of the family; or much worse, on a so-called nurse, but one without training, and whose ignorance of asepsis is equalled only by her assurance, and her readiness to act on her own initiative and in defiance of instructions. In this class the young physician, struggling to make his way, finds most of his obstetric work. Should he choose the usual position for delivery, his examinations are fraught with danger. Bedding and patient are likely to be in a sorry plight at the end of labor, and the

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... nces are that these conditions will continue during the lying-in period. If he adopts the position herein recommended he needs only soap and sterilized water to insure safety to his patient. A liberal application of soap and the use of a large fountain syringe of hot water, followed by an antiseptic solution, comprises a ready means of cleansing the external parts. If necessary, this can be done by the physician, and there is need of little or no exposure. If he will exercise the forethought to sterilize forceps, ligatures, sutures, needles, scissors, etc., and place these within convenient reach, it will be unnecessary for him to leave his chair until the labor has terminated and every necessary detail has received attention. He is in complete control of the situation and protects his patient from infection in the most unfavorable surroundings. Incidentally, in an emergency such as post-partum hemorrhage, this position is advantageous. There is necessarily a prompt notification of the danger, and the woman is already in the most favorable position for treatment. Moreover, the young physician will find the position the best for studying the mechanism of labor. In conclusion a brief recapitulation embraces the following claims for this position: 1. There is less liability of infection with fecal bacteria. 2. Fewer examinations are necessary. 3. There is better control of the head at the time of delivery, and consequently less danger to the perineum. 4. The woman can be more thoroughly cleansed after labor, and clothing and bedding are not soiled. 5. There is less danger of infecting the eyes or cord of the child and less risk of its aspirating fluids into its air passages. 6. In managing cases in the unfavorable environments of the lower classes, the position is especially valuable to the young physician, whose experience is gained largely among these classes. THE PROPHYLAXIS AND TREATMENT OF PUERPERAL SEPSIS. ococcus and pneumococcus are the most frequent causes of puerperal infection, while the bacillus of diptheria, anaerobic and other micro-organisms have been demonstrated to be occasional factors in the pathogeny. Streptococcus pyogenes is found in the body under a variety of circumstances, and is probably the most important cause of septicemia and pyemia following wounds of ulcerative endocarditis, of tonsillitis and erysipelas. Bacteriologic investigation shows it to be the most frequent cause of the various septic processes following labor, and it may be found pure or associated with other organisms. It has long been recognized that its manifestations are varied and that they depend upon several factors: the nature of the organism; the soil; the dose of virus, and the place of entrance. The most important factors are the virulence and character of the infecting organism. Variation is common to different specimens of the same species. Under certain conditions the virulence is increased, while under others it may be decreased or attenuated. It may produce abscesses at the point of inoculation, which may, or may not, become diffused throughout the body, or it may even cause death without the appearance of any local change. The staphylococcus and colon infection are as a rule milder forms of sepsis, but Strunkman has collected twenty-five fatal cases of the former and three of the latter. The writer has seen one fatal case of staphylococcus aureus and two of the colon variety. The parturient tract has been aptly compared to a surgical wound and it is easy to conceive, that, with the contusions and lacerations together with the lowered resistance of the system incident to labor, the conditions are very favorable for the development of germs when once they are introduced. According to Widal, Baum, and Gartner, the placental site is the favorite point of invasion of the infecfing germs, either by way of the lymphatics, or veins, or both. Yet infection frequently takes place from wounds of vagina and cervix. The results of the bacteriologic examination, with regard to the presence or absence of pathogenic germs in the vaginal secretion under ordinary conditions, are by no means in harmony. Conner and Doderlein in 1887 investigated the subject and. while the former obtained negative results, the latter obtained many varieties of pathogenic organisms, including streptococci. Since then, numerous capable observers have investigated the subject with variable results. Menge, Kronig, and Williams have gone over the work very carefully and find that the uterus and vagina, under ordinary conditions, ares sterile as regards pathogenic organisms, and, that the discrepancies of other observers are due to faulty technique in obtaining cultures. Further, the investigations directed more particularly to the vulva, show that it is rarely, if ever, free from pathogenic organisms, and that it is almost impossible to render it so. Doderlein attributes the absence of pathogenic organisms in the vaginial secretion to the bactericidal influence of the acid products of the vaginal bacillus. Kronig does not think this view justifiable and believes that several factors play a part, namely: chemical substances in the secretion, probably acids; antagonism of the bacteria living in the vagina to imported bacteria; leucocytosis and phagocytosis; lack of oxygen and tissue juices. From the foregoing survey of the literature, it is seen that the uterus, under normal conditions, is sterile and some hold a similar view regarding the vagina; but