may be very fafely extracted, and flipped
through the os externum, and thus the wo-
man will be fafely delivered.
But if the placenta does not feparatc from
its adhefion to the uterus almofl: immedi-
ately after the child is delivered, and can-
not be felt in the vagina by the practitioner's
finger when introduced into the vagina, he
muft then wait patiently until the fepara-
tion of the placenta takes place by a ftill
further contradion of the uterus, which is
known by pains alternly coming on, which
are the more clofe contractions or natural
clofing up of the uterus ; if then, after
having waited for ten, fifteen, twenty, nay
thirty minutes, for a few after-pains to con-
trad the fundus uteri, and to caft off the
placenta, fo that it may be funk down into
the vagina and there readily touched with
the finger, it may then be fafely affifted
along at the next occurring pains, after the
manner jufl mentioned, and thus extraded.
But if no pains occur after the child is de-
delivered,
( 77 )
delivered, and the placenta cannot as yet be
touched with the finger, it mufl: be left to
nature, and the pradlitioner muft wait even
if it is for feveral days, two, three, four, or
even longer, avoiding by every means the
ra(h and rude introduction of the hand into
the uterus *, for feparating it, or I may fay
tearing or rather flaying it off with the
finger from the tender and irritable furface
of the uterus. Therefore if the gentleft
efforts to extract the placenta do not fuc-
ceed, and prove fufKcient, it mufl be left
entirely to nature; for after a few days it
will probably be expelled naturally, and
thrown out through the os externum, and
this I have known greatly to be aflifted by
the gentle efforts or expuUive bearings as at
ftool, occafioned merely by the return even
of an emollient clyfler.
Such then are the modes f by which
labors
* Though fo generally, but yet (o injudicioufly, ad-
vifed in adhefions, or rather retentions of the placenta
within the uterus.
f With refpedl to the efpeclal manner how each
operation in the different kinds of labor fliould be per-
formed
( 78 )
labors fhould be conduced, and fuch are the
accidents, injuries, &c. that may happen to
women injudicioufly treated and hurried in
their deliveries. Thus much for the ma-
nagement of natural labors and fafe extrac-
tion of the placenta.
It will now, fixthly^
Be proper to mention, that there is yet
another accident which may happen to a
lying-in woman, and which fome pra61;i-
tioners may not think of, nay perhaps never
imagine, and which is equally, if not more
formed particularly, the author has not here attempted to
explain, that will be the fubjeil of future dilTertations,
comprehending alfo a general review of the feveral opi-
nions of the different authors of midwifery, as to the par-
ticular condufl and management of pregnant, parturient
and lying-in women ; but in this, as a kind of introduc-
tory or general diflertation thereunto, he has only endea->
voured chiefly to fiiew and point out the neceflity, what-
ever may be the mode or infcrument necefTary for the de-
livery, that it fhould be conducted flov^Iy, gently, gra-
dually and regularly, with patience and humanity, avoid-
ing every degree of unneceflary force, leaving the whole
entirely, or as much as pollible, to the efforts of na-
ture.
dangerous
( 79 )
dangerous than any other, perhaps from not
being fufpeded ; and that is from, certain
parts of the uterus through the hurry and
violence of labor irregularly and unduly con-
tracting, by which means certain portions
of the uterine veffels are as it were encircled
and conftriiled as in a ligature, hence from
fuch conftri<9:ed portions of the uterus arife
many uterine complaints, as excruciating
after- pains, inflammation, mortification
with all its dreadful effeds ; and hence the
fource perhaps of every child-bed fever f >
very frequently fatal. How flow, how re-
gular, how gradual, attentive and cautious,
ought then every practitioner to conduCl
even the mofl natural labor.
Hence, to prevent any painful, {evere^
or dangerous complaint happening to wo-
men during or after their parturition (and
particularly from too great hurrj^ or offici-
ous afiifl:ance to haden delivery), every
kind of labor fliou14 be conduced flowly^
graduall}^ and gently ; and the woman
fhoitld be even conftantly exhorted not to
bear down, or force with her pains, or ufe
any other means to increafe the natural ef-
forts
( 8o )
forts of her labor ; fo that the child may
he delivered gently, gradually and flowly,
and with as little force as poffible ; and the
feparation, &c. of the placenta fhould in
like manner be left to nature, it being ten
to one but that fome mifchief will arife, if
the practitioner attempts to hurry, or im-
prudently affumes according to the labor to
allift beyond w^hat is neceffary ; for it has
ever been obferved, that rafh, impetuous
and injudicious pra6litioners in midwifery
have always the greateft number of bad
cafes, and that ariling merely from their
own too hafty, ra(h, imprudent and bad
management ; and indeed how fhould it be
otherwife, as they never confider nor re-
fledl on the cafes that they attend, and per-
haps are totally ignorant how to manage
them ? It is coolnefs in temper, conflant
affiduity, attention and length of time only,
that can make a good, fafe and experienced
pra6titioner in midwifery..
In fine, what I have mentioned in thefe
few pages I can aver to be true, from a
practice of more than thirty years, and
from the attendance -on more than five
thoufand
( Si )
thoufand * labors ; out of thefe, I could re-
late many inftances or cafes to illuflrate
what I have here aflerted, but omit them
as being tedious, and perhaps fimilar to
what other praftitioners in midwifery may
have alfo feen, probably without paying any
kind of attention to them ; but if any one
doubt what I have here afferted, let them
for the future obferve, and remark -every
cafe that they may attend, and then I am
confident they will in a little time find,
* This number perhaps to fome perfons may appear
great, and too many to fall to the pradlice of one manj
but the author muft inform them that for upwards of
twenty years there wa? no other male pradlitioner in
midwifery than himfelf in Oxford, and but very hw
round it for many miles, confequently many very tedi-
ous, dangerous, laborious and preternatural cafes fell to
his attendance and care, all which he endeavoured to
conduct after the manner here related, and indeed fuch
modes and treatment, a#" relates to the mother, child, and
placenta, he has for many years inculcated amongft his
medical friends j andlf it had not been for the delay of
waiting for the occurrence of a number of flooding cafes
at the onfet of or during labor to have fatisfied his mir,d
from whence ihe haemorrhage really proceeded, and to
afcertain poiitjvely the beft' and moft fafe mode, &c. of
condudting fuch cafes, a fomewhat limilar difTertation to
this, as relative to its other parts, would have appeared
ilTome years aeo.
G that
( 82 )
that what I have here related is nothing but
the truth.
Thus much for the condudl and manage-
ment of labors in general ; but as the Ob-
ftetric Forceps is of fuch confequence in
the delivery of retarded labors, it will
now.
Seventhly,
Be necelTary to attempt geometrically to
proportion and dehneate the different forms
of the fingle curved Obftetric Forceps, as
mentioned in the foregoing pages ; and firft
with refpe6l to the common iingle curved
Forceps as delineated in
Fig. I.
Which fhews the two fides of the iingle
curved Forceps connected or locked to-
gether, confequently can only exhibit the
fhicknefs of the blades, their proper curva-
ture, the breadth of their (hanks, together
with the length, tbicknefs, fhape, &c. of
the handles.
But to form the iingle curved Obfletric
Forceps geometrically, and as near as pof-
liblc
( 83 )
fible to the alterations of Dr. Smellie's For-
ceps, as mentioned page lo, and thereby
to fix it to one general fhape, fize or ftand-
ard. Firft, as in Fig. i, draw in length a
right line as A B eleven inches and one half
of an inch, which will be the axis of the
Forceps ; then from the point A, fet off fix
inches and one half of an inch towards B as
at the point C, which line A C divide in its
middle as at the point D, with the line
EF, at right angles with the line AC;
then on the line D E, fet off one inch and
the four tenths of an inch as at the point G,
and again on the line D F, fet off one inch
and the four tenths of an inch as at the
point H ; then w^ith the radius of four
inches and one half of an inch on the line
G F as from G to J, draw a curve line from
A through G to C, and again, with the
like radius on the line H E as from H to K,
draw another curve line from A through H
to the point C, and thus two regular curves
as A GC, and A H C (the fegments of a
quadrant), for the internal curvature of the
Forceps' blades are formed.
And now, to give the blades their pro-
G 2 per
( 84 )
per expanfion at their ends, from the point
A fet off on each curve line A G, and A H,
the fix tenths of an inch as at the points L.
and M, which are the ends of the Forceps'
blades, and thus the ends of the blades gain
an expanfion of about the eight tenths of an
inch as from L to M, and hence the length
of the chord line of each blade when locked
together will be, from the point C to the
points L and M, about fix inches and half
the tenth of an inch.
And further, to give the blades their
proper thicknefs, through the points Land
M, draw a right line as the line N O, and
then from the point L toward N fet off two
tenths of an inch as at P, and again from
the point M towards O fet ofi two tenths,
of an inch as at Qj. then from the point G
on the line GK fet off two tenths and half
a tenth of an inch as at the point R, and
then on the line R J fet off from R four
inches and four tenths of an inch as from R
to S, and on that radius draw a curve line-
from R to the point P ; again ^ from the
point H on the hne H S, fet off two tenths
and half the tenth of an inch as at the point
T,
( §5 )
T, and then on the line T K fet off four
inches and four tenths of an inch as frona
T to U, and on that radius draw a curve
line from T to Q. and thus the thicknefs
of the blades from their utmoil: curvature,
as at the points R G and H T, is regularly-
formed to their ends at PL and MQ^
which from their outer edge muft be gra-
dually rounded off to their inner as at L
and M.
Again, to give the full length and curva-
ture of each blade, firfl fet one foot of the
compaffes at the point J, and with the
other foot continue the curve line frorn G
through C to the fix tenths of an inch as to
the point V ; and again, fet one foot of the
compaffes at the point K, and with the
other continue the curve line from H
through C to the fix tenths of an inch as
to the point W;— then to give the (hanks
of the blades their proper breadth from their
utmoft curvature as at R G and H T, with
a radius of fix inches two tenths and half
the tenth of an inch ^on the line R F, as
from R to the point X, draw a curve line
from R to the point W as the curve line
G q RW;
( 86 )
R W ; then with the like radius of fix in-
ches two tenths and half a tenth of an inch
on the line T E as from T to the point Y,
draw a curve line from T to the point V
as the curve line T V, and thus the major
part of the fhanks of the Forceps' blades are
formed.
But to 2;ive the fhanks their final length
and breadth, fet off from the point C on
the line C B one inch as at the point Z ;
then from the point \V draw a right line to
the point Z as the line W Z ; and again,
from V to Z draw another right line as the
line V Z, which two right lines terminate
the length and breadth of the fhanks of the
Forceps' blades, and alfo from the doping
part of the groove for the locking part of
each blade, as from W to Z, and from V
to Z ; and thus, are geometrically afcer-
tained, the length and proper curvature of
the Forceps' blades, together with their
thicknels from their ends to their utmofL
curvature, and from thence the breadth or
width of their flianks as necefTarj for their
flrength in their different parts even to
their locking parts, and alio the flopes
of
( 8; )
of the grooves for the locking parts of the
Forceps.
As to the formation of the Forceps'
handles, I can only fay pofitively that in
length from the point C to their ends as at
B, they fhould not exceed five inches ; or
from the point Z (the bottom part of the
groove for the locking of the Forceps'
blades) to B four inches, fo that the whole
length of the Forceps fhall not exceed
eleven inches and half the tenth of an inch :
as to the vt^idth of the groove for the lock-
ing part, it fhould be only juft fo wide as
to admit eafily the thicknefs of the fhank of
the oppolite blade ; and the cheek a of the
locking part fhould be of fuch a thicknefs
as one tenth of an inch, or what is necef-*
fary only to give them ftrength, fo as to
keep the fhanks of the blades fteady (vid.
Fig. 2) : but thefe particulars will always
vary a little to the fancy of the maker, as
will alfo the fize and fhape of the handles,
for as the handles of the Forceps if they
were made entirely of folid iron would be
very heavy, therefore the maker, as foon as
he has formed the cheek a^ and the breadth
G 4 of
( 88 )
of the groove for the locking part and its
thicknefs (which may be two or three
tenths of an inch as from the points W and
V to the points h^ b,^ of fufficient ftrength,
fize, &c. he then beats the remaining part
of the iron into a thin plate as at c, c, c, c,
{o as not to be more than one tenth, or
hardly to be more than half the tenth of an
inch thick at the bottom or end of the
handles as at B : the other part is made up
of hard wood or horn, rivetted to it as at
J,d,J,d; and then it is cut. Hoped and
fhaped, to the fancy of the maker, who
for the mofl part finally covers it with
leather.
But to fix in fome refped the fize, fhape
and thicknefs of the handles j firfl, through
the point B at right angles with the line
B Z C D and A the axis of the Forceps,
draw the right line ef, and then on that
line fet off one inch on each fide of the
point B, as at the points g and L; then draw
a right line from the point g to the point
W, the top of the groove for the locking
part of the handle, and the like on the
other fide from the point /> to the point V,
5 and
( 89 )
and thus is obtained a regular {lope for
forming the Forceps' handles ; and further,
to regulate the indentations in the handles
neceflary for the operator's firm holding
them, fet off from the point g on the line
^W, firil: half an inch, then another half
inch, and then one inch more, and another
inch beyond that towards W, as at the
points /, i, /,m; and the like on the other
fide from the point /? on the line A V, as at
the points n, o, p, q ; then let the maker in
forming the thicknefs of the handles gra-
dually round and indent them from the
points W and V, to the points 7n and^ ^,
about one tenth of an inch, and from
whence let him again gradually fwell them
out to their full extent as at the points /
and ^, from thence again gradually round
and indent them to the points k and o, two
tenths of an inch, and from thence again
gradually let them fwell out to their full
extent as at the points / and n^ and then
gradually round them off to their ends, as
reprefented by the black wavering line from
the points b^ b^ to the bottom of the handles
^t B.
Hence
( 9*^ )
Hence from this defcription and view of
Fig. I , I believe that any artifl: may form
geometrically the proper curvature of the
Forceps' blades, their thicknefs, and the
length and width of the fhanks in all their
fe^^eral parts as neceflary for their ftrength,
together with the regular flopes of the
grooves for the locking parts, and the fize,
(hape and thicknefs of their handles.
Fig. 2.
But, as it is impoflible to fhcw the ne-
celTary breadth of. the Forceps' blade, the
thicknefs of its fhank, and the width of the
groove for the locking part, and height and
thicknefs &c. of the cheek of the locking
part, together with the proper curvature of
the blade, &c. in one figure, it is therefore
iieceffary to reprefent them in another as in
fig. 2, and even here as it is impoflible on
paper to reprefent any depreflion or curva-
ture in a forefliortened manner, that is, by
a right line, fo the breadth of the blades,
&c. can only be given as correfpondent to
the different parts of their curvature, as in
Fig. I, and therefore thereunto to confl:ru<5l
geometrically
( 91 )
geometrically the breadth of the Forceps*
blade, the thicknels of its {hank, with the
width of the groove for the locking part,
the height and thicknefs of its cheek, and
breadth of the handle, firfl: draw a right
line eleven inches and half the tenth of an
inch in length as the line AB in Fig. 2,
which is the axis of the Forceps ; then from
the point A on the line A B fet off the
feven tenths of an inch as at the point C^
and then on that point, and with that radius
defcribe the femicircle DAE, after which
draw its diameter D E, and this forms the
iliape and breadth of the blade at its end 1
then fet off from the point C on the line
C B two inches and one tenth of an inch as
at the point F, and crofs it at right angles
with the line G H, and from the point F
onthe line GF fet off half an inch and the
half tenth of an inch, and the fame diftance
on the line FH as at the points J and K,,
and thus the breadth correfponding to the
utmofl: curvature of the blade is formed :
then from the point F on the line F B fet
off two inches and three tenths of an inch
as at the point L, which is the point of the
blade's
( 92 )
blade's bifurcation, or divifioii of the fur-
rounding iron which forms the blade ; then
fronri the point L on the line LB fet off the
iix tenths of an inch as at the point M,
through which point at right angles draw
the line N O, and then on each fide of the
point M on the line N O fet off one tenth
and half the tenth of an inch as at the points
PQ; then draw a right line from the point
P to the point J, and likewife from the
point J to the point D ; and again, draw a
right line from the point Qto K, and from
K to the point E, and thus the breadth of
the Forceps* blade is formed from its end to
the narrowefl part of its fhank. But as
this blade, if it were compofed of one folid
iron plate, would be very heavy, it has
therefore, to make it lighter and ftill to have
the fame effe6l, been cuftomary for the
maker to take out the inner part, leaving
only a furrounding border about the breadth
of two tenths or three tenths of an inch :
but, however, to form this part of the For-
ceps' blade, tlrft fet off from the point J on
the line J F two tenths and half a tenth of
an inch ; and the fame diflance from the
point
( 93 )
point D on the line D C ; and the fame
from A on the line A C ; and then from E
on the line E C ; and again from K on the
line K F, as at the points R, S, T,U and V;
then draw a right line from the point L to
the point R, and from R to S, and then de-
fcribe the femicircle S T V, on the radius
of S C ; and then from the point U draw a
right line to the point V, and from V to L,
and thus the proper breadth of the fur-
rounding part or iron of the Forceps' blade
is afcertained.
And further, to form the thicknefs of the
bottom part of the fhank of the Forceps'
blade, &c. firfl fet off from the point M on
the line M B half an inch as at the point W,
from which point to the left hand draw aC
a right angle with the line WB a right line
as the line WX, and then fet off half aa
inch from the point W on the line WX as
at the point Y, and again fet off one tenth
of an inch more towards X as at the point
Z, this gives the height and thicknefs of
the cheek of the locking part ; — then from
the point W on the line VV B fet off a quar-
ter of an inch as at the point «, from which
draw
( 94 )
draw to the left hand at a right angle with
the hne aB the Hue a b^ and on which from
the point a fet off one tenth and half the
tenth of an inch as at the point c, and then
from c fet off three tenths and half the
tenth of an inch more towards b as at the
point d, which gives the width and top of
the groove for the locking part ; then from
the point a on the line aB fet off the fix
tenths of an inch as at the point e^ through,
which point at right angles draw the line
fg^ then on each lide of the point e on the
\\i\Q,fg fet off one tenth and half the tenth
of an inch as at the points h and /, then fet
off three tenths and half the tenth of an
inch from the point h oa the line hf as at
the point i, which gives the width of the
groove at the bottom of the locking part ;
and then from the point k on the line kf
fet off one tenth of an inch as at the point
/, which fixes the thicknefs of the cheek of
the locking part. Hence, to form out the
cheek of the groove for the locking part,
draw a right line from the point / to the
point Z, and from Z to Y, and from Y
through d to k, and to form the width of
the
{ 95 )
the groove at the top of the locking part,
draw a line from d to c, which is the top of
the groove ; and to form the width of the
groove at the bottom of the locking part,
draw a line from the point i to Z', which is
the bottom of the groove; and finally, to
form the thicknefs of the (hank of the For-
ceps' blade, draw a right line from the point
Z* through c to the point P ; and then from
the point Qdraw a line to the point /, and
thus far is formed the breadth of the For-
ceps' blade, the thicknefs of its fhanks, the
width of the groove for the locking part, and
thicknefs of its cheek.
But with refpedl to the further conftruc-
tion of the Forceps' handles, it can only
again be obferved, that the length of the
handle ihould be four inches from the point
e, or bottom of the groove for the locking
part, to the end of the handle at the point
B ; and in its width towards its bottom it
may be about one inch and three tenths of
an inch. However to form the breadth of
the handle fo as fomewhat geometrically to
anfwer to its thicknefs in Fig. i, draw
through the point B at right angles with
the
( 96 )
the line eB the Vine mn; and from the point
B on the line fn B fet off nine tenths of an
inch as at the point o; and again on the line
B« fet off four tenths and half the tenth of
an inch as at the point p ; then draw a right
line from the point o to the point /, and
again from /to p; and thus is obtained a
regular Hope (for forming the handle) from
the bottom of the groove for the locking
part to the end of the handle 5 and further,
to make it correfpond with the fhape of the
thicknefs of the handles in Fig. i, fet off
on the line /, firft, half an inch, then an-
other half inch, and then one inch, and then
another inch more towards / as at the points
^, r, s and / ; and the like diftances on the
other fide as on the line p i as at the points
u<i V, w and x, on that line ; and further, to
regulate the necellary indentations of the
handle to anfwer agreeably to thofe in Fig. i ,
let the maker in fhaping the breadth of the
handle gradually round and flope it on each
fide from the points // to the points fx,
about half the tenth of an inch ; then from
the points / a; to the points s w as gradually
fwell it out to the full extent ; then again,
gradually
( 97 )
gradually round and indent it on both fides
about one tenth or one tenth and half the
tenth of an inch to the points r v ; and then
again gradually Iwell it out to the full extent
at the points ^ zl 3 and laflly, as gradually
round it off to the end, as reprefented by
the waverhig black lines from the points /
and i to the bottom of the handle as at B.
And further, with refpedt to the other
parts of the Forceps, the maker muft ever
temerriber carefully to fmooth, polifli and
round off every part, fo as not to leave any
kind of fharp, prominent, or acute edge
whatever ; and thus by obferving and mi-
nutely following thefe directions and geo-
metrical proportions, one general ftrudlure
of the Oblletric fingle curved Forceps may
by anyartiftbeeafily conftru(Sted and made;
which in the hands even of the mod; inex-
pert pra6litioner, will rarely hurt or bruife