Butif the damage in these cases resulting from an unskilful use of the hands should be urged against me: I answer, in the first place, that I am not arguing for any thing but what is to be effectuated by good practice: my point, is only to establish the superiority of skilful hands to the use of instruments: and in these cases, I aver, that even the damages done by the mispractice of defective hands, may be better repaired by sufficient ones, than by a recourse to instruments. How often too are instruments used by such men-operators, as are to the full as unfit to manage such instruments, bad as they are, as somewomen may be to use their hands! But if I could give no better reason for the rejection of instruments, than the abuse of them, even by the numbers of ignorant superficial men-practitioners that employ them, I should not expect to be heard; and yet the great argument against midwives is the ignorance of a few of them: though that ignorance of theirs could never produce such a multiplicity of horrors, of murders, injuries, tortures of mothers, such mutilations and massacres of children, as the deep learning of the instrumentarians!
Myplea then is much more fair. The reader will be pleased to consider, and decide upon his own reflexions, whether, it is not at least probable, from what has been shewn in the cases of the obliquity of the uterus, of a head separate from the body of the fœtus, or even of that reputed most dangerous extremity, the head being hitched in the passage, when the whole body shall have come out, that every thing may be at least as hopefully attempted with the hands alone, as with those instruments, the use of which forms the sole reason fora recourse to men-practitioners; tho’, well considered, nothing could be a stronger reason against such a recourse than their using them. But let us proceed to the next case;
Forthis section it is, that I have reserved to treat incidentally and more at large of the objections to be made in general to all instruments, and in particular to the principal ones.
Amongthe severe labors, which give much trouble, and exact much patience from all parties, from the patient, the midwife, and all the assistence, this case may challenge a place. It is that, in which the head of the child having presented itself foremost, and having ingaged itself half way, or thereabouts, in the streight of the bones of the pelvis, and of the orifice of the uterus, the labor-pains remit, languish, and the progress of the labor becomes suspended. Whether there be any mis-conformation of the bones of the pelvis,or whether (as our practitioners are pleased to express it,) the head of the fœtus be too large for the passage, or whether, in short, both these causes concur to the formation of this obstacle, or exist in complication with other circumstances; it is, in this case, we may say the head is hitched, stuck or ingaged in the passage.
Mr.De la Motte, book the 3d. chapter the 20th, describes this state of the fœtus.
“When(says he) the head has struck into the streight of the passage which, at first, affords a great deal less room than were to be wished, for its letting it pass, the head ingages itself as much forward as possible, from the continual and violent pains the woman suffers, which act upon the child, whose head lengthens and flattens, in such a manner, to adjust and mould itself to the passage, that the hairy scalp becomes quite tumefied, so as to make the head look almost like a double head, which however remains stuck fast between the bones,without being able to get out, and only ingages itself the more the more it advances ... but growing larger as it advances, and the aperture which it obliged to force diminishing more and more, makes it so that the head remains at length so jammed in, that it cannot be drawn out without diminishing its volume, which (as this author says) cannot be executed without instruments: as I was obliged to do, to accomplish the following delivery.”
Mr.De la Motte then proceeds to tell us, that he was called to lay the wife of a laborer, the head of whose child was hitched in the passage. After having well examined the state of the mother and child, and ascertained as much as it is possible to ascertain the death of the latter——“I determined, (says he) to finish the delivery, which I did by opening the head of the child with my incision-knife, and scooped out therewith part of the brain. After which, I made use of my hand, with which I got hold of the inside of the skull, and in an instant drew thechild out, who appeared to have been dead a long time.”
Itis 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.
“Thereis, 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 aresmallenough 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.
Thislast 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 specifyingthem. Dyonis is of the same opinion with Mauriceau.
Thosewho 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 atire-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 thefontanelle, to admit a little round plate of steel of another instrument.
MonsieurSoumain, 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.
Afterthis 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.
Manyother modern practitioners advise the use of one or two crotchets, be the child dead or alive, or of a tire-tête, made in form of strait blades, with spoon-bills, to introduce them one after another into the uterus; and after having placed them on each side of the child’s head, and made them meet together, to try the extraction with them.
Thislast contrivance, as ingenious as it may appear, does not save the child’s life, as all these authors would insinuate. For these instruments, wherever they are applied,must pierce to get a solid hold; without which they could serve for nothing but to crush or lacerate the teguments; so that they should not be used where the child is a live one: and even when it’s dead, the mother is not absolutely safe from the damage they may do, whatever precaution the operator may take, or whatever may be his dexterity of hand. If one of the blades should slip, which frequently happens, it will be difficult for him not to do the mother a mischief. For as to the child, it is very rare that the crotchet does not instantly destroy it.
Menardhas again given us another figure of an instrument, to appearance less dangerous; but the make of it sufficiently denotes its want of power in the operation, which is also confirmed by the testimony of the most celebrated practitioners.
Itis now (1760) about forty years ago, that Palfin, a surgeon of Ghent in Flanders, and demonstrator of anatomy in the same town, went to Paris, and there presented to the academy of sciences an instrumentfor extracting, by the head, children stuck in the passage. Gilles le Doux, surgeon of the town of Ypres, put in his claim to the invention of this curious instrument, which has however been ever looked upon as insufficient, and to have too much bulge, to allow its introduction into a place already so difficult by its being blocked up with the body that requires the extraction. After at least a dozen of corrections of this pretended tire-tête or forceps of Palfin, Gilles le Doux himself corrected it, so did afterwards Messieurs Petit, Gregoire, Soumain, Duffé, and I do not know how many more.
Inshort, one may say, that never did any instrument undergo more alterations than this forceps has done. One of the greatest improvements, according to the opinion at the time here in England, which it received, was that given it by Dr. Chamberlain. Chapman, whose treatise on midwifery is esteemed, to give this tire-tête the greater lustre, tells us, that Dr. Chamberlain kept this instrument a long while a secret; and that the Dr.’s father,his two brothers, and himself, used it with good success. Mr. Boëhmer, public professor of physic and anatomy at Hall, in the Lower Saxony, in the College Royal of Frederic, and of the society of curious Naturalists, from whom I quote this, calls this instrument, I am here speaking of, the English tire-tête, or forceps.
Alldue honor be to the original author of this sublime invention of the forceps, whoever was the happy mortal! happy, I say, according to Dr. Smellie, who calls it a “fortunate contrivance”[36]; though perhaps by fortunate, he rather means its having been so to himself. For hitherto, in all truth, I must own, that I do not find, even by the most exagerated accounts of the learned men-midwives, that those poor instruments of God’s making, the women’s fingers, would not much better, and much safer, do every thing that is pretended to be done by that same boasted instrument, or that can be done by any other human means.
Butlet us suppose for an instant, what both my love and knowledge of the truth would hinder me from granting, that instruments are at some times, and in some sort necessary: in what case is it that they are necessary? this is what hitherto I do not know. And which instrument is it that a man-midwife must use? that is what I yet know less: nor do I believe there is any practitioner so presumptuously silly, as to admit any particular one, as the only one universally received and approved. It will perhaps be said, that according to the circumstances, each practitioner will, out of his bag of hard-ware, pick out that which will be fit for the occasion. But then, a waggon would not carry their whole armory, to calculate not only according to the various alterations made, if but in the forceps, by whim, desire of getting a name, or of increasing practice, but according to the various exigencies and circumstances to which the form of the instrument ought to be peculiarly adjusted. And upon every occasion, there is not the time for inventing, directing,or making a new instrument. But if it is said, that for want of such exactness, the general make of an instrument must do, inallcases: that general make is not at least to be looked for in any of the kinds I have already quoted, by which such numbers of women and children must have been tortured or sacrificed, before they were exploded and given up, as good for nothing or insufficient, even by the men-practitioners themselves, who however substituted no others to them but what were rarely less exceptionable. They were only newer. Let us then now proceed to pass in a summary review the later and pretended improvements of this prodigious invention of the forceps, and candidly examine the validity of their claim over the women’s hands.
Mr.Rathlaw, a famous surgeon of Holland, in his dissertation on the means, or secret of Roger Roonhuysen, which was transmitted to his heirs, for extracting (as was said) in a very little time, a child, whose head should be embarrassed in the neck of the uterus, says thus,
“Tome it appeared impossible, to establish an instrument, whose use should be so certain, so general, so necessary, that one could not be a man-midwife without having a knowledge of it.”
Thesame Mr. Rathlaw, in the same piece, exclaiming against the use of the crotchets has this remark.
“Noone (says he) can be ignorant of it’s being no longer the practice in France, or in England, to employ crotchets, or murderous tire-têtes (would this were truth!) in the deliveries, unless for a monstrous or hydrocephalous head, when the bulk of it is so enormous, that there is no possibility of getting it out whole, and especially if the child should be dead.... In my time, (adds this author) every eminent man-midwife had invented different means of extricating himself out of the plunge of such a case, and their reputation grew in proportion to their respective success. Yet, hitherto, I do not know, that eitherat Paris or at London, they have got such a length, as to take any particular instrument under their protection. Nine years ago, (Mr. Rathlaw continues) I had made a forceps almost wholly of my own invention to extract the fœtus by the head, and it often succeeded well with me. It was, as to its make, a good deal resembling that which Butter describes in the Edinburgh-acts, volume III. art. 20. But mine (proceeds he) seem to possess better proportions, and is certainly of a more handy use, than those which have hitherto appeared.”
Pleaseto observe, that this forceps of Mr. Rathlaw is the same as Palfin’s, or rather as that of Gilles le Doux, excepting only the semilunar hollow cuts in the claws, which Monsieur Duffé, a surgeon of Paris, had contrived in them. The author says, it hadoftensucceeded well with him: he does not sayalways, and why? most probably because, when he did sooftenfind it of service, that was, only whenever there was no sort of occasion for using it at all. Do not let it here be imagined, that I forcean inference. I give my reason. Supposing that such an instrument was necessary to every practitioner, the case for his using it cannot but rarely occur. Now those rare cases where Rathlaw judged his forceps necessary, and in which it failed him, were in all likelihood the true tests of its merit: whereas those other cases, in which heoftensucceeded, may very well be taken for such as, with hands and patience, might have afforded a better account of them, than the silly superfluous quackery of employing a forceps, unless indeed his hands were too clumsy to attempt it. Otherwise the using instruments, where they sometimes do the work with so much more pain and danger, when the bare hands well conducted would do so much better, remind me naturally enough of what I have seen a pretty master do with a steel-instrument called a zig-zag or fruit-tongs, when, to display it, or out of wantonness, he has catched up fruit with it, that lay fully within the reach of his hand. In this piece of childishness there is however no mischief; whereas the man-midwife, for considerations of lucre, dallies with two lives to pluck at a fruit that is never, I repeat it,never, out of reach of the hand, where that steel-instrument of his, a forceps, can bring it away.
Mr.Rathlaw also tells us of another instrument, of which he gives us an account. He had got the secret from one Velsen, a physician at the Hague. This Velsen had it of Vanderswam, who had been a pupil of Roonhuysen, the inventor of this pretended nostrum, with which he always helped the women in labor, snug under the bed-cloaths, the better to conceal his miraculous secret. He had long promised his pupil to discover it to him.
“Inshort (says Mr. Rathlaw) one day that Roonhuysen was returning from laying a woman, a burgomaster of Amsterdam came to speak with him: in the hurry Roonhuysen was to receive him, he hid his nostrum-instrument in some apartment. His curious pupil (Vanderswam) who had for several years been watching such an occasion with great eagerness, found it, and took a draught of it. This instrument was in a casewith two long steel crotchets, and a piece of whalebone, in the shape of a pipe for smoaking, only shorter, and at one of the ends of which was a piece of steel, of the shape of an acorn, and there was no other instrument in this case.”
IfMr. Velsen is to be believed, it seems, on the one hand, that Roonhuysen made the whole science of midwifery consist in the knowledge and use of this his instrument, since it is there said, that Roonhuysen had promised this pupil of his to teach him the art of midwifery, but taught him nothing of it; and indeed it does not appear, that he had hidden any thing from Vanderswam but this wonderful instrument, with which he used, under the bed-cloaths, to smuggle the child through the difficult passage[37].
Onthe other hand again, it may be judged, that this pretended marvellous instrument was not of effectual enough service to its inventor, unless in those cases where he might as well have done without them, since this very same Roonhuysen made use of crotchets, doubtless, when he found his instrument fail him. O women! women! thus it is that your pretious lives, and that of your children (to say nothing of the additional tortures you are put to, as if those of Nature’s own ordering were not already enough) are trifled with, in practices being tried upon you with such instruments, for which you are besides to pay exorbitantly; and all for what? To increase the practice of some quack, who raises into notice his worthless name, or perhaps swells some work of his, published by way of advertising himself, with the rare boast of having delivered you with an instrument, that has only, not murdered some of you, though it may sometimes perhaps have done you irreparable damage, and will have always occasioned you an unnecessary increase of painand danger. Is it possible to inculcate this truth too often or too strongly to you?
“Thereare many people, (adds Mr. Rathlaw) who make a doubt whether this instrument is not the same as that with which the three Chamberlains, brothers, acquired in Ireland and other countries the reputation of being the most eminent men-midwives in the world. In those circumstances in which others employed crotchets, they could, by their manual operation, and with less labor, hasten the delivery of the women in less time, and without the least danger to mother and child.”
I amnot unwilling to believe that the three brothers, the Chamberlains, might pass for the most eminent men-midwives in the world, especially in Ireland, where before there never had, as I understand, been seen any practitioners of midwifery but women. As to other countries, these brothers might very easily surpass in skill those, who knew no gentler way of terminating a delivery than by the means ofcrotchets. Therefore it is that our author adds, that the Chamberlains only made use of the manual operation; he does not add of other instruments. It is a great pity however, that the surgeons of all countries have not yet got hold of, and adopted this marvellous secret of Roonhuysen’s, which would extricate them so gloriously, in their attendance on such difficult labors. They would thereby greatly reduce their armory, from its complex state at present of variety of crotchets, tire-tête, forceps, spoons, blunt hooks, pinchers, fillets, lacs, scissors, incision-knives, and the rest of their tremendous apparatus.
Accordingthen to Mr. Rathlaw, the forceps of Roonhuysen was the same as that of the Chamberlains. How he got the secret from them matters not. He only changed the figure of the blade-parts. In short, our author adds, that to him it seems probable, that this instrument has been brought to perfection by the continual experience of men-midwives, who have successively employed it. He pretends himself to have made some alterations in it forthe better, but what they are he is not pleased to tells us.
Theillustrious Janckius, a great practitioner, mentions another corrected forceps in his dissertation upon the forceps and pinchers, instruments invented by Bingius, a surgeon of Copenhagen, and of their use in difficult labors, printed at Leipsic, 1750, page 211. This forceps resembles mostly that which the celebrated Monsieur Gregoire, senior, first imagined upon the model of Palfin’s tire-tête.
“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.”
Thencethis consequence seems derivable, that to obviate these difficulties and dangers, it would be requisite to have asmany 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, thetearingthe perinæum, which it is no suchindifferentmatter as not to be remarked.
ThisJanckius had, it seems, that bad habit of employing toosoonthe 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 instantlyrecourse 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.”
Littleby 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.
Artshould 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 attemptingthe 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.
Theinstrument used by Mr. Giffard, man-midwife, is supposed by Levret and others to be nothing more than the windowed forceps, of which the use had been long before known. But that appears as unsatisfactory as others. Mr. Freke too, it seems, furnished a new kind of corrected forceps, the chief merit pretended of which was, that the extremity of one of the blades was curved in form of a crotchet, and that this extremity might beconcealedwhen not employed as a crotchet, and consequently helped to avoid the having a multiplicity of instruments, as this new-fangledone might, upon an occasion, serve either for crotchet or forceps.—What a prodigious strain of sublime invention is this of death and wounds in various shapes!
I findtoo that Chapman is blamed, for that, in his essay on the art of midwifery, he very frankly condemns all the tire-têtes he had seen employed till his time by all other practitioners, but he has not, it seems, given a description of the one he himself used, nor doubtless the method of using it, the one necessarily depending on the other. Nor where that author speaks of passing a ribbon over the head of a child, is he so good as to tell you how he managed to get it over.
I mustnot here omit some mention of the forceps, pretended to be improved by Dr. Smellie. Upon which, however, I shall spare the reader a tedious minute discussion of its form, and of its advantages and disadvantages, comparatively to other forceps calculated for the same use. Levret may to the curious furnish sufficient satisfaction on that head. He has examined it with great exactness and seemingcandor, even though he prefers his own to it. Nothing can be plainer, than its being just as insignificant and foolish a gimcrack as any of the rest. But there is one particularity, of which Levret takes notice, that I cannot well omit mentioning. The Dr. has, it seems, whether to spare the women the shock of the gleam from a polished steel instrument, or, whether to defend them from the injury of that metalline chill, which is not well to be cured by any warming at the fire, covered his instrument with leather spirally wound round it. Levret upon this concludes his remarks with the following one. “The ledges or roughness which the leather must,besides increasing its bulk, create by those its spiral circumvolutions, cannot but be such an obstacle to the introduction of the instrument, as to let it be serviceable only in those cases where (N. B.)—one may dovery well without it. For it is well known, than in those cases where recourse to it is requisite, the most polished, the most smooth instrument often finds such great difficulties in its intromission, that nothing but a hand,consummatelyexpert in the use of thisinstrument[38]can, without damage, remove the impediments.”
Dr.Smellie has, however, himself salved one of Levret’s objections to his instrument, as to any offensive smell or infection that might be contracted by the use of it. (Treatise of Mid. p. 291.) “The blades of the forceps ought to benew coveredwith stripes ofwashedleather, after they shall have been used, especially in delivering a woman suspected of having aninfectiousdistemper.” Certainly, certainly, not only the Doctor’s nine hundred pupils, but all other practitioners, that use this famous instrument, will do well to observe this injunction. It is the very best thing they can do, next to never using it at all.
I comenow to the boasted instrument of Levret; who is the last, at least that I know of, who has invented a new make of a tire-tête, or forceps corrected, overall that have appeared since Palfin. He gives us, in a book written on purpose to recommend it, a minute analysis of it, and an ingenious delineation in some pretty prints of it. The work is intitled,Observations sur les causes et les accidens de plusieurs accouchemens laborieux.
Butto make use of the instrument or instruments which Levret recommends, requires not only a hand consummately dextrous and skilful in the art, but an infinite number of perplexing precautions, as may be seen, p. 106, and seq. of his observations.
I willnot here undertake a circumstantial account, I shall content myself with mentioning some of them.
“There is here (says our author) a very important remark to be made, when you are for using this forceps. It is absolutely necessary that the orifice of the uterus should be, as it were, totally effaced or erased, that is to say, that the vagina and the uterus should, in amanner, no longer form other than one and the same cavity, from a sort of uninterrupted continuity, because, without that, there would be a danger of getting hold of the orifice of the uterus between the head of the child and the instrument, which would be extremely hurtful.
“I ought(continues he) to add, that great attention should be given to the attenuation of that orifice, for before it’s intirely disappearing, it becomes sometimes so thin, and so exactly close fitted to the child’s head, that, without a most scrupulous examination, one might commit a mistake.”
Besidesthe measures, observations and remarks this practitioner urges in that place, which require infinite attentions, he adds to them the following ones.
“First, when you introduce the instrument you are never sure of being in the uterus, but, when, besides the precaution I have above recommended, youfeel that the axis of the instrument, or the extremity of the branches, is in a kind of vacuum. This sign would I own be a very equivocal one, for a person that should use this forceps without having practised surgery[39]; but so it will not be for him, whose sense of the touch is habituated to the feeling of instruments of different sorts, as they enter into empty cavities of vessels or of hollow organs, or in short of any cavity.
“Secondly, when by drawing towards yourself the instrument, you are assured of the preceding sign, you will feel a small resistence to a certain degree.
“Thirdly, the blades of the instrument should suffer themselves to be opened out with some sort of ease, and what is opened out should not make resistence enough for the blades to return with any violence to the place whence the opening out began.
“Fourthly, the blades in the instrument should, as they open wider and wider, rather tend to augment the diameter of the void of the instrument than diminish it.
“Fifthly, these same blades should, in their expansion, go a little depth in the vagina.
“Ifthe man-midwife, (says Levret) perceive, thatanyof these favorable signs should bewanting, he ought tomistrustthesuccess, and to have recourse to hissagacityfor the remedying it.”
Thusfar as to the handling this forceps of Levret’s, to whom the defectiveness of the English and French forceps had inspired an idea of providing such a supplement to it, from the richness of his own invention.
I donot wonder however at no instrument pleasing Mr. Levret so well as his own. Nothing is more common among the instrumentarians, than their disagreementabout the make of their instruments. Some will have their forceps long, others short, some strait and flat, others curve: in short, there is no adapting the mechanism of it to their various fancies, so apt too as they are to change. Levret complains bitterly of the inability or injustice of the instrument-makers; but by what I believe of them, very unjustly. The gift of the fault is not in the instrument; it is in the use to which they are so often put of attempting impossibilities.
Butnow let us examine, what surely very competent judges have thought of this famous new forceps of Mr. Levret, which he callshisinstrument.
Whenthe book and instrument were presented the Royal Society at London, it appears by a quotation inserted by Mr. Levret himself, that his instrument was allowed to be ingenious enough, but that “there wasnothing extraordinary in it.”
Pagethe 10th of his preface, he has the candor to own, that he does not absolutelypretend that success will always attend its application, even in the cases he points out.
Pagethe 36th, and seq. of his observations, after having exploded the forceps, and other instruments of the authors who have preceded him; and after having described the alterations and corrections made in the English and French tire-têtes, he gives us indeed the better opinion of his, by a fair confession of the insufficiency of them all without exception, and even of his own: by which, however, it is plain, he can mean no more than that, imperfect as they are, they all are still preferable to the hands alone; but the question of this superiority is as constantly as it is shamelessly begged by him, and all his fraternity of instrumentarians.
Thushowever he expresses himself as to his own instruments. “This instrument is actually, to all appearance, now at the very utmost degree of perfection, to which it is possible for it to arrive, without however having all the perfectionthat might be wished, for the most expert practitioners in the use of it, agree in the opinion.
“First, of the difficulty of its introduction in certain cases.
“Secondly, of its stubbornness as to the crossing of the blades.
“Thirdly, of its contributing totearthefourchette, orfrænum labiorum.”
[Ourauthor is very angry, that Boëhmer, who, in his critical objections, opposes those his own words to him, has not added the subsequent lines.]
“Thecorrection I have made in this instrument (continues Levret) by means of the shifting axis, has rendered the difficulty of crossing the bladeslessconsiderable, and the two following reflexions may servegreatlyto overcome the other two inconveniences.”
Butshould it be granted to Levret, that the shifting axis somewhat lessens the difficulty of crossing the blades of this instrument, it would still remain too great an one, for all that correction. The reflexions he adds, for the overcoming the other two inconveniences, carry no conviction with them; and indeed he himself seems to think so, by his adding afterwards (p. 99.)
“Toobviate this inconvenience of tearing thefourchette, or the perinæum, I caused to be made acurveforceps, as to any thing else not differing, in its dimensions, from the first. I took the idea of it from the curve pinchers used in the operations of lithotomy. It will be easier to conceive, than for me to describe the advantage it must gain by it. That was not however the only end I proposed by it, as all the good practitioners at present agree on thesmallefficacy of the common forceps, in the case of a head stuck in the passage when the face is turned upwards.”
Itis in consequence of this opinion that Levret, in the sequel to his observations, p. 301, tells us.
“I could(says he) answer Mr. Boëhmer, that all the most eminent men-midwives are convinced, that when the child presents with the face upwards, or turned forwards, that is to say, towards the os pubis, and that in this position, the head sticks, the forceps commonly used can be ofnoservice: I do not (adds he) even except the one I have had made with a shifting axis. The defectiveness of these instruments, in these particular cases, sufficiently proves, I should think on one hand, that the English forceps is not so good as Mr. Boëhmer seems to believe; and on the other, I presume, he will be convinced, that I am not more servilely attached to my own productions, than those of others.”
Thisinsufficiency then of the common forceps has given rise to the curve forcepsof our author. Here follows what he further adds to what I have above (p. 427) quoted from page 99 of his work.
“Theform I have given to my forceps, renders it then very useful, since, by means of the curve, it lays holds of the head with all the efficaciousness that can be found in the use of the common forceps, employed on the most advantageous position that the head can be imagined.... Notwithstanding all the corrections made in the English and French forceps (continues the other practitioners) if my instrument is compared to all the other forceps it will appear;
“First, that it has none of their faults.
“Secondly, that it is very feasible with it to extract the head of a child separated from the body and remaining in the uterus. This is so possible, that all those who have seen my instrument, are unanimously of opinion, that no other forceps can do as much.
“Thirdly, 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.
“Fourthly, my instrument has this in common with the ordinary forceps, that it can extract a child by the head, when this part shall be stuck in the passage.”
Itmay well be said here, that Mr. Levret attributes such excellent qualities, and marvellous properties, to that same new forceps of his, as ought to immortalize his memory, and render his forceps universal over the whole earth,—if they were but proved. Ay! there lies the difficulty. Messieurs Rathlaw, Boëhmer, Janckius, and the most notable practitioners in England, do not believe a syllable of the matter. Even Dr. Smellie, though I think he approves the crooked part ofthe forceps, speaks slightly enough of it, and has even dared to falsify the inventor’s assertion of the ne-plus-ultra of it, by altering the form, as he tells us, p. 370. “in a manner that renders it more simple, more convenient, and less expensive.” Mr. Levret cannot then expect we shall take these advantages for granted upon his own bare assertion, in the blind enthusiasm he manifests for this rare production of his genius. I do not so much as believe, that he was even himself, at times, clearly persuaded of its excellence. At least he, in several places, appears to contradict himself. As it is then greatly of use to show into what a maze of errors these are capable of falling, who neglecting the guidance of judgment in the road of truth, wander into the wilds of imagination, I shall just point out here some of Levret’s, at least, to me, seeming inconsistencies with himself, but especially with plain reason and common-sense. The reader will find the notice I take of them far from digressive, serving as they do even for connexion, as well as enforcement of my arguments.
Mr.Levret, p. 161, concludes the first part of his observation thus.
“Nota, some very intelligent persons have been pleased to charge me with an opinion, which I have never had as toCURVE 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.”
Herethe 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 theuterus.”——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.”
Nowthese 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.
Iftherefore 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 denywhat 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 amhere to observe, that if I have made use of the terms of “a head notseparated 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 bodycome 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.)
Herefollows 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.
“Thereis, says he, a general precept by which it is established, that a surgeon ought never to thrust instruments into deep places, without guiding orconducting them with the hand, or with the extremity of the fingers of that hand that does not hold the instrument.”
Itis 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 exceptionto 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 sillyCURVE FORCEPS! Yes; it is by way of trying practices with that same instrument, that the patient is liable to bespread 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.
Inthese 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 withinhimself 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.
Thisbrings me to this case particularly, the title of which is prefixed to this section, that of a head stuck in the passage, which the gentlemen-midwives may perhaps second Levret, in maintaining to be an exception to that admirable axiom above quoted, and maintain it purely, in evasion of the conclusion against their miserable instruments, which I aver need neverbe resorted to, nor never are, but for want of sufficient skill in the manual function to terminate such labors without them.
I answerthen to these instrumentarians, that an instrument, even, no more dangerous than a probe, would in so tender a place as I am treating of, not perhaps be quite enough exempt from a possibility of doing mischief, to deserve an exception: but as to those instruments, which are so palpably likely to hurt both mother and child, to injure, in short, or even to destroy both the mould and the cast, they are all of them within the case of exception, or rather exclusion. It is then, in knowing what to do, and in the faculty of operating with the hand according to that knowledge, that the art of midwifery principally consists. If instruments are deemed ingenious, the doing without them is surely not less so.
Nowas to the case proposed in this section, that of a child’s head stuck in the passage, I aver, that it is not absolutely impossible to terminate this delivery by the hand.
I ameven ready to demonstrate this before any competent judges. I speak by experience. I have hitherto executed with all desirable success this operation without any aid but that of the hand, with a little patience and proper assiduity. I have many and many a time seen it practised at the Hôtel Dieu, and elsewhere. I never in my whole course of practice saw sufficient reason for attempting so hazardous an extraction, as that which is executed by means of a tire-tête. Why then those needless terrors, those superfluous tortures with instruments, to women already in too much pain and anguish? care enough could not be taken to spare those of the weaker-nerved sex in that condition such horrors, the very idea of which, to say no more, is enough to put them into imminent peril of their lives. All the forceps, and the rest of the chirurgical apparatus, especially the more complex instruments, very justly frighten the women, and their friends and assistents for them. Their introduction requires at once a painful, a shocking, and a needless devarication. The patients areput into attitudes capable of making them die with apprehension, if not with shame, from that native modesty of theirs, which, in these cases, may however be pronounced rather a wise instinct than a virtue.
Howmuch preferable is the true midwife’s practice, who will have oftenest prevented, by her knowledge and skill, this very situation! That is to say, if she has been called in time. She knows how to predispose the passages, and by gentle reductions to restore Nature to her right road, where she has been through mispractice driven out of it, or through negligence suffered to deviate from it, or not preventively watched.
I havenever but seen, with respect to the uterus in this case, that it was possible to insinuate first one finger, then another, and little by little the whole hand, not indeed a hard hand, as big as a shoulder of mutton, the hand of some lusty he-midwife, but of a midwife, such as it is commonly seen.
WhenNature does not proceed as could be wished in her labor-pains, the point is then to husband well the strength of the patient, to restore it where it fails, by giving her good broths and corroboratives, that do not heat, or cooling things, where heating ones have been injudiciously administered. She is then to lie as composed and tranquil as possible; to be cherished, comforted, inheartened. There is, humanly speaking, no fear but her strength will return; her pains must not be irritated, nor herself harrassed with ineffectual interference. Nature will come to herself again: the situation will, by her benign energy, change for the better, and become favorable enough, for the midwife to be able to assist her in the due time with a manual operation, that will terminate happily her delivery. It is at least, with this success, that I have delivered many, who, by the unskilfulness of those who had attended them, at the beginning of their pains, had been reduced to a deplorable condition, by their labor lingering some for upwards of six days.
Inshort, it is extremely rare that this case of a head stuck in the passage ever happens, unless under the hands of unskilful practitioners, or of over-dilatory or neglectful midwives, who will not have duly attended to the prognostics of this event; who will not have watched and taken the benefit of the favorable critical moment; who give the head time to engage itself, or get fast jammed, for want of their removing the impediments to Nature’s doing the rest, or when help has been called or come too late. It may also be owing to those who hasten too much, who precipitate the women’s labor by forcing draughts, that heat, burn them up, exhaust their strength, and prematurate the coming on of the labor-pains. Some practitioners fatigue them, with making them walk, or keep them up too much.
Butwhen the membranes are not too soon pierced and the waters let out, when the pains are not provoked, when time is given to Nature to form to herself a passage, not omitting the precautions I havesummarily intimated; when due care is taken to procure all possible ease of body and mind to the patient; who may vary her posture, sometimes lying along, sometimes sitting up, or well supported when she walks: little by little the head will frank itself a passage with the weight of the body acting by an innate energy, and with a little due assistence of the midwife’s art: and with this practical advertence, that, in these arduous cases, much may be safely left to Nature, but not every thing. There are times in which she cannot bear neglect, but there are none in which she can bear extreme violence.
Herethe reader will not expect I should in a treatise, purely calculated to expose the abuses of midwifery, attempt to particularize either all the contingent cases, or all the modes of operation in them. That would require a work a-part. I shall only then, to the four principal cases, in which instruments are so falsely supposed necessary, add a summary account of that of apendulous belly, which is not without its difficulty.
Asto aPENDULOUS BELLY, madam Justine, midwife to the Electress of Brandenbourg, remarks, in her Treatise of the Art, that she knows, by experience, that some children turn upon their heads with their feet upwards, in women who have a large and prominent abdomen; because, says she, they are pitched too much into the fore-part of the belly, that is become pendulous. But she does not explain the consequence of this situation, which however does not fail of causing a severe and troublesome labor; in that the uterus being fallen into the capacity of the hypogastrium, and the child being got above the os pubis, there it sticks, and the labor-pains are ineffectual, if proper assistence is not given to Nature.
Thepractice which my success on experience encourages me to propose is, to have the patient lye on her back, the belly to be braced upwards with a large linnen-fold or roller, to reduce the uterus and fœtus to its better position in the capacity of the pelvis; but if, notwithstanding thathelp, the head of the child continues to rest on the os pubis, the finger must be insinuated between those bones and the head, in order to make, it, little by little, retrograde into the pelvis towards the coccyx.
Inevery case then that can be imagined, so far as my own experience and observation have reached, I am authorized to aver, that the gentleness of the manual assistence to women is at once more agreeable to Nature, and more salutary than the violence of the instrumental practice; which not only conveys the idea, but the very reality of a butchery. While its being sheltered under the plausible pretext of tenderness and pious regard to the safety of the poor women and children, cannot but provoke the greater indignation, at seeing vile interest trifling thus wantonly with their lives, and add to the cruel outrages on the human person, the greatest of insults on the human understanding.
Itcannot however have escaped observation, that while I am, with the utmost regard to truth, endeavouring to recommendthe preference of the hands to instruments, there is nothing I mean so little, as that some deliveries may not be accomplished by instruments, and especially by that divine invention of the forceps. What I presume to exclaim against, is the needless torture to the mother, the needless increase of danger to which she and her child both are exposed, for the sake of that practice being tried upon them, with those instruments, when the bare hands would be so much more safe and effectual. I could myself, no doubt, in many cases, if I could be inhuman and wicked enough to dally with any thing so sacred as the health or life of a woman and child, in some measure, entrusted to me, give myself the learned air of delivering with aCURVE FORCEPS. But in the very same cases, though at the hazard of being called ignorant for my pains, I would always be sure to do it more cleverly, less dangerously, less hurtfully, with only my hands. So that, without straining any comparison, the forceps may deliver indeed, but how? Why just as a man may, if he chuses it, hobble round St. James’s Park, on a pair of thoseartificiallegs[41]called stilts, when one would imagine, that the mock-elevation from them could scarce atone for their uncouth totteringness, and that he might full as well deign to use his ownnaturallegs.
Inthe slighter cases then, that is to say, in those cases, where it is a jest to doubt of the hands not being the preferable instrument, since they may be truly averred to be so even in the most difficult ones, instrumentarians commonly go to work,only(please to mind thatonly) with the forceps. So that it isonlyin those slighter cases, where, once more nothing is more certain than that no instrument is wanted at all, that they find matter of triumph over their predecessors in theory and practice, over common sense, and especially over humanity. And this is that amazing, thatFORTUNATE IMPROVEMENT, the superhuman invention of the forceps, the philosopher’s stone of the modern art of midwifery,found out by the male-practitioners. Yet, after all it plainly appears, that even themselves do not rely on it in the more difficult cases. They are then obliged to return to theoldcrotchet, or the like methods, which bad, very bad, and very inferior to the hands as they are, never however are supposed to be resorted to, without an appearance of extremities to afford some color, some plea of humanity to employ them, in a kind of dernier resort, to prevent a greater evil by a less one. Whereas, when the forceps is used, the cruelty of that torture it cannot but create, must be greatly aggravated by the consideration of its being perfectly needless. But in the case of using either crotchet or forceps, or indeed any instruments at all, the truth is, that besides the increase of danger and pain they bring, to the already too much afflicted patients, they defraud them of the more efficacious, less painful, and especially more safe help of the hands alone.
Theinstrumentarians all then agree on that insufficiency of this precious forceps, which occasionally compels their recourseto the crotchet so detested even by themselves. Levret, for example, confesses this, p. 24, of the appendix to his observations.
“Thecrotchets (says he) are, generally speaking, instruments, the very sight of which shocks and terrifies: but notwithstanding the repugnance which allgoodmen-midwives ought to have to the using of them, there are cases in which there is no doing without them.”
Nowin these cases, that of the monster with two heads[42], is not meant to be included, as Levret himself afterwards explains himself. If then there are such cases as necessitate a recourse to crotchets, it will, I presume, be allowed me, that they can be no other than those which render the delivery the most laborious. What those cases are, I have, from after the instrumentariansthemselves reduced to the four capital ones, I have above set forth, without reckoning the pendulous belly. At least I know of no other situations than those, that can produce the very severe labors, nor do I believe that the instrumentarians know any other, or they would tell us so. Now if, in the more difficult of those cases, there is no doing without the crotchet, what becomes of the prodigious merit of the forceps, so insignificant in cases of the greatest need, and so superfluous in those others, where there being no occasion at all for it, it must be the most inhuman wantonness to employ it?
Herecan you be with too much insistence desired to observe the solemn banter, in such a matter of life and death too, of these kind, tender-hearted modern instrumentarians! they are so transported with stark love and compassion to the poor women and children, that they do not know what they are about; they fall into the most palpable contradictions, and would have even Hippocrates, and the antients, appear as so many bloody-minded Cannibalscompared to them. Hippocrates, it seems, and the antients, according to the best of their apprehension, in points of midwifery, prescribed the crotchet, in no case however but where the child was certainly dead, which, by the by, is next to the not prescribing it at all, since the ascertainment of that death is scarce not impossible. So because they recommended this practice in the last necessity, the ingeniousness of the modern instrumentarians was “[43]stimulated to contrive somegentlermethod of bringing along the head” —— without any necessity at all; that is to say, in the minor difficulties, for the crotchet of the old practice is, to this instant, even with them, left in possession of the greater ones. Thus was produced the forceps, that prodigiously bright refinement upon the dull antients, and goes on improving without end under the wise heads of our gentlemen-midwives. But if the modern Genius of arts and sciences has no better improvement than this to boast over Hippocrates and the antients, may the instinctof self-preservation defend mothers, and, in them, their children, from being the trophy-posts of their victorious atchievements! may the midwives continue in their happy ignorance of their curious devices! may they ever preserve a due aversion from indeed all instruments whatever! for they are all needless and pernicious substitutes to the hands. May none of them, especially in any labors committed to their conduct, prove so criminally false to their sacred trust, as through negligence, or through an interested designing reliance upon instruments, to repair their failures or mispractice, slacken their attention to their duty, or afford, by their defective performance, an excuse, though a fallacious one, for resorting to instruments, when skilful hands are incomparably more fit for a remedy or retrieval!
I cannotthen too ardently wish, for the women not to be so cruel to themselves, and to their so naturally dear children within them, as inconsistently to suffer their aim at superior safety, to be the very snare that betrays them into the greaterdanger, and often worst of consequences, from those male-practitioners, to whom that aim drives them for recourse; while that examination they owe to so interesting a point would issue, or deserve to issue, in rescuing them from such a shameful subjection of body and spirit to a band of mercenaries, who palm themselves upon them, under cover of their crotchets, knives, scissors, spoons, pinchers, fillets,terebra occulta,speculum matricis, all which, and especially theirtire-têtes, orforceps, whether Flemish, Dutch, Irish, French or English, bare or covered, long or short, strait or crooked, flat or rounding, windowed or not windowed, are totally useless, or rather worse than good for nothing, being never but dangerous, and often destructive.