the error of jumping at a conclusion. You ought never to do that: you ought to arrive at all your conclusions in medicine, by a regular process of perception and of reasoning. Let me tell you a story about leaping at conclusions, which may serve better to put you on your guard, than ten pages of mere homily about prudence and cautiousness.

A gentleman here, for whose medical judgment and chirurgical skill I have the very highest respect, called on me some time ago to request I would be present at the removal of a polypus uteri, for which he proposed to operate the next morning. He said, the polypus was already partially descended into the vagina; but the patient had been much annoyed by it, both as giving pain, and causing the loss of a good deal of blood. He had carefully made out the diagnostic of the case, and should be provided with a Gooch canula for adjusting the ligature.

Upon reaching the rendezvous next day, I found a good many of the lady's friends assembled on account of the operation; and of course no little anxiety was visible in their inquiring faces, for notwithstanding such an operation is a trifling matter in fact, the women will not so deem of it.

My good friend informed me he had repeated his diagnosis, which was satisfactory; whereupon I was requested to examine the tumor, in order to found my own opinion. When we had retired to another apartment, I said,

"Are you sure, my dear doctor, that your diagnosis is correct in the case?"

"Oh, yes, certainly, I made it very carefully."

"I am afraid you have made a mistake."

"How?"

"Why, I do not take it to be certainly a polypus." "What do you take it to be, then?"

"I think it is a compressed ovum that she has been long casting off, and that is now ready to come away from the canal of the cervix."

"Oh no, sir, not at all; I assure you I have most carefully examined it, and I am sure it is a polypus. Did not you observe its pear-shape, its smooth and polished surface, its resistance? It is clearly a polypus uteri."

66

'Certainly, I do not like to differ from you in opinion on the case; I may be mistaken myself, but I shall be greatly obliged if

you will do me the favor to repeat your examination, carefully noting the diagnostic differences of polypus, and the case I supposed. I am far from presuming on my own judgment, but I must doubt you will come to my way of thinking as to this matter."

So he went to the patient's room, and soon came back, assuring me most confidently, that I had been mistaken, and that the case was a case of polypus uteri, pointing out to me all the infallible signs of that diagnostic.

"Very well, doctor, it may be that I have made a strange mistake, but you know that a man's perceptions are his perceptions, and they are what he is to go by. I hope you will allow me, before the operation is performed, to correct myself by a new exploration."

"Oh, certainly, I wish that you should do so, for I am quite sure you will find it as I have said."

We went to the chamber; I passed the right index finger along the tumor into the canal of the cervix, which was considerably dilated by the ovum, and having carried it as high up as I could, I bent the last joint, indented the mass with the finger-nail so as to make it serve as a crotchet, and then exhorting the woman urgently, to bear down,-to strain,-hard,-harder,—the dead ovum slipped into my palm.

I called for a basin of water, to put it in, and taking it to the window, I showed him the dead compressed ovum, of which the chorion and amnion were the irrefragable evidences.

"What is it, doctor?"

"It is an ovum.

"I told you so."

"Yes, but it is very strange! Do you know that I have attended a thousand labors? How could I make such a mistake!"

Now, do you, my friends, ask why I make all this detail of so simple an affair? All medical practice is a simple affair; it only requires, 1st, that you should be well informed as to the nature of your duties; and, 2d, that you should reflect upon those duties, in order to perceive what they be. The gentleman in question is a man of talents, very superior to hundreds or thousands of our brethren. But you see what a mistake! I make all this detail, in hopes of warning you not to frighten a whole household, by discovering that the mother of it has a polypus uteri, when she has no such thing. In fact, I make

it to prevent you from jumping at a conclusion. How jump at a conclusion, say you? Why! certainly my friend did so; and in this way. "The woman bleeds. She has a polypoid mass in the vagina, with certain uneasiness and pain; ergo, it is polypus, ergo, it must be extirpated." He ought to have reasoned differently. He should have said, "The woman bleeds; she has bled not many days; she has young children; she is a breeding woman; she has a polypoid mass in the cervix and vagina; but a polypus requires a long time for its development; ergo, though polypoid, this mass is not polypous, it is an ovum, compressed, and which is grasped by the cervix; I shall pick it away with my finger; and when it is done, I shall say, you are well, now, madam; the miscarriage is over, for I have the whole product of the pregnancy in my hand."

I have no further remarks to make upon the subject of concluding too suddenly an opinion on such a case. If you will perpend the circumstances I have just related, the facts, for they are facts, ought to serve to arouse your attention; but, if you be really attentive to the business before you, how can you fail to make just and right conclusions ?

Let me relate another case to you, which is that of a lady about six-and-twenty years of age, the mother of a child about two years old.

Having for some time complained of pain apparently situated in the womb, and of vaginal discharge, and aching of the loins, and, indeed, of the pelvis generally, with increasing general debility, she was prevailed on to submit to an examination by the Touch. The os tince was low down in the pelvis, and painfully sensitive; but I could not discover any marks of swelling of the vaginal cervix, nor of engorgement of the whole uterus.

By means of the speculum, I found that the os uteri as to the left half of its anterior lip was red, injected-the venules and arterioles being visibly enlarged. The color was that of the brightest and healthiest lip of a young person. The rest of the os tince was of the natural pale whitish hue.

I advised rest; recumbency during part of the day, and all night; a regulated diet; and as for the local turgescence, I treated it with contacts of the nitrate of silver pencil. But I did not make any progress towards a cure. As soon as the effect of the caustic was done away, the redness was found to be more intense,

and occupying a larger base. The substance of the inner aspect of the said lip, and as far up the canal of the cervix as I could trace it by sight, was red and swollen, and vascular. This vascularity augmented, and the mass became a small tumor, which began to hang outside of the os uteri, so that I could lift it, and move it about from side to side, and up and down, with the points of the speculum forceps; and, in short, it had converted itself by degrees into a cellulo-vascular polypus; very small, it is true, but a real polypus. I cut it down to the level of the surface from which it sprung, with acid nitrate of mercury; but it sprung again, and again I cauterized it; and so for several repetitions, until at last the tendency of the part to develope a polypus was abolished, and now I consider the patient as cured.

Have I not cured this patient of a nascent cellulo-vascular polypus of the os uteri? I believe that I have, and the case is on that account rare, and worthy of your attention. The little tumor always carried with it an epithelial covering, which was so tender, that on some occasions it would give way and bleed, upon being touched very gently, with a plumasseau of lint. Perhaps some of you may think it was a mere vivace that I cured; but I cannot but suppose that had I let it alone, it would soon have become a bleeding polypus, like the small one that I mentioned in a former part of this letter, and which caused so long and exhausting a hemorrhage from the lady. I am, &c. C. D. M.

LETTER XXI.

GENTLEMEN:-I showed you on several different occasions last winter, samples of uteri containing one or more hard nodular looking tumors, and also specimens, in which the entire mass of the womb had by disease, been converted into a tumor. You may remember that of the smaller tumors, some rose to a considerable height above the general level of the peritoneal surface; some of them being mere knots, and others having the appearance of being attached by necks or peduncles to the superficies of the organ

from whence, and through a faulty operation of the development force, they had sprung.

You shall find cases in which a womb shall be covered with such botryoidal prominences. They are to be met with as large as a child's head, and of every intermediate size, down to that of a filbert or a pea. They are, doubtless, all of them polypes, and they differ from the other sort, of which we have been before speaking, only in this, that they grow in a direction towards the serous, instead of in a direction towards the mucous paries of the uterus. The same principle is employed in causing the growth of either sort. There are some of them that appear to have pressed themselves, or rather to have been pressed down into the substance of the uterine walls, and sit, as it were, like an acorn in its cup, but attached at the bottom of the cup by a root, neck, or peduncle.

These tumors are not in themselves painful. They may give rise, however, to pain, by irritating the organ from which they grow, and yet they are not unfrequently met with in considerable numbers, in the uteri of patients who, having perished with other maladies, had never any suspicion of being affected in this way. In the long run they may be expected, however, to bring on disorders by disturbing the womb, which you know is eminently a disturbing organ, when it is itself disturbed. Upon attaining a certain size, they are likely also to introduce a bad state of health by their intrusion on the places of other organs and parts, whose circulation, absorption, nutrition, and innervation, they directly oppress and contravene by their mechanical displacement and pressure.

People talk of taking medicines for such tumors, and they even take homœopathic pellets in decillionths of grains! Leaving out of question the unspeakable nonsense of the homœopathic dosings, I see not on what ground they should take even real physic for such complaints, since drugs cannot, and were never designed to heal such tumors and make them return under obedience to the natural development laws of the organ, and restore its outline and contexture to a normal form and dimensions.

Don't you see that these are really chirurgical maladies,-that is to say, they would be subjects for chirurgical manipulation and operation, provided they could become accessible to the fingers, or