414 DYSTOCIA. 



These reasons are, in my opinion, of the highest authority; for 

 although, as M. Duges asserts, it be true that a slight degree of 

 hydrocephalus ought not necessarily to occasion the death of the 

 child, does not alvvaj's prevent its viability, and may sometimes be 

 cured, it is equally certain, that in case the head is not so large as 

 absolutely to require the operation, and that where even the disease 

 is so advanced as to render the delivery impossible, we have no 

 ground to rely upon the viability of the child. But how is the liquor 

 amnii to be evacuated? Should it be done with Smellie's scissors, 

 Stein's perce-crdne, a common bistoury, or is it better, like MM. 

 Maygrier and Duges, to be content with a simple trocar? Since, 

 according to Holbrock, Vose, &c., the puncture has been success- 

 fully performed after birth, and as large lacerations are not required 

 to give issue to the serum of hydrocephalus, I perceive no inconve- 

 nience likely to arise in pursuing this last named course, inasmuch 

 as it at once satisfies the indications of prudence and the wants of 

 practice. But if the head should not be thereby emptied sufficiently 

 to render its escape easy, I should not hesitate about plunging one 

 of the other instruments into the head. 



After the operation of cephalotoray has been performed, the con- 

 tractions of the womb generally suffice for the expulsion of the head; 

 but if this should not be the case, recourse is had to the forceps, to 

 turning, or to the crotchet. 



942. I do not know that hydro-rachis has ever proved to be a real 

 obstacle to the termination of a labor. It is a dangerous disease to 

 the foetus, and that is all; besides, nothing could be easier than to 

 empty the tumor by pushing a trocar into it, should it appear to 

 interrupt the progress of the labor. 



943. It is rare also hr ascites, and particularly {or kydrothorax, to 

 be of such extent as to furnish considerable obstacles to the delivery 

 of the child, as appears from the remarks of Baudelocque, M. Lamou- 

 reux, andM. Duges. In all cases those lacerations and eviscerations 

 that were practised by Deventer should be avoided, as well as the 

 mode recommended by Mauriceau, of perforating the navel or the 

 neighboring parts with the finger; simple punctures, made with a 

 trocar or a bistoury, always suffice to produce the eflect which it is 

 desirable to obtain. 



944. Solid tumors developed upon certain parts of the trunk, 

 or any decided deformity, like the case related by Baudelocque, and 

 another one published by M. JNivert, might require some peculiar 

 attention; or even render delivery wholly impossible. Cases of this 

 sort are particularly untoward, inasmuch as it is, generally, quite 

 impossible to ascertain the circumstances until after delivery. Thus, 



