difficulty passed between it and the anterior wall of the vagina this pressure had created considerable vesical trouble. The fundus was considerably retroverted or rather retroflexed, and could be readily traced in the Douglas culde-sac per vaginam, and the rectal touch reached even to the anterior wall. What perplexed me most in this case was such an amount of flexion, and none of the induration which I had heretofore found existing in all flexion cases; besides, the cervix was soft and the os very large, and but slight dysmenorrhoea had existed, although menstruation was attended with a most disagreeable relaxation and depression of the nervous system. Hæmorrhoids of course were found, for retroflexion or retroversion without them is the exception, when of long standing. When the Sims' speculum was introduced, the perineum being retracted and the tenaculum hooked into the cervix, a mass of granular ulceration seemed to obliterate the entire os; further traction however revealed that it was confined to the posterior wall; the anterior being pale, slightly indurated and enlarged; the sound (Simpson's) passed in without any difficulty to the ordinary depth of about 2 3-4 inches, measured from the os uteri anteriorly, but not more than I 3-4 from the upper end of the ulcer. I at once recognized that it was a fissure of the cervix, extending from the left margin of the posterior wall of the neck obliquely upwards to the vaginal junction towards the right, and was about 1 3-4 inches in length. The lining membrane was prolapsed and erected, its papillæ or villi increased in size, forming a granulationlike ulceration, known to gynæcologists as granular erosion, or granular ulcer. The pathology of this lesion consists of an absence of epithelium, and each papilla or villus contains a looped vessel, hypertrophied and enlarged, and greatly tending to bleed; these vessels are sometimes so much distended that they become varicose, and the term "varicose ulcer" has been given to them. According to SCANZONI, FARRE, THOMAS, and others, this papillahypertrophy may take place in the folds of the everted membrane of the cervix, producing so much" of convolution and projection, as to have caused the appellations of fungous ulcer, or cockscomb granulation, to be applied to it." There was, of course, but one plan of treatment to be followed. Here was a traumatism producing uterine harelip; at least it had to be treated as hare-lip; which treatment consisted in vivifying the edges and approximating the raw surfaces by silver wire sutures. The dissections were easily made by means of scissors, and a long-handled, narrow-bladed bistoury: the hæmorrhage was but trifling. Great difficulty is always encountered in passing the sutures, from the fact that most of the needles purchased of the instrument makers are of most miserable quality, and they either break or bend, in being pushed through such a dense structure as the neck of the uterus, besides there are as yet no instruments ever devised which will hold a needle sufficiently firm across the longitudinal axis.* The wounds, after the wires had been passed and twisted, presented the appearance as in Fig. 14. The vagina was syringed out, and the sound passed in the uterus for the double purpose of determining the axis of the canals of the neck and the body, and to see if that of the neck had been embraced in any one of the sutures. The axis was almost normal; the sigmoid shape of the cavities, the result of the double flexion, had disappeared. The operation was performed in the presence of Drs. M. M. PALLEN and J. W. McLURE. The result of the operation proved that the anteflexion. depended upon the contractility of the neck anteriorly, and Fig. 14. * Since making this operation, I have had occasion to pass silver wire sutures through the neck of the uterus, and have experienced no difficulty by using a strong curved needle with an eye just behind its point, three and a half inches long, and with a flat wooden handle. A silk ligature is introduced in the eye of the needle, passed through and caught by a forceps, when a silver wire is looped over it and drawn through by the silk ligature. This needle is very similar to Wood's hernia needle, or Post's perineal needle. that the retroflexion was caused by a want of infravaginal support posteriorly, together with the general relaxation of the ligaments above and anteriorly. The wound healed in about ten days (or rather the wires were removed at that time) by primary adhesion, with the exception of about the eighth of an inch in the centre, notwithstanding the menstrual flow came on during this period. I touched this fistulous opening with nitrate of silver, and passed another silver wire suture in four or five days afterward, which cut through without producing union. I then applied the actual cautery, and passed a suture pin very deep in the tissue of the neck, and secured it with a very fine iron wire; this was removed in about ten days, and union was complete. The pains in the back, lumbar region, and in the hypogastrium have ceased; the leucorrhoea exists no longer, and the general constitutional troubles are very much ameliorated. The result, then, proves that the removal of a cause of irritation seated in the uterus or its appendages is frequently followed by a restoration of health. The medication in such cases is principally nutrition, such as good wines, or porter, or ale, with beef, eggs, milk, etc., and some of the bitter tonics. Iron alone seems to do no good, but combined with manganese, principally the lactates and phosphates, either in pill or in solution (glycerole in calisaya bark elixir), has a most charming effect. 821 PINE STREET, April 11, 1868. A CASE OF ANEURISM OF THE ARCH OF THE AORTA. Reported by N. S. RICHARDSON, M.D., and A. M. WILLIAMS, M.D., J. B., æt. 39; married; intemperate. One year previous to his death he fell from a horse, since which time until his death he had pain in the dorsal region of the spine. First 1 attendance was given him by Dr. Subsequently Dr. for "nervous II. treated him by shock. mercury to ptyalism for "diseased liver." In turn, Dr. III. pronounced the case "unimportant-not worthy of attention.” Dr. A., next in charge, after examination, declared the existence of "an anomalous tumor.” On the 11th of Nov. (last), Dr. A. called Dr. S., one of the former attendants of the patient, in consultation. Under the impression that the tumor, for months previous apparent, was but a common abscess, a small incision was made by Dr. A. through the integument, and a female catheter introduced. Not finding pus, a bistoury was introduced beside the catheter, and an incision three inches in length made. At the bottom of this was found a very firm clot; scarcely a moment transpired before this was driven out, followed by a pulsating stream of blood. At this moment, the truth flashed on the minds of the operators. Promptly grasping the sides of the wound and closing them firmly, they retained them in apposition by stitches, then applied a firm wooden compress and a bandage; they were thus enabled to control the hæmorrhage; the amount of blood lost being probably three quarts. Supposing the aneurism to be situated on one of the smaller arteries, external to the cavity of the chest and probably the subscapular, it was proposed by Dr. S. to ligate the left sub-clavian artery. Time passed without an operation. On the morning of Nov. 14th, the patient died. The reporters of this case were present at the post-mortem examination, which revealed the following condition : On opening the thorax, some injection of the pleura of the left side was observed, likewise adhesions of different degrees of firmness, and considerable serous fluid in the cavity. An aneurism of the aorta, situated on the posterior wall of the descending portion of the arch, was found, which had by pressure caused the absorption of the left side of the bodies of the third, fourth, fifth, and sixth dorsal vertebræ. About four inches of the fourth rib were also entirely de stroyed, with partial destruction of the third and fifth ribs of the same side. There were adhesions of the sac and pleura at the point where the bony walls of the chest had been partially destroyed. It can easily be seen by this that should the sac by any means open in its posterior portion, where it was already protruding through the opening in the ribs, there might still be no hæmorrhage into the pleural cavity. Such was really the case. The sac had opened posteriorly, and the blood had been poured out under the muscles of the back and between them and the pleura costalis, forming in this manner a new tumor much larger than the original sac. It was this new tumor formed by the bursting of the aneurism, and not the true sac of the aneurism, which was incised. Both the original sac and the new cavity were, to a large extent, filled with white fibrinous clots, deposed in firm, strong layers, such as are always noted in long standing aneurisms. The locality, disposition, and effect of the aneurism described will undoubtedly enlist the attention of the profession; but, in addition, it is worthy of note, that notwithstanding the extent and duration of this remarkable lesion, its aneurismal character was not suspected by the medical men in charge! February, 1868. AN UNUSUAL CASE OF NEVUS MATERNUS. Reported by W. N. BRENNAN, M.D., of St. Louis. NATALIE LOGAN, a half-breed Indian woman, native of Green Bay, Wisc., aged 23 years, a widow, was admitted in the Sisters' Hospital, Dec. 27, 1867. She suffered from phthisis pulmonalis, of which she died Feb. 14th, 1868. She was also afflicted with epilepsy. The complexion of her face, the greater part of her body and limbs, was that of a half-breed' Indian. She had a nævus maternus, or mother's mark, covering the whole trunk posteriorly, extend |