put in as good an antiseptic condition as the surroundings will allow, and under full antiseptic precaution introduce two or three solid bougies. Those known to the trade as Vermilion Olive Pointed are the best in the market for this purpose. These should be inserted to the fundus and on different lines if possible. When they come in contact with the placenta, a partial withdrawal and reintroduction will usually overcome the difficulty.

Sometimes during the required manipulations they become too soft. A few minutes on ice will correct this condition. Care should be taken to prevent rupture of membranes, which fortunately happens rarely. The patient should then be given an anodyne and allowed to rest. If there is no indication of labor within twelve or fifteen hours, two or three more bougies should be inserted in the same manner. This procedure has never failed to induce labor within a reasonable time in my experience. Should it not do so, I would remove all bougies and reintroduce them, or pack the cervix and lower cavity with gauze, as seemed most appropriate in the given case. Once pains are well established, the bougies should be removed and the case allowed to progress as any normal labor; at the same time, if all indications are not most favorable, an early forcep delivery is advisable, for the longer labor lasts the more liable we are to have convulsions.

When eclampsia already exists, as in the third case, if there is no effort at labor and the condition not grave, packing the lower segment of the uterus with gauze and waiting a reasonable length of time seems the safest course. Failing in this, digital dilatation and high forceps or version has thus far served me.

In fact, in these cases, as in all other obstetrical work,

the more assistance we can get from the natural process of labor, the safer is our patient.

We can only regard the fourth case as one of those catastrophes of the toxemias of pregnancy that is liable to occur to any of us, as no indications of the grave condition were given prior to or during labor.

In following this method of practice for a good many years, I have yet to regret the induction of labor in any case, as it has been my fortune thus far not to have to record the loss of a mother or a viable child in such cases as the two above recorded.

During the same time I have regretted the non-induction of labor in some cases, and in many others where for various reasons the proper examination of the urine had not been carried out. I have seen the explosion come as from a clear sky when nothing in our art could avail to save the life of either mother or unborn child.

THE TOXEMIA OF PREGNANCY.

By A. P. TAYLOR, M.D., THOMASVILLE.

My object in writing on the subject of the toxemia of pregnancy is to bring this complication of pregnancy more prominently before the general practitioner. I wish to state that I have nothing original to advance, and only hope to rouse a greater interest on this subject. My observation is that we are too negligent in looking after this class of patients, trusting to nature to bring them through the gravid state-it being too frequently regarded by both laity and the practitioner as a physiological process needing but little attention. There was a day, perhaps, before the high civilization of the present, when this idea was correct, but to-day I fear we might question the correctness of this principle.

Frequently women are allowed to drag miserably through the pregnant state suffering from a toxemia peculiar to that condition, without due care on the part of the practitioner. The definition of the toxemia of pregnancy by W. H. Wells, of Philadelphia, and some others, is "An autoinfection occurring in pregnancy;" by Professor Edgar, of New York, Cornell University, "The toxemia of pregnancy may be defined as a state of the blood and metabolism arising from the hepatic insufficiency to which the pregnant woman is strongly predisposed; expressed most commonly by trivial ailments (petty morbidity of pregnancy), but exceptionally by serious, severe and even pernicious affections, such as acute yel

low atrophy of the liver, pernicious vomiting, eclampsia; conditions which while once thought to have nothing in common now seem to be closely related."

The theory of a specific toxemia of pregnancy is now accepted. I shall not go into, except in a general way, the etiology, pathology and symptomatology; I will speak of the grave conditions, eclampsia, pernicious vomiting. and acute yellow atrophy of the liver; also anemia, mania, hysterical conditions and gastro-intestinal disturbances.

The liver is probably the greatest factor in producing the toxemic conditions of pregnancy, the pregnancy itself producing a greater tax upon the liver. That organ, presiding over anabolism, plays an important part in the development of the fetus. Suppressed menstruation produces congestion of the liver, increasing the tension and drain upon that organ.

To this may be added in the production of the toxemia previous pregnancies and the heredity of hepatic insufficiency. In the pathology of the toxemia of pregnancy the changes chiefly affect the liver, kidneys and spleen, other organs being occasionally involved-these conditions producing hepatic insufficiency; the liver being the chief organ for the elaboration and purification of the blood, any insufficiency produces a corresponding interference in metabolism; this improper action of the liver throws an extra burden upon the kidney and spleen, and these conditions besides create a toxemia and also prevent the elimination of the poison.

The symptoms of the toxemia of pregnancy are hysterical conditions, exceptionally mania and anemia, and tenderness over the epigastrium and right hypochondrium, increased hepatic dullness, nausea and vomiting, gastro-intestinal disturbances, and a lessened quantity of urea, irascibility, peevishness, insomnia, agitation, ede

ma, convulsions and cutaneous eruptions. The toxemia of pregnancy is divided into fulminant, acute, subacute and benign forms.

The benign form is a mild expression of the autotoxic state; the symptoms of this condition are vertigo, nausea, simple vomiting, constipation and anxiety. The treatment for this condition is partially that given below for eclampsia. The fulminant type is always fatal, sometimes producing death suddenly and frequently within. twenty-four hours. Its symptoms are those of acute yellow atrophy of the liver and is practically the same disease. Acute toxemia of pregnancy is very nearly always fatal, the brain and nervous centers becoming involved, producing agitation, insomnia, mental confusions, convulsions, maniacal excitement, coma and death. These conditions may occur without warning and occur in women of robust health, as well as those of delicate physique. Its treatment, although of no avail, is that given below for eclamptic conditions.

I do not remember ever to have seen either of these conditions in my practice.

The subacute type is divided by authorities into eclampsia and hyperemesis. I am very much inclined to the opinion that hysterical manifestations, mania and anemia should be more emphasized in speaking of the subacute type and not spoken of as manifestations of the two types, eclampsia and hyperemesis.

CASES IN POINT.

I attended a patient through the gestation period who belonged to a neuropathic family, having severe nervous symptoms from the beginning of the pregnancy and about the fourth or fifth month she developed mania, which lasted about one month; the nervous conditions continued until the end of pregnancy. One week after delivery she