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I.

DURING the publication of this Review, I have received a valuable communication from an Indian practitioner, a thorough stranger to me, which so fully bears out the truth of an assertion elsewhere made, that I think I cannot do better than here append it. I allude to the statement contained in the preface to the second edition of my treatise on " Uterine Inflammation,” to the effect that "the descriptions of uterine disease which I have given are the expression of facts truly observed and faithfully reproduced, and will hold good alike in all climes, in all lands, and in all grades of social life." I may add that Dr. Stewart's testimony, as to the frequent existence of inflammatory and ulcerative disease of the neck of the uterus amongst the native women of India, is thoroughly corroborated by the experience of Dr. Scott, formerly Physician to the Hospital for Native Women at Madras, and now practising at Ootacamund. Dr. Scott has repeatedly informed me that he has found these diseased conditions to be quite as frequent amongst the native women at Madras as I have done in Paris and London. I merely transcribe Dr. Stewart's communication, which is as follows:

"Warley Barracks, Brentwood, Essex, 19th March, 1856. "DEAR SIR,—It may perhaps interest you and the readers of The Lancet to know that your views and observations regarding the frequency and importance of ulceration of the cervix and os uteri are amply borne out in India, as everywhere else. In proof of this, I take the liberty of sending you a somewhat curious memorandum, drawn up for me by one of my late esteemed associates in the Calcutta Medical School, Baboo Madoosudun Goopta, of the appearances observed in these parts on the post-mortem examination of fifty native Indian females, whose deaths occurred in hospital from other casual diseases.

"A long and extensive experience amongst native families in Calcutta, from the highest to the lowest classes, fully satisfied me that the particular affections which you have so ably described and brought to the notice of the profession are of immense frequency, and that the plan of treatment which you so ably advocate is the only right one. "I am, Sir, yours truly,

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"D. S. STEWART, M.D., Surgeon Hon. E. I. Co.'s Depôt, Warley."

Memorandum of the Condition of the Genital Organs in the Bodies of Fifty Native Indian Women, who had Died of various Diseases. By MADOOSUDUN GOOPTA, S.A.S.

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D. STEWART, M.D., First-Class Staff Surgeon, Late Professor of Midwifery in the Medical College of Calcutta.

Calcutta, March, 1855.

This interesting and valuable document from the far east speaks for itself. In fifteen cases out of the fifty, there was inflammatory ulceration; and in many the ulceration is noticed as extensive. In various other instances the cervix was also inflamed and indurated. Thus does it bear out all my statements and opinions respecting the frequency of inflammatory and ulcerative lesions of the cervix uteri in the dead as well as the living. It corroborates the results arrived at by Dr. West, and proves, at the same time, the utter fallacy of Dr. Robert Lee's and Dr. Tyler Smith's negative assertions in 1850— assertions founded on the old post-mortem records of St. George's Hospital. It is impossible, also, to cast an eye over the list of lesions, uterine and ovarian, which it reveals, and not to feel that the defective nutrition and debility which usually accompany such lesions during life must have exercised a pernicious influence on the individuals in whom they were found, and must have thus contributed to their death, by depriving them of the power of resisting intercurrent disease.

II.

THE USE AND ABUSE OF THE STRONGER CAUSTICS, AND OF THE ACTUAL CAUTERY, IN THE TREATMENT OF UTERINE DISEASE.

In the course of the discussion to which the publication of this Review has given rise, it has been stated that I recommend the stronger caustics to be used to destroy the indurated and hypertrophied tissues in chronic inflammatory disease of the neck of the uterus. I cannot better disprove such assertions. —which are thoroughly unfounded and untrue—than by giving a few extracts from my own writings. They will show, in the most undeniable manner, not only that I am not open to any such accusation, but that I have been the very first to raise my voice against the abuse of the surgical agents, the discreet use of which I recommend in the treatment of intractable disease of the cervix uteri. They will also tend to place the question in its real light, should it become the subject of further discussion.

Extracts from the Third Edition of my Work on "Uterine Inflammation," published 1853.

"It cannot, however, be denied that cauterization of the cervix, as above described, and especially deep cauterization, is an operation, and, like all operations, surrounded with danger. It must not, therefore, be either injudiciously resorted to, or carelessly carried out. Although my own practice has hitherto been free, or all but free, from serious accidents, the same immunity does not appear to have attended that of others. Various cases in which serious accidents have followed the use of the caustic potash have been narrated as arguments against its use since the last edition of this work was published; and M. Gendrin has himself, within the last few years, had several cases of acute metritis, and of abscess in the lateral ligaments, the evident and immediate result of deep cauterization. He has, however, seen the same results follow the use of the nitrate of silver, and of injections; and I may mention, that the two most severe instances of acute metritis that I have myself witnessed for some time in the unimpregnated womb, occurred after the use of weak astringent vaginal injections." -p. 297.

"I must, however, most emphatically guard practitioners against an error into which there would appear to be some danger of their falling, from misinterpretation of my views. I wish it to be most distinctly understood that I do not propose to destroy the hypertrophied cervix by cauterization, but merely to set up an artificial eliminatory inflammation, by means of an eschar or issue, of limited extent, established in the centre of the hypertrophied region. I do not calculate, in the remotest degree, on the destruction of tissue to which the caustic or cautery gives rise, for diminishing the size of the hypertrophied cervix, but solely and entirely on the inflammation subsequently set up. Any attempt actually to destroy the hypertrophy by direct cauterization appears to me both dangerous and unnecessary; dangerous, because I should be afraid that the intensity of the reactional inflammation would be so great as often to extend to the uterus or to the lateral ligaments, and because I

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