where the lives of both mother and child are threatened by repeated hemorrhages, premature delivery should be induced. The only contra-indication claimed to premature delivery is, that less than nine months of intra-uterine life fails to give a child as good a chance for life as one arrived at full term has. Dr. T. says that, "an eight months' child out of the uterus, depending upon pulmonary respiration, has brighter prospect for life than one in the cavity depending for aeration of its blood upon a crippled and bleeding placenta." The author reports eleven cases of premature delivery conducted by him, being the number in full of all his cases of placenta prævia treated by the prophylactic method. Of the eleven cases, labor occurred at the eighth month in seven; of these, one mother died of septicemia, and two children were still-born; of the rest of the cases, (4) two were delivered a little before full term (8 m.). One child was born dead, and one was stillborn. In all cases of placenta prævia, premature delivery should not be induced, before the period of viability of the child, unless the life of the mother is threatened. Barnes' dilators were employed to dilate the cervix, as a preparatory step to delivery.

W. F. L.

ANNOUNCEMENTS FOR THE MONTH.

SOCIETIES Mondays, August 6 and 20, Chicago Medical Society.

CLINICS Saturdays, at Rush College, 2 P. M. Surgical, Prof. Gunn. Tuesdays, at Chicago Medical College, 9 A. M. Surgical, Prof. Hyde.

LECTURES-Mondays, 4 P. M., at Cook Co. Hospital Necroscopy Theatre. On Pathological Anatomy, Prof. I. N. Danforth.

THE

Chicago Medical Fournal

AND

EXAMINER.

VOL. XXXV.-SEPTEMBER, 1877.-No. 3.

A NEW RESTING AND INVALID CHAIR.

EPHRAIM CUTTER, M. D., Cambridge, Mass.

The philosophy of rest in chairs, embraces some of the following principles :

1st. The weight of the body necessitates rest upon some support during its physical existence. In the standing position, the feet must be supported upon fixed or floating material.

It is proposed to confine these remarks to supine, horizontal, or inclined positions.

In each case the body is in a state of perfect rest, when it is supported at as many points of contact as possible between it and the supporting material. The weight must be distributed as evenly as possible over the largest extent of surface, for then there is a minimum of compression of the tissues. When a swimmer is floating in water, the surrounding fluid is applied over the body, and the weight evenly distributed over the largest amount of surface. But water cannot be employed as a support except in a bed, since its chemical and physical qualities prevent its adoption for a chair except in the condition of ice.

Dry material used for a chair, to be thoroughly adapted as a support, must be accurately fitted to the whole posterior surface of the body. It should be a non-conductor of heat; elastic or non-elastic; ventilated or not ventilated.

2d. The position of the human body at rest should be such as to allow the least amount of expenditure of energy, in order to conduct the circulation of the blood. If there is local compression of any part, there the circulation is impeded; the resistance to be overcome requires the heart to put forth more force, or nutrition becomes impaired. When the pressure is long continued in the case of sickness, bed-sore often results. The posture in which the circulation is the most easily performed, is that in which the thighs are flexed and the feet supported higher than the head. This position avoids hydrostatic pressure of the blood in the veins of the lower extremities, amounting sometimes in tall persons standing, to several pounds to the square inch, the numerous valves in the same veins also obstruct the passage of the blood. Now in the case supposed, the blood gravitates towards the heart, and facilitates its own return. A quickened circulation means improved nutrition, hence, surgeons used formerly to elevate the lower limbs in the treatment of ulcers of the leg. It means also comfort, hence, the habit acquired by our legal brethren of putting their feet upon chairs and mantels. The habit of sitting in chairs tipped backward is a partial attempt at gaining rest by the same process, a habit which has been regarded by foreigners as a national reproach to us.

But it should not be dismissed with a sneer, for it is a partial carrying out of a principle which faciliates rest; because, by it the blood is more readily returned through the veins, aided by it own weight plus the absence of hydrostatic pressure; and because there is a saving of heart-force. A few moments of heart-rest are not only refreshing but necessary.

This may not amount to so much in health as in disease. Take for example, a case of valvular disease of the heart; there the organ works on under great disadvantages, it is like a pump with one box deranged. It labors hard to push forward the life stream. Sometimes it fails suddenly and the result is death; but generally it succeeds in maintaining the circulation. This is done, however, at the expenditure of a great amount of vital force. If the other organs of the body, are sound and carefully managed, this strain is readily borne,

but if the body becomes from any cause wearied, the strain is felt, and palpitation and labored respiration result.

Now if in such a case, the lower extremities be elevated, so that the body will represent an angle somewhat larger than that of the letter V; the head being at the left extremity of the V, the hips at the angle, and the feet at the right hand extremity, then we have the position in which the blood gravitates towards the centre of the body. The heart has the minimum of work to perform, and the conditions of good physical rest are attained, because the body touches its posterior planes, curves and surfaces from head to foot.

A man, aged about 61 years, furnished a practical illustration of the effect of this position. He had organic disease of the heart, indicated by palpitation, only one cardiac sound, dyspnoea, sleeplessness and inability to lie in bed over two hours at a time in the night. He had overworked in mind and body, and thus aggravated all his bad symptoms. At the writer's request he assumed the V position on a chair [to be described], and after two days use of it, his heart became so much rested that he found no difficulty in sleeping all night in bed. Without employing medicine, and aided by rest alone, his heart, relieved of its overload, regained power enough to do its work under the unfavorable conditions of valvular lesion.

3d. Paradoxical as it may seem, rest for the living human body requires motion. The body is a bundle of kinetic energies. It is unlike inanimate bodies in this, that if kept in one position, the joints become stiff, the body cramped; and, if one single position, no matter how comfortable, be long maintained, the person becomes incapable of normal motion. Let a strong, healthy man lie in bed continuously for weeks, as in fractures of the thigh, and he will become incapable of rising and walking at one effort.

It is then desirable, after having arranged for a perfect contact of the under surface of the body, to have the medium of support capable of motion at the great natural points of motion; viz., the hip and the knee.

Let a, b, c, d, represent the support in question. At b, place

a joint moving in a vertical plane for the hip. At c, place a like joint for the knee. It is seen at once that a variety of movements may be executed with this device, analagous to those of the body, as follows:

Elevate a, b, to a right angle with the b, c, d.

Suppose a man extended upon this support, and we have the very comfortable chair found in the Boston barber-shops. Here the weight of the body comes upon the legs and thighs. The hydrostatic pressure is lessened by the height of the lower limb, and the heart column is correspondingly relieved.

But if long maintained, this position becomes irksome. A healthy person can change it, but the invalid cannot. How, then, can we give this support, and permit a change?

Simply by putting the support on a frame work and jointing it at b, so that the V rotates 90°, upward.

FIGURE I.
a

a, back; b, thigh; c, leg.

FIG. I. represents this motion; a, b, d, is the position described; a', b, d', the same when the support is turned back. The angle d',b, d, represents the angle of inclination of the thighs. The dotted line d', d, represents the hydrostatic pressure relieved; a'', b, d'', the V position exaggerated, as d'' is higher than a''.