of the vagina is a very difficult matter. This canal should be first douched with a sterile normal salt solution, and then scrubbed with tincture of green soap by means of pledgets of iodoform gauze held in long dressing forceps, the walls being widely separated by Sims's speculum or the fingers, after which another douche of normal salt or creolin solution should be given. Bichloride should never be used in the birth-canal for the reason that, as Steffeck has shown, it has no effect, even in 1 to 1000 solution, upon the bacteria present. It forms an insoluble albuminate with the secretions and damages the epithelium so as to greatly decrease its resisting power, and thus it increases rather than diminishes the danger of infection. Futhermore, intense poisoning has followed its use. When an antiseptic is indicated in the vagina or uterus creolin is the agent to be preferred, because it is unirritating, non-toxic, and just as effective as any of the others. LUBRICANTS. The vaseline jar of the general practitioner is often to the lying-in woman a veritable Pandora's box, out of which come a variety of ills. In normal cases of labor, lubricants are never necessary, and the sooner they are abandoned the better. Lard should never under any circumstances be employed. If a lubricant is used, it should be perfectly sterile material, such as boiled sweet oil, or a five per cent. creolin solution in boiled water. THE NURSE. As the success of an operation largely rests upon the preparation and after care of the patient, no obstetrician who has his own reputation and the interest of his patient at heart will consent to treat a case unless he has the selection of the nurse. She should be intelligent, conscientious, and thoroughly reliable and be fully alive to the importance of asepsis in every detail, and well trained The in carrying it out. Unless she is all this the most skillful operation and the most elaborate technique will prove an utter failure. Every aseptic precaution observed by the obstetrician applies with even greater force to the nurse, for she comes in more frequent contact with the woman, and if she touches her with unclean hands she is just as apt to infect. The nurse should see that the environment of the lying-in woman is clean: that is, that the bed, the dressings, the guards, bandages, wash-cloths, and utensils are aseptic. The clothing of the lying-in woman should be freshly laundered, and during operations the field of operation should be surrounded by sterilized towels and fully exposed to view. The bed should be prepared with sheets just from the wash. Dressings are prepared by steaming in an Arnold sterilizer or baking in a common oven. guards for the vulva are made by cutting a piece of cotton batting twelve inches long, four wide and half an inch thick and folding it in a piece of cheese cloth of a little larger size. These are rendered aseptic by baking for half an hour in an oven or steaming for the same length of time in a sterilizer. The vulva pads should be changed frequently and always burned after removal. Cheese cloth is a valuable material for use in the lying-in room, as it is cheap and easily rendered aseptic by boiling in soda solution. Those physicians who aspire to be specialists in obstetric surgery should keep their dressings and instruments packed in some portable sterilizer always ready for immediate Booth's sterilizer is very convenient for this purpose. Precision in diagnosis and asepsis in technique is the key-note of the great advance that obstetric art has made during the last quarter of a century, and the obstetrician, in order to measure fully up to the responsibilities that now devolve upon him, must ever remember that the price of safety is eternal vigilance." use. THE INDUCTION OF PREMATURE LABOR IN THE INTEREST OF MOTHER AND CHILD. BY EUGENE R. CORSON, B.S., M.D., SAVANNAH, GA. The two following cases seem to be of sufficient interest and significance to suggest some thoughts on the above subject. Mrs. N., aged twenty-two, primipara, about eight months gone, sent for me on account of dimness of vision and violent facial neuralgia; she could not recognize her husband across the room; the urine had a sp. gr. of 1010 and showed by volume 25 per cent. albumin; there was some anasarca. She was at once put to bed, on a milk diet exclusively, and free catharsis by salts. By the end of three days the general swelling was relieved, but the eye symptoms and the neuralgia continued; vision had become so bad that she could not recognize any one at the foot of the bed; the fetal heart sounds were strong and regular, and the position of the child was O. D. Ant. Under strict antisepsis, a large flexible bougie was introduced into the uterus. Labor began in twenty-four hours, and in eight hours the patient was delivered of a healthy female child, apparently a little over eight months. The labor was in every way normal and the convalescence uneventful. The child is now six months old and has not had a day's illness. The mother's urine still contains a trace of albumin; the eye symptoms were gone by the end. of the second week; otherwise she seems to be in perfect health. The second case is an entirely different one. On Sep tember 1, 1895, I was called to deliver Mrs. C., aged twenty-five, primipara, short and stout, though with every appearance of health. The position of the child was O. L. Ant. I had previously examined her pelvis, and found the following external measurements: Intertrochanteric diameter.....11 inches The pains started at 8 p.m., and became rapidly very severe, the cervix dilating well and the head coming down to a certain point where it suddenly stopped. The pains continued severe and frequent up to 3:30 a.m., when they became less and almost stopped, the head of course making no further progress. At 4:40 a.m., I gave chloroform and easily applied the forceps. I found the head very tight, however, and only after great efforts for twenty minutes brought it down to the perineum. I pressed out the head without any perineal tear. The child was dead. I made the following measurements of the child's head: Occipito-frontal circumference....16 inches. Mother had an afebrile convalescence. The child evidently died from cerebral compression. Patient again pregnant the following year. On December 21, 1896, I brought on labor about three weeks before the completion of the ninth month, by inserting a flexible bougie between the membranes and the uterine wall. The fetal hearts sounds were very strong; child in the first position. Inserted the bougie at 11 a.m.; labor began at 12 m. the day following; expulsive pains began at 5 p.m.; head born at 6:30 p.m.; placenta delivered at 6:38; child a vigorous male, about three weeks premature, weighing six pounds. The diameters of the child's head Neither mother nor child have had an untoward symptom since delivery. The first case clearly called for the induction of premature labor. The severe eye symptoms were quite enough to warrant interference, especially as the strong fetal heart and the other signs of advanced pregnancy pointed to an easily viable child. Where there is albuminuria alone, simpler methods must first be tried. Should, however, this albuminuria increase, as well as the anasarca and the cerebral symptoms, the induction of labor, after the assured vitality of the child, must be in every way in the interest of the mother and child. The second case has a much wider bearing, involving, as it does, the question of more or less contraction of the pelvis, and offers much greater difficulties in the way of a proper solution of the problem and its efficient execution. Of the decided forms of contracted pelvis, I shall have nothing to say here. The entire question, with all the data, for example, as furnished by Ahlfeld, forms an important part of our text-books. It is of the minor forms of contraction as exemplified in our second case that I wish to say a few words. It not infrequently happens that we deliver women under difficulties which the premature induction of labor two or three weeks before would have prevented, and with results incomparably better for both mother and child. I have, at present, for example, three such cases, which, in the event of pregnancy, I shall deliver two or three weeks |