interrogated more narrowly, it will almost uniformly be found that she suffers pain either before or during the flow, in the back or loins, and that in the intervals she is troubled with leucorrhoeal discharge. To these inquiries she gives a reluctant reply; will often, perhaps from delicacy, conceal the truth, or, if she acknowledge it, will probably add, 'Oh, that is of no consequence; that is not my complaint; I have long been accustomed to that, and it does me no harm ;' and then winds up the case with telling you that she has taken a load of tonic medicines without benefit. If you ask her whether such questions were ever pat to her before, you are generally answered in the negative. Such a case as this, with slight modifications, is of common occurrence, yet it most frequently happens, that, with the general disorder, we have decided derangement of some internal organ or organs; and of these, the organs of digestion appear to be almost uniformly the first to participate; indeed the derangement of the digestive organs, to a greater or less extent, is so commonly associated with the general affection I have described, that one cannot but conclude that the general affection is most materially influenced, if not in part produced by it. It is sufficient, however, for our purpose to know that the exalted susceptibility of the general system and this deranged condition of the first passages, are very commonly co-existent, however they may stand in the relation of cause and effect. "The first appreciable disturbance of the stomach is most frequently a tendency to flatulency, which flatulency is productive of different effects in different individuals, although, in all, the stomach itself appears to be in a morbidly irritable condition, so as greatly to modify or aggravate the consequences that would otherwise arise from the presence of such flatulency. The patient experiences uneasiness at the scrobiculus cordis ; she complains of a sense of load or distension after meals, or, if the stomach be uncharged with food, of prickings and anomalous pains in the organ, all of which symptoms are pretty uniformly relieved for a time by the expulsion of flatus from the stomach. In other cases, the irritation produced by the flatus about the cardiac orifice, excites a sympathetic affection in the throat, a sort of globus hystericus, which is variously described by patients, some calling it spasm, whilst others compare it to a mechanical obstruction, and indeed one lady somewhat fancifully compared it to a bullock in her throat. It is a sensation, however, which will often last, in a greater or less degree, for days, or even weeks, with little intermission.

"At other times, the patient suffers from repeated vomiting, or is perhaps seized suddenly, but only occasionally, with vomiting, preceded, accompanied, or followed by an irregularly inverted action, chiefly of the oesophagus, and attended with an ascent of flatus; so as, in some instances, to threaten suffocation." 18.

Of the painful affections which attack particular organs or parts, the most serious, or at least the most prominent, are those which locate themselves among the abdominal viscera. The chief of these are,―

"Ist. A pain seated under the left mamma, or under the margin of the ribs of the same side. 2dly. A pain under the margin of the ribs of the right side. 3dly. Pain in the course of the descending colon. 4thly. Pain in the course of the ascending colon, especially towards the right hypochondrium. 5thly. Pain affecting the abdomen generally. 6thly. Pain in the region of the stomach. And lastly, Pain in the region of the kidneys, sometimes extending down the course of the ureters to the bladder." 22.

With respect to to the real seat of these painful affections, our highly giffed author is in considerable doubt. The natural functions of the organs or parts do not appear so necessarily disordered as to clearly indicate the localization of the pain. The pain under the mamma, or under the margin of the ribs of the left side, however, is, out of all proportion, more frequent than in any other place, and will often last for weeks, or even months, with little intermission.

"This pain is very circumscribed; it is not necessarily or constantly increased by a deep inspiration or by external pressure, although this is occasionally observed; it is seldom attended with cough; it is not materially affected either by a charged or by an empty state of the stomach, but varies in its intensity, and now and then goes off altogether for a few minutes, hours, or even days, or the pain shall subside and be succeeded by a mere uneasiness or sense of fulness in the part. This, pain, as I have said, is of extremely frequent occurrence, and is very often associated with palpitation of the heart, or, what is much more usual, with unnatural pulsation of the organ, if I may be allowed the expression; ie. the patient is conscious of the heart's action, or she feels as if its impulse were communicated to a part so sensitive as to excite distinct sensation, which, you know, is not the case in a state of health." 23.

The pain under the right ribs, though occasionally circumscribed, almost to a point, usual extends from the scrobiculus cordis along the margin of the ribs, nearly to the loin of that side. It is sometimes, but not generally increased by a full inspiration. It is aggravated by external pressure, and sometimes there is very great tenderness indeed. Dr. A. has sometimes supposed this pain to be seated in the colon-sometimes in the duodenumbut is in doubt as to the actual seat of the uneasy sensation.

It is by no means rare to find pain affecting the abdomen generally, and that so closely resembling peritonitis as often to be treated as such. Our author confesses that he has often been puzzled, and sometimes deceived by this masked disorder, which might be termed a neuralgia of the abdomen. It is sometimes attended with a tympanitic, at others, with a flaccid state of the bowels-the former being the more distressing. The slightest touch can scarcely be borne, such is the norbid sensibility of the parts. By carefully watching the phenomena, some incongruity will be detected sufficient to aid the discrimination between neuralgia and peritonitis.

The pain in the stomach is usually strongly marked, "and the more intense the disorder, the more positive is the evidence of its being really seated in the organ mentioned." The pain sometimes comes on suddenly, occa sioning the most excruciating agony, the patient screaming from the violenceof her sufferings, and her countenance indicating extreme distress. Temporary cessations of pain occur, succeeded by other paroxysms more or less

severe.

Lastly, the region of the kidneys is occasionally the seat of the pain, sometimes extending down the course of the ureters to the bladder. Or the bladder itself will be affected alone.-Dysuria is a general attendant on both forms.

The diagnosis is very important-sometimes difficult.

“Whenever a female complains to you of pain under the left breast, with or without palpitation or pulsation of the heart; of pain in the right hypochondrium; in the situation of the left or right colon; or of acute pain generally over the whole belly, or in the region of the kidneys or bladder-always be upon your guard, and if on inquiry you find a few, or many of the constitutional symptoms I have described, together with indications of uterine irritation, as shown by pain in the pelvis, in the loins, or in the thighs, before or during the cata menial flow; by too frequent or too profuse menstruation; or by leucorrhoeal discharge; I say, when you find such an assemblage of symptoms and circumstances, your suspicions will amount to a high degree of probability, that the complaint is not of an inflammatory nature." 31.

But as all these symptoms may proceed from organic diseases of the

uterus, that organ should be examined, if possible, especially if the age of the patient be that in which such diseases are apt to take place.

The indications are, 1st, to correct the morbid condition of the uterus; 2dly, to remove or mitigate the violence of troublesome symptoms in any individual case; and thirdly, to restore tone and vigour to the general constitution.

Dr. Addison has been induced to make the correction of the uterine disorder the first, or at least, the principal indication. He criticises the instructions which are usually given in respect to cupping the loins, leeching the pubes, the administration of purgatives, anodynes, baths, &c. and prefers applications made directly to the uterus itself and parts adjacent.

"The applications to which I allude, are cold astringent washes, injected per raginam by means of a proper syringe. The ordinary womb syringe answers the purpose exceedingly well, but one of any convenient shape may be used, provided it be sufficiently large to contain from four to six or eight ounces of fluid. The injection should be introduced with such a degree of force, as shall secure its application to the upper part of the vagina, and to the os uteri ; and the operation should be repeated two, three, or four times a day, according to the circumstances of the individual case.

"Either the mineral or vegetable astringents may be used, the former however I prefer, as they do not stain the patient's linen, and consequently are not so much objected to. With respect to the precautions to be observed in the employment of these injections, very few are required beyond what common sense would dictate. Should the injection occasion smarting, which is by no means unfrequently the case at first, it may be diluted with water, or water alone may be used till the original tenderness subsides, which for the most part it will soon do. It will also be prudent to instruct the patient to relinquish it a little before the expected period of menstruation, and to resume it as soon as that period is over. These are almost the only pecautions I have ever deemed it necessary to observe. Although in very irritable habits, and especially when the stomach is liable to be affected with pain and spasm, it may be as well to direct the wash to be used tepid at first, gradually diminishing the warmth till it is brought to the ordinary temperature of the patient's apartment, which will pretty uniformly be borne exceedingly well after a time, except perhaps during a few of the coldest months in winter. The wash I most frequently employ is the Liquor Aluminis Compositus, of the London Pharmacopoeia, that is, two drams of alum, and two drams of sulphate of zinc, to a pint of water. This practice must be persevered in for a length of time, proportionate to the obstinacy of the case and the effects it produces. Indeed, I myself recommend females never to relinquish it, but to employ it from time to time, as long as they continue to menstruate, to prevent the recurrence of the disorder, and its unhappy consequences. I have said that the patient should desist from the use of the injection, a little before and during the menstrual period, but she ought also to be specially cautioned against using any violent exertion, or undergoing any unusual fatigue at that time, as nothing so completely thwarts your purpose as imprudence committed whilst the irritable uterus is performing its functions."

38.

When the uterine irritation is characterized by frequent and excessive flow of the inenses, Dr. A. has directed the patient to remain quiet or in bed, and to desist from the wash during each recurrence.

Upon the means of removing occasional symptoms Dr. A. has given much judicious advice, and then proceeds to the third indication, the restoration of health and vigour to the general constitution. The early use of tonics has been extensively tried, with very unsatisfactory results in a ma

jority of cases. The cause, Dr. A. believes to be, inattention to the local irritation. The sulphate of zinc may, however, be given early, provided it do not offend the stomach. Dr. A. begins with a grain night and morning, either alone, or with a few grains of extract of conium or hyosciamus, the pil. galb. comp. or extract of gentian or bark. The diet is of the greatest importance, and should be carefully regulated. A number of cases, chiefly copied from the hospital-books are given in illustration, and with which the volume concludes. These cases and the whole work 'we recommend to the serious attention of our readers, who will profit by its perusal.

V.

ON THE ANATOMICAL CHARACTERS OF SOME ADVENTITIOUS STRUCTURES. By Dr. Hodgkin.

[Medico-Chirurgical Transactions, Vol. XV. Part II.]

Our readers are aware of our sentiments respecting the value of morbid anatomy, and we need not repeat them at any length now. None can appreciate more highly than we do the real advantages which have been and will be derived from this source, one of the most pregnant with certain information of any within the range of the various departments of medical learning. But, as generally happens, there are some of an enthusiastic temper and a theoretical turn, who look upon morbid anatomy as the elixir vitæ, the arcanum of our science, which is to solve all mysteries, dispel all doubts, raise the modern physician with his scalpel and dissecting-case immeasurably beyond the disciple of Hippocrates in former centuries, and in short can transform the most uncertain of all species of human knowledge into the sober and positive reality of a mathematical proposition. We appeal to the several journals of the day for evidence of the accuracy of the character we have given of this wild and visionary party, a character which might readily have been looked on as caricature. It is not so, however; and on more than one occasion we have raised our voices against individual disciples of this modern and credulous sect. We would then encourage the prosecution of morbid anatomy by every means in our power, but let those who do so bear in mind this caution, that the appearances visible to the eye and palpable to the touch are not always the disease he has been treating ineffectually during life, but its sequela; they are not the emblems of what it is his business, and should be his aim, to cure, but the gloomy trophy of a victorious malady, the signs that he has failed in arresting the morbid ac tions by which their organic lesions were produced.

Bearing these facts in mind, the cultivator of morbid anatomy will improve himself and his profession, and the facts which he accumulates, if carefully observed and faithfully recorded, will give to his writings a perpetuity of fame and value, which the views of systematists and speculations of theorists cannot possibly maintain. The works of Morgagni will be referred to so long as medicine and science shall endure. Dr. Hodgkin, whom we are happy to call our friend, deservedly holds a distinguished place as a

morbid anatomist, for great opportunities, seconded by equal or greater diligence, have given his opinions in this department the weight and measure of authority. The "Memoir on some Adventitious Structures," in the last volume of the Medico-chirurgical Transactions, is one that we would earnestly recommend to the attention of our readers. Our limited space and the practical nature of this Journal must, we fear, prevent our entering on the analysis of the paper, and to attempt a review of it would be much such a farce, as professing to review a work on trigonometry in half a dozen columns. We confess that we are deficient in the cool assurance and consummate gravity, which enable critics to knock off a review in a page of large print, and compress the pith of a dense octavo in a short remark and a long quotation. In the present case, then, we can neither promise a review nor an analysis, but shall merely offer one or two samples of the Doctor's fare, to serve, like the quails to the Scotchman, for a whet to his reader's appetite. Unlike the Scotchman, however, we cannot doubt that the said reader will find his appetite not a whit the worse for the dejeuné.

Dr. Hodgkin divides the adventitious serous membranes or serous cysts into two classes. The first comprises those which are simple, for the most part solitary, and not possessed of the remarkable property of giving origin to similar new growths. Such are the cysts in the plexus choroides, female mamma, and occasionally in the ovaries, &c. The second class consists of those which are capable of producing other cysts of a similar character with themselves, or morbid growths, which, if they do not present, strictly speaking, the character of cysts, are nevertheless referrible to the same type or mode of formation. Such are most frequent in the ovaria. At the time when a post-mortem examination is usually obtained the cure has been long in progress, and the cyst has to a great degree lost the character of a serous membrane. It now presents the following appearances:

"Its parietes appear to be rather fleshy, or coriaceous, than membranous; and the internal surface becomes more or less generally roughened, as if by ulceration or abrasion. The most important feature which it presents, is the appearance of tumours and elevations dispersed more or less thickly over the internal surface, and which, notwithstanding the very great variety which at the first view they seem to present, are nevertheless referrible to one general mode of formation.

** I shall commence with the description of that form which is intermediate between the two extremes; not merely because I shall more readily proceed from this as a standard to the explanation of its modifications, but also because the peculiar structure is, in this form, the most distinct and intelligible.

"In this form we observe on the interior surface of the principal cyst elevations more or less rounded, and of various sizes, projecting into the interior of the cavity, and covered by a membrane, which is continuous with the lining of the principal sac.

"On making an incision into these tumours, we find that they also consist of cysts of a secondary order, filled by a secretion, often serous, but almost as frequently mucous. It is not, however, merely by this secretion that these cysts are filled. On looking more minutely into them, we shall generally find, that from one or more points on the interior of these cysts there grows a cluster of other or tertiary cysts, upon which is reflected the lining membrane of the cyst in which they are contained. Cysts of the secondary order not unfrequently afford as complete specimens of a reflected serous membrane as either the pericardium or the tunica vaginalis, the lining membrane of the containing cyst corresponding to the reflected portion, as that covering the contained bunch of cysts does to the close portion.