THE FORCEPS. 95 



the introduction of the first blade, it occupies so much of the anterior 

 commissure of the vulva as to leave insufficient space for the intro- 

 duction of the second. To obviate this, after the first, or male blade 

 is introduced, retract it a little till it is opposite the left ischium, then 

 give it in charge of an assistant, and introduce the female blade to 

 its proper position ; now pass the male blade up to its position under 

 the ramus of the left pubis, and lock as before; the handles will point 

 towards the right thigh, and tlie lock will look upwards and to the 

 right. Make traction as before. 



Jn the occipito-posterior positions, the forceps ought to be intro- 

 duced and fixed as in the former positions, only the handles must be 

 much more depressed, and the perineum thrust back, so as to allow 

 them to adapt themselves to the occipito-mental diameter. 



If rotation has taken place into the hollow of the sacrum, as the 

 vertex must escape first, the first movement in extraction should be 

 to raise the handles up a little, so as to increase flexion; then as the 

 vertex escapes over the perineum, (which is greatly distended in this 

 operation, and should be carefully guarded,) they should he depressed^ 

 so that the head may extend itself backwards, as it always does in 

 these labours. The rest of the process is completed as in natural 

 labour. 



In the fourth and fifth positions, where rotation has not taken 

 place, the application is more difficult ; the blades rather seize the 

 head in its vertical diameter, and are brought into parallelism with 

 the oblique as the extraction proceeds. The introduction must 

 take place as in a first or second position, the fifth corresponding to 

 the first, and the fourth to the second. In these positions the forceps 

 ought to be so placed, that the concave edge may look forwards, and 

 it is allowable to rotate the vertex into the hollow of the sacrum, pro- 

 vided all hope of bringing it to the pubis has failed. 



There is one position of the child's head in which it is recom- 

 mended to introduce the right hand, or female blade first, viz., the 

 left occipito-iliac, according to Velpeau, where the head is trans- 

 verse, the occiput at the left ilium, and forehead at the right ; the 

 right hand blade is to be introduced first, and conducted with care in 

 front of the right sacro-iliac junction, as high up as the forehead ; 

 then by the assistance of the fingers of the left hand, placed under its 

 convex edge, and in concert with the right hand, move it from behind 

 forwards, and from right to left, until its concave edge is turned to- 

 wards the left iliac fossa, and the blade has arrived upon the right 

 parietal protuberance. The handle, strongly depressed, is then given 

 to an assistant, who holds it against the woman's left thigh. 



The lefi; branch is held in the left hand, and passed up along the 

 posterior part of the pelvis, until its point is above the superior strait, 

 and the pivot even with the mortice that is in the other branch. 

 After having joined them, and dislodged the head, if it be still in the 



