efforts, I finally succeeded in converting this abnormal position into an occipito-anterior. The feet and hands could be no longer felt, but instead, the firm dorsum of the fetus could be detected through the anterior walls of the uterus. There was no further trouble, and at term the vertex engaged and the labor was normal in all respects. I was much gratified with the results in this case, because I felt that I had greatly improved the prognosis, inasmuch as I had converted what would probably have been an occipitoposterior position into an occipito-anterior, thereby avoiding the usual peril, both to mother and child, in this muchto-be-dreaded position.

The position of the fetus may be neither transverse nor longitudinal, but oblique. In this event, conjoined abdomino-vaginal examination will aid in the diagnosis. This form of manipulation will detect to one or the other side a round body, hard to the touch (the head), or a softer body (the breech). If there be a normal amount of amniotic fluid, one of these poles of the fetus by conjoined manipulation may be brought over the pelvic inlet and there leit in the hands of nature for delivery.

If the examination be made prior to labor, our endeavor should be simply to determine what information may be secured through abdominal palpation and auscultation, because at this stage of pregnancy the fetal presenting part is not accurately palpable through the vagina owing to the closed condition of the cervical canal. Most authorities agree that all face presentations were originally transverse positions.

If this be true, and we recognize and correct this position, we seldom, if ever, have a face presentation to contend with.

In conclusion, under the head of oblique positions, will say that the author was called hurriedly in March of last

year, to attend a lady who was supposed to be in precipitous labor. Upon my arrival I found her in the eighth month of pregnancy with a history of slow, nagging and ineffectual pains for six hours. After waiting a short while for the patient to recover from the shock of my arrival, I proceeded to cleanse my hands preparatory to an examina

tion.

Inserting the index finger of the right hand in the vagina and palpating with the left above the pubes, I found a round, hard body-the cephalic pole-just above the left iliac crest. Tracing the hand across the abdomen I found the firm dorsum of the fetus applied closely to the anterior wall of the uterus, with the pelvic pole occupying the right side of the upper uterine segment. By vaginal examination I observed that the cervix had dilated to the size of a watch glass, and the shoulder had presented at the pelvic inlet. The liquor amnii was abundant.

By placing the right hand against the head, and the left against the fetal pelvis, I experienced but little difficulty in converting this false position into a normal one of the vertex. Not a dose of medicine was administered, and the woman never had another pain until term, when she had a perfectly normal and satisfactory labor in all respects.

AN ABSTRACT OF PAPER ON IMPROVED PERINEORRHAPHY, APPROXIMATION OF SPHINCTER MUSCLE AND FASCIA OF PERINEUM BY BURIED SUTURES.

BY GEO. H. NOBLE, M.D., ATLANTA, GA.

Not having secured all the cuts necessary, I dislike to let my paper go in the Transactions imperfectly illustrated; so a few of the photographs, with a short description or explanation of each, are presented, to show that the paper was read at the Macon meeting.

I hope to have everything ready for the coming meeting, or the next Transactions.

As stated at the Memphis meeting of the Southern Surgical and Gynecological Association, in the discussion of Dr. Kelly's paper, I have closed the perineum a number of times, uniting the ends of the sphincter muscle, with buried sutures.

This I first did in the King's Daughters' Hospital nine years ago. Soon after it was repeated in the same institution, and later, on a case of Dr. Benson, of this city, and at various times.

I have stitched in this way, the ends of sphincter muscle, whenever they came into my hands.

Following this, it became my practice, to close the perineum by buried sutures, dissecting the fascia out from its bed of cicatricial tissue, and approximating it on the same principle of putting layer sutures in the abdominal incision. The object, being to secure greater strength and support,

No. 2 is a drawing illustrating the method of securing the ends of the sphincter muscle. After denuding the surface over the ends of the muscle, the tissues are grasped with a pair of forceps and incised in a line parallel to its fibers (A). If there is very much retraction of the muscle, the incision may be made deeper, onehalf to three-fourths of an inch, or until the sheath is opened. B shows the end of the muscle drawn out of its sheath. Cisa mucous flap on the vaginal surface. Dis the rectum.