THE CROTCHET. 535 



handles of the instrument passes a screw, which enables them to 

 be closed with such force that the head of the fcetus will be easily 

 reduced to any desirable dimensions without exposing the woman 

 to the least risk. This instrument appears to me to be an ingenious 

 one; but previously to forming a decided opinion concerning it, I 

 should like to have an opportunity of seeing it employed in a case 

 of labor. 



1174. However, when the base of the cranium has reached the 

 excavation, the head may be taken hold of with the hands, and the 

 crotchet is of no further use, unless it should be applied to the trunk, 

 supposing, moreover, that the blunt crotchet when applied to the 

 axillae should prove incompetent to the extraction. 



In this, as in all cases where the head is completely separated 

 from the body, there are only three points upon the tnmk which 

 can bear the action of the sharp crotchet: these are the spine, 

 the sternum and the ribs, and even the latter is a very insecure 

 hold, so that the whole of the ribs of one side are sometimes found 

 to give way one after the other, as soon as a certain degree of 

 extractive force has to be employed. It is therefore particularly 

 upon the vertebral column that we should endeavor to fix the point, 

 and then act as we should have to do provided it were attached 

 upon the head. 



1175. There is one single circumstance which seems to me to 

 require the use of the sharp crotchet upon the trunk in a pelvis pre- 

 sentation; it is where the lower limbs have been separated from the 

 body, or where they are wanting in consequence of monstrous con- 

 formation, or where they do not admit of a hold being taken, suffi- 

 ciently firm to pull the body down by them. In such cases the 

 crotchet should be applied to the pubis, the crista of the ilium, or 

 what is still better, to the sacrum.* 



SECTION 8. 



Of the Extraction of the Head when it has been left alone in the 

 Genital Passages. 



1176. When the head is separated from the trunk, and left in the 



* The crotchet is a most detestable instrument, on account of the utter want 

 of security which every conscientious physician must feel, who is, by stress of 

 circumstances, compelled to make use of it. In a very bad pelvis, it is more dan- 

 gerous than in such as are not very much deformed; and the danger of its ap- 

 plication becomes enhanced by every degree of diminution in the pelvic diame- 

 ters. For my own part I abjure it, since I have employed the craniotomy for- 



