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William Smellie

Born 1697
Died 1763

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Scottish obstetrician, born 1697, Lanark, Southern Scotland; died March 5, 1763, Lanark.

Biography of William Smellie

William Smellie was the greatest figure in English obstetrics. He was first to teach obstetrics and midwifery on a scientific basis; first to lay down safe rules for the use of forceps, and to separate obstetrics from surgery.

Smellie was the son of Archibald Smellie and his wife, Sara Kennedy. He attended the grammar school in his native town and probably received his medical education in Glasgow. In 1720 he commenced practice as a surgeon and apothecary in Lanark. He remained a country practitioner for almost twenty years.

In 1724 he married Eupham Borland, who survived him, and died on 27 June 1769. They had no children.

Smellie became e member of the Faculty of Physicians and Surgeons of Glasgow in 1733. Following studies in Paris, where he attended lectures on midwifery, in 1739 he went to London, where he established a pharmacy.

In London, William Hunter (1718-1783) came to live with him, and he began to give obstetrical lecture-demonstrations to midwives and medical students in 1741.The courses attracted large numbers of students, and his teaching is described by a pupil as "distinct, mechanical, and unreserved." His fee for a single course was three guineas, Smellie obtained his medical doctorate from the University of Glasgow in 1745.

He delivered poor women free of charge if his students were allowed to attend the delivery, thus establishing a trend towards the attendance of medically trained persons at childbirth.

Smellie had a prospering practice, and in 1759 he retired to Lanark to devote the last years of his life to completing his literary works. He bought a small property called Kingsmuir. This, with other land which he had bought before, formed an estate called Smellom, on which he built a house, and there died on 5 March 1763. He was buried near the church of St. Kentigern in Lanark, where his grave is marked by a tombstone and inscription.

Smellie always emphasised the importance of the natural birth process, and in general advised against resorting to surgical methods. He is best known for his descriptions of “the mechanisms of labour”, or how the infant’s head adapts to changes in the pelvic canal during birth. To him are owed the first attempts to measure the foetal cranium in utero.

Smellie was also reluctant to use the forceps, and permitted caesarean section only in the most extreme cases of narrow pelvis. To him the life of the mother always had priority to that of her offspring, so, when he saw it necessary, he never hesitated to perforate and destroy the brain of the foetus in order to save the mother.

Smellie developed various types of obstetric forceps, some with lock and curved blades, called Smellie’s forceps. He developed a craniotomy scissors, Smellie’s scissors. The method of delivery of the after-coming head with the child resting on the physicians forearm is known as the Smellie method. This was a rational attitude considering infant mortality at his time.

    Those who intend to practise Midwifery, ought first of all to make themselves masters of anatomy, and acquire a competent knowledge in surgery and physic; because of their connection with the obstetric art, if not always, at least in many cases. He ought to take the best opportunities he can find of being well instructed; and of practising under a master, before he attempts to deliver by himself.
    A Treatise on the Theory and Practice of Midwifery

    Nurses, as well as midwives, ought to be of middle age, sober, patient, and discreet, able to bear fatigue and watching, free from external deformity, cutaneous eruptions, and inward complaints that may be troublesome or infectious.
    A Treatise on the Theory and Practice of Midwifery

    I diligently attended the course of operations of Nature which occurred in my practice, regulating and improving myself by that infallible standard.

    Of washing and dressing the child
    The child being delivered, the navel-string tied and cut, a warm cloth or flannel cap put on its head, and its body wrapped in a warm receiver, it may be given to the nurse or assistant, in order to be washed clean from that scurf which sometimes covers the whole scarf-skin, and is particularly found upon the hairy scalp, under the arm-pits, and in the groins. This ablution is commonly performed with warm water, mixed with a small quantity of Hungary water, wine, or ale, in which a little pomatum, or fresh butter, hath been dissolved. This composition cleans all the surface, and the oily part, by mixing with, and attenuating the Mucus, prepares it for the linnen cloth, which dries and wipes off the whole: nevertheless, milk and water, or soap and water, is preferable to this mixture.
    In laborious or preternatural cases, when considerable force has been used in delivering the child, the whole body ought to be examined; and if there is any mark or contusion on the head, it will disappear, if anointed with pomatum, and gently rubbed or chafed with the accoucheur's hand: if any limb is dislocated or broke, it ought to be reduced immediately: luxations, though they seldom happen, are more incident to the shoulder, than to any other part, the Humerus being easily dislocated, and as easily reduced. The bones of the arm and thigh are more subject to fractures, than any other of the extremities: the first is easily cured, because the limb can be kept from being moved; but a fracture in the thigh bone is a much more troublesome case, because, over and above the difficulty of keeping the bones in a proper situation, the part is often necessarily moved in cleaning the child. In this case, the best method is, to keep the child lying on one side, after the thigh hath been secured by proper bandage, so that the nurse may change the cloth without moving the part; and to lay it upon bolsters or pillows raised above the wet nurse, that it may suck with greater freedom: if any of the bones are bent, they may be brought into their proper form, by a slow, gentle, and proper extension.
    The navel-string must be wrapped in a soft linnen rag, and folded up on the belly, over which is to be laid a thick compress, kept moderately tight with a bandage commonly called a belly-band. This compression must be continued for some time, in order to prevent an Exomphalus, or rupture, at the navel; and kept tighter and longer on children that are addicted to crying, than on those that are still and quiet: yet not so tight as to be uneasy to the child, and the bandage must be loosened and the part examined, every second day. The navel-string shrinks, dies, and about the sixth or seventh day, commonly drops off from the belly; though not at the ligature, as some people have imagined. This being separated, a pledgit of dry lint must be applied to the navel, and over it, the thick compress and bandage, to be continued several weeks, for the purpose mentioned above.
    During the time of washing and dressing the child, it ought to be kept moderately warm, especially in the head and breast, that the cold air may not obstruct perspiration: the head and body ought also to be kept tolerably tight with the cloaths, for the convenience of handling, and to prevent its catching cold, especially if the child be weakly; but, if it is vigorous and full grown, it cannot be too loosely cloathed, because the brain, Thorax, and Abdomen, suffer by too great compression. The cloathing of new-born children, ought also to be suitable to the season of the year, and the nature of the weather; the extremes of cold and heat being avoided, as equally hurtful and dangerous. Instead of the many superfluous inventions of nurses, and those who make cloaths for children, with a view to make an expensive and pompous appearance, the dress ought to be contrived with all imaginable simplicity: the child being washed, the navel-string secured, and the head covered with a linnen or woolen cap, as already directed, a shirt and waist-coat may be put upon the body, and over it a flannel skirt or petticoat, open before, with a broad head-band, as commonly used, or rather a waistcoat joined to it, so as that they can be put on at once; this ought to be rather tied than pinned before, and, instead of two or more blankets, may be covered with a flannel or fustian gown; while the head is accomodated with another cap, adorned with as much finery as the tire-woman shall think proper to bestow.
    In short, the principal aim in this point is, to keep the child's head and body neither too tight nor too slovenly, too hot nor too cold; that it may be warm, though not over-heated, and easy, though not too loose; that respiration may be full and large; that the brain may suffer no compression; and that, while the child is awake, the legs may be at liberty; to reject all unnecessary rollers, cross-cloths, neckcloths, and blankets; and to use as few pins as possible, and those that are absolutely necessary, with the utmost caution.
    A Treatise on the Theory and Practice of Midwifery
    "Of the Management of new-born Children, with the Diseases to which they are subject"
    Volume 1, Book 4, Chapter II.

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