The ordinary practitioner, however, is utterly unfitted to do a cesarean section of any kind. In large cities it is easy to find a trained surgeon to do the operation, but in small towns and in country places there is seldom any one available. The physician who chooses to practise medicine in an isolated place knows that he will almost certainly be called upon to do a cesarean section some day, and he should not take up the responsibility of the general practitioner in such a place until he is competent to do that operation when life depends upon him. This is as things should be; but unfortunately a man who is trained well enough to do major surgery will not live in a small town if he can get into a large city. The physician in any case should be able at least to make the diagnosis in time, before labor sets in, and have the woman sent to the nearest city, if possible. Dr. Bull[109] reported that he had traveled seventy-five miles to see a woman who was having severe hemorrhages at term. He found her in a log cabin, with a centrally implanted placenta (_i.e._, right across the opening of the cervix uteri), and she had had three hemorrhages before his arrival. He narcotized her, took her in a train to a hospital, delivered her by cesarean section, and saved her and the child. If he had delivered her by version in the log cabin, he would almost certainly have lost both the mother and the child. [109] _Jour. Amer. Med. Assoc._, September 30, 1916. The question of removing the uterus comes up when the uterus is infected, or as a method of sterilizing the woman to avoid the danger of a subsequent gestation. Whenever a uterus is gravely infected and a cesarean delivery is finally necessary, the infection is commonly due to ignorance or carelessness, and the physician or midwife is guilty. There should be no such business as that of the midwife who actually delivers the patient. The state should provide physicians for the poor. Even the midwife who calls herself "a practical nurse," but who is not a licensed trained nurse, is commonly a public danger, although some so-called practical nurses are better than the ordinary trained nurses.