7 IJUj+utyS/ NEW YORK UNIVERSITY —MEDICAL DEPARTMENT. LECTURE ON OBSTETRICS AND THE DISEASES OF WOMEN AND CHILDREN. BY * GUNNING S. BEDFORD, M. D. PROFESSOR OF OBSTETRICS AND THE DISEASES OF WOMEN AND CHILDREN IN THE UNIVERSITY OF NEW YORK. SESSION MDCCCXLVIII—IX. NEW YORK: JOSEPH II. JENNINGS, PRINTER, 122 NASSAU STREET. 1848. A. LECTURE, INTRODUCTORY TO A COURSE ON OBSTETRICS AND THE DISEASES OF WOMEN AND CHILDREN, Oi: LITE BED NOVEMBER 5, 1848. " l/ GUNNING S. BEDFORD, M. D. PROFESSOR OF OBSTETRICS AND THE DISEASES OF WOMEN AND CHILDREN IN THE UNIVERSITY OF NEW YORK. NEW YORK: PRESS OF THE NEW YORK UNIVERSITY, ' J. H. JENNINGS, PRINTER, 122 NASSAU STREET. 1848. New York, November 16, 1848. Professor Bedford,— Dear Sir—At a meeting of the Students of the University Medical College, held on the 15th instant, Don Leon Y. de Alvear, of Buenos Ayres, being in the Chair, and Newton F. Vowles, of Virginia, acting as Secretary, it was unanimously Resolved, That a Committee be appointed to solicit from your accus- tomed kindness, a copy of your very instructive and interesting Introduc- tory Lecture for publication. The undersigned having the honor to constitute the above Committee, take great pleasure in expressing the warmest desires of the Class, and most respectfully add their solicitations to those of the Class, and trust that you will not refuse so unanimous a request. We have the honor to be, Sir, Your obedient Servants, Leonde Alvear, Buenos Ayres. J. C. McGee, Tennessee. Newton F. Vowles, Virginia. A. C. Deane, Massachusetts. J. J. Jarvis, New York. C. Olcott, New Jersey. L. D. Sheets, Maryland. John Burke, New Brunswick. William Beebe, Ohio. G. D. Wilcox, Rhode Island. L. N. Dimmick, Illinois. E. P. Cum.mings, N. Hampshire. Chas. Abbott, Maine. Geo. Y. Bingay, Nova Scotia. James W. Ranney, Vermont. John I. W. Payne, Mississippi. S. F. Charlton, Pennsylvania. O. S. Strange, Canada West. J. M. Dunlap, Indiana. O. Bannon, South Carolina. ' El. A. Metcalfe, Iowa. J. McRae, North Carolina. F. D. Brandegee, Connecticut. John T. Simmons, Alabama. C. McDermont, Kentucky. F. P. Leavenworth, Missouri. Leon Y. de Alvear, Chairman, fyc. Newton F. Vowles, Secretary. 70 Fifth Avenue, Nov. 17th, 1848. My Dear Sir,— I have the pleasure to acknowledge the receipt of your polite note of the 16th inst., requesting, in behalf of the Class, a copy of my Introduc- tory Lecture for publication. The manuscript is at your disposal. Be pleased to convey to the Class my thanks for this mark of their confi- dence ; and, whilst assuring them of my best wishes for their prosperity and happiness, accept for yourself personally my high regards. Yours, very truly, • G. S. BEDFORD. Mr. Leon de Alvear, Chairman. LECTURE. Gentlemen,— Allow me to offer my salutations, and extend to you all a cor- dial and earnest welcome to the halls of this University. You have assembled for the purposes of instruction and self-improvement; and you have visited this school of medicine in the full hope that the prin- ciples of your profession will be properly inculcated, and its great dogmas, as transmitted to us by the venerable and learned fathers of our science, faithfully expounded. These are duties whicli our posi- tion necessarily calls upon us to discharge—duties too sacred to be re- garded lightly, for they involve consequences momentous not only to you, but to those, also, who are hereafter to be confided to your profes- sional care. In this school, then, you are to learn the principles which are to guide you in the treatment of disease ; and may they, in the hour of peril, when all around is gloom and darkness, prove beacon-lights to illumine your way to truth and science; may they, under those try- ing circumstances, redeem the pledge which we make to you this night, to spare no effort, shrink from no labor necessary for the zeal- ous and faithful performance of the trust imposed on us as your in- structors. To the Faculty of this Institution has been delegated the high privilege of preparing you for the emergencies of professional life; soon you will be called upon to exhibit, through your acts, testi- mony of the fidelity with which you have pursued your studies—testi- mony, too, of the manner in which we, your teachers, have discharged our duty. These are considerations which I know full well no mem- ber of this Faculty can contemplate without appreciating, to the full extent, the fearful responsibility of his position; and whatever may be the feelings of my colleagues on this subject—I know they are deep and abiding—allow me to say. for myself personally, that I never enter on the performance of duty in this University, without a senti. meht of apprehension and distrust. It will, however, be my earnest care to consecrate to your service every energy of my mind; and feeling, as I do, an undisguised interest in your advancement, you may rely on my best efforts to impress upon you the principles and practice of the department assigned to me in this Institution. Obstetricgnedicine may be divided into midwifery proper, the acci- dents of the puerperal state, and the diseases peculiar to females and infancy; to these may be added the subject of embryology, and the 0 numerous medico-legal questions necessarily involved in the discus- sion of these various topics. It is, therefore, manifest that this depart- ment embraces a vast field of inquiry, and is fruitful in subjects of the deepest interest to society at large, as well as to individuals. Certain writers have endeavored to show that the process of child- birth is extremely simple ; and I hat Nature, under all circumstances, is competent to effect delivery. This opinion, too, they have attempted to fortify by an appeal to analogy, contending that, because animals bring forth their young with comparative facility, in human parturition, the process being essentially the same, the interference of art is not re- quired. Nothing can be more fallaoious in point of fact than a theory of this kind ; it not only bespeaks unpardonable ignorance on the part of those who advance it, but it has often led to the most painful results in practice. The organization of the human female is peculiar, and it is to this peculiarity of structure that we are to refer the characteristic suf- fering necessarily connected with the parturient process as exhibited in woman. To the same cause, likewise, is to be ascribed the protracted, and frequently difficult and dangerous progress of the child through the maternal organs. In animals, on the contrary, where parturition is comparatively a simple act, the organization is much less complex, and the difficulty is proportionately diminished. The distinguishing characteristic of the human species—the physical attribute which draws the broad line of difference between our race and all other crea- ted beings—is the erect position of the body. It is, therefore, in conse- quence of this special circumstance, that a peculiar arrangement of the organs connected with reproduction in the human female was found necessary, in order to afford ample protection to the germ during intra-uterine existence; every thing, in a word, is made subservient to this cardinal object. But it must be remembered that this arrange- ment, whilst it becomes absolutely essential for the purpose of counter- acting the effects of the upright position which God has affixed to the human kind as one of its prominent peculiarities, renders, at the same time, labor tedious, painful, and difficult, calling frequently for the in- terposition of consummate skill, in order that delivery may be effected with safety to both mother and child. Between human and compara- tive parturition, therefore, there is a marked distinction; in the one, it is painful and protracted ; in the other, simple and of short duration— the distinction being due to the difference in structure and position of the respective organs. In the latter case, delivery is accomplished by the unaided efforts of Nature ; in the former, the interference of art is often demanded, and the exercise of the soundest judgment required, in order that the work of death may be arrested. Remember, however, this cardinal principle, that all interference in midwifery must be based on positive knowledge—a knowledge of the laws on which rests the mechanism of labor; ignorant of these laws, and your interference will be perilous, if not fatal. Without them to guide you, your presence in the lying-in room can only result disastrously to your confiding patient, and bring dishonor on your own njime. Mid- wifery, you must constantly hear in memory, is a demonstrative science ; and the passage of the child through the pelvis and soft parts of the r mother is easy or difficult, possible or impossible, precisely as the ad- aptation of certain mechanical principles is or is not in keeping with the exactions of Nature. To make this proposition perfectly lucid, it will only be necessary to direct your attention to the palpable fact that, in the mechanism of natural labor, there is a motive power impelling a body through a given space. The motive power is the contracting womb; the body on which the womb acts is the fcetus, and the space is the maternal pelvis. Now, as the foetus possesses certain dimensions much greater than those presented by the pelvis, it follows as a neces- sary consequence that there must be a correspondence and adaptation be- tween the respective dimensions of the foetus and pelvis, in order that the motive power may prove efficient in accomplishing the expulsion of the child. That you may clearly appreciate the argument, suppose, for example, the case of a shoulder presentation; here, the dispro- portion of the fcetus to the pelvis is such that it is physically impos- sible for it to pass through this canal, no matter what may be the force of the motive power. If an ignorant practitioner attempt to overcome the difficulty by violence, and should resort to tractions on the arm, his violence would have no other effect than to tear the arm from the body, and peradventure rupture the uterus. He would commit no such act of murder—for you can designate it by no other name—if he com- prehended the principles on which Nature proceeds in the delivery of the child. The mechanism which she institutes is so perfect, that it commends itself in an especial manner to our admiration. Let me en- treat you, gentlemen, to study Nature ; contemplate her as she pro- gresses in the perfection of her works; take her as your model and guide, and you will be forced to acknowledge that, in all her opera- tions, there is a happy blending of wisdom and benevolence—wis- dom, in comparison with which all human effort is insignificant; bene- volence, by which a conservative interest is constantly exercised over the animal economy. This excellence cannot be the work of chance ; it bears the impress, and carries with it the evidences of a power eminently above all earthly influence—the impress of God himself! I cannot, therefore, too emphatically urge upon you the necessity of understanding in all its details the mechanism of natural delivery. It is ignorance of this mechanism which causes oftentimes such me- lancholy disaster in the lying-in chamber; the reckless pretender, un- conscious of the laws by which the act of childbirth is ordinarily reg- ulated, cannot do otherwise than inflict serious injury by his rude manipulations during the progress of labor, whether it be to hasten the process, correct a real or supposed malposition, or extract the pla- centa. All these, as well as every other act of the accoucheur, must be based on a thorough knowledge of what Nature does ; otherwise his in- terference will result in injury and death. But there is another mo- tive, which should urge you to a diligent pursuit of this interesting de- partment__a department which involves the consideration of the suf- ferings and dangers to which gentle and lovely woman is exposed during the most interesting period of her existence. How proud and honored are the reminiscences which woman naturally brings to our mind; memory loves to dwell on them, for they are the very embodi- 8 ment of our happiest days. Who can think of maternal love, and not have his heart filled with gratitude and veneration for the devoted and self-sacrificing mother, who watched with such unwavering fidelity over his infancy, and whose constant prayer to Heaven in her nightly vigils was, ' Oh, God! protect my child !' Again, in her character of wife, is not woman an object worthy of our holiest love ? In the hour of adversity she is our solace ; when the spirit is broken, and the faith- less world looks with chilling indifference on our crushed fortunes, it is the influence of her example, and the eloquence of her devoted love, which animate the sunken heart, rekindle and bring into active ex- ercise the slumbering energies of him, to whom she has pledged eter- nal fidelity. These are some of the beautiful results of the influence which woman exercises on society ; and they at once indicate the striking and lovely attributes of female character. This gentle being, so steadfast in her affections, so true to her duty, whilst she has excited the enthusiasm of the poet, has not failed to call forth the profound admiration of the philosopher. This interesting being, therefore—the procreatrix as it were of our species—will constitute the chief topic of my department. I shall have frequent occasion to appeal to your sympathies in her regard ; the perils by which she is surrounded at the different periods of her life will be earnestly, and I trust effectively, laid before you; her sufferings and sorrows, if truthfully depicted, will not only excite your sympathies, but they will also, by eliciting the generous and noble impulses of your nature, urge you to a faithful prosecution of your studies. In order that you may form some estimate of the cruel wrongs occasionally imposed on suffering woman, allow me to call your at- tention to a case which occurred some years since in this city, in the practice of an individual who styled himself 'Doctor;' and who, I am informed, enjoyed the confidence of his patients. On a cer- tain night, he was sent for to attend a female in labor with her first child. The pains were severe, and the labor somewhat advanced when he arrived. About ten hours after he reached the house, the patient was delivered of a child, which bore unequivocal evidences of the Doctor's ignorance. One of the parietal bones was crushed; the left eye was seriously injured, and the thigh dislocated. The child was delivered in this mangled condition ; and, heedless of the remonstrances of friends, who were gathered around the bed of the wretched patient, the Doctor proceeded to remove the after-birth. Such was the violence of the force employed to extract this body, and so wanting was his brutal heart in feeling, that, utterly regardless of the piercing shrieks of his dying patient, and the fervent appeals of her friends to desist from his work of death, he continued the torture for half an hour longer, when, suddenly bracing his feet against the bed, with one prodigious effort he dragged the womb from the body of that woman. But the tale of woe is not yet completed ; the fullness of that man s guilt has not yet been told ; the blackness of his heart no tongue can describe. It was proved by those who were witnesses^ this foul deed of blood, that, for ten minutes before the womb was torn from her person, the patient gave no manifestation of suffering; she uttered not 9 a word; and this silence the operator stated was an evidence of his skill—an evidence of the relief he had afforded her! Gentlemen, that silence was no evidence of skill ; it was the damning testimony of his guilt. That woman was silent, but it was the silence of death ; her light had gone out, and with its extinction ended all her sufferings. It is, indeed, almost beyond belief that an instance of such extreme atrocity, such cold-blooded murder, perpetrated under the broad man- tle of science, could be found in this enlightened age, and especially in a community professing itself to be Christian. And yet the records of our courts of justice will demonstrate that similar acts of barbarity have occurred more than once in the city of New York. In this University, you will be taught conservative midwifery; Nature will be constantly held up to you as a model worthy of imitation; the operations to which she has recourse in order to consummate her work will be earnestly pointed out, and this substantial principle em- phatically inculcated—that in order to become Nature's substitute in the lying-in room, you must first accurately comprehend the mechanism ' by which she, when uncontrolled by accident or disease, accomplishes her object. I have alluded to one branch only of my department. The diseases peculiar to females constitute another branch of my subject, and they present a field of unbounded interest. There is, perhaps, no class of maladies more neglected by the general practitioner, and yet there is no class which of late years has attracted to the same extent the pro- found attention of the best writers. The philanthropist—he who feels a sincere and unaffected interest in all that concerns the human fam- ily—if he cast his eye over the community as it exists at the present day, will find ample material for melancholy thought; the fountains of his sympathy will be freely drawn upon, and he will shed many a tear over the follies of poor human nature. On the one hand, he will contemplate with sorrow the moral degradation which, as the penalty of crime, attaches to those who have become involved in debauchery and vice; on the other, he will view with mortified pride the disas- trous results of fashion, and the conventional forms of society, as evin- ced in the blanched cheek and emaciated persons of our fair couutrv- women. There are several causes which conspire to impair the health, and lead to an early decay of the female. The period of puberty is one of fearful interest to the young girl. It may, indeed, be called a transition state, distinctly characterized by phenomena which demand the serious attention of the physician. At this period of her life, the system of the young female undergoes a remarkable revolution—a revolution which, if interfered with by officiousness on the part of the practitioner, or the imprudence of the girl herself, is too often followed by premature decline and death. If, however, Nature should not be contravened in her efforts; if this change should be accomplished in entire accordance with Nature's laws, the foundation of future health will generally be secured. The change which puberty occasions in the economy of the female appertains both to her moral and physical sys- tems ; previous to this period, she presents the aspect of a mere child ; all her bearings are those of a child whose mind has not yet been 10 occupied with the important relations which she is hereafter to hold towards society. Would that these relations, and the sacred offices to be performed when the period of childhood has passed away, were constantly kept in view by those who have the direction of the female youth of our country! Then would attention be paid to those principles of health, without which there can be neither long life, nor happiness. The object of education, under these circumstances, would not be, as is too frequently the case, to make a pretty toy of the young girl ; to give her the gilding of mere tinsel, and thus sacrifice a lovely being to the unholy caprice of an imbecile mother, whose study it has been so to educate her daughter, that when exposed to the vulgar gaze she may become the object of admiration. This admiration, should it be secured to the full measure of that mother's ambition, will, I imagine, but poorly reconcile her to the early grave which she has thus thoughtlessly prepared for her child. How often does it become our melancholy duty to witness these painful results; and how often, too, do we be- come the witnesses of the sincere contrition of those, who feel that they have thus wantonly sported with human life, and consigned to a pre- mature tomb the idol of their fondest affections. A common error, I think, in practice is to lose sight of the important fact that menstruation is a natural function ; as much so, indeed, as respiration, digestion, or any of the other numerous functions more or less directly connected with the well-being of the economy. On what, in truth, does menstruation depend ? Certainly not on the develop- ment of the womb ; but essentially and exclusively on the maturity of the ovaries ; these are the female organs of generation, and hence the propriety of calling them the testes muliebres. Suppose a young girl should have attained her thirteenth or fourteenth year of ao-e—the period at which this function usually shows itself for the first °lime in our climate—and she should not menstruate. The presumption is that her friends would become apprehensive that something was wrong, and your advice would most probably be solicited. If you were careless and suffered your judgment to be controlled by the uneasiness of the parent, the course of conduct you would pursue under the circumstan- ces, it would not be difficult to predict. The idea which generally pervades the mind of the mother, and of those to whom the direction of female youth is committed, is this : the system, they say, is too weak; it has not power to bring about this important change. Hence, the treatment consists in the administration of powerful emmena»o"ue medicines ; iron, and the various tonics are also freely employed ; and the poor child, after having been subjected to this empirical prac- tice for months, not only derives no benefit, but frequently finds her system shattered, and often, too, beyond the possibility of reaction. There are, I admit, cases in which it may become necessary for you to stimulate the sluggish condition of the system ; but these cases, in my judgment, are to be viewed more in the light of exceptions to the gen- eral rule than as guides for general practice. When the menstrual function does not appear at the ordinary period in the young girl, its absence may be usually ascribed to one of three causes : 1st Im- perforate os tines. 2d. Imperforate hymen. 3d. Defective phvsi- 11 cal organization of the ovaries ; or, in other words, a want of ma- turity ia these bodies. The first two causes merit the gravest con- sideration of the practitioner, for they have, in eluding his vigilance, sometimes inflicted the severest wounds on character, and brought ruin on immaculate purity. If, however, the non-appearance of the function be due to defective organization, or want of maturity in the ovaries, this result is at once indicated by the general appearance of the girl. She is, in fact, but a child ; her physical appearance presents nothing of that fullness, and has undergone none of those changes, so perfectly characteristic of the advent of menstruation, and so directly dependent on the maturity of the ovaries. In the absfcice, therefore, of these physical developments of the system, you may, in almost every case, impute them to tardiness on the part of Nature in bringing these bodies to the usual state of maturity. If this reasoning be correct, the indication is obviously not to force Nature by drugging the frail system of the girl; but to place the latter under all the influences which com- mon sense tells us are the best calculated to aid in accomplishing the desired object. These influences will consist in improving the diges- tive functions, exercise in the open air, generous diet, cheerful com- pany, &c. In a word, why does the infant walk ? Is it not that its organs of locomotion are sufficiently developed to sustain the weight of the body, and thus afford it the means of progression ? What would you think of the physician who, in the absence of this development, should attempt to accomplish locomotion through the agency of med- icine ? And yet there would be nothing more absurd in such efforts than the attempt to induce menstruation before the ovaries have at- tained the necessary degree of maturity. This tardiness on the part of Nature may be due to several causes ; we know very well how remarkably the menstrual function is influenced by climate, race, edu- cation, mode of life, &c. ; to these may be added the influence of cer- tain peculiarities of constitution. These latter demand the special attention of the practitioner. Let it, then, be constantly borne in memory that the effort, which Nature makes at the age of puberty to bring into efficient and healthy action the menstrual function, is one of serious import to the young girl. It is, indeed, her starting-point in life—the corner-stone on which is to be erected the superstructure of her future health. The uterine system is controlling in its influence ; it holds the entire economy in perfect subjection ; and many of the constitutional dis- turbances, frequently mistaken for local disease, are but the result of those numerous sympathies by which the womb is allied to the vari- ous portions of the general system. The aberrations from the normal menstrual function are numerous and grave, and they cannot con- tinue for any lengthened period without being followed by more or less disturbance of the general health. Dysmenorrhea, or painful menstruation, constitutes one of the most formidable of these complica- tions. Oftentimes, this derangement of the menstrual function arises from the formation of a membrane within the cavity of the womb ; and, under thesS circumstances, the female is subjected to the most agoniz- ing suffering ; equal, indeed, to the pains of parturition. Again, Dys- 12 menorrhea is occasionally of a spasmodic character, and the relief to be afforded in either case will depend on the acumen of the. practi- tioner ; he must distinguish between the two causes, otherwise his treatment will be essentially empirical, and most frequently without the slightest avail. Dysmenorrhea, it is conceded, is often the cause of sterility ; and this fact being overlooked by the practitioner, and the dis- ease treated without any special reference to its pathology, the married lady is often not only subjected for many years, during the menstrual period, to extraordinary suffering, but she passes through life disappoint- ed and unhappy, because she has not been blessed with offspring. This latter circumstance is rH>t unfrequently the source of deep and bitter regret; and why should it not be ? Is it not natural for the married to desire offspring ?—is not the child the mother's idol ? Is it not her very heart's blood ? Oh ! where is there love so intense and abiding as in the depths of the maternal heart? If science, therefore, will enable you to remove disease, and grant this boon to woman, it will not only be your imperative duty, but it should also afford you pleasure to per- form so acceptable a service—a service not soon forgotten, and which will secure for you the lasting friendship of your grateful patient. An interesting case of this kind occurred to me about fourteen months since. A married lady from Louisiana requested my professional opin- ion. The following is an outline of the case. At the time I saw her she was nearly twenty-seven years of age, and had been married nine years. Previously to her marriage her health had not been good, she having for several years labored under Dysmenorrhea. Various remedies had been employed, but all without effect. The malady continued after marriage, and she had not passed a month without experiencing the most distressing pain, accompanied generally by the severer forms of Hysteria, and occasionally by Eclampsia. She had never become pregnant, and in consequence of her continued sufferings and disap- pointed hopes a deep melancholy had pervaded her mind for the last two years. She had abandoned society, and her husband, who ap- peared devotedly attached to her, finding all medical treatment unavail- ing, resolved as a last resort to test the efficacy of travel, trusting that from the change of air and scene his wife might possibly derive some benefit. In the course of her journeyings she visited the city of New York, and I was requested to see her professionally during one of the attacks of Dysmenorrhea. It was, indeed, painful to behold the ago- ny of this lady; her paroxysms of torture were well calculated to elicit the sympathy of the spectator; and to the physician, who could comprehend the nature and intensity of the suffering, it was a scene of deep and affecting interest. In looking at this patient after the attack had passed over, she presented all the ordinary appearances of good health. She had not lost flesh, nor did her general aspect indicate se- rious organic disease. I learned on inquiry that, during the intervals between the menstrual periods, with the exception of the melancholy under which she labored, she exhibited not the slightest evidence of infirm health. She was inclined to plethora ; her appetite was remark- ably good, and her digestion excellent. Here, then, was a case of great professional interest, A ladv with all the evidences of good 13 health was, on the recurrence of each menstrual evacuation, attacked with the anost excruciating pain, occasionally accompanied by con- vulsions ; and this condition of things, in resistance to all the remedial agents that had been suggested, had continued for more than twelve years. In viewing this case deliberately, and giving to the consid- eration of it all the attention its importance demanded, it occurred to me that the difficulty was most probably due to that particular form of Dysmenorrhea in which at each catatnenial period a membrane, result- ing from the pouring out of coagulable lymph, is formed within the cavity of the womb. I did not arrive at this conclusion without a minute and thorough examination of all the circumstances connected with the case ; and, having formed my opinion, I proceeded with the treatment which appeared to me to be indicated. The form of Dys- menorrhea to which 1 am now alluding, is almost always due to an en- gorged condition of the uterus. In an examination per vaginam, a few days before the expected attack, the uterus I found in a state of tumes- cence ; the cervix was soft and tumefied, and the body of the organ larger than is usual in the unimpregnated condition. In accordance with the view I entertained respecting the cause of the disease, the treatment I adopted was, in the first place, antiphlogistic, and secondly, alterative. The lady was informed very frankly that it would probably require several months to effect a change in her condition, and that, in consequence of the length of time the malady had existed, it was doubt- ful whether she could be entirely relieved. I obtained her consent to proceed with the case, and no time was lost in commencing the treat- ment. My regular professional attendance begun on the 7th of Sep- tember, 1847, and on the 24th of the following January she left the city, perfectly established in health. I had the pleasure of receiving a letter from her husband, dated New Orleans, March 10th, containing the gratifying intelligence that his wife was pregnant; and I have recently been honored with a second epistle, announcing the birth of a fine son on the 3d of last October. I am thus particular in these details, in order that you may clearly appreciate all the bearings of the case. Here you perceive, was a ladv who for many years had been a martyr to agonizing suffering; all hope of relief had been abandoned ; she had lost all interest in life ; and her mind, despondent and melancholy, had begun to vield to this combination of unhappy circumstances. It was my good fortune to discover the true cause of her sufferings, and havino- applied the proper remedies the disease gave way, and the patient was restored to health, and will, I trust, live to enjoy many years ° TheTsTases peculiar to females are often extremely obscure, and the practitioner must remember that successful treatment depends on a iust discrimination of the actual cause of the malady. Many a valu- able life has been sacrificed by error of judgment in this particular, and discredit brought upon our science by mistaking effects for causes In the present state of physiological knowledge, it would indeed be dif- ficult to present such a classification of these diseases as shall accord perfectly with pathology and therapeutics. The old doctrines, how- ever, as propounded by the early Greek writers with regard to these 14 maladies, and especially Hysteria, have yielded to the advances of mod- ern science. The functions of the nerves, as now unders£)od, have thrown a flood of light on points formerly obscure and unsatisfactory ; and we may be permitted to predict, in view of what has already been accomplished through our knowledge of the brain and nervous system, that all rational deductions in disease will sooner or later be based on the anatomy and physiology of this system. That there subsists between the nerves of the uterus and the general nervous system an intimate connection, cannot, for one moment, be doubted. Deny this, and we are at a loss to explain many of the phenomena so constantly occurring in the economy of the female. For example, the diseases which may be considered as peculiar to woman are, with good reason, divided into organic and functional. The pathology of the former can be determined without difficulty, for they involve lesion of structure, which becomes manifest to the sense either of touch or sight. This organic lesion will occasionally give rise to the same series of phenomena which are known to follow mere functional disturb- ance. The only evidence that these phenomena are due to structural, and not functional disease, is furnished by the fact that a lesion does in truth exist. The pathology, therefore, of organic disease of the womb is simple, and of easy comprehension ; not so with the functional de- rangement of this organ, for here there is no change of structure—none at least appreciable in the minutest autopsy. We have already seen that the important function of the uterus—that which is in fact the bal- ance-power between health and disease in the female, menstruation— cannot, under ordinary circumstances, be interrupted ; or, in other words, cannot depart from its normal standard, without involving, to a greater or less extent, the general economy in constitutional disturb- ance ; and this result is produced through the medium of the gan- glionic system of nerves. There are two points you are constantly to keep in view, so far as the diseases of women are concerned : 1st. Is the disease organic, or is it functional ? 2d. Is any given disturbance in the system local, or is it dependent on the structural or functional derangement of the uterine or- gans ? If you will steadily bear in memory these two interrogatories— suffering your minds on no account to be diverted from the true issue —you will have overcome one of the principal difficulties in the treat- ment of these special maladies. In order that you may clearlv ap- preciate the value of the principle we are inculcating, let us, for ex- ample, take the case of a lady who consults you in the hope that she may derive from your skill a remedy for a distressing head-ache—so distressing, indeed, that her mind almost becomes bewildered. Your first duty in a case of this kind is to decide whether the pain is the result of an affection of the head, or whether it is a mere symptom of trouble in some remote organ. You see at once how essentially your treat- ment, if rational and effective, must depend on a just distinction. Again, if the head-ache should be found to proceed from functional disturbance of the womb, which is a very usual circumstance, it must be remembered that two opposite, or, if you choose, two contradictory conditions of this organ are alike capable of producing this same result, In intense head-ache. For example, a lady whose menstrual evacuation is deficient in quantity is extremely liable to severe cephalalgia ; pre- cisely the same thing occurs in a female whose system has been drain- ed by an excessive loss of blood. Hence, in miscarriage, where the patient has become nearly exsanguinated, a very common result will be, distressing head-ache. If you should decide erroneously in these two cases—if, for instance, you should mistake the one condition of the system for the other, the most serious consequences may ensue to your unhappy patient. Head-ache, produced by deficient menstru- ation, will yield to the judicious abstraction of blood, cathartics, diet, &c, these remedies being employed, not empirically, but in reference to the peculiar circumstances which may exist at the time. Head- ache, on the contrary, the result of excessive loss of blood, would not only be aggravated by this treatment, but fortunate, indeed, would it be for the sufferer, if her life did not pay the forfeit of erroneous judg- ment. _ You will frequently be consulted by ladies for a supposed disease ot the liver; pain in the right side, over the region of this organ, giving rise to the belief that the liver is affected. Under this conviction mer- curials are administered, and frequently serious mischief ensues to the general system. The pain does not yield to the treatment; the mer- cury is still continued, and oftentimes the most fearful ravages result from the administration of this valuable, but much abused remedy. The plan for you to pursue is a simple one ; if your opinion be invoked in a case of this kind, do not take it forgranted that, because the patient suffers pain in the right side, she is therefore laboring under disease of the liver. You must remember that this very character of pain is sometimes the result of pregnancy, and occasionally an important symptom of disease of the womb. In engorgement without ulceration, and in ulceration of the neck of this organ, I have frequently known this pain to be present; and it exists, also, in other derangements of the uterus. In a word, gentlemen, the distinction between the scien- tific physician and the empiric is this—the former traces effects to causes •" before prescribing he endeavors to ascertain what there is wroncr in the wonderful machinery of the human fabric ; he will not content himself with mere conjecture, but true to the principles of his science and devoted to its interests, by diligent investigation he d.s- covers what the matter is, and then applies the remedy. The latter— the heartless empiric-true, too, to the principles of his calling specu- lating with human life as the broker does with dollars and cents—the great object of his existence being the amassing of wealth-makes human nature his study, and devotes his nights and days to the forma- don of schemes by which he will be the better enabled to practice on human credulity. , , ,. . ,,. I cannot too emphatically admonish you that, in the diagnosis of dis- ease, symptoms will often prove faithless guides; and I am anxious to ffuard vou against the error, too common unhappily, of prescribing for mere symptoms. The following case will to a certain extent, exem- SSv the truth of the remark. On the ] 2th of last May I was requested fo visit a married lady from Rockland County, in this State. She was 16 forty-six years of age, the mother of nine children, the youngest being two years old. Her health had been uniformly good until thr.ee months after the birth of her last child. At this time she experienced an uneasy sensation in the region of the womb ; a torturing pressing-down feeling, as she expressed it. These sensations came on at intervals, and were always accompanied by more or less discharge of blood. Her dif- ficulties continued to increase, and the loss of blood at times was so profuse that her health began to give way; the disease not yielding to the various remedies employed, and her system becoming drained by the losses of blood, she was finally told that she must die, as her mal- ady was cancer of the womb. It was under these circumstances that my opinion was asked. I found her almost exsanguinated ; utterly in- capable of taking exercise ; palpitation of the heart, and hurried res- piration on the slightest exertion ; oedema of the lower extremities, and the coldness of death on her hands and feet; her pulse was thready, and her general appearance gave strong indications of approaching dis- solution. After receiving from her sister a full and graphic history of the case, I made a vaginal examination, with a view of ascertaining the actual condition of the womb. The mouth of this organ was consid- erably dilated, and there protruded through it a tumor about the size of an egg; the tumor was insensible to pain on touching it; its largest portion or base was downward, and by carefully insinuating my finger within the womb I found the tumor began to narrow, and it was evi- dently pediculated. My opinion was at once given that there was no cancer of the womb, and that all her sufferings arose from the pre- sence of a polypoid growth. The following day I applied a ligature to the tumor ; in thirty-six hours the pedicle sloughed, and the tumor was removed. The bearing-down sensation ceased, and so did the bleeding ; because the tumor, which caused both these results, no long. er existed. This lady on the 20th of July left the city much improved in health, and, agreeably to my suggestion, spent several weeks at Sar- atoga Springs. She is now a healthy, and happy woman. Bear with me, I pray you, whilst I cite another case, melancholy indeed in its issue, but strongly confirmatory of the position I have assumed, that symptoms are faithless guides. Some months since a respectable tradesman from London arrived in this city with his wife and five children. He came here with the view to establish himself in business. About a year before his arrival in this coun- try his wife's health began to decline. She suffered greatly from pain in the region of the womb; and her catamenial periods were very irregular, occurring sometimes once in two months, and acrain once in two weeks ; but at each return they were more profuse than usual, and were followed by extreme debility. Her physician in Lon- don had treated her for profuse menstruation, and assured her there was no cause for alarm, promising at the same time a speedy restoration to health. The husband stated to the physician that he contemplated coming to America to reside, but would abandon all idea of doing so if there were any probability that his wife would not recover her health. He was, however, informed there was not the slightest ground for apprehension, and accordingly made his arrangements to embark for 17 this country. One week after his arrival in New York I was requested to visit his wife professionally. I found her in an extremely prostrated condition ; her face was pale and waxen; she complained of intense and burning pain in the womb; the odor exhaled from her person was highly offensive, but peculiar ; and she was subject to occasional losses of blood from the vagina, which had reduced her to a state of alarming exhaustion. The husband made an earnest appeal to me not to deceive him ; he spoke touchingly of his little children, and their dependence on their mother; he was, as he remarked most feelingly, in a land of strangers—and he said, with all the emphasis of truth, " Doctor, if it be the will of God that my wife should die, let her die among her friends ; do not deceive me ; and if you cannot restore her, tell me so at once, in order that I may take her home." These words, gentle- men, are simple, but are they not eloquent? Are they not full of meaning, and calculated to reach the heart, unless that heart be of adamant ? Oh ! they tell the story of professional responsibility, and point out professional duty far more graphically than any language or argument I can employ. The sequel of this case is soon told. On making a vaginal examination my fears were at once realized ; the unfortunate patient, I found, was laboring under the last stage of that frightful and loathsome malady, cancer of the womb. The character of the disease was such that the entire neck of the uterus had yielded to its destructive progress, and the adjacent parts were now becoming involved in the merciless grasp of a malady which, of all others, is the most fearful with whicli poor suffering woman can be afflicted. The flooding was now easily accounted for ; the disease, phagedenic and unrelenting as it is, sparing no tissue, and laying open vesse after vessel, had thus caused fearful periodical hemorrhages. I remarked to the husband that the case was without hope. I flattered him not, but told him the melancholy truth. In ten days from the morning on which this opinion was given, his wife was a corpse ! . There is in this tale of sorrow a moral. Think sometimes of it when vou shall have left this University, and become engaged in active professional duty ; and let it admonish you that, when disease cannot be controlled by human skill, agonized friends should be spared the additional pang of disappointed hope. In your rounds of professional life amid the cares and embarrassments incident to your vocation, you will often be called upon to commingle your sympathies with the tears of those who pour forth their lamentations over the couch of the dying ; then it will become your duty, as far as this object can be achieved, to assuage their sorrows, and comfort them m their affliction. W>thhoW not your condolence under circumstances like these ; and whilst I would not have you prostitute the sacred offices of religion by merely affectin- to feel its holy and sublime influences-yet, in the hour of anguish0, when the human heart feels a void by the loss of some beloved frifnd, then it may not be improper for the physician to use the lan- guage of solace, and speak, to those str.cken in grief of the glorious futu°re promised, by the God of the universe, to all who keep inviolate hi, word The history of our art is but a record of good deeds; its emblems' are benevolence and good will; its objects all that enlightened o 18 philanthropy will at once recognize as worthy of the best efforts of man. It is, indeed, true that there is nothing dazzling in the practical duties of medicine; our science cannot boast of the eclat of the battle- field; her sphere is limited; and the only triumphs in her record are those obtained over disease and death. How strangely do her humble efforts contrast with the proud bearing of the warrior, who, stimulated by love of country, presses on the foe, and makes by his deeds of prowess the field of carnage still more frightful, covered as it already is by the slain and the wounded. Amid the shouts of victory, and the deep tones of the deadly cannon, the physician is occupied in a more humble but not less glorious work. He, like the good Samaritan, amidst all this glitter of arms and thirst for blood, is seeking for the sick and the dying; he forgets the noise and tumult of the scene, and, re- gardless of all personal danger, devotes himself with fidelity to the per- formance of his humane duties. Here he amputates a limb ; there he dresses a wound ; here again he slakes the thirst of the dying soldier, and peradventure lets him die, as a soldier loves to die, amid the folds of his flag. There is, however, on that same battle-field one other individual whose godlike duties, humbly yet faithfully performed, claim for him a high and honorable position among his fellow-men. I allude to the humble priest, who, prompted by his love of doing good, and always happy when engaged in the sacred cause of humanity— always, too, obedient to authority—responds heartily to the bidding of his superior, and a moment's warning finds him on his way to the scene of active and perilous duty. Let history tell how nobly this servant of God has, under circumstances like these, redeemed his pledge to heaven and earth. Invoke the spirits of the dead, whose bones are now bleaching on the bloody fields of Palo Alto and Buena Vista, and let them tell of the consolation derived from the prayers and kind offi- ces of this good man in the agony of death. Those spirits, could they utter the language of grateful hearts, would be eloquent in praise of the priest and physician in that dark hour of deadly strife. The profession of medicine, you see, is an honorable and glorious one; it embodies all the elements of human excellence; and, when legitimately pursued, its tendencies are elevated and ennobling. In a few months, many of you will be admitted to the Doctorate ; the diplo- ma of this University will be conferred on you ; not, however, without exacting the pledge that you will guard its honor as you would your life. She will send you forth as the standard-bearers of our school; on your integrity we shall rely most confidently, and to your custody we shall commit the character of this Institution. I congratulate you, gentlemen, on the honors which await you ; let it be your aim to merit them. Believe me, I feel for you all a sincere friendship. Soon the relation of pupil and preceptor will cease to exist; your diploma will constitute you our peers, and with it will devolve on you the heavy re- sponsibilities of professional life. When engaged in active duty, and far removed from these halls, revert sometimes to the pleasant hours we have spent together; and allow me to say, that whatever may be your destiny in life, our best wishes and benedictions will attend you. But, gentlemen, I must conclude; and, in doing so, I cannot dis- 19 guise the fact, that a large portion of you, who have left your homes thousands of miles distant, feel that you are here in a land of stran- gers ; new scenes now break upon your view, and new influences will be brought to operate. This is the first time that many of you have been separated from the paternal roof, and the confusion and tumult of this busy metropolis must present a striking contrast with the peace and quiet of your own homes. Though away from those you love, yet they are with you here this night in spirit. The aged father and fond mother, the gentle sister, and brother, whom you left a few weeks since, are now engaged in holy converse about you. Their hearts beat in unison with yours; every throb is for your honor and your happiness. Disappoint not their hopes ; but let your conduct here be such as to make the measure of their joy complete; and when you again return to the homestead, let each one of you feel that you merit the greeting of your parents, when they exclaim, God bless you, my son ; you have fulfilled your promise, and made happy our days. r