X, B, 6 Calderon: Tropical Obstetrical Problems 379 
We have had 4 per cent of placenta previa, as against 1 per 
cent of eclampsia, which shows that placenta previa is more 
frequent in this country than eclampsia, a fact which is just 
the opposite to what I have observed in several clinics of France 
and America, where eclampsia seems to be more frequent than 
placenta previa. Placenta previa occurs in the majority of 
cases in multiparz, and the reason why it is common in this 
country is, to my mind, due to the defective management of 
previous labors which almost always give rise to many kinds 
of uterine diseases and displacements which favor defective 
implantation of the placenta during the development of the 
foetus. 
In regard:-to puerperal infection we have 3 per cent, which 
is not high, due to the fact that we had practically no cases 
with puerperal infection except those brought from outside, 
who came after they had already been infected, either during 
a prolonged labor attended by midwives and friends, or during 
the puerperium. In the hospital parturient women who come 
before or at the onset of labor do not develop puerperal infection, 
as a rule, and those who become infected develop only a mild 
type of infection. 
The great majority of forceps applications has been for inertia 
of the uterus and in a few cases of contracted pelvis. Podalic 
version is resorted to in all cases of transverse presentation when 
the foetus is alive and, also, when the fcetal head is high and not 
engaged in the pelvic inlet. We found from experience, how- 
ever, that podalic version is not always a safe procedure in cases 
of transverse presentation, as when version is made several hours 
after the rupture of the amniotic sac, and the foetus is already 
dead, there is almost always danger of rupturing the lower seg- 
ment of the uterus, leading to postpartum hemorrhage, perito- 
nitis, or infection. For this reason we have made it a rule in our 
practice in the hospital to resort to embryotomy in all cases of 
neglected transverse presentation—that is, when the uterine 
cavity is already drained of its amniotic fluid and the fcetus is 
dead. Also, in prolonged labors due to contracted pelvis, or 
large foetal head, instead of applying forceps and other measures, 
we perform craniotomy as soon as we determine that the foetus 
is dead. We have performed Cesarean section in all cases, 
except one, on women with placenta previa, the exception being 
a case of intrapartum eclampsia in a primigravida. In this case 
Cesarean section was the best way to extract the foetus, as the 
cervix was not dilated and rapid delivery was indicated. The 
