A Treatise on the Art of Midwifery / Setting Forth Various Abuses Therein, Especially as to the Practice With Instruments: the Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgement Upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-midwife; Or, a Midwife

by Elizabeth Nihell

Of DIFFICULT and SEVERE Cases.

If an easy delivery requires nothing of extraordinary assistence; it is not so with a difficult one. All the knowledge, experience, dexterity, strength, prudence, tenderness, charity, and presence of mind, of which a woman is capable, are requisite to accomplish certain laborious deliveries.

It has been, in all times, very well known, that the most natural situation for the fœtus coming into the world, is that, in which the head presents first, it being that which commonly makes way for the rest of the body. Yet this delivery may become difficult, in proportion to the obstacles incident to it: obstacles not always surmountable, without great skill and industry employed in aid of Nature.

On the other hand, when it is felt that the fœtus presents any other part than the head, this position, called preternatural, oftenest occasions the delivery to be more laborious and hard to accomplish, in proportion to the more or less trouble there may be to search and come rightly at the feet.

Many English and French authors have given us a long enumeration of the causes which may make deliveries difficult and laborious. The curious may have recourse to them; as for me, who have not proposed to myself here a treatise compleat on all points, I shall content myself with setting forth only what tends to fullfil my proposed aim, that is to say, to take notice of those principal points, which first moved insufficient midwives to call in surgery to their assistence, to remedy their blunders, to retrieve their mischief, or to repair their omissions. I shall consider the kinds of exigencies, which the men-operators seized for a pretext of employing their iron and steel-instruments, the use of the natural hand, being yet more unknown to them than to the meanest midwife, and by this means, for the cure of confessedly a great evil, obtruded an infinitely greater one, and more extensive, in every sense, and in every point of light, that of men taking the practical part of midwifery into their own hands, or rather into their artificial ones of iron and steel, from which they derive all the authority of their introduction in the character of men-midwives.

The labors then which are generally speaking looked on the most nice, and arduous, may be comprized under the following heads.

1st. The obliquity of the uterus or womb.

2dly. The extraction of the head of the fœtus severed from the body, and which shall have remained in the uterus.

3dly. That labor in which the head of the fœtus remains hitched in the passage, the body being intirely come out of the uterus.

4thly. When the head of the fœtus presents itself foremost, but sticks in the passage.

To these I shall add the case of the pendulous belly, which is not without its difficulty.

Of all these classes of labors I shall treat separately. But before I proceed on them, I presume, that it may not be improper preliminarily to corroborate what I have said of the intrusion of the men into the practice of a profession, of the essential part of which they were so ignorant and disqualified for it, by the testimony which one of the best men-midwives in Europe has not refused to the truth.

This is M. de la Motte, one of the ablest and most intelligent modern writers on the subject of midwifery, of which his works form an incontestable proof. The ingenuity and candor with which he has written, must render him less suspected than any other. This is no midwife. He is a man, and esteemed an able practitioner, who learned the principles of the art from Madam la Marche, head-midwife of the Hôtel Dieu at Paris. He made his advantage of the works of his predecessors Mauriceau, Peu, and of all the best authors on this subject. All that was worth it in them he has transfused into his own writings; and that in a very clear manner. He collected whatever the best physicians had usefully said on the diseases of mother and child: in short, he has added many good observations and reflexions of his own, in the journals of his manual practice: the reading of his works, with some precaution however, cannot but be useful to the students of the art.

I do this writer this justice, with the more readiness and pleasure, for, that though he himself exercised the profession of man-midwife, and consequently in favor of his own practice, and of the pupils he was bringing up, was not without the injustice of adopting the prejudices of his cotemporaries too indiscriminately against the midwives; he does not suppress any truth relative to the art itself. But even, as to the midwives, the truth escapes him without any design on his side of its coming out. But such is the force of truth. And thus it appears. M. De la Motte wrote in a little sorry country-town at a great distance from the capital, being at the very extremity of the kingdom of France, on a sea-coast, where there were no other midwives than poor country-women, without knowledge, without skill, or any other qualification, than a little of the habit of attending women in labor. Yet with all these deficiencies it will appear, that the men-practitioners were far more to be dreaded than those poor ignorant creatures, who had scarce any thing but Nature for their guide.

I shall here give the substance of what he says in his preface, followed by some examples of the unskilfulness, or rather of the most profound ignorance of the most able men-midwives of his time, for forty leagues round his place of residence in the country.

“It is (says M. De la Motte) astonishing, that the obstetrical art should, until the beginning of the preceding age, have been left either to ignorant women, or to surgeons, who had not (any more than too many to this day) any other resource in difficult labors, than some instrument guided by undextrous hands, always sure of killing the child, and endangering the mother. Do not these poor innocents deserve compassion for being exposed to operations of surgery, which one would rationally think they could not need, till providence should have at least given them leave to come into the world?”

Here be it observed, that by the word “ignorant,” M. De la Motte should not intend the application of it to the midwives of the Hôtel Dieu at Paris, since, by his own confession, it is the best school of midwifery in Europe. Nor certainly is he in the wrong. Be it in honor of truth allowed me to say, that I know of those women who have served their apprenticeship in this hospital, who would think they made a wretched bargain, if they exchanged the manner of operating they learned there, for all the Latin, Greek, Arabic, or the iron and steel instruments of the best man-practitioner in Europe; even though his excellence in the manual function should be thrown into the scale for make-weight. The most constant success justifies their practice. In whatever situation the fœtus has presented, I have seen them, without having recourse to a man-midwife, and consequently to instruments, procure a happy delivery in very difficult labors. I have myself seen one deliver a child that had been dead in the mothers womb for near six weeks, without dismembering it; and though it was half-putrified, and the head so rotten-tender as to have no solid consistence, I dare advance this, without fear of being falsified, since I can name the mother, now alive in London, the witnesses, the place and year.

Such real midwives as I am here discribing, for I do not mean the spurious nominal ones, only fit to create work for the instrumentarians, or whose cue of interest is to do so, have no reason to apprehend, that in the numbers they have lain, there can be any found, that can complain of having suffered, or of suffering any the least damage or inconvenience, after their lying-in, that might be imputed to ignorance or mispractice.

On the contrary, I dare aver, that such, genuine midwives have cured many women who had received notable injury, before they came under their hands, in their having passed through those of the men-practitioners. Nothing being more agreeable to Nature, to Reason, to Experience, than that the method of practice of a skilful midwife is not only the most easy and gentle, the least painful, but assuredly the most safe both for mother and child. This is what the most severe examination will to those, who give themselves the trouble of making it, establish, in contempt of that fashion, by which so pernicious an error, as that of preferring men-practitioners, has acquired more credit and influence than so salutary and demonstrable a truth, as that for which I am contending. In the mean time, let us hear what M. De la Motte himself, a man-midwife, says of those brethren of his, of whom heaven grant there may not exist to this day too many resemblers!

“To the shame (says M. de la Motte) of the profession they exercise, they have no guide but their avarice, while the grossest ignorance of the art of midwifery itself is their lot. Such are much to be dreaded by women in difficult labor; for (adds he) they having no help to offer them but that of their instruments, they employ them indifferently in all the situations in which the fœtus presents. Nay, even the hands of some who will use their hands, are not less dangerous when misconducted. The ignorant therefore should never meddle with lyings-in. It would save them from the reproach they may incur of murder, in undertaking what they cannot execute, and what surpasses their skill. They would not furnish scenes that make one shudder with horror.

“I speak here of so many poor women, whose strength shall have been exhaust—by a great loss of blood, caused by the violences which an ignorant man-midwife shall have made them suffer, I speak of women, whose parts shall have been all bruised, and so vilely treated and torn, as in some to lay the anus and vagina into one, besides their children being dismembered, some their arms or legs plucked off, others the whole body, the head being left behind in the uterus.”

This is the language of a man-midwife himself, who candidly declaims against the errors of his fellow-practitioners, undoubtedly without designing that such their errors should be wrested into an objection to the practice of that art being committed to the men. Such a conclusion would in me be unfair, and a vain attempt to impose on the reader the laudable condemnation of an abuse, for an indiscriminate reproach to the whole set of men-midwives. This would however be but a kind of retaliative treatment of those, who, from the defective practice of the ignorant and unskilful midwives, of which if there was no more than one in the world, that one would be much too many, take the unjust handle of inveighing against midwives in general.

Even la Motte himself, who, as I have before with pleasure observed, was really as capable a man in the profession of midwifery as a man can be, at least to judge of him by his writings, has embraced every occasion of boasting the superiority of the men to the women in the exercise of midwifery. But while he taxes men of scenes that make one shudder with horror, the mistakes he imputes to the women, which are bad enough in all conscience, are not however of that atrocious nature, as those he relates of the men. Nay, with all his desire of under-rating the women, he falls into even pitiful contradictions. Let the reader himself decide on the following one.

Upon an article of practice, for which M. De la Motte blames the midwives, and what an article? not such as he reproaches to the men-practitioners, murdering, maiming the women, or tearing their children limb from limb, but purely for their applying certain bandages to the belly of women after their lying-in, in order to keep that part smooth from wrinkles; this very author, I say, who allowed the Hôtel Dieu at Paris, where the manual function is wholly confined to women, to be the best school of midwifery in Europe, where he himself wished, and wished in vain, to be admitted to practise, and, in short, from the head-midwife, of which Madam de la Marche he himself probably learned all that was worth any thing in his practice, thus speaks of the midwives bred up in that hospital.

“This prerogative of having served apprentice in the Hôtel Dieu at Paris, is not for these women, an indifferent matter, for though they were to have no more than a shadow of sense, they are persuaded, that in setting themselves off with a title that does not render them more capable, they ought to be honored and respected above all others, which they would not fail of being, if they were to give some marks of sufficiency beyond what others can give.[^[28]]”

The nonsense of this objection of Mr. De la Motte is too glaring to need a comment. If an education in the best school of midwifery in Europe, does not give a woman a right to plead it for a title to reliance on her superior sufficiency, without any reason therefore to accuse her of vanity, what can give her a title?

But to return to M. De la Motte’s sentiments on the practice of the men-midwives; it will easily be seen, that the horrors he objects to their practice, and of which he himself undoubtedly endeavoured to steer as clear as he could, were of a nature, without the least breach of candor, to suppose liable to repetitions wherever so false a doctrine and practice prevail as the substituting steel and iron-instruments, or “artificial hands” to natural ones.

Let us now see what Mr. De la Motte thinks of the use of the CROTCHET.

“When I settled in my province (says this author[^[29]]) I found several ancient master-surgeons, who pretended to help the women in their difficult, or preternatural labors, solely with the use of the crotchet; without ever, in their life having made any delivery, but in that manner, and as soon as they had extracted the fœtus with their crotchet, they left the rest or the after-birth to be brought away by a woman, as they themselves knew nothing of the matter. When they were fetched to help a woman in labor, they took their crotchet, went to the woman, whom they put into posture, and whether the child presented the head, breech, arm or leg, whether it was dead or alive, a woman’s having passed a day and a half in labor was cue more than enough for them to go to work with their crotchet.”

The following extracts from the same Mr. De la Motte, may serve to confirm the foregoing observation.

“Observation 187. I was sent for to lay Madam de ... about fifteen leagues from Valognes, the place of my residence, and there was at the same time a surgeon of the town where I then was, who had been fetched to lay a woman that had been in labor from the day before, whose child presented the vertex: he, without further examination, put her into a convenient posture, and with his crotchet brought away the child at several pulls, with much pain and labor, and threw it under the bed, with the after-birth, in the most severe season of the year: after which, the operator hugged himself prodigiously, for having so happily accomplished so difficult a labor. Having rested a little, and just as he was going, a woman curious, bethought herself of seeing whether it was a boy or girl: she found the poor child yet alive, though so mangled with the crotchet, and that after having remained, in this condition, an hour and a half, without its having been in the power of so violent an operation, or of the rigor of the weather to terminate a life which seemed to have held out against so many barbarities, only to reproach the detestable operator with the enormity of his crime. The child was christened and died soon after.

“Reflexion. This is what may be called a cruel ignorance, &c.”——To the which I add, that if this wretched operator had had the patience to wait some time, the child would in all probability have come naturally with any the least help of the hand at every throw of the mother: for she had not been over-time in labor, and the head was not, it seems, stuck in the passage.

“Observation 196, p. 274. I was desired to go to Cherbourg to lay a poor woman there, whom a surgeon and a man-midwife by profession, belonging to that place, had given over.... I found the woman in a condition hard to describe, with an arm and a leg of her child pulled off, and the remainder of the body left behind in the mother’s womb. I put her into posture, and instantly delivered her of one child (it seems she went with twins) who had only an arm plucked off: I then sought out the other, whose leg had been torn away. Strange and fatal sight, which was seen by more than twenty women present, all ready to swear to the truth of this! I left the woman to their care, after having delivered her of the after-birth. She had been as much hurt as the children, of whom nothing remained in the uterus, by the care I took to evacuate it. I left the mother tolerably well considering her condition.”

Reflexion. This was the more surprizing, for that the first operator was an old practitioner, who had been an out-surgeon to the Hôtel Dieu above eight years, before M. De la Motte was apprentice there. Yet this man neither was sensible of the being twins in the case, nor had dexterity enough in the manual function. Here I ask, could the most ignorant midwife have acquitted herself worse than this man?

“Observation 185. A tradesman’s wife of Valognes being taken in labor sent for a midwife. A little while after her coming, the membranes burst, the waters were discharged, and the child presented an arm. The midwife required help. (Probably she might be one of the ignorant and unskilful ones) and two surgeons were sent for, who passed for being the most expert ones in the town. They begun with plucking off the arm that presented, though the child was alive. The other arm, as soon as they got hold of it, underwent the same fate. After which they struck the crotchet into a rib, which they brought away, then two, then three, and, at length, struck the crotchet into the back-bone, and pulled so cleverly together, that they brought the child away doubled up. The midwife delivered her of the after-birth, and notwithstanding all this ill usage, the woman recovered; but it was a long while first.”

Reflexion. (Mr. De la Motte’s own) “Was there ever a crueller operation seen both for the mother and child; the first terribly torn, the other barbarously dismembered?”

“Observation 186. The wife of a tallow-chandler of this town was taken in labor: the waters were discharged, after which an arm of the child presented. Help was sent for; one of the two operators (mentioned in the foregoing observation) came with his servant and crotchet. He began his operation, by plucking off the arm of this certainly live child, then, without further examination, he strikes the crotchet into its body, and pulled, without being able to bring away any thing. The master, whose strength was exhausted, made his pupil help him, and they both pulled as hard as they could: still nothing came, and I verily believe that the master would have called in some body else to his assistence, if the handle of the crotchet had been long enough, or that the poor woman had not given up the ghost under the cruel torments they made her suffer, to such a degree that they forced her to part with her life, sooner than with her child.

“Reflexion. Here was a delivery in intention, but the execution had something horrid, and perfectly odious in it. I never could have imagined, that two men could have pulled in this manner, without dislocating the bones of the woman into whom the crotchet had been struck: for so it was shown to be, upon the body being opened, in which the child was found with an arm plucked off, entangled in the umbilical chord round its neck, without the least mark of the crotchet upon its body: too plain a proof this of the crotchet having been struck into the mother and not the child, and consequently of the little circumspection, not to say rage, with which the surgeon had acted upon the body of this unhappy creature: for surely it must be granted, that it could be no part of the child that could have resisted the terrible efforts made both by master and man, jointly to bring it away; and yet this was one of the BEST[^[30]] operators in the country for HELPING women in labor.

“I could make a VOLUME of these histories, if they were good for any thing but to excite horror.” Such is the witness born by M. De la Motte, as to the ablest men-midwives of his time, in all his province. Now in order to invalidate the conclusion, so natural to be drawn from so unexceptionable an attestation, against the superiority of the practice of the men to that of the women, will it be said, that the men-practitioners, in this country, are in general better educated than such operators as have been above shown? If so great a falsity should be advanced, let the reader himself reflect on what he may easily find to be the common method of training up of men-pupils in this art. I have in the first part of this work, stated some reasons for their insufficiency, both in study and practice; and the more this point is examined, the more clear will that undoubted truth appear, that if the ignorant midwives are, as they undoubted are, a great evil, they are even blessings in comparison to the generality of the men-practitioners, bred up with the help of artificial Dolls, pretty prints, or even of their personal visitation of those miserable wretches hired, or under the mask of charity, forced to undergo, from apprentices or pupils, so many inhuman tortures and outrages in vain.

It will also perhaps be said, as to the examples I have just produced from M. De la Motte, that since his time, that is to say, about the beginning of this century, that the art of midwifery has received so much improvement, as to cancel all impressions of fear from such examples. Yes! It has received improvement with a vengeance. If a vain endeavour to perfect instruments, impossible to be perfected, or against common sense to suppose, even when perfected superior to skilful hands, are an improvement, then the art may be called improved. In the mean time, infinite is the mischief done by so many pretending operators, with each his bag of hard-ware at hand, his only proof of superiority to a woman, in practice, confiding in those instruments. Their negative damage is almost as great as their actual one. For by occasioning the men, and even ignorant midwives to trust to the calling in their help, the methods of predisposing of the women to parturition, the proper precautions, and actual manual function in the labor-pains, which is a point of the utmost importance, are at best but slightly and prefunctorily, consequently not sufficiently, performed, or perhaps wholly neglected. And why? because the instruments, the crotchet, the tire-tête, the forceps, are considered as sure reserves to remedy such deficiencies. This, besides many other reasons, encourages the indolence, carelessness, and inattention of the men-practitioners, and even of the midwives, especially of those poor suborned creatures recommended by the men-practitioners, paid, as one may say in some sense, not to do their work so well, as that none should be left for their honorable patrons. Thence it has happened, that where an ignorant midwife has, through her unskilfulness, or for whatever other reason, been wanting in predisposing the passage, or lapsed the critical moments of the manual aid, so that she really is or pretends to be out of her depth, by the exigence being beyond her ability; the man-midwife is called in, who, with his instruments, forces that delivery, which might, if justice had been done to the patient, have proceeded in a natural way, with much less pain and danger. Be this remarked, without my speaking here of the extraordinary tortures and outrages, such as M. De la Motte himself has related. The woman then is, by the help of instruments, delivered by the man-midwife so called in. “If he had but staid a few minutes longer, both mother and child must have been lost”. So believes the father of the child, so believes the mother, so believe most of the parties concerned, and what is more, sometimes so believes the man-midwife himself. Though the strict truth has been, that the greatest part of the pain the mother endured, and every appearance of danger, either to her or to her child, were positively owing to nothing but the negligence and mispractice used, either by man or woman-practitioner, in reliance, if matters should come to the worst, on the supplemental aid or reparation of errors, by those miserable instruments, which constitute all the boasted improvements of an art, the true nicety and requisite accuracy of which they are so much more calculated to banish or destroy.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“First, that it has none of their faults.

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

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

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

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

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

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

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

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

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

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

Here follows a much more material contradiction, rather however to common sense than to Levret himself, to which I intreat the reader’s particular attention.

Observations, part the 2d, p. 160. Levret gives us the following preliminary general precept.

“There is, says he, a general precept by which it is established, that a surgeon ought never to thrust instruments into deep places, without guiding or conducting them with the hand, or with the extremity of the fingers of that hand that does not hold the instrument.”

It is then to this general axiom strongly dictated by reason, and surely in no case more obviously so, than where the exquisitely tender texture of the uterus protests against committing its safety from the cruellest injuries, to the necessarily blind random agency of an iron or steel instrument, so palpably ungovernable in so remote, intricate, and slippery a place by even the most skilful hand[^[40]]; it is, I say, in exception to this so salutary general precept, that Mr. Levret will have it that there are exceptions, and in favor of what, do you think, not surely of the poor woman who, is to be the subject, or rather the victim of the experiment, but of——his most egregiously silly CURVE FORCEPS! Yes; it is by way of trying practices with that same instrument, that the patient is liable to be spread out, in that delicate attitude which I have above, (p. 237) described from Levret, to the perusal of whom, for a thorough conviction of the perfect insignificance of that instrument, or indeed of any of that sort, I would recommend even the most sanguine in favor of instruments, if they would but grant, to their own reason, its just prerogative of a previous suspence of prejudice.

In these cases, however, for the which being exceptions to that excellent general rule, Levret contends; and, to do him justice, contends so auckwardly, that he rather provokes pity than indignation, at his endeavouring to establish even so pernicious an error; let the reader consider within himself the part into which this forceps is to be thus blindly thrust, at the risque of so many almost inevitable dangers. And for what?——In those cases it is either possible or not possible to introduce the fingers. Where they absolutely cannot be insinuated, the introduction of those instruments is in all human probability big with the worst of mischiefs, where neither hand nor fingers can controul the effects of the iron or steel: which, consequently, endanger more than they can help, and are therefore not to be used. But if the hand or the fingers can be insinuated, the hand or the fingers well conducted will do the work without the help of instruments, which in this second supposition become also useless.

This brings me to this case particularly, the title of which is prefixed to this section, that of a head stuck in the passage, which the gentlemen-midwives may perhaps second Levret, in maintaining to be an exception to that admirable axiom above quoted, and maintain it purely, in evasion of the conclusion against their miserable instruments, which I aver need never be resorted to, nor never are, but for want of sufficient skill in the manual function to terminate such labors without them.

I answer then to these instrumentarians, that an instrument, even, no more dangerous than a probe, would in so tender a place as I am treating of, not perhaps be quite enough exempt from a possibility of doing mischief, to deserve an exception: but as to those instruments, which are so palpably likely to hurt both mother and child, to injure, in short, or even to destroy both the mould and the cast, they are all of them within the case of exception, or rather exclusion. It is then, in knowing what to do, and in the faculty of operating with the hand according to that knowledge, that the art of midwifery principally consists. If instruments are deemed ingenious, the doing without them is surely not less so.

Now as to the case proposed in this section, that of a child’s head stuck in the passage, I aver, that it is not absolutely impossible to terminate this delivery by the hand.

I am even ready to demonstrate this before any competent judges. I speak by experience. I have hitherto executed with all desirable success this operation without any aid but that of the hand, with a little patience and proper assiduity. I have many and many a time seen it practised at the Hôtel Dieu, and elsewhere. I never in my whole course of practice saw sufficient reason for attempting so hazardous an extraction, as that which is executed by means of a tire-tête. Why then those needless terrors, those superfluous tortures with instruments, to women already in too much pain and anguish? care enough could not be taken to spare those of the weaker-nerved sex in that condition such horrors, the very idea of which, to say no more, is enough to put them into imminent peril of their lives. All the forceps, and the rest of the chirurgical apparatus, especially the more complex instruments, very justly frighten the women, and their friends and assistents for them. Their introduction requires at once a painful, a shocking, and a needless devarication. The patients are put into attitudes capable of making them die with apprehension, if not with shame, from that native modesty of theirs, which, in these cases, may however be pronounced rather a wise instinct than a virtue.

How much preferable is the true midwife’s practice, who will have oftenest prevented, by her knowledge and skill, this very situation! That is to say, if she has been called in time. She knows how to predispose the passages, and by gentle reductions to restore Nature to her right road, where she has been through mispractice driven out of it, or through negligence suffered to deviate from it, or not preventively watched.

I have never but seen, with respect to the uterus in this case, that it was possible to insinuate first one finger, then another, and little by little the whole hand, not indeed a hard hand, as big as a shoulder of mutton, the hand of some lusty he-midwife, but of a midwife, such as it is commonly seen.

When Nature does not proceed as could be wished in her labor-pains, the point is then to husband well the strength of the patient, to restore it where it fails, by giving her good broths and corroboratives, that do not heat, or cooling things, where heating ones have been injudiciously administered. She is then to lie as composed and tranquil as possible; to be cherished, comforted, inheartened. There is, humanly speaking, no fear but her strength will return; her pains must not be irritated, nor herself harrassed with ineffectual interference. Nature will come to herself again: the situation will, by her benign energy, change for the better, and become favorable enough, for the midwife to be able to assist her in the due time with a manual operation, that will terminate happily her delivery. It is at least, with this success, that I have delivered many, who, by the unskilfulness of those who had attended them, at the beginning of their pains, had been reduced to a deplorable condition, by their labor lingering some for upwards of six days.

In short, it is extremely rare that this case of a head stuck in the passage ever happens, unless under the hands of unskilful practitioners, or of over-dilatory or neglectful midwives, who will not have duly attended to the prognostics of this event; who will not have watched and taken the benefit of the favorable critical moment; who give the head time to engage itself, or get fast jammed, for want of their removing the impediments to Nature’s doing the rest, or when help has been called or come too late. It may also be owing to those who hasten too much, who precipitate the women’s labor by forcing draughts, that heat, burn them up, exhaust their strength, and prematurate the coming on of the labor-pains. Some practitioners fatigue them, with making them walk, or keep them up too much.

But when the membranes are not too soon pierced and the waters let out, when the pains are not provoked, when time is given to Nature to form to herself a passage, not omitting the precautions I have summarily intimated; when due care is taken to procure all possible ease of body and mind to the patient; who may vary her posture, sometimes lying along, sometimes sitting up, or well supported when she walks: little by little the head will frank itself a passage with the weight of the body acting by an innate energy, and with a little due assistence of the midwife’s art: and with this practical advertence, that, in these arduous cases, much may be safely left to Nature, but not every thing. There are times in which she cannot bear neglect, but there are none in which she can bear extreme violence.

Here the reader will not expect I should in a treatise, purely calculated to expose the abuses of midwifery, attempt to particularize either all the contingent cases, or all the modes of operation in them. That would require a work a-part. I shall only then, to the four principal cases, in which instruments are so falsely supposed necessary, add a summary account of that of a pendulous belly, which is not without its difficulty.

As to a PENDULOUS BELLY, madam Justine, midwife to the Electress of Brandenbourg, remarks, in her Treatise of the Art, that she knows, by experience, that some children turn upon their heads with their feet upwards, in women who have a large and prominent abdomen; because, says she, they are pitched too much into the fore-part of the belly, that is become pendulous. But she does not explain the consequence of this situation, which however does not fail of causing a severe and troublesome labor; in that the uterus being fallen into the capacity of the hypogastrium, and the child being got above the os pubis, there it sticks, and the labor-pains are ineffectual, if proper assistence is not given to Nature.

The practice which my success on experience encourages me to propose is, to have the patient lye on her back, the belly to be braced upwards with a large linnen-fold or roller, to reduce the uterus and fœtus to its better position in the capacity of the pelvis; but if, notwithstanding that help, the head of the child continues to rest on the os pubis, the finger must be insinuated between those bones and the head, in order to make, it, little by little, retrograde into the pelvis towards the coccyx.

In every case then that can be imagined, so far as my own experience and observation have reached, I am authorized to aver, that the gentleness of the manual assistence to women is at once more agreeable to Nature, and more salutary than the violence of the instrumental practice; which not only conveys the idea, but the very reality of a butchery. While its being sheltered under the plausible pretext of tenderness and pious regard to the safety of the poor women and children, cannot but provoke the greater indignation, at seeing vile interest trifling thus wantonly with their lives, and add to the cruel outrages on the human person, the greatest of insults on the human understanding.

It cannot however have escaped observation, that while I am, with the utmost regard to truth, endeavouring to recommend the preference of the hands to instruments, there is nothing I mean so little, as that some deliveries may not be accomplished by instruments, and especially by that divine invention of the forceps. What I presume to exclaim against, is the needless torture to the mother, the needless increase of danger to which she and her child both are exposed, for the sake of that practice being tried upon them, with those instruments, when the bare hands would be so much more safe and effectual. I could myself, no doubt, in many cases, if I could be inhuman and wicked enough to dally with any thing so sacred as the health or life of a woman and child, in some measure, entrusted to me, give myself the learned air of delivering with a CURVE FORCEPS. But in the very same cases, though at the hazard of being called ignorant for my pains, I would always be sure to do it more cleverly, less dangerously, less hurtfully, with only my hands. So that, without straining any comparison, the forceps may deliver indeed, but how? Why just as a man may, if he chuses it, hobble round St. James’s Park, on a pair of those artificial legs[^[41]] called stilts, when one would imagine, that the mock-elevation from them could scarce atone for their uncouth totteringness, and that he might full as well deign to use his own natural legs.

In the slighter cases then, that is to say, in those cases, where it is a jest to doubt of the hands not being the preferable instrument, since they may be truly averred to be so even in the most difficult ones, instrumentarians commonly go to work, only (please to mind that only) with the forceps. So that it is only in those slighter cases, where, once more nothing is more certain than that no instrument is wanted at all, that they find matter of triumph over their predecessors in theory and practice, over common sense, and especially over humanity. And this is that amazing, that FORTUNATE IMPROVEMENT, the superhuman invention of the forceps, the philosopher’s stone of the modern art of midwifery, found out by the male-practitioners. Yet, after all it plainly appears, that even themselves do not rely on it in the more difficult cases. They are then obliged to return to the old crotchet, or the like methods, which bad, very bad, and very inferior to the hands as they are, never however are supposed to be resorted to, without an appearance of extremities to afford some color, some plea of humanity to employ them, in a kind of dernier resort, to prevent a greater evil by a less one. Whereas, when the forceps is used, the cruelty of that torture it cannot but create, must be greatly aggravated by the consideration of its being perfectly needless. But in the case of using either crotchet or forceps, or indeed any instruments at all, the truth is, that besides the increase of danger and pain they bring, to the already too much afflicted patients, they defraud them of the more efficacious, less painful, and especially more safe help of the hands alone.

The instrumentarians all then agree on that insufficiency of this precious forceps, which occasionally compels their recourse to the crotchet so detested even by themselves. Levret, for example, confesses this, p. 24, of the appendix to his observations.

“The crotchets (says he) are, generally speaking, instruments, the very sight of which shocks and terrifies: but notwithstanding the repugnance which all good men-midwives ought to have to the using of them, there are cases in which there is no doing without them.”

Now in these cases, that of the monster with two heads[^[42]], is not meant to be included, as Levret himself afterwards explains himself. If then there are such cases as necessitate a recourse to crotchets, it will, I presume, be allowed me, that they can be no other than those which render the delivery the most laborious. What those cases are, I have, from after the instrumentarians themselves reduced to the four capital ones, I have above set forth, without reckoning the pendulous belly. At least I know of no other situations than those, that can produce the very severe labors, nor do I believe that the instrumentarians know any other, or they would tell us so. Now if, in the more difficult of those cases, there is no doing without the crotchet, what becomes of the prodigious merit of the forceps, so insignificant in cases of the greatest need, and so superfluous in those others, where there being no occasion at all for it, it must be the most inhuman wantonness to employ it?

Here can you be with too much insistence desired to observe the solemn banter, in such a matter of life and death too, of these kind, tender-hearted modern instrumentarians! they are so transported with stark love and compassion to the poor women and children, that they do not know what they are about; they fall into the most palpable contradictions, and would have even Hippocrates, and the antients, appear as so many bloody-minded Cannibals compared to them. Hippocrates, it seems, and the antients, according to the best of their apprehension, in points of midwifery, prescribed the crotchet, in no case however but where the child was certainly dead, which, by the by, is next to the not prescribing it at all, since the ascertainment of that death is scarce not impossible. So because they recommended this practice in the last necessity, the ingeniousness of the modern instrumentarians was “[^[43]]stimulated to contrive some gentler method of bringing along the head” —— without any necessity at all; that is to say, in the minor difficulties, for the crotchet of the old practice is, to this instant, even with them, left in possession of the greater ones. Thus was produced the forceps, that prodigiously bright refinement upon the dull antients, and goes on improving without end under the wise heads of our gentlemen-midwives. But if the modern Genius of arts and sciences has no better improvement than this to boast over Hippocrates and the antients, may the instinct of self-preservation defend mothers, and, in them, their children, from being the trophy-posts of their victorious atchievements! may the midwives continue in their happy ignorance of their curious devices! may they ever preserve a due aversion from indeed all instruments whatever! for they are all needless and pernicious substitutes to the hands. May none of them, especially in any labors committed to their conduct, prove so criminally false to their sacred trust, as through negligence, or through an interested designing reliance upon instruments, to repair their failures or mispractice, slacken their attention to their duty, or afford, by their defective performance, an excuse, though a fallacious one, for resorting to instruments, when skilful hands are incomparably more fit for a remedy or retrieval!

I cannot then too ardently wish, for the women not to be so cruel to themselves, and to their so naturally dear children within them, as inconsistently to suffer their aim at superior safety, to be the very snare that betrays them into the greater danger, and often worst of consequences, from those male-practitioners, to whom that aim drives them for recourse; while that examination they owe to so interesting a point would issue, or deserve to issue, in rescuing them from such a shameful subjection of body and spirit to a band of mercenaries, who palm themselves upon them, under cover of their crotchets, knives, scissors, spoons, pinchers, fillets, terebra occulta, speculum matricis, all which, and especially their tire-têtes, or forceps, whether Flemish, Dutch, Irish, French or English, bare or covered, long or short, strait or crooked, flat or rounding, windowed or not windowed, are totally useless, or rather worse than good for nothing, being never but dangerous, and often destructive.

Nature, if her expulsive efforts are but, in due time, and when requisite, gently and skilfully seconded by the hands alone, will do more, and with less pain than all the art of the instrumentarians, with their whole armory of deadly weapons. The original and best instrument, as well as the antientest, is the natural hand. As yet no human invention comes near it, much less excells it: and in that part it is that the women have incomparably and evidently the advantage over the men for the operations of midwifery, in which dexterity is ever so much more efficacious than downright strength.

And, indeed, let every requisite faculty for the assistence of lying-in women be well considered, and the resulting determination cannot but be, that in the common labors, where the men themselves are either simple by-standers or receivers of the child, or operate with the hand only, they are the very best of them, not comparable to a common midwife, and in those cases, in which they pretend the use of instruments necessary, hardly better than the worst one. So that, not less than justly speaking, they are not receivable, either as substitutes, or even as supplements to midwives.

The art of midwifery then, in its management by women, carries with it, in the recommendation of order, modesty, propriety, ease, diminution of pain and danger, all the marks of the providential care of Nature. It is imaged by the incubation of a brood-hen, assiduously watching over her charge, and tenderly hatching it with her genial heat. Whereas the function of this art, officiated by men, has ever something barbarously uncouth, indecent, mean, nauseous, shockingly unmanly and out of character: and, above all, of lame or imperfect in it. It strongly suggests the idea of the chicken-ovens in Egypt, kept by a particular set of people, who make a livelihood of the secret, which they, it seems, ingross of that curious art of hatching of eggs by a forced artificial heat: a practice, which, like the other refinements of dungbeds for the same purpose, or that of committing the rearing or education of the chickens to[^[44]]“cocks, to capons, or to artificial wooden mothers,” may sound indeed vastly ingenious; but besides the numbers that perish the victims of those experiments, many of the productions of such methods of hatching are observed to be maimed, wanting a leg or a wing, or some way damaged or defective. The comparison breaks indeed in that, at least, the grown hens themselves escape damage, which is not often the case of mothers under those heteroclite beings the men-midwives; or, if they do escape, it is no thanks to those operators, but to the prevalence of Nature over their pragmatical intervention, so fit only to disturb, thwart, or oppose her effects, and in every sense to deprive the unhappy women that trust them of her common benefit.

But while superior considerations of humanity so justly intercede for the mothers, while I strenuously contend for the preference to be, without hesitation, due to the mother over the child, especially in that dreadful dilemma, where one must be sacrificed to the safety of the other; supposing such a dreadful alternative ever to exist, which I much doubt, or at least, not to exist so often as it is rashly taken for granted, and even then, where the effects do not always follow the resolution taken thereon, since, though the child is always certainly lost, the mother is far from always saved, when, by a judicious preventiveness in practice, neither of them might perhaps have been so much as in jeopardy; while, I say, I plead for the preferable attention to the mothers, I hope no mothers will think me the worse intentioned towards them, for giving the lives of their children the second place in my tender concern for the safety of both.

And surely never was a time, when children more required the intercession of humanity in their favor. Mothers can speak for themselves. But the poor infants, so often precluded, by violence, from the pity-moving faculty of their own cry, have nothing but the cry of Nature to plead for them. A cry, the listening to which is prevented by those vain imaginary terrors, inspired by designing Art in the service of Interest, through which Nature is seduced to act against herself, and deliver herself up to her greatest enemies.

In short, one would imagine, that all the rage of cruelty was unchained, and let loose against especially those tender innocents, born or unborn.

Among the poor, particularly as to those infants cast upon the public charity, a barbarously premature ablactation, under a pretext so easily foreknown to be as false as it is fatal, of bringing them up by hand for cheapness-sake, has destroyed incredible numbers.

Among the rich, or those able enough to pay for the learned murder of their offspring, how many of their children, even before they have well got hold of life, in this, literally speaking as to them, iron age, encounter their death or wounds, stuck in the brain by a crotchet, or crushed by a forceps, to say nothing of their being now and then ingeniously strangled in the noose of a fillet!

And those horrors proceed unchecked and unexploded, and in what a nation? a nation, that values herself upon the distinction of profound thinking: a nation that, besides that interest she has in common with all other well-governed nations, to protect and promote population, stands, be it said, in that true spirit of justice, which as much disdains to pay a fulsome compliment, as good sense ever will to receive it, moreover eminently distinguished above them all, for producing a race of natives, one would think could hardly be too numerous, since they are the most remarkable in the known world for courage, for personal beauty, and for many other liberal gifts of Nature, among which surely not the least is, that inborn spirit of liberty, to which they owe the honorable acquisition of so many additional advantages.

Can it then be too strongly recommended to the women especially, at least, to examine whether their notion of superior safety under the hands of a man, in their lying-in, bears upon the solid foundation of Nature, or merely on the treacherously weak one of a delusive opinion? an opinion that owes its existence to fears cruelly played upon, and turned to account by designing Interest. If those then of them who are under the force of prejudice, or governed by habit, or by both at once, would, on a point that concerns themselves and children so nearly, assume liberty enough of mind to shake off the dangerous yoke, they would undoubtedly find it better and safer to listen to that salutary instinct of Nature so authorized by reason, which inspires them with that repugnance to submit themselves in the manner they must do that submit themselves to men-midwives, who have the impudence to call that repugnance a “false modesty:” as if that Modesty could not be a true one, a foolish one I am sure it could not be, that should murmur at being so cruelly sacrificed to such a bubble’s bargain as it is, by those innocents, who, over-persuaded by a deceitful promise of more effectual aid, too often embrace a torturous and a shameful death, for which, to add ridicule to horror, they are expected to pay their executioners larger fees than to one of their own sex for a more decent, a more safe, and always a less painful delivery.

May the women then, for their own sakes, for the sake of their children, cease to be the dupes, sure as they are to be in some measure the victims of that scientific jargon, employed to throw its learned dust in their eyes, and to blind them to their danger or perdition! may they, in short, see through that cloud of hard words used by pedants, whose interest it is to impose themselves upon them: a cloud, which is oftener the cover-shame of ignorance, than the vehicle of true knowledge, and perhaps oftener yet the mask of mercenary quackery, than a proof of medical ability!

As to the writings of the men-midwives especially, I dare aver, that, though there may be here and there some very just theoretic notions, borrowed from able physicians and surgeons, nothing is more contemptible than most of their practical rules; what is tolerable in them being most probably got from midwives, but so disfigured with their own absurd sophistications, that I should heartily pity any woman, subjected to have her labor governed by such, as should have no better guidance than their ridiculous instructions.

Then it is that a sensible woman would, in defence of her own life, or of any life that she holds dear to her, in the case of needing the aid of midwifery, view with equal disdain, with equal horror, either the rough manly[^[45]] he-midwife, that in the midst of his boisterous operation, in a mistimed barbarous attempt at waggery or wit, will ask a woman, in a hoarse voice, “if she has a mind to be rid of her burthen,” or the pretty lady-like gentleman-midwife, that with a quaint formal air, and a gratious smirk, primming up his mouth, in a soft fluted tone, assures her, and lies all the while like a tooth-drawer, that his instruments will neither hurt nor mark herself nor child but a little, or perhaps not at all. (See p. 448.)

This last character, if less brutal than the other, is not perhaps the least dangerous, since the practice being at bottom the same, pregnant consequently with the same mischief, the gentleness of the insinuation gives the less warning, and paves the way for the admission of a handling not the less rough for the smoothness of the address. But is there any such thing as polite murder? is mischief the less mischief for being perpetrated with an air of kindness? well considered it is but the more provoking. The male-practitioners then are not quite in the wrong, to presume as they do upon the weakness of the women’s understanding, since they can so grossly pass upon them their needless cruelties, under so inconsistent and false a color as that of a tender compassion. Thus to all the rest of the shame to which they put them, they add that of so palpable an imposition in that flimsy cover of the mean interest, which is so probably the real motive at bottom of their taking up a function, to which they were never called by Nature, nor by any necessity, unless, perhaps, of their own.

In the mean time, the truth is, that, in vain, would the men, by way of sparing the women the terror of their masculine figure, upon those delicate occasions of officiating, and to appear the more natural in the business, aim at an occasional effemination of their dress, manner and air. They can never in essentials atone for their interested intrusion into an office, so clearly a female one, that, if but only as to the manual discharge of it, not even the qualifying them for the opera, would, perhaps, sufficiently emasculate them.