perceived pain in micturition on the 8th inst.; very slight discharge, light-coloured, and thin; frequent desire to pass water, with much straining; the urine is occasionally bloody. Ordered a mixture of liquor potassæ, tincture of hyoscyamus, and camphor mixture; and to inject thrice a day with one part of chloroform to two of mucilage.

Jan. 15th.-Much improved, but slight discharge; the injection causes great pain for a minute or two. 19th.-Discharge quite ceased, and he is perfectly well, with the exception of a little cedema of the prepuce, which disappeared under the application of a saturnine lotion; no recurrence of the discharge.

CASE 4.-April 29, 1852: Mrs. R—, aged forty-five, contracted gonorrhoea from her husband seven days ago; the discharge has gradually increased in quantity, in spite of a regular employment of the acetate-of-lead injection. Directed her to inject the chloroform of a similar strength to that used May 3rd.-Discharge nearly ceased; all that now exists is an exceedingly small quantity of a colourless, watery fluid; no complaint of pain from the injection. To repeat it once a day. 10th.-Has been quite free from all discharge for five days.

in the last case.

Encephaloid Disease of the Lower Portion of the Femur; Amputation high up; New Tourniquet; Recovery. (Under the care of Mr. HILTON.)

It is unfortunately but too true that cases of encephaloid cancer come very frequently before the profession; and as a large proportion of patients thus affected are sent to the hospitals of this metropolis, it will be readily understood that many cases of this disease come under our cognizance. Now, we have thought, whilst observing the pathological phenomena presented by these patients, that it would perhaps answer a useful end to collect some of the most striking cases from all the hospitals which, by the courteous sanction of the officers, we regularly visit, and present a sort of synoptical sketch of their principal features. Every one will allow that facts are extremely valuable in the study of disease, even where our notions are tolerably correct and complete; so that facts must, à fortiori, become of still greater importance when bearing upon the aetiology of an affection which is surrounded by great obscurity. Encephaloid cancer falls under this head, not only as to its etiology, but also as to the ultimate results of operations for the removal of the disease; and we have therefore no doubt but our readers will gladly give a few minutes to the perusal of the data which we have collected from six of our metropolitan hospitals.

Before, however, entering upon the cases, we would just cast a retrospective glance on the most important instances of the disease in question which have already appeared in the "Mirror."

Four cases of encephaloid disease of the femur have been

7

reported; they were respectively under the care of the followlowing surgeons:-Mr. Prescott Hewett, St. George's, (THE LANGET, vol. ii. 1850, p. 244; vol. i. 1851, p. 293; vol. ii. 1851, p. 456;) Mr. H. C. Johnson, St. George's, (vol. i. 1851, p. 572;) Mr. Charles Guthrie, Westminster Ophthalmic Hospital, (vol. ii. 1850, p. 603;) Mr. Lloyd, St. Bartholomew's, (vol. ii. 1850, p. 630.) Mr. Lawrence, at St. Bartholomew's, and Mr. Partridge, at King's College Hospital, had under their care patients with whom encephaloid tumours had sprung up in the soft parts of the thigh, (vol. ii. 1849, p. 477.) Mr. Hawkins, St. George's, has treated a case which admitted of no operation, and where the disease had invaded both the femur and ilium, (vol. ii. 1850, p. 154;) Mr. Luke and Mr. Adams, London Hospital, have had under treatment female patients who were affected with encephaloid disease of the bones of the forearm, (THE LANCET, vol. i. 1851, p. 354;) Mr. Holt, Westminster Hospital, has had under his care a case of encephaloid disease of the upper jaw, (vol. i. 1851, p. 514;) Mr. Hawkins, St. George's, has amputated the thigh of a female patient, (vol. ii. 1851, p. 171;) and Mr. Stanley, St. Bartholomew's where the medullary tumour occupied the popliteal space, Hospital, has had under his care a remarkable case, in which medullary disease sprung up between the two tables of the skull, (vol. i. 1852, p. 238.)

Having thus briefly recapitulated, we enter upon the details of Mr. Hilton's case, as furnished by Mr. Alexander Coleman, the dresser of the patient.

Sarah W, aged fifteen, residing at Gravesend, was admitted into Dorcas ward, December 31, 1851, under the care of Mr. Hilton. She is a delicate-looking girl, with a fine clear skin and very intelligent aspect; there is no trace of cancerous disease in the family, but the patient suffered, eight years ago, an attack of continued fever, and has since then been troubled with cough. (We hold it of paramount importance to take into account the various febrile affections which a patient may have suffered in childhood; for it may eventually be proved that their influence upon the constitution is perhaps greater and more lasting than has hitherto been supposed.) Three months before admission, the patient felt occasionally shooting pains, most troublesome at night, around the right knee-joint; no injury had been sustained, and she underwent, for some time, under the care of various practitioners, the treatment usual in such incipient cases—— viz., blisters, lotions, &c. A small, defined, smooth swelling soon appeared on the outer side of the knee; it was firm, but not hard, and the skin over it remained unchanged in colour. Under various applications the swelling subsided on the external portion of the joint, but a similar tumour then appeared on the inner side. She soon was unable to walk; the whole knee swelled; and the lancinating and throbbing pain became very urgent. Apparent fluctuation now induced Dr. Armstrong, of Gravesend, to introduce an exploring needle, both on the inner and outer aspect of the joint, and also a little above the patella. About one ounce of blood escaped, and on the next morning a malignant-looking mass protruded through the opening above the patella; and the tumour, as well as the fungus, went on increasing, up to her admission.

The aspect of the parts, on a first inspection, is thus described:-The whole of the upper part of the right knee is very much increased in size as compared with the left side; tortuous veins are coursing under the smooth and shining integuments, and pretty deep furrows pervade the swelling. The latter has an elastic feel to the touch, and is so exquisitely painful that the slightest pressure causes the patient to cry with agony. The pain extends along the femur and tibia, and continues at night without direct pressure; there is oedema of the leg, and much constitutional distress.

Mr. Hilton, having no doubt as to the malignant character of the disease, determined to amputate above the knee without delay; but the patient was so weak that he apprehended the effects of the hemorrhage which might be expected. Mr. Hilton therefore employed a tourniquet, which he had had some time before constructed, which could be so adapted as to make pressure on the femoral artery as it is passing under Poupart's ligament.

The patient having been put under the influence of chloroform, the limb was removed a little above the junction of the upper and middle third of the thigh, by the lateral flap operation.

On looking at the flaps, no trace of diseased structure could be observed; the posterior one was somewhat oedematous, but the surface of the divided bone remarkably healthy, and the glands in the groin free from disease. Not more than about two ounces of blood were lost, a result mainly owing to the rapidity with which the operation was performed, and to the

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This tourniquet is furnished with three sets of rollers, instead of
two, as in the ordinary Petit's tourniquet. The arms of the
lower platform are somewhat curved upwards, so as to prevent
pressure on the abdomen, on the one side, and the thigh on the
other. In both upper and lower platforms, the arms of two of
the sets are fixed, and so directed upwards and backwards, that
the tapes easily embrace and hold on to the pelvis. The third
set of arms are horizontally movable, so that the tape con-
nected with them can be adjusted under the thigh, on the
right or left side, as the occasion may require, brought up
under the gluteal region, and buckled to the pelvis-strap at
the most convenient spot. The pad on which the tourniquet
rests is to be placed on the artery as it passes over the ramus of
the os pubis; and the instrument can be tightened in the ordi-
nary way, until twenty-seven inches of the tape are taken up;
so that any necessary amount of pressure can be made on the
vessel. This instrument, together with the drawings, models,
and patterns, was made, under Mr. Hilton's suggestion and
direction, at Mr. Biggs's establishment, St. Thomas's-street,
Borough.

On making a longitudinal section of the amputated limb, some serous and synovial fluid escaped through the joint; the encephaloid disease appeared to have commenced in the interior of the shaft of the femur, immediately above its junction with the condyles, and to have radiated from that point, implicating and displacing the surrounding structures. No distinct or separate fungoid tubercles could be detected in any of the surrounding textures, but the whole mass appeared to be continuous with the original seat of the disease in the femur. The morbid growth had not extended to the interior of the knee-joint, nor had it involved the epiphyses of the femur; but it had passed up the medullary canal of the bone, so as to reach the lower part of the middle third of the femur, encroaching much higher internally than externally. The inner portion of the cylinder of the shaft was not destroyed beyond the inferior part of the lower third, although its outer half was overlapped by the fungoid mass, which had broken through the continuity of the bone a little above the epiphysis, spreading beneath the periosteum, and separating it from the bone. This circumstance probably explains the extreme pain which the patient suffered, from the tension of the periosteum. The fungus, which had protruded through one of the punctured openings in the skin, was found to be a prolongation of a large mass of fungoid growth, which had perforated the periosteum, and thence had grown through the track made by the lancet before the patient's admission into hospital. The periosteum, at the posterior part of the femur, although much distended, and pressed towards the popliteal space, had not given way.

For one month after the operation the patient progressed very favourably by means of careful nursing, unremitted attention, and the cautions exhibition of tonics and stimulants. After this period, Mr. Hilton, considering that country air would be very beneficial, and might ensure the completion of the

recovery, sent the patient to her native place, quite free from indications of local or constitutional disease. We have since been informed, that up to the end of June, 1852, being six months after the operation, the patient was in excellent health, without any sign of a relapse.

This is extremely cheering, and much of this favourable result is probably owing to the soundness of the bone above the amputated point. A contrast to this circumstance will be found in Mr. Skey's case, as given below. We shall make a point of watching the further progress of Mr. Hilton's patient; for if she remains well, the case will be greatly in support of early operations.

ST. BARTHOLOMEW'S HOSPITAL. Encephaloid Disease of the Femur; Amputation; Small Fungus of the Bone soon after the operation; Death; Autopsy.

(Under the care of Mr. SKEY.)

WE now proceed to the second case of the series. The patient, a young man, about twenty-two years of age, was admitted in April, 1852. He had presented himself to Mr. Skey nearly four months before he was received into the hospital, complaining of pain in the lower and inner part of the left femur. The swelling was not considerable; it felt yielding and elastic; and as no indications of malignancy then existed, either in the patient himself or his family, the case was looked upon as one of abscess, and treated accordingly. As, however, week after week passed on without any improvement being obtained, Mr. Skey modified the first-formed opinion, and thought that something more than abscess affected the patient.

About six weeks before admission, an exploring needle was introduced into the tumour, which had increased in size, and caused the thigh to look about one-fourth larger than the corresponding part on the right side. Blood was obtained by the puncture, and the swelling felt now somewhat hard and tough. The same kind of fluid again escaped upon the tumour being a little while afterwards a second time punctured with a grooved needle. Very little doubt now existed as to the malignancy of the growth, and Mr. Skey took the opinion of his colleagues before resorting to the only means of relief which could be had recourse to-viz., amputation.

The question arose during the consultation, whether the limb should be removed at the hip-joint or at some point of the thigh. Mr. Skey was rather inclined to propose the removal at the joint, but did not deceive himself as to the formidable nature of this operation; he laid due weight on the unfavourable results which had been recorded, and thought that the past clearly showed that we are hardly justified in resorting to it except where extension of the disease to the head of the bone is extremely probable. Mr. Skey's colleagues were likewise unfavourable to amputation at the coxo-femoral articulation; so that it was resolved to take off the thigh in the continuity of the shaft.

The operation was accordingly performed on the 9th of April, 1852, the patient having previously been narcotized by chloroform. Before proceeding to the removal of the limb, Mr. Skey made a puncture into the tumour, first with a grooved needle and then with a trocar, when a broken-down mass mixed with blood protruded. No doubt was now left on the minds of the surgeons, and the amputation was forthwith performed. The parts were immediately examined - the investigation being made very complete by a longitudinal section of the bone and tumour. The affection was found to be of the encephaloid kind, and to have sprung up between the periosteum and the bone-the former being broken down, and the tumour invested by a fibrous envelope. The cancel lous portion of the bone was considerably softened, and the original laminae of the cortical structure had been split in the progress of the disease, but could be still distinguished. Towards the upper portion of the femur the cortical portion was very hard, and became somewhat expanded and very thin below. The encephaloid growth was situated close to the condyles, covering about the lower third of the femur and surrounding the whole circumference of the shaft; it presented exactly the consistence and colour of brain, when it had been submitted to cleansing with cold water. On examining the bone it was discovered that the disease had clearly run up the medullary canal, and it thus became plain that the malignant growth might soon develop again in the stump. Mr. Skey stated the fact to the pupils assembled, and added that this circumstance strengthened the presumption that the disease would soon return; he was, however, not prepared to proceed any further just now. If the affection were to recur, other measures, as for instance amputation at the hip-joint,

10

a second marriage. About two years before the boy was received into the hospital, he struck, while running, the posterior part of the right ilium against a lamp-post; he experienced much pain, walked lame for two months, but became again quite well. Twenty months after this accident, the patient was suddenly seized, while at play, with a very sharp pain exactly at the spot where he had long before struck himself; he immediately felt a difficulty of walking, and noticed a swelling on the upper and back part of the ilium, which swelling has ever since been increasing. The pain now was principally referred to the groin and knee, and he was soon obliged to keep his bed.

When admitted, the tumour was about the size of a small plate; but it has, for the last six months, taken an enormous development towards the groin and the femur, invading the whole of the right half of the abdomen from the umbilicus downwards, the entire ilium, and the upper third of the femur. The largest mass of the disease lies over the great trochanter, the whole tumour presenting about the same size as the trunk of a full grown man. Large veins ramify over this enormous growth, and so great has of late been the distention that vessels the size of a crow-quill, and filled with light fluid, are seen coursing under the skin, these being hypertrophied lymphatics. The emaciation of the poor boy has kept pace with the dreadful increase of the encephaloid tumour; he is extremely thin, the scrotum and right leg being at the same time cedematous from pressure on the pelvic veins.

The patient has taken large doses of cod-liver oil; he is principally kept up by wine and opiates; and the power of these must indeed be great, as his debilitated frame has not yet sunk under this formidable disease.

We beg a few moments' attention for an analogous case at the following institution.

ST. BARTHOLOMEW'S HOSPITAL.
Encephaloid Disease of the Femur and Ilium.

(Under the care of Mr. LAWRENCE.)

WILLIAM W, aged twenty three years, following the occupation of porter, was admitted into Henry VIII.'s ward, under the care of Mr. Lawrence, June 23, 1851. The patient was born in London, and has had all the diseases of early age, including small-pox. His father died at forty years of age, but the patient does not know of what affection; the mother is alive, and his brother and sister are in the enjoyment of good health. He has been accustomed to very rough work, but could always procure good food; he indulged now and then in excessive drinking, but has never suffered in his health, except from the venereal disease.

Two years before admission, he was suddenly seized with pain in the knee while running, the uneasy sensation extending down along the tibia and up to the thigh. No tumour whatever had at that time made its appearance, and he was admitted into the Westminster Hospital, where he stayed one month, under the care of Dr. Hamilton Roe. After the patient had returned home, where he lay three months, the tumour began to appear in the great trochanter, and grew very rapidly. He was now re-admitted into the Westminster Hospital, and placed under the care of Mr. Lynn, the swelling having attained the size of a Dutch cheese.

It was evident at this juncture that the disease was of a very serious kind, and that hardly any measures, except palliative ones, could be resorted to. The tumour grew in the meanwhile pretty rapidly upwards and downwards, and was soon as large as an adult head.

In this state the patient was received into St. Bartholomew's Hospital, under the care of Mr. Lawrence; and as it was plain that the disease had invaded the upper third of the femur and almost the whole of the ala of the ilium, no direct relief could be thought of. For the last twelve months the tumour has made continual progress, and is now double the size it was on admission, being rather larger than two men's heads. It reaches to about five inches above the knee, and involves the whole of the left side of the pelvis. The patient has during the course of the disease suffered very acute pain, and is even now in great distress. Belladonna plaster to the tumour, and the internal administration of opium, give him, however, great relief.

The unavoidable length of these reports places us under the necessity of dividing them into two portions. We shall therefore continue these sketches next week, and present examples of encephaloid cancer as developed in the humerus, clavicle, and testis.

RHŒA, BASED UPON THE MICROSCOPICAL ANATOMY OF THE OS AND CERVIX UTERI. By W. TYLER SMITH, M.D., Physician-Accoucheur to St. Mary's Hospital.

THE author first directed attention to the minute anatomy of the os and cervix uteri; and here, at the outset, he was desirous of expressing his warmest thanks and obligations to Dr. Arthur Hassall for his valuable assistance in the microscopical part of the investigation, and without which he could not successfully have prosecuted his researches. The mucous membrane of the os and cervix uteri, like the mucous membrane of other parts, consisted of epithelium, primary or basement membrane, and fibrous tissue, blood vessels and nerves. But as there were some special characteristics pertaining to this tissue, he proposed, for the convenience of description, to examine, first, the mucous membrane of the os uteri and external portion of the cervix; and, secondly, the mucous lining of the cervical cavity or canal. The epithelial layer of the former of these situations was tesselated or squamous, and so arranged as to form a membrane of some thickness: by maceration, it could be easily detached, and it was then found closely to resemble the epithelial covering of the vagina, with which it was continuous. Beneath this epithelial layer was the basement membrane, covering numerous villi or papilla, which studded the whole surface. Each villus contained a looped blood vessel, which, passing to the end of the villus, returned to its base, and inosculated with other blood vessels of the contiguous villi. These villi had been mistaken for mucous follicles, usually described as covering the surface of the os uteri; but the microscope failed to discover any distinct follicular structure in this situation. When a thin section of the surface of the os uteri was examined by a low power, the points of the villi could be seen as dark spots through the epithelial layer. A careful examination exhibited these spots as slightly depressed in the centre, yet nevertheless slightly elevated in their margins, nipple-shaped, and containing red points, which were the terminations of the looped blood vessels. These appearances were produced by the villi being obscured by their epithelial covering. The thick layer of scaly epithelium, and the villi with their looped vessels, were the principal anatomical features of the mucous membrane of the os and external part of the cervix uteri; and these structures played an important part in the pathological changes which occurred in the lower segment of the uterus in leucorrhoea. Between the margin of the lips of the os uteri and the commencement of the penniform ruge, within the precincts of the cervical canal, a small tract of smooth surface was usually found, which to the naked eye seemed of more delicate structure than the neighbouring parts, and when examined by the microscope was found to be composed of cylinder epithelium, arranged after the manner of the epithelium covering the villi of the intestinal canal. The cylinder epithelium covered in this situation villi two or three times larger than the villi upon the surface of the os uteri-so large, indeed, as to be visible to the naked eye when viewed by transmitted light. Within the cavity of the cervix uteri, the mucous membrane contained four columns of rugæ, or folds, arranged in an oblique, curved, or transverse direction; and between these columns were four longitudinal grooves. The two sulci in the median line, anteriorly and posteriorly, were the most distinct; and of these, the sulcus of the posterior columns was the most strongly marked. In the normal state, the transverse ruga, with the fosse between them, were filled with viscid, semi-transparent mucus; and when this was brushed away, a reticulated appearance, caused by numerous secondary ruga, was visible. The author gave a very minute description of these four rugous columns, and the furrows between them, which was illustrated by some very beautiful drawings of the cervical canal, displaying the rugous columns and fosse of the natural size, and magnified nine and eighteen diameters. The latter power showed a large number of mucous fosse and follicles, crowding the depressions between the rugæ, and the rugous elevations also. The author mentioned that a healthy virgin cervix, of normal size, contained at least ten thousand mucous follicles. This anatomical arrangement secured a vast extent of superficial surface, which was still further increased by the presence of villi similar to those found in the lower part of the cervix: they were found in considerable numbers on the large rugæ and other parts of the mucous membrane in this situation. By this disposal of the mucous mem

brane of the canal of the cervix, a very large extent of glandular surface was obtained for the purposes of secretion. In effect, the cervix was an open gland; and in the opinion of the author, it was in this part of the utero-vaginal tract that the principal seat of leucorrhoea would be found to exist. There was an analogy here which should not be lost sight of, bearing, as it did, on the pathology and treatment of leucorrhoea, which was, the great similarity which existed between the skin and the mucous membrane of the vagina and the external part of the os and cervix uteri. The resemblance, in these situations, was certainly much nearer to the cutaneous structure than to the mucous membrane of more internal parts. These analogies were strongly confirmed by what was observed of the pathological conditions to which these parts were liable, and by the effect of therapeutical applications. The author dwelt on the fact that the epithelium of the os uteri and external portion of the cervix was constantly squamous, and that the epithelium imme. diately within the os uteri was cylindrical but not ciliated, but that in the rugoas portion of the cervical canal the cylindrical epithelium became eiliated. The mucous secreted by the glandular portion of the cervix was alkaline, viscid, and transparent; it adhered to the crypts and rugæ, so as to fill the canal of the cervix. It consisted chiefly of mucus-corpuscles, oil-globules, and occasionally dentated epithelium, all entangled in a thick, tenacious plasma; it was remarkable for its tenacity; while the mucus found in the lowest part of the canal was thinner in appearance. There was an essential chemical difference between the vaginal mucus and the secretion of the interior of the canal of the cervix, the first was always acid, and the latter invariably alkaline. Mr. Whitehead, of Manchester, had noticed this fact, and the observations of the author confirmed his views. The acid of the vaginal secretion was more than sufficient to neutralize the alkaline secretion of the cervix, and when any secretion from the cervical canal entered the vagina it became curdled from the coagulation of its albumen. It was worthy of note, that that part of the mucous membrane of the uterus and vagina which resembled the skin was the only part which, like the skin, furnished an acid secretion. The vaginal mucus was a simple lubricatory fluid. But the uterine cervical mucus had other uses besides that of lubrication; in the healthy condition, in the intervals of the ca amenia, it blocked up the passage from the ragina to the fundus; it thus defended the cavity of the uterus from external agencies, and from its alkaline character afforded a suitable medium for the passage of spermatozoa into the uterus. Having stated his views of the structure of the utero-vaginal mucous membrane, the author expressed his opinion that the glandular portion of the cervix uteri was the chief source of the discharge in leucorrhoea. Leucorrhoea, in its most simple and uncomplicated form, was the result of an increased activity of the glandular portion of the cervix. A follicular organ, which I should only take an active condition at certain intervals, became constantly engaged in secretion. Instead of the discharge of the plag of mucus at the catamenial period, an incessant discharge was set up. At first the discharge was but an unusual quantity of the elements of the healthy mucus of the cervix. The quantity increases, and becomes a serious drain to the constitution, and the glandular cervix in some cases becomes so excitable, that any unusual stimulus, even mental emotions, provokes an augmentation. The au hor next referred to the conditions under which the epithelium of the os and external part of the cervix uteri and upper portion of the vagina might be partially or entirely removed. The mucous membrane then presented an intensely red colour, from the presence of the naked villi, and an appearance of roughness or excoriation presented itself. He thought that among the causes which produced this aspect of ulceration were eruptive disord rs, similar to herpes or eczema, which strongly marked the analogy between this tract of mucous surface and the skin. Ile had observed cases in which an occasional herpetic eruption upon the os uteri always produced herpes præputialis in the husband. But the most frequent cause of denudation arose from the alkaline mucous discharge of the cervix irritating the acid surface of the os uteri, and causing the rapid she lding of the epithelium round the margin of the os. microscopical examination was given of the various discharges met with in these affections, in making which the author was assisted by Dr. Handfield Jones and Dr. Hassall. In cervical leucorrhoea the discharge consisted of quantities of mucus-corpuscles, and in severe cases pus-corpuscles and blood-discs, with fatty matter, involved in a transparent plasma. The epithelial debris is constantly present, but in limited quantity. In vaginal leucorrhoea, including the secretions of the external portion of the os and cervix uteri, the plasma is opaque, and contains myriads of epithelial particles in all stages of development, with pus and blood globules when the villi are affected. When a circum

A

11

scrioed ulcer is visible upon the os uteri to the naked eye, after death, such as occurs in eruptive affections of the os and cervix, and is examined by the microscope, with a low power, it is found to consist of a base from which the villi are entirely removed, or in which only the scattered debris of villi remain; and surrounding this base there is a fringe of enlarged villi, partially or entirely denuded of epithelium. The character of the so-called ulceration of the os uteri was detailed, and the nature of the discharges described. The author then observed that if any division of leucorrhea were made, two principal forms must be recognised

I. The mucous variety, secreted by the follicular canal of the cervix.

II. The epithelial variety, in which the discharge was vaginal. With respect to the so-called ulcerations of the os and cervix, two kinds of morbid change would be observed—

1. Epithelial abrasion, by far the most common, in which the epithelium alone was deficient.

2. Villous abrasion, erosion, or ulceration, in which the villi are affected by superficial ulceration.

It was to the villi, denuded of epithelium and partly eroded, that the marked forms of granular os uteri were owing. The ovules of Naboth, often referred to by writers as obstructed follicles, the author had found to be in reality an eruptive disease of the mucous membrane analogous to a cutaneous affection. In these affections of the cervix uteri it frequently happened that the cervix uteri was partially everted, and the deep-red surface covered by vascular villi thus exposed, had frequently been mistaken for breach of continuity in the mucous surface. The author then offered some remarks on the practical deductions which might be drawn from the present investigation. The glandular structure of the parts from whence the leucorrheal discharge arose pointed to the influence of constitutional causes, and exemplified why this affection should be so common in women of strumous habit and leuco-phlegmatic temperament: it vindicated the importance of constitutional treatment, and directed attention to the more rational employ ment of topical remedies; and it was evident that the profuse application of caustics, as recommended by the French school of uterine pathology, was both unnecessary and unscientific. He admitted that leucorrhoea of the cervical canal was sometimes cured by the use of caustics to the os uteri, but in these cases they acted as counter-irritants to the glandular structure. The indications of treatment, based on a knowledge of the minute anatomy of the os and cervix uteri, and the study of its pathology in leucorrhoe, appeared to the author to require constitutional medicines and regimen, with local applications. Local measures, to be of any use in cervical leucorrhoea, should be applied, not to the vagina, nor the os uteri, but to the canal of the cervix. In vaginal or epithelial leucorrhoea, common injections were serviceable; but in cervical or mucous leucorrhoea no benefit could result unless the injection passed into the cervix. He mentioned the metho's he adopted to secure this result, and concluded by expressing a hope that the prosecution of these researches might prove serviceable, by rendering a troublesome class of maladies more intelligible than they had hitherto been, and by tending to correct errors of practice, and to indicate the just value of constitutional and topical remedies.

[Dr. Tyler Smith's paper was illustrated by a number of beautiful drawings, which excited great attention among the Fellows, representing the novel points described in the paper, and which were made under the superintendence of Dr. Hassall.]

At the conclusion of Dr. Smith's paper, the PRESIDEnt observed that he should be happy to hear any observations upon it from the fellows. After a short pause,

Dr. Locock rose and said that he regretted an appointment obliged him to leave the Society immediately, but he could not do so without first offering his thanks, and he was sure he might add the thanks of the whole Society, to Dr. Tyler Smith, for his very admirable paper. He could scarcely remember an occasion on which he had listened to a paper with greater interest, or from which he had derived so much instruction. The present communication was, in his opinion, a step in the right direction, and he felt convinced that researches of this kind would eventually lead to a better understanding and an improved treatment of what was most certainly a very intractable class of disorders. He was glad to learn the author intended to pursue the subject, and he should certainly look forward with great interest to the progress of his further investigations. (Cheers)

(To be continued.)