The Abuse 
of the Forceps. 
FADS AND FACTS. 
U/illiam B. Dotyerty, fT\. D. 
Reprint from American Practitioner and News, 
December 19, 1891. The Abuse of the Forceps; 
FADS AND FACTS 
BY 
WILLIAM B. DOHERTY, M. D. 
Reprint from American Practitioner and News, 
December 19, 1891. 
LOUISVILLE : 
John P. Morton and Company 
1891 THE ABUSE OF THE FORCEPS; 
FADS AND FACTS.* 
BY WILLIAM B. DOHERTY, M. D. 
Humanity demands that no condition of suf- 
fering or disease requires such undivided care 
and attention and deep sympathy on the part 
of the physician as the woman in labor. The 
beautiful language of our own great poet and 
physician, Dr. Oliver Wendell Holmes, on this 
point is very appropriate : "The woman about 
to become a mother, or with her newborn infant 
upon her bosom, should be the object of trem- 
bling care and sympathy wherever she bears 
her burden or stretches her aching limbs. The 
very outcast of the street has pity upon her 
sister in degradation when the seal of prom- 
ised maternity is impressed upon her. The re- 
morseless vengeance of the law, brought down 
upon its victim by a machinery as sure as des- 
tiny, is arrested in its fall at a word which 
*Read before the Louisville Clinical Association, October 
6, 1891. 4 
reveals her transient claim for mercy. The 
solemn prayer of the liturgy singles out her 
sorrows from the multiplied trials of life to 
plead for her in the hour of peril. God forbid 
that any member of the profession to which 
she trusts her life, doubly precious at that 
eventful period, should hazard it negligently, 
unadvisedly, or selfishly." 
One of the most important questions which 
arises before the obstetrician is to determine, 
in cases of tardy or prolonged labor, when and 
under what conditions is the use of the forceps 
a necessity? The tendency of the teaching and 
practice of the profession at the present day is 
to terminate labor too expeditiously, and this, 
in my opinion, springs from the dangers inci- 
dent to prolonged labor being exaggerated. 
No rule can be laid down as to what should 
be the duration of the second stage of labor. 
Every case possesses its individuality; but we 
are advised that in cases of well-formed pelves, 
when the membranes are ruptured, the os uteri 
fully dilated or dilatable, and a condition of 
inertia of the uterus exists, or no advance in 5 
the progress of labor is evidenced within the 
space of two hours, that the forceps should be 
employed, labor terminated, and suffering re- 
lieved. Whether the advice is sound, whether 
it should be accepted as the embodiment of a 
canon which it would be folly to impeach, de- 
serves the gravest consideration. If the course 
counseled is to be taken as the best course to 
pursue for the safety of the parturient woman 
and her child in utero under the conditions we 
have indicated, dispassionate students of ob- 
stetrics, fettered by no hard and fast lines, will 
probably conclude, and conclude with reason, 
that the tendency of our teaching and practice 
is to reduce labor from a physiological to a 
pathological process. Have our high-strung 
civilization and the luxurious mode of living 
which obtains so enervated woman that her 
life and that of her child be jeopardized if the 
second stage of labor be prolonged for three, 
four, five, or even six hours? Does the expe- 
rience of the members of this Association war- 
rant such a conclusion? Are the dangers from 
exhaustion and compression so great in unduly 6 
prolonged labor that it is better to use the for- 
ceps than to rely any longer on the vis medi- 
catrix naturae ? 
The dangers of the use of the forceps to the 
mother are: "Laceration of the uterus, vagina, 
or perineum from a too rapid extraction of the 
head, fracture of the coccyx and of the bones of the 
pelvis, and stretching of the ligaments of joints, 
and lacerations of external genitals, and abscesses 
arising from contusions. 
These unfortunate and dangerous sequelae 
are more likely to arise when the child is 
forced by instrumentation through the pelvis 
with a degree of speed too great for the elas- 
ticity of the vagina and relaxation of the peri- 
neum, than if labor be physiologically prolonged. 
Besides these results from violence, there are 
reflex headaches, backaches, etc. which so many 
neurotic women suffer from simple lacerations 
of the cervix uteri. The dangers which menace 
the child are: Contusions and injuries to the face, 
injuries to the scalp, skull, or brain, or paralysis. 
The indications for the use of the forceps 
are not influenced by the duration of the sec- 7 
ond stage of labor so much as by other condi- 
tions. 
First, as to the child: The head must be 
engaged in a suitable pcsition; a decline in the 
fetal heart-sound below 100 during a pain or in- 
terval between pains, or above 160 with a weakened 
impulse; a prolapsed cord, if the pulsations are 
still present or have ceased but for a short time. 
Second, as to the mother: In case of extreme 
prostration resulting from prolonged efforts at ex- 
pulsion, temperature above 100°, serious hemor- 
rhages, convidsions, bruising and compression o 
the maternal soft parts, varicosities which are on 
the point of rupturing, and accidental complica- 
tions of disease. 
In any of these conditions of extreme 
danger to the mother or to the child or to 
both, the use of the forceps is impera- 
tively necessary, and its employment is the 
most conservative of operative or instrumental 
procedures. But the use of the forceps as in- 
struments of convenience or of speed, to save 
time, or for the purpose of relieving pain by 
yielding to the implorations of the sufferer, in 8 
cases of weak pains or tardy labor, can not be 
too strongly deprecated. 
Besides the dangers from laceration and in- 
juries above referred to; serious copious hem- 
orrhage may set in from the too sudden expul- 
sion of the placenta when the forceps is used 
too early. Weak pains alone, which can often 
be combated by the use of hot local applica- 
tions, warm drinks, etc., are no indication per 
se for the use of the forceps, for 
" It is the curse of evil deeds, 
That they give rise to greater evils." 
The forceps, I am fully convinced from ex- 
perience in the lying-in room, is used too fre- 
quently and disastrously for the purpose of 
saving time by hastening labor. 
The general practitioner is too often led by 
the views of enthusiasts in specialism, some of 
whom are book-makers, and whose experience 
is confined in a great measure to dispensary 
and hospital practice. We know the dangers 
FADS AND FACTS. 9 
from puerperal fever are enhanced in the septic 
lying-in wards of hospitals, and statistics based 
on results of practice among the chronic clin- 
icians and habitual medicine-takers who fre- 
quent these institutions are not so reliable or 
useful to the general practitioner as the expe- 
rience he obtains by treating patients who are 
so fortunate as not to be compelled to take 
advantage of these institutions. 
The profession is in danger of being disinte- 
grated and engulfed by the speculative, busi- 
ness-like methods of some specialists and med- 
icine-venders. The enthusiastic tyro in micros- 
copy and bacteriology, from the emotional dis- 
turbance produced by a strain of expectant 
attention, we know, can not be relied upon as 
an exponent of the germ theory. The grave 
importance of personal equation in the consid- 
eration of such issues is but little thought of. 
There is danger of his seeing germs every- 
where. 
Only a few years ago the profession was 
startled with the announcement of the discov- 
ery of a real Elixir of Life. Under its potent 10 
and magic influence the decrepitude of senility, 
with its attendant harrowing cares and enfee- 
bled mind, was transformed into the agility, 
zeal, and elasticity of youth. The period of 
life known as old age was to become obsolete, 
and physiological laws were to be ignored and 
trampled upon. The impressible octogenarian 
was to have his youth " renewed as the eagle's," 
and we were assured that what Ponce de Leon 
had sought in vain, and lost his life in pursuit 
of, was given to mankind by Brown-Sequard. 
It seemed to be accepted that death, which fol- 
lowed the primal disobedience, was to disap- 
pear from earth. A nostrum was to effect this 
wondrous revolution! The "fad''was taken 
up by some members of the profession who 
coveted patients to submit to the exhibition; 
the daily press greedily sought the records of 
the return from age to youth of those injected 
with th© elements of rejuvescence, and physi- 
cians gave bulletins of the condition and prog- 
ress of their patients to panting reporters. The 
tone of the profession was lowered when phy- 
sicians set a fairy tale against the immutable 11 
laws of science, against the records of human- 
ity. The dignity which attaches to a science 
was abased when physicians advertised their 
adherence to a fad in a manner that would be 
associable with the heralding of the contortions 
of an acrobat or the grimaces of a clown. 
We were later invaded by the "fad" of 
"Kochine," and some physicians, through the 
daily press, informed the profession that under 
the influence of Koch's lymph the temperature 
of the tuberculous patient fell, the pulse was 
lowered, and a careful examination revealed 
the fact that tuberculous products were rap- 
idly disappearing. Physicians again sank to 
the level of chapmen advertising their wares, 
and the " fad" vanished after a brief period. 
It is unfortunate that songs of fame and 
glory are being constantly sung around the 
daring of the knife in surgery. A flash of 
light seems to give a brilliance to the career 
of an enthusiastic surgeon, when he wantonly 
and unjustly unsexes woman by removing her 
ovaries for the relief of neuralgia or obscure 
nervous trouble, without any well-marked evi- 12 
dence of organic lesion to justify such a radi- 
cal procedure. Such an exploit is essentially 
vicious and destructive to.the best interests of 
science and humanity. Possibly some ventur- 
ous surgeon, fired by ambition and sensation- 
alism, will in the near future suggest castra- 
tion for the relief of neurasthenia, now so 
prevalent in the male as well as the female 
species of the human race. If the removal of 
the ovaries be justifiable for the relief of neu- 
rotic trouble in women, why should not the 
man with a vitiated nervous organization be 
also unsexed ? It is scarcely necessary to say 
that for lack of subjects for experimentation 
the "fad " could never be introduced. 
Many of our medical associations are only 
mutual admiration societies, where some mem- 
bers report for publication, success, success, 
success, while their unsuccessful cases are rele- 
gated to the realms of innocuous desuetude. 
Unfortunately many of those who read papers 
at conventions remember that "we chronicle 
no French defeats in the galleries at Versailles." 13 
Away with the plague-spots of sensationalism, 
''shop-talk" cures, successful radical opera- 
tions, and speculative nonentities which are 
often reported in the daily press as advertising 
matter. 
Happily the tendency to such acts of noto- 
riety exists only among a small number of 
physicians. The great majority labor faith- 
fully and earnestly in the field of true science, 
and are not so possessed of the ego but that 
they can still believe the word cure means to 
care for properly, and that the vis medicatrix 
naturae exercises a potent influence for the re- 
lief of disease. The general practitioner, with 
the broadest field for observation, must be alive 
to every advance of medicine, and carefully 
reject the views of extremists, who have only 
theories to sustain. He is called to the bed- 
side of the patient at the warning of disease ; 
he forecasts its attack ; he watches its endur- 
ance ; he sees out its close. He is the main- 
stay of the afflicted, the solace of the sufferer. 
He will best succeed in his capacity as physi- 14 
cian or surgeon who holds that rational prog- 
ress in harmony with true and proper conserv- 
atism is the grandest gem in the diadem of 
medicine. 
Louisville