A TREATISE OF MIDWIFERY. Part the Second. (continued 2)

“To change, (says Daventer) this situation, thus you must proceed. The woman must rest upon her knees and elbows, with her head low. And what (adds he) determines the placing a woman in this posture, is, that the weight of the uterus may impel it to the side of the diaphragma, and consequently withdraw it from the sinuosity of the coccyx.”

To me it appears impossible, that a woman, whose strength shall have been exhausted, or but much diminished, can put herself into such a posture, which could only serve to make her lose any little strength she might have left.

At the end of the said chap. xlvi. Daventer concludes in the following terms.

“However, to say the truth, of whatever kind the obliquity of the uterus 342may be, I hold, that the safest, the easiest, and the least painful expedient, is the footling-extraction of the child, from the very beginning of the labor, before or immediately after the discharge of the waters, as soon as one can be assured that the pains the woman feels are the labor-pains. If this method should be followed, which I hope (adds he) it will one day be, it would preserve an incredible number of women and children, the unhappy victims of a contrary practice.”

Here I must confess the shallowness of my understanding. Such a reasoning as Daventer’s in this case passes my conception. He allows, that in all the obliquities of the uterus, it is extremely difficult to find the orifice, to come at it, and to introduce the fingers into it: nay, he owns, that it is not without a great deal of trouble, that you can get to touch but the surface of that orifice; and after that confession, he tells you very gravely that, in such cases, you must deliver the child by the feet, in the very beginning of the 343labor, before even the discharge of the waters, or at least soon after.

Ought then the translator of Daventer, who is at the same time his apologist, in good conscience, boast so much the discoveries of this author upon the obliquity of the uterus? is it possible for common sense to give the approbation that he does to those easiest, safest, and least painful methods, that he recommends for relieving the mother and child in those cases of obliquity?

I am then too much prepared to be surprized, in the chapter following that from which I have quoted, to find him, where treating of an uterus too much inclined towards the vertebræ, not scruple to reason as follows.

“But if the child is too much compressed, or has a head over large, so that it is not without much difficulty to the midwife, and pain to the woman, that it can be hoped to bring the child into the pelvis, a state of things which does 344not unseldom happen, I judge that, to prevent the danger, the best method is the footling-extraction. But (adds our author by way of reflexion) this work is more befitting a man than a woman, unless she has a quick judgment, and an alert hand: a man-midwife should therefore be called (Doubtless!) and he must lay his account with having work enough, for it is not without a great deal of trouble and difficulty, that he will accomplish the turning the child, and that for three reasons.

“The First. Commonly, the orifice of the uterus in this situation is but little open: it must be violently dilated, that is to say, in forcing Nature, or doing violence to her. Yet this must be done slowly, for too much precipitation would cause to the woman very acute pains. (To be sure, a slow violence would not hurt her.)

“Reason the Second. It is not more easy to penetrate to the bottom of the uterus, of which the orifice already, 345narrow as it must be, is moreover occupied by the head of the child, than to open the orifice. No wonder then, that so much trouble and patience should be required to get at the child’s feet.

“Thirdly, It will be found, that the distance there is between the orifice of the vagina to the bottom of the uterus, must render the man-midwife’s work so much the more difficult for the sinuosity of it, and his being forced to operate in a part so narrow and close, and in which the hand is much cramped for room. It is obvious to sense, that a place so oblique and streight must deny the liberty of passage.”

The advice which Daventer gives here of extracting the child by the feet in the case he supposes, and, for that purpose, violently to dilate the orifice of the uterus, appears to my weak mind such mad, such frantic doctrine, as to be beneath refutation. The bare recital of his own reasons, 346and of the difficulties there are to surmount, which he himself confesses, abundantly demonstrate the impossibility and absurdity of the method he proposes.

But after taking the liberty of dissenting from that celebrated man-midwife in cases of obliquity, as to the practical part, which I take indeed to be his own discovery, it is but just I should offer what I conceive to be the true midwife’s practice, for terminating happily the labor of a woman in the case of obliquity of the uterus: submitting the same to better judgment.

All the deflexions or byasses of the uterus, whatever they are, are to be known by the touch. An expert and knowing hand will never fail of ascertaining the discovery of them. I say, an expert and knowing hand, for without an exact knowledge of the figure of the whole pelvis, the situation of the bladder, of the rectum, the vagina, and the uterus, before and after pregnancy, the situation of the orifice with respect to the pelvis, there is no distinguishing for example, an over-elevated orifice 347from one too low, nor a direct from an oblique one. In vain would one conceive clearly what those terms signify, or have some knowledge of the distinctive parts of the female sex, without one has at the same time sufficient experience, and fineness of sense in the touching part. Without these qualifications there is no proceeding but darkling, and in danger of deception.

The orifice of the uterus is always diametrically opposite to the fundus of it. When then you know what the situation of the orifice of the uterus is, when in its due place, you may, if well versed in touching, calculate any aberration from the right line, and by the situation of the orifice giving that of the fundus, know how the rest is disposed.

When, by touching, I perceive, there is an obliquity of the uterus in the case, in the proper time, I desire the patient to lay on her back, and introducing my finger, endeavour to come at the orifice of the uterus. Upon getting hold of it, I support it so long as the labor-throw continues, 348and I take care the child should not engage itself too much.

I am obliged, with my hand, continually to repeat this service; and after resting a little from the fatigue, whenever I can snatch a moment safely for such relaxation, I re-introduce my finger, as before, in order to prevent the pains, and hinder the orifice from falling, that is to say, from sinking, so as to turn too much backwards, or from rising too high, or, in short, from deviating towards the right or the left, according to the circumstances or kinds of inclination that may present themselves. I also take great care, that the child may not engage itself too far under the os pubis. I do not discontinue these cares, these attentions, until, whatever assiduity, length of time, or trouble it may cost me, I shall have arrived at rectifying the wrong direction, by thus constantly supporting the internal orifice, till, in short, I have brought it, little by little, to turn and come directly on a line with the external orifice. By this management of the hand, I procure the child a fair opening, and its falling forward, 349without being wrapped up or embarrassed in the uterus.

And yet, in certain cases of obliquity I sometimes find so great an inversion of order, such an intanglement, that the child presents itself in the vagina with the body of the uterus covering it wholly, and by its volume totally impeding the coming at the orifice.

I have before observed, that I required my patients, in these cases, to lye upon their backs, and this, because, if they set up straight, the uterus would overset, and render the obstacle, if not invincible, at least, much more hard to remove.

However, both to ease my patients, and to prevent the child’s ingaging itself too far in the pelvis, I get them, according to the circumstances, to keep still lain down, but to turn sometimes to one side, sometimes to the other, without ceasing my attentions, without discontinuing to rectify the turn of the internal orifice from over the summit of the child’s head, and 350to uphold the said orifice, if it should tend to turn backwards, to depress it downward, by a gentle pressure, if it is inclined to rise towards the os pubis. This operation, this support, this depression, ought always to be managed with as much tenderness as skill, and there cannot be too much of both.

Certain it is, that the bad situation of the uterus often occasions a severe and difficult labor. A midwife therefore, from the very first of the labor-pains, cannot bestow too much attention to the giving such preventive or actual aid as I have proposed. Nothing, on these occasions, is more dangerous than delay. The pretious moments of operation must not be lost, least the child, coming to engage itself, should throw us into an embarrassment yet greater than the first.

In the beginning of the labor, it is no very great matter, to know exactly, what part the child presents to the orifice of an oblique uterus. It is enough to know, that it is not the head, in order to determine 351you, in due time, to the footling-extraction. What I mean is, that as soon as a good position shall have been procured to the orifice of the uterus; if it is any other part but the head that presents itself at that orifice, and that it is sufficiently dilated for the hand to get by gentle degrees introduced, dilated, in short, to about the diameter of a crown-piece, then, if the membranes do not break of themselves, the midwife should pierce them, and search for the feet of the child, to bring it away. But if the head it is that presents at the orifice, there is no need of any hurry: it is even better to wait till the membranes burst of themselves, unless they should be come out of the vagina, in which case they are to be opened, in order to terminate the delivery, not with scissors, but with the fingers alone.

The reader will here please to observe, that in these cases of obliquity, almost every thing depends, as to the prognostication, and prevention of difficulties, as well as to the relief in actual labor, on the exploration of the touch, and consequently 352the manual function. The last is especially and palpably indispensable. What can supply the place of it? not surely those forcing medicines, which some ignorant men-practitioners obtrude on the unhappy patient, and which only serve to exasperate the pains in vain, and certainly not to accelerate that parturition, which is retarded by the purely local indisposition of the womb. An obstacle which a skillful, tender, experienced hand cannot but be the fittest to remove.

In this case however it is, that Monsieur l’Accoucheur oftenest looks extremely silly and disconcerted. Though the throws redouble, the child is never the nearer coming out. On the contrary, till its passage is franked by the reduction of the uterus, it bears in vain upon any part, but that aperture, through which alone lies its issue: and, in fact, the harder it bears, the more it obstructs its own deliverance, and damages its mother. Monsieur l’Accoucheur stands by, does nothing, and can do nothing, or worse than nothing, if he should pretend to it: if he had the head, he has not the hand to give the patient any 353efficacious aid. Then it is, that where thus incapable by Nature, for the manual function, the men-practitioners abuse that excellent, that divine, but here mistimed and misplaced maxim, of leaving things to Nature, of trusting to Nature. The power of Nature is just then, all of a sudden, acknowledged to be self-sufficient, when she really wants human help to redress her wrong. She is then at her greatest need, left to shift for herself. The fruitless pangs increase. Monsieur l’Accoucheur stands by an idle spectator, or perhaps goes about his business. In the mean time both mother and child, exhausted by fruitless efforts, for perhaps four, five, or six days, perish for want of the proper and only relief. Thus the ignorant operators abstain from interfering, when interfering, if they were fit for it, might be of service, only because they cannot so well in this case employ their iron or steel instruments: and as to their hands, they would most probably indeed make sad bungling work of it. Their action, in short, is, if that can be imagined, yet worse than their inaction.

354Some of them, in this case, content themselves with saying, that the orifice is as yet too distant, and that nothing is urgent. They go away then, and leave the patient in the hope of some favorable change which is never to happen. They return, and find a strange disorder in the state of things, the child is too far engaged: it is too late to retrieve the damage, as they imagine, and I readily believe, when they have lapsed the due time of operation, of which it is not only probable they knew nothing, but, if they had known what to do, would have done it very ill. Then the vast knowledge and learning of these disconcerted instrumentarians can furnish them no better expedient, than that of murdering the child (as they pretend) to save the mother, though it is not always that the mother does not follow the fate of her poor infant.

I know, by my own experience, that often to make a happy end of such deliveries, requires an extreme attention and indefatigable pains. But practitioners should resolve, either to go through with the undertaking 355as it should be, or not begin it, in such cases, especially where the lives of mother and child depend upon their doing their duty, as they will answer the contrary to God, to man, and to themselves.

These cases are but too frequent in England. I have myself met with several of them, and sometimes even in persons extremely well made, in which I have been obliged to perform this manual aid, for many hours together, ay, even for half-a-day and more by the clock; all my motions keeping time with those of Nature narrowly watched, so as to rectify and adjust the orifice and the uterus; constantly reducing any detortion, and keeping things in their due direction, without tiring, or without losing patience.

Here I ask of my reader, is such work as this, naturally speaking, the work of a man, as Daventer would persuade us?

If the Monsieur l’Accoucheur is an ignorant, or rather not a very intelligent one 356indeed, the mother, or the child, or perhaps both, will probably be his victims.

But you say, if he is an intelligent one all will be safe. No; he may perhaps know what to do, but will he have the woman’s faculty of acquitting himself of his duty? all the theory in the universe will not do here without the practical part; and will the hands of a man in that respect ever equal the suppleness, the dexterity, the tenderness of a woman’s? once more, is a man made for such work?

I say nothing here of the patience so remarkable in the true midwife on such trying occasions. I will grant, that Monsieur l’Accoucheur may, in the view of forty, fifty, or a hundred guineas perhaps, have enough of it not to slacken an attendance on his part, so dangerous, so insignificant, and often so pernicious; that it would be much better to pay him for his absence: I grant then, that he may employ his divine hippocratic fingers in such handy-work, for so many hours together, without stepping into the next room for refreshment; 357or, in short, without hazarding the lives of the mother and child, by a remission of actual attention and manual assistence. But granting all this, can any one, who has a respect for truth, a respect for his own knowledge and sense of things, a respect, in short, for two such precious lives, as those of mother and child, not, I may say, intuitively, perceive and feel, the impropriety and danger of the practice, in such cases, being committed to a man preferably to a woman?

But would a woman especially, who loves herself, who loves the child in her womb, and who is capable of thinking at all, sacrifice herself and child to so palpable an imposition, as that of the pretended superiority of the men to the women in this point? She cannot even, well, without repugnance, submit, nor but for the indispensable necessity probably would submit to receive such service even from one of her own sex, whose tender, soothing, congenial softness, must make it more easy and supportable. But what can she expect from a man’s clumsy, aukward, unnatural, disgustful operation, but increase of danger, 358or of pain, perhaps of both; while she and her child may not improbably be the victims of the rudiments in the art of a man by Nature condemned for ever to be a novice only, and who, for possibly a great hire to assist her, earns it only, as I have before observed, by excluding that due relief he is himself not capable of giving her; earns it by the not preventing enough her pains, and even by increasing her torments; till at length, not unfrequently, some infernal instrument is produced, like the dagger, in the fifth act of a tragedy, and forms the catastrophe of mother, or of child, or of both?

Of the EXTRACTION of the head of the Fœtus, severed from the Body, and which shall have remained in the Uterus.

I agree with our modern writers, that there can hardly exist a more vexatious accident, than that of the head’s remaining in the uterus, after the extraction of the body. There are many causes of this effect. The death of the child for some time past, so that the waters may have had time to relax, to macerate the fibres, and thereby 359to render them incapable of resisting any efforts; there will result from thence a great difficulty of procuring the total issue of the dead fœtus, without dismembering it.

Some mis-conformation of parts in the mother may also contribute to it, or the obliquity of the uterus, where the child is brought away by the feet.

Independently of all these causes, this accident is almost always the effect of unskilfulness; it is, in truth, so rare, that it will scarce ever happen, where the delivery is conducted by an accurate and able practitioner of the art. If we have some examples, that even under skilful hands this case has come into existence, a thorough examination of it would shew, that it was only owing to the cruel necessity the practitioner may have been under, of being aided by persons not duly qualified to afford the least effectual help, or to conceive what they were directed to do.

360But, however that may be, the damage is not absolutely without remedy. The great point is, without loss of time, to introduce the hand into the uterus, which does not proceed in its contraction, but gradually and leisurely enough, to give leave for the needful evacuation. It is true, that this operation requires a very nice skilful hand; with which, where it is found, surely no instrument, nor other invention, can come into competition.

This accident has appeared to occasion such severe labors, that many practitioners, and Peu, among others, (page 308) have advised abandoning the expulsion to Nature, rather than to fatigue the patient by fruitless and torturous attempts, to the success of which such obstacles presented themselves, as they looked upon to be unsurmountable.

Mauriceau (Aphor. 240) is of the same opinion, which he thus expresses. “When the head of the fœtus shall have remained in the uterus, which is no 361longer open enough to give it passage forth, it is better to commit the expulsion to Nature, than to attempt the extraction with too much violence.”

These practitioners ground their opinion on that Nature, always wise and intent on self-preservation, taking more care to expel a superfluity, than even to attract the needful, often discharges herself, and that without violence, if she is but ever so little assisted, of all extraneous bodies, or other things retained in us against her intention.

Messieurs de la Motte, Peu, and Viardel adduce examples of Nature’s doing spontaneously, what some of our later moderns are for absolutely doing themselves by means of those curious instruments, in which they make such a parade of the rare inventiveness of their genius, particularly in the extraction of a head remaining detached in the uterus, on its contracting some hours after the unskilful operation of some deficient practitioners. In such cases, I say, 362those gentlemen furnish instances of Nature’s expelling the superfluous and extraneous incumbrance, with only the help of some glysters, and other remedies administered to the patient.

Now though no one can be more intimately convinced than I am, that Nature, acting for ever upon surer principles than Art, possesses resources which she often displays in the most desperate exigencies; I own, that in this case I am not for totally relying upon her beneficence^[32]. Here is a wrong to redress, not owing to her, but to deficient practice; and this wrong can hardly be repaired by her alone, unless something of a better practice contributes to relieve her. That practice is not, however, the less recommendable for being plain and obvious. The most gentle, the most guarded, but withal the most efficacious means must be tried, little by little, to insinuate 363the fingers and hand into the uterus, how closely contracted soever it may be; for yield it will; and then seize the head by the mouth, the occipital cavity, or whatever other part affords the least slippery hold, without waiting whole hours, as do certain ignorant or negligent practitioners with respect to the after-birth, who give time to the uterus to enter into too strong contraction.

Some authors, and other persons of much that depth of practical merit, having learned solely by the experience of delaying to bring away the after-birth, that, to abandon thus the head of a child remaining in the uterus, was, at the same time, to expose the mother to the highest danger, judged it expedient to have recourse to auxiliary methods. They have therefore employed and directed for this purpose such edge-tools, as instruments and crotchets of different figures, some to incide and separate the bones of the skull; others to bring them away piece-meal, or all together, according as they should find the operation the easiest. 364^[33] Dyonis and Mauriceau are of opinion, that the crotchet should be thrust into the most convenient place of the head, such as the mouth, one of the orbits of the eye, or the occipital cavity; after which, you are to endeavour to bring away the head by redoubled efforts. But if the crotchet slips, as the head is of a round figure, and may turn like a ball, they direct you to thrust the crotchet into the hole of the ear, then giving some one the handle to hold, you are to strike another crotchet of the same figure in the other ear, and so pulling with both crotchets at once, extract the head, that is to say, if possible.

Ay, that “if possible,” is well added; for with infinite submission to those very learned gentlemen, nothing appears to me more impracticable; and, I fancy, if they had ever made the experiment, they would 365have found it so. What a blind operation, with such instruments, and in such a place!

Guillemeau (Treat. of Mid. Book II. chap. 17.) remarks, that, in such case, you should take the time that the woman has a labor-pain to accomplish the extraction by this method, that is to say, to snatch that moment to extract the head, when you BELIEVE you have got fast hold of it.

But if the woman is too badly conformed, Dyonis (Book II. page 287) advises the use of the edged crotchets to cut the head to pieces, and bring away, by parts, what you could not do whole.

Mauriceau (Book II. page 287) would have it so, that this sort of crooked knife should have a long handle; and says, that Ambrose Paræus and Guillemeau are for a short one to it. Doctors will disagree. They all however give their respective reasons, and it is indeed hard to say which does not give the worst.

366Mr. De la Motte, in the like circumstances, made use of a bistory, or incision-knife inserted in a sheath, open at both ends; of which he gives the following account. (Observ. 259.)

“I introduced, said he, into the uterus, my left hand, over which I fixed the head; and with my right, I slipped in a sheath open at both ends, in which was an incision-knife, that I applied to this head, and made an opening in it capable of admitting my fingers. I widened it afterwards, as much as I thought proper, and scooped out a part of the brain; after which, I got hold sufficient to bring away the head, of which the volume was considerably diminished.”

Ambrose Paræus (Book of Gener. chap. 33.) tells us he had, to his great regret, a case of this sort fall to his share, the head of a fœtus remaining in the uterus. To extricate himself from which, he proposes much the same methods 367I have described after Dyonis and Mauriceau; and advises, in the same case, that if they do not succeed, recourse should be had to an instrument, called pied de griffon, (Griffin’s claw) which he says he took from the French surgery of d’Alechamp. He gives two forms of one, one of two branches, another of four. These instruments, both the one and the other, are made on the principle of the Speculum Matricis^[34], of which the use is at once, so detestably cruel, and so perfectly unavailing. 368The Griffin’s claw however differs from the speculum matricis, in that the latter has its branches elbowing in an angle, and that the former has its branches streight a-top and at bottom, and arched in the middle, and furnished with roughnesses to seize and keep hold of the head.

Those who will take the trouble to see the delineation of these instruments, in these authors, will, at the very first glance of the eye, be convinced of their unserviceableness. So would they be of that of another instrument of the like nature, invented some years ago, and attributed to a surgeon of Rouen, which is composed of two crotchets, of which the blades are arched, and their extremities claw-footed.

The horror which these means of extraction naturally inspire, the damage and inconveniences inseparable from them, notwithstanding all the improvements pretended to have been made, have engaged several authors to imagine other less dangerous expedients. But before I mention them, I cannot well avoid taking notice of 369a suggestion of Celsus, if but to warn those whom it may concern, not to be too much carried away by the authority of a great name.

In such a case the method Celsus recommends, is, for one of the robustest men that may be got, to press strongly upon the belly of the patient, with his heavy hands, inclining them downwards, so that such a pressure may force out the head that shall have remained in the uterus. Is not this a right learned, and especially a very tender expedient?

Mauriceau and Amand giving a loose to their genius have proposed less perilous methods.

The first tells us, that it came into his head, in this case, that a fillet of soft linnen might be made, in from of a sling, to be slipped over the head, and so bring it away.

Amand has imagined a silk caul, of net work, to wrap the head in. This caul 370is to be pursed up by means of a string, that gathers four ribbons fastened to four opposite points of the circumference, or opening of this kind of purse, by which the head so wrapped up is to be extracted.

Mr. Walgrave professor at Copenhagen has improved on the first scheme of a fillet, by stitching together the two extremities of a fillet of linnen of about two yards long and four or five inches wide, in which he makes three slits lengthways, to seize the head more firmly, and hinder the fillet from slipping off the rounder parts of it. The figure of it may be seen in a Latin work intitled, Dissertation upon the separated head of a child, and the different ways of extracting it from the mother’s womb. By Mr. John Voigt, at Giessen, 1749.

Monsieur Gregoire, man-midwife at Paris, has disputed with Monsieur Amand the glory of this invention of the caul.

But if a reader will deign to consult his own reflexion, upon even these last, less however injurious means than those of 371iron and steel instruments, he will probably conclude, that if it is possible to come at the head, so as to fix, for example, a caul over it, the same liberty of access will serve to do all that can be necessary to secure a sufficient hold and purchase for the naked hand to bring it away, without such aids, as must necessarily suppose a free play of the hand in the uterus. I own this requires great shreudness of discernment by the touch, great expertness, great slight of hand and neat conveyance, but these are all points of excellence which midwives should be exhorted, encouraged, and even obliged to acquire: for acquire them they may; which is more than the men, generally speaking, ever can, and are therefore supplementally obliged to have recourse to such substitutes to hands, as those horrid instruments or silly inventions of theirs, with which, even at the best, they can never do so well as the women, who understand their business, can do without them.

Let it also be here remembered, what I observed at the beginning of this section, that this case of a separated head, I might almost say, never, no never comes into existence 372but through some previous neglect, error or failure of practice: so that surely the preventing it must be rather, preferable to the necessity of remedying it, either with crotchets, fillets, or even with but the hand alone; the trusting to any of which may make practitioners so often remiss, where remissness can hardly ever be but of bad consequence, where no fault, in short, can be other than a great one, and for which, the innocent patient it is that must most commonly be the sufferer, both in her own person, and in that of her child.

Of that labor in which the head of the fœtus remains hitched in the passage, the body being entirely come out of the uterus.

It is here to be observed that though the body may be intirely free of the uterus, some of the causes deduced in the precedent section, may produce impediments or obstacles to the issue of the head. The head never detaches itself from the body 373but in that labor where the feet of the child come out first, and are too forcibly hauled by rash or unskilful hands, by such in short as do not know how to disingage or remove the let or obstacle to the issue of the head, with one hand, while with the other they properly support the body of the child. As it is then greatly to be wished that this accident might never happen, I shall, to the means I have already indicated for preventing or remedying it, add others coincidently with the design of this section, to prove the inutility of instruments in the case of the title prefixed to it. I shall then quote the practical tenets of the best authors upon this point, together with reflexions, which my own experience and practice have suggested to me.

Mauriceau explains this case tolerably justly, where he treats of the footling-extraction.

“Care (says he) should be taken that the child should have its face and belly directly downwards; to prevent, on their being turned upwards, the head of 374it being, towards the chin, stopped by the os pubis. If therefore it should not be so turned, it must be put into that posture. This will easily be done if, as soon as you begin drawing the child out by the feet, you incline and turn it little by little, in proportion as your extraction of it proceeds, till its heels bear in a direct line with the belly of the mother,”

[Here I must beg leave to interrupt Mr. Mauriceau, to observe, that it is not enough to have hold of the child’s feet to begin turning it: but the breech must have come out: then, if it is not well turned, by placing one hand on the belly, and the other on the breech of the child, there will be time enough easily to turn it immediately and naturally, neither with too much precipitation, nor yet too leisurely, not little by little, or by slow degrees. This last precaution being of no use but to flag an operation, in which a delay may be fatal to the child, without any service to the mother, it only keeping her the longer in pain.]

“There are (he goes on) however children with so large a head, that it 375remains stopped in the passage after the body is intirely got out, notwithstanding all the precautions that can be used to avoid it. In this case, you must not stand amusing yourself with so much as attempting to bring the child away by the shoulders, for sometimes you will sooner part the body from the neck, than get the child out by this means. But while some other person shall pull it by the two feet or beneath the knees,” [here Monsieur Mauriceau is much out: great care should be taken not to have it pulled by any one, but purely to give the body of the child to be supported by some discret person, while the delivery proceeds as the author goes on to describe] “the operator will disingage little by little the head from between the bones of the passage, which he may do by sliding softly one or two fingers of his left hand into the mouth of the child, to disingage the chin in the first place, and with his right hand, he will embrace the back of the child’s neck, above the shoulders, to draw it afterwards, with the help of one of the fingers of his left hand, employed, as I have just observed, in disingaging the 376chin. For it is this part which the most contributes to detain the head in the passage, whence it cannot be drawn out before the chin shall have been intirely disingaged. Observe also, that this is to be done with all possible dispatch for fear the child should be suffocated, as would indubitably happen, were he to remain any time thus held and stopped: because the umbilical chord, which will have come out, being turned cold, and strongly compressed by the body or by the head of the child, remaining too long in the passage, the child cannot then be kept alive by means of the mother’s blood, whose motion is stopped in that chord, as well by its cooling which coagulates it, as by the compression which hinders it from circulating, for want of which it is a necessity for the child to breathe, which he cannot do till his head shall be intirely out of the uterus: therefore when once you have begun the extraction of the child, you must try to procure the total issue of it as quick as possible.”

Monsieur Levret, who has wrote for no end on earth but to recommend his tire-tête, 377seizes the occasion of the foregoing passage extracted from Mauriceau to tell us, page 51, of the first part of his work.

“Mauriceau acknowledges here, that there are children who have the head so large, as for it to remain stopped in the passage, after the body shall have been wholly got out, notwithstanding all the precautions that can be taken to avoid it.”

From whence this zealous instrumentarian draws the following conclusion. “Here (says he) is one of those cases, in which my instrument may be of great service.”

This conclusion however does not to me at all appear a just one.

First, because Mauriceau, after those lines of his, just above quoted by Levret, adds immediately the method of practice pursuable in this case, to give a good account of it without the help of instruments.

378Secondly, because we are not at all to be concluded by what any author says, any farther than the truth of things bears him out. Mauriceau^[35] might have explained himself better: he might have said, 379that, in this case, the child should be pushed back a little into the uterus, to have the freer play for its being more easily disingaged: he might have advised, as I have before observed, rather a safer method of proceeding than what he has done. Mr. Levret himself allows this p. 56. Then, still with a view to recommend his forceps, his tire-tête, as being absolutely necessary, he continues thus (p. 58.)

“Though every thing should apparently have been done that is above set forth, still we are not always so happy as to accomplish the delivery. It sometimes happens, that we cannot get the head of the child out of the uterus. There are of this two examples in the treatise of M. De la Motte, of which I do not think it here out of place to furnish an extract.

“Mr. De la Motte, in his 253d. Observation, (goes on M. Levret) relates, that in a case in which he was obliged to turn the child, in order the better to finish the delivery, he turned it very 380easily; that having brought it out as far as to the thighs ... it being alive, he gave its body a half turn, so as to put its face downwards which it had upwards, and that then he continued drawing out the child as far as to the shoulders and neck.

“After that (says M. De la Motte) I gave it some gentle shakes, and even pulled it pretty hard, and had several tugs at it, to make an end of a delivery I had so happily begun; but all was in vain. This obliged me, according to my usual method, to put my finger into its mouth. I was mistaken, for what I took to be the mouth, I found to be the nape of the neck, and that the neck, not having followed the motion of the body, was twisted round, and consequently the face still remained turned upwards, so that the chin it was that, being hitched at the os pubis, was the obstacle to have been conquered to terminate the delivery.”

Mr. Levret here observes, there being a great probability that, when la Motte 381turned the body of the child, he was pulling it towards him, and that the mother was in a labor-throw: for it is well known, that then the uterus contracts itself in all directions round the body it contains: she was then compressing exactly the head of the child, which must render it immoveable, while he was turning the body. These two co-incidences must have contributed to twist the neck of the child, consequently to make it lose its life. And to clench the misfortune, he gave its little body to be held by the husband of the mother, while he was pushing back the head with one hand, and with the other disingaging the chin. He told the husband at the same time to pull softly; “but he hauled with such violence, in the hope of easing his wife, that he fell with a jerk six foot off the bed, with the body of the child, of which the head had remained in the uterus.”

Let us proceed to the second example. This is the fact. M. De la Motte tells us, that he was called to assist a poor woman in labor, in which she had been 382lingering for two days, that this patient was a very little woman, and of about forty five years of age; the arm of a very small child had come out the day before.

“I slipped (said he) my hand along this little arm, to go in quest of the feet, which I presently found, and after having closed them together, I brought them away out of the uterus. The body followed till it came to the neck. The patient being on the edge of the bed, which was very high from the ground, and where there was not room enough left to support the child in proportion as I drew it out, I was obliged to give it a woman to hold, while I proceeded gently to disengage the head which was stopped in the passage. This was no wonder, considering the streightness of it, being correspondent to the littleness of her size; considering withal the advanced age of the patient, the length of time since the discharge of the waters, during which the uterus being irritated by the lingeringness of the labor, the presence of the arm in the passage 383had caused an inflammation, consequently some induration, all these joined to the time that the fœtus had been dead, which as before observed was a very small creature, were reasons more than sufficient to manage very tenderly with the child, so as to bring it away whole. This (says M. De la Motte) induced me to introduce my hand flat towards the frænum labiorum, and to put my middle finger into the child’s mouth, while my other hand was over its neck. My measures being thus taken, I desired the midwife, while I should disingage the parts, to pull softly, for fear of an accident. But she nevertheless, senselessly and foolishly, gave it much such a pull, as the woman’s husband I have before mentioned. This indeed forced out the body of the child, but severed from the head, which remained in the uterus.”

Here it may be observed that Monsieur Levret, by this preamble, on the one hand prepares us for the necessity of his instrument, by a constant supposition of cases, in which, notwithstanding all the precautions 384that may be taken, it happens sometimes (as he says) “that it is not possible to terminate happily the delivery, nor get the child’s head out of the uterus;” to support which opinion he produces the two examples from De la Motte, which I have just before quoted.

On the other hand, he owns, as it were, en passant, that there are means, which he even explains of accomplishing successfully the deliveries, in such labors, by solely the operation of the hands, avoiding the faults committed by M. De la Motte, after which, as if those faults were any proof in favor of his instrument, he concludes, that, “if through any cause whatever, this case was not to be got over, the child should be given to some one to be held, with the precautions before set forth, and that then the operator was to proceed with his instruments.”

In the first example we see that De la Motte was guilty of three grievous errors. The first, in taking the nape of the neck for the mouth: the second, in having 385taken the time of the mother’s throw, in which the uterus must have contracted round the neck in all directions, to turn the body of the child, which contributed to twist its neck: thirdly, in having given the body of the child to the husband to hold, with direction to pull it, even tho’ he cautioned him to do it gently. He ought rather not to have trusted him with the body at all, or have absolutely forbid him to make the least motion, his part being only to support it.

In the second example, De la Motte committed no more than the last fault, in trusting a midwife, of whom he might not know all the stupidity: but this was sufficient to produce that accident; an accident which it will not even be hard to avoid, with due management, or hands skilfully conducted.

With Mons. Levret’s leave (whom I ought to honor, since it is from him I have chiefly taken what he has said against all instruments but his own) I shall then 386say, that it is against the laws of candor, or of common sense, to seek, from the faults which may be committed in the manual practice, either through ignorance, inadvertence, or want of circumspection, to infer the necessity of instruments.

The point here under discussion turns intirely upon a child extracted by the feet. Now it is extremely rare, that in this case, the head does not follow the body. But if, in exception to this general rule, the head should be stopped in the passage, upon proceeding to disengage it, with all the proper measures and precautions which I have added to those above specified from Mauriceau, the sole aid of the hands will be full sufficient to accomplish the total delivery. But if they were to be ill managed, the risk would be evidently great of detaching the body from the head; and this would change the case from that of the head stuck in the passage, to the one of the head separated from the body, of which I have treated in the preceding section. Without then multiplying cases without necessity, as the reader will easily 387see, that the first is but the consequence of a mis-treatment of the last, so that, by the same rule, the right management of the last case is a sure prevention of the first, I shall only observe, that it might be shewn, that capable, well-conducted hands are sufficient to guard against both dangers, and shewn, even by Mons. Levret’s own confession, which he so inconsistently contradicts, in favor of his own instrument, without offering any thing like a reason for such a contradiction.

But if the damage in these cases resulting from an unskilful use of the hands should be urged against me: I answer, in the first place, that I am not arguing for any thing but what is to be effectuated by good practice: my point, is only to establish the superiority of skilful hands to the use of instruments: and in these cases, I aver, that even the damages done by the mispractice of defective hands, may be better repaired by sufficient ones, than by a recourse to instruments. How often too are instruments used by such men-operators, as are to the full as unfit to manage such instruments, bad as they are, as some 388women may be to use their hands! But if I could give no better reason for the rejection of instruments, than the abuse of them, even by the numbers of ignorant superficial men-practitioners that employ them, I should not expect to be heard; and yet the great argument against midwives is the ignorance of a few of them: though that ignorance of theirs could never produce such a multiplicity of horrors, of murders, injuries, tortures of mothers, such mutilations and massacres of children, as the deep learning of the instrumentarians!

My plea then is much more fair. The reader will be pleased to consider, and decide upon his own reflexions, whether, it is not at least probable, from what has been shewn in the cases of the obliquity of the uterus, of a head separate from the body of the fœtus, or even of that reputed most dangerous extremity, the head being hitched in the passage, when the whole body shall have come out, that every thing may be at least as hopefully attempted with the hands alone, as with those instruments, the use of which forms the sole reason for 389a recourse to men-practitioners; tho’, well considered, nothing could be a stronger reason against such a recourse than their using them. But let us proceed to the next case;

When the head of the fœtus presents itself foremost, but sticks in the passage.

For this section it is, that I have reserved to treat incidentally and more at large of the objections to be made in general to all instruments, and in particular to the principal ones.

Among the severe labors, which give much trouble, and exact much patience from all parties, from the patient, the midwife, and all the assistence, this case may challenge a place. It is that, in which the head of the child having presented itself foremost, and having ingaged itself half way, or thereabouts, in the streight of the bones of the pelvis, and of the orifice of the uterus, the labor-pains remit, languish, and the progress of the labor becomes suspended. Whether there be any mis-conformation of the bones of the pelvis, 390or whether (as our practitioners are pleased to express it,) the head of the fœtus be too large for the passage, or whether, in short, both these causes concur to the formation of this obstacle, or exist in complication with other circumstances; it is, in this case, we may say the head is hitched, stuck or ingaged in the passage.

Mr. De la Motte, book the 3d. chapter the 20th, describes this state of the fœtus.

“When (says he) the head has struck into the streight of the passage which, at first, affords a great deal less room than were to be wished, for its letting it pass, the head ingages itself as much forward as possible, from the continual and violent pains the woman suffers, which act upon the child, whose head lengthens and flattens, in such a manner, to adjust and mould itself to the passage, that the hairy scalp becomes quite tumefied, so as to make the head look almost like a double head, which however remains stuck fast between the bones, 391without being able to get out, and only ingages itself the more the more it advances ... but growing larger as it advances, and the aperture which it obliged to force diminishing more and more, makes it so that the head remains at length so jammed in, that it cannot be drawn out without diminishing its volume, which (as this author says) cannot be executed without instruments: as I was obliged to do, to accomplish the following delivery.”

Mr. De la Motte then proceeds to tell us, that he was called to lay the wife of a laborer, the head of whose child was hitched in the passage. After having well examined the state of the mother and child, and ascertained as much as it is possible to ascertain the death of the latter——“I determined, (says he) to finish the delivery, which I did by opening the head of the child with my incision-knife, and scooped out therewith part of the brain. After which, I made use of my hand, with which I got hold of the inside of the skull, and in an instant drew the 392child out, who appeared to have been dead a long time.”

It is not here that, in answer to M. De la Motte, I shall stop to propose a more gentle and more natural method of giving a good account of this case of a hitched head, than the cruel and dangerous expedients suggested by the instrumentarians: I reserve the submission to better judgment of my own ideas of practice, in this point, till after I shall have quoted the notions of more authors.

Daventer, p. 343, of his observations, supposes to us the case of a head stuck in the passage, when the difficulty of the labor shall have been increased, as well by the ignorance, as by the negligence of the practitioner, male or female, that may not have given the proper aid in due time, or not have foreseen the danger; he moreover supposes a complication of obliquity, caused by the mis-conformation of the bones in the patient. If this embarrassment then should not have been foreseen or guarded against, he advises the opening of the head of the child.

393“There is, for this no occasion (says he) for any instruments of a particular make; a common knife guarded as far as the point, a pair of scissors, a pointed spatula do the business. The opening they make may be dilated with the fingers, and the brain taken out; after which, you seize the head with your hand, or with a linnen cloth, and try, in this manner, to bring away the body. When I say you may draw the head out with a linnen cloth, I mean a broad strip or fillet cut lengthways of the cloth, and hemmed in the borders, or any piece of linnen that is fine and strong, to be passed round the back of the head, and bringing in under the chin, you twist the fillet, and draw out the child.”——He then adds, that he much esteems this method; that those, whose hands are small enough to pass this linnen round the back of the head, without opening it, are not obliged to open it, and have therein a great advantage over others.

394This last method proposed by Daventer ought doubtless to be preferably pursued, as being the less cruel. But, in the first place, it is utterly impracticable. A head represented to be hitched or jammed, does not leave the least hands that can be imagined room or liberty to pass a fillet round the back of the head, in order to bring it under the chin. But were it even practicable, it would be useless, and dangerous: useless, in that the hands alone, so introduced, might of themselves, little by little, disingage this head; dangerous, for that this fillet might most likely produce the effect that fillets commonly do, strangle the child.

Mauriceau, to conquer this obstacle of the head so stuck, proposes several kinds of crotchets, to apply various ways, to the head of the child, after having scooped out the brain, by means of an opening made in the skull. He gives us several examples in his observations, but as they are absolutely fit for nothing but to inspire horror, I shall refrain from specifying 395them. Dyonis is of the same opinion with Mauriceau.

Those who will give themselves the trouble to peruse the authors who have preceded thus, will find, that their method differs very little from that of la Motte and Mauriceau, which most assuredly kills the child if it is not dead: and the ascertainment of the death of a child stuck in the passage is so difficult, that the ablest practitioners cannot answer for not being mistaken in it. The reader will please to apply here what I set forth, p. 139, and following, to which I beg leave to refer.

Mauriceau, at length, imagined, that he had out-done all others, in his invention of an instrument he calls a tire-tête. He specifies it in his 26th observation. But it is as dangerous as the crotchets, since, in order to use it, you must begin by opening the skull with an incision-knife, or with a sort of steel spike, double-edged, which he invented on purpose for the use of piercing the child’s scull at the fontanelle, to admit a little round plate of steel of another instrument.

396Monsieur Soumain, and other celebrated practitioners, have acknowledged the insufficiency of this instrument of Mauriceau; but were it good for any thing, as to drawing out the head so stuck, it would for ever be fatal to those poor unfortunates, since it could not fail of killing them if they were still alive.

After this we have the tire-tête of Mr. Fried, but it is as murderous as that of Mauriceau, nor answers the intentions which its author had proposed to himself. He has therefore himself had the candor to condemn it, as may be seen p. 154. in a treatise of midwifery, published in 1746, by the care of Mr. Boëhmer, who has added two dissertations to the treatise on this art by Dr. Manningham.

Mr. Menard, in his preface, p. 24, gives the figure of an instrument, of which the idea seems to have been taken from a twibill, with a ducks beak. Mr. Menard has endeavoured at perfecting it, by having it made angular, shortened, and grooved. 397He has given it a figure of dented pinchers, with curve claws. He gives us also the figure of an instrument pointed and edged, made like the head of a spear, which he uses for opening the scull, and introducing the pinchers, by means of which he draws the child out by the head, as he keeps pinching the bones of the scull and teguments. By this it is easy to conceive, that this instrument has no advantage over that of Mauriceau, and has all its inconveniences.

Many other modern practitioners advise the use of one or two crotchets, be the child dead or alive, or of a tire-tête, made in form of strait blades, with spoon-bills, to introduce them one after another into the uterus; and after having placed them on each side of the child’s head, and made them meet together, to try the extraction with them.

This last contrivance, as ingenious as it may appear, does not save the child’s life, as all these authors would insinuate. For these instruments, wherever they are applied, 398must pierce to get a solid hold; without which they could serve for nothing but to crush or lacerate the teguments; so that they should not be used where the child is a live one: and even when it’s dead, the mother is not absolutely safe from the damage they may do, whatever precaution the operator may take, or whatever may be his dexterity of hand. If one of the blades should slip, which frequently happens, it will be difficult for him not to do the mother a mischief. For as to the child, it is very rare that the crotchet does not instantly destroy it.

Menard has again given us another figure of an instrument, to appearance less dangerous; but the make of it sufficiently denotes its want of power in the operation, which is also confirmed by the testimony of the most celebrated practitioners.

It is now (1760) about forty years ago, that Palfin, a surgeon of Ghent in Flanders, and demonstrator of anatomy in the same town, went to Paris, and there presented to the academy of sciences an instrument 399for extracting, by the head, children stuck in the passage. Gilles le Doux, surgeon of the town of Ypres, put in his claim to the invention of this curious instrument, which has however been ever looked upon as insufficient, and to have too much bulge, to allow its introduction into a place already so difficult by its being blocked up with the body that requires the extraction. After at least a dozen of corrections of this pretended tire-tête or forceps of Palfin, Gilles le Doux himself corrected it, so did afterwards Messieurs Petit, Gregoire, Soumain, Duffé, and I do not know how many more.

In short, one may say, that never did any instrument undergo more alterations than this forceps has done. One of the greatest improvements, according to the opinion at the time here in England, which it received, was that given it by Dr. Chamberlain. Chapman, whose treatise on midwifery is esteemed, to give this tire-tête the greater lustre, tells us, that Dr. Chamberlain kept this instrument a long while a secret; and that the Dr.’s father, 400his two brothers, and himself, used it with good success. Mr. Boëhmer, public professor of physic and anatomy at Hall, in the Lower Saxony, in the College Royal of Frederic, and of the society of curious Naturalists, from whom I quote this, calls this instrument, I am here speaking of, the English tire-tête, or forceps.

All due honor be to the original author of this sublime invention of the forceps, whoever was the happy mortal! happy, I say, according to Dr. Smellie, who calls it a “fortunate contrivance”^[36]; though perhaps by fortunate, he rather means its having been so to himself. For hitherto, in all truth, I must own, that I do not find, even by the most exagerated accounts of the learned men-midwives, that those poor instruments of God’s making, the women’s fingers, would not much better, and much safer, do every thing that is pretended to be done by that same boasted instrument, or that can be done by any other human means.

401But let us suppose for an instant, what both my love and knowledge of the truth would hinder me from granting, that instruments are at some times, and in some sort necessary: in what case is it that they are necessary? this is what hitherto I do not know. And which instrument is it that a man-midwife must use? that is what I yet know less: nor do I believe there is any practitioner so presumptuously silly, as to admit any particular one, as the only one universally received and approved. It will perhaps be said, that according to the circumstances, each practitioner will, out of his bag of hard-ware, pick out that which will be fit for the occasion. But then, a waggon would not carry their whole armory, to calculate not only according to the various alterations made, if but in the forceps, by whim, desire of getting a name, or of increasing practice, but according to the various exigencies and circumstances to which the form of the instrument ought to be peculiarly adjusted. And upon every occasion, there is not the time for inventing, directing, 402or making a new instrument. But if it is said, that for want of such exactness, the general make of an instrument must do, in all cases: that general make is not at least to be looked for in any of the kinds I have already quoted, by which such numbers of women and children must have been tortured or sacrificed, before they were exploded and given up, as good for nothing or insufficient, even by the men-practitioners themselves, who however substituted no others to them but what were rarely less exceptionable. They were only newer. Let us then now proceed to pass in a summary review the later and pretended improvements of this prodigious invention of the forceps, and candidly examine the validity of their claim over the women’s hands.

Mr. Rathlaw, a famous surgeon of Holland, in his dissertation on the means, or secret of Roger Roonhuysen, which was transmitted to his heirs, for extracting (as was said) in a very little time, a child, whose head should be embarrassed in the neck of the uterus, says thus,

403“To me it appeared impossible, to establish an instrument, whose use should be so certain, so general, so necessary, that one could not be a man-midwife without having a knowledge of it.”

The same Mr. Rathlaw, in the same piece, exclaiming against the use of the crotchets has this remark.

“No one (says he) can be ignorant of it’s being no longer the practice in France, or in England, to employ crotchets, or murderous tire-têtes (would this were truth!) in the deliveries, unless for a monstrous or hydrocephalous head, when the bulk of it is so enormous, that there is no possibility of getting it out whole, and especially if the child should be dead.... In my time, (adds this author) every eminent man-midwife had invented different means of extricating himself out of the plunge of such a case, and their reputation grew in proportion to their respective success. Yet, hitherto, I do not know, that either 404at Paris or at London, they have got such a length, as to take any particular instrument under their protection. Nine years ago, (Mr. Rathlaw continues) I had made a forceps almost wholly of my own invention to extract the fœtus by the head, and it often succeeded well with me. It was, as to its make, a good deal resembling that which Butter describes in the Edinburgh-acts, volume III. art. 20. But mine (proceeds he) seem to possess better proportions, and is certainly of a more handy use, than those which have hitherto appeared.”

Please to observe, that this forceps of Mr. Rathlaw is the same as Palfin’s, or rather as that of Gilles le Doux, excepting only the semilunar hollow cuts in the claws, which Monsieur Duffé, a surgeon of Paris, had contrived in them. The author says, it had often succeeded well with him: he does not say always, and why? most probably because, when he did so often find it of service, that was, only whenever there was no sort of occasion for using it at all. Do not let it here be imagined, that I force 405an inference. I give my reason. Supposing that such an instrument was necessary to every practitioner, the case for his using it cannot but rarely occur. Now those rare cases where Rathlaw judged his forceps necessary, and in which it failed him, were in all likelihood the true tests of its merit: whereas those other cases, in which he often succeeded, may very well be taken for such as, with hands and patience, might have afforded a better account of them, than the silly superfluous quackery of employing a forceps, unless indeed his hands were too clumsy to attempt it. Otherwise the using instruments, where they sometimes do the work with so much more pain and danger, when the bare hands well conducted would do so much better, remind me naturally enough of what I have seen a pretty master do with a steel-instrument called a zig-zag or fruit-tongs, when, to display it, or out of wantonness, he has catched up fruit with it, that lay fully within the reach of his hand. In this piece of childishness there is however no mischief; whereas the man-midwife, for considerations of lucre, dallies with two lives to pluck at a fruit that is never, I repeat it, 406never, out of reach of the hand, where that steel-instrument of his, a forceps, can bring it away.

Mr. Rathlaw also tells us of another instrument, of which he gives us an account. He had got the secret from one Velsen, a physician at the Hague. This Velsen had it of Vanderswam, who had been a pupil of Roonhuysen, the inventor of this pretended nostrum, with which he always helped the women in labor, snug under the bed-cloaths, the better to conceal his miraculous secret. He had long promised his pupil to discover it to him.

“In short (says Mr. Rathlaw) one day that Roonhuysen was returning from laying a woman, a burgomaster of Amsterdam came to speak with him: in the hurry Roonhuysen was to receive him, he hid his nostrum-instrument in some apartment. His curious pupil (Vanderswam) who had for several years been watching such an occasion with great eagerness, found it, and took a draught of it. This instrument was in a case 407with two long steel crotchets, and a piece of whalebone, in the shape of a pipe for smoaking, only shorter, and at one of the ends of which was a piece of steel, of the shape of an acorn, and there was no other instrument in this case.”

If Mr. Velsen is to be believed, it seems, on the one hand, that Roonhuysen made the whole science of midwifery consist in the knowledge and use of this his instrument, since it is there said, that Roonhuysen had promised this pupil of his to teach him the art of midwifery, but taught him nothing of it; and indeed it does not appear, that he had hidden any thing from Vanderswam but this wonderful instrument, with which he used, under the bed-cloaths, to smuggle the child through the difficult passage^[37].

408On the other hand again, it may be judged, that this pretended marvellous instrument was not of effectual enough service to its inventor, unless in those cases where he might as well have done without them, since this very same Roonhuysen made use of crotchets, doubtless, when he found his instrument fail him. O women! women! thus it is that your pretious lives, and that of your children (to say nothing of the additional tortures you are put to, as if those of Nature’s own ordering were not already enough) are trifled with, in practices being tried upon you with such instruments, for which you are besides to pay exorbitantly; and all for what? To increase the practice of some quack, who raises into notice his worthless name, or perhaps swells some work of his, published by way of advertising himself, with the rare boast of having delivered you with an instrument, that has only, not murdered some of you, though it may sometimes perhaps have done you irreparable damage, and will have always occasioned you an unnecessary increase of pain 409and danger. Is it possible to inculcate this truth too often or too strongly to you?

“There are many people, (adds Mr. Rathlaw) who make a doubt whether this instrument is not the same as that with which the three Chamberlains, brothers, acquired in Ireland and other countries the reputation of being the most eminent men-midwives in the world. In those circumstances in which others employed crotchets, they could, by their manual operation, and with less labor, hasten the delivery of the women in less time, and without the least danger to mother and child.”

I am not unwilling to believe that the three brothers, the Chamberlains, might pass for the most eminent men-midwives in the world, especially in Ireland, where before there never had, as I understand, been seen any practitioners of midwifery but women. As to other countries, these brothers might very easily surpass in skill those, who knew no gentler way of terminating a delivery than by the means of 410crotchets. Therefore it is that our author adds, that the Chamberlains only made use of the manual operation; he does not add of other instruments. It is a great pity however, that the surgeons of all countries have not yet got hold of, and adopted this marvellous secret of Roonhuysen’s, which would extricate them so gloriously, in their attendance on such difficult labors. They would thereby greatly reduce their armory, from its complex state at present of variety of crotchets, tire-tête, forceps, spoons, blunt hooks, pinchers, fillets, lacs, scissors, incision-knives, and the rest of their tremendous apparatus.

According then to Mr. Rathlaw, the forceps of Roonhuysen was the same as that of the Chamberlains. How he got the secret from them matters not. He only changed the figure of the blade-parts. In short, our author adds, that to him it seems probable, that this instrument has been brought to perfection by the continual experience of men-midwives, who have successively employed it. He pretends himself to have made some alterations in it for 411the better, but what they are he is not pleased to tells us.

The illustrious Janckius, a great practitioner, mentions another corrected forceps in his dissertation upon the forceps and pinchers, instruments invented by Bingius, a surgeon of Copenhagen, and of their use in difficult labors, printed at Leipsic, 1750, page 211. This forceps resembles mostly that which the celebrated Monsieur Gregoire, senior, first imagined upon the model of Palfin’s tire-tête.

“Janckius, in the same dissertation, tell us, that it would be of service to have spoons or blades of the forceps of various curvatures, and of different lengths, for the shorter the arching, and more crooked the blades or spoons are, the more difficult and dangerous will the application be, according to Chapman and Boëhmer.”

Thence this consequence seems derivable, that to obviate these difficulties and dangers, it would be requisite to have as 412many crooked spoons as there are particular cases, as well as to take measure of the heads that are stuck, which still would imply the introduction of the hand, and, of course, the uselessness of instruments.

Mr. Levret, in his notes, p. 377, makes us observe, that the branches of the forceps of Bingius, which are solid, being considerably more crooked than the windowed forceps, the expansion of their middle part must be too wide not to risque, in the extraction, the tearing the perinæum, which it is no such indifferent matter as not to be remarked.

This Janckius had, it seems, that bad habit of employing too soon the instrument of Bingius, which is extremely dangerous. This however, is not seldom the case, when Monsieur l’Accoucheur is in a hurry.

Boëhmer, in a dissertation on this subject, thus expresses himself, as to the instrument of Levret, and the forceps of Bingius.

413“I shall only observe (says that learned physician) what Mr. Levret has himself very justly remarked, that the application of the forceps is dangerous, unless the head should have already descended low enough into the pelvis for the orifice of the uterus to be effaced, and to make but one and the same cavity with the vagina. This counsel is essential for two reasons;

“First, for fear of hurting the orifice of the uterus which might easily happen without this precaution.

“Secondly, on account of the instrument itself, the blades of which could not embrace more than a part, and not the whole of the head, which remaining too high, they could not consequently compress it equally, nor extract it. It is for the same reasons (continues he) that I rather differ in opinion from the celebrated Janckius, who, as soon as the waters are discharged, and he perceives that the head does not pass, has instantly 414recourse to the instrument.... Some time (says he) should be indulged to the action of Nature.... There is often more success obtained by temporising, than by too early a recourse to instruments.”

Little by little the truth will come out. Little by little, even the men-practitioners themselves, will be forced to allow, that the very least imperfect of the instruments are prejudicial and dangerous: though perhaps they will not speak out the whole truth, and confess that total uselessness, which would, in so great a measure, imply their own. But common-sense will inform whoever consults the light of it within himself, that these instruments are of a nature so heterogeneous, from the service expected from them, so impossible to be adapted to the infinitely tender texture of the organ of gestation, that the very best of them must occasion lacerations, especially by the opening of the branches, the strain of which bears upon the mother’s body, and can never but hurt the child, in crushing it’s head; 415as they make that to be done precipitately, about which Nature has, for taking her own longer time, no doubt a very good reason, if there was no more than that one of gradually dilating the passage; but there are probably many others.

Art should aim at imitating Nature: now Nature proceeds leisurely, instead of which the forceps goes too quick to work. The action of it depends on an artificial compression, which begins by moulding, or rather crushing the child’s head, adaptingly to the figure of the pelvis, to facilitate its extraction; and though the divine providence has in its wisdom provided for the preservation of the human species, by means of what is called the duramater, and by the void of the sutures in the cranium of children, the manual compression of the instrument is either too strong or too weak. If too strong, the child is lost; the head being so compressed by the instrument, that the brain escapes through the occipital cavity: if it is too weak, so that the head has not been sufficiently compressed, nor it’s bulk competently diminished, in attempting 416the extraction, not only the uterus can scarce escape the being wounded, but the perinæum and the bladder the being torn: and indeed in either case they hardly escape, the instruments occasioning various inflammations and contusions, of the worst consequence, both in the internal and external parts, besides the great danger of the blades slipping and violently hurting the mother, not to mention the painful divarications and shocking attitudes in order to the introduction.

The instrument used by Mr. Giffard, man-midwife, is supposed by Levret and others to be nothing more than the windowed forceps, of which the use had been long before known. But that appears as unsatisfactory as others. Mr. Freke too, it seems, furnished a new kind of corrected forceps, the chief merit pretended of which was, that the extremity of one of the blades was curved in form of a crotchet, and that this extremity might be concealed when not employed as a crotchet, and consequently helped to avoid the having a multiplicity of instruments, as this new-fangled 417one might, upon an occasion, serve either for crotchet or forceps.—What a prodigious strain of sublime invention is this of death and wounds in various shapes!

I find too that Chapman is blamed, for that, in his essay on the art of midwifery, he very frankly condemns all the tire-têtes he had seen employed till his time by all other practitioners, but he has not, it seems, given a description of the one he himself used, nor doubtless the method of using it, the one necessarily depending on the other. Nor where that author speaks of passing a ribbon over the head of a child, is he so good as to tell you how he managed to get it over.

I must not here omit some mention of the forceps, pretended to be improved by Dr. Smellie. Upon which, however, I shall spare the reader a tedious minute discussion of its form, and of its advantages and disadvantages, comparatively to other forceps calculated for the same use. Levret may to the curious furnish sufficient satisfaction on that head. He has examined it with great exactness and seeming 418candor, even though he prefers his own to it. Nothing can be plainer, than its being just as insignificant and foolish a gimcrack as any of the rest. But there is one particularity, of which Levret takes notice, that I cannot well omit mentioning. The Dr. has, it seems, whether to spare the women the shock of the gleam from a polished steel instrument, or, whether to defend them from the injury of that metalline chill, which is not well to be cured by any warming at the fire, covered his instrument with leather spirally wound round it. Levret upon this concludes his remarks with the following one. “The ledges or roughness which the leather must, besides increasing its bulk, create by those its spiral circumvolutions, cannot but be such an obstacle to the introduction of the instrument, as to let it be serviceable only in those cases where (N. B.)—one may do very well without it. For it is well known, than in those cases where recourse to it is requisite, the most polished, the most smooth instrument often finds such great difficulties in its intromission, that nothing but a hand, consummately expert in the use of this 419instrument^[38] can, without damage, remove the impediments.”

Dr. Smellie has, however, himself salved one of Levret’s objections to his instrument, as to any offensive smell or infection that might be contracted by the use of it. (Treatise of Mid. p. 291.) “The blades of the forceps ought to be new covered with stripes of washed leather, after they shall have been used, especially in delivering a woman suspected of having an infectious distemper.” Certainly, certainly, not only the Doctor’s nine hundred pupils, but all other practitioners, that use this famous instrument, will do well to observe this injunction. It is the very best thing they can do, next to never using it at all.

I come now to the boasted instrument of Levret; who is the last, at least that I know of, who has invented a new make of a tire-tête, or forceps corrected, over 420all that have appeared since Palfin. He gives us, in a book written on purpose to recommend it, a minute analysis of it, and an ingenious delineation in some pretty prints of it. The work is intitled, Observations sur les causes et les accidens de plusieurs accouchemens laborieux.

But to make use of the instrument or instruments which Levret recommends, requires not only a hand consummately dextrous and skilful in the art, but an infinite number of perplexing precautions, as may be seen, p. 106, and seq. of his observations.

I will not here undertake a circumstantial account, I shall content myself with mentioning some of them.

“There is here (says our author) a very important remark to be made, when you are for using this forceps. It is absolutely necessary that the orifice of the uterus should be, as it were, totally effaced or erased, that is to say, that the vagina and the uterus should, in a 421manner, no longer form other than one and the same cavity, from a sort of uninterrupted continuity, because, without that, there would be a danger of getting hold of the orifice of the uterus between the head of the child and the instrument, which would be extremely hurtful.

“I ought (continues he) to add, that great attention should be given to the attenuation of that orifice, for before it’s intirely disappearing, it becomes sometimes so thin, and so exactly close fitted to the child’s head, that, without a most scrupulous examination, one might commit a mistake.”

Besides the measures, observations and remarks this practitioner urges in that place, which require infinite attentions, he adds to them the following ones.

“First, when you introduce the instrument you are never sure of being in the uterus, but, when, besides the precaution I have above recommended, you 422feel that the axis of the instrument, or the extremity of the branches, is in a kind of vacuum. This sign would I own be a very equivocal one, for a person that should use this forceps without having practised surgery^[39]; but so it will not be for him, whose sense of the touch is habituated to the feeling of instruments of different sorts, as they enter into empty cavities of vessels or of hollow organs, or in short of any cavity.

“Secondly, when by drawing towards yourself the instrument, you are assured of the preceding sign, you will feel a small resistence to a certain degree.

“Thirdly, the blades of the instrument should suffer themselves to be opened out with some sort of ease, and what is opened out should not make resistence enough for the blades to return with any violence to the place whence the opening out began.

423“Fourthly, the blades in the instrument should, as they open wider and wider, rather tend to augment the diameter of the void of the instrument than diminish it.

“Fifthly, these same blades should, in their expansion, go a little depth in the vagina.

“If the man-midwife, (says Levret) perceive, that any of these favorable signs should be wanting, he ought to mistrust the success, and to have recourse to his sagacity for the remedying it.”

Thus far as to the handling this forceps of Levret’s, to whom the defectiveness of the English and French forceps had inspired an idea of providing such a supplement to it, from the richness of his own invention.

I do not wonder however at no instrument pleasing Mr. Levret so well as his own. Nothing is more common among the instrumentarians, than their disagreement 424about the make of their instruments. Some will have their forceps long, others short, some strait and flat, others curve: in short, there is no adapting the mechanism of it to their various fancies, so apt too as they are to change. Levret complains bitterly of the inability or injustice of the instrument-makers; but by what I believe of them, very unjustly. The gift of the fault is not in the instrument; it is in the use to which they are so often put of attempting impossibilities.

But now let us examine, what surely very competent judges have thought of this famous new forceps of Mr. Levret, which he calls his instrument.

When the book and instrument were presented the Royal Society at London, it appears by a quotation inserted by Mr. Levret himself, that his instrument was allowed to be ingenious enough, but that “there was nothing extraordinary in it.”

Page the 10th of his preface, he has the candor to own, that he does not absolutely 425pretend that success will always attend its application, even in the cases he points out.

Page the 36th, and seq. of his observations, after having exploded the forceps, and other instruments of the authors who have preceded him; and after having described the alterations and corrections made in the English and French tire-têtes, he gives us indeed the better opinion of his, by a fair confession of the insufficiency of them all without exception, and even of his own: by which, however, it is plain, he can mean no more than that, imperfect as they are, they all are still preferable to the hands alone; but the question of this superiority is as constantly as it is shamelessly begged by him, and all his fraternity of instrumentarians.

Thus however he expresses himself as to his own instruments. “This instrument is actually, to all appearance, now at the very utmost degree of perfection, to which it is possible for it to arrive, without however having all the perfection 426that might be wished, for the most expert practitioners in the use of it, agree in the opinion.

“First, of the difficulty of its introduction in certain cases.

“Secondly, of its stubbornness as to the crossing of the blades.

“Thirdly, of its contributing to tear the fourchette, or frænum labiorum.”

[Our author is very angry, that Boëhmer, who, in his critical objections, opposes those his own words to him, has not added the subsequent lines.]

“The correction I have made in this instrument (continues Levret) by means of the shifting axis, has rendered the difficulty of crossing the blades less considerable, and the two following reflexions may serve greatly to overcome the other two inconveniences.”

427But should it be granted to Levret, that the shifting axis somewhat lessens the difficulty of crossing the blades of this instrument, it would still remain too great an one, for all that correction. The reflexions he adds, for the overcoming the other two inconveniences, carry no conviction with them; and indeed he himself seems to think so, by his adding afterwards (p. 99.)

“To obviate this inconvenience of tearing the fourchette, or the perinæum, I caused to be made a curve forceps, as to any thing else not differing, in its dimensions, from the first. I took the idea of it from the curve pinchers used in the operations of lithotomy. It will be easier to conceive, than for me to describe the advantage it must gain by it. That was not however the only end I proposed by it, as all the good practitioners at present agree on the small efficacy of the common forceps, in the case of a head stuck in the passage when the face is turned upwards.”

428It is in consequence of this opinion that Levret, in the sequel to his observations, p. 301, tells us.

“I could (says he) answer Mr. Boëhmer, that all the most eminent men-midwives are convinced, that when the child presents with the face upwards, or turned forwards, that is to say, towards the os pubis, and that in this position, the head sticks, the forceps commonly used can be of no service: I do not (adds he) even except the one I have had made with a shifting axis. The defectiveness of these instruments, in these particular cases, sufficiently proves, I should think on one hand, that the English forceps is not so good as Mr. Boëhmer seems to believe; and on the other, I presume, he will be convinced, that I am not more servilely attached to my own productions, than those of others.”

This insufficiency then of the common forceps has given rise to the curve forceps 429of our author. Here follows what he further adds to what I have above (p. 427) quoted from page 99 of his work.

“The form I have given to my forceps, renders it then very useful, since, by means of the curve, it lays holds of the head with all the efficaciousness that can be found in the use of the common forceps, employed on the most advantageous position that the head can be imagined.... Notwithstanding all the corrections made in the English and French forceps (continues the other practitioners) if my instrument is compared to all the other forceps it will appear;

“First, that it has none of their faults.

“Secondly, that it is very feasible with it to extract the head of a child separated from the body and remaining in the uterus. This is so possible, that all those who have seen my instrument, are unanimously of opinion, that no other forceps can do as much.

430“Thirdly, with my instrument it appears to me possible to assist powerfully the getting out the head of a child that shall have remained in the uterus, the body being entirely come out, but of which a part is still in the vagina.

“Fourthly, my instrument has this in common with the ordinary forceps, that it can extract a child by the head, when this part shall be stuck in the passage.”

It may well be said here, that Mr. Levret attributes such excellent qualities, and marvellous properties, to that same new forceps of his, as ought to immortalize his memory, and render his forceps universal over the whole earth,—if they were but proved. Ay! there lies the difficulty. Messieurs Rathlaw, Boëhmer, Janckius, and the most notable practitioners in England, do not believe a syllable of the matter. Even Dr. Smellie, though I think he approves the crooked part of 431the forceps, speaks slightly enough of it, and has even dared to falsify the inventor’s assertion of the ne-plus-ultra of it, by altering the form, as he tells us, p. 370. “in a manner that renders it more simple, more convenient, and less expensive.” Mr. Levret cannot then expect we shall take these advantages for granted upon his own bare assertion, in the blind enthusiasm he manifests for this rare production of his genius. I do not so much as believe, that he was even himself, at times, clearly persuaded of its excellence. At least he, in several places, appears to contradict himself. As it is then greatly of use to show into what a maze of errors these are capable of falling, who neglecting the guidance of judgment in the road of truth, wander into the wilds of imagination, I shall just point out here some of Levret’s, at least, to me, seeming inconsistencies with himself, but especially with plain reason and common-sense. The reader will find the notice I take of them far from digressive, serving as they do even for connexion, as well as enforcement of my arguments.

432Mr. Levret, p. 161, concludes the first part of his observation thus.

“Nota, some very intelligent persons have been pleased to charge me with an opinion, which I have never had as to CURVE FORCEPS: they think, that I believe it capable of going into the uterus in search of the child’s head when it is not ingaged in the orifice: and yet I do not advise the use of it, unless in those cases where the other (the common forceps) is employed, over which it has essential advantages.”

Here the reader will please to observe, that all the wonders, just before quoted from himself, are reduced only to the cases in which it may be advantageously substituted to the common forceps. This, by the by, is reducing it to less than nothing. But how is this consistent with those same marvellous excellencies he displayed to us a little before, to wit? “It is very feasible with it to extract the head of a child separate from the body, and remaining in the 433uterus.”——And again, “with my instrument it appears to me possible, to assist powerfully the getting out the head of a child that shall have remained in the uterus, the body being entirely come out, but of which a part is still in the vagina.”

Now these two cases clearly imply, that Mr. Levret’s curve forceps is capable of going into the uterus in search of the child’s head, even when it is not engaged in the orifice: for here the case meant, is either that of a head remaining detachedly in the uterus, after having been severed or torn away from its body: or of a head not separated, but remaining in the uterus after the body shall have come out, and part of it is still in the vagina.

If therefore Mr. Levret’s forceps had the advantage over the common forceps, confessedly insignificant in these cases, of being able to lay hold of these heads, he might be somewhat in the right to exalt it as he has done. But at present he must be wrong, which ever side he takes. The dilemma is self-evident. He is in the wrong to deny 434what he had certainly said. He is in the wrong to complain of being taxed with an opinion, which his own allegations prove he had entertained. I therefore refer Mr. Levret from himself to himself. If he did not believe, that his curve forceps had over all the rest the properties he sets forth, why has he so confidently affirmed them? and after affirming them, why would he hinder us from thinking that he believed what he affirmed?

I am here to observe, that if I have made use of the terms of “a head not separated but remaining in the uterus after the body shall have come out, and part of it is still in the vagina,” it is purely because I would not change any thing in the expression of this celebrated instrumentarian. It is this exactness of quotation, that has made me conform myself to his manner of speaking, in my answer upon this difficulty. Otherwise, I own, I do not apprehend the propriety of his description of the case. It surprized me too the more, in so intelligent a writer as Mr. Levret, that he should represent to us a body 435come out of the uterus, and yet remaining in the vagina; as if, on such an occasion, the vagina could be distinguished from the orifice of the uterus. It is even stranger to me yet in Mr. Levret, for that he himself, in a note, p. 106, of his observations (by me before quoted) expressly says, that “when you are for using this forceps, it is absolutely necessary that the orifice of the uterus should be, as it were, totally erased or defaced;” so that the vagina and orifice should be laid into one. (See p. 420.)