USE OF THE LEVER. 487 



§. II. Of the Ijcver used as a I^ever, 



1091. The use of the lever after the manner of the Dutch and 

 English accoucheurs, that is, as a substitute for the forceps, is very 

 simple as to its mechanism: in the first place, it is best that the head 

 should be in the excavation; then that it should have already, or at 

 least chiefly executed its pivot-movement; in the third place, that 

 there should be but a slight degree of contraction of the inferior 

 strait, or that the retardation of the labor should depend solely upon 

 a want of action of the womb, or of the woman herself. What- 

 ever may be the position of the head, the right hand must be 

 made use of for extracting with, at least in all cases where the ac- 

 coucheur is not left-handed; for the purpose of introducing it, we 

 have recourse to the right hand, if the lever is to be passed upon 

 the right side of the pelvis, and to the left hand in the contrary 

 case. 



1092. Where the occiput is in front or somewhat to the left, the 

 left hand introduces the lever, as if it were the right branch of the for- 

 ceps, in front of the right sacro-iliac symphysis; when it has passed 

 up sufficiently far, the action of the two hands is combined so as to 

 guide the concavity of its blade on to the right temporo-parietal re- 

 gion, that is to say, in the direction of the occipito-mental diameter, 

 and on the same parts that would be embraced by the corresponding 

 blade of the forceps. The left side of the vertex is supported by the 

 fingers of the left hand; the thumb, placed near to the vulva, em- 

 braces the back of the lever, to which, conjointly with the right side 

 of the pubic arch, it serves as 2. point d'appui; we are now to wait 

 for a pain, and then draw down slowly but strongly, as^ if we were 

 making a lever of the first kind swing from below upwards, and from 

 left to right; the head 'generally yields readily; it is gradually drawn 

 down in the axis of the inferior strait, which it clears as it executes 

 its extension-movement. 



In this way the force exerted upon the head acts in a direction 

 from the chin towards the occiput, or in that of a line drawn from 

 the angle of the right jaw to the left side of the vertex; so that, as 

 it is supported elsewhere by the left side of the pelvis, there is no- 

 thing surprising in the circumstance that it allows itself to be so 

 easily extracted. 



1093. Should the occiput be on the right side, in the second posi- 

 tion for example, the lever ought to be introduced with the left hand 

 but then it must be changed, as above, and the right hand seizing the 

 handle of the instrument, should also extract in the same manner, 

 with this difference only, that the see-saw movement should take 

 place from right to left, and not from left to right. 



