486 THE LEVER. 



case it acts upon the occiput, or on a parietal protuberance like a 

 simple crotchet; in the second, it really performs the office of a 

 lever of the first kind. 



As a crotchet, the'lever offered for sale by the different cutlers in 

 the vicinity of the Ecole de Medecine, and which is very nearly the 

 instrument modified by Pean and Baudelocque, leaves nothing to be 

 desired; as a lever, I prefer one that is rather shorter, and that may 

 shut up by means of a hinge joint, which does not at all diminish its 

 strength; further, it ought to be strait from the extremity of the 

 handle to within about three inches of the end of thS blade; the 

 latter should be broad, oval and ending in a long flat root, which 

 narrows, gradually, to continue into the handle; its curve should be 

 considerable, at least greater than that of the forceps; with the ex- 

 ception of the middle part, its concavity, that which ought specially 

 to bear upon the head, it ought to be very well polished; and lastly, 

 in the construction of such instruments the best steel ought to be 

 selected. 



§. I. Use of the Lever as a Crotchet. 



1090. If then it be intended to make use of the lever in con- 

 formity to the principles of the French authors, it must be taken 

 hold of with the right hand for the right occipito-iliac position, and 

 with the left hand in a case of the left occipito-iliac position, and 

 with either hand in the antero-posterior positions. Introduced with 

 the same precautions as if it were one of the branches of the for- 

 ceps, it is passed up between the surface of the genital organs and 

 the child's head, until it gets beyond the occipital projection or pari- 

 etal protuberance, and in such a way that its concavity may be easily 

 applied to one of the parts above mentioned; as, in the occipito and 

 fronto-pubic positions, it is impossible to pass it up directly behind 

 the occiput, it must be at first carried a little to one side, and after- 

 wards conducted on the part which it is intended to depress; when 

 it is well placed, the hand that directed the blade takes hold of 

 the root of the instrument; in order to make sure that it shall not 

 slip, and that the back of it shall not rub against the soft parts of the 

 woman, the operator should employ the extracting force with the 

 hand that holds the handle, in a direction backwards, forwards, or 

 sideways; in short, in a direction opposite to that pointed to by the 

 protuberance which he wishes to depress. In general, the intervals 

 between the pains is to be selected for acting and as soon as the ver- 

 tex has reached the centre of the pelvis, the operation is complete; 

 the instrument is to be withdrawn, and the labor abandoned to itself; 

 or, if necessary, other means of assisting it are resorted to. 



