The intestinal tract is one of the greatest alternating emunctories of the body, and when the kidneys fail temporary relief may be obtained by producing catharsis. Small doses of Mercurius dulcis, from one-tenth to one-half a grain, or even one grain, repeated at hourly intervals until six or eight doses have been taken and then followed by a saline draught is of great value. Portal and intestinal congestion is relieved, the watery evacuations induced by the medicines depletes the blood not only of water and salts but also of its noxious ingredients. Following such a course of treatment the urinary reaction will be increased and an improvement in specific gravity will be noticed.

The patient should be advised to drink as much pure water as possible. To meet the emergency of urinary suppression the kidneys may be stimulated to increased action by the following: Two drachms each of the acetate, the citrate and bicarbonate of potash in eight ounces of the infusion of triticum repens. Of this one tablespoonful may be given once in four to six hours. By pursuing this line of eliminative treatment the danger of toxæmia and convulsions may be averted if begun early and faithfully carried out. I am aware that such treatment will be severely criticized and denounced as nonHomœopathic. I am willing to endure such criticism. I have seen so many patients drift helplessly and hopelessly into a state of coma, convulsions and death with no attempt to save them except to give Apis or Apocynum or some other remedy of that kind that I have learned to resort to a rational system of medication to meet the urgent demands of these dangerous cases. If, in spite of this rational treatment, the symptoms of toxæmia do not yield permanently, I think we should imitate nature and proceed to empty the uterus by means of an English webbing catheter introduced between the membranes and the uterine wall or by injections of sterilized glycerine (11 to 2 ounces) through a catheter, as directed by Pilzer and Edgar.

It is better to resort to the induction of premature labor while there is yet time, rather than wait until convulsions are imminent or actually present. Forced delivery under such circumstances becomes one of the most dreadful operations in obstetrics.

NATURE AND ART IN OBSTETRICS.

BY R. H. FOSTER, M.D., CHICAGO, ILL.

IN obstetrics, in the complete sense of the term, three distinct elements are combined, nature, science and art. They follow each other genetically in the order named. Nature is the primary, science the secondary and art the tertiary movement in the complete unfolding of the obstetrical process, or rather in the process known as parturition. No one of these movements is of itself sufficient; no one is possible without the other two. The most perfect-that is to say, the most real and the most ideal parturient achievement-is effected when the three movements are combined simultaneously and in right relation to each other. The perfect obstetrical procedure is the working of this combination in proper place, not the effort to employ it always, under all circumstances, whether it is necessary or not, whether it is injurious or not; but the effort to employ it just when conditions concur that demand it imperatively and at no other time. Often it occurs that nature alone is sufficient to the attainment, most perfectly, of the end in view. Then our science is simply to know this fact and our art is to abstain from interference. This is not the same as the entire absence of science and art. On the contrary, it is their full presence in wise inactivity, preventing atrocious meddling, where all is well. Of all obstetrical accomplishments this seems the most difficult to attain.

All depends upon a correct understanding of the true relation existing among the three elements in question. Without a very clear and true conception of this relation the whole obstetrical procedure is liable to confusion and abuse. Science will be summoned to do through art what ought to be the work of nature, and again nature will be left to struggle alone when science and art ought to be prompt to aid and rescue. Have we not all seen abundant examples? A woman labors for twenty-four hours at imminent risk to

herself and child when a half hour of obstetrical science and art would have accomplished the work perfectly without injury to either. Again, a given case is natural and right in all respects, but art interferes to mar its perfection, inflicts injury and inaugurates diseased processes which would otherwise not have taken place. In other words, art is art, not the bungling application of means out of time and place.

Since, then, it is so important to be able to recognize the distinctions that exist in conditions and the relations existing among our three great obstetrical factors—nature, science and art—it might be allowable to attempt a definition of these relations in general terms. Such definition, if true, would be valid and trustworthy in all particular cases.

We have abundant material for the illustration of the principle of nature; for the whole world of animal life offers itself as such illustration. Reproduction is its greatest effort and its greatest work. Parturition is the supreme process and the final effort in which all is summed up and accomplished and crowned.

Now, what are the marked features of natural obstetrics as displayed in this great field?

In the first place, nature, unaided by art and unguided by science, proves herself adequate to the complete conduct of a vast, varied and complex obstetricy. Nothing can be more perfectly finished than is this marvellous work of nature. It is very It is very seldom followed by lacerations, puerperal fevers, sub-involutions, or (notwithstanding the absence of all antiseptic treatment) by septic disturbances of any kind. Where this last named diseased condition occurs, it is among domesticated animals, which have been led physically astray by our "civilized" coddling and meddling. Only one exception must here be noted to this uniform excellence of nature's obstetrical work. According to the modern doctrine of evolution, the enormous experience of the animal world ought, in this department of reproduction, to exhibit a steady improvement in the adaptation of means to ends. The mechanism, the physiology and the reproductive impulse ought to have grown to more perfect relation. They have not done so. The young, after birth, are cherished more tenderly and for longer periods by the higher animals. But the mechanism has grown less adequate to the requirements. Especially in the higest group-the human-is this inadequacy revealed. But

all along the line there is increase of pain, injury and complication, from the lowest to the highest. This increase of suffering, danger, and, finally, of mortality, is greatest of all among the most refined and most highly cultivated women, among whom it finally appears, even in the psychic sphere, as an aversion to childbearing. The indications now are that a little further advance in so-called civilization will put an end to reproduction altogether among the higher races. As the populations of the great cities would die out by slow diminution, were it not for the fresh supply of natural and vigorous blood daily imported from the country, so would our highly developed people wane, and at last perish utterly, were it not for the continual introduction among them of material elements drawn from regions where life clings more closely to the breast of nature. The increase of suffering, complications, accidents, and of diseases both before and after parturition, and finally the greater exhaustion experienced by the woman of high and complex development, all point in the same direction-namely, to the incompatibility of vigorous reproduction and of psychical development along modern lines in the individual woman. Particular exceptions, we know, will array themselves against this doctrine; but they avail nothing against the broad facts presented. And the reduction of the family of higher civilization from a former average of ten to the present average of three is of itself sufficient to wipe out all exceptions.

This brief review of the status of natural obstetrics will suffice for our purpose. It reveals at a glance the wonderful energy and capacity of unaided nature in parturition. But it also reveals something more, and possibly something of more importance. In a word, it leads inevitably to the use and the very ground and necessity of science and art also in obstetrics.

For notwithstanding that nature has thus revealed herself as a great power in reproduction, she has, at the same moment, exposed her weakness and her limitations. Before the advance of culture, of the development of the higher form of manhood and womanhood, she withers and fades away, as barbarous races wane before advancing civilization. And unless obstetrical science and art can come to the rescue, the continuous existence of a race of high quality cannot be maintained.

In fact, this is the real and exalted function of obstetrical science

and art—to make possible the continuance of a superior race, which race, again, is not possible without the factors of science and art, neither in obstetrics nor in any other department of our complex existence.

But this must not be interpreted to mean that science and art are to ignore nature, or to destroy nature, or to injure or viciously meddle with her; on the contrary, it means that they are to respect and cherish a form of nature so refined and delicate that it cannot thrive without such aid.

Of course, obstetrical science can save a future criminal or monster of wickedness as readily as it can a Tennyson. But its value is in saving the latter, not the former. The science would have no broad reason for being, if it were not for its possible service to the race in saving individuals of value.

Nature is a great force in obstetrics. But in the feature just mentioned, scientific obstetrics is a greater force. Nature is blind and indifferent, notwithstanding her exquisite and minute perfection. She fails utterly where science is needed-where science alone can save. She furnishes a transverse position, and will blindly destroy both mother and child in the effort to extricate herself. She will bruise, tear, break, lacerate and destroy, with ghastly indifference, urged by the mighty impulse to be delivered. Against accidents, complications, and injuries, or even death, nature is helpless. Here is her limitation. She has not intelligence. Intelligence is of the mind and brain, not of the generative organism and its adnexa.

Now the science and art of obstetrics is intelligence-is born of the mind overlooking, searching into, inquiring after the ends, causes, and means of the parturient process, and learning what reproductive nature in all her kingdoms and with all her experience could never learn, how to adapt ends, causes and means to each other, so that by proper means, and through proper causes, the proper ends may be attained.

To extricate herself from an abnormal position which renders delivery impossible, nature has no means. She has no forceps. This instrument is one embodiment of the science and art of midwifery. This is something more, too, than an ingenious contrivance for effecting delivery. It is educated society sending forth its educated obstetrician fully equipped and able to save the civilized woman and