I subjoin here a drawing, Fig. 124, taken in the camera lucida, of

Fig. 124.

my Davis's forceps made by Botschan, applied to the head of a child. It will be seen by inspec tion of the concave edge of the new curve, that that edge is not very much bent, while the convex edge of the curve represents almost the quadrant of a circle; and as the convex edge turns upwards to join the handle, which springs mainly from the concave edge, and is continuous therewith, it follows that, when the instrument is introduced into the cavity of the pelvis, it rests easily therein, because it does not strain back the anterior edge of the perineum to wards the anus, or, what would be worse, even near to the point of the coccyx, as must happen when

the head is seized high up in the pelvis with any other instrument. The edge of the perineum, in using this instrument, comes forward almost as far as the line which is continuous with the concave edge of the curve. The great advantage attending the use of Davis's forceps, weighing ten ounces and three-quarters, is found in its lightness, and in the shortness of its handles, which, while they afford all the requisite purchase for making powerful and dangerous traction, yet from the shortness of the lever, serve to guard the child against the mischiefs of excessive compression; and I am convinced that the obstetric forceps was never designed to act as a compressor, but only as a tractor and double lever. Dr. Davis's implement is forged in such fashion that its interior face is perfectly adapted to the convexity of those parts of the head which it touches; while the fenestræ permit considerable portions of the parietal protuberances to project as segments of curves outside and beyond the fenestral openings. It would be true to say that the instrument, when accurately adjusted upon the sides of the cranium, scarcely presses the maternal tissues within the pelvis, for the exterior curves are formed so accurately that the tissues of the mother can never touch the edges of them; so that they cannot be cut by them, the surfaces of contact being everywhere broad and gently rounded. The admirable form of the old-curve or head-curve enables the instrument to touch large portions of the cranial surfaces, pressing them equably, not unequably: so that, indeed, when the instrument is accurately applied, it would be a difficult matter to do with it the least injury to the foetus, since it can scarcely slide. I prefer it for ordinary cases to all the other instruments that I have seen or heard of.

Each blade of this forceps is provided with a supplementary counterpart much narrower than the principal blades, which may be usefully resorted to in cases where, after easily adjusting the first blade, the apposition of the second blade is found to be difficult, dangerous, or impossible, in consequence of that portion of the head which the blade ought to cover, being jammed with violence against the bony wall of the pelvis. Under such circumstances, a narrow blade might admit of adjustment, whereas a broad one could by no means be safely applied.

I fervently desire the Student to have a proper idea of the meaning and intention of the accoucheur in using the obstetric forceps, for his course as a practitioner will depend much on the impressions he receives concerning the nature and design of the instrument. If I were possessed of such place and reputation in the world as might give to my opinion any semblance of authority, I do not know in what man

ner I could exercise such authority more favorably to the interests of humanity, in this particular, than by establishing the doctrine that the obstetric forceps is the child's instrument; that the perforator, the crotchet, and the embryotomy forceps, are instruments for the mother; and that the Cæsarean operation is an operation to be performed solely for the benefit of the parturient woman.

If a woman in labor is in a situation demanding immediate delivery by instrumental means without any reference to the interests of the child, it is clear that, to lessen the volume of the cranium by perfora tion and extract it with the crotchet or with my embryotomy forceps, is the safest as well as the swiftest method that can be employed; and every accoucheur should prefer this method in a case exhibiting undeniable proofs of the death of the foetus. Hence I repeat that the obstetric forceps is designed to save the child, and that the relief which it gives to the mother is but an appurtenant to it.

It is true that, in the conduct of a labor, the accoucheur shall often come to the conclusion to deliver with the forceps on account of some excessive pain, inability, or danger to which the woman is exposed; and this in cases where he would not adopt the resolution from views relative to the safety of the child alone.

In this sense, then, the Student might reply that the forceps is the mother's instrument; to which I answer, nay, but it is the child's instrument; and I select it for my operation only because it makes the child safe, which could not be were I to use the mother's instrumentsto wit, the perforator and the embryotomy forceps. I dare not to use the mother's instruments in contravention of the rights of the child, but I may with the child's instrument relieve the mother, and save her, while I do it no injury.

If the Student should take his impressions of this duty from study. ing the English books of midwifery, he will go into the world believing that the obstetric forceps is the mother's instrument, and he will use it for her, and for her alone; whereas, should he adopt the views above set forth, and which I deem to be perfectly sound and practical, he will enter upon his career feeling and knowing that he possesses an apparatus with which to rescue the child when in danger; and he will employ the instrument as often from indications relative solely to the child, as from indications relative solely to the mother; and he would, cæteris paribus, become a better accoucheur than the European Student, who, it seems to me, does not know more clearly than Chamberlen himself did, that the forceps is really designed for the rescue of the child. He will save more lives; for he will rescue many an

infant that but for such intervention would be stillborn; and he will save many a mother, who in Europe is allowed to test the spontaneous power up to a point at which embryotomy becomes indispensable to save the mother, a point at which she too often begins irrecoverably to sink.

The obstetric forceps is designed to be applied only to the cranium; it should never be applied to the pelvic extremity of the child.

The blades are to be applied to the sides of the head, the extremities of them passing up nearly as far as the chin. (See again Fig. 124.) They may be applied to the head in occipito-anterior and in occipitoposterior positions of it, and also in the transverse positions which it sometimes assumes. They may also be applied to the head in face presentations, whether the chin be to the pubis or to the sacrum; and their consummate conservatism must be frequently appealed to, for the succor of the child, in pelvic presentations in which the head cannot be extricated by the hand alone.

When properly adjusted in a suitable case, they give to the surgeon complete control over the progress of the labor.

I have said that the forceps is not a compressor, but merely a tractor; I might have said that, while it is a tractor, it is also a double lever.

In order to get a good idea of the lever-like action of the forceps, let the Student endeavor to deliver the foetus on the machine; and, for this purpose, let him employ a Baudelocque or French forceps. Hav. ing grasped the head, let him take hold of the blunt-hook of the left hand branch, and pull by that alone; and, as he pulls, very gently move the hook towards the left side, and having carried it far enough over in that direction, let him take hold of the blunt-hook of the righthand branch, and pulling gently, or even merely holding on enough to keep the clamp of that branch from sinking into the pelvis, if he carries the handle over to the right side, he will find what is meant by, and what is the great and efficacious power of the lever-like operation of the forceps when drawn from handle to handle; for, as he carries the hook to the right, the blade of the other half of the forceps will be seen to emerge a little from the pelvis; and so, by alternating the lever-like motions, he will at last find that the forceps is withdrawn wholly from the pelvis, bringing away in its clamp the head of the young child unhurt by compression.

One of the most dangerous errors relative to the forceps that a Student could take up, would be the opinion that the forceps is, in its very design, a compressive instrument. It is not so; the forceps is not a pincers, it is an extractor-it is a real tire-tête; and I think it

ought to be established as a principle in obstetrics, that, where there is not space enough for the descent of the head without the forceps there cannot be produced a due proportion by merely squeezing the head down to the required dimensions by such an instrument. If, however the Student will hold such a disproportioned head firmly with the cochleæ, and draw it downwards, the pelvis and the tissues may wire-draw it so as to enable it to pass the too narrow apertures or canal. An ounce of gold may, by a certain force, be drawn through the hole in a wire plate; while the force, a million times multiplied, could by no means drive it through from the opposite side of the same wire-plate. Lest, however, I might by the above give a wrong impression of my views, it is needful that I should state, that a head, by long pressure of the pains, may sometimes be so moulded and reduced in diameter as to pass through a pelvis smaller than the head was at the commencement of the travail; whenever, therefore, the pains cease, or are insufficient to reduce it, the forceps, used as an extractor, may assist to that end by wire-drawing it; they should never squeeze it merely to compress and diminish its dimensions; they should always embrace it firmly enough to hold on and draw it down, so that the passages may mould it as it descends.

The celebrated Baudelocque, in order to learn, by inspection, the effects of direct pressure by the forceps, procured nine stillborn children, and, by moulding their heads in the hand, restored them to the natural shape. He also procured three forceps of the very best quality, and as nearly alike as possible; he then applied the instruments over the parietal protuberances and squeezed the heads until the handles were brought into contact and tied firmly with a string, so that each head might be accurately measured while under the compression and then compared with its dimensions before the instruments were applied. Such was the force employed in bringing the handles into contact, that the instruments, though very choice ones, were all spoiled by the experiment. These excellent experiments, for the particulars of which I refer the Student to L'Art des Accouchemens, Part IV., chap. i., are commented on by Baudelocque as follows:

"It may be concluded from these experiments: 1st, that the reduction in size of the foetal head included in the clamp of the forceps, differs according to the different degrees of firmness of the cranium at birth, and the more or less complete closure of the sutures and fontanels. 2d, that this reduction cannot in any case be so considerable as has by accoucheurs been supposed, and can with difficulty, and very rarely, exceed four or five lines, the instrument acting upon the sides of the head. 3d, that the degree of reduction should never be