Missouri Botanical Garden PETER H. RAVEN LIBRARY Pagination Note: Since many of the items lack a specific page number, the page number dispiayed oniine refers to the sequentiaily created number each item was given upon cataloging the materials. 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. Botanical cm copyright reserved garde 268 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. c/^. JyL€-*^€^jf ^ , ... r. /.;=, „/. .,.-a — ^ .C J^... / / A-- 6^ 0^ 0 y^z ^.rt ' -e ^4 , -€c.,- X >*' C^. . a./. y ' N' .y-^, iV’--. -y- £> ■ ^r ■ / ( i ■'I ■n..')/t^- 1 A Jy-U jTci 4 2 3 1 xz.£R5 31 234567 89 10 Missouri Botanical cm copyright reserved garden 28i MARYLAND MEDICAL JOURNAL, system of classification, but such sub- jects as are of more importance in the author’s estimation are discussed to greater or less extent, according to individual bias. This book has re- cently been revised and enlarged by new suggestions and advanced opini- ons. Its clinical teachings have been modified to conform to the most recent views in practice. Exceptions will be taken by many to some of Dr. Hewitt’s peculiar views upon patholo- gy and treatment, but the fair minded thinker will give him credit for his sincerity and courage in defending his convictions. The American Public Health Association will hold its eighth an- nual meeting in New Orleans, com- mencing Tuesday, December yth, 1880, and ending PTiday, December loth, 1880. Papers will be presented on Abat- toirs, PLpidemics, Life Insurance in its relation to Public Health, The Storm- water question in City Sewerage, The Sanitary Engineering problems of the Mississippi River, The Hygiene of Emigrant Ships, The Prevention of Venereal Diseases, Voluntary Sani- tary Associations, etc., etc. The special questions suggested for discussion at this meeting, in addition to those connected with the papers above referred to, relate to methods of preventing the spread within a town or city — after they have once been introduced — of such contagious or spreading diseases as Diphtheria, Scarlet Fever, Yellow Fever, Measles, Small Pox, etc., and are as follows: A, — What are the best means of securing prompt and reliable informa- tion as to the presence and location of cases of such disease ? B, — What are the best means of securing isolation of the first or of single cases of such diseases, and what are the chief difficulties in secur- ing such isolation? C, — Under what circumstances is it proper to declare such diseases epi- demic in a place? D. — Under what circumstances is it proper to recommend the closure of schools on account of the prevalence of such diseases? E. — What precautions should be taken at the termination of each case as to — a. — Care and disposal of the dead ? b. — Disinfection and cleansing of the room and house? c. — Period of time at which it is safe to allow the convalescent to re- turn to school or society? Brief practical papers upon any or all of these points are earnestly re- quested, and it is hoped that those attending the meetings will come pre pared to give the results of their ex- perience upon the questions, and to make positive recommendations. Gentlemen who propose to present papers at this meeting are respect- fully requested to notify the President or Secretary of their intentions and of the title of their papers, in order that they may be assigned a proper place in the programme. By order of the Executive Commit- tee, [Signed] John S. Billings, M. D , Pres, E. H. Janes, M. D., Sec. Dr. Joseph H. Warren, of Boston, has been grandly received in London. After reading a paper before the Royal College of Surgeons, he was not only feted by several members of the pro- fession, but was given a reception by the editors and publishers of the Lancet. His new work on Hernia is nearly out of the printer’s hands. Sir Henry Thompson has accepted the dedication. It will be issued in Lon- don — and simultaneously in this coun- try, by Mr. Charles N. Thomas, of this city, — solely to subscribers. As a whole, the work promises to be of great value and attractiveness. — Med. Library Journal. Botanical cm copyright reserved garden 282 MARYLAND MEDICAL JOURNAL. MARYLAND MEDICAL JOURNAL A SEMI-MONTHLY JOURNA L OF MEDICINE & SURGERY, T. A. ASHBY, M. D., Editor. Subscription $3.00 Per Annum, in Advance. !^”Contributions, from practitioners in g-ood standing invited ; and advertisements, from reliable houses solicited. Address all business communications to J. W. BORST & CO.. Publishers, No. 9 S. Charles Street. BALTIMORE, OCTOBER 15, 1880. EDITORIAL. The Library of the Surgeon General’s Office.— This Library, lo- cated on loth street, between E and F, Washington, D. C., is a vast store house of medical knowledge. With consum- mate skill and management, over one hundred thousand volumes of medical and scientific works have been collected and filed in this library. These volumes are arranged with such perfect order and system, that within a few moments any one may be secured by the librarian, and is made ready for immediate use. No time is lost in searching through dusty shelves for any information desired, but by a few moments reference to a catalogue, provided by the librarian, the title of a book, its date of publication, number and volume are given. Re- cently an Index Catalogue has been issued by the War Department, com- piled under the direction of Dr. J. S. Billings. This catalogue will be complete in about ten volumes. The magnitude of this work may be appreciated when it is understood that volume I, of some nine hundred pages, includes only the letter A. to Berlinski. Congress appro- priated $20,000 for the preparation of the first two volumes; but this appropria- tion is entirely inadequate to complete the work, and additional aid must be rendered by the Government. This In- dex Catalogue includes not only the names of authors, but titles of original articles in books, medical journals and transactions contained in the library. It will thus appear that its value is immense to every student of medical sciences who may have occasion to make use of the library. Only a limited number of the Index Catalogue \\2iS been published, but is understood that copies maybe obtained from the Government printing office by enclosing two dollars for each volume. It frequently happens that the writer of an original article has occasion to refer to authorities which can only be found in the library of the Surgeon General’s office. It becomes a matter of necessity to visit Washington to secure the infor- mation desired, unless this catalogue is at his command. By reference to the cata- logue it may be ascertained whether a desired volume can be found in the libra- ry, and also the character of the various publications bearing upon a given sub- ject. By a most admirable arrangement at the library access to books desired for temporary reference may be obtained under a reasonable guarantee of their return by the reader, by the following handy method: A letter should be addressed to the librarian, giving the titles of books and authors, and a guar- antee of their return. The books desig- nated — if not otherwise in use — will be forwarded and deposited in some adja- cent library, where they can be examined. It will be observed that this plan will only work in cities containing large pub- lic libraries, where books are carefully guarded. However, it will often prove of great convenience to writers living at a distance from Washington. When- ever it is possible to visit the library in person, it will be found provided with conveniences for writing, and with ac- comodating and intelligent officers wil- ling to render any reasonable assistance. The great growth of medical literature, past and present, makes a library of this character an absolute necessity. The Government has liberally provided for its support; but it should be the pleasure and duty of every physician to contribute books, periodicals and transactions to an institution which guards with jealous care every donation made to it. The management of this library should be a model for the government of similar institutions throughout the coun- try. Every city, and even many small villages, can boast of one or more libra- ries containing a few hundred, or per- haps a few' thousand, volumes ; but as a rule, these books are kept with such indifi Botanical cm copyright reserved c a r D E 1 234567 89 10 Missouri Botanical copyright reserved garden .Ul- jh'- '-'I' t()ii '/// j C<.iMe, aduCc ^ I X V' ^ ‘ ^ J '• ^ rt/j^^)' l^l c < ^ i ^ ! XI 7 fH, '^•‘ >= ^'- I ;; *s. ' ir- - U 1 ! 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