the facts of their force made manifest in their operations. I do not pretend to know why it is that iron dissipates, like a coup de théatre, the whole train of evils concomitant on the state which I call Anæmia. But this I do know, or at least I think I know it, that when a person labouring under anæmia is submitted to my control, and who has no organic lesion that I can detect, of the great organisms of circulation, oxygenation, and gastro-intestinal digestion, I look forward with an undoubting confidence to the cure, which I expect to see begun within a few days, and completed within some twenty-one days or thereabouts.

I do not consider myself as credulous in believing that iron has a special power to invigorate the tissues composing the hæmatosic membrane, the membrana vasorum commune; certainly not more so than ten thousand American physicians, who confidently administer five or twenty grains of calomel with the utmost certainty of exciting the liver into greater or more healthy activity; squills to excite the mucous follicles of the bronchi; nitre to arouse the kidney; or belladonna to stimulate the skin; and strychnia to wake up again the torpid muscle of a paralytic leg or arm. In methodus operandi of medicines, and drugs, all our cognitions are purely empirical-the results of the experience and observations made by mankind in a series of centuries, an innumerabilis annorum series, et fuga temporum.

Do you ask a further explanation of the confident tone with which I speak of health to be restored by restoring the crasis of the blood?

Why what else is health if that be not it which depends on perfect solids and perfect fluids? What is the blood? What its use, destination or design, in the body? It is the chaire coulante (the fluid flesh) of Bordeu. When the chaire coulante comes to be fixed, it is the chaire solide-but the blood is more than that, it has a higher function still; it is the direct agent in extricating the life-flash; the nerve force; the excito-motive power; the life itself.

Dr. L. Cerise, in his prize paper, in the Mem. of the Royal Acad. of Med., on "The Excitation of the Nervous System," says at page 294, vol. 9th, "Every instance of nervous-excitation is therefore a result of the concurrence of a sanguine with a nervous element. Hence every sample of excitation may be represented by a product formed by the contact of these two elements."

Dr. Cerise proposes to denominate this product, this result, by the word neurosity. I cite Dr. Cerise's words, as I wish you to understand that I disagree with him in his opinion that the result is the product of contacts of blood and nerve matter. For I adhere to the opinion I have so often expressed to you that the product is the result of the contact of oxygen (of the blood) and nerve-matter. Black blood, blood without oxygen, cannot produce the result. There is no neurosity developed in true, complete asphyxia or cyanosis, though the brain is gorged full of blood.

The brain and nerve are the creature; the animal; the perceptive being. It demands two conditions of existence, to wit: the substance of brain-the neurine-and the oxygen, whose contact and immiscence with it extricate the power. Give to the brain the oxygen, and the force is present; diminish the oxygen, and the force is lessened; take away the oxygen wholly, and force is gone-it is death.

But a watery and anæmical blood cannot carry sufficient endowment of oxygen. None but a blood whose crasis is true,-just,normal, can carry to the neurine the true, just, normal amount of oxygen; or extricate from the neurine by its action on it, the true, just, normal sum of innervative or excito-motive power. Such are my views. Such is my physiological explanation. Such are the motives that lead me in my walks to desire to cure the solids first, and then to find the fluids cured.

I am not a Solidist, nor a Humoralist, but I am Eclectic in preferring the best and most rational theorems of both the schools. I shall make no further remarks in this letter, which, perhaps, you will consider as sufficiently visionary, on the theory of anæmical disorders, remarks into which I have been perhaps prematurely led by remembering the considerable number of persons who have recovered from symptoms and accusations of prolapsus, without recourse to the usual remedies of prolapsus. I shall in a future letter enter into fuller statements of the views I have long held on these topics, and which I have so often discussed in your hearing at the Lecture room. I beg you to understand that my hypothetical conversation detailed in the last letter, is not very different from many long conversations I have had with patients, situated as the imaginary patient Miss Helen Blanque was.

Farewell.

C. D. M.

LETTER XIV.

GENTLEMEN-I am still to treat of prolapsions; I mean not the simulative descents of the womb, but those clearly decided cases of malady, proceeding from weakness and relaxation of the supporting tissues, and involving the patient in distress and inconveniences arising from the traction and distortion of important nerves, and bundles, and filaments of nerves, and from pressure upon points unaccustomed to it, and unsuitable for it.

In these cases the remedy is mechanical; it consists in adjusting beneath the descended womb an instrument which lifts it up to its proper height or level within the pelvis, and maintains it at that natural situation until the tone, the strength of the tissues can be restored by time and by remedies.

The comfort desirable from this method of support, is scarcely describable. A woman who for months had been unable to walk, or even to stand, without an ineffable sense of weakness and pain, moves freely and spontaneously after the adjustment; and in short, is as greatly relieved as is the man who has his humerus reposited after a dislocation. To show you how great that relief is, let me tell you that I was called to a very pious citizen, who dislocated his humerus into the axilla, and who, when I arrived, was holding the right arm in an elevated position, by means of the left hand, with which he supported it; as the least descent of the elbow gave him exquisite pain. I took hold of the limb, made the extension in the proper direction, and then depressing the elbow, reposited the head of the bone in the glenoid cavity. As the orbicular head took its place, he ejaculated with the utmost unction, "Bless the Lord, oh my soul! and all that is within me, bless and magnify his holy name!" He had occasion to ejaculate his thankfulness, for he passed from agony into perfect calm. It is true I have never heard a female make such an ejaculation upon a repositio uteri,—but I doubt not the relief has many times been almost as great in the one case as in the other.

Pessaries are as various as the ingenuity of the doctors, and

sometimes, of the patient herself. Most of those used here, are of blown glass, and consist of globes from an inch and a half to two and a half inches in diameter, or else of concavo-convex discs, about the same size.

The best of our pessaries, however, have been for many years constructed by Mr. Joseph Warner, gold and silver-smith, No. 16 Merchant Street, Philadelphia.

Mr. Warner is an admirable workman, and produces articles of this sort of the most perfect construction. The material is hammered silver; gilt, either by fire gilding, or by the galvanic

process.

Silver is preferred in the manufacture, on account of its hardness, which enables it to be reduced to the thickness of letter paper, while retaining its firmness, which could not be expected of so thin a plate of gold. While it is lighter, it is also less costly than gold. A globe of two inches in diameter, thus formed, weighs not more than two scruples, and when polished and covered with a sufficient coating of gold, possesses properties preferable in practice, to one of pure gold, inasmuch the lighter an instrument of this kind, the less objectionable is it. The same material is employed in the fabrication of the discus, the ring, the elytroid, and the horse-shoe pessary, as well as the olive of the stem pessary, from out of the whole great number and variety of which you can select, according to your opinion of the indication. Mr. Warner could readily supply your wants in his line, through the various express companies established here for parcels-delivery. Should you have occasion, therefore, to use any of his instruments, your letters, with description of the kind of instrument required, would probably meet his prompt attention. It would be only necessary to order a globe pessary of one and three-quarter inch diameter, or two inches, or two and one-eighth, &c., or a flat pessary, or a ring, &c. There are few towns in the United States, that are not reached, almost with the rapidity of the mail, by the Express lines of Adams & Co., Harnden & Co., &c. &c.

The object to be gained in employing a pessary is the elevation of the uterus to its proper level in the pelvis, and the maintaining of it in sitû naturalî. Many of my friends prefer the discus or the horse-shoe, the ring, &c. The late Dr. Dewees, invariably I believe, made use of the discus, commonly in this city called Dewees' pessary; and his deserved reputation as a practitioner,

gives to the instrument of his choice a great vogue, so that multitudes of them are made and sold.

The equally distinguished Professor, the late Dr. Physick, who seemed to me, in his lifetime, almost never to be in error in any. surgical or medical indication, as invariably preferred the globe, very generally known as Dr. Physick's globe pessary. In a conversation I had with him, some years before his lamented death,. (such men ever die too soon,) he told me, that while he was dresser at Guy's Hospital, under John Hunter, he had charge of a female under prolapsus, who was treated by a discus pęssary, having the usual perforation; that a portion of the os uteri had slowly engaged itself, and become strangulated in the aperture; so that he had difficulty in extricating it, an accident which I also have witnessed more than once. As he would not venture to expose the woman to a second strangulation from the same ill-constructed pessary, and as an old billiard ball that had been some time in the ward was at hand, he adjusted it beneath the uterus. The new application succeeded so admirably in sustaining the organ, that the Doctor ordered globes to be constructed, and we are, I believe, truly indebted to him for the beautiful and valuable resources thus placed in our reach. Such is my understanding of the history of the globe pessary of Dr. Physick.

As to my own preferences in the matter of pessaries, I have only to say, that whatever may keep the womb at its due height without irritating it, or incommoding the other organs and textures implicated in the descent, is a good pessary; but I deem the globe the most perfect and most suitable for the ordinary simple cases. An instrument of two inches, pressed upwards to the uterine extremity of the vagina, lifts the womb high enough; higher in fact than the position occupied by it in eight out of ten of those women who have had a child, and that is high enough. It is kept up by the double and consentaneous actions of the sphincter vaginæ muscle, and the levator ani. It has no angles, no sides; it cannot be displaced, save by being ejected. Its pressure is uniform over its whole superficies, save where its lower segment looks down the tube of the vagina. This cannot be so truly said of any other instrument, if we except, perhaps, the gum-elastic bottle, used and recommended by Dr. Hervez de Chegoin, in his paper in the Mem. de l'Acad. Roy. de Méd. The globe has a perfect polish, and an unoxydizable surface. It may be worn a year or