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in 1854, in a paper read before the Medical Society of London,I expatiated at considerable length on the danger to patientsfrom the rash and indiscriminate use of surgical agents,-hereas elsewhere, potent for evil as well as good,-illustrating mywarning by cases drawn from my own observation. The ques-tion of use and abuse is well illustrated by the clinical lectureon the Use of the Actual Cautery in the Treatment of ChronicArticular Disease, by Mr. Syme, of Edinburgh, which appearedrather opportunely in THE LANCET of April 19th. It musthave shown Dr. Tyier Smith that he need not go back to " thedays of Ambrose Pare," even in Great Britain, to find surgeonswho believe the actual cautery, carefully and discreetly used,to be a valuable means of treatment in intractable disease.What Mr. Syme says of it with reference to articular affections,I say of it with reference to morbid uterine conditions. Usedwitk caution and discretion, it is a most invaluable addition toour means of treatment; used without discretion, it is a dan-

gerous surgical weapon, like many other surgical agencies.Finally, I have again to complain that Dr. Tyler Smith

having signalised, in his controversies with me, every possibleabuse (real or imaginary) in uterine treatment, whether arisingfrom ignorance, carelessness, or professional immorality, andhaving mingled them up together, has so expressed himself-either by design or accident I leave others to judge-that anyordinary reader would, almost of necessity, refer such abuses tome, notwithstanding that I have in my writings constantlypointed out and condemned such abuses, and that years beforeDr. Smith had written a line on uterine pathology.As regards Dr. Scott, of Ootocamund, whom Dr. Smith so very

violently attacks, I must ask the profession to suspend theirjudgment until he can be heard in defence, as he is now manythousand miles away. Several cases of uterine disease treatedby Dr. Scott in India have come under my notice, and I ambound to say that they had all been treated most skilfully,most prudently, and most efficiently, and that all did Dr.Scott very great credit. In none of them was there theslightest trace of "mutilation."

Grosvenor-street, May, 1856.

ULCERATION OF THE CERVIX UTERITREATED BY POTASSA C. CALCE.

BY T. H. SHUTE, M.D.,PHYSICIAN TO THE TORBAY INFIRMARY.

I SHOULD not have thought the following case worth report-ing, had I not read the strictures of Dr. Tyler Smith on Dr. H.Bennet’s treatment, which he designates mutilation: " I believethe application of potassa fusa to the os and cervix uteri tomean mutilation;" and also Dr. Boulton’s appeal to the profes-sion for the result of their experience. It appears clear thatDr. Tyler Smith does not understand the mode in which the Istronger caustics are properly applied; indeed he avows that hehas had no experience in their use, and as I never knew a casein which the great benefit resulting from them, and the totalabsence of "mutilation" was better exemplified, I am inducedto publish it, for the benefit of those who may be deterred fromusing them in proper cases by Dr. Tyler Smith’s dictum, thattheir application means "mutilation."

E. C--, an out-patient, aged twenty-nine, married elevenyears. Previous to marriage she enjoyed good health, anddates her illness from the birth of her only child, one year after-wards. Since that time she has been suffering from severeleucorrhcea; scanty, irregular, and painful menstruation, andat each catamenial period a flow of milk from her breasts;habitual constipation; loss of appetite; cough; palpitation, withfainting fits, lasting two or three hours; pain in the back, withgreat weakness, bearing-down, and her sight so dim as tocause a fear of its total loss. She has been under the care ofvarious medical men, but never derived any benefit from theirtreatment, and when on a visit in London went to some medicalman, whose name and residence she does not remember, whotold her at once that he saw what was the matter, but as shewas returning to Torquay, " she had better place herself undermy care, and that I should soon put her to rights."

Feb. 28th, 1855.-Ordered iodide of potassium and quassia,but no topical application, as I was willing to see what couldbe done without it.March 1st.—Ordered an injection of alum twice a day; this

was continued until the 10th, when, no benefit having resulted,she was examined with the speculum. The cervix uteri, so

much retroverted as to render it difficult to bring it within thefield of the speculum, was bathed in pus, the os largely open,the anterior lip much hypertrophied, and the posterior one,divided by a fissure into lobes, and reduced to the breadth of aquarter of an inch, had nearly its whole surface occupied by adeep ulcer with jagged edges. Nitrate of silver was applied.

14th.—She was admitted an in-patient. A stick of potassacum calce was applied during a few seconds to the ulceration,which was well washed out afterwards with acidulated water.Emollient injections, and the recumbent posture enjoined.

15th.—No pain or uneasiness from the cauterization.19th. - The eschar has separated, leaving a granulating

surface. Slightly touched with nitrate of silver.29th.-The ulcer showing no disposition to heal, an eschar

about the size of a fourpenny-piece and as thick as a shilling,was formed with potassa cum calce on the posterior and alsoon the anterior lip of the os. Great care was enjoined, andemollient injections, &c.

30th. -State satisfactory.31st.-Having, contrary to orders, been sitting up, found

her complaining of abdominal tenderness and pain in thewomb. Ordered a large poultice to the abdomen, and anenema with tincture of opium and a hip-bath every night.

April lst.---Abdominal tenderness gone. Ordered to use,once a day, an injection of zinc and alum, and cold water inthe morning, as also an enema of cold water, and to take ashower-bath three times a week.The case continued to progress favourably, the exuberant

granulations being occasionally touched with nitrate of silveror creosote; and on the 24th of April the catamenia appearedmore abundantly than she had experienced for years, withoutpain, and her countenance expressed the utmost satisfaction atthe happy change in her state at such times.May 3rd.-Discharged, cured; but advised to continue in-

jections of alum with a Clarke’s syringe.This patient presented herself the other day (about one year

since she was in the infirmary). She states that she had con-tinued well and strong, and had enjoyed such health as hadbeen unknown to her for ten years, notwithstanding two mis-carriages she had had during the last year (for ten years she

. had not conceived). Probably the tendency to abort might beprevented by the application of a few leeches.Remembering Dr. Tyler Smith’s "mutilation" myth, I exa-

mined her with the speculum, and found the cervix perfectlyf’ound and well-formed, and the os of its natural size, and pre-senting, altogether, almost the appearance of a virgin cervix.As corroborative testimony is unfortunately necessary, where

’

such strange moral obliquity of vision is attributed to us by- our opponents, I may state that the above case is confirmed in

every respect by our house-surgeon, Mr. Stabb. I will only) add, in conclusion, that I have frequently used the potassa_

cum calce, and always without producing " mutilation" ort any bad consequences.

Torquay, April, 1856.

A MirrorOF THE PRACTICE OF

MEDICINE AND SURGERYIN THE

HOSPITALS OF LONDON.

Nulla est alia pro certo noscendi via, nisi quam plurimas et morborumetdissectionum historias, tarn aliorum proprias, collectas habere et interse comparare.—MORGAGNI. De Sed, et Caus. Morb.lib. 14. Procemium.

ST. MARY’S HOSPITAL.

DOUBLE LUMBAR AND PSOAS ABSCESS, IN THE SAME PERSON;ERYSIPELAS OF THE BACK FROM THE PUNCTURE OF A

GROOVED NEEDLE; OPENING OF THE LUMBAR ABSCESS;GREAT DEBILITY, HECTIC FEVER, AND PULMONARY TUBER-CULOSIS.

(Under the care of Mr. COULSON.)COMMON as these diseases are, it is not a very usual occur-

rence that the two sides of the body are simultaneously affected,although there is of course no reason why it should not be so;a matter which is sufficiently obvious, since the labours of

pathologists, from the days of Pott, have cleared up manyobscure points connected with the origin, course, and termina-

483

tion of this almost universally fatal affection. The followingcase is interesting, as affording a very well-marked example ofthe disease, together with that condition with which it is usu-ally associated, in a greater or less degree, namely-tuberculosisof the lungs. The case is not quite perfect, inasmuch as thesequel, which cannot be far distant, has not yet taken place,or at least had not done so when the patient left the hospital.There are a few points in connexion with caries of the ver-tebrae and lumbar abscess which future observers would dowell to take up and examine, such as the relation of tuberclegenerally to tubercle of the vertebral bones, and the manner inwhich the existence of tubercle in the latter position influencesthe progress of like matter deposited in the lungs,-how far,in short, the one may be vicarious of the other. To these

questions no answer can be afforded in the present state ofmedical knowledge. It will be observed that the patient inthis case had no angular curvature, nor projection of any ofthe spines of the vertebrae, but a certain straightness of theback was a prominent peculiarity. Now it is this condition ofthe spine which is so generally found in the most fatal cases, apoint long ago observed by Boyer, and subsequently verifiedby other surgeons; whereas, on the other hand, actual curva-ture of the spine is looked upon, in comparison with thestraight position, as not so serious and much less fatal.Thomas S-, aged twenty-nine, a labourer, who has re- IIsided all his life in the country, was admitted November 9th,

1855. He is a man of above the average height, and well- ’’,made; hair dark; irides blue. He states that there is no par-ticular disease in his family. He attributes his illness, whethercorrectly or not may be a matter of opinion, to an accidentwhich happened four years ago. Whilst carrying a sack ofcoals he slipped, and in attempting to prevent the sack of coalsfrom falling he strained his back considerably. The effects ofthe strain passed off, however, after two days, and he feltnothing of it until one year afterwards. He then began to feela little pain at the left side in the loins; and whenever heattempted to stoop forwards, he became conscious of an un-pleasant sensation in the back. Together with this, there wasa little difficulty in walking any distance. This state of thingscontinued without material aggravation for two years. Hewas able to follow his occupation, but did not get about withany comfort. One year ago a swelling formed at the upperpart of the left thigh, in the groin. It was soft, and unat-tended with pain. Soon afterwards this swelling broke, anddischarged purulent matter: the opening has continued todischarge, more or less, ever since. During the course of thelast twelvemonth he has frequently suffered from pain acrossthe back, both on the right and the left side, and lie has be-come thinner than before. In March last, a swelling appearedat the left side of the spine in the lumbar region, but thistumour has not increased much in size since its first appear-ance, and the patient states that it is at times smaller than atothers.At present this latter swelling is as large as the palm of the

hand. It is situated at the left side of the upper lumbar ver-tebrae, is flat, soft, and fluctuating. Pressure over it does notproduce pain. There is no projection of any of the spinesof the vertebrae; no angular curvature, but the general outlineof the back is not quite natural, there being a certain straight-ness about it, as if the bones were not moved on each otherwith the usual facility. The patient cannot bend the body,partly owing to the pain the motion gives him, and he is notable to sit up straight in the bed. There is a small opening inthe groin, capable of admitting a large probe, from which, asbefore stated, there has been a discharge for some time. Theleft leg is a little smaller than the other, and he cannot bringthe knee up so as to make the angle formed by the leg and thebody less than a right angle. The pulse is quiet, the appetitegood, and he sleeps pretty well. Outwardly he has the appear-ance of a strong man, though there is not a superabundance offlesh on the bones. To take iodide of ’potassium and decoctionof sarsaparilla three times a day.Nov. 21st.-The patient is in much the same state as on ad-

mission. The swelling in the lumbar region is observed to besmaller at some times than at others, and this seems to dependon the freeness of discharge from the opening in the groin. Itis probable that the two abscesses communicate with the samecyst, which would account for this relation of the quantity ofdischarge to the size of the tumour in the lumbar region.24th.-The compound tincture of iodine to be painted over

the lumbar swelling every day.Dec. 15th.-Mr. Coulson introduced a grooved needle into

the abscess in the loin, and ascertained that it contained pus.The day following erysipelas set in, and spread over the back

from the prick of the needle upwards and downwards. Forthree or four days the patient took no food, and delirium wasnoticed at night.On the 22nd, Mr. Coulson opened the abscess in the back by

a moderately long incision, and as much as ten ounces of matterwas evacuated. The patient was ordered to take tincture ofbark and decoction of logwood every six hours, there beingsome diarrhœa present.Two days after, the low state to which the man had been

reduced, necessitated the administration of carbonate of am-monia and bark every four hours, with wine and nourishingfood, of which latter, however, he was able to take but little.Ten grains of Dover’s powder were ordered every night at bed.time.On the 27th, his state had become very critical. He was

lying on the back, breathing very hurriedly, and with a veryanxious countenance; the tongue was brown and dry, and thelips covered with sordes; pulse very weak and quick. To havea mutton chop and porter.

Jan. 2nd.-The man is a little improved since the last re-port. The tongue is now dry and glazed; the speech some-what indistinct. He says he is better. There is a little erysi-pelatous redness left on the right side of the back at its lowerpart. The discharge from both openings is considerable. Hehas lately become affected with a bad cough, and sweats atnight a little. Ras emaciated very considerably in the courseof the last fortnight.9th.-Cough very troublesome, sputa pneumonic, consider.

able hectic present; the expression of the countenance hascompletely altered, and the skin has a dingy unhealthy look;appetite not good; sleep very indifferent.14th.-A little better; cough and expectoration as before.

There is evidence, from the physical examination of the chest,that tuberculization is rapidly progressing in the apices of thelungs.

Feb. 14th.—For the last month matters have become dayby day gradually worse. The condition of the patient is nowsuch as to render its early termination a matter of great pro-bability. For the last few days a swelling has been slowlyforming in the right groin, and there is now present in thisposition a large fluctuating tumour, pointing just belowPoupart’s ligament. This was opened by the house-surgeon, Mr.Gascoyne, and a quantity of greenish-coloured pus came away.

19th.—His friends having expressed a strong desire that heshould be removed to his home, he was discharged, though theadvanced state of the disease and the weak condition of thepatient rendered the removal a matter of some risk, especiallyas it involved a journey of some length.

NECROSIS OF THE FEMUR, FROM A FALL AT A HEIGHT OF

TEN FEET ON THE HIP THREE YEARS BEFORE; ABSCESSES

AND FISTULÆ NEAR THE TROCHANTERS; REMOVAL OF NE-CROSED BONE; GOOD RESULTS.

(Under the care of Mr. COULSON.)We have frequently witnessed the removal of portions of

diseased bone from the shafts of most of the long bones ofpatients at different hospitals. Our " Mirror contains therecords of a number of these cases. At the present momentwe can call to mind several cases under the care of Mr. Fer-gusson, at King’s College, in which the femur was especiallyimplicated; one in particular, last year, where the shaft wasaffected at its lower third for a period of twenty years, in ayoung man, who was perfectly relieved by the removal of aportion of the shell of the bone, on two occasions, which hadbeen the source of irritation during that period of time. Suchoperations as these are the triumphs of modern surgery. Itwas only last Saturday that we saw Mr. Stanley removeseveral pieces of dead bone from the upper part of the shaft ofthe tibia of a man, whose leg we feel quite sure some years agowould have been amputated.

In the subjoined case, a portion of necrosed bone had pro-duced a long-standing disease, which incapacited the patient,who was a seaman, from earning his livelihood. It affords a

good example of the course and effects of necrosis produced bya local injury, and it is an evidence that operative measures,when judiciously employed, as was done here, are productiveof the best results, although an immediate cure was not effected,his complete restoration to health being merely a question oftime.James C-, aged twenty-seven, was admitted into St.

Mary’s Hospital, under the care of Mr. Coulson, Sept. 28th,1855. The patient was until lately a seaman in her Majesty’s

service, but for the last two years he has been unable to serve.