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As to the support of the perineum, the doctor's remarks were very good in that, indeed, suggesting many methods. I believe that I can do more for a retarded labor with a forceps than I can with anything else. When I can get a forceps on a child's head, I can handle it just like I want to. If he is not coming in the right direction, I can pull against the perineum as hard as I like. I can do more to protect a perineum with a forceps than by any other means, and I believe I have lacerated less with forceps than I have without it, and where I have a head down where there is no use for that, I slip them up. As to shelling the head, as spoken about, I think it would take a right heartless man to do that. When a woman has gone through the intense agonizing time and the child is passing through the gates of his mother's anguish, in that little period of rest I feel that she ought to rest a little while, and don't think that much is gained by that procedure.

As to the introduction of the finger in the rectum, I think that something can be accomplished by that. I don't think, as I have often said, that there is anything septic about fecal matter. When matter has passed through nature's laboratory, after the food is taken through one's mouth and gone through the stomach and passed through the bowel, there is nothing septic about it. If so, the majority of lying-in women would have trouble. I don't think there is anything unclean in introducing the finger in the rectum, and during the confinement handling it as we think best.

I wish to thank Dr. Erskine again for his talk.

Dr. Erskine (closing)—I have nothing more to say, except on these two points: As far as Barnes' plan of shelling the head is concerned, I don't think there is anything improper in that. I will tell you why. We find a certain number of women in whom the perineum is very thin, in which it is exceedingly distensable where the head is forced down, but up to this point the pains have not been sufficient to force it through. The patient is in all probability asleep, and it is an easy thing, in my observation, under those circumstances to shell a head out. In doing this I push the perineum backward over the advancing head, which in many cases is easily done, and when the pain comes on again the head is born. I

have never found any particular trouble in that. If I had an exceedingly thick, indistensable perineum, I would not try that at all. The probability is I could not accomplish it if I did. At the same time, it is recommended in delivering the head of the child between the pains, and I have never seen it add anything to the sufferings of my patient, but rather to relieve them.

As far as the management of the patient through the bowel is concerned, we shrink from what seems to us repulsiveness, but I think the rectal expression is an admirable one. I practice it almost constantly, because it aids a great deal towards the expulsion of the head when the pains are insufficient. Sometimes if you can bring an additional force to bear, as with the forceps, of course the head comes over.

There is one point that I forgot to mention, and that is in regard to the use of ergot. Some are for the ergot and some against it. My own judgment is that ergot of rye is very admirable, and my plan is to give it a half hour in advance of the delivery of the head. It is going to take it a half hour to act, and while it is doing that of course the pains are going on and the head is being gradually expelled. There are some who say, don't give it until the head is born or until the child is delivered. Others say let it alone until the placenta is delivered. You can let it alone until the child is born and then give it, or you may give it either to expel the placenta or after the placenta is delivered. This is a point that I wanted to make, but I just simply overlooked it. As far as the forceps is concerned, I still maintain my position.

DISCUSSION OF DR. McFALL'S PAPER.

Dr. B. G. Henning said that he had seen diseases of the stomach cured by successful operation upon the rectum. It is very hard in many cases to say positively whether the disease of the intestine was primary to the disease of the stomach, or the disease of the stomach primary to that of the intestine.

Dr. Alexander Erskine reported a case of cancer of the stomach and duodenum. The patient was a woman sixtysix years of age, who died two years after the cancer developed. Another case was that of an old woman in the country, who

had hemorrhages from the stomach and was supposed to have cancer of that organ, but who subsequently recovered.

In the call for reports of cases, Dr. Erskine further reported an interesting case of hydrocephalus.

BORE SIXTY-TWO CHILDREN; ELEVEN SETS OF TRIPLETS, QUADRUPLETS AND A SEXTET-It has remained for an Italian woman to break all maternity records, says a special from Paris to the St. Louis Post Dispatch. Madeline Cranatta, in the course of nineteen years of wedlock, became the mother of sixty-twochildren. This extraordinary statement is vouched for by two or three thousand witnesses, who testify to its truth in a petition now before the Italian government, asking for the woman a yearly pension of 1800 lire ($360).

Of Madeline's children, fifty-nine are boys and three are girls. Eleven times in succession in nine years she she gave birth to triplets, three times four boys arrived at one birth, and once five boys and a girl. The other twelve were born singly, but very close together. The woman is a native of Nocera, a little village near Naples, and at 57 is incapable of earning her livelihood, hence the petition.-Ex.

BOOK REVIEWS.

A Text-Book of Legal Medicine and Toxicology. Edited by Frederick Peterson, M.D., Chief of Clinic, Nervous Department of the College of Physicians and Surgeons, New York; and Walter S. Haines, M.D., Professor of Chemistry, Pharmacy and Toxicology, Rush Medical College, in affiliation with the University of Chicago. Two imperial octavo volumes of about 750 pages each, fully illustrated. Philadelphia, New York, London: W. B. Saunders & Co., 1903. Per volume: cloth, $5 net; sheep or half Morocco, $6 net.

It has been many a day since such an addition has been made to the text-book literature of legal medicine and toxicology. The excellent qualities of the work are explained when the names of its editors are noted.

The work has been divided into two sections, the first part considering expert evidence, post mortem examination, the signs of death, wounds of various kinds, railway injuries, inebriety, insanity, etc. The second part is devoted to toxicology and all other portions of legal medicine in which laboratory investigation is an essential feature.

The contributors to this work comprise many of the best known members of the medical profession, who have all contributed chapters on subjects in which they have gained prominence as being especially well versed.

The general run of the medical profession will find the chapter on expert evidence of pertinent interest, since this is a feature of medicine that is greatly abused, and in which physicians have many opportunities of acquitting themselves with credit, and in which it is so easy to present one's self in an attitude that will gain unfavorable criticism.

The Bertillon and Greenleaf-Smart systems of identification are concisely and intelligibly described, and this should also prove interesting reading. Among the many other interesting chapters in this work are those on "The Destruction and Attempted Destruction of the Human Body by Fire and Chemicals," and 'X-rays: Their Medico-Legal Relations."

66

Tuberculosis. Recast from Lectures delivered at Rush Medical College, in affiliation with the University of Chicago. By Norman Bridge, A.M., M.D., Emeritus Professor of Medicine in Rush Medical College; Member of the Association of American Physicians. Handsome 12mo. volume of 302 pages, illustrated. Philadelphia, New York, London: W. B. Saunders & Co., 1903. Cloth, $1.50 net.

Although the subject of tuberculosis is constantly bringing forth an immense volume of literature of varying degrees of scientific value, this is a topic upon which there can never be too much written. As it is, the inculcation of the principles of hygiene and general prophylaxis in the minds of the laity will do much more toward ridding the community of this great devastator of the human race than will any quantity of drugs.

In this work the author has given much consideration to prophylaxis. He also devotes chapters to the bacillus of tuberculosis, the pathology, etiology, symptoms, physical signs, diagnosis and prognosis of the disease. The portion devoted to treatment is most thorough in its consideration, for the author has exhaustively discussed hygienic treatment, management of the disease, climatic treatment, medicinal and local treatments, special treatments, and devotes a chapter to the subject of sanatoria.

The Surgery of the Head. By Bayard Holmes, B.S., M.D., Professor of Surgery in the University of Illinois. Cloth, 569 pages. Price, $2.50. New York: D. Appleton & Co. 1903.

The tendency of latter day medicine toward specialization is further demonstrated in this book. The complete works on general surgery that we now have are constantly being supplemented by special treatises devoted to the consideration of some particular surgical field. Among these the surgery of the head takes first rank, on account of its importance in connection with everyday practice. Fractures of the skull and brain lesions are especially common. By such special works are brought out the main facts which become lost in the more voluminous treatises on general surgery.

In this work of Holmes' is used a simple style of treatment of a subject that also may be said to be simple in itself. He uses actual clinical cases as an introduction to the treatment of certain principles in surgery, and for this purpose has drawn his cases from personal experience and current literature. In style the work is eminently practical, and the reader feels that he is gleaning facts and not theories from this book. The work is well adapted to the needs of both practitioner and student.

The Care of the Baby. A Manual for Mothers and Nurses, containing Practical Directions for the Management of Infancy and Childhood in Health and Disease. By J. P. Crozier Griffith, M.D., Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania; Physician to the Children's Hospital, Philadelphia. Third edition, thoroughly revised. Handsome 12mo. volume of 436 pages, fully illustrated. Philadelphia, New York, London: W. B. Saunders & Co., 1903. Cloth, $1.50 net.

Dr. Griffith has done much to promote the welfare of the baby by giving mothers and nurses a book of so much practical information. The work is now in its third edition, and since it has not been a very long time since we reviewed the first edition, this is most excellent testimony as to the position that the book has taken with those for whom it was written. This third edition has received the customary careful revision.

Findley's Gynecological Diagnosis. The Diagnosis of Diseases of Women. A Treatise for Students and Practitioners. By Palmer Findley, M.D., Instructor in Obstetrics and Gynecology in Rush Medical College, in affiliation with the University of Chicago. In one octavo volume of 494 pages, richly illustrated with 210 engravings and 45 full-page plates in colors and monochrome. Cloth, $4.50 net; leather, $5.50 net. Lea Brothers & Co., Publishers, Philadelphia and New York.

In keeping with the trend of specialties, the author of this work has prepared a book that might be regarded as a specialty in a specialty. He has endeavored to further elucidate the subject of gynecology as a whole by giving us a work which treats of diagnosis alone in this field. The author gives for consideration the well-recognized procedures for pelvic examination, microscopical appearances and microscopical findings, and attempts to make the work thoroughly clinical in its teaching. Illustrations in abundance have been provided, many of which are original. As an adjunct to the popular treatises on gynecology, this work should meet with a very favorable reception.

Veasey's Ophthalmology. A Manual of Diseases of the Eye. For Students and General Practitioners. By Clarence A. Veasey, A.M., M.D., Demonstrator of Ophthalmology in Jefferson Medical Collège, Philadelphia. 12mo. 410 pages, with 194 engravings and 10 full-page colored plates. Cloth, $2 net. Lea Brothers & Co., Publishers, Philadelphia and New York. Naturally students and general practitioners do not care to incur the expense of nor burden themselves with the large and complete treatises on ophthalmology. To them a work such as the present will appeal particularly. The author is a teacher of wide experience and realizes fully the needs of both under-graduate and post-graduate students. In a systematic and concise manner he has arranged and presented such facts in ophthalmology as the reader to whom he appeals will require. The book is illustrated with 200 engravings and 10 full-page plates, and is printed and bound most tastily.

The Practical Medicine Series of Year Books. Comprising Ten Volumes on the Year's Progress in Medicine and Surgery. Issued Monthly. Under the General Editorial Charge of Gustavus P. Head, M.D., Professor of Laryngology and Rhinology, Chicago Post-Graduate Medical School. Volume IV. Gynecology. Edited by Emilius C. Dudley, A.M., M.D., Professor

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