PARTURITION. 
718 
that inftrument; but he declined the offer, both becaufe 
he was not convinced that any inftrument was then re¬ 
quired, and besaufe he doubted whether the fillet could 
be applied or afted with. Dr. R. therefore proceeded to 
the operation himfelf. 
A ftrong new fillet being procured, and the proper 
noofe made, it was dexteroufly-enough introduced, and, 
though it put the woman to a great deal of pain, at length 
fixed, and drawn clofe round the neck of the child. The 
doflor then began pulling with confiderable force; but, as 
the fillet galled his hands, he procured a common rolling- 
pin, round which he tied the ends of the fillet, and pulled 
again with very great force, till he exerted the whole of 
his ftrength, perhaps not judicioufly enough waiting for, 
and taking advantage of, the pains. This exertion put 
the patient to inexprefiible torture, but did not feem to 
anfwer the end propofed, as the head advanced but very 
little, and probably was turned to one fide by the fillet ; 
which, from the nature of its hold, could only draw in 
one dire&ion, and that perpendicularly from the part to 
which the noofe was fixed, which, whether on one fide 
of the neck, over the occiput, or over the chin, mud have 
a tendency to drag down that part firft, and confequently, 
the head mud be doubled on the neck, and the difficulty 
thereby increased, rather than diminifhed. That this was 
really the cafe, the event fhowed; for, by the prodigious 
force ufed in pulling, the fillet at length came away, 
bringing inclofed in its noofe fome of the fkin and fledi, 
with one of the vertebras of the neck. 
This was an undeniable proof, that the fillet had ac¬ 
tually cut off the child’s head, which was left in the pel¬ 
vis. There remained therefore no remedy, but to try 
what could be done by opening the head and extrafting 
with the crotchets; and, luckily, the head was by this 
time fo engaged in the bones of the pelvis, that it was 
not pufhed back into the uterus by the attempt to perfo¬ 
rate the fkull. This perforation was made in one of the 
offa parietalia, and not in the vertex, by which it plainly 
appeared, that the head had been drawn to one fide by 
the fillet. At length, with much difficulty, the head 
was extracted, and the body eafily followed. Immedi¬ 
ately after delivery the lochia ceafed, a violent fever with 
delirium came on, and the abdomen was prodigioufiy tu¬ 
mefied ; on the fecond day the patient grew flupid and 
infenfible, and in a few hours died. 
Dr. Merriman has been frequently heard to fay, that 
the fcreams of this poor woman, under the operation, 
were greater than he ever witnefl'ed in any other cafe of 
labour. There is reafon to believe this was the laft time 
that the fillet, in natural prefentations, was ufed in 
London. 
In Hamilton’s Elements of the Practice of Midwifery, 
(1775,) the extraordinary cafe of a young woman is re¬ 
corded, who, when apparently in the agonies of death, 
was deferted by her medical attendant, after he had by 
fome means feparated the head of the foetus from the 
body. This poor woman was afterwards delivered, firft 
of the body, and then of the child’s head, by Mr. Robert 
Smith, a celebrated furgeon at Edinburgh, and ulti¬ 
mately recovered. Tt is probable that the feparation in 
this inftanee was effe&ed by injudicious and violent force 
with a fillet. 
The preceding inftruments are thofe which do not, of 
rteceflity, injure either the mother or the child. The fol¬ 
lowing are intended to deftroy the life of the child for the 
pufpofe of preferving that of the mother. 
5. The perforator is an inftrument formed like fciffors 
on a large fcale, viz. about thirteen inches in length* and 
of proportionate thicknefs, with the edges rounded, that 
they may not cut, and with a guard, or projection, on 
each blade, about three inches from the points, to pre¬ 
vent their entering farther thanfis neceflary into the Ikull 
of the child. Having pufhed the perforator through one 
of the parietal bones of the head of the child, or through 
a future, if one can be found, until flopped by the guard, 
the handles mult be opened, and the inftrument turned 
round, by which means the aperture in the fkull will be 
enlarged in every direction, when the perforator may be 
withdrawn. See the Engraving, fig. 3. 
The cafes which require the perforator are thofe where 
the pelvis is fo fmall at the brim, that the child’s head 
cannot pafs through it. Other caufes do indeed fome- 
times render the perforator neceflary : but the legitimate 
caufe for ufingthis inftrument, is “ diftortion of°the pel¬ 
vis.” 
Prefentations of the face now and then demand perfo¬ 
ration of the cranium, to diminifh its fize. In thefe cafes, 
the perforator fhould be introduced juft above the nofe, 
in the fagital future. When it becomes neceflary to 
open the head after the lower extremities are expelled, 
the perforation muft be made behind the ear. 
6. The crotchet is contrived for extracting the cranium, 
after it has been broken down by the perforator. It is a 
very fimple inftrument, with a handle removeable by a 
fpring, as reprefented at fig. 4. Sometimes a blunt hook 
may be advantageoufly fubftituted for it. But Dr. C011- 
queftpropofes to lay afide both the fharp and the blunt 
hook, and to introduce, 
7. The craniotomy-forceps, invented by Dr. Davis, and 
improved by himfelf. This inftrument, reprefented at fig. 
5. is 12 inches in length. The blade which is applied 
externally to the cranium, and which is hollowed out, 
has fixed into it twelve fharp teeth, not riling above its 
edges. This blade is 4! inches in length from its point 
to the joint of the inftrument, being half an inch longer 
than the inner blade, to carry up to any pendulous part 
of the os uteri, which might otherwife be included in the 
grafp. The oppofite blade, which is to be introduced 
within the cranium, is only 4 inches in length : its hol¬ 
low is filled with a piece of fteel, having a convex furface 
perforated with twelve holes to receive the angular points 
of its antagonizing blade ; fo that, when the cranium is 
firmly preffed between them, the teeth transfix it, and fe- 
cure a very commanding hold. The flianks are 5 inches 
in length, and curved, the concavity correfponding with 
the curve of the blades. This conftruftion is intended 
to accommodate the inftrument to the perinaeum in thofe 
cafes in which it muft be endangered by preffure, if the 
flianks were ftraight, in confequence of the neceflity 
which may exift for carrying the blades over and anteri¬ 
orly to the pubes; thus this one inftrument becomes 
adapted at once to ordinary cafes, and to fuch as prefent 
unufual difficulty. The parts which may be more ftrictly 
called the handles, are not more than two inches and a 
half in length. The prefumed fuperiority of thefe inftru¬ 
ments over thofe in ordinary ufe, is fully treated of in 
p. 693, 4. 
8. The bi/loury, or fctdpel, ufed in the divifion of the 
fymphyfis pubis, or in the cefarian operation, is nothing 
more than a fmall ftraight knife, fimilar to that which is 
employed in various other operations of furgery and ana¬ 
tomy. See, therefore, the article Surgery. 
