II. CEPHALOTRIPSY.
This is an operation which consists in crushing the head of the fcetus, in order to diminish both its volume and its resistance. The operation was in reality first placed on a scientific basis by Baudelocque, the nephew, in 1829. It was not, however, till 1834, that he gave to the in strument its present shape.
Baudelocque's cephalotribe (Fig. 144) is composed of two strong blades, 21 inches long, weighing about 41 pounds, with no fenestrte. The maxi mum breadth is about 11} inches. The lock is similar to that of Brun ninghausen's forceps. The distance between the blades is about 1 inch, and these are slightly convex externally, and concave within. The vic curve is about 4 inches. The blades are approximated by a screw rod.
Since the time of Baudelocque the cephalotribe has been modified as extensively as the forceps. (For a detailed description of each form, see Lauth's thesis, 1863.) The best known instruments are those of Busch, Cazeaux, Ritgen, Langenreith, Martin, Dubois, Kilian, Depaul (Fig. 145), Kiwisch, Chailly (Fig. 146), Scanzoni (Fig. 147 and 148), Braiin, Brei sky, Bailly, Tarnier, Blot.
We will describe simply the three last.
Blot's cephalotribe (Fig. 149) is composed of two blades; like the for ceps, each blade is fenestrated. The blades are a trifle more curved than is the case in Baudelocque's instrument. They are convex on one surface and concave on the other. Their extremities touch. The instrument is constructed of steel, and the handles are roughened for firm grasp. The left blade holds the pivot on which the compressing bar articulates; the right blade is bifurcated at its extremity to allow of the passage of the same bar. The lock is Brunninghausen's. The blades having been applied, even as with the forceps, the compressor bar is articulated and passed through the bifurcated extremity of the right blade, and then, to crush the head, it is only necessary to turn the screw, and the blades are approximated.
Bailly's cephalotribe (Fig. 150) is thus described by the inventor: " My idea in devising this instrument was to poisess one which, while strong enough to crush, would seize the head better than the ordinary cephalo tribe My instrument has the form of the forceps and its large and con cave blades and, in addition, the power of the cephalotribe. The inter nal surface of the fenestrra is studded with points, which dig into the head and hold it firmly as compression is made. Antero-posteriorly the breadth of the blades is 2.2 inches. When their extremities are in contact the greatest width between them is 2.1 inches. My cephalotribe, therefore, may be used in contractions of the pelvis between and 3.7 inches. In contractions below 21 inches it is not applicable. The compressing mechanism is similar to Blot's."
For our part, we can affirm that between these limits Bailly's cephalo tribe is an excellent instrument. We have used it in twenty-three in stances: 17 times in vertex presentations, 5 times in face (once with co incident prolapse of a limb), and once where a large fibroma obstructed delivery. The instrument has never slipped, and we have always been able to extract the head. The only possible objection to it, indeed, is the fact that its utility is limited to the lesser degrees of contraction.
Tarnier's has invented a number of cephalo tribes. (Figs. 151-153.) One of his modifications is furnished with a number of transverse projections to grasp and firmly hold the head; in another he has added a perinea] curve; in his last model he has modified Blot's lock,' so as to render it easier to adjust the compressing bar.
[Lusk has devised an excellent and effective instrument, which presents certain advantages over Blot's. It has a cephalic curve of 21 inches. The pelvic curve is a trifle beyond 3 inches in length. The blades are fenes trated, and are grooved on the inner surface. With this instrument it is possible to grasp the head above the pelvic brim, and since, after the head has been crushed, " the points approach each other closely, the instrument becomes a perfect tractor, holding the head as securely as an ordinary forceps. Its construction is, however, the abandonment of two favorite but chimerical ideas regarding the capacity and mode of action of the cephalotribe, rm., that it is capable of flattening the head so that the latter can be drawn through a pelvis measuring but two inches in the con jugate diameter, and that this can be accomplished by rotating the in strument, so as to make the flattened head correspond to the shortened diameter of the pelvis." (Lusk.) Lusk's instrument, further, is less bulky than any, actually so efficient, as yet devised.—Ed.] Indications.—Cephalotripsy is indicated whenever delivery is impossi ble, without mutilation of the foetus. Benoit in his thesis, 1881, divides the indications into the following categories: 1. Those from the side of the mother. 2. Those from the side of the child. 3. Those dependent on both. Before studying the indications, we wish to emphasize our previous statement, that before resorting to cephalotripsy we ought, when ever the pelvis allows, to make one to two attempts at delivery with for ceps, always within the limits of prudence, and that only when we have thus assured ourselves of the impossibility of delivery without mutilation are we justified in first perforating and then crushing the head. In many instances, we would also add, it is advantageous to allow a number of hours to elapse after perforation, before using the cephalotribe.