iii!ii*'iii|
HUftf!|ji[[(t!iiM!l!iji!|ij!ijili;nmm
|iiiii|ii(i!iiii||ii|l|||iffl
iHiii(iU[iti[titt|imi!ii.fpiii!|i!ii|nii[i^
^?r
THE LIBRARY
OF
THE UNIVERSITY
OF CALIFORNIA
PRESENTED BY
PROF. CHARLES A. KOFOID AND
MRS. PRUDENCE W. KOFOID
ULCERATION OF THE OS UTERI.
AN INQUIEY
INTO THE
PATHOLOGICAL IMPORTANCE
ULCERATION OF THE OS UTERI.
BEING
THE CROONIAN LECTURES
FOR THE YEAR 1854,
BY
CHARLES WEST, M.D.,
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS; PHYSICIAN-ACCOUCHErR TO
ST. BARTHOLOMEW'S HOSPITAL; PHYSICIAN TO THE HOSPITAL
FOR SICK children; AUTHOR OF "LECTURES
ON THE DISEASES OF INFANCY AND
CHILDHOOD," &C. &C.
PHILADELPHIA:
BLAN CHARD AND LEA
1854.
T. K.
PHILADELPHIA:
AND P. G, COLLINS, PRINTER
CONTENTS.
LECTURE I.
Knowledge of diseases of women imperfect, and its progress slow
Employment of speculum, and disputes as to its value
Peculiarities of uterus in health and disease
Ulcerations of os uteri described; their alleged Importance
Doubts suggested; and plan of inquiry proposed
I. Evidence of physiology . . .
II. Evidence of morbid anatomy . . • .
PAGB
11
21
22
26
29
31
32
LECTURE II.
Inquiry continued. III. Results of ulceration of procident uterus 41
ly. Results of clinical observation , . 45
Influence of ulceration on fecundity 49
Comparison of symptoms in absence of, or in connection
with ulceration 51
Conclusions from inquiry 60l
LECTURE III.
Inquiry into causes of uterine ailments
Constitutional causes frequent and various .
Local causes ; sequelae of abortion and labor
Other causes productive of hypertrophy
6a
64-
68
10
M354G59
Vlll
CONTENTS.
Results of inflammation of uterus; and their independence of
ulceration
Importance of affections of uterine cavity underrated — ^those of
cervix over-estimated
Symptoms of ulceration, and of ailments akin to it
Local treatment of ulceration ....
Objections to indiscriminate local treatment
Conclusion
71
75
78
81
85
88
AN INQUIKY
INTO THE
PATHOLOGICAL IMPORTANCE
OP
ULCERATION OF THE OS UTERI
LECTURE I.
Introduction — Imperfection of our knowledge concerning the Diseases of "Women;
reasons for it. State of opinion at time of first employment of speculum ; facts
which use of that instrument brought to light ; different estimates of its value.
Important principles involved in the disputes on this subject — Proposed inquiry into
them in these Lectures.
Preliminary remarks on some peculiarities of the uterus in health and in disease —
Supposed cause of most uterine ailments — Alleged importance of ulceration of
the OS uteri — Description of those ulcerations — How they are supposed to react
on the uterus ; suggestions for their cure.
Doubt as to correctness of these opinions — Plan of proposed inquiry into them —
I. Conclusions from anatomy and physiology unfavourable to them. II. Results
of examinations after death hitherto unsatisfactory, and why — Observations of
lecturer; inferences from them opposed to idea of great importance of ulceration
of OS uteri.
Mr. President —
Sir : I enter on the honourable task which you have assigned
to me, with much apprehension and misgiving. It is not merely
that I appear in the teacher's garb before those from whom I have
learned much, and might still be well content to learn all my life
long — nor that I address an audience whose criticism I dread and
whose unfavourable censure I would deprecate — which fills me with
anxiety ; but it is, that I am here to-day in some sort as the repre-
sentative of those who follow a department of medical practice
which, till but recently, this College scarcely countenanced — to
whom it has but lately extended honourable distinctions — on whom
2
18 IMPERFECTION OF KNOWLEDGE
it has now for the first time imposed a still more honourable duty.
While I rejoice, Sir, in the full recognition by this College, of the
fact that all departments of our profession, by which suffering can
be assuaged, disease arrested, or life prolonged, are alike honour-
able — that none are alien from the paths of scientific inquiry, nor
unfriendly to that culture of the mind which confers distinction
more precious far than any worldly honours — I dread lest anything
that comes from me should seem unworthy of this body, undeserving
of that liberality of sentiment and enlargement of view to which
I owe it that I have now the opportunity of addressing you.
Never, Sir, have I wished so much as I do now for that insight
into Nature's ways, which might enable me- to justify your appoint-
ment of me as Croonian Lecturer for this year, by bringing before
this assembly some new truth, or by throwing fresh light on some
great principle but dimly seen, or partially understood before ; or
at least for those rare gifts of speech which can impart interest and
freshness even to subjects trite and commonplace. But, while to
such endowments I have no pretensions, my need of your indulgence
is all the greater, since I have had most to do with small complaints
and e very-day diseases ; and if from them I select a subject for
these Lectures, though obscure, it still must seem familiar, and,
with all the disadvantages of novelty, yet have none of its charms.
Frequent as is the occurrence, it must nevertheless be confessed
that the Diseases of Women are those concerning which our know-
ledge is most defective. And yet there seems, at first sight, to be
but little reason for these deficiencies ; so little, indeed, that their
existence has been made a constant ground of reproach against
those who, having to do with ailments so simple as they are assumed
to be, yet have left so much concerning them uncertain or unex-
plored. I believe, however, that many of the doubts and uncertain-
ties which beset these subjects depend on the difiiculties in the way
of arriving at truth concerning them, far more than on any want
either of diligence or of honest purpose, on the part of those whose
special duty it was to engage in their investigation.
If, now, for a few minutes I occupy your time in the endeavour
to point out whence those difficulties have arisen which did, and do
still, retard the advancement of knowledge concerning uterine dis-
ease, you must bear with me, since my object is not only to account
for the apparent omissions of obstetric practitioners in general, but
also, by showing the uncertainty of much that we seem to know,
CONCERNINa DISEASES OF WOMEN. 19
to excuse myself for the choice which I have made of a subject for
these Lectures.
In wonder, says the ancient writer, all philosophy begins, in
wonder it ends ; but wide, indeed, is the distance which separates
the marvelling of the ignorant from the admiration of the learned.
Processes such as those by which the perpetuation of the species is
accomplished, could not but excite in every stage, the wonder of all
people, in all times. The principle of life, symbolized under various
forms, was in the earliest ages the object of reverence, or of actual
worship, while the happy issue of the mysterious process of parturi-
tion was sought to be secured by rites and ceremonies, and charms,
propitiating the various deities who superintended it. If these
failed of their looked-for result, or if some untoward event hap-
pened, passing the skill of the attendant women, the aid of the
surgeon was sent for, though only to perform some barbarous
operation. In the diseases of their own sex, it was natural that
women should be first consulted ; and the instances were compara-
tively few in which application was made for the assistance of any
physician : hence it resulted, from sheer w^ant of opportunity, that
the anatomical and physiological discoveries which were made,
though slowly and imperfectly, remained long unapplied ; that for
ages, all knowledge of the pathology of the female sex continued
fragmentary, and all treatment of their diseases empirical.
Nor was this state of things as much amended as might have
been expected by the general advancement of knowledge in compa-
ratively modern times. Anatomists devoted themselves to the task
of exploring the mysteries of generation, but passed by without
inquiry the scarcely less mysterious process of parturition, and the
changes which succeed to it ; while, by their unquestioning adop-
tion of many errors which time had rendered venerable, they lent to
them a fresh sanction, and gave them, as it were, the stamp of
truth. In subjects thought to be beneath the dignity of science,
advances must needs be slow ; and the whole history of the obstet-
ric art is a most appropriate commentary on this fact. By slow
degrees, indeed, and by steps which we cannot now stop to trace,
improvement came, though amended practice in this, as in so many
other instances, preceded correct theory ; and even now we not
infrequently do what experience has taught us to be right, although
we are unable to assign a thoroughly satisfactory reason for our
proceeding.
\
20 IMPERFECT KNOWLEDGE OF DISEASES OF WOMEN.
But if our knowledge be still incomplete concerning a process like
that of parturition, which is transf^cted in a few hours, and is con-
stantly offering itself to our observation, there is little cause for
surprise that it should be still more imperfect with reference to the
physiology and pathology of the generative system in the unimpreg-
nated state. So recently, indeed, as thirty years ago, neither was
the structure nor were the functions of the sexual organs at all cor-
rectly understood. The uterus, it is true, was known to be muscu-
lar ; but neither the process by which its muscularity becomes so
marked during pregnancy, while it ceases to be clearly apparent
soon after delivery, nor the intimate nature of its structure in the
virgin state, had been the subject of inquiry. The interior of its
neck was seen to be invested by a membrane arranged in folds,
between which minute glands or follicles were present in great
abundance ; but the existence of a distinct lining membrane in its
cavity was rather inferred from the results of observation in some
forms of disease, than demonstrated by anatomical investigation in
a state of health. Though the structure of the ovaries was in the
- main understood, yet the ovarian ovule had not been discovered,
■ and the function of the ovaries was supposed to be called into exer-
cise only during the stimulus of sexual congress. Hence it resulted
that the import of menstruation continued to be a riddle unread ;
all that was certainly known about it being that it was a function
which bore an important, though undefined relation, to the genera-
tive process.
To have written, under such disadvantages, a work on the Dis-
eases of Women — so full of sound observation — so abounding in
practical instruction of the highest kind — that, like Pemberton's
Treatise on the Abdominal Viscera, it has not only not been ren-
dered obsolete by the lapse of time, but that it still remains, after
forty years, our safest guide in the management of these diseases,
is certainly not the least among the many honours which its author
has won, and wears so well. But, in trying to judge fairly of the
labours of our more immediate predecessors, or to estimate what
remains for us to do, we must not forget that where the knowledge
of healthy structure and of natural function is defective, the know-
ledge of diseased structure and of perverted function must be imper-
fect too.
Very few facts will suffice to illustrate the defective pathology
of but a few years ago. It was assumed that an organ of such
EMPLOYMENT OF SPECULUM. 21
dense structure as the unimpregnated uterus must be little liable
to inflammation, and its kindred processes ; though in some rare
cases the neck of the womb was allowed to be their seat. Its lining
membrane, supposed to be so rudimentary in the unimpregnated
state, was not thought worth consideration among the possible seats
of disease ; and leucorrhoeal discharges, supposed to be always
furnished by the vagina, were usually regarded as the consequence
and the index of constitutional debility. The different morbid
growths were not properly discriminated; scirrhus, a disease of
extreme rarity, was assumed to be of very frequent occurrence ;
and to it were attributed almost all chronic affections of the neck of
the womb, attended with induration of its substance and increase of
its size.
In this state of knowledge, when observation must have been
perpetually clashing with preconceived opinions, M. Recamier first
thought of employing an instrument — the Speculum — for the more
convenient application of local remedies to cancerous ulcerations of
the womb. Its use, however, was not long confined to this object ;
for practitioners found that by means of it they were enabled to
discover yarious morbid conditions of the uterus, with which they
were hitherto unacquainted, and to which it w^as but natural to
attach importance, as the probable cause of many previously inex-
plicable symptoms. In fact, by its means one important question
was speedily and decisively set at rest — for leucorrhoeal discharges
were ascertained to be derived in great measure, not from the
vagina, but from the uterus ; to be associated with various diseased
appearances of its orifice, and to be, sometimes at least, removed by
different remedies directed to that part and to the neck of the
womb. So long as the lining membrane of the uterine cavity was
supposed to exist in the unimpregnated state merely in a rudiment-
ary condition, it was most natural that an exaggerated importance
should be attached to the various morbid appearances of the os
and cervix uteri ; and so long as the ovaries were believed to be
called into activity only at the time of sexual congress, it was to be
expected that their share in the production of diseased phenomena
should be rated very low. Ignorance, with reference to these two
points, was shared alike by the advocates of the employment of the
speculum, and by the opponents of its use ; and under these circum-
stances their controversies were not likely to lead to any satisfac-
tory result.
2Sf PECULIARITIES OF THE UTERUS
We need not, indeed, wonder that the disputants on both sides,
thus imperfectly furnished for the debate, should have narrowed
the question to one of details touching the expediency of employing
an instrument which some pronounced to be all important, while
others decried it as useless, mischievous, and even immoral. It
must be obvious, however, to us who enjoy the advantage of the
additions to physiological knowledge which the past quarter of a
century has brought with it, that our decision on this subject in-
volves much more than the mere acceptance or rejection of a certain
therapeutical proceeding, but that it really concerns the opinions
which we entertain with reference to the main principles of uterine
pathology. Regarded in this light, what might at first have seemed
a trivial inquiry, at once assumes a greater importance, and be-
comes, I think, not unworthy the attention even of such an audience
as the present.
It is not without reluctance that once again I venture to delay
you with some further preliminary considerations touching the
structure and the functions of the womb ; though my doing so
might perhaps be justified on the plea of the desirableness that we
should, before entering on an examination of conflicting opinions,
ascertain what facts are accepted as true on either side. But there
is another reason for this course, in the circumstance that the womb
presents peculiarities of situation, structure, and function, such as
render it probable that the diseases of the organ may likewise ex-
hibit distinctive features, and possible that their cure may call for
modes of treatment which otherwise would not be expedient, nor even
justifiable.
Now, it would not be easy to imagine a state of things more
favourable to the occurrence of ailments dependent on venous con-
gestion, or in which those ailments would be more difficult to remove,
or more apt to return, than is observed in the case of the uterus
during the whole period of activity of the generative powers. The
return of blood from the organ, which is rendered difficult by its
situation at the lowest part of the trunk, is still further impeded by
the absence of valves from its veins ; while every month, for several
days together, this organ and its appendages are the parts towards
which blood flows in superabundant streams. During this period,
the natural secretion from the uterus and Fallopian tubes is much
increased; the epithelium covering their surface is detached, and
reproduced again and again; hemorrhage breaks forth along the
IN HEALTH AND IN DISEASE. 28
■whole tract — and it is not until this has continued for some days,
that the congestion ceases and the parts subside once more into
their former state of quiescence — the uterus remaining, however,
for a short time heavier, and its tissue looser, and more abundantly
supplied with blood, than it was before. I need not stop to tell
how a slight cause may protract this hemorrhage, or how some
accident may check it ; nor need I labour hard to prove that in
either case there must be a general disturbance of the function of
the organ — a general impairment of the health of the individual :
exhausted in the one instance by loss of blood, broken down in the
other by the suffering, both general and local, which the return of
the periodical excitement of the generative organs, unrelieved by
their customary depletion, cannot fail to bring with it. In what
organ of the body does one find a parallel to this series of occur-
rences ?
Again ; the uterus is held in its position by supports which allow
to it a large measure of mobility, and whose power is generally
diminished by the very causes that increase the weight of the body
they have to bear. Hence, it is very apt to become displaced, and
to be displaced in a downward direction, or prolapsed. And such
prolapsus not only brings with it a variety of painful sensations,
due to the womb dragging upon its ligaments, but the moment the
organ ceases to be suspended in the pelvic cavity, it becomes ex-
posed to shocks of various kinds, to irritation from sources from
which it was previously safe. The neck of the womb, even when
that descent is not very considerable, becomes a sort of stem on
which the organ rests upon the floor of the vagina. In this position
it is liable to disturbing causes almost numberless — sitting, riding,
exertion of any kind, the very passage of the feces along the
rectum, produce pain, keep up congestion, and favour that slow
increase of size which seldom fails to occur in parts the seat of long-
continued irritation, and which offers one great impediment to the
cure of many affections of the womb.
Another peculiar and fertile source of disorders of the womb is
furnished by the changes that attend upon conception and parturi-
tion, and their frequent interruption. With these changes, even in
the healthy state, our acquaintance is at present too imperfect for
us to appreciate with accuracy the nature of the mischief which
may result from their disturbance. We know, indeed, many things
concerning these processes of which our predecessors were ignorant ;
24 PECULIARITIES OP THE UTERUS
but our increased knowledge is as yet sufficient to show us the dif-
ficulties of the problem, not sufficient to furnish its solution. The
growth of the pregnant womb is not, as it was once supposed to be,
a mere increase in size and unfolding of texture of the muscular
fibres already present there, but is as much the result of a new
formation as is that of the foetus contained within it ; its tissues
going through the same development from a rudimentary condition
to a high organization. Cells elongate into caudate bodies ; these
unite into fibrillae, while the mucous membrane increases in vascu-
larity, grows in thickness, and becomes developed into decidua.
The small, dense, lowly organized uterus becomes the large, vascu-
lar, powerful muscle which we see it to be at the end of pregnancy ;
when having served as the residence of the foetus, and as the
medium through which it derived its support, the organ accom-
plishes in the act of parturition the last of that wonderful series of
processes to which it owed in old time its appellation Miraculum
Naturae. But even before this period has arrived, indications of
decay have manifested themselves in the changes that have taken
place in the decidua ; while no sooner is the child born, than all the
tissues of the womb evince the commencement of similar alterations,
which go on with a rapidity such as is observed in no other body
and under no other circumstances. The muscular fibres undergo
fatty degeneration, and to a great extent disappear ; nerve-matter
ceases to be apparent within the sheaths which had contained it,
while even the fibres of elastic tissue interwoven with the muscular
substance of the womb, lose their distinctness or become entirely
absorbed. The old uterus has done its work and is removed ; but
in the midst of its decaying fibres the elements of a new organ are
developed, and the microscopist tells us of a new generation of
spindle-shaped cells, which he can discover in its tissue, just like
those which existed in the organ before pregnancy began, and
which remain stationary at the same low stage of formation, till in
their turn excited by impregnation to go through higher phases of
development.
In these changes, the body of the uterus, and the lining of its
cavity, bear a far greater part than either the substance of its
cervix or the mucous membrane which lines that canal. The
mucous membrane of the body only is developed to the decidua,
and it alone is thrown ofi" after delivery ; the lining membrane of
the neck undergoes much slighter alterations, and is not deciduous.
IN HEALTH AND IN DISEASE. 25
It is in the body of the uterus that its muscularity is most evident ;
firm fibro-cellular tissue predominates in the cervix, with which are
interwoven here and there bundles of narrow, smooth, muscular
fibres ; and the stimulus of pregnancy, which works such changes
in the former situation, brings to pass far slighter alterations in the
latter.
At present, we are too imperfectly acquainted with the nature of
those changes which I have thus briefly sketched, to be able to say
exactly what influence is produced by accidents which interrupt the
course of pregnancy and originate the processes of degradation of
the uterine tissue prematurely ; or what results follow from disease
succeeding to delivery at the full period. We may confidently hope
in time to know more ; at present, we have learned from every-day
experience that such occurrences interrupt the ready return of the
womb to the size and condition which are natural to it in the unim-
pregnated state ; that the organ is apt to remain permanently
increased in size ; that this enlargement is often especially marked
in the more lowly organized cervix; that under such circumstances
the menstrual function is usually in some respect or other ill per-
formed, while secretions are likely to be furnished from the organ
differing in quantity or quality from those which proceed from it in
a state of health ; that the performance of all the sexual functions
is very apt to be attended by pain, that impregnation is less likely
to occur, and that, if pregnancy should take place, there is very
great probability of its coming to a premature termination.
This set of symptoms, however, or at least many of them, are
met with independent of pregnancy and its consequences ; superven-
ing sometimes, indeed, under the influence of causes which evidently,
and in a marked manner, interfere with the generative functions,
but coming on at other times slowly, and, as far as we can discover,
without cause. How are they to be explained ? Do they proceed
from an invariable pathological occurrence, which is present in
every case, how wide soever may be in other respects the points of
difi'erence between them — or are they the indications of disordered
function, which may depend on causes as various as those which
produce vomiting or occasion dyspnoea ? The inquiry is manifestly
an important one ; its elucidation will be the object of these Lec-
tures. It has been said that there is an invariable, or almost
invariable, cause of these symptoms — that, be the remote occasion
of them what it may, inflammation and ulceration of the neck of the
lib ALLEGED IMPORTANCE OF ULCERATION.
womb is their immediate cause — that the key to the right under-
standing of uterine diseases is to be found in the correct appreciation
of the importance of this condition ; and the cardinal point in their
treatment consists in the adoption of means for its cure.
The ulcerations to which such important results are attributed,
are for the most part mere superficial abrasions of the epithelium
investing the lips of the os uteri, whose abraded surface is of a
vivid red colour, and finely granular. In other cases, in which the
absence of epithelium is less complete, the surface seems beset by a
large number of minute, superficial, aphthous ulcerations, between
which the tissue appears healthy, or slightly redder than natural.
The ulcerations of the os uteri seldom or never present an exca-
vated appearance with raised edges, as ulcers of other parts often
do ; but either their surface is smooth or it projects a little beyond
the level of the adjacent tissue. They are usually, but not con-
stantly, of greater extent on the posterior than on the anterior lip,
are sometimes confined to the former, but very rarely indeed limited
to the latter. They appear to commence at the inner margin of the
OS uteri, whence they extend outwards, and sometimes, though by
no means invariably, the short extent of the canal of the cervix
uteri which can be brought into view by the speculum, appears
denuded of its epithelium. The adjacent parts of the os uteri vary
considerably in their appearance ; sometimes their natural pale rose
tint is preserved up to the edge of the abrasion, which is marked by
a distinct, well-defined line, while at other times the whole surface
is of a much more vivid red than natural, and the line of demarca-
tion between the abraded and the healthy surface is irregular and
indistinct, the one encroaching on the other. The orifice of the
uterus is generally more open than in a state of health ; and the
disappearance of the abrasion, which always takes place from the
periphery towards the centre, is accompanied by the gradual closure
of the previously patent orifice. The state of the tissue of the os
and cervix varies ; sometimes there is a very marked softness of the
parts, the condition resembling that of the uterus soon after abor-
tion or delivery, while at other times it is much harder than natural ;
but it certainly is not at all a common occurrence for extensive
abrasion of the os uteri to coexist with a condition of the organ
such as would seem healthy to the touch. The secretion from the
surface varies considerably in diff"erent cases, and the chief part of
the leucorrhoeal discharge from which patients sufi'er is derived from
STATEMENTS IN SUPPORT OF IT. 27
■within the canal of the cervix, or from the cavity of the womb —
not from the abrasion itself. Still, in some instances, those espe-
cially in which the ulceration presents a very marked granular
character, the discharge derived from this source alone is far from
inconsiderable. The degree of sensibility which the ulcerated
surface possesses also varies greatly; now and then the slightest
touch is extremely painful ; but, in the majority of cases, the ulce-
rated surface is not more sensitive than the adjacent parts, nor is
the neck of the uterus, whose os is abraded, by any means con-
stantly more tender to the touch than the same part of an organ
entirely free from that affection.
Such, then, are the chief characters of these ulcerations or abra-
sions of the OS uteri. I retain the old name of ulceration in spite
of the objections which have been raised to it, because it seems to
me better, as there is no risk of our being thereby led into error
with reference to the appearances to which that name has been
applied, to accept for the present the current terminology, and
to avoid those disputes about words which are so proverbially fruit-
less.
The really important question is, whether ulceration of the os
uteri is to be regarded as the first in a train of processes which are
the direct or indirect occasion of by far the greater number of the
ailments of the generative system ; or whether, on the other hand,
it is to be considered as a condition of slight pathological import-
ance, and of small semeiological value — a casual concomitant,
perhaps, of many disorders of the womb, but of itself giving rise
to few symptoms, and rarely calling for special treatment ?
The former opinion, according to which it would be difficult to
overrate the pathological importance of ulceration of the os uteri,
is supported by the following allegations, which I will endeavour to
state as briefly, but at the same time as correctly as possible. It
is stated that the mucous membrane of the cervix uteri, by reason
of its vascularity and of the abundance of mucous follicles which
are imbedded between its duplicatures, is extremely liable to inflam-
mation ; and that this predisposition is still further increased by
the abundant afllux of blood towards the neck of the womb, as well
as by the position of that part of the organ, and its consequent
exposure to irritation and injury from various sources. This in-
flammation of the cervix is said to manifest itself by the secretion
of an abundant albuminous matter from the cervical glands, and by
28 ALLEGED IMPORTANCE OF ULCERATION.
the opening of the otherwise closed os uteri — as also in by far the
greater number of cases by abrasion or ulceration of the os uteri,
which usually occurs at a very early period. The cervix becomes
swollen and congested, and, it increases in size; but, while in some
instances it remains soft to the touch, even after years of disease,
its substance becomes more frequently the seat of inflammation,
lymph is effused into it, and it is not merely enlarged, but indu-
rated — a change which takes place to a greater degree in those who
have given birth to children than in the unmarried or the sterile.
The different extent of the ulceration is the only cause assigned for
the presence of induration of the cervix in one case, and its absence
in another ; but the relation of the two conditions does not seem to
be by any means invariable. The degree to which the ulceration
spreads appears also to be uncertain ; in the great majority of
cases it passes more or less deeply into the canal of the cervix, and
sometimes occupies its whole extent, the internal os uteri, however,
forming a barrier to its further progress, and preventing almost
invariably its extension into the cavity of the womb. It is then
inflammation, with its attendant ulceration of the os and cervix
uteri, and usually with consecutive induration of its tissue, to which,
according to these views, the sufferings of the patients are due ; and
all the varied disorders of the uterine functions, the pain, the leu-
corrhoea, the hemorrhages, the irregular menstruation, the sterility,
or the frequently occurring abortions, are attributed to the sympa-
thies of contiguous parts with that small portion of the womb which
is the seat of disease. Ulceration, too, when once it has occurred,
is alleged to have scarcely any tendency to heal ; while, so long as
it remains, there may perhaps be a lull in the patient's sufferings,
and some temporary mitigation of her symptoms ; but there can be
no real cure until the time when, the period of sexual vigour having
expired, the organs which subserved it pass into a common state of
atrophy — while cure, even then, is uncertain, and the consequences
of disease outlast, by no means rarely, the uses of the part.
This picture (and I have added nothing to its colouring) of all
the ills which follow from the seemingly trivial ulceration of the os
uteri, must certainly be allowed to warrant those who drew it, if
only it be a faithful portraiture, in attaching great importance to
this affection — in trying to discover it as early, to cure it as
speedily as possible.
As uterine pathology is simplified beyond expectation by the dis-
CORRECTNESS OF THESE OPINIONS DOUBTED. 29
covery of an almost invariable cause of the most diverse symptoms,
so uterine therapeutics also are made easy, according to the writers
whose opinions I am relating, by one remedy being found almost
always applicable for its cure, be the duration of the disease or its
severity what it may. If the evil be slight, its removal will be
speedy ; if severe, a longer time will be required ; but to modify
the vitality of the part by caustics is the one unfailing indication ;
and, this accomplished, the ulceration and the inflammation and its
results disappear together, and the sufferings of years are thus
almost infallibly got rid of in a few weeks, or, at latest, in a few
months. There are, indeed, some cases of slight mischief, which
rest, antiphlogistic treatment, and vaginal injections may cure ; but
these are rare. There are also some circumstances under which
the local abstraction of blood may be of service ; but what caustics
to use, how often to repeat their application, how to prevent or to
remove those inconveniences which sometimes result from their
employment, are questions discussed as of chief importance ; since
to these remedies all other local measures, as well as all general
treatment, are but secondary and subservient.
If I thought that the accuracy of these opinions were beyond a
doubt, or, on the other hand, that their entire fallacy had been
satisfactorily demonstrated, I would not now venture to occupy
your time in conducting you over twice travelled ground. I believe,
however, that the profession is much divided, both as to the facts
and as to their interpretation ; and that it may, therefore, prove no
profitless task to endeavour to bring both to the test of a rigid
inquiry, and to ascertain, as far as may be, where an error has
been committed in observation, or where wrong inferences have
been drawn from right observations. In doing this I must crave
your indulgence, and that of all persons from whom I may differ ;
for I am fully sensible how often I may need for myself that candid
interpretation of my statements, and that lenient judgment of my
errors, which I hope always to manifest to others.
The evidence by which to try the accuracy of those statements
that I have endeavoured fiiithfully to set before you, is very various
in its kind, and also of very various worth. It may, however admit
of being arranged under four principal heads, to each of which, in
succession, our attention must be directed.
In the first place, we may inquire how far these statements receive
30 PLAN OF INQUIRY INTO THESE
confirmation from what we know of the anatomy and physiology of
the uterus in a state of health.
Still, what answer soever we may receive to this question, it
cannot, from its very nature, be conclusive ; it may render a certain
occurrence probable or improbable, may substantiate or disprove
the correctness of certain opinions or explanations, but cannot
invalidate the evidence of positive facts.
In the second place, we may try to ascertain whether examination
of the dead body shows the morbid conditions of the os uteri which
have been described to be frequent or rare, slight or extensive; and
we may also endeavour to make out what connection subsists be-
tween ulceration of the mucous membrane of the os and cervix uteri,
and other changes in the tissue of the organ.
It must, however, be borne in mind that many evidences of dis-
ease, such as are very obvious during life, may be greatly obscured,
or may even entirely disappear after death : and further, that uterine
disorders of the class which we are considering, though exceedingly
painful, and seriously interfering with a woman's health and com-
fort, are yet not of a kind to prove the direct occasion of her death.
Evidence derived from this source will therefore be open to the
objection that it understates both the frequency and the importance
of these diseases.
We may inquire, in the third place, whether there is any condi-
tion in which ulceration of the os uteri comes under our notice
unconnected with other disease, and with such circumstances as to
admit readily of our observing its characters and watching its course
and consequences. Such a state of things presents itself to us
often in the case of the procident uterus, since the irritation to
which the displaced organ is unavoidably exposed has the almost
invariable effect of producing ulceration of the surface of the os
uteri, and of the immediately adjacent parts of the organ.
But, whatever conclusions we may deduce from this source are
open to all the objections inseparable from analogical reasoning.
The probabilities of certain occurrences taking place in the uterus
under other circumstances may be increased or weakened ; but the
evidence still falls short of absolute proof, either of the affirmative
or of the negative of the question.
The fourth and most important inquiry of all concerns the fre-
quency of these ulcerations of the os uteri under those circum-
stances in which they ordinarily come under our notice, and call,
OPINIONS PROPOSED. 31
or are supposed to call, for our interference. This inquiry, how-
ever, must include not only the frequency of ulceration, but also
the conditions generally associated -with it, and the symptoms to
which it commonly gives rise. If the alleged symptoms of ulcera-
tion are found to be not rarely present without ulceration, and if
ulceration is discovered even where there are no symptoms ; or if,
in the same case, the ulceration may vary in extent, with no corre-
sponding change in the symptoms ; if an indurated state of the
cervix exists without ulceration, and ulceration even of long stand-
ing, without induration — the conclusion, especially if supported by
the answers obtained to our previous inquiries, seems to me irre-
sistible that the importance of inflammation of the cervix and of
ulceration of the os uteri has been overstated ; that they are not
the cause of all the symptoms which they have been alleged to
occasion, and that, in the treatment of uterine disease, many other
considerations must influence us more than the mere removal of
ulceration of the orifice of the womb.
If this were proved, it would still remain for us to consider
whether, in any case, we may fairly look upon the ulceration of the
OS uteri as a symptom calling for distinct recognition and special
treatment. There are, I am aware, some persons of deserved
repute who will look upon this inquiry as superfluous ; but, for my
own part, I do not conceive that, even if we arrived at a conclusion
never so unfavourable to the supposed great importance of ulcera-
tion of the OS uteri, we should be thereby entitled to regard its
symptoms as a mere delusion, its very existence as little more than
a figment of the fancy.
I. It was observed that, in the first place, something of additional
probability or improbability might be imparted to those views which
we propose to investigate by what anatomy and physiology teach
us of the uterus and its functions. Now it is alleged, as one reason
for the liability of the cervix uteri to affections from which the body
of the organ is comparatively free, that it receives a greater amount
of blood, that it is endowed with a higher degree of vitality than
other parts of the organ. But surely this statement is erroneous-;
and it sufiices to examine the healthy uterus for any one to satisfy
himself of the smaller vascularity of the neck than of the body of
the womb. It is the body which chiefly grows as the period of
puberty approaches, it is the body to which the great determination
of blood takes place during each menstrual period, and from the
32 PHYSIOLOGICAL FACTS UNFAVOURABLE TO
lining membrane of the body that the menstrual flux is poured out.
The looser tissue, the large vessels, the congested mucous membrane
characteristic of the menstruating uterus, are limited, or nearly so,
to the body and fundus of the organ ; and it is the epithelium of
its cavity, not that of the neck of the womb, which is abundantly
intermixed with the menstrual fluid. When conception takes place,
it is the body of the uterus which first and chiefly enlarges, its
mucous membrane which becomes developed to the decidua, ita
tissue which grows and is metamorphosed into muscular fibre;
while the changes in the membrane of the cervix are limited to an
increased activity of its mucous follicles, and the alterations in its
substance to an increased formation of fibro-cellular tissue, with a
comparatively scanty growth of muscular fibre. After delivery, the
retrograde processes are much more striking in the body than in the
neck of the womb. The mucous membrane of the cervix, stretched
during pregnancy till the folds which it presented in the unimpreg-
nated condition are obliterated, resumes once more its former pli-
cated arrangement, while that of the body is detached and repro-
duced again and again before the organ reverts to its former state.
The cervix is less sensitive than the body of the uterus : the sound
which passes along the canal of the former almost unfelt, generally
finds the lining of the uterine cavity acutely sensitive. The cervi-
cal canal has been forcibly dilated, it has been incised ; the tissue
of the cervix has been burnt with the strongest caustics, or with the
actual cautery, or portions of it have been removed by the knife,
generally with no injurious consequence ; often with so slight a
degree of constitutional disturbance, or even of local sufi'ering, as to
surprise those who advocate, little less than those who condemn,
such proceedings.
But, if structurally so lowly organized — if physiologically of such
secondary importance — if so much less subject than the body of the
uterus to alterations in its intimate structure — and if so compara-
tively insensible even to rude modes of therapeutical interference —
it certainly does appear to me that the assumption that some slight
abrasion of the mucous membrane covering this part is capable of
causing a list of ills so formidable as are attributed to it, ought to
rest for its support upon some other and stronger foundation than
any inference fairly deducible from anatomical or physiological
data.
II. We will now, however, inquire, in the second place, into the
SUPPOSED IMPORTANCE OF ULCERATION. 33
nature of the evidence on this subject which can be deduced from
anatomical investigation. At first sight, indeed, it seems somewhat
strange that those who believe in the frequency and importance of
ulceration of the os uteri, have made no attempt to demonstrate
those facts by examination of the body after death ; while the only
persons who have appealed to its results, allege this condition to be
very rare and very trivial. It must not be forgotten, however,
that appearances, the most striking characters of which consist in
increased vascularity, and in that vital turgescence which disap-
pears soon after life has departed, cannot be expected to be very
marked some days after death. Indeed, no one who has felt the
large firm growth of cauliflower excrescence sprouting from the
neck of the womb during life, and has contrasted with it the small
bundle of collapsed filaments which are all that remains of it after
death, but must be prepared to admit that a condition of the os
uteri very obvious during life, and the cause of very grave symp-
toms, may yet leave but very few traces after death.
Besides, it must, I think, be acknowledged that the data on which
the negative assertions of morbid anatomists rest are not so fault-
less as to command by any means implicit confidence. Neither M.
Lair,^ who, in 1828, gave some of the results of the inspection of
500 female subjects, nor M. Pichard,^ who, in 1846, added to them
the results of 300 more, gives the least information as to when,
where, or how these examinations were made. They do not even
state the age of any of the subjects, nor afibrd, either directly or
indirectly, the slightest guarantee that these inspections were made
with due care ; on the contrary, indeed, the appearances observed
are described so loosely that, with reference to many of them, it is
by no means easy to determine their exact nature. Of this want
of exactness no better proof can be given than the fact that while
M. Lair discovered but 12 ulcerations of the os uteri out of 500
examinations, and M. Pichard but 5 out of 300 more, the latter
mentions that in 54, or rather more than a sixth of his cases, a
granular state of the os uteri was present ; while M. Lair makes no
reference to his having ever met with such a condition. But I
1 Nouvelle Methode de Traitement des Ulceres, etc., de I'Uterus, 8vo., Paris, 2d
edit. 1828.
2 Des Abus de la Cauterisation, etc., dans les maladies de la matrice, 8vo., Paris,.
1846.
3
34 RESULTS OF
need say no more about these two writers, since any attempt to
reconcile their statements leaves us in hopeless bewilderment, satis-
fied of but one thing, namely, that facts so collected and so arranged
are available for no useful purpose.
I fear that a very similar statement must be made with reference
to the facts bearing on this subject which have been collected in our
own country. Not only is there no evidence of their having been
observed with that minute care which is needed to render them
thoroughly trustworthy ; but, with reference to many hundreds of
the cases, if not to all, conclusions have been drawn as to the
frequency of certain morbid conditions of the uterus, from the
examination alike of the infant of a few weeks old and of the old
woman of seventy; an oversight, to call it by the mildest term,
which renders any results deduced from such data worse than
useless.
It is idle to expect to meet with frequent indications of uterine
disease before the generative organs have arrived at maturity suf-
ficient to commence the performance of their functions; while,
after the time of sexual vigour has passed, the only diseases we are
likely to find are such as commenced at an earlier period, or such
as may be incidental to the mere tissue of the organ, wholly inde-
pendently of the function which it once performed.
The question then is, with what frequency, and associated with
what other changes, do we meet with indications of inflammation
and ulceration of the os and cervix uteri, in the bodies of women
after puberty, and especially during the period of sexual activity ?
My own observations, which amount only to 62, are too few
conclusively to settle this inquiry ; though I cannot but hope that
the care with which they were made may compensate to some
extent for the smallness of their number, and that they may serve
at least to indicate the side towards which the weight of evidence
inclines. Each examination was recorded according to a printed
form, on which were specified for separate notice the dimensions of
the uterus, the condition of the os, the length and breadth of the
cervix uteri, the size of the uterine cavity, the thickness of the walls
of the organ, and so on ; — points some of which were of practical
interest, while the enforced attention to others had at least this
advantage, that it prevented anything from being overlooked.
The uteri were taken from patients who died in the medical
wards of St. Bartholomew's Hospital of other than uterine disease.
PERSONAL OBSERVATION. 35
Of the total number, 13 were above forty-five years of age, the
remaining 49 between the years of fifteen and forty-five. Concern-
ing all of the former class, and 30 of the latter, making a total of
43, it was either known with certainty, or concluded with great
probability, that they were married, or had had sexual intercourse ;
the remaining 19 were believed to be virgins.
The subjoined table shows the general results of the examination
of the uterus in these cases, and the relations borne to ulceration
of the OS uteri by the more important morbid appearances.^
TABLE
Showing the chief results of the examination of 62 uteri:
Uterus healthy in .
'* diseased in .
Ulceration of os uteri in .
" existed alone in .
'* with diseased lining of uterus in
" with induration of walls of uterus in
Induration of walls of uterus, without ulceration of os
Disease of lining of uterus, without ulceration of os
. 29
. 17
11
3
3—17
. 6
. 7
Total of diseased uteri, 29
The OS uteri was abraded in 1 of the subjects above 45 years of
age ; and the lining of its interior was diseased in 5 of that number.
In 11 of the 19 patients, all under 45 years old, who were virgins,
the uterus was perfectly healthy ; in 8 it presented some sign or
other of disease. This consisted 5 times in slight abrasion of the
OS uteri, which existed alone in 3 cases ; but was associated in the
other 2 with some morbid state of the interior of the womb. Twice
the interior of the uterus was the only part afi'ected ; and once the
uterine walls were much harder than natural.
There is certainly something at first not a little startling in the
result at which we arrive, that the womb was found in a perfectly
healthy condition in little more than the half of 62 women, none of
whom died of uterine disease, nor were supposed to be suffering
from any grave uterine ailment. But it may, it ought indeed to be,
asked, what is the value of these appearances? Some of them
' In the above table, and in the general statements of the state of the uterus, no
notice is taken of morbid conditions of the uterine appendages, nor of those affections
of the womb (such, for instance, as fibrous tumors) which obviously stand in no
necessary relation to inflammation of the organ, or to ulceration of its orifice.
86 ULCERATION GENERALLY SLIGHT.
may be of little moment, and the very frequency of their occurrence,
instead of substantiating the opinion that they are of great import-
ance, rather militates against that supposition. When ulceration of
the OS uteri was first observed, it was natural enough to attribute to
it many symptoms, and to refer to its influence many structural
changes. But what if such ulceration be found to be usually very
limited in extent, and so superficial as to be unassociated with
changes in the basement membrane of the afi'ected surface, and
exercising so little influence on the state of the uterus in general, as
to be unconnected in a large number of instances with changes
either in the interior of the womb, or in its substance ; while indu-
ration of the uterine tissue and disease of the lining membrane of
the womb are found independently of it, or of each other ? Should
such appear to be the case, it will, I think, be rendered in the highest
degree probable that this abrasion of the os uteri has not the long
train of sequences which have been supposed to follow it, but that
it is of comparatively small pathological import; that it may be
found to vary under the influence of comparatively trifling causes ;
and not unfrequently to be dependent on functional disorder of the
uterus, just as the mucous membrane of the tongue and mouth
betrays the disturbance of the digestive system ; that it may, in
short, be the consequence, and sometimes the index, but rarely the
occasion, of the ailments with which it is associated.
Abrasion of the os uteri was observed in 11 instances unconnected
with any other morbid condition of the womb. In 6 cases it was
extremely slight, afi"ecting just the edges of the os uteri, but not
extending for more than a line in breadth ; the mucous membrane
lining the canal of the cervix was in all of these instances quite
pale, but twice the lining of the uterine cavity was of a brighter red
than natural. In the other 5 cases, the abrasion, though retaining
the same character, was more extensive ; once the abraded surface
presented a finely granular aspect, but was quite uniform ; but in
the other four cases it had an uneven worm-eaten appearance,
probably due to a partial destruction of the papillae which beset the
OS uteri. ^ In 4 of these cases the abrasion extended for a short
distance up the canal of the cervix, while once it was limited to that
exclusively, the lips of the os being perfectly pale and healthy, and
' As in the delineation, by Drs. Hassall and Tyler Smith, in vol. xxxv. of the
Medico-Chirurgical Transactions.
INDURATION OF CERVIX UTERI. 87
the mucous membrane of the cervix unaltered, except along a strip
a third of an inch in breadth by an inch in length, where the pos-
terior wall was abraded. In 3 of the above 4 instances there was
some increase of vascularity in the mucous membrane of the cervix,
which on one occasion extended for nearly half an inch up its canal ;
and once this condition was very marked, and the mucous membrane
appeared swollen and infiltrated, but in no other case was there any
appearance of thickening of the membrane either at the seat or in
the immediate neighbourhood of the abrasion.
It is alleged, as we have already seen, that in the great majority
of instances ulceration of the os uteri gives rise to induration of the
cervix, the result of the extension of inflammation to it, and of the
efi'usion of plastic lymph into its structure, which lymph comes by
degrees to be more and more organized. This description, however,
of the manner in which induration of the cervix uteri takes place is
purely imaginary ; there are no observations whatever bearing on
the subject, and the difficult task of tracing the results of chronic
inflammation in any tissue is obstructed by so many special impedi-
ments in the case of the uterus, that it will probably be long before
we shall be in a position to speak with any measure of certainty
concerning it. The account of the process by which induration of
the cervix uteri is produced may possibly be correct, but at any
rate it is not proven ; and few things have so retarded the advance
of medical knowledge as the accepting some plausible hypothesis as
if it were a statement of well-ascertained facts, and then proceeding
to reason from it as if from some secure basis.
Under what circumstances is induration of the uterine tissue met
with, and in connection with what other changes in the organ ? It
existed in 9 cases ; in 5 of which it was not associated with any
other disease of the uterine substance ; in 3 it coexisted with ulcera-
tion of the OS ; and in 1 with a morbid state of the interior of the
uterus. In an unmarried girl, aged eighteen, who died of capdiac
dropsy, the tissue of the fundus, and of the upper half of the body
of the uterus, presented its usual characters; but about half-way
down the body of the organ there began a strip of a dead yellow
colour, and much denser texture, resembling fibro-cartilage or the
elastic coat of an artery. The dense tissue lay immediately beneath
the lining membrane of the uterus, and being at first only one line
in thickness, increased in width till it came to constitute the whole
thickness of the cervix uteri. In the case of another patient, aged
38 ' OTHER APPEARANCES DISCOVERED
forty-seven, a similar condition was met with in the body of the
uterus, but scarcely at all involved the cervix ; and in the three
other cases, in all of which the women were under thirty years old,
the cervix uteri alone was affected, being white, hard, creaking
under the knife, and seeming under the microscope to be composed
of an extremely dense fibrous tissue.
It appears, then, that most marked induration of the tissue of the
cervix, and of part of the body of the womb, may exist where there
is no other trace of inflammation, either past or present. It may
also occur in connection with inflammation and ulceration of the
lining membrane of the uterine cavity. In a woman who died at
the age of fifty-six, about a third of the thickness of the wall both
of the body and of the neck of the womb was exceedingly firm, and
creaked under the knife. Abundant glairy secretion from the
cervical glands, and some want of transparency of its lining mem-
brane, were the only unusual conditions of the interior of the uterine
neck ; but the cavity of the organ Contained a copious purulent
secretion mixed with blood ; its mucous membrane was thickened,
vascular, and destitute of polish, and about the middle of the pos-
terior wall completely destroyed, leaving the substance of the womb
beneath uneven, rather soft, and presenting the appearance of a
granulating surface.
Ulceration of the os uteri, and induration of the uterine walls,
were associated together in three instances. On one occasion the
ulceration was but slight, and the interior of the cervix extremely
pale, though there was great injection of the lining of the uterine
cavity. In this instanfce the cervical wall was much indurated, ,
that of the body of the uterus rather less so. Extreme induration
of the cervix existed in one case where there was rather extensive
ulceration of the os uteri ; and in this instance the cervix was con-
siderably hypertrophied. The patient from whom this uterus was
taken had been under my care for some years^ previously, suffering
from symptoms such as Gooch describes under the name of irritable
uterus ; her sufferings had been most severe, and the enlargement
of her womb most considerable at a time when there was no abra-
sion of its orifice. In one case only, in which there was consider-
able induration of the cervix, there was a distinct line of congestion,
about half a line in depth, between the ulcerated surface and the
pale tissue of the indurated cervix.
In 10 cases, the condition of the lining membrane of the uterine
MORE SERIOUS THAN ULCERATION. 39
cavity deviated from that which characterizes it in a state of health.
Thrice this state of the interior of the womb coexisted with ulcera-
tion of its orifice of moderate extent, and presenting its ordinary
appearance ; but in the remaining 7 instances the os uteri was per-
fectly healthy. In 7 of the 10 cases the uterine mucous membrane
was vividly injected, so as to present a bright rose tint, and was
more or less swollen and softened. Once very extensive disease of
the lining membrane of the uterine cavity, probably of a tuberculous
character, was discovered in the body of a woman fifty-six years old.
In a second case, in which the patient was stated to have had a
copious leucorrhoeal discharge, and to have complained of pain and
of a sense of heat at the lower part of the abdomen, the intensely
red mucous membrane of the uterine cavity presented an almost
gelatinous appearance, and looked not unlike decidua. In this
instance, though there was some ulceration of the os, yet the lining
membrane of the cervix was quite pale ; no secretion occupied its
canal, and the tissue of the uterus was quite healthy. In a third
case a small patch of ecchymosis was present beneath the lining of
the uterine cavity ; and in a fourth, where the patient had not
menstruated for five months, the lining membrane, though of a
pinkish colour, had lost its polish, and looked more like an injected
serous membrane than like the mucous lining of the womb.
It has not been from want of perception of the hopeless tedious-
ness of such details, that I have ventured to take up your time so
long with an account of the morbid appearances of the uterus, ob-
served in these cases. Many, probably very many, of these condi-
tions ought to be classed with pseudo-morbid, rather than with
pathological appearances ; but the data at present fail us for dis-
tinguishing with accuracy the one from the other. But, be this as
it may, it is yet abundantly evident that many of them imply de-
viations from a healthy state more considerable than the trifling
abrasion or ulceration of the os uteri, -vVhich existed on several
occasions. We have seen that, in by far the majority of cases, the
ulceration, when present, was not merely trifling in extent, but that
it had not given rise to so much irritation of the neighbouring
tissues as to produce any appreciable congestion of the mucous
membrane in its vicinity ; while the changes in the uterine sub-
stance alleged to depend upon it were often er present without than
in connection with it ; and, moreover, none of the alterations about
40 CONCLUSION UNFAVOURABLE TO ITS IMPORTANCE.
the OS and cervix of the womb were so considerable as those which
were apparent in its cavity.
Other evidence, indeed, must be adduced than that which ana-
logical reasoning from the facts of physiology has suggested, or
than that which examinations after death have furnished, before
we shall be entitled to reject the opinion that inflammation of the
cervix, and ulceration of the os uteri, are occurrences of very
serious pathological importance — the occasion of ijearly all the ills
which affect the physical well-being of woman. That other evidence
must be reserved till the next Lecture ; but yet, unless I have
altogether failed in my endeavours, the question is not left to-day
quite where it was before ; since, tempting though this hypothesis
may be, and numerous the difficulties which it may appear to solve,
we yet have found that it is opposed by the facts of physiology,
unsupported, to say the least, by the results of anatomical investi-
gation.
LECTURE II.
Inquiry continued. III. Course and consequences of ulceration of the prolapsed
uterus; they do not seriously disorder the uterine functions, or alter its struc-
ture. IV. Kesults of clinical observation. Examination of prostitutes suffering
from gonorrhoea or syphilis shows susceptibility of cervix uteri to have been
over-estimated. Question considered with reference to importance of ulceration
when present. Three different solutions of it suggested. Tests by which it is
proposed to determine it. Nature of materials for this purpose stated.
Influence of ulceration of os on fecundity inconsiderable — Its occurrence connected
with activity of sexual functions, as shown by patient's age and alleged cause of
illness. Similarity in these respects to cases where ulceration is absent shown
further by duration of symptoms, by disorder of menstruation, by occurrence of
leucorrhoea, by complaints of pain, and in the main by condition of the uterus.
Further examination into relation of ulceration of the os uteri to induration of its
cervix shows it not to be constant, nor bearing any necessary relation in degree.
General inferences from inquiry unfavourable to first two solutions of question con-
cerning importance of ulceration of os uteri ; and consequently to opinion that
it is a condition of great importance.
Mr. President —
Sir : The facts and considerations which I had the honour to
submit to you in my former Lecture, were, as you will remember,
not brought forward as conclusive of the question that they were
intended to elucidate. They seemed, however, to raise a presump-
tion against rather than in favour of the opinion, that inflammation
of the cervix and ulceration of the orifice of the uterus are condi-
tions of great pathological importance ; and at any rate to warrant
us in scrutinizing very closely such other evidence as may be ad-
duced to substantiate its correctness.
I purpose to-day to advance further in this investigation ; to
abandon for the present physiological reasoning, to lay aside the
scalpel of the anatomist, and to learn what we may of this subject
from the study of the living.
The complex character of disease offers one great impediment to
our thoroughly understanding it : the having surmounted this dif-
ficulty constitutes the great difference between the experienced
42 CHARACTERS OF ULCERATION OF
physician and the novice. In the matter of uterine disease, we are,
I fear, all novices ; and it was this consideration which induced me
to propose that we should, if possible, study —
III. As the third point m this inquiry, ulceration of. the os
uteri, under some condition in which it presents itself to our notice
unconnected with other disease, and with such circumstances as to
admit readily of our observing its characters, and noting its course
and consequences.
Fortunately, the opportunities for this study abound ; and in
almost every woman whose uterus has become prolapsed beyond
the external parts, we may observe the effects which ulceration of
the OS uteri commonly produces, the symptoms to which it gene-
rally gives rise ; we can trace it in its progress, can watch it for
weeks or months together, and see what it has led to where it has
existed even for years.
A previously healthy woman leaves her couch too soon after her
delivery, while her vagina is still lax, and its power of supporting
the uterus is perhaps still further diminished by laceration of the
perineum. The retrograde process by which the bulk of the womb
should be eventually reduced to its former dimensions is still in-
complete ; while the outstretched uterine ligaments have not had
time to contract to their former size, nor to recover their former
resiliency. The heavy uterus, thus ill-supported, sinks down in the
pelvis, approaches by degrees nearer and nearer to the external
parts, and at length occasionally projects beyond them ; and in the
course of a few weeks or months the occasional prolapse becomes
habitual. At first, it is only a portion of the womb which thus pro-
jects ; but often the whole uterus comes in the course of time to
hang externally ; while in many instances, a portion of the bladder
in front, and of the rectum behind, descends into the sac of the
tumor and increases its bulk. The delicate lining of the vagina,
dragged down and inverted by the descent of the womb, furnishes
an investment to the whole mass, and, assuming by degrees the
characters of ordinary integument, becomes adapted to its new
condition. The lips of the os uteri, however, and the immediately
adjacent portion of the cervix which the vagina does not cover,
retain in most cases much of their original delicate structure, while
their very position at the most depending part of the tumor exposes
them more than any other part to external injury ; so that, with
THE PROCIDENT UTERUS. 43
comparatively few exceptions, they are, permanently in a state of
abrasion or superficial ulceration.
These ulcerations are generally indolent, though by no means so
much so as the ulcers of the inverted vagina itself, which are apt
to become deep and excavated with raised and callous edges, and
exactly to resemble chronic ulcers of the skin of other parts of the
body. The abrasions of the os, however, after weeks or months
still retain much the same characters as they originally presented.
They extend, indeed, at one time over a larger extent of surface
than they occupy at another; but they very rarely increase in
depth, or extend into the subjacent tissue. The ulcerated surface
is denuded of epithelium ; now and then it is partially covered by
a thin layer of yellowish lymph, but usually it is of a rather vivid
red colour, and of a granular appearance. This granular character
is generally more marked in proportion to the age of the ulceration ;
while in a few instances the granulations are distinct from each
other, rather elongated in form, and look exactly like hypertrophied
papillae. A transparent albuminous secretion in general covers the
ulcerated surface, and is sometimes poured out freely from it ; but
there is seldom any abundant discharge from the interior of the
uterus, or even from the canal of the cervix.
In almost all cases of procidentia uteri (those alone excepted in
which the misplacement of the womb occurs in advanced life, as a
consequence of that general wasting of the tissues within the pelvis
which takes place when the generative functions have been long
extinct), the organ becomes in the course of time more or less con-
siderably hypertrophied. This hypertrophy usually affects the
neck of the womb more than its body, involving it in all its dimen-
sions, though mostly to a greater degree in length than in thickness.
It seems to be a simple increase of growth, such as we find occurs
in other parts when subjected to constant and long-continued irri-
tation ; but nowhere, except perhaps in the female mamma, is it
observed so frequently or to so great a degree as in the uterus,
since nowhere else does there exist the same store of formative
material, which needs but a stimulus to excite it to active develop-
ment. To the touch the enlarged cervix presents no remarkable
hardness ; but its substance feels generally healthy, and the knife
of the anatomist detects no alteration in its tissue. There is over-
growth of the part, but nothing more.
That such is the case, we have additional proof in the fact that a
44 RESULTS NOT VERY SERIOUS.
uterus misplaced, enlarged, with its orifice even abraded, and
retained within the pelvis only by some mechanical contrivance, is
nevertheless capable of performing all its functions, even its highest ;
and this in many instances with a remarkably small degree of dis-
turbance. Not only does conception take place readily in spite of
the existence of prolapse of the womb, but pregnancy and labour
are not seldom passed through with no additional suffering beyond
that which attended those processes on former occasions, or, at the
worst, the increased discomfort of the patient is obviously due to
purely mechanical causes.
It can scarcely be necessary to say, that it is not my intention for
one moment to assert that misplacement of the womb produces no
inconvenience, or that ulceration of its orifice, when it is thus mis-
placed, is of no importance. Daily experience yields abundant
proof to the contrary ; but a detail of the symptoms of prolapse of
the uterus forms no part of our present object. I referred to the
accident and its consequences only for the sake of suggesting the
reasonable inference, that if inflammation of the neck of the womb
were as frequent as has been supposed, or ulceration of its orifice
the necessary occasion of such serious disorder of function apd
alteration of structure, we ought to meet with some of the most
striking illustrations of these facts in cases where the womb, by its
misplacement, is exposed to injuries from without, such as it was
never intended to encounter.
But though it be conceded, as I think it must be by all observers,
that the symptoms supposed to characterize inflammation of the
neck of the womb, and ulceration of its orifice, are not met with
either constantly or in a specially marked degree in cases of pro-
lapsus or procidentia uteri; still, we should not be justified in drawing
an absolute conclusion from what we observe in the misplaced uterus,
as to the effects produced by similar ailments attacking the organ
when in its natural position. It may be alleged, and with plausi-
bility, that during the gradual process of its misplacement, the
sympathies of the womb have been rendered less keen than they
were while the organ retained its natural position ; and that thus it
comes to bear, with comparative impunity, injuries which might
otherwise have produced great disorder of its functions and great
alteration of its tissue.
Bearing in mind, then, the necessity for care, lest from any facts
we draw a wider inference than they really warrant, let us now turn
ULCERATION NOT SEVERE IN PROSTITUTES. 45
to the fourth and most important part of this inquiry, and seek to
ascertain —
IV. What clinical observation generally teaches us concerning
ulceration of the os uteri — its course, its symptoms, and its im-
portance.
Before entering on the general consideration of the subject, how-
ever, there is one point specially elucidated by a particular class of
patients, and concerning which it may not be inappropriate to say
a few words. The peculiar susceptibility of the cervix and os uteri,
the extreme readiness with which they become the seat of inflamma-
tion and ulceration, are much insisted on by those writers whose
opinions we are considering. Now, assuming such views to be
correct, we may, I think, expect them to receive full confirmation
from the medical history of those wretched women who live by
prostitution. In them, more than in any other class of persons, do
we meet with the conditions best calculated to inflict local injury on
the neck of the uterus. It will therefore be reasonable to expect
that they will present, with remarkable frequency and intensity, an
ulcerated condition of the os uteri, an indurated and hypertrophied
state of its cervix. It is true that the severest forms of these affec-
tions must prevent persons labouring under them from exercising
their disgraceful calling ; but yet no one who is familiar with the
state of wretchedness, suffering, and disease, in spite of which the
lower order of prostitutes continue to ply their trade, but would
expect to meet among them with many instances of those ailments
in their acute stage, if they were in reality very frequent. More-
over, as a hypertrophied cervix uteri returns, even under favourable
circumstances, extremely slowly to its original size, there would be
many occasions in which the chronic effects of bygone inflammation
must be evident in those who had devoted themselves for months or
years to a vicious life.
Observation, however, seems to show that, be the causes of ulcer-
ation of the OS uteri, of inflammation, hypertrophy, and induration
of its cervix, what they may, sexual excesses, at any rate, have no
great share in their production. Four years ago, being anxious to
satisfy my mind on this point, I examined, by permission of Mr.
Lawrence, forty women on their admission into the venereal wards
of St. Bartholomew's Hospital. Of these 40 patients, 18 suffered
from gonorrhoea alone, 10 from gonorrhoea and syphilis, and the
remaining 12 only from syphilis. The cases were unselected, and
46 THREE DIFFERENT ANSWERS
the examinations were made as soon as possible after the admission
of the patients into the Hospital.
In 27 instances, the os and cervix uteri were absolutely healthy,
or presented only, and this but rarely, a slight blush of redness,
deepening the natural hue of those parts. In 10 of the remaining
thirteen, the ulceration, if indeed it deserved the name, was a mere
excoriation not above a line in breadth, partially or completely
circumscribing the os uteri, but associated with no other change of
its tissue. In the remaining 3 cases, the abrasion was more ex-
tensive, surrounding the os uteri for about a third of an inch ; and
in the case of one of these three, that of a woman who had given,
birth to children, the lips of the os were noted to be elongated:
this, however, was the nearest approach to a hypertrophied state of
the cervix met with in the whole forty cases ; while in no instance
was there any such alteration of the texture of the part as to de-
serve the name of induration.
These facts, however, after all, prove no more than this — that
the susceptibility of the os and cervix uteri to the effects of local
injury has probably been over-estimated ; they do not bear, or bear
but very slightly, on the more important inquiry as to the value to
be attached to ulceration of the os uteri when present. In ap-
proaching this question, as we are bound to do with no conscious
bias of the mind in one or the other direction, three different pos-
sibilities at once suggest themselves to us, of which any one may be
correct.
1st. Ulceration of the os uteri may be the cause of all the symp-
toms of uterine disease which have been attributed to it ; and con-
sequently it may be of no less importance to remove it when present,
than to ascertain the fact of its existence.
2d. Though not in itself the cause of the symptoms, or at least
of the greater part of them, it may yet be the concomitant of certain
forms of uterine disease ; of the state and progress of which its
extent and degree may be a trustworthy index. In this case,
though of small importance as far as therapeutical proceedings are
concerned, it may yet be of great semeiological value.
3d. Neither the one nor the other of these suppositions may be
correct ; but either the ulceration may exist alone, giving rise in
that case to few symptoms, or to none at all ; or it may, in other
instances, complicate different uterine ailments, though not an index
of their state, nor varying with their changes.
SUGGESTED TO THE INQUIRY. 47
Considering that, in the opinion of some writers, so large a pro-
portion as 81 per cent, of all women presenting symptoms of uterine
ailment, are suffering from inflammatory disease of the tissue or
canal of the cervix uteri, and 70.4 per cent, likewise from ulceration
of the OS uteri, this inquiry can scarcely be expected to detain us
long. The evidence in support of such a view may fairly be ex-
pected to be overwhelming ; and the symptoms of ulceration of the
OS uteri to be characteristic, either from their peculiarity or their
severity, or from both together ; and to differ in important respects
from such as attend upon those uterine ailments which are not
associated with that condition. Fortunately, too, the presence or
absence of ulceration of the mouth of the womb is a fact easily
ascertainable ; so that there can be no difficulty in making this the
ground of a division of cases of uterine disease into two grand
classes for the purpose of comparison.
I purpose, then, to inquire whether sterility is more frequent,
whether the rate of fecundity is lower, and whether abortion occurs
oftener in the one class of cases than in the other ? Whether men-
strual disorder is more common, more severe, or different in kind ;
whether leucorrhoea is more abundant, or furnished from a different
source ; or whether pain is less tolerable when the os uteri is ulcer-
ated, than when that condition is absent ? And lastly, whether
similar or different causes produce the uterine affections in the two
classes of cases; whether the duration of illness is the same; whether
the structural alterations of the womb are alike or diverse ?
If this inquiry should discover marked differences between the
two classes of cases, it will then be for us to determine whether the
ulceration is to be regarded as the cause of the coexisting disease,
or only as a constant attendant upon it ? That it must hold one or
other of these places, will, I think, be established beyond cavil; and
it will follow that, on either supposition, the importance of ascer-
taining its existence can scarcely be overrated.
If, on the other hand, we find that a very great degree of resem-
blance exists between the two classes of cases ; that women of the
same age, under similar circumstances, present the same symptoms,
leading to the same results, having the same duration, and attended
with similar structural changes, whether ulceration of the os uteri
be absent or present ; it may then be inferred with equal certainty
that ulceration of the womb can neither be regarded as a general
cause of uterine disease, nor as a trustworthy index of its progress ;
48 DATA ON WHICH TO FOUND REPLY.
but that it is a pathological condition of secondary moment, and
this even though there be still some difficulty in assigning to it in
every instance its proper value.
The materials from which I hope to make some approach to a
satisfactory answer to these questions are derived from 1226 cases,
of which records were preserved while the patients were under my
care, either at the Middlesex or at St. Bartholomew's Hospital. Of
these, 300 were in-patients of one or other institution, and the re-
maining 926 were out-patients of St. Bartholomew's Hospital,
between Jan. 1, 1850, and Oct. 15, 1853. Conclusions as to the
results of treatment can of course be drawn only from the in-
patients of a hospital ; but the history of out-patients yields, if
carefully recorded, trustworthy data with reference to the symp-
toms of disease. It has been my custom for the past three years
to keep a minute account of the history of my out-patients at St.
Bartholomew's Hospital — recording with reference to each one her
age, the number of years she has been married ; if a widow, the
duration of her widowhood, the number of children to whom she
has given birth, as well as that of the abortions which she has expe-
rienced, with the date of her last pregnancy. Further, the date of
her first menstruation, with the manner in which that function has
generally been performed, as also the ordinary presence or absence
of leucorrhoeal discharge, have always been noted ; together with
the date of the commencement of her present illness, its symptoms,
and the result of vaginal examination ; which last I have invariably
made, and dictated the account of, myself. These particulars have
been taken of all cases without selection — or if any were omitted,
they were only some of those cases of trivial ailment which all who
have had much experience of hospitals know to be never absent, in
certain proportions, from these institutions ; cases sometimes of
mere loitering idleness, but oftener of destitution, where the symp-
toms are those of want, not of disease, and food, not physic, is the
appropriate remedy.
In 268 of the 1226 cases, the symptoms appeared to me to justify
the use of the speculum ; and in 125 instances, the os uteri was
found to be the seat of ulceration ; while in the remaining 143 it
showed no sign of that condition. Though for some purposes con-
clusions may be drawn from the whole number of patients, yet ob-
viously the solution of the questions before us must be attempted
INFLUENCE OF ULCERATION ON FECUNDITY. 49
by a comparison of the smaller number of instances in -which exa-
mination with the speculum was instituted.
Thus much premised as to the grounds on which the different con-
clusions rest, to which I now have to crave your attention, we are
in a position to take up successively the various points that I have
already referred to as likely to elucidate the question of the influ-
ence of ulceration of the os uteri in the production of uterine dis-
ease, or in occasioning functional disorder of the generative system.
The perpetuation of the species being the highest function of the
generative apparatus in either sex, it is but natural to expect that
any serious disease of the organs which subserve that function shall
produce some appreciable effect in interfering with its performance,
and that it shall, in the case of women, show its influence either in
the production of absolute sterility, in lessening the number of con-
ceptions, or in increasing the number of abortions.
For our purpose it is not sufiicient as a standard of comparison to
know the proportion of children to a marriage generally throughout
this country (which is about 4.2) ; but we ought to ascertain the
general fecundity of women in the same class of life, and placed
under the same general circumstances with those who apply as pa-
tients at the hospital.
In the subjoined table, therefore, the first division represents the
proportion of pregnancies which reached their full term, and also
the proportion of abortions to a marriage in 980 married women at
different ages who were attended in their confinement by pupils of
St. Bartholomew's Hospital. The second division represents the
same fact in the case of 980 women married above one year, who
applied during the childbearing period of life for relief on account
of any ailment of the uterine system, and shows also the proportion
of cases in which marriage had proved absolutely sterile. The third
division represents the same facts with reference to 125 of the above
980 persons in whom, examination with the speculum having been
made, the os uteri was found unaffected by ulceration ; and its results
may be compared with those in the fourth division, which refers to
117 of the same number of patients in whom ulceration of the os
uteri existed.
50
INFLUENCE OF ULCERATION ON FECUNDITY.
PATIENTS WITH UTERINE
SYMPTOMS, WITH
ULCERATION.
To each
fruitful
marriage.
•suoT^jxoqv
.84
1.1
1.75
^
•«»-iPMO 1
rH Cq -^ CO
CO
Proportion
of sterile
marriages.
lin 1.5
1 in 6.3
1 in 10.7
CO
.a
•jaqranj^j
CO CO CO 00
CO Tj<
t^
PATIENTS WITH UTERINE
SYMPTOMS WITHOUT
ULCERATION.
To each
fruitful
marriage.
•suoi'^aoqy
.6
1.29
2.47
CO
•uaxpnqo
lO CO
: <N CO
rH* ^ -^
CO
co'
Proportion
of sterile
marriages.
1 in 4.4
lin 4
id
.a
•jaqranjij;
: o (N CO
■^ CO <M
§
no H .
SI
To each
fruitful
marriage.
-•suoi:^joqv
rH
^
•uajpiiijO
00
rH (M Tt< CO
t^
d
Proportion
of sterile
marriages.
1 in 3.3
lin 7.7
lin 6.8
lin 17
00
.a
•jaqranj^i
O CO o t>-
rH -"^ lO 1:^
CO CO (M
O
OO
CD
1^
s
Abortions
to each
marriage.
q "* ^ "3 «>:
Children
to each
marriage.
rH CO t-; CO
rH (?q vd l-^
•jaquin^
<M (M 00 -^
lO CO
en
Under 20 years
Between 20 and 30 years . . .
" 30 "40 " ...
" 40 "50 " ...
Totals and ayerages ....
FECUNDITY NOT LESSENED BY ULCERATION. 51
With reference to the results of this table, there can be no doubt
but that the proportion of sterile marriages is really less, especially
in the case of women between twenty and thirty years old, than is
here represented. It is true that no cases are included in it in which
the women had been married for only a year, or for a shorter time ;
but instances are by no means uncommon of conception not taking
place till after a lapse of two years or more from marriage, although
there be no obvious cause in the health of either husband or wife to
account for this delay.^ But leaving the sterile marriages out of
the question, we cannot but be struck with the great diminution in
fecundity in those women who were suffering from ailments of the
generative system. This result, however, instead of being more
marked in cases of ulceration of the os uteri, than in those where
no such condition existed, appears in reality to be less so ; while a
comparison of the third and fourth divisions of the table with the
second, indicates that other causes (such, I believe, as ovarian dis-
eases and uterine tumors) exert a more unfavorable influence on
female fecundity than the various morbid conditions of the cervix or
OS uteri.
Though the table seems to show that the number of successful
pregnancies was slightly greater ; and the number of abortions
slightly less, in those cases in which ulceration of the os uteri was
present, than in those in which it was absent, I do not wish to draw
from it such a conclusion. The difference between the two classes
of cases is but small, and the number of facts from which this table
is constructed are too few to justify any such inference; but I do
think that we are warranted in concluding that ulceration of the os
uteri does not interfere with the performance of the most important
function of the generative system in any peculiar manner, or to a i
greater degree than many other uterine ailments.
So many other causes, however, besides the state of a woman's
sexual health, may interfere with conception, that we must be ex-
tremely guarded in drawing conclusions with reference to it from
the rate of her fecundity alone. The manner in which her menstrual '
function is performed affords a better index to the healthy or diseased
state of her generative system; and to that we shall presently direct
our attention. But the more numerous the points of view from which
we compare cases of ulceration of the os uteri with other cases of
uterine disease, unattended by ulceration, the greater will be the
* See M. Villenne's observations on this subject in Annales d'Hygi^ne, torn. v. p. 86.
52
CONNECTION OF ULCERATION WITH
probability of our coming ultimately to a correct conclusion with
reference to the value of that condition. Before inquiring into the
state of menstruation in the two classes of cases, we will therefore
compare them in one or two other respects.
The facts to which I called your notice this afternoon with reference
to the comparative immunity of prostitutes from serious ulceration of
the OS uteri, showed that mere excessive sexual intercourse does not
exert a special influence in the production of that affection : the table
we have just examined has proved that a woman's fecundity is not
peculiarly diminished by its existence. This second table, however,
seems to render it probable that some connection exists between the
period of the most vigorous performance of the sexual functions and
that state of the uterus in which ulceration of its orifice is most apt
to occur; since, while 43 per cent, of the cases where ulceration was
absent occurred after the age of 35, only 13.6 per cent, of those in
which ulceration existed were met with subsequent to that age.
TABLE II.
Showing the Age of the Patients in the two Classes of Cases.
ULCERATION.
AGE.
Absent.
Present.
Under 20 years
:..■
4
Between 20 and 30 years
47
69
" 30 " 35 " ...
36
35
'' 35 " 40 *'
31
9
" 40 *< 50 "
23
8
** 60 " 60 "
3
Above 60 years
2
...
142
125
Of Ist class .... 9
single 3 not one year married
Of2d " . . . .6
2
The same fact may, perhaps, be thought to receive some slight
confirmation from the circumstance that if we inquire into the cause
of the patient's symptoms in the two classes of cases, we shall find
that they were attributed to marriage, pregnancy, or delivery, in 48
per cent, of those in which the os uteri was ulcerated, and only in
41 per cent, of those in which nictation was absent — a difference
however, which is less marked if t^^ cases only are included in
which a definite cause was assigned for the symptoms.
ACTIVITY OP SEXUAL FUNCTION^.
53
But be this as it may, there is at least one point which the sub-
joined table clearly illustrates, namely, the general identity of the
causes which produce the symptoms of uterine disease, whether
ulceration of the os uteri is present or absent.
TABLE III.
Showing alleged Causes of Uterine Ailment.
ULCERATION.
CAUSES.
ABSENT.
PRESENT.
Actual
Proportion
Actual
Proportion
numbers.
per cent.
numbers.
per cent.
None assigned
55
38.4
41
32.8
Of the remaining ....
88
61.6
84
67.2
Marriage
10
11.3
7
8.3
Pregnancy
3
3.4
2
2.3
Abortion
17
19.2
16
19
Delivery
27
30.7
• 32
38
Lactation
2
2.2
3
3.5
Gonorrhoea or syphilis .
13
14.7
11
13
Disordered menstruation
3
3.4
Uterine or abdominal inflammation
1
1.1
*3
3.5
Injury, operations on, or diseases of
Uterus
7
7.9
4
4.7
Sedentary occupation .
2
2.2
3
3.5
Other causes ....
3
3.4
3
3.5
88
99.5
84
99.3
Nor, indeed, as far as can be judged from the duration of the
symptoms before their severity or their continuance impelled the
patients to seek relief at the hospital, do we find materials for draw-
ing any distinction between the two classes of cases. It appears
that, while 46 per cent, of those cases in which ulceration was absent
applied at the hospital within a year after the commencement of
their ailments, not more than 47 per cent, of those in which ulcera-
tion existed sought relief during the same period. From this fact
it is, I think, fair to infer that the patients suffered about equally
under both circumstances, and that the symptoms were not mate-
rially aggravated by the presence of ulceration of the os uteri.
54
SIMILARITY OP SYMPTOMS
TABLE IV.
Showing Duration of Symptoms at Commencement of Treatment.
ULCERATION.
DURATION.
ABSENT.
PRESENT.
Actual
Proportion
Actual
Proportion
numbers.
per cent.
numbers.
per cent.
Under 1 month
7
6.1
7
5.9
Between 1 and 3 months .
14
10.2
15
12.7
u 3 " 6 "
27
19.1
13
11
« 6 " 9 "
10
7.3
7
5.9
" 9 <« 12 "
6
4.4
14
11.8
♦* 12 « 18 "
8
5.8
6
5
<' 18 months and 2 years
11
8
9
7.6
" 2 and 3 years
12
8.8
16
13.5
" 3 " 5 "
16
11.7
19
16.1
*' 5 '* 10 ** . .
15
11
10
8.4
From 10 years and upwards
10
7.3
2.
1.6
136
98.7
118
99.5
If we pursue this inquiry further, and endeavor to ascertain, as I
proposed doing a few minutes ago, whether the manifestations of
menstrual disorder are alike or diverse in the two classes of cases,
we shall but obtain another proof of the same general correspond-
ence between them.
TABLE y.
Slwwing the State of Menstruation.
MENSTRUATION.
ULCERATION.
ABSENT.
PRESENT.
Actual
Proportion
Actual
Proportion
numbers.
per cent.
numbers.
per cent.
Natural
52
37.6
36
30
Ceased from age ....
8
5.7
—
In the remainder ....
78
56.9
84
70
Modified as follows:—
Suppressed from suckling or preg-
•
nancy
6
7.6
13
15.4
Suppressed
2
2.5
1
1.1
Irregular
5
6.4
5
5.9
Scanty, or postponing .
10
12.8
12
10.7
Painful
17
21.7
9
10.7
Profuse, or anticipating .
30
38.4
37
44
Always unnatural in some respect .
8
10.2
7
8.3
78
99,6
84
99.6
Gross total
138
120
WITH AND WITHOUT ULCERATION.
55
This table, like the others, comments on itself, and needs but little
to be said in the way of explanation; for such differences as are
observed between the two classes of cases show no more than a
somewhat greater activity of the sexual function in those where
ulceration was present than in the others. In them, pregnancy or
Jactation was more frequent ; scanty, irregular, suppressed, or painful
menstruation was rarer ; while excessive or over-frequent menstrua-
tion occurred with greater frequency.
TABLE VI.
Showing the Relation of Leucorrhoea to Ulceration of the Os Uteri.
LBUCOBBH(EA.
ULCERATION.
ABSENT.
PRESENT.
Actual
numbers.
Proportion
per cent.
Actual
numbers.
Proportion
per cent.
Absent
Present
13
125
138
10.4
89.6
5
115
120
4
96
100
100
Its quantity estimated in .
101
80.8
68
59.1
Of these— Profuse
Scanty ....
Moderate
38
21
42
37.6
20.7
41.5
30
10
28
44.1
14.7
41.1
101
99.8
68
99.9
Its sources determined in .
80
64
85
73.8
Of these— from Uterus . , .
Vagina . .
Both
Also to an appreciable degree from
ulceration in ... .
From ulceration alone .
54
19
7
67.5
23.7
8.7
53
6
8
12
6
62.3
7
9
14.1
7
80
99.9
85
99.8
But there are other respects in which, though at the risk of seem-
ing tedious, a comparson may be instituted between the two classes
of cases, with the view of determining whether the presence of ulcer-
ation of the mouth of the womb alters the character of the symptoms,
or increases or otherwise modifies their severity. Leucorrhoeal dis-
charges are enumerated as among the most constant and most charac-
teristic symptoms of ulceration of the os uteri. The discharge is sup-
56
SIMILARITY OF SYMPTOMS
posed to be furnished either from the ulcerated surface itself, or from
the inflamed and irritated canal of the cervix ; and the healing of the
ulceration is conceived to be the first step towards the cure of the
discharge — often, indeed, all that is necessary for its removal. Let
us, therefore, see whether leucorrhoea is greatly more frequent, more
profuse, or furnished from a difi'erent source, where ulceration exists,
than in cases where it is absent (see Table VI.).
Now Table YI. appears to me to show very clearly that leucorrhoeal
discharges are not dependent for their cause upon any peculiar con-
dition of the uterus, such as of necessity gives rise to ulceration of the
OS uteri, or such as is itself consequent upon ulceration of the os ; and
still more, that they are not furnished to any considerable degree by
the ulcerated surface itself. It will be seen that, in 67 out of 85
cases in which the source of the discharge was determined by the
speculum, or in 78.8 per cent., no appreciable amount of secretion
was furnished from the abraded surface ; while the instances in which
the abrasion seemed to be the sole source of the discharge did not
exceed 6 out of 85 cases, or 7 per cent, of the total number.
If the same kind of inquiry be extended to another symptom
seldom absent in uterine affections — namely, pain — we shall once
more find a close correspondence between the two classes of cases.
TABLE YII.
Showing the Frequency and the Seat of Pain in the two Classes of Cases.
PAIN.
ULCERATION.
ABSENT.
PBESENT.
Actual
numbers.
Proportion
per cent.
Actual
numbers.
Proportion
per cent.
No complaint of pain
Pain referred to uterus
" back
" pubic or iliac region .
" uterus and back
*' uterus and pubic or
iliac region .
" back and iliac region
" all these regions
21
36
31
7
24
12
9
21
143
14.6
25.1
9
4.8
16.7
8.3
6.2
14.6
99.3
18
28
6
3
20
9
11
30
125
14.4
22.4
4.8
2.4
16
7.2
8.8
24
100
The only difiference, indeed, seems to be a slight one in degree,
such as has been already exemplified in other instances.
WITH AND WITHOUT ULCERATION.
6T
Menstruation was found to be oftener excessive, leucorrhoea to be
more frequently profuse, in cases where the os uteri was ulcerated ;
and, in like manner, the existence of that condition seems to be
accompanied by pain diffused generally over the whole pelvic region
more frequently when the os uteri is ulcerated than when ulceration
is absent.
Lastly, it remains for us to inquire what was the condition of the
uterus, in as far as it could be ascertained by examination, in the
two classes of cases, selecting for comparison those points which
admit of being ascertained most readily (see Table VIII.).
TABLE YIII.*
Showing the State of the Uterus, in as far as it could he ascertained, in
the two Classes of Cases.
STATE OP UTERUS.
ULCERATION.
ABSENT.
PRESENT.
Actual
numbers.
Proportion
per cent.
Actual
numbers.
Proportion"
per cent.
Uterus apparently healthy
29
20.8
36
30
Not healthy in some respect or other
Misplaced in
Lower than natural
Eetroverted or retroflected
Anteverted or anteflected
110
36
28
3
5
79.2
32.7
25.4
2.7
4.6
84
31
21
5
5
70
36.9
25
7.9
7.9
Its body enlarged ....
Body alone
Os or cervix also enlarged or indurated
30
20
10
27.2
18.1
9
36
12
24
42.8
14.2
28.5
Its cervix or os enlarged or indurated,
or both
Cervix or os alone ....
Body also
44
34
10
40
30.9
9
47
23
24
55.9
27.3
28.5
Its orifice more or less congested
With otherwise healthy uterus
With enlarged uterus .
With misplaced uterus .
With enlarged or indurated os or cervix
58
20
9
12
17
52.7
18.1
8.1
10.9
15.4
This last table once more exemplifies the same general correspond-
ence as we have already noticed between the two classes of cases ;
' It is almost needless to observe that this table represents only those morbid con-
ditions of the uterus which bear upon the subject of these Lectures, and even they
existed in several other combinations besides those which are here represented.
t»
INFLUENCE OF ULCERATION OF OS
but it also shows that enlargement of the body of the uterus, and
enlargement or induration of its cervix, existed much more frequently
in connection with ulceration of the os uteri than independently of
that condition. Still, the exceptional cases are far too numerous to
allow of the assumption that the latter state is usually the cause of
the former. Moreover, in two-thirds of the cases where ulceration
was absent, and in one-third of those in which it was present, the
enlargement was confined to the body of the womb — a fact easily
reconcilable with the belief that that part of the organ, as it is of
the greatest physiological importance, so is also the more frequent
seat of the gravest pathological processes, or, at any rate, their
most usual point of departure.
It also seems questionable, from the data which this table furnishes,
whether induration of the os or cervix uteri is so generally dependent
on ulceration of the os uteri as has been asserted, since it was present
in 40 per cent, of the cases where no ulceration existed. Besides,
if such a connection as that of cause and effect subsisted between
ulceration of the os uteri and induration of its cervix, or even if there
were any necessary relation of degree between them, we ought to
find the most extensive ulceration coexist with the greatest hypertro-
phy and most considerable induration ; while slight ulceration of the
OS, and an otherwise healthy state of the cervix, might be expected
to be usually found together. Facts, however, as will be presently
seen, do not bear out this opinion.
The tables to which I now beg your attention show the data on
which this assertion is rested.
TABLE IX.
Showing the Different Seats and Comparative Frequency of Different Forms
of Ulceration of Os Uteri.
ULCERATION.
SIMPLE ABRASION.
GRANULAR.
BOTH VARIETIES.
Actual
numbers.
Proportion
per cent.
Actual
numbers.
Proportion
per cent.
Actual
numbers.
Proportion
per cent.
Of anterior lip
Of posterior lip
Of both lips
6
11
57
73
4.1
9
47.1
60.2
"i
44
48
3.'3
36.3
39.6
5
15
101
121
4.1
12.3
83.4
99.8
ON STATE OF UTERUS.
(59
TABLE X.
Showing the Degree in which the Different Forms of Ulceration existed.
ULCERATION.
SIMPLE ABRASION.
GRANULAR.
BOTH VARIETIES.
Actual
numbers.
Proportion
per cent.
Actual
numbers.
Proportion
per cent.
Actual
numbers.
Proportion
per cent.
Slight ....
Moderate . .
Extensive . .
31
33
9
73
25.6
27.2
7.4
60.2
15
26
7
48
12.4
21.2
6.7
39.3
46
59
16
121
38
48.4
13.1
99.5
In 121 out of the total 125 cases of ulceration of the os uteri, its
seat, character, and extent were described with minuteness sufficient
to warrant conclusions being drawn from them. I have endeavored
to discriminate between that form of abrasion which is smooth, con-
sisting in a mere absence of the epithelium, or slightly aphthous,
presenting somewhat of a worm-eaten appearance — the epithelium
being removed only from small circumscribed spots or points — and
the other distinctly granular variety of the affection. I have also
considered as slight those abrasions which neither extended along the
canal of the cervix nor reached for more than a line around the os
uteri; as moderate, those which, whether on one lip or on both,
occupied a surface of two or three lines in extent ; and as consider-
able, all those of greater dimensions.
A further examination of the cases represented in the two pre-
ceding tables elicited two important facts.
1st. That in 25 out of the 46 cases in which the ulceration is
stated to have been slight, more or less considerable induration or
enlargement of the lips or neck of the womb was present.
2dly. That in 9 out of 16 cases in which the ulceration was
stated to have been considerable, there was no induration nor en-
largement either of the cervix or os uteri.
The following table represents the further particulars of the above-
mentioned 16 cases.
60
INFLUENCE NOT CONSIDERABLE.
TABLE XI.
Showing the Various Conditions of the Uterus associated with Extensive
Ulceration of its Orifice.
Uterus otherwise healthy
Body of uterus large
Uterus lower than natural
Uterus large, cervix hard
Uterus healthy, but cervix hard
Uterus healthy, but lips of os hard
Simple
abrasion.
Granular.
Both
varieties.
It seems, then, that while, on the one hand, very slight ulceration
of the OS uteri may coexist with induration of the cervix of the
organ, very extensive ulceration of the os may, on the other hand,
be compatible with an apparently healthy condition of the cervix ;
and that, consequently, ulceration of the mouth of the womb and
induration of its cervix stand in no constant nor necessary relation
to each other.
It would be possible, and perhaps not without some profit, to
compare together the two classes of cases which we have been
studying from some other points of view. But we have examined
all their more important features, and each separate examination
has seemed to me to lead to the same conclusion. More numerous
cases would doubtless have cleared up some obscure questions —
would have imparted a greater exactness to some of our deductions ;
but I venture to think they would not have materially altered the
results which the facts laid before you in this Lecture appear to
warrant.
These results may be best summed up under the five following
heads ; and the order in which they are enumerated nearly corre-
sponds with that in which the facts whence they are deduced were
successively brought under your notice.
1st. Uterine pain, menstrual disorder, and leucorrhoeal dis-
charges — the symptoms ordinarily attributed to ulceration of the
08 uteri — are met with independently of that condition almost as
often as in connection with it.
2d. These symptoms are observed in both classes of cases with a
vastly preponderating frequency at the time of the greatest vigor
of the sexual functions, and no cause has so great a share in their
CONCLUSIONS ON ULCERATION. 61
production as the different incidents connected with the active exer-
cise of the reproductive powers. But it does not appear that
ulceration of the os uteri exerts any special influence, either in
causing sterility or in inducing abortion.
3d. While the symptoms are identical in character in the two
classes of cases, they seem to present a slightly increased degree of
intensity in those instances in which ulceration of the os uteri
existed.
4th. In as far as could be ascertained by careful examination,
four-fifths of the cases of either class presented appreciable changes
in the condition of the uterus — such as misplacement, enlargement,
and hardening of its tissue, while frequently several of these condi-
tions coexisted. An indurated or hypertrophied state of the cervix
uteri was, however, more frequent in connection with ulceration of
the OS uteri than independently of that condition.
5th. The inference, however, to which the last-mentioned fact
would seem to lead, as to the existence of some necessary relation,
such as that of cause and effect — between ulceration of the os uteri
and induration of its cervix, is in great measure negatived by two
circumstances : —
1. The number of instances in which an indurated cervix coex-
isted with a healthy os uteri.
2. The fact that, while induration of the cervix was present in
25 out of 46 cases in which the ulceration of the os was very slight,
it was altogether absent in 9 out of 16 cases in which the ulceration
was noted as having been very extensive.
These inferences sufficiently show that I do not subscribe to
either the first or second of those three conclusions, one or other of
which, it was stated at an early period of this Lecture, would
probably be found to represent the truth of this matter ; that I do
not regard ulceration of the os uteri either as the general cause
of the symptoms which have been attributed to it, or even as
a general concomitant of them, and index of their degree and seve-
rity. It would, indeed, have simplified the study and the treatment
of uterine disease very much, to have found that a slight erosion of
the mucous membrane of the least important part of the womb was
the cause of four-fifths of those painful ailments to which the female
sex is liable ; but I will venture to add that it would have shown
diseases of the womb to constitute a most marvellous exception to
the ordinary rules of pathology.
62 CONCLUSIONS ON ULCERATION.
If, then, there be no more here thai^ elsewhere, any royal road to
knowledge, it remains for us only to make out, as best we may,
with what varied states of the general health, or of the sexual
system, the various signs of uterine disease are connected ; to learn
how, in different cases, we may surely distinguish, or even shrewdly
guess, their import. The task is tedious, perhaps, but it is the
same as in all other departments of medical inquiry we have to en-
counter.
LECTUEE III.
Causes of uterine ailments very various — sometimes independent of local disease, as
in the case of chlorosis, of hepatic disorder, of granular disease of the kidneys,
of the gouty or rheumatic patient — all illustrate the dependence of uterine
disorder on constitutional disease. Ulceration of the os uteri, when present in
such cases, of secondary importance; and equally so in many instances where
disease really begins in the uterus itself, as in ailments succeeding to pregnancy,
abortion, delivery, etc.
Sketch of the history of a patient in whom menorrhagia succeeds to delivery or to
abortion; case in illustration of defective involution of the uterus, and its
results. Inquiry as to the result of inflammation attacking the uterus under
these circumstances; case in illustration — reasons for believing the mischief in
such cases to begin in the interior of the womb, confirmed by history of patient
in whom uterine inflammation succeeded to gonorrhoea ; extension of this hypo-
thesis to explanation of other somewhat similar cases. Importance of a£"ections
of canal of cervix uteri believed to have been overrated, and why.
Ulceration of os uteri not absolutely unimportant ; case illustrative of symptoms of
its simplest form — characters which it presents — uncertainty as to nature of
some of them — remarks on so-called Granular Metritis. Question of local treat-
ment in some instances in which ulceration persists after subsidence of original
ailment.
Explanation suggested of alleged cures of uterine ailment by local use of caustics —
mischievous result, both to patient and practitioner, of the opinions on which
their indiscriminate employment is founded. Cases considered in which the
stronger caustics are alleged to be required; practice objected to, and why.
Reference to exceptional cases of ulceration calling for local treatment; pecu-
liarity in case of uterus modifies nature and mode of employment of local
remedies. — Concluding observations.
Mr. President —
Sir: The task of to-day is a far more difficult one than was that
of either of the two previous days ; and in my endeavor to fulfil it,
I shall stand more than ever in need of your kind indulgence.
Hitherto, I have been engaged in the attempt to show what I believe
to be the fallacies of certain opinions which come before us not only
recommended by high authority, but also attractive from their sim-
plicity, from the easy explanation that they profess to offer of very
varied and very complex processes of disease, and from the uniformity
of the treatment that they suggest as applicable alike to all.
64 CONSTITUTIONAL CAUSES.
It may not unnaturally be expected that, before undertaking so
invidious an oflSce, I was prepared with some other solution of these
different morbid phenomena equal to that which I reject in its sim-
plicity and in the universality of its application, but claiming to
rest OQ stronger grounds, and to be open to fewer objections.
Unfortunately, I can put forward no such pretensions, for I believe
that instead of the different symptoms which are supposed to depend
on ulceration of the os uteri being produced by that or by any other
single cause, they in reality arise from very various causes ; that at
one time they attend on general constitutional disorder, at another
on some ailment of the sexual system, and that ailment by no means
the same in every instance. If this be so, however, instead of the
consideration of one pathological condition of the uterus and its
possible consequences, we have to inquire into little less than uterine
disorders in general, their causes and their symptoms — an under-
taking which would occupy not one Lecture, but several ; and the
preparation for which would be the study of a lifetime.
All, then, which I can attempt will be to furnish a few illustrations
of the subject, such as may serve, if to do no more, at least to show
the direction that investigation should take in order to remove the
difficulties by which it is surrounded.
A not infrequent instance of disorder of the uterine function,
independent of ailment of the organ itself, is afforded us in the case
of the chlorotic girl, in whom the menses scarcely show themselves
for months together, while an abundant white discharge is often
poured forth from the uterus, either constantly or with an ill-marked
periodicity, and uterine and lumbar pains attend upon the symptoms.
Remedies improve the general health, correct the morbid state of the
circulating fluid, and step by step the local ailments improve too ;
the leucorrhoea subsides, the pain ceases, and all indications of
uterine disorder disappear, although the womb itself has never been
the object of special treatment.
Or, in another and usually a much older person, the liver performs
its functions but imperfectly; constipation, headache, an icteroid
tinge of the skin, mark its disorder : at length menstruation comes
on with unusual profuseness, and the signs of hepatic disturbance
disappear. This may, occur but once, or it may occur several times ;
the slightest error in diet, the slightest neglect of the state of the
bowels, or some cause too trivial to be discovered, may produce
the same derangement of the function of the liver, which may
CAUSES OF UTERINE AILMENTS. Q5
again give rise to the same train of symptoms, and cease on the
recurrence of a similar hemorrhage. But nature's healing power
is often ill-regulated; and, erring in too little or too much, the regu-
lar periodicity of the menstrual function becomes deranged ; many
weeks pass without the appearance of the menses, and then they
appear again and again with a frequency and profuseness which
seriously impair the patient's health, which sometimes even threaten
her life.
Or, again, the kidneys, from unsuspected disease, perform their
duties incompletely, and the blood, imperfectly depurated, its red
particles diminished, its watery elements increased, pours forth at
the return of each periodical congestion of the womb in larger
quantities than when the patient was in health. Leucorrhoeal dis-
charges follow in the intervals of menstruation ; pain is felt in the
back ; bearing-down follows any exertion ; the frequent micturition
seems to indicate the sympathetic suffering of the bladder, while the
loss of muscular tone, and the long persistence of congestion of the
womb at every period, favor the actual prolapsus of the organ. The
patient seems to be sinking under monorrhagia ; she is really dying
from the effects of granular degeneration of the kidneys, and conse-
quent albuminuria.
Or, lastly, to take another illustration of the mode in which uterine
symptoms depend on constitutional causes,* let us notice how im-
portant a part the gouty and rheumatic diathesis sometimes plays
in the production of uterine symptoms. A casual attack of cold is in
some instances referred to as the occasion of the patient's illness, while
in other cases the ailment comes on by degrees, and with no definite
exciting cause. Menstruation begins to be more painful than was
its wont, often more scanty ; an unusual degree of constitutional
disturbance attends each period ; the pulse at those times is very
frequent, the skin hot though perspiring, and lithates abound in the
urine. In the intervals, profuse leucorrhoeal discharges take place ;
the pain, though less intense, is yet severe, and is aggravated by
trifling causes, or without any obvious reason. The pain at one
time is most severe in the back, at another is referred to one or
other iliac region, shooting down the legs, in the course of the
^ The observations of Dr. Todd on this subject, in Section ix. of Practical Remarks
on Gout, Rheumatism, Fever, &c. 8vo. London, 1843, and those of Dr. Rigby, in his
work on Dysmenorrhoea, published in 1844, have more specially called attention to
this subject.
5
66 CONSTITUTIONAL CAUSES
crural nerve, or, like sciatica, aifecting the back of the thighs ; while
occasionally, in addition to these abiding discomforts, the patient is
kept in bed for a day or two at a time by slight feverish attacks,
accompanied by wandering pains in the limbs, though seldom at-
tended by inflammation and swelling of any of the joints.
Cases of this kind are met with in all classes of society ; and
wherever they occur they are chronic in their course and difficult
of cure. Among the poor they do badly out of a hospital ; for rest,
uniformity of temperature, and a suitable diet can seldom be ob-
tained ; while they do but ill in a hospital, since the absence of
regular occupation and of exercise cannot but be injurious, while
the listlessness of mind which the patient's state and circumstances
engender is favourable to hypochondriasis, and to the exaggeration of
any ailment of the nervous system. The aff"ection is one not unusual
among young women who follow the occupation of book-folding,
working, as they are compelled to do, in a heated, but at the same
time in a damp atmosphere, and for the most part in ill-ventilated
apartments. A very obstinate case of it came under my notice
some time since in a young person who had been compelled, by
lameness from birth, to lead a very sedentary life, and who had
always suff'ered from vague rheumatic pains. And not long since,
a washerwoman, whose finger-joints were enlarged by chalk-stones,
but in whom menstruation had already ceased, applied at the Out-
Patient room of St. Bartholomew's Hospital on account of profuse
leucorrhoea and rheumatic pains, which disappeared simultaneously
under the use of colchicum and iodide of potassium.
The rich enjoy no immunity from this ailment. A lady, who had
suff'ered severely from rheumatism in India some twenty years before,
experienced more or less of these symptoms ever since ; and when
I saw her, menstruation having ceased for more than a year, leu-
corrhoea still persisted, associated with abundant deposits of lithates
in the urine, a tendency to eczema of the vulva, and most intense
tenderness of the uterus, though that organ had already begun to
undergo the atrophy of age. An unmarried lady, aged 35, who
inherited gout from her father, displayed the symptoms just men-
tioned, with the exception of the cutaneous affection, most severely ;
and, in addition, suff'ered much from pain in the back and dysuria,
excreting from time to time very large quantities of lithic acid
crystals. Errors in diet, and all the accidents inseparable from
mixing in society, render this ailment almost as unmanageable among
OF UTERINE AILMENTS. 67
•the wealthy as it is among the poor, and the chances of relapse
nearly as great. In either class of patients improvement in the
general health is associated with amendment, though not with an
equivalent amendment, in the uterine symptoms ; while any exa-
cerbation of suffering is accompanied by most abundant deposits of
lithates in the urine, and by a specific gravity of that fluid as high
as 1030° or 1035°.
That the muscular tissue of the uterus should, under these circum-
stances, be the seat of extreme pain is just what might be expected.
The distinction, indeed, between rheumatic and neuralgic pain is not
very clear ; and many cases resembling those of irritable uterus, as
described by the late Dr.Gooch, with all that graphic skill of which
he was so great a master, may be referred to this category. The
treatment which affords relief is just such as the state of the urine
and the assumed rheumatic character of the symptoms would seem
to indicate. Colchicum, iodide of potassium, diaphoretics and seda-
tives, alkalies and vegetable bitters, are the remedies on which we
must rely to obtain amendment, and by which, under favourable cir-
cumstances, we may even accomplish a cure.
Now it scarcely need be observed that, in the different classes of
cases glanced at, disease of the womb is not the cause of the symp-
toms, nor can it be by medication of that organ that we can hope to
cure the patient. I have known a lady in whom amenorrhoea and
nienorrhagia alternated, associated with obstinate functional disorder
of the liver, flood to death from a uterus which was small and, as
far as careful examination during life could ascertain, quite healthy.
Pain and exquisite tenderness of the uterus existed in another case
just referred to, together with abundant leucorrhoeal discharge,
although the menstrual function had not only ceased, but the uterus
had begun to undergo the atrophy of age. True it is, that a uterus
from which hemorrhage takes place more frequently and more abun-
dantly than natural, may be found larger and heavier than it will
be weeks afterwards, when treatment has stanched the bleeding or
reduced its occurrence to the proper times, and confined its quantity
within the natural limits. It is also true that a limited abrasion of
the OS uteri is now and then present in some of these cases, but it
is neither considerable in extent nor uniform in its presence ; it
exists one day, and is not to be discovered a week afterwards ; and
then again it reappears, once more to vanish. But what of that ?
The dyspeptic patient has a congested palate, or enlarged tonsils, or
68 OCCURRENCE OF UTERINE
even aphthous ulcerations of the mucous membrane of the mouth ;
and, as the extremity of the digestive tube sympathizes with the
disorders of its important parts, so does the orifice of the womb
often afford an index to the condition of its interior. With the
restored health, the swollen tonsils or the soreness of the mouth
disappear ; and so, when the uterine congestion subsides, its orifice
resumes a natural aspect. The abrasion of the os in these cases is
indeed very slight, much slighter than we shall find it to be in other
instances in which the cause of the symptoms is seated in the sexual
organs themselves ; but, if I do not mistake, the explanation just
suggested of the import of ulceration will be found to be often appli-
cable even to them.
The tables to which reference was made in the last Lecture
showed that, in a very large proportion of cases — between 40 and
50 per cent. — marriage, pregnancy, abortion, or delivery, was re-
ferred to as the exciting cause of the symptoms from which the
patients suffered ; while these symptoms were just of that kind which
are often attributed to ulceration of the os uteri.
According to the opinion of some observers, these causes act by
producing inflammation of the cervix uteri, and consequent ulceration
of its orifice, of which occurrences all the different phenomena we
have noticed are the direct or indirect results. Others, however
— and I confess myself to be of that number — demur to this ex-
planation, and believe that these cases not only allow, but require,
a different interpretation. We will select for examination one of
the most frequent, and at the same time of the simplest kind. A
woman, after delivery, leaves her bed too soon, or makes some inju-
dicious exertion at a time when the uterus is still heavy, its vessels
are still large, and the process of involution of its tissue is still
incomplete, while the persistence of some lochial discharge shows
that exfoliation of the mucous membrane of its cavity, which is re-
peated again and again after parturition, has not come to an end.
Perhaps no striking ill effect is produced at the time, but blood still
continues to flow through vessels which, under other circumstances,
would long since have ceased to convey it, and whose collapsed walls,
undergoing the same fatty degeneration as the rest of the old uterine
tissue, would have been in course of removal. The lochial discharge,
indeed, persists, but the patient experiences no other inconvenience
until the lapse of about a month after her delivery. Then, however,
the ovaries, in obedience to the law of their periodic activity, make
AILMENTS AFTER DELIVERY. 69
a slight effort to resume their wonted function— an effort which, in
the healthy subject, is just indicated, and no more. But, under the
less favourable circumstances in which this woman has placed herself,
the undue congestion of her sexual organs that before existed be-
comes now raised to a point at which hemorrhage breaks out from
the interior of her womb. This hemorrhage lasts for some days
and then subsides, but abundant secretion from the mucous mem-
brane still continues ; and before long — probably under the influence
of a return of ovarian excitement — a fresh outbreak of hemorrhage
occurs, and then another, until, by the frequent return of bleeding,
and by the profuse secretion from the mucous membrane in the
intervals, the blood becomes impoverished and the health enfeebled.
If we examine such a patient, we shall probably find her uterus
lower down than natural, its size and weight increased, its orifice
open, its cervix short, and its tissue soft, while the epithelium of the
OS may or may not be somewhat abraded. Whence, now, in this
case comes the hemorrhage ? whence the abundant leucorrhcea ?
what importance is to be attached to the abrasion of the os uteri
when it is present ? The discharges are doubtless furnished in great
measure from the uterine cavity, within which all the important
physiological processes of pregnancy, labour, and its consequences
have been recently transacted ; in part, perhaps, from the whole
tract of the Fallopian tubes, which may be found, at an ordinary
menstrual period, distended to double or treble their usual caliber
by a thick mucus stained by admixture of blood to a rose colour, or
even to a deeper tint. The lining membrane of the cervix uteri
doubtless participates in the general congestion ; its mucous crypts
probably pour out their secretion with more than usual abundance,
and thus add to the leucorrhcea ; but no one can suppose that, in
such a case as this, the source of the symptoms is to be found in
the neck of the womb, or that the absence of epithelium for a few
lines around its orifice is here a matter of the slightest pathological
importance.
The same occurrence may follow after abortion, and happens,
indeed, more frequently then than after delivery at the full period,
since the necessity for care is less apparent. The symptoms which
attend it are the same, and under their persistence the involution of
the uterus may for weeks be completely arrested.
A married woman, the mother of five children, and who had
miscarried three times, but not successively, was received into St.
70 DEFICIENT INVOLUTION OF THE UTERUS.
Bartholomew's Hospital on account of symptoms which she had ex-
perienced since a miscarriage at the third month six weeks pre-
viously. She suffered from a constant discharge, almost always
tinged with blood, and sometimes from profuse hemorrhage. She
complained of great pain at the lower part of her back and of her
abdomen, and of a constant bearing-down sensation, which was much
aggravated on any attempt at exertion, or effort at defecation ;
her countenance was pale, and expressive of pain, and her pulse was
feeble. On examination, the uterus was found low down, retroverted,
its orifice looking directly forwards, and about two inches from the
vulva ; its body and fundus enlarged, so as to form a globular tumour,
about the size of a small apple, the walls of which were elastic.
The anterior lip of the uterus was thin and small, the posterior
somewhat thicker, and about half an inch longer. The os uteri
was open, and the finger could be passed for a short distance without
occasioning pain. The uterine sound was introduced with the con-
cavity directed backwards : on turning it round, the tumour before
mentioned completely disappeared, the sound passing to the extent
of 5| inches, showing the uterus to be three inches larger than
natural. >
Rest, tonics, and the cold douche to the uterus, arrested the he-
morrhage, greatly checked the discharge, and improved the patient's
health. The uterus, however, remained of about the same dimen-
sions at the end of a fortnight, when the outbreak of smallpox in
the ward necessitated the woman's discharge from the hospital. I
saw her again once six weeks afterwards, and the uterus was greatly
diminished in size ; but I had not then the opportunity of ascertaining
its exact dimensions by means of the uterine sound. Other cases of
a similar kind have at different times come under my notice, but I
do not remember any in which the uterus remained of so large a
size as in the instance just related.
In the above-mentioned instance, and in many others of a similar
kind, there is no evidence of any other morbid condition than a mere
deficient involution of the uterus.^
It must, however, be at once apparent that- such a state is one in
which processes akin to inflammation will be very likely to supervene,
* See, with reference to this subject, a short but very interesting paper, by Pro-
fessor Simpson, on Morbid Deficiency and Morbid Excess, in the Involution of the
Uterus after Delivery, in the Monthly Journal for 1852.
TENDENCY OF UTERUS TO HYPERTROPHT. 71*
and to aggravate the patient's condition ; while, even should that
not be the case, the law which connects hypertrophy of an organ
with long-continued congestion of its vessels, will, at any rate, not
meet with an exception in the case of the uterus. No organ of the
body presents naturally conditions so favourable to the occurrence of
hypertrophy as the uterus, since nowhere else is there the same store
of formative material, only awaiting some stimulus to excite it to
development. The presence of an impregnated ovum in its cavity,
is the appropriate stimulus which awakens to the full its dormant
vital energies. But I need not mention how the development of
an extra-uterine ovum, the formation of a polypus in the cavity of
the womb, the growth of a fibrous tumour in its wall, even the can-
cerous disease which destroys its substance, will also call those
energies into activity, and cause the uterus to grow to dimensions
far exceeding those which it naturally presents. It may, indeed,
be stated that excitement of the uterus of almost any kind during
the period of sexual activity tends to increase its size : and further,
that this increase of size will be marked in proportion as the stimulus
acts upon the cavity of the organ, and not simply upon its cervix.
How different is the amount of uterine enlargement produced by a
small fibrous tumour imbedded in its walls near to its cavity, from
-that which accompanies even a large cancerous growth from its cer-
vix ! Enlargement of the neck of the womb may, probably generally
does, accompany enlargement of its body ; but that the latter is the
consequence of the former appears to me to be, in the majority of
instances, not merely not proved, but even opposed to probability.
But it may be asked, what does inflammation do if it attacks the
uterus in these cases ? If this question be put as to the intimate
nature of the changes which it works in the uterine tissue, I must
confess that I do not know ; and may add that, to the best of my
knowledge, no one competent to attempt the investigation has ap-
plied himself to the elucidation of this so difficult problem. If,
however, the inquiry be limited to those obvious results apparent to
the ordinary observer, I think I may say that it produces pain of a
severer kind than is experienced in the other cases; pain present-
ing somewhat of a paroxysmal character, and sometimes even being
excruciating from its intensity ; while even in its absence there is
extreme tenderness of the uterus, with great heat of the vagina, and
usually a very abundant purulent leucorrhoea, often, though by no
means invariably, tinged with blood. Moreover, these local symp-
72 RESULTS OF INFLAMMATION
toms are associated with more or less considerable constitutional
disturbance ; while on their subsidence, the uterine tissue, as far as
its state can be ascertained, is felt to be harder in texture than
before ; and lastly, these symptoms, when once they have occurred,
are apt to return at uncertain intervals during a period of many
years, presenting on each occasion the same characters, amenable to
the same treatment, but in spite of it retaining the same disposition
to recur over and over again.
In September, 1851, a married woman, aged 41, was admitted into
St. Bartholomew's Hospital, and told the following history of her
ailments : Having married at sixteen, at which time the menstrual
discharge was scanty, and irregular in its return, she at once became
pregnant, but miscarried at the third month. A second pregnancy
terminated at the full period after a lingering labour of two days and
a half duration, in the eighteenth year of her age ; and a third
pregnancy soon afterwards likewise terminated prematurely at the
fourth month. Her symptoms dated from the time of her lingering
abour; and consisted of leucorrhoeal discharge, sometimes very
copious, occasionally also very offensive ; constant sense of dis-
comfort in the uterine region, with occasional sharp stabbing pain,
chiefly referred to the right groin, and always aggravated at a men-
strual period ; while the menstrual discharge, which for years had
been gradually increasing in quantity, and was now extremely pro-
fuse, was always succeeded by temporary relief to the patient's suffer-
ings. The pain and the hemorrhage together had worn down her
health ; her countenance was anxious, and her pulse 128, and feeble.
The uterus was found to be rather low down, but not much enlarged,
though very tender; the cervix uteri was indurated, somewhat elon-
gated, and very painful; and the os uteri, which was small and
circular, presented no trace of abrasion, either affecting its lips
or extending into the canal of the cervix, though the congestion
of that part was very marked. Rest, frequent local leeching, and
sedatives, relieved the patient's sufferings, improved diet restored
her strength, and when she left the hospital, in November, she
had lost the sense of pain and bearing-down ; there was but little
leucorrhoea, the tenderness of the uterus was much diminished,
and the congestion of its orifice had entirely disappeared. It may
be added that once, during the course of her treatment, superficial
abrasion of the os uteri showed itself, but disappeared of its own
accord in a few days. Great as the relief was which this poor woman
OF ENLARGED UTERUS. T8|
had obtained, I did not anticipate that she would continue free from
suffering if she returned home to bear a part in the duties, and to
submit to the hardships, which are inseparable from poverty. Ac-
cordingly, in less than twelve months, she returned to the Hospital,
presenting the same symptoms as before, and submitted to a similar
plan of treatment with the like result. The os uteri on this occasion
«lso presented no abrasion, though frequent examinations were made
with the speculum to ascertain this fact. The patient remained this
time somewhat longer than before in the Hospital, and took small
doses of the bichloride of mercury for several weeks, though never in
such quantities as to affect the mouth. For six months after her
discharge she continued almost free from suffering; but in September,
1853, her symptoms began to return: menstruation, though not so
profuse as before, became once more very painful: and for some days
before her admission into the Hospital on October 20, she had pa-
roxysms of such intense severity that she rolled about the bed in
uncontrollable agony ; which large doses of sedatives were unable to
subdue. On her admission, there was the same intense congestion of
the OS uteri as on former occasions, with a very abundant, highly
offensive, purulent discharge, slightly tinged with blood from its
interior ; the womb itself being low down, somewhat larger than
natural, and the cervix large, hard, swollen, and intensely tender ;
but no trace of abrasion of the os was perceptible. The application
of six leeches to the uterus was followed by bleeding so profuse as to
cause syncope ; but for several days subsequently the patient con-
tinued perfectly free from pain, and though it afterwards returned,
yet it never again attained the same degree of intensity. She
remained in the Hospital for six weeks ; during which time local
leeching was occasionally resorted to, small doses of the bichloride
of mercury were again given, together with the syrup of the iodide
of iron ; and under this treatment improvement once more took
place, and the neck of the womb at the time of the patient's dis-
charge was at least a third smaller than it had been at her admis-
sion.
In this instance, we observe symptoms of the greatest severity
recurring again and again without ulceration of the os uteri, or of
the canal of the cervix (for the slight abrasion apparent once, and
then vanishing spontaneously in the course of a few days, cannot
be regarded as of importance) ; and this was observed during three
distinct attacks of illness, spread over a period of three years. I
74' ' IMPORTANCE OF AFFECTIONS
apprehend that one does not err in connecting the patient's illness
■with some inflammatory affection of the mucous membrane of her
uterus, which, supervened upon her delivery, and which, during the
many subsequent years, was every now and then lighted up afresh
by causes which in the household of the poor are not far to seek.
In this instance it is true that the most marked enlargement of the
uterus was perceptible in the neck, not in the body of the womb;
but I doubt whether a diff"erence from other cases in this respect is
a matter of so much importance as at first it may appear. When a
woman has frequently given birth to children at the full period, the
portio vaginalis of the cervix uteri, or in other words that portion
of the neck of the womb which projects into the vagina, becomes
greatly shortened, sometimes almost completely disappears, while it
commonly remains of considerable length in the case of women who
have only aborted, or at most have given birth only to one or two
children at the full period. The deficient involution of the uterus
after a miscarriage, will in such cases be shared in its measure by
the cervix uteri, and by as much of the portio vaginalis as exists ;
and to this circumstance, rather than to any essential difference, I
am disposed, in a large proportion of instances, to attribute the
difference in size of the portio vaginalis. But admitting even that
this explanation is not conclusive, and that the condition of the
cervix is of more importance than I have just suggested, the fact
still remains that all the symptoms of ulceration of the os uteri, and
even that enlargement of the cervix which is said to depend upon it,
were observed during a period of many months, and observed to be
unconnected with any such state during the whole of that period.
It would not be difficult to multiply cases of this description if
time allowed ; but, in further illustration of the subject, I will just
refer to one other of a kindred nature. In some few, h'appily very
few cases, the inflammation, which in gonorrhoea is usually limited
to the vagina, not only attacks the mucous membrane of the bladder,
but affects the lining of the uterus also, and even extends to the
peritoneum, sometimes endangering the patient's life. But without
causing those most formidable results, acute inflammation of the
vagina sometimes extends beyond its original seat, and gives rise to
symptoms such as we are now considering. A patient, aged thirty-
five, was admitted into St. Bartholomew's Hospital, complaining of
dysuria and frequent micturition, of painful and profuse menstrua-
tion, and of leucorrhoeal discharge — symptoms which she referred
OF UTERINE CAVITY. 75
to a somewliat severe attack of gonorrhoea three months before.
Her uterus was found much enlarged, anteverted, and fixed in its
unnatural position, while its tissue generally was much harder than
natural, and the margins of the os uteri, though free from the
slightest trace of abrasion, presented a very marked congestion, and
discharge was poured out from the interior abundantly. It is here,
I think, no unfair assumption to suppose that all these symptoms,
from which the patient had never suffered previous to the gonorrhoea,
were excited by it ; that that had affected the interior of the uterus,
and had also bound down the organ in its unnatural position by
adhesions consequent on peritoneal inflammation. At any rate,
here was no ulceration of the orifice of the womb, and yet here
were all the symptoms which are usually described as indicative of
its presence.
It is w^ell, also, to bear in mind, with reference to cases of this
and of a similar kind, that the assumption of inflammation affecting
the body of the womb is not sufficiently negatived by the absence in
the patient's history of any mention of symptoms so grave as we
might be inclined to imagine that inflammation of the more import-
ant parts of this viscus must of necessity produce. In making*
examinations after death, we constantly find adhesions between the
uterus and rectum, or matting together of the parts within the fold
of one or other broad ligament, although the patient during her
lifetime may never have mentioned any attack of uterine or abdomi-
nal inflammation. Not unfrequently, too, we find the uterus firmly
fixed in the pelvis, with most obvious thickening of the broad liga-
ment, or of the pelvic cellular tissue ; while yet the closest inquiry
will fail to elicit anything more definite than the statement that a
bad confinement or a bad miscarriage some time before was succeeded
by a painful and tedious convalescence.
Other cases might be mentioned which, I believe, admit of the
same interpretation — cases where the symptoms have succeeded to
marriage, or where they have followed suppressed menstruation ;
nor would I propose a different explanation of those instances in
which uterine misplacements, as anteflexion or retroflexion, are
succeeded by signs of sexual disorder such as we have been consid-
ering, or where they have been associated with misplacement of the
ovary. In all of these instances it is, I believe, the interior of the
uterine cavity which suffers first — it is thence that the hemorrhages
are derived, thence that the greater part of the leucorrhoeal discharge
7d. IMPORTANCE OF AFFECTIONS
is furnislied ; and it is the irritation of that part of the organ in
which its most important functions are transacted, which leads to
the increase of its size so apparent in the great proportion of cases
of long- continued uterine ailment. That the ovaries suifer too,
constant observation proves ; and facts illustrative of the affection
of the neck of the womb are also perpetually coming under our
notice ; but that, as a general rule, inflammation of the canal of the
cervix is the first step in the disease, and ulceration of the os uteri
the second ; and that these two conditions are the two factors pro-
ducing all the symptoms we have been studying, is an assumption
which I cannot but regard as unsupported by facts, and as opposed
to any fair inference from what anatomy, physiology, or analogical
reasoning teach us.
There are, however, some writers who, while they concede the
comparatively small importance of ulceration of the os uteri, yet
appear to me (and I trust that these my doubts are always expressed
with that respect and deference for the opinions of others which I
sincerely entertain) scarcely to attach due weight to the ailments of
the uterine cavity. The elaborate secretory apparatus of the cervix
uteri, so minutely described and so beautifully delineated by Dr.
Hassall and Dr. Tyler Smith, seems indeed to furnish an ample
source for almost any conceivable amount of discharge. But it
must be remembered that, like many other secreting apparatuses,
this is by no means in constant activity. Its full action seems to
be called forth only during pregnancy ; and my own observation does
not by any means confirm the statement, that in the intervals between
the menstrual periods a mucous plug is secreted, hermetically closing,
as it were, the canal of the cervix ; for I have observed any such
secretion, to say the least, quite as often absent as present in uteri
which I have examined. Moreover, at each menstrual period it is
the mucous membrane of the body of the uterus which is congested,
and from which the mucus and epithelium, as far as we can ascertain,
are derived, which form at its commencement and end the greater
part of the menstrual flux, and constitute the white discharge that
not infrequently continues in the healthy subject for twelve or twenty-
four hours after the cessation of all admixture of blood. Nor must
it be forgotten that the mucous membrane of the uterine cavity is
furnished with appropriate glands to furnish such secretion almost
infinite in number, curiously convoluted to increase the extent of
their surface, and susceptible of a peculiar hypertrophy more re-
OF CERVICAL CANAL EXAGGERATED. 77
markable than any which is observed to take place in the glands of
the cervix. Observation also not infrequently discovers the mem-
brane of the uterine cavity abundantly moistened with secretion ;
while cases are now and then met with in which inflammation having
attacked it, it pours out abundance of pus.
Such a case sometime since came to my knowledge ; and the
uterus, removed from the patient after death, is now in the Museum
of St. Bartholomew's Hospital. A fibrous tumour growing in the
substance of the posterior uterine wall occasioned an unusual amount
of irritation of the pelvic viscera, the cause of which was not detected
during the patient's life. After death, this tumour, of the size of a
small apple, was seen to be most intensely injected, while the mucous
membrane of the uterine cavity, into which, however, the tumour
did not at all project, was of the brightest possible rose tint, and
looked like red velvet. Pus had been poured out from the ftiflamed
mucous membrane, and collecting within the uterine cavity all the
more readily from the neck of the womb having become bent upon
itself, so as to prevent the ready escape of fluids from the interior,
had distended it, as may be seen in the specimen, to the size of a
hen's egg.
It is true, indeed, that our means of investigation do not enable
us, during the lifetime of our patients, to ascertain beyond a doubt
whether a discharge poured out from the os uteri is furnished from
the cervical canal, or from higher up in the body of the uterus, or
from both. Probability appears to me to incline to its being chiefly
derived from the uterine cavity ; though I do not doubt but that it
is often furnished in a measure by the cervix also. The weight of
proof seems to me to lie upon those who see in leucorrhoea only a
hypersecretion from the glandular apparatus of the cervix uteri.
Moreover, it is not only the excessive mucous or purulent discharge
which in these cases attracts our notice and calls for our interference,
but menstrual disorder, abdominal and pelvic pain, uterine enlarge-
ment — all that category of symptoms, in short, which have been so
often dwelt on in these Lectures, that to refer to them again, even
in the briefest manner, seems an almost needless tediousness.
But it may not unnaturally be asked, whether I then believe that
the condition of so-called ulceration of the os uteri is one of abso-
lutely no importance, adding nothing to a patient's suff'erings, in no
respect protracting her illness, calling for no treatment ? I do not
believe this ; though at the same time disease of the os uteri is so
"TjS symptoms of ulceration
almost invariably associated with other evident ailments of the organ
as to render it very difficult to distinguish accurately one set of
symptoms from the other. That the existence of an abraded condi-
tion of the OS uteri is capable of producing under some circumstances
very considerable discomfort, is, however, certain ; and is proved
by cases such as the following : —
A woman, twenty-seven years of age, who had lived in sterile
marriage with two husbands, was admitted into St. Bartholomew's
Hospital on account of dysmenorrhoea. The canal of the cervix
uteri was extremely narrow ; and, under the impression that the
case was one of those comparatively rare instances of menstruation
rendered difficult by mechanical causes, sponge tents were introduced
to dilate the contracted cervix. The presence of the sponge tent,
though causing no other inconvenience, occasioned a very distressing
sense of itching referred to the uterus : on the withdrawal of the tent,
the edges of the os uteri and the cervical canal, as far as it could
be seen, were observed to be very red, and quite denuded of their
epithelium, while a rather abundant glairy secretion was poured out
from their surface. So long as the abrasion continued, and it did not
disappear till three days after the removal of the sponge tent, the
sense of itching and the discharge continued, though with gradually
diminishing severity. Causes so purely local in their action are of
course very rare ; but symptoms such as were here produced by
mechanical irritation are sometimes observed in other cases in which
disease, as far as can be ascertained, is confined to the os uteri.
I will but just allude here, by way of illustration, to cases in
which the earliest stage of uterine cancer has been attended with
some vague sense of itching, burning, or smarting, referred to the
mouth of the womb : to do more than merely mention them would
take us away from our more immediate subjects. But, independent
of such cases, it happens now and then that without any other, or
at any rate with very little other, appreciable evidence of uterine
disease, one observes the orifice of the womb present a red, coarsely
granular surface, from which a glairy secretion is poured forth
abundantly. This surface is somewhat tender to the touch, and
bleeds so readily that even the most careful examination with the
speculum causes the blood to flow. Much more rarely I have also
"Seen what looked more like an ordinary ulcer with sharply cut edges ;
its surface apparently a little depressed below the adjacent tissue,
partially covered by a thin layer of dirty yellowish lymph, but red,
OF OS UTERI. 79
and bleeding on its removal. Both of these conditions I have
usually noticed in women whose previous history contained mention
of some syphilitic infection only a few months previously ; though I
should hesitate to class the appearances among secondary syphilitic
symptoms. ,.
I apprehend that the marked granular appearance is due to hyper-
trophy of those papillae covering the surface of the os uteri, for our
acquaintance with which we are indebted to the late Dr. Franz
Kilian, of Mayence ; whose early death it may be permitted me
here to deplore, since it was' as much too soon for science as for his
own fair fame ; while unanswered problems remind one painfully
every day of the loss of him who had proved himself so well fitted
to attempt their solution. In these cases, the analogy between the
state of the os uteri and that granular condition of the palpebral
conjunctiva observed in purulent ophthalmia, would seem to be com-
plete ; and no one who has observed the abundant secretion poured
out from between the lids of the infant affected by that disease, need
wonder at the amount of discharge furnished from so comparatively
small a surface as the os uteri. That sometimes there is an actual
destruction of substance over and above the mere abrasion of epithe-
lium, can also not be doubted ; but I believe that this is not generally
the case. With reference to the morbid states of the os uteri, how-
ever, there is much need of careful microscopic research. We hear
of phlebitis of its minute vessels, of herpes and eruptive diseases
affecting its surface : terms expressive sometimes of a theory, at
other times descriptive of the character of an appearance which
presented itself to the observer; but such phraseology cannot at
present be accepted as a statement of any well-ascertained patholo-
gical fact.
One of these conditions I must notice, because it is met with
independent of other uterine disease, and presents characters so
-marked as to have attracted the notice of Boivin and Dug^s, and
to have received from them a distinct name as granular metritis.
Under this not very appropriate name, two different conditions at
least have been described. In one, numerous small, rather hard,
miliary prominences beset both lips of the os uteri, usually, but not
invariably, destitute of epithelium, giving exit when pricked to a
small drop of mucus or muco-pus, and being probably hypertrophied
follicles. The other condition is produced by a number of small,
soft, red papulae, similar in size to those just mentioned, very vascu-
80 AFFECTIONS OF OS UTERI AKIN TO ULCERATION.
lar, bleeding easily, but solid, and probably identical in structure
with the granulations ascertained by M. Robin to be small hyper-
trophied points of mucous membrane ; and which, occasionally deve-
loped in the uterine cavity, have been the object of a somewhat
over-active treatment on the part of M. R^camier and some other
practitioners, who, believing them to produce obstinate leucorrhoea,
menstrual irregularity, and other ills, scrape out the uterine cavity
with a blunt instrument, and find in the blood-stained debris of the
mucous membrane the proofs of their diagnostic skill, and the tro-
phies of their chirurgical dexterity. These states of the os uteri,
however, though by no means common, are unquestionably attended
with leucorrhoeal discharge, often very profuse, with a tendency to
slight bleeding from their surface ; while they produce uncomfort-
able sensations of itching, smarting, and the like, not amounting,
indeed, to actual pain, but quite sufficient to keep alive all the
patient's anxiety lest they should be the portent of some worse
ailment to follow.
Affections such as these have seemed to call for local treatment,
and when resorted to, I have seen them yield under it, and the
patient return rapidly to health. These cases, however, are, I be-
lieve, exceptional ones, and, in the majority of instances, the morbid
state of the os uteri is but a part of the general disease which has
attacked the organ ; the ulceration persisting, now larger, now
smaller, presenting different aspects, not as the cause of the symp-
toms, but with them dependent on, and expressive of, the influence
of another and a common cause. What causes these may be I have
already stated. But even in such cases, it has seemed to me that
the ulceration has itself sometimes outlasted the graver evils under
which it arose, and has remained ; causing discomfort, leucorrhoea,
and slight sanguineous discharge, and keeping up a perpetual dispo-
sition to uterine congestion, which but for it would subside. That,
under such circumstances, a tendency to slow increase in the size
of the cervix uteri should exist, is surely no matter for wonder,
since the neck of the womb is more exposed to irritation of every
kind than any other part of the organ ; while, slight though the
morbid state may be, it yet is sufficient to produce some increased
afflux of blood thither, whence its return is more difficult than from
any other part ; and we have already seen how great is the tendency
in the uterine tissue under any stimulus, either natural or morbid, to
LOCAL TREATMENT OF ULCERATION. 81
some degree of that hypertrophy which, during thirty years of life,
represents its highest physiological condition.
It cannot be necessary that I should say a word to point out the
difference between these opinions and those which I have ventured
to criticize, and according to which inflammation of the cervix and
ulceration of the os uteri are the first and the last in uterine patho-
logy. It may, however, be asked, how is it that such successful
results have followed a course of treatment directed exclusively to
the cure of the ulceration — that^ the application of caustics to the
OS uteri has been succeeded by the restoration of the patient to
health ? Now, I think it should be borne in mind that, in connection
with this mode of treatment, various other measures are of necessity
adopted, eminently calculated to relieve many of the slighter forms
of uterine ailment. The married woman is for a time taken from
her husband's bed; the severe exertion to which either a sense of
duty urged, or a love of pleasure prompted her, is discontinued ;
while rest in the recumbent posture places the uterus and the pelvic
viscera in just that position in which the return of blood from them j
encounters the smallest difficulties. The condition of the bowels,
probably before habitually neglected, is now carefully regulated,
and the patient's diet, bland, nutritious, and unstimulating, often
differs widely from that with which, while all her functions were
overtaxed, she vainly strove to tempt her failing appetite. Add to
this, that the occurrence of the menstrual period is carefully watched
for ; that all precautions are then redoubled, and each symptom of
disorder, such as on former occasions had been borne uncomplain-
ingly, though often not without much suffering, is at once encoun-
tered by its appropriate remedy ; while generally returning conva-
lescence is met in the higher classes of society by a quiet visit to
the country, or to some watering-place, in pursuit not of gayety, but
of health; and we have assembled just those conditions best fitted^
to remove three out of four of the disorders to which the sexual J
system of woman is subject. But the very simplicity of these mea-
sures is a bar to their adoption ; for you will bear me out in saying,
that the rules which common sense cannot but approve, but which
seem to require nothing more than common sense to suggest them,
are just those to which our patients least readily submit. The case
is altered, however, when these same rules are laid down not as the
means of cure themselves, but only as conditions indispensable to
the success of that cauterization which, repeated once or oftener in
6 ■
82 ITS INDISCRIMINATE ADOPTION
the week, is the great remedy for the ulceration that the doctor has
discovered, and which he assures his patient, and with the most
perfect good faith, produces all the symptoms from which she suffers.
The caustic used in these milder cases is the nitrate of silver ; the
surface to which it is applied is covered by a thin layer of albuminous
secretion, which it is not easy to remove completely, and which serves
greatly to diminish the power of the agent, while the slightly stimu-
lating action that it nevertheless exerts seldom does harm, sometimes,
I believe, does real good, though no more than might have been
equally attained by vaginal injections, or other similar remedies,
which the patient might have employed without the intervention of
her medical attendant.
There is no more difficult problem in therapeutical inquiry than
how to distinguish between the results which really depend on our
remedies, and such as only casually follow their employment. The
patient had symptoms of uterine ailment ; the orifice of her womb
was abraded, caustic was applied, and the healing of the abrasion and
the subsidence of the uterine symptoms took place simultaneously.
From these facts a formula is framed, which is applied to the manage-
ment of uterine ailments generally — to three-fourths or four-fifths
of the diseases of the female sex that come under the care of the
practitioner. So far, indeed, are these views sometimes carried,
that even the utter absence of all signs of uterine disease is not
always thought a sufficient reason for doubting its existence ; but
examination with the speculum is made, and the detection of some
slight speck of abrasion of the os uteri is thought to furnish an
explanation of chronic ailments of the most dissimilar kinds ; and a
panacea for those ills is sought in the use of the caustic. There are
those here who can bear me out in the assurance that this is no
overcharged statement ;, but the annals of medicine are full of in-
stances of the extent to which preconceived ideas modify the experi-
ence of men whose honesty is as much above suspicion as their ability
is beyond question ; and no fellow of this college will doubt the
integrity or the talent of either of the would-be combatants who,
some hundred and twenty years ago, drew their swords in Cheap-
side to settle the proper treatment of the smallpox.
It would be a matter of comparatively little moment whether the
views which I believe to be erroneous really were so or not, if they
led to nothing more than an over-estimate, on the part of some
practitioners, of the value of a certain kind of therapeutical pro-
INJURIOUS TO PATIENT. 83
ceeding. But their evil, if they be erroneous, does not cease
here ; they exert an injurious influence, both on the patient and
the practitioner. No one engaged in the practice of medicine, but
must have been often struck with the important part which the
sexual system plays, unconsciously to herself, in almost all the
diseases of woman. The frequent sadness and low spirits in celibacy,
the grief, the almost shame of childless marriage, depend on causes /
more deeply seated than reason can dispel, and are familiar to us as \
often stamping a peculiar character on the diseases of our patients. «
To the same cause is due the nervous susceptibility which women
often manifest on the least symptom of ailment affecting their uterine
system ; to control which, and to prevent the disposition to uncon-
scious exaggeration of their symptoms, becomes often one of our '
most important, and at the same time one of our least easy, duties, j
Any course of proceeding, then, which, without the most urgent and
absolute necessity, directs the patient's attention in the slighter
ailments painfully and frequently to her uterine system, is in the
highest degree objectionable. The patient recovers from her illness,
but with the impression that all the sensations that for weeks or
months before she had experienced were exclusively due to the
local disease which had called for local remedies. On the first
return of any symptoms resembling them, all her apprehensions are
revived, lest the same painful investigation, the same distressing
manipulations as before, should be again required. The fact that^
it needs but to watch the beatings of one's heart for a few minutes
in order notably to quicken its pulsations, and to become painfully
conscious of its action, is one of the most familiar illustrations of j
that influence of attention upon the functions of the body of which, /
both in health and in disease, we see so many instances. Digestion,"
watched through its diff'erent stages with the not unnatural anxiety
of a dyspeptic invalid, often leaves him a hypochondriac, unable to
take other than certain articles of diet, and those cooked in some
peculiar fashion ; while in many instances, neither in the food itself,
nor in its mode of preparation, is there any reason to be found why
that alone should be tolerated by his fastidious stomach. More or^
less discomfort — often, indeed, much positive pain — attends in the
great majority of women upon the performance of the menstrual
function, precedes or follows it. These pains are now thought to
be of more importance than before ; their occurrence is watched
for, the sufl'ering of one month is weighed against that of the month )
84 INJURIOUS TO PATIENT AND PRACTITIONER.
#
before, as the woman thinks she finds in its increase or diminution
grounds for hope or for apprehension. But the sensations thus
attended to increase in intensity and in persistence ; the slight ail-
ment, which, but for the coming evil that it is supposed to portend,
would in a few days be forgotten, is noted with anxious vigilance;
and the more it is observed, the more it seems to grow ; she fears
she never shall be well again, and at length makes up her mind once
more to go through the same treatment as before relieved her, though
it brought to her the painful revelation of the grave cause on which
her suiFerings, once thought so little of, in reality depended. Such
persons among the poor come to our hospitals ; and on questioning
them as to their ailments, they at once, and without waiting to
describe their symptoms, say that they are suffering from ulceration
of the womb ; though on examination one finds no trace of it, or at
most a little redness of the edges of the os uteri, or it may be even
that slight abrasion which I trust that I have shown to be as trivial
in importance as it is frequent in occurrence. But though they
have no serious disease, they are not the less, or perhaps one might
say all the more, real sufferers, and sufferers most difficult to cure.
The treatment they perhaps are once more subjected to serves but
to confirm the morbid habit of mind which has been gradually
increasing upon them, and destroying both their present happiness
and their capacity for it in future years. They are the victims, I
believe, not of the want of honest purpose or of high motive in
those who practise our art, but of an erroneous opinion.
This erroneous opinion, however, reacts injuriously upon the
practitioner himself. He unlearns what physiology might teach him
of the uterus and its functions, and sees in all the varied manifesta-
tions of disorder the expression of one fact, and of one alone ; namely,
the existence of ulceration of the womb, and its reaction first on the
uterine system, then on the general health. For him, indeed, there
is little more to learn in uterine pathology ; for when once a case
has been ascertained not to be one of fibrous tumour, polypus,
or cancer, then ulceration of the os uteri is the almost invariable
cause to which the symptoms are referred, and the cure of this
ulceration is the one grand object at which he endeavours. All the
evils inseparable from the practice of a specialty are thus aggravated,
and the natural tendency of such practice to subside into routine,
or to degenerate into empiricism (I use the word in no invidious
sense), becomes almost unavoidable.
OBJECTIONS TO THE USE OF THE STRONGER CAUSTICS. B5
There was a time in a neighbouring country, and not very long
since, when the clue to the understanding of all diseases, the
essential cause on which they depended, was supposed to be Gastro-
Enteritis. It was conceived to be the primary pathological condition,
or proximate cause of fevers, to play a most important part in the
disorders of the cerebral and respiratory systems; and all that
ingenious argument could do was done by M. Broussais to support
his new doctrines. For years, France was divided into two schools —
the supporters and the opponents of M. Broussais's theories ; and
though truth was elicited by the contest, yet medical science ad-
vanced during the time much more slowly than, but for these
divisions, it doubtless would have done. In the same way, i believe
that the progress of uterine pathology has been retarded by the
disputes about ulceration of the os uteri ; for while one party has
denied its very existence, and another has exaggerated its import-
ance, both have allowed numerous important questions to pass
"Vv'ithout even an attempt at a reply.
But though it is my conviction that, in the great majority of
instances in which the nitrate of silver is applied to the os uteri,
the proceeding is simply superfluous, it yet would not be right to
leave unnoticed other cases in which the neck of the womb beins:
more or less enlarged, stronger agents are employed. On these
occasions, the caustic potash is generally used, and by some with
the view of destroying outright a certain portion of the enlarged
cervix, by others with the intention of getting rid of the enlarge-
ment by means of the inflammation which it sets up in the uterine
tissue. With whichever object resorted to, this proceeding is con-
fessedly devoid neither of sufi'ering nor of danger. If the caustic
be introduced, as is usually done, within the cervical canal, it is
allowed that the pain produced, and which sometimes lasts for two
or three days, is very intense, causing nausea or sickness, and
sometimes even syncope, or occasioning extreme depression, pros-
trating a patient so completely as to render her unable to quit her
bed or sofa for several days. Thus much for the present eff'ect of
this remedy, for which its strongest advocates can scarcely lay
claim to such an epithet as jucunde. But it does not fare much
better with it as far as cito is concerned. The application of the
pot~assa fusa, so as to produce an eschar, implies a subsequent course
of treatment with frequent applications of the nitrate of silver for a
period of about forty days, at the end of which time, the action of
86 EXCEPTIONAL CASES
the remedy being supposed to be exhausted, unless the patient is
cured, it will be necessary to repeat the same treatment again and
again. This treatment, too, it will be observed, confines the patient
during the whole time that it is in progress to her room, and almost
to her couch, and entails upon her the necessity of one or two ex-
aminations with the speculum every week during its continuance.
But if it can be said to act neither eito nor jucunde, it might be
hoped that this mode of proceeding had at least the third merit of
tuto ; but it has not. The tendency to contraction or obliteration
of the cervical canal after these proceedings is very considerable,
and is referred to even as a frequent occurrence, while inflammation,
both of the uterus generally, and of its appendages, is a contingency
far from uncommon. Of the last of these accidents I have seen
several instances among patients at the 'Hospital, who, previous to
their coming under my care, had been treated with the stronger
caustics for ulceration of the os uteri.
I will not attempt to follow the advocates of this puactice through
the explanation which they give of its mode of action; and the
rather, since where some see a healthy stimulus to the affected
tissues, others discern what they consider to be a dulling, stupefying
influence, as they term it, weakening the vital force ; while, through-
out the language used with reference to this subject, there is a
mingling of metaphor with scientific terminology, from which it is
extremely difficult to arrive at a clear notion of what is meant. I
do not doubt but that, by either mode of applying the caustic potass,
the cervix uteri may be reduced in size ; but my dissent from the
practice is founded on the fact that it has none of the three recom-
mendations of painlessness, speed, or safety ; while my own experience
would lead me to believe that, when adopted, it is usually either out
of place or superfluous. During the presence of any active symptom
of inflammation, such a proceeding as the destruction of a portion of
the uterine tissue by caustics cannot but be perilous ; after their
removal, the womb will return slowly, often indeed but imperfectly,
to its previous size. This return, however, does take place, as far
at least as my experience goes, in the immense majority of cases ;
and takes place as surely, and not much more slowly, under just
those conditions which best promote the general health, as under a
course of treatment which, apart from other evils, confines a woman
for weeks and months to her chamber and her couch, to the grievous
impairment of her general health, and the utter ruin of her cheerful-
JUSTIFYING LOCAL TREATMENT. 87
ness, as o» several occasions I have had the opportunity of observ-
ing. Moreover, very wide variations in the size of the womb seem to
be equally compatible with the healthy performance of its functions;
while the special tendency which it exhibits, under any circumstances
that produce congestion of its vessels to increase in size, must never
be forgotten in estimating the pathological importance of hypertro-
phy, either of the whole or of a part of the organ. In this opinion,
too, I am further strengthened by the fact that some of the most
marked instances of enlargement of the neck of the womb, with
increased hardness of its tissue, which have come under my observa-
tion, occurred in cases where there was no trace of ulceration either
of the OS uteri or of the canal of its cervix.
At the same time there are some exceptional cases, which I have
already referred to, where ulceration, or some allied morbid condition
of the OS uteri, is found to exist independent of any appreciable
disease elsewhere ; and others, equally rare, in which, after symp-
toms of uterine ailment have been subdued, a morbid state of the
OS uteri persists, which is benefited by stimulant applications. In
such cases, I use either the nitrate of silver or the acid nitrate of
^mercury, though neither of them frequently ; and for weeks together
no case appears among my patients at St. Bartholomew's Hospital
in which the employment of either appears to me indicated. In
justice to others, it should, I think, be observed, that we have no
right to infer that the majority of practitioners, who resort to those
agents with much greater frequency than some of us feel warranted
in doing, regard them as absolutely the best remedies that could be
used, but merely as the best under the peculiar circumstances in
which uterine diseases have to be treated. Were it possible to keep
any of those milder agents in contact with the abraded os uteri,
which can generally be applied to an irritated or ulcerated surface
elsewhere, this would doubtless be allowed in many instances to be
a preferable proceeding. The problem, however, is to find some
agent sufficiently powerful to exert an influence which may continue
for several days, and thus to obviate the necessity fo'P that frequent
painful interference which would otherwise be required. That lo-
tions, batks, and other remedial agents which may be safely intrusted
to the patient herself, will answer the desired ends more frequently
than some practitioners imagine, is my firm conviction ; but I could
not refrain from stating what seems to me to be the candid interpre-
tation of their conduct who pursue a different course of proceeding.
88 CONCLUSION.
Time forbids that I should enter into further detail — nor, indeed,
does my subject need it; for I proposed to myself only " To inquire
into the Pathological Importance of Ulceration of the Os Uteri."
In doing this, I have had of necessi1:y to refer to opinions from
which I diifered. It was no want of respect for many of those who
entertain those opinions, and whose talents have done so much to
render them popular, which has led me studiously to abstain from
referring to them by name ; but I believe, and have high authority
for acting on the belief, that " The cause of truth gains much by a
course, which not only avoids personal controversy, but confines
attention to the real merits of the case, independently of the ex-
traneous circumstances which ought not to influence the decision."
I have treated this inquiry, Sir, into what is after all but a com-
paratively small ailment, as gravely as though it were one of those
dire diseases, in the study and the cure of which the highest skill of
the greatest votaries of our art has found its fit employment. But
you will not blame me, I trust, for this : the thousand smaller ills
to which mankind is subject bring, in their frequent repetition, as
much suiFering, cause as much sorrow, and therefore are as worthy
or our heartiest labour to understand, and of our best efforts to
relieve, as those perilous visitants — inflammations, fevers, apoplex-
ies, which threaten life only at long intervals or on rare occasions.
If, however, it should still seem to any that I have chosen a theme
beneath the dignity of this College, may I remind them that Syden-
ham himself has told us, he should not deem his life ill-spent if he
had contributed to even the least improvement in the very humblest
branches of practical medicine ;^ and, taking shelter behind his great
name, plead in extenuation of my poor performance, " Quantacum-
que fuerint aliorum conamina, semper existimavi mihi vitalis auras
usum frustra datum fore, nisi ^t ipse in hoc stadio versatus symbolam
aliquam utcunque exiguam in commune medicinse aerarium contri-
buerim."
^ <'Etsi nihil magnificentius," says he, "quam odontalgiae, aut clavorum pedibus
iunascentium curatio."
THE END.
CATALOGUE
OP
BLANCHARD & LEA'S
MEDICAL im SURGICAL PUBLICATIONS.
TO THE MEDICAL PROFESSION.
In submitting the following catalogue of our publications in medicine and the
collateral sciences, we beg to remark that no exertions are spared to render the issues
of our press worthy a continuance of the confidence which they have thus far enjoyed,
both as regards the high character of the works themselves, and in respect to every
point of typographical accuracy, and mechanical and artistical execution. Grentlemen
desirous of adding to their libraries from our list, can in almost all cases procure the
works they wish from the nearest bookseller, who can readily order any which may
not be on hand; and who, as well as ourselves, will be happy to answer any
inquiries as to price, &c.
BLANCHARD & LEA.
Philadelphia, November, 1854.
TWO MEDICAL PERIODICALS, FREE OF POSTAGE,
FOR FIVE BOI^IiARS PER Al^rVlJM.
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, subject to
postage, when not paid for in advance, $5 00
THE MEDICAL NEWS AND LIBRARY, invariably in advance, - - 1 00
or, BOTH PERIODICALS fumished, free of postage, for Five Dollars remitted
in advance.
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES,
Edited by ISAAC HAYS, M. D.,
18 published Quarterly, on the first of January, April, July, and October. Each number contains
at least two hundred and eighty large octavo pages, appropriately illustrated, wherever necessary,
by engravings. It has now been issued regularly for a period of thirty- five years, during a quarter
of a century of which it has been under the control of the present editor. Throughout this long
space of time, it has maintained its position in the highest rank of medical periodicals both at home
and abroad, and has received the cordial support of the entire profession in this country. Its list of
Collaborators will be found to contain a large number of the most distinguished names of the pro-
fession in every section of the United States, rendering the department devoted to
ORIGINAL COMMUNICATIONS
full of varied and important matter, of great interest to all practitioners.
As the aim of the Journal, however, is to cambine the advantages presented by all the different
varieties of periodicals, in its
REVIEW DEPARTMENT
will be found extended and impartial reviews of all important new works, presenting subjects of
novelty and interest, together with very numerous
BIBLIOGRAPHICAL NOTICES,
including nearly all the medical publications of the day, both in this country and Great Britain, with
a choice selection of the more important continental works. This is followed by the
BLANCHARD & LEA'S MEDICAL
QUARTERLY SUMMARY,
being a very full and complete abstract, methodically arranged, of the
IMPROVEMENTS AND DISCOVERIES IN THE MEDICAL SCIENCES.
This department of the Journal, so important to the practising physician, is the object of especial
care on the part of the editor. It is classified and arranged under diflerent heads, thus facilitating
the researches of the reader in pursuit of particular subjects, and will be found to present a very
full and accurate digest of ail observations, discoveries, and inventions recorded in every branch of
medical science. The very extensive arrangements of the publishers are such as to afford to the
editor complete materials for this purpose, as he not only regularly receives
ALL THE AMERICAN MEDICAL AND SCIENTIFIC PERIODICALS,
but also twenty or thirty of the more important Joi:rnals issued in Great Britain and on the Conti-
nent, thus enabling him to present in a convenient compass a thorough and complete abstract of
everything interesting or important to the physician occurring in any part of the civilized world.
An evidence of the success which has attended these efforts may be found in the constant and
steady increase in the subscription li^t, which renders it advisable for gentlemen desiring the
Journal, to make known their wishes at an early day, in order to secure a year's set with certainty,
the publishers having frequently been unable to supply copies when ordered late in the year. To
Vheir old ^ubscribers, many of whom have been on their list for twenty or thirty years, the publish-
ers feel that no promises are necessary; but those who may desire for the first time to subscribe,
ean rest as-sured that no exertion will be spared to maintain the Journal in the high position which
it has occupied for so long a period.
By reference to the terms it will be seen that, in addition to this large amount of valuable and
practical information on every branch of medical science, the subscriber, by paying in advance,
becomes entitled, without further charge, to
THE MEDICAL NEWS AND LIBRARY,
a monthly periodical of thirty-two large octavo pages. Its « News Department" presents the
earrent information of the day, while the " Library Department" is devoted to presenting stand-
ard works on various branches of medicine. Within a few years, subscribers have thus received,
without expense, the following works which have passed through its columns : —
WATSON'S LECTCJRES ON THE PRACTICE OF PHYSIC.
BRODIE'S CLINICAL LECTURES ON SURGERY.
TODD AND BOWMAN'S PHYSIOLOGICAL ANATOMY AND PHYSIOLOGY OF MAN.
724 pages, with numerous wood-cuts, being all that has yet appeared in England.
WEST'S LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD.
MALGAIGNE'S OPERATIVE SURGERY, with wood-cuts, and
SIMON'S LECTURES OxN GENERAL PATHOLOGY.
While the year 1854, presents
BENNETT ON PULMONARY TUBERCULOSIS, '
BEAUTIFULLY ILLUSTRATED ON WOOD.
AND
WEST ON ULCERATION OF THE OS UTERI.
To be followed in 1855 by
A VALUABLE WORK ON A PRACTICAL DEPARTMENT OF MEDICAL SCIENCE.
It will thus be seen that for the small sum of FIVE DOLLARS, paid in advance, the subscriber
wttl obtain a Quarterly and a Monthly periodical,
EMBRACING ABOUT FIFTEEN HUNDRED LARGE OCTAVO PAGES,
mailed to any part of the United States, free of postage.
These very favorable terms are now presented by the publishers with the view of removing all
difficuUies aiid objections to a full and extended circulation of the Medical Journal to the office of
every member of the profession throughout the United Slates. The rapid extension of mail faciH-
lies, will now place the numbers before subscribers with a certainty and dispatch not heretofore
attainable ; while by the system now proposed, every subscriber throughout the Union is placed
upon an equal footing, at the very reasonable price of Five Dollars for two periodicals, without
fiirther expense.
Those subscribers who do not pay in advance will bear in mind that their subscription of Five
Dollars will entitle them to the Journal only, without the News, and that they will be at the expen«««
of their own postage on the receipt of each number. The advantage of a remittance when order-
ing the Journal will thus be apparent.
As the Medical News and Library is in no case sent without advance payment, its subscribers
will always receive it free of postage.
It should also be borne in mind that the publishers will now take the risk of remittances by mail,
«ily requiring, in cases of loss, a certificate from the subscriber's Postmaster, that the money was
duly mailed and forwarded
I^^ Funds at par at the subscriber's place of residence received in payment of subscriptions.
Address, BLANCHARD & LEA, Philadelphia.
AND SCIENTIFIC PUBLICATIONS,
ANALYTICAL COMPENDIUM
OF MEDICAL SCIENCE, containing Anatomy, Physiology, Surgery, Midwifery,
Chemistry, Materia Medica, Therapeutics, and Practice of Medicine. By John Neill, M. D.,
and F. G. Smith, M. D. Second and enlarged edition, one thick volume royal 12mo. of over
1000 pages, with 350 illustrations. 1^ See Neill.
ABEL (F. A.), F. C. S.
Professor of Chemistry in the Royal Military Academy, Woolwich.
C. L. BLOXAM,
Formerly First Assistant at the Royal College of Chemistry.
HANDBOOK OF CHEMISTRY, Theoretical, Practical, and Technical, with a
Recommendatory Preface by Dr. Hofmann. In one large octavo volume of 662 pages, with
illustrations. {Now Ready.)
There was still wanting some book which should who resolves to pursue for himself a steady search
aid the young analytical chemist through all the into the chemical mysteries of creation. For such
phases of the science. The " Handbook" of Messrs. ■ a student the 'Handbook' will prove an excellent
Abel and Bloxam appears to supply that want. As ' guide, since he will find in it, not merely the most
Dr. Hofmann says in his brief Preface, " The pre- approved modes of analytical investigation, but
sent volume is a synopsis of their (the authors') ex- ■ descriptions of the apparatus necessary, with such
perience in laboratory teaching ; it gives the neces- ; manipulatory details as rendered Faraday's ' Che-
sary instruction in chemical manipulation, a concise j mical Manipulations' so valuable at the time of its
account of general chemistry as far as it is involved I publication. Beyond this, the importance of the
in the operations of the laboratory, and lastly, quali- work is increased by the introduction of much of the
tative and quantitative analysis. It must be under- technical chemistry of the manufactory." — Athe-
stood that this is a work fitted for the earnest student, ' nceum.
ASHWELL (SAMUEL), M. D.
A PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN.
Illustrated by Cases derived from Hospital and Private Practice. With Additions by Paul Beck
GoDDARD, M. D. Second American edition. la one octavo volume, of 520 pages.
ARNOTT (NEILL), M. D.
ELEMENTS OF PHYSICS; or Natural Philosophy, General and Medical.
Written for universal use, in plain or non-technical language. A new edition, by Isaac Hays,
M. D. Complete in one octavo volume, of 484 pages, with about two hundred illustrations.
BENNETT (J. HUGHES), M. D., F. R. S. E.,
Professor of Clinical Medicine in the University of Edinburgh, &c.
THE PATHOLOGY AND TREATMENT OF PULMONARY TUBERCU-
LOSIS, and on the Local Medication of Pharyngeal and Laryngeal Diseases frequently mistakea
for or associated with, Phthisis. In one handsome octavo volume, with beaulilul wood-cuts.
{Now Ready.)
How it may be most effectually carried into prac-
tice, our readers will learn from Dr. Bennett's pages,
especially from the histories of the valuable and in-
teresting cases which he records. Indeed, if the au-
thor had only reported these cases he would have
benefited his profession, and deserved our thanks. As
it is, however, his whole volume is so replete with
valuable matter, that we feel bound to recommend
our readers, one and all, to peruse it. — Lond. Lancet.
The elegant little treatise before us shows how
faithfully and intelligently these investigations have
been pursued, and how successfully the author's
studies have resul ted in clearing up some Qf the most
doubtful points and conflicting doctrines hitherto
entertained in reference to the history and^reatment
of pulmonary tuberculosis. — N. Y. Journal of Medi-
cal and Collateral Science, March, 1851.
BENNETT (HENRY), M. D.
A PRACTICAL TREATISE ON INFLAMMATION OF THE UTERUS,
ITS CERVIX AND APPENDAGES, and on its connection with Uterine Disease. Fourth
American, from the third and revised London edition. In one neat octavo volume, of 430 pages,
with wood-cuts. {Now Ready.)
This edition will be found materially improved over its predecessors, the author having carefully
revised it, and made considerable additions, amounting to about seventy-five pages.
This edition has been carefully revised and altered, that the bulk of the profession are not fully alive to
and various additions have been made, which render the importance and frequency of the disease of which
it more complete, and, if possible, more w^orthy of -^ '- •"■
the high appreciation in which it is held by the
medical profession throughout the world. A copy
stiould be in the possession of every physician. —
Charleston Med. Journal and Review, March, 1854.
We are firmly of opinion that in proportion as a
knowledge of uterine diseases becomes more appre-
ciated, this work will be proportionably established
as a text-book in the profession. — The Lancet.
it takes cognizance. The present edition is so much
enlarged, altered, and improved, that it can scarcely
be considered the same work.— Dr. Ranking^s Ab-
stract.
Few works issue from the medical press which
i are at once original and sound in doctrine ; but such,
I we feel assured, is the admirable treatise now before
I us. The important practical precepts which the
author inculcates are all rigidly deduced from facts.
When, a few years back, the first edititm of the 1 . . • Every page of the book is good, and eminently
present work was published, the sul)ject was one al- ^ practical. ... So far as we know and believe, it is
most entirely unknown to the obstetrical celebrities ! the best work on the subject of which it treats. —
of the day ; and even now we have reason to know Monthly Journal of Medical Science.
BLANCHARD & LEA'S MEDICAL
BEALE (LIONEL JOHN), M. R. C. S., &,c.
THE LAWS OF HEALTH IN RELATION TO MIND AND BODY.
A Series of Letters from an old Practitioner to a Patient. In one handsome volume, royal 12mo..
extra cloth.
BILLING (ARCHIBALD), M. D.
THE PRINCIPLES OF MEDICINE. Second American, from the Fifth and
Improved London edition. In one handsome octavo volume, extra cloth, 250 pages.
BLAKISTON (PEYTON), M. D., F. R. S., &.C.
PRACTICAL OBSERVATIONS ON CERTAIN DISEASES OF THE
CHEST, and on the Principles of Auscultation. In one volume, 8vo., pp. 384.
BURROWS (GEORGE), M. D.
ON DISORDERS OF THE CEREBRAL CIRCULATION, and on the Con-
nection between the Affections of the Brain and Diseases of the Heart. In one 8vo. vol., with
colored plates, pp. 21t).
BUDD (GEORGE), M. D., F. R. S.,
Professor of Medicine in King's College, London.
ON DISEASES OF THE LIVER. Second American, from the second and
enlarged London edition. In one very handsome octavo volume, with four beautifully colored
plates, and numerous wood-cuts. pp. 468. New edition. {Just Issued.)
The reputation which this work has obtained as a full and practical treatise on an important class
of diseases will not be diminished by this improved and enlarged edition. It has been carefully and
thoroughly revised by the author ; the number of plates has been increased, and the style of its me-
chanical execution will be found materially improved.
The full digest we have given of the new matter
introduced into the present volume, is evidence of
the value we place on it. The fact that the profes-
sion has required a second edition of a monograph
such as that before us, bears honorable testimony
to its usefulness. For many years, Dr. Budd's
work must be the authority of the great mass of
British practitioners on the hepatic diseases ; and it
is satisfactory that the subject has been taken up by
so able and experienced a physician. — British and
Foreign Medic o-Chirurgical Review.
BUSHNAN (J. S.), M. D.
THE PHYSIOLOGY OF ANIMAL AND VEGETABLE LIFE: a Popular
Treatise on the Functions and Phenomena of Organic Life. To which is prefixed a Brief Expo-
sition of the great departments of Human Knowledge. In one handsome royal 12mo. volume,
with over one hundred illustrations.
Though cast in a popular form and manner, this work is the production of a man of science, and
presents its subject in its latest development, based on truly scientific and accurate principles.
It may therefore be consulted with interest by those who wish to obtain in a concise form, and at
a very low price, a resume of the present state of animal and vegetable physiology.
BLOOD AND URINE (MANUALS ON).
BY JOHN WILLIAM GRIFFITH, G. OWEN REESE, AND ALFRIID
MARKWICK. One thick volume, royal 12mb., extra cloth, with plates, pp. 460.
BRODIE (SIR BENJAMIN C), M. D., &c.
Ca:iD^ICAL LECTURES ON SURGERY. 1 vol. 8vo., cloth. 850 pp.
BY THE SAME AUTHOR.
SELECT SURGICAL WORKS, 1 vol. 8vo. leather, containing Clinical Lectures
on Surgery, Diseases of the Joints, and Diseases of the Urinary Organs.
URINARY DEPOSITS: THEIR DIAGNOSIS, PATHOLOGY, AND
THEllAPEUTICAL INDICATIONS. A new and enlarged American, from the last improved
London edition. With over sixty illustrations. In one royal 12ino. volume, extra cloth.
The n<nv edition of Dr. Bird's work, though not
increased in size, has been greatly modified, and
much of it rewritten. It now presents, in a corn-
p^endious form, the gist of all that is known and re-
iiable in this department. From its terse style and
convenient size, it is particularly applicable to the
Btadent, to whom we cordially commend it. — The
Medical Examiner. ^
It can scarcely be necessary for us to say anything
of the merits of this well-known Treatise, wiiich so
admirably brings into practical application the re-
sults of those microscopical and chemical researches
regarding the physiology and pathology of the uri-
nary secretion, which nave contributed so much to
the increase of our diagnostic powers, and to tine
extension and satisfactory employment of our thera-
peutic resources. In the preparation of this new
edition of his work, it is obvious that Dr. Golding
Bird has spared no pains to render it a faithful repre-
sentation of the present state of scientific knowledofo
on the subject it emhrRces.— The British and Foreign
Medico- C hirurgical Review.
BY THE SAME AUTHOR.
ELEMENTS OF NATURAL PHILOSOPHY; being an Experimental Intro-
duction to the Physical Sciences. Illustrated with nearly four hundred wood-cuts. From the
third London edition. In one neat volume, royal r2mo. pp. 402.
AND SCIENTIFIC PUBLICATIONS.
BARTLETT (ELISHA), M. D.,
ProfcBSor of Materia Medica and Medical Jurisprudence in the College of Physicians and
Surgeons, New York.
THE HISTOKY, DIAaNOSIS, AND TREATMENT OF THE FEVERS
OF THE UNITED STATES. Third edition, revised and improved. In one octavo volume,
of six hundred pages, beautifully printed, and strongly bound.
In preparing a new edition of this standard work, the author has availed himself of such obfter-
vations and investigations as have appeared since the publication of his last revision, and he has
endeavored in every way to render it worthy of a continuance of the very marked favor with which
it has been hitherto received.
The masterly and elegant treatise, by Dr. Bartlett
is invaluable to the American student and practi-
tioner. — Dr. Holmes''s Report to the Nat. Med. Asso-
tiation.
We regard it, from the examination we have made
of it, the best work on fevers extant in our language,
Rnd as such cordially recommend it to the medical
public. — St. Louis Medical and Surgical Journal.
Take it altogether, it is the m»st complete history
of our fevers which has yet been published, and
every practitioner should avail himself of its con-
teats. — The Western Lancet.
Of the value and importance of such a work, it i«
needless here to speak ; the profession of the United
States owe much to the author for the very able
volume which he has presented to them, and for the
careful and judicious manner in which he has exe-
cuted his task. No one volume with which we arc
acquainted contains so complete a history of our
fevers as this. To Dr. Bartlett we owe our best
thanks for the very able volume he has given us, as
embodying certainly the most complete, methodical,
and satisfactory account of our fevers anywhere to
be met with.— The Charleston Med. Journal and
Review.
BUCKLER (T. H.), M. D.,
Formerly Physician to the Baltimore Almshouse Infirmary, &c.
ON THE ETIOLOGY, PATHOLOGY, AND TREATMENT OF FIBRO-
BRONCHITIS AND KHEUMATIC PNEUMONIA. In one handsome octavo volume, extra
cloth. (Just Isstted.) ''■'^
BOWMAN (JOHN E.), M.D.
PRACTICAL HANDBOOK OF MEDICAL CHEMISTRY. In one neat
volume, royal 12mo., with numerous illustrations, pp. 288.
BY THE SAME AUTHOR. "^
INTRODUCTION TO PRACTICAL CHEMISTRY, INCLUDING ANA-
LYSIS. With numerous illustrations. In one neat volume, royal 12mo. pp.350.
BARLOW (GEORGE H.), M. D.
A MANUAL OF THE PRINCIPLES AND PRACTICE OF MEDICINE.
In one octavo volume. {Preparing.)
CYGLOP/EDIA OF PRACTICAL MEDICINE.
Edited by Dunglison, Forbes, Tweedie, and Conolly, in four large octavo
volumes, strongly bound. "S^ See Dunglison.
COLOMBAT DE L'ISERE. .^i
A TREATISE ON THE DISEASES OF FEMALES, and on the Speciil
Hygiene of their Sex. Translated, with many Notes and Additions, by C. D. Meigs, M. D.
Second edition, revised and improved. In one large volume, octavo, with numerous wood-cuts,
pp. 720.
Tlie treatise of M. Colombat is a learned and la- i M. Colombat De L'lsere has not consecrated ten
borious commentary on these diseases, indicating | years of studious toil and research to the frailer sex
very considerable research, great accuracy of judg- j in vain; and although we regret to hear it is at the
ment, and no inconsiderable personal experience, expense of health, he has imposed a debt of gratitude
With the copious notes and additions of its experi- I as well upon the profession, as upon the mothers and
eaiced and very erudite translator and editor, Dr
Meigs, it presents, probably, one of the most com-
plete and comprehensive works on the subject we
possess. — American Med. Journal.
daughters of beautiful France, which that gallant
nation knows best how to acknowledge. — New Or-
leans Medical Journal.
COPLAND (JAMES), M. D., F. R.S., 8cc.
OF THE CAUSES, NATURE, AND TREATiMENT OF PALSY AND
APOPLEXY, and of the Forms, Seats, Complications, and Morbid Relations of Paralytic and
Apoplectic Diseases. In one volume, royal 12mo., extra cloth, pp. 326.
CLYMER (MEREDITH), M. D., 5tc.
FEVERS; THEIR DIAGNOSIS, PATHOLOOY, AND TREATMENT.
Prepared and Edited, with large Additions, from the Essays on Fever in Tweedie's Libi-ary ^
Practical Medicine. In one octavo volume, of 600 pages.
CARSON (JOSEPH), M. D.,
Professor of Materia Medica and Pharmacy in the University of Pennsylvania. 'H
SYNOPSIS OF THE COURSE OF LECTURES ON MATERIA MEDICJS;
AND PHARMACY, delivered in the University of Pennsylvania. In one very neat octavo
volume, of 208 pages.
BLANCHARD & LEA'S MEDICAL
CARPENTER (WILLIAM B.), M. D., F. R. S., &.C.,
Examiner in Physiology and Comparative Anatomy in the University of London.
PRINCIPLES OF HUMAN PHYSIOLOGY; with their chief applications to
Psychology, Pathologv, Therapeutics, Hygiene, and Forensic Medicine. Fifth American, from
the fourth and enlarged London edition. With three hundred and fourteen illustrations. Edited,
with additions, by Francis Gurney Smith, M. D., Professor of the Institutes of Medicine in the
Pennsylvania Medical College, &c. In one very large and beautiful octavo volume, of about 1100
large pages, handsomely printed and strongly bound in leather, with raised bands. New edition.
{Lately Issued.)
The most complete work on the science in our
language.— ^w. Med. Journal.
The most complete exposition of physiology which
any language can at present give. — Brit, and For.
Med.-Chirurg. Review.
We have thus adverted to some of the leading
"additions and alterations," which have been in-
troduced by the author into this edition of his phy-
siology. These will be found, however, very far to
exceed the ordinary limits of a new edition, " the
old materials having been incorporated with the
new, rather than the new with the old." It now
certainly presents the most complete treatise on the
subject within the reach of the American reader ;
and while, for availability as a text-book, we may
perhaps regret its growth in bulk, we are sure that
the student of physiology will feel the impossibility
of presenting a thorough digest of the facts of the
science within a more limited compass. — Medical
Examiner.
The greatest, the most reliable, and the best book
(Ml the subject which we know of in the English
language. — Stethoscope.
The most complete work now extant in our lan-
guage. — N. O. Med. Register.
The changes are too numerous to admit of an ex-
tended notice in this place. At every point where
the recent diligent labors of organic chemists and
micrographers have furnished interesting and valu-
able facts, they have been appropriated, and no pains
have been spared, in so incorporating and arranging
them that the work may constitute one harmonious
system. — Southern Med. and Surg. Journal.
The best text-book in the language on this ex-
tensive subject. — London Med. Times.
A complete cyclopsedia of this branch of science.
—N. Y. Med. Times.
The standard of authority on physiological sub-
jects. * * * In the present edition, to particularize
the alterations and additions -which have been made,
would require a review of the whole work, since
scarcely a subject has not been revised and altered,
added to, or entirely remodelled to adapt it to the
present state of the science. — Charleston Med. .Tourn.
Any reader who desires a treatise on physiology
may feel himself entirely safe in ordering this. —
Western Med. and Surg. Journal.
From this hasty and imperfect allusion it will be
seen by our readers that the alterations and addi-
tions to this edition render it almost a new work —
and we can assure our readers that it is one of the
best summaries of the existing facts of physiological
science within the reach of the English student and
physician. — N. Y. Journal of Medicine.
The profession of this country, and perhaps also
of Europe, have anxiously and for some time awaited
the announcement of this new edition of Carpenter's
Human Physiology. His former editions have for
many years been almost the only text-book on Phy-
siology in all our medical schools, and its circula-
tion among the profession has been unsurpassed by
any work in any department of medical science.
It is quite unnecessary for us to speak of thig
work as its merits would justify. The mere an-
nouncement of its appearance will afford the highest
pleasure to every student of Physiology, while its
perusal will be of infiuite service in advancing
physiological science. — Ohio Med. and Surg. Journ.
BY THE SAME AUTHOR. (NoW Ready.)
PRINCIPLES OF COMPARATIVE PHYSIOLOGY. New American, from
the Fourth and Revised London edition. In one large and handsome octavo volume, with oA'er
three hundred beautiful illustrations.
The delay which has existed in the appearance of this work has been caused by the very thorough
revision and remodelling which it has undergone at the hands of the author, and the large number
of new illustrations which have been prepared for it. It will, therefore, be found almost a new
work, and fully up to the day in every department of the subject, rendering it a reliable text-book
for all students engaged in this branch of science. Every effort has been made to render its typo-
graphical finish and mechanical execution worthy of its exalted reputation, and creditable to the
mechanical arts of this country. A few notices of the last edition are appended.
critical, and unprejudiced view of those labors, and
Without pretending to it, it is an Encyclopedia of
the subject, accurate and complete in all respects —
a truthful reflection of the advanced state at which
the science has now arrived. — Dublin Quarterly
Journal of Medical Science.
A truly magnificent work— in itself a perfect phy-
siological study. — Ranking^s Abstract.
This work stands without its fellow. It is one
few men in Europe could have undertaken ; it is one
no man, we believe, could have brought to so suc-
cessful an issue as Dr. Carpenter. It required for
its production a physiologist at once deeply read in
the labors of others, capable of taking a general,
of combining the varied, heterogeneous materials at
his disposal, so as to form an harmonious whole.
We feel that this abstract can give the reader a very
imperfect idea of the fulness of this work, and no
idea of its unity, of the admirable manner in which
material has been brought, from the most various
sources, to conduce to its completeness, of the lucid-
ity of the reasoning it contains, or of the clearness
of language in which the whole is clothed. Not the
profession only, but the scientific world at large,
must feel deeply indebted to Dr. Carpenter for this
great work. It must, indeed, add largely even to
his high reputation. — Medical Times.
BY THE SAME AUTHOR. (Prepari7ig .)
THE MICROSCOPE AND ITS REVELATIONS. In one handsome volume,
beautifully illustrated with plates and wood-cuts.
BY THE SAME AUTHOR. {Preparing.)
GENERAL PHYSIOLOG-Y. In one large and very handsome octavo volume,
with several hundred illustrations.
The subject of general physiology having been omitted in the last edition of Ihe author's " Com-
parative Physiology," he has undertaken to prepare a volume which shall present it more tho-
roughly and fully than has yet been attempted, and which may be regarded as an introduction to
his other works.'
^ j^4 04'J. iw ^.tuiii\m
AND SCIENTIFIC PUBLICATIONS.
CARPENTER (WILLIAM B.), M. D., F. R. S.,
Examiner in Physiology and Comparative Anatomy in the University of London.
ELEMENTS (OR MANUAL) OF PHYSIOLOGY, INCLUDINa PHYSIO-
LOGICAL ANATOMY. Second American, from a new and revised London edition. With
one hundred and ninety illustrations. In one very handsome octavo volume.
In publishing the first edition of this vv^ork, its title was altered from that of the London volume,
by the substitution of the word "Elements" for that of " Manual," and with the author's sanction
the title of "Elements" is still retained as being more expressive of the soope of the treatise. A
comparison of the present edition with the former one will show a material improvement, the
author having revised it thoroughly, with a view of rendering it completely on a level with the
most advanced state of the science. By condensing the less important portions, these numerous
additions have been introduced without materially increasing the bulk of the volume, and while
numerous illustrations have been added, and the general execution of the work improved, it has
been kept at its former very moderate price.
To say that it is the best manual of Physiology
now before the public, would not do sufficient justice
to the author. — Buffalo Medical Journal.
In his former works it would seem that he had
exhausted the subject of Physiology. In the present,
he gives the essence, as it were, of the whole. — N. Y.
Journal of Medicine.
Those who have occasion for an elementary trea-
tise on Physiology, cannot do better than to possess
themselves of the manual of Dr. Carpenter. — Medical
Examiner.
The best and most complete expos6 of modern
Physiology, in one volume, extant in the English
language. — St. Louis Medical Journal.
With such an aid in his hand, there is no excuse
for the ignorance often displayed respecting the sub-
jects of which it treats. From its unpretending di-
mensions, it may not be so esteemed by those anxious
to make a parade of their eruditicm ; but whoever
masters its contents will have reason to be proud of
his physiological acquirements. The illustrations
are well selected and finely executed.— Dwdim Med.
Press.
BY THE SAME AUTHOR.
A PRIZE ESSAY ON THE USE OF ALCOHOLIC LIQUORS IN HEALTH
AND DISEASE. New edition, with a Preface by D. F. Condie, M. D., and explanations of
scientific words. In one neat 12mo. rolume. {Now Ready.)
This new edition has been prepared with a view to an extended circulation of this important little
work, which is xmiversally recognized as the best exponent of the laws of physiology and pathology
applied to the subject of intoxicating liquors, in a form suited both for the profession and the public.
To secure a wider dissemination of its doctrines the publishers have done up copies in fiexible
cloth, suitable for mailing, which will be forwarded through the post-office, free, on receipt of fifty
cents. Societies and others supplied in quantities for distribution at a liberal deduction.
CHELIUS (J. M.), M. D.,
Professor of Surgery in the University of Heidelberg, &c.
A SYSTEM OF SURGERY. Translated from the German, and accompanied
with additional Notes and References, by John F. South. Complete in three very large octavo
volumes, of nearly 2200 pages, strongly bound, with raised bands and double titles.
We do not hesitate to pronounce it the best and
most comprehensive system of modern surgery with
which we are acquainted. — Medico- C hirurgical Re-
view.
The fullest and ablest digest extant of all that re-
lates to the present advanced state of surgical pa-
thology. — American Medical Journal.
As complete as any system of Surgery can well
be. — Southern Medical and SurgicalJournal.
The most learned and complete systematic treatise
now extant. — Edinburgh Medical Journal.
A complete encyclopaedia of surgical science — a
very complete surgical library — by far the most
complete and scientific system of surgery in the
English language. — N. Y. Journal of Medicine.
The most extensive and comprehensive account of
the art and science of Surgery in our language. —
Lancet.
CHRISTISON (ROBERT), M. D., V. P. R. S. E., &c.
A DISPENSATORY; or, Commentary on the Pharmacopoeias of Great Britain
and the United States ; comprising the Natural History, Description, Chemistry, Pharmacy, Ac-
tions, Uses, and Doses of the Articles of the Materia Medica. Second edition, revised and im-
proved, with a Supplement containing the most important New Remedies. With copious Addi-
tions, and two hundred and thirteen large wood-engravings. By R. Eglesfeld Griffith, M. D.
In one very large and handsome octavo volume, of over 1000 pages.
It is not needful that we should compare it with
the other pharmacopoeias extant, which enjoy and
merit the confidence of the profession : it is enough
to say that it appears to us as perfect as a Dispensa-
tory, in the present state of pharmaceutical science,
could be made. If it omits any details pertaining to
this branch of knowledge which the student has a
right to expect in such a work, we confess the omis-
sion has escaped our scrutiny. We cordially recom-
mend this work to such of our readers as are in need
of a Dispensatory. They cannot make choice of a
better. — Western Journ. of Medicine and Surgery.
There is not in any language a more complete and
perfect Treatise. — N. Y. Annalist.
In conclusion, we need scarcely say that we
strongly recommend this work to all classes of our
readers. As a Dispensatory and commentary on the
Pharmacopoeias, it is unrivalled in the English or
any other language. — The Dublin Quarterly Journal .
We earnestly recommend Dr. Christison's Dis-
pensatory to all our readers, as an indispensable
companion, not in the Study only, but in the Surgejy
also. — British and Foreign Medical Review.
BLANCHARD & LEA»9 MEDICAL
CONDIE (D. F.), M. D., &c.
A PKACTICAL TREATISE ON THE DISEASES OE CHILDREN. Fourth
edition, revised and augmented. In one large volume, 8vo., of nearly 750 pages. {Just Issued.)
From the Author's Preface.
The demand for another edition has afforded the author an opportunity of again subjecting the
entire treatise to a careful revision, and of incorporating in it every important observation recorded
since the appearance of the last edition, in reference to the pathology and therapeutics of the several
diseases of which it treats.
In the preparation of the present edition, as in those which have preceded, while the author has
appropriated to his use every important fact that be has found recorded in the works of others,
having a direct bearing upon either of the subjects of which he treats, and the numerous valuable
observations — pathological as well as practical — dispersed throughout the pages of the medical
journals of Europe and America, he has, nevertheless, relied chiefly upon his own observations and
experience, acquired during a long and somewhat extensive practice, and under circumstances pe-
culiarly well adapted for the clinical study of the diseases of early life.
Every species of hypothetical reasoning has, as much as possible, been avoided. The author has
endeavored throughout the work to confine himself to a simple statement of well-ascertained patho-
logical facts, and plain therapeutical directions — his chief desire being to render it what its title
imports it to be, a practical treatise on the diseases of children.
Dr. Condie-s scholarship, aciimenj industry, and
practical sense are manifested in this, as in all his
numerous contributions to science. — Dr. Holmes's
Report to the American Medical Association,
Taken as a whole, in our judgment. Dr. Condie's
Treatise is the one from the perusal of which the
practitioner in this country will rise with the great-
est satisfaction — Western Journal of Medicine and
Surgery.
One of the best works upon the Diseases of Chil-
dren in the English language. — Western Lancet.
Perhaps the most full and complete work now be-
fore the profession of the United States ; indeed, we
may say in the English language. It is vastly supe-
rior to most of its predecessors. — Transylvania Med.
Journal.
We feel assured from actual experience that no
physician's library can be complete without a copy
of this work. — N. Y. Journal of Medicine.
A veritable peediatric encyclopeedia, and an honor
to American medical literature. — Ohio Medical and
Surgical Journal.
We feel persuaded that the American medical pro-
fession will soon regard it not only as a very good,
but as the very best "Practical Treatise on the
Diseases of Children." — American Medical Journal.
We pronounced the first edition to be the best
work on the diseases of children in the English
language, and, notwithstanding all that has been
published, we still regard it in that light. — Medical
Examiner.
COOPER (BRANSBY B.), F. R. S.,
Senior Surgeon to Guy's Hospital, &c.
LECTURES ON THE PRINCIPLES AND PRACTICE OF SURGERY.
In one very large octavo volume, of 750 pages. {Lately Issued.)
For twenty- five years Mr. Bransby Cooper has
been surgeon to Guy's Hospital; and the volume
before us may be said to consist of an account of
th^ results of his surgical experience during that
long period. We cordially recommend Mr. Bransby
Cooper's Lectures as a most valuable addition to
our surgical literature, and one which cannot fail
to be of service both to students and to those who
are actively engaged in the practice of their profea-
sion. — The Lancet.
COOPER (SIR ASTLEY P.), F. R. S., <Stc.
A TREATISE ON DISLOCATIONS AND FRACTURES OF THE JOINTS.
Edited by Bransby B. Cooper, F. R. S., &c. With additional Observations by Prof. J. C,
Warren. A new American edition. In one handsome octavo volume, with numerous illustra-
tions on wood.
BY THE SAME AUTHOR.
ON THE ANATOMY AND TREATMENT OF ABDOMINAL HERNIA.
One large volume, imperial 8vo., with over 130 lithographic iigures.
BY THE SAME AUTHOR.
ON THE STRUCTURE AND DISEASES OF THE TESTIS, AND ON
THE THYMUS GLAND. One vol. imperial 8vo., with 177 figures, on 29 plates.
BY THE SAME AUTHOH.
ON THE ANATOMY AND DISEASES OF THE BREAST, with twenty-
five Miscellaneous and Surgical Papers. One large volume, imperial 8vo., with 252 figures, oa
36 plates.
These last three volumes complete the surgical writings of Sir Astley Cooper. They are very
handsomely printed, with a large number oi lithographic plates, executed in the best style, and arc
pr«8ented at exceedingly law price*.
AND SCIENTIFIC PUBLICATIONS.
CHURCHILL (FLEETWOOD), M. D., M. R. I. A'/' ^
ON THE THEORY AND PRACTICE OF MIDWIFERY. A new American,
from the last and improved English edition. Edited, with Notes and Additions, by D. Fkancis
CoNDiE, M. D., author of a "Practical Treatise on the Diseases of Children," &;o. With 139
illustrations. In one very handsome octavo volume, pp. 510. (Lately Issued.)
No work holds a higher position, or is more de-
serving of being placed in the hands of the tyro,
the advanced student, or the practitioner. — MedicM
Exami-ner.
To bestov/ praise on a book that has received such
Marked approbation would be superfluous. We need
only say, therefore, that if the first edition was
thought worthy of a favorable reception by the
aiedical public, we can confidently affirm that this
will be found much more so. The lecturer, the
practitioner, and the student, may all have recourse
fco its pages, and derive from their perusal much in-
terest and instruction in everything relating to theo-
retical and practical midwifery,— Du6itn Quarterly
Journal of Medical Science.
A work of very great merit, and such as we can
confidently recommend to the study of every obste-
tric practitioner. — London Medical Gazette.
This is certainly the most perfect system extant,
ft is the best adapted for the purposes of a text-
b(X)k, and that which he whose necessities confine
him to one book, should select in preference to ail
others. — Southern Medical and Surgical Journal.
The most popular work on midwifery ever issued
from the American press. — Charleston Med. Journal.
Were we reduced to the necessity of having but
tme v/ork on midwifery, and permitted to choose,
we would unhesitatingly take Churchill. — Western
Med. and Surg. Journal.
It is impossible to conceive a more useful and
elegant manual than Dr. Churchill's Practice of
Midwifery. — Provincial Medical Journal.
Certainly, in our opinion, the very best work on
ike subject which exists. — N. Y. Annalist.
Previous editions, under the editorial supervision
of Prof R. M. Huston, have been received with
marked favor, and they deserved it; but this, re-
printed from a very late Dublin edition, carefully
revised and brought up by the author to the present
time, does present an unusually accurate and able
exposition of every important particular embraced
in the department of midwifery. *= *= The clearness,
directnesG, and precision of its teachings, together
with the great amount of statistical research which
its text exhibits, have served to place it already in
the foremost rank of works in this department of re-
medial science. — N. O. Med. and Surg. Journal.
In our opinion, it forms one of the best if not the
very best text-book and epitome of obstetric science
which we at present possess in the English Vda-
gxtai^e.— Monthly Journal of Medical Science.
The clearness and precision of style in which it is
written, and the great amount of statistical research
which it contains, have served to place it in the first
rank of works in this department of medical science.
—N. Y. Journal of Medicine.
Few treatises will be found better adapted as a
text-book for the student, or as a manual for the
frequent consultation of the young practitioner, —
American Medical Journal.
BY THE SAME AUTHOR.
ON THE DISEASES OF INFANTS AND CHILDREN. In one large and
handsome volume of over 600 pages.
The present volume will sustain the reputaCioa
acquired by the author from his previous works.
The reader will find in it full and judicious direc-
tions for the management of infants at birth, and a
compendious, but clear account of the diseases to
which children are liable, and the most successful
mode of treating them. We must not close this no-
tice without calling attention to the author's style,
which is perspicuous and polished to a degree, we
regret to say, not generally characteristic of medical
works. We recommend the work of Dr, Churchill
most cordially, both to students and practitioners,
as a valuable and reliable guide in the treatment of
the diseases of children. — Am. Journ. of the Med.
Sciences.
We regard this volume as possessing more claims
fco completeness than any other of the kind with
which we are acquainted. Most cordially and earn-
estly, therefore, do we commend it to our profession-
al brethren, and we feel assured that the stamp of
their approbation will indue time be impressed upon
it. After an attentive perusal of its contents, we
hesitate not to say, that it is one of the most com-
prehensive ever written upon the diseases of chil-
dren, and that, forcopiousnessof reference, extent of
research, and perspicuity of detail, it is scarcely to
be ©quailed, and not to be excelled, in any lan-
guage. — Dublin Quarterly Journal.
After this meagre, and we know, very imperfect
notice of Dr. Churchill's work, we shall conclude
by saying, that it is one that cannot fail from its co-
piousness, extensive research, and general accuracy,
to exalt still higher the reputation of the author in
this country. The American reader will be particu-
larly pleased to find that Dr. Churchill has done full
justice throughout his work to the various A merican
authors on this subject. The names of Dewees,
Eberle, Condie, and Stewart, occur on nearly every
page, and these authors are constantly referred to by
the author in terms of the highest praise, and with
the most liberal courtesy. — The Medical Examiner.
We know of no work on this department of Prac-
tical Medicine which presents so candid and unpre-
judiced a statement or posting up of our actual
knowledge as this. — N. Y. Journal of Medicine.
Its claims to merit both as a scientific and practi-
cal %vork, are of the highest order. Whilst we
would not elevate it above every other treatise on
the same subject, we certainly believe that very few
are equal to it, and none superior. — Southern Med.
and Surgical Journal.
BY THE SAME AUTHOR.
ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PE-
CULIAR TO WOMEN. Selected from the writings of British Authors previous to the close of
the Eighteenth Century. In one neat octavo volume, of about four hundred and fifty pages.
To these papers Dr. Churchill has appended notes,
embodying whatever information has been laid be-
fore the profession since their authors' time. He has
also prefixed to the Essays on Puerperal Fever,
which occupy the larger portion of the volume, an
interesting historical sketch of the principal epi-
demics of that disease. The whole forms a very
valuable collection of papers, by professional writers
of eminence, on some of the most important accidents
to which the puerperal female is liable. — Ainerietm
Journal of Medical Sciences.
10
BLANCHARD & LEA'S MEDICAL
CHURCHILL (FLEETWOOD), M. D., M. R. I. A., &,c.
ON THE DISEASES OF WOMEN; including those of Pregnancy and Child-
bed. A new American edition, revised by the Author. With Notes and Additions, by D Fran-
cis CoNDiE, M. D., author of "A Practical Treatise on the Diseases of Children." In one large
and handsome octavo volume, with wood-cuts, pp. 684. (Just Issued.)
From the Author'' s Preface.
In reviewing this edition, at the request of my American publishers, I have inserted several new
sections and chapters, and I have added, I believe, all the information we have derived from recent
researches ; in addition to which the publishers have been fortunate enough to secure the services'
of an able and highly esteemed editor in Dr. Condie.
We now regretfully take leave of Dr. Churchill's
book. Had our typbgraphical limits permitted, we
should gladly have borrowed more from its richly
stored pages. In conclusion, we heartily recom-
mend it to the profession, and would at the same
time express our firm conviction that it will not only
add to the reputation of its author, hut will prove a
work of great and extensive utility to obstetric
practitioners.— Dwiiin Medical Press.
Former editions of this'work have been noticed in
previous numbers of the Journal. The sentiments of
high commendaticm expressed in those notices, have
only to be repeated in this; not from the fact that
the profession at large are not aware of the high
merits which this work really possesses, but from a
desire to see the principles and doctrines therein
contained more generally recognized, and more uni-
versally carried out in practice. — JV. Y. Journal of
Medicine.
We know of no author who deserves that appro-
bation, on " the diseases of females," to the same
extent that Dr. Churchill does. His, indeed, is the
only thorough treatise we know of on the subject;
and it may be commended to practitioners and stu-
dents as a masterpiece in its particular department.
The former editions of this work have been com-
mended strongly in this journal, and they have won
their way to an extended, and a well-deserved popu-
larity. This fifth edition, before us. is well calcu-
lated to maintain Dr. Churchill's high reputation.
It was revised and enlarged by the author, for his
American publishers, and it seems to us that there is
scarcely any species of desirable information on its
subjects that may not be found in this work. — Ths
Western Journal of Medicine and Surgery.
We are gratified to announce a new and revised
edition of Dr. Churchill's valuable work on the dis-
eases of females We have ever regarded it as one
of the yery best works on the subjects embraced
within its scope, in the English language; and the
present edition, enlarged and revised by the author,
renders it still more entitled to the confidence of the
profession. The valuable notes of Prof. Huston
have been retained, and contribute, in no small de-
gree, to enhance the value of the work. It is a
source of congratulaticm that the publishers have
permitted the author to be, in this instance, his
own editor, thus securing all the revision which
an author alone is capable of making. — The Western
Lancet.
As a comprehensive manual for students, or a
work of reference for practitioners, we only speak
with common justice when we say that it surpasses
any other that has ever issued on the same sub-
ject from the British press. — The Dublin Quarterly
Journal.
DEWEES (W. P.), M.D., &.c,
A COMPKEHENSIVE SYSTEM OF MIDWIFERY. Elustrated by occa-
sional Cases and many Engravings. Twelfth edition, with the Author's last Improvements and
Corrections. In one octavo volume, of 600 pages. {Jfust Issued.)
BY THE SAME AUTHOR.
A TREATISE ON THE PHYSICAL AND MEDICAL TREATMENT OF
CHILDREN. Tenth edition. In one volume, octavo, 548 pages. {Just Iss^ied.)
BY THE SAME AUTHOR.
A TREATISE ON THE DISEASES OF FEMALES. Tenth edition.
one volume, octavo, 532 pages, with plates. {Just Issued.)
In
DICKSON (PROFESSOR S. H.), M.D.
ESSAYS ON LIFE, SLEEP, PAIN, INTELLECTION, HYGIENE, AND
DEATH. In one very handsome volume, royal 12mo.
DANA (JAMES D).
ZOOPHYTES AND CORALS. In one volume, imperial quarto, extra clotli,
with wood-cuts.
ALSO,
AN ATLAS TO THE ABOVE, one volume, imperial folio, with sixtj-one mag-
nificent plates, colored after nature. Bound in half morocco.
ALSO,
ON THE STRUCTURE AND CLASSIFICATION OF ZOOPHYTES.
Sold separate, one vol., cloth.
DE LA BECHE (SIR HENRY T.), F. R. S., &c.
THE GEOLOGICAL OBSERVER. In one very large and handsome octavo
volume, of 700 pages. "With over three hundred wood-cubs. {Lately Issued.)
AND SCIENTIFIC PUBLICATIONS.
11
DRUITT (ROBERT), M.R. C.S., &c.
THE PRINCIPLES AND PRACTICE OF MODERN SURGERY. A new
American, from the improved London edition. Edited by P. W. Sargent, M. D., author of
"Minor Surger}/^," &c. Illustrated with one hundred and' ninety-three wood-eng-ravings. In
one very handsomely printed octavo volume, of 576 large pages.
Dr. Druitt'a researches into the literature of his
subject have been not only extensive, but well di-
rected ; the most discordant authors are fairly and
impartially quoted, and, while due credit is given
to each, their respective merits are weighed with
an unprejudiced hand. The grain of wheat is pre-
served, and the chaff is unmercifully stripped off.
The arrangement is simple and philosophical, and
the style, though clear and interesting, is so precise,
that the book contains more information condensed
into a few words than any other surgical work with
which we are acquainted. — London Medical Times
and Gazette, February 18, 1854.
No work, in our opinion, equals it in presenting
so much valuable surgical matter in so small a
compass. — St. Louis Med. and Surgical Journal.
Druitt's Surgery is too well known to the Ameri-
can medical profession to require its announcement
anywhere. Probably no work of the kind has ever
been more cordially received and extensively circu-
lated than this. The fact that it comprehends in a
comparatively small compass, all the essential ele-
ments of theoretical and practical Surgery — that it
is found to contain reliable and authentic informa-
tion on the nature and treatment of nearly all surgi-
cal affections — is a sufficient reason for the liberal
patronage it has obtained. The editor, Dr. F. W.
Sargent, has contributed much to enhance the value
of the w^ork, by such American improvements as are
calculated more perfectly to adapt it to our own
views and practice in this country. It abounds
everywhere with spirited and life-like illustrations,
which to the young surgeon, especially, are of no
minor consideration. Every medical man frequently
needs just such a work as this, for immediate refe-
rence in moments of sudden emergency, when he has
not time to consult more elaborate treatises. — The
Ohio Medical and Surgical Journal.
The author has evidently ransacked every stand-
ard treatise of ancient and modern times, and all that
is really practically useful at the bedside will be
found in a form at once clear, distinct, and interest-
ing. — Edinburgh Monthly Medical Journal.
Druitt's work, condensed, systematic, lucid, and
practical as it is, beyond most works on Surgery
accessible to the American student, has had much
currency in this country, and under its present au-
spices promises to rise to yet higher favor. — The
Western Journal of Medicine and Surgery.
The most accurate and ample resum6 of the pre-
sent state of Surgery that we are acquainted with.—
Dublin Medical Journal,"
A better book on the principles and practice of
Surgery as now understood in England and America,
has not been given to the profession.— JSos^on Medi-
cal and Surgical Journal.
An unsurpassable compendium, not only of Sur-
gical, but of Medical Practice. — London Medical
Gazette.
This work merits our warmest commendations,
and we strongly recommend it to young surgeons as
an admirable digest of tlie principles and practice of
modern Surgery. — Medical Gazette.
It maybe said with truth that the work of Mr.
Druitt affords a complete, though brief and con-
densed view, of the entire field of modern surgery.
We know of no work on the same subject having the
appearance of a manual, which includes so many
topics of interest to the surgeon ; and the terse man-
ner in which each has been treated evinces a most
enviable quality of mind on the part of the author,
who seems to have an innate power of searching
out and grasping the leading facts and features of
the most elaborate productions of the pen. It is a
useful handbook for the practitioner, and we should
deem a teacher of surgery unpardonable who did not
recommend it to his pupils. In our own opinion, it
is admirably adapted to the wants of the student. —
Provincial Medical and Surgical Journal.
DUNGLISON, FORBES, TWEEDIE, AND CONOLLY.
THE CYCLOPiEDIA OF PRACTICAL MEDICINE: comprising Treatises on
the Nature and Treatment of Diseases, Materia Medica, and Therapeutics, Diseases of Women
and Children, Medical Jurisprudence, &c. &c. In four large super royal octavo volumes, of
3254 double-columned pages, strongly and handsomely bound.
*^* This work contains no less than four hundred and eighteen distinct treatises, contributed by
SL3».y-eight distinguished physicians.
The most complete work on Practical Medicine
extant; "or, at least, in our language.— .Bu/^aZo
Medical and Surgical Journal.
For reference, it is above all price to every prac-
titioner.— Western Lancet.
One of the most valuable medical publications of
the day — as a work of reference it is invaluable. —
Western Journal of Medicine and Surgery.
It has been to us, both as learner and teacher, a
work for ready and frequent reference, one in which
modern English medicine is exhibited in the most
advantageous light.— JVIed/ca/ Examiner.
We rejoice that this work is to be placed within
the reach of the profession in this country, it being
unquestionably one of very great value to the prac-
titioner. This estimate of it has not been formed
from a hasty examination, but after an intimate ac-
quaintance derived from frequent consultation of it
during the past nine or ten years. The editors are
practitioners of established reputation, and the list
of contributors embraces many of the most eminent
professors and teachers of London, Edinburgh, Dub-
lin, and Glasgow. It is, indeed, the great merit of
this work that the principal articles have been fur-
nished by practitioners who have not only devoted
especial attention to the diseases about which they
have written, but have also enjoyed opportunities
for an extensive practical acquaintance with them,
and whose reputation carries the assurance of their
competency justly to appreciate the opinions of
others, while it stomps their own doctrines with
high and just authority. — American Medical Joum.
DUNGLISON (ROBLEY), M. D.,
Professor of the Institutes of Medicine in the Jefferson Medical College, Philadelphia.
HUMAN HEALTH; or, the Influence of Atmosphere and Locality, Change of
Air and Climate, Seasons, Food, Clothing, Bathing, Exercise, Sleep, (tec. &c., on Healthy Man;
constituting Elements of Hygiene. Second edition, with many modifications and additions. In
one octavo volume, of 464 pages.
12
BLANCHARD & LEA'S MEDICAL
DUNGLISON (ROBLEY), M. D.,
Professor of Institutes of Medicine in the Jefferson Medical College, Philadelphia.
MEDICAL LEXICON; a Dictionary of Medical Science, containinsr a concise
Explanation of the various Subjects and Terms of Physiology, Pathology, Hygiene, Therapeutics,
Pharmacology', Obstetrics, Medical Jurisprudence, &c. With the French and other Synonymes ;
Notices of Climate and of celebrated Mineral Waters; Formute for various Officinal, Empirical,
and Dietetic Preparations, etc. Eleventh edition, revised. In one very thick octavo vohune, ol
over nine hundred large double-columned pages, strongly bound in leather, with raised bands.
(Just Isstied.)
Every successive edition of this work bears the marks of the industry of the author, and of his
determination to keep it fully on a level with the most advanced state of medical science. Thus
nearly fifteen thousand words have been added to it within the last few years. As a complete
Medical Dictionary, therefore, embracing over FIFTY THOUSAND DEFINITIONS, m all the
branches of the science, it is presented as meriting a continuance of the great favor and popularity
which have carried it, within no very long space of time, to an eleventh edition.
Every precaution has been taken in the preparation of the present volume, to render its mecha-
nical execution and typographical accuracy worthy of its extended reputation and universal use.
The very extensive additions have been accommodated, without materially increasing the bulk oi
the volume by the employment of a small but exceedingly clear type, cast for this purpose. The
press has been watched with great care, and every effort used to insure the verbal accuracy so ne-
cessary to a work of this nature. The whole is printed on fine white pap-er ; and, while thus exhi-
biting in every respect so great an improvement over former issues, it is presented at the original
exceedingly low price.
We welcome it cordially ; it is an admirable work,
and indispensable to all literary medical men. The
labor which has been bestowed upon it is something
prodigious. The work, however, has now been
done, and we are happy in the thought that no hu-
man being will have again to undertake the same
gigantic task. Revised and corrected from time to
time, Dr. Dunglison's " Medical Lexicon" will last
for centuries. — British and Foreign Med. Chirurg.
Review, July, 1853.
The fact that this excellent and learned work has
passed through eight editions, and that a ninth is
rendered necessary by the demands of the public,
affords a sufficient evidence of the general apprecia-
tion of Dr. Dunglison's labors by the medical pro-
fession in England and America. It is a book which
w^ill be of great service to the student, in teaching
him the meaning of all the technical terms used in
medicine, and w^ill be of no less use to the practi-
tioner who desires to keep himself on a level with
the advance of medical science. — London Medical
Times and Gazette.
In taking leave of our author, we feel compelled
to confess that his work bears evidence of almost
incredible labor having been bestowed upon its com-
position. — Edinburgh Journal of Med. Sciences,
Sept. 1853.
A miracle of labor and industry in one who has
written able and voluminous works on nearly every
branch of medical science. There could be no more
useful book to the student or practitioner, in the
present advancing age, than one in which would be
found, in addition to the ordinary meaning and deri-
vation of medical terms — so many of which are of
modern introduction — concise descriptions of their
explanation and employment ; and ail this and much
more is contained in the volume before us. It is
therefore almost as indispensable to the other learned
professions as to our own. In fact, to all who may
have occasion to ascertain the meaning of any word
belonging to the many branches of medicine. From
a careful examination of the present edition, we can
vouch for its accuracy, and for its being brought
quite up to the date of publication ; the author states
ia his preface that he has added to it about four thou-
sand terms, which are not to be found in the prece-
ding one. — Dublin Quarterly Journal of Medical
Sciences.
On the appearance of the last edition of this
valuable work, we directed the attention of our
readers to its peculiar merits ; and we need do
little more than state, in reference to the present
reissue, that, notwithstanding the large additions
previously made to it, no fewer than four thou-
sand terms, not to be found in the preceding edi-
tion, are contained in the volume before us. —
Whilst it is a wonderful monument of its author's
erudition and industry, it is also a work of great
practical utility, as we can testify from o»r owa
experience; for we keep it constantly within out
reach, and make very frequent reference to it,
nearly always finding in it the information Ave seek.
— British and Foreign Med.-Chirurg. Review.
It has the rare merit that it certainly has no rivai
in the English language for accuracy and extent
of references. The" terms generally include short
physiological and pathological descriptions, so that,
as the author justly observes, the reader does not
possess in this work a mere dictionary, but a book,
which, while it instructs him in medical etymo-
logy, furnishes him with a large amount of useful
information. The author's labors have been pro-
perly appreciated by his own countrymen ; and we
can only confirm their judgment, by recommending
this most useful volume to the notice of our cisat-
lantic readers. No medical library will be complete
without it. — London Med. Gazette.
It is certainly mot^ complete and comprehensive
than any with which we are acquainted in the
English language. Few, in fact, could be found
better qualified than Dr. Dunglison for the produc-
tion of such a work. Learned, industrious, per-
severing, and accurate, he brings to the task ail
the peculiar talents necessary for its successful
performance; while, at the same time, his fami-
liarity with the writings of the ancient and modera
" masters of our art," renders him skilful to note
the exact usage of the several terms of science;
and the various modifications which medical term-
inology has undergone with the change of theo-
ries or the progress of improvement. — American
Journal of the Medical Sciences.
One of the most complete and copious known to
the cultivators of medical science. — Boston Med.
Journal.
The most comprehensive and best English Dic-
tionary of medicaL terms extant. — Buffalo Medical
Journal.
BY THE SAME AUTHOR.
THE PRACTICE OF MEDICINE. A Treatise on Special Pathology and The-
rapeutics. Third Edition. In two large octavo volumes, of fifteen hundred pages.
Upon every topic embraced in the work the latest
information will be found carefully posted up. —
Medical Examiner.
The student of medicine will find, in these two
elegant volumes, a mine of facts, a gathering of
precepts and advice from the world of experience,
that will nerve him with courage, and faithfully
direct him in his efforts to relieve the physical suf-
ferings of the race.
Journal .
-Boston Medical and Surgical
It is certainly the most complete treatise of which
we haveany knowledge. — Western Journal of Medi-
cine and Surgery.
One of the most elaborate treatises of the kinti
we have. — Southern Med. and Surg. Journal.
AND SCIENTIFIC PUBLICATIONS.
IS
DUNGLISON (ROBLEY), M.D.,
Professor of Institutes of Medicine la the Jefferson Medical College, Philadelphia.
HUMx\N PHYSIOLOGY. Seventh edition. Thoroughly revised and exten-
sively modified and enlarged, with nearly five hundred illustralions. In two large and hand-
somely printed octavo volumes, containing nearly 1450 pages.
It has long since taken rank as one of the medi-
eal classics of our language. To say that it is by
fur the best text-book ot physiology ever published
in this country, is but echoing the general testi-
mony of the profession. — N. Y. Journal of Medicine.
There is no single book we would recommend to
•he student or physician, with greater confidence
than the present, because in it will be found a mir-
ror of almost every standard physiological work of
the day. We most cordially recommend the work
to every member of the profession, and no student
sfhould be without it. It is the completest work on
Physiology in the English language, and is highly
creditable to the author and publishers. — Canadian
Medical Journal.
The most complete and satisfactory system of
Physiology in the English language. — Amer. Med.
Journal.
The best work of the kind in the English iau-
guage. — Silliman's Journal.
The most full and complete system of Pliysiology
in our language. — Western Lancet.
BY THE SAME AUTHOR. {Just IsSUed.)
GENEKAL THERAPEUTICS AND MATERIA MEDIC A; adapted for a
Medical Text-book. Fifth edition, much improved. With one hundred and eighty-sevea illus-
trations. In two large and handsomely printed octavo vols., of about 1100 pages.
The new editions of the United States Pharmacopoeia and those of London and Dublin, have ren-
dered necessary a thorough revision of this work. In accomplishing this the author has spared no
pains in rendering it a complete exponent of all that is new and reliable, both in the department*
of Therapeutic* and Materia Medica. The book has thus been somewhat enlarged, and a like im-
provement will be found in every department of its mechanical execution. As a convenient text-
book for the student, therefore, containing within a moderate compass a satisfactory resume of il«
important subject, it is again presented as even more worthy than heretofore of the very great favor
which it has received.
In this work of Dr. Dunglison, we recognize the
same untiring industry in the collection and em-
bodying of facts on the several subjects of which he
treats, that has heretofore distinguished him, and
we cheerfully point to these volumes, as two of the
most interesting that we know of. In noticing the
additions to this, the fourth edition, there is very
little in the periodical or annual literature of the
profession, published in the interval which has
elapsed since the issue of the first, that has escaped
the careful search of the author. As a book for
reference, it is invaluable. — Charleston Med. Jour-
nal and Review.
It may be said to be the work now upon the sub-
iects upon which it treats. — Western Lancet.
As a text-book for students, for whom it is par-
ticularly designed, we know of none superior to
it. — St. Louis Medical and Surgical Journal.
It purports to be a new edition, but it is rather
a new book, so greatly has it been improved, both
in the amount and quality of the matter which it
contains. — N. O. Medical and Surgical Journal.
We bespeak for this edition, from the profession,
an increase of patronage over any of its former
ones, on account of its increased merit. — N. Y.
Journal of Medicine.
We consider this work unequalled.
and Surg. Journal.
■Boston Med
BY THE SAME AUTHOR.
NEW REMEDIES, WITH FORMULA FOR THEIR ADMINISTRATION.
Sixth edition, with extensive Additions. In one very large octavo volume, of over 750 pages.
One of the most useful of the author's works. — diseases and for remedies, will be found greatly to
Southern Medical and Surgical Journal. enhance its value. — New York Med. Gazette.
This well-known and standard book has now
Feached its sixth edition, and has been enlarged and
improved by the introduction of all the recent gifts
to therapeutics w^hich the last few years have so
richly produced, including the anajsthetie agents,
&c. This elaborate and useful volume should be
found in every medical library, for as a book of re-
ference, for physicians, it is unsurpassed by any
other work in existence, and the double index for
The great learning of the author, and his remark-
able industry in pushing his researches into every
source whence information is derivable, has enabled
him to throw together an extensive mass of facts
and statements, accompanied by full reference to
authorities; which lust feature renders the work
practically valuable to investigators who desire to
examine the original papers. — The American Journal
of Pharmacy.
DURLACHER (LEWIS).
A TREATISE ON CORNS, BUNIONS, THE DISEASES OF NAILS,
AND THE GENERAL MANAGEMENT OF THE FEET. In one 12mo. volume, cloth.
pp. 134.
DE JONGH (L. J.), M. D., Sec.
THE THREE KINDS OF COD-LIVER OIL, comparatively considered, with
their Chemical and Therapeutic Properties. Translated, with an Ap^iendix and Cases, by
Edward Carey, M. D. To which is added an article on the subject from "Dunglisou on New
Remedies." In one small 12mo. volume, extra cloth.
DAY (GEORGE E.), M. D.
A PRACTICAL TREATISE ON THE DOMESTIC MANAGEMENT AND
With an Appendix on a new
MORE IMPORTANT DISEASES OF ADVANCED LIFE.
and successful mode of treating Lumbago and other forms of Chronic Rheumatism.
octavo, 226 pages.
One volume
14
BLANCHARD & LEA'S MEDICAL
ELLIS (BENJAMIN), M.D.
THE MEDICAL FORMULARY : being a Collection of Prescriptions, derived
from the writings and practice of many of the most eminent physicians of America and Europe.
Together with the usual Dietetic Preparations and Antidotes for Poisons. To which is added
an Appendix, on the Endermic use of Medicines, and on the use of Elher and Chloroform. The
whole accompanied with a few brief Pharmaceutic and Medical Observations. Tenth edition,
revised and much extended by Robert P. Thomas, M. D., Professor of Materia Medica in the
Philadelphia College of Pharmacy. In one neat octavo volume, of Iwo hundred and ninety-six
pages. (Now Keady. Revised a?id enlarged to 1854.)
This work has received a very complete revision at the hands of the editor, who has made what-
ever alterations and additions the progress of medical and pharmaceutical science has rendered ad
visable, introducing fully the new remedial agents, and revising the whole by the latest improvements
of the Pharmacopoeia. To accommodate these additions, the size of the page has been increased,
and the volume itself considerably enlarged, while every elfort has been made to secure the typo-
graphical accuracy which has so long merited the confidence of the profession.
After an examination of the new matter and the
alterations, we believe the reputation of tiie work
built up by the author, and the late distinguished
editor, will continue to flourisli under the auspices
of the present editor, who has the industry and accu-
racy, and, we would say, conscientiousness requi-
site for the responsible task. — American Journal of
Pharmacy, March, 1854.
It will prove particularly useful to students and
young prnctitioners, as the most important prescrip-
tions employed in modern practice, which lie scat-
tered through our (medical literature, are here col-
lected and conveniently arranged for reference. —
Charleston Med. Journal and Review.
ERICHSEN (JOHN),
V Professor of Surgery in University College, London, &c.
THE SCIENCE AND ART OF SURGERY; being A Treatise on Surgical
Injuries, Diseases, and Operations. Edited by John H. Brinton, M. D. Illustrated with
three hundred and eleven engravings on wood. In one large and handsome octavo rolume, oi
over nine hundred closely printed pages. {Now Ready .)
This is a new work, brought up to May, 1854.
It is, in our humble judgment, decidedly the best
book of the kind in the English language. Strange
That just such books are notofieuer produced by pub-
lic teachers of surgery iu this country and Great
Britain. Indeed, it is a matter of great astonishment,
but no less true than astonishing, that of the many
works on surgery republished in this country within
the last fiileeu or twenty years as text-books for
medical students, this is the only one, that even ap-
proximates to the fulfilment of the peculiar wants of
young men jupt. entering upon the study of this l)ranch
of the profession. — WesUTn.Tour. of Med. a?id Surgery.
Embracing, as will be perceived, the whole surgi-
cal domain, and each division of itself almost com-
plete and perfect, each chapter full and explicit, each
subject faithfully exhibited, we can only express our
extimate of it in the aggregate. We consider it an
excellent contribution to surgery, as probably the
best single volume now exiaiii on the subject, and
with great pleasure we add it to our textbooks —
Nashville Journal of Medicine and Surgery.
Its value is greatly enhanced by a very copious
well-ai-ranged index. We regard this as one of the
most valuable contributions to modern surgery. To
one entering his novitiate of practice, we regard ii
the most serviceable guide which he can consult. He
will fittd a fulness of detail leading him through every
step of the operation, and not deserting him until the
final issue of the case is decided. For the same rea-
son we recommend it to those whose routine of prac-
tice lies in such parts of the country that they must
rarely encounter cases requiring surgical manage-
ment.— 5<et^o5co7>e.
Prof Erichsen's work, for its size, has not been
surpassed; his nine hundred and eight pages, pro-
fusely illustrated, are rich in physiological, patholo-
gical, and operative suggestions, doctrines, details,
and processes; and will prove a reliable resource
for information, both lo physician and surgeon, in the
hour of peril.— JV. 0. Med. and Surg. Journal.
FERGUSSON (WILLIAM), F. R. S.,
Professor of Surgery in King's College, London, &c.
A SYSTEM OF PRACTICAL SURGERY. Fourth American, from the third
and enlarged London edition. In one large and beautifully prmted octavo volume, of about seven
hundred pages, with three hundred and ninety-three handsome illustrations. (Just Issued.)
The most important subjects in connection w^ith
practical surge-iy which have been more recently
brought under the notice of, and discussed by, the
surgeons of Great Britain, are fully and dispassion-
ately considered by Mr. Fergusson, and that which
was before wanting has now been supplied, so that
we can now look upon it as a work on practical sur-
gery instead of one on operative surgery alone. And
we think the author has shown a wise discretion in
making the additions on surgical disease which are
to be found in the present volume, and has very
much enhanced its value; for, besides tw;o elaborate | Journal.
The addition of many new pages makes this work
more than ever indispensable to the student and prac-
titioner. — Ranking^s Abstract.
sively on operative surgery ; but this defect is now
removed, and the book is more than ever adapted for
the purposes of the practitioner, whether he confines
himself more strictly to the operative department,
or follows surgery on a more comprehensive scale. —
Medical Ti?7ies and Gazette.
No work was ever written which more nearly
comprehended the necessities of the student and
practitioner, and was more carefully arranged to
that single purpose than this.— IV. Y. Med. and Surg.
chapters on the diseases of bones and joints, which
were wanting before, he has headed each chief sec-
tion of the work by a general description of the sur-
gical disease and injury of that region of the body j
which is treated of in each, prior to entering into the I ^ . _ .
consideration of the more special morbid conditions I lished of late years, we know of none we value
and their treatment. There is also, as in former j more highly than the one before us. It is perhaps
editions, a sketch of the anatomy of particular re- the very best we have for a text-book and for ordi-
gions. There was some ground formerly for the nary reference, being concise and eminently practi-
eoraplaint before alluded to, that it dwelt too exclu- | ca\.— Southern Med. and Surg. Journal.
Among the numerous works upon surgery pub-
FRICK (CHARLES), M. D.
RENAL AFFECTIONS; their Diagnosis and Pathology.
One volume, royal 12mo., extra cloth.
With illustrations.
AND SCIENTIFIC PUBLICATIONS.
1$
FOWNES (GEORGE), PH. D., See.
ELEMENTARY CHEMISTRY; Theoretical and Practical. With numerous
illustrations. A new American, from the last and revised London edition. Edited, with Addi-
tions, by Robert Bridges, M. D. In one large royal 12mo. volume, of over 550 pages, with 181
wood-cuts, sheep, or extra cloth. (Now Ready.)
The lamented death of the author has caused the revision of this edition to pass into the hands ot
those distinguished chemists, H. Bence Jones and A, W. Hofmann, who have fully sustained its
reputation by the additions which they have made, more especially in the portion devoted to Organic
Chemistry, considerably increasing the size of the volume. This labor has been so thoroughly
performed, that the American Editor has found but little to add, his notes consisting chiefly of suck
matters as the rapid advance of the science has rendered necessary, or of investigations which had
apparently been overlooked by the author's friends.
The volume is therefore again presented as an exponent of the most advanced state of chemical
science, and as not unworthy a continuation of the marked favor which it has received as an ele-
mentary text-book.
We know of no better text-book, especially in the
difficult department of organic chemistry, upon
w^hich it is particularly fall and satisfactory. We
would recommend it to preceptors as a capital
" office book" for their students who are beginners
in Chemistry. It is copiously illustrated with ex-
cellent wood-cuts, and altogether admirably "got
up."— iV. J. Medical Reporter, March, 1854.
A standard manual, ^vhich has long enjoyed the
reputation of embodying much knowledge in a small
space. The author hasachieved the difficult task of
condensation with masterly tact. His book is con-
cfse without being dry, and brief without being too
dogmatical or general. — Virginia Med. and Surgical
Journal.
The work of Dr. Fownes has long been before
the public, and its merits have been fully appreci-
ated as the best text-book on chemistry now in
existence. We do not, of course, place it in a rank
superior to the works of Brande, Graliam, Turner,
Gregory, or Gmelin, but we say that, as a work
for students, it is preferable to any of them. — Lon-
don Journal of Medicine.
A work well adapted to the wants of the student.
It is an excellent exposition of the chief doctrines
and facts of modern chemistry. Thesizeof the work,
and still more the condensed yet perspicuous style
in -which it is written, al)solve it from the charges
very properly urged against most manuals termed
popular. — Edinburgh Monthly Journal of Medical
Science.
GRAHAM (THOMAS), F. R. S.,
Professor of Chemistry in University College, London, &c.
THE ELEMENTS OF CHEMISTRY. Including the application of the Science
to the Arts. With numerous illustrations. With Notes and Additions, by Robert Bridges,
M. D., &e. &c. Second American, from the second and enlarged London edition
PART I. (Lately Issvsd) large 8vo., 430 pages, 185 illustrations.
PART II. (Preparing) to match.
The great changes which the science of chemistry has undergone within the last few years, ren-
der a new edition of a treatise like the present, almost a new work. The author has devoted
several years to the revision of his treatise, and has endeavored to embody in it every fact and
inference of importance which has been observed and recorded by the great body of chemical
investigators who are so rapidly changing the face of the science. In this manner the work has
been greatly increased in size, and the number of illustrations doubled ; while the labors of the editor
have been directed towards the introduction of such matters as have escaped the attention of the
author, or as have arisen since the publication of the first portion of this edition in London, in 1850.
Printed in handsome style, and at a very low price, it is therefore confidently presented to the pro-
fession and the student as a very complete and thorough text-book of this important subject.
GROSS (SAMUEL D.), M. D.,
Professor of Surgery in the Louisville Medical Institute, &c.
A PRACTICAL TREATISE ON THE DISEASES AND INJURIES OF
THE URINARY ORGANS. In one large and beautifully printed octavo volume, of over seven
hundred pages. With numerous illustrations.
A volume replete with truths and principles of the
utmost value in the investigation of these diseases. —
American Medical Journal.
Dr. Gross has brought all his learning, experi-
ence, tact, and judgment to the task, and has pro-
duced a w^ork worthy of his high reputation. We
feel perfectly safe in recommending it to our read-
ers as a monograph unequalled in interest and
practical value by any other on the subject in our
language. — Western Journal of Med. and Surg.
It has remained for an American writer to \vipe
away this reproach ; and so completely has the task
been fulfilled, that we venture to predict for Dr.
Gross's treatise a permanent place in the literature
of surgery, worthy to rank with the best works of
this department of art. We have, indeed, unfeigned
pleasure in congratulating all concerned in this pub-
lication, on the result of their labours; and expe-
rience a feeling something like what animates a long-
expectant husbandman, who, often times disappointed
by the produce of a favorite field, is at last agree-
ably surprised by a stately crop which may bear
comparison -with any of its former rivals. The
grounds of our high appreciation of the work\vill
be obvious as we proceed; and we doubt not that
the present facilities for obtaining American books
will induce many of our readers to verify our re-
commendation by their own perusal of it. — British
and Foreign Medico-C hirurgical Review.
AVhoever will peruse the vast amount of valuable
the present age. Not merely is the matter good, i practical information it contains, and wliich we
but the getting up of the volume is most creditable i have been unable even to notice, will, we think,
to transatlantic enterprise; the paper and print ' agree with us, that there is no work in the Knglislv
would do credit to a first-rate London establishment; language which can make any jnst pretensions to
and the numerous wood-cuts which illustrate it, de- be its equal. — N. Y. Journal of Medicine.
monstrale that America is making rapid advances in i
BY THE SAME AUTHOR. (NoW Ready.)
A PRACTICAL TREATISE ON FOREIGN BODIES IN THE AIR-PAS-
SAGES. In one handsome octavo volume, with illustrations.
BY THE SAME AUTHOR. (Preparing.)
A SYSTEM OF SURQERY; Diagnostic, Pathological, Therapeutic, and Opera-
tive. With very numerous engravings on wood.
16
. '• y ; > rr A ■ ; T "Z :^ i D ^ ( i ;4 .^
BLANCHARD & LEA'S MEDICAL
GRIFFITH (ROBERT E.), M. D., &.C.
A UNIVERSAL FORMULARY, containing the methods of Preparing and Ad-
ministering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceu-
tists. Second Edition, thoroug-hly revised, with numerous additions, by Robert P. Thomas,
M. D., Professor of Materia Medica in the Philadelphia College of Pharmacy. In one large an<3
handsome octavo volume, of over six hundred pages, double columns. {Jiist Issued.)
The speedy exhaustion of a large edition, and the demand for a second, sufficiently show the posi-
tion which this work has so rapidly attained as an authoritative and convenient work of reference for
the physician and pharmaceutist. The opportunity thus afforded for its improvement has not been
neglected. In its revision, Professor Thomas (to whom this task has been confided inconsequence
of the death of the author), has spared no labor, in the hope of rendering it the most complete and
correct work on the subject as yet presented to the profession All the newly introduced articles
of the Materia Medica have been inserted, such formulae as had escaped the attention of the author
have been added, and the whole has been most carefully read and examined, to insure the absolute
correctness, so indispensable in a work of this nature. The amount of these additions maybe esti-
mated from the fact that not only has the page been considerably enlarged, but the volume has also
Ijeen increased by about fifty pages, while the arrangement of the forraulee and the general typo-
graphical execution will be found to have undergone great improvement. To the practitioner, its
copious collection of all the forms and combinations of the articles of the Pharmacopoeia render it
an invaluable book of reference, while its A'ery complete embodiment of officinal preparations of aUt
kinds, derived from all sources, American, English, and Continental, make it an indispensable assisl-
tant to the apothecary.
It was a work requiring much perseverance, and
when published was looked upon as by far the best
work of its kind that had issued t'rom the American
press, beinjT free of much of the trashy, and embrac-
ing most of the non-officinal formul.'^e used or known
in American, English, or French practice, arranged
under the heads of the several constituentdrugs, plac-
ing the receipt under its more important constituent.
Prof Thomas lias certainly "improved," as well as
added ;o this Formulary, and has rendered it addition-
ally deserving of the confidence of pharmaceutists
and physicians. — American Journal of Pharmacy.
We are happy to announce a new and improved
edition of this, one of the most valuable and useful
works that have emanated from an American pen.
It would do credit to any country, and will be found
of daily usefulness to practitioners of medicine; it is
better adapted to their purposes than the dispensato-
ries.— SoitzAern Med. and Surg. Journal.
A new edition of this well-known work, edited by
R. P. Thomas, M D., affords occasion for renewing
our commendation of so useful a handbook, which
ought to be universally studied by medical men of
every class, and made use of by way of reference by
ofiice pupils, as a standard authority. It has been
much enlarged, and now condenses a vast amount
of needful and necessary knowledge in small com-
pass. The more of such books the better for the pro-
fession and the public— N. Y. Med. Gazette.
It is one of the mo«t useful books a country practi-
tioner can possibly have in his possession. — Mtdieal
Chronicle.
The amount of useful, every-day matter, for a prac-
ticing physician, is really immense.— jBos^o/i Mtd,
and Surg. Journal.
This is a work of six hundred and fifty one pages.
embracmg all on the subject of preparing and admi-
nistering medicines that can be desired by the physi-
cian and pharmaceutist. — Wester7i Lancet.
In short, it is a full and complete work of the kind,
and should be in the hands of every physician and
apothecary. — O. Bled, and Surg. Journal
We predict a great sale for this work, and we espe-
ciallv recommend it to all tnedical teachers. — Rich-
mond Stethoscope.
This edition of Dr. Griffith's work has been greatly
imoroved by the revision and ample additions of Dr.
Thomas, and is now, we believe, one of the most
complete works of its kind in any language. The
additions amount to about seventy pages, and no
effort has been spared to include in them all the re-
cent improvements which have been published in
medical journals, and sy.slematic treatisas. A work
of this kind appears to us indispensable lo the physi-
cian, and there is none we can more cordially recom-
mend. — iV. y. Journal of Medicine.
BY THE SAME AUTHOR.
MEDICAL BOTANY; or^ a Description of all the more important Plants used
in Medicine, and of their Properties, Uses, and Modes of Administration. In one large octavo
volume, of 704 pages, handsomely printed, with nearly 350 illustrations on wood.
GLUGE (GOTTLIEB), M. D.,
Professor of Physiology and Pathological Anatomy in the University of Brussels, &c.
AN ATLAS OF PATHOLOGICAL HISTOLOGY. Translated, with Notes
and Additions, by Joseph Leidy, M. D., Professor of Anatomy in the University of Pennsylva-
nia. In one volume, very large imperial quarto, with three hundred and twenty figures, plain
and colored, on twelve copperplates.
This being, as far as we know, the only work in
which pathological histology is separately treated
of in a comprehensive manner, it will, we think, for
this reason, be of infinite service to those who desire
to investigate the subject systematically, and -who
have felt the difficulty of arranging in their mind
the unconnected observations of a great number of
authors. The development of the morbid tissues,
and the formation of abnormal products, may now
be followed and studied with the same ease and
satisfaction as the best arranged system of phy-
siology. — American Med. Journal.
GREGORY (WILLIAM), F. R. S. E.,
Professor of Chemistry in the University of Edinburgh, &c.
LETTERS TO A CANDID INQUIRER ON ANIMAL
In one neat volume, royal 12mo., extra cloth.
MAGNETISM.
GARDNER (D. PEREIRA), M. D. ^
MEDICAL CHEMISTRY, for the use of Students and the Profession: being a
Manual of the Science, with its Applications to Toxicology, Physiology, Therapeutics, Hygiene,
&c. In one handsome royal i2mo. volume, with illustrations.
iiyiO iUOiDUUi
AND SCIENTIFIC PUBLICATIONS. 17
HASSE (C. E.), M. D.
AN ANATOMICAL DESCllIPTION OF THE DISEASES OP RESPIRA-
TION AND CIRCULATION. Translated and Edited by Swaine. In one volume, octavo.
HARRISON (JOHN), M. D.
AN ESSAY TOWARDS A CORRECT THEORY OF THE NERVOUS
Si^STEM. In one octavo volume, 292 pages.
HUNTER (JOHN).
TREATISE ON THE VENEREAL DISEASE. With copious Additions, by
Db. Ph. Ricord, Surgeon to the Venereal Hospital of Paris. Edited, with additional Notes, by
F. J. BuMSTEAD, M. D. In one octavo volume, with plates {Now Ready.) ^W See Ricord.
Also, HUNTER'S COMPLETE WORKS, with Memoir, Notes, &c. &c. In four neat octavo
volumes, with plates.
HUGHES (H. M.), M. D.,
Assistant Physician to Guy's Hospital, tea.
A CLINICAL INTRODUCTION TO THE PRACTICE OF AUSCULTA-'
TION, and other Modes of Physical Diagnosis, in Diseases of the Lungs and Heart. Second
American from the Second and Improved London Edition. In one royal ]2mo. vol. {Now Ready.)
It has been carefully revised throughout. Some small portions have been erased ; much has
been, I trust, amended; and a great deal of new matter has been added; so that, though funda-
mentally it is the same book, it is in many respects a new work. — Preface.
HORNER (WILLIAM E.), M. D.,
Professor of Anatomy in the University of Pennsylvania.
SPECIAL ANATOMY AND HISTOLOGY. Eighth edition. Extensively
revised and modified. In two large octavo volumes, of more than one thousand pages, handh
somely printed, with over three hundred illustrations.
This work has enjoyed a thorough and laborious revision on the part of the author, with the
view of bringing it fully up to the existing state of knowledge on the subject of general and special
anatomy. To adapt it more perfectly to the wants of the student, he has introduced a large number
of additional wood-engravings, illustrative of the objects described, while the publishers have en-
deavored to render the mechanical execution of the work worthy of the extended reputation which
it has acquired. The demand which has carried it to an EIGHTH EDITION is a sufficient evi-
dence of the value of the work, and of its adaptation to the wants of the student and professional
reader.
HOBLYN (RICHARD D.), A. M .
A DICTIONARY OF THE TERMS USED IN MEDICINE AND THE
COLLATERAL SCIENCES. Second and Improved American Edition. Revised, with nu-
merous Additions, from the second London edition, by Isaac Hays, M. D., &c. In one large
royal 12mo. volume, of over four hundred pages, double columns. {Nearly Ready.)
In passing this work a second time through the press, the editor has subjected it to a very tho-
rough revision, making such additions as the progress of science has rendered desirable, and sup-
plying any omissions that may have previously existed. As a concise and convenient Dictionary
of Medical Terms, at an exceedingly low price, it will therefore be found of great value to the stu-
dent and practitioner.
HOPE (J.), M. D., F. R. S., &tc.
A TREATISE ON THE DISEASES OF THE HEART AND GREAT
VESSELS. Edited by Pennock. In one volume, octavo, with plates, 572 pages.
JONES (C. HANDFIELD), F. R. S., 8l EDWARD H. SIEVEKING, M.D.,
Assistant Physicians and Lecturers in St. Mary's Hospital, London.
A MANUAL OF PATHOLOGICAL ANATOMY. With 400 engravings on
wood. In one large and handsome octavo volume, of about seven hundred pages. {Now Ready.)
This work will supply a want which has been felt of a volume which, within a reasonable size,
should contain a clear and connected view of the present advanced state of pathological anatomy,
embodying the numerous investigations and discoveries of recent observers, who, with the aid of
the microscope, have so greatly enlarged the boundaries of pathological science. This has Ijeen
the aim of the authors, and their reputation is sufficient guarantee that the object has been attained.
The publi?-hers have omitted nothing that is requisite to the full appreciation and understanding of
the subject, and the very numerous illustrations with which the volume abounds, will, it is hoped,
fully elucidate the details and descriptions. r
JONES (T. WHARTON), F. R. S., &ic.
THE PRINCIPLES AND PRACTICE OF OPHTHALMIC MEDICINE
AND SURGERY. Edited by Isaac Hays, M. D., &c. In one very neat volume, large royal
12mo., of 529 pages, with four plates, plain or colored, and ninety-eight wood-cuts.
migrht become, a manual for daily reference and
I The work amply sustains, in every point the al-
rejtdy high reputation of the author as an ophthalmic
Burgeon as well as a physiologist and pathologist.
The book is evidently the result of much labor and
research, and has been written with the greatest
care and attention. We entertain little doubt that
tills book will become what its author hoped it
consultation by the student and the general practi-
tioner. The work is marked by that correctness,
clearness, and precision of style which distinguish
all the productions of the learned author. — British
and Foreign Medical Review,
18
BLANCHARD & LEA'S MEDICAL
KIRKES (WILLIAM SENHOUSE), M. D.,
Demonstrator of Morbid Anatomy at St. Bartholomew's Hospital, &c.; and
JAMES PAGET, F. R. S.,
Lecturer on General Anatomy and Physiology in St. Bartholomew's Hospital.
A MANUAL OF PHYSIOLOaY. Second American, from the second and
improved London edition. Witii one hundred and sixty-five illustration!?. In one larg-e and
handsome royal r2mo. volume, pp.550. {Just Issued.)
In the present edition, the Manual of Physiology
has been brought up to the actual condition of th
science, and fully sustains the reputation which it
has already so deservedly attained. We consider
the work of MM. Kirkes and Paget to constitute one
of the very best handbooks of Physiology we possess
— presenting just such an outline of the science, com-
prising an account of its leading facts and generally
admitted principles, as the student requires during
his attendance upon a course of lectures, or for re-
ference whilst preparing for examination. The text
is fully and ably illustrated by a series of very supe-
rior wood-engravings, by which a comprehension of
some of the more intricate of the subjects treated of
is greatly facilitated. — Am. Medical Journal.
We need only say, that, without entering into dis-
cussions of unsettled questions, it contains all the
recent improvements in tliis department of medical
science. For the student beginning this study, and
the practitioner who has but leisure to refresh his
memory, this book is invaluable, as it contains all
that it is important to know, without special details,
which are read with interest only by those who
would make a specialty, or desire to possess a criti-
cal knowledge of the subject. — Charleston Medical
Journal.
One of the best treatises that can be put into the
hands of the student. — London Medical Gazette.
The general favor with which the first edition of
this Avork was received, and its adoption as a favor-
ite text-book by many of our colleges, will insure a
large circulation to this improved edition. It will
fully meet the wants of the student. — Southern
Med. and Surg. Journal.
Particularly adapted to those who desire to pos-
sess a concise digest of the facts of Human Physi-
ology. — British and Foreign Med.-Chirurg. Review.
We conscientiously recommend it as an admira-
ble " Handbook of Physiology." — London Journal
of Medicine.
KNAPP (F.), PH. D., &,c.
TECHNOLOG-Y ; or, Chemistry applied to the Arts and to Manufactures. Edited,
with numerous Notes and Additions, by Dr. Edmund Ronalds and Dr. Thomas Richardson.
First American edition, with Notes and Additions, bj'- Prof. Walter R. Johnson. In two hand-
some octavo volumes, printed and illustrated in the highest style of art, with about five hundred
wood-engravings.
PHYSIOLOGICAL
(Preparing.)
LEHMANN.
CHEMISTRY. Translated by George E. Day, M. D.
LEE (ROBERT), M. D., F. R. S., &c.
CLINICAL MIDWIFERY; comprising the Histories of Five Hundred and
Forty-five Case? of Difficult, Preternatural, and Complicated Labor, with Commentaries. From
the second London edition. In one royal 12mo. volume, extra cloth, of 238 pages.
LA ROCHE (R.), M. D., &,c.
PNEUMONIA ', its Supposed Connection, Pathological and Etiological, with Au-
tumnal Fevers, including an Inquiry into the Existence and Morbid Agency of Malaria. In one
handsome octavo volume, extra cloth, of 500 pages.
the periodical press, and yet in the work before us
he has exhibited an amount of industry and learning,
research and ability, beyond what we are accustomed
to discover in modern medical writers; while his
own extensive opportunities for observation and
experience have been improved by the most laudable
diligence, and display a familiarity with the whole
subject in every aspect, which commands both our
respect and confidence. As a corrective of prevalent
and mischievous error, sought to be propagated by
novices and innovators, we could wish that Dr. La
Roche's book could be widely read. — N. Y. Medical
Gazette.
A more simple, clear, and forcible exposition of
the groundless nature and dangerous tendency of
certain pathological and etiological heresies, has
seldom been presented to our notice. — N. Y. Journal
of Medicine and Collateral Science, March, 1854.
This work should be carefully studied by Southern
physicians, embodying as it does the reflections of
an original thinker and close observer on a subject
peculiarly their own. — Virginia Med. and Surgical
Journal.
The author had prepared us to expect a treatise
from him, by his brief papers on kindred topics in
BY THE SAME AUTHOR. (In PresS.)
YELLOW FEVER, considered in its Historical, Pathological, and Etiological
Relations. In one very large and handsome octavo volume.
LONGET (F. A.)
TREATISE ON PHYSIOLOGY. With numerous Illustrations. Translated
from the French by F. G. Smith, M. D., Professor of Institutes of Medicine in the Pennsylvania
Medical College. {Preparing.)
AND SCIENTIFIC PUBLICATIONS. 19
LAWRENCE (W.), F. R. S., Sec.
A TREATISE ON DISEASES OF THE EYE. A new edition, edited,
with numerous additions, and 243 illustrations, by Isaac Hays, M. D., Surgeon to Wills Hospi-
tal, &c. In one very large and handsome octavo volume, of 950 pages, strongly bound in leather
with raised bands. {Now Ready.)
This work is thoroughly revised and brought up to 1854.
This work is so universally recognized as the standard authority on the subject, that the pub-
Mshers in presenting this new edition have only to remark that in its preparation the editor has
carefully revised every portion, introducing additions and illustrations wherever the advance of
science has rendered them necessary or desirable. In this manner it will be found to con-
tain over one hundred pages more than the last edition, while the list of wood-engravings
has been increased by sixty-seven figures, besides numerous improved illustrations substituted
for such as were deemed imperfect or unsatisfactory. The various important contributions to
ophthalmological science, recently made by Dalrymple, Jacob, Walton, Wilde, Cooper, &c.,
both in the form of separate treatises and contributions to periodicals, have been carefully
examined by the editor, and, combined with the results of his own experience, have been
freely introduced throughout the volume, rendering it a complete and thorough exponent of
the most advanced state of the subject.
In a future number we shall notice more at length ■ octavo pages- has enabled both author and editor to
this admirable treatise— the safest guide and most ' do justice to all the details of this subject, and con-
comprehensive work of reference, which is Avithin ! dense in this single volume the present state of our
the reach of all classes of the profession. — Sietho- ] knowledge of tlie whole science in this department,
scope, March, 1854. I whereby its practical value cannot be excelled. We
j heartily commend it, especially as a book of refe-
This standard text-book on the department of : renee, indispensable in every medical library. The
which it treats, has not been superseded, by any or | additions of the American editor very greatly en-
all of the numerous publications on the subject hance the value of the work, exhibiting the learning
heretofore issued. Nor with the multiplied improve- ! and experience of Dr. Hays, in the light in which he
nients of Dr. Hays, the American editor, is it at all i ought to be held, as a standard authority on all sub-
likely that this great work will cease to merit the ; jects appertaining to this specialty, to which he has
confidence and preference of students or practition- j rendered so many valuable contributions. — N. Y.
ers. Its ample extent — nearly one thousand large j Medical Gazette.
BY THE SAME AUTHOR.
A TREATISE ON RUPTURES; from the fifth London edition. In one octavo
volume, sheep, 480 pages.
LUDLOW (J. L.), M. D.,
Lecturer on Clinical Medicine at the Philadelphia Almshouse, &c.
A MANUAL OF EXAMINATIONS upon Anatomy and Physiology, Surgery,
Practice of Medicine, Chemistry, Obstetrics, Materia Medica, Pharmacy, and Therapeutics.
Designed for Students of Medicine throughout the United States. A new edition, revised and
extensively improved. In one large royal 12mo. volume, with several hundred illustrations.
{Prepart?ig.)
LISTON (ROBERT), F. Fl. S., &c.
LECTURES ON THE OPERATIONS OF SURGERY, and on Diseases and
Accidents requiring Operations. Edited, with numerous Additions and Alterations, by T. D.
MiJTTER, M. D. In one large and handsome octavo volume, of 566 pages, with 216 wood-cuts.
LALLEMAND (M.).
THE CAUSES, SYMPTOMS, AND TREATMENT OF SPERMATOR-
RHCEA. Translated and edited by Henry J. McDougal. In one volume, octavo, 320 pages.
Second American edition. {Now Ready.)
LARDNER (DIONYSIUS), D. C. L., &c.
HANDBOOKS OF NATURAL PHILOSOPHY AND ASTRONOMY.
Kevised, with numerous Additions, by the American editor. First Course, containing Mecha-
nics, Hydrostatics, Hydraulics, Pneumatics, Sound, and Optics. In one large royal l2rao.
volume, of 750 pages, with 424 wood-cuts. Second Course, containing Heat, Electricity, Mag-
netism, and Galvanism, one volume, large royal 12mo., of 450 pages, with 250 illustrations.
Third Course ( now ready), containing Meteorology and Astronomy, in one large volume, royal
12mo. of nearly eight hundred pages, with thirty-seven plates and two hundred wood-cuts. The
whole complete in three volumes, of about two thousand large pages, with over one thousand
figures on steel and wood.
The various sciences treated in this work will be found brought thoroughly up to the latest period.
factory manner the information they desire. — The
Virginia Med. and Surg. Journal.
The work furnishes a very clear and satisfactory
account of our knowledge in the important depart-
ment of science of which it treats. Although the
medical schools of this country do not include the
study of physics in their course of instruction, yet
no student or practitioner should be ignorant of its
laws. Besides being of constant application in prac-
tice, such knowledge is of inestimable utility in fa-
eilitating the study of other branches of science. To
students, then, and to those who, having already en-
tered upon the active pursuits of business, are desir-
ous to sustain and improve their knowledge of the
general truths of natural philosophy, we can recom-
mend this work as supplying in a clear and aatis-
The present treatise is a most complete digest of
all that has been developed in relation to the great
forces of nature. Heat, Magnetism, and Electricity.
Their laws are elucidated in a manner both pleasing
and familiar, and at the same time perfectly intelli-
gible to the student. The illustrations are suffi-
ciently numerous and appropriate, and altogether
we can cordially recommend the work as well-de-
serving the notice both of the practising physician
and the student of medicine. — The Med. Examiner.
BLANCHARD & LEA'S MEDICAL
MEIGS (CHARLES D.), M. D.,
; Professor of Obstetrics, &c. in the Jefferson Medical College, Philadelphia.
ON THE NATURE, SIGNS, AND TREATMENT OF CHILDBED
FEVER. In a Series of Letters addressed to the Students of his Class. In one handsome
octavo volume, of three hundred and sixty-five pages. {Now Ready.)
BY THE SAME AUTHOR.
WOMAN : HER DISEASES AND THEIR REMEDIES. A Series of Lee-
tures to his Class. Third and Improved edition. In one large and beautifully printed octavo
volume. {Just Issued. Revised and enlarged to 1854.)
The gratifying appreciation of his labors, as evmced by the exhaustion of two large impressions
ol' this work within a few years, has not been lost upon the author, who has endeavored in eA'ery
way to render it worthy of the favor with which it has been received. The opportunity thiw
afforded for a second revision has been improved, and the work is now presented as in every way
superior to its predecessors, additions and alterations having been made whenever the advance of
science has rendered them desirable. The typographical execution of the work will also be found
to have undergone a similar improvement and the work is now confidently presented as in every
way worthy the position it has acquired as the standard American text-book on the Diseases of
Females.
It contains a vast amount of practical knowledge.
by one who has accurately observed and retained
ihe experience of many years, and who tells the re-
sult in a free, familiar, and pleasant manner. — Buh-
lin Quarterly Journal.
Tliere is an off-hand fervor, a glow, and a warm-
heartedness infecting the effort of Dr. Meigs, which
is entirely captivating, and which absolutely hur-
ries the reader through from beginning to end. Be-
eides, the book teems with solid instruction, and
it shows the very highest evidence of ability, viz.,
the clearness with which the information "is pre-
sented. We know of no better test of one's under-
standing a subject than the evidence of the power
of lucidly explaining it. The most elementary, as
well as the obscurest subjects, under the pencil of
Prof. Meigs, are isolated and made to stand out in
such bold relief, as to produce distinct impressions
upon the mind and memory of the reader. — The
Charleston Med. Journal.
Professor Meigs has enlarged and amended this
great work, for such it unquestionably is, havin?
passed the ordeal of criticism at home and abroad,
but been improved thereby ; for in this new edition
the author has introduced real improvements, and
increased the value and utility of the book fm-
measurably. It presents so many novel, bright,
and sparkling thoughts ; such an exuberance of new
ideas on almost every page, that we confess our-
selves to have become enamored with the book
and its author ; and cannot withhold our congratu-
lations from our Philadelphia confreres, tliat such a
teacher is in their service. We regret that our
limits will not allow of a more extended notice of
this work, but must content ourselves with thus
commending it as worthy of diligent i>erusal by
physicians asM'^ell as students, who are seeking Iro
be thoroughly instructed in the important practical
subjects of which it treats. — N. Y. Med. Gazette.
BY THE SAME AUTHOR.
OBSTETRICS : THE SCIENCE AND THE ART. Second edition, revised
and improved. With one hundred and thirty-one illustrations. In one beautifully printed octavo
volume, of seven hundred and fifty-two large pages. {Lately Published.)
The rapid demand for a second edition of this work is a sufficient evidence that it has supplied
a desideratum of the profession, notwithstanding the numerous treatises on the same subject which
have appeared within the last few years. Adopting a system of his own, the author has combined
the leading principles of his interesting and difficult subject, with a thorough exposition of its rules
of practice, presenting the results of long and extensive experience and of familiar acquaintance
with all the modern writers on this department of medicine. As an American Treatise on Mid-
wifery, which has at once assumed the position of a classic, it possesses peculiar claims to the at-
tention and study of the practitioner and student, while the numerous alterations and revisions
which it has undergone in the present edition are shown by the great enlargement of the work,
which is not only increased as to the size of the page, but also in the number. Among other addi-
tions may be mentioned
A NEW AND IMPORTANT CHAPTER ON "CHILDBED FE7ER."
BY THE SAME AUTHOR. {Now Ready.)
A TREATISE ON ACUTE AND CHRONIC DISEASES OF THE NECK
OF THE UTERUS. With numerous plates, drawn and colored from nature in the higliest
style of art. In one handsome octavo volume, extra cloth.
The object of the author in this work has been to present in a small compass the practical results
of his long experience in this important and distressing class of diseases. The great changes intro-
duced into practice, and the accessions to our knowledge on the subject, within the last few years,
resulting from the use of the metroscope, brings within the ordinary practice of every physician
numerous cases which were formerly regarded as incurable, and renders of great value a work like
the present combining practical directions for diagnosis and treatment with an ample series of illus-
trations, copied accurately from colored drawings made by the author, after nature. No such accu-
rate delineations of the pathology of the neck of the uterus have heretofore been given, requiring,
as they do the rare combination of physician and artist, and their paramount importance to life
physician in whose practice such cases are frequent, is too evident to be dwelt upon, while in
artistic execution they are far in advance of anything of the kind as yet produced in this country.
BY THE SAME AUTHOR.
OBSERVATIONS ON CERTAIN OF THE DISEASES
CHILDREN. In one handsome octavo volume, of 214 pages.
OF YOUNG
AND gCIENTIFIG PUBLICATIONS.
21
MILLER (JAMES), F. R. S. E.,
Professor of Surgery in the University of Edinburgh, &c.
PRINCIPLES OF SURGERY. Third American, from the second and revised
Edinburgh edition. Revised, with Additions, by F. W. Sargent, M. D., author of '< Minor Sur-
gery," &c. In one large and very beautiful volume, of seven hundred and fifty-two pages, with
two hundred and forty exquisite illustrations on wood.
The publishers have endeavored to render the present edition of this work, in every point of me-
chanical execution, worthy of its very high reputation, and they confidently present it to the pro-
fession as one of the handsomest volumes as yet issued in this country.
This edition is far superior, both in the abundance I guage. This opinion, deliberately formed after a
and quality of its material, to any of the preceding
We hope it will be extensively read, and the sound
principles which are herein taught treasured up for
future application. The work takes rank with
Watson's Practice of Physic ; it certainly does not
fall behind that great work in soundness of princi-
ple or depth of reasoning and research. No physi-
cian who values his reputation, or seeks the interests
of his clients, can acquit himself before his God and
Hie world without making himself familiar with the
sound and philosophical views developed in the fore-
5oing book. — Ntw Orleans Medical and Surgical
ournal.
Without doubt the ablest exposition of the prin-
ciples of that branch of the healing art in any lan-
BY THE SAME AUTHOR. {NoW Ready.)
THE PRACTICE OF SURGERY. Third American from the second Edin-
burgh edition. Edited, with Additions, by F. W. Sargent, M. D , one of the Surgeons to Will's
Hospital, &c. Illustrated by three himdred and nineteen engravings on wood. In one large
octavo volume, of over seven hundred pages. '
This new edition will be found greatly improved and enlarged, as Avell by the addition of much
new matter as by the introduction of a large and complete series of handsome illustrations. An
equal improvement exists in the mechanical execution of the work, rendering it in every respect
a companion volume to the "Principles."
careful study of the first edition, we have iiad no
cause -to change on examining the second. This
edition has undergone thorough revision by the au-
thor ; many expressions have been modified, and a
mass of new matter introduced. The book is got up
in the finest style, and is an evidence of the progress
of typography in our country. — Charleston Medical
Journal and Review.
We recommend it to both student and practitioner,
feeling assured that as it now comes to us, it pre-
sents the most satisfactory exposition of the modern
doctrines of the principles of surgery to be found in
any volume in any language. — N. Y. Journal of
Medicine .
No encomium of ours could add to the popularity
of Miller's Surgery. Its reputation in this country
ia unsurpassed by that of any other work, and, when
taken in connection with the author's Principles of
Surgery, constitutes a whole, without reference to
which no conscientious surgeon would be willing
to practice his art. The additions, by Dr. Sargent,
have materially enhanced the value of the work. —
Southern Medical and Surgical Journal.
It is seldom that two volumes have ever made so
profound an impression in so short a time as the
" Principles" and the " Practice" of Surgery by
Mr. Miller — or so richly merited the reputation they
have acquired. The author is an eminently sensi-
ble, practical, and well-informed man, who knows
exactly what he is talking about and exactly how to
talk it. — Kentucky Medical Recorder.
The two volumes together form a complete expose
9f the present state of Surgery, and they ought to be
on the shelves of every surgeon. — N. J. Med. Re-
porter.
By the almost unanimous voice of the profession,
his works, both on the principles and practice of
surgery have been assigned the highest rank. If we
were limited to but one work on surgery, that one
should be Miller's, as we regard it superior to aU
others. — St. Louis Med. and Surg. Journal.
The author distinguished alike as a practitioner
and writer, has in this and his " Principles," pre-
sented to the profession one of the most compl ete and
reliable systems of Surgery extant. His style of
writing is original, impressive, and engaging, ener-
getic, concise, and lucid. Few have the faculty of
condensing so much in small space, and at the same
time so persistently holding the attention; indeed,
he appears to make the very process of condensation
a means of eliminating attractions. Whether as a
text-book for students or a book of reference for
practitioners, it cannot be too strongly recommend-
ed. — Southern Journal of the Medical and Physical
Sciences.
MALGAIGNE (J. F.).
OPERATIVE SURGERY, based on Normal and Pathological Anatomy. Trans-
lated from the French, by Frederick Brittan, A. B., M. D. With numerous illustrations on
wood. In one handsome octavo volume, of nearly six hundred pages.
To express in a few words our opinion of IVTal-
gaigne's work, we unhesitatingly pronounce it the
We have long been accustomed to refer to it as one
of the most valuable text-books in our library. —
Buffalo Med. and Surg. Journal.
Certainly one of the best books published on ope-
rative surgery.— Edinburgh Medical Journal.
very best guide in suro^ical operations that has come
before the profession in any language. — Charleston
Med. and Surg. Journal.
MOHR (FRANCIS), PH. D., AND REDWOOD (TH EOPH I LUS).
PRACTICAL PHARMACY. Comprising the Arrangements, Apparatus, and
Manipulations of the Pharmaceutical Shop and Laboratory. Edited, with extensive Additions,
by Prof. William Procter, of the Philadelphia College of Pharmacy. In one handsomely
printed octavo volume, of 570 pages, with over 500 engravings on wood.
It is a book, however, which will be in the hands
of almost everyone who is much interested in phar-
maceutical operations, as we know of no other pub-
lication so well calculated to fill a void long felt. —
Medical Examiner.
The book is strictly practical, and describes only
manipulations or methods of performing the nume-
rous processes the pharmaceutist has to go through,
in the preparation and manufacture of medicines,
together with all the apparatus and fixtures necea-
sary thereto. On these matters, this work is very
full and complete, and details, in a style uncom-
monly clear and lucid, not only the more compli-
cated and difficult processes, but those not less im-
portant ones, the most simple and common. — Buffalo
Medical Journal.
The country practitioner who is obliged to dis-
pense his own medicines, will find it a most valuable
assistant. — Monthly Journal and Retrospect.
22
BLANCHARD & LEA'S MEDICAL
MACLISE (JOSEPH), SURGEON.
SURGICAL ANATOMY. Forming one volume, very large imperial quarto.
With sixty-eight large and splendid Plates, drawn in the best style and beautifully colored. Con-
taining one hundred and ninety Figures, many of them the size of life. Together with copiou.s
and explanatory letter-press. Strongly and handsomely bound in extra cloth, being one of the
cheapest and best executed Surgical works as yet issued in this country.
Copies can be sent by mail, in five parts, done up in stout covers. ^
This great work being now concluded, the publishers confidently present it to the attention of the
profession as worthy in every respect of their approbation and patronage. No complete work of
the kind has yet been published in the English language, and it therefore will supply a want long
felt in this country of an accurate and comprehensive Atlas of Surgical Anatomy to which the
student and practitioner can at all times refer, to ascertain the exact relative position of the various
portions of the human frame towards each other and to the surface, as well as their abnormal de-
viations. The importance of such a work to the student in the absence of anatomical material, and
to the practitioner when about attempting an operation, is evident, while the price of the book, not-
withstanding the large size, beauty, and finish of the very numerous illustrations, is so low as to
place it within the reach of every member of the profession. The publishers therefore confidently
anticipate a very extended circulation for this magnificent work.
of keeping up his anatomical knowlecige. — Medical
Times.
The mechanical execution cannot be excelled. —
Transylvania Medical Journal.
A work which has no parallel in point of accu-
racy and cheapness in the English language. — JV. Y.
Journal of Medicine.
To all engaged in the study or practice of their
profession, such a work is almost indispensable. —
Dublin Quarterly Medical Journal.
No practitioner whose means will admit should
fail to possess it. — Ranking^s Abstract.
Country practitioners will find these plates of ini-
mense value. — N. Y. Medical Gazette.
We are extremely gratified to announce to the
profession the completion of this truly magnificeat
work, which, as a whole, certainly stands unri-
valled, both for accuracy of drawing, beauty of
coloring, and all the requisite explanations of the
subject in hand. — The New Orleans Medical and
Surgical Journal.
This is by far the ablest work on Surgical Ana-
tomy that has come under our observation. W«
know of no other work that would justify a stu-
dent, in any degree, for neglect of actual dissec-
tion. Jn those sudden emergencies that so often
arise, and which require the instantaneous command
of minute anatomical knowledge, a work of this kind
keeps the details of the dissecting-room perpetually
fresh in the memory. — The Western Journal of Medi-
cine and Surgery.
The very low price at which this work is furnished, and the beauty of its execiition,
require an extended sale to compensate the publishers for the heavy expenses incurred.
One of the greatest artistic triumphs of the age
in Surgical Anatomy. — British American Medical
Journal.
Too much cannot be said in its praise ; indeed,
we have not language to do it justice. — Ohio Medi-
cal and Surgical Journal.
The most admirable surgical atlas we have seen.
To the practitioner deprived of demonstrative dis-
sections upon the human subject, it is an invaluable
companion. — N. J. Medical Reporter.
The most accurately engraved and beautifully
colored plates we have ever seen in an American
book — one of the best and cheapest surgical works
ever published. — Buffalo Medical Journal.
It is very rare that so elegantly printed, so well
iilustriiied, and so useful a work, is offered at so
moderate a price. — Charleston Medical Journal.
Its plates can boast a superiority which places
khem almost beyond the reach of competition. — Medi-
cal Examiner.
Every practitioner, we think, should have a work
of this kind within reach. — Southern Medical and
Surgical Journal.
No such lithographic illustrations of surgical re-
gions have hitherto, we think, been given. — Boston
Medical and Surgical Journal.
As a surgical anatomist, Mr. Maclise has proba-
bly no superior. — British and Foreign Medico-Chi-
rurgical Review.
Of great value to the student engaged in dissect-
ing, and to the surgeon at a distance from the means
MULLER (PROFESSOR J.), M. D.
PRINCIPLES OF PHYSICS AND METEOROLOGY.
Edited, with Addi-
tions, by R. Eglesfeld Griffith, M. D. In one large and handsome octavo volume, extra
cloth, with 550 wood-cuts, and two colored plates.
The Physics of Mailer is a work superb, complete, I tion to the scientific records of this country may be
unique : the greatest want known to English Science [ duly estimated by the fact that the cost of the origi-
could not have been better supplied. The work is I nal drawings and engravings alone has exceeded tiie
of surpassing interest. The value of this contribu- | sum of £2,000. — Lancet.
MAYNE (JOHN), M. D., M. R. G. S.
A DISPENSATORY AND THERAPEUTICAL REMEMBRANCER. Com-
prising the entire lists of Materia Medica, with every Practical Formula contained in the three
Britifih Pharmacopoeias. With relative Tables subjoined, illustrating, by upwards of six hundred
and sixty examples, the Extemporaneous Forms and Combinations suitable for the different
Medicines. Edited, with the addition of the Formulae of the United States Pharmacoposia, by
R. Eglesfeld Griffith, M. D. In one 12mo. volume, extra cloth, of over 300 large pages.
MATTEUCCI (CARLO).
LECTURES ON THE PHYSICAL PHENOMENA OF LIVINa BEINGS.
Edited by J. Pereira, M. D. In one neat royal 12mo. volume, extra cloth, with cuts, 388 pages.
AND SCIENTIFIC PUBLICATIONS. 23
NEILL (JOHN), M. D.,
'•■ Surgeon to the Pennsylvania Hospital, &c.; and
FRANCIS GURNEY SMITH, M. D.,
Professor of Institutes of Medicine in the Pennsylvania Medical College.
AN ANALYTICAL COMPENDIUM OF THE VARIOUS BRANCHES
OF MEDICAL SCIENCE ; for the Use and Examination of Students. Second edition, revised
and improved. In one very large and handsomely printed royal 12mo. volume, of over one
thorteand pages, with three hundred and fifty illustrations on wood. Strongly bound in leather,
with raised bands.
The speedy sale of a large impression of this work has afforded to the authors gratifying evidence
oi the correctness of the views which actuated them in its preparation. In meeting the demand
for a second edition, they have therefore been desirous to render it more worthy of the favor with
which it has been received. To accomplish this, they have spared neither time nor labor in embo-
dying in it such discoveries and improvements as have been made since its first appearance, and
such alterations as have been suggested by its practical use in the class and examination-room.
Considerable modifications have thus been introduced throughout all the departments treated of in
the volume, but more especially in the portion devoted to the "Practice of Medicine," which has
been entirely rearranged and rewritten. The authors therefore again submit their work to the
profession, with the hope that their efforts may tend, however humbly, to advance the great cause
of medical education.
Notwithstanding the enlarged size and improved execution of this work, the price has not been
increased, and it is confidently presented as one of the cheapest volumes now before the profession.
In the rapid course of lectures, where work for
the students is heavy, and review necessary for an
examination, a compend is not only valuable, but
it is almost a sine qua non. The one before us is,
in most of the divisions, the most unexceptionable
erf all books of the kind that we know of. The
newest and soundest doctrines and the latest im-
provements and discoveries are explicitly, though
concisely, laid before the student. Of course it is
useless for us to recommend it to all last course
students, but there is a class to whom we very
sincerely commend this cheap book as worth its
weight in silver — that class is the graduates in
medicine of more than ten years' standing, who
have not studied medicine since. They will perhaps
find out from it that the science is not exactly now
what it was when they left it off. — The Stethoscope
Having made free use of this volume in our ex-
aminations of pupils, we can speak from experi-
ence in recommending it as an admirable compend
for students, and as especially useful to preceptors
who examine their pupils. It will save the teacher
much labor by enabling him readily to recall all of
the points upon which his pupils should be ex-
amined. A work of this sort should be in the hands
of every one who takes pupils into his office with a
view of examining them; and this isunquestionablj'
the best of its class. Let every practitioner who has
pupils provide himself with it, and he will find the
labor of refreshing his knowledge so much facilitated
that he will be able to do justice to his pupils at very
little cost of time or trouble to himself. — TransyU
vania Med. Journal.
• NELIGAN (J. MOORE), M. D., M. R. I. A., &c.
A PRACTICAL TREATISE ON DISEASES OF THE SKIN. In one
neat royal 12mo. volume, of 334 pages.
.^^j OWEN (PROF. R.),
■'* Author of Lectures on Comparative Anatomy," '* Archetype of the Skeleton," &c.
ON THE DIFFERENT FORMS OF THE SKELETON, AND OF THE
TEETH. One vol. roj'-al 12mo., with numerous illustrations. {IVow Ready.)
The name of the distinguished author is a sufficient guarantee that this little volume will prove
a satisfactory manual and guide to all students of Comparative Anatomy and Osteology. The im-
portance of this subject in geological investigations will also render this work a most valuable
assistant to those interested in that science.
PHILLIPS (BENJAMIN), F. R. S., &c.
SCROFULA; its Nature, its Prevalence, its Causes, and the Principles of its
Treatment. In one volume, octavo, with a plate.
PANCOAST (J.), M. D.,
Professor of Anatomy in the Jefferson Medical College, Philadelphia, &c.
OPERATIVE SURGERY; or, A Description and Demonstration of the various
Processes of the Art ; including all the New Operations, and exhibiting the State of Surgical
Science in its present advanced condition. Complete in one royal 4to. volume, of 380 pages of
letter-press description and eighty large 4to. plates, comprising 486 illustrations. Second edition,
improved.
Blanchard & Lea having become the publishers of this important book, have much pleasure in
oflering it to the profession.
This excellent work is constructed on the model
of the French Surgical Works by Velpeau and Mal-
gaigne; and, so far as the English language is con-
cerned, we are proud as an American to say that,
OF ITS KIND IT HAS NO SUPERIOR. — N. Y. Journal of
Medicine.
PARKER (LANGSTON),
Surgeon to the Queen's Hospital, Birmingham.
THE MODERN TREATMENT OF SYPHILITIC DISEASES, BOTH PRL
MARY AND SECONDARY; comprisingtheTreatment of Constitutional and Confirmed Syphi-
lis, by a safe and successful method. With numerous Cases, Formulae, and Clinical Observa-
tions. From the Third and entirely rewritten London edition. In one neat octavo volume.
{Now Ready.)
' j mux ](flLiv«iiii8-'tK>ow \o iiB dfli dsitiv; o) soila»»eq
24
BLANCHARD & LEA'S MEDICAL
(Now Complete,)
PEREIRA (JONATHAN), M. D., F. R. S., AND L. S.
THE ELEMENTS OF MATERIA MEDICA AND THERAPEUTICS.
Third American edition, enlarged and improved by the author ; including Notices of most of the
Medicinal Substances in use in the civilized world, and forming an Encyclopaedia of Materia
Medica. Edited, with Additions, by Joseph Cakson, M. D., Professor of Materia Mediea and
Pharmacy in the University of Pennsyivania. In two very large octavo volumes of 2100 pages,
on small type, with over four hundred and fifty illustrations.
Volume I. — Lately issued, containing the Inorganic Materia Medica, over 800 pages, with 144
illustrations.
Volume II.— Now ready, embraces the Organic Materia Medica, and forms a very large octavo
volume of 1250 pages, with two plates and three hundred handsome wood-cuts.
The present edition of this valuable and standard work will enhance in every respect its well-
deserved reputation. The care bestowed upon its revision by the author may be estimated by the
fact that its size has been inci-eased by about five hundred pages. These additions have extended
to every portion of the work, and embrace not only the materials aflbrded by the recent editions of
the pharmacopoeias, but also all the important information accessible to the care and industry of
the author in treatises, essays, memoirs, monographs, and from correspondents in various parts of
the globe. In this manner the work comprises the most recent and reliable information respecting
all the articles of the Materia Medica, their natural and commercial history, chemical and thera-
peutical properties, preparation, uses, doses, and modes of administration, brought up to the present
time, with a completeness not to be met with elsewhere. A considerable portion of the work
which preceded the remainder in London, has also enjoyed the advantage of a further revision by
the author expressly for this country, and in addition to this the editor, Professor Carson, has made
whatever additions appeared desirable to adapt it thoroughly to the U. S. Pharmacopoeia, and to
the wants of the American profession. An equal improvement will likewise be observable in every
department of its mechanical execution. It is printed from new type, on good white paper, with a
greatly extended and improved series of illustrations.
Gentlemen who have the first volume are recommended to complete their copies without delay.
The first volume will no longer be sold separate.
When we remember that Philology, Natural His-
tory, Botany, Chemistry, Physics, and the Micro-
scope, are all brought forward to elucidate the sub-
ject, one cannot fail to see that the reader has here
a work worthy of the name of an encyclopedia of
Materia Medica. Our own opinion of its merits is
that of its editors, and also that of the whole profes-
sion, both of this and foreign countries— namely,
" that in copiousness of details, in extent, variety,
and accuracy of information, and in lucid explana-
tion of difficult and recondite subjects, it surpasses
all other works on Materia Medica hitherto pub-
lished." We cannot close this notice without allud-
ing to the special additions uf the American editor,
which pertain to the prominent vegetable produc-
tions of this country, and to the directions of the
United States Pharmacopcsia, in connection with all
the articles contained in the volume which are re-
ferred to by it. The illustrations have been increased,
atid this edition by Dr. Carson cannot well be re-
garded in any other light than that of a treasure
which should be found in the library of every physi-
cian. — New York Journal of Medical and Collateral
Science, March, 1854.
The third edition of his "Elements of Materia
Medica, although completed under the supervision of
others, is by far the most elaborate treatise in the
English language, and will, while medical literatune
is cherished, continue a monument alike honorable
to his genius, as to his learning and industry. —
American Journal of Pharmacy, March, 1854.
The work, in its present shape, and so far as can
be judged from the portion before the public, forms
the most comprehensive and complete treatise on
materia medica extant in the English language.—
Dr. Pereira has been at great pains to introduce
into his work, not only all the information on the
natural, chemical, and commercial history of medi-
cines, which might be serviceable to the physician
and surgeon, but whatever might enable his read-
ers to understand thoroughly the mode of prepar-
ing and manufacturing various articles employed?
either for preparing medicines, or for certain pur-
poses in the arts connected with materia medica
and the practice of medicine. The accounts of the
physiological and therapeutic eflects of remedies are
given with great clearness and accuracy, and in a
manner calculated to interest as M^ell as instruct
the reader.— TAe Edinburgh Medical and Surgical
Journal.
AJTT'
PEASELEE (E. R.), M. D.,
Professor of Anatomy and Physiology in Dartmouth College, &c.
HUMAN HISTOLOGY, in its applications to Physiology and General Pathology;
designed as a Text-Book for Medical Students. With numerous illustrations. In one handsonie
royal 12mo. volume. (Preparing.)
The subject of this work is one, the growing importance of which, as the basis of Anatomy and,
Phvsiology, demands for it a separate volume. The book will therefore supply an acknowledged
deficiency in medical text-books, while the name of the author, and his experience as a teacher for
the last thirteen years, is a guarantee that it will be thoroughly adapted to the use of the student.
PIRRIE (WILLIAM), F. R. S. E.,
Professor of Surgery in the University of Aberdeen.
THE PRINCIPLES AND PRACTICE OF SURGERY. Edited by John
Neill, M. D., Demonstrator of Anatomy in the University of Pennsylvania, Surgeon to the
Pennsylvania Hospital, &c. Li one very handsome octavo volume, of 780 pages, with 316 illus-
(Just Issued.)
trations.
We know of no other surgical work of a reason-
able size, wherein there is so much theory and prac-
tice, or where subjects are more soundly or clearly
taught. — The Stethoscope.
There is scarcely a disease of the bone or soft
parts, fracture, or dislocation, that is not illustrated
by accurate wood-engravings. Then, again, every
instrument employed by the surgeon is thus repre-
sented. These engravings are not only correct, but
really beautiful, showing the astonishing degree of
perfaetion to which the art of wood- engraving has
arrived. Prof. Pirrie, in the work before us, has
elaborately discussed the principles of surgery, and
a safe and effectual practice predicated upon them.
Perhaps no work upon this subject heretofore issued
is so full upon the science of the art of surgery. —
Nashville Journal of Medicine and Surgery.
One of the best treatises on surgery in the English
language. — Canada Med. Journal.
Our impression is, that, as a manual for student*,
Pirrie's is the best work extant.— Western Med. and
Surg. Journal.
AND StJIENTIFia PUBLICATIONS.
25
RAMSBOTHAM (FRANCIS H.), M.D.
THE PRINCIPLES AND PRACTICE OF OBSTETRIC MEDICINE AND
SURGERY", in reference to the Process of Parturition. Sixth American, from the last London
edition. Illustrated with one hundred and forty-eight Figures, on fifty-five Lithographic Plates.
In one large and heuidsomely printed volume, imperial octavo, with 520 pages.
In this edition, the plates have all been redrawn, and the text carefully read and corrected. It
is therefore presented as in every way worthy the favor with which it has so long been received.
From Prof. Hodge, of ths University of Pa.
To the American public, it is most vahiabie, from its intrinsic undoubted excellence, and as beiny
the best authorized exponent of British Midwifery. Its circulation will, I trust, be extensive throughout
our country.
We recommend the student who desires to mas-
ter this difficult subject with the least possible
trouble, to possess himself at once of a copy of this
work. — American Journal of the Med. Sciences.
It stands at the head of the long list of excellent
obstetric w^orks published in the last few years in
Great J3ritiiin, Ireland, and the Continent of Eu-
rope. We consider this book indispensable to the
library of every physician engaged in the practice
of midwifery. — Southern Med. and Surg. Journal.
When the whole profession is thus unanimous
in placing such a work in the very first rank as
regards the extent and correctness of all the details
of the theory and practice of so important a branch
of learning, our commendation or condemnation
would be of little consequence; but regarding it
as the most useful of all works of the kind, we
think it but an act of justice to urge its claims
upon the profession. — N. O. Med. Journal.
RICORD (P.), IVl. D.,
Surgeon to the Hopital du Midi, Paris, &c.
ILLUSTRATIONS OF SYPHILITIC DISEASE. Translated from the French,
by Thomas F. Betton, M. D. With the addition of a History of Syphilis, and a complete Bib-
liography and Formulary of Remedies, collated and arranged, by Paul B. Goddabd, M.D. With
fifty large quarto plates, comprising one hundred and seventeen beautifully colored illustrations.
In one large and handsome quarto volume.
Blanchard & Lea having purchased the remainder of this valuable work, which was originally
sold as a subscription book, are now prepared to offer it to the profession. It is universally known
as one of the handsomest volumes as yet presented m this country, and as containing the only ex-
tended and thorough series of illustrations on the subject.
BY THE SAME AUTHOR. (NoW Ready.)
A TREATISE ON THE VENEREAL DISEASE. By John Hunter, F. R. S.
With copious Additions, by Ph. Ricord, M. D. Edited, with Notes, by Freeman J. Bumstead,
M. D. In one handsome octavo volume, with plates.
From the Translator's Preface.
" M. Ricord's annotations to Hunter^s Treatise on the Venereal Disease were first published at
Paris, in 1840, in connection with Dr. G. Richelot's translation of the work, including the contri-
butions of Sir Everard Home and Mr. Babington. In a second edition, which has recently ap-
peared, M. Ricord has thoroughly revised his part of the work, bringing it up to the knowledge of
the present day, and so materially increasing it that it now constitutes full one-third of the volume.
" This publication has been received with great favor by the French, both because it has placed
within their reach an important work of Hunter, and also because it is the only recent practical
work which M. Ricord has published, no edition of his Traite des Maladies vineriennes having
appeared for the last fifteen years."
Every one will recognize the attractiveness and
value which this work derives from ihus presenting
ihe opinions of these two masters side by side. But,
it must be admitted, what has made the fortune of
the book, is the fact that it contains the " most com-
plete embodiment of the veritable doctrines of the
Hopital du Midi," which has ever been made public.
The doctrinal ideas of M. Ricord, ideas which, if not
universally adopted, are incontestably dominant, have
heretofore only been interpreted by more or less skilful
secretaries, sometimes accredited and sometimes not.
In the notes to Hunter, the master substitutes him-
self for his interpreters, and gives his original thoughts
to the world, in a summary form it is true, but m a
lucid and perfectly intelligible manner. In conclu-
sion we can say that this is incontestably the best
treatise on syphilis with which we are acquainted,
and, as we do not often employ the phrase, we may
be excused for expressing the hope that it may find
a place in the library of every physician — Virginia
Med. and Surg. Journal.
BY THE SAME AUTHOR.
LETTERS ON SYPHILIS, addressed to the Chief Editor of the Union Medicale.
With an Introduction, by Amedee Latour. Translated by W. P. Lattimore, M. D. In one neat
octavo volume.
Blanchard & Lea are now the publishers of this valuable work.
From the Translator's Preface.
To those who have listened to the able and interesting lectures of our author at the Hopital da
Midi, this volume will need no commendation; while to those who have not had the pleasure to
which we allude, the book will commend itself by the truths it contains, told as they are in the
same inimitable style in which M. Ricord delivers his clinical lectures.
BY THE SAME AUTHOR.
A PRACTICAL TREATISE ON VENEREAL DISEASES. With a Thera-
peutical Summary and Special Formulary. Translated by Sidney Doane, M. D. Fourth edition.
One volume, octavo, 340 pages.
26
BLANCHARD & LEA'S MEDICAL
RIGBY (EDWARD), M. D.,
(T Physician to the General Lying-in Hospital, &c.
A SYSTEM OF MIDWIFERY. With Notes and Additional Illustrations.
Second American Edition. One volume octavo, 422 pages.
ROYLE (J. FORBES), M. D.
MATERIA MEDIC A AND THERAPEUTICS; including the Preparations of
the Pharmacopoeias of London, Edinburgh, Dublin, and of the United States. With many new
medicines. Edited by Joseph Carson, iVI. D., Professor of Materia Medica and Pharmacy ia
the University of Pennsylvania. With ninety-eight illustrations. In one large octavo volume,
of about seven hundred pages.
This work is, indeed, a most valuable one, and
will fill up an important vacancy that existed be-
tween Dr. Pereira's most learned and complete
system of Materia Medica, and the class of pro-
ductions on the other extreme, which are neces-
sarily imperfect from their small extent. — British
and Foreign Medical Revieiv.
SKEY (FREDERICK C), F. R. S., &,c.
OPERATIVE SURGERY. In one very handsome octavo volume of over 650
pages
with about one hundred wood-cuts.
Its literary execution is superior to most surgical
treatises. It abounds in excellent moral hints, and
is replete with original surgical expedients and sug-
gestions. — Buffalo Med. and Surg. Journal.
With high talents, extensive practice, and a long
experience, Mr. Skey is perhaps competent to the
task of writing a complete work on operative sur-
gery. — Charleston Med. Journal.
We cannot withhold from this work our high com-
mendation. Students and practitioners will find it an
invaluable teacher and guide upon every topic con-
nected with this department. — N. Y. Medical Ga^
zette.
A work of the very highest importance — a w#trk
by itself.— Loncfon Med. Gazette.
SHARPEY (WILLIAM), M. D., JONES QUAIN, M. D., AND
RICHARD QUAIN, F. R. S., &c.
HUMAN ANATOMY. Revised, with Notes and Additions, by Joseph Leidy,
M. D. Complete in two large octavo volumes, of about thirteen hundred pages. Beautifully
illustrated with over five hundred engravings on wood.
It is indeed a work calculated to make an era in
anatomical study, by placing before the student
every department of his science, with a view to
the relative importance of each ; and so skilfully
have the different parts been interwoven, that no
one who makes this work the basis of his studies,
will hereafter have any excuse for neglecting or
undervaluing any important particulars connected
with the structure of the human frame; and
whether the bias of his mind lead him in a more
especial manner to surgery, physic, or physiology,
he will find here a work at once so comprehensive
and practical as to defend him from exclusiveness
on the one hand, and pedantry on the other. —
Monthly Journal and Retrospect of the Medical
Sciences.
We have no hesitation in recommending this trea-
tise on anatomy as the most complete on that sub-
ject in the Engli.sh language; and the only one,
perhaps, in any language, which brings the state
of knowledge forward to the most recent disco-
veries. — The Edinburgh Med. and Surg. Journal.
Admirably calculated to fulfil the object for vvhkh
it is intended. — Provincial Medical Journal.
The most complete Treatise on Anatomy in the
English language. — Edinburgh Medical Journal.
There is no work in the English language to be
preferred to Dr. Quain's Elements of Anatomy. —
London Journal of Medicine.
SMITH (HENRY H.), M. D., AND HORNER (WILLIAM E.), M. D.
AN ANATOMICAL ATLAS, illustrative of the Structure of the Human Body.
In one volume, large imperial octavo, with about six hundred and fifty beautiful figures.
late the student upon the completion of this Atlas,
as it is the most ccmvenient work of the kind that
has yet appeared ; and we must add, the very beau-
tiful manner in which it is " got up" is so creditable
These figures are well selected, and present a
complete and accurate representation of that won-
derful fabric, the human body. The plan of this
Atlas, which renders it so peculiarly convenient
for the student, and its superb artistical execution,
have been already pointed out. We must congratu-
to the country as to be flattering to our national
pride. — American Medical Journal.
In
SARGENT (F. W.), M. D.
ON BANDAaiNO AND OTHER POINTS OF MINOR SURGERY.
one handsome royal 12mo. volume of nearly 400 pages, with 128 wood-cuts.
The very best manual of Minor Surgery we have l We have carefully examined this work, and find it
Been;an American volume, with nearly four hundred [well executed and admirably adapted to the use of
Besides the subjects usually embraced
pages of good practical lessons, illustrated by about
one hundred and thirty wood-cuts. In these days
o( '' trial," when a doctor's reputation hangs upon
a clove hitch, or the roll of a bandage, it would be
well, perhaps, to carry such a volume as Mr. Sar-
gent's always in our coat-pocket, or, at all events,
to listen attentively to his instructions a$ home. —
Buffalo Med. Journal.
the student.
in works on Minor Surgery, there is a short chapter
on bathing, another on anajsthetic agents, and an
appendix of formulae. The author has given an ex-
cellent work on this subject, and his publishers have
illustrated and printed it in most beautiful style. —
The Charleston Medical Journal.
STANLEY (EDWARD).
A TREATISE ON DISEASES OF THE BONES.
extra cloth, 286 pages.
In one volume, octavo,
AND SCIENTIFIC PUBLICATIONS.
27
STILLE (ALFRED), M. D.
PRINCIPLES OF THERAPEUTICS. In one handsome volume. ^Preparing.)
SIMON (JOHN), F. R. S.
GENERAL PATHOLOGY, as conducive to the Establishment of Rational
Principles for the Prevention and Cure of Disease. A Course of Lectures delivered
Thomas's Hospital during the summer Session of 1850. In one neat octavo volume.
at St
SMITH (TYLER W.), M. D.,
Lecturer on Obstetrics in the Hunterian School of Medicine.
ON PARTURITION, AND THE PRINCIPLES AND PRACTICE OP
OBSTETKICS. In one large duodecimo volume, of 400 pages.
SIBSON (FRANCIS), M.D.,
Physician to St. Mary's Hospital.
MEDICAL ANATOMY. Illustrating the Form, Structure, and Position of the
Internal Organs in Health and Disease. In large imperial quarto, Vf\\h. splendid colored plates.
To match "Maclise's Surgical Anatomy." {Preparing.)
SOLLY (SAMUEL), F. R. S.
THE HUMAN BRAIN; its Structure, Physiology, and Diseases. With a
Description of the Typical Forms of the Brain in the Animal Kingdom. From the Second and
much enlarged London edition. In one octavo volume, with 120 wood-cuts.
SCHOEDLER (FRIEDRICH), PH.D.,
Professor of the Natural Sciences at Worms, &c.
THE BOOK OF NATURE; an Elementary Introduction to the Sciences of
Physics, Astronomy, Chemistry, Mineralogy, Geology, Botany, Zoology, and Physiolog>\ First
American edition, with a Glossary and other Additions and Improvements; from the second
English edition. Translated from the sixth German edition, by Henry Medlock, F. C. S., &c.
In one thick volume, small octavo, of about seven hundred pages, with 679 illustrations on wood.
Suitable for the higher Schools and private students. {Now Ready.)
This volume, as its title shows, covers nearly all
the sciences, and embodies a vast amount of informa-
tion for instruction. No other work that we have
seen presents the reader with so wide a range of ele-
mentary knowledge, with so full illustrations, at 90
cheap a rate. — Silliman-s Journal^ Nov. 1853.
TAYLOR (ALFRED S.), M. D., F. R. S.,
Lecturer on Medical Jurisprudence and Chemistry in Guy's Hospital.
MEDICAL JURISPRUDENCE. Third American, from the fourth and improved
English Edition. With Notes and References to American Decisions, by Edward Hartshorne,
M. D. In one large octavo volume, of about seven hundred pages, {Just Issued.)
We know of no work on Medical Jurisprudence
which contains in the same space anything like the
same amount of valuable matter .—JV. Y. Journal of
Medicine.
The American editor has appended several im-
portant facts, the whole constituting by far the best,
most reliable, and interesting treatise on Medical
Jtrrisprudence, and one that we cannot too strongly
recommend to all who desire to become acquainted
with the true and correct exposition of this depart-
ment of medical literature. — Northern Lancet.
No work upon the subject can be put into the
hands of students either of law or medicine which
will engage them more closely or profitably ; and
none could be offered to the busy practitioner of
either calling, for the purpose of casual or hasty
reference, that would be more likely to afford the aid
desired. We tlierefore recommend it as the best and
safest manual for daily use. — American Journal of
Medical Sciences.
We have heretofore had reason to refer to it in
terms of commendation, and need now only state
that, in the edition before us, the author has com-
pletely revised the whole work, making many addi-
tions and alterations, and brought it fully up to the
present state of knowledge. The task of the Ameri-
can editor has been to present all the important
facts and cases that have recently occurred in our
own country, bearing on the subjects treated of.
No better work can be placed in the hands of the
physician or jurist. — St. Louis Medical and Surgical
Journal.
BY THE SAME AUTHOR.
ON POISONS, IN RELATION TO MEDICAL JURISPRUDENCE AND
JVIEDICINE. Edited, with Notes and Additions, by R. E. Griffith, M. D. In one large octavo
volume, of 688 pages.
One of the most practical and trustworthy works
on Poisons in our language. — Western Journal of
Medicine.
The most elaborate work on the subject that our
literature possesses. — British and Foreign Medico-
Chirurgical Review.
It contains a vast body of facts, which embrace
ail that is important in toxicology, all that is
ttecessary to the guidance of the medical jurist, and
all that can be desired by the lawyer, — Medico-
Chirurgical Review.
It is, so far as our knowledge extends, incompa-
rably the best upon the subject; in the highest de-
gree creditable to the author, entirely trustworthy,
and indispensable to the student and practitioner. —
JV. Y. Annalist
THOMSON (A. T.), M. D., F. R. S., &c.
DOMESTIC MANAGEMENT OF THE SICK ROOM, necessary in aid of
Medical Treatment for the Cure of Diseases. Edited by R, E. Griffith, M. D. In one large
royal 12mo. volume, with wood-outs, 360 pages.
(NMMil i,U
3$
B L AN C H A R D & LEA' S Mfel) I C A L
TOMES (JOHN), F. R. S.
A MANUAL OF DENTAL PRACTICE. Illustrated by numerous engravings
on wood. In one handsome volume. {Preparing.)
TODD (R. B.), M. D., AND BOWMAN (WILLIAM), F. R. S.
PHYSIOLOaiCAL ANATOMY AND PHYSIOLOaY OF MAN. With
numerous handsome wood-cuts. Paris I, II, and III, in one octavo volume, 552 pages. Part IV
will complete the work.
The distinguishing peculiarity of this work is, that the authors investigate for themselves every
fact asserted ; and it is the immense labor consequent upon the vast number of observations re-
quisite to carry out this plan, which has so long delayed the appearance of its completion. Tlie
first portion ot Part IV, with numerous original illustrations, was published in the Medical News
and Library for 1853, and the completion will be issued immediately on its appearance in London.
Those who have subscribed since the appearance of llie preceding portion of the work can haw
the three parts by mail, on remittance of $2 50 to the publishers.
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION.
VOLUME VI, for 1853, large 8vo., of 870 pages, with numerous colored platea
and wood-cuts.
Also to be had, a few sets of the Transactions from 1848 to 1853, in six large octavo volumes,
price $25. These volumes are all published by and sold on account of the Association.
WATSON (THOMAS), M.D., &c.
LECTURES ON THE PHINCIPLES AND PRACTICE OF PHYSIC.
Third American, from the last London edition. Revised, with Additions, by D. Francis Condie,
M. D., author of a "Treatise on the Diseases of Children," &c. In one octavo volume, of nearly
eleven hundred large pages, strongly bound with raised bands.
To say that it is the very best work on the sub-
ject now extant, is but to echo the sentiment of the
medical press throughout the country. — N. O.
Medical Journal,
Of the text-books recently republished Watson is
very justly the principal favorite. — Holmes's Rep.
to Nat. Med. Assoc,
By universal consent the work ranks among the
vxjry best text-books in our language. — Illinois and
Indiana Med. Journal.
Regarded on all hands as one of the very best, if
not the very best, systematic treatise on practical
medicine extant. — St. Lxmis Med. Journal.
Confessedly one of the very best works on tb«
principles and practice of physic in the English or
any other language. — Med. Examiner.
Asa text-book it has no equal ; as a compendium
of pathology and practice no superior.— iVet^" York
Annalist.
We know of no work better calculated for being
placed in the hands of the student, and for a text-
book; on every important point the author seems
to have posted up his knowledge to the day. —
Amer. Med. Journal.
One of the most practically useful books that
ever was presented to the student. — N. Y. Med.
Journal,
WALSHE (W. H.), M. D.,
Professor of the Principles and Practice of Medicine in University College, London.
DISEASES OF THE HEART, LUNGS, AND APPENDAGES; their
Symptoms and Treatment. In one handsome volume, large royal 12mo., 512 pages.
We consider this as the ablest work in the En- 1 the author being the first stethoscopist of the day.—
gfieh language, on the subject of which it treats; | Charleston Medical Journal.
WHAT TO OBSERVE
AT THE BEDSIDE AND AFTER DEATH, IN MEDICAL CASE,S.
published under the authority of the London Society for Medical Observation,
handsome volume, royal 12mo , extra cloth. {Just Issued.)
In one very
We hail the appearance of this book as the grand
desideratum. — Charleston Medical Journal.
This is truly a very capital book. The whole
medical world will reap advantages from its publi-
cation. The medical journals will soon show its
influence on the character of the " Reports of Cases"
which they publish. Drs. Ballard and Walshe have
given to the world, through a small but useful
medical organization, a cheap but invaluable book.
We do advise every reader of this notice to buy it
and use it. Unless he is so vain as to imagine him-
self superior to the ordinary human capacity, he wiW
in six months tee its inestimable advantages.—
Stethoscope.
WILDE (W. R.), 'OPTm •
Surg-eon to St. Mark's Ophthalmic and Aural Hospital, Dublin.
AURAL SURGERY, AND THE NATURE AND TREATMENT OF DIS-
EASES OF THE EAR. In one handsome octavo volume, with illustrations. {Now Ready.)
So little is generally known in this country concerning the causes, symptoms, and treatment of
aural affections, that a practical and scientific work on that subject, from a practitioner of Mr.
Wilde's great experience, cannot fail to be productive of much benefit, by attracting attention
lo this obscure class of diseases, which too frequently escape attention until past relief The im-
mense number of cases which have come under Mr. Wilde's observation for many years, have
afforded him opportunities rarely enjoyed for investigating this branch of medical science, and hia
work may therefore be regarded as of the highest authority.
This work certainly contains more information on
the subject to which it is devoted than any other
with which we are acquainted. We feel grateful to
the author for his manful effort to rescue this depart-
ment of surgery from the hands of the empirics who
nearly monopolize it. We think he has successfully
shown that aural diseases are not beyond the re-
sources of art; that they are governed by the same
laws, and amenable to the same general methods of
treatment as other morbid processes. The work \% ,
not written to supply the cravings of popular patro-
nage, but it is wholly addressed to tlie profession,
and bears on every page the impress of the reflections
of a sagacious and practical surgeon.— Va. Surg, and
Med. Journal.
AND SCIENTIFIC PUBLICATIONS.
f9
WILSON (ERASMUS), M.D., F. R. S.,
Lecturer on Anatomy, London.
A SYSTEM OF HUMAN ANATOMY, General and Special. Fourth Ameri-
can, from the last English edition. Edited by Paul B. Goddard, A. iM., M. D. With two hun-
dred and fifty illustrations. Beautifully printed, in one large octavo volume, of nearly six hun-
dred pages.
In many, if not all the Colleges of the Union, it
has become a standard text-book. This, of itself,
is sufficiently expressive of its value. A work very
desirable to the student; one, the possession of
which will greatly facilitate his progress in the
study of Practical Anatomy. — New York Journal of
Medicine.
Its author ranks with the highest on Anatomy. —
Southern Medical and Surgical Journal.
It offers to the student all the assistance that can
be expected from such a work. — Medical Examiner.
The most complete and convenient manual for the
student we possess. — American Journal of Medittd
Science.
In every respect, this work as an anatomical
guide for the student and practitioner, merits our
warmest and most decided praise. — London Medical
Gazette.
BY THE SAME AUTHOR.
THE DISSECTOR; or, Practical and Surgical Anatomy. Modified and Re-
arranged, by Paul Beck Goddard, M. U. A new edition, with Revisions and Additions. In
one large and handsome volume, royal 12mo., with one hundred and fifteen illustrations.
In passing this work again through the press, the editor has made such additions and improve-
ments as the adv^ance of anatomical knowledge has rendered necessary to maintain the work in the
high reputation which it has acquired in the schools of the United States, as a complete and faithftil
guide to the student of practical anatomy. A number of new illustrations have been added, espe-
cially in the portion relating to the complicated anatomy of Hernia. In mechanical execution tb«
work will be found superior to former editions.
ON DISEASES OF THE
BY THE SAME AUTHOR.
SKIN. Third American, from the third London
edition. In one neat octavo volume, of about five hundred pages, extra cloth. (J its t Is sited.)
Also, to be had done up with fifteen beautiful steel plates, of which eight are exquisitely colored ;
representing the Normal and Pathological Anatomy of the Skin, together with accurately colored
delineations of more than sixty varieties of disease, most of them the size of nature. The PlatefS
are also for sale separate, done up in boards.
The increased size of this edition is sufficient evidence that the author has not been content
with a mere republication, but has endeavored to maintain the high character of his work as the
standard text-book on this interesting and difficult class of diseases. He has thus introduced such
new matter as the experience of the last three or four years has suggested, and has made such
alterations as the progress of scientific investigation has rendered expedient. The illustrations have
also been materially augmented, the number of plates being increased from eight to sixteen.
The "Diseases of the Skin," by Mr. Erasmus
Of these plates it is impossible to speak too highly.
The representations of the various forms of cuta-
neous disease are singularly accurate, and the color-
ing exceeds almost anything we have met with in
ptnnt of delicacy and finish. — British and Foreign
Medical Review.
by Mr.
Wilson, may now be regarded as the standard work
in that department of medical literature. The
plates by wliich this edition is accompanied leave
nothing to be desired, so far as excellence of delinea-
tion and perfect accuracy of illustration are con-
eorned. — Medico-Chirurgical Review.
BY THE SAME AUTHOR.
ON CONSTITUTIONAL AND HEREDITARY SYPHILIS, AND ON
SYPHILITIC ERUPTIONS. In one small octavo volume, beautifully printed, with four exqui-
site colored plates, presenting more than thirty variettes of syphilitic eruptions.
Dr. Wilson's views on the general subject of connection with its transmissibility, pathology and
Syphilis appear to us in the main sound and judi- sequelae. His facts and references will, we are satis-
cious, and we commend the book as an excellent fied, be received as decisive, in regard to many
monograph on the subject. Dr. Wilson has pr^- questiones vexata;. They appear to us entitled to
sented us a very faithful and lucid description of notice at some length. — Medical Examiner.
Syphilis and has cleared up many obscure points in
BY THE SAME AUTHOR. (NoW Read?/.)
HEALTHY SKIN; A Popular Treatise on the Skin and Hair, their Preserva-
tion and Management. Second American, from the fourth London edition. One neat voluro«,
royal 12mo., with numerous illustrations.
Copies can be had done up in paper covers for mailing, price 75 cents.
WHITEHEAD (JAMES), F. R. C. S
THE CAUSES AND TREATMENT
being the Result of an Extended Practical Inq
Second American Edition. In
&-C,
of the Uterus.
The simple title of this work gives a very imper-
fect idea of its contents. The subject of sterility
occupies a mere fraction of space, and upwards of
one-half of the whole volume is taken up with an
elaborate account of menstruation as a physiological
process, and of the disorders which its deviations
from health are apt to produce. — Medical Chirurg.
Review .
Such are the adyances made from year to year in
OF ABORTION AND STERILITY;
uiry into the Physiological and Morbid Conditions
one volume, octavo, 368 pages. {Now Ready.)
this department of our profession, thnt the practi-
tioner who does not consult the recent works on the
complaints of females, will soon find himself in tb«
rear of his more studious bretiiren. This is one of
the works which must be studied by those who
would know what the present state of our kmnvledg«
is respecting the causes and treatment of abortion
and sterility. — The Western Journal of Medicin4 cmd
Surgery.
30
BLANCHARD & LEA'S MEDICAL
WEST (CHARLES), M. D.,
Physician to the Hospital for Sick Children, &c.
LECTURES ON THE DISEASES OF INFANCY AND CHILDHOOD.
Second American, from the Second and Enlarged London edition. In one volume, octavo, of
nearly five hundred pages. {Now Ready.)
From the Preface to the Second Edition.
In the preparation of the second edition of these Lectures, the whole work has been carefully
revised. A few formulae have been introduced and a minute alphabetical index has been appended
while additions amounting altogether to fifty pages, have been made, wherever I felt that more
extended observation, or more careful reflection had enabled me to supply some of those deficiencies
which I am well aware, are still far too numerous. The work now contains the result of 640
observations, and 199 post-mortem examinations, chiefly made among 16,276 children who came
under my notice during the ten years of my connection with the Children's Infirmary in Lambeth.
We take leave of Dr. West with great respect for
his attainments, a due appreciation of his acute
powers of observation, and a deep sense of obliga-
tion for this valuable contribution to our profes-
sional literature. His book is undoubtedly in manj'
respects the best we possess on diseases of children.
The extracts we have given will, we hope, satisfy
our readers of its value ; and yet in all candor \ve
must say that they are even inferior to some other
parts, the length of which prohibited our entering
upon them. That the book will shortly be in the
hands of most of our readers we do not doubt, and it
will give us much pleasure if our strong recommend-
ation of it may contribute towards the result.— TAe
Dtiblin Quarterly Journal of Medical Science.
Dr. West has placed the profession under deep ob-
ligation by this able, thorough, and finished work
upon a subject which almost daily taxes to the ut-
most the skill of the general practitioner. He has
with singular felicity threaded his way through all
the tortuous labyrinths of the difficult subject he has
undertaken to elucidate, and has in many of the
darkest corners left a light, for the benefit of suc-
ceeding travellers, which will never be extinguished.
Not the least captivating feature in this admirable
performance is its easy, conversational style, w^hich
acquires force from its very simplicity, and leaves
an impression upon the memory, of the truths it
conveys, as clear and refreshing as its own purity.
The author's position secured him extraordinary fa-
cilities for the investigation of children's diseases,
and his powers of observation and discrimination
have enabled him to make the most of these great
advantages. — Nashville Medical Journal.
BY THE SAME AUTHOR. [NoiV Ready.)
AN ENQUIRY INTO THE PATHOLOaiCAL IMPORTANCE OF ULCER-
ATION OF THE OS UTERI. Being the Croonian Lectures for the year 1854. In one neat
octavo volume, extra cloth.
This work will appear in the " Medical News and Library" during the latter portion of 1854, and
will be published in a separate form about December.
WILLIAMS (C. J. B.), M. D., F. R. S.,
Professor of Clinical Medicine in University College, London, &o.
PRINCIPLES OF MEDICINE; comprising General Pathology and Therapeu-
tics, and a brief general view of Etiology, Nosology, Semeiology, Diagnosis, Prognosis, and
Hygienics. Edited, with Additions, by Meredith Clymer, M. D. Fourth American, from the
last and enlarged London edition. In one octavo volume, of 476 pages. {Now Ready.)
This new edition has been materially enlarged and brought up by the editor.
It possesses the strongest claims to the attention of the medical student and practitioner, from
the admirable manner in which the various inquiries in the diflerent branches of pathology are
investigated, combined, and generalized by an experienced practical physician, and directly applied
to the investigation and treatment of disease. — Editor's Preface.
The best exposition in our language, or, we be-
lieve, in any language, of rational medicine, in its
present improved and rapidly improving state. —
British and Foreign Medico-Chirurg. Review.
Few books have proved more useful, or met with
a more ready sale than this, and no practitioner
should regard his library as complete without it.
— Ohio Med. and Surg. Journal.
BY THE SAME AUTHOR.
A PRACTICAL TREATISE ON DISEASES OF THE RESPIRATORY
ORGANS; including Diseases of the Larynx, Trachea, Lungs, and^Pleurse. With numerous
Additions and Notes, by M. Clymer, M. D. With wood-cuts. In one octavo volume, pp. 508.
YOUATT (WILLIAM), V. S.
THE HORSE. A new edition, with numerous illustrations; together with a
general history of the Horse; a Dissertation on the American Trotting Horse; how Trained and
Jockeyed ; an Account of his Remarkable Performances ; and an Essay on the Ass and the Mule.
By J. S. Skinner, formerly Assistant Postmaster-General, and Editor of the Turf Register.
One large octavo volume.
BY THE SAME AUTHOR.
THE DOa.
illustrations.
Edited by E. J. Lewis, M. D.
In one very handsome volume, crown 8vo.
With numerous
crimson cloth, gilt.
and beautiful
AND SCIENTIFIC PUBLICATIONS.
hdn
31
B. & L. subjoin a condensed list of their publications in general and educational
literature, of which more detailed catalogues will be furnished on application.
HISTORY AND BIOGRAPHY.
BROWNING'S HISTORY OF THE HUGUE
NOTS, 1 vol. 8vo.
CAMPBELL'S (LORD) LIVES OF THE LORD
CHANCELLORS OF ENGLAND, from the earl-
iest I'imes to the Reign of George IV. In seven
handsome crown octavo volumes, extra cloth or
half morocco.
GAVIPBELL S (LORD) LIVES OF THE CHIEF
JUSTICES OF ENGLAND, from the Norman
Conquest. In two hand.some crown octavo vols.,
to match the " Chancellors."
DiXON'S LIFE OF WILLIAM PENN. A new
work. 1 vol. royal liimo., extra cloth.
GRAHAME'S COLONIAL HISTORY OF THE
TTNITED STATES. 2 vols. 8vo. A new edition.
GUIZOT'S LIFE OF CROMWELL. Two large
vols., royal 12mo. (Now readv.)
HERVEY'S MEMOIRS OF GEORGE II. 2 vols,
royal 12mo., extra cloth.
HUGIIESS OUTLINES OF SCRIPTURE GEO-
GRAPHY AND HISTORY, I vol., royal 12mo.,
with colored maps. (Just issued.)
IIVGERSOLL'S HISTORY OF THE LATE WAR.
2 vols 8vo.
KENNEDY'S LIFE OF WILLIAM WIRT. 2d
edition, 2 vols, royal l2mo., extra cloth, with Por-
trait.
Same work, library edition, 2 vols. 8vo.
KAVANAGHS WOMAN IN FRANCE IN THE
EIGHTEENTH CENTURY. 1 vol. royal 12mo.,
extra cloth.
LOUIS BLANC'S FRANCE UNDER LOUIS PHI-
LIPPE, 1830-1840. 2 vols, crown 8vo., extra cloth.
LOUIS BLANC'S FRENCH REVOLUTION. 1 V9l.
crown 8vo , extra cloth.
MARSH (MRS.) ROMANTIC HISTORY OF THE
HUGUENOTS. 2 vols, royal 12mo., extra cloth.
NIEBUHRS ANCIENT HISTORY. By Leonhard
ScHMiTz. It) three handsome crown octavo vols.,
(Lately Issued.)
PARDOE'S FRANCIS THE FIRST. 2 vols, royal
12mo.. extra cloth.
PALGRAVE'S NORMANDY AND ENGLAND.
In three vols, crown 8vo., (Preparing.)
RUSH'S COURT OF LONDON. 1 vol.Svo.
RANKE'S HISrORY OF IHE REFORMATION
IN GERMANY. To be complete in 1 vol. 8vo.
RANKE S HISTORY OF THE aPTOMAN AND
SPANISH EMPIRES. 8vo. Price 50 cents.
RUSSEL'S LIFE OF CHARLES JAMES POX.
2 vols., handsome royal 12mo. (Now ready.)
Same Work, Second Series. (Preparing )
STRICKLAND'S LIVES OF THE QUEENS OF
ENGLAND, from the Norman Conquest. Conr>-
plete in 6 handsome crown 8vo. volumes, various
styles of binding.
STRICKLAND'S LIVES OF THE QUEENS OF
HENRY VIII. Ill one handsome crown 8vo. vol.,
extra cloth, various styles.
STRICKLAND'S LIFE OF QUEEN ELIZABETH.
In one handsome crown 8vo. volume, extra cloth,
various styles.
STEINMETZ'S HISTORY OF THE JESUITS.
2 vols, crown 8vo., extra cloth.
MISCELLANEOUS.
ACTON (MRS.) MODERN COOKERY. Edited by
Mrs. S J. Hale. 1 handsome volume, royal 12mo.,
extra cloth, with illustrations.
ADDISON ON CONTRACTS, and on Parties to
Actions, ex contractu. 1 large octavo volume, law
sheep.
BUFFUMS SIX MONTHS IN THE GOLD
MINES. 1 vol. royal 12mo., extra cloth or paper,
50 cents.
BAIRD'S WEST INDIES AND NORTH AMERI-
CA. 1 vol. royal 12mo.. extra cloth.
OT^ATER ON THE DISEASES OF HORSES. By
Skinner. lvol.l2mo.
OJ.ATERS CATTLE AND SHEEP DOCTOR. 1
vol.l2mo.. cuts.
DON QUIXOTE. With numerous illustrations by
Johaunot. 2 vols. 8vo. cloth, or half morocco.
ENCYCL0PJ^:DIA of geography, in three
octavo vols., many cuts and maps, various bindings.
ENCYCL0P.^:DIA AMERICANA. U vols. 8vo.,
various bindings.
Vol. 14. bringing the work up to 1846, sold separate.
^PLORLVG EXPEDITION, NARRAITVE OF.
In six vols., imperial quarto, with several hundred
plates, maps, and wood-cuts
EVANS'S SUGAR-PLANTER S MANUAL. 1 vol.
8vo . extra cloth, plates,
BflMAN'S TRAVELS IN SIBERIA 2 vols, royal
12mo.. extra cloth.
FIELDING'S SELECT WORKS. In one vol. Svo.
cloth, or 4 parts, paper.
FLETCHER'S NOTES FROM NINEVEH. 1 vol.
royal 12mo., extra cloth.
HAWKER ON SHOOTING. Edited by Porter.
With plates and cuts. 1 vol. 8vo., beautiful extra
eloth, new edition, (Just I.«sued.)
HOLTHOUSES LAW DICTIONARY. By Pen-
tKGTON. 1 vol. large 12mo., law sheep.
JOHNSON'S DICTIONARY OF GARDENING
By Landbeth. 1 vol. large royal 12mo., 650 pages,
many cuts.
LANGUAGE OF FLOWERS. 8th edition. 1 vol.
18mo., colored plates, crimson cloth, gilt
LEWIS'S HINTS TO SPORTSMEN. 1 vol. royal
12mo., extra cloth, illustrated.
• NATURAL
AMERICAN ORNITHOLOGY. By PrinceCharlks
Bonaparte. In four handsome folio volumes, with
beautiful colored plates.
ARNO TT'S ELEMEN rS OF PHYSICS. New Edi-
ition. By Isaac Hays, M. D. In one octavo volume,
with 200 illustrations.
LYNCH'S NARRATIVE OF THE U. S. EXPE-
DITION TO I'HE DEAD SEA AND RIVER
JORDAN. 1 large octavo volume, with numerous
plates and maps.
Same work, condensed edition, in neat royal 12mo.
MACFARLANE'S TURKEY AND ITS DES-
TINY. 2 vols, roval 12mo., extra cloth.
MACKAY'8 TRAVELS IN THE UNITED
S TATES. 2 vols, royal 12mo., extra cloth.
MARTINEAU'S EASTERN LIFE. 1 vol. crown
8vo.. extra cloth.
MARTINEAU'S HOUSEHOLD EDUCATION. 1
vol. royal 12mo., extra cloth.
PAGET'S HUNGARY AND TRANSYLVANIA.
2 vols, royal ]2mo., extra cloth.
PULSZKY'S HUNGARIAN LADY. 1 vol. royal
12rno., extra cloth.
PICCIOLA— The Pri.?oner of Fenestrella. Illustrated
edition, with cuts, royal 12mo., beautiful crimson
cloth.
Same work, fancy paper, price 50 cents.
READINGS FOR THE YOUNG FROM SIR
WALTER SCOTT, 2 vols, royal 18mo., extra
crimson cloth, plates.
SELECT WORKS OF TOBIAS SMOLLETT
Cloth or paper.
SHAW'S OUTLINES OF ENGLISH LITERA-
TURE. 1 large vol. royal 12mo., extra cloth.
SMALL BOOKS ON GREAT SUBJECTS. In three
neat volumes, royal ISmo., extra cloth.
SAM SLICK'S NEW WORK— WISE SAWS AND
MODERN INSTANCES. 1 vol. 12mo., (Now
Ready.)
THOMSON'S DOMESTIC MANAGEMENT OF
THE SICK ROOM. 1vol. 12mo.
WHEATON'S INTERNATIONAL LAAV. 1 vol
large 8vo , law sheep, or extra cloth. 3d edition,
much improved.
YOUATT ON THE HORSE, &c. By SkinnWI. ■ i
vol. 8vo., many cuts.
YOUATT ON THE DOG. With plates. 1 vol.
crown Svo., beautiful crimson cloth.
YOUATT ON THE PIG. 1 vol. 12mo., extra cldth,
with cuts.
Same work in paper, price 50 cents.
SCIENCE.
BRODERIP'S ZOOLOGICAL RECREATIONS. 1
vol. royal 12iuo., extra cloth. ■
BOWMAN S PRACTICAL CHEMISTRY. 1^61.
royal 12mo., extra cloth ; cuts.
BIRD'S NATURAL PHILOSOPHY. 1 vol. royal
12ino., with many cuts.
:.i.iciOq Zi
32
BLANCHARD & LEA'S SCIENTIFIC PUBLICATIONS.
NATURAL SCIENCE— Continued.
BEALE ON THE LAWS OF HEALTH IN RE-
LATION TO MIND AND BODY. 1 vol. royal
12mo., extra cloih.
BREWSTER'S TREATISE ON OPTICS. 1 vol.
]2mo., cuts.
CARPENTER'S GENERAL AND COMPARA-
TIVE PHYSIOLOGY. With numerous wood-
cuts. 1 vol. large 8vo., new edition. (Preparing.)
CARPENTER ON THE MICROSCOPE. Hand-
somely illustrated. (Preparing.)
DANA ON CORALS. 1 vol. royal 4to., extra cloth,
with wood-cuis.
Atlas to do., large imperial folio, half morocco, with
over 60 magnificent colored plates.
DE LA BECHE'S GEOLOGICAL OBSERVER.
1 large vol. Svo over 300 cuts, (Now Ready)
FOWNES'S RECENT WORK ON CHEMISTRY.
New edition. By Bridges. 1 vol. 12mo., many
cuts, sheep or extra cloth.
GRAHAM'S ELEMENTS OF CHEMISTRY. Large
8vo., many cuts. (Part I, lately issued, Part II,
preparing.)
GREGORY ON ANIMAL MAGNETISM. 1 vol.
royal 12mo.
GRIFFITH'S CHEMISTRY OF THE FOUR SEA-
SONS. 1 vol. l2mo.,many cuts.
GRIFFI TH'S MEDICAL BOTANY. 1 vol. large
8vo., extra cloth, nearly 400 cuts.
HERSCHEL'S OUTLINES OF ASTRONOMY.
1 vol. crown Bvo., ex. cl., with plates and woodcuts.
HUMBOLDT'S ASPECTS OF NATURE. 2d edi-
tion. 1 large vol. royal 12mo., extra cloth.
HANDBOOKS OF NATURAL PHILOSOPHY
AND ASTRONOMY. By Dionysitjs Lardnek.
3 thick vols, royal 12mo., with 1000 wood-cuts.
HALE'S ETHNOLOGY AND PHILOLOGY OF
THE U. S. EXPLORIJVG EXPEDITION, 1 vol.
royal 4io., extra cloth.
JOHNSTON'S PHYSICAL ATLAS OF NATU-
RAL PHENOMENA. In one large and handsome
imperial 4to. vol., half bound in morocco, with 26
maps, beautifully colored.
KNAPP'S TECHNOLOGY, OR CHEMISTRY
APPLIED TO THE ARTS AND TO MANU-
FACTURES. Translated by Ronalds. Edited by
Johnson. Vol. I., with 244 large wood engravings.
Vol. II., large 8vo., with 250 wood engravings.
MULLER'S PHYSICS AND METEOROLOGY. 1
vol. large 8vo., 2 colored plates, and 55U wood-cuts.
MILLWRIGHT'S AND MILLER'S GUIDE. By
Oliver Evans. In one vol. 8vo., sheep, many plates.
MATTEUCCI ON PHYSICAL PHENOMENA OF
LIVING BEINGS. 1 vol. royal 12mo., ex. cl., cuts.
ORR'S CIRCLE OF THE SCIENCES, royal l2rao.,
with numerous illustrations, containing Animal
and Vegetable Physiology, by Dr. Bushnan. The
Different Forms of the Skeleton, by Prof. Owen.
Physical Geography and Geology, by Prof. Ansted.
Natural Philosophy, by Rev. W. Mitchell, &c. &c.
SOMERVILLE'S PHYSICAL GEOGRAPHY.
New edition. 1 large vol. royal 12mo., extra cloth.
SCHOEDLER AND MEDLOCK'S BOOK OF NA-
TURE. With Additions and Improvements. In
one thick volume, crown 8vo., with over 679 illus-
trations.
WEISBACH'S PRINCIPLES OF THE MECHA-
NICS OF MACHINERY AND ENGINEERING.
2 large octavo volumes, extra cloth, 900 beautiful
wood engravings.
EDUCATIONAL WORKS.
ARNOTT'S ELEMENTS OF PHYSICS. New edi-
tion. Complete in 1 vol. Svo , many illustrations.
BOLMAR'S FRENCH SERIES, consisting of :-
LEVIZAC'S FRENCH GRAMMAR, 1 volume,
12mo., sheep.
PERRIN'S FABLES, with Key. 1 vol. 12mo., half
bound.
COLLOQUIAL PHRASES, 1 vol. 18mo., hf bound.
A VENTURES DE TELEMAQUE, 1 vol. 12rao.,
halfbound.
KEY to do. do. do.
FRENCH VERBS, 1 vol. 12mo., halfbound.
BAIRD'S CLASSICAL MANUAL. An Epitome of
Ancient Geography, Mythology, Antiquities, and
Chronology. 1 vol. royal 18mo., extra cloth.
Same work, halfbound, embossed leather backs.
BUSHNAN'S PHYSIOLOGY OF ANIMAL AND
VEGETABI/E LIFE. A new and popular work.
1 vol. royal 12mo. with illustrations. {Just Ready.)
BIRD'S ELEMENTS OF NATURAL PHILOSO-
PHY. 1 vol. royall2mo.. sheep, or ext. cl. 372 cuts.
BUTLER'S ATLAS OF ANCIENT GEOGRAPHY.
Revised edition. 1 vol. Svo. halfbound, 21 colored
maps.
BUTLER'S GEOGRAPHIA CLASSICA. Revised
edition ; 1 vol. 12mo., halfbound.
BREWSTER'S TREATISE ON OPTICS. With
additions. By Baohe. I vol. l2mo., halfbound, cuts.
BROWNE'SGREEK CLASSICAL LITERATURE.
1 vol. crown Bvo., extra cloth.
BROWNE'S ROMAN CLASSICAL LITERA-
TURE. 1vol. crown 8vo., ex. ciolh. (Now Ready.)
FOSTER'S HANDBOOK OF MODERN EURO
PEAN LITERATURE 1 vol. royal 12mo.,ex.cl.
FOWNE'S CHEMISTRY FOR STUDENTS. New
edition. By Bridges. 1 vol. royal 12mo., many cuts,
extra cloth, or sheep.
GRAHAM'S ELEMENTS OF CHEMISTRY. 2d
edition, enlarged. Edited by Bridges. 8vo. many
cuts. Part I., lately issued. Part II., preparing.
HERSCHEL'S OUTLINES OF ASTRONOMY. A
new edition. With numerous plates and wood-
cuts. 1 vol. crown 8vo., extra cloth.
HUGHES'S OUTLINES OF SCRIPTURE GEO-
GRAPHY AND HISTORY, 1 vol., royal 12mo.,
with colored maps. (Just issued.)
JOHNSTON'S ATLAS OF PHYSICAL GEOGRA-
PHY. 1 vol., with 26 colored plates, hf. bound.
LARDNER'S HANDBOOKS OF NATURAL PHI-
LOSOPHY AND ASTRONOMY.
First Course, containing Mechanics, Hydrosta-
tics, Hydraulics, Pneumatics, Sound, and Optics.
1 very large vol., royal 12mo., sheep, 424 cuts.
Second Course, containing Heat, Electricity, Mag-
netism, and Galvanism. 1 vol. royal 12mo., sheep,
250 cuts.
Third Course, containing Astronomy and Meteo-
rology. 1 very large vol., royal 12mo., 37 plates
and 216 wood-cuts. (Now ready.)
MULLER'S PHYSICS AND METEOROLOGY. 1
vol. 8vo., over 500 beautiful cuts and two colored
plates, extra cloth.
NATIONAL SCHOOL MANUAL. 4 parts. 12mo.
SOMERVILLE'S PHYSICAL GEOGRAPHY. 3d
and enlarged edition, with American notes. 1 large
vol. royal 12mo., extra cloth,
SHAW'S OUTLINES OF ENGLISH lilTERA-
TURE. 2d ed. With Sketch of American Litera-
ture. By Tuckerman. 1 vol. royal 12mo., ext. cl.
SCHOEDLER AND MEDLOCK'S BOOK OF NA-
TURE. Edited and revised. 1 large vol., crown
8vo., with 679 wood cuts. (Now ready.)
SCHMITZ AND ZUMPT'S CLASSICAL SERIES
FOR SCHOOLS. In neat royal 18mo. volumes, as
follows: —
KALTSCHMIDT'S LATIN DICTIONARY.
Complete, handsome embossed leather.
SCHMITZ'S ELEMENTARY LATIN GRAM-
MAR AND EXERCISES.
SCHMITZ'S ADVANCED LATIN GRAMMAR.
ADVANCED LATIN EXERCISE BOOK, whh
Selections for Reading. (Now Ready.)
C^SAR, extra cloth, with a Map.
SALLUST, extra cloth, with a Map.
VIRGIL, extra cloth.
OVID, extra cloth.
HORACE, extra cloth.
LIVY. extra cloth, two colored Maps.
CICERO, extra cloth.
QUINTUS CURTIUS, extra cloth, with a Map.
CORNELIUS NEPOS, now ready, extra cloth.
OTHER WORKS OF THE SERIES PREPARING.
ILLUSTRATED MEDICAL CATALOGUE.
BLANCHAED & LEA have now ready a Catalogue of their Medical, Surgical, and Scien-
tific Publications, containing descriptions of the works, with Notices of the Press, and
specimens of the Illustrations, making a pamphlet of sixty-four large octavo pages. It has
been prepared with great care, and without regard to expense, forming one of the most beau-
tiful specimens of typographical execution as yet issued in this country. Copies will be
sent by mail, and the postage paid, on application to the Publishers, by inclosing two three
eeat postage stamps.
14 DAY USE
RETURN TO DESK FROM WHICH BORROWED
BIOLOGY LIBRARY
TEL. NO. 642-2532
This book is due on the last date stamped below, or
on the date to which renewed.
Renewed books are subject to immediate recall.
FEB .^3 1970
APR 1-1970 3
i
^Vlo'rAlT.%'' vn^S^U^,..
il^i
^i '<
ii'iiSiffliill
p. Ill 1 , /Ml'l!
l/l
I'l^'liimiii