Page:Clinical Lectures on the Diseases of Women.djvu/25

 requires consideration, are held as showing success resulting from a certain frequency of their use, and practitioners are directed to look at that frequency as a criterion of good practice — the better judgment founded on a full and careful consideration of all the particulars of each case, or of each group of cases, being again also omitted.

Although it is out of place, I shall here make one remark on using statistics in judging of the forceps practice re- ferred to. The forceps cases of a forceps enthusiast are unfairly set against those of one who rarely uses the instru- ment. I advise you to trust to Nature as far as you wisely can ; to be loth to take a case into your own comparatively ignorant and unskilful hands ; and to judge that the success which the forceps practitioner seems to have, as against leaving cases to Nature, is a fallacious appearance of success, if it be true that Nature is on the whole better than forceps. For, if a forceps practitioner delivered all his cases artifici- ally, his so-called success would be still greater, which is absurd. Practices in which the forceps is often used should be compared with practices in which the instrument is rarely used. We require more diagnostic refinement of the causes and conditions of difficult labours ; and it is a part of this diagnostic progress that I am trying to teach you to-day. This improvement will diminish the number of cases going by the name of the treatment — as forceps — and describe them less nosologically and more pathologically. No doubt it will diminish also the number of cases vaguely called inertia, or declared to be from an undiscoverable cause.

The third class of cases — the gravest cases — cases which run from two and a half inches downwards to less — have also undergone very great improvement, the improvement being in the kind of instrumental treatment, the means of carry- ing out the design of the practitioner ; not as in the former class, deciding what is to be done, but the method of doing