5. Order alternative hot and cold douches to be taken in the dorsal position. Use the fountain syringe only, with one quart in quantity-patient to remain in recumbent position for thirty minutes after taking.

The alternate hot and cold douche tends to cause contraction of the muscular fibers of the uterus and uterine ligaments, thus bringing about good nutrition and muscular tone, as is produced by electricity. The cold douches should be taken last.

6. Guard well and build up your patient's general condition. As to the special treatment of this case in hand, the patient should be placed in the genu-pectoral position and uterus replaced. This position should be well explained and taught the patient, with instructions to assume it three or four times daily, and at the same time open the vagina and allow it to distend with air, then to take successive long breaths and remain in this position for ten minutes, then gradually lie over on her side and remain quiet for awhile; thus a replacement three or four times daily is accomplished.

If the uterus or pelvic organs are very tender the organ should be supported with a cotton wool tampon made like this one I show you, and soaked in glycerine and rose water aa one-fourth, Lloyd's hydrastis one-half, placed directly behind the cervix; transversely two or three smaller pledgets are placed in front; these to remain for not over forty-eight hours, when they should be replaced by fresh

ones.

If patient can tolerate it a hard rubber Hodge pessary is better, as it allows the douches to be taken without its removal. This pessary should be fitted to the patient as follows: Measure, while in knee-chest position, distance from posterior wall of cul-de-sac of Douglas to inner surface of pubic arch; then the transverse width. This can be nicely done with dressing forceps. Having these measurements, select the pessary you wish and emerse it in boiling water till soft; then mould to suit the case by measurements taken. It should not give pain, and should scarcely be felt.

Now, this patient is suffering from subinvolution; so we will give her, in addition to a good tonic, fifteen or twenty drops of Squibb's fluid extract of ergot tid. and ten grains of potassium bromide in solution, the latter to be given after meals and to be continued till uterus is normal in size.

If endometritis exists, begin all treatment by a good curetting, and pack uterus with a long strip of iodoform gauze, to be removed on the third day.

The laws of antisepsis should be carefully carried out throughout the treatment.

Now in this plate, No. 4, we have a very interesting case, bringing out strongly another frequent cause for displacement.

Miss G, aged twenty-five, when twelve years old fell upon a steelyard hook, the hook entering the vagina and tearing the tissues badly, its course being upward and outward against the inner surface of the pubic bone.

Had been a sufferer in the long line of symptoms so familiar to us all, till she fell into my hands five months ago. On examination,

the condition you see here represented was found. The vesicouterine ligaments were taut; cervix fixed in its anterior and prolapsed position; uterus retroverted.

Patient placed in genu-pectoral position and uterus returned as far as practicable to its normal position. Then I began to stretch the vesico-uterine ligaments by daily pushing the cervix backward as far as she could tolerate, and after ten days of this treatment succeeded in getting it back sufficiently to use a figure-of-8-pessary, which she wore with comfort for one month, when length was increased till uterus was in normal position and freely movable.

The uterus was decidedly sinistro-rotated, and when pessary was removed would immediately return to its former position to a certain extent.

Thinking it was one of those cases in which Alexandre's operation would be of benefit, I operated and found that the hook, which entered the vagina on the right side, had torn out the round ligament, causing the sinistro displacement; so was compelled to sew up the wound and depend upon a figure-of-8-pessary to do the work.

(Continued.)

CLINICAL REPORT OF A CASE OF HEPATIC
ABSCESS.*

By A. J. BLOCH, M. D.,

Visiting Physician to Charity Hospital; Clinical Assistant to the Chair of Physical Diagnosis and Practice of Medicine, New Orleans Polyclinic; Assistant Instructor in Physical Diagnosis, Tulane Medical College.

My only excuse to read a paper before you this evening is prompted by a desire to furnish you with my unfortunate experience, which, probably, might be of some benefit to some of our members.

I was called on the 30th of March last to see a gentleman sent

* Read before Orleans Parish Medical Society, April 29, 1893.

from the country by his physicians to see whether surgical treatment would not be of benefit to him. Mr. B. was a native of Louisiana; his family history was free from tuberculosis or syphilis. Prior to January, 1892, he enjoyed excellent health, at which time he was first confined to his bed by fever and pain in the right side. After prolonged medical treatment he experienced no relief, and came five months subsequently to New Orleans. This proving of slight benefit to him he returned home, and again came to New Orleans, this latter time five months ago. Being discouraged, having experienced no benefit, he determined to return home and die. Whilst on the train he was suddenly taken with most violent pains in the affected side, and in another moment he coughed up what he supposed to be a quantity of blood, but which subsequently proved to be liver pus.

The diagnosis of his trouble was quite evident now; his general condition being so much below par, his physician at home placed him on cod-liver oil, quinine and a cough mixture. They did not attempt a free incision to remove the septic material, not knowing exactly where to locate the pus cavity. Thus his condition remained, constantly coughing up pus, continuous septic fever and great progressive emaciation.

Upon taking charge of his case I immediately explored and located a pus cavity in the right lobe of the liver. I could not make out any definite destruction of lung tissue. There was an abundance of râles; these, however, might have been due to accumulated pus in the bronchial tubes. Dullness was well marked at the lower lobe of the right lung. It was quite evident to me that a chronic pneumonia must have supervened from a constant irritation of the septic material coughed up. The day following my first examination I had him sent to the New Orleans Sanitarium, and on April 1, under chloroform, I resected the rib and made a large opening into the abscess cavity, removing fully one pint of very foul pus.

Fearing to irrigate under chloroform, as the cavity communicated with the lung and the water might clog up the latter and produce death from asphyxia, I packed the cavity with iodoform gauze and had the patient removed to bed. The patient rallied well;