uterus and the right side of the pelvis. The mass appears to be about the size of a large orange and on pressure a sense of fluctuation can be elicited. This is confirmed by vaginal examination, FIG. 3. CASE I. Portion of omentum adherent over abscess removed. Cavity drained with rubber tube. Intestinal adhesions left undisturbed. the uterus being markedly enlarged and fixed in its normal position. The blood count showed 15,000 leukocytes with 80 per cent. of polymorphonuclear cells. Vaginal and cervical smears negative for gonococci. This patient was operated upon on February 29 by median incision. The right cornu of the uterus was the site of a single large abscess which was surrounded by extensive adhesions of intestines and omentum (Fig. 1). The adhesions of the omentum were freed and the omentum divided between catgut ligatures (Fig. 2), that portion immediately over the tumor being left undisturbed until the intestinal adhesions were freed sufficiently to permit of the walling off by bolsters of the field. of operation. As the right tube and ovary were both involved in the inflammatory process and were considerably damaged by the separation of the adhesions, they were removed. The abscess cavity was drained by a large rubber tube and the neighboring peritoneal area by two cigarette drains, the three drains being brought out at the lower angle of the wound. This patient ran an irregular temperature for six weeks after the operation, but at that time was discharged well. Pelvic examination before discharge showed that the uterus had returned to its normal size and was freely movable in the pelvis without pain or tenderness. CASE II. Intramural abscess (streptoccccus) at right cornu six weeks after normal delivery, incision, transperitoneal, suprapubic drainage, recovery. Mrs. M. W., primipara, twenty years old, was admitted to ward 23, Bellevue Hospital on March 10, 1910, with the following history: Six weeks prior to her admission to Bellevue Hospital the patient was delivered normally of a full-term child without complications of any kind. She remained in bed for two weeks, but on getting up began to suffer from a constant pain and soreness in the right lower quadrant of her abdomen. This pain continued for two weeks when she went to the Women's Infirmary where she was put to bed and an ice-bag kept over the tender area. She had no discharge and no chills or other systemic disturbances, but was informed that she had an abscess which needed opening and was sent to Bellevue Hospital. On admission her physical examination is negative except for slight tenderness without muscular spasm over the right iliac region where a mass about 4 inches in diameter can be felt, which is fixed to the uterus and pelvic wall. The vaginal examination shows the right fornix lessened by a mass from above which extends into the posterior fornix. This mass is hard, very tender, and gives a sense of deep fluctuation. The uterus is somewhat enlarged and fixed with the mass in the pelvis. A blood count shows a leukocytosis of 23,000, 83 per cent. of which are polymorphonuclear cells. Vaginal and cervical smears are negative for gonococci (Fig. 4). Operation March 13. A posterior colpotomy was made but no pus was found. The abdomen was then opened by median incision. The omentum and intestines were found adherent to a mass which reached to the anterior superior iliac spine. The omentum and intestines being freed an intramural uterine abscess was revealed, involving a greater part of the anterior wall of the uterus. The pus was evacuated by a free incision and drainage (transperitoneal and suprapubic) was established by means of the rubber tube and cigarette drains. The drains were FIG. 4.-CASE II. Intramural abscess involving greater part of anterior wall of uterus. removed on the sixth day, the sutures on the ninth day, and the patient was discharged on the twenty-fourth day, well. CASE III.-Puerperal (streptococcus) intramural abscess in left upper anterior portion of uterine wall dissecting anteriorly between the folds of the broad ligament to pelvic wall. Incision, drainage, recovery. FIG. 5.-CASE III. Abscess in left anterior portion of fundus of uterus Mrs. M. B., eighteen years of age and mother of two children, was admitted to ward 23, Bellevue Hospital on March 14, 1910, with the following history: Her first child was born nine |