To one of some practical experience it must be difficult to understand why in unnatural labors there should be the slightest hesitation in the selection of this remedy in order to prepare the patient for the mechanical means necessary to unload the uterus, when, by anææsthesia produced by a confident hand, all the physiological irregularities existing can be subdued, and the woman placed in a posi tion of non-resistance to any act of the operator by her voluntary muscles, so as to enable him to perform most of the obstetrical manipulations with comparative ease, as version, necessitated by an arm presentation, hours after the waters have been drained off, where the irresistible and intractable conduct of the woman, together with the uterine contractions, are so violent and continuous as to paralyze the hand in the effort to seize a foot and turn the child.

And above all, in true puerperal eclampsia, where pathology has failed to establish any fixed lesions beyond renal congestion in its various grades, and nervo-motor consequences, where a modification of that reflex influence, existing between the pelvic organs engaged in parturition and the brain and spinal marrow, is positively and promptly demanded, and where, by venesection, exsanguined systems, rarely and but slowly recover, and are usually attended with loss of the child, as well as the time necessarily lost in effecting the desired impression by opium, how can there be a question as to the selection of the remedy, or any hesitation of instantly adopting anæsthesia as pre-eminently the indication, by virtue of its sedative action in relieving that extreme nervous irritability of the nerve centres that threatens life, during the period necessary for emptying the uterus of the offending mechanical cause in the body of the child and its appendages?

Will any advocate of venesection or opium question the relative tardiness or inefficiency of these agencies with anesthesia as to time, a matter so essential for the safety of both mother and child, or can any question of additional risk from the anesthetic be reasonably entertained?

We speak from experience, and can declare that where venesection, opium, purgation, enemata, counter-irritation, and baths were depended upon, physicians in this locality not only generally lost the mother, but universally the child. Now we rarely hear of such results; and, in my own individual practice, have neither lost mother nor child during the last thirteen years, i. e., in cases at full term, where the child was living at the onset of the eclamptic seizure; because I have always acted in obedience to convictions that have led me to regard anesthesia in the parturient state as not identical in its toxicological effects with the same agent in the same individual

under other circumstances in a dental chair. And a subject presenting conditions that would induce the surgeon to discard his anæsthetic and toss it from the room, should compel the accoucheur to crowd it upon his eclamptic patient, in the full belief that in this vapor, during the paroxysms, rests her safety more than in that of pure atmospheric air.

Several years ago I saw, at full term, a primipara with general anasarca, fearfully apprehensive because of her condition, and the fact that her mother died giving her birth, almost blind, urine albuminous and scanty, exhausted from loss of rest, and exhibiting the prodromes of convulsions. Without any evidence of labor I directed an active purge and large doses of bromide of potassium, believing that when labor set in I would have a typical case for the test of the virtues of anesthesia in this particular character of convulsive trouble. Before either of the remedies could be administered convulsions occurred with great violence, and I commenced at once the inhalation of the English mixture of ether, chloroform, and alcohol at each exacerbation until she was lulled to quiet. Turning a deaf ear to all appeals of the friends for venesection, the anæsthetic was steadily continued for two hours, when it was evident her labor had set in, and the chief aim was to deliver as soon as possible.

Whilst bringing down the child with the forceps the general appearance of the woman became so alarming as to unmistakably portend to the by standers certain and immediate death, and so unwilling were my medical assistants to continue the anesthetic that I was compelled to leave my portion of the work to take the charged towel from their hands and crowd it over the entire face of my patient, who had apparently almost ceased to breathe; when, to my anxious hope against what seemed an inexorable fate, I soon saw the blueness fade from the finger nails, the extremities assume a more natural color, the pulse increase in force, and the respiration return to its former stertor. This gave confidence, and the assistants, assured of no responsibility in the event of a fatal termination, complied with my instructions, and for another tedious hour we so guarded her from death as to complete her labor in safety of a healthy living child.

Without relating any further cases in detail, showing the effects of the anaesthetic, as well as others exhibiting almost marvellous escapes, in which such alarming symptoms followed the labor as to have made it impossible to believe otherwise than that the nervous distress in vertigo, formication, numbness of the limbs, profuse sweats, etc., had been the direct effect of such administration, and

in which no anæsthetic had been used, I would submit the following general conclusions drawn from at least one thousand cases under my own observation and management :

1st. That the parturient state is the only condition of the system during life in which anaesthetics, judiciously administered, are entirely devoid of danger.

2d. That the physiological action of chloroform, ether, and alcohol in a woman during labor is not identical with that in an ordinary subject in a dental chair, or upon the surgeon's table, and from the history of such administration, free from a single well-authenticated case of death, with statistics showing its superiority over venesection, opium, etc., in the desperate emergencies attending irregular labors, as eclampsia, it is fair to infer that this agent is an especial therapeutic indication for parturient women, and should be so regarded in all labors where by its use the pains of the second and third stages could be obviated, and this, too, to the ultimate benefit of the mother and safety of the child.

3d. That in puerperal eclampsia it is especially indicated, because of its direct, rapid, and general action, controlling nervous physiological irregularities, exciting secretion, relaxing the os and perineum and, in short, so preparing the parts as to aid the accoucheur in his manipulations for the essential emptying of the uterus-to accomplish which, venesection, opiates, purgation, counter-irritation, etc., either singly or combined, bear to anæsthetics the relation of mere fractions to a grand whole.

4th. Its application is universal; no diseased condition of the heart or lungs, at all likely to exist where pregnancy can occur, should forbid its use-for where has a post-mortem examination revealed a dilated and weak right heart from fatty degeneration in the body of a pregnant woman at full term?

5th. That in view of its known therapeutic action and safety in the small quantity required to produce narcosis, no use of the forceps, version, nor obstetric operation of any moment should be performed without it; not only to save the patient from shock and its consequences, but because of the great saving of time and labor and, in most instances, the assistance it affords the operator.

6th. Owing to the fact that uterine contractions are often lessened by the administration, it is always important to precede it by an oxytocic, in all labors and at any stage, where the pains are slight, so as to increase their force, and also to guard against post-partum hemorrhage-a very infrequent occurrence where such precaution is taken.

7th. Accidents to the unemptied bladder, ruptures of perineum

and sphincter ani may be prevented, as well as death of the child in prolapsus of the cord by the facilities afforded for rapid delivery, especially in primipara.

8th. That in no instance have I seen narcosis of the child attributable to the anaesthetic.

9th. Without any special reason, excepting the common disagreeable feature of ether, and the supposed risk of chloroform, I have generally used the mixture proposed by the Medico-Chirurgical Society of London, consisting of ether 3 pts., chloroform 2 pts., and alcohol 1 pt., being careful as to the quality of the preparation, and having them recently mixed. With this combination I have never been disappointed, or regretted its use; and, in truth, nearly all the troublesome cases I have had after the labor were those in which, for some reason, the anæsthetic was not used.

How few physicians would refuse an anæsthetic to a man or woman who required the lancing of a whitlow, the extraction of a tooth, the amputation of a breast or limb, or any of the ordinary minor or major operations in surgery, where danger to some extent always attends, and in which exists but a small amount of pain, from the shortness of duration, in comparison with that of an average labor, where statistics declare no danger under any administration can be apprehended from the anaesthetic alone!

Where is the man, who as physician or surgeon in his legitimate province, could stand coldly by and see with indifference the writhing of a human being in broken or continued pain, without offering to him an anodyne or anæsthetic; and yet, why the stolid and heartless indifference that same man exhibits when he becomes an accoucheur and has in his sole charge a helpless woman in the agonizing throes of labor, earnestly beseeching him to relieve her of her anguish or give to her immediate relief in death?

Fortunately, in unnatural labors many physicians regard anæsthetics as directly indicated, and rarely attempt version or craniotomy without them, but unless some desperate emergency exists, a morbid apprehension of some mythical possibility seems to seize the mind and govern their actions, and a humanity, for which as physicians and surgeons they may be proverbial, deserts them in the very hour when above all others the tenderest sympathies and promptest care should demand the consummation of a possible painless and happy conduct by that boon, which to parturient women, in the travail of labor, falls but little short of what may well be termed an especial therapeutic divination.

ROSACEA.

BY JOHN V. SHOEMAKER, A.M., M.D.,

OF PHILADELPHIA.

THIS affection of the skin is also known as acne rosacea, gutta rosacea, and cuperosa. It is described by some authors as one of the varieties of acne, and by others as a separate and distinct disease. As the blood vessels and dermal connective tissue are primarily the seat of the disorder, and as the glands only become involved secondarily, the latter view seems to me the more philosophical.

Rosacea is a chronic inflammatory disease of a portion of the face, characterized by vivid redness due to an enlargement of the capillary blood vessels, and later, by hypertrophy of the subcutaneous cellular tissue. It may present three stages: the congestive, varicose, and hypertrophic. The first consists in a reddened state of the nose, at times the same condition existing on the cheeks. It is more common for it to occur alone upon the nose, but it may also be found occasionally isolated on the cheeks or forehead. The redness may either be uniformly distributed over the part involved, or it may be made up of small patches having normal skin between them. The disease usually begins in the form of spots, and so it will spread until the most prominent portion of the face is covered by a diffuse redness which, when exposed to the cold, assumes a livid tint. Sometimes, owing to the excessive vascularity of the part, the sebaceous glands are excited and rapidly accumulate and discharge oily sebum. The nose will then have in addition to the redness an oily and shining aspect. The progress of the disease in the majority of cases is very slow, often requiring months and even years for its development. It occasionally, however, runs rapidly through its different stages, this being generally due to the condition of the system and the violence of the exciting cause.

It may continue in the first stage for an indefinite period, but it is more frequently succeeded by the next, in which small capillary blood-vessels appear upon the surface. The skin now remains con