Surgical Instrumentation in the Practice of Craniotomy in 19th-Century Brazil

This paper focuses on the use of craniotomy in the exhausting and long labor of the imperial heiress of Brazil, Isabel de Bragança, in 1875. It analyzes the arguments around the use of this technique using as its main source the medical report of that event (1876). Obstetricians performed the craniotomy technique with the Smellie scissors, created by English obstetrician William Smellie in the 18th-century, for use in cases of either a restricted pelvis or an excessively voluminous fetal skull. These scissors decreased the volume of the fetal skull by removing the cerebral mass. The decision to conduct the craniotomy on such a high-ranking woman caused controversy in the Brazilian medical world. Most medical literature understood craniotomy as a procedure more dangerous than forceps because it caused fetal death. Disagreement over the use of craniotomy showed that, while this technique ensured maternal survival, it also led to the inevitable mutilation of the fetus and damage of the maternal perineum. For these reasons, the procedure was considered to be inherently violent. This paper argues that a tension remains between having knowledge of a technical resource and the use of it. Technical resources, even when deemed violent by medical opinion, were nonetheless used when necessary.