the cavity of the womb regularly distended. Each fragment is about two inches and a half in length, an inch and a half wide, and about a line in thickness. One side of these membranes has the rough and floccular appearance of the decidual membrane as it is detached from the womb, and the other side is soft, smooth, and punctuated, like the inner surface of the same membrane, by the openings of the uterine glands. This case is well worth discussion. Health was perfect until marriage. Marriage so influenced the womb as to cause it to detach, more or less, its mucous membrane at every menstrual period. Raciborski has proposed a simple solution for this occurrence, by admitting pregnancy and a very early miscarriage in all cases of membranous dysmenorrhoea; but decidual membranes are passed at menstrual periods by virgins, by widows, by women at the change of life, and by married women living apart from their husbands. With regard to my patient, menstruation was regular, there was no sickness, nor any other sign of pregnancy; no portions of a foetus were found by Mr. Powell, nor by Mr. Hammond on many subsequent occasions. Thus it is clear that sexual influence, operating directly on the womb, or mediately by the ovaria, had caused the periodical exfoliation of the uterine mucous membrane, the prime morbid element of the case. What is the nature of this morbid element? For the last two years there had been no evidence of chronic inflammation of the womb during intermenstrual periods, no fixed pain, no red or brown discharge, or nausea; so I do not feel justified in giving the name of inflammation to a process of the womb which only occurs at each menstrual period. This case confirms Dr. Oldham's idea, that the mucous membrane of the womb exfoliates under some influence independent of inflammation, much better than those he has himself adduced; for, in his cases, uterine disease existed previous to the passing of the decidual membranes, and a relation of cause and effect might fairly be supposed to exist between the chronic inflammation of the uterine mucous membranes and its exfoliation, as I have shown, and as my friend Dr. Bernutz has stated. Did uterine exfoliation occur at every menstrual period after marriage? The patient's report is probably correct, for ever since attention has been awakened to the fact, the mem branes have always accompanied menstruation. Since the membranes which I have depicted were passed, Mr. Hammond has carefully watched the case, and when I last heard from him in March, 1862, the patient remained in the same state, passing decidual membranes at the termination of each menstrual period, and at other times large quantities of glutinous discharge. The inflammation of the neck of the womb is a secondary element of the case, and was caused by the forcible distension necessary to let pass so voluminous a body as that of which I have depicted the fragments. Inflammation of thousands of mucous follicles that line the cervix, explains the abundant ropy discharge; and its alkaline nature accounts for the extensive excoriation of the os uteri. The monthly expulsion of a voluminous body through the neck of the womb, prevented tonics and injections being of much use, and counteracted the usual curative effects of nitrate of silver. I have never met with any other case of deciduous dysmenorrhoea not preceded by uterine inflammation; but is this the cause of the exfoliation, or merely a sequel? As in my case, so in many others, doubtless the inflammation of the neck of the womb is only the sequel, and could not induce that condition of the body of the womb which causes its mucous membrane to exfoliate. It is only when distinct symptoms of internal metritis are met with between the menstrual periods, thereby rendered menorrhagic and unusually painful, that inflammation of the body of the womb and the exfoliation of its mucous membrane, can be fairly considered to stand as cause to effect, and very few recorded cases contain sufficient evidence to solve the question. Chaussier, in his letter to Madame Boivin, says, that he found a tumour hanging from the neck of the womb, with its most voluminous extremity dependent, as if it were a polypus, but the tumour was soft, easily came away, and was full of blood, being a cast of the womb, which cast had become inverted. A good instance of this is related by Dr. Vannoni of Florence. CASE 45.-M. Marinelli had been married six years when she consulted Dr. Vannoni. She had never borne children, and for the last three years connexion had been very painful. A polypus was found and extracted from the neck of the |