Another objection to the use of the vectis is, that it requires one of the hands to be employed as a fulcrum, in order to prevent injuring the soft parts against which it would otherwise rest : and that while the hand is so employed, the peri neum is neglected to the hazard of its being lacerated ; and that if we chose ra ther to take care of the perineum, the soft parts are violently pressed against the bone, by which they suffer great pain and injury.
The forceps consists, as we have alrea dy said, 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 instrument ; and now having two levers united by a joint, we need not look to the pelvis to furnish the fulcrum, neither need we neglect the perinzum. There is still a query, that if the forceps be so much better than the vectis, how is it that the vectia is still in use by some ? for no other reason than because it is easier to use ; for one instrument requires less skill than two, and for that reason it is preferred by those who have not more skill than they know what to do with. They say they think it is best, and with them so it is. The man is simple, the instrument should therefore be simple. The complex instruments are safer in the hands of those only who have learned all the uses of them as well as the modes of managing them. Though, as to instru ments of every kind, the knowledge of them and the way to use them dexterously can never be taught ; they must be used before the management of them is ac quired. It is only learned by practice ; just as the habit of stopping the notes correctly on a stringed instrument of mu. sic.
In the Application of the Forceps we must first learn the state of the pelvis ; if that be narrow or deformed, we next cal culate 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 ascertain 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 be then applied is this, we know the instrument to be so much longer than the finger, that if from the os externum the latter be able to reach the ear, the former will effectually encompass. the head. The next thing after feeling the ear, is to ascertain the exact position of the head, which being done by examina tion of the sutures and fontanelles, 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 unable to turn the head round, we maytben apply the instruments to it as it lays ; first feel ing for the occipital bone and fontanelle; and if in examination we be abletofeel the posterior fontanelle, we know that the oc ciput must be somewhere in the range of the pubes, which will be more precisely determined by the direction of the sagit tal 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 forceps, 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; be cause 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 direction of the in. strument, which should at its point be pressed towards the centre of the head, and passed forward with a gentle riggling motion, which serves to form itself a space . between the uterus and the head, taking care also to keep the handle of the for ceps outward, so that we may assist our intention of keeping the point of the blade close to the head. In carrying the instrument 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 ute rus, and should 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 introdu ced, the instrument is next to be and it is convenient to pass the finger se veral times round the lock, to see that no hair or skin is included, which might give some uneasiness to the patient at the time of using the instrument; and before be ginning 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 to wards expulsion while unassisted. It is nut possible to bring the child into the world without pain.