of tolerance. Stimulants, too, should be used freely. Keep the heart regular and as strong as possible by the use of digitalis, strophanthus and strychnine, the last of which should be given throughout the disease. Most authors advise the use of quinine in doses of thirty to forty grains in twenty-four hours. This is used both for its antipyretic and antiphlogistic properties. As a rule, the temperature can be reduced better by the use of cold water, either in the form of a sponge or full bath or in extreme cases by the cold pack. The temperatnre will be quickly lowered with the least disagreeable after effects and other symptoms will not be masked by its use. For this purpose, next to cold, I would place phenacetin. The general effect is much superior to any of the other coal tar preparations.

Since the great success of the diphtheria antitoxin, many are hoping for a revolution in methods of attack on the bacterial world. For some years enthusiastic bacteriologists have been working to obtain a serum from immunized animals that would overcome septicæmia. That they have produced an antistreptococci serum there is no doubt, but it has not been of so much assistance practically as all would hope.

I take the following extract from a paper read in May by Dr. B. C. Hirst of Philadelphia. There is a streptococci infection so virulent that the antitoxine will be of no avail, no matter how strong it may be. There is an indeterminable time in streptococcic infection when the serum will be too late. The antistreptococci serum has no antagonistic power over other pathogenic microorganisms. It is not easy to determine during life whether the infection is pure or mixed, though the majority of puerperal infections are due to the streptococci. Where

fore, the use of the serum must be more or less empirical. Finally, the clinical results of serum therapy for puerperal infection have not been, as yet, at all encouraging.

I would like to add the history of one simple case that illustrates what has been said.

Mrs. A., an American lady, with slightly contracted pelvis, anæmic, but otherwise in good health before delivery. With previous child she had tedious labor. At this time, pains began in the early morning and she was delivered by Elliot's forceps under chloroform of a nine pound girl at 8 P. M., Feb. 25th, 1896. No pains were spared to make everything aseptic. A large amount of meconium was discharged into the genital tract during delivery. Antiseptic douche was used after delivery of placenta. Her temperature ranged between 99 and 100% until the forenoon of Feb. 28th, when, during my absence, she had severe cramps in left leg. At 6:00 P. M. her temperature was 103.5; pulse and respiration rapid; expression anxious; very little tenderness over uterus. Gave an intrauterine douche of corrosive water; returned clear, bringing no shreds. The following day her condition seemed improved. Temperature 102; no pain or tenderness. In the evening her temperature was again 103. March 1st and 2d were very good days. She received an intra-uterine corrosive douche morning and night and seemed to be steadily gaining. I began to think her trouble due to inflammation of the breasts which the nurse had allowed to become distended with milk. But on the morning of March 5th she had a severe rigor and the temperature jumped to 105.5. The uterus was then large and soft but no severe after pains or purulent lochia. Notwithstanding this, I curetted thoroughly with a sharp instrument, and after the use of a

large antiseptic irrigation which brought away only shreds. of the endometrium, I introduced a tampon of iodoform gauze. In a few hours the patient seemed greatly relieved; the temperature dropped to 102 and the pulse became more regular. As every symptom seemed favorable, the gauze was left in place for forty-eight hours, and then replaced by a smaller quantity, the corrosive douche being used.

The cervix at this time, March 5th, was becoming more solid and this I believe to be one of the first indications of improvement. The constitutional treatment was nourishing and stimulating. The packing was repeated four times and then daily intra-uterine douches substituted, which in time gave way to the simple vaginal douche. Her condition rapidly improved and I dismissed her in perfect health March 14th, 1896.

The Operation of Shortening the Round Ligaments, Its Indications and Technique.

By E. H. Ross, M. D., St. Johnsbury, Vt.

Mr. President, and Gentlemen of the Vermont State Medical Society:

Any operation undertaken for the relief or cure of diseased conditions should have for its prime object the restoration of the parts to as near the normal condition as possible. This is true of Alexander's operation when undertaken for the relief of:

(1) Retroversion or retroflexion uncomplicated.

(2) Retroversion or retroflexion with prolapsed

ovaries.

(3) Retroversion or retroflexion with adhesions.
(4) Retroversion or retroflexion with prolapse of the

uterus.

(5) All cases of prolapse or procidentia.

My reasons for making the above statement can best be explained by considering for a moment the normal anatomical condition of the uterus as compared with the pathological conditions already mentioned.

The uterus normally is a freely movable organ, being suspended in the pelvis and held in position largely by its

ligaments, the utero sacral behind, the broad ligaments on either side and the round ligamenis and utero-vesical in front.

When from loss of the support of the perineum, due to its rupture in child-birth, or when the uterus from repeated congestions becomes too heavy, these ligaments yield gradually under the strain and the uterus sinks down in the pelvis, taking any one of the positions of displacement determined by the conditions then existing. Or the same result may be reached after child-birth, when the ligaments are relaxed, if involution does not proceed normally and the heavy uterus prevents the ligaments from regaining their natural condition. When this state of affairs is reached, the interference with circulation, and the innervation consequent upon it naturally tend to increase the difficulties and the woman begins to complain of all the symptoms with which you are so familiar. To relieve these symptoms, you must raise the uterus to its normal position and keep it there. This can be done sometimes by pessaries. pessaries are annoying and require frequent attention.

Let us see what takes place when the round ligaments are shortened. Starting as they do from the anterior superior portion of the uterus, they extend outward and forward, lying between the folds of the broad ligaments, to the internal abdominal rings, then on through the inguinal canal to become lost in the fatty tissue of the mons veneris. Now as they are shortened, by drawing them out through the inguinal canal, they lift the uterus upward and forward, at the same time acting as purse strings in the broad ligaments they shorten them as well and tend to lift the ovaries, if prolapsed, at the same time.