as well as pain, particularly if the patient tried to assume the erect posture. I first saw this lady in July of the present year, and found the uterus somewhat enlarged, and externally irregular in form, from the presence of one or two small fibrous tumours in its body and fundus. But the os uteri was shut, and I could not ascertain if the debilitating hemorrhage was the result merely of the irritation of these tumours in the parietes of the uterus; or whether one of them, forming a polypus in the cavity of the organ, was its source. I wrote her medical attendant to dilate the os in order to determine this point; and she returned home to England. In September she came back to Edinburgh ; but, in consequence of the state of her health, I did not venture to dilate fully the os and uterine cavity till towards the end of October. On doing so, I was enabled to detect the rounded extremity of a polypus hanging down, into the cervical cavity. During two or three days it descended somewhat lower, but ultimately remained fixed and stationary above and within the os. I found I could not move it further downwards, by fixing a vulsellum into it, and applying some dragging force. On the 6th November, assisted by Dr Duncan, I applied a silver wire above the body, and around the neck of the tumour, by the instrument figured in Plate III. After the instrument was fixed and adjusted, a few turns of the screw made the wire cut through the pedicle of the polypus, and without any pain or suffering on the part of the patient. The separated tumour was then pulled, by the vulsellum, through the os uteri. The polypus was of the size and shape of a plum, with a small portion of the pedicle attached. It was fibrous in its internal structure. The patient's recovery was slow, but uninterrupted. She has menstruated once since the operation, but without the discharge being excessive, as formerly, either in quantity or duration (it lasted only three days); and also without her former distressing dysmenorrheal pains.

The instrument employed in the preceding case (See Plate III.),1 is a modification of one kindly sent to me by my friend, Dr Sabine, of New York. I am told it has been successfully used by various American practitioners for the removal of polypi in the vagina. The advantage which it possesses over the instruments of Niessens, Gooch, Davis, and others, in the removal of intra-uterine polypi is, that the screw power with which it is furnished enables us to use it with the power of a small chain-saw, for the immediate division of the pedicles of the polypi. And it is almost superfluous to observe, that if we can finish our operation, it will be much safer for our patient than leaving a rough instrument within the cavity of the uterus. The instrument itself consists of two parts, viz., two hollow canulæ, like those pertaining to the instruments of Niessens and Gooch; and of a second part, resembling the polypus instrument of Graefe of Berlin, with this difference, that it has a ring

'Plate III. shows the instrument alluded to in the text, for seizing and dividing the pedicle of a polypus. Fig. 3 represents the two canule as they stand after their contained wires have been passed around the pedicle, d (Fig. 3), of a polypus. Fig. 1 shows the instrument used specially to divide the pedicle; a is the ring of the instrument, into which the canule are slipped, and which is run up along them to the pedicle (d); e is the noose of wire by which the pedicle is encircled; b is the knob or button on which the wires are twistedit is made to descend along the linear slit f, by revolving the handle c. Fig. 2, shows the screw enclosed in the instrument (Fig. 1), with the handle C, and button b, in which it moves.