DOCTOR NEY: While dealing with many acute diseases and most chronic diseases, there is ample time to refer to the literature bearing upon them; but when called to the bedside of a patient afflicted with placenta previa, the physician should be prepared to cope with the situation. I am glad the subject has been presented for discussion. Only about three weeks ago I was called in consultation with Doctor Lewis, of this city, who had a case of placenta previa. The patient had a slight hemorrhage in the seventh month and another slight one the evening I called. DocTOR LEWIS wished to administer the anesthetic and asked me to assume

charge of the labor. I found the cervix very indistinct and exceedingly high in the canal. The presentation was abnormal-the head and shoulder on the right side, the shoulder presenting, the buttocks turned to the left, and the feet flexed upon the abdomen. There was not a direct central implantation of the placenta; this organ was imbedded in the right side and extended around to the left. The body was supported on the left side so that I could put my hand up beyond it. The woman was placed under the influence of chloroform, and using two fingers I dilated the cervix sufficiently to enable me to manipulate the fetus, which I began to turn, but it would not remain in position. There was very little pain. I had considerable difficulty in getting the feet down, but after some time I succeeded, when the hemorrhage ceased. The child was alive at first but eventually succumbed to asphyxiation. Until the head became engaged in the cervix there was not sufficient dilatation. The cervix was large, following up and protruding, and there was considerable delay, so much that the cord was pressed upon and the child asphyxiated. The woman had no hemorrhage after being delivered and made a good recovery. The question arises whether Caesarean section would not be justified in dealing with central implantation of the placenta. It seems to me that a mortality of fifty per cent. of the mothers and almost all of the children would justify this procedure if we were absolutely sure of central implantation of the placenta. We would be almost certain of saving one life in the later stages. Instead of ninety per cent. of deaths we ought to have ninety per cent. of recoveries of mothers subjected to Caesarean section. I would be disgusted with myself if I were to lose more than one patient in ten subjected to Caesarean operation, It is an easy and safe operation and one that I would not hesitate to perform if I had the endorsement of the family physician. I would rather trust these cases to the trained physician than to nature. I think they need assistance from the beginning, and it is the physician's duty to deliver as soon as he has control of an extremity, when the danger to the mother is practically over, except in cases of central implantation, and we should not wait until the second hemorrhage. I think the mortality of mother and child ought to be lowered.

DOCTOR GREENSHIELDS: I have practiced medicine forty years and never had but one case of placenta previa. The patient was the mother of six children. She had a slight hemorrhage, for which I employed the tampon, the remedy then in vogue, and the hemorrhage continued, eventually becoming excessive, whereupon I introduced my hand and dilated the cervix sufficiently to permit the removal of placenta and child. In a few minutes my patient was dead.

DOCTOR GILLETT: I have had only one case of placenta previa, but I managed that one nicely. It was not a complete implantation. The edge of the placenta only covered the os until after labor began. I am inclined

to the opinion expressed by DOCTOR NEY; I believe that Caesarean section is perfectly justifiable.

DOCTOR RANDALL: I had an experience in Detroit with a case of placenta previa. Three doctors examined the case and made a diagnosis of this condition. We wanted to give the patient chloroform and deliver the fetus, but were not allowed, whereupon we withdrew. I afterward learned that a Polish doctor delivered the child, and that the woman made a good recovery. In regard to introducing Caesarean operation for placenta previa, SIR LAWSON TAIT was the first person to advocate it.

DOCTOR STEWART: At what stage of pregnancy should Caesarean section be performed? I am sorry DOCTOR WILSON is out of the city. He had a case of placenta previa, in which I was called to assist him,that I believe he would like to report at this meeting. It was a case of central implantation and hemorrhage had been present some time. The woman was quite weak but the uterus finally contracted. DOCTOR WILSON was obliged to hasten away, and asked me to remain an hour. I complied, but he did not return at the appointed time, and as I also had another engagement to meet, I went away. I was not aware at that time that in low central implantation in proportion as the neck is involved in the implantation will the uterus refuse to contract and hold its contraction. Within an hour after I left the woman was taken with a hemorrhage, DOCTOR WILSON arrived on the scene a few minutes later, and sent for me. We knelt on a pillow and with one hand held the uterus with a sponge shoved into it, and with the other hand pressed upon the abdomen from 6 o'clock that evening until 8 o'clock the next morning. We took turns of about an hour each throughout the night. There were times when it seemed impossible for that woman to live, but she lived and withstood an operation to enlarge the vagina. The pressure caused a constriction of the upper part of the vagina until it was the size of a lead pencil, and that necessitated an operation to relieve it. That woman since has borne children. Another case was one of DOCTOR CLANCY'S. He had occasion

to be absent from the city and left the woman in my charge. I made the mistake of letting nature proceed too far before interfering. The patient having bled quite profusely for four or five days, I called DOCTOR STOCKWELL, who gave an anesthetic while I introduced my hand directly through the center alongside the cord and turned and delivered the child. The woman lived six or seven days after the delivery. These are the only cases with which I have had experience. As far as Caesarean section is concerned, I believe it is the proper procedure if the child is viable, as it seems impossible to deliver a child alive when the physician has to pass his hand through the placenta. I cannot think the child would live much longer than it would if immersed in a pail of cold water. Undoubtedly certain things must be considered before resorting to operative measures. There is not always a hospital at hand, and sometimes it is difficult to procure assistance, but when these desiderata are at command, I think the Caesarean operation should be performed.

DOCTOR SMITH: I do not know that I have anything more to add to this discussion. My experience with cases in which hemorrhage occurred early prompted me to write this paper. It seemed to me that in all the cases delivery should be accomplished at once, and yet I was advised by different physicians to delay. The woman who died from placenta previa was told to be sure and advise me if hemorrhage occurred, but she allowed flowing to continue a week without her husband or my knowing

anything about it. I believe had I interfered at once she would have been saved. As DOCTOR RANDALL says, SIR LAWSON TAIT was the first person to shock the obstetric world by advising the Caesarean section in these I believe, in view of the mortality among children, that the operation is justifiable.

cases.

EDITORIAL ARTICLES.

PRESIDENT WILLIAM MCKINLEY.

AT this date the tragic death scenes of PRESIDENT WILLIAM MCKINLEY have passed from view. The last public utterance, the kindly smile, the murderous assault, the struggle for life, the last breath, all are now events of the past, and yet they are still fresh in our minds as if of yesterday, and their impress remains on our hearts. Today as we remember his last counsel, his solicitude for the dependent wife, his hopeful spirit and submissive will, we feel the presence of a great and good man. We are loth to think him dead, and yet his lips move not, nor will his hand be lifted in kindly service.

The details of the assassination of our late President are too well known and too vividly remembered to need repetition here. The daily bulletins also were as promptly and zealously posted as the eager throngs could wish. The story has all been told. This is an occasion only for reflection, consolation and thought for the future.

Afterward is a favorite time for some people to indulge in carping criticism and "I-told-you-so." It is also sometimes the only time to make any remark. It is so with us, but we do not feel critical with regard to the medical aspect of this case. It was as if the supreme efforts of their lives were required of those employed in supplying the needs of that awful occasion, and we are content to believe that they were expended to the limit. Surgical attention was prompt, courageous, dignified and careful. The only regret is that such service did not end in recovery.

The bulletins were as a rule satisfactory. They reflected the best judgment of the medical attendants. It seemed provoking, however, that he, who would naturally be supposed to know least about the real conditions of things, not having assisted or been present at the operation, should nevertheless prognosticate with the most assurance. It is possible, however, that that bulletin was incorrectly reported.

The regret has been publicly expressed that a specialist in internal medicine was not called into the case at the first, and the occasion is made use of to insist that in surgical cases generally specialists in internal medicine as well as surgeons should be consulted. In this instance it is perhaps unfortunate that the physician was not called in earlier, as, had he been, that regret would not have been felt. We are not willing to admit,

however, that such a rule should be established. It is our opinion, and everyone is entitled to hold an opinion, that, except when the attending physician or surgeon feels the need of other or more experienced counsel, an undivided responsibility will insure the best results.

ANNOTATIONS.

ANARCHISTS.

THE very name anarchist excites a terror something like the fear of a venomous snake. The study of them as a class is not productive of either pleasure or interest, as some other subjects are, but, from a sociologic standpoint, few subjects are more important. On account of our recent sad bereavement it assumes unusual prominence at this time.

As a result of comparison and analysis this type is found among the criminal and insane in the large class of degenerates. All three do murder and other acts of violence, but from different motives. A common murderer represents one individual against another, while an anarchist makes war upon society as an institution and attempts to break it up. The former is an enemy of good society from personal motives, the latter is hostile only as the representative of an organized class.

As is suggested by the principals in the assassination of PRESIDENT MCKINLEY, anarchists compose two smaller classes-leaders and followers —which are respectively the brains and tools of the organization. Discontent, a malignant feeling of dissatisfaction, pervades them all and rises at times to the heat of an epidemic, which spreads as by a contagion. At these times, not the individuals as such themselves, but the officers of the government are held responsible for the fancied wrongs and become the objects of assault.

The control of the exciting cause or causes and the repression of the outbreaks of this social disease constitute a great task. The infliction of severe punishment, which we in our indignation feel like bringing upon the poisoned criminal, is at once suggested, but will no more protect from further violence than will the death of one patient stamp out a contagious disease. The death of one anarchist will not prevent the making of others. By it the seeds of dissatisfaction are liable to be further spread. From the point of view here assumed and reasoning by analogy, isolation and quarantine are most prominently indicated, or, as NOYES suggests in the Medical Review of Reviews, "segregation and breaking up their headquarters form the only remedy." The nature of our government possibly favors or allows the spread of anarchy, but as the people are now anxious and determined that repressive measures be institufed, we shall look to our legislators and executive officers to carry out their, the people's, will.

THE PUT-IN-BAY MEETING OF THE MISSISSIPPI VALLEY MEDICAL ASSOCIATION.

MANY Michigan doctors failed to attend a good meeting of the Mississippi Valley Medical Association at Put-in-Bay, September 12-14, 1901. Indeed, a large proportion of its members did not materialize there. The attendance was reported at about 200. These represented the South, East and West as well as the North. The papers were of a high order and discussions were practical. The limited passenger service seemed to have been disappointing. The next meeting will be held in Kansas City.

THE PREVALENCE OF SMALLPOX.

SMALLPOX continues to be prevalent. It has visited Michigan ninetynine times during the last quarter. According to reports to the Marine Hospital Service, it exists also in several other sections of this country, in the States of South America, in India and Europe. In Paris its spread and the mortality from it have been considerable, having reached a maximum in 1900 of one hundred and thirty-two cases and fourteen deaths in the forty-ninth week, and in 1901 a maximum of one hundred and fortyfive cases with twenty-four deaths during the twenty-third week. The condition in London causes equal alarm. The disease is not limited to any one part, but has appeared in at least eighteen different sections of the city. Having been a rarity for several years, considerable laxity in prophylaxis seems to have developed. It is estimated that one-third of the children in the elementary schools are unvaccinated. Many others have failed to revaccinate, so that the percentage of susceptible individuals is very large. The British Medical Journal, in reviewing the situation, shows some anxiety and seems to favor the proposal that the medical men of London be educated concerning the diagnosis of the disease.

CONTEMPORARY.

OPPORTUNITIES FOR MEDICAL RESEARCH IN AMERICA. [MEDICAL RECORD.]

WHEN One pauses to examine the currents in the stream of medical progress in this country, one cannot but see that in the drift of events research in experimental medicine is gradually assuming a more and more important position. The two factors that led to the growth of the present opportunities for research in pathology, bacteriology, and hygiene were the evolution of the American university from a mere "boarding school where the elements of the learned languages were taught to youths," as MR. PATTISON, rector of Lincoln College, once said of Oxford, to a seat of learning and research modeled after the German prototype, and