know that pain immediatly ceases when it becomes complete, as I shall state presently." "This patient 'was very faint and no pulse could be felt in either arm;' a condition which constantly attends the partial inversion; especially when the mouth of the uterus contracts firmly upon the body, producing a strangulation of the uterus; which was precisely the situation of Dr. W.'s patient, for he declares 'the neck was a little contracted.' Now, it must be obvious, upon a moment's reflection, that if the inversion were complete, the mouth of the uterus cannot be felt; for this part now offers its opening to the cavity of the abdomen and is not tangible by the finger." (Par. 1286-7.)

I am free to admit that I am not aware of any case of complete inversion being characterized by great pain, but Dr. D. has certainly forgotten to redeem his pledge to show a state in which "pain immediately ceases when it (inversion) becomes complete." I understand, when it is said the patient had lost much blood, that we have a very fair right to infer that the bleeding had abated on Dr. W.'s arrival-"she was in great pain and had lost," &c. After the Dr. had completed the inversion in his second case, would it have been fair or true to have said that the "inversion was not complete because she had lost much blood?" Again: "She was very faint and no pulse could be felt in either arm," "a condition which constantly attends a partial inversion, especially if strangulated.” Now, I am truly glad that it is not added that great faintness and extinguished pulse do not attend complete inversion, or uterus not strangulated. An examination of his own cases would have shown that strangulation of the uterus was not necessary to produce great faintness and exhaustion, or even death itself. And my first case proves that a complete inversion is no infallible indemnity against the same state. Again, where Dr. White says "the neck was a little contracted,” Dr. D. considers it conclusive that the inversion was partial and strangulated, because if the inversion were complete, the mouth of the uterus could not be felt. With due submission, I would suppose there would be no difficulty in determining

that the neck of the uterus was "a little contracted" by feeling that portion of it which was, at the time, external—even if we could not touch the os tincæ. I have no hesitation in saying that the neck, as well as body of the uterus, was contracted in my first case, and that from actual and careful examination, although I could not insert my finger into the os uteri. But in Dr. Teallier's case, there was, on the 10th day after delivery, "a smooth red tumor of the size of a large pear, the large end resting on the thighs, the small tied in the pelvis. No hæmorrhage and little pain." Why was this declared to be a case of partial inversion? "Because the neck of the uterus is charged with the difficulty of reduction, in the first attempts for that purpose."-Par. 1325. If the neck is not the cause of difficulty in all these cases, in the name of common sense, what is? And lastly, Dr. D. proves that a case, recorded in the New England Journal, is also one of partial inversion. "First-Because there was too much hæmorrhage and too many distressing symptoms. SecondBecause the author expressly and conclusively determines this point, by saying the neck of the uterus reached above the pubis."-Par. 1307. To the first branch of the proof, it is not necessary to repeat what was said on the same subject when speaking of Dr. White's case. To the second branch we may oppose one part of Dr. D.'s definition of a complete inversion. "When this takes place, the mouth of the uterus is looking upwards, and is within the cavity of the abdomen." I will not say that these are convertible phrases, but I do think that the difference, if any, is too slight to be laid hold on by a liberal critic. I think that a careful and impartial examination of Dr. D.'s criticisms will result in a conviction, that he has failed to prove that the cases referred to, were not cases of complete inversion. At the same time, I candidly acknowledge that it is only since my second case, and a more thorough consideration of the subject, occasioned by the result of that case, that I feel myself authorized to come to a conclusion different from that of the author.

A few words concerning Dr. Dewees' recommendation to

convert a partial strangulated inversion, into a complete one. I expressly disclaim any idea of ability to offer any thing decidedly for or against the proposition; but simply to express some reflections which offer themselves to my mind, upon an examination of the cases above referred to. The object is to relieve the patient from pain, flooding, and the various nervous and distressing symptoms. Its usefulness is founded upon one successful case. But all the cases on record, so far as I know, go to show that all these symptoms attend all cases of inversion, whether partial or complete, strangu lated or free; not, to be sure, with equal severity in every case; but Dr. D.'s first case proves that the very worst train of symptoms, and even death itself, may attend a simple dipping of the fundus; and my first shows that the like train of symptoms, and the same result may attend the complete inversion as I suppose where it was instantaneous, and of course, not strangulated even for a moment. We may suppose it probable that the Dr. himself had no overweening confidence in the remedy, because nearly twenty years after his successful case, he was called to a patient who "was nearly exhausted by hæmorrhage and suffering, and almost pulseless;" yet he "persevered in the attempt at reduction, nearly two hours."-Note to par. 1301. At last he completed the inversion, but the woman died. Thus we see that he truly considered it a dernier resort, and I think we may add "anceps remedium." Perhaps, where there is a strangulated inversion with considerable hemorrhage, upon finding it impracticable to reduce, we might complete the inversion. It is certainly proper to know and recollect what has been the treatment, and result, in as many cases as possible. Burns, in his system of midwifery, refers to the following cases. The appearance of gangrene from strangulation took place. The womb was scarified and the swelling quickly disappeared. The patient got well. In another case, the uterus was mistaken for a polypus, and the ligature applied. The mistake being discovered, it was instantly withdrawn, but the woman died in a few days.

In conclusion, I hope I am distinctly understood as not speaking with authority. I only wish to bring the subject before the profession for their consideration: knowing that they are entitled to the reflections of their most humble member, most especially upon subjects, concerning which the experience of the most exalted must of necessity be very limited.

ART. II-A Case of Cataract Complicated with Tremulous Iris, successfully treated. By WM. M. BOLING, M.D., of Montgomery, Alabama.

The following case of "Tremulous Iris" combined with cataract, I am induced to offer for publication, from meeting with the following passage in Lawrence's Treatise on the Eye. Speaking of the preternaturally fluid state of the vitreous humour, on which the tremulous iris depends, he says:-"Usually this state of the vitreous humour indicates a diseased condition of the internal parts of the eye-and we find that the retina has lost its sensibility in such cases. Such a state of the vitreous humour cannot be remedied, and if a catarat be present, its removal will not improve vision."

Isaac, a negro slave, between fifty-five and sixty years old, of a large and powerful frame, and good general health, twenty-five years ago become entirely blind, soon after which, his left eye was operated on for cataract. A high degree of inflammation followed the operation, and any improvement in his vision was for a long time despaired of. The inflammation, however, subsided, and gradually his sight improved, so that at the end of a year a very useful degree of vision was obtained. He recently changed masters, and his new one, anxious to have his sight improved, if possible, brought him to me for that purpose.

May 29th, 1843. His eyes presented the following appearance. The pupil of the left eye was clear, and a good deal

dilated. The slightest motion of the head caused the free margin of the iris to float about in a very peculiar manner. A slight movement of the head to the right would cause the left or outer portion of its free margin to become narrowed, or folded on itself so as to appear narrowed-reverse the motion, and the other side would assume the same appearance. Throw the head back and its margin would float forward-or throw the head forward and it would float back. The pupil was almost entirely uninfluenced by light, yet the vision was tolerably good, but had failed some within the last year. In the right eye was a cataract of a white color. The pupil was very much contracted. The iris had the same tremulous motion, but its movements were only backward and forward. This was owing to adhesions between the pupillary margin of the iris and the capsule of the lens. The application of belladonna produced scarcely a perceptible degree of dilatation, but caused the margin of the pupil to have a ragged, uneven appearance. No better effect was produced by the application of the bruised leaves of the stramonium, for several hours to the eye. He had a slight perception of light with this eye, when placed in a darkened room, with one open window, the eye directed towards it.

June 2d.—I operated by breaking up the cataract, which proved to be very soft. After the introduction of the needle, I discovered that the capsule was opaque, and became fully satisfied respecting the adhesion between it and the iris. I separated, completely as I thought at the time, the adhesions, and depressed the capsule, together with some of the larger portions of the lens below the axis of vision. Some small portions of the lens fell into the anterior chamber. Immediately on the separation of the capsule, the pupil became largely dilated. On the withdrawal of the needle, which was much more delicate than the cataract needles in common use, a very perceptible quantity of the vitreous humour followed it. I closed the eye immediately, and did not allow him to open it for several days. The usual means to prevent inflammation in such cases, were resorted to, and so little incon

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