the blood, hence several days elapse before the freezing point rises again to normal. In cases in which the heart perceptibly weakens the freezing point becomes still lower, and in fatal cases, when the heart gives out, the freezing point of the blood is extremely low. The lowered freezing point of the blood is apparently not due to deficient kidney function, but may be due to the inability of the kidney to excrete the excessive products of metabolism. The freezing point of urine in pneumonia is considerably lowered, more than would be accounted for by a mere concentration of normal urine. The chlorids excreted are diminished, on account of a lesser amount taken in (Sollmann). The quantity of the urine is decreased while the freezing point is lower, and this lowering is not due to chlorids but to metabolic molecules excreted. The freezing point of the urine does not rise to normal until after that of the blood, that is, several days after the crisis. The specific gravity of the urine is no accurate index of its degree of concentration. The freezing point of the urine bears no constant relation to that of the blood normally, for with a freezing point of blood at -0.54° C. the freezing point of the urine may be normally lower than in a case in which the freezing point of the blood is 0.57° C., or vice versa. NUX VOMICA IN HYPERCHLORHYDRIA.-J. H. Musser (Boston Medical and Surgical Journal, June 29, 1905) has found that in cases of gastric neurasthenia with hyperchlorhydria in which sedatives and acids, etc., have failed, large doses of nux vomica gave relief when administered in ascending doses. He begins with small doses, and increases until 40, 50, 60, or even 80 drops of the tincture are given thrice daily. It has been given with effect for a period of four or five months. In young subjects it should be given in much larger doses than in older persons. The beneficial effect of nux vomica does not turn on strychnine alone. There are other elements in the tincture which are of value. The drug should be given until physiological effects result, shown by slight stiffness in the neck and vertigo. Its dose may then be reduced five or ten drops for a while, and then increased again. It is best given before meals. GRAND RAPIDS THE PERFECT LIQUID-FOOD exhibits 50% Choicest Norway Cod Liver Oil with the Soluble Phosphates. PHILLIP'S EMULSION. Pancreatized. THE CHAS. H. PHILLIPS CHEMICAL CO., 128 PEARL ST., NEW YORK. THE SOUTHERN PRACTITIONER AN INDEPENDENT MONTHLY JOURNAL DEVOTED TO MEDICINE AND SURGERY SUBSCRIPTION PRICE, ONE DOLLAR PER YEAR BY ROBERT CALDWELl, m. d., nashville, Tenn. SHOULD I desire an excuse for presenting this subject to you to-night, I could find no better than the fact that it has been discussed so frequently and so extensively in medical literature. For any subject about which there is such a diversity of opinion we can at once draw the conclusion that none of them are correct. Retro-displacement is the most frequent abnormal position of the uterus which we meet in gynecological practice, and various authorities estimate that from fifteen to twenty per cent. of the women that come to the examining table have this condition in some form. With these facts before us, should we not be stimulated to some effort along this line? In order Read at meeting of the Nashville Academy of Medicine, Tuesday, Aug. 29, 1905. to arrive at a correct conclusion regarding this pathological condition, we shall mention some of the different opinions as to how the uterus is suspended. A great many regard the perineum as very important in the suspension; but Tate claims that the perineum has no part in its support, and cites the fact that when we have a completely lacerated perineum, the uterus is found occupying its normal position. Of course, when we have an incomplete laceration, the pressure upon the posterior wall of the vagina, making traction on the posterior wall of the uterus, will necessarily pull it over. Still others think the round ligaments have a part in the support. One of the latest ideas along this line is advanced by Dr. Coffey, of Portland, who thinks that the whole peritoneum, extending from the diaphragm to the pelvis, constitutes its support, and this appeals to me very much, if he will use the term peritoneum in a broad sense, allowing it to include the fibrous. tissue immediately beneath the endothelium which fastens the peritoneum proper to the abdominal wall. He illustrates by likening it to an object that has been pushed into the bottom of a closed sack, the sack covering about three-fourths of the object. This seems quite reasonable when we consider that the liver, which weighs three or four pounds, has no support other than peritoneal ligaments. Coffey also denies that the round ligaments have any part in this, from the fact that they are muscular tissue, and are not designed for continuous traction. I doubt if the supports of the uterus have as much bearing upon this subject-retro-displacement as is usually attributed to them, for it is possible for the uterus to revolve upon its transverse axis without descending to any appreciable degree. Doubtless many times we do find that there is descent, which should be considered one of the complications. The forces which retain the uterus in its normal position, which is slightly anteverted, are (1) the round ligaments, which act as guy ropes, holding it forward; (2) the utero-sacral ligaments, which hold the cervix back in the hollow of the sacrum, thereby tilting the fundus forward; (3) intra-abdominal pressure, which is exerted upon the posterior aspect of the fundus. We have always been taught that retro-displacement was the beginning of prolapse, but I do not think this necessarily the case, only to the extent that the long axis of the uterus occupies the same plane as the long axis of the vagina, and we have prolapse only after the retro-displacement has been in existence for some. time. For study, retro-displacements are divided into movable and non-movable, owing to whether or not the uterus can be replaced by bi-manual manipulation or without severing adhesions. Another division is complicated and uncomplicated, which I think conveys a very much more important idea to the mind; for upon this depends the treatment to be instituted, while the same cannot be said of movable and non-movable. A complicated retroversion is not necessarily immovable, but immovable is always complicated. So, then, the movable can be either complicated or uncomplicated, but very frequently it is uncomplicated. Whether or not all cases of retro-displacement give rise to symptoms, is a matter that has given ground for no little discussion. Theilhaber claims that many cases of simple, uncomplicated retrodisplacement give rise to no symptoms whatever; while Halban thinks that all cases produce more or fewer symptoms, either subjective or objective. The symptoms to which an uncomplicated retroversion may give rise are rather few. However, we may mention the most frequent ones: Headache, either occipital or vertex; heavy weight feeling in the pelvis, due to interference with return circulation; backache; pain radiating down the thighs; dysmenorrhea; and possibly some bladder irritation. The objective symptoms, metrorrhagia and menorrhagia, are frequently present; also some leucorrheal discharge. A great many uncomplicated cases of retro-displacement do not produce symptoms, but for the most part these are recent cases, and, as Montgomery says, after they have existed for some time, they become complicated by an endometritis or prolapse of ovary, at which time the symptoms appear; hence the symptoms are due to the complication rather than to the displace ment. Considering this fact, should we not treat every case of retroversion which comes under our observation, especially those cases that have existed for any length of time? Symptoms of the complicated variety are exceedingly variable, owing, of course, to the complication which may be anywhere from a slight to a very extensive and dangerous one. Consequently in this class of cases the symptoms may be so numerous within such a wide range that it would be almost impossible even to enumerate them. The most important sequelæ of retro-displacement of the uterus are, first, hypertrophic endometritis, due to the passive congestion produced by the twisting of the uterus on its axis, this, in turn, bringing sterility, because the soil is not in a healthy condition to receive the seed; second, abortion, due to incarceration of the fetus below the promontory of the sacrum, and also prolapse of the ovary, which is frequently the origin of a great many symptoms. The cases of retro-displacement in which we should be very guarded as to our prognosis are those which exist in nervous, neurasthenic individuals. These cases should be studied very carefully, and our mind thoroughly satisfied that the displacement is responsible for the symptoms before any line of treatment is instituted. While in these cases there are a few brilliant cures effected, yet a great many of them are never benefited at all. In order that we may succeed in the treatment of any given case, we should take into consideration the cause of the displacement before we outline the treatment. For instance, if we had a case due to sub-involution, and only displaced because of its weight, the treatment then would be to obtain involution, which, if accomplished, would correct the mal-position. The same would be applicable to a case due to incomplete laceration of the perineum ; when the perineum is repaired we can reasonably hope for restoration of the normal position of the uterus, provided the laceration had not been in existence for too long a time. The ideal treatment of posterior displacements is mechanical, but, unfortunately, it is only applicable to the uncomplicated va |