THE VECTIS, OR LEVER. 97 



one parietal protuberance being held at the pubis, and the other at 

 the projection of the sacrum ; there is not space enough, therefore, 

 at these points to admit the blades, and if they are to be applied to 

 the head, it can only be on those parts that are free from great 

 pressure, as the face on one side, and the occiput on the other. 

 After applying the forceps in these cases, they should be well pressed 

 together, to prevent their slipping when the traction effort is made. 

 The motion from handle to handle, assisted by the traction, will 

 generally be sufficient to disengage the head, after which the forceps 

 should be removed. 



Lastly, in pelvic presentations, when the trunk is delivered, and 

 the head detained, the method of proceeding is as follows : if the 

 face is in the hollow of the sacrum, the body, wrapped in a napkin, 

 should be raised upwards, and held in a position nearly perpen- 

 dicular; then the left branch is introduced and applied to the head, 

 from the chin to the vertex, afterwards the right is adjusted, follow- 

 ing the same rules as when the head descends first. 



If, however, the occiput is in the hollow of the sacrum, and it can- 

 not be turned to the front of the pelvis by manual assistance, the 

 child should be carried back over the perineum as far as can be 

 done with safety to its neck, and the forceps introduced in front of 

 its body, as before. In extracting the head, we should endeavour to 

 act with such force as to cause the chin and forehead to emerge 

 under the arch of the pubis. 



In all cases the trunk is to be turned towards the direction in 

 which the occiput looks, and the forceps introduced along the sides 

 of the head, in such a way that the concavity of its edges may be 

 towards the front, or brought there in the progress of the operation. 



Under whatever circumstances the forceps are applied, the extrac- 

 tion should always be performed in the line of the axes, and always 

 with gentleness. 



THE VECTIS, OR LEVER. 



A just idea of this instrument will be had, by considering it as one 

 blade o? t\\Q forceps^ a little lengthened and enlarged, with the handle 

 placed in a direct line with the blade, that is, without any lateral 

 curvature. 



The general conditions and circumstances of labour before 

 stated as requiring and allowing the use of the forceps, will hold 

 equally good when the vectis is intended to be used. Three modes 

 of using this instrument have been suggested ; either as a lever of 

 the first order, or as an antagonist to the left hand introduced into 

 the pelvis, or as a simple tractor ; the last is considered the only 

 safe method. If used as a lever of the first kind at all, the fulcrum 

 should be made by the hand of the accoucheur, and not by the soft 

 parts of the mother, 



9 



