When the ordinary practitioner in small cities, towns, and country places operates the mortality is very high. Newell[106] said that in four cities of from 25,000 to 40,000 inhabitants within forty miles of Boston he collected the following data: in A no patient on whom cesarean section had been done is known to have recovered--a mortality of 100 per cent. In B the mortality is from 60 to 70 per cent. In C the operation is invariably fatal when done by the local surgeons. In D the fatality is from 10 to 20 per cent. in average cases, but since cesarean section has become popular as a method of treatment for eclampsia the mortality is over 50 per cent. [106] _Jour. Amer. Med. Assoc._, February 24, 1917. In spite of perfect technic by the best obstetricians, the operation has a high morbidity: fever, peritonitis, pneumonia, dilatation of the stomach, and other bad results are common. Before antiseptic surgery began, opening the abdominal cavity was almost always fatal, and some obstetricians tried to get the child out of the uterus in cases where cesarean delivery is indicated by going in above the pelvis without opening the peritoneum. The uterus was incised near its cervical end. This method, called extraperitoneal cesarean delivery, has been restored for use in cases where there is some infection of the uterus and the operator wishes to save the child without removing the womb. The technic is more difficult than in the classic cesarean, and the operation was not kindly received, but of late some men are having so much success with it that it is reviving, and rightly so. Baisch[107] says that the first eleven women he delivered by extraperitoneal cesarean section recovered more readily than they would from an ordinary laparotomy. In nineteen cases of transperitoneal but cervical section he had no trouble, and six of these were infected cases. The technic of this low incision protects the peritoneal cavity better than the classic incision, apparently. Two of the nineteen women were in slight fever and the uterine fluids were fetid. Two primiparae forty years of age had been in labor seventy hours. Eight of the women were able to leave the clinic on the tenth day. Only one child was lost, and that was a delayed case. Hofmeier[108] compiled 194 cases of transperitoneal cervical cesarean section with three deaths. Küstner did 110 extraperitoneal cesarean sections with no mortality. This makes 304 cases of cesarean cervical section, not the classic operation, with only three deaths, less than 1 per cent. mortality; and fully 50 per cent. of these cases were not surgically clean. From these statistics it is evident that the cervical operation in the hands of competent surgeons should be the operation of choice. [107] _Zentralblatt f. Gynäkologie._ Leipsic, October 30, 1915. [108] _Münchener medizinische Wochenschrift_, January 4, 1916.