1 84 CEPHALOTOMY. 



inject a copious amount of tepid lysol solution into the va- 

 gina, then carry thr chisel carefully guarded by one hand into 

 the passage and place it accurately upon that part of the head 

 of the foetus where it is desired to begin the operation ; 

 generally on the median line of the nose with the blade of 

 the chisel standing parallel to the septum nasi of the fetus. 

 Holding the blade of the chisel firmly against the part with 

 one hand in such a manner as to effectively guard the in- 

 strument from slipping aside and wounding the maternal 

 organs, steady and direct the handle with the other hand 

 and have an assistant drive the chisel by means of blows of 

 proper vigor with the mallet into the bones of the face and 

 head. Do not drive the chisel deeper than the length of 

 the blade without stopping and forcibly revolving the chisel 

 upon its long axis and breaking the foetal bones apart. 

 The partially detached pieces of bone may be torn away 

 with the fingers or in case the skin is quite adherent to them 

 the bone may be held with the fingers of one hand, the 

 chisel introduced with the other and using it as a spatula 

 separate the skin from the bone. Repeat the use of the 

 chisel as often as may be necessary in order to bring about 

 the required diminution of the head, care being taken at 

 all times to not wound the maternal parts and to conserve as 

 far as practicable the skin of the face and head in order that 

 it may protect the maternal parts from the jagged bones 

 during the passage of the remains of the head. The re- 

 moval of the partially detached pieces of bone may in many 

 cases be greatly facilitated by looping one of the cords over 

 them and having an assistant apply traction sufficient to pull 

 them away, the operator guarding the maternal organs by 

 holding the piece of bone during its detachment and extrac- 

 tion, in the palm of his hand. 



