Cyclopædia of obstetrics and gynecology . no risk. EJIBRYOTOilY. 245 On the -vrithdrawal of the instrument blood and cerebral matter gener-ally issue from the vulva. (Fig. 139.) 2. Presentation of the Face.—Perforation, in this instance, is a triflemore difficult. The instrument may be made to penetrate either throughthe orbit, the frontal bone, or the palatine arch, the last offering thegreatest difficulties. We prefer the frontal bone, although we do notagree with Naegele and Grenser in believing it indispensable to perforatethrough the frontal Fig. 139.—CRA^^OTOM:Y with the Scissor
Cyclopædia of obstetrics and gynecology . no risk. EJIBRYOTOilY. 245 On the -vrithdrawal of the instrument blood and cerebral matter gener-ally issue from the vulva. (Fig. 139.) 2. Presentation of the Face.—Perforation, in this instance, is a triflemore difficult. The instrument may be made to penetrate either throughthe orbit, the frontal bone, or the palatine arch, the last offering thegreatest difficulties. We prefer the frontal bone, although we do notagree with Naegele and Grenser in believing it indispensable to perforatethrough the frontal Fig. 139.—CRA^^OTOM:Y with the Scissor Perforator. 3. Tlie after-coming —Here manipulation is still more difficult,since the body of the child is in the way and the occipital bone is so thick. We must, therefore, perforate either under the chin, or else, as is pre-ferable, through one of the posterior lateral fontanelles. (Fig. 140.)Chailly prefers perforating through the palatine vault for the reason thathe believes the point of the instrument is less likely to slip. He recom-mends the insertion of two fingers into the mouth, forcible depression ofthe inferior maxilla, and penetration with Smellies scissors through thepalate into the skull. Perforation alone rarely suffices. Cephalotripsy must ordinarily be 246 A TREATISE OX OBSTETRICS. superadded. For extraction of the head, bhint and sliarp hooks luivebeen recommended (Figs. 141 and 142), but we absolutely condemn themon account of the risks which they entail. Bone forceps have also beendevised (Fig. 143), and the simple
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