incident to strictly physiological development, as upon the womb during the "critical period;" (e) the direct and simultaneous impression on the part-with any or all of the above of mechanical or chemical agents (hence the mouth and neck of the womb are more liable to cancer than the body).

Sixth. The constant or frequently repeated temporary impression of a single formative stimulus may develop cancer, if it (the stimulus) is of such an anomalous or foreign kind as that it tends to develop a modification of structure for which there exists no analogue in man or in the natural formation of other animals; instance cancer of the tongue from the frequent application of nicotine in smoking rank tobacco-pipes.

Seventh.-For evident reasons in accordance with the foregoing premises, cancer will occur most frequently in organs whose normal structure is complicated and unstable, and whose natural functions are complex in character, varied in kind, and periodical in occurrence; instance the uterus, the breasts, the stomach.

Eighth. The liability to cancer increases with age (generally speaking), for the reason that time is thus afforded for the factors mentioned in proposition 5 to be brought into play.

Ninth. The treatment of cancer is either preventive or curative. To prevent its development, avoid the impression of the several factors already indicated. To cure the patient by radical means when cancer is developed, we must either destroy the life of the histological elements composing it, for which at present

science has provided no adequate means; or starve out the growth by cutting off its nutrient supply, as by the obliteration of its nutrient arteries, or extract com pletely the diseased organ. For cancer of the uterus get out the womb-get it out soon.

In conclusion, speaking figuratively, cancer is like the twig that naturally intended to grow in a perpendicular direction, until reaching the towering height of a vertical oak, it becomes, by being bent first to the right, then to the left, then laterally again and again, a crooked, knotted, and irregular dwarf. The evolutionary nature of the cancerous organ has, so to speak, been lashed into a pathological fury-goaded to madnesstortured into suicide: like the teased viper, it turns to bite itself with the identical fang naturally designed for its own preservation. Just as a shell, fired at an enemy in a direct line, by unluckily impinging upon a succession of oblique surfaces, may eventually describe a circle and return to burst in the face of the gunner himself: it was fired with the same conservative design of self-preservation, nevertheless.

CLINICAL REPORTS.

CLINICAL LECTURE

ON THE

DISEASES OF WOMEN,*

By T. GAILLARD THOMAS, M.D., Prof. of Obstetrics and the Diseases of Women and Children, in the College of Physicians and Surgeons, New York.

CASE OF MENORRHAGIA.

Mrs. D., aged 17, married. Has had a flowing every month since a miscarriage which occurred five months ago; being then in the third month of pregnancy. Previous to her miscarriage was perfectly well. Ever since her miscarriage she has suffered from menorrhagia, and comes to be treated for that difficulty. There is nothing more which the woman presents in the way of symptoms. The menorrhagia is quite excessive, but not sufficient to keep her in bed, though far in excess of the ordinary loss of blood at her menstrual periods previous to her miscarriage.

Physical Exploration. The uterus being touched, is found to be in its normal position; and conjoined manipulation shows it to be of normal size, and in proper position. Above the ovaries there is nothing noticeable. We have as yet nothing to account for the menorrhagia. The position of the woman is now changed, and a speculum introduced. The uterine sound is introduced, and the wall of the uterine cavity is touched, and instantly a free flow of blood comes from the uterus. Men

*

Phonographically reported for the Journal by Wesley Carpenter, M. D.

struation is not present, nor is it near the menstrual epoch, so that the flow cannot depend upon that. But does not blood flow freely from the uterus when its walls are touched? It does not. In a healthy uterus no blood will be discharged when its inner surface is touched, or at most a drop. But here a flow of blood takes place. There is no ulceration about the uterus; nothing wrong about the cervix, or the cervical canal. The menorrhagia is all there is; and what is the cause of the menorrhagia? To speak in full of the causes of menorrhagia, and the method of examination, would occupy the whole of the hour, for there are a great many causes for menorrhagia.

A woman may have carcinoma uteri and have menorrhagia; may have a retroverted uterus, and have menorrhagia; have a granular ulcer of the os, and have menorrhagia; and so menorrhagia may be a symptom of a great many diseases of the uterus; and when you meet with a case of menorrhagia in practice it will annoy you very much, unless it is cured. A patient afflicted with dyspepsia may receive treatment at your hands, and not know whether she is cured or not; but a patient who suffers from menorrhagia knows whether she is cured or not, and unless you succeed in curing her, will give you a great deal of trouble.

The only method of curing this disease is to find out what the cause of it is, and cure that. I come now to speak of the etiology of this case. During utero-gestation, the mucous membrane of the organ is developed very much in excess of what is present in the unimpregnated condition. After the emptying of the cavity, this tissue undergoes certain changes, and it is cast off; it molts, as it were, and the wall of the uterus is returned to its normal condition. When this does not properly take place, the wall of the uterus may be covered over with little warty growths, or fungoid excrescences. This condition may follow abortion, and sometimes full labor. give rise to the most persistent form of menorrhagia, except malignant growths in the uterus. Make your diagnosis, and

These little growths

you may cure this most persistent form of the disease. The diagnosis and treatment is to be effected by means of an instrument invented by the reviver of the use of the speculum. Récamier, in 1820, invented the curette. That which I employ, consists of a loop of copper wire attached to a handle. The wire can be bent to any angle desired, hence can receive any curve desired for entering the cavity of the uterus. To test for the existence of these growths, place your patient in the posi tion for the introduction of the speculum, and, introducing the instrument, draw out some of the growths by gently scraping the walls of the uterus. Be careful in the application of the instrument, and you will draw out twelve or fourteen of the growths, as large, perhaps, as a pea. Place them in water, and they will separate from the mucus with which they are covered, and then can be examined.

Your diagnosis being made, the treatment consists in the removal of these growths, by the same careful scraping manipulation with the curette. This is the most satisfactory plan of treatment. Another plan of treatment is to wrap about an inch and a half of the extremity of a probe, curved properly for introduction into the cavity of the uterus, firmly with a pledget of cotton, and with this apply the tincture iodini or tincture iodini co., all over the walls of the cavity. Cutting-curettes, used by some, are dangerous. Peritonitis may follow their use, and is not very uncommon. I employ the cutting instrument freely upon the os, and in the cervical canal, but never in the cavity of the uterus.

CASE OF AMENORRHOEA.

Miss -, aged 18; has been sick three years. Her chief complaint, she says, has been salt-rheum; and for this she has been doctoring. Since that time, she says, she has had "inflammation of the womb." The doctors, she says, have told her that this was her disease. All this time she has complained of steady headache on the top of the head and over the eyes; pain