MIDWIFERY. 
first learn the state of the pelvis ; if that be 
narrow or deformed, we next calculate 
whether the head can pass ; if it be too 
small, the forceps is useless. It is best 
never to apply it, but when we are able 
to include the whole in the grasp ; to ascer- 
tain which, we should examine and feel 
the ear; when we can feel an ear, the 
head is within the cavity of the pelvis. The 
reason why we know the forceps may 
then be applied is this, we know the instru- 
ment to be so much longer than the finger, 
that' if from tlie os externum the latter be 
able to reach the ear, the former will ef- 
fectually encompass the head. The next 
thing after feeling the ear, is to ascertain 
the exact position of the head, which being 
done by examination of the sutures and fon- 
tanelles, we judge whether a change of 
position in the head might not enable the 
woman to expel the child by her own 
powers alone ; and if we find ourselves un- 
able to turn the head round, we may then 
apply the instruments to it as it lays ; first 
feeling for the occipital bone and fontanelle : 
and if in examination we be able to feel 
the posterior fontanelle, we know that the 
occiput must be somewhere in the range 
of the pubes, which will be more precisely 
determined by the direction of the sagittal 
suture. 
Supposing this known, the instruments 
are to be applied, the convex sides of the 
blades to the cavity of the sacrum,, so as to 
accord with the direction of the axis of the 
pelvis. Before the introduction of the for- 
ceps, it will be necessary to dilate the parts 
gently, especially if it be the first child. 
The blades of the- forceps must be greased 
before being passed, to ensure an easier 
passage, and then one blade first is passed 
gently up between the finger and the head 
of the child : because by this means we 
are certain no soft parts can be injured, or 
pinched by it ; further than the finger will 
reach we must depend on the proper direc- 
tion of the instrument, which should at its 
point be pressed towards the centre of the 
head and passed forward with a gentle rig- 
gling motion, which serves to form itself a 
space between the uterus and the head, 
taking care also to keep tlte handle of the 
forceps outward, so that we may assist our 
intention of keeping the point of the blade 
close to the head. In carrying the instru- 
ment up, we should always put the woman 
upon her guard to warn us if we give her 
much pain, because if we do, we know 
that we have pinched the uterus, and should 
VOL. IV. 
then withdraw the blade a little way and 
return it till we get as far as necessary 
without much pain ; which being done, the 
other blade is to be introduced in the same 
manner ; which is easily accomplished after 
the introduction of the first. Both blades 
being introduced, the instrument is next 
to be locked ; and it is convenient to pass 
the finger several times round the lock, 
to see that no hair or skin is included, 
which might give some uneasiness to the 
parent at the time of using the instrument; 
and before beginning to operate it will be 
as well to take the forceps and give it a 
sort of vibration or shake, that we may 
feel that we hold the child firmly. We 
should then explain to the patient that every 
thing relative to the application of the in- 
strument is done; but that she must not 
expect our assistance will give her no pain, 
for it must give pain, though less than she 
would feel in her attempts towards expul- 
sion while unassisted. It is not possible to 
bring the child into the world without pain. 
Now we must remember that labour 
pains are not continual ; therefore we must 
not use the forceps as if they were. The 
head will not bear constant pressure, there- 
fore we must desist every now and then 
beginning with the least possible force that 
is of any use, which may be easily increas- 
ed as may be necessary. We should rest 
frequently, and from time to tirhe go round 
the head with our finger to see how the 
business comes forward; always satisfying 
ourselves that the instrument still encom- 
passes the whole of the head. The motion 
we make with the forceps must be slow 
and gradual, inclining it very gently from 
side to side, or from blade to blade; al- 
ways acting in a line with the axis of the 
pelvis, till we can feel the occiput, when 
we move with regard to the axis of the 
vagina; using in the latter part of the ope- 
ration very little force, for the head re- 
quires very little force to bring it through 
the vagina. 
Deformed Pelvis from Rickets or Mol- 
lities Ossium. In both these diseases the 
cavity of the pelvis is often so much con- 
tracted, that it is impossible for the child to 
be brought down it whole and alive by any 
means : and hence when we meet with de- 
formity from either of these sources our first 
question should be whether there be space 
enough to allow the child's head to pass.?' 
and if the space be above three inches, it is 
sufficient, and the head may pass. Where 
it is less than three inches it is not sufficient. 
