ated cervix April 11, 1894, since which time she has been plump and strong.

CASE II. Mrs. P., 22 years of age. Primipara. Called on the afternoon of June 27, 1894, on account of convulsion. Found from the condition of the cervix the patient was not ready for labor at full term.

Administered a gr. tablet of morphia and atropia hypodermically and sooner than it had time to take effect a second convulsion occurred. After an interval of an hour a third spasm, when a teaspoonful of Tr. gelseminum was given. After another interval of three-quarters of an hour a fourth convulsion and the second dose of morphia administered. After this convulsions ceased and patient slept all night. Awoke next morning conscious though somewhat dazed for a time and complaining of headache, muscular soreness and general malaria. The headache had preceded her illness for several days. Urine rather scant and low sp. gr. No albumen. I administered a cathartic with directions to repeat every day. On the third day got out of bed and was about the house for a time as usual.

On the evening of July 4th was again hastily summoned on account of recurrence of convulsions. Morphia was again administered and after the third spasm it was repeated. The condition of the cervix indicated that the time was at hand for labor to begin. A soft catheter was introduced as in the first case and tamponned in position.

Pains progressed regularly and at 2 o'clock A. M., July 5th, was delivered of a healthy seven-pound boy. This patient complained of headache and general nervousness for four or five months. I first put her upon bromide of soda and afterward upon Buffalo Lithia water, shortly after which her distress disappeared and she has since remained well. Examination was made in this case to confirm or disprove the synchronism of uterine contraction and general spasm with the same result as before.

CASE III-Mrs. H., about 35 years of age. Primipara. This patient had suffered intensely with nausea during the first few weeks of pregnancy which was controlled finally by the use of the dilator after all medicinal agents had failed. Had her under treatment for a week prior to delivery for intense headache and later amaurosis, and which consisted in the administration

of laxatives and sedatives, and in spite of which I was called in the afternoon of January 14, 1893, about 4 o'clock on account of an attack which from the description was one of syncope-at least was not recognized by the friends as a convulsion and which was. followed by delirium lasting about two days. The os uteri was found on my arrival to be about the size of a half dollar and the head of the fetus very low in the pelvis. The usual hypodermic injection was administered and after three or four hours waiting proceeded to dilate the cervical canal by digital manipulation and about II P. M. the forceps were applied and delivery accomplished with a good deal of difficulty and resulted in a still birth. Patient had a slight temperature for a couple of days and had no recollection of what had transpired. No albumen was found in the urine which was of low sp. gr. Made a good recovery.

To attempt to give a synopsis of the medical teaching of our subject during the past quarter of a century would be to leave it just where we began, in an impenetrable maze of uncertainty and mystery. The astute text-book author ordinarily leaves the student to come to his own conclusions after having regaled him with theories new and old and for the most part dodges the question so far as individual opinion is concerned.

I think, too, when the inspired Psalmist said in his haste that "All men are liars," among other things he must have been consulting some of the medical statistics of his time, for it is a fact that figures do not tell the truth unless all sources of error are eliminated and I cannot but feel that herein lies one of the obstacles in the way of a more complete knowledge of our subject. to-day. Another is in the refinement of symptomatology without reference to the central lesion, or the causes leading thereto.

In our discussion we will assume that it is the convulsion that kills both mother and child. That is due to changes in the convulsive centers brought about by the presence of a toxic substance having its origin somewhere in the nutritive processes in which the ingesta fails to reach its usual ultimate products. That the materies morbi is capable of producing structural changes in other organs of the body interfering somewhat with the processes of elimination. And that the convulsive seizure is precipitated by uterine contractions.

These, of course, are offered as hypotheses and are presented as the most unassailable of any yet given.

Having reviewed the description of a number of autopsies made by competent observers, nothing is found at all constant except that which the convulsive seizure will readily explain, viz: Hemorrhagic extravasions and transudations which shut off the arterial blood supply from any or all parts of the nervous system including the centers governing the vital processes. Neither is adequate explanation furnished post mortem for a cause of death in the fetus hence we conclude that death does not occur in the fetus as a result of the maternal toxemia except in the mind of the accouchier until produced by asphyxia, the result of the convulsions or hurried operations of delivery.

And

It is a very easy matter after having introduced our hand through an imperfectly dilated cervix and performed podalic version, to hurriedly bring the fetus feet foremost through the parturient canal, or having applied the forceps at the superior strait in relation to the pelvis with the point of one blade impinging upon the neck making pressure upon the base of the skull midway between its lateral and posterior aspects and thus making the required amount of traction to accomplish delivery, to make ourselves believe that the fetus was dead before we began. no reasonable ground of faith can be established to support any claim other than that of interference with the placental and general circulation of the mother during a convulsion which may be so prolonged or so frequently repeated as to produce death by asphyxia in the unborn babe. Again, the nutritive processes in the pregnant woman are in a condition of stimulation to meet the growing demands of the developing fetus. Most women grow robust and stout with appetites so ravenous as never to be gratified by a sense of complete satisfaction, and many are led thereby to gormandize. This has been the state of affairs in the cases of eclampsia with which I have met, though perhaps not worse than many others who escape, and I am willing to venture the opinion that this has been the experience of others who have taken the trouble to go into the details of the every day life of their patients. Nor have I ever heard of a case of eclampsia occurring when a sick stomach continued during the greater part of the period of gestation-a condition that I have come to regard as a conservative one and only a misfortune when transcending the bounds of good behavior.

Coupled with this state of affairs in eclamptic women is scant urine, the cause of which is for the most part centric, of rather low

specific gravity. This gives an excess of products to be taken care of in some other manner-albumen often percolates through the kidneys, especially during the time of eclamptic seizure; an irritant poison which is represented by the relative difference between the amount of food digested and the quantity and specific gravity of the urine is everywhere present inducing changes of a complex character, chiefly inflammatory and degenerative, and some day a product will be isolated to compensate for the difference alluded to with which we will be able to produce the characteristic phenomena at will, and some enterprising concern will start an antitoxine factory and compel us to purchase and use its wares by creating a popular demand for the

same.

It is estimated that convulsions occur with greater relative frequency in multiple pregnancies in the proportion of about 31⁄2 to I, an increase which is commonly ascribed to greater uterine distention with consequent mechanical interference with other organs of the body; but I see no difficulty in harmonizing this ratio with the toxemic theory.

A greater amount of nutrient pabulum is demanded with a corresponding eagerness of the alimentary sense or desire which is gratified by a more frequent ingestion of food, or it may be in greater quantities than can be utilized properly by nature's laboratory; but why it will produce gout or diabetes in the nonpregnant and eclampsia in the pregnant condition I will leave for future ages to demonstrate. Again statistics show that primipara are far more frequently the victims of eclampsia, but none of the theories heretofore advanced offer any adequate explanation. The advocates of the toxic origin have none to offer, consequently we cannot accept the dictum without notification.

There are a far greater number of first confinements than second or third ones, diminishing rapidly as the numerical order increases. That is one source of considerable error. Then when a case of eclampsia does occur in an individual it is pretty generally seen to that this sort of a calamity does not happen in that household again, which eliminates most of those having the peculiar susceptibility after the initial trial and which obliterates the remainder of the excess and clears away the last obstacle to the toxemic theory.

If it is the toxemia that is the immediate cause of death then we who advocate the use of opium in the treatment "are of all men most miserable," as by locking up the secretions and excretions we are defeating the very object we are trying to accomplish, but the facts of experience teach that it is more like applying the brakes to a car rushing down a steep incline-don't get there quite so quick but far less liable to jump the track.

That the morbific agent is not of microbic origin need scarcely be discussed, as the operations of nature in the human economy are not so unerring but what the bacteria would at some time enter the alimentary canal while the attending physician was making up his mind that his possible case of pregnancy was one of uterine fibroid. There is no reason why a micro-organism should be more accurate in its discrimination than the doctor.

If as we have stated the rule of the order of sequence is that the poison which is also abortifacient, produces the spasm either by direct influence on the nerve cells or by gross changes in the convulsive centers and the convulsion precipitated by uterine contraction it follows that whatever will quiet the pains of labor or hold the excited reflexes in check will aid in obviating the tendency to death. Sometimes the reflexes may be controlled by drug administration, the pains of labor proceeding naturally, while at others, either from the neurotic condition of the victim or the intensity of the toxemia, it is necessary to narcotize to the point of abolition of the uterine contractions which is almost to the point of tolerance of the patient, the number of respirations per minute being the guide.

I have said the morbific principle is oxytoxic; thus when the system becomes saturated to the limit of endurance the natural tendency is to get rid of the conditions causing it making about one-third of all the cases occurring that of premature birth, not because the fetus is dead, but because its presence in utero with its attendant conditions is an offense to the maternal economy.

When human intelligence cannot or will not govern the animal instinct in the way of appetite it will open up the very fountains of life turning out their occupants unprepared and unbidden into the world.

The physician is often not summoned until the period of crisis when the only thing then left for him to do is in imitation