FREQUENCY OF THE APPLICATION OF THE FORCEPS.
It is nearly impossible to give exact statistics, for the frequency varies with the accoucheur and with the country.
In stating this we meet with the same difficulty as in the preceding. The figures vary with the accouchours. Aside from the question of oper air() ability, which is of great weight, can we compare the different con litions which call for the forceps? Can we compare forceps used in case )f inertia uteri, or of resistance of the soft parts, or of delay of the head it the inferior strait or in the cavity, with the instrument used in case of )elvie deformity, or of arrest of the head at the superior strait, or of .clampsia, etc.? What we can say is that the forceps in the hands of an expert is not )nly inoffensive per se, but is a true savior both of the mother and of the whilst in clumsy hands, or when used contrary to classical rules, t may mean grave injury to the mother and the child.
Pajot and Budin have mentioned nearly all such injuries in their theses.
For the mother, injuries of the vulva, perineum, vagina, of the cervix, of the uterus, of the rectum, the urinary organs, the pelvic cellular tissue, the vessels, nerves, bones of the pelvis, etc. For the child, every lesion from simple excoriation to fracture. There is one which is very frequent, and happily transitory, and this is facial paralysis. Nadaud, in 1872,
mentioned two cases of paralysis of the common motor of the eye, (ob served by Dr. Lisbonne, at Dublin), and cases of paralysis of the limbs observed by Smellie. Gu(niot, pilot, Depaul, Duchenne of Bologne, Doherty, and ourselves.
The danger to the infant increases, of course, with the force used, the irregular grasp and elevation of the head. Internally, the vessels of the brain may be torn, or the venous sinuses, and there are effects resulting from compression of the brain.
Poppel, in 102 cases of forceps without complication, found 61 living children, 36 asphyxiated, of whom 30 were saved, and 5 dead, mortality of 10.8 per cent.
Hugenberger in 100 cases of forceps in pelvic deformity, had 70 sick women, 30 of whom died.
•Rigaud and Stanesco have shown that the mortality increases with the degree of contraction.
Sickel, in 475,616 births, found 6,963 applications of the forceps.
Of 6,228 infants born by forceps, 5,159 living, 1,069 dead. Of 6,685 labors by forceps 5,501 mothers living, 184 dead.
As Zweifel says, "forceps applications are one-half less dangerous than version." The following tables taken from Murphy and Harper, give the figures of certain English accoucheurs :