vagina that it was useless to attempt to keep it sponged away. It was therefore decided to pack the cavity to stop it.* This we did daily, as described by Dr. Taliaferro himself.

The improvement was marked as it progressed by a gradual decrease in the bleeding at each treatment, and in a few days by the appearance of pus, which gradually increased as the packing went on. Immediately following the removal of first few dressings there was very free bleeding, but this was of no moment, as it was quickly checked by the fresh packing.

We continued this treatment for eight weeks, at the end of which time there was not even a stain of blood upon the cotton as it came away. We subsequently found to our astonishment that we came near producing atrophy of the uterus, as that organ was just a little under the normal size for a multipara.

Case 2.-I report this case because of its most unfavorable condition for such treatment. In fact it was contra-indicated. The patient was a small Irish woman with a history of good health up to two years prior to the time I first saw her. Her trouble began with a miscarriage, complicated with bilateral laceration of the cervix and post-partem hemorrhage. She said the placenta was removed by the hand. The usual train of symptoms accompanying this laceration and sub-involution followed with occasionally an attack of peri-uterine inflammation. She had metrorrhagia for two months before I saw her, for which she was treated by another physician with tents. This resulted in peri-uterine inflammation and a very great increase of the bleeding. Tamponing the vagina was required to check it.

Though active inflammation had been going on, she bled until she was reduced to a sub-normal temperature when I first saw her. At the end of two weeks the inflammation had subsided, and an exploration of the pelvic organs was made. The uterus was nearly as large as an infant's head, almost filling the pelvic cavity. Some inflammatory deposits were in the broad ligaments, yet the womb was slightly movable. The cervical portion of

*"Just after the war" Dr. Taliaferro made a practice of packing the uterus with strips of cloth with a view to medication, but found that in a few hours they were invariably forced out. In the summer of 1882, I successfully dilated the uterus with cotton tampon for the removal of a fibroid polypus, three inches in diameter, without having the packing thrown out.

the os was three inches in diameter and very greatly congested. A slight brush would remove the epithelium and set up a profuse oozing of blood from the cervico-vaginal mucous membrane. The os and cavity was granular. The cervical canal and internal os were very much dilated. The lips were very much enlarged. The anterior lip was about the size of a black walnut and felt like a fibroid induration. During my absence from the State she had a recurrence of her menorrhagia, and I returned in time to check it just as it had increased to a hemorrhage that bled her almost to syncope while lying in bed. Her circulation was in a very feeble condition from the loss of blood.

I began the uterine packing at once, as she had no more blood to spare, guarding it with a vaginal tampon. Each treatment was followed by a decrease of blood and a corresponding improvement in strength. At first the uterine cavity seemed to dilate until I could pack three little soft twists of absorbent cotton about half the size of a lead pencil and about fourteen inches long into it. Then it began to give her pain—a bearing-down pain-for about two hours after its introduction. As the improvement went on the uterus contracted more firmly until finally it threw the whole dressing into the vagina. The blood had ceased to stain the dressing for three weeks, and as other evidences of disease had disappeared, I decided to leave the treatment off for a few days that I might determine the size of the uterus. This I found was normal, and as she refused an operation on the cervix, the case was dismissed, at the end of the fifth week, cured-all but the cervical rupture.

This case is interesting from the fact that such a large subinvoluted uterus was cured in five weeks, and from the fact that this treatment followed without detriment an attack of peri-uterine inflammation, while there yet remained inflammatory deposits in the pelvis.

Case 3. This case is an inmate of our infirmary and still under treatment. She is a large and corpulent woman, very anæmic, has been unwell since her last child-birth, thirteen years ago, and bleeding from the uterus for five years almost constantly. Slight exertion caused a great increase in the flow; she was

therefore confined to the bed a great part of the time. She gave no history of peri-uterine inflammation. The uterus was sub-involuted, and fully as large as a three-month pregnancy. There were large fungus granulations throughout the cavity extending to the external os. Deep lacerations of the cervix extended on both sides to the vaginal junction. There was great distress and soreness in the rectum, due to the presence of a hard ball of focal This mass was about the size of an orange, somewhat oblong and pointed at the lower extrenity. For thirteen months it had been presenting at the anus during defecation, receding to the sigmoid flexure when the bowel was inactive. The act of defecation caused great pain and distressing tenesmus.

matter.

A surgeon of acknowledged reputation visited her at her home in a distant portion of this State, and as she states made a diagnosis of fibroid tumor of the uterus and stretched the sphincter ani. The day of her entrance to our infirmary, I pressed the mass down in the pelvis with one hand from above the brim, and by the aid of my finger and ox-gall enemetas completely cleared the rectum. This put an immediate end to the painful defecation. The following day we began the intra-uterine packing with little rolls of cotton about half the size of a lead pencil and about fifteen inches long. One of these was passed through the patulous canal into the cavity of the uterus to the fundus, and this followed by others until the whole organ was filled up, and then a firm tampon was placed in the vaginal vault. This latter caused some pain from pressure upon the sore rectum, but the soreness rapidly grew better.

Day after day this treatment was carried out, gradually increasing the length and number of the little cotton twists that were placed in the womb. As the first few dressings were removed the blood welled up from the uterus like a little spring. It was indeed alarming to persons not accustomed to such sights and treatments, but it was promptly checked by the fresh packing, which was ready to be introduced as soon as the old one was withdrawn, no blood of any consequence was lost. This was repeated at each treatment, but in a less degree, until