I HAVE however quoted the foregoing examples from M. De la Motte.

FIRST, Because that he himself being a man-midwife, and greatly partial

to the practice being best in the hands of men, his attestation must be

the less suspicious: but especially, because he was a professed enemy to

instruments, and adhered as closely as Nature would allow him, to the

imitation of those midwives from whom he had received all his

_knowledge_, and abused them afterwards for their _ignorance_, as if

their communication to him of their knowledge could not have been,

without leaving themselves wholly destitute of it to enrich him.

SECONDLY, Because, the stories which he relates upon his own knowledge,

leaving me the fairest room to infer the necessary repetition of the

like tragical wents wherever instruments are admitted, it became less

invidious to specify them, than incidents of the like nature here:

especially, I say here, in London, or in England, where the use of those

instruments grows every day more and more rife, and must consequently

furnish the more examples of pain, destruction and danger caused by them

to the women, weak or prejudice-ridden enough to prefer the men to the

women-practitioners.

BOTH Charity then and Prudence prescribe to me the not pointing out

particular persons to whom I could impute mispractice. If any one will

affect to treat this suppression as not owing thereto, but purely to an

impossibility of specifying cases of that sort, and of proving them; I

appeal to the candid reader, whether the nature of the charge

considered, such a specification can be expected from me, since, from

the examples I have produced, I pretend to infer no more than a

probability, the grounds of which I submit to himself, of the repetition

of the like acts from the same, or even from increasing the same

practice.

IT would not perhaps be otherwise impossible to give some instances. For

example, I could expand a hint before given, of a man-midwife of this

town, who passes for eminent in his profession, and who not above five

years ago, was called to deliver a woman in labor, whose child presented

an arm. This practitioner, instead of searching out for the feet, to

extract this fœtus, that was quite alive, first plucks off one arm, then

another, then, at length, gives over the job, and left the poor mother

in this condition, who was forced to have recourse to a midwife to

finish the delivery.

MORE than one operator, as I have before observed, in very natural

deliveries, instead of bringing away the after-birth, tore out the body

of the uterus; for all their boasted anatomy.

ANOTHER gentleman-midwife delivered a woman of a fine child, or rather

received it, for it came naturally and easily. Upon which, he took it

into his head that he would not deliver her of the after-birth,

proposing to defer this work till next day. And so he would have done,

if he had not casually met with a less senseless practitioner, who

represented to him the danger to which, by so doing, he exposed the poor

patient he had left, and advised him to go back as fast as he could to

deliver her.[31]

I HAVE myself been not a little surprized at hearing lately some ladies

mention, with much approbation, the inimitable complaisance of certain

gentlemen-midwives, who have the patience, as they call it, to wait

five, six, seven hours by the clock, before they deliver of the

after-birth after the issue of the child, and that out of tenderness to

the patients, who, as they say, would be sadly off, if they fell into

hands more quick and expeditious.

BUT while I am thus taking notice of the errors of practice in the

men-practitioners, it may be objected to me, that I deal unfairly with

my reader.

FIRST, In not furnishing instances of male-practice of the midwives.

SECONDLY, That whereas I have confessed the incapacity of some of the

midwives, without allowing inferences from them against all the

professors of the art who are of the female sex, I ought to make the

same equitable allowance as to the men-practitioners, and not condemn

all for the sake of those insufficient ones, which the capable ones

themselves candidly condemn, witness among others, M. De la Motte.

NOW, as to my omitting such a specification of instances of mispractice

in my own sex, it is neither from partiality, nor affectation, that this

omission of mine proceeds. For could any one be so weak as retaliatively

to state cases, in the manner I have done, of mispractice of some

midwives; nothing could be more superfluous, nor less to the purpose. My

confession, my lamentation, that there are but too many ignorant

midwives, palpably obviate the necessity of proving what is granted. The

public would be very little the better for a truth, with which it cannot

but be too well acquainted, that there are ignorant midwives, and

insufficient men-practitioners. The truth then, for which I contend, is,

that the faults of the midwives, however it may be wished that they

could be prevented, are, comparatively speaking, neither so likely to

exist in Nature, nor of that horrid, atrocious kind, that are to be

found in the practice of the men-practitioners or instrumentarians.

There is nothing among the midwives of the puncturing, tearing with cold

pinchers, maiming, mangling, pulling limb from limb, disabling, as must

be inseparable in a greater or less degree from the use of those iron

and steel-instruments, which are so often and so unnecessarily employed.

AS to the second objection, of my not making any distinction of the

capable from the incapable men-practitioners. The reason of that is

obvious. It results from the fairest comparison of the two sexes, in

respect to midwifery, independent of any such examples as have been

produced against any particular individuals of that profession in the

men. Nature has so favored the midwives, that among them the bad ones

are evidently an exception to the general rule, of the fitness of that

sex for the art: whereas among men, the bad practitioners are, and must

for ever be, the general rule, and the good ones the exception, if so it

is, that, in Nature, there can be such an exception: he that makes a

practice of using instruments can hardly be one.

NOTHING however will more conduce to establish the natural

disqualification of the men for this art, than a fair consideration of

that capitally essential branch of it, the ART of TOUCHING, in order to

ascertain the state of pregnant women, and the difficulties so necessary

to be foreknown in order to be lessened or avoided. On due prevention

often depends the saving the life of both mother and child; it cannot

then be thought a digression, that I transiently give a summary account

of this great light or guidance to that prevention, even though this

work is nothing of a regular treatise of the art.

Of TOUCHING.

CONDUCIVELY to a just idea of touching, there should be a just

foundation laid of a competent knowledge of the fabric of the sexual

parts, of the conformation of the _pelvis_, and of the bones which

constitute it. There requires no depth of anatomy to know, in general,

that the _pelvis_ is composed of that part of the back-bone called the

_os sacrum_, terminated at the bottom by the _coccyx_, of the _ilia_,

and the _os pubis_. In the cavity formed by the assemblage of these

bones is the _uterus_, suspended between the bladder and the _intestinum

rectum_, by four ligaments called broad and round. The two broad ones

are a production of the _peritonæum_, on the side of the _vertebræ_, and

terminate on each side of the uterus near the fallopian tubes. The round

issue on the side of the _fundus uteri_, immediately under the tubes,

and from thence passing through the _peritonæum_, and crossing the

muscles of the hypogastrium, are inserted at the pubis and common

membrane or integument of the fore-part of the thighs. I pretend here

nothing further, than to give a summary sketch of these parts, a more

particularized one being here needless. Suffize it to observe, that no

good midwife can be without a proper and distinct conception of their

position and conformation, not only for touching, but for operating with

success.

TOUCHING, in the terms of art, consists in the introduction of one or

two fingers into the vagina, and thereby into the orifice of the uterus

of the person, whose state or situation requires to be known. There

scarcely needs admonishing on this occasion, a midwife, of the due care

of her hands, being properly prepared and guarded from the least danger

of hurting. Such a precaution recommends itself.

THE touch then is the most nice and essential point of the art of

midwifery. Nor to acquire a sufficient degree of accuracy in it, can

there be too much pains taken, considering how much depends on it.

Midwives only of great practice, or lying-in hospitals, where there is

full liberty for the young female practitioners to make observations,

can render it familiar to the learner. I presume I may take for granted,

that such a practical study is not extremely decent, nor proper for

young lads. And yet, at their season of life it is, that this study

should be begun, if but to give expertness the necessary time to attain,

through habit, its full growth, against the age of exercising the manual

function. It must surely be rather too late, for a man to commence his

course of touching at the age of practising; as it must be too soon, at

a season of life, where his capital end of _touching_ will probably not

be the acquisition of the science. At whose expence then must the

rudiments of a man’s study of this branch of the art be? surely at that

of the unfortunate women, subjected to the annoyance of such nauseous

and profitless visitation. In short, this is ONE of the points of the

art, from the nature of which it may fairly, and without implication of

contradiction, be pronounced, that the greatest anatomist in Europe may

nevertheless be a very indifferent, not to say a miserable man-midwife:

or even that a very indifferent anatomist may for all that be an

excellent manual practitioner.

A MIDWIFE, duly qualified by Nature and art, with a shreudness and

delicacy of the touch, is, when requisite, capable of giving, in virtue

thereof, a just account of a woman’s condition. She is enabled to make

faithful reports to the physician, and inform him of the needful

concerning the state of his patient, where any co-incidence of pregnancy

sollicits his attention. By the same means she can distinguish the true

labor-pains from the false ones; and when the term of delivery is at

hand, it may, by the touch, be discerned, whether the labor will be easy

or hard, whether the fœtus is well or ill situated. With other

precognitions, highly necessary for our taking proper measures both

obviative and actual.

I SAY necessary, because it is from this practice of touching that we

draw our prognostics, both for the predisposition of the passage, in

order to save pain by proper anticipation, and to smooth or facilitate a

happy delivery. It is then the touch that serves us for a guide, and

certifies to us the situation of the uterus, its rectitude or its

obliquity, as well as what part the fœtus presents.

IT is in short by the information we receive from the touch, that we are

enabled in good time to remedy, or at least to lessen all the obstacles:

so that by the very same means, by which we obviate any necessity of

recourse to instruments, we at the same time alleviate the pains and

sufferings of the party: which one would think no inconsiderable

advantage of the female over the male practice, which last is so

constitutionally more rough and more violent.

SUCH is the capital importance of the TOUCH, undeniable, I presume even

by the men-practitioners. But will any of the hemidwives then, with

those special delicate soft hands of theirs, and their long taper pretty

fingers, pretend to vye with the women in the exquisite sense or faculty

of the touch, with which Nature herself has so palpably endowed and

qualified them for the necessary shreudness of discernment, that in them

it can scarcely be deemed an acquisition of art? If the encroachments

however of the male-practitioners proceed, under color of their vast

superiority, I should not be surprized at seeing, ere long, a grave set

of grey-bearded gentlemen-midwives impannelled in lieu of a jury of

matrons, on a female convict pleading her belly. What can hinder the

redress of such a grievance, as the law has authorized for so many ages,

but the object not being one of a pecuniary enough interest to tempt the

men to interfere in it? they would be in the wrong however not to apply

for the office, since it would not be one of the least innocent

occasions for them to improve their hand in the mistery of _touching_.

BUT let them pretend what they will, so great is the advantage, so

liberal of her gift has Nature been to women, in that aptitude of

theirs, which may be termed a knack of touching, that the hand of a true

midwife will, at the deriving of indications from the report of its

touch, beat the most scientific head of a man-practitioner, though

stuffed never so full with Greek and Latin. Yes, an ignorant midwife,

without perhaps anatomy enough to know where the _pineal gland_ is, or

without so much as having heard the name of the _ossa innominata_, and

with purely her expertness, and with that sort of knowledge she has at

her fingers ends, will give you a more useful and practical account of

matters, as they go, where it is sometimes so infinitely important to

know how they go, than the most learned anatomist that ever dissected a

corpse, brandished a forceps, stuck a crotchet into a child’s brain-pan,

or tore open a living woman.

UPON this point of touching there occurs a consideration, on which I

have before just transiently touched, and beg leave, for the sake of its

importance, to give it some expansion.

IN my objection to a man’s practising this branch of art, TOUCHING, I

wave here the natural repugnance all the parties must have to it, even

the man-midwife himself, on any footing but of that of interest,

allowing an exclusion of any libertine design, I wave especially the

argument against it, from its being a kind of invasion of a husband’s

incommunicable prerogative; I even wave the breach of modesty, I suppose

all this to be answered by the plea of superior safety, however false

and imaginary that plea may be. But surely it will be allowed me to pity

the unfortunate condition of a woman, subjected to so disagreeable a

visitation; a visitation which, instead of being performed in the

gentle, congenial, and especially, as to the end, satisfactory manner,

of which the women alone are capable, must furnish a scene, not only

unprofitable, disgustfully coarse, and even ridiculous, but also most

probably a very painful one. Figure to yourself that respectable

personage a He-midwife, quite as grave and solemn as you please, with a

look composed to all that “DELICACY _of_ DECORUM,” recommended by Dr.

Smellie, and so suitable to the high DIGNITY of the _office_ he is

undertaking of _touching_ the unhappy woman, subjected to his

pretentions of useful discovery by it. What must not parts, which

dispute exquisiteness of sensibility with the eye itself, suffer from

hands, naturally none of the softest, and perhaps callous with handling

iron and steel instruments, from some hands, in short, scarce less hard

than the instruments themselves, boisterously grabbling and rummaging

for such nice indications, as their want of fineness in the touch must

for ever refuse them? what if they may possibly, by such coarse

_touching_, find some common, obvious signs presenting themselves, so

that the grossest touch cannot escape distinguishing them; does it

therefore follow, that the nicer points on which so much may depend for

preparatory disposal, will not escape hands, scarce not less

disqualified for the necessary discernment, than a midwife’s if she had

gloves on? in the mean while, what torture must not the poor woman

endure, in every sense, from the wounds of modesty, and even of her

person? and for what? that the doctor may, with a significant nod, or

silent shrug, give himself the false air of being satisfied about what

he was pretending to look for; or, if he speaks, come off with some

jargon, only the more respectfully received by the patient, for its

neither being common sense, nor intelligible to her; or perhaps, if he

has any by-ends in view, or is a man of gallantry, here is a fine

occasion for his placing a compliment. But for any essential advantage

to her, from such a quackery of painful perquisition, she need not

expect it. The infinitely important service of predisposing the

passages, and of obviating difficulties, to be only ascertained by that

faculty of touching, is palpably and peculiarly appropriated by Nature

to the women only; and it is from them alone that a woman must,

naturally and truly speaking, be the least shocked at receiving such

service. Whereas in being _touched_ by a man, besides, I once more say,

besides the revoltingness of Nature, and the protest of female modesty

against it, besides the pain inseparable from it, besides even its

insufficiency; the safety of the woman is destroyed to the very

foundations, by the negation of due foreknowledge and proper disposal,

against the actual crisis of danger or the real labor-pains, the

mitigation of which, and facilitating the delivery, depend so much on

the _accuracy_ of the _touch_.

WHOEVER then will but consider that greater aptitude of organization in

the women for fineness of that sense of touching, will allow, that I beg

no question, when I aver, proverbially, but truly speaking, that if one

hundred points of qualification were requisite to constitute this

capital faculty of TOUCHING, a midwife already possesses, in the but

being a woman, ninety-nine of them, the sure and certain gift of Nature:

and the remaining one from Art, may with great ease, with a little

instruction and experience, be acquired. Whereas, the He-midwife, not

only, as not being a woman, wants the whole ninety-nine, but can never

receive the hundredth at the hands of Art, but in so imperfect a degree,

that his trusting it will make it worse to the unfortunate woman that

shall trust him, than if he was wholly without it. I might perhaps, not

without reason, extend this allegation of the superiority of the female

sex over the male in this point, and in the same proportion, to the

whole of the manual function, but that I am more afraid of exagerating,

than even of falling short of the truth.

SURELY then, one might imagine, that the parties principally concerned

in liquidating this difference for the government of their decision, on

a point of such capital importance, would not do amiss to consider it,

before they suffer themselves to be imposed upon in the manner they are

by the men-pretenders to a purely female office. An imposition so very

gross, that instead of answering the end of those on whom it passes,

that of greater safety, only encreases the dreaded danger. And most

assuredly, the women who subject themselves to it, do so, if with no

scandal to their modesty at least to their understanding; for being sunk

to so low a degree of cheapness, as even to purchase, with a sort of

prostitution, innocent let it be, it is still a prostitution, after

which money is a consideration beneath mention, and to purchase what?

danger to their own life, danger to that of the pretious burthen within

them, and, at the very least, an increase of bodily pain to themselves.

MR. De la Motte, in his 188th OBSERVATION, p. 265, _Leyden ed._ makes an

animadversion upon a midwife’s _touching_ a patient, which, unless he

was induced to it by that spirit of injustice to midwives in general,

against which injustice all his usual candor is sometimes not proof,

would persuade me, that he was more ignorant of the nature and ends of

_touching_, than what his works show him to have been in other parts of

the profession.

IN that OBSERVATION he gives you the case of a woman in labor, to whom

he was called, whose membranes a midwife had prematurely broke, whom she

had actually over-fatigued with making her too often shift her posture,

and also with incessant and reiterated TOUCHINGS (_attouchemens qu’elle

reïteroit sans relâche_) and all this, from a principle of avarice, in

order to make the quicker riddance, for the sake of attending a richer

patient, where she expected greater gain; “as if (says Mr. De la Motte,

in words that ought to be engraved in every practitioners heart) a poor

woman was more to be neglected than a wealthy one, in the presence of a

God who judges all our actions.”

FOR my quoting this case, especially as it regards the point of TOUCHING

now under discussion, my reason, from the considerations to which it

will give rise in the reader’s own mind, will probably appear so

satisfactory to him, that he will easily absolve me of any charge of

digression.

AS to the midwife’s bringing on the premature discharge of the waters,

if the fact was true: it was very blameable practice. It is a practice

that all capable midwives reprove and forbid, as it is robbing the part

of the most natural and necessary lubrication for facilitating the

launch in due time of the fœtus. I have been assured, with what truth I

cannot well warrant, that the men-practitioners are commonly much too

precipitate in the breaking of the membranes. Be the practitioners then

of what sex they may, such practice is bad.

BUT, as to the motive M. De la Motte attributes to the midwife, of

avarice for such a procedure, I should heartily join with him in

condemning her, if the mention he makes of the REITERATED TOUCHINGS did

not make me suspect not his sincerity but his knowledge. If the poor

midwife had been to write the case, I have the charity to think she

could, with truth, have given a better reason for her practice than a

suggestion of avarice. At the worst, however, so criminal a spring of

action in such a conjuncture, could only be personal to herself, not

affect the midwives in general. Mr. De la Motte himself would own this,

who, as the reader may see p. 286, does not spare the men-practitioners

on this head, without meaning, that he or his fraternity should be

involved in any sinister inference from thence. And, indeed, I should

have a right to laugh at men-practitioners reproaching the midwives with

interestedness. I fancy I can have few readers so ignorant, as not to

know by which of the two sexes the greater fees are expected; which sex,

in short, looks the most out of humor, when those same fees do not

amount to the practitioner’s idea of the DECORUM of his “DIGNITY.”

BUT let that pass. I come now to the great point of the TOUCHINGS

complained of by M. De la Motte, and I sincerely believe unjustly

complained of. My cause of such belief is this: I am well grounded in my

averring, that in many labors much depends on the rectification of

things, (this will be hereafter more at large explained) by the act of

touching, not only reiterated, but sometimes even not to be discontinued

for hours together. And these _touchings_ are so far from fatiguing, or

vexing the patient, that they often prove her greatest relief from pain,

and even preservation from danger, by the facilitation they procure to

the issue of the fœtus, that is to say, if they are skilfully managed.

I HAVE myself known women in pain, and even before their labor-pains

came on, find, or imagine they found, a mitigation of their complaints,

by the simple application of the midwife’s hand; gently chasing or

stroaking them: a mitigation which, I presume, they would have been

ashamed to ask, if they had been weak enough to expect it, from the

delicate fist of a great-horse-godmother of a he-midwife, however

softened his figure might be by his pocket-night-gown being of flowered

callico, or his cap of office tied with pink and silver ribbons; for I

presume he would scarce, against Dr. Smellie’s express authority, go

about a function of this nature in a full-suit, and a tie-wig.

I AM also the more ready to believe, that these same _touchings_, with

which M. De la Motte, finds fault had in this case been really of

service, since he confesses, he found the child “_well situated, and_

FAR ADVANCED _in the passage_”; and withal offers no reason to think,

but that it was so _far advanced_ from the _touchings_, not in spite of

the _touchings_.

WE shall now see what followed. Mr. De la Motte, that despiser of

midwives; Mr. De la Motte, who so consistently regretted his not being

admitted to the Hôtel Dieu at Paris, and accuses the women, educated at

that Hospital, of vanity, for valuing themselves on that education,

behaved himself on this occasion, as indeed his merit was that on most

occasions he did so, like a true good midwife: he found things _far

advanced_ enough, for him to leave the rest very wisely to Nature, and

so he did. The consequence of which was, that the patient was soon

delivered of a fine boy, and both mother and child did well.

SUCH was the result of Mr. De la Motte’s true midwifely proceeding. But

what would an instrumentarian have probably done? One of those, I say,

who, as to all the boasted improvement of the obstetrical art, produce

the stupendous inventions of those surely rather weapons of death, than

of life, which Dr. Smellie calls his REINFORCEMENTS, and is so good as

“_principally_” to recommend, “_namely the small forceps, blunt hook,

scissors, and curve crotchets_”, the unenviable privilege of using which

blessed substitutes to the soft fingers of women, being supposed

inherent to the men by right of superiority of skill, has so greatly

IMPROVED the art of midwifery, and thinned the number of good midwives,

by exploding their so much less painful, and certainly more safe method

of practice, both for mother and child? For after all, what can such

instruments be expected to do, but, instead of improving the art, to

multiply murders? if this should appear too severe, hear what Mr. De la

Motte himself says to the very case in point: to this very case, in

which himself, I repeat it, did no more than play the part of the good

midwife, and was only the more commendable for doing so.

“IF the operator of the place had been called, he would DOUBTLESS have

proceeded in this delivery, as he had done in the other (see p. 292.)

that is to say, he would have _quickly_ dispatched it with his

_crotchet_: but on the contrary, if he had had any experience, he would

have conducted the other delivery as I did this, and thereby have

exempted himself from the reproach he must have made to himself, for

having killed a poor woman in the most _cruel_ manner.”

HAPPY! thrice happy it is for the midwives, that, at least, if avarice

should tempt any of them to the injustice of hurrying a poor patient’s

delivery, in order to attend a rich one; a circumstance which, I fancy

however, does not more often occur to the female than to the

male-practitioners; the woman cannot, at least, use towards

precipitating such deliveries means so violent as the men. They appear

only in guise of peaceable simple seconds to Nature: the men take the

field, armed as combatants against her. The women can but prematurate

things by excitation of the hand; they may be guilty of reprehensible

negligence, they may be over curious in their bandages, by way of

smoothing wrinkles after delivery; in short, they may commit many

faults, which I am far from justifying, or even extenuating; but at the

very worst, I defy them to equal the instrumentarians in mischief; nor

can their practice abound with those horrors, of which a man-midwife

tells us he could furnish VOLUMES (p. 298.) horrors which must be so

greatly multiplied since his time, as the recourse to instruments is

more than ever pursued, in practice, though so fallaciously disowned in

the theory; under which disavowal the gentlemen midwives figuratively

conceal their bag of hard-ware, just as Dr. Smellie directs them

literally to do in their visits to patients.

BUT to resume the subject of TOUCHING, I am to observe, that among its

essential services on many occasions, both during the pregnancy, and in

the actual labor-pains, there is one case, which, for its frequency and

importance, deserves a separate consideration: it is that of the

obliquity of the uterus, of which touching not only serves to inform,

but to rectify it. I shall therefore dedicate a section to the treating

of it.

Of the OBLIQUITY of the UTERUS.

BY the obliquity of the uterus I mean its untoward situation. For either

the uterus preserves its natural direction, or does not preserve it.

Where the uterus preserves it, I call it well placed: the point of it is

turned directly to the cavity of the pelvis, and the _fundus uteri_ is

suspended in the space between the umbilical region and the vertebræ: if

the uterus does not preserve its natural direction, if it inclines too

much forwards, backwards, or towards either the right or the left side,

I call it oblique, or untowardly placed. All the other situations of the

uterus are reducible to these four, from which they differ no otherwise

than as its line that should naturally be perpendicular to that of the

vagina deviates more or less from it towards any of them. It is from

this obliquity, greater or less, that proceeds, by much the most often,

the greater or the less difficulty of the lyings-in.

IT would be superfluous here to analise all the causes of such

obliquity, because, being mostly natural ones, there is no preventing

them. But there are some causes of it, or at least, that appear to me to

be sometimes the causes of it, that it cannot be improper for me to

premise here, for precaution-sake.

I HAVE then some reason to think, that both here and in Holland the

stays contribute much to the obliquity of the uterus. For though women,

during their pregnancy, may perhaps wear them looser than at other

times; yet their natural hardness pressing on the belly, with the stiff

whalebones, always too many if there are any at all, cramp the fœtus and

the womb, to which the stays too often give a bad situation, according

to their motion or swagging more to one side than to the other, in their

state of looseness; and if they were laced tighter, that would be yet

more dangerous.

I COULD wish then, that women with child would either content themselves

with wearing a bodice only, or stays without any whalebone, but at the

back just to serve the loins, and even those not to come so low down as

I have seen some. The obliquity of the uterus is much rarer in France

than it is here, for which I cannot account otherwise, than from the

women there avoiding any prejudice from their stays, during their

pregnancy. There is another cause, as I apprehend it, of the lateral

byass, which is the lying too constantly on either side, whence the

uterus contracts a habit of inclination to that side. The probability of

such an effect I submit to the anatomists, as I speak here only

conjecturally, and not with the presumption of certainty.

THE obliquity of the uterus may be discerned from the difficulty there

will be, in touching, to come at its orifice. And it is by touching

alone that you can hope to discover which way its deviation points,

whether it is placed too high towards the _os pubis_, too much turned

towards the curve of the vertebræ, or in a lateral direction, towards

either the right or left _ilion_. But which ever way that mis-direction

points, the difficulty of the delivery is proportionable to the degree

of it: and the skill and knowledge of the midwife in not only the

reduction, but the keeping of the uterus to its due position, till the

delivery is accomplished, form one of those principal branches of the

art, for which the gentlemen-midwives must be naturally so unfit.

THERE are very few authors who have treated of this obliquity of the

uterus. Some do not mention it at all, others speak of it, but so

slightly as to escape attention.

DR. Smellie in his enumeration of the cases, by which laborious labors

are occasioned, which he ranges under seven heads, has intirely omitted

this case of obliquity. He has bestowed indeed a whole chapter on the

distortion of the pelvis, a case I take to be comparatively infinitely

rarer than an obliquity of the uterus. He might as well suppose a

frequent vitious conformation of the cheek-bones, as of those that form

the pelvis: which, were it so, must necessarily imply a constant

recurrence of hard labors in the same woman, which is not often the

case. Whereas the liableness of the uterus to an obliquity from various

accidents, principally accounts for the easiness of one labor in a

woman, being no argument for her not having a hard one in future, or

convertibly. I dare aver then, that in the course of my practice, which

is not the least extensive one, this very case of obliquity has occurred

to me oftener than all the others put together, and indeed caused me the

most pain to remedy or conquer. Why then such an omission by these

writers? I cannot conceive, unless that they were aware of the

consequence, obvious to be drawn from thence, that women, by the

superior fitness of their hands, must be the properest to apply the

topical remedy; and that their iron and steel instruments could not so

well be set to work in such a case, at least in due time. This is

absolutely so true, that in the case of this very obliquity, which

occasions most of the very lingering labors, for which the midwives, who

have not preventively exerted themselves to reduce it, and thereby to

clear the passage for the fœtus, have no remedy but patience; those very

lingering labors, I say, which shall have thus arisen from the want of

skill or prevention, furnish the men-practitioners with a pretence to

dispatch them with their instruments. Thus they, often murderously for

the child, and injuriously to the mother, terminate many a delivery,

which a gentle and constant reduction of the uterus would have so much

more safely and less painfully accomplished. And how accomplished?

evidently not by any violence to Nature, but purely by redressing the

wrong she is in, oftenest not by her own fault, but by some adventitious

cause, in which she has been rather a passive sufferer than originally

herself deficient. A justice this of distinction too often refused her,

and from which too many errors of practice arise, perhaps in more cases

than this.

HOWEVER, this is certain, that this case of the obliquity of the uterus

deserves much more notice and attention than have been paid to it. It is

one of the most important difficulties of the art.

HE who treats the most at large of this matter is Daventer, who, I have

strong reasons for believing, first took the hint from some midwife: but

a hint, which the usual imperfection of the manual function in men

hindered him from duly improving. For in the way he sets forth the

different inclinations of the uterus, and the methods of rectifying

them, instead of throwing a practical light upon the subject, he has

obscured it with errors, absurdities, and repetitions without number or

excuse.

BUT that I may not appear to treat this author dogmatically, and

especially as he furnishes me with an occasion of further elucidating a

point of such great importance to the art of which I am treating, I must

here intreat the attention of those readers, especially who deign to

peruse me rather in the search of useful truth, than of amusement, of

which indeed so serious a matter is so little susceptible.

LET us then examine some of Daventer’s methods of practice, so

inconsequential to so just a theory as that of the mis-direction

incident to the uterus.

DAVENTER, chap. xlvi. p. 288, French edition, treating of the

rectification of an obliquity of the uterus fallen forwards, goes on

thus. “When the membrane is broke, and the vertex of the head partly

come forth, there is no longer occasion to support, as before, the

orifice of the uterus. It should be let fall with the head beyond the

curvature of the os sacrum. The head will make its way much more easily

than if it was still wrapped up in the uterus (_indeed!_) Now to make

the fœtus come forth, the midwife must, as she did at the beginning,

employ both her hands; the one internally applied, the other externally;

but take care so to do judiciously. Neither must she wait till the

labor-pains are over, before she sets her hands to work, as I have just

before observed. On the contrary, it is in the time of the throws that

she must operate, and when they are on the decline, terminate the

delivery. The midwife therefore should not barely content herself with

watching the time of the pains, but should also admonish, at every one

of them, her patient to second them with all her strength, in order that

the child may advance the more under their stronger protrusion. During

which, the midwife having her hand in the vagina, the back turned

towards the rectum is to advance the tip of her fingers, the most she

can, under the head of the child, taking care however not to overpress

them; and in this posture, she is to keep her hands unmoveable, till she

feels the labor-pains come on. The other hand she is to put on the

hypogastrium, nearly over the place answering to the _fundus uteri_; and

when the pains shall begin, she is to give her hands such action, that

that which is in the vagina shall push back the coccyx, and the other

applied externally shall push up gently the _fundus uteri_, and at the

same time determine its orifice towards the pelvis. I say gently. But

this is to be understood of the beginning of the throws, for in

proportion as they increase, the midwife must press the harder.

“CARE must, in the mean time, be taken, that the pression made on the

belly must not be too violent but _very_ moderate: whereas that made on

the coccyx must be with the midwife’s whole strength, with this

attention however, _first_, that this great effort must not be made but

when the force of the throws obliges the woman strongly to contract the

muscles of the hypogastrium, and must cease with those throws.

_Secondly_, that the hand must be laid flat on the coccyx, not with the

fingers half-bent, least the joints should hurt the woman. _Thirdly_,

that the hand may be as much expanded as possible, that the pression may

be equal on all parts. Observing these three conditions, the midwife may

employ her _whole_ strength, without _fear_ of doing any harm to the

woman. On the contrary, she will greatly relieve her.”

TO the which I have to say, that I should greatly pity a woman that

should fall under the hands of a woman that should receive such

directions from Monsieur l’Accoucheur, and much more yet, if she was to

be under his. A midwife to operate thus! with one hand in and the other

out, over the lower part of the belly, “gently” says Daventer, and yet

stronger in proportion as the throws increase: and a little after he

says, this pression on the belly must not be too violent, but _very_

moderate. I confess, I do not understand, but that may be my fault, how

a pression can be stronger and stronger as the pains increase, without

ceasing to be gentle or very moderate.

BESIDES; as to the pression of the midwife’s hand on the coccyx of the

patient, so violent as he advises it, with the whole strength of the

midwife, can this be executed without causing to the vagina or rectum a

contusion, very capable of bringing on a gangrene, of causing a

mortification, or, in short, the laceration of the frænum labiorum,

whatever he may say to the contrary?

I OBSERVE, by the way, that in this very chapter Daventer supposes the

heads of children breaking themselves, sometimes against the os pubis,

or the vertebræ, as if these were bare bones, at least he is to me, in

these points, unintelligible.

HE goes on to object, that if, through ignorance, Nature has been so far

left to herself, that the point of the uterus should be fallen into the

pelvis, that its orifice, and the head of the child, should be fallen

into the lower curve of the _os sacrum_, that the membrane should be

broke, and the child’s head a little discovered, and withal, the woman’s

strength much exhausted,

“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

may 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 labor,

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 not 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, narrow 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, and 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 from 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, and 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, without 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 to 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 you, 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 the 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 efficacious 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.

SOME 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

as 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 indeed, 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; or, 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, or 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 to 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.

BUT, 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 longer 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, those 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 the

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. [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 have 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.

MR. 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 I 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. The 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 a 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 is 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 iron 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 but 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 but 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 it 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

remains 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 chin. 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_, seizes 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.

SECONDLY, 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, that, 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 easily; 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 turned 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 lingering 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 had 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 that

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 taken 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 say, 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 see, 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 women 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 a 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, or 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, without 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

child 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.

“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.

THIS 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 them. 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.

MONSIEUR 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. He 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, must 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 for

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, his 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.