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

“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.