like sponge. Lobulated aggregations of small, whitish, opaque bodies, manifestly tubercular, were thickly scattered throughout its extent, interspersed with distinct cavities containing transparent hydatids. The size of the morbid growth was much reduced upon removal, showing that its great bulk was chiefly owing to the quantity of blood which it had contained. In some weeks the rapid regeneration of the tumour compelled the unfortunate patient to solicit again its removal, even at the risk of sinking under the loss of blood. She bore up against the hæ. morrhage at the operation, but the drainage of the system was too much, and she sunk in a few days under the general symptoms of anemia and constitutional exhaustion. This lady was an only daughter, and gave me to understand that her mother and aunt had both died before the age of 40, under similar circumstances with herself.

It is a sad admission to make that this formidable disease, selecting its victims amongst women in the prime of life, and generally making its appearance at times connected more or less. with parturition, should be unmanageable by the curative agents which science has yet placed within our reach. Attempts to destroy cauliflower excrescence of the womb by the application of the ligature and use of caustic are only temporary measures, and there is much reason to fear that the irritation consequent upon these means sometimes gives increased activity to the development of the disease. If it was possible to recognize this growth at a very early period, and to ascertain that the base was confined to a defined part of the cervix, and did not involve the texture of the body of the uterus, amputation of the cervix uteri offers the only chance of removing the disease with ultimate success. These cases, however, at their commencement, are most insidious, and on account of the absence of pain and any leading symptom are completely masked under the appearance of menorrhagia, or profuse lochial discharge. It is only when the morbid growth has attained a certain bulk, encompassing the greater part of the internal circle of the cervix,

and filling up, and distending the cavity of the uterus itself, that the real nature of the disease is recognized. In every case I have yet seen the tumour grew from within the uterus, and its aspect was widely different, and easily distinguishable from the florid warty vegetations, which are often seen upon the external lip of the cervix, accompanying obstinate leucorrhoea and certain forms of syphilis. Partial excision of the neck of the womb would be worse than useless, and amputation of the whole cervix, to insure extirpation of all the diseased part, could alone be entertained. In estimating the cogency of the reasons which should influence us in determining amputation upon an organ so inaccessible as the uterus, we should bear in mind the unfortunate results of the majority of operations performed for the removal of diseases really malignant. The tubercular character of cauliflower polypi of the womb, together with the presence of hydatids in their structure, and the tendency to the development of encephaloid deposit leaves little doubt of their malignant nature, although they may run their course without carcinomatous ulceration, and the other symptoms which distinguish true cancer. There is no question of deeper interest at present occupying the minds of professional men than to arrive at some satisfactory principles for determining the diseases in which operations are advisable. The proposition in medicine has not yet been solved, whether diseases mild in their origin become malignant in their maturity. Upon this point, however, the more recent manifestations of opinion appear to assume, that growths essentially malignant are malignant ab initio, or from their first development in the system; and that when the peculiar state of constitution occurs which suffers the malignant formation to start into existence, there can be no security against a renewed invasion of the disease. It must be confessed that the honest exposition of the accumulative experience of modern surgeons is diminishing the confidence hitherto reposed in the knife for the removal of cancerous and malignant growths; and strong proofs are daily being adduced that the average duration

of life is longer in those cases which are not subjected to operation. By the statistical Report read before the last Scientific Congress of Italy by Dr. Regnoli, it appears that out of 250 persons on whom cancerous formations had been extirpated by the knife, scarcely twenty had survived three years. The discussions at present going on in the Academie de Medicine of Paris, show that the more extended researches in the pathological anatomy of abnormal organic productions have materially modified the current opinions which have heretofore prevailed amongst the most eminent operative surgeons in France. Upon this subject a most valuable light has been thrown by the statistical statements of M. Leroy d'Etiolles, which shew the importance of calculations made of the relative duration of life between numbers of persons affected by cancerous complaints who have been operated on, and who have not undergone operation. My own experience leads me to the conclusion that carcinomatous developments, if left to themselves, may be eventually, but are not immediately fatal, and that the extirpation of cancerous and malignant growths does not prolong life. In tubercular polypus of the womb I would not therefore, unless the case presented itself under singularly favourable circumstances, advise a patient to undergo excision of the cervix uteri. This question of accurately determining the differential diagnoses in cases of cancerous degeneration and fibrous formations, with regard to deciding the propriety of operating and avoiding operations, is most important, not only in a scientific point of view, but as deeply involving the comforts and feelings of a large class of patients and their friends. Happily for society the time is rapidly passing away when medical men could build a reputation of professional eminence upon the mere practice of mechanical dexterity. Other and higher qualifications are now required, and it is the special province and first duty of associations formed for the advancement of medical science, to collect the individual experience of their members, and, by accumulating evidence, to lay the groundwork for enabling the Profession to arrive at true and

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practical judgments upon such subjects. In such inquiries speculation only leads to error. Facts and the aggregate testimony derived from the results obtained by the practice of medical men scattered over great space and much time, giving, with candour and fairness, the number of recoveries and deaths, can alone furnish the elements for sound and satisfactory conclusions.

ART. XVI.-Some Observations on the early History of aural Surgery, and the nosological Arrangement of Diseases of the Ear. By W. R. WILDE, M. R. I. A., Surgeon to St. Mark's Ophthalmic Hospital and Dispensary for Diseases of the Eye and Ear.

In the present day, when literature in every Protean shape and form has compassed the land, and knowledge may be truly said to run to and fro throughout the earth; and when the polyglott cyclopædia of the press has outstripped in the race all other feats of human prowess of the nineteenth century, it might be deemed unnecessary to follow the old school system of detailing the early history of that particular branch of the healing art, or its elementary or collateral sciences, of which this essay treats, were it not that in an art but just emerging from the darkness, ignorance, empiricism, prejudice, and superstition, which is even yet the condition of aural medicine and surgery, its history not only becomes interesting, but practically instructive.

I might, with the generality of writers upon the history of medicine, commence with the times of Hippocrates, for he makes several allusions to the affections of the organs of hearing, not, however, as idiopathic forms of disease, but as symptomatic of other maladies of an acute and chronic nature; but it must be borne in mind that at that period of medical science (and, I regret to add, that it has in a great part descended to the present) the affections of the ear, whether functional or organic, were spoken of, lectured on, written of, and described, not according

to the laws of pathology which regulate other diseases, but by a single symptom, that of deafness. "If," says Dr. Kramer, "by tumours behind the ears, to be dispersed by copious diarrhoea if they are not to prove fatal, we are to understand otitis interna and its terminations, and carious destruction of the mastoid process, as a result of the otitis interna; and if, further, I mention that the treatment of deafness (viz. as it occurs as a functional disorder only of the ear, without any perceptible external alteration of the organ) merely consists of not washing out the ear, but cleansing it with wool, dropping in oil, directing the patient to walk out, rise early, drink white wine, abstain from salads, and allowing him to eat bread, and such fish as inhabit rocky shores, I shall have collected all that is of most importance to give an idea of acoustic medicine at that time."

To Celsus, the successor of Hippocrates, we are indebted for the first acknowledgment of the specific or independent forms of aural disease-for having introduced the practice of ocular inspection of the auditory canal-and for some general rules for the treatment of the inflammatory affections of the organs of hearing; but this advance in acoustic medicine, which we owe to Celsus, is more than counterbalanced by his introduction into practice of those stimulating nostrums which were then, and have been since, applied to the membrana tympani without discrimination and without mercy; and many of which are made use of in the present day. Galen followed in the track of his great predecessor, and although he advanced somewhat in symtomatology, and although he was evidently better acquainted with the causes of the inflammatory diseases of the ear, yet he and his disciples so increased the number of remedial agents, which were applied to the external meatus, that we find aural medicine and surgery, toward the end of the fifteenth century, but a collection of hard names, and unconnected symptoms, the fanciful theories based on causes the most improbable, and a category of medical substances from the animal, mineral, and vegetable kingdoms, principally, however,