to attract your attention to the very important question how to make all our Medical Associations more useful in promoting the science of medicine by more complete methods of investigation, especially in directions where the coincident action of several persons in different places is essential for success.

I fully appreciate the great benefit resulting from the simple mingling of large numbers of medical men in social contact where each is made to hear constantly, whether on the street, in the hotel, or the assembly room, new suggestions, new modes of expression, and to observe the physical and mental effects of the various habits and customs of the different peoples until each one leaves the general gathering with largely increased mental activity and resources, as was so happily expressed by Sir James Paget in his address to the Congress of 1881 in London. And I appreciate in a still higher degree the benefits derived from the preparation and reading of papers by individuals and the discussion of important questions in all our assemblies.

But for reasons I have already briefly stated, I hope to see added in every permanent general medical society two standing committees one, to whom should be referred for critical examination every communication claiming to embody a new discovery in either the science or art of medicine, and the other should be in charge of devising such lines of investigation for developing additional knowledge as require the coöperation of different individuals, and perhaps societies, and of superintending their efficient execution until crowned with success.

If ten or twenty per cent. of the money paid for initiation and membership dues by the members of each society were appropriated and judiciously expended in the prosecution of such systematic and continuous investigations from year to year, it would accomplish more in advancing medical science directly and indirectly in benefiting the human race than ten times that amount would accomplish if expended in any other direction.

For it must be remembered that when money is expended for material objects, even for food, clothing, or medicine, such materials feed, clothe, relieve but one set of needy individuals, and are themselves consumed; but the expenditure of money and

time in any such a way as to develop a new fact capable of practical application, either in preventing, alleviating, or curing disease, that fact does not, like the food or medicine, perish with the using, but it becomes literally imperishable. Neither are its benefits limited to one set of individuals, but it is transmitted with the speed of lightning over the land and under the sea to every civilized people; and whatever benefits it is capable of conferring are as capable of being applied to a million as to one, and of being repeated with increasing efficiency from generation to generation.

It has been tersely and correctly stated that associated action constitutes the characteristic and predominating power of the age in which we live.

It is by associated action that education in its broadest sense, religion, and civilization have been more rapidly diffused among the masses of mankind during the present century than during any other period of the world's history.

It is by the association of capital, wielded by the associated intellects of the nineteenth century, that highways of commerce, have been opened over the valleys, through the mountains, across the deserts, and on the oceans, over some of which the material productions of the nations are borne by the resistless power of steam, and along others the products of mental action are moved with the speed of electric currents, until both time and space are so far nullified that the most distant nations have become neighbors, and the inhabitants hold daily converse with each other from opposite sides of the globe.

Indeed, it is only by means of such of these highways as have been constructed within the memory of him who addresses you, that you have been gathered in this hall from the four quarters of the earth, and through which an account of your doings may be daily transmitted to your most distant homes.

I congratulate you on the fact that the profession you represent has taken the lead of all other professions or classes of men in rendering available these grand material achievements of the age, for cultivating fraternal relations, developing and interchanging knowledge, and planning concerted action for render

ing human life every where healthier, happier, and of longer duration.

This is the Ninth Grand International Congress in regular series within little more than two decades, and let us hope that all its work will not only be done in harmony and good order, but with such results as will add much to the aggregate of human happiness through all the coming generations.

Without trespassing further on your patience, I must ask your forbearance with my own imperfect qualifications and your generous assistance in the discharge of the responsible duties you have devolved upon me.

PROLONGED

GESTATION,

FOLLOWED BY RE

TAINED PLACENTA.

BY CHARLES P. M'NABB, M. D., OF KNOXVILLE, TENN.

On the morning of June 5th, 1887, I was called to attend Mrs. G—— in labor; age 29 years; the mother of five children. The messenger stated that the child was born when he left home, four and a half miles distant, but the request was to hurry. Accordingly, after a brisk horseback ride of forty minutes, I found myself at the bedside of the patient. The friends present said the child had been born one and a half hours, and during all of this time the patient was having very hard expulsive pains at very short intervals, which, together with the size and shape of the abdominal enlargement, led them to think there was another child in utero. And indeed my first impression, when I observed the character of the pains that were following rapidly one after another, was that there was another child in mal-position. However, a vaginal examination showed the true condition of things The placenta had not descended, the cord was full and warm, showing the placenta to be still adherent. Passing the finger

well up through the cervix revealed a large placental mass firmly adherent, presumably for its whole extent, as no blood had es

caped so far; however, slight effort on my part to pass the finger around the edge of the mass, thereby to hook it down, resulted in partial separation and furious hoemorrhage. I now made as firm traction upon the loosened portion, while also making firm external pressure, as I felt safe in doing; but the mass would not descend. I gave Squibbs' Fl. Ext. Ergot, 2 drachms, and passed my hand on into the uterine cavity and detached the remaining portion as rapidly as possible.

In the process of peeling off the mass the finger encountered a number, perhaps ten or a dozen, of firm, disseminated bands of attachment, that imparted to the touch a sensation very like that of those found as a result of inflammation of the serous membranes.

It is upon account of this feature and its probable cause that I have reported the case.

These bands were tough, thin, and narrow, and strange as it first appeared to me, were about one inch long. They were constricted in the middle to about one-eighth of an inch in width, and not much thicker than common note paper. A finger nail that projected well beyond the palp would doubtless have snipped them off, but I had to pass my finger around each one separately and break them loose by a pretty strong pull, and very one of them broke loose at the placental extremity, leaving a very small plug of placental tissue attached by them to the uterine wall. I can account for their length only by supposing that one extremity was attached to the interstices between the lobules of the placenta, and when the remainder of the mass was peeled off these were put on the stretch, hence the appearance of a constricted middle.

As to the probable cause, it will be necessary to go back and glance over the history of her gestation to establish a conclusion. Her last menses appeared June 10, 1886; morning sickness and vomiting about 10th of August; quickening occurred November 10; patient was calculating her confinement for the 10th of March, 1887. Everything went along smoothly with her until March 1, when she sickened with febrile symptoms; nausea, vomiting and severe pain in the back and limbs, followed in a few hours by

pains simulating labor, and extreme soreness over the fundus and body of the womb.

My diagnosis was an inflammation involving the placental site, which I feared would produce serious adhesions, and I so expressed myself to the husband at the time. There was no tenderness of the abdominal parietes, neither was there trouble in the bowels; but pressure directly over the fundus uteri produced agonizing pain. The constitutional symptoms were not grave enough for uterine phlebitis, and there were no objective signs of syphilis. The patient had only miscarried once in six pregnancies. However the placenta showed traces of inflammatory action over something near two-thirds of its surface, looking as if it had been hardened in alcohol, more solid, less friable, and heavier than normal; while the child had an old, pinched, or starved appearance.

Now, then, was this one of the many phases of constitutional syphilis? If so there were no visible signs of it, and so far as the patient and her husband are concerned, they are both above suspicion. Upon that account I am somewhat disposed to regard it as of rheumatic origin. Did the placental adhesion prolong the period of gestation? If so, does it not bear witness to the correctness of Sir John Simpson's theory, "that labor is caused by a normal disintegration and detachment of the decidua serotina at or about the ninth month of gestation?"

Naturally the question arises, When did she conceive? From the previous history there is small doubt in my mind but that she conceived early in July, just before the appearance of her menses, which therefore did not appear, and that the period of gestation was prolonged from nine to about eleven months, and that it was the result of inflammatory adhesion of the placenta interfering with or preventing certain structural changes that should have occurred in the membranes at or about the ninth month of gestation, whereby labor is brought about.

A great deal of blood was lost during the very few minutes required to complete the delivery, and we were sore afraid lest the prostration then apparent, and the further loss of blood to be apprehended on account of the retained placental debris, should