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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..4d41854 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #52086 (https://www.gutenberg.org/ebooks/52086) diff --git a/old/52086-0.txt b/old/52086-0.txt deleted file mode 100644 index eda15aa..0000000 --- a/old/52086-0.txt +++ /dev/null @@ -1,1525 +0,0 @@ -The Project Gutenberg EBook of The Province of Midwives in the Practice of -their Art, by William Clark - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - - - -Title: The Province of Midwives in the Practice of their Art - Instructing them in the timely knowledge of such - difficulties as require the assistance of Men, for the - preservation of Mother and Child; very necessary for the - perusal of all the sex interested in the subject, and - interspersed with some New and Useful Observations. - -Author: William Clark - -Release Date: May 16, 2016 [EBook #52086] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK MIDWIVES *** - - - - -Produced by RichardW and the Online Distributed Proofreading -Team at http://www.pgdp.net (This file was produced from -images generously made available by The Internet Archive) - - - - - - - - - The Province of Midwives in the Practice of their Art, - by William Clark, M. D. 1698–ca. 1780. - - - - - THE PROVINCE OF MIDWIVES - - IN THE - - Practice of their ART: - - Instructing them in the timely Knowledge of such - _Difficulties_ as require the Assistance of MEN, - - For the Preservation of - - MOTHER and CHILD. - - Very necessary for the Perusal of ALL the SEX - interested in the Subject, - - And interspersed with some - - _New_ and _Useful_ OBSERVATIONS. - - _By_ WILLIAM CLARK, _M. D._ - - _And of the_ College _of_ PHYSICIANS. - - _Molliter Aufer Onus._ OVID. FASTI. - - Printed for _William Frederick_, in BATH; and sold by - _M. Cooper_, in _Pater-Noster-Row_, LONDON. - - MDCCLI. - - - - -ADVERTISEMENT TO THE READER. - - -_The following small Tract will appear contemptible to those who -judge of the Worth of Books by their Bulk; but the Author believes -such as are practis’d in Midwifry will acknowledge both the Want -and Usefulness of an Essay of this Kind._ - -_The Division of the Chapters, naturally arising from the various -Circumstances which are treated of, will rather assist than -burden the Memory, and admit of a ready Recourse to the short -Instructions, in the Knowledge and Practice_ absolutely necessary, -_given under each Head._ - -_The Reader will the more readily excuse any Defect in the Stile, -when he considers_ _the Necessity of a strict Expression on the -Subject and the Difficulty a Man lies under, who writes not to -the learned and experienced, but chiefly for the Sake of Persons -ignorant in Anatomy and Philosophy, on a Subject which for the most -Part excludes Information by Sight._ - -_On such a Subject it will not be imagined Vanity or Applause can -incline a Man to write a Pamphlet, rather than a Volume; when the -Author is not conscious of having omitted the Instruction to be -found in any Book extant, within the Limits of his Design; and -hopes Experience will teach its Value both to Midwives and Matrons; -and that the Perusal will not at all injure, if it does not -improve, the most knowing and experienced._ - - * * * * * - -The READER is desir’d to correct the following ERRORS with the Pen. - - Page 9, Line 16, _read_ Pains about the Back, Navel, _&c._—P. 33, - l. 12. omit the Period after the Word Pain; and make a Semicolon, - instead of the Comma, after touch’d it. - - - - -CHAPTER I. - -_The_ DESIGN. - - -The Case of _Child-bearing_ Women is very lamentable, in the -Country especially, by Reason of the Ignorance and Unskilfulness -of _Midwives_; for by their Negligence and perverse Management, -many Mothers and Children are destroyed, to the great Misfortune of -particular Families, as well as of the _Publick_, at a Time when it -suffers by the Loss of useful Hands, from too many other Causes. It -were therefore to be wished, that all Midwives were so far appris’d -of their Duty, as to be able to distinguish between Cases within -their Abilities, and such Difficulties as may occasion the Loss of -the Mother, or Child, or both, for Want of necessary Assistance. - -They who intend to practice Midwifry in PARIS, are oblig’d to -attend _anatomical_ Lectures and _Dissections_, that their -Judgments may be inform’d, by the Knowledge of the Structure of the -Body, for an Undertaking so hazardous in ignorant Hands. - -London, at present, affords equal Advantages of Information; for -the _anatomical_ Wax-work, with suitable Lectures, might furnish as -good a Qualification, with less Offence than real Dissections; and -there are not wanting those who professedly instruct both Sexes by -_mechanical Demonstrations_. - -And for the future, it is to be hoped, there will be no Necessity -for Men to have Recourse to PARIS for _Observation_, since we have -_Infirmaries_ at Home for the Accommodation of Women in Child-bed; -and tho’ they are expos’d naked to the Eye in the _Hotel de Dieu_, -it must be confess’d, that the fundamental Rules of the _Art_ are -not built on what the Eye of the Observer can possibly discover in -the most expert _Operators_; but depend on Circumstances conceal’d -from Sight, within the Body of the Patient. - -But whatever Advantages LONDON and WESTMINSTER afford for the -Instruction of Midwives, the Country is entirely destitute of them; -and the best Books on the Subject, adorn’d with elegant Figures, -can give but a very imperfect Notion of the Parts they represent, -to any who have not attended _Dissections_, or seen more natural -_Resemblances_ than Cuts. - -The Figures in Books, exhibit the _Bones_ of the _Pelvis_, a -Variety of _Situations_ of the Infant, and _Uterus_, the Placenta -and umbilical Vessels and Membranes, _&c._ whereas it would be -no less serviceable to those, who assist Women in Travel, to be -acquainted with the Viscera, liable to suffer by a difficult -Labour; for the _Liver_, _Spleen_, _Sweetbread_ and _Kidneys_, -if not the principal Contents of the Chest, may be so injured by -the ill _Position_ of the Child, Compression of the Parts, and -rash Assistance, as to prove fatal, more or lets immediately; -occasioning _Inflammations_, _Suppurations_, _Mortifications_, -_Schirrhu’s_, _Cancers_, or _Consumptions_. - -The best Writers of Midwifry, such as _Mauriceau_, _Deventer_, _De -la Motte_, _Heister_ and others, explain the Causes of difficult -Births, and the proper Methods of Assistance; but instead of -improving most _Country_ Midwives, fill them with Conceits of what, -it is impossible, they should understand, and thereby occasion the -Loss of great Numbers of Women and Children. - -In order therefore that Midwives may acquit themselves with -Reputation, and that _Child-bearing_ Women may be the better -Judges for themselves, or the charitable Part of the Sex, who are -past these Dangers, the better able to assist their Friends and -Neighbours, I shall endeavour to shew how far they may act with -Safety under the Disadvantage of Country Practice, and describe -those Symptoms, which for the most Part accompany hard Labours, -very probably beyond their Abilities; when they will justly incur -the Censure of Inhumanity and Rashness to depend upon their own -Skill. - - - - -CHAPTER II. - - -In this Chapter I have avoided the Use of Terms of Art, or -explain’d them, in Regard to those for whom I chiefly write, as -far as my Regard to Decency admits; but if any Word should occur -not easily understood by any of my Readers, almost any _English_ -Dictionary will explain its Meaning; and it cannot be expected that -any Book can instruct those who cannot read, tho’ I am sorry to say -too many such assume the Office of _Midwives_. - -As Curiosity may reasonably induce many of the Sex concern’d in -the Subject of these Sheets, to be inform’d of somewhat of the -Provision supreme Wisdom has made for the Existence of Children in -the Womb, I shall briefly mention the most obvious _Instruments_ -relating to their Breeding and Birth, without puzzling my Readers -with minute _anatomical_ Descriptions. - -The Vagina, or Passage, lies between the Neck of the _Bladder_ and -the large or strait Gut; it is connected at the inward extreme to -the _Womb_, and called the _outward Orifice_ at its beginning. - -The _Womb_ lies between the _Bladder_ and _Strait Gut_, and is -connected to both; during the Time of _Breeding_ it increases in -its _Dimensions_, and rising higher in the Body, by Reason of -the Weight and Substance of it, with its Contents, at the Fund, -or remote End of it, may be liable to swag too much _forward_ or -_backward_, or incline more or less to either Side, especially in -such, as by their Occasions of Industry in Life are obliged to -a Variety of _indirect_ Situations; by which Means the _inward_ -Orifice is perverted from a _direct Site_ with Respect to the -Passage, and obstructs an easy Exclusion of the Infant in Travel. - -The _Placenta_ or _After-birth_, adhering to the _Fund_ of the -_Womb_, receives the _Mother_’s Blood, by the _Umbilical-Vessels_, -or _Navel-String_, conveys it to the Child for its Nourishment, and -retransmits what is superfluous; maintaining by the Intercourse of -_Arteries_ and _Veins_, the Circulation of the Blood between Mother -and Child. - -The _Membranes_ closely connected to the _Placenta_, and the _Fund_ -of the _Womb_, between both which they seem to take their Rise, -contain the _Humours_ in which the Infant swims, the better to -preserve it from Injuries, by its Pressure against _unyielding_ -Parts, and the _Humours_ before, and after the _Breaking_ of the -_Membranes_, commonly call’d the _Breaking of the Waters_, in the -Birth, very much facilitate it, by opening the _inward Orifice_ -of the _Womb_, and lubricating the _Passage_ for the Child: These -_Membranes_ come away with the _Placenta_, under the Name of the -_After-birth_, or _Secundines_, indifferently. - -The _Pelvis_ or _Bason_, wherein the _Uterus_ or _Womb_ is seated, -is form’d by the _forward_ Bones, commonly call’d the _Share-Bone_, -the _Hip-Bones_ and their Continuation on each Side, and the lower -Part of the _Back-Bone_, all which are so contiguous to each other, -as to form this Cavity, generally much larger in Women than Men, -cloathed with Muscles, between which the _Vagina_ is inserted. - -The right Formation of the _Pelvis_, is of the greatest Consequence -in Favour of an _easy_ Birth; when the _Bones_ forming it, -_forward_ and _backward_, and on _each_ Side, both above and below, -don’t too much approach each other, and prevent the Exclusion of -the Child between, by a free Admission. - - - - -CHAPTER III. - -_The Symptoms preceeding_ Natural Labours. - - -I shall pass over the Symptoms of Pregnancy, and the Distinctions -of true and false Conceptions, as Things of which Midwives can -seldom be expected to be _proper_ Judges, and proceed to their -Business, _Natural Labours_; comprehending, under this Name, all -such Cases, which require no further Assistance than _Midwives_, in -a general Way, may easily give; or in their Absence a Nurse, or any -sensible Woman, who has attended Deliveries. - -After the Woman has gone her due Time of Nine Months, the most -usual Term; the Signs preceeding Labour are Pains about the Back, -Navel and Loins; a considerable Falling of the Tumour of the Belly, -by the Burden’s sinking lower; and incommoding the Woman in -walking; a more frequent Inclination to make Water: These Symptoms -increase in Proportion as the Birth approaches; but as the most -certain Knowledge of _natural_ Births, can only be obtained by -_Touching_ the Woman in Labour, after having premised some Things -concerning her _proper_ Situation; I shall direct how it ought to -be done. - - - - -CHAPTER IV. - -_Of_ SITUATION. - - -Many in the Country choose to be on their _Legs_ or _Knees_, -supported by a Woman on each Side, or _lean_ on a Chair or Bed, and -pass well enough through the present Scene of their Miseries: But -I would preferably advise a Posture between _lying_ and _sitting_, -on a _Pallet_ or _common_ Bed, the _Head_ and _Shoulders_ being -_rais’d_ by Bolsters or Pillows, the Feathers _beat back_ from the -Bed’s Feet, to support the hollow of the Loins, and prevent the -Pressure of any Thing against the _Bottom_ of the Back Bone, to -obstruct the Passage of the Child. - -This _Situation_ is most commodious, during Labour, for a Woman to -_assist_ her Pains with the greater Freedom of Respiration, and the -least Fatigue and Expence of Spirits; especially if the _labouring_ -Woman lay hold of a _folded_ Napkin, held stiffly for that Purpose, -drawing her Feet _upwards_ towards her Seat, _separating_ her -Knees, and _fixing_ her Feet against something that will not easily -give Way. - -If the Person in Labour will not be in Bed, the End may be -answered by her _sitting_ in _another_’s Lap, with the _Bottom_ of -her Back-Bone situate between the other’s Knees, with her _own_ -separated and supported, and Feet fixed as aforesaid, to favour -her bearing down. - -’Tis inconsistent with the Design of my Writing to describe all -the _convenient_ Situations, necessary in Cases of Difficulty, yet -when the Operator has rectified all Obstructions to the Birth, the -same Situation of the Body upon a _Slope_, from the Head downwards -is most suitable, even altho’, for Conveniency, she should be -deliver’d lying on one Side. - -I shall, on this Occasion, observe, what I have found Advantageous -in my own Experience, as well as consonant to the Advice of the -best Writers on the Subject: That the Delivery on the _Back_, by -the Assistance of one placed on _each Side_, supporting her by -the _Hams_, with her Knees _separated_, and raising her _Back -Bone_ a little from the Bed during the _Activity_ of Pains, and -the _Midwife_’s _Assistance_ of either Sex, is vastly preferable -to the Delivery on _one Side_, to which I impute the Loss of many -Children brought by _Turning_, as well as a more _tedious_ Labour -in other Cases; because this Posture, in some Degree, _contracts_ -the _Passage_, and only admits the proper Separation of _one_ Knee. - - - - -CHAPTER V. - -_Concerning_ TOUCHING. - - -This ought to be put in Practice, as soon as, from the Symptoms -given in the Third Chapter, it is reasonable to expect the Birth -approaching; and a _Child-bearing_ Person would be very much her -own Enemy to refuse the only Means of giving a _true_ Information -of her Case, and the Knowledge how to do her the most effectual -Service. - -The Midwife, having her Nails well pared, and very smooth, and her -Fingers anointed with Oil or Lard, must introduce the two _fore -Fingers_ of either Hand into the _Passage_ or _Neck_ of the _Womb_, -as far as its _inward_ Orifice, directing them with a _gentle_ -and _easy_ Motion, somewhat upwards, as it were with a Tendency -through the _Passage_ towards the _Navel_; in this Search she will -find the _internal_ Orifice, joining the _Passage_ or _Neck_ of -the _Womb_ more or less open, relaxed, and thinner than usual; -and cautiously protruding her Fingers farther, she may possibly -touch the _Crown_ of the Child’s Head; she will easily, by the -_Sutures_, or _Opening_ between the Bones of the Skull, distinguish -the _Crown_: Keeping her Fingers in this Situation, _during_ the -Beginning, and Continuance of _strong_ Pains, she will observe the -_Waters_ contain’d in the _Membranes_ including the Child, and -After-birth _forming_ within the _inward_ Orifice, as if something -like a Bladder _blown_, or _distended_ with Water, presented to -the _Touch_, dilating the _Orifice_ with each _Throw_; these -Appearances presage a _speedy_ and _easy_ Birth. - - - - -CHAPTER VI. - -_Of a natural_ Birth, _and the_ Office _of the Midwife._ - - -As the _Birth_ approaches, the Woman grows _hotter_ and _red_ in -the Face; the Pains bear more _strongly_ down; the _internal_ -Orifice _opens_; the _Vagina_ or _Passage_, at its _Entrance_, -becomes more swell’d, as the Child’s Head advances; and the -_Membranes_ are more and more _tensely_ stretched; before the -_Birth_, the Person is often seized with a _Vomiting_, and -_universal_ Tremor, without the Coldness of an _Ague_; and very -often a _Humour_, _discolour’d_ with _Blood_, immediately preceeds -the _Breach_ of the _Membranes_; when these Symptoms, or several -of them, become urgent, ’tis Time to put the Woman in a proper -Situation, as describ’d in the preceeding Chapter: The Midwife -ought by no Means to break the _Membranes_, but _encourage_ the -Woman now to make the best of her Pains, by _strongly bearing -down_, as if going to Stool; the Midwife with her Fingers well -anointed, putting them gently within the _internal_ Orifice, may -cautiously, by separating them, assist its _opening_, and Removing -it more behind the Child’s Head, thereby gradually promote its more -easy Transmission, and at the same Time prevent, if necessary, the -Womb from being too far protruded: After the _Waters_ are _broke_, -as it is called, and the _Head_ of the Child comes into the -_Passage_, the Midwife may lay hold on each Side of it, taking Care -not to bruise it by rough Handling, and drawing it, by _Waving_ her -Hands, if necessary, to loosen it, when fixed, rather than in a -strait Line, assist the Birth; and if obstructed by the Shoulders -in the Passage, inserting a Finger under each Arm-Pit, extricate -them by the like Action. - -’Tis true, it happens, tho’ unobserv’d by Writers, as far as -I remember, that _many_ Women have no _Waters breaking away_, -either before or after the Birth; whether absorbed or not, in -Time of Labour, I shall not at present determine; this is called, -by the Country People, a _dry_ Labour, and often attended with -Difficulty; however, if the _Crown_ appear _forward_, the Issue may -nevertheless be favourable. - -The Child being born, the next Business is to tie the -_Navel-string_ with a _waxed_ Thread, so _doubled_, as not to -endanger _cutting_, about _two_ Inches from the Child’s Body, -making another Ligature near the Body of the Mother, so far distant -from the former, as may be convenient for _Cutting_ between _both_ -Ligatures, and separating the Infant from its _After-birth_. -Midwives are too apt to leave a greater Length, which can be of no -Service, but has been thought, on the contrary, by our Countryman -CHAPMAN, to occasion _Navel_ Ruptures. - -After the _Separation_ of the _Navel-string_, the Care to get the -_After-birth_ succeeds; this will often come by the Assistance of -Nature, with a gentle Motion of the Hand gradually drawing and -loosening it, by the Navel-string: But if it adheres to the _Fund_ -of the _Womb_, which is frequently the Case, whether from the -_Waters_ being come away before the Birth or otherwise; it must -cautiously be separated, and extracted by the Hand, to prevent the -most mischievous and fatal Consequences. - -The Assistant holding the _Navel-string_ with _one_ Hand, must -with great Caution introduce the _other_ into the _Womb_, avoiding -_all Violence_ to any Part in the Way, ’till she reaches the -_After-birth_, some Part of which probably, being loosened, will -be found more _forward_ than the rest; which _taking_ between her -_Thumb_ and _Fore-Fingers_, she must, by an easy Motion of her -other Fingers, between the _Womb_ and _After-birth_, gradually -_separate_ the Parts adhering all _round_, ’till finding the -whole free, before the Palm of the Hand and Fingers, she brings it -intirely away; for should any Part remain, the poor Woman’s Labour -would still continue, and occasion _dangerous_ Floodings, requiring -the immediate Assistance of an able Hand, to rescue the Patient -from the immediate Hazard of Death. - -Sometimes when the _Womb_ has discharged its _Waters_, and the -_Child_, by Reason of a Defect of Pains, or otherwise, remains -_long_ very _forward_ near the _Birth_, the _Womb_ so _contracts_ -about the _After-birth_, as to make the _Separation_ of it very -difficult; in which case Assistance is requisite, from one well -acquainted with the Structure of the Body; and the longer this is -delay’d, the more Danger there will be of all the bad Consequences -of the Retention, and Corruption of the _After-birth_ in the Body. - -It requires great Care to prevent the _Protrusion_ of the _Womb_ in -some Women of a _large Pelvis_, or _Opening_ between the _Bones_; -or if the _After-birth_ remains closely fixed, the _Womb_, in a -very _open Pelvis_, may be _thrust_ by the Violence of the Pains; -or _drawn_ out of the Body by an _unskilful_ Hand, which is -commonly very soon fatal to the poor Woman; and I believe happens -much oftner than is apprehended, tho’ industriously conceal’d, -by _guilty_ Midwives, under the Colour of the poor Woman’s dying -in Child-bed, from some other Cause. DEVENTER says, he saw a sad -Spectacle at the HAGUE, the _Head_ of the Child excluded to the -_Shoulders_ quite without the _Passage_, when Three-fourth Parts of -the _Head_ were conceal’d within the _Womb_, the _Crown_ appearing -within its _inward Orifice_†. - - † See Chir. Op. Part ii. Page 32. - -A much worse Case happen’d in my Neighbourhood, _Sept._ 23, 1749. I -was call’d to a Woman, whose Child, on the 21st came unexpectedly, -without the least Assistance, in the Presence of an _old_ Midwife -of _large_ Practice; she puzzled an Hour, as I was inform’d, to -bring away the _After-birth_, which closely adhered to the _Fund_ -of the _Womb_; while the _unfortunate_ Woman lay senseless, saving -the Memory of being long expos’d to the Cold, when she came to -herself; after which she continued in violent _Labour-like_ Pains; -upon Scrutiny, I found a large _Substance_ in the _Pelvis_, of the -Size of a Child’s Head, considerably resisting my Touch; I observ’d -on Trial, a Part of the Woman’s Body every Way _interposed_ -between my Fingers and this _Substance_, by her Sensibility of -my _Touch_; therefore contenting myself with giving her some -palliative Medicines, and telling the Persons present, a Mole, as -I thought, or Child still remain’d to come away, I for that Time, -took my Leave: On the 24th, she was said to be much better; on the -29th, I was again call’d to this poor Woman, and inform’d, that -upon her first going to Stool, since I had before seen her, which -happen’d the same Day, the large _Substance_ before-mention’d, -came intirely out of her Body; to which it join’d by a thinner -Substance, of some length: I now perceived it was no less than -the _Womb_ turned _inside out_, suspended by its _Ligaments_, and -joining to the _Vagina_, but very much swell’d by the Obstruction -of the circulating Humours; And an old Gentlewoman, who was present -when the Child was born, inform’d me, she saw the Midwife draw -this _Body_ from the Woman, by the _Navel-string_, and indeed, -the Impression of her _Nails_, in separating the _After-birth_, -remain’d still visible at the _Bottom_ of the _Womb_, and the -Midwife having long expos’d the Patient, put this _inverted Womb_ -again into her Body. - -The Condition of the Part, after so long Delay, did not admit the -Possibility of rightly reinstating it; I therefore return’d it, -as well as I could, into the Pelvis, and introduc’d a Pessary to -retain it; and as this Person had already contracted a Hectick, I -charg’d her, as she valu’d her Life, to confine herself strictly -to a _cooling Milk_, or _vegetable Diet_; she has since had -large Discharges of a _bloody_ Corruption, with Portions of a -fleshy Confidence from the Parts affected. In _April_, 1751, she -told me the Discharge coming from her had long been much abated -in Quantity, and what remain’d was the Whites; that she had an -inward Fever, and the Piles, for which I gave her my Advice; her -Complexion was chang’d from the most florid to a languishing -Paleness. - -My Brother, much better known in this Country, and longer practis’d -in Midwifry, has been concern’d in furnishing Medicines for the -Person, whose History I have given, altho’ by Means of his Absence, -he did not attend her on the most emergent Occasions. - -I have since been call’d to the Assistance of the _old_ Midwife, -who attended, and she frankly told me, she had another Woman under -the like Circumstance, who died the same Day. - -Having related such Things as occur in the most favourable -Circumstances of Travil, about which all Midwives ought to be well -inform’d, and those Injuries to which Women are sometimes liable, -notwithstanding the most _promising_ Appearances: In the next Place -I proceed to shew, what are the Symptoms preceeding _difficult_ -Labours, which by timely Assistance, may be secured from the most -dangerous, if not fatal Consequences, and are of great Moment to be -known by Midwives, as well as Matrons and Child-bearing Women, to -enable them to judge when it is absolutely necessary to recommend -calling that Aid, which is beyond their Capacity to give. - - - - -CHAPTER VII. - -_The Difficulty from the_ Membranes. - - -An _unforeseen_ Difficulty may occur, when Appearances are -otherwise favourable, from the Strength of the _Membranes_, -obstructing the _Birth_, and requiring great Caution to prevent; -for in this Case, the Operator must break the _Membranes_, in order -to promote the _Birth_; and as the _Waters_, they contain, are a -Means to open the _internal Orifice_, lubricate the _Passage_, and -facilitate the _Birth_; the _breaking_ the _Membranes_ too soon, -will render the Labour more _tedious_; and should it be too long -delay’d, the Patient’s Misery would be _prolonged_; wherefore -the Midwife must not break _them_, before the _Orifice_ is -sufficiently _open_ to admit the Head, when she may tear them with -her _Nails_, but by no Means pull them, for as they adhere to the -_After-birth_, she might by that Means separate it, and bring on a -Flooding. - - - - -CHAPTER VIII. - -_Difficulties occasion’d by the_ Navel-String. - - -The _Navel-string_, by a Variety of Convolutions, sometimes -obstructs the Birth, for being shortned, by its Contortions -about the Neck, or any Part of the Body, the _Labour_ will -become _unnatural_, by Reason tho’ the Pains are _strong_, the -_Navel-string_, by its _shortness_, will pull the Child back with -each Pain; and here an unskilful Management may break the String, -and occasion a dangerous Flooding; but as the Woman’s Pains will -prove _ineffectual_, notwithstanding their Strength and Force, the -Midwife will, by this Means, find the Case out of her Province; I -mean, where the _Navel-string_ is very much _abbreviated_. - -If the _Navel-string_ comes forward before the Child’s Head, it -will seldom remain, when put backward by the Hand; therefore, if -the Midwife has any Regard for the Life of the Child, she ought to -call for Assistance, before the Birth is further advanc’d, or it -will be extremely difficult, if not impossible, to save the Infant; -and she would probably be foil’d for want of sufficient Strength, -had she Skill to save it. - - - - -CHAPTER IX. - -_Difficulties from the_ Placenta _or_ Secundines. - - -The _Placenta_ or _After-birth_, being from any violent Shock -or Accident, more or less, _separated_ from its Seat, during -any Time of Breeding, will produce a Flooding, in Proportion to -its Quantity, _dangerous_, which is sometimes so violent, as -to occasion Death in an Hour’s Time; and nothing but _instant_ -Delivery can prevent it. When the Case is not so desparate, as all -the _Blood_ in the Mother’s Body, necessary to support her own and -Infant’s Life, may be drain’d away, the Consequence may be equally -fatal in a more lingering Way. - -The 26th _Feb._ 1748, I was sent for to a Woman at -MOUNTAIN-DEVEREL, within about Five Weeks of her Time, in a violent -Flooding; her Midwife gave her an Opiate, which she thought check’d -her Flooding, excepting that once a Week, it became very violent, -for about three Weeks past; when I came, the Neighbours told me she -had lost a Pail full of Blood; the poor Woman was so weak, that -her Pulse were scarcely perceptible, and her Voice but a Whisper; -I was unwilling to meddle, for fear she should die under my Hands, -but yielded to the Importunity of her Friends: It was with great -Difficulty I introduced the _Tops_ of my two Fore-fingers and -Thumbs into the _internal Orifice_, which I gradually dilated, -’till I could pass my Hand, when by _turning_, I brought away a -_dead_ Child, depriv’d of its Nutriment by the great Loss of its -_maternal_ Blood; but had considerable Trouble in getting the -_After-birth_, by Reason of its _Adhesion_: After Delivery, the -Flooding immediately very much abated, the poor Woman reviv’d -to Admiration, and I left her the next Day, as well as could be -expected in so low a Circumstance, tho’ dubious of her Recovery: I -heard she died five or six Weeks after; but I am well satisfied, -had she had an earlier Recourse for Assistance, she might have -recover’d. - -In these Cases, Midwives are too apt to trust to their own -Judgments, instead of calling for better Assistance; and tho’ -they have Recourse to external _Applications_, _Ligatures_, and -_Opiates_, these Things, injudiciously practis’d, are frequently -more detrimental than beneficial: For Instance, should the -_Arteries_ be compress’d by too tight a Ligature of the _Arms_ and -_Legs_, the _Flooding_ would become more violent. - -When ignorant Midwives, by rashly pulling the _Navel-string_, break -it, or by the Adhesion of the _After-birth_, find it out of their -Power to bring it away, they are apt to persuade People, it will -come without further Help, which seldom happens; on the Contrary -it most frequently occasions Death, more or less suddenly, or -Hecticks and Consumptions, when left to corrupt in the Body: The -_Uterus_ sometimes so strongly contracts about, and embraces it, -that it may be impossible, after a few Hours Delay, to procure -it, as I found in a Case that occur’d to me at COLEHORN, the 30th -_Sept._ 1748, tho’ little more than four Hours passed, from the -Time the Midwife broke the _String_ close to the _Placenta_, for -the Part of the _Uterus_ next the _Placenta_ was so contracted, as -barely to admit the _Tops_ of my two Fore-fingers; I endeavour’d, -with all possible Caution, to make a larger Aperture, but in the -ill _Situation_ of the _Uterus_, at the Extent of my Reach, all -my Attempts were in Vain; this Woman rested well the succeeding -Night, and had no extraordinary Complaints when I left her in the -Morning, first prescribing what I thought most suitable to her -Condition: I afterwards heard she died with a Frenzy, succeeding a -_Suppression_ of the _usual_ Purgations; where the Corruption of -the _Placenta_ takes Place, the Case is, at least, more Chronical, -and the _Secundines_, gradually wasting, come away Piece-meal, the -Patient labouring under a Hectick from the Contagion of putrid -Humours, mixing with the circulating Fluids. - -I have at other Times, after a longer Delay, been more successful; -the 28th _December_, the same Year, I was call’d, by Order of -the late Lord WEYMOUTH, to the Assistance of a poor Woman at -HORNISHAM, whose _After-birth_ had been retain’d three Days; she -had contracted a Fever from its Putrefaction, which was so great, -that scarcely any Body could bear the Room, and had lost a great -deal of Blood by Flooding; the poor Woman soon recover’d after her -Delivery, in the Use of a little Medicine, from his Lordship’s -House: I have seldom found the Business difficult, when speedily -call’d in the like Cases. - - - - -CHAPTER X. - -_Difficulties attending the Contraction, or Ill-site of the_ Inward -Orifice. - - -In the Fifth Chapter I have told, how the Midwife may judge, -by touching, of an easy Birth; carefully introducing her two -Fore-fingers into the Passage, to find the internal Orifice of -the Womb in the Beginning of Labour; now, in doing this, if the -Orifice, she is in Search for, does not readily occur, she has -great Reason to apprehend Difficulty; and if not well acquainted -with the Parts she handles, by rude Usage, piercing through any -Part of the _Vagina_, which presents to the _Touch_, may do -Mischief. Such an Injury was done to one of Box, where I was -called _Sept._ 21, 1748. This Woman had been in Labour several -Days; the Midwife having, the last Time, been with her eighteen -Hours, the Pole of the Child’s Head lay upon the Share-bone, which -was rectifyed by one Limb of the Extractor and brought into the -Passage; the other Limb being joined, the Infant was soon born; but -what before surprized me, was to find a _Passage_, for my Fingers, -considerably remote from the _internal Orifice_, with great -Complaints of a smarting Pain when I touch’d it; a Suppuration -follow’d, but the Woman soon recover’d, after the frequent Use of -an emollient and discutient Fomentation. - -When the _Orifice_ presents rightly, and is easily found, it -is next of Consequence to observe, whether the Pains _relax_, -_open_ and _enlarge_ it; for should it remain _thick_ and -_contracted_, instead of relaxing and growing thinner, if the -Infant comes rightly directed, the Woman’s Pains are not _genuine_ -but _spurious_; it will then be proper to give an emollient -and carminative Glyster, and probably the false Pains will be -reliev’d, and the true succeed; or some Time may intervene, before -her true Labour, especially if the full Time of Breeding should not -be expired. - -If the Midwife cannot reach the _internal Orifice_, and the Child’s -Head lays _high_, the Orifice may possibly lay _high_, _backwards_ -or _forwards_, or more or less so, inclining _Sideways_; the Reason -of which may be apprehended, from the brief Account of the _Womb_, -and the _Pelvis_, in the Second Chapter. In this Case it may be -with great Difficulty, the Assistant can reach the nearest Margin -of the _internal Orifice_, tho’ well instructed and experienced, -and it will often require the Hand of an expert Artist, early in -Labour to rectify it, or turn the Child, when Travil is advanced; -or if too long neglected may occasion the Death of one, or both -Mother and Child. - - - - -CHAPTER XI. - -_Difficulties attending a wrong Position of the_ Child_’s_ Head. - - -If in the Progress of Travil, the Midwife perceives any Part of -the Head, besides the _Crown_, discoverable by its _Sutures_, -presenting, and it appear _broad_, and very _hard_ to the _Touch_: -If the _Waters_ may be _felt_ descending in a _long_ Form through -the _internal Orifice_, somewhat like a Piece of a Gut distended -with Water: These Appearances presage the utmost Difficulty and -Danger, commonly owing to the small Distance between the _forward_ -and _back_ Bones; an ill Situation of the _internal Orifice_; the -_comparative Largeness_ of the Child’s Head; or the _ill_ Site -of the _Womb_; whereby the Head may be pressed against the Bones -_forward_ or _backward_, or somewhat inclined to _either_ Side, -in a wrong Direction for the _Passage_. These Causes, singly or -concurring, render the Case much beyond the Skill, and very often -the Strength, of a Midwife to redress. - -When unqualified Midwives observe the Head present to the inward -Orifice, they are too apt to promise good Success, and behave with -the utmost Confidence, wherein they are often egregiously mistaken; -for there cannot be a more difficult Birth, than frequently -happens, when any other Part, instead of the Crown, offers; and -the Misfortune is, the longer Recourse to proper Assistance is -delay’d, the greater the Difficulty becomes every Moment; and the -poor Woman may think herself happy, if she escapes with her Life, -the Danger of a most _fatiguing_ and _tedious_ Labour, succeeded, -perhaps, by such a Relaxation of the _Vagina_ or _Passage_, as -will occasion great Uneasiness in going, or being in an _upright_ -Posture, without the immediate Help of Medicines, both externally -and internally; or wearing a _Pessary_ for its Support, during -Life. - -Whereas ’tis certain, that if the Mother’s Pains, _strongly bearing -down_, the Muscles of the Belly contracting and becoming sensibly -_hard_ to the _Touch_, don’t manifestly promote the Birth, it must -needs be owing to some Obstruction beyond the Midwife’s Skill; -who in this Circumstance is apt to complain, the Pains are not -sufficiently _strong_, ’till the poor Woman is ready to expire, -from the Loss of her Strength, by her long Suffering under them; -and told she must patiently wait God’s Time, who in Case he -miraculously interpos’d, wants not the Midwife’s Assistance: And -what still adds to this deplorable Calamity, ’tis likely she is -put upon exerting her utmost Strength, assisted by Cordials; when -_encouraging_ her _Labour_ and _provoking_ her _Pains_, ’till the -Obstructions in the Way of the _Birth_ are remov’d, contribute -still further to the Danger attending. - -I don’t deny but that in some Cases, a _tedious_ Labour may be -owing to a Defect of _sufficiently_ strong Pains; but as this -often proceeds from _Circumstances_ obstructing the _Birth_, -true Labour naturally takes Place, when they are remov’d; and, by -a right Management of the Hand, is more _effectually_ promoted, -without Cordials or _forcing_ Medicines, where the Pains are -deficient. - -Under this Sort of unnatural Birth, may very well be enumerated, -the _Face_ presenting _towards_ the Mother’s Belly, or the _Side_ -of the Head coming _Foremost_, for its Passage must be extreamly -difficult in these Postures; as well as when the _Face_ comes -_forward_; for then by Reason of the great Tumour, about the -_Head_, _Face_, _Eyes_, and _Mouth_, from Lodging between the -Bones, the Infant expiring in the Birth, has been often taken for -a Monster. I have often been so happy, when the Head has long -remain’d, wedg’d between the Bones, as to bring the Child alive, -by the _Forceps_, in a few Minutes, if seasonably call’d, when the -Woman in Travil has been in the utmost Danger of Death. - -The 5th of _May_, 1751, I met with as bad a Case, as most of this -Kind at WIGGLETON: This Woman, by the Midwife’s Account, seem’d to -be in _Labour_ at Times near a Month, and for a Week last, almost -in continual Pain, with her first Child: as I was call’d late to -her Assistance, I could not judge, by early Appearances, of the -Situation of the _Uterus_, or _Infant_; this is most commonly only -in the Power of the Midwife to observe; her _Waters_ had gradually -drain’d away above a Week, and there still remain’d some Part of -the _Membranes_ depending like a _Gut_ in the _Vagina_, the _Head_ -offer’d, firmly wedg’d in the _Pelvis_; the Part most obvious -to the _Touch_, by its Softness and fleshy Consistence, seem’d -to be the _Cheek_: The poor Woman’s Pains, for some Hours, were -_ineffectual_ for want of Strength, her Spirits being exhausted, by -a Labour so fatiguing; there was no Possibility of _turning_ the -Child; I endeavour’d, with some Success, to promote the _Birth_, by -bearing _strongly_ against the inferior Part of the _Os-sacrum_, -but her Weakness, depriving me of the small Benefit of her Pains, -I had for a Time; there was an absolute Necessity for a speedy -Delivery, for the Mother’s Sake: ’Twas with some Difficulty I -overcame her Prejudice, and those Present against the Use of any -Instrument, tho’ at length they yielded; when introducing a _Limb_ -of the Extractor on each Side of the Head, and Co-operating with a -small Pain, encouraging the Woman to bear down as strongly as she -could, I immediately brought a Daughter, with a monstrous long Head -alive. - -I HAVE, however, met with some Cases, which I could relieve by -no better Method, than lessening the Head; but considering for -whose Benefit I am chiefly Writing, and how dangerous the Use of -Instruments may be in injudicious Hands, I rather choose to advise -Women not to meddle with them, than pretend to relate the Method of -using them. - - - - -CHAPTER XII. - -_Difficulties from other_ ill Positions _of the Infant._ - - -The _Arm_ or _Shoulder_ presenting, is so well known to be attended -with Difficulty, that few Women will attempt such Deliveries, -unless they are so very ignorant, as to imagine they can bring the -Child by _pulling_ at an _Arm_. - -As our Miscarriages, or rather Misfortunes, in Practice, may no -less contribute to the Information of others, by Caution, than our -Success, by Example; I shall not scruple to give a candid Relation -of the most fatal Occurrence, which ever fell to my Lot. - -The 12th _September_, 1748, I was called to a Woman at TROUBRIDGE, -her _Matrix_ lay _forward_ in a _prominent Abdomen_ hanging very -low, the _Os-uteri Internum_ lay very much _backward_, _both_ Hands -_presented_ to it, this Woman had been very ill the preceeding -Week, and in extreme Misery the last Twenty-four Hours; with a -great deal of Trouble, I got and drew towards me one _Foot_, -with the _Heel turn’d towards the Mother’s Belly_; in drawing -the _Infant_ so far as the _Arm-pits_, I found the _Face_ of the -Child did not _turn_ so readily as I expected towards the Mother’s -_Back_; as soon as I had brought the _Feet_ some Distance without -the _Vagina_, while I endeavour’d to extract the Child by hold of -its _Thighs_, the Midwife, unknown to me, officiously laying hold -of the Infant’s _Feet_, exerted her Strength at the same Time with -mine; I intended to leave the _Arms_ according to DEVENTER, as a -Security to the more safe Transmission of the _Head_; and while -our united Strength was exerted, I found the _Neck_ gave way, with -something of an _audible_ Crack; and with some Surprize, looking -about me, saw the Midwife _labouring_ at the Child’s _Feet_, and -check’d her, as acting very rashly, without my Direction; thus -we had really separated the _Spine_ of the _Neck_, and the _Head_ -only adhering to the _Body_ by the _Skin_, was with little or no -Force separated from it: In passing my Hand, after a tye on the -_Navel-string_, I found the _Head_ fell _back_ into the prominent -Part of the _Abdomen_, insomuch that I could only reach the -separated Part of the _Neck_, and I endeavour’d, in vain, to get -hold of the _Head_ by the _Crotchet_: While I was thus employ’d, -a _Flooding_ came on, by the Separation of the _Placenta_, which -quick’ned my Endeavours, from the Apprehensions of her sudden -Death, if she was not immediately deliver’d; but the poor Woman, -much spent with Fatigue and Loss of Blood, begg’d I would desist, -preferring Death to Life; in which being join’d by the People -present, and not a little exhausted of Spirit and Strength myself, -I was, much against my Will, obliged to leave her to her Fate. - -Here I would observe, it appear’d the _Body_ was that of a large -Boy, and tho’ I find GIFFARD and others made no Scruple of leaving -the _Arms_ of a small Child, I must join with them in advising -not to bring a _large one_, without first _procuring_ the _Arms_; -tho’ I will not say, whether the Method of delivering on one Side -instead of the _Back_, the lower Part somewhat _raised_ from the -Bed, at the same Time _encouraging_ Labour with Hopes of immediate -Delivery, recommended by DEVENTER, may not occasion the Danger of -leaving the _Arms_. - -There are Variety of other wrong _Situations_, and _Cases_ of -Difficulty, which I could illustrate by Examples in my own -Practice, and may be found in the Observations of MAURICEAU -DE-LA-MOTTE, GIFFARD and others, for the Information of such as -practise Midwifry, that have no Relation to the Information of -Midwives, either in their own Practice, or Occasions of Assistance. - - - - - -CHAPTER XIII. - -_Of_ TWINS. - - -The Case of _Twins_ may, in many Country Places, be esteemed beyond -the Skill of Women _practicing_ Midwifry; but as they are not alike -ignorant, and this Delivery, with a right Management, is attended -with no great Difficulty, I shall describe it as plainly as I can. - -If a Child comes naturally by the Force of the _Mother_’s Pains, -and the _After-birth_ does not easily follow, the Midwife, by -passing her Hand to separate its Adhesion as directed in the sixth -Chapter, will readily find whether _another_ Child still remains -to be born, by the Appearance of other _Membranes_, including -_Waters_, &c. And as where more than one is to be born, they are -generally proportionably smaller, and tho’ the first Child comes -naturally, the second may not, she need not wait for the _Birth_ -of the other, by the meer Force of Nature, for this would greatly -hazard the Life of the Child, and sometimes of the Mother, by -a Flooding; but ought to break the _Membranes_, and search for -the _Feet_, carefully preventing their being intangled with the -_Navel-string_; and having got both in her Hand, draw them into -the _Passage_; if the Child’s _Toes_ point to the _Mother’s Back_, -there will be no Danger of the _Chin_ or _Nose_ being hung on the -_Bones_ before, and she may draw the _Feet_ forth with the rest of -the _Body_, without delaying to bring down the _Arms_, encouraging -the Mother to assist in the mean Time, by _bearing down with or -without Pains_. - -In Case the _Child’s Toes_ should point to the _Mother’s Belly_, -the Midwife, in drawing the Child forth from the _Hips forward_, -must gradually _turn_ the _Belly_ of the Child towards the -_Mother’s Back_, by the Assistance of the other Hand in the -proceeding. - -If the Woman be straiter, or the Child larger, than ordinary, -when she has brought the Infant into the _Passage_ somewhat short -of the _Arm-pits_, she must, by introducing her Fingers, first -over one _Shoulder_, cautiously bring down one _Arm_, and then in -like Manner the _other_, and drawing the Child forward, she must -make Use of both Hands to extricate the _Head_; the _Fingers_ of -one Hand between the _Mother’s Back_ and _Child’s Jaws_, bearing -and drawing them from the _Back-bone_, and with the Fingers of -the other Hand over the _Shoulders_, and the _flat_ against the -_Child’s Back_, draw it forth, the Mother as aforesaid assisting -all the while. - -Writers advise putting two Fingers into the _Child’s Mouth_; but -as great Injury has often been done that Way, it is much safer to -bring the Child by _bearing_ with the Fingers against its _Jaws_. -If an _Arm_ should be broke in _bringing down_, let it be spliced -with thin Paste-board, and bound at its full Extent to preserve its -right Shape. - -In fetching an Infant by _turning_, ’tis necessary to draw its -_Feet_ into the _Passage_, with the _Toes situate_ towards the -_Infant’s Belly_, for it may be extreamly difficult, if not -impossible, to draw it backwards, contrary to the natural _Bent_ -of its _Thighs_ and _Back_; and a _Limb_ may sometimes as easily -be pull’d off, as the Child brought to the _Birth_ this Way; the -Midwife must therefore make Use of the _right_, or _left_ Hand -in doing it, which happens to be most convenient, to the natural -_bending_ of the Infant’s Body. - -I THINK it cannot be safe for a Woman to _turn_ a Child upon ether -Occasions requiring it; their Strength, as well as Skill being -frequently inferior to the Task; besides, there may be great Danger -of injuring the Vitals of the Mother in other Cases, especially -after the Operation is unseasonably delay’d. - -As each Child has a Navel-string, as well as After-birth belonging -to it (tho’ both _Placenta_’s are sometimes so joined as easily -to be distinguished) the Care respecting the _Navel-string_, -already related in the Sixth Chapter, must of Course be taken for -the First-born, and its _Secundines_ left, ’till after the Birth -of the Second, when both, if necessary, must be separated and -brought away, as there advis’d, with Regard to one alone, and the -_Navel-string_ of the last Infant tied after the same Manner as in -the Birth of one Infant. - - - - -CHAPTER XIV. - -_Of a_ Dead Child. - - -A Dead Child is often born with abundantly more Difficulty than a -_living_ one, for the last by its Struggles considerably promotes -its own Birth; whereas, the first lies _immoveably_ in the _same_ -Posture, without changing Situation by its own Activity. - -When the Death of the Child proceeds from any _accidental_ Injury, -the _breeding_ Woman commonly knows it, by the Perception of a -_Weight_ within her, in the Part where it lies, instead of its -_usual_ Motions, which from that Time cease, and occasion, not -without Reason, a Solicitude for the best Assistance. - -One of my Neighbours, whom I lately deliver’d, had the Misfortune -to fall flat on her Face, between the 7th and 8th Month of her -Pregnancy; from which Time to that of her Labour, above three -Weeks after, she had a continual Sensation of a Weight within her, -without _any_ of the Child’s Motions, as before this Accident, -although it was not succeeded by a _Flooding_, as is common upon -a _partial_ or _total Separation_ of the _Placenta_: She had -frequently been attacked with Pains resembling Travil, for above -two Weeks before it came on effectually; in this Case after I had -brought the Child by _turning_, I found the Secundines extremely -offensive, by Reason of their Putrefaction. - -From Causes less manifest, ’tis a Thing more precarious to judge -of the Infant’s Death; the Woman in Travil has not perceived the -_Motion_ of the Child for some Days, while it was yet living; -a _cadacerous_ Smell is not infallible; the coming away of the -Child’s _Excrement_, may proceed from the _Compression_ of its -Abdomen in the _Birth_, especially when the _Buttocks_ present; -these Appearances therefore can only be a Foundation at best for -_probable_ Conjecture; nothing short of the Peeling of the Cuticle -or Scarf-Skin of the Child upon _Touching_ it, can be a _certain_ -Token of its Death. - - - - -CHAPTER XV. - -_The necessary Care of a_ Mother _and_ Child. - - -After Delivery, tis too universal a Practice to palliate the -After-pains by _Opiates_, which if given beyond the Proportion, -necessary to take off the Spasms attending, are mischievous, -tending to obstruct the natural Cleansings, so absolutely -necessary to succeed; and as these Pains cease of Course for -the most Part in two or three Days, it were much better to have -recourse to _Sperma Ceti_ dissolv’d with the Yolk of an Egg in a -Draught of Caudle, or a Linctus of Sallad Oil and Sugar, if Oil -of Sweet Almonds cannot be had fresh, as often as the Pains are -violent. - -Particular Occasions may indeed require other Methods, but -then ’tis best to be well advis’d, whether _Opiates_, or other -_Medicines_ are necessary. During their Purgations, the Woman, in -Child-bed, ought to be kept warm, from all Danger of taking cold, -to a Degree of sensible Perspiration, and if she has no Stool by -the third Day, which commonly brings, with the Milk, a feverish -Heat, a Kitchen Glyster ought to be given and repeated in costive -Habits, as there is Occasion. - -I SHALL conclude with some Things of the Care of Infants newly -born; a Subject the more interesting, as our Natives are known -greatly to decrease from the free Use of Spirituous Liquors; which -Loss might in some Degree be repaired by a better Care of their -Offspring, who are not only expos’d to suffer by the Ignorance of -Midwives, but must undergo a second Martyrdom from swadling and -cramming. - -Their fond Nurses greatly contribute to the general Cause of all -their Distempers, _Indigestion_, frequently feeding them ’till they -return it by the Mouth, which under these Circumstances, unless -supply’d by a Looseness, is the only Means of their Preservation -from more immediate Death. - -This Overcharge of their Stomachs, producing Crudities, gives them -the most excruciating Pains in their Bowels; occasioning very -often Fevers and Convulsions, and yet their Cries are customarily -appeas’d by more Food, furnishing an Encrease of sharp Crudities -in their Bowels; and ’tis well if Syrup of Poppies, _Godfrey_’s -Cordial, or some other Opiate, be not given to stifle their -Complaints, but in Effect to encrease the Mischief, by confining -the Acrimony of an Overload within them. - -Infants are born with their Stomachs and Intestines charged with -the Recrements of the Humours in which they swim, before Birth, and -the glandular Secretions within them, which will naturally purge -away with the first Milk they draw from the Mother’s Breast; and -they would sleep, were they not too soon fed, ’till this Provision -of Nature is ready for them, as Dr. CADOGAN found from Experience -in his own Family; but as the Humour of Feeding them sooner -generally obtains, and the Mother too often is not the Nurse; Half -a Drachm of _Castile_ Soap diffolv’d in a Spoonful or two of thin -Caudle, and sweetened with Honey, would cleanse the Child, and -prevent many Distempers, owing to a Retention of Impurities within -them before the Birth, if given soon after. - -’Tis well worth remarking, that the Food the Nurse takes -communicates its Nature to the Milk, so that the Child may be -intoxicated by her giving Suck too soon after strong Drink or -Spirituous Liquors, by which Means many are destroy’d; it is -likewise well known, if the Nurse takes a Purge, her Milk will -purge the Child. - -This informs us, that when the Child is troubled with Gripes, -attended with green, sour-smelling Stools, the Mother, or Nurse, by -being confin’d to an Animal Diet, will, in a great Degree, prevent -the Gripes, Looseness, or Convulsions, occasion’d by the Acidities -of the Child’s Stomach and Bowels, from the contrary Qualities -communicated to her Milk. On the Contrary, a vegetable Diet will -greatly relieve the same Complaints, attended with strong smelling -Stools, and a Tendency to the Putrefaction of the Humours, and the -Child’s Spoon-meat, when any Thing is given besides the Mother’s -Milk, may be regulated accordingly: In the mean Time, in both -Cases, these Indigestions ought to be purged off with a few Grains -of Rhubarb, or double the Quantity infus’d at Night in a Spoonful -of common Drink, strain’d and sweetened with Honey. - -This, with a suitable and commodious Dress, leaving them Freedom -for all their Motions, taking Care not to fill them with Crudities, -by over-charging their Stomachs, would preserve the Health of young -Children, they would then sleep away most of their Time, without -those continual Cries of Misery, calling on the Compassion of all -about them, whereby abundance of Trouble to their Nurses, and the -continual Occasion of Medicines, to sweeten and purge away the -Effects of Indigestion, would be prevented. - - -_FINIS._ - - - - -TRANSCRIBER’S NOTE - -Original spelling and grammar were generally retained. The -following two corrections were made in conformance with the spirit -of the list of errata on page vi. - - Page 9, l. 16. “Pains about the Navel and Loins” was changed to - “Pains about the Back, Navel and Loins”. - - Page 33, l. 12. Changed “great Complaints of a smarting Pain; - when I touch’d it a Suppuration” to “great Complaints of a - smarting Pain when I touch’d it; a Suppuration”. This correction - is not quite what the erratum on page vi recommends—but the - recommendation is not quite correct. - -Page 21. Changed “which happpen’d the same Day” to “which happen’d -the same Day”. - -Page 49. 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- } - blockquote, div, h1, h2, p { - max-height:none; - } - .chapter { - padding:0; - } -} - - </style> - </head> -<body> - - -<pre> - -The Project Gutenberg EBook of The Province of Midwives in the Practice of -their Art, by William Clark - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - - - -Title: The Province of Midwives in the Practice of their Art - Instructing them in the timely knowledge of such - difficulties as require the assistance of Men, for the - preservation of Mother and Child; very necessary for the - perusal of all the sex interested in the subject, and - interspersed with some New and Useful Observations. - -Author: William Clark - -Release Date: May 16, 2016 [EBook #52086] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK MIDWIVES *** - - - - -Produced by RichardW and the Online Distributed Proofreading -Team at http://www.pgdp.net (This file was produced from -images generously made available by The Internet Archive) - - - - - - -</pre> - - -<div class="imctr01t"> -<img id="coverpage" src="images/cover.jpg" width="600" height="800" alt="" /> -</div> - -<h1 class="thisbook">The -Province of Midwives in the Practice of their Art, -by William Clark, M. D. 1698–ca. 1780.</h1> - -<div class="front"> -<div class="fsize4 ltspb">THE</div> -<div class="fsize2 ltspb padtopb"><b>PROVINCE</b></div> -<div class="fsize5 ltspb padtopb">OF</div> -<div class="fsize1 ltspb padtopb"><b>MIDWIVES</b></div> - -<div class="fsize5 ltspb padtopb">IN THE</div> - -<div class="fsize3 padtopc">Practice of their -<span class="smcap">A<span>RT</span>:</span></div> - -<div class="fsize5 padtopc pjust">Instructing them in -the timely Knowledge of such <i>Difficulties</i> as require -the Assistance of <span class="smcap">M<span>EN</span></span>, -</div> - -<div class="fsize6 padtopc">For the Preservation of</div> - -<div class="fsize4 ltspb padtopc">MOTHER and CHILD.</div> - -<div class="fsize5 padtopc pjust">Very necessary for the -Perusal of <span class="smmaj">ALL</span> the SEX -interested in the Subject,</div> - -<div class="fsize6 padtopc">And interspersed with some</div> - -<div class="fsize4 padtopc"><i>New</i> and <i>Useful</i> <span class="smcap">O<span>BSERVATIONS</span>.</span></div> - -<div class="hrspan">-</div> - -<div class="fsize4 padtopc ltspa"><i>By</i> WILLIAM CLARK, <i>M. D.</i></div> - -<div class="fsize6 padtopc"><i>And of the</i> College <i>of</i> <span class="smcap">P<span>HYSICIANS</span>.</span></div> - -<div class="hrspan">-</div> - -<div class="fsize7 padtopc"> - <img class="glyphsa" src="images/bar2em.jpg" - width="120" height="60" alt="horizontal bar" /><img class="glyphsa" src="images/bar2em.jpg" - width="120" height="60" alt="horizontal bar" /><img class="glyphsa" src="images/bar2em.jpg" - width="120" height="60" alt="horizontal bar" /><i>Molliter - Aufer Onus.</i> -     <span class="smcap">O<span>VID.</span></span> - <span class="smcap">F<span>ASTI.</span></span></div> - -<div class="fsize7 padtopc pjust">Printed for <i>William Frederick</i>, - in <span class="smcap">B<span>ATH</span>;</span> and sold by -<i>M. Cooper</i>, - in <i>Pater-Noster-Row</i>, - <span class="smcap">L<span>ONDON</span>.</span></div> - -<div><div class="fsize7 nowrap imwth11 bortop">MDCCLI.</div></div> -</div> - -<div class="chapter"> -<div class="hrspan">-</div><div class="hrspan">-</div> - -<h2 class="nobreak" title="Advertisement to the Reader."> -ADVERTISEMENT TO THE READER.</h2> - -<div class="dropcap"><img src="images/a.org-07.t.jpg" - width="60" height="58" alt="T" /></div> -<p class="dropcap"> -<i><span class="ltspc">HE</span> -following small Tract will appear -contemptible to those who judge -of the Worth of Books by their Bulk; -but the Author believes such as are practis’d -in Midwifry will acknowledge both the -Want and Usefulness of an Essay of this -Kind.</i></p> - -<p><i>The Division of the Chapters, naturally -arising from the various Circumstances -which are treated of, will rather assist than -burden the Memory, and admit of a ready -Recourse to the short Instructions, in the -Knowledge and Practice</i> absolutely necessary, -<i>given under each Head.</i></p> - -<p><i>The Reader will the more readily excuse -any Defect in the Stile, when he considers</i> -<i>the Necessity of a strict Expression on the -Subject and the Difficulty a Man lies under, -who writes not to the learned and experienced, -but chiefly for the Sake of Persons -ignorant in Anatomy and Philosophy, -on a Subject which for the most Part excludes -Information by Sight.</i></p> - -<p><i>On such a Subject it will not be imagined -Vanity or Applause can incline a Man to -write a Pamphlet, rather than a Volume; -when the Author is not conscious of having -omitted the Instruction to be found in any -Book extant, within the Limits of his Design; -and hopes Experience will teach its -Value both to Midwives and Matrons; -and that the Perusal will not at all injure, -if it does not improve, the most knowing -and experienced.</i></p> -</div><!--chapter--> - -<div class="chapter"> -<div class="hrspan" id="errata">-</div> -<div class="fsize6"> -<p class="pcenter">The -<span class="smcap">R<span>EADER</span></span> -is desir’d to correct the following <span class="smcap">E<span>RRORS</span></span> -with the Pen.</p> - -<div class="dropcapletter">P</div> -<p class="dropcap">AGE -9, Line 16, <i>read</i> Pains about the Back, Navel, <i>&c.</i>—P. 33, -l. 12. omit the Period after the Word Pain; and make -a Semicolon, instead of the Comma, after touch’d it.<br class="clearfix" /></p> -</div> -</div><!--chapter--> - -<div class="chapter"> -<div class="hrspan">-</div><div class="hrspan">-</div> - -<h2 class="nobreak" title="Chapter I. The Design."> -CHAPTER I. -<span class="h2smaller"> -<i>The</i> DESIGN.</span></h2></div> - -<div class="dropcap"><img src="images/a.org-09.t.jpg" - width="60" height="59" alt="T" /></div> -<p class="dropcap"> -HE Case of <i>Child-bearing</i> Women -is very lamentable, in the Country -especially, by Reason of the -Ignorance and Unskilfulness of <i>Midwives</i>; -for by their Negligence and perverse Management, -many Mothers and Children -are destroyed, to the great Misfortune of -particular Families, as well as of the <i>Publick</i>, -at a Time when it suffers by the -Loss of useful Hands, from too many -other Causes. It were therefore to be -wished, that all Midwives were so far -appris’d of their Duty, as to be able to -distinguish between Cases within their -Abilities, and such Difficulties as may occasion -the Loss of the Mother, or Child, or -both, for Want of necessary Assistance.</p> - -<p>They who intend to practice Midwifry -in <span class="smcap">P<span>ARIS</span>,</span> are oblig’d to attend <i>anatomical</i> -Lectures and <i>Dissections</i>, that their -Judgments may be inform’d, by the -Knowledge of the Structure of the Body, -for an Undertaking so hazardous in ignorant -Hands.</p> - -<p>London, at present, affords equal Advantages -of Information; for the <i>anatomical</i> -Wax-work, with suitable Lectures, -might furnish as good a Qualification, -with less Offence than real Dissections; -and there are not wanting those who -professedly instruct both Sexes by <i>mechanical -Demonstrations</i>.</p> - -<p>And for the future, it is to be hoped, -there will be no Necessity for Men to -have Recourse to <span class="smcap">P<span>ARIS</span></span> for <i>Observation</i>, -since we have <i>Infirmaries</i> at Home for -the Accommodation of Women in Child-bed; -and tho’ they are expos’d naked -to the Eye in the <i>Hotel de Dieu</i>, it must -be confess’d, that the fundamental Rules -of the <i>Art</i> are not built on what the -Eye of the Observer can possibly discover -in the most expert <i>Operators</i>; but depend -on Circumstances conceal’d from Sight, -within the Body of the Patient.</p> - -<p>But whatever Advantages <span class="smcap">L<span>ONDON</span></span> -and <span class="smcap">W<span>ESTMINSTER</span></span> afford for the Instruction -of Midwives, the Country is -entirely destitute of them; and the best -Books on the Subject, adorn’d with elegant -Figures, can give but a very imperfect -Notion of the Parts they represent, to -any who have not attended <i>Dissections</i>, or -seen more natural <i>Resemblances</i> than Cuts.</p> - -<p>The Figures in Books, exhibit the -<i>Bones</i> of the <i>Pelvis</i>, a Variety of <i>Situations</i> -of the Infant, and <i>Uterus</i>, the Placenta -and umbilical Vessels and Membranes, -<i>&c.</i> whereas it would be no less -serviceable to those, who assist Women in -Travel, to be acquainted with the Viscera, -liable to suffer by a difficult Labour; -for the <i>Liver</i>, <i>Spleen</i>, <i>Sweetbread</i> and -<i>Kidneys</i>, if not the principal Contents of -the Chest, may be so injured by the ill -<i>Position</i> of the Child, Compression of -the Parts, and rash Assistance, as to -prove fatal, more or lets immediately; -occasioning <i>Inflammations</i>, <i>Suppurations</i>, -<i>Mortifications</i>, <i>Schirrhu’s</i>, <i>Cancers</i>, or -<i>Consumptions</i>.</p> - -<p>The best Writers of Midwifry, such -as <i>Mauriceau</i>, <i>Deventer</i>, <i>De la Motte</i>, -<i>Heister</i> and others, explain the Causes -of difficult Births, and the proper Methods -of Assistance; but instead of improving -most <i>Country</i> Midwives, fill them -with Conceits of what, it is impossible, -they should understand, and thereby occasion -the Loss of great Numbers of Women -and Children.</p> - -<p>In order therefore that Midwives may -acquit themselves with Reputation, and -that <i>Child-bearing</i> Women may be the -better Judges for themselves, or the charitable -Part of the Sex, who are past -these Dangers, the better able to assist -their Friends and Neighbours, I shall -endeavour to shew how far they may act -with Safety under the Disadvantage of -Country Practice, and describe those -Symptoms, which for the most Part accompany -hard Labours, very probably -beyond their Abilities; when they will -justly incur the Censure of Inhumanity and -Rashness to depend upon their own Skill.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" -title="Chapter II.">CHAPTER II.</h2></div> - -<div class="dropcapletter">I</div> -<p class="dropcap"> -N this Chapter I have avoided the -Use of Terms of Art, or explain’d -them, in Regard to those for whom I -chiefly write, as far as my Regard to -Decency admits; but if any Word should -occur not easily understood by any of my -Readers, almost any <i>English</i> Dictionary -will explain its Meaning; and it cannot -be expected that any Book can instruct -those who cannot read, tho’ I am sorry -to say too many such assume the Office of -<i>Midwives</i>.</p> - -<p>As Curiosity may reasonably induce -many of the Sex concern’d in the -Subject of these Sheets, to be inform’d of -somewhat of the Provision supreme Wisdom -has made for the Existence of Children -in the Womb, I shall briefly mention -the most obvious <i>Instruments</i> relating -to their Breeding and Birth, without -puzzling my Readers with minute <i>anatomical</i> -Descriptions.</p> - -<p>The Vagina, or Passage, lies between -the Neck of the <i>Bladder</i> and the large -or strait Gut; it is connected at the inward -extreme to the <i>Womb</i>, and called the -<i>outward Orifice</i> at its beginning.</p> - -<p>The <i>Womb</i> lies between the <i>Bladder</i> -and <i>Strait Gut</i>, and is connected to -both; during the Time of <i>Breeding</i> it -increases in its <i>Dimensions</i>, and rising -higher in the Body, by Reason of the -Weight and Substance of it, with its -Contents, at the Fund, or remote End -of it, may be liable to swag too much -<i>forward</i> or <i>backward</i>, or incline more -or less to either Side, especially in such, -as by their Occasions of Industry in Life -are obliged to a Variety of <i>indirect</i> Situations; -by which Means the <i>inward</i> Orifice -is perverted from a <i>direct Site</i> with Respect -to the Passage, and obstructs an easy -Exclusion of the Infant in Travel.</p> - -<p>The <i>Placenta</i> or <i>After-birth</i>, adhering -to the <i>Fund</i> of the <i>Womb</i>, receives the -<i>Mother</i>’s Blood, by the <i>Umbilical-Vessels</i>, -or <i>Navel-String</i>, conveys it to the Child -for its Nourishment, and retransmits what -is superfluous; maintaining by the Intercourse -of <i>Arteries</i> and <i>Veins</i>, the Circulation -of the Blood between Mother -and Child.</p> - -<p>The <i>Membranes</i> closely connected to -the <i>Placenta</i>, and the <i>Fund</i> of the <i>Womb</i>, -between both which they seem to take -their Rise, contain the <i>Humours</i> in -which the Infant swims, the better to -preserve it from Injuries, by its Pressure -against <i>unyielding</i> Parts, and the <i>Humours</i> -before, and after the <i>Breaking</i> of -the <i>Membranes</i>, commonly call’d the -<i>Breaking of the Waters</i>, in the Birth, -very much facilitate it, by opening the -<i>inward Orifice</i> of the <i>Womb</i>, and lubricating -the <i>Passage</i> for the Child: These -<i>Membranes</i> come away with the <i>Placenta</i>, -under the Name of the <i>After-birth</i>, or -<i>Secundines</i>, indifferently.</p> - -<p>The <i>Pelvis</i> or <i>Bason</i>, wherein the -<i>Uterus</i> or <i>Womb</i> is seated, is form’d by -the <i>forward</i> Bones, commonly call’d the -<i>Share-Bone</i>, the <i>Hip-Bones</i> and their -Continuation on each Side, and the lower -Part of the <i>Back-Bone</i>, all which are so -contiguous to each other, as to form this -Cavity, generally much larger in Women -than Men, cloathed with Muscles, between -which the <i>Vagina</i> is inserted.</p> - -<p>The right Formation of the <i>Pelvis</i>, is -of the greatest Consequence in Favour of -an <i>easy</i> Birth; when the <i>Bones</i> forming -it, <i>forward</i> and <i>backward</i>, and on <i>each</i> -Side, both above and below, don’t too -much approach each other, and prevent -the Exclusion of the Child between, by a -free Admission.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter III. The Symptoms -preceeding Natural Labours."> -CHAPTER III. -<span class="h2smaller"> -<i>The Symptoms preceeding</i> Natural -Labours.</span></h2></div> - -<div class="dropcapletter">I</div> -<p class="dropcap"> -<span class="smcap">S<span>HALL</span></span> -pass over the Symptoms of -Pregnancy, and the Distinctions of -true and false Conceptions, as Things of -which Midwives can seldom be expected -to be <i>proper</i> Judges, and proceed to their -Business, <i>Natural Labours</i>; comprehending, -under this Name, all such Cases, -which require no further Assistance than -<i>Midwives</i>, in a general Way, may easily -give; or in their Absence a Nurse, or any -sensible Woman, who has attended Deliveries.</p> - -<p id="p9l16">After the Woman has gone her due -Time of Nine Months, the most usual -Term; the Signs preceeding Labour are -Pains about the Back, Navel and Loins; a -considerable Falling of the Tumour of -the Belly, by the Burden’s sinking lower; -and incommoding the Woman in walking; -a more frequent Inclination to make Water: -These Symptoms increase in Proportion -as the Birth approaches; but as -the most certain Knowledge of <i>natural</i> -Births, can only be obtained by <i>Touching</i> -the Woman in Labour, after having premised -some Things concerning her <i>proper</i> -Situation; I shall direct how it ought to -be done.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter IV. Of Situation.">CHAPTER IV. -<span class="h2smaller"> -<i>Of</i> SITUATION.</span></h2> -</div> - -<div class="dropcapletter">M</div> -<p class="dropcap">ANY in the Country choose to -be on their <i>Legs</i> or <i>Knees</i>, supported -by a Woman on each Side, or -<i>lean</i> on a Chair or Bed, and pass well -enough through the present Scene of -their Miseries: But I would preferably -advise a Posture between <i>lying</i> and <i>sitting</i>, -on a <i>Pallet</i> or <i>common</i> Bed, the <i>Head</i> and -<i>Shoulders</i> being <i>rais’d</i> by Bolsters or Pillows, -the Feathers <i>beat back</i> from the -Bed’s Feet, to support the hollow of the -Loins, and prevent the Pressure of any -Thing against the <i>Bottom</i> of the Back -Bone, to obstruct the Passage of the -Child.</p> - -<p>This <i>Situation</i> is most commodious, -during Labour, for a Woman to <i>assist</i> -her Pains with the greater Freedom of -Respiration, and the least Fatigue and -Expence of Spirits; especially if the <i>labouring</i> -Woman lay hold of a <i>folded</i> -Napkin, held stiffly for that Purpose, -drawing her Feet <i>upwards</i> towards her -Seat, <i>separating</i> her Knees, and <i>fixing</i> -her Feet against something that will not -easily give Way.</p> - -<p>If the Person in Labour will not be -in Bed, the End may be answered by -her <i>sitting</i> in <i>another</i>’s Lap, with the -<i>Bottom</i> of her Back-Bone situate between -the other’s Knees, with her <i>own</i> separated -and supported, and Feet fixed as aforesaid, -to favour her bearing down.</p> - -<p>’Tis inconsistent with the Design of -my Writing to describe all the <i>convenient</i> -Situations, necessary in Cases of Difficulty, -yet when the Operator has rectified -all Obstructions to the Birth, the -same Situation of the Body upon a <i>Slope</i>, -from the Head downwards is most suitable, -even altho’, for Conveniency, she -should be deliver’d lying on one Side.</p> - -<p>I shall, on this Occasion, observe, -what I have found Advantageous in my -own Experience, as well as consonant to -the Advice of the best Writers on the -Subject: That the Delivery on the <i>Back</i>, -by the Assistance of one placed on <i>each -Side</i>, supporting her by the <i>Hams</i>, with -her Knees <i>separated</i>, and raising her -<i>Back Bone</i> a little from the Bed during -the <i>Activity</i> of Pains, and the <i>Midwife</i>’s -<i>Assistance</i> of either Sex, is vastly preferable -to the Delivery on <i>one Side</i>, to -which I impute the Loss of many -Children brought by <i>Turning</i>, as well as a -more <i>tedious</i> Labour in other Cases; -because this Posture, in some Degree, <i>contracts</i> -the <i>Passage</i>, and only admits the -proper Separation of <i>one</i> Knee.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter V. - Concerning Touching.">CHAPTER V. -<span class="h2smaller"> -<i>Concerning</i> TOUCHING.</span></h2></div> - -<div class="dropcapletter">T</div> -<p class="dropcap">HIS -ought to be put in Practice, -as soon as, from the Symptoms -given in the Third Chapter, it is reasonable -to expect the Birth approaching; -and a <i>Child-bearing</i> Person would be -very much her own Enemy to refuse the -only Means of giving a <i>true</i> Information -of her Case, and the Knowledge how to -do her the most effectual Service.</p> - -<p>The Midwife, having her Nails well -pared, and very smooth, and her Fingers -anointed with Oil or Lard, must introduce -the two <i>fore Fingers</i> of either -Hand into the <i>Passage</i> or <i>Neck</i> of the -<i>Womb</i>, as far as its <i>inward</i> Orifice, directing -them with a <i>gentle</i> and <i>easy</i> Motion, -somewhat upwards, as it were with -a Tendency through the <i>Passage</i> towards -the <i>Navel</i>; in this Search she will find -the <i>internal</i> Orifice, joining the <i>Passage</i> -or <i>Neck</i> of the <i>Womb</i> more or less open, -relaxed, and thinner than usual; and -cautiously protruding her Fingers farther, -she may possibly touch the <i>Crown</i> of the -Child’s Head; she will easily, by the -<i>Sutures</i>, or <i>Opening</i> between the Bones of -the Skull, distinguish the <i>Crown</i>: Keeping -her Fingers in this Situation, <i>during</i> -the Beginning, and Continuance of <i>strong</i> -Pains, she will observe the <i>Waters</i> contain’d -in the <i>Membranes</i> including the -Child, and After-birth <i>forming</i> within -the <i>inward</i> Orifice, as if something like -a Bladder <i>blown</i>, or <i>distended</i> with Water, -presented to the <i>Touch</i>, dilating the <i>Orifice</i> -with each <i>Throw</i>; these Appearances -presage a <i>speedy</i> and <i>easy</i> Birth.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter VI. -Of a natural Birth, and the Office of the -Midwife.">CHAPTER VI. -<span class="h2smaller"> -<i>Of a natural</i> Birth, <i>and the</i> Office <i>of the -Midwife.</i></span></h2></div> - -<div class="dropcapletter">A</div> -<p class="dropcap">S the <i>Birth</i> approaches, the Woman -grows <i>hotter</i> and <i>red</i> in the -Face; the Pains bear more <i>strongly</i> -down; the <i>internal</i> Orifice <i>opens</i>; the -<i>Vagina</i> or <i>Passage</i>, at its <i>Entrance</i>, becomes -more swell’d, as the Child’s Head -advances; and the <i>Membranes</i> are more -and more <i>tensely</i> stretched; before the -<i>Birth</i>, the Person is often seized with a -<i>Vomiting</i>, and <i>universal</i> Tremor, without -the Coldness of an <i>Ague</i>; and very -often a <i>Humour</i>, <i>discolour’d</i> with <i>Blood</i>, -immediately preceeds the <i>Breach</i> of the -<i>Membranes</i>; when these Symptoms, or -several of them, become urgent, ’tis -Time to put the Woman in a proper Situation, -as describ’d in the preceeding -Chapter: The Midwife ought by no -Means to break the <i>Membranes</i>, but <i>encourage</i> -the Woman now to make the -best of her Pains, by <i>strongly bearing -down</i>, as if going to Stool; the Midwife -with her Fingers well anointed, putting -them gently within the <i>internal</i> Orifice, -may cautiously, by separating them, assist -its <i>opening</i>, and Removing it more -behind the Child’s Head, thereby gradually -promote its more easy Transmission, -and at the same Time prevent, -if necessary, the Womb from being -too far protruded: After the <i>Waters</i> are -<i>broke</i>, as it is called, and the <i>Head</i> of -the Child comes into the <i>Passage</i>, the -Midwife may lay hold on each Side of it, -taking Care not to bruise it by rough -Handling, and drawing it, by <i>Waving</i> -her Hands, if necessary, to loosen it, -when fixed, rather than in a strait Line, -assist the Birth; and if obstructed by the -Shoulders in the Passage, inserting a -Finger under each Arm-Pit, extricate -them by the like Action.</p> - -<p>’Tis true, it happens, tho’ unobserv’d -by Writers, as far as I remember, -that <i>many</i> Women have no <i>Waters breaking -away</i>, either before or after the Birth; -whether absorbed or not, in Time of Labour, -I shall not at present determine; -this is called, by the Country People, a -<i>dry</i> Labour, and often attended with -Difficulty; however, if the <i>Crown</i> appear -<i>forward</i>, the Issue may nevertheless be -favourable.</p> - -<p>The Child being born, the next Business -is to tie the <i>Navel-string</i> with a -<i>waxed</i> Thread, so <i>doubled</i>, as not to endanger -<i>cutting</i>, about <i>two</i> Inches from -the Child’s Body, making another Ligature -near the Body of the Mother, so far -distant from the former, as may be convenient -for <i>Cutting</i> between <i>both</i> Ligatures, -and separating the Infant from its -<i>After-birth</i>. Midwives are too apt to -leave a greater Length, which can be of -no Service, but has been thought, on the -contrary, by our Countryman <span class="smcap">C<span>HAPMAN</span>,</span> -to occasion <i>Navel</i> Ruptures.</p> - -<p>After the <i>Separation</i> of the <i>Navel-string</i>, -the Care to get the <i>After-birth</i> -succeeds; this will often come by the -Assistance of Nature, with a gentle Motion -of the Hand gradually drawing and -loosening it, by the Navel-string: But -if it adheres to the <i>Fund</i> of the <i>Womb</i>, -which is frequently the Case, whether -from the <i>Waters</i> being come away before -the Birth or otherwise; it must cautiously -be separated, and extracted by the Hand, -to prevent the most mischievous and fatal -Consequences.</p> - -<p>The Assistant holding the <i>Navel-string</i> -with <i>one</i> Hand, must with great Caution -introduce the <i>other</i> into the <i>Womb</i>, avoiding -<i>all Violence</i> to any Part in the Way, -’till she reaches the <i>After-birth</i>, some -Part of which probably, being loosened, -will be found more <i>forward</i> than the rest; -which <i>taking</i> between her <i>Thumb</i> and -<i>Fore-Fingers</i>, she must, by an easy Motion -of her other Fingers, between the -<i>Womb</i> and <i>After-birth</i>, gradually <i>separate</i> -the Parts adhering all <i>round</i>, ’till -finding the whole free, before the Palm -of the Hand and Fingers, she brings it intirely -away; for should any Part remain, -the poor Woman’s Labour would still -continue, and occasion <i>dangerous</i> Floodings, -requiring the immediate Assistance -of an able Hand, to rescue the Patient -from the immediate Hazard of Death.</p> - -<p>Sometimes when the <i>Womb</i> has discharged -its <i>Waters</i>, and the <i>Child</i>, by -Reason of a Defect of Pains, or otherwise, -remains <i>long</i> very <i>forward</i> near the -<i>Birth</i>, the <i>Womb</i> so <i>contracts</i> about the -<i>After-birth</i>, as to make the <i>Separation</i> of -it very difficult; in which case Assistance -is requisite, from one well acquainted -with the Structure of the Body; and the -longer this is delay’d, the more Danger -there will be of all the bad Consequences -of the Retention, and Corruption of the -<i>After-birth</i> in the Body.</p> - -<p>It requires great Care to prevent the -<i>Protrusion</i> of the <i>Womb</i> in some Women -of a <i>large Pelvis</i>, or <i>Opening</i> between the -<i>Bones</i>; or if the <i>After-birth</i> remains -closely fixed, the <i>Womb</i>, in a very <i>open -Pelvis</i>, may be <i>thrust</i> by the Violence of -the Pains; or <i>drawn</i> out of the Body by an -<i>unskilful</i> Hand, which is commonly very -soon fatal to the poor Woman; and I believe -happens much oftner than is apprehended, -tho’ industriously conceal’d, by -<i>guilty</i> Midwives, under the Colour of the -poor Woman’s dying in Child-bed, from -some other Cause. <span class="smcap">D<span>EVENTER</span></span> says, he -saw a sad Spectacle at the <span class="smcap">H<span>AGUE</span>,</span> the -<i>Head</i> of the Child excluded to the <i>Shoulders</i> -quite without the <i>Passage</i>, when -Three-fourth Parts of the <i>Head</i> were -conceal’d within the <i>Womb</i>, the <i>Crown</i> -appearing within its <i>inward Orifice</i>†.</p> - -<p class="pright">† See Chir. Op. Part ii. Page 32.</p> - -<p>A much worse Case happen’d in my -Neighbourhood, <i>Sept.</i> 23, 1749. I was -call’d to a Woman, whose Child, on the -21st came unexpectedly, without the least -Assistance, in the Presence of an <i>old</i> -<span id="p21">Midwife</span> of <i>large</i> Practice; she puzzled an -Hour, as I was inform’d, to bring away -the <i>After-birth</i>, which closely adhered to -the <i>Fund</i> of the <i>Womb</i>; while the <i>unfortunate</i> -Woman lay senseless, saving the -Memory of being long expos’d to the -Cold, when she came to herself; after -which she continued in violent <i>Labour-like</i> -Pains; upon Scrutiny, I found a large -<i>Substance</i> in the <i>Pelvis</i>, of the Size of a -Child’s Head, considerably resisting my -Touch; I observ’d on Trial, a Part of the -Woman’s Body every Way <i>interposed</i> between -my Fingers and this <i>Substance</i>, by -her Sensibility of my <i>Touch</i>; therefore -contenting myself with giving her some -palliative Medicines, and telling the Persons -present, a Mole, as I thought, or -Child still remain’d to come away, I for -that Time, took my Leave: On the -24th, she was said to be much better; -on the 29th, I was again call’d to this -poor Woman, and inform’d, that upon -her first going to Stool, since I had before -seen her, which happen’d the same Day, -the large <i>Substance</i> before-mention’d, -came intirely out of her Body; to which -it join’d by a thinner Substance, of some -length: I now perceived it was no less -than the <i>Womb</i> turned <i>inside out</i>, suspended -by its <i>Ligaments</i>, and joining to -the <i>Vagina</i>, but very much swell’d by -the Obstruction of the circulating Humours; -And an old Gentlewoman, who -was present when the Child was born, -inform’d me, she saw the Midwife draw -this <i>Body</i> from the Woman, by the <i>Navel-string</i>, -and indeed, the Impression of -her <i>Nails</i>, in separating the <i>After-birth</i>, -remain’d still visible at the <i>Bottom</i> of the -<i>Womb</i>, and the Midwife having long -expos’d the Patient, put this <i>inverted -Womb</i> again into her Body.</p> - -<p>The Condition of the Part, after so -long Delay, did not admit the Possibility -of rightly reinstating it; I therefore return’d -it, as well as I could, into the -Pelvis, and introduc’d a Pessary to retain -it; and as this Person had already contracted -a Hectick, I charg’d her, as she -valu’d her Life, to confine herself strictly -to a <i>cooling Milk</i>, or <i>vegetable Diet</i>; she -has since had large Discharges of a <i>bloody</i> -Corruption, with Portions of a fleshy -Confidence from the Parts affected. In -<i>April</i>, 1751, she told me the Discharge -coming from her had long been much -abated in Quantity, and what remain’d -was the Whites; that she had an inward -Fever, and the Piles, for which I gave -her my Advice; her Complexion was -chang’d from the most florid to a languishing -Paleness.</p> - -<p>My Brother, much better known in -this Country, and longer practis’d in -Midwifry, has been concern’d in furnishing -Medicines for the Person, whose -History I have given, altho’ by Means of -his Absence, he did not attend her on the -most emergent Occasions.</p> - -<p>I have since been call’d to the Assistance -of the <i>old</i> Midwife, who attended, and -she frankly told me, she had another -Woman under the like Circumstance, -who died the same Day.</p> - -<p>Having related such Things as occur -in the most favourable Circumstances of -Travil, about which all Midwives ought -to be well inform’d, and those Injuries to -which Women are sometimes liable, notwithstanding -the most <i>promising</i> Appearances: In -the next Place I proceed to -shew, what are the Symptoms preceeding -<i>difficult</i> Labours, which by timely Assistance, -may be secured from the most dangerous, -if not fatal Consequences, and -are of great Moment to be known by -Midwives, as well as Matrons and Child-bearing -Women, to enable them to judge -when it is absolutely necessary to recommend -calling that Aid, which is beyond -their Capacity to give.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter VII. -The Difficulty from the Membranes.">CHAPTER VII. -<span class="h2smaller"> -<i>The Difficulty from the</i> Membranes.</span></h2></div> - -<div class="dropcapletter">A</div> -<p class="dropcap">N -<i>unforeseen</i> Difficulty may occur, -when Appearances are otherwise -favourable, from the Strength of the -<i>Membranes</i>, obstructing the <i>Birth</i>, and -requiring great Caution to prevent; for in -this Case, the Operator must break the -<i>Membranes</i>, in order to promote the <i>Birth</i>; -and as the <i>Waters</i>, they contain, are a -Means to open the <i>internal Orifice</i>, lubricate -the <i>Passage</i>, and facilitate the -<i>Birth</i>; the <i>breaking</i> the <i>Membranes</i> too -soon, will render the Labour more <i>tedious</i>; -and should it be too long delay’d, -the Patient’s Misery would be <i>prolonged</i>; -wherefore the Midwife must not break -<i>them</i>, before the <i>Orifice</i> is sufficiently <i>open</i> -to admit the Head, when she may tear -them with her <i>Nails</i>, but by no Means -pull them, for as they adhere to the <i>After-birth</i>, -she might by that Means separate -it, and bring on a Flooding.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter VIII. -Difficulties occasion’d by the Navel-String.">CHAPTER VIII. -<span class="h2smaller"> -<i>Difficulties occasion’d by the</i> Navel-String.</span></h2> -</div> - -<div class="dropcapletter">T</div> -<p class="dropcap">HE <i>Navel-string</i>, by a Variety of -Convolutions, sometimes obstructs -the Birth, for being shortned, by its Contortions -about the Neck, or any Part of -the Body, the <i>Labour</i> will become <i>unnatural</i>, -by Reason tho’ the Pains are <i>strong</i>, -the <i>Navel-string</i>, by its <i>shortness</i>, will pull -the Child back with each Pain; and here -an unskilful Management may break the -String, and occasion a dangerous Flooding; -but as the Woman’s Pains will prove -<i>ineffectual</i>, notwithstanding their Strength -and Force, the Midwife will, by this -Means, find the Case out of her Province; -I mean, where the <i>Navel-string</i> is very -much <i>abbreviated</i>.</p> - -<p>If the <i>Navel-string</i> comes forward before -the Child’s Head, it will seldom remain, -when put backward by the Hand; -therefore, if the Midwife has any Regard -for the Life of the Child, she ought to -call for Assistance, before the Birth is further -advanc’d, or it will be extremely -difficult, if not impossible, to save the Infant; -and she would probably be foil’d -for want of sufficient Strength, had she -Skill to save it.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter IX. -Difficulties from the Placenta or Secundines.">CHAPTER IX. -<span class="h2smaller"> -<i>Difficulties from the</i> Placenta <i>or</i> Secundines.</span></h2></div> - -<div class="dropcapletter">T</div> -<p class="dropcap">HE -<i>Placenta</i> or <i>After-birth</i>, being -from any violent Shock or -Accident, more or less, <i>separated</i> from -its Seat, during any Time of Breeding, -will produce a Flooding, in Proportion -to its Quantity, <i>dangerous</i>, which is sometimes -so violent, as to occasion Death in -an Hour’s Time; and nothing but <i>instant</i> -Delivery can prevent it. When the Case -is not so desparate, as all the <i>Blood</i> in the -Mother’s Body, necessary to support her -own and Infant’s Life, may be drain’d -away, the Consequence may be equally -fatal in a more lingering Way.</p> - -<p>The 26th <i>Feb.</i> 1748, I was sent for -to a Woman at -<span class="smcap">M<span>OUNTAIN</span>-D<span>EVEREL</span>,</span> -within about Five Weeks of her Time, -in a violent Flooding; her Midwife gave -her an Opiate, which she thought check’d -her Flooding, excepting that once a -Week, it became very violent, for about -three Weeks past; when I came, the -Neighbours told me she had lost a Pail -full of Blood; the poor Woman was so -weak, that her Pulse were scarcely perceptible, -and her Voice but a Whisper; -I was unwilling to meddle, for fear she -should die under my Hands, but yielded -to the Importunity of her Friends: It -was with great Difficulty I introduced the -<i>Tops</i> of my two Fore-fingers and Thumbs -into the <i>internal Orifice</i>, which I gradually -dilated, ’till I could pass my Hand, -when by <i>turning</i>, I brought away a <i>dead</i> -Child, depriv’d of its Nutriment by the -great Loss of its <i>maternal</i> Blood; but -had considerable Trouble in getting the -<i>After-birth</i>, by Reason of its <i>Adhesion</i>: -After Delivery, the Flooding immediately -very much abated, the poor Woman reviv’d -to Admiration, and I left her the -next Day, as well as could be expected -in so low a Circumstance, tho’ dubious of -her Recovery: I heard she died five or -six Weeks after; but I am well satisfied, -had she had an earlier Recourse for Assistance, -she might have recover’d.</p> - -<p>In these Cases, Midwives are too apt to -trust to their own Judgments, instead of -calling for better Assistance; and tho’ -they have Recourse to external <i>Applications</i>, -<i>Ligatures</i>, and <i>Opiates</i>, these -Things, injudiciously practis’d, are frequently -more detrimental than beneficial: -For Instance, should the <i>Arteries</i> be compress’d -by too tight a Ligature of the -<i>Arms</i> and <i>Legs</i>, the <i>Flooding</i> would -become more violent.</p> - -<p>When ignorant Midwives, by rashly -pulling the <i>Navel-string</i>, break it, or by -the Adhesion of the <i>After-birth</i>, find it -out of their Power to bring it away, they -are apt to persuade People, it will come -without further Help, which seldom happens; -on the Contrary it most frequently -occasions Death, more or less suddenly, -or Hecticks and Consumptions, when left -to corrupt in the Body: The <i>Uterus</i> -sometimes so strongly contracts about, and -embraces it, that it may be impossible, -after a few Hours Delay, to procure it, as -I found in a Case that occur’d to me at -<span class="smcap">C<span>OLEHORN</span>,</span> the 30th <i>Sept.</i> 1748, tho’ -little more than four Hours passed, from -the Time the Midwife broke the <i>String</i> -close to the <i>Placenta</i>, for the Part of the -<i>Uterus</i> next the <i>Placenta</i> was so contracted, -as barely to admit the <i>Tops</i> of my -two Fore-fingers; I endeavour’d, with -all possible Caution, to make a larger -Aperture, but in the ill <i>Situation</i> of the -<i>Uterus</i>, at the Extent of my Reach, all -my Attempts were in Vain; this Woman -rested well the succeeding Night, and had -no extraordinary Complaints when I left -her in the Morning, first prescribing what -I thought most suitable to her Condition: -I afterwards heard she died with a Frenzy, -succeeding a <i>Suppression</i> of the <i>usual</i> Purgations; -where the Corruption of the -<i>Placenta</i> takes Place, the Case is, at least, -more Chronical, and the <i>Secundines</i>, gradually -wasting, come away Piece-meal, -the Patient labouring under a Hectick -from the Contagion of putrid Humours, -mixing with the circulating Fluids.</p> - -<p>I have at other Times, after a longer -Delay, been more successful; the 28th -<i>December</i>, the same Year, I was call’d, -by Order of the late Lord <span class="smcap">W<span>EYMOUTH</span>,</span> -to the Assistance of a poor Woman at -<span class="smcap">H<span>ORNISHAM</span>,</span> whose <i>After-birth</i> had been -retain’d three Days; she had contracted a -Fever from its Putrefaction, which was so -great, that scarcely any Body could bear -the Room, and had lost a great deal of -Blood by Flooding; the poor Woman -soon recover’d after her Delivery, in the -Use of a little Medicine, from his -Lordship’s House: I have seldom found the -Business difficult, when speedily call’d in -the like Cases.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter X. -Difficulties attending the Contraction, or -Ill-site of the Inward Orifice.">CHAPTER X. -<span class="h2smaller"> -<i>Difficulties attending the Contraction, or -Ill-site of the</i> Inward Orifice.</span></h2></div> - -<div class="dropcapletter">I</div> -<p class="dropcap" id="p33l12">N the Fifth Chapter I have told, how -the Midwife may judge, by touching, -of an easy Birth; carefully introducing -her two Fore-fingers into the Passage, to -find the internal Orifice of the Womb in -the Beginning of Labour; now, in doing -this, if the Orifice, she is in Search for, -does not readily occur, she has great Reason -to apprehend Difficulty; and if not -well acquainted with the Parts she handles, -by rude Usage, piercing through -any Part of the <i>Vagina</i>, which presents -to the <i>Touch</i>, may do Mischief. Such an -Injury was done to one of Box, where I -was called <i>Sept.</i> 21, 1748. This -Woman had been in Labour several Days; -the Midwife having, the last Time, been -with her eighteen Hours, the Pole of the -Child’s Head lay upon the Share-bone, -which was rectifyed by one Limb of the -Extractor and brought into the Passage; -the other Limb being joined, the Infant -was soon born; but what before surprized -me, was to find a <i>Passage</i>, for my Fingers, -considerably remote from the <i>internal -Orifice</i>, with great Complaints of a smarting -Pain when I touch’d it; a Suppuration -follow’d, but the Woman soon recover’d, -after the frequent Use of an emollient -and discutient Fomentation.</p> - -<p>When the <i>Orifice</i> presents rightly, and -is easily found, it is next of Consequence -to observe, whether the Pains <i>relax</i>, <i>open</i> -and <i>enlarge</i> it; for should it remain <i>thick</i> -and <i>contracted</i>, instead of relaxing and -growing thinner, if the Infant comes -rightly directed, the Woman’s Pains are -not <i>genuine</i> but <i>spurious</i>; it will then be -proper to give an emollient and carminative -Glyster, and probably the false Pains -will be reliev’d, and the true succeed; or -some Time may intervene, before her true -Labour, especially if the full Time of -Breeding should not be expired.</p> - -<p>If the Midwife cannot reach the <i>internal -Orifice</i>, and the Child’s Head lays -<i>high</i>, the Orifice may possibly lay <i>high</i>, -<i>backwards</i> or <i>forwards</i>, or more or less so, -inclining <i>Sideways</i>; the Reason of which -may be apprehended, from the brief Account -of the <i>Womb</i>, and the <i>Pelvis</i>, in -the Second Chapter. In this Case it may -be with great Difficulty, the Assistant can -reach the nearest Margin of the <i>internal -Orifice</i>, tho’ well instructed and experienced, -and it will often require the Hand of -an expert Artist, early in Labour to rectify -it, or turn the Child, when Travil is advanced; -or if too long neglected may occasion -the Death of one, or both Mother -and Child.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter XI. -Difficulties attending a wrong Position of -the Child’s Head.">CHAPTER XI. -<span class="h2smaller"> -<i>Difficulties attending a wrong Position of -the</i> <span class="nowrap">Child<i>’s</i> -Head.</span></span></h2></div> - -<div class="dropcapletter">I</div> -<p class="dropcap">F in the Progress of Travil, the Midwife -perceives any Part of the Head, -besides the <i>Crown</i>, discoverable by its <i>Sutures</i>, -presenting, and it appear <i>broad</i>, -and very <i>hard</i> to the <i>Touch</i>: If the <i>Waters</i> -may be <i>felt</i> descending in a <i>long</i> Form -through the <i>internal Orifice</i>, somewhat -like a Piece of a Gut distended with Water: -These Appearances presage the utmost -Difficulty and Danger, commonly -owing to the small Distance between the -<i>forward</i> and <i>back</i> Bones; an ill Situation -of the <i>internal Orifice</i>; the <i>comparative -Largeness</i> of the Child’s Head; or the <i>ill</i> -Site of the <i>Womb</i>; whereby the Head may -be pressed against the Bones <i>forward</i> or -<i>backward</i>, or somewhat inclined to <i>either</i> -Side, in a wrong Direction for the <i>Passage</i>. -These Causes, singly or concurring, render -the Case much beyond the Skill, and -very often the Strength, of a Midwife to -redress.</p> - -<p>When unqualified Midwives observe -the Head present to the inward Orifice, -they are too apt to promise good Success, -and behave with the utmost Confidence, -wherein they are often egregiously mistaken; -for there cannot be a more difficult -Birth, than frequently happens, when any -other Part, instead of the Crown, offers; -and the Misfortune is, the longer Recourse -to proper Assistance is delay’d, the greater -the Difficulty becomes every Moment; -and the poor Woman may think herself -happy, if she escapes with her Life, the -Danger of a most <i>fatiguing</i> and <i>tedious</i> -Labour, succeeded, perhaps, by such a -Relaxation of the <i>Vagina</i> or <i>Passage</i>, as -will occasion great Uneasiness in going, -or being in an <i>upright</i> Posture, without -the immediate Help of Medicines, both -externally and internally; or wearing a -<i>Pessary</i> for its Support, during Life.</p> - -<p>Whereas ’tis certain, that if the Mother’s -Pains, <i>strongly bearing down</i>, the -Muscles of the Belly contracting and becoming -sensibly <i>hard</i> to the <i>Touch</i>, don’t -manifestly promote the Birth, it must -needs be owing to some Obstruction beyond -the Midwife’s Skill; who in this Circumstance -is apt to complain, the Pains -are not sufficiently <i>strong</i>, ’till the poor -Woman is ready to expire, from the Loss -of her Strength, by her long Suffering -under them; and told she must patiently -wait God’s Time, who in Case he miraculously -interpos’d, wants not the Midwife’s -Assistance: And what still adds to -this deplorable Calamity, ’tis likely she is -put upon exerting her utmost Strength, -assisted by Cordials; when <i>encouraging</i> -her <i>Labour</i> and <i>provoking</i> her <i>Pains</i>, ’till -the Obstructions in the Way of the <i>Birth</i> -are remov’d, contribute still further to the -Danger attending.</p> - -<p>I don’t deny but that in some Cases, a -<i>tedious</i> Labour may be owing to a Defect -of <i>sufficiently</i> strong Pains; but as this -often proceeds from <i>Circumstances</i> obstructing -the <i>Birth</i>, true Labour naturally -takes Place, when they are remov’d; -and, by a right Management of the -Hand, is more <i>effectually</i> promoted, -without Cordials or <i>forcing</i> Medicines, -where the Pains are deficient.</p> - -<p>Under this Sort of unnatural Birth, -may very well be enumerated, the <i>Face</i> -presenting <i>towards</i> the Mother’s Belly, or -the <i>Side</i> of the Head coming <i>Foremost</i>, -for its Passage must be extreamly difficult -in these Postures; as well as when the <i>Face</i> -comes <i>forward</i>; for then by Reason of the -great Tumour, about the <i>Head</i>, <i>Face</i>, -<i>Eyes</i>, and <i>Mouth</i>, from Lodging between -the Bones, the Infant expiring in the -Birth, has been often taken for a Monster. -I have often been so happy, when the -Head has long remain’d, wedg’d between -the Bones, as to bring the Child alive, -by the <i>Forceps</i>, in a few Minutes, if -seasonably call’d, when the Woman in -Travil has been in the utmost Danger -of Death.</p> - -<p>The 5th of <i>May</i>, 1751, I met with -as bad a Case, as most of this Kind at -<span class="smcap">W<span>IGGLETON</span>:</span> This Woman, by the -Midwife’s Account, seem’d to be in -<i>Labour</i> at Times near a Month, and for -a Week last, almost in continual Pain, -with her first Child: as I was call’d late to -her Assistance, I could not judge, by -early Appearances, of the Situation of the -<i>Uterus</i>, or <i>Infant</i>; this is most commonly -only in the Power of the Midwife -to observe; her <i>Waters</i> had gradually -drain’d away above a Week, and there -still remain’d some Part of the <i>Membranes</i> -depending like a <i>Gut</i> in the <i>Vagina</i>, the -<i>Head</i> offer’d, firmly wedg’d in the <i>Pelvis</i>; -the Part most obvious to the <i>Touch</i>, by its -Softness and fleshy Consistence, seem’d to -be the <i>Cheek</i>: The poor Woman’s Pains, -for some Hours, were <i>ineffectual</i> for want -of Strength, her Spirits being exhausted, -by a Labour so fatiguing; there was no -Possibility of <i>turning</i> the Child; I endeavour’d, -with some Success, to promote -the <i>Birth</i>, by bearing <i>strongly</i> against the -inferior Part of the <i>Os-sacrum</i>, but her -Weakness, depriving me of the small Benefit -of her Pains, I had for a Time; -there was an absolute Necessity for a -speedy Delivery, for the Mother’s Sake: -’Twas with some Difficulty I overcame -her Prejudice, and those Present against -the Use of any Instrument, tho’ at length -they yielded; when introducing a <i>Limb</i> -of the Extractor on each Side of the -Head, and Co-operating with a small -Pain, encouraging the Woman to bear -down as strongly as she could, I immediately -brought a Daughter, with a monstrous -long Head alive.</p> - -<p>I <span class="smmaj">HAVE,</span> however, met with some Cases, -which I could relieve by no better Method, -than lessening the Head; but considering -for whose Benefit I am chiefly -Writing, and how dangerous the Use of -Instruments may be in injudicious Hands, -I rather choose to advise Women not to -meddle with them, than pretend to relate -the Method of using them.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter XII. -Difficulties from other ill Positions of the -Infant.">CHAPTER XII. -<span class="h2smaller"> -<i>Difficulties from other</i> ill Positions <i>of the -Infant.</i></span></h2></div> - -<div class="dropcapletter">T</div> -<p class="dropcap">HE -<i>Arm</i> or <i>Shoulder</i> presenting, is -so well known to be attended with -Difficulty, that few Women will attempt -such Deliveries, unless they are so very ignorant, -as to imagine they can bring the -Child by <i>pulling</i> at an <i>Arm</i>.<br class="clearfix" /></p> - -<p>As our Miscarriages, or rather Misfortunes, -in Practice, may no less contribute -to the Information of others, by Caution, -than our Success, by Example; I shall -not scruple to give a candid Relation of -the most fatal Occurrence, which ever fell -to my Lot.</p> - -<p>The 12th <i>September</i>, 1748, I was -called to a Woman at <span class="smcap">T<span>ROUBRIDGE</span>,</span> her -<i>Matrix</i> lay <i>forward</i> in a <i>prominent -Abdomen</i> hanging very low, the <i>Os-uteri Internum</i> -lay very much <i>backward</i>, <i>both</i> Hands -<i>presented</i> to it, this Woman had been very -ill the preceeding Week, and in extreme -Misery the last Twenty-four Hours; with -a great deal of Trouble, I got and drew -towards me one <i>Foot</i>, with the <i>Heel turn’d -towards the Mother’s Belly</i>; in drawing -the <i>Infant</i> so far as the <i>Arm-pits</i>, I found -the <i>Face</i> of the Child did not <i>turn</i> so -readily as I expected towards the Mother’s -<i>Back</i>; as soon as I had brought the <i>Feet</i> -some Distance without the <i>Vagina</i>, while -I endeavour’d to extract the Child by -hold of its <i>Thighs</i>, the Midwife, unknown -to me, officiously laying hold of -the Infant’s <i>Feet</i>, exerted her Strength at -the same Time with mine; I intended to -leave the <i>Arms</i> according to <span class="smcap">D<span>EVENTER</span>,</span> -as a Security to the more safe Transmission -of the <i>Head</i>; and while our united -Strength was exerted, I found the <i>Neck</i> -gave way, with something of an <i>audible</i> -Crack; and with some Surprize, looking -about me, saw the Midwife <i>labouring</i> at -the Child’s <i>Feet</i>, and check’d her, as -acting very rashly, without my Direction; -thus we had really separated the <i>Spine</i> of -the <i>Neck</i>, and the <i>Head</i> only adhering to -the <i>Body</i> by the <i>Skin</i>, was with little or -no Force separated from it: In passing -my Hand, after a tye on the <i>Navel-string</i>, -I found the <i>Head</i> fell <i>back</i> into the prominent -Part of the <i>Abdomen</i>, insomuch -that I could only reach the separated Part -of the <i>Neck</i>, and I endeavour’d, in vain, -to get hold of the <i>Head</i> by the <i>Crotchet</i>: -While I was thus employ’d, a <i>Flooding</i> -came on, by the Separation of the <i>Placenta</i>, -which quick’ned my Endeavours, -from the Apprehensions of her sudden -Death, if she was not immediately deliver’d; -but the poor Woman, much spent -with Fatigue and Loss of Blood, begg’d I -would desist, preferring Death to Life; -in which being join’d by the People present, -and not a little exhausted of Spirit -and Strength myself, I was, much against -my Will, obliged to leave her to her -Fate.</p> - -<p>Here I would observe, it appear’d the -<i>Body</i> was that of a large Boy, and tho’ I -find <span class="smcap">G<span>IFFARD</span></span> and others made no Scruple -of leaving the <i>Arms</i> of a small Child, I -must join with them in advising not to -bring a <i>large one</i>, without first <i>procuring</i> -the <i>Arms</i>; tho’ I will not say, whether -the Method of delivering on one Side instead -of the <i>Back</i>, the lower Part somewhat -<i>raised</i> from the Bed, at the same -Time <i>encouraging</i> Labour with Hopes of -immediate Delivery, recommended by -<span class="smcap">D<span>EVENTER</span>,</span> may not occasion the Danger -of leaving the <i>Arms</i>.</p> - -<p>There are Variety of other wrong <i>Situations</i>, -and <i>Cases</i> of Difficulty, which I -could illustrate by Examples in my own -Practice, and may be found in the Observations -of <span class="smcap">M<span>AURICEAU</span></span> -<span class="smcap">D<span>E-LA</span>-M<span>OTTE</span>,</span> -<span class="smcap">G<span>IFFARD</span></span> and others, for the Information -of such as practise Midwifry, that have -no Relation to the Information of Midwives, -either in their own Practice, or -Occasions of Assistance.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter XIII. -Of TWINS.">CHAPTER XIII. -<span class="h2smaller"> -<i>Of</i> <span class="ltspb">TWINS.</span></span></h2></div> - -<div class="dropcapletter">T</div> -<p class="dropcap">HE -Case of <i>Twins</i> may, in many -Country Places, be esteemed beyond -the Skill of Women <i>practicing</i> Midwifry; -but as they are not alike ignorant, and -this Delivery, with a right Management, -is attended with no great Difficulty, I -shall describe it as plainly as I can.<br class="clearfix" /></p> - -<p>If a Child comes naturally by the Force -of the <i>Mother</i>’s Pains, and the <i>After-birth</i> -does not easily follow, the Midwife, by -passing her Hand to separate its Adhesion -as directed in the sixth Chapter, will readily -find whether <i>another</i> Child still remains -to be born, by the Appearance of -other <i>Membranes</i>, including <i>Waters</i>, &c. -And as where more than one is to be born, -they are generally proportionably smaller, -and tho’ the first Child comes naturally, -the second may not, she need not wait for -the <i>Birth</i> of the other, by the meer Force -of Nature, for this would greatly hazard -the Life of the Child, and sometimes of -the Mother, by a Flooding; but ought to -break the <i>Membranes</i>, and search for the -<i>Feet</i>, carefully preventing their being -intangled with the <i>Navel-string</i>; and -having got both in her Hand, draw them -into the <i>Passage</i>; if the Child’s <i>Toes</i> point -to the <i>Mother’s Back</i>, there will be no -Danger of the <i>Chin</i> or <i>Nose</i> being hung -on the <i>Bones</i> before, and she may draw -the <i>Feet</i> forth with the rest of the <i>Body</i>, -without delaying to bring down the <i>Arms</i>, -encouraging the Mother to assist in the -mean Time, by <i>bearing down with or without -Pains</i>.</p> - -<p>In Case the <i>Child’s Toes</i> should point -to the <i>Mother’s Belly</i>, the Midwife, in -drawing the Child forth from the <i>Hips -forward</i>, must gradually <i>turn</i> the <i>Belly</i> -of the Child towards the <i>Mother’s Back</i>, -by the Assistance of the other Hand in the -proceeding.</p> - -<p>If the Woman be straiter, or the Child -larger, than ordinary, when she has -brought the Infant into the <i>Passage</i> somewhat -short of the <i>Arm-pits</i>, she must, by -introducing her Fingers, first over one -<i>Shoulder</i>, cautiously bring down one <i>Arm</i>, -and then in like Manner the <i>other</i>, and -drawing the Child forward, she must make -Use of both Hands to extricate the <i>Head</i>; -the <i>Fingers</i> of one Hand between the <i>Mother’s -Back</i> and <i>Child’s Jaws</i>, bearing and -drawing them from the <i>Back-bone</i>, and -with the Fingers of the other Hand over -the <i>Shoulders</i>, and the <i>flat</i> against the -<i>Child’s Back</i>, draw it forth, the Mother -as aforesaid assisting all the while.</p> - -<p>Writers advise putting two Fingers -into the <i>Child’s Mouth</i>; but as great Injury -has often been done that Way, it is -much safer to bring the Child by <i>bearing</i> -with the Fingers against its <i>Jaws</i>. If an -<i>Arm</i> should be broke in <i>bringing down</i>, -let it be spliced with thin Paste-board, and -bound at its full Extent to preserve its -right Shape.</p> - -<p>In fetching an Infant by <i>turning</i>, ’tis -necessary to draw its <i>Feet</i> into the <i>Passage</i>, -with the <i>Toes situate</i> towards the <i>Infant’s -Belly</i>, for it may be extreamly difficult, -if not impossible, to draw it backwards, -contrary to the natural <i>Bent</i> of its <i>Thighs</i> -and <i>Back</i>; and a <i>Limb</i> may sometimes as -easily be pull’d off, as the Child brought -to the <i>Birth</i> this Way; the Midwife must -therefore make Use of the <i>right</i>, or <i>left</i> -Hand in doing it, which happens to be -most convenient, to the natural <i>bending</i> -of the Infant’s Body.</p> - -<p>I <span class="smmaj">THINK</span> it cannot be safe for a Woman -to <i>turn</i> a Child upon ether Occasions requiring -it; their Strength, as well as -Skill being frequently inferior to the -Task; besides, there may be great Danger -of injuring the Vitals of the Mother in -other Cases, especially after the Operation -is unseasonably delay’d.</p> - -<p>As each Child has a Navel-string, as -well as After-birth belonging to it (tho’ -both <i>Placenta</i>’s are sometimes so joined as -<span id="p49">easily</span> to be distinguished) the Care respecting -the <i>Navel-string</i>, already related -in the Sixth Chapter, must of Course be -taken for the First-born, and its <i>Secundines</i> -left, ’till after the Birth of the Second, -when both, if necessary, must be -separated and brought away, as there advis’d, -with Regard to one alone, and the -<i>Navel-string</i> of the last Infant tied after -the same Manner as in the Birth of one -Infant.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter XIV. -Of a Dead Child.">CHAPTER XIV. -<span class="h2smaller"> -<i>Of a</i> Dead Child.</span></h2></div> - -<div class="dropcapletter">A</div> -<p class="dropcap"><span class="smcap">D<span>EAD</span></span> -Child is often born with -abundantly more Difficulty than a -<i>living</i> one, for the last by its Struggles -considerably promotes its own Birth; -whereas, the first lies <i>immoveably</i> in the -<i>same</i> Posture, without changing Situation -by its own Activity.<br class="clearfix" /></p> - -<p>When the Death of the Child proceeds -from any <i>accidental</i> Injury, the <i>breeding</i> -Woman commonly knows it, by the Perception -of a <i>Weight</i> within her, in the -Part where it lies, instead of its <i>usual</i> -Motions, which from that Time cease, -and occasion, not without Reason, a Solicitude -for the best Assistance.</p> - -<p>One of my Neighbours, whom I lately -deliver’d, had the Misfortune to fall flat -on her Face, between the 7th and 8th -Month of her Pregnancy; from which -Time to that of her Labour, above three -Weeks after, she had a continual Sensation -of a Weight within her, without <i>any</i> of -the Child’s Motions, as before this Accident, -although it was not succeeded by a -<i>Flooding</i>, as is common upon a <i>partial</i> or -<i>total Separation</i> of the <i>Placenta</i>: She had -frequently been attacked with Pains resembling -Travil, for above two Weeks -before it came on effectually; in this Case -after I had brought the Child by <i>turning</i>, -I found the Secundines extremely offensive, -by Reason of their Putrefaction.</p> - -<p>From Causes less manifest, ’tis a Thing -more precarious to judge of the Infant’s -Death; the Woman in Travil has not -perceived the <i>Motion</i> of the Child for -some Days, while it was yet living; a <i>cadacerous</i> -Smell is not infallible; the coming -away of the Child’s <i>Excrement</i>, may -proceed from the <i>Compression</i> of its Abdomen -in the <i>Birth</i>, especially when the -<i>Buttocks</i> present; these Appearances therefore -can only be a Foundation at best for -<i>probable</i> Conjecture; nothing short of the -Peeling of the Cuticle or Scarf-Skin of -the Child upon <i>Touching</i> it, can be a <i>certain</i> -Token of its Death.</p> - -<div class="chapter"> -<h2 class="nobreak bortop" title="Chapter XV. -The necessary Care of a Mother and Child.">CHAPTER XV. -<span class="h2smaller"> -<i>The necessary Care of a</i> Mother <i>and</i> Child.</span></h2></div> - -<div class="dropcapletter">A</div> -<p class="dropcap">FTER Delivery, tis too universal a -Practice to palliate the After-pains -by <i>Opiates</i>, which if given beyond the -Proportion, necessary to take off the -Spasms attending, are mischievous, -tending to obstruct the natural Cleansings, so -absolutely necessary to succeed; and as -these Pains cease of Course for the most -Part in two or three Days, it were much -better to have recourse to <i>Sperma Ceti</i> dissolv’d -with the Yolk of an Egg in a -Draught of Caudle, or a Linctus of Sallad -Oil and Sugar, if Oil of Sweet Almonds -cannot be had fresh, as often as the Pains -are violent.</p> - -<p>Particular Occasions may indeed require -other Methods, but then ’tis best to -be well advis’d, whether <i>Opiates</i>, or other -<i>Medicines</i> are necessary. During their -Purgations, the Woman, in Child-bed, -ought to be kept warm, from all Danger -of taking cold, to a Degree of sensible -Perspiration, and if she has no Stool by -the third Day, which commonly brings, -with the Milk, a feverish Heat, a Kitchen -Glyster ought to be given and repeated in -costive Habits, as there is Occasion.</p> - -<p>I <span class="smmaj">SHALL</span> conclude with some Things of -the Care of Infants newly born; a -Subject the more interesting, as our Natives -are known greatly to decrease from the -free Use of Spirituous Liquors; which -Loss might in some Degree be repaired by -a better Care of their Offspring, who are -not only expos’d to suffer by the Ignorance -of Midwives, but must undergo a -second Martyrdom from swadling and -cramming.</p> - -<p>Their fond Nurses greatly contribute -to the general Cause of all their Distempers, -<i>Indigestion</i>, frequently feeding them -’till they return it by the Mouth, which -under these Circumstances, unless supply’d -by a Looseness, is the only Means of -their Preservation from more immediate -Death.</p> - -<p>This Overcharge of their Stomachs, -producing Crudities, gives them the most -excruciating Pains in their Bowels; occasioning -very often Fevers and Convulsions, -and yet their Cries are customarily appeas’d -by more Food, furnishing an Encrease of -sharp Crudities in their Bowels; and ’tis -well if Syrup of Poppies, <i>Godfrey</i>’s Cordial, -or some other Opiate, be not given to stifle -their Complaints, but in Effect to encrease -the Mischief, by confining the Acrimony -of an Overload within them.</p> - -<p>Infants are born with their Stomachs -and Intestines charged with the Recrements -of the Humours in which they -swim, before Birth, and the glandular Secretions -within them, which will naturally -purge away with the first Milk they draw -from the Mother’s Breast; and they would -sleep, were they not too soon fed, ’till -this Provision of Nature is ready for them, -as Dr. <span class="smcap">C<span>ADOGAN</span></span> found from Experience -in his own Family; but as the Humour -of Feeding them sooner generally obtains, -and the Mother too often is not the Nurse; -Half a Drachm of <i>Castile</i> Soap diffolv’d in -a Spoonful or two of thin Caudle, and -sweetened with Honey, would cleanse the -Child, and prevent many Distempers, owing -to a Retention of Impurities within -them before the Birth, if given soon -after.</p> - -<p>’Tis well worth remarking, that the -Food the Nurse takes communicates its -Nature to the Milk, so that the Child -may be intoxicated by her giving Suck too -soon after strong Drink or Spirituous Liquors, -by which Means many are destroy’d; -it is likewise well known, if the Nurse -takes a Purge, her Milk will purge the -Child.</p> - -<p>This informs us, that when the Child -is troubled with Gripes, attended with -green, sour-smelling Stools, the Mother, -or Nurse, by being confin’d to an Animal -Diet, will, in a great Degree, prevent the -Gripes, Looseness, or Convulsions, occasion’d -by the Acidities of the Child’s Stomach -and Bowels, from the contrary Qualities -communicated to her Milk. On the -Contrary, a vegetable Diet will greatly -relieve the same Complaints, attended -with strong smelling Stools, and a Tendency -to the Putrefaction of the Humours, -and the Child’s Spoon-meat, when any -Thing is given besides the Mother’s Milk, -may be regulated accordingly: In the mean -Time, in both Cases, these Indigestions -ought to be purged off with a few Grains -of Rhubarb, or double the Quantity infus’d -at Night in a Spoonful of common -Drink, strain’d and sweetened with Honey.</p> - -<div class="pbkia"> -<p>This, with a suitable and commodious -Dress, leaving them Freedom for all their -Motions, taking Care not to fill them with -Crudities, by over-charging their Stomachs, -would preserve the Health of young Children, -they would then sleep away most of -their Time, without those continual Cries -of Misery, calling on the Compassion of -all about them, whereby abundance of -Trouble to their Nurses, and the continual -Occasion of Medicines, to sweeten and -purge away the Effects of Indigestion, -would be prevented.</p> - -<div class="padtopa ltspc fsize3"><i>FINIS.</i></div> -</div><!--pbkia--> - -<div class="transnote">TRANSCRIBER’S NOTE - -<p>Original spelling and grammar were generally retained. -The cover image was constructed from the original title page, and -is in the public domain. -The following two corrections were made in conformance with the spirit -of the list of <a href="#errata">errata</a> on page vi.</p> - -<blockquote> -<p><a href="#p9l16">Page 9, l. 16.</a> “Pains about the Navel and Loins” was changed to -“Pains about the Back, Navel and Loins”.</p> - -<p><a href="#p33l12">Page 33, l. 12.</a> Changed “great Complaints of a smarting -Pain; when I touch’d it a Suppuration” to “great Complaints of a smarting -Pain when I touch’d it; a Suppuration”. This correction is not quite -what the erratum on page vi recommends—but the recommendation is not -quite correct.</p></blockquote> - -<p><a href="#p21">Page 21.</a> Changed “which happpen’d the same Day” to -“which happen’d the same Day”.</p> - -<p><a href="#p49">Page 49.</a> Changed “and its <i>Secondines</i> -left” to “and its <i>Secundines</i> -left”.</p> - - - - -</div> - - - - - - - - - - -<pre> - - - - - -End of the Project Gutenberg EBook of The Province of Midwives in the -Practice of their Art, by William Clark - -*** END OF THIS PROJECT GUTENBERG EBOOK MIDWIVES *** - -***** This file should be named 52086-h.htm or 52086-h.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/2/0/8/52086/ - -Produced by RichardW and the Online Distributed Proofreading -Team at http://www.pgdp.net (This file was produced from -images generously made available by The Internet Archive) - - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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