THE

AMERICAN

JOURNAL OF OBSTETRICS

AND

Diseases of Women and Children

EDITED BY

BROOKS H. WELLS, M. D.

Professor of Gynecology at the New York Polyclinic and Gynecological Surgeon to
the New York Polyclinic Hospital; Consulting Gynecologist to Beth Israel Hos-
pital, New York; Consulting Abdominal Surgeon to the Brattleboro Me-
morial Hospital, Brattleboro, Vermont; Associate Surgeon to the

Woman's Hospital of the State of New York; Fellow of the
American Gynecological Society; Associate Fellow of the
American Association for Cancer Research; Fellow of
the New York Academy of Medicine, the New
York Obstetrical Society, The American
Medical Association.

AND

THOMAS S. SOUTHWORTH, M. D.

Attending Physician, Nursery and Child's Hospital, New York City Children's
Hospital (Randalls Island); The Hospital for Scarlet Fever and Diphtheria
Patients; Physician Out-Patien! Department, Babies Hospital; Fellow
of the American Pediatric Society, The American Medical
Association, New York Academy of Medicine.

VOLUME LXIII.

January-June, 1911

NEW YORK

WILLIAM WOOD & COMPANY

1911

AGER, LOUIS CURTIS, Brooklyn, N. Y.
ASHLEY, DEXTER D., New York, N. Y.
AYNESWORTH, K. H., Waco, Tex.

BARRETT, CHANNING W., Chicago, Ill.

BARROWS, CHARles Clifford, New York, N. Y.
BARTLEY, ELIAS H., Brooklyn, N. Y.
BLOCK, SIEGFRIED, Brooklyn, N. Y.
BOYD, GEORGE M., Philadelphia, Pa.

BRICKNER, SAMUEL M., New York, N. Y.
BYFORD, HENRY T., Chicago, Ill.

CARSTENS, J. H., Detroit, Mich.

CATURANI, M., New York, N. Y.

CHAPIN, HENRY DWIGHT, New York, N. Y.
COE, H. C., New York, N. Y.

CULLEN, THOMAS S., Baltimore, Md.

DARLINGTON, THOMAS, New York, N. Y.

DEAVER, JOHN B., Philadelphia, Pa.

DENNETT, ROGER HERBERT, New York, N. Y.

DICE, WILLIAM G., Toledo, O.

DICKINSON, G. K., Jersey City, N. J.

DICKINSON, ROBERT L., Brooklyn, N. Y.

DRENNAN, JENNIE G., Arrochar, Staten Island, N. Y.

EDGAR, J. CLIFTON, New York, N. Y.

ELTERICH, THEODORE J., Pittsburg, Pa.

FINDLEY, PALMAR, Omaha, Neb.

FOSTER, CURTIS SMILEY, Pittsburg, Pa.
FOULKROD, COLLIN, Philadelphia, Pa.

FRAUENTHAL, HENRY W., New York, N. Y.
GILLETTE, WILLIAM J., Toledo, O.
GOODALL, JAMES R., Montreal, Can.
GRAD, HERMANN, New York, N. Y.
HARRAR, JAMES A., New York, N. Y.
HAYD, HERMAN E., Buffalo, N. Y.
HILL, I. J., New York, N. Y.

HIRST, BARTON COOKE, Philadelphia, Pa.
HOPKINS, FRANK T., New York, N. Y.
HORSLEY, J. SHELTON, Richmond, Va.
HUGGINS, RALPH R., Pittsburg, Pa.
HUMISTON, WILLIAM H., Cleveland, O.
HUMPSTONE, O. PAUL, Brooklyn, N. Y.
HUNNER, GUY L., Baltimore, Md.
ILL, EDWARD J., Newark, N. J.
INGRAHAM, CLARENCE B., Denver, Colo.
JACKSON, FRANK H., Houlton, Me.

JOHNSON, JOSEPH TABER, Washington, D. C.

JONES, ARTHUR THOMS, Providence, R. I.

iii

228827

KELLY, HOWARD A., Baltimore, Md.

KENNEDY, J. W., Philadelphia, Pa.
KEPPLER, CHARLES OBER, Boston, Mass.

KERR, LEGRAND, Brooklyn, N. Y.

KNIPE, WILLIAM H. WELLINGTON, New York, N. Y.
KOSMAK, GEO. W., New York, N. Y.

LITTLE, GEORGE F., Brooklyn, N. Y.
LOBENSTINE, RALPH WALDO, New York, N. Y.
LOTT, HENRY STOKES, Winston, N. C.
LYNCH, JEROME, Hoboken, N. J.
MCCLELLAN, BENJAMIN R., Xenia, O.
MCMURTRY, LEWIS S., Louisville, Ky.
MCPHERSON, Ross, New York, N. Y.

MANNING, JACOLYN VAN VILIET, Brooklyn, N. Y.
MANTON, W. P., Detroit, Mich.

MORAN, JOHN F., Washington, D. C.
MORRIS, ROBERT T., New York, N. Y.
NOBLE, THOMAS B., Indianapolis, Ind.
NORRIS, CHARLES C., Philadelphia, Pa.
PARRISH, JOHN W., Brooklyn, N. Y.
PARKE, WM. E., Philadelphia, Pa.
PETERSON, REUBEN, Ann Harbor, Mich.
PFEIFFER, D. B., Philadelphia, Pa.
PRICE, JOSEPH, Philadelphia, Pa.

RADIN, HERMAN THEODORE, Lebanon, N. Y.

ROSENTHAL, MAURICE J., Fort Wayne, Ind.

RUBIN, I. C., New York, N. Y.

SACHS B., New York, N. Y.

SCHILDECKER, CHARLES B., Pittsburg, Pa.
SCHUMACKER, FREDERICK C., New York, N. Y.
SCOTT, A. C., Temple, Tex.

SCOTT, N. STONE, Cleveland, O.

SMART, ISABELLE THOMPSON, New York, N. Y.

SMITH, A. LAPTHORN, Montreal, Can.

SOUTHWORTH, THOMAS S., New York, N. Y.

STEWART, DOUGLAS H., New York, N. Y.

STRAUSS, I., New York, N. Y.

TAUSSIG, FRED J., St. Louis, Mo.

TRACY, STEPHEN E., Philadelphia, Pa.

WERDER, X. O., Pittsburg, Pa.

WIENER, SOLOMON, New York, N. Y.

WILSON, W. REYNOLDS, Philadelphia, Pa.

YOUNG, JOHN VAN DOREN, New York, N. Y.

ZINKE, E. GUSTAV, Cincinnati, O.

AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS. CHICAGO PEDIATRIC SOCIETY.

NEW YORK ACADEMY OF MEDICINE.

NEW YORK OBSTETRICAL SOCIETY.

Society of the Alumni of the Sloane MaterniTY HOSPITAL.

SOUTHERN SURGICAL AND GYNECOLOGICAL ASSOCIATION.

THERE is probably no condition in obstetrics which is of graver import to the mother and which at the same time tests the knowledge and taxes the skill and courage of the accoucheur more than a case with an abnormal implantation of the placenta; there is no complication of child-birth which requires to an equal degree intuitive reasoning, keen judgment, and prompt action.

Therefore, to arrive at an adequate understanding of the abnormality, it will be necessary first to consider the normal development of the placenta and pari passu the embedding of the ovum; and, second, to investigate why, when, and how the abnormality occurs; and, third, to dwell upon the practical or treatment aspect of this complication of pregnancy.

My regret is that the time at our disposal will compel us to be rather superficial in the consideration of a subject which, from a scientific point of view, is fascinating and from a practical standpoint is colossal in its importance.

When the fecundated ovum, having traversed the Fallopian tube and having been in the process of segmentation for several days, comes to rest upon the mucous membrane of the uterus, generally on the anterior or posterior surface and near the fundus there begins an active warfare between the burrowing ovum and the connective-tissue cells of the endometrium. The proliferating trophoblast, i.e., the outer epiblastic layer of the blastocyst *Read before the New York Obstetrical Society, November 8, 1910.