undoubtedly; but during this scrubbing, which continues for a longer or shorter time, depending upon the age and eyesight of the nurse, have we not all seen the child blue, its jaws quivering with the cold, the next day the "snuffles"? and, if you were to say any thing about it, you would be met with the answer, "Why, that is nothing: babies always have the 'snuffles.' And so they do, and so they will as long as this practice continues. But I have had no "snuffles" where I can induce a nurse to follow my directions, which are, keep the child covered as warm as possible; oil a small portion only, and wipe dry with a piece of soft flannel; use no water, no soap, until the child is twenty-four hours old at least. You can cleanse a child better in this manner than you can with soap and water; and you avoid the danger of getting soap into the child's eyes, which, in my opinion, is a more frequent cause of ophthalmia than a specific infection from the vaginal discharges of the mother. Another apparently trivial thing: all nurses give the child, directly after it is washed, a teaspoonful of water, or sugar and water, or milk and water, or gin and water, or something worse; this I oppose all I can. I say to the nurse, "Put nothing whatever into the child's mouth, not even water: give it the breast within twelve hours if it is awake, and let it have absolutely nothing else." Of course, if the mother cannot nurse her child, always a sad thing, we are compelled to feed; and almost always the child has sore mouth. I should like to have members try this course, and see if their experience will correspond with mine, no sore mouth. — These things I have spoken of in the hope of eliciting discussion, and hearing the experiences of others. V. PUERPERAL CONVULSIONS CAUSED BY BY GEORGE F. Forbes, m.D., WEST BROOKFIELD, MASS. WHILE this Society need expect nothing new in relation to the subject of puerperal eclampsia, perhaps it will be well once in a while to refresh our memories in regard to this dread malady. I need not weary you with a recital of the many causes of this disease, but will give what may be regarded as one of the principal causes of puerperal eclampsia, and take the liberty to add some cases which occurred in my own practice with their treatment. In studying the etiology of puerperal convulsions, we are at once struck with the manifold theories of as many authors as to the nature and causes of the different forms of this disease, whether it appears as hysterical, epileptic, or apoplectic. My own experience is limited to cases, all of which began during dilatation of the os uteri in primiparæ, and apparently all of them caused by the presence of an abnormal quantity of albumen in the urine. After a few words on the nature and consequences of albumen in the urine during the later months of pregnancy, I will give the symptoms and treatment of these cases. It should be borne in mind, that albumen must be diminished in the blood in the same ratio that it is increased in the urine. Cases of albuminuria might be cited illustrating all the different degrees, from the slightest and scarcely perceptible trace of albumen which appears in the urine for a brief period only of pregnancy, up to those forms of anasarca which involve the entire system, and in which the urinary secretion, almost totally suppressed, is so loaded with albumen as to become almost entirely solid on boiling. Those who hold to the nervous origin of puerperal convulsions may be divided into two classes. The first of these recognizes in the pregnant state a peculiarly impressible condition of the nervous system, in which slight causes, not ordinarily harmful, may engender the most fearful consequences. If the fit sets in during labor, the pressure of the present-. ing part, the forcible dilatation of the os uteri, an unyielding perineum, the contact of the finger of the accoucheur, or of instruments when the forceps are attempted to be applied, or of the hand in the operation of version, may be the exciting cause of impressions that are telegraphed to the spinal centre, and thence to the medulla oblongata, to be reflected upon the muscles successively convulsed during the paroxysm. The defective elimination of urea by the kidneys, the presence of albumen in the urine, and oedema, which sometimes occur at an advanced period of gestation, imply a state of liability to convulsions. The non-elimination of urea from the blood is believed, by Braun and others, to be the chief cause of the phenomena presented in puerperal eclampsia. The history of the renal complication in this disease is singularly interesting and suggestive. The presence of albumen in the urine in almost every example of puerperal convulsions is something more than a mere coincidence. According to Blot, the average proportion of albumen in the urine in albuminuria without eclampsia is thirty-three per cent, while in the eclamptic it may be seventy-four per cent. There are doubtless many cases of albuminuria in pregnant women, that are not accompanied or followed by convulsions, but the converse of this proposition is not true. As an accidental ingredient of the urine, a considerable proportion of albumen implies a great drain upon the nutritive resources of the economy. It also signifies that the elimination of urea is less thoroughly performed than it should be by the kidneys. Viewed as a premonitory symptom of puerperal eclampsia, albuminuria is of the utmost significance. The oedema of the inferior extremities, the ascites, and dropsy of the amnion, which are not complicated with albuminous urine containing fibrine cylinders, are not followed by uræmic eclampsia in the parturient state. Whether it be the urea, the carbonate of ammonia, or some other primary, secondary, or tertiary product of the depurating process, that is dammed up in the circulation, and works all this mischief, we may perhaps never know. That some post-organic material is responsible therefor, is evident. That it is urea, is very probable; and it is to the action of this noxious principle that the cerebro-spinal centres are especially susceptible. Churchill lost of the mothers, by puerperal convulsions, one in four and a half; thirty-seven out of forty-eight cases reported by Dr. Merriman recovered; and, of thirty cases reported by Dr. Collins, only five died. The merely hysterical form of convulsions will almost always recover, even under unfavorable circumstances. Authorities are divided as to the relative danger in convulsions coming on before, during, or after delivery. Ramsbotham is of opinion that convulsions coming on after labor, if the patient has not suffered an attack before, are not so dangerous as those which arise during pregnancy and labor. Dugès is of the same mind, and Churchill regards the postpartum variety nearly as manageable as those which occur during gestation. Churchill's worst examples are those in which the convulsions commence while labor is progressing, and continue afterwards. In my opinion, the most dangerous cases are those in which the convulsions begin, with little or no premonition, shortly after the birth of the child. When from twelve to twentyfour or more hours have elapsed after delivery, and convulsions ensue, they are almost always of an hysterical character, and therefore less dangerous. CASE I. Mrs. C., aged twenty-one; first labor, eight and a half months in pregnancy; injured by doing a hard washing, tand lifting a tub of water; was taken Wednesday morning, wo days afterwards, with a convulsion. On arrival, I imme diately ascertained if labor had commenced. Found the os uteri dilated sufficiently to allow the index-finger to pass with difficulty; no mucous discharge, or show; vagina hot and dry. In about one hour from first spasm she had another, still more severe and of longer duration. Gave belladonna3, a dose every ten minutes for two hours, then once in half-hour, which seemed to partially control the spasm, but only for a few hours. In the evening and during the night she had convulsions, averaging about three-fourths of an hour apart. Had her take a sitz-bath, adding hot water till the temperature was 110°, also hot foot-baths, and gave chloroform and ignatia At 9 P.M. she had a hypodermic injection of morphine, the spasms not returning till 11 P.M.; os uteri no more dilated: gave cicuta. At 4 A.M., the spasms returning at regular intervals of one hour, or at every uterine contraction, and lasting about three minutes, an allopath was called in consultation by the friends. He advised gelsemium in massive doses, which did not relieve. We then gave another injection of morphine hypodermically, which relieved for four hours, when the spasms returned again as hard as ever, and I determined to give ergot, thirty-drop doses of the extract, and repeat once in ten minutes, and proceeded to carefully dilate the os till it readily admitted two fingers, then three; and then, by much patience and perseverance, I was able to introduce the finger enough to puncture the membranes; and by using bi-manual, pressure over the abdomen, and considerable force, I succeeded in extracting the child, which was dead. After the placenta had been removed, the woman was made as comfortable as circumstances would permit; but she never rallied, and suddenly expired after about six hours. CASE 2. Mrs. B., aged twenty-three; also first labor. Began at II A.M., at full term, and proceeded slowly for about six hours; nothing unusual about the case being noticed, except a general dropsical appearance of patient. The os uteri being dilated so as to readily allow the admission of the |