You may confidently hand them to the patient, or let friends point out their advantages. Be particular to impress the fact that there are no sharp edges or rough places about them, so that they cannot possible cut, or do any other injury; also that in all probability in from five to fifteen minutes the labor will be completed. They yield; the instruments are used, and the labor terminates about as predicted. The child is alive; the mother is not exhausted, but is deeply thankful; the friends rejoice; and all have lost prejudice and fear of harm from instruments. In due time the patrons will cheerfully pay the bill. They are loud in their praises to their acquaintance and neighbors, who are likely to require the services of a physician not only in such cases but in others. I doubt not, that it will be admitted by all of you, that under certain circumstances it becomes necessary to resort to the use of instruments, but that we should be extremely cautious as to when we use them, and never think of doing so until other means have been tried and exhausted. With this idea in view, that very popular cry of" meddlesome midwifery" has been sent forth both by orator and author with sufficient force to drive out of the mind of every young obstetrician, all idea of doing anything to help the parturient woman beyond sitting down, watching and waiting, and occasionally making a digital examination, which may leave him just about as wise as before; then in answer to interrogations, he may very gravely reply: "Let nature take its course." Young physicians are advised for the same purpose, not to take their forceps with them, unless they are in the country and are called a long way from home. I have even heard of some being advised not to buy instruments, so that they should not fall into the habit of using them on every occasion. We might with about the same propriety advise the dentist not to have any improved forceps for the molar teeth for fear he might use them to take out a child's incisor, when it could just as well be extracted with a piece of thread.

The following cases which occurred in my practice will serve to illustrate my points:

A few years since I attended a lady in her second confine

ment. She informed me that about four years before, while she was in Europe, she was confined with her first child, and that she came very near losing her life. She was a lady of culture and wealth. The physician engaged to attend her was a man of many years' experience and a graduate of one of the European colleges, who ought to have been prepared for any emergency. Labor came on, the physician was called, and was in attendance the greater part of the time, for three days and nights. The lady suffered intensely, nearly all the time. In answer to the inquiries of friends, as to whether something could not be done to relieve her, he would reply: "Let nature take its course." The friends finally became alarmed, and called two other physicians. A consultation was held, and it was decided to deliver with instruments. They stated that in a very short time both mother and child would have died. Those who used the instruments and safely delivered the woman, received all the glory; and the one who had been attending her for three days and nights lost the case, and bore all the blame. One of the conditions of my engagement, and one that relieved the lady of the greater part of dread in the coming trial, was my perfect willingness to use the instruments in good season, if there should be any need of them, and not allow her to suffer as she had before.

I attended another lady in her ninth confinement; she had been delivered twice with instruments while under the influence of ether. At the time of engaging me the chief thing she required was, that if she had very severe pains, I would give her ether and deliver her with the instruments. I gave the promise. Soon after the second stage of labor had commenced, she asked for the ether. It was ready, and so were the instruments.

I administered it slowly, and carried it to complete anæsthesia. The child's head had not descended far down, but the dilatation was complete. I adjusted the instruments; in a few minutes the head was delivered; and before she came from under the influence of the ether, the birth was complete. In all my experience I never had a mother or child do better.

On one occasion I was accosted by a woman, who said that

her sister was in labor. They had sent for their physician, but he was not at home. They were afraid to delay any longer. Would I go and see her? I consented. "But," said she, "Doctor, it may be a serious case. She has a deformed pelvis, and we are very anxious. Do you think you will be able to manage the case?" I replied: "I will go and see, and then give my opinion."

What I had been told was true. The tip of the coccyx was not more than two and a quarter to two and a half inches from the symphyses pubis, and their was also obliquity. I explained the nature of things to the friends, and at the same time stated that the only chance for life was to deliver her with instruments. The child, I thought, could not possibly be born alive. I insisted that they should send again for their physician. I also send for Dr. Miles. They were out. I said: "Send again; and in the mean time I will do what I can alone; we have no time to loose, and some one will be here before long." I sent for my instruments. It was one of the most difficult labors that I ever saw. I had just succeeded in delivering the head, as Dr. Miles came into the room. In a short time the labor was complete. To my astonishment the child was born alive; but I never have seen such a looking head. It was flattened from side to side and fearfully elongated. In time however, it got all right. The family has removed from the city; but the last I heard from them, the mother and child were well.

Another woman lived very near to the one just mentioned; was pregnant for the first time; she was the third wife of her husband, but the first of the three that had ever been in such a condition, although he had lived with one of them over twenty years. They had not been married much more than a year and both were somewhat advanced in life; she being over thirty-nine years of age and her husband considerably older. For the first time in his life there was a prospect that he would become a father. You may naturally suppose that they were very anxious, both on account of the age of the mother and also for the expected child. They had been considering into whose hands they should commit the case. Several prominent

physicians in the city had been mentioned, but no one was engaged, when the report of the above case induced them to call on me. In due time I attended, gave ether and delivered with instruments. The mother and child are both living and doing well.

I now respectfully insist that it is better to employ instruments, whenever by so doing we have good reason to hope that we can shorten the process one hour, providing the patient herself consents. When the head is in the pelvis, and from any cause its progress is delayed, I claim that it is good practice to state to the patient that everything is going on well, and that in all probability she will be delivered in one, two or more hours, just as we may think, without any interference; yet that if she wishes, we are prepared to apply the instruments, that everything is in perfect condition for the passage of the child, and all that is required is a little assistance when the pains come on; and that with such assistance delivery will most likely take place with the next pain.

Some will object, and prefer to wait. In such cases we should express ourselves as entirely willing that they should do so, and state that it is only for their sake we made the suggestion. Fully one-half of those persons who at first object, will, in case that the pains continue severe, and the labor does not soon terminate, request you to do something to help them. The instruments are very easily put on in such cases. If the head is delivered with the first or second pain which is almost always the case, we have probably removed the prejudice from the mind of the patient and attendants, and made a reputation for ourselves in regard to the use of instruments.

The especial point gained is this: that we do not press the use of instruments against the wish of a patient, but simply give our advice, and stand ready to use them if this is desired.

It is sometimes argued that it is better not to get into the habit of using instruments, because in such cases a doctor is liable to do this on every occasion where there is a little delay. I fail to see any reasonable objection to this, provided their use is not urged upon an unwilling patient, if thereby

I can shorten and thereby mitigate a woman's suffering. During the past five years I have applied instruments very many times, and I have never been able to perceive any real objection to their use. Besides I know that I have secured a number of good friends and patrons and prevented a vast amount of needless suffering.

QUESTIONS FOR PHYSICIANS AND ANSWERS FOR MOTHERS.

By ORIN DAVIS, M. D., Attica, N. Y.

Every physician is often and earnestly requested to answer these difficult questions: What are the causes of the early decline of American women? Why is it that physical deterioration prematurely breaks down our girls and unfits them for the duties of life?

Emerson, with poetic beauty, says: "Sunshine and good cheer make a fine climate." But in our zone, climate, like a relentless sword, pricks the restless sensibilities of body and mind, thus engendering wear and waste in the system; punctures with nervous disorders, headaches and dyspepsia; pierces with influenzas, rheumatisms and inflammations; and slays its thousands with nameless infirmities. While we cannot expect to overcome wholly the perils of our climate, we may avert those weaknesses due to bad habits and misspent energies.

WHERE THE MISCHIEF BEGINS.

Ill-management begins in the nursery as soon as the babe is born. The child breathes the foul air of unventilated chambers, is girded with tight bandages, roasted by a gassy stove, sweltered in bungling clothing, starved or overfed, jounced on the knee, paregoricked, castor-oiled and otherwise maltreated by nurses, who bring into practice more prejudices than good sense. Nature is so strict an accountant that an excess in one direction is balanced by a deduction elsewhere.