and practised in the case of cancerous mamma. The possibility of the success of this operation, he founded on the repeated and well known observation, that the inverted and prolapsed uterus has been sometimes cut off designedly by surgeons, and by midwives through ignorance, and yet the persons survived its excision. A woman still lives in the neighbourhood of Göttingen, from whom, 26 years ago, an old ignorant midwife cut, or rather sawed, off, with a bread knife, the uterus inverted and prolapsed after delivery. The late Professor Wrisberg at that time read the history of this woman before the Royal Society; and it is to be found in this Journal (Götting. gelehrte Anzeigen) for 1787, No. 81, p. 810. It likewise appeared in the 8th volume of the Commentat. Götting.

These observations induced Professor Osiander to propose, 15 years ago, in his lectures on the diseases of women, the bold measure of curing cancer of the uterus by extirpation; and he suggested various methods of doing so, and, among others, the very same which the late Dr Struve, one of his former pupils, and physician in Prenzlau, afterwards published as his own invention, in the 3d number of the 16th volume of Hufeland's Journal for Practical Medicine, in the year 1803, and against which Professor Osiander cautioned the public at the time. Professor Osiander, however, found the performance of this operation to be very different from what he had conceived, when at last, on the 5th of May 1801, an opportunity offered itself to perform it. The patient was a widow, whose situation was indeed as deplorable as could be imagined. The vagina was distended by a carcinomatous fungus of the orifice of the womb, as large as a child's head. It was extremely fetid, and bled very violently. The fungus was seized and brought low down in the vagina by means of Smellie's forceps; but, in endeavouring to put a loop round the neck of the womb, the fungus broke off, and the bleeding was terrible. The young physicians and surgeons, and a few experienced physicians who were present, among whom Professor Osiander quotes as a witness Dr Althof, physi cian to the Elector of Saxony, advised him to give up the operation, because they believed the woman would not be able to undergo it, after losing so much blood. But the patient herself begged that the operation once begun should be completed, and encouraged the Professor to continue it, to the great surprise of all who were present. But, as there was no longer any of the neck of the womb hanging down in the vagina, by which the uterus could be drawn down, necessity, the mother of many inventions, suggested to Professor Osiander the idea of pulling down the uterus by passing threads through it with a

needle, and securing it in this manner till the operation was finished. Crooked needles were immediately mounted with fine waxed pack-thread, and carried with great caution to the bottom of the vagina, pushed through it and through the body of the womb, and then brought out through the inner orifice of the uterus; for the neck of the womb and its external mouth were already destroyed by the cancerous fungus. In this way four threads, one from each side, from before, from behind, and from both sides, were brought through, by which the uterus was gently drawn low down into the vagina, and kept fast as soon as it was near the external orifice. Professor Osiander then introduced a strong Pott's bistoury under the fore-finger of the right hand, and cut horizontally through the womb above the scirrhous part, as straight as if it were divided out of the body, where he could see it. The part that was cut off, preserved in spirits of wine, along with many other products of similar operations, was exhibited to the Royal Society. The bleeding for an instant was violent, but was very soon stopt by a sponge saturated with a powder made of equal parts of alum, gum Arabic, and colophony, applied in the vagina. After the bleeding had ceased, sponges dipt in a solution of sacchar. saturni and vinegar, were applied to mitigate the inflammation, and as soon as matter was perceived on the sponge, suppurants were employed. Professor Osiander for this purpose made use of a mixture of the extract of unripe walnut-shells, with honey, and red precipitate, which was introduced on sponges with great caution, so that the anterior part of the vagina was scarcely touched by it. When the discharge is very copious, the quantity of the mixture must be reduced, and the red precipitate omitted; if inconsiderable, its quantity must be increased. The cure of this first operation went on so rapidly by the assistance of tonics, particularly cinchona, internally, that the patient could leave her bed in the third week, and in the fourth walked about, totally recovered.

This success of this first operation gave Professor Osiander the courage to undertake it again soon afterwards; and he has now performed it nine times, and always with similar success. Even one of those patients, after enjoying good health for three years, came to him to be operated upon a second time, for the cancer broke ont again, and he performed it with the same success as before. He reserves to another occasion the circumstantial relation of each ease, and at present only gives the following result of the observations which he had so many opportunities of making with regard to this disease, and others which are frequently mistaken for it.

The scirrhus and cancer of the womb begin almost always on

the external orifice of the uterus, and proceed from thence to its body; and often before the disease has destroyed half of the womb, death puts an end to the agonies of the sufferer. In rare cases, an ulcer is formed in the bottom of the womb, which degenerates into a cancer that admits of no cure. But, in the first case, a perfect cure may be obtained by cutting out in time the scirrhous and cancerous portions. When the cancer spreade from the orifice of the womb down into the vagina, which it very often does, no cure is to be expected from excision.

True scirrhus and cancer are, however, very often mistaken for other diseases.

First, for the benignant swelling and thickening of the womb, which often happens after abortion, miscarriage, or difficult natural labours. The neck of the womb and its orifice swell to twice their natural thickness. The weight and pressure of the whole womb becomes disagreeable to the woman, and causes a sensation as if it would fall out of the body. This swelling is caused by accumulation of blood in and about the womb, from plethora localis; and being for the most part joined with hemorrhoidal symptoms, and indeed oftener with hæmorrhoids in the vagina, physicians and others, even accoucheurs skilled in investigation, are frequently misled, and conceive it to be a bleeding cancer of the womb. This swelling (ovxwors) and thickening (oxλngua) of the womb may remain during life without becoming malignant, when no other cause comes into operation. It may be cured by remedies which take away the plethora localis; but it may also degenerate into a true scirrhus and cancer, when local irritation or morbid matter, e. g. a chronic exanthema, repelled from the skin to the womb, supports and augments the swelling.

Professor Osiander had repeated opportunities of treating such cases, which, as well as their causes, are frequently misunderstood. In some instances, a round hard pessary, introduced with force, so squeezed and pressed the neck of the womb, as to cause an obstinate scleroma, which could only be cured by an operation. In one case, cancer of the womb, lameness of the lower extremities, and miserable death, were the consequences of a pessary forgotten in the vagina, and pressing on the mouth of the womb.

Another cause of scleroma, and several symptoms resembling cancer of the womb, which is often misunderstood, is the incarceration of a retroverted unimpregnated womb. The fold behind the womb is in many women of such a form, that it is very narrow above, and wide below, nay, even sometimes divided into VOL. XII. NO, 47.

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two parts by a perpendicular partition. After labour, and by hard straining to have a stool, the bottom of the womb is sometimes pressed backwards and downwards into this fold, and cannot recover itself again; the womb begins to swell, and causes a great pressure on the anus, irritation on the bladder, and violent hæmorrhoidal symptoms. Professor Osiander met with four cases of this kind, three of which he treated with success, instructed by the first.

In the first case, a widow complained of constant hæmorrhoidal symptoms, a disagreeable pressure on the anus, and frequent faintings. The seat of pain was not examined, but external and internal remedies for the hæmorrhoids were administered. She was suddenly attacked by nervous fever, and died. On opening the body, the unimpregnated womb was found retroverted, and adhering to the bottom of the fold. Behind this a wide spreading ulcer was discovered, with traces of inflammation on the intestines and spleen. The ovaria were indurated.

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In a second case, after abortion, the hæmorrhoidal symptoms continued a long time, and caused excruciating pain, and most obstinate costiveness. On examination, the womb was found retroverted and incarcerated, with a sarcoma on its outer and anterior side, of the size of a very large chesnut. As it was impossible to bring it back by the common taxis with the point of the finger, Professor Osiander contrived a peculiar manner of operating, which, in this, as well as in the two following cases, gave speedy relief. He introduced his dilator from above to the bottom of the retroverted uterus, and turned the instrument round at once. By this method, the bottom of the womb started up suddenly. In the next case, the womb, together with a polypus as big as a pear, had been retroverted upwards of a year, and had caused effects like those of pregnancy, hæmorrhoidal affections, and symptoms resembling cancer. Professor Osiander recognised the disease at the first examination; raised up the womb as in the former case; and, after a few days, he dilated the uterus with the same instruments, and cut the polypus out by the root, with crooked-bladed scissars of his own invention, which he is in the habit of doing with all polypi, for he never either ties or tears them out. In the last case, the womb was retroverted for some years, and had caused the severest hæmorrhoidal affections, as well as difficulty in passing urine, and going to stool. These symptoms were aggravated by the many warm injections that were applied in ano and in vagina, the affection being mistaken by the physicians for a cancer of the womb. But

Professor Osiander, on the first examination, discovered the real nature of the disease, and, by the skilful application of his dilator, soon put an end to its long existing cause.

Secondly, Cancer of the womb is often confounded with ulcerated polypus of the womb discharging fetid ichor, and with sarcoma of the uterus. These constitute a peculiar, and not very uncommon disease of the female sex, generally misunderstood, and frequently left as incurable; but Professor Osiander, for some years past, has cut out and cured many, after a peculiar and successful method of his own, and his method of treatment, and his observations on it, will be laid before the public on some future occasion.

The causes of cancer of the womb are manifold. One very common cause, besides mechanical injury of the external orifice of the womb, is syphilis, obvious or latent, or a scrofulous, herpetic, atrabilious and gouty disposition. Besides, all eruptions of the skin fall readily on the private parts of women, in consequence of a continual local irritation, and cause fluor albus of various kinds, which sometimes precedes cancer of the womb, and sometimes accompanies it.

Among the internal remedies used in the cure of cancer of the womb, along with the operation, Professor Osiander found none so powerful as mercurials with antimonials, and the free use of diuretic drinks. He has not hitherto ventured to make trial of arsenic, although he believes, that, in doubtful cases, it might be cautiously used; but he has not as yet met with a pro.per opportunity, which occurs oftener in hospitals than in private practice. Professor Osiander admits only now and then into the lying-in-hospital, of which he is the director, a patient afflicted with cancer of the womb, where there is some hope of her being cured; and last year, he again relieved such a patient from her long sufferings, by operating upon her in the presence of many of his pupils. He never made a secret of his manner of operating, although he has been publicly upbraided for having done so; nay, never was such an operation undertaken without strangers as witnesses. He has taught it every year in his lectures, and often performed it publicly before his pupils. He communicated it to every physician in his own country or abroad, who wrote or spoke to him on the subject. Last year he sent an account of the operation to Mr Maunoir senior, of Geneva, in a letter, written in the Latin tongue, which Mr Maunoir communicated to Mr Martin, surgeon to the hospital in Lyons, and to the medical faculty of Montpellier. This letter, along with Mr Maunoir's theory of cancer, was printed in the annals of the medical society of