Page Letter of Instructions to Medical Societies in Affiliation with State 426 Leucorrhea and its Treatment.. 331 Malarial Hemoglobinuria 198 Naevi: Report of a Case and Treatment of Electrolysis.... 329 News and Miscellany.........24-27, 61-62, 103-105, 146-150, 178-182, 229-233, 272-282, 314-322, 358-362, 398-402, 436-444, 482 Quarantine in Relation to the Present Statute Regulating Same..... 50 Recollections of the Big Dallas Meeting.. Reorganization: Its Effect Upon the Country Society. 472 292 363 Report of Committee on Constitution and By-Laws Texas State Medi- 411 The Age of First Menstruation in the United States.. 89 The American Congress of Tuberculosis.... 295 The Association of Army and Navy Medical Officers of the Confeder- The Dallas Meeting. 466 The Dallas Meeting of the State Medical Association of Texas. The Record of Yellow Fever in the United States for the Past Does 235 The Treatment of Pneumonia, with Special Reference to Creosote. 195 293 West Texas Medical Association.... .204, 253, 295, 384 What Shall We do with Our Consumptives.. 370 Yellow Fever and the Mosquito.. 245 PUBLISHED MONTHLY.-SUBSCRIPTION $1.00 A YEAR. Professor of Anatomy, Medical Department, University of Galveston, Texas. GENTLEMEN: When I heard that you had appointed me Chairman of the Section on Obstetrics of this Association my first thought was one of pleasure because of the honor you had conferred upon me, my second a realization of my unfitness to fill satisfactorily such an honorable position in a branch of medical practice in which I have to confess to a somewhat limited experience during the ten years that I have spent among you. As Chairman of this Section in the year 1901 it would not be out of place were I to glance briefly at the enormous progress that has been made in obstetrics in the past century, or, indeed, in the past twenty years; and in such a retrospect one would have, among other things, to allude to the present status of forceps delivery, as one of the most important of life saving devices, which has at least been thoroughly legitimized and brought almost to perfection during the century just gone. Not second in importance, but of much later birth, would be antiseptics and the almost complete exclusion from all up to date practice of the deadly home-desolating puerperal fever. And then would come the whole rational physiology and pathology of pregnancy and labor, and most of obstetric surgery. Today the physician who has a case of puerperal fever develop where he has been in full charge from the beginning should have, *Read at the Thirty-third Annual Meeting of the Texas State Medical Association, Galveston, April 25, 1901. to say the least of it, a very uneasy conscience, and in city practice Cæsarean section should be so safe as to make craniotomy a crime. I propose, however, to ask your consideration of axis traction forceps, the more so that the teaching of the Edinburgh school and my practice for the past twelve years has been different from the teaching of American text-books. American text-books recommend axis traction forceps only when the head of the child is entering the pelvic brim, while the Edinburgh school uses no other forceps for any position, considers them the best possible instruments in all cases where forceps are indicated, and some regard them as an excellent means of saving the perineum. By way of retrospect, in the early part of the past century forceps were dreaded, too often meant the death of both the mother and child, and the legitimacy of their use was hotly contested by a large section of the profession. One does not wonder that it is so, when one learns that they were often covered with leather to make them softer and less formidable in appearance, were taken surreptitiously out of the dirty pocket of the accoucheur, slipped in stealth under the bed clothes, and applied with dirty hands through the unwashed vulva, without if possible letting the friends, patient or even the nurse know they were being applied. Today if a woman is once delivered by forceps it is difficult to get her to have patience to wait on nature in any subsequent labor, it is often the patient and her anxious friends rather than the physician who urge their use; the instruments are sterilized by boiling, the patient carefully cleansed, the pain abolished by an anesthetic, the instruments used with all the precautions of modern surgery, and the operation one of the safest of modern procedures, if not absolutely devoid of danger. Let us first glance at the mechanism and principles of axis traction. The head of the child must descend through a curved canal whose axis is ever changing, while the head itself must all the time be free to change its position through various phases of increase of flexion, internal rotation, extension and restitution. If the expulsive force of the uterus is to be substituted by mechanical traction an ideal tractor should grasp the head firmly with the least possible compression, and should be fixed as near the center round which the head bends and rotates as possible. It should offer no resistance to the necessary movements of the child's head, should make traction possible in the axis of the part of the canal in which the head lies, should give the greatest possible result with the least possible expenditure of force, and should indicate in all possible stages of the descent the exact direction in which traction should be applied. All this is done with almost perfect accuracy by properly made axis traction forceps. It is evident that a straight pull on the handles of the ordinary forceps as in Fig. 1 will result in much waste of force in pulling the head of the child against the pubes of the mother, and only a fraction of the force expended will act in the direction of the pelvis axis. This defect is overcome by a down |