Page:Clinical Lectures on the Diseases of Women.djvu/24

 half inches in the conjugate. In such cases the great im- provement which is still going on is an improvement, not in diagnosis, but in our judgment of the method to be pur- sued in delivering. In such cases it has been common — indeed, it may be said to be prevalent — for students or practitioners to divide themselves into two classes, and one set to swear a belief in version as the proper mode of delivering women with deformed pelvis ; while another set believe in the forceps as the proper mode. All such judg- ments are ill-founded. They are founded upon the mea- surement of the conjugate as the criterion ; and it was and is taught extensively that according to certain minute mea- surements of the conjugate, so you should proceed to deliver a woman by podalic extraction after version, or by forceps, or by craniotomy. Such a method of judgment must be entirely given up. It is necessary nowadays, if you are to treat your patients properly, to come to each case unpre- judiced, to study it as an individual case in which there are a great many elements besides the mere measurement of the conjugate, some of them more important than any refine- ment of that measurement. Among these elements are the presence or absence of general contraction of the pelvis, the position and other relations of the head, the state of the membranes, and the state of the uterine retraction. Now I wish to point out very impressively this error, which leads a man to treat a case on the assumption that all he has to do is to measure the conjugate.

A similar defect in judgment runs through the recent writings in favour of the increased frequency of the use of the forceps in what may be called ordinary labours. In the case of deformed pelvis it is the measurement of the conju- gate that is held to be the criterion of practice — the better judgment founded on the consideration, not of one, but of all the important elements of the case, being omitted or lost. In the case of forceps, statistics, whose accuracy