Edward Rigby

THE FORCEPS.

Description of the straight and curved forceps.—Mode of action.—Indications.—Rules for applying the forceps.—History of the forceps.

Before describing the various species of dystocia, or faulty labour, it will be necessary to consider the different means with which the increasing experience of years has furnished us, of giving artificial assistance in such cases. These may be brought under two heads, first, where delivery can be effected with safety to the mother and her child; secondly, where this can only be effected at the expense of the infant’s life. Under the first head come the forceps, turning, the CÆsarean operation, and artificial premature labour; under the second are craniotomy or perforation, and embryotomy.

Of these the forceps is by far the simplest and safest means of artificial delivery, and is therefore an operation which should always be had recourse to in preference to any of the others wherever it is possible.

The forceps is the simplest imitation of nature, for in fact it is nothing more than a pair of artificial hands introduced one on each side the head. It is impossible to define any precise limits of pelvic contraction, within which the forceps can, or beyond which it cannot, be safely applied, for the difference in the size and hardness of the child’s head, and in the condition of the soft parts, will greatly modify the degree of resistance to the progress of the labour: hence the attempt to fix the exact degree of contraction beyond which the forceps becomes inapplicable is quite impracticable, as in some cases we might be led to make a trial of it where it would be quite improper, and in others have recourse to the perforator where a cautious application of the forceps would have been attended with success. For the farther consideration of this subject we must refer to the chapter on Dystocia Pelvica.

The forceps consists of three parts—the blades, the lock, and the handles.

The blades of the present forceps are not solid, but are merely elongated bows of polished metal, by which they are not only rendered much lighter, but allow the most prominent parts of the head to project between them, and thereby take up no additional room when introduced into the pelvis. In the simplest form, viz. the straight forceps, the blades have only one curvature for adapting them to the convexity of the head. The degree of curve varies a good deal in different instruments: the greater the curve the more firmly will the blades hold, because they act more or less as blunt hooks, and do not require much pressure upon the head for the purpose, but on the other hand, they are more difficult to introduce; whereas, blades which are slightly curved can be applied with greater ease, but require much more pressure upon the head in order to hold fast.

It has been a general rule with almost every modification of forceps, that the greatest distance between their blades should not be less than two inches and a half, for as this is the breadth of the basis cranii in the foetal head, it would be impossible to compress the head beyond this extent. The form of the head curvature will determine the situation of the point where the blades are most distant from each other: in some forceps it is about one-third the length of the blades from their extremities; in some it is nearly equidistant; whereas, in others it is nearer to the lock; the medium between these extremes is the best. The extremities of the blades ought to be at least half an inch apart: in this country they are usually somewhat more; on the Continent they are much less, being rarely more than one or two lines asunder. The fenestrÆ, or open spaces in the blades, should be wide and ample, for not only are the projecting parts of the head allowed to protrude between them, but the pressure of the blades is diffused over a larger extent of surface: this is remarkably seen in the forceps of the late Dr. Hopkins and that of Professor Davis, both of which are extensively used. It is also important that the edge at the extremities of the blades should be well rounded and not too thin; it is thus less liable to catch against corrugations either of the vagina or foetal scalp. The greatest breadth of the fenestrÆ is generally towards the extremities of the blades; in some, their edges are parallel; whereas, in those of Drs. Orme and Lowder the greatest breadth is near the lock: upon the whole, an oval shaped fenestra is the best, for it can be easily introduced, and has the advantages of a wide blade.

In 1751 and the following year another curve was given to the blades of the forceps by the celebrated M. Levret of Paris, and by the equally distinguished Dr. Smellie of London, by which the instrument was adapted to the curve formed by the axes of the brim, cavity, and outlet of the pelvis, and by which the head could be seized much higher in the pelvis than by the straight forceps. Each have an equal claim to the merit of having invented this “pelvic curvature,” as it has been called: the priority of the invention is perhaps due to Levret; but as he made a secret of it for some years, it is impossible to ascertain the precise fact. The pelvic curve, as it is called,[81] is especially adapted to the long forceps, which thus becomes an instrument of very considerable power. Numerous modifications of these curved forceps have since been made, but they are merely varieties of the original ones invented by Smellie and Levret, which have become the national instruments of their respective countries.

Perhaps the greatest improvements in the blades of modern times is seen in the forceps of Dr. Hopkins, above alluded to: the head curvature forms an elongated oval, admirably adapted to the form of the foetal head when considerably compressed during a difficult labour; and from the great breadth of the fenestrÆ, the pressure of the blades is applied over a large extent of surface; the pelvic curve is but slight, being greater on the posterior edge of fenestrÆ than on the anterior; the blades themselves are thin, their inner surface flat to ensure a firmer hold, their outer surface slightly rounded in order to be introduced with greater ease; and for a similar reason the edges of their extremities are somewhat thicker and carefully rounded in a peculiar manner.

The lock of the modern English forceps consists of two deep grooves, into which the shank of each blade mutually fits, so that the two blades are fixed upon each other merely by the pressure exerted upon the handles. In former times the blades were united together by a pivot, which could screw and unscrew at pleasure. This was abandoned by Chapman, who published the first work in English on operative midwifery.[82] He found that the forceps held better without the pivot than with it; and from what we have brought forward elsewhere (Med. Gaz. Jan. 8, 1831,) there can be little doubt that he invented the lock which is now generally used in this country. Chapman’s forceps was adopted in France prior to this improvement in its lock, especially by Gregoire, and has retained the original pivot lock which now forms one of the most distinguishing marks between the French and English forceps. Although the pivot forms by far the firmest lock, for the blades can never slip from each other, still the difficulty in locking, and also in separating, the blades at a moment’s notice, render it much inferior to the English lock. An ingenious modification was invented by the late Professor Von Siebold of Berlin, but the most perfect lock is that of Professor BrÜninghausen of WÜrzburg, first introduced by ourselves into this country, and commonly known among the instrument-makers under the name of Professor NaegelÉ’s forceps. The shank of one blade has a semicircular indentation, which at the moment of locking fits into a fixed pivot in the other: this, therefore, combines the advantages of the French and English locks. We can safely affirm, from extensive experience for many years, that there is even less difficulty in locking it than with the English lock: the blades are capable of instant separation, and yet when locked, the firmness of their union is equal to that of a pivot joint.

The handles of the English forceps are pieces of wood or ivory fixed upon each shank below the lock, flat upon the inside, convex externally and furnished with a depression or groove at the lower end for fixing a ligature round them. These handles were probably first introduced by Dr. Smellie, who seems to have borrowed the idea from the forceps of M. Mesnard, for the earlier English forceps, viz. of Giffard and Chapman, terminated in blunt hooks, those of the former being curved inwards, those of the latter outwards, a form of handle which has been retained in the French forceps up to the present time.

There are two pieces of forceps, the long and the short forceps; the former for cases where the head is still high in the pelvis, the latter when it is at the pelvic outlet and approaching the os externum; the former with few exceptions being curved, the latter straight.[83]

The forceps act in three ways, 1. by mere pulling; 2. as a species of double lever, by moving the handles from side to side; and 3. by compressing the head, thus still farther disposing it to elongate and adapt itself to the passage through which it has to be expelled.

The blades should always, if possible, be applied one on each side of the head, the position of which must be determined by the direction of the fontanelles and sutures, not by feeling for the ear, as is usually recommended in this country. The ear can seldom be reached without causing a good deal of pain, even under the most favourable circumstances; in cases, therefore, where the head is so impacted as to be incapable of advancing by the natural powers, it cannot surely be justifiable to force up the finger between the head and the pelvis to ascertain this point, the more so, as the soft parts soon become swollen and more or less inflamed, and, therefore, little able to bear such rude treatment. No operation requires such an intimate acquaintance with the mechanism of parturition as that for applying the forceps: it is simple and generally perfectly easy when the precise position of the head and its relations to the pelvis are accurately known; on the other hand, it is not less injurious and painful to the patient than difficult and unsatisfactory to the practitioner.

The most usual circumstances under which the forceps is applied, are where the head is already deep in the pelvis and approaching the os externum; in such cases it is generally required not so much for the purpose of overcoming an unusual degree of resistance, as for assisting the natural powers, which are becoming exhausted: the head is near the os externum, and therefore easily reached; and from there being little or no impaction present, the blades are applied without difficulty.

The application of the forceps when the head is at the upper part of the pelvis, and where the greater portion of it has not yet passed the brim, is rarely practised in this country, because as the necessity for performing the operation at this stage arises in most instances from contraction of the brim, the perforator has usually been preferred, wherever the expelling powers have proved incapable of overcoming the resistance to the passage of the head. The circumstance also of this condition requiring the long forceps has been another source of objection, from the much greater power which this instrument is capable of exerting, and from its being therefore more liable than the short forceps to prove mischievous in the hands of the inexperienced.

Cases however do occur where there is but a very slight want of proportion between the head and pelvis, where the obstacle is easily overcome, and where, but for the application of the forceps, the labour would either have been protracted to a dangerous degree, or have required the use of the perforator.[84] “On the whole,” says Dr. Burns, “I would give it as my opinion that a well instructed practitioner, who has already had some experience in the use of the short forceps, is warranted to make a cautious, steady, but gentle attempt to apply and act with the long forceps in a case where he is not quite decided that the perforator is indispensable, and where the head is higher than admits the application of the short forceps.” (Principles of Midwifery, 9th ed. p. 493.)

In applying the forceps, whether short or long, there are two conditions which, cÆteris paribus, are requisite in every case; first, that the os uteri shall be fully dilated; secondly, that the pains are within the bounds of what are commonly known as moderate pains. In the first case it will be very difficult and frequently quite impossible to pass the blades between the head and os uteri when only partly dilated; it will be difficult to avoid injuring its edge more or less, and if we do succeed in applying and locking the forceps, on making an extractive effort we shall find that the uterus descends with the head as we draw it down.

In the second place we ought never to apply the forceps whilst the pains are violent, for not only do they render its application difficult and even dangerous, but we are adding still farther to the force (already too great) with which the head is pressed against the pelvis. Where the head remains immoveable under violent exertions of the uterus, it is not a case for the forceps but for the perforator; nor does it admit of much delay, for it endangers much injury of the soft parts or even rupture of the uterus.

It is exceedingly difficult to assign any precise limits of pelvic contraction, within which the forceps can, and beyond which they cannot be applied, for the size and hardness of the foetal head, the nature of the pains, and the condition of the patient must also be taken into account in every instance; hence, we frequently meet with cases where the pelvis is scarcely if at all contracted, and yet where the labour has been terminated with the greatest difficulty by means of the forceps; whereas, in others where we know the pelvis to be more or less deformed, the child has been delivered by the natural powers. This subject will be still farther considered under Dystocia Pelvica.

The general indications for the use of the forceps are two: 1. They are indicated in all labours which are difficult or impossible to complete, either from deficiency in the expelling powers, or from misproportion between the head and pelvis, or from the arm coming down with the head. 2. They are indicated by circumstances or accidental causes, which render labour dangerous for the mother or child, and where the danger can only be removed by hastening labour, as in cases of hÆmorrhage, convulsions, syncope, alarming debility, faulty condition of the organs of respiration, danger of suffocation, obstinate vomiting, unusually severe pains in nervous irritable habits, hemorrhoids which have burst, hernia, retention of urine, determination of blood to the head, prolapsus of the cord, (in certain cases,) inflammation of the uterus, &c. (NaegelÉ, MS. Lectures.)

We have already stated that an intimate acquaintance with the mechanism of parturition is of the greatest importance in applying the forceps. Knowing that the head always presents in one of the two oblique diameters of the pelvis, and that the blades are applied on each side of the head, it follows that the forceps must always be applied in the contrary oblique diameter of the pelvis to that in which the head is. Before speaking of the operation itself, we must first consider what position of the patient will be the most convenient. In this country no alteration is made in her position, beyond bringing her close to the side of the bed, with the nates projecting as much as possible over the edge, for the greater convenience of the operator; unless this be attended to, it will be difficult to depress the handle of the upper blade sufficiently when introducing it. Upon the continent, and also in America, where the long forceps is more generally used, the patient is usually delivered on her back; she is placed in a half-sitting posture upon the edge of the bed, her back supported by pillows, &c., her feet resting on two chairs, between which the operator stands or sits, and applies the forceps in this position. This, in many respects, is the most convenient posture for him, but the very preparation which it requires cannot but be alarming to the patient, who is obliged to be a witness of all his manipulations; whereas, when she lies upon her left side, she is aware of little or no preparation being made, and if any slight exposure happens to be necessary, viz. at the moment of locking, it can be done without her knowledge.[85]

The simplest case for applying the forceps is, where the head has already descended nearly to the os externum, and has begun to press upon the perineum: it is for this that the straight forceps is chiefly intended; and as this is the instrument which is generally used, we shall describe its application first.

Mode of applying the forceps. Having ascertained that the rectum and bladder are empty, examined the position of the head, and warmed and greased the blades, we proceed to introduce the upper or lower blade first, according as its lock is directed forwards: this precaution is for the purpose of preventing the locks being turned away from each other when brought together after the introduction of the second blade. The trochanter major will guide us as to the precise position of the patient’s pelvis, and is especially useful in pointing out the direction of the left oblique diameter, in which the forceps (on account of the first position of the head being in the right oblique diameter) should be most frequently applied: in this case, we pass the upper blade, as it were, beneath the trochanter, and the lower one in the opposite direction.[86]

Let us suppose that the head is in the first position, with its sagittal suture parallel with the right oblique diameter of the pelvis, and that in accordance with the above rule, the upper blade is to be introduced first. Having passed one or two fingers up to the head, we guide the blade along them, depressing the handle so as to make the extremity of the blade lie closely upon the head, neither allowing the point alone to impinge upon the head, nor vice versÂ, to protrude against the vagina. The extremity of the blade, therefore, must be our guide for the direction in which we hold the handle: we must carefully insinuate this by a gentle vibratory motion between the head and passage which surrounds it: the convexity of the head will show the course which it has to take, nor is there any need of passing the finger farther; for when once the extremity of the blade is fairly engaged between the head and passage, it will almost guide itself, and needs little more than to be pushed on gently, the handle gradually rising according to the curve of the blade. The shank or handle should, therefore, be held lightly like a pen, by which means the operator will possess much more feeling with his instrument, than if he grasped it with his whole hand. As the blade advances, he should keep his eye on the general form of the pelvis, the curve of the loins, the situation of the trochanter and symphysis pubis, and thus gain a more accurate idea of the course which the instrument must take. This will, in great measure, depend upon the situation of the head: if it be quite down upon the perineum, the blade should be pointed towards the promontory of the sacrum, and the handle turned downwards and forwards; if it be still in the cavity of the pelvis, and only beginning to engage in the outlet, the blade must be directed upwards towards the centre of the brim, and the handle turned directly downwards. Having passed the blade to its full extent, we must press the handle backwards against the perineum, to allow sufficient room for the introduction of the second blade, and give it to an assistant or the nurse, with the caution to hold it steadily and firmly, especially during the pains, when it is apt to slip into the hollow of the sacrum if held carelessly.As we have passed the upper blade behind the right acetabulum or foramen ovale, so now we must introduce the other in the opposite direction, viz. before the left sacro-iliac synchondrosis: and, as the blades being exactly opposite to each other is essential to the easy locking of the instrument, it will be necessary to guide the course of the second blade, not so much by the form of the pelvis, as by the direction of the first blade. It must, therefore, pass up, so that when introduced to its full extent, the inner surface of its handle shall correspond precisely to that of the first blade. The easy or difficult locking of the blades is a proof of their having been correctly or incorrectly introduced. If, therefore, on bringing the locks together we find that they do not correspond, that the inner surfaces of the handles are not parallel, but form an angle with each other, we must endeavour to rectify this, by withdrawing, to a short extent, that blade which deviates most from the proper direction, and pass it up again more correctly. All attempts to twist the handles so as to correspond with each other, are bad and cannot fail to put the patient to much suffering.

When we are about to lock the blades, we cannot be too careful in preventing the soft parts from being pinched between them, for it causes most intolerable pain, and frequently makes the patient give such an involuntary start, as to run the risk of altering the position of the instrument.

The whole process of introducing and fixing the forceps should be conducted in as gentle and gradual a manner as possible: no attempt should be made to proceed with the operation during a pain; and in no case is force either necessary or justifiable.

Every thing being now prepared for the extraction, we must endeavour to make this resemble as far as possible the natural expulsion. When a pain, therefore, comes on, we should grasp the handle firmly, and pull gently, at the same time giving them a rotatory motion. The direction of the handles, as before said, will depend upon the situation of the head in the pelvis: if it be at the outlet, it will point downwards and forwards; if in the cavity, nearly directly downwards. If the head makes but little or no advance with one or two efforts, it will be advisable to tie the handles firmly together, and thus keep up a continued pressure upon it, and dispose it the more to elongate and adapt itself to the passages. As it advances and begins to press upon the perineum, we must be more than ever cautious not to hurry the expulsion, and give the soft parts time to dilate sufficiently. At this period it is desirable to make the extractive effort not so much forwards as the direction of the handles would seem to indicate: we thus avoid pressing too severely upon the urethra and neck of the bladder, which might otherwise suffer, and assist the dilatation of the perineum. When the head is on the point of passing the os externum, all farther extractive efforts should cease; the perineum must be supported in the usual manner, and the head should be expelled if possible by the patient herself.[87]

In applying the curved forceps we must bear in mind another rule in addition to the one above-mentioned for selecting the first blade, viz. the pelvic curvature must correspond with that of the sacrum. As with the straight, so also with the curved forceps, the extremity of the blade will be our best guide as to the direction in which we should hold the handle at the moment of introduction; it must be directed more or less forwards in proportion to the degree of the pelvic curvature of the blade. If, for instance, it be the upper blade which is to be introduced first, we pass it obliquely over the lower thigh or nates of the mother, making it glide closely round the convexity of the head, between it and the pelvis, without impinging either on the one or the other. As the position of the head is still more distinctly oblique at this earlier period of its progress through the pelvis, so will the blades require a more oblique direction, and also (as in the former case) they must be introduced in the contrary oblique diameter to that in which the head is.

As the blade passes up between the head and pelvis, so does the handle gradually make a sweep backwards, until at length it approaches to the edge of the perineum. During the process of introduction, one or two fingers should press against the posterior edge of the blade to guide it up to the brim of the pelvis, and prevent its slipping too far backwards towards the hollow of the sacrum.

The second blade will be guided in its direction by that of the first: it must be introduced so that the inner surface of its handle corresponds exactly with that of the first. The locking must be performed under the same precautions as with the straight forceps: the more so, as in some cases it has to take place just within the os externum, and therefore requires the most careful attention to prevent the soft parts from being caught and pinched between the blades when they are brought together. In extracting the head we must bear in mind the part of the pelvis in which it is impacted, and make our effort in the direction of its axis; we must also recollect the curved form of the instrument, and that we must not pull in the direction in which the handles point, but rather hold them firmly with one hand, and, by pressing against the middle of the forceps with the other, guide the head downwards and backwards into the cavity of the pelvis. We shall thus make our extractive effort in the direction of the upper portion of the blades, or that part which has the chief hold upon the head: hence, therefore, as it descends, the handles are directed more and more forwards, so that when it has reached the perineum, the handles will not only point forwards, but considerably upwards. Whilst extracting we should, as with the straight forceps, slowly move the handles from side to side, and even make them describe a circle: we thus not only use the forceps as a simple extracting instrument, but make it act as a lever in every direction, and greatly facilitate the advance of the head, even under circumstances of considerable impaction. It is in these cases where keeping up a continued pressure upon the head by tying the handles tightly together, and tightening it after every successive effort, has such excellent effects in diminishing the degree with which it is wedged against the pelvis and soft parts, and in disposing it by gradual elongation to assume a form which is better adapted for advancing through the passages.

The slow and gradual pressure of the forceps thus exerted upon the head of a living foetus will have a very different result to that of the experiments by Baudelocque and others, in attempting to compress the head of a dead foetus by the application of a sudden and powerful force. Even if we were capable of effecting no greater diminution of its lateral diameter than a quarter, or at the most, three-eighths of an inch, as stated by Dr. Burns, we should, in most cases of impacted head, where the forceps is justifiable, find it quite sufficient to remove the obstructing causes.

The forceps is also occasionally required in presentations of the face and nates. In the first case we must pass up the blades on each side of the face, and along the side of the head, having previously ascertained to which side of the pelvis the chin is turned. In nates cases, the blades should also be passed up along the sides of the child’s pelvis, and here the advantages of a broad fenestra will be very evident, for otherwise our hold will not be firm enough without exerting an improper degree of pressure.

Cases every now and then occur, where from convulsions, &c., it is desirable to apply the forceps whilst the patient is lying upon her back, as is practised upon the continent. “The patient is placed across the bed, propped up in a half-sitting posture, by pillows, &c., her pelvis resting upon the edge, her feet on two chairs, the knees supported by assistants. Two, and generally three fingers are passed, if possible, up to the os uteri, on the side where the blade is to be introduced: the index finger, is held a little behind the middle finger, so that this last, by projecting somewhat, forms a species of ledge upon which the blade slides, and which acts as a fulcrum to it. The handle is held at first nearly perpendicular; but as the blade advances, it gradually approaches the horizontal direction, being guided by the pelvic curve of the instrument. The middle finger, along the ulnar surface of which the convex edge of the blade slides, prevents its extremity from passing too far backwards, and directs it in the axis of the pelvis. When introduced to the full extent, the handle is inclined obliquely downwards, and is now grasped by an assistant passing his hand below the patient’s thigh. The other blade is introduced in the same way on the opposite side of the pelvis; and the locking, extraction, &c., conducted much in the same manner as in England.” (British and Foreign Med. Rev. vol. iii. April 1837, p. 419.)

History of the forceps. We have already mentioned some historical points connected with the improvements of the present French and English forceps; it will now be unnecessary to enter more fully into the history of this instrument. The earliest trace of the midwifery forceps which we possess is under the form of a secret in the hands of an English family, named Chamberlen. As to when and by whom it was first invented, this must probably remain for ever unknown; and at any rate there is no more reason to suppose that Dr. Hugh Chamberlen was the inventor than his father or brothers were. He was compelled to quit England on account of being involved in the political troubles of the time, and went to Paris in the beginning of the year 1770, and evidently had then been some time in possession of the secret. He returned to London, in August of the same year, having in vain attempted to sell it to the French government, after having entirely failed in a case of difficult labour which he had asserted he could deliver in a few minutes, although Mauriceau had stated that the CÆsarean operation would be required. Dr. H. Chamberlen published in 1772, a translation of Mauriceau’s work, which had appeared four years previously, and in his preface he publicly alludes to this secret, and says, “My father, brothers, and myself (though none else in Europe, as I know) have, by God’s blessing and our industry, attained to, and long practised a way to deliver women in this case without any prejudice to them or their infants: though all others (being obliged, for want of such an expedient, to use the common way) do or must endanger, if not destroy, one or both, with hooks.” He thus apologizes for not having divulged this secret: “there being my father and two brothers living, that practice this art, I cannot esteem it my own to dispose of, nor publish it without injury to them.”

Whether a work, entitled Midwife’s Practice, by Hugh Chamberlen, 1665, was by the translator of Mauriceau’s work, or by his father, must now remain a matter of doubt: it was, however, in all probability by the latter, from what the translator says in his preface, viz. “I designed a small manual to that purpose, but meeting some time after in France, with this treatise of Mauriceau, I changed my resolution into that of translating him.” On account of his being attached to the party of James II. he was again obliged to quit England, in 1688, and crossed over to Amsterdam, where he settled, and in five years after succeeded in selling his secret to three Dutch practitioners, viz. Roger Roonhuysen, Cornelius BÖkelman, and Frederick Ruysch, the celebrated anatomist. In their hands, and in those of their successors, it remained a profound secret until 1753, when it was purchased by two Dutch physicians, Jacob de Visscher and Hugo van de Poll, for the purpose of making it generally known. It turned out to be a flat bar of iron, somewhat curved at each end: this lever was stated to have been received from Roonhuysen, one of the original purchasers of the Chamberlen secret; but there is no reason to suppose that any such instrument had been communicated by Chamberlen either to him or the others, as we have distinct evidence that both Ruysch and BÖkelman possessed forceps, the blades of which united at their lower end by means of a hinge and pin. It is known also that Roonhuysen used a double instrument consisting of two blades. The above-mentioned flat bar of iron, commonly called Roonhuysen’s lever, was, without doubt, invented after his time, by Plaatman, who received the Chamberlen secret from him. (Edin. Med. and Surg. Journal, Oct., 1833.)

Not many years ago a collection of obstetric instruments were found at Woodham, Mortimer Hall, near Mildon, in Essex, which formerly belonged to Dr. Peter Chamberlen, who, having purchased this estate “some time previous to 1683,” was, in all probability, one of the brothers alluded to by Dr. Hugh Chamberlen, in his preface to the translation of Mauriceau’s work. This collection, (now in the possession of the Medico-Chirurgical Society, of London,) contains several forceps, two of which appear to have been used in actual practice: these differ from each other only in size, and present a great improvement upon the instrument possessed by Hugh Chamberlen, at Amsterdam. The blades are fenestrated and remarkably well formed: the locks are the same as of a common pair of scissors, except that in one case the pivot is riveted into one lock, which passes through a hole in the other when the blades are brought together. In the smaller forceps there is merely a hole in each lock through which a cord is passed, and then wound round the shanks of the blades to fasten them together, an improvement in which Dr. Peter Chamberlen had evidently anticipated Chapman, in making the first approach to the present English lock.

The earliest professors of the forceps, besides the Chamberlens, were Drinkwater, who commenced practice at Brentford, in 1668, and died in 1728; Giffard, who has given cases where he used his extractor as early as 1726; and Chapman, who possessed a similar instrument about the same time. These forceps correspond very nearly with the above-mentioned ones of Dr. Peter Chamberlen; and as it is well known that from those of Giffard and Chapman, the forceps of the present day are descended, we cannot consider ourselves so much indebted to Dr. Hugh Chamberlen for these instruments, to which his bear so distant a resemblance, as to his relations, who, from living together in England, had doubtless assisted each other by their mutual inventions, and thus brought the instrument to that state of improvement in which it was found as above-mentioned.

For more detailed information respecting the history of the forceps we may refer our readers to Mulder’s Historia Forcipum, &c., particularly, the German translation by Schlegel, to a similar work brought down to the present time, by Professor Edward von Siebold, to our own lectures on this subject, published in the London Med. and Surg. Journal, for March 28, 1835, vol. vii., and to the two papers already alluded to in the London Med. Gazette, Jan. 8, 1831, and Edinburgh Med. and Surg. Journal, October, 1833. [Also, Researches on Operative Midwifery, &c. By Fleetwood Churchill, M. D., essay iv. on the Forceps. Dublin, 1841.—Ed.]