College, London. riRead before the Royal Medical aRd Chirurgicat Society, J#ncit 1:3th, 18-54.] THz following communication contains a record of observations-undertaken for the purpose of determining the extent to which the uterine organs suffer from syphilis, and the character and type of the ensuing derangement. It is s8arcely necessary to premise that such an inquiry is attended with many and peculiar difficulties. It is as difficult, on the one hand, to elicit a truthful narrative of facts

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... rom persons suffering from this disease respecting the history of their maladies, as it is, on the other hand, to determine the significance and relations of such facts, when truthfully obtained, to the many morbific influences with which they are associated, or by which they may have been preceded. The sufferers from syphilis are commonly those who have been exposed to the operation of many other causes besides syphilis, equally calculated to derange the uterine organs. Irregularities of living, sexual excesses, dissipation, destitution, and mental distress, are amongrst some of the most constant; and, where so many conspire to a common resuilt, it is difficult to assign the exact share of each in its production. Whilst, then, I believe that all inquiries undertaken with a view of determining the precise action of syphilis upon the uterine organs must to a certain extent be imperfect, I am yet not without hopes that some good may result from the attempt, and that a careful narrative of facts directed to this erd, if not immediately decisive of the question, will at least serve as a basis for further inrestigation. From the inquiries I have made, I am led to believe that the influence of syphilis in deranging the utcrine organs is more considerable than is commonly supposed, and that the various forms of uterine derangement which result from this cause are but little known to or recognised by the profession at large. It is, ho-wever, very far from my intention to disparage the many valuable researches which have been published in this branch of professional inquiry. The morbid appearances of the cervix uteri, becurring in connexion with syphilis, have been carefully noted and accurately recorded; the influence this disease has in disturbing the repioductive functions has received considerable attention, as also its effects upon the offspring, both immediate and remote. But many questions remain to be solved. The several forms of functional derangement of the uterus which follow upon syphilitic infection, and their relations to physical and vascular changes of the organ, have not, in my opinion, been either comprehensively surveyed, or satisfactorily determined; and it is upon these subjects that I have inore particularly sought for information. As already stated, my inquiries have not been altogether as conclusive as could be wished; but, believing that they have put me in possession of many facts, which are not only interesting in themselves, bpt important in their general relations to uterine pathology, I trust that no apology is necessary in submitting them to the notice of the profession. The cases upon which the present communication is founded are eighty in number. Nearly all of them occurred in the practice of the Lock Hospital; and, for the opportunity of making the necessary observations and in(luirics, t.am indebted to the kindness of the surgeons of that institution. The histories of these cases; the condition of the uterine functions, before and after infection respectively; and the physical. appearances of the cervix uteri, were in: every instance noted by myself, and, with few exceptions, in the presence of the house surgeon, to whom my written eport of each case was subsequently submitted for correc-ion. X hve stated this circumstance, becausm I am anxious to show that the record of facts embodied i this inquiry does not rest solely upon my own individual testimony, and that I was anxious to arrive at as truthful results as the nature of the subject permitted. Having thus collected all the facts I could rely upon, I proceeded in the next place to reduce them to a tabular form, placing under separate heads those relating to the syphilitic affection; to the state of the uterine organs before and after infection; to the physical condition of the cervix uteri; and to the state of the general health as observed in each case: and, from the tables so constructed, I proceeded lastly to deduce those general conclusions which it is the more especial object of this paper to submit to professional notice. With all the care that could be taken, I fear, however, that I have not avoided many sources of fallacy. As already stated, it is difficult to elicit the real facts of the case from persons suffering from syphilitic disease: nay more, there is often a strong motive for wilful misrepresentation; and many of the uterine derangements met with in syphilitic patients maywith reason be imputed as much to sexual excesses, etc., as to the syphilitic poison itself. Notwithstanding the magnitude of these difficulties, it does not appear to me that they should altogether debar the attempt. I have endeavoured to obviate some sources of error, by taking and contrasting the uterine history before and after syphilitic infection, rather than before and after prostitution. I have throughout closely questioned patients upon each particular fact hearing upon the inquiry, rejecting such as appeared to be doubtful; and I have endeavoured, by giving each series of facts in different groupings, according to the social condition of each patient, to allow of a distinction being made between the effects on the uterine organs of profligacy and intemperance on the one hand, and those of the syphilitic poison on the other. Believing the latter circumstance to be one of considerable importance to the present inquiry, I think it right to premise that, of the eighty patients whose cases I have taken, twenty-four were married, and fifty-six wvere single. Among the latter, it is reasonalble to suppose that intemperance, irregularity of living, etc., might have co-operated with syphilis in producing aiy uterinie derangements under which they may have suffer-ed; but, in the instance of the former, such influences would be less likely to have prevailed. With these preliminary observations, I proceed to observe that, of the eighty cases, in sevenity-two some form of functional derangement of the uterus was present, and in sixtyfour some physical abuormuity of the cervix was observed on ocular examination. I will proceed, in the first place, to give a detailed account of these lesions, as they respectively relate to function and structure. The former class comprehends lesions of enervation, menstruation, mucous secretion, and reproduction ; the latter includes lesions of the cervical mucous membrane, affecting its vascularity and integrity, and of the body of the cervix, such as hypertrophy and induration. I. LESIONS OF INNERVATION. It would appear that abnormal sensibility of the uterine organs is present in a large propi,i ion of cases of syphilis. Of the eighty I have collected. it was present in thirty-six; and of these, in twenty-four it occurred during the periods, in ten in the intervals of menstruation, and in two it was present both during and between the menstrual periods. The cervix uteri was found morbidly sensitive on tactile examination in ten cases; and of-these, in ninie this condition co-existed with uterine pain, either during or in the intervals of menstriuation. The social condition of the thirty-six patients in whom this abnormity was present is as follows. Of the whole number, eleven were married, and twenty-five were single. Of the twenty-four in which pain occurred during menstruation, six were married, and eighteen were single. Of the ten in whom it was present in the intervals of menstruation, three were married, and seven were single. The two patients