J. WHITRIDGE WILLIAMS 195 



pelvis lay in the use of high forceps, or craniotomy, if the 

 former proved unsuccessful. In the latter operation the child 

 was always sacrificed, while in difficult high forceps operations 

 the employment of great force was sometimes necessary, with 

 the result that the mother was sometimes seriously injured and 

 the child born dead, or so injured during delivery as to succumb 

 later. 



At present the trained obstetrician is expected to detect the 

 existence of disproportion before the onset of labor and to gauge 

 his conduct accordingly. If the disproportion is pronounced 

 Caesarean section should be performed at an appointed time, 

 whereby all of the children and 98 per cent, of the mothers will 

 be saved. On the other hand, in less marked degrees the 

 patient should be allowed to go into labor and be watched in 

 order to determine what Nature can do, when 75-80 per cent, 

 of the labors will end spontaneously, while the remainder will 

 require operative interference. Formerly, high forceps were em- 

 ployed in the latter category of cases, but are now replaced by 

 pubiotomy or Caesarean section if necessary. 



The more radical operations are undertaken in the interest of 

 the child, and many are now saved which previously perished. 

 My experience shows that the greater saving of foetal life is 

 not accomplished at the expense of the mother, as in my hands the 

 maternal mortality has been decreased by one half by the em- 

 ployment of such measures. 



(b). Restriction of destructive operations: In times past 

 craniotomy was resorted to whenever delivery could not be 

 accomplished by means of high forceps or version. With the 

 development of the line of treatment just outlined the employ- 

 ment of destructive operations has been greatly restricted; 

 and most obstetricians now hold that craniotomy is unjustifiable 

 except when the child is already dead, and even those less radical 

 consider that it should be reserved for most unusual emergen- 

 cies. 



At present one may gauge the excellence of an obstetrician by 

 the stand he takes upon the subject; as the better his training, 

 the fewer craniotomies will he perform. This restriction has 

 resulted in saving many foetal lives, and represents one of the 

 great advances in modern obstetrics. 



(c). Use of lying-in hospitals: In large cities a great saving 

 of both foetal and maternal life may be effected by educating 

 the poor to make more extensive use of the lying-in hospitals and 

 obstetrical. charities, instead of relying upon the services of poorly 

 trained doctors or ignorant midwives. The well conducted 

 lying-in hospital has lost the ill repute which it enjoyed in pre- 



