On axis-traction forceps / by Alexander Russell Simpson.

Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: On axis-traction forceps / by Alexander Russell Simpson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    only succeeded at last in effecting its delivery by perforation and crushing of the after-coming head. In some there was failure in the powers ; one of these patients, a primipara, having disease of the mitral valve. In three we had to deal with occipito-posterior positions of the head, in all of which the rotation occurred regularly under the steady effective traction. In two the child's head was large, one of them from commencing hydrocephalus. In this last case the head was already at the floor of the pelvis, and had lodged there for three hours when I was called to the case. The mother of this infant, which was born alive and lives still with gradually widening sutures, is the only case of maternal death, and the fatal issue from septicaemia was no way connected with the forceps application. The only death among the infants was due to the cord having been coiled several times round the neck, and the upper coil having been caught in the grasp of the forceps-tip. It was the first time I had seen a forceps case fatal to the infant from this cause, though I had been accustomed in my class lectures to enumerate it as among the sources of danger in their use. I ought to add that in some of the earliest cases the infants had a partial paresis from pressure of the facial nerve in front of the ear. This was found to be due to a fault in the construction of the blades of the instrument employed; for whilst the measurement between the anterior rims at three inches from the point was the normal three inches, the distance between the posterior fenestral rims was only two inches and seven- eighths. IV. EULES FOll THE USE OE FOECEPS. I proceed to formulate rules for the employment of forceps, adapted from the plan of procedure of my predecessor. A. Preliminary Rules. 1. Be perfectly assured of their necessity. 2. Tell the relatives always—the patient generally. 3. Be cautious in your prognosis regarding the inl'aut. 4. Have the bladder and rectum emptied. 5. Place the patient on her left side, her body across the bed, with nates at edge of it. (Sometimes it becomes desirable to turn the patient on her back during the extraction.) 6. Warm and grease tlie instrument, and if necessary lubricate the maternal passages. 7. Anaesthetize the patient. 8. Assure yourself of the precise position and relations of the head, introducing the hand as far as is necessary. B. Rules Regarding Introduction of Forceps. 1. Insinuate, do not force on the instrument, and withdraw it partially when any great resistance offers.