PARTURITION. 
vanced for the application of the fhort forceps when the 
ear of the child can be felt, or, if that is impra< 5 iicable, 
when the head of the child has defcended within an inch 
of the os externum. But the long forceps may be ufed 
whenever the circle of the uterus is obliterated, or fo 
much dilated that the head of the child is likely to 
emerge without producing laceration. When the diame¬ 
ter of the pelvis is not two inches and a half, no good 
can refult from the ufe of the forceps; and, even in 
cafes where the pelvis is of thofe dimensions, it will be re- 
quifite to ufe inftruments the blades of which are not 
fo wide apart as thofe in common ufe. 
The following are the moll approved rules for the ap¬ 
plication of the forceps. The hips of the patient Ihould 
be placed quite on the edge of the bed, to obviate the in¬ 
convenience with which the upper blade would be intro¬ 
duced, if the mattrefs, &c. remained in the way. Then 
the accoucheur, kneeling down, and oppoling liimfelf to 
the axis of the pelvis, Ihould carefully introduce the fore¬ 
finger of his right hand over the ear of the child as far 
as poffible ; he Ihould then pafs the inferior blade of the 
forceps between his finger and th6 head of the child : 
if, in fo doing, the point of the blade Ihould come in 
contact with the ear of the child, the handle mull be ele¬ 
vated till the point has palled over the obftru&ion, Ihould 
be deprelfed again immediately, and pulhed llowly for¬ 
ward, keeping the point clofely in contact with the child 
to avoid inclofing the os uteri. This blade is to be kept 
in its fituation by the third and little fingers of the left 
hand, while the fore-finger is inferted over the ear of the 
child, and after it the fuperior blade of the forceps, ob- 
ferving the fame care, with regard to the ear and os uteri, 
as in the introduction of the inferior blade. 
The next part of the operation confilts in locking the 
inftrument; in doing which, care mull be taken not to 
include any of the foft parts, or of the hair; fuch an acci¬ 
dent being productive of great pain. The locking of the 
blades is fometimes attended with difficulty; it is 
generally neceffary to withdraw one or both of them a 
little way, and crofs them in different directions until 
the Hop or Ihoulder of each can be felt on the outfide of 
the other. When thus fixed, the handles may be fattened 
together with a piece of tape, but not fo tightly as to 
comprefs the head ; and the operator may proceed to the 
extraction of the child; in the performance of which, 
particular attention mull be paid to the different axes of 
the brim, cavity, and outlet, of the pelvis. When the 
obftruCtion is at the brim, (in which cafe the long forceps 
are ufed,) traCtion mull be made with the handles of the 
inftrument as near as pofiible to the anus; when in the 
cavity, force mutt be exerted in a direction a little way 
removed from the perineum; and, when at the outlet, 
the handles of the inftrument Ihould be pulhed towards 
the pubis, and extraClion performed clofe to the fuperior 
part of the vagina. In all thefe fituations, a lateral mo¬ 
tion Ihould be conjoined with direCl traCtion ; and, du¬ 
ring thefe exertions, the handles of the inftrument Ihould 
be held firmly for the purpol'e of comprelfing the head of 
the child. But, in all cafes, the force at firft ufed Ihould 
be very moderate, and is to be increafed as occafion may 
require ; for, if the head advances at all, however llowly, 
with the force firft applied, it need not be increafed ; be- 
caufe, as Dr. Denman has very truly obferved, “ a Small 
degree of force continued for a long time, will in general 
be equivalent to a greater force haftily exerted, and with 
infinitely lefs detriment either to mother or child.” An 
invaluable little work, entitled “ Aphorifms on the Ap¬ 
plication and Ufe of the Forceps and VeCtis,” by Thomas 
Denman, M.D. Ihould be in the hands, and impreffed on 
the memory, of every praClitioner in midwifery. 
3. Of the long forceps we have met with no printed de- 
fcription but that by Dr. Conqueft, who calls it “ an in¬ 
valuable inftrument.” It is not, however, anew difco- 
yery, as it was “ originally employed by Levret; and, 
Vob. XVIII. No. 1276. 
717 
although it has fince been fomewhat modified, and recom¬ 
mended by feveral refpeClable authors and lecturers, it 
is but little known, and much lefs eftimated, or it would 
be employed by accoucheurs as a moft important fubfti- 
tute for the perforator and crotchet, in many of thofe 
cafes in which children are now deftroyed.” 
This inftrument is principally applicable ; Firft, to 
thofe cafes of deformity at the brim of the pelvis, in 
which the diminifhed capacity of the pelvis is from facrum 
to pubes, and yet fo flight, that a little power beyond 
what the uterus can employ would expel living children 
which are now almoft univerfally facrificed at the fhrine 
of prejudice. Secondly, to thofe cafes of hemorrhage, 
convulfions, &c. in which the head of the child is refting 
on the fuperior aperture of the pelvis; and in which, de¬ 
livery, being effential to the well-doing of the mother, is 
now ufually effected by opening the head of the child. 
The long forceps, in contra-dittindtion to the fliort one, 
is to be applied over the occiput and face of the child, fo 
that the convex edges of the blades may correfpond to 
the concavity of the facrum. When ufed, the power may 
be exerted laterally, or from fide to fide, with moderate 
tradlion, remembering that the axis of the brim of the 
pelvis requires the handles to be kept backwards towards 
the os coccygis ; but, as the head defcends, its moft fa¬ 
vourable pofition in relation to the pelvis mull be fecured. 
Dr. Conqueft concludes, “ It has been extremely grati¬ 
fying to myfelf and to feveral highly-efteemed friends, 
to have been, by this means, inflrumental already 
in refcuing not a few children whofe heads had been con-- 
demned to be opened.” 
4. The fillet, or lacque, is very feldom ufed in modern 
pradtice. It confifted of a ftrip of ftrong cloth formed 
into a noofe ; and it was fometimes contrived with whale¬ 
bone or fteel, fo as to be more eafily palled over the chin, 
or round the neck of the child, and thus to give the ope¬ 
rator the means of ufing much force to extradl the head. 
Before the forceps became generally known, the pradli- 
tioners of midwifery entertained a very high opinion of 
the merits of this inftrument; as may be judged, from 
the care taken by different perfons to inculcate a belief 
that they poffeffed a fecret and fuperior method of form¬ 
ing and employing this contrivance; and alfo from the 
high price which was fometimes demanded for the fale of 
this l'uppofed fecret; which, in the cafe of Dr. Birch, 
was 500I. It is impoffible to diveft onefelf of the opinion, 
that there was frequently much of trick in the ufe of this 
contrivance; that the operator claimed for liimfelf the 
merit of having effected the labour by his fkill and ad- 
drefs in employing an inftrument, when in fail the pa¬ 
tient was indebted to nature alone for her delivery; for 
it is fufficiently apparent that this kind of inftrument 
was inadequate to the purpofe of fafely terminating the 
delivery in cafes of real difficulty. 
Probably there is no prailitioner now living in Eng¬ 
land, who has w'itnefl'ed the ufe of the fillet in natural 
prefentations. The late Dr. Merriman, when young in 
practice, was engaged to attend a woman of her fecond 
child. In her firft labour fhe was delivered by a mid¬ 
wife ; the child came footling, and, after a very painful 
labour, it was ftill-born. When her fecond labour came 
on, which was preceded by a difcharge of the liquor am- 
nii, fhe fent for Dr. M. who, finding the pains to be very 
inefficient, left her. For two days little progrefs was 
made; but on the third the os uteri began to dilate, 
though very llowly, the head continuing very high in the 
pelvis. The lofs of the firft child having made the friends 
of this patient very anxious refpedting her, it was pro- 
pofed that another accoucheur fhould vifither; and, this 
being agreed to, Dr. R. a native of France, and an accou¬ 
cheur of much celebrity, was fent for. On examining 
the patient, he gave it as his opinion, that fhe might be 
fpeedily delivered, if affifted by the fillet, and politely 
propofed that Dr. M. fhould endeavour to deliver with 
8 U that 
