thought would occasion less hemorrhage than to cut the whole of it. I then suffered all the blood to escape that I could, while the whole cavity of the abdomen was filled; and wiped away all I could before trying to remove the child.

The child lay with the back presenting to the incision, the head resting on the superior strait of the pelvis; the uterus and placenta being thus divided, the contractions of the former were rapid, and the latter soon became entirely detached. As soon as the gush of blood partially subsided, I commenced my efforts to remove the child; but the latter was uncommonly large, and the mother very fat. Having no assistance I found this part of my operation more difficult than I had anticipated. My first endeavor was to raise the child sufficiently towards the stomach to bring the head from under the pubis; but this I was unable to do by any force which appeared to me safe to exert. I then made several vain attempts to raise the breech, after which I endeavored to pass my hand around the child, and get hold of the feet, but this the patient could not endure. Thinking the danger of the mother to be very great, and believing or supposing that the child was dead from the detachment of the placenta, and considering, at all events, that a childless mother was better than a motherless child, I determined to do all I could for the preservation of the mother. Accordingly I made a transverse incision across the back of the fetus, near the upper lumbar vertebræ, and the muscles of the back being divided it formed an angle instead of the curve, by which means I was enabled easily to extract it. The placenta being entirely detached from the uterus, was at once removed, the blood carefully wiped out of the uterus, and the surrounding parts properly cleansed.

I now determined to make, if possible, some discovery in relation to the orificium uteri. I accordingly passed my hand into the uterus, and by examining carefully I found an aperture which, to the touch from within, did not seem to bear any resemblance to a natural orifice. I introduced the finger of the other hand into the vagina, and could not bring them into contact with each other. There seemed to be a kind of tube leading from the uterus to within about three-fourths of an inch of the meatus urinarius, into which I could not pass my finger at the upper extremity, to any distance, and not at all below. I then dressed the wound in the common manner, with sutures and adhesive straps, leaving about two inches of the lower extremity open.

She now lay perfectly easy and went to sleep. I kept her in one position for four days, keeping the bowels open with saline purge and injections. The lochial discharge commenced in about eight hours and continued for five days; some discharge also occurred from the open incision. That part of the wound which was closed adhered by the first intention. I suffered her to take no nourishment but weak gruel. On the seventh day I closed the lower part of the wound, but finding on the twelfth that an accumulation had taken place in the

cavity of the abdomen, I opened a small orifice from which a large quantity of black, very offensive blood and water was discharged. I then introduced a female catheter, and with a pint syringe threw in three pints of warm water with a small quantity of soap in it, and drew it back with the syringe, after the manner of a stomach pump. This I repeated six successive days, when the water which was injected ceased to be colored, and the orifice was suffered to close. The patient never complained of pain during the whole course of the cure. She commenced work in twenty-four days from the operation, and in the fifth week walked a mile and back the same day.

One circumstance I can not forbear relating. As I was syringing out the abdomen, as above mentioned, a neighboring woman standing by my side said to her, "What makes you laugh?" To which she replied, "Because it feels so queer." I looked into her face and she was laughing.

I have made a recent examination of this patient per vaginam. The condition of the vagina remains as above described, only it is now more shallow than it was when the uterus was raised into the abdomen. The whole depth of the vagina is now only two-thirds of a finger's length, the orifice, or abnormal os tincæ, would not be discovered by the most minute examiner, who was not apprised of its situation. The anterior coat of the vagina now feels like a kind of septum, passing obliquely upward from before backward, leaving, I think, about one and a half inches between it and the fourchette. I should think, if such were possible, that it is an unnaturally situated hymen. Here is as much room for others to theorize on the physiology of conception as for me. She has been married since and lived two years with a husband, during which time she tells me that she has suffered great inconvenience on account of the shallowness of the vagina, but no conception has taken place. She suffers no inconvenience from the abdominal cicatrix, it being perfectly firm.

That Richmond's case was the first of its kind in the United States is admitted by all historians. That a colored girl, aet. 14, performed a Cæsarean section on herself five years previously does not detract from Richmond's glory. Robert P. Harris mentions this curious case. It happened in Nassau, New York, in 1822. The patient, a negress, aet, 14, with a carving-knife cut through her abdominal wall and delivered herself of a child, which died shortly after. The young mother got well and was none the worse for her experience. The case reminds me of a similar one in which a colored woman was operated upon by a drunken negress. Both the mother and the child were saved. This happened in New Orleans in 1838, eleven years after Richmond's case. Between 1822 and 1870 the operation of Cæsarean section is supposed to have been done fifty-nine times in the United States. Two of these cases

occurred in Ohio, the second one being operated upon in 1840 by another one of the early graduates of the Medical College of Ohio, Dr. Cyrus Falconer, of Hamilton, Ohio. He lost the mother, but saved the child. In connection with the statistical aspect of our subject it should be remembered that the elaboration of any historical subject in medicine, especially the early medical history of this Western country, must be based on the strictest kind of historical analysis and must under no circumstances be developed in a speculative or imaginative way. Only that which can be demonstrated by unimpeachable testimony can pass as medical history. When I say that we have a record of fifty-nine cases of Cæsarean section in the United States before 1870, I do not mean that there may not have been more cases. I do, however, say that there are no cases outside of the fifty-nine mentioned that have any value as historical material. A legendary proof or hearsay evidence, especially after fifty or one hundred years, has no value whatever in a serious scientific question. Among the Negroes Cæsarean section was and is a common practice. Stanley found evidence of this in Africa, where he saw many women who had been operated upon for the relief of difficult labor. Sometimes the husband, at other times some neighboring woman, had been the operator. Most of these cases, in spite of all the unfavorable circumstances surrounding them, got and get well. I have no doubt that long before Richmond's time the blacks in Louisiana performed many a gastrohysterotomy in their own way. Harris mentions this remarkable. fact for which we have no evidence beyond the traditional legends of these people. One thing is certain, however, Richmond's case is the first recorded case in the United States the authenticity of which can not possibly be questioned. Every now and then some patriotic Kentuckian renews the old claim of priority of Cæsarean section on behalf of Ephraim McDowell. If McDowell performed a Cæsarean section before 1827 or at any time, there is no record and, therefore, no evidence of it. None of McDowell's biographers (and there are at least four of these who can be taken seriously) know anything about McDowell's reported priority in Cæsarean section. McDowell himself was a most careful and painstaking reporter of his work. That he left no record of a Cæsarean section is surely a significant fact. That none of his very able associates and assistants, like Alban Goldsmith, who died thirty-five years after McDowell, say nothing about a Cæsarean section performed by McDowell, proves that the

whole subject is a myth. Our friends in Kentucky ought to be satisfied with the proud surgical history of their State without drawing on their imagination to glorify one who is already deservedly immortal. Our brethren in the Blue Grass State can point with pardonable pride to many pioneers in medicine and surgery whose names will for all time to come spread luster on our country, Ephraim McDowell, the greatest of them all; Benjamin Winslow Dudley, one of the most marvelous lithotomists in all history; Alban Goldsmith, friend and pupil of McDowell, a brilliant surgeon and teacher; Joseph Nash McDowell, wonderful anatomist and surgeon; John Esten Cooke, a genius in clinical pathology; Samuel Brown, one of the most accomplished scholars that ever graced the medical profession of this country, and all that brilliant galaxy of men of extraordinary power who were the pride of Transylvania University in Lexington and of the old Louisville Medical Institute.

In connection with our subject it is a significant circumstance that McDowell's name is mentioned by none of the great American surgical and obstetrical writers and statisticians. Wm. P. Dewees in his writings is satisfied to reproduce the opinions of European authorities on the Cæsarean operation. Fleetwood Churchill, in his list of thirty-two cases, does not mention McDowell's name. The list includes mostly European cases. Richmond's case, however, is mentioned, although the author erroneously states that the child was saved. Chas. D. Meigs mentions but one case. It happened in 1856, the operator being J. H. Bayne, of Maryland. In this case there had taken place a rupture of the uterus and subsequent escape of the uterine contents into the peritoneal cavity. The abdomen was opened and the child removed. The patient recovered. Meigs knows nothing about McDowell's alleged Cæsarean section. Samuel D. Gross, who never tired of lauding the achievements of McDowell, does not mention a Cæsarean section, although he gives an exhaustive account of McDowell's work in every department of surgery. Ridenbaugh, author of a very pretentious Memorial Volume of McDowell, goes into painstaking detail in giving McDowell's surgical record, but does not mention a Cæsarean section. W. W. Dawson, president of the American Medical Association, in a number of addresses discusses McDowell's work, but nowhere refers to any Cæsarean section performed by McDowell. Hugh L. Hodge, in his great work on obstetrics, confines his clinical discussion of Cæsarean section to a case which in its day attracted

much attention because the most famous American surgeons and obstetricians of that time saw the case in consultation. They were Wm. Gibson, Robert P. Nancrede, and P. S. Physick, the foremost American surgeons; Thomas C. James, the celebrated accoucheur, of the University of Pennsylvania; C. D. Meigs, his famous pupil, and Wm. E. Horner, the world-renowned anatomist. The case in all statistical tables is referred to as Gibson's case. The patient passed through an embryotomy in 1831, a second embryotomy in 1833, a Cæsarean section in 1835, a second Cæsarean section in 1837. Compare the professional environment of this patient with that of the case operated upon by our John L. Richmond, a poor country doctor, who had nothing to depend upon except his knowledge, his conscience and his God. Ephraim McDowell's first case of ovariotomy was not a greater act of heroism than Richmond's case. McDowell had at least two very able assistants. He had seen the surgical work of his teacher, John Bell, and was familiar with the cases of John Lizars, who is thought by many even to-day to be the real father of ovariotomy instead of McDowell. Summing up all the evidence in connection with the priority of Cæsarean section in this country, the claim set forth by the admirers of the great Ephraim McDowell must be dismissed as being based on the flimsiest kind of hearsay evidence transmitted through lay channels. This kind of evidence at this late day is too foolish to be considered even for a moment. The distinction belongs to John L. Richmond. Palmam, qui meruit, ferat!

The case of Cæsarean section in 1827 was the climax of Richmond's career as a surgeon. When the cholera broke out in Cincinnati in 1831, he was one of the first physicians who volunteered to take care of cholera victims. He worked night and day, ministering to the sick and comforting the dying. Finally he contracted the disease himself. He recovered, but was broken in body and spirit. He sold his property and in 1834 he decided to locate in Pendleton, Indiana, with a view to recover his health. One year later he moved to Indianapolis, where he practiced medicine and preached the gospel. In 1842 he suffered an attack of apoplexy. He never regained the use of his left side. Thus disabled, he made his home with some of his children in Covington, Fountain Co., Indiana. In spite of his broken-down health, however, he never lagged in his enthusiasm in connection with all questions pertaining to the medical profession. He took great interest in all