a partial implantation of the placenta, or when it only comes down to the edge of the os uteri, for, although the detachment of the placenta will increase with the dilatation, yet the flooding will be arrested by the pressure of the body of the child upon the placenta, and also saves the introduction of the hand to turn the child.

The diagnosis of placenta prævia is easily made if we bear in mind the apparently causeless hemorrhage which occurs three or four weeks prior to the commencement of labor; and the increased discharge which accompanies every pain during labor; and the detection of the placenta upon vaginal examination.

The treatment varies with the actual existence of hemorrhage, period of pregnancy, amount of attachment, and state of the os uteri. The indications in early hemorrhage is to restrain the bleeding by temporary expedients; use rest in the horizontal position in a cool room, covering the patient lightly with clothing, and give cold and acid drinks, injections of cold water and small doses of opium, and if necessary use the plug.

As several such hemorrhages are likely to occur, we should direct the patient to send for assistance immediately upon its recurrence. Some authors state that if it occurs at the sixth month nature will effect a delivery unaided; if not, it is recommended to perforate the membranes with a stilletto, and if there is only a partial attachment, rupturing the membranes and giving ergot is advised; but there is some objection to the administration of ergot, since in case version is required, it is found to be more difficult.

If we find the os dilated and the hemorrhage profuse, version must be attempted at once, but if it is not dilated, must wait until it is dilatable only. The size of the os uteri is not to be our guide, but its dilatability, for death may occur and the os uteri be but little dilated. Sometimes the placenta may prevent dilatation. Cases occurring early, say at the seventh month, the os uteri is found, not only undilated, but the cervix also is rigid and firm, Therefore, we must be guided by the amount, frequency and suddenness of the hemorrhage, and especially by its effects upon the system, and by the dilatability of the os uteri. If we find the os uteri not dilatable, we may use an alum plug applied to the os, and on this use a full tampon to the vagina, must watch the patient carefully, for hemorrhage may proceed internally. Watch the surface, countenance and pulse, and if the patient complains

of a sensation of bursting, hemorrhage is probably occurring and may become serious. The tampon is not to be left longer than twenty-four hours; must enquire into the state of the bladder olso, for the catheter may be required. We must be ready to turn on the removal of the tampon. Dewees objects to perforating the placenta, and gives his reason as follows:

First-We lose time.

Second-It augments flooding by detaching more of the pla

centa.

Third-The aperture made is too small for the fœtus.

Fourth-The opening made by the child's body will not permit the head to pass.

Fifth-This increases the hemorrhage.

Sixth-It destroys vessels on which the child's life depends. Seventh-It is sometimes impossible in central cases.

As soon as version is accomplished and the feet brought down, give ergot to hasten labor, and we may expect the hemorrhage to moderate as soon as the breech engages. We must be on the guard to secure firm contraction by pressure over the fundus, cold applications and by gradual delivery. Should the delivery of the placenta be delayed, must remove it as soon as possible.

Sometimes the hemorrhage is so profuse that the patient is greatly reduced, even to syncope. When this occurs, the bleeding is arrested for a time, but will recur again upon recovery. The danger in these cases is, that if we attempt delivery the flooding may come on again and the patient die even before a delivery can be affected. In such cases we must use stimulants freely, both externally and internally, and avoid delivery unless the hemorrhage is severe. Must wait for reaction, and as soon as flooding comes on proceed to delivery. Must be guided by the fact as to whether the syncope is caused by a sudden gush, or by dribbling hemorrhage.

Version has many advocates, among whom are some of our noblest obstretricians, and probably in the majority of cases it is our only resource. Still, there is great danger attending it, for in many instances the mother perishes before delivery can be effected.

Kinder, Wood, Radford and Simpson advocate the detachment of the placenta and leaving the delivery to nature, and support their views by the fact that the placenta is sometimes expelled before the fœtus, and, also, that in such cases the hemorrhage

ceases.

teen.

Simpson reports 141 cases; of these ten died, or one in fourBy the old practice of version the mortality is about one in three, and in 110 cases, seventy-three children were dead, or about sixty-nine per cent, and thirty-three alive, or one in three. Simpson also says that the bleeding is either diminished or ceases entirely on detaching the placenta.

The cases in which it is proposed to detach the placenta are as follows:

First-Where the hemorrhage is excessive and the os uteri undilated and undilatable.

Second-In premature labor with an undeveloped os uteri.
Third-In all cases occurring before the seventh month.
Fourth-Where the uterus is too contracted.

Fifth-Where the passage is too contracted.

Sixth-In most primiparæ.

Seventh-In cases of extreme expansion, and when the child is

dead.

Churchill objects to the extraction of the placenta, exceptFirst-In cases of extreme exhaustion, where the mother is unable to bear the shock of turning or any additional loss of blood, if the os uteri is dilated or dilatable, and the circumference of the placenta is within reach. He thinks it might be done with safety, as the hemorrhage is said to cease after the removal of the placenta, and we may give time, even if we have to resort to artificial delivery afterwards.

Second-In cases where the flooding is considerable, the presentation natural and the pains strong (the cases in which the placenta is sometimes expelled before the child), he seems to think there would be no objection to arrest the hemorrhage by the removal of the placenta and leaving the conclusion of labor to the natural powers, either alone or stimulated by galvanism.

In these two classes of cases, he thinks the results of Dr. Simpson's statistics almost exclusively apply, and he would recommend even then the utmost caution.

ARTICLE LXXXIX.

Petroleum in the Treatment of Burns. By G. J. JONES, M. D.

I was called April 8th, 1867, to see the son of our landlord, said to have been barned quite badly. I found him suffering intensely from the pain; his face presented a frightful appearance.

His hands, too, were badly burned. As he had been exposed to the air for nearly half an hour, his face was partially covered with blisters. The hair on the fore-part of the head was badly singed, and his eye-lashes were completely gone.

The lad was pouring powder out of a can, which he held in his right hand, when the whole of the powder ignited, exploding the

can.

I ordered an application of crude petroleum to the surface and ⚫ covered the hands loosely with raw cotton.

In fifteen minutes the pain had ceased, and the next morning he felt well. I gave him from the first aconite and cantharides3 in alternation every two hours.

After the expiration of seven or eight weeks there were scarcely any traces of the injury visible.

This is only one of many cases of like character in which I have used petroleum with good success.

ONONDAGA COUNTY MEDICAL SOCIETY. ARTICLE 90.-List of Officers, Delegates, Committees and Members. 91. Clinical report. A Characteristic. By R. E. BELDING, M. D.

ARTICLE XC.

List of Officers, Delegates, Committees and Members.

Officers.

Drs. Stephen Seward, President.

R. D. Rhodes, Vice-President.

R. E. Belding, Secretary and Treasurer.

G. B. Palmer, East Hamilton, Madison County.
T. W. Stowe, Fulton, Oswego County.

H. B. Fellows, Aurora, Cayuga County.

M. F. Sweeting, South Butler, Wayne County.

Members.

Drs. J. G. Bigelow, Syracuse, Onondaga County.