and with the pessary it is impossible to benefit the patient. This only further emphasizes the fact that in order to cure, the cervix must be kept posterior.

This condition can usually be overcome by making a transverse incision in front of the cervix, separating slightly the uterus from the bladder, and converting the incision into a longitudinal one.

I do not want to close this subject without calling attention to the opportunity for a cure that is offered after a confinement. If it be a simple case with a fairly good pelvic floor, the chances of success at this time are good. If during involution the uterus is maintained in its normal position it is likely to stay there permanently. The use of a pessary may be necessary for some time, as involution of the uterus and pelvic tissues are not complete for some weeks.

Dunning has made some investigations, and his results are summed up in Progressive Medicine of 1904. As the subject is treated so concisely I will quote his summary in closing. "1. Simple, uncomplicated retroversion of the uterus gives rise to but few symptoms, the chief of which are backache and bearing-down pain. Painful menstruation occurred in 37 per cent. of the cases. Uncomplicated cases constituted but 7.01 per cent. of the entire number under observation (112). Five uncomplicated cases were treated by the non-operative plan; 3 were cured and 2 were greatly relieved.

"2. The severity of the symptoms and the prospect of a cure depend largely upon the number and character of the complications. Prolapsed and chronically inflamed ovaries, endometritis, and laceration of the cervix uteri constitute the most common and serious complications. The most common symptom is pain, occurring in 74 per cent. of cases. This includes painful menstruation, 36 per cent.; backache, 35 per cent. In but 21 per cent. of the cases was there habitual constipation. Various degrees of invalidism existed in all complicated cases.

"3. In the treatment of the simpler and less complicated cases the nonoperative method yields satisfactory result. Recent cases, especially those following labor, improved rapidly under this form of treatment.

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4. Displacements of long duration accompanied by the more serious complications are not cured by this method, and the benefits resulting are scarcely sufficient to justify the effort.

"5. Operative methods in the severest forms of displacements and complication are attended by a large percentage of cures, and should be employed in preference to all other means. So large a percentage of these cases have multiple complications that two or more operations may occur in each case.

"6. The danger attending the operative method of treatment is very small. In the 21 cases reported there was no mortality."

By non-operative treatment Dunning means the use of a suitable posture, tampons, pessaries, topical applications, and internal medicine.

A CONTRIBUTION TO THE TREATMENT OF PLACENTA PRÆVIA.*

BY L. C. GROSVENOR, M. D.,

Professor Obstetrics Chicago Homeopathic College.

In this we have one of the most anxious and trying complications of the lying-in chamber.

Whether partial or complete, it is fraught with imminent peril to two lives. He who is resourceful and conscious of his reserved power has already won a great point.

This very fact will show in his face and manner and inspire confidence in his patient and the near ones most interested.

Promptness and directness in the use of these resources gains you still further prestige. Indecision and dilly-dallying at this point are most unfortunate.

Now what are the resources which constitute our armamentarium?

First and foremost is the resilient tampon. This is made of alternate thin fluffy layers of oakum and absorbent cotton about eight or ten inches long and four inches wide. Make layers enough to completely pack and fill the vagina. This tampon does not wad and become solid, but has the rare virtue of distending as moisture is absorbed, and completely filling the exit and controlling hemorrhages which so terrify the patient and friends. This is applied with bivalve speculum and dressing forceps.

After inserting and rotating the speculum, dilate it widely and with cotton or gauze sponges sweep out the accumulated clots so as to have a clear field. This tampon is so compressible that it is easily placed.

Another resource is adrenalin or suprarenalin 1 to 2000 with which the upper end is well soaked before placing. This is a prompt hemostatic, blanching the tissues and stopping the flow.

* Read before the Obstetric Society of the American Institute of Homeopathy.

This is held by the tampon in close touch with the dilating os and raw surface of the presenting placenta.

The result will be so comforting and assuring as to throw a cheering light upon the whole picture.

This tampon should be removed in twenty-four hours and the parts cleansed with the lysol douche.

Often the patient will go for days or weeks without further trouble.

As the gravid uterus enlarges and the os dilates-new placental surfaces present and the operation may have to be repeated-and so you carry your patient to term.

In labor this tampon is equally helpful, holding the hemorrhage in check till dilation is complete.

Now remove the dressing-poke the placenta to one side, apply the forceps-bring down the head as a plug, and your peril is at an end.

If adrenalin is not at hand, a fluff of raw silk applied to the os before inserting the tampon is a valuable hemostatic.

But neither of these is of any value without the new tampon to hold it in apposition to the os. To illustrate:

My friends, Drs. Reise and Grosser, called me hurriedly from church. The patient was nearly moribund-gaping and almost pulseless from loss of blood.

I immediately applied the above treatment and the patient went twenty-one hours without further loss.

A slight oozing now alarmed the patient, and the dressing was removed and a fresh one applied. In this way we carried our patient five days, when labor supervened, she being at term.

I crowded the placenta to one side, applied the forceps, and delivered without further peril.

Both mother and child were safe, and the household were happy, for repeated previous disasters in the lying-in chamber had left the husband without issue.

In primiparæ and closely built patients, the classic teachings of the great masters of obstetric art are very difficult of application, but this is as easy here as in multiparæ.

HOMEOPATHIC OBSTETRICY AS PRACTICED.

BY GEO. B. PECK, M. D.

Foster declares "obstetricy (to be) the medical and surgical management of pregnancy, parturition, and the puerperium." He also states homeopathy to be "the therapeutical doctrine that certain morbid conditions may be corrected by the use of drugs that in health produce similar conditions." While the latter definition is not absolutely correct, it is sufficiently accurate to be accepted in a general way for the purposes of the present discussion. Hence it follows that homeopathic obstetricy consists solely in the medical management of morbid conditions occurring during pregnancy, parturition, and the puerperium, by the administration of drugs capable of producing similar conditions. The average practice of hundreds of members of the American Institute of every age, sex, and professional standing, is the only reliable evidence possessed in the premises. Their statements are valuable not merely from a therapeutic standpoint but from a pathological as well, for they indicate the comparative frequency with which certain types of disease are met with in the entirety of the country. Figures are not given, lest they should influence to an improper selection of remedies. At the same time the date of investigation of the several complications referred to is stated, so that those desiring further information may consult the original report. When medicaments are not enumerated alphabetically, their order conforms to their recurrent demand. It should, however, be borne in mind that any drug in the entire materia medica may be required at any moment. Indications have not been given because the purpose of the paper is suggestion merely. Moreover, unless the new-school reader can instantly give the differential indications of each drug, he proves himself ignorant of that which he professes to know.

For the relief of placenta prævia, arnica, belladonna, chamomilla, china, crocus, hamamelis, helonias, ipecacuanha, millefolium, pulsatilla, sabina, secale, and viburnum have been employed. A generous diet is allowed (1880.)