25 per cent alcohol, but about 53 per cent, thus getting a very appreciable disinfecting quality of the alcohol.

It is to the production of alcohol dew that Dr. Carossa mainly ascribes the excellent results of the method employed. Of course, if such a thing took place there would be by constant evaporation, a production of high per cent alcohol, and constant return flow of diluted alcohol from the mucous membrane of the uterus.

Unfortunately, this theory must be relegated to the fantastic, since an evaporation can take place only in a hollow organ filled with air, and such the uterus is known not to be. What little air is introduced with the gauze or the alcohol solution must soon be carried away through the cervical canal.

It is not in the province of this paper to go further into the learned and far-fetched arguments of Dr. C., which he thinks would prove the above-mentioned theory.

There are, however, several things about the method which recommend themselves to our consideration. There is by this method a possibility of keeping the genital tract clean by the use of non-poisonous antiseptic, and at the same time removing débris from the uterus, which would otherwise tend to leave material, and form a culture medium for germs.

We all know from our alcohol preparations that they will keep very well in a twenty-five per cent solution.

Since the whole uterus is filled with gauze we are sure to have by diffusion of the alcoholic solution, a penetration into the furthermost recesses of the cavity.

A further reason why I have employed it is, the possibility of its use in the houses of the poor, where the most primitive nursing only, can be had, and where, unfortunately, the disease is inost frequent.

The way I have used it in five cases is thus: I first cleanse the uterus in the usual way by curetage and irrigation, and then introduce into the uterus, an ordinary small-size soft rubber stomach-tube with an open end and a funnel attachment. This tube I take of the usual length as is used for lavage of the stomach. Near the funnel end there should be a clamp screw. The uterus and vagina are loosely but completely filled with iodoform gauze, the patient lying on her back and the perineum retracted with the speculum.

I now pour a twenty-five per cent solution of ninety-five per cent alcohol in water to the amount of 60 c.cm. into the funnel, and by slightly opening the clamp, allow the fluid to flow slowly, so that the smarting of the alcohol will not be felt by the patient too severely. As soon as the last part of the solution reaches the clamp, this should be closed down and the tube will remain filled so that a new instalment of the solution will not carry too large a quantity of air with it.

The accompanying drawing will show the relation that gauze and tube take within the uterus.

The addition of 60 c.cm. is done once in two hours. It will be easily understood how any attendant may carry out these simple instructions. The gauze is changed not oftener than once in three days, and may be left six days. This would depend somewhat upon the febrile condition of the patients. I have used the method five times with entire satisfaction. The treatment lasted anywhere from four to twelve days, and the term of pregnancy

from six to nine months. No alcohol poisoning was ever observed. At my suggestion, my colleague, Dr. W. E. Carroll, has carried it out successfully; once in a case of pelvic abscess, where he had done a posterior colpotomy, and the ordinary means of drainage failed.

A single illustration will suffice.

I was asked to see Mrs. M., an Italian, living in the surroundings usual to those people of the lower classes, with Dr. A. K. Baldwin, on the fifth day after her confinement. She had had several chills; high temperature (104°) and a correspondingly high pulse.

The treatment outlined above was carried out with the result that her temperature was normal six days afterwards, when gauze and tube were removed, the patient having a purulent vaginitis left, which rapidly gave way to the permanganate solution.

I wanted to report my experience with this, because anything that would enhance the simplicity of the treatment of this malady, deserves our attention and trial.

1002 Broad Street, Newark, N. J.

SOME OBSERVATIONS UPON VENTRAL FIXATION.*

HERMAN E. HAYD, M.D., M.R.C.S. ENG.

WITHIN recent years, the various deviations and displacements of the uterus have been corrected by operative measures, and, on the whole, with very satisfactory results. The Alexander operation and the various intra-peritoneal operations upon the round ligaments, have relieved and cured a great number of women hitherto doomed to more more or less chronic invalidism. So ventral fixation and ventral suspension, when properly performed in well-selected cases, bring their reward in comfort and happiness. However, an operation which forcibly fixes an organ in an unnatural position, cannot be ideal; but when nature's beautiful symmetry has been distorted by mutilation and disease, anatomically ideal procedures cannot be expected.

Much has been written on the influences exerted by these op

* Read before the American Association of Obstetricians and Gynecologists at Niagara Falls, N. Y., August 17-19, 1897.

erations upon future pregnancies, and it is by studying carefully these disappointments and complications that one narrows the field of indefinite surgical possibilities and its ever increasing failures and shortcomings to possible surgical triumphs.

Ventral fixation, or suspension of the uterus, coupled with the various plastic operations upon the cervix and vagina, is the only means surgically or anatomically, which will fix and support for future comfort and well-being, an extremely prolapsed uterus. Simply because that uterus sometimes offers a serious impediment to delivery, by interfering with the proper dilatation of the organ, is no reason why the operation must be relegated to oblivion; but, on the contrary, it should be employed to relieve that large class of suffering women who have passed beyond the child-bearing period and who most frequently are the victims of extreme procidentia uteri. In common with every operation, certain disappointments and unexpected shortcomings appear, but I am satisfied to the unbiased and unprejudiced there is less to complain about and to annoy in the future progress of these patients than any other class upon whom major operations have been performed. By some operators, indefinite nervous symptoms are attributed to the fixed uterus. An irritable bladder may result, or a persistent backache. But these vague symptome so often exist after various surgical operations in persons with neuropathic tendencies and with little nerve force, that we must not be too ready to accept them as evidences of surgical failure.

In my earlier operations, I used the buried silkworm suture, and had in view the necessity of thoroughly anchoring the organ in its new position, but I am satisfied that this course is not necessary. Suture material which will insure the safety of the organ in its new location for a few weeks, is all that need be looked for; because by this time sufficient adhesive union has taken place to hold it there. It was the fashion a few years ago to use catgut as thick as a whip cord, in tying the pedicle of a hysterectomy stump, or silk thick enough to fly a big kite; but this practice has been abandoned by many men because experience has demonstrated that No. III catgut is strong enough for the most important operations, and if chromicized, will be retained in situ as long as any suture material is required. Morris says No. 25 American gauge will remain ten days, and No. 20 twenty days. These sizes correspond to No. 1 and No. 3 catgut.

The Alexander operation has very properly appropriated many cases upon which many of us would have performed a ventral fixation; but I am inclined to believe that we are pushing the pendulum too far, and in our enthusiasm with the new are forgetting the splendid successes of the old. Of course, it should be the design of every operation to have the organ operated upon functionally strong, and the great advantage of the Alexander operation over its fellows is that it insures a movable uterus, and with its shortened ligaments is capable of undergoing the changes consequent upon pregnancy, like any other uterus with the capacity to hypertrophy and subsequent involution.

In cases of prolapse, and even procidentia, when the ovaries and tubes are healthy and future pregnancy is desirable, one can be reasonably certain that the organ can be retained in position and pregnancy not seriously incommoded, if the sutures which pass through the uterine body only take in their bite the visceral peritoneum and connective tissue and not the recti muscles and its fascia, as is done by many operators. In this way the uterus soon draws upon these thin structures, and makes a band much like a suspensory ligament, which permits the usual excursions of a normally poised organ. It is surprising how slight need be the band of attachment to the uterus and yet be sufficiently strong to hold the organ well forward, and be capable of resisting the intra-abdominal pressure under all circumstances providing the various plastic operations of the vagina and perineum have been properly attended to. However, careful judgment must be exercised in this class of cases because many of these women have marked procidentia, and are short and corpulent, and often have very large pendulous bellies. I think in these persons it is better to securely fix the uterus, and take the chances associated with possible pregnancy than fail in the operation. The band of adhesion stretches too easily when the abdominal parietes are lax and flaccid, and the heavy visceral contents may force the uterus even into the introitus vagina and still the organ may be attached to the abdominal wall. Such an experience I have recently had in a short, stout woman of forty years of age, in whom the uterus has fallen, and I am satisfied because I did not securely enough fasten it. I shall operate again shortly, but shall sew the uterus higher up, and get a good grip by taking in the bite of suture, the rectus, muscle and fascia. Hernia I have not found

the