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was used-often as the principal reliance-by the reporters in this collection.

The material used has been various-sponge, cotton or rags. Some have been content with simply applying a plug against the os or cervix, while others have packed the cervix and vagina full and secured it with a bandage. Some have used styptics or astringents on the plug. In one case rubber dilators and in one a colpeurynter was used.

In the following table are included all cases treated by tampon, whatever may have been the substance used:

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The proportion of cases of partial presentation, and with moderate hemorrhage, are larger in this table than in the whole collection.

The mortality to the mother in cases of partial presentation is about the same as the average in the whole collection, but under every other condition exceeds it, especially in the cases of moderate hemorrhage.

The mortality to the child was some less than the average in the cases of partial presentations, and those having profuse hemorrhage.

To investigate more closely the value of the tampon as shown in this collection, I will analyze those cases treated by the tampon alone, in the following table:

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In all the cases noted, the placental presentation was partial. The hemorrhage was profuse in a large proportion.

Only one mother died, and she died undelivered. The mortality to the child was very light, as far as reported.

The cases treated by tampon and ergot have been already studied, showing unfavorable to the mother in cases having complete presentations, or profuse hemorrhages, but favorable to the child under every condition,

The following table includes all cases treated by the tampon and version :

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In this table we find the larger proportion are cases having complete presentation and profuse hemorrhage.

The mortality to the mother was heavier in the table under every condition than the average, especially in the cases of partial presentation, or those with moderate hemorrhage.

The mortality to the child was equal to or heavier under each

condition, except those with profuse hemorrhage, but not so heavy proportionately as was the fatality attending the mother.

This table will be considered more fully when we review the treatment.

Study these cases and see in what class of cases the tampon has proven to be a comparatively valuable agent in the treatment of placenta previa.

First, as regards the mother:

In cases of partial presentation we have found the mortality comparatively light in all the tampon cases, except those followed by version, in which it was almost twice that of the average in the whole collection. In cases of complete presentations, each table presents a mortality heavier than the average. Therefore, as regards the mother, the tampon has not proven to be of decided value in partial presentations, and of none whatever in complete.

In cases of small or moderate hemorrhage, the loss was none in the cases treated by tampon alone, or by the tampon and ergot, but in those treated by version the mortality was decidedly heavy. In cases of profuse hemorrhage the mortality was very heavy, except in the cases treated by the tampon alone, of which only four are reported, indicating that it may be of some value where the hemorrhage is either moderate or profuse.

Second, as regards the child :

In cases of partial presentations the mortality was light, except those delivered by version, in which the loss was slightly in excess of the average. In cases of complete presentations the mortality was about the same in each table as in the average, showing that it may be of value as regards the child in cases of partial presentation, but not in complete.

In cases of moderate hemorrhage, the mortality was light in all, except in those cases in which version was subsequently necessary. In profuse hemorrhage the loss was less than the average in every table, though heavier in cases delivered by turning than in either of the other tables; therefore, as regards the child, where version may be subsequently demanded the tampon does not show its value so definitely.

In our review of treatment we will consider more fully the value of the tampon.

Version. The operation of version is very closely associated in the mind of the general practitioner with placenta previa, and it is undoubtedly estimated by many of the profession as a measure of great value, and one that should not always be considered as a last resort. As one of the great dangers in version is in passing the hand into the uterine cavity, I have included in the following table of version cases a few of breech presentations, where the reporters speak of passing the hand through the cervix, to seize and bring down the feet, subjecting the patient to almost all the dangers of version proper.

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This table shows that a much larger proportion were cases of complete presentations, and cases of profuse hemorrhage, than we have shown as the average in the whole collection.

The mortality to the mother was comparatively light under each condition; except those cases with moderate hemorrhage, it was more than double the average in the whole collection.

The mortality to the child does not vary a great deal from that shown in the whole collection.

The cases treated by version alone are shown in the following table:

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The mortality was lighter under every condition than in the whole collection.

The mortality to the child was somewhat heavier in the cases of partial presentation and that having profuse hemorrhage.

Having heretofore tabulated the cases treated by version in conjunction with ergot, or the tampon, we will endeavor to estimate from those tables the relative value of turning as a treatment in placenta previa.

First, as regards the mother:

In cases of partial presentations the mortality was light in each table, except those by the tampon and version. In cases of complete presentation the loss was also light, except in the same table as above. We would, therefore, conclude as regards the mother that version is undoubtedly a valuable agent in either partial or complete presentations.

In cases of small or moderate hemorrhage the mortality was light in those treated by version and ergot, and those treated by version alone, but in those treated by the tampon and version the percentage of loss was about five times that of the whole collection. In cases of profuse hemorrhage, the mortality was light in every table, except in those in which version was preceded by the tampon. Therefore, as regards the mother, in either moderate or profuse hemorrhage, version is a comparatively successful treat

ment.

Second, as regards the child:

In cases of partial presentations the mortality was heavier in both the tampon-version cases, and version alone cases, but lighter

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