103

plays npon a piano who has no taste ,for music, she pats her fingers nponthe keys like sticks, but if she feelswhat she plays then observe her mo-tions. So of wit and the other powers.

Following up the subject of thenatural language, yon will find thatit will be more actively expressed insome countries than in others ; somewill speak with the whole body, otherswith particular parts ; do not, how-ever, confound what is essential withwhat is merely a modification. Theessential powers are always the same,bnt the slyness of an Italian will hedifferently indicated from the slynessof an Englishman ; the first win showit by his whele actions, and the secondonly in his eyes. In the expression ofcharacters yon may study gracefiil-ness, and this is commonly done, butthe artists have forgotten too much toimitate nature. Moreover, those whowish to make a study of the naturallanguage are invited to study first theprimitive powers, then the languageby which their activity is indicated ;next the modifications ; and lastly,the combinations of the powers as wellas the expression of the individualpowers.

REVIEW.

Edemeyrts of Operative Midwifery,comprising a Description of certainnew and improved Powers for assist-in difficult and dangerous Labours ;illustrated by Plates, with Caution-

ary Strictures on tlee improper use ofInstruments. By DAVID D. DAYIS,M. D. Member of the RoyaL Col-leges of Physicians of London andEdinbnrgh, and Lectmer on Mid-wifery. 4to. pp. 345. London,1825. Hurst, Rohinson, and Co. andS. Highley.

THE ancient physicians, it would

appear from CELSUS,* knew bnt little

Lib. vii. Cap. xxix. Thia anthorspeaks ouly " of the method of ex.

of operative midwifery, and were

consulted for the most part, only,when the loss of the child was cer-

tain, and the recovery of the parentdoubtful ; and as such cases probablyoccurred but seldom, the imperfec-tion of their knowledge is not to bewondered at, since they necessarilywanted experience, and the tact ac-

quired by practice, by which alone

the art could have been well under-

stood, successfuity practised, or ma-

terially improved. During the dark

ages which succeeded to the down-

fall of the Romau empire but little

was done towards the improvement of

midwifery; and until the middle of

the seventeenth century, when male

practitioners of the obstetric art firstsame into vogue in ordinary cases, no

decided addition had probably beenmade to the knowledge of the an-cients.-« It is pretty generallyknown," says Dr. Davis, " that theDuchess de !a Viliere, a favourite

mistress of Louis the Fourteenth of

France, was the first female v,ho was

induced to place herself under theexclusive obstetric care of a professorof surgery, independent of any aiitici-pated necessity for a surgical opera-tion. That event took place in De-

cember 1663; and Julian Clement,the fortunate attendant upon the case,was soon after appointed to the newand lucrative office of Midwifer to thePrincesses of France." Ctement ad-

vanced the practice of midwifery,but introduced no improvements into

tracting a dead taetus," and apparent-ly knew no instrument but the crot-chet. HIPPOCRATRS and GALEN wefeequally uninformed.

104

the instrumental part of the art; nor" were any accessions of this kind

made to it for near half a centary af-ter his time." Improvements, how-

ever, beginning to multiply, a prodi-gious clamour was raised by the fe-male practitioners, who accused thesurgeons (and probably with justice)of an undue attachment to the use ofinstruments; indeed the clamour to

.the present day has not wholly sub-sided. The forceps and vectis, beingemployed unnecessarily, were after-wards disregarded where they were

indicated, like some of the contriv-

ances and remedies of our own day,which, being overrated at first, are

sooner or later entirely abandoned.

No doubt labour is a natural and not

a morbid process-that the resourcesof unassisted nature " are generallysufficient, and that the interference

of art (in ninety-nine cases of a hun-dred) is at best but auxiliary and tri-fling; still as anomalous cases, and

cases of difficulty and danger, may_.and do occur, it is certainly incum-bent on those who may practise thisbranch of the profession, to capaci-tate themselves for acting with

. promptitude in every case to which

they may be called, without trustingto the chances (which undoubtedly.are much in their favour) of havinglittle to do. Thus, although a fatalissue may not always be inevitable,yet it will seldom occur, and if it do,a consciousness of having done theutmost for the patient will be the bestand only solid satisfaction the practi-tioner can have. Having premisedthese few observations, we are sorry- to remark, that Dr. DAVIS, in his ex-

treme zeal for the advancement of

operative midwifery, has not alwaysdone justice to the labours of his pre.decessors and contemporaries. We

shall pass over GIFFORD, DRINK-

WATER, and other minor artists, and

proceed at once to our author’s re.marks on the late Dr. WILLIAM HUN-

TER ; and although we will concede

that his works « still retain some

splendour beyond that which geniushas bestowed," * we cannot agreewith Dr. DAVIS, that he did not in a

very material degree improve both

the art and practice of midwifery, orthat his dislike to instruments, in

some cases, allowed him to disregardor doubt their powers in others.

Speaking of Dr. HUNTER, our authorsays :-

" By a concurrence of several for-tunate circumstances he soon suc-

ceeded tg the practice of Sir RICHARDMANNINGHAM and Dr. SANDYS, with-out the drudgery usually attendantupon what is called establishing a

practice, and therefore, presumably,without having been ccmpelled to

make himself master of the great dif-ficulties of the art. Not to insist,however, on the value of this infer-ence, it is a well-known fact, that henever made a single accession to itsmechanical resources. (This seems tohave been the doctor’s heresy.) It

may be worthy ofrematk, that it wasa part of the character of Dr. Hm-TER’S mind to admire, even to devo-

tion, the resources of unassisted na-ture, and to look with extreme jea-lousy and distrust upon all interfer-ences of art, as auxiliary to naturalfnnctions. For these reasons, andothers perhaps more especially con-nected with’ the state of midwifery athis time, and having reference moreespecially to its then migforttiiiei,im-perfections, and competitions; hewas not many years in the practice of

* Johnson’s life of Rochester.

105

it before he became the leader of -apowerful party of obstetric alarmists,who, by gtowing representations ofthe sufficiency of nature in almost allcases whatever, and heavily chargeddescriptions of the abuses and dangersof instruments, embodied a prodigi-ous influence against the pretensionsof operative midwifery in general;-an influence, indeed, which not onlyhad the effect of repressing much ofthe ignorant daring of the period. towhich it was intended to apply; butwhich has continued to operate, moreor less actively, ever since ; and,upon the whole, to the extreme pre-judice, t might add, to the almost en-tire suspension of impovement inthis department of the art."--pp. 7, 8.

We do not think the passage here

cited requires any serious refutationfor if, as our author tells us, Dr. HUN-TER’s practice " had the effect of re-

pressing much of-the ignorant daringof the period," it was certainly so farbeneficial; and how are we to knowthat the disuse of instruments which

has succeeded (instead of being owing:to any practice of Dr. HUNTER) is notto be attributed to the reaction which

such "ignorant daring of the period"referred to might naturally be ex-

pected to produce ? To us the latter

appears by far the more probable ori-

gin of the evil (if it really be an evil)of which the Doctor complains.

" Since the time of SMELLIE," ouranthor tells tis, 11 operative midwiferyhas not been cuttivated by any person,either in this country or abroad, pos-sessing even a moderate share of talentfor practical mechanics." The pro-fession, generally, have wanted op-portonities, and of those " who havebeen attached to oar more extensiveobstetric institutions, some may haveneglected it from simple preterencefor other studies, of perhaps equalimportance to the art, without intend-ing to disparage its value ; whilstothers, there is reason to fear, from a

false estimate of its utility, immutable,possibly, to early prejudices, havetreated it with blameable indifference,and, occasionally, I believe, with looselevity and reprobation. Now, the na.tnral function of parturition eitherdoes or does not, in any circumstanceswhatever, require the aid of instru-ments for its safe or even possible per-formance. If it does not, then, inthe name of all that is consistent inconduct, and for the sake of our com-mon humanity, why does not someascendant genius, some fond discipleof HuNTER’s wary school, shake off anunworthy lethargy in so sacred acause, and advance boldly to proveand proclaim the truth of so deliglitfitla doctrine ? But if, on the other hand,it is an incontrovertible fact that in-sttments are sometimes of gteat usein the practice of midwifery ; nay,that they are sometimes indispensablynecessary to save life ; then, indeed,must it inevitably foUow, that thebusiness of this department of the artis (shonld be) at least as much the ob-ject of study and improvement as thatof any other ; and that to attempt toinvolve its very serious duties in dis-credit, or to connect with them theimputation of an inferior degree of im-portance, can only be deemed worthyof great ignorance or extravagant con-ceit—the sources, in fact, from whichsnch conducthas invariably proceeded.If any such practice be chargeableupon peisons professing to teach theart, it should he considered as a strongpresumption of their incompetency tomake good their pretensions. With-out insisting, however, on any assump-tion of this kind, I may venture toasert, that teachers of midwiferyhave not usually paid what 1 consider(it is on this that the entire argumentturns) sufficient attention to instructtheir pupils in the particular branch oftheir business (operative midwifery)which it is the special object of thefollowing sheets to illustrate," pp. 8, 9.That great abuses exist at our Me-

tropolitan Hospitals no one will be

hardy enough to deny ; and it is utoxe -than probable, that some, at least, ofthe " obstetric institutions" in ques-tion have, like the former, their pre-

106

siding genii, fiddle-faddling spirits andcotemporaries, at least of the greatJOE BURNS. Teachers of L4idwifervthere may 194 too, cf " great ignor-ance and extravagant conceit," andunable to make " good their preten-sions." All this may be true enough,but Dr. DAVIS will excuae as for think-

ing that practitioners and lecturers,generally, have not shown much dis-inclination to the use of instruments; Ior, at any rate, that they can hardlybe charged with " blameahle iyidif-

ference," or with having treated thesubject of operative midwifery " withloose levity and reprobation." It is

perfectly natural that our author (whohas perhaps paid more attention to the

subject than any other teacher in thismetropolis) should view with symp-toms of distrust the practice of thosewho have not made the same pro-

gress, or who have not cultivated the

art with his ardor, and with his or

equal zeal for its improvement. It is

perfectly nattiral, we say, that Dr.

DAVIS, or any other practitioner who

may have a particular hobby, shouldvote every nag a bad roadster that

cannot amble and prance with equalgrace, or trot and gallop quite as tiutas his own. There is nothing wonder-fiiiin tfiis ; it is quite professional andof every d ay occurrence. " The func-tion of parturition," says onr author," either does or does not in any cir-

cumstance whatever require the aid ofinstruments for its safe or even possible performance," and from this pro-position sets np an argument, witen in

reafity no argument is necessary, or,

indeed, is capable of being main-tained ; since all are agreed that in-

strnments are sometimes required,and " that the business of this de-

partment of the art is at leasf of as

much importance as that of any other."This, as far as, we know any thing ofthe subject, is the general feeling.Some senior surgeons might hold it to

be aù ax.iom never to operate for her-nia but on the dying or the dead, butthe profession in general will not bebound by their dieta nor infltienced bytheir bad example.Having disposed of the lecturers

and practitioners at obstetric institti-

tions, onr author comes next to hospital pupils, and the want of encourage-ment given to the art by the learnedprofessional colleges or corporationsof England ;" and those of Londonand Edinburgh, it seems, in this re-

spect are equally negligent. But, stip.pose any of these " learned" bodies-

the College of Surgeons, for instance— should patronize his art, does Dr.

DAVIS suppose it would flourish under

a dynasty that withers every sparkof genius, and nips in the bud all

efforts of enthusiasm or desire of im-

provement in their own ? It cannot

be. The progress of a science or an

art may be retarded by such patron-age, but it never can be accelerated.

Injury is certain, but improvement isout of the qtiestion. Let the Collegeof despots in Lincoln’s Inn Fields be

consecrated to the " Bona Dea," letthe president for the time being beher priestess, and the examiners turnsage-femmes to all the parturientiadies in town; and under the manage-ment of such dexterous old women,

ne have no doubt the obstetric art

will soon sink to a menial occupation.

107

" I am informed," says onr author,14 that of late years it has beceme a

very common practice with a certainclass, even of students, whilst en-

gaged in walking (runnning) the hos-pitals, to speak of midwifery us a verysubordinate object of attention, andof the knowledge of its few and sim-ple duties, as being easily attainableby private reading, and therefore notworth the time and very moderate ex-pence bestowed on the acquisition ofit by some of their better informedfellow-pupils."—P. 10.

Cettain’y, if such be the practice,it is highly to be reprobated, for

no one should engage in the prac-

tice of an art which lie has not

taken the trouble to learn ; butwe are disposed to consider, that ofthose who intend to practise mid-wifery, by far the greater proportiondo attend lectures on the subject, andthat they are competently instructedin the use of instruments. The indig-nation of Dr. DAVIS on this pointknows no bounds, and as he conceivesthat ignorant masters, when " foistingtheir last and farewell instructions on

their pupils, are accustomed to tell

them ’ not to put themselves to much

inconvenience as to attendance on

midwifery lectures,’ &c." breaks ont

into the following heroic strain of

declamation, which, being very prettywithal, we shall transcribe entire."In accounting for a’ condnct so

preposterous on the part of these ve-

terans (for I am not willing to impnteit to any considerable number of theyoung general practitioners of the

kingdom,) we are bound to presumethat they must themselves be miser-ably incompetent to encountcr thegreater difficulties of the art-oftentoo ignorant to recognise some of thedifficulties here supposed, and there-fore, probably, wholesale dealers inone or two of the more capital andfatal observationi) of midwifery. Such

men, hoowevrr, are many of yonr re-pnted clever fellows, the tondty land-ed darlings of their districts, expe-rienced masters of many arts, personsrenowned for quick decisions, solitaryand self-alone consulting operators,cool and steady-handed drivers ofpointed steel into living fretal skulls.New and simple dnties! What dif-ficulties, indeed, could be anticipatedas likely to arise in the routine of ordi-nary practice, of sufficient magnitudeto resist the pewer of such ruthlessopetators? Dead children, like deadmen, can tell no tales ; and, at anyevent, still births are occasional andunavoidable occurrences in the prac-tice of the most consummate profes-sors of the art. Nevertheless let thewretchedly-taught pupils of snch in-structors be persuaded, at lcast, totake the opinion of better infotmcdadvisers as to the essential value otobstetric studies."—p. 11.

B Safe instruments and good opera-tors, according to onr author, are

equally wanting, and Dr. RAMSBO-

THAM has expressed an opinion to thesame effect; and when we see the

state of surgery, and what sort of ope-rators some of our hospital surgeons

are, we do not much wonder that theobstetric art should also number with

its professors a certain proportion ofimbeciles. It cannot be prevented,for, God knows, the public are notable to distinguish between right andwrong in matters which most of a11

concern them.The following observations are a

sort of summary of our author’s opinions on the subject of the neglectwhich, by his account, operative mid-

i wifery has received :-C. The truth is, and it should not be

concealed by side-wind compliments,i that the entire subject of operativei midwifery has been in a state 4-;f the

most abject neglect for the last fiftyyears. By this I do not mean to as-

sert, that instruments

of one kind or

108

another have not been employed with. suflicient frequency, nor that in many

instances they have not been employedunnecessarily during that period ; Godknows the reverse is my firm convic-tion. What, on the contrary, I domean to assert is, that this essential

department of obstetrics has beenshamefully undervalued as a study,and its practice, as might be expect-ed from a general incompetence, forits studies has been the subject of allsorts of abuses. I may be neistaken,but it is really my opinion, that not- one practitioner in fifty, during thelast fifty years, has possessed a com-petent elementary knowledge of theuse of obstetric instruments, uponfirst engaging in the practice of hisprofession; and how could it be other-wise, when the proper mechanics ofthe art have never been made the

subject of adequate instrnction in onrschools ? Whatever number, thereforeof skilful operators we have in theprofession (I believe it is respectable,and dailv iiiereasina) thev have madeout anti established their claim tothat merit by dint of ulterior privatestudies, aided by an assiduous culti-vation of such opportunities as theymay have severally possessed, for ap-plying the results of their self-ac-quired attainments to actual prac-tice: ’-p. 17.

. In justice to our author, we mustfind room for another extract, from

the general remarks at the openingof the volume. ,

Before I conclude this introduc-tory section," says he, " I must notomit the performance of an act ofstrict justice to my own professionalcharacter—that of guarding myselfagainst the imputation of a fondness Ifor the use of instrument’- in the ordi-

nary practice of midwifery; which

might not unnaturally be inferred,from the considerable attention whichit will he presumed I most have paidto the subject. I have to request myreaders to suspend their opinion enthis point, until they shall have pe-3’used,atteiitively the whole of my dis-sertation. I believe there is no gen-tleman in the profession really com-petent to use obstetric instruments, with

perfect safety and snccess, who is lessdisposed to have recourse to snch

powers inexpezlieutly or unnecessarilythan myself," &e.—pp. 15, 16.

A taste for practical mechanics hasenabled the author to create for him-

self and his pupils certain automata,or

" artificial subjects, both maternaland fœtal; and he is " not ashamed

to acknowledge, that he is principally

indebted to these opportunities for

whatever skill he may possess in theuse of obstetric instruments on the

living subject, npon which also his

practice for several years has been

extensive., The late Dr. CMUGH, of

Berners-street, and other teachers of

midwifery, have possessed some suchmechanical contrivances, but whetherthe author has rendered them more

perfect, or invented others, we areunable to say.

It is rather difficult to furnish any

adequate analysis of the remainder ofthe work, as the instruments, andmethods of employing them, can onlybe understood by a reference to the

plates (twenty in number) by which itis illustrated. We shall endeavonr,however, (and as briefly as possible,)to give our readers some idea of onrauthor’s instruments, and first of his common forceps."

The length of this entire iostru-ment is between eleven inches and ahalf and twelve inches and a half,English measure; the difference to

depend upon the discretion of the pro-fe.ssor as to the length of the handtes;the length of the blades, from the com-mencement of their separation at theirshanks, (that is, supposing the forceps,when locked, to represent an ellipse,its long diameter,) is about 6½ inches,or 6! inches, (and the short diameter2 inches) ; the length of their shanks,from the commencement of their sepa-

109

ration to their point of crossing eachother at the lock, is one inch and Ithree-eighths ; and the length of thehandles, including the lock, is aboutfonr inches and a half; somethingmore or less, at the owner’s discre-tion."—pp. 37, 38.The width given to the fenestrae is

one inch and a half, at their widest

part, " without which," says the au-thor, they will not be competentto receive any useful portion of thefœtal head, notwithstanding the asser-tions so invariably made by authorsto the contrary. Not only are the

blades of this instrument broad and

fenestrated, like HAIGHTON’S, but theyare much more hollowed out interiorlythan those of any other forceps thatI have seen, so as to be adapted to

lie in close contact to every part ofthe child’s head to which they are ap-plied, and to admit of the receptionand firm purchase of extensive por-tions of its lateral parietes."Dr. DAVIS objects to the locality of

the locking of the small English for-

ceps, which, when they are used,takes place immediately at the out-letof the vagina, where the importantstructure there situated, being more,or less disturbed and distended bythe movements of the instrument, is

much exposed to contusion and en-

tanglement during either a careless ora difficult adjustment of the lock."This inconvenience is obviated in the

construction of his forceps, by addingto the length of the shank of the com-mon forceps about an inch and three-

eighths. The ;ight-handed blade, viz.the blade which is made to correspondwith the right side of the pelvis whenintroduced, is made flexible at its

shank by means of a joint, which, as

far as we can see of the matter, is as

much in the way as the locking of thecommon English forceps, to which, wethink, Dr. DAVIS has very properlyobjected.The author next treats of " forceps

with blades of unequal breadth,", and

again, " with blades of unequallength," of which he has two modifi-cations, and for which we must referto the plate.

Of the circumstances indicating the useof the Forceps.

" 1. The first and most importantindication for the use of obstetric in-struments of any kind is a positiveand well-ascertained insnfficiency ofthe natural powers to accomplish theact of parturition with safety to thelives and structures implicated in theprocess.2..The use of the modern forceps

presumes, also, upon a snfficiency ofspace within the pelvis to admit, withits assistance, an eventually livingbirth.

3. Bnt even then, the forceps canonly be used with propriety when itsapplication is upon the whole judgedpreferable to all other modes of de-

livery. -

4. Cases of head presentations aregenerally considered in this country,and I think justty, as the exclusive ob-jects of treatment by this class of in-struments.

5. Inasmnch as the forceps cannotbe used without exposing the motherto some degree of inconvenience, ifnot of positive injury of structure,it should never be employed for de-livering dead children."-pp. 44,45.

The author next proceeds to treatfully of the various indications for theuse of instruments, and cites manycases to show the correctness of his

practice. These subjects are discussedunder no less than thirty heads, andas it is impossible to give an abstractof them in our present number, weshall resume their consideration in

our next.