Whoeverthen 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 ofTOUCHING, 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 withoutit. 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.
Surelythen, 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 188thOBSERVATION, p. 265,Leyden ed.makes an animadversion upon a midwife’stouchinga 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 oftouching, than what his works show him to have been in other parts of the profession.
InthatOBSERVATIONhe 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 reiteratedTOUCHINGS(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 attendinga 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.”
Formy quoting this case, especially as it regards the point ofTOUCHINGnow 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.
Asto 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 theREITERATED TOUCHINGSdid 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 sexesthe 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 theDECORUMof his “DIGNITY.”
Butlet that pass. I come now to the great point of theTOUCHINGScomplained 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 thesetouchingsare 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 havemyself known women in pain, and even before their labor-pains came on, find, or imagine they found, a mitigationof 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 amalso the more ready to believe, that these sametouchings, 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, andFAR ADVANCEDin the passage”; and withal offers no reason to think, but that it was sofar advancedfrom thetouchings, not in spite of thetouchings.
Weshall 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 thingsfar advancedenough, 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.
Suchwas 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 hisREINFORCEMENTS, 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 menby right of superiority of skill, has so greatlyIMPROVEDthe 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.
“Ifthe operator of the place had been called, he wouldDOUBTLESShave proceeded in this delivery, as he had done in the other (see p. 292.) that is to say, he would havequicklydispatched it with hiscrotchet: 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 apoor woman in the mostcruelmanner.”
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 furnishVOLUMES(p. 298.) horrors whichmust 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.
Butto resume the subject ofTOUCHING, 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.
Bythe 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 preservesit, I call it well placed: the point of it is turned directly to the cavity of the pelvis, and thefundus uteriis 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.
Itwould 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 havethen 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 couldwish 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 theirpregnancy. 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.
Theobliquity 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 theos pubis, too much turned towards the curve of the vertebræ, or in a lateral direction, towards either the right or leftilion. 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.
Thereare 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 caseof 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.
Hewho 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.
Butthat 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.
Letus 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 thechild, 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 thefundus 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 thefundus 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.
“Caremust, in the mean time, be taken, that the pression made on the belly must not be too violent butverymoderate: 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 contractthe 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 herwholestrength, withoutfearof doing any harm to the woman. On the contrary, she will greatly relieve her.”
Tothe 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, butverymoderate. I confess, I do not understand, but that may be my fault, how a pression can be stronger andstronger 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.
Hegoes 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 theos sacrum, that themembrane should be broke, and the child’s head a little discovered, and withal, the woman’s strength much exhausted,
“Tochange, (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.”
Tome 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.
Atthe end of the said chap. xlvi. Daventer concludes in the following terms.
“However, to say the truth, of whatever kind the obliquity of the uterusmay 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.”
HereI 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 thelabor, before even the discharge of the waters, or at least soon after.
Oughtthen 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 amthen 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.
“Butif 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 doesnot 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 morebefittingamanthan awoman, unless she has aquickjudgment, and analerthand: 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 forthreereasons.
“The First.Commonly, the orifice of the uterus in this situation is but little open: it must beviolentlydilated, that is to say, inforcingNature, ordoing violenceto her. Yet this must be done slowly, for too much precipitation would cause to the womanvery acute pains. (To be sure, a slow violence would not hurt her.)
“ReasontheSecond. 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 theman-midwife’swork 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.”
Theadvice 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.
Butafter 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 hisowndiscovery, 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.
Allthe 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 orificefrom 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.
Theorifice of the uterus is always diametricallyopposite 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 intouching, 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, bytouching, 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 amobliged, 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.
Andyet, 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 havebefore 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, andto 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.
Certainit 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.
Inthe 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 determineyou, 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.
Thereader 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 consequentlythe 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.
Inthis 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 anyefficacious 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.
Someof 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 undertakingas 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.
Thesecases 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.
HereI ask of my reader, is such work as this, naturally speaking, the work of a man, as Daventer would persuade us?
Ifthe Monsieur l’Accoucheur is an ignorant, or rather not a very intelligent oneindeed, the mother, or the child, or perhaps both, will probably be his victims.
Butyou 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 saynothing 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?
Butwould 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 theEXTRACTIONof the head of theFœtus, severed from theBody, and which shall have remained in theUterus.
I agreewith 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 therebyto 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.
Somemis-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.
Independentlyof 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.
Thisaccident 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 nolonger 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.”
Thesepractitioners 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.
Messieursde 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.
Nowthough 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 insinuatethe 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.
Someauthors, 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]Dyonisand 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 verylearnedgentlemen, nothing appears to me more impracticable; and, I fancy, if they had ever made the experiment, they wouldhave 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 youBELIEVEyou have got fast hold of it.
Butif 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 methodsI 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, calledpied 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 theSpeculum Matricis[34], of which the use is at once, so detestably cruel, and so perfectly unavailing.The Griffin’s claw however differs from thespeculum 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.
Thosewho 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.
Thehorror 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 ofa suggestion ofCelsus, if but to warn those whom it may concern, not to be too much carried away by the authority of a greatname.
Insuch 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 rightlearned, and especially a very tender expedient?
Mauriceauand Amand giving a loose to their genius have proposed less perilous methods.
Thefirst 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.
Amandhas imagined a silk caul, of net work, to wrap the head in. This caulis 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.
MonsieurGregoire, man-midwife at Paris, has disputed with Monsieur Amand the glory of this invention of the caul.
Butif a reader will deign to consult his own reflexion, upon even these last, less however injurious means than those ofiron 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.
Letit 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 existencebut 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.
Itis 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 bodybut 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.
Mauriceauexplains 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 ofit 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.]
“Thereare (he goes on) however children with so large a head, that itremains 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 thechin. 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.”
MonsieurLevret, who has wrote for no end on earth but to recommend histire-tête,seizes the occasion of the foregoing passage extracted from Mauriceau to tell us, page 51, of the first part of his work.
“Mauriceauacknowledges 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.”
Fromwhence this zealous instrumentarian draws the following conclusion. “Here (says he) is one of those cases, in which myinstrumentmay be of great service.”
Thisconclusion 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, histire-tête, as being absolutely necessary, he continues thus (p. 58.)
“Thoughevery 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 veryeasily; 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.
“Afterthat (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. Levrethere observes, there being a great probability that, when la Motteturned 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.”
Letus 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 beenlingering 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 passagehad 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 thefrænum 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.”
Hereit 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 precautionsthat 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.
Onthe 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.”
Inthe 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 havingtaken 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.
Inthe 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.
WithMons. 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 thensay, 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.
Thepoint 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 easilysee, 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.