THE USE OF FORCEPS. Demelin (Jour. des Prat.) discusses under what circumstances the application of forceps, being apparently indicated, may be deferred or avoided. He deprecates the present teaching that the forceps are to be used very exceptionally; he considers a good pair of forceps, handled with care, slowly and gently, is an invaluable instrument. Many cases are met with in practice in which it is possible to temporize or even to abstain. from their use; there are others in which it is absolutely indicated to save the life of the fetus or mother. Presentations of the shoulder or breech call for extraction by the feet, but which the head in fixed or engaged and the uterine muscle is retracted instrumentation is needed. The question whether to wait or to assist is often difficult to decide when there is no danger and the labor is normal, only tardy; this occurs usually in primiparae who have been exhausted by the long period necessary for the dilation of the os. After twenty to twenty-four hours of labor the pains become few and feeble and the patient inclines to sleep; if then the fetal heart sounds are normal and there is no sign of meconium in the amniotic fluid it is wise to allow her to sleep for an hour or two. On awakening give an alcoholic drink, hot, with plenty of sugar in it,since sugar is a good muscular stimulant; follow this with a hot bath and a large dose of sulphate of quinine, and generally expulsive efforts will be re-established and terminate favorably. Hot douches do not reach the uterine muscle when the head is engaged and low down. When there is complete dilation and the membranes are still intact they must be ruptured in an interval between the pains. Some women, although, are nervous and cowardly when they feel the head on the perineum, cease from expulsive effort, and make not progress. A few whiffs of chloroform are sufficient to encourage the patient and produce the desired result. In primiparae, in spite of strong effort, the firm perineum prevents progress, it is permissible to add abdominal expression to

the efforts of Nature. Mounting upon a chair beside the bed the palms of the hands are placed on the fundus, and

when the contractions occur steady pressure is made upon the fetus in the direction of the pelvic outlet, the perineal resistance is thus overcome, and the application of forceps is avoided. In a case where there is full dilation of the os and no advance is being made, examination may show the head lying in the transverse or oblique diameter, and not fully flexed. It is possible to assist the head to flex and turn; this is best done during the pains by introducing the first finger into the vagina, and during the contraction pressing upon the head near the anterior fontanelle in such a manner as to promote flexion, or it may be possible to get under the convexity of the occiput and draw it downwards. By pressing behind the ear in the direction required rotation is assisted; should the contraction cease before complete rotation is complete, the hand should be retained in position ready for the next pain. Rotation and flexion having been procured delivery will not be long delayed. There should be a limit to the time of waiting after the full dilation has occurred. In uterine inertia often one may safely wait for five or six hours, but it is unwise to allow the maternal soft parts to be bruised too long between the head and the bony pelvis; there is a risk of oedema, lacerations, and possibly of fistula resulting. When the pains are vigorous and no progress is being made two hours after full dilation, interference is necessary. Such cases used to be left for ten or twelve hours until the fetal head was increased in size by a haematoma, and the difficulty of delivering resulted in a torn perineum, a vesicovaginal fistula, and infection by lacerations. These fistulae are now very rarely seen. In deciding whether to wait or to intervene, the position of the head in the cavity is an important point. As long as conditions are favorable it is well to temporize, but when symptoms of urgency arise there should be no resitation in applying the forceps.-British Medical Journal.

Publication Office: 532 Altman Building.

A'

O. L. McKillip, M. D., Managing Editor,

VOL. XXXI.

WHOLE NUMBER, 344

DR. GEORGE HUNTINGTON AND

HUNTINGTON'S CHOREA.

We have always been of the opinion

that the best time to do honor to a man, who is worthy of honor, is while he is alive the ears of the dead are deaf. Neurographs, Vol. I, No. 2, 1908, actuated by this principle, devotes a whole number to the discussion of hereditary degenerative chorea, commonly known. as Huntington's chorea, and to the man. whose name has been given to this disease. Our accurate knowledge of this condition dates from 1872, when Dr. George Huntington wrote the classic description which has served as the clinical guide in its identification. This article was published in the Medical and Surgical Reporter, Philadelphia, April 13, 1872. It was widely abstracted, appearing in Virchow's and Hirsch's Jahrbuch for 1872, and partly reprinted in Osler's "Chorea," published in 1894. Up to the present time there have been published over two hundred articles on the disease, references to which are given in the number of Neurographs above referred to, and it may be said that a very wide interest has been accorded to it.

The chorea described by Huntington presents three characteristics: It 1S hereditary; there is a tendency to in

sanity; and it manifests itself only in adult life. In this country the disease early settlers of New England and the to have originated among the

seems

Middle States and to have some relation to intermarriage. The cases observed have been in patients who were the children either of such choreics or of parents who died before the disease developed. The histories of the disease show a most interesting family continuity. Huntington observed that it never skips a generation to manifest itself in another; once having yielded its claims it never regains them.

It is good to know that the man who first gave the classic description of this disease, and whose name is now committed, for all time, to the nomenclature of science, is an honored general practitioner of medicine at Hopewell Junction, Dutchess county, New York, preferring the simple life of a country practitioner, with the advantages of rural life for his children, to the stress of the city. Born at Easthampton, N. Y., where his father and grandfather had practiced medicine before him, he has continued the period of practice of three generations, which began one hundred and eleven years ago.

It is wise and profitable for medicine. to take notice, now and then, of the men

who have contributed the new things to the knowledge of our science. Among these is Dr. George Huntington, to whom we wish long life and many more years of usefulness.-New York State Medical Journal.

FEDERAL INTEREST IN PUBLIC HEALTH.

As a result of the slow and persistent educational work which has been in progress there is beginning to be manifested a public interest in the public

health. This is one of the most salutary signs of progress in this great country. The president has explicitly advocated a greater attention on the part of the federal government to questions of public health, and throughout the country there is an awakening to the importance of this subject.

One of the most significant steps in this direction is the plank in the platform of the Republican party, adopted

at the last National Convention at Chicago, which declares in favor of a National Department of Health. This appears particularly significant when we stop to think that expediency prompts

the introduction of such features as this in the policies of political parties. It means that the political leaders believe that it will meet with public favor. We of the medical profession have always believed that such action would be for the public good; but now we may add to this belief the knowledge that, in the judgment of the most astute public men, it will meet with public approval. In all probability the leaders of the National Democratic party will be of the same mind, and we may hope to see a similar plank in its platform. This means

that

we are soon to have a National Health Department.

It is with much gratification that we observe also the attitude of the government toward the International Congress on Tuberculosis which is to meet in Washington from September 21 to October 12. We already have called attention to the aid which our government has given to it. President Roosevelt has President Roosevelt has accepted the presidency of the congress.

In his letter to Dr. Lawrence F. Flick, chairman of the committee of arrangements, he said that the importance of the crusade against tuberculosis, in the interest of which this congress convenes, cannot be overestimated when it is realized that tuberculosis costs our country two hundred thousand lives a year, and the entire world a million lives a year, handicap to material progress, prosperbesides constituting a most serious ity and happiness, and being an enorthose walks of life where the burden is mous expense to society, most often in least bearable. The president also said:

Science has demonstrated that this disease can be stamped out, but the rapidity and completeness with which this can be accomplished depends upon the docpromptness with which the new

trines about tuberculosis can be inculcated into the minds of the people and customs, habits engrafted upon our representatives of world wide workers and laws. The presence in our midst of in this magnificent cause gives an unusual opportunity for accelerating the educational part of the program.

losis brings hope and bright prospects The modern crusade against tubercuof recovery to hundreds and thousands of victims of the disease, who under old teachings were abandoned to despair. The work of this congress will bring the results of the latest studies and investi

gations before the profession at large and place in the hands of our physicians all the newest and most approved methods of treating the disease-a knowluable life to our people and will thereby edge which will add many years of valincrease our public wealth and happi

ness.

The International Congress on Tuberculosis is in the interest of universal peace. By joining in such a warfare against a common foe the peoples of the world are brought closer together and made to better realize the brotherhood of man; for a united interest against a common foe fosters universal friendship. Our country which is honored this year as the host of other nations in this great gathering of leaders and experts and as

the custodian of the magnificent exhibit which will be set up by the entire world, should manifest its appreciation by giving the congress a setting worthy of the cause, of our guests, and of ourselves. We should endeavor to make it the greatest and the most fruitful congress which has yet been held, and I assure you of my interest and services to that end.-New York State Medical Journal.

CHRISTIAN SCIENCE AND ITS VERDICT.

Those of our readers who have not been fortunate enough to read the fourteen valuable articles on "Christian Science," published from month to month in McClure's Magazine, has certainly missed a great opportunity to become enlightened on the subject of mental healing by the power of suggestion. Moreover they have also failed to learn the fallacies of so-called Christian Science and its false teachings.

Any impartial observer cannot fail in this series of papers to recognize the commercialism which underlies the practice of this form of healing and the shrewd methods employed by its found

er and followers to enforce its doctrines.

The editor of McClure's well known publication deserves the thanks of the American people for the information thus imparted at great expense through its columns, while the reputable medical profession in particular are under lasting obligations to "Georgine Milmine" for this unbiased story of the life of Mary Baker G. Eddy and the true inward history of her so-called Christian Science.

In this connection we also call especial attention to the splendid article (see page 287) on the "Philosophy of Christian Science," by Borden P. Bonne, LL.D., professor in Boston University. This needs no comment on our part as its forceful logic and sensible, convincing argument speaks for itself.

The occurrence of cholecystitis as a sequel of general infection of the excretory apparatus of the liver is like chronic salpingitis, persisting after the acute septic endometritis which established t has subsded.-Bland-Sutton.

Medical Society of the Missouri Valley. The twenty-first annual meeting of the society will be held at Council Bluffs, Ia., under the presidency of Dr. W. F. Milroy, on September 3 and 4, 1908. Invitations have been sent to the presidents of the various state societies within our province, a number of whom will make addresses. The arrangements are in the hands of Drs. Treynor, Meyer and Reichenbach, which insures an enjoyable session. Those desiring to present papers should send their titles to the secretary before August 1, and abstracts not later than August 10. Papers will

appear on the program in the order in which they are received, and will be limited in number to twenty-five.

International Congress on Tuberculosis.

Preparations are in progress for an excursion party to Washington from the Missouri valley to attend the International Congress on Tuberculosis, which meets on September 21, and continues for three weeks. For itinerary and full particulars address Dr. Chas. Wood Fassett, secretary Medical Society of the Missouri Valley, St. Joseph, Mo.