of the child's head, and that there are no contra-indications to delivery by the forceps, proceeds to apply it.

The blades, for purposes of designation, are known as right and left, corresponding to the right and left sides of the pelvic canal. The left blade should be introduced first on account of the method of locking. The left blade, grasped near the handle with the left hand, is introduced into the vagina (Plate IV and Fig. 37). Two or more fingers of the right hand passed into the vagina until the head is felt will serve as a guide to its

Fig. 37.-Introduction of the Left Blade of the Forceps.

introduction. The blade is made to glide along the palmar surface of the right hand and pass between the fingers of that hand and the head. It is necessary to remember the two curves of the forceps in introducing it. As the blade passes the fingers the handle is to be depressed and carried slightly outward. At no time must force be used in its introduction. If the blade cannot be made to easily adjust itself, it is better to withdraw it entirely and make another attempt. Force is so certain to do injury to the soft parts that it is never justifiable.

After the left blade has been introduced its handle should

be given into the hands of an assistant, and the right blade introduced. Here the left hand acts as the guide and the right hand manages the blade (Fig. 38). No attempt should be made to introduce the blades during a contraction of the uterus.

It is customary to apply the blades first to the sides of the pelvis, irrespective of the position of the child's head, and afterward, if possible, have them grasp the child's head in its biparietal diameter. As soon as the blades are passed and adjusted, they should be locked (Fig. 39). This is usually accomplished easily by slightly depressing both handles. Should

Fig. 38.-The Left Blade Introduced; the Right Blade (in Outline) Ready to be
Introduced.

this not accomplish the desired end they may be advanced or slightly withdrawn, and another attempt made to lock them. Forced locking must not be attempted. The very fact that the blades will not easily lock indicates that there is either faulty application or else the case is not one in which forceps should be used.

There is no operation which calls for more gentleness, judgment, and patience than the application of forceps. It is always necessary to bear in mind the possibility of including the

mother's soft parts in the grasp of the forceps, and the injury which would result therefrom.

It is necessary to study the subject of forceps operations in their various phases, inasmuch as they each present their own peculiarities.

The operations may be divided into low, medium, and high applications. Again, whether the occiput is anterior or posterior, and whether the head is proportionate to the pelvic canal

or not.

The Application of Low Forceps, Occipito-anterior Position,

Fig. 39.-The Forceps Adjusted and Ready to be Locked.

Head and Birth-Canal Proportionate.-This operation is the most simple of all forceps deliveries. It is indicated when for any reason it is an advantage to mother or child that the labor be terminated. These are the cases where non-interference so often results in injury to the mother's pelvic floor, the head remaining on the pelvic floor for so long a time that the levator ani muscle and the triangular ligaments are not able to regain their tonicity after the labor and their diaphragmatic action is impaired.