believed to be completed, but at times she suffered from metrorrhagia. The cervix was of good consistency, the os not patulous, The corpus uteri was somewhat enlarged and yet not more than might be explained by the fact that involution was not completed,in fact, had not had time to be completed. It was, of course, probable that there yet remained some placental tissue within the cavity of the uterus; or in other words, that the abortion was not complete. The uterine cavity was therefore curetted and some small masses of tissue removed, which under the microscope presented the usual appearances of chorionic villi and decidual tissue, as seen in photo-micrograph No. II. After this the metrorrhagia at once ceased and involution was rapidly completed.

Case IV. The case just related may have appeared to possess but little interest, for the history is a common one, and the diagnosis and treatment are widely recognized. But may I beg you to bear this case in mind during the recital of the next case: A woman of about forty years of age, of foreign birth, who could not give a very intelligible history, presented herself at the out-patient department

of one of the hospitals where I was studying. Enough of her history. was learned to make it clear that she had had a number of children, and had aborted a few weeks previously. She was still flowing at irregular intervals, and profusely-had metrorrhagia. On examination, the finger found the cervix moderately firm,the os not widely open; but by a little pressure the finger could be forced some little distance into the cervical canal and could detect a tissue of less firm consistency than that of the cervix. Was not this a case of incomplete abortion? Why, the finger could touch the retained placental masses (?). A dull curette at hand was used to remove some fragments of this tissue, which under the microscope, presented a well defined picture of carcinoma which is reproduced in photo-micrograph No. III.

This revelation made a profound impression upon me, and affirmed the imperative necessity for bringing a knowledge of pathology and of microscopic technique to the efficient practice of gynecology. The case was beyond question one of abortion, it is

true, probably also of incomplete abortion, but was likewise one of those extremely interesting cases in which impregnation had taken place in the presence of early carcinoma of the cervical canal.

Case V. The next case is one which exemplifies another cause of metrorrhagia, which is induced by an accident to which I have called the attention of physicians on some former occasions, namely ectopic pregnancy. The patient, Mrs. V., under the care of one of my professional friends, was suffering from metrorrhagia. That was the complaint for which she sought treatment. It is true she had pain in one side of the abdomen. She had missed her period once or possibly twice, and now believed that it returned in this irregular way because of having been delayed. After persistent inquiry she recalled having had pain in one side, sudden, acute, with a tendency to syncope. In short, the other symptoms, as you doubtless know them, were present. The point I wish to make is that this was a case of metrorrhagia (?). There were some sinall fragments passed in the bloody discharge from the uterus, which I prepared for the microscope. This means of diagnosis in gynecology served me excellently well in that it revealed decidual tissue with no inclusion of chorionic villi, and thus confirmed the diagnosis of ectopic preg

nancy.

Case VI. The next case is one of metrorrhagia for sure! A young girl, unmarried, was sent to me as a "difficult case." Some months before the patient had a profuse menstrual discharge after the period had been delayed, and thereafter she suffered both from profuse menorrhagia and metrorrhagia. She had received medicinal treatment for quite a long time and still that flow would return. With innocent (?) persistency she repeatedly asked for an explanation as to the cause of the frequently returning flow. On examination the hymen was found intact, or rather not torn. The cervix was not round, but was inclined to be flattened anteroposteriorly as if there had been a slight lateral laceration, and about the os there was a slight erosion. Now, of course, we recognize the occasional occurrence of erosion, and even of ectropion in the virgin, but ———. Well, a microscopic examination of these small fragments which were discharged with pain when the flow came on (membranous dysmenorrhoea?) would be a short cut to accurate information! On microscopic examination, chorionic villi in decidual tissue stared one in the face, as you will see in the illustration, and the "difficulty" in the diagnosis was abolished, for the case was one of incomplete abortion, though of long duration.

Case VII.-The next case to which I wish to refer as exemplifying the cause of metrorrhagia, is that of Mrs. L. The menstrual period was profuse and often lasted eight or ten days, and in the intervals she had a profuse leucorrhoea which was often bloody. She complained of many other symptoms, which will not be related for the sake of brevity. On examination, the cervix presented a remarkable condition of inflammation. It was highly congested, deep red in color, everted, and hypertrophied. The surface around the os was covered by a tenaceous mucus, which was difficult to remove, and after its removal exposed a bleeding surface. The history of menorrhagia, the inter-menstrual bleeding, the profuse leucorrhoeal discharge, mostly mucus, but at times also watery, in conjunction with pelvic pain and a weak, sickly appearance of the patient, called for an accurate determination of the question whether there was not present a cancer of the cervix proper. These cases present a somewhat different picture locally from cancer of the portio vaginalis. A small fragment was excised from the cervix for the purpose of miscroscopic diagnosis. A frozen section was stained

and mounted, which, under the microscope, presented a beautiful picture of glandular erosion of the cervix, which I reproduced and herewith submitted.

Erosion of the cervix does not commonly lead to profuse hemorrhage from the uterus. The bloody flow rather streaks the mucous or other discharge. The lesion may be extensive, as in the case recited, and then there will be an exaggeration of some other symptoms, for example, hemorrhage after coitus, or after any unusual

exercise.

Case VIII.-As we discuss these symptoms, the account gradually but surely leads to the description of malignant disease. The recognition, and the early recognition especially, of malignant disease of the uterus is one of the most important subjects in gynecological practice, and one with which every physician should be conversant who essays at any time to make a vaginal examination. That statement is thus forcibly made because women have at times submitted to internal examination and their well-founded fears have been allayed by reason of lack of diagnostic skill on the part of the