of Medicine in the Medical College of South Carolina. ELEMENTS OF MEDICINE; a Compendious View of Pathology and Thera- peutics, or the History and Treatment of Diseases. In one large and handsome octavo volume, of 750 pages, leather (Now Ready.) $3 75. As an American text-book on the Practice of Medicine for the student, and as a condensed work of reference for the practitioner, this volume will have strong claims on the attention of the profession. Few physicians have had wider opportunities than the author for observation and experience, and few perhaps have used them better. As the result of a life of study and practice, therefore, the present volume will doubtless be received with the welcome it deserves. This book is eminently what it professes to be: a distinguished merit in these days. Designed for " Teachers and Students of Medicine," and admira- bly suited to their wants, we think it will be received, on its own merits, with a hearty welcome.—Boston Med. and Surg. Journal. Indited by one of the most accomplished writers of our country, as well as by one who has long held a high position among teachers and practitioners of medicine, this work is entitled to patronage and careful study. The learned author has endeavored to condense in this volume most of the practical matter contained in his former productions, so as to adapt it to the use of those who have not time to devote to more extensive works.—Southern Med. and Surg. Journal. We can strongly recommend Dr. Dickson's work to our readers as one of interest and practical utility, well deserving of a place in their libraries as a book of reference ; and we especially commend the first part as presenting an admirable outline of the princi- ples of medicine.—Dublin Quarterly Journal, Feb. 1656 This volume, while as its title denotes it is a compendious view, is also a comprehensive system of practice, perspicuously and pleasantly written, and admirably suited to engage the interest, and in- struct the reader.—Peninsular Journal of Medicine, Jan. IsoG. This volume is designed as a text-book for teachers and students; but its merits extend far beyond its modest dedication ; it is a complete treatise upon me- dicine, and one that will stand the test of years. The arrangement is simple, a feature oftentimes obscured in otherwise excellent works. This Treatise is a valuable addition to ourmedical literature, and in the | Lancet clear and accurate descriptions, purity, and simpli- city of style, and soundness of precept, the reader will find much to admire and adopt, and Dot a little that calls for deep reflection. We cordially recom- mend this volume to our readers, whether old prac- titioners or students, for we take it that the physician should always be a student.—American Lancet. Prof. Dickson's work supplies, to a great extent, a desideratum long felt in American medicine.—iV. O. Med. and Surg. Journal. Estimating this work according to the purpose for which it is designed, we must think highly of its merits, and we have no hesitation in predicting for i t a favorable reception by both student s and teachers. Not professing to be a complete and comprehensive treatise, it will not be found full in detail, nor filled with discussions of theories and opinions, but em- bracing all that is essential in theory and practice,, it is admirably adapted to the wants of the American student. Avoiding all that is uncertain, it presents more clearly to the mind of the reader that which is established and verified by experience. The varied and extensive reading of the author is conspicuously apparent, and all the recent improvements and dis- coveries in therapeutics and pathology are chroni- cled in its pages.—Charleston Med. Journal. In the first part of the work the subject of gene- ral pathology is presented in outline, giving a beau- tiful picture of its distinguishing features, and throughout the succeeding chapters we find that he has kept scrupulously within the bounds of sound reasoning und legitimate deduction. Upon the whole, we do not hesitate to pronounce it a superior work in its class, and that Dr. Dickson meriti a place in the first rank of American writers.__Western DAY'S PRACTICAL TREATISE ON THK DO- MESTIC MANAGEMENT AND MORE DO- DE JONGH ON COD-LIVER OIL, comparative!v IM- | considered, with its Chemical and Theranentin PORTANT DISEASES OF ADVANCED LIFE. I Properties. In one 12mo. vol., ex. cloth 75 cent One volume, octavo, cloth, 220 pages. $100. | s' AND SCIENTIFIC PUBLICATIONS. 1L DRUITT (ROBERT), M.R. C.S., &c. THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. A new American, from the improved London edition. Edited by F. W. Sargent, M. D., author of " Minor Surgery," &c. Illustrated with one hundred and ninety-three wood-engravings. In one very handsomely printed octavo volume, leather, of 576 large pages. $3 00. Dr. Druitt's researches into the literature of his subject have been not only extensive, but well di- rected ; the most discordant authors are fairly and impartially quoted, and, while due credit is given to each, their respective merits are weighed with an unprejudiced hand. The grain of wheat is pre- served, and the chaff is unmercifully stripped off. The arrangement is simple and philosophical, and the style, though clear and interesting, is so precise, that the book contains more information condensed into a few words than any other surgical work with which we are acquainted.—London Medical Times and Gazette. No work, in our opinion, equals it in presenting so much valuable surgical matter in so small a compass.—St. Louis Med. and Surgical Journal. Druitt's Surgery is too well known to the Ameri- can medical profession to require its announcement anywhere. Probably no work of the kind has ever been more cordially received and extensively circu- lated than this. The fact that it comprehends in a comparatively small compass, all the essential ele- ments of theoretical and practical Surgery—that it is found to contain reliable and authentic informa- tion on the nature and treatment of nearly all surgi- cal affections—is a sufficient reason for the liberal patronage it has obtained. The editor, Dr. F. W. Sargent, has contributed much to enhance the value of the work, by such American improvements as are calculated more perfectly to adapt it to our own views and practice in this country. It abounds everywhere with spirited and life-like illustrations, which to the young surgeon, especially, are of no minor consideration. Every medical man frequently needs just such a work as this, for immediate refer- ence in moments of sudden emergency, when he has not time to consult more elaborate treatises.—The Ohio Medical and Surgical Journal. The author has evidently ransacked every stand- ard treatise of ancient and modern times, and all that is really practically useful at the bedside will be found in a form at once clear, distinct, and interest- ing.—Edinburgh Monthly Medical Journal. Druitt's work, condensed, systematic, lucid, and practical as it is, beyond most works on Surgery accessible to the American student, has had much currency in this country, and under its present au- spices promises to rise to yet higher favor.—The Western Journal of Medicine and Surgery. The most accurate and ample resume of the pre- sent state of Surgery that we are acquainted with.— Dublin Medical Journal. A better book on the principles and practice of Surgery as now understood in England and America, has not been given to the profession.—Boston Medi- cal and Surgical Journal. An unsurpassable compendium, not only of Sur- gical, but of Medical Practice.—London Medical Gazette. This work merits our warmest commendations, and we strongly recommend it to young surgeons as an admirable digest of the principles and practice of modern Surgery.—Medical Gazette. It may be said with truth that the work of Mr. Druitt affords a complete, though brief and con- densed view, of the entire field of modern surgery. We know of no work on the same subject having the appearance of a manual, which includes so many topics of interest to the surgeon ; and the terse man- ner in which each has been treated evinces a most enviable quality of mind on the part of the author, who seems to have an innate power of searching out and grasping the leading facts and features of the most elaborate productions of the pen. It is a useful handbook for the practitioner, and we should deem a teacher of surgery unpardonable who did not recommend it to his pupils. In our own opinion, it is admirably adapted to the wants of the student.— Provincial Medical and Surgical Journal. DUNGLISON, FORBES, TWEEDIE, AND CONOLLY. THE CYCLOPAEDIA OF PRACTICAL MEDICINE: comprising Treatises on the Nature and Treatment of Diseases, Materia Medica, and Therapeutics, Diseases of Women and Children, Medical Jurisprudence, &c. &c. In four large super-royal octavo volumes, of 3254 double-columned pages, strongly and handsomely bound, with raised bands. $12 00. **.* This work contains no less than four hundred and eighteen distinct treatises, contributed by sixty-eight distinguished physicians, rendering it a complete library of reference for the country practitioner. The most complete work on Practical Medicine | titioner. This estimate of it has not been formed extant- or, at least, in our language.—Buffalo from a hasty examination,_but after an intimate ac- Medical and Surgical Journal For reference, it is above all price to every prac- titioner.—Western Lancet. One of the most valuable medical publications of the day__as a work of reference it is invaluable.— Western Journal of Medicine and Surgery. It has been to us, both as learner and teacher, a work for ready and frequent reference, one in which modern English medicine is exhibited in the most advantageous light.—Medical Examiner. We rejoice that this work is to be placed within the reach of the profession in this country, it being unquestionably one of very great value to the prac- quaintance derived from frequent consultation of it during the past nine or ten years. The editors are practitioners of established reputation, and the list of contributors embraces many of the most eminent professors and teachers of London, Edinburgh, Dub- lin, and Glasgow. It is, indeed, the great merit of this work that the principal articles have been fur- nished by practitioners who have not only devoted especial attention to the diseases about which they have written, but have also enjoyed opportunities for an extensive practical acquaintance with them, and whose reputation carries the assurance of their competency justly to appreciate the opinions of others, while it stamps their own doctrines with high and just authority.—American Medical Journ. DEWEES'S COMPREHENSIVE SYSTEM OF MIDWIFERY. Illustrated by occasional cases and many engravings. Twelfth edition, with the author's last improvements and corrections In one octavo volume, extra cloth, of 600 pages. $320. IIFWEES'S TREATISE ON THE PHYSICAL AND MKDICAL TREATMENT OF CHILD- REN Tenth edition. In one volume, octavo, extra cloth, 518 pages. $2 80. DEWEES'S TKEATISE ON THE DISEASES OF FEMALES. Tenth edition. In one volume, octavo, extra cloth, 532 pages, with plates. S3 00. DANA ON ZOOPHYTES AND CORALS. In one volume, imperial quarto, extra cloth, with wood- cuts. $15 00. Also, AN ATLAS, in one volume, imperial folio, with sixty-one magnificent colored plates. Bound in half morocco. $30 00. DE LA BECHE'S GEOLOGICAL OBSERVER. In one very larjreand handsome octavo volume, ex- tra cloth, of 700 pages, with 300 wood-cuts. $4 00. FRICK ON RENAL AFFECTIONS; their Diag- nosis and Pathology. With illustrations. One volume, royal 12mo., extra cloth. 75 cents 12 BLANCHARD & LEA"S MEDICAL DUNGLISON (ROBLEY), M.D., Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia. MEDICAL LEXICON; a Dictionary of Medical Science, containing a concise Explanation oft Pharmacology, Notices of Climaic ami ui mcwuicu iumu9 work, to thoroughly revise and render it in every respect worthy, so far as in his power, oMne very flattering reception which has been accorded to it b"y the profession. The new matter thus added amounts to almost one-third of the original work, while the number of illustrations has been nearly doubled. These additions pervade every portion of the work, which thus has rather the aspect of a new treatise than a new edition. In its present improved form, therefore, it may confidently be presented as a complete and reliable storehouse of information on this important class of diseases, and as in everyway fitted to maintain (he position which it has acquired in Europe and in this country, as the standard of authority on the subjects treated of. provements, it will probably remain one of the most valuable works on this subject so long as the science of medicine shall exist— Boston Med. and Surg. A volume replete with truths and principles of the utmost value in the investigation of these diseases.— American Medical Journal. On the appearance of the first edition of this work, the leading English medical review predicted that it would have a " permanent place in the literature of surgery worthy to rank with the best works of the present age." This prediction has been amply ful- filled. Dr. Gross's treatise has been found to sup- ply completely the want which has been felt ever since the elevation of surgery to the rank of a science, of a good practical treatise on the diseases of the bladder and its accessory organs. Philosophical in its design, methodical in its arrangement, ample and sound in its practical details, it may in truth be said to leave scarcely anything to be desired on so im- portant a subject, and with the additions and modi- fications resulting from future discoveries and im- Journal. "Dr. Gross has brought all his learning, experi- ence, tact, and judgment to the task, ami has pro- duced a work worthy o( his high reputation. AVe feel perfectly safe in recommending it to our read- ers as a monograph unequalled in interest and practical value by any other on the subject in our language.—Western Journal of Med. and Surg. Whoever will peruse the vast amount of valuable practical information it contains, and which we have been unable even to notice, will, we think, agree with us, that there is no work in the English language which can make any just pretensions to be its equal.—N. Y. Journal of Medicine. BY THE SAME AUTHOR. (Just Issued). A PRACTICAL TREATISE ON FOREIGN BODIES IN THE AIR-PAS- SAGES. In one handsome octavo volume, extra cloth, with illustrations, pp.468. $2 75. A very elaborate work. It is a complete summary of the whole subject, and will be a useful book of reference.—British and Foreign Medico-Chirurg. Review. A highly valuable book of reference on a most im- portant subject in the practice of medicine. We conclude by recommending it to onr readers, fully persuaded that its perusal will afford them much practical information well conveyed, evidently de- rived from considerable experience and deduced from an ample collection o{ facts. — Dublin Quarterly Journal, May, 1855. » BY THE same AUTHOR. (Preparing.) A SYSTEM OF SURGERY; Diagnostic, Pathological, Therapeutic, and Opera- tive. With very numerous engravings on wood. BY THE SAME AUTHOR. ELEMENTS OF PATHOLOGICAL ANATOMY; illustrated by colored En- gravings, and two hundred and fifty wood-cuts. Second edition, thoroughly revised and greatly enlarged. In one very large and handsome imperial octavo volume, leather, raised bands, pp. S2-J. §5 75. > > i F GLUGE (GOTTLIEB), M. D., Professor of Physiology and Pathological Anatomy in the University of Brussels, fcc. AN ATLAS OF PATHOLOGICAL HISTOLOGY. Translated, with Notes and Additions, by Joseph Leidy, M. D., Professor of Anatomy in the University of Pennsylva- nia. In one volume, very large imperial quarto, extra cloth, with 320 figures, plain and colored, on twelve copperplates. $5 00. GARDNER'S MEDICAL CHEMISTRY, for the use of Students and the Profession. In one royal l2mo. vol., ex. cloth, pp. 396, with illustrations. St 00. HARRISONS ESSAY TOWARDS A CORRECT THEORY OF THE NERVOUS SYSTEM. In one octavo volume, leather, 292 pages. SI 50. HUGHES' CLINICAL INTRODUCTION TO THE PRACTICE OF AUSCULTATION AND OTHER MODES OF PHYSICAL DIAGNOSIS. IN DISEASES OF THE LUNGS AND HEART! Second American, from the second London edition 1 vol. royal 12mo., ex. cloth, pp. 3(4. -Si 00. In one handsome HAMILTON (FRANK H.), M. D., Professor of Surgerv, in Buffalo Medical College, ice. A TREATISE ON FRACTURES AND DISLOCATIONS. octavo volume, with numerous illustrations. (Preparing.) The numerous improvements which this important branch of surgery has received from the «k'll and ingenuity of American surgeons, renders particularly appropriate and valuable a comnletonnH systematic original work on the subject. The es.-ays which Professor Hamilton has published on kindred topics are already widely and favorably known, and give earnest that his forthcoming work will prove indispensable, both as a text-book for the student, and as a guide for the practitioner AND SCIENTIFIC PUBLICATIONS. 17 HOBLYN (RICHARD D.), M. D. A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE COLLATERAL SCIENCES. By Richard D. Hoblyn, A. M, &e A new American from the last London edition. Revised, with numerous Additions, by Isaac Hays, M. D., editor of the "American Journal of the Medical Sciences." In one large royal 12mo. volume, leather, of over 500 double columned pages. (Now Ready, 1856.) $1 50. The great care bestowed on the revision of this work, and the extensive additions made to it by the editor, have caused the delay in its appearance. While carefully excluding obsolete words, it has been his aim to render it a complete manual of definitions, in which the student of medicine or of its allied sciences might feel assured of being able to find concise explanations of all terms occur- ring in his course of reading. The amount of the additions thus made, may be estimated from the fact that the present edition contains fully one-third more matter than the last, the number of pages having been increased by over one hundred, notwithstanding an enlargement of the size of the page, while at the same time it has been kept at the former exceedingly low price.' If the frequency with which we have referred to this volume since its reception from the publisher, two or three weeks ago, be any criterion for the future, the binding will soon have to be renewed, even with careful handling. We find that Dr. Hays has done the profession great service by his careful and industrious labors. The Dictionary has thus become eminently suited to our medical brethren in this country. The additions by Dr. Hays are in brackets, and we believe there is not a single page but bears these insignia; in every instance which we have thus far noticed, the additions are really needed and ex- ceedingly valuable. We heartily commend the work to all who wish to be au courant in medical termi- nology.—Boston Med. and Surg. Journal. To both practitioner and student, we recommend this dictionary as being convenient in size, accurate in definition, and sufficiently full and complete for ordinary consultation.—Charleston Med. Journ. and Review. Admirably calculated to meet the wants of the practitioner or student, who has neither the means nor desire to procure a larger work. — American Lancet. Hoblyn has always been a favorite dictionary, and in its present enlarged and improved form will give greater satisfaction than ever. The American editor, Dr. Hays, has made many very valuable additions. —Ar. J. Med. Reporter. To supply the want of the medical reader arising from this cause, we know of no dictionary better arranged and adapted than the one bearing the above title. It is not encumbered with the obsolete terms of a bygone age, but it contains all that are now in use ; embracing every department of medical science down to the very latest date. The volume is of a convenient size to be used by the medical student, and yet large enough to make a respectable appear- ance in the library of a physician.—Western Lancet. Hoblyn's Dictionary has long been a favorite with us. It is the best book of definitions we have, and ought always to be upon the student's table.— Southern Med. and Surg. Journal. HUNTER (JOHN). TREATISE ON THE VENEREAL DISEASE. With copious Additions, by Dr. Ph. Ricord, Surgeon to the Venereal Hospital of Paris. Edited, with additional Notes, by F. J. Bumstead, M. D. In one octavo volume, with plates. $3 25. I3P See Ricord. Also, HUNTER'S COMPLETE WORKS, with Memoir, Notes, &c. &c. In four neat octavo volumes, leather, with plates. $10 00. HORNER (WILLIAM E.), M. D., Professor of Anatomy in the University of Pennsylvania. SPECIAL ANATOMY AND HISTOLOGY. Eighth edition. Extensively revised and modified. In two large octavo volumes, extra cloth, of more than one thousand pages, handsomely printed, with over three hundred illustrations. $6 00. ■ This edition enjoyed a thorough and laborious revision on the part of the author shortly before his death, with the view of bringing it fully up to the existing state of knowledge on the subject of general and special anatomy. To adapt it more perfectly to the wants of the student, he introduced a large number of additional wood-engravings, illustrative of the objects described, while the pub- lishers have endeavored to render the mechanical execution of the work worthy of its extended reputation. JONES (T. WHARTON), F. R. S., Professor of Ophthalmic Medicine and Surgery in University College, London, &c. THE PRINCIPLES AND PRACTICE OF OPHTHALMIC MEDICINE AND SURGERY. With one hundred and ten illustrations. Second American from the second arid revised London edition, with additions by Edward Hartshorne, M. D., Surgeon to Wills' Hospital, &c. In one large, handsome royal 12mo. volume, extra cloth, of 500 pages. (Now Ready.)' $1 50. The thorough revisions which this work has undergone at the hands of both author and editor have broughtu thoroughly up to the present state of the subject, and have rendered it complete, without detracting from its character as a manual, or deviating from its orig-inal object of affording a digest of the present condition of ophthalmic science for study and reference by tho?e whose leisure does not admit of their perusing the larger works of Mackenzie or Lawrence. By an en- largement of the size of the page, the numerous additions to this edition have been accommodated without increasing the bulk of the volume, and at Ihe very low price at which it is offered, a con- tinuance of the favor which it has hitherto received is confidently expected. ly wrought up, and digested in the author's mind, as to come forth with the freshness and impressive- ness of an original production. We entertain little doubt that this book will become what its author hoped it might become, a manual for daily reference and consultation by the student and the general prac- titioner. The work is marked by that correctness, clearness, and precision of style which distinguish all the productions of the learned author.—British and For. Med. Review. We are confident tha* the reader will find, on nerusal, that the execution of the work amply fulfils the promise of the preface, and sustains, in every point, the already h.gh reputation of the author as an ophthalmic surgeon as well as a physiologist and pathologist. The book is evidently the result of much labor and research, and has been written with the greatest care and attention; it possesses that best quality whi(* a general work, like a sys- tem or manual can show, viz: the quality of having all the materials whencesoever derived, so thorough- 18 BLANCHARD & LEA'S MEDICAL JONES (C. HANDFIELD), F. R. S., &. EDWARD H. SI EV EKING, M.D., Assistant Physicians and Lecturers in St. Mary's Hospital, London. _ A MANUAL OF PATHOLOGICAL ANATOMY. First American Edition, Revised. With three hundred and ninety-seven handsome wood engravings In one large tyia beautiful octavo volume of nearly 750 pages, leather. (Lately Issued.) $J 7,)- Asa concise text-book, containing, in a condensed authors have not attempted to in^.r"''P "f^IA^L"" form, n complete outline of what is known in the their professional brethren, Dl".^Lm» ' 011 tline of the domain of Pathological Anatomy, it is perhaps the them, what has long been wonteti.M ouiiuie best work in the English language. Its great merit present condition ol pathological' nn«omy. in_inu consists in its completeness Slid brevity, and in this j they have been completely success! I. e w ^u respect it supplies a great desideratum in our lite- one of the best compilations wh eh we I ave ever raturc. Heretofore the student of pathology was perused. The opinions and d .coveries ot tta obliged to glean from a great number of monographs, I leading pathologists and P'iy«'ol<>g,st8 aTe. *"fi™]*?^ and the field was so extlnsive that but few cultivated I so that by reading any subject; treat.ed in the book it with any de-ree of success. The authors of the I you have a synopsis of the views ot the most ap- present work have sought to corrrct this defect by | proved authors.-CAaW«*on Medical Journal and placing before the reader a summary of ascertained Review. facts, together with the opinions of the most eminent j yye have no hesitation in recommending it as pathologists both of the Old and New World. Asa ! WOrthyof careful and thorough study by every men- at I ber of the profession, old or young.—N. W. Med. simple work of reference, therefore, it is of greal value to the student of pathological anatomy, and Bhould be in every physician's library.— Western Lancet. We urge upon our readers and the profession gene- rally the importance of informing themselves in re- gard to modern views of pathology, and recommend to them to procure the work before us as the best means of obtaining this information.—Stethoscope. In offering the above titled work to the public, the and Surg. Journal. From the casual examination we have given we are inclined to regard it as a text-book, plain, ra- tional, and intelligible, such a book as the practical man needs for daily reference. For this reason it will be likely to be largely useful, as it suits itself to those busy men who have little time for minute investigation, and prefer a summary to an elaborate treatise.—Buffalo Medical Journal. KIRKES (WILLIAM SENHOUSE), M. D., Demonstrator of Morbid Anatomy at St. Bartholomew's Hospital, &c; and JAMES PAGET, F. R. S., Lecturer on General Anatomy and Physiology in St. Bartholomew's Hospital. A MANUAL OF PHYSIOLOGY. Second American, from the second and improved London edition. With one hundred and sixty-five illustrations. In one large and handsome royal 12mo. volume, leather, pp. 550. $2 00. the practitioner who has but leisure to" refresh hia me"mory, this book is invaluable, as it contains all that it is important to know, without special details, In the present edition, the Manual of Physiology has been brought up to the actual condition of the Bcience, and fully sustains the reputation which it has already so deservedly attained. We consider the work of MM. Kirkes and Paget to constitute one of the very best handbooks of Physiology we possess —presenting just such an outline of the science, com- prising an account of its leading facts and generally admitted principles, as the student requires during his attendance upon a course of lectures, or for re- ference whilst preparing for examination.— Am. Medical Journal. We need only say, that, without entering into dis- cussions of unsettled questions, it contains all the recent improvements in this department of medical science. For the student beginning this study, and which are Tead with interest only by those who would make a specialty, or desire to possess a criti- cal knowledge of the subject.—Charleston Medical Journal. One of the best treatises that can be put into the hands of the student.—London Medical Gazette. Particularly adapted to those who desire to pos- sess a concise digest of the facts of Human Physi- ology.—British and Foreign Med.-Chirurg. Review. We conscientiously recommend it as an admira- ble "Handbook of Physiology."—London Journal of Medicine. KNAPP'S TECHNOLOGY; or,Chemistry applied to the Arts and to Manufactures. Edited, with numerous Notes and Additions, by Dr. Edmund Ronalds and Dr. Thomas Richardson. First American edition, with Notes and Additions, by Prof. Walter R. Johnson. In two handsome octavo volumes, extra cloth, printed and illus- trated in the highest style of art, with about 500 wood-engravings. $6 00. LALLEMAND ON THE CAUSES, SYMPTOMS, AND TREATMENT OF SPERMATORRHOEA. Translated and edited by Henry J. McDougal. In one volume, octavo, extra cloth, 320 pages. Second American edition. $1 75. LUDLOW'S MANUAL OF EXAMINATIONS upon Anatomy and Physiology, Surgery, Practice of Medicine, Chemistry, Obstetrics, Materia Me- dica, Pharmacy, and Therapeutics. Designed foe Students of Medicine throughout the United States. A new edition, revised and improved. Inonela'ge royal 12mo. volume, with several hundred illus- trations. (Preparing.) LEES CLINICAL MIDWIFERY. In one royal 12mo. volume, extra cloth, of 238 pages. 75 cents. LISTON'S LECTURES ON THE OPERATIONS OF SURGERY. Edited, with numerous Addi- tions and Alterations, by T. D. Mutter, M. D. In one large and handsome octavo volume, leather, of 566 pages, with 216 wood-cuts, f 3 00. LARDNER (DIONYSIUS), D. C. L., &.c. HANDBOOKS OF NATURAL PHILOSOPHY AND ASTRONOMY. Revised, with numerous Additions, by the American editor. First Course, containing Mecha- nics, Hydrostatics, Hydraulics, Pneumatics, Sound, and Optics. In one large royal 12mo. volume, of 750 pages, with 424 wood-cuts. §1 75. Second Course, containing Heat, Electricity Magnetism, and Galvanism, one volume, large royal 12mo., of 450 pages, with 250 illustrations! 81 25. Third Course (now ready), containing Meteorology and Astronomy, in one large volume royal 12mo. of nearly eight hundred pages, with thirty-seven plates and two hundred wood-cuts! S2 00. The whole complete in three volumes, of about two thousand large pages, with over one thousand figures on steel and wood. $5 00. Any volume sold separate, strongly bound in leather. The various sciences treated in this work will be found brought thoroughly «p to the latest period. AND SCIENTIFIC PUBLICATIONS. 19 LEHMANN (C. G.) PHYSIOLOGICAL CHEMISTRY. Translated from the second edition by George E. Day, M. D., F. R. S., &c, edited by R. E. Rogers, M. D., Professor of Chemistry in the^Medical Department of the University of Pennsylvania, with illustrations selected from ]? unke's Atlas of Physiological Chemistry, and an Appendix of plates. Complete in two large and handsome octavo volumes, extra cloth, containing 1200pages, with nearly two hundred illus- trations. (Now Ready.) $6 00. This great work, universally acknowledged as the most complete and authoritative exposition of the principles and details of Zoochemistry, in its passage through the press, has received from Professor Rogers such care as was necessary to present it in a correct and reliable form. To such a work additions were deemed superfluous, but several years having elapsed between the appear- ance in Germany of the first and last volume, the latter contained a supplement, embodying nume- rous corrections and additions resulting from the advance of the science. These have all been incor- porated in the text in their appropriate places, while the subjects have been still further elucidated by the insertion of illustrations from the Atlas of Dr. OttoFunke. With the view of supplying the student with the means of convenient comparison, a large number of wood-cuts, from works on kindred subjects, have also been added in the form of an Appendix of Plates. The work is, therefore, pre- sented as in every way worthy the attention of all who desire to be familiar with the modern facts and doctrines of Physiological Science. The most important contribution as yet made to Physiological Chemistry__Am. Journal Med. Sci- ences, Jan. 1856. The present volumes belong to the small class of medical literature which comprises elaborate works of the highest order of merit.—Montreal Med. Chron- icle, Jan. 1856. The work of Lehmann stands unrivalled as the most comprehensive book of reference and informa- tion extant on every branch of the subject on which it treats.—Edinburgh Monthly Journal of Medical Science. All teachers must possess it, and every intelligent physician ousrht to do likewise.—Southern Med. and Surg. Journal, Dec. 1855. by the same author. (Now Ready, 1856.) MANUAL OF CHEMICAL PHYSIOLOGY. Translated from the German, with Notes and Additions, by J. Cheston Morris, M. D., with an Introductory Essay on Vital Force, by Samuel Jackson, M. D., Professor of the Institutes of Medicine in the University of Pennsylvania. With illustrations on wood. In one very handsome octavo volume, extrac'oth, of 336 pages. $2 25. The original of this work, though but lately issued by its distinguished author, has already assumed the highest position, as presenting in their latest development the modern doctrines and discoveries in the chemistry of life. The numerous additions by the translator, and the Introduc- tion by Professor Jackson will render its physiological aspect more complete than designed by the author, and will adapt it for use as a text-book of physiology, presenting more thoroughly than ha-s yet been attempted, the modifications arising from the vast impulse which organic chemistry has received within a few years past. From Prof. Jackson's Introductory Essay. In adopting the handbook of Dr. Lehmann as a manual of Organic Chemistry for the use of the students of the University, and in recommending his original work of Physiological Chemistry for their more mature studies, the high value of his researches, and the great weight of his autho- rity in that important department of medical science are fully recognized. The present volume will be a very convenient one I densed form, the positive facts of Physiological for students, as offering a brief epitome of the more Chemistry.—Am. Journal Med. Sciences, April, 185G. elaborate work, and as containing, in a very con- | Already well known and appreciated by the scien- tific world, Professor Lehmann's great work re- quires no laudatory sentences, as, under a new garb, it is now presented to us. The little space at our command would ill suffice to set forth even a small portion of its excellences. To all whose studies or professional duties render the revelations of Physio- logical Chemistry at once interesting and essential, these volumes will be indispensable. Highly com- plimented by European reviewers, sought for with avidity by scholars of every nation, and admirably written throughout, it is sure to win a welcome and to be thoroughly studied.—Boston Med. and Surg. Journal, Dec. 1855. LAWRENCE (W.), F. R. S., &.c. A TREATISE ON DISEASES OF THE EYE. A new edition, edited, with numerous additions, and 243 illustrations, by Isaac Hays, M. D., Surgeon to Will's Hospi- tal, &c. In one very large and handsome octavo volume, of 950 pages, strongly bound in leather with raised bands. $5 00. This work is so universally recognized as the standard authority on the subject, that the pub- lishers in presenting this new edition have only to remark that in its preparation the editor has carefully revised every portion, introducing additions and illustrations wherever the advance of science has rendered them necessary or desirable, constituting it a complete and thorough exponent of the most advanced state of the subject. This admirable treatise—the safest guide and most comprehensive work of reference, which is within the reach of the profession.—Stethoscope. This standard text-book on the department of which it treats, has not been superseded, by any or all of the numerous publications on the subject heretofore issued. Nor with the multiplied improve- ments of Dr. Hays, the American editor, is it at all likely that this great work will cease to merit the confidence and preference of students or practition- ers. Its ample extent—nearly one thousand large octavo pages—has enabled both author and editor to do justice to all the details of this subject, and con- dense in this single volume the present state of our knowledge of the whole science in this department, whereby its practical value cannot be excelled. We heartily commend it, especially as a book of refer- ence, indispensable in every medical library. The additions of the American editor very greatly en- hance the value of the work, exhibiting the learning and experience of Dr. Hays, in the light in which he ought to be held, as a standard authority on all sub- jects appertaining to this special ty.—N.Y. Med.Gaz. 20 BLANCHARD & LEA'S MEDICAL LA ROCHE (R.), M. D., &c. YELLOW FEYER, considered in its Historical, Pathological, Etiological, and Therapeutical Relations. Including a Sketch of the Disease as it has occurred in Philadelphia from 1<)99 to 1854, with an examination of the connections between it and the fevers known unoer the same name in other parts of temperate as well as in tropical regions^ In two large ana handsome octavo volumes of nearly 1500 pages, extra cloth. (Now Ready.) $7 00. The publishers are happy in being able at lensrth to present to the profession this great work, which they are assured will be regarded as an honor to the medical literature of the country, as the result of many years of personal observation and study, as embodying an intelligent resume ol all that has been written regarding the disease, and as exhausting the subject in all its various aspects, these volumes must at once take the position of the standard authority and work ol refer- ence on the many important questions brought into consideration. erection of this towering monument to his own fame, and to the glory of the medical literature of his own country It is destined to remain the great autho- rity upon the subject of Yellow Fever. The student and physician will find in these volumes a risumi - . " J i /-.l 1______1 _ -1__„ril,n ...nrU linn. From Professor S. H. Dickson, Charleston, S. C, September 18, 1855. A monument of intelligent and well applied re- search, almost without example. It is, indeed, in itself, a large library, and is destined to constitute the special resort as a book of reference, in the subject of which it treats, to all future time. We have not time at present, engaged as we are, by day and by night, in the work of combating this very disease, now prevailing in our city, to do more than give this cursory notice of what we consider as undoubtedly the most able and erudite medical publication our country has yet produced But in view of the startling fact, that this, the most malig- nant and unmanageable disease of modern times, has for several years been prevailing in our country to a greater extent than ever before; that it is no longer confined to either large or small cities, but penetrates country villages, plantations, and farm- houses; that it is treated with scarcely better suc- cess now than thirty or forty years ago; that there is vast mischief done by ignorant pretenders to know- ledge in regard to the disease, and in view of the pro- bability that a majority of southern physicians will be called upon to treat the disease, we trust that this able and comprehensive treatise will be very gene- rally read in the south.—Memphis Med. Recorder. This is decidedly the great American medical work of the day—a full, complete, and systematic treatise, unequalled by any other upon the all-important sub- ject of Yellow Fever. The laborious, indefatigable, and learned author has devoted to it many years of arduous research apd careful study, and the result is such as will reflect the highest honor upon the author and our country.— Southern Med. and Surg. Journal. The genius and scholarship of this great physician could not have been better employed than in the of the sum total of the knowledge of the world upon the awful scourge which they so elaborately discuss. The style iB so soft and so pure as to refresh and in- vigorate the mind while absorbing the thoughts of the gifted author, while the publishers have suc- ceeded in bringing the externals into a most felicitous harmony with the inspiration that dwells within. Take it all in all, it is a book we have often dreamed of, but dreamed not that it would ever meet our waking eye as a tangible reality.—Nashville Journal of Medicine. We deem it fortunate that the splendid work of Dr. La Roche should have been issued from the press at this particular time. The want of a reliable di- gest of all that is known in relation to this frightful malady has long been felt—a want very satisfactorily met in the work before us. We deem it but faint praise to say that Dr. La Rcche has succeeded in presenting the profession with an able and complete monograph, one which will find its way into every well ordered library.— Va. Stethoscope. Although we have no doubt that controversial treatises on the mode of origin and propagation of the fever in question will, as heretofore, occasionally appear, yet it must be some time before another sys- tematic work can arise in the face of so admirable and carefully executed a one as the present. It is a mine of information, quite an encyclopaedia of refer- ences, and risumi'. of knowledge relative to what has been recorded upon the subject.—London Lancet. A miracle of industry and research, constituting a complete library of reference on the disease of which it treats.—Dublin Quarterly Journal. BY THE SAME AUTHOR. PNEUMONIA; its Supposed Connection, Pathological and Etiological, with Au- tumnal Fevers, including an Inquiry into the Existence and Morbid Agency of Malaria. In one handsome octavo volume, extra cloth, of 500 pages. $3 00. A more simple, clear, and forcible exposition of I This work should becarefully studied by Southern the groundless nature and dangerous tendency of | physicians, embodying as it does the reflections of certain pathological and etiological heresies, has I an original thinker and close observer on a subject seldom been presented to our notice.—JV. Y. Journal peculiarly their own.— Virginia Med. and Surgical of Medicine and Collateral Science. I Journal. MULLER (PROFESSOR J.), M. D. PRINCIPLES OF PHYSICS AND METEOROLOGY. Edited, with Addi- tions, by R. Eglesfeld Griffith, M. D. In one large and handsome octavo volume, extra cloth, with 550 wood-cuts, and two colored plates, pp. 636. $3 50. The Physics of Mailer is a work superb, complete, I tion to the scientific records of this country may be unique: the greatest want known to English Science | duly estimated by the fact that the cost of the oriiri- could not have been better supplied. The work is I nal drawings and engravings alone has exceeded the of surpassing interest. The value of this contribu- sum of £2,000.—Lancet. MAYNE'S DISPENSATORY AND THERA- PEUTICAL REMEMBRANCER. Comprising the entire lists of Materia Medica. with every Practical Formula contained in the three British Pharmacopoeias. With relative Tables subjoined, illustrating, by upwards of six hundred and sixty examples, the Extemporaneous Forms and Com- binations suitable for the different Medicines. Edited, with the addition of the Formulas of the United States Pharmacopreia, by R. Eglesfeld Griffith, M. D. In one 12mo volume/extra cloth, of 300 large pages. 75 cents. MATTEUCCIS LECTURES ON THE PHYSI- CAL PHENOMENA OF LIVING BEINGS. Edited by J. Peueira,M.D. In one neat royal 12mo. volume, extra cloth, with cuts, 3a8 pages. MALGAIGXE'S OPERATIVE SURGERY based on Normal and Pathological Anatomy. Trans- lated from the French by Frederick Brittan A. B., MD. With numerous illustrutions on wood' In one handsome octavo volume, extra cloth of nearly six hundred pages. $2 25 ' ' AND SCIENTIFIC PUBLICATIONS. 21 MEIGS (CHARLES D.), M. D., Professor of Obstetrics, &c. in the Jefferson Medical College, Philadelphia. OBSTETRICS: THE SCIENCE AND THE ART. Second edition, revised and improved. With one hundred and thirty-one illustrations. In one beautifully printed octavo volume, leather, of seven hundred and fifty-two large pages. $3 75. The rapid demand for a second edition of this work is a sufficient evidence that it has supplied a desideratum of the profession, notwithstanding the numerous treatises on the same subject which have appeared within the last few years. Adopting a system of his own, the author has combined the leading principles of his interesting and difficult subject, with a thorough exposition of its rules of practice, presenting the results of long and extensive experience and of familiar acquaintance with all the modern writers on this department of medicine. As an American Treatise on Mid- wifery, which has at once assumed the position of a classic, it possesses peculiar claims to the at- tention and study of the practitioner and student, while the numerous alterations and revisions which it has undergone in the present edition are shown by the great enlargement of the work, which is not only increased as to the size of the page, but also in the number. BY THE same author. (Lately Issued.) WOMAN: HER DISEASES AND THEIR REMEDIES. A Series of Lee- tures to his Class. Third and Improved edition. In one large and beautifully printed octavo volume, leather. pp. 672. $3 60. The gratifying appreciation of his labors, as evinced by the exhaustion of two large impressions o£ this work within a few years, has not been lost upon the author, who has endeavored in every way to render it worthy of the favor with which it has been received. The opportunity thus afforded for a second revision has been improved, and the work is now presented as in every way superior to its predecessors, additions and alterations having been made whenever the advance ol science has rendered them desirable. The typographical execution of the work will also be found to have undergone a similar improvement, and the work is now confidently presented as in every way worthy the position it has acquired as the standard American text-book on the Diseases ol Females. It contains a vast amount of practical knowledge. by one who has accurately observed and retained the experience of many years, and who tells the re- sult in a free, familiar, and pleasant manner.—Dub- lin Quarterly Journal. There is an off-hand fervor, a glow, and a warm- heartedness infecting the effort of Dr. Meigs, which is entirely captivating, and which absolutely hur- ries the reader through from beginning to end. Be- sides, the book teems with solid instruction, and it shows the very highest evidence of ability, viz., the clearness with which the information is pre- sented. We know of no better test of one's under- standing a subject than the evidence of the power of lucidly explaining it. The most elementary, as well as the obscurest subjects, under the pencil of Prof. Meigs, are isolated and made to stand out in by the same author. (Lately Published.) ON THE NATURE, SIGNS, AND TREATMENT OF CHILDBED FEVER. In a Series of Letters addressed to the Students of his Class. In one handsome octavo volume, extra cloth, of 365 pages. S2 50. such bold relief, as to produce distinct impressions upon the mind and memory of the reader. — The Charleston Med. Journal. Professor Meigs has enlarged and amended this great work, for such it unquestionably is, having passed the ordeal of criticism at home and abroad, but been improved thereby ; for in this new edition the author has introduced real improvements, and increased the value and utility of the book im- measurably. It presents so many novel, bright, and sparkling thoughts j such an exuberance of new ideas on almost every page, that we confess our- selves to have become enamored with the book and its author; and cannot withhold our congratu- lations from ouf>*Philadelphia confreres, that such a teacher is in their service.—N. Y. Med. Gazette. This book will add more to his fame than either of those which bear his name. Indeed we doubt whether any material improvement will be made on the teachings of this volume for a century to come, since it is so eminently practical, and based on pro- found knowledge of the science and consummate skill in the art of healing, and ratified by an ample and extensive experience, such as few men have the industry or good fortune to acquire.—JV. Y. Med. Gazette. The instructive and interesting author of this work, whose previous labors in the department of medicine which he so sedulously cultivates, have placed his countrymen under deep and abiding obli- gations, again challenges their admiration in the fresh and vigorous, attractive and racy pages before us. It is a delectable book. * * * This treatise upon child-bed fevers will have an extensive sale, being destined, as it deserves, to find a place in the library of every practitioner who scorns to lag in the rear of his brethren.—Nashville Journal of Medi- cine and Surgery. by the same author ; with colored plates. (Lately Published.) A TREATISE ON ACUTE AND CHRONIC DISEASES OF THE NECK OF THE UTERUS. With numerous plates, drawn and colored from nature in the highest style of art. In one handsome octavo volume, extra cloth. $4 50. The object of the author in this work has been to present in a small compass the practical results of hi* lon°- experience in this important and distressing class of diseases. The great changes intro- duced into practice, and the accessions to our knowledge on the subject, within the last few years, resulting from the use of the metroscope, brings within the ordinary practice ol every physician numerous cases which were formerly regarded as incurable, and renders of great value a work like the present combining practical directions for diagnosis and treatment with an ample series of illus- trations, copied accurately from colored drawings made by the author, after nature. BY THE SAME AUTHOR. OBSERVATIONS ON CERTAIN OF THE DISEASES OF YOUNG CHILDREN. In one handsome octavo volume, extra cloth, of 214 pages. $175. 32 BLANCHARD & LEA'S MEDICAL MACLISE (JOSEPH), SURGEON. SURGICAL ANATOMY. Forming one volume, very large imperial quarto. With sixtv-eight large and splendid Plates, drawn in the best style and beautiful y ™°j™- V££ taining one hundred and ninety Figures, manv of them the size of Iile. {°Peul^r ^" 'f tte and explanatory letter-press. Strongly and handsomely bound in extra cloth, beni? one oc ine cJieapest and best executed Surgical works as yet issued in this country, ^nuu-..... cJieape *** The size of this work prevtnts its transmi who desire to have copies forwarded by mai' wrappers. Price §9 00. One of the greatest artistic triumphs of the age in Surgical Anatomy.—British American Medical Journal. Too much cannot be said in its praise; indeed, we have not language to do it justice.—Ohio Medi- cal and Surgical Journal. The most admirable surgical atlas we have seen. To the practitioner deprived of demonstrative dis- sections upon the human subject, it is an invaluable companion.—N. J. Medical Reporter. The most accurately engraved and beautifully colored plates we have ever seen in an American book—one of the best and cheapest surgical works ever published.—Buffalo Medical Journal. It is very rare that so elegantly printed, so well illustrated, and so useful a work, is offered at so moderate a price.—Charleston Medical Journal. Its plates can bbast a superiority which places them almost beyond the reach of competition.—Medi- cal Examiner. Every practitioner, we think, should have a work of this kind within reach.—Southern Medical and Surgical Journal. ' No such lithographic illustrations of surgical re- gions have hitherto, we think, been given.—Boston Medical and Surgical Journal. As a surgical anatomist, Mr. Maclise has proba- bly no superior.—British and Foreign Medico-Chi- rurgical Review. Of great value to the student engaged in dissect- ing, and to the surgeon at a distance from the means ion through the post-office as a whole, but those can receive them in five parts, done up in stout of keeping up his anatomical knowledge.—Medical Times. The mechanical execution cannot be excelled— Transylvania Medical Journal. A work which has no parallel in point of accu- racy and cheapness in the English language.—N. Y. Journal of Medicine. To all engaged in the study or practice of theil profession, such a work is almost indispensable.— Dublin Quarterly Medical Journal. No practitioner whose means will admit should fail to possess it.—Ranking's Abstract. Country practitioners will find these plates of im- mense value.—N. Y. Medical Gazette. We are extremely gratified to announce to the profession the completion of this truly magnificent work, which, as a whole, certainly stands unri- valled, both for accuracy of drawing, beauty of coloring, and all the requisite explanations of the subject in hand.—The New Orleans Medical and Surgical Journal. This is by far the ablest work on Surgical Ana- tomy that has come under our observation. We know of no other work that would justify a stu- dent, in any degree, for neglect of actual dissec- tion. In those sudden emergencies that so often arise, and which require the instantaneous command of minute anatomical knowledge, a work of this kind keeps the details of the dissecting-room perpetually fresh in the memory.—The Western Journal of Medi- cine and Surgery. Jgg^° The very low price at which this work is furnished, and the beauty of its execution, require an extended sale to compensate the publishers for the heavy expenses incurred. MOHR (FRANCIS) PH. D., AND REDWOOD (TH EOPH I LUS). PRACTICAL PHARMACY. Comprising the Arrangements, Apparatus, and Manipulations of the Pharmaceutical Shop and Laboratory. Edited, with extensive Additions, by Prof. William Procter, of the Philadelphia College of Pharmacy. In one handsomely printed octavo volume, extra cloth, of 570 pages, with over 500 engravings on wood. $2 75. MACKENZIE (WJ, M.D., Surgeon Oculist in Scotland in ordinary to Her Majesty, &c. &c. A PRACTICAL TREATISE ON DISEASES AND INJURIES OF THE EYE. To which is prefixed an Anatomical Introduction explanatory of a Horizontal Section ol the Human Eyeball, by Thomas Wharton Jones, F. R. S. From the Fourth Revised and En- larged London Edition. With Notes and Additions by Addinell Hewson, M. D., Surgeon to Wills Hospital, &c. &c. In one very large and handsome octavo volume, leather, raised bands, with plates and numerous wood-cuts. (Now Ready.) $5 25. The treatise of Dr. Mackenzie indisputably holds | accordance 'with the advances in the science which the first place, and forms, in respect of learning and research, an Encyclopaedia unequalled in extent by any other work of the kind, either English or foreign. —Dixon on Diseases of the Eye. Few modern books on any department of medicine or surgery have met with such extended circulation, or have procured for their authors a like amount of European celebrity. The immense research which it displayed, the thorough acquaintance with the subject, practically as well as theoretically, and the able manner in which the author's stores of learning and experience were rendered available for general use, at once procured for the first edition, as well on the continent as in this country, that high position as a standard work which each successive edition has more firmly established, in spite of the attrac- tions of several rivals of no mean ability. This, the fourth edition, has been in a great measure re-writ- ten ; new matter, to the extent of one hundred and fifty pages, has been added, and in several instances have been made of late years. Nothing worthy of repetition upon any branch of the subject appears to have escaped the author's notice. We consider it the duty of every one who has the love of his profes- sion and the welfare of his patient at heart, to make himself familiar with this the most complete work in the English language upon the diseases of the eye. —Med. Times and Gazette. The fourth edition of this standard work will no doubt be as fully appreciated as the three former edi- tions. It is unnecessary to say a word in its praise, for the verdict has already been passed upon it by the most competent judges, and " Mackenzie on the Eye" has justly obtained a reputation which it is no figure of speech to call world-wide.—British and Foreign Medico-Chirurgical Review. This new edition of Dr. Mackenzie's celebrated treatise on diseases of the eye, is truly a miracle of industry and learning. We need scarcely say that he has entirely exhausted the subject of his specialty formerly expressed opinions have been modified in —Dublin Quarterly Journal AND SCIENTIFIC PUBLICATIONS. 23 MILLER (JAMES), F. R. S. E., Professor of Surgery in the University of Edinburgh, &c. PRINCIPLES OF SURGERY. Fourth American, from the third and revised Edinburgh edition. In one large and very beautiful volume, leather, of 700 pages, with two hundred and forty exquisite illustrations on wood. (Now Ready, 1856.) $3 75. The extended reputation enjoyed by this work will be fully maintained by the present edition. Thoroughly revised by the author, it will be found a clear and compendious exposition of surgical science in its most advanced condition. In connection with the recently issued third edition of the author's " Practice of Surgery," it forms a very complete system of Surgery in all its branches. The work of Mr. Miller is too well and too favor- ably known among us, as one of our best text-books, to render any further notice of it necessary than the announcement of a new edition, the fourth in our country, a proof of its extensive circulation among us. As a concise and reliable exposition of the sci- ence of modern surgery, it stands deservedly high— we know not its superior.—Boston Med. and Surg. Journal, May, 1856. The works of Professor Miller are so well known to the profession, that it is unnecessary for us say anything in relation to their general merits. The present edition of his "Principles," however, de- serves a special notice, from the number, variety, and faithfulness of its illustrations. The wood-cuts are beautifully executed, and many of them are new and exceedingly instructive, particularly those illus- trating mortification, diseased and fractured bones, and the varieties of aneurism.—Western Lancet, May, 1656. This edition is far superior, both in the abundance feeling assured that as it now comes to us, it pre- amd quality of its material, to any of the preceding, sents the most satisfactory exposition of the modern We hope it will be extensively read, and the sound doctrines of the principles of surgery to be found in principles which are herein taught treasured up for any volume in any language.—N. Y. Journal oj future application. The work takes rank with | Medicine. by the same author. (Lately Published.) THE PRACTICE OF SURGERY. Third American from the second Edin- burgh edition. Edited, with Additions, by F. W. Sargent, M. D., one of the Surgeons to Will's Hospital, &c.v Illustrated by three hundred and nineteen engravings on wood. In one large octavo volume, leather, of over 700 pages. $3 75. No encomium of ours could add to the popularity I his works, both on the principles and practice of of Miller's Surgery. Its reputation in this country surgery have been assigned the highest rank, it we is unsurpassed by that of any other work, and, when - taken in connection with the author's Principles of Watson's Practice of Physic; it certainly does not fall behind that great work in soundness of princi- ple or depth of reasoning and research. No physi- cian who values his reputation, or seeks the interests of his clients, can acquit himself before his God and the world without making himself familiar with the sound and philosophical views developed in the fore- going book.—New Orleans Med. and Surg. Journal. Without doubt the ablest exposition of the prin- ciples of that branch of the healing art in any lan- guage. This opinion, deliberately formed after a careful study of the first edition, we have had no cause to change on examining the second. This edition has undergone thorough revision by the au- thor; many expressions have been modified, and a mass of new matter introduced. The book is got up in the finest style, and is an evidence of the progress of typography in our country.—Charleston Medical Journal and Review. ' We recommend it to both student and practitioner, Surgery, constitutes a whole, without reference to which no conscientious surgeon would be willing to practice his art. The additions, by Dr. Sargent, have materially enhanced the value of the work.— Southern Medical and Surgical Journal. It is seldom that two volumes have ever made so profound an impression in so short a time as the. " Principles" and the " Practice'' of Surgery by Mr. Miller—or so richly merited the reputation they have acquired. The author is an eminently sensi- ble, practical, and well-informed man, who knows exactly what he is talking about and exactly how to talk it.—Kentucky Medical Recorder. By the almost unanimous voice of the profession, were limited to but one work on surgery, that one should be Miller's, as we regard it as superior to all others.—St. Louis Med. and Surg. Journal. The author, distinguished alike as a practitioner and writer, has in this and his " Principles," pre- sented to the profession one of the most complete and reliable systems of Surgery extant. His style of writing is original, impressive, and engaging, ener- getic, concise, and lucid. Few have the faculty ot condensing so much in small space, and at the same time so persistently holding the attention; indeed, he appears to make the very process of condensation a means of eliminating attractions. Whether as a text-book for students or a book of reference for practitioners, it cannot be too strongly recommend- ed.— Southern Journal of Med. and Phys. Sciences. NEILL (JOHN), M. D., Professor of Surgery in the Pennsylvania Medical College, &c. OUTLINES OF THE ARTERIES. With short Descriptions. Designed for the Use of Medical Students. With handsome colored plates. Second and improved edition. In one octavo volume, extra cloth. $1 25. OUTLINES OF THE NERVES. With short Descriptions. Designed for the Use of Medical Students. With handsome plates. Second and improved edition. In one octavo volume, extra cloth. $1 25. OTTTTJNES OF THE VEINS AND LYMPHATICS. With short Descrip- tion s7 Designed for the Use of Medical Students. With handsome colored plates. In one octavo ALSO-ThM^workf done up in one handsome volume half bound, with numerous plates, pre- renting a complete view of the Circulatory, Nervous, and Lymphatic Systems. 5 This book should be in the hand of every medical student It is cheap, portable, and precisely the S needed in studying an important, though dim- & part of Anatomy.-Boston Med. and Surg. Journal. We recommend every student of medicine to pur- chase a copy of this work, as a labor-saving ma- Shine, admirably adapted to refresh the memory, with knowledge gained by lectures, dissections, and the reading of larger works.—N. Y. Journal of Medicine. This work is from the pen of a Philadelphia ana- tomist, whose familiar knowledge of the subject has been aided by the press, the result of which is a vo- lume of great beauty and excellence. Its fine exe- cution commends it to the student of Anatomy. It requires no other recommendations.—Western Journ. of Medicine and Surgery. 24 BLANCHARD * LEA'S MEDICAL NEILL (JOHN), M. D., Surgeon to the Pennsylvania Hospital, Ac; and FRANCIS GURNEY SMITH, M. D., Professor of Institutes of Medicine in the Pennsylvania Medical college. AN ANALYTICAL COMPENDIUM OF THE VARIOUS BRANCHES OF MEDICAL SCIENCE; for the Use and Examination of Students. Aow( ^J^u! one and improved. In one very large and handsomely printed royal 12mo vol..^'X^^ thousand pases, with three hundred and seventy-four illustrations on wood. Strongly oouno. __":.'■- ..•__. ■___1- ,v... 77„„,/„ 1S:ihl S3 00. and such errors as had onf former( occasions escaped ob -rvjion ^ ^ . ^^^ The^en™ eriTo^ ™™^ alld much i-P.roved, while, by a slight enlargement of the page, these various additions have been incorporated without increasing lhTheworVKSfore,againpresentedaseminent.ywo^ established.- In the rapid course of lectures, where work for | what it was when they left it off.—The Stethoscope the students is heavy, and review necessary for an ^-e recommend it to our readers as the best work examination, a compend is not only valuable, but 0f tne kind with which we are acquainted.—Med. it is almost a sine qua non. The one before us is, | Examiner, April, 1850. in most of the divisions, the most unexceptionable of all books of the kind that we know of. The newest and soundest doctrines and the latest im- provements and discoveries are explicitly, though concisely, laid before the student. Of course it is useless for us to recommend it to all last course students, but there is a class to whom we very Bincerely commend this cheap book as worth its weight in silver —that class is the graduates in medicine of more than ten years' standing, who have not studied medicine since. They will perhaps find out from it that the science is not exactly now Having made free use of this volume in our ex- aminations of pupils, we can speak from experi- ence in recommending it as an admirable compend for students, and as especially useful to preceptors who examine their pupils. It will save the teacher much labor by enabling; him readily to recall all of the points upon which his pupils should be ex- amined. A work of this sort should be in the hands of every one who takes pupils into his office with a view of examining them; and this is unquestionably the best of its class.—Transylvania Med. Journal. NELIGAN (J. MOORE), M. D., M. R. I. A., &.C. (A splendid work. Now Ready.) ATLAS OF CUTANEOUS DISEASES. In one beautiful quarto volume, extra cloth, with splendid colored plates, presenting nearly one hundred elaborate representations of disease. $4 50. This beautiful volume is intended as a complete and accurate representation of all the varieties of Diseases of the Skin. While it can be consulted in conjunction with any work on Practice, it has especial reference to the author's " Treatise on Diseases of the Skin," so favorably received by the profession some years since. The publishers feel juslified in saying that no more beautifully exe- cuted plates have ever been presented to the profession of this country. The diagnosis of eruptive disease, however, under all circumstances, is very difficult. Nevertheless Dr. Neligan has certainly, " as far as possible," given a faithful and accurate representation of this class of diseases, and there can be no doubt that these plates will be of great use to the student and practitioner in drawing a diagnosis as to the class, order, and species to which the particular case may belong. While looking over the ;l Atlas" we have been induced to examine also the " Practical Trea- tise." This was published in 1852, and we are in- clined to consider it a very superior work, combin- ing accurate verbal description, with sound views of the pathology and treatment of eruptive diseases. —Glasgow Medical Journal. placed within its reach and at a moderate cost a most accurate and well delineated series of plates illus- trating the eruptive disorders. Theseplates are all drawn from the life, and in many of the'm the daguer- reotype has been employed with great success. Such works as these are especially useful to country prac- titioners, who have not an opportunity of seeing the rarer forms of cutaneous disease, and hence need the aid of illustrations to give them the requisite infor- mation on the subject. With these plates at hand, the inexperienced practitioner is enabled to discri- minate with much accuracy, and he is thus, com- paratively speaking, put on an equal footing with those who have had the opportunity of visiting the large hospitals of Europe and America.— Va. Med. Journal, June, 1856. The profession owes its thanks to the publishers of Neligan's Atlas of Cutaneous Diseases, for they have BY THE SAME AUTHOR. A PRACTICAL TREATISE ON DISEASES OF THE SKIN. In one neat royal 12mo. volume, extra cloth, of 334 pages. SI 00. We must say he bears off the palm for clearness, I chapter is devoted to " those general points in thera- conciseness, and rigid plainness of expression. This peutics which are specially applicable to this class style enables him to compress much in a single sen- of affections." The present work forms a favorable tence, without in any degree injuring the sense, but, contrast to the voluminous and disputed details of on the contrary, making it more comprehensive and many of its predecessors, and will, we feel assured, impressive. By far the largest proportion of the I be admirably conducive to facilitating the study of volume is devoted to therapeutic considerations, j the student, and improving the practice of the prac- Not merelyare full details of treatment and formulas | titioner.—Dublin Quarterly Journ. of Med. Science. given at the close of each section, but an entire Egg- The two volumes will be sent by mail on receipt of Five Dollars. OWEN ON THE DIFFERENT FORMS OF I One vol. royal 12mo., extra cloth, with numerous THE SKELETON, AND OF THE TEETH. | illustrations. (Just Issued.) $1 25. AND SCIENTIFIC PUBLICATIONS. 25 (Now Complete.) m„„ PEREIRA (JONATHAN), M. D., F. R. S., AND L. S. THE ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS. ™ id American edition, enlarged and improved by the author; including Notices of most of the Medicinal Substances in use in the civilized world, and forming an Encyclopedia of Materia Mediea. Edited, with Additions, by Joseph Carson, M. D., Professor of Materia Medica and Pharmacy in the University of Pennsylvania. In two very large octavo volumes of 2100 pa°-es on small type, with about 500 illustrations on stone and wood, strongly bound in leather, with raised bands. $9 00. Gentlemen who have the first volume are recommended to complete their copies without delay he first volume will no longer be sold separate. Price of Vol. II. $5 00. ' The When we remember that Philology, Natural His- tory, Botany, Chemistry, Physics, and the Micro- scope, are all brought forward to elucidate the sub- ject, one cannot fail to see that the reader has here a work worthy of the name of an encyclopeedia of Materia Medica. Our own opinion of its merits is that of its editors, and also that of the whole profes- sion, both of this and foreign countries—namely, " that in copiousness of details, in extent, variety, and accuracy of information, and in lucid explana- tion of difficult and recondite subjects, it surpasses all other works on Materia Medica hitherto pub- lished." We cannot close this notice without allud- ing to the special additions of the American editor, which pertain to the prominent vegetable produc- tions of this country, and to the directions of the United Slates Pharmacopoeia, in connection with all the articles contained in the volume which are re- ferred toby it. The illustrations have been increased, and this edition by Dr. Carson cannot well be re- garded in any other light than that of a treasure which should be found in the library of every physi- cian.—New York Journal of Medical and Collateral Science. The third edition of his "Elements of Materia Medica, although completed under the supervision of others, is by far the most elaborate treatise in the English language, and will, while medical literature is cherished, continue a monument alike honorable to his genius, as to his learning and industry.— American Journal of Pharmacy. The work, in its present shape, forms the most comprehensive and complete treatise on materia medica extant in the English language. — Dr. Pereira has been at great pains to introduce into his work, not only all the information on the natural, chemical, and commercial history of medi- cines, which might be serviceable to the physician and surgeon, but whatever might enable his read- ers to understand thoroughly the mode of prepar- ing and manufacturing various articles employed either for preparing medicines, or for certain pur- poses in the arts connected with materia medica and the practice of medicine. The accounts of the physiological and therapeutic effects of remedies are given with great, clearness and accuracy, and in a manner calculated to interest as well as instruct the reader.—Edinburgh Medical and Surgical Journal. PEASELEE (E. R.), M. D., Professor of Anatomy and Physiology in Dartmouth College, &c. HUMAN HISTOLOGY, in its applications to Physiology and General Pathology; designed as a Text-Book for Medical Students. With numerous illustrations. In one handsome royal 12mo. volume. (Preparing.) The subject of this work is one, the growing importance of which, as the basis of Anatomy and Physiology, demands for it a separate volume. The book will therefore supply an acknowledged deficiency in medical text-books, while the name of the author, and his experience as a teacher for the last thirteen years, is a guarantee that it will be thoroughly adapted to the use of the student. PIRRIE (WILLIAM), F. R. S. E., Professor of Surgery in the University of Aberdeen. THE PRINCIPLES AND PRACTICE OF SURGERY. Edited by John Neill, M. D., Professor of Surgery in the Penna. Medical College, Surgeon to the Pennsylvania Hospital, &c. In one very handsome octavo volume, leather, of 780 pages, with 316 illustrations. m 75. We know of no other surgical work of a reason- able size, wherein there is so much theory and prac- tice, or where subjects are more soundly or clearly taught.—The Stethoscope. There is scarcely a disease of the bones or soft parts, fracture, or dislocation, that is not illustrated by accurate wood-engravings. Then, again, every instrument employed by the surgeon is thus repre- sented. These engravings are not only correct, but really beautiful, showing the astonishing degree of perfection to which the art of wood-engraving has arrived. Prof. Pirrie, in the work before us, has elaborately discussed the principles of surgery, and a safe and effectual practice predicated upon them. Perhaps no work upon this subject heretofore issued is so full upon the science of the art of surgery.— Nashville Journal of Medicine and Surgery. One of the best treatises on surgery in the English language.—Canada Med. Journal. Our impression is, that, as a manual for students, Pirrie's is the best work extant.— Western Med. and Surg. Journal. PANCOAST (J.), M. D., Professor of Anatomy in the Jefferson Medical College, Philadelphia, &c. OPERATIVE SURGERY; or, A Description and Demonstration of the various Processes of the Art; including all the New Operations, and exhibiting the State of Surgical Science in its present advanced condition. Complete in one royal 4to. volume, extra cloth, of 380 pages of letter-press description and eighty large 4to. plates, comprising 486 illustrations. Second edition, improved. $10 00. This excellent work is constructed on the model of the French Surgical Works by Velpeau and Mal- gaigne j and, so far as the English language is con- cerned, we are proud as an American to say that, or its kind it has no strpEKioR__N. Y. Journal of Medicine. PARKER (LANGSTON), Surgeon to the Queen's Hospital, Birmingham. THE MODERN TREATMENT OF SYPHILITIC DISEASES, BOTH PRI- MARY AND SECONDARY; comprising the Treatment of Constitutional and Confirmed Syphi- lis, by a safe and successful method. With numerous Cases, Formulae, and Clinical Observa- tions. From the Third and entirely rewritten London edition. In one neat octavo volume, extra cloth, of 316 pages. (Just Issued.) §175. 26 BLANCHARD & LEA'S MEDICAL PARRISH (EDWARD), . Lecturer on Practical Pharmacy and Materia Medica in the Pennsylvania Academy of Medicine, «c. AN INTRODUCTION TO PRACTICAL PHARMACY. Designed as a Text- Book for the Student, and as a Guide for the Physician and Pharmaceutist. With many or- mulae and Prescriptions. In one handsome octavo volume, extra cloth, ol DOU page>, v*nu *io Illustrations. (Now Ready, 1856.) $2 75. This work, while necessary to the educated pharmaceutist, will also be found of the greatest importance to those practitioners who, residing at a distance from apothecaries, are cauea upon 10 dispense as well as to prescribe. The author has not only given a thorough outline ol llie principles of pharmacy and its general processes, but has also presented their special applications 111 llie details of preparing all the different classes of medicines, illustrated with numerous engravings ol apparatus and implements, which, in all cases, are of the simplest description. Under the different heads are contained many tables and syllabi of classes of medicines, presenting the remedies of the United States Pharmacopoeia, together with many new ones, so arranged as to render their relations of easy comprehension, and embodying all the more important formulae of the Pharmacopoeia, as well as many others from the practice of distinguished physicians, not hitherto in print. Especial notice has been taken of the numerous important remedies recently obtained from our indigenous flora, and their composition and preparation pointed out. The long experience of the author as a teacher of pharmacy has rendered him familiar with the wants of students, and entirely competent to supply them. He has accordingly descended to those minutiae which so often interpose difficulties in the way of the young practitioner, who has hitherto had no practical guide to point out the modes of overcoming them A careful examination of this work enables us to speak of it in the highest terms, as being the best treatise on practical pharmacy with which we are acquainted, and an invaluable vade-mecum, not only to the apothecary and to those practitioners who are accustomed to prepare their own medicines, but to every medical man and medical student. Through- out the work are interspersed valuable tables, useful formulae, and practical hints, and the whole is illus- trated by a large number of excellent wood-engrav- ings.—Boston Med. and Surg. Journal. This is altogether one of the most useful books we have seen. It is just what we have long felt to be needed by apothecaries, students, and practitioners of medicine, most of whom in this country have to put up their own prescriptions. It bears, upon every page, the impress of practical knowledge, conveyed in a plain common sense manner, and adapted to the comprehension of all who may read it. No detail has been omitted, however trivial it may seem, al- though really important to the dispenser of medicine. —Southern Med. and Surg. Journal. To both the country practitioner and the city apo- thecary this work of Mr. Parrish is a godsend. A careful study of its contents will give the young graduate a familiarity with the value and mode of administering his prescriptions, which wi.l be of as much use to his patient as to himself.— Va. Med. Journal. Mr. Parrish has rendered a very acceptable service to the practitioner and student, by furnishing this book, which contains the leading facts and principles of the science of Pharmacy, conveniently'arranged for study, and with special reference to those features of the subject which possess an especial practical in- terest to the physician. It furnishes the student, at the commencement of his studies, with that infor- mation which is of the greatest importance in ini- tiating him into the domain of Chemistry'and Materia Medica; it familiarizes him with the compounding of drugs, and supplies those minutiae which but few practitioners can impart. The junior practitioner will, also, find this volume replete with instruction. —Charleston Med. Journal and Review, Mur. 1856. PHYSICIAN'S DAILY RECORD FOR 1857. COMPRISING: A REGISTER OF VISITS, ENGAGEMENTS, AND CASES. Together with Tables of Doses, Weights and Measures, Poisons and Antidotes, and other Memo- randa for Clinical Reference. A neat volume, for the Pocket. (Preparing.) For 25 patients, flexible cloth, 50 cents; leather, tucks, 75 cents. For 50 " " 75 " " « $1 00. The object of this little volume is to afford the physician a convenient means of recording and arranging his daily practice, and of registering under every day and for every patient what visits have been paid, so that they can readily and expeditiously be charged for collection, besides keep- ing such memoranda of cases and treatment as may be deemed desirable for future reference; thus at once enabling him to regulate his business, and to preserve and accumulate the record of his clinical experience. Space is also furnished for such memoranda as are most likely to be re- quired in a physician's daily avocations; while a portion of the work comprises in a condensed form such information as is likely to prove convenient for reference at the bedside. The copies in leather have pockets for loose memoranda, prescription papers, dec. The very low price at which it is offered places it within the reach of every practitioner, in the expectation that all will avail themselves of the great advantages which it offers. RICORD (P.), M. D., A TREATISE ON THE VENEREAL DISEASE. By John Hunter, F. R. S. With copious Additions, by Ph. Ricord, M. D. Edited, with Notes, by Freeman J. Bumstead M. D. In one handsome octavo volume, extra cloth, of 520 pages, with plates. $3 25. ' secretaries, sometimes accredited and sometimes not. In the notes to Hunter, the master substitutes him- self for his interpreters, and gives hisoriginal thoughts to the world in a lucid and perfectly intelligible man- ner. In conclusion we can say that this is incon- testably the best treatise on syphilis with which we are acquainted, and, as we do not often employ the phrase, we may be excused for expressing the hone that it may find a place in the library of , Every one will recognize the attractiveness and value which this work derives from thus presenting the opinions of these two masters side by side. But, it mast be admitted, what has made the fortune of the book, is the fact that it contains the " most com- plete embodiment of the veritable doctrines of the Hopital du Midi," which has ever been made public. The doctrinal ideas of M. Ricord, ideas which, if not nniversally adopted, are incontestably dominant, have ................. -~~r—1----~--^.-«.j uu..u..>.,.,..„.^ .,,„ .. ...„j ...,u a. iJiace m me HDrary of everv nhv- heretofore only been interpreiedby more or less skilful sician.— Virginia Med. and Surg. Journal BY THE SAME AUTHOR. ILLUSTRATIONS OF SYPHILITIC DISEASE. Translated by Thomas F. Betton, M.D. With fifty large quarto colored plates. In one large quarto volume, extra cloth. SIS 00. LETTERS ON SYPHILIS, addressed to the Chief Editor of the Union Medicale. Translated byW P. Lattimore, M.D. In one neat octavoVul urne, of 270 pages, extra cloth. 82 00. AND SCIENTIFIC PUBLICATIONS. 27 RAMSBOTHAM (FRANCIS H.), M.D. THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND SURGERY, in reference to the Process of Parturition. A new and enlarged edition, thoroughly revised by the Author. With Additions by W. V. Keating, M. D. In one large and handsome imperial octavo volume, of 650 pages, strongly bound in leather, with raised bands; with sixty- four beautiful Plates, and numerous Wood-cuts in the text, containing in all nearly two hundred large and beautiful figures. (Lately Isstted, 1856.) $5 00. In calling the attention of the profession to the new edition of this standard work, the publishers would remark that no efforts have been spared to secure for it a continuance and extension of the remarkable favor with which it has been received. The last London issue, which was considera- bly enlarged, has received a further revision from the author, especially for this country. Its pas- sage through the press here has been supervised by Dr. Keating, who has made numerous addi- tions with a view of presenting more fully whatever was necessary to adapt it thoroughly to American modes of practice. In its mechanical execution, a like superiority over former editions will be found. From Prof. Hodge, of the University of Pa. To the American public, it is most valuable, from its intrinsic undoubted excellence, and as being the best authorized exponent of British Midwifery. Its circulation will, I trust, be extensive throughout our country. The publishers have shown their appreciation of the merits of this work and secured its success by the truly elegant style in which they have brought it out, excelling themselves in its production, espe- cially in its plates. It is dedicated to Prof. Meigs, and has the emphatic endorsement of Prof. Hodge, as the best exponent of British Midwifery. We know of no text-book which deserves in all respects to be more highly recommended to students, and we could wish to see it in the hands of every practitioner, for they will find it invaluable for reference.—Med. Gazette. But once in a long time some brilliant genius rears his head above the horizon of science, and illumi- nates and purifies every department that he investi- gates ; and his works become types, by which innu- merable imitators model their feeble productions. Such a genius we find in the younger Ramsbotham, and such a type we find in the work now before us. The binding, paper, type, the engravings and wood- cuts are all so excellent as to make this book one of the finest specimens of the art of printing that have gives such a world-wide reputation to its enter- prising and liberal publishers. We welcome Rams- botham's Principles and Practice of Obstetric Medi- cine and Surgery to our library, and confidently recommend it to our readers, with the assurance that it will not disappoint their most sanguine ex- pectations.— Western Lancet. It is unnecessary to say anything in regard to the utility of this work. It is already appreciated in our country for the value of the matter, the clearness of its style, and the fulness of its illustrations. To the physician's library it is indispensable, while to the student as a text-book, from which to extract the material for laying the foundation of an education on obstetrical science, it has no superior.—Ohio Med. and Surg. Journal. We will only add that the student will learn from it all he need to know, and the practitioner will find it, as a book of reference, surpassed by none other.— Stethoscope. The character and merits of Dr. Ramsbotham's work are so well known and thoroughly established, that comment is unnecessary and praise superfluous. The illustrations, which are numerous and accurate, are executed in the highest style of art. We cannot too highly recommend the work to our readers.—St. Louis Med. and Surg. Journal. ROKITANSKY (CARD, M.D., Curator of the Imperial Pathological Museum, and Professor at the University of Vienna, &c. A MANUAL OF PATHOLOGICAL ■ANATOMY. Four volumes, octavo, bound* in two, extra cloth, of about 1200 pages. (Now Ready.) $5 50 Vol. I.—Manual of General Pathological Anatomy. Translated by W. E. Swaine. Vol. II.—Pathological Anatomy of the Abdominal Viscera. Translated by Edward Sieveking, M.D. Vol. III.—Pathological Anatomy of the Bones, Cartilages, Muscles, and Skin, Cellular and Fibrous Tissue, Serous and Mucous Membrane, and Nervous System. Translated by C. H. Moore. Vol. IV.—Pathological Anatomy of the Organs of Respiration and Circulation. Translated by G. E. Day. To render this large and important work more easy of reference, and at the same time less cum- brous and costly, the four volumes have been arranged in two, retaining, however, the separate paging, &c. The publishers feel much pleasure in presenting to the profession of the United States the great work of Prof. Rokitansky, which is universally referred to as the standard of authority by the pa- thologists of all nations. Under the auspices of the Sydenham Society of London, the combined labor of four translators has at length overcome the almost insuperable difficulties which have so lon°- prevented the appearance of the work in an English dress, while the additions made from various papers and essays of the author present his views on all the topics embraced, in their latest published form. To a work so widely known, eulogy is unnecessary, and the publishers would merely state that it is said to contain the results of not less than thirty thousand post-mortem examinations made by the author, diligently compared, generalized, and wrought into one com- plete and harmonious system. The profession is too well acquainted with the re- putation of Rokitansky's work to need our assur- ance that this is one of the most profound, thorough, and valuable books ever issued from the medical press It is sui generis, and has no standard of com- tmrison. It is only necessary to announce that it is issued in a form as cheap as is compatible with its size and preservation, and its sale follows as a matter of course. No library can be called com- plete without it.-Buffalo Med. Journal. An attempt to give our readers any adequate idea of the vast amount of instruction accumulated in these volumes, would be feeble and hopeless. The effort of the distinguished author to concentrate in a small space his great fund of knowledge, has so charged his text with valuable truths, that any attempt of a reviewer to epitomize is at once para- lyzed, and must end in a failure.—Western Lancet. As this is the highest source of knowledge upon the important subject of which it treats, no real student can afford to be without it. The American publishers have entitled themselves to the thanks of the profession of their country, for this limeous and beautiful edition.—Nashville Journal of Medicine. As a book of reference, therefore, this work must prove of inestimable value, and we cannot too highly recommend it to the profession.—Charleston Med. Journal and Review, Jan. 1856. This book is a necessity to every practitioner.— Am. Med. Monthly. 28 BLANCHARD & LEA'S MEDICAL RIGBY'S SYSTEM OF MIDWIFERY. With Notes and Additional Illustra- tions. Second American Edition. One volume octavo, extra cloth, 422 pages. ^2 50. ROYLES MATERIA MEDICA~ANI) THERAPEUTICS; including the Preparations of the Pharmacopoeias of London, Edinburgh, Dublin, and of the United States. With many new medicines. Edited by Joskph Carson, M. D. With ninety-eight illustrations. In one large octavo volume, extra cloth, of about 700 pages. S3 00. SMITH (HENRY H.), Professor of Surgery in the University of Pennsylvania, &c. MINOR SURGERY; or, Hints on the Every-day Duties of the Surgeon. Illus- trated by two hundred and forty-seven illustrations. Third and enlarged edition. In one hand- some royal 12mo. volume, pp. 456. In leather, 82 25; extra cloth, $2 00. And a capital little book it is. . . Minor Surgery, we repeat, is really Major Surgery, and anything which teaches it is worth having. So we cordially recommend this little book of Dr. Smith's.—Med.- CJiir. Review. This beautiful little work has been compiled with a view to the wants of the profession in the matter of bandaging, &c, and well and ably has the author performed his labors. Well adapted to give the requisite information on the subjects of which it treats.—Medical Examiner. The directions are plain, and illustrated through- out with clear engravings.—London Lancet. One of the best works they can consult on the subject of which it treats.—Southern Journal of Medicine and Pharmacy. BY THE SAME AUTHOR, AND . HORNER (WILLIAM E.)f M. D., Late Professor of Anatomy in the University of Pennsylvania. AN ANATOMICAL ATLAS, illustrative of the Structure of the Human Body. In one volume, large imperial octavo, extra cloth, with about six hundred and fifty beautiful figures. S3 00. A work such as the present is therefore highly useful to the student, and we commend this one to their attention.—American Journal of Medical Sciences. No operator, however eminent, need hesitate to consult this unpretending yet excellent book. Those who are young in the business would find Dr. Smith's treatise a necessary companion, after once under- standing its true character.—Boston Med. and Surg. Journal. No young practitioner should be without this little volume; and we venture to assert, that it may b« consulted by the senior members of the profession with more real benefit, than the more voluminom works.—Western Lancet. These figures are well selected, and present a complete and accurate representation of that won- derful fabric, the human body. The plan of this Atlas, which renders it so peculiarly convenient for the student, and its superb artistical execution, have been already pointed out. We must congratu- late the student upon the completion of this Atlas, as it is the most convenient work of the kind that has yet appeared ; and we must add, the very beau- tiful manner in which it is " got up" is so creditable to the country as to be flattering to our national pride.—American Medical Journal. SARGENT (F. W.), M. D. ON BANDAGING- AND OTHER OPERATIONS OF MINOR SURGERY Second edition, enlarged. One handsome royal 12mo. vol., of nearly 400 pa°-es with 182 wood cuts. (Now Ready, 1856.) Extra cloth, $1 40; leather, $1 50. This very useful little work has long been a favor- ite with practitioners and students. The recent call for a new edition has induced its author to make numerous important additions. A slight alteration in the size of the page has enabled him to introduce the new matter, to the extent of some fifty pages of the former edition, at the same time that his volume is rendered still more compact than its less compre- hensive predecessor. A double gain in thus effected, which, in a vade-mecum of this kind, is a material improvement.—Am. Medical Journal. Sargent's Minor Surgery has always been popular, and deservedly so. It furnishes that knowledge of the most frequently requisite performances of surgical art which cannot be entirely understood by attend- ing clinical lectures. The art of bandaging, which is regularly taught in Europe, is very frequently overlooked by teachers in this country ; the student and junior practitioner, therefore, may often require that knowledge which this little volume so tersely and happily supplies. It is neatly printed and copi- ously illustrated by the enterprising publishers, and should be possessed by all who desire to be thorough- ly conversant with the details of this branch of our art.—Charleston Med. Journ. and Review, March 1856. ' A work that has been so long and favorably known to the profession as Dr. Sargent's Minor Surgery, needs no commendation from us. We would remark, however, m this connection, that minor surgery sel- dom gets that attention in our schools that its im- portance deserves. Our larger works are also very defective in their teaching on these small practical points. This little book will supply the void which all must feel who have not studied its pages.—West- ern Lancet, March, 1856. We confess our indebtedness to this little volume on many occasions, and can warmly recommend it to our readers, as it is not above the consideration of the oldest and most experienced.—American Lan- cet, March, 1856. SKEYS OPERATIVE SURGERY. In one very handsome octavo volume, extra cloth, of over 650 pages, with about one hundred wood-cuts. $3 25 much enlarged London edition. In one octavo cutsmes!X00a ' 5°° PaSeS' With V2° w00d- STANLEY'S TREATISE ON DISEASES OF gIMnv,a rrVT,„ , T „ m THE BONES. In one volume, octavo, extra cloth, , SI^e £ ?h^ £t h" k PAT"OLOGY. •»■ ™ndu 236 pages. SI 50. 'I *ve *? the Establishment of Rational Principl SOLLY ON THE HUMAN BRAIN : it, s„„nf„« ! n/.ibL?.r!r"t'l?_a.nd..C.ure «?f 9"™*°- la o, SOLLY ON THE HUMAN BRAIN ; its Structure, Physiology, and Diseases. From the Second and , —.... „..^. ^UIC ln j^iiseuse. in nnA nea^octavo volume, extra cloth, of 212 pages STILLE (ALFRED), M. D. PRINCIPLES OF GENERAL AND SPECIAL THERAPEUTICS t handsome octavo. (Preparing.) -"* AND SCIENTIFIC PUBLICATIONS. 29 SHARPEY (WILLIAM), M.D., JONES QUAIN, M.D., AND RICHARD QUAIN, F. R. S., &c. HUMAN ANATOMY. Revised, with Notes and Additions, by Joseph Leidt, M. D., Professor of Anatomy in the University of Pennsylvania. Complete in two large octavo volumes, leather, of about thirteen hundred pages. Beautifully illustrated with over five hundred engravings on wood. $6 00. It is indeed a work calculated to make an era in anatomical study, by placing before the student every department of his science, with a view to the relative importance of each ; and so skilfully have the different parts been interwoven, that no one who makes this work the basis of his studies, will hereafter have any excuse for neglecting or undervaluing any important particulars connected with the structure of the human frame; and whether the bias of his mind lead him in a more especial manner to surgery, physic, or physiology, he will find here a work at once so comprehensive and practical as to defend him from exclusiveness on the one hand, and pedantry on the other. — Journal and Retrospect of the Medical Sciences. We have no hesitation in recommending this trea- tise on anatomy as the most complete on that sub- ject in the English language; and the only one, perhaps, in any language, which brings the state of knowledge forward to the most recent disco- veries.—The Edinburgh Med. and Surg. Journal. OF SMITH (W. TYLER), M.D., Physician Accoucheur to St. Mary's Hospital, &c. ON PARTURITION, AND THE PRINCIPLES AND PRACTICE OBSTETRICS. In one royal 12mp. volume, extra cloth, of 400 pages. $125. BY THE SAME AUTHOR.—(Just Issued.) A PRACTICAL TREATISE ON THE PATHOLOGY AND TREATMENT OF LEUCORRHOEA. With numerous illustrations. In one very handsome octavo volume, extra cloth, of about 250 pages. $1 50. We decide this book to be one of the most useful monographs which has appeared in this country. What was before unutterable confusion in regard to its subject has now the order, regularity, and har- mony of a most beautiful science. Dr. Smith has placed the whole profession directly, and mankind indirectly, under abiding obligations. — Nashville Journ. of Medicine. We hail the appearance of this practical and in- valuable work, therefore, as a real acquisition to our medical literature.—Medical Gazette. SIBSON (FRANCIS), M. D., Physician to St. Mary's Hospital. MEDICAL ANATOMY. Illustrating the Form, Structure, and Position of the Internal Organs in Health and Disease. In large imperial quarto, with splendid colored plates. To match "Maclise's Surgical Anatomy." Part I. (Preparing.) SCHOEDLER (FRIEDRICH), PH.D., Professor of the Natural Sciences at Worms, &c. THE BOOK OF NATURE; an Elementary Introduction to the Sciences of Physics, Astronomy, Chemistry, Mineralogy, Geology, Botany, Zoology, and Physiology. First American edition, with a Glossary and other Additions and Improvements; from the second English edition. Translated from the sixth German edition, by Henry Mkdlock, F. C. S., &c. In one thick volume, small octavo, extra cloth, of about seven hundred pages, with 679 illustra- tions on wood. Suitable for the higher Schools and private students. (Now Ready.) $1 80. TANNER (T. H.), M. D., Physician to the Hospital for Women, &c. A MANUAL OF CLINICAL MEDICINE AND PHYSICAL DIAGNOSIS. To which is added The Code of Ethics of the American Medical Association. In one neat volume, small 12mo. Price in extra cloth, 87 i cents; flexible style, for the pocket, 80 cents. (Lately Published.) In this admirable little work the author's object has been to give the young practitioner that kind of information which enables him to make practical application of the knowledge acquired by his studies and which is not to be found in the text-books. Such a manual has been much wanted, as it fills a void which has long been felt, but which there has hitherto been no attempt to supply. That the author has succeeded in his endeavor, is sufficiently shown by the unusually favorable reception which the work has already received, although only just published. Dr Tanner has, in a happy and successful manner, indicated the leading particulars to which, in the clinical study of a case of disease, the attention of the physician is to be directed, the value and import of the various abnormal phenomena detected, and the several instrumental and accessory means which and increase its certainty.—Am. Journal of Med Sciences. In this small work is collected a fund of such in- formation as the student at the commencement and even during the continuance of his studies, is often wdly troubled to know where to look for .-Montreal Med. Chronicle. The woik is an honor to its writer, and must ob- tain a wide circulation by its intrinsic merit alone. iTseems to us that but slight effort on the part of the publishers will be requisite to exhaust even a large I Journal edition. Suited alike to the wants of students and , practitioners, it has only to be seen, to win for itself a place upon the shelves of every medical library. Nor will it be " shelved" long at a time ; if we mis- take not, it will be found, in the best sense of the homely but expressive word, " handy." The style is admirably clear, while it is so sententious as not to burden the memory. The arrangement is, to our mind, unexceptionable. The work, in short, de- serves the heartiest commendation.—Boston Med. and Surg. Journal We cordially recommend every young practitioner who wishes to reap the greatest "possible benefit from his observation of disease to make this book his daily companion.—New Hampshire Journal of Medi- cine. As a convenient and suggestive book of reference, weaccord it our hearty praise.—Va. Med. and Surg. 30 BLANCHARD & LEA'S MEDICAL TAYLOR (ALFRED S.), M. D., F. R. S., Lecturer on Medical Jurisprudence and Chemistry in Guy's Hospital. MEDICAL JURISPRUDENCE. Fourth American, from the fifth improved and enlarged English Edition. With Notes and References to American Decisions, by Edward Hartshorne, M. D. In one large octavo volume, leather, of over seven hundred pages. (Just Ready, June, IS.jG.) S3 00. This standard work has lately received a very thorough revision at the hands of the author, who has introduced whatever was necessary to render it complete and satisfactory in carrying out the objects in view: Tne editor has likewise used every exertion to make it equally thorough with regard to all matters relating to the practice of this country. In doing this, he has carefully ex- amined all that has appeared on the subject since the publication of the last edition, and has incorpo- rated all the ne*r information thus presented. The work has thus been considerably increased in size, notwithstanding which, it has been kept at its former very moderate price, and in every respect it will be found w >rthy of a continuance of the remarkable favor which has carried it through so many editions on bolh sides of the Atlantic. A few notices of the former editions are appended. most attractive books that we have met with ; sup- plying so much both to interest and instruct, that we do not hesitate to affirm that after having once We know of no work on Medical Jurisprudence which contains in the same space anything like the same amount of valuable matter.—N. Y. Journal of Medicine. No work upon the subject can be put into the hands of students either of law or medicine which will engage them more closely or profitably; and none could be offered to the busy practitioner of either calling, for the purpose of casual or hasty reference, that would be more likely to afford the aid desired. We therefore recommend it as the best and safest manual for daily use.—American Journal of Medical Sciences. So well is this work known to the members both of the medical and legal professions, and so highly is it appreciated by them, that it cannot be necessary for us to say a word in its commendation ; its having already reached a fourth edition being the best pos- s ble testimony in its favor. The author has ob- viously subjected the entire work to a very careful revision.—Brit, and Foreign Med. Chirurg. Review. This work of Dr. Taylor's is generally acknow- ledged to be one of the ablest extant on the subject of medical jurisprudence. It is certainly one of the commenced its perusal, few could be prevailed upon to desist before completing it. In the last London edition, all the newly observed and accurately re- corded facts have been inserted, including much that is recent of-Chemical, Microscopical, and Patholo- gical research, besides papers on numerous subjects never before published.-Charleston Medical Journal and Review. It is not excess of praise to say that the volume before us is the very best treatise extant on Medical Jurisprudence. In saying this, we do not wish to be understood as detracting from the merits of the excellent works of Beck, Ryan, Traill, Guy, and others; but in interest and value we think it must be conceded that Taylor is superior to anything that has preceded it. The author is already well known to the profession by his valuable treatise on Poisons; and. the present volume will add materially to his high reputation for accurate and extensive know- ledge and discriminating judgment.—N. W. Medical ana Surgical Journal. BY THE SAME AUTHOR. ON POISONS, IN RELATION TO MEDICAL JURISPRUDENCE AND MEDICINE. Edited, with Notes and Additions, by R. E. Griffith, M. D. In one large octavo volume, leather, of 688 pages. 5-3 00 TODD (R. B.), M. D., AND BOWMAN (WILLIAfVP, F. R. S. PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN. With numerous handsome wood-cuts. Parts I, II, and III, in one octavo volume, 552 pages. S3 50. Part IV will complete the work. The first portion of Part IV, with numerous original illustrations, was published in the Medical News and Library for 1853, and the completion will be issued immediately on its appearance in London. Those who have subscribed since the appearance of the preceding portion of the work can have the three parts by mail, on remittance of $2 50 to the publishers. WATSON (THOMAS), M.D., &c. LECTURES ON THE PRINCIPLES AND PRACTICE OF PHYSIC. Thjrd American edition, revised, with Additions, by D. Francis Condie, M.D., author of a 1 Treatise on the Diseases of Children," &c. large pages, strongly bound with raised bands. To say that it is the very best work on the sub- ject now extant, is but to echo the sentiment of the medical press throughout the country. — N. O. Medical Journal. Of the text-books recently republished Watson is very justly the principal favorite.—Holmes's Rep. to Nat. Med. Assoc. By universal consent the work ranks among the very best text-books in our language.—Illinois and Indiana Med. Journal. Regarded on all hands as one of the very best, if not the very best, systematic treatise on practical medicine extant.—St. Louis Med. Journal. In one octavo volume, of nearly eleven hundred $3 25. 0 Confessedly one of the very best works on the principles and practice of physic in the English or any other language.—Med. Examiner. Asa text-book it has no equal; as a compendium of pathology and practice no superior.—New York Annalist. We know of no work better calculated for being placed in the hands of the student, and for a text- book; on every important point the author seems to have posted up his knowledge to the day — Amer. Med. Journal. ' ' One of the most practically useful books that ever was presented to the student.__N Y Med Journal. WHAT TO OBSERVE AT THE BEDSIDE AND AFTER DEATH, IN MEDICAL CASES Published under the authority of the London Society for Medical Observation. A new Ame ' from the second and revised London edition. In one very handsome volume, rnval 19.„„ "^f"' cloth. (Just Issued.) $1 00. very handsome volume, royal 12mo., extra To the observer who prefers accuracy to blunders I One of the finest aids to a young practition and precision to carelessness, this little book is in- have ever seen.—Peninsular Journal of Af.w ■ we valuable.—N. H. Journal of Medicine. I J meatcine. AND SCIENTIFIC PUBLICATIONS. 31 WILSON (ERASMUS), M.D., F. R. S., Lecturer on Anatomy, London. A SYSTEM OF HUMAN ANATOMY, General and Special. Fourth Ameri- can, from the last English edition. Edited by Paul B. Goddard, A. M., M. D. With two hun- dred and fifty illustrations. Beautifully printed, in one large octavo volume, leather, of nearly six hundred pages. $3 00. In many, if not all the Colleges of the Union, it has become a standard text-book. This, of itself, is sufficiently expressive of its value. A work very desirable to the student; one, the possession of which will greatly facilitate his progress in the study of Practical Anatomy.—JVeio York Journal of Medicine. Its author ranks with the highest on Anatomy.- Southern Medical and Surgical Journal. It offers to the student all the assistance that can be expected from such a work.—Medical Examiner. The most complete and convenient manual for the student we possess.—American Journal of Medical Science. In every respect, this work as an anatomical guide for the student and practitioner, merits our warmest and most decided praise.—London Medical Gazette. BY THE SAME AUTHOR. (Now Ready.) THE DISSECTORS MANUAL; or, Practical and Surgical Anatomy. Third American, from the last revised and enlarged English edition. Modified and rearranged, by William Hunt, M. D., Demonstrator of Anatomy in the University of Pennsylvania. In one large and handsome royal 12mo. volume, leather, of 582 pages, with 154 illustrations. $2 00. The modifications and additions which this work has received in passing recently through the author's hands, is sufficiently indicated by the fact that it is enlarged by more than one hundred pages, notwithstanding that it is printed in smaller type, and with a greatly enlarged page. So com- plete has the author rendered it, that the editor has found but little to do, except in rearranging it to suit the mode of dissection practised in this country, and in introducing a large number of additional illustrations. Of these, many new ones have been engraved expressly ibr the work, and the series throughout will be found greatly enhanced in value. The typographical execution of the volume has undergone a like improvement, and in every respect the work is presented as merit- ing an increase of the favor which it has hitherto enjoyed as a sound practical guide to the study of anatomy. It remains only to add, that after a careful exami- I ing very superior claims, well calculated tq facilitate nation, we have no hesitation in recommending this | their studies, and render their labor less irksome, by work to the notice of those for whom it has been constantly keeping before them definite objects of expressly written—the students—as a guide possess- | interest.—The Lancet. BY THE SAME AUTHOR. ON DISEASES OF THE SKIN. Third American, from the third London edition. In one neat octavo volume, of about five hundred pages, extra cloth. $1 75. The "Diseases of the Skin," by Mr. Erasmus I in that department of medical literature.—Medico- Wilson, may now be regarded as the standard work | Chirurgical Review. BY THE SAME AUTHOR. ON CONSTITUTIONAL AND HEREDITARY SYPHILIS, AND ON SYPHILITIC ERUPTIONS. In one small octavo volume, extra cloth, beautifully printed, with four exquisite colored plates, presenting more than thirty varieties of syphilitic eruptions. $2 45. BY THE SAME AUTHOR. (Just Issued.) HEALTHY SKIN; A Popular Treatise on the Skin and Hair, their Preserva- tion and Management. Second American, from the fourth London edition. One neat volume, royal 12mo., extra cloth, of about 300 pages, with numerous illustrations. $1 00 ; paper cover, 75 cents. WHITEHEAD (JAMES), F. R. C. S., &c. THE CAUSES AND TREATMENT OF ABORTION AND STERILITY; being the Result of an Extended Practical Inquiry into the Physiological and Morbid Conditions of the Uterus. Second American Edition. In one volume, octavo, extra cloth, pp. 368. $1 75. WALSHE (W. H.), M. D., Professor of the Principles and Practice of Medicine in University College, London. DISEASES OF THE HEART, LUNGS, AND APPENDAGES; their Symptoms and Treatment. In one handsome volume, extra cloth, large royal 12mo., 512 pages. $i 50.- We consider this as the ablest woTk in the En- I the author being the first stethoscopist of the day.__ glish language, on the subject of which it treats; | Charleston Medical Journal. WILDE (W. R.), Surgeon to St. Mark's Ophthalmic and Aural Hospital, Dublin. AURAL SURGERY, AND THE NATURE AND TREATMENT OF DIS- EASES OF THE EAR. In one handsome octavo volume, extra cloth, of 476 pages, with illustrations. $2 80. This work certainly contains more information on laws, and amenable to the same general methods of the subject to which it is devoted than any other treatment as other morbid processes. The work is with which we are acquainted. We feel grateful to not written to supply the cravings of popular patrou- the author for his manful effort to rescue this depart- age, but it is wholly addressed to the profession and mentof surgery from the hands of the empirics who bears on every page the impress of the reflections nearlv monopolize it. We think he has successfully of a sagacious and practical surgeon.— Va. Surg, and shown that aural diseases are not beyond the re- Med. Journal. sources of art; that 1 hey are governed by the same 32 BLANCHARD & LEA'S SCIENTIFIC PUBLICATIONS. WEST (CHARLES), M.D., Accoucheur to and Lecturer on Midwifery at St. Bartholomew's Hospital, Physician to the Hospital lor Sick Children, &c. LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD. Second American, from the Second and Enlarged London edition. In one volume, octavo, extra cloth, of nearly five hundred pages. (Just Issued.) S2 00. We take leave of Dr. West with great respect for ligation by this able, thorough, and finished work his attainments, a due appreciation of his acute upon a subject which almost daily taxes to tne ui- powersof observation, and a deep sense of obliga- most the skill of the general practitioner, lie has tion for this valuable contribution to our profes- with singular felicity threaded his way through all sional literature. His book is undoubtedly in many the tortuous labyrinths of the difficult subject lie has respects the best we possess on discasesof children, undertaken to elucidate, and lias in many ot the Dublin Quarterly Journal of Medical Science. darkest corners left a light, which will never be Dr. West has placed the profession under deep ob- extinguished.-iVasW^ Medical Journal. BY the same author. (Nearly Ready.) Publishing in the "Medical News and Library," for 1856. LECTURES ON THE DISEASES OF WOMEN. In two parts. Part I. 8vo. of about 300 pages, comprising the Diseases of the Uterus. Part IL (Preparing), will contain Diseases of the Ovaries, and of all the parts connected with the Uterus ; of the Bladder, Vagina, and External Organs. The object of the author in this work is to present a complete but succinct treatise on Female Di>eases. embodying the results of his experience during the last ten years at St. Bartholomew's and the Midwifery Hospitals, as well as in private practice. The characteristics which have se- cured to his former works so favorable a reception, cannot fail to render the present volume a standard authority on its important subject. To show the general scope of the work, an outline ol the Contents of Part I. is subjoined. Lectures I, II—Introductory—Symptoms—Examination of Symptoms—Modes of Examina- tions. Lectures III., IV., V—Disorders of Menstruation, Amenorrhcea, Menorrhagia, Dys- nienorrhcea. Lectures VI., VII., VIII.—Inflammation of the Uterus, Hypertrophy, Acute Inflammation, Chronic Inflammation, Ulceration of the Os Uteri, Cervical Leucorrhoea. Lectures IX , X,., XL, XII, XIII.—Misplacement of the Uterus, Prolapsus, Anteversion, Retrover- sion, Inversion. Lectures XIV., XV., XVI, XVII.—Uterine Tumors and Outgrowths, Mucous, Fibro-cellular, and Glandular Polypi, Mucous Cysts, Fibrinous Polypi, Fibrous Tumors, Fibrous Polypi, Fatty Tumors, Tubercular Diseases. Lectures XVIII., XIX., XX.—Cancer of the Uterus. Part II. will receive an equally extended treatment, rendering the whole an admirable text-book for the student, and a reliable work for reference by the practitioner. by the same author. (Just Issued) AN ENQUIRY INTO THE PATHOLOGICAL IMPORTANCE OF ULCER- ATION OF THE OS UTERI. In one neat octavo volume, extra cloth. $1 00. WILLIAMS (C. J. B.), M. D., F. R. S., Professor of Clinical Medicine in University College, London, &c. PRINCIPLES OF MEDICINE; comprising General Pathology and Therapeu- tics, and a brief general view of Etiology, Nosology, Semeiology, Diagnosis, Prognosis, and Hygienics. Edited, with Additions, by Meredith Clymer, M. D. Fourth American, from the last and enlarged London edition. In one octavo volume, leather, of 476 pages. $2 50. The best exposition in our language, or, we be- I Few books have proved more useful, or met with lieve, in any language, of rational medicine, in its | a more ready sale than this, and no practitioner present improved and rapidly improving state.—I should regard his library as complete without it. British and. Foreign Medico-Chirurg. Review. \ —Ohio Med. and Surg. Journal. YOUATT (WILLIAM), V. S. THE HORSE. A new edition, with numerous illustrations; together with a general history of the Horse; a Dissertation on the American Trotting Horse; how Trained and Jockeyed; an Account of his Remarkable Performances; and an Essay on the Ass and the Mule. By J. S. Skinner, formerly Assistant Postmaster-General, and Editor of the Turf Register'. One large octavo volume, extra cloth. $1 50. The attention of all who keep horses is requested to this handsome and complete edition of a work which is recognized as the standard authority on all matters connected with veterinary medi- cine. The very low price at which it is now offered, free by mail, places it within the reach of every one. BY THE SAME AUTHOR. THE DOG. Edited by E. J. Lewis, M. D. With numerous and beautiful illustrations. In one very handsome volume, crown Svo., crimson cloth, gilt. $L 25. ILLUSTRATED MEDICAL CATALOGUE. BLANCHARD & LEA have lately issued a Catalogue of their Medical, Surgical and Sci- entific Publications, containing descriptions of the works, •with Notices of the Press and specimens of the Illustrations, making a very handsome pamphlet of sixty-four large octav pages. Copies will be sent by mail, and the postage paid, on application to the Publishers° by inclosing six cents in postage stamps. ' US-J s \TjT