MIDWIFERY. 
opposite side of the head, of wounding the 
uterus. The way they are used is this : we 
bring the points upon a suture or fonta- 
nelle, recollecting that when they are intro- 
duced, the handles are close together, and 
consequently, that both the points form one 
perforator ; now when, by the hand in the 
vagina, we have laid the points opposite the 
part of the head we intend to open, we 
press the instrument down with force siitti- 
cient to make it pass through the integu- 
ments, which, being done, and the perfora- 
tor pushed in up to the stops, we are next 
to lay our hand between the handles, and 
pass it lip between them to the joint. The 
effect of this will be, by its acting as a 
wedge to force asunder the points, and to 
dilate and tear open the sides of the wound 
before made ; we next close the sides of it 
and change its position, so that the handles 
will have their rings in a horizontal posi- 
tion ; we then open the instrument again as 
before, which gives us a cruciform opening. 
This being done, the perforator is next to 
be pushed into the head, and screwed round 
backward and forward, so as entirely to 
break down the consistence and connection 
of every thing within the skull j this will ge- 
nerally be sufficient, the pains will quickly 
press out the cerebrum, which may be re- 
moved from time to time; or we may scoop 
it out with a table-spoon. 
If the pelvis be not greatly deformed, the 
delivery may now soon be effected ; if it 
be, we proceed to remove the bones piece- 
meal, taking care to guard each piece 
through the vagina, by laying the scabrous 
edges of it against the hand, which, during 
the whole operation, should be in the vagi- 
na. The sides of the two points of the per- 
forator, which come against each other 
when the instrument is shut, are made 
rough, so that as with a pair of pliars we 
may take hold of a bone which is too large 
to pass, and break. In this way we must 
bring away the frontal bone, and occipital 
bone ; the temporal bones, and the parie- 
tals ; after which, in order to have a firm 
hold, we .should lay the scalp as tar over the 
parts within as we can, making a sort of 
flap to lay hold of. It is best to put on a 
glove well greased in order to catch hold 
with. It will sometimes answer very well 
to carry up the blunt hook, with which we 
may occasionally be able to catch hold 
somewhere, so as to have a good purchase ; 
but it is very apt to slip, as it has no point. 
If it do slip, we can then only pass the 
crotche ; in the construction of wliich we 
should observe that the flat point, at ite 
sharp extremity, looks inward; so that if 
laid to a surface parallel to it in direction, 
it will not be able to peck into it, or wound 
it. When using the crotchet, we should 
begin with as little force as may be attend- 
ed with a good effect ; since, if not suffi- 
cient to bring down the head, it may be ea- 
sily encreased ; recollecting that whenever 
this instrument is using, we must always 
keep that hand which is within the uterus 
directly opposite the beak of the instru- 
ment, so that in the event of the parts of 
the child giving way, no accident may hap- 
pen to the uterus. We should use a force 
that we can command ; and if the pelvis be 
of sufficient dimensions, bring the body 
down without removing any more than the 
head ; for when once the head is delivered, 
the body will soon follow, as it is easily 
compressed. 
a Where the deformity is very great, and 
the passage very small, we should begin to 
open the head very early in labour, punc- 
turing whatever part we first reach, by a 
hole drilled up to the stops. We should 
then cease, and trust in some measure to 
that putrefaction which the moisture and 
warmth of the parts will be sure to produce 
instantly. This putrefaction will proceed 
very rapidly ; and the hones, and indeed 
the whole body, will come away easier, 
separating from each other with infinitely 
less force than before they could have done. 
When the patient cannot be left longer with 
propriety, after about thirty-six hours, we 
may proceed to bring away piecemeal, the 
various bones of the cranium ; the tempoial, 
frontal, occipital, and parietal bones; after 
which the remaining part of the head will 
only be the basis of the skull, which admits 
of being placed in a more favourable posi- 
tion for passing through the pelvis; for the 
parietes being carefully laid over the bones 
whenever they may be felt exposed, it will 
protect the uterus from injury, and then if 
the remains of the head be brought forward, 
and doubled down with the chin to the 
breast, it will, in this state, be frequently ca- 
pable of being delivered. This sort of labour 
is very tedious ; it lasts a very great length 
of time ; but it requires no skill. We must 
be aware, that when we have brought the 
head down, we must not always expect the 
body to follow as in other cases, but shall 
sometimes be obliged to bring away the 
whole child by pieces. It may be neces- 
sary, in order that the body may pass, to 
take out the heart and lungs, and every or- 
