Page:Clinical Lectures on the Diseases of Women.djvu/34

 from any increasing deformity, and simply from the powers of labour being less as pregnancies increase in number — a well-known fact.

I go back to repeat what I said when I was speaking of the second class of deformed pelvis, that the measurement of the pelvis, and especially the measurement of the con- jugate, even if accurately made, is not the criterion of the mode of delivery to be adopted at the full time, or if pre- mature labour is induced. In the same woman, conditions may vary in different labours ; and, in different cases of the same dimension, conditions may vary, so that at one time perforation may be the right operation, and at another time turning may be the right operation ; and I may state to you that turning, or rather delivery by podalic extraction after turning, is not to be resorted to unless you have a rational prospect of getting a living child. If your delivery by turning ends in the birth of a dead child it is, to a con- siderable extent, a failure ; it would have been better to perforate — safer for the woman. You may not justly condemn your practice retrospectively. Nevertheless, it is a fact that you would not choose to turn a dead child ; and if you turn a living one, and do not extract it alive, your opera- tion is partly a failure j perforation would have been better.

You may use the forceps, and you can easily understand that not only may the forceps be used in one instance in the same woman, where in another instance turning is the right operation but you may be pretty sure that as the forceps is the operation most used in the slightest cases, so it will be the most frequent operation : you will more fre- quently have recourse to the forceps than to podalic extraction after version : but that frequency is nothing at all in favour of the forceps as an operation in jealous rivalry with version. There is no just occasion for any rivalry. Every case must be judged of on its own merits, the whole particulars being taken into consideration.