after the operation she died. To the last she never regretted the operation. It had lengthened life and enabled her to enjoy it. Cheerfully would she submit again to the same measure, if it promised her the least chance of continued existence. I could offer her no inducements to submit to it. Her power of living was well nigh gone, and she sunk and died.

Cases of Uterine Polypi removed by Ligature.

CASE V.-Miss. S., aged 18. Came under my charge last summer. She was perfectly anæmic. I have seen many instances of this disease, but in no one do I remember its physiognomy to have been more strongly marked. The lips, gums, tongue, inside of cheeks, carunculæ lachrymales, nostrils, every texture was blanched. She had suffered from uterine hemorrhage for about four years. She had grown tall in that time, the time of growing, and was not emaciated. Other signs were palpitation on exertion or mental emotion, with dyspnoea, a sharp, quick, and frequent pulse, pink-colored veins, ringing or rather buzzing in the ears, and a throbbing of the cerebral arteries, compared to the sound of the discharging pipe of a steam engine. Stomach at times irritable. Great feeling of lassitude, and of exhaustion. The catamenial periods were attended by excessive flow, and in the intervals hemorrhage was frequent. She had been recently examined, and a tumor projecting out of the os uteri diagnosed. Upon examination I found the tumor to be very hard, insensible and small, of the size of a smal pullet egg. Hemorrhage attended, and followed the examination. I could not reach the pedicle, if the tumor had one. I was disposed to consider it as springing from the cervix with a broad base. The ligature was applied. I tried different canule in this case, and though the tumor was not large, I found the largest instrument to answer best.

As soon as pain Some soreness of

Pain was produced by tightening the ligature. occurred, the ligature was fastened where it was. the abdomen was complained of next day, and the instrument was not touched. The next day it was tightened, and pain again produced. Soreness of abdomen again occurred. I was satisfied that the tumor was insensible, but the neck being very short, if any existed, the strain of the whipcord was upon the womb, at the spot whence the polypus sprung. This explains the pain and the abdominal tenderness. In about a week the tumor and instrument came away. The polypus was perfectly white. I scarce recollect so white an animal texture. From this time hemorrhage ceased. The catamenia became regular, and the patient is now perfectly well. The tumor was accidentally lost.

CASE VI.-Mrs. W., aged about forty; has children. Has suffered greatly of late from uterine hemorrhage, and the exhaustion induced. Of late she has been obliged to keep still, and in bed, as in this way only can she prevent flooding. She suffers many of the symptoms given in Miss S.'s case, but not in so severe a degree. Within a few weeks her case has become alarming, and her physician, upon examination per vaginam, discovered a tumor projecting from the os

It

uteri I was desired to see Mrs. W., and upon examination detected a tumor, in, but hardly projecting from, the os uteri. It was hard and insensible. It was closely embraced by the os uteri, so close that I could only pass a probe between them. It seemed very much as the glans penis looks in a severe case of phymosis. The woman was bleeding badly every day, but it was not possible to operate. was advised to give her ergot in ten-grain doses, as often as five or six times daily, if her stomach would bear it. This was done, and pains in region of womb produced, and after a few days I found the tumor so much out of the womb as to allow the use of the ligature. It was applied. Hemorrhage at once ceased. Pain in the womb and abdomen was produced by tightening the cord, as in Miss S.'s case. But no untoward complication ensued, and in four days the tumor came away; since which, Mrs. W. has done perfectly well. The tumor was very firm and of a deep red color.

Cases of Ovarian Tumor.

CASE VII.-Mrs. ; married, has children. I saw this patient with Dr. Hanaford, A tumor, filling most of the lower part of the abdomen, presented itself. It was unequal in its outline, as if composed of many tumors. It was felt in the vagina, and so far filling it as to press the neck of the womb firmly against the symphysis, giving much trouble in passing urine. The uterine periodical function continued. Much suffering attended this disease. At times acute inflammatory attacks. The health had sunk, emaciation had occurred, the situation of the patient seemed hopeless. In its treatment constant efforts were made to sustain the patient while means were used to keep inflammatory processes in check, and to prevent increase of the tumor. Leeches, vesication, iodine ointment, hydriodate internally, sol. muriate of lime, &c., were among the means employed. At length a new symptom showed itself, which was the precursor of recovery. An involuntary and copious liquid discharge took place from the rectum. Some of it was collected in a vessel and examined. It was a perfectly transparent, dense, gelatinous liquid, very adhesive, and having a distinct albuminous odor. There was not the least trace of fecal smell in it at any time. The discharge went on. The tumor grew less. The pains which Mrs. - had so long suffered, ceased. She regained appetite, strength, flesh, and is now well. Is not this case of some interest in this regard, that it shows how a disease of the ovary, consisting of a fluid deposit, and threatening life, may disappear, and recovery happen, where opportunity is offered for a constant discharge of the fluid as it forms. The sac or sacs thus have an opportunity to contract. New processes occur in them from exposure to the air, and at length the sac disappears. What is done by a rude surgery, the pulling away, or cutting away the sac, or removal of the tumor by excision, is done by a gentler and wiser hand, and recovery follows. May not the ovary be punctured through the rectum, or vagina, and the natural surgery be thus in some sort imitated?

CASE VIII.-E. L., about 30, unmarried. Has a large tumor oc

cupying one side of the abdomen, extending from the right iliac region. beyond the median line towards the left, and above the umbilicus. Tumor apparently solid. I say apparently, for it is not easy to diagnose the liquid contents of such tumors, if liquids be in them, especially if the walls be thick, and the cavity within be formed of two or more noncommunicating sacs. Examination per vaginam discovered a solid tumor filling most of the pelvis, and which seemed to be a part of the general mass above described. This patient suffers much from her disease. At times the bladder and urethra are so compressed that urine cannot pass. At times the rectum is obstructed. The result is most severe pain and distress throughout the abdomen. The trouble here is spasmodic, and at times exactly resembles violent colic. In the intervals of these attacks she was able to do some work in a family, to walk the streets, &c. She had for some time been engaged to be married. A desire had been manifested to have the engagement broken off. I was consulted. I gave an opinion decidedly in favor of the measure; and had there been a legal question raised, I should have felt it my duty to state that such an "impediment" (I use the word in its ritual technicality) existed as made the state of marriage improper. I remembered well a case of recent marriage, in which the husband desired my advice on account of important disease, not known to exist before marriage. I discovered that a tumor absolutely filled the whole cavity of the pelvis, and which, if it continued to grow, would in no long time be seen externally.

I began an active course of treatment very soon after I saw this case of E. L. The diet was regulated, so was exercise and rest. Iodine ointment was constantly applied over the whole extent of tumor; and sol. mur. lime was steadily given. She took of this larger doses than has any other patient to whom I have prescribed it. The dose amounted at last to about three hundred drops, three times a-day. Leeches were used whenever pain existed in the tumor, and occasionally counter-irritation was employed. This course was persisted in for a long time. The tumor gradually diminished. This was ascertained by careful admeasurement. The strength returned. She gained flesh. She has for a long time passed from my professional care, but I occasionally see her, and always learn that she has no complaint. I have made no examination for a long time; but I feel sure that if the disease had become active again, I should have known it.

Remarks.-Mrs. K.'s case, No. IV., occupies a large space in this record. It was a case of much interest. It involved some important principles. Are we authorized to operate in such cases? How far are we to be influenced by our patient in deciding such a question? Here was entire faith in what was to be done. It was faith in it as the only means of life-offering the only chance, however faint, that was of good. It was associated with an intense desire to live. The disease, called by C. M. Clarke and others malignant, has within a few years been successfully treated by ligature. The immediate effect of ligature in this case was good. It lengthened life, and made

life comfortable. I do not recollect a circumstance in this case which brings with it any regret that the operation was done. A question has been asked above, how far shall the physician be influenced in his judgment in treating disease by the demands, or wishes of his patient? As a rule, and the demand existing by itself, there being nothing in the case which promises good from any known agencies, he is not to be influenced at all by the wishes of his patient. But cases do occur which form, or are regarded as exceptions to the rule, and the physician is, and will be, governed by them. I remember, when a hospital pupil, a sailor entering the hospital for an affection of the heel which renderd him perfectly useless, and for years, under all sorts of treatment, had made him a great sufferer. He came to have his leg cut off. He had hobbled over the country, and applied for the radical treatment in vain. His leg, heel, foot, all, had not the slightest appearance of disease about them. His demand was heeded, his request granted, and he had the operation done with apparently as little suffering, certainly with as little complaint, as if he had been under the fullest power of ether.

I remember another case. It occurred in Scotland. An unmarried woman had a swelling of the abdomen of great size. It troubled her extremely. It did so principally in preventing her getting employment, she being supposed pregnant. This was a sore charge, and most grevious in its consequences, for she depended on work for her living. She roamed about to have an operation done on the abdomen, by means of which a large tumor, which surgeons regarded her trouble to be, might be removed. She applied in vain, till at length Mr. Lizars, then of Edinburgh, consented to do the operation. An incision was made of great extent, into the peritoneal cavity. But no tumor was found. The abdominal intumescence was owing entirely to a very large deposit of fat in the walls of the abdomen, and a very fat omentum.

In deciding the question of an operation in the cases referred to, the surgeon acts upon his own responsibleness, and his sense of this must determine for him what the practice must be.

A word more. In cases V. and VI., of polypi of the womb, it is said that pain was complained of when the ligature was tightened, and that soreness of the abdomen followed. The same was said of tightening the ligature in Mrs. K's. case. Now these three tumors are insensible, wholly so, certainly were they in the cases referred to. Whence, then, the pain? I have already answered this question, by supposing that it happened from the nearness of the ligature to the proper substance of the womb itself. The tumors had no pedicles. They sprung from broad bases, and the ligature was applied very near to the base. The womb, though no portion of it was included in the ligature, did receive pressure from the ligature applied so near to it. Now it is not important that the ligature should embrace polypi round the pedicle, or very near the base, especially in cylindrical or globular polypi which have no pedicle. If the ligature be applied at such a distance as not at all to affect the womb, the whole of the

tumor will drop of, just as does the whole of the umbilical cord, let us leave what amount we may adherent to the abdomen.

But if the pain on tightening the ligature be such as to attract regard-if it be accompanied by the constitutional or local symptoms of uterine or peritoneal inflammation, slacken or remove it at once, and treat the disease it has produced at once with appropriate remedies. When applied again, select a spot more distant from the womb. Make the pressure less severe if pain again accompany it. If there be no pain, make it firm enough to strangulate the tumor at once, or as far as may be, as less constitutional trouble is apt to arise from such an operation, than from a less perfect and positive one.-Boston Med. and Surg. Journ.

Prosecutions for Mal-Practice in the State of New York.

To the Editor of the Boston Medical and Surgical Journal.

SIR,-I saw, by a notice in a late No. of your Journal, that a physician in Delaware County, of this State, had been prosecuted for mal-practice in the treatment of a surgical case. Perhaps a history of the case, treatment and result, in connection with another of alleged mal-practice in surgery, disposed of last week, in the Washington County Circuit Court, may not be uninteresting, if not instructive to the medical profession.

In giving the report of these cases publicity in a widely-circulated medical journal, I trust the public interest may be subserved, and the junior members of the profession benefited. I desire not to wound the feelings of any professional man; and shall, therefore, avoid giving the names of the physicians charged with the mal-treatment of the following surgical cases.

Some time about the 11th of September, 1845, two young men, both "posse men," or in the employ of the State, during the late antirent difficulties, were wrestling; one of whom was about to be thrown upon the ground, and in the act of falling, thrust out his left hand, which met the ground rather outwards and backwards from his body, receiving not only the weight of his own body, but in all probability that of his antagonist; which resulted in a fracture of the external condyle of the humerus, and a backward dislocation of the ulna. In fifteen or twenty minutes after the receipt of the injury, the patient was placed in the hands of a young physician, who, I believe, regarded the accident a backward dislocation of the elbow.

By the testimony it appeared that he attempted to reduce it, by directing one person to make use of counter-extension from the humerus, midway between the shoulder and elbow, and another individual was directed to extend upon the fore-arm, by grasping the limb at the wrist; while the physician, by the aid of his own hands, endeavoured to crowd the articulating extremity of the humerus, situated in what should be the hollow of the arm, backwards. The extension and counter-extension was applied while the limb was in the extended or straight position; and after the application of considerable force, for some little time, there was an apparent yielding, when the physi