second stage of labor, with the fetus presenting by the breech. I ruptured the membranes, causing all the liquor amnii to be caught in a large dish pan placed upon the floor by the side of the bed. The actual amount of liquor amnii, when measured, was 4 quarts, 134 pints. The child, a female, was alive at the time of my first examination, but was dead when born. Its weight was 3 pounds.

As is usual when there is a high degree of hydramnion, it showed serious defects in development. The bones of the face were peculiarly distorted, otherwise their anatomical structure was normal. The parietal bones were absent. The vertical portion of the frontal bone ended at the superciliary ridge; the horizontal

portion was present. The temporal bone was wanting in its squamous portion; the mastoid and petrous portions were present. The occipital bone was absent. There was a small, rudimentary piece of bone, corresponding to its basilar portion, with which the atlas articulated, interposed between the body of the sphenoid and petrous portion of the temporal. The sphenoid and ethmoid bones were present and normally developed.

The vertebræ were normal in number. The anterior solid segment, or body, of each individual vertebra was normal. The posterior segment consisted of a pedicle and transverse process only; the lamina and spinous processes were absent.

There was neither bony arch, spinal canal, brain, or spinal cord. There was no cranial cavity. A thin tissue membrane extended from the posterior free edge of the frontal bone downward and backward to the shoulders, ending in a free edge, and simply resting upon the exposed bony surfaces, after the manner of a

curtain.

The integument was present over the entire body, except as shown in the second photograph. The skin is seen to divide over the sacrum and to pass upward on either side of the exposed spinal canal, its free edges being attached over the superficial groups of muscles and posterior extremities of the ribs, external to their fixation articulation to the vertebræ, to be continuous with the skin over the side of the neck, face, and forehead. The long muscles of the back were absent. The posterior surfaces of the bodies of the vertebræ, their pedicles, and transverse processes were exposed to view. The spinal column bulged outward beyond the skin surface.

307 YORK STREET.

A CASE OF PUERPERAL ECLAMPSIA.

BY

WILLIAM E. LIPPOLD, M.D.,
Brooklyn, N. Y.

Instructor of Laboratory Diagnosis, Long Island College Hospital; Surgeon to Bushwick and East Brooklyn Dispensary.

WHILE there is such a variance of opinion and such a diversity of theories as to the etiology and treatment of convulsions during the puerperium, a detailed report of each case of eclampsia ought

to considerably increase our knowledge of the same. For this reason, I take pleasure in reporting the following case: Mrs. L., age twenty-seven, has a sister who is subject to violent epileptic attacks; otherwise her family history is negative. She is well nourished and in good health. Primigravida. Date of expected confinement, October 5, 1907. Repeated urinary examinations showed an average specific gravity of 1,017. No albumin. The daily excretion of urea averaged 450 grains. The abdomen was very large and tense, so that I suspected twin pregnancy without being able to demonstrate it. During the eighth month the patient complained of some backache, but otherwise felt well. There was some edema of the lower extremities. On September 17 the patient sent for me, and I found considerable edema of the legs as high as the knees. Administered a diuretic and the edema diminished tc a marked degree. There was some enlargement of the thyroid gland. The patient was still feeling well. Two days later, at 3 A.M., I was again sent for. She was having rhythmical bearingdown pains at twenty-minute intervals. On examination, the cervix was found dilated to admit three fingers, membranes were ruptured, and head presenting. Pains continued all day, dilatation increasing. At 6 P.M. I was again hurriedly sent for, as the patient had had a convulsive attack. Found the cervix completely dilated, head engaged. Decided on immediate delivery, as patient was weakening, and pains had little force.

While waiting for an anesthetist, she had a second convulsion. It began with spasm of the left hand; the head was drawn to the left side, eyes twitching, face greatly distorted. The right arm and legs were next involved. Respiratory muscles became rigid and patient became cyanotic. This was followed by coma with heavy, stertorous breathing. In a half hour she awoke, was chloroformed and forceps applied. First child delivered at 9:40 P.M. On examination I found a second head presenting. Forceps were again applied and a second child delivered. Placenta was delivered forty-five minutes later by the Credé method and three sutures taken in perineum. A half-hour later, when she had recovered from the anesthesia, the patient had a third convulsion, followed by nineteen more before morning. Chloroform was used, hot pack given, and chloral hydrate 3ss in one pint hot saline was administered per rectum. The convulsions continued during the morning. (Veratrum viride was not used.)

Called in consultation Dr. Sewall Matheson. We decided on

eclampsia as the condition, the kidneys as the cause; administered magnesium sulphate 3ii, in dram doses, per os, q 2 h, with one quart saline per rectum, high, q 3 h, and chloral hydrate 3ss once more. Patient did not have any more convulsions, voided large amounts of urine involuntarily, and had repeated bowel evacuations. Edema of hands and face gradually subsided. UrineSp. gr. 1,010, albumin abundant, urea grs. iv to 3i, some hyaline

casts.

On the third day patient complained of headache and "seeing things" when she slept. Temperature 100°, pulse 80, and not so tense as before. Kemp irrigation given, using six quarts water at 110° F., also 10 grains each of sodium potassium and ammonium bromide. The twins, girls, weighed seven pounds each, were not asphyxiated, and did nicely on modified milk until the fifth day, when they were put to the breast. Mother made an uneventful recovery. Urinalysis on eighth day: Sp. gr., 1,017, albumin moderate amount, urea grs. ix to 3i, no casts.

A TELEPHONIC CURET.

BY

ARTHUR C. JACOBSON, M.D.,

Brooklyn, N. Y.

(With one illustration.)

IN the Annals of Surgery for September, 1907, the writer described a telephonic searcher for use in the bladder. Since devising the searcher it has occurred to him that the principle can be utilized in another and much more useful way, and he has accordingly applied it to the curet.

In curetting, as it is now practiced, one must depend almost entirely upon the sense of touch. Of course, one uses one's eyes, too, to guide the instrument. Now, the employment of still another sense, hearing, cannot help but aid the operator to curet thoroughly and safely. When using the telephonic curet one can hear, as well as feel, what he is doing, and, needless to say, the sense of hearing is more trustworthy than the sense of touch.

The instrument is exceedingly sensitive and transmits micro