COOPER AL

SAN FINGISCO, CAL

and is not to be removed from the

by czy person or
whatever.

CHAPTER XV,

OF THE FORCEPS.

"BUT yf all these medicines profite not, then must be used more severe and hard remedies, with instruments, as hokes, tongues, and such other thynges made for the nonce. And fyrst, the woman muste be layde along upright, the middle part of her bodye lying hier then all the rest, companyed with women assisting her about, to comfort ber and to kepe her downe, that when the byrth is plucked out she rise not withall. Then let the Mydwyfe annoynt her lefte hande with the oyle of white Lillies, or other that may make it soople and smothe, and holding out her fingers, shutting together her hand, let her put it into the Matrix to feele and perceyve after what fashion the dead byrth lyeth in the Mother's wombe, so that she may the better put in hookes and such other instruments to plucke it out withall."

"Yf it be that it lye the head forwarde then fasten a hooke eyther uppon one of the eyes of it," &c. &c.

The above quotation from the "Woman's Booke, or the Byrth of Mankynde," may serve to show the Student what notions of Midwifery were entertained in the glorious age of Queen Elizabeth. Thomas Rainald, the author of this quaint old English, is the earliest English author on Midwifery. The volume from which I have made the extract was "imprinted London 1565," 4to. It consists chiefly of a translation from Rhodion. Let the Student be thankful that, in the age in which he lives, he is not foreordained to the use of hooks and other such instruments in difficit cases, for, in modern times, the resources of the obstetric art have been signally augmented by the discovery, and by the great perfection attained in constructing and using instruments for the forced delivery of the parturient woman. The ancients were not wanting in numerous inventions for expediting the birth of children, but, unhappily, all their instruments were constructed with the sole view and intention of being useful to the mother, and had no applicability to the child, except to extract it after depriving it of existence, or even to draw it forth from the womb still palpitating with life,

and presenting the most shocking spectacle of mutilation and distress. The Uncus, or Crotchet, described by Celsus, continued, indeed, to be the model of obstetric instruments down to the close of the seventeenth century, when a happy thought resulted in the construction of an apparatus most perfectly adapted for the security both of mother aud child, and which, at the present day, and in the hands of skilful and well-instructed persons, may be considered one of the greatest triumphs of art in behalf of suffering humanity.

Perhaps one of the ideas that would most readily and spontaneously present itself, in a case of difficult labor with a head presentation, would be to take hold of the head and draw it forth; and I believe that most of the good women who so assiduously exhort us to help our patients, • actually do believe that we can take hold of the child's head with our fingers, and draw it into the world as readily as we can draw a dollar out of a purse, or take an apple from a basket. But we cannot take hold of the head and pull it down, simply because we cannot grasp an infant's head in the hand: we can apply the fingers to one side, and a thumb to the other side, and press it between them; but when we attempt to pull the head down, we find that the fingers and thumb are not long enough to admit of our grasping it; and we withdraw the hand, leaving the head just where it was before we made the foolish attempt, and the woman so much the worse for the additional irritation.

This attempt during the lapse of centuries, must have been made many thousands of times, and always with the same result; and the idea of extracting it with a pincers or forceps, sufficiently large to grasp the head, must also have presented itself for ages; but how to apply the forceps? A straight forceps could not grasp the head, for it would slip off, as if wedge-shaped; while to make the forceps curved, so as to grasp the head, would render it impossible to introduce it, since the forceps must first enter closed into the genital fissure, and then expand considerably to pass over the parietal protuberances so as to grasp the head when carried upwards far enough. It could not expand sufficiently to go over a head large enough to occupy with its own bulk the entire capacity of the excavation. Such, in fact, was the forceps of Palfyn, and such must have been the instrument spoken of by some of the Arabians. No forceps that could be got on to the undeli vered head had been discovered; and in all cases, where the child could not be pushed back and turned, or where the head became permanently arrested, the medical people were obliged either to let the mother and her offspring perish together, or they unscrupulously sacrificed the child, to insure the escape of its parent. Our ancestors consoled themselves with a quotation from Tertullian to the following

effect: "Atquin et in ipso adhuc utero, infans trucidatur necessariâ crudelitate, quum in exitu obliquatus, denegat partum, matricidus qui moriturus." Barely to look over some of the plates representing the obstetric instruments employed previously to the discovery of the modern obstetric forceps, is sufficient to produce a shudder in any one familiar with the difficulties met with in parturition; and the griffin's claws, sharp crotchets, and tire-têtes, which were the boast of their inventors in a barbarous age, serve but to set forth more signally, by comparison, the eminent usefulness of the modern instrument to which we are indebted for our own escape from the necessity of employing such means as were familiar and commonplace with our predecessors.

The great desideratum in Midwifery was a forceps that might seize the head and extract it without inflicting a wound; and we are indebted for it to a Doctor Paul Chamberlen, who practised Midwifery in England towards the close of the sixteenth century. He constructed, probably with his own hands, two curved pieces of iron, which, being introduced separately, were applied one to the left and then one to the right side of the head, and united by a pivot-joint, by means of which the two separate pieces were converted into a pincers, or forceps, the handles of which crossed at the pivot or joint, and thus made the blades become capable of grasping and firmly holding the egg-shaped head of the child, while still contained in the vagina. As the handles crossed each other, and were secured by the pivot, which passed through a drilled or mortised hole in the joint, it followed that when the outer extremities or the handles were pressed towards each other, the head was firmly grasped betwixt the blades or clamps. The compressing or holding force being duly applied, a sufficient degree of extracting power enabled the Surgeon to draw the head forth from the passages, and the child was born without experiencing the smallest injury. In inventing this instrument, Chamberlen happily combined the ideas of a cochlea or blade, a junctura or lock, and a manubrium or handle; and it is surprising, seeing how simple, how manageable and how powerful is the apparatus, how beneficent and desirable, that so many centuries were allowed to pass over the records of medicine before the discovery of this method of conducting difficult labors with safety to the child. For centuries, the perforator and crotchet were the mother's instrument. The child's instrument, or forceps, was reserved to honor the seventeenth century by its invention.

This great discovery, the value of which is known only to medical men, would have entitled its author to the everlasting gratitude of his fellow-creatures, had he not tarnished his fame by shamefully making a secret of what ought to have been instantly promulgated for the

general use of all who should stand in need of its merciful interven. tion. But the spirit of the age, or perhaps his own venal spirit induced him to confine the secret to his own breast, to be communicated, at length to his sons, who were instructed in the mode of its use, and are supposed to have drawn large profits from the necessities of the unfortunate women who, knowing their superior skill, were compelled to seek for safety at their hands only.

Little is now known of these persons except their names; and they have deservedly sunk into the comparative oblivion that ought to overtake all those who, having by accident or by genius, come into the enjoyment of facilities that ought to be the common property of humanity, instead of divulging them, and spreading their use and employment as far as the want of them extends, are induced by a sordid thirst for gold to retain them within their own hands, and sometimes inhumanly permit the secret to perish, rather than give it all the publicity and currency its importance entitles it to. Such is the spirit of quackery or empiricism under whatever guise or in whatever art; and the fate of the Chamberlens, whose history is almost for gotten already, is but a just retribution for their base reservation of so valuable a secret.

There is a curious and interesting case related by Mauriceau, in which he informs us that Hugh Chamberlen, one of the sons of the inventor, went to Paris in 1670, with a view to sell his secret to government, and while there, boasted in the most confident manner of his ability to deliver any woman, in any labor, no matter how difficult, in half-a-quarter of an hour. It happened, at the time, that a woman with a deformed pelvis fell in labor, who, after vain attempts to deliver her, was put in Chamberlen's hands. He undertook the management of the case with the utmost boldness, but, after a cruel perseverance of three hours, was compelled through sheer fatigue and exhaustion, to give it over, and confess his inability to effect the delivery. The poor woman perished shortly after his retreat, and the body being examined, it was found that he had lacerated the womb and vagina in various places with the points of the forceps. Mauriceau was so disgusted with the issue of the affair, that he afterwards inveterately opposed the use of such instruments; while Chamberlen immediately returned to England, where he drew very large receipts from the prac tice of Midwifery in London.

As Chamberlen's preface to Mauriceau's work on the diseases of women with child and in childbed is exceedingly rare, and particularly so in the United States; and notwithstanding my detestation of his wicked conduct in concealing his invention, I deem it proper to repub

lish in this work his address to the readers of his translation of MauriIt is but a proper contribution to the literary history of Midwifery, which I am sure my readers will not be sorry to possess. The following are his words:

"Having long observed the great want of necessary directions how to govern women with child, and in childbed, and also how new-born babes should be well ordered, I designed a small manual to that purpose; but meeting, some time after in France, with this treatise of Mauriceau (which, in my opinion, far exceeds all former authors, especially Culpeper, Sharp, Speculum Matricis, Sermon, &c., being less erroneous, and enriched with divers new observations), I changed my resolution into that of translating him; whom I need not much commend, because he is fortified with the approbation of the wardens of the Chirurgeons' Company of Paris.

"His anatomy was in the first edition omitted, but is in this; which, with the book, I have carefully rendered into English, for the benefit of our midwives; of whom many may yet very well admit of an additional knowledge. The principal thing worthy their observation in this book is, accurately to discover what is properly their work, and when it is necessary to send for advice and assistance, that so, many women and children may be preserved that now perish for want of seasonable help. My author makes out the breaking of the right waters, for the proper season of a natural delivery, and whenever a child is not born then, or soon after, nature is so much short of performing her office. This is certainly a great truth; and all wrong births should never be longer delayed: and for the most part floodings and convulsions not so long, lest the woman lose her life before ever the water breaks; but if no dangerous accident intervene, in a right labor, one may lengthen out their expectation to twelve hours after; and though some may have been happily delivered twenty-four hours, or two days after, yet I should not advise any to run that hazard, provided they can have an expert artist to deliver them, without destroying the child; because many have perished in that case; and it is not prudent to venture, where but one of many escapes. For the longer the labor continues after the breaking of the waters, the weaker both woman and child grow, and the drier her body, which renders the birth more difficult; and 'tis ever good taking time by the foretop.

"And that midwife's skill is certainly the greatest, and she deserves most commendation, who can soonest discover the success of the labor, and accordingly either wait with patience, or timely send for advice and help. Nor can it be so great a discredit to a midwife (let some of