CRANIOTOMY. '99 



use of it to effect extractive force upon the ham, groin, or axilla ; 

 but, as the hlunt hook answers a better purpose, and is more easily 

 applied, it is now rarely used, except to confine the hand in shoulder 

 presentations, where turning is necessary. 



The hluni hook is applied to the groin in breech cases, or to the 

 axilla where the shoulders are delayed ; it is also sometimes used 

 to produce flexion in breech cases, when the body is born and the 

 head detained. In these cases it may be tried first in the mouth, if 

 that fail, it may be fixed upon the lower edge of the orbit, 



CRANIOTOMY. 



This operation is demanded at times on account of either mother 

 or child ; on account of the mother, in consequence of deformed 

 pelvis ; on account of the child, in consequence of the dispropor- 

 tionate size of the head, tumours of the chest or abdomen ; or both 

 these conditions may occur at the same time. 



Uniform smallness of the pelvis, or contraction of its brim, or of 

 any part of its cavity or outlet, are, of course, most serious obstacles 

 to labour. Unless timely aid be given, not only may the child be 

 destroyed, but the mother's vital powers may be exhausted, in inef- 

 fectual parturient efforts, and the most serious consequences result to 

 the soft parts, from the long-continued pressure upon them, such 

 as sloughing, apertures from the vagina into the bladder or rectum, 

 and other accidents, rendering her miserable for life. 



Care should be taken, therefore, never to delay assistance until 

 the woman has become exhausted. Shivering, or vomiting, dry 

 brown tongue, and a pulse above 100, show a necessity for active 

 interference. 



The object of the operation of craniotomy is to terminate the 

 labour with safety to the mother in cases where, from the dispro- 

 portion between the size of the foetal head and the pelvis, a living 

 child can neither be expelled by the natural powers, nor extracted 

 by the forceps ; it being always understood that the distortion is not 

 so great as to prevent the extraction of the child when mutilated. 



According to most authorities, whenever the bones of the pelvis 

 approach much nearer to each other than three inches in the antero- 

 posterior diameter, it is unequal to the transmission of the skull 

 entire ; and unless there be at the superior strait an antero-posterior 

 diameter of an inch and a half with a transverse of three, it would 

 be useless to attempt to deliver per vias naturales^ even after the 

 head has been reduced in size. 



In some cases, where the sutures are very loose, the evacuation of 

 the brain is often sufficient, as the bones of the cranium collapse so 

 much by the pressure of the womb, that the child may be expelled by 

 the natural powers. But it is presumed in this case, that the pains are 



