. On the theory and practice of midwifery . 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 Thescissors are then to be withdrawn, and the first part of the operation iscompleted.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
. On the theory and practice of midwifery . 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 Thescissors are then to be withdrawn, and the first part of the operation iscompleted.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 at once, the crotchet may be fixed on the outside or inside ofthe head ; the former was adopted by the older practitioners, but the latteris recommended generally at present (fig. 120). In some cases it is usefulto employ two crotchets—one internally and the other externally. Fig. The scalp should be carefully folded over the edges of the bones, inorder to prevent injury to the passages, and then extracting force must begradually and steadily applied during the pains, or at intervals, in imitation of them. The left hand should be passed into the vagina, and placed on thehead, opposite to the insertion of the crotchet, both for the purpose ofsteadying it and of preventing mischief if the instrument should slip. Ifthe part of the skull in which the crotchet is fixed give way, we mustobtain another purchase. 35G CRANIOTOMY. The amount of force, and its continuance, will depend of course uponthe resistance to the passage of the child; but if after a certain time noprogress be made, in order to avoid contusion of the soft parts of themother, it will be well to break up the skull with the forceps adapted forthat purpose (fig. 113). The perineum must be carefully guarded, and care must be taken thatno injury be inflicted by
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