Mr Gray states to me further, that redness, slight abrasions, and granulations were sometimes, but not frequently, observed.

Neither in the living nor in the dead body have I ever seen ulceration of the os and cervix uteri except of a SPECIFIC character, and especially scrofulous and cancerous; but I have met with a very considerable number of cases, in which it had been affirmed by others to exist during life after deliberate and repeated examination by them with the speculum, where I ascertained that ulceration did not exist in the os and cervix uteri, nor disease of any kind. This mistake has happened not once, and to one individual, but in a number of cases, and to several practitioners, who avow that they are "in the daily and almost hourly use of the speculum."

Two years ago, I saw a young unmarried lady suffering from hysteria. She had been examined with the speculum by a practitioner previously in attendance, and was declared to have an engorgement of the uterus and ulceration of the cervix. The speculum and caustic, twice a week for several months, were required, it was said, to complete the cure. At the request of the ordinary medical attendant of the family, I examined the os uteri both with and without the speculum, and he did the same most carefully, but no trace of ulceration or disease of any kind could be detected in the parts. We recommended that the patient should leave her couch, to which she had been doomed; and, by the use of valerian, and other appropriate remedies, with exercise and sea-air, she speedily and most completely recovered without the speculum and caustic.

On the 3d October 1849, I was consulted by a lady, aged twenty, who had enjoyed good health before her marriage. Soon after this, pregnancy took place; and for ten weeks, according to her own report, she was extremely ill, had constant sickness, pain in the region of the uterus, and in the legs; swimming in the head, inability to walk;-the whole nervous system was greatly disordered. Miscarriage took place in May 1848, about the tenth week, with much hemorrhage. I was requested by the patient's mother to examine the uterus, and to state whether it was in a sound or diseased condition. I did so by the touch, and ascertained that it was small, moveable, and neither displaced nor diseased, but very tender on pressure about the crevix. I was then request to examine carefully with the speculum, and state whether or not ulceration existed in the mouth and neck of the womb, and whether one of the ovaria was not diseased. I did so, but could see nothing like an ulcer in these parts. I was then informed that she had been examined by another physician with the speculum the day before, and that he had declared, in the most positive manner, that ulceration existed, which would render

it necessary for the patient to remain several months in London to have caustic frequently applied. I recommended her to return home immediately, to avoid the speculum and caustic, and trust her recovery to sea-air, carriage exercise, sedatives, and mild tonics. For some months the pains in the uterine region, and inability to walk, continued; but in the progress of time all the symptoms wholly disappeared, without any other treatment being adopted; pregnancy again took place, she went to the full period, was safely delivered, suckled her child, and is now in the enjoyment of excellent health.

On the 22d February 1850, at the request of Dr Page, Physician to St George's Hospital, I saw a married lady, aged 32, who had suffered severely from hysteria, both before and after her marriage. She was the mother of several healthy children, the youngest being two years of age. The general health was good, the catamenia were regular, there was no leucorrhoea nor sign of uterine disease. This lady was, however, made to believe by a friend, who had herself been treated with the speculum and caustic during some months, that there was something wrong about her womb, and that she must, therefore, consult the practitioner referred to in the last case, The lady did so, and was immediately informed that she was labouring under inflammation and ulceration of the cervix, and that it would be necessary to come to London for six months, at least, be confined to her couch, and have caustic frequently applied through the speculum. I examined the os and cervix uteri of this patient, both with the finger and the eye, but I could discover no trace of inflammation, ulceration, excoriation, granulation, or disease of any kind whatNever in the whole course of my experience had I seen and felt the os and cervix uteri in a more healthy condition.

ever.

I will not fatigue the Society by relating the histories of many additional cases, which have come under my observation, in which it had been previously affirmed, after deliberate examination with the speculum, that ulceration of the os and cervix uteri existed, where there was actually no ulceration nor disease of any kind.

VI. Dr Copland has communicated to me the following history of a remarkable case, in which the speculum was used, in my opinion, contrary to every scientific principle, and with fatal effects.

"A lady, aged fifty," says Dr Copland, "had been several years afflicted with jaundice, and in the latter period of those years became paraplegic. The paraplegia was to a certain extent removed, so that she was able to drive out in her carriage. She had consulted several physicians before she came to me, and I had seen her repeatedly during the last few years. She had heard that a physician had cured the wife of a distinguished person of some very serious disease of the womb. When this was

related to her, and that it was done in consequence of his employing a new method of examination, and that, by having recourse to this, he had not only cured the lady referred to, but was also better able than any other physician in London to find out the source of all diseases occurring in females, she went and consulted him, and at the same time informed him that she was under my care. This lady begged me to meet this practitioner in consultation, which I did, when he informed me what this new method of examination was. He stated, that from the previous conversation he had had with the patient, he believed that all her illness arose from disease of the uterus, and he wished to demonstrate this with the speculum. To this I answered, that there could be no disease of the uterus or its appendages, because the uterine functions had been performed regularly up to the age of forty-nine years, and that she had never complained of leucorrhoea, or of any uneasiness about the uterus. He succeeded, nevertheless, in recommending, with the concurrence of this lady's married sister, who had accompanied her from the country, that an examination with the speculum should be made. I said it appeared to me wholly unnecessary, but I would leave the patient to her own discretion.

"The examination was commenced, and I remained some time, but was shocked with the proceedings, for the hymen was unbroken, and the doors were all obliged to be closed to prevent the people in the house from hearing her screams and being alarmed. The examination went on, and after having stopped the greater part of an hour, during which it continued and was not completed, I left. About seven or eight days after this, I was informed, that the paraplegic symptoms, which had previously been much mitigated, had become exasperated, and had extended so as to produce general palsy, and ultimately delirium and coma. She died in eight days after the examination with the speculum, and I requested an examination of the body to be made.

"This was done in the presence of Dr King, two surgeons from Woolwich, and myself. The operator with the speculum was also requested to attend, but he did not appear. The spine was opened, and as high as the first and second dorsal vertebra, lymph was effused between the membranes, but it was not recent, and was partially converted into a gelatinous adipose substance. But above this, and up as high as the base of the brain, there were indications of recent inflammation, with a copious effusion of coagulated lymph, observed. The uterus and all its appendages were perfectly healthy, the os cervix and every part of the uterus was in a sound state, and the vagina also was perfectly healthy except at its orifice, which presented appearances of recent violence. The hymen was completely torn."

PART II.

CRITICAL ANALYSIS.

ART. I.-An Essay on a New Mode of Treatment for Diseased Joints and the Non-Union of Fracture; with Cases and Formula of the Various Preparations used. BY THOMAS BUCHANAN, C.M., &c., Surgeon to the Hull Dispensary for Diseases of the Eye and Ear. London, 1828. 8vo. Pp. 100. 2. A Practical Treatise on Diseases of the Joints. By W. J. WICKHAM, Surgeon to the County Hospital, Winchester. Winchester. London, 1833. 8vo. Pp. 178.

3. On Ankylosis or Stiff-Joint; a Practical Treatise on the Contractions and Deformities resulting from Diseases of the Joints. By W. J. LITTLE, M.D., Lecturer on Medicine at, and Assistant Physician to, the London Hospital, &c. &c. London, 1843. 8vo. Pp. 145.

In the seventy-second volume of this Journal* is given an account of a method of treating that form of stiff-joint called imperfect ANKYLOSIS, by means of the use of cold water applied in a particular mode; with some observations on ANKYLOSIS and the inefficiency of the usual methods of treatment. In that account no mention is made of a method of treatment which was proposed in 1843 by Dr Little, and which that gentleman has since practised on an extended scale. To that method it may -be proper shortly to advert, in order to compare its merits with those of the method so strongly recommended by M. Fleury.

Dr Little informs the reader that it is not his intention, in his remarks on the nature and varieties of Ankylosis, to examine the opinions of other authors, but rather to state the results of his own observation and experience; and hence the view which he gives of this lesion is short, and chiefly in reference to the mode of treatment which he recommends. It may be not unprofitable, nevertheless, to advert to the notions of various observers, on the peculiar nature and causes of this lesion, in order to form a correct estimate of the comparative merits of the several methods proposed by different individuals for its relief or removal.

The only true method, we conceive, of forming just ideas on the nature of Ankylosis, is to consider the several morbid states * Edinburgh Med. and Surg. Journal, Vol. lxxii. July 1849.

of an articulation which may give rise to and terminate in that condition.

ANKYLOSIS is differently defined by different authors; yet all agree in this, that it consists in the motion of a joint being impeded, partially or completely, in consequence of certain changes which the articular tissues have undergone. By Ankylosis, Dr Little understands unnatural rigidity of a joint, arising from causes operating in a direct manner on the structures immediately concerned in the articulation, and by which its natural movements are rendered impossible. He adds, that the term includes the ideas of distortion and deformity, in so far as in the majority of cases of ankylosis, the part is fixed in a position different from that assumed by the limb in a state of repose, and accompanied by a change in form, detracting from its symmetry. Though occasionally used synonymously with Contracture, it differs from that in several circumstances.

A great evil in Medicine and Surgery is, that several of the terms are employed in a careless and irregular manner; and scarcely any term has been employed with so little precision, and so loosely, as that of ANKYLOSIS. This might be of small moment, were it not, that the use of the term has a direct reference, in many instances, to the use of remedies, and to the admissibility of certain methods of treatment. It has been observed that certain forms of stiff-joint are susceptible of cure; and that other forms of it are either not susceptible of cure in any mode, or admit of improvement only in a very slight degree. The means under which the restoration has taken place in the first class of cases are multiplied, various, and not unfrequently contradictory. One or more of these remedial means and therapeutic methods, nevertheless, have been applied, with different degrees of confidence, to attempt the restoration of the second class of cases of stiff-joint, and very generally without success, sometimes with serious injury to the joint, and to the health of the individual. Cases are from time to time taking place, in which it is said Ankylosis has been cured, and the movements of the joint have been restored. The remedies and therapeutic methods, under the use of which these restorations were effected, have been applied to other instances of stiff-joint; but no improvement has taken place. These varied results depend very much, if not altogether, upon the circumstance that the remedies which were efficacious in the former class of cases, were inadequate and inapplicable in the latter. From this discordance results an important inquiry,-in what respect or respects the latter class of cases differs from the former? account for the discordance, several surgeons have recognised two forms of ANKYLOSIS, one true and permanent, the other false or

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spurious and temporary. The curable class of cases, or those

admitting of restoration, have been referred to the second head; while those not admitting in any manner or degree of such resto