Two Cases Illustrating the Use of the Cephalotribe
BMJ (Clinical Research Edition)
tage of removing the calvarium, and inducing face-presentation, as recommended by me in a paper in the Trasactions of the Obsterical Sotiety J Lonton, vol. vi, has niot been fully recognised; because I believe that there are very few cases of contracted pelvis in which we cannot as certainly deliver l)y this means a. by the help of crushing, though perhaps not so readily. I [ence the comparison rests ratlher between these two plans, thani between the cephalotribe and C.esarean section; for the
... n section; for the latter wvoul(I be reserved for a more complete obstruction. I am here, of course, discussing the subject on the assumption that we are acting unider necessity (for instance, where the child is dead). W'here we are cnploying the Ci.sarean operation as one of election, other considerations entcr. I think that, by means of this instrument, or the plan to which I have alluded, wve can extend cephalotomy to its extremne point; so that, if the outlet be good, we can deliver in a brim with an antero-posterior diameter of i to i inxclhes without serious risk, provide(d the transverse be above 32 inches, and the fretus of medium size. The four cases in which 1 have employed the cephalotribe are briefly as follows. CASE 1. ThC hbead had been perforated; but the practitioner had been unable to deliver by crotchet. The head was very firrmly ossified, anid partly in cavitv. I applied the instrument twice, when the head came down readily; the pains beingstill strong. The re(luction of the size of the pelvis was niot severe. CASE i . This was a case of lerforatioll, where the head was well down in the cavity of the pelvis. After the perforation, delivery was unable to bc effected by the attendlaint. After some time had elapsed, I employed the cephalotribc; but the head resisted very considerably, and there was; a tendency in the lhad to slil. After two applications, I thought this tendency to slip might prove troublesome, because some lesion of the vagina had been effected before I saw her. I therefore adopted the cranioclasmic movement with the craniotomy-forceps, and succeeded, after a short time, in delivcring the head. CASE 11. The pelvis was very small in all (lirectiotns. Besides which, the antero-posterior diameter was below three inches. It w-.Ls one v ery difficult to work in. The hand ha( presented w ithi the head, which could not enter the pelvis. Attemilpts hbad been ma(le to turnt, but. the uterine spasm prev-elnted it. Chloroform failed to relax it. I tlen, after perforatinig the head, crusihed it with the ceplhalotribe;. but no descent could yet be obtained till I had removed some of the parietal bouc;s, When, passing a small blunit liook-inlto thle orbit, face-presentation wvas induIiced, and ra,pid descent made. I then found that the ceplihalo. tribc hadn much facilitated the delivery; the whole vailt of the crmnitum being crushed upl, so as to permit the easy descent of the head, after very slight furthler redtuction of the bones. CASE IV w.as not a completed case. The lhead was left in wtero, and( the uterus had been riptured before I sawv the patienit. I found the patient exceedingly ill, and applied the cephalotribe; but, as the head was lhigh up and the patienit enormously fat, the head couild not well be reached, so as thioroughly to fix it; anid, as shc was (lying, I did not push its use. But I could see that it wouild in some sucl cases be a tgreat help to delivery.