 No discussion of forceps would be complete without a demonstration of the application and use of the Piper forceps No student of obstetrics would feel that his training was complete without a thorough knowledge of this instrument Dr. Edward H. Denon Consultant of the surgeon general of the army will present the proper use of the Piper forceps Dr. Denon. Thank you, Colonel Riva. In 1924 the late Edmund B. Piper of Philadelphia presented this instrument which is intended for the aftercoming hit and is not to be confused with his instrument the two-piece axis traction forceps intended for the forecoming hit. In the construction the blades are a modification of the tarnier type with the slight pelvic curve and a narrow cephalic curve. The shanks are extra long and separated and bent backward in the middle lowering the handles and the adjacent portion of the shanks to a lower level than that of the classical instrument. The shanks in addition have a unique type of construction in that it consists of two planes. The portion of the shank adjacent to the blade is in the same plane of the blade down beyond the bend to within about two inches of the lock where it changes to right angles to correspond to the plane of the handles. The advantages of this instrument lie in these points of construction. The extra long shanks with the backward bend to the handles and the adjacent portion of the shanks permits an easy accurate application directly to the sides of the head without the necessity of elevating the body much above the horizontal. The two planes in the shanks gives extra spring to the blades hence minimizing compression of the head and tends to permit adjustment to heads of different sizes and shapes. The backward bend of the handles and the adjacent portion of the shanks lowering them to a lower plane gives access traction. Disadvantages are few. Mainly because of the flexibility they may slip on a large head especially if one does not have an accurate application. Now for the technique. After the breach in the body and the arms have been delivered and the head has been brought into the pelvis by the smelly-vite morosal maneuvers. If there's any resistance to progress the Piper faucets are applied to avoid the possibility of injury due to traction on the body or pressure on the aftercoming head. The operator assumes the sitting position. Piper advised the kneeling position and he stated that when one is confronted with the situation of this gravity it is advisable to adopt the attitude of prayer. But during the course of the years it is found it's a little more comfortable to sit down in making the application and one isn't under any great stress as he would be if he was on his knees and felt that he had to get off the floor without assistance. The first blade to be applied is the left blade and it's applied from below upward directly to the sides of the head. If the chin is directly posterior the blade is inserted directly to the left side. The chin is to the patient's right the blade is a bit posterior. If the chin is to the patient's left the blade is anterior in order to have it directly opposite the right ear. Again, we have an exception to the four cardinal points of left blade to left ear. As in the breech presentation the head is reversed so that the left blade goes to the left side but opposite the right ear. It's carried directly in to the side and the handle is brought around to the midline as the blade passes into the vagina. Once in place the assistant carries the body to the opposite side exposing the approach to the right side of the patient for the introduction of the right blade. The handle held near the left thigh and carried in one brought around to the midline and dropped into locking position. Upturned palm of the right hand grasps the handles with the middle finger in the space between the shanks. The body is lowered and the thigh is clamped to the handles by the thumb. At the hands are encircled by the thumb and the fingers to keep them out of the field of operation. Traction is downward with the left hand splinting the neck. In the middle finger in the suboccipital region. Traction downward in the direction of the handles then gradually elevating the handles to about the level of the horizontal then lowering the handles of the pump handle maneuver splinting the neck with the middle finger bringing the suboccipital region under the synthesis. Gradually repeating the maneuver of elevation and depression with advance of the head following each maneuver. Eventually the head is flexed so that it can be withdrawn directly from the vulva. Gently without any explosive exit with the blades still in place. The advantage of holding the thigh on the against the handles prevents the head falling through the faucets once the it has left the vulva. There is another maneuver advocated by Savage which may simplify the handling of the arms in which a towel is placed around the body and closing the arms and keeping them out of the field of operation. Play the left side to right ear and the body is carried to the opposite side right blade, right hand, right side left ear and then the body is lowered to the level of the shanks. The left hand of the operator splints the neck pump handle maneuver gradually making progress until with good flexion at the outlet the head comes out with the handles at the level of the horizontal.