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After her delivery the patient was more comfortable, and the edema of both the vulva and the extremities, which had markedly decreased immediately after the puncture, rapidly disappeared. . The puerperium was uneventful. She left the hospital, March 13, in good physical condition, except for her cardiac disease. The interesting feature in the case was the onset of labor following the puncture of the edematous vulva, obviating the necessity for any intra-uterine manipulation to bring on labor. Adoi:10.1001/jama.1920.26220290002010e fatcat:f247rngm6zan7bvi2m25sjx6x4