It was once my pleasure to be present at a medical society meeting at which, from a psychological point of view, the discussions of a most highly interesting and instructive paper on the use of "Forceps in Obstetrics" interested me very much.

One physician related his experience in a recent case where he, with another physician present, had found it necessary to make several prolonged and strenuous efforts at traction upon the fore-coming head before they succeeded in a delivery, which resulted in a badly lacerated cervix and a most completely lacerated perineum, stating in the conclusion of his remarks that he found it frequently necessary to resort to the use of forceps, and for this reason he highly appreciated the paper.

Another physician referred to a recent high forceps operation, and the difficulty in applying forceps before the head began to descend and while the os was as yet but partially dilated.

A third referred to the frequency with which he had found it necessary to resort to the use of forceps in obstetrics, and how he dreaded such ordeals.

Still another speaker emphasized, among other valuable ideas, the small amount of traction with which she had been able to deliver her forceps cases, even while the patient had been thoroughly chloroformed.

Among those who discussed the paper was yet another, a large, self-possessed, and magnificent-looking physician, a little past fifty-five I should judge, who stated that he rarely, if ever, had to resort to the use of forceps, and he urged the advisibility of not being in a hurry, and giving the natural physiological processes time to accomplish their work, rather than hastily resorting to instrumental assistance or interference.

I do not claim to be perfectly accurate in my passing references to the discussion to which I have referred, but the features brought out in those discussions illustrate conclusively the importance of more attention being paid to the psychologic factor in obstetric practice.

It was quite evident that the large, self-possessed physician to whom I referred did appreciate the psychologic factor, and hence "rarely, if ever," had to resort to the use of forceps. It was also equally evident that some of the physicians present were rather inclined to be nervous, and unconsciously had been a potent factor in producing the condition in their patients which necessitated the use of instruments.

More than in any other part of the practice of medicine, in obstetrics the physician should be well-poised and self-possessed, and should maintain a quiet demeanor, keeping his mental and nervous equilibrium well conserved in the presence of an excitable, frightened, and nervous patient.

In the early years of my professional work I assisted three times in the instrumental delivery of a lady who at the time of her fourth delivery fell into my hands. Knowing the difficulty that she had experienced with her previous deliveries, and seeing the depression that her condition and the approaching ordeal produced upon her, I had her come to see me quite frequently and positively assured her that I had her on a treatment that would insure a safe and easy delivery, and before her confinement I had eliminated all element of fear. When I was called to see her at the time of delivery, after making a careful diagnosis, I again positively assured her that it was absolutely impossible for her to do otherwise than get along nicely, and I have never attended an easier delivery than hers.

Where it has been possible, it has been my habit to see the prospective mothers often enough before parturition to keep well en rapport with them. I have frequently placed them in the suggestive state two or three times during the last weeks of pregnancy in order to insure a perfect psychological attitude at the time of delivery.

The influence of the mind upon metabolism is well established. To keep our prospective mothers in a buoyant, hopeful, cheerful state of mind helps to prevent albuminuria, eclampsia, and other complications. All other essentials requisite to the well-being of our patient should not, of course, be overlooked. A wholesome vegetable diet, with milk and eggs, as well as regular out-door exercise, should be insisted upon.

When called to see your patient when in labor manifest a kindly interest in her well-being, and make her feel that you are kind, firm, and self-sufficient by your conduct in her presence. After carefully making your diagnosis, do all you can to calm her spirit, assuage her fears, and inspire her with confidence in your ability and intentions to do what is best for her. Assume absolute command of the situation, and allow no environing influence, such as overanxious expressions of friends, to influence her. Let her feel the masterful, helpful, encouraging influence of your personality, as well as get the benefit of your kindly assistance.

When the members of the medical profession become awake to the importance of the psychological factor in obstetrics, forceps deliveries and lacerated cervices and perinei will be far less frequent.

While in a southern city four years ago a well-known physician requested me to see with him a woman in labor, and I quote the following from his report of the case: "About two o'clock in the morning I was called to Mrs. W., a young primipara, who was frightened, exceedingly nervous, and hard to control. Two hours later Doctor Munro came at my request and demonstrated the efficacy of suggestion in a most satisfactory manner by substituting for the extreme nervousness a condition of placid repose. The rapid heart beats became normal, the patient slept peacefully between contractions and 'bore down' to her pains without complaint. It proved especially efficacious during that nagging stage of dilation. Later on, with the aid of only a few drops of chloroform, the case was conducted to a finish with perfect satisfaction both to myself, my patient, and her friends. I am fully convinced that when physicians learn to practice intelligently what for ages we have all been practicing ignorantly - i. e., suggestive therapeutics - the obstetric couch will be robbed of its horrors."