96 OBSTETRICS. 



superior strait, and forced the occiput to descend into the excavation, 

 provided it were not already there, the concave edges of the instru- 

 ment are gradually brought to the front, and the remainder, of the 

 operation is conducted as in the occipito-pubic positions. 



Dr. Meigs describes a similar operation, when the head is trans- 

 verse, but lower in the pelvis, with the vertex resting on the left 

 ischium, and the forehead on the right. 



" When the instrument has grasped the head in this position, the 

 handles will project very much towards the left thigh in abduction ; 

 but if we introduce the male blade first, inasmuch as its handle will 

 project towards the left thigh, it will occupy all the space on that 

 side, and prevent the insertion of the second branch, for there is no 

 place in which to depress the handle. To avoid this difficulty, take 

 the female blade in the right hand, and introduce it into the posterior 

 and right side of the vagina, causing its point to sweep over the face 

 to the right side of the head, behind the pubis, leaving the handle to 

 project towards the left thigh. Next take the male blade into the 

 right hand, and turning the concave edge of the new curve down- 

 wards, insert the point into the right side of the vagina, below the 

 female branch. Let the foetal face of the clam apply itself to the 

 convexity of the head, and slide it onwards, and in proportion as it 

 enters, make it sweep round the crown of the head towards the back 

 of the pelvis. In effecting this, the handle comes gradually down 

 as the clam gets on the left side of the cranium, and at last the lock 

 is found where it ought to be, viz. : under the upper or female blade, 

 with which it is then locked." 



Having ascertained that the head is properly grasped, the attempt 

 may be made to rotate it, and the latter stage of the operation will 

 be the same as already described. 



Right occijnto-iliac position. — The only difference between this 

 and the left occipito-iliac position is in the application of the forceps, 

 in doing which the left blade is applied first. 



The forceps are sometimes necessary in face presentations. In 

 these cases they may be applied to the sides of the head, as in the 

 preceding. In those examples in which the chin comes to the pubis, 

 the method of application is the same as when the vertex is at this 

 point ; but in those in which the forehead is at the pubis, the handles 

 must be very much depressed at first, as in the occipito-posterior 

 positions ; as the case proceeds they must be strongly elevated, so 

 as to draw the chin down to the fourchette, over which it must slip. 

 As soon as the chin is free the handles must be allowed to descend 

 again, whilst the traction is continued until the head is born. 



In cases of locked or impacted hcad^ instead of applying the for- 

 ceps to the sides of the head, one blade is passed over the face, and 

 the other over the vertex, for this reason ; it generally happens when 

 the head is thus locked, it is in its transverse, or bi-parietal diameter, 



