Objection the Seventh.
It is only for the ignorant to be so rash as to raise an out-cry against the use of all instruments; people who do not know the absolute necessity there is for employing them on certain occasions. This clamor must proceed “from the interested views of some low, obscure and illiterate practitioners, both male and female, who think that they find their account in decrying the practice of their neighbours.” Such is the objection in the words of Dr. Smellie, in his Treatise on Midwifery (page 241.) and for this panegyric, he prepares us in his Introduction (page 55.) where, speaking of the midwives of the Hôtel Dieu of Paris, he first indeed tells us, that the surgeons had, in that hospital, perfected themselves in the art of midwifery; but then for fear that from thence occasion might be taken of saying, that to women it was they were beholden for that perfection; he takes care immediately after to add, that what “got the better of those ridiculous prejudices which the fair sex had used to entertain,” was, that the women or midwives of this hospital “had recourse to the assistance of men in all difficult cases of midwifery.”
ANSWER.
These gentlemen will permit me to tell them that they make great pretentions, and prove little or rather nothing. Calling hard names with a disdainful tone, and with airs of triumph, are not overwhelming reasons.
But to the point. Those who reject instruments, say you, do not know what they are: they reject them from ignorance. This is soon said. Nevertheless a number of authors, much more experienced and versed in the matter than Dr. Smellie, are of this opinion. Deventer exclaims against instruments; Viardel does the same; Levret admits none but those of his own invention, and rejects universally all others; and well might he except his own, since he wrote only to recommend them. Delamotte was not very fond of instruments: he tells us in his preface, that in a course of thirty years practice, he had not twice made use of the crotchet, though he had an extent of country forty leagues round, in which he regularly exercised his profession, insomuch as to have four lyings-in in a day under his management.
I have very exactly read almost all the modern authors who have written on this art; and have been surprized to observe that whilst, on one hand, they agree, they own, that in England, France, and Holland, people are much come off, or undeceived, as to all those dangerous or mortal instruments of which the antients made use, such as the short broad-bladed knife, (call it, if you please, a pen-knife) the bistory, the crotchets, &c. especially since the invention of the new forceps, or tire-tête: on the other hand, these same doctors tell you, that recourse must be had to crotchets, or to the Cæsarean operation, when the new forceps will not do. A comfortable resource this, in an instrument so boasted as the best discovery that has been made since the creation of the world, and for which we are indebted to the moderns!
I have also scrupulously examined all that authors have been pleased to say of great, wonderful and magnificent, with regard to the new forceps of Palfin, as it now stands after infinite corrections, as well in foreign countries, as in this one, which have dignified it with the name of the English forceps; and I find all these great elogiums reduced, at the most, to no more than the proving, as clear as the sun, that it is allowable for an operator, extremely able and extremely prudent, to make use of it, when the business might be perfectly well done without it.
From thence I deduce my demonstration directly opposite to the pretentions of Dr. Smellie and of his followers. According to the instrumentarians, and according to certain doctors, there are certain occasions, certain cases, in which there is an absolute necessity for employing the forceps. If we will hearken to and follow other doctors of more celebrity and credit, it is not right to make use of it, but when one may very well do without it: for example, after the having obviated all the obstacles which retard the delivery, after having, with the hands only, dis-engaged the head or the shoulders of the child, without which (say these same writers) the instrument would be found insufficient or useless; this palpably implies the being able to do without it. Now since it is not allowable, in good practice, to make use of it, but when it is perfectly needless to use it at all, there is then no absolute necessity for it; as surely, what can be done without, is not absolutely necessary. Be this only transiently remarked. For I reserve most convincingly to prove this proposition in the second part of this work. There I shall treat of all the instruments of our antients and our moderns, and besides an enumeration of them shall demonstrate their danger and uselessness. In the mean time, it must be owned, that either Mr. Smellie has been much misinformed of what passes at the Hôtel Dieu of Paris, in the ward of the lying-in women, or else, which I the least believe, is not sincere in the account he gives us, that the women of that hospital “had recourse to the assistence of men, in all the difficult cases of midwifery;” which, he observes, “got the better of those ridiculous prejudices the fair sex had been used to entertain.” That is to say, in preference of midwives to men-practitioners.
I frequented this Hôtel Dieu two whole years, before being received an apprentice-midwife, which I accomplished with great difficulty, on account of being born a subject of England, and consequently a foreigner there: my admission, however, I gained at length, through the favor, protection, and special recommendation of his royal highness the duke of Orleans. Now, I dare aver, that in all the time before, and after I was admitted there, I never but once saw Mr. Boudou, surgeon-major called, who did nothing more than to make us, one after another, touch the patient, about whom we had been embarrassed; and as he interrogated, he made us discover an uterus full of schirrous callosities, which joined to its obliquities, impeded the palpation of it properly with the hand, the orifice being very difficult to come at. Every thing, however, was done without his help, and very successfully. And most certainly we should have spared him the trouble of coming at all into our ward, if the head-midwife, who was a little capricious in her temper, had not taken it into her head to keep us in our perplexity, which engaged us to send for Mr. Boudou without her knowledge, and for which she was afterwards heartily angry with us.
I never once saw an occasion in which there was any necessity for using instruments, though in my time we had, at least, five or six hundred women a month to deliver.
Very far then are the midwives from having often occasion of recourse to the assistence of the men, in difficult cases; and indeed to those prejudiced in favor of men-practitioners, it may, though true, appear strange, that in a place where there are every year so many thousand women delivered, and consequently many difficult labors amongst them, and even cases of monsters, there is no recourse to the surgeon-major but in the last occurence, which falls out very rarely.
About eighteen or twenty years ago, Madam Poor, head-midwife of this hospital, delivered a woman of a monster with two heads, with no help but only her fingers and a young prentice. Not an instrument was employed: no man assisted her. The child was christened, and died presently after. The mother remained some months upon recovery, and did perfectly well. This fact requires no proofs, being of such public notoriety. The monster was carried to St. Cosmo’s, where any surgeon may see it. I served my time with this same mistress some years after this kind of prodigy had happened.
As to what I have advanced concerning the procedure in the wards of the lying-in women, should my testimony appear in the least suspicious, I appeal to the justice and veracity of all the doctors in England, who have been at the Hôtel Dieu at Paris, who cannot but confirm what I have said. In the mean time Mr. De la Motte, who passes for an author of credit may certify, the same. Here follows what he says in his preface to his observations, page 2.
“One would think (says this author) from reading the books of Messieurs Mauriceau and Peu, that it was impossible to succeed in the practice of midwifery, without having operated at Paris in the lying-in ward of the Hôtel Dieu. It is true, that this hospital is the best school in Europe, and that I would have ardently wished to have been admitted to the operations of midwifery during the five years I staid in that hospital: but as there is no more than one surgeon only, who is in charge to attend when he is called to consultation with the midwives, and that it is a place which goes only by favor, I was forced to content myself with following in quality of topical surgeon, to the physicians who performed their visits there. So that I followed only, for six months, three physicians in their rounds there, during which time I applied myself to examine the conduct observed by those gentlemen, to preserve the women after their lying-in from the accidents which follow thereon. By this means I made myself amends for my want of recommendation; but I can safely say, that during the six months I was admitted in the above-mentioned quality, there was no more than one extraordinary labor, which was that of a child engaged in the passage, where the presence of a surgeon was required, and which however was terminated without any other help than that of patience. And yet there were (so far back as then) from three hundred and fifty, to four hundred pregnant women, who were all delivered by the apprentices and rarely by the Dame De la Marche, at that time, head midwife of the hospital: so that I am persuaded, that those who boast of having lain a great many women there, exaggerate furiously.”
For me, I dare yet go farther, and will maintain it, that those persons impose upon the public in such boasts: since the naturalized surgeons, those of the nation, those of Paris itself, have no right to come into our ward. There is no one admitted but the surgeon-major, whose place is a place of favor, and rather matter of form than any thing else. Much more then are strangers excluded, and the truth is, that they never did, nor ever do operate there.
As to the reproach which Mr. Smellie makes to us of being interested, I can, for myself, prove that I have delivered gratuitously, and in pure charity, above nine hundred women. I doubt much, whether our critic can say as much, unless he reckons it for a charity, that which he exercised on his automaton or machine, which served him for a model of instruction to his pupils. This was a wooden statue, representing a woman with child, whose belly was of leather, in which a bladder full, perhaps, of small beer, represented the uterus. This bladder was stopped with a cork, to which was fastened a string of packthread to tap it, occasionally, and demonstrate in a palpable manner the flowing of the red-colored waters. In short, in the middle of the bladder was a wax-doll, to which were given various positions.
By this admirably ingenious piece of machinery, were formed and started up an innumerable and formidable swarm of men-midwives, spread over the town and country. By his own confession, he has made in less than ten years nine hundred pupils, without taking into the account the number of midwives whom he has trained up, and formed in so miraculous a manner. See the preface of this author. He speaks of his machine in the first page, and p. 5, of the number of his pupils.
Now as to these worthy pupils, must not they be finely enabled to judge of the situation of women with child, and of that of their fœtus? Must not they be deeply skilled in that branch of anatomy? Must not they acquire a habit of the touch exquisitely nice, exquisitely just, for discerning the proportion and analogy between a mere wooden machine, and a body, sensible, delicate, animated, and well organized?
I hope too that it is an injustice done to that doctor, by those who say that his pupils have too often a way of hurrying out the waters, which can only serve to render the labor more dry, consequently more laborious, and by that means furnish a handle for setting their instruments to work. If this should be so, as once more I hope it is not, may not the bad habit they will have contracted during their pupilship, of drawing the small-beer out of their wooden-woman, have contributed to this method of practice?
In the mean time, does it become a doctor to call us interested, who himself, for three guineas in nine lessons, made you a man-midwife, or a female one, by means of this most curious machine, this mock-woman?