MIDWIFERY. 
the constitution? No. While there is a 
number of little pains which last four or five 
days, is it right to leave a woman? No. 
Then why not deliver her with the forceps, in 
which there is no danger; it is only bringing 
along the child, while the mother has not 
power sufficient to do it herself. In a case 
of impaction the powers of a woman may 
be as good as those of any woman in the 
highest health. But there is a resistance 
which cannot be overcome, so that things 
are very differently situated to what occurs 
in arrest only. The bones of the head are 
wrapped over each other, the scalp is swel- 
led and wi inkled, and is so altered, that up- 
on any person feeling it who had never been 
at a labour, he would guess it to be any 
part but what it is. If it be a genuine case 
of impaction, the bead will be locked in the 
surrounding parts, producing a stoppage of 
the evacuations of stool and urine ; so that 
on this account it would be clear that the 
head filled the aperture of the pelvis. 
In the next place we must attend to the 
constitutional changes. For the first twenty- 
four hours after being taken in labour the 
woman works away very vigorously ; while 
during the last twelve hours the labour will 
hardly make any progress, and she is sweat- 
ing extremely. This state will at last 
change; it will gradually sink down to a 
mumbling half delirious state, wandering 
and low. No woman should be allowed to 
go into this state ; and if she be in such a 
situatiop, she should not be allowed to re- 
main in it. For if the pressure of the ves- 
sels upon the brain be allowed to continue, 
she will become apoplectic, Besides, there 
will be harm done to the abdominal mus- 
cles. What good will be done by allowing 
the woman to deliver herself, if (he vagina 
and bladder slough with the parts around, 
which is another thing that may happen ? 
In a consultation that was held in a case of 
this kind, it was agreed that nature certainly 
should be able to deliver the woman : she 
therefore was not interfered with; she did 
deliver herself, but lost her life for it ; she 
died, and that at a time whennn ear was to 
be felt, which certainly was a piece of bar- 
barity. It is safe to assert, that if, after w'e 
are able to feel the ear, the woman is not 
delivered in six hours, we ought always to 
deliver with instruments. We know that in 
strangulated hernia nature has, in one case out 
of 50,000, made an artificial anus through 
the side, after the parts themselves have 
sloughed off. But are we for that reason to 
avoid operating for the strangulated hernia? 
Are we to leave the patient to the powers 
of nature? There is not any difference be- 
tween pushing a man into the water, and 
not helping him out of it, if we see him 
drowning ; neither in the same way is there 
any difference between destroying a wo- 
man purposely, and neglecting to employ 
those means which, when she is in danger 
will certainly save her life. There are ma- 
ny other cases in which the forceps may 
with propriety be used: hoemoptoe, syn- 
cope, flooding, presentation of the navel 
string, rupture of the uterus; all these oc- 
currences justify its application, provided 
the case is within the power of management 
by these means, either forming impaction or 
arrest. 
We proceed, therefore, to examine into 
the origin and nature of the instruments 
usually and advantageously employed ou 
such occasions. 
ORIGIN AND USE OF INSTRUMENTS. 
Sometime towards the latter end of the 
century before last, two instruments were 
invented ; the vectis, and the forceps. 
The vectis is what the name implies, a 
lever which is intended to assist the deli, 
very of the child’s head. The forceps con- 
sists of two levers joined to each other in 
such a way that the fulcrum of each blade 
is found in the opposite half of the instru- 
ment. ' 
In employing a lever there are three 
points to be considered ; the point of ac- 
tion, the moving power, and the fulcrum 
or intermediate space between the two. 
In using, then, the vectis, the point of ac- 
tion is the head of the child. And here 
it is too obvious to need mentioning, that 
the force applied by the instrument must 
be equal do the resistance, if not superior 
to it; and then the mischief may arise to 
the parts of the child’s head so acted upon, 
producing much injury : the ear may be 
injured; the lower jaw or zygomatic pro- 
cess of the temporal bone may be broken ; 
or any part of the surface from the pres- 
sure may slough otf : these evils are by no 
means imaginary ; there are various in- 
stances recorded of each of them, and that 
under the hands of the most careful and 
dextrous men. When an instrument of 
this sort is used, it is proper to make the 
hand the fulcrum on which it acts ; now if 
the. force required be but small, this may 
certainly do well enough ; but where great 
force is required, this is a very bad support ; 
