Part 19
IT is 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 instrument for 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.
IN short, 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.
ALL due 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.
BUT let 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, in _all_ cases: 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,
“TO me 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.”
THE same Mr. Rathlaw, in the same piece, exclaiming against the use of the crotchets has this remark.
“NO one (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 either at 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.”
PLEASE to 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 had _often_ succeeded well with him: he does not say _always_, and why? most probably because, when he did so _often_ find 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 force an 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 he _often_ succeeded, 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.
“IN short (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 case with 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.”
IF Mr. 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].
ON the 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 pain and danger. Is it possible to inculcate this truth too often or too strongly to you?
“THERE are 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 AM not 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 of crotchets. 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.
ACCORDING then 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 for the better, but what they are he is not pleased to tells us.
THE illustrious 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.”
THENCE this consequence seems derivable, that to obviate these difficulties and dangers, it would be requisite to have as many crooked spoons as there are particular cases, as well as to take measure of the heads that are stuck, which still would imply the introduction of the hand, and, of course, the uselessness of instruments.
MR. Levret, in his notes, p. 377, makes us observe, that the branches of the forceps of Bingius, which are solid, being considerably more crooked than the windowed forceps, the expansion of their middle part must be too wide not to risque, in the extraction, the _tearing_ the perinæum, which it is no such _indifferent_ matter as not to be remarked.
THIS Janckius had, it seems, that bad habit of employing too _soon_ the instrument of Bingius, which is extremely dangerous. This however, is not seldom the case, when Monsieur l’Accoucheur is in a hurry.
BOËHMER, in a dissertation on this subject, thus expresses himself, as to the instrument of Levret, and the forceps of Bingius.
“I shall only observe (says that learned physician) what Mr. Levret has himself very justly remarked, that the application of the forceps is dangerous, unless the head should have already descended low enough into the pelvis for the orifice of the uterus to be effaced, and to make but one and the same cavity with the vagina. This counsel is essential for two reasons;
“FIRST, for fear of hurting the orifice of the uterus which might easily happen without this precaution.
“SECONDLY, on account of the instrument itself, the blades of which could not embrace more than a part, and not the whole of the head, which remaining too high, they could not consequently compress it equally, nor extract it. It is for the same reasons (continues he) that I rather differ in opinion from the celebrated Janckius, who, as soon as the waters are discharged, and he perceives that the head does not pass, has instantly recourse to the instrument.... Some time (says he) should be indulged to the action of Nature.... There is often more success obtained by temporising, than by too early a recourse to instruments.”
LITTLE by little the truth will come out. Little by little, even the men-practitioners themselves, will be forced to allow, that the very least imperfect of the instruments are prejudicial and dangerous: though perhaps they will not speak out the whole truth, and confess that total uselessness, which would, in so great a measure, imply their own. But common-sense will inform whoever consults the light of it within himself, that these instruments are of a nature so heterogeneous, from the service expected from them, so impossible to be adapted to the infinitely tender texture of the organ of gestation, that the very best of them must occasion lacerations, especially by the opening of the branches, the strain of which bears upon the mother’s body, and can never but hurt the child, in crushing it’s head; as they make that to be done precipitately, about which Nature has, for taking her own longer time, no doubt a very good reason, if there was no more than that one of gradually dilating the passage; but there are probably many others.
ART should aim at imitating Nature: now Nature proceeds leisurely, instead of which the forceps goes too quick to work. The action of it depends on an artificial compression, which begins by moulding, or rather crushing the child’s head, adaptingly to the figure of the pelvis, to facilitate its extraction; and though the divine providence has in its wisdom provided for the preservation of the human species, by means of what is called the duramater, and by the void of the sutures in the cranium of children, the manual compression of the instrument is either too strong or too weak. If too strong, the child is lost; the head being so compressed by the instrument, that the brain escapes through the occipital cavity: if it is too weak, so that the head has not been sufficiently compressed, nor it’s bulk competently diminished, in attempting the extraction, not only the uterus can scarce escape the being wounded, but the perinæum and the bladder the being torn: and indeed in either case they hardly escape, the instruments occasioning various inflammations and contusions, of the worst consequence, both in the internal and external parts, besides the great danger of the blades slipping and violently hurting the mother, not to mention the painful divarications and shocking attitudes in order to the introduction.
THE instrument 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 be _concealed_ when not employed as a crotchet, and consequently helped to avoid the having a multiplicity of instruments, as this new-fangled one 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 FIND too 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 MUST not 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 seeming candor, 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 do _very 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, _consummately_ expert in the use of this instrument[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 be _new covered_ with stripes of _washed_ leather, after they shall have been used, especially in delivering a woman suspected of having an _infectious_ distemper.” 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 COME now 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, over all 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_.
BUT to 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 WILL not 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 a manner, 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.”
BESIDES the 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, you feel 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.