The
forceps originally were crude, particularly in the lock that held the blades
together. Laurence Sterne in Tristram Shandy says: "Dr. Slop had lost his teeth - his
favourite instrument (the obstetrical forceps) - by some misapplication of
it, unfortunately slipping, he formerly, in a hard labour, knocked out three
of the best of them with the handle of it..."
The
purpose of the forceps is to assist in the extraction of the child when the
pushing forces of the mother are lacking, or when it is advisable to
terminate labour rapidly, however the forceps did not replace the podalic
version. Each of the three procedures - podalic version, forceps and Caesarean
section has its particular province. Podalic version makes it possible to
correct the position of the child and to extract it by its feet, but the
child must still be in the uterus and freely moveable. When labour has
advanced and the child, in the normal position, has its head engaged in the
inelastic ring formed by the pelvic bones it cannot be disengaged and pushed
back into the uterus. If the strength of the mother fails, earlier
practitioners could not assist in extracting the baby and could only wait for
labour to proceed, which was often too late to save the child. The
obstetrical forceps could overcome these difficulties.
The
forceps consists of two wide flat blades curved to fit gently over the
child's head. The blades are inserted and brought into position separately,
then locked together, firmly gripping the head. By turning and gently pulling
the child is extracted. Any opening through which the head will pass will
readily allow the passage of the rest of the body, for the baby's head is of
a larger diameter than is its shoulders or trunk or hips.
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Neither
the application of forceps nor podalic version will aid birth when the ring
made by the bones of the pelvis is too small to admit the head of the child.
The only procedure which could be applied in these circumstances was Caesarean
section which was then far too dangerous.
Although
it was clearly recognised, in the sixteenth century, that the child must pass
through the ring formed by the pelvic bones, they did not know the exact
structure or relation of these bones. Parè, in fact, believed, as did most
other physicians, that the pelvis separated in the front and spread, as might a
broken hoop, to make room for the child's head to pass. It was Andreas Vesalius
who, in his book of anatomy, in 1543, first showed, although crudely, the true
relation of the bones of the pelvis.
Anatomical
study, as begun by Vesalius, gradually showed the fallacy of the separation of
the pelvic bones during childbirth. An extract from a book on midwifery
published in 1682 indicates both the passing of this fallacy and also the means
for the study of anatomy used by men as eminent as Paré. This book is entitled,
The English Midwife, Enlarged, Containing Directions to Midwives;…the
Whole Fitted for the Meanest Capacities. It was published in London, where
it was "Printed for Rowland Reynolds, next door to the Golden Bottle in
the Strand, at the middle Exchange door."
The book
was a plagiarism of Wolveridge's Speculum
Matricis Hibernicum, a standard text of its time, but now the rarest book
of its kind. The quotation in question, written a century after the time of
Versalius and Parè, is as follows:
"...Ambroise
Paré, a most famous Chirurgion in his time at Paris (quoting many witnesses to
the thing), gives us an History of a Woman in whom (having been hang'd 14 days
after she was delivered in Child-birth,) he found (as he saith) the share bone
separated in the middle the breadth of half a finger, and the flanck-bones
themselves disjointed from the hoop-bone. But we will not in this matter accuse
him of an imposture as having too much respect, and a better opinion of so
worthy a person, and believing him to be too sincere as to commit such a crime;
but do indeed believe the good man might be mistaken in this separation; for we
cannot probably conceive that being so at the time of her labour it would
remain so a fortnight after, the breadth of half a finger; for then they would
have been forc'd to carry this Woman to execution; (for they are executed at
Paris within the City or Suburbs,) because she would not have been able to
have supported her self, or climbe the ladder of the Gibbet; and keep her self
on her Legs according to the custome of other Malefactors; because the body is
only supported by the stability of these bones; wherefore we must believe, as
most probable, that such a disjunction and separation were caused either from
the falling of this Woman's body from the high Gibbet to the ground after
execution or from some blow on that place from some hard thing."
TITLE PAGE
OF THE ENGLISH MIDWIFE, ENLARGED
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Published in 1682. The text of this book
is presented as a dialogue between the doctor and the midwife, and much sound
practical advice is given. The book not only covers obstetrics, but also the
diseases of children and the diseases peculiar to women; The type of women
undertaking midwifery and the care of women and children is indicated by the
statement on the title page, "The whole fitted for the meanest
capacities."
NURSES SWADDLING A CHILD
In the seventeenth century, the period of this
woodcut, the baby, at birth, was first bathed and then salted all over (in
accord with the teachings of Galen), and its head tightly bandaged to shape it.
Next it was bound round and round in swaddling bandages until it was unable to
make the slightest movement. These bandages were usually taken off only once a
day, when the child was allowed a few minutes of exercise. The swaddling
continued for several months. About half of the children so treated died during
the first year of life
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Prior to the time of anaesthesia and asepsis, the
woman with a deformed pelvis could have serious difficulties at the time of
her delivery. Caesarean section with its then high mortality for the mother
might be attempted, or the pelvic bones might be cut apart at their joint at
the front of the body, or the resort of earlier times might be used and the
child destroyed, but in serious deformity even this last procedure was far
from successful. The induction of abortion, or later of premature labour,
offered a solution to this difficulty.
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Abortion had long been practiced and within the
Greek and Roman cultures the procedure of inducing abortion was continued,
being used by midwives extensively for any and all reasons. However, some of
the more discerning physicians adopted a more restrained view; clearly
outlined in the quotation given from Soranus: "...The fruit of
conception is not to be destroyed at will because of adultery or of care for
beauty, but is to be destroyed to avert danger appending to birth..."
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With the supremacy of the Catholic Church in
Europe the practice of abortion was forbidden under penalty of eternal
damnation.
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In England, in the eighteenth century, means of
measuring the size of the pelvis were sufficiently established, so in cases
of abnormality the pregnancy was brought to an end late in the seventh month
or early eighth month, before the child had reached its full development. The
smaller size of the child enabled its passage through a narrower than normal
pelvis, and with good care the child could be nurtured.
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French
physicians did not follow the example of the English physicians, probably
strongly influenced by the Catholic Church in France. However, despite the
attitude taken by the medical profession of France, and also the civil and
ecclesiastical decrees and proclamations, abortion was extensively practiced
and had been for many years, but not for medical reasons. The great ladies of
the day made light of the earthly and spiritual terrors held up to them and
resorted to the crime to hide the consequences of their sexual irregularities.
Bayles, actually, uses this fact to support the theory that fear of worldly
shame is a stronger sentiment than that of religion.
The conditions existing in Paris at this time,
seventeenth and early eighteenth centuries, can be gathered from a letter of
Guy Patin, at one time dean of the Faculté de Médecine. Patin was a man of
satirical humour and of keen observation, as may be judged from the fact that
as early as 1657 he made the statement: "As to our publishers - I can
hope for nothing from them. They print nothing at their own expense but
novela utrisque " ( sex novels ).
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At the
time Patin wrote there was a large class of men and women who made a business
of producing abortion; the women in this trade were chiefly the midwives. Patin's
letter, written in 1660, comments on the case of Mademoiselle de Guerchi, who
had been seduced by the Duc de Vitry and who had died from infection
resulting from an induced abortion.
From
Patin's letter:
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" They make a great
clamour here about the death of Mademoiselle de Guerchi. They had imprisoned
the midwife at the Chatelet, but she had been taken from there to the conciergerie by order of the
court. The curé of Saint Eustache has refused sepulture to the body of the
lady. They say that it was carried to the hotel de Condé, and was there put
in quicklime in order to consume it soon, so that it could not be identified
if anyone came to see it. The midwife had defended herself well up to
now...But I believe the question (torture) will be put to her. The
vicars-general and the plenipotentiaries went to complain to the Premier
President that in a year six hundred women, by actual count, have confessed
to killing and destroying their fruit."
The midwife was later found
guilty and hanged at Croix du Trahoir, as Patin says, " in good
company."
INVITATION TO GUY PATIN'S FUNERAL
At
the time the English physicians revived the practice of inducing premature
birth as a means of avoiding difficult labour; midwifery had not been separated
from surgery. In earlier times the physician's role was restricted to
destructive surgical procedures, however, the arrival of podalic version and
the use of forceps reduced the number of cases in which it was necessary to
destroy the child. As obstetrics remained in the hands of the surgeons, they
tended to make child-bearing a surgical operation and to use instruments
whenever possible - a practice labelled 'meddlesome midwifery'.
It
It was said at that time of one prominent German
obstetrician that he employed instruments twenty-nine times in sixty-one
births, and of another that he 'began to cut and slash' as soon as everything
was not precisely normal, and in this way had a mortality of twenty per cent.
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Blood-letting was also carried into the field of
obstetrics, and the woman in labour was bled to prevent disease if everything
seemed normal, and for treatment if anything seemed abnormal.
There was strong reaction to even beneficial
surgical and instrumental procedures at child-birth, and for a time these
practices were discarded. In the middle of the eighteenth century William
Hunter, to emphasise his views of interfering with childbirth, was in the
habit of showing his obstetrical forceps covered with rust, as evidence of
the fact that he never used it. William Hunter was trained at the University
of Glasgow - renowned for educating prominent medical practitioners - and was
the leading consultant in midwifery in London. His views were extremely
influential on the physicians in England.
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The practice of avoiding the use of instruments
and trusting the powers of nature went so far that in 1819 Sir Richard Croft,
obstetrician to Princess Charlotte, upon whose life depended the hope of the
dynasty, permitted the princess to remain in labour for fifty- two hours. The
child was born dead and the mother died six hours later. Croft shot himself in
remorse for his error of judgment.
In time, the reaction against operative
interference caused obstetrics to be an art in its own right and not simply a
branch of surgery. In the nineteenth century obstetrics became a recognised
part of medical practice; the rational use of forceps and other operative
procedures returned merely as necessary aids in difficult cases.
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An etching
by Daumier showing
the
midwife and her sign
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Three Kids Gripped By Evil By Polly Mullaney
Amazon Kindle, Amazon paperback
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