+

man was in the habit of carrying her in his arms up and down stairs, in consequence of her weakness and her pelvic pain.

Upon making the vaginal taxis, I found the os tincæ just at the os magnum, and that it would recede but very little upon my pushing it with the palp of the finger. It was as firmly fixed as if it had grown fast there.

As I concluded that all her pelvic distress was reasonably to be attributed to a prolapsed condition of the womb, I resolved to get it out of the way, and I was sure to accomplish my object; for I had many times before met with this so-called immobility of the womb, which I had proved to my own conviction not to be immovable.

I procured, therefore, a small globe pessary, the diameter of which did not exceed an inch and a quarter. This pessary I slowly pressed through the os magnum, allowing time enough to permit the vagina to yield in the direction of its axis. I was a long time engaged in pressing the globulus into its position, and I did fail to adjust it to my mind's contentment; for I was compelled to cease any further prosecution of the attempt, and leave it so far immerged that the equator of the ball was within the grasp of the vagina, yet leaving a small segment of the sphere projecting betwixt the labia pudendorum, that were slightly disparted by it, rendering it easily tangible externally. I now caused her to be drawn up into her place in bed, lying on the back, with an urgent request that she would tolerate any pain or strangury that might come on during the night, and holding out the expectation that the protracted and gentle pressure to be exercised by the contractility of the tissues, would by the next morning carry the ball high up into the pelvis, though it was now just under and perhaps, a little in the rear of the crown of the pubal arch.

And so it happened. In the morning I found the globulus had been pressed completely into the more lax segment of the vagina, by the contractions of the sphincter and the contractility of the non-muscular tissues.

In short-she began to go about the city; soon afterwards returned to her own home, and within about six months I had a letter asking my advice, as to the continued employment of the pessary, in her then condition; as she was in the fourth month of her pregnancy. Of course, I advised the removal of the instrument, since which I have had no intelligence from her.

By way of parenthesis, let me inform you that the pessary does not put a bar either to gestation, or to conception. I say this, being founded on repeated observations; one of which, but yesterday, May 22d; the woman having told me she had never removed the globe, though she is now enceinte.

Why should you, then, feel any anxiety as to the escape of the + mucous and mensual excretions? The globe and the disc are alike incapable of preventing the due discharge of all the products of secretion, the hemorrhages, &c., that may appear beyond it.

You would reasonably expect that the pressure, and even the presence of any foreign body in the vagina, and touching the womb, might excite an increased mucous discharge. This is a general consequence of the first use of such methods, but these newly excited discharges soon disappear. Take heed though, and take good heed too, that the patient shall inform you of any such discharges coming on at a later period of the treatment; and particularly if such discharge should have any, the smallest trace of blood mixed with it. Such an occurrence would lead strongly to the inference that the instrument had excited ulcerative inflammation, with purulent discharge. It is of the highest moment in any such case, to take away the support and carefully examine the parts by the speculum uteri. If the os tincæ, or either of its lips should be found red, with visibly enlarged venules and capillaries; or if any abrasion or granulations should be detected; touch them with sulphate of copper in solution held in a camel-hair pencil; or with Goulard's extract of lead; or with acetate of zinc and wine of opium; or with nitrate of silver. Ten grains sulphate of copper, to half an ounce of water will do; Goulard's extract and water, equal parts; ten grains acetate of zinc, forty drops wine of opium, and half an ounce of rose water; ten grains, or twenty grains of nitrate of silver, to the ounce of water. These formulæ are perhaps sufficient.

If the vaginal cervix is turgid, red and sensitive, eight or ten leeches dropped into the speculum of Recamier, will, in twenty-five to thirty minutes, have drawn from the cervix caught in the uterine extremity of the speculum, a quantity of blood, sufficient to lessen the turgescence of the cervical circulation.

+

Surely such a patient should keep her bed or her couch until cured of the abrasion and inflammation.

As to the use of the pessary. I recommend that you adopt as

+

an invariable rule of practice, that you will not prescribe, nor even sanction its employment, until convinced by actual knowledge, that the indication for it is there. I say so, because everybody knows something, however imperfect, about the pessary; and every woman who has a pelvic misery, will naturally be disposed to play the quack as to her own case. If the case be one likely to be benefited by it, you ought to allow and recommend it; but that you cannot know by instinct. Inquire, examine for yourself, and if there be sensibility, discharges,—and especially discharges of a bad color,-away with a pernicious instrument, which can only make the sick woman more ill, and bring into discredit a means of relief commended by the united voices of twenty centuries.

And now, what shall I say of those utero-abdominal supporters, that you see paraded in the newspapers, and forced into vogue by the certificates of physicians, and proh pudor! of Professors in the Schools of Medicine!

What shall I say of them? Have you a skeleton in your office? I pray you open the door where the grim and ghastly representative of our poor mortality stands, as the mocker of all human pride and ambition. Don't you see that if you draw a line from the pubis to the xyphoid cartilage, it will represent the linea alba of the grim horror? Look again, and observe the place where the mesentery was attached, and the root of the mesocolon too. Look down through the plane of the superior strait to see where the uterus was, and where grew the vagina that supported it.

Now take a utero-abdominal supporter, and adjust it as the mesmerized do, mentally, upon the skeleton, and you will see that it can have no effect to hold up the bowels: that it can only push your fancied tractus of the linea alba backwards against the spinal column; and with what effect, pray? Surely, with none other than one of encroachment on the capacity of the abdomen. Do you not see, that the belly of a living man or woman, is a vacuum plenum. How can you hold up the bowels by a pad? If you could thrust them upwards in the vacuum plenum, which you cannot do, you would only thrust them towards the concave of the diaphragm. But the diaphragm must come down, or the woman will die. She can't breathe but by the descent of her diaphragm. Her diaphragm is her respiratory piston, and the trunk of the body is the cylinder in which this piston moves downwards in the aspi

ration, and upwards in the expiration of the air of the atmosphere. But your utero-abdominal Supporter knows better than the Providence that made this great machine; and he is about to make the piston, work half strokes in breathing; like an engine that one is afraid of. No, young gentlemen! the utero-abdominal supporter cannot hold up the bowels; it can make the belly too small to contain them, and they will make haste to get out of the squeeze by falling down into the pelvis, where they were not before, and ought never to be.

How could the surgeons of the United States and England, put their names, like so many notes of admiration, to such an anti-chirurgical and anti-physiological nonsense! Did they not forget that one-fifteenth of the human family is asserted to labor under hernia in some shape? And why? Because the belly is too small for its contents in one out of every fifteen of us, and they force their way of escape by the umbilical ring, by the abdominal canal, under Gimbernat's ligament, and elsewhere, wherever the pressure can force them out: yet these recommenders of an unblushing advertisement come to put on utero-abdominal supporters, forsooth. I am ashamed for my cloth, when I see their names so wrongfully appended to a quack advertisement. I thank Heaven you do not see my friend Dr. Hodge's name there; and you may take my word, that mine shall suffer from no such use of it.

You perceive I am not quoting in these letters a hundred authors + to sustain me, in my instructions to the cherished members of my class. I promised you to make for you a book out of my own brains, and that I shall try to do, avoiding useless citations. It would be far easier to take my scissors and cut these letters, paragraph by paragraph, out of the volumes in my library. I hope you will not be inclined to say it would be better had I done so, as the letters would have been better letters. There, however, are the volumes; too many of which, like all the early literature of our calling, have been made by the scissors, being the lazy repetitions of what has been said a thousand times. I hope, though, you will take every opportunity of reading what those books contain on all these topics. There is no danger of your reading too much. The more you read, the better will you be prepared to judge, whether what I say here and in the lecture room, be just and reasonable or not. Farewell. C. D. M.

LETTER XVI.

RETROVERSIO UTERI.

GENTLEMEN :-My purpose as to this letter, is to put down in it the opinions I have formed, as to a very common malady, which, though it has been the subject of frequent publications, and of much discussion, seems to me not to have been placed in that clear open light, that the simplicity of its causes, ought to have enabled authors to shed upon it, in their printed communications.

Retroversion of the womb, or the state wherein the womb is turned over backwards, is one of the most common of the deviations of the organ met with in practice: it appears to me to be a case whose principles, as well as the methods of cure, ought to be easily understood; yet I have been much surprised to find many women come to this city from remote districts and states, in order to be treated for some uterine disorder, which had never been fully investigated by their physicians at home; cases of which the outward signs were in general, sufficiently clear to warrant one, if not to pronounce this diagnosis, yet at least sufficiently to point out the necessity of completing this diagnosis by touching.

Before we proceed farther, let me beg you to stop for a moment, in order to reflect upon the situation of the womb within the pelvis, and its relations and connections with the various parts by which it is environed; to regard it as placed betwixt the bladder and the rectum, being largely attached to the bladder at the uterovesical, and vesico-vaginal septum; to the vagina, upon whose top it is invaginated, and subject, therefore, to be alternately moved backwards towards the sacrum, or forwards towards the pubes, by the varying conditions of the bladder of urine, as filled or empty.

Whenever the urine is evacuated, the bladder is collapsed, or rather contracted; and the womb is brought nearer the pelvis,when the bladder is full, it pushes the womb towards the sacrum. What is the limit of this retreat of the womb? Is there no apparatus to prevent it from being carried beyond due measure back