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lar inflammation of which I am speaking. Portions are bright or deep red, and rough; other parts are paler and smooth; except in the severe cases, where we find no healthy portions of mucous membrane. I have mentioned that I have seen a few cases in which the os uteri was not more open than usual, and in which I ascertained that granular inflammation existed. In such cases, I have observed that the introduction of the sound in the gentlest manner caused some bleeding, or, in other cases, gave actual pain. If, in such cases, the canal be dilated with a tangle tent, its granular condition may at once be ascertained; so that I regard these two symptoms-slight bleeding or pain when the sound is passed very gently-as conclusive. Reasoning d priori, I think we should expect to find the canal narrowed or closed, as the ordinary result of granular inflammation; but the opposite is the case in the vast majority of instances. Nor am I able to offer any scientific explanation; all I know is the fact, that of this disease the most unvarying accompaniment is an os uteri unusually patulous. I have been thus particular in describing the anatomico-pathological peculiarities of the disease, because, as one might expect, the symptoms (properly so-called) are less distinctive, but have much in common with other affections of the uterus. There may be, and generally is, the usual aching pain in the back, with, possibly, some feeling of weight or bearing down. The menstrual flow is almost always increased, sometimes excessive, or recurring at short intervals and from slight causes. I recollect only one case where the opposite extreme was observed. There is always more or less leucorrhoeal discharge, thinner, and white or yellowish, if there be vaginitis; thick and tenacious when the disease is limited to the canal of the cervix. When the speculum is used, we may see this stringy discharge hanging out of the os uteri, and it is sometimes difficult to remove it. When the disease is of long standing, it interferes, more or less, with the general health, giving rise to languor, listlessness, loss of appetite, and imperfect digestion. In addition, it is not less potent than other disorders of the uterus in exciting reflex irritation, of which, perhaps, the most common is ovarian pain and irritability of the bladder; very distressing while they last, but not absolutely requiring any special treatment beyond a vaginal suppository of belladonna or morphia, and which disappear as the cure of the disease progresses. Upon one uterine function, gestation, the influence of a severe attack of granular inflammation is apt to be disastrous. It does not always prevent conception; but, in a great number of cases, it causes abortion. I have known a succession of miscarriages apparently result from this cause alone; and I think that, in all cases of the disease, no risk of impregnation should be incurred. It will be wise also, in any case of abortion, to examine into the condition of the canal after the lochial discharge has ceased. DIAGNOSIS. After what I have already said, I need occupy very little time with the diagnosis. Our suspicions will probably be first excited, when making a digital examination, by finding the point of the finger pass more or less freely into the os uteri, and the inference from this will be turned into certainty by a sunlight or endoscopic investigation. A little longer process will be necessary when the os is not patulous; the occurrence of pain when the sound is passed, or a drop of blood escaping afterwards, leave but little doubt, and that may be removed by Ldilating the os with tangle, and a subsequent careful examination. TREATMENT. The disease is curable enough, and the course of cure steady but slow. It must be for such cases that the different kinds of curette have been invented, to scrape off the granulations. This does not appear a very scientific procedure, and I am sure you can cure this disease as effectually without it. The endoscope affords us a very nice and precise mode of applying remedies to any part, either of the cavity of the uterus or the canal of the cervix, without the risk of doing more than we intend, so that we may safely use stronger remedies than we dare in any other way. By this means, strong nitric acid, tincture of iodine, or lunar caustic, may be applied when we please, and to a greater or less surface as may be necessary, or if we wish to limit our treatment to the cervical canal, a smooth piece of deal may be dipped in the acid or the tincture, and freely applied. I have found it better to begin with a free application of strong nitric acid, so as to destroy the granular surface, and this may be repeated at intervals of three or four days, until we obtain a smooth surface. The vagina should be syringed with cold water, or camomile tea, once or twice a day. After this, I dip a small twist of cotton-wool in tincture of iodine, and apply it to the entire diseased surface, twice a week, continuing the syringing as before. As the cure progresses, the lining membrane becomes paler and smooth, and the os uteri closes somewhat, but it is not restored to its natural size for some time. I have found a strong astringent applied to the inner surface, in the way I have described, the best aid, and with this view I have used with benefit both the pemitrate and perchloride of iron, at the same time syringing the vagina with a strong astringent. I should strongly advise " separation" until the treatment is finished, as conception might seriously interfere with our procedure. There is a disease which I meet with occasionally, which may possibly have some relation to the foregoing, but of this I am not sure. I mean a vascular tumour at the os uteri, exactly like that we find at the meatus urinarius. It varies in size from a pin's head to a raspberry, and, unlike the small polypi found in the same situation, bleeds on the slightest touch. So far as I know, it gives rise to no symptoms but menorrhagia. It can seldom be recognised by the touch, because of its small size and softness, but it is easily detected by the speculum. The cure is simple-excision by scissors, or Dr. Braxton Hicks's small wire icraseur, or torsion by Wilde's snare, and, subsequently, repeated cauterisation.

Three Cases of Spontaneous Fracture of Urinary Calculi in the Bladder