so small that I could scarcely get the tip of my finger through sufficiently to free the membranes. By firm pressure, however, on the fifth day after the expulsion of the fœtus I depressed the uterus and detached some small, partially decomposed masses.

Strict watchfulness was constantly observed. Antiseptic vaginal injections were used several times daily as long as any odor or discharge remained, and nothing more was done except to administer tonics and nourishment. She gradually regained her health, and in a month was riding out, and now looks well. She has menstruated twice since her recovery; at first the flow was black, thick, and offensive, but subsequently became clear and free from clots. There was nothing unusual noticed about her second period, and no hemorrhage occurred in the interval. Nothing has ever been seen of the retained membranes. The injections and all discharges were carefully watched and inspected, and nothing resembling the masses removed by my finger has ever come away. They may have become liquefied and passed without the knowledge of the patient. They may be there yet. I think neither theory is correct. Nothing was observed to come away, and the menstrual flow is now natural in color and quantity, and painless.

Especial attention is directed to the unusual effect of ergot upon the circular fibres about the internal os uteri in some cases of abortion in the early months. The pains produced by its administration in the case just recited were simply terrible. The patient was only six weeks pregnant. The os, which had previously been sufficiently patulous to allow the admission of the first phalanx of the index finger, with which the mass of membranes could be distinctly felt, was under the influence of ergot completely closed, and remained so for some time afterwards. The very means nsed for exciting more powerful uterine contractions seemed to be the cause of the failure to effect their expulsion. The circular uterine muscular fibres near and about the internal os appeared to receive the effects of the oxytocic first, and when the fundus and body of the uterus contracted, the advance of the contained mass was resisted, and the pains were intensified and rendered of none effect. I have noticed this fact in other cases. Noegerath has reported similar effects of ergot in abortion, in the American Journal of Obstetrics.

With my experience the retention of a small piece of placenta or membrane has been accompanied by increased flow which

was more or less constant, sub-involution, frequently by displace. ment on account of its increased size and weight, and the various other symptoms which naturally result from such condi

tions.

I have removed several placenta or parts of placentæ, and portions of membranes, months after a miscarriage, when the above symptoms had been observed. If the placenta is ever absorbed, this is possibly one of the cases.

This lady made a narrow escape. The error was in not persisting in the removal of the secundines immediately after the delivery of the foetus. There probably would have been some difficulty in their complete removal, but the pain and the risk would have been slight in comparison to the agony which she suffered from the effects of the ergot, and the risks of impending anæmia and blood-poisoning.

I can readily understand how we might feel justified in permitting delay in some cases, when there is great nervous excitement or exhaustion. These might, perhaps, better be allayed or overcome by appropriate treatment, keeping a most careful watch, in the mean time, for symptoms indicative of trouble, and acting promptly should they arise. Hemorrhage might have been so excessive as to make delay for a short time the wiser plan. The added shock of immediate removal might better be delayed until reaction had set in.

The point which I wish to emphasize, and which this paper is presented to emphasize, is, that the patient is not safe until her uterus is empty and firmly contracted; and that it is the duty of the attending physician to see that these ends are accomplished before he leaves the case.

The President of the New York Obstetrical Society, in 1878, when this subject was being discussed, said: "The sooner the uterus is emptied, the sooner can the physician feel that the patient is safe. If the cervix is not dilated, which is rather a rare occurrence, and there is no hemorrhage, it should be dilated at once, and the placenta removed." If left behind, and serious trouble ensues, the responsibility should be placed upon the physician, who knowingly left this secret enemy lying in ambush ready to spring at any favorable moment upon the fair and trusting patient, poisoning her blood, devouring her strength, and perhaps killing her outright. A septicemia once set up by the absorption of putrid material cannot always be relieved by its

speedy removal, and the vigorous use of antiseptics. It may be too late.

The general principle, then, of securing the complete and speedy removal of the contents of the uterus, and its firm contraction after abortion, I insist upon as the only safe practice. The rare exceptions demand the closest watchfulness.