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quent that they should not be cited as an argument in favor of a do-nothing policy.

After-treatment. This may be as important as the more active treatment used before the suppression of the hemorrhage. The uterus should be maintained in a state of retraction by the hand or a compress and firm binder. The patient should not move nor make muscular exertion, should be kept free from mental emotion. Stimulants may be used for exhaustion. The patient should be watched for hours to see if hemorrhage returns.

Of the many remedies mentioned in this paper it is appropriate to inquire which are the safest and most effective. Doubtless success has been secured by each of them. Each obstetric practitioner has his favorite remedy. If, in a particular case, he is unable to accomplish his purpose by his own special method he can easily select another or several others. All cases of postpartum hemorrhage which appear to be alike or very similar cannot be controlled by the same means. Perhaps the most popular method at the present time is the intrauterine injection of hot water.

The two favorite remedies of the author are the pouring of cold water from a height upon the abdominal wall and the passing of the closed hand, made as aseptic as practicable, into the uterine cavity and using it as a compress. Cold water in a pitcher is quickly obtainable and rapidly usable. Although it floods the patient and the bed, an outside flooding with water is safer than an inside flooding with blood. The obstetric hand is always ready and can be effectively used at a moment's warning. In the author's experience both of these methods have been employed with gratifying success.

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SECONDARY HEMORRHAGE. The term secondary may be applied appropriately to a profuse bleeding which occurs a few hours, a few days or even a few weeks after the primary hemorrhage has ceased. This is a very uncommon accident. Coliins, in the Dublin Hospital, found 40 such cases out of 16,654 cases of labor observed by him.

The causes of secondary postpartum hemorrhage are generally a portion of placenta, a clot or fragment of membrane remaining in the uterus. Contamin attributes the cause in 6 cases out of 56 to a coagulum. Other exceedingly rare cases are caused by a placenta succenturiata, a uterine polypus or fibroid, mental emotion, hardened feces, alteration of the blood and various other occurrences. The presence of foreign bodies in the uterus demands their immediate removal, such treatment to be followed

by those measures which are appropriate for the relief of postpartum hemorrhage of a primary character.

PROPHYLAXIS.

As preventive medicine is more important than curative medicine, so the prophylaxis of postpartum hemorrhage demands more earnest attention than its treatment. Is it not true that too slight consideration has been given to the puerperal woman both before and during labor? In many cases of postpartum hemorrhage the flooding would not have occurred if proper prophylactic measures had been taken. This statement empha. sises the importance of medical superintendence of the pregnant woman from the incipiency of her pregnancy to its close. The physician should familiarise himself thoroughly with the causes of postpartum hemorrhage and should study every pregnant case brought to his attention through both his practical and theoretical knowledge. The physical system should be maintained in a condition as near the normal as possible. All organs should be watched and their disturbances corrected.

Anemia should have special attention whether it arises from albuminuria or any other cause. Any derangement of the blood which disturbs the proper proportion of its constituents, as a subnormal amount of fibrin which will prevent the usual coagulability, should receive vigilant and corrective care. A course of treatment by iron may be specially useful. Calcium, being an essential constituent of fibrin, should have a thoroughly remedial trial in such cases. If inquiry concerning the patient's own or her ancestral history leads to the suspicion of a hemorrhagic diathesis, prophylactic measures should be carried out with thoroughness. In such cases the use of an anesthetic is of very doubtful propriety and, in most cases, should be forbidden. If, during labor, postpartum hemorrhage is a foreseen probability an early evacuation of the amniotic fluid may be advisable, which is specially applicable in cases of hydramnios ; ergot should be given and there should be a slow delivery of the fetus.

The points in this paper to which the writer wishes to call special attention may be summarised as follows:

1. The gravity of the subject.

2. Uterine atony the most frequent cause of postpartum hemorrhage.

3. Meddlesome midwifery a prolific cause of postpartum hemorrhage.

4. Profound anesthesia a causal factor of postpartum hemorrhage.

5. The need of watchfulness and alertness on the part of the accoucheur.

6. The treatment demands that the accoucheur be prompt and resourceful.

7. The necessity of not only contraction, but of retraction of the uterus.

8. Although cases left to nature have recovered a do-nothing policy is strongly condemned.

9. The usefulness of prophylactic treatment, especially in . cases which indicate the existence of a hemorrhagic diathesis.

10. Heredity a causal factor of the hemorrhagic diathesis.

11. The advantages of medical superintendence of pregnancy from its incipiency to its close.

12. The importance of after-treatment.

Fellows of the Buffalo Academy of Medicine: In terminating my duties as your presiding officer permit me to tender to you my grateful acknowledgments for your confidence expressed by electing me, one year ago, to the official position which I am about to surrender to my successor. I did not aspire to the position and did not suspect that your esteem would select me for your official leader. The place was accepted with much reluctance. Having accepted it, I resolved to make at least a creditable record. My high resolution was entirely dissipated by a physical disability to which I was subjected a few months following my election and which continues to hold me with a tyrannical grip. Kindly accept my sincere apology that my labors in behalf of the academy have been comparatively fruitless of expected results.

A review of the year's work shows that 19 members have been added to our numbers; 13 members have been dropped from the membership roll; hence the year is closed with a membership of 206. Although numerically our organisation maintains a fairly flourishing condition it has not yet received into its fold more than a moiety of the host of physicians resident in our rapidly growing city. The soundness of our treasury presents a solid reason for hearty congratulations.

The scientific and literary productions presented to the academy during the year may not have met the large expectations of some of our members, but many of them have shown careful observation, extensive thought and excellent literary talent. The pathological section deserves special mention on account of its departure from its usual method of conducting its meetings which have been held in different laboratories where scientific truth has

been demonstrated by microscopic slides, statistical charts and bacteriologic specimens.

In relation to the general attendance upon the meetings of the sections and the interest taken in the subjects under consideration, it is evident that the papers read should be the result of careful study and thorough investigation and should be presented in an attractive form. Our efforts should be directed towards attracting rather than compelling interest in all the literary and scientific activities of the academy. It is not exaggeration to assert that from the members of this academy often emanate discussions as thoroughly profitable and papers as profoundly scientific as are heard at the meetings of state and national societies.

It has been my fortune to hear various criticisms of the conduct and status of our academy not only during the official year now closing, but also in years past. Some one criticises us for spending too much time in discussing questions that are not strictly scientific, and too much money in forwarding movements that should be directed and maintained by other medical organisations. It is my opinion that too great vigilance cannot be exercised along this line. The academy was organised for the promotion of medical science and art. Questions relating to the investigation of the conduct of public and private institutions and to the enactment and enforcement of laws, should be relegated to the action of the county society which has a broader field and is more polemic in its character.

The criticism is made that the sections do not elect to official position their most competent members. I have heard this criticism from those members who seldom are seen at the meetings of the sections and apparently take but little interest in their success. No doubt the sections are the bulwark, the stronghold of the academy's work and should secure the energetic support of all our members and the leadership of our foremost ability.

Occasionally a member is heard to say, “The academy is of no account to me. I derive no advantage from it.” Generally such members attend only one or two meetings each year and do not place themselves in a position to derive advantages which legitimately belong to their membership. Those academicians who are regularly present at the meetings testify that each year brings to them large profit in social relations, official emoluments and scientific attainments.

Not infrequently the opinion has been expressed that the academy holds too many meetings. It may be that the mental, like the physical appetite, becomes clogged by a too frequent administration of literary and scientific pabulum. It is suggested that this subject be taken into full consideration by the incoming council. Other criticisms of a minor or major magnitude have been heard, but the conditions to which they refer can be removed by intelligent planning and unanimity of action. It is evident that the academy has not reached its highest privileges and possibilities. It lacks that personal interest, that esprit de corps which kindles enthusiasm and develops self-sacrifice.

In forecasting the academy's future it should be remembered that its success is dependent upon the medical profession of this city. Our physicians can make it or mar it. A strong and common interest in its welfare will lift it to a much higher plane than it occupies at present. A carping, hypercritical spirit united to persistently divided action will reduce it to a level on which none of us will prefer to stand. Every well-regulated physician in Buffalo should regard the academy as his medical home and should exercise towards it the anxious thought and tender regard closely akin to the feeling which he indulges for his domestic fireside. He should look to it as a spring from which flows social happiness, as a light which may illuminate many dark problems demanding solution in his daily round of professional duty, as an inspiring mentor that will point him to lofty ideals and allure him into paths leading to their attainment.

A pressing need of this institution is a permanent home, a dwelling place that we can call our own. It is a fortunate circumstance that already a permanent fund has been set apart for supplying this positively felt want. Although this fund is small it is steadily growing and is, no doubt, a nucleus to which will be added larger or smaller sums till ere long it will become a fund sufficiently large for the construction of a solid structure, commodious enough to concentrate within its walls all the medical society interests of our city. For the near consunimation of this project it is unfortunate that Buffalo's medical fraternity contains so few medical men and women of large wealth. Indeed, it is probable that not a single physician of our city is a millionaire. However, it is possible that many of us by persistent attention and wise diplomacy may open the purse-strings of some large-hearted millionaire who belongs to some other profession or calling.

Buffalo is the western metropolis of the Empire State. Many of its physicians are in the front rank of the medical profession of this country,-indeed, of the world. Our academy should enjoy the like reputation among medical societies. It should be recognised as holding a large place by its scientific productions and its continual progress towards high attainments along all medical lines. It should be the unwavering and untiring effort of our membership to win the affections and coöperation of that

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