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a medal from the Royal Society of London-been affirmed to be no nerves at all.
From a remark by Dr. Gilbert, Dr. Watson will find that the Professor of Surgery in the Pennsylvania Medical College has no objectiou to surgical cases being brought before a class, which is all that is done in the regular “school clinics."
“Without pretending for a moment," he says, " to present, in addition to the regular course, an adequate surgical clinic, whenever the character of the case, however, and other circumstances are such as to render it compatible with the feelings and general advantage of the patient, I will present to the class as much practical surgery as can, with propriety, be brought before them. The experience of the two last sessions warrants me in saying to you, that cases of this kind may be expected; which, with the ample surgical and medical clinics of that time-honored institution, the Pennsylvania Hospital, will afford you clinical facilities equal and we believe superior to those of any school in the country." [!!]
Lastly. It is not many years since the excellent institution-the Baltimore College of Dental Surgery, which has done, and is still doing, so much to elevate the professional character of the dentist—was chartered by the State of Maryland ; and already many interesting and useful prodactions have emanated from it. The lecture of Dr. Westcott may be esteemed one of these. It canvasses whether “dental colleges possess peculiar advantages over any other means of securing a dental education"--determining the question-as might be expected-in the affirmative, and we are not disposed to cavil at the decision.
We are pleased, to observe, that extensive, general, and professional attainments are urged as indispensable to make up the character of an accomplished dentist. Whilst manual dexterity is important, it is wisely maintained, that the operator should be a well-educated gentleman, and that a knowledge of every branch of medical science should enter into the list of his evidences of fitness to do credit to himself, to the avocation which he has embraced, and to the community.
A Practical Treatise on Inflammation, Ulceration, and In
duration of the Neck of the Uterus: with remarks on the value of Leucorrhea and Prolapsus Uteri as symptoms of Uterine Disease. By JAMES Henry BENNET, M. D., etc. etc, 12mo. pp. 146. Lea & Blanchard. Philadelphia, 1847.
, The basis of the present work was submitted by the author, a few years since, to the Faculty of Medicine of Paris as a thesis, on his graduating in that University. Subsequently, more elaborated, the essay was published, in parts, in the London Lancet; and afterwards in a yet more extended form, as a separate publication, of which the present is a reprint.
a From the brief autobiography given in the Preface, we learn that the author spent seven years in the Saint Louis, La Pitié, and Salpetrière Hospitals of Paris, first as pupil, and then as “interne" or resident physician.
“ Under such circumstances,” says the author, “I cannot, certainly, be reproached with not having matured my opinions. In the first instance, they were formed after I had long enjoyed very great opportunities of seeing uterine disease. They have since been considered over and over again, and have stood the test of several years additional experience.'
“Some of the views which I bring forward will, I believe, be found original, at least, if I can trust the results of my bibliographical researches. I have also many details of great interest and importance to present, with reference to the various modes of treatment in inflammation, ulceration, and induration of the uterine neck adopted by the Paris physicians and surgeons-details which will, I believe, be new to most of my readers. Having carefully watched, during a great length of time, the effects of the treatment followed by the eminent Parisian practitioners, with whom the knowledge of this form of disease recently originated, and that under the most favourable circumstances—as their pupil or assistant-I have been able, I hope, to form a correct estimate of the comparative value of the different agents they employ. I have thus, I am also inclined to think, learnt how to avoid the exclusiveness which most of them show in the choice of their therapeutic agents."
One can scarcely repress a smile at the confidence with which many of the young members of our profession express their opinions, after a residence of a few years, or as it some
times happens, of a few months, in Paris, and of which the preceding extract is no very bad example.
The natural enthusiasm of youth, operated upon by the example and habits common, to a great extent, in the French metropolis, are perhaps a sufficient apology for this self-complacency, until time chastens the one, and better example corrects the other.
We have looked through Dr. Bennet's brochure with some interest to find the "original” views which he deems so important without discovering them, although we have found much in it to approve, and we are inclined to think that his “biblio. graphical researches" have not been remarkably extensive, even among Parisian authors, to say nothing of British and German.
The subjects embraced in this treatise are of great importance, and we regret to say, generally too little understood by those entrusted with the treatment of such complaints; this, rather than any novelties contained in the book, or that we have to offer, claims from us more than a passing notice.
The author asserts that inflammation of the neck of the uterus, with its sequelæ, ulceration and induration, “is an exceedingly common affection”-and" is the principal cause, also, of several morbid states which are generally, if not always, studied independently of any such origin; as, for instance, prolapsus of the uterus and leucorrhea."
That inflammation of the neck “is the principal cause” of prolapse of the uterus, is not very clear to our mind, but that it is often mistaken and treated for the latter affection, we know from abundant experience—no mistake indeed is more common.
“ With reference to leucorrhoea,” says the author, “indeed, I have ascertained, to my complete satisfaction-firstly, that, set. ting aside cancerous disease, in the very great majority of adult females who have been exposed to sexual intercourse, a confirmed leucorrhæal discharge, whatever may be its nature, is accompanied by inflammation of the neck of the uterus; secondly, that this inflammation seldom exists long without producing ulceration; and, thirdly, that ulceration is always accompanied by
) more or less engorgement (swelling, with or without induration) of the substance of the uterine neck.”
We have no doubt of the correctness of these propositions; they are true as far as they go; but they do not go far enough,
as it regards leucorrhea. That inflammation of the vagina, and often of the neck of the uterus, precedes leucorrhæa, no one will deny; and we are prepared to admit with Dr. Bennet that, after no long time, ulcerations of the cervix uteri frequently occur ; but this does not account for uterine leucorrhea,-in which the discharge comes from the cuvi'y of the uterus.
The author makes what he considers “a fundamental and most important distinction between inflammations and ulcerations which occur in the uterine neck of females who have never conceived, and those which take place in the same region in females who have conceived—that is, who have either miscarried or borne children.” In the consideration of these diseases, he carries this division throughout the hook; and in doing so, we cannot doubt that he magnifies unduly the influence of conception on the permanent condition of the parts. Those who bear children, and especially those who suffer frequent miscarriages, are undoubtedly most prone to inflammation and its consequences in the sexual organs, if we except prostitutes, with whom such complaints are almost universal, whether they have conceived or not. It is rare to meet with a woman has been long “on the town” who has not more or less disease of the neck of the uterus, although she may never have suffered from any of the forms of syphilis; nor is it rare to find individuals who have conceived, and even borne one or more children, in whom the condition of the neck of the uterus has returned in its physical condition very nearly to the virgin state—to a condition in no respect less healthy than before conception.
The following fact noticed by the author is one of great importance in practice, and often not appreciated by the prac. titioner.
“ The size and length of the cervix uteri vary considerably in different females—a fact which must necessarily be taken into consideration if we wish to appreciate the existence or non-existence of engorgement, or morbid increased volume, of the organ. Indeed, these physiological (anatomical) variations are so great, that were we to allow ourselves to be guided by size alone, as appreciated by the toucher or speculum, we should, undoubtedly be often misled, and induced to suppose that disease existed when it did not. In reality, a very voluminous healthy cervix uteri is perfectly compatible with entire freedom, even from unVOL. X.
easy sensation. The difference in length of that part of the cervix uteri which projects into the vaginal cavity, is evidently owing principally, to the vagina being implanted, as it were, at different heights on the cervix, so that in some females it is merely a few lines in length, whereas in others it is an inch and a half, or more. This physiological elongation of the cervix uteri may, it appears, be carried to such an extent, that its free extremity reaches the orifice of the vulva. Dr. Henning, in his essays on uterine diseases, lately published in The Lancet,' mentions several curious cases of the kind."
The following observations on the subject of hypertrophy of the cervix accords so fully with our own experience, that we cannot refrain from calling the attention of the profession to their importance.
“If the hypertrophy is considerable and general, the prolapsus of the cervix is constant, the irritation great; and ulceration and abundant leucorrhea are nearly always present. If inconsiderable, or limited to one region of the cervix, the surface of the organ may be free from the disease, and the uterus may prolapse only after long standing, or walking or great fatigue of any kind. These are by no means uncommon states. Indeed, I have no hesitation in saying, that a very large proportion of the cases, both of slight and of severe uterine prolapsus, which are met with in practice, and for which pessaries are so improperly used, are the result of chronic hypertrophy of the uterine cervix."
We would even go further than the author, and say that a large number of the cases treated as prolapsus are either simple inflammation of the cervix or engorgement of the uterus, which result in ulceration or hypertrophy from neglect, and too often from the irritation produced by the improper use of pessaries and other means for the cure of simple prolapse proceeding from relaxation of the uterine supports.
The author witnessed the treatment of a great many cases of cancer of the uterus in the Parisian hospitals, and the following is the result of his observations.
"I have hitherto always found cancers of the cervix uteri, whether ulcerated or not, incurable; like cancer in other parts of the economy. In other words, I have never seen an evidently cancerous tumour or ulceration of the cervix, respecting the existence and identity of which there was not a shadow of doubt,