Compliments of the Author, 
BLOOD-LETTING 
AND 
The Use of Forceps in Cases of Labor 
BY 
JOHN FRISSELL, M. D„ 
OF WHEELING, W. VA. 
Reprint fromthe transactions of the 
Medical Society of the State of West Va. 
1885. A Few Thoughts on Blood-Letting, 
AND THE USE OF FORCEPS, 
BEFORE THE 
STATE MEDICAL SOCIETY 
OF- WEST VIRGINIA. 
BY 
JOHN FRISSELL, M.D., 
OF WHEELING, W. VA. 
Held in Weston, FRay 20 and 21,1885? 
WHEELING: 
DAILY INTELLIGENCER STEAM JOB PRESS. 
1885. A FEW THOUGHTS ON BLOOD-LETTING, 
AND 
THE USE OF FORCEPS. IN CASES OF LJIBOR, 
BY JOHN FRISSELL. M.D., WHEELING. 
I had intended, if I furnished the Society a paper at this meeting, 
to have given a short history of a few surgical cases, as a gun-shot 
wound through the axilla, the ball and a wad of clothes passing 
through and lodging against the back part of the shoulder blade ; 
another in which the head of the humerus and the glenoid portion 
of the scapula were shot away, a somewhat useful shoulder being left 
after recovery ; a third, a patient of Dr. Todd’s, of Bridgeport, where 
two inches of the upper third of the humerus were shot away, the 
ends of the bones being trimmed and brought together, the union 
was perfect and no deformity except shortening; and also a perfect 
recovery from a gun-shot wound through the left side of the chest 
and the left lung, to which others might be added, but I have con- 
cluded to leave them, perhaps for another time, and make some 
remarks on blood-letting as a general remedy in child-bearing and 
child-bearing diseases, and the use of forceps in cases of labor. 
In the spring of 1833,1 went to Woodstock, Vermont, as demon- 
strator for Professor Parker in his Woodstock course of lectures on 
Anatomy. > 
While there I became acquainted with the history and character 
of Dr. Gallop, then an old man, but one of the most distinguished 
physicians of Vermont. He was oneot the founders of the Woodstock 
Medical School, and for many years one ol the Professors in that 
institution. He had the reputation of being a great advocate for 
blood-letting and of using it largely in his practice, and his advice 
was said to be “to bleed to the point of relief.” I think from what 
I learned of him that he was in the habit of bleeding freely in many 
inflammatory diseases; but the saying was in the mouth of every 
one that Dr. Gallop advised bleeding to the point of relief 
In those days diseases were largely inflammatory, and were much 
benefitted by bleeding, and I am satisfied that in many instances 
bleeding till the patient was relieved was the correct doctrine. 
The younger members of the profession know nothing by experi- 
ence of things as they were in those days, nor how common bleed- 
ing was, nor how great was the benefit derived from it. 
No doubt blood-letting was resorted to oftener than was necessary, 4 
State Medical Society of West Virginia. 
but I am satisfied that in these times patients often die for the want 
of being properly bled. There is a medium line between the two 
extremes that is safe to follow. 
Dr. Gallop’s maxim was in many cases a life-saving maxim, and 
no one without actual experience could tell its value. 
I was in the habit of bleeding often in my early years of practice, 
but not in large quantities in ordinary cases. Many, especially 
females, wanted to be bled every spring—it was fashionable and 
thought to be necessary. 
I have many times bled to faintness when the patient was in a 
sitting posture. I had not been in practice in this city more than 
two or three years when a Mrs. P., a friend and patient of mine, was 
taken sometime before confinement with puerperal convulsions and 
spasms. She became unconscious and lay like a person in apoplexia, 
and in spite of all I and some of the best physicians of the city 
could do, she lay in that comatose state without consciousness or 
power of motion, and gradually sinking for several days. All her 
friends had given her up to die. 
We had bled her in the usual way and used all the remedies we 
could think of without benefit. 
The maxim of Dr. Gallop, bleed to the point of relief was all the 
time in my mind, but the other physicians would not sanction that 
course, and so things stood. One night, while studying the case 
over, I thought to myself she is my patient, and Dr. Gallop is a 
greater man and knows more about bleeding than any or all of us 
put together, and in the morning when I visit my patient if I 
find her no better, I will, with Dr. Gallop as my adviser and backer, 
have everything fixed and make a good opening in the vein of her 
arm, and I will bleed her to the point of relief, and take the respon- 
sibilities and the risks. 
When I called in the morning she was still no better, but sink- 
ing. I told her friends that I would bleed her, and had things pre- 
pared, moved her to the edge of the bed, had her arm corded 
and held in the proper position. I then made a large opening in 
the vein, the blood started but soon refused to flow, but by placing 
the hand in hot water and using friction, the blood began to move 
slowly, and after coaxing for ten or fifteen minutes the stream 
became full and free. I let one wash-basin become well filled and 
took a second, and let the blood keep flowing on, and after a time a 
second became well -filled, when I had the second changed for a 
third. 
I let the blood still flow on, but the blood ran slower and 
slower, and she grew more and more pale and death-like, her pulse 
had nearly ceased beating at the wrist, and the blood was flowing 
only by slow drops, and about the time we all thought she was 
going to leave us, she opened her eyes and turned her head a little, 
and looked up and wanted to know what I was doing there. 
The brain pressure had been removed, all her senses returned 
and she was well, all but what time and good nursing would finish. 
When Mrs. P. looked up and spoke, and asked me in her natural 
voice what I was doing there, I think it was the happiest moment of 
my life. I have always thanked Dr. Gallop, and even to this day I Frissell—Blood-Letting and the Use of the Forceps. 
5 
thank him for that bit of practical advice, which no one else had 
the good sense or the courage to give. 
I have in my practice of over lifly years had a good number of 
cases very similar to the one just related, and cases that I have 
cured in the same way, by bleeding to the point of relief. I have 
known other physicians to have, so far as I could learn, similar 
cases that died simply because they were not properly bled. 
Those physicians had not learned the lesson and could not appre- 
ciate its importance. The patients die from the lack of practical 
knowledge and skill in their physicians to treat them properly ; 
but the above was perhaps the most marked case of them all, the 
one that attracted the most attention, and the one over which there 
was the greatest joy in the result. 
I have never had a patient die from being bled too much, but I 
am sure I have let a good number die by following the fashions of 
the day and not bleeding them properly at the proper time. 
Blood-letting is one of the great and powerful remedies, and will 
accomplish results that nothing else will. I will not undertake to 
discuss the great subject, but would advise every one to study it 
for themselves; but so long as the present doctrine or fashion pre- 
vails in regard to blood-letting, I fear many of the profession will 
never understand much about it, for it is by practical or clinical ex- 
perience alone that the subject can be understood and appreciated. 
Dr. Gallop gave that advice from long experience and observation. 
It requires great knowledge of the system and of disease, to be 
able to tell at what time and under what circumstances blood- 
letting and other great remedies should be used. There is no doubt 
but the remedy has been abused, and there is no more doubt but it 
has been neglected when it would have been of great benefit. 
A great amount of the general bleeding formerly practiced was 
useless, but it was harmless. 
It is one of the many things in medicine which, if it does no spec- 
ial good, seldom does harm. 
A spring bleeding or a bleeding before a confinement of a strong 
woman was never known to do injury, but often seemed of great 
benefit by moderating vital action; but where there is over disten- 
tion and engorgement of the heart and large vessels, and the equi- 
librium of the circulation is disturbed, bleeding often restores the 
lost equilibrium and relieves the heart, lungs, large vessels and the 
brain from embarrassment, and there is no way we can relieve the 
trouble so easily and so quickly as by taking away a portion, and a 
large portion if necessary, of the fluid that is blocking up the 
sources of life, as in the case related. 
We have to take blood almost to the point of taking life before 
the pent up trouble will give way, but when it does give way and 
the circulation becomes equalized, the result is most satisfactory 
and most wonderful. Such inen as Parker, Gross and Atlee, as also 
nearly all who commenced practice fifty or sixty years ago, are in 
favor of judicious blood-letting. 
Many who did not come on the stage till since the fashion chang- 
ed and blood-letting became unpopular, hold on strongly to that 
view and reject bleeding almost entirely. Many of the young 6 
State Medical Society of West Virginia. 
physicians have never learned to bleed, and do not even carry with 
them a spring lancet; much less a thumb lancet, which requires 
more skill to use properly. 
Our professors of surgery used to lecture on venesection and show 
us how to perform the operation. 
In the winter of 1844 and 1845, when spending a couple of months 
in New York city, I heard old Doctor Valentine Mott, then regarded 
the greatest surgeon in America, give a clinical lecture of an hour 
on venesection, in which he showed and explained, better than I 
had ever seen done before, all the minutia and management of the 
operation, and spoke of blood-letting as the greatest and most val- 
uable of our remedies. 
When I was in New York, a little over a year ago, the young 
doctors, some of them sons of the old doctors, and standing high 
in the profession, called their fathers and such men as Austin 
Flint, Willard Parker, Alonzo Clark, and Frank Hamilton, old 
fogies. 
They thought they were wiser than those who had studied and 
practiced through both periods, and knew from experience the 
merits of both methods of practice. 
I endeavored to criticise some whom I knew well, but they did' 
not like criticism any better than young doctors do with us, who 
have old fogies to deal with. 
A great many new discoveries have been made and new things 
learned during the last fifty years, but it is an unsettled question 
whether the doctors of the present day, with all their science and 
superior knowledge, save, by their practice, as many patients as 
physicians did forty years ago. 
The late Dr. A. S. Todd, who commenced practice in this city in 
1819, when Wheeling was but a small town, and continued for near 
sixty years, had probably a greater run of success both with females 
and in general practice, than any other physician who has prac- 
ticed in this city. 
He was a practical, common sense physician, who believed in 
letting nature have a chance to do her own work, and did not in- 
terfere, except to watch and see that all things were kept in good 
condition for delivery. 
Altogether his cases of labor numbered about two thousand, and 
in all that number he used instruments or had them used only 
five or six times, and he lost fewer females and fewer children 
in proportion than any other physician here. He would bleed, 
give laxatives, opiates and stay away from patients to gain time 
for the system to become relaxed and the soft parts yielding. 
He would manipulate, change the position of the child in the 
uterus, and when necessary perform what has been called in mod- 
ern times cephalic version, and do anything necessary to keep the 
child in a normal position for delivery. 
He would never hurry a woman to give birth to a child before 
she was in every way ready, however much she and her attendants 
might complain or call for help. 
He did not believe that the Lord made females with so little 
consideration and forethought that they could not give birth to Frissell—Blood-Letting and the Use oj Forceps. 
7 
their own children without the aid of instruments to be used by 
the rough hands of man. 
He considered they were able, if they were properly managed, 
to give birth to their children, and that opinion he adhered to 
through all his practice, and would not, if he had been left to him- 
self, have had instruments used in more than two or three anoma- 
lous cases in the whole of his two thousand births. 
He had but little to do with modern gynecology. He seldom used 
pessaries or intra-uterine injections, which are often dangerous if 
the mouth of the womb is not widely open. 
He never had any lacerated os uteri, which gynecologists are so 
fond of operating upon. I never knew any of his patients to have 
vesico-vaginal fistulas or lacerated perineums that gave trouble. 
He seldom disturbed the uterus by handling or manipulating, or 
by blocking up with instruments, but as much as possible left 
everything in the hands of nature to finish in her own way and 
according to her rules. 
I was consulted last summer by a lady from a distance in regard 
to some female troubles, and among other things she told me she 
was at one time greatly afflicted with falling of the womb. I in- 
quired of her what treatment she followed to make her recovery so 
perfect. Her answer was that she “lay in bed a year.” 
That cure was very much in accordance with the practice of Dr. 
Todd. Three months, six months, a year or two years are remedies 
of great value. 
They will cure more uterine troubles than all the pessaries and 
instruments ever invented for that purpose. 
They are the only remedies for inflamed and injured joints, bro- 
ken bones, mashed up limbs, crippled spines, old rheumatisms and 
neuralgias. 
Females often go to the cities to be doctored for womb troubles. 
They are put to bed or kept quiet, instruments are used, and after 
a time they go away improved and are told that the instruments 
have made them better, when in fact it was the rest that improved 
them and the instruments made the show. 
Dr. Todd told me he always had a desire to carry out the teach- 
ings of the celebrated Prof. Richardson, of the Transylvania Uni- 
versity, who in one of his lectures said to his class: “Gentlemen, I 
feel it my duty to admonish you against the use of instruments, for 
you will not have real occasion to use them in more than one case 
in a thousand, and you had better let that case die or take the risks, 
for you will probably kill many more than that by the frequent 
use of instruments.” 
His long experience, sound judgment and good common sense 
made him as successful in general practice as he was with females. 
He was always a moderate bleeder, but in that as in everything 
else he pursued a middle course, which except in special cases was 
the safe course, and was one cause of his great success in general 
practice. I have a good number of times in fifty years been bent 
for in great haste to visit with another physician a woman in 
labor, with the request to bring forceps and all instruments neces- 
sary for delivery. I have made it a rule for many years in most  State Medical Society of West Virginia. 
8 
cases of that kind not to be in a hurry, but to make all the delays I 
could to give the attending physician time to get through with the 
labor before I would arrive, and often I would find the labor over 
and the mother, the child and the doctor all doing well. If the 
doctor had had his instruments in time, he would probably have 
used them with great vigor and perhaps left in the wind-up of the 
case a lacerated perineum, a lacerated os uteri, and perhaps a vesico- 
vaginal fistula, all common results of using instruments, which 
would have made several hundred dollars worth of work to be 
placed in the hands of some gynecological operator for repairs. 
I never knew Dr. Todd to have any of these accidents to happen 
in his practice, wThere no instruments were used; but among gyne- 
cologists and those who use instruments largely all these accidents 
frequently occur. 
The following case will illustrate what we may often expect 
from the use of forceps in cases of labor. I was .consulted recently 
by a lady suffering from injuries received during labor by the use 
of forceps. In her first confinement, which was painful and lingei- 
ing, in order to shorten her suffering and save time, her physician 
used forceps, at the request of friends, while the soft parts were still 
rigid and unyielding, with the result of lacerating the perineum 
almost to the rectum, lacerating extensively one side of the mouth 
and neck of the uterus, and producing such injury to the bladder 
and the surrounding pelvic organs that she had involuntary pass- 
ing of urine for two months. 
Since these extensive injuries she has remained feeble, almost 
unable to walk, suffering from her back and side and across her 
hips, with general pain and weakness, which may permanently 
affect her health. If the lady had been left to herself and watched 
carefully she would have got through, if not as soon at least in a 
few hours more time, safely and avoided all these accidents. 
Gynecologists say that these lacerations very seldom occur from 
the use of instruments, but gynecologists are not usually the tear- 
ers of females, but the repairers ; but my observation and experi- 
ence teaches me that they occur very much the oftenest in females 
on whom instruments have been used in delivery. 
Several of those I have seen delivered by instruments had their 
purineums lacerated, and two that I remembered had vesico-vagi- 
nal fistulas produced. Meddlesome fingers are often used instead 
of forceps, and do much of the same class of injury. Dr. L. R. 
Charter one of the old members of this Society, has attended even 
more females in labor than Dr. Todd, never used forceps, and never 
had any of these accidents occur with patients that were properly 
his own. I have always attended cases of labor, but not as many 
as some others, but have never used instruments or had them used 
more than four or five times. 
I have been with other physicians, who used them much oftener, 
and have seen the various accidents occur. In my own cases, and 
those I have seen of other physicians, I am satisfied that by time 
and careful management they would have most of them at least got 
along without instruments and without accidents. 
Forceps in the hands of those who have the tact and talent and Frissell—Blood-Letting and the Use of Forceps. 
9 
care to use them properly may occasionally be useful, but as they 
are used in these times they do much more harm than good. They 
are used largely to save time and give notoriety to the doctors, 
when they should be used only to preserve the safety and comfort 
of the female. 
I remember being called in great haste to a case of labor, with 
another physician, with the request to take him instruments. 
I took instruments to him, and while he was making all possible 
haste to place the woman in a position to apply the forceps, she 
gave birth to the child. 
The curtain dropped and the scene was ended. The poor peri- 
neum, the uterus and bladder were all left unharmed. 
I noticed the other day in one of the journals an article in which 
the writer, in commenting on the use of instruments in cases of 
labor, mentioned several instances of physicians who had attended 
from one to two thousand cases of births, and had never used in- 
struments nor had any'serious lacerations or accidents occur. 
I have occasionally, when the child has been dead, perforated 
the skull, removed a portion of the brain, and, by traction with the 
fingers and bone forceps, elongated the head, making it cone shaped 
and facilitating delivery in that way, making it easier and safer 
for the mother, saving time and avoiding the dangers of the forceps. 
Bleeding, time, laxatives, opiates,manipulations when necessary, 
ergot when the muscular action of the uterus is feeble, are means 
used to aid in hard and lingering cases of labor. 
Chloroform, ether and other articles have been used of late 
years to ease pain, relax the system, and in severe cases of labor 
have been found useful. It is often said, by those who never bleed, 
that patients can not stand the loss of blood, but we often see large 
quantities of blood lost in child-bearing sickness, in operations, 
and in wounds, and the patients recover just as well and just as 
quickly as they did fifty years ago. 
*1 date at least one item of the change that makes bleeding less 
called for now than it was forty or fifty years ago, back to 1843, the 
period of the great epidemic influenza, or as it was called the 
Tyler Grip. 
After that epidemic, I thought we had more cases of marked ty- 
phoid fever and fevers of a low grade than I had seen before, in 
which bleeding was less required and tonics and stimulants more 
useful. 
Before that epidemic we had inflammatory croup, pleurisies and 
pneumonias, but soon we began to have diphtheria and diphtheric 
or membranous croup. These w’ith malignant pustule, typhoid fever, 
fever, black tongue fever, spotted fever, or cerebro-spinal 
meningitis, have more often than before made their appearance 
and given trouble. 
The most important part of our profession is hygiene; any one 
can bleed and administer medicine, but the laws of health, in 
order to understand them in all their bearings, demand much study 
and thought. 
No one knows—no one can tell—how much of mischief and evil, 
how much of the seeds of disease are mixed in with the atmos- 10 
State Medical Society of West Virginia. 
phere we breathe, the water that we drink, or the soil that is under 
us and about us. 
Investigations are being made in regard to the atmosphere, which 
in time may be useful. 
The more highly people become civilized, the more they indulge 
in idleness and luxury; the more thickly they become crowded 
together in cities, the more will health and vigor of body and mind 
be found impaired. 
Physical and intellectual stalwarts are never born and raised in 
city houses. They come from the mountains, the forests and the 
farms. 
The specialties, good in their place, and in the hands of proper 
men, are greatly overdone. The people as a whole would be better 
off if there were none. 
The throat, the nose, the skin, rectal, urinary and womb diseases 
were as a whole better treated thirty years ago. 
'Many of the diseases upon which so much attention is bestowed 
are but symptoms. Diagnosticate the cause, and when that is cor- 
rected and understood, what becomes of the specialty? 
Much of the uterine treatment now so fashionable, is useless or 
even harmful. I have at various times examined females who 
thought they were afflicted with serious womb diseases, and had 
been treated for long periods by celebrated gynecologists at full 
prices, and found their disease to be imaginary. 
Our mothers and grand mothers performed the functions of women 
and mothers and hardly knew there was a womb. Certainly they 
never heard of uterus.