A TREATISE ON MIDWIFERY. (continued 2)

If it should be here to this objected that the women may, through that very spirit of patience, wait too long, or overstay the time of saving the patients life, for want of calling in proper assistence; I have already implicitly obviated this objection, by remarking before, that a true thorough midwife, from her quickness of apprehension, and knowledge of the danger, will ever be readier to call in the assistence and advice of a physician, than the common men-midwives, who are ever in proportion to their ignorance the more rash, the more fearless, and consequently averse to calling in that help, of which they will be ashamed to confess their want, and 96thus cruelly, though with impunity, lose the opportunity of others endeavouring at least to repair those damages, of which themselves are oftenest the authors. Now a midwife has no such shame; she pretends to no extraordinary skill in physic or surgery; she knows her art, and will not presume to transgress its bounds; she would think herself accountable if she did: and even that very tenderness and sensibility, upon which nature has founded her patience, will make her cautious how she pushes that patience too far. She may easily see, feel and discern those cases in which nature calls the physician in aid to the midwife; nature, who seems to have placed such boundaries between those professions, as nothing but interest, presumption, or ignorance of nature, could ever render their union in one person supposable: tho’ the quality of physician may not indeed exclude that of the surgeon, but rather implies, at least, the theory of surgery. For I presume anatomy is the great basis of true rational physic, though it can very little assist practical midwifery, which depends so much upon purely manual operation, 97and needs only a sufficient general idea of the structure of the sexual parts in woman, the conceptacle, and passages of the delivery.

This is so true, that any impartial observer of the male and female practitioners in midwifery, will easily distinguish the characteristic difference of the sexes, in their respective manner of operation.

In the men, with all their boasted erudition, you cannot but discern a certain, clumsy untowardly stiffness, an unaffectionate perfunctory air, an ungainly management, that plainly prove it to be an acquisition of art, or rather the rickety production of interest begot upon art.

In women, with all their supposed ignorance, you may observe a certain shrewd vivacity, a grace of ease, a handiness of performance, and especially a kind of unction of the heart, that all evidently demonstrate this talent in them to be a genuine gift of nature, which more than compensates what she is supposed to have 98refused them, in depth of study, though even of that they are not so unsusceptible, as some men detractingly think; and in midwifery, most certainly they attain all that they need of learning to perfect them, with a facility the greater for nature, having collaterally endowed them with an organization of head, heart and hand, obviously adapting them to this her most capital mystery. This will be denied by none who have any regard for truth, and who do them justice, as to the keenness of their apprehension, as to that simpathizing sensibility which supplies them with the needful fund of patience, and tender attention; and as to that peculiar suppleness of the fingers, as well as slight of hand, in a function which rather exacts a kind of knack or dexterity, than mere strength, of which they have also a competency. Nor can it be quite without weight, that the midwives, besides their personal experience, being sometimes themselves the mothers of children, have a kind of intuitive guide within themselves, the original organ of conception, itself pregnant, in more cases than that, with a strong instinctive influence on the mind and actions 99of the sex; an influence not the less certainly existing, for its being undefinable and unaccountable, even to the greatest anatomists^[4].

100The men, it will be said, have many or all of these qualifications, except indeed the last. Granted that they have: but how very few are there of the men that possess the most essential ones to a degree comparable to that of the women: or rather not so imperfectly, as that all their boasted skill in literary theory and anatomy, cannot supplement or atone for the deficiency? Nor theory, nor all the books that ever were written on that subject from the divine Hippocrates, who understood so much of physic, and so little of midwifery, down to Dr. Smellie, who is so great a man in both, will ever amount to so much as the practical experience of a regular bred midwife.

As to that superior skill of the men in anatomy which is sounded so high, against the women, I shall not imitate the men in their want of candor towards the female-sex in their availing themselves of false arguments. I will not then take the benefit of the slight opinion which Celsus and Galen had of the depths of anatomy; they 101who contented themselves with a gross superficial notion of the principal viscera. I will not even desire to countenance that contempt by the example of that great philosopher Mr. Lock, the intimate friend, and even the counsellor of the British Esculapius Sydenham, who paid a great deference to his physical knowledge; and yet this very Mr. Lock wrote an ingenious treatise (though not published by him) upon the insignificance of the refinements of anatomy in the practice of physic. Neither will I here insist on the absurdities into which even the greatest anatomists have fallen; as for example, Pecquet, the famous discoverer of the thoracic duct in the human body, who nevertheless adopted so extravagant a notion, as that digestion of food ought not to be promoted by exercise, but by drinking spirituous liquors, a practice to which himself fell a victim, dying suddenly at the anatomical theatre. It is only for those who have a false cause to defend to shut their eyes against those truths which seem against them. Those on the contrary who defend purely the truth, know that one truth cannot hurt or exclude another truth, and 102that all truths may very well coexist. It may be true that anatomy, though it does not give the nature of the elementary composition of parts intrinsic and too minute for the human sense, since a new incision only presents a new surface, much conduces however to ground the student in mechanical principles of great assistence to him in practice, of which they are doubtless the most solid foundation: yet that truth is not incompatible with another quite as much a truth, that midwifery can have no occasion but for a general notion of the configuration of those parts upon which it is exercised. A midwife, for example, may be a very safe and a very good one, without knowing whether the uterus is a hollow muscle, or purely a tissue of membranes, arteries and veins: but if that ascertainment is necessary, she must wait for it till the anatomists have settled among them that point, which, like many other capital points of anatomy, is not however yet done. In short, once more, a woman in labor requires a midwife to lay her, not an anatomist to dissect her, or read lectures over the corpse, he will be 103most likely to make of her, if he depends more on the refinements of anatomy, than on the dexterity of hand, and the suggestions of practical experience and common sense.

If then, there are who can examine things fairly and with a sincere desire of determining according to the preponderance of reason, they cannot but on their own sense of nature, on their own feelings, in short, discern that no ignorance, of which the women are undistinguishingly taxed, can be an argument for the men’s supplanting them in the practice of midwifery, on the strength of that superiority of their learning, so rarely not perfectly superfluous, and often dangerous, if not even destructive both to mother and child. Consult nature, and her but too much despised oracle common sense; consult even the writings of the men-midwives themselves, and the resulting decision will be, that great reason there is to believe, that the operation of the men-practitioners and instrumentarians puts more women and infants to cruel and torturous deaths, in the few countries where they are received, than the ignorance of the midwives 104in all those countries put together where the men-practitioners are not yet admitted, and where, for the good of mankind, it is to be hoped they never will.

I have here said few countries have hitherto countenanced men-midwives. That I presume is too notorious to require proof: for even those Saracen or Arabian physicians, Avicen, Rhazes, &c. who, by the by, are little more than servile translators or copists of the Grecian ones, wrote only theoretically in quality of physicians; for it does not appear that they ever practised midwifery themselves, nor ever got the practice of it by men introduced into their countries. Among the Orientals there is no such being known as a man-midwife; that refinement of real barbarism, under the specious pretext of humanity, is happily unknown to them. But if it should be said, that the jealousy so constitutional to the inhabitants of the warmer climes, has a share in the exclusion of men-practitioners; the women have, at least in that point, a weakness to thank for its production to them of so great a good, as the greater safety of their 105persons and children, in that capital emergency of their lying-in. For, after all, the art of midwifery is, in the hands of men, like certain plants, which, by dint of a forcing culture, exhibit more of florish, or a broader expansion; but besides ever retaining a certain exotic appearance, they never come up to the virtue of those spontaneously growing in the full vigor of a soil of nature’s own choice for them. Art may often indeed improve nature, but can never be a supplement to her, where she is essentially wanting. Deep learning may, in very extraordinary cases perhaps, repair the errors, or assist the deficiencies of the manual function, but the deepest learning will never bestow the manual function, nor indeed can in the same person exist, but at the expence of the manual function, which must have been in some measure neglected for it. And yet the greatest practical skill that any man can with the utmost labor and experience acquire, will hardly ever equal the excellence in it of the women, Great Nature’s chosen instruments for this work: an excellence by them attained with scarce any learning at 106all, or at least of that abstruse theoretical sort, on which the men make their superiority principally depend.

But that I may not herein be taxed of maintaining any thing that has only the air of a paradox, or of begging the question, I shall implicitly, in the course of my answer to the following objection, endeavor to remove any remaining doubt on this head.

Objection the Eleventh.

In like manner, as there are particular parts of the human body which have their appropriate undertakers or protectors under their proper distinctive names, as oculists, dentists, and corn-cutters, who by making respectively one part their particular care and study, arrive at a greater perfection, at least in the practical operations on it, than regular physicians or surgeons, whose object is the whole fabric; Why, by parity of reasoning, should not the men-practitioners in midwifery be preferable to the midwives, since a man has 107to his manual function superadded a theory superior to that of the women, who, it is confessed, stand sometime in need of calling in the physician to their assistence? As a man then will have laid in a stock of medical knowledge, peculiarly adapted to the exigencies and disorders incident to women during their pregnancy and lying-in, he must consequently excel the midwife, or the physician singly considered; he who with so much greater convenience will have united in one person both their faculties, besides that of the surgeon.

ANSWER.

That certain parts of the human body enjoy the protection of practitioners, who respectively devote themselves to their service, I confess. Such appropriations may also be beneficial, at least, to the practitioners. I can even conceive, that a professed dentist may clean, scale, and draw teeth, or an oculist couch a cataract, better than either a physician or surgeon. These may in their respective practice be excelled by those partial artists. But I 108much doubt, even as to these, whether their trusting too much to that partial excellence, does not sometimes do more mischief than good, for want of duly consulting the relation of such parts to the universal fabric, of which physicians and surgeons must be so much better judges. Galen does not appear in contradiction to common sense, where he observes, that to rectify a disorder of the eye, the head must be rectified, which cannot well be done without rectifying the whole body. In confirmation of which, I once myself knew a gentleman, whom a professed oculist, at Paris, assured of the loss of his eyes being infallible; and who upon his despondingly consulting a regular physician, was by him as positively assured, that those very condemned eyes might be saved by a proper regimen. The gentleman happily believed him, and his eye-sight was not only saved, but perfectly restored.

Another instance of the like nature occurs to me, which seems applicable to the dentist, and which I quote here from a translation of the learned and ingenious 109Dr. Huxham’s observations on the constitution of the air.

“Many years ago I knew a gentleman of a hale, robust habit of body, who, from being too much addicted to the drinking of brandy, fell into a violent jaundice, from which however he would have recovered well enough, would he have conformed himself to the advice of his physicians: but he on the contrary, because his gums were very apt to bleed, and his teeth stunk from the scorbutic taint, put himself into the hands of an ignorant pretender to physic for the cure of these inconveniencies. This fellow immediately set about scaling his teeth, and rubbing his gums with his famous teeth-powder, till at last, by perpetually fretting and irritating the loose texture, he brought on such a hemorrhage, that baffled all the stiptics that could be invented by the most expert surgeons, and continuing to spout forth in small streams from the little arteries of the gums, which were now every where divided: in the space of 110sixteen hours the poor man died through mere loss of blood.”

These instances are however only adduced to justify that doubt which I expressed of these partial artists being always to be beneficially consulted in those local affections, to which their talent is supposed exclusively appropriated.

Corn-cutter is indeed a homely plain English term, but if the teeth give from the Latin the appellation of dentist, as the eye that of oculist, what name, taking it from the part in question, will remain for that language, to give the men-practitioners of midwifery, in substitution to that hermaphrodite appellation, that absurd contradictory one in terms, of man-midwife, or to that new-fangled word accoucheur, which is so rank and barefaced a gallicism? But let what name soever be given them, it can hardly be too burlesque an one, considering the gross revolting impropriety of men, addicting themselves to a profession naturally so little made for them.

Paint to yourself one of these sage deep-learned Cotts, dressed for proceeding 111to officiate^[5], and presenting himself with his pocket-nightgown, or loose washing wrapper, a waistcoat without sleeves, and those of his shirt pinned up to the breasts of his waistcoat; add to this,^[6]fingers, if which not the nicest paring the nails 112will ever cure the stiffness and clumsiness; and you will hardly deny its being somewhat puzzling, the giving a name to such an heteroclite figure? Or rather can a too ludicrous one be assigned it?

Those however who will consider this grave Doctor in his margery field-uniform, this ridiculous piece of mummery, in a light of seriousness, such as the matter perhaps more justly deserves, especially combining with all the rest, the idea of his crotchets, forceps, and the rest of his bag of instruments, may think he less resembles a priestess of Lucina, than the sacrificer, in a surplice, with his slaughtering-knife, to one of those heathen deities whose horrid worship required human victims, which the poor lying-in women but too nearly resemble.

But whether or not, in imitation of the dentist, or oculist, he receives his title from the particular part he has taken under his protection, so much is certain, that the same arguments, which militate for those partial artists claiming their respective 113departments of the human body, will not avail the man-midwife. An oculist, a dentist, a corn-cutter, have no operations to perform but those of which disorders equally incident to both sexes are the object. There is nothing in their practice repugnant to the nature of the male-sex, nor to that reasonable decency, which only requires that no sacrifices of it should be made in vain, or at least not made to no better a purpose than to increase at once the danger and the pain of both mother and child, in whose favor it is sacrificed, as it may be clearly proved to be oftenest the case. But of the chirurgical part of the man-midwife’s pretention, I reserve to treat after considering him in the capacity of a physician; in which a man may indeed be wanted, but in that of surgeon never, or at least so very rarely, as not to atone for the dangers which attend the men forming themselves into a set under the name of men-midwives.

Where there is no complication of any collateral disorder with the gestation and parturition of women, it is even a jest for men to pretend the necessity of any 114study or practice to which women may not arrive, and even much excel them.

But where there exists the case of a singular constitution, or of symptoms declarative of other help being necessary than just the common one, that quickness of discernment, that peculiar shrewdness of the women, in distinguishing what is relative to their art from what is foreign from it, gives them the alarm in time, and if they have a just sense of their duty, or but common sense, they must know that such disorders cannot be partial, cannot therefore be considered as they are by the man-midwife, as subordinate to his particular province, relative as they are to the whole fabric or system. All partial practice then is here absolutely out of the question, and now what help can, consistently with good sense, be expected from a man-midwife, who, under a natural impossibility of ever acquiring the female dexterity in the manual operation, cannot however, be supposed to attain even that imperfect degree of skill, without sacrificing to the endeavours at it the time and pains in 115study and practice, which are requisite to form the able physician?

But, in fact, the men, that is to say, those of that sex who have the best understood all the refinements of anatomy, all the variety of female distempers, never that I can learn, attempted to invade the practical province of midwifery. The immortal Harvey, Sydenham, the great Boerhave, Haller, and numbers of others who have written so usefully upon all the objects of midwifery, have never pretended or dropped a hint of the expedience of substituting men-midwives to the female ones. They contented themselves with lamenting the ignorance of some midwives, from which has been drawn a very just inference of the necessity of their being better instructed; but even those great men never chose the character of practitioners themselves, nor probably would have thought it any detraction from their merit to have it said, they might make a bad figure in the function of delivering a woman.

116Whoever then will consider but how the common run of men-midwives actually are and must be formed, and assuredly the number of exceptions to the general insufficiency cannot oppose the inference, must allow that, where a woman has distempers collateral to her pregnancy, with which they must also become dangerously complicated, she must expose herself to the utmost hazard, in any confidence she may place in a man-midwife.

The truth is, that most of the dangerous lyings-in are so far from being likely to be relieved by a man-midwife, that it is often to the having relied upon his medical judgment, and especially to his manual skill they are owing. But of the first only it is we are now here speaking.

The women captivated by that assiduity of the men-midwives, of which they only fail when they are not paid or likely to be paid, in some form or other, up to the value they set upon themselves, lightly take for granted, that, as men, they are also 117capable physicians. It is enough, in short, for these practitioners not to be women; for the women to think they can prescribe for them in all disorders. A mistake this, often big with the utmost danger to them.

The men-midwives, in general, have never, at the most, carried their studies beyond the disorders commonly incident to pregnant women: the knowledge of all the other possibly collateral ones, is what even the least modest of them will hardly claim, unless to the profoundly ignorant, and is in fact scarce less than impossible to one who has applied himself essentially to the manual function. In such cases the ignorance of a midwife can hardly be greater than that of the men-practitioners, and must be less dangerous from her less of pretention. Her consciousness of her own want of sufficient light, will engage her readily to state the exigency to some able and experienced physician, whom she must allow, in such cases, to be her superior judge: whereas the other, the man-midwife, acknowledges no greater authority than that with which he is pleased 118to invest himself. He stands, in virtue of a distinct business, and a business for which he never was made, of a sudden the self-constituted sovereign dictator and inspector-general of all female disorders whatsoever, where the woman is with child, that is to say, where the case is only thereby rendered much the more nice and difficult, and, not rarely, does he continue under the same pretext, to extend his practice to where there is no pregnancy at all in the case. And yet ask him for his titles, they are all implicitly dependent on or subordinate to that same midwifery, for which he is so naturally unqualified, even if a due study and exercise of it would permit those avocations, that would contribute to accomplish him in the so necessary general knowledge of physic. But indeed why need he acquire it, since it is so commonly taken for granted, or that he is believed upon his own word, especially if he is backed with a diploma, for form’s sake, that may have cost him little or nothing of medical study, or indeed of any thing but the amount of the fees for it?

119Yet how serious, how important is it for women, if they tender their own lives, and that of the precious burthen of which they are the depositaries, to make that distinction between the physician and the midwife, which they seem so little to make! How little do they consider, what nevertheless is strictly true, that a man can never at the best be but an indifferent practitioner of midwifery, though he may be an excellent one in physic; but that as bad a midwife as he can be, he must be yet, if possible, a worse physician, if he attempts to throw both professions into one, and exercise them jointly! They are incompatible, from the justly presumable impossibility of one man doing justice to the practice of the one, unless at the expence of the study of the other: by which other, to obviate cavils, I repeat it, I mean the general practice of physic, which comprehends the speculative part of midwifery, as well as all other branches understood to be the province of the physician. This distinction then I make, because, as to the diseases purely incident to 120pregnant women, experimental practice will rather assist the medical study of them: and it is in that part only the men-midwives can make any figure at all, and that not a superior one to midwives who are regularly bred, and who have, in their favor, their excellence in the manual function besides.

Once more, in complicated cases, the most dreadful mistakes are to be dreaded from those common-men-midwives, who so groundlessly erect themselves into physicians on those occasions. A purge, a venesection, or any other prescription injudiciously ordered, may be the occasion proximate or remote of death to both mother and child; yet a woman, at least, ought not to expect better from one of these practitioners who, for the most part, has neither study nor experience in general physic; nor more than a smattering of anatomy, joined to the index-learning of dispensatories. Such a man-midwife can never have thoroughly made himself master of the course of the fluids, nor of the order of their circulation. Their relation 121to the solids, and the efficacy of medicines upon both, can hardly be sufficiently known to a man, who must have been too much employed in trying to form a hand never to be formed, and in attendances on the practice of his midwifery, to acquire those collateral requisites for the effectual multiplication of his professions.

Yet this man void of knowledge, experience, observation, and, in consequence, of physical ability, shall boldly decide on the expedience of an internal remedy, of which he does not know the power or operation; of a venesection, of which he can but guess at the consequence; and of a narcotic, of which he is unaware of the danger. In all which, observe, he may possibly sometimes be tolerably right, in cases where there is no complication; that is to say, in cases when a midwife, duly bred, is as sufficient as the best man-practitioner. But then she is moreover not only quicker of apprehension, as to danger, where the case appears complicated, but readier to call in proper help where she discerns it to be above her reach, and consequently above that of the man-midwife, 122who must be equally or rather more at a loss, because his boasted theory will serve only to puzzle him, or what is worse yet, since a shew must be made of doing something, will most probably determine him improperly, if not fatally, to random prescriptions, in points out of his sphere of knowledge, or rote of practice.

Many a man who to-day undertakes prescribing for a fever, for a fit, a convulsion in a lying-in woman, only because he appears in the character of a man-midwife, would have been ashamed the day before he had taken up that business to give himself out for a physician. He would have been afraid of ordering any thing for her if she was not his patient, as to lying-in, and would not, even after assuming the profession of midwifery, perhaps order any thing for the same woman, out of the time in which his office is supposed necessary. This plainly proves, that many of those gentlemen are weak enough to imagine, that the man-midwife implies the physician, though the greatest physicians that ever were never dreamt of such an absurdity, 123as that the physician implied the midwife, whose master and instructor he rather is, in points highly useful indeed at times to her profession, but in which that profession does not consist.

I do not however charge all the men-midwives with so much modesty, as to confine their striking out of midwifery into physic, to the women lying-in, or to the time of their lying-in, since there have not been wanting some who, with equal ignorance, but superior effrontery, have intrepidly hoisted, the standard of a general knowledge of physic, and having originally insinuated themselves into families in the character of men-midwives, have easily maintained their ground in them afterwards on the foot of physicians. A circumstance not much to be wondered at, considering the endearment of such an office as that of a man-midwife, and the ascendant it must serve to give them over the heads of families, even in points where a midwife can have no shadow of pretention, for interfering. In the mean time, let any one of sense or common humanity consider but the consequences 124of this dangerous admission of the sufficiency of a man-midwife in those complicated cases, which require the consultation of a regular physician; to say nothing, for the present, of the other objections already mentioned, or which I shall hereafter more at large discuss, and the result must be, to allow that the medical pretentions, or indeed any pretentions, of these men-practitioners, cannot be too much discouraged, nor confidence more misplaced than in them. For once that they may hit the mark by chance, they will often take the part of the distemper instead of that of the patient; they will do what they have only a gross guess of being the right, not what they know to be so: and physic, at best, but a conjectural science, must in them want even the common grounds of conjecture.

Instead then of the dangerous self-sufficiency of these complex smatterers, you have in a plain midwife, supposing her regularly bred, and duly qualified for her profession (for I am no more an advocate for ignorance in the women than in the men) one, who, being called in time, will 125duly consider, and observe the constitution of the person that wants her assistence. If nothing appears extraordinary, or out of the common-rules in her patient’s constitution and conformation, she needs only lay down for her the previous course of management, and as the hour of delivery approaches predispose her properly: a point in which the men must be grossly deficient, for want of that skill of prognostic inherent to the women, from their particular delicacy and shrewdness in the faculty of touching; upon which more depends than can be well imagined. Wherever a case occurs to a midwife, so complicated as to be above her reach, her interest, her reputation, her duty, all conspire to prescribe to her a timely application to a regular physician. She communicates her doubts or difficulties to him, who, at the same time that he receives a just information from her of the state of things, combines it with his own knowledge of the human constitution. He does not confound, as the man-midwife does, ideas so different as those of the manual operation, and the medicinal prescription. The object of the physician, being the same as that of the midwife, the prevention 126or alleviation of pain to the mother, and the greatest safety to the mother and child, but preferentially that of the mother; there is this advantage to both mother and child, that all harshness of practice, all the violenter remedies will be as much corrected as can be done, consistent with the safety of mother and child, by the midwife’s tenderness, by which the physician will at the same time be above the being misled into omissions of any thing absolutely requisite. In short, on such occasions, they serve to temper one another. A truly great physician will not disdain the lights furnished him by her practical experience, and she knows the bounds of her mechanical duty and profession too well, to interfere with his superior intellectual province, in those points submitted to it. A pragmatical man-midwife, on the strength of his miserable half-learning, would think it a derogation from his character, to call in a physician in supplement to his deficiency, of which he is always ashamed, though indeed he has sometimes the excuse of himself not knowing it. Then when a fatal accident has happened, under his hands, 127against which, with more knowledge he might have guarded, or which with less of presumption or dependence on himself he might have prevented, by procuring previous or collateral advice; he thinks himself abundantly acquitted by laying the blame on occult causes. Even the great man-midwife, Mauriceau himself, has made use of that trite exploded apology^[7]: where he expressly says, “that a sudden unexpected death of his patient was one of those FATALITIES, that not all the human prudence can prevent.”

But that I may not here incur the least charge of unfairness, as if I meant by this quotation any thing so absurd or unjust, as that in the labors of pregnant women, as well as in other diseases unconnected with them, there may not sometimes happen accidents impossible to be foreseen, as well under the care of the best physician, called 128in by the very best midwife, as under the most ignorant assuming man-midwife, I shall here introduce another quotation from the same Levret, that will especially shew the ladies, and all parties concerned, to what an imaginary safety, so much, and even the very point sought for, is sacrificed as is sacrificed, in preferring the men-practitioners to the midwives. ^[8] “M. de la Motte says, that for the fifth time he laid the wife of a glover of Valogne, the 16th of March, 1704; that the woman was but an hour in her labor-pains, and that he delivered her with all the facility imaginable; that he left her upon the couch till he had given her some broth, after which he recommended her to the care of the nurse, and went where his business called him. He adds, that he had time but just to bleed two persons in the neighbourhood, before he was fetched away in haste to see the patient he had just laid, whom he found dead upon the bed. 129The cause of this death was instantly manifest to him from the stream of blood, which ran about the floor, and even penetrated to the apartment beneath, after soaking through the bed itself, in which there remained clots of blood of an extraordinary size.

“This author adds, in the reflexions at the end of this observation, that this delivery had been both more easy and more expeditious than any this woman had precedently had: and he notes, that these melancholic accidents are not without example, since such ladies as the princess of ... and madam la Presidente de —— with numbers of others, have, on the like occasion, undergone the same fate, as her he here treats of. These are, according to him, proofs that all human science and dexterity often cannot prevent the like misfortunes, since these great ladies had been lain by the most celebrated men-midwives.”

Now I might here, without much probability of being contradicted, aver, that 130where such accidents, said to happen so frequently and inevitably, should happen under the hands of midwives, there would be but one voice among the men-practitioners and their credulous adherents, to impute them to the ignorance and malpractice of the women. The plea of occult causes would be hooted at in them, tho’ receivable, it seems, from the men.

Not however to imitate what I condemn in them, a gross want of candor to the women, of whom, by the by, the very best of the men-practitioners have learnt all the laudable part of practice, I shall allow that among those frequent examples, of sudden deaths upon delivery, some few might perhaps be of those unaccountable surprizes with which nature mocks human ignorance; but then it must be allowed too, that not all of them admit of that favorable solution. The truth is that nature, to those who have studied her course, and watched her motions with a due spirit of practical observation, hardly ever but gives warning enough to prepare proper obviative methods. It is not here the place to enter into the discussion of those 131deaths by sudden hemorrhage upon delivery, of which I shall hereafter attempt to give a more satisfactory account, as well as of the measures of prevention, than Levret. My end in the preceding quotation is to show;

First, that by the confession of the men-midwives themselves, the most fatal accidents frequently, and inevitably happen under them in spite of all their science and dexterity!

Secondly, to offer to the reader a reflexion for himself to judge of the validity of it, to wit, that, not only in the cases of the hemorrhage, but in many others, where there is a complication of disorders with the state of pregnancy and parturition, much of the safety of mother and child must depend on that general medical knowledge, to which the men-midwives have so little grounds of pretention. Nor indeed, for the symptoms of necessity for resorting to medical help, have they the same shrewd prognostic or acute sense as the experienced women, who much 132sooner perceive the danger before it is too late, and are neither with-held by a false shame, nor by a criminal or senseless presumption, from calling in proper assistence. Such at least has been and still is their practice in all ages, and in all countries, where the matters of pregnancy and lyings-in are committed to them. The great object of the man-midwife is to impose so false a notion on his patient, as that his partial knowledge is sufficient to every thing. The consequence of which is, that if he is not too officious, too pragmatical, by way of ostentation of his art, in common cases, that is to say, where there is no complication of disorders, every thing may pass off tolerable well, till the crisis of labor-pains. And in that crisis I defy him, with all his learning, to equal the female skill and cleverness, not only for lessening the sufferings of the patient, but for facilitating the happy issue of her burden.

But where there is a complicated case, dependent on the physician’s art, then the trusting to those men-dabblers in midwifery is a folly that may be fatal to both 133mother and child, or, at the best, the delivery will have been rendered more painful, more laborious, more big with danger, for those precautions having been neglected, which can be so little supposed to occur to the common run of men-midwives in cases foreign from their rote of practice. Yet it is precisely in those disorders collaterally contingent to pregnancy, and no disorder does that state exclude, that the greatest skill and knowledge of physic are required. Then it is, that not only the preservation of the mother claims regard, and certainly the preferable one, but even that of the child is no indifferent point. And to save both, the state of the mothers constitution must be carefully considered. Thus the combination of the disease with the pregnancy, the due regard to the mother as well as that to the child, form a triple object that takes in a compass of comprehension to which no midwife will pretend, nor can be imagined to exist in the mere man-practitioner of midwifery. Such a nicety of observation does not seem to be the province of a manual operator, and indeed useless to him in that character. And as he will be more likely 134to trust to conjectures, which no sufficient grounds of study will have justified his presuming to trust, he must oftener take the part of the disease than of the patient. It is well if sometimes, disconcerted at the excess of a danger of which he does not understand the origin or nature, he does not, in default of the head, employ the hand, and engage the mother in a premature or forced delivery of the child, to the imminent hazard of the lives of both. Now comes the chirurgical operation in play; and we shall now see, that the ingraftment of the surgeon upon the midwife, deserves equally at least reprobation with that of the physician.

But before I enter on this disquisition, I am to observe, that this objection to the surgeon’s commencing midwife, does not in the least attack the merit of that respectable body of men, the surgeons. No one can honor their profession more than I do: I even readily grant, that their skill in anatomy is of service to midwifery itself, into which it throws a great light. It would be easy for me to name, if requisite, several 135surgeons, who are not only an honor to their country, from their excellence in an art so beneficial to mankind, but an ornament to society, from their extensive humanity and charity. These, I am so far from thinking, will hold themselves honored by the men-midwives attempting to make a common-cause with them, that I rather depend on their bearing witness on the part of the women in this cause, which is indeed the cause of Nature, of that Nature which they study so practically, consequently so usefully, and with which they are so conversant. I am persuaded they can even furnish me with arguments, from their superior store of knowledge, in supplement to my deficiencies. The surgeons must look on these professors of midwifery as a kind of amphibious beings, hard to define, whose claim exhibits rather the deformity of a preternatural excrescence, or wen growing out of the chirurgical art, than the becomingness of a natural member of it. Most of the first founders of this new sect of instrumentarians in this country were, or I am greatly misinformed, neglected physicians, or surgeons without practice, who in supplement to their 136respective deficiencies, greedily snatched at the occasion at that time of a prevailing whim in France, of employing men-midwives, with just such a rage of fashion, as some of the ladies there prefer valet-de-chambres to waiting maids. This novelty then appeared to practitioners despairing of business enough in their own way, an excellent scheme for eking out their scanty cloth with this bit of a border, of which by degrees they have made to themselves a whole cloak. In short novelty joined, to the much exagerated objections to perhaps a few insufficient midwives, brought in and established a remedy yet worse than the disease. Their success encouraged others; and now behold swarms of pupils pullulating, and forming on the models before-mentioned. Thus two or three maggots have produced thousands. Iron and steel are not tender: and yet it was by the pretended necessity of resorting to instruments made of these metals, that these out-casts of either profession effectuated their introduction into a business so little made for them. Then it was, that not with the least squinting view to filthy lucre, but purely out of stark love and 137kindness to the women, that these redressers of wrongs, armed with their crotchets, and other weapons of death, took the field on the hardy adventure of rescuing the fair sex out of the dreadful hands of the ignorant midwives. But as to the validity of that plea of theirs, of the necessity of employing instruments, I reserve to treat of it at large in its place in my second part.

Here I shall only request the reader to remember, what has been said of the indecent, superficial, and even cruel method of training up pupils in this upstart profession. But if I was to add here my having been credibly informed, that there are novices who watch the distresses of poor pregnant women, even in private lodgings, where, under a notion of learning the business, they make those poor wretches, hired for their purpose, undergo the most inhuman vexation, in a condition so fit to inspire compassion, and where those scenes must be rather a school of brutality than of art: if I was to urge, what from the great probability of the thing I firmly believe, that more than one unhappy creature 138has fallen a victim to the rudiments of these novices; that especially not long ago, one of them in a hurry and confusion of presumption and ignorance, instead of the after-birth from a woman, tore away, by mistake, her womb itself, which occasioned, of all necessity, the poor creature’s dying in unutterable agonies of torture: if I was yet to go farther and assert, that even not one of the least eminent men-midwives pulled off the arms of a child in his attempt to extract it, and very gravely laid them upon the table; what would be replied to me? It would be said I had invented these horrors, or forged such raw-head and bloody-bones stories, purely in favour of my own cause. And to this objection, while I produce no proof, and for my producing no proof other reasons may be obviously assigned, besides that of those cases being non-existent, some of which I am very certain are true, and firmly believe all the rest; to this objection then I say, I make no reply. The reader, who will have considered this matter, may easily decide within himself the degree of probability in such allegations. But what objection will stand good against authorities 139of reasonings and facts, produced from the writings of the men-midwives themselves? Will they be suspected of partiality or aggravation of things against themselves?

I shall here select one of perhaps the most excusable examples from the circumstances accompanying it, or it would probably not have been produced by the author a man-midwife, to shew, by the confession of the men-midwives themselves, the insufficiency of their discernment, whether a child is dead or not.

“Edge-tools and crotchets naturally inspire horror, and though they ought not to be employed unless on a dead child, it is well known the mother is not always safe from the effect of them. Besides there are no signs of the death of a child, though he should have stuck in the passage for several days ... certain enough to authorize a recourse to a method which infallibly kills it, if it is not dead before. This is so true, that whoever will turn over the authors antient 140and modern, on this subject, there is not one of them that gives us satisfaction on this point. On the contrary, they all seem agreed on the insufficiency of these signs, and there are even few of them who do not bring examples to support this uncertainty.

“Here follows one taken from the observations of Saviard, p. 367. This author says, that a chirurgical operator, whose name he prudently suppresses, being sent for in aid of a midwife^[9], to 141extract a child that had stuck six days in the passage, and which he thought dead, from several of the signs most essential to conviction, it happened however, that having opened with his bistory the teguments and membranes which occupy the as yet unossified space, at the commissure of the parietal bones with the fontanelle, it happened (said he) that on opening this place with his bistory, introducing his crotchet at this opening, and having fixed it in one of the parietals, he drew out the child, who began to cry piercingly, all hurt as he was by so large a wound, that there came out of it more than an egg full of its brains, which made a cruel sight in the eyes of the by-standers, and a very mortifying one for the operator.

“It were to be wished that this was the only example: but I will not relate any more; it is easy to think one cannot be too circumspect in the matter of such relations. Levret, p. 77.”

142Now I, who have not the same reason for circumspection in this case, as Monsieur Levret, with strict regard both to matter of fact and to candor, agree with him, in averring, that this is not the only example perhaps, by thousands, of the rash resort to the expedient of opening the head, and extracting the child with the crotchet; an expedient which, as Dr. Smellie observes, (p. 248.) “produced a GENERAL CLAMOR among the women, who observed, that when recourse was had to the assistance of a man-midwife, either the mother or child, or both were lost.” Now of not filling up the cry of those women, I must own I should be most ashamed. Especially when the good Dr. by way of curing our fears and weak apprehensions, and of shewing the nonsensicalness of them, first very gravely tells you the insufficiency of all hitherto invented instruments, and only modestly concludes, that the forceps of his own ingenious contrivance, is indeed the best, but still imperfect. His homage to truth would however not have been so imperfect as it is if he had said that instruments may be totally left out of good practice, and that no 143“artificial hands”, as he calls them, can, in any case, constitute a worthy supplement to the natural ones; no not even to his own, supposing iron and steel to be ever so little less tender than his fingers. ^[10] But why do these gentry then so much insist on the absolute necessity there is of sometimes having recourse to instruments?——Why? The motive for that insistence is so transparent, that not to see through it would indeed be blindness. It is the capital, and perhaps the only plea that has the least shadow of plausibility for the men to intrude themselves into the women’s business of midwifery. The women do not pretend to the art of handling those instruments, and would be very sorry to pretend to it. Nor do those midwives, 144who are sufficiently skilled in their art, ever need the supplemental aid of them: whatever is done with them is as well, and infinitely more safely done without them: so that the only grounds of introducing men into that female practice is essentially false. The making then the surgeons art a pandar to a sordid interest, by the incorporation of midwifery with it, is, in fact, engrafting on a noble stock, a scion of another one, both which would bear very well separate, but, thus joined, can produce nothing but a vile poisonous fruit.

If there could be such a thing as laughing in a matter of such general importance to human kind as the fixing of this point, there could hardly be any refraining from it, with regard to the conduct of the men-midwives, especially in Paris. There the novices of them, sensible of the natural defect there must be in men-practitioners, apply for improvement to the regular midwives. There is particularly, among others, one Madam Clavier, who, when I knew her, lived in the Rue de St. André, that gave lessons, at so much a-head, to 145the men-students of midwifery. Yet these same men have no sooner got a smattering of all that is valuable in the profession, for beyond a practical smattering at most nature refuses them further progress; they, I say, have no sooner acquired a little useful insight from these laudably communicative midwives, but they are the first to swell the cry against them of, “oh these ignorant midwives!”——or “what can be expected from a woman?” And what is more yet, among women it is, that they can make this equally ungrateful and false clamor prevail. And women, in a point of the utmost importance to themselves, prove that the men have, in fact, not quite a wrong idea of their weakness, since they are weak enough to countenance a notion, that so unjustly dishonors them in every sense. But that is not enough. What one should imagine, women especially would consider, is that this notion received with its consequential exclusion of those of their own sex, tends to have their own pains aggravated, and the safety not only of themselves but of their so naturally dear children, yet more endangered.

146For the truth of this increase of pain and danger from the practice of the instrumentarians, it is not to any representations from me only, who may be supposed too interested a party, but to reason, and even to reason’s best mistress, Nature herself, that I appeal. I appeal even to the very writings of the most celebrated men-midwives themselves, to which I would refer all who are sincere enough with themselves to be resolved to embrace truth when discovered to them. It is then even in the writings of those men-practitioners, that a lover of truth might find enough to satisfy himself, that all the mighty pretences of the men-midwives to superiority of skill and practice to the women are false and absurd. Look into Deventer, Peu, La Motte, Mauriceau, Levret, Smellie, &c. and you will find that, except their accounts of the innocent manual function, in which midwives must so much excel them; except their pernicious practical part, on which they so tediously insist, by way of recommending each some particular instrument that is to usher him into employment, and increase his profit, in which 147noble view he takes care to decry the instruments of all others, or at least prefer his own; except the scientific jargon of hard Latin and Greek words, so fit to throw dust in the eyes of the ignorant, and give their work an air of deep learning; except what they have pillaged from regular physicians and surgeons, who have treated upon these matters: except in short all the quacking verboseness of the various histories of their exploits and deliverances of distressed women, and you will find the merit of their whole works shrink to little or nothing, under the appraisement of common sense and true practical knowledge. The most that you will find in them, is, hard or lingering labors, oftenest precipitated fatally to the mother, or at least to the child; they hardly, you may be sure, carrying their candor so far, as always to mention when it has proved so to both; of which however the tenor of their practice with instruments gives you but too much room to presume the probability. In short those cases, of which their works are chiefly patched up, are little better than so many quack-advertisements; and their best exploits 148therein recounted not a whit preferable; nor indeed so practically just, as what would appear in the common daily practice of a regular well-bred midwife, that should keep a register of her deliveries. There might not indeed appear so much anatomy in her descriptions, but, I am very sure, there would be couched in them much more solid instruction. Not that I therefore have not the highest deference to the true physicians, the true surgeons. But as far as I can presume to judge, it is not in the works of the men-midwives, that the best lights in midwifery are to be looked for. They are themselves for every thing that is worth reading in their writings indebted, both to the physicians and surgeons, whose arts they have despised enough to think, they may be well enough learnt collaterally and subordinately to the mechanical operation of midwifery, as well as obliged to the midwives, to whom they ought at least to go to school, tho’ sure to rail at their ignorance the minute after being taught by them. In short, the most valuable lights thrown into this subject are undoubtedly furnished by those great men 149Boerhave, Haller, Heister, the great Harvey, and other the like excellent physicians and surgeons, not one of whom however, I presume, in the way of making a trade of it, ever delivered a woman in his life.

Nay! was any accident requiring a chirurgical operation to befall a pregnant woman, I should think the application would be more safely made to a thorough regular-bred surgeon, than to one of the common run of these men-midwives; and the exceptions are so few, they are hardly worth making. The reason too for such a preference is obvious and natural. A regular surgeon probably would not only be more consummately skilful and expert in his general notions, both theoretical and practical, so far as surgery was in the question, but would not, from any thing only partial in his profession, have the same temptation of bringing into play a horrid apparatus of murderous instruments, to show the importance and utility of that anatomical midwifery of theirs, all the art of which consists in the violences it offers to 150Nature. What would be to be done, the true surgeon could hardly do worse than the pragmatical man-midwife, and most probably would perform it much more artistlike, except perhaps in the sole point of striking a crotchet into the brain-pan of a live-child, or needlessly tearing open, with iron and steel, parts so tender and so delicate, as hardly to bear the touch of even the softest hand, guarded with all precaution. He would not, in short, be so forward to use means destructively dangerous to both mother and child, and at the best often to ruin a woman for being a mother for ever after.

Upon the whole then, if any one will dare give his own understanding fair play, against the powers of prejudice and interested imposition, it cannot but, on a fair examination satisfy him, that that strange anomalous complex creature of the three arts, physic, surgery and midwifery, is most likely to excel in neither. It may by great chance be an indifferent physician; IT must be in this respect a dangerous surgeon, but IT can never be any thing 151but a despicable midwife; or if that favorite name of accoucheur, IT is so fond of assuming, should not be popular enough from its gallicism, let IT change it for the Latin one of Pudendist: a word of not one jot a more pedantic coinage than Dentist, or Oculist, but of which moreover the propriety of the sound may somewhat atone for the pitiful play of words it contains, and which can yet scarcely be more pitiful than the object of its application.

Objection the Twelfth.

It is not probable, that the men-practitioners would have come into the vogue in which we see them, if numbers of instances were not to be produced in their favor, of their having terminated happily many labors, in which they have been preferably employed, and to the exclusion of the midwives.

ANSWER.

This only proves, what none in their senses will deny, that the greater part of the cases of labor are so mild, that not 152even that faultiness of the men-practitioners, which is palpably owing to an incurable imperfection of Nature, not, in short, all that is bungling or deficient in their preliminary disposition and manual operation, can absolutely frustrate the kindness of that Nature, of which these intruders are not ashamed of assuming the honor. But that inference of the men in favor of themselves is as ridiculous as it is false. In those cases of labor, which are much the less frequent, and require no extraordinary assistence, the utmost of the real merit of these bunglers is only of the negative kind: that is to say, they have not destroyed the mother nor the child; and indeed, every thing considered, great is the praise to them thereof. It is not always, even in naturally easy labors, that the women who employ men to lay them have not a harder bargain of them.

But even in these propitious labors, the mischief done to a lying-in woman, by employing of a man to the exclusion of a midwife, is not a small one, if pain is an evil, and the lessening that evil a desirable 153good. For certainly there can hardly be a case of lying-in supposed, in which some labor-pains are not felt. The bringing forth children in pain, stands hitherto the irreversible decree of nature, from which few women can promise themselves a total exemption. But these pains, if they cannot be entirely spared, to the lying-in woman, will always admit of actual or preventive alleviation. That alleviation can be no inconsiderable object to women, who are by their nature so tender and so impatient of pain. Even then in the prospect and presence of the very gentlest labors, there are two natural points to be respectively attended to. The one is the predisposition of every thing, according to art, so as to render the expected labor-pains as moderate as possible. The second is in the manual function, at the actual crisis of the delivery. Now, in both these points, for reasons above-deduced of the superior aptitude in women derived to them from Nature herself, a woman may reasonably depend not only on a more simpathizing cherishment, but a more efficacious assistence from those of her own sex. There 154are a thousand little tender attentions suggested by nature, and improved by experience, that a midwife can employ both preventively and actually to the mitigation of her charge’s pain; attentions which, if even they ever entered into a man-midwife’s head, could not be accepted but with repugnance, I will not say only by a modest woman, but by any woman at all. And the truth is, that there can be few men in the world, but what, the more tender lovers they are of the women, but must be only the more disgusted, the more impatient of the midwife’s preparatory part of her office, which is however the most important one, both as to the prevention of pain, and to the safety of the delivery.

But even where those preparatory offices have been omitted, or at best perfunctorily performed by a man-midwife, and where the actual function in the crisis of labor has been deficient, or at best indifferent, the labor may still have proceeded, and the patient delivered with only more pain, than she would probably have suffered 155under a good midwife’s hands. What follows then? Why this; that the patient in the transport of joy at her delivery from pains which are hardly ever but great, even though much less than her fear had magnified them to her; instead of gratitude to that Nature, which can constitute to her only a vague object of the mind, her weak imagination gives to the assistent man-midwife, a more palpable being, as he is of flesh and blood, the merit of a deliverance, in which he had most probably no other share, than its being his fault that it was not yet less painful than she has found it. But this is not at all. What sounds towards a paradox, and yet is strictly true, is, that the more pain the patient has endured, through the man-midwife’s fault, the greater will her gratitude be to him. The reason is as obvious as it is natural. Herself not knowing, nor having perhaps any idea of what ought to have been done for her more perfect relief, she will have no conception that the man has omitted any thing: she will give him credit for what he has appeared to do for her; and measure her sense of acknowledgement by 156the pain from which she will suppose he has helped to rid her; and in her joy at her delivery would think it even an ingratitude to listen to suggestions from others, or even from herself, that should tend to diminish, explain away, or may be reduced to less than nothing, the benefit she so vainly imagines was his work.

Yet nothing is more true, nor indeed more likely to be true, than that besides the natural pains of labor not having been obviated by a due preventive method of assuagement; besides their having been unskilfully attended to in the article of the delivery, through the natural unhandiness of the men-midwives, it does not unrarely happen, that their defective practice, not only occasions to the women much greater pains, but even much greater danger than would probably have been the case, I will not say if a midwife, but even if Nature had barely been left to herself, that is to say, if nature had been neither injured by a clumsy aukward attempt to help her, nor injudiciously interrupted, nor prematurely forced or cruelly hurried. The patient 157is however delivered, and delivered so that, if she was better informed, or less blinded with joy, instead if thanking the operator, to whom she attributes her deliverance, she would have to impute to him all the increase of pain she had unnecessarily suffered, all the increase of danger of which this man so thanked was himself the author. Then it is, that even in a subject so serious, a judicious by-stander might give himself the comedy of observing the airs of consequence, which an operator assumes for a woman under his case not losing the life, of which but for him she would most probably not have been in the least danger. Thus a man, whose all of merit well weighed, is no more than not having been able to consummate the destruction of mother and child, in spite of the kindness of nature, shall for that negative merit be allowed the positive one of having performed wonders of art. Then it is that the mother naturally in a rapture of joy at her deliverance, in which she never remembers but with a gratitude, of which she only mistakes the object, by paying to the operator, what in fact was 158due to nature; then it is, I say, that the mother, father or parties concerned, for want of making due allowances in a point they are so excusable for not understanding, cordially join the self-applause of the man-midwife. Nor does it unfrequently happen, that one of these instrumentarians, after an operation, for which he deserves the severest censure, and of which, whatever necessity he had to plead was originally owing to his own unskilfulness or omission, shall strut about the room, and florishing his butcher’s steel, sing an Io Peean to himself, “for that his victorious art had saved nature as it were by enchantment”^[11]. Then it is, that in full chorus the deluded parties, in the innocence of their heads and hearts, hold up their hands to heaven, and piously exclaim, “what a narrow escape the patient had, thanks to the learned Dr. and what a mercy it was she had not been trusted to such an ignorant creature as a midwife must be.”

159This folly has even sometimes gone so far, that when a woman has, through a man-midwife’s mispractice, suffered perhaps a wrong, so deep as to be disqualified for ever after for being a mother, or had a fine child, literally speaking, murdered (secundum artem indeed) he has, what with scientific jargon, through the cloud of which it was impossible for persons unversed in the matter to discern the truth, what with an air of importance, and what with especially her own weak prepossession in favor of the superiority of men to women-practitioners, known how to impose on her the most atrocious injury for so great a service as that of saving life is for ever held. The deceived patient then thinks she cannot thank him too much, nor reward him sufficiently for what he could be scarce punished enough, if proportionably to the mischief he had done; and to which his mis-representations have perhaps even made herself innocently an accomplice.

This indeed is easily to be accounted for. A pregnant woman must especially, in the moment of her labor-pains, think 160herself too much in the power of the operator, to whom she has trusted herself, to dispute his judgment. She may even, and that is probably oftenest the case, have too good an opinion of it, to dispute it. Her labor is severe, and, as before observed, severe, or at least the more so, very likely from some fault of his. Her deliverance lingers; Nature, from some vice of conformation, or defect of art in her assistent, appears faint, remiss, insufficient, in short, in her expulsive efforts; in the mean time, the pains of the patient grow more and more intense and intolerable: the man-midwife, either perplexed or impatient, or not knowing what better to do, has recourse to those fatal instruments, with which the odds are so great, that he will gall, bruise, or irreparably wound the child, or the mother^[12]. In 161some cases indeed, he may take the dreadful advantage of the mother’s agonies of pain, to use those instruments, and do her a mischief she may not just then feel, from the pain of the operation being absorbed in the greater one; to use them, I say, unobserved by her^[13].

But where the exigency appears yet greater, where, in short, the operator imagines, as he too often imagines such an extremity where it does not exist, as that either the mother or the child must perish, it is his maxim, and certainly a very just one, to consider the mother’s safety, as the preferable object. Of this preference then he makes a merit, so much the more acceptable to the mother for her own self-preservation being so palpably concerned, and so much the less disputable for her not knowing but he may be in the right, as to the reality of the fatal dilemma. In such a doubt, if nature takes the part of 162the child’s life, which is at stake in the decision, she also much more strongly and reasonably takes the part of the mother’s own existence in the mother’s own breast. She cannot then deny the premisses, of which she is no judge, when the inference is not only in favor of her life, but even a very just one upon the admission of those premisses. The temptation also of a quick riddance from a violent state of pain, is too great a temptation for a weak woman, overpowered with her actual feelings in that rack of nature, to resist: she acquiesces then, or perhaps her husband, her friends, equally ignorant with herself of the truth of things, and duly simpathizing with her in her impatience of her longer suffering, even virtuously, even piously acquiesce in the recourse to these instruments, which are so sure of destroying the child, and hardly ever fail of doing the mother great and sometimes irreparable mischief.

When then the child has been destroyed, the mother damaged; in satisfaction for all this tragic-work, what have you 163but perhaps the learned Doctor’s assertion, “^[14]that if this force had not been used, the mother must have been lost as well as the child.”

Now granting what is the utmost that candor can be expected to grant, that in but the doubt of the mother’s life, it is right to sacrifice the life of the child to that doubt, and much more to the certainty of the mother’s life not to be otherwise saved, than by these fatal instruments, I beg and entreat all fathers and mothers, or who are likely to be so, to consider with themselves whether:

In the first place, an experienced midwife is not more likely to prevent such an extremity by previous management, proper anticipations, and actual handiness during the labor-pains, than the aukward man-practitioner (as most of them evidently are) who must, naturally speaking, be so much her inferior in those points of her art, which conduce essentially to the 164smoothing the way for, and effectuating a delivery; and from the defect of which points that necessity which, is pleaded of a recourse to instruments, originally takes its rise. So that in fact they who are the authors of the danger, pretend to remove it, and how? by an evil only inferior to death itself, from which however those are not always safe, to whose safety so much is sacrificed in vain.

In the next place, it may well be recommended to consideration, whether, as the common methods^[15] confessedly allowed 165by the men-midwives to be the preferable ones, since the recourse to instruments is not even by them allowed, until the common methods are exhausted, there is not great reason, without breach of charity, to imagine that the natural unfitness of the men for the common methods does not determine especially the common men-midwives to an over-hasty recourse to the extraordinary ones, and make them see very dangerous symptoms, where they are no better than phantoms of their own creation; so that by their eagerness to embrace them for an excuse, they lose to the patient that benefit of patience in general, which Dr. Smellie himself allows in a 166particular case^[16]. To which patience the midwives are so much more inclined than the men, as indeed they may well be, since, should that even be exhausted, they have no instruments to fly to for the abridgment of a labor: and where they understand their business, not only every thing is best done without them, but the want of them is prevented.

But besides the common motive of impatience in the men-practitioners for resorting 167to that dangerous expedient of making short work, of which the women are unhappily incapable^[17], or at least which the good artists among them hold in the contempt and detestation it deserves; are there no other motives from which recourse may be had to the instruments? I have hinted at some: but as the matter is of infinite importance, from the use made of these instruments, in introducing men into the practice of an art so appropriated to the women, it cannot but be of service even to the public, to discuss the justice at least of some of those hints, and examine whether there is any farther foundation for my fears, that the precipitancy of the men in their resorting to instruments, or to the prematurely forcing a delivery, to 168the utmost danger if both mother and child, whether, in short, the pretence of extremities may not, in some cases, have even other causes, than a natural incapacity for the common method, an ignorance of better practice, or their impatience.

I have before remarked what I here repeat, and repeat it without the least apprehension of being justly taxed with breach of charity, that a mere sordid view of lucre, of supplementing, in short, deficiencies of success in other professions, was originally the foundation in this country of that novel sect of men-midwives, which we have in our days seen so much multiplied. If any can imagine that the instrumentarians, with their crotchets, their forceps, and the rest of their iron or steel apparatus, had more in view the relief of the distressed females, from the dangers to them in the ignorance of the midwives, than they had their own interest, in the stepping into the place of those they so injuriously decried; if any, I say, can believe that sheer humanity, and not sordid gain, was their view, I can only 169pity a credulity, that must proceed more from a goodness of the heart, than of the head. But to whoever will deign to consult his own reason, exercised upon facts and the nature of things, may easily satisfy himself, that interest, and interest only, inspired and actuated these intruders into a province so little made for them, of which there can hardly be a stronger presumption than the very recommendation of instruments, of which not one of them but must know the perniciousness, though they make it the capital handle of the introduction of themselves. Not one of them but rails at them, and uses them. Now, as I may safely take it for granted, that interest is at the bottom of this innovation, where that same interest is the principle, it will hardly be denied me, that it is generally speaking the leading or the governing one. It is rarely contented with acting a second part. It often exacts sacrifices, but is rarely itself one. All the actions and procedure of its votaries take the tincture of it. Humanity and all the virtuous or tender passions are either totally excluded, or exist with little or no efficacy in a heart enslaved by interest.

170In virtue of this reasoning, and I should be much more glad of finding myself mistaken (knowingly I am sure I am not so) than that it should be but too much verified by matter of fact, I shall here submit a case to the reader for his own decision on the probability, and I dare swear, that among the female readers especially, I may chance to have, there will be more than one, who, on her own personal experience, could attest the existence of such a case, or at least has the strongest grounds of presumption of it.

A Woman then, lingering in a severe labor, and urged by her pains naturally to wish the speediest end of them, is yet by another superior promptership of nature desirous of meriting the sweet name of mother, and is inclined of herself not to think it over-purchased by a little more patience. In this crisis, much must depend on the judgment, and consequently on the advice of the assistent practitioner, male or female. If a midwife, besides the tenderness constitutional to her sex, her natural 171fears for the mother especially, not without a due share of concern for the child, where there is a possibility of saving it without too great a risk to the parent, besides the superior execution of her art in points of the manual function, she is moreover bound in all duty to see one labor come to its issue before she undertakes another; for the sake of which, she cannot well, if she would, without instruments, prematurely force a delivery by such violent, dangerous and so often destructive means. She will then in course encourage and inspirit her charge with patience, and use all the blandishments, soothing methods imaginable to comfort, relieve, and strengthen the resolution and spirit of the lying-in-woman. Now, a man-midwife, well paid, will perhaps in that cold unaffectionate manner, with which a duty that has no foundation but in interest is ever performed, exhort to endurance that patient whom his dexterity is insufficient to relieve, that patient whose pains are perhaps for the greatest part his own fault. But should he, during some lingering labor, be called elsewhere, to a more rich employer, 172or should one from whom he has greater expectations, require an attendance from him incompatible with his duty to his prior employer, is not here a temptation to make a quick dispatch with his instruments? A temptation to which it is at least doubtful whether a man, actuated by interest, may not be over-inclined to yield. It may even byass him, without his perceiving it himself. A man’s determining motive, when it is not of a very justifiable nature, is often skreened even from himself by a more specious one. Such, in the present case, is the saving the mother, oftenest by destroying, and sometimes by only galling, bruising, or maiming the child, when the mother rarely escapes her share of the suffering. How many mothers have pathetically interceded, and interceded in vain, for a respite of execution, when the operator has in a peremptory tone cut short their instances, by telling them in a magisterial way, that he knew best what to do, and could not answer for the patient’s life, if the operation was longer delayed! What reply has a poor woman, weak by nature, oppressed by pain, and subdued 173by her prepossession to oppose to such an argument of necessity, of which her own life appears to be the favored object? What husband, what friends, but must unhesitatingly subscribe to so just a preference as that of the mother and the child? Not that I would insinuate here, that such a dilemma does not sometimes though certainly very rarely exist: but is it not to be feared, that it is too often rather lightly taken for granted that it does exist? May it not be presumed, that the instruments are brought oftener into use than is necessary, for the sake of a dispatch, of which the child is almost ever the victim, and not unseldom the mother herself, who is always hurt, and sometimes irreparably damaged? May it not be justly suspected, that the abuses of Art have occasioned to many women an appearance of barrenness, from the reality of which kinder Nature had in fact exempted them?

But as if ignorance, inability, impatience, interestedness, were not all of them sufficient motives for the forcing use of these instruments, Dr. Smellie has unmeaningly 174added another, which alone must, to the greatest number of the men-practitioners, prove a greater excitement than all the others put together, if it be true, that Vanity has so great a predominancy over the human heart as it is generally imagined to have. But let us first quote him: the inference will follow.

“(P. 265.) at any rate, as women are commonly frightened at the very name of an instrument, it is adviseable to conceal them as much as possible, untill (mind pray that UNTILL) the character of the operator is established.”

(P. 273.) “Though the forceps are covered with leather, and appear so simple and innocent, I have given directions for concealing them, that young practitioners BEFORE their characters are fully established, may avoid the calumnies and mis-representations of those people who are apt to prejudice the ignorant and weak-minded against the use of any instrument, though never so necessary, in this profession; and who taking the advantage of unforeseen accidents 175which may afterwards happen to the patient, charge the whole misfortune to the INNOCENT OPERATOR.”

Here I appeal to every reader of common-sense, to every reader who knows any thing of the human heart, whether it can be imagined that any man-midwife, who is called in to the aid of a lying-in woman, will choose to appear in the character of a young practitioner, or of such an one, as that his character is not enough established to dare to use instruments, for fear of after-reflexions. Is not there, if but in this lesson of the Doctor’s, couched a strong temptation for a man-practitioner not indeed to produce openly and barefacedly his apparatus of instruments, but to be very uncautious of concealing them? Since the reason for concealing them, that of the women being apt to be frightened at them, stands coupled with another reason, the fittest in the world to work a contrary effect to both; by piquing the vanity of the operator to suffer them to be seen, and what is worse yet, to the using them only that they might be seen, especially if to this motive of ostentation you add, that if 176these instruments being the very grand and capital point of their imaginary superiority to the women-practitioners; over whom every occasion of using them seems to the men a kind of triumph.

But while it is to the novices in the art, that Dr. Smellie recommends more especially the concealment of these same terrifying instruments, the good Dr. does not seem aware, that an advice much more honest and humane might be given to the women, for whose benefit the instruments are supposed to be invented, which is, not to employ young practitioners or novices, not in short to employ those whose character was not fully established, since they might, in order to pass for adepts, or at least for no novices, be too apt to embrace occasions of florishing those same instruments with less necessity, if possible, than the great men themselves of the profession.

In the mean time, this curious injunction to the young practitioners, while the old ones are by that distinction implicitly allowed more openness in using the instruments, 177reminds me of the caution of the Regent-duke of Orleans, who taking monsieur de St. Albin^[18], a natural son of his, that was in priest’s orders, to task, for some irregularities, of which certain bishops had complained, said to him in their presence, “Sirrah, could not you stay till you were a bishop?”

But whatever may be the motives of recourse to instruments, and there are other possible ones which I have omitted, certain it is, that in this nation they are more frequently employed than even in France, where that pernicious fashion first took birth. And yet in this very nation it is, that the men-practitioners themselves own, that the less they are used the better. Now will they, to solve this contradiction of their practice to their doctrine, plead that the labors of the women here are, in general, more difficult than they are in France? Common sense and truth will however furnish a juster solution: men-midwives are more employed here than in 178France, where the women-practitioners are still respected, and less driven out of practice, consequently instruments are less frequently used. For I will not pay the men-operators of this country so ill a compliment, as to excuse them, by saying they are less dexterous at the manual function than those of France, and therefore the more obliged to have recourse to those instruments, of which they themselves have so ill an opinion, though indeed not a so thoroughly bad one as they deserve.

In the mean while they may well proceed triumphing in their career, notwithstanding all the fatal trips they make in it, while, if they did not even run it in the dark, they have so much learned dust ready to throw into the peoples eyes whom it is so much their interest to blind. No wonder then, that since, in the more severe cases, in the preternatural labors, they so often receive from well-meaning employers both pay and thanks for the greatest mischiefs, owing to their errors both of omission and commission, they should, in the less difficult, and which are by much 179the most frequent ones, where no tragic accidents have happened, have credit given them for a merit, to which their pretentions are so little examined. For this they are indebted to the overflow of a gratitude at a loss for a living object and from an impatience of doubt mistaking that object so grosly, as well as to that same prepossession’s continuing, from which they were preferably employed. Hence it is, that one might often hear women, who had not even suffered a little by their practice, from the want of knowing, that by their practice it was they did not suffer less, very sincerely say, “Dr. such an one attended me in my lying-in —— He delivered me very well.” —— Or, “I have been lain for four or more children by a man-midwife, and never had room to complain.” All which proves no more than what may very well have happened, that Nature has been too favorable to them, for even the untoward assistence of a man, in the office of a midwife, entirely to frustrate her beneficence. I do not here add the weight that fashion throws into the scale of prejudice, reserving to treat of that separately.

180But to that conclusion in favor of the men-midwives, from the supposed superiority of their success to that of the women-practitioners, contained in the objection I am now answering, I have further to oppose an argument drawn from matter of fact, to which I should imagine it difficult to find a satisfactory reply. This argument then consists in a fair appeal to Experience herself.

I have before observed, that in the Hôtel-Dieu at Paris, there are no men-practitioners suffered, for I do not include the surgeon-major, who is absolutely no more than an officer for the form-sake. Consequently there are no instruments ever employed in the delivery of the women admitted to that hospital. It is true they are extremely well taken care of; all necessaries are found them by that noble charity; but yet it cannot be thought, that the same abundance of ease and conveniences can be afforded, as by those persons, generally speaking, who employ men-midwives. This distinction I mention for the 181sake of the allowance justly to be made in the calculate I am about to propose. Notwithstanding however the superiority in this point on the side of men-midwives practice, notwithstanding the grief of mind from various causes, as well as the bad constitution of the bodies of many of those indigent wretches, prior to the reception into that hospital, notwithstanding other easily conceivable disadvantages; notwithstanding all these, I say, take any given number of patients, delivered purely by the midwives of that hospital, without the intervention of one man-practitioner, and especially without instruments, and to that given number, oppose an equal one of women attended from the first of their labor to their delivery by the men-midwives, and see on the side of which sex, in the operators, there will be found the greater number of those who shall have done well, or suffered least.

I am the more emboldened to propose such an experiment from my own certain knowledge. I have seen more than two thousand women delivered under my eyes, at the Hôtel-Dieu at Paris, some of whose 182cases must be readily imagined to have been severe or preternatural ones. Yet all of them were delivered by our midwives and apprentices without the aid of a man-practitioner; nor an instrument so much as thought of. And in all this number I can safely aver, there were but four who died upon their lying-in; and that not from any fault of the midwife’s art; but one from the complication of a dropsy, the other three, who were daughters to honest tradesmen, sunk under the shock of grief and shame at the being deserted by the men who had brought them into that condition. They died, in short, of their desire to die. Yet the children all did well.

This is a fact that does not require the being believed upon my word. The known practice at that hospital, and the registers regularly kept, will attest the truth of this computation. And here, I appeal to every intelligent reader’s own sense, to his own knowledge of things, whether it is unfairly presumed, that in the same number of two thousand women, delivered by the men-practitioners, they 183could show a roll so innocent, so free from fatal mischief or damage to their patients, to mother and to child. Let any parents, or who may hope to be parents, or are concerned but for the interest of mankind in population, weigh but the force of this argument, purely drawn from a matter of fact, of which there can be so few who are not, in some measures, judges enough to decide upon their own knowledge, or at least on strong grounds of belief or conjecture. In such a number as two thousand women delivered by the men-operators, how many, by what I know, and by what many others must know as well as I, must have perished, or been torn, ruptured, grievously hurt, or irreparably damaged! How many innocent infants must have lost their little lives, in proof of that superiority of practice in the men to the women! Or rather, in proof of that infatuate credulity, which has prevailed in favour of an innovation so unauthorized by nature, by common sense, or by experience!

184

Objection the Thirteenth.

Say what you will, the fashion will predominate. It is now the fashion to prefer men-practitioners of midwifery to midwives. You will oppose the torrent in vain.

ANSWER.

The conclusion against me that I shall oppose the torrent in vain, is a very just one. As to myself, I ought to expect that I should oppose it in vain, if the decision of the public was to turn upon any thing of so little authority as my private opinion, especially in a point where it is so justly liable to the suspicion of its being byassed, both by private interest, and partiality to my own sex. I readily then grant that my own opinion should go for nothing. But what ought to go for a great deal is my reader’s own judgment, formed upon his own reason and knowledge. But that is not all. I have some dependence on Nature and common sense recovering their rights, from this preference of the men-midwives 185which shocks both, being, in truth, nothing more than a fashion, not even of the growth of this country, but transplanted from a neighbouring one, whose follies are unhappily so contagious, though for the most part so despicable. How a few interested men, for want of business in their own professions, transplanted this baneful exotic here, where it has met with such undue cherishment has already been touched upon.

But then as this unnatural preference has all the folly and whim of fashion in it, it may be hoped, that it will also have all the instability and transitoriness of one. Time that confirms the dictates of Nature destroys the fictions of opinion. But in points where Nature is herself attacked or injured, inconveniencies and damages never fail of following thereon, enough to oppose the duration of them. The numbers of lying-in women (thanks to beneficent Nature) rather not destroyed than duly assisted by the men-operators, can neither atone for those who perish, sometimes the mother, sometimes the child, sometimes both, 186while none of them are but sufferers in some degree; nor long blind a public, that has so much interest not to be imposed upon in a matter so essential to it, by false pretences, or by an injurious and interested degradation of the midwives, who at the worst can hardly be so bad as the very best of the men, in the capital point of their business, the manual function. The oftenest greater danger, and always the greater pain, under men-operators than under the midwives hands will, sooner or later, determine the parties concerned to open their eyes on their greatest interest, in a point of such infinite importance to them.

Granting then to Fashion all the power it really has, and a greater one it is, than for the honor of human kind, can well be imagined, still, it not only has its limits of extension, but duration. It is only for the truth of Nature to be universal and eternal.

Fashion, it is true, may not only govern people in indifferent matters, such as dress, furniture, equipage, or so forth, but 187even in essential, even in capital ones, such, for example, as is this point of option between the men-operators and the midwives: it may, in short, exert its tyranny in many things, one would rather think left better to the determination of Reason. But then this tyranny cannot well be long-lived. The evils which such a fashion begets destroy at length their own parent. No opinion then, as I have before observed, can be permanent that is not founded on the truth of Nature: but where the consequences of such an opinion are detrimental to the good of society, which is the darling object of Nature; that spirit of self-preservation which she has so manifestly diffused thro’ human kind, will hardly suffer errors pernicious to it long to subsist. There is no fashion can, under such objections, long hold out against victorious Nature, who is sure to revenge the violences offered her.

And here I even officiously seize on an occasion that rises to me out of the very bowels, I may say, of my subject, of selecting for one proof of the danger of adopting innovations offensive to Nature, a 188point of such near analogy to midwifery, as that of nursing children, the care of whom, next to that of the mothers, is the true midwife’s tender province.