Suppose, however, that the uterus is infected unavoidably. If this infection has been done by a competent obstetrician working in a hospital with sterile instruments, it may be safe to deliver the woman by an extraperitoneal or cervical trans-peritoneal cesarean section. If the practitioner has tried to deliver the woman at her home with forceps and has failed, especially if repeated attempts have been made by the physician and an assistant or consultant, the uterus should be amputated. It will not do to deliver by a low cesarean and await developments, because if the infection is serious no subsequent removal of the uterus will save the woman's life. The grave mutilation of removing the uterus is, of course, licit, as it is the only means of saving the woman's life. Some moralists hold that a woman from whom the uterus has been removed is impotent, but this question has never been decided authoritatively, as we shall show in the chapter on Vasectomy; and until it has been so decided the woman must be given the benefit of the doubt. The question of removing the uterus solely to prevent the danger of subsequent deliveries differs from the condition just considered. If the woman has had a cesarean delivery for an absolutely narrow pelvis, her subsequent deliveries must be by the same method. After a cesarean section there is more or less danger of rupture at the scar in other labors. Some think the danger is greater if the placenta becomes implanted on the scar; others think this implantation does not weaken a good scar. If the convalescence after the cesarean section already done has been abnormal, the prognosis for rupture is not good. Where there has been an abnormal convalescence, each new pregnancy must be watched closely, and often an early subsequent cesarean is indicated to prevent rupture. No matter how well the section has been done, latent gonorrhea may prevent perfect healing of the wound. Twins, hydramnios, and overtime gestation are other causes of rupture. The tendency with obstetricians in the future will probably be to do the section toward the cervical end of the uterus; and as the uterus is thinnest there, it might be thought that it will be more likely to break, but Spalding[110] found the contrary true--the rupturing was usually in the thick part of the uterus. Version, high forceps, uterine tampons, hydrostatic bags, and pituitary extract should be avoided where an old cesarean scar exists, but Vogt and Kroback have done version a few times without rupture. Vogt had one patient with a true conjugate of 6-3/4 cm. (2-8/16 inches) to 7 cm. (2-3/4 inches). She was delivered in the first three labors by craniotomy; in the fourth by version; in the fifth and sixth by cesarean section; in the seventh she had twins one of which was born spontaneously; in the eighth by version and perforation of the after-coming head; in the ninth she refused operation and was delivered spontaneously. Skilful operators have the