584 Veteri?iary Obstetrics 



or the operator. It is an ugly instrument to handle unless we 

 first place our patient under complete anaesthesia, because, while 

 carrying a sharp hook in the hand for insertion at a given point, 

 we are almost certain to have our progress interrupted by violent 

 expulsive efforts on the part of our patient, and it is only by the 

 very greatest caution and dexterity that we avoid at such times 

 serious wounds to our hands or to the genital organs of the 

 mother. After repeated trials with the sharp hooks, without 

 having been benefitted by them in a single case, we finally aban- 

 doned all attempts to use them. Even should we desire to fix a 

 hook in a part where the blunt point would not enter on account 

 of the skin, we may, as a rule, incise the integument and thus 

 prepare an opening for the blunt instrument. 



The form of the hook is highly important. They are made in 

 every conceivable form, and many makers apparently ignore all 

 mechanical principles and construct an instrument which does 

 not serve the purpose with that security and safety desired. 

 Aside from the question of strength and finish, it is essential that 

 a hook be so constructed that, when once inserted into the 

 tissues and traction is exerted upon it, its form shall cause it 

 to sink deeper and deeper into the parts and acquire a hold with 

 constantly increasing security. The hook should leave the shaft 

 at an angle of about 45° and need continue in a straight line, or 

 nearly so, to the end. The right and wrong forms of hooks are 

 illustrated by Figs. 92 a, d, and 106 g. A study of tlie.se instru- 

 ments will show that 92 a w^ould have scarcely any tendency 

 to sink deeper and deeper into the tissue, while Fig. 106 g would 

 constantly press deeper into the parts to which it is applied. 

 The width of the opening of the hook should not exceed 2.5 to 

 3 in. .so that the operator may readily conceal it in his hand dur- 

 ing insertion or withdraw^al. 



Double hooks have been proposed by many obstetrists, and some 

 of them have been u.sed extensively. Harms especially rec- 

 ommends his flank hooks. Fig. 92 i, which are about 17 cm. 

 long and are intended to be inserted one in each flank, when the 

 fetus presents by its croup and it is wished to bring about forci- 

 ble extraction. We constantly prefer embryotomy to forcible 

 extraction, which Harms and others recommend, and conse- 

 quently find no need for the.se appliances. Others use hooks of 

 a somewhat .similar character for correction of the deviation of 

 the head by applying one hook in each orbit. 



