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

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.