ABUSE OF THE OBSTETRIC FORCEPS.

BY L. G. HARDMAN, M. D., HARMONY GROVE, GA.

Thinking perhaps that no one ever had such an experience in the misuse of the obstetric forceps, as I will now present, is the reason for consuming your valuable time in the consideration of this paper.

Not but a short time since I was called in consultation to see a case of labor in a primipara of about thirty-five years of age. Soon after my arrival I made an examination per vagina and found the os uteri not well dilated, or completely; head high up, in superior straight. The lips of the os could be felt, and part of the head projecting through, which was soft and fluctuating, as though no bony material covered it, and around the margin of the soft mass was a rough edge, showing evidently that part of the cap of the skull had been removed and leaving only the membranes to hold the brain intact. The pains were coming on regular, and of medium strength; pulse good; diameters of the pelvis all right; patient in good condition generally. On retiring for consultation, the physician stated that the woman had been in labor some eighteen or twenty hours, and after she had progressed for some six hours he found the cord prolapsed, at which time he ruptured the membrane and applied the forceps. The instrument which he used was a short, straight forcep, which was pressed upon sufficiently to get hold of the head to bite or crush the top of the skull and remove part of the frontal and parietal bones.

Woman of good

Now the condition of our patient was: strength; normal pelvis pains coming on regularly; of medium strength; child not unusually large; os not well dilated; child dead.

What shall I do? I advised the physician to let her have her pains for several hours, or if anything developed which would require immediate interference, then it would be time enough. Had the os been well dilated I do not believe the forceps could have been used at this degree of advancement, because the membranes of the brain would have ruptured and the brain discharged and cranium collapsed and forcep slipped off; but other instruments could have been used, but not well, or as I believe, better for the patient. I went away and returned in seven hours and found the patient in very good condition, with considerable advancement of the fetus. I washed out the vagina with a solution of bichloride, and etherized the patient, applied the forceps, and delivered in a few minutes. The membrane ruptured and brain discharged and the head collapsed, but the advancement was far enough, so that the delivery was accomplished without any trouble; child was well developed; mother made a good recovery.

OVARIAN TUMOR WITH APPARENTLY A DOUBLE

PEDICLE-OPERATION, ETC.

BY K. P. MOORE, M. D., MACON, GA.

First saw Mrs. G., a widow with no children, age forty-six, on the 8th of July, 1888. She had during the previous night, slight chill, temperature now 103, pulse, 130. Considerable pain and tenderness in lower part of abdomen, especially on right.

Early in May, 1888, she felt some discomfort in the right iliac fossa, and by accident discovered a tumor about the size of a small orange. Its rapid growth gave her some solicitude, and she consulted a physician of this city who made a diagnosis of uterine fibroid. The tumor was now, July 8th, as large as the two fists, but owing to the extreme tenderness now existing, and the high temperature, I could not make out a positive diagnosis as to the true character of the tumor. Whatever it might be, I felt sure she was now suffering from a circumscribed pelvic peritonitis, and hence put her upon such general treatment as seemed indicated for that condition; reserving my final opinion until after further developments. The acute symptoms subsided after a few days, and on the 18th July, I made a more careful exploration of the uterus and tumor, and became satisfied in my own mind that the new growth was ovarian, although the tumor was in very close proximity to the uterus, and quite immovable; and to the sense of touch, through the vagina seemed as if it was really connected to the uterus. Having no sound with me, and as a diagnosis of uterine fibroid had been previously made by

another physician, I determined to call to my aid further counsel, and hence asked my friend Dr. F. Walker to see her with me. With a sound in the uterus, and by the aid of careful palpation, we satisfied ourselves beyond question that the tumor was in no way connected with the uterus, and as certainly as such a thing could be out, that it was ovarian.

I should say in justice to the physician who made the diagnosis of uterine fibroid, that in consequence of the extreme short stalk, and the broad and thick band of adhesion anchoring the tumor down into such firm proximity to the uterus, a mistake of this sort was very easily and naturally made.

Her condition was made known to her, and an operation advised as the surest and speediest route to relief. But she preferred to give herself the benefit of any doubt as to whatever good might possibly be obtained from constitutional treatment. She was consequently put upon the Iod. of Pot. and Mur. Ammo., and it was faithfully kept up, and pressed to the fullest extent for some months.

Seeing that the tumor was growing rapidly from day to day, she finally surrendered herself to be operated upon, whenever in my judgment she was in a condition for it. A week or two of preparatory treatment brought us up to January 7th, 1889. The tumor was now almost as large as a woman at full term in pregnancy. In the presence of Drs. F. Walker, H. McHatton, W. C. Gibson and R. E. Fuller, I made the operation. So far as human judgment could go, I should have said that my patient was in fine condition for the operation, and yet I found quite an extensive sub-peritonitis, with a large amount of ascites. The usual incision was made, and a sound passed around the tumor, and, although several attachments were encountered, none of them appeared very formidable. Most of the attachments could be easily broken up by the fingers as the operation progressed, and nothing of special interest