Presentations, 92: vertex, 1st position, 50; 2d position, 34; face, 1st position, 3; brow, 1st position, 2; brow, 2d position, 3.
Head above superior strait, 47: occiput, 24; sinciput, 20; posterior parietal, 3.
head at the superior strait, 13: Occiput, 5; sinciput, 4; posterior parie tal, 4.
Head deeply engaged, 26: Occiput, 15; sinciput, 9; posterior parietal, 1; brow, 1.
Head in excavation, 10: Occiput, 8; brow, 1; face, 1.
Operation was performed: After the death of foetus, 36 times; mother in critical state, 39; prolonged labor, 23; putrefaction of foetus, 10; sep tic peritonitis, 1; eclampsia, 3; chorea, with affection of heart, 1.
In twenty instances many attempts at delivery with forceps had been made before perforation, the head above the brim. The results were: Died, 2; vesico-vaginal fistula, 1; vesico-uterine fistula, 1.
Version had been attempted in 4: Died, 2; recovered, 2.
Degree of pelvic deformity: 1st degree, simple flattened, 12; 2c1 degree, simple flattened, 14; 1st degree generally contracted, 17; 2d degree gen erally contracted, 39; 3d degree generally contracted, 4; funnel-shaped, 9; oblique-oval, 1; transversely contracted, 1.
Except in 9 cases where, after perforation, labor was allowed to termi nate spontaneously, extraction was always resorted to. Until 1871 the blunt hook or the cephalotribe was used for extraction. Since then the cranioclast has been used.
Extraction with blunt hook, 20; extraction with cephalotribe, 17; ex traction with cranioclast, 39; extraction with forceps 6.
While extraction with the cephalotribe succeeded 17 times and failed 11, the cranioclast succeeded 33 times and failed in only 7 instances. The cases in which the cranioclast was used are thus decomposed: Head above the brim, 19; head movable at the brim, 3; head fixed at the brim, 8; head in cavity, 8.
Where the cranioclast failed, labor was terminated by: Version and extraction, 3; cephalotribe, 2; forceps, 1; Caesarean section, 1.
Where the cephalotribe failed, termination by: Blunt hook, 1; version and extraction, 2; cranioclast, 5; forceps, 2; post-mortem section, 1.
The characteristics of the puerperium were: After cephalotripsy: Normal, 2; diphtheritic ulcers, 2; endometritis, 3; phlebitis, 1; vesico-vaginal fistula, 1; left paramotritis, 1.
After cranioclasty: Normal, 15; intestinal catarrh, 1; abscess of left arm, 1; endometritis, 1; septicemia, left pleurisy, 1; fever, 2; vesico-vaginal fistula, 4.
After blunt hook: Peritonitis, 4; endometritis. 5.
The total maternal mortality was 25.7 per cent. thus: Of 26 maternal deaths after: Cephalotripsy, 7; cranioclasty, 7; forceps, 3; blunt hook, 3; version, 3; traction on perforated head, 1; during extraction, 1; un known, 1.
Wiener draws the following conclusions: 1. As soon as the necessity of perforation is evident, every other method of delivery, in particular the forceps, should be rejected.
2. Extraction should always follow perforation.
3. The objections to the cephalotribe are: a. Risk of slipping. b. Augmentation of the diameter of the head in one direction, and decrease in the opposite. c. Frequent injuries of the maternal parts. d. Grave troubles more frequently follow its use than that of the cranioclast.
4. The advantages of the cranioclast are: a. It never slips if the inter nal blade be carried high towards the base of the skull, and the external blade grasps the head over the ear and maxilla. b. It may be used in a smaller space and the operator may place it where he pleases. c. It in jures the mother less frequently than the cephalotribe. d. It diminishes the base of the skull.
Cred(, without detracting from the value of the cranioclast, prefers the cephalotribe, because he has been enabled by it to end labor where the cranioclast had been tried in vain. In Italy, Fabri and Cuzzi, from a series of experiments with Braiin's cranioclast, limit the utility of the instrument to instances where the sacro-pubic-diameter is not below 2.3 inches, and Cuzzi adds that if Rokitansky was able to succeed in greater degrees of contraction, it was because the foetuses had been dead for some time, and the bones and the sutures were, therefore, very movable.