{235} In the intervals between the application of iodine and the other remedies the hot-water douche should be used daily. When the hot water is administered the patient must be in the recumbent position. I am opposed to indiscriminately advising walking patients to use hot water, because, as a rule, it is not given as intended--that is, hot and in large quantity--and the object for which it has been recommended is not attained. The water is either used at too low a temperature or in too small a quantity, or both. When administered by the patient herself she becomes tired of the pumping and of the position which she must assume, and fails to keep it up during the length of time required for the injection of the quantity of water usually advised--that is, a gallon or two--and the constrained squatting position is of itself injurious. I believe that the long-continued use of hot water is followed by relaxation of the pelvic organs, and this would constitute another objection to the indiscriminate recommendation of this measure, for when it is placed in the patient's hands she is apt to continue its use for too long a period. The remedy is no doubt most efficacious in the treatment of these chronic cases of pelvic peritonitis, and great credit is due Emmet for introducing it to the profession. It should, however, be administered in accordance with fixed rules and under certain restrictions, and these I would class as follows: 1, the patient must always be in the recumbent posture; 2, she must not administer the injection herself; 3, the water should be at a certain temperature, which is best determined by the sensations of the patient. It should be used as hot as can be easily borne, and the temperature gradually increased during the administration of the injection, for the patient will be able to bear it at a higher temperature after the current has been flowing a few minutes than when the application is first made. I believe that the douche is better than pumping, as by Davidson's syringe, because the application is more likely to be thorough and the effect to be maintained longer, for even when the injection is given by the physician or nurse the hand is apt to become tired and the application stopped, for a time at least. It is the continuous application of the remedy which is beneficial. In other words, the organs should be kept as it were in a hot bath. For use in my private hospital I have had constructed a tripod five feet high, with a hook in the centre on which a bucket is easily hung. This bucket holds two gallons of water, and near the bottom is placed a stopcock, to which is attached a tube provided with a nozzle and stopcock at its distal end. The patient is placed on a bed-pan, which is modified after that devised by Meriman. The nozzle is then introduced into the vagina, and the stopcock at the bucket turned by the nurse, the water being at a temperature of at least 110°. The patient can then regulate the flow herself.