204 CEPHALOTOMY. 



inject a copious amount of tepid lysol solution into the va- 

 gina, then carry the chisel carefully guarded by one hand into 

 the passage and place it accurately upon that part of the head 

 of the fetus where it is desired to begin the operation ; 

 generally on the median line of the nose with the blade of 

 the chisel standing parallel to the septum nasi of the fetus. 

 Holding the blade of the chisel firmly against the part with 

 one hand in such a manner as to effectively guard the in- 

 strument from slipping aside and wounding the maternal 

 organs, steady and direct the handle with the other hand 

 and have an assistant drive the chisel by means of blows of 

 proper vigor with the mallet into the bones of the face and 

 head. Do not drive the chisel deepeir than the length of 

 the blade without stopping and forcibly revolving it upon 

 its long axis and breaking the foetal bones apart. The 

 partially detached pieces of bone may be torn away with the 

 fingers or in case the skin is quite adherent to them the 

 bone may be held with the fingers of one hand, the chisel 

 introduced with the other and using it as a spatula complete 

 the separation. Repeat the use of the chisel as often as may 

 be necessary in order to bring about the required diminution 

 of the head, care being taken at all times not to wound the 

 maternal parts and to conserve as far as practicable the skin 

 of the face and head in order that it may protect the ma- 

 ternal parts from the jagged bones during the passage of the 

 remains of the head. The removal of the partially detached 

 pieces of bone may in many cases be greatly facilitated by 

 looping one of the cords over them and having an assistant 

 apply traction sufficient to pull them away, the operator 

 guarding the maternal organs by holding the piece of bone 

 during its detachment and extraction, in the palm of his 

 hand. 



