LETTER XIX.

POLYPUS UTERI.

GENTLEMEN :-Before proceeding to my remarks on polypus, allow me to premise an account of a case of Inversion, that of right belongs to the last letter, but which, having been accidentally omitted, I shall relate here. It is a case of inversion of the womb, related by Dr. Thos. F. Betton, of Germantown. I desire you carefully to read it, in order that you may more fully appreciate the danger to which a woman is exposed by such an accident. You will see that Dr. Betton took, upon his arrival, all the possible precautions against the danger; but the loss of eighty ounces of blood had so exhausted the vessels of the unfortunate woman, that it was impossible, even by Dr. B.'s judicious, prompt, and scientific course, to rescue her from the consequences of the accident. The case was originally published in the Am. Journ. of the Med. Sci., for 1836, vol. 19.

Dr. Betton says, "On the evening of the 4th of August, 1836, I was called to see the wife of S. B—, living at the Rising Sun Village, about three miles distant. On reaching the house, I found a woman of about 18 years of age, in extremis. The midwife gave me the following history. The patient had had an easy delivery: the midwife placed her hand upon the abdomen, to feel if the uterus were contracted, but could not perceive it. A violent pain followed immediately, and the placenta, with something adhering to it she did not understand, was forcibly expelled. This, I found on examination, to be the uterus, completely inverted and prolapsed, lying like a gum elastic bottle, between the thighs. I immediately separated the placenta, and endeavored to restore the uterus, which endeavor was successful in two or three minutes. The woman was pulseless, from loss of blood; the carotids could not be felt, and the action of the heart was extremely feeble; jactitation extreme; mind wandering. About twenty ounces of blood had coagulated around the uterus, and between it and the placenta, which was partially

separated. From the distance at which she lived, I did not see her for at least one hour after the occurrence of the accident, and she had lost full eighty ounces of blood before my arrival. She did not lose more than two or three ounces after the reduction of the uterus, but in her exhausted state, that was too much. I gave her immediately a large dose of the vin. sec. corn., but it failed in producing any effect. Brandy, and wine and water, were freely administered, but in three-quarters of an hour after my first seeing her, she expired.

"My own conviction always has been, although the midwife denied it at the time, that she had produced the inversion and prolapsus, by pulling too strongly at the cord."

Let us now proceed to our inquiries upon polypus of the womb; and I ask, is it not obvious that all the tissues of a living body are undergoing a perpetual accretion and waste? that the perfect balance between this deposit and absorption, maintains all the organs and the parts, and the whole body in one even tenor of health, of weight, and dimensions, for months and years of time; and that the loss of such a balance or equableness of the waste and deposit, changes the weight and dimensions, as well as the health of the body, or of any of the parts or organs of it? But, when the accretions of a part become excessive, then we have either a hypertrophy or a tumor.

It is one of the standing miracles of nature, that the bodies of creatures are maintained at one even tenor, not only through the lifetime of the particular individual, but from age to age. Thus a single herring shall develop 300,000 eggs, from each of which shall be evolved a herring, whose weight in no instance, perhaps, in the countless myriads of that tribe, will ever be found to exceed by 200 per cent., the weight of a perfect fish of its genus Clupea.

On the other hand, an army of wild pigeons so numerous as to darken the air for days and days of its migratory flight, will not contain a single bird as large as the barn-door fowl; because each genus of creatures, by its miraculous generic law, is limited to a certain stature, weight, and dimensions.

The same thing is true of the vegetable tribes. You shall never expect to see an arbutus rival the forest oak, nor a violet to grow on the branches of a trunk as tall as the plane tree. You wonder not, nor become amazed at this miraculous order; but

you and all your County would turn out in crowds to see an ear of Indian corn growing on a wheat stalk, or a magnolia grandiflora blossoming on the tender vine of a cucumber. You are, therefore, not surprised at the daily miracle set before your eyes in the order and regularity of Nature's operations; but you are startled, and lift up your hands in a gesture of wonderment, when she errs, and in her errors gives rise to some unnatural form or conjunction; some Sæculum Pyrrhæ, nova monstra quæstæ. Do you not perceive in this statement reasons to be far more surprised, when you observe that men and women too, are found to live out their threescore years and ten, and even longer, without having experienced during their whole life, a single deviation from the natural forms and weights of their organs, or of their external configuration?

There can never be deposited in an organ, any atom or moleculus of its constituent tissue, but by an act of a blood-vessel; which puts it down in its place, and puts down the true chemical elements in the right place. But the blood-vessel that carries and deposits the moleculus, can only deposit it under the indicating and controlling force of the accompanying nerve. You are very well aware that each organ has its own nutritious artery to convey to it the materials for its daily accretion; that it has its lymphatic absorbent, to remove the daily detritus of the life of the organ; and also its generic nerve which indicates and controls by its force, the kind, as well as the amount of the daily deposit, and the kind and amount of the daily absorption.

You do not doubt if the generic nerve becomes compressed, or is tied or cut off-or softened, that the organ will waste away, or become atrophied, however sound and perfect the artery may remain; or if too energetic in its indication and compulsion of the daily deposit, that the organ may become hypertrophied, from a faulty rate of action of the generic nerve.

In the womb, for example, the daily detritus and accretions of life will maintain the form, consistence, and weight of that body in one even tenor, for a lifetime, if it continue obedient to the generic law of its development-for that law which tends to keep it always two inches long, and of the weight of two ounces, and of a certain form, is as truly a generic law for the womb, as is the law that commands the genus Bos, or Equus for those genera. But, if it disobey its generic law! What then?

Now in the code of morals-the Decalogue-we have plainly set down for our guidance, certain rules, or laws of action, to be obedient to which, or to be disobedient to which, constitutes us good or bad men, righteous or sinners.

So, in the physical nature of living beings, there is a law which they ought to obey, and be bound by; if they disobey! if they fail to be governed by the provisions ordained for their just maintenance! then they may be likened to sinners against the moral law. They, in fact, do sin, rebel against, or contemn the law ordained for their government, their protection, and security. In this physical disobedience, I can perceive a close analogy with moral disobedience. In each, it is the first step that is fatalc'est le premier pas qui coûte. In the moral law, the first sin, or corruption, leads to still renewed wickedness, until the whole moral constitution of the man is subverted, changed and ruined, and becomes a mass of moral pollution. So, in the physical, or organic sin; the first error is followed by the second, until the entire constitution of the organ is subverted and ruined so completely, so completely changed, that the most expert anatomist can no longer detect its old familiar features in the depraved and heterologue mass that lies under his scalpel and his doublet.

In the hopeless wreck of the moral creature, brought about by vicious indulgence, the voice of conscience is raised in vain, the appeal of reason is powerless; the invitation of the minister of the Gospel is like the idle wind, and suasion and argument equally fail to recall him to the path of duty and safety. Just so is it in the physical sin of the organs; when they have fairly broken the generic law, they continue free from all future bonds, and go, like the idle wind, where they list, and no one knows whither. It is in vain that you apply the restraints of your hygienic and therapeutic forces. The heterologue mass has no generic law, and the cry of the rest of the organs that suffer for its rebellion, like the cry of society against the breaker of the law, is raised for ears that are deaf. Such an organ is become like a wild horse in a boundless plain, that scorns the caress; and, fleeter than the winds, will not bend his neck to the accustomed rein.

I have been led into these reflections, by having witnessed today, June 10th, the dissection of a preparation brought into the city, by two medical gentlemen from a distant county. Prof. Horner made the examination. The whole mass weighed thirty

pounds, and consisted of a womb, very much thinned and attenuated, which, upon being laid open by an incision from the fundus to the os uteri, disclosed a solid tumor, whose weight could not have been less than twenty-nine pounds avoirdupois. This solid mass was a fibrous polypus, springing apparently from the side, not the fundus of the uterus; and attached here and there by strong exudation or accidental attachments-the results of pressure and inflammation long endured.

Now, this vast mass probably sprung, at the beginning, from the very slightest aberration of the development force. The offence was small, and then became greater, until, in the end, you see how "rank" it was. What therapeutical power could you bring to bear as a control upon such a heterologue mass as this polypus of twenty-nine pounds avoirdupois; a polypus, whose sole connection with the living constitution of the poor victim it destroyed, may have been by a root, neck, or pedicel, not bigger than your thumb?

Don't you see what a physical sinner it was, and how small was its first offence? It had broken its generic law, and you perceive the end.

Let us take good heed, that in our small and venial offences, we do not come to say with the king, "Oh, my offence is rank; it smells to heaven!"

This parallel between the moral and physical states of disobedience to the laws that ought to govern both, I have run in order that I might haply impress your minds, and my own also, with clearer perceptions of what we have to hope, and what we have to fear, in the conduct of those maladies that are, in the strictest sense of the term, chirurgical. I also hope that the analogy I have set forth, may be not without some advantage in its moral, since from it we may lay to heart the equal necessity in morals and physics, of opposing the very beginnings of evil; and since we ought, like Jacques in the forest, to be able to find sermons in stones, books in the running brooks, and good in everything."

But let us leave moralizing, and return to our physic; all the cavities of the living body, as the cavity of the nostrils, the ventricles of the brain, the womb, and even some of the solid parts are liable to become the seats of excrescence or growths, some of which take the name of polypus, which is a tumor grow