716 PARTU 
tied. Of courfe, if uterine contractions have ceafed, all 
that can be done in this refpedl is to imitate nature by 
employing power with intervals of reft. Except under 
very peculiar circumftances, fuch as may occur in cafes 
of hemorrhage, fyncope, &c. the power employed Ihould 
be rather fteady than quick ; and, if it fecure perceptible 
advance of the child, however little the progrefs may be, 
it Ihould be confidered as fatisfadlory. 
Inftruments fhould always be introduced flowly and 
cautioufly ; and ought to be brought as nearly as poflible 
to the temperature of the body, and well anointed, be¬ 
fore being ufed. 
The extracting power fhould be employed in the di¬ 
rection of the axis of the pelvis ; fo that, if the obftacle be 
at the brim, the handle of the inftrument rauft be directed 
backwards againft the coccyx ; but, as the child advances, 
that part of the inftrument grafped by the operator’s 
hand fhould be gradually directed towards the pubes. 
Should the inftrument, when ufed, give much pain, we 
may reft allured that fome part of the mother is included 
in the grafp, and Ihould immediately change the hold. 
The inftruments molt approved in modern practice are 
reprefented on the annexed Plate. 
1. The vettis, or lever, is a very fimple inftrument, al¬ 
though capable, in unfkilful or incautious hands, of 
doing a great deal of mifchief. It has been noticed at p. 
683. and is reprefented at fig. 1. it is about 12 inches long. 
Of the comparative merits of this inftrument and the fol¬ 
lowing (the forceps), different writers and pra&itioners 
think very differently: fome have lavilhed the higheft en¬ 
comiums on the one, and men equally eminent have be¬ 
llowed the moll unqualified approbation on the other. 
We are of opinion that, in general, the forceps eft'edts 
the delivery better than the lever ; but that, in a few rare 
inftances, the lever is capable of effecting the delivery, 
though the forceps is not. As the lever is capable of 
being introduced more eafily, and at an earlier period of 
the labour, (much earlier indeed than the cafe requires,) 
it is more frequently ufed unneceflarily, and of courfe 
liazardoufly, than the forceps. What has been Hated, 
as an advantage in the lever, viz. the practicability of 
ufing it fecretly, is one of its worft properties : for it is a 
facred duty, which an accoucheur owes to his patients, 
as well as to himfelf, never to employ inftruments fecret¬ 
ly. He owes it to his patients, becaufe there can be no 
fecurity againft the rafh and improper ufe of inftruments, 
unlefs the practitioner avows his intentions, and explains 
to the friends his reafon for employing them: he owes 
it to himfelf, becaufe, if the cafe requires the aid of in¬ 
ftruments, he gains credit and reputation for his pro¬ 
ficiency and fkill. 
2. The Jhort forceps is a double lever, fo conftruCted 
that the fulcrum of each blade is in the handle of the 
other. The forceps exhibited in the engraving, at fig. 
a. differs fomewhat from thofe in ordinary ufe in feveral 
important particulars. The feneftrce are fo wide as to 
admit the protuberances of the parietal bones to pafs 
through them, by which two very important objeCts are 
fecured. 
The ftrft is, a diminution of bulk, becaufe the aim of the 
blades lie along the fides of the parietal bones, inftead of 
adding to the fize of the head, by being direClly on or 
over them, as is inevitable with Smellie’s and all fimi- 
larly-conflruCled forceps, the aim of which approximate 
too clofely to permit any part of the cranium to pafs 
through the feneflrm : in confequence of which, the dif¬ 
ficulty of parturition (prefuming it to confift in difpro- 
portion between the head and the pelvis) is materially 
augmented: and, alfo, inftead of having the hard un¬ 
yielding metal oppofed to the foft parts of the mother, 
by which their fafety is endangered, the prominences of 
the parietal bones palling through the feneflrm, when 
the forceps are well applied, will be in conta& with the 
vaginaj by which, it is obvious, there is much lefs pro- 
RITION. 
bability of its fuftaining injury, than from the blades of 
the forceps in ordinary ufe. 
A fecond diftinguifhing feature of thefe fhort forceps is 
the curvature of the intermediate part between the 
blade and the handle, and which is intended to fave the 
perineum from preffure and laceration. It is familiar to 
every practical man, that in many cafes which require 
the employment of the forceps there is great danger of 
the perineum being torn, notwithftanding the utmoft 
precaution on the part of the pra&itioner ; particularly 
in that cafe in which the occiput, inftead of being op¬ 
pofed to the fymphyfis pubis, is found defcending along 
the hollow of the facrum, (or in other words, the face 
inclined to the pubes ;) and this, it need fcarcely be ob- 
ferved, is one of the moll common caufes of protrafted 
parturition demanding the aid of the forceps, prefum¬ 
ing that the malpofition of the head has been omitted 
to be rectified in the early ftage of labour. If, in this 
malpofition of parts, the forceps are well applied, the 
points will be directed forwards to the pubis, and the 
handles backwards towards the reCtum, endangering, by 
preffure, the fafety of the perineum. Now, the fimple 
contrivance of a curvature in the fhanks fully meets this 
ferious evil, independent of the permiflion which it gives 
to the handles to be carried much further back than they 
could otherwife be, by which a firmer and more favour¬ 
able hold is obtained of the child’s head ; and for want 
of which, in many inftances, the points of the blades, 
inftead of being direCted over the cheeks and towards the 
chin, pafs on, and even wound the neck of the infant. 
This inftrument meafures, from the point of the blade 
to the extremity of the handle, iif inches. The blades 
are 5 inches in length, exclufive of the curve. Their 
greateft width is at the middle, and meafures 2^ inches; 
the feneftrae at that part being inch wide; the open¬ 
ing at the points and fhouiders being about half an inch. 
The alae of the blades fhould not exceed a quarter of an 
inch in width; and the wideft part, between the oppofite 
blades, ought not to meafure more than two inches and a 
half, or five-eighths. The fhank of either blade is juft 
two inches in length, extending from the fhoulderof the 
blade to the locking-part of the handle, making the 
blades all together 7 inches in length. The handles are 
about 4^ inches in length. The one, which, when 
viewed with the concavity of its blade upwards, and 
with the convexity of the curvature in the fhank to the 
left hand, has the low-er three inches and a half of it fo 
conftruCted as to be moveable by a fcrew, for the purpofe 
of more eafily introducing that upper handle in particu¬ 
lar cafes without changing the pofition of the woman. 
It is neceffary to the fuccefsful application of forceps, 
that the head or face prefent, that the labour be fuffi- 
ciently advanced, and that there exift not a great dif- 
proportion between the diameter of the pelvis, and the 
head of the child. It fhould be remarked moreover, that 
no cafe is commonly efleemed eligible for the application 
of the lever or fhort forceps, unlefs the ear of the child 
can be diftin&ly felt; by which time it is prefumed that 
the os uteri will be fully dilated, and the perineum fome¬ 
what relaxed : fhould the perineum be rigid, there will 
be great hazard of lacerating it, when the head is brought 
dowm. So careful have the bell profefTors of midwbfery 
been, to guard againft an improper ufe of thefe inftru¬ 
ments, that it has been laid down as a rule of practice ; 
“ That the forceps fhail never be applied, till the ear of 
the child has been within reach of the operator’s finger 
for at leaft fix hours.” This is a judicious rule, and 
ought to be generally adhered to, fince very few cafes 
indeed occur (hemorrhage and convulfions excepted) in 
which it would be unlafe to wait for fix hours after the 
ear comes within reach of the finger: nor fhould recourfe 
be had to inftruments even then, if a probable chance 
exifts of finifhing the labour fafely without them. 
Parturition is now confidered to be fufficiently ad¬ 
vanced 
