der; so largely was the urethra of the child dilated by the longcontinued distending pressure of the inverted bladder on its walls. If the ligature had been put on, the child must have died.

Mr. Crosse could never learn how long the inversion had lasted; he could only ascertain that it had lasted for a "considerable time."

There was no relapse of the inversion, so far as he had learned. Dr. Murphy saw a similar case at Dublin, which was cured by reposition.

You will also meet with cases in which the mucous membrane of the urethra becomes hypertrophied and inflamed, producing a fiery-red tumor at the orifice of the urinary canal. This is attended with much burning pain, and obstruction to the flow of the water. It may be cut off by passing a silver canula into the bladder, and excising all the out-hanging mucous tissue, by a bistoury; cutting on to the silver tube by a process like the first incision in amputation. Or where the patient is afraid of the knife, it may be readily cut off by half a drop of acid nitrate of mercury, or a camel's-hair pencil, which destroys at contact.

I will not, however, close this letter, without cautioning you not to shut your eyes upon many samples you must be destined to meet with, of incomprehensible maladies-maladies, however, that become perfectly intelligible to us, if we study them in the light lent to us by investigation into the nature, extent, and great power of that aphrodisiac or reproductive instinct, which, however disastrous and shameful its excesses, must be admitted to control, to a certain extent, a very considerable part of the motives and actions of men, and without the incitations of which, the entire scene of living nature would soon be blotted out, leaving the earth a howling and desolate waste. Very sincerely yours,

C. D. M.

LETTER XII.

DISPLACEMENTS OF THE WOMB.

GENTLEMEN :-The uterus, as you well know, is situated between the bladder and the rectum; resting on the upper end of the tube of the vagina; attached in front, to the bas-fond of the bladder; held in situ by two ligamenta rotunda in front, which prevent it from turning over backwards in the direction towards the promontorium of the sacrum; and, lastly, prevented from librating to the right or left, by the left and right ligamenta lata.

It is easy, now, to understand, one would think, that if the vagina preserves its natural length, and if the round ligaments are neither too short, nor too long, while the broad ligaments are also in a healthful state of tension, there can be no displacement of the womb-for the womb cannot settle downwards in the pelvis, unless the vagina also settles down, by growing shorter—nor can it be turned over backwards, while the round ligaments are only two and a-half or three inches in length. Nor can it librate, and become oblique to the right, while the left broad ligament prevents it, nor to the left, if the right broad ligament be not relaxed and elongated. This is clear-and if it be clear, then it seems to me, that it might hardly be worth while to give you any further trouble in the way of indoctrinating you as to the deviations of the womb. But I have some plain remarks to make, that may possibly assist you in obtaining such clear notions, as to put it out of the question for you to be embarrassed in the treatment of such cases, and these remarks will be numerous.

Prolapsion of the womb, commonly in the world spoken of as falling of the womb, and bearing down of the womb, is so frequent an occurrence in married women who bear children, and is attended with so much distress and vexation for many of them, that I am sure no man can long practice physic without being appealed to for counsel and relief in this form of disease. But, with just views of the pathology and the semeiology of the case, there are few samples of it that may not be made to yield to a

judicious treatment, based on correct views of the state of the affection.

Let us speak, first, of prolapsus uteri-or falling of the womb. By this is understood a case in which the os tincæ approaches too near the orifice of the vagina; and the degree of the prolapsion might, perhaps, in strictness, be measured by the distance between the orificium vaginæ and the orificium uteri. I say, in strictness, yet I wish you to understand, that the amount of pain, distress, or inconvenience, is by no means proportioned to such a measurement; because you shall find that a woman, with but a slight descent, shall suffer vastly more therefrom, than another woman, whose womb has fallen twice as low down in the pelvis. Indeed, there are women who always find the mouth of the womb to peer out at the genital fissure when they are on their feet; and who appear to feel no pain from it; while others are observed to suffer the most vexatious and even intolerable pain, from a very slight depression indeed.

That excellent old author, the Sieur de la Motte, sworn Surgeon and Accoucheur, at Vallognes, in Normandy, and who deserves for his good sense, prudence, and skill, ever to be gratefully remembered, makes two divisions of the malady, one of which he calls relaxation, and the other, descent of the womb. It is very curious to see how, by the use of a few quaint expressions, he paints the picture of the case.

"L'on appelle relaxation de la matrice lorsque l'orifice intérieur de ce viscère descend à l'entrée du vagin, et quelquefois jusques entre les grandes lévres, qui se fait remarquer en y touchant avec le doigt, par un corps d'une consistance moyenne, entre le dur et le mou, qui retrograde à mésure qu'il le pousse, et qui revient aussitôt qu'on à oté son doigt, et qui se rétire ou reprend sa place d'elle même lorsque la femme se couche sur le dos, et qu'elle à dans sa situation les reins un peu plus bas que le siege."

The descente is where the os uteri comes quite out of the sinus pudoris. You see that La Motte, by the few words above quoted, has given a perfectly graphic picture of the phenomena of our

case.

Among the inconveniences connected with falling of the womb, are those depending on the disturbance of the utero-vesical and the vesico-vaginal septum, for the womb and vagina cannot settle

downwards in the pelvis, without dragging down with them the posterior part of the bladder of urine; which being fretted and vexed with this pulling force, is frequently prompted to contract on its contents and thus is set up a course of urinary tenesmus. But a urinary tenesmus is itself a disturbing force. Tenesmus relates to a pelvic sensation; and when your patient has a continual prompting to make water, she has also a continual forcing or bearing-down feeling, which compromits the repose and comfortable sensations of all the other pelvic contents. There is a sense of weight, ponderosity, or pressure, at the perineal strait, which excites pain in the hypogastric and sacral plexuses and their branches; so that the poor patient not only has sensation where there ought to be no sensation, but it is absolute distress and pain. As the nerves of the womb, and vagina, and bladder, have a very extensive fibre connection with the whole of the splanchnic plexuses, and with the great sympathetic and the spinal nerves, you may readily suppose that a displaced womb, like an aching tooth, may disturb the renal, the hypogastric and sacral plexuses, just as the tooth starts into existence the most frightful trifacial neuralgia; and you will find on examination and reflection, that hundreds of poor creatures are bled and cupped, hydrargyrised and blistered, and antimoniated, under a false accusation of hepatitis or nephritis, or spinal irritation, who really have committed the small and venial fault only of letting their uterus fall downwards a meagre half inch perhaps. I hereby warn you against false diagnosis, for diagnosis is in practice like Captain Greatheart in Bunyan, encountering and overthrowing all obstacles, so that even Apollyon, who in words less polite was the devil himself, could by no means oppose a bar to his habit in his practice of succeeding always.

You have all learned what is meant by Professor Carus' curve; well-the womb, when in its proper position, coincides as to its long axis with the superior part of this curve; and if from any degree of prolapsion it settles downwards, it follows the curved line of the great Saxon teacher in its fall. When at the top of that curve, the woman being in a standing position, the long axis of the womb is directed upwards and forwards, and downwards and backwards. Suppose the womb to fall half way down to the os magnum, then it would be vertical in the pelvis of a woman

standing upon her feet:-if it were to lapse downwards, so as to show its lips jutting through the os magnum, the womb would necessarily lie in a position nearly horizontal; its mouth looking forwards under the crown of the pubal arch, and its fundus pointing backwards towards the lower third of the sacrum.

Imagine your patient situated as I have just described; and I think you may readily understand why she has both vesical and rectal tenesmus; pains in the sacral and lumbar regions; pains in the groins from discomfort and traction as to the ligamenta rotunda; some uneasiness in the ligamenta lata; while the rectovaginal septum is strained, and the fundus of the womb actually rests and is pressed upon the inferior parts of the rectum, irritating it like a mass of scybala lodged in it.

Nerves from the lower end of the spinal cord are distributed on the womb and vagina, and to the bladder and rectum, as you may perceive in good Professor Tiedemann's beautiful drawings of the uterine nerves, and in Robert Lee's Treatise on Midwifery, but they receive a considerable endowment of nerve filaments detached from the great sympathetic. They also, in the same manner, are allied to the renal plexuses, the solar plexus, and, in fact, to the whole organic innervative apparatus. What a great disturbing power does this impart to the reproductive organs when sick! what an uncomfortable creature is a woman with a prolapsion! have we any cause of surprise or wonder to hear her complain of her hypogaster, of her groins, of her thighs, of her loins of the region of the kidney or liver-or, indeed, need we feel astonished if the whole interior of the belly become affected with the most intense and insupportable neuralgia.

I had been long accustomed to regard much of the distress experienced by females with prolapsus, as belonging to the class of neuralgic disorders, and my opinion on this point has been, for many years, confirmed by the occurrence of singular cases, to which I had not seen any allusion in books, until I met with an account of similar cases in the recently published work of Mr. Maunsell, of Dublin, a work which, although small in size, is replete with sound doctrine, and rich in numerous and important practical details. I have now met with about thirty instances; in which, the most cruel neuralgia of the whole belly, with sensibility equal to that of acute peritonitis, proceeded solely from a very slight degree of uterine prolapsion. I say so, for when I