month, when we are satisfied that a living child cannot be born at
the ninth month.

The induction of premature labour is one of the greatest improve-
ments in modern practice, because by its means the leading
principle of obstetric operations may be carried out, and both
mother and child preserved, in cases in which otherwise we could
hardly hope for such a result. We shall not occupy your time
with by-gone discussions on the propriety of prematurely forcing
labour ; it is sufficient to say, that its propriety — nay, its necessity
— is admitted in the cases which we have described to you, and
the only point to be determined, is the case in which the operation is
required. We must recollect that, independently of other objec-
tions, we have a strong reason for not inducing premature action
of the uterus if it can be avoided. The uterus is not prepared for
such a change : the cervix is still unfolded, the connexion between
the uterus and the placenta is more intimate, the circulation in
the uterus less easily diverted into other channels ; consequently,
you expose your patient to greater risk than at the conclusion of
pregnancy, and this you would not be justified in doing without
a sufficiently powerful motive. The safety of the child is your
justification; but you must have clear proof that it is in danger.
You cannot trust to an examination of the pelvis only, because,
unless distortion is great, it would be premature to say that the



INDUCTION OF PREMATURE LABOUR. 207

child cannot be delivered. The most certain evidence is the result
of previous labours, and in the diseased pelvis you have generally
sufficient proof of its necessity. Perforation may have been per-
formed in the previous labour; or with every successive labour
the contraction of the pelvis may have increased, so as to render
the last more difficult than that which preceded it. If, in such a
case, the previous dehvery were completed with much difficulty
by the forceps, you may fairly assume that the next will require
perforation. Thus, you will generally have sufficient evidence to
guide you in these cases ; but remember the induction of labour is
not suitable in ffi'st pregnancies.

Different modes of exciting the action of the uterus have been
proposed: — 1st. By direct irritation, as frictions over this organ,
artificial dilatation of the os uteri with the fingers, or by the in-
troduction of a sponge tent ; 2nd. By the specific action of ergot of
rye ; 3rd, and lastly, By deranging the connexion between the uterus
and the ovum, either by detaching the membranes from the sides
of the uterus, or puncturing the membranes and allowing the
liquor amnii to escape. Of these means the last is the most
certain, but, at the same time, one which it would be preferable
to avoid if other means were efficient for the purpose, because the
liquor amnii would ensure a more favourable dilatation of the
uterus, and the child be more secure. Ergot of rye is unsafe,
because of the child, the preservation of which is your only motive
for interfering; therefore, artificial dilatation by a sponge tent
may be first tried, and if it fail, the membranes may be ruptured
with a stilette. The action of the uterus sometimes commences
immediately, but it may not begin for twenty-four or forty-eight
hours after the operation.



208 LECTURES ON PARTURITION.



LECTUEE XIII.

OBSTETRIC INSTRUMENTS.

TheVectis: History of — Invented by Roonhuysen, De Bruyn— Secret purcliased
by Visscher, and Van de Poll — Denman, Bland, Aitken, Lowder, Gaitskill. —
The Fokceps : Invented by Dr. Paul Chamberlen, and used extensively by him
and his Sons, Hugh and Peter — Forceps contrived by Giiiard, Chapman, Gregoire
— Smellie's Improved Forceps, the Parent of those at present iised — Varieties in
the Construction of different Forceps — Objects intended by them — Difference in
the Principle adopted — Dr. Davis's Forceps, Dr. Denman's, Dr. Beatty's, Dr.
Ziegler's. — The Peeeoeator: Smellie's Scissors, Denman's, Naegele's —
Holmes's Perforators — Crotchet— Ci'aniotomy Forceps— Conclusion.

From the details of those instrumental deliveries, we wish now to
draw your attention to the instruments themselves, and, giving
you briefly their history, to point out the alterations and improve-
ments which have been made in them. First, we shall speak of
the vectis and the forceps.

Previously to the introduction of either of these instruments,,
the state of midwifery was such, that it was sufficient that a labour
was difficult, to assume the death of the child. No other opera-
tion was known or practised but perforation, and when a midwife
(the accoucheur of that day) called for assistance, it was generally
because the patient was in danger of her life. The medical man
who undertook the operation of delivering the child, did so under
the most unfavourable circumstances : the child must be destroyed,
and perhaps the parent was not saved by the operation. It is not
surprising, therefore, that the obstetrician (or man- midwife, as he
was called) should have held a very humble rank amongst his
professional brethren — like the plague, destruction seemed to
follow in his path — and, consequently, he was an object rather to
be shunned than sought after. Operative midwifery was in this
condition, when, in the seventeenth century, two practitioners.



INVENTION OF THE VECTIS AND FORCEPS. 209

one in Holland, tlie other in this country, contrived instruments
by which delivery could be accomphshed, and the child's life, at
the same time, preserved. One of those inventors was Roonhuy-
sen, a Dutch practitioner, who invented the vectis; the other,
Dr. Paul Chamberlen, the inventor of the forceps. The intro-
duction of steam did not produce a greater revolution in the
commercial world, than did these instruments in obstetric practice.
Deliveries were effected safely that before would have been
despaired of, and, not unlike our illustration, with a great
economy of time. The reputation of both men soon rose to the
highest pitch, but, I regret to add, they did not elevate their
profession to the same degree. Governed by mercenary motives,
the invention was kept secret by both, and all the aid that mystery
could give was employed to magnify its importance. It served
the intended purpose : the practice of both increased to the fullest
extent, and consequently the number of patients delivered by
these instruments was considerable. De Bruyn, one of Roonhuy-
sen's pupils, admits having delivered eight hundred women with
the vectis ; and from this you may form an estimate of the general
number of operations. In fact, the practice of midwifery assumed
a new character: formerly, parturition was left to the efforts of
nature, and very often far beyond what prudence would dictate.
If she failed, and the patient was in danger of sinking under the
inefficient efforts of the uterus, the child was dragged away by
hooks and crotchets, in whatever way the practitioner could best
accomplish it. Now, the principle was changed; art pushed
nature aside; delivery became a question of mechanical skill; and,
in these times, the principal merit of Roonhuysen and Chamberlen
was, that by their invention they could not only deliver a woman
where the natural efforts failed to do so, but also they could effect
the delivery in a much shorter time than nature could generally
accomplish, even where assistance was not so obviously required.
Dr. Hugh Chamberlen boasted, that " by this manual operation
[the forceps] a labour may be dispatched (in the least difficulty)
with fewer pains, and sooner" — than nature could — " to the great
advantage, and without danger, both of woman and child."*
These secret means of delivering women were sold from one to
another, like patent medicines, until at length the secret made its
way into the profession.

* Churchill's Operative Midwifeiy, p. 74.
P



210 LECTURES ON PARTURITION.

We have stated that Koonhuysen invented the vectis, the
use of which he taught to his son Koger, to Ruysch, and to
Bockelman. They instructed De Bruyn, and at length, after the
secret had passed through three generations, two Dutch prac-
titioners, Jacob de Visscher, and Hiigo Van de Poll, influenced
by the true spirit of science and philanthropy, purchased the
secret from De Bruyn's daughter for 5000 livres, and at once
made it known to the world. " Roonhuysen's lever consisted of
a flat piece of iron bent into a slight curve at both ends, and he
generally employed it covered with soft leather."*



Eoonhuysen's Vectis.

This simple contrivance was soon improved upon on the con-
tinent by Titsing, Morand, and Herbiniaux. Dr. Denman states,
" that when the vectis was first known in this country [England],
that described by Heister was preferred to those recommended by
the surgeons of Amsterdam. The vectis used by Dr. Cole was
like one blade of the forceps, somewhat lengthened and enlarged.
That of Dr. Griflith was of the same kind, with a hinge between
the handle and the blade ; and that of Dr. Wathen was not unlike
Palfyn's, but with a flat handle, and a hook at the extremity of
the handle, which prevented its slipping through the hand, and
might be occasionally used as a crotchet. Many other changes
have been made in the construction of the instrument, but the
vectis now generally used is of the following dimensions: — The
whole length of the instrument before it is curved is 12i inches;
the length of the blade before it is curved, 7|- inches; the length
of the blade when curved, 6^ inches; the widest part of the blade
is If inches. The weight of the vectis is 6^ ounces. The handle
is fixed in wood."f Dr. Bland, who was, equally with Denman,
an advocate for the vectis, used an instrument much straighter,
and one which could not be employed otherwise than as a lever.
Dr. Bland's vectis had the advantage of facility in the introduction ;
Denman's of security in its purchase on the head. Dr. Aitken, of
Edinburgh, wished to combine both advantages, and invented

* Churchill, p. 87. f DeniiiiUi's lutrod action, p. 28G.



AITKEN, LOWDER, AND GAITSKILL's VECTES. 211

what he called the living lever, from its motion resembling that of
the finger. A screw was fixed in the handle, bj turning which,
the blade might be curved to any extent. This instrument soon
fell out of use; the mechanism was not sufficiently strong to keep
the blade curved when any force was employed in extraction.
Lowder's vectis is made with a hinge-joint between the blade and
the handle; it can thus be carried very conveniently — unfortu-
nately too conveniently — in the pocket; there is, therefore, a great
temptation to misapply the instrument. It had been in very
general use when Mr. Gaitskill introduced an improved vectis.
He says, " The vectis should be thirteen inches long; one-half to
form the handle, the other the curve. The handle should be
made of hard wood, rendered rough, for the purpose of obtaining
a firmer hold, and made to screw on and off. Wlien the instnmient
is made with a hinge-handle it is very difl&cult to introduce, there-
fore this construction of the instrument should never be adopted."*



Lowder's vectis, with hinge handle.



Gaitskill's vectis (handle screwed on).

In the variety of these instruments you will observe a striking
difference in their curvatu.re : some are nearly straight, like
Roonhuysen and Bland's; others, like Lowder's, are very much
curved. The principle of the former is the lever ; of the latter,
the tractor. The mode in which Gaitskill applied the vectis has
been already explained; and the instrument, in its construction, is
adapted to his manner of using it ; but it cannot be so conve-
niently employed in the way we have recommended. The curve
of the blade is too abrupt, and the blade itself rather too wide, to
introduce conveniently on the pubic side of the pelvis. If the
curvature were less and the blade narrower, it would be more
suitable for the purpose indicated.

* London Medical Repository, pp. 82.3, 80, 8L



212 LECTURES ON PARTURITION.

The forceps was invented by Dr. Paul Cliamberlen, somewhere
about the year 1650 (tlie exact date is uncertain); it was kept a
secret from all, except liis sons Peter and Hugh, for more than
sixty years, and at length, in the year 1716, its principle transpired
through some channels that have not been correctly ascertained.

We have already stated the boast of Dr. Hugh Chamberlen,
that " by God's blessing and their own industry, his father,
brother, and himself, had attained to, and long practised, a way to
deliver women in this case, without any prejudice to them and
their infants." Their success had led Dr. Hugh Chamberlen to
calculate rather too confidently on the powers of the instrument ;
he seemed to think it omnipotent. In the year 1670, he went to
Paris for the purpose of selling his secret, and, it is said, had
offered it for 10,000 crowns to the first physician of Louis XI Y.
It was necessary, however, to determine its value; and a case of
deformed pelvis soon after presented itself to Mauriceau. The
woman had been altogether eight days in labour : on the fifth day
the OS uteri was fully dilated, but the narrowness of the pelvis was
such, that the head could not advance. Mauriceau was again sent
for at the end of three days more, and " declared to all the assist-
ants that the delivery could not be effected ; of which (says
Mauriceau) they being fully persuaded, urged me to draw the
child from the belly by the Caesarian operation, which I would
not undertake, knowing well that it is always very certainly
mortal to the mother. But after I had left the woman^ without
being able to afford her relief, there arrived, unexpectedly, an
English physician, named Chamberlen, who was then in Paris,
and who, from father to son, practised midwifery in London,
where he has since acquired the highest reputation in this art.
This physician, seeing the woman in the condition I have de-
scribed, expressed his astonishment that I, whom he pronounced
and affirmed to be the most dexterovis accoucheur in Paris, could
not deliver her, and promised that he would do so in less than
half a quarter of an hour, whatever difficidty he might encounter. He
accordingly went to work, and laboured upwards of three hours,
without stopping to take breath, and then being thoroughly ex-
hausted, and seeing the poor woman almost dead, he was com-
pelled to abandon the case, and avow the delivery could not be
effected, as I had declared. The woman died, undelivered, twenty-
four hours after; and I foimd, on opening the body, which 1 did



CHAMBERLEN AND CHAPMAN'S FORCEPS. 213

hj performing tlie C^sarian operation after death, that the whole
uterus was torn and pierced in several places by the instruments
which this physician had employed blindly without the guidance
of his hand, which, being one-half larger than mine, could not be
introduced."* Chamberlen left Paris in disgust, or, as Mauriceau
says, " he returned to England in a few days, seeing clearly that
there were men in Paris more skilful in the art of midwifery than
he." The case quoted does not, however, prove any great skill
on either side. Chamberlen may have killed the patient by his
violence in using the forceps, but Mauriceau left her for eight
days in labour, and, for all that we are informed to the contrary,
would have allowed her to die without relief. The case, however,
proves the indiscriminate use which Chamberlen made of the
forceps. His secret was not sold, like Roonhuysen's, so that the
instruments invented by him remained unknown for a very long-
time.

Dr. Churchill states, " About this time [1716], or soon after,
the secret appears to have been communicated to one or two, for
Dr. R. W. Johnston, when speaking of the forceps, says, ' Besides
these, I have a pair of forceps which did belong to the late Mr.
Drinkwater (late surgeon and man-midwife at Brentford), who
began practice in 1668, and died in 1728. The size and form of
this pair agree with those of Chapman and Giffard, save only that
the hooks of the handles are turned outwards.' And Mr. Chap-
man, in 1733, published a description and a plate of the instrument
which he had used from the year 1726, stating it to be the in-
strument used by the Chamberlens, but without stating whence he
procured it"t (vide fig. 7, p. 229). We have now sufficient proof
that Chapman's forceps was quite different fr-om the Chamberlens',
and, consequently, the only way in which the secret was revealed
to them was by an explanation of the principle, but not by any
exhibition, of the instrument. Chamberlen's forceps was disco-
vered by mere accident many years afterwards. It happened in
this manner, as described by Mr. Causardine. The estate of
Woodham Mortimer Hall, near Maiden, was purchased by Dr.
Peter Chamberlen, some time previous to 1683, and continued in
his family till about 1715, when it was sold by Hope Chamberlen
to William Alexander, wine merchant. In the year 1818 (more

* Mauriceau, vol. ii., pi3. 23, 24; Lee's Lectm-es, p. 291.
t ChurchiU's Op. Mid. p. 112.



214 LECTURES ON PARTURITION.

than a century afterwards), in an old chest, found in one of the
chambers of this house, certain obstetric instruments were disco-
vered, along with old coins, trinkets, gloves, fans, spectacles, etc.
Mr. Causardine's description of these instruments is as follows: —
" First we have a simple vectis with an open fenestrum; then we
have the idea of uniting two of these instruments by a joint,
which makes each blade seem as a fulcrum to the other, instead
of making a fulcrum of the soft parts of the mother ; and which
also rmites a power of drawing the head forward. This idea is,
at first, by a pivot, which, being riveted, makes the instrument
totally incapable of application. Then he goes to work again,
and having made a notch in each vectis for a joint, he fixes a
pivot in one only, which, projecting, is to be received into a cor-
responding hole in the other blade, after they have been applied
separately. It may be observed, that although there is a worm
in the projecting part of the pivot, yet there is no corresponding
female screw in the hole to receive it. Every practical accoucheur
will know that it is not easy, nor always possible, to lock the joint
of the forceps with such accuracy as to bring this pivot and hole
into opposite contact. This Chamberlen soon discovered, and
next produced a more light and manageable instrument, which,
instead of uniting by a pivot, he passes a tape through the two
holes, and winds it round the joint, which method combines suf-
ficient accuracy of contact, security, and mobility"* (vide fig. 1.
p. 227).

The instruments here described were altogether different from
those afterwards brought forward by Chapman and Giffard, about
the year 1730. Chapman was the second practitioner who gave
lectures on midwifery in London. In them, he explained the
new instrument, and the mode of its application. The forceps he
employed resembled in the shape of the blades those at present
in use; the handles were of steel and hooked at the extremity,
the blunt hooks being turned inwards. The blades were united
by a kind of mortice-lock, just like the blades of a pair of scissors.
Gifiard's were similar. Soon after Chapman published his
account of the forceps, the inventive genius of the profession was
busily employed in making improvements in it. Some of these,
as Burton's, did not deserve the name, being rather more clumsy
even than the original instrument. Others were only alterations,
without the introduction of any new principle. But in 1752,

* Med. (!liir. Trans, vol. ix. p. 18.3.



smellie's forceps. 215

Smellie's work appeared, and to liim we are indebted for the
forceps that is the basis of all the modern instruments. The
practice before his time is best described in his own words : —
*' The common way of using them [the forceps] formerly, was by
introducing each blade at random, taking hold of the head any
how, pulling it straight along, and delivering with downright
force and violence, by which means both the os internum and the os
externum were often torn, and the child's head much bruised. On
account of these bad consequences, they had been altogether disused
by many practitioners, some of whom endeavoured, in lieu of them,
to introduce divers kinds of fillets over the child's head, but none
of them can be so easily used or have so many advantages, as the
forceps, when rightly apphed and conducted according to the
directions that shall be laid down in the next section."

" Mr. Chapman, as mentioned in the introduction, was the first
author who described the forceps, with the method of using
them ; and we find in the observations of Giffard, several cases
in which he dehvered and saved the child by the assistance of this
instrument. A forceps was also contrived at Paris, a drawing of
which may be seen in the Medical Essays of Edinburgh, in a paper
communicated by Mr. Butter, surgeon ; but after Mr. Chapman
had published a delineation of his instrument, which was that
originally used by the Chamberlens, the French adopted the same
species, which, among them, went under the denomination of
Chapman's forceps. For my own part, finding, in practice, that,
by the directions of Chapman, Giffard, and Gregoire, at Paris, I
frequently could not move the head along without contusing it,
and tearing the parts of the woman (for they direct us to intro-
duce the blades of the forceps where they will easiest pass, and,
taking hold of the head in any part of it, to extract, with more or
less force, according to the resistance), I began to consider the
whole in a mechanical view, and reduce the extraction of the
child to the rules of moving bodies in different directions. In
consequence of this plan, I more accurately surveyed the dimen-
sions and form of the pelvis, together with the figure of the
child's head, and the manner in which it passed along in natural
labours; and, from the knowledge of these things, I not only deli-
vered with greater ease and safety than before, but also had the
satisfaction to find, in teaching, that I could convey a more dis-
tinct idea of the art in this mechanical light than in any other,



216 LECTURES ON PARTURITION.

and particularly give more sure and solid directions for applying
the forceps, even to the conviction of many old practitioners,
when they reflected on the uncertainty attending the old method
of application. From this knowledge, too, joined with the expe-
rience and hints which have occurred and been communicated to
me in the course of teaching and practice, I have been led to alter
the form and dimensions of the forceps, so as to avoid the incon-
veniences that attend the use of the former kinds." Smellie intro-
duced two very obvious improvements in the forceps, which have
since been retained, and may be considered the essential attributes
of the British forceps.* He first proposed the present mode of
locking the forceps, f and also had the handles made of wood in
place of iron (vide fig. 2, p. 227). These alterations have not
been followed in France. The forceps of Gregoire differed from
Chapman's only in the iron handles; Gregoire's had their hooked
extremities turned outwards ; the method of locking was the
same : these are still retained in Levret's forceps, which has been
for many years in general use in France. So that Gregoire's
forceps may be considered the parent of the French — Smellie's,
of the British forceps.

From the date of Smellie's forceps to the present day, these
leading characters have, with a few exceptions, been continued in
the construction of the British instruments, but they are almost
the only points in which they agree. The varieties in other
respects are almost endless : no two instruments are alike ; and
the zeal with which new changes are proposed and defended, the
superiority which each inventor claims for his favourite instrument,
and the constant introduction of some slight alteration, just suffi-
cient to establish the parentage of the new forceps, — this desire
for novelty would lead us to suppose that a new forceps was an
essential introduction to practice. It would be only a tedious con-
tinuation of the history of this instrument to mention in detail all
the different forceps proposed, or employed, with the names of the
inventors; it is more desirable to point out to you the varieties
suggested in the different parts of the instrument, and the objects
which they are intended to accomplish.