100 



OBSTETRICS. 



Fig. 34. 



strong and frequent. 

 Should this not be the 

 case, the brain must 

 be evacuated and ex- 

 tmcting force appHed. 

 The instruments re- 

 quired are of two 

 kinds, — the one to 

 perforate the skull, 

 and the other to ex- 

 tract, after the neces- 

 sary diminution is ef- 

 fected. The first are 

 called perforators ; the 

 second,crotchets, blunt 

 hooks, craniotomy for- 

 ceps, &c. 



Mode of operating, 

 — It is not absolutely 

 necessary for the suc- 

 cess of this operation, 

 that the os uteri should 

 be entirely dilated, al- 

 though the wider the 

 orifice is, the less dan- 

 ger will there be of 

 injuring that organ. 

 The rectum and blad- 

 der having been pre- 

 viously emptied, the 

 woman is to be placed in the same position as in forceps operations. 

 The perforator should then be carefully applied upon the groove 

 between two fingers of the left hand, previously introduced and 

 placed upon the part of the head which it is proposed to open. It 

 must now be passed forwards with a semi-rotatory motion until it 

 penetrates the bone; if the scissors are used, the handles should be 

 separated as widely as possible. The cutting edges are then to be 

 placed at right angles to the first incision, and again separated so as 

 to make a crucial opening. The instrument should now be passed 

 into the skull, and the brain broken up, after which it (the 

 instrument) should be withdrawn. (Fig. 34.) Then the crotchet 

 should be introduced in the same manner, and fixed upon the 

 inside or outside of the head, and extraction practised, being very 

 carefiil to guard the soft parts of the mother. 



If the head cannot be delivered in this manner, recourse must be 

 had to the craniotomy forceps, and the bones broken up and ex- 

 tracted in pieces. Sometimes the forceps may be used advanta- 



