tient, and the bowel will discharge all its stercoraceous contents, and much liquid and mucous matter, but the gas will stay in, and the belly be as big after, as before the operation. You cannot get along, however, without your purgative, or aperients; and when you choose them, pray take my advice, and use one of Dr. Brown's formulas. I have used it for many years, and if it was not unprofessional to do so, I would imitate the epigraph I have seen in many old ladies' family recipe-books, and write over it probatum est.

Dr. Brown was a famous physician who lived at Port Tobacco, in Maryland, many years ago. He was one of three brothers, all of whom obtained considerable eminence in medicine, in their own districts and States. He was the Dr. Brown who was called in consultation with Dr. Dick and Dr. Craik, at the last illness of Gen. Washington. My master, Dr. Thomas Hanson Marshall Fendal, of Georgia, was his pupil, and he told me, thirty-eight years ago, that this was one of Brown's formulas. Dr. F. used it in almost all severe cases of tympanitic disorder, and I have used it ever since, and ever shall.

Take one ounce of manna;

One drachm of anise seed;

Eight ounces of boiling water.

Mix them, and let the mixture rest for half an hour, then strain the liquor.

To the strained liquor add three drachms or four drachms of carbonate of magnesia, so as to make a perfect mixture.

A wineglassful may be given for the dose, to be repeated every two hours, or three hours, until it operates. This is Dr. Brown's carminative cathartic, and if a man may venture to speak on an experience of thirty-eight years, I am willing to say that I have all that time found it the most dependible carminative physic that I know of; and I heartily recommend Dr. Brown's formula to you.

I do not pretend to know why it is the most efficacious dose in tympanitis; nobody knows why one medicine acts thus, and another so; it is enough to know that ipecac. makes you vomit, and that jalap purges you. The why, is a metaphysical, if not a psychological proponendum.

If, in the treatment of these wind pregnancies, or tympanies,

you can get the bowels once to discharge the flatus which seems to stay, in some instances, for weeks and months, in one even tenor of tension, you will gain an important point. If you can do it, then pray tighten the flannel roller, and keep all the advantage you have gained by aiding the weakened intestinal muscles to compress the intestinal contents. Keep up the activity of the muscles of the bowels, by means of an aloetic, such as Lady Webster's pill, or by draughts of infusion of rhubarb, quickened with some compound tinct. of rhubarb or senna.

Let her drink brandy and water with her dinner, and a hot glass of punch at bed-time; have a good index expurgatorius of eatables, in which you should carefully set down sour-krout, pork, veal, duck, goose, beans, beets, corn, and id genus omne of the wind-begetting vegetables, that are fitter for the dura messorum ilia, than for the tender intestinal constitution of hysterical ladies.

Some of the doctors will tell you, for they still do insist on it with me, that these wind-swellings, these tympanites are produced by collections of gas secreted in the peritoneal sac.

I should be astonished at any one of you, could I hear him say he had a case of tympanitis of the pericardium, arising from secretion of gas by that serous sac. I should be equally astonished to hear any one of you attribute an ordinary tympany of the belly to such a cause. The air in tympany is always in the bowel; never outside of it. Farewell.

C. D. M.

LETTER XXIV.

GENTLEMEN:-The womb is sometimes distended with water, which, after having enlarged it to a certain size, suddenly gushes forth, leaving the organ to return to its non-gravid size. This state is called hydrometra, or dropsy of the womb.

Now, as to hydrometra, I do not believe in it. It is indifferent to me who has seen it, or who has heard of it. I repeat, I do not believe in such a malady, and therefore I had serious intentions of passing over it in silence. The womb is a cul-de-sac, which

can hold no water, except when the mouth of the cul-de-sac is turned upwards, in which I admit it would be possible for it to hold a little water; but, when the mouth of the cul-de-sac is turned downwards, the water would run out of it, as surely as it would fall out of a teacup or tumbler, that you should turn upside down.

Still, they say the womb fills with water, and becomes as large as the gravid womb at seven months. There is no doubt of it; I have seen it; but that does not make a dropsy of the womb; it is only a case of a womb expanded by a body growing or enlarging within its cavity.

It is said an acephalocyst, or rather a half million of acephalocysts, might develop themselves in the womb. These acephalocysts, or bladder-worms, fill with water by some process of absorption, or endosmosis, and as they expand, the womb which does not know it is not pregnant, yields to the delusion, and gives way to the internal pressure, just as it does under the pressure of a growing healthy ovum. The acephalocysts fill more and more, until at last, the womb will no longer tolerate the incumbrance, and beginning to contract, soon expels the intruding masses by a regular process of labor-pains.

When the mass is expelled, it is found sometimes to be in quantity sufficient to fill a wash-hand basin, and you call it a mass of hydatids. These hydatids look like bunches of grapes; like the finest Malaga grapes, and are of various sizes, from an inch in diameter, to that of a small pin-head. Each one is attached to a mass of partially organized matter, consisting mainly in laminar cellular tela, with blood-vessels creeping among the grapes.

I have seen them come off with very great hemorrhage, even to fainting.

I said they are called acephalocysts. I ask you whether that is likely; and whether each one of the grapes of a bunch of hydatids, is to be esteemed an independent ens?

I have never heard of hydatids in the virgin, nor do I believe that a virgin could have an hydatid or anything like it developed in her womb. I have met with them only in married women. I do not regard them as hydatids, or acephalocysts; but I think they are morbid products of conception.

A woman shall conceive healthfully, and carry on the gestation for a few weeks, when the embryo dying, she ought to throw off

the ovum by an act of abortion; but she does not do so. The ovum having formed its mesenteric attachment, keeps up a sort of life within its textures, and the floating extremities of the villi of the chorion imbibe, by means of the endosmosis, the transparent fluid which you see in the bunches of hydatids. They are not animals, they are dilated and hypertrophied villi of the chorion. A bunch of hydatids is a dropsical placenta, and a dropsical placenta is the dropsy of the womb, or hydrometra, of which you have heard. To have a true dropsy of the womb, you must imagine the os uteri hermetically sealed, and the cavity of the organ filled, and distended with serum. That would be a dropsy.

It is said that a single acephalocyst, or living hydatid animal, has filled the womb to a great size, and suddenly bursting, has discharged its whole fluid contents, at a gush. I have never seen such a case, but I have seen many times a pool of water on the flow, from rupture of the ovum, where I know the ovum was not ruptured. Such pools of water were hysterical discharges of urine. And, as I cannot conceive of a cysticercus, or acephalocyst, large as a child's head, I prefer to suppose that the doctor and the patient have both been deceived, than that so improbable a magnitude should ever be attained by an animalculus.

In true pregnancy, the womb is occupied by the ovum, whose growth causes the womb to grow pari passù. The ovum in pregnancy, consists of the embryo or foetus, the cord, the placenta, the amnion, and the chorion. The ovum is a living, independent, self-supported creature. It may well be likened to an acephalocyst, and yet its head might be stated to be the placenta, which attaches itself to the uterine walls, and sucks or draws from thence the materials for the development of itself, and its dependencies. Its dependencies I say; and by that word, I mean to imply the child, and all its parts. The child may be regarded as one of the complex organs of the acephalocyst, which perishes at the end of a prescribed term, leaving the organ it has developed, a complete and self-existent creature, as it had itself been before it. This is the only true single acephalocyst that I can conceive of, as filling and distending the womb to a great size. And this acephalocyst may become morbid, that is to say, it may become enormously overgrown, so as to distend the womb beyond measure, and greatly interfere with the woman's health, by the distention and intrusion. The womb itself may be injured, or

weakened, by the extension; and the constitution may suffer from pressure of an overcharged womb on the vessels and nerves, and other organs in the belly.

A womb, in this sense, might be said to be dropsical; but, rather, it would be truer to say the ovum is become dropsical.

In general, there is no remedy for this dropsical state of the womb, of which I now speak. Not that you could not readily bring it to an end; for nothing could be easier than to do so, by pushing a catheter through the os uteri, and through the chorion and amnion, to let off the water. The escape of the water would end the dropsy, but I hope you will not think of resorting to such a treatment for any degree of inconvenience that might arise from the over-distention, short of one involving the woman manifestly in danger. You have no right to bring on anybody's labor, but upon the strongest and most clearly understood motives of necessity, and of indispensable necessity, to do so. It should always be determined on in a formal Consultation with persons of ripe judgment, and enlarged clinical experience and knowledge. Where the necessity for removing the accumulation exists, it is, I repeat, easy to effect the removal. But I find I am lapsing insensibly into an obstetrical topic, and shall, therefore, cease to discuss it here, in hopes of presenting it at fuller detail, in my work on Midwifery; and as I have now treated, tant bien que mal, on all the particular maladies of the womb, I shall close this letter, in order to take up some of the questions as to diseases of the uterine appendages, as they are called. It would be far truer to call them the reproductive organs, for I am always of the opinion announced in an early letter of this series, that the stroma of ovaries is the true sexual tissue of females; in fact, that stroma is sex for them. C. D. M.

LETTER XXV.

GENTLEMEN:-I have now to offer you some remarks upon the diseases of the ovaries; and I wish that in doing so I could feel that the study and treatment of such affections had enabled us to