MIDWIFERY. 



JS9 



HUtorj . he communicatetl at least part of his secret to Roger 



, mm' Itoonhuyscn, from whom it passed to Ruisch and others 

 as a nostrum ; nor was it revealed till 1753, when De 

 :cr and Van de Poll purchased it, and made it 

 public. It was long afterwards in repute under the 

 name of the Lever ; but ha* now deservedly lost 

 ground. It would appear that Chamberlain used both 

 th* lever and the forceps ; but whether he only reveal- 

 ed the former to Roonhuysen, or had not then employ- 

 ed the forceps, is uncertain, and unimportant in the 

 annals of quackery. Of late, a discovery has been made 

 of the original instruments, in an old building in Essex, 

 where, in the floor of a closet, a door was perceived 

 with hinges. This being opened not by Mrs. Rad- 

 diffe, but by a sober matter-of-fact-man there was' 

 found neither blood-stained armour nor mysterious 

 parchment, but some rusty instruments of three diffe- 

 rent descriptions, a lever and two pair of forceps, one a 

 little more improved than the other. Soon after this 

 time, other practitioner', both in Britain and on the 

 continent, etnplnved i:n:!.ir instruments ; but it was not 

 for many years afterwards that a description of them 



>" was made public. Dr. IVnman. in a very desultory 



'i which ' I to his work, and 



r unlike that work, say*, that Dr. 



Chapman first 1 the forceps in the Edinburgh 



, but he cannot have read these 



essay-, for it H Mr. Btttlw who there gives a plate of 

 the instrument he had seen in Paris, whilst in the end 

 of the volume Chapman is criticised for not depicting 

 his forceps. This lie afterwards did. He is reported 

 to have been the second person who taught midwifery 

 in this kingdom. Mm dray, about ten years before, 

 the first time as a lecturer ; but is chief- 

 ly known for his opposition to the use of instruments. 



'<; C. Soon after Chapman taught, Dr. Smellie came for- 



ward, and gained deserved reputation both as a practi- 

 tioner and teacher. He published, 1752, system, 

 which, although unimportant now, was long the ele- 

 mentary work consulted by all students, and to this he 

 afterwardi added two volumes of cases, and one of 

 plates. He gave distinct rules for using the forceps, 

 which he improved in their construction. He did not, 

 however, carry their utility far enough ; for he is found 

 still advising the old mode of turning when the head is 

 not fixed. In htclass he made considerable ue of ma- 



<; and, if we may credit hit * 



IM endeavoured to condense his information, so as to 

 suit all purses as well as all capacities ; fur he is said to 

 have hung out a paper lantern with these words, " Mid- 

 wifery taught here for five shillings." 



-ttret. About the same time, I.evret, in Paris, acquired high 



i.not only ion and improvement 



of the fon-fpi, but for his general knowledge of mid- 

 wifery. His observations on uterine hemorrhage, con- 

 sidering the state of vience at the time, are admirable 

 and important. Accoucheurs have made a distinction 

 of flooding* into those arising from detachment of the 

 nu sstoim l, or part of the placenta which is properly 

 situated, and those produced by the placenta being at- 

 tached in a greater or less degree to the os uteri. In the 

 former case, Puzos advised the membranes to be rup- 

 tured, in order to excite contraction of the womb. 

 In the latter, I.evret decided that nothing but delivery 

 could be useful. By blending these two works, i 

 afterwards compiled a treatise on the subject ; but the 

 opinion now of every judicious practitioner is, that in 

 all case* of flooding requiring manual interference, that 

 ought to ru'uit in - as soon as it can safely 



be accomplished. This is subject of very peculiar im- 



portance, and it is necessary that the practitioner History. 

 make himself well acquainted with the principles of ' ' ' 

 conduct, and act with promptitude and decision. 



Dr. Hunter appeared also on the field about the Hunter, 

 same time; for he came to London in 1741. His ta- 

 lents, his general learning, his professional knowledge, 

 his zeal and industry, together with a good manner, 

 introduced him into extensive practice. His obstetri- 

 cal works consist of the anatomy of the gravid uterus, 

 illustrated with very splendid plates, and a descrip- 

 tion of the rctroversion of the womb. He added to 

 his anatomical lectures a few on midwifery, which it 

 is much to be feared have done essential injury to the 

 profession and the community. Patience was his ad- 

 vice in most cases, and an almost unbounded reliance 

 on the power of nature formed the basis of his prac- 

 tice. That much good sprung from his admonitions 

 to avoid irritation and the use of stimulants in natural 

 labour, is unquestionable. But it is equally true, that, 

 when assistance is necessary, patience becomes an- 

 other name for negligent procrastination. It is not to 

 be credited how many women and children are lost by 

 too great reliance on the power of nature, and a re- 

 prehensible delay in having recourse to the assistance 

 of art; and with the hii;Lc-t respect for the memory 

 of Dr. Hunter, the writer of this article remains con- 

 vinced that his authority contributed greatly to intro- 

 duce and ttipport that passive conduct which is too 

 often pursued in protracted labour. The directions of 

 the late Dr. Oaborn on this subject, which sprung from Otboni. 

 the school of patience, cannot be read without asto- 

 nishment, and the deepest regret ; and the consequence 

 of this system of delay is, and must be, that in many 

 instances, although the child be at last expelled, it is 

 born dead, and the mother soon follows; or instru- 

 ments are at last used, when they are less likely to 

 save both parties than if they had been employed ear- 

 lier, whil.it, in all, the patient suffers more pain by this 

 supine conduct than she would have done by more 

 vigorous practice. 



It unfortunately happens, that in some instances the 

 pelvis is so contracted^ or deformed, that by no me- 

 thod can a living child be brought through it. In 

 such cases four different methods have been proposed: 

 lit, To open the head, and fix a hook or crotchet on 

 it, and then draw down the cTiild. .'</, To make an 

 incision through the skin and muscles into the womb, 

 and thus extract the child alive. This is called the 

 Canswean operation. 3d, To divide the joining of the 

 bones of the pelvis in front, and thus endeavour to 

 enlarge the cavity through which the child must pass. 

 I/A, To induce premature labour. It is not necessary 

 to enter here into any critical examination of the com- 

 parative merits of these different methods. It may 

 only be observed, that the chief point of controversy 

 is, whether the crotchet or the Grsnrean operation 

 should be preferred. In this country the former is 

 always resorted to when possible, and the latter is 

 only performed in extreme cases. These, it may . 

 therefore be expected, can seldom prove successful ; 

 and, as if the condition of the patient were not a suffi- 

 cient source of danger, it is seldom performed till she 

 has been some time in labour, and perhaps consider- 

 ably exhausted. This has arisen from the same cause 

 which has been already so strongly reprehended. It 

 surely may be early ascertained in such extreme cases, 

 that the pelvis is too small to permit of delivery by 

 any means through it ; and delay, after this is known, 

 is adding to the hazard of an operation which require! 

 no additional risk to render it formidable. This delay 



