PARTURITION. 
694 
mended by him. But it is to Dr. D. D. Davis that the 
profeffion is laid under the deepeft obligations for the 
very great improvement which this inftrument has at¬ 
tained under his direction. The progreffive fteps by 
which it arrived at its prefent improved conftruCtion are 
detailed in the eighth volume of the London Medical 
Repofitory, and the inftrument itfelf is exhibited in an 
engraving contained in the fame volume. By comparing 
the craniotomy forceps there fketched with thofe repre- 
fented in the engraving which accompanies thefe pages, 
(fee fig. 5.) the mechanifm of the two will be feen to be 
different, whilft their principle of action is the fame. To 
the inftrument exhibited in the plate preference is given 
merely on account of its fimplicily, eafy application, 
and adaptation at once to ordinary cafes, and to fuch as 
require peculiar management.” 
The operation is to confift of two different proceffes ; 
firft, the diminution of the head 5 and, fecondly, the 
extraction of the mangled child. In many cafes the 
latter Ihould be performed immediately after the former 
is accompliffied ; but, whenever the refiftance is very 
confiderable, an interval fnould be interpofed between 
the two. The advantages refulting from this practice 
were fil'd publicly noticed by Dr. Ofborn, though there 
can be little doubt that the practice itfelf was the effeCt 
of neceffity. By waiting after the head has been opened, 
the woman’s ftrength will be reftored, fo that the affift- 
ance of the pains in the expulfion of the child may be 
obtained; the fwellitig of the foft parts will fubfide, by 
which the refiftance may be greatly leffened, as well as 
the danger of inflammation removed. 
In opening the head, which is to be done by means of 
the perforator, the two great points to be aimed at are, 
to avoid injuring any part of the woman, and to make a 
fufficiently large opening of the head. On the complete 
accomplifhment of the latter, the eventual fuccefs of 
the operation mull depend in all cafes of extreme de¬ 
ficiency of fpace. 
Should it be found expedient to delay the extraction 
of the infant after the head has been opened and its 
contents evacuated, the teguments are to be carefully 
brought over the ragged edges of the bones, fo that, in 
the event of labour throes recurring, there fliall be no 
rifle of the parts within the pelvis being injured. 
After the head has been fufficiently reduced in bulk, 
it has been ufual to fix the crotchet at firft on the infide 
of the cranium; and, while two fingers of the left hand are 
to be kept conftantly fo applied, that, if the inftrument 
fhould flip in the procefs of extraction, it ffiall be re¬ 
ceived on the fingers, and not touch any part of the 
mother, the operator is to draw down with a Tuitable 
exertion of force, in fuch a direction that the largeft part 
of the head (hall be brought through the wideft part of 
the pelvis. 
In fome cafes, much time and very violent exertions 
are required to accomplish the delivery with the crot¬ 
chet ; but thefe inconveniences we think are likely to 
be obviated by the fubftitution of the craniotomy forceps, 
of which Dr. Conqueft farther fays, “Some fuch contri¬ 
vance as this mult, ere long, altogether fuperfede the 
crotchet with every fcientific practitioner ; though for 
fome little time it (the crotchet) may be continued in 
ufe, to the manifell danger of both patient and operator. 
That the craniotomy forceps will foon be generally fub- 
ftituted for the crotchet, is inferred from the follow¬ 
ing important data. Firft, becaufe with them the ac¬ 
coucheur may obtain fo firm a purchafe or hold of the 
fcetal cranium, as will enable him to rectify any thing 
that may be unfavourable in the pofition of the head, and 
alfo to regulate the degree of power which it may be ne- 
ceffary to employ for its extraction ; two highly impor¬ 
tant advantages, which it is evident the crotchet can 
never confer. Secondly, becaufe with this inftrument 
there is no danger of injuring the vagina, even Ihould 
it flip from its hold, whilft confiderable extracting power 
is being employed. On the contrary, not only is tbs' 
crotchet much more likely to flip, but many molt de¬ 
plorable inftances are recorded in which it has torn the 
foft parts of the mother, or lacerated the fingers of the 1 
accoucheur. And, laftly, becaufe it is efienrial to the 
fecurity of the vagina and contiguous organs, that,- 
whenever the crotchet is ufed, the precautionary meafure 
of keeping a hand in the paffage Ihould always be had re- 
courfe to; a precaution extremely painful to the patient 
and practitioner, and one altogether needlefs when the 
craniotomy forceps are employed.” 
Thus armed. Dr. Conquell direCts the operation to 
proceed as follows. When the cerebral mafs is well 
broken down, fome hours, unlefs circumftances impe¬ 
ratively forbid, may pafs without any thing further being 
done, during which time uterine contractions will force 
out the contents of the cranium, fo that the bulk of the 
head becomes materially diminiffied; and, the difficulty 
being overcome, the labour may be terminated by the 
unaided powers of the mother. If this Ihould not take 
place, by waiting a few hours more, the tumefaction of 
the foft parts of the mother have time to fubfide, and 
the head will have defeended more or lefs into the ca¬ 
vity of the pelvis. The craniotomy forceps are now to 
be palled up the vagina; and, on reaching the perfora¬ 
tion, the handles are to be opened a little way, and the 
blade without teeth is to be introduced within the cra¬ 
nium fo that the cavity of the (hanks fliall be oppofed to 
the perineum. On clofing the handles, the teeth tranf- 
fix the bones of the head, which is to be extracted in 
the line of the axis of that part of the pelvis through 
which it is palling. It is well only to co-operate with 
uterine efforts; and every attempt mult be made to over¬ 
come any remaining obltacle by improving the fituation 
of the head, and by the Heady employment of extracting 
power. The extraction of the body is to be effected as 
under other circumftances ; and, when the child is fepa- 
rated from its mother, the mangled head ought to be 
fluffed and lewed up neatly. 
Sometimes, the mere adaptation of the fhoulders to 
the longed diameter will not much facilitate their paf¬ 
fage; and the obftruCtion may be fo confiderable as to 
juftify affiltance with the blunt hook fixed in the axilla. 
In other inftances, it becomes neceffary cautioufly to 
perforate and remove the contents of the thorax and ab¬ 
domen before the body can be extracted. 
Should extreme difficulty exift in obtaining the paffage 
of the head through the brim of the pelvis, the bones 
of the fummit of the cranium and of the face mult be 
removed feriatim, fo that the bafe alone fliall remain. 
The chin is then to be brought through firft, by which 
means there will be rarely more than an inch and a half 
from the chin to the root of the nofe to enter the pelvis. 
But even this fpace cannot always be commanded; and 
there are cafes wherein the operation of embryotomy 
is abfolutely impracticable, fo that we feeni to be ab- 
folutely driven to the Ccefarian operation, in order to 
have a chance of faving one life at leaft; ' 
In this dreadful fituation, Mr. Simmons of Manchefter 
has propofed a revival of the Sigaultian operation, not 
with the hope of faving the child, but to a Hi ft the aCtion 
of the crotchet or of the craniotomy forceps. 
“ When a cafe ffiall a rife in which the child cannot be 
delivered by the crotchet, from the brim of the pelvis 
being no more than one inch in diameter: I propofe to 
combine the two operations, and to divide theJ'ymphyfis 
pubis to ma/ce way for the crotchet. Dr. Ofborn has urgedfe- 
veral objections againil this propofal, although he admits 
that the operation at the fymphyfis is not fo certainly fatal 
as the Ctefarian feCfion. Weighty objections doubtleis 
prefs again ft it; but, whilft there are no other means for 
preferving life, bad as the chance is, it becomes a queltion 
whether it be worth rifking; and, after maturely con- 
fid ering the cafe, fhould an attempt for faving the life 
of the mother be judged expedient, as the laft refource 
3 it 
