cause, or with a malady foreign to the tubercle and acting in concert with it. The influence of wounds, catarrhal affections, and of suppurations is studied from this point of view.Gazette des Hôpitaux. 30th January, 1883.-J. L. S.

Treatment of Cancer of the Uterus.-We make the following extracts from a very interesting and readable clinical lecture on "Cancer of the Uterus," by Prof. W. Goodell, author of Lessons in Gynecology. The case under discussion was that of a woman aged 37, a multipara, who suffered from menorrhagia, bleeding after coition, and a foul-smelling discharge. As regards physical examination, he says:-" Passing my finger into the vagina, I come upon a sore which is characteristic. It is crater-like. There is a hard, irregular margin surrounding an excavation, which has on its bottom and sides. friable granulations. This is typical of carcinoma.

"The examination that I made has caused a little bleeding. That is one reason why you should never use a speculum in these cases. The finger tells the whole story, and a speculum may cause a hæmorrhage difficult to control.

"What about the prognosis? It is very unfavourable. Out of all the cases on which I have operated, and of which I know the after results, only three have I considered cured. Still, I can prolong life, and that is a great thing. In some of the cases on which I have operated, the disease has not returned in the cervix, but in some other part of the body. I have operated on women apparently in the last stages of the disease, so low that you would not give them two weeks' lease of life, and have seen them get out of bed and live for over two years. My experience is, that the older the woman the more likely is the operation to be followed by success. In younger women there is more blood in the part, there is a luxuriance of growth, and they are not so apt to be benefited by an operation."

In reference to treatment Goodell says that Freund's operation is rarely permissible, and then only when the womb is freely movable. "The operation which I shall perform to-day will consist in scraping away the cancerous matter as far as possible, and trying to reach healthy structures. The removal of the friable granulations will arrest the bleeding, which may not return. In doing this, I shall use this serrated curette, and this fenestrated forceps. In buying a fenestrated forceps, you should get it with the obstetrical lock, so that you can fasten the blades securely together. I am removing a large quantity of this offensive material, and my fingers are

going to smell very badly. How shall I get rid of it? I shall first wash them well with soap and water, and then with turpentine, which is very useful under these circumstances. Then I shall again use soap and water, with another go with the turpentine. After this I shall probably immerse them in carbolised water. Permanganate of potassium is an excellent disinfectant, but it has the disadvantage of so staining the hands that one is not presentable for several days after its use.

Now, suppose a woman comes to you and you diagnose cancer of the uterus, are you going to say, 'Madam, I am very sorry to tell you that you have a cancer?' No, don't you do that. I should not tell even if she asked me to tell her the truth; but in the majority of cases they do not want to know, and will say to you, 'Now, doctor, if you find a cancer, don't tell me.' No matter how good a woman is, or how fully prepared for the future she may be, the knowledge that she has a cancer is a terrible blow, and she at once gives up, begins to go down hill rapidly, and soon dies. I never, except in very rare instances, tell the patient that she has a cancer; but I always tell some member of the family, or a friend, exactly what is the matter. Suppose the patient asks straight up and down, 'Is it a cancer?' You do not want to tell a lie, and you do not want to say that it is a cancer. I get out of it in this way: I say, 'This is not that kind of cancer which you understand. This is not a hard cancer like that which comes in the breast, and which is hopeless. You have a bad ulceration of the womb. It is not hopeless; there are cases which are cured.' In the case which I have mentioned, where the lady took thirty-five grains of morphia a day, the word 'cancer never passed my lips, nor did it pass hers. None of the members of the family used that word, yet she knew as well as I did that it was a cancer. It was always spoken of as that 'bad ulceration.' About three years ago I learned a lesson on this point. I was asked by a physician to see a near relative of his. His suspicion was that it was a cancer. I said to him, 'Suppose that this is the case, shall I tell the lady?' He replied, 'Yes, she ought to know; tell her by all means.' After I had examined and found a carcinoma, I said, 'I am very sorry to say that this is malignant,' and then went on and told in so many words what the trouble was. She never rallied from that. She made up her mind that her days were numbered, and that there was no use in doing anything, and in a short time she died. I say, then, never tell a woman that she has a cancer.

"I have now made a funnel-shaped opening, into which I can readily introduce three or four fingers; before, I could barely get one in. I have not gotten into the bladder nor into the peritoneal cavity, but I am afraid if I go farther posteriorly, that I shall open Douglas' pouch. I can trace the cancerous tissue to the internal os, but it does not pass to the cavity of the womb.

"You see that while there has been some hæmorrhage, still it has not been alarming. Sometimes there is unpleasant hæmorrhage. During the operation you are not apt to have much hæmorrhage if you work rapidly, and quickly get down to healthy tissue. If hæmorrhage should occur, do not use Monsel's solution (the sub-sulphate of iron), for it makes plaster-like clots, and so corrugates and contracts the parts that you cannot continue the operation. Under these circumstances, ordinary cider vinegar serves an excellent purpose as a hæmostatic, without the inconveniences of Monsel's solution.

"Having removed as much as possible of this friable material, I purpose to apply fuming nitric acid to the raw surface. Usually, I prefer the application of Paquelin's thermo-cautery; but the instrument is out of order, and I do not think that I can reach all parts as well with the cautery as with a fluid. I apply the acid with a piece of cotton, allow it to remain for a short time, and remove by injecting water. I then again apply the acid. It is not necessary to use alkalies or oil to neutralise the acid. If enough water is injected, it will so dilute the acid that it cannot injure adjacent parts.

"There will be but little pain from the operation, but she will probably feel some soreness from the position in which the limbs have been held. When she is put to bed she will receive a suppository of the extract of opium (gr. j).

"I am sorry to say that these cases are very common. Cancer is, I think, on the increase; but why it is I cannot say. The disease more frequently affects the uterus than any other part of the body, unless it be the breast.

"You see that I have a little wound upon one of my fingers, but I am not afraid of inoculating myself with the cancerous matter, for I am in good health. If I were run down, it might be somewhat hazardous to get such offensive matter on a wound. It is the same with dissecting wounds, which occur usually towards the end of the session, and with those who are overworked. This is not the case with venereal disease. No matter whether the health is good or bad, one is liable to

be inoculated with syphilis. Nothing would tempt me to thrust my finger into a vagina in which I knew there was a chancre. It was only yesterday that I was asked to take charge of a patient who had a chancre, but I absolutely refused to have anything to do with it. Some years ago I got caught. After examining a case, there appeared on my fingers a sore which would not heal. I showed it to Dr. Agnew, and he pronounced it to be a chancre. For awhile I believe that I was the most unhappy man in Philadelphia. The diagnosis, I think, was incorrect, for the sore disappeared, simply leaving a scar, and was never followed by any constitutional symptoms. A burnt child dreads the fire, and I cannot be hired to put my finger where I know there is a chancre. Winter before last, in one of the ward classes, after I and a number of the gentlemen had examined the uterus in one of our patients, she called attention to a sore in the vagina, which proved to be a chancre. Some of the gentlemen looked rather frightened, and I cannot say I liked it very well myself.

"A number of years ago, I attended a respectable woman in confinement. I then lost sight of her for several years, when she again wished me to attend her. When I called to see her, I noticed that she kept herself wrapped up. the previous occasion it had been necessary to use the forceps on account of the narrowness of the pelvis, I was prepared when the head would not come down, to apply the forceps. When I exposed her, I found the nates and buttocks one mass of venereal disease, and her neck was raw from the same trouble. I would have presented any gentleman with a hundred dollars to have applied the forceps and delivered the child. I stripped my arms to the elbows, and thoroughly applied a mixture of carbolic acid and vaseline. I then applied the forceps, using one hand only in the vagina. As soon as they were in position, I ran out of the room, and carefully washed my hands, and again applied the carbolised vaseline. I then delivered her, and again washed myself with the utmost care. For a number of days I waited anxiously to see what the result would be, but no bad effects followed."

ERRATUM.-Dr. J. Whitson desires us to correct an error which appeared in the heading of his paper in last month's Journal-For Micro-photograph read Photo-micrograph.

THE

GLASGOW MEDICAL JOURNAL.

No. V. MAY, 1883.

ORIGINAL ARTICLES.

TISSUE REPAIR, OR THE PATHOLOGY OF THE SUBCUTANEOUS OPERATION BY INJECTION FOR THE CURE OF HERNIA.

BY JOSEPH H. WARREN, A.M., M.D.,

Member of the British Medical Association; Member of the American Medical Association (Judiciary Council); Hon. Member of Vermont State Medical Society; Member of Massachusetts Medical Society.

PART II. PERMANENT CURE OF HERNIA BY SUBCUTANEOUS INJECTION.

Tendinous Irritation.-It is strange that, in view of all the logical and scientific thinking of the present day, so many erroneous ideas should be perpetuated in regard to the permanent cure of hernia. Professor Gross, years ago, struck the keynote of the subject when he said that the only chance of curing this complaint lay in compression by a truss, or the inflammation produced by the subcutaneous injection of some fluid. Yet, how little is the pathology of such an operation understood, even at the present moment, by the great majority of medical men.

Dr. Heaton ascribed his cures to a method of "tendinous irritation" without inflammation, attempting thereby to develop a pathology whose chief element is the total absence of all pathology; and on this account some operators have expected a miraculous cure to take place, but finding that the same laws govern this operation as govern all other surgical * Heaton On Rupture, edited by Bavenport.

No. 5.

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Vol. XIX.