If there are clots, retained placenta or membranes, or any foreign growth present in the uterus, they must be removed by surgical interference, before uterine contractions can be effected and maintained. PELVIC PERITONITIS, PUERPERAL OR CHILD-BED FEVER. “There is a word of fear that I shall pronounce when I utter the name of Puerperal Fever; for there is almost no acute disease that is more terrible than this. The small pox itself, which reduces the fairest form of humanity to a mass of breathing corruption, can not be looked upon with greater dread. Child-bed fever, like an inexorable Atropos, cuts the thread of life for those to whom Clotho and Lachesis would give the longest span. “There is something so touching in the death of a woman who has recently given birth to a child; something so mournful in the disappointment of cherished hopes; something so pitiful in the deserted condition of the new-born, helpless creature, forever deprived of those tender cares and caresses necessary to it, that the hardest heart is not found insensible to the catastrophe. It is a sort of desecration for an accouchee to die.” Thus feelingly writes Prof. Meigs, of Philadelphia, of this disease, the very thoughts of which strike terror to the stoutest heart. This disease is an inflammation of the uterus and its peritoneal covering, and often extends to the entire membrane lining the abdominal cavity, and possibly involves all the pelvic viscera. The attack ordinarily commences from the third to the ninth day after delivery. Previous to this, the patient has seemed all right, when suddenly, often apparently without cause, she is taken with a chill. Rigors more or less severe extend up and down the spinal column. Clothing does not seem to impart any warmth. Almost simultaneously with the chill, periodical pains will be felt in the womb, and if there is not much constitutional disturbance, may be taken for _after pains_. Usually, however, they are accompanied by great soreness and tenderness in the pelvis; the abdomen soon bloats and becomes tympanitic; the legs are flexed to relieve the tension; the weight of the clothes, even, cannot be borne. The milk dries up, the lochia cease, there is headache, great thirst, increase of temperature, a quick, wiry or bounding pulse. All of these appalling symptoms are accompanied by great anxiety of mind and distressed expression of countenance. A dark circle forms about the eyes, which are sunken, the nose pinched, and the lips drawn, and the face is flushed or very pale. The course of this dread disease is extremely rapid. “It will not unfrequently happen that she shall die within thirty-six or forty-eight hours from the onset of the malady, and some cases terminate fatally even in eight hours. They are to be cured promptly or not at all. Such a malady as this hurries with hot and furious haste to a turn, beyond which there is not and cannot be any useful therapia.”