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 250perfection 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.

251Let 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 252the 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 253nostrum-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 254to 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 255which 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; 256I 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.

257The 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 258for 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 259in 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.

260It 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.

261Messieurs 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.

262“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 263could 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 264too 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 265salutary 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.

266With 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, 267till 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 268demonstration 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, 269the 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, 270of 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 271surprized 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.”

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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 273before 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 274denied, 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.

275As 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, 276through 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.

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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 278laborious 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 279practical 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.

280To 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 281of 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 282distance 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 283instrument 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 284constant 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.

285On 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!

286“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 287of 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.

288Even 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; 289this 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]”

290The 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.

291“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.

292“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 293weather 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 294womb. 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?

295“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.”

296Reflexion. (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 297the 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 298efforts 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 299insufficiency, 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 300done 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, 301or 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 302used, 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.

303Secondly, 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 304from 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.

305Another 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 306they 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 307sex, 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 308steel-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 309the 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 310production 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.

311The 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 312to 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.

313I 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 314then, 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 315gift 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.

316In 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 317by 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 318for 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 319safety 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 320it. 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? 321danger 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 322a 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. 323Be 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 324the 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 325of 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; 326Mr. 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 327by 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 328poor 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 329must 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 330it, 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.

331I 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 332pregnancy. 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.

333There 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 334of 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. 335And 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, 336and 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. 337It 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 338child, 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 339the 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 340stronger 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 341membrane should be broke, and the child’s head a little discovered, and withal, the woman’s strength much exhausted,