forceps is still available, and in which the cephalotribe can do good service, the forceps-saw could hardly answer, owing to the size of the blades and the necessity of getting them to lock accurately in order to work the chain. It is capable of being most useful in dividing the neck or other part of the body in cases of impaction of shoulder-presentation.

5. Delivery by the Author's New Method of Embryotomy.-I have now to describe a new method of embryotomy, designed by myself, to effect delivery in the most extreme cases of pelvic contraction. It had long appeared to me that, if the problem, how to break up and extract such a body as the mature fœtus through a chink measuring an inch wide and three or four inches long, were proposed to a skilful engineer, he would find a solution. It did not seem to me that we were necessarily restricted from the use of new instruments. I thought I saw in the wire-écraseur the means of effecting the object in view. I had found no great difficulty in snaring an intra-uterine polypus of considerable size with a wire-loop passed through a cervix uteri whose aperture was much smaller than the tumour, guided only by one or two fingers. Why should not the foetal head be seized in a similar manner and cut in pieces? I performed several experiments with a very diminutive and delicate rickety pelvis, measuring an inch in the antero-posterior diameter, and scarcely more in the sacro-cotyloid diameter, and I will now repeat the operation before you.

The best instrument is Weiss's écraseur, which has an

I also demonstrated this operation at the meeting of the Obstetrical Society of the 2nd June, 1869.

Archimedean screw and a windlass, admitting the use of a loop of any size. As in cephalotripsy, but not so

E, stem of écraseur carrying loop of wire over occiput. F, stem of écraseur carrying loop of wire over lateral segment of head. G, crotchet, the point of which is passed into the opening in the cranium made by the perforator, and held by an assistant to steady the head whilst the wire is being applied. A, the occipital segment of the head seized by the wire-loop at c, which buries itself in the head. B, a lateral segment of the head seized by the second application of the wire-loop at D.

urgently, it is desirable, first of all, to perforate the head. The wire cuts through the skull more easily if

this be done. In doing this, the head is firmly supported against the brim by an assistant. The crotchet is next passed into the hole made by the perforator, and held by an assistant so as to steady the head. A loop of strong steel wire is then formed large enough to encircle the head. The elasticity of the wire permits of the loop being compressed by the fingers so as to make it narrow enough to slip through the cervix uteri and the chink of the pelvic brim. The loop is thus guided over the crotchet to the left side of the uterus, where the occiput lies. The compression being removed, the loop springs open to form its original ring, which is guided over the occiput, embracing all the posterior segment of the head, as in Fig. 90. The screw is then tightened. Instantly, the wire is buried in the scalp; and here is manifested a singular advantage of this operation. The whole force of the necessary manœuvres is expended on the fœtus. In the ordinary modes of performing embryotomy, as by the crotchet especially, and in a lesser degree by the craniotomy-forceps and cephalotribe, the mother's soft parts are subjected to pressure and contusion. The child's head, imperfectly reduced in bulk, is forcibly dragged down upon the narrow pelvis, the intervening soft parts being liable to be bruised, crushed, and even perforated. And this danger, obviously rising in proportion to the extent of the pelvic contraction, together with the bulk of the instruments used, deprive the mother, in all cases of extreme contraction, of the benefit of embryotomy, leaving her only the terrible prospect of the Cæsarian section. When the posterior segment of the head is seized in the wire-loop, a steady working of the screw

cuts through the head in a few minutes. The loose segment is then removed by the craniotomy-forceps.

In minor degrees of contraction, the removal of the occipital segment is enough to enable the rest of the head to be extracted by the craniotomy-forceps. But in the class of extreme cases in which this operation is especially useful, it is desirable still further to reduce the head, by taking off another section. This is best done by re-applying the loop over the anterior side of the head as seen in B, Fig. 90. The wire seizes under the lower jaw beyond the ear. When the screw is worked, the wire has to cut through the base of the skull, dividing the sphenoid bone. The segment thus made is removed by the craniotomy-forceps.

The small part of the head still remaining attached to the trunk offers no obstacle. It is useful as a hold for traction. The craniotomy-forceps now seizes this firmly, and you proceed to deliver the trunk. If the child be well developed, this part of the operation will require considerable skill and patience. An assistant draws steadily on the craniotomy-forceps, directing traction to one side, so as to bring a shoulder into the brim. The operator then hooks the crotchet into the axilla, draws it down, and with strong scissors amputates the arm at the shoulder. This proceeding is then repeated on the other arm. Room is thus gained to deal with the thorax. You perforate the thorax. Introduce one blade of a strong pair of scissors into the aperture, and cut through the ribs in two directions. Then, by the crotchet, eviscerate the thorax and abdomen, until the trunk is in a condition to collapse completely. This done, moderate traction will complete the delivery.

I have imagined a proceeding by which the arms can be amputated even more easily. A curved tube, shaped like Ramsbotham's hook, may be made to carry a strong wire under the axilla, and the end being brought out, and the tube removed, the wire can be attached to the écraseur, which then cuts through the limb with ease and security. Decapitation may be conveniently performed in the same way.

This operation is particularly adapted to extreme cases of narrowing of the pelvic brim from rickets, in which there is commonly left a moderate amount of space at the outlet for manipulation. Indeed, I believe, a case of rickety deformity will rarely be found so great as to compel resort to the Cæsarian section. No doubt the operation I have recommended is more difficult, demands more skill and richness of resource than the Cæsarian section-an operation which cuts the Gordian knot with despotic simplicity, not perhaps unpleasing to the operator, but certainly full of extremest peril to the mother.

The operation is, I freely admit, less practicable in extreme cases of osteomalacic deformity. Here the pelvis is deeper than in rickets; and the deformity bearing in an aggravated degree upon the outlet, leaves insufficient room for manipulation. Where two fingers can barely pass between the tuberosities of the ischia, it will be scarcely possible to guide the écraseur through the pelvis, and to get the loop over the head. But in these cases, as I have already stated, the bones will often open up, under pressure applied within. Professor Lazzati tells me he relies upon this dilatability in all cases