bacillus of typhoid. The treatment by producing a collection of abscesses is much in vogue in France Convulisons are very rare in typhoid fever; Murchison' says they are rarer than in typhus, and less frequently uremic In 2,960 cases observed by him in the Fever Hospital only six had convulsions. The peculiar striæ are most uncommon. Sir Dyce Ducksworth report a case in which these cutaneous lesions appeared some time after the patient recovered from an attack of enteric fever, and in whom they were extremely painful. He refers to a number of cases recorded and concludes that this condition must be a very rare sequela of typhoid fever. In my case the striæ appeared during the height of the patient's illness, and when her mental condition prevented the possibility of determining whether the areas affected were specially hyperesthetic. 7 Murchison: Continued Fevers, 1884, page 541. 8 Dyce Duckworth, British Journal of Dermatology, December, 1893. THE LYING IN ROOM AND THE AFTER CARE OF THE PATIENT. BY DR. JESSIE V SMITH, WINTERSET, Iowa. HEN we are called to wait on a parturient woman, It we should ascertain as soon as possible the sanitary condition of the surroundings. Upon making an examination of the patient if we find labor not too far advanced, order a warm bath at once, to be followed by clean underclothing and a borated vaginal douche to render the birth canal aseptic, empty the rectum by thorough irrigation. Next the bed should receive attention. should be placed so as to allow access from both sides. Upon it place a mattrass made of some firm material, over this spread a rubber cloth or oil cloth and over all spread a clean comforter and a clean sheet. If the patient is one of the poorer class and I see there is a scarcity of bed linen, I use a dozen newspapers opened out and spread one over the other, with needle and thread sew them together around the border, on these place an old clean sheet folded, and place the whole under the hips of the patient. After the labor is completed these can be removed and the parts washed with an antiseptic solution and the gown brought down over the hips and limbs and a clean folded cloth placed to the vulva. To prepare your table, spread upon it a clean towel, upon which place a hypodermatic syringe, a solution of morphia, the fluid extract of Ergot, the perchloride of iron an antiseptic solution (corrosive sublimate is the most efficient), an anaesthetic, hot and cold water, brandy and ice, scissors and cord for ligating. In the majority of cases it is best to withhold from view the obstetric forceps, and other instruments; the sight of them will often excite fear in the minds of ner Vous women. Every obstetrician should put on a clean white overwrapper for the labor. During the first stage of labor I rarely allow the patients to lie down in bed as the upright position favors the dilitation of the cervix and the decent of the head into the pelvis. At the beginning of the second stage the patient should be placed in bed. For drink-I prefer small drinks of cold water and from time to time have the nurse bath the patients face and hands with a cloth wrung out of cold water. If the membranes do not rupture spontaneously when the cervix is well dilated they should be artificially broken. If there is a scarcity of the natural secretions, I insert small suppositories of fresh sterilized lard from time to time to facilitate the passage of the child's head through the vaginal canal. In delivery I prefer to have the patient lie on the left side with the knees well drawn up and a folded pillow placed between them. In this position and with watchful care perineum may in the majority of cases be preserved intact. "But rupture of the perineum will occasionally happen even in the hands of the most skillful physicians and the will continue to occurr until there are invented smaller headed children and mothers with a better constructed and more elastic sexual apparatus. Thanks to modern surgery if we are unable to prevent the occurence of the rupture, we have it in our power to effectually remedy it. It is the duty of the physician to make a careful examination of every woman she attends in confinement immediately after the birth of the child and ascertain if any damage has been done to the cervix or perineum. If a laceration exists and the mother is in good condition the parts should be neatly drawn together with sutures of silk worm gut as at this time the parts are so benumbed by the distention that the introduction of the stiches cause but little pain. If the mother's condition is not favorable, the stitching can be delayed from six to twelve hours. If this plan is universally carried out, Dr. Clinton Cushing tells us that more than ninety per cent of the cases of epithelioma of the cervix uteri would be prevented. If the head remains stationary at the prineal floor for two hours, labor should be terminated by use of the forceps, and let me urge early relief for nervous women from their sufferings by the use of chloroform and the forceps. We should make it a rule even in the most favorable cases to visit those in town on the second, third and fifth days and make at least one call (probably the third or fifth day will be better) to our patients in the country. I commenced practicing in April 1892 and in nearly 500 cases have had one bad case of laceration and five partially lacerated and one case of puerpural fever, have never lost a child nor a mother and I attribute a great deal of my success to the aftervisits. THE Woman's Medical Journal Subscription Price $2.00 Per Year. Single Copy 20 Cents. DEPARTMENT OF OBSTETRICS Eliza H. Root, M. D.. DEPARTMENT OF DIETETICS. Chicago, Ill. ..Grand Rapids, Mich. Frances Rutherford, M. D.. DEPARTMENT OF PAEDIATRICS & INFANT FEEDING ASSOCIATE EDITORS, Chicago, Ill. Indianapolis, Ind. .Cincinnati, O. MARGARET L. HACKEDORN, Managing Editor. The Editors and publishers are not responsible for the views of contributors. REPRINTS-Contributors desiring reprints should notify us when copy is sent. as to number desired. Seventy-five will be furnished gratis to those desiring them. T EDITORIAL. DEMAND A THOROUGH INVESTIGATION. HE necessity of an independent medical corps in the army, an organization complete, capable of carrying out within itself all orders for supplies, has clearly been proven by the deplorable conditions resulting from the lack of such an organization during the war with Spain. The world unites in praising, without stint, the bravery of the American soldier, and yet that same brave man has been allowed, through the inexcusable neglect or incapacity, it matters not what it is called; of those in authority, to die on field and in hospital, for the lack of medicine and, aye, even of food. This nation is stirred to its depths by the heartbreaking reports that tell of this needless suffering and sacrifice, and is crying out with insistence for the blame to be put upon the right shoulders, for prompt measures to prevent any recurrence of these tragic scenes. The cry of the fatherless little ones, the sad-eyed wife and sorrowing mother have aroused American loyalty to her heroes, to discover and punish the parties responsible for this blot upon her glorious record. The war for humanity has well-nigh been too costly to our own people, and the nation demands a reckoning. The medical department, hampered as it has been by red tape and useless subservience to authority, should not be made the scapegoat. The trouble, we believe, lies not with this department, and the medical profession, should unite in insisting that the investigation be carried on until the true source of this criminal neglect is found. reorganization of the army is certain, and in that organization the medical department should be recognized as an entity, be given full authority; and then, and not until then, be held responsible for conditions they were powerless to change. The THE UNFOLDING OF OBSTETRICAL ART AS IT RELATES TO INCE the time of Solayres, who lived from 1737-1772, considerable attention has been given to the classification of presentations and their positions. In 1771, Solay res wrote his "Disertatio du Parto Viribus Maternis Absoluto," which marks au epoch in the history of obstetrical art. In it the author seriously discusses presentations and positions, and classifies positions for the first time. Baudelocque, a pupil of Solay res closely followed his young master with a classification that is complex and confusing, admitting something like 102 positions. He in turn, was followed by several others with classifications aiming at greater simplicity. The principle ones belong to the French schools, and are those of Gardien, Capuron, Lachappelle, Velpeau and Moreau. The classification of positions, like all other steps taken in the advancement of obstetrical art was strongly controverted by rivals, down to the time of Boer of Germany. All obstetricians have been agreed, since the time of Solayres and Baudelocque, upon the two cardinal positions, left and right, and upon the points of reference fixed upon the foetal head, breech and trunk. But the landmarks upon the pelvis were arbitrarily chosen, each authority selecting his own. A multiplicity of positions resulted. The nomenclature employed is wanting in uniformity, is confusing to the beginner and often proves troublesome to the more practiced student. Since the relation of certain landmarks of the presenting part must in fact sustain a fixed uniformity to certain landmarks of the pelvic inlet, it is unfortunate that so much confusion has existed for so long. Left occipito-anterior is, and always has been, left occipito-anterior. It is identically the same position as left occipito-iliac anterior, first oblique position, left occipito-acetabular, left occipito-cotyloyd, etc. The variance in naming the points of the pelvis extends to all the different vertex, face, breech and trunk positions. In a copy of Charpentier's (English Trans) 1882 and in a Cazeau and Tarnier that appeared a little later, we find the following table of classification, made include presentations and positions with their varieties. We insert this table, in part, for the purpose of comparison. The reader may complete the the table by substituting mento for occipito in the table and m. for o. in the index: Iliac is introduced as indicating the point on the pelvic brim in contact with the point of the presentation. |