III.—THE INFLAMED ULCER. THE indiscriminating association in modern works of the term "inflammation" with "ulceration" of the neck of the womb, has been, in my opinion, a real mischief to uterine pathology. Inflammation may or may not have preceded, or co-exist with, the ulcer; but in many cases presenting themselves to notice all active inflammation is long since spent, and a condition of mere atony and congestion comes to characterize the sore which once took a higher pathological degree. Of

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... his class is the fungous ulcer of my last article. The truly inflamed ulcer is, however, a common disease; and it is, as its ' ' -name imports, an ulcer itself the seat of inflammation, and seated on an inflamed basis. I am well aware that up to this time a very decided repugnance has been shown towards the classification of uterine ulcers, founded to a certain extent on the assumed little practical advantage of such distinctions. But :it is really of the greatest practical importance to distinguish the diphtheritic or the fungous from the inflamed ulcer, since the whole question of their cure turns upon the right discrimination of the mode of treatment proper for each; and in my judgment, the same remark applies to other phases of the ulcerative diseases of the os and cervix. The inflamed ulcer, in its most characteristic form, is more common in women under than above thirty. Taking that age as the middle period of uterine activities, the inflammatory .character of disease in this region begins thence slowly to lose its intensity, and gradually smks to the vanishing point soon after the cessation of the menstrual function. This is a mere general expression of the fact; there are, of course, many ex. ceptions. By the inflamed ulcer, I mean, an ulcer of the cervix, irritable, red, with small granulations, hot and tender to the touch, resting on a basis which is also red (though not 8o red), swelled, hard, and sensitive. In these marks may be recog. nised a state of inflammation which has sunk through the mucous and subjacent tissues (supposing the ulcer to have arisen as a result of laceration in pregnancy or from other causes), and pervades the general structure of the uterine neck; or, on the supposition of a centric origin to the ulcer, we are to regard the whole organ (the cervix) as affected with interstitial in. flammation and deposit, and the ulcer resting upon it and partaking of the character of its disorders. I believe the inflamed ulcer capable of taking origin out of either of these two conditions. The inflammatory process rises no higher than to the sub-acute, at which point it may remain stationary, with perio. dical exacerbations; and in process of time it begins to decline, and in the indolent ulcer we have the next stage of the metastasis. Between these phases of ulceration there are of necessity grades of transition, but this is, so far as I have observed, the most ordinary history of the disease. It is so much the less necessary for me to particularise the symptoms of this disorder, as they have been so often and so well given by others, and by none as by Dr. Bennet. My purpose is to establish the position of the inflamed ulcer, so that-as is most necessary and importantit may not be confounded with other and later aspects of disease in this locality. I shall therefore merely take down a typical case-such a one as just before writing this article has presented itself to notice, and while its features are still fresh to mind they shall be transferred to this page. The sufferer is twenty-two; is tall, thin, very pale, and has fair hair and skin; her face is drawn and anxious, and her general appearance is that of one much out of health. Her hands and feet are cold and wet with a constant clammy moisture. She has for several years been under the charge of physicians and surgeons, with only temporary relief. She has taken quantities of quinine, iron, and alum, but is wearied with perpetually recurring pain and weakness notwithstanding. She has most perseveringly used all kinds of injections, yet her leucorrhcea, her ache in the back, loins, and under the left breast, have never left her-have only sometimes been a little relieved. She was married at seventeen ; in a year bore one child; and from that date has never had a day's real health, and has had no other children. She has wearying pains in her limbs; and a perpetual thick, slightly yellow discharge, "very different from the whites." She stands in a peculiar lolling attitude, as if her body had lost all its stiffness, and she leans for support anywhere rather than transmit its weight to the pelvis. She has pain during and after intercourse, and much pain at the monthly period-the discharge, though scanty, being pale, and hanging about for six or seven days. She is weary of her miserable state, and begins to despair of a cure. A local examination was never instituted. To the finger the vagina is somewhat hot and tender: most hot at its two extremities-most tender at the cervix. The cervix is deeply lobulated; its anterior is separated from the posterior lip by a wide sulcus, as if in the childbirth it had been laterally torn open, and had never subsequently reunitedwhich is most probably true. There is a rough and granular feeling over a part of the cervix, which is hard, almost stony, to the touch. The os is open enough to admit the point of the ! finger, and the finger returns from the exploration bathed in thick mucus and stained with blood. The speculum has disclosed a state of the cervix which is truly pitiable. Of a bright brick-red colour, it projects its tumid and glossy lips into the instrument, and gives exit by the os to a rope of clear, yellowish viscid mucus, in the core of which is a drop of dark blood. An angry-looking ulcerated patch occupies both lips, studded with bright-red points, and terminating by a most distinct livid-red line, about a twelfth of an inch in diameter. Beyond this the cervix is inflamed, tumid, and tender to the touch. So far as the thick mucus permits the canal to be examined, it is seen to be very vascular, covered with small red granulations, which bleed a little when the cotton wool is used. The whole canal of the vagina is tender, and the instrument, though a small one, is borne with some impatience. The application of the caustic gives rise to a deep and overpowering pain, and an irregular, opaque, white mark indicates the extent of the ulceration. The heat, the greater degree of tenderness, the character of the mucous discharge, the colour of the cervix and granulations, and the tense and indurated character of the cervical structure, are the diagnostic marks of the inflamed ulcer, and they contrast strongly with the lineaments of fungous ulceration which were recently drawn in these pages.