. On the theory and practice of midwifery . care will be required when this dilatation has nottaken place. The rectum and bladder are first to be evacuated; the patient is thento be placed on her left side, with the hips over the edge of the bed, andan assistant beside her, to fix and steady the abdomen. One or two fingers of the left hand are then to be introduced into thevagina, and their extremities fixed upon that part of the head of the childwhich is to be perforated. Contrary to ancient practice, this should neverbe the sutures, because after the incision is made in that situation, thebo
. On the theory and practice of midwifery . care will be required when this dilatation has nottaken place. The rectum and bladder are first to be evacuated; the patient is thento be placed on her left side, with the hips over the edge of the bed, andan assistant beside her, to fix and steady the abdomen. One or two fingers of the left hand are then to be introduced into thevagina, and their extremities fixed upon that part of the head of the childwhich is to be perforated. Contrary to ancient practice, this should neverbe the sutures, because after the incision is made in that situation, thebones collapse and close it. Having determined upon the situation, theperforator is to be passed along close to the palm of the hand and theinside of the fingers, so as to avoid injury to the soft parts of themother. Having arrived at the point of insertion into the skull, guided andguarded by the fingers of the operator, it is to be pressed firmly forwardswith a semi-rotatory motion, until it pierce the bone (fig. 118); it is then Fig. to be passed in up to the shoulders, ana the handles are to be separatedby an assistant as widely as possible (fig. 119). The cutting edges of CRANIOTOMY. 355 the scissors are then to be placed at right angles with the first incision,and again separated, so as to make a crucial incision. This being effected, the perforator is to be passed into the skull, thebrain thoroughly broken up, and the medulla oblongata cut across. Thescissors are then to be withdrawn, and the first part of the operation iscompleted. The left hand is again to be introduced, as a guide and guard to thecrotchet, which should be passed into the cranium for the purpose of com-pletely breaking up the brain. I dwell upon this point, because instancesare on record of the child being born alive after the operation of cranio-tomy, to the disgrace of the operator, and the distress of the patient andher friends. When this object is attained, if we wish to terminate theoperation
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