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488 


PROGRESS OF MEDICAL SCIENCE. 


this method has advantages, it is not to be relied upon Bolely. Ahlfeld pre¬ 
fers to estimate carefully the period of gestation, measure the length of the 
foetal body within the womb, to compute the length and weight of the foetus, 
and to combine these data with those given by palpation. It is also to be 
remembered that a foetal head which cannot be pressed downward into the 
pelvis can be brought through after version, the breech preceding. 

The Use of Forceps as Practised ix the Prague Obstetric Clinic. 

Shick ( MonaUschrifl fur Qtburt&hufe und Qyndkologie, Band i. Heft 6) 
gives the results of the U3e of forceps in 2920 labors. Birth was completed 
by forceps in 3.63 per cent, of cases. The majority of the cases were primi- 
paral, between twenty and thirty years old. In 60 per cent of cases the 
mother was lacerated. The maternal mortality was 4.7 per cent., while 11.32 
per cent of children perished. Of the mothers, 1.8 per cent had septic infec¬ 
tion. The conclusion reached from comparing the use of forceps with other 
methods of delivery is that the forceps is the bloodiest method of delivery, 
and that its mortality-rate renders it a serious procedure for mother and 
child. Other means of accomplishing delivery should be exhausted before 
recourse is had to the forceps. 

The Conduct of Normal Labor by External Examination Only. 

Leopold and Orb (Arehiv fur Qyndkologie, Band xlix. Heft 2) report the 
results of the conduct of normal labor by external examination only in 1000 
cases. Errors in diagnosis occurred in 65 (6.5 per cent.). Fifty-four of these 
were in occipital presentation, 2 in brow, 2 in breech, 1 in twin gestation; 
while in 6 cases of face-presentation an error was made in diagnosticating 
the entire number. In 168 cases contracted pelvis was diagnosticated. The 
writers show by statistical comparison of series of cases that palpation may 
be relied upon to determine a most important point—namely, the presence 
or absence of descent of the fetus into the pelvis. 

The Vaginal Secretion of Newborn Infants. 

In the ZeiUchrift fur Qcburlthulfe und Qyndkologie, Band xxii. Heft 3, 
Vahle gives the results of his examination of the vaginal secretion of new¬ 
born infants to determine the presence or absence of bacteria. He finds that 
for twelve hours after birth the vulva and vagina are sterile. From this 
time until the third day germs are occasionally found, and after the third 
day they are present in most cases. In 4 per cent of cases staphylococci 
were discovered, while in 14.6 per cent streptococci were isolated. 

Intrauterine Infection with Typhoid. 

Freund and Levy ( Berliner klinieche Wochenschrifl , 1895, No. 25) report 
the case of a mnltigravida who was admitted to the hospital in the eighth day 
of typhoid, being five months pregnant. She progressed favorably until the 
fourth weet, the temperature being but slightly elevated. Without apparent 
cause she expelled a living fetus, which soon perished. Her temperature 



OBSTETRICS. 


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rose daring labor, but fell immediately afterward. The fcetuB and placenta 
were received in sterile glass vessels, and an examination made of the spleen, 
blood of the heart, and placenta twenty minutes after birth. No gross lesions 
were found. Typhoid bacilli developed, however, after incubation. An old 
endometritis was present in the mother, who Bpeedily recovered. 

The case is a remarkable demonstration of the direct passage of infection 
from mother to child, without anatomical lesions. 

A Case op Long Retention of an Ovum in the Uterus. 

Obloff reports in the Pragcr mcdicinischc Wochenschrift, 1895, No. 22, an 
interesting case from the obstetrical clinic at St. Petersburg. The patient 
had borne ten children and came to the clinic with a history of icterus and 
vomiting of blood. There was also enlargement of the abdomen, and punc¬ 
ture was made to relieve the pressure-symptoms. A diagnosis was made of 
cirrhosis of the liver, with intestinal hemorrhage. The patient shortly after¬ 
ward died, and upon post-mortem examination an impregnated ovum was 
found lying in the right horn of the uterus. The ovum had ruptured, and 
only the chorial sac remained. So far as the history and appearance of the 
tissues indicated the ovum had remained for more than a year within the 
uterus. 

The Choice of Cesarean Section, Symphysiotomy, and Induction 
of Labor. 

Tarnier, in La Prase Medicate , July 20,1895, describes in a clinical lec¬ 
ture a case of symphysiotomy in which the antero-posterior diameter of the 
pelvis was less than 8 cm. 

He reviews the results obtained by induced labor, and finds that in pelves 
whose antero-posterior diameter ranges from cm. to 8^ cm., in thirty 
cases, he had no maternal mortality, but 40 per cent infantile death-rate. In 
forty-nine cases in which the same diameter measured from 8^ to 9^y cm. 
there was no maternal mortality, with 20^ per cent infantile mortality. 
In his third series of seventeen cases in pelves whose antero-posterior diam¬ 
eter measured from 9^ to 11 cm. he had no maternal mortality, but an 
infantile death-rate of 29^fr per cent. He calls attention to the fact that 
fhe mortality-rate of children is les3 in the middle range of pelvic contrac¬ 
tion, because pregnancy is interrupted in these cases after the end of the 
eighth month, at a time when the foetus is well developed. The high mor¬ 
tality among children in the third series of larger pelves occurs because these 
patients call aid too late, when the child has become too large to pass favor¬ 
ably through the pelvis. 

In comparing the results of induced labor and symphysiotomy one finds 
that in classes of cases in which interference is practised most often, namely, 
in those in which the antero-posterior diameter of the pelvis is between 8& 
and 9& cm., that the total mortality-rate of mothers and children in 200 
cases was 20^ ff per cent, while the best statistics of symphysiotomy give a 
mortality-rate of mothers and children of 33 for 200 cases. 

Pinard’s statistics give a total of 18^,V per cent, mortality-rate for 200 
cases after symphysiotomy. The difference, however, between the results of