again took place. In performing the second operation the fistula was enlarged to incision from below upward; the peritoneal cavity was opened, in order to obtain the necessary amount of room. A living fœtus was extracted. The patient passed through this unique experience with satisfactory results as to the healing of the wounds; she is now in good health. Noble does not approve of the performance of any subsidiary operations for the purpose of preventing future pregnancies, as was done in Crimail's case; he would do nothing to prolong the section. 3 May 27 Korn, of Dresden, said, at the Fourth Congress of the German Gynæcological Society, that he had performed Cæsarian section three times on the same woman. He had never observed adhesions. The cicatrix was found to be quite superficial at the third operation, with normal muscular tissue beneath. He was struck by the intensity of the suffering during contractions at the third labor, morphia being practically useless. The subject was also discussed before the Michigan State Medical Society, having been introduced by Hugh McColl, of Lapeer, who considers craniotomy as unjustifiable, unless the patient positively refuses Cæsarian section. Manton, Carsten, Longyear, Martin, and Cogshall, took part in the discussion. 1002 July Howard A. Kelly, lays down the following rules, based on the collected experience of many authorities: 1. Do not use antiseptic solutions for instruments or hands after the operation has begun. Above all, do not use them in the abdominal cavity. Use pure water throughout, preferably distilled, which has been boiled half an hour. 2. Do not turn the uterus out of the abdomen before delivering the child, unless its contents are doubtfully septic. It does no good, adding an unnecessary step, and calling for a larger abdominal incision. 3. Do not cut the placental tissue, thus bleeding the child, in placenta prævia Cæsariana. 4. Do not waste time picking off small shreds of decidua from the inner surface of the uterus. 5. Do not do a conservative Cæsarian operation when the uterus is already septic. If the uterus be infected, do a supra-vaginal operation after Porro's method. 6. Do not use catgut of any kind as a uterine suture. It has proved dangerous and uncertain. 7. Never use a continuous suture in the uterus. 8. Do not attempt to drain the abdominal cavity; it cannot be done effectually. 9. Do not douche out the vagina as a matter of routine after the operation. It must be carefully disinfected beforehand; afterward an aseptic genital tract will need no active antiseptic régime. 10. Let all preparations be so full and carefully made beforehand that no time shall be lost, and each successive step shall follow its predecessor with the utmost rapidity consistent with accuracy, and the whole be completed with dispatch. Münchmeyer, reports 3 cases of Cæsarian section performed according to Sänger's method, making the record of the Dresden clinic 28 Cæsarian sections, with 3 maternal deaths and 1 fœtal death. Münchmeyer has had the opportunity of examining, post-mortem, two uteri on which the Cæsarian section had been performed. The patients had survived several months, and died by some intercurrent disease. Microscopical examination of the chromic-acid catgut sutures employed found them holding the parts firmly in good apposition, and the suture material itself undissolved and resembling in firmness silver wire. The silk suture, however, which had been used to close the abdominal wall, had been partly absorbed. In his opinion, chromic-acid catgut is the best suture for the uterus, and silk the best for the abdominal wall. Cases are reported as follows: 1 by Queirel, of Marseilles 236 (successful); 1 by G. Galaud, of Ixelles, Belgium (successful); 1 by R. F. Granger, of London (successful); 10 by Murdoch Cameron, Glasgow (9 successful; 1 death, the result of an accident immediately before the labor); 1 by J. N. Bartholomew, of Trenton, Ohio (successful); 1 by M. Bar, of Paris (successful); 1 by M. Guéniot, of Paris (successful); 1 by Seth Hill, of Stepney, Conn. (successful); 1 Sänger-Cæsarian by P. Meirowitz, of New York (successful); 1 by Herman, of London (made necessary by an osteosarcoma of the pelvis nearly filling the pelvic cavity; death; child saved); 4 by Howard A. Kelly, of Baltimore, (all successful); 1 by H. P. Wenzel, of Milwaukee 23, (successful); 1 by Henry Gibbons, Jr., of San Francisco, Cal. 147 (successful); 2 Sänger-Cæsarian by E. Fraenkel, of Breslaus (successful); 1 by J. Praeger (successful); 2 by Staude, of Hamburg (successful). 2002 May 27-20 2 1 Mar.14 69 Oct. 8 101 May 2 Mar.7 24 Mar.7 317 No.35 288 Dec. 28,'90 24 Apr.5 May 2 Des., 90 July Porro's Operation.-Clement Godson, in reporting 2 cases, makes an earnest plea in favor of Porro's operation, and emphasizes his opinion that every accoucheur should be prepared to perform Porro's operation, and not resort to craniotomy as a matter of course, in a case of pelvic obstruction in which delivery cannot be effected by the forceps, and especially when the fœtus is living. He believes that Porro's operation is less dangerous to the mother than difficult craniotomy. He cites an instance in which he was called to a primipara to assist two excellent practitioners who had used one forceps after another, and pulled, first one and then the other; the cervix uteri had been extensively lacerated, but the head had never moved. The foetus was dead. He managed to deliver the woman by craniotomy, but the extraction was very difficult; after he got the head out he thought he should never have extracted the shoulders. It was a large fœtus. He made out the conjugate to be about three inches. This woman would probably have recovered had abdominal section been performed early; as it was, she died on the fourth day. It is very sad to think that here a woman and a fine child were sacrificed, both of whom might have been saved. He does not mean, however, that Porro's operation or Cæsarian section should be undertaken impetuously or without proper consideration and preparation, but is convinced that it should often be undertaken by the general practitioner in place of craniotomy. Piskaček,100 in absolute contraction of the pelvis, pronounces himself in favor of the Porro operation. His reason is the danger of a second Cæsarian section in the event of a new pregnancy, and the risk of uterine rupture, should the operation not be done immediately at the onset of labor. Cases are reported as follows: 1 by Ginsani (successful); 1 by Joseph Price, of Philadelphia (successful); 1 by G. G. Maclaren, of Dehra Dun, India (successful); 1 Porro-Müller by Wm. E. Ashton, of Philadelphia (successful); 3 by Frank, of Cologne (successful); 1 by G. Helbing, of Bonham, Texas 192 (successful); 1 by J. F. Baldwin, of Columbus, Ohio (successful); 1 case of Tait-Porro, by Colin G. Campbell, of Saddleworth, York, England (successful); 1 by Bagot, of Dublin (successful); 1 by N. T. Brewis, of Edinburgh (successful); 2 by James Murphy, of Sunderland, England, oo (successful); 1 by Carmichael, of Barrow-in-Furness, England on (successful). 3 May 27 6 Aug.8 213 2 Mar.7 23 Mar. 6 Oct.31 9 Apr. 4 2 Oct.10 36 Sept. INSTRUMENTS. 16 Sept. 849 June Duke, of Dublin, 2 suggests additional traction in forceps cases as an alternative of craniotomy. He stated that the idea of at taching the forceps in some way to the body of the operator struck him several years ago, while assisting at a delivery, when he grasped the practitioner around the wrist to get additional power, and a living child was delivered. Without this additional power they would have been forced to do craniotomy. He uses tractors which can be buttoned into the fenestra of any long forceps before application. The power is got by means of a belt from the tractors around the body. By throwing his weight alone on the belt he could get a power of 140 pounds (56 kilogrammes), measuring with a manometer; while by using his arms also he could put a further strain of 28 pounds (11.2 kilogrammes) on. He gave several difficult cases in which he had found it of great use. 36 Aug. An elaborate and excellent article on the axis-traction forceps, their mechanical principles, construction, and scope, was presented by R. Milne Murray, of Edinburgh. A He justly gives to Tarnier, of Paris, the credit of discovery, notwithstanding the fact that others had recognized the desideratum, and in their efforts to comply with the latter had either partially or completely failed. Tarnier applied to the solution of the problem an entirely novel principle, solving the difficulty. Murray's article, which covers almost 100 pages, is entitled to careful study by all those who devote their ingenuity to the perfection of forceps. 1 more, July 25 61 Aug 82 Modifications have been suggested by J. E. Elston, Ohio, -an upright lever fastened to the lock; A. B. Lyman, of Balti-a movable attachment for any kind of forceps, so shaped as to obtain direct axis traction; T. J. McGillicuddy, of New York, a hinged flange to the handle, which serves as grasp when turned downward, and enables the operator to produce axis traction; W. O. Lambert, of London, 2-a screw and slot to the extremity of the handles, to do away with the necessity of tying them. C. R. Hoffmann, of New York, contributed a modified (in size and thickness of blades) short perineal forceps. Peter McCahey11 demonstrated on the manikin his atmospheric tractor, described in last year's ANNUAL, before the New York Academy of Medicine; an interesting discussion took place between the inventor and A. W. Herzog, of Hoboken. 227 1 Apr.25 June 20 As a sling to support the limbs in forceps deliveries, R. L. Dickinson, of Brooklyn, passes a rolled sheet behind the neck and under the bent knees, the thighs being flexed as high as 72 Mo., describes a portable, Feb. possible. Dargatz, of Kansas City, light, and strong obstetrical chair. An obstetric slipper, to dispense with the traction towel or sheet, was described by D. L. Hubbard, of New York. Jans Henry Leaman of Philadelphia, described what he calls a "parturiometer,”—an instrument devised to measure the force with which the foetal mass is advancing along the parturient canal. 23 June A new craniotome, including the saw and forceps features, was introduced by Poirier, of Paris. 73 Jan.10 STATISTICS OF LABOR CASES. 55 A series of statistical reports have been published during the year. The papers are enumerated for the benefit of those who might wish to use the information contained in the journals mentioned for the preparation of general reports: Pozzi, of Paris, D 625 labors; Tournay, of Brussels, 256 380; E. R. B. Elderdice, of McKnightstown, Pa., 186 500; N. Charles, of Liége, Belgium, 25 456; W. H. Taylor, of Cincinnati, 5 300; W. A. Dunn, of Jan. Jan.30 53 Des. 26, '90 Feb.15 Boston, May 7 99 1168; G. S. Stein, of Columbus, Ohio, 233822; G. H. 99 185 Rohé, of Baltimore, 10100; W. Sealy, of New Zealand, 552589; A. Worcester, of Waltham, Mass., J, 200; W. J. Cree, of Detroit, J 200; J. L. Beeston, of Newcastle, New South Wales, 800 cases. HISTORICAL DATA. 267 Our corresponding editor, J. K. Kimura, of Tokio, Japan, 673 Nov. FIG. 1.-METHOD OF PUNCTURING THE MEMBRANE. sends us an illustrated report on midwifery in the sixteenth century, taken from old works, which are, of course, difficult to |