TO DR. THOMAS DENMAN.
[3]IT is now above three years ſince Dr. Leake publiſhed a deſcrip⯑tion of his New Forceps with three Blades, together with an elegant Copper-plate Print of that Inſtrument. From this Publication, though attended with conſiderable expence, he derived no advantage, ſince it was chiefly intended as a compliment to his Pupils, and to ſuch other Gentlemen of the Profeſſion as were par⯑ticularly engaged in the province of Midwifery. * Of this I can ſpeak with confidence, as I had at that time the pleaſure of attending the Doctor's Lectures, and was therefore, well acquainted with the truth of the particulars which I now mention. I was likewiſe one of the many, who, from the principles on which it was recom⯑mended, thought this a valuable addition to the Apparatus of Mid⯑wifery; nor has my experience of its uſe in Practice hitherto failed to confirm this opinion. But the merit of Dr. Leake's Forceps reſts on a much better foundation than any thing I can pretend to ad⯑vance in its favour. Many of the beſt Accoucheurs, both at home and abroad, have been pleaſed to commend it as a conſiderable Im⯑provement; many Commiſſions were ſoon received by the Inſtru⯑ment-Makers, for ſending it to different quarters; and to my cer⯑tain knowledge, it has been for ſome time paſt a familiar Inſtru⯑ment [4]in the hands of ſeveral Practitioners of the firſt name in France, Ruſſia, and Holland, as well as Great Britain and Ireland.
With ſo many and ſuch reſpectable Suffrages in its favour, I thought the credit and uſe of the new Forceps had been univerſally eſtabliſhed, till I was lately convinced, by peruſing your Remarks on that Inſtrument, that there was at leaſt one diſſenting voice. When, or in what manner, theſe Remarks were firſt uſhered into light, I will not take upon me to ſay; but I am apt to think they had a clandeſtine Birth, as I do not remember to have ſeen them advertiſed in the uſual way; a circumſtance which would not have readily eſcaped me, as my fondneſs for Improvement, eſpecially at ſo great a diſtance from Town, makes me always very attentive to the Ar⯑ticle of new Publications. It was by mere accident therefore, and only very lately, that I had the happy opportunity of ſeeing this ſtriking Specimen of your Candour and literary Talents; and as ſoon as I had glanced it over, I was determined to employ my firſt in⯑tervals of leiſure, from the duties of my Profeſſion in vindicating Dr. Leake from ſo illiberal and injurious an Attack. Together with this motive you may attribute as much as you pleaſe to the vanity of a young man, whom you may ſuſpect, perhaps, of ſeeking for an occaſion to try his ſtrength in the liſts of Controverſy; and in⯑deed, to be perfectly ingenuous with you on this head, I will frank⯑ly own, that ſo far as it may be natural to take courage from the weakneſs of an Adverſary, I did think I could never hope for a bet⯑ter opportunity of making a firſt Eſſay with ſo little hazard to my Reputation.
In cenſuring Dr. Leake's Forceps, which you are pleaſed to de⯑clare an ineffectual as well as a dangerous Inſtrument, you alledge the public good as your ſole inducement for undertaking the trou⯑ble of your precious Remarks upon it. This is certainly a good Plea, and worthy of a good Man; but it has been ſo often hackneyed and abuſed, that we are ſometimes apt to ſuſpect a counterfeit. It is a [5]convenient pretence, however, when a man is either aſhamed or a⯑fraid to avow his real motives, and in the preſent caſe, it would not perhaps be difficult to aſſign others. But as this may be a matter of conjecture only, I ſhall not inſiſt upon it, as I would not wiſh to attack even an ungenerous Adverſary, by the ſly method of Inſinuation.
Allowing you, therefore, the full merit of your pretended zeal for the public ſafety; let me aſk you, why you did not ſound the alarm ſooner, when as you ſay and would have it believed, there was ſo much impending danger, and ſuch dreadful conſequences to be appre⯑hended from the uſe of this Inſtrument? Let me ſtill further aſk you, why at length, theſe benevolent remarks of yours were not exhibited to the world in a public and open manner, inſtead, as I am informed, of being privately handed about, among ſuch young and unexperienced Gentlemen of the Profeſſion as were not compe⯑tent Judges of the ſubject? Did you mean that the poiſon conveyed in this artful and inſidious manner, ſhould have time to operate and produce it effects before an antidote could be adminiſtered?
As every man has an undoubted right to approve or diſapprove of whatever is preſented to public view, I by no means blame you for making Dr. Leake's Forceps a ſubject of enquiry, provided you had done it in the way of a candid examination, founded on the evidence of his own Deſcription: a mode of trial to which no Au⯑thor can reaſonably object, and to which every one has an undeni⯑able claim. But how far you have done juſtice to that Gentleman in your Quotations, or the concluſions you draw from them, will be left to the following Strictures, and the Reader's judgment without farther anticipation.
You will pleaſe to obſerve, Sir, that contrary to your method, I ſhall quote and examine thoſe your remarks fairly, without pervert⯑ing your meaning, where that is to be found, or omitting one part and inſerting another, as beſt ſuits my purpoſe. I muſt likewiſe [6]inform you, that in quoting an Author you have no right either to alter the Diction or tranſpoſe the Sentences, eſpecially in points of Controverſy, becauſe from thence may ariſe an alteration in the ſenſe, which may wholly miſrepreſent the original meaning; both which you have frequently done without ceremony, in your Remarks on Dr. Leake's paper on the new Forceps. With the ſkilful and candid, I believe, that paper might very ſafely have been left to vindicate itſelf; but leaſt your Remarks, puerile and ſuperficial as they are, ſhould chance to miſlead the unex⯑perienced, who ſometimes miſtake ſound for ſenſe, I will proceed to examine and place them in their proper point of view.
I ſhall paſs over in a general way, the ſelf-conceit, and fini⯑cal preciſion, as well as the childiſh vanity and formal parade with which you are pleaſed to bring forth your elaborate trifle; which examined in all its parts, will appear to every eye but your own, a ſhapeleſs abortion, deformed, unfiniſhed, and ſent before its time.
In the firſt article of your Remarks, you take the liberty to aſſert, that Dr. Leake's Deſcription of the Forceps is not correct; but in what manner you make good that aſſertion, the Reader will beſt be able to judge, from an exact quotation of his Deſcrip⯑tion, compared with your own.
Dr. Leake's Deſcription of the Forceps is as follows: ‘"The Forceps uſed in Midwifery may be conſidered as an Inſtrument conſiſting of two Levers, which act in contrary Directions from one common Centre or Fulcrum, where their Blades unite and are ſuſtained by each other, conſequently, their power on the Body to be moved will be in Proportion to the length of their Levers or Handles."’
The following in your Deſcription. The Forceps ought to be conſidered as an inſtrument conſiſting of two Levers, acting alter⯑nately [7]from two centres, which are thoſe parts of the Child's head undergoing the greateſt friction.
To ſpeak thus, is to aſſert that the Forceps, which is the active body, finds a Fulcrum or reſting point upon the Child's head which is wholly paſſive, being the very part which is to be extracted. I ſhould be glad to aſk, how the Child's head can be the part from which the Blades act, ſince it is demonſtratively the part acted upon? A very ſlender knowledge of Mechanics might have taught you that every Lever muſt neceſſarily act from its centre of motion; but on the contrary, if the Child's head afforded a centre of motion to the Blades of the Forceps, as you aſſert, then it would follow, that thoſe Blades, conſidered as Levers, would not act from, but towards their centre of Mo⯑tion; a thing ſo contrary to reaſon and common ſenſe as to de⯑ſerve no further attention. In a word, Sir, you have palpably confounded the idea of the part acted upon by the Lever, with that of the part from which it acts. But perhaps you are about to eſtabliſh ſome new Principle in Mechanics, which may ſolve this Paradox, and prove that an active and a paſſive body is one and the ſame thing.
You ſay—It is true, that with reſpect to themſelves, viz. (the Blades) the Centre of Motion will be at that part where they 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.
It is wholly inconſiſtent and improper, thus to talk of Motion, or a Centre of Motion in a body (the Forceps) which as above, you are deſcribing totally at reſt; that is unemployed and not in the hands of the Operator.
Again, you ſay, That when the Blades are really in the hands of the Operator, then the whole circumſtance is changed—Without doubt the circumſtance is changed, but not at all in the manner [8]you apprehend; for if the blades contain a body within their Curve, the action for the extraction of that body, muſt ſtill be derived from their Junction as a reſting Point, otherwiſe they would want a Fulcrum, and therefore could not act at all.—If this is difficult to be underſtood, you may, if you pleaſe, ſup⯑poſe two Blades without ſuch junction, to be paſſed up along the Child's head, and as theſe Blades could not poſſibly then be locked, they would not act on the Child's head, and conſequently it could not be extracted.
Beſides, the Blades of the Forceps, conſidered as two Levers, do not act alternately as you tell us; for as both of them cloſely and equally embrace the Child's head, the one cannot poſſibly be made to act without the other; their action therefore is not alternate but ſimultaneous.
Such frivolous and far-fetched Objections ſhew that you have taken great pains to find them out, and that you have been at whip and ſpur in purſuit of Game; but like an unſkilful Hunts⯑man who miſtakes the mettle of his Stead, as well as his own; you have unfortunately quite unhorſed yourſelf in attempting the five Bar-gate. Upon the whole, either your knowledge of Me⯑chanics ſhould have been greater, or your preſumption leſs, in contradicting eſtabliſhed and ſelf-evident principles.
So much for your Accuracy and Skill; I ſhall next quote your ſecond Article verbatim, as a curious ſpecimen of your Candour, and the reſpect due to your Superiors:—Reader, pleaſe to attend to the following modeſt Aſſertion.
Profeſſors have generally miſled us in the perſuit 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.
If ſuch Profeſſors are any where to be found, your preceding Remarks evidently ſhew that you have no ſmall Title to be [9]included in their number." Nomine mutato, de te fabula narratur. In a word, if ſuch Reflections in one of real conſequence, whoſe judgement was ripened by time and experience, would juſtly be thought uncommonly preſuming, and ſo replete with arrogance as to have got the better of both prudence and decency;—What then ſhall be ſaid of—Dr. Thomas Denman.
Thus you proceed,
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.
You ought to have mentioned thoſe Reaſons at large, other⯑wiſe an affertion ſo rude and injurious, on your own authority only, is claiming more credit than the Reader may be willing to allow you; for you muſt know that M. Crantz was an eminent Profeſſor of Midwifery at Vienna, and that he wrote judiciouſly on the Uſe of Inſtruments, in his Diſſert. de re inſtrumentaria in arte obſtetricaria, a book very neceſſary for your peruſal.
M. Levrette, you ſay, is not unexceptionable authority—If none but yours is oppoſed to it, I believe it will remain un⯑exceptionable. To tell any other of the profeſſion but yourſelf who Levrette was, would be unneceſſary; but as you have ſpelt his name wrong as often as you have had occaſion to mention it, it appears you have no better acquaintance with him than with the former Gentleman, whom you have ſo uncivilly cen⯑ſured. Levret of Paris is ſufficiently known throughout Europe, both by his Writings and public Lectures. In ſhort, the Merit and Judgment of the two reſpectable Authors in queſtion are ſo univerſally acknowledged, and their reputation ſo ſuperior to your inſignificant Cavils, that the preſent circumſtance would be apt to put one in mind of a Village-cur barking at the Moon.
I ſhall now proceed to quote the ſubſtance of what Dr. Leake has advanced, and to examine the propriety and validity of your [10] Remarks on the preſent ſubject.—In his deſcription of the Forceps he ſpeaks thus:
‘"H. Crantz, profeſſor of Midwifery at Vienna, and Levret of Paris, both obſerve, that when the Child's head is wedged within the bones of the Pelvis, (capite incuneato) it can ſcarcely ever be extracted by the common Forceps recommended by Smellie, becauſe of their ſhortneſs; and as their Blades are only curved in one Direction, whenever it happens that the Hind-head is forced over the Symphyſis of the Pubes, it cannot be got hold of within the curve of the Blades, which being only applied along the Ears in a ſtreight Direction, are therefore apt to ſlip downwards over the Face, and to foil the Operator in the Extraction of the Head: This will the rather happen, becauſe they are made taper towards their Points, which will diminiſh their contact on the head and prevent them from taking a firm hold;—ſo that they are the leaſt ſerviceable in thoſe very Caſes where they are the moſt wanted,—that is, where the Pelvis is narrow; for it muſt be allowed, of all Difficulties, that which happens from the above cauſe, is by far the moſt in⯑ſurmountable obſtacle to the birth, ſince it can only be over⯑come by very ſtrong Pains, which compreſs the head and force it to conform to the bony Paſſage."’
Your remarks on the preceding Paragraph are as follows:—When the Head is incuneatum, enclavée, 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 parts of the Mother, cruſhed between the Child's head and Forceps on one hand, and the bones of the Pelvis on the other.
The Reader is here preſented with a diſh of all ſorts,—a perfect Oleo, but without a ſingle grain of ſalt or ſeaſoning, curiouſly garniſhed with freſh rhetorical flowers, but of the exotic [11]kind; ſuch as that of miſcarrying happily; ſucceſs being attended with dreadful conſequences, &c.
You tell us that, The Doctrine of applying Forceps before the bulk of the Head has paſſed the ſuperior aperture of the Pelvis, carries great danger and inſurmountable 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 difficulties they met with, of the miſchiefs they did, and a retraction of their Errors.
According to your account, this Doctrine wears a very frightful and gorgon-like countenance.—Alas poor proſtituted word Doctrine! how miſerably art thou profaned and miſapplied; I fear thou wilt next be tack'd to the method of making peaſe-pottage, or manufacturing mutton-pies. But to be ſerious; was it not doing injuſtice to John Bunyan by the compariſon; I ſhould think I had been reading his deſcription of the Pilgrim's Progreſs through the Vale of Tears.
When the greateſt bulk of the Head has paſſed the ſuperior Aperture of the Pelvis, the greateſt difficulty is over, as appears by the following quotation from Dr. Leake, and therefore the Forceps are ſeldom ever then neceſſary, except floodings or other dangerous ſymptoms ſhould ſuddenly exhauſt the Patient's ſtrength.
‘"The ſhort Forceps may indeed be effectually applied when the Child's head is low in the Pelvis, but where that is the Caſe, artificial Aſſiſtance is ſeldom neceſſary, the principal Difficulty being then over; and ſhould any ſtill remain, it will now be removed by the Concurrence of two Cauſes, viz. the inferior Parts of the Pelvis will gradually dilate and give way to the Preſſure of the Head, which, at the ſame time, will be ſqueezed into a longitudinal Form, and therefore its tranſverſe Diameter, in reſpect to the Paſſage, will become conſiderably [12]leſs and leſs; both which Circumſtances have a manifeſt ten⯑dency to facilitate the Birth."’
Thoſe then, and ſuch like your Remarks, are more than ſuffi⯑ciently anſwered by the following quotation from Dr. Leake's Paper, which ſhews the neceſſity and propriety of the practice he recommends, and alſo that he was not unaware of Cavil and Criticiſm.
"I know that the Application of the Forceps is objected to by ſome, till after the Head has got below the Brim of the Pelvis, on the Suppoſition that the Force applied to bring it down would prove injurious to the Mother;—but will not the violent and long continued Compreſſion of the ſoft Parts, viz. the Vagina and Neck of the Bladder, &c. when ſqueezed between the Head and Bones of the Pelvis, as two ſolid Bodies, be much more liable to endanger the Patient?—Since Inſtances may be found where a Mortification has been the Conſequence, and where the Child, which always ſuffers in Proportion, was alſo born dead.
In caſes, therefore, extremely laborious, when the Head is large, —the Pelvis narrow, or both;—where the Patient's Strength is exhauſted by a Flooding,—where ſhe is ſuddenly at⯑tacked with Convulſions, Faintings, or other alarming Symptoms, and conſequently, where the labour Pains are inſufficient to bring forth the Child; the long double curved Forceps, hereafter de⯑ſcribed, may be uſed with great ſafety and advantage, either with or without the Lever or third blade, as occaſion may re⯑quire.—Every one who has had much Experience knows, that it is often improper, as well as difficult and dangerous to turn the Child, and ſometimes even impracticable without burſting the Uterus, or applying ſo much Violence as might be fatal to the Mother; and to open the head of a living infant, before the long Forceps and every other Expedient had been tried in vain, would ſurely be deemed raſh and unnatural Practice."
It may be obſerved, that whatever Dr. Leake recommends he al⯑ways gives his reaſons for it; but what you advance is only mere matter of aſſertion, or if you attempt any thing further, ſuch is your ſucceſs, that what you endeavour to prove, ſtill remains to be proved by ſome other perſon.
The queſtion is—What ſhould be done for the ſafety of the Mo⯑ther when her ſtrength is exhauſted, and her pains inſufficient to bring the Child; ſo that ſhe is every moment in danger of dying undelivered.—Dr. Leake admits, there is danger in the Operation, but at the ſame time ſhews why there is much more, when it is neglected, and therefore, of two evils, the leaſt is to be choſen; eſpecially ſince there is no other alternative, than that one of kil⯑ling the Child, by opening its head; for he has ſhewn that Smellie's Forceps are much too ſhort to reach and extract it thus ſituated, and that it is by no means eligible to turn the child: ſo that all you have been able to advance againſt this practice, is mere invective; being nothing but a few formidable Epithets to excite horror, and to deter the weak and timorous from uſing the Forceps recom⯑mended by Dr. Leake; and leſt his ingenious Invention of combi⯑ning the action of the Forceps and Lever, ſhould chance to pluck a feather out of your wing.
You talk of dreadful conſequences, and cruſhing of heads, as others would talk of cracking nuts; but if ſuch reaſoning as this could prevail; then the uſe of the ſhort Forceps, of which you are ſo fond, ſhould alſo be rejected, even when the Child's head is below the brim of the Pelvis; for fear of lacerating the Perinaeum; and for the very ſame reaſon if it could be found to have any weight, no Surgeon would ever venture to cut for the Stone, leſt the patient ſhould die by the conſequence of the Operation.
You ſay,—It is ſuppoſed that the hind-head is forced over the Sym⯑phyſis 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 [14]I call upon every Gentleman converſant in practice to confirm the truth of the Aſſertion.
It is not poſſible, you ſay, to apply Forceps of any kind. Dr. Leake being apprized of the difficulty attending the application of all Forceps in this particular caſe, becauſe of their lateral preſſure, which increaſes the longitudinal diameter of the head, and forces the Occiput ſtill more over the Pubes, has therefore, invented a third Blade, which combined with the Forceps acts as a Lever, applied immediately to the reſiſting point or Occiput; and that without the leaſt danger of hurting the mother; a circumſtance which has often happened by the uſe of the common Lever.
Thoſe things premiſed and duly attended to, I think it will fol⯑low that you may call on Gentlemen converſant in practice a long time before they anſwer to the truth of your Aſſertion, without your appeal is made to thoſe who are as much averſe to improvement as you ſeem to be yourſelf, and who chuſe to grope in the dark, when they might walk in open day.
The following Abſtract from Dr. Leake's deſcription of his Forceps, will ſtill more fully illuſtrate and explain the true nature and uſe of the Lever or third Blade, and ſhew under what particular circum⯑ſtances its application becomes neceſſary and advantageous.
"When the fore-head preſents to the Os Sacrum, and the hind-head to the Pubes, the long axis of the head interſects the ſhort axis of the Pelvis, and therefore, theſe Parts may be conſidered as two Ellipſes croſſing each other;—a Poſition of the head very un⯑favourable to the Birth of the Child.—Whenever this is the Caſe, a very capital Inconvenience, even in the long double-cur⯑ved Forceps will occur, for when they are thus applied on the Sides of the Head, the more it is there compreſſed by the Action of the Blades, the more will the Hind-head be forced over the Pubes, and the Fore-head againſt the Sacrum, which will ſtill add to the difficulty, and conſequently it cannot be extracted in this [15]manner, without great violence both to the Mother and the Child:—This Circumſtance has happened to me in Practice ſeveral times, particularly in two laborious Caſes, where the re⯑peated Application of the Blades at the ſides proved ineffectual; and dangerous Symptoms appearing, I was afraid of further delay, and therefore, (the patient being placed on her ſide) I introduced them at the Sacrum and Pubes, that is, on the Face and Occiput, and extracted the head with eaſe at the firſt effort.
As this Succeſs was plainly owing to the Compreſſion of the longeſt part of the Head, it firſt ſuggeſted to me the Hint of ap⯑plying a pair of Forceps with three Blades, one of which may be occaſionally uſed as a Lever, which will act on the ſame Princi⯑ple as that of Roonhuyſen's.
But notwithſtanding the ſeeming Simplicity of Roonhuyſen's Lever, it may be attended with the utmoſt Danger; for, as the Symphyſis of the Pubes is the Centre from which it acts, and the Point upon which the whole Streſs is laid, whenever much force is applied to bring down the head, (Action and Re-action being the ſame) the Vagina, Neck of the Bladder, and nervous Parts may be ſo violently bruiſed, as to occaſion a Mortifi⯑cation, or even the very Symphyſis of the Pubes may happen to give way.
To remedy this Inconvenience, which is the principal Objec⯑tion to the Lever, I have, for ſome Years paſt, in my Courſe of Lectures on Midwifery, recommended an Inſtrument conſiſting of three Blades, being, in fact nothing more than a Pair of long Forceps with a double Curve, and the Addition of a Lever, which may be applied without the leaſt danger of hurting the Mother; for here the Fulcrum of the Lever is removed from the Pubes to the Junction of the two Blades, which not only act as a Pair of Forceps, but at the ſame time afford a firm reſting Point [16]for the third Blade, by means of a ſmall Pivot or central Pin, placed on the under Side of one of their Blades.
After the Introduction of the Blades of theſe Forceps at the Sides of the Child's-head, this Lever is to be paſſed up between the Occiput and Pubes, and as the Pelvis there forms a kind of Arch, and is alſo extremely ſhallow; by inclining the Handle low towards the Perinaeum, it may be introduced without the leaſt Degree of Violence.
The additional Blade or Lever applied immediately to the re⯑ſiſting Point or Occiput, where it reſts at the Pubes, will not only effectually ſhorten the Head, and detach it from the Place of its Obſtruction, but will alſo prevent the Forceps from ſlip⯑ping; for if they tend down towards the Face, the Lever, which is fixed at the Hind-head, and ſuſtained at the Junction of the Blades, muſt be drawn down with them, and conſequently the head alſo will ſtill be the more brought into the Centre of the Pelvis, and therefore more eaſily extracted; which may be better underſtood by referring to the third Figure in the Copper-plate.
In ſhort, theſe two mechanical Powers of the Forceps and Lever thus combined, will mutually aſſiſt each other;—For, the Lever will not only prevent the Forceps from ſlipping, but will alſo ſhorten the Head, and bring it down below the Arch of the Pubes into the Centre of the Pelvis, by which means it may be the more eaſily extracted; on the other Hand, the Forceps will afford a reſting Point to the Lever, from which it may effectually act without any Sort of Danger to the Patient, ſo that we have the Advantages of both Inſtruments, without the defects of either."
Dr. Leake does not here vainly magnify the merit of inventing this new Inſtrument, but plainly tells us, it was owing to a mere matter of accident which occurred to him in practice.
[17]You tell us that—The cenſure of Dr. Smellie's Forceps is unpro⯑fitable—You cannot then ſay, that Dr. Leake is mercenary; but I muſt inform you that to cenſure and to diſapprove are very different things: Thoſe who are beſt acquainted with Dr. Leake well know that he is leſs diſpoſed to cenſure than commend; and it is apparent he has not treated Dr. Smellie in the diſreſpectful manner with which you mention the Names of M. Leveret and H. Crantz.
You next proceed as a panegyriſt—Dr. Smellie was a Man of great candour, induſtry, and ingenuity, and we are all indebted to him. I have often heard Dr. Leake in the courſe of his Lectures men⯑tion his name with great reſpect, and chearfully ſubſcribe to his merit.
You ſay—We are all indebted to him. Thoſe who have attended his Lectures, I preſume, will not deny it; for your part, Sir, had you been as grateful to the Gentleman from whom you received your Inſtructions in Midwifery, we ſhould not have ſeen you engaged with him in a News-paper Billingſgate conteſt, A. D. 1769.
Again you ſay—Dr. Smellie's Forceps are not taper at the point—Not ſo taper as the point of a Sword;—but they are taper—verily they are taper.
You add—The largeneſs of the head, and narrowneſs of the Pelvis are relative terms, &c.—This ſeems to be a new and very notable diſco⯑very, and what makes it the more valuable, it is not more difficult to be demonſtrated, than that two and one make three.
You ſay—The caſe ſuppoſed in this Paragraph, I believe, never can happen at the upper part of the Pelvis.
In what Paragraph? for you do not ſay, whether in Dr. Leake's, or your own. Pray Doctor what Profeſſor, except ſuch as you have mentioned in the beginning of your Remarks, ever talks of a Caſe happening at the upper part of the Pelvis; I ſuppoſe you mean a caſe where the Child's head could not happen to be ſo placed [18]at the upper part of the Pelvis; if this is not your meaning, the caſe you allude to muſt be a headleſs caſe, a caſe without a head;—a very piteous caſe indeed, and ſuch as probably never happened to any one except Dr. Thomas Denman.
You proceed—My reaſon for preferring the ſtreight Forceps, is a conviction that this opinion is true, and that under theſe circumſtances the curvilinear Forceps become inconvenient.
Your reaſon is a conviction that this Opinion is true:—A very curious reaſon indeed; but I ſhall ſay no more on this paſſage, leſt I make a miſtake; for I confeſs 'tis far too ſublime for my comprehenſion.
Again, you ſay—I know enough of the Hiſtory of the Vectes, in as able hands as Roonhuyſen's, to convince any reaſonable man, that much miſchief may, and has been done by them.
For this very reaſon Dr. Leake has contrived a Lever or Vectes, which occaſionally combined with the Forceps, will produce all the effects of a Lever without the leaſt danger of hurting the Mother.
Thus you proceed—Roonhuyſen's Vectes changes its centre of action, and though it may be fixed againſt the Symphyſis of the Pubes, the Ramus of the Iſchium, near the obtuſe proceſs, muſt become the Ful⯑crum, or you will not be able to extract the head.
Here it is preſumed you meant to have ſaid ignoramus, and that by ſome unaccountable blunder of the Printer's, the word Ramus unluckily ſlipt in.
You tell us that—The reſiſting Point is not particularly where the hind head preſſes againſt the Pubes; but that the head is wedged and preſſes on many Points.
You ſeem here to have forgot what every Practitioner in Mid⯑wifery ought particularly to remember, viz. that the Brim of the Pelvis is an Ellipſis from ſide to ſide, and meaſured in that direc⯑tion, is one inch wider than from Sacrum to Pubes; and conſe⯑quently [19]the Head thus wedged in the bony paſſage, muſt of courſe meet with moſt reſiſtance where the Pelvis is narroweſt; particularly, as the long axis of the Head is now turned to the narrow axis of the Pelvis, or as Dr. Leake expreſſes it, where two Ellipſes are croſſing each other; and therefore, contrary to your aſſertion, the reſiſting point muſt neceſſarily be where the hind-head preſſes againſt the Pubes.
You ſay—You object to the uſe of all curvilinear Forceps—I ſup⯑poſe then you mean to make uſe of none at all; for all Forceps are curvilinear, or they could not be Forceps; but all Forceps have not a two-fold curve, which I preſume is the thing you mean.
Thus, Sir, you continue to ſpeak, and leſt the elegance of your expreſſions ſhould ſuffer by the leaſt alteration, I ſhall ſet them down verbatim.—The curve of M. Levrett's Forceps ſeems the moſt convenient, and Mr. Oſborn has contrived a very elegant pair, by diminiſhing the ſize of Levrett's and very little alteration beſides.
Juſt now you objected to the uſe of all ſuch Forceps, but now all of a ſudden Levret's are the moſt convenient; how does this accord?
Beſides, as you ſay that Mr. Oſborn's Forceps differs very little from Levret's, except in ſize, it is not eaſy to conceive how a diminution of the ſize alone, can properly be conſidered as a new invention. But here let me aſk you whether this Contrivance of Mr. Oſborn's, whatever it may be, was prior or ſubſequent to that deſcribed by Dr. Leake. A direct anſwer to this ſimple queſtion might probably unfold the myſtery, and determine what merit is due to Mr. Oſborn from this very elegant pair of Forceps.
Again you ſay—Allowing Dr. Leake the full force of his own reaſoning, I cannot conceive the advantage ariſing from this complicated Inſtrument.
[20]Here, like the Satyr in the Fable, you blow hot and cold with the ſame breath; for hitherto you have endeavoured to con⯑trovert his reaſoning in the beſt manner you were able; but now comes a kind of aukward and indirect aſſent.
You ſay—You cannot conceive the advantage ariſing from this complicated Inſtrument.
The Forceps recommended by Dr. Leake is by no means complicated, for whenever the Lever is unneceſſary, they may always be applied alone with the ſame eaſe and ſafety, and gene⯑rally with a better effect than any other, for the reaſons which he has ſpecified.
Thus you proceed—If we act with the Forceps from handle to handle, the third Blade can do no ſervice.
The Lever or third Blade will effectually prevent the Forceps from ſlipping down over the Child's Face, which is a very capital advantage, eſpecially as it cannot in the leaſt injure the Mother more than the other two, although we act with them from handle to handle.
Again you ſay—If we act with the Lever, the Forceps are uſeleſs or prejudicial.
You have before allowed that Roonhuyſen's Lever is a dangerous Inſtrument; but as Dr. Leake has proved to a demonſtration, that the Lever combined with the Forceps, may always be ſafely and advantageouſly applied, both your aſſertions become evidently groundleſs. Indeed, throughout the whole of your performance, from a doating affection for every thing you have ſaid on the ſubject, you have never been fortunate enough to diſtinguiſh the very great difference between ſimple aſſertions and ſolid proofs; the firſt are always ready at every man's call—upon the laſt de⯑pends the fair and equitable deciſion of all points of controverſy whatever.
[21]I have now examined moſt of your Remarks, yet I confeſs that ſome of them are abſolutely unanſwerable;—thoſe, Sir, alone are they which are utterly unintelligible; and to conclude, if I am not miſtaken, as you were, when in ſpeaking of the Forceps, you miſ⯑took the Child's Head for their Centre of Motion, all your Views centre in yourſelf; though even that part of your deſign you have executed but very indifferently, for your Style is clumſy, aſſum⯑ing, and pedantic; your Objections are frivolous and unfairly urged, and your Aſſertions, though poſitive, and highly expreſ⯑ſive of ſelf-importance, are generally unſupported by reaſoning and matter of fact.—To conclude, conſidering the air of exultation with which you ſet out, it may be ſaid with great juſtice and truth, that the whole of your performance is moſt pompouſly poor indeed.
You tell us, that you pay great regard to Dr. Leake's Abilities; I wiſh I could with a ſafe conſcience ſay as much for you; for if I was diſpoſed to compliment you on your abilities, your candour muſt ſuffer; and if I had an opinion of your candour, it muſt neceſſarily be at the expence of your Abilities.
Thus, Sir, you have ſhot your lilliputian Arrows and wounded nothing but Air; when you can ſpare a little more of your precious time to advance any thing further on this ſubject for the public good, I ſhall not be wanting in giving it due Attention.