In some instances the resources of the medical art fail, and then the ligature holds out a prospect of relief, which has now and then been realized. True it is, that the fungus may, and probably will, be regenerated ;-but a considerable time may elapse before a tumour of large size forms, and in the interim, by the removal of the secreting surface, the discharge will be restrained, and time will be afforded for the powers of the patient to recruit.

Hydatids of the Uterus. These are connected with the uterus and with each other by small filaments and by portions of substances partly bloody and partly gelatinous. A similar substance is attached to the internal part of the uterus, from which the footstalks of the hydatids grow. The number of these hydatids increasing, the cavity of the uterus enlarges, and when the organ has attained a large size, it seems to be offended by its contents, and then contracts upon them. The causes of this complaint are quite conjectural, or rather they are totally unknown.

When the pelvis can no longer contain the enlarged uterus, that viscus rises into the cavity of the abdomen, and may be felt as a circumscribed tumour through the parietes. The function of menstruation is usually interrupted.

In the examination of a patient labouring under hydatids of the uterus, the body of this viscus will be found enlarged, and suddenly bulging out from the upper part of the cervix. All these symptoms attend other enlarged states of the uterus; but there remains to be mentioned one other symptom which serves to distinguish this disease from all others, and from pregnancy,—and this symptom is the discharge of an almost colourless watery fluid. This watery discharge is to be distinguished from that which attends the cauliflower excrescence, by the irregularity and suddenness of its appearance and cessation; being produced by a rupture of one or more of the coats of these hydatids, in consequence of the occasional contraction of the uterus upon them, or of any sudden violence, as in the act of coughing or sneezing; whereas the discharge from the cauliflower excrescence being a secretion from its surface is constantly escaping. The fluid watery discharge may be distinguished from those splashes of urine which sometimes come away from pregnant women, by being wholly inodorous." 118.

Sooner or later a parturient nisus takes place the os uteri opens the hydatids are expelled by periodical pains—and then, for the first time, danger presents itself in the form of a frightful hæmorrhage. The reason of this last is obvious. The placenta covers only a limited space of the internal surface of the uterus, whereas the hydatids spring from every portion of the cavity,

No means of curing or arresting the progress of this disease have hitherto been discovered. The patient is to be apprised of the nature of the complaint, and the event is to be patiently waited for, treating occasional symptoms as they arise. When the time arrives at which the uterus struggles to unload itself of its contents, then all the skill and energy of the practitioner will be necessary to control the hæmorrhage and sustain the powers of the constitution. Perfect quietude in the horizontal posture should be enjoined, and all stimulating food and drink denied. Cold applications are to be applied to the loins, abdomen, and external organs, and portions of ice, (their acute edges being rounded off by being held in the hand,) may be introduced into the vagina, or into the uterus.

"Let it not, however, be forgotten, that the great remedy for uterine hæmorrhage is uterine contraction, and every possible mode of exciting this is to be put in practice. The application of a bandage round the abdomen has sometimes the power of exciting this contraction; but if the hæmorrhage should continue profuse, and if any portion of the hydatids should remain in the uterus, an attempt should be made to remove these in order to produce complete contraction of the muscular fibres." P. 121.

Two or three fingers, or the whole hand, should be covered with pomatum, carefully introduced into the uterus, and carried up between the sides of the uterus and the hydatids, which are to be detached from the part to which they adhere by the most gentle means.

"The mass, being now included in the hand of the operator, is to be brought out of the uterus, the surgeon recollecting always, in the performance of this operation, that the degree to which the os uteri is dilatable without laceration, is in proportion to the size of the whole uterus, both in pregnancy, as well as in this disease. So that, supposing the uterus in this disease to be enlarged to the size of that viscus in the sixth or seventh month of pregnancy, the whole hand of the operator may be, ifnecessary, introduced through the cervix; whereas, in smaller dimensions of the uterus, if any attempt is made to introduce the whole hand through the cervix, however carefully it may be attempted, a laceration of it may ensue, and thus the patient may be involved in a new danger." P. 122.

The expulsion over, and hæmorrhage restrained, the constitution must be invigorated by suitable means-particularly by the cinchona and mineral acids.

Another variety of this consists in a single cyst which distends the uterus. Our author has never met with a case of this kind. We need not therefore do more than refer to the usual sources of information on this subject. In the 34th Vol. II. No. 8. 5 H

and 35th sections of Burns's fifth edition, the reader will find information and references, on single and conglomerated hydatids.

Oozing Tumour of the Labium. In this, the discharge arises from the surface, or rather from the interstices of the tumour. The fluid is of a watery nature, and sometimes very abundant in quantity, being renewed almost immediately after the surface has been dried by a napkin. Blood never issues from the tumour, so that it has no analogy with cauliflower excrescence. The tumour is sometimes so large as to occupy the whole of the labia, extending even to the mons veneris. It seldom projects more than a line or two above the plane of the surrounding skin. The colour of the tumour varies little from that of the cuticle of the neighbouring parts.

"In the immediate neighbourhood of the tumour œdema is occasionally met with, but the tumour itself is not oedematous; soon after the surface of the tumour has been wiped quite dry, a watery fluid begins to ooze from it, and to form drops, which, having become large, at length run off, and keep the surrounding parts in a state of constant humidity; sometimes soreness and excoriation take place, as upon the upper lip, when the secretion from the nostrils is increased, but the tumour itself is seldom rendered more sensible." P. 129.

The secretion from this tumour corresponds, in appearance, with that from the cauliflower excrescence. The disease baving begun, continues to enlarge, and insulated patches of it appear in the neighbouring parts, at length running into each other. Within the author's knowledge the complaint does not attack young women. The principal inconveniences of this disease are, an itching, sometimes preternatural sense of heat, and a watery discharge.

"When excoriations of the neighbouring parts are present, or an erysipelatous blush appears upon them, more advantage will be derived from the internal exhibition of the cinchona in substance, than from any other medicine; but no impression will be made upon the disease itself by this valuable remedy, and even the symptoms above mentioned will frequently recur, and call for the employment of the same remedies." 133.

A nutritious diet, and a moderate allowance of wine, should be prescribed. External applications may mitigate but never cure the complaint. Common starch-powder repeatedly sprinkled over the parts till it cakes upon them, is a very efficient remedy; but it will be necessary to keep the patient in the horizontal posture during its use-a position indeed which has a beneficial influence in itself.

"A mixture of starch-powder and cupri sulphas, very finely levigated, has been found serviceable; or a solution of cupri sulphas, or of argentum nitratum, may be used. A solution of gum arabic in decoctum quercûs may be tried. Cold water is also a valuable remedy, and there are no cases in which it will not afford much temporary comfort." P. 135.

Perhaps the most effectual applications are of a spirituous nature. Strong new port wine has afforded great relief; and when this has failed, brandy or arquebusade may be employed, or even alcohol. The complaint, upon the whole, is very rare.

Involuntary Discharge of Urine. Discharges of the urinary secretion, whether occasional or permanent, are troublesome, and often ulcerate the parts over which they pass. At the close of pregnancy, and in other enlargements of the uterus, the bladder can contain but small quantities of water, and this is often squeezed out in the act of coughing, laughing, or straining. For this case there is no remedy. Flat sponges sewed into the folds of a napkin should be constantly worn. If the inability depend on local or general debility, applications of cold water, bark, and the mineral acids, &e. may be used. If these fail, the lytta may be cautiously tried, or electricity. When all these are unsuccessful, mechanical means of compressing the meatus urinarius must be employed.

When a communication exists between the posterior part of the neck of the bladder and the anterior portion of the vagina, a most distressing case of involuntary discharge of urine will be the result.

"When the mischief has arisen from laceration or sloughing, it may be worth while to introduce into the vagina a large thin globular pessary, made either of wood or (which is better) of silver, perforated by a great number of holes, capable of containing a large piece of sponge. At the lower part of this pessary there should be a circular opening, through which sponges may be removed occasionally; and for this purpose a piece of string may be attached to the sponge, which, being emptied of the urine contained in it, may be again introduced into the cavity of the pessary without the removal of the vagina." P. 144.

The above extract has brought us to the third and last chapter of the work, which, however, occupies nearly half the volume. It embraces the important class of purulent discharges, and will furnish a short analytical article for our succeeding number.

Of what use would it be to offer an opinion of a work, of which we have presented so copious an analysis? Many

hundreds of our readers can appreciate the value of Mr. Clarke's practical precepts far better than we can. The wide experience, the known talents, and the unquestionable accuracy of Mr. Clarke, stamp a great value upon any work emanating from such a source; and we are happy in having the opportunity of selecting a part of our literary freight, this quarter, from a granary of such rich and precious materials. These materials are now sailing on the four winds, consigned to multitudes of unknown purchasers. We wish them a prosperous voyage, and bespeak for them a kindly reception. Sive per syrtes iter æstuosas, Sive facturus per inhospitalem Caucasum, vel quæ loca fabulosus

Lambit Hydaspes.

VI.

On the Nature, Symptoms, and Treatment of the different Species of Amaurosis, or Gutta Serena; Illustrated by Cases. By JOHN STEVENSON, Esq. Surgeon-Oculist and Aurist to his Royal Highness the Duke of York, and His Royal Highness Prince Leopold of Saxe Cobourg : Member of the Royal College of Surgeons, &c. &c. One vol. 8vo. pp. 277. London, 1821.

"But thou

"Revisit'st not these eyes-that find no dawn;

"So thick a drop serene hath quench'd their orbs,
"Or dim suffusion veil'd."-MILTON.

THE fate of Homer, and the plaint of our immortal bard, have, as it were, consecrated amaurosis, and rendered it an interesting, though melancholy subject of contemplation. It is often so insidious in its approach, as to give no warning till the patient unexpectedly finds one eye entirely deprived of sight. About ten years ago, an interesting young lady of our acquaintance, was standing on the Calton Hill, surveying the romantic scenery that surrounds that enchanting spot. She took a small telescope from the hand of a gentleman present, and shutting one eye, applied the instrument to the other, in order to view the opposite coast of Fyfe. She found herself, to her astonishment and dismay, in utter darkThe right eye was completely amaurotic, while the left was perfectly sound. Oculists were applied to; but gradually the remaining eye lost its function, and the unfortunate lady is now blind, though in the prime of life!

ness.