circumscribed anesthesias, hyperesthesias, insensibility of the larynx and pharynx, narrowing of the visual field and painful points. Treatment-Special attention should be paid to prophylaxis, especially where there is hereditary predisposition. If the disease has developed the treatment must consider the mental as well as the bodily condition. The physician must get the full confidence of the patient, he must make her understand that he takes great interest in her case and that he can and wants to help her. He must work gradually, always encouraging and making the patient take a more hopeful view of her condition. Control your patient and never let her control you. This is the most important part of the treatment, from the so-called nervines little can be expected; with the use of narcotics we should be very careful. Freiderich recommended cauterization of the clitoris, castration has also been done, but this should be reserved for cases where pathological changes are present in the ovaries. Hypnotism has given good results in the treatment of this disease and most of the so-called faith-cures are undoubtedly due to aura-hypnosis. Eichhorst reports good results from warm baths 30 degrees R. of 30 or 40 minutes duration. Liebermeister recommends cold baths 15 degrees R., the patient to take exercise after the bath until he feels warm. S. Wier Mitchell has obtained excellent results with his rest cure-isolation, forced feeding, rest, massage and electricity. In some cases a change of air is beneficial. DIAPHRAGMATIC PLURISY. CASE REPORTED BY DR. JOHN F. SHAW, READ APRIL 16, 1902. Mrs. H., age 45 years; mother of twelve children, two died in infancy, ten living. Family history, good; mother still living, 70 years old and in good health. Previous history, no diseases since childhood. Present illness began the evening of January 29, 1902; I was called on the morning of the 30th; found the woman suffering with severe pain just below lower border of ribs on right side, pain increased on taking deep inspiration. Temperature sub-normal, 972; pulse, 90; cold clammy skin; bowels constipated; vomiting incessantly greenish substance, also everything taken into the stomach was immediately rejected; circumscribed tympanitis in right upper portion of the abdomen. Gave the patient an enema; nothing, or at least very little, returned except the water. Gave anodyne for pain and a dose of Epson salts, and prescribed bismuth sub-nitrate for vomiting. Next day, January 31, conditions remained nearly the same; pain more severe on inspiration; abdomen a little more distended; nausea and vomiting quite as severe; temperature still sub-normal; pulse 85. Fourth day, February 1st, bowels had moved well. During night pain very much relieved, only present on very deep inspiration; distention of abdomen had almost entirely disappeared. Temperature had risen to 102; pulse 100; vomiting had ceased; a cough had developed with a muco-purulent sputum, which was occasionally slightly streaked with blood. Fifth day, February 2d, very little change. except that the abdominal symptoms had entirely disappeared leaving only the cough which did not annoy the patient very much; temperature, 104; pulse, 100. Subsequent course of case was uneventful. At the end of ten days from the beginning of the symptoms, the temperature had dropped to normal, the patient made rapid convalescence. The case was interesting to me for the reason that for the first two or three days it had every appearance of being a case of intestinal obstruction. THE CARE AND TREATMENT OF THE PREGNANT AND PARTURIENT WOMAN. BY DR. J. B. TOBIAS, WILKES-BARRE, PA. It is not within the province of this paper to discuss every phase of this broad subject, but just to call your attention to a few points in the management of normal pregnancy, labor and child-bed, which, in my opinion, are not sufficiently recognized in their importance by the general practitioner. The trend of modern medicine is toward prevention, and there is no greater field in private practice than is presented in the care and management of normal, physiological pregnancy; labor and child-bed. One writer has said that fifty per cent. of all gynecological operations are traceable to the simple, normal labors which confront the general practitioner, and which, in nearly every case, by proper medical care and nursing, could be prevented. The time has come when the laity demand that we should exercise a more watchful oversight of our pregnant and parturient patients. That our supervision of them shall not begin with the inception of labor and cease with a few hasty calls after. But that we shall use our best efforts that the mother shall approach her coming ordeal in the best possible condition, both mental and physical, and that not only her life and that of her offspring shall be preserved but that she shall be returned to her every-day life and duties with a sound mind in a sound body, as far as medical skill and care can effect it. To accomplish this it is not only necessary for us to be accomplished obstetricians, but success lies almost wholly in attention to minute details, and to this end physicians must school their patients to put themselves under medical care as soon as they become pregnant. This is not a task easy to accomplish, as the natural aversion of all women to have their condition known is familiar to every physician. Yet there are not many women among our regular patrons when once brought to see the benefit accruing to themselves, but would gladly acquiesce. "The first step toward betterment is knowledge." Women must be taught a knowledge of their functional life, its conditions and requirements. When and where are they to obtain this knowledge? If the physician is not appealed to the education of the primipara is left to the grandmother, or perhaps the mother, mother, who consider preg. nancy an every-day occurrence, and little or no heed is taken in regard to her care and comfort until she is seized with eclampsia or one of the many conditions which carry off our patients before labor. There is no other subject of which the laity knows so little and yet so inadequate provisions are provided for the proper instructions in our public schools as the human organism and its functions in relation to reproduction. It is true, physiology and hygiene are taught, but the knowledge is deficient. The school teachers are not sufficiently trained to impart the proper knowledge in the higher grades. I believe this instruction should be given by a physician whose special training has fitted him for the work, and that the girls in the last grade of our grammar schools should receive instruction pertaining to the generative organs and their functions; the changes which take place in the nervous, vascular and digestive systems as well as the uterus and its appendages; the dangers of abortion and miscarriage, and the bad results which follow if proper care is not taken. I feel sure that many a young girl whose life has been lost, or perhaps ruined, would have averted this calamity, had she been cognizant of the dangers before her. Then let our public schools educate the girls so they may be prepared and understand the part they are to take in the function of reproduction, then will the task of the physician be lightened and a step taken, which is the foundation of preventive medicine. "That the mother influences the character of her child in utero and moulds its brain structure cannot be successfully controverted." The Care of the Kidneys-There are few physicians who make it their practice to examine the urine of their pregnant patients from time to time throughout their pregnancy, but there are a greater number, from my experience, who never take the trouble unless the condition of the patient becomes so grave that attention and treatment are demanded, when often it is too late and abortion or miscarriage is inevitable in order to save the life of the mother. "The time to treat puerperal exclampsia is thirty days before it occurs." It is true we are seldom called upon to treat diseases of the kidneys prior to the fourth or fifth month, but even after that the kidneys may show signs of degeneracy without any warning. The urine of the pregnant woman should be examined at least once a month; not alone for albumen, but for the amount of urea excreted in twenty-four hours which seems to be a better index to the condition of the kidneys than the amount of albumen. I remember one case of exclampsia in which I found only a trace of albumen. Last summer I was called to see a woman, six months pregnant, who was found dead in bed, and I found her so dropsical that her features were almost unrecognizable, and learned that she had been suffering with all the symptoms of kidney trouble for some time and yet she had never had her urine examined. During the latter weeks of pregnancy the urine should be examined once a week and at the first indication of kidney weakness, if proper care and treatment is instituted, eighty per cent. of patients who are in danger from renal failure and faulty metabolism may be tided over until they are safely delivered. Diet is a subject about which there is a great deal of superstition among a certain class of people, especially old women ; as I have heard said that a woman with child must not eat too heartily, or she will have a large child and she must shun meat or the head will be large and hard, and the desire is so great to have an easy labor that often their diet is restricted to an extent dangerous to both mother and child. The pregnant woman's system demands more food, both in quality and quantity, than the non-pregnant, and the effect upon the child is |