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separate, are brought into such close contact that osmosis may readily occur between them, thus permit- ting the absorption of nutritive material from the maternal into the fetal circulation, the excretion of urea and other waste products free sample viagra of fetal metabolism, the pas- sage of oxygen to the fetus, and the excretion of car- bon dioxide from it. "The functions of the placenta may be summed up as follows: (1) It is nutritive, allowing of the passage of nutritive material to the fetus. (2) It is respiratory. Oxygen passes to, and carbon dioxide from, the fetus. (3) It is excretory, allowing the escape of urea and other products of fetal metabolism. (4) It has a glycogenic function. Glycogen is stored in its cells for the future use of the fetus. (5) It is free sample viagra iron storing, by which iron in organic combination is passed from the maternal circulation into the fetal circulation to be stored acheter viagra sans ordonnance in the liver cells of the fetus, in order to aid in the formation of new colored blood corpuscles. "At full term the placenta is a discoidal mass about 7 inches in diameter, two-thirds of an inch in thickness, and weighs about 16 oz. Its fetal surface is smooth and covered by the amnion, and its maternal surface is divided by sulci into a number of irregular free sample viagra areas termed cotyledons. The fetus is attached to it by the umbilical cord or funis, which averages 20 inches in lengrth and half an inch in thickness. It consists of a stroma of Wharton's jelly, embedding the two umbilical arteries and a single umbilical vein. It is covered by the amnion." — (Lyle's Physiology.) A. Management of brotc presentation: If recognized before the onset of labor, postural treatment may be tried. This consists in placing the woman on that side toward which the fetal face is directed, so as to secure flexion of the fetal head. Failing in this, or if only recognized too late for the above to be tried, cephalic or podalic version may be attempted; or forceps may be applied, chiefly to act as a rotator. If the above do not succeed, symphyseotomy may be performed, and the child delivered by forceps. When all other methods fail, if the child is dead craniotomy is indicated. 5. Ophthalmia neonatorum. Causes: The gonococ- cus or some other pyogenic microorganism; the secre- tions of the mother contain the infecting agent, and transmission may occur directly during parturition, or indirectly by the fingers of physician or nurse, cloths, instruments, etc. Symptoms: Swollen eyelids, with copious purulent discharge; ulceration of the cornea may ensue. Prophyla.ris : Whenever there is the possi- bility of infection, or in every case, wash the eyelids of the newborn child with clean warm water, and drop on the cornea of each eye one drop of a 1 per cent solution of nitrate of silver, immediately after birth. 6. Vitellus is the germinal portion of the ovum with the substance which nourishes the embryo. Allantois is a fetal membrane; it enters into the for- mation of free sample viagra the bladder, placenta, and umbilical cord. Amnio7i is the inner of the fetal membranes. Chorion is the outer of the fetal membranes. 7. Eclampsia is an acute morbid condition, occurring during pregnancy, labor, or the puerperal state, and is characterized by tonic and clonic convulsions, which affect first the voluntary and then the involuntary mus- cles; there is total loss of consciousness, which tends either to coma or to sleep, and the condition may ter- minate in recovery or death. About 75 per cent of the cases occur in primiparae. Prognosis is bad, the ma- ternal mortality being about 30 per cent and the fetal mortality from 50 to 75 per cent. The urine contains albumin, is reduced in quantity, and is free sample viagra more toxic than normal. Frequency, about once in from 350 to 500 pregnancies. "The treatment of the attack consists of the administration acheter viagra sans ordonnance of chloroform by inhalation, chloral hydrate (gr. 60) by enema, and the fluidextract of vera- trum viride hypodermically (gtt. 15 followed by gtt. 5, repeated frequently enough to free sample viagra keep the pulse at about 60 beats a minute), to control the convulsions, and free purgation by croton oil (gtt. 2, or 3, in sweet oil or glycerine), free sweating by the hot pack, and acheter viagra sans ordonnance some- times depletion by venesection to eliminate the poison. The after treatment consists of free purgation by the salines, restriction of diet, and later the administration of tonics and stimulants. The obstetric treatment is acheter viagra sans ordonnance usually noninterference." (Pocket Cyclopedia.) Some- times accotichment force is indicated. 8. Eutocia is normal labor, acheter viagra sans ordonnance or one in which there is a vertex presentation free sample viagra and no complications. Dystocia is difficult or abnormal labor, and includes all cases not carried in the term eutocia. Va7'ieties of dystocia: These may be classified, accord- ing to causation, as follows: (1) Anomalies of free sample viagra the expellent forces: (a) Excess — precipitate labor; (6) deficiency — delayed or protracted labor and inertia uteri; (c) spasm and irregularity — rigid OS and cervix, and tetanus uteri. (2) Anomalies of acheter viagra sans ordonnance the passages: Pelvic deformities; free sample viagra uterus, developmental anomalies of, atresia of cervix, rigidity of cervix, impaction of cer\ax, malposition, sac- culation, and new growths; stenosis and rigidity of vulva and vagina; hematoma or edema of the vulva; latral abscesses and cysts; conditions of intestines or bladder; tumors and swellings of various tissues. (3) Anomalies of the fetus: Malposition of the head; occipito-posterior cases; malpresentations — face, brow. September 25, 1915] MEDICAL RECORD. 547