who oppose "venesection in the convulsions of pregnant and parturient women," to say that it was merely the custom or fashion of that day for a pregnant woman to ride miles in a springless wagon or go on foot to see her physician on account of severe headaches or perverted vision, which symptoms were almost invariably relieved by the loss of more or less blood.

I need not give details of other cases of a like character, which occurred during our copartnership, although "their names are legion," but shall describe a few, the treatment and responsibility of which devolved upon me alone, as for some years death has deprived me of the society and advice of one of the most judicious and conscientious physicians I have ever known.

Mrs. McC. had lived the life of a celibate until she was thirtynine years of age, when she married. She was a large, muscular woman, weighing one hundred and seventy pounds. At fortyone she became pregnant.

When eight months advanced, and after suffering from excruciating headaches at times for weeks, she was found, as I was informed, upon the floor, at 10 A. M., in an unconscious condition, "with purple face and frothing at the mouth." I was immediately sent for, and I saw her in thirty minutes. I then found no spasmodic movements. She was not fully restored to consciousness, but she was able to tell me that she had been "suffering throughout the night from pain in the back of the head." The pulse was irregular both in frequency and volume, although quite incompressible.

While trying to elicit more information, I noticed an increased hesitancy in her answers, which was soon followed by spasmodic twitchings of the muscles of the face, with slight strabismus. She was then sitting in a chair. Knowing that a convulsion was near, and as the bed was some distance away, I suggested that she be immediately laid upon the floor, with the head elevated. By that time she was generally convulsed. Chloroform was at once used, for at that period (1860) I was in the habit of using it frequently and always carried it when going into the country. With cold to the head, and chloroform, the spasmodic symptoms began to abate, and were followed by the usual stupor, loud and laborious respira

tion, with frothy mucus issuing from the mouth. After waiting half an hour, and discovering no change in her intelligence, with the same irregularity of the pulse, I opened a vein, intending, if possible, as I had done in another case of a like character, to lessen the volume of blood and prevent stasis sufficiently to enable the heart's action to become regular. Having made a larger opening than usual, twenty-six ounces were lost before a satisfactory condition of the pulse was obtained, when the complexion and breathing began to improve. While the patient was in this condition, I made a vaginal examination and found the os uteri unchanged. Consciousness returned sufficiently to enable me to ascertain that she had had no uterine pains. I then administered a dose of castor-oil and turpentine, to be repeated, if necessary, in two hours. She was placed in bed, and I left her at 2 P. M. with no indications of convulsions, promising to return in the evening. I saw her at 8 P. M., in a comfortable condition, she having had a quiet sleep of one hour. I saw her again the following morning, and notwithstanding that, at some time during the night, the bandage had become loosened and she had met with another loss of blood, she appeared quite well and cheerful.

After the necessary advice, I temporarily discharged her. Three weeks after, labor-pains came on. I saw her soon after, and, without giving details, which would extend the history to too great a length, I can simply say that the patient's life, as I believe, was saved only by another loss of a less amount of blood for the relief of a severe headache, and by chloroform and craniotomy. Her recovery was uninterrupted.

I desire to report, in addition, the following case:

Mrs. B., a primipara, aged twenty-four, of slight figure, was taken in labor at 3 A. M. I saw her about daylight and found labor progressing well. The child was delivered at nine o'clock the same morning. No unusual complaint had been made, and, from what I learned from her, there had been no functional derangements of importance, and she was cheerful and happy. After remaining with her for more than an hour, I left for home.

At 12 M., after having asked her mother, "Have I got to have my baby yet?" notwithstanding that it had been given to her after being dressed, and receiving a reply, she had a severe con

vulsion, which was epileptoid in character, as far as I could judge from the description given to me upon my return at 2 P. M. I learned that consciousness had returned to some extent as the paroxysm subsided.

As I sat down by the bed, she was again convulsed, this time with bitten tongue. I then prepared some chloral and bromide of potassium for administration when she became able to swallow, and administered chloroform. The patient appearing to be fraggile, with a pulse exceedingly rapid and not very incompressible, the question of venesection was not seriously entertained. Although consciousness had not returned, yet I was able, with some difficulty, to give twenty grains each of chloral and bromide of potassium. Notwithstanding the administration of the above agents and the use of chloroform and morphia, the convulsive seizures recurred once in seventy-five minutes, almost to a minute, throughout the afternoon. The pulse was distinctly to be counted at the rate of one hundred and seventy beats per minute.

Toward evening, as death seemed inevitable, I determined upon venesection in case liberal doses of Squibb's fluid extract of veratrum viride, in connection with the other treatment, should fail to lessen the heart's action and prolong the interval between the convulsions.

Until 2 A. M. the following morning, I jeopardized this patient's life, as I afterward thought and now believe, fearing, from her delicate appearance, her inability to bear up under the loss of blood. She weighed only one hundred and five pounds.

After despairing of saving her by other means, and fearing that my delay had been disastrous, I opened a vein, making a large orifice, immediately after a convulsion. Watching closely the pulse of the opposite wrist, I noticed, after the loss of about twelve ounces of blood, that the beats became slower and fuller, being still sufficiently firm. I allowed the flow to continue, as the heart's action seemed to encourage it, until twenty-five ounces had been lost, when the pulse numbered one hundred and twenty-five distinct, full, and soft beats. Everything then seemed suddenly metamorphosed. Instead of the purplish hue of the face, with stertorous breathing, the skin became somewhat pale and the breathing quiet, and pulse remaining as last stated. I then gave half a grain of sulph. morphia, applying it to the tongue, and determined

to wait for the rest of the seventy-five minutes to elapse. I continued to wait until 6 A. M., when a slight and last convulsive seizure occurred, making twelve in all, the first eleven of which, although I did not witness the first, were the most terrifying of any I had ever before looked upon. The mental condition continued unchanged until the following evening, forty-two hours after the first seizure.

So confident am I that the free bleeding saved this patient's life, that, had she died while I was dabbling with medicinal agents, I should have considered myself responsible for the fatal result. When such a complete change in symptoms takes place after fourteen hours, produced mainly by the loss of twentyfive ounces of blood, no anti-phlebotomist can be so prejudiced as to ascribe the improvement to any other agency.

I saw this patient not many weeks since, when she told me that she had not the slightest knowledge of my having been her accoucheur or of having given birth to a child. She facetiously remarked: "I only know that this child is mine because my mother told me so." She has never been pregnant since, twelve years having elapsed.

Mrs. W., aged twenty-three, primipara, unusually small in stature, and weighing ninety pounds, was taken in labor during the night, and I was called at 8 A. M. I had not seen the case, although engaged to attend her, but had insisted, among other things, upon having a specimen of her urine for examination at about the eighth month of gestation, or before, if certain symptoms were present. My request, however, was disregarded.

I found her very generally ædematous, even to the vulva, having been unable to wear her shoes for several weeks. The urine was scanty, and the skin pearly in color, but there was no complaint of headache. I tested the urine passed that morning, and found twenty-five per cent. of albumen. Although she appeared to be feeling very well, I feared trouble, and gave her one ounce of Rochelle salts.

The pains gradually increased, and, although the surrounding temperature was very high (it being an August day), there was no thirst or suffering from the heat of the weather.

Her invariable reply when spoken to, notwithstanding the severity of her pains, was, "I am very comfortable," which will be accounted for further on. Labor progressed fairly well during the forenoon. The bowels moved at 11.15. At 12.30, when spoken to, she said: "Doctor, as it is dark, I think you will need a light." When asked if objects in the room were not distinctly visible, she made no reply. She soon had a violent convulsion. It being impossible for me to protect her tongue, it was severely lacerated, causing considerable hæmorrhage. To epitomize as much as possible, I may state that chloroform, chloral, bromide of potassium, and morphia were used as my judgment dictated. Her intelligence and speech were entirely abolished. There was much jactitation throughout the afternoon. At 6 P. M., after another convulsion, making four up to this hour, I was unable to detect the fœtal pulsations. Labor was not progressing satisfactorily in view of the complications, the perinæum was intensely rigid, and all the tissues were unusually infiltrated.

I believed the case would terminate fatally if the patient were not delivered as soon as possible. A resort to craniotomy seemed to me the proper course to pursue. After laying the question before the husband and mother, notwithstanding their great anxiety for an heir, a ready acquiescence was given. After the most tedious and exhausting operation of the kind that I had ever made, the child was delivered at 7.30 that evening. From this time up to 11 P. M., no convulsion occurred, but no other favorable symptom could be discovered. At this hour, there being not the slightest relaxation in treatment, an increased restlessness was observed, which soon culminated in a general spasm, although chloroform had been used early. From that hour, the clouds seemed to thicken around us, and, being completely jaded, I asked that a young medical friend be called in to aid in carrying out whatever course I might think it necessary to adopt.

From 11 P. M. until 2 A. M., notwithstanding every effort on my part, three more convulsions occurred. The pulse, for an hour or more, had been irregular, being at one time very rapid, at another preternaturally slow, which character I had never, in puerperal eclampsia, failed to change by venesection.

To my faithful young friend I said: "If venesection, with the remedies we have been using, will not save this patient, there is