of Skeen's and Wyeth's methods, and follow Skeen in the preparation of the patient as near as the surroundings will

admit.

The following cases occurred to me as being unusual, so I decided to report them:

Case 1. Some time ago I was called to see Mrs. R. Primipara. I found her in the second stage of labor, and the head just about through; a strip of tissue that I thought to be the chord was stretched tightly across the center of the occiput. I attempted to slip it to one side, but a pain was on, so the strip lacerated; the child was born; then I discovered that the strip of tissue was not the chord; it had its orign a little above and to the right of the prepuce and insertion at the fourchette, at which end it had torn loose. I considered this extra lavium minor (if such it was), that seemed to be guarding the vaginal orifice, as entirely unnecessary for the future happiness of all concerned, so I removed it with scissors.

Case 2.-I was called to see Mrs H.-, who was having a premature labor; on examination I found an unusual deformity, a tumor on the right labium majus as large as a hen egg, a vagina but no anus until my finger passed one and a half or two inches up; I found her labor too far gone to save her from a miscarriage; so I delivered her of a four or five months old fetus that had been dead several days; she made an uneventful recovery. She has two living children. She would get married, and did so against the will of her mother. It was the first case of atresia of the anus that I have seen in the country.

Case 3.-A few years ago I was called to see Angeline W-, colored, who was in the second stage of labor, and insisted on standing up. I tried to get her to lie down so I could render some assistance, but she would keep saying: "I will give it to you to-reckly." The next pain or two

but a few more failed, so I got her in bed; I felt the shoulder presenting; the next pain brought out one arm its entire length; I assured her that she would not be delivered very soon; directed that she open her mouth and holler during the pains so as to give them as little support as possible, while I ran down to a store, about two hundred yards, to get a bottle of chloroform; you may imagine my relief and surprise when I returned and found the child born. The negro woman that was with her said: "Lordy, doctor, it come here double." I said, "I guess it did." It was my first and only case of spontaneous evolution. I am inclined to think it was the second variety as described by Rofrrer, or more fully by Kleinwachter-a birth with double body. (Evelutio conduplicato corpoœ.) The child was dead, and had been for several days; it would have weighed about seven pounds; the chest walls were abnormally soft and flexible; that was the main reason I had for thinking it was the second variety. This woman was then forty-nine years old, that being her sixteenth child; she made an uneventful recovery, and has had one child since, and rumor has it that she is pregnant again. We can well boast of our South Georgia negro's capacity for having children.

Case 4. I was called to see Mrs. P-, who was in labor; delivered her of a well-developed child at full term. I discovered something unusual about the placenta; on examination I found a smaller placenta and an unruptured amniotic sac, which I opened and found a small well-formed fetus about six inches long; this was the only case of the kind that I have had, and even the three old midwives that happened to be present said they had never seen nor heard of anything like it in all their lives.

COMPLICATED GUNSHOT WOUND IN RURAL

PRACTICE, WITH REMARKABLE

RECOVERY.

BY W. O'DANIEL, M.D., BULLARDS, GA.

On the 26th of December, 1897, one of my neighbors, soon after nightfall, and after two of his children had retired for the night upon their trundle-bed, near one of the doors of his bedroom, in attempting to uncock his loaded gun, while it was thoughtlessly pointed in the direction of the bed upon which his little children were lying, was startled by the accidental discharge of the gun, which tore away with small shot the calf of the leg of his little eightyear-old boy, leaving fragments of bedding and wads in the ghastly wound, and passing through into the mattress below. Upon examination by the parents, is was ascertained that perhaps only the leg had been contused and lacerated by the shot. No time was lost in dispatching a messenger for me, a distance, perhaps, less than two miles. I lost no time in placing the patient on a table, etherized him, and upon a very careful examination, found that the bones (tibia and fibula) of the leg had escaped injury, and that the tendoachillis had not been severed, and that the foot could be extended, but the gastrocnemius, the double-headed muscle from the condyles of the femur and supra-condyloid ridges, had been nearly all torn away. I intimated to the parents a favorable prognosis, and with scissors removed all rédundant tissue, and stopped all hemorrhage by torsion and ligation. The very free use of hot water and bichloride solution, 1-3000 left wound, which extended from malleoli nearly to popliteal space posteriorly, aseptic and clean. The anterior portion of leg was not injured. The wound was dressed antiseptically with several layers of iodoform gauze, and the leg enveloped in absorbent cotton, and a roller bandage carefully applied. The little sufferer came out from the ether all right and was given one-eighth grain of morphine, to be repeated when necessary, and put to bed. He rested fairly well balance of the night, considering the depression of vital forces from shock.

In two days he had a rise of temperature of three degrees above normal. Quinine was given to combat surgical fever and expected malaria, which in this section sometimes plays a hand even in surgical cases, which is manifested by well-marked periodicities. On the morning of the third day the dressings were removed, the scissors again used to lop off the remaining redundant and unsightly tissue. Antiseptic dressings reapplied in the same way as at first dressing. I will say right here, that on account of the nervous condition of the little patient, we did everything that was done by persuasion, never resorting to force or coercion at any time in the application of dressings, which was a very tedious and trying task, and generally required more than an hour to thoroughly cleanse, disinfect and dress the wound. He was so extremely sensitive to pain at each dressing that nervous rigors would come on, together with dread, causing him to resist examination of wound by the touch of anything whatever. This state of affairs existed and continued for weeks. The naturally expected and extensive sloughing process, having removed much tissue, caused the exposure of the bones at different points, leaving a raw granulating surface. After this the wound commenced to heal by granulation. Skin-grafting or transplantation was duly considered, but not thought advisable in this case. In a short time he began to use crutches and was going where he pleased. The leg, however, because of pain at first and later on by the contraction of muscles, was involuntarily flexed to an angle of about forty-five degrees. Neither the child nor his parents could in any way up to this time be induced to allow any kind of mechanical appliance used to counteract this growing tendency to flexion, but finally when expectancy promised no relief, we became thoroughly convinced that something had to be done or the leg would be forever useless on account of this flexion, and the crutch would continue to be his companion, without timely mechanical or surgical interference.

Therefore, I improvised a corset-like brace for the thigh, made of rubber belting (perhaps sole leather, or tin, would have done as well), and laced in the same way that a corset or shoe is laced, and attached to its sides two wooden pieces by rivets, and allowing them to extend as far as the heel of the uninjured leg and separated four inches apart, and held in position by a small iron rod. By strong elastics attached to this rod and to the toe of a slipper on the foot of the injured limb, gradual, continuous and equal pressure was brought on the flexed leg, with effect of straightening as far as could be done, with this appliance, in its present shape, which brought the toe of slipper up to the little rod. The straightening process was then continued by removing the iron rod and putting in its stead a horseshoe shaped piece of iron, in order that the toe of the slipper might be extended upward sufficiently to bring the incompletely anchylosed limb on a line with its fellow, and kept so as long as necessary to accomplish the desired effect. This done, the crutch was laid aside, much to the gratification of patient, parents and surgeon. The little boy has to-day a perfect leg save a large cicatrix, and is a standing index to