Brit J Obs Gyn 1957 V-64 OBSTETRICAL-GYNAECOLOGICAL EPONYMS : JAMES YOUNG SIMPSON AND. HIS OBSTETRIC FORCEPS BY HAROLDSPEERT From the Department of Obstetrics and Gynecology, Columbia University, New York THEobstetric forceps has been modified and re- the same as Dr. F. Ramsbotham’s, but scarcely designed in new form probably more times than so much curved. The lock is Smellie’s, but with any of the other countless number of instruments knees or projections above it of such size as to and devices that man’s mind has conjured up for prevent the blades readily unlocking in the the diagnosis and treatment of his ills. The intervals between the pains, these giving it the Chamberlen family is often credited with inven- fixed character of the locks of Levret and tion of the first safe and effective forceps, in the Bunninghausen’s instruments, without their late sixteenth or early seventeenth century ; but complexity. The joints are made so loose as to archaeological evidence (Fig. 1) shows the allow of their lateral motion and overlapping to forceps to have been in use for the delivery of a very considerable degree, thus facilitating their living infants much earlier, probably the second introduction and application. And, lastly, the or third century, in the days of the Roman handle is that used by Naegele and other German Empire (Baglioni, 1937). During the latter part accoucheurs, viz., with transverse knees or rests of the nineteenth century almost every obstetri- below the lock for one or two of the first fingers cian of renown seems to have felt the need to of the right hand to drag by, the long forceps add his own modification to the forceps; and being only properly used as an instrument of even now scarcely a year passes without the traction, not of compression. In addition, the addition of at least one new instrument to our handles are grooved and marked 011 the anterior forceps arsenal. For fully a century now, how- side, to distinguish that from the other side ever, year in and year out, the vast majority of when the blades are within the pelvis . .” forceps deliveries has been carried out by means The forceps were used in the management of of an instrument popularized by Sir James uterine inertia, haemorrhage during labour, Young Simpson and usually known as the and other complications, “but the common Simpson forceps, although models embodying reason for employment of the long forceps,” in minor changes continue to bear the names of Simpson’s words, “is morbid contraction of the their new inventors. brim of the pelvis in its most general form, and Simpson demonstrated his forceps for the from its most general cause, viz., in the conjugate first time on 10th May, 1848 at a meeting of the or antero-posterior diameter, from projecting Edinburgh Obstetrical Society (Simpson, 1848). forward of the promontory of the sacrum. How “They differ from the short forceps in some points are the long forceps applied when used in this, of construction,” he explained, “but more the case in which they are most generally had particularly in regard to their mode of appli- recourse to in practice? It is first requisite to cation and working. They differ for example in state, that under this complication the child’s their length; in the shanks being parallel for head is found situated in the brim, with its long some distance beyond the lock, an indispensable or fronto-occipital diameter lying in the trans- point in order to prevent them injuring the verse diameter of the brim, or with the forehead outlet; in their blades being curved; and in the looking to one ilium, and the occiput looking part intended to embrace the head being to the other. In other words, the long diameter sufficiently long and large . The blades are of the head is not placed, as usual, in the right 2 PI. 744 history-of-obgyn.com JAMES YOUNG SIMPSON AND HIS OBSTETRIC FORCEPS 745 diagonal diameter of the brim, but more in its sacrum; the lumbar portion of the spine was transverse; for where the promontory of the distorted; and she walked very lamely. The sacrum forms a morbid projection, the trans- present was her second confinement. Her first verse forms the longest diameter of the brim, labour had been long and difficult . delivered and, consequently, the one in which the child’s by craniotomy . Even after the cranium had head comes to be placed by the uterine efforts been fully broken down, a considerable time and . the lateral surfaces of the child’s head come much traction had been required to drag the to be compressed between the protruding sacral diminished and mutilated head of the infant promontory and the interior of the symphysis through the contracted brim of the pelvis; and pubis . .” she was long in recovering. Contrary to the Modern obstetrical teaching emphasizes the urgent advice of her medical attendant, Mr. importance of symmetric, or cephalic, appli- Figg, he was not made aware of her present or cation of the forceps to the sides of the foetal second pregnancy till she had arrived at nearly head. Simpson, by contrast, advised asymmetric, the end of the ninth month. It was thus too late or pelvic, application of the blades. “The blades to have recourse to the induction of premature of the long forceps,’’ he wrote, “should be placed labour, which had been strongly pressed upon obliquely upon the child’s head-one, the her as the only means of saving her child, posterior, over the side of the occiput; and the should she again fall in the family way. The pains other, or anterior, over the side of the brow or of her second labour commenced in the forenoon temple, and consequently should be situated of the 19th. I saw her with Mr. Figg at five in the oblique diameter of the brim. (See o’clock in the afternoon, and again at seven. Woodcut, Fig. 3.)-The markings on the child’s The 0s uteri was pretty well dilated, the liquor head after birth always show this mode of amnii not evacuated, the presenting head very application of the instrument: when properly high, mobile, and difficult to touch; and a applied upon the mother, and when their pulsating loop of the umbilical cord was felt situation relative to the pelvis is examined, they floating below it in the unruptured bag of are found to have assumed this position; and membranes. From five to nine o’clock the pains in experiments with the instrument (when the seemed only to push the circle of the 0s uteri head of a dead child is fixed in a pelvis with a further downwards, without increasing its contracted brim), this is the position and dilatation, or making the head in any degree relation which the instrument will be seen to enter into the pelvic brim. Assisted by Dr. assume with relation to the infantile head and Ziegler, Dr. Keith, and Mr. Figg, I shortly after maternal pelvis. Besides, in thus placing the nine o’clock made the patient inhale the ether instrument, while we incur less danger of vapour. As she afterwards informed us, she injuring the urethra and other important parts, almost immediately came under the anodyne we place the blades of the instrument in exactly influence of the ether. But in consequence of those parts of the pelvic circle where there is doubts upon this point, its use was continued least pressure and consequently most room for for nearly twenty minutes before I proceeded to them . .” turn the infant (as I had previously pre- Simpson is remembered eponymically for his determined to do). A knee was easily seized, forceps, but far greater to his credit was his and the child’s extremities and trunk readily introduction of anaesthesia into obstetrical drawn down; but extreme exertion was required practice. On 19th January, 1847, for the first in order to extract the head. At length it passed time, he administered ether to a patient in the contracted brim with the anterior part of its labour, reporting the case in the March issue right parietal bone deeply indented by pressure of the Monthly Journal of Medical Science against the projecting promontory of the (Simpson, 1847a). “The pelvis of the mother”, sacrum, and the whole cranium flattened and Simpson wrote, “was greatly contracted in its compressed laterally. The infant gasped several conjugate diameter from the projection forwards times, but full respiration could not be and downwards of the promontory of the established . 48 4 history-of-obgyn.com 746 JOURNAL OF OBSTETRICS AND GYNAECOLOGY “On questioning the patient after her delivery, to be joyfully and gratefully welcomed by she declared that she was quite unconscious of medical science, as one of the most inestimable pain during the whole period of the turning and boons which man could confer upon his suffering extracting of the infant, or indeed from the first fellow-mortals.” minute or two after she first commenced to Arguing for the extension of anaesthesia to breathe the ether. The inhalation was dis- obstetrics, Simpson (1847a) made the forceful, continued towards the latter part of the process, impassioned plea : “NOW,if experience betimes and her first recollections on awaking were goes fully to prove to us the safety with which ‘hearing’, but not ‘feeling’, the head of the ether may, under proper precautions and infant ‘jerk‘ from her (to use her own expres- management, be employed in the course of sions), and subsequently she became more parturition, then . instead of determining , . roused by the noise caused by the preparation whether we shall be ‘justified’ in using this of a bath for the child.