needed in these cases is oxygen, purgatives, stimulation of the skin, a selected diet and abundant rest. In the presence of persistent and increasing toxaemia which does not yield to treatment, the question of the induction of labor naturally arises. It must be kept in mind that the artificial termination of pregnancy often brings with it shock to the mother and in many cases increases her toxaemia. If she be suitably cared for, nature will usually adjust the question of pregnancy by allowing gestation to continue or by bringing about changes in the placenta which will result in the death of the child. This course is safe for the mother, although less prompt than the induction of labor. Of especial value in preventing serious toxaemia is the use of saline water, and of these Celestin Vichy is of special advantage. In the presence of threatening toxaemia, the free use of normal salt solution by hypodermoclysis or by rectal injection is especially indicated. The use of the hot pack or bath requires caution, for the temporary increase in pulse-tension following the beginning of the bath or pack may induce eclampsia; hence the physician must be prepared to administer veratrum viride hypodermatically should the pack increase the tension of the pulse. We cannot remember too clearly the fact that in the toxaemia of pregnancy the vital organs of the patient are undergoing extensive degenerative changes. Cloudy swelling and fatty degeneration of the heart muscle, minute hemorrhages in the substance of the liver, spleen and lungs, and serous effusions or inflammations seriously threaten the patient's life. The toxaemic woman is not safe with the termination of pregnancy, for she may pass through eclampsia only to perish from pneumonia, cardiac syncope, pernicious jaundice or general debility. Eclampsia is but a step in the march of the toxaemic process, marking its acutest attack, but not guaranteeing the patient against further disease. Ahlfeld: Ahlfeld: Albert: Albert: Andrews: Ascoli: Berkeley: Berkeley: Bidone: Boissard and Rozzart: Bolle : Büttner: Christiani: Dienst: Dienst: Eden: Elder: Fothergill : BIBLIOGRAPHY. Zentralblatt für Gynäkologie, No. 10, 1904. Zentralblatt für Gynäkologie, No. 52, 1903. Zentralblatt für Gynäkologie, No. 49, 1902. Journal of Obstetrics of the British Empire, Journal of Obstetrics of the British Empire, Scottish Med. and Surg. Journal, July, 1901. {L'Obstétrique, No. I, 1902. Zeitschrift f. G. und G. Bd. 44, Heft 2, 1901. Journal of Obstetrics British Empire, Feb- British Medical Journal, No. 2096, 1901. Journal of Obstetrics British Empire, Jan. 1904. Zentralblatt für Gynäkologie, No. 25, 1901. Glockner: Goedecke: Goedecke: Groves : Helme: Herzfeld: Hitschmann: Jardine : Knapp: Zentralblatt für Gynäkologie, No. 31, 1901. Archiv für Gynækologie, Bd. 63, Heft 1 and 2, 1901. Zeitschrift für G. und G., Band 45, Heft 1, 1901. Zentralblatt für Gynäkologie, No. 29, 1901. British Medical Journal, April 20, 1901. Zentralblatt für Gynäkologie, No. 49, 1902. Hammerschlag: Zentralblatt für Gynäkologie, No. 36, 1904. British Medical Journal, April 11, 1903. Zentralblatt für Gynäkologie, No. 40, 1901. Zentralblatt für Gynäkologie, No. 37, 1904. British Medical Journal, No. 2096, 1901. Zentralblatt für Gynäkologie, No. 36, 1904. Monatsschrift für G. und G., Band 14, Heft 1, 1901. König: Kroemer: Krönig: MacElroy : Malins: Mathes : McDowell: Zentralblatt für Gynäkologie, No. 40, 1903. British Medical Journal, No. 2101, 1901. British Medical Journal, July 25, 1903. Meyer-Wurz: Archiv für Gynækologie, Band 71, Heft 1, Müller: Nicholson: Nicholson: Nicholson: Norris: Odon: Ostracil: 1904. Archiv für Gynækologie, Band 66, Heft 2, British Medical Journal, May 17, 1902. uary, 1904. Journal of Obstetrics British Empire, July, 1902. American Journal of Obstetrics, July, 1903. Salin: Schröder : Schröder : Schumacher: Seitz : Sippel : Sippel : Sippel : Streckeisen: Stroganoff: Zentralblatt für Gynäkologie, No. 50, 1903. Zentralblatt für Gynäkologie, No. 6, 1902. Zentralblatt für Gynäkologie, No. 27, 1904. Archiv für Gynækologie, Band 68, Heft 3, Zentralblatt für Gynäkologie, No. 48, 1901. Stroganoff: Zentralblatt für Gynäkologie, No. 46, 1902. Monatsschrift für G. und D., Band 13, Heft 5, 1901. Stroganoff: Strurmer: Tridondani: Weichardt: Westphal : Wilson: Journal of Obstetrics British Empire, June, 1904. Annali di Ostetricia, No. 1, 1901. Zeitschrift für G. und G., Band 50, Heft 1, Zentralblatt für Gynäkologie, No. 46, 1903. Wolff: Wormser: Zweifel : 1903. Archiv für Gynækologie, Band 72, 1904. CASES REPORTED. BY DR. WALTER DAVIS, WILKES-BARRE, PA. READ DECEMBER 7, 1904. It has been my fortune to attend quite a number of interesting but difficult obstetrical cases during the past few months. They have included the delivery of a dwarf with a kyphotic dorsal spine, in which the external pelvic measurements were 25, 23 and 27 centimeters, showing considerable contraction of the pelvis. In this case the feet came first and the child was delivered alive without great difficulty. In another case I found a shoulder presentation with an arm protruding. After trying in vain to return the arm I was able on account of the small size of the child, to hook my fingers in the groin and pulling down on the arm at the same time, to double the body and bring the feet down. The cervix then contracted firmly around the neck, and its dilatation to permit the escape of the head was very difficult. In three other cases of contracted pelvis I assisted in the performance of version. In one of these the premature ossification of the baby's head made its delivery exceedingly difficult. On another woman there was in addition to the contraction, great rigidity of the pelvis because she was having her first baby at forty years of age. In this case there was prolapse of the cord, and finally a complete perineal tear, which extended up the rectal wall nearly to the cervix. In this case salt solution intravenously was necessary for her shocked condition, but she is recovering. There are two cases which have occurred in the past month which I desire to report more fully to-night. The first is one of extra uterine pregnancy. Mrs. B., aged 23, is the mother of one child of which I delivered her about 4 years ago. In August she had an attack of pain on the right side of the abdomen, with fever to 101, which I diagnosed as a mild case of appendicitis. This cleared up after two days in bed. She was then about her duties for a month when she had another attack. The pain this time was in the centre of the abdomen and there was a slight discharge of blood. This history of irregular menstruation suggesting pregnancy, together |