of Dr. Kidd, who kindly lent me the instrument, I determined to try Dr. Marion Sims' porte chaine ecraseur. The first step in the operation was to endeavour to draw the polypus partially through the dilated os; for this purpose a double hook was fixed in it, but the pedicle was so thick and dense that it was quite impossible to accomplish this; the hook, however, as it served to steady the uterus, was not removed till after the operation was completed; the end of the ecraseur was now introduced into the uterus, and I succeeded, without difficulty, in carrying the chain to the fundus, and consequently beyond the attachment of the polypus; but the moment I began to expand the spring blades the difficulty commenced, for the uterus, probably from its never having been impregnated, was most unyielding; and though I twice succeeded in expanding the blades, the chain on each occasion became displaced, and slipped off the spring blades, and I consequently failed to secure the polypus. I now made an effort to use an ordinary wire ecraseur, carrying the wire up by means of a gum-elastic catheter; this plan, however, failed also, and as it was evident that the patient would speedily sink from the effect of the hemorrhage unless we could remove the polypus, I had recourse to the canula of Gouch, and with them, though not without considerable difficulty, succeeded in passing a strong ligature of double whip-cord round the pedicle; once, however, applied it never slipped; and having been moderately tightened, was secured; the patient was greatly exhausted after the operation; some vomiting followed, which was checked by ice, and a tolerable night's rest was secured by an opiate enema. On the following and succeeding days the ligature was tightened, morning and evening; this was most satisfactorily effected by means of a small winch, which Dr. Beatty has most ingeniously adapted to the end of the connecting rod of the canula, and which, when sufficiently tightened, is secured by a screw; this worked admirably, and saved much trouble.

Five days elapsed before the ligature cut through the pedicle, and even then the polypus remained in utero. I succeeded, however, in extracting it with a pair of small forceps; it was then about the size of a large egg, but originally must have been much greater; in structure it proved to be purely fibrous.

The woman recovered slowly, but after the lapse of three weeks was able to return home convalescent.

This case, though presenting nothing very unusual, is instructive. We may consider the result eminently satisfactory; for, without

doubt, this woman would have died had the removal of the polypus been delayed but a few days longer: but the means by which its removal was accomplished were not what we would desire; for though the dilatation of the os was rapidly effected, my failure in applying, first, Dr. Marion Sims' ecraseur, and subsequently an ordinary wire one, compelled me to have recourse to the old and objectionable method of the ligature, an operation only justified by the urgency of the case-an operation always disagreeable, and often followed by dangerous and even fatal consequences. In the present instance not only was the inseparable accompaniment of a very fetid discharge present, but I greatly dreaded the occurrence of blood-poisoning or some low form of peritonitis, as the patient had more than one well-marked rigor, and vomiting returned almost daily. I therefore bitterly regretted my failure in applying Dr. Marion Sims' instrument; perhaps the failure was due to my own want of skill, but certainly

I did not give up the attempt till I was
perfectly satisfied that snare the polypus
with that instrument, I could not. The
instrument, though a very ingenious one,
is complicated, and in a case like the pre-
sent, where the vagina was very narrow
and the uterus extremely rigid and com-
pletely filled by a very firm tumour, its
application became simply impossible.
These circumstances led me to consider
whether a less complicated instrument
could not be devised, which would unite
to the great advantages attending the rapid
action of the ecraseur the facility of apply-
ing the ligature afforded by the canule of
Gouch: and it occurred to me that if the
extremity of the ecraseur were modified,
so as to allow the ordinary canula of e
Gouch to pass through it, we would have
a simple and efficient instrument. I have
had an ecraseur, so modified, made by
Weiss, and append a woodcut to exem-
plify its application. With the canula
a a, a wire rope, bb, of considerable
strength, can be passed round the pedicle

a

a

b

of the polypus; the canula are then to be passed through the opening cc in the extremity of the ecraseur: the ecraseur is then to be pushed up, guided by the canulæ, till it comes in contact with the pedicle of the polypus, filling the place exactly that the connecting rod of Gouch did in his instrument; the canulæ can then be entirely withdrawn, and the wire rope, being attached to the ecraseur at e and d, the operation is completed, as if we were using an ordinary wire ecraseur. If the engraving given here be compared with that in Dr. Gouch's work on Diseases of Women, it will at once appear that it differs from his instrument only in the substitution of an ecraseur for the connecting rod, but a great advantage is obtained in the power conferred by the ecraseur of enabling us to complete the operation at once, and thereby save the patient from the great dangers often following the application of the ligature in the old way: and I think if this simple modification of the ecraseur enables us to succeed in even but a moderate proportion of cases it will be no slight gain, and will prove a useful addition to our obstetric instruments. I am well aware that cases will be met with which will resist the action of the wire rope, or break it; but they are rare; and if a strong twisted wire rope be used where the pedicle seems likely to offer much resistance to the action of the instrument, they will prove still more so. In conclusion, I wish to add that I do not desire to depreciate the merits of Dr. Marion Sims' ingenious instrument; but it is too complicated, and I feel that it is inapplicable to many cases. Dr. Braxton Hicks' instrument, too, though possessing the advantage of simplicity, will often fail in carrying the wire rope round the pedicle if seated at a distance from the os, and will always be difficult of application. I think that the modification I have suggested, which in reality is the adaptation of the canule of Gouch to the ecraseur, will be found superior, at least in facility of application, to any yet made.

The following case illustrates how little inconvenience may, under certain circumstances, be caused by even large polypii-how slight may be the symptoms, and how nature sometimes effects a

cure:

I was requested by a nursetender to visit a woman, the wife of a cabman, who, she informed me, had been confined under her care three days previously, after a natural labour, of a strong wellnourished child. I found her to be a healthy robust woman, aged about thirty. She stated that when in the ninth week of this her

third pregnancy, having exerted herself to raise a heavy weight, she "felt something to give way inside" her, and immediately after perceived a tumour to protrude through the vulva; smart hemorrhage followed, but this soon ceased, and the tumour receded.

During the remainder of her pregnancy she continued to enjoy good health, and experienced no inconvenience unless she were to take a long walk, or make any unusual exertion, in either of which cases the tumour would again partially protrude, but it receded again on her lying down; there was also, on one or two occasions, slight hemorrhage. The midwife who attended her in her confinement, which appeared to have been rapid and easy, did not perceive anything unusual till, on the third day after delivery, she found a large mass protruding through the vulva-when, being alarmed, she came for me. I found, just as she described, a soft mass, of considerable size, lying in and nearly filling the vagina. At first I thought that was a portion of the placenta which had been left behind, it resembled it so much in appearance, but a careful examination proved it to be a polypus, which could be easily traced up to its attachment by a long and slender pedicle to the posterior lip of the os uteri; some hemorrhage followed the examination. As the woman was so recently delivered I thought it better to defer for a short time the removal of this polypus.

On visiting her again, after the lapse of two days, I found the pedicle shrivelled up, and the polypus itself beginning to decompose. I, therefore, divided the pedicle with a pair of scissors, at a distance of about half an inch from the os, and removed the mass, which proved to be a soft mucous polypus. The woman recovered without a bad symptom.

ART. VII.—A Comparison between the Accidents which have Occurred in Scutch Mills, and in Factories Subject to Government Inspection, as they have come under my Notice during the Eight Years of my Connexion with the County Down Infirmary. By JOHN K. MACONCHY, M.B., F.R.C.S.I.

IN the November number of the Dublin Quarterly Journal Dr. Babington, of the Londonderry Infirmary, has given some valuable information on the subject of the frequency of accidents occurring in scutch mills. My present object is to give further evidence on VOL. XLIII., No. 85, N. s.

F

this matter, and, if possible, aid in drawing attention to it, as I have no doubt there would be a diminution in the number and severity of accidents in these mills if they were subject, as far as practicable, to the same rules and inspection as factories.

Many of the accidents which have come under my notice have arisen from circumstances which improved machinery and due caution in management would obviate.

The worst source of injury and loss of life has been the use of the old wooden rollers, through which the flax has to pass several times; they are served from a narrow table, to which the flax is returned after passing through, and from which it is again started, so that the hands of the operative serving them are in frequent and close proximity to danger. The patent rollers used in most new mills are much smaller, capable of being completely covered, served from a table of over three feet long, and the flax has only to pass through once, and is delivered at the opposite end to its entrance, so that the operative serving them need never be in danger; and, owing to the small size and the fencing, even if he were caught, could not be so seriously injured.

Other sources of accident, such as carelessness in not giving due notice when the machinery is about being put in motion, want of proper fencing, and imperfection in the machinery, would come properly under the cognizance of a Government Inspector.

Apropos of imperfect machinery. I lately visited an old mill in which the handle for putting the rollers out of gear was held to a beam of wood by a holdfast; the removal of the holdfast occupied at least two minutes; and when removed the handle itself would not consent to stir; had a finger been caught in these rollers the arm would have been drawn in to the shoulders before they could have been stopped.

It often happens in these mills that the owners of flax, or their servants, help in the rolling of it, and not being accustomed to machinery, they are peculiarly liable to accident. Any means of preventing this practice would be most desirable.

In order to estimate the comparative frequency of accidents arising from the two sources mentioned in the heading of this paper, I have endeavoured to arrive at some approximation to the numbers employed in each, and for how much of the year they are so employed in this district. This infirmary receives all the accidents of consequence occurring in four factories, which employ from 2,700 to to 3,000 operatives constantly. In the same district there are now,