THE FORCEPS.
History.
Schroeder has well said, obstetrics remained so long in the hands of the midwives, from the lack of proper instruments to save the mother and the child, and because the accoucheur only interfered in case of Leta] death. Not that the ancients did not endeavor to devise means for extracting living infants, but they had recourse either to more or less complicated manual means, or else to dangerous or imperfect instruments, and, therefore, the death of the foetus was necessarily the result of their manipulations.
In the eleventh century, Avicenne devised an instrument for saving the child, and in 1554 Jacques Rueff described a similar one. It was not, however, till 1647, that the Chamberlens invented the true forceps. Up to 1721 the instrument had to fight its way into favor, for, in that year, we find Lamotte absolutely condemning it. Times changed, how ever, and to-day this remarkable and inoffensive instrument saves an in calculable number of children, who otherwise would almost infallibly die. And what modifications in the instrument since the days of the Chamber lens. From Chamberlen to Tarnier! We simply aim below to describe the most important modifications of an instrument which now resembles only in principle the first forceps of Chamberlen and of Palfyn.
Description of the Principal Forceps.
In 1618 Dr. Causardine found, in an old chest in a house formerly in habited by the Chamberlens, four models of forceps, and it is thus proved that to them belongs the honor of having devised this instrument, al though, to their shame be it said, they concealed for many years an in strument so useful to humanity. In 1688 the forceps was sold to Roon• huysen, and by him to Nicholas Boclkmann and to Ruysch, and it was not generally known till 1753, when Jacob de Vischer, and Hugo de Poli, who had bought it from the wife of Jean de Bruyn, under the name of Itoonhuysen's lever, described it. The original Chamberlen forceps con sisted of two fenestrated branches, crossed, and articulated by a pivot, like that of a pair of scissors. (Figs. 32, 33, 34.) In England, from 1668 to 1728, Drinkwater, Giffard, and Chapman, used the Chamberlen instrument, and in 1713 Palfyn, of Gand, presented to the Paris Academy of Medicine a forceps composed of two blades, not crossed, not fenestrated, greatly curved. (Fig. 35.)
In 1733, Dus6e modified this forceps by increasing the curve of the blades, and adapting to the handles two hooks turned outward.
In 1734 to 1735,Giffard and Chapman used fenestrated blades. It was not, however, till 1747, Levret, and 1752, Smellie, that the forceps was much perfected. Up to the time of the former it was straight, and he gave it the pelvic curve. Five years after, Smellie gave it a still greater curve in order to adapt the instrument to the head above the brim, and further lengthened the blades. (Figs. 36, 37, 38.) Since then the modifications in the forceps of Levret and of Smellie are only in slight details, and Levret's forceps is still the type of all others.
Every forceps is composed of two blades—the male, the left blade, be cause it goes to the left of the pelvis, the pivot blade; and the female, the right blade, the lock blade. Each blade is made up of a fenestrated por tion, an articular portion, a handle.
The blades are always fenestrated, in order to make the instrument light, and that it may the better adapt itself to the head. They present a double curve along the borders and along the inner surface. The former is Levret's pelvic curve. The blades alone enter the pelvis.
The articular portion varies with the country and the instrument.
The handles are for manipulating the instrument, and are terminated by two hooks turned outward. They unite at the lock, or articular por tion.
Levret's Forceps were variously modified, and are thus described by Naegele and Grenser: " His first instrument was 18.9 inches long, of which 6.8 belonged to the blades. It was fenestrated, and the internal surface was scooped out like a gutter. The handles were of metal, and ended in hooks turned outward. The cephalic curve was slight, and the ends of the fenestue were 2.7 inches apart. His second instrument pos sessed the new curve; the extremities of the fenestra were 3.4 inches above the horizontal line when the forceps lay flat. Its length was 17.2 inches, 7 inches of which belonged to the handles; the greatest width between the fenestra was 3.6 inches. It had a screw lock.