514 OBSTETRIC OPERATIONS. 



is made on it, and that its position in them must be most attentively 

 noted, in order to guard against accidents arising from its tearing away. 

 2. The Head. — The head offers many good points for implanting the 

 crotchets — such as the symphysis of the lower jaw, the palate, and the 

 orbit, as well as the ear and angle of the inferior maxilla, on particular 

 occasions. 



• It must be observed, however, that all these points are not of equal 

 value. The maxillary symphysis is convenient, but not very firm ; mod- 

 erately strong traction will rupture it, and damage may then occur. Still, 

 there are times and occasions when this part may be advantageously 

 seized by the crotchet, which may be inserted in two ways : the point of 

 the instrument may be passed from below the chin into the mouth, or 

 from the cavity of the latter through the mucous membrane beneath the 

 tongue, to below the chin. The first is generally preferable. When 

 traction begins, the operator must be on the lookout for tearing away of 

 the two branches of the jaw. 



The orbital cavity is the best part of all the head for a solid hold. 

 Some authorities have expressed doubts as to the propriety of fixing a 

 crotchet in the ocular cavity of a living foetus, from a belief that the eye- 

 ball must be damaged, and Rainard goes so far as to advise that it should 

 only be done when the creature is dead ; though he adds that, if there is 

 no other means of remedying a deviation of the head in the living calf, 

 it is well to attempt it, " as it is better to have a living, if blind calf, than 

 a dead one with both its eyes intact." 



But it is rare indeed that the eyes are seriously damaged by fixing the 

 crotchet in their socket ; and innumerable instances testify that, if the 

 foetus is alive, the ocular globe is retracted to the bottom of the cavity 

 when the instrument begins to be inserted, and so escapes injury. 

 Schaack, who has freely resorted to this mode of adjusting the head or 

 neck — in the sheep and goat more particularly (the smallness of the pel- 

 vis not allowing any other means to be employed) — describes 

 Ibis manner of operating as follows : " The crotchet I use," 

 says he, " is a solid (or long) one ; the point is blunt and 

 slightly flattened (Fig. i66). When it is desired to pull at 

 the head of the foetal goat or lamb, the left hand at first 

 seizes the nose, and the crotchet is fixed in the right orbit ; 

 with the right hand the other instrument is passed into the 

 left orbit, the thumb of the left hand keeping the hook in the 

 other orbit by pressing the stalk against the cheek. In this 

 way I can pull wi^h the two hands on both orbits, so as to 

 keep the nose in a good direction." He has never seen the 

 point of the crotchet cause the slightest injury to the globe of 

 the eye, although he has had, in the majority of cases, to pull 



ivery hard. The means has answered very well. And Cart- 

 wright informs us that " it is astonishing how wounds heal 

 up in the cheek where hooks have been in the orbit. I have 

 had two or three men pulling at the rod (of the crotchet), and 

 the hook did not break out." 



This immunity from injury, in the case of the living foetus. 



Fig. 166. does not, however, absolve the operator from exercising all 



Schaack's due care in fixing and pulling at the crotchet. The inner 



Crotchet, ^gp^^^j- q£ ^j^g orbital cavitv is thc most favorable, and if the 



foetus is alive, the blunt instrument must be first tried, the sharp-pointed 



