kARVtANb medical JOURNAL 267 
Sumed from time to time, not one of 
these dangers will be encountered. 
To what strange use statistics may 
be put, is illustrated in a paper pub- 
lished by Dr. Harold Williams, of 
Boston,* in which he furnished statis- 
tics, proving to his satisfaction, “ That 
the high forceps operation should be 
undertaken with the greatest hesitation, 
inasmuch as its results to the mother 
are more fatal than Caesarean sec- 
tion.” This is another proof of the 
utter unreliability of statistics of 
operations collected at random from 
the journals, leaving the compli- „ 
cations, time of performance and 
relative skill of the operators out 
of account. How much the dangers 
of the forceps operation are here ex- 
aggerated, will appear when we con- 
sider that the eighteen cases above 
reported constitute only the worst 
cases that I have encountered, and 
that after an hour’s faithful tugging at 
the forceps the risks of craniotomy, 
and in two of them the dangers of ver- 
sion were added without losing a 
single mother. In the light of this 
experience, I am forced to say, at the 
risk of appearing dogmatic, that if the 
high forceps operation becomes dang- 
erous to the mother, it is either a rare 
accident, or it is the fault of the ope- 
rator. In most cases of this operation 
ending fatally, this result should be 
attributed to the long delay and the 
previous use of ergot. If ergot had. 
not been given, and the forceps had 
been earlier applied, the mother’s parts 
would not have become so hot, dry 
and adhesive as I have generally found 
them, and the probability is that in all 
those cases where the disproportion 
was small the delivery might have 
been effected without the use of the 
perforator. In a case of shoulder- 
presentation to which I was called at 
‘The eleventh hour” the stickiness of 
the maternal and foetal surfaces was so 
great that after I had brought down the 
feet and fastened strong bandages to 
*Am. Journ. Obst,^ Jan., 1879. 
them, it required my full strength and 
that of the midwife in attendance to 
deliver the hips and body of the child, 
although there was no narrowing of 
the pelvis. 
The other side of the question is 
strongly advocated by Byford, of Chi- 
cago ; Matthews Duncan, of London; 
Depaul, of Paris ; Ellwood Wilson, of 
Philadelphia, and many other high 
authorities, McClintock, of Dublin, is 
opposed to version, and in favor of 
head-first delivery in contracted pelvis. 
Fleetwood Churchill* says that in a 
pelvis of 3.25" in the conjugate diam- 
eter, turning is unnecessary, as a living 
child may be delivered through it 
either with or without the forceps. If 
the conjugate is less than 2.75" turn- 
ing is unjustifiable, as a living child 
cannot be extracted. The limits of 
the operation then, are when the 
antero-posterior diameter is between 
2.75" and 3.25". Barnesf says that 
in cases where the antero-posterior 
diameter is less than 3." turning is 
not to be tried. 
LeishmanJ says that “when the 
conjugate diameter is less than three 
inches, to attempt to turn would be 
to subject the woman to needless risk, 
while we may be confident that nothing 
but failure would attend our efforts.” 
He also says, that delivery with the 
forceps is a safer operation to the 
mother than turning. Cazeaux states 
that when version is performed in a pel- 
vis of three, or less than three inches, 
the result is almost always fatal to the 
child. Capuron affirms that the fa- 
tality to the children delivered by 
podalic version in contracted pelvis 
amounts to 70 or 75 per cent. This 
is endorsed by Cazeaux. Version is 
fatal to the mother according to Ca- 
zeaux in about ten per cent, of the 
cases, (i in loj^) while the statistics 
of Churchill place it at 7 per cent, (i 
♦Theory and Practice of Midwifery, Ed. of 
1866. 
\Med, Times and Gazette^ Sept., 1868. 
:j: System of Midwifery, Am. Edition, p. 520-1. 
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