menstruation to its normal type, I do not mean that the type always continues normal, for in several cases where the ovarian temperament was strongly marked, I have known menstruation return to the three-weekly type on ceasing the exhibition of bark. Since making these therapeutical essays I have met with two authors who have used quinine in diseases of menstruation. Fothergill has done so when menorrhagia coincided with intermittent fever, and he observes: "It has happened that a regular intermittent has been attended by an immoderate flux. In seasons when autumnal intermittents are frequent, such circumstances will now and then happen to patients who have suffered considerable loss about the time of cessation. In such cases bark safely cures both the flux and the intermittent."

Dr. Kennedy mentions as a cure for the fortnightly menstruation, to forestal its appearance by the application of leeches a day or two before its occurrence; but I prefer my own plan, and as a means of preventing remittent menstruation, I advise,

1. The strengthening of the nervous system by the rules laid down in my work on Female Hygiene.

2. The improvement of the blood by tonics and steel.

3. The observance of a judicious regimen during the menstrual crisis.

4. The forbidding the domestic use of purgative medicines, which frequently disturb the regularity of the menstrual type.

5. In general marriage brings about the adoption of the normal type of menstruation, and parturition has often the same effect.

Thus have I passed, in rapid review, the many evidences of that species of fermentation admitted to exist at the menstrual periods, by Bayle and Etmuller, by De Graaf and Van Helmont, of the peculiar commotion of the blood which Democritus had in view when he talked of a "fervor uterinus," and I have shown that the menstrual flow, far from being a passive discharge, to be accounted for by mechanical causes, must be more than ever considered a critical termination, often preceded by mucous discharges

from the generative and intestinal canals, and determined by the complicated nervous phenomena which originate in the ganglionic nervous system. No one has hitherto attempted to follow out each of the manifestations of the ovarian nisus, in all the various phases of a healthy or a morbid action of the reproductive organs; and I hope that this careful sorting and classification of the effects of these organs on the system, and the philosophical deductions to which they have naturally led, may somewhat help to raise the standard of obstetric literature to a level of that of many other branches of medical science, and also contribute to the elucidation of many obscure forms of disease, for without this accurate study of menstruation it would have been useless to have attempted the investigation of uterine and ovarian inflammation.

PART II.

ON INFLAMMATION OF THE WOMB.

CHAPTER XV.

ON INFLAMMATION OF THE NECK OF THE WOMB.

"If ulceration of the womb occur after miscarriage, or from any other cause, all the circumstances of the patient's constitution should be taken into consideration, so as to determine whether it be right to influence the whole system, or only the womb itself."-HIPPOCRATES, On Diseases of Women.

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Abernethy's work, On the Constitutional Origin of Local Diseases, sheds a new light upon numerous diseases previously ill understood, but I cannot persuade myself that it did not, at the same time, have the effect of dividing attention too much from the opposite of his position, from the consequences of insidious local irritation upon the general constitution. Proceeding with little short of enthusiasm upon the newly-established principle, men began to discover a purely constitutional origin for all local disorders; they forgot, or at least slighted, the secondary effects produced on the system by the continuance of local irritation, and regulated their practice accordingly."-ADDISON, On the Disorders of Females connected with Uterine Irritation.

THESE quotations from the father of medicine, and from the lamented pathologist of Guy's Hospital, will show the spirit in which I wish to conduct this inquiry into the pathology of the womb; and it would be unintentionally, should I diverge from the precepts inculcated by these illustrious

men.

It was doubtless an error to deduce all pathology from inflammation; but in practice, inflammation is the main pathological condition ever present to the medical mind, as a reality to contend with, or an eventuality to guard against. Having to treat a case, we almost instinctively ask ourselves, Is the disease inflammatory or not? Is inflammation the sole element, or merely a complicating circumstance of the morbid problem? If inflammation, of what kind and type, and at what stage of its career? We do this because we know the

frequency of inflammation; that if acute, it may speedily prove fatal, or undermine the constitution; while if chronic, we are better able to check its progress than that of many other morbid conditions. This applies altogether to the pathology of the ovario-uterine organs. In non-parturient women, acute inflammation seldom terminates fatally, though chronic very frequently renders life a burden, by the numerous morbid states which it often developes-such as diseases of menstruation, ulceration, and other morbid conditions of the uterine mucous membrane, hypertrophy, and displacements of the womb, various forms of neuralgia, and sterility.

I assume it granted that most of the diseased conditions of organs lined by mucous membranes, originate in the inflammation of these mucous surfaces, which remove from the system what would be prejudicial to its welfare, and are also susceptible of being more or less injured by external influences. I therefore believe that any further unravelling of the secrets of uterine pathology must be sought in the study of the diseased conditions of the mucous membranes lining the womb. I also admit that the body and the neck of the womb have each its pathology, although the inflammation of one part, is much oftener communicated to the other, than is usually supposed.

INFLAMMATION OF THE NECK OF THE WOMB.

Brought up in the same illustrious school of medicine as my friend Dr. H. Bennet, and professing the same views, it would be useless for me to treat ex-professo of diseases of the neck of the womb, as I should have to put in other words much of what he has written on the subject in his fourth edition; so after briefly studying inflammation of the lining membrane of the neck of the womb, I shall only touch on certain points on which I differ from him, or have something to add to his statements. I will conclude these preliminary remarks by expressing my dissent from Dr. H. Bennet's statement, that the neck of the womb, in the natural state, may be called a highly vitalized organ, for one might as well say that tendons are highly vitalized on account of the pain caused by their being overstrained. This statement is in opposition with that of former observers and with those of

the present time. De Graaf says "that the neck of the womb is harder and whiter than its body;" Roederer, "that the neck of the womb is hard and white, while its body is grey, and of a softer texture." I agree with these accurate observers, with Lisfranc, Dr. Forget, &c., believing that the neck of the womb is far from being composed of highly vitalized tissues, for when the whole organ is successfully injected, the body of the womb is found pink with the colour injected, while a section of the neck shows, by its remaining white, with how few vessels it is. injected in the ordinary state; but this lowly vitalized structure is covered over by an erectile tissue, the continuation of that which lines the vagina. The impunity with which the neck of the womb bears surgical interference, sufficiently shows that it is not a highly vitalized organ; another proof will be found in some experiments of Dr. Duchesne, who has made many interesting applications of electricity to physiology and therapeutics. Dr. Duchesne's electrical apparatus is equal in power to 100 piles of Bunsen; and on directing the amount of electricity thus generated to the neck of the unimpregnated womb, no feeling was determined and no pain. There was a similar absence of sensation when the electrical current was directed to the bladder, but its contractibility was excited. Such is the structure and sensibility of the womb at intermenstrual periods; and the increase of size, and the softened texture of the body and neck of the womb, occurring at menstruation, are to be attributed to their becoming congested, owing to the healthy stimulus they receive from the ovary.

CERVICAL CATARRH.

Inflammation of the lining membrane of the neck of the womb is the most frequent uterine disease. It is often cured by nature, though often interminable, as inflammation is known to be when it takes possession of a mucous membrane. From this parent stock come the different kinds of ulceration which appear around the os uteri; for generally it is a misnomer to talk of ulceration dipping into the neck of the womb, and it would be more correct to speak of it as cropping out of the cervical canal. The slight ulcerations which are often found round the os uteri, are, in themselves,