CEPHALOTOMY AND EMBRYOTOMY. 531 



the head which is to be opened. To insert the scalpel, a fontanel, 

 or at least a suture, is to be selected, when the vertex is the pre- 

 senting part: where the trunk of the body is delivered we may be 

 obliged to perforate the bones themselves, in which case we ad- 

 dress the instrument to the forehead, or even to the base of the oc- 

 cipital bone. When the head is left in the pelvis, we ought also to 

 endeavor to find one of the membranous spaces; but it is not always 

 easy to reach them, and the accoucheur must then choose the bone 

 which offers the least resistance, and which his finger can touch. 

 During this operation, if the head be somewhat movable, an assistant 

 ought to embrace the womb with both hands, as advised by Celsus, 

 and push it down towards the strait, so as to steady, as much as 

 possible, the parts about to be divided. On the other hand, the 

 point of the instrument ought never to move, while within the ma- 

 ternal organs, without being guarded by covering it with the point 

 of one of the fingers. When it is once plunged into the cranium, 

 the incision is prolonged as far as possible, at least to the extent of 

 an inch; most commonly, we should not be satisfied with making 

 only one incision; we ought to make a crucial opening, through 

 which the finger may be passed so as to break up the brain, which 

 may also be lacerated with the cephalotome itself. 



If Smellie's perforator is selected for the operation, it is to be in- 

 troduced and shut with the same precautions pointed out when speak- 

 ing of the use of the bistoury; when closed it resembles a common 

 cephalotome; but as the two branches of which it is composed are 

 sharp on their outer edges, when they are opened, it necessarily en- 

 larges the incision at first made by its introduction, in direct propor- 

 tion to the degree of the opening; it is then shut, to be opened again 

 in another direction; after which it may be made use of to reduce 

 the brain to the consistence of gruel. 



If the disproportion betwixt the child's head and the pelvis is not 

 considerable, and the womb still retains its energy, the remainder 

 of the labor is confided to the efforts of the woman, and terminates 

 with much rapidity; in the contrary case, we are obliged to resort 

 to the employment of the forceps, or crotchet. The forceps would 

 be always preferable where it could be applied, and when the head 

 is still somewhat firm; and provided it were not so liable to slip and 

 lose its hold, upon the application of some degree of extractive 

 force. 



