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MARYLAND MEDICAL JOURNAL 
in 14). Chailly-Honore says * that 
“ obstetricians up to 1866 are agreed 
to consider malformation of the pelvis 
as a motive for the exclusion of ver- 
sion/’ and also that version should 
not be made where there is any dis- 
proportion between the head of the 
child and the pelvis of the mother. 
Spiegelberg,t perhaps the highest liv- 
ing German authority on obstetrics, 
restricts version to those cases where 
there is an unfavorable position of the 
head above the brim, preventing its 
engagement, or to inefficient pains. 
In these cases it is indicated when it 
can be performed at the proper time. 
The cases should likewise be selected. 
It is only in flat pelves that version 
should be undertaken ; in the uni- 
formly contracted pelvis it is worse 
than useless. Dr. Angus McDonald J 
states it as his opinion ‘That turning 
does not present any proved advan- 
tages to the mother over long forceps 
in cases of contracted flat pelvis, and 
is undoubtedly more dangerous to the 
child. That it is entirely unsuitable 
when the contraction is general, being 
much more dangerous t6 the mother 
than long forceps or miy of the higher 
operations'' 
The late Professor Hugh L. Hodge, 
perhaps the greatest master among 
American obstetricians, in a paper 
written just before his death, says: 
It has been said that success justifies 
the means; but how a practitioner can 
be justified, in a protracted case of de- 
livery, where the waters have long 
been evacuated and the body of the 
uterus firmly contracted upon the 
body of the child and placenta, and 
when a portion, if not the whole, of 
the presenting part has passed the 
circle of the os uteri, in attempting 
version, is inexplicable. A priori, it 
* Quoted by Wilson, Am Journal Obstetrics, 
VIII, p. 679. 
f Quoted on the authority of Dr. J. C. Reeve, 
Am. journal of Obstetrics, vol. IX, Review. 
I On the Comparative Advantages of Forceps, 
of Turning; and Premature Labor in Contracted 
Pelvis. — Obstet. Journal of Great Britain and Ire- 
land, Nov., 1873. 
would seem to be impossible. The 
uterus is firmly contracted to a com- 
paratively small size, there is no room 
for the return of the presenting part, 
and every attempt to push up the head 
and to introduce the hand must be of 
the most imminent danger to the in- 
tegrity of the vagina and uterus, and 
we know that the operation is often 
impracticable and fatal. No latent 
hope that the child might possibly be 
saved under these circumstances can 
compensate for the immense risk to 
the mother.” * 
My eighth case furnishes pretty 
strong evidence that a living child can 
not be delivered by version after the 
forceps have been fairly tried and 
failed. It was a delivery of twins. 
The first born having been delivered 
with comparative ease after perforation 
and partial evacuation of the contents 
of the cranium after failure to deliver 
by the forceps previous to the perfo* 
ration, I thought, here, if ever, was 
the case to test the merits of the ques- 
tion. Finding that after the most 
persistent efforts on my part, the 
second child also could not be deliv- 
ered with the forceps, I proceeded to 
deliver by version. Although I final- 
ly succeeded in delivering the head 
without perforating, the child perished 
before I could accomplish its delivery. 
The mother having refused to take 
chloroform, suffered much more from 
the delivery by version than from the 
.previous one by craniotomy. In two 
other cases, not included in those 
above reported, I have tried version 
after the forceps had failed. In the 
first of these, the delivery could not 
be accomplished without perforating, 
which was done by another operator. 
The mother died some hours after the 
delivery. In the second case, multi- 
para, disproportion in size of head to 
pelvic canal, the mother being an edu- 
cated German midwife, requested a 
* On Compression of tbe Foetal Head by the 
Forceps and Cephalotribe. Am. Journal of 
Obstetrics, May, 1875. 
