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 tincæ 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

bistoury, or ligature, &c.? True, Mr. Lisfranc has proposed to enucleate them, and possibly, when one of them happens to spring from the vaginal cervix, it might be turned out with the handle of a scalpel, or dug out with the finger nails. If you like such surgery, it may be well, but I confess I am not of that class of people. As to doing anything with those that grow outwards towards the peritoneum, I look upon it as hopeless. I detest all abdominal surgery, save that which is clearly warranted by the otherwise imminent death of the patient. I say imminent death, not inevitable death, for death is ordained for us all.

It does not, however, follow, that because you have come to the conclusion, that nothing can be done in the way of curing a fibrous tumor of the womb looking towards its serous surface, you are to do nothing for the patient herself.

Much may be done in a way of wise counsel and prudent.prescription as to her conservation; as to putting off the evil day; as to obviating and combating all the provocatives to an unnecessary increase of the malady; and as to counteracting the effects of pressure and intrusion, the natural accompaniments of the tumor. She may be confined, by your orders, to the house, the sofa, or the bed, whenever the disturbance arises to a height rendering such intervention of yours desirable. If obstruction of the pelvis attend the complaint, the enema, the aperient, the strong purgative, are at hand, under your direction. Her diet and clothing may be regulated wisely and usefully. If inflammation and pain be threatened, or actually make the attack, you will save the perilous organs by your venesection, your leechings, cuppings, counter-irritants, stupes, and cataplasms; by your tartar of antimony and potash, your calomel, and your opium. So that when you cannot cure the fibrous tumor, you see I do not advise you to turn your back on the patient, leaving her to an inevitable fate, rendered tenfold intolerable by unwise treatment, or by no manner of treatment. For I deem those who are doomed to an inevitable and not distant death from incurable disease, to have no less need of the physician than those who are certainly curable; and I think no higher exercise of the medical functions can ever be found than in those euthanasial benefactions that can smooth. the way of the dying, and through composure, and comfortable counsels, and charitableness, and "sweet oblivious antidotes,"

divest of some portion of their terror and pain, the last fast fleeting hours of men.

I am, my dear friends, in no little danger of making a rambling sort of letter of this, as well as the last one; for I find myself disposed very strongly to come back again in this one to the contemplation of principles that I find I have partially discussed in the former. I hope, however, that as I am writing letters, and not a regular book, you will pardon me if I depart from the regular epopeia form of book-making, and preserve in this series of communications the liberty and latitude which would be unbecoming in a regular gradus operis. In fact, I am very desirous to lay before you a translation of part of Article XVII. of M. Serres' Anatomie Transcendante, which is at page 130 of that admirable work; and I do this, because I feel very sure that no one is likely to republish the work in this country, and that you will probably not have an opportunity to see the passages in question, unless I give them to you here. You will judge whether the citation be german or not, to the matter in hand, to wit, the abnormal developments to which the womb is liable.

Mr. S. says, "The structure, as well as the form of organs, is subject to various metamorphoses. An organ passes through various phases or gradations, before it reaches the condition in which it is destined to remain throughout the rest of its existence. An aberration of its form produces monstrosity; an aberration of its structure produces disease. Both these aberrations are subject to certain rules, and very nearly to the same rules.

"In order to conceive just ideas of an aberration of form, we must follow the successive evolutions of such form from the moment of its first manifestation, up to the period of its complete development.

"To conceive of aberrations of structure, we must adopt the same plan. But, inasmuch as a case of monstrosity is nothing more than the retrocession of an organ towards another and more simple condition of such organ, or its arrest at one of its embryonal and primitive conditions; in the same sense, an organic disease is often nothing else than a return of an organic tissue towards a textural condition, which it naturally possessed at some one period of its embryonal life.

"Diseases consisting in retrocession of tissues, correspond to cases of monstrosity by default; and monstrosities from excess