opium, of saccharum saturni, of alum, of krameria, kino, &c. &c. But, I have seen all these fail, and yet the hemorrhage held in check, by doses of a decoction of dewberry root, and black currant root, taken in half-teacupfuls at a time, and repeated pro re natâ. I mention it here, as an article worthy of your attention, especially in the examples of hemorrhages in which you find yourselves baffled. The ultima ratio, the tampon, will, of course, ever supply your wants in the instances wherein it may be indicated.

Lastly, never despair; never give up the patient; never pronounce the case hopeless, even when it is to all appearance hopeless. Not that I advise you to deceive the sick, or their friends, which is cruel and useless; but you should remember, that men and women and children, have recovered from even apparent death. In these cases of enlarged womb, you have the hope that the growth will cease, and you have the example that they sometimes diminish again. It is time enough to pronounce that there is no more hope, when the life has left the body. I have seen the life resumed, even when I had regarded the signs of death as complete.

I wish, my friends, I had more comfortable prospects to hold out for you than those which, as to tumors of the womb, are contained in this letter. Medicine is always making progress, however, and let it be your duty so to study, to observe, and to reflect upon these mighty disorders, as to enable you in the next half century, to leave more consolatory counsels to your pupils, than I can to mine. C. D. M.

LETTER XXII.

GENTLEMEN:-There is a frightful malady to which women, the subjects of these letters, are very much exposed; I mean carcinoma, or malignant degeneration of the womb.

I have little to say on this subject, and, I might add, there is little to be done for those who are attacked with it; I mean little

to be done under prospects of curing the persons so attacked, or restoring their health.

It is enough to make a physician's heart sink within him to make the diagnostic of cancer uteri, for such a diagnostic is ipso facto a prognostic of death; and when the physician has made it, and is brought to the point of giving true expression to his opinion, he might be supposed to be as painfully situated as an English judge, when he puts on the black cap before the final announcement of the judgment unto death.

It is probable that the double functions of the uterus, as a menstruating and a child-bearing organ, render it more liable to the attack of this atrocious malady, and that its structure, also, which in the healthful state is solid, hard, and elastic, without excessive abundance of circulation or nerves, exposes it more constantly to the causes of carcinomatous change.

What is that condition, that carcinomatous condition which results in ulceration or open carcinoma of the womb? and how is it originally established and set up in the texture of the cervix? Do you say it is cell-life begun and carried on there ab initio? How is the cell-life begun?-what gives origin to it?-when does the cell development begin?-is cancer always an inoculation, and whence the inoculation?-can the healthy actions of the womb deposit mother cells in a healthy texture, and furnish them with the indispensable cytoblastem, without which they would die? These are questions more easy to propound than to answer, because physicians, very rarely enjoying opportunities of inquiring into the rise and progress of these disorders, do not begin to observe them until they have reached a stage of development so advanced as to leave little ground to expect any advantage from treatment, beyond the mere benefits arising from cleanliness, and some suppression, perhaps, of the progress as well as of the pain and irritation. Such cases cannot be studied ab initio. A mere schirrus of the cervix does not give pain, and the woman herself will not ask our aid or our opinion on a case of whose existence she is not aware. I say, then, we cannot study these carcinomas ab initio. They can be reasoned of, however.

I have never been able to bring myself to a consent that these diseases are the results of anything but inflammation. I have always regarded the transformed materials of a carcinomatous cervix, as the transformations of deposit brought about by inflam

matory action. And, if you will keep in view the remarks of M. Serres as to the gentle and slow progress of those actions that result in morphological changes, you will not find it difficult to agree with me that a carcinoma is an inflammatory result; for the slowness of the process, of which M. Serres speaks, is an attribute of those chronical inflammatory movements which produce, not hemorrhage, not secretions, not pus, not sphacelus, but new textures. But a carcinoma is a new and a changed texture. It is an imperfect texture. It is a texture whose combination of vessels, absorbents, and nerves is a perishing and unpermanent one; one that, from the very nature of the proportions of these instruments and agents of life, cannot exist long in one tenor of life, but must change and decay from the very fault of their crasis or composition. In a healthy cervix, the accretion and waste are duly balanced, because the absorbent and the nerve are there to regulate them; but when, in consequence of a slow, a chronic inflammation of the cervix, the interstitial textures become filled with laminæ, or fibres, or bands, or granules of coagulating lymph, or fibrine of the blood, it is manifest that the vessels are to be collapsed or compressed and closed by these deposits outside of them, as is clearly shown by Pujol, in his admirable doctrine of inflammation; and that the absorbents are sealed or compressed so effectually, and the nerves so absolutely destroyed, that the quasi organization of the carcinomatous cervix has come to its end, its term, and no longer, in truth, exists as to the sum of the particles of the cervix; and then commences a process of absorptions, and sloughings, and suppurations, and hemorrhages, and macerations, and sanious putrid excretions, which proceed until the constitution of the victim being entirely exhausted or overthrown, she sinks into the grave, her only and her last best refuge.

In the progress of this half erosion or maceration, and half phagedenic ulceration of the parts, the mother cell makes its beginning; and once begun, the parts once inoculated with this new and wild, unconstrained, uncontrolled form of life, the destruction goes on with rapidity; nothing stays, nothing arrests it, and the sole resource of our art consists in the exhibition of opium in some one of its forms, for the subduction of the distress.

The principal matter, however, is to make a correct diagnosis. There is danger of an incorrect one in this, that if you come to the clear conviction that the case is one of veritable carcinoma or

cancer, you will be paralyzed by that conviction; and, like everybody else, will settle down in the conclusion that nothing is to be done beyond the administration of those palliatives, which, though they cannot cure, yet can console and comfort the patient.

I have certainly met, in the course of thirty years, with several cases of diseased uterus, which I had the greatest reason to suppose cancerous, but which yielded to persevering treatment, and ended in the perfect recovery of health.

Far be from me the intention to proclaim that I have been more fortunate than my brethren, and that I have cured cancer of the womb. My desire is to say that I was mistaken in my diagnosis, and that I treated a curable and not an incurable malady. I am of the opinion that everybody holds on the subject of this terrible evil, viz., that it is one of the opprobria medicorum, and that it cannot be cured. No, not even by the excision of the part affected. I speak of the true cancer.

Dr. Muller, in his work on the Nature and Structural Characteristics of Cancer, &c., combats the opinion of Wenzel, that scirrhus and carcinoma are mere inflammatory induration, followed by ulcerative action. Yet, notwithstanding my ready assent to the doctrine of cells, as the agents of vital development, I confess myself to be quite in favor of the doctrine of Wenzel, and of those who, while they deny not the destructive activity of the developing cells, which are so readily detected in various forms of ulcerated carcinoma, and of fungoid disorders, yet regard the antecedents of cancer as caused by inflammation. Perhaps you, my friends, may be in favor of Prof. Muller's views, and I acknowledge his arguments are very powerful, and that his citations of examples and varieties in the forms of cancerous degenerations, add to the force of his reasoning. But I cannot bring myself to believe that cancer ever commences anywhere, as a punctum saliens of disease. There is always an antecedent state of alteration of tissue; a state which lays the foundation for the wild evolution and increase of cells, out of and beyond the control of the accretion and waste laws of the part or organ.

When a part has once become changed by a certain form of induration, the control of the generic nerves is abolished in it; and a cell deposited within it, or inoculated from without it, might live and multiply upon its morbid cytoblastema, so as to result at last in the strangest modifications of the texture; becoming carcinoma

reticulare, alveolare, fasciculatum, melanodes, or medullare. These several forms of degeneration depend on the loss or retention of more or less of the nerve-power of the part, by which one or another of the constituent elements of a fabric may be held in check, or allowed to run into riot and ruin, under the action of the disease.

But it is not my purpose, and I confess I have not sufficient information upon these points, to enter into a useful discussion of the microscopic characteristics of the various forms of cancer. There seems little profit in such discussions, beyond that which enures to the enrichment of our possessions in biology. They will probably have but little influence in a utilitarian sense, since they add not to the power of the therapeutist, nor to the success of the surgeon. I cheerfully refer you, therefore, to Prof. Muller's beautiful work, hoping, however, that you will always endeavor to exercise an independent judgment on all matters of science; not without that due respect to the superior knowledge and opportunities of such men as John Muller, whose great learning and noble devotion to the enlargement of the boundaries of medical science, have earned for him so distinguished a name. name. I shall refer you to Colombat for a fuller description of the phenomena of scirrhus and cancer of the womb; merely saying here that, when the os tince becomes covered with hard lumps, that feel like shot lodged under the epithelium, that give sharp pain when pressed with the finger; that deform the os uteri, by causing it to swell unequably; by unnatural discharges; you will have a right to suspect scirrhus. If it have gone so far as to bleed for a touch, and to give rise to sanious discharge, with a peculiar odor, not very different from that of carious ulcer, it is ulcerated cancer, and the patient will die.

You will find that many of the European surgeons have treated cancer of the cervix, by cutting off the diseased part, and that they assert the patients to have been sometimes cured by the operation. I think the remark made to me by an eminent Philadelphia surgeon some time since, is worthy of being repeated. "If the cervix was cut off," said he, "and the woman recovered, it affords the most incontestable proof that the operation was unnecessary." It is probable that the course of your future experience, in recovering certain forms of enlargement, induration, and ulceration of the cervix uteri, will bring you, in the end,