Placenta Praevia.

BY D. R. PELTON, M. D., TOPEKA, KS.

I know of no case that taxes one's self-possession and judgment in obstetrics, more than placenta prævia.

immediately turned out the placenta. The mother and child did well and made a good recovery.

The next case of which I will speak is that of Mrs. K., age 28 years, spare but of general good I was health. She had borne three children. summoned to her bedside a distance of six To wait or not to wait is the question. miles. Found her laboring under shock from These cases are, fortunately, quite infre- violent hemorrhage. Four or five quilts were quent when we sift out those of premature saturated with blood as well as the mattress, separation of placenta which causes hemor- and a large pool upon the floor beneath. Upon examination I found total placenta rhage called by Dr. Parvin accidental. Leaving each one to study the physiology prævia, the placenta quite large, with the atand pathology of his own cases, or rather al-tachment of the cord directly over the os, lowing that all do understand them, I will which was dilated to about the size of a silver pass in brief to two cases of placenta prævia dollar. The history of the case reported sevwhich occurred recently in my obstetrical eral hemorrhages at intervals of from one to practice, differing in their nature and treat- two weeks, dating back for two or three months. The pulse was hardly perceptible

ment.

Mrs. O., aged about 35 years, spare and and the patient was unable to speak. I immeanæmic, had slight show of blood at different diately gave stimulants and ergot. The case times two weeks prior to confinement. On demanded immediate interference. I introthe occurrence of the pains slight hemorrhage duced my hand into the vagina and engaged took place, at which time I was immediately the point of three fingers within the os, using called. On examination I found the placenta them as dilators to gain an entrance into the attached over the entire opening but only womb. I ordered the nurse present to give reaching a few lines to the left of the dilating the chloroform, as the patient was now rallyAfter the action of each pain the hemoring from the state of collapse in which I found rhage increased rapidly. I separated the edge her. The child was already dead. I passed of the placenta nearest the os, thereby reliev- my hand directly through the placenta, ing the traction upon the other portion which reached the feet of the child and with conwould otherwise have been torn loose by the joined manipulation performed podalic veroncoming child. The entire attachment sion, bringing the feet through the opening seemed below Baudle's Ring. Determining of the placenta.

Os.

upon the expectant plan of treatment, I then The pain now began to increase from the introduced a tampon of cotton carrying it ergot and the reflex action or the partly The delivery was completed high up against the cervix and supporting it emptied uterus. below with other of same material to control as rapidly as circumstances would permit. by pressure the increasing hemorrhage. This With my left hand upon the abdomen I folhad the desired effect, in increasing the pains lowed closely the descending head and graspas well as restraining the flow. I was soon ing the uterus to prevent further hemorable to rupture the membrane on the free rhage, delivered the child and placenta. The side of the placenta, allowing the head to engage within the pelvic brim, so precluding all possibility of fatal hemorrhage with good and efficient pains.

The child was delivered naturally and in a very fair condition, which I attribute to preserving the attachments of the placenta as long as possible upon the right lower segment of the uterus. Upon delivery of the child I

mother rallied with the use of stimulants. Lowering the head I placed bottles of hot water to extremities. She made a slow but steady progress to recovery.

My experience in several such cases is that circumstances must be a guide to one's action. there is no absolute plan of treatment but Whether the treatment shall be operative or expectant, must rest with the judgment of the physician.

Sanitary Instruction in Schools and Colleges.

AN ADDRESS DELIVERED AT THE STATE SANITARY CON

VENTION.

modification, and so secure to themselves, and extend to those over whom their opportunities have given them guardianship, life and health, happiness and prosperity.

You may tell me that we have in every

BY W. L. SCHENCK, M.D., OF OSAGE CITY, KAN. community members of a profession devoted

(Continued from March No.)

to the protection of health; that that is the business of the doctor, whose education should qualify him for its discharge. The business of the physician, as he understands it, is to relieve suffering and cure disease; yet you expect him to teach hygiene, and so does the state; and you not only expect him to abridge his income by preventing disease, but to do it free of charge, and so does the state. When the state appoints a board of health it expects physicians to gratuitously report vital

It is not our purpose to discuss the various sources of disease to show the laws that govern the origin and being of septic poisons, the methods of their detection and prevention, the results of their infection or the means of their removal. England's great statesman and historian, who thoroughly comprehended the logic of events, in speaking of the death of Good Queen Mary truly said, "That disease, over which science has achieved a succession statistics, and the board to protect the health of glorious and beneficent victories, was then of the people without law and without pay. the most terrible of all ministers of death. In this respect Kansas is not unique. SevThe havoc of the plague had been far more eral of the states, who very properly pay their rapid, but the plague had visited our shores governors and legislators, their judges and only twice within living memory; and the juries, even those they appoint to supervise small pox was always present filling the the health of cattle and swine, expect their church yard with corpses, tormenting with state boards of health to supervise the health constant fear all whom it had not yet stricken, of the people without authority and without leaving on those whose lives it spared the consideration. Whilst physicians do perform hideous traces of its power; turning the babe a large amount of this kind of labor, and perinto a changling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to her lover." Yet public sentiment has not demanded of the Kansas legislator protection against this dread destroyer which during the past year, has appeared at more points in this state than any other in the union.

form it not only without hope of fee or reward, and as no other class of philanthropists do charitable service as a genuine altruism, destroying their means of support by gratuitous labor in the interests of humanity, the simple statement of the fact that the prevention of disease is wholly in the hands of those who live by curing disease, sufficiently emphasizes the necessity for professorships of preventive and state medicine in every normal school, college and university in America.

While it is easy to demonstrate that water supplied from streams that drain a wide extent of territory, must contain much of the animal and vegetable remains that lie upon Until such professorships can be establishthe surface of the country drained, and may ed and bring forth fruit, the state should not contain the specific poisons of typhoid fever leave to school boards ignorant of sanitary and other septic diseases, and that we are sur- science, interests as vital as the life of its rounded by preventable sources of disease, children, but should provide a system of saniwe rather desire to press home the thought tary supervision, through which in every city that the educated people of every community and township, a competent sanitarian must should be so educated in sanitary science that be employed to inspect school buildings, they will be able to recognize the cause of school methods and schools, and their surdisease, and exert an influence that will secure roundings, and to give instruction to teachers the enactment of laws, and provision for their and pupils in the principles and practice of exécution, for their prevention, removal or sanitary science.

Life is not, as it seems to be considered in our American civilization, the cheapest commodity in the market. It is the sine qui non without which the opportunity for enjoyment, improvement and progress are not. That without which we are not.

If it is the purpose of education to store the mind with such truths as shall be of the greatest practical value to the individual and to society, what more important knowledge than that which will enable us to preserve health and prolong life; and what knowledge will better enable us to earn the blessed benediction: "Ye served your brethren; ye served the Lord?"

While our people would rise as one man and avenge the death of a neighbor slain by the assassin's bullet, as I saw them do the other night here in the capitol city of the state, a Hygeia was heaven born. Without her bullet from a pistol is not a more certain mes- blessing spiritual life is manacled, and every senger of death than the poisons by which ig- joy embittered. In her right hand are length norance, carelessness and cupidity contami- of days. How much that means we hardly nate our common inheritance of earth, air and know. While the editor of a medical journal water, and deteriorate and adulterate neces- said in one of his late numbers, "We cannot sary food and drugs, and thus bring to our expect to bring out any new theory and have firesides suffering and death in an hundred old men accept it;" that depends largely forms, and a thousand times more frequently whether the theory is too juvinal for facts and than the assassin's pistol. To protect our- logic. At fifty years men are just prepared selves and our neighbors we must compre- to give to the world the rich fruitage of their hend the methods by which death thus in- accummulated wisdom. And as the years of vades the home as we comprehend the pistol shot. We must know the causes, their modes of action, and their means of prevention. To know these we must understand the laws of

life and sanitary science. This knowledge does not come by intuition, but is acquired as other knowledge, through education. As life is the factor, without which all knowledge is useless in this world, every institution that educates should make this knowledge fundamental. And why not?

If it is the purpose of education to draw out the mind, to teach it to reason from cause to effect, and from effect to cause, and by analogy, what better field than a study of the laws of life, physical and spiritual, and of the various causes and processes that change physiological into pathological action, and the means by which they may be prevented and restored.

If it is the purpose of education to interest while it instructs, what grander field than biology?—the laws that govern our own being, following life from a simple embryonic cell, proliferating and differentiating other cells, until a million lives are bound in one, working in perfect harmony, each for all and all for each, and the investigation of the various causes and processes that disturb their harmonious action and relations.

man are three score and ten, the world is entitled to the harvest. But, alas! when the harvest is ripe how few are the reapers.

Death crowds our pathway from the cradle to the grave. The babe is scarce born before an ignorant attendant plies it with some indigestible mixture causing pain and intestinal debility, when the nourishment nature has provided is blamed for the indigestion and suffering, and the changes are wrung on "baby foods" until a "mysterious providence" takes it where "the wicked cease from troubling and the weary are at rest:" If it escapes the pitfalls of infancy, where a majority are buried before they pass their fifth year, when school life begins, with hardly a properly ventilated, warmed and lighted school building in the land, with no system of regulated exercise, and all sorts of unsanitary surroundings, it again runs the gauntlet of disease. If it again escapes and enters the college or university, with over exercise or under exercise, with injudicious stimulants, to study for the sake of success rather than for the sake of knowledge; starving the body with a "potluck" system of "batching," and too often graduating with a practical knowledge of disease, but ignorant of the causes that produced it and that abound in all our surroundings, physical, social, and even religious, and of the

means of detecting, preventing or removing show the education and legal enactments that them. With a degree, earned by a thorough shall protect against preventable disease and acquaintance with the college curriculum, but death, and secure the full development and with a broken life, and utterly ignorant of the preservation of the physical life, and the precept of Solon, gnothi seanton. What won- grandest possibilities to its immortal tennant, der that the wise man said, and that wise have been wholly neglected. men continue to repeat, "Man that is born of a woman is of few days and full of trouble. He cometh forth as a flower and is cut down. He fleeth as a shadow and continueth not."

The historian tells us "the difference in salubrity between the London of the nineteenth century and the London of the seventeenth century, is very far greater than the National education is a necessary part of difference between London in an ordinary the American system. The glory and per- season and London in cholera." Statistics petuity of free governments is in the intelli- show that during this period the average gence and morality of the people. Though length of life has been increased about fifty the institutions of America are sometimes per cent. With proper sanitary instruction slandered in the name of religion, and her in our schools and colleges, and as a legitischools denounced as "Godless" and "im-mate sequence, proper sanitary laws for the moral," the state is probably as divine in its protection of life and health, and all they reporigin as any other, whether Hebraic or Roman, and the religion of its schools as pure and uplifting.

every

resent, may we not expect that e'er the close of the twentieth century preventive medicine and surgery will well nigh cover the field of medical science, and that if men do not live to the mythological age of Methusalah, England's great Octogenarian will have many peers.

We cry

The state recognizes accountability to God, condemns profanity, promotes temperance, denounces polygamy, abolishes slavery (upheld by some churches), and says blessed are And now do we hear you say, "physician equal rights-" For He hath made of one blood heal thyself." See that medical colleges give all nations of men"-free speech and a fair full and thorough courses in scientific and ballot. It feeds the hungry, clothes the nak-practical hygiene before you insist upon other ed, and cares for those who are unable to care schools engaging in the work. for themselves. It reforms criminals, protects "peccavi," but still repeat that the average character and property, and pensions those physician considers the cure of disease his who are weak and wounded, that it might be proper field, and that school boards and legisstrong. It taxes the rich that all may be edu- latures pay little heed to the suggestions of cated, and in its schools the children of scientific sanitarians. The educator must station and religion meet upon the level, and reach the people. Only their voice is heeded/ are inspired with a patriotic regard for each or heard by the legislator; and if medical colleges fail to give efficient instruction in any other and for a common country, and taught department of medical science, they will reto do unto others as they would others should spond to the suggestions of legislators who do unto them. They are imbued with the appreciate the importance of medical educaimmutable principles of righteousness and tion and public health. truth, taught to subdue self-will and strengthen STENOSIS OF THE ESOPHAGUS.-M. H. self-control; encouraged in punctuality, perseverance and industry, and in the exercise of Secratan (Soc. Vaudais de Med., July 13, '89,) justice, obedience and order, and every com- communicated to the society that in cases of mendable virtue; and all are sought to be stenosis of the œsophagus, if the patient drank illlustrated by the living example of the a quantity of oil before the dilating bougies teacher-all this in addition to instruction in were used, the operation would be facilitated literature, art and science. So much has been to a marked degree. The operation performed in this manner has been done with great done to protect, uplift and enlarge, that many ease in cases where the bougie, thoroughly seem to think that nothing has been left un- oiled, has met with considerable resistance, done; and yet, as we have endeavored to and occasioned extreme pain.-The Satellite.

but discovered in the region of the globus of scrotal tumors, I have never met one like major of the left epididymis, and in fact involving all the epididymis and extending along the cord to the pubic bone, an enlargement indu-one side, while both sides usually are involved; its large size; but most remarkable of all was rated and almost cartilaginous to the feel. its involving the cord.