REMARKS ON Dr. LEAKE's PAPER ON THE USE OF HIS FORCEPS.

TO prevent confuſion, I ſhall examine the doctrine laid down in each paragraph, according to the order in which they ariſe.

I. The deſcription of the Forceps is not correct. The Forceps ought to be conſidered as an Inſtrument conſiſting of two Levers, acting alternately from two centres, which are thoſe parts of the child's head undergoing the greateſt friction. It is true, that with reſpect to themſelves, the centre of motion will be at that part where the blades unite; but when in the hands of the Operator, and containing a body within their Curve, the alternate motion neceſſary for the extraction of that body through a ſmall ſpace, changes the whole circumſtance. Then all that part of the blades, not bearing upon the child's head, becomes an additional length of Lever.

II. Profeſſors have generally miſled us in the purſuit of practical knowledge, being too often of that order of men, who are the bane of real improvement. ‘"Inquirunt,’ ſays Dr. Harvey, ‘non quomodo res ſunt, ſed quid alii dicunt".’ I believe there are reaſons for ſuſpecting that M. Crantz is but little qualified for laying down rules for the uſe of Inſtruments in Midwifery; and M. Levrette is not unexceptionable authority: The latter however ſet an example highly worthy of imitation, when he condemned the uſe of his Tire Tete, after having univerſally recommended it in the unexperienced part of his Life.

Dr. Leake ſays, ‘"When the Child's head is wedged within the bones of the Pelvis, it cannot be extracted by Smellie's Forceps, becauſe of their ſhortneſs; and when the Hind-head is forced over the Symphyſis of the Pubes, it cannot be got hold of, within the Curve of the Blades, becauſe they are only curved in one direction, and being applied along the Ears, they are apt to ſlip over the Face, more eſpecially as they are taper towards the point".’

When the Head is incuneatum, enclaveé, or wedged in the Pelvis, it is a caſe in which Forceps of any kind cannot be uſed with prudence. If we did try them, we ſhould happily miſcarry in the attempt; for if we ſucceeded, dreadful would be the conſequence to the ſoft parts of the Mother, cruſhed between the Child's head and Forceps on one hand and the bones of the Pelvis on the other.

It is ſuppoſed that the Hind-head is forced over the Symphyſis of the Pubes. Whenever this is the caſe, it is not poſſible to apply Forceps of any kind with advantage, or without the utmoſt danger; and I call upon every Gentleman converſant in practice to confirm the truth of the aſſertion. This ſituation can only be occaſioned by the projection of the Sacrum and laſt Vertebrae of the Loins. The Doctrine of applying Forceps before the bulk of the Head has paſſed the ſuperior aperture of the Pelvis, carries great danger and unſur⯑mountable [4]difficulties on the face of it. Thoſe who have endeavoured to reduce it to practice (for it is an old and obſolete doctrine) have in their accounts given us hiſtories of their attempting it, of the diffi⯑culties they met with, of the miſchief they did and a retraction of their errors.

The Cenſure on Dr. Smellie's Forceps is unprofitable. He was a man of great Candour, Induſtry and Ingenuity, and we are all indebted to him. Perhaps he purſued his favourite opinion too far, but let us attribute his errors to the common infirmity of Human Nature. Dr. Smellie's Forceps are not taper at the point.

The only poſſible advantage to be reaped from the third blade of the Forceps, is, the prevention of their ſlipping over the face, which does not happen once in a hundred times, if the Forceps are properly applied and the head of the child be low enough for their application.

III. Independent of the dimenſions of the Pelvis, it is well known that there are many caſes which require the uſe of the Forceps.

IV. Objections are made to the uſe of the Forceps, 'till the bulk of the head of a child has paſſed the ſuperior aperture of the Pelvis, not only for the reaſon ſpecified by Dr. Leake, but alſo be⯑cauſe force cannot be exerted in a proper direction. It is true that terrible accidents have followed from the cauſes here mentioned; ſeldom of neceſſity however, but generally from miſmanagement or innatention after delivery. They do not happen near ſo frequently when a Labor is wholly reſigned to the efforts of Nature, as when the Forceps are injudiciouſly applied.

V. The largeneſs of the Head and the narrowneſs of the Pelvis are relative Terms. However deſirable it might be to deliver a Woman under theſe circumſtances, Facts prove, that if the bulk of [5]the head is not deſcended through the ſuperior aperture of the Pelvis, the attempt with Forceps would be fruitleſs with reſpect to the living Child and exceedingly pernicious with reſpect to the Mother.

No Practitioner who has a competent knowledge of [...] ever thinks of turning a Child when the head has entered the Pelvis and the Uterus is contracted. If the head is wedged in the Pelvis, this operation is abſolutely impracticable.

VI. The caſe ſuppoſed in this paragraph, I believe never can happen at the upper part of the Pelvis; if it is meant at the lower part, the caſe requires no Inſtruments. For before it is perfectly turned, the Hind-head begins to emerge from under the arch of the Pubes. All preſentations of the head, with regard to inſtrumental delivery, may be devided into two kinds;—with the face to the Sacrum;—or to the Pubes. Yet neither of theſe are exact at the time when it is judged neceſſary or proper to apply Inſtruments. At the ſuperior aperture of the Pelvis the head deſcends with one ear to the Pubes, with the other to the Sacrum, or diagonally. As it progredes it neceſſarily turns to one of the general preſentations, and it is compelled to this turn by the converging form of the internal ſurface of the Pelvis, and by the ſpinal proceſſes of the Iſchia. Now the Head is not placed with the Ears to each ſide, but diagonally, in all caſes, invariably, when it is neceſſary to apply the Forceps. When they are applied, if the action be gentle with them, as it ought, the head will be turned, without our aſſiſtance, into the moſt favourable poſition, as in a natural Delivery. My reaſon for preferring the ſtreight Forceps is a conviction that this opinion is true, and that under theſe circum⯑ſtances the curvilinear Forceps become inconvenient, except with regard to the preſervation of the Perinaeum. I do [...] not think any one caſe ſufficient for the eſtabliſhment of any practice.

VII. I know enough of the hiſtory of Vectes, in as able hands as [6] Roonhuyſen's, to convince a reaſonable man that much miſchief may be and has been done by them. It is not ſufficient to know that Women have been delivered; we ſhould be acquainted with the general events, or we cannot form any comparative judgement of the pro⯑priety of this or that Practice. Roonhuyſen's Vectis changes it's centre of action, and though it may be firſt fixed againſt the Symphyſis of the Pubes, the Ramus of the Iſchium, near the obtuſe proceſs, muſt become the Fulcrum, or you will not be able to extract the head. I allow his Inſtrument to be very dangerous, but not to ſuch a degree as the Forceps applied and acting before the bulk of the head has paſſed through the ſuperior aperture of the Pelvis.

VIII. The application of a third blade is as free from danger as of either of the other blades.

IX. The reſiſting point is not particularly where the Hind-head preſſes againſt the Pubes;—the head is wedged and preſſes on many points.

X. The line of action will certainly be from the extremity of the curve. Without great caution, when the curved Forceps are intro⯑duced, we ſhall fix them on a part we do not mean, and when we act with them, we ſhall do it in a wrong direction.

The uniformity of the compreſſive force does not prevent the laceration of the Perinaeum; but ſlowneſs in acting and a recollection that the Vagina has an axis different from that of the Pelvis. Compreſſive force is not intended in the uſe of the Forceps, but it alway sis produced,

XI. There is a poſſibility of exerting inſinitely more power with every kind of Forceps that has been contrived, than can be uſed, if we attend either to the ſafety of the Mother or Child. The deſigns of Nature are effected very ſlowly. The only method by which we can [7]avoid every inconvenience which attends the uſe of the Forceps, is by imitating the progreſs of a Natural Delivery.

XII. Great advantages are ſaid to be obtained by the uſe of Forceps curved, though of the common ſize. I object to the uſe of all curvilinear Forceps, becauſe the head of the Child is always in a diagonal ſituation when it is proper or neceſſary to apply them The curve of M. Levrette's Forceps ſeems the moſt convenient, and Mr. Oſborn has contrived a very elegant pair, by diminiſhing the ſize of Levrette's and very little alteration beſides.

XIII. Allowing Dr. Leake the full force of his own reaſoning, I cannot conceive the advantage ariſing from this complicated Inſtru⯑ment. But the caſe is really thus:

If we act with the Forceps, from handle to handle, the third blade can do no ſervice, but muſt do much miſchief by bruiſing the ſoft parts.

If we act with the Lever, the Forceps are uſeleſs or prejudicial.

I pay great regard to Dr. Leake's abilities, but being convinced that the Inſtrument which he has recommended will do great miſ⯑chief, if the attempt to introduce it into practice ſhould ſucceed, I have taken the trouble of writing theſe Remarks.