before the appointed time. With the present tendencies of our modern civilization ever towards a more highly differential brain and nervous system, such cases are more apt to increase rather than diminish. It means a larger fetal head at birth with no increase in pelvic capacity, so that this question of premature labor must become more and more a serious consideration. And with our advancing knowledge and improved methods, this operation becomes more and more a legitimate procedure. Nature herself has given us the hint in certain cases where premature labor occurs spontaneously and evidently in the interest of mother and child. The idea prevails generally among the laity that first labors are often slightly premature; I have never been able to satisfy myself on the subject. Certainly, if true, it is a strong argument in favor of the induction of premature labor. The thought often comes to me while attending the usually difficult first labor, what a blessing if we could accurately bring on labor just two weeks before the appointed time. It is only the difficulty of absolutely estimating the time of gestation which stands in the way. I should like to see every first child born two weeks premature, reserving the full nine months child for the second labor.

Nature has certainly given us the hint in that strange order of mammals, the marsupials, where the young are born prematurely and are afterwards cared for in the marsupium or pouch very much as we provide the couveuse or incubator for the premature infant.

The difficulties attending the induction of premature labor are very great. First and most important is the measurement of the pelvis, an exceedingly difficult thing to do to one's satisfaction. And even if accomplished, we still have to face our inability to estimate correctly the size of the fetal head. We have only averages to go by, and often in those very cases where definite knowledge is

necessary, the average fails us. Short, stout women approaching the dwarf type should always cause solicitude. External pelvic measurements a half inch below the average, especially in the conjugate diameter, should call for the most careful consideration. It is just here that skill and judgment are so in demand, and he who ascertains correctly the conditions and acts promptly and judiciously proves himself the right man.

It is with the primipara that the difficulty largely lies. The history of the first labor is always an immense help in the treatment of subsequent labors. In my second case, had I correctly estimated all the conditions of the first pregnancy, I might have saved the child by a premature labor of two or three weeks. It is the old story of "cab wit" over again. So, when the first labor gives evidence of a pelvis slightly under size, we have no excuse in failing to forestall trouble in future labors.

As to the best method of bringing on labor, the one method, to my mind, most suitable in the large majority of cases, is that known as Krause's, namely, the introduction of a solid flexible bougie between the membranes and the uterine wall. Under strict antisepsis it is without danger; it is painless, and it is sure, labor pains starting in about twenty-four hours. It has never failed me. I can imagine that in certain cases more heroic measures may be necessary, but the conditions must be rare.

Of course the most difficult part of the whole problem is the correct estimation of the time of gestation. we may, we are liable to an error of two weeks.

Do what

It is the

careful weighing of all the data at our disposal which reduces this error to a minimum.

My second case illustrates the difficulty of relying upon dates:

In the first pregnancy conception evidently occurred just before the menstrual period in November, for there are 308 days between the first day of the last menstruation and confinement, there being thus a difference of 33 days between the estimated time and the real time. Had we attempted to use this record as a guide in the second pregnancy, we should have had May 1st as the most probable time of conception, and February 1st (276 days) as most probable time of confinement. Note the more liableness of the dates given for quickening. In the first pregnancy there are only 116 days between the dates of last sickness and quickening, but we know that conception could not have taken place much before the last week in November, leaving only about 84 days for the period of gestation when the patient felt life. In the second pregnancy quickening was first felt a good four months and a half after conception.

A careful study of the dates in the second pregnancy made delivery between two and three weeks premature, and I got as close to the real time as we can generally expect to do. My guides, however, were: The measurement of the height of the uterus, estimating the size of the child and the child's head by bimanual examination and the strength and distinctness of the fetal heart. These symptoms are all the more valuable when they tally with the dates given, as they did in this case.

My object in writing this paper has been attained if I have succeeded in calling the attention of the Association to the value of induced premature labor in certain cases of minor contraction, especially among primiparæ.

TREATMENT OF PLUERITIS.

BY NEWT ANDERSON, M.D., EUDORA, GA.

Pluerisy is a disease of which the treatment becomes a matter of exceeding importance, for, as we have been told, while some cases are so mild that they go on to perfect recovery almost without medication, others are followed by suffering, deformity and death.

The object of treatment is to modify and change the difficult and dangerous cases that they shall give results more like the milder ones. Apart from the possibility of aborting the inflammatory process at the very onset of the invasion, there are several indications which demand the attentive consideration of the physician. The first of these is the physiological indication of rest. Strips of adhesive plaster two or three inches in breadth should be applied extending from the spine posteriorly to the sternum, anteriorly around the affected side, or an ordinary cotton bandage two and a half to four inches in width be applied tightly to the thorax. At first it is rather uncomfortable, but if removed by the solicitation of the patient he will soon beg to have it reapplied.

It is necessary, no matter how mild the case, to place the patient in bed, and a nutritious but plain diet should be given without stimulants. The sick room should be well ventilated. A saline purgative or compound cathartic pill, as best suits the requirements of each particular case, should be administered. To diminish the intensity of the pleural engorgement is of primary importance at this stage of the disease. To meet this indication was the object of the older