Fuhrmann, in 1868, prefers version in case of partially contracted pelvis, but rejects it in other forms.
Schroeder prefers version to forceps. He believes the operation indi cated in contracted pelves whenever, dilatation being complete, the head remains movable above the superior strait. It is then inoffensive for the mother. In support of this opinion, he cites 36 cases of version, 5 chil dren being dead before operation. Of the 31 remaining, 18 were living, 3 lived but a few hours or days, 10 were delivered dead or dying.
In 9 cases shoulder presentation, . 9 living children In 1 case asphyxia before version, . 1 dying child In 2 cases eclampsia and placenta prsevia, 1 living, 1 dead " 6 " prolapse of cord, . 2 4 " " 13 " rachitic pelvis, 3.7 to 2.7 inches, 11 " 2 " " 1 case " 3.4 1 living 1 ,t " 2.7 to 2.9 " 1 " c, 1 << gc " 2.8 " 2.5 " 1 " He concludes as follows: 1. Even in case of pronounced contraction we may hope for a living child by version. 2. Version is more favorable to the child than labor by the vertex. 3. It is more favorable for the mother than the forceps. 4. Energetic, momentary pressure is less grave for the mother and the child than continuous, persistent pressure.
Strassmann, in 4 cases of irregularly contracted pelvis, saved 3 children, 1 being dead before. In previous deliveries, twice perforation had been resorted to, and twice the forceps had extracted dead children.
Otto de Haselberg, although a partisan of version, admits that we can not always bring the occiput into the roomiest part of the pelvis. In 14 cases practised by him. 6 times the head engaged differently from what he desired.
If now we add together the statistical tables, compiled by Stanesco, and by Rigaud, in connection with the results in various degrees of pelvic deformity, we obtain the following: Borinsky prefers the forceps, and reserves version for the cases where there is abnormal deviation of the head, presentation of the face and brow, and providence of the cord or limbs. In the face presentations which he has observed, he used the forceps twice out of 13 cases, and Barnes, 1873, after recalling the mechanism of labor, concludes that ver. sion is applicable to pelves of 3.1 to 3.5 inches. At 3.1 inches the forceps
is equally applicable. Under 2.9 inches he absolutely rejects it.
Otto de llaselberg, 1873, endeavors to justify his preference for version by a purely mechanical explanation. According to him, in presentation of the vertex, where the pelvis is relatively too narrow, the inclination of the head to the superior strait, instead of being disadvantageous, is in dispensable, since it allows the head to engage. With the after-coming head, aside from the solid grasp which we have on the trunk, the head is in a still more favorable position. It is perpendicular to the plane of the superior strait, and two.symmetrical points are between the promon tory and the symphysis. The small transverse diameter is shortened by the compression of the head, and this diameter is already shorter than the great oblique, which is the one by which the before-coming head passes the superior strait. In this respect, then, he agrees with Mme. Lachapelle.
Schatz simply cites figures; He has practised version forty to fifty times in contracted pelves, and has usually obtained living children. The majority of the women had, in former labors, been delivered of dead chil dren by forceps or perforation. Nevertheless, lie has observed deep de pressions, fractures of the skull, six times fracture of the clavicle, and once of the arm. According to him, the obstacle in case of forceps is Naegele's obliquity, which does not' exist in case of version. The force used in version is less than with forceps. He never, however, resorts to version until dilatation is complete. An arm must always be brought down, but rotation of the back forwards is not always indispensable; the head must not be extracted quickly, but, before resorting to traction, two fingers should be inserted in the mouth to give the head a good position. The operation should be avoided in primiparm; he does not resort to Kristeller's expression. [A most valuable adjunct, nevertheless, for the delivery of the after-coming head.—Ed.] Alnlfeld rejects version. Ile awaits spontaneous labor as long as possi ble, and resorts to the forceps as a last resort.