Soon after Chapman taught, Dr Smellie came for ward, and gained deserved reputation both as a practi tioner and teacher. He published, 1752, a system, which, although unimportant now, was long the ele mentary work consulted by all students, and to this he afterwards added two volumes of cases, and one of plates. He gave distinct rules for using the forceps, which he improved in their construction. He did not, however, carry their utility far enough ; for he is found still advising the old mode of turning when the head is not fixed. In his class he made considerable use of ma chines ; and, if we may credit his enemy Dr. Douglass, he endeavoured to condense his information, so as to suit all purses as well as all capacities; for he is said to have hung out a paper lantern with these words, Mid wifery taught here for five shillings " About the same time, Levret, in.Paris, acquired high reputation, not only for his description and improvement of the forceps, but for his general knowledge of mid wifery. HIS observations on uterine hemorrhage, con sidering the state of science at the time, are admirable and important. Accoucheurs have made a distinction of floodings into those arising from detachment of the membranes, or part of the placenta which is properly situated, and those produced by the placenta being at tached in a greater or less degree to the os uteri. In the former case, Puzos advised the membranes to be rup tured, in order to excite contraction of the womb. In the latter, Levret decided that nothing but delivery could be useful. By blending these two works, Rigby afterwards compiled a treatise on the subject ; but the opinion now of every judicious practitioner is, that in all cases of flooding requiring manual interference, that ought to consist in delivering as soon as it can safely be accomplished. Tois is a subject of very peculiar im portance, and it is necessary that the practitioner make himself well acquainted with the principles of conduct, and act with promptitude and decision.
Dr. Hunter appeared also on the field about the same ti Tx; for he came to London in 1741 His ta lents, his general learning. his profession.ci knowledge, his zeal and industry, together with a good manner, introduced him into extensive practice. His obstetri cal works consist of the anatomy of the gravid uterus, illustrated with very splendid plates, and a descrip tion of the retroversion of the womb. He added to his anatomical lectures a few on midwifery, which, it is much to be feared, have done essential injury to the profession and the community. Patience was his ad vice in most cases, and an almost unbounded reliance on the power of nature formed the basis of his prac tice. That much good sprung from his admonitions to avoid irritation, and the use of stimulants in natural labour, is unquestionable. But it is equally true, that, vvhen assistance is necessary, patience becomes an other name for negligent procrastination. It is not to be credited how many women and children are lost by too great reliance on the power of nature, and a re prehensible delay in having recourse to the assistance or art ; and with the highest respect for the memory of Dr. Hunter, the writer of this article remains con vinced, that his authority contributed greatly to intro duce and support that passive conduct which is too often pursued in protracted labour. The directions of the late Dr. Osborn on this subject, which sprung from the school of patience, cannot be read without asto nishment, and the deepest regret ; and the consequence of this system of delay is and must be, that in many instances, although the child be at last expelled, it is born dead, and the mother soon follows ; or instru ments are at last used, when they are less likely to save both parties than if they had been employed ear lier, whilst, in all, the patient suffers more pain by this supine conduct, than she would have done by more vigorous practice.
It unfortunately happens, that in some instances the pelvis is so contracted or deformed, that by no me thod can a living child he brought through it. In such cases four different methods have been proposed : 1st, To open the head, and fix a hook or crotchet on it, and then draw down the child. 2d, To make an incision through the skin and muscles into the womb, and thus extract the child alive. This is called the Caesarean operation. 3d, To divide the joining of the bones of the pelvis in front, and thus endeavour to enlarge the cavity through which the child must pass. 4th. To induce premature labour. It is not necessary to enter here into any critical examination of the com parative merits of these different methods. It may only be observed, that the chief point of controversy is, whether the crotchet or the Caesarean operation should be preferred. In this country the former is always resorted to, when possible, and the latter is only performed in extreme cases. These, it may therefore be expected, can seldom prove successful ; and, as if the condition of the patient were not a suffi cient source of danger, it is seldom performed till she has been some time in labour, and perhaps consider ably exhausted. This has arisen from the same cause which has been already so strongly reprehended. It sorely may he early ascertained in such extreme cases, that the pelvis is too small to permit of delivery by any means through it ; and delay, after this known, is adding to the hazard of an operation which requires no additional risk to render it lormidable. This delay has greatly arisen from the arguments and statements of the late Dr. Osborn, who maintained that no case of deformity so great could occur as would prevent the extraction of the child by the crotchet. In proof of this, he published a case where the operation proved successful in extreme contraction. The fallacy of his reasoning was very ably shewn by the late Dr. Hamil ton, whilst Dr. Johnston experimentally proved, that it was impossible to bring a mutilated child through an aperture cut in a piece of wood exactly of the di mension of the pelvis described by Dr. Osborn, who consequently must have been deceived. It is of great importance to humanity to have this point ascertained ; for, although ever} British practitioner prefers the crot chet to the Caesarean operation, yet, it be conceded that in sonic cases the former cannot he employed, it follows that in such cases the sooner %se resort to the operation, the more likely it is to be successful. It has almost uniformly been fatal in country, but often successful on the Continent. This must arise either from its being perlormed earlier there, or on more favourable subjects. If in this country we per form it only on the most deformed and unhealthy, it is our duty to these sufferers not to increase their dan ger by delay, in the senseless expectation of being able to accomplish a physical impossibility.