voyage, but it was found impracticable. At last the idea occurred to me of trying the effect of a sponge tent. On her return to town from the sea-side, and on the 1st of October, 1867, I passed a large sized sponge tent, recently made as. I have already directed, and rather more than two inches long, through the internal os, and left it for twenty-four hours. The next period showed a decided improvement. On November 28th I passed another: the result was still more satisfactory, all the former remedies were discontinued, the menstrual flow became reduced to a degree often exceeded by what is in some persons normal, and altogether she was so improved that she was able to return to India in the following October, having spent the preceding summer and autumn months in various parts of the country, without any treatment whatever. Previous to her departure she passed a fortnight in really hard work, purchasing, packing, &c. A few months after her return to India she again became pregnant, and was delivered at full term on May 18th 1870. The menorrhagia returned, but not with its former severity. She is now in this country, having come back in July of this year, 1871, and although her menstrual periods are abundant they are not sufficiently so to require any treatment.

CASE 2.-Mrs. W- came under my care as an out-patient at the Samaritan Free Hospital, suffering from excessive menstruation as well as intercurrent discharges of blood. She was the mother of several children, and until the commencement of her present symptoms had enjoyed good health. She had suffered from a slight increase of menstruation since the birth of her last child between two and three years ago, but it was within the preceding few months that it had acquired its greatest severity, and that she had become the subject of intercurrent discharges. There was considerable leucorrhoea, chiefly vaginal. She had graduallymore rapidly of late-become weak and anæmic, and could hardly bear the walk from Lisson Grove to the hospital.

On examination the uterus was found to be slightly increased in volume: the cervix thickened but not indurated, the os

patulous, its mucous membrane thickened, soft, spongy and granular. The passing of the sound caused rather free bleeding. I administered iron alone and in combination with ergot, gallic acid, &c., but without any effect on the bleeding. Local remedies such as cold douche and astringent injections were of no use. After some hesitation I determined to try a sponge tent, and accordingly I introduced one of medium size and the patient returned home.' Next day, with some degree of anxiety and apprehension of the result-as it was the first time I had attempted the treatment in out-patient practice I visited the patient at her own home and removed the tent. It had acted extremely well-whether this was due to its containing no gum, or whether the copious sero-sanguinolent discharge set up had washed it all out I am not prepared to say-and held its place firmly, its meshes interlocking with the lining membrane of the cervical canal, and it was only by first passing the finger around the tent and successively pressing it away from the opposing surface that I was able to withdraw it. There was a very abundant watery discharge, excessively offensive: the vagina was immediately washed out with a solution of chlorate of potash (5 grs. to oz.); she was ordered to keep her bed for a couple of days and to continue the Tr. Fer. Perchl. which she was then taking. At the end of a week she presented herself at the hospital.

From that time the intercurrent hæmorrhages ceased, her menstrual periods assumed normal proportions, and in a few weeks she was discharged. I met her accidentally some months after and she stated that she was quite well. More recently she has been again under my care, but for dyspeptic symptoms.

CASE 3.-Mrs. T-, æt. 24, a native of Calcutta of very dark complexion, from a considerable infusion of Indian blood, began to menstruate at the age of fourteen; the periods recurred very regularly every month, and lasted from six to eight days, the total amount of discharge being above I find that this tent was obtained from Duncan and Flockhart, EDIN.

the average, but unaccompained by clots. She married at the age of seventeen, and two months afterwards had a miscarriage. Her next period assumed the character of menorrhagia with clots. Repeated miscarriages at varying intervals took place, amounting to a total of seven, the last occurring in September, 1868, at the fourth month, after a voyage to the Mauritius for the benefit of her health. During her pregnancies she always suffered from slight hæmorrhages at irregular periods. From the date of her last miscarriage the menorrhagia was so severe as to compel her to keep her bed for the whole period of from five to seven days. On the first day she usually complained of rather severe pain in the "waist;" on the third and fourth days large clots passed; and at the end of the period she was in a state of great prostration, from which she had scarcely recovered before the next period was upon her. In addition to this she suffered from frequent attacks of pain of a sickening character in the lumbar region, during the intervals of menstruation, and these were usually accompanied by a more or less decidedly sanguineous discharge. She sought advice in various quarters and was subjected to a variety of treatment, local as well as general, but, deriving no benefit, and receiving no definite information as to the nature of her disease, it was determined that she should seek advice in London. The opinions pronounced on her case were various, one of them being that she was the subject of a tumour; another was to the effect that she required an operation. The removal of the supposed tumour, or whatever condition required operation, was the cause of the long journey. She menstruated for the last time in India from the 26th to 31st March, 1871 (inclusive), passing many clots, and she was taken on board ship on 3rd April, per Suez Canal,-being then in a very weak state. There was a scanty discharge on the 20th and 21st April; and again on 15th May there was a slight "shew." On 25th May she landed in England. This patient came under my care on 10th June. She had not been unwell again but complained very much of the frequency and severity of the attacks of the pain above mentioned, but without discharge of any

kind. Her general health was very good, having undergone great improvement on the voyage. She had experienced a similar result from her voyage to the Mauritius, but the improvement was only temporary. On that occasion, it should be noted, her pregnancy extended to the fourth month.

Diagnosis.-On external abdominal examination not even the suspicion of a tumour was aroused, but vaginal examination revealed the following condition :-The uterus was of normal size, both as measured by the sound, and by the combined external and internal manipulation; there was a slight anteflexion; the os was patent; the whole cervix soft and flabby; the mucous membrane of the anterior lip especially, felt as if loosened in its submucous connections. Before placing her under treatment, and after having explained the nature of her disease and the treatment I proposed, I recommended her to obtain the opinion of one skilled in the treatment of uterine disorders. Accordingly on the following day she accompained me to Mr. Spencer Wells. The result was a perfect agreement as to the absence of any tumour and the presence of the condition described. Nor was there any difference on the question of operation, while we were agreed as to the treatment to be pursued.

Treatment.—On 12th June, a small sponge tent was introduced and left for twenty-four hours; another was introduced on the 19th and removed on the 20th, and on the latter day I prescribed 10-minim doses three times daily, of the Tr. Fer. Mur. and Extr. Ergot Liquid. The menses appeared on the 29th and lasted three days, moderate in amount and not preceded by pain. There were no clots, nor was she compelled to keep her bed. She was allowed to pass over a month without another tent, and on 23rd July the menses again appeared. The quantity was greater, and there were several small clots. On this occasion I gave her a few doses of gallic acid. On the 29th she was complaining of the old pain and was rather disheartened. For this I prescribed gr.extract of Indian hemp to be taken every four hours while the pain lasted, and to be had recourse to on each recurrence. On 2nd August I passed a small tent, and on the

following day another of larger size. Neither of these acted well as they were saturated with thick gum. On the 9th I introduced another of medium size, of same make, and next day had the mortification of finding it in the vagina little changed. However, I replaced it by another, and this by a third on the 11th, and the result was satisfactory. (These latter tents were made by myself for the occasion, and the sponge was merely moistened with the solution of carbolic acid. They were quite devoid of unpleasant smell on extraction:) To make sure work (as the patient limited me to time), I introduced another on the 16th. This acted perfectly, opening the cervix well. After the use of the sponge tents the vagina was washed out daily with a solution of ten grains of tannin in two ounces of water. The menses appeared on the 23rd and lasted three whole days; the discharge was moderate, and the patient was not confined to bed at all. From this time she ceased to complain of pain. On September 21st she again became unwell, and the discharge ceased on the fourth day. During the whole of this menstrual period she went about sight-seeing daily without inconvenience of any kind.

Result.-On the 10th October she sailed for Calcutta in a state of perfect health, rejoicing as much at the cessation of the attacks of pain as of the menorrhagia. During the last month all treatment, local and general, was suspended.

Remarks.-These three cases are good examples of that form of uterine hemorrhage and menorrhagia to which I have desired to call attention, which is not described definitely in our text-books, and in the treatment of which the sponge tent is so valuable. There is no tumour, no fibroid thickening or induration, nor is there a polypus. The condition is one of relaxation of the tissues of the uterine body to some extent, but especially of the mucous membrane lining the cervical canal, and probably that of the uterine cavity—if I may be allowed to adhere to the established nomenclature for the sake of convenience, without prejudice to the question whether it be a distinct membrane or a layer of soft tissue. This state of relaxation permits congestion or stasis of blood