The accidents which have followed from the use of the forceps are numerous and terrible, and I could give a most horrifying account of them if it were necessary. It must be recollected however, that these accidents have chiefly followed from want of skill in managing the instrument, or from its being used under improper circumstances. It is true that there is always more or less of pain and injury to be dreaded from the forceps, even in the most favorable cases, and with the most competent operators, but this is no argument against their employment altogether. In every case where they are really called for, the female would, most probably, die undelivered, or have to be cut open, so that it is simply a choice of evils, of which the forceps are the least.
The cases in which the forceps are absolutely necessary however, are VERY RARE, much more so in fact than many people suppose. Patience, and the persevering use of ordinary assistance, would probably succeed alone in half the cases where they are now employed.
In Murphy's lectures on difficult Labors, he gives us some valuable statistics on this subject. He tells us that in seventy-five thousand nine hundred and eleven labors, the forceps were used only one hundred and thirty-eight times, or once in every five hundred and fifty labors. In these one hundred and thirty-eight cases thirty-five of the children died, and ten of the mothers. Dr. Murphy however, thinks that the general results, to both mother and child, would be equally favorable if the forceps were not used at all, and he gives the tables of Dr. Collins to support his opinions. From these tables it really appears that, when all the difficult labors were left entirely to nature, the number of deaths was just about the same as when the forceps are used, in fact rather less, while the accidents, and subsequent evils, were not nearly so great. Dr. M. therefore thinks that the forceps should never be used, except in a few cases where everything is quite favorable to the passage of the fœtus; and the uterus cannot be made, in a reasonable time, to contract and expel it; and also when immediate delivery is needed to save the mother's life, as in flooding. In cases of mere ordinary difficulty or delay, he decries their use entirely; and he evidently thinks that when the labor is fit to be terminated by the forceps, nature can and will terminate it herself if left alone. There is no doubt but that they are now used a great deal too much, either from a desire to operate, or from want of patience; and I have no hesitation in expressing my opinion that more have been killed than saved by them.
OTHER INSTRUMENTS.
Respecting other instruments, such as the Crotchet, the Vectis, and the Cephalotribe, or crushing forceps, it is not necessary to say anything here, as their use, when imperatively needed, must necessarily be confined to the surgeon; and fortunately may now be dispensed with altogether. The recently introduced practice of bringing on premature labor, in all cases of deformity or smallness of the pelvis, entirely obviates the necessity for any of these dreadful resorts, if the difficulty be known in time, which it is sure to be when a sufficient degree of knowledge is disseminated.
The Cesarian operation, or cutting open the womb externally; and Cephalotomy, or the opening of the child's head, may also be dismissed with the same observations. They can always be avoided, if the real condition of the patient is known in time; and if from neglect nothing else can be done, they must always be performed by a skillful surgeon.