extending force, is oftentimes curative. As in fracture of bones, so in curvature of spine, rest will allow of cure; not, perhaps, without deformity, but, nevertheless cure, while in many cases, it is believed that to attempt perfect restoration of form, would be to insure permanent disease."

While I have advised means for relieving pressure—for sustaining the weight above the curvature, and have spoken of rest and general or constitutional support, I have almost forgotten to caution you against adopting that old and barbarous practice of counter irritation or derivation; blister, seton, issue and moxa, have been the names of the various modes of torture, which have been adopted as means of cure, in every way I believe opposed to all pathology and good reason. These means of cure were adopted when the tubercular theory of causation predominated, but how they could ever have been supposed capable of removing tubercular matter if deposited, or prevent or in any way overcome the tubercular tendency if present in the constitution, it is wholly impossible to conceive. Clinical experience was referred to for defense of this practice, but facts of this nature did not however exist except in the minds of those who had already determined to see the most favorable results, generally only in the minds of those who never saw unfavorable effects from favorite remedies.

Observe carefully for yourselves; meanwhile accept my assurance that these measures are not only wholly incapable of good but largely productive of evil, creating irritative fever, disturbing rest and appetite, and causing drain upon the system, now requir ing support and rest. While I do not ask you to adopt my opinions, I beg of you to observe the effects of these remedies in the practice of others, as I am sorry to say, frequent opportunity will permit, before trying them in your own.

Mortality after Amputation of the Thigh.-M. Hussan, in publishing the statistics of the Hospitals of Paris, embracing the returns of 100,000 patients, gives the following results of amputation of the thigh: In 1861, 42 amputations, and only 7 recoveries; a mortality of 83.33 per cent. In 1862, 40 amputations, and 19 recoveries; a mortality of 52.50 per cent. In 1863, 40 rmputations, and 15 recoveries; a mortality of 62.50 per cent. Average mortality for three years, 66.11 per cent., or 41 recoveries in 122 operations. -Boston Medical and Surgical Journal.

ART. III.-Review of Dr. C. C. F. Gay's Article upon "Uterine Surgery," in the March Number of the Buffalo Medical & Surgical Journal. BY FRANK W. ABBOTT, M. D.

When an article on any particular branch of medicine appears in a medical Journal, the natural and reasonable expectation of the reader is, that the author has either something new to communicate, drawn from his own observation and found useful in his own practice, or has studied faithfully the latest deliverances of acknowledged authorities, and has collected from them such facts and theories as are of practical or speculative interest. Moreover, when the author speaks in a tone of authority and assumption, it is but natural to infer that he is an acknowledged authority in the branch of which he treats among those whose names appear as contributors to the Journal, and is the exponent of their best ideas and practice. With these thoughts in mind, let us look for a few moments at an article on "Uterine Surgery, by C. C. F. Gay, M. D.," which appeared in the March number of this Journal.

The author proposes, as we learn from the first paragraph, to show that "our theory" of uterine disease "has been founded on a false pathology, and that such theory has led to erroneous treatment," and that the practitioner of the present day, whether engaged in general practice or devoting some attention to uterine disease as a specialty, "must lay aside old theories," "dispose of preconceived ideas," "put away old instruments to rust, and begin de novo to study up the true pathology and treatment of uterine disease." Surely this arraignment of the whole medical profession for ignorance and false practice must be supported by pretty strong proof to be received as true. Let us look at his statements, one by one, to see how he has sustained his position.

He commences by speaking of dislocations of the fundus uteri (the os remaining in position we suppose) as retroversions and anteversions, while those who have hitherto been regarded as authorities, call these displacements flexions, and limit the word version to those mal-positions where the whole body is displaced, constituting a very different condition. One who recognized the difference between versions and flexions would not thus confound them. But with reference to the treatment of these displacements, he says that "Simpson's sound must be laid aside," giving as a reason that it causes much pain and may produce pelvic cellu

litis. We venture the assertion, appealing for proof to the general experience of the profession, that in the great majority of cases the introduction of the sound by skillful hands is not attended with pain, and when the uterine canal is of normal size its use is safer than the use of the probe, as it fills the canal, and is less likely to be caught in the lacunæ or folds of the mucus membrane lining the cervix or body. The pathognomonic physico-phyiognomy of the anteflected female, as detailed in the next paragraph, must have been introduced as a bit of burlesque, for, since pain in the top of the head accompanies many forms of uterine disease and other diseases, even in that part of the human family who have no uterus, it is manifestly absurd to call it pathognomonic of any particular disease.

As to the statement, that as yet nothing but failure has attended efforts to permanently restore the uterus to its normal position, the author has probably been unfortunate in his authorities, as we can point out to him, in his own city, women who have been permanently relieved by the use of the sound, together with stem and other pessaries and appropriate general treatment, and have since borne children. While we are waiting for some surgeon to gain immortal honor by discovering an operation for the radical cure of these displacements, is it not best to continue to use the measures which have often been found to fulfill the requirements of the case? While we would reprobate the use of the sound in careless or unskillful hands, we think that it should not be laid aside, for, the dislocated uterus does sometimes retain its normal position after simply being replaced by it, and not very infrequently, if after being thus replaced it is kept in position by stem pessaries, etc., and we think also that by no other means can we so easily and safely diagnose displacements of the uterus, whether idiopathic or caused by hæmatocele or pyocele, etc., or intra-uterine tumors or polypi.

The writer closes this part of his article with the satisfactory exclamation, that he has accomplished his aim of showing that many appliances, now in use for the relief of displacements of the fundus uteri, have given way to the more effectual procedure of surgical interference; but after carefully re-reading his article we fail to find that he has mentioned any surgical interference whatever, but on the contrary he says, we must lay aside the instrument which in other hands has accomplished the desired object.

The writer then turns to the subject of abrasions, congestions and ulcerations of the os uteri, proposing to treat of them practically, and not from a pathological or etiological stand-point, but what has become of his opening proposition, viz: to show that our false pathology has led to erroneous treatment? We have not found any pathology, so far, unless it may be in the case of the aforesaid pathognomonic physico-physiognomy.

Briefly stated, the assumptions of the next paragraph amount to this: Ulcerations of the os uteri may be healed in a very short time, but when they appear to be healed they are not healed, for ulcers of the os are not ulcers of the os, but only manifestations of disease within or beyond the cervix. The inconsistency of these assumptions is only equaled by the error of the last, for it is the testimony of those who have made careful post mortem examinations, that in ulcerations of the external os, the disease but very rarely extends beyond the cervix.

But we hasten to see what of practical good is to be learned from this apostle of progress, and the first thing is, that he has applied nitrate of silver every four or five days for three months, before effecting a cure, and the next thing is that "glycerine" or "equal parts of iodine and ol. morrhua" will in three days heal an "ulcerated point" caused by the application of nit. of silver. We are not yet utterly overwhelmed by the proof of our ignorance, for we have heard of applying nit. of silver to the os uteri before, and also that the "ulcerated point" caused by its application will in three days heal spontaneously.

In his paragraph on leucorrhoea, the author speaks as though it were the result simply of a diseased os or cervix or lining membrane of the uterus, and to be treated solely by local applications, utterly ignoring the general causes which may produce it, as phthisis and other lung diseases, valvular disease of the heart, etc., or more local causes, as irritation from excessive coition, polypi and fibrous tumors, retro and ante-versions and flexions, catarrhal inflammation of the vagina and diseases of the neighboring parts, as hæmorroids, vesical catarrh and calculi, etc., etc., and yet he set out with the proposition that the whole profession must learn de novo the true pathology of the special subject concerning which he assumes to write, without giving a single fact to sustain his assumptions.

But as it may sometimes be necessary to apply medicaments to the interior of the uterus, let us look at the instruments which he has invented to see whether they supply a vacant place in our armament. If he had attended lectures at the Medical College in his own city at any time during the past fifteen years, he might have learned to use Lallemand's straight porte caustique for precisely the same purposes for which his first instrument is designed, with this advantage, that the caustic may be covered until the precise point desired is reached; and to supply the place of the second he might have seen whalebone probes of any required size which by simply heating may be bent to any angle, and they have this advantage, that the cotton adheres better to them than to silver, and they are also cheaper.

With regard to the kind of speculum to be employed, the writer certainly has a right to his opinion that the cylinder and bivalve have had their day, but the assertion that Sim's or Emmet's is "the best by all odds in all cases," unsupported by a single argument, is rather sweeping. They certainly are invaluable in some operations, but American ladies, as a rule, will not submit to the presence of a competent assistant, and for ordinary purposes the cylindrical speculum, which may be used with the patient lying supine, and which brings into full view the os, without pulling it out of place with a tenaculum, is so much more convenient than the complications of the Emmet speculum, with the patient in the uncomfortable semi-prone position, that we doubt whether the profession generally are willing to exchange the one for the other, unless some better reason be given than the mere assertion that the new one is by all odds the best.

As for the cotton stem pessary, it has for a long time been the custom and teaching of some of our physicians to form a stem by twining a thread around a part of the cotton, to rest on the perineum, or a perineal band, to keep the ball in contact with the os uteri, and the ends of the thread are to be left long enough to be easily laid hold of, but the idea of leaving a stiff handle sticking out far enough to be seized, we are sure never entered their heads, when for this purpose a bit of tape attached to the cotton ball would do just as well. Imagine the sensation experienced in walking about for a day with such a handle protruding far anough to be grasped!