should be introduced after twelve hours to ensure continuous dilatation. I have never seen any bleeding follow this limited incision; but if it ensue the perchloride of iron is reported as successful for its arrest.

Where the constriction, in whatever part of the canal it may occur, cannot be distinctly traced to organic changes produced by those causes above enumerated, the simple use of dilating tents often proves successful. The ingenious instrument employed by Dr. Barnes* does away with the necessity for employing the speculum on their introduction. The laminaria tents are superior to those made of sponge, but necessitate some care, since they are more liable to expulsion on any effort. Sponge tents are preferable where it is required to so dilate the cervix that an examination of the cavity of the uterus may be made. For sponge itself really exercises very little direct power; merely soddening the parts in contact with it, so that they readily yield, but soon contract again. A string placed round an expanded sponge tent reduces it to its original dimensions without exercise of force; but the sea-tangle tent, when fully swelled out, resists this test of its power.

* Made by Messrs. Weiss, 59, Strand.

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CHAPTER IV.

DISORDERS OF STRUCTURE.

MINUTE physiological investigation of the structures composing the human frame has afforded indubitable proof that the development of each tissue and organ, even in its immature or rudimentary stage, is ordered with special regard to an ultimate thorough fulfilment of its highest functional purpose. The nutritive activity which predetermines the order of development in different parts, has relation to the duties which each will have to fulfil. Thus, the lungs and larynx of the fœtus, absolutely useless organs during intra-uterine existence, are yet so completely finished before birth that the baby breathes and cries on the moment of its entry into independent life. Thus it is that the ovary of the child teems with Graafian vesicles; though years must come and go before any one of these can assume the semblance of a purpose.* The virgin womb is, in its structure, but a homologue of the gravid uterus, and the increase occurring during pregnancy is only an orderly development of tissue. For each of the coarse

* So far as I know, it has never been ascertained that a germ has escaped from a follicle and entered the oviducts, except just at the commencement of puberty.— Grohe Virchow's Archiv. 1862.

muscular fibres of the gravid uterus is but a filling in (that is, a completion of the purpose) of one of the fusiform fibrils which make up the dense structure of the unimpregnated organ. Such increase of the proper tissue of the gravid uterus may augment its weight from one ounce to three pounds. The capability represented by this marvellous structural change is conferred by that provisional recurrence of tissue-renovation effected at each menstrual period, and which has already been described (p. 105).

The natural structural changes which take place in the ovaries and uterus represent a significant difference in the order which governs throughout the accomplishment of their respective duties. The ripe Graafian vesicle has, prior to its extrusion, undergone a process of advanced cellular organization never found in those intra-stromal ovules which still remain embedded in the substance of the ovary. This change is something more than a mere increase of growth or size; it represents an advance towards a new condition. It is the earliest indication of an heterogeneous development. Under favourable conditions, it may be elaborated into a distinct vitality, and determine the production of a new life. Hence the early activity of ovarian development for ensuring the establishment of perfect order in the functional co-relations, on which so much depends. The changes that occur in the healthy uterus during pregnancy are exclusively homogeneous. The virgin womb is simply a rudimentary organ of which the development is stayed; but with a special vascular arrangement,

adapted for the due supply, on any exigency, of material to carry out to the full its structural purpose. This condition of latent power in the unimpregnated uterus is in accordance with a law of the economy already frequently referred to; the provision of power being constantly in excess of apparent physiological requirements. Thus the heart beating seventy times in the minute, has a constant power equal, on emergency, to double that action; the muscles of the leg, when simply lifting the weight of the foot, may, if a slip occur, be suddenly called on to resist a strain two hundred times greater than that just previously thrown upon them. In these instances, and in many others, each tissue is constantly in perfect repair; and we judge its power, not so much by what it does, as by what it is always capable of doing. If the life of the virgin uterus were similarly ordered, with a wall-structure sufficient to lodge a fullgrown fœtus, the physical inconvenience which would result is obvious. Hence the development of the organ is arrested whilst yet in a rudimentary condition; but it is surrounded and penetrated by vessels peculiarly and exceptionally arranged to facilitate rapid progress of its growth, when occasion arises. These are the curled arteries (" capreolorum vitium instar eleganter intortæ," as Swammerdam describes and figures them), and the venous plexûs already mentioned (p. 37). I repeat that the changes which take place in the structure of the uterus during pregnancy represent simply a continuance of its growth until the organ attains that perfect development for which provision was distinctly made throughout the time of virgin life. This

a

view is assuredly more in accordance with that exquisite orderly arrangement which governs all the processes of life, than the bewildering suggestions which accredited the uterus as "miraculum naturæ". '-a microcosm-an animal within an animal; an organ undergoing extreme and marvellous changes, and such as to prohibit its consideration as merely an illustration of ordinary processes of nutritive development.

The practical applications of the distinctions thus drawn between ovarian and uterine purpose (a),—and considerations as to the important bearing which the order of uterine changes holds to certain modern views about its disorders (B),—may, more conveniently, succeed a mention of the proposed synopsis of diseases resulting from structural disorder.

I. CACOPLASIA.-Structural disease which is of systemic origin, where the blood itself is depraved and induces a resultant local disorganization—as in cancer and tubercle.

2. HETEROPLASIA.-Structural disease by which products in themselves natural, are developed in incongruent situations-as the hair and teeth in dermoid ovarian tumours.

3. HYPERPLASIA. 4. APLASIA.

Excess or deficiency in the reinstatement of particular component tissues, as in fibrous tumours and ulceration. The above division accords pretty closely with the order adopted in the previous chapter. Thus cacoplastic changes are of systemic origin. Heteroplastic developments principally affect the ovaries. Hyper- and a- plasiæ represent changes which chiefly occur in the uterus.