excavation or pelvis it is better for the woman to lie on one side or the other with her knees drawn up a little. She will choose the side she is most comfortable on, which is generally the side she sleeps on, for a pregnant woman should sleep on one side or the other and not on her back, for if she sleeps on her back she is sure to have horrid dreams and the child is apt to turn on its back, and when labor sets in it is apt to present with the occiput posterior.

The pregnant woman, like everybody else, ought mainly to sleep on her right side with her head to the north; in fact, she will get through and recover better with her head to the north.

If the uterus or child in the beginning of labor mainly lies or is inclined to the right side of the mother it is because the legs and arms of the child are on that side, weighing the child and uterus in that direction, thus indicating that the vertex of the child is to the left, or first position, and vice versa.

If the vertex is in the first position, i. e. the vertex to the left cotyloid cavity, in the first stages of labor the woman, if lying down, should lie on her left side, and vice versa if the vertex is in the second position, but finally, when the vertex has come down under the arch of the pubis, and the head is down on the perineum and extensively dilating it, the woman ought to lie on her back to complete the delivery, for by so doing the fundus and body of the uterus and body of the child falls back, acting as a lever to pry the vertex and head and body of the child out into the light of the world by the proper route of the proper axis of the pelvis.

If the vertex is presenting in the first position after labor has advanced considerably, the right parietal bone at the sagittal suture will be more elevated than the left, and when the head is born the vertex will be seen to bulge to the right, and vice versa if the vertex is presenting in the second position; all these effects will be reversed.

The reason the vertex bulges to the right in first presentations is because the right side of the vertex is exposed to the open space, while the left side is

pressed against the left ischiatic and pubic bones of the mother, and the reasons are obvious why all the effects are reversed in second presentations.

In breech or feet presentations always manage that the child shall be delivered with its back to the front of the mother, and that the mother shall lie on her back when the breech is emerging from the outlet, and also during the remaining delivery of the child.

Undoubtedly, in the last stages of the delivery, while the perineum is being dilated, if the woman lies on her back. with the legs extended it relaxes the perineum, but in the early stages of laborit does not hurt to bend the legs at the knees and to draw the thighs up a little while the woman is lying on one side or the other.

If the child is propped up by its elbow or elbows on the brim of the pelvis so that it cannot be delivered, then elevate the body of the mother even more than in the knee-breast position, and even to standing on her head for a minute or two, in hopes that the arms of the child may assume their right position and thus the obstruction be removed.

It would be a good thing had the Walche's position never been suggested. In the early stages of labor his position is a nuisance. It favors the propping of the vertex on the pubic bones, thus converting the presentation to a forehead or face case, or favoring the turning of the child on its back, thus making a posterior vertex presentation; and there is no advantage of his position in the last stages of delivery, for the perineum is just a much relaxed by the woman lying in her bed on her back with her legs extended, while she would be much more comfortable, and all the advantages of the rotation of the head and the expulsion of the child through the outlet would be equally as great.

If you watch a woman in labor, untrammeled and not interfered with, you will ordinarily see her up and about, or on one side or the other, in the early stages of labor, but in the last stages of labor she will ordinarily turn on her back, which is the easiest way for her to be delivered at last. She naturally assumes

those positions which naturally favors delivery the easiest and best.

If a physician wishes to hurry labor in the middle and latter stages, he would do well to encourage the woman to sit over a vessel as much as he consistently can. It favors her having expulsive pains with freedom, and without fear of wetting or or soiling anything.

When the vertex has been propped up on the pubic bones and the presentation has been converted into a face case, with the chin posterior the woman ought to get in the knee-chest position to have the head righted, for that position would tend to force the vertex in the right position, and I would suggest, what before was never in print, that the woman's hips be raised even more than the knee-chest position, and even so that she would stand on her head a minute or two. It would give the vertex a chance to fall away from its props and to assume its natural position. The head frequently rights itself by a proper change of the position of the mother.

In forehead or face presentations, if the chin is to the left have the woman lie on the left side if you wish to bring the chin under the arch of the pubis; if the chin is to the right reverse last said position. When the vertex cannot be brought down, then manage, if possible, to always bring the chin at last under the arch of the pubis.

It is very rare that the vertex is propped on the promontory of the sacrum, converting the presentation into a forehead or face case with the chin to the front, but if it should happen lay the woman on her back, or even raise her hips from this position till she nearly or completely

stands on her head for a minute or two, and the child will fall into the fundus of the uterus, thereby giving the head an opportunity to assume it natural position, or at least converting it into a posterior

vertex case, which is far better than a forehead or face case.

In turning by the feet some obstetricians place the patient in the knee-chest position, but I say let every physician exercise his own discretion regarding the position of the woman during the operation. I would suppose that lying on her back

across the bed would be the best position. I am aware that some of the aforesaid operations, although new and effective for good, appear so simple that the physician would not get the credit and fees that he would in using forceps and taking stitches in the perineum, etc., but let him satisfy his conscience without regard to the amount of the fees or popularity.

The above gives only one phase of the obstetrical art, but there are other phases, as protection and dilatation of the perineum, delivery of the secundines, etc., which can be found in obstetrical books and medical journals. Hudson, Ill.

LAST

IS IT A UNIQUE CASE?

BY D. M. B. THOM, M. D.

AST fall Ibrahim Pasha, the head of a tribe of Hamideh, sent a raiding party against some of the Shumar Arabs to bring off what horses and cattle they could find. The result was a fight, in which a number were killed and wounded. One of these latter came to me recently with an open sinus, the source of which was the neck of the right humerus.

He gave the following history: "I was in the thick of the fight, riding my horse, with the halter rope in my left hand, while my right hand was high above my head carrying the long Arab spear, when suddenly my arm dropped and I was no longer able to raise it again. I found I was wounded, a bullet having entered my body through the supraspinous fossa of left scapula, making its exit through the neck of the right humerus, where it splintered the bone, leaving undetached pieces that prevented the healing of the wound." Seven or eight months later he comes to me for treatment, when I cut down, removing the partially detatched spicula and giving the wound a chance to heal up. But the power to elevate the arm seems quite destroyed.

What route did that bullet take to avoid all the vital points that were in the way of its passage from its point of entrarce to its point of exit? I have tried to study it in all its bearings, but have failed to come to a satisfactory conclusion of the

case.

Mardin, Turkey-in-Asia.

Medical Progress.

Under this head we endeavor to present a condensed summary of practical medicine, drawn from the best and most reliable sources, thus saving our readers much labor in winnowing out from the chaff medical grains of real value.

Clay Dressing.

Students of medical history know how great value was attributed by Galen and others to Lemnian earth, "terra sigillata," as an absorbent. Dr. Stumpf having noticed the remarkable preservation of a dead body embedded in clay, and considering this due to the antiseptic and absorbent properties of the earth, determined to use the latter in the treatment of suppurating wounds and ulcers. He first sterilizes the clay by heat and then powders it over the wound, covering the whole with a gauze compress. "Under the dressing, which it is often unnecessary to renew, wounds and ulcers rapidly cleanse and cicatrize."

Dr. Melissinos, of Gaute, confirms this by the history of a vine-dresser who, on the advice of his companions, dressed a severe wound penetrating the knee-joint with clay, and though not otherwise attended to for 15 hours the wound healed by first intention and the joint remained intact. Med. Magazine.

Angina Pectoris.

Morphine

The tension of the vascular system is to be relieved by inhalation of nitrite of amyl, and, if pain persists, a few whiffs of ether should be given. Morphine should not be continually used, because of its resulting depression, and if given should always be combined with atropine, which is an excellent analeptic. Camphor, also, is one of the best of the cardiac stimulants. Irritation, in the way of sinapisms, etc., to the precordia, eases the distress. The ice-bag or very hot applications have the same effect. The kidneys, skin, and respiratory functions should be kept active. In the interval nitroglycerin or nitrate of sodium and iodide of potassium should be used, and the doses should be pushed to tolerance. Good results are obtained from the baths

as recommended by the Oertel method or as carried out by Dr. Scott, of Nauheim.

A saline bath at the temperature of 92°, and reduced 5° or 6° in the course of the treatment, has many of the good effects of the Nauheim bath. It is well in ordering the bath to see that the patient is gently massaged, and while in the bath, which should last no longer than 10 to 15 minutes, that slight restraint be given to the flexion and the extension of the limbs and body, which the patient is directed to follow.

To obtain any measure of success in the treatment all excesses of every kind must be corrected and the general functions of the body made to act properly.-Dr. J. D. Morgan, Jour. Amer. Med. Asso., for July.

Congenital Nasal Atresia.

Dr. Hal Foster, in the Laryngoscope, May, 1899, reports an interesting case of congenital nasal atresia in a boy eight years old. According to the mother's statement the nose was closed at the child's birth. There was no other deformity. On examination a definite white fibrous membrane, stretching between the septum and the side-wall of the nostril, was found. Occlusion existed on one side only. As there was a history of syphilis in the boy's father, specific medication was resorted to for eight weeks. At the end of that time the membrane was divided by a surgical drill and the galvano-cautery applied, after which a small Asch nasal splint was inserted and held in place by a piece of plaster. Antiseptic sprays were used three times daily, and Europhen blown into the nose every morning. Under this treatment a perfect cure was effected.

Extreme Anemia After Post-Partum Hemorrhage.

Dr. C. F. Bachmann, of Allegheny, Pa., writes: "The prompt and decisive results obtained in the following case of anemia, secondary to severe postpartum hemorrhage, induce me to report it for publication.

"Mrs. O. T., white, aged 23, primipara, weight 145 pounds; passed successfully

through the ordinary diseases of childhood, and two years ago I treated her during an attack of typhoid fever, from which she completely recovered. About a year ago she became pregnant. The course of pregnancy was normal, with the exception of a slight edema and a varicose condition of the veins of the lower extremities.

"On Jan. 2, 1899, she was taken in labor. Position, R. O. P. Owing to an excessively large head I was obliged to apply the forceps without anesthesia. The placenta was firmly adherent, and, after an hour's wait, was delivered by hand. Scarcely had the placenta been delivered when a frightful hemorrhage occurred. scooped out all clots and fluid blood and controlled the hemorrhage by injections of hot water, compression and tamponage. So much blood had been lost as to cause a sub-normal temperature and a small, weak pulse of but 32 to the minute; extreme anemia, great shock and prostration, thirst, sighing respiration, etc.

"I administered strychnine sulphate, 1-20 grain, hypodermically; also, brandy and extract of ergot. The hemorrhage occurred at about 8 a. m., and by noon the patient had revived to some extent, but was suffering from nausea and occasional vomiting, for which I prescribed Liquid Peptonoids and Elixir Lactopeptine with good effect.

"January 3d, I found the patient somewhat improved, but very weak and almost bloodless, her lips being literally 'as white as snow.' I then ordered Hemaboloids (a preparation of the iron-bearing nucleo-albumens of the vegetable food stuffs, reinforced by bone marrow, beef peptones and nuclein), two drachms every three hours; also stimulants and a nourishing liquid diet. The excellent results obtained from this treatment are best shown by the following table:

Adeondelia or stink weed, resembles rag weed, having a long, narrow, sawedge leaf. In Argentine Republic, Province of Salta, near the Bolevian line, the cure for felon is to take the leaf and grease it with lard and wilt it over the fire and envelope the part. It gives ease in a few minutes. After the felon has been drawn until open, instead of putting on the grease it is moistened with saliva, wilted over the fire and put on the felon. It is a great healer.

The miners in the silver mines of Potosi, Bolivia, come down into the city at the foot of the mountain twice a week -Sundays and Thursdays-and fill themselves with meats and beer, and return to the mines in the evening, carrying noth

ing with them but cocoa and whisky, upon which they all feed until the next Sunday or Thursday, when they repeat their meals as before, and so they live from year to year and are happy.

This cocoa is put up in rawhide bags holding about two bushels, and is so sold. It is one of the principal articles of commerce used by the common people, who keep their mouths always full. The better class use it on the sly, and it is very nice.

There is a better article used for tea, called yerba, which they drink from silver mugs through a silver tube, and is taken very hot. It is a most delightful and refreshing drink when exhausted and hungry. It is also called matty, and is one of the largest articles of commerce in the country. It is the South American tea plant, and is in general use and very cheap.-V. B. H.

Constipation in Infants.

Give no laxative before the third month and no purgative during the first year. To correct, give cow's milk, four parts, and sweetened water, 96 parts; rectal lavage by means of the urethral catheter, employing two tablespoonfuls of oil, with the yolk of an egg and mixed with four drachms of water; massage; electricity.

Correction of the Taste of Unpalatable Drugs.

In his "Pocket Formulary of Diseases of Children," Dr. L. Freyberger has devoted considerable attention to the important question of how to disguise the taste of nauseous drugs. The following list is given:

Acetanilid-One grain is disguised by three grains of white sugar or two grains of elæosaccharum menthæ piperitæ.

Aconite-One minim of tincture is disguised by five minims of elixir simplex.

Ætheris nitrosi spirit-Five minims by one drachm of sugar water or aqua carui. Aloin-One-quarter grain by 10 minims of ext. glycyrrhizæ liquidum.

Ammon. acetatis liq.-Five minims by one drachm of aqua camp., menth. pip.. or mist., amygdalæ, milk and boiling

water.