tubes usually should be removed. However, there are plenty of cases of pyosalpinx that recover without operation.

In conclusion the writer would sum up the treatment of puerperal infection thus:

(a) Pay religious attention to prophylaxis.

(1)

Put the patient in the semi-upright position.

(3) Give ergot to favor involution.

(3) Increase patient's resistance by every known means. (4) Do not spread the infection by ill-advised operative measures on the genital tract.

(5) Treat complications as indications arise.

CLINICAL REPORTS.

A Case In Practice.

Mrs. T., primipara at term, having warnings of approaching labor, apprised me of her condition and said I could arrange any time accordingly. An examination revealed absence of any real progress and that attendance would not be required for some hours. Both ankles were slightly oedematous, though in one it was so slight that she had not noticed it at all. She had had the best of health all through her gestation and expressed herself as feeling perfectly weil that morning. I took a specimen of her urine to my office and found it highly albuminous, the picric acid test revealing 5 per cent. I at once put her upon a strictly milk diet, had her take magnesia sulphate in level tablespoonful doses every three hours and use colonic irrigation with hot normal solution every four hours, having her assume the knee-chest posture when taking the enema and instructed her to retain each one as long as possible without provoking labor pains. I told neither her nor her husband what I feared, and in answer to their questions as to what all this was for I told them it was simply to pute her in good condition for her confinement, but to her husband's mother, with whom they were living, I gave due warning. I kept in touch with the case. all day and made a call late in the evening, and noting that the excretions were all that could be desired, felt that there was nothing more needed for the time. Nothing occurred during the night and I visited her at 9 the next morning and found the os soft and commencing to dilate and pains normal. A trained nurse was placed in charge with instructions. After a perfectly

normal labor she was delivered at 5:30 p. m. of a ten-pound boy and was perfectly happy at the thought that she was the mother of a living child. The placenta was expelled within twenty minutes with but little assistance and was followed by profuse hemorrhage, which recurred at more or less regular intervals for the next half hour; while it was at no time alarming, it far exceeded the ordinary, but there were good contractions in the intervals, and feeling that this was a salutary measure, aside from grasping the fundus and kneading it occasionally, I did nothing to control the hemorrhage. After good contractions had obtained, three stitches were taken in the perineum to which she neither offered any objections nor complained of pain; the dressings were applied and when I was thus engaged she complained of seeing colors in front of her eyes. I had her turn upon her side and told her to close her eyes and rest awhile, and after about twenty minutes she looked up and said she felt all right. The baby was then put to the breast and he nursed vigorously and without any untoward effect upon the mother. I then left her, it being a little more than two and a half hours after the completion of the labor. A phone message about half an hour later stated that she was perfectly rigid, but that there was no convulsive movement. I was soon with her and at once gave 15 drops of Norwood's Veratrum by mouth and dissolving 30 grains of chloral hydrate and 60 of potassa brom in a pint of hot normal solution, threw it into the rectum and held it there for half an hour, at the end of which time she opened her eyes, spoke to us and at once returned to perfect consciousness. I left her at 11:30 p. m. with a pulse of 84 and a normal temperature. She had a comfortable night and at 9 a. m. the following morning her temperature was normal and pulse 58, but good in quality. The rest of her purperium was normal in every respect except that the bowels would not act without aid, but this was easily met by a small enema every morning given within half an hour after she had had breakfast. Her urine contained one-half of one per cent of albumen as late as the twelfth day.

I have reported this case, giving only what I consider the material facts and for no other purpose than that of adding another lesson to the study of puerperal eclampsia, let the teachings be what they may.

I wish to call especial attention to some of the features this case presented, viz: That the labor was what could be called perfectly normal in every particular except that the post-par

tum hemorrhage was excessive while it lasted, though at no time approaching the danger line, but did it have any influence upon the final result? The volume of blood was certainly reduced and the pressure proportionately diminished, but even so it is still a question in my mind whether the loss of so much. blood through the uterine sinuses has any immediate beneficial effect upon the convulsions, but there is plenty of evidence testifying to the good effect of venesection, even in one-tenth the volume of that lost by post-partum hemorrhage; hence the inference must be that it is the kind of blood extracted and not the quantity always that determines the result.

It is to be regretted, perhaps, that the blood pressure was not taken, but at no time prior to or during labor did either the rate or quality of the pulse indicate that it was increased.

Another feature of this case is that there being no manifestations of toxaemia until some three hours after the completion of labor, it furnishes negative evidence at least as to the utility of emptying the uterus as one of the desiderata in our efforts to control the convulsions and save the woman.

While I do not claim that the management of this case could not have been improved upon, I do claim that the course pursued was rational and that every means employed had a definite object to be accomplished.

I attribute the favorable outcome to the mildness of the toxaemia and the measures instituted prior to the onset of labor as much or more than to the remedies used after the seizure. In fact, I believe she would have recovered without the use of any medicine after the completion of labor, but at the same time I do not believe that one would be justified in taking such a risk, but believing that I had a sufficiently accurate estimate of the degree of the toxaemia, as indicated by both the urinary findings and the abundant excretions for the twentyfour hours preceding labor, I did not deem heroic measures at all indicated at any time. And since the case yielded or seemed to yield so readily I believe more radical measures would have been harmful.

J. Lue Sutherland (Grand Island, Neb.)

St. Peter (to fair applicant)-What caused your death?
Fair Applicant-I was operated on in a hospital.
St. Peter-Private room and four nurses, I suppose?
Fair Applicant-No, I was in a ward.

St. Peter-Select your wings.-Life.

Bone Conduction In Lues.

A rather odd finding has been made in the bone conduction of the hearing apparatus in luetics, which is, that the hearing may be normal for conversation and air conduction, but that the bone conduction is diminished out of all proportion to the amount of hearing power present.

Beck tested more than one thousand luetic patients, finding this condition present in all. It was not necessary for the ears to be complicated in the disease, but he claimed that this rule applied to any person affected with lues.

At the present time no explanation is offered for the cause of this, still if the test proves true in all cases, we have a very important sign, and in a matter of differential diagnosis it should receive some notice. BUSHMAN, Omaha.

Toxicity of Ovarial and Testicular Extracts.

Champy and Gley (abst. in Cb. f. Bacteriologie 51, 7, p. 516) have found that extracts of the corpus luteum and the ovaries, when quickly prepared and used fresh are highly toxic for dogs and rabbits. But if a sub-lethal dose of corpus luteum extract be first given, immunity to the ordinary lethal dose is conferred within a few minutes. They have named this rapid immunization, tachyphylaxie. Supplementing this work on the ovary is that of Graefenburg and Thies (ibid. p. 536) who report that the intra-venous injection of a watery testicular extract rapidly produced death in rabbits and guinea pigs. Homo-extracts, i. e., from the same species, are more deadly than hetero-extracts. Sub-lethal doses instead of producing immunity caused a hypersensibility to testicular extracts both from the same and other species of animals. GIFFORD, (Omaha)

The Resuscitation of Stillborn Infants.

The Journal of Therapeutics and Dietetics for December last contains among its editorials a graphic account of how the physician succeeded in resuscitating a child that had been stillborn after an exceedingly strenuous labor in which first high forceps had been applied and which then had been terminated by version. The cord was parted in the fray and free hemorrhage had taken place in the parturient canal, the little inanimate object being as white as a piece of marble.

After all known methods for starting life in a fetus had been employed without results, the doctor wrapped the body in a warm wet cloth and then in a warm dry blanket. He then applied a small hemostat-forceps to the end of the tongue and made rhythmic tractions sixteen times to the minute, timed exactly by the watch. After keeping this up for nearly twenty minutes, a faint gasp from the little body gave evidence that some reflex impulse was traveling down that branch of the pneumogastric nerve and was waking up the slumbering heart. In five more minutes the heart was beating under its own steam, and life had started.

We congratulate the doctor on the pluck and persistence with which he defied death, and can understand the satisfaction he must have felt when he laid the little newcomer in his mother's arms. We mention the case because all too often the attempts to resuscitate still-born babies are gipen up early. Often persistent and prolonged effort will be successful against apparently overpowering odds.

Photography of the Eye-ground.

Professor Dimmer, Vienna, has practically perfected a method of photographing the fundus of the eye. At a recent demonstration he explained how this field of work had begun, the many obstacles overcome in its progress up to the present time, when it has reached a stage of practical application and importance.

With a device of his own invention, he is not only able to make a direct examination of the fundus, but to take photographs of different magnifications. Foreign bodies may be located, various intra-ocular diseases be observed, in fact, a picture so well detailed as to be of greatest diagnostic importance.

However, Professor Dimmer's device is so large and costly as to be prohibitive in private practice, but of great value in a large hospital or clinic. BUSHMAN, Omaha.

A New Form of Salvarsan.

It is authoritatively announced that Professor Ehrlich has succeeded in perfecting a new form of salvarsan, his famous "606," which overcomes many of the difficulties of use and objections as to after effects of the original preparation. The improvement consists of a method of making the drug completely soluble in distilled water without the addition of alkalies, and