to be made profitable. Geology, Natural History, Mineralogy, and every other ology, worth mentioning, seem to stare with their treasures of knowledge invitingly spread before you, and it is a sort of self-denial to pay more attention to one than the other.

"The Indians of Puget Sound alone present the most interesting subject of study and observation. The beautiful faces of some of the children, and the forms and features of some of the men and women, give evidences of origin from a highly intelligent and peculiar race of men. And in many of their qalities too, they show a striking contrast to some of the other Indians of the coast. Their amiable gentle manners and musical tastes, make them, in comparison with the other tribes, what the Italians are to the Germans or Russians. A thousand interesting questions arise in relation to them which can only be answered by patient investigation.

In Geology, what a field of untrodden ground! the strange and peculiar character of the whole coast, forming for several thousands of miles an abrupt mountain wall, against which the sea is battling, with its everlasting solemn war, here and there breaking through and forming islands, or gradually washing away salient points, leaving but a dangerous ledge of hidden rocks; and the outlets of the large rivers, too, particularly the Sacramento and Columbia, following now new channels, produced by the combined action of the sea and volcanoes. presents another subject which would give work for all the geogolists of the world; and then, Natural History :--here is indeed an unknown field! The Rocky Mountains seem to present an insurmountable barrier to the propagation of species, for here you find everything different from similiar species on the eastern side, and thousands of species entirely new. All these things I would enjoy more if there were only some one here to enjoy them with me, but, with rare exceptions, nothing is interesting to men here unless it brings gold to the purse.

"I learn that you are starting a Medical Journal at Ann Arbor. I wish you much success, and am sure that you, as well as your readers, will receive much benefit from it. Please enter my name on your subscription books, and address the papers to Lieut. W. P. TU. S. Army, San Francisco,

California.

"I found a curiosity, which I wish I could send you, while I was at Bellingham Bay, Straights of Fuca. It is the skeleton of a man, which I found under circumstances which justify me in conjecturing that it is the remains of one of the early navigators of that unexplored region. It was taken from a mound in the vicinity of an angular breast work, and althongh the works appeared to be very old, yet the soil was so dry that the skeleton was perfectly preserved. It had a fracture in the skull, as if done by a war club, and is, no doubt, the only relic of the little party who here attempted to defend themselves against the Indians. I am quite certain that it is not an Indian skeleton from the manner in which it was buried, and when I get it I will write a history of the manner in which it was found, and, if possible, send you the skeleton.

"How would you like the skull of a Flat-Head? They are quite abundant on the Columbia.

"Don't forget to send me your paper. It will be good company for me in my wanderings.

"Yours truly,

W. P. T

ART. I.-Practical Observations upon Polypus of the Uterus. By Dr. HELFFT. Translated from the German, by Professor A. SAGER.

It is well known that pregnancy occurring during the existence of uterine polypi is not an unfrequent event. When the polypus is attached to the os uteri, and occupies the upper part of the vagina, it may give rise to hæmorrhage during pregnancy, and excite the premature expulsion of the ovum, or, if gestation proceeds to full term, it may seriously impede parturition. In this latter relation, especially, it forms a subject of consideration in most of the works upon obstetrics. When, however, the polypus occupies the cavity of the uterus, danger is rarely threatened until after the expulsion of the ovum, when it may immediately give rise to a dangerous hæmorrhage, or cause a retroversion of the organ. Not unfrequently, also, the projecting tumor is mistaken for an inverted uterus, and the indications of treatment derived from this erroneous diagnosis.

When a female afflicted with uterine polypus becomes pregnant, whatever may be the structure of the morbid growth, or wherever it may be attached, it rapidly acquires a considerable size, resulting from great development of its own vessels, in common with the tissues and vessels of the uterus itself. This fact is observable even when the polypus is of a fibroid character, and covered with merely a thin lamina of

the muscular tissue of the uterus, which also constitutes the pediculated attachment of the morbid growth; but it attains a much greater size when its development takes place in, and is enveloped by, the proper tissues of the uterus.

This rapid growth of polypi, together with the circumstance that they always constitute a highly dangerous complication of pregnancy, should dmonish us of the necessity of removing small polypi as soon as they are discovered, and not to wait until after delivery, even when neither hæmorrhage nor symptoms of pressure of adjacent organs present themselves.

In the treatment of uterine polypi which, during pregnancy, pass out of the uterus into the vagina, we must be guided in the selection of means to be employed by the size of the tumor, and the accidents that accompany its growth. If it be discovered in the early months of gestation, when its size is yet moderate, and the pedicle thin, and hæmorrhage, with muco-purulent discharge, takes place, it may be removed by torsion. Generally, its influence upon the uterus is so insignificant as scarcely to attract attention, and furnishes no intimation of its formidable nature, and the ever-increasing danger of the disease.

A case of this character is described by Dr. Oldham. He was called to a lady who had been married five months. As the menses appeared but once after her marriage, she was now in the third or fourth month of pregnancy. From that time she experienced a frequently-returning and moderate hæmorrhage, that was seldom absent more than two days, and at last sexual commerce, or any active exertion, always produced a return of the discharge. From the frequency of this occurrence, the lady was led to doubt the fact of her pregnancy. The general condition of the lady was good, and the signs of pregnancy were unmistakeable. Upon examination, there was a very vascular polypus situated upon the anterior wall of the cervix uteri of about the size of a plum. She was directed to recline upon the back for two days, and an aperient was ordered. A speculum introduced embraced the polypus, which was easily twisted off with a forceps. An insignificant hæmorrhage followed, which spontaneously ceased. Perfect recovery took place, and the lady was fortunately delivered at term.

Now, although such polypi may be removed without inducing abortion or other dangerous accident, it cannot be denied that a less fortunate result may sometimes develop itself when, as the only practicable method, a ligature has been applied around the thick pedicle of a large polypus. In consequence of the great development and intimate union of the venous system of the uterus with that of the tumor, the violent

separation of the latter may give rise to phlebitis, or direct absorption of the putrescent matter, arising from its decay, may take place. In either event, a fatal termination is justly to be apprehended. To this, moreover, may be added the danger of an abortion. The following unfortunate case furnishes evidence of the correctness of these views:

Dr. Oldham was called to a lady twenty-six years old, who was dangerously ill, in consequence of an early abortion. He found all the symptoms of a wide-spread metroperitonitis, with phlebitis, under which the patient succumbed in thirty hours.

He now learned that about five weeks previous she was attacked with a profuse metrorhagia, the cause of which was not at first detected. After the continuance of the discharge for eight or ten days, the attending physician directed her to take acid, and enjoined strict rest. The haemorrhage, however, did not cease, and, upon making an examination, he discovered a polypus, of the size of an apple, attached by a thick pedicle to the anterior lip of the os uteri. Up to this time neither the physician nor the patient had the least suspicion of the existence of pregnancy. A ligature was applied with considerable difficulty, and, after two days, the tumor dropped off. The patient very imprudently left her bed immediately, and walked about the chamber. Pains supervened, and terminated only with the expulsion of a six weeks' foetus. The hypogastrium remained quite sensitive, and pains of a severe character returned; chills occurred; vomiting of a green fluid supervened; the abdomen became tympanitie; and, although the usual remedies were had recourse to, the patient sank under symptoms of collapse, and soon expired.

Yet polypi of a large size have sometimes been removed, both in the early and advanced periods of gestation, as when the operation has been performed to remove an obstacle to parturition, or to check an excessive hæmorrhage, with a fortunate result. In others, as in the case cited above, the termination has been an unhappy one. And the fortunate results attending operations, under these circumstances, are quite too exceptional to justify a resort to such measures, except in cases of the greatest emergency, and should, even then, be undertaken with the greatest caution and circumspection.

In those cases in which the polypus occupies the cavity of the uterus, and, in its development, corresponds with the progress of gestation, numerous considerations require especial attention.

Polypi of this character, by a rapid growth during gestation, not unfrequently attain the size of a melon. Yet their development is not attended with the slightest accident, nor does the uterus attain a greater

size or firmer consistency than when pregnancy is uncomplicated with this anormality. In a case related by Vidal there existed a transverse presentation of the foetus, which may have been caused by the tumor; yet, inasmuch as in other published cases this presentation was not observed, the connection should, probably, be regarded as rather accidental than necessary.

But, immediately after the expulsion of the foetus, and while the pla centa yet remains, the attention of the obstetrician will be attracted by the unusual size of the uterus, and a suspicion excited of the existence of twin pregnancy, although the size is less than usual in that condition. After the completion of the parturient act, the uterine parieties contract firmly about the polypus, and a hard and tense tumor is readily perceived upon examination of the hypogastrium. In the absence of a more thorough exploration, we may anticipate that, sooner or later, depending upon the size of the polypus, and the mobility of its pedicle, it will be extruded into the vagina. A profuse hemorrhage and severe pains sometimes accompanies the extrusion, which, in other instances, takes place without either.

Having satisfied ones self, by the absence of the fœtal membranes and the foetal heart sounds, that the tumor which appears under such circumstances is not another ovum, but a solid tumor, it is better to leave the uterus quite unmolested, than to introduce the hand for the purpose of removing its contents, or to attempt its expulsion by the exhibition of ergot. So long as the uterine contraction remains firm, a very notable increase of volume may be experienced, without the occurrence of hæmorrhage; and, if no attempt be made to remove the polypus, there exists far less proportional danger, as the shrivelling of the tumor results from the hæmorrhagic discharge.

Every operative procedure will excite an irritation, and may induce a hæmorrhage, from the partial separation of the pedicle of the polypus. There is, moreover, reason to apprehend the retroversion of the organ. Such patients are, therefore, enjoined to observe the strictest rest, to employ mild aperient medicines, and avoid all causes of local irritation. Nevertheless, we can never be certain that, in the extrusion of the polypus into the vagina, an exhausting hemorrhage, with severe suffering, will not take place, rendering the removal of the tumor a matter of urgent necessity. With this object, we may employ torsion, when the pedicle of the polypus is thin; and in those in which the thickness of the pedicle precludes any other operation, a ligature should first be applied, to prevent hæmorrhage, and it may then be safely excised.