478 USE OF THE FORCEPS. 



tions that are indicated in relation to the matter in the latest publica- 

 tion on midwifery. 



§. IL Occipito-posterior Position. 



1076. The forceps ought to be introduced and fixed in the same 

 manner as in the former position; only, it is unnecessary to depress 

 the handles so much while drawing down: as the occiput, which 

 however ought to emerge first, constantly tends to lodge against the 

 anterior face of the sacrum and coccyx, which is very long and very 

 concave, more numerous difficulties must be expected, as well as 

 greater dangers to the perineum. But the operation would be still 

 more dangerous and difficult, if, as has by some been advised, the 

 concave edge of the instrument should be turned backwards instead 

 of looking towards the pubis. In the first place, to conform to this 

 precept, it would be necessary to change the posture of the woman; 

 and then it would be impossible to grasp the head at the superior 

 strait, otherwise than in a line from the anterior fontanel to the nucha; 

 in the third place, as the forceps would no longer be parallel with 

 the curve of the pelvis, its concave edge would, during the tractions, 

 of necessity press the vagina and bladder with violence against the 

 pubis, while the ends of the blades would operate in the same man- 

 ner, and still more certainly upon the soft parts behind. If, on the 

 other hand, the head should be grasped only with the view of turn- 

 ing the occiput round to the front of the pelvis, as it would be nearly 

 impossible to act at the same time upon the trunk of the foetus, we 

 should succeed only in wringing the child's neck. In this, as in 

 the occipito-anterior position, the forceps ought therefore to be so 

 placed that its concave edge may look forwards, even though it may 

 be turned towards the child's forehead, and not towards the occiput, 

 as the general rule would require. 



§. III. Left Occipito-iliac Position. 



1077. It does not appear to me that such a position, in the exca- 

 vation, is admissible; but should it ever be met with at the superior 

 strait, and require the application of the forceps, I do not see how 

 ■we could dispense with following the precept of the German accou- 

 cheurs, unless indeed we should imitate M. Flaraant, and proceed 

 beforehand to take hold of the head with the hand and place it in a 

 more convenient position; a proceeding much easier to recommend 

 than to execute, in a majority of cases. The sacro-vertebral angle, 

 the coccyx and the perineum would not admit of the instrument being 

 placed transversely; at least, it would be absolutely impossible to ex- 

 tract in the direction of the axis of the superior strait. 



