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

“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.