scissors) it is a very practical instrument for this purpose, as well as for perineal and other operations, and it should be found in the armamentarium of every gynæcologist. With these wire nippers, which have a groove near the end or point of one limb, this little depression at the point is hooked into one side of the wire suture and it is cut through, and then the suture carefully withdrawn from the opposite side, using at the same time a blunt hook to make counter pressure and support. The upper suture is removed first, and the others in succession except the last one at the os, which may be left for a day or two longer and then removed. In speaking of the consequences of these lacerations I did not mention epithelioma. In the last five years, I have known of four deaths from cancer of the uterus following upon lacerations of the cervix. Dr. T. A. Emmet, in speaking of these lacerations, says: "Its importance cannot be exaggerated, since at least one-half of the ailments among those who have borne children are to be attributed to lacerations of the cervix."

This operation, although apparently rather difficult to perform, is one of the safest and most satisfactory, and perhaps the least dangerous in the whole practice of gynecology; and moreover, it is usually followed by a complete cure. It is not so painful to the woman as might be supposed by the inexperienced-it is more the fatigue of the operation that the patient usually complains of, than the pain endured. In most of my operations I have not employed any anesthetic, but sometimes this will be necessary, and in such cases I would use one part of Chloroform to three of Ether. The passing of the sutures is the most difficult part of the operation, and it is possible that Chinese silk sutures will hereafter be found to be quite as safe as the silver wire. This wire greatly simplifies the operation for beginners and young surgeons. Prof. Skene, of the Long Island Medical College, reported many cases where he employed only silk sutures, and his operations were all successful.

TREATMENT OF LACERATION OF
THE CERVIX UTERI.

BY RICHARD C. ALLEN, M.D.

As my object is to give the treatment of laceration of the cervix, I will not preface this article with a description of the causes, but will begin at once with an account of the treatment as pursued daily at my office.

I am convinced, through experience, that many of the surgical operations performed for the relief of a laceration could be dispensed with, and the more agreeable, the medicinal treatment, substituted with far better results. Through medicines, topically applied, in conjunction with internal treatment, I am able in a short time to permanently cure many of the worst forms of lacerated cervix.

It is impossible, I think, by internal treatment alone to cure a lacerated or erosed cervix. Every case must be treated by internal and external means at the same time. Before applying my local remedies, I wash out the vagina with water as hot as the patient can bear, previously mixing with the water some Chloride of sodium, Sulphate of soda, Chlorate of potash, Extract of pinus canadensis, Tannic acid, or some other mild astringent to give purity and tone to the vaginal surface. After the vagina is thoroughly washed out and dried and the cervix is brought into view by means of a speculum, I apply directly to the lacerated surface Tincture of iodine, Ext. of pinus canadensis, Pyroligneous acid, Diluted turpentine, or an ointment made of Belladonna, Sub-nitrate of bismuth, Oxide of zinc, Nut gall, Ammoniated mercury, Creasote, or some other ointment or wash, as the case may seem to indicate.

When using the ointment, I place it on a tampon of cotton and smear the remaining surface of the cotton with cosmoline and adjust the tampon so that the medicated ointment comes directly in contact with the erosed surface. The cosmoline is used to allay the vaginitis which usually co-exists with a laceration. Always after

the local wash has been used the vagina is filled with a large tampon of cotton smeared well with cosmoline.

In those cases where there is considerable rolling out of the lacerated surfaces, giving the appearance of an elongated cervix, if there is a displacement of the uterus, I adjust a pessary, after the inflammation and tenderness of the parts have disappeared, to give support to the womb and cervix; if no displacement of the womb exists, a large size tampon is used. The pessary is removed once or twice a week, the vagina washed out with hot water, the lacerated surface and surrounding parts topically treated with a medicinal wash, after which the pessary is readjusted. By continuing the treatment in this manner for a few weeks, many of the worst forms of laceration are permanently healed with a good, soft, mucous surface.

The pessary I prefer, and which gives entire satisfaction to my patients, is the Fowler pessary. It is light, simple in construction and easily adjusted. Besides keeping the womb in proper position its walls give a healing support to the cervix. The ring pessary should never be used, most positively, if a laceration exists, for it certainly works decided injury by stretching an already gaping laceration. A pessary should not be used until all tenderness upon pressure has disappeared from the vagipa and surrounding parts; and until such times as a pessary can be used I substitute the tampon of cotton coated well with cosmoline. I use cosmoline mostly in preference to glycerine, as its emollient properties possess greater healing qualities; yet when there is a leucorrhoeal discharge, I find great benefit from the use of glycerine for a short time. Acting as a hydragogue, glycerine changes the white or yellow milky discharge into a watery flow, soon followed by great relief.

The enlargement of the womb which is present and in an irritable condition, producing constitutional symptoms, rapidly disappears after the laceration is healed. The cysts which are often found on the lacerated surface should remain undisturbed and not punctured as is recommended by some gynecologists. If a cyst on the surface of the skin, the result of a burn or scald, should not be punctured, neither should a cyst on a lacerated surface be punctured, for the air is admitted, producing a raw surface which delays heal

ing. This cystic appearance is obliterated and the parts restored to a natural condition by the liberal use of medicinal washes.

I place my patients in the gluteo-dorsal position when making an examination or operation upon the vagina, using a bi-valve speculum for examinations and Simon's specula when performing an operation. The internal treatment is given in accordance with the symptomatology of each case.

INTRAMURAL FIBRO CELLULAR TUMOR OF UTERUS, AND REMOVAL.

BY C. ORMES, M.D.

Mrs. H. Age thirty-seven.

Large, fleshy, full habit, weight 180 pounds. Irregular month action for last twelve months, dark and profuse, with occasional small and offensive clots. Pain in front of left ilium for one or two years, with an enlargement near centre of bowels and extending down into pelvis.

At this time, October, 1879, found uterus enlarged, tender on pressure, and very sensitive to introduction of sound, uterine cavity showed a depth of five inches and walls thickened. Examined her again in March, 1880; found uterus more enlarged with increased heat, pain and soreness on pressure, discharge more copious, and offensive, uterine cavity six inches in depth, tumor readily fixed between fingers in vagina and hand on abdomen, considered it entirely uterine, and from the malignant symptoms developing, as constitutional disturbance began to tell upon her, in loss of flesh and strength and a cachectic expression of countenance, having lost twelve pounds of flesh in the last two months, advised its removal, whatever might be the result.

Consequently on the 6th of May, 1880, anæsthesia being produced, the abdomen was laid open, in the line of the linea alba, from the umbilicus to near pubis. Nothing unusual in laying open the abdominal cavity save the large amount of adipose substance to cut through. Opening the abdomen exposed a slightly dark, reddish tumor, surface even, but flattened from before backwards; on front and left side of tumor, was an apparently soft attenuated surface, and just above and forward of the left fallopian tube which entered the tumor near this point, on introducing the trocar into it, discharged about one gill of a dark grumous fluid; ovary on this side twice its natural size, of a dark purple appearance, tube also enlarged, right ovary of natural size, apparently healthy.