Emptying the bladder does not relieve the condition, nor does pressure alone, but pressure will afford some relief. The labor is tedious on account of the redundant tissue that still causes the trouble and rolls in front of the pressing head.

Dr. H. F. Scott, Atlanta: I think in the doctor's case, when he attempted to withdraw the urine, he did not use a long enough catheter, and it made it difficult to entirely remove it with the patient on the back. The principal trouble with the doctor's case was his failure to use an anesthetic when the patient was having severe and expulsive pains. If he had had chloroform or ether with him and had given it to a sufficient extent, then by suitable pressure I am satisfied he would have removed the trouble at once without any further difficulty.

Dr. R. R. Kime, Atlanta: The case of cystocele related by the doctor is one of considerable interest with reference to enlargements or accumulations in the pelvic cavity. One important point in the treatment of these cases is the posture of patient. It is essential first and always to empty the bladder, but after the bladder is thoroughly emptied, if we have prolapse of the vaginal walls or a cystocele, or a cystic accumulation, or in some cases where we have a fibroid tumor in the pelvic cavity, by putting the patient in the exaggerated Sims position and elevating the hips until the bowels and pelvic contents gravitate forward, we not only lift the redundant tissue out of the pelvic cavity, but we relieve those cases of incomplete labor without operative interference, so that labor will be completed naturally by the unaided efforts of nature itself; in other words, without instrumental interference. At the same time, if we place the patient in the exaggerated Sims position, or in some cases in the knee-chest position, while making firm and gradual pressure on the growth in the pelvic cavity, we will be surprised to see it disappear above the brim of the pelvis, the child come dov n into the cavity and be delivered.

Not long since I took charge of a case of labor for a physician who was taken sick and could not attend the woman. In making an examination I found an enlargement which seemed to almost fill the pelvic cavity. It was in the posterior part of pelvis filling the hollow of the sacrum and extended farther up. The woman was placed in the exaggerated Sims position, and in less than fifteen minutes thereafter the child was delivered.

In reporting

Dr. Lockhart (closing the discussion): this case I have honestly tried to confess my fault and failure in diagnostic skill; but, as you will observe in the closing lines of my paper, I am not the first to make the same mistake, and it is because of such mistakes that the paper was presented. It is true that I did not recognize the true nature of the trouble, but I think we ought to be as willing to record our failures as our successes, for the benefit of others who may have similar clinical experience at any time.

There is one point that I wish to mention as the cause of these troubles. It is laceration of the perineum. The prolapse commences with a loss of that firm support which the perineum would afford if not torn. The bladder being in a state of chronic inflammation, with the vagina also in a relaxed condition, gradually yields to the weight above, with the result mentioned.

In my case the bladder had been inflamed for a long time without appropriate treatment, resulting in great thickening of its walls. In fact, I do not think that some of the members who have discussed my paper realize to what an enormous extent such thickening may extend in some cases. I had carefully emptied the bladder of its contents with a flexible catheter, but the trouble was not on account of accumulation of urine, but to enormous thickening of the bladder walls, which had rolled down in front of the descending head, presenting a formidable tumor, increasing in size and firmness with each return of pain.

ATYPICAL CONTINUED FEVER.

BY EVERARD HAMILTON RICHARDSON, M.D., ATLANTA, GA.

Marked progress is being made, and rapid revolutions are occurring, in both the art and science of medicine. Well equipped pathologists, with the requisite technical information and the microscope in the field of histology and bacteriology are diffusing new light, especially upon histology and the etiology of disease. And this knowledge disseminated by the medical profession is being utilized for the abridgment of human suffering, by the prevention of disease and the promotion of the happiness and longevity of the human family. The mission of preventive medicine is godlike, and has received renewed impetus during the last quarter of the nineteenth century. The knowledge of its achievements in the past, and a forecast of its future possibilities, stamps her true devotees with some of the qualities of divinity.

Upon the threshold of this investigation of atypical continued fever, a definition of the regular typical form of the disease is obviously necessary, and before entering upon the consideration of the anomalous form of continued fever it is proper for me to state that typhus fever, catarrhal, eruptive, inflammatory or septic fevers will not be discussed in this article.

The subject of fever is perhaps the largest in the whole realm of medicine, and it is one of vast concern to mankind.

For the first intelligent and comprehensive study of idiopathic essential continued fever we are indebted to Louis of France. In 1829 Louis gave the name "typhoid" to

continued fever. Up to this period typhus and typhoid fever were regarded as identical. The occurrence of the intestinal lesions of the latter disease was considered an accidental complication of typhus fever. Autopsies made during the seventeenth century revealed the intestinal lesions of typhoid fever, but it was reserved for the nineteenth century to appreciate their real significance, and to differentiate it from other forms of fevers. Gerhard of Philadelphia, a student of Louis, shortly afterwards demonstrated the difference between typhus and typhoid fever. This important knowledge, first discovered by Gerhard, was widely disseminated in America before it was recognized in Europe or Great Britain. Modern research in bacteriology has made the study of the etiology and pathology of typhoid fever one of great interest to the student of medicine.

The disease had long been known as a "filth disease," but in 1884 Eberth demonstrated that the direct cause of it was a specific micro-organism, now known as the bacillus of Eberth. The testimony is, I think, indisputable that it is unlike the malarial germ, which is in all probability an airborne disease, but is water-borne, infecting the human organism through polluted water, milk, raw oysters and vegetables or contaminated food. Professors Conn and Broadbent have proven beyond cavil the absolute certainty of raw oysters having infected the inmates of colleges with typhoid fever. The specific micro-organism is conveyed per orem, infecting the organism through the lymphatic system, generating toxins which act as a powerful sedative to the nerve centers, and which has an elective affinity for the mucous membrane of the primæ viæ, producing congestion, infiltration and effusion of Peyer's glands of the ileum, and often leading to ulceration and hemorrhage from these surfaces. Thus we observe it is not the bacilli that produce the local and constitutional disturbance inci

dent to typhoid fever but their toxins or ptomaines. Heat destroys the typhoid germ, though it exhibits great tenacity to life.

Sultan in 1894 published the history of a case of chronic osteomyelitis of the clavicle supervening upon typhoid fever, where the bacilli were found in the pus and cultivated six years after the recovery from typhoid fever.

The bacilli of typhoid fever have been found in the tissues of new-born infants, but owing to the close resemblance of the typhoid and colon bacilli, this does not demonstrate the intra-uterine infection of the infant from the mother suffering from typhoid fever, though the enlargements of the spleen and liver that have been observed in these cases justify the belief in the possibility of the fetus being thus infected from the mother.

The onset, duration and general type of the disease we shall undertake to make manifest is not by any means always constant or uniform in its course.

European

The disease is eminently a preventable one. cities, by enforcement of proper sanitation, drainage and cremation, have almost stamped out the disease from their large centers of population, but our records demonstrate that American cities are far in the rear of Europe in sanitary laws for the prevention of the disease.

Dr. Osler's statistics show that in 1895 two thousand and five hundred cases occurred in Baltimore, while it is the consentient opinion of all medical men in this country that the malady has increased in our rural districts. Its prevalence in the country and many interior towns is appalling, and is due solely to the failure of enforcing intelligent sanitary laws.

The established typical cases, with the prodromata, pain in head, great prostration of the nervous system, nosebleed, gradual rise of temperature, slight pain and gurgling in the right iliac region of the abdomen, enlargement