Before using, the apparatus must be tested by forcibly filling the bag with sterile solution. One lip and sometimes both are seized by vulsellum forceps and brought down. Usually, even in primiparas, the os is sufficiently patulous to admit the bag—if not, dilate. [Illustration: Fig. 91.—Vorhees bag in place.] The bag, emptied of residual air and fluid, is rolled up into a compact mass like a cigarette, seized with Pean forceps so that the tips extend just to the end of the bag. Turn the concavity of forceps toward patient’s left leg and introduce. As the bag enters turn the mass to the left—a quarter turn—so that when operation is completed the forceps curve faces upward. Release the lock on forceps. Connect the tube of the bag with syringe tube and force the solution slowly into bag. Pean forceps may be removed as bag fills. Remove vulsellum. Tie tube of bag with tape when bag is full—disconnect syringe. Put sterile pad on either side of tube. If pains do not start within an hour, or if compression is desired as in placenta prævia or a more rapid dilatation, then a weight of one or two pounds is attached by a tape to the protruding tube and passed over the foot of the bed. =Digital dilatation of cervix= may be indicated in cases of rigid os or where prolonged labor or some danger to mother or child requires the hastening of the delivery. No instruments are needed, but a complete anæsthetic is necessary. Thorough asepsis must be observed. The patient’s genitals and the doctor’s hands are prepared as described for labor, and rubber gloves are imperative. The gloved hands and the vagina and vulva are well rinsed with lysol solution 1 per cent. The operation must be done carefully, patiently and gently, lest the cervix be lacerated. The hand is introduced into the vagina, and first the thumb and index finger are introduced into the os and separated as widely as possible, then the second finger and so on, until the dilatation is complete. (Hirst’s method.) Another method is the introduction of the tips of both index fingers, back to back. Force exerted will dilate the canal so second fingers may also be inserted. Then patiently and gently the rigid ring of the os is overcome. (Edgar’s method.) =Episiotomy.=—This is a clean incision of the vulva, which is done to avoid an apparently inevitable and ragged tear of the perineum. The _instruments_ required are either a blunt tipped knife or a pair of blunt scissors.