previa; three were performed for uræmia; one was performed for excessive vomiting; one was performed for septicemia; one was performed for threatened death of child; one was performed for approaching death of mother. Of the children, ten were delivered living, of which number two died subsequently; one delivered at the sixth and one at the seventh month. Of the mothers, one died. Of the three children delivered still-born, two were known to be dead before the operation was performed, and the mother who died was supposed to be moribund before interference was established."

With the hope of learning something of the extent to which the operation was resorted to, or thought to be indicated by the profession in our own State, I addressed a few inquiries to physicians in different parts of the State, but at so late a date that but part of them could be answered, and those very hurriedly. The facts elicited, however, are of much importance, and lead me to join in the regrets of my correspondents that lack of time prevented fuller replies, and that I had not begun earlier and made the prosecution of the inquiries more thorough and extended.

My inquiries included cases of successive destructive operations to child in successive labors of same patient; also successive still births at term; and successive spontaneous premature births of dead foetus after period of viability.

One obvious practical difficulty in the application of the induction of premature labor is the fact that the necessity for it in a given case is often not known until too late for its employment in that labor. But such a discovery could be utilized with profit should such a patient again become pregnant, were she properly instructed as to her duty to inform her physician in time to determine the propriety of interference.

Dr. Chas. T. Folsom, Secretary Massachusetts State Board of Health, Dr. Walter D. F. Day, Secretary Metropolitan Board of Health, New York city, nor Dr. H. B. Baker, Secretary

Michigan State Board of Health, could give no statistics or information from their respective offices.

Dr. C. T. Southworth, of Monroe, reports cases of five patients with difficult labors.

Case first.-Version had been required in third labor. Cephalotripsy resorted to by Dr. S. in fourth labor; mother recovered well; not seen her since.

Case second.-First labor, delivery by forceps; second labor, craniotomy and cephalotripsy; mother recovered well.

Case third.-Version and forceps required to extract head; conjugate diameter, 24 inches, lateral 44 inches and irregular. Case fourth.-First four labors without trouble; fifth, case of anæmia (cephalomata); patient refused the forceps in time, and after twelve hours was obliged to perforate skull and deliver with forceps; patient not been pregnant since.

Case fifth.-Primipira,-narrow pelvis,-labor had been going on 30 hours when seen; performed cephalotripsy; mother recovered slowly, but well; was again confined this present month (April, 77,) and delivered with the forceps after considerable difficulty without injury to herself or child.

Dr. Southworth remarks the often observed fact that though one or more labors in the same patient may require craniotomy; a subsequent labor may be comparatively easy. But this fortunate exception cannot be depended on.

A slight difference in the size, maturity and ossification of the foetal skull may make a difference in the delivery fatal to the child at term.

Dr. Edward Dorsch, of Monroe, has four times performed perforation of the head of child-all the mothers were primipira-three times on account of too narrow pelves, once on account of great rigidity of soft parts. All except the last mentioned recovered immediately, she more slowly. Dimensions of the pelves not known in any till labor began.

Drs. John P. Stoddart of Albion, J. H. Beech of Coldwater,

C. H. Lewis of Jackson, H. B. Landon of Bay City, report no cases of their own of premature labor, and are unable from lack of time to procure information from others, or give statistics of indications for its use.

Dr. H. O. Hitchcock, of Kalamazoo, reports two cases of induced premature labor in same patient, rendered necessary in the mother's interest on account of persistent nausea and vomiting in both cases, that threatened the life of the patient by the interference with nutrition. The labor was brought on, after consultation in the first instance-primiparia at the end of the seventh month, and in the second at about the beginning of the sixth. The methods employed were by digital dilatation and ergot in the first labor, and the same in the second, with the addition of copious vaginal injections of warm water, the ergot being used after dilatation. The first labor was completed in about twelve hours. The child was dead in both instances. Of course there would be little ground to expect any other result in the second case, as it had probably not arrived at the age of viability. The mother, though frail and much enfeebled by a train of symptoms of other illness, including a bronchial cough, added to the exhaustion from the nausea, made a safe and speedy convalescence, the stomach tolerating solid food within three days.

Dr. R. A. Everett, of Hillsdale, reports two cases of induced premature labor. "The first in woman of 35, in eighth month of fourth pregnancy, suffering from acute inflammation of brain. Labor was induced by passing an instrument between the membrane and the side of the womb. In the attempt the membranes were ruptured and the amniotic fluid escaped. Labor supervened inside of twelve hours, and the mother was delivered of a dead foetus, and died herself within a short time after the termination of the labor. The case was well-nigh hopeless at the time of the induction of the labor. The operation was resorted to in the second case at about the fifth month

of gestation on account of placenta previa. The method was by separating the membranes from uterine wall, and this time without rupturing the membranes. The labor, which came on in about thirty hours after the operation, was short and energetic-hemorrhage profuse-placenta came first, fœtus soon followed dead. The mother, a healthy woman of about 38 years of age, in her third pregnancy, made a good recovery."

Dr. J. B. White, of Saginaw City, had two cases in which he was satisfied the induction of premature labor would have been better had he been consulted in time. One case of craniotomy and embryotomy,-mother made a rapid recovery. Another case of embryotomy, on account of deformed pelvis,— mother recovered well. Two cases craniotomy for hodrocephalous children,-mothers made good recoveries. He also mentions cases that occurred in the practice of Doctor Bliss, who performed craniotomy three times in one woman in three successive years,-mother recovered well each time.

Also mentions case of Dr. Barber, whom he assisted to perform the cæsarean section, when pelvic deformity was so great that craniotomy or embryotomy were impracticable. The child was saved, though the mother died eight days after, from septicemia.

Part of these cases, though out of the direct line of inquiry, are quoted for their general interest.

Dr. Jno. Kapp, of Ann Arbor, reports cases of four patients, German women, all of whom had difficult labors :

First Case-Was pregnant six times; in first labor, was delivered naturally of a still-born child; in second and third and fourth labors, was delivered by instrumental aid, by Dr. Rominger, assisted by Dr. Sager; children all still-born. In fifth labor was delivered by forceps, by Dr. Kapp, assisted by Dr. Cheever, the child apparently dead, restored by artificial respiration after persistent effort. In sixth labor was delivered by craniotomy, by Dr. Kapp, Dr. Frothingham in consulta

tion. Patient died three days after in consequence, it was thought, of an over-dose of ergot, through a mistake of a

nurse.

Second Case.-Patient delivered by forceps three times, with fatal result to all the children.

Third Case.-Two labors, very difficult from contracted pelvis; delivered with forceps in both, one child saved.

Fourth Case.-Contracted pelvis,-last three labors all difficult,-presentations abnormal,-children all lost. Thinks induction of premature labor would have been justifiable in all the above cases if the necessity for it could have been known in time for its employment.

Dr. E. W. Jenks, of Detroit, has induced premature labor several times-generally in cases of convulsions-with good results to mothers, in one case saving both mother and child; also two cases in which he has performed craniotomy twice in each patient. These were patients seen in consultation, the child found dead before the operation; has advised the induction of premature labor in a number of cases for the purpose of saving the child where the mother has given birth to several dead children; knows of the operation being done successfully several times by his advice by other physicians; thinks premature labor should be induced more frequently than it is.

Dr. J. wrote in haste and from memory, not having time to look up data and tabulate cases.

Dr. Sager reports from memory a case in which many years ago he induced premature labor on account of pelvic deformity, the result being successful to mother and child.

Dr. J. Andrews, of Paw Paw, reports from memory two very interesting cases of artificially induced premature labor:

Case 1.-A woman about thirty-five years of age, who had been three times previously delivered by embryotomy in western New York, and had been told by her medical attendant that she could not have a living child or live through another