flammation. Cup the sacral region-or apply leeches to the groins once a week-use the hip-bath night and morningthrow warm water up the vagina-give opium or other narcotics to diminish sensibility, while purgatives are to be employed to prevent constipation, and lessen inflammatory action. If the uterus attain the size of the fourth month of pregnancy, it may be presumed that the disease is not carcinoma~no tumour of this kind having ever attained such a size in our author's experience. The rapidity of purulent enlargement of the uterus, comparatively with that of fleshy tubercle, will throw some light on the diagnosis; and if there be reason to suppose the enlargement depends on purulent accumulation, "it may be advisable, gently to introduce the extremity of a bougie, or of a male catheter, into the os uteri, and to pass it onwards, until it has reached the cavity of the uterus.'

"

II. Vaginal Inflammation. The symptoms attending common and specific inflammation of the vaginal membrane are nearly the same, and are pretty well known. Attempts indeed, have been made to distinguish between the purulent discharge of gonorrhoea and of common inflammation; but such pretensions are generally professed for self-interested purposes. The lymphatic glands of the groin, Mr. Clarke thinks, are more disposed to enlarge and suppurate in gonorrhoeal, than common inflammation.

"In simple inflammation of the mucous membrane of the vagina, the purulent discharge being established in large quantity, the inflammatory symptoms frequently subside very rapidly, after which a termination is put to the secretion; the parts returning to a state of health, provided there be no acting cause producing its continuance; in which case the symptoms will continue until its removal, when they will speedily cease.

"In the case arising from specific contagion, the duration of the disease is greater; and the discharge, once established, continues for weeks, or perhaps for months, although not always accompanied by the other local symptoms." 169.

Mr. C. justly remarks that, it is impossible to determine at what period of the disease, the power of communicating infection ceases. A prudent practitioner will be careful to give no decisive opinion on the subject, especially as regards the non-existence of this power-for, as Mr. Clarke properly observes, "no person is secure from danger, who indulges in intercourse with a woman so long as the discharge continues."

"It is a curious fact, that in young subjects, both male and female, purulent discharge from the urethra and from the vagina takes place in consequence of the existence of irritation in distant parts;

thus, during dentition, whilst the capsule of the tooth, or the gum covering it, is violently pressed upon by the crown of the tooth, the above circumstance is not unusual; medical men, therefore, should be careful to avoid denominating this symptom venereal; since, were it actually so, it would lead to nothing useful in the treatment; and discussions, highly destructive of the peace of families, might be thereby introduced." 170.

Mr. Clarke leaves, of course, the consideration of gonorrhoeal inflammation to those writers who have made it the subject of distinct monographs; but, he gives it as his opinion, en passant, that the treatment of venereal gonorrhoea, differs little, if at all, from that which is applicable to common inflammation. As far as temperance, rest, and antiphlogistic measures are concerned, this may be true; but, would bals. copaiba and cubebs be applicable to common inflammation of the lining membrane of the urethra?- We should not like to try the experiment.

When the inflammatory symptoms have subsided, and a purulent discharge continues from relaxation or mal-habit. of secretion, then our author recommends the cinchona, and copaiva; with astringent injections. Respecting the possi bility of secondary symptoms following gonorrhoea, our author seems undecided— at least, he declines to offer an opinion upon the subject.

"He has certainly seen copper-coloured spots on the bodies of patients, who have laboured under gonorrhoea virulentą, removable only by the oxymuriate of mercury and sarsaparilla: but he thinks that he has seen similar appearances upon the skin of patients, whose chastity could not be suspected." 173.

Mr. Clarke has known several instances of married women, who had laboured under a purulent discharge, (possibly the effect of contagion,) bringing forth children prematurely, some dead, and others having dark-coloured furfuraceous cuticle in different parts of the body, which yielded only to mild preparations of mercury.

Modern experience has put the matter quite beyond a doubt, that secondary symptoms will occasionally follow gonorrhoea; but the chances are so much against the accident, that we should never dream of giving mercury as a preventive. Indeed, we are disposed to believe that, were mercury given as a preventive, there would be more secondary symptoms than if omitted, in consequence of imprudence in diet, and exposure to wet or cold, which, it is well known, are very injurious where mercury is in administration.

Abscesses sometimes occur in the cellular membrane surrounding the vagina, and do not admit of the same modes of cure, that are applicable to other purulent discharges. Such

cases, however, are very rare. At the commencement of the complaint, there is nothing to discriminate it. Inflammatory symptoms are followed by a discharge of matter, and the patient supposes herself well. But after some time, a sense of fulness and pressure is experienced, and pus again escapes. On examination, a soft tumour will be found behind the vagina, which, being pressed, discharges pus. A continuance of this state impairs the health, and the neighbouring parts become more than usually irritable. Indeed, it has only occurred in women of lax fibre and irritable constitution. In cases of this kind, the abscess generally breaks into the vagina high up, which aggravates the inconvenience, the abscess being seldom emptied of its contents, which become, from retention, highly offensive. These cases are very unmanageable. No astringents can restrain the discharge-no stimulants can reach the cavity of the abscess-and it is hazardous to attempt an operation, unless the most depending part of the abscess should be situated so low, as to be capable of being brought within sight of the surgeon. Mr. Clarke relates three cases. In two of them, there was a cure effected by remedies adapted to improve the general health. In the third, he failed to remove the diseases.

III. Ulceration of the Os and Cervix Uteri. Our author has long been in the habit of describing two different kinds of ulceration of the uterus-the one denominated the " corroding," the other, the "carcinomatous" ulcer of the os uteri. They are both malign.

Corroding Ulcer. This disease usually takes place about the cessation of the catamenia. About this period, the uterus naturally attains a larger size than ordinary, and is not reduced to its usual volume, until the balance of the constitution is restored.

Inflammation attacking a part of firm texture, as the os uteri, an extravasation of coagulable lymph is more frequently formed than abscess, occasioning a thickening of the part. Sometimes this proceeds to ulceration-sometimes the inflammation recedes, leaving only an induration of the part.

"In the corroding ulcer of the os uteri, the membrane which covers it first takes on disease, and very shortly afterwards the ulcer extends to the whole circumference of the opening, and to the parts immediately beneath it; so that the natural shape of the os uteri is destroyed. Thence the ulceration proceeds to the cervix, and consumes it; so that, if the patient should die in this stage of the disease, nothing will be found, after death, but the body and the fundus of the uterus. Sometimes the disease does not stop here, but, before the patient is destroyed, the absorbents employed in the process of Vol. III. No. 9.

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ulceration will have taken up nearly the whole body of the uterus, so that very little more than the fundus will remain." 188.

This does not happen in the carcinomatous ulcer, by which the patient is worn down before there is time for such a degree of absorption to take place. "If an examination be made, per vaginam, the breach of surface may be readily distinguished, and the extent of the discase ascertained; but no hardness of the parts will be present, no thickening, no deposit of new matter." The appearances, post mortem, will correspond. From our excellent author's symptomatology, we shall make the following extract.

"The menstruous secretion, it has been already said, has ceased; in its stead a yellowish discharge escapes, perhaps trifling in quantity, and now and then mixed with a streak of blood; by degrees the sense of warmth is converted into a glowing heat, affecting the region of the uterus; and it is by no means uncommon with patients to state, that they feel as if a hot coal was within them.'

"As this sensation of heat increases, so the quantity of the discharge increases, the ulceration extending more rapidly.

"The perpetual drain necessarily diminishes the quantity of cireulating blood; in consequence of which the countenance becomes pallid, and weakness of the whole system is produced." 191.

Had the disease been carcinomatous ulceration, lancinating pain would have been the most prominent feature of the complaint. But this distressing symptom is comparatively absent in the ulceration under discussion.

"When a finger, introduced into the vagina, is made to pass over the ulceration, the patient does not complain of pain; she does not suddenly shrink from pressure, as when carcinomatous ulceration is present: but if asked what sensation she experiences, she will commonly reply, that she has a sense of soreness."

192.

Still the disease in question is as uniformly fatal as carcinoma uteri; but it will last during a much longer time, unless the fatal termination is hastened by hæmorrhage.

Treatment. Although the uterus performs no office in the constitution when menstruation has ceased, yet it is liable to morbid changes, that too often involve the constitution in destruction. Ulceration having once commenced in the uterus, this organ never, in our author's experience, recovers its healthy structure; "but increased action of the blood-vessels of the os uteri, which would eventually terminate in ulceration, may probably be diminished or controlled, so that no ulceration may take place, and, by such a mode of treatment, much advantage may be gained."

"Whenever, therefore, a patient in whom the menstruous secretion has recently ceased, complains of an increase of heat in the

lower part of the back, or of the abdomen, or in the parts of generation themselves, a 'prudent practitioner, foreseeing the probable result, will direct the loss of some blood from the neighbouring parts. The most precise mode of obtaining this blood will be by cupping; although, if the patient be averse to the operation, leeches may be applied; but, upon the whole, they do not afford the same certain and immediate relief, neither can the quantity of blood removed by them be so exactly estimated." 194.

The operation should be repeated at the termination of a fortnight or three weeks, and if the sense of heat should continue, a still further loss should be directed-since temporary weakness is the only disadvantage which can accrue. General bleedings are not proper of course. The warm hip-bath twice a day is highly serviceable, and some of the warm water may be thrown up the vagina-both processes are equally beneficial in the indurated and ulcerated stages of the complaint.

"Saline purgatives, exhibited in very small doses, possess not only the power of allaying inflammation, by the watery secretions which they produce from the intestines, but they appear also to possess a specific power of tranquillizing the system, when in a state of disturbance and increased action, even when they produce very little sensible effect." 196.

Small doses of the sulphas magnesia vel potassæ may be exhibited twice a day, in combination with moderate doses of conium or hyoscyamus. Mr. Clarke does not object to the use of sarsaparilla or other alterative, provided such medicines do not derange the functions of the stomach, or impair the powers of the constitution. An abstemious diet should be enjoined, as fish, puddings, boiled fruits, and vegetables; and all excitants religiously avoided.

Even in the second stage, when ulceration is proceeding, and the patient is already weakened by the purulent discharge, what supports that ulceration but the inflammatory process? What remedies are likely to be more serviceable than those which retard it? It at length, however, happens that the patient becomes so debilitated by the purulent secretion that she is in danger of sinking from its effects. Mild astringent injections must then be thrown up into the vagina. Hæmorrhage may arise, and then still stronger applications are necessary, as alum in decoct. querci vel granati. If this should fail, solutions of sulphate of copper, or even nitrate of silver must be employed. The horizontal position-and small doses of the acidum sulphuricum in a mixture containing equal parts of decoct. cinchona and infus. rosa, will be found proper auxiliaries.