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say will never progress one iota from the old systems of practice, but the BRIEF will teach progression to all who read it, and I have no other journal that I think as much of as the MEDICAL BRIEF-it is the best medical journal in existence.

I think that Dr. McCarty has expressed a bold and positive opinion in relation to the removal of the placenta, and I hope that all who have profited by his advice may continue to practice the same in defiance of the old fogy opinions and writings of past defunct systems of practice, and thereby save the lives of numerous mothers of children.

Would to God we had more men

who were willing to cast old fogyism in the shade and come squarely out on principle, instead of adhering to the unsuccessful and dangerous practices of the past. We live in an age of progress, and should each and every one do his utmost to improve the time in instructing the young men in ideas. of advancement, instead of following in the rut made by our predecessors. They would be more successful as practitioners.

I am of opinion that the parties to whom reference is made by Dr. Livezey will not be very apt to turn over in their coffins on account of the straying off of some of our number from the old pathway which caused so many deaths for want of immediate removal of the placenta.

I will assert, right here, that there have been seven lives lost for want of

quick action for the removal of the placenta to one done prematurely. I, for one, never had to regret premature action in the removal of the afterbirth; but am sorry to say I have lost two by delay, but will never be guilty of doing so again.

I have taken the BRIEF for only a few months, and will say that I have

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As to Dr. Livezey's manner of delivering the placenta, would say that Dr. McCarty, in his reply, has stated fully the manner I have almost invariably adopted for over forty years.

In this time I have delivered over one thousand, and never waited a minute. In not a single case have I had flooding, laceration, etc., as the result; but often, indeed, I verily believe, saved the life of my patient by this outrageous (!) act.

One instance, a few days since. The labor proceeded all right; nothing unusual till the end of second stage. Before I could tie and sever the cord, there was such a rush of blood that I verily believed the patient would not survive five minutes. I immediately introduced my hand and found the placenta firmly attached. I broke down the adhesion, pulled down the placenta, the womb immediately contracted, and the patient was safe.

In this case, would Dr. L. have waited for nature? I think not.

I will, while on this subject, state that during my obstetrical practice I have never used instruments in a single case, and have had shoulder, arm, breech and foot presentations. In my humble opinion. the use of instruments is very seldom necessary-patient and nature, with a little help, will do the work.

Timpson, Tex. A. H. WILSON, M. D.

I desire to come to Dr. McCarty's relief in regard to early delivery of the placenta. I never wait longer than to tie and to cut the cord. I give the babe to some one to dress, and then turn my attention to the mother. I do not follow Dr. McC. in every

particular, but take hold of the cord with my right hand and place my left over the fundus, press gently, and at the same time knead the fundus, making slight traction on the cord. By these means, I generally succeed in bringing the placenta away. Should I fail by the above means, I then oil my hand and introduce it into the womb, sweep it around to see if there are any attachments, and, if so, I break them up, allowing the placenta to precede my hand, at the same time. kneading the fundus with my left hand to act as an additional stimulus to cause the womb to contract. I have had no reason to change my practice. I have been practicing five years; have delivered fifty cases, which is a reasonable amount for a country doctor.

The only case I ever had any trouble with was one that was attended by an "old granny," who, after the child was born, failing to get the placenta in the usual way, tied the cord to the woman's leg, and sent for me in haste; and it was well she did, for the woman was almost cadaverous from the loss of blood. There was no time to be lost, so I oiled my hand and introduced it into the womb, and found the placenta detached all but about two or three inches at one edge; the other side, falling down, stopped up the mouth of the womb, and hence, you see the danger she was in. I gave ergot, used cold water on the bowels, and gave small toddies, but it was several hours before I could bring

about a reaction.

Would Dr. Livezey have waited until the womb expelled the placenta? I hope not.

The women in the country have the notion that to let the placenta remain is very dangerous-that is, for nature to expel-consequently, they are very uneasy until it is expelled. We all

know what effect the mind has over the nervous system. When the mind is ill at ease, it tends to relax the system, and hence the necessity of delivering the placenta as early as possible, to relieve the mind and give nature a chance to come to her rescue. I do not think she has anything to lose, but, on the contrary, everything to gain. J. M. BOLGER, M. D. Magnolia, Ark.

I have read with much interest the controversy between Drs. Livezey and McCarty, and wish to add my experience. I have been in the practice of medicine nearly six years. In that time I have delivered over three hundred women of children. I have never had a case of "hour-glass contraction," but one case of adherent placenta, and two of serious flooding. My method is to give, at the commencement of the second stage of labor in multiparæ, a full dose of fl. ext. ergot, and, at the end of this stage, another dose. After severing the cord, I take it in my right hand, and with my left grasp the uterus firmly, and express placenta after the method of Playfair. I use Playfair. I use no traction on the cord, but only hold it extended sufficiently to tell when the placenta is expelled. Never, under any circumstances, introduce the hand into the uterus, except to deliver retained placenta, either adherent or from hourglass contraction. I consider such a proceeding barbarous. I have never had any difficulty in delivering placentæ by this method, and by it not only save the patient much mortification, but much intense suffering too. "Where a child's head can pass, a man's hand can not pass without much pain."

In primiparæ I never use ergot until the expulsion of the head. If Dr. M. will read Playfair on the third

stage, he will keep his hand outside of the uterus in the future, I think.

My patients are seldom troubled. with "after-pains," which I think is a result of my method of delivery.

the head of malpractice. Credé's method, in the majority of instances, answers much better; and if I were on a jury, and a physician should be sued for malpractice, I would certainly give a verdict for the plaintiff and for full amount sued for. Forcing the hand into the uterus is vile and unscientific in the extreme, and inex

Meddlesome midwifery is the opprobrium of the profession. When nature can't do, then assist her-and not till then. With best wishes for the BRIEF, I cusable as well. will close.

LUTHER CARTLEDGE, M. D.

Fairplay, Ark.

New York City. L. G. DOANE, M. D.

I wish to state that for twenty-seven years I have followed the teachings of my honored preceptor, Dr. D. W. Brickell, of New Orleans, whose maxim was, as soon as the cord was cut and the child handed to the nurse, to deliver the placenta. I have never had cause to regret this practice.

In reply to your request as to whether I, as one of your readers, promptly deliver the placenta, or wait as Dr. Livezey suggests, would say that when the head is delivered, I administer one drachm fl. ext. ergot. When the child has been delivered and the cord severed, I turn the babe Lexington, Miss. over to somebody, and proceed at once to gently deliver the placenta. Have never had any trouble liable to accompany labor.

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For twenty-five years I have almost invariably delivered the placenta as soon as the child was born, and have never had any unpleasant sequelæ. In a few cases I have had serious hemorrhage to occur, when I arrived after the birth of the child, and found the placenta undelivered. I, therefore, believe that prompt delivery of

the afterbirth is the correct method.
I also believe that every judicious
physician knows how to deliver the
placenta-gently, and without lacer-
ating, tearing or producing hemor
rhage.
J. W. RITCHIE, M. D.

White Mound, Tex.

G. C. PHILLIPS, M. D.

I, for one, heartily concur in the mode spoken of by Dr. McCarty, of immediately delivering the placenta. For it can be done without causing the patient much pain or uneasiness, and, should there be adhesions, then you know just how you must proceed. By practicing this mode of delivering the placenta, I am satisfied that I have averted some otherwise bad sequelæ. T. N. WILLIS, M. D. Finchville, Ky.

Concerning the delivery of placenta, I will state that I always, as soon as child is born, try by gentle traction on the cord and by a grasping motion over the fundus, to deliver the placenta. I take good care that the womb contracts firmly, and succeed in getting away the placenta always in

from five to ten minutes after birth of child. In my fifteen years' practice, I never had flooding from this cause. I seldom use ergot.

I should like to enter a protest against the forcible extraction of the placenta in labor cases. I fully believe that such practice comes under Covington, Ky.

A. KNOLLMANN, M. D.

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As regards my views in reference to prompt delivery of placenta, I have done this kind of practice for twenty years, and my custom is to deliver it promptly, and do not wait, and have never had cause to regret this practice. If either attached or detached, I find this by far the safest mode. It has performed its function and is now a foreign body-why wait? "Delays are dangerous." Deliver the placenta at once, gently, and see that the womb. contracts. JAMES A. GOSLIN, M. D. Springfield, Mo.

In compliance with your request in October BRIEF, would say: I deliver immediately. Do so, though, without introducing the hand. Have tried both. ways, and immeasurably prefer delivery at once. Submitted without argument. LYNN W. HENDERSHOTT, M. D. Mill Shoals, Ill.

As per your request in BRIEF for October, "as to whether we deliver the placenta promptly, or as Dr. Live

zey suggests," I will report my mode of procedure: As soon as the head of child is born, I give a drachm of fl. ext. ergot, and as soon as child is born and breathes, I tie and cut cord, turn child over to the nurse, and at once attend to the mother by placing one hand over the fundus of the uterus, and kneading it gently until the placenta and membranes are expelled into the vagina, then remove them with my right hand. If, after kneading the fundus for twenty minutes and the contractions are good, the placenta has not been expelled, I introduce my hand into the womb and gently loosen the placenta from its attachments. I never had a case of flooding.

I would ask, through the BRIEF, if others put a band on the child? I never do, and know of but one other doctor in this country who does not. Leave the band off in the future, and you will be pleased. Your patients will praise you, and the little innocents would, too, if they could speak. Here, even the old midwives are

adopting my plan, and they think they know more than any doctor about lying-in women and babies.

A. D. MCCABE, M. D.

Medina City, Tex.

On receipt of the October BRIEF, I noticed a somewhat plain statement by an apparent young physician (they always make plain statements) in reply to an older practitioner, which interested me considerably. And, inasmuch as a request was kindly made for any member of the profession who might have read the discussion to give his experience pro or con, I ask permission to give my limited experience in this one class of cases.

I refer to the Dr. Livezey-McCartyGriffin discussion, concerning the immediate delivery of placenta and use of ergot.

My obstetrical treatment is as follows: After carefully making my examination and finding presentation proper and all right, I await natural developments. After second stage of labor sets in and is lagging slowly along, I at once, and with a perfectly free and easy conscience, administer a dose of ergot infus. (the infusion, from the fact that I have been left in the lurch once or twice with an inferior article of fl. ext.). When labor progresses, as a rule, finely, or if second administration in twenty or thirty minutes is necessary, I give it as freely as the first. When the child is born, I ligate the cord and sever, same (always using my own ligature, heavy silk, and my own funis scissors) and hand the child into the hands of the nurse to wash. Then I at once proceed to deliver the afterbirth, as does my friend, Dr. McCarty. First, I make "gentle" traction on the cord, and if I find it does not yield, I take cord in left hand and introduce one or two fingers, as the case may be, and gently sweep around placenta and break up any adhesions that may exist, and have time to remove my hand when the placenta follows. After which I compress lightly with hand over fundus of uterus, and at same time ask some one present to give patient another dose of the infusion, about two or three tablespoonfuls. When the womb contracts finely and perfectly safe, I cleanse my hands and bandage the mother, and then turn my attention to the child and see it properly bandaged and that the cord is properly tied. As I do all such work under cover, I never expose the person of my patient.

If the placenta, on the other hand, has grown so fast that an ordinary sweeping of the fingers does not loosen it, I introduce my whole hand and loosen where it may be attached.

When I get the whole placenta at once, in such a case, I again introduce my hand and remove any large blood-clots that may have formed after delivery of child. Then my patient rests easy so far as severe after-pains are concerned.

I have adopted this practice from the start, and do so yet, and propose to continue until convinced from some better reason than has yet presented itself that I am doing an injury. I have handled over seventy child-bed cases in three and one-half years, and have my first hemorrhage, laceration (except such as fanchette), involution or inversion, hour-glass contraction, or any other complication that Dr. Livezey may be pleased to name, to follow. I never, in my practice of obstetrics, have lost a patient, never had one to have half a degree of fever or anything, and I am no scientist, either-only a young country practitioner, in practice about nine years. I endeavor, in all cases, to "keep my head," as the saying is, and use common sense; and I think this will win very often where so much over-scientific practice often fails.

By introducing the hand immediately, if necessary, and removing af terbirth, it gives the patient an incalculably less amount of pain, as the parts are yet thoroughly relaxed, not yet having overcome the necessary shock, and the parts are benumbedif you will allow the expression-and not so sensitive to touch.

One more remark: I am an advocate of carbolic acid in ALL labor cases, dropping the clear fluid on each napkin put to patient, and using it in the water each time a bath is taken.

I would say to Dr. McCarty, we will keep on in our old channel until convinced that the new one is better, but stronger argument will first have to be presented.

Trenton, O. H. SCHOENFELD, M. D.

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