MECHANICAL EXTRACTION OF THE FCETUS. 515 



care in watching that the hook does not break loose and do mischief. 

 I have found that Nve may pull by the hook in the orhit witli great force, 

 without tearing the skin of the Calf, providtd the latter is not in a de- 

 composed state. From my experience, 1 can speak highly of the hooks; 

 indeed, you cannot get the head up without them sometimes." And in 

 embryotomy they may be most usefully resorted to for many purposes. 

 Reference will now be briefly made to the parts of the fcL'tus upon 

 which the crotchets can be most effectively employed, and the manner 

 of employing them. 



Pauts into which the Crotchets may be implanted. — The parts 

 into which the crotchets may be implanted are numerous, but those 

 which are selected by the obstetrist will not only depend upon the 

 luiture of the malpresentation or malposition, but alsoupon the simplest 

 indications for the adjustment of these. ^Vhen the desirable part has 

 been reached, the point of the crotchet is inserted in such a way that 

 the instrument is directed towards the source of traction — the assistant. 

 When blunt crotchets are employed, except in cavities, it will be ucces- 

 aai'y to make an incision through the skin before they can be inserted. 

 Cartwright states that sometimes the sharp crotchets cannot be used 

 without making these preliminary incisions ; but then the instruments 

 must be rather blunt. The best parts for implantation are (1) the 

 muscular tissues, (2) the head, (3) the spine, and (4) the jiel vis. 



1. The Muscular 2'issues. — These tissues are not advantageous for the 

 employment of the crotchets, for although they are easily inserted, they 

 are as easily torn out. Nevertheless, these instruments, when lixed in 

 certain muscular regions, such as the croup, thighs, loins, and neck — 

 more especially the latter, may render useful service in rectifying devia- 

 tions, as the skin offers a good amount of resistance. But, from the 

 fragile and yielding nature of the textures, it must be borne in mind 

 that the hand of the obstetrist should never leave the crotchet while 

 traction 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 tlie 

 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 7naxillar>/ si/ynphi/sis is convenient, but not very firm ; 

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

 Still, there are times and occasions when this part may be advan- 

 tageously 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 look-out for tearing 

 away of the two branches of the jaw. 



The orbital cavity is the best part of 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 fcc-tus, from a belief that the 

 eyeball 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 



