if they do no good they will do no harm, for these are perplexing cases.

From what has been said, I would not be understood as contending that even a considerable number of hysterical complaints, as occurring in this vicinity, are the offspring of invermination; but my own observation warrants me in asserting that some of those obscure disorders, reckoned most commonly hysteria, are but the symptoms of verminous irritation; and, in a vast majority of instances, at least, intestinal worms date their existence subsequently to impaired digestion. The treatment, then, of such cases as those above narrated, is at once manifest. The worms, though the result of primary disorder themselves, constitute a first indication in the treatment. A second indication is to restore to healthful play the digestive system; and a third is to avoid the original remote cause. A vermifuge is, in the first place, to be given. Though by no means ellegant, the following combination will be found very effectual: two drachms of finely pulverized radix spigelia, one drachm of finely pulverized seeds of the chenopodium, mixed with two ounces of a mixture of castor oil and the oil of turpentine, a portion of which is to be taken every two or three hours, until free action of the bowels ensues. The second indication is to be fulfilled by gentle tonics, cathartics, alteratives, &c. If borne, iron will be found extremely serviceable now. The third indication will be found more difficult of fulfilment than either of the preceding. The digestive system must be kept in good condition; to do which requires, however, not unfrequently more temperance and more dietetic restrictions than we can enforce our patients to o'.serve. We are so constituted, that even slight, often repeated, violations of the laws of our being, subject us to inexpressible misery. And, unfortunately, the temptations to infract those laws are, to a comparatively uneducated and unrefined class of people--such as, I regret to say, too many of us are-stronger than the beautifully symmetrical laws of God. But it is the duty of every high-minded physician to do his might, to labor assiduously, not only to repair those breaches, the effects of the insulted laws of man's nature; but also to elevate him, both mentally and morally-thereby insuring to him the best possible condition of his physical frame.

ARTICLE III.

Retroversion and Anteversion of the Uterus. By JNO. EVANS, M.D., Professor of Obs., &c., in Rush Medical College.

RETROVERSION is the displacement next in frequency to prolapsion of the uterus. It may occur at any age of the patient after the organs of generation are developed, but is by far the most common during the early months of pregnancy.

The Causes of this dislocation may be divided into the predisposing, and the exciting. Any affection of the system producing debility and relaxation of the tissues, may be regarded as a constitutional predisposing cause, if existing in connection with those local changes in the relation of the parts concerned, termed the local causes. These are, great capacity of the pelvis, enlargements of the fundus of the uterus, elongations, or relaxations of the round and broad ligaments, and distention of the bladder, tumors, &c.

The exciting causes are violent exertions of any kind, as coughing, sneezing, efforts at stool, or in lifting, falls, &c., while the conditions above mentioned are present.

But, perhaps, the most common cause is, exertion while the bladder is distended with urine, and the uterus slightly enlarged by pregnancy. Indeed, it is a matter of surprise, when we observe the very lax attachment of the ligaments, and the loose manner in which the uterus floats in the pelvis, that these conditions should be present, without causing a retroversion in every case, upon violent exertion.

The Pathology of retroversion is plain and simple. The uterus is so changed from its natural position, that the fundus is pressed down below the promontory, and occupies the hollow of the sacrum, while the os tincæ is elevated above and rests on the symphysis pubes. By this position, the round and lateral ligaments are extended, and the vagina is thrown forward with the mouth of the uterus, so that in tracing its posterior wall upward, the finger passes over a tumor formed by the uterus, and is brought to the pubis. The rectum is compressed by the fundus, and the neck of the Vol. I. No. 1-3

bladder by the mouth of the womb, which, generally, gives rise to difficulties in evacuating urine and fæces, and at the same time, by the irritation of these parts, keeps up a more or less constant desire for it.

The malposition may, in the quiescent condition of the uterus, remain for a considerable length of time without giving rise to intolerable inconvenience, and adhesions are liable to form in cases of long standing, that will prevent reposition, which, in case of pregnancy, must necessarily give rise to abortion, about the fourth month, when the uterus becomes too large to remain in the pelvis, if not earlier.

As in the development of the uterus during the early months of gestation, the enlargement first takes place at the fundus, it is not surprising that we should have the displacement occurring most commonly at this period.

The displacement may occur in connection with diseases of the parts concerned, but, generally, these, unless they relax the attachments of the uterus, load the fundus by enlargements, or, in consequence of tumefaction, push it down, have nothing to do with it. It is, of itself, a purely mechanical derangement.

In those countries where the abdominal viscera are more frequently the seat of disease, as in the south and west, we should expect, both from the congestions and enlargements to which they are liable, and the relaxations produced in the uterine attachments, in common with other parts, that this malposition would be more common. And when to this is

added the frequently laborious life of females in the west, necessitating them frequently to make violent exertions at lifting, &c., we may infer that here retroversion will be comparatively of frequent occurrence. But whether these inferences are sustained by facts or not, has not, as yet, been clearly made out by observation.

The Symptoms of retroversion of the uterus vary in the different conditions under which it occurs. As a general rule, the larger the uterus at the time, the greater the suffering attending it.

There is pain in the loins and sacral region, passing around the ilium to the pubes, produced by the extension of

the ligaments and vagina, and compression of other pelvic viscera a desire to urinate, with a more or less complete retention of urine, produced by the irritation and compression of the neck of the bladder-often a tenesmus from the irritation and inability to evacuate the bowels, on account of the compression of the rectum-bearing down, resembling labor pains, produced by a sense of the presence of a large tumor, pressing on the perinæum. When it occurs suddenly, and produces much suffering, it is sometimes attended with fainting, paroxyms of hysteria, and frequently by vomiting. Inflammatory fever, with thirst, coated 'tongue, dry skin, quick pulse, and increased suffering, often superAn examination, per vaginum, will disclose a tumor of greater or less size and density, according to the condition of the uterus, in the cavity of the sacrum, and either an absence of the os tincæ, or it situated against the symphysis pubes, and the parts will be pretty firmly fixed in this position.

venes.

The Diagnosis of retroversion will be easily made out, as there is no other affection that gives the same relation of the parts, as ascertained by an examination, per vaginum. A tumor in the cavity of the sacrum may resemble it; but the position and mobility of the os tincæ and corpus uteri will enable us to distinguish it from retroversion. The pain, suppression of urine, and sympathetic affections, may attend prolapsus or anteversion; but the os uteri, found by tracing the posterior wall of the vagina, will distinguish retroversion from them or any other possible condition.

The Terminations of retroversion are liable to be of the most serious character. The distension of the bladder from the retention of urine, produced by the pressure upon its neck or the urethra, which, perhaps, in some cases, from other causes, existed before the displacement, is liable to result in rupture, and a discharge of urine into the peritoneal cavity, which will be certainly fatal; or in the cellular tissue of the pelvis-scarcely a less dangerous accident, as extensive gangrene must necessarily follow. The large intestine is liable to become impacted in consequence of the pressure on the rectum.

The pressure produced by the uterus against the bladder and rectum, is liable, if long continued, to cause sloughing of these parts, of a most serious character.

An inflammation of the bladder, rectum, uterus, or vagina, and particularly of the ligaments, is liable to result in consequence of the distension and compression to which they are subjected.

In pregnant cases, especially in patients of an irritable system, abortion, with its attendant serious consequences, is liable to ensue; and where the retroversion is old and bound by adhesions, death sometimes results. This is certainly the fate of such a case, if abortion does not occur.

A case of retroversion, probably attended by adhesions, which produced three successive abortions, was reported by Dr. Golliday in the Illinois Med. and Surg. Journal, vol. II, No. 10, in all of which cases the patient did well. In the last case, the patient is stated to have gone to the seventh month of pregnancy, when abortion occurred spontaneously, or from the effects of efforts at reposition.

The adhesions, where the uterus is repeatedly subjected to distensions by pregnancy, might be absorbed, and eventually allow of reposition; and, on this account, we should not be hasty in our interference in such cases.

The Treatment of retroversion, as a general rule, is plain and easy, in all cases of recent occurrence. The indications are, to replace the uterus, retain it in its natural position, and meet any irritation or inflammatory symptoms by their appropriate anodyne or antiphlogistic remedies.

The facility with which the first indication can be fulfilled, will depend, to some extent, upon the size of the uterus, the capacity of the pelvis, the amount of inflammation, the condition of the rectum and bladder, the length of time that has elapsed since the displacement occurred, and the formation of adhesions between the uterus and other pelvic viscera, the most liable seat of which is between the fundus and the rectum.

If it be a recent case, there need be no fear of adhesions, and the reposition should be attempted at once. Before proceeding to the fulfillment of this indication, the condition