membrane, but to trust that any secretions of the wound might be led outwards or drain, as it were, along the thick silk threads, into Fig. 21.

Fig. 21.-Shows the Epithelioma at the Os; the Vagina dilated, the womb pulled down by a vulsellum. The three ligatures are numbered in the order of their application. En, is the point of entrance of my prophylactic ligature, Ex, its point of exit. The dotted line shows the amount of tissue which it encompasses. The other ligatures are represented loosely drawn together in the diagram.

the vagina where they could be readily removed. I believed also that in this way I could secure the best physiological, as well as mechanical rest to the parts and would not be obliged to remove sutures on the fifth or sixth day. I therefore, without placing any tampon of cotton or any drainage arrangement whatever into the vagina, had the patient carried to her bed and an injection of morphine administered. My orders to the nurse were no nourishment at all for 24 hours and only a little chopped ice to allay thirst. The temperature of the patient at no time during the healing process reached 100° with the exception of one afternoon during the 6th day, when she had a chill followed by a temperature of 104°, that lasted about three hours. The house physician sent for me hastily that day, but an examination showed nothing particularly alarming, about one-half teaspoonful of slightly bloody matter was found in the cavity of Sims speculum.

I will not weary the readers with a tabulated account of the daily pulse and temperature, but let the following resume give a short account of the healing process and after-treatment. During five days the water, used for injections, always returned slightly reddened to the bedpan but was not in the least offensive in smell. These injections were made three times daily and once about midnight. After this period there was a slight purulent discharge and about the eight day it became slightly offensive. About this time, also, a tender spot, in the right ovarian region, the size of a Fig. 22.

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Fig. 22. Shows the vault of the vagina partly closed by the stumps of the parametria or the broad ligaments. The three ligatures are all well tied and the ends hang down into the vagina. The Fallopian tubes and the broad ligaments are seen to come together and partly fill up the space which was left by the removal of the uterus. It becomes apparent that the small opening left in the peritoneal cavity between the ligated parametria will be obturated by a kind of valvular closure between anterior and posterior flaps of the vaginal fornix, and this kept in situ by the involuntary abdominal press.

hens egg, developed, which remained for ten days and then gradually disappeared. During this period the pulse ranged from 100-120 beats, but, as the patient had some old heart trouble, traceable to an attack of articular rheumatism during her youth, no conclusions could be drawn therefrom. On the 16th day the first ligature came away, its loop was found to be about the size

of a small lead pencil, the others gradually came away by the injections, which were reduced to only two per day, after the third week. The secretions now became very thick and of a yellow color. The patient left her bed, for the first time, on the 28th day, she gradually improved in looks, her appetite came back and she gained considerable in weight and left the hospital rejoicing on March the 13th. The vagina had completely closed up, there was no secretion at all, as there was no wound. The vagina ended in a blind sack, like the finger of a glove, and there was no hardness to be felt anywhere.

From this single experience I should be very much inclined to believe, with Billroth, that the operation of KOLPOHYSTERECTOMY will soon become as safe and well established in surgery as the removal of a breast for cancer. I must add, however, that this can only be true of such cases where the disease is confined to the vaginal portion or the os. This would postulate the very early discovery of the cancerous disease. Since visits to the Gynecologists office are fast beginning to take the place of "ladies fashionable morning calls" in larger cities of our country, we may cheerfully hope that the diagnosis of cancer of the womb. will be made in its earliest stages when this operation will find a large, hitherto unknown, field of usefulness.

The easy manner of after-treatment and, in fact, the slight shock, which my patient sustained by the operation, was a revelation to me and set me to thinking whether or not ovariotomy might, in some cases, be advantageously performed through the vagina. On January 6th I operated upon a case of cyst of the board ligament through the vagina, and although this case was followed by considerable inflammation and suppuration, which drained off nicely through the large opening into the posterior cul de sac, the patient has entirely recovered; I am therefore still more sanguine in my opinion about the vaginal method for removing small tumors of the pelvic organs, than at first, and I will take occasion, in the near future, together with an accurate report of the above mentioned case to give my reasons for this opinion.

Finally, let me say, I had so much reason to be pleased with my primary or rather PROPHYLACTIC LIGATURES en masse, that I earnestly recommend them to all surgeons who may have occasion to perform this operation. Any amount of time spent in the careful and proper adjustment of these ligatures will never

be regretted. When we compare the time consumed, or rather lost, in the very difficult and tedious application of ligatures to bleeding vessels in this operation, by the old method, with the time necessary to the application of my ligatures an enormous gain in their favor will be found.

The safety and certainty which is reached by this, almost bloodless method, is a great boon and relief to the operator and, no doubt will help reduce the percentage of mortality that still attaches to this curative measure. I am aware that complicated instruments and contrivances, for ligating the uterine arteries, have been described and suggested. They have been given up however as impracticable. The simplicity of my method lets me think that a better fate awaits it.

NOTE. Since the above operation I have constructed an instrument, for the purpose of drawing down the womb, which differs from others by being so constructed that it holds the womb firmly from within its cavity or canal.

At the same time it can be used to draw the entire womb to either side, so as to make the opposite parametrium tense and easily accessible for the application of my prophylactic ligatures. The instrument is also made with a view to allow of firm traction where the tissues of the womb are very friable.

An accurate description with cuts of this instrument will soon be ready for publication.

A SIMPLE REMEDY FOR THE DROPSY OF SCARLET FEVER.-Dr. P. Heuser writes to the Medicinal Zeitung, that with the following simple prescription, he has almost invariably obtained a cure in the severest forms of dropsy consequent upon scarlet fever, even in cases where internal remedies could no longer be taken. He rubs the region of the kidneys daily with a mixture of one part of ol. crotonis and two parts of ol. papaveris. A single application is sufficient, in the majority of cases, to produce a copious eruption within a few hours, which in turn is followed by marked improvement of all the symptoms. The application must be repeated if the distressing symptoms recur after a few days. Internally he uses small doses of Spts. Mindereri.

Correspondence

ARTICLE LXIX.

PUERPERAL FEVER.

EDITORS JOURNAL:-I had thought for a long time that I would contribute to the journal; but a busy life and a lack of command of language to express what I really think, have kept me from it so for. Besides that I am sorry to say I am not, and cannot be, entirely orthodox, the "authorities" being the standard, and therefore fear some gifted brother might feel that the honor of the authoritics required him to defend them against such a puny assault from an unknown, obscure "Country Doctor." Be that as it may I have had several years experience and can refer to "cases," and have always tried, in my humble way, to observe closely the course and effects of diseases. In doing so I have found many things which appeared very different to me from what is stated by the "authorities" of the same trouble, and have thought for a long time I would contribute my thoughts to the Journal on some of what I thought the more vital points, to see if others had come to like conclusions. In this country, through the winter season, we have a great deal of puerperal fever and as it is so vitally important, thought I would speak of it first. So far as I can learn, the "authorities" all treat of puerperal fever as an inflammation from the start, and direct the treatment for it accordingly. And they are pretty uniform in stating that nearly half of all genuine cases of "child-bed fever" will terminate fatally; treated after their recommendations I agree with them. When I graduated I had the "Inflammation" idea well ground in to me and began practice with the full belief that they were correct in treatment as well as diagnosis. The first two cases I had, I found no trouble in the diagnosis, for they had taught me but to well the symptoms and etc., and I treated them energetically and had the mortification to bury both cases. This, you may depend, set me to thinking, I recollected that both cases began with what appeared to be a moderate trouble that might be readily controled, that the fever almost intermitted, at least greatly remitted the first and second night, then became continuous and lasted until death, the fourth or fifth day.

I came to the conclusion that a fever that would subside so much after an exacerbation or two, ought to give way to quinine; the next case I had I gave quinine, during these remissions, but