MONSTROUS FCETUS. 413 



tions are of such magnitude as to deserve any particular attention, 

 by engaging in the space under the arch of the pubis, such tumors 

 prevent the rotation movement which the head ought to execute in 

 order to clear the inferior strait. 



940. Hydrocephalus constitutes a much more real, and particu- 

 larly much more serious cause of dystocia; it is recognised by va- 

 rious signs: the finger feels a broad and tense tumor; the bones of 

 the head are evidently separated and very moveable; the dimen- 

 sions of the fontanels are very considerable; sometimes we meet 

 with Wormian bones of various sizes in the midst of spaces that are 

 completely membranous; as to the infiltration of the limbs and hypo- 

 gastrium of the mother during gestation, ascites, hydramnios, ana- 

 sarca, the lymphatic constitution, and the rational signs, that have 

 been supposed derivable from the size of the head, tongue, and fore- 

 head of the woman, they can give rise only to conjectures that are 

 wholly useless in the establishment of a positive diagnosis. More- 

 over, it is necessary to take care not to be imposed upon by an 

 accidental deficiency of ossification, by a fontanel, by abnormal 

 sutures, or a great degree of flexibility of the bones, and to recollect 

 that hydrocephalus during intra-uterine life is so rare,* that according 

 to Madame Lachapelle and M. Duges it was only met with fifteen 

 times in 43,555 labors. 



941. In order to comprehend the dangers of this species of dys- 

 tocia, it should be well understood that serous fluids may accumu- 

 late in various quantity in the cranium, and that if the head is soft 

 and its size not very greatly augmented, the mere energies of the 

 woman in general suffice for its expulsion. When its size is not 

 excessive and the womb threatens to fall into inertia, recourse is had 

 to the forceps, taking care to make use of a moderate degree of pres- 

 sure, so as not to burst the head, nor allow of the instrument's slip- 

 ping. Where the child is dead and the head is too large to get 

 through the straits, cephalotomy becomes a last resource, which we 

 are obliged to employ. 



Notwithstanding, 1 ought not to conceal that this subject has been 

 and still is the subject of a very important question among practi- 

 tioners. Where we have a certainly that the child is dead every 

 body is agreed; but in the contrary case, it has been asserted that 

 we have no right to kill it, and that it would be better to perform 

 the cesarean operation or symphyseotomy. Others have objected 

 that a child ought not to be the assassin of its mother; that as 

 hydrocephalous children die very soon after their birth, it would be 

 contrary to humanity as well as to morality to sacrifice a sound 

 and healthy woman for a being whose existence is so precarious. 



36* 



