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Title: A Treatise on the Art of Midwifery
- Setting Forth Various Abuses Therein, Especially as to the Practice With Instruments: the Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgement Upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-midwife; Or, a Midwife
Author: Nihell, Elizabeth
Language: English
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- Setting Forth Various Abuses Therein, Especially as to the Practice With Instruments: the Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgement Upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-midwife; Or, a Midwife" ***
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A
TREATISE
ON THE
ART of MIDWIFERY.
SETTING FORTH
VARIOUS ABUSES therein,
Especially as to the
PRACTICE with INSTRUMENTS:
THE WHOLE
Serving to put all Rational Inquirers in a fair Way of very safely
forming their own Judgement upon the QUESTION;
Which it is best to employ,
In Cases of PREGNANCY and LYING-IN,
A
MAN-MIDWIFE;
MIDWIFE.
By Mrs. ELIZABETH NIHELL,
PROFESSED MIDWIFE.
LONDON:
Printed for A. MORLEY, at Gay’s-Head, near Beaufort Buildings, in the
Strand.
MDCCLX.
------------------------------------------------------------------------
[Illustration]
TO
All FATHERS, MOTHERS
and likely soon to be EITHER.
THOUGH the subject of the following sheets is of such universal
importance, that it would be difficult to name that human individual, to
whom it does not in some measure relate, you, it doubtless, more
immediately concerns.
UNDER no protection then so properly as yours can a work be put, not
presumingly calculated to determine your judgment, but only to recommend
to you the examination of a point, in which Nature would have such just
reproaches to make to you, for cruelty to yourselves, if you was
indolently to determine yourselves either without an examination, or on
a blind implicit confidence in others; in others, perhaps, interested to
mislead you. This last advertence of mine will, more than all that I
could offer besides, prove to you my sincere unaffected with for your
favorable acceptance of this essay of mine, on the footing of absolutely
no interest but purely yours. And that interest how dear! how sacred!
How indispensably ought it to challenge your preference almost to any
other interest of your own, and much more surely to any of others.
HAPPILY then for you, in a matter of such common concernment to
human-kind, Nature has not been so unjust, nor so unprovident as to
place a competent notion of it out of the reach of common sense.
DEIGN then, for your own sakes, to examine it by that light of Reason,
the spring of which is for ever in yourselves. It cannot fail of
affording you a sufficient certainty on which to rest your opinion, in a
point upon which it is of such deep, such tender importance to you, not
to form your resolutions on a wrong one. In virtue of such your own fair
examination, the decision will no longer be dangerously and precariously
that of others for you, no longer be nothing better than a lightly
adopted prejudice, but become truly and meritoriously the genuine result
of your own judgment.
BUT whatever your decision may be, at least to me you can hardly impute
it as an offence, my seeking to supply you with matter, whereon to
exercise that judgment of yours in so interesting a point. At the worst,
I have the consolation of being in my duty, while thus aiming, however
deficiently, at proving that with the most tender regard and unfeigned
zeal.
I am, respectfully,
Your most devoted, and
most faithful humble servant,
ELIZABETH NIHELL.
Haymarket,
Feb. 21, 1760.
[Illustration]
PREFACE.
THE preservation of so valuable a part of the human Species as pregnant
women, as well as that of their dear and tender charge, their children,
so powerfully recommended by the voice of Nature and Reason, to all
possible human providence for their safe birth, forms an object so
sensibly intitled to the private and national care, and even to that of
universal society, that all enforcement of its importance would be an
injury to the human understanding, or at least to the human heart. It
would look too like imagining that it could be wanted.
WHAT I have then to say preliminarily, must chiefly arise from my own
due sense of my inequality to the subject of which I presume to treat.
Though, if example could be any countenance, I might plead that of so
many authors who have, with the utmost confidence and the utmost
absurdity, written upon the art of midwifery, without understanding any
thing at all of it. The truth is, that my very natural and strong
attachment to the profession, which I have long exercised and actually
do exercise, created in me an unsuppressible indignation at the errors
and pernicious innovations introduced into it, and every day gaining
ground, under the protection of Fashion, sillily fostering a preference
of men to women in the practice of midwifery: a preference first
admitted by credulous Fear, and admitted without examination, upon the
so suspicious recommendation of those interested to make that Fear
subservient to their selfish ends.
OF these disorders, pernicious as they are to society, I have however
been long with-held from taking public notice by far from groundless
scruples. Being myself a practitioner, I had just reason to fear, that
my representation would have the less influence, from a supposition of
personal interest in them. They might naturally enough be construed as
the result of a jealousy of profession. I had yet a reason more
particular to myself against interfering in this matter. My husband is
unhappily for me a surgeon-apothecary: I say unhappily, because though
of a business I maintain to be so foreign and distinct from the function
which I profess, there might not be wanting, among such as would imagine
their private interest attempted at least to be hurt by me, a suspicion
that I was indirectly aiming at recommending his advantage in prejudice
to theirs. Yet so far, so very far is this from being the case, that the
main scope of my essay is to prove, that his business has no relation at
all to mine, and that especially as to the particular point I would wish
to establish, he is absolutely as indifferent to me as any other person,
either of his own profession, or of any other whatsoever. This prejudice
then of self-interest being fairly annulled by the appeal to the
manifest drift of the work itself, which gives him as formally the
exclusion as to any other of his sex, I had still a repugnance to the
entering into a discussion of abuses, that could not be laid open
without exposing truths, that might have an air of invidiousness or
detraction.
SOME friends of mine, to whom I communicated my doubts, agreed with me,
that there are faults which cannot innocently be revealed, where their
manifestation may be attended with some greater evil, but that it could
not be right to rank among the faults to be spared any error in an art,
where one single false idea, suffered to subsist, may prove the occasion
of wounds or torturous death to thousands. On the contrary, the due
knowledge of faults of this nature is, in fact, a public benefit. They
serve, as one may say, for beacons to the art, they hold a light to it,
and show it the rocks it should avoid.
IT is certain then, that I have not the least intention to attack any
particular persons, any farther than in what I conceive to be false
theory, or mispractice in the art I profess; I hope then it will not be
imputed to me as unfair or over-presumptuous, if I especially do not
over-respect writers or practitioners, who themselves have not respected
either common-sense or common-humanity.
HAVE not some of our modern authors, especially the male-practitioners,
who in these later times have treated of midwifery, added new and worse
errors of their own to those bequeathed to us by the antients, whom they
have insulted, as they themselves will probably one day be, but with
more reason, by their successors, if the world should continue blind
enough for them to have any in this profession? One would even imagine,
that in the criticisms in which they indulge themselves of one another’s
systems and instruments, they are inflicting part of the punishment due
for their common offences against Nature, in the abuse of an Art,
originally intended to assist her. At the same time, even from their own
showing, nothing can be plainer, than that their boasted inventions
have, under the specious pretence of improvement, fallen from bad to
worse, as is ever the case of superstructures on the crazy foundation of
false principles.
READ the men-writers on this art, and you will find interspersed in most
of them, amidst the most flagrant proofs of their own ignorance of it,
reproaches to that of the midwives, too just, perhaps as to some, but
shamelessly absurd in them, who to that ignorance substitute their own
subtilities of theory, which, when reduced to practice, are infinitely
worse than any deficiency in some particular female-practitioners; being
mostly, in truth, fit for nothing so much, as to prepare dreadful work
for their instruments.
BUT if they so falsely exalt their own learning above the ignorance of
women; they have their reason for it. They seek to drive out of the
practice those who stand in the way of their private interest: that
private interest, to which the public one is for ever sacrificed under
the specious and stale pretext of its advancement.
CAN it then be wrong in any of our sex and profession to endeavour, at
least, to justify ourselves, and to undeceive the public, of the ill and
false impressions which have been given it of our talents and ability?
Pernicious prejudices have sometimes their run, like epidemical
distempers: and surely it is more for the service of mankind, that their
duration should be shortened, than suffered to proceed without at least
an endeavour to oppose them.
I SHOULD, however, be much more pleased with an exemption from the
disagreeable task of composing the apology of our sex in this matter, it
being contrary to that modesty which becomes us so well; but as the
men-midwives, in their system of exalting their powers of Art over ours
of Nature, keep no measures with truth, I see myself forced to do
justice to our function, and to manifest the unreasonableness of that
contempt, with which they treat and depreciate our services; and with
which they have, in favor of their own interest, perhaps too
successfully imbued the public.
IN this attempt of mine there is no blamable ostentation. If I set in
their just light of utility the qualifications of the women of our
profession, as to industry, dexterity, ease of execution, patience,
constitutional tenderness, and especially natural aptitude, it is no
more than practical truth warrants, and the throwing a due light into
the matter of comparison requires. Yet I do not wish, that we should
pass for any thing beyond what we really are. All the partiality, all
the tender feelings it is so natural for me to have for the sufferings
of my own sex, would be sufficient to with-hold me from desiring to
establish any opinion or practice tending to endanger the personal
safety of women in child-birth, or of any thing so dear to them as their
children. I am myself a mother.
I OWN however there are but too few midwives who are sufficiently
mistresses in their profession. In this they are some of them but too
near upon a level with the men-midwives, with this difference however in
favor of the female practitioners, that they are incapable of doing so
much actual mischief as the male-ones, oftenest more ignorant than
themselves, but who with less tenderness and more rashness go to work
with their instruments, where the skill and management of a good midwife
would have probably prevented the difficulty, or even after its coming
into existence, prove more efficacious towards saving both mother and
child; always with due preference however to the mother.
I WILL also, with the same candor, own that there are some not intirely
incapable men-midwives: but they are so very rare, and must forever
necessarily be so, and even, at the best, so inferior to good midwives,
that a worse office could scarce be done to mankind, that on so false a
supposition as that of a sufficient ability in them, to explode the
practice of the art by women, because some of them might be
exceptionable. And how should it be otherwise, than that some should be
more deficient than others? is there that art in the world, to which the
same objection does not lie of different degrees of merit in the
professors of it, as well as that of the imperfection of all human arts
in general?
IN the mean time, the consequences of this unfair conclusion against the
women professors of midwifery, in affording the men a plea for
supplanting them, do not hitherto appear very advantageous ones to the
public. It remains, I fancy, to be proved, that population is any gainer
by the diminution of that evil, to which the instruments or other
methods of practice, employed by the men, are pretended to be such a
remedy.
TO examine this point is the object of the following sheets; the work
being divided into two parts.
THE first treats of our title to the practice of this art, of the pleas
used by the men for arrogating to themselves the preference, of the
knowledge of Anatomy, of the necessity of the instruments, of the
incapacity of women, of the Fashion: and whether the superior safety is
on the side of employing men-practitioners.
THE answers inserted to each objection, all together, constitute an
essay to remove the prejudices, which have been so industriously, and
too successfully disseminated against the female practice of this art;
and to show that the substitution of the men, more especially of their
iron and steel-implements, is attended with greater danger, greater
mischiefs, than those which that substitution is pretended to prevent or
redress.
THE second has more particularly for object to demonstrate the
insufficiency, danger, and actual destructiveness of instruments in the
art of midwifery. To this purpose I therefore pass all that is needful
of them in review, in the several cases, in which the antients and
moderns would persuade us they are necessary. I set myself to establish
my exceptions to them by incontestable examples; but above all, by the
authority of reason and experience. I take notice of some of the
manifest contradictions to be met with in almost all the authors, to one
another. I have ventured to subjoin some observations, taken from my own
observations and practice, in lieu of what I condemn, and to point out a
method of operation, much more plain, more tender, more secure, than the
one by instruments. I support this by those general principles, which
have happily guided me on all occasions, and from which it is even easy
to refute the pretentions and system of the instrumentarians, in which I
shall note here only three essential defects.
THE _first_, in that the origin of the men, insinuating themselves into
the practice of midwifery, has absolutely no foundation in the plea of
superior safety, and, consequently, can have no right to exact so great
a sacrifice as that of decency and modesty.
THE _second_, for that they were reduced first to forge the phantom of
incapacity in the women, and next the necessity of murderous
instruments, as some color for their mercenary intrusion. And, in truth,
the faculty of using those instruments is the sole tenure of their
usurped office.
THE _third_, their disagreement among themselves about, which are the
instruments to be preferred; a doubt which, the practices tried upon the
lives and limbs of so many women and children trusted to them, have not
yet, it seems, resolved, even to this day.
BUT reserving to treat upon these and other points more at large, in
their place, I am to bespeak the reader’s candid construction, of my
having, especially in the beginning of the first part, transiently
availed myself of the authorities of authors, sacred and prophane. It is
less that I think truth stands in need of such corroboratives, than to
show that it is not destitute of them. It is not by authority, but by
reason, that truth, in matters of temporal concernment, claims
acceptance from reasonable beings. At the worst, those to whom they may
present a tiresome prospect, have but to skip them over; or if they
peruse them, they are desired not to forget that no stress is laid on
them, beyond their being answers to arguments of the like nature, urged
on the opposite side of the question.
THOUGH instruments are not within my sphere of practice; though
consequently I have the honor of not being personally very well
acquainted with them, nor have I at hand all the original authors who
have published their own inventions of them, I have been sufficiently
enabled to do justice to their pretentions, by a recourse to those who
professedly and fully treat of them. My guide is commonly Monsieur
Levret, who is one of the exactest describers of them. Not most
certainly that I otherwise prefer him, for of the utility of his forceps
I think just as ill as I do of all the rest.
I SHOULD have been glad to avoid at once the barren driness of
abridgments furnishing no distinct ideas, and the tedious exactness of
particularized descriptions and histories; as for example, of the
forceps, as well as of errors committed by practitioners; but this
medium I could rather wish than hope to keep. I have then been so afraid
of obscuring matters by brevity, that of the two I have perhaps run too
far into the contrary and less agreeable excess: which, however, in
consideration of its favoring explicitness, is not perhaps the most
inexcusable one.
I WISH I could make an apology as receivable by a reader, who will
doubtless be justly disgusted at the repetitions I have too little
scrupled the making of the same thoughts, and even sometimes of the same
expressions. Yet I dare bespeak, from his candor, some indulgence to the
confession of a fault, it will easily be perceived I could not well
escape, without the worse inconvenience to himself, of his being
perplexed with references back to past pages, besides, that sometimes a
chain of argument would be broke, consequently weakened, by the
suppression of some link of it, on account of the matter having been
elsewhere already employed in other connexions.
UPON the whole, I throw myself, with the more confidence, on the
favorable acceptance of the public, from my consciousness of its not
being but with the best intentions for the good of society that I hazard
this production: and have therefore reason to hope, that it will
occasionally be remembered, that my object is purely that of
representing a truth, and not of recommending a composition.
Page 20. For blood into water _read_ water into blood.
[Illustration]
CONTENTS
OF
PART the FIRST.
_In gratitude of the men-midwives at Paris to their women-teachers of
the art_, page 6.
_Regulations of the profession of midwifery not unworthy the national
care_, 9.
OBJECTION I. _Prior possession of the art in the men_, 14.
ANSWER, 14.
OBJ. II. _Preference of the men founded on the nobility of the art_,
17.
ANS. 15.
_Egyptians not so simple as Dr. Smellie pretends_, 19.
OBJ. III. _Writings of the men-authors prove the antiquity of
men-midwives_, 24.
ANS. 24.
OBJ. IV. _Manual operation a science fittest for the men_, 28.
ANS. 29.
OBJ. V. _Anatomy necessary_, 32.
ANS. 32.
OBJ. VI. _Instruments, their use peculiar to the men_, 35.
ANS. 36.
OBJ. VII. _Ignorance only exclaims against instruments_, 39.
ANS. 40.
_Dr. Smellie’s false account of the_ Hôtel-Dieu _at_ Paris, 44.
_No men-practitioners suffered in it_, 47.
_Dr. Smellie’s Doll-machine_, 50.
_Compendious forming of pupils_, 52.
OBJ. VIII. _It is a presumption in women to enter into competition with
men in this art_, 52.
ANS. 53.
OBJ. IX. _Opinion prevalent of superior safety under the hands of the
men_, 58.
ANS. 59.
OBJ. X. _Ignorance of the women_, 73.
ANS. 73.
_How the young men students get their_ learning, 80.
_Women cruelly used to procure it them_, 83.
_Story of a woman’s child killed with a crotchet_, 92.
_Examination of a passage of Plato quoted by Dr. Smellie_, 99.
_Pecquet, a great anatomist, the victim of his own erroneous
speculation_, 101.
OBJ. XI. _Partial artists the best_, 106.
ANS. 107.
_Story of a Dentist_, 109.
_A man-midwife’s toilette_, 111.
_Story of a woman perishing suddenly after delivery_, 128.
_Cruel method of training up pupils_, 137.
_Story of a child horribly murdered_, 139.
_Lessons of midwifery given by Madam Clavier_, 144.
PUDENDIST, _a name in the stile of oculist or dentist, more proper
for a male-practitioner of midwifery than_ ACCOUCHEUR, 151.
OBJ. XII. _Men-midwives have terminated happily many labors_, 151.
ANS. 151.
_Triumph of a man-midwife_, 158.
_Why young practitioners should conceal their instruments_, 173.
_Appeal to numbers for the greater safety with women, verified by the
practice of the midwives at the_ Hôtel-Dieu _at_ Paris, 180.
OBJ. XIII. _Prevalence of the Fashion_, 184.
ANS. 184.
_Parallel of error in the preference of men-midwives to that of
bringing up of charity-children by hand_, 187.
_Story of a woman ashamed of having been lain by a midwife_, 204.
_Inoculation justified_, 207.
_The greatest lady in Britain no example in favor of_ Accoucheurs,
210.
_Midwives formed by the men-practitioners liable to caution against
them, and why_, 213.
_Alarming danger of a scarcity of good midwives, to what owing_, 217.
OBJ. XIV. FALSE-MODESTY, _that of the women, who prefer the
practitioners of their own sex_, 219.
ANS. 219.
_Story of Agnodice and the Athenian women canvassed_, 219.
_Dr. Smellie’s_ COMMANDMENT _to his pupils against immodesty_, 224.
_No stress laid on the Rabbit-woman of Godalmin_, 225.
_Attitude indecent, and to no end nor purpose_, 237.
_A stone of more virtue than a man-midwife_, 239.
CONCLUSION _of the_ FIRST PART, 244.
PART the SECOND.
_Containing various observations on the labors and delivery of lying-in
women, including a description of the pretended necessity for the
employing instruments_, INTRODUCTION, 249.
_Of_ DELIVERIES, 256.
_Story of the sudden death of a woman after delivery_, 261.
_Accounted for_, 262.
_Method of prevention_, 263.
_Histeric medicines invented by the_ learned _men-practitioners, and
examples of their insignificance_, 267.
_Of_ DIFFICULT _and_ SEVERE _cases_, 277.
_Divisions of them_, 279.
_Profound ignorance of certain men-midwives_, 282.
_Their avarice and cruelty set forth by a man-midwife_, 286.
_Midwives incapable of such horrors_, 288.
_The Crotchet used, and its horrid effects, exemplified in several
stories_, 291.
_A_ VOLUME _might be made of them, says a man-midwife_, 298.
_Some instances of male-practice_, 304.
_Of_ TOUCHING, 309.
_Of the_ OBLIQUITY _of the_ UTERUS, 329.
_Of the_ EXTRACTION _of the_ HEAD _of the_ FŒTUS _severed from the_
BODY, _and which shall have remained in the_ UTERUS, 358.
Speculum matricis _given up by Dr. Smellie: so would other
instruments be, if justice was done them_, 367.
_A curious method of_ CELSUS, 369.
_Inventions of_ CAWLS _and_ FILLETS, 369.
_Of that labor in which the_ HEAD _of the_ FŒTUS _remains hitched in
the passage, the_ BODY _being intirely come out of the_ UTERUS, 372.
_Quackery of Daventer_, 378.
_Two examples of children, the one killed, the other supposed dead,
and losing its head by errors in the manual function_, 379.
WHEN _the_ HEAD _of the fœtus presents itself foremost but sticks in
the passage_, 289.
_Objections to instruments more at large included under the title to
this section_, 389.
_Mauriceau’s_ tire-tête, 395.
_Palfin’s_ FORCEPS,
_with the improvements of various practitioners_, 398.
_A waggon load of instruments insufficient, and why_, 401.
_A curious nostrum of an instrument_, 406.
_Mr. Freke’s ingenious invention of a_ FORCEPS _and_ CROTCHET _all in
one_, 416.
_Dr. Smellie’s improvement of the forceps_, 417.
_The curve forceps of Levret_, 419.
_Case of a_ PENDULOUS BELLY, 445.
_Triumph of the moderns over Hippocrates and the antients in the
invention of the forceps_, 452.
_Inhumanity and folly of the general conspiracy against children_,
458.
CONCLUSION _of the_ SECOND PART, 466.
[Illustration]
A
TREATISE
ON
MIDWIFERY.
WHOEVER considers the absolute necessity of the art of midwifery, will
readily allow it a place among the capital ones in the primeval times of
the world. All the other arts are no further necessary to man, than to
procure him the conveniencies or luxuries of life; that of midwifery is
of indispensable necessity to his living at all, imploring as he does
its aid for his introduction into life. Without this art the earth
itself must soon become dispeopled and a desert, whereas by means of it
men have been multiplied, with inconceivable rapidity.
IN conformity to its claim of importance, this art appeared in all its
lustre among the Jews, the Egyptians, the Athenians and Romans, and
indeed in all nations during thousands of ages. Nor was the confinement
of the exercise of it to women deemed any derogation to it. It even gave
honor to its professors of that sex. Socrates, so ennobled by his
character of being the greatest philosopher in all antiquity, did not
disdain to boast himself the son of a very able midwife Phanarete, as
may be seen in Plato’s book on science, in Diogenes Laertius and others.
AMONG the Egyptians and the Greeks it cannot be hard to conceive what
emulation, what ardor it must have excited among the women of that
profession, the custom of distributing prizes to those of the greatest
merit in it, in the face of the people. No one is ignorant of the power
of honors and distinction to bring arts to perfection.
BUT from the instant the midwives sunk into dis-esteem, and wherever
that has happened, it will be found by woeful experience, that not only
the art itself has suffered in the very midst of the most falsely
boasted improvements, but that human-kind itself has much and very
justly to complain of the change.
THE native inconstancy and levity of the French nation opened the first
inlet, in these modern-times, to men-practitioners. In antient history
we meet with but one feeble attempt of that sort, which however soon
gave way to the united powers of modesty and common sense. In France,
and may it not be the same case soon here! the women of a competent
class of life and education, begin to decline forming themselves for
this profession, as beneath them, considering the slight put upon those
women who exercise it.
NOR has this injustice remained unpunished. Many women have found, by
severe experience, their having been enemies to themselves, in
abandoning or slighting those of their own sex, from whom, at their
greatest need, they used to receive the most effectual service, and who
alone are capable of discharging their duty by them, with that sympathy
for their pains, that tender affectionate concern, which may so
naturally be expected from those who have been, are, or may be subject
to the same infirmities.
MANY out of a distrust inspired them of midwives, have thrown themselves
into the hands of men, who have promised them infinitely more than they
were able to perform; and who behind all the tender alluring words, of
superior skill and safety in the employing of them, conceal the ideas
with which they are full, of cutting, hacking, plucking out piece-meal,
or tearing limb from limb.
THE murder of so many children, the fruits of their bowels, might, one
would imagine, have induced mothers to consider this point a little more
carefully. Yet, through the prevalence of groundless fears, and of
imaginary dangers they have run into real ones, and have sometimes found
their death precisely where they sought their life; and not seldom where
nature has even favored them enough in their labor, for them not to need
any extraordinary ministry of art, the men have put them to cruel and
dangerous tortures.
NOTWITHSTANDING some examples, and many violent presumptions of such
mal-treatment, too many women have been so miserably misled by fashion,
as to prefer the betraying the cause of their own sex, and the
subjecting themselves to those who deceive them with false hopes, to the
entrusting their preservation to those of their own sex, in the hands of
which the care of it has been for so many ages, with so much reason, and
such little cause of complaint.
YET we do not see that any of these men-midwifes have been capable of
forming a good midwife. On the contrary, we see, that in order to remedy
the abuses, or rather to prevent the fatal accidents which every day
occur in the practice of a profession so necessary to the preservation
of the human species, they were in France obliged to have recourse to
one of the ablest midwives in that kingdom, who was placed at the head
of the practice in the Hôtel Dieu at Paris, to preside over the
lyings-in there, and to found and cultivate that inexhaustible seminary
of excellent female practitioners, who have actually restored the art to
its antient degree of esteem, with all fair judges. These worthy
proficients have been so public-spirited, as to communicate their
talents and knowledge to a number of surgeons, who never had any reason
to be ashamed of the lessons they assiduously took from the midwives,
unless indeed for themselves not being able to come up to them in the
practice, so true it is, that the business is not at all natural to
them.
YET have even many of those very men-practitioners, influenced by that
self-interest which has such a power in all human affairs, revolted
against their mistresses in the art, and their benefactresses. They
have, at various times, commenced lawsuits, about the Hôtel Dieu at
Paris, in order to get the lyings-in there committed to them: but the
administrators, the persons of a just sense of things, together with the
parliament of that town, ever attentive to decency, without excluding
the due regard to the preservation of the subjects, have constantly
opposed and frustrated the pretentions of these innovators. These again
thus disappointed, were forced to content themselves with practising
upon some women of quality, under the favor and protection of some of
the old ladies of the court of Lewis XIV. who had their reasons for
propagating this fashion. And now these innovators, not without a due
proportion of ingratitude to the injustice, began to run down the
midwives, and exalt themselves. The novelty prevailed, and the contagion
of example soon communicated itself to the provinces, and thence into
neighbouring nations. A few men perhaps of real abilities, but governed
by the most sordid interest, associated to their party a number of the
most ignorant and unexpert practitioners, but who served to fill up the
cry, and made a common cause against the midwives, whose pretended
insufficiency was now to be pleaded in favor of themselves being
admitted to supplant them. Nor was the concurrent attestation in their
favor, of so many ages, during which the practice was entirely in female
hands, to weigh any thing against the boasts of their own superior
ability. They picked up and sounded loud a few real instances perhaps,
and undoubtedly many false ones of faults of practice in women: though
were the numbers of human creatures, who have barbarously perished by
the unskilfulness of the practitioners, to be fairly liquidated, it
would appear that fewer have been the victims of female ignorance, than
of the presumption and indexterity of the men. The women are undoubtedly
liable to error: there have even been monsters of iniquity among them,
but certainly in no number to form a general prejudice against them: but
as to the men they are all of them, as will be more fully demonstrated
hereafter, naturally incapable of the exercise of this profession. A
history of their murders might even be collected out of the books
written by them to establish their superiority over the women. From
Deventer, Mauriceau, and the most celebrated of their writers, amongst
many excellent observations in the way of the chirurgical art, many of
the grossest absurdities have escaped, where they transgress its bounds
and go into that of midwifery. Some of those absurdities too are so
glaring, that they have not even been overlooked by themselves.
MANY persons in Holland, having set up for men-midwives, without being
duly qualified, the government thought proper to interfere, and
consequently there was an ordinance issued on the 31st of January, 1747,
by which it was enjoined, that no one should practise in the quality of
man-midwife, or exercise this art, unless he were especially authorized
for this function, by a certificate of his having undergone a sufficient
examination before capable and intelligent judges for that purpose
appointed.
IT will appear, in the sequel of this work, that it were to be wished,
for the sake of the good that would redound from it, to the preservation
of the human species, both in parent and child, that those who are
entrusted with the public welfare, would establish the same regulation
in the British dominions, to expel and exclude from the art all the
ignorant pretenders of either sex, who are, in fact worse than the
Herods of society. The cruelty of Herod extended to no more than to the
infants; not to the mothers; that of such pretenders to both.
IF their conduct was to be examined with attention, how many fatal
mistakes would be discovered in the practitioners of both sexes? But I
dare aver it more in the men than in the women-practitioners. With what
horror would not there in these be remarked, tearings, rendings, and
tortures of no use to which they put both the mother and the child? One,
upon some most learnedly erroneous hypothesis, pulls and hauls the arm
of an innocent infant yet living, so that he plucks it off; or repels it
with such violence, that he breaks it: another unmercifully opens the
infant’s head, and takes the brain out: some bring the whole away
piece-meal: operations often to be defended only by hard words and
harder hearts.
NOR need this procedure astonish. Every thing is at the disposal, I had
almost said, at the mercy of these executioners: but have they any? all
their handy-work is transacted in private, and remains buried in the
tomb of oblivion. The parents suspecting nothing, think every thing has
been done, according to art, that is to say, very right. The operator
thinks he has done nothing but his duty, and is highly satisfied with
himself, after he has ordered some draughts for his patient. The
magistrate knows no injury done to the subject, or is insensible to the
consequences from the same spirit of confidence. In the mean time, a
husband loses a fine child, or a beloved wife, perhaps both; children, a
tender mother, and if they are of the same sex, have the same fate to
dread for themselves. The man-midwife is clear, for only saying, that he
has done all for the best. But this is probably true too, as to the
intention; but as to the fact, it shall be shewn that there is often
great reason to doubt it.
BE this observed, without offence to the few able men-midwives who are
masters enough of the business, not to deserve the reproaches due to by
much the greater number of rash and ignorant pretenders to it: whose
practice, well examined, would bring to light such terrible truths, as
would alarm even the legislature to provide a remedy against the danger.
IN contradiction to this, it may be urged, that the practice by women is
susceptible upon that account, of superior objections. That remains now
to be examined. The chief object of this work being a fair discussion,
which of the two sexes is the most appropriated by nature and art, to
the exercise of this function.
TO this end, I shall present, in a candid view, the two opinions which,
on this point, divide the English yet more than they do the French. Most
of the surgeons, all the men-midwives, no doubt, many apothecaries, a
number of women and nurses maintain, that midwifery is the business of
the men: whilst on the other hand, the best part of the able physicians,
with many other persons of both sexes, defend the contrary side of the
question, and insist on this art being, for many invincible reasons,
solely the province of female practitioners.
NOT to lose sight of the fundamental arguments and proofs brought to
support respectively these two opinions, I shall place them in parallel
with one another, in form of objections and answers. The objections made
to women-practitioners precede the answers. If the men-midwives, or
their partizans, shall think I have omitted any thing that makes for
them, or against us, or have any stronger or more essential arguments to
oppose, I shall endeavour to satisfy them.
OBJECTION the First.
REGARD ought to be paid to prior possession. The art of midwifery being
a branch of the art of physic, must have been originally in the hands of
man, the inventor of all arts.
ANSWER.
THE just deference so universally paid to holy writ will, I presume,
allow no prejudice to be found against my availing myself of those
inferences and decisions to be drawn from it, which are so agreeable to
the eternal laws of common sense.
IF the arts and sciences, acquired by experience, and by acts often
repeated, had, as they certainly were not invented by men only, that
could not at least be said of those acts of the human life, which are
indispensably necessary to its preservation. Such faculties may with
more propriety be termed instinctive, than invented ones. The faculties
of eating, of drinking, of lying down to rest, common to both sexes, are
not perhaps more natural, more matter of instinct, than the faculty of
one woman assisting another in her labor-pains being appropriated to the
female sex.
THERE is no occasion to give one’s imagination the torture to account
for Eve’s delivering herself of her first children. There is no reason
to establish it as an absolute necessity that Adam should have assisted
Eve in her first lyings-in; whose labor-pains might not only be less
severe, than they afterwards became in accomplishment for the curse
pronounced on the human race for the sin of those first parents, but
also more consonant to piety, to believe that God, being the best of
fathers, infused into Eve knowledge sufficient of the manner of
delivering herself; a manner more natural and more conformable to the
ideas of that decency imprinted with his own hand in the human heart, in
no point more strongly, nor more universally, than in this matter of the
women lying-in, when both men and women have an equal repugnance to the
interposition of any assistance, but that of the female sex, to which
the faculty of ministering in that case seems innate.
BUT admitting even that Adam, for the want of females for that function,
before the daughters of Eve were grown up to a capacity of it, actually
did assist Eve, in the seasons of her delivery; that would establish no
inference of right for the future: since we know that their children and
descendents in time following did not make use of men to lay the women.
IN Genesis, chap. xxxv. ver. 17. there is mention made of Rachel’s
midwife. In the same book, chap. xxxviii. ver. 27, and 28. we see they
were intelligent midwives. Thamar being with child. “It came to pass in
the time of her travail, that behold, twins were in her womb.”
VER. 28. “And it came to pass that when she travailed, that the one put
out his hand, and the _Midwife_ took and bound upon his hand a scarlet
thread, saying, this came out first.”
AND here I intreat the reader not to impute to me any idea so absurd as
that of meaning to defend an erroneous practice solely from the
antiquity of it; I intend nothing further by this citation, than to
prove the antiquity itself, which if not decisive in favor of the
practice by women, can at least be no prejudice against it.
OBJECTION the Second.
THE art of midwifery being equally noble for its subject as for its end,
since it is the only one which enjoys the prerogative of saving, at one
operation of the hand, more than one individual at once; ought the less
noble sex to dispute pre-eminence in it with the men? On tracing things
back to the remotest distance of times, it must be allowed, that if the
women, through a mistaken modesty, in those times of ignorance and
simplicity, commonly made use of midwives, it may be presumed there were
also men-practitioners employed in difficult cases.
ANSWER.
READILY granting that the art is a noble one; noble in its subject and
ends: all that I am surprised at is, that the men did not find it out
sooner. Probably the nobility of this art is only begun to be sounded so
high by the men, till they discovered the possibility of making it a
lucrative one to themselves. Then indeed the ignorance and incapacity of
the poor women for it, came all of a sudden to be doubted and despised.
The art with all its nobility was for so many ages thought beneath the
exercise of the noble sex: it was held unmanly, indecent, and they might
safely have added impracticable for them. But had even any of the
medical profession not thought so, there is great reason to think the
rest of mankind would have viewed their interested endeavors to usurp
this province from the female sex, in the light they deserve. It was
only for the eternal fondness which prevails among the French for
novelties, that paved the way for the admission of so dangerous and
indecent an one, as that of men making a common practice of midwifery,
and taking it out of the women’s hands, to which it was so much more
natural.
I AM here far from wishing to enter into a contest with the men, on the
superiority and excellence they assume over the women; though not quite
so indisputable perhaps as is commonly imagined. All that I contend for,
to the purpose of the present question, is, that there are certain
employments and vocations, which are generally and naturally more proper
for one sex than for another. A woman would seem to aim at something
above her sex, that would set up an academy for teaching to fence, or
ride the great horse: but a man sinks beneath his sex, who interferes in
the female province. It is not with quite so good a grace as a woman
that he would spin, make beds, pickle and preserve, or officiate as a
midwife. Be this observed without impeachment of the superiority of men.
OPEN books, sacred and profane, you will find that the Egyptians were
not so simple as Dr. Smellie would give us to understand they were; when
in the beginning of his introduction, pages 1st and 2d, he grants us,
out of his special grace and favor, “that in the first ages the practice
of the art of midwifery was _altogether_ in the hands of women, and that
men were never employed but in the utmost extremity: indeed (says he) it
is natural to suppose, that while the _simplicity_ of the early ages
remained, women would have recourse to none but persons of their own
sex, in diseases _peculiar_ to it: accordingly we find that in Egypt
midwifery was practised by women.”
ACCORDING to scripture, however, the sorcerers of Egypt were not so very
simple neither, since they had art enough to imitate some of the
miracles of Moses, in transforming their rods into serpents, blood into
water, and covering the land with frogs[1]. All this did not favor of
simplicity.
THE Egyptians[2] have ever passed for the most intelligent and
enlightened of all the other nations of the earth, who respected them as
oracles of wisdom and sound philosophy. They are the first people who
established systematically rules of good government. This profound and
serious nation saw early the true end of human policy; and virtue being
the principal foundation and cement of all society, they industriously
cultivated it. At the head of all virtues they placed that of gratitude.
The honor attributed to them of being the most grateful of men, shews
that they were also the most social. They had an inventive genius: their
Mercuries, who filled Egypt with surprizing discoveries, scarce left any
thing wanting to the perfection of their understanding, or to the
convenience and happiness of life. The first people among whom libraries
were known to exist, is that of Egypt. In short, so far from being
simple or ignorant, they excelled in all the sciences. There were indeed
among them no _men-midwives_; but to make up for this deficiency, they
had, it seems, excellent midwives.
BESIDES it is even ridiculous to confine the practice of midwifery by
females only to early ages. Who does not know, that it was so in all
ages, and in all countries, till just the present one, in which the
innovation has crept into something of a fashion into two or three
countries. The exceptions before, or any where else, to the general
rule, are so few, that they are scarce worth mentioning.
BUT to return to the so _simple_ Egyptians. We read in Exodus, chap. i.
v. 15. and following, that Pharaoh said to the midwives, “When ye do the
office of midwife to the Hebrew women, and set them upon the stools, if
it be a son then ye shall kill him, but if it be a daughter she shall
live.
“17. But the midwives feared God, and did not as the king of Egypt
commanded them, but saved the men-children alive.”
THE king reproached them, as may be seen in the same place.
WHY did not Pharaoh give the same order to the men-midwives, if there
had been any such employed in difficult or extraordinary pains? (as Mr.
Smellie supposes.) Or rather, if the king had not thought it too
unnatural for women to be delivered by men, he certainly would not have
failed to have commanded it, especially on perceiving that the midwives
had deceived him. This would have been a fine occasion to have forbidden
them their function, and for the men-practitioners to have come into
vogue. The men would certainly have been of the two not the improperest
to have executed the intentions of the tyrant: as tender-heartedness is
surely not more the character of their sex, than of the women. Besides,
their instruments would have served admirably to have thinned the
species, without distinction of the sexes. They might also have
concealed the barbarity of the murders by such instruments, under the
pretext of their necessity from hard-labors, as the midwives excused
their disobedience under that of easy ones, which had rendered their aid
superfluous.
OBJECTION the Third.
SO many authors as have wrote on the art of midwifery, from the age in
which Hippocrates florished, whom we look on as the first and father of
the men-midwives, with the disciples whom he formed, and their
successors, do not they satisfactorily prove the antiquity of
man-midwives?
ANSWER.
AS for satisfactorily, no. It can only be concluded from this objection,
that the ignorance of the pretended men-midwives is very antient: and
yet posterior by much to the function of the midwives, since that is
coeval with the world itself, embraces all times, extends through all
parts of the earth, whereas we hear nothing of the other till the times
of Hippocrates.
NEVERTHELESS I greatly respect Hippocrates, and all the authors who have
treated of this art. Some thanks are due to them, though but from those
whom they have set to work in our days. Consider but the most celebrated
authors among them down to our times, there may be found in them great
progresses by degrees, especially in our modern writers on this subject.
Yet the most intelligent of them feel and confess that the matter is yet
far from exhausted. For after having studied all the treatises we have
upon it, there may, there must be perceived an aberration and emptiness
with which the understanding remains unsatisfied, and feels that much is
yet wanting to the requisite perfection.
NOTWITHSTANDING likewise the veneration confessedly due to Hippocrates,
I cannot dispense myself from saying the truth; he might be and
doubtless was an excellent physician: he has wrote upon all the female
disorders, and on the means of delivering them; he may have been
consulted in his time, but he can never pass for an able man-midwife.
His writings contain some violent remedies and strange prescriptions for
women in labor, which must be the produce of the most dangerous
ignorance of what is proper for them in that condition.
THIS author was also evidently ignorant of what concerns preternatural
deliveries, as indeed were his successors till the beginning of the last
century.
TO prove what I advance, there needs no recourse back to very remote
times: it will be sufficient to peruse the treatises of Ambrose Paræus,
Jacques Guillemeau, Peter-Paul Bienassis, printed 1602, and even that of
De la Motte, who is of this century, to own, that the practice of the
men-midwives was far from having attained any degree of perfection.
THE manner in which the antients proceeded, when the child presented in
an untoward situation, is a fully convincing proof thereof; since they
obstinately, in such cases, continued their efforts to reduce it to its
natural situation, in spite of a thousand difficulties and dangers,
instead of bringing it away footling, as is now done by all who
understand the right practice.
HIPPOCRATES is the first who discovered that wonderful secret of killing
the child, and bringing it away piece-meal from the mother’s womb. He
advises it, in the manner taken notice of by Dr. Smellie, in his
introduction, (page 10. & seq.) I do not know whether it is from that
branch of practice that he adopts him for “the father of midwifery” (p.
4.) but, what is certain is, that Galen, and all the successors of
Hippocrates, till towards the end of the last century, exactly followed
his method of not delivering women in hard labors, but by the means of
murderous instruments. I shall not here detain myself with rehearsing
the long legend Mr. Smellie gives us of all the authors who have written
on this subject to the time of Ambrose Paræus; time when to the
progresses made by the midwives of the Hôtel Dieu at Paris in the art of
midwifery, it was owing, that the surgeons, guided by their superior
lights, made some greater progress towards perfection.
THAT the reader however may not suspect me of exaggeration, or
over-straining points, I request of him to suspend his judgment, to have
the patience to hear me out to the end, and he will find, that I have
here advanced nothing but what in the sequel stands clearly and
manifestly proved.
OBJECTION the Fourth.
IN a word, the manual operation of midwifery is an art, a science, and
as such consequently more competently to be professed by men, than by
women. It is making the art cheap, say the moderns, to allow the
practice of it to women.
ANSWER.
I AGREE with you in the first part of your objection: but I absolutely
deny the consequences.
THERE are women, who, besides the gifts received from nature, are
improved by study, by reading, and experience, who succeed much more
easily than men in the practice. To say the truth, nature has, in this
point, been even lavish to the women, for this art is a gift innate to
them.
I WILL however own, that not all women indistinctly are proper for this
business; that there must be natural dispositions cultivated by art;
that a purely speculative knowledge is not sufficient; that there are
required good intellects, memory, strength of body and mind, sentiments,
some taste, and practice joined to theory; so that when I say that the
women are born with dispositions for this art; this can only be
understood in general, and relatively to the men, among whom those
dispositions are more rare, because they are less natural to them in
this branch.
WOULD it not be a sort of blasphemy against the divine providence to
maintain, that what God has placed and left in possession of the women,
was fitter for the men? the attentive, beneficent, and tender manner
with which he governed his people elect, obliges us to believe that he
omitted nothing of what was necessary or advantageous to it; since he
regarded that people as his own particular dominion and appendage;
honoring it with his presence, like a master in his dwelling-house, or a
father in his family. He had taken pleasure in the forming and
instructing it from its infancy. He put the women in possession of the
art of midwifery, he blessed, approved, and recompenced the midwives. It
is but just, that men should hear and keep silence where God speaks.
They may think themselves happy, to learn from him the true secrets of
nature, and not from those pretended doctors who abandon the rules of
truth to cleave to themselves; who, instead of her, present us with a
phantom of their own creation, who, in short, would make us the
worshippers of their dreams and imaginations.
THE women have for them the authority of God, who has declared himself
in their favor; they have for them the authority of men from one pole to
the other, who have in all ages made use of the female ministry in this
art. Such a plurality of votes has surely some claim to prevalence,
especially, since it is founded upon the natural order of things, upon
truth and reason supported by experience. This experience we have on our
side: none can deny it, without denying self-evidence.
ONE would think there is a kind of curse attends the operations of
men-practitioners, as I dare aver it for a truth, that difficult and
fatal labors have never been so rife, or so frequent, as since the
intermeddling of the men. Whereas, God has ever so blessed the work of
the midwives, that never were lyings-in so happily conducted, nor so
successful, as when the practice was entirely in their hands.
OPEN the book of Numbers, you will observe, that God having ordered
Moses to number his people: out of seventy individuals of the family of
Jacob, who had come to dwell in Egypt, two hundred and forty years
before, there had issued above six hundred thousand men fit to carry
arms, without taking into the account an almost infinite multitude of
children, of youths under twenty years of age, of women, of old men,
besides a whole tribe, that of Levi, which was entirely set apart for
the divine worship.
OBJECTION the Fifth.
THERE is no such thing as being a good practitioner of midwifery without
understanding anatomy: now this science is the province of a man, of a
physician, or surgeon, not of a woman.
ANSWER.
IT is sufficient that a woman understands and knows the structure and
mechanical disposition of the internal parts which more particularly
distinguish her sex; that she can discern the container from the
contents, what belongs to the mother from what belongs to the child, as
well as what is foreign to both. In short, she ought to be skilled
enough to give full satisfaction to all questions that the most able
anatomist could put to her, in respect to that part purely necessary to
the art of midwifery, and to its operations with mastery and safety.
NOW the midwife, especially one instructed in hospitals, ought to be
well acquainted with all that is essential and necessary to that effect;
and she cannot but be so, unless she is of herself incapable, or that
those who are charged with the instruction of pupils, wrong the
confidence of the public.
I MYSELF know more than one midwife, so well educated as to be able to
give demonstrations on this subject, to analyze things by their names,
either upon drawings of them, upon skeletons, or upon the originals
themselves. It is true, that these poor midwives do not understand
anatomy enough to make dissections; but I fancy that the ladies who want
assistence in their lyings-in, are not very curious of having one that
can dissect instead of delivering them.
PROPHANE history has preserved to us the names and talents of a number
of illustrious women who have distinguished themselves in all kinds of
arts. Cleopatra queen of Egypt, is one of the first ladies that have
written on the art of midwifery. Mr. Smellie, in his introduction,
endeavours to render doubtful this quality of queen and princess, with a
design, probably to weaken the credit of it, or rather out of contempt
to the women; but as all those who have made collections of antient
history, assure us, that notwithstanding the wars in which this princess
was engaged, she did not neglect an assiduous application to physic, I
had rather adhere to their authority, than to that of Mr. Smellie.
IN Greece, Aspasia, and a number of other celebrated women, quoted by
various authors, have applied themselves to our profession, and have
left behind them valuable works on the method of delivering women, and
of managing them both before and after their lying-in.
MADAM Justin, midwife to the Electress of Brandenbourg, has also given
us a very good treatise. Several professed midwives appointed to form
the apprentices of the Hôtel Dieu at Paris, have written very clearly on
the same subject, without however being mistresses of any more anatomy,
than what was sufficient for their business.
OBJECTION the Sixth.
THE different instruments which the men have invented in aid of, and
supplement to the deficiency of nature, and of which they are frequently
obliged to make use in different labors, ought not to be put into the
hands of midwives: and were it but for this reason alone, they ought to
be excluded from the practice of this art. As, why multiply attendants
unnecessarily? A man-midwife, with his instruments which he ought always
to have about him, is enough for every thing: whereas a midwife, if the
case requires instruments, will be obliged to have recourse to a man:
consequently double embarrassment, double expence.
ANSWER.
THE keen instrumentarians bring an argument they imagine capable of
banishing or exterminating all the midwives. The men, they say, enjoy
alone the glorious privilege of using instruments, in order, as they
pretend, to assist nature. But let them, I intreat of them, answer,
whether if the question could be decided by votes, where is the kingdom,
where is the nation, where is the town, where, in short, is the person
that would prefer iron and steel to a hand of flesh, tender, soft, duly
supple, dextrous, and trusting to its own feelings for what it is about:
a hand that has no need of recourse to such an extremity as the use of
instruments, always blind, dangerous, and especially for ever useless?
WHAT has engaged men to invent and bequeath to their successors so many
wonderful productions, for such they imagine them? Is it not the thirst
of fame and money? These gentry have judged, that they ought to spare no
lucubrations, no labor of the head, no efforts of the tongue and pen to
procure themselves a strange reputation, supported by these horrible
instruments. But these lucubrations, this labor of the head, would have
been much better employed in seeking for the means of absolutely doing
without them, as our good female practitioners have ever done, and as
those of them still do, who are instructed in the right practice.
WE are no longer in the times of the Pharaohs and the Herods, who
mercilessly massacred the innocents; we are no longer in the times of
those pure Arabs, who were the inventors of a number of cruel
operations, and of several instruments, which often cause more
apprehension and terror to a woman in labor, though concealed from her
light, but never from her imagination, than the actual presence of all
the apparatus of the rack, where that torture is in use.
IT were to be wished, that all the men-midwives, who had wrote on this
matter, had suppressed the mention of their instruments; for as their
books often fall into the hands of women, so deeply interested as the
sex is in that subject, it is not to be imagined what bad effects they
have. Their variations among themselves would be sufficient to frighten
the women: you meet with authors condemning in the morning the
over-night’s sentiment. I can observe them losing their way in
systematical errors, which explain nothing to me, and in which nothing
can be discovered but disagreement with one another, and with
themselves. The wisest and most able of them, after having well examined
all the kinds of instruments hitherto invented, have doubtless seen and
been convinced of their ridiculousness and usefulness, but all of them
have not hitherto dared to speak out and say as much.
THE most interested of them would fain persuade us, that, in their
display of a whole armory of instruments, they have discovered the
philosopher’s stone of midwifery, in virtue of which they have a right
to wrest out of the women’s hands, the practice of an art, which nature
has appropriated to them. But certainly the point, and the whole point
is, to find an expert dexterous hand, the sex is out of the question,
provided it is but a human hand, and provided the work is done to the
satisfaction of society, it seems to me that nothing more need be
required.
OBJECTION the Seventh.
IT is only for the ignorant to be so rash as to raise an out-cry against
the use of all instruments; people who do not know the absolute
necessity there is for employing them on certain occasions. This clamor
must proceed “from the interested views of some low, obscure and
illiterate practitioners, both male and female, who think that they find
their account in decrying the practice of their neighbours.” Such is the
objection in the words of Dr. Smellie, in his Treatise on Midwifery
(page 241.) and for this panegyric, he prepares us in his Introduction
(page 55.) where, speaking of the midwives of the Hôtel Dieu of Paris,
he first indeed tells us, that the surgeons had, in that hospital,
perfected themselves in the art of midwifery; but then for fear that
from thence occasion might be taken of saying, that to women it was they
were beholden for that perfection; he takes care immediately after to
add, that what “got the better of those ridiculous prejudices which the
fair sex had used to entertain,” was, that the women or midwives of this
hospital “had recourse to the assistance of men in all difficult cases
of midwifery.”
ANSWER.
THESE gentlemen will permit me to tell them that they make great
pretentions, and prove little or rather nothing. Calling hard names with
a disdainful tone, and with airs of triumph, are not overwhelming
reasons.
BUT to the point. Those who reject instruments, say you, do not know
what they are: they reject them from ignorance. This is soon said.
Nevertheless a number of authors, much more experienced and versed in
the matter than Dr. Smellie, are of this opinion. Deventer exclaims
against instruments; Viardel does the same; Levret admits none but those
of his own invention, and rejects universally all others; and well might
he except his own, since he wrote only to recommend them. Delamotte was
not very fond of instruments: he tells us in his preface, that in a
course of thirty years practice, he had not twice made use of the
crotchet, though he had an extent of country forty leagues round, in
which he regularly exercised his profession, insomuch as to have four
lyings-in in a day under his management.
I HAVE very exactly read almost all the modern authors who have written
on this art; and have been surprized to observe that whilst, on one
hand, they agree, they own, that in England, France, and Holland, people
are much come off, or undeceived, as to all those dangerous or mortal
instruments of which the antients made use, such as the short
broad-bladed knife, (call it, if you please, a pen-knife) the bistory,
the crotchets, &c. especially since the invention of the new forceps, or
tire-tête: on the other hand, these same doctors tell you, that recourse
must be had to crotchets, or to the Cæsarean operation, when the new
forceps will not do. A comfortable resource this, in an instrument so
boasted as the best discovery that has been made since the creation of
the world, and for which we are indebted to the moderns!
I HAVE also scrupulously examined all that authors have been pleased to
say of great, wonderful and magnificent, with regard to the new forceps
of Palfin, as it now stands after infinite corrections, as well in
foreign countries, as in this one, which have dignified it with the name
of the English forceps; and I find all these great elogiums reduced, at
the most, to no more than the proving, as clear as the sun, that it is
allowable for an operator, extremely able and extremely prudent, to make
use of it, when the business might be perfectly well done without it.
FROM thence I deduce my demonstration directly opposite to the
pretentions of Dr. Smellie and of his followers. According to the
instrumentarians, and according to certain doctors, there are certain
occasions, certain cases, in which there is an absolute necessity for
employing the forceps. If we will hearken to and follow other doctors of
more celebrity and credit, it is not right to make use of it, but when
one may very well do without it: for example, after the having obviated
all the obstacles which retard the delivery, after having, with the
hands only, dis-engaged the head or the shoulders of the child, without
which (say these same writers) the instrument would be found
insufficient or useless; this palpably implies the being able to do
without it. Now since it is not allowable, in good practice, to make use
of it, but when it is perfectly needless to use it at all, there is then
no absolute necessity for it; as surely, what can be done without, is
not absolutely necessary. Be this only transiently remarked. For I
reserve most convincingly to prove this proposition in the second part
of this work. There I shall treat of all the instruments of our antients
and our moderns, and besides an enumeration of them shall demonstrate
their danger and uselessness. In the mean time, it must be owned, that
either Mr. Smellie has been much misinformed of what passes at the Hôtel
Dieu of Paris, in the ward of the lying-in women, or else, which I the
least believe, is not sincere in the account he gives us, that the women
of that hospital “had recourse to the assistence of men, in all the
difficult cases of midwifery;” which, he observes, “got the better of
those ridiculous prejudices the fair sex had been used to entertain.”
That is to say, in preference of midwives to men-practitioners.
I FREQUENTED this Hôtel Dieu two whole years, before being received an
apprentice-midwife, which I accomplished with great difficulty, on
account of being born a subject of England, and consequently a foreigner
there: my admission, however, I gained at length, through the favor,
protection, and special recommendation of his royal highness the duke of
Orleans. Now, I dare aver, that in all the time before, and after I was
admitted there, I never but once saw Mr. Boudou, surgeon-major called,
who did nothing more than to make us, one after another, _touch_ the
patient, about whom we had been embarrassed; and as he interrogated, he
made us discover an _uterus_ full of schirrous callosities, which joined
to its obliquities, impeded the palpation of it properly with the hand,
the orifice being very difficult to come at. Every thing, however, was
done without his help, and very successfully. And most certainly we
should have spared him the trouble of coming at all into our ward, if
the head-midwife, who was a little capricious in her temper, had not
taken it into her head to keep us in our perplexity, which engaged us to
send for Mr. Boudou without her knowledge, and for which she was
afterwards heartily angry with us.
I NEVER once saw an occasion in which there was any necessity for using
instruments, though in my time we had, at least, five or six hundred
women a month to deliver.
VERY far then are the midwives from having often occasion of recourse to
the assistence of the men, in difficult cases; and indeed to those
prejudiced in favor of men-practitioners, it may, though true, appear
strange, that in a place where there are every year so many thousand
women delivered, and consequently many difficult labors amongst them,
and even cases of monsters, there is no recourse to the surgeon-major
but in the last occurence, which falls out very rarely.
ABOUT eighteen or twenty years ago, Madam Poor, head-midwife of this
hospital, delivered a woman of a monster with two heads, with no help
but only her fingers and a young prentice. Not an instrument was
employed: no man assisted her. The child was christened, and died
presently after. The mother remained some months upon recovery, and did
perfectly well. This fact requires no proofs, being of such public
notoriety. The monster was carried to St. Cosmo’s, where any surgeon may
see it. I served my time with this same mistress some years after this
kind of prodigy had happened.
AS to what I have advanced concerning the procedure in the wards of the
lying-in women, should my testimony appear in the least suspicious, I
appeal to the justice and veracity of all the doctors in England, who
have been at the Hôtel Dieu at Paris, who cannot but confirm what I have
said. In the mean time Mr. De la Motte, who passes for an author of
credit may certify, the same. Here follows what he says in his preface
to his observations, page 2.
“ONE would think (says this author) from reading the books of Messieurs
Mauriceau and Peu, that it was impossible to succeed in the practice of
midwifery, without having operated at Paris in the lying-in ward of the
Hôtel Dieu. It is true, that this hospital is the best school in Europe,
and that I would have ardently wished to have been admitted to the
operations of midwifery during the five years I staid in that hospital:
but as there is no more than _one_ surgeon _only_, who is in charge to
attend when he is called to consultation with the midwives, and that it
is a place which goes only by favor, I was forced to content myself with
following in quality of topical surgeon, to the physicians who performed
their visits there. So that I followed only, for six months, three
physicians in their rounds there, during which time I applied myself to
examine the conduct observed by those gentlemen, to preserve the women
after their lying-in from the accidents which follow thereon. By this
means I made myself amends for my want of recommendation; but I can
safely say, that during the six months I was admitted in the
above-mentioned quality, there was no more than one extraordinary labor,
which was that of a child engaged in the passage, where the presence of
a surgeon was required, and which however was terminated without any
other help than that of patience. And yet there were (so far back as
then) from three hundred and fifty, to four hundred pregnant women, who
were all delivered by the apprentices and rarely by the Dame De la
Marche, at that time, head midwife of the hospital: so that I am
persuaded, that those who boast of having lain a great many women there,
exaggerate furiously.”
FOR me, I dare yet go farther, and will maintain it, that those persons
impose upon the public in such boasts: since the naturalized surgeons,
those of the nation, those of Paris itself, have no right to come into
our ward. There is no one admitted but the surgeon-major, whose place is
a place of favor, and rather matter of form than any thing else. Much
more then are strangers excluded, and the truth is, that they never did,
nor ever do operate there.
AS to the reproach which Mr. Smellie makes to us of being interested, I
can, for myself, prove that I have delivered gratuitously, and in pure
charity, above nine hundred women. I doubt much, whether our critic can
say as much, unless he reckons it for a charity, that which he exercised
on his automaton or machine, which served him for a model of instruction
to his pupils. This was a wooden statue, representing a woman with
child, whose belly was of leather, in which a bladder full, perhaps, of
small beer, represented the uterus. This bladder was stopped with a
cork, to which was fastened a string of packthread to tap it,
occasionally, and demonstrate in a palpable manner the flowing of the
red-colored waters. In short, in the middle of the bladder was a
wax-doll, to which were given various positions.
BY this admirably ingenious piece of machinery, were formed and started
up an innumerable and formidable swarm of men-midwives, spread over the
town and country. By his own confession, he has made in less than ten
years nine hundred pupils, without taking into the account the number of
midwives whom he has trained up, and formed in so miraculous a manner.
See the preface of this author. He speaks of his _machine_ in the first
page, and p. 5, of the number of his pupils.
NOW as to these worthy pupils, must not they be finely enabled to judge
of the situation of women with child, and of that of their fœtus? Must
not they be deeply skilled in that branch of anatomy? Must not they
acquire a habit of the touch exquisitely nice, exquisitely just, for
discerning the proportion and analogy between a mere wooden machine, and
a body, sensible, delicate, animated, and well organized?
I HOPE too that it is an injustice done to that doctor, by those who say
that his pupils have too often a way of hurrying out the waters, which
can only serve to render the labor more dry, consequently more
laborious, and by that means furnish a handle for setting their
instruments to work. If this should be so, as once more I hope it is
not, may not the bad habit they will have contracted during their
pupilship, of drawing the small-beer out of their wooden-woman, have
contributed to this method of practice?
IN the mean time, does it become a doctor to call us interested, who
himself, for three guineas in nine lessons, made you a man-midwife, or a
female one, by means of this most curious machine, this mock-woman?
OBJECTION the Eighth.
BUT you who come so late (it will be said) What new discoveries do you
bring us? Can you imagine you will, with one dash of the pen, cancel the
impression of so many excellent works as have appeared before you? Do
you believe a woman can have more ability than so many men of letters,
who have labored all their life-time in perfecting the art, and who so
strongly recommend the use of instruments, as the most expeditious
method of extricating one self, in all the cases they specify, and where
there is a necessity for recourse to extremities? Can you think, that
these personages have all spent their time in vain?
ANSWER.
ALMOST all the sciences and arts attain to perfection, in process of
time, through the experience and assiduous attention of those who
cultivate them. We owe the most of our rare and precious inventions to
the ages of barbarism, in which as yet reigned that brutality and
ignorance which the irruption of the northern swarms had diffused over
all Europe. This invention and perfection of arts cannot be attributed
to merely human industry; but, with more probability, to a particular
over-ruling providence, which commonly concealing itself under what
seems to us the weakest, and under occurrences which appear to us the
effect of chance, have guided men to wonderful discoveries. Do not we
owe to a fair Circassian the art of inoculating children? And surely the
art of midwifery, perhaps more than any other, stands the fairest chance
of being improved by women.
FOR my part, I dare maintain it, that the surgeons, in form of
men-midwives, have been the death of more children, with their _speculum
matricis_, their _crotchets_, their _extractors_ or _forceps_, their
_tire-têtes_, &c. than they have preserved. If in killing the children,
they have saved the lives of some mothers, they have hurt and damaged,
not to say murdered, a number of others. Their faults ought to set us
upon searching out for a better way of going to work; a more easy, a
more safe one. This fatal operation by instruments might even be
pronounced absolutely useless in the profession. There is no inveighing
severely enough against so dangerous a doctrine as that which recommends
them. Even common humanity requires an endeavour to open the eyes of
those, who imagine they cannot do better than blindly to assent, in
every point, to authors recommendable, it is true, by a number of good
things, but whose authenticity in those points procures them but the
more dangerously credit in erroneous ones. Good sense does not dictate
undistinguishingly receiving all that is advanced even by the best
authors. As they may have been themselves deceived, they may also
deceive us. The sacrifice of our reason is what we owe to nothing but to
revelation. Books written by men have no title to it. As their
understanding is not above the impositions of others, or errors of their
own, they may adopt falsities, through ignorance, through prejudice, for
want of examination, or of right reasoning. Their heart may also have
been byassed or corrupted by views of interest or of ambition. I may
therefore, without over-presumption aver, that with regard to
instruments, it is wrong to lay any stress on the authority of others.
For, with all the respect due to some illustrious writers in these
modern times, who defend the party opposed to ours, it may be assuredly
said, that either they have not known the art of midwifery, or that they
have formed their judgment of it by nothing but the abuses of the
antients, who practiced it without knowing it. Is it not a crying shame,
that operators, who in their life-time massacred such numbers of human
creatures, should still retain, after death, credit enough to
assassinate common sense? Faith is given to unskilful authors, who have
deceived their cotemporaries, posterity, and perhaps themselves:
ignorance admires, enthusiasm protects them. But what a cruel and mean
policy must be that of supposing, that the knowledge of truth ought not
to have a clearer title to dominion than the illusions of imposture? I
hope however, that, when the eyes of the public shall, in this point,
come to be opened, and opened they will be, if true physicians will give
themselves the trouble to enlighten it, that public will at length see,
that an approbation, unpreceded by a due examination, does it as little
honor as service.
LYING-IN women principally require an early assistence. For unless they
are pregnant of a monster with two heads (a case so rare, that in the
practice of a thousand surgeons, in their whole life, it may not twice,
nor perhaps once fall in their way) there need never be an occasion of
recourse to a surgeon: for in this case, of a monster, it must be the
affair of a most profoundly skilled operator and not of merely a common
man-midwife.
RUN over all the authors who have written on this matter, and you will
find that the men-midwives, for want of right, and of true knowledge of
the profession, have introduced themselves by force and violence, as one
may say, sword in hand, with those murderous instruments: read the
ancients, it will appear, that they cut their way in, with iron and
steel, forerunners of murders. Our moderns to palliate these violences
and injustices, agree on one hand, that the common and gentlest methods
are to be preferred: but, on the other hand, when you tell them, that
the common and gentlest methods are the hands of women, who ought
therefore to be preferred to the men, and to be restored to their
antient and rightful possession; then you will see the whole pack open
in full cry: to arms! to arms! is the word: and what are those arms by
which they maintain themselves, but those instruments, those weapons of
death! would not one imagine, that the art of midwifery was an
art-military?
AS for we women, we can but in our weakness groan under this tyranny.
Our protest, joined to that of reason and experience, avails little. Our
wise innovators have a great deal more wit than we have; but it is not a
wit of which we would be ambitious: for it serves them no better, than
under the pretence of saving to be paid for destroying: at least it is
not unfrequently so.
OBJECTION the Ninth.
OPINION often makes a stronger impression on us than truth. Whatever you
may say to the contrary, the imagination will prevail of life, being
safer in the hands of a man than of a woman. For, in short, of what
importance can a woman be, who, after all, is but a woman? This is so
true, that most of our women now a-days will have a man-midwife, some
through prejudice, others through good œconomy, because if there are any
prescriptions necessary for the patient, the man-midwife, who is also
stiled the doctor, will write for them; whereas, if there is a midwife,
a physician may moreover be requisite: this is an additional charge.
ANSWER.
A HAPPINESS founded on opinion only, is rather too slightly founded,
especially in a point where not less than life is at stake. I know there
are women so obstinately wedded to their opinion of certain pretended
doctors, that they would not look upon it to be a good office done them,
though certainly it would be one, to undeceive them. I also know that
the title of doctor is so common in this country, that it ought to be
very cheap.
MOST of the women in labor, (you say) will have men to assist them, as
thinking their life more in safety with them, than in the hands of
women. May be so. But what does that prove but the deplorable blindness,
the weakness of the human understanding, and the silly prejudices in
favor of novelty? Is it then the instruments of these men-midwives that
give this confidence or this security? As if a king, a queen, or
princess dangerously ill, could be defended from death, by doubling
their guards.
THE women have on this occasion the delicacy not to suffer even their
husband to assist at their labor, and this out of decency. This is very
well for those who are contented with midwives; but as for those who
will be attended by men to lay them, it is very wrong in them not even
to insist on their husband to stay by them. For this preference of men
to deliver them, comes either from a greater inclination to the men, or
from a greater confidence in them than in the women, or, in short, from
the pure necessity they imagine themselves under to employ a man. If it
is from inclination, or from necessity, it will be always proper for the
husband to stay, to contain the man-midwife, as much as possible, within
the bounds of modesty. If the man-practitioner is preferred by them, out
of the great confidence they have in men: in what man can they place
more confidence than in a tender husband: who more than he can interest
himself in the man-midwife’s acquitting himself duly of his office?
I WONDER that this great confidence which is reposed in the male sex
should be limited to the man-midwife only. I promise the women, that
they may with equal justice imagine a greater handiness about them in
men-attendants than in women; they may just as well have men-nurses as
men-midwives: the convenience will be as much greater in the one, as the
safety will be in the other. Away then with all the women, who croud
round to comfort and relieve a woman in labor: away with your mothers,
sisters, aunts or female acquaintance: in consequence to the preference
due to the male-sex, let the patient’s labor be attended by fathers,
brothers, uncles, or men-acquaintance.
BUT let common opinion lower women as much as it will, so much is
certainly and experimentally true, that, notwithstanding the prejudice
and superiority of the men, the judgments and decisions of the women are
often more shrewd, more exact than theirs. Women have a certain delicacy
of mind, which, not being spoilt by undigested studies, renders their
taste much more quick, and more to be depended on, than that of the
half-learned.
THE distribution of merit and talents is entirely in the hands of divine
providence, that gives what and to whom it pleases, without respect to
the quality of persons; forming out of the assemblage of sciences of all
sorts, a sort of empire, which, generally speaking, embraces all ages,
and all countries, without distinction of age, sex, condition or
climate. The rightful claim to solid praise in this empire, is for every
one to be contented with his place, without bearing envy to the glory of
others. These he ought to look on as his colleagues, destined as well as
himself to enrich society, and become its benefactors. As this
providence places kings on the throne for nothing but the good of the
people, neither does it distribute different talents to men but for the
public utility. But, as in states it has been seen, that tirants and
usurpers have sometimes got the upper-hand, so, amongst men of talents
there may, if I dare so express myself, creep in a sort of tyranny,
which, in the present case for example, consists in looking on the women
with a jealous eye, especially those who from an eminence of talents
might dispute precedence with them. Thence it is that they are, as it
were, hurt by their successes, and by their reputation, and that they
endeavour to depreciate their merit, in order to establish the sole
dominion in themselves. A hateful defect this, and entirely contrary to
the good of society.
THIS is nevertheless the defect of most of our young men-midwives. But
when I consider the mercenary interest by which they are guided, I am
far from wondering at their inveteracy against those midwives,
especially who are distinguished for their merit and science. The
objects of this malignity of theirs are principally those, who have a
reputation they fear may enable them to be their competitors in
practice. From this mean jealousy of profession, they warmly inveigh
against its being trusted in our sex. This is a doctrine they spread
every where, and the stale burthen of their abuse is ever, “What is a
woman? What effectual service can be expected from a woman?” And thus,
by dint of this repetition and of clamor, they come at length to
accomplish the persuading an over-credulous public. The common people
have in all ages been easily seducible, open to imposition, and when
once an error has got full possession of them, it is a miracle if it
does not maintain itself in it. They love novelty, are readily taken
with striking objects, and stop at the surface of things, which they
eagerly seize. Singularity especially moves them. Reason alone, and
divested of chimeras, appears too naked to them. They must have
something that borders upon the marvellous. Is it not from thence that
the dreams of the poets found faith among the Heathens, or that the
fables of the Coran pass for so many truths among the Mahometans? To the
same weakness in favor of every thing that will make one stare, is owing
that silly credulity, which so often leads men to the swallowing the
grossest absurdities. One would think fictions had peculiar charms for
them.
NOTHING however can be more pitiful, than the injustice of running down
a sex, which has, in this very matter of midwifery, served the whole
earth through all ages, till just the present one, that a small part of
the world, becomes in imagination, all of a sudden a land of Goshen, or
the only enlightened spot, and takes the ignis fatuus of a mercenary
presumption for the sun-shine of sound reason. But after this injustice,
where will the men stop? What profession will they leave to the women?
It will at last be discovered, that the men can spin, raise paste, cut
out caps, pickle and preserve better than we do. After all, is it not
even ridiculous to see a custom, established for above five thousand
years, universally approved by great and little, fall into disgrace, I
will not say by the opinion, but by the whim of a handful of people,
most of whom too are, most probably, perfectly sensible of the nonsense
and absurdity of that whim, but defend it from a spirit that can hardly
not be suspected of interestedness, which indeed will make men defend
any thing?
AND after all, even common decency and common gratitude might engage the
men-midwives to speak less slightingly of the women of that profession;
since of whom is it, that the most famous of our present
master-men-midwives of London have learned their science but of the
women? Do not even the principal ones of them make it their boast to
have served a kind of apprenticeship under those midwives, who had
served theirs in the Hôtel Dieu at Paris?
BUT surely the reader will not think it here impertinent to observe,
that the wise administrators of that famous hospital, would hardly have
failed establishing men-midwives in it, if the safety of the subject had
had any thing to fear in the hands of women. But women alone it is that
preside at all the lyings-in there, be they never so extraordinary or
laborious. The men-midwives have never yet been able to extend their
footing within that place. Their emissaries can gain no admission, nor
are any proficients trained up there but women only. Notwithstanding
which, all the women who are there delivered are satisfactorily and
skilfully assisted. Vexatious accidents are less frequent there, in
proportion to the numbers, than elsewhere, under the eyes and operation
of the men-midwives. Mother and child are both more in safety under the
hands of those dextrous matrons, than in those of the most renowned
men-practitioners[3].
TO those then, who with a contemptuous tone ask what is a woman but a
woman? I shall with equal modesty and truth answer, that generally
speaking women are inferior to men in most public services. They are
scarcely so fit to head armies, to navigate ships, break horses, or the
like manly employs: but there are certainly domestic branches, in which
they rather make a better figure than the men. Midwifery seems their
appropriate lot: and rather a gift than an acquisition. They hold from
nature herself, in this matter, a certain expertness and dexterity, to
which not all the more abstruse refinement of art can ever conduct the
men. Nor will the operation of iron and steel instruments ever equal the
suppleness, safety and effectual ministry of the fingers of an expert
midwife, who understands her business.
LET me then be permitted to ask retortingly in my turn, What is, at the
best, a man-midwife? Is not he one of a new set of operators unknown to
our ancestors? A creature in short hard to be defined? In no original or
primitive language is there so much as a word to express one of this
profession. The common word for him in the English language is a
contradiction in terms, a monstrous incongruity; a MAN-_mid_-WIFE.
Sensible of the ridiculous sound of this expression, scarcely less so
than that of a _woman_-coach-_man_, they have, by way of remedy,
borrowed the term of _accoucheur_ from that nation whence the fashion
was unhappily borrowed, among many other fashions, so many of which are
however rather ridiculous, than like this one _big_ with danger, added
to the ridicule of it. But even that affected French word _accoucheur_
is of a very recent date in France. No French authors employ it, who are
not themselves of a more modern date than the word itself, which has not
above the antiquity of a century to boast. The name and vocation of a
midwife are found in the most primitive languages, being, in fact,
coeval with mankind itself.
AS to those who, from a principle of œconomy, prefer a man-midwife to a
midwife for conducting a lying-in, with respect to the remedies and
prescriptions which may be necessary on those occasions, Œconomy is
doubtless a laudable consideration, but I am much afraid, that those who
on this occasion make it a reason of preference, much mis-calculate
things. This man-midwife you prefer is either an eminent or an ordinary
one. If he is an eminent one, you are not always sure of having him in
the greatest need; for besides their being so rare, they cannot be every
where at one time. But admitting that you are fortunate enough to fall
into the hands of a man-midwife of the greatest name in the profession,
can you imagine that you will have a very cheap bargain of him? These
gentlemen expect no small fees, and will not attend without them. You
would besides be ashamed of not doing honor to the footing on which they
give themselves out. Whereas the same gratitude is not always shewn to a
midwife, however skilful in her profession, and whatever trouble she may
give herself both before and after the lying-in of her patients;
notwithstanding too the assiduous attendance and visits she bestows upon
them till they are out of danger; notwithstanding these tender
attentions she has for the children, which are so seldom regarded by the
men-midwives; there are who imagine they cannot give a midwife of this
sort too little, and that for no other reason on earth, but because she
is not a man.
IF on the contrary, and what the most frequently happens, you fall into
the hands of one of the common men-midwives, either of that multitude of
disciples of Dr. Smellie, trained up at the feet of his artificial doll,
or in short of those self-constituted men-midwives made out of broken
barbers, tailors, or even pork-butchers (I know myself one of this last
trade, who, after passing half his life in stuffing sausages, is turned
an intrepid physician and man-midwife) must not, I say, practitioners of
this stamp be admirably fitted, as well for the manual operation, as for
the prescriptions? If then it is from thrift they are employed, by way
of sparing fees to a real physician, I own, I think this is pushing
savingness too far; as I should be almost as much afraid of the
prescriptions of these mock-doctors as of their operation. I should have
more confidence in the advice of a discreet matron, or of a skilful
midwife, who, by habit and a long experience of seeing ladies in their
lyings-in attended by the best physicians, is in the most common cases
of the labor-pains, more able to advise the sick person to innocent
remedies, where there is no complication in the disorder, than those
half-bred or ignorant pretenders: but if there is a complication, then
there must absolutely be a good physician called in, the expence of
which should not be regretted, since life is at stake.
NOW in such cases, a midwife, though never so skilful, will neither be
ashamed nor backward to require such aid: whereas a man-midwife, the
more ignorant he is, will be but the more careful of concealing that
ignorance, and from the most false prejudice that both the faculties of
physic and surgery are implicit ingraftments on the profession of
midwifery in a man, will rather let mother and child perish, than call
in that assistance, of which he will be ashamed to confess his standing
in any need. He will then rashly do the best he can for his patient: but
what will that best most probably be? Torture and death; and that with
perfect impunity. I say most probably, for not even the most credulous,
or the most zealous for the appropriation of this profession to the
male-sex, can hardly carry the blindness of credulity and obstinacy the
length of assenting in earnest, that in the common run of
men-practitioners you are to find at once the man-midwife, the
physician, and the surgeon. Whereas women, fully sufficient for all
cases but the very extraordinary ones indeed, are ever ready to call for
proper help, on the first alarm of danger, of which too their
apprehension is much more quick and just than that of the men.
OBJECTION the Tenth.
THE ignorance of the women is the cause of the little confidence there
is reposed in them.
ANSWER.
IF this objection was fairly stated, it should be said, that the
ignorance of the women in the art of destroying mother and child,
occasions their not being trusted so much as they deserve with the
office of saving both. In that art indeed of perpetrating double murder
with perfect impunity, under the sanction of the public credulity,
imposed upon by a vain parade of learning, I readily confess the men
superior to the women. I do more than confess it, I will prove it; and
how? even from their own writings and confession, not extorted from them
by the spirit of candor, but from an interested desire of decrying or
supplanting one another, in order to self-recommendation.
IN fact, whoever will, with a competent degree of knowledge of the
subject, and of due impartiality, peruse the practical treatises of
midwifery, written by the most celebrated practitioners, some of whom
have so vainly pretended to the triple union of the characters of
man-midwife, surgeon and physician in one person, and it will be found,
that all their boasted superiority of erudition, has only led them into
the greater errors of practice, and the most barbarous violences to
nature.
BUT perhaps I exaggerate. Let the reader judge for himself, and
pronounce as his own reason shall dictate to him. Let him if he can read
without shuddering, the following quotation from one of the most
celebrated _men_-midwives of the age, Levret, p. 199. “Mauriceau had
invented a new _tire-tête_, which was to be introduced into that part
(the uterus). Peu or Pugh, like _many_ others, made use of different
hooks (_crochets_) and La Motte opening the head with scissors, scooped
out the brain, &c. We read, with horror, in _all_ these authors, that
they have extracted children, who, tho’ much _maimed_ or _mutilated_,
have yet _lived_ several hours.”
UPON this many reflections will naturally occur. These children thus
destroyed, owed most probably their death neither to nature, nor to the
difficulties of the passage through which the launch is made into our
world, but to the labor being prematurely forced, and the delivery
effectuated by those torturous instruments, which at once kill the
child, and not seldom irreparably wound the mother in the tender
contexture of these parts. A midwife, with less learning and more
patience than those gentlemen, and well acquainted with the power and
custom of Nature to operate in some subjects, sometimes more slowly, and
in all ever more safely and gently than art, would have left to nature,
not without her tenderest assistance of that nature, the expulsion of
the child. A proper predisposal of the passage, and direction of the
posture, with an unremitting attention to employ the fingers, so as not
to lapse the critical moment of operation, often never to be recovered
with safety to mother and child, would have, I repeat it, and appeal to
common sense for the probability thereof, saved the lives of those
innocents, which thus fell the victims of those _learned_ experiments,
with instruments, which, by the way, be it remarked, none are so forward
to use, as those who are the loudest in exclaiming against the employ of
them. And reason good, if they exclaim against them, it is evidently in
order to cover their practice with them, against which the minds of
their patients must so naturally be revolted. But that exclaiming does
not evidently hinder their being used, when, the truth is, that if due
care was previously taken with the patients, those execrable substitutes
to the fingers need never be used at all.
BUT if these instrumentarians were called to account for their so justly
presumable massacres, what would be their defence? Most certainly not
the truth. One would not own, that in order to attend a richer patient,
or perhaps to return to his bottle, he had recourse to his fatal
instruments, to make the quicker riddance or _effectual_ dispatch;
another would not confess, that he employed them purely because his fund
of _patience_ was exhausted; some would not care to allow, that they
used them purely on the scheme of trying experiments; and none of them
would, you may be sure, plead guilty of ignorance of better and more
salutary methods. No! their wilful error, or that want of skill, they
would be sure to conceal under the cloud of hard words and scientific
jargon, in which they would dress up their respective cases, and insult
the ignorance of those silly good women, who _know_ no _better_ than to
deliver those of their own sex with the help of their fingers and hands,
and who are so undextrous, as to have no notion of putting them to such
unnecessary tortures and risks, as are inseparable from the use of those
iron and steel instruments. Instruments which rarely fail of destroying
the child, or at least cruelly wounding it, and never but injure the
mother, not only in those exquisitely tender-textured parts, where they
are so blindly and ungovernably introduced; but in the often
irrecoverable dilatations of the external orifice, the vagina, and
especially the _fourchette_ or _frænum labiorum_, all which, in general,
they considerably damage: and always originally without necessity. For
if through carelessness, if through an impatience, so much more natural
to men than to women, in a case and position of this nature; if through
ignorance of the critical minute of extraction, the occasion of
operating with the fingers has _not_ been _lapsed_, any recourse to
instruments is perfectly unnecessary, and they will hardly ever succeed
where the subject is inaccessible to the fingers, without having the
worst of consequences to dread from them both to mother and child.
Nothing then can be worse for a man-midwife, than to be tempted to any
negligence, to any precipitation, to any ostentation, in short, of
expedition or of superiority of skill to that of the women, by his
having those instruments at hands, the doing without which is at once so
much better and safer, even by the confession of those who use them
nevertheless.
HOW greatly then is the ignorance of the midwives preferable to _such_
an use, as the male-practitioners commonly make of that deep learning of
theirs, which only misleads them, at the expence of humanity! How
over-compensated is that want of theoretical knowledge, so unjustly
reproached to women, since they profess a sufficiency even of that
knowledge; how over-compensated, I say, is that supposed want, by that
instinctive keenness of apprehension, and ready dexterity of theirs in
the manual operation, which in them is a pure gift of nature, and to
which not the utmost efforts of art or experience can ever make the men
arrive, for reasons which will be made clearly appear in the two
following considerations.
FIRST, It will hardly be denied, that the art of midwifery requires a
regular training or education for it. The season of that education can
only be that of youth. And surely in that season precisely, the very
nature of the study excludes those of the male-sex, at the same time,
that there is nothing in it indecent or improper for the females
destined to that profession. This proposition will be more clearly
illustrated, by an appeal to the reader’s own sense and reason upon what
passes, and must necessarily pass in those hospitals for the reception
of lying-in women, where those of the male-sex are allowed to attend for
the sake of learning the profession.
THIS Charity is indeed founded upon specious motives, but the conduct of
it would make humanity shudder, even where no violence is expressly
intended to humanity; and without the least forced or uncharitable
conclusion, may serve to demonstrate the impropriety of attempting to
throw the practical part of midwifery into the hands of
male-practitioners, the implicit consequence of which must be the
exclusion of the midwives, without any direct and formal exclusion of
them, but purely from the discouragement that will hinder any good and
able ones being formed in future. And that no thoroughgood men-midwives,
except perhaps two or three extraordinary men in a whole nation, can
ever be formed, the procedure at the lying-in hospitals, open to
men-pupils, such as it must of all necessity be from the nature of the
thing itself, without any the least reproach herein meant to the worthy
managers, will convince all who will make an unprejudiced use of their
judgment.
WE will then suppose a lying-in hospital, in which, for the sake of
training up _men_ to the profession of mid_wives_, there are young
pupils of the male-sex admitted to attend and learn the practical and
manual part of the business. To obtain this end, we will not say that
women of virtue and character are subjected to the inspection and
palpation of a set of youths, who perhaps pay largely for their
privilege of attendance; but we will grant, that the objects of this
charity are entirely women, who, though they may have unfortunately
forfeited their right to virtue, cannot however have lost their claim to
the protection of that humanity, which, besides the great and most
political attention due to population, pays especially a tender regard
to the innocent burthen, though of a guilty mother. Yet among these
wretched victims, there may be not a few who, if they were not even to
deserve more compassion than blame, for particular circumstances of
their ruin, in which the villainy of men has often a much greater share
than female frailty itself, cannot surely deserve that all traces of
modesty, or natural remains of regard for it, should be utterly
eradicated by that hard necessity of theirs to accept of a charity, by
which they must be abandoned up to the researches of a set of young men,
to whose approaches their age and sex must alone give an air of
petulance and wantonness not to be explained away, to the satisfaction
of the poor passive sufferer, by the goodness of the intention. Every
one must be sensible of the dreadful effects such a treatment must have
on the mind of a poor creature in that condition, when the imagination
is known to be the most weak, and susceptible of the most dangerous
impressions. At that critical time, amidst all the terrors and
apprehensions inseparable from her situation, she is moreover exposed to
the greatest indignity that can be well imagined, that of serving for a
pillar of manage to break young men into the exercise of that most
unmanly profession. Nay, that very circumstance of the use she is put
to, which she is in fact to consider as a kind of valuable consideration
by her paid for the relief afforded her, and which in that light can
scarce be called a charity; that very circumstance, I say, of her
submission, at all calls, and upon all pretences of the pupils, being
accounted for to her by the good intention of it, will yet hardly pass
on a wretched, frightened, harrassed woman, who, whatever may be said to
procure her tame acquiescence, can scarcely, if she has a spark of
female modesty left in her, be reconciled to the grossness of such
usage, whether she considers herself as the butt of wantonness, or the
victim of experiments, or perhaps of both the one and the other. It is
well if she is defended by her ignorance from any idea of those dreadful
instruments, of the having practices tried upon her with which, her
circumstances might but too reasonably render her apprehensive, since a
needless resort to them may be too often presumed in the course of
practice, where the men are even paid for their assistence. These the
men-midwives may possibly indeed conceal from the sight of their
patients, but I defy him to conceal them from their wounded imagination,
if they are not wholly ignorant or can think at all.
YET in pure justice to all parties it should be observed, that, besides
many other points to be learned only by ocular inspection and manual
palpation, of which no theory by book or precepts can convey
satisfactory or adequate notions, that great and essential point in our
profession, a skill in what we call the _Touching_, is not to be
acquired without a frequent habit of recourse to the sexual parts whence
the indications are taken. And in this nothing but personal experience
can perfect the practitioner. But this admitted, only proves the more
clearly the utter impropriety of men addicting themselves to this
occupation. For, once more, most certainly the season of acquiring the
nicety of that faculty of _Touching_, besides other requisites in the
art, is for obvious reasons that of youth. Now let any one figure to
himself boys or young men, running at every hour, and exercising a kind
of cruel assault on those bodies of the unfortunate females, upon which
they are to learn their practice. But will they learn it by this means?
It is much to be doubted. It may perhaps be granted, that men of a
certain age, men past the slippery season of youth, may claim the
benefit of exemption from impressions of sensuality, by objects to which
custom has familiarized them. But, in good faith, can this be hoped or
expected in the ungovernable fervor of youth? Can such a stoic
insensibility be imagined in a boy or young man, as that he can direct
such his researches by pawing and grabbling to the end of instruction
only? Must not those researches, humanly speaking, be made in such a
disorder of the senses, as to exclude the cool spirit of learning and
improvement? May he not lose himself, and yet not find what was the
occasion of losing himself? In short, granted, though it is surely hard
to grant, that the wretched women, admitted to this so falsely called
Charity, may not deserve much tender consideration; but in what can the
poor young pupils have deserved so ill of their parents or guardians, as
to be thus exposed to temptations so shockingly indecent? What father,
what mother, what considerate relation can paint to himself a child, or
charge of his, at an age so incapable of resisting the power of sensual
objects, as is that of youth, employed in exploring such arcanums, and
exploring them too in vain? It is surely easier to guess the natural
consequences, than to defend either the subjecting youths to them, or
the hoping any good from the subjecting them. In short, even Dr.
Smellie’s doll is a more laudable method of instruction.
BUT besides this reason taken from the moral impossibility of laying a
timely foundation of practical knowledge in the male-sex, for preferring
women under the false charge of ignorance, to the so unconsequentially
boasted learning of the men, there remains a yet stronger argument
against the male-practitioners: an argument furnished by nature herself,
and of the which, every impartial reader’s own feelings will in course
render himself the judge.
NATURE has to all animals, from the man down to the lowest insect, to
all vegetables, from the cedar to the hyssop, to all created beings, in
short gives what is respectfully necessary for them. Nor can it without
the grossest absurdity be imagined, that this tender universal parent,
or call her by a yet more sacred name, the divine providence, would have
failed women in a point of so great importance to them, as that of the
ability to assist one another, in lying-in, at the same time, that she
has given them so strong and so reasonable a sympathy for those of their
sex in that condition? Can it be thought that nature, so vigilant, so
attentive, to the production of fresh generations, through all beings,
should have been deficient or indifferent as to women, her favourite
work, the friend, the ornament of human kind? And so she must have been,
if she had left her in the necessity of recourse to others than those of
her own sex, in whom there exists so sensibly a superior aptitude for
tending, nursing, comforting and relieving the sick, that even the men
themselves, in their exigences of infirmities, can hardly do without
them. But to say the truth, and as I have before remarked, nature has
been even liberal in her accomplishments of those of the female sex for
this office. Not content with giving them a heart strong imprinted with
a particular sympathy for their own sex, on this occasion, a sympathy,
which for its tenderness, has some resemblance or affinity to the
instinctive love or _storge_ that parents have for their children; she
has also bestowed on them a particular talent, both for the manual
function in the delivery of women, and for all the concomitant
requisites of their aid during the time of their lying-in: a talent in
short, which may even be felt, without the necessity of definition or
proof, to be superior to any possible attainment of the men in that art,
though they should have sacrificed hecatombs of pregnant rabbits, or
have brooded over thousands of coveys of eggs in their search of
excellence in it. To say nothing of a certain softness, flexibility, and
dexterity of hand, palpably denied to the men, there is, both in the
management of the manual operation, and in the attendance due on those
occasions, a quality in which the women, generally speaking, excel the
men, and that is, patience, a quality more essential, more indispensable
than can well be imagined. For on patience it is, that the salvation of
both mother and child often depend; whether that patience is considered
in the so needful point of predisposing the passages, or of waiting,
without however over-waiting, the critical efforts of nature in the
expulsion of her burden. Now nothing is more certain, than that nature,
who to woman has in general given all that vivacity and quickness of
spirit, which seems incompatible with the phlegmatic quality of
patience, has, as if she had purposely meant an exception favourable to
her darling end, the propagation of beings, especially the human one,
bestowed on the female sex, such a remarkable assiduity and diligence in
aid of women’s labors, as are rarely to be seen in men, and when seen,
appear rather forced than naturally constitutional to them. Women, in
those cases, have more bowels for women: they feel for those of their
own sex so much, that that feeling operates in them like an irresistible
instinct, both in favor of the pregnant mother and of the child. Thence
it is, that a woman-practitioner will employ, without stint, or
remission, all that is necessary to predispose the passages, for the
least pain, and the greater safety; she will patiently, even to sixteen,
to eighteen hours, where an extraordinary case requires so extraordinary
a length of time, keep her hands fixedly employed in reducing and
preserving the uterus in a due position, so as that she may not lapse
the critical favorable moment of extraction, or of assisting the
expulsive effort of nature: and what man is there, can it be imagined,
would have endurance enough to remain so long in a posture, the very
image of which, in one of his sex, is so nauseating and so revolting, to
say nothing of the want of that pliability and dexterity of management
of the fingers, on those occasions, so necessary, and so uncommon in the
men, especially in that very age, when their practice should be supposed
the greatest.
IT is then in those cases where nature is slow, as she sometimes is, in
her operation, and often so, for the greater good of the patient, so
conformed perhaps, that a quicker expulsion would only destroy her, that
the midwife, not only uses all patience consistent with safety of life
to the mother especially, but inculcates patience to her suffering
charge. Whereas _the men_, from their natural impatience, or from
whatever other motives their precipitation may arise, having those
infernal iron and steel instruments at hand, are but too often tempted
to make use of them, not only without necessity, but against all the
indications of nature, pleading for a just indulgence to her of her own
time in her own work. In vain then do too many of them declaim as loudly
as can be wished, or as the thing deserves, against all recourse to
instruments, but in extremities which, they pretend, justify them. In
the first place, those extremities are often the fault of deficient and
unskilful practice. The precious moments of the assistence due to nature
have been lapsed, or there has been some failure of preliminary
treatment; or what is worse yet, extremities are rashly taken for
granted when they are not existing.
HERE, in the history of one single woman, I give the history probably of
thousands.
A HEALTHY woman, about twenty five years of age, and remarkably robust,
was in labor of her second child. Her first had come in that natural
smooth way, as had given the same man-midwife, who was now to lay her
again, not the least trouble, as often happens. In this second labor,
however, the head of the child stuck in the passage; and was so far
advanced, that the Doctor told her, whether in jest or earnest I cannot
say, that he could discern the color of its hair. Her pain, though
extremely great, had not however hindered her observing the Doctor
rummaging for his instruments; her frightful apprehension, of which, she
had all the reason to imagine, did not a little contribute to retard her
throws. She taxed him with his intention to use them, and he did not
deny it. Upon this she used the most moving fervorous entreaties for a
respite of execution; but all in vain; he told her, with a resolute
tone, that he knew surely better what was for her good than she did,
that he had even already waited longer than he could justify; and that
her life was absolutely desperate if the child was not instantly
extracted, of the which being dead, he was sure from many incontestable
symptoms. Her thorough confidence in a man, whom she had often heard
declaim vehemently against the use of instruments unless in extremities,
and which she understood in the most literal sense, without considering,
or perhaps knowing that, on too many occasions, nothing is so different
as words and actions; her thorough confidence in him, I say, joined to a
natural love of life, and to her present feelings of exquisite pain,
determined her to an acquiescence. The fatal instrument was struck into
the brain-pan of the child, who at the instant gave the lie to the first
part of the Doctor’s asseveration as to its death, by such a strong kick
inwards as had almost killed her, and convinced her not only of its
being alive but lively. This did not, you may be sure, add to her belief
of the second part of his averment, that waiting any longer for the
operation of nature, would infallibly have been her death. It might be
so: yet surely there are strong reasons for concluding, that a little
more patience might have saved a fine boy, and yet not have destroyed,
or even hazarded the destroying the mother, whose life is certainly the
preferable object. But how cruel to state the dreadful alternative where
it does not exist! And how easy, in the presumption of that alternative,
to extort the dreadful consent from a weak woman, yet more weakened by
her condition, and naturally determined by her present feelings, to
embrace the appearance of an immediate relief, presented to her in the
form of salvation of life! However, scenes similar or a-kin to this,
may, without breach of charity, be presumed too frequent, especially
under those superficial men-midwives, whom the facility of forming, in
the manner they are generally formed, renders so suspicious as to their
ability, and who for so many reasons, both of nature and interest, are
but too liable to the murderous want of that patience, for which the
women are but the more remarkable in this case, for their not being
perhaps so capable of it in any other. But here their duty is even their
nature; as if in so capital a point, she would trust it to nothing but
herself.
IF it should be here to this objected that the women may, through that
very spirit of patience, wait too long, or overstay the time of saving
the patients life, for want of calling in proper assistence; I have
already implicitly obviated this objection, by remarking before, that a
true thorough midwife, from her quickness of apprehension, and knowledge
of the danger, will ever be readier to call in the assistence and advice
of a physician, than the common men-midwives, who are ever in proportion
to their ignorance the more rash, the more fearless, and consequently
averse to calling in that help, of which they will be ashamed to confess
their want, and thus cruelly, though with impunity, lose the opportunity
of others endeavouring at least to repair those damages, of which
themselves are oftenest the authors. Now a midwife has no such shame;
she pretends to no extraordinary skill in physic or surgery; she knows
her art, and will not presume to transgress its bounds; she would think
herself accountable if she did: and even that very tenderness and
sensibility, upon which nature has founded her patience, will make her
cautious how she pushes that patience too far. She may easily see, feel
and discern those cases in which nature calls the physician in aid to
the midwife; nature, who seems to have placed such boundaries between
those professions, as nothing but interest, presumption, or ignorance of
nature, could ever render their union in one person supposable: tho’ the
quality of physician may not indeed exclude that of the surgeon, but
rather implies, at least, the theory of surgery. For I presume anatomy
is the great basis of true rational physic, though it can very little
assist practical midwifery, which depends so much upon purely manual
operation, and needs only a sufficient general idea of the structure of
the sexual parts in woman, the conceptacle, and passages of the
delivery.
THIS is so true, that any impartial observer of the male and female
practitioners in midwifery, will easily distinguish the characteristic
difference of the sexes, in their respective manner of operation.
IN the men, with all their boasted erudition, you cannot but discern a
certain, clumsy untowardly stiffness, an unaffectionate perfunctory air,
an ungainly management, that plainly prove it to be an acquisition of
art, or rather the rickety production of interest begot upon art.
IN women, with all their supposed ignorance, you may observe a certain
shrewd vivacity, a grace of ease, a handiness of performance, and
especially a kind of unction of the heart, that all evidently
demonstrate this talent in them to be a genuine gift of nature, which
more than compensates what she is supposed to have refused them, in
depth of study, though even of that they are not so unsusceptible, as
some men detractingly think; and in midwifery, most certainly they
attain all that they need of learning to perfect them, with a facility
the greater for nature, having collaterally endowed them with an
organization of head, heart and hand, obviously adapting them to this
her most capital mystery. This will be denied by none who have any
regard for truth, and who do them justice, as to the keenness of their
apprehension, as to that simpathizing sensibility which supplies them
with the needful fund of patience, and tender attention; and as to that
peculiar suppleness of the fingers, as well as slight of hand, in a
function which rather exacts a kind of knack or dexterity, than mere
strength, of which they have also a competency. Nor can it be quite
without weight, that the midwives, besides their personal experience,
being sometimes themselves the mothers of children, have a kind of
intuitive guide within themselves, the original organ of conception,
itself pregnant, in more cases than that, with a strong instinctive
influence on the mind and actions of the sex; an influence not the less
certainly existing, for its being undefinable and unaccountable, even to
the greatest anatomists[4].
THE men, it will be said, have many or all of these qualifications,
except indeed the last. Granted that they have: but how very few are
there of the men that possess the most essential ones to a degree
comparable to that of the women: or rather not so imperfectly, as that
all their boasted skill in literary theory and anatomy, cannot
supplement or atone for the deficiency? Nor theory, nor all the books
that ever were written on that subject from the divine Hippocrates, who
understood so much of physic, and so little of midwifery, down to Dr.
Smellie, who is so great a man in both, will ever amount to so much as
the practical experience of a regular bred midwife.
AS to that superior skill of the men in anatomy which is sounded so
high, against the women, I shall not imitate the men in their want of
candor towards the female-sex in their availing themselves of false
arguments. I will not then take the benefit of the slight opinion which
Celsus and Galen had of the depths of anatomy; they who contented
themselves with a gross superficial notion of the principal viscera. I
will not even desire to countenance that contempt by the example of that
great philosopher Mr. Lock, the intimate friend, and even the counsellor
of the British Esculapius Sydenham, who paid a great deference to his
physical knowledge; and yet this very Mr. Lock wrote an ingenious
treatise (though not published by him) upon the insignificance of the
refinements of anatomy in the practice of physic. Neither will I here
insist on the absurdities into which even the greatest anatomists have
fallen; as for example, _Pecquet_, the famous discoverer of the thoracic
duct in the human body, who nevertheless adopted so extravagant a
notion, as that digestion of food ought not to be promoted by exercise,
but by drinking spirituous liquors, a practice to which himself fell a
victim, dying suddenly at the anatomical theatre. It is only for those
who have a false cause to defend to shut their eyes against those truths
which seem against them. Those on the contrary who defend purely the
truth, know that one truth cannot hurt or exclude another truth, and
that all truths may very well coexist. It may be true that anatomy,
though it does not give the nature of the elementary composition of
parts intrinsic and too minute for the human sense, since a new incision
only presents a new surface, much conduces however to ground the student
in mechanical principles of great assistence to him in practice, of
which they are doubtless the most solid foundation: yet that truth is
not incompatible with another quite as much a truth, that midwifery can
have no occasion but for a general notion of the configuration of those
parts upon which it is exercised. A midwife, for example, may be a very
safe and a very good one, without knowing whether the uterus is a hollow
muscle, or purely a tissue of membranes, arteries and veins: but if that
ascertainment is necessary, she must wait for it till the anatomists
have settled among them that point, which, like many other capital
points of anatomy, is not however yet done. In short, once more, a woman
in labor requires a midwife to lay her, not an anatomist to dissect her,
or read lectures over the corpse, he will be most likely to make of her,
if he depends more on the refinements of anatomy, than on the dexterity
of hand, and the suggestions of practical experience and common sense.
IF then, there are who can examine things fairly and with a sincere
desire of determining according to the preponderance of reason, they
cannot but on their own sense of nature, on their own feelings, in
short, discern that no ignorance, of which the women are
undistinguishingly taxed, can be an argument for the men’s supplanting
them in the practice of midwifery, on the strength of that superiority
of their learning, so rarely not perfectly superfluous, and often
dangerous, if not even destructive both to mother and child. Consult
nature, and her but too much despised oracle common sense; consult even
the writings of the men-midwives themselves, and the resulting decision
will be, that great reason there is to believe, that the operation of
the men-practitioners and instrumentarians puts more women and infants
to cruel and torturous deaths, in the few countries where they are
received, than the ignorance of the midwives in all those countries put
together where the men-practitioners are not yet admitted, and where,
for the good of mankind, it is to be hoped they never will.
I HAVE here said few countries have hitherto countenanced men-midwives.
That I presume is too notorious to require proof: for even those Saracen
or Arabian physicians, Avicen, Rhazes, &c. who, by the by, are little
more than servile translators or copists of the Grecian ones, wrote only
theoretically in quality of physicians; for it does not appear that they
ever practised midwifery themselves, nor ever got the practice of it by
men introduced into their countries. Among the Orientals there is no
such being known as a man-midwife; that refinement of real barbarism,
under the specious pretext of humanity, is happily unknown to them. But
if it should be said, that the jealousy so constitutional to the
inhabitants of the warmer climes, has a share in the exclusion of
men-practitioners; the women have, at least in that point, a weakness to
thank for its production to them of so great a good, as the greater
safety of their persons and children, in that capital emergency of their
lying-in. For, after all, the art of midwifery is, in the hands of men,
like certain plants, which, by dint of a forcing culture, exhibit more
of florish, or a broader expansion; but besides ever retaining a certain
exotic appearance, they never come up to the virtue of those
spontaneously growing in the full vigor of a soil of nature’s own choice
for them. Art may often indeed improve nature, but can never be a
supplement to her, where she is essentially wanting. Deep learning may,
in very extraordinary cases perhaps, repair the errors, or assist the
deficiencies of the manual function, but the deepest learning will never
bestow the manual function, nor indeed can in the same person exist, but
at the expence of the manual function, which must have been in some
measure neglected for it. And yet the greatest practical skill that any
man can with the utmost labor and experience acquire, will hardly ever
equal the excellence in it of the women, Great Nature’s chosen
instruments for this work: an excellence by them attained with scarce
any learning at all, or at least of that abstruse theoretical sort, on
which the men make their superiority principally depend.
BUT that I may not herein be taxed of maintaining any thing that has
only the air of a paradox, or of begging the question, I shall
implicitly, in the course of my answer to the following objection,
endeavor to remove any remaining doubt on this head.
OBJECTION the Eleventh.
IN like manner, as there are particular parts of the human body which
have their appropriate undertakers or protectors under their proper
distinctive names, as oculists, dentists, and corn-cutters, who by
making respectively one part their particular care and study, arrive at
a greater perfection, at least in the practical operations on it, than
regular physicians or surgeons, whose object is the whole fabric; Why,
by parity of reasoning, should not the men-practitioners in midwifery be
preferable to the midwives, since a man has to his manual function
superadded a theory superior to that of the women, who, it is confessed,
stand sometime in need of calling in the physician to their assistence?
As a man then will have laid in a stock of medical knowledge, peculiarly
adapted to the exigencies and disorders incident to women during their
pregnancy and lying-in, he must consequently excel the midwife, or the
physician singly considered; he who with so much greater convenience
will have united in one person both their faculties, besides that of the
surgeon.
ANSWER.
THAT certain parts of the human body enjoy the protection of
practitioners, who respectively devote themselves to their service, I
confess. Such appropriations may also be beneficial, at least, to the
practitioners. I can even conceive, that a professed dentist may clean,
scale, and draw teeth, or an oculist couch a cataract, better than
either a physician or surgeon. These may in their respective practice be
excelled by those partial artists. But I much doubt, even as to these,
whether their trusting too much to that partial excellence, does not
sometimes do more mischief than good, for want of duly consulting the
relation of such parts to the universal fabric, of which physicians and
surgeons must be so much better judges. Galen does not appear in
contradiction to common sense, where he observes, that to rectify a
disorder of the eye, the head must be rectified, which cannot well be
done without rectifying the whole body. In confirmation of which, I once
myself knew a gentleman, whom a professed oculist, at Paris, assured of
the loss of his eyes being infallible; and who upon his despondingly
consulting a regular physician, was by him as positively assured, that
those very condemned eyes might be saved by a proper regimen. The
gentleman happily believed him, and his eye-sight was not only saved,
but perfectly restored.
ANOTHER instance of the like nature occurs to me, which seems applicable
to the dentist, and which I quote here from a translation of the learned
and ingenious Dr. Huxham’s observations on the constitution of the air.
“MANY years ago I knew a gentleman of a hale, robust habit of body, who,
from being too much addicted to the drinking of brandy, fell into a
violent jaundice, from which however he would have recovered well
enough, would he have conformed himself to the advice of his
_physicians_: but he on the contrary, because his _gums_ were very apt
to bleed, and his _teeth_ stunk from the _scorbutic taint_, put himself
into the hands of an ignorant _pretender to physic for the cure of these
inconveniencies_. This fellow immediately set about _scaling his teeth_,
and _rubbing his gums_ with _his famous teeth-powder_, till at last, by
perpetually fretting and irritating the loose texture, he brought on
such a hemorrhage, that baffled all the stiptics that could be invented
by the most expert surgeons, and continuing to spout forth in small
streams from the little arteries of the gums, which were now every where
divided: in the space of _sixteen hours_ the poor man _died_ through
mere loss of blood.”
THESE instances are however only adduced to justify that doubt which I
expressed of these partial artists being _always_ to be beneficially
consulted in those local affections, to which their talent is supposed
exclusively appropriated.
CORN-CUTTER is indeed a homely plain English term, but if the teeth give
from the Latin the appellation of dentist, as the eye that of oculist,
what name, taking it from the _part_ in question, will remain for that
language, to give the men-practitioners of midwifery, in substitution to
that hermaphrodite appellation, that absurd contradictory one in terms,
of _man_-mid_wife_, or to that new-fangled word _accoucheur_, which is
so rank and barefaced a gallicism? But let what name soever be given
them, it can hardly be too burlesque an one, considering the gross
revolting impropriety of men, addicting themselves to a profession
naturally so little made for them.
PAINT to yourself one of these sage deep-learned _Cotts_, dressed for
proceeding to officiate[5], and presenting himself with his
pocket-nightgown, or loose washing wrapper, a waistcoat without sleeves,
and those of his shirt pinned up to the breasts of his waistcoat; add to
this,[6]fingers, if which not the nicest paring the nails will ever cure
the stiffness and clumsiness; and you will hardly deny its being
somewhat puzzling, the giving a name to such an heteroclite figure? Or
rather can a too ludicrous one be assigned _it_?
THOSE however who will consider this grave Doctor in his margery
field-uniform, this ridiculous piece of mummery, in a light of
seriousness, such as the matter perhaps more justly deserves, especially
combining with all the rest, the idea of his crotchets, forceps, and the
rest of his bag of instruments, may think he less resembles a priestess
of Lucina, than the sacrificer, in a surplice, with his
slaughtering-knife, to one of those heathen deities whose horrid worship
required human victims, which the poor lying-in women but too nearly
resemble.
BUT whether or not, in imitation of the dentist, or oculist, he receives
his title from the particular part he has taken under his protection, so
much is certain, that the same arguments, which militate for those
partial artists claiming their respective departments of the human body,
will not avail the man-midwife. An oculist, a dentist, a corn-cutter,
have no operations to perform but those of which disorders equally
incident to both sexes are the object. There is nothing in their
practice repugnant to the nature of the male-sex, nor to that reasonable
decency, which only requires that no sacrifices of it should be made in
vain, or at least not made to no better a purpose than to increase at
once the danger and the pain of both mother and child, in whose favor it
is sacrificed, as it may be clearly proved to be oftenest the case. But
of the chirurgical part of the man-midwife’s pretention, I reserve to
treat after considering him in the capacity of a physician; in which a
man may indeed be wanted, but in that of surgeon never, or at least so
very rarely, as not to atone for the dangers which attend the men
forming themselves into a set under the name of men-midwives.
WHERE there is no complication of any collateral disorder with the
gestation and parturition of women, it is even a jest for men to pretend
the necessity of any study or practice to which women may not arrive,
and even much excel them.
BUT where there exists the case of a singular constitution, or of
symptoms declarative of other help being necessary than just the common
one, that quickness of discernment, that peculiar shrewdness of the
women, in distinguishing what is relative to their art from what is
foreign from it, gives them the alarm in time, and if they have a just
sense of their duty, or but common sense, they must know that such
disorders cannot be _partial_, cannot therefore be considered as they
are by the man-midwife, as subordinate to his particular province,
relative as they are to the whole fabric or system. All _partial_
practice then is here absolutely out of the question, and now what help
can, consistently with good sense, be expected from a man-midwife, who,
under a natural impossibility of ever acquiring the female dexterity in
the manual operation, cannot however, be supposed to attain even that
imperfect degree of skill, without sacrificing to the endeavours at it
the time and pains in study and practice, which are requisite to form
the able physician?
BUT, in fact, the men, that is to say, those of that sex who have the
best understood all the refinements of anatomy, all the variety of
female distempers, never that I can learn, attempted to invade the
practical province of midwifery. The immortal _Harvey_, _Sydenham_, the
great _Boerhave_, _Haller_, and numbers of others who have written so
usefully upon all the objects of midwifery, have never pretended or
dropped a hint of the expedience of substituting men-midwives to the
female ones. They contented themselves with lamenting the ignorance of
some midwives, from which has been drawn a very just inference of the
necessity of their being better instructed; but even those great men
never chose the character of practitioners themselves, nor probably
would have thought it any detraction from their merit to have it said,
they might make a bad figure in the function of delivering a woman.
WHOEVER then will consider but how the common run of men-midwives
actually are and must be formed, and assuredly the number of exceptions
to the general insufficiency cannot oppose the inference, must allow
that, where a woman has distempers collateral to her pregnancy, with
which they must also become dangerously complicated, she must expose
herself to the utmost hazard, in any confidence she may place in a
man-midwife.
THE truth is, that most of the dangerous lyings-in are so far from being
likely to be relieved by a man-midwife, that it is often to the having
relied upon his medical judgment, and especially to his manual skill
they are owing. But of the first only it is we are now here speaking.
THE women captivated by that assiduity of the men-midwives, of which
they only fail when they are not paid or likely to be paid, in some form
or other, up to the value they set upon themselves, lightly take for
granted, that, as men, they are also capable physicians. It is enough,
in short, for these practitioners not to be women; for the women to
think they can prescribe for them in all disorders. A mistake this,
often big with the utmost danger to them.
THE men-midwives, in general, have never, at the most, carried their
studies beyond the disorders commonly incident to pregnant women: the
knowledge of all the other possibly collateral ones, is what even the
least modest of them will hardly claim, unless to the profoundly
ignorant, and is in fact scarce less than impossible to one who has
applied himself essentially to the manual function. In such cases the
ignorance of a midwife can hardly be greater than that of the
men-practitioners, and must be less dangerous from her less of
pretention. Her consciousness of her own want of sufficient light, will
engage her readily to state the exigency to some able and experienced
physician, whom she must allow, in such cases, to be her superior judge:
whereas the other, the man-midwife, acknowledges no greater authority
than that with which he is pleased to invest himself. He stands, in
virtue of a distinct business, and a business for which he never was
made, of a sudden the self-constituted sovereign dictator and
inspector-general of all female disorders whatsoever, where the woman is
with child, that is to say, where the case is only thereby rendered much
the more nice and difficult, and, not rarely, does he continue under the
same pretext, to extend his practice to where there is no pregnancy at
all in the case. And yet ask him for his titles, they are all implicitly
dependent on or subordinate to that same midwifery, for which he is so
naturally unqualified, even if a due study and exercise of it would
permit those avocations, that would contribute to accomplish him in the
so necessary general knowledge of physic. But indeed why need he acquire
it, since it is so commonly taken for granted, or that he is believed
upon his own word, especially if he is backed with a diploma, for form’s
sake, that may have cost him little or nothing of medical study, or
indeed of any thing but the amount of the fees for it?
YET how serious, how important is it for women, if they tender their own
lives, and that of the precious burthen of which they are the
depositaries, to make that distinction between the physician and the
midwife, which they seem so little to make! How little do they consider,
what nevertheless is strictly true, that a man can never at the best be
but an indifferent practitioner of midwifery, though he may be an
excellent one in physic; but that as bad a midwife as he can be, he must
be yet, if possible, a worse physician, if he attempts to throw both
professions into one, and exercise them jointly! They are incompatible,
from the justly presumable impossibility of one man doing justice to the
practice of the one, unless at the expence of the study of the other: by
which other, to obviate cavils, I repeat it, I mean the general practice
of physic, which comprehends the speculative part of midwifery, as well
as all other branches understood to be the province of the physician.
This distinction then I make, because, as to the diseases purely
incident to pregnant women, experimental practice will rather assist the
medical study of them: and it is in that part only the men-midwives can
make any figure at all, and that not a superior one to midwives who are
regularly bred, and who have, in their favor, their excellence in the
manual function besides.
ONCE more, in complicated cases, the most dreadful mistakes are to be
dreaded from those common-men-midwives, who so groundlessly erect
themselves into physicians on those occasions. A purge, a venesection,
or any other prescription injudiciously ordered, may be the occasion
proximate or remote of death to both mother and child; yet a woman, at
least, _ought_ not to expect better from one of these practitioners who,
for the most part, has neither study nor experience in general physic;
nor more than a smattering of anatomy, joined to the index-learning of
dispensatories. Such a man-midwife can never have thoroughly made
himself master of the course of the fluids, nor of the order of their
circulation. Their relation to the solids, and the efficacy of medicines
upon both, can hardly be sufficiently known to a man, who must have been
too much employed in trying to form a hand never to be formed, and in
attendances on the practice of his midwifery, to acquire those
collateral requisites for the effectual multiplication of his
professions.
YET this man void of knowledge, experience, observation, and, in
consequence, of physical ability, shall boldly decide on the expedience
of an internal remedy, of which he does not know the power or operation;
of a venesection, of which he can but guess at the consequence; and of a
narcotic, of which he is unaware of the danger. In all which, observe,
he may possibly sometimes be tolerably right, in cases where there is
_no_ complication; that is to say, in cases when a midwife, duly bred,
is as sufficient as the best man-practitioner. But then she is moreover
not only quicker of apprehension, as to danger, where the case appears
complicated, but readier to call in proper help where she discerns it to
be above her reach, and consequently above that of the man-midwife, who
must be equally or rather more at a loss, because his boasted theory
will serve only to puzzle him, or what is worse yet, since a shew must
be made of doing something, _will_ most probably determine him
improperly, if not fatally, to random prescriptions, in points out of
his sphere of knowledge, or rote of practice.
MANY a man who to-day undertakes prescribing for a fever, for a fit, a
convulsion in a lying-in woman, only because he appears in the character
of a man-midwife, would have been ashamed the day before he had taken up
that business to give himself out for a physician. He would have been
afraid of ordering any thing for her if she was not his patient, as to
lying-in, and would not, even after assuming the profession of
midwifery, perhaps order any thing for the same woman, out of the time
in which his office is supposed necessary. This plainly proves, that
many of those gentlemen are weak enough to imagine, that the man-midwife
implies the physician, though the greatest physicians that ever were
never dreamt of such an absurdity, as that the physician implied the
midwife, whose master and instructor he rather is, in points highly
useful indeed at times to her profession, but in which that profession
does not consist.
I DO not however charge _all_ the men-midwives with so much modesty, as
to confine their striking out of midwifery into physic, to the women
lying-in, or to the time of their lying-in, since there have not been
wanting some who, with equal ignorance, but superior effrontery, have
intrepidly hoisted, the standard of a general knowledge of physic, and
having originally insinuated themselves into families in the character
of men-midwives, have easily maintained their ground in them afterwards
on the foot of physicians. A circumstance not much to be wondered at,
considering the endearment of such an office as that of a man-midwife,
and the ascendant it must serve to give them over the heads of families,
even in points where a midwife can have no shadow of pretention, for
interfering. In the mean time, let any one of sense or common humanity
consider but the consequences of this dangerous admission of the
sufficiency of a man-midwife in those complicated cases, which require
the consultation of a regular physician; to say nothing, for the
present, of the other objections already mentioned, or which I shall
hereafter more at large discuss, and the result must be, to allow that
the medical pretentions, or indeed any pretentions, of these
men-practitioners, cannot be too much discouraged, nor confidence more
misplaced than in them. For once that they may hit the mark by chance,
they will often take the part of the distemper instead of that of the
patient; they will do what they have only a gross guess of being the
right, not what they know to be so: and physic, at best, but a
conjectural science, must in them want even the common grounds of
conjecture.
INSTEAD then of the dangerous self-sufficiency of these complex
smatterers, you have in a plain midwife, supposing her regularly bred,
and duly qualified for her profession (for I am no more an advocate for
ignorance in the women than in the men) one, who, being called in time,
will duly consider, and observe the constitution of the person that
wants her assistence. If nothing appears extraordinary, or out of the
common-rules in her patient’s constitution and conformation, she needs
only lay down for her the previous course of management, and as the hour
of delivery approaches predispose her properly: a point in which the men
must be grossly deficient, for want of that skill of prognostic inherent
to the women, from their particular delicacy and shrewdness in the
_faculty of touching_; upon which more depends than can be well
imagined. Wherever a case occurs to a midwife, so complicated as to be
above her reach, her interest, her reputation, her duty, all conspire to
prescribe to her a timely application to a regular physician. She
communicates her doubts or difficulties to him, who, at the same time
that he receives a just information from her of the state of things,
combines it with his own knowledge of the human constitution. He does
not confound, as the man-midwife does, ideas so different as those of
the manual operation, and the medicinal prescription. The object of the
physician, being the same as that of the midwife, the prevention or
alleviation of pain to the mother, and the greatest safety to the mother
and child, but preferentially that of the mother; there is this
advantage to both mother and child, that all harshness of practice, all
the violenter remedies will be as much corrected as can be done,
consistent with the safety of mother and child, by the midwife’s
tenderness, by which the physician will at the same time be above the
being misled into omissions of any thing absolutely requisite. In short,
on such occasions, they serve to temper one another. A truly great
physician will not disdain the lights furnished him by her practical
experience, and she knows the bounds of her mechanical duty and
profession too well, to interfere with his superior intellectual
province, in those points submitted to it. A pragmatical man-midwife, on
the strength of his miserable half-learning, would think it a derogation
from his character, to call in a physician in supplement to his
deficiency, of which he is always ashamed, though indeed he has
sometimes the excuse of himself not knowing it. Then when a fatal
accident has happened, under his hands, against which, with more
knowledge he might have guarded, or which with less of presumption or
dependence on himself he might have prevented, by procuring previous or
collateral advice; he thinks himself abundantly acquitted by laying the
blame on _occult causes_. Even the great man-midwife, _Mauriceau_
himself, has made use of that trite exploded apology[7]: where he
expressly says, “that a sudden unexpected death of his patient was one
of those FATALITIES, that not all the human prudence can prevent.”
BUT that I may not here incur the least charge of unfairness, as if I
meant by this quotation any thing so absurd or unjust, as that in the
labors of pregnant women, as well as in other diseases unconnected with
them, there may not sometimes happen accidents impossible to be
foreseen, as well under the care of the best physician, called in by the
very best midwife, as under the most ignorant assuming man-midwife, I
shall here introduce another quotation from the same _Levret_, that will
especially shew the ladies, and all parties concerned, to what an
imaginary safety, so much, and even the very point sought for, is
sacrificed as is sacrificed, in preferring the men-practitioners to the
midwives. [8] “M. de la Motte says, that for the fifth time he laid the
wife of a glover of Valogne, the 16th of March, 1704; that the woman was
but an hour in her labor-pains, and that he delivered her with all the
facility imaginable; that he left her upon the couch till he had given
her some broth, after which he recommended her to the care of the nurse,
and went _where his business called him_. He adds, that he had time but
just to bleed two persons in the neighbourhood, before he was fetched
away in haste to see the patient he had just laid, whom he found _dead_
upon the bed. The cause of this _death_ was instantly manifest to him
from the stream of _blood_, which ran about the floor, and even
penetrated to the apartment beneath, after soaking through the bed
itself, in which there remained clots of blood of an extraordinary size.
“THIS author adds, in the reflexions at the end of this observation,
that this delivery had been both more easy and more expeditious than any
this woman had precedently had: and he notes, that these _melancholic
accidents_ are not _without example_, since such ladies as the princess
of ... and madam la Presidente de —— with _numbers_ of _others_, have,
on the like occasion, undergone the same _fate_, as her he here treats
of. These are, according to him, _proofs_ that all human science and
dexterity _often_ cannot prevent the _like misfortunes_, since these
_great ladies_ had been lain by the most _celebrated men-midwives_.”
NOW I might here, without much probability of being contradicted, aver,
that where such accidents, said to happen so _frequently_ and
inevitably, should happen under the hands of midwives, there would be
but one voice among the men-practitioners and their credulous adherents,
to impute them to the ignorance and malpractice of the women. The plea
of _occult causes_ would be hooted at in them, tho’ receivable, it
seems, from the men.
NOT however to imitate what I condemn in them, a gross want of candor to
the women, of whom, by the by, the very best of the men-practitioners
have learnt all the laudable part of practice, I shall allow that among
those frequent examples, of sudden deaths upon delivery, some few might
perhaps be of those unaccountable surprizes with which nature mocks
human ignorance; but then it must be allowed too, that not all of them
admit of that favorable solution. The truth is that nature, to those who
have studied her course, and watched her motions with a due spirit of
practical observation, hardly ever but gives warning enough to prepare
proper obviative methods. It is not here the place to enter into the
discussion of those deaths by sudden hemorrhage upon delivery, of which
I shall hereafter attempt to give a more satisfactory account, as well
as of the measures of prevention, than Levret. My end in the preceding
quotation is to show;
FIRST, that by the confession of the men-midwives themselves, the most
fatal accidents _frequently_, and _inevitably_ happen under them in
spite of all their _science_ and _dexterity_!
SECONDLY, to offer to the reader a reflexion for himself to judge of the
validity of it, to wit, that, not only in the cases of the hemorrhage,
but in many others, where there is a complication of disorders with the
state of pregnancy and parturition, much of the safety of mother and
child must depend on that general medical knowledge, to which the
men-midwives have so little grounds of pretention. Nor indeed, for the
symptoms of necessity for resorting to medical help, have they the same
shrewd prognostic or acute sense as the experienced women, who much
sooner perceive the danger before it is too late, and are neither
with-held by a false shame, nor by a criminal or senseless presumption,
from calling in proper assistence. Such at least has been and still is
their practice in all ages, and in all countries, where the matters of
pregnancy and lyings-in are committed to them. The great object of the
man-midwife is to impose so false a notion on his patient, as that his
partial knowledge is sufficient to every thing. The consequence of which
is, that if he is not too officious, too pragmatical, by way of
ostentation of his art, in common cases, that is to say, where there is
no complication of disorders, every thing may pass off tolerable well,
till the crisis of labor-pains. And in that crisis I defy him, with all
his learning, to equal the female skill and cleverness, not only for
lessening the sufferings of the patient, but for facilitating the happy
issue of her burden.
BUT where there is a complicated case, dependent on the physician’s art,
then the trusting to those men-dabblers in midwifery is a folly that may
be fatal to both mother and child, or, at the best, the delivery will
have been rendered more painful, more laborious, more big with danger,
for those precautions having been neglected, which can be so little
supposed to occur to the common run of men-midwives in cases foreign
from their rote of practice. Yet it is precisely in those disorders
collaterally contingent to pregnancy, and no disorder does that state
exclude, that the greatest skill and knowledge of physic are required.
Then it is, that not only the preservation of the mother claims regard,
and certainly the preferable one, but even that of the child is no
indifferent point. And to save both, the state of the mothers
constitution must be carefully considered. Thus the combination of the
disease with the pregnancy, the due regard to the mother as well as that
to the child, form a triple object that takes in a compass of
comprehension to which no midwife will pretend, nor can be imagined to
exist in the mere man-practitioner of midwifery. Such a nicety of
observation does not seem to be the province of a manual operator, and
indeed useless to him in that character. And as he will be more likely
to trust to conjectures, which no sufficient grounds of study will have
justified his presuming to trust, he must oftener take the part of the
disease than of the patient. It is well if sometimes, disconcerted at
the excess of a danger of which he does not understand the origin or
nature, he does not, in default of the head, employ the hand, and engage
the mother in a premature or forced delivery of the child, to the
imminent hazard of the lives of both. Now comes the chirurgical
operation in play; and we shall now see, that the ingraftment of the
surgeon upon the midwife, deserves equally at least reprobation with
that of the physician.
BUT before I enter on this disquisition, I am to observe, that this
objection to the surgeon’s commencing midwife, does not in the least
attack the merit of that respectable body of men, the surgeons. No one
can honor their profession more than I do: I even readily grant, that
their skill in anatomy is of service to midwifery itself, into which it
throws a great light. It would be easy for me to name, if requisite,
several surgeons, who are not only an honor to their country, from their
excellence in an art so beneficial to mankind, but an ornament to
society, from their extensive humanity and charity. These, I am so far
from thinking, will hold themselves honored by the men-midwives
attempting to make a common-cause with them, that I rather depend on
their bearing witness on the part of the women in this cause, which is
indeed the cause of Nature, of that Nature which they study so
practically, consequently so usefully, and with which they are so
conversant. I am persuaded they can even furnish me with arguments, from
their superior store of knowledge, in supplement to my deficiencies. The
surgeons must look on these professors of midwifery as a kind of
amphibious beings, hard to define, whose claim exhibits rather the
deformity of a preternatural excrescence, or wen growing out of the
chirurgical art, than the becomingness of a natural member of it. Most
of the first founders of this new sect of instrumentarians in this
country were, or I am greatly misinformed, neglected physicians, or
surgeons without practice, who in supplement to their respective
deficiencies, greedily snatched at the occasion at that time of a
prevailing whim in France, of employing men-midwives, with just such a
rage of fashion, as some of the ladies there prefer valet-de-chambres to
waiting maids. This novelty then appeared to practitioners despairing of
business enough in their own way, an excellent scheme for eking out
their scanty cloth with this bit of a border, of which by degrees they
have made to themselves a whole cloak. In short novelty joined, to the
much exagerated objections to perhaps a few insufficient midwives,
brought in and established a remedy yet worse than the disease. Their
success encouraged others; and now behold swarms of pupils pullulating,
and forming on the models before-mentioned. Thus two or three maggots
have produced thousands. Iron and steel are not tender: and yet it was
by the pretended necessity of resorting to instruments made of these
metals, that these out-casts of either profession effectuated their
introduction into a business so little made for them. Then it was, that
not with the least squinting view to filthy lucre, but purely out of
stark love and kindness to the women, that these redressers of wrongs,
armed with their crotchets, and other weapons of death, took the field
on the hardy adventure of rescuing the fair sex out of the dreadful
hands of the ignorant midwives. But as to the validity of that plea of
theirs, of the necessity of employing instruments, I reserve to treat of
it at large in its place in my second part.
HERE I shall only request the reader to remember, what has been said of
the indecent, superficial, and even cruel method of training up pupils
in this upstart profession. But if I was to add here my having been
credibly informed, that there are novices who watch the distresses of
poor pregnant women, even in private lodgings, where, under a notion of
learning the business, they make those poor wretches, hired for their
purpose, undergo the most inhuman vexation, in a condition so fit to
inspire compassion, and where those scenes must be rather a school of
brutality than of art: if I was to urge, what from the great probability
of the thing I firmly believe, that more than one unhappy creature has
fallen a victim to the rudiments of these novices; that especially not
long ago, one of them in a hurry and confusion of presumption and
ignorance, instead of the after-birth from a woman, tore away, by
mistake, her womb itself, which occasioned, of all necessity, the poor
creature’s dying in unutterable agonies of torture: if I was yet to go
farther and assert, that even not one of the least eminent men-midwives
pulled off the arms of a child in his attempt to extract it, and very
gravely laid them upon the table; what would be replied to me? It would
be said I had invented these horrors, or forged such raw-head and
bloody-bones stories, purely in favour of my own cause. And to this
objection, while I produce no proof, and for my producing no proof other
reasons may be obviously assigned, besides that of those cases being
non-existent, some of which I am very certain are true, and firmly
believe all the rest; to this objection then I say, I make no reply. The
reader, who will have considered this matter, may easily decide within
himself the degree of probability in such allegations. But what
objection will stand good against authorities of reasonings and facts,
produced from the writings of the _men-midwives_ themselves? Will they
be suspected of partiality or aggravation of things against themselves?
I SHALL here select one of perhaps the most excusable examples from the
circumstances accompanying it, or it would probably not have been
produced by the author a man-midwife, to shew, by the confession of the
men-midwives themselves, the insufficiency of their discernment, whether
a child is dead or not.
“EDGE-TOOLS and crotchets naturally inspire horror, and though they
_ought_ not to be employed unless on a dead child, it is well known the
mother is not always _safe_ from the effect of them. Besides there are
_no signs_ of the death of a child, though he should have stuck in the
passage for several days ... _certain enough_ to authorize a recourse to
a method which infallibly _kills_ it, if it is not dead before. This is
so true, that whoever will turn over the authors antient and modern, on
this subject, there is not _one_ of them that gives us _satisfaction_ on
this point. On the contrary, they _all_ seem _agreed_ on the
_insufficiency_ of these signs, and there are even _few_ of them who do
not bring examples to support this uncertainty.
“HERE follows one taken from the observations of Saviard, p. 367. This
author says, that a chirurgical operator, whose name he _prudently_
suppresses, being sent for in aid of a midwife[9], to extract a child
that had stuck six days in the passage, and which he _thought_ dead,
from several of the signs most essential to conviction, it happened
however, that having opened with his _bistory_ the teguments and
membranes which occupy the as yet unossified space, at the commissure of
the parietal bones with the fontanelle, it happened (said he) that on
opening this place with his bistory, introducing his crotchet at this
opening, and having fixed it in one of the parietals, he drew out the
child, who began to cry _piercingly_, all hurt as he was by so _large_ a
_wound_, that there came out of it more than an egg full of its
_brains_, which made a _cruel_ sight in the eyes of the by-standers, and
a very mortifying one for the operator.
“IT were to be wished that this was the _only_ example: but I will not
relate any _more_; it is easy to think one cannot be too _circumspect_
in the matter of such relations. Levret, p. 77.”
NOW I, who have not the same reason for _circumspection_ in this case,
as Monsieur Levret, with strict regard both to matter of fact and to
candor, _agree_ with _him_, in averring, that this is not the _only_
example perhaps, by thousands, of the rash resort to the expedient of
_opening_ the head, and extracting the child with the crotchet; an
expedient which, as Dr. Smellie observes, (p. 248.) “_produced a_
GENERAL CLAMOR _among the women, who observed, that when recourse was
had to the assistance of a man-midwife, either the mother or child, or
both were lost_.” Now of not filling up the cry of those women, I must
own I should be most ashamed. Especially when the good Dr. by way of
curing our fears and _weak_ apprehensions, and of shewing the
nonsensicalness of them, first very gravely tells you the insufficiency
of _all_ hitherto invented instruments, and only modestly concludes,
that the forceps of his own ingenious contrivance, is indeed the best,
but still imperfect. His homage to truth would however not have been so
imperfect as it is if he had said that instruments may be totally left
out of good practice, and that no “_artificial hands_”, as he calls
them, can, in any case, constitute a worthy supplement to the _natural_
ones; no not even to his own, supposing iron and steel to be ever so
little less tender than his fingers. [10] BUT why do these gentry then
so much insist on the absolute necessity there is of _sometimes_ having
recourse to instruments?——Why? The motive for that insistence is so
transparent, that not to see through it would indeed be blindness. It is
the capital, and perhaps the only plea that has the least shadow of
plausibility for the men to intrude themselves into the women’s business
of midwifery. The women do not pretend to the art of handling those
instruments, and would be very sorry to pretend to it. Nor do those
midwives, who are sufficiently skilled in their art, ever need the
supplemental aid of them: whatever is done with them is as well, and
infinitely more safely done without them: so that the only grounds of
introducing men into that female practice is essentially false. The
making then the surgeons art a pandar to a sordid interest, by the
incorporation of midwifery with it, is, in fact, engrafting on a noble
stock, a scion of another one, both which would bear very well separate,
but, thus joined, can produce nothing but a vile poisonous fruit.
IF there could be such a thing as laughing in a matter of such general
importance to human kind as the fixing of this point, there could hardly
be any refraining from it, with regard to the conduct of the
men-midwives, especially in Paris. There the novices of them, sensible
of the natural defect there must be in men-practitioners, apply for
improvement to the regular midwives. There is particularly, among
others, one Madam Clavier, who, when I knew her, lived in the Rue de St.
André, that gave lessons, at so much a-head, to the men-students of
midwifery. Yet these same men have no sooner got a smattering of all
that is valuable in the profession, for beyond a practical smattering at
most nature refuses them further progress; they, I say, have no sooner
acquired a little useful insight from these laudably communicative
midwives, but they are the first to swell the cry against them of, “oh
these _ignorant midwives!_”——or “_what can be expected from a woman?_”
And what is more yet, among women it is, that they can make this equally
ungrateful and false clamor prevail. And women, in a point of the utmost
importance to themselves, prove that the men have, in fact, not quite a
wrong idea of their weakness, since they are weak enough to countenance
a notion, that so unjustly dishonors them in every sense. But that is
not enough. What one should imagine, women especially would consider, is
that this notion received with its consequential exclusion of those of
their own sex, tends to have their own pains aggravated, and the safety
not only of themselves but of their so naturally dear children, yet more
endangered.
FOR the truth of this increase of pain and danger from the practice of
the instrumentarians, it is not to any representations from me only, who
may be supposed too interested a party, but to reason, and even to
reason’s best mistress, Nature herself, that I appeal. I appeal even to
the very writings of the most celebrated men-midwives themselves, to
which I would refer all who are sincere enough with themselves to be
resolved to embrace truth when discovered to them. It is then even in
the writings of those men-practitioners, that a lover of truth might
find enough to satisfy himself, that all the mighty pretences of the
men-midwives to superiority of skill and practice to the women are false
and absurd. Look into _Deventer_, _Peu_, _La Motte_, _Mauriceau_,
_Levret_, _Smellie_, &c. and you will find that, except their accounts
of the _innocent_ manual function, in which midwives must so much excel
them; except _their_ pernicious practical part, on which they so
tediously insist, by way of recommending each some particular instrument
that is to _usher_ him into employment, and increase his profit, in
which noble view he takes care to decry the instruments of all others,
or at least prefer his own; except the scientific jargon of hard Latin
and Greek words, so fit to throw dust in the eyes of the ignorant, and
give their work an air of deep learning; except what they have pillaged
from regular physicians and surgeons, who have treated upon these
matters: except in short all the quacking verboseness of the various
histories of their exploits and deliverances of distressed women, and
you will find the merit of their whole works shrink to little or
nothing, under the appraisement of common sense and true practical
knowledge. The most that you will find in them, is, hard or lingering
labors, oftenest precipitated fatally to the mother, or at least to the
child; they hardly, you may be sure, carrying their candor so far, as
always to mention when it has proved so to _both_; of which however the
tenor of their practice with instruments gives you but too much room to
presume the probability. In short those cases, of which their works are
chiefly patched up, are little better than so many quack-advertisements;
and their best exploits therein recounted not a whit preferable; nor
indeed so practically just, as what would appear in the common daily
practice of a regular well-bred midwife, that should keep a register of
her deliveries. There might not indeed appear so much anatomy in her
descriptions, but, I am very sure, there would be couched in them much
more solid instruction. Not that I therefore have not the highest
deference to the true physicians, the true surgeons. But as far as I can
presume to judge, it is not in the works of the men-midwives, that the
best lights in midwifery are to be looked for. They are themselves for
every thing that is worth reading in their writings indebted, both to
the physicians and surgeons, whose arts they have despised enough to
think, they may be well enough learnt collaterally and subordinately to
the mechanical operation of midwifery, as well as obliged to the
midwives, to whom they _ought_ at least to go to school, tho’ sure to
rail at their _ignorance_ the minute after being taught by them. In
short, the most valuable lights thrown into this subject are undoubtedly
furnished by those great men Boerhave, Haller, Heister, the great
Harvey, and other the like excellent physicians and surgeons, not one of
whom however, I presume, in the way of making a trade of it, ever
delivered a woman in his life.
NAY! was any accident requiring a chirurgical operation to befall a
pregnant woman, I should think the application would be more safely made
to a thorough regular-bred surgeon, than to one of the common run of
these men-midwives; and the exceptions are so few, they are hardly worth
making. The reason too for such a preference is obvious and natural. A
regular surgeon probably would not only be more consummately skilful and
expert in his general notions, both theoretical and practical, so far as
surgery was in the question, but would not, from any thing only
_partial_ in his profession, have the same temptation of bringing into
play a horrid apparatus of murderous instruments, to show the importance
and utility of that anatomical midwifery of theirs, all the art of which
consists in the violences it offers to Nature. What would be to be done,
the true surgeon could hardly do worse than the pragmatical man-midwife,
and most probably would perform it much more artistlike, except perhaps
in the sole point of striking a crotchet into the brain-pan of a
live-child, or needlessly tearing open, with iron and steel, parts so
tender and so delicate, as hardly to bear the touch of even the softest
hand, guarded with all precaution. He would not, in short, be so forward
to use means destructively dangerous to both mother and child, and at
the best often to ruin a woman for being a mother for ever after.
UPON the whole then, if any one will dare give his own understanding
fair play, against the powers of prejudice and interested imposition, it
cannot but, on a fair examination satisfy him, that that strange
anomalous complex creature of the three arts, physic, surgery and
midwifery, is most likely to excel in neither. IT may by great chance be
an indifferent physician; IT must be in this respect a dangerous
surgeon, but IT can never be any thing but a despicable midwife; or if
that favorite name of _accoucheur_, IT is so fond of assuming, should
not be popular enough from its gallicism, let IT change it for the Latin
one of _Pudendist_: a word of not one jot a more pedantic coinage than
_Dentist_, or _Oculist_, but of which moreover the propriety of the
sound may somewhat atone for the pitiful play of words it contains, and
which can yet scarcely be more pitiful than the object of its
application.
OBJECTION the Twelfth.
IT is not probable, that the men-practitioners would have come into the
vogue in which we see them, if numbers of instances were not to be
produced in their favor, of their having terminated happily many labors,
in which they have been preferably employed, and to the exclusion of the
midwives.
ANSWER.
THIS only proves, what none in their senses will deny, that the greater
part of the cases of labor are so mild, that not even that faultiness of
the men-practitioners, which is palpably owing to an incurable
imperfection of Nature, not, in short, all that is bungling or deficient
in their preliminary disposition and manual operation, can absolutely
frustrate the kindness of that Nature, of which these intruders are not
ashamed of assuming the honor. But that inference of the men in favor of
themselves is as ridiculous as it is false. In those cases of labor,
which are much the less frequent, and require no extraordinary
assistence, the utmost of the real merit of these bunglers is only of
the negative kind: that is to say, they have not destroyed the mother
nor the child; and indeed, every thing considered, great is the praise
to them thereof. It is not always, even in naturally easy labors, that
the women who employ men to lay them have not a harder bargain of them.
BUT even in these propitious labors, the mischief done to a lying-in
woman, by employing of a man to the exclusion of a midwife, is not a
small one, if pain is an evil, and the lessening that evil a desirable
good. For certainly there can hardly be a case of lying-in supposed, in
which some _labor-pains_ are not felt. The bringing forth children in
pain, stands hitherto the irreversible decree of nature, from which few
women can promise themselves a total exemption. But these pains, if they
cannot be entirely spared, to the lying-in woman, will always admit of
actual or preventive alleviation. That alleviation can be no
inconsiderable object to women, who are by their nature so tender and so
impatient of pain. Even then in the prospect and presence of the very
gentlest labors, there are two natural points to be respectively
attended to. The one is the predisposition of every thing, according to
art, so as to render the expected labor-pains as moderate as possible.
The second is in the manual function, at the actual crisis of the
delivery. Now, in both these points, for reasons above-deduced of the
superior aptitude in women derived to them from Nature herself, a woman
may reasonably depend not only on a more simpathizing cherishment, but a
more efficacious assistence from those of her own sex. There are a
thousand little tender attentions suggested by nature, and improved by
experience, that a midwife can employ both preventively and actually to
the mitigation of her charge’s pain; attentions which, if even they ever
entered into a man-midwife’s head, could not be accepted but with
repugnance, I will not say only by a modest woman, but by any woman at
all. And the truth is, that there can be few men in the world, but what,
the more tender lovers they are of the women, but must be only the more
disgusted, the more impatient of the midwife’s preparatory part of her
office, which is however the most important one, both as to the
prevention of pain, and to the safety of the delivery.
BUT even where those preparatory offices have been omitted, or at best
perfunctorily performed by a man-midwife, and where the actual function
in the crisis of labor has been deficient, or at best indifferent, the
labor may still have proceeded, and the patient delivered with only more
pain, than she would probably have suffered under a good midwife’s
hands. What follows then? Why this; that the patient in the transport of
joy at her delivery from pains which are hardly ever but great, even
though much less than her fear had magnified them to her; instead of
gratitude to that Nature, which can constitute to her only a vague
object of the mind, her weak imagination gives to the assistent
man-midwife, a more palpable being, as he is of flesh and blood, the
merit of a deliverance, in which he had most probably no other share,
than its being his fault that it was not yet less painful than she has
found it. But this is not at all. What sounds towards a paradox, and yet
is strictly true, is, that the more pain the patient has endured,
through the man-midwife’s fault, the greater will her gratitude be to
him. The reason is as obvious as it is natural. Herself not knowing, nor
having perhaps any idea of what ought to have been done for her more
perfect relief, she will have no conception that the man has omitted any
thing: she will give him credit for what he has _appeared_ to do for
her; and measure her sense of acknowledgement by the pain from which she
will suppose he has helped to rid her; and in her joy at her delivery
would think it even an ingratitude to listen to suggestions from others,
or even from herself, that should tend to diminish, explain away, or may
be reduced to less than nothing, the benefit she so vainly imagines was
his work.
YET nothing is more true, nor indeed more likely to be true, than that
besides the natural pains of labor not having been obviated by a due
preventive method of assuagement; besides their having been unskilfully
attended to in the article of the delivery, through the natural
unhandiness of the men-midwives, it does not unrarely happen, that their
defective practice, not only occasions to the women much greater pains,
but even much greater danger than would probably have been the case, I
will not say if a midwife, but even if Nature had barely been left to
herself, that is to say, if nature had been neither injured by a clumsy
aukward attempt to help her, nor injudiciously interrupted, nor
prematurely forced or cruelly hurried. The patient is however delivered,
and delivered so that, if she was better informed, or less blinded with
joy, instead if thanking the operator, to whom she attributes her
deliverance, she would have to impute to him all the increase of pain
she had unnecessarily suffered, all the increase of danger of which this
man so thanked was himself the author. Then it is, that even in a
subject so serious, a judicious by-stander might give himself the comedy
of observing the airs of consequence, which an operator assumes for a
woman under his case _not_ losing the life, of which but for him she
would most probably _not_ have been in the least danger. Thus a man,
whose all of merit well weighed, is no more than not having been able to
consummate the destruction of mother and child, in spite of the kindness
of nature, shall for that negative merit be allowed the positive one of
having performed wonders of art. Then it is that the mother naturally in
a rapture of joy at her deliverance, in which she never remembers but
with a gratitude, of which she only mistakes the object, by paying to
the operator, what in fact was due to nature; then it is, I say, that
the mother, father or parties concerned, for want of making due
allowances in a point they are so excusable for not understanding,
cordially join the self-applause of the man-midwife. Nor does it
unfrequently happen, that one of these instrumentarians, after an
operation, for which he deserves the severest censure, and of which,
whatever necessity he had to plead was originally owing to his own
unskilfulness or omission, shall strut about the room, and florishing
his butcher’s _steel_, sing an _Io Peean_ to himself, “_for that his
victorious art had saved nature as it were by enchantment_”[11]. Then it
is, that in full chorus the deluded parties, in the innocence of their
heads and hearts, hold up their hands to heaven, and piously exclaim,
“_what a narrow escape the patient had, thanks to the learned Dr. and
what a mercy it was she had not been trusted to such an ignorant
creature as a midwife must be_.”
THIS folly has even sometimes gone so far, that when a woman has,
through a man-midwife’s mispractice, suffered perhaps a wrong, so deep
as to be disqualified for ever after for being a mother, or had a fine
child, literally speaking, murdered (_secundum artem_ indeed) he has,
what with scientific jargon, through the cloud of which it was
impossible for persons unversed in the matter to discern the truth, what
with an air of importance, and what with especially her own weak
prepossession in favor of the superiority of men to women-practitioners,
known how to impose on her the most atrocious injury for so great a
service as that of saving life is for ever held. The deceived patient
then thinks she cannot thank him too much, nor reward him sufficiently
for what he could be scarce punished enough, if proportionably to the
mischief he had done; and to which his mis-representations have perhaps
even made herself innocently an accomplice.
THIS indeed is easily to be accounted for. A pregnant woman must
especially, in the moment of her labor-pains, think herself too much in
the power of the operator, to whom she has trusted herself, to dispute
his judgment. She may even, and that is probably oftenest the case, have
too good an opinion of it, to dispute it. Her labor is severe, and, as
before observed, severe, or at least the more so, very likely from some
fault of his. Her deliverance lingers; Nature, from some vice of
conformation, or defect of art in her assistent, appears faint, remiss,
insufficient, in short, in her expulsive efforts; in the mean time, the
pains of the patient grow more and more intense and intolerable: the
man-midwife, either perplexed or impatient, or not knowing what better
to do, has recourse to those fatal instruments, with which the odds are
so great, that he will gall, bruise, or irreparably wound the child, or
the mother[12]. In some cases indeed, he may take the dreadful advantage
of the mother’s agonies of pain, to use those instruments, and do her a
mischief she may not just then feel, from the pain of the operation
being absorbed in the greater one; to use them, I say, unobserved by
her[13].
BUT where the exigency appears yet greater, where, in short, the
operator imagines, as he too often imagines such an extremity where it
does not exist, as that either the mother or the child must perish, it
is his maxim, and certainly a very just one, to consider the mother’s
safety, as the preferable object. Of this preference then he makes a
merit, so much the more acceptable to the mother for her own
self-preservation being so palpably concerned, and so much the less
disputable for her not knowing but he may be in the right, as to the
reality of the fatal dilemma. In such a doubt, if nature takes the part
of the child’s life, which is at stake in the decision, she also much
more strongly and reasonably takes the part of the mother’s own
existence in the mother’s own breast. She cannot then deny the
premisses, of which she is no judge, when the inference is not only in
favor of her life, but even a very just one upon the admission of those
premisses. The temptation also of a quick riddance from a violent state
of pain, is too great a temptation for a weak woman, overpowered with
her actual feelings in that rack of nature, to resist: she acquiesces
then, or perhaps her husband, her friends, equally ignorant with herself
of the truth of things, and duly simpathizing with her in her impatience
of her longer suffering, even virtuously, even piously acquiesce in the
recourse to these instruments, which are so sure of destroying the
child, and hardly ever fail of doing the mother great and sometimes
irreparable mischief.
WHEN then the child has been destroyed, the mother damaged; in
satisfaction for all this tragic-work, what have you but perhaps the
learned Doctor’s assertion, “[14]_that if this force had not been used,
the mother must have been lost as well as the child_.”
NOW granting what is the utmost that candor can be expected to grant,
that in but the doubt of the mother’s life, it is right to sacrifice the
life of the child to that doubt, and much more to the certainty of the
mother’s life not to be otherwise saved, than by these fatal
instruments, I beg and entreat all fathers and mothers, or who are
likely to be so, to consider with themselves whether:
IN the first place, an experienced midwife is not more likely to prevent
such an extremity by previous management, proper anticipations, and
actual handiness during the labor-pains, than the aukward
man-practitioner (as most of them evidently are) who must, naturally
speaking, be so much her inferior in those points of her art, which
conduce essentially to the smoothing the way for, and effectuating a
delivery; and from the defect of which points that necessity which, is
pleaded of a recourse to instruments, originally takes its rise. So that
in fact they who are the authors of the danger, pretend to remove it,
and how? by an evil only inferior to death itself, from which however
those are not always safe, to whose safety so much is sacrificed in
vain.
IN the next place, it may well be recommended to consideration, whether,
as the _common methods_[15] confessedly allowed by the men-midwives to
be the _preferable_ ones, since the recourse to instruments is not even
by them _allowed_, until the _common methods_ are exhausted, there is
not great reason, without breach of charity, to imagine that the natural
unfitness of the men for the _common methods_ does not determine
especially the common men-midwives to an over-hasty recourse to the
_extraordinary_ ones, and make them see very _dangerous symptoms_, where
they are no better than phantoms of their own creation; so that by their
eagerness to embrace them for an excuse, they lose to the patient that
benefit of patience in general, which Dr. Smellie himself allows in a
particular case[16]. To which patience the midwives are so much more
inclined than the men, as indeed they may well be, since, should that
even be exhausted, they have no instruments to fly to for the abridgment
of a labor: and where they understand their business, not only every
thing is best done without them, but the want of them is prevented.
BUT besides the common motive of impatience in the men-practitioners for
resorting to that dangerous expedient of making short work, of which the
women are unhappily incapable[17], or at least which the good artists
among them hold in the contempt and detestation it deserves; are there
no other motives from which recourse may be had to the instruments? I
have hinted at some: but as the matter is of infinite importance, from
the use made of these instruments, in introducing men into the practice
of an art so appropriated to the women, it cannot but be of service even
to the public, to discuss the justice at least of some of those hints,
and examine whether there is any farther foundation for my fears, that
the precipitancy of the men in their resorting to instruments, or to the
prematurely forcing a delivery, to the utmost danger if both mother and
child, whether, in short, the pretence of extremities may not, in some
cases, have even other causes, than a natural incapacity for the _common
method_, an ignorance of better practice, or their impatience.
I HAVE before remarked what I here repeat, and repeat it without the
least apprehension of being justly taxed with breach of charity, that a
mere sordid view of lucre, of supplementing, in short, deficiencies of
success in other professions, was originally the foundation in this
country of that novel sect of men-midwives, which we have in our days
seen so much multiplied. If any can imagine that the instrumentarians,
with their crotchets, their forceps, and the rest of their iron or steel
apparatus, had more in view the relief of the distressed females, from
the dangers to them in the ignorance of the midwives, than they had
their own interest, in the stepping into the place of those they so
injuriously decried; if any, I say, can believe that sheer humanity, and
not sordid gain, was their view, I can only pity a credulity, that must
proceed more from a goodness of the heart, than of the head. But to
whoever will deign to consult his own reason, exercised upon facts and
the nature of things, may easily satisfy himself, that interest, and
interest only, inspired and actuated these intruders into a province so
little made for them, of which there can hardly be a stronger
presumption than the very recommendation of instruments, of which not
one of them but must know the perniciousness, though they make it the
capital handle of the introduction of themselves. Not one of them but
rails at them, and uses them. Now, as I may safely take it for granted,
that interest is at the bottom of this innovation, where that same
interest is the principle, it will hardly be denied me, that it is
generally speaking the leading or the governing one. It is rarely
contented with acting a second part. It often exacts sacrifices, but is
rarely itself one. All the actions and procedure of its votaries take
the tincture of it. Humanity and all the virtuous or tender passions are
either totally excluded, or exist with little or no efficacy in a heart
enslaved by interest.
In virtue of this reasoning, and I should be much more glad of finding
myself mistaken (knowingly I am sure I am not so) than that it should be
but too much verified by matter of fact, I shall here submit a case to
the reader for his own decision on the probability, and I dare swear,
that among the female readers especially, I may chance to have, there
will be more than one, who, on her own personal experience, could attest
the existence of such a case, or at least has the strongest grounds of
presumption of it.
A WOMAN then, lingering in a severe labor, and urged by her pains
naturally to wish the speediest end of them, is yet by another superior
promptership of nature desirous of meriting the sweet name of mother,
and is inclined of herself not to think it over-purchased by a little
more patience. In this crisis, much must depend on the judgment, and
consequently on the advice of the assistent practitioner, male or
female. If a midwife, besides the tenderness constitutional to her sex,
her natural fears for the mother especially, not without a due share of
concern for the child, where there is a possibility of saving it without
too great a risk to the parent, besides the superior execution of her
art in points of the manual function, she is moreover bound in all duty
to see one labor come to its issue before she undertakes another; for
the sake of which, she cannot well, if she would, without instruments,
prematurely force a delivery by such violent, dangerous and so often
destructive means. She will then in course encourage and inspirit her
charge with patience, and use all the blandishments, soothing methods
imaginable to comfort, relieve, and strengthen the resolution and spirit
of the lying-in-woman. Now, a man-midwife, _well paid_, will perhaps in
that cold unaffectionate manner, with which a duty that has no
foundation but in interest is ever performed, exhort to endurance that
patient whom his dexterity is insufficient to relieve, that patient
whose pains are perhaps for the greatest part his own fault. But should
he, during some lingering labor, be called elsewhere, to a more rich
employer, or should one from whom he has greater expectations, require
an attendance from him incompatible with his duty to his prior employer,
is not here a temptation to make a quick dispatch with his instruments?
A temptation to which it is at least doubtful whether a man, actuated by
interest, may not be over-inclined to yield. It may even byass him,
without his perceiving it himself. A man’s determining motive, when it
is not of a very justifiable nature, is often skreened even from himself
by a more specious one. Such, in the present case, is the saving the
mother, oftenest by destroying, and sometimes by only galling, bruising,
or maiming the child, when the mother rarely escapes her share of the
suffering. How many mothers have pathetically interceded, and interceded
in vain, for a respite of execution, when the operator has in a
peremptory tone cut short their instances, by telling them in a
magisterial way, that he knew best what to do, and could not answer for
the patient’s life, if the operation was longer delayed! What reply has
a poor woman, weak by nature, oppressed by pain, and subdued by her
prepossession to oppose to such an argument of necessity, of which her
own life appears to be the favored object? What husband, what friends,
but must unhesitatingly subscribe to so just a preference as that of the
mother and the child? Not that I would insinuate here, that such a
dilemma does not sometimes though certainly very rarely exist: but is it
not to be feared, that it is too often rather lightly taken for granted
that it does exist? May it not be presumed, that the instruments are
brought oftener into use than is necessary, for the sake of a dispatch,
of which the child is almost ever the victim, and not unseldom the
mother herself, who is always hurt, and sometimes irreparably damaged?
May it not be justly suspected, that the abuses of Art have occasioned
to many women an appearance of barrenness, from the reality of which
kinder Nature had in fact exempted them?
BUT as if ignorance, inability, impatience, interestedness, were not all
of them sufficient motives for the forcing use of these instruments, Dr.
Smellie has unmeaningly added another, which alone must, to the greatest
number of the men-practitioners, prove a greater excitement than all the
others put together, if it be true, that Vanity has so great a
predominancy over the human heart as it is generally imagined to have.
But let us first quote him: the inference will follow.
“(P. 265.) _at any rate, as_ women _are commonly_ frightened _at the
very_ name _of an_ instrument, _it is adviseable to_ conceal _them as
much as possible_, untill (mind pray that UNTILL) _the_ character _of
the_ operator _is_ established.”
(P. 273.) “_Though the_ forceps _are covered with leather, and_ appear
_so_ simple _and_ innocent, _I have given directions for_ concealing
_them, that_ young practitioners BEFORE _their_ characters _are_ fully
established, _may avoid the calumnies_ and _mis-representations of those
people who are apt to prejudice the ignorant and weak-minded against the
use of any instrument, though never so necessary, in this profession;
and who taking the advantage of unforeseen accidents which may
afterwards happen to the patient, charge the whole misfortune to the_
INNOCENT OPERATOR.”
HERE I appeal to every reader of common-sense, to every reader who knows
any thing of the human heart, whether it can be imagined that any
man-midwife, who is called in to the aid of a lying-in woman, will
choose to appear in the character of a _young practitioner_, or of such
an one, as that his _character_ is not enough _established_ to _dare_ to
use instruments, for fear of after-reflexions. Is not there, if but in
this lesson of the Doctor’s, couched a strong temptation for a
man-practitioner not indeed to produce openly and barefacedly his
apparatus of instruments, but to be very uncautious of concealing them?
Since the reason for concealing them, that of the women being apt to be
frightened at them, stands coupled with another reason, the fittest in
the world to work a contrary effect to both; by piquing the vanity of
the operator to suffer them to be seen, and what is worse yet, to the
using them only that they might be _seen_, especially if to this motive
of ostentation you add, that if these instruments being the very _grand_
and _capital_ point of their imaginary _superiority_ to the
women-practitioners; over whom every occasion of using them seems to the
men a kind of triumph.
BUT while it is to the novices in the art, that Dr. Smellie recommends
more especially the concealment of these same terrifying instruments,
the good Dr. does not seem aware, that an advice much more honest and
humane might be given to the women, for whose _benefit_ the instruments
are supposed to be invented, which is, not to employ _young
practitioners_ or novices, not in short to employ those whose character
was not _fully_ established, since they might, in order to pass for
adepts, or at least for no novices, be too apt to embrace occasions of
florishing those same instruments with less necessity, if possible, than
the _great men_ themselves of the profession.
IN the mean time, this curious injunction to the _young_ practitioners,
while the _old_ ones are by that distinction implicitly allowed more
openness in using the instruments, reminds me of the caution of the
Regent-duke of Orleans, who taking monsieur de St. Albin[18], a natural
son of his, that was in priest’s orders, to task, for some
irregularities, of which certain bishops had complained, said to him in
their presence, “_Sirrah, could not you stay till you were a bishop?_”
BUT whatever may be the motives of recourse to instruments, and there
are other possible ones which I have omitted, certain it is, that in
this nation they are more frequently employed than even in France, where
that pernicious fashion first took birth. And yet in this very nation it
is, that the men-practitioners themselves own, that the less they are
used the better. Now will they, to solve this contradiction of their
practice to their doctrine, plead that the labors of the women here are,
in general, more difficult than they are in France? Common sense and
truth will however furnish a juster solution: men-midwives are more
employed _here_ than in _France_, where the women-practitioners are
still respected, and less driven out of practice, consequently
instruments are less frequently used. For I will not pay the
men-operators of this country so ill a compliment, as to excuse them, by
saying they are less dexterous at the manual function than those of
France, and therefore the more obliged to have recourse to those
instruments, of which they themselves have so ill an opinion, though
indeed not a so thoroughly bad one as they deserve.
IN the mean while they may well proceed triumphing in their career,
notwithstanding all the fatal trips they make in it, while, if they did
not even run it in the dark, they have so much learned dust ready to
throw into the peoples eyes whom it is so much their interest to blind.
No wonder then, that since, in the more severe cases, in the
preternatural labors, they so often receive from well-meaning employers
both pay and thanks for the greatest mischiefs, owing to their errors
both of omission and commission, they should, in the less difficult, and
which are by much the most frequent ones, where no tragic accidents have
happened, have credit given them for a merit, to which their pretentions
are so little examined. For this they are indebted to the overflow of a
gratitude at a loss for a living object and from an impatience of doubt
mistaking that object so grosly, as well as to that same prepossession’s
continuing, from which they were preferably employed. Hence it is, that
one might often hear women, who had not even suffered a little by their
practice, from the want of knowing, that by their practice it was they
did not suffer less, very sincerely say, “_Dr. such an one attended me
in my lying-in —— He delivered me very well._” —— Or, “_I have been lain
for four or more children by a man-midwife, and never had room to
complain._” All which proves no more than what may very well have
happened, that Nature has been too favorable to them, for even the
untoward assistence of a man, in the office of a midwife, entirely to
frustrate her beneficence. I do not here add the weight that _fashion_
throws into the scale of prejudice, reserving to treat of that
separately.
BUT to that conclusion in favor of the men-midwives, from the supposed
superiority of their success to that of the women-practitioners,
contained in the objection I am now answering, I have further to oppose
an argument drawn from _matter of fact_, to which I should imagine it
difficult to find a satisfactory reply. This argument then consists in a
fair appeal to Experience herself.
I HAVE before observed, that in the Hôtel-Dieu at Paris, there are no
men-practitioners suffered, for I do not include the surgeon-major, who
is absolutely no more than an officer for the form-sake. Consequently
there are no instruments ever employed in the delivery of the women
admitted to that hospital. It is true they are extremely well taken care
of; all necessaries are found them by that noble charity; but yet it
cannot be thought, that the same abundance of ease and conveniences can
be afforded, as by those persons, generally speaking, who employ
men-midwives. This distinction I mention for the sake of the allowance
justly to be made in the calculate I am about to propose.
Notwithstanding however the superiority in this point on the side of
men-midwives practice, notwithstanding the grief of mind from various
causes, as well as the bad constitution of the bodies of many of those
indigent wretches, prior to the reception into that hospital,
notwithstanding other easily conceivable disadvantages; notwithstanding
all these, I say, take any given number of patients, delivered purely by
the midwives of that hospital, without the intervention of one
man-practitioner, and especially without instruments, and to that given
number, oppose an equal one of women attended from the first of their
labor to their delivery by the men-midwives, and see on the side of
which sex, in the operators, there will be found the greater number of
those who shall have done well, or suffered least.
I AM the more emboldened to propose such an experiment from my own
certain knowledge. I have seen more than two thousand women delivered
under my eyes, at the Hôtel-Dieu at Paris, some of whose cases must be
readily imagined to have been severe or preternatural ones. Yet all of
them were delivered by our midwives and apprentices without the aid of a
man-practitioner; nor an instrument so much as thought of. And in all
this number I can safely aver, there were but four who died upon their
lying-in; and that not from any fault of the midwife’s art; but one from
the complication of a dropsy, the other three, who were daughters to
honest tradesmen, sunk under the shock of grief and shame at the being
deserted by the men who had brought them into that condition. They died,
in short, of their desire to die. Yet the children all did well.
THIS is a fact that does not require the being believed upon my word.
The known practice at that hospital, and the registers regularly kept,
will attest the truth of this computation. And here, I appeal to every
intelligent reader’s own sense, to his own knowledge of things, whether
it is unfairly presumed, that in the same number of two thousand women,
delivered by the men-practitioners, they could show a roll so innocent,
so free from fatal mischief or damage to their patients, to mother and
to child. Let any parents, or who may hope to be parents, or are
concerned but for the interest of mankind in population, weigh but the
force of this argument, purely drawn from a matter of fact, of which
there can be so few who are not, in some measures, judges enough to
decide upon their own knowledge, or at least on strong grounds of belief
or conjecture. In such a number as two thousand women delivered by the
men-operators, how many, by what I know, and by what many others must
know as well as I, must have perished, or been torn, ruptured,
grievously hurt, or irreparably damaged! How many innocent infants must
have lost their little lives, in proof of that superiority of practice
in the men to the women! Or rather, in proof of that infatuate
credulity, which has prevailed in favour of an innovation so
unauthorized by nature, by common sense, or by experience!
OBJECTION the Thirteenth.
SAY what you will, the fashion will predominate. It is now the fashion
to prefer men-practitioners of midwifery to midwives. You will oppose
the torrent in vain.
ANSWER.
THE conclusion against me that I shall oppose the torrent in vain, is a
very just one. As to myself, I ought to expect that I should oppose it
in vain, if the decision of the public was to turn upon any thing of so
little authority as my private opinion, especially in a point where it
is so justly liable to the suspicion of its being byassed, both by
private interest, and partiality to my own sex. I readily then grant
that my own opinion should go for nothing. But what ought to go for a
great deal is my reader’s own judgment, formed upon his own reason and
knowledge. But that is not all. I have some dependence on Nature and
common sense recovering their rights, from this preference of the
men-midwives which shocks both, being, in truth, nothing more than a
fashion, not even of the growth of this country, but transplanted from a
neighbouring one, whose follies are unhappily so contagious, though for
the most part so despicable. How a few interested men, for want of
business in their own professions, transplanted this baneful exotic
here, where it has met with such undue cherishment has already been
touched upon.
BUT then as this unnatural preference has all the folly and whim of
fashion in it, it may be hoped, that it will also have all the
instability and transitoriness of one. Time that confirms the dictates
of Nature destroys the fictions of opinion. But in points where Nature
is herself attacked or injured, inconveniencies and damages never fail
of following thereon, enough to oppose the duration of them. The numbers
of lying-in women (thanks to beneficent Nature) rather not destroyed
than duly assisted by the men-operators, can neither atone for those who
perish, sometimes the mother, sometimes the child, sometimes both, while
none of them are but sufferers in some degree; nor long blind a public,
that has so much interest not to be imposed upon in a matter so
essential to it, by false pretences, or by an injurious and interested
degradation of the midwives, who at the worst can hardly be so bad as
the very best of the men, in the capital point of their business, the
manual function. The oftenest greater _danger_, and always the greater
_pain_, under men-operators than under the midwives hands will, sooner
or later, determine the parties concerned to open their eyes on their
greatest interest, in a point of such infinite importance to them.
GRANTING then to Fashion all the power it really has, and a greater one
it is, than for the honor of human kind, can well be imagined, still, it
not only has its limits of extension, but duration. It is only for the
truth of Nature to be universal and eternal.
FASHION, it is true, may not only govern people in indifferent matters,
such as dress, furniture, equipage, or so forth, but even in essential,
even in capital ones, such, for example, as is this point of option
between the men-operators and the midwives: it may, in short, exert its
tyranny in many things, one would rather think left better to the
determination of REASON. But then this tyranny cannot well be
long-lived. The evils which such a fashion begets destroy at length
their own parent. No opinion then, as I have before observed, can be
permanent that is not founded on the truth of Nature: but where the
consequences of such an opinion are detrimental to the good of society,
which is the darling object of Nature; that spirit of self-preservation
which she has so manifestly diffused thro’ human kind, will hardly
suffer errors pernicious to it long to subsist. There is no fashion can,
under such objections, long hold out against victorious Nature, who is
sure to revenge the violences offered her.
AND here I even officiously seize on an occasion that rises to me out of
the very bowels, I may say, of my subject, of selecting for one proof of
the danger of adopting innovations offensive to Nature, a point of such
near analogy to midwifery, as that of nursing children, the care of
whom, next to that of the mothers, is the true midwife’s tender
province.
I wish then that those, who too readily admit that this so recent a
fashion of employing men-midwives preferable to female ones, is an
improvement receivable on the foot of its supposed advantage to human
kind, would consider a little the actual consequences of having flown in
the face of Nature with respect to the bringing up young children, in a
way scarce more foreign from her dictates, than that of _men_ delivering
_women_. That women are by Nature herself formed for the office of
aiding women in their lying-in; that they are also formed to bring up
children by the breast, are two parts of their destination by Nature,
which in all ages, and in all countries seem to have born little or no
controversy. Interest has lately invaded both these provinces. With this
difference, that as to the first, that of women supplanted in their
business of delivering women, an active interest has prevailed; as in
that of denying the female breast to children, it is a purely passive
one[19]; and we shall soon see what a dreadful effect this sacrifice of
Nature to interest has produced.
AS to the mischief produced by the other, of the implicitly excluding
the women from midwifery, by the power of prejudice and fashion, it is
not, as yet, of a Nature for obvious reasons quite so susceptible of
proof, though most certainly not the less therefore existent. And that
mischief is palpably owing to the gain which the men-midwives find or
presume in the exercise of that profession. This is the active interest:
that end to which the means give so justly the construction of base and
sordid. The rich are the object of this wretched imposition, which will
probably last so much the longer, for the interest to be found in
imposing upon them.
BUT for the denying the female breast to children; it has not indeed
passed hitherto into a tenet, that children may as well be reared by the
spoon as by the breast, because there is not that prospect of the place
of a _dry-nurse_ being as lucrative as that of a _man-midwife_. If it
was so, I should not dispair of seeing a great he-fellow florishing a
pap-spoon as well as a forceps, or of the public being enlightened by
learned tracts and disputations, stuffed full of Greek and Latin
technical terms, to prove, that water-gruel or scotch-porridge was a
much more healthy aliment for new-born infants than the milk of the
female breast, and that is was safer for a man to dandle a baby than for
an insignificant woman.
AS this unnatural treatment then of children is almost entirely as yet
confined to the very poor, that is to say, to new-born babes thrown upon
the public CHARITY for their SUSTENANCE, the rearing by the spoon is not
yet regularly established as a general _doctrine_, it is only admitted
in PRACTICE! As _proper_ wet-nurses, from the difficulty in procuring
them, might be _dearer_ than dry ones; the _cheapest_ method is
preferred, and forms a kind of passive interest or saving œconomy.
BUT what are the consequences of this violation of Nature, in the
grudging her peculiarly appointed aliment to these poor little
candidates for life? What follows the substituting, for cheapness-sake,
such food as is meant to be afforded them, and is perhaps sometimes even
not given them? Death. Death with all that cruelty of torture that
attends atrophy or inanition. Thus perish these miserable victims to the
false opinion, that the course of Nature can be changed with impunity. I
have said here false opinion only, because, with all the obduracy of
heart that the spirit of interest so notoriously creates, with all the
crimes it so often produces, I cannot think, that such an horror, as the
murder of so many innocents, can be entirely imputed to interest without
ignorance coming in for its share, though interest has doubtless
contributed to the so long continuance of it.
IF that maxim is not a false one, that he who knowingly suffers an
innocent person to perish, and can help it, is actually guilty of
murder: and I prefer here the term of guilty to that of accessary;
because I am told, that where there is guilt of murder, all are in the
eye of equity and law, principals. Ignorance then, of the sure murder of
these innocents by their method of treatment, can be the only plea for
those to whom the national charity had committed the care of them. I
should think too, that even I myself sinned against charity, if I did
not believe, that there is none of those trustees of the poor children,
that would not shudder at the thought, of himself taking an infant up by
the leg and dashing its brains out against the wall. And yet that would
be balmy mercy, the dispatch considered, compared to the lingering
tortures, in which those poor little creatures must expire, in the
common way of parish-nursing. What is certain however is, that Death
would scarce more assuredly be the consequence of the child’s brains
being at once beat out, than of that impropriety of aliment, which in
the mildest construction is owing to an error in opinion or belief, that
any aliment could be salutarily substituted to the one dictated by
Nature.
I HAVE here mentioned barely impropriety, or sometimes negation of
aliment, without allowance for other causes of destruction to those
infants, such as cold, bad air, uncleanliness, neglect of due
attendence, or deficiency, in short, of requisites, which are not to be
expected from the very poorer sort of the people, to whom the rearing of
those infants is generally committed. But that omission of mine is
neither undesigned nor unfair. I presume I shall have the greatest
physicians on my side, in averring, that even new-born babes are endowed
with a surprizing hardiness. Their little seemingly so delicate bodies
bear cold to a degree scarcely credible, but from the commonness of both
observation and practice, that they only thrive the better for
immersions in cold water. Cleanliness, a good air, and attendence, have
doubtless indeed some share in the well-doing of children of that age:
but all together are in no degree of comparison to the importance of
bestowing on children their appropriate aliment. The physical
disquisitions into the reason of this do not belong to me here: nor are
a few instances of infants reared by the spoon any valid justification
for breaking the general rule of Nature, assigning to the female breast
the nutrition of children: of which too there is this salutary
consequence, that in the very act of lactation there is, by Nature,
generated such an indearment of the suckled child to the nurse[20], as
that she who began it perhaps only for hire, finds herself engaged by a
growing affection to supply in some measure the place of the mother to
the orphan or deserted babe. The rearing by the spoon is so far from
inspiring any such dearness, that the innocent infant is considered only
as an embarrassment, of which the quicker the riddance, in the death of
the _brat_, so much the better.
THE opinion, however, that this one of the greatest institutes of Nature
for the preservation of the species, for which she has so admirably
organized the female breast, could be dispensed with in favor of a most
sordid savingness, has alone caused more human sacrifices, to that black
Demon of INTEREST, than probably were ever made to the “grim idol of”
Moloch in the valley of Hinnom, while the cries of the poor children
could not be heard by ears closely stopped up in honor of that infernal
spirit.
BUT if any reader should imagine that I here invent any thing, or that,
in favor of my inference of danger from the case of revolting against
the unalterable institutes of Nature, I have exagerated matters, nothing
will be more easy, nor probably at the same more shocking, than the
procuring himself a proof of the scarce not actual murders I have
mentioned.
THE parish-registers of this great metropolis are, I presume, open for
inspection. There needs but to examine them, to discover the red-letter
catalogue of the armies of innocents that have been put to death under
the management of the charity destined to preserve their life. There
will be found not one but many, even of the most populous parishes,
where for fourteen, twenty, or more years, not one poor babe of the
thousands taken in have escaped the general destruction, and sacrifice
to that inhuman fiend of Hell, _Interest_. Here with what propriety
might Nature borrow from one of her most dutiful children and darling,
the following exclamation,
—— —— ALL _my pretty ones?
Did you say_ ALL! _what_ ALL?
· · · · ·
_I cannot but remember such things were,
That were most_ PRECIOUS _to me_: did Heav’n look on,
_And would not take their part?_ ACCURSED INTEREST,
They were all STRUCK for thee!
This is so rigidly true of some parishes, that if I am not misinformed,
the verification was not long ago made, as to one of them before a court
of justice, of not a single infant having been brought up in the term of
fourteen years. And I could name another, in which, during the course of
above twenty years, ALL, ALL the new-born children that fell under the
administration of the Parish-CHARITY, perished, except one boy, of whom
it is recorded as a prodigy, that he lived till he was five years of
age, when he filled up the number, and died like the rest. Will any one
here say, that this TOTAL mortality was purely accidental?
BUT this can be no wonder to those who know there is such an expression,
even proverbially in use, as that of children being a BURTHEN to the
parish. An expression of which it is hard to pronounce whether it is
more execrable or more silly. But what is so inconsequential as the
spirit, or rather the no-spirit of interest? Children may indeed be a
burthen to private families; and yet for the sweetness of it, how
chearfully is it oftenest born, or with very few extraordinary
exceptions to the general rule? But to a nation, or what is the same
thing, to the lawful representative of the nation, a parish, what can be
on earth a falser light to view children in, than that of a burthen?
What could be so intolerable in the sum to be added to that actually
paid for their being worse than murdered out of hand, to save their
little lives, and bring them up to that age, in which the national
wisdom should have established for them, at once, the means of earning
their likelihood, and of earning it with such beneficial retribution to
their truly mother-country, as should amply reward her for her not
having neglected the duties of humanity towards them? All the good, all
the sensible part of mankind allow, that the true riches of a state, are
in the numerousness of it subjects. Trade, arts, the navy, the militia,
our colonies all open inexhaustible channels of employment and
maintenance. And yet there are who can call children, those children too
of the public, not in a ludicrous, but in the dearest tenderest sense,
since in the public they ought to find that office of a parent, of which
the guilt, the inability, the want of nature in their natural relations,
or their death may have defrauded them; there are, I say, who can call
such children a _burthen_! We complain of the defect of population, and
yet have seen interest creative of obduracy, and perpetuating ignorance
and error, manifestly thinning the species, by nipping those tender
blossoms of human kind.
HERE, if this notice of the treatment of children should even appear a
digression, I should, in favor of the intention, hope forgiveness from a
humane reader. He would scarce impute it to me as matter for criticism,
the having sacrificed propriety to the introduction of a point so
important to humanity. But the truth is, that neither as a digression,
nor as a false or over-strained argument, nor as a misapplication, can
the same well be considered, by any who will withal consider its strict
affinity in so many points to the subject of which I am treating.
IT will readily appear, that both these violences offered to Nature in
the substituting the men-midwives to the females, and dry-nurses to
wet-ones, acknowledge exactly the same common parent, interest, and have
exactly the same common effect, the destruction of infants. Is it then
possible to be too much on one’s guard against those so flagrant
impositions, which are the offspring of that proof-hardened passion? Is
any thing sacred from it, since the lives of innocents palpably have not
been so, in one branch of practice, nor very presumably are one jot more
respected in the other? It is true indeed, that the practice of
employing dry-nurses has not yet ascended much among the great and rich;
first, because fashions rarely do ascend from the lower classes of life,
and next, because there is no such temptation of actual lucre to defend
or spread it: but as to that of preferring men-midwives, nothing is so
likely as its descending, as it is so much the nature of fashion to
descend, and none are more readily adopted by the lower ranks of people
from the higher ones, than those fashions which are the most foolish and
the most pernicious. And certainly this is not the one that the least
deserves those epithets.
WAS it not for this influence of the fashion, in making the most
unreasonable as well as the most dangerous things pass into practice
from the highest down to the lowest life, many an honest man might
escape the bad consequences of his following the example of those, than
whom none are so liable to be imposed on in such matters, the great and
the opulent. These make it worth the while of interested persons to
deceive them, and thus often for being cheated, pay with their money,
their health, and even with their lives. In the mean time, many who are
seduced by the vogue in which they see the men-midwives, employ them on
a principle which cannot be enough commended, their natural affection to
their wives and children. The reasoning which occurs to a husband in
middling or low life on this occasion is probably as follows. “My wife
and child are full as dear to me as those of the greatest man in the
kingdom are to him, and shall I grudge a little more expence in the
provision for their greater _safety_?” So far he reasons right: all his
mistake lies in taking too readily for granted, that same _greater
safety_, to be on the side of the men-practitioners in preference to the
midwives, because the former are employed by the great, who, by the by,
consult Nature the least of any class of life, even in points of their
own health. And certainly in many respects to that _sine-quo-non_ of
human happiness, the great had better follow the example even of the
poor, than the poor theirs. Make the most then of your reasoning from
the prevalence of fashion, the gout and the men-midwives, well
considered, are no very enviable appendixes of high-life.
IF in some that laudable tenderness for mother and child, is the
determining consideration for employing a man-midwife by whom Nature, if
consulted, would assure all concerned, that the safety of both was more
likely to be endangered than not, there are others again, in whom
calling in the aid of a man-midwife is rather matter of luxury, of
parade or ostentation, than of opinion of superior safety. These are of
that imitative kind of beings, with whom the preference of a
man-practitioner for the conducting of his wife’s lying-in, turns upon
no other motive, than what would equally make them bestow a silk gown of
a new fashion, or a laced-head upon her; from a spirit of emulation of
some neighbour or superior.
BUT what is more surprizing yet, is that notwithstanding the kind of
loathing and repugnance with which Nature inspires the women to receive
such an office from a man, as that of delivering them, a repugnance to
which they had so much better listen, since it has all the characters of
a salutary instinct; there are women so weak, as not only not to
represent to their husbands the expedience of examining, at least, the
propriety of such a fashion, before they blindly adopt it on the faith
either of others liable to be deceived, or of those interested in the
deceiving them; but who even, in a ridiculous complaisance to that
fashion, of which themselves and children are not unlikely to be the
victims, will make a point of being attended by a man-midwife, by way of
a piece of state.
I HAVE myself known women so infected by this silly vanity, that on
receiving visits from their friends after lying-in, and being delivered
by a woman, with the utmost safety and satisfaction to them, have been
ashamed of having had the better sense and regard for themselves, to
employ a midwife in defiance of the fashion, and have told their
friends, that it is true Mrs. —— had lain them, but that there was a
Doctor at hand in the next room. This by the by was false, for such a
_Led-Doctor_ is neither needed nor employed, where a midwife that knows
her business is called. If any occasion for medical or even chirurgical
skill arises from the complication of a case, there is always time to
have the advice of a regular physician, or a regular surgeon, because
that complication can never escape timely notice. It can only then be,
for the sake of his iron and steel instruments, that a man-midwife has
so much as the pretext of being necessary, and I hope to prove, that all
the needful can be much better done without them. Yes, I repeat it,
better done without them.
FOR here and throughout the reader will please to observe, that it is on
the superiority of safety in employing midwives that I impugn the
growing fashion of a recourse to men-practitioners. It is the side of
Nature I take against a set of mean mercenaries, who commit the
cruellest outrages upon her, under the falsest of all pretences in them,
that of assisting her. I would not be so criminal as to wish the benefit
of a false argument, in a point of life and death to those mothers and
children, my tender care, even could I be silly enough to imagine, that
I could pass such an one upon my reader. I wave therefore all plea of
the novelty of this upstart profession of men-midwives. Such a plea I
readily confess is not receivable. Were It so, how many valuable
discoveries or improvements must have been stifled in their birth, if
the objection to their being novelties was a valid one? All that I would
contend for is, that an innovation should not be admitted only because
it is an innovation; and that the decision of a matter of such capital
importance, is better left to Reason, always herself submissive to
Nature, than abandoned to Fashion, which so often acknowledges no other
jurisdiction than that of whim or humor.
THERE is no prescription for error, no sanction in custom against
improvements. But certainly in such a capital point as the life of so
many human creatures, in short, in one of the most sacred objects of
government, that of population, such a novelty as that of bringing
men-midwives into general practice, requires rather a greater authority
than that of Fashion, while there is such a standard of essay as Reason.
INOCULATION was not long since a novelty in this nation. The lady who
introduced it, for any thing I know to the contrary, still lives to
enjoy the honor of having procured so great a benefit to mankind. But
then this benefit would bear the fairest of all trials, that of
calculation: for what is reason itself but another word for calculation?
The procuring then the small-pox by inoculation, in a body duly
prepared, and especially at an eligible age, affords, according to the
doctrine of chances, so much a fairer prospect of safety, than in the
case of a spontaneous or accidental infection, that nothing scarcely
could be imagined more friendly to Nature than such a rational
prevention of her danger, from a distemper too rarely escaped, for the
possibility of that escape to be employed as an argument against such a
method of prevention. Here then the seeming violence offered to Nature,
appeals for its justification to Nature, Reason and Experience.
CONSULT Nature as to this innovation in the employing men-practitioners
preferably to the midwives, who have been for ages, and so universally
considered as the properest for that function. Nature will tell you,
that it is injuring her to suspect her of being so cruel a
mother-in-law, as to deny her tenderest production the female sex
sufficient succors within herself, or leave women under a necessity of
recurring to men for aid in their greatest need of it, during those
sufferings, to which it has pleased the great master of Nature to
subject peculiarly the women. If Nature then is but another name for his
Fiat through all his works, never was his will more plainly signified
than by her voice in this point: a repugnance in both sexes to that
office being administered by a man. A repugnance which is not even one
of Nature’s least remarkable signs of abhorrence from this innovation,
and is only to be surmounted in the men by interest, and in the women by
their false fear, or what is weaker yet, by their rage in following that
bell-weather Fashion, though it should lead them like sheep to the
slaughter. The uncouthness and inaptitude of the men, so ill compensated
by their miserable inventions of iron and steel instruments, form
another loud protest of Nature against this important function being
committed to men-operators.
CONSULT reason, and reason founded upon those dictates of Nature, to
which time only gives the more strength, will tell you, in contempt of
fashion, that the men-midwives will never do any thing in a matter
rather too universal for any excellence in it to depend upon Greek,
Latin, or Arabic; that they are, in short, only hatching of wind-eggs,
in the study of an art, which no incubation on it will ever sufficiently
naturalize to them.
IF to experience you appeal, I have already furnished unrefutable
arguments of that’s being against the men-midwives. But let them
remember my confession, that the number which I have quoted of women
happily delivered is taken from the course of practice of good midwives.
I am not here an advocate for bad ones, nor would I wish to authorize
them if I could. All that I shall say, and dare aver is, that the very
worst of them, unless their hands are cut off, or at least deserve to be
cut off, can hardly be worse than the best of the men-operators.
BUT while it is to the tribunal of Nature, of Reason, and of Experience,
that I presume to wish that this same Fashion might be brought; I
readily acknowledge its force though not its justice. I feel the power
of it, with pain, for the sake of humanity[21]! My opposition then to
this fashion is rather founded in duty than in hope. The weakness of it
will probably furnish fashion only a new matter of triumph, not indeed
over me who am too low for it, but over the welfare of mankind, which it
has often, in more points than this, the pleasure to see sacrificed to
it, though in not one perhaps more palpably than in this one.
IN the mean time it might be worth the while of even those who not being
themselves men-midwives, nor having any personal interest in patronizing
them, owe their favorable notion of them to their own fair judgment; it
would, I say, even be worth their while to consider that there may
possibly be a time, when they may themselves see reason to change that
judgment of theirs. They may possibly discover the illusions of
interest, under the old stale mask of service to the public. They may
find out the folly of fashion. But will not it be too late, when that
fury of fashion shall, like a pestilence, have either swept away the
good midwives, or at least have so thinned their numbers, as not to
leave enough for the demand of the service? They must in time become, to
all intents and purposes, like an old obsolete law, as effectually
abolished by disuse, as if abrogated by a formal repeal. “The matter
would not be much if they were,” an instrumentarian will probably say,
but I doubt much, whatever he might gain by it, whether mankind or
population would profit much by that extermination, even though the
men-midwives with their tire-têtes, crotchets, and forceps, were to
succeed to their business.
AND that such an extermination is far from improbable, will appear no
strained inference to those who consider the power of Fashion, which
establishes its tyranny, much as the first Roman emperors did theirs
over that commonwealth, by leaving a semblance of liberty without the
substance; whence the baneful effects do not the less follow, or rather
the more surely follow. Thus there is indeed as yet no act of parliament
for the preference of men-practitioners or the extinction of the
midwives, but the statutes of fashion are not only more forcible than
any act of a human legislature, but, in this matter even than the laws
of Nature herself tho’ inculcating their observance, under pain of
death, or at the least of severe corporal punishment; such as being torn
with cold pinchers, or cut or punctured with instruments, or put to more
pain than necessary.
ALREADY has fashion driven numbers of women out of their livelihood to
make way for the encroachments of the men on the female provinces of
industry, though there never was a time, in which it was not a just
complaint that there were rather much too few means of employment for
women. Fashion has determined it otherwise, and many callings formerly
appropriated to females are now exercised by men.
BUT as to this profession of midwifery, even the total extinction of the
real midwives, would not be perhaps so bad as giving that name to those
poor creatures in training under the men-practitioners, who
independently of their own incapacity of practice, consequently of
forming good practitioners, have a palpable interest not to suffer their
women-pupils to gain any eminence in the profession that might give
umbrage to themselves[22]. The midwives whom these men-practitioners
would perhaps gratiously allow to subsist, might to their own
insufficiency add the dangerous circumstance of creating, or at least of
not preventing, by duly exerting themselves in the predisposing part,
the necessity of calling in their protectors, especially where
recommended by them. Not that I imagine even these mock-midwives would
wilfully be guilty of such prevarication in their duty. For them not to
deserve such a suspicion, it is enough that they are women, consequently
tender-hearted. But that does not exclude the idea of weakness. But
where so fair a virtue as gratitude may disguise even from themselves
the fouler motive of interest lurking at bottom, if that tenderness is
not even destroyed, it may not impossibly be made a tool of, and join in
persuading them, that things had really better be left to the
men-practitioners, whose creatures and devotees they are. Thence a
negligence superadded to their defect of skill. Such subalterns then
would, at least, not be dis-inclined to the “FINDING” _themselves_ “AT A
LOSS”, or yet worse for the patient, have by their omissions, if not
commissions, bred the occasion of “_finding_” themselves “_at that
loss_”, even mechanically, and without the direct design of paying their
court to their recommending “_accoucheur_, _their man of honor_ and
_real friend_,” in a _candid_ recourse to him. Pity it were indeed that
so charming a harmony should not subsist between _the accoucheurs_ and
such _midwives_, for the “MUTUAL ADVANTAGE” of both! A harmony, which
however could hardly be established but at the expence of the sacrificed
patients.
AND here I appeal to the reader’s own fair judgment, whether I
over-strain the consequence against such wretched creatures as they
cannot but be who must, for bread, be so subservient to the
men-midwives, and be what the French call, their _âmes damnées_ (souls
sold). Can any thing be more probable than that these _good women_
dignified by the men-practitioners, out of their special grace and favor
with the title of midwives, will on all occasion consult the
“_advantage_” of their kind _patrons_ and “_real friends_”. And how can
that advantage be better consulted than by bungling their work so as to
make it _appear_ necessary to have a _candid recourse_ to the good
Doctor, who recommended and warranted them? can it, in short, be
imagined, that they will be less mere machines than Dr. Smellie’s Dolls,
or indeed furnish less occasion, than the education under those Dolls,
for the _iron_ and _steel instruments_, which are the most part
understood to be indispensably necessary where the midwife shall have
failed. And as to such midwives as have been formed or recommended by
the men-practitioners, their _not_ failing would indeed be the wonder!
THUS the name of a midwife may subsist after the reality shall have
perished, and the world so often deceived by mere names, may not
perhaps discover this annihilation till long after it is effectuated,
or till it is too late to repair the damages, which will hardly fail
of discovering it to them. Of good midwives there never were too many;
but they are now much too few; though still not more rare in
proportion than those of the men-midwives, who may be called good,
comparatively to so many of them as are dangerously superficial.
Discouragement has already greatly hindered the places of the good
female-practitioners who are gone off the stage, from being duly
supplied. Proper subjects decline taking up a profession, in which
they must have to dread the prevalence of so false a prejudice against
them, as that which determines the preference of the male-operators.
It is easier to destroy, than to create a-new; and perhaps when the
need of good midwives shall be at the greatest, the difficulty of
finding such, will make the employing of men-practitioners, with all
the so just objections to them, even a necessity. Things are not at
present perhaps far from that point, and an alarming consideration
that would be to all women, if they were but to reflect on the
increase of pain and danger to themselves in the hours already too big
with both, of their increase, I say, by the most aukward and violent
aid of the men, compared to the so much more effectual and gentle
methods so natural to the women-assistents.
IF the parties then principally concerned in the decision of this
question, and especially the women who are the patients, and their
tender relations of husband, father, or brother, &c. were but to consult
their own feelings, their reason, and even that instinct which, in this
point, is itself so strong a reason from its being the voice of Nature
never unhearkened to with impunity, they would soon, to your objection
drawn from a fashion scarce less ridiculous than pernicious, allow no
more weight than, in fact, it deserves.
OBJECTION the Fourteenth.
YOU must allow, however, that it must be a false modesty that, in the
women, which can oppose the preference of the men-practitioners to the
female ones.
ANSWER.
I KNOW indeed that Dr. Smellie (page 2. of his introduction) attributes
the opposition made by the Athenian women[23] to the prohibition of
midwives, and to the acceptance of men-practitioners in their room to
“_mistaken modesty_.” It may however with more reason and truth be
averred, that the admittence of men to that function by women, would be
in the women a most egregiously MISTAKEN IMMODESTY. Since, surely the
virtue or grace of female modesty is not an object to be held so cheap,
as to be sacrificed for worse than nothing, for nothing better, in
short, than the purchase with it of danger or perdition to both the
mother and child. After so valuable a sacrifice as that of modesty
itself, it may perhaps sound mean to add any thing comparatively, so
trifling as that of the hire not given to the person who prostitutes
herself in some sort on a so much mistaken hope, but to the very person
to whom she is prostituted in that hope of superior safety.
I AM not then here to assume a character, that would become me so ill,
of a Casuist or Divine, by pretending to fix the degree of moral
turpitude in the submission of modest women to a practice, which, I will
even allow might be justified by the superior consideration of safety to
two lives, if that consideration was not a question most impudently
begged, with so little foundation, that the very contrary thereof is the
truth.
NEITHER would I here incur the just charge of impertinence, in giving my
private and insignificant opinion on an undecency so unwarranted by any
necessity. That would look too like dictating to others, what they are
to think of a practice, of which every one will doubtless judge for
himself. The boundaries of female modesty are so well known, and so
ascertained by common consent, that surely it little belongs to me to
offer new lights upon that subject.
WHAT I have then to say, on this head, is purely in justification of
that modesty, which the men-midwives are for obvious reasons pleased to
call a false one, though so far as it pleads for excluding them, it is
an ingratitude to that Nature, of which it is the peculiar gift to the
female sex, not to term it even a wise virtue.
SOCIETY especially stands indebted to Nature for her suggestion of
modesty in this point. If in all ages, in all civilized countries, the
wife is considered as the peculiar property of a husband, insomuch, that
all laws human and divine consecrate, if I may use the expression, to
him alone, exclusive of all other men, the access to the reserved parts
of the wife’s body, certainly such a privilege can hardly be thought
lightly communicable. And what can be more so than suffering a man,
mercenarily or wantonly, or perhaps both, to invade that so sacred
property, under the mask of a service, for which he is by Nature so
evidently disqualified? While Nature too has made so ample a provision
for this very service, in fitting the women for it, with so much more
propriety and safety, both to the concern of the public in the welfare
of population, as well as to the domestic honor of families, which is
not without some danger, at least, from the practice of midwifery being
in the hands of men.
AS to this last averment of mine, the truth of it is so glaring, that it
does not even need Dr. Smellie’s own implicit confession of it, in his
instructions to the men-practitioners in general, or, if you please, to
his more than nine hundred pupils.
“_He_ (_the_ ACCOUCHEUR) _ought to_ ACT _and_ SPEAK _with the utmost_
DELICACY _of_ DECORUM, _and_ NEVER VIOLATE _the_ TRUST _reposed in him,
so as to harbour the least_ IMMORAL _or_ INDECENT _design; but demean
himself in all respects suitable to the_ DIGNITY _of his_ PROFESSION,”
p. 447.
HERE I confess myself so smitten with the propriety and sanctity of the
precept of the good Doctor’s, and particularly with the needfulness of
it, that I would advise every man-practitioner of midwifery, of a
certain age that might require it, to have the said commandment wrote
out in _gold letters_, and wear it about his arm, especially on his
proceeding to _officiate_, by way of amulet, phylactery or preservative
against any incident temptation to _violate_ his _trust_, or to fall off
from the high _dignity_ of his profession. All that I fear is, that its
virtue may not always be to be depended upon, against the energy planted
by nature in the difference of the sexes. No one would be farther than I
from the cruel injustice of drawing consequences unfavorable to any set
of men, from the misconduct of any particular individual in
it.[24]Errors are purely personal. If I then so much as mention the case
of a man-midwife convicted of having debauched a gentleman’s wife, in
consequence of his admission to the practice of his profession of
midwifery upon her, it is by no means neither with a design to insult
the unhappy criminals, nor to draw from thence an inference to the
disfavor of the men-practitioners in this point, beyond what I am
authorized by the constancy of the temptation from Nature, to all, yes,
to all, who, by their age, in one sex, are not past it: I say in one
sex, because in the other, the female, the very circumstances of a
woman’s needing a midwife, shews that she is not past the age of, at
least, causing a temptation. Further, it would even be a matter of
argument on the side of the men-midwives, that so _few_ instances come
to the knowledge of the public, of the ill-consequence of a practice
which breaks down the capital barriers of modesty; if those
ill-consequences were not, in the nature of them, not only a secret, but
easy to be kept secret. Who would complain but the husband or relations
of transactions between a man-midwife and his patient? But then how
seldom need a third to be let into such a secret?
I WOULD not then have the men-midwives to be too forward to treat the
modesty of the women on this head as a false one, or their scruples as a
weakness. Modesty in this case is not only the safeguard of the lives of
themselves and children, but of their own honor, which if it does not
receive an actual fall in such a subjection to a man-midwife, had
perhaps better not be so unnecessarily risked so near the brink of the
precipice.
I AM not writing here for Italians or Spaniards, or any of the
inhabitants of those countries who are so prone to jealousy, perhaps
because they know their women. I am now addressing myself to Englishmen,
not jealous, because, if they know theirs, they must know that, in
proportion to the number, no women on the earth have more of the reality
of virtue and modesty. I will not suppose then any thing so offensive,
as that the chastity of the generality of them is not infinitely
superior to the advantages or overtures for design afforded the men
admitted to such a privacy, as that of attending them in their lying-in
and delivering them. But would the honestest woman, or one however sure
of herself or of her virtue, think it eligible, without a full
satisfactory proof of that superior safety, which is her object in
preferring men-midwives, to be herself the occasion of temptation to
those people? How can she answer that she will not be it? In that so
formidable army of mercenaries, actually continuing to form itself under
the banners of Fashion, and headed by Interest, can she answer that the
insensible stoics of it, will fall to her share? Would a woman, I will
not say, of strict principles of honor, but barely of not the most
abandoned ones, submit herself in the manner she must to a man-midwife,
on her employing him, if she would but satisfy herself, as she easily
may, that his aid cannot be more effectual than that of a woman? But
what! if it is most undoubtedly a less safe one?
BUT this is far from all to be objected on the head of modesty to this
practice. The opportunities, if not of temptation, if not of seduction
by it, at least of offensiveness to female reserve are such, as would
make even a husband, the least susceptible of jealousy, so uneasy for
the outrages to which the employing of a man-midwife in the course of
his wife’s pregnancy and delivery might expose her, as would make him
think it no indifferent point for his judgment to settle whether such
outrages might not better be spared her. It will not I presume be
denied, that all female modesty is a flower, the delicacy of which
cannot be too much guarded against any tendency to blast it, and that
nothing can threaten more that effect, than such infringements of the
unity of a husband’s privilege in the sole incommunicable possession of
his wife’s body, as are implied in the course of a man-midwife’s
attendance. An unity of privilege, which, when broke in one point, does
not always stop at that, but may proceed to farther breach, where there
is art on one side, and weakness on the other. Many women are doubtless
proof against the slipperiness of such an overture: but all have not
alike strength of mind.
BUT lest I should be here taxed with forging of phantoms merely for the
honor of combating them, I shall only entreat all parties concerned to
consider the following so probable circumstance, and then let them
decide as their own judgment will direct them: a circumstance taken (can
any thing be fairer?) even from a man-midwife’s own stating, as well as
from the nature of things, of which none need be ignorant that will
think at all about them.
IT is then to be observed, that during a woman’s pregnancy, and before
the labor-pains come on, one of the principal points of midwifery is,
what is called the art of _Touching_. Thence are derived the surest
prognostics for preparation, and especially from the signs it affords of
rectitude or obliquity of the Uterus. I have already offered reasons
needless to repeat, why the men can never arrive at the excellence of
skill in the women in this particular. But as to the importance of this
faculty of _Touching_, hear what Dr. Smellie himself says.
P. 180. “The design of _touching_ is to be informed, whether the woman
is or is not with child; to know how far she is advanced in her
pregnancy; if she is in danger of a miscarriage; if the _os uteri_ be
dilated; and in time of labor to form a right judgment of the case, from
the opening of the _os internum_, and the pressing down of the membranes
with their waters, and lastly, to distinguish what part of the child is
presented.”
Again, P. 448. speaking of a _midwife_, he says, “she ought to be well
skilled in the art of _touching_ pregnant women, and know in what manner
the womb stretches, together with the situation of all the abdominal
VISCERA: she ought to be perfectly mistress of the ART of EXAMINATION in
the time of labour”.
HERE you have from an unsuspected authority a certainly not over-rated
importance of the expedience of preliminary TOUCHING. Now granting, only
for argument’s sake, what is assuredly false, that a man-practitioner
can be equal (superior he would not in this point, at least, have the
impudence to pretend himself) to a midwife; let a husband, let a wife,
but reflect on the difference, every thing else being equal, there must
be as to _modesty_, between the function of _touching_ being performed
by a man or by a woman. Let a husband, I say, for an instant figure to
himself what a figure he must make, what a figure his wife must make,
under such a ceremony performed by a lusty HE-MIDWIFE, exploring those
arcana of the female fabric, and especially to so little purpose, with
his natural disqualifications for so much as knowing what he is about.
Will the husband be present? What must be the wife’s confusion during so
nauseous and so gross a scene? Will he _modestly_ withdraw while his
wife is so _served_? What must be his wife’s danger from one of those
rummagers, if she should be handsome enough to deserve his attention, or
a compliment from him on such a visitation of her secret charms, the
more flattering from _him_, not only as he must be supposed so good a
judge from the frequency of his occasions of comparison, but as it must
imply a superior corporal merit in the woman so visited, as could
overcome that satiety which a fastidious plenty of patients might so
naturally be imagined to create in a man-midwife? Will any one say, that
these suppositions are over-strained, or out of Nature? I fancy, that if
the secret histories of many families were ransacked, of the practice on
which the men-midwives were in possession, it would not be always found,
that those preliminary visitations were not turned to some account of
interest or seduction. And yet an omission of that _touching_ might be
dangerous. How kind is it then in Nature, to have of herself so far
consulted the good and tranquility of society, in palpably bestowing
upon women a faculty, which she has as palpably refused to the men, in
whom the exercise of it would for obvious reasons be big with so many
inconveniences? Is there any breach of charity in the taking for granted
the existence of such inconveniences, unless indeed, all of a sudden, in
favor of this lucre-begotten sect, the men were ceased to be men, and
the women women?
BUT allowing that nothing was to pass between a man-midwife and his
patient, in this _act_ of _touching_, beyond the necessity of the
practice, or in a merely technical sense, that in short no such
libertine impression should make itself be felt in the course of such
_touches_, as should discompose the good _Doctor_’s DIGNITY, and
endanger the patient’s honor, by present or future attempts derived from
such a strange privity; is it not to be feared, that a designing or
interested person may take other advantages besides that of gratifying
sensuality? May not a woman, the more attached she is to her modesty,
the greater sacrifice she has made of it, in her innocence of intention,
only imagine herself but the more subjected to a man, to whom she has
submitted in the manner she must do to a man-midwife, and let him take
an ascendant over her and her family, of which a midwife would not so
much as dream, from her office being so much in course, and too little
extraordinary for her to have any extraordinary pretentions or designs?
On the contrary, a man-midwife need scarce set any bounds to his. In any
differences in a family, especially between man and wife, must not a
man-practitioner, from such a familiarity with the wife’s person, have
such a footing in the confidence of the wife, as may enable him to
dispose of her will almost in any thing? He may be her apothecary,
physician, surgeon, privy-councellor, what not? What can a woman refuse
a man, to whom she is so deluded as to think she owes her own life, or
that of a darling child, all his merit, in which I have before
explained? What can a woman in short refuse a man, to whom nothing of
that has been refused, in which consist all the preliminaries of
granting every thing? She may indeed refuse him the sacrifice of her
virtue, if he should think it worth designing upon, but how few things
else could she refuse him? Once more the greater value she put on the
sacrifice of so much of her modesty, the less would she be able to deny
him any thing else, as any thing else must comparatively appear so
inconsiderable.
BUT hitherto I have spoke only of those outrages and dangers to modesty
from the preparatory attendance of the man-midwife as occasion may
require, during the pregnancy. But as to his officiating in the crisis
of the labor-pains and delivery, there are two very essential points of
consideration.
THE FIRST. The modesty of the women, unaccustomed to the approaches of
other men than a husband, must be in great sufferance in the moments of
their labor-pains. All Nature agonizes in them. They are at once
weakened in the flesh and in the spirit. The bare presence of a man to
officiate at such a time, may excite in them a revolution capable of
stopping the labor-pains caused by the expulsive efforts of delivery,
which thus becomes dangerously retarded, and may so overpower them, as
to put them in the greatest peril of their lives. This is what has often
happened. You may see frequent examples of this revolt of Nature against
the ministry of men-midwives in Dr. La Motte himself, a man-midwife. If
Nature then suffers so much in women at that juncture, when a person,
nay even of the same sex, offers her aid, in certain indispensable
occasions, to which humanity is subjected; how greatly must the presence
of a man increase their constraint and embarrassment, and rob them still
more of that so necessary freedom in the animal functions! But how
greatly ought the women to thank that their instinctive repugnance of
Nature to such a prostitution of their persons, if they consider those
tortures, which, by the listening to that same repugnance, may at once
be saved to their modesty, and to their personal feeling. Let them paint
themselves the following posture prescribed by a man-midwife. “_The
patient must be commodiously placed, that is to say, on the bed-side,
her thighs raised and expanded, her feet drawn up to her posteriors, and
kept steady in that posture by some trusty helpers._”[25] Levret, p.
161. _On the use of the new crooked forceps._ Here it may be said; “why
there is nothing in this attitude, however shockingly indecent, but what
may be sanctified by the extremities of necessity”. Very well. But what
must a husband, what must a wife think at her being _spread out_ in this
manner, under the hands and eyes of a man-practitioner, with his
helpers, perhaps his trusty apprentices, only for the experiment of a
_forceps_ of a new invention, the merit of which too is a so contested
an one, that Levret himself is forced to own that, “that same FORCEPS
_would be[26] an instrument of pure_ SPECULATION, _and not of_ PRACTICE,
IF (N. B. that IF) _a certain general precept should be true_,” which,
by the by, is most certainly so! So that, in this case, for example, you
see how a woman may be treated, only to ascertain the merit of some
new-fangled gimcrack of an instrument. But to how many occasions of as
little, or even less necessity than this, for putting a woman into
postures of this sort, might not wantonness, interest, or other motives
give birth? Or can pretexts for such insults to modesty be wanting to
designingness?
THE SECOND consideration is this. Those moments of weakness of spirit,
and infirmity to which the labor-pains subject the women may, in some of
naturally the weakest of them be, liable to leave impressions in favor
of a man-midwife, the less suspected of harm, and consequently the more
dangerous for their being suggested by that gratitude for his
imaginary[27] contribution to their deliverance, which is itself a
virtue, though the object of it is so miserably mistaken by them. Let
any one image to himself what must often happen in Nature, a woman
sinking under her pains, her mind all softened and overpowered with her
present feelings, and looking up for _relief_ to the _man_, employed, as
she imagines, to procure it her, though the real fact oftenest is, that
he will not have enough prevented her pain, or perhaps greatly
occasioned its increase. Of this however she knowing nothing, sees him
in the amiable light of her deliverer from her actual and intolerable
state of pain. In the mean time, those aukward uncouth endeavours of his
to relieve and deliver her, even though they should aggravate her
torture, pass upon her for master-pieces of art or skill. “Who would be
without a man-midwife?” At length, Nature sometimes, even in spite of
all his omissions, or bungled operation, proceeds in her favorite task
of delivery, that is to say, if he has not hurried or made tragic work
of it, with his mispractice or his instruments. The patient then is rid
of her burthen, and what are then her feelings? Those of exquisite
delight, from the comparison with what she was induring but the instant
before. It is a transport of joy, not unmingled with gratitude, to the
person to whom she fancies herself in any measure obliged for it. The
ugliest wretch on earth, so he could but be imagined the cause of such a
delivery, would, in those instants, assume in her eyes the form of
Loveliness itself. Even with the greatest innocence of heart she could
hug, she could kiss him in the ebullitions of her joy and gratitude. Let
no one imagine these expressions are over-strained. Such a rapture of
felicity, in the sudden case of being taken as it were down from a rack,
is not of a Nature to know any bounds of moderation, nor can be
conceived but by those who have felt it. Her gratitude would even extend
to inanimate things, much more to the dear Doctor, to whom she conceives
she owes so much. She eyes him with all the intense eagerness of a
gratitude so fond, that its transiency into a passion of another nature
would not appear such a prodigy, to those who consider how apt passions
of tenderness are to confound motives and run into one another. The
melting-softness of those moments of infirmity and weakness of spirit,
affords a susceptibility of impressions, which may not afterwards be so
soon worn out, and of which the usual affection from the difference of
sexes, in the parties, may sooner or later come in for its share. Dr.
Smellie has, as I have before observed, implicitly allowed the
possibility of a temptation to men, and shall I not follow his laudable
example of candor, and confess that there may also be weak women?
IT is indeed true that in cases of extremities, such as most certainly
are not the frequentest ones, any thought of immodesty may be intirely
out of the question. The sad and suffering state of a woman agonizing
with pain, at the gates one may say of death, leaves little room for
licentious temptations. But, once more, those cases are much the rarest:
and even in those, the greater the danger will have been, the greater
must the gratitude afterwards be for the imaginary service, that will be
supposed to have accomplished the deliverance. Let a midwife have really
rendered that service, the gratitude will scarce be so quick, so lively
or so lasting, only because she is not a man.
IF it shall be here objected, that the men-midwives ought to be above
all suspicion or scandal of this sort; I shall only say, that at least
it is their interest to appear so. But they themselves will not pretend
to an exemption from temptation, nor can answer for themselves that such
a temptation may not come into existence, as that all their virtue,
fortified by the divine precept before quoted from Dr. Smellie, may not
defend them from yielding to it. They are not, or at least ought not to
be men in years for obvious reasons as to that manual practice of theirs
which at the best is so indifferent. Let any one then consider the
consequence of this worse than unnecessarily putting young women, in
such manner, into the hands of men in the vigor of their age. Let any
impartial person but reflect what barriers are thrown down, what a door
is opened to licentiousness, by the admission of this so perfectly
needless innovation. Think of an army, if but of barely Dr. Smellie’s
nine-hundred pupils, constantly recruiting with the pupils of those
pupils, let loose against the female sex, and of what an havock they may
make of both its safety and modesty, to say nothing of the detriment to
population, in the destruction of infants, and I presume, it will not
appear intirely in me a suggestion of private interest to wish things,
in this point, restored to the old course of practice of this art of
midwifery by women. A course which Nature has so self-evidently
established, in her tender regard to the female sex, and to its darling
offspring, and in which she has not less consulted one of her primary
ends, the Good of Society, in the greater security of the conjugal union
and property, which ought to be so sacred, and especially so, for the
honor of the human understanding, from the invasion of an upstart
profession, sordidly mean in its motives, infamously false in its
pretences, shamefully ridiculous in its practice, and yet dreadfully
serious in all its consequences.
CONCLUSION of the FIRST PART.
In the foregoing part of this work I have contented myself with
asserting, in general, the perfect inutility of those instruments, of
which the male-practitioners themselves confess the danger, and use them
not a bit the less for that confession. It is then for the following and
second part, that I have reserved the entering into a more particular
discussion of them. Therein will appear, upon how false and slender a
foundation the gentlemen-midwives have insinuated themselves into a
business so little made for them. The truth is, that the pernicious
quackery of those same instruments has been artfully made the pretext,
and become the sanction of an innovation set on foot by Interest,
adopted by Credulity, and at length fostered by Fashion. The employing
of midwives was undoubtedly not long since, in this country, the General
Rule. The calling in of men-practitioners, upon very extraordinary
occasions, was an Exception, and a very rare one, to that General Rule.
But by a fatal inversion of the natural order of things, the Exception
is recently crept into the place of the General Rule. The point is to
consider, whether this palpable violence to Nature is of that benefit to
society which it is pretended to be.
I HAVE already examined some of the arguments in favor of the
men-practitioners. But the principal one, deduced from the incapacity,
or rather aversion of the midwives, upon just grounds, from using
instruments, merits an ampler scrutiny. In proof of my candor in it, I
shall take most of my remarks on those instruments from what the
men-practitioners themselves say, and confess of them. This, I presume,
cannot be deemed unfair.
UPON the whole, those parties whom the decision may concern, will please
to decide on which side the force of Reason and Truth shall appear the
greatest; and so deciding, it is, in fact, in their own favor, and in
one of their most capital concerns, that they will decide.
THEY will decide, in short, whether, upon the whole, the plea of the
men-practitioners, founded upon the ignorance of a few midwives which,
bad as it is, is more than balanced by their incompetency in the manual
function, and to which a remedy might easily be found, is a valid one
for driving out of the practice of midwifery a sex, to which the faculty
of it is self-evidently the genuine gift of Nature herself, only to make
way for a set of interested male-practitioners, whose so boasted art is
oftenest signalized by the most barbarous and horrid outrages upon
Nature, with this aggravation, that they are needlessly committed under
the specious and plausible pretext of flying to her assistence.
The End of the FIRST PART.
[Illustration]
[Illustration]
A
TREATISE
OF
MIDWIFERY.
PART the SECOND.
Containing various observations on the labor and delivery of lying-in
women, including a discussion of the pretended necessity for the
employing instruments.
INTRODUCTION.
NOTWITHSTANDING the numerous productions of writers on the art of
succoring women in labor, all that has hitherto appeared on that
subject, still leaves the mind unsatisfied; not that it is so unjust as
to expect perfection in any human art, but from its feeling that, in
this particular one, too much is given to theory, and too little to the
practical part, or manual function.
WHILE the causes of difficult labors are far from solidly or
sufficiently explained, and rather obscured by a cloud of scientific
jargon, than practically illustrated, they give us no tolerably sure
method for preventing or remedying those difficulties. On the contrary,
the whole boasted improvement of the art is reduced, to a pernicious
recourse to instruments, which cut at once the knot they cannot unty.
IT is then no wonder that there should still, in all the books and
observations hitherto given on this matter, exist a void lamentably
unfilled; and as this void evidently consists less in the theory than
the practice, the superior qualifications, and natural endowments of the
women for the manual operation, point out the fitness of the greater
dependence on them for the filling up what, humanly speaking, can be
filled up of that void.
LET the physicians, the surgeons instruct the midwives in so much of
anatomy as is necessary to their function; let them afford them, either
in writing or verbally, their guidance and direction in the consequences
or occasionally in the preliminaries of management of the lying-in; all
this is right, salutary, and in due course: but that men should pretend
to the manual operation in these cases, it certainly neither is nor can
be their business. Nor is this negation of propriety a reproach to them.
Will any man think it an indignity to be told, he cannot clear-starch,
hem a ruffle, or make a bed as handily as a woman? The exceptions are
the shame; and in this department of art it would be truer to say, that
there are no exceptions than that there are only a few.
BUT can we wonder at the insufficiency of the lights thrown into the art
of midwifery by that cloud of writers who have treated of it, when so
few of them having had any other view than advertising themselves, and
being incapable of saying any thing to the purpose, of the art of
delivering the women, have filled up their books with insignificant
digressions, or things intirely foreign from the point?
IN some you see all distempers of women collateral to their pregnancy,
which is certainly a very necessary and an infinitely extensive subject,
while on the practical article of the deliverance they give you nothing
but what is barren, jejune, or even false. Others, by way of filling up,
run digressively into a discussion of the methods of treating infants.
Others again have written only to recommend some pretended secrets, as
powders, preparations, &c. Some have swelled their volumes with the more
or less commodious structure of a couch, or the mechanism of a
close-stool, or the make of different sorts of syringes for anodine
injections. In others you meet with remedies for the deformities of the
human body, for the contractions or stiffnesses of the muscles of the
shoulders, arms, hands, legs, feet, thighs, haunches, &c. to straiten
the crooked, and even, in a treatise on midwifery, to extirpate a
polypus from the nose. Others, with all the parade of justly exclaiming
against nostrum-mongers, the plausible writing against which serves at
once to fill up, and give them an air of superiority to such trumpery,
substitute however nothing better of their own than the recommendation
of some instrument, which they give you for a master-piece of invention;
and to establish which, they cry down every instrument of other
practitioners, though not one jot inferior to it in any thing, but the
not being the newest. Thus, after having perused such a multiplicity of
authors, it is incredible to say how little true, or practically useful
knowledge is to be picked out of the whole mass of them. You find almost
every thing in them but what you are looking for.
IN the mean time, the superficial examiner of things, who sees such a
number of volumes, furnished by these pretenders to the art of
midwifery, cannot conceive they contain matter so little essential as
they do. The scientific air diffused over them, not a little embellished
with pretty prints of machines, as of a windowed forceps, a stool, or of
a gravid uterus, all these contribute to throw the dust of erudition
into the eyes of those, who do not penetrate beyond the surface of
things. And thus the aids and appendages of the art, or what is yet
worse, even the abuses of it, pass for the art itself, the main of
which, as it undoubtedly consists in the expertness or dexterity of the
manual practice, can be so little and so imperfectly conveyed by
description. I am however far from denying the benefit which may result
to midwives, from consulting all that has been written on this subject.
I am far from encouraging ignorance in the women of this profession.
Their skill in the manual function cannot but be improved by the
addition of a sound and competent theory. But it should always be
remembered, that the very basis or capital point of the art is the
manual dexterity; and in that point, the most learned of the men must
yield to the most ignorant of the women. A point which the men
surpassing the women in every thing else can never compensate: no not
with all those dreadful “artificial hands”, of which they boast so much
their invention, in the room of the infinitely preferably _natural_
ones, of which the use, in this office, becomes the men as little, as
their hands seem formed for it; and I might add, their heads, if they
themselves can possibly think otherwise. In such an opinion the
ignorance is theirs.
AS to the treatise herein offered on the art of midwifery, as the object
of it is principally to attack particular abuses and dangerous
innovations in it, it will not be expected that the same should furnish
a compleat general course of practice. But this I dare aver that if I
should be induced to attempt such a work, it will not be the worse for
my consulting more the experience I have of Nature in her operations in
this one of her so capital concerns, than the authorities of men, who
seem or pretend to know so little of her, as to think of assisting her
with instruments, formed only for her destruction, or at least for doing
her more damage by their violence, than any reason to hope good from
them can justify.
HERE I shall not offer any digressions on physic, anatomy, chemistry, or
pharmacy; I shall confine myself entirely to the points of my business
of the manual operation. Let the physician prescribe, the surgeon bleed,
the chymist contribute medicines, the apothecary make them up; with none
of these professions do I presume to interfere. But as to the
man-midwife, who not only so often presumes in some measure to represent
them all, but to join to them the exercise of an art so unnatural to his
sex, I should think myself wanting to my duty in my profession, if I did
not point out the mischief I apprehend to result from especially that
method of practice, on which he grounds the pretence of necessity for
his practising it at all; and this chiefly forms the object of this
second part, in supplement to my first.
Of DELIVERIES.
WE understand, by deliveries, in general, the issue of the fœtus out of
the mother’s womb.
THESE are distinguished into two kinds, the one natural, the other
preternatural.
THE natural one, is that in which the fœtus comes out in the most
ordinary way, when it presents the head foremost.
IT is deemed preternatural, when the fœtus presents in the passage any
other part than the head.
THESE two kinds are again subdivided into two distinctions of labor, of
easy or difficult, because both the natural and preternatural mode of
delivery may be easy or difficult.
THE delivery is termed easy when the fœtus comes out readily, and
without the aid of art.
IT is termed difficult, when the labor of it is hard, and the fœtus does
not make its way out but with pain, and with the help and assistent
industry of the midwife.
IN the cases of a natural and easy delivery, there is little or no
actual occasion for the presence of the midwife, beyond that of
receiving the fœtus, tying the navel-string, giving the child to be kept
warm, and then delivering the mother of the after-birth. The spirits of
the patient are then to be recomposed, her agitation calmed, a warm and
soft linnen cloth applied to the stomach; a warm shift and bed-gown put
on her; a linnen cloth to be laid on four-fold over the belly; a
double-napkin round her, and she to be placed in a bed well warmed. Such
is the summary of the process to be observed in those common cases.
IN the deliveries, on a preternatural labor, when they are easy, the
same method takes place: there being no difference, but that in one the
child will have been received by the head, in the other by the feet.
THESE kinds of labors are so easy, that there is no need of
demonstrating their being to be terminated without the aid of
instruments. When the fœtus presents itself promisingly, Nature is best
left to her own action, and nothing should be precipitated in the manual
function, unless some unexpected accident should intervene, and require
interposition, such as a great flooding, or other exigency.
AS to the preternatural delivery, the better practice is not to delay
the extraction of the fœtus, after the discharge of the waters; nor stay
till her strength shall have been exhausted. On the presenting of a fair
hold, and a sufficient overture, no difficulty should be made of
extracting.
ALL that is to be observed then, is not to prematurate this extraction:
not to proceed, in short, like those unskilful, or inconsiderate
practitioners, who are no sooner entered the patient’s room, but they
want to have their operation dispatched out of hand. Nothing can be more
important to the well-doing of the patient, than for no violence to be
used to Nature, who loves to go her own full time, without disturbance
or molestation. In this point then great caution and circumspection are
requisite.
IT should also be observed, that it is wrong for the midwife to leave a
woman newly lain-in, however happily delivered. It is necessary to stay
by her for some hours afterwards, till she is in such a state of
tranquility and ease, as may leave nothing to fear of those
after-disasters which too often happen.
SOME celebrated practitioners and authors upon midwifery have been
surprized to see women, after their going their time without
mis-adventure, and after having been readily and happily brought to bed
die suddenly. There are too many of both the female and the men-midwives
who have no notion of this misfortune till it is too late to prevent it.
The cause of this melancholic accident is unknown to many practitioners
of the art. Some have confessed their ignorance of it: others have
erroneously, others deficiently accounted for it. But all are surprized
when the patient is the victim of it: especially as it follows, in some
cases that afford the best grounded hopes.
MESSIEURS MAURICEAU and De la Motte give us examples of these unexpected
deaths. The first, in his 230th observation, says,
“I DELIVERED a woman of a very corpulent habit, aged about thirty-five
years, of her first child, which was a lusty girl, alive, and that came
naturally. This woman had been near two days in labor, with small slow
pains or throws, after which the waters having burst forth with a strong
throw, she had subsequently favorable ones, which made her bring forth
as happily as one could wish. I immediately delivered her: but to my
great surprize, scarce had she been a quarter of an hour after delivery,
that she of a sudden fell into violent faintings, with an oppression at
the breast, and a great agitation of the whole body, which was instantly
followed by a convulsion, caused by a loss of blood, of which she died a
quarter of an hour afterwards.
“THIS (adds Mr. Mauriceau) was one of those kind of fatalities which no
human prudence can elude or parry.”
LA MOTTE had the same case happened under his hands, which I need not
repeat here, being inserted in the first part of this work, where, p.
131, I ventured to promise an essay of mine, to give a less
unsatisfactory reason of such deaths, than what is to be found even in
those two celebrated authors whom our cotemporaries consider as their
masters in the art of midwifery. These impute those unforeseen deaths to
occult and inevitable _causes_. I own, I do not intirely think them
either occult or inevitable. I doubtless may be mistaken, but of this I
am sure, I shall advance nothing but what is authenticated to me by my
own observation and experience.
AN over-repletion of blood, and a defect in the contraction of the
uterus, of which all the vessel being open are too slow in recovering
their occlusion, are generally speaking, the causes of these diseases. I
could support this opinion by some chirurgical axioms, but I presume it
will be thought more satisfactorily proved by the success of the method
of practice, which I would recommend to prevent or cure those dangerous
or rather fatal causes.
AS to know that a woman may thus perish unexpectedly a quarter of an
hour after delivery, is enough to require the being on one’s guard for
using a salutary prevention; I would advise attention, especially to her
constitution.
WHENEVER therefore a pregnant woman is observed to be remarkably
corpulent, and full of blood, with a good constitution, she should be
advised to lose some blood, once or twice during her pregnancy, by way
of precaution. This is of great service to rarefy the blood, and obviate
those excessive hemorrhages, which are to be dreaded on their lying-in.
Then nothing is to be precipitated during their labors, that Nature may
have full time to predispose the uterus to enter into contraction by due
degrees, that is to say, neither too quick, not too slow. But if,
notwithstanding these precautions, there should, after delivery,
supervene any considerable loss of blood, followed with faintings or
oppressions, the patient must be stirred, excited to cough and sneeze
contributively to the evacuation of the blood, which otherwise is apt to
clot in the uterus, and would suffocate her if not expelled.
IF by this mean the evacuation does not naturally take place, which may
be perceived by the faintings of the patient, the midwife must, without
losing time, put her hand into the bowel, and extract all the clots of
blood she will not fail of finding there, and of which the presence, as
being extraneous matter, necessarily oppose the contraction of this
organ, and quickly suffocates the woman, if she is not timely relieved.
THESE hemorrhages are but too frequent, especially with those women who
neglect the precautionary bleeding; and such sudden death too commonly
the consequence of neglecting, or of not knowing that the most salutary
practice, in these cases, is to well evacuate the uterus by the
operation of the hand, where Nature appears in the least tardy or
deficient.
THE long experience I have of this manual help, which has never failed
of success with me, warrants my averring, that there is little or no
danger, in these cases, to women, provided the midwife employs herself
dextrously to clear them while time serves. Their relief is
instantaneous. They come to themselves presently: they are restored to a
freedom of respiration: nor will they have so much as been sensible of
this operation of the hand, which will nevertheless have saved their
lives.
THERE have been men-midwives, that pass even for learned, but who from
their ignorance of this so simple and easy method of relief, have been
in the disagreeable circumstance of seeing many women perish under their
hands, though they had to all appearance been very happily delivered.
WITH respect to pregnant women, there is again another point of great
consequence to ascertain. Great care must be taken not to mistake the
signs of delivery. This is a very essential matter. Nothing scarce can
be more dangerous, than to excite a woman to the last labor-pains, which
will not fail of exhausting that strength of her’s, in vain, which had
so much better be reserved for the support of her in the time she will
really need it. So that a midwife ought to make it her business clearly
to distinguish the spurious pains from the true ones. Where a woman near
her time feels pains in the belly, the loins, or even the sexual parts;
they are not always to be taken for the true labor-pains. In this point,
the _touching_ will be a great guidance.
IF the fœtus is still high in the uterus, and the situation of it does
not indicate a readiness for extrusion; if the waters are not
sufficiently prepared, or their pressure down not in due forwardness,
the pains must be assuaged by some calming anodine remedies: the patient
must be left to her rest, till things declare themselves more openly;
and then, as she will not have been fruitlessly fatigued and tormented,
the labor may proceed happily.
THERE have been men-practitioners so very unskilful, or at a loss for
delivering women by the operation of their _hands_, that they tortured
their _heads_ to discover _medicines_ to save themselves the tediousness
of Nature’s taking her own time, as if she was to do her work the better
for their hurrying her. Towards the atchievement of this end, they
brought into play certain drugs, to which they gave the appellation of
hysteric, and placed or pretended to place great confidence in them.
EVEN some of our modern practitioners prove, at least, by their
practice, that they have faith in the virtue of such drugs, since they
continue to use them. They are still suffered to make a figure in many
of the Pharmacopœas, though no sure experience hitherto has verified
their efficacy. On the contrary, a thousand and a thousand examples
might be quoted in demonstration of their insufficiency and danger. I
shall content myself with producing here the testimony of Mr. De la
Motte, in the second book of his observations, and he is not the only
man-midwife that does such medicines the justice of disapproving them.
_Observation_ 174.
“A CELEBRATED man-midwife of this town (says Mr. de la Motte) pretended
to have a marvellous powder to provoke labor-pains, and accelerate
parturition. This powder was composed of galbanum, myrrh, savin, rue,
and other drugs, of which he made the patient take a dose, to hasten a
delivery, when the labor was lingering, from half a drachm to a drachm,
and after the effect of this medicine, which ended commonly in leaving
the patient in a worse condition than before the taking it, he
substituted the use of the crotchet, which was indeed an infallible
method of putting a speedy end to the labor; and of which he as well as
his fellow-practitioners made such a murderous use, the aid of the hand
well conducted being unknown to them.
“THE same operator (says Mr. de la Motte) was sent for to assist a lady
who had continued in labour for three days, to whom he proposed a dose
of his powders, to which she readily consented in the hopes of a speedy
delivery. Unluckily, not most certainly for the lady, but for the honor
of the powders, the operator, not having had the providence of having
them about him, was forced to go home for them. The lady, in the mean
while, was brought very happily to bed, just as he was re-entering the
room with his dose for her. What a pity this was! What would not have
been the boast of the virtue of those pretious powders, if the delivery
had waited for them but half a quarter of an hour, though they would not
have had the least share in it, since it would have been purely the work
of Nature and Time.
“THIS celebrated man-midwife was called to two other women of my
acquaintance, of whom the labor somewhat resembled that of this lady,
but of which the consequences were very different: he had made them take
his powders to no manner of purpose, when seeing that a day had passed
without their producing the expected effect, he had recourse to his
_crotchet_, with which he quickly _dispatched_ both the deliveries.”
_Observation_ 174, of the same Mr. De la Motte.
“A GENTLEMAN who lived upon his fortune, without professing surgery,
though he had served his time to it, and had even formerly exercised it,
not only in France, but in Italy, and in other foreign countries, told
me, in conversation, that he had an infallible remedy to make a woman
bring forth instantaneously, however lingering and difficult her labor
might naturally be. Of this, he said, he had made undoubted experiments,
and that he had obtained this secret from an Italian, under oath of not
disclosing it to any one. He was more than a little surprized at finding
me without curiosity to learn from him this pretended secret, which he
imagined must concern me so much, as one who made open prefession of the
obstetrical art; and still greater was his surprize at seeing me change
the subject, without any sign of attention to what he had been saying on
this head.”
“IN process of time, he married, and his wife being pregnant was got
into the time of her labor-pains towards delivery. It became now
expedient for him to declare this famous secret to me, which was no
other than half a drachm of borax in a glass of any innocent liquid
agreeable to the palate of the patient. But as this dose happened to be
administered by one who had no sort of faith in it, it had no effect:
his wife lay four days and four nights in labor; the child died the
moment after it was born, and the mother narrowly escaped following it.”
_Observation_ 176, (of M. De la Motte)
“AS I was at Caën, a town of Normandy, attending the lying-in of a lady
there, an old stander of a practitioner of that place, and a man of good
abilities, told me, that he had been lately sent for to a woman who had
continued several days in labor, with slow and moderate pains. As he
found the fœtus well situated, he made the patient take an infusion of
three drachms of sena in the juice of a Seville orange, in order to
quicken the throws and advance the delivery, which indeed came on ten or
twelve hours afterwards, but the woman died, one may say, immediately
after it.
“TO this account (continues M. De la Motte) I opposed, for answer, that
being at Bayeux, on the like occasion, an old practitioner in surgery of
that place, in conjunction with whom I had been called to visit a
patient, told me, in conversation, that he understood midwifery very
well, that he had even, not long before terminated a delivery given over
by another surgeon; that the child, one arm of which hung out, was dead,
before he put his hand to it, and that the mother, though well
delivered, died soon after.”
THESE examples may suffice to prove, that the notion of giving histeric
medicines, for which the inventors did not forget to make themselves be
well paid, existed in M. De la Motte’s time, who is not but a modern
author: nor are they even to this hour absolutely exploded, tho’ some of
the men-midwives themselves have joined Mr. de la Motte’s cry against
them. It gives however those men-practitioners, who exclaim against a
quackery in others, by which themselves get nothing, a good sort of an
air: it serves even to render that more pernicious quackery of their
instruments the less obnoxious to suspicion. Nothing is easier to give
up than that by which nothing is got. If the instruments were not a plea
for the very essence of such a thing as a man-midwife, they too would be
given up. However, it will hardly be denied, that those same pompous
histeric medicines were the invention of _learned_ men-practitioners,
and not of those poor ignorant midwives, who, with respect to women in
labor, are of opinion, that there can nothing be more effectual for
their well-doing, than in the first place giving Nature fair-play, and,
when requisite, to assist her with the management of _natural_ hands
skilfully conducted: always observing neither to lapse nor precipitate
the critical time of such assistence. In the mean time, let a humane
reader but reflect how many mothers and children must have been, and
perhaps still continue to be the victims of a reliance in such
medicines, and he will allow, that such errors of practice, tho’ not
capital in the intention, are too often deplorably so in the effect. Is
it not true to say, considering the havock of the human species, so
presumably made by quackery and empiricism in general, that the lives of
the subject are less sacred than their property? Surely they are less
guarded, either by the laws, or by common sense.
AS to a fœtus that presents an arm, or any other part than the head or
feet, there is rarely any thing to do but to slide the hand all along
that arm, or other part it may present, to find out the feet, and
terminate the delivery; without its being necessary to attempt the
reduction of any part or member.
MOST of the writers on midwifery often start difficulties where there
are really none. They often give us emphatical accounts of a head too
large, and a passage too narrow, in which they state them as
difficulties that are invincible, when the case is far from being so.
When the fœtus presents fair, and is in a good posture, our method of
practice is, to advise the patient to remain as quiet a-bed as possible,
avoiding every thing that may tend to fatigue her body, or hurry her
spirits, to reserve in short her strength as much as possible. With time
and patience the head of the fœtus scarcely ever fails of moulding
itself to the passage, through a particular providence of Nature, which
has so ordered it, that the parietal bones of the head of the fœtus, so
flexile as to ride over one another, form a kind of oval figure, which
facilitates the issue, and dispose it for making way for itself, through
the extrusive pressure of the labor-throws. Mean while nothing should be
done to irritate the pains; the membranes should not be unnecessarily or
untimely burst, which loses the benefit of the waters. You can hardly,
in this case, rely too much on the benevolent efforts of Nature: she is
constantly at work for the patient’s delivery. Interruptions sometimes
only serve to mar or retard a favorable crisis: but all abrupt force or
violence is carefully to be avoided. As to bad postures of children, I
shall treat of them in the sequel, and of the means to remedy them.
Of DIFFICULT and SEVERE Cases.
IF an easy delivery requires nothing of extraordinary assistence; it is
not so with a difficult one. All the knowledge, experience, dexterity,
strength, prudence, tenderness, charity, and presence of mind, of which
a woman is capable, are requisite to accomplish certain laborious
deliveries.
IT has been, in all times, very well known, that the most natural
situation for the fœtus coming into the world, is that, in which the
head presents first, it being that which commonly makes way for the rest
of the body. Yet this delivery may become difficult, in proportion to
the obstacles incident to it: obstacles not always surmountable, without
great skill and industry employed in aid of Nature.
ON the other hand, when it is felt that the fœtus presents any other
part than the head, this position, called preternatural, oftenest
occasions the delivery to be more laborious and hard to accomplish, in
proportion to the more or less trouble there may be to search and come
rightly at the feet.
MANY English and French authors have given us a long enumeration of the
causes which may make deliveries difficult and laborious. The curious
may have recourse to them; as for me, who have not proposed to myself
here a treatise compleat on all points, I shall content myself with
setting forth only what tends to fullfil my proposed aim, that is to
say, to take notice of those principal points, which first moved
insufficient midwives to call in surgery to their assistence, to remedy
their blunders, to retrieve their mischief, or to repair their
omissions. I shall consider the kinds of exigencies, which the
men-operators seized for a pretext of employing their iron and
steel-instruments, the use of the natural hand, being yet more unknown
to them than to the meanest midwife, and by this means, for the cure of
confessedly a great evil, obtruded an infinitely greater one, and more
extensive, in every sense, and in every point of light, that of men
taking the practical part of midwifery into their own hands, or rather
into their artificial ones of iron and steel, from which they derive all
the authority of their introduction in the character of men-midwives.
THE labors then which are generally speaking looked on the most nice,
and arduous, may be comprized under the following heads.
1st. THE obliquity of the uterus or womb.
2dly. THE extraction of the head of the fœtus severed from the body, and
which shall have remained in the uterus.
3dly. THAT labor in which the head of the fœtus remains hitched in the
passage, the body being intirely come out of the uterus.
4thly. WHEN the head of the fœtus presents itself foremost, but sticks
in the passage.
TO these I shall add the case of the pendulous belly, which is not
without its difficulty.
OF all these classes of labors I shall treat separately. But before I
proceed on them, I presume, that it may not be improper preliminarily to
corroborate what I have said of the intrusion of the men into the
practice of a profession, of the essential part of which they were so
ignorant and disqualified for it, by the testimony which one of the best
men-midwives in Europe has not refused to the truth.
THIS is M. de la Motte, one of the ablest and most intelligent modern
writers on the subject of midwifery, of which his works form an
incontestable proof. The ingenuity and candor with which he has written,
must render him less suspected than any other. This is no midwife. He is
a man, and esteemed an able practitioner, who learned the principles of
the art from Madam la Marche, head-midwife of the Hôtel Dieu at Paris.
He made his advantage of the works of his predecessors Mauriceau, Peu,
and of all the best authors on this subject. All that was worth it in
them he has transfused into his own writings; and that in a very clear
manner. He collected whatever the best physicians had usefully said on
the diseases of mother and child: in short, he has added many good
observations and reflexions of his own, in the journals of his manual
practice: the reading of his works, with some precaution however, cannot
but be useful to the students of the art.
I DO this writer this justice, with the more readiness and pleasure,
for, that though he himself exercised the profession of man-midwife, and
consequently in favor of his own practice, and of the pupils he was
bringing up, was not without the injustice of adopting the prejudices of
his cotemporaries too indiscriminately against the midwives; he does not
suppress any truth relative to the art itself. But even, as to the
midwives, the truth escapes him without any design on his side of its
coming out. But such is the force of truth. And thus it appears. M. De
la Motte wrote in a little sorry country-town at a great distance from
the capital, being at the very extremity of the kingdom of France, on a
sea-coast, where there were no other midwives than poor country-women,
without knowledge, without skill, or any other qualification, than a
little of the habit of attending women in labor. Yet with all these
deficiencies it will appear, that the men-practitioners were far more to
be dreaded than those poor ignorant creatures, who had scarce any thing
but Nature for their guide.
I SHALL here give the substance of what he says in his preface, followed
by some examples of the unskilfulness, or rather of the most profound
ignorance of the most able men-midwives of his time, for forty leagues
round his place of residence in the country.
“IT is (says M. De la Motte) astonishing, that the obstetrical art
should, until the beginning of the preceding age, have been left either
to ignorant women, or to surgeons, who had not (any more than too many
to this day) any other resource in difficult labors, than some
instrument guided by undextrous hands, always sure of killing the child,
and endangering the mother. Do not these poor innocents deserve
compassion for being exposed to operations of surgery, which one would
rationally think they could not need, till providence should have at
least given them leave to come into the world?”
HERE be it observed, that by the word “ignorant,” M. De la Motte should
not intend the application of it to the midwives of the Hôtel Dieu at
Paris, since, by his own confession, it is the best school of midwifery
in Europe. Nor certainly is he in the wrong. Be it in honor of truth
allowed me to say, that I know of those women who have served their
apprenticeship in this hospital, who would think they made a wretched
bargain, if they exchanged the manner of operating they learned there,
for all the Latin, Greek, Arabic, or the iron and steel instruments of
the best man-practitioner in Europe; even though his excellence in the
manual function should be thrown into the scale for make-weight. The
most constant success justifies their practice. In whatever situation
the fœtus has presented, I have seen them, without having recourse to a
man-midwife, and consequently to instruments, procure a happy delivery
in very difficult labors. I have myself seen one deliver a child that
had been dead in the mothers womb for near six weeks, without
dismembering it; and though it was half-putrified, and the head so
rotten-tender as to have no solid consistence, I dare advance this,
without fear of being falsified, since I can name the mother, now alive
in London, the witnesses, the place and year.
SUCH real midwives as I am here discribing, for I do not mean the
spurious nominal ones, only fit to _create_ work for the
instrumentarians, or whose cue of interest is to do so, have no reason
to apprehend, that in the numbers they have lain, there can be any
found, that can complain of having suffered, or of suffering any the
least damage or inconvenience, after their lying-in, that might be
imputed to ignorance or mispractice.
ON the contrary, I dare aver, that such, genuine midwives have cured
many women who had received notable injury, before they came under their
hands, in their having passed through those of the men-practitioners.
Nothing being more agreeable to Nature, to Reason, to Experience, than
that the method of practice of a skilful midwife is not only the most
easy and gentle, the least painful, but assuredly the most safe both for
mother and child. This is what the most severe examination will to
those, who give themselves the trouble of making it, establish, in
contempt of that fashion, by which so pernicious an error, as that of
preferring men-practitioners, has acquired more credit and influence
than so salutary and demonstrable a truth, as that for which I am
contending. In the mean time, let us hear what M. De la Motte himself, a
man-midwife, says of those brethren of his, of whom heaven grant there
may not exist to this day too many resemblers!
“TO the shame (says M. de la Motte) of the profession they exercise,
they have no guide but their avarice, while the grossest ignorance of
the art of midwifery itself is their lot. Such are much to be dreaded by
women in difficult labor; for (adds he) they having no help to offer
them but that of their instruments, they employ them indifferently in
all the situations in which the fœtus presents. Nay, even the hands of
some who will use their hands, are not less dangerous when misconducted.
The ignorant therefore should never meddle with lyings-in. It would save
them from the reproach they may incur of murder, in undertaking what
they cannot execute, and what surpasses their skill. They would not
furnish _scenes_ that make one _shudder_ with _horror_.
“I SPEAK here of so many poor women, whose strength shall have been
exhaust—by a great loss of blood, caused by the violences which an
ignorant man-midwife shall have made them suffer, I speak of women,
whose parts shall have been all bruised, and so vilely treated and torn,
as in some to lay the anus and vagina into one, besides their children
being dismembered, some their arms or legs plucked off, others the whole
body, the head being left behind in the uterus.”
THIS is the language of a man-midwife himself, who candidly declaims
against the errors of his fellow-practitioners, undoubtedly without
designing that such their errors should be wrested into an objection to
the practice of that art being committed to the men. Such a conclusion
would in me be unfair, and a vain attempt to impose on the reader the
laudable condemnation of an abuse, for an indiscriminate reproach to the
whole set of men-midwives. This would however be but a kind of
retaliative treatment of those, who, from the defective practice of the
ignorant and unskilful midwives, of which if there was no more than one
in the world, that one would be much too many, take the unjust handle of
inveighing against midwives in general.
EVEN la Motte himself, who, as I have before with pleasure observed, was
really as capable a man in the profession of midwifery as a man can be,
at least to judge of him by his writings, has embraced every occasion of
boasting the superiority of the men to the women in the exercise of
midwifery. But while he taxes men of _scenes_ that make one _shudder_
with _horror_, the mistakes he imputes to the women, which are bad
enough in all conscience, are not however of that atrocious nature, as
those he relates of the men. Nay, with all his desire of under-rating
the women, he falls into even pitiful contradictions. Let the reader
himself decide on the following one.
UPON an article of practice, for which M. De la Motte blames the
midwives, and what an article? not such as he reproaches to the
men-practitioners, murdering, maiming the women, or tearing their
children limb from limb, but purely for their applying certain bandages
to the belly of women after their lying-in, in order to keep that part
smooth from wrinkles; this very author, I say, who allowed the Hôtel
Dieu at Paris, where the manual function is wholly confined to women, to
be the best school of midwifery in Europe, where he himself wished, and
wished in vain, to be admitted to practise, and, in short, from the
head-midwife, of which Madam de la Marche he himself probably learned
all that was worth any thing in his practice, thus speaks of the
midwives bred up in that hospital.
“THIS prerogative of having served apprentice in the Hôtel Dieu at
Paris, is not for these women, an _indifferent_ matter, for though they
were to have no more than a _shadow_ of _sense_, they are persuaded,
that in setting themselves off with a _title_ that does not render them
more _capable_, they ought to be honored and respected above all others,
which they would not fail of being, if they were to give some marks of
sufficiency beyond what others can give.[28]”
THE nonsense of this objection of Mr. De la Motte is too glaring to need
a comment. If an education in the best school of midwifery in Europe,
does not give a woman a right to plead it for a title to reliance on her
superior sufficiency, without any reason therefore to accuse her of
vanity, what can give her a title?
BUT to return to M. De la Motte’s sentiments on the practice of the
men-midwives; it will easily be seen, that the horrors he objects to
their practice, and of which he himself undoubtedly endeavoured to steer
as clear as he could, were of a nature, without the least breach of
candor, to suppose liable to repetitions wherever so false a doctrine
and practice prevail as the substituting steel and iron-instruments, or
“artificial hands” to natural ones.
LET us now see what Mr. De la Motte thinks of the use of the CROTCHET.
“WHEN I settled in my province (says this author[29]) I found several
ancient master-surgeons, who pretended to help the women in their
difficult, or preternatural labors, solely with the use of the crotchet;
without ever, in their life having made any _delivery_, but in that
manner, and as soon as they had extracted the fœtus with their crotchet,
they left the rest or the after-birth to be brought away by a woman, as
they themselves knew nothing of the matter. When they were fetched to
help a woman in labor, they took their crotchet, went to the woman, whom
they put into posture, and whether the child presented the head, breech,
arm or leg, whether it was dead or alive, a woman’s having passed a day
and a half in labor was cue more than enough for them to go to work with
their crotchet.”
THE following extracts from the same Mr. De la Motte, may serve to
confirm the foregoing observation.
“OBSERVATION 187. I was sent for to lay Madam de ... about fifteen
leagues from Valognes, the place of my residence, and there was at the
same time a surgeon of the town where I then was, who had been fetched
to lay a woman that had been in labor from the day before, whose child
presented the vertex: he, without further examination, put her into a
convenient posture, and with his crotchet brought away the child at
several pulls, with much pain and labor, and threw it under the bed,
with the after-birth, in the most severe season of the year: after
which, the operator hugged himself prodigiously, for having so happily
accomplished so difficult a labor. Having rested a little, and just as
he was going, a woman curious, bethought herself of seeing whether it
was a boy or girl: she found the poor child yet alive, though so mangled
with the crotchet, and that after having remained, in this condition, an
hour and a half, without its having been in the power of so violent an
operation, or of the rigor of the weather to terminate a life which
seemed to have held out against so many barbarities, only to reproach
the detestable operator with the enormity of his crime. The child was
christened and died soon after.
“REFLEXION. This is what may be called a cruel ignorance, &c.”——To the
which I add, that if this wretched operator had had the patience to wait
some time, the child would in all probability have come naturally with
any the least help of the hand at every throw of the mother: for she had
not been over-time in labor, and the head was not, it seems, stuck in
the passage.
“OBSERVATION 196, p. 274. I was desired to go to Cherbourg to lay a poor
woman there, whom a surgeon and a man-midwife by profession, belonging
to that place, had given over.... I found the woman in a condition hard
to describe, with an arm and a leg of her child pulled off, and the
remainder of the body left behind in the mother’s womb. I put her into
posture, and instantly delivered her of one child (it seems she went
with twins) who had only an arm plucked off: I then sought out the
other, whose leg had been torn away. Strange and fatal sight, which was
seen by more than twenty women present, all ready to swear to the truth
of this! I left the woman to their care, after having delivered her of
the after-birth. She had been as much hurt as the children, of whom
nothing remained in the uterus, by the care I took to evacuate it. I
left the mother tolerably well considering her condition.”
REFLEXION. This was the more surprizing, for that the first operator was
an old practitioner, who had been an out-surgeon to the Hôtel Dieu above
eight years, before M. De la Motte was apprentice there. Yet this man
neither was sensible of the being twins in the case, nor had dexterity
enough in the manual function. Here I ask, could the most ignorant
midwife have acquitted herself worse than this _man_?
“OBSERVATION 185. A tradesman’s wife of Valognes being taken in labor
sent for a midwife. A little while after her coming, the membranes
burst, the waters were discharged, and the child presented an arm. The
midwife required help. (Probably she might be one of the ignorant and
unskilful ones) and two surgeons were sent for, who passed for being the
most expert ones in the town. They begun with plucking off the arm that
presented, though the child was _alive_. The other arm, as soon as they
got hold of it, underwent the same fate. After which they struck the
crotchet into a rib, which they brought away, then two, then three, and,
at length, struck the crotchet into the back-bone, and pulled so
cleverly together, that they brought the child away doubled up. The
midwife delivered her of the after-birth, and notwithstanding all this
ill usage, the woman recovered; but it was a long while first.”
REFLEXION. (Mr. De la Motte’s own) “Was there ever a crueller operation
seen both for the mother and child; the first terribly torn, the other
barbarously dismembered?”
“OBSERVATION 186. The wife of a tallow-chandler of this town was taken
in labor: the waters were discharged, after which an arm of the child
presented. Help was sent for; one of the two operators (mentioned in the
foregoing observation) came with his servant and crotchet. He began his
operation, by plucking off the arm of this certainly live child, then,
without further examination, he strikes the crotchet into its body, and
pulled, without being able to bring away any thing. The master, whose
strength was exhausted, made his pupil help him, and they both pulled as
hard as they could: still nothing came, and I verily believe that the
master would have called in some body else to his assistence, if the
handle of the crotchet had been long enough, or that the poor woman had
not given up the ghost under the cruel torments they made her suffer, to
such a degree that they forced her to part with her life, sooner than
with her child.
“REFLEXION. Here was a _delivery_ in intention, but the execution had
something horrid, and perfectly odious in it. I never could have
imagined, that two men could have pulled in this manner, without
dislocating the bones of the woman into whom the crotchet had been
struck: for so it was shown to be, upon the body being opened, in which
the child was found with an arm plucked off, entangled in the umbilical
chord round its neck, without the least mark of the crotchet upon its
body: too plain a proof this of the crotchet having been struck into the
mother and not the child, and consequently of the little circumspection,
not to say rage, with which the surgeon had acted upon the body of this
unhappy creature: for surely it must be granted, that it could be no
part of the child that could have resisted the terrible efforts made
both by master and man, jointly to bring it away; and yet this was one
of the BEST[30] operators in the country for HELPING women in labor.
“I COULD make a VOLUME of these histories, if they were good for any
thing but to excite horror.” Such is the witness born by M. De la Motte,
as to the _ablest_ men-midwives of his time, in all his province. Now in
order to invalidate the conclusion, so natural to be drawn from so
unexceptionable an attestation, against the superiority of the practice
of the men to that of the women, will it be said, that the
men-practitioners, in this country, are in general better educated than
such operators as have been above shown? If so great a falsity should be
advanced, let the reader himself reflect on what he may easily find to
be the common method of training up of men-pupils in this art. I have in
the first part of this work, stated some reasons for their
insufficiency, both in study and practice; and the more this point is
examined, the more clear will that undoubted truth appear, that if the
ignorant midwives are, as they undoubted are, a great evil, they are
even blessings in comparison to the generality of the men-practitioners,
bred up with the help of artificial Dolls, pretty prints, or even of
their personal visitation of those miserable wretches hired, or under
the mask of charity, forced to undergo, from apprentices or pupils, so
many inhuman tortures and outrages in vain.
IT will also perhaps be said, as to the examples I have just produced
from M. De la Motte, that since his time, that is to say, about the
beginning of this century, that the art of midwifery has received so
much improvement, as to cancel all impressions of fear from such
examples. Yes! It has received improvement with a vengeance. If a vain
endeavour to perfect instruments, impossible to be perfected, or against
common sense to suppose, even when perfected superior to skilful hands,
are an improvement, then the art may be called improved. In the mean
time, infinite is the mischief done by so many pretending operators,
with each his bag of hard-ware at hand, his only proof of superiority to
a woman, in practice, confiding in those instruments. Their negative
damage is almost as great as their actual one. For by occasioning the
men, and even ignorant midwives to trust to the calling in their help,
the methods of predisposing of the women to parturition, the proper
precautions, and actual manual function in the labor-pains, which is a
point of the utmost importance, are at best but slightly and
prefunctorily, consequently not sufficiently, performed, or perhaps
wholly neglected. And why? because the instruments, the _crotchet_, the
_tire-tête_, the _forceps_, are considered as sure reserves to remedy
such deficiencies. This, besides many other reasons, encourages the
indolence, carelessness, and inattention of the men-practitioners, and
even of the midwives, especially of those poor suborned creatures
recommended by the men-practitioners, paid, as one may say in some
sense, not to do their work so well, as that none should be left for
their honorable patrons. Thence it has happened, that where an ignorant
midwife has, through her unskilfulness, or for whatever other reason,
been wanting in predisposing the passage, or lapsed the critical moments
of the manual aid, so that she really is or pretends to be out of her
depth, by the exigence being beyond her ability; the man-midwife is
called in, who, with his instruments, forces that delivery, which might,
if justice had been done to the patient, have proceeded in a natural
way, with much less pain and danger. Be this remarked, without my
speaking here of the extraordinary tortures and outrages, such as M. De
la Motte himself has related. The woman then is, by the help of
instruments, delivered by the man-midwife so called in. “If he had but
staid a few minutes longer, both mother and child must have been lost”.
So believes the father of the child, so believes the mother, so believe
most of the parties concerned, and what is more, sometimes so believes
the man-midwife himself. Though the strict truth has been, that the
greatest part of the pain the mother endured, and every appearance of
danger, either to her or to her child, were positively owing to nothing
but the negligence and mispractice used, either by man or
woman-practitioner, in reliance, if matters should come to the worst, on
the supplemental aid or reparation of errors, by those miserable
instruments, which constitute all the boasted improvements of an art,
the true nicety and requisite accuracy of which they are so much more
calculated to banish or destroy.
I HAVE however quoted the foregoing examples from M. De la Motte.
FIRST, Because that he himself being a man-midwife, and greatly partial
to the practice being best in the hands of men, his attestation must be
the less suspicious: but especially, because he was a professed enemy to
instruments, and adhered as closely as Nature would allow him, to the
imitation of those midwives from whom he had received all his
_knowledge_, and abused them afterwards for their _ignorance_, as if
their communication to him of their knowledge could not have been,
without leaving themselves wholly destitute of it to enrich him.
SECONDLY, Because, the stories which he relates upon his own knowledge,
leaving me the fairest room to infer the necessary repetition of the
like tragical wents wherever instruments are admitted, it became less
invidious to specify them, than incidents of the like nature here:
especially, I say here, in London, or in England, where the use of those
instruments grows every day more and more rife, and must consequently
furnish the more examples of pain, destruction and danger caused by them
to the women, weak or prejudice-ridden enough to prefer the men to the
women-practitioners.
BOTH Charity then and Prudence prescribe to me the not pointing out
particular persons to whom I could impute mispractice. If any one will
affect to treat this suppression as not owing thereto, but purely to an
impossibility of specifying cases of that sort, and of proving them; I
appeal to the candid reader, whether the nature of the charge
considered, such a specification can be expected from me, since, from
the examples I have produced, I pretend to infer no more than a
probability, the grounds of which I submit to himself, of the repetition
of the like acts from the same, or even from increasing the same
practice.
IT would not perhaps be otherwise impossible to give some instances. For
example, I could expand a hint before given, of a man-midwife of this
town, who passes for eminent in his profession, and who not above five
years ago, was called to deliver a woman in labor, whose child presented
an arm. This practitioner, instead of searching out for the feet, to
extract this fœtus, that was quite alive, first plucks off one arm, then
another, then, at length, gives over the job, and left the poor mother
in this condition, who was forced to have recourse to a midwife to
finish the delivery.
MORE than one operator, as I have before observed, in very natural
deliveries, instead of bringing away the after-birth, tore out the body
of the uterus; for all their boasted anatomy.
ANOTHER gentleman-midwife delivered a woman of a fine child, or rather
received it, for it came naturally and easily. Upon which, he took it
into his head that he would not deliver her of the after-birth,
proposing to defer this work till next day. And so he would have done,
if he had not casually met with a less senseless practitioner, who
represented to him the danger to which, by so doing, he exposed the poor
patient he had left, and advised him to go back as fast as he could to
deliver her.[31]
I HAVE myself been not a little surprized at hearing lately some ladies
mention, with much approbation, the inimitable complaisance of certain
gentlemen-midwives, who have the patience, as they call it, to wait
five, six, seven hours by the clock, before they deliver of the
after-birth after the issue of the child, and that out of tenderness to
the patients, who, as they say, would be sadly off, if they fell into
hands more quick and expeditious.
BUT while I am thus taking notice of the errors of practice in the
men-practitioners, it may be objected to me, that I deal unfairly with
my reader.
FIRST, In not furnishing instances of male-practice of the midwives.
SECONDLY, That whereas I have confessed the incapacity of some of the
midwives, without allowing inferences from them against all the
professors of the art who are of the female sex, I ought to make the
same equitable allowance as to the men-practitioners, and not condemn
all for the sake of those insufficient ones, which the capable ones
themselves candidly condemn, witness among others, M. De la Motte.
NOW, as to my omitting such a specification of instances of mispractice
in my own sex, it is neither from partiality, nor affectation, that this
omission of mine proceeds. For could any one be so weak as retaliatively
to state cases, in the manner I have done, of mispractice of some
midwives; nothing could be more superfluous, nor less to the purpose. My
confession, my lamentation, that there are but too many ignorant
midwives, palpably obviate the necessity of proving what is granted. The
public would be very little the better for a truth, with which it cannot
but be too well acquainted, that there are ignorant midwives, and
insufficient men-practitioners. The truth then, for which I contend, is,
that the faults of the midwives, however it may be wished that they
could be prevented, are, comparatively speaking, neither so likely to
exist in Nature, nor of that horrid, atrocious kind, that are to be
found in the practice of the men-practitioners or instrumentarians.
There is nothing among the midwives of the puncturing, tearing with cold
pinchers, maiming, mangling, pulling limb from limb, disabling, as must
be inseparable in a greater or less degree from the use of those iron
and steel-instruments, which are so often and so unnecessarily employed.
AS to the second objection, of my not making any distinction of the
capable from the incapable men-practitioners. The reason of that is
obvious. It results from the fairest comparison of the two sexes, in
respect to midwifery, independent of any such examples as have been
produced against any particular individuals of that profession in the
men. Nature has so favored the midwives, that among them the bad ones
are evidently an exception to the general rule, of the fitness of that
sex for the art: whereas among men, the bad practitioners are, and must
for ever be, the general rule, and the good ones the exception, if so it
is, that, in Nature, there can be such an exception: he that makes a
practice of using instruments can hardly be one.
NOTHING however will more conduce to establish the natural
disqualification of the men for this art, than a fair consideration of
that capitally essential branch of it, the ART of TOUCHING, in order to
ascertain the state of pregnant women, and the difficulties so necessary
to be foreknown in order to be lessened or avoided. On due prevention
often depends the saving the life of both mother and child; it cannot
then be thought a digression, that I transiently give a summary account
of this great light or guidance to that prevention, even though this
work is nothing of a regular treatise of the art.
Of TOUCHING.
CONDUCIVELY to a just idea of touching, there should be a just
foundation laid of a competent knowledge of the fabric of the sexual
parts, of the conformation of the _pelvis_, and of the bones which
constitute it. There requires no depth of anatomy to know, in general,
that the _pelvis_ is composed of that part of the back-bone called the
_os sacrum_, terminated at the bottom by the _coccyx_, of the _ilia_,
and the _os pubis_. In the cavity formed by the assemblage of these
bones is the _uterus_, suspended between the bladder and the _intestinum
rectum_, by four ligaments called broad and round. The two broad ones
are a production of the _peritonæum_, on the side of the _vertebræ_, and
terminate on each side of the uterus near the fallopian tubes. The round
issue on the side of the _fundus uteri_, immediately under the tubes,
and from thence passing through the _peritonæum_, and crossing the
muscles of the hypogastrium, are inserted at the pubis and common
membrane or integument of the fore-part of the thighs. I pretend here
nothing further, than to give a summary sketch of these parts, a more
particularized one being here needless. Suffize it to observe, that no
good midwife can be without a proper and distinct conception of their
position and conformation, not only for touching, but for operating with
success.
TOUCHING, in the terms of art, consists in the introduction of one or
two fingers into the vagina, and thereby into the orifice of the uterus
of the person, whose state or situation requires to be known. There
scarcely needs admonishing on this occasion, a midwife, of the due care
of her hands, being properly prepared and guarded from the least danger
of hurting. Such a precaution recommends itself.
THE touch then is the most nice and essential point of the art of
midwifery. Nor to acquire a sufficient degree of accuracy in it, can
there be too much pains taken, considering how much depends on it.
Midwives only of great practice, or lying-in hospitals, where there is
full liberty for the young female practitioners to make observations,
can render it familiar to the learner. I presume I may take for granted,
that such a practical study is not extremely decent, nor proper for
young lads. And yet, at their season of life it is, that this study
should be begun, if but to give expertness the necessary time to attain,
through habit, its full growth, against the age of exercising the manual
function. It must surely be rather too late, for a man to commence his
course of touching at the age of practising; as it must be too soon, at
a season of life, where his capital end of _touching_ will probably not
be the acquisition of the science. At whose expence then must the
rudiments of a man’s study of this branch of the art be? surely at that
of the unfortunate women, subjected to the annoyance of such nauseous
and profitless visitation. In short, this is ONE of the points of the
art, from the nature of which it may fairly, and without implication of
contradiction, be pronounced, that the greatest anatomist in Europe may
nevertheless be a very indifferent, not to say a miserable man-midwife:
or even that a very indifferent anatomist may for all that be an
excellent manual practitioner.
A MIDWIFE, duly qualified by Nature and art, with a shreudness and
delicacy of the touch, is, when requisite, capable of giving, in virtue
thereof, a just account of a woman’s condition. She is enabled to make
faithful reports to the physician, and inform him of the needful
concerning the state of his patient, where any co-incidence of pregnancy
sollicits his attention. By the same means she can distinguish the true
labor-pains from the false ones; and when the term of delivery is at
hand, it may, by the touch, be discerned, whether the labor will be easy
or hard, whether the fœtus is well or ill situated. With other
precognitions, highly necessary for our taking proper measures both
obviative and actual.
I SAY necessary, because it is from this practice of touching that we
draw our prognostics, both for the predisposition of the passage, in
order to save pain by proper anticipation, and to smooth or facilitate a
happy delivery. It is then the touch that serves us for a guide, and
certifies to us the situation of the uterus, its rectitude or its
obliquity, as well as what part the fœtus presents.
IT is in short by the information we receive from the touch, that we are
enabled in good time to remedy, or at least to lessen all the obstacles:
so that by the very same means, by which we obviate any necessity of
recourse to instruments, we at the same time alleviate the pains and
sufferings of the party: which one would think no inconsiderable
advantage of the female over the male practice, which last is so
constitutionally more rough and more violent.
SUCH is the capital importance of the TOUCH, undeniable, I presume even
by the men-practitioners. But will any of the hemidwives then, with
those special delicate soft hands of theirs, and their long taper pretty
fingers, pretend to vye with the women in the exquisite sense or faculty
of the touch, with which Nature herself has so palpably endowed and
qualified them for the necessary shreudness of discernment, that in them
it can scarcely be deemed an acquisition of art? If the encroachments
however of the male-practitioners proceed, under color of their vast
superiority, I should not be surprized at seeing, ere long, a grave set
of grey-bearded gentlemen-midwives impannelled in lieu of a jury of
matrons, on a female convict pleading her belly. What can hinder the
redress of such a grievance, as the law has authorized for so many ages,
but the object not being one of a pecuniary enough interest to tempt the
men to interfere in it? they would be in the wrong however not to apply
for the office, since it would not be one of the least innocent
occasions for them to improve their hand in the mistery of _touching_.
BUT let them pretend what they will, so great is the advantage, so
liberal of her gift has Nature been to women, in that aptitude of
theirs, which may be termed a knack of touching, that the hand of a true
midwife will, at the deriving of indications from the report of its
touch, beat the most scientific head of a man-practitioner, though
stuffed never so full with Greek and Latin. Yes, an ignorant midwife,
without perhaps anatomy enough to know where the _pineal gland_ is, or
without so much as having heard the name of the _ossa innominata_, and
with purely her expertness, and with that sort of knowledge she has at
her fingers ends, will give you a more useful and practical account of
matters, as they go, where it is sometimes so infinitely important to
know how they go, than the most learned anatomist that ever dissected a
corpse, brandished a forceps, stuck a crotchet into a child’s brain-pan,
or tore open a living woman.
UPON this point of touching there occurs a consideration, on which I
have before just transiently touched, and beg leave, for the sake of its
importance, to give it some expansion.
IN my objection to a man’s practising this branch of art, TOUCHING, I
wave here the natural repugnance all the parties must have to it, even
the man-midwife himself, on any footing but of that of interest,
allowing an exclusion of any libertine design, I wave especially the
argument against it, from its being a kind of invasion of a husband’s
incommunicable prerogative; I even wave the breach of modesty, I suppose
all this to be answered by the plea of superior safety, however false
and imaginary that plea may be. But surely it will be allowed me to pity
the unfortunate condition of a woman, subjected to so disagreeable a
visitation; a visitation which, instead of being performed in the
gentle, congenial, and especially, as to the end, satisfactory manner,
of which the women alone are capable, must furnish a scene, not only
unprofitable, disgustfully coarse, and even ridiculous, but also most
probably a very painful one. Figure to yourself that respectable
personage a He-midwife, quite as grave and solemn as you please, with a
look composed to all that “DELICACY _of_ DECORUM,” recommended by Dr.
Smellie, and so suitable to the high DIGNITY of the _office_ he is
undertaking of _touching_ the unhappy woman, subjected to his
pretentions of useful discovery by it. What must not parts, which
dispute exquisiteness of sensibility with the eye itself, suffer from
hands, naturally none of the softest, and perhaps callous with handling
iron and steel instruments, from some hands, in short, scarce less hard
than the instruments themselves, boisterously grabbling and rummaging
for such nice indications, as their want of fineness in the touch must
for ever refuse them? what if they may possibly, by such coarse
_touching_, find some common, obvious signs presenting themselves, so
that the grossest touch cannot escape distinguishing them; does it
therefore follow, that the nicer points on which so much may depend for
preparatory disposal, will not escape hands, scarce not less
disqualified for the necessary discernment, than a midwife’s if she had
gloves on? in the mean while, what torture must not the poor woman
endure, in every sense, from the wounds of modesty, and even of her
person? and for what? that the doctor may, with a significant nod, or
silent shrug, give himself the false air of being satisfied about what
he was pretending to look for; or, if he speaks, come off with some
jargon, only the more respectfully received by the patient, for its
neither being common sense, nor intelligible to her; or perhaps, if he
has any by-ends in view, or is a man of gallantry, here is a fine
occasion for his placing a compliment. But for any essential advantage
to her, from such a quackery of painful perquisition, she need not
expect it. The infinitely important service of predisposing the
passages, and of obviating difficulties, to be only ascertained by that
faculty of touching, is palpably and peculiarly appropriated by Nature
to the women only; and it is from them alone that a woman must,
naturally and truly speaking, be the least shocked at receiving such
service. Whereas in being _touched_ by a man, besides, I once more say,
besides the revoltingness of Nature, and the protest of female modesty
against it, besides the pain inseparable from it, besides even its
insufficiency; the safety of the woman is destroyed to the very
foundations, by the negation of due foreknowledge and proper disposal,
against the actual crisis of danger or the real labor-pains, the
mitigation of which, and facilitating the delivery, depend so much on
the _accuracy_ of the _touch_.
WHOEVER then will but consider that greater aptitude of organization in
the women for fineness of that sense of touching, will allow, that I beg
no question, when I aver, proverbially, but truly speaking, that if one
hundred points of qualification were requisite to constitute this
capital faculty of TOUCHING, a midwife already possesses, in the but
being a woman, ninety-nine of them, the sure and certain gift of Nature:
and the remaining one from Art, may with great ease, with a little
instruction and experience, be acquired. Whereas, the He-midwife, not
only, as not being a woman, wants the whole ninety-nine, but can never
receive the hundredth at the hands of Art, but in so imperfect a degree,
that his trusting it will make it worse to the unfortunate woman that
shall trust him, than if he was wholly without it. I might perhaps, not
without reason, extend this allegation of the superiority of the female
sex over the male in this point, and in the same proportion, to the
whole of the manual function, but that I am more afraid of exagerating,
than even of falling short of the truth.
SURELY then, one might imagine, that the parties principally concerned
in liquidating this difference for the government of their decision, on
a point of such capital importance, would not do amiss to consider it,
before they suffer themselves to be imposed upon in the manner they are
by the men-pretenders to a purely female office. An imposition so very
gross, that instead of answering the end of those on whom it passes,
that of greater safety, only encreases the dreaded danger. And most
assuredly, the women who subject themselves to it, do so, if with no
scandal to their modesty at least to their understanding; for being sunk
to so low a degree of cheapness, as even to purchase, with a sort of
prostitution, innocent let it be, it is still a prostitution, after
which money is a consideration beneath mention, and to purchase what?
danger to their own life, danger to that of the pretious burthen within
them, and, at the very least, an increase of bodily pain to themselves.
MR. De la Motte, in his 188th OBSERVATION, p. 265, _Leyden ed._ makes an
animadversion upon a midwife’s _touching_ a patient, which, unless he
was induced to it by that spirit of injustice to midwives in general,
against which injustice all his usual candor is sometimes not proof,
would persuade me, that he was more ignorant of the nature and ends of
_touching_, than what his works show him to have been in other parts of
the profession.
IN that OBSERVATION he gives you the case of a woman in labor, to whom
he was called, whose membranes a midwife had prematurely broke, whom she
had actually over-fatigued with making her too often shift her posture,
and also with incessant and reiterated TOUCHINGS (_attouchemens qu’elle
reïteroit sans relâche_) and all this, from a principle of avarice, in
order to make the quicker riddance, for the sake of attending a richer
patient, where she expected greater gain; “as if (says Mr. De la Motte,
in words that ought to be engraved in every practitioners heart) a poor
woman was more to be neglected than a wealthy one, in the presence of a
God who judges all our actions.”
FOR my quoting this case, especially as it regards the point of TOUCHING
now under discussion, my reason, from the considerations to which it
will give rise in the reader’s own mind, will probably appear so
satisfactory to him, that he will easily absolve me of any charge of
digression.
AS to the midwife’s bringing on the premature discharge of the waters,
if the fact was true: it was very blameable practice. It is a practice
that all capable midwives reprove and forbid, as it is robbing the part
of the most natural and necessary lubrication for facilitating the
launch in due time of the fœtus. I have been assured, with what truth I
cannot well warrant, that the men-practitioners are commonly much too
precipitate in the breaking of the membranes. Be the practitioners then
of what sex they may, such practice is bad.
BUT, as to the motive M. De la Motte attributes to the midwife, of
avarice for such a procedure, I should heartily join with him in
condemning her, if the mention he makes of the REITERATED TOUCHINGS did
not make me suspect not his sincerity but his knowledge. If the poor
midwife had been to write the case, I have the charity to think she
could, with truth, have given a better reason for her practice than a
suggestion of avarice. At the worst, however, so criminal a spring of
action in such a conjuncture, could only be personal to herself, not
affect the midwives in general. Mr. De la Motte himself would own this,
who, as the reader may see p. 286, does not spare the men-practitioners
on this head, without meaning, that he or his fraternity should be
involved in any sinister inference from thence. And, indeed, I should
have a right to laugh at men-practitioners reproaching the midwives with
interestedness. I fancy I can have few readers so ignorant, as not to
know by which of the two sexes the greater fees are expected; which sex,
in short, looks the most out of humor, when those same fees do not
amount to the practitioner’s idea of the DECORUM of his “DIGNITY.”
BUT let that pass. I come now to the great point of the TOUCHINGS
complained of by M. De la Motte, and I sincerely believe unjustly
complained of. My cause of such belief is this: I am well grounded in my
averring, that in many labors much depends on the rectification of
things, (this will be hereafter more at large explained) by the act of
touching, not only reiterated, but sometimes even not to be discontinued
for hours together. And these _touchings_ are so far from fatiguing, or
vexing the patient, that they often prove her greatest relief from pain,
and even preservation from danger, by the facilitation they procure to
the issue of the fœtus, that is to say, if they are skilfully managed.
I HAVE myself known women in pain, and even before their labor-pains
came on, find, or imagine they found, a mitigation of their complaints,
by the simple application of the midwife’s hand; gently chasing or
stroaking them: a mitigation which, I presume, they would have been
ashamed to ask, if they had been weak enough to expect it, from the
delicate fist of a great-horse-godmother of a he-midwife, however
softened his figure might be by his pocket-night-gown being of flowered
callico, or his cap of office tied with pink and silver ribbons; for I
presume he would scarce, against Dr. Smellie’s express authority, go
about a function of this nature in a full-suit, and a tie-wig.
I AM also the more ready to believe, that these same _touchings_, with
which M. De la Motte, finds fault had in this case been really of
service, since he confesses, he found the child “_well situated, and_
FAR ADVANCED _in the passage_”; and withal offers no reason to think,
but that it was so _far advanced_ from the _touchings_, not in spite of
the _touchings_.
WE shall now see what followed. Mr. De la Motte, that despiser of
midwives; Mr. De la Motte, who so consistently regretted his not being
admitted to the Hôtel Dieu at Paris, and accuses the women, educated at
that Hospital, of vanity, for valuing themselves on that education,
behaved himself on this occasion, as indeed his merit was that on most
occasions he did so, like a true good midwife: he found things _far
advanced_ enough, for him to leave the rest very wisely to Nature, and
so he did. The consequence of which was, that the patient was soon
delivered of a fine boy, and both mother and child did well.
SUCH was the result of Mr. De la Motte’s true midwifely proceeding. But
what would an instrumentarian have probably done? One of those, I say,
who, as to all the boasted improvement of the obstetrical art, produce
the stupendous inventions of those surely rather weapons of death, than
of life, which Dr. Smellie calls his REINFORCEMENTS, and is so good as
“_principally_” to recommend, “_namely the small forceps, blunt hook,
scissors, and curve crotchets_”, the unenviable privilege of using which
blessed substitutes to the soft fingers of women, being supposed
inherent to the men by right of superiority of skill, has so greatly
IMPROVED the art of midwifery, and thinned the number of good midwives,
by exploding their so much less painful, and certainly more safe method
of practice, both for mother and child? For after all, what can such
instruments be expected to do, but, instead of improving the art, to
multiply murders? if this should appear too severe, hear what Mr. De la
Motte himself says to the very case in point: to this very case, in
which himself, I repeat it, did no more than play the part of the good
midwife, and was only the more commendable for doing so.
“IF the operator of the place had been called, he would DOUBTLESS have
proceeded in this delivery, as he had done in the other (see p. 292.)
that is to say, he would have _quickly_ dispatched it with his
_crotchet_: but on the contrary, if he had had any experience, he would
have conducted the other delivery as I did this, and thereby have
exempted himself from the reproach he must have made to himself, for
having killed a poor woman in the most _cruel_ manner.”
HAPPY! thrice happy it is for the midwives, that, at least, if avarice
should tempt any of them to the injustice of hurrying a poor patient’s
delivery, in order to attend a rich one; a circumstance which, I fancy
however, does not more often occur to the female than to the
male-practitioners; the woman cannot, at least, use towards
precipitating such deliveries means so violent as the men. They appear
only in guise of peaceable simple seconds to Nature: the men take the
field, armed as combatants against her. The women can but prematurate
things by excitation of the hand; they may be guilty of reprehensible
negligence, they may be over curious in their bandages, by way of
smoothing wrinkles after delivery; in short, they may commit many
faults, which I am far from justifying, or even extenuating; but at the
very worst, I defy them to equal the instrumentarians in mischief; nor
can their practice abound with those horrors, of which a man-midwife
tells us he could furnish VOLUMES (p. 298.) horrors which must be so
greatly multiplied since his time, as the recourse to instruments is
more than ever pursued, in practice, though so fallaciously disowned in
the theory; under which disavowal the gentlemen midwives figuratively
conceal their bag of hard-ware, just as Dr. Smellie directs them
literally to do in their visits to patients.
BUT to resume the subject of TOUCHING, I am to observe, that among its
essential services on many occasions, both during the pregnancy, and in
the actual labor-pains, there is one case, which, for its frequency and
importance, deserves a separate consideration: it is that of the
obliquity of the uterus, of which touching not only serves to inform,
but to rectify it. I shall therefore dedicate a section to the treating
of it.
Of the OBLIQUITY of the UTERUS.
BY the obliquity of the uterus I mean its untoward situation. For either
the uterus preserves its natural direction, or does not preserve it.
Where the uterus preserves it, I call it well placed: the point of it is
turned directly to the cavity of the pelvis, and the _fundus uteri_ is
suspended in the space between the umbilical region and the vertebræ: if
the uterus does not preserve its natural direction, if it inclines too
much forwards, backwards, or towards either the right or the left side,
I call it oblique, or untowardly placed. All the other situations of the
uterus are reducible to these four, from which they differ no otherwise
than as its line that should naturally be perpendicular to that of the
vagina deviates more or less from it towards any of them. It is from
this obliquity, greater or less, that proceeds, by much the most often,
the greater or the less difficulty of the lyings-in.
IT would be superfluous here to analise all the causes of such
obliquity, because, being mostly natural ones, there is no preventing
them. But there are some causes of it, or at least, that appear to me to
be sometimes the causes of it, that it cannot be improper for me to
premise here, for precaution-sake.
I HAVE then some reason to think, that both here and in Holland the
stays contribute much to the obliquity of the uterus. For though women,
during their pregnancy, may perhaps wear them looser than at other
times; yet their natural hardness pressing on the belly, with the stiff
whalebones, always too many if there are any at all, cramp the fœtus and
the womb, to which the stays too often give a bad situation, according
to their motion or swagging more to one side than to the other, in their
state of looseness; and if they were laced tighter, that would be yet
more dangerous.
I COULD wish then, that women with child would either content themselves
with wearing a bodice only, or stays without any whalebone, but at the
back just to serve the loins, and even those not to come so low down as
I have seen some. The obliquity of the uterus is much rarer in France
than it is here, for which I cannot account otherwise, than from the
women there avoiding any prejudice from their stays, during their
pregnancy. There is another cause, as I apprehend it, of the lateral
byass, which is the lying too constantly on either side, whence the
uterus contracts a habit of inclination to that side. The probability of
such an effect I submit to the anatomists, as I speak here only
conjecturally, and not with the presumption of certainty.
THE obliquity of the uterus may be discerned from the difficulty there
will be, in touching, to come at its orifice. And it is by touching
alone that you can hope to discover which way its deviation points,
whether it is placed too high towards the _os pubis_, too much turned
towards the curve of the vertebræ, or in a lateral direction, towards
either the right or left _ilion_. But which ever way that mis-direction
points, the difficulty of the delivery is proportionable to the degree
of it: and the skill and knowledge of the midwife in not only the
reduction, but the keeping of the uterus to its due position, till the
delivery is accomplished, form one of those principal branches of the
art, for which the gentlemen-midwives must be naturally so unfit.
THERE are very few authors who have treated of this obliquity of the
uterus. Some do not mention it at all, others speak of it, but so
slightly as to escape attention.
DR. Smellie in his enumeration of the cases, by which laborious labors
are occasioned, which he ranges under seven heads, has intirely omitted
this case of obliquity. He has bestowed indeed a whole chapter on the
distortion of the pelvis, a case I take to be comparatively infinitely
rarer than an obliquity of the uterus. He might as well suppose a
frequent vitious conformation of the cheek-bones, as of those that form
the pelvis: which, were it so, must necessarily imply a constant
recurrence of hard labors in the same woman, which is not often the
case. Whereas the liableness of the uterus to an obliquity from various
accidents, principally accounts for the easiness of one labor in a
woman, being no argument for her not having a hard one in future, or
convertibly. I dare aver then, that in the course of my practice, which
is not the least extensive one, this very case of obliquity has occurred
to me oftener than all the others put together, and indeed caused me the
most pain to remedy or conquer. Why then such an omission by these
writers? I cannot conceive, unless that they were aware of the
consequence, obvious to be drawn from thence, that women, by the
superior fitness of their hands, must be the properest to apply the
topical remedy; and that their iron and steel instruments could not so
well be set to work in such a case, at least in due time. This is
absolutely so true, that in the case of this very obliquity, which
occasions most of the very lingering labors, for which the midwives, who
have not preventively exerted themselves to reduce it, and thereby to
clear the passage for the fœtus, have no remedy but patience; those very
lingering labors, I say, which shall have thus arisen from the want of
skill or prevention, furnish the men-practitioners with a pretence to
dispatch them with their instruments. Thus they, often murderously for
the child, and injuriously to the mother, terminate many a delivery,
which a gentle and constant reduction of the uterus would have so much
more safely and less painfully accomplished. And how accomplished?
evidently not by any violence to Nature, but purely by redressing the
wrong she is in, oftenest not by her own fault, but by some adventitious
cause, in which she has been rather a passive sufferer than originally
herself deficient. A justice this of distinction too often refused her,
and from which too many errors of practice arise, perhaps in more cases
than this.
HOWEVER, this is certain, that this case of the obliquity of the uterus
deserves much more notice and attention than have been paid to it. It is
one of the most important difficulties of the art.
HE who treats the most at large of this matter is Daventer, who, I have
strong reasons for believing, first took the hint from some midwife: but
a hint, which the usual imperfection of the manual function in men
hindered him from duly improving. For in the way he sets forth the
different inclinations of the uterus, and the methods of rectifying
them, instead of throwing a practical light upon the subject, he has
obscured it with errors, absurdities, and repetitions without number or
excuse.
BUT that I may not appear to treat this author dogmatically, and
especially as he furnishes me with an occasion of further elucidating a
point of such great importance to the art of which I am treating, I must
here intreat the attention of those readers, especially who deign to
peruse me rather in the search of useful truth, than of amusement, of
which indeed so serious a matter is so little susceptible.
LET us then examine some of Daventer’s methods of practice, so
inconsequential to so just a theory as that of the mis-direction
incident to the uterus.
DAVENTER, chap. xlvi. p. 288, French edition, treating of the
rectification of an obliquity of the uterus fallen forwards, goes on
thus. “When the membrane is broke, and the vertex of the head partly
come forth, there is no longer occasion to support, as before, the
orifice of the uterus. It should be let fall with the head beyond the
curvature of the os sacrum. The head will make its way much more easily
than if it was still wrapped up in the uterus (_indeed!_) Now to make
the fœtus come forth, the midwife must, as she did at the beginning,
employ both her hands; the one internally applied, the other externally;
but take care so to do judiciously. Neither must she wait till the
labor-pains are over, before she sets her hands to work, as I have just
before observed. On the contrary, it is in the time of the throws that
she must operate, and when they are on the decline, terminate the
delivery. The midwife therefore should not barely content herself with
watching the time of the pains, but should also admonish, at every one
of them, her patient to second them with all her strength, in order that
the child may advance the more under their stronger protrusion. During
which, the midwife having her hand in the vagina, the back turned
towards the rectum is to advance the tip of her fingers, the most she
can, under the head of the child, taking care however not to overpress
them; and in this posture, she is to keep her hands unmoveable, till she
feels the labor-pains come on. The other hand she is to put on the
hypogastrium, nearly over the place answering to the _fundus uteri_; and
when the pains shall begin, she is to give her hands such action, that
that which is in the vagina shall push back the coccyx, and the other
applied externally shall push up gently the _fundus uteri_, and at the
same time determine its orifice towards the pelvis. I say gently. But
this is to be understood of the beginning of the throws, for in
proportion as they increase, the midwife must press the harder.
“CARE must, in the mean time, be taken, that the pression made on the
belly must not be too violent but _very_ moderate: whereas that made on
the coccyx must be with the midwife’s whole strength, with this
attention however, _first_, that this great effort must not be made but
when the force of the throws obliges the woman strongly to contract the
muscles of the hypogastrium, and must cease with those throws.
_Secondly_, that the hand must be laid flat on the coccyx, not with the
fingers half-bent, least the joints should hurt the woman. _Thirdly_,
that the hand may be as much expanded as possible, that the pression may
be equal on all parts. Observing these three conditions, the midwife may
employ her _whole_ strength, without _fear_ of doing any harm to the
woman. On the contrary, she will greatly relieve her.”
TO the which I have to say, that I should greatly pity a woman that
should fall under the hands of a woman that should receive such
directions from Monsieur l’Accoucheur, and much more yet, if she was to
be under his. A midwife to operate thus! with one hand in and the other
out, over the lower part of the belly, “gently” says Daventer, and yet
stronger in proportion as the throws increase: and a little after he
says, this pression on the belly must not be too violent, but _very_
moderate. I confess, I do not understand, but that may be my fault, how
a pression can be stronger and stronger as the pains increase, without
ceasing to be gentle or very moderate.
BESIDES; as to the pression of the midwife’s hand on the coccyx of the
patient, so violent as he advises it, with the whole strength of the
midwife, can this be executed without causing to the vagina or rectum a
contusion, very capable of bringing on a gangrene, of causing a
mortification, or, in short, the laceration of the frænum labiorum,
whatever he may say to the contrary?
I OBSERVE, by the way, that in this very chapter Daventer supposes the
heads of children breaking themselves, sometimes against the os pubis,
or the vertebræ, as if these were bare bones, at least he is to me, in
these points, unintelligible.
HE goes on to object, that if, through ignorance, Nature has been so far
left to herself, that the point of the uterus should be fallen into the
pelvis, that its orifice, and the head of the child, should be fallen
into the lower curve of the _os sacrum_, that the membrane should be
broke, and the child’s head a little discovered, and withal, the woman’s
strength much exhausted,
“TO change, (says Daventer) this situation, thus you must proceed. The
woman must rest upon her knees and elbows, with her head low. And what
(adds he) determines the placing a woman in this posture, is, that the
weight of the uterus may impel it to the side of the diaphragma, and
consequently withdraw it from the sinuosity of the coccyx.”
TO me it appears impossible, that a woman, whose strength shall have
been exhausted, or but much diminished, can put herself into such a
posture, which could only serve to make her lose any little strength she
might have left.
AT the end of the said chap. xlvi. Daventer concludes in the following
terms.
“HOWEVER, to say the truth, of whatever kind the obliquity of the uterus
may be, I hold, that the safest, the easiest, and the least painful
expedient, is the footling-extraction of the child, from the very
beginning of the labor, before or immediately after the discharge of the
waters, as soon as one can be assured that the pains the woman feels are
the labor-pains. If this method should be followed, which I hope (adds
he) it will one day be, it would preserve an incredible number of women
and children, the unhappy victims of a contrary practice.”
HERE I must confess the shallowness of my understanding. Such a
reasoning as Daventer’s in this case passes my conception. He allows,
that in all the obliquities of the uterus, it is extremely difficult to
find the orifice, to come at it, and to introduce the fingers into it:
nay, he owns, that it is not without a great deal of trouble, that you
can get to touch but the surface of that orifice; and after that
confession, he tells you very gravely that, in such cases, you must
deliver the child by the feet, in the very beginning of the labor,
before even the discharge of the waters, or at least soon after.
OUGHT then the translator of Daventer, who is at the same time his
apologist, in good conscience, boast so much the discoveries of this
author upon the obliquity of the uterus? is it possible for common sense
to give the approbation that he does to those easiest, safest, and least
painful methods, that he recommends for relieving the mother and child
in those cases of obliquity?
I AM then too much prepared to be surprized, in the chapter following
that from which I have quoted, to find him, where treating of an uterus
too much inclined towards the vertebræ, not scruple to reason as
follows.
“BUT if the child is too much compressed, or has a head over large, so
that it is not without much difficulty to the midwife, and pain to the
woman, that it can be hoped to bring the child into the pelvis, a state
of things which does not unseldom happen, I judge that, to prevent the
danger, the best method is the footling-extraction. But (adds our author
by way of reflexion) this work is more _befitting_ a _man_ than a
_woman_, unless she has a _quick_ judgment, and an _alert_ hand: a
man-midwife should therefore be called (_Doubtless!_) and he must lay
his account with having work enough, for it is not without a great deal
of trouble and difficulty, that he will accomplish the turning the
child, and that for _three_ reasons.
“THE FIRST. Commonly, the orifice of the uterus in this situation is but
little open: it must be _violently_ dilated, that is to say, in
_forcing_ Nature, or _doing violence_ to her. Yet this must be done
slowly, for too much precipitation would cause to the woman _very acute
pains_. (_To be sure, a slow violence would not hurt her._)
“REASON the SECOND. It is not more easy to penetrate to the bottom of
the uterus, of which the orifice already, narrow as it must be, is
moreover occupied by the head of the child, than to open the orifice. No
wonder then, that so much trouble and patience should be required to get
at the child’s feet.
“THIRDLY, It will be found, that the distance there is between the
orifice of the vagina to the bottom of the uterus, must render the
_man-midwife’s_ work so much the more difficult for the sinuosity of it,
and his being forced to operate in a part so narrow and close, and in
which the hand is much cramped for room. It is obvious to sense, that a
place so oblique and streight must deny the liberty of passage.”
THE advice which Daventer gives here of extracting the child by the feet
in the case he supposes, and, for that purpose, violently to dilate the
orifice of the uterus, appears to my weak mind such mad, such frantic
doctrine, as to be beneath refutation. The bare recital of his own
reasons, and of the difficulties there are to surmount, which he himself
confesses, abundantly demonstrate the impossibility and absurdity of the
method he proposes.
BUT after taking the liberty of dissenting from that celebrated
man-midwife in cases of obliquity, as to the practical part, which I
take indeed to be his _own_ discovery, it is but just I should offer
what I conceive to be the true midwife’s practice, for terminating
happily the labor of a woman in the case of obliquity of the uterus:
submitting the same to better judgment.
ALL the deflexions or byasses of the uterus, whatever they are, are to
be known by the touch. An expert and knowing hand will never fail of
ascertaining the discovery of them. I say, an expert and knowing hand,
for without an exact knowledge of the figure of the whole pelvis, the
situation of the bladder, of the rectum, the vagina, and the uterus,
before and after pregnancy, the situation of the orifice with respect to
the pelvis, there is no distinguishing for example, an over-elevated
orifice from one too low, nor a direct from an oblique one. In vain
would one conceive clearly what those terms signify, or have some
knowledge of the distinctive parts of the female sex, without one has at
the same time sufficient experience, and fineness of sense in the
touching part. Without these qualifications there is no proceeding but
darkling, and in danger of deception.
THE orifice of the uterus is always diametrically opposite to the fundus
of it. When then you know what the situation of the orifice of the
uterus is, when in its due place, you may, if well versed in _touching_,
calculate any aberration from the right line, and by the situation of
the orifice giving that of the fundus, know how the rest is disposed.
WHEN, by _touching_, I perceive, there is an obliquity of the uterus in
the case, in the proper time, I desire the patient to lay on her back,
and introducing my finger, endeavour to come at the orifice of the
uterus. Upon getting hold of it, I support it so long as the labor-throw
continues, and I take care the child should not engage itself too much.
I AM obliged, with my hand, continually to repeat this service; and
after resting a little from the fatigue, whenever I can snatch a moment
safely for such relaxation, I re-introduce my finger, as before, in
order to prevent the pains, and hinder the orifice from falling, that is
to say, from sinking, so as to turn too much backwards, or from rising
too high, or, in short, from deviating towards the right or the left,
according to the circumstances or kinds of inclination that may present
themselves. I also take great care, that the child may not engage itself
too far under the os pubis. I do not discontinue these cares, these
attentions, until, whatever assiduity, length of time, or trouble it may
cost me, I shall have arrived at rectifying the wrong direction, by thus
constantly supporting the internal orifice, till, in short, I have
brought it, little by little, to turn and come directly on a line with
the external orifice. By this management of the hand, I procure the
child a fair opening, and its falling forward, without being wrapped up
or embarrassed in the uterus.
AND yet, in certain cases of obliquity I sometimes find so great an
inversion of order, such an intanglement, that the child presents itself
in the vagina with the body of the uterus covering it wholly, and by its
volume totally impeding the coming at the orifice.
I HAVE before observed, that I required my patients, in these cases, to
lye upon their backs, and this, because, if they set up straight, the
uterus would overset, and render the obstacle, if not invincible, at
least, much more hard to remove.
HOWEVER, both to ease my patients, and to prevent the child’s ingaging
itself too far in the pelvis, I get them, according to the
circumstances, to keep still lain down, but to turn sometimes to one
side, sometimes to the other, without ceasing my attentions, without
discontinuing to rectify the turn of the internal orifice from over the
summit of the child’s head, and to uphold the said orifice, if it should
tend to turn backwards, to depress it downward, by a gentle pressure, if
it is inclined to rise towards the os pubis. This operation, this
support, this depression, ought always to be managed with as much
tenderness as skill, and there cannot be too much of both.
CERTAIN it is, that the bad situation of the uterus often occasions a
severe and difficult labor. A midwife therefore, from the very first of
the labor-pains, cannot bestow too much attention to the giving such
preventive or actual aid as I have proposed. Nothing, on these
occasions, is more dangerous than delay. The pretious moments of
operation must not be lost, least the child, coming to engage itself,
should throw us into an embarrassment yet greater than the first.
IN the beginning of the labor, it is no very great matter, to know
exactly, what part the child presents to the orifice of an oblique
uterus. It is enough to know, that it is not the head, in order to
determine you, in due time, to the footling-extraction. What I mean is,
that as soon as a good position shall have been procured to the orifice
of the uterus; if it is any other part but the head that presents itself
at that orifice, and that it is sufficiently dilated for the hand to get
by gentle degrees introduced, dilated, in short, to about the diameter
of a crown-piece, then, if the membranes do not break of themselves, the
midwife should pierce them, and search for the feet of the child, to
bring it away. But if the head it is that presents at the orifice, there
is no need of any hurry: it is even better to wait till the membranes
burst of themselves, unless they should be come out of the vagina, in
which case they are to be opened, in order to terminate the delivery,
not with scissors, but with the fingers alone.
THE reader will here please to observe, that in these cases of
obliquity, almost every thing depends, as to the prognostication, and
prevention of difficulties, as well as to the relief in actual labor, on
the exploration of the touch, and consequently the manual function. The
last is especially and palpably indispensable. What can supply the place
of it? not surely those forcing medicines, which some ignorant
men-practitioners obtrude on the unhappy patient, and which only serve
to exasperate the pains in vain, and certainly not to accelerate that
parturition, which is retarded by the purely local indisposition of the
womb. An obstacle which a skillful, tender, experienced hand cannot but
be the fittest to remove.
IN this case however it is, that Monsieur l’Accoucheur oftenest looks
extremely silly and disconcerted. Though the throws redouble, the child
is never the nearer coming out. On the contrary, till its passage is
franked by the reduction of the uterus, it bears in vain upon any part,
but that aperture, through which alone lies its issue: and, in fact, the
harder it bears, the more it obstructs its own deliverance, and damages
its mother. Monsieur l’Accoucheur stands by, does nothing, and can do
nothing, or worse than nothing, if he should pretend to it: if he had
the head, he has not the hand to give the patient any efficacious aid.
Then it is, that where thus incapable by Nature, for the manual
function, the men-practitioners abuse that excellent, that divine, but
here mistimed and misplaced maxim, of leaving things to Nature, of
trusting to Nature. The power of Nature is just then, all of a sudden,
acknowledged to be self-sufficient, when she really wants human help to
redress her wrong. She is then at her greatest need, left to shift for
herself. The fruitless pangs increase. Monsieur l’Accoucheur stands by
an idle spectator, or perhaps goes about his business. In the mean time
both mother and child, exhausted by fruitless efforts, for perhaps four,
five, or six days, perish for want of the proper and only relief. Thus
the ignorant operators abstain from interfering, when interfering, if
they were fit for it, might be of service, only because they cannot so
well in this case employ their iron or steel instruments: and as to
their hands, they would most probably indeed make sad bungling work of
it. Their action, in short, is, if that can be imagined, yet worse than
their inaction.
SOME of them, in this case, content themselves with saying, that the
orifice is as yet too distant, and that nothing is urgent. They go away
then, and leave the patient in the hope of some favorable change which
is never to happen. They return, and find a strange disorder in the
state of things, the child is too far engaged: it is too late to
retrieve the damage, as they imagine, and I readily believe, when they
have lapsed the due time of operation, of which it is not only probable
they knew nothing, but, if they had known what to do, would have done it
very ill. Then the vast knowledge and learning of these disconcerted
instrumentarians can furnish them no better expedient, than that of
murdering the child (as they pretend) to save the mother, though it is
not always that the mother does not follow the fate of her poor infant.
I KNOW, by my own experience, that often to make a happy end of such
deliveries, requires an extreme attention and indefatigable pains. But
practitioners should resolve, either to go through with the undertaking
as it should be, or not begin it, in such cases, especially where the
lives of mother and child depend upon their doing their duty, as they
will answer the contrary to God, to man, and to themselves.
THESE cases are but too frequent in England. I have myself met with
several of them, and sometimes even in persons extremely well made, in
which I have been obliged to perform this manual aid, for many hours
together, ay, even for half-a-day and more by the clock; all my motions
keeping time with those of Nature narrowly watched, so as to rectify and
adjust the orifice and the uterus; constantly reducing any detortion,
and keeping things in their due direction, without tiring, or without
losing patience.
HERE I ask of my reader, is such work as this, naturally speaking, the
work of a man, as Daventer would persuade us?
IF the Monsieur l’Accoucheur is an ignorant, or rather not a very
intelligent one indeed, the mother, or the child, or perhaps both, will
probably be his victims.
BUT you say, if he is an intelligent one all will be safe. No; he may
perhaps know what to do, but will he have the woman’s faculty of
acquitting himself of his duty? all the theory in the universe will not
do here without the practical part; and will the hands of a man in that
respect ever equal the suppleness, the dexterity, the tenderness of a
woman’s? once more, is a man made for such work?
I SAY nothing here of the patience so remarkable in the true midwife on
such trying occasions. I will grant, that Monsieur l’Accoucheur may, in
the view of forty, fifty, or a hundred guineas perhaps, have enough of
it not to slacken an attendance on his part, so dangerous, so
insignificant, and often so pernicious; that it would be much better to
pay him for his absence: I grant then, that he may employ his divine
hippocratic fingers in such handy-work, for so many hours together,
without stepping into the next room for refreshment; or, in short,
without hazarding the lives of the mother and child, by a remission of
actual attention and manual assistence. But granting all this, can any
one, who has a respect for truth, a respect for his own knowledge and
sense of things, a respect, in short, for two such precious lives, as
those of mother and child, not, I may say, intuitively, perceive and
feel, the impropriety and danger of the practice, in such cases, being
committed to a man preferably to a woman?
BUT would a woman especially, who loves herself, who loves the child in
her womb, and who is capable of thinking at all, sacrifice herself and
child to so palpable an imposition, as that of the pretended superiority
of the men to the women in this point? She cannot even, well, without
repugnance, submit, nor but for the indispensable necessity probably
would submit to receive such service even from one of her own sex, whose
tender, soothing, congenial softness, must make it more easy and
supportable. But what can she expect from a man’s clumsy, aukward,
unnatural, disgustful operation, but increase of danger, or of pain,
perhaps of both; while she and her child may not improbably be the
victims of the rudiments in the art of a man by Nature condemned for
ever to be a novice only, and who, for possibly a great hire to assist
her, earns it only, as I have before observed, by excluding that due
relief he is himself not capable of giving her; earns it by the not
preventing enough her pains, and even by increasing her torments; till
at length, not unfrequently, some infernal instrument is produced, like
the dagger, in the fifth act of a tragedy, and forms the catastrophe of
mother, or of child, or of both?
Of the EXTRACTION of the head of the FŒTUS, severed from the BODY, and
which shall have remained in the UTERUS.
I AGREE with our modern writers, that there can hardly exist a more
vexatious accident, than that of the head’s remaining in the uterus,
after the extraction of the body. There are many causes of this effect.
The death of the child for some time past, so that the waters may have
had time to relax, to macerate the fibres, and thereby to render them
incapable of resisting any efforts; there will result from thence a
great difficulty of procuring the total issue of the dead fœtus, without
dismembering it.
SOME mis-conformation of parts in the mother may also contribute to it,
or the obliquity of the uterus, where the child is brought away by the
feet.
INDEPENDENTLY of all these causes, this accident is almost always the
effect of unskilfulness; it is, in truth, so rare, that it will scarce
ever happen, where the delivery is conducted by an accurate and able
practitioner of the art. If we have some examples, that even under
skilful hands this case has come into existence, a thorough examination
of it would shew, that it was only owing to the cruel necessity the
practitioner may have been under, of being aided by persons not duly
qualified to afford the least effectual help, or to conceive what they
were directed to do.
BUT, however that may be, the damage is not absolutely without remedy.
The great point is, without loss of time, to introduce the hand into the
uterus, which does not proceed in its contraction, but gradually and
leisurely enough, to give leave for the needful evacuation. It is true,
that this operation requires a very nice skilful hand; with which, where
it is found, surely no instrument, nor other invention, can come into
competition.
THIS accident has appeared to occasion such severe labors, that many
practitioners, and Peu, among others, (page 308) have advised abandoning
the expulsion to Nature, rather than to fatigue the patient by fruitless
and torturous attempts, to the success of which such obstacles presented
themselves, as they looked upon to be unsurmountable.
MAURICEAU (Aphor. 240) is of the same opinion, which he thus expresses.
“When the head of the fœtus shall have remained in the uterus, which is
no longer open enough to give it passage forth, it is better to commit
the expulsion to Nature, than to attempt the extraction with too much
violence.”
THESE practitioners ground their opinion on that Nature, always wise and
intent on self-preservation, taking more care to expel a superfluity,
than even to attract the needful, often discharges herself, and that
without violence, if she is but ever so little assisted, of all
extraneous bodies, or other things retained in us against her intention.
MESSIEURS de la Motte, Peu, and Viardel adduce examples of Nature’s
doing spontaneously, what some of our later moderns are for absolutely
doing themselves by means of those curious instruments, in which they
make such a parade of the rare inventiveness of their genius,
particularly in the extraction of a head remaining detached in the
uterus, on its contracting some hours after the unskilful operation of
some deficient practitioners. In such cases, I say, those gentlemen
furnish instances of Nature’s expelling the superfluous and extraneous
incumbrance, with only the help of some glysters, and other remedies
administered to the patient.
NOW though no one can be more intimately convinced than I am, that
Nature, acting for ever upon surer principles than Art, possesses
resources which she often displays in the most desperate exigencies; I
own, that in this case I am not for totally relying upon her
beneficence[32]. Here is a wrong to redress, not owing to her, but to
deficient practice; and this wrong can hardly be repaired by her alone,
unless something of a better practice contributes to relieve her. That
practice is not, however, the less recommendable for being plain and
obvious. The most gentle, the most guarded, but withal the most
efficacious means must be tried, little by little, to insinuate the
fingers and hand into the uterus, how closely contracted soever it may
be; for yield it will; and then seize the head by the mouth, the
occipital cavity, or whatever other part affords the least slippery
hold, without waiting whole hours, as do certain ignorant or negligent
practitioners with respect to the after-birth, who give time to the
uterus to enter into too strong contraction.
SOME authors, and other persons of much that depth of practical merit,
having learned solely by the experience of delaying to bring away the
after-birth, that, to abandon thus the head of a child remaining in the
uterus, was, at the same time, to expose the mother to the highest
danger, judged it expedient to have recourse to auxiliary methods. They
have therefore employed and directed for this purpose such edge-tools,
as instruments and crotchets of different figures, some to incide and
separate the bones of the skull; others to bring them away piece-meal,
or all together, according as they should find the operation the
easiest. [33] DYONIS and Mauriceau are of opinion, that the crotchet
should be thrust into the most convenient place of the head, such as the
mouth, one of the orbits of the eye, or the occipital cavity; after
which, you are to endeavour to bring away the head by redoubled efforts.
But if the crotchet slips, as the head is of a round figure, and may
turn like a ball, they direct you to thrust the crotchet into the hole
of the ear, then giving some one the handle to hold, you are to strike
another crotchet of the same figure in the other ear, and so pulling
with both crotchets at once, extract the head, that is to say, if
possible.
AY, that “_if possible_,” is well added; for with infinite submission to
those very _learned_ gentlemen, nothing appears to me more
impracticable; and, I fancy, if they had ever made the experiment, they
would have found it so. What a blind operation, with such instruments,
and in such a place!
GUILLEMEAU (Treat. of Mid. Book II. chap. 17.) remarks, that, in such
case, you should take the time that the woman has a labor-pain to
accomplish the extraction by this method, that is to say, to snatch that
moment to extract the head, when you BELIEVE you have got fast hold of
it.
BUT if the woman is too badly conformed, Dyonis (Book II. page 287)
advises the use of the edged crotchets to cut the head to pieces, and
bring away, by parts, what you could not do whole.
MAURICEAU (Book II. page 287) would have it so, that this sort of
crooked knife should have a long handle; and says, that Ambrose Paræus
and Guillemeau are for a short one to it. Doctors will disagree. They
all however give their respective reasons, and it is indeed hard to say
which does not give the worst.
MR. De la Motte, in the like circumstances, made use of a bistory, or
incision-knife inserted in a sheath, open at both ends; of which he
gives the following account. (Observ. 259.)
“I INTRODUCED, said he, into the uterus, my left hand, over which I
fixed the head; and with my right, I slipped in a sheath open at both
ends, in which was an incision-knife, that I applied to this head, and
made an opening in it capable of admitting my fingers. I widened it
afterwards, as much as I thought proper, and scooped out a part of the
brain; after which, I got hold sufficient to bring away the head, of
which the volume was considerably diminished.”
AMBROSE PARÆUS (Book of Gener. chap. 33.) tells us he had, to his great
regret, a case of this sort fall to his share, the head of a fœtus
remaining in the uterus. To extricate himself from which, he proposes
much the same methods I have described after Dyonis and Mauriceau; and
advises, in the same case, that if they do not succeed, recourse should
be had to an instrument, called _pied de griffon_, (Griffin’s claw)
which he says he took from the French surgery of d’Alechamp. He gives
two forms of one, one of two branches, another of four. These
instruments, both the one and the other, are made on the principle of
the _Speculum Matricis_[34], of which the use is at once, so detestably
cruel, and so perfectly unavailing. The Griffin’s claw however differs
from the _speculum matricis_, in that the latter has its branches
elbowing in an angle, and that the former has its branches streight
a-top and at bottom, and arched in the middle, and furnished with
roughnesses to seize and keep hold of the head.
THOSE who will take the trouble to see the delineation of these
instruments, in these authors, will, at the very first glance of the
eye, be convinced of their unserviceableness. So would they be of that
of another instrument of the like nature, invented some years ago, and
attributed to a surgeon of Rouen, which is composed of two crotchets, of
which the blades are arched, and their extremities claw-footed.
THE horror which these means of extraction naturally inspire, the damage
and inconveniences inseparable from them, notwithstanding all the
improvements pretended to have been made, have engaged several authors
to imagine other less dangerous expedients. But before I mention them, I
cannot well avoid taking notice of a suggestion of _Celsus_, if but to
warn those whom it may concern, not to be too much carried away by the
authority of a great _name_.
IN such a case the method Celsus recommends, is, for one of the
robustest men that may be got, to press strongly upon the belly of the
patient, with his heavy hands, inclining them downwards, so that such a
pressure may force out the head that shall have remained in the uterus.
Is not this a right _learned_, and especially a very tender expedient?
MAURICEAU and Amand giving a loose to their genius have proposed less
perilous methods.
_THE_ first tells us, that it came into his head, in this case, that a
fillet of soft linnen might be made, in from of a sling, to be slipped
over the head, and so bring it away.
AMAND has imagined a silk caul, of net work, to wrap the head in. This
caul is to be pursed up by means of a string, that gathers four ribbons
fastened to four opposite points of the circumference, or opening of
this kind of purse, by which the head so wrapped up is to be extracted.
MR. Walgrave professor at Copenhagen has improved on the first scheme of
a fillet, by stitching together the two extremities of a fillet of
linnen of about two yards long and four or five inches wide, in which he
makes three slits lengthways, to seize the head more firmly, and hinder
the fillet from slipping off the rounder parts of it. The figure of it
may be seen in a Latin work intitled, _Dissertation upon the separated
head of a child, and the different ways of extracting it from the
mother’s womb_. By Mr. John Voigt, at Giessen, 1749.
MONSIEUR Gregoire, man-midwife at Paris, has disputed with Monsieur
Amand the glory of this invention of the caul.
BUT if a reader will deign to consult his own reflexion, upon even these
last, less however injurious means than those of iron and steel
instruments, he will probably conclude, that if it is possible to come
at the head, so as to fix, for example, a caul over it, the same liberty
of access will serve to do all that can be necessary to secure a
sufficient hold and purchase for the naked hand to bring it away,
without such aids, as must necessarily suppose a free play of the hand
in the uterus. I own this requires great shreudness of discernment by
the touch, great expertness, great slight of hand and neat conveyance,
but these are all points of excellence which midwives should be
exhorted, encouraged, and even obliged to acquire: for acquire them they
may; which is more than the men, generally speaking, ever can, and are
therefore supplementally obliged to have recourse to such substitutes to
hands, as those horrid instruments or silly inventions of theirs, with
which, even at the best, they can never do so well as the women, who
understand their business, can do without them.
LET it also be here remembered, what I observed at the beginning of this
section, that this case of a separated head, I might almost say, never,
no never comes into existence but through some previous neglect, error
or failure of practice: so that surely the preventing it must be rather,
preferable to the necessity of remedying it, either with crotchets,
fillets, or even with but the hand alone; the trusting to any of which
may make practitioners so often remiss, where remissness can hardly ever
be but of bad consequence, where no fault, in short, can be other than a
great one, and for which, the innocent patient it is that must most
commonly be the sufferer, both in her own person, and in that of her
child.
Of that labor in which the head of the fœtus remains hitched in the
passage, the body being entirely come out of the uterus.
IT is here to be observed that though the body may be intirely free of
the uterus, some of the causes deduced in the precedent section, may
produce impediments or obstacles to the issue of the head. The head
never detaches itself from the body but in that labor where the feet of
the child come out first, and are too forcibly hauled by rash or
unskilful hands, by such in short as do not know how to disingage or
remove the let or obstacle to the issue of the head, with one hand,
while with the other they properly support the body of the child. As it
is then greatly to be wished that this accident might never happen, I
shall, to the means I have already indicated for preventing or remedying
it, add others coincidently with the design of this section, to prove
the inutility of instruments in the case of the title prefixed to it. I
shall then quote the practical tenets of the best authors upon this
point, together with reflexions, which my own experience and practice
have suggested to me.
MAURICEAU explains this case tolerably justly, where he treats of the
footling-extraction.
“CARE (says he) should be taken that the child should have its face and
belly directly downwards; to prevent, on their being turned upwards, the
head of it being, towards the chin, stopped by the os pubis. If
therefore it should not be so turned, it must be put into that posture.
This will easily be done if, as soon as you begin drawing the child out
by the feet, you incline and turn it little by little, in proportion as
your extraction of it proceeds, till its heels bear in a direct line
with the belly of the mother,”
[_Here I must beg leave to interrupt Mr. Mauriceau, to observe, that it
is not enough to have hold of the child’s feet to begin turning it: but
the breech must have come out: then, if it is not well turned, by
placing one hand on the belly, and the other on the breech of the child,
there will be time enough easily to turn it immediately and naturally,
neither with too much precipitation, nor yet too leisurely, not little
by little, or by slow degrees. This last precaution being of no use but
to flag an operation, in which a delay may be fatal to the child,
without any service to the mother, it only keeping her the longer in
pain._]
“THERE are (he goes on) however children with so large a head, that it
remains stopped in the passage after the body is intirely got out,
notwithstanding all the precautions that can be used to avoid it. In
this case, you must not stand amusing yourself with so much as
attempting to bring the child away by the shoulders, for sometimes you
will sooner part the body from the neck, than get the child out by this
means. But while some other person shall pull it by the two feet or
beneath the knees,” [_here Monsieur Mauriceau is much out: great care
should be taken not to have it pulled by any one, but purely to give the
body of the child to be supported by some discret person, while the
delivery proceeds as the author goes on to describe_] “the operator will
disingage little by little the head from between the bones of the
passage, which he may do by sliding softly one or two fingers of his
left hand into the mouth of the child, to disingage the chin in the
first place, and with his right hand, he will embrace the back of the
child’s neck, above the shoulders, to draw it afterwards, with the help
of one of the fingers of his left hand, employed, as I have just
observed, in disingaging the chin. For it is this part which the most
contributes to detain the head in the passage, whence it cannot be drawn
out before the chin shall have been intirely disingaged. Observe also,
that this is to be done with all possible dispatch for fear the child
should be suffocated, as would indubitably happen, were he to remain any
time thus held and stopped: because the umbilical chord, which will have
come out, being turned cold, and strongly compressed by the body or by
the head of the child, remaining too long in the passage, the child
cannot then be kept alive by means of the mother’s blood, whose motion
is stopped in that chord, as well by its cooling which coagulates it, as
by the compression which hinders it from circulating, for want of which
it is a necessity for the child to breathe, which he cannot do till his
head shall be intirely out of the uterus: therefore when once you have
begun the extraction of the child, you must try to procure the total
issue of it as quick as possible.”
MONSIEUR Levret, who has wrote for no end on earth but to recommend his
_tire-tête_, seizes the occasion of the foregoing passage extracted from
Mauriceau to tell us, page 51, of the first part of his work.
“MAURICEAU acknowledges here, that there are children who have the head
so large, as for it to remain stopped in the passage, after the body
shall have been wholly got out, notwithstanding all the precautions that
can be taken to avoid it.”
FROM whence this zealous instrumentarian draws the following conclusion.
“Here (says he) is one of those cases, in which my _instrument_ may be
of great service.”
THIS conclusion however does not to me at all appear a just one.
FIRST, because Mauriceau, after those lines of his, just above quoted by
Levret, adds immediately the method of practice pursuable in this case,
to give a good account of it without the help of instruments.
SECONDLY, because we are not at all to be concluded by what any author
says, any farther than the truth of things bears him out. Mauriceau[35]
might have explained himself better: he might have said, that, in this
case, the child should be pushed back a little into the uterus, to have
the freer play for its being more easily disingaged: he might have
advised, as I have before observed, rather a safer method of proceeding
than what he has done. Mr. Levret himself allows this p. 56. Then, still
with a view to recommend his forceps, his _tire-tête_, as being
absolutely necessary, he continues thus (p. 58.)
“THOUGH every thing should apparently have been done that is above set
forth, still we are not always so happy as to accomplish the delivery.
It sometimes happens, that we cannot get the head of the child out of
the uterus. There are of this two examples in the treatise of M. De la
Motte, of which I do not think it here out of place to furnish an
extract.
“MR. De la Motte, in his 253d. Observation, (goes on M. Levret) relates,
that in a case in which he was obliged to turn the child, in order the
better to finish the delivery, he turned it very easily; that having
brought it out as far as to the thighs ... it being alive, he gave its
body a half turn, so as to put its face downwards which it had upwards,
and that then he continued drawing out the child as far as to the
shoulders and neck.
“AFTER that (says M. De la Motte) I gave it some gentle shakes, and even
pulled it pretty hard, and had several tugs at it, to make an end of a
delivery I had so happily begun; but all was in vain. This obliged me,
according to my usual method, to put my finger into its mouth. I was
mistaken, for what I took to be the mouth, I found to be the nape of the
neck, and that the neck, not having followed the motion of the body, was
twisted round, and consequently the face still remained turned upwards,
so that the chin it was that, being hitched at the os pubis, was the
obstacle to have been conquered to terminate the delivery.”
MR. LEVRET here observes, there being a great probability that, when la
Motte turned the body of the child, he was pulling it towards him, and
that the mother was in a labor-throw: for it is well known, that then
the uterus contracts itself in all directions round the body it
contains: she was then compressing exactly the head of the child, which
must render it immoveable, while he was turning the body. These two
co-incidences must have contributed to twist the neck of the child,
consequently to make it lose its life. And to clench the misfortune, he
gave its little body to be held by the husband of the mother, while he
was pushing back the head with one hand, and with the other disingaging
the chin. He told the husband at the same time to pull softly; “but he
hauled with such violence, in the hope of easing his wife, that he fell
with a jerk six foot off the bed, with the body of the child, of which
the head had remained in the uterus.”
LET us proceed to the second example. This is the fact. M. De la Motte
tells us, that he was called to assist a poor woman in labor, in which
she had been lingering for two days, that this patient was a very little
woman, and of about forty five years of age; the arm of a very small
child had come out the day before.
“I SLIPPED (said he) my hand along this little arm, to go in quest of
the feet, which I presently found, and after having closed them
together, I brought them away out of the uterus. The body followed till
it came to the neck. The patient being on the edge of the bed, which was
very high from the ground, and where there was not room enough left to
support the child in proportion as I drew it out, I was obliged to give
it a woman to hold, while I proceeded gently to disengage the head which
was stopped in the passage. This was no wonder, considering the
streightness of it, being correspondent to the littleness of her size;
considering withal the advanced age of the patient, the length of time
since the discharge of the waters, during which the uterus being
irritated by the lingeringness of the labor, the presence of the arm in
the passage had caused an inflammation, consequently some induration,
all these joined to the time that the fœtus had been dead, which as
before observed was a very small creature, were reasons more than
sufficient to manage very tenderly with the child, so as to bring it
away whole. This (says M. De la Motte) induced me to introduce my hand
flat towards the _frænum labiorum_, and to put my middle finger into the
child’s mouth, while my other hand was over its neck. My measures being
thus taken, I desired the midwife, while I should disingage the parts,
to pull softly, for fear of an accident. But she nevertheless,
senselessly and foolishly, gave it much such a pull, as the woman’s
husband I have before mentioned. This indeed forced out the body of the
child, but severed from the head, which remained in the uterus.”
HERE it may be observed that Monsieur Levret, by this preamble, on the
one hand prepares us for the necessity of his instrument, by a constant
supposition of cases, in which, notwithstanding all the precautions that
may be taken, it happens sometimes (as he says) “that it is not possible
to terminate happily the delivery, nor get the child’s head out of the
uterus;” to support which opinion he produces the two examples from De
la Motte, which I have just before quoted.
ON the other hand, he owns, as it were, _en passant_, that there are
means, which he even explains of accomplishing successfully the
deliveries, in such labors, by solely the operation of the hands,
avoiding the faults committed by M. De la Motte, after which, as if
those faults were any proof in favor of his instrument, he concludes,
that, “if through any cause whatever, this case was not to be got over,
the child should be given to some one to be held, with the precautions
before set forth, and that then the operator was to proceed with his
instruments.”
IN the first example we see that De la Motte was guilty of three
grievous errors. The first, in taking the nape of the neck for the
mouth: the second, in having taken the time of the mother’s throw, in
which the uterus must have contracted round the neck in all directions,
to turn the body of the child, which contributed to twist its neck:
thirdly, in having given the body of the child to the husband to hold,
with direction to pull it, even tho’ he cautioned him to do it gently.
He ought rather not to have trusted him with the body at all, or have
absolutely forbid him to make the least motion, his part being only to
support it.
IN the second example, De la Motte committed no more than the last
fault, in trusting a midwife, of whom he might not know all the
stupidity: but this was sufficient to produce that accident; an accident
which it will not even be hard to avoid, with due management, or hands
skilfully conducted.
WITH Mons. Levret’s leave (whom I ought to honor, since it is from him I
have chiefly taken what he has said against all instruments but his own)
I shall then say, that it is against the laws of candor, or of common
sense, to seek, from the faults which may be committed in the manual
practice, either through ignorance, inadvertence, or want of
circumspection, to infer the necessity of instruments.
THE point here under discussion turns intirely upon a child extracted by
the feet. Now it is extremely rare, that in this case, the head does not
follow the body. But if, in exception to this general rule, the head
should be stopped in the passage, upon proceeding to disengage it, with
all the proper measures and precautions which I have added to those
above specified from Mauriceau, the sole aid of the hands will be full
sufficient to accomplish the total delivery. But if they were to be ill
managed, the risk would be evidently great of detaching the body from
the head; and this would change the case from that of the head stuck in
the passage, to the one of the head separated from the body, of which I
have treated in the preceding section. Without then multiplying cases
without necessity, as the reader will easily see, that the first is but
the consequence of a mis-treatment of the last, so that, by the same
rule, the right management of the last case is a sure prevention of the
first, I shall only observe, that it might be shewn, that capable,
well-conducted hands are sufficient to guard against both dangers, and
shewn, even by Mons. Levret’s own confession, which he so inconsistently
contradicts, in favor of his own instrument, without offering any thing
like a reason for such a contradiction.
BUT if the damage in these cases resulting from an unskilful use of the
hands should be urged against me: I answer, in the first place, that I
am not arguing for any thing but what is to be effectuated by good
practice: my point, is only to establish the superiority of skilful
hands to the use of instruments: and in these cases, I aver, that even
the damages done by the mispractice of defective hands, may be better
repaired by sufficient ones, than by a recourse to instruments. How
often too are instruments used by such men-operators, as are to the full
as unfit to manage such instruments, bad as they are, as some women may
be to use their hands! But if I could give no better reason for the
rejection of instruments, than the abuse of them, even by the numbers of
ignorant superficial men-practitioners that employ them, I should not
expect to be heard; and yet the great argument against midwives is the
ignorance of a few of them: though that ignorance of theirs could never
produce such a multiplicity of horrors, of murders, injuries, tortures
of mothers, such mutilations and massacres of children, as the deep
learning of the instrumentarians!
MY plea then is much more fair. The reader will be pleased to consider,
and decide upon his own reflexions, whether, it is not at least
probable, from what has been shewn in the cases of the obliquity of the
uterus, of a head separate from the body of the fœtus, or even of that
reputed most dangerous extremity, the head being hitched in the passage,
when the whole body shall have come out, that every thing may be at
least as hopefully attempted with the hands alone, as with those
instruments, the use of which forms the sole reason for a recourse to
men-practitioners; tho’, well considered, nothing could be a stronger
reason against such a recourse than their using them. But let us proceed
to the next case;
When the head of the fœtus presents itself foremost, but sticks in the
passage.
FOR this section it is, that I have reserved to treat incidentally and
more at large of the objections to be made in general to all
instruments, and in particular to the principal ones.
AMONG the severe labors, which give much trouble, and exact much
patience from all parties, from the patient, the midwife, and all the
assistence, this case may challenge a place. It is that, in which the
head of the child having presented itself foremost, and having ingaged
itself half way, or thereabouts, in the streight of the bones of the
pelvis, and of the orifice of the uterus, the labor-pains remit,
languish, and the progress of the labor becomes suspended. Whether there
be any mis-conformation of the bones of the pelvis, or whether (as our
practitioners are pleased to express it,) the head of the fœtus be too
large for the passage, or whether, in short, both these causes concur to
the formation of this obstacle, or exist in complication with other
circumstances; it is, in this case, we may say the head is hitched,
stuck or ingaged in the passage.
MR. De la Motte, book the 3d. chapter the 20th, describes this state of
the fœtus.
“WHEN (says he) the head has struck into the streight of the passage
which, at first, affords a great deal less room than were to be wished,
for its letting it pass, the head ingages itself as much forward as
possible, from the continual and violent pains the woman suffers, which
act upon the child, whose head lengthens and flattens, in such a manner,
to adjust and mould itself to the passage, that the hairy scalp becomes
quite tumefied, so as to make the head look almost like a double head,
which however remains stuck fast between the bones, without being able
to get out, and only ingages itself the more the more it advances ...
but growing larger as it advances, and the aperture which it obliged to
force diminishing more and more, makes it so that the head remains at
length so jammed in, that it cannot be drawn out without diminishing its
volume, which (as this author says) cannot be executed without
instruments: as I was obliged to do, to accomplish the following
delivery.”
MR. De la Motte then proceeds to tell us, that he was called to lay the
wife of a laborer, the head of whose child was hitched in the passage.
After having well examined the state of the mother and child, and
ascertained as much as it is possible to ascertain the death of the
latter——“I determined, (says he) to finish the delivery, which I did by
opening the head of the child with my incision-knife, and scooped out
therewith part of the brain. After which, I made use of my hand, with
which I got hold of the inside of the skull, and in an instant drew the
child out, who appeared to have been dead a long time.”
IT is not here that, in answer to M. De la Motte, I shall stop to
propose a more gentle and more natural method of giving a good account
of this case of a hitched head, than the cruel and dangerous expedients
suggested by the instrumentarians: I reserve the submission to better
judgment of my own ideas of practice, in this point, till after I shall
have quoted the notions of more authors.
DAVENTER, p. 343, of his observations, supposes to us the case of a head
stuck in the passage, when the difficulty of the labor shall have been
increased, as well by the ignorance, as by the negligence of the
practitioner, male or female, that may not have given the proper aid in
due time, or not have foreseen the danger; he moreover supposes a
complication of obliquity, caused by the mis-conformation of the bones
in the patient. If this embarrassment then should not have been foreseen
or guarded against, he advises the opening of the head of the child.
“THERE is, for this no occasion (says he) for any instruments of a
particular make; a common knife guarded as far as the point, a pair of
scissors, a pointed spatula do the business. The opening they make may
be dilated with the fingers, and the brain taken out; after which, you
seize the head with your hand, or with a linnen cloth, and try, in this
manner, to bring away the body. When I say you may draw the head out
with a linnen cloth, I mean a broad strip or fillet cut lengthways of
the cloth, and hemmed in the borders, or any piece of linnen that is
fine and strong, to be passed round the back of the head, and bringing
in under the chin, you twist the fillet, and draw out the child.”——He
then adds, that he much esteems this method; that those, whose hands are
_small_ enough to pass this linnen round the back of the head, without
opening it, are not obliged to open it, and have therein a great
advantage over others.
THIS last method proposed by Daventer ought doubtless to be preferably
pursued, as being the less cruel. But, in the first place, it is utterly
impracticable. A head represented to be hitched or jammed, does not
leave the least hands that can be imagined room or liberty to pass a
fillet round the back of the head, in order to bring it under the chin.
But were it even practicable, it would be useless, and dangerous:
useless, in that the hands alone, so introduced, might of themselves,
little by little, disingage this head; dangerous, for that this fillet
might most likely produce the effect that fillets commonly do, strangle
the child.
MAURICEAU, to conquer this obstacle of the head so stuck, proposes
several kinds of crotchets, to apply various ways, to the head of the
child, after having scooped out the brain, by means of an opening made
in the skull. He gives us several examples in his observations, but as
they are absolutely fit for nothing but to inspire horror, I shall
refrain from specifying them. Dyonis is of the same opinion with
Mauriceau.
THOSE who will give themselves the trouble to peruse the authors who
have preceded thus, will find, that their method differs very little
from that of la Motte and Mauriceau, which most assuredly kills the
child if it is not dead: and the ascertainment of the death of a child
stuck in the passage is so difficult, that the ablest practitioners
cannot answer for not being mistaken in it. The reader will please to
apply here what I set forth, p. 139, and following, to which I beg leave
to refer.
MAURICEAU, at length, imagined, that he had out-done all others, in his
invention of an instrument he calls a _tire-tête_. He specifies it in
his 26th observation. But it is as dangerous as the crotchets, since, in
order to use it, you must begin by opening the skull with an
incision-knife, or with a sort of steel spike, double-edged, which he
invented on purpose for the use of piercing the child’s scull at the
_fontanelle_, to admit a little round plate of steel of another
instrument.
MONSIEUR Soumain, and other celebrated practitioners, have acknowledged
the insufficiency of this instrument of Mauriceau; but were it good for
any thing, as to drawing out the head so stuck, it would for ever be
fatal to those poor unfortunates, since it could not fail of killing
them if they were still alive.
AFTER this we have the tire-tête of Mr. Fried, but it is as murderous as
that of Mauriceau, nor answers the intentions which its author had
proposed to himself. He has therefore himself had the candor to condemn
it, as may be seen p. 154. in a treatise of midwifery, published in
1746, by the care of Mr. Boëhmer, who has added two dissertations to the
treatise on this art by Dr. Manningham.
MR. Menard, in his preface, p. 24, gives the figure of an instrument, of
which the idea seems to have been taken from a twibill, with a ducks
beak. Mr. Menard has endeavoured at perfecting it, by having it made
angular, shortened, and grooved. He has given it a figure of dented
pinchers, with curve claws. He gives us also the figure of an instrument
pointed and edged, made like the head of a spear, which he uses for
opening the scull, and introducing the pinchers, by means of which he
draws the child out by the head, as he keeps pinching the bones of the
scull and teguments. By this it is easy to conceive, that this
instrument has no advantage over that of Mauriceau, and has all its
inconveniences.
MANY other modern practitioners advise the use of one or two crotchets,
be the child dead or alive, or of a tire-tête, made in form of strait
blades, with spoon-bills, to introduce them one after another into the
uterus; and after having placed them on each side of the child’s head,
and made them meet together, to try the extraction with them.
THIS last contrivance, as ingenious as it may appear, does not save the
child’s life, as all these authors would insinuate. For these
instruments, wherever they are applied, must pierce to get a solid hold;
without which they could serve for nothing but to crush or lacerate the
teguments; so that they should not be used where the child is a live
one: and even when it’s dead, the mother is not absolutely safe from the
damage they may do, whatever precaution the operator may take, or
whatever may be his dexterity of hand. If one of the blades should slip,
which frequently happens, it will be difficult for him not to do the
mother a mischief. For as to the child, it is very rare that the
crotchet does not instantly destroy it.
MENARD has again given us another figure of an instrument, to appearance
less dangerous; but the make of it sufficiently denotes its want of
power in the operation, which is also confirmed by the testimony of the
most celebrated practitioners.
IT is now (1760) about forty years ago, that Palfin, a surgeon of Ghent
in Flanders, and demonstrator of anatomy in the same town, went to
Paris, and there presented to the academy of sciences an instrument for
extracting, by the head, children stuck in the passage. Gilles le Doux,
surgeon of the town of Ypres, put in his claim to the invention of this
curious instrument, which has however been ever looked upon as
insufficient, and to have too much bulge, to allow its introduction into
a place already so difficult by its being blocked up with the body that
requires the extraction. After at least a dozen of corrections of this
pretended tire-tête or forceps of Palfin, Gilles le Doux himself
corrected it, so did afterwards Messieurs Petit, Gregoire, Soumain,
Duffé, and I do not know how many more.
IN short, one may say, that never did any instrument undergo more
alterations than this forceps has done. One of the greatest
improvements, according to the opinion at the time here in England,
which it received, was that given it by Dr. Chamberlain. Chapman, whose
treatise on midwifery is esteemed, to give this tire-tête the greater
lustre, tells us, that Dr. Chamberlain kept this instrument a long while
a secret; and that the Dr.’s father, his two brothers, and himself, used
it with good success. Mr. Boëhmer, public professor of physic and
anatomy at Hall, in the Lower Saxony, in the College Royal of Frederic,
and of the society of curious Naturalists, from whom I quote this, calls
this instrument, I am here speaking of, the English tire-tête, or
forceps.
ALL due honor be to the original author of this sublime invention of the
forceps, whoever was the happy mortal! happy, I say, according to Dr.
Smellie, who calls it a “_fortunate contrivance_”[36]; though perhaps by
fortunate, he rather means its having been so to himself. For hitherto,
in all truth, I must own, that I do not find, even by the most
exagerated accounts of the learned men-midwives, that those poor
instruments of God’s making, the women’s fingers, would not much better,
and much safer, do every thing that is pretended to be done by that same
boasted instrument, or that can be done by any other human means.
BUT let us suppose for an instant, what both my love and knowledge of
the truth would hinder me from granting, that instruments are at some
times, and in some sort necessary: in what case is it that they are
necessary? this is what hitherto I do not know. And which instrument is
it that a man-midwife must use? that is what I yet know less: nor do I
believe there is any practitioner so presumptuously silly, as to admit
any particular one, as the only one universally received and approved.
It will perhaps be said, that according to the circumstances, each
practitioner will, out of his bag of hard-ware, pick out that which will
be fit for the occasion. But then, a waggon would not carry their whole
armory, to calculate not only according to the various alterations made,
if but in the forceps, by whim, desire of getting a name, or of
increasing practice, but according to the various exigencies and
circumstances to which the form of the instrument ought to be peculiarly
adjusted. And upon every occasion, there is not the time for inventing,
directing, or making a new instrument. But if it is said, that for want
of such exactness, the general make of an instrument must do, in _all_
cases: that general make is not at least to be looked for in any of the
kinds I have already quoted, by which such numbers of women and children
must have been tortured or sacrificed, before they were exploded and
given up, as good for nothing or insufficient, even by the
men-practitioners themselves, who however substituted no others to them
but what were rarely less exceptionable. They were only newer. Let us
then now proceed to pass in a summary review the later and pretended
improvements of this prodigious invention of the forceps, and candidly
examine the validity of their claim over the women’s hands.
MR. Rathlaw, a famous surgeon of Holland, in his dissertation on the
means, or secret of Roger Roonhuysen, which was transmitted to his
heirs, for extracting (as was said) in a very little time, a child,
whose head should be embarrassed in the neck of the uterus, says thus,
“TO me it appeared impossible, to establish an instrument, whose use
should be so certain, so general, so necessary, that one could not be a
man-midwife without having a knowledge of it.”
THE same Mr. Rathlaw, in the same piece, exclaiming against the use of
the crotchets has this remark.
“NO one (says he) can be ignorant of it’s being no longer the practice
in France, or in England, to employ crotchets, or murderous tire-têtes
(_would this were truth!_) in the deliveries, unless for a monstrous or
hydrocephalous head, when the bulk of it is so enormous, that there is
no possibility of getting it out whole, and especially if the child
should be dead.... In my time, (adds this author) every eminent
man-midwife had invented different means of extricating himself out of
the plunge of such a case, and their reputation grew in proportion to
their respective success. Yet, hitherto, I do not know, that either at
Paris or at London, they have got such a length, as to take any
particular instrument under their protection. Nine years ago, (Mr.
Rathlaw continues) I had made a forceps almost wholly of my own
invention to extract the fœtus by the head, and it often succeeded well
with me. It was, as to its make, a good deal resembling that which
Butter describes in the Edinburgh-acts, volume III. art. 20. But mine
(proceeds he) seem to possess better proportions, and is certainly of a
more handy use, than those which have hitherto appeared.”
PLEASE to observe, that this forceps of Mr. Rathlaw is the same as
Palfin’s, or rather as that of Gilles le Doux, excepting only the
semilunar hollow cuts in the claws, which Monsieur Duffé, a surgeon of
Paris, had contrived in them. The author says, it had _often_ succeeded
well with him: he does not say _always_, and why? most probably because,
when he did so _often_ find it of service, that was, only whenever there
was no sort of occasion for using it at all. Do not let it here be
imagined, that I force an inference. I give my reason. Supposing that
such an instrument was necessary to every practitioner, the case for his
using it cannot but rarely occur. Now those rare cases where Rathlaw
judged his forceps necessary, and in which it failed him, were in all
likelihood the true tests of its merit: whereas those other cases, in
which he _often_ succeeded, may very well be taken for such as, with
hands and patience, might have afforded a better account of them, than
the silly superfluous quackery of employing a forceps, unless indeed his
hands were too clumsy to attempt it. Otherwise the using instruments,
where they sometimes do the work with so much more pain and danger, when
the bare hands well conducted would do so much better, remind me
naturally enough of what I have seen a pretty master do with a
steel-instrument called a zig-zag or fruit-tongs, when, to display it,
or out of wantonness, he has catched up fruit with it, that lay fully
within the reach of his hand. In this piece of childishness there is
however no mischief; whereas the man-midwife, for considerations of
lucre, dallies with two lives to pluck at a fruit that is never, I
repeat it, never, out of reach of the hand, where that steel-instrument
of his, a forceps, can bring it away.
MR. Rathlaw also tells us of another instrument, of which he gives us an
account. He had got the secret from one Velsen, a physician at the
Hague. This Velsen had it of Vanderswam, who had been a pupil of
Roonhuysen, the inventor of this pretended nostrum, with which he always
helped the women in labor, snug under the bed-cloaths, the better to
conceal his miraculous secret. He had long promised his pupil to
discover it to him.
“IN short (says Mr. Rathlaw) one day that Roonhuysen was returning from
laying a woman, a burgomaster of Amsterdam came to speak with him: in
the hurry Roonhuysen was to receive him, he hid his nostrum-instrument
in some apartment. His curious pupil (Vanderswam) who had for several
years been watching such an occasion with great eagerness, found it, and
took a draught of it. This instrument was in a case with two long steel
crotchets, and a piece of whalebone, in the shape of a pipe for
smoaking, only shorter, and at one of the ends of which was a piece of
steel, of the shape of an acorn, and there was no other instrument in
this case.”
IF Mr. Velsen is to be believed, it seems, on the one hand, that
Roonhuysen made the whole science of midwifery consist in the knowledge
and use of this his instrument, since it is there said, that Roonhuysen
had promised this pupil of his to teach him the art of midwifery, but
taught him nothing of it; and indeed it does not appear, that he had
hidden any thing from Vanderswam but this wonderful instrument, with
which he used, under the bed-cloaths, to smuggle the child through the
difficult passage[37].
ON the other hand again, it may be judged, that this pretended
marvellous instrument was not of effectual enough service to its
inventor, unless in those cases where he might as well have done without
them, since this very same Roonhuysen made use of crotchets, doubtless,
when he found his instrument fail him. O women! women! thus it is that
your pretious lives, and that of your children (to say nothing of the
additional tortures you are put to, as if those of Nature’s own ordering
were not already enough) are trifled with, in practices being tried upon
you with such instruments, for which you are besides to pay
exorbitantly; and all for what? To increase the practice of some quack,
who raises into notice his worthless name, or perhaps swells some work
of his, published by way of advertising himself, with the rare boast of
having delivered you with an instrument, that has only, not murdered
some of you, though it may sometimes perhaps have done you irreparable
damage, and will have always occasioned you an unnecessary increase of
pain and danger. Is it possible to inculcate this truth too often or too
strongly to you?
“THERE are many people, (adds Mr. Rathlaw) who make a doubt whether this
instrument is not the same as that with which the three Chamberlains,
brothers, acquired in Ireland and other countries the reputation of
being the most eminent men-midwives in the world. In those circumstances
in which others employed crotchets, they could, by their manual
operation, and with less labor, hasten the delivery of the women in less
time, and without the least danger to mother and child.”
I AM not unwilling to believe that the three brothers, the Chamberlains,
might pass for the most eminent men-midwives in the world, especially in
Ireland, where before there never had, as I understand, been seen any
practitioners of midwifery but women. As to other countries, these
brothers might very easily surpass in skill those, who knew no gentler
way of terminating a delivery than by the means of crotchets. Therefore
it is that our author adds, that the Chamberlains only made use of the
manual operation; he does not add of other instruments. It is a great
pity however, that the surgeons of all countries have not yet got hold
of, and adopted this marvellous secret of Roonhuysen’s, which would
extricate them so gloriously, in their attendance on such difficult
labors. They would thereby greatly reduce their armory, from its complex
state at present of variety of crotchets, tire-tête, forceps, spoons,
blunt hooks, pinchers, fillets, lacs, scissors, incision-knives, and the
rest of their tremendous apparatus.
ACCORDING then to Mr. Rathlaw, the forceps of Roonhuysen was the same as
that of the Chamberlains. How he got the secret from them matters not.
He only changed the figure of the blade-parts. In short, our author
adds, that to him it seems probable, that this instrument has been
brought to perfection by the continual experience of men-midwives, who
have successively employed it. He pretends himself to have made some
alterations in it for the better, but what they are he is not pleased to
tells us.
THE illustrious Janckius, a great practitioner, mentions another
corrected forceps in his dissertation upon the forceps and pinchers,
instruments invented by Bingius, a surgeon of Copenhagen, and of their
use in difficult labors, printed at Leipsic, 1750, page 211. This
forceps resembles mostly that which the celebrated Monsieur Gregoire,
senior, first imagined upon the model of Palfin’s tire-tête.
“Janckius, in the same dissertation, tell us, that it would be of
service to have spoons or blades of the forceps of various curvatures,
and of different lengths, for the shorter the arching, and more crooked
the blades or spoons are, the more difficult and dangerous will the
application be, according to Chapman and Boëhmer.”
THENCE this consequence seems derivable, that to obviate these
difficulties and dangers, it would be requisite to have as many crooked
spoons as there are particular cases, as well as to take measure of the
heads that are stuck, which still would imply the introduction of the
hand, and, of course, the uselessness of instruments.
MR. Levret, in his notes, p. 377, makes us observe, that the branches of
the forceps of Bingius, which are solid, being considerably more crooked
than the windowed forceps, the expansion of their middle part must be
too wide not to risque, in the extraction, the _tearing_ the perinæum,
which it is no such _indifferent_ matter as not to be remarked.
THIS Janckius had, it seems, that bad habit of employing too _soon_ the
instrument of Bingius, which is extremely dangerous. This however, is
not seldom the case, when Monsieur l’Accoucheur is in a hurry.
BOËHMER, in a dissertation on this subject, thus expresses himself, as
to the instrument of Levret, and the forceps of Bingius.
“I shall only observe (says that learned physician) what Mr. Levret has
himself very justly remarked, that the application of the forceps is
dangerous, unless the head should have already descended low enough into
the pelvis for the orifice of the uterus to be effaced, and to make but
one and the same cavity with the vagina. This counsel is essential for
two reasons;
“FIRST, for fear of hurting the orifice of the uterus which might easily
happen without this precaution.
“SECONDLY, on account of the instrument itself, the blades of which
could not embrace more than a part, and not the whole of the head, which
remaining too high, they could not consequently compress it equally, nor
extract it. It is for the same reasons (continues he) that I rather
differ in opinion from the celebrated Janckius, who, as soon as the
waters are discharged, and he perceives that the head does not pass, has
instantly recourse to the instrument.... Some time (says he) should be
indulged to the action of Nature.... There is often more success
obtained by temporising, than by too early a recourse to instruments.”
LITTLE by little the truth will come out. Little by little, even the
men-practitioners themselves, will be forced to allow, that the very
least imperfect of the instruments are prejudicial and dangerous: though
perhaps they will not speak out the whole truth, and confess that total
uselessness, which would, in so great a measure, imply their own. But
common-sense will inform whoever consults the light of it within
himself, that these instruments are of a nature so heterogeneous, from
the service expected from them, so impossible to be adapted to the
infinitely tender texture of the organ of gestation, that the very best
of them must occasion lacerations, especially by the opening of the
branches, the strain of which bears upon the mother’s body, and can
never but hurt the child, in crushing it’s head; as they make that to be
done precipitately, about which Nature has, for taking her own longer
time, no doubt a very good reason, if there was no more than that one of
gradually dilating the passage; but there are probably many others.
ART should aim at imitating Nature: now Nature proceeds leisurely,
instead of which the forceps goes too quick to work. The action of it
depends on an artificial compression, which begins by moulding, or
rather crushing the child’s head, adaptingly to the figure of the
pelvis, to facilitate its extraction; and though the divine providence
has in its wisdom provided for the preservation of the human species, by
means of what is called the duramater, and by the void of the sutures in
the cranium of children, the manual compression of the instrument is
either too strong or too weak. If too strong, the child is lost; the
head being so compressed by the instrument, that the brain escapes
through the occipital cavity: if it is too weak, so that the head has
not been sufficiently compressed, nor it’s bulk competently diminished,
in attempting the extraction, not only the uterus can scarce escape the
being wounded, but the perinæum and the bladder the being torn: and
indeed in either case they hardly escape, the instruments occasioning
various inflammations and contusions, of the worst consequence, both in
the internal and external parts, besides the great danger of the blades
slipping and violently hurting the mother, not to mention the painful
divarications and shocking attitudes in order to the introduction.
THE instrument used by Mr. Giffard, man-midwife, is supposed by Levret
and others to be nothing more than the windowed forceps, of which the
use had been long before known. But that appears as unsatisfactory as
others. Mr. Freke too, it seems, furnished a new kind of corrected
forceps, the chief merit pretended of which was, that the extremity of
one of the blades was curved in form of a crotchet, and that this
extremity might be _concealed_ when not employed as a crotchet, and
consequently helped to avoid the having a multiplicity of instruments,
as this new-fangled one might, upon an occasion, serve either for
crotchet or forceps.—What a prodigious strain of sublime invention is
this of death and wounds in various shapes!
I FIND too that Chapman is blamed, for that, in his essay on the art of
midwifery, he very frankly condemns all the tire-têtes he had seen
employed till his time by all other practitioners, but he has not, it
seems, given a description of the one he himself used, nor doubtless the
method of using it, the one necessarily depending on the other. Nor
where that author speaks of passing a ribbon over the head of a child,
is he so good as to tell you how he managed to get it over.
I MUST not here omit some mention of the forceps, pretended to be
improved by Dr. Smellie. Upon which, however, I shall spare the reader a
tedious minute discussion of its form, and of its advantages and
disadvantages, comparatively to other forceps calculated for the same
use. Levret may to the curious furnish sufficient satisfaction on that
head. He has examined it with great exactness and seeming candor, even
though he prefers his own to it. Nothing can be plainer, than its being
just as insignificant and foolish a gimcrack as any of the rest. But
there is one particularity, of which Levret takes notice, that I cannot
well omit mentioning. The Dr. has, it seems, whether to spare the women
the shock of the gleam from a polished steel instrument, or, whether to
defend them from the injury of that metalline chill, which is not well
to be cured by any warming at the fire, covered his instrument with
leather spirally wound round it. Levret upon this concludes his remarks
with the following one. “The ledges or roughness which the leather must,
_besides increasing its bulk_, create by those its spiral
circumvolutions, cannot but be such an obstacle to the introduction of
the instrument, as to let it be serviceable only in those cases where
(N. B.)—one may do _very well without it_. For it is well known, than in
those cases where recourse to it is requisite, the most polished, the
most smooth instrument often finds such great difficulties in its
intromission, that nothing but a hand, _consummately_ expert in the use
of this instrument[38] can, without damage, remove the impediments.”
DR. Smellie has, however, himself salved one of Levret’s objections to
his instrument, as to any offensive smell or infection that might be
contracted by the use of it. (Treatise of Mid. p. 291.) “The blades of
the forceps ought to be _new covered_ with stripes of _washed_ leather,
after they shall have been used, especially in delivering a woman
suspected of having an _infectious_ distemper.” Certainly, certainly,
not only the Doctor’s nine hundred pupils, but all other practitioners,
that use this famous instrument, will do well to observe this
injunction. It is the very best thing they can do, next to never using
it at all.
I COME now to the boasted instrument of Levret; who is the last, at
least that I know of, who has invented a new make of a tire-tête, or
forceps corrected, over all that have appeared since Palfin. He gives
us, in a book written on purpose to recommend it, a minute analysis of
it, and an ingenious delineation in some pretty prints of it. The work
is intitled, _Observations sur les causes et les accidens de plusieurs
accouchemens laborieux_.
BUT to make use of the instrument or instruments which Levret
recommends, requires not only a hand consummately dextrous and skilful
in the art, but an infinite number of perplexing precautions, as may be
seen, p. 106, and seq. of his observations.
I WILL not here undertake a circumstantial account, I shall content
myself with mentioning some of them.
“There is here (says our author) a very important remark to be made,
when you are for using this forceps. It is absolutely necessary that the
orifice of the uterus should be, as it were, totally effaced or erased,
that is to say, that the vagina and the uterus should, in a manner, no
longer form other than one and the same cavity, from a sort of
uninterrupted continuity, because, without that, there would be a danger
of getting hold of the orifice of the uterus between the head of the
child and the instrument, which would be extremely hurtful.
“I OUGHT (continues he) to add, that great attention should be given to
the attenuation of that orifice, for before it’s intirely disappearing,
it becomes sometimes so thin, and so exactly close fitted to the child’s
head, that, without a most scrupulous examination, one might commit a
mistake.”
BESIDES the measures, observations and remarks this practitioner urges
in that place, which require infinite attentions, he adds to them the
following ones.
“FIRST, when you introduce the instrument you are never sure of being in
the uterus, but, when, besides the precaution I have above recommended,
you feel that the axis of the instrument, or the extremity of the
branches, is in a kind of vacuum. This sign would I own be a very
equivocal one, for a person that should use this forceps without having
practised surgery[39]; but so it will not be for him, whose sense of the
touch is habituated to the feeling of instruments of different sorts, as
they enter into empty cavities of vessels or of hollow organs, or in
short of any cavity.
“SECONDLY, when by drawing towards yourself the instrument, you are
assured of the preceding sign, you will feel a small resistence to a
certain degree.
“THIRDLY, the blades of the instrument should suffer themselves to be
opened out with some sort of ease, and what is opened out should not
make resistence enough for the blades to return with any violence to the
place whence the opening out began.
“FOURTHLY, the blades in the instrument should, as they open wider and
wider, rather tend to augment the diameter of the void of the instrument
than diminish it.
“FIFTHLY, these same blades should, in their expansion, go a little
depth in the vagina.
“IF the man-midwife, (says Levret) perceive, that _any_ of these
favorable signs should be _wanting_, he ought to _mistrust_ the
_success_, and to have recourse to his _sagacity_ for the remedying it.”
THUS far as to the handling this forceps of Levret’s, to whom the
defectiveness of the English and French forceps had inspired an idea of
providing such a supplement to it, from the richness of his own
invention.
I DO not wonder however at no instrument pleasing Mr. Levret so well as
his own. Nothing is more common among the instrumentarians, than their
disagreement about the make of their instruments. Some will have their
forceps long, others short, some strait and flat, others curve: in
short, there is no adapting the mechanism of it to their various
fancies, so apt too as they are to change. Levret complains bitterly of
the inability or injustice of the instrument-makers; but by what I
believe of them, very unjustly. The gift of the fault is not in the
instrument; it is in the use to which they are so often put of
attempting impossibilities.
BUT now let us examine, what surely very competent judges have thought
of this famous new forceps of Mr. Levret, which he calls _his_
instrument.
WHEN the book and instrument were presented the Royal Society at London,
it appears by a quotation inserted by Mr. Levret himself, that his
instrument was allowed to be ingenious enough, but that “there was
_nothing extraordinary in it_.”
PAGE the 10th of his preface, he has the candor to own, that he does not
absolutely pretend that success will always attend its application, even
in the cases he points out.
PAGE the 36th, and seq. of his observations, after having exploded the
forceps, and other instruments of the authors who have preceded him; and
after having described the alterations and corrections made in the
English and French tire-têtes, he gives us indeed the better opinion of
his, by a fair confession of the insufficiency of them all without
exception, and even of his own: by which, however, it is plain, he can
mean no more than that, imperfect as they are, they all are still
preferable to the hands alone; but the question of this superiority is
as constantly as it is shamelessly begged by him, and all his fraternity
of instrumentarians.
THUS however he expresses himself as to his own instruments. “This
instrument is actually, to all appearance, now at the very utmost degree
of perfection, to which it is possible for it to arrive, without however
having all the perfection that might be wished, for the most expert
practitioners in the use of it, agree in the opinion.
“FIRST, of the difficulty of its introduction in certain cases.
“SECONDLY, of its stubbornness as to the crossing of the blades.
“THIRDLY, of its contributing to _tear_ the _fourchette_, or _frænum
labiorum_.”
[OUR author is very angry, that Boëhmer, who, in his critical
objections, opposes those his own words to him, has not added the
subsequent lines.]
“THE correction I have made in this instrument (continues Levret) by
means of the shifting axis, has rendered the difficulty of crossing the
blades _less_ considerable, and the two following reflexions may serve
_greatly_ to overcome the other two inconveniences.”
BUT should it be granted to Levret, that the shifting axis somewhat
lessens the difficulty of crossing the blades of this instrument, it
would still remain too great an one, for all that correction. The
reflexions he adds, for the overcoming the other two inconveniences,
carry no conviction with them; and indeed he himself seems to think so,
by his adding afterwards (p. 99.)
“TO obviate this inconvenience of tearing the _fourchette_, or the
perinæum, I caused to be made a _curve_ forceps, as to any thing else
not differing, in its dimensions, from the first. I took the idea of it
from the curve pinchers used in the operations of lithotomy. It will be
easier to conceive, than for me to describe the advantage it must gain
by it. That was not however the only end I proposed by it, as all the
good practitioners at present agree on the _small_ efficacy of the
common forceps, in the case of a head stuck in the passage when the face
is turned upwards.”
IT is in consequence of this opinion that Levret, in the sequel to his
observations, p. 301, tells us.
“I COULD (says he) answer Mr. Boëhmer, that all the most eminent
men-midwives are convinced, that when the child presents with the face
upwards, or turned forwards, that is to say, towards the os pubis, and
that in this position, the head sticks, the forceps commonly used can be
of _no_ service: I do not (adds he) even except the one I have had made
with a shifting axis. The defectiveness of these instruments, in these
particular cases, sufficiently proves, I should think on one hand, that
the English forceps is not so good as Mr. Boëhmer seems to believe; and
on the other, I presume, he will be convinced, that I am not more
servilely attached to my own productions, than those of others.”
THIS insufficiency then of the common forceps has given rise to the
curve forceps of our author. Here follows what he further adds to what I
have above (p. 427) quoted from page 99 of his work.
“THE form I have given to my forceps, renders it then very useful,
since, by means of the curve, it lays holds of the head with all the
efficaciousness that can be found in the use of the common forceps,
employed on the most advantageous position that the head can be
imagined.... Notwithstanding all the corrections made in the English and
French forceps (continues the other practitioners) if my instrument is
compared to all the other forceps it will appear;
“FIRST, that it has none of their faults.
“SECONDLY, that it is very feasible with it to extract the head of a
child separated from the body and remaining in the uterus. This is so
possible, that all those who have seen my instrument, are unanimously of
opinion, that no other forceps can do as much.
“THIRDLY, with my instrument it appears to me possible to assist
powerfully the getting out the head of a child that shall have remained
in the uterus, the body being entirely come out, but of which a part is
still in the vagina.
“FOURTHLY, my instrument has this in common with the ordinary forceps,
that it can extract a child by the head, when this part shall be stuck
in the passage.”
IT may well be said here, that Mr. Levret attributes such excellent
qualities, and marvellous properties, to that same new forceps of his,
as ought to immortalize his memory, and render his forceps universal
over the whole earth,—if they were but proved. Ay! there lies the
difficulty. Messieurs Rathlaw, Boëhmer, Janckius, and the most notable
practitioners in England, do not believe a syllable of the matter. Even
Dr. Smellie, though I think he approves the crooked part of the forceps,
speaks slightly enough of it, and has even dared to falsify the
inventor’s assertion of the ne-plus-ultra of it, by altering the form,
as he tells us, p. 370. “in a manner that renders it more simple, more
convenient, and less expensive.” Mr. Levret cannot then expect we shall
take these advantages for granted upon his own bare assertion, in the
blind enthusiasm he manifests for this rare production of his genius. I
do not so much as believe, that he was even himself, at times, clearly
persuaded of its excellence. At least he, in several places, appears to
contradict himself. As it is then greatly of use to show into what a
maze of errors these are capable of falling, who neglecting the guidance
of judgment in the road of truth, wander into the wilds of imagination,
I shall just point out here some of Levret’s, at least, to me, seeming
inconsistencies with himself, but especially with plain reason and
common-sense. The reader will find the notice I take of them far from
digressive, serving as they do even for connexion, as well as
enforcement of my arguments.
MR. Levret, p. 161, concludes the first part of his observation thus.
“NOTA, some very intelligent persons have been pleased to charge me with
an opinion, which I have never had as to CURVE FORCEPS: they think, that
I believe it capable of going into the uterus in search of the child’s
head when it is not ingaged in the orifice: and yet I do not advise the
use of it, unless in those cases where the other (the common forceps) is
employed, over which it has essential advantages.”
HERE the reader will please to observe, that all the wonders, just
before quoted from himself, are reduced only to the cases in which it
may be advantageously substituted to the common forceps. This, by the
by, is reducing it to less than nothing. But how is this consistent with
those same marvellous excellencies he displayed to us a little before,
to wit? “_It is very feasible with it to extract the head of a child
separate from the body, and remaining in the uterus._”——And again,
“_with my instrument it appears to me possible, to assist powerfully the
getting out the head of a child that shall have remained in the uterus,
the body being entirely come out, but of which a part is still in the
vagina_.”
NOW these two cases clearly imply, that Mr. Levret’s curve forceps is
capable of going into the uterus in search of the child’s head, even
when it is not engaged in the orifice: for here the case meant, is
either that of a head remaining detachedly in the uterus, after having
been severed or torn away from its body: or of a head not separated, but
remaining in the uterus after the body shall have come out, and part of
it is still in the vagina.
IF therefore Mr. Levret’s forceps had the advantage over the common
forceps, confessedly insignificant in these cases, of being able to lay
hold of these heads, he might be somewhat in the right to exalt it as he
has done. But at present he must be wrong, which ever side he takes. The
dilemma is self-evident. He is in the wrong to deny what he had
certainly said. He is in the wrong to complain of being taxed with an
opinion, which his own allegations prove he had entertained. I therefore
refer Mr. Levret from himself to himself. If he did not believe, that
his curve forceps had over all the rest the properties he sets forth,
why has he so confidently affirmed them? and after affirming them, why
would he hinder us from thinking that he believed what he affirmed?
I AM here to observe, that if I have made use of the terms of “a head
not _separated but remaining in the uterus after the body shall have
come out, and part of it is still in the vagina_,” it is purely because
I would not change any thing in the expression of this celebrated
instrumentarian. It is this exactness of quotation, that has made me
conform myself to his manner of speaking, in my answer upon this
difficulty. Otherwise, I own, I do not apprehend the propriety of his
description of the case. It surprized me too the more, in so intelligent
a writer as Mr. Levret, that he should represent to us a body come out
of the uterus, and yet remaining in the vagina; as if, on such an
occasion, the vagina could be distinguished from the orifice of the
uterus. It is even stranger to me yet in Mr. Levret, for that he
himself, in a note, p. 106, of his observations (by me before quoted)
expressly says, that “when you are for using this forceps, it is
absolutely necessary that the orifice of the uterus should be, as it
were, totally erased or defaced;” so that the vagina and orifice should
be laid into one. (See p. 420.)
HERE follows a much more material contradiction, rather however to
common sense than to Levret himself, to which I intreat the reader’s
particular attention.
OBSERVATIONS, part the 2d, p. 160. Levret gives us the following
preliminary general precept.
“THERE is, says he, a general precept by which it is established, that a
surgeon ought never to thrust instruments into deep places, without
guiding or conducting them with the hand, or with the extremity of the
fingers of that hand that does not hold the instrument.”
IT is then to this general axiom strongly dictated by reason, and surely
in no case more obviously so, than where the exquisitely tender texture
of the uterus protests against committing its safety from the cruellest
injuries, to the necessarily blind random agency of an iron or steel
instrument, so palpably ungovernable in so remote, intricate, and
slippery a place by even the most skilful hand[40]; it is, I say, in
exception to this so salutary general precept, that Mr. Levret will have
it that there are exceptions, and in favor of what, do you think, not
surely of the poor woman who, is to be the subject, or rather the victim
of the experiment, but of——his most egregiously silly CURVE FORCEPS!
Yes; it is by way of trying practices with that same instrument, that
the patient is liable to be _spread out_, in that delicate attitude
which I have above, (p. 237) described from Levret, to the perusal of
whom, for a thorough conviction of the perfect insignificance of that
instrument, or indeed of any of that sort, I would recommend even the
most sanguine in favor of instruments, if they would but grant, to their
own reason, its just prerogative of a previous suspence of prejudice.
IN these cases, however, for the which being exceptions to that
excellent general rule, Levret contends; and, to do him justice,
contends so auckwardly, that he rather provokes pity than indignation,
at his endeavouring to establish even so pernicious an error; let the
reader consider within himself the part into which this forceps is to be
thus blindly thrust, at the risque of so many almost inevitable dangers.
And for what?——In those cases it is either possible or not possible to
introduce the fingers. Where they absolutely cannot be insinuated, the
introduction of those instruments is in all human probability big with
the worst of mischiefs, where neither hand nor fingers can controul the
effects of the iron or steel: which, consequently, endanger more than
they can help, and are therefore not to be used. But if the hand or the
fingers can be insinuated, the hand or the fingers well conducted will
do the work without the help of instruments, which in this second
supposition become also useless.
THIS brings me to this case particularly, the title of which is prefixed
to this section, that of a head stuck in the passage, which the
gentlemen-midwives may perhaps second Levret, in maintaining to be an
exception to that admirable axiom above quoted, and maintain it purely,
in evasion of the conclusion against their miserable instruments, which
I aver need never be resorted to, nor never are, but for want of
sufficient skill in the manual function to terminate such labors without
them.
I ANSWER then to these instrumentarians, that an instrument, even, no
more dangerous than a probe, would in so tender a place as I am treating
of, not perhaps be quite enough exempt from a possibility of doing
mischief, to deserve an exception: but as to those instruments, which
are so palpably likely to hurt both mother and child, to injure, in
short, or even to destroy both the mould and the cast, they are all of
them within the case of exception, or rather exclusion. It is then, in
knowing what to do, and in the faculty of operating with the hand
according to that knowledge, that the art of midwifery principally
consists. If instruments are deemed ingenious, the doing without them is
surely not less so.
NOW as to the case proposed in this section, that of a child’s head
stuck in the passage, I aver, that it is not absolutely impossible to
terminate this delivery by the hand.
I AM even ready to demonstrate this before any competent judges. I speak
by experience. I have hitherto executed with all desirable success this
operation without any aid but that of the hand, with a little patience
and proper assiduity. I have many and many a time seen it practised at
the Hôtel Dieu, and elsewhere. I never in my whole course of practice
saw sufficient reason for attempting so hazardous an extraction, as that
which is executed by means of a tire-tête. Why then those needless
terrors, those superfluous tortures with instruments, to women already
in too much pain and anguish? care enough could not be taken to spare
those of the weaker-nerved sex in that condition such horrors, the very
idea of which, to say no more, is enough to put them into imminent peril
of their lives. All the forceps, and the rest of the chirurgical
apparatus, especially the more complex instruments, very justly frighten
the women, and their friends and assistents for them. Their introduction
requires at once a painful, a shocking, and a needless devarication. The
patients are put into attitudes capable of making them die with
apprehension, if not with shame, from that native modesty of theirs,
which, in these cases, may however be pronounced rather a wise instinct
than a virtue.
HOW much preferable is the true midwife’s practice, who will have
oftenest prevented, by her knowledge and skill, this very situation!
That is to say, if she has been called in time. She knows how to
predispose the passages, and by gentle reductions to restore Nature to
her right road, where she has been through mispractice driven out of it,
or through negligence suffered to deviate from it, or not preventively
watched.
I HAVE never but seen, with respect to the uterus in this case, that it
was possible to insinuate first one finger, then another, and little by
little the whole hand, not indeed a hard hand, as big as a shoulder of
mutton, the hand of some lusty he-midwife, but of a midwife, such as it
is commonly seen.
WHEN Nature does not proceed as could be wished in her labor-pains, the
point is then to husband well the strength of the patient, to restore it
where it fails, by giving her good broths and corroboratives, that do
not heat, or cooling things, where heating ones have been injudiciously
administered. She is then to lie as composed and tranquil as possible;
to be cherished, comforted, inheartened. There is, humanly speaking, no
fear but her strength will return; her pains must not be irritated, nor
herself harrassed with ineffectual interference. Nature will come to
herself again: the situation will, by her benign energy, change for the
better, and become favorable enough, for the midwife to be able to
assist her in the due time with a manual operation, that will terminate
happily her delivery. It is at least, with this success, that I have
delivered many, who, by the unskilfulness of those who had attended
them, at the beginning of their pains, had been reduced to a deplorable
condition, by their labor lingering some for upwards of six days.
IN short, it is extremely rare that this case of a head stuck in the
passage ever happens, unless under the hands of unskilful practitioners,
or of over-dilatory or neglectful midwives, who will not have duly
attended to the prognostics of this event; who will not have watched and
taken the benefit of the favorable critical moment; who give the head
time to engage itself, or get fast jammed, for want of their removing
the impediments to Nature’s doing the rest, or when help has been called
or come too late. It may also be owing to those who hasten too much, who
precipitate the women’s labor by forcing draughts, that heat, burn them
up, exhaust their strength, and prematurate the coming on of the
labor-pains. Some practitioners fatigue them, with making them walk, or
keep them up too much.
BUT when the membranes are not too soon pierced and the waters let out,
when the pains are not provoked, when time is given to Nature to form to
herself a passage, not omitting the precautions I have summarily
intimated; when due care is taken to procure all possible ease of body
and mind to the patient; who may vary her posture, sometimes lying
along, sometimes sitting up, or well supported when she walks: little by
little the head will frank itself a passage with the weight of the body
acting by an innate energy, and with a little due assistence of the
midwife’s art: and with this practical advertence, that, in these
arduous cases, much may be safely left to Nature, but not every thing.
There are times in which she cannot bear neglect, but there are none in
which she can bear extreme violence.
HERE the reader will not expect I should in a treatise, purely
calculated to expose the abuses of midwifery, attempt to particularize
either all the contingent cases, or all the modes of operation in them.
That would require a work a-part. I shall only then, to the four
principal cases, in which instruments are so falsely supposed necessary,
add a summary account of that of a _pendulous belly_, which is not
without its difficulty.
AS to a PENDULOUS BELLY, madam Justine, midwife to the Electress of
Brandenbourg, remarks, in her Treatise of the Art, that she knows, by
experience, that some children turn upon their heads with their feet
upwards, in women who have a large and prominent abdomen; because, says
she, they are pitched too much into the fore-part of the belly, that is
become pendulous. But she does not explain the consequence of this
situation, which however does not fail of causing a severe and
troublesome labor; in that the uterus being fallen into the capacity of
the hypogastrium, and the child being got above the os pubis, there it
sticks, and the labor-pains are ineffectual, if proper assistence is not
given to Nature.
THE practice which my success on experience encourages me to propose is,
to have the patient lye on her back, the belly to be braced upwards with
a large linnen-fold or roller, to reduce the uterus and fœtus to its
better position in the capacity of the pelvis; but if, notwithstanding
that help, the head of the child continues to rest on the os pubis, the
finger must be insinuated between those bones and the head, in order to
make, it, little by little, retrograde into the pelvis towards the
coccyx.
IN every case then that can be imagined, so far as my own experience and
observation have reached, I am authorized to aver, that the gentleness
of the manual assistence to women is at once more agreeable to Nature,
and more salutary than the violence of the instrumental practice; which
not only conveys the idea, but the very reality of a butchery. While its
being sheltered under the plausible pretext of tenderness and pious
regard to the safety of the poor women and children, cannot but provoke
the greater indignation, at seeing vile interest trifling thus wantonly
with their lives, and add to the cruel outrages on the human person, the
greatest of insults on the human understanding.
IT cannot however have escaped observation, that while I am, with the
utmost regard to truth, endeavouring to recommend the preference of the
hands to instruments, there is nothing I mean so little, as that some
deliveries may not be accomplished by instruments, and especially by
that divine invention of the forceps. What I presume to exclaim against,
is the needless torture to the mother, the needless increase of danger
to which she and her child both are exposed, for the sake of that
practice being tried upon them, with those instruments, when the bare
hands would be so much more safe and effectual. I could myself, no
doubt, in many cases, if I could be inhuman and wicked enough to dally
with any thing so sacred as the health or life of a woman and child, in
some measure, entrusted to me, give myself the learned air of delivering
with a CURVE FORCEPS. But in the very same cases, though at the hazard
of being called ignorant for my pains, I would always be sure to do it
more cleverly, less dangerously, less hurtfully, with only my hands. So
that, without straining any comparison, the forceps may deliver indeed,
but how? Why just as a man may, if he chuses it, hobble round St.
James’s Park, on a pair of those _artificial legs_[41] called stilts,
when one would imagine, that the mock-elevation from them could scarce
atone for their uncouth totteringness, and that he might full as well
deign to use his own _natural_ legs.
IN the slighter cases then, that is to say, in those cases, where it is
a jest to doubt of the hands not being the preferable instrument, since
they may be truly averred to be so even in the most difficult ones,
instrumentarians commonly go to work, _only_ (please to mind that
_only_) with the forceps. So that it is _only_ in those slighter cases,
where, once more nothing is more certain than that no instrument is
wanted at all, that they find matter of triumph over their predecessors
in theory and practice, over common sense, and especially over humanity.
And this is that amazing, that FORTUNATE IMPROVEMENT, the superhuman
invention of the forceps, the philosopher’s stone of the modern art of
midwifery, found out by the male-practitioners. Yet, after all it
plainly appears, that even themselves do not rely on it in the more
difficult cases. They are then obliged to return to the _old_ crotchet,
or the like methods, which bad, very bad, and very inferior to the hands
as they are, never however are supposed to be resorted to, without an
appearance of extremities to afford some color, some plea of humanity to
employ them, in a kind of dernier resort, to prevent a greater evil by a
less one. Whereas, when the forceps is used, the cruelty of that torture
it cannot but create, must be greatly aggravated by the consideration of
its being perfectly needless. But in the case of using either crotchet
or forceps, or indeed any instruments at all, the truth is, that besides
the increase of danger and pain they bring, to the already too much
afflicted patients, they defraud them of the more efficacious, less
painful, and especially more safe help of the hands alone.
THE instrumentarians all then agree on that insufficiency of this
precious forceps, which occasionally compels their recourse to the
crotchet so detested even by themselves. Levret, for example, confesses
this, p. 24, of the appendix to his observations.
“THE crotchets (says he) are, generally speaking, instruments, the very
sight of which shocks and terrifies: but notwithstanding the repugnance
which all _good_ men-midwives ought to have to the using of them, there
are cases in which there is no doing without them.”
NOW in these cases, that of the monster with two heads[42], is not meant
to be included, as Levret himself afterwards explains himself. If then
there are such cases as necessitate a recourse to crotchets, it will, I
presume, be allowed me, that they can be no other than those which
render the delivery the most laborious. What those cases are, I have,
from after the instrumentarians themselves reduced to the four capital
ones, I have above set forth, without reckoning the pendulous belly. At
least I know of no other situations than those, that can produce the
very severe labors, nor do I believe that the instrumentarians know any
other, or they would tell us so. Now if, in the more difficult of those
cases, there is no doing without the crotchet, what becomes of the
prodigious merit of the forceps, so insignificant in cases of the
greatest need, and so superfluous in those others, where there being no
occasion at all for it, it must be the most inhuman wantonness to employ
it?
HERE can you be with too much insistence desired to observe the solemn
banter, in such a matter of life and death too, of these kind,
tender-hearted modern instrumentarians! they are so transported with
stark love and compassion to the poor women and children, that they do
not know what they are about; they fall into the most palpable
contradictions, and would have even Hippocrates, and the antients,
appear as so many bloody-minded Cannibals compared to them. Hippocrates,
it seems, and the antients, according to the best of their apprehension,
in points of midwifery, prescribed the crotchet, in no case however but
where the child was certainly dead, which, by the by, is next to the not
prescribing it at all, since the ascertainment of that death is scarce
not impossible. So because they recommended this practice in the last
necessity, the ingeniousness of the modern instrumentarians was
“[43]stimulated to contrive some _gentler_ method of bringing along the
head” —— without any necessity at all; that is to say, in the minor
difficulties, for the crotchet of the old practice is, to this instant,
even with them, left in possession of the greater ones. Thus was
produced the forceps, that prodigiously bright refinement upon the dull
antients, and goes on improving without end under the wise heads of our
gentlemen-midwives. But if the modern Genius of arts and sciences has no
better improvement than this to boast over Hippocrates and the antients,
may the instinct of self-preservation defend mothers, and, in them,
their children, from being the trophy-posts of their victorious
atchievements! may the midwives continue in their happy ignorance of
their curious devices! may they ever preserve a due aversion from indeed
all instruments whatever! for they are all needless and pernicious
substitutes to the hands. May none of them, especially in any labors
committed to their conduct, prove so criminally false to their sacred
trust, as through negligence, or through an interested designing
reliance upon instruments, to repair their failures or mispractice,
slacken their attention to their duty, or afford, by their defective
performance, an excuse, though a fallacious one, for resorting to
instruments, when skilful hands are incomparably more fit for a remedy
or retrieval!
I CANNOT then too ardently wish, for the women not to be so cruel to
themselves, and to their so naturally dear children within them, as
inconsistently to suffer their aim at superior safety, to be the very
snare that betrays them into the greater danger, and often worst of
consequences, from those male-practitioners, to whom that aim drives
them for recourse; while that examination they owe to so interesting a
point would issue, or deserve to issue, in rescuing them from such a
shameful subjection of body and spirit to a band of mercenaries, who
palm themselves upon them, under cover of their crotchets, knives,
scissors, spoons, pinchers, fillets, _terebra occulta_, _speculum
matricis_, all which, and especially their _tire-têtes_, or _forceps_,
whether Flemish, Dutch, Irish, French or English, bare or covered, long
or short, strait or crooked, flat or rounding, windowed or not windowed,
are totally useless, or rather worse than good for nothing, being never
but dangerous, and often destructive.
NATURE, if her expulsive efforts are but, in due time, and when
requisite, gently and skilfully seconded by the hands alone, will do
more, and with less pain than all the art of the instrumentarians, with
their whole armory of deadly weapons. The original and best instrument,
as well as the antientest, is the natural hand. As yet no human
invention comes near it, much less excells it: and in that part it is
that the women have incomparably and evidently the advantage over the
men for the operations of midwifery, in which dexterity is ever so much
more efficacious than downright strength.
AND, indeed, let every requisite faculty for the assistence of lying-in
women be well considered, and the resulting determination cannot but be,
that in the common labors, where the men themselves are either simple
by-standers or receivers of the child, or operate with the hand only,
they are the very best of them, not comparable to a common midwife, and
in those cases, in which they pretend the use of instruments necessary,
hardly better than the worst one. So that, not less than justly
speaking, they are not receivable, either as substitutes, or even as
supplements to midwives.
THE art of midwifery then, in its management by women, carries with it,
in the recommendation of order, modesty, propriety, ease, diminution of
pain and danger, all the marks of the providential care of Nature. It is
imaged by the incubation of a brood-hen, assiduously watching over her
charge, and tenderly hatching it with her genial heat. Whereas the
function of this art, officiated by men, has ever something barbarously
uncouth, indecent, mean, nauseous, shockingly unmanly and out of
character: and, above all, of lame or imperfect in it. It strongly
suggests the idea of the chicken-ovens in Egypt, kept by a particular
set of people, who make a livelihood of the secret, which they, it
seems, ingross of that curious art of hatching of eggs by a forced
artificial heat: a practice, which, like the other refinements of
dungbeds for the same purpose, or that of committing the rearing or
education of the chickens to[44]“_cocks_, to _capons_, or to _artificial
wooden mothers_,” may sound indeed vastly ingenious; but besides the
numbers that perish the victims of those experiments, many of the
productions of such methods of hatching are observed to be maimed,
wanting a leg or a wing, or some way damaged or defective. The
comparison breaks indeed in that, at least, the grown hens themselves
escape damage, which is not often the case of mothers under those
heteroclite beings the men-midwives; or, if they do escape, it is no
thanks to those operators, but to the prevalence of Nature over their
pragmatical intervention, so fit only to disturb, thwart, or oppose her
effects, and in every sense to deprive the unhappy women that trust them
of her common benefit.
BUT while superior considerations of humanity so justly intercede for
the mothers, while I strenuously contend for the preference to be,
without hesitation, due to the mother over the child, especially in that
dreadful dilemma, where one must be sacrificed to the safety of the
other; supposing such a dreadful alternative ever to exist, which I much
doubt, or at least, not to exist so often as it is rashly taken for
granted, and even then, where the effects do not always follow the
resolution taken thereon, since, though the child is always certainly
lost, the mother is far from always saved, when, by a judicious
preventiveness in practice, neither of them might perhaps have been so
much as in jeopardy; while, I say, I plead for the preferable attention
to the mothers, I hope no mothers will think me the worse intentioned
towards them, for giving the lives of their children the second place in
my tender concern for the safety of both.
AND surely never was a time, when children more required the
intercession of humanity in their favor. Mothers can speak for
themselves. But the poor infants, so often precluded, by violence, from
the pity-moving faculty of their own cry, have nothing but the cry of
Nature to plead for them. A cry, the listening to which is prevented by
those vain imaginary terrors, inspired by designing Art in the service
of Interest, through which Nature is seduced to act against herself, and
deliver herself up to her greatest enemies.
IN short, one would imagine, that all the rage of cruelty was unchained,
and let loose against especially those tender innocents, born or unborn.
AMONG the poor, particularly as to those infants cast upon the public
charity, a barbarously premature ablactation, under a pretext so easily
foreknown to be as false as it is fatal, of bringing them up by hand for
cheapness-sake, has destroyed incredible numbers.
AMONG the rich, or those able enough to pay for the learned murder of
their offspring, how many of their children, even before they have well
got hold of life, in this, literally speaking as to them, iron age,
encounter their death or wounds, stuck in the brain by a crotchet, or
crushed by a forceps, to say nothing of their being now and then
ingeniously strangled in the noose of a fillet!
AND those horrors proceed unchecked and unexploded, and in what a
nation? a nation, that values herself upon the distinction of profound
thinking: a nation that, besides that interest she has in common with
all other well-governed nations, to protect and promote population,
stands, be it said, in that true spirit of justice, which as much
disdains to pay a fulsome compliment, as good sense ever will to receive
it, moreover eminently distinguished above them all, for producing a
race of natives, one would think could hardly be too numerous, since
they are the most remarkable in the known world for courage, for
personal beauty, and for many other liberal gifts of Nature, among which
surely not the least is, that inborn spirit of liberty, to which they
owe the honorable acquisition of so many additional advantages.
CAN it then be too strongly recommended to the women especially, at
least, to examine whether their notion of superior safety under the
hands of a man, in their lying-in, bears upon the solid foundation of
Nature, or merely on the treacherously weak one of a delusive opinion?
an opinion that owes its existence to fears cruelly played upon, and
turned to account by designing Interest. If those then of them who are
under the force of prejudice, or governed by habit, or by both at once,
would, on a point that concerns themselves and children so nearly,
assume liberty enough of mind to shake off the dangerous yoke, they
would undoubtedly find it better and safer to listen to that salutary
instinct of Nature so authorized by reason, which inspires them with
that repugnance to submit themselves in the manner they must do that
submit themselves to men-midwives, who have the impudence to call that
repugnance a “_false modesty_:” as if that Modesty could not be a true
one, a foolish one I am sure it could not be, that should murmur at
being so cruelly sacrificed to such a bubble’s bargain as it is, by
those innocents, who, over-persuaded by a deceitful promise of more
effectual aid, too often embrace a torturous and a shameful death, for
which, to add ridicule to horror, they are expected to pay their
executioners larger fees than to one of their own sex for a more decent,
a more safe, and always a less painful delivery.
MAY the women then, for their own sakes, for the sake of their children,
cease to be the dupes, sure as they are to be in some measure the
victims of that scientific jargon, employed to throw its learned dust in
their eyes, and to blind them to their danger or perdition! may they, in
short, see through that cloud of hard words used by pedants, whose
interest it is to impose themselves upon them: a cloud, which is oftener
the cover-shame of ignorance, than the vehicle of true knowledge, and
perhaps oftener yet the mask of mercenary quackery, than a proof of
medical ability!
AS to the writings of the men-midwives especially, I dare aver, that,
though there may be here and there some very just theoretic notions,
borrowed from able physicians and surgeons, nothing is more contemptible
than most of their practical rules; what is tolerable in them being most
probably got from midwives, but so disfigured with their own absurd
sophistications, that I should heartily pity any woman, subjected to
have her labor governed by such, as should have no better guidance than
their ridiculous instructions.
THEN it is that a sensible woman would, in defence of her own life, or
of any life that she holds dear to her, in the case of needing the aid
of midwifery, view with equal disdain, with equal horror, either the
rough manly[45] he-midwife, that in the midst of his boisterous
operation, in a mistimed barbarous attempt at waggery or wit, will ask a
woman, in a hoarse voice, “if she has a mind to be rid of her burthen,”
or the pretty lady-like gentleman-midwife, that with a quaint formal
air, and a gratious smirk, primming up his mouth, in a soft fluted tone,
assures her, and lies all the while like a tooth-drawer, that his
instruments will neither hurt nor mark herself nor child but a little,
or perhaps not at all. (See p. 448.)
THIS last character, if less brutal than the other, is not perhaps the
least dangerous, since the practice being at bottom the same, pregnant
consequently with the same mischief, the gentleness of the insinuation
gives the less warning, and paves the way for the admission of a
handling not the less rough for the smoothness of the address. But is
there any such thing as polite murder? is mischief the less mischief for
being perpetrated with an air of kindness? well considered it is but the
more provoking. The male-practitioners then are not quite in the wrong,
to presume as they do upon the weakness of the women’s understanding,
since they can so grossly pass upon them their needless cruelties, under
so inconsistent and false a color as that of a tender compassion. Thus
to all the rest of the shame to which they put them, they add that of so
palpable an imposition in that flimsy cover of the mean interest, which
is so probably the real motive at bottom of their taking up a function,
to which they were never called by Nature, nor by any necessity, unless,
perhaps, of their own.
IN the mean time, the truth is, that, in vain, would the men, by way of
sparing the women the terror of their masculine figure, upon those
delicate occasions of officiating, and to appear the more natural in the
business, aim at an occasional effemination of their dress, manner and
air. They can never in essentials atone for their interested intrusion
into an office, so clearly a female one, that, if but only as to the
manual discharge of it, not even the qualifying them for the opera,
would, perhaps, sufficiently emasculate them.
CONCLUSION of the SECOND and LAST PART.
HERE, confessing my just apprehensions of not having fulfilled the
promise of my title-page; there will not, I hope, to that reproach of my
deficient powers in the performance, be added the undeserved ones of
vanity or injustice in the design or conduct of my feeble essay.
FOR as to vanity, or any presumption, on my part, of any thing so weak,
so unauthoritative as my representation, having any chance to remove the
abuses, not however the less existent for that incapacity of mine to
remove them, my knowledge of the world would alone defend me from so
ridiculously wild a thought. I am but too well aware of the
tenaciousness of especially false prejudice in most minds, where it has
once gained entrance, and with whom prepossession is ever eleven points
of the right. I have then purely had in view the discharge of that duty,
incumbent on every member of human society, to oppose such errors as
appear to be pernicious to the good of it. In that light I have beheld
the growing practice of the instrumentarians, and in that sincere belief
I have hazarded the publication of my sentiments, without surely
pretending to any authority over the opinion of others. That I
chearfully leave to every one’s reason, who is capable of reason. And to
write for others than the rational, would be only labor deservedly lost.
AS to injustice, I am, at least, clear of that of partiality to my own
sex. I grant and lament as much as any one the incompetency of but too
many of the midwives. The number of such cannot be too little. But then
would the banishing them out of the practice be preferable to the having
them better taught, especially since there is nothing but what is so
much worse to put in their room, men and instruments? What occasion too
for such a dangerous extremity? For as the deficiency is evident, so are
the causes: which are not only the want of sufficient care in the
training and education of women to this profession, but the actual
discouragement, which must grow every day greater and greater, by the
encroachments of the instrumentarians, whose plea for supplanting them
will be consequently strengthened by that alarming scarcity of capable
midwives, which themselves will have so much contributed to create.
These being then the principal causes, and well known to be so, the
remedies are not obscure, nor hard to attain.
A GOOD education especially is of great importance, to accomplish what
Nature has already gone so great a way in, by her giving in many
respects to the women such a superior aptitude for the business. Capable
midwives would much help to form good female pupils; and the lying-in
hospitals especially might be made highly useful to so desirable an end.
But surely as to the practical part of midwifery in these hospitals, it
ought not to be under the direction of men, whose interest it should be,
only to form the women so deficiently, as that themselves might be the
less unnecessary; to form them, in short, more for their own service,
than for that of the public. That temptation being removed, the
female-practitioners could not receive too respectfully from the
surgeons lectures or instructions, any lights in anatomy relative to
their theoretic proficiency. But to nothing should they be more
constantly and effectually excited, than to perfect themselves in the
manual operation; and indeed, in general, so to capacitate themselves
for their function, as to prove and establish the perfect inutility of
all instruments whatever. Nor will it be a difficult task for a woman to
acquire a superiority in her hands to the most boasted of those
unnatural substitutes. This is the true way of laudably disarming the
instrumentarians, and of thereby depriving them of the only shadow of a
pretence they have for supplanting the women, and invading the female
province, of which invasion it is so probable, that not the cause they
plead, but the pay they squint at, is the real motive.
AS to the discouragement of proper women from applying themselves to the
profession, it can only cease by the concurring of those, on whom the
choice out of either sex occasionally depends, to restore things to
their antient channel: and that will in course, for their own sakes,
follow on their ceasing to be imposed upon by the false pretences of the
men-practitioners. But this is a point upon which I am too much a party
to be heard, though even as no more than an advocate, and much less as a
judge. All I shall then presume to say is, that I very readily leave the
decision of the question to Reason, that inward oracle in every one’s
breast; an oracle, which, in a cause so interesting to human Nature, can
never return a false answer, where consulted by those who deserve to
find the truth by sincerely seeking it, with a firm design to sacrifice
to it the poor vanity of defending a prejudice, or any other interest of
the passions. And surely there can hardly exist a point of more capital
importance to Society, than the determining, what however one would
imagine not very difficult to determine, on which side in this
profession of midwifery particularly, the superiority of auxiliary power
may be expected, on that, where there is evidently a great deal of
Nature, assisted with a little but a competency of Art, or on that,
where what there is of Art is most barbarously abused, and without any
Nature at all.
The END.
[Illustration]
-----
Footnote 1:
Exod. Chap. vii. and viii.
Footnote 2:
Diod. Sic. Herodotus.
Footnote 3:
The Commentator on Boerhave’s Lectures, vol. V. p. 252. or §. 694.
says, “_At Paris women are taken into the Hôtel Dieu, fifteen days
before their lying-in, at the public expence, so that the business of
midwifery can be no where better learn’d._”
Footnote 4:
_It is evidently this universal influence of the_ Uterus _over the
whole animal system, in the female sex, that Plato has in view in that
his description of it, which Mr. Smellie (introd._ p. 15_) calls_ odd
_and_ romantic, _from his not making due allowance for the figurative
stile of that florid author. Thus the diffusion of the energy of the_
uterus, _Plato calls its_ “wandering up and down thro’ the body.” _A
power of activity which, towards conquering the otherwise natural
coldness of the female constitution, nature would hardly give to the_
uterus _merely to excite in women a desire, sanctified under due
restrictions, by her favorite end, that of propagation, if she had
not, at the same time, endowed that uterus with an instinct,
beneficial by its influence in the preservation of the issue of that_
desire. _And the real truth is, that there is something that would be
prodigious, if any thing natural could be properly termed prodigious,
in that supremely tender sensibility with which women in general are
so strongly impressed towards one another in the case of lying-in.
What are not their bowels on that occasion? It may not be here quite
foreign to remark, in support of the characteristic importance of the_
uterus _or the_ womb, _that in the antient Saxon language the word_
Man _or_ Mon _equally signified one of the male or female sex, as_
Homo _in Latin. But for distinction-sake the male was called_
Weapon-man, _(not however for any offensive weapon or_ instrument _in
midwifery;) and the female_ Womb-man, _or man with an_ uterus: _from
whence by contraction the word_ woman.
Footnote 5:
Smellie. Treatise of midwifery, p. 339. _where it appears, that the
above dress is reserved for a man-midwife’s masquerade-habit in
private practice, before ladies, not to frighten them; whereas to the
poor women in hospitals his looking like a butcher, is it seems
necessary, with bases and an apron; the_ steel _of course._ But if it
is not too presumptuous for me to offer so _learned_ a gentleman as
the Dr. a hint of improvement for his man-practitioner’s toilette,
upon these occasions, I would advise, for the younger ones, a
round-ear cap, with pink and silver bridles, which would greatly
soften any thing too masculine in their appearance on a function which
is so thoroughly a female one. As to the older ones, a double-clout
pinned under their chin could not but give them the air of very
venerable old women.
Footnote 6:
_If a man happens by great chance to have long taper fingers, it is a
circumstance so uncommon, that it is proverbially said of him, “He has
rare_ midwife’s _fingers.”_ Nor was it quite unhumorously observed of
one of the founders of the sect of instrumentarians in England,
remarkable for a raw-boned coarse, clumsy hand, that no forceps he
could _invent_ of iron or steel, being more likely to hurt than his
fingers, he had, at least, that excuse for recommending instruments.
Footnote 7:
_A la veritê_ Mauriceau _raporte cette mort inopineê à une_ CAUSE
OCCULTE, _puisqu’il dit expressement que_ “ce fut un de ces fortes de
malheurs de la destinée que toute la prudence humaine ne peut pas
eviter.” _C’est aussi l’opinion de_ la Motte. LEVRET, p. 272.
Footnote 8:
Levret, p. 269.
Footnote 9:
This will doubtless be laid hold of as one proof, that midwives have,
in cases where they are puzzled, been forced to have recourse to
men-practitioners: but I have no where said, there were not some
midwives unequal to their business. The sequel will shew, that this
most probably was one of them, and the case was not much mended by the
assistent she called in. A little more patience, though I confess
there is some room to think it in this so long lingering case
excusably exhausted, would have prevented the murder of the child: but
as the concomitant circumstances are not specified, I cannot pretend
to determine that point. All I shall say is, that there is not hardly
one case in a thousand, in which nature does not know her own time
best, and does not take it kindly to be hurried. It has been known,
that sometimes the quickest deliveries have been the most fatal, and
the most liable to sudden death, by consequent hemorrhages.
Footnote 10:
_Dr._ Smellie _has himself_ (p. 403.) _ranked among the causes of
sudden death to women by violent floodings after delivery the
following one; “if in separating the_ placenta _the_ accoucheur _has_
scratched _or_ tore _the inner surface or membrane of the_ womb.” _But
if unpared nails, or the rough hands of a man, may cause such a
dreadful accident, what may not be dreaded from iron and steel
instruments, blindly thrust into parts of a scarce less tender texture
than the apple of the eye? But of that more hereafter._
Footnote 11:
Levret’s words, p. 279.
Footnote 12:
_It is among the smaller mischiefs done to the mother, that I here
mention my having not unfrequently seen ruptures brought on by the
practice of men-midwives, upon patients in other lyings-in,
precedently to the one in which I attended them. These ruptures I have
sometimes been able to remedy by good management in my laying them._
Footnote 13:
“Let the _forceps_ be unlocked, and the blade _cautiously_ disposed
under the cloaths, so as not to be _discovered_”. Smellie, p. 272.
Footnote 14:
See Smellie, p. 307.
Footnote 15:
Smellie, p, 291. “When the head presents, and _cannot_ be delivered by
the labor-pains; when all the _common methods_ have been used without
success, the woman being exhausted, and all her efforts vain; and when
the child cannot be delivered without such _force_ as will _endanger_
the _life_ of the _mother_, because the head is too large, or the
_pelvis_ too narrow: it then becomes absolutely necessary to open the
head, and extract with the hand, forceps, or crotchet. Indeed this
last method formerly was the _common_ practice when the child could
not be _easily_ turned, and is still in use with _those_ who do not
know how to save the child by delivery with the _forceps_: for this
reason their chief care and study was to distinguish, whether the
_Fœtus_ was dead or alive; and as the _signs_ were _uncertain_, the
operation was often delayed until the woman was in the most imminent
danger; or when it was performed sooner, the operator was frequently
accused with _rashness_, on the supposition that the child _might_ in
time have been delivered _alive_ by the _labor-pains_: perhaps he was
sometimes conscious to himself, of the _justice_ of this _imputation_,
although what he had done was with an _upright_ intention.”—This last
indeed would be too uncharitable not to grant.
Footnote 16:
Smellie, p. 255. “In this case, we find, _by_ experience, that, unless
the woman has some VERY DANGEROUS SYMPTOM, the head will in time slide
_gradually_ down into the _pelvis_, even when it is too _large_ to be
_extracted_ with the _fillet_ or _forceps_, and the child be SAFELY
delivered by the _labor-pains_, although _slow_ and _lingering_, and
the mother seems _weak_ and _exhausted_, provided she be supported
with nourishing and strengthening cordials.” Now in this Dr. Smellie
is very right; his wrong consists in not making this conclusion more
extensive, as that of his fellow-practitioners too often does, in
fancying or exagerating _dangerous symptoms_: whereas for once that
nature really occasions them, they are incomparably oftener the
effects of the operator’s own mispractice: this observation I cannot,
for the truth and importance of it, too often repeat.
Footnote 17:
In honor to truth, be it here noted, that a few, and very few indeed
of the midwives, dazzled with that vogue into which the instruments
brought the men, to the supplanting themselves, attempted to employ
them, and though certainly they could handle them at least as
dextroussly as the men, they soon discover’d that they were at once
insignificant and dangerous substitutes to their own hands, with which
they were sure of conducting their operations both more safely, more
effectually, and with less pain to the patient.
Footnote 18:
At this day archbishop of Cambray.
Footnote 19:
By this interest, with respect to the mis-government of the infants
that fall upon the parish, I do not mean such a personal interest, as
that the super-intendants of the charity put a single farthing into
their own private pockets, out of the savings, by the with-holding or
grudging a proper provision for the children, but merely the interest
of a parish, or the public, in so false and inhuman an article of
parcimony. A consideration which, if that were possible, renders it
the more inexcusable from the temptation being so much the less.
Footnote 20:
I have somewhere read, that brutes have not been insensible of this
effect, on suckling animals, though even of so different a kind from
their own, that the most mortal enmity naturally existed between them:
such was the instance, transmitted from Pensylvania, of a cat so
softened towards a rat, by having accidentally given suck to it
amongst its own kittens, that it forbore exerting towards it its usual
hostility to that species.
Footnote 21:
The candid reader will please to observe, that in giving up so much as
I do of the argument from the prevalence of fashion, I do not give up
a little: since I might justly oppose to it the instances of our Royal
Family, in which we see so many happily living and florishing
monuments of the midwive’s capacity. _Accoucheurs_ had, I presume, no
_hand_ in delivering the greatest Lady in this kingdom. The
men-midwives will perhaps treat this as trifling. But what will they
say to so victorious a proof in favor of the female-practitioners, as
that taken from themselves, who, for the most part, were obliged to
the midwives for their ushering them into that world, of which they
are so much the light and ornament; and out of which world they are
rather not so gratefully employed in driving those, by whose function
they were helped into it?
Footnote 22:
Pray remark the following directions for the _choice_ of a midwife,
from Dr. Smellie, p. 448.
“She (the midwife) ought to _avoid_ ALL _reflections_ upon
_men-practitioners_, and when she finds herself _at a loss_, candidly
have recourse to their assistence: on the other hand, this
_confidence_ ought to be _encouraged_ by the _men_, who, when called,
instead of openly condemning her method of practice (even though it
should be _erroneous_) ought to make allowance for the weakness of the
sex, and rectify what is amiss, without exposing her mistakes. This
conduct will as effectually conduce to the welfare of the patient, and
operate as a silent rebuke upon the conviction of the midwife, who,
finding herself treated so tenderly, will be more _apt_ to _call_
necessary assistence on future occasions, and to consider the
ACCOUCHEUR as a MAN OF HONOR and a REAL FRIEND. These gentle methods
will prevent that calumny, which too often prevail among the male and
female practitioners; and redound to the ADVANTAGE of both: for no
ACCOUCHEUR is so _perfect_, but that he may err sometimes, and on such
occasions he must expect to meet with retaliations from those midwives
whom he may have roughly used.”
Footnote 23:
As the story is told in Hyginus, it should seem that the practice of
midwifery at Athens, was, on a season interdicted to the women, who,
by a fixt resolution to die rather than submit to be delivered by the
men, procured from the Areopagus the repeal of that statute, and the
saving from imminent condemnation one Agnodice, who had dressed
herself in men’s cloaths, to elude the cognizance of the law. The
great practice she had obtained by this means had alarmed the
physicians, who thereon accused her as a seducer of the women: against
which she easily defended herself by a declaration of her sex. But
this brought her under the penalty of the law against women exercising
the midwife’s profession. The story imperfectly related in Hyginus, at
the same time that it does honor to the modesty of the Athenian women,
that is to say, if modesty is not, according to the men-midwives, a
false honor, gives room to suspect, that the midwives themselves had
perhaps occasioned the promulgation of so absurd a law. It is well
known, that in those antient times, there were for female disorders
women-physicians in form. Perhaps their encroachments on the province
of the men, by exercising the art of physic in general, might make a
restraint necessary, which was only so far faulty as that the remedy
was in this, as it often is in other cases, carried into extremes. I
would no more justify the women overstepping their proper sphere of
employment into that of the men, than I would the men sinking into
that of women. They are both reprehensible, both dangerous, but
assuredly, the last must be the most ridiculous.
Footnote 24:
It is from this principle, that, with so fair a field for raillery,
often not the least forcible of arguments, I have, against those who
are such advocates for the use of _anatomy_ in _midwifery_, abstained
from laying any stress on the famous imposition of the Rabbet-woman of
Godalmin, upon professors of anatomy. I am so far from attacking
anatomy, that I aver, every good midwife ought to know _enough_ of it
to assist her practice. This would not however constitute her an
anatomist, nor is it requisite that she should be one.
Footnote 25:
“Il faut d’abord placer convenablement la malade, c’est-à-dire, sur le
bord de son lit; les cuisses élevées et écartées, les pieds rapprochés
des fesses, et maintenus en cette situation par des aides dont on soit
sûr.” _Levret_, UTILITÉ DU NOUVEAU FORCEPS COURBE, p. 161.
Footnote 26:
“Si on s’arrêtoit au précepte général, le _forceps_ seroit un
instrument de pure spéculation et non de pratique.” Lev. p. 161.
Footnote 27:
The term _imaginary_ is here far from an unjust one, and why should
not the honor of a deliverance, effectuated by Nature, be as well
given to a being of flesh and blood as to a stone? The virtue of the
_ætites_, or Eagle-stone, has currently passed for abridging the pains
of labor, and accelerating parturition. A French consul in Egypt,
ordered one of those stones to be tied to his wife’s thigh, who was in
a lingering labor. The stone in this case, more innocent than probably
a man-midwife would have been, who would have used means to hurry the
birth, or perhaps have gone to work with his _forceps_ at least,
suffered Nature quietly to go her own pace. What was the consequence?
The lady was soon after happily delivered, which there is no doubt but
she would equally have been if a brick-bat had been tied to her thigh.
But Nature lost the thanks so justly due to her: the stone ran away
with all her merit; and this case was added to the catalogue of the
miraculous operations of the stone. In how many cases might it be
said, that the stone here represents the man-midwife, if to the stone
it was not so much more innocent and less dangerous to have a
recourse?
Footnote 28:
See La Motte, p. 646, of the quarto edition, Leyden.
Footnote 29:
See La Motte, p. 262. lib. v. chap. 2.
Footnote 30:
If these _best_ operators had been examined touching their opinion of
midwives; they would most probably have told you, they were a parcel
of poor insignificant ignorant creatures.
Footnote 31:
Dr. Smellie seems to countenance this practice, where he says, p. 232.
“_We have already observed_, (p. 229) _that if there is no danger from
a flooding, the woman may be allowed to rest a little, in order to
recover from the fatigue she has undergone, and that the uterus may in
contracting have time to squeeze and separate the placenta from its
inner surface._”
Footnote 32:
It is but fair to observe, that M. De la Motte, (Obs. 248) instances,
from Peu, two patients perishing by the midwife’s trusting to the pure
actings of Nature in this very case.
Footnote 33:
Dyonis in his Treatise, book III. ch. 12. Mauriceau, book II. chap.
14.
Footnote 34:
This instrument was once as much in vogue, as can be supposed of a
time, when instruments were not so common as they are now. But how
much torture in vain must it have given before it was discovered, that
“so far from answering the _supposed_ intention of it, namely, to
extend the bones of the Pelvis; it can serve no other purpose than
that of _bruising_ or _inflaming_ the parts of the woman.” SMELLIE, p.
296.
Possibly the more modern instruments, which have supplanted this now
exploded one, under the notion of improvement, will, in time be found
to be liable to as just objection. But in the mean while what lives
must be lost, what tortures endured, in the experiment! How many will
have been the victims, women and children!
Footnote 35:
Even this very Mauriceau allowed, by his brother practitioner M. De la
Motte, to have been an excellent man-midwife, is however very justly
animadverted upon by him for his weakness in giving into such
nonsense, as prescribing histeric medicines by way of hastening the
delivery. His capital receipt was the juice of a Seville orange in an
infusion of Sena. Let any one imagine, what an effect such a laxative
potion must have on a woman, commonly rather wanting to have her
strength recruited by proper restoratives, than diminished by purges,
on so senseless a view. But how many other instances might be brought
of these same most learned men-midwives, making almost as pitiful a
figure in the character of physicians, as they must for ever do in
that of manual practitioners of our art! Even the works of Daventer,
who has such glimpses of true theory, prove him not uninfected with a
spice of quackery. This is generally speaking so true of the
men-dabblers in practical midwifery, that one would imagine the
extension of that meanness of theirs, in putting their nose into such
a function, even to their collateral profession, whatever it be, of
physician, surgeon, chemist or apothecary, was the revenge of Nature,
for the outrages of their pretended art upon her.
Footnote 36:
Page 249, of his treatise of midwifery.
Footnote 37:
That is to say, if he touched the woman at all with it, and did not
sometimes, at least, _make believe_ that he delivered her with it
though Nature alone should have done the work. Sure I am that that
piece of quackery in him of pretending to hide the instrument, might
justify such a suspicion, of a less guilt however than that of really
applying an instrument insignificant to any purpose but that of
torture in vain.
Footnote 38:
How few are there such? consequently how great the danger of such
instruments, even if they were good for any thing, to be introduced
into _common_ practice?
Footnote 39:
As the practice of midwifery is, properly speaking, under no
regulation, may not this be too often the case?
Footnote 40:
If any one doubts of this, he, in order to settle his opinion, needs
but to peruse the instructions given by Levret, and other
instrumentarians, for the use especially of the forceps. He will find
such obscurity, such intrepidity of practices upon flesh not their
own, as would make one shudder. The very cautions against _locking in_
a part of the uterus between the blades of the instrument, prove the
existence of a danger no caution can scarce answer for its being able
to avoid. What do you think of young or unskilful practitioners
thrusting up instruments at RANDOM into such a place? yet Dr. Smellie,
p. 288, expressly tells you, there is a case in which “_The forceps_
MUST _be introduced at random_.” This however may give the
practitioner boldness, that whatever is his fault, the poor woman it
is that is sure to suffer for it, and how cruelly!
Footnote 41:
“The forceps may be introduced with great _ease_ and _safety_, like a
pair of _artificial hands_, by which the head is very _little_ (if at
all) _marked_, and the woman very _seldom tore_.” Smell. p. 257.
Footnote 42:
In this case of a monster of two heads, which happens so rarely as
that it might almost be reputed null or of no consideration, _once
more_, it is neither a midwife’s business, nor even of one of the
common men-practitioners of midwifery. Application should be instantly
made to one of the best and ablest surgeons procurable, for reasons
too obvious to need specification.
Footnote 43:
Smellie, p. 248.
Footnote 44:
See Reaumur’s art of hatching domestic fowls, &c.
Footnote 45:
If any of my readers imagine that I have, in my objection to the
men-midwives, exagerated matters, I intreat of them to consider the
following quotation from a _male-practitioner_, from Daventer, who
endeavoured, as much as Nature would allow him, to be a good midwife,
however he fell short of it. These are his own words translated, from
p. 11. of the French quarto edition.
“Can any thing be more shocking to the mother, and to those about her,
than to see a man in liquor, scarce knowing what he is about, divested
of all compassion, of all sentiment of humanity, his hands _armed_
with a _knife_, a _crotchet_, a _pair_ of _pinchers_, or other
_horrible_ instruments, come to the ASSISTENCE of a woman in agonies,
begin, for his first attestation of skill, by _wounding_ the _mother_,
then go on to _destroy_ the _child_, bring it away piece-meal, with
exquisite tortures to the woman, and, after all, grumble in the
notion, that he could not be PAID enough for such a fine spot of work?
had not such better at once take on to be _butchers_ or _hangmen_,
than treat thus the image of God, and render the profession odious?”
Have I any where said any thing STRONGER than this? Daventer, however,
certainly did not mean by it to insinuate, that _all_ men-midwives
answered intirely this description; no, nor I neither. But leaving the
brutality out of the question, the mischief and mercenariness of them
all differ perhaps in no very considerable degree. Please to remark in
the following quotation, the DOCTRINE and practice of that famous
_man-midwife_ Peu. “He determines himself, without much ceremony, to
the _breaking_ a child’s _arm_ or a _thigh_, when he _imagines_ this
_operation_ will facilitate the delivery, and that, on the PRINCIPLE
of its being _easy_, to repair such _damages_ of _new-born_ infants.
For the same reason the luxation of a jaw-bone gives him no scruple.”
(Translator of Daventer’s Preface.)
------------------------------------------------------------------------
TRANSCRIBER’S NOTES
1. P. 11, changed “at the mercy of these excutioners” to “at the mercy
of these executioners”.
2. P. 19 and subsequent, changed “womens” to “women’s”. The authors
usage was inconsistent.
3. P. 30 and subsequent, changed “it’s” to “its” where possesive was
intended. The authors usage was inconsistent.
4. P. 156, changed “may be reduce” to “may be reduced”.
5. P. 171, changed “during some lisgering labor” to “during some
lingering labor”.
6. P. 173, changed “sometimes inseparably damaged” to “sometimes
irreparably damaged”.
7. P. 175, changed “very uncautions of concealing them” to “very
uncautious of concealing them”.
8. P. 208, changed “signs of abborrence” to “signs of abhorrence”.
9. P. 216, changed “ames” to “âmes”.
10. P. 220, changed “than in those antient times” to “that in those
antient times”.
11. P. 237, changed “elevées et ecartées, les pieds rapprochés des
fesses, et maintenus en cette situation par des aides dont on soit
sur. Levret, Utilite” to “élevées et écartées, les pieds
rapprochés des fesses, et maintenus en cette situation par des
aides dont on soit sûr. Levret, Utilité”.
12. P. 237, changed “arrétoit au precepte general” to “arrêtoit au
précepte général”.
13. P. 241, changed “inaminate things” to “inanimate things”.
14. P. 246, changed “ballanced by their incompetency” to “balanced by
their incompetency”.
15. P. 250, changed “evidently consist less” to “evidently consists
less”.
16. P. 253, changed “they cry down every instrumen of other
practitioners” to “they cry down every instrument of other
practitioners”.
17. P. 347, changed “diamatrically opposite” to “diametrically
opposite”.
18. Silently corrected typographical errors and variations in spelling.
19. Retained anachronistic, non-standard, and uncertain spellings as
printed.
20. Footnotes have been re-indexed using numbers and collected together
at the end of the last chapter.
21. Enclosed italics font in _underscores_.
*** End of this LibraryBlog Digital Book "A Treatise on the Art of Midwifery
- Setting Forth Various Abuses Therein, Especially as to the Practice With Instruments: the Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgement Upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-midwife; Or, a Midwife" ***
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