TH E 
PNEUMATIC FORCEPS. 
OPERATES IN CHILD-BIRTH DELIVERY BY VAGINAL DILATION, SUC- 
TION AND GRASP. WARRANTED TO HOLD MORE THAN FIFTY LBS. 
TO THE VERTEX WITH EVERY INSTRUMENT. MANUFACTURED 
(BY EXCLUSIVE RIGHT) AND SOLD BY THE 
PNEUMATIC FORCEPS CO, 
HEADQUARTERS, USQUEPAUG, R. I. 
H. L. STILLMAN, M. D., Inventor. 
A, CRAWFORD GREENS, P RIN T E R,' PR 0 VIDEN0ft Fig. 1 represents the position of the Cup for introduction. 
a Cup. b Flexible Neck, c Connecting Cylinder, d d d d Dilators. 
e Dilator Collar, f Set Screw. <j Dilating Band, h Pump Barrel. 
t Handle for Trection. j Pump Handle, k Anti-congestion Valve. 
Fig. / Fig. 2. Position after being introduced. 
« Cup. b Flexible Neck. c Connecting Cylinder, ddd Dilators, 
e Dilator Collar. f Set Screw, g Dilating Band, h Pump Barrel. 
i Handle for Trection. j Pump Handle, k Anti-congestion Valve. 
I Circle of Notches and Depressions. 
Fig. 2 HISTORY 
OF THE 
PNEUMATIC FORCEPS, 
More than twenty years ago, Prof. James Y. Simp- 
son, of the Edinburgh College, conceived the idea of 
child-birth delivery by means of suction, or atmos- 
pheric pressui'e to the vertex of the child. 
Nearly every one has seen those circular pieces of 
leather, with cords attached to the center, by which 
boys pick up bricks, stones and other plain surfaced 
objects, by first pressing the leather, when wet, upon 
the object, so as to exclude all air, and raising by the 
string. 
Now Prof. Simpson proposed to use a concave, cir- 
cular piece of leather, fitting to the convexity of the 
vertex of the child, and the air therein to be ex- 
hausted by means of the ordinary air pump, attached to the center of the leather, the pump also acting as 
a handle for traction. 
Since that time the cups have been constructed of 
India rubber, with a tubed stem several inches in 
length, communicating with the pump, and are at 
the present time used to some extent in Europe 
These instruments are, in a great measure, inopera- 
tive, and fail to meet their requirements, as will he 
hereafter shown. 
In the year 1873, Dr. II. L. Stillman, a regular 
practitioner of Usquepaug, R. I., probably from the 
same observations of the Edinburgh professor, con- 
ceived the idea of an instrument similar to the one 
mentioned. He, at that time, had never heard of 
Simpson’s plan. 
After giving it due consideration, he concluded that 
it would not be sufficiently operative, from the fact 
that suction, from its general application, means 
nothing more than atmospheric pressure, and recol- 
lecting that only a small portion of the center of the 
vertex receives a fair share of this pressure, when in 
the uterus or vagina, all of the rest of the child is 
subject to the natural suction and pressure of the soft 
parts of the mother, and partial atmospheric exclu- 
sion. Subsequent experiments and observation have 
proved this theory to be correct. 
Dr. Stillman then set himself to work to overcome 
this difficulty, and succeeded in a plan of dilation of the vagina, letting air in on the full surface of the 
cup, when engaged with the vertex, also thereby ren- 
dering an easier passage for the head. 
The dilators are so constructed (as seen in the en- 
graving) as to present the appearance of a cone, the 
base on thevvertex, with the apex pointing outwardly 
when expanded, acting in a similar manner upon the 
vagina as the pointed sac of liquor amnii, to dilate 
the os uteri, previous to its rupture, and the expulsion 
of the head. The dilators also hold the cup in a cen- 
tral position upon the vertex. They are made to ex- 
pand and contract at the will of the operator. (See 
engraving.) 
In addition to this the Doctor has made other 
marked improvements in the original instrument, 
that will be shown hereafter. 
The elastic cup, as shown by the engraving, is 
composed of soft and moderately hardened India rub- 
ber, moulded together. The tube neck is composed 
of the soft, the outer end of the pump filling about 
one-half of it. It will be seen that it admits of flexion 
only close to the body of the cup, in less than one- 
half inch space. The advantage in a short neck is 
this: the cup admitting of flexion on the pump, ac- 
commodates itself to the curvature of the vaginal pas- 
THE ELASTIC CUP. 8 
sage, and the leverage requisite to convey the head 
around this curve, is here obtained, where space 
would not admit of the working of a long neck. 
The space from the neck of the cup to one-half inch 
of the edge is composed of the moderately hardened 
India rubber, sufficiently hard to prevent collapse of 
the cup on the vertex, when the air is exhausted. It 
is found thereby to retain a much better hold. The 
edge, like the neck, is composed of the soft, which 
stretches firmly upon the vertex, andjyinswers as 
packing, preventing the admission of air or liquids 
from its exterior; also prevents pain or injury in its 
introduction to the soft parts of the mother. 
Just back of the inner margin of the soft edge is a 
circle of notches, pointing’mwardly, with depressions 
behind. (See engraving.) These, when stretched 
upon the vertex by suction of air, leaves congestion 
of the scalp sufficient to fill these depressions; the 
notches hold by grasp to the scalp, exterior to the 
vacuum, ten or twelve pounds, independently of at- 
mospheric pressure. They also prevent any rotatory 
or sliding movement upon the vertex. 
The change in the neck, the combination in the 
cup of soft and moderately hardened India nibber, 
and the circle of notches and depressions, are Still- 
man’s improvements in the cup. The cavity of the 
cup measures in breadth, at the edges, 3 1-10 inches, 
by 1 1-2 inches deep. 9 
When introduced, the dilators should be drawn 
backwardly and collapsed, the cup flexed so as to 
bring the edges on a line with the pump; the two 
edges flattened together by grasp of the thumb and 
fore linger. The cup being well lubricated upon its 
exterior surface, with its edges turned upwardly, is 
easily introduced so that the outer extremity passes 
readily on the posterior Avail of the vagina to the 
A'ertex. The thumb and forefinger is then drawn to- 
wards the inner extremity of the cup, allowing the 
outer to flatten upon the posterior wall of the A7agina, 
until the inner extremity passes behind the pubic 
arch, and the cup becomes engaged with the A’ertex. 
This is very easily accomplished. A stroke or two 
of the pump Avill be necessary to hold it in position, 
until the dilators are introduced. 
Tn case the head has not yet passed through the os 
uteri, if open two inches in diameter, the same rule 
should be observed in its introduction, only that the 
outer extremity comes in contact Avith the vertex and 
is allowed to glide backwardly, between the os and 
vertex. The index linger being then introduced 
anteriorly, (and, if necessary, posteriorly) to adjust 
the edges of the womb over the cup. This require* 
more tact, but can be accomplished without difficulty. 
A strip of thin membrane, if accidentally caught 
under] the 4edge [of the cup, does not prevent a fair 
working and hold. 10 
TIIE DILATORS. 
The dilators, six in number, are attached to a slid- 
ing collar on the barrel of the pump. They are com- 
posed of the best of spring steel, nickeled, rounded 
and smooth, so as not to do injury in case of the slip- 
ping of the cup. The outer extremities should lap 
over each other when collapsed. A ring of India 
rubber over the collar and around the dilators, when 
pressed outwardly, collapses the dilators, when drawn 
inwardly, expands them. 
A set screw holds the sliding collar (as shown in 
the engraving) at any place on the barrel, at the will 
of the operator. The dilators, to be introduced, 
should be drawn backward, toward the handle of the 
pump, collapsed until after the introduction of the 
cup, the set screw loosened, the rubber band then 
drawn backward a little, so as to tend to expand the 
dilators, but which should be held compressed by the 
hand, and slid down the barrel, introduced in this 
manner, until the dilators come in contact with the 
shoulder of the cup. They then should be allowed to 
expand, so as to clear the shoulder of the cup as they 
are pressed inwardly, as far as its edge. They are 
then to be expanded as much more as practicable, 
the set screw made fast, and the air exhausted from 
the cup, and traction commenced. 
A moderate working of the pump, kept up while 
traction is being made, secures a firm hold. In case 11 
of a superfluous growth of hair, a brisk action of the 
pump may be required; a firm hold will thereby be 
secured. The atmospheric pressure collapses the 
abdomen from above in proportion as the head re- 
cedes downward. 
TIIE AIR PUMP. 
This does not essentially differ from air pumps in 
general (being made of brass and other hard metal, 
rendered non-corrosive by nickel), with the exception 
of the valves. Instead of the ordinary oiled silk 
vah res, which are soon injured by moisture, and easi- 
ly clogged up, we employ an indestructible light 
metal valve, (Stillman’s invention), held to its seat 
by a small spiral spring. The valve and seat ground 
together, so as to secure a perfect contact. 
To keep them in order, all that will be necessary is 
to wipe occasionally the valves anti their seats, in 
case foreign substances prevent their working per- 
fectly. The Spiral spring should be made to press 
upon the valve about sufficient to hold its weight. 
In case of a thick and tenacious secretion, which 
sometimes exists in the vagina, at child-birth deliv- 
ery, and would be likely to obstruct the working of 
the pump, it should be wiped out with a soft sponge, 
before the introduction of the cup. 12 
INDICATION FOR THE USE OF TIIE PNEU- 
MATIC FORCEPS. 
From the liarmlessnpss of its action, its use is much 
more frequently indicated than the ordinary forceps. 
It. may be used in all cases of tedious labor, in the 
second stage, and many in the tirst, where the os 
uteri is sufficiently dilated, whether from obstruction 
or exhaustion. In vertex presentations others of the 
head are very rare. Statistics show only one other 
to about every two hundred and fifty vertex presenta- 
tions, making their chances such that an ordinary 
practitioner would hardly expect to meet with one 
oftener than once in seven or eight years. 
Its use, as a rule, is indicated in about one case in 
ten, we think. While the ordinary forceps, from the 
severity and danger of their use, hospital statistics 
give them a place only to one in every two hundred 
cases. 
Notk —Iu a case where the head of the child is high 
up, the hips should be elevated, the handle of the pump 
carried as low down as possible. Let the dilators on the 
anterior side touch the margin of the cup, and if leverage 
is necessary, the cup being somewhat flexed on the pump, 
the dilators must be allowed to fall short an inch, or 
more if necessary, on the posterior side. 13 
ITS ADVANTAGES OVER THE ORDINARY 
FORCEPS. 
Its advantages over the ordinary forceps are these: 
1. It is much quicker and easier introduced. 
2. It does not cause pain or suffering to the 
mother, and is devoid of the danger of the ordinary 
forceps. 
3. It has thus far proved to he devoid of danger to 
the child. 
4. It does not increase the transverse diameter of 
the head, as the forceps do. 
5. From its easy introduction, without pain, its use 
is much oftener indicated than the ordinary forceps. 
Any intelligent practitioner may use it. 
6. Not increasing the diameter of the head (and 
for reasons hereafter shown), it thereby facilitates a 
much easier delivery. 
The cup is capable o° holding to the vertex, by suc- 
tion alone, from fifty to ninety pounds, although us- 
ually requiring much less than this. 
It has been said that the ordinary forceps are 
capable of diminishing the transverse diameter of the 
head as much or moi*e than the thickness of the 
blades. This we admit, as the head is more or less 
elastic, but the anterior posterior diametei is thereby 
necessarily increased. As shown from the following 
feet, the central point of traction must be near the end 14 
of the blades of the forceps, while the soft parts ob- 
struct the head anteriorly and posteriorly below it, 
This tends to diminish the occipito mental diameters, 
thereby much increasing the anterio posterior di- 
ameter, so that really there is little or nothing gained 
by compression. While traction from our instrument, 
after removing vaginal obstruction and producing a 
vacuum at the vertex, sensibly elongates the head, 
and thereby diminishes all of the other diameters, and 
this may account for the limited amount of power 
many times required in its use. 
THE EFFECT OX THE HEAD. 
While no plausible objection has yet been offered in 
its use on the mother, t <vo have been offered in its use 
upon the child, viz: separation of the scalp, and con- 
gestion of the brain. It has been claimed that the 
force of suction is spent on the scalp, and that violent 
traction -would be sufficient to separate the scalp from 
the cranial bones, by rupturing the connecting tissues. 
From the first we concluded that, as air is excluded 
between the scalp and skull, and the same amount of 
suction here exists after the application of the cup, as 
between the cup and scalp, and as the connecting tis- 
sue is strong, not the slightest danger exists. Here 
is an experiment which any one having an instrument 
may try. 15 
Take a circular piece of leather, four or live inches 
in diameter, saturate it thoroughly with hot water or 
mucilage, (which is better), press it firmly upon a 
plain surface, so as to exclude all air, apply the cup 
centrally over it, and exhaust the air by the pump, 
and make traction. If properly applied, it will be 
found to hold fifteen or twenty pounds to a plain sur- 
face, and when the suction breaks, it will be found to 
be between the cup and the leather, the latter still 
clinging to its surface. This ought to be sufficient 
proof of the correctness of our theory. 
Congestion of the brain has been mentioned. Con- 
gestion of the scalp is always present from its use, but 
its duration is usually short. But it is to be remem- 
bered that the posterior fontanelle (the only one that 
is covered by the cup) is nearly always closed at the 
time of birth, rendering a wall of protection to the 
brain. Of the several cases that have come under our 
observation, not one has received the slightest harm. 
The force of traction upon the instrument is nearly as 
follows: 
Upon the dilators, when well expanded, about 1-3, 
by suction 1-2, by the notches and depressions 1-6, 
nearly. This may be given as a rule, but cannot in 
every case be adhered to, as a superfluous growth of 
hair moderates the hold of the notches, and there are 
some women that a full expansion of the dilators 
causes considerable annoyance. Hence, in these 
cases, a moderate dilation. 16 
Doctor,— 
We have given yon a description of onr in- 
strument, together with an explanation of its use. We 
hope that you have been favorably impressed with it; 
we believe that you have. The instrument has merit, 
and it must stand upon it, and it is due it here to state 
that it has been favorably received by every eminent 
physician to whose notice it has been brought. 
It now remains for you to say whether you will 
have an instrument or not, and if so, when ? I)o not 
wait, thinking thereby to better yourself. The price 
of it is $20.00. It is made by skillful workmen, out 
of the best of material, and costs at least three times 
as much to manufacture it as it does the ordinary 
forceps, selling for $10.00. And we calculate that 
every part of the metal work is good for a hundred 
years’ use, and the other parts, which are few pro- 
portionately. Each instrument is supplied with two 
cups in case of injury or accident to one. And it is 
probable that ve sell it as low as ever we can afford 
to. Again, the physician who gets an instrument 
now, lias the credit of its introduction in his own com- 
munity. The physician who first uses a new and 
valuable remedy, and introduces it to his neighbor 
physicians, will, other things being equal, continue 
to hold the first rank in its use. Each instrument 
will be sent in a velvet-lined black walnut case. 
Women who have seen a trial of this instrument, 17 
have been uniformly pleased with its operation, and 
as much inclined to favor it, as they are to condemn 
the use of the ordinary forceps, and what practitioner 
is there that is not dependent upon their influence ? 
The instrument will be sent C. O. 1). to any ad- 
dress. A fair discount to dealers. For the present, 
we make the following offer. Any physician paying 
us twenty dollars ($20.00) for an instrument, if not 
satisfied with its working, will have the privilege of 
returning it to us within twenty days, C. O. D., for 
exchange or receipt of the amount paid. We are 
aware that we are dealing with a learned and intel- 
ligent profession, and we wish to introduce it with 
perfect satisfaction in every case. 
Should you not have an opportunity to use it in the 
lying-in chamber, a good test of its power in opera- 
tion may be made as follows. Flex the knee to an 
acute angle, wret the 6dges of the cup well, and apply 
it over the integument of the tuberosity of the inner 
condile of the femer on the rounded prominence, ex- 
haust the air and make traction. This will give you 
a good idea of its action upon the head, although the 
same amount of traction here can not be obtained. 
All orders will be promptly attended to. 
Address Pneumatic Forceps Co., or If. L. Stillman, 
M. I)., Usquepaug, It. I. Note. 
Usquepaug, R. I., March 6, 1875. 
To the Medical Profession :— 
Allow me the honor to state that, from recent 
trials with my latest improved cup, I have succeeded ad- 
mirably without the use of the dilators, and here give it 
as my opinion that a large majority of all cases coming 
under its use can be delivered without their assistsnce, 
and done much easier, and without exposure. From 
thirty to fifty pounds can, in nearly every case, thus be 
obtained ; much more than we had formerly supposed. 
To prevent undue congestion of the scalp, we have in- 
serted an additional valve, near the neck of the cup, so 
that, if necessary, suction may be used only when traction 
is being made. With a slight wound or abrasion of the 
scalp, undue hemorrhage may be thus prevented, al- 
though hemorrhage, if not extensive, is not dangerous as 
long as the umbilical cord is not divided. 
These trials also were attended without injury to 
mother or child. 
Signed, 
H. L. Stillman, M. D.