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

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.