EMBRYOTOMY: TRIPSY.—CRANIOCLASTY.—EVISCERATION.
embryotomy is an operation by which the volume of the fcetus is diminished in order to render delivery easier, or even pos sible. It is known under the various names which head this chapter. It has been practised from the earliest times where the infant is dead, but to-day it is still rejected by certain accoucheurs, notably Stoltz, where the infant is alive. Stoltz, however, is about the only one who absolutely rejects the operation where the infant is living, for the most pronounced advocates of the Caesarean section resort to embryotomy where the mother refuses the section. For our part, we believe that the accoucheur should never forget that the life of the child is not at all comparable to that of the mother, and that, therefore, ho ought never to hesitate to sacrifice the former in order to increase the chances of the latter. We must never for get, furthermore, that embryotomy will give the most favorable results the earlier it is resorted to, and the less the previous efforts to obtain a living child. Once then we are satisfied that Nature cannot accomplish her task, and we have tried by reasonable means to save the life of both child and mother, we are of the opinion that we should absolutely neglect the child and turn our whole attention to saving the mother.
The statistical results vary considerably according to the country and operator. Sickel gives us the following figures in regard to frequency of
employment of various operations: In a table constructed by Plow, giving the statistics of perforation and cephalotripsy in the German maternities, there are 540 out of 291,618 labors.
Pawlick, recapitulating the cases reported of decapitation by Braiin's hook, gives a mortality of 24 per cent.; Spaeth gives the recoveries as 77 per cent.; Muller in 17 perforations had only 2 deaths; in 26 premature labors 3 deaths of the mother, and 12 of the children.
At the Clinique, Paris, from 1852 to 1880 (the year 1853 lacking): Cephalotripsy, 202 cases.—Mothers living 145; mothers dead 57. Em bryotomy, 56 cases.—Mothers living 39; mothers dead 17. Maternal mortality 28.68 per cent.
The statistics of Rigaud and of Stanesco give a mortality of 38.52 per cent. in 122 cephalotripsies.
Once having determined on embryotomy the choice of the method re-• mains. In one operation the head of the fostus is alone involved, at other times the trunk. We will consider these methods under the follow ing headings: 1. Perforation of the skull.
2. .Cephalotripsy.
3. Cranioclasty.
4. Sawing of the head.
5. Sape sphonoidienne of Gueniot, intra-cranial cephalotripsy of Guyon, transforation of Hubert.
6. Decapitation, decollation, detruncation: 7. Evisceration, brachiotomy, spondylotomy.