480 USE OF THE FORCEPS. 



front of the pelvis by means of the hands, the foetus is to be turned 

 back over the perineum, and the branches of the forceps are still to 

 be introduced as before.* But in extracting the head we should en- 

 deavor to act with sufficient force upon the forehead and chin to 

 make those parts descend early under the symphyses of the pubis. 



Lastly, should it be found on one side, the trunk ought first to be 

 moved to the right or to the left, and then we should proceed as has 

 been directed for the corresponding positions of the vertex. 



Thus, 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 shall be brought there in the progress of the 

 operation. 



1080. It is easy to perceive that the presence of the trunk must add 

 to the difficulties that are experienced in head presentations. Still, 

 many practitioners have thought, that under such circumstances the 

 fingers might be beneficially substituted for the forceps, and that it is 

 entirely useless to attempt its application where the head has not 

 yet reached the excavation. 



This seems to me to be dangerous doctrine. I know very well 

 that a skilful accoucheur will generally triumph over the difficulties 

 presented by this position without having recourse to the forceps; I 

 am also aware that the forceps, here, cannot easily be applied to the 

 head at the superior strait; but it is also undeniable that the head 

 may be arrested at the superior strait by such a degree of contraction 

 that the best combined efforts of the hand shall be insufficient for its 

 extraction; but, why should not the forceps oflfer the same advan- 

 tages in this case as in the positions of the vertex? Moreover, ex- 

 cepting symphyseotomy, what other means is there of extracting the 

 fcEtus alive? I will add, that, the trunk being without, and the head 

 in some measure beyond the reach of the uterine contractions, any 

 force exerted upon the body with the hand, and sufficient to enforce 

 its passage through the organs, will generally act on the spine of the 

 child to the extent of seriously compromitting its existence, whereas 

 the forceps does not expose it to the same dangers. 



1081. Consequently we may have recourse to the forceps, in pel- 

 vis presentations, 1. When the head is stopped by the inferior strait 

 only, and we are convinced that the powers of the hand alone 



* The woman should lie on her back, with the perineum projecting over the 

 foot of the bed. If the body of the child be now supported in a vertical position 

 by an assistant, it will be found that there will be space enough to introduce the 

 forceps on each side of the face. I have, in general, found the application of the 

 forceps quite as easy in a footling or pelvis case as in any vertex presentation. — M.. 



