ever, should one occur, I almost believe I would risk treatment by Dr. Forest's method, even though I could not make a clear diagnosis.

CASE II.-July 14th, in the evening, we were called to see C. S., æt. 3, female. The mother informed us that for ten days the baby had been suffering intensely, and that the physician who had been in attendance had been unable to give any relief. There had been some diarrhea, but most of each passage was mucus, with a little blood, accompanied by great tenesmus. The bowel also had been noticed to protrude during the attempts at stool, from onehalf inch to one inch, for the last three days. The patient was rapidly emaciating. The diagnosis being plain, the child was given a prescription of tr. opii camph. with pot. brom., to take until seen the next morning. In the morning, the mother stated that the symptoms had increased in severity. We had made the apparatus described by Dr. Forest, except that we had used a tube about five feet long. At the time the rectal part was inserted in the bowel the child was suffering intense pain. On account of length of duration of the disease, we thought it best to use a great deal of caution in the reduction of the tumor. On this account, and also on account of the great pain occasioned, the operation was a slow one, but at its conclusion the patient was calm and wanted to go to sleep. Our only instructions were to keep the child on her back, in this way hoping to avoid straining. On the morning of the next day the child was to all appearance well, but in the afternoon we were called again. On account of difficulty in finding a vaginal syringe small enough to enter the bowel easily, and yet strong enough to stand the pressure of the gas, we made use of the rectal tube, and were gratified at the ease with which it entered the rectum. The tumor was easily reduced, and after giving a sedative mixture we left orders to call us should anything untoward happen. Investigation soon after showed no return of trouble, and September 6th I heard from the case and it remains perfectly well.

CASE III.-C. M., æt. 6, female. The father of this patient was sent to us on Thursday, August 2d. He reported a condition similar to the last one, except that it had existed but about one day, the straining, mucous and bloody stools, and intense agony, all being present. To quiet the child, pulv. Doveri, gr. ij. each hour, was given till the case could be seen. The symptoms increased in severity, and at our visit, about 3:30, the suffering was intense. The bowel had not protruded, but on deep palpation a tumor was felt in the descending colon. The apparatus was used, and in a very short time the symptoms disappeared. The night, however, was a sleepless and painful one, and by morning the symptoms had returned. The operation was repeated with success, and morph. sulph., gr. ij., ad aq. menth. pip., ij., was left, to be given as needed, which proved to be each hour. On Saturday the operation was repeated twice, and

on Sunday once, the pain always returning in a short time. On Sunday evening, the child was comatose and cold, with all the signs of approaching death. A mixture of spts. ammon. arom., digitalis, etc., was given; whiskey, hot bottles, etc., were also ordered. At midnight, however, it was evident that a change was taking place, and by 6 A.M. the change was confirmed, the patient going rapidly on to recovery. When last seen, August 18th, the child was recovering nicely, and when last heard from, September 6th, no return had been experienced; the child was reported well.

This case also furnishes food for reflection. If, as reported, the case was of only one day's duration, why should we have the symptoms of collapse? Either the case must have lasted so long that ulcers formed naturally, or else the constriction of the mass was so great as to form gangrenous ulcers. The only history we could gain on this point was that the child had seemed to be uneasy for some days previous to the more aggravated symptoms. Whatever the cause may be, the difference between these cases is remarkable; the one which had been under treatment for ten days yielding without special trouble and the use of but one siphon, while the other, of but one day's duration, required three siphons and careful watching.

Prof. Ashhurst, in his article in the Am. Jour. Med. Sciences, July, 1874, on laparotomy for intussusception, tells us of the high mortality (86%, according to Leichtenstern) of this accident, and also of the percentage of deaths in laparotomy when performed for its cure. We ought to hail with joy any invention which will aid us in reducing the chances of accident, and hence the necessity of resorting to operation. Dr. Illoway, in the same journal, January, 1886, tells us of his force pump. It was a step upwards, but this apparatus of Dr. Forest, it seems to me, is still another step onward and upward, because it has the advantage of being easily procured, easily managed, of great or little force as required, very portable, and is also cheap, requiring but a little outlay and time to make it.

My changes in the apparatus may be unimportant, but they seemed to assist in results.

1st. The rectal tube being smaller, and yet very strong, is more adapted to the child's rectum, the vaginal syringe being so large is apt to occasion some pain, remaining, perhaps, af

ter the main trouble has passed away. The tube is to be wrapped in the same manner as the syringe.

2d. The longer tube; this I think is an advantage in that it allows the operator to be farther away from the patient than he otherwise could, and, as two are necessary to operate the apparatus successfully, the advantage is evident.

If the operation is begun slowly, the chances of success are better.

Of course, two cases are but little to boast of, but those two were, it seems to me, snatched from death, for which the instrument mentioned above deserves the praise.

Anesthesia is not necessary, but a sedative mixture after the operation is important.

These suggestions are offered, not in a spirit of criticism, but in accordance with the motto we all have in common: onward and upward.

CORRESPONDENCE.

THE DIAGNOSIS OF DISEASE OF THE UTERINE APPENDAGES AND THE INDICATIONS FOR "TAIT'S OPERATION."

TO THE EDITOR OF THE AMERICAN JOURNAL OF OBSTETRICS.

I AM much flattered by the remarks concerning myself and my work by my friend, Dr. Mundé, in the September number of the JOURNAL OF OBSTETRICS, but I trust he will forgive me if I put on record a gentle protest against one sentence in the paper, to the effect that "he appears to pride himself on not attempting to make the diagnosis with accuracy in those cases which call for removal of the uterine appendages, the so-called Tait's operation,' except through the abdominal incision."

I know not what in my appearance or my words could have sent Dr. Mundé off with a belief that I have any such pride. I have, on the contrary, a feeling of deep humiliation when I have to confess that I cannot diagnose the condition with accuracy before the exploratory incision, but this humiliation is tempered with comfort when I hear of the results obtained by those who pretend to perfect accuracy in pelvic diagnosis.

Had I known that Dr. Mundé was about to favor his readers with an account of what he saw, I should have taken care to supply him with full details, for without them I am sure his "Case XXIII." will be misunderstood and misapplied. The patient was 29 years of age, and was sent to me by Dr. Lidiard, of Hull, with the following history: She was single and had suffered from severe and constant pain in the uterine and ovarian regions ever since the commencement of menstruation, when she was fifteen years of age. When first examined nine months before, the uterus was found to be acutely retroverted; efforts were made to remedy this by extra- and intra-uterine pessaries, but they not only completely failed, but they made her worse. She was sent by Dr. Lidiard to a Women's Hospital, in London, where it is stated a small intrauterine tumor, about the size of a large currant, was removed, and she was again treated by pessaries, but was utterly unable to endure them. The patient was then sent to a Convalescent Home at Brighton, and returned after a time to Hull, worse than she had ever been. In his letter to me, Dr. Lidiard said, "She is prepared to have anything done that you like, since she is quite unable to earn her own living, being a dressmaker, and has no comfort in life. If you think it is a case you can do anything for, I should feel very happy to place her under your care." I saw her for the first time on July 14th, and I found that her menstruation was every three weeks; that it lasted for five or six days very profusely, with intense pain lasting all the time, from which pain she was never free, and that the pain was at its greatest intensity during the two or three days anticipating the period. The uterus was completely retroverted and there fixed. As this girl had to earn her living, it was perfectly clear that nothing but removal of the uterine appendages would benefit her, and this I did. I found the contents of the pelvis matted together, and the appendages were removed with very great difficulty, both tubes and ovaries being densely adherent, but on their removal, of course, they did not present any trace of these adhesions until they were placed in water, and I presume Dr. Mundé did not see them so placed. The patient went home early in August, and up to the present time she has had no return of pain or menstruation. She wrote to me to say that she is steadily improving in health and trusts that, if she goes on as she is now doing, she will be quite strong, and this, I believe, she will be in another two or three months. I am, etc.,

BIRMINGHAM, Oct., 1886.

LAWSON TAIT.

TRANSACTIONS OF THE OBSTETRICAL SOCIETY OF NEW YORK.

Stated Meeting, October 5th, 1886.

The President, DR. PAUL F. MUNDE, in the Chair. APPLIANCES FOR THE SUPPORT OF THE FEMALE BREAST DURING LACTATION.

DR. PARTRIDGE exhibited two forms of bandage, the aim of which was to give support to the breast during lactation. Both were rendered especially desirable on account of simplicity and the lack of exposure of patient in their application, such as attends the use

of strips of adhesive plaster or the roller bandage. The first is in use at the Maternity Hospital with the very best results.

It con

sists of a waist cut to fit over the thorax and under the axillæ, being pinned down the front, and then over the shoulders. A

1 For a more extended description of this bandage see Appendix to Cazeaux and Tarnier's "Obstetrics," 8th edit., page 1,077.