Every case of labor must be conducted with the most scrupulous attention to surgical cleanliness on the part of the patient, doctor and nurse. Puerperal infection in most cases is due to the introduction of disease-producing microbes into the wounded genital canal. To be sure, the successful enforcement of surgical cleanliness is attained only in good hospitals, but it can be approximated in a private house if the patient insists upon delivery at home. A nurse or doctor who is clean of person, is most apt to have an “aseptic conscience.” The possession of such a conscience may entail financial sacrifices, but it has many compensations. Neither the nurse nor the doctor is doing justice to the patient, nor to the profession, who indiscriminately takes pus cases, contagious diseases, and confinements. The public will soon learn that such a nurse and such a doctor are unsafe attendants. How may the nurse know that the patient is in labor? This is the final assumption that must be confirmed or refuted when the nurse is called to her case. It is ascertained partly by the history and partly by the conditions found. Thus, the patient may report the passage of a piece of blood-stained mucus, and the nurse will observe that the contractions of the uterus are regular, rhythmical and painful. She will observe that when the patient complains of pain, the uterus gets hard. She will also observe the definite regularity of the contractions by timing them. Under such conditions, the doctor should be called at once if the symptoms develop between 7 A. M. and 11 P. M. If the pains begin in the night, say from 11 P. M. to 7 A. M., the doctor need not be called unless he has requested it, or, unless in the judgment of the nurse or the anxiety of the patient, it is desirable for him to see her. [Illustration: Fig. 51.—Points of greatest intensity of fœtal heart tones. _V_, vertex presentations; _B_, breech presentations. (Eden.)] When the doctor is notified he will want to know, and the well trained nurse will be able to inform him, when the pains began, their strength, duration and frequency. He will want to know whether or not the membranes have ruptured. Many doctors also require, and a well trained nurse who specializes in obstetrics should be able to say by external examination, whether the head seems high or low, as well as the position and frequency of the fœtal heart tones. In the hospital the following rules for summoning the resident physician may be found useful: 1. For multipara, when pains are regular and five minutes apart. 2. For primipara, when pains are regular and two minutes apart, or when head is visible if pains are less frequent. 3. If a precipitate is imminent, delivery must be delayed until arrival of attending man by— (a) Turning patient on side with legs straight; (b) Instructing patient to breathe deeply or to cry out with mouth wide open; then