470 USE OF THE FORCEPS. 



tions of the womb, is one of the cases for which the forceps is most 

 frequently applied. When the head passes with difficulty through 

 the straits, and the woman is exhausted with vain efforts, the efficacy 

 of this instrument is not contested by any one; but this is not the 

 case where there is inertia only, without any narrowness of the pas- 

 sages. Here every thing should be tried with a view of restoring 

 tlie action of the womb, and the forceps ought not to be made use 

 of until after the ergot has been tried in suitable doses. 



1057. Accidents. When the child presents by the vertex or by 

 the face and one of the complications pointed out in another article 

 renders it necessary to deliver the woman without delay, one of the 

 two following conditions will necessarily exist: 1. The membranes 

 have been ruptured and the waters discharged for a long time; the 

 womb is strongly applied to the foetus, and the head has reached 

 the excavation, or it is at least pretty firmly engaged in the superior 

 strait; in which case nothing can supply the place of the forceps; 

 2. The OS uteri is dilated, the head is engaging, the membranes are 

 ruptured: strictly, the forceps might be applied: but the child is 

 still sufficiently movable to admit of our going in search of its feet. 

 In this case practitioners are not agreed as to the best mode of pro- 

 ceeding; some think, with Levret, Smellie, Plenck, and especially 

 with M. Flamant, that the forceps promises greater advantages than 

 turning; others, along with Madame Lachapelle, M. Desormeaux, 

 and almost all the modern practitioners, are of a contrary opinion. 

 I think there is error and reason on both sides. M. Flamant speaks 

 the truth when he maintains that the forceps is much less dangerous 

 for the foetus than turning by the feet, and that it is to be preferred 

 in all cases where too much difficulty does not arise in its applica- 

 tion; but he relies too much upon his personal address, and certainly 

 inculcates a dangerous principle when he affirms that turning and 

 delivering the child by the feet is almost never necessary; and that, 

 however movable and high up above the abdominal strait the head 

 may be, the forceps is always to be preferred. 



1058. Every accoucheur knows that if the head is still movable, 

 it will displace itself during the introduction of each branch of the 

 forceps, and most generally is difficult to get hold of; that as the 

 blades of the instrument cannot in reaching it be accompanied by 

 the fingers, unless, as is M. Flamant's practice, the whole hand is in- 

 troduced into the pelvis, they are in some measure introduced at 

 hap-hazard into the uterine cavity; that it is most generally impossi- 

 ble to say, exactly, whether ihey embrace the occipito-frontal diame- 

 ter, rather than any other; finally, that the woman is exposed to a 

 thousand dangers, whereas the feet may be brought down with far 



