diff options
Diffstat (limited to 'old/60334-0.txt')
| -rw-r--r-- | old/60334-0.txt | 9190 |
1 files changed, 0 insertions, 9190 deletions
diff --git a/old/60334-0.txt b/old/60334-0.txt deleted file mode 100644 index 9048fb0..0000000 --- a/old/60334-0.txt +++ /dev/null @@ -1,9190 +0,0 @@ -Project Gutenberg's A Treatise on the Art of Midwifery, by Elizabeth Nihell - -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: A Treatise on the Art of Midwifery - Setting Forth Various Abuses Therein, Especially As to the - Practice With Instruments: the Whole Serving to Put All - Rational Inquirers in a Fair Way of Very Safely Forming - Their Own Judgement Upon the Question; Which It Is Best - to Employ, in Cases of Pregnancy and Lying-in, a - Man-midwife; Or, a Midwife - -Author: Elizabeth Nihell - -Release Date: September 20, 2019 [EBook #60334] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK A TREATISE ON THE ART OF MIDWIFERY *** - - - - -Produced by Richard Tonsing and the Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - - - - - - - - - - A - TREATISE - ON THE - ART of MIDWIFERY. - SETTING FORTH - VARIOUS ABUSES therein, - Especially as to the - PRACTICE with INSTRUMENTS: - THE WHOLE - Serving to put all Rational Inquirers in a fair Way of very safely - forming their own Judgement upon the QUESTION; - Which it is best to employ, - In Cases of PREGNANCY and LYING-IN, - A - MAN-MIDWIFE; - OR, A - MIDWIFE. - - - By Mrs. ELIZABETH NIHELL, - - PROFESSED MIDWIFE. - - - LONDON: - - Printed for A. MORLEY, at Gay’s-Head, near Beaufort Buildings, in the - Strand. - - - MDCCLX. - ------------------------------------------------------------------------- - - - - -[Illustration] - - - - - TO - All FATHERS, MOTHERS - and likely soon to be EITHER. - - -THOUGH the subject of the following sheets is of such universal -importance, that it would be difficult to name that human individual, to -whom it does not in some measure relate, you, it doubtless, more -immediately concerns. - -UNDER no protection then so properly as yours can a work be put, not -presumingly calculated to determine your judgment, but only to recommend -to you the examination of a point, in which Nature would have such just -reproaches to make to you, for cruelty to yourselves, if you was -indolently to determine yourselves either without an examination, or on -a blind implicit confidence in others; in others, perhaps, interested to -mislead you. This last advertence of mine will, more than all that I -could offer besides, prove to you my sincere unaffected with for your -favorable acceptance of this essay of mine, on the footing of absolutely -no interest but purely yours. And that interest how dear! how sacred! -How indispensably ought it to challenge your preference almost to any -other interest of your own, and much more surely to any of others. - -HAPPILY then for you, in a matter of such common concernment to -human-kind, Nature has not been so unjust, nor so unprovident as to -place a competent notion of it out of the reach of common sense. - -DEIGN then, for your own sakes, to examine it by that light of Reason, -the spring of which is for ever in yourselves. It cannot fail of -affording you a sufficient certainty on which to rest your opinion, in a -point upon which it is of such deep, such tender importance to you, not -to form your resolutions on a wrong one. In virtue of such your own fair -examination, the decision will no longer be dangerously and precariously -that of others for you, no longer be nothing better than a lightly -adopted prejudice, but become truly and meritoriously the genuine result -of your own judgment. - -BUT whatever your decision may be, at least to me you can hardly impute -it as an offence, my seeking to supply you with matter, whereon to -exercise that judgment of yours in so interesting a point. At the worst, -I have the consolation of being in my duty, while thus aiming, however -deficiently, at proving that with the most tender regard and unfeigned -zeal. - - I am, respectfully, - Your most devoted, and - most faithful humble servant, - ELIZABETH NIHELL. - - Haymarket, - Feb. 21, 1760. - - - - -[Illustration] - - - - - PREFACE. - - -THE preservation of so valuable a part of the human Species as pregnant -women, as well as that of their dear and tender charge, their children, -so powerfully recommended by the voice of Nature and Reason, to all -possible human providence for their safe birth, forms an object so -sensibly intitled to the private and national care, and even to that of -universal society, that all enforcement of its importance would be an -injury to the human understanding, or at least to the human heart. It -would look too like imagining that it could be wanted. - -WHAT I have then to say preliminarily, must chiefly arise from my own -due sense of my inequality to the subject of which I presume to treat. -Though, if example could be any countenance, I might plead that of so -many authors who have, with the utmost confidence and the utmost -absurdity, written upon the art of midwifery, without understanding any -thing at all of it. The truth is, that my very natural and strong -attachment to the profession, which I have long exercised and actually -do exercise, created in me an unsuppressible indignation at the errors -and pernicious innovations introduced into it, and every day gaining -ground, under the protection of Fashion, sillily fostering a preference -of men to women in the practice of midwifery: a preference first -admitted by credulous Fear, and admitted without examination, upon the -so suspicious recommendation of those interested to make that Fear -subservient to their selfish ends. - -OF these disorders, pernicious as they are to society, I have however -been long with-held from taking public notice by far from groundless -scruples. Being myself a practitioner, I had just reason to fear, that -my representation would have the less influence, from a supposition of -personal interest in them. They might naturally enough be construed as -the result of a jealousy of profession. I had yet a reason more -particular to myself against interfering in this matter. My husband is -unhappily for me a surgeon-apothecary: I say unhappily, because though -of a business I maintain to be so foreign and distinct from the function -which I profess, there might not be wanting, among such as would imagine -their private interest attempted at least to be hurt by me, a suspicion -that I was indirectly aiming at recommending his advantage in prejudice -to theirs. Yet so far, so very far is this from being the case, that the -main scope of my essay is to prove, that his business has no relation at -all to mine, and that especially as to the particular point I would wish -to establish, he is absolutely as indifferent to me as any other person, -either of his own profession, or of any other whatsoever. This prejudice -then of self-interest being fairly annulled by the appeal to the -manifest drift of the work itself, which gives him as formally the -exclusion as to any other of his sex, I had still a repugnance to the -entering into a discussion of abuses, that could not be laid open -without exposing truths, that might have an air of invidiousness or -detraction. - -SOME friends of mine, to whom I communicated my doubts, agreed with me, -that there are faults which cannot innocently be revealed, where their -manifestation may be attended with some greater evil, but that it could -not be right to rank among the faults to be spared any error in an art, -where one single false idea, suffered to subsist, may prove the occasion -of wounds or torturous death to thousands. On the contrary, the due -knowledge of faults of this nature is, in fact, a public benefit. They -serve, as one may say, for beacons to the art, they hold a light to it, -and show it the rocks it should avoid. - -IT is certain then, that I have not the least intention to attack any -particular persons, any farther than in what I conceive to be false -theory, or mispractice in the art I profess; I hope then it will not be -imputed to me as unfair or over-presumptuous, if I especially do not -over-respect writers or practitioners, who themselves have not respected -either common-sense or common-humanity. - -HAVE not some of our modern authors, especially the male-practitioners, -who in these later times have treated of midwifery, added new and worse -errors of their own to those bequeathed to us by the antients, whom they -have insulted, as they themselves will probably one day be, but with -more reason, by their successors, if the world should continue blind -enough for them to have any in this profession? One would even imagine, -that in the criticisms in which they indulge themselves of one another’s -systems and instruments, they are inflicting part of the punishment due -for their common offences against Nature, in the abuse of an Art, -originally intended to assist her. At the same time, even from their own -showing, nothing can be plainer, than that their boasted inventions -have, under the specious pretence of improvement, fallen from bad to -worse, as is ever the case of superstructures on the crazy foundation of -false principles. - -READ the men-writers on this art, and you will find interspersed in most -of them, amidst the most flagrant proofs of their own ignorance of it, -reproaches to that of the midwives, too just, perhaps as to some, but -shamelessly absurd in them, who to that ignorance substitute their own -subtilities of theory, which, when reduced to practice, are infinitely -worse than any deficiency in some particular female-practitioners; being -mostly, in truth, fit for nothing so much, as to prepare dreadful work -for their instruments. - -BUT if they so falsely exalt their own learning above the ignorance of -women; they have their reason for it. They seek to drive out of the -practice those who stand in the way of their private interest: that -private interest, to which the public one is for ever sacrificed under -the specious and stale pretext of its advancement. - -CAN it then be wrong in any of our sex and profession to endeavour, at -least, to justify ourselves, and to undeceive the public, of the ill and -false impressions which have been given it of our talents and ability? -Pernicious prejudices have sometimes their run, like epidemical -distempers: and surely it is more for the service of mankind, that their -duration should be shortened, than suffered to proceed without at least -an endeavour to oppose them. - -I SHOULD, however, be much more pleased with an exemption from the -disagreeable task of composing the apology of our sex in this matter, it -being contrary to that modesty which becomes us so well; but as the -men-midwives, in their system of exalting their powers of Art over ours -of Nature, keep no measures with truth, I see myself forced to do -justice to our function, and to manifest the unreasonableness of that -contempt, with which they treat and depreciate our services; and with -which they have, in favor of their own interest, perhaps too -successfully imbued the public. - -IN this attempt of mine there is no blamable ostentation. If I set in -their just light of utility the qualifications of the women of our -profession, as to industry, dexterity, ease of execution, patience, -constitutional tenderness, and especially natural aptitude, it is no -more than practical truth warrants, and the throwing a due light into -the matter of comparison requires. Yet I do not wish, that we should -pass for any thing beyond what we really are. All the partiality, all -the tender feelings it is so natural for me to have for the sufferings -of my own sex, would be sufficient to with-hold me from desiring to -establish any opinion or practice tending to endanger the personal -safety of women in child-birth, or of any thing so dear to them as their -children. I am myself a mother. - -I OWN however there are but too few midwives who are sufficiently -mistresses in their profession. In this they are some of them but too -near upon a level with the men-midwives, with this difference however in -favor of the female practitioners, that they are incapable of doing so -much actual mischief as the male-ones, oftenest more ignorant than -themselves, but who with less tenderness and more rashness go to work -with their instruments, where the skill and management of a good midwife -would have probably prevented the difficulty, or even after its coming -into existence, prove more efficacious towards saving both mother and -child; always with due preference however to the mother. - -I WILL also, with the same candor, own that there are some not intirely -incapable men-midwives: but they are so very rare, and must forever -necessarily be so, and even, at the best, so inferior to good midwives, -that a worse office could scarce be done to mankind, that on so false a -supposition as that of a sufficient ability in them, to explode the -practice of the art by women, because some of them might be -exceptionable. And how should it be otherwise, than that some should be -more deficient than others? is there that art in the world, to which the -same objection does not lie of different degrees of merit in the -professors of it, as well as that of the imperfection of all human arts -in general? - -IN the mean time, the consequences of this unfair conclusion against the -women professors of midwifery, in affording the men a plea for -supplanting them, do not hitherto appear very advantageous ones to the -public. It remains, I fancy, to be proved, that population is any gainer -by the diminution of that evil, to which the instruments or other -methods of practice, employed by the men, are pretended to be such a -remedy. - -TO examine this point is the object of the following sheets; the work -being divided into two parts. - -THE first treats of our title to the practice of this art, of the pleas -used by the men for arrogating to themselves the preference, of the -knowledge of Anatomy, of the necessity of the instruments, of the -incapacity of women, of the Fashion: and whether the superior safety is -on the side of employing men-practitioners. - -THE answers inserted to each objection, all together, constitute an -essay to remove the prejudices, which have been so industriously, and -too successfully disseminated against the female practice of this art; -and to show that the substitution of the men, more especially of their -iron and steel-implements, is attended with greater danger, greater -mischiefs, than those which that substitution is pretended to prevent or -redress. - -THE second has more particularly for object to demonstrate the -insufficiency, danger, and actual destructiveness of instruments in the -art of midwifery. To this purpose I therefore pass all that is needful -of them in review, in the several cases, in which the antients and -moderns would persuade us they are necessary. I set myself to establish -my exceptions to them by incontestable examples; but above all, by the -authority of reason and experience. I take notice of some of the -manifest contradictions to be met with in almost all the authors, to one -another. I have ventured to subjoin some observations, taken from my own -observations and practice, in lieu of what I condemn, and to point out a -method of operation, much more plain, more tender, more secure, than the -one by instruments. I support this by those general principles, which -have happily guided me on all occasions, and from which it is even easy -to refute the pretentions and system of the instrumentarians, in which I -shall note here only three essential defects. - -THE _first_, in that the origin of the men, insinuating themselves into -the practice of midwifery, has absolutely no foundation in the plea of -superior safety, and, consequently, can have no right to exact so great -a sacrifice as that of decency and modesty. - -THE _second_, for that they were reduced first to forge the phantom of -incapacity in the women, and next the necessity of murderous -instruments, as some color for their mercenary intrusion. And, in truth, -the faculty of using those instruments is the sole tenure of their -usurped office. - -THE _third_, their disagreement among themselves about, which are the -instruments to be preferred; a doubt which, the practices tried upon the -lives and limbs of so many women and children trusted to them, have not -yet, it seems, resolved, even to this day. - -BUT reserving to treat upon these and other points more at large, in -their place, I am to bespeak the reader’s candid construction, of my -having, especially in the beginning of the first part, transiently -availed myself of the authorities of authors, sacred and prophane. It is -less that I think truth stands in need of such corroboratives, than to -show that it is not destitute of them. It is not by authority, but by -reason, that truth, in matters of temporal concernment, claims -acceptance from reasonable beings. At the worst, those to whom they may -present a tiresome prospect, have but to skip them over; or if they -peruse them, they are desired not to forget that no stress is laid on -them, beyond their being answers to arguments of the like nature, urged -on the opposite side of the question. - -THOUGH instruments are not within my sphere of practice; though -consequently I have the honor of not being personally very well -acquainted with them, nor have I at hand all the original authors who -have published their own inventions of them, I have been sufficiently -enabled to do justice to their pretentions, by a recourse to those who -professedly and fully treat of them. My guide is commonly Monsieur -Levret, who is one of the exactest describers of them. Not most -certainly that I otherwise prefer him, for of the utility of his forceps -I think just as ill as I do of all the rest. - -I SHOULD have been glad to avoid at once the barren driness of -abridgments furnishing no distinct ideas, and the tedious exactness of -particularized descriptions and histories; as for example, of the -forceps, as well as of errors committed by practitioners; but this -medium I could rather wish than hope to keep. I have then been so afraid -of obscuring matters by brevity, that of the two I have perhaps run too -far into the contrary and less agreeable excess: which, however, in -consideration of its favoring explicitness, is not perhaps the most -inexcusable one. - -I WISH I could make an apology as receivable by a reader, who will -doubtless be justly disgusted at the repetitions I have too little -scrupled the making of the same thoughts, and even sometimes of the same -expressions. Yet I dare bespeak, from his candor, some indulgence to the -confession of a fault, it will easily be perceived I could not well -escape, without the worse inconvenience to himself, of his being -perplexed with references back to past pages, besides, that sometimes a -chain of argument would be broke, consequently weakened, by the -suppression of some link of it, on account of the matter having been -elsewhere already employed in other connexions. - -UPON the whole, I throw myself, with the more confidence, on the -favorable acceptance of the public, from my consciousness of its not -being but with the best intentions for the good of society that I hazard -this production: and have therefore reason to hope, that it will -occasionally be remembered, that my object is purely that of -representing a truth, and not of recommending a composition. - - Page 20. For blood into water _read_ water into blood. - -[Illustration] - - - - - CONTENTS - OF - PART the FIRST. - - - _In gratitude of the men-midwives at Paris to their women-teachers of - the art_, page 6. - - _Regulations of the profession of midwifery not unworthy the national - care_, 9. - - OBJECTION I. _Prior possession of the art in the men_, 14. - ANSWER, 14. - - OBJ. II. _Preference of the men founded on the nobility of the art_, - 17. - ANS. 15. - _Egyptians not so simple as Dr. Smellie pretends_, 19. - - OBJ. III. _Writings of the men-authors prove the antiquity of - men-midwives_, 24. - ANS. 24. - - OBJ. IV. _Manual operation a science fittest for the men_, 28. - ANS. 29. - - OBJ. V. _Anatomy necessary_, 32. - ANS. 32. - - OBJ. VI. _Instruments, their use peculiar to the men_, 35. - ANS. 36. - - OBJ. VII. _Ignorance only exclaims against instruments_, 39. - ANS. 40. - _Dr. Smellie’s false account of the_ Hôtel-Dieu _at_ Paris, 44. - _No men-practitioners suffered in it_, 47. - _Dr. Smellie’s Doll-machine_, 50. - _Compendious forming of pupils_, 52. - - OBJ. VIII. _It is a presumption in women to enter into competition with - men in this art_, 52. - ANS. 53. - - OBJ. IX. _Opinion prevalent of superior safety under the hands of the - men_, 58. - ANS. 59. - - OBJ. X. _Ignorance of the women_, 73. - ANS. 73. - _How the young men students get their_ learning, 80. - _Women cruelly used to procure it them_, 83. - _Story of a woman’s child killed with a crotchet_, 92. - _Examination of a passage of Plato quoted by Dr. Smellie_, 99. - _Pecquet, a great anatomist, the victim of his own erroneous - speculation_, 101. - - OBJ. XI. _Partial artists the best_, 106. - ANS. 107. - _Story of a Dentist_, 109. - _A man-midwife’s toilette_, 111. - _Story of a woman perishing suddenly after delivery_, 128. - _Cruel method of training up pupils_, 137. - _Story of a child horribly murdered_, 139. - _Lessons of midwifery given by Madam Clavier_, 144. - PUDENDIST, _a name in the stile of oculist or dentist, more proper - for a male-practitioner of midwifery than_ ACCOUCHEUR, 151. - - OBJ. XII. _Men-midwives have terminated happily many labors_, 151. - ANS. 151. - _Triumph of a man-midwife_, 158. - _Why young practitioners should conceal their instruments_, 173. - _Appeal to numbers for the greater safety with women, verified by the - practice of the midwives at the_ Hôtel-Dieu _at_ Paris, 180. - - OBJ. XIII. _Prevalence of the Fashion_, 184. - ANS. 184. - _Parallel of error in the preference of men-midwives to that of - bringing up of charity-children by hand_, 187. - _Story of a woman ashamed of having been lain by a midwife_, 204. - _Inoculation justified_, 207. - _The greatest lady in Britain no example in favor of_ Accoucheurs, - 210. - _Midwives formed by the men-practitioners liable to caution against - them, and why_, 213. - _Alarming danger of a scarcity of good midwives, to what owing_, 217. - - OBJ. XIV. FALSE-MODESTY, _that of the women, who prefer the - practitioners of their own sex_, 219. - ANS. 219. - _Story of Agnodice and the Athenian women canvassed_, 219. - _Dr. Smellie’s_ COMMANDMENT _to his pupils against immodesty_, 224. - _No stress laid on the Rabbit-woman of Godalmin_, 225. - _Attitude indecent, and to no end nor purpose_, 237. - _A stone of more virtue than a man-midwife_, 239. - - CONCLUSION _of the_ FIRST PART, 244. - - - PART the SECOND. - - _Containing various observations on the labors and delivery of lying-in - women, including a description of the pretended necessity for the - employing instruments_, INTRODUCTION, 249. - - _Of_ DELIVERIES, 256. - _Story of the sudden death of a woman after delivery_, 261. - _Accounted for_, 262. - _Method of prevention_, 263. - _Histeric medicines invented by the_ learned _men-practitioners, and - examples of their insignificance_, 267. - - _Of_ DIFFICULT _and_ SEVERE _cases_, 277. - _Divisions of them_, 279. - _Profound ignorance of certain men-midwives_, 282. - _Their avarice and cruelty set forth by a man-midwife_, 286. - _Midwives incapable of such horrors_, 288. - _The Crotchet used, and its horrid effects, exemplified in several - stories_, 291. - _A_ VOLUME _might be made of them, says a man-midwife_, 298. - _Some instances of male-practice_, 304. - - _Of_ TOUCHING, 309. - - _Of the_ OBLIQUITY _of the_ UTERUS, 329. - - _Of the_ EXTRACTION _of the_ HEAD _of the_ FŒTUS _severed from the_ - BODY, _and which shall have remained in the_ UTERUS, 358. - Speculum matricis _given up by Dr. Smellie: so would other - instruments be, if justice was done them_, 367. - _A curious method of_ CELSUS, 369. - _Inventions of_ CAWLS _and_ FILLETS, 369. - - _Of that labor in which the_ HEAD _of the_ FŒTUS _remains hitched in - the passage, the_ BODY _being intirely come out of the_ UTERUS, 372. - _Quackery of Daventer_, 378. - _Two examples of children, the one killed, the other supposed dead, - and losing its head by errors in the manual function_, 379. - - WHEN _the_ HEAD _of the fœtus presents itself foremost but sticks in - the passage_, 289. - _Objections to instruments more at large included under the title to - this section_, 389. - _Mauriceau’s_ tire-tête, 395. - _Palfin’s_ FORCEPS, - _with the improvements of various practitioners_, 398. - _A waggon load of instruments insufficient, and why_, 401. - _A curious nostrum of an instrument_, 406. - _Mr. Freke’s ingenious invention of a_ FORCEPS _and_ CROTCHET _all in - one_, 416. - _Dr. Smellie’s improvement of the forceps_, 417. - _The curve forceps of Levret_, 419. - - _Case of a_ PENDULOUS BELLY, 445. - - _Triumph of the moderns over Hippocrates and the antients in the - invention of the forceps_, 452. - _Inhumanity and folly of the general conspiracy against children_, - 458. - - CONCLUSION _of the_ SECOND PART, 466. - - - - -[Illustration] - - - - - A - TREATISE - ON - MIDWIFERY. - - -WHOEVER considers the absolute necessity of the art of midwifery, will -readily allow it a place among the capital ones in the primeval times of -the world. All the other arts are no further necessary to man, than to -procure him the conveniencies or luxuries of life; that of midwifery is -of indispensable necessity to his living at all, imploring as he does -its aid for his introduction into life. Without this art the earth -itself must soon become dispeopled and a desert, whereas by means of it -men have been multiplied, with inconceivable rapidity. - -IN conformity to its claim of importance, this art appeared in all its -lustre among the Jews, the Egyptians, the Athenians and Romans, and -indeed in all nations during thousands of ages. Nor was the confinement -of the exercise of it to women deemed any derogation to it. It even gave -honor to its professors of that sex. Socrates, so ennobled by his -character of being the greatest philosopher in all antiquity, did not -disdain to boast himself the son of a very able midwife Phanarete, as -may be seen in Plato’s book on science, in Diogenes Laertius and others. - -AMONG the Egyptians and the Greeks it cannot be hard to conceive what -emulation, what ardor it must have excited among the women of that -profession, the custom of distributing prizes to those of the greatest -merit in it, in the face of the people. No one is ignorant of the power -of honors and distinction to bring arts to perfection. - -BUT from the instant the midwives sunk into dis-esteem, and wherever -that has happened, it will be found by woeful experience, that not only -the art itself has suffered in the very midst of the most falsely -boasted improvements, but that human-kind itself has much and very -justly to complain of the change. - -THE native inconstancy and levity of the French nation opened the first -inlet, in these modern-times, to men-practitioners. In antient history -we meet with but one feeble attempt of that sort, which however soon -gave way to the united powers of modesty and common sense. In France, -and may it not be the same case soon here! the women of a competent -class of life and education, begin to decline forming themselves for -this profession, as beneath them, considering the slight put upon those -women who exercise it. - -NOR has this injustice remained unpunished. Many women have found, by -severe experience, their having been enemies to themselves, in -abandoning or slighting those of their own sex, from whom, at their -greatest need, they used to receive the most effectual service, and who -alone are capable of discharging their duty by them, with that sympathy -for their pains, that tender affectionate concern, which may so -naturally be expected from those who have been, are, or may be subject -to the same infirmities. - -MANY out of a distrust inspired them of midwives, have thrown themselves -into the hands of men, who have promised them infinitely more than they -were able to perform; and who behind all the tender alluring words, of -superior skill and safety in the employing of them, conceal the ideas -with which they are full, of cutting, hacking, plucking out piece-meal, -or tearing limb from limb. - -THE murder of so many children, the fruits of their bowels, might, one -would imagine, have induced mothers to consider this point a little more -carefully. Yet, through the prevalence of groundless fears, and of -imaginary dangers they have run into real ones, and have sometimes found -their death precisely where they sought their life; and not seldom where -nature has even favored them enough in their labor, for them not to need -any extraordinary ministry of art, the men have put them to cruel and -dangerous tortures. - -NOTWITHSTANDING some examples, and many violent presumptions of such -mal-treatment, too many women have been so miserably misled by fashion, -as to prefer the betraying the cause of their own sex, and the -subjecting themselves to those who deceive them with false hopes, to the -entrusting their preservation to those of their own sex, in the hands of -which the care of it has been for so many ages, with so much reason, and -such little cause of complaint. - -YET we do not see that any of these men-midwifes have been capable of -forming a good midwife. On the contrary, we see, that in order to remedy -the abuses, or rather to prevent the fatal accidents which every day -occur in the practice of a profession so necessary to the preservation -of the human species, they were in France obliged to have recourse to -one of the ablest midwives in that kingdom, who was placed at the head -of the practice in the Hôtel Dieu at Paris, to preside over the -lyings-in there, and to found and cultivate that inexhaustible seminary -of excellent female practitioners, who have actually restored the art to -its antient degree of esteem, with all fair judges. These worthy -proficients have been so public-spirited, as to communicate their -talents and knowledge to a number of surgeons, who never had any reason -to be ashamed of the lessons they assiduously took from the midwives, -unless indeed for themselves not being able to come up to them in the -practice, so true it is, that the business is not at all natural to -them. - -YET have even many of those very men-practitioners, influenced by that -self-interest which has such a power in all human affairs, revolted -against their mistresses in the art, and their benefactresses. They -have, at various times, commenced lawsuits, about the Hôtel Dieu at -Paris, in order to get the lyings-in there committed to them: but the -administrators, the persons of a just sense of things, together with the -parliament of that town, ever attentive to decency, without excluding -the due regard to the preservation of the subjects, have constantly -opposed and frustrated the pretentions of these innovators. These again -thus disappointed, were forced to content themselves with practising -upon some women of quality, under the favor and protection of some of -the old ladies of the court of Lewis XIV. who had their reasons for -propagating this fashion. And now these innovators, not without a due -proportion of ingratitude to the injustice, began to run down the -midwives, and exalt themselves. The novelty prevailed, and the contagion -of example soon communicated itself to the provinces, and thence into -neighbouring nations. A few men perhaps of real abilities, but governed -by the most sordid interest, associated to their party a number of the -most ignorant and unexpert practitioners, but who served to fill up the -cry, and made a common cause against the midwives, whose pretended -insufficiency was now to be pleaded in favor of themselves being -admitted to supplant them. Nor was the concurrent attestation in their -favor, of so many ages, during which the practice was entirely in female -hands, to weigh any thing against the boasts of their own superior -ability. They picked up and sounded loud a few real instances perhaps, -and undoubtedly many false ones of faults of practice in women: though -were the numbers of human creatures, who have barbarously perished by -the unskilfulness of the practitioners, to be fairly liquidated, it -would appear that fewer have been the victims of female ignorance, than -of the presumption and indexterity of the men. The women are undoubtedly -liable to error: there have even been monsters of iniquity among them, -but certainly in no number to form a general prejudice against them: but -as to the men they are all of them, as will be more fully demonstrated -hereafter, naturally incapable of the exercise of this profession. A -history of their murders might even be collected out of the books -written by them to establish their superiority over the women. From -Deventer, Mauriceau, and the most celebrated of their writers, amongst -many excellent observations in the way of the chirurgical art, many of -the grossest absurdities have escaped, where they transgress its bounds -and go into that of midwifery. Some of those absurdities too are so -glaring, that they have not even been overlooked by themselves. - -MANY persons in Holland, having set up for men-midwives, without being -duly qualified, the government thought proper to interfere, and -consequently there was an ordinance issued on the 31st of January, 1747, -by which it was enjoined, that no one should practise in the quality of -man-midwife, or exercise this art, unless he were especially authorized -for this function, by a certificate of his having undergone a sufficient -examination before capable and intelligent judges for that purpose -appointed. - -IT will appear, in the sequel of this work, that it were to be wished, -for the sake of the good that would redound from it, to the preservation -of the human species, both in parent and child, that those who are -entrusted with the public welfare, would establish the same regulation -in the British dominions, to expel and exclude from the art all the -ignorant pretenders of either sex, who are, in fact worse than the -Herods of society. The cruelty of Herod extended to no more than to the -infants; not to the mothers; that of such pretenders to both. - -IF their conduct was to be examined with attention, how many fatal -mistakes would be discovered in the practitioners of both sexes? But I -dare aver it more in the men than in the women-practitioners. With what -horror would not there in these be remarked, tearings, rendings, and -tortures of no use to which they put both the mother and the child? One, -upon some most learnedly erroneous hypothesis, pulls and hauls the arm -of an innocent infant yet living, so that he plucks it off; or repels it -with such violence, that he breaks it: another unmercifully opens the -infant’s head, and takes the brain out: some bring the whole away -piece-meal: operations often to be defended only by hard words and -harder hearts. - -NOR need this procedure astonish. Every thing is at the disposal, I had -almost said, at the mercy of these executioners: but have they any? all -their handy-work is transacted in private, and remains buried in the -tomb of oblivion. The parents suspecting nothing, think every thing has -been done, according to art, that is to say, very right. The operator -thinks he has done nothing but his duty, and is highly satisfied with -himself, after he has ordered some draughts for his patient. The -magistrate knows no injury done to the subject, or is insensible to the -consequences from the same spirit of confidence. In the mean time, a -husband loses a fine child, or a beloved wife, perhaps both; children, a -tender mother, and if they are of the same sex, have the same fate to -dread for themselves. The man-midwife is clear, for only saying, that he -has done all for the best. But this is probably true too, as to the -intention; but as to the fact, it shall be shewn that there is often -great reason to doubt it. - -BE this observed, without offence to the few able men-midwives who are -masters enough of the business, not to deserve the reproaches due to by -much the greater number of rash and ignorant pretenders to it: whose -practice, well examined, would bring to light such terrible truths, as -would alarm even the legislature to provide a remedy against the danger. - -IN contradiction to this, it may be urged, that the practice by women is -susceptible upon that account, of superior objections. That remains now -to be examined. The chief object of this work being a fair discussion, -which of the two sexes is the most appropriated by nature and art, to -the exercise of this function. - -TO this end, I shall present, in a candid view, the two opinions which, -on this point, divide the English yet more than they do the French. Most -of the surgeons, all the men-midwives, no doubt, many apothecaries, a -number of women and nurses maintain, that midwifery is the business of -the men: whilst on the other hand, the best part of the able physicians, -with many other persons of both sexes, defend the contrary side of the -question, and insist on this art being, for many invincible reasons, -solely the province of female practitioners. - -NOT to lose sight of the fundamental arguments and proofs brought to -support respectively these two opinions, I shall place them in parallel -with one another, in form of objections and answers. The objections made -to women-practitioners precede the answers. If the men-midwives, or -their partizans, shall think I have omitted any thing that makes for -them, or against us, or have any stronger or more essential arguments to -oppose, I shall endeavour to satisfy them. - - - OBJECTION the First. - -REGARD ought to be paid to prior possession. The art of midwifery being -a branch of the art of physic, must have been originally in the hands of -man, the inventor of all arts. - - - ANSWER. - -THE just deference so universally paid to holy writ will, I presume, -allow no prejudice to be found against my availing myself of those -inferences and decisions to be drawn from it, which are so agreeable to -the eternal laws of common sense. - -IF the arts and sciences, acquired by experience, and by acts often -repeated, had, as they certainly were not invented by men only, that -could not at least be said of those acts of the human life, which are -indispensably necessary to its preservation. Such faculties may with -more propriety be termed instinctive, than invented ones. The faculties -of eating, of drinking, of lying down to rest, common to both sexes, are -not perhaps more natural, more matter of instinct, than the faculty of -one woman assisting another in her labor-pains being appropriated to the -female sex. - -THERE is no occasion to give one’s imagination the torture to account -for Eve’s delivering herself of her first children. There is no reason -to establish it as an absolute necessity that Adam should have assisted -Eve in her first lyings-in; whose labor-pains might not only be less -severe, than they afterwards became in accomplishment for the curse -pronounced on the human race for the sin of those first parents, but -also more consonant to piety, to believe that God, being the best of -fathers, infused into Eve knowledge sufficient of the manner of -delivering herself; a manner more natural and more conformable to the -ideas of that decency imprinted with his own hand in the human heart, in -no point more strongly, nor more universally, than in this matter of the -women lying-in, when both men and women have an equal repugnance to the -interposition of any assistance, but that of the female sex, to which -the faculty of ministering in that case seems innate. - -BUT admitting even that Adam, for the want of females for that function, -before the daughters of Eve were grown up to a capacity of it, actually -did assist Eve, in the seasons of her delivery; that would establish no -inference of right for the future: since we know that their children and -descendents in time following did not make use of men to lay the women. - -IN Genesis, chap. xxxv. ver. 17. there is mention made of Rachel’s -midwife. In the same book, chap. xxxviii. ver. 27, and 28. we see they -were intelligent midwives. Thamar being with child. “It came to pass in -the time of her travail, that behold, twins were in her womb.” - -VER. 28. “And it came to pass that when she travailed, that the one put -out his hand, and the _Midwife_ took and bound upon his hand a scarlet -thread, saying, this came out first.” - -AND here I intreat the reader not to impute to me any idea so absurd as -that of meaning to defend an erroneous practice solely from the -antiquity of it; I intend nothing further by this citation, than to -prove the antiquity itself, which if not decisive in favor of the -practice by women, can at least be no prejudice against it. - - - OBJECTION the Second. - -THE art of midwifery being equally noble for its subject as for its end, -since it is the only one which enjoys the prerogative of saving, at one -operation of the hand, more than one individual at once; ought the less -noble sex to dispute pre-eminence in it with the men? On tracing things -back to the remotest distance of times, it must be allowed, that if the -women, through a mistaken modesty, in those times of ignorance and -simplicity, commonly made use of midwives, it may be presumed there were -also men-practitioners employed in difficult cases. - - - ANSWER. - -READILY granting that the art is a noble one; noble in its subject and -ends: all that I am surprised at is, that the men did not find it out -sooner. Probably the nobility of this art is only begun to be sounded so -high by the men, till they discovered the possibility of making it a -lucrative one to themselves. Then indeed the ignorance and incapacity of -the poor women for it, came all of a sudden to be doubted and despised. -The art with all its nobility was for so many ages thought beneath the -exercise of the noble sex: it was held unmanly, indecent, and they might -safely have added impracticable for them. But had even any of the -medical profession not thought so, there is great reason to think the -rest of mankind would have viewed their interested endeavors to usurp -this province from the female sex, in the light they deserve. It was -only for the eternal fondness which prevails among the French for -novelties, that paved the way for the admission of so dangerous and -indecent an one, as that of men making a common practice of midwifery, -and taking it out of the women’s hands, to which it was so much more -natural. - -I AM here far from wishing to enter into a contest with the men, on the -superiority and excellence they assume over the women; though not quite -so indisputable perhaps as is commonly imagined. All that I contend for, -to the purpose of the present question, is, that there are certain -employments and vocations, which are generally and naturally more proper -for one sex than for another. A woman would seem to aim at something -above her sex, that would set up an academy for teaching to fence, or -ride the great horse: but a man sinks beneath his sex, who interferes in -the female province. It is not with quite so good a grace as a woman -that he would spin, make beds, pickle and preserve, or officiate as a -midwife. Be this observed without impeachment of the superiority of men. - -OPEN books, sacred and profane, you will find that the Egyptians were -not so simple as Dr. Smellie would give us to understand they were; when -in the beginning of his introduction, pages 1st and 2d, he grants us, -out of his special grace and favor, “that in the first ages the practice -of the art of midwifery was _altogether_ in the hands of women, and that -men were never employed but in the utmost extremity: indeed (says he) it -is natural to suppose, that while the _simplicity_ of the early ages -remained, women would have recourse to none but persons of their own -sex, in diseases _peculiar_ to it: accordingly we find that in Egypt -midwifery was practised by women.” - -ACCORDING to scripture, however, the sorcerers of Egypt were not so very -simple neither, since they had art enough to imitate some of the -miracles of Moses, in transforming their rods into serpents, blood into -water, and covering the land with frogs[1]. All this did not favor of -simplicity. - -THE Egyptians[2] have ever passed for the most intelligent and -enlightened of all the other nations of the earth, who respected them as -oracles of wisdom and sound philosophy. They are the first people who -established systematically rules of good government. This profound and -serious nation saw early the true end of human policy; and virtue being -the principal foundation and cement of all society, they industriously -cultivated it. At the head of all virtues they placed that of gratitude. -The honor attributed to them of being the most grateful of men, shews -that they were also the most social. They had an inventive genius: their -Mercuries, who filled Egypt with surprizing discoveries, scarce left any -thing wanting to the perfection of their understanding, or to the -convenience and happiness of life. The first people among whom libraries -were known to exist, is that of Egypt. In short, so far from being -simple or ignorant, they excelled in all the sciences. There were indeed -among them no _men-midwives_; but to make up for this deficiency, they -had, it seems, excellent midwives. - -BESIDES it is even ridiculous to confine the practice of midwifery by -females only to early ages. Who does not know, that it was so in all -ages, and in all countries, till just the present one, in which the -innovation has crept into something of a fashion into two or three -countries. The exceptions before, or any where else, to the general -rule, are so few, that they are scarce worth mentioning. - -BUT to return to the so _simple_ Egyptians. We read in Exodus, chap. i. -v. 15. and following, that Pharaoh said to the midwives, “When ye do the -office of midwife to the Hebrew women, and set them upon the stools, if -it be a son then ye shall kill him, but if it be a daughter she shall -live. - -“17. But the midwives feared God, and did not as the king of Egypt -commanded them, but saved the men-children alive.” - -THE king reproached them, as may be seen in the same place. - -WHY did not Pharaoh give the same order to the men-midwives, if there -had been any such employed in difficult or extraordinary pains? (as Mr. -Smellie supposes.) Or rather, if the king had not thought it too -unnatural for women to be delivered by men, he certainly would not have -failed to have commanded it, especially on perceiving that the midwives -had deceived him. This would have been a fine occasion to have forbidden -them their function, and for the men-practitioners to have come into -vogue. The men would certainly have been of the two not the improperest -to have executed the intentions of the tyrant: as tender-heartedness is -surely not more the character of their sex, than of the women. Besides, -their instruments would have served admirably to have thinned the -species, without distinction of the sexes. They might also have -concealed the barbarity of the murders by such instruments, under the -pretext of their necessity from hard-labors, as the midwives excused -their disobedience under that of easy ones, which had rendered their aid -superfluous. - - - OBJECTION the Third. - -SO many authors as have wrote on the art of midwifery, from the age in -which Hippocrates florished, whom we look on as the first and father of -the men-midwives, with the disciples whom he formed, and their -successors, do not they satisfactorily prove the antiquity of -man-midwives? - - - ANSWER. - -AS for satisfactorily, no. It can only be concluded from this objection, -that the ignorance of the pretended men-midwives is very antient: and -yet posterior by much to the function of the midwives, since that is -coeval with the world itself, embraces all times, extends through all -parts of the earth, whereas we hear nothing of the other till the times -of Hippocrates. - -NEVERTHELESS I greatly respect Hippocrates, and all the authors who have -treated of this art. Some thanks are due to them, though but from those -whom they have set to work in our days. Consider but the most celebrated -authors among them down to our times, there may be found in them great -progresses by degrees, especially in our modern writers on this subject. -Yet the most intelligent of them feel and confess that the matter is yet -far from exhausted. For after having studied all the treatises we have -upon it, there may, there must be perceived an aberration and emptiness -with which the understanding remains unsatisfied, and feels that much is -yet wanting to the requisite perfection. - -NOTWITHSTANDING likewise the veneration confessedly due to Hippocrates, -I cannot dispense myself from saying the truth; he might be and -doubtless was an excellent physician: he has wrote upon all the female -disorders, and on the means of delivering them; he may have been -consulted in his time, but he can never pass for an able man-midwife. -His writings contain some violent remedies and strange prescriptions for -women in labor, which must be the produce of the most dangerous -ignorance of what is proper for them in that condition. - -THIS author was also evidently ignorant of what concerns preternatural -deliveries, as indeed were his successors till the beginning of the last -century. - -TO prove what I advance, there needs no recourse back to very remote -times: it will be sufficient to peruse the treatises of Ambrose Paræus, -Jacques Guillemeau, Peter-Paul Bienassis, printed 1602, and even that of -De la Motte, who is of this century, to own, that the practice of the -men-midwives was far from having attained any degree of perfection. - -THE manner in which the antients proceeded, when the child presented in -an untoward situation, is a fully convincing proof thereof; since they -obstinately, in such cases, continued their efforts to reduce it to its -natural situation, in spite of a thousand difficulties and dangers, -instead of bringing it away footling, as is now done by all who -understand the right practice. - -HIPPOCRATES is the first who discovered that wonderful secret of killing -the child, and bringing it away piece-meal from the mother’s womb. He -advises it, in the manner taken notice of by Dr. Smellie, in his -introduction, (page 10. & seq.) I do not know whether it is from that -branch of practice that he adopts him for “the father of midwifery” (p. -4.) but, what is certain is, that Galen, and all the successors of -Hippocrates, till towards the end of the last century, exactly followed -his method of not delivering women in hard labors, but by the means of -murderous instruments. I shall not here detain myself with rehearsing -the long legend Mr. Smellie gives us of all the authors who have written -on this subject to the time of Ambrose Paræus; time when to the -progresses made by the midwives of the Hôtel Dieu at Paris in the art of -midwifery, it was owing, that the surgeons, guided by their superior -lights, made some greater progress towards perfection. - -THAT the reader however may not suspect me of exaggeration, or -over-straining points, I request of him to suspend his judgment, to have -the patience to hear me out to the end, and he will find, that I have -here advanced nothing but what in the sequel stands clearly and -manifestly proved. - - - OBJECTION the Fourth. - -IN a word, the manual operation of midwifery is an art, a science, and -as such consequently more competently to be professed by men, than by -women. It is making the art cheap, say the moderns, to allow the -practice of it to women. - - - ANSWER. - -I AGREE with you in the first part of your objection: but I absolutely -deny the consequences. - -THERE are women, who, besides the gifts received from nature, are -improved by study, by reading, and experience, who succeed much more -easily than men in the practice. To say the truth, nature has, in this -point, been even lavish to the women, for this art is a gift innate to -them. - -I WILL however own, that not all women indistinctly are proper for this -business; that there must be natural dispositions cultivated by art; -that a purely speculative knowledge is not sufficient; that there are -required good intellects, memory, strength of body and mind, sentiments, -some taste, and practice joined to theory; so that when I say that the -women are born with dispositions for this art; this can only be -understood in general, and relatively to the men, among whom those -dispositions are more rare, because they are less natural to them in -this branch. - -WOULD it not be a sort of blasphemy against the divine providence to -maintain, that what God has placed and left in possession of the women, -was fitter for the men? the attentive, beneficent, and tender manner -with which he governed his people elect, obliges us to believe that he -omitted nothing of what was necessary or advantageous to it; since he -regarded that people as his own particular dominion and appendage; -honoring it with his presence, like a master in his dwelling-house, or a -father in his family. He had taken pleasure in the forming and -instructing it from its infancy. He put the women in possession of the -art of midwifery, he blessed, approved, and recompenced the midwives. It -is but just, that men should hear and keep silence where God speaks. -They may think themselves happy, to learn from him the true secrets of -nature, and not from those pretended doctors who abandon the rules of -truth to cleave to themselves; who, instead of her, present us with a -phantom of their own creation, who, in short, would make us the -worshippers of their dreams and imaginations. - -THE women have for them the authority of God, who has declared himself -in their favor; they have for them the authority of men from one pole to -the other, who have in all ages made use of the female ministry in this -art. Such a plurality of votes has surely some claim to prevalence, -especially, since it is founded upon the natural order of things, upon -truth and reason supported by experience. This experience we have on our -side: none can deny it, without denying self-evidence. - -ONE would think there is a kind of curse attends the operations of -men-practitioners, as I dare aver it for a truth, that difficult and -fatal labors have never been so rife, or so frequent, as since the -intermeddling of the men. Whereas, God has ever so blessed the work of -the midwives, that never were lyings-in so happily conducted, nor so -successful, as when the practice was entirely in their hands. - -OPEN the book of Numbers, you will observe, that God having ordered -Moses to number his people: out of seventy individuals of the family of -Jacob, who had come to dwell in Egypt, two hundred and forty years -before, there had issued above six hundred thousand men fit to carry -arms, without taking into the account an almost infinite multitude of -children, of youths under twenty years of age, of women, of old men, -besides a whole tribe, that of Levi, which was entirely set apart for -the divine worship. - - - OBJECTION the Fifth. - -THERE is no such thing as being a good practitioner of midwifery without -understanding anatomy: now this science is the province of a man, of a -physician, or surgeon, not of a woman. - - - ANSWER. - -IT is sufficient that a woman understands and knows the structure and -mechanical disposition of the internal parts which more particularly -distinguish her sex; that she can discern the container from the -contents, what belongs to the mother from what belongs to the child, as -well as what is foreign to both. In short, she ought to be skilled -enough to give full satisfaction to all questions that the most able -anatomist could put to her, in respect to that part purely necessary to -the art of midwifery, and to its operations with mastery and safety. - -NOW the midwife, especially one instructed in hospitals, ought to be -well acquainted with all that is essential and necessary to that effect; -and she cannot but be so, unless she is of herself incapable, or that -those who are charged with the instruction of pupils, wrong the -confidence of the public. - -I MYSELF know more than one midwife, so well educated as to be able to -give demonstrations on this subject, to analyze things by their names, -either upon drawings of them, upon skeletons, or upon the originals -themselves. It is true, that these poor midwives do not understand -anatomy enough to make dissections; but I fancy that the ladies who want -assistence in their lyings-in, are not very curious of having one that -can dissect instead of delivering them. - -PROPHANE history has preserved to us the names and talents of a number -of illustrious women who have distinguished themselves in all kinds of -arts. Cleopatra queen of Egypt, is one of the first ladies that have -written on the art of midwifery. Mr. Smellie, in his introduction, -endeavours to render doubtful this quality of queen and princess, with a -design, probably to weaken the credit of it, or rather out of contempt -to the women; but as all those who have made collections of antient -history, assure us, that notwithstanding the wars in which this princess -was engaged, she did not neglect an assiduous application to physic, I -had rather adhere to their authority, than to that of Mr. Smellie. - -IN Greece, Aspasia, and a number of other celebrated women, quoted by -various authors, have applied themselves to our profession, and have -left behind them valuable works on the method of delivering women, and -of managing them both before and after their lying-in. - -MADAM Justin, midwife to the Electress of Brandenbourg, has also given -us a very good treatise. Several professed midwives appointed to form -the apprentices of the Hôtel Dieu at Paris, have written very clearly on -the same subject, without however being mistresses of any more anatomy, -than what was sufficient for their business. - - - OBJECTION the Sixth. - -THE different instruments which the men have invented in aid of, and -supplement to the deficiency of nature, and of which they are frequently -obliged to make use in different labors, ought not to be put into the -hands of midwives: and were it but for this reason alone, they ought to -be excluded from the practice of this art. As, why multiply attendants -unnecessarily? A man-midwife, with his instruments which he ought always -to have about him, is enough for every thing: whereas a midwife, if the -case requires instruments, will be obliged to have recourse to a man: -consequently double embarrassment, double expence. - - - ANSWER. - -THE keen instrumentarians bring an argument they imagine capable of -banishing or exterminating all the midwives. The men, they say, enjoy -alone the glorious privilege of using instruments, in order, as they -pretend, to assist nature. But let them, I intreat of them, answer, -whether if the question could be decided by votes, where is the kingdom, -where is the nation, where is the town, where, in short, is the person -that would prefer iron and steel to a hand of flesh, tender, soft, duly -supple, dextrous, and trusting to its own feelings for what it is about: -a hand that has no need of recourse to such an extremity as the use of -instruments, always blind, dangerous, and especially for ever useless? - -WHAT has engaged men to invent and bequeath to their successors so many -wonderful productions, for such they imagine them? Is it not the thirst -of fame and money? These gentry have judged, that they ought to spare no -lucubrations, no labor of the head, no efforts of the tongue and pen to -procure themselves a strange reputation, supported by these horrible -instruments. But these lucubrations, this labor of the head, would have -been much better employed in seeking for the means of absolutely doing -without them, as our good female practitioners have ever done, and as -those of them still do, who are instructed in the right practice. - -WE are no longer in the times of the Pharaohs and the Herods, who -mercilessly massacred the innocents; we are no longer in the times of -those pure Arabs, who were the inventors of a number of cruel -operations, and of several instruments, which often cause more -apprehension and terror to a woman in labor, though concealed from her -light, but never from her imagination, than the actual presence of all -the apparatus of the rack, where that torture is in use. - -IT were to be wished, that all the men-midwives, who had wrote on this -matter, had suppressed the mention of their instruments; for as their -books often fall into the hands of women, so deeply interested as the -sex is in that subject, it is not to be imagined what bad effects they -have. Their variations among themselves would be sufficient to frighten -the women: you meet with authors condemning in the morning the -over-night’s sentiment. I can observe them losing their way in -systematical errors, which explain nothing to me, and in which nothing -can be discovered but disagreement with one another, and with -themselves. The wisest and most able of them, after having well examined -all the kinds of instruments hitherto invented, have doubtless seen and -been convinced of their ridiculousness and usefulness, but all of them -have not hitherto dared to speak out and say as much. - -THE most interested of them would fain persuade us, that, in their -display of a whole armory of instruments, they have discovered the -philosopher’s stone of midwifery, in virtue of which they have a right -to wrest out of the women’s hands, the practice of an art, which nature -has appropriated to them. But certainly the point, and the whole point -is, to find an expert dexterous hand, the sex is out of the question, -provided it is but a human hand, and provided the work is done to the -satisfaction of society, it seems to me that nothing more need be -required. - - - OBJECTION the Seventh. - -IT is only for the ignorant to be so rash as to raise an out-cry against -the use of all instruments; people who do not know the absolute -necessity there is for employing them on certain occasions. This clamor -must proceed “from the interested views of some low, obscure and -illiterate practitioners, both male and female, who think that they find -their account in decrying the practice of their neighbours.” Such is the -objection in the words of Dr. Smellie, in his Treatise on Midwifery -(page 241.) and for this panegyric, he prepares us in his Introduction -(page 55.) where, speaking of the midwives of the Hôtel Dieu of Paris, -he first indeed tells us, that the surgeons had, in that hospital, -perfected themselves in the art of midwifery; but then for fear that -from thence occasion might be taken of saying, that to women it was they -were beholden for that perfection; he takes care immediately after to -add, that what “got the better of those ridiculous prejudices which the -fair sex had used to entertain,” was, that the women or midwives of this -hospital “had recourse to the assistance of men in all difficult cases -of midwifery.” - - - ANSWER. - -THESE gentlemen will permit me to tell them that they make great -pretentions, and prove little or rather nothing. Calling hard names with -a disdainful tone, and with airs of triumph, are not overwhelming -reasons. - -BUT to the point. Those who reject instruments, say you, do not know -what they are: they reject them from ignorance. This is soon said. -Nevertheless a number of authors, much more experienced and versed in -the matter than Dr. Smellie, are of this opinion. Deventer exclaims -against instruments; Viardel does the same; Levret admits none but those -of his own invention, and rejects universally all others; and well might -he except his own, since he wrote only to recommend them. Delamotte was -not very fond of instruments: he tells us in his preface, that in a -course of thirty years practice, he had not twice made use of the -crotchet, though he had an extent of country forty leagues round, in -which he regularly exercised his profession, insomuch as to have four -lyings-in in a day under his management. - -I HAVE very exactly read almost all the modern authors who have written -on this art; and have been surprized to observe that whilst, on one -hand, they agree, they own, that in England, France, and Holland, people -are much come off, or undeceived, as to all those dangerous or mortal -instruments of which the antients made use, such as the short -broad-bladed knife, (call it, if you please, a pen-knife) the bistory, -the crotchets, &c. especially since the invention of the new forceps, or -tire-tête: on the other hand, these same doctors tell you, that recourse -must be had to crotchets, or to the Cæsarean operation, when the new -forceps will not do. A comfortable resource this, in an instrument so -boasted as the best discovery that has been made since the creation of -the world, and for which we are indebted to the moderns! - -I HAVE also scrupulously examined all that authors have been pleased to -say of great, wonderful and magnificent, with regard to the new forceps -of Palfin, as it now stands after infinite corrections, as well in -foreign countries, as in this one, which have dignified it with the name -of the English forceps; and I find all these great elogiums reduced, at -the most, to no more than the proving, as clear as the sun, that it is -allowable for an operator, extremely able and extremely prudent, to make -use of it, when the business might be perfectly well done without it. - -FROM thence I deduce my demonstration directly opposite to the -pretentions of Dr. Smellie and of his followers. According to the -instrumentarians, and according to certain doctors, there are certain -occasions, certain cases, in which there is an absolute necessity for -employing the forceps. If we will hearken to and follow other doctors of -more celebrity and credit, it is not right to make use of it, but when -one may very well do without it: for example, after the having obviated -all the obstacles which retard the delivery, after having, with the -hands only, dis-engaged the head or the shoulders of the child, without -which (say these same writers) the instrument would be found -insufficient or useless; this palpably implies the being able to do -without it. Now since it is not allowable, in good practice, to make use -of it, but when it is perfectly needless to use it at all, there is then -no absolute necessity for it; as surely, what can be done without, is -not absolutely necessary. Be this only transiently remarked. For I -reserve most convincingly to prove this proposition in the second part -of this work. There I shall treat of all the instruments of our antients -and our moderns, and besides an enumeration of them shall demonstrate -their danger and uselessness. In the mean time, it must be owned, that -either Mr. Smellie has been much misinformed of what passes at the Hôtel -Dieu of Paris, in the ward of the lying-in women, or else, which I the -least believe, is not sincere in the account he gives us, that the women -of that hospital “had recourse to the assistence of men, in all the -difficult cases of midwifery;” which, he observes, “got the better of -those ridiculous prejudices the fair sex had been used to entertain.” -That is to say, in preference of midwives to men-practitioners. - -I FREQUENTED this Hôtel Dieu two whole years, before being received an -apprentice-midwife, which I accomplished with great difficulty, on -account of being born a subject of England, and consequently a foreigner -there: my admission, however, I gained at length, through the favor, -protection, and special recommendation of his royal highness the duke of -Orleans. Now, I dare aver, that in all the time before, and after I was -admitted there, I never but once saw Mr. Boudou, surgeon-major called, -who did nothing more than to make us, one after another, _touch_ the -patient, about whom we had been embarrassed; and as he interrogated, he -made us discover an _uterus_ full of schirrous callosities, which joined -to its obliquities, impeded the palpation of it properly with the hand, -the orifice being very difficult to come at. Every thing, however, was -done without his help, and very successfully. And most certainly we -should have spared him the trouble of coming at all into our ward, if -the head-midwife, who was a little capricious in her temper, had not -taken it into her head to keep us in our perplexity, which engaged us to -send for Mr. Boudou without her knowledge, and for which she was -afterwards heartily angry with us. - -I NEVER once saw an occasion in which there was any necessity for using -instruments, though in my time we had, at least, five or six hundred -women a month to deliver. - -VERY far then are the midwives from having often occasion of recourse to -the assistence of the men, in difficult cases; and indeed to those -prejudiced in favor of men-practitioners, it may, though true, appear -strange, that in a place where there are every year so many thousand -women delivered, and consequently many difficult labors amongst them, -and even cases of monsters, there is no recourse to the surgeon-major -but in the last occurence, which falls out very rarely. - -ABOUT eighteen or twenty years ago, Madam Poor, head-midwife of this -hospital, delivered a woman of a monster with two heads, with no help -but only her fingers and a young prentice. Not an instrument was -employed: no man assisted her. The child was christened, and died -presently after. The mother remained some months upon recovery, and did -perfectly well. This fact requires no proofs, being of such public -notoriety. The monster was carried to St. Cosmo’s, where any surgeon may -see it. I served my time with this same mistress some years after this -kind of prodigy had happened. - -AS to what I have advanced concerning the procedure in the wards of the -lying-in women, should my testimony appear in the least suspicious, I -appeal to the justice and veracity of all the doctors in England, who -have been at the Hôtel Dieu at Paris, who cannot but confirm what I have -said. In the mean time Mr. De la Motte, who passes for an author of -credit may certify, the same. Here follows what he says in his preface -to his observations, page 2. - -“ONE would think (says this author) from reading the books of Messieurs -Mauriceau and Peu, that it was impossible to succeed in the practice of -midwifery, without having operated at Paris in the lying-in ward of the -Hôtel Dieu. It is true, that this hospital is the best school in Europe, -and that I would have ardently wished to have been admitted to the -operations of midwifery during the five years I staid in that hospital: -but as there is no more than _one_ surgeon _only_, who is in charge to -attend when he is called to consultation with the midwives, and that it -is a place which goes only by favor, I was forced to content myself with -following in quality of topical surgeon, to the physicians who performed -their visits there. So that I followed only, for six months, three -physicians in their rounds there, during which time I applied myself to -examine the conduct observed by those gentlemen, to preserve the women -after their lying-in from the accidents which follow thereon. By this -means I made myself amends for my want of recommendation; but I can -safely say, that during the six months I was admitted in the -above-mentioned quality, there was no more than one extraordinary labor, -which was that of a child engaged in the passage, where the presence of -a surgeon was required, and which however was terminated without any -other help than that of patience. And yet there were (so far back as -then) from three hundred and fifty, to four hundred pregnant women, who -were all delivered by the apprentices and rarely by the Dame De la -Marche, at that time, head midwife of the hospital: so that I am -persuaded, that those who boast of having lain a great many women there, -exaggerate furiously.” - -FOR me, I dare yet go farther, and will maintain it, that those persons -impose upon the public in such boasts: since the naturalized surgeons, -those of the nation, those of Paris itself, have no right to come into -our ward. There is no one admitted but the surgeon-major, whose place is -a place of favor, and rather matter of form than any thing else. Much -more then are strangers excluded, and the truth is, that they never did, -nor ever do operate there. - -AS to the reproach which Mr. Smellie makes to us of being interested, I -can, for myself, prove that I have delivered gratuitously, and in pure -charity, above nine hundred women. I doubt much, whether our critic can -say as much, unless he reckons it for a charity, that which he exercised -on his automaton or machine, which served him for a model of instruction -to his pupils. This was a wooden statue, representing a woman with -child, whose belly was of leather, in which a bladder full, perhaps, of -small beer, represented the uterus. This bladder was stopped with a -cork, to which was fastened a string of packthread to tap it, -occasionally, and demonstrate in a palpable manner the flowing of the -red-colored waters. In short, in the middle of the bladder was a -wax-doll, to which were given various positions. - -BY this admirably ingenious piece of machinery, were formed and started -up an innumerable and formidable swarm of men-midwives, spread over the -town and country. By his own confession, he has made in less than ten -years nine hundred pupils, without taking into the account the number of -midwives whom he has trained up, and formed in so miraculous a manner. -See the preface of this author. He speaks of his _machine_ in the first -page, and p. 5, of the number of his pupils. - -NOW as to these worthy pupils, must not they be finely enabled to judge -of the situation of women with child, and of that of their fœtus? Must -not they be deeply skilled in that branch of anatomy? Must not they -acquire a habit of the touch exquisitely nice, exquisitely just, for -discerning the proportion and analogy between a mere wooden machine, and -a body, sensible, delicate, animated, and well organized? - -I HOPE too that it is an injustice done to that doctor, by those who say -that his pupils have too often a way of hurrying out the waters, which -can only serve to render the labor more dry, consequently more -laborious, and by that means furnish a handle for setting their -instruments to work. If this should be so, as once more I hope it is -not, may not the bad habit they will have contracted during their -pupilship, of drawing the small-beer out of their wooden-woman, have -contributed to this method of practice? - -IN the mean time, does it become a doctor to call us interested, who -himself, for three guineas in nine lessons, made you a man-midwife, or a -female one, by means of this most curious machine, this mock-woman? - - - OBJECTION the Eighth. - -BUT you who come so late (it will be said) What new discoveries do you -bring us? Can you imagine you will, with one dash of the pen, cancel the -impression of so many excellent works as have appeared before you? Do -you believe a woman can have more ability than so many men of letters, -who have labored all their life-time in perfecting the art, and who so -strongly recommend the use of instruments, as the most expeditious -method of extricating one self, in all the cases they specify, and where -there is a necessity for recourse to extremities? Can you think, that -these personages have all spent their time in vain? - - - ANSWER. - -ALMOST all the sciences and arts attain to perfection, in process of -time, through the experience and assiduous attention of those who -cultivate them. We owe the most of our rare and precious inventions to -the ages of barbarism, in which as yet reigned that brutality and -ignorance which the irruption of the northern swarms had diffused over -all Europe. This invention and perfection of arts cannot be attributed -to merely human industry; but, with more probability, to a particular -over-ruling providence, which commonly concealing itself under what -seems to us the weakest, and under occurrences which appear to us the -effect of chance, have guided men to wonderful discoveries. Do not we -owe to a fair Circassian the art of inoculating children? And surely the -art of midwifery, perhaps more than any other, stands the fairest chance -of being improved by women. - -FOR my part, I dare maintain it, that the surgeons, in form of -men-midwives, have been the death of more children, with their _speculum -matricis_, their _crotchets_, their _extractors_ or _forceps_, their -_tire-têtes_, &c. than they have preserved. If in killing the children, -they have saved the lives of some mothers, they have hurt and damaged, -not to say murdered, a number of others. Their faults ought to set us -upon searching out for a better way of going to work; a more easy, a -more safe one. This fatal operation by instruments might even be -pronounced absolutely useless in the profession. There is no inveighing -severely enough against so dangerous a doctrine as that which recommends -them. Even common humanity requires an endeavour to open the eyes of -those, who imagine they cannot do better than blindly to assent, in -every point, to authors recommendable, it is true, by a number of good -things, but whose authenticity in those points procures them but the -more dangerously credit in erroneous ones. Good sense does not dictate -undistinguishingly receiving all that is advanced even by the best -authors. As they may have been themselves deceived, they may also -deceive us. The sacrifice of our reason is what we owe to nothing but to -revelation. Books written by men have no title to it. As their -understanding is not above the impositions of others, or errors of their -own, they may adopt falsities, through ignorance, through prejudice, for -want of examination, or of right reasoning. Their heart may also have -been byassed or corrupted by views of interest or of ambition. I may -therefore, without over-presumption aver, that with regard to -instruments, it is wrong to lay any stress on the authority of others. -For, with all the respect due to some illustrious writers in these -modern times, who defend the party opposed to ours, it may be assuredly -said, that either they have not known the art of midwifery, or that they -have formed their judgment of it by nothing but the abuses of the -antients, who practiced it without knowing it. Is it not a crying shame, -that operators, who in their life-time massacred such numbers of human -creatures, should still retain, after death, credit enough to -assassinate common sense? Faith is given to unskilful authors, who have -deceived their cotemporaries, posterity, and perhaps themselves: -ignorance admires, enthusiasm protects them. But what a cruel and mean -policy must be that of supposing, that the knowledge of truth ought not -to have a clearer title to dominion than the illusions of imposture? I -hope however, that, when the eyes of the public shall, in this point, -come to be opened, and opened they will be, if true physicians will give -themselves the trouble to enlighten it, that public will at length see, -that an approbation, unpreceded by a due examination, does it as little -honor as service. - -LYING-IN women principally require an early assistence. For unless they -are pregnant of a monster with two heads (a case so rare, that in the -practice of a thousand surgeons, in their whole life, it may not twice, -nor perhaps once fall in their way) there need never be an occasion of -recourse to a surgeon: for in this case, of a monster, it must be the -affair of a most profoundly skilled operator and not of merely a common -man-midwife. - -RUN over all the authors who have written on this matter, and you will -find that the men-midwives, for want of right, and of true knowledge of -the profession, have introduced themselves by force and violence, as one -may say, sword in hand, with those murderous instruments: read the -ancients, it will appear, that they cut their way in, with iron and -steel, forerunners of murders. Our moderns to palliate these violences -and injustices, agree on one hand, that the common and gentlest methods -are to be preferred: but, on the other hand, when you tell them, that -the common and gentlest methods are the hands of women, who ought -therefore to be preferred to the men, and to be restored to their -antient and rightful possession; then you will see the whole pack open -in full cry: to arms! to arms! is the word: and what are those arms by -which they maintain themselves, but those instruments, those weapons of -death! would not one imagine, that the art of midwifery was an -art-military? - -AS for we women, we can but in our weakness groan under this tyranny. -Our protest, joined to that of reason and experience, avails little. Our -wise innovators have a great deal more wit than we have; but it is not a -wit of which we would be ambitious: for it serves them no better, than -under the pretence of saving to be paid for destroying: at least it is -not unfrequently so. - - - OBJECTION the Ninth. - -OPINION often makes a stronger impression on us than truth. Whatever you -may say to the contrary, the imagination will prevail of life, being -safer in the hands of a man than of a woman. For, in short, of what -importance can a woman be, who, after all, is but a woman? This is so -true, that most of our women now a-days will have a man-midwife, some -through prejudice, others through good œconomy, because if there are any -prescriptions necessary for the patient, the man-midwife, who is also -stiled the doctor, will write for them; whereas, if there is a midwife, -a physician may moreover be requisite: this is an additional charge. - - - ANSWER. - -A HAPPINESS founded on opinion only, is rather too slightly founded, -especially in a point where not less than life is at stake. I know there -are women so obstinately wedded to their opinion of certain pretended -doctors, that they would not look upon it to be a good office done them, -though certainly it would be one, to undeceive them. I also know that -the title of doctor is so common in this country, that it ought to be -very cheap. - -MOST of the women in labor, (you say) will have men to assist them, as -thinking their life more in safety with them, than in the hands of -women. May be so. But what does that prove but the deplorable blindness, -the weakness of the human understanding, and the silly prejudices in -favor of novelty? Is it then the instruments of these men-midwives that -give this confidence or this security? As if a king, a queen, or -princess dangerously ill, could be defended from death, by doubling -their guards. - -THE women have on this occasion the delicacy not to suffer even their -husband to assist at their labor, and this out of decency. This is very -well for those who are contented with midwives; but as for those who -will be attended by men to lay them, it is very wrong in them not even -to insist on their husband to stay by them. For this preference of men -to deliver them, comes either from a greater inclination to the men, or -from a greater confidence in them than in the women, or, in short, from -the pure necessity they imagine themselves under to employ a man. If it -is from inclination, or from necessity, it will be always proper for the -husband to stay, to contain the man-midwife, as much as possible, within -the bounds of modesty. If the man-practitioner is preferred by them, out -of the great confidence they have in men: in what man can they place -more confidence than in a tender husband: who more than he can interest -himself in the man-midwife’s acquitting himself duly of his office? - -I WONDER that this great confidence which is reposed in the male sex -should be limited to the man-midwife only. I promise the women, that -they may with equal justice imagine a greater handiness about them in -men-attendants than in women; they may just as well have men-nurses as -men-midwives: the convenience will be as much greater in the one, as the -safety will be in the other. Away then with all the women, who croud -round to comfort and relieve a woman in labor: away with your mothers, -sisters, aunts or female acquaintance: in consequence to the preference -due to the male-sex, let the patient’s labor be attended by fathers, -brothers, uncles, or men-acquaintance. - -BUT let common opinion lower women as much as it will, so much is -certainly and experimentally true, that, notwithstanding the prejudice -and superiority of the men, the judgments and decisions of the women are -often more shrewd, more exact than theirs. Women have a certain delicacy -of mind, which, not being spoilt by undigested studies, renders their -taste much more quick, and more to be depended on, than that of the -half-learned. - -THE distribution of merit and talents is entirely in the hands of divine -providence, that gives what and to whom it pleases, without respect to -the quality of persons; forming out of the assemblage of sciences of all -sorts, a sort of empire, which, generally speaking, embraces all ages, -and all countries, without distinction of age, sex, condition or -climate. The rightful claim to solid praise in this empire, is for every -one to be contented with his place, without bearing envy to the glory of -others. These he ought to look on as his colleagues, destined as well as -himself to enrich society, and become its benefactors. As this -providence places kings on the throne for nothing but the good of the -people, neither does it distribute different talents to men but for the -public utility. But, as in states it has been seen, that tirants and -usurpers have sometimes got the upper-hand, so, amongst men of talents -there may, if I dare so express myself, creep in a sort of tyranny, -which, in the present case for example, consists in looking on the women -with a jealous eye, especially those who from an eminence of talents -might dispute precedence with them. Thence it is that they are, as it -were, hurt by their successes, and by their reputation, and that they -endeavour to depreciate their merit, in order to establish the sole -dominion in themselves. A hateful defect this, and entirely contrary to -the good of society. - -THIS is nevertheless the defect of most of our young men-midwives. But -when I consider the mercenary interest by which they are guided, I am -far from wondering at their inveteracy against those midwives, -especially who are distinguished for their merit and science. The -objects of this malignity of theirs are principally those, who have a -reputation they fear may enable them to be their competitors in -practice. From this mean jealousy of profession, they warmly inveigh -against its being trusted in our sex. This is a doctrine they spread -every where, and the stale burthen of their abuse is ever, “What is a -woman? What effectual service can be expected from a woman?” And thus, -by dint of this repetition and of clamor, they come at length to -accomplish the persuading an over-credulous public. The common people -have in all ages been easily seducible, open to imposition, and when -once an error has got full possession of them, it is a miracle if it -does not maintain itself in it. They love novelty, are readily taken -with striking objects, and stop at the surface of things, which they -eagerly seize. Singularity especially moves them. Reason alone, and -divested of chimeras, appears too naked to them. They must have -something that borders upon the marvellous. Is it not from thence that -the dreams of the poets found faith among the Heathens, or that the -fables of the Coran pass for so many truths among the Mahometans? To the -same weakness in favor of every thing that will make one stare, is owing -that silly credulity, which so often leads men to the swallowing the -grossest absurdities. One would think fictions had peculiar charms for -them. - -NOTHING however can be more pitiful, than the injustice of running down -a sex, which has, in this very matter of midwifery, served the whole -earth through all ages, till just the present one, that a small part of -the world, becomes in imagination, all of a sudden a land of Goshen, or -the only enlightened spot, and takes the ignis fatuus of a mercenary -presumption for the sun-shine of sound reason. But after this injustice, -where will the men stop? What profession will they leave to the women? -It will at last be discovered, that the men can spin, raise paste, cut -out caps, pickle and preserve better than we do. After all, is it not -even ridiculous to see a custom, established for above five thousand -years, universally approved by great and little, fall into disgrace, I -will not say by the opinion, but by the whim of a handful of people, -most of whom too are, most probably, perfectly sensible of the nonsense -and absurdity of that whim, but defend it from a spirit that can hardly -not be suspected of interestedness, which indeed will make men defend -any thing? - -AND after all, even common decency and common gratitude might engage the -men-midwives to speak less slightingly of the women of that profession; -since of whom is it, that the most famous of our present -master-men-midwives of London have learned their science but of the -women? Do not even the principal ones of them make it their boast to -have served a kind of apprenticeship under those midwives, who had -served theirs in the Hôtel Dieu at Paris? - -BUT surely the reader will not think it here impertinent to observe, -that the wise administrators of that famous hospital, would hardly have -failed establishing men-midwives in it, if the safety of the subject had -had any thing to fear in the hands of women. But women alone it is that -preside at all the lyings-in there, be they never so extraordinary or -laborious. The men-midwives have never yet been able to extend their -footing within that place. Their emissaries can gain no admission, nor -are any proficients trained up there but women only. Notwithstanding -which, all the women who are there delivered are satisfactorily and -skilfully assisted. Vexatious accidents are less frequent there, in -proportion to the numbers, than elsewhere, under the eyes and operation -of the men-midwives. Mother and child are both more in safety under the -hands of those dextrous matrons, than in those of the most renowned -men-practitioners[3]. - -TO those then, who with a contemptuous tone ask what is a woman but a -woman? I shall with equal modesty and truth answer, that generally -speaking women are inferior to men in most public services. They are -scarcely so fit to head armies, to navigate ships, break horses, or the -like manly employs: but there are certainly domestic branches, in which -they rather make a better figure than the men. Midwifery seems their -appropriate lot: and rather a gift than an acquisition. They hold from -nature herself, in this matter, a certain expertness and dexterity, to -which not all the more abstruse refinement of art can ever conduct the -men. Nor will the operation of iron and steel instruments ever equal the -suppleness, safety and effectual ministry of the fingers of an expert -midwife, who understands her business. - -LET me then be permitted to ask retortingly in my turn, What is, at the -best, a man-midwife? Is not he one of a new set of operators unknown to -our ancestors? A creature in short hard to be defined? In no original or -primitive language is there so much as a word to express one of this -profession. The common word for him in the English language is a -contradiction in terms, a monstrous incongruity; a MAN-_mid_-WIFE. -Sensible of the ridiculous sound of this expression, scarcely less so -than that of a _woman_-coach-_man_, they have, by way of remedy, -borrowed the term of _accoucheur_ from that nation whence the fashion -was unhappily borrowed, among many other fashions, so many of which are -however rather ridiculous, than like this one _big_ with danger, added -to the ridicule of it. But even that affected French word _accoucheur_ -is of a very recent date in France. No French authors employ it, who are -not themselves of a more modern date than the word itself, which has not -above the antiquity of a century to boast. The name and vocation of a -midwife are found in the most primitive languages, being, in fact, -coeval with mankind itself. - -AS to those who, from a principle of œconomy, prefer a man-midwife to a -midwife for conducting a lying-in, with respect to the remedies and -prescriptions which may be necessary on those occasions, Œconomy is -doubtless a laudable consideration, but I am much afraid, that those who -on this occasion make it a reason of preference, much mis-calculate -things. This man-midwife you prefer is either an eminent or an ordinary -one. If he is an eminent one, you are not always sure of having him in -the greatest need; for besides their being so rare, they cannot be every -where at one time. But admitting that you are fortunate enough to fall -into the hands of a man-midwife of the greatest name in the profession, -can you imagine that you will have a very cheap bargain of him? These -gentlemen expect no small fees, and will not attend without them. You -would besides be ashamed of not doing honor to the footing on which they -give themselves out. Whereas the same gratitude is not always shewn to a -midwife, however skilful in her profession, and whatever trouble she may -give herself both before and after the lying-in of her patients; -notwithstanding too the assiduous attendance and visits she bestows upon -them till they are out of danger; notwithstanding these tender -attentions she has for the children, which are so seldom regarded by the -men-midwives; there are who imagine they cannot give a midwife of this -sort too little, and that for no other reason on earth, but because she -is not a man. - -IF on the contrary, and what the most frequently happens, you fall into -the hands of one of the common men-midwives, either of that multitude of -disciples of Dr. Smellie, trained up at the feet of his artificial doll, -or in short of those self-constituted men-midwives made out of broken -barbers, tailors, or even pork-butchers (I know myself one of this last -trade, who, after passing half his life in stuffing sausages, is turned -an intrepid physician and man-midwife) must not, I say, practitioners of -this stamp be admirably fitted, as well for the manual operation, as for -the prescriptions? If then it is from thrift they are employed, by way -of sparing fees to a real physician, I own, I think this is pushing -savingness too far; as I should be almost as much afraid of the -prescriptions of these mock-doctors as of their operation. I should have -more confidence in the advice of a discreet matron, or of a skilful -midwife, who, by habit and a long experience of seeing ladies in their -lyings-in attended by the best physicians, is in the most common cases -of the labor-pains, more able to advise the sick person to innocent -remedies, where there is no complication in the disorder, than those -half-bred or ignorant pretenders: but if there is a complication, then -there must absolutely be a good physician called in, the expence of -which should not be regretted, since life is at stake. - -NOW in such cases, a midwife, though never so skilful, will neither be -ashamed nor backward to require such aid: whereas a man-midwife, the -more ignorant he is, will be but the more careful of concealing that -ignorance, and from the most false prejudice that both the faculties of -physic and surgery are implicit ingraftments on the profession of -midwifery in a man, will rather let mother and child perish, than call -in that assistance, of which he will be ashamed to confess his standing -in any need. He will then rashly do the best he can for his patient: but -what will that best most probably be? Torture and death; and that with -perfect impunity. I say most probably, for not even the most credulous, -or the most zealous for the appropriation of this profession to the -male-sex, can hardly carry the blindness of credulity and obstinacy the -length of assenting in earnest, that in the common run of -men-practitioners you are to find at once the man-midwife, the -physician, and the surgeon. Whereas women, fully sufficient for all -cases but the very extraordinary ones indeed, are ever ready to call for -proper help, on the first alarm of danger, of which too their -apprehension is much more quick and just than that of the men. - - - OBJECTION the Tenth. - -THE ignorance of the women is the cause of the little confidence there -is reposed in them. - - - ANSWER. - -IF this objection was fairly stated, it should be said, that the -ignorance of the women in the art of destroying mother and child, -occasions their not being trusted so much as they deserve with the -office of saving both. In that art indeed of perpetrating double murder -with perfect impunity, under the sanction of the public credulity, -imposed upon by a vain parade of learning, I readily confess the men -superior to the women. I do more than confess it, I will prove it; and -how? even from their own writings and confession, not extorted from them -by the spirit of candor, but from an interested desire of decrying or -supplanting one another, in order to self-recommendation. - -IN fact, whoever will, with a competent degree of knowledge of the -subject, and of due impartiality, peruse the practical treatises of -midwifery, written by the most celebrated practitioners, some of whom -have so vainly pretended to the triple union of the characters of -man-midwife, surgeon and physician in one person, and it will be found, -that all their boasted superiority of erudition, has only led them into -the greater errors of practice, and the most barbarous violences to -nature. - -BUT perhaps I exaggerate. Let the reader judge for himself, and -pronounce as his own reason shall dictate to him. Let him if he can read -without shuddering, the following quotation from one of the most -celebrated _men_-midwives of the age, Levret, p. 199. “Mauriceau had -invented a new _tire-tête_, which was to be introduced into that part -(the uterus). Peu or Pugh, like _many_ others, made use of different -hooks (_crochets_) and La Motte opening the head with scissors, scooped -out the brain, &c. We read, with horror, in _all_ these authors, that -they have extracted children, who, tho’ much _maimed_ or _mutilated_, -have yet _lived_ several hours.” - -UPON this many reflections will naturally occur. These children thus -destroyed, owed most probably their death neither to nature, nor to the -difficulties of the passage through which the launch is made into our -world, but to the labor being prematurely forced, and the delivery -effectuated by those torturous instruments, which at once kill the -child, and not seldom irreparably wound the mother in the tender -contexture of these parts. A midwife, with less learning and more -patience than those gentlemen, and well acquainted with the power and -custom of Nature to operate in some subjects, sometimes more slowly, and -in all ever more safely and gently than art, would have left to nature, -not without her tenderest assistance of that nature, the expulsion of -the child. A proper predisposal of the passage, and direction of the -posture, with an unremitting attention to employ the fingers, so as not -to lapse the critical moment of operation, often never to be recovered -with safety to mother and child, would have, I repeat it, and appeal to -common sense for the probability thereof, saved the lives of those -innocents, which thus fell the victims of those _learned_ experiments, -with instruments, which, by the way, be it remarked, none are so forward -to use, as those who are the loudest in exclaiming against the employ of -them. And reason good, if they exclaim against them, it is evidently in -order to cover their practice with them, against which the minds of -their patients must so naturally be revolted. But that exclaiming does -not evidently hinder their being used, when, the truth is, that if due -care was previously taken with the patients, those execrable substitutes -to the fingers need never be used at all. - -BUT if these instrumentarians were called to account for their so justly -presumable massacres, what would be their defence? Most certainly not -the truth. One would not own, that in order to attend a richer patient, -or perhaps to return to his bottle, he had recourse to his fatal -instruments, to make the quicker riddance or _effectual_ dispatch; -another would not confess, that he employed them purely because his fund -of _patience_ was exhausted; some would not care to allow, that they -used them purely on the scheme of trying experiments; and none of them -would, you may be sure, plead guilty of ignorance of better and more -salutary methods. No! their wilful error, or that want of skill, they -would be sure to conceal under the cloud of hard words and scientific -jargon, in which they would dress up their respective cases, and insult -the ignorance of those silly good women, who _know_ no _better_ than to -deliver those of their own sex with the help of their fingers and hands, -and who are so undextrous, as to have no notion of putting them to such -unnecessary tortures and risks, as are inseparable from the use of those -iron and steel instruments. Instruments which rarely fail of destroying -the child, or at least cruelly wounding it, and never but injure the -mother, not only in those exquisitely tender-textured parts, where they -are so blindly and ungovernably introduced; but in the often -irrecoverable dilatations of the external orifice, the vagina, and -especially the _fourchette_ or _frænum labiorum_, all which, in general, -they considerably damage: and always originally without necessity. For -if through carelessness, if through an impatience, so much more natural -to men than to women, in a case and position of this nature; if through -ignorance of the critical minute of extraction, the occasion of -operating with the fingers has _not_ been _lapsed_, any recourse to -instruments is perfectly unnecessary, and they will hardly ever succeed -where the subject is inaccessible to the fingers, without having the -worst of consequences to dread from them both to mother and child. -Nothing then can be worse for a man-midwife, than to be tempted to any -negligence, to any precipitation, to any ostentation, in short, of -expedition or of superiority of skill to that of the women, by his -having those instruments at hands, the doing without which is at once so -much better and safer, even by the confession of those who use them -nevertheless. - -HOW greatly then is the ignorance of the midwives preferable to _such_ -an use, as the male-practitioners commonly make of that deep learning of -theirs, which only misleads them, at the expence of humanity! How -over-compensated is that want of theoretical knowledge, so unjustly -reproached to women, since they profess a sufficiency even of that -knowledge; how over-compensated, I say, is that supposed want, by that -instinctive keenness of apprehension, and ready dexterity of theirs in -the manual operation, which in them is a pure gift of nature, and to -which not the utmost efforts of art or experience can ever make the men -arrive, for reasons which will be made clearly appear in the two -following considerations. - -FIRST, It will hardly be denied, that the art of midwifery requires a -regular training or education for it. The season of that education can -only be that of youth. And surely in that season precisely, the very -nature of the study excludes those of the male-sex, at the same time, -that there is nothing in it indecent or improper for the females -destined to that profession. This proposition will be more clearly -illustrated, by an appeal to the reader’s own sense and reason upon what -passes, and must necessarily pass in those hospitals for the reception -of lying-in women, where those of the male-sex are allowed to attend for -the sake of learning the profession. - -THIS Charity is indeed founded upon specious motives, but the conduct of -it would make humanity shudder, even where no violence is expressly -intended to humanity; and without the least forced or uncharitable -conclusion, may serve to demonstrate the impropriety of attempting to -throw the practical part of midwifery into the hands of -male-practitioners, the implicit consequence of which must be the -exclusion of the midwives, without any direct and formal exclusion of -them, but purely from the discouragement that will hinder any good and -able ones being formed in future. And that no thoroughgood men-midwives, -except perhaps two or three extraordinary men in a whole nation, can -ever be formed, the procedure at the lying-in hospitals, open to -men-pupils, such as it must of all necessity be from the nature of the -thing itself, without any the least reproach herein meant to the worthy -managers, will convince all who will make an unprejudiced use of their -judgment. - -WE will then suppose a lying-in hospital, in which, for the sake of -training up _men_ to the profession of mid_wives_, there are young -pupils of the male-sex admitted to attend and learn the practical and -manual part of the business. To obtain this end, we will not say that -women of virtue and character are subjected to the inspection and -palpation of a set of youths, who perhaps pay largely for their -privilege of attendance; but we will grant, that the objects of this -charity are entirely women, who, though they may have unfortunately -forfeited their right to virtue, cannot however have lost their claim to -the protection of that humanity, which, besides the great and most -political attention due to population, pays especially a tender regard -to the innocent burthen, though of a guilty mother. Yet among these -wretched victims, there may be not a few who, if they were not even to -deserve more compassion than blame, for particular circumstances of -their ruin, in which the villainy of men has often a much greater share -than female frailty itself, cannot surely deserve that all traces of -modesty, or natural remains of regard for it, should be utterly -eradicated by that hard necessity of theirs to accept of a charity, by -which they must be abandoned up to the researches of a set of young men, -to whose approaches their age and sex must alone give an air of -petulance and wantonness not to be explained away, to the satisfaction -of the poor passive sufferer, by the goodness of the intention. Every -one must be sensible of the dreadful effects such a treatment must have -on the mind of a poor creature in that condition, when the imagination -is known to be the most weak, and susceptible of the most dangerous -impressions. At that critical time, amidst all the terrors and -apprehensions inseparable from her situation, she is moreover exposed to -the greatest indignity that can be well imagined, that of serving for a -pillar of manage to break young men into the exercise of that most -unmanly profession. Nay, that very circumstance of the use she is put -to, which she is in fact to consider as a kind of valuable consideration -by her paid for the relief afforded her, and which in that light can -scarce be called a charity; that very circumstance, I say, of her -submission, at all calls, and upon all pretences of the pupils, being -accounted for to her by the good intention of it, will yet hardly pass -on a wretched, frightened, harrassed woman, who, whatever may be said to -procure her tame acquiescence, can scarcely, if she has a spark of -female modesty left in her, be reconciled to the grossness of such -usage, whether she considers herself as the butt of wantonness, or the -victim of experiments, or perhaps of both the one and the other. It is -well if she is defended by her ignorance from any idea of those dreadful -instruments, of the having practices tried upon her with which, her -circumstances might but too reasonably render her apprehensive, since a -needless resort to them may be too often presumed in the course of -practice, where the men are even paid for their assistence. These the -men-midwives may possibly indeed conceal from the sight of their -patients, but I defy him to conceal them from their wounded imagination, -if they are not wholly ignorant or can think at all. - -YET in pure justice to all parties it should be observed, that, besides -many other points to be learned only by ocular inspection and manual -palpation, of which no theory by book or precepts can convey -satisfactory or adequate notions, that great and essential point in our -profession, a skill in what we call the _Touching_, is not to be -acquired without a frequent habit of recourse to the sexual parts whence -the indications are taken. And in this nothing but personal experience -can perfect the practitioner. But this admitted, only proves the more -clearly the utter impropriety of men addicting themselves to this -occupation. For, once more, most certainly the season of acquiring the -nicety of that faculty of _Touching_, besides other requisites in the -art, is for obvious reasons that of youth. Now let any one figure to -himself boys or young men, running at every hour, and exercising a kind -of cruel assault on those bodies of the unfortunate females, upon which -they are to learn their practice. But will they learn it by this means? -It is much to be doubted. It may perhaps be granted, that men of a -certain age, men past the slippery season of youth, may claim the -benefit of exemption from impressions of sensuality, by objects to which -custom has familiarized them. But, in good faith, can this be hoped or -expected in the ungovernable fervor of youth? Can such a stoic -insensibility be imagined in a boy or young man, as that he can direct -such his researches by pawing and grabbling to the end of instruction -only? Must not those researches, humanly speaking, be made in such a -disorder of the senses, as to exclude the cool spirit of learning and -improvement? May he not lose himself, and yet not find what was the -occasion of losing himself? In short, granted, though it is surely hard -to grant, that the wretched women, admitted to this so falsely called -Charity, may not deserve much tender consideration; but in what can the -poor young pupils have deserved so ill of their parents or guardians, as -to be thus exposed to temptations so shockingly indecent? What father, -what mother, what considerate relation can paint to himself a child, or -charge of his, at an age so incapable of resisting the power of sensual -objects, as is that of youth, employed in exploring such arcanums, and -exploring them too in vain? It is surely easier to guess the natural -consequences, than to defend either the subjecting youths to them, or -the hoping any good from the subjecting them. In short, even Dr. -Smellie’s doll is a more laudable method of instruction. - -BUT besides this reason taken from the moral impossibility of laying a -timely foundation of practical knowledge in the male-sex, for preferring -women under the false charge of ignorance, to the so unconsequentially -boasted learning of the men, there remains a yet stronger argument -against the male-practitioners: an argument furnished by nature herself, -and of the which, every impartial reader’s own feelings will in course -render himself the judge. - -NATURE has to all animals, from the man down to the lowest insect, to -all vegetables, from the cedar to the hyssop, to all created beings, in -short gives what is respectfully necessary for them. Nor can it without -the grossest absurdity be imagined, that this tender universal parent, -or call her by a yet more sacred name, the divine providence, would have -failed women in a point of so great importance to them, as that of the -ability to assist one another, in lying-in, at the same time, that she -has given them so strong and so reasonable a sympathy for those of their -sex in that condition? Can it be thought that nature, so vigilant, so -attentive, to the production of fresh generations, through all beings, -should have been deficient or indifferent as to women, her favourite -work, the friend, the ornament of human kind? And so she must have been, -if she had left her in the necessity of recourse to others than those of -her own sex, in whom there exists so sensibly a superior aptitude for -tending, nursing, comforting and relieving the sick, that even the men -themselves, in their exigences of infirmities, can hardly do without -them. But to say the truth, and as I have before remarked, nature has -been even liberal in her accomplishments of those of the female sex for -this office. Not content with giving them a heart strong imprinted with -a particular sympathy for their own sex, on this occasion, a sympathy, -which for its tenderness, has some resemblance or affinity to the -instinctive love or _storge_ that parents have for their children; she -has also bestowed on them a particular talent, both for the manual -function in the delivery of women, and for all the concomitant -requisites of their aid during the time of their lying-in: a talent in -short, which may even be felt, without the necessity of definition or -proof, to be superior to any possible attainment of the men in that art, -though they should have sacrificed hecatombs of pregnant rabbits, or -have brooded over thousands of coveys of eggs in their search of -excellence in it. To say nothing of a certain softness, flexibility, and -dexterity of hand, palpably denied to the men, there is, both in the -management of the manual operation, and in the attendance due on those -occasions, a quality in which the women, generally speaking, excel the -men, and that is, patience, a quality more essential, more indispensable -than can well be imagined. For on patience it is, that the salvation of -both mother and child often depend; whether that patience is considered -in the so needful point of predisposing the passages, or of waiting, -without however over-waiting, the critical efforts of nature in the -expulsion of her burden. Now nothing is more certain, than that nature, -who to woman has in general given all that vivacity and quickness of -spirit, which seems incompatible with the phlegmatic quality of -patience, has, as if she had purposely meant an exception favourable to -her darling end, the propagation of beings, especially the human one, -bestowed on the female sex, such a remarkable assiduity and diligence in -aid of women’s labors, as are rarely to be seen in men, and when seen, -appear rather forced than naturally constitutional to them. Women, in -those cases, have more bowels for women: they feel for those of their -own sex so much, that that feeling operates in them like an irresistible -instinct, both in favor of the pregnant mother and of the child. Thence -it is, that a woman-practitioner will employ, without stint, or -remission, all that is necessary to predispose the passages, for the -least pain, and the greater safety; she will patiently, even to sixteen, -to eighteen hours, where an extraordinary case requires so extraordinary -a length of time, keep her hands fixedly employed in reducing and -preserving the uterus in a due position, so as that she may not lapse -the critical favorable moment of extraction, or of assisting the -expulsive effort of nature: and what man is there, can it be imagined, -would have endurance enough to remain so long in a posture, the very -image of which, in one of his sex, is so nauseating and so revolting, to -say nothing of the want of that pliability and dexterity of management -of the fingers, on those occasions, so necessary, and so uncommon in the -men, especially in that very age, when their practice should be supposed -the greatest. - -IT is then in those cases where nature is slow, as she sometimes is, in -her operation, and often so, for the greater good of the patient, so -conformed perhaps, that a quicker expulsion would only destroy her, that -the midwife, not only uses all patience consistent with safety of life -to the mother especially, but inculcates patience to her suffering -charge. Whereas _the men_, from their natural impatience, or from -whatever other motives their precipitation may arise, having those -infernal iron and steel instruments at hand, are but too often tempted -to make use of them, not only without necessity, but against all the -indications of nature, pleading for a just indulgence to her of her own -time in her own work. In vain then do too many of them declaim as loudly -as can be wished, or as the thing deserves, against all recourse to -instruments, but in extremities which, they pretend, justify them. In -the first place, those extremities are often the fault of deficient and -unskilful practice. The precious moments of the assistence due to nature -have been lapsed, or there has been some failure of preliminary -treatment; or what is worse yet, extremities are rashly taken for -granted when they are not existing. - -HERE, in the history of one single woman, I give the history probably of -thousands. - -A HEALTHY woman, about twenty five years of age, and remarkably robust, -was in labor of her second child. Her first had come in that natural -smooth way, as had given the same man-midwife, who was now to lay her -again, not the least trouble, as often happens. In this second labor, -however, the head of the child stuck in the passage; and was so far -advanced, that the Doctor told her, whether in jest or earnest I cannot -say, that he could discern the color of its hair. Her pain, though -extremely great, had not however hindered her observing the Doctor -rummaging for his instruments; her frightful apprehension, of which, she -had all the reason to imagine, did not a little contribute to retard her -throws. She taxed him with his intention to use them, and he did not -deny it. Upon this she used the most moving fervorous entreaties for a -respite of execution; but all in vain; he told her, with a resolute -tone, that he knew surely better what was for her good than she did, -that he had even already waited longer than he could justify; and that -her life was absolutely desperate if the child was not instantly -extracted, of the which being dead, he was sure from many incontestable -symptoms. Her thorough confidence in a man, whom she had often heard -declaim vehemently against the use of instruments unless in extremities, -and which she understood in the most literal sense, without considering, -or perhaps knowing that, on too many occasions, nothing is so different -as words and actions; her thorough confidence in him, I say, joined to a -natural love of life, and to her present feelings of exquisite pain, -determined her to an acquiescence. The fatal instrument was struck into -the brain-pan of the child, who at the instant gave the lie to the first -part of the Doctor’s asseveration as to its death, by such a strong kick -inwards as had almost killed her, and convinced her not only of its -being alive but lively. This did not, you may be sure, add to her belief -of the second part of his averment, that waiting any longer for the -operation of nature, would infallibly have been her death. It might be -so: yet surely there are strong reasons for concluding, that a little -more patience might have saved a fine boy, and yet not have destroyed, -or even hazarded the destroying the mother, whose life is certainly the -preferable object. But how cruel to state the dreadful alternative where -it does not exist! And how easy, in the presumption of that alternative, -to extort the dreadful consent from a weak woman, yet more weakened by -her condition, and naturally determined by her present feelings, to -embrace the appearance of an immediate relief, presented to her in the -form of salvation of life! However, scenes similar or a-kin to this, -may, without breach of charity, be presumed too frequent, especially -under those superficial men-midwives, whom the facility of forming, in -the manner they are generally formed, renders so suspicious as to their -ability, and who for so many reasons, both of nature and interest, are -but too liable to the murderous want of that patience, for which the -women are but the more remarkable in this case, for their not being -perhaps so capable of it in any other. But here their duty is even their -nature; as if in so capital a point, she would trust it to nothing but -herself. - -IF it should be here to this objected that the women may, through that -very spirit of patience, wait too long, or overstay the time of saving -the patients life, for want of calling in proper assistence; I have -already implicitly obviated this objection, by remarking before, that a -true thorough midwife, from her quickness of apprehension, and knowledge -of the danger, will ever be readier to call in the assistence and advice -of a physician, than the common men-midwives, who are ever in proportion -to their ignorance the more rash, the more fearless, and consequently -averse to calling in that help, of which they will be ashamed to confess -their want, and thus cruelly, though with impunity, lose the opportunity -of others endeavouring at least to repair those damages, of which -themselves are oftenest the authors. Now a midwife has no such shame; -she pretends to no extraordinary skill in physic or surgery; she knows -her art, and will not presume to transgress its bounds; she would think -herself accountable if she did: and even that very tenderness and -sensibility, upon which nature has founded her patience, will make her -cautious how she pushes that patience too far. She may easily see, feel -and discern those cases in which nature calls the physician in aid to -the midwife; nature, who seems to have placed such boundaries between -those professions, as nothing but interest, presumption, or ignorance of -nature, could ever render their union in one person supposable: tho’ the -quality of physician may not indeed exclude that of the surgeon, but -rather implies, at least, the theory of surgery. For I presume anatomy -is the great basis of true rational physic, though it can very little -assist practical midwifery, which depends so much upon purely manual -operation, and needs only a sufficient general idea of the structure of -the sexual parts in woman, the conceptacle, and passages of the -delivery. - -THIS is so true, that any impartial observer of the male and female -practitioners in midwifery, will easily distinguish the characteristic -difference of the sexes, in their respective manner of operation. - -IN the men, with all their boasted erudition, you cannot but discern a -certain, clumsy untowardly stiffness, an unaffectionate perfunctory air, -an ungainly management, that plainly prove it to be an acquisition of -art, or rather the rickety production of interest begot upon art. - -IN women, with all their supposed ignorance, you may observe a certain -shrewd vivacity, a grace of ease, a handiness of performance, and -especially a kind of unction of the heart, that all evidently -demonstrate this talent in them to be a genuine gift of nature, which -more than compensates what she is supposed to have refused them, in -depth of study, though even of that they are not so unsusceptible, as -some men detractingly think; and in midwifery, most certainly they -attain all that they need of learning to perfect them, with a facility -the greater for nature, having collaterally endowed them with an -organization of head, heart and hand, obviously adapting them to this -her most capital mystery. This will be denied by none who have any -regard for truth, and who do them justice, as to the keenness of their -apprehension, as to that simpathizing sensibility which supplies them -with the needful fund of patience, and tender attention; and as to that -peculiar suppleness of the fingers, as well as slight of hand, in a -function which rather exacts a kind of knack or dexterity, than mere -strength, of which they have also a competency. Nor can it be quite -without weight, that the midwives, besides their personal experience, -being sometimes themselves the mothers of children, have a kind of -intuitive guide within themselves, the original organ of conception, -itself pregnant, in more cases than that, with a strong instinctive -influence on the mind and actions of the sex; an influence not the less -certainly existing, for its being undefinable and unaccountable, even to -the greatest anatomists[4]. - -THE men, it will be said, have many or all of these qualifications, -except indeed the last. Granted that they have: but how very few are -there of the men that possess the most essential ones to a degree -comparable to that of the women: or rather not so imperfectly, as that -all their boasted skill in literary theory and anatomy, cannot -supplement or atone for the deficiency? Nor theory, nor all the books -that ever were written on that subject from the divine Hippocrates, who -understood so much of physic, and so little of midwifery, down to Dr. -Smellie, who is so great a man in both, will ever amount to so much as -the practical experience of a regular bred midwife. - -AS to that superior skill of the men in anatomy which is sounded so -high, against the women, I shall not imitate the men in their want of -candor towards the female-sex in their availing themselves of false -arguments. I will not then take the benefit of the slight opinion which -Celsus and Galen had of the depths of anatomy; they who contented -themselves with a gross superficial notion of the principal viscera. I -will not even desire to countenance that contempt by the example of that -great philosopher Mr. Lock, the intimate friend, and even the counsellor -of the British Esculapius Sydenham, who paid a great deference to his -physical knowledge; and yet this very Mr. Lock wrote an ingenious -treatise (though not published by him) upon the insignificance of the -refinements of anatomy in the practice of physic. Neither will I here -insist on the absurdities into which even the greatest anatomists have -fallen; as for example, _Pecquet_, the famous discoverer of the thoracic -duct in the human body, who nevertheless adopted so extravagant a -notion, as that digestion of food ought not to be promoted by exercise, -but by drinking spirituous liquors, a practice to which himself fell a -victim, dying suddenly at the anatomical theatre. It is only for those -who have a false cause to defend to shut their eyes against those truths -which seem against them. Those on the contrary who defend purely the -truth, know that one truth cannot hurt or exclude another truth, and -that all truths may very well coexist. It may be true that anatomy, -though it does not give the nature of the elementary composition of -parts intrinsic and too minute for the human sense, since a new incision -only presents a new surface, much conduces however to ground the student -in mechanical principles of great assistence to him in practice, of -which they are doubtless the most solid foundation: yet that truth is -not incompatible with another quite as much a truth, that midwifery can -have no occasion but for a general notion of the configuration of those -parts upon which it is exercised. A midwife, for example, may be a very -safe and a very good one, without knowing whether the uterus is a hollow -muscle, or purely a tissue of membranes, arteries and veins: but if that -ascertainment is necessary, she must wait for it till the anatomists -have settled among them that point, which, like many other capital -points of anatomy, is not however yet done. In short, once more, a woman -in labor requires a midwife to lay her, not an anatomist to dissect her, -or read lectures over the corpse, he will be most likely to make of her, -if he depends more on the refinements of anatomy, than on the dexterity -of hand, and the suggestions of practical experience and common sense. - -IF then, there are who can examine things fairly and with a sincere -desire of determining according to the preponderance of reason, they -cannot but on their own sense of nature, on their own feelings, in -short, discern that no ignorance, of which the women are -undistinguishingly taxed, can be an argument for the men’s supplanting -them in the practice of midwifery, on the strength of that superiority -of their learning, so rarely not perfectly superfluous, and often -dangerous, if not even destructive both to mother and child. Consult -nature, and her but too much despised oracle common sense; consult even -the writings of the men-midwives themselves, and the resulting decision -will be, that great reason there is to believe, that the operation of -the men-practitioners and instrumentarians puts more women and infants -to cruel and torturous deaths, in the few countries where they are -received, than the ignorance of the midwives in all those countries put -together where the men-practitioners are not yet admitted, and where, -for the good of mankind, it is to be hoped they never will. - -I HAVE here said few countries have hitherto countenanced men-midwives. -That I presume is too notorious to require proof: for even those Saracen -or Arabian physicians, Avicen, Rhazes, &c. who, by the by, are little -more than servile translators or copists of the Grecian ones, wrote only -theoretically in quality of physicians; for it does not appear that they -ever practised midwifery themselves, nor ever got the practice of it by -men introduced into their countries. Among the Orientals there is no -such being known as a man-midwife; that refinement of real barbarism, -under the specious pretext of humanity, is happily unknown to them. But -if it should be said, that the jealousy so constitutional to the -inhabitants of the warmer climes, has a share in the exclusion of -men-practitioners; the women have, at least in that point, a weakness to -thank for its production to them of so great a good, as the greater -safety of their persons and children, in that capital emergency of their -lying-in. For, after all, the art of midwifery is, in the hands of men, -like certain plants, which, by dint of a forcing culture, exhibit more -of florish, or a broader expansion; but besides ever retaining a certain -exotic appearance, they never come up to the virtue of those -spontaneously growing in the full vigor of a soil of nature’s own choice -for them. Art may often indeed improve nature, but can never be a -supplement to her, where she is essentially wanting. Deep learning may, -in very extraordinary cases perhaps, repair the errors, or assist the -deficiencies of the manual function, but the deepest learning will never -bestow the manual function, nor indeed can in the same person exist, but -at the expence of the manual function, which must have been in some -measure neglected for it. And yet the greatest practical skill that any -man can with the utmost labor and experience acquire, will hardly ever -equal the excellence in it of the women, Great Nature’s chosen -instruments for this work: an excellence by them attained with scarce -any learning at all, or at least of that abstruse theoretical sort, on -which the men make their superiority principally depend. - -BUT that I may not herein be taxed of maintaining any thing that has -only the air of a paradox, or of begging the question, I shall -implicitly, in the course of my answer to the following objection, -endeavor to remove any remaining doubt on this head. - - - OBJECTION the Eleventh. - -IN like manner, as there are particular parts of the human body which -have their appropriate undertakers or protectors under their proper -distinctive names, as oculists, dentists, and corn-cutters, who by -making respectively one part their particular care and study, arrive at -a greater perfection, at least in the practical operations on it, than -regular physicians or surgeons, whose object is the whole fabric; Why, -by parity of reasoning, should not the men-practitioners in midwifery be -preferable to the midwives, since a man has to his manual function -superadded a theory superior to that of the women, who, it is confessed, -stand sometime in need of calling in the physician to their assistence? -As a man then will have laid in a stock of medical knowledge, peculiarly -adapted to the exigencies and disorders incident to women during their -pregnancy and lying-in, he must consequently excel the midwife, or the -physician singly considered; he who with so much greater convenience -will have united in one person both their faculties, besides that of the -surgeon. - - - ANSWER. - -THAT certain parts of the human body enjoy the protection of -practitioners, who respectively devote themselves to their service, I -confess. Such appropriations may also be beneficial, at least, to the -practitioners. I can even conceive, that a professed dentist may clean, -scale, and draw teeth, or an oculist couch a cataract, better than -either a physician or surgeon. These may in their respective practice be -excelled by those partial artists. But I much doubt, even as to these, -whether their trusting too much to that partial excellence, does not -sometimes do more mischief than good, for want of duly consulting the -relation of such parts to the universal fabric, of which physicians and -surgeons must be so much better judges. Galen does not appear in -contradiction to common sense, where he observes, that to rectify a -disorder of the eye, the head must be rectified, which cannot well be -done without rectifying the whole body. In confirmation of which, I once -myself knew a gentleman, whom a professed oculist, at Paris, assured of -the loss of his eyes being infallible; and who upon his despondingly -consulting a regular physician, was by him as positively assured, that -those very condemned eyes might be saved by a proper regimen. The -gentleman happily believed him, and his eye-sight was not only saved, -but perfectly restored. - -ANOTHER instance of the like nature occurs to me, which seems applicable -to the dentist, and which I quote here from a translation of the learned -and ingenious Dr. Huxham’s observations on the constitution of the air. - -“MANY years ago I knew a gentleman of a hale, robust habit of body, who, -from being too much addicted to the drinking of brandy, fell into a -violent jaundice, from which however he would have recovered well -enough, would he have conformed himself to the advice of his -_physicians_: but he on the contrary, because his _gums_ were very apt -to bleed, and his _teeth_ stunk from the _scorbutic taint_, put himself -into the hands of an ignorant _pretender to physic for the cure of these -inconveniencies_. This fellow immediately set about _scaling his teeth_, -and _rubbing his gums_ with _his famous teeth-powder_, till at last, by -perpetually fretting and irritating the loose texture, he brought on -such a hemorrhage, that baffled all the stiptics that could be invented -by the most expert surgeons, and continuing to spout forth in small -streams from the little arteries of the gums, which were now every where -divided: in the space of _sixteen hours_ the poor man _died_ through -mere loss of blood.” - -THESE instances are however only adduced to justify that doubt which I -expressed of these partial artists being _always_ to be beneficially -consulted in those local affections, to which their talent is supposed -exclusively appropriated. - -CORN-CUTTER is indeed a homely plain English term, but if the teeth give -from the Latin the appellation of dentist, as the eye that of oculist, -what name, taking it from the _part_ in question, will remain for that -language, to give the men-practitioners of midwifery, in substitution to -that hermaphrodite appellation, that absurd contradictory one in terms, -of _man_-mid_wife_, or to that new-fangled word _accoucheur_, which is -so rank and barefaced a gallicism? But let what name soever be given -them, it can hardly be too burlesque an one, considering the gross -revolting impropriety of men, addicting themselves to a profession -naturally so little made for them. - -PAINT to yourself one of these sage deep-learned _Cotts_, dressed for -proceeding to officiate[5], and presenting himself with his -pocket-nightgown, or loose washing wrapper, a waistcoat without sleeves, -and those of his shirt pinned up to the breasts of his waistcoat; add to -this,[6]fingers, if which not the nicest paring the nails will ever cure -the stiffness and clumsiness; and you will hardly deny its being -somewhat puzzling, the giving a name to such an heteroclite figure? Or -rather can a too ludicrous one be assigned _it_? - -THOSE however who will consider this grave Doctor in his margery -field-uniform, this ridiculous piece of mummery, in a light of -seriousness, such as the matter perhaps more justly deserves, especially -combining with all the rest, the idea of his crotchets, forceps, and the -rest of his bag of instruments, may think he less resembles a priestess -of Lucina, than the sacrificer, in a surplice, with his -slaughtering-knife, to one of those heathen deities whose horrid worship -required human victims, which the poor lying-in women but too nearly -resemble. - -BUT whether or not, in imitation of the dentist, or oculist, he receives -his title from the particular part he has taken under his protection, so -much is certain, that the same arguments, which militate for those -partial artists claiming their respective departments of the human body, -will not avail the man-midwife. An oculist, a dentist, a corn-cutter, -have no operations to perform but those of which disorders equally -incident to both sexes are the object. There is nothing in their -practice repugnant to the nature of the male-sex, nor to that reasonable -decency, which only requires that no sacrifices of it should be made in -vain, or at least not made to no better a purpose than to increase at -once the danger and the pain of both mother and child, in whose favor it -is sacrificed, as it may be clearly proved to be oftenest the case. But -of the chirurgical part of the man-midwife’s pretention, I reserve to -treat after considering him in the capacity of a physician; in which a -man may indeed be wanted, but in that of surgeon never, or at least so -very rarely, as not to atone for the dangers which attend the men -forming themselves into a set under the name of men-midwives. - -WHERE there is no complication of any collateral disorder with the -gestation and parturition of women, it is even a jest for men to pretend -the necessity of any study or practice to which women may not arrive, -and even much excel them. - -BUT where there exists the case of a singular constitution, or of -symptoms declarative of other help being necessary than just the common -one, that quickness of discernment, that peculiar shrewdness of the -women, in distinguishing what is relative to their art from what is -foreign from it, gives them the alarm in time, and if they have a just -sense of their duty, or but common sense, they must know that such -disorders cannot be _partial_, cannot therefore be considered as they -are by the man-midwife, as subordinate to his particular province, -relative as they are to the whole fabric or system. All _partial_ -practice then is here absolutely out of the question, and now what help -can, consistently with good sense, be expected from a man-midwife, who, -under a natural impossibility of ever acquiring the female dexterity in -the manual operation, cannot however, be supposed to attain even that -imperfect degree of skill, without sacrificing to the endeavours at it -the time and pains in study and practice, which are requisite to form -the able physician? - - -BUT, in fact, the men, that is to say, those of that sex who have the -best understood all the refinements of anatomy, all the variety of -female distempers, never that I can learn, attempted to invade the -practical province of midwifery. The immortal _Harvey_, _Sydenham_, the -great _Boerhave_, _Haller_, and numbers of others who have written so -usefully upon all the objects of midwifery, have never pretended or -dropped a hint of the expedience of substituting men-midwives to the -female ones. They contented themselves with lamenting the ignorance of -some midwives, from which has been drawn a very just inference of the -necessity of their being better instructed; but even those great men -never chose the character of practitioners themselves, nor probably -would have thought it any detraction from their merit to have it said, -they might make a bad figure in the function of delivering a woman. - -WHOEVER then will consider but how the common run of men-midwives -actually are and must be formed, and assuredly the number of exceptions -to the general insufficiency cannot oppose the inference, must allow -that, where a woman has distempers collateral to her pregnancy, with -which they must also become dangerously complicated, she must expose -herself to the utmost hazard, in any confidence she may place in a -man-midwife. - -THE truth is, that most of the dangerous lyings-in are so far from being -likely to be relieved by a man-midwife, that it is often to the having -relied upon his medical judgment, and especially to his manual skill -they are owing. But of the first only it is we are now here speaking. - -THE women captivated by that assiduity of the men-midwives, of which -they only fail when they are not paid or likely to be paid, in some form -or other, up to the value they set upon themselves, lightly take for -granted, that, as men, they are also capable physicians. It is enough, -in short, for these practitioners not to be women; for the women to -think they can prescribe for them in all disorders. A mistake this, -often big with the utmost danger to them. - -THE men-midwives, in general, have never, at the most, carried their -studies beyond the disorders commonly incident to pregnant women: the -knowledge of all the other possibly collateral ones, is what even the -least modest of them will hardly claim, unless to the profoundly -ignorant, and is in fact scarce less than impossible to one who has -applied himself essentially to the manual function. In such cases the -ignorance of a midwife can hardly be greater than that of the -men-practitioners, and must be less dangerous from her less of -pretention. Her consciousness of her own want of sufficient light, will -engage her readily to state the exigency to some able and experienced -physician, whom she must allow, in such cases, to be her superior judge: -whereas the other, the man-midwife, acknowledges no greater authority -than that with which he is pleased to invest himself. He stands, in -virtue of a distinct business, and a business for which he never was -made, of a sudden the self-constituted sovereign dictator and -inspector-general of all female disorders whatsoever, where the woman is -with child, that is to say, where the case is only thereby rendered much -the more nice and difficult, and, not rarely, does he continue under the -same pretext, to extend his practice to where there is no pregnancy at -all in the case. And yet ask him for his titles, they are all implicitly -dependent on or subordinate to that same midwifery, for which he is so -naturally unqualified, even if a due study and exercise of it would -permit those avocations, that would contribute to accomplish him in the -so necessary general knowledge of physic. But indeed why need he acquire -it, since it is so commonly taken for granted, or that he is believed -upon his own word, especially if he is backed with a diploma, for form’s -sake, that may have cost him little or nothing of medical study, or -indeed of any thing but the amount of the fees for it? - -YET how serious, how important is it for women, if they tender their own -lives, and that of the precious burthen of which they are the -depositaries, to make that distinction between the physician and the -midwife, which they seem so little to make! How little do they consider, -what nevertheless is strictly true, that a man can never at the best be -but an indifferent practitioner of midwifery, though he may be an -excellent one in physic; but that as bad a midwife as he can be, he must -be yet, if possible, a worse physician, if he attempts to throw both -professions into one, and exercise them jointly! They are incompatible, -from the justly presumable impossibility of one man doing justice to the -practice of the one, unless at the expence of the study of the other: by -which other, to obviate cavils, I repeat it, I mean the general practice -of physic, which comprehends the speculative part of midwifery, as well -as all other branches understood to be the province of the physician. -This distinction then I make, because, as to the diseases purely -incident to pregnant women, experimental practice will rather assist the -medical study of them: and it is in that part only the men-midwives can -make any figure at all, and that not a superior one to midwives who are -regularly bred, and who have, in their favor, their excellence in the -manual function besides. - -ONCE more, in complicated cases, the most dreadful mistakes are to be -dreaded from those common-men-midwives, who so groundlessly erect -themselves into physicians on those occasions. A purge, a venesection, -or any other prescription injudiciously ordered, may be the occasion -proximate or remote of death to both mother and child; yet a woman, at -least, _ought_ not to expect better from one of these practitioners who, -for the most part, has neither study nor experience in general physic; -nor more than a smattering of anatomy, joined to the index-learning of -dispensatories. Such a man-midwife can never have thoroughly made -himself master of the course of the fluids, nor of the order of their -circulation. Their relation to the solids, and the efficacy of medicines -upon both, can hardly be sufficiently known to a man, who must have been -too much employed in trying to form a hand never to be formed, and in -attendances on the practice of his midwifery, to acquire those -collateral requisites for the effectual multiplication of his -professions. - -YET this man void of knowledge, experience, observation, and, in -consequence, of physical ability, shall boldly decide on the expedience -of an internal remedy, of which he does not know the power or operation; -of a venesection, of which he can but guess at the consequence; and of a -narcotic, of which he is unaware of the danger. In all which, observe, -he may possibly sometimes be tolerably right, in cases where there is -_no_ complication; that is to say, in cases when a midwife, duly bred, -is as sufficient as the best man-practitioner. But then she is moreover -not only quicker of apprehension, as to danger, where the case appears -complicated, but readier to call in proper help where she discerns it to -be above her reach, and consequently above that of the man-midwife, who -must be equally or rather more at a loss, because his boasted theory -will serve only to puzzle him, or what is worse yet, since a shew must -be made of doing something, _will_ most probably determine him -improperly, if not fatally, to random prescriptions, in points out of -his sphere of knowledge, or rote of practice. - -MANY a man who to-day undertakes prescribing for a fever, for a fit, a -convulsion in a lying-in woman, only because he appears in the character -of a man-midwife, would have been ashamed the day before he had taken up -that business to give himself out for a physician. He would have been -afraid of ordering any thing for her if she was not his patient, as to -lying-in, and would not, even after assuming the profession of -midwifery, perhaps order any thing for the same woman, out of the time -in which his office is supposed necessary. This plainly proves, that -many of those gentlemen are weak enough to imagine, that the man-midwife -implies the physician, though the greatest physicians that ever were -never dreamt of such an absurdity, as that the physician implied the -midwife, whose master and instructor he rather is, in points highly -useful indeed at times to her profession, but in which that profession -does not consist. - -I DO not however charge _all_ the men-midwives with so much modesty, as -to confine their striking out of midwifery into physic, to the women -lying-in, or to the time of their lying-in, since there have not been -wanting some who, with equal ignorance, but superior effrontery, have -intrepidly hoisted, the standard of a general knowledge of physic, and -having originally insinuated themselves into families in the character -of men-midwives, have easily maintained their ground in them afterwards -on the foot of physicians. A circumstance not much to be wondered at, -considering the endearment of such an office as that of a man-midwife, -and the ascendant it must serve to give them over the heads of families, -even in points where a midwife can have no shadow of pretention, for -interfering. In the mean time, let any one of sense or common humanity -consider but the consequences of this dangerous admission of the -sufficiency of a man-midwife in those complicated cases, which require -the consultation of a regular physician; to say nothing, for the -present, of the other objections already mentioned, or which I shall -hereafter more at large discuss, and the result must be, to allow that -the medical pretentions, or indeed any pretentions, of these -men-practitioners, cannot be too much discouraged, nor confidence more -misplaced than in them. For once that they may hit the mark by chance, -they will often take the part of the distemper instead of that of the -patient; they will do what they have only a gross guess of being the -right, not what they know to be so: and physic, at best, but a -conjectural science, must in them want even the common grounds of -conjecture. - -INSTEAD then of the dangerous self-sufficiency of these complex -smatterers, you have in a plain midwife, supposing her regularly bred, -and duly qualified for her profession (for I am no more an advocate for -ignorance in the women than in the men) one, who, being called in time, -will duly consider, and observe the constitution of the person that -wants her assistence. If nothing appears extraordinary, or out of the -common-rules in her patient’s constitution and conformation, she needs -only lay down for her the previous course of management, and as the hour -of delivery approaches predispose her properly: a point in which the men -must be grossly deficient, for want of that skill of prognostic inherent -to the women, from their particular delicacy and shrewdness in the -_faculty of touching_; upon which more depends than can be well -imagined. Wherever a case occurs to a midwife, so complicated as to be -above her reach, her interest, her reputation, her duty, all conspire to -prescribe to her a timely application to a regular physician. She -communicates her doubts or difficulties to him, who, at the same time -that he receives a just information from her of the state of things, -combines it with his own knowledge of the human constitution. He does -not confound, as the man-midwife does, ideas so different as those of -the manual operation, and the medicinal prescription. The object of the -physician, being the same as that of the midwife, the prevention or -alleviation of pain to the mother, and the greatest safety to the mother -and child, but preferentially that of the mother; there is this -advantage to both mother and child, that all harshness of practice, all -the violenter remedies will be as much corrected as can be done, -consistent with the safety of mother and child, by the midwife’s -tenderness, by which the physician will at the same time be above the -being misled into omissions of any thing absolutely requisite. In short, -on such occasions, they serve to temper one another. A truly great -physician will not disdain the lights furnished him by her practical -experience, and she knows the bounds of her mechanical duty and -profession too well, to interfere with his superior intellectual -province, in those points submitted to it. A pragmatical man-midwife, on -the strength of his miserable half-learning, would think it a derogation -from his character, to call in a physician in supplement to his -deficiency, of which he is always ashamed, though indeed he has -sometimes the excuse of himself not knowing it. Then when a fatal -accident has happened, under his hands, against which, with more -knowledge he might have guarded, or which with less of presumption or -dependence on himself he might have prevented, by procuring previous or -collateral advice; he thinks himself abundantly acquitted by laying the -blame on _occult causes_. Even the great man-midwife, _Mauriceau_ -himself, has made use of that trite exploded apology[7]: where he -expressly says, “that a sudden unexpected death of his patient was one -of those FATALITIES, that not all the human prudence can prevent.” - -BUT that I may not here incur the least charge of unfairness, as if I -meant by this quotation any thing so absurd or unjust, as that in the -labors of pregnant women, as well as in other diseases unconnected with -them, there may not sometimes happen accidents impossible to be -foreseen, as well under the care of the best physician, called in by the -very best midwife, as under the most ignorant assuming man-midwife, I -shall here introduce another quotation from the same _Levret_, that will -especially shew the ladies, and all parties concerned, to what an -imaginary safety, so much, and even the very point sought for, is -sacrificed as is sacrificed, in preferring the men-practitioners to the -midwives. [8] “M. de la Motte says, that for the fifth time he laid the -wife of a glover of Valogne, the 16th of March, 1704; that the woman was -but an hour in her labor-pains, and that he delivered her with all the -facility imaginable; that he left her upon the couch till he had given -her some broth, after which he recommended her to the care of the nurse, -and went _where his business called him_. He adds, that he had time but -just to bleed two persons in the neighbourhood, before he was fetched -away in haste to see the patient he had just laid, whom he found _dead_ -upon the bed. The cause of this _death_ was instantly manifest to him -from the stream of _blood_, which ran about the floor, and even -penetrated to the apartment beneath, after soaking through the bed -itself, in which there remained clots of blood of an extraordinary size. - -“THIS author adds, in the reflexions at the end of this observation, -that this delivery had been both more easy and more expeditious than any -this woman had precedently had: and he notes, that these _melancholic -accidents_ are not _without example_, since such ladies as the princess -of ... and madam la Presidente de —— with _numbers_ of _others_, have, -on the like occasion, undergone the same _fate_, as her he here treats -of. These are, according to him, _proofs_ that all human science and -dexterity _often_ cannot prevent the _like misfortunes_, since these -_great ladies_ had been lain by the most _celebrated men-midwives_.” - -NOW I might here, without much probability of being contradicted, aver, -that where such accidents, said to happen so _frequently_ and -inevitably, should happen under the hands of midwives, there would be -but one voice among the men-practitioners and their credulous adherents, -to impute them to the ignorance and malpractice of the women. The plea -of _occult causes_ would be hooted at in them, tho’ receivable, it -seems, from the men. - -NOT however to imitate what I condemn in them, a gross want of candor to -the women, of whom, by the by, the very best of the men-practitioners -have learnt all the laudable part of practice, I shall allow that among -those frequent examples, of sudden deaths upon delivery, some few might -perhaps be of those unaccountable surprizes with which nature mocks -human ignorance; but then it must be allowed too, that not all of them -admit of that favorable solution. The truth is that nature, to those who -have studied her course, and watched her motions with a due spirit of -practical observation, hardly ever but gives warning enough to prepare -proper obviative methods. It is not here the place to enter into the -discussion of those deaths by sudden hemorrhage upon delivery, of which -I shall hereafter attempt to give a more satisfactory account, as well -as of the measures of prevention, than Levret. My end in the preceding -quotation is to show; - -FIRST, that by the confession of the men-midwives themselves, the most -fatal accidents _frequently_, and _inevitably_ happen under them in -spite of all their _science_ and _dexterity_! - -SECONDLY, to offer to the reader a reflexion for himself to judge of the -validity of it, to wit, that, not only in the cases of the hemorrhage, -but in many others, where there is a complication of disorders with the -state of pregnancy and parturition, much of the safety of mother and -child must depend on that general medical knowledge, to which the -men-midwives have so little grounds of pretention. Nor indeed, for the -symptoms of necessity for resorting to medical help, have they the same -shrewd prognostic or acute sense as the experienced women, who much -sooner perceive the danger before it is too late, and are neither -with-held by a false shame, nor by a criminal or senseless presumption, -from calling in proper assistence. Such at least has been and still is -their practice in all ages, and in all countries, where the matters of -pregnancy and lyings-in are committed to them. The great object of the -man-midwife is to impose so false a notion on his patient, as that his -partial knowledge is sufficient to every thing. The consequence of which -is, that if he is not too officious, too pragmatical, by way of -ostentation of his art, in common cases, that is to say, where there is -no complication of disorders, every thing may pass off tolerable well, -till the crisis of labor-pains. And in that crisis I defy him, with all -his learning, to equal the female skill and cleverness, not only for -lessening the sufferings of the patient, but for facilitating the happy -issue of her burden. - -BUT where there is a complicated case, dependent on the physician’s art, -then the trusting to those men-dabblers in midwifery is a folly that may -be fatal to both mother and child, or, at the best, the delivery will -have been rendered more painful, more laborious, more big with danger, -for those precautions having been neglected, which can be so little -supposed to occur to the common run of men-midwives in cases foreign -from their rote of practice. Yet it is precisely in those disorders -collaterally contingent to pregnancy, and no disorder does that state -exclude, that the greatest skill and knowledge of physic are required. -Then it is, that not only the preservation of the mother claims regard, -and certainly the preferable one, but even that of the child is no -indifferent point. And to save both, the state of the mothers -constitution must be carefully considered. Thus the combination of the -disease with the pregnancy, the due regard to the mother as well as that -to the child, form a triple object that takes in a compass of -comprehension to which no midwife will pretend, nor can be imagined to -exist in the mere man-practitioner of midwifery. Such a nicety of -observation does not seem to be the province of a manual operator, and -indeed useless to him in that character. And as he will be more likely -to trust to conjectures, which no sufficient grounds of study will have -justified his presuming to trust, he must oftener take the part of the -disease than of the patient. It is well if sometimes, disconcerted at -the excess of a danger of which he does not understand the origin or -nature, he does not, in default of the head, employ the hand, and engage -the mother in a premature or forced delivery of the child, to the -imminent hazard of the lives of both. Now comes the chirurgical -operation in play; and we shall now see, that the ingraftment of the -surgeon upon the midwife, deserves equally at least reprobation with -that of the physician. - -BUT before I enter on this disquisition, I am to observe, that this -objection to the surgeon’s commencing midwife, does not in the least -attack the merit of that respectable body of men, the surgeons. No one -can honor their profession more than I do: I even readily grant, that -their skill in anatomy is of service to midwifery itself, into which it -throws a great light. It would be easy for me to name, if requisite, -several surgeons, who are not only an honor to their country, from their -excellence in an art so beneficial to mankind, but an ornament to -society, from their extensive humanity and charity. These, I am so far -from thinking, will hold themselves honored by the men-midwives -attempting to make a common-cause with them, that I rather depend on -their bearing witness on the part of the women in this cause, which is -indeed the cause of Nature, of that Nature which they study so -practically, consequently so usefully, and with which they are so -conversant. I am persuaded they can even furnish me with arguments, from -their superior store of knowledge, in supplement to my deficiencies. The -surgeons must look on these professors of midwifery as a kind of -amphibious beings, hard to define, whose claim exhibits rather the -deformity of a preternatural excrescence, or wen growing out of the -chirurgical art, than the becomingness of a natural member of it. Most -of the first founders of this new sect of instrumentarians in this -country were, or I am greatly misinformed, neglected physicians, or -surgeons without practice, who in supplement to their respective -deficiencies, greedily snatched at the occasion at that time of a -prevailing whim in France, of employing men-midwives, with just such a -rage of fashion, as some of the ladies there prefer valet-de-chambres to -waiting maids. This novelty then appeared to practitioners despairing of -business enough in their own way, an excellent scheme for eking out -their scanty cloth with this bit of a border, of which by degrees they -have made to themselves a whole cloak. In short novelty joined, to the -much exagerated objections to perhaps a few insufficient midwives, -brought in and established a remedy yet worse than the disease. Their -success encouraged others; and now behold swarms of pupils pullulating, -and forming on the models before-mentioned. Thus two or three maggots -have produced thousands. Iron and steel are not tender: and yet it was -by the pretended necessity of resorting to instruments made of these -metals, that these out-casts of either profession effectuated their -introduction into a business so little made for them. Then it was, that -not with the least squinting view to filthy lucre, but purely out of -stark love and kindness to the women, that these redressers of wrongs, -armed with their crotchets, and other weapons of death, took the field -on the hardy adventure of rescuing the fair sex out of the dreadful -hands of the ignorant midwives. But as to the validity of that plea of -theirs, of the necessity of employing instruments, I reserve to treat of -it at large in its place in my second part. - -HERE I shall only request the reader to remember, what has been said of -the indecent, superficial, and even cruel method of training up pupils -in this upstart profession. But if I was to add here my having been -credibly informed, that there are novices who watch the distresses of -poor pregnant women, even in private lodgings, where, under a notion of -learning the business, they make those poor wretches, hired for their -purpose, undergo the most inhuman vexation, in a condition so fit to -inspire compassion, and where those scenes must be rather a school of -brutality than of art: if I was to urge, what from the great probability -of the thing I firmly believe, that more than one unhappy creature has -fallen a victim to the rudiments of these novices; that especially not -long ago, one of them in a hurry and confusion of presumption and -ignorance, instead of the after-birth from a woman, tore away, by -mistake, her womb itself, which occasioned, of all necessity, the poor -creature’s dying in unutterable agonies of torture: if I was yet to go -farther and assert, that even not one of the least eminent men-midwives -pulled off the arms of a child in his attempt to extract it, and very -gravely laid them upon the table; what would be replied to me? It would -be said I had invented these horrors, or forged such raw-head and -bloody-bones stories, purely in favour of my own cause. And to this -objection, while I produce no proof, and for my producing no proof other -reasons may be obviously assigned, besides that of those cases being -non-existent, some of which I am very certain are true, and firmly -believe all the rest; to this objection then I say, I make no reply. The -reader, who will have considered this matter, may easily decide within -himself the degree of probability in such allegations. But what -objection will stand good against authorities of reasonings and facts, -produced from the writings of the _men-midwives_ themselves? Will they -be suspected of partiality or aggravation of things against themselves? - -I SHALL here select one of perhaps the most excusable examples from the -circumstances accompanying it, or it would probably not have been -produced by the author a man-midwife, to shew, by the confession of the -men-midwives themselves, the insufficiency of their discernment, whether -a child is dead or not. - -“EDGE-TOOLS and crotchets naturally inspire horror, and though they -_ought_ not to be employed unless on a dead child, it is well known the -mother is not always _safe_ from the effect of them. Besides there are -_no signs_ of the death of a child, though he should have stuck in the -passage for several days ... _certain enough_ to authorize a recourse to -a method which infallibly _kills_ it, if it is not dead before. This is -so true, that whoever will turn over the authors antient and modern, on -this subject, there is not _one_ of them that gives us _satisfaction_ on -this point. On the contrary, they _all_ seem _agreed_ on the -_insufficiency_ of these signs, and there are even _few_ of them who do -not bring examples to support this uncertainty. - -“HERE follows one taken from the observations of Saviard, p. 367. This -author says, that a chirurgical operator, whose name he _prudently_ -suppresses, being sent for in aid of a midwife[9], to extract a child -that had stuck six days in the passage, and which he _thought_ dead, -from several of the signs most essential to conviction, it happened -however, that having opened with his _bistory_ the teguments and -membranes which occupy the as yet unossified space, at the commissure of -the parietal bones with the fontanelle, it happened (said he) that on -opening this place with his bistory, introducing his crotchet at this -opening, and having fixed it in one of the parietals, he drew out the -child, who began to cry _piercingly_, all hurt as he was by so _large_ a -_wound_, that there came out of it more than an egg full of its -_brains_, which made a _cruel_ sight in the eyes of the by-standers, and -a very mortifying one for the operator. - -“IT were to be wished that this was the _only_ example: but I will not -relate any _more_; it is easy to think one cannot be too _circumspect_ -in the matter of such relations. Levret, p. 77.” - -NOW I, who have not the same reason for _circumspection_ in this case, -as Monsieur Levret, with strict regard both to matter of fact and to -candor, _agree_ with _him_, in averring, that this is not the _only_ -example perhaps, by thousands, of the rash resort to the expedient of -_opening_ the head, and extracting the child with the crotchet; an -expedient which, as Dr. Smellie observes, (p. 248.) “_produced a_ -GENERAL CLAMOR _among the women, who observed, that when recourse was -had to the assistance of a man-midwife, either the mother or child, or -both were lost_.” Now of not filling up the cry of those women, I must -own I should be most ashamed. Especially when the good Dr. by way of -curing our fears and _weak_ apprehensions, and of shewing the -nonsensicalness of them, first very gravely tells you the insufficiency -of _all_ hitherto invented instruments, and only modestly concludes, -that the forceps of his own ingenious contrivance, is indeed the best, -but still imperfect. His homage to truth would however not have been so -imperfect as it is if he had said that instruments may be totally left -out of good practice, and that no “_artificial hands_”, as he calls -them, can, in any case, constitute a worthy supplement to the _natural_ -ones; no not even to his own, supposing iron and steel to be ever so -little less tender than his fingers. [10] BUT why do these gentry then -so much insist on the absolute necessity there is of _sometimes_ having -recourse to instruments?——Why? The motive for that insistence is so -transparent, that not to see through it would indeed be blindness. It is -the capital, and perhaps the only plea that has the least shadow of -plausibility for the men to intrude themselves into the women’s business -of midwifery. The women do not pretend to the art of handling those -instruments, and would be very sorry to pretend to it. Nor do those -midwives, who are sufficiently skilled in their art, ever need the -supplemental aid of them: whatever is done with them is as well, and -infinitely more safely done without them: so that the only grounds of -introducing men into that female practice is essentially false. The -making then the surgeons art a pandar to a sordid interest, by the -incorporation of midwifery with it, is, in fact, engrafting on a noble -stock, a scion of another one, both which would bear very well separate, -but, thus joined, can produce nothing but a vile poisonous fruit. - -IF there could be such a thing as laughing in a matter of such general -importance to human kind as the fixing of this point, there could hardly -be any refraining from it, with regard to the conduct of the -men-midwives, especially in Paris. There the novices of them, sensible -of the natural defect there must be in men-practitioners, apply for -improvement to the regular midwives. There is particularly, among -others, one Madam Clavier, who, when I knew her, lived in the Rue de St. -André, that gave lessons, at so much a-head, to the men-students of -midwifery. Yet these same men have no sooner got a smattering of all -that is valuable in the profession, for beyond a practical smattering at -most nature refuses them further progress; they, I say, have no sooner -acquired a little useful insight from these laudably communicative -midwives, but they are the first to swell the cry against them of, “oh -these _ignorant midwives!_”——or “_what can be expected from a woman?_” -And what is more yet, among women it is, that they can make this equally -ungrateful and false clamor prevail. And women, in a point of the utmost -importance to themselves, prove that the men have, in fact, not quite a -wrong idea of their weakness, since they are weak enough to countenance -a notion, that so unjustly dishonors them in every sense. But that is -not enough. What one should imagine, women especially would consider, is -that this notion received with its consequential exclusion of those of -their own sex, tends to have their own pains aggravated, and the safety -not only of themselves but of their so naturally dear children, yet more -endangered. - -FOR the truth of this increase of pain and danger from the practice of -the instrumentarians, it is not to any representations from me only, who -may be supposed too interested a party, but to reason, and even to -reason’s best mistress, Nature herself, that I appeal. I appeal even to -the very writings of the most celebrated men-midwives themselves, to -which I would refer all who are sincere enough with themselves to be -resolved to embrace truth when discovered to them. It is then even in -the writings of those men-practitioners, that a lover of truth might -find enough to satisfy himself, that all the mighty pretences of the -men-midwives to superiority of skill and practice to the women are false -and absurd. Look into _Deventer_, _Peu_, _La Motte_, _Mauriceau_, -_Levret_, _Smellie_, &c. and you will find that, except their accounts -of the _innocent_ manual function, in which midwives must so much excel -them; except _their_ pernicious practical part, on which they so -tediously insist, by way of recommending each some particular instrument -that is to _usher_ him into employment, and increase his profit, in -which noble view he takes care to decry the instruments of all others, -or at least prefer his own; except the scientific jargon of hard Latin -and Greek words, so fit to throw dust in the eyes of the ignorant, and -give their work an air of deep learning; except what they have pillaged -from regular physicians and surgeons, who have treated upon these -matters: except in short all the quacking verboseness of the various -histories of their exploits and deliverances of distressed women, and -you will find the merit of their whole works shrink to little or -nothing, under the appraisement of common sense and true practical -knowledge. The most that you will find in them, is, hard or lingering -labors, oftenest precipitated fatally to the mother, or at least to the -child; they hardly, you may be sure, carrying their candor so far, as -always to mention when it has proved so to _both_; of which however the -tenor of their practice with instruments gives you but too much room to -presume the probability. In short those cases, of which their works are -chiefly patched up, are little better than so many quack-advertisements; -and their best exploits therein recounted not a whit preferable; nor -indeed so practically just, as what would appear in the common daily -practice of a regular well-bred midwife, that should keep a register of -her deliveries. There might not indeed appear so much anatomy in her -descriptions, but, I am very sure, there would be couched in them much -more solid instruction. Not that I therefore have not the highest -deference to the true physicians, the true surgeons. But as far as I can -presume to judge, it is not in the works of the men-midwives, that the -best lights in midwifery are to be looked for. They are themselves for -every thing that is worth reading in their writings indebted, both to -the physicians and surgeons, whose arts they have despised enough to -think, they may be well enough learnt collaterally and subordinately to -the mechanical operation of midwifery, as well as obliged to the -midwives, to whom they _ought_ at least to go to school, tho’ sure to -rail at their _ignorance_ the minute after being taught by them. In -short, the most valuable lights thrown into this subject are undoubtedly -furnished by those great men Boerhave, Haller, Heister, the great -Harvey, and other the like excellent physicians and surgeons, not one of -whom however, I presume, in the way of making a trade of it, ever -delivered a woman in his life. - -NAY! was any accident requiring a chirurgical operation to befall a -pregnant woman, I should think the application would be more safely made -to a thorough regular-bred surgeon, than to one of the common run of -these men-midwives; and the exceptions are so few, they are hardly worth -making. The reason too for such a preference is obvious and natural. A -regular surgeon probably would not only be more consummately skilful and -expert in his general notions, both theoretical and practical, so far as -surgery was in the question, but would not, from any thing only -_partial_ in his profession, have the same temptation of bringing into -play a horrid apparatus of murderous instruments, to show the importance -and utility of that anatomical midwifery of theirs, all the art of which -consists in the violences it offers to Nature. What would be to be done, -the true surgeon could hardly do worse than the pragmatical man-midwife, -and most probably would perform it much more artistlike, except perhaps -in the sole point of striking a crotchet into the brain-pan of a -live-child, or needlessly tearing open, with iron and steel, parts so -tender and so delicate, as hardly to bear the touch of even the softest -hand, guarded with all precaution. He would not, in short, be so forward -to use means destructively dangerous to both mother and child, and at -the best often to ruin a woman for being a mother for ever after. - -UPON the whole then, if any one will dare give his own understanding -fair play, against the powers of prejudice and interested imposition, it -cannot but, on a fair examination satisfy him, that that strange -anomalous complex creature of the three arts, physic, surgery and -midwifery, is most likely to excel in neither. IT may by great chance be -an indifferent physician; IT must be in this respect a dangerous -surgeon, but IT can never be any thing but a despicable midwife; or if -that favorite name of _accoucheur_, IT is so fond of assuming, should -not be popular enough from its gallicism, let IT change it for the Latin -one of _Pudendist_: a word of not one jot a more pedantic coinage than -_Dentist_, or _Oculist_, but of which moreover the propriety of the -sound may somewhat atone for the pitiful play of words it contains, and -which can yet scarcely be more pitiful than the object of its -application. - - - OBJECTION the Twelfth. - -IT is not probable, that the men-practitioners would have come into the -vogue in which we see them, if numbers of instances were not to be -produced in their favor, of their having terminated happily many labors, -in which they have been preferably employed, and to the exclusion of the -midwives. - - - ANSWER. - -THIS only proves, what none in their senses will deny, that the greater -part of the cases of labor are so mild, that not even that faultiness of -the men-practitioners, which is palpably owing to an incurable -imperfection of Nature, not, in short, all that is bungling or deficient -in their preliminary disposition and manual operation, can absolutely -frustrate the kindness of that Nature, of which these intruders are not -ashamed of assuming the honor. But that inference of the men in favor of -themselves is as ridiculous as it is false. In those cases of labor, -which are much the less frequent, and require no extraordinary -assistence, the utmost of the real merit of these bunglers is only of -the negative kind: that is to say, they have not destroyed the mother -nor the child; and indeed, every thing considered, great is the praise -to them thereof. It is not always, even in naturally easy labors, that -the women who employ men to lay them have not a harder bargain of them. - -BUT even in these propitious labors, the mischief done to a lying-in -woman, by employing of a man to the exclusion of a midwife, is not a -small one, if pain is an evil, and the lessening that evil a desirable -good. For certainly there can hardly be a case of lying-in supposed, in -which some _labor-pains_ are not felt. The bringing forth children in -pain, stands hitherto the irreversible decree of nature, from which few -women can promise themselves a total exemption. But these pains, if they -cannot be entirely spared, to the lying-in woman, will always admit of -actual or preventive alleviation. That alleviation can be no -inconsiderable object to women, who are by their nature so tender and so -impatient of pain. Even then in the prospect and presence of the very -gentlest labors, there are two natural points to be respectively -attended to. The one is the predisposition of every thing, according to -art, so as to render the expected labor-pains as moderate as possible. -The second is in the manual function, at the actual crisis of the -delivery. Now, in both these points, for reasons above-deduced of the -superior aptitude in women derived to them from Nature herself, a woman -may reasonably depend not only on a more simpathizing cherishment, but a -more efficacious assistence from those of her own sex. There are a -thousand little tender attentions suggested by nature, and improved by -experience, that a midwife can employ both preventively and actually to -the mitigation of her charge’s pain; attentions which, if even they ever -entered into a man-midwife’s head, could not be accepted but with -repugnance, I will not say only by a modest woman, but by any woman at -all. And the truth is, that there can be few men in the world, but what, -the more tender lovers they are of the women, but must be only the more -disgusted, the more impatient of the midwife’s preparatory part of her -office, which is however the most important one, both as to the -prevention of pain, and to the safety of the delivery. - -BUT even where those preparatory offices have been omitted, or at best -perfunctorily performed by a man-midwife, and where the actual function -in the crisis of labor has been deficient, or at best indifferent, the -labor may still have proceeded, and the patient delivered with only more -pain, than she would probably have suffered under a good midwife’s -hands. What follows then? Why this; that the patient in the transport of -joy at her delivery from pains which are hardly ever but great, even -though much less than her fear had magnified them to her; instead of -gratitude to that Nature, which can constitute to her only a vague -object of the mind, her weak imagination gives to the assistent -man-midwife, a more palpable being, as he is of flesh and blood, the -merit of a deliverance, in which he had most probably no other share, -than its being his fault that it was not yet less painful than she has -found it. But this is not at all. What sounds towards a paradox, and yet -is strictly true, is, that the more pain the patient has endured, -through the man-midwife’s fault, the greater will her gratitude be to -him. The reason is as obvious as it is natural. Herself not knowing, nor -having perhaps any idea of what ought to have been done for her more -perfect relief, she will have no conception that the man has omitted any -thing: she will give him credit for what he has _appeared_ to do for -her; and measure her sense of acknowledgement by the pain from which she -will suppose he has helped to rid her; and in her joy at her delivery -would think it even an ingratitude to listen to suggestions from others, -or even from herself, that should tend to diminish, explain away, or may -be reduced to less than nothing, the benefit she so vainly imagines was -his work. - -YET nothing is more true, nor indeed more likely to be true, than that -besides the natural pains of labor not having been obviated by a due -preventive method of assuagement; besides their having been unskilfully -attended to in the article of the delivery, through the natural -unhandiness of the men-midwives, it does not unrarely happen, that their -defective practice, not only occasions to the women much greater pains, -but even much greater danger than would probably have been the case, I -will not say if a midwife, but even if Nature had barely been left to -herself, that is to say, if nature had been neither injured by a clumsy -aukward attempt to help her, nor injudiciously interrupted, nor -prematurely forced or cruelly hurried. The patient is however delivered, -and delivered so that, if she was better informed, or less blinded with -joy, instead if thanking the operator, to whom she attributes her -deliverance, she would have to impute to him all the increase of pain -she had unnecessarily suffered, all the increase of danger of which this -man so thanked was himself the author. Then it is, that even in a -subject so serious, a judicious by-stander might give himself the comedy -of observing the airs of consequence, which an operator assumes for a -woman under his case _not_ losing the life, of which but for him she -would most probably _not_ have been in the least danger. Thus a man, -whose all of merit well weighed, is no more than not having been able to -consummate the destruction of mother and child, in spite of the kindness -of nature, shall for that negative merit be allowed the positive one of -having performed wonders of art. Then it is that the mother naturally in -a rapture of joy at her deliverance, in which she never remembers but -with a gratitude, of which she only mistakes the object, by paying to -the operator, what in fact was due to nature; then it is, I say, that -the mother, father or parties concerned, for want of making due -allowances in a point they are so excusable for not understanding, -cordially join the self-applause of the man-midwife. Nor does it -unfrequently happen, that one of these instrumentarians, after an -operation, for which he deserves the severest censure, and of which, -whatever necessity he had to plead was originally owing to his own -unskilfulness or omission, shall strut about the room, and florishing -his butcher’s _steel_, sing an _Io Peean_ to himself, “_for that his -victorious art had saved nature as it were by enchantment_”[11]. Then it -is, that in full chorus the deluded parties, in the innocence of their -heads and hearts, hold up their hands to heaven, and piously exclaim, -“_what a narrow escape the patient had, thanks to the learned Dr. and -what a mercy it was she had not been trusted to such an ignorant -creature as a midwife must be_.” - -THIS folly has even sometimes gone so far, that when a woman has, -through a man-midwife’s mispractice, suffered perhaps a wrong, so deep -as to be disqualified for ever after for being a mother, or had a fine -child, literally speaking, murdered (_secundum artem_ indeed) he has, -what with scientific jargon, through the cloud of which it was -impossible for persons unversed in the matter to discern the truth, what -with an air of importance, and what with especially her own weak -prepossession in favor of the superiority of men to women-practitioners, -known how to impose on her the most atrocious injury for so great a -service as that of saving life is for ever held. The deceived patient -then thinks she cannot thank him too much, nor reward him sufficiently -for what he could be scarce punished enough, if proportionably to the -mischief he had done; and to which his mis-representations have perhaps -even made herself innocently an accomplice. - -THIS indeed is easily to be accounted for. A pregnant woman must -especially, in the moment of her labor-pains, think herself too much in -the power of the operator, to whom she has trusted herself, to dispute -his judgment. She may even, and that is probably oftenest the case, have -too good an opinion of it, to dispute it. Her labor is severe, and, as -before observed, severe, or at least the more so, very likely from some -fault of his. Her deliverance lingers; Nature, from some vice of -conformation, or defect of art in her assistent, appears faint, remiss, -insufficient, in short, in her expulsive efforts; in the mean time, the -pains of the patient grow more and more intense and intolerable: the -man-midwife, either perplexed or impatient, or not knowing what better -to do, has recourse to those fatal instruments, with which the odds are -so great, that he will gall, bruise, or irreparably wound the child, or -the mother[12]. In some cases indeed, he may take the dreadful advantage -of the mother’s agonies of pain, to use those instruments, and do her a -mischief she may not just then feel, from the pain of the operation -being absorbed in the greater one; to use them, I say, unobserved by -her[13]. - -BUT where the exigency appears yet greater, where, in short, the -operator imagines, as he too often imagines such an extremity where it -does not exist, as that either the mother or the child must perish, it -is his maxim, and certainly a very just one, to consider the mother’s -safety, as the preferable object. Of this preference then he makes a -merit, so much the more acceptable to the mother for her own -self-preservation being so palpably concerned, and so much the less -disputable for her not knowing but he may be in the right, as to the -reality of the fatal dilemma. In such a doubt, if nature takes the part -of the child’s life, which is at stake in the decision, she also much -more strongly and reasonably takes the part of the mother’s own -existence in the mother’s own breast. She cannot then deny the -premisses, of which she is no judge, when the inference is not only in -favor of her life, but even a very just one upon the admission of those -premisses. The temptation also of a quick riddance from a violent state -of pain, is too great a temptation for a weak woman, overpowered with -her actual feelings in that rack of nature, to resist: she acquiesces -then, or perhaps her husband, her friends, equally ignorant with herself -of the truth of things, and duly simpathizing with her in her impatience -of her longer suffering, even virtuously, even piously acquiesce in the -recourse to these instruments, which are so sure of destroying the -child, and hardly ever fail of doing the mother great and sometimes -irreparable mischief. - -WHEN then the child has been destroyed, the mother damaged; in -satisfaction for all this tragic-work, what have you but perhaps the -learned Doctor’s assertion, “[14]_that if this force had not been used, -the mother must have been lost as well as the child_.” - -NOW granting what is the utmost that candor can be expected to grant, -that in but the doubt of the mother’s life, it is right to sacrifice the -life of the child to that doubt, and much more to the certainty of the -mother’s life not to be otherwise saved, than by these fatal -instruments, I beg and entreat all fathers and mothers, or who are -likely to be so, to consider with themselves whether: - -IN the first place, an experienced midwife is not more likely to prevent -such an extremity by previous management, proper anticipations, and -actual handiness during the labor-pains, than the aukward -man-practitioner (as most of them evidently are) who must, naturally -speaking, be so much her inferior in those points of her art, which -conduce essentially to the smoothing the way for, and effectuating a -delivery; and from the defect of which points that necessity which, is -pleaded of a recourse to instruments, originally takes its rise. So that -in fact they who are the authors of the danger, pretend to remove it, -and how? by an evil only inferior to death itself, from which however -those are not always safe, to whose safety so much is sacrificed in -vain. - -IN the next place, it may well be recommended to consideration, whether, -as the _common methods_[15] confessedly allowed by the men-midwives to -be the _preferable_ ones, since the recourse to instruments is not even -by them _allowed_, until the _common methods_ are exhausted, there is -not great reason, without breach of charity, to imagine that the natural -unfitness of the men for the _common methods_ does not determine -especially the common men-midwives to an over-hasty recourse to the -_extraordinary_ ones, and make them see very _dangerous symptoms_, where -they are no better than phantoms of their own creation; so that by their -eagerness to embrace them for an excuse, they lose to the patient that -benefit of patience in general, which Dr. Smellie himself allows in a -particular case[16]. To which patience the midwives are so much more -inclined than the men, as indeed they may well be, since, should that -even be exhausted, they have no instruments to fly to for the abridgment -of a labor: and where they understand their business, not only every -thing is best done without them, but the want of them is prevented. - -BUT besides the common motive of impatience in the men-practitioners for -resorting to that dangerous expedient of making short work, of which the -women are unhappily incapable[17], or at least which the good artists -among them hold in the contempt and detestation it deserves; are there -no other motives from which recourse may be had to the instruments? I -have hinted at some: but as the matter is of infinite importance, from -the use made of these instruments, in introducing men into the practice -of an art so appropriated to the women, it cannot but be of service even -to the public, to discuss the justice at least of some of those hints, -and examine whether there is any farther foundation for my fears, that -the precipitancy of the men in their resorting to instruments, or to the -prematurely forcing a delivery, to the utmost danger if both mother and -child, whether, in short, the pretence of extremities may not, in some -cases, have even other causes, than a natural incapacity for the _common -method_, an ignorance of better practice, or their impatience. - -I HAVE before remarked what I here repeat, and repeat it without the -least apprehension of being justly taxed with breach of charity, that a -mere sordid view of lucre, of supplementing, in short, deficiencies of -success in other professions, was originally the foundation in this -country of that novel sect of men-midwives, which we have in our days -seen so much multiplied. If any can imagine that the instrumentarians, -with their crotchets, their forceps, and the rest of their iron or steel -apparatus, had more in view the relief of the distressed females, from -the dangers to them in the ignorance of the midwives, than they had -their own interest, in the stepping into the place of those they so -injuriously decried; if any, I say, can believe that sheer humanity, and -not sordid gain, was their view, I can only pity a credulity, that must -proceed more from a goodness of the heart, than of the head. But to -whoever will deign to consult his own reason, exercised upon facts and -the nature of things, may easily satisfy himself, that interest, and -interest only, inspired and actuated these intruders into a province so -little made for them, of which there can hardly be a stronger -presumption than the very recommendation of instruments, of which not -one of them but must know the perniciousness, though they make it the -capital handle of the introduction of themselves. Not one of them but -rails at them, and uses them. Now, as I may safely take it for granted, -that interest is at the bottom of this innovation, where that same -interest is the principle, it will hardly be denied me, that it is -generally speaking the leading or the governing one. It is rarely -contented with acting a second part. It often exacts sacrifices, but is -rarely itself one. All the actions and procedure of its votaries take -the tincture of it. Humanity and all the virtuous or tender passions are -either totally excluded, or exist with little or no efficacy in a heart -enslaved by interest. - -In virtue of this reasoning, and I should be much more glad of finding -myself mistaken (knowingly I am sure I am not so) than that it should be -but too much verified by matter of fact, I shall here submit a case to -the reader for his own decision on the probability, and I dare swear, -that among the female readers especially, I may chance to have, there -will be more than one, who, on her own personal experience, could attest -the existence of such a case, or at least has the strongest grounds of -presumption of it. - -A WOMAN then, lingering in a severe labor, and urged by her pains -naturally to wish the speediest end of them, is yet by another superior -promptership of nature desirous of meriting the sweet name of mother, -and is inclined of herself not to think it over-purchased by a little -more patience. In this crisis, much must depend on the judgment, and -consequently on the advice of the assistent practitioner, male or -female. If a midwife, besides the tenderness constitutional to her sex, -her natural fears for the mother especially, not without a due share of -concern for the child, where there is a possibility of saving it without -too great a risk to the parent, besides the superior execution of her -art in points of the manual function, she is moreover bound in all duty -to see one labor come to its issue before she undertakes another; for -the sake of which, she cannot well, if she would, without instruments, -prematurely force a delivery by such violent, dangerous and so often -destructive means. She will then in course encourage and inspirit her -charge with patience, and use all the blandishments, soothing methods -imaginable to comfort, relieve, and strengthen the resolution and spirit -of the lying-in-woman. Now, a man-midwife, _well paid_, will perhaps in -that cold unaffectionate manner, with which a duty that has no -foundation but in interest is ever performed, exhort to endurance that -patient whom his dexterity is insufficient to relieve, that patient -whose pains are perhaps for the greatest part his own fault. But should -he, during some lingering labor, be called elsewhere, to a more rich -employer, or should one from whom he has greater expectations, require -an attendance from him incompatible with his duty to his prior employer, -is not here a temptation to make a quick dispatch with his instruments? -A temptation to which it is at least doubtful whether a man, actuated by -interest, may not be over-inclined to yield. It may even byass him, -without his perceiving it himself. A man’s determining motive, when it -is not of a very justifiable nature, is often skreened even from himself -by a more specious one. Such, in the present case, is the saving the -mother, oftenest by destroying, and sometimes by only galling, bruising, -or maiming the child, when the mother rarely escapes her share of the -suffering. How many mothers have pathetically interceded, and interceded -in vain, for a respite of execution, when the operator has in a -peremptory tone cut short their instances, by telling them in a -magisterial way, that he knew best what to do, and could not answer for -the patient’s life, if the operation was longer delayed! What reply has -a poor woman, weak by nature, oppressed by pain, and subdued by her -prepossession to oppose to such an argument of necessity, of which her -own life appears to be the favored object? What husband, what friends, -but must unhesitatingly subscribe to so just a preference as that of the -mother and the child? Not that I would insinuate here, that such a -dilemma does not sometimes though certainly very rarely exist: but is it -not to be feared, that it is too often rather lightly taken for granted -that it does exist? May it not be presumed, that the instruments are -brought oftener into use than is necessary, for the sake of a dispatch, -of which the child is almost ever the victim, and not unseldom the -mother herself, who is always hurt, and sometimes irreparably damaged? -May it not be justly suspected, that the abuses of Art have occasioned -to many women an appearance of barrenness, from the reality of which -kinder Nature had in fact exempted them? - -BUT as if ignorance, inability, impatience, interestedness, were not all -of them sufficient motives for the forcing use of these instruments, Dr. -Smellie has unmeaningly added another, which alone must, to the greatest -number of the men-practitioners, prove a greater excitement than all the -others put together, if it be true, that Vanity has so great a -predominancy over the human heart as it is generally imagined to have. -But let us first quote him: the inference will follow. - -“(P. 265.) _at any rate, as_ women _are commonly_ frightened _at the -very_ name _of an_ instrument, _it is adviseable to_ conceal _them as -much as possible_, untill (mind pray that UNTILL) _the_ character _of -the_ operator _is_ established.” - -(P. 273.) “_Though the_ forceps _are covered with leather, and_ appear -_so_ simple _and_ innocent, _I have given directions for_ concealing -_them, that_ young practitioners BEFORE _their_ characters _are_ fully -established, _may avoid the calumnies_ and _mis-representations of those -people who are apt to prejudice the ignorant and weak-minded against the -use of any instrument, though never so necessary, in this profession; -and who taking the advantage of unforeseen accidents which may -afterwards happen to the patient, charge the whole misfortune to the_ -INNOCENT OPERATOR.” - -HERE I appeal to every reader of common-sense, to every reader who knows -any thing of the human heart, whether it can be imagined that any -man-midwife, who is called in to the aid of a lying-in woman, will -choose to appear in the character of a _young practitioner_, or of such -an one, as that his _character_ is not enough _established_ to _dare_ to -use instruments, for fear of after-reflexions. Is not there, if but in -this lesson of the Doctor’s, couched a strong temptation for a -man-practitioner not indeed to produce openly and barefacedly his -apparatus of instruments, but to be very uncautious of concealing them? -Since the reason for concealing them, that of the women being apt to be -frightened at them, stands coupled with another reason, the fittest in -the world to work a contrary effect to both; by piquing the vanity of -the operator to suffer them to be seen, and what is worse yet, to the -using them only that they might be _seen_, especially if to this motive -of ostentation you add, that if these instruments being the very _grand_ -and _capital_ point of their imaginary _superiority_ to the -women-practitioners; over whom every occasion of using them seems to the -men a kind of triumph. - -BUT while it is to the novices in the art, that Dr. Smellie recommends -more especially the concealment of these same terrifying instruments, -the good Dr. does not seem aware, that an advice much more honest and -humane might be given to the women, for whose _benefit_ the instruments -are supposed to be invented, which is, not to employ _young -practitioners_ or novices, not in short to employ those whose character -was not _fully_ established, since they might, in order to pass for -adepts, or at least for no novices, be too apt to embrace occasions of -florishing those same instruments with less necessity, if possible, than -the _great men_ themselves of the profession. - -IN the mean time, this curious injunction to the _young_ practitioners, -while the _old_ ones are by that distinction implicitly allowed more -openness in using the instruments, reminds me of the caution of the -Regent-duke of Orleans, who taking monsieur de St. Albin[18], a natural -son of his, that was in priest’s orders, to task, for some -irregularities, of which certain bishops had complained, said to him in -their presence, “_Sirrah, could not you stay till you were a bishop?_” - -BUT whatever may be the motives of recourse to instruments, and there -are other possible ones which I have omitted, certain it is, that in -this nation they are more frequently employed than even in France, where -that pernicious fashion first took birth. And yet in this very nation it -is, that the men-practitioners themselves own, that the less they are -used the better. Now will they, to solve this contradiction of their -practice to their doctrine, plead that the labors of the women here are, -in general, more difficult than they are in France? Common sense and -truth will however furnish a juster solution: men-midwives are more -employed _here_ than in _France_, where the women-practitioners are -still respected, and less driven out of practice, consequently -instruments are less frequently used. For I will not pay the -men-operators of this country so ill a compliment, as to excuse them, by -saying they are less dexterous at the manual function than those of -France, and therefore the more obliged to have recourse to those -instruments, of which they themselves have so ill an opinion, though -indeed not a so thoroughly bad one as they deserve. - -IN the mean while they may well proceed triumphing in their career, -notwithstanding all the fatal trips they make in it, while, if they did -not even run it in the dark, they have so much learned dust ready to -throw into the peoples eyes whom it is so much their interest to blind. -No wonder then, that since, in the more severe cases, in the -preternatural labors, they so often receive from well-meaning employers -both pay and thanks for the greatest mischiefs, owing to their errors -both of omission and commission, they should, in the less difficult, and -which are by much the most frequent ones, where no tragic accidents have -happened, have credit given them for a merit, to which their pretentions -are so little examined. For this they are indebted to the overflow of a -gratitude at a loss for a living object and from an impatience of doubt -mistaking that object so grosly, as well as to that same prepossession’s -continuing, from which they were preferably employed. Hence it is, that -one might often hear women, who had not even suffered a little by their -practice, from the want of knowing, that by their practice it was they -did not suffer less, very sincerely say, “_Dr. such an one attended me -in my lying-in —— He delivered me very well._” —— Or, “_I have been lain -for four or more children by a man-midwife, and never had room to -complain._” All which proves no more than what may very well have -happened, that Nature has been too favorable to them, for even the -untoward assistence of a man, in the office of a midwife, entirely to -frustrate her beneficence. I do not here add the weight that _fashion_ -throws into the scale of prejudice, reserving to treat of that -separately. - -BUT to that conclusion in favor of the men-midwives, from the supposed -superiority of their success to that of the women-practitioners, -contained in the objection I am now answering, I have further to oppose -an argument drawn from _matter of fact_, to which I should imagine it -difficult to find a satisfactory reply. This argument then consists in a -fair appeal to Experience herself. - -I HAVE before observed, that in the Hôtel-Dieu at Paris, there are no -men-practitioners suffered, for I do not include the surgeon-major, who -is absolutely no more than an officer for the form-sake. Consequently -there are no instruments ever employed in the delivery of the women -admitted to that hospital. It is true they are extremely well taken care -of; all necessaries are found them by that noble charity; but yet it -cannot be thought, that the same abundance of ease and conveniences can -be afforded, as by those persons, generally speaking, who employ -men-midwives. This distinction I mention for the sake of the allowance -justly to be made in the calculate I am about to propose. -Notwithstanding however the superiority in this point on the side of -men-midwives practice, notwithstanding the grief of mind from various -causes, as well as the bad constitution of the bodies of many of those -indigent wretches, prior to the reception into that hospital, -notwithstanding other easily conceivable disadvantages; notwithstanding -all these, I say, take any given number of patients, delivered purely by -the midwives of that hospital, without the intervention of one -man-practitioner, and especially without instruments, and to that given -number, oppose an equal one of women attended from the first of their -labor to their delivery by the men-midwives, and see on the side of -which sex, in the operators, there will be found the greater number of -those who shall have done well, or suffered least. - -I AM the more emboldened to propose such an experiment from my own -certain knowledge. I have seen more than two thousand women delivered -under my eyes, at the Hôtel-Dieu at Paris, some of whose cases must be -readily imagined to have been severe or preternatural ones. Yet all of -them were delivered by our midwives and apprentices without the aid of a -man-practitioner; nor an instrument so much as thought of. And in all -this number I can safely aver, there were but four who died upon their -lying-in; and that not from any fault of the midwife’s art; but one from -the complication of a dropsy, the other three, who were daughters to -honest tradesmen, sunk under the shock of grief and shame at the being -deserted by the men who had brought them into that condition. They died, -in short, of their desire to die. Yet the children all did well. - -THIS is a fact that does not require the being believed upon my word. -The known practice at that hospital, and the registers regularly kept, -will attest the truth of this computation. And here, I appeal to every -intelligent reader’s own sense, to his own knowledge of things, whether -it is unfairly presumed, that in the same number of two thousand women, -delivered by the men-practitioners, they could show a roll so innocent, -so free from fatal mischief or damage to their patients, to mother and -to child. Let any parents, or who may hope to be parents, or are -concerned but for the interest of mankind in population, weigh but the -force of this argument, purely drawn from a matter of fact, of which -there can be so few who are not, in some measures, judges enough to -decide upon their own knowledge, or at least on strong grounds of belief -or conjecture. In such a number as two thousand women delivered by the -men-operators, how many, by what I know, and by what many others must -know as well as I, must have perished, or been torn, ruptured, -grievously hurt, or irreparably damaged! How many innocent infants must -have lost their little lives, in proof of that superiority of practice -in the men to the women! Or rather, in proof of that infatuate -credulity, which has prevailed in favour of an innovation so -unauthorized by nature, by common sense, or by experience! - - - OBJECTION the Thirteenth. - -SAY what you will, the fashion will predominate. It is now the fashion -to prefer men-practitioners of midwifery to midwives. You will oppose -the torrent in vain. - - - ANSWER. - -THE conclusion against me that I shall oppose the torrent in vain, is a -very just one. As to myself, I ought to expect that I should oppose it -in vain, if the decision of the public was to turn upon any thing of so -little authority as my private opinion, especially in a point where it -is so justly liable to the suspicion of its being byassed, both by -private interest, and partiality to my own sex. I readily then grant -that my own opinion should go for nothing. But what ought to go for a -great deal is my reader’s own judgment, formed upon his own reason and -knowledge. But that is not all. I have some dependence on Nature and -common sense recovering their rights, from this preference of the -men-midwives which shocks both, being, in truth, nothing more than a -fashion, not even of the growth of this country, but transplanted from a -neighbouring one, whose follies are unhappily so contagious, though for -the most part so despicable. How a few interested men, for want of -business in their own professions, transplanted this baneful exotic -here, where it has met with such undue cherishment has already been -touched upon. - -BUT then as this unnatural preference has all the folly and whim of -fashion in it, it may be hoped, that it will also have all the -instability and transitoriness of one. Time that confirms the dictates -of Nature destroys the fictions of opinion. But in points where Nature -is herself attacked or injured, inconveniencies and damages never fail -of following thereon, enough to oppose the duration of them. The numbers -of lying-in women (thanks to beneficent Nature) rather not destroyed -than duly assisted by the men-operators, can neither atone for those who -perish, sometimes the mother, sometimes the child, sometimes both, while -none of them are but sufferers in some degree; nor long blind a public, -that has so much interest not to be imposed upon in a matter so -essential to it, by false pretences, or by an injurious and interested -degradation of the midwives, who at the worst can hardly be so bad as -the very best of the men, in the capital point of their business, the -manual function. The oftenest greater _danger_, and always the greater -_pain_, under men-operators than under the midwives hands will, sooner -or later, determine the parties concerned to open their eyes on their -greatest interest, in a point of such infinite importance to them. - -GRANTING then to Fashion all the power it really has, and a greater one -it is, than for the honor of human kind, can well be imagined, still, it -not only has its limits of extension, but duration. It is only for the -truth of Nature to be universal and eternal. - -FASHION, it is true, may not only govern people in indifferent matters, -such as dress, furniture, equipage, or so forth, but even in essential, -even in capital ones, such, for example, as is this point of option -between the men-operators and the midwives: it may, in short, exert its -tyranny in many things, one would rather think left better to the -determination of REASON. But then this tyranny cannot well be -long-lived. The evils which such a fashion begets destroy at length -their own parent. No opinion then, as I have before observed, can be -permanent that is not founded on the truth of Nature: but where the -consequences of such an opinion are detrimental to the good of society, -which is the darling object of Nature; that spirit of self-preservation -which she has so manifestly diffused thro’ human kind, will hardly -suffer errors pernicious to it long to subsist. There is no fashion can, -under such objections, long hold out against victorious Nature, who is -sure to revenge the violences offered her. - -AND here I even officiously seize on an occasion that rises to me out of -the very bowels, I may say, of my subject, of selecting for one proof of -the danger of adopting innovations offensive to Nature, a point of such -near analogy to midwifery, as that of nursing children, the care of -whom, next to that of the mothers, is the true midwife’s tender -province. - -I wish then that those, who too readily admit that this so recent a -fashion of employing men-midwives preferable to female ones, is an -improvement receivable on the foot of its supposed advantage to human -kind, would consider a little the actual consequences of having flown in -the face of Nature with respect to the bringing up young children, in a -way scarce more foreign from her dictates, than that of _men_ delivering -_women_. That women are by Nature herself formed for the office of -aiding women in their lying-in; that they are also formed to bring up -children by the breast, are two parts of their destination by Nature, -which in all ages, and in all countries seem to have born little or no -controversy. Interest has lately invaded both these provinces. With this -difference, that as to the first, that of women supplanted in their -business of delivering women, an active interest has prevailed; as in -that of denying the female breast to children, it is a purely passive -one[19]; and we shall soon see what a dreadful effect this sacrifice of -Nature to interest has produced. - -AS to the mischief produced by the other, of the implicitly excluding -the women from midwifery, by the power of prejudice and fashion, it is -not, as yet, of a Nature for obvious reasons quite so susceptible of -proof, though most certainly not the less therefore existent. And that -mischief is palpably owing to the gain which the men-midwives find or -presume in the exercise of that profession. This is the active interest: -that end to which the means give so justly the construction of base and -sordid. The rich are the object of this wretched imposition, which will -probably last so much the longer, for the interest to be found in -imposing upon them. - -BUT for the denying the female breast to children; it has not indeed -passed hitherto into a tenet, that children may as well be reared by the -spoon as by the breast, because there is not that prospect of the place -of a _dry-nurse_ being as lucrative as that of a _man-midwife_. If it -was so, I should not dispair of seeing a great he-fellow florishing a -pap-spoon as well as a forceps, or of the public being enlightened by -learned tracts and disputations, stuffed full of Greek and Latin -technical terms, to prove, that water-gruel or scotch-porridge was a -much more healthy aliment for new-born infants than the milk of the -female breast, and that is was safer for a man to dandle a baby than for -an insignificant woman. - -AS this unnatural treatment then of children is almost entirely as yet -confined to the very poor, that is to say, to new-born babes thrown upon -the public CHARITY for their SUSTENANCE, the rearing by the spoon is not -yet regularly established as a general _doctrine_, it is only admitted -in PRACTICE! As _proper_ wet-nurses, from the difficulty in procuring -them, might be _dearer_ than dry ones; the _cheapest_ method is -preferred, and forms a kind of passive interest or saving œconomy. - -BUT what are the consequences of this violation of Nature, in the -grudging her peculiarly appointed aliment to these poor little -candidates for life? What follows the substituting, for cheapness-sake, -such food as is meant to be afforded them, and is perhaps sometimes even -not given them? Death. Death with all that cruelty of torture that -attends atrophy or inanition. Thus perish these miserable victims to the -false opinion, that the course of Nature can be changed with impunity. I -have said here false opinion only, because, with all the obduracy of -heart that the spirit of interest so notoriously creates, with all the -crimes it so often produces, I cannot think, that such an horror, as the -murder of so many innocents, can be entirely imputed to interest without -ignorance coming in for its share, though interest has doubtless -contributed to the so long continuance of it. - -IF that maxim is not a false one, that he who knowingly suffers an -innocent person to perish, and can help it, is actually guilty of -murder: and I prefer here the term of guilty to that of accessary; -because I am told, that where there is guilt of murder, all are in the -eye of equity and law, principals. Ignorance then, of the sure murder of -these innocents by their method of treatment, can be the only plea for -those to whom the national charity had committed the care of them. I -should think too, that even I myself sinned against charity, if I did -not believe, that there is none of those trustees of the poor children, -that would not shudder at the thought, of himself taking an infant up by -the leg and dashing its brains out against the wall. And yet that would -be balmy mercy, the dispatch considered, compared to the lingering -tortures, in which those poor little creatures must expire, in the -common way of parish-nursing. What is certain however is, that Death -would scarce more assuredly be the consequence of the child’s brains -being at once beat out, than of that impropriety of aliment, which in -the mildest construction is owing to an error in opinion or belief, that -any aliment could be salutarily substituted to the one dictated by -Nature. - -I HAVE here mentioned barely impropriety, or sometimes negation of -aliment, without allowance for other causes of destruction to those -infants, such as cold, bad air, uncleanliness, neglect of due -attendence, or deficiency, in short, of requisites, which are not to be -expected from the very poorer sort of the people, to whom the rearing of -those infants is generally committed. But that omission of mine is -neither undesigned nor unfair. I presume I shall have the greatest -physicians on my side, in averring, that even new-born babes are endowed -with a surprizing hardiness. Their little seemingly so delicate bodies -bear cold to a degree scarcely credible, but from the commonness of both -observation and practice, that they only thrive the better for -immersions in cold water. Cleanliness, a good air, and attendence, have -doubtless indeed some share in the well-doing of children of that age: -but all together are in no degree of comparison to the importance of -bestowing on children their appropriate aliment. The physical -disquisitions into the reason of this do not belong to me here: nor are -a few instances of infants reared by the spoon any valid justification -for breaking the general rule of Nature, assigning to the female breast -the nutrition of children: of which too there is this salutary -consequence, that in the very act of lactation there is, by Nature, -generated such an indearment of the suckled child to the nurse[20], as -that she who began it perhaps only for hire, finds herself engaged by a -growing affection to supply in some measure the place of the mother to -the orphan or deserted babe. The rearing by the spoon is so far from -inspiring any such dearness, that the innocent infant is considered only -as an embarrassment, of which the quicker the riddance, in the death of -the _brat_, so much the better. - -THE opinion, however, that this one of the greatest institutes of Nature -for the preservation of the species, for which she has so admirably -organized the female breast, could be dispensed with in favor of a most -sordid savingness, has alone caused more human sacrifices, to that black -Demon of INTEREST, than probably were ever made to the “grim idol of” -Moloch in the valley of Hinnom, while the cries of the poor children -could not be heard by ears closely stopped up in honor of that infernal -spirit. - -BUT if any reader should imagine that I here invent any thing, or that, -in favor of my inference of danger from the case of revolting against -the unalterable institutes of Nature, I have exagerated matters, nothing -will be more easy, nor probably at the same more shocking, than the -procuring himself a proof of the scarce not actual murders I have -mentioned. - -THE parish-registers of this great metropolis are, I presume, open for -inspection. There needs but to examine them, to discover the red-letter -catalogue of the armies of innocents that have been put to death under -the management of the charity destined to preserve their life. There -will be found not one but many, even of the most populous parishes, -where for fourteen, twenty, or more years, not one poor babe of the -thousands taken in have escaped the general destruction, and sacrifice -to that inhuman fiend of Hell, _Interest_. Here with what propriety -might Nature borrow from one of her most dutiful children and darling, -the following exclamation, - - —— —— ALL _my pretty ones? - Did you say_ ALL! _what_ ALL? - - · · · · · - - _I cannot but remember such things were, - That were most_ PRECIOUS _to me_: did Heav’n look on, - _And would not take their part?_ ACCURSED INTEREST, - They were all STRUCK for thee! - -This is so rigidly true of some parishes, that if I am not misinformed, -the verification was not long ago made, as to one of them before a court -of justice, of not a single infant having been brought up in the term of -fourteen years. And I could name another, in which, during the course of -above twenty years, ALL, ALL the new-born children that fell under the -administration of the Parish-CHARITY, perished, except one boy, of whom -it is recorded as a prodigy, that he lived till he was five years of -age, when he filled up the number, and died like the rest. Will any one -here say, that this TOTAL mortality was purely accidental? - -BUT this can be no wonder to those who know there is such an expression, -even proverbially in use, as that of children being a BURTHEN to the -parish. An expression of which it is hard to pronounce whether it is -more execrable or more silly. But what is so inconsequential as the -spirit, or rather the no-spirit of interest? Children may indeed be a -burthen to private families; and yet for the sweetness of it, how -chearfully is it oftenest born, or with very few extraordinary -exceptions to the general rule? But to a nation, or what is the same -thing, to the lawful representative of the nation, a parish, what can be -on earth a falser light to view children in, than that of a burthen? -What could be so intolerable in the sum to be added to that actually -paid for their being worse than murdered out of hand, to save their -little lives, and bring them up to that age, in which the national -wisdom should have established for them, at once, the means of earning -their likelihood, and of earning it with such beneficial retribution to -their truly mother-country, as should amply reward her for her not -having neglected the duties of humanity towards them? All the good, all -the sensible part of mankind allow, that the true riches of a state, are -in the numerousness of it subjects. Trade, arts, the navy, the militia, -our colonies all open inexhaustible channels of employment and -maintenance. And yet there are who can call children, those children too -of the public, not in a ludicrous, but in the dearest tenderest sense, -since in the public they ought to find that office of a parent, of which -the guilt, the inability, the want of nature in their natural relations, -or their death may have defrauded them; there are, I say, who can call -such children a _burthen_! We complain of the defect of population, and -yet have seen interest creative of obduracy, and perpetuating ignorance -and error, manifestly thinning the species, by nipping those tender -blossoms of human kind. - -HERE, if this notice of the treatment of children should even appear a -digression, I should, in favor of the intention, hope forgiveness from a -humane reader. He would scarce impute it to me as matter for criticism, -the having sacrificed propriety to the introduction of a point so -important to humanity. But the truth is, that neither as a digression, -nor as a false or over-strained argument, nor as a misapplication, can -the same well be considered, by any who will withal consider its strict -affinity in so many points to the subject of which I am treating. - -IT will readily appear, that both these violences offered to Nature in -the substituting the men-midwives to the females, and dry-nurses to -wet-ones, acknowledge exactly the same common parent, interest, and have -exactly the same common effect, the destruction of infants. Is it then -possible to be too much on one’s guard against those so flagrant -impositions, which are the offspring of that proof-hardened passion? Is -any thing sacred from it, since the lives of innocents palpably have not -been so, in one branch of practice, nor very presumably are one jot more -respected in the other? It is true indeed, that the practice of -employing dry-nurses has not yet ascended much among the great and rich; -first, because fashions rarely do ascend from the lower classes of life, -and next, because there is no such temptation of actual lucre to defend -or spread it: but as to that of preferring men-midwives, nothing is so -likely as its descending, as it is so much the nature of fashion to -descend, and none are more readily adopted by the lower ranks of people -from the higher ones, than those fashions which are the most foolish and -the most pernicious. And certainly this is not the one that the least -deserves those epithets. - -WAS it not for this influence of the fashion, in making the most -unreasonable as well as the most dangerous things pass into practice -from the highest down to the lowest life, many an honest man might -escape the bad consequences of his following the example of those, than -whom none are so liable to be imposed on in such matters, the great and -the opulent. These make it worth the while of interested persons to -deceive them, and thus often for being cheated, pay with their money, -their health, and even with their lives. In the mean time, many who are -seduced by the vogue in which they see the men-midwives, employ them on -a principle which cannot be enough commended, their natural affection to -their wives and children. The reasoning which occurs to a husband in -middling or low life on this occasion is probably as follows. “My wife -and child are full as dear to me as those of the greatest man in the -kingdom are to him, and shall I grudge a little more expence in the -provision for their greater _safety_?” So far he reasons right: all his -mistake lies in taking too readily for granted, that same _greater -safety_, to be on the side of the men-practitioners in preference to the -midwives, because the former are employed by the great, who, by the by, -consult Nature the least of any class of life, even in points of their -own health. And certainly in many respects to that _sine-quo-non_ of -human happiness, the great had better follow the example even of the -poor, than the poor theirs. Make the most then of your reasoning from -the prevalence of fashion, the gout and the men-midwives, well -considered, are no very enviable appendixes of high-life. - -IF in some that laudable tenderness for mother and child, is the -determining consideration for employing a man-midwife by whom Nature, if -consulted, would assure all concerned, that the safety of both was more -likely to be endangered than not, there are others again, in whom -calling in the aid of a man-midwife is rather matter of luxury, of -parade or ostentation, than of opinion of superior safety. These are of -that imitative kind of beings, with whom the preference of a -man-practitioner for the conducting of his wife’s lying-in, turns upon -no other motive, than what would equally make them bestow a silk gown of -a new fashion, or a laced-head upon her; from a spirit of emulation of -some neighbour or superior. - -BUT what is more surprizing yet, is that notwithstanding the kind of -loathing and repugnance with which Nature inspires the women to receive -such an office from a man, as that of delivering them, a repugnance to -which they had so much better listen, since it has all the characters of -a salutary instinct; there are women so weak, as not only not to -represent to their husbands the expedience of examining, at least, the -propriety of such a fashion, before they blindly adopt it on the faith -either of others liable to be deceived, or of those interested in the -deceiving them; but who even, in a ridiculous complaisance to that -fashion, of which themselves and children are not unlikely to be the -victims, will make a point of being attended by a man-midwife, by way of -a piece of state. - -I HAVE myself known women so infected by this silly vanity, that on -receiving visits from their friends after lying-in, and being delivered -by a woman, with the utmost safety and satisfaction to them, have been -ashamed of having had the better sense and regard for themselves, to -employ a midwife in defiance of the fashion, and have told their -friends, that it is true Mrs. —— had lain them, but that there was a -Doctor at hand in the next room. This by the by was false, for such a -_Led-Doctor_ is neither needed nor employed, where a midwife that knows -her business is called. If any occasion for medical or even chirurgical -skill arises from the complication of a case, there is always time to -have the advice of a regular physician, or a regular surgeon, because -that complication can never escape timely notice. It can only then be, -for the sake of his iron and steel instruments, that a man-midwife has -so much as the pretext of being necessary, and I hope to prove, that all -the needful can be much better done without them. Yes, I repeat it, -better done without them. - -FOR here and throughout the reader will please to observe, that it is on -the superiority of safety in employing midwives that I impugn the -growing fashion of a recourse to men-practitioners. It is the side of -Nature I take against a set of mean mercenaries, who commit the -cruellest outrages upon her, under the falsest of all pretences in them, -that of assisting her. I would not be so criminal as to wish the benefit -of a false argument, in a point of life and death to those mothers and -children, my tender care, even could I be silly enough to imagine, that -I could pass such an one upon my reader. I wave therefore all plea of -the novelty of this upstart profession of men-midwives. Such a plea I -readily confess is not receivable. Were It so, how many valuable -discoveries or improvements must have been stifled in their birth, if -the objection to their being novelties was a valid one? All that I would -contend for is, that an innovation should not be admitted only because -it is an innovation; and that the decision of a matter of such capital -importance, is better left to Reason, always herself submissive to -Nature, than abandoned to Fashion, which so often acknowledges no other -jurisdiction than that of whim or humor. - -THERE is no prescription for error, no sanction in custom against -improvements. But certainly in such a capital point as the life of so -many human creatures, in short, in one of the most sacred objects of -government, that of population, such a novelty as that of bringing -men-midwives into general practice, requires rather a greater authority -than that of Fashion, while there is such a standard of essay as Reason. - -INOCULATION was not long since a novelty in this nation. The lady who -introduced it, for any thing I know to the contrary, still lives to -enjoy the honor of having procured so great a benefit to mankind. But -then this benefit would bear the fairest of all trials, that of -calculation: for what is reason itself but another word for calculation? -The procuring then the small-pox by inoculation, in a body duly -prepared, and especially at an eligible age, affords, according to the -doctrine of chances, so much a fairer prospect of safety, than in the -case of a spontaneous or accidental infection, that nothing scarcely -could be imagined more friendly to Nature than such a rational -prevention of her danger, from a distemper too rarely escaped, for the -possibility of that escape to be employed as an argument against such a -method of prevention. Here then the seeming violence offered to Nature, -appeals for its justification to Nature, Reason and Experience. - -CONSULT Nature as to this innovation in the employing men-practitioners -preferably to the midwives, who have been for ages, and so universally -considered as the properest for that function. Nature will tell you, -that it is injuring her to suspect her of being so cruel a -mother-in-law, as to deny her tenderest production the female sex -sufficient succors within herself, or leave women under a necessity of -recurring to men for aid in their greatest need of it, during those -sufferings, to which it has pleased the great master of Nature to -subject peculiarly the women. If Nature then is but another name for his -Fiat through all his works, never was his will more plainly signified -than by her voice in this point: a repugnance in both sexes to that -office being administered by a man. A repugnance which is not even one -of Nature’s least remarkable signs of abhorrence from this innovation, -and is only to be surmounted in the men by interest, and in the women by -their false fear, or what is weaker yet, by their rage in following that -bell-weather Fashion, though it should lead them like sheep to the -slaughter. The uncouthness and inaptitude of the men, so ill compensated -by their miserable inventions of iron and steel instruments, form -another loud protest of Nature against this important function being -committed to men-operators. - -CONSULT reason, and reason founded upon those dictates of Nature, to -which time only gives the more strength, will tell you, in contempt of -fashion, that the men-midwives will never do any thing in a matter -rather too universal for any excellence in it to depend upon Greek, -Latin, or Arabic; that they are, in short, only hatching of wind-eggs, -in the study of an art, which no incubation on it will ever sufficiently -naturalize to them. - -IF to experience you appeal, I have already furnished unrefutable -arguments of that’s being against the men-midwives. But let them -remember my confession, that the number which I have quoted of women -happily delivered is taken from the course of practice of good midwives. -I am not here an advocate for bad ones, nor would I wish to authorize -them if I could. All that I shall say, and dare aver is, that the very -worst of them, unless their hands are cut off, or at least deserve to be -cut off, can hardly be worse than the best of the men-operators. - -BUT while it is to the tribunal of Nature, of Reason, and of Experience, -that I presume to wish that this same Fashion might be brought; I -readily acknowledge its force though not its justice. I feel the power -of it, with pain, for the sake of humanity[21]! My opposition then to -this fashion is rather founded in duty than in hope. The weakness of it -will probably furnish fashion only a new matter of triumph, not indeed -over me who am too low for it, but over the welfare of mankind, which it -has often, in more points than this, the pleasure to see sacrificed to -it, though in not one perhaps more palpably than in this one. - -IN the mean time it might be worth the while of even those who not being -themselves men-midwives, nor having any personal interest in patronizing -them, owe their favorable notion of them to their own fair judgment; it -would, I say, even be worth their while to consider that there may -possibly be a time, when they may themselves see reason to change that -judgment of theirs. They may possibly discover the illusions of -interest, under the old stale mask of service to the public. They may -find out the folly of fashion. But will not it be too late, when that -fury of fashion shall, like a pestilence, have either swept away the -good midwives, or at least have so thinned their numbers, as not to -leave enough for the demand of the service? They must in time become, to -all intents and purposes, like an old obsolete law, as effectually -abolished by disuse, as if abrogated by a formal repeal. “The matter -would not be much if they were,” an instrumentarian will probably say, -but I doubt much, whatever he might gain by it, whether mankind or -population would profit much by that extermination, even though the -men-midwives with their tire-têtes, crotchets, and forceps, were to -succeed to their business. - -AND that such an extermination is far from improbable, will appear no -strained inference to those who consider the power of Fashion, which -establishes its tyranny, much as the first Roman emperors did theirs -over that commonwealth, by leaving a semblance of liberty without the -substance; whence the baneful effects do not the less follow, or rather -the more surely follow. Thus there is indeed as yet no act of parliament -for the preference of men-practitioners or the extinction of the -midwives, but the statutes of fashion are not only more forcible than -any act of a human legislature, but, in this matter even than the laws -of Nature herself tho’ inculcating their observance, under pain of -death, or at the least of severe corporal punishment; such as being torn -with cold pinchers, or cut or punctured with instruments, or put to more -pain than necessary. - -ALREADY has fashion driven numbers of women out of their livelihood to -make way for the encroachments of the men on the female provinces of -industry, though there never was a time, in which it was not a just -complaint that there were rather much too few means of employment for -women. Fashion has determined it otherwise, and many callings formerly -appropriated to females are now exercised by men. - -BUT as to this profession of midwifery, even the total extinction of the -real midwives, would not be perhaps so bad as giving that name to those -poor creatures in training under the men-practitioners, who -independently of their own incapacity of practice, consequently of -forming good practitioners, have a palpable interest not to suffer their -women-pupils to gain any eminence in the profession that might give -umbrage to themselves[22]. The midwives whom these men-practitioners -would perhaps gratiously allow to subsist, might to their own -insufficiency add the dangerous circumstance of creating, or at least of -not preventing, by duly exerting themselves in the predisposing part, -the necessity of calling in their protectors, especially where -recommended by them. Not that I imagine even these mock-midwives would -wilfully be guilty of such prevarication in their duty. For them not to -deserve such a suspicion, it is enough that they are women, consequently -tender-hearted. But that does not exclude the idea of weakness. But -where so fair a virtue as gratitude may disguise even from themselves -the fouler motive of interest lurking at bottom, if that tenderness is -not even destroyed, it may not impossibly be made a tool of, and join in -persuading them, that things had really better be left to the -men-practitioners, whose creatures and devotees they are. Thence a -negligence superadded to their defect of skill. Such subalterns then -would, at least, not be dis-inclined to the “FINDING” _themselves_ “AT A -LOSS”, or yet worse for the patient, have by their omissions, if not -commissions, bred the occasion of “_finding_” themselves “_at that -loss_”, even mechanically, and without the direct design of paying their -court to their recommending “_accoucheur_, _their man of honor_ and -_real friend_,” in a _candid_ recourse to him. Pity it were indeed that -so charming a harmony should not subsist between _the accoucheurs_ and -such _midwives_, for the “MUTUAL ADVANTAGE” of both! A harmony, which -however could hardly be established but at the expence of the sacrificed -patients. - -AND here I appeal to the reader’s own fair judgment, whether I -over-strain the consequence against such wretched creatures as they -cannot but be who must, for bread, be so subservient to the -men-midwives, and be what the French call, their _âmes damnées_ (souls -sold). Can any thing be more probable than that these _good women_ -dignified by the men-practitioners, out of their special grace and favor -with the title of midwives, will on all occasion consult the -“_advantage_” of their kind _patrons_ and “_real friends_”. And how can -that advantage be better consulted than by bungling their work so as to -make it _appear_ necessary to have a _candid recourse_ to the good -Doctor, who recommended and warranted them? can it, in short, be -imagined, that they will be less mere machines than Dr. Smellie’s Dolls, -or indeed furnish less occasion, than the education under those Dolls, -for the _iron_ and _steel instruments_, which are the most part -understood to be indispensably necessary where the midwife shall have -failed. And as to such midwives as have been formed or recommended by -the men-practitioners, their _not_ failing would indeed be the wonder! - -THUS the name of a midwife may subsist after the reality shall have -perished, and the world so often deceived by mere names, may not -perhaps discover this annihilation till long after it is effectuated, -or till it is too late to repair the damages, which will hardly fail -of discovering it to them. Of good midwives there never were too many; -but they are now much too few; though still not more rare in -proportion than those of the men-midwives, who may be called good, -comparatively to so many of them as are dangerously superficial. -Discouragement has already greatly hindered the places of the good -female-practitioners who are gone off the stage, from being duly -supplied. Proper subjects decline taking up a profession, in which -they must have to dread the prevalence of so false a prejudice against -them, as that which determines the preference of the male-operators. -It is easier to destroy, than to create a-new; and perhaps when the -need of good midwives shall be at the greatest, the difficulty of -finding such, will make the employing of men-practitioners, with all -the so just objections to them, even a necessity. Things are not at -present perhaps far from that point, and an alarming consideration -that would be to all women, if they were but to reflect on the -increase of pain and danger to themselves in the hours already too big -with both, of their increase, I say, by the most aukward and violent -aid of the men, compared to the so much more effectual and gentle -methods so natural to the women-assistents. - -IF the parties then principally concerned in the decision of this -question, and especially the women who are the patients, and their -tender relations of husband, father, or brother, &c. were but to consult -their own feelings, their reason, and even that instinct which, in this -point, is itself so strong a reason from its being the voice of Nature -never unhearkened to with impunity, they would soon, to your objection -drawn from a fashion scarce less ridiculous than pernicious, allow no -more weight than, in fact, it deserves. - - - OBJECTION the Fourteenth. - -YOU must allow, however, that it must be a false modesty that, in the -women, which can oppose the preference of the men-practitioners to the -female ones. - - - ANSWER. - -I KNOW indeed that Dr. Smellie (page 2. of his introduction) attributes -the opposition made by the Athenian women[23] to the prohibition of -midwives, and to the acceptance of men-practitioners in their room to -“_mistaken modesty_.” It may however with more reason and truth be -averred, that the admittence of men to that function by women, would be -in the women a most egregiously MISTAKEN IMMODESTY. Since, surely the -virtue or grace of female modesty is not an object to be held so cheap, -as to be sacrificed for worse than nothing, for nothing better, in -short, than the purchase with it of danger or perdition to both the -mother and child. After so valuable a sacrifice as that of modesty -itself, it may perhaps sound mean to add any thing comparatively, so -trifling as that of the hire not given to the person who prostitutes -herself in some sort on a so much mistaken hope, but to the very person -to whom she is prostituted in that hope of superior safety. - -I AM not then here to assume a character, that would become me so ill, -of a Casuist or Divine, by pretending to fix the degree of moral -turpitude in the submission of modest women to a practice, which, I will -even allow might be justified by the superior consideration of safety to -two lives, if that consideration was not a question most impudently -begged, with so little foundation, that the very contrary thereof is the -truth. - -NEITHER would I here incur the just charge of impertinence, in giving my -private and insignificant opinion on an undecency so unwarranted by any -necessity. That would look too like dictating to others, what they are -to think of a practice, of which every one will doubtless judge for -himself. The boundaries of female modesty are so well known, and so -ascertained by common consent, that surely it little belongs to me to -offer new lights upon that subject. - -WHAT I have then to say, on this head, is purely in justification of -that modesty, which the men-midwives are for obvious reasons pleased to -call a false one, though so far as it pleads for excluding them, it is -an ingratitude to that Nature, of which it is the peculiar gift to the -female sex, not to term it even a wise virtue. - -SOCIETY especially stands indebted to Nature for her suggestion of -modesty in this point. If in all ages, in all civilized countries, the -wife is considered as the peculiar property of a husband, insomuch, that -all laws human and divine consecrate, if I may use the expression, to -him alone, exclusive of all other men, the access to the reserved parts -of the wife’s body, certainly such a privilege can hardly be thought -lightly communicable. And what can be more so than suffering a man, -mercenarily or wantonly, or perhaps both, to invade that so sacred -property, under the mask of a service, for which he is by Nature so -evidently disqualified? While Nature too has made so ample a provision -for this very service, in fitting the women for it, with so much more -propriety and safety, both to the concern of the public in the welfare -of population, as well as to the domestic honor of families, which is -not without some danger, at least, from the practice of midwifery being -in the hands of men. - -AS to this last averment of mine, the truth of it is so glaring, that it -does not even need Dr. Smellie’s own implicit confession of it, in his -instructions to the men-practitioners in general, or, if you please, to -his more than nine hundred pupils. - -“_He_ (_the_ ACCOUCHEUR) _ought to_ ACT _and_ SPEAK _with the utmost_ -DELICACY _of_ DECORUM, _and_ NEVER VIOLATE _the_ TRUST _reposed in him, -so as to harbour the least_ IMMORAL _or_ INDECENT _design; but demean -himself in all respects suitable to the_ DIGNITY _of his_ PROFESSION,” -p. 447. - -HERE I confess myself so smitten with the propriety and sanctity of the -precept of the good Doctor’s, and particularly with the needfulness of -it, that I would advise every man-practitioner of midwifery, of a -certain age that might require it, to have the said commandment wrote -out in _gold letters_, and wear it about his arm, especially on his -proceeding to _officiate_, by way of amulet, phylactery or preservative -against any incident temptation to _violate_ his _trust_, or to fall off -from the high _dignity_ of his profession. All that I fear is, that its -virtue may not always be to be depended upon, against the energy planted -by nature in the difference of the sexes. No one would be farther than I -from the cruel injustice of drawing consequences unfavorable to any set -of men, from the misconduct of any particular individual in -it.[24]Errors are purely personal. If I then so much as mention the case -of a man-midwife convicted of having debauched a gentleman’s wife, in -consequence of his admission to the practice of his profession of -midwifery upon her, it is by no means neither with a design to insult -the unhappy criminals, nor to draw from thence an inference to the -disfavor of the men-practitioners in this point, beyond what I am -authorized by the constancy of the temptation from Nature, to all, yes, -to all, who, by their age, in one sex, are not past it: I say in one -sex, because in the other, the female, the very circumstances of a -woman’s needing a midwife, shews that she is not past the age of, at -least, causing a temptation. Further, it would even be a matter of -argument on the side of the men-midwives, that so _few_ instances come -to the knowledge of the public, of the ill-consequence of a practice -which breaks down the capital barriers of modesty; if those -ill-consequences were not, in the nature of them, not only a secret, but -easy to be kept secret. Who would complain but the husband or relations -of transactions between a man-midwife and his patient? But then how -seldom need a third to be let into such a secret? - -I WOULD not then have the men-midwives to be too forward to treat the -modesty of the women on this head as a false one, or their scruples as a -weakness. Modesty in this case is not only the safeguard of the lives of -themselves and children, but of their own honor, which if it does not -receive an actual fall in such a subjection to a man-midwife, had -perhaps better not be so unnecessarily risked so near the brink of the -precipice. - -I AM not writing here for Italians or Spaniards, or any of the -inhabitants of those countries who are so prone to jealousy, perhaps -because they know their women. I am now addressing myself to Englishmen, -not jealous, because, if they know theirs, they must know that, in -proportion to the number, no women on the earth have more of the reality -of virtue and modesty. I will not suppose then any thing so offensive, -as that the chastity of the generality of them is not infinitely -superior to the advantages or overtures for design afforded the men -admitted to such a privacy, as that of attending them in their lying-in -and delivering them. But would the honestest woman, or one however sure -of herself or of her virtue, think it eligible, without a full -satisfactory proof of that superior safety, which is her object in -preferring men-midwives, to be herself the occasion of temptation to -those people? How can she answer that she will not be it? In that so -formidable army of mercenaries, actually continuing to form itself under -the banners of Fashion, and headed by Interest, can she answer that the -insensible stoics of it, will fall to her share? Would a woman, I will -not say, of strict principles of honor, but barely of not the most -abandoned ones, submit herself in the manner she must to a man-midwife, -on her employing him, if she would but satisfy herself, as she easily -may, that his aid cannot be more effectual than that of a woman? But -what! if it is most undoubtedly a less safe one? - -BUT this is far from all to be objected on the head of modesty to this -practice. The opportunities, if not of temptation, if not of seduction -by it, at least of offensiveness to female reserve are such, as would -make even a husband, the least susceptible of jealousy, so uneasy for -the outrages to which the employing of a man-midwife in the course of -his wife’s pregnancy and delivery might expose her, as would make him -think it no indifferent point for his judgment to settle whether such -outrages might not better be spared her. It will not I presume be -denied, that all female modesty is a flower, the delicacy of which -cannot be too much guarded against any tendency to blast it, and that -nothing can threaten more that effect, than such infringements of the -unity of a husband’s privilege in the sole incommunicable possession of -his wife’s body, as are implied in the course of a man-midwife’s -attendance. An unity of privilege, which, when broke in one point, does -not always stop at that, but may proceed to farther breach, where there -is art on one side, and weakness on the other. Many women are doubtless -proof against the slipperiness of such an overture: but all have not -alike strength of mind. - -BUT lest I should be here taxed with forging of phantoms merely for the -honor of combating them, I shall only entreat all parties concerned to -consider the following so probable circumstance, and then let them -decide as their own judgment will direct them: a circumstance taken (can -any thing be fairer?) even from a man-midwife’s own stating, as well as -from the nature of things, of which none need be ignorant that will -think at all about them. - -IT is then to be observed, that during a woman’s pregnancy, and before -the labor-pains come on, one of the principal points of midwifery is, -what is called the art of _Touching_. Thence are derived the surest -prognostics for preparation, and especially from the signs it affords of -rectitude or obliquity of the Uterus. I have already offered reasons -needless to repeat, why the men can never arrive at the excellence of -skill in the women in this particular. But as to the importance of this -faculty of _Touching_, hear what Dr. Smellie himself says. - -P. 180. “The design of _touching_ is to be informed, whether the woman -is or is not with child; to know how far she is advanced in her -pregnancy; if she is in danger of a miscarriage; if the _os uteri_ be -dilated; and in time of labor to form a right judgment of the case, from -the opening of the _os internum_, and the pressing down of the membranes -with their waters, and lastly, to distinguish what part of the child is -presented.” - -Again, P. 448. speaking of a _midwife_, he says, “she ought to be well -skilled in the art of _touching_ pregnant women, and know in what manner -the womb stretches, together with the situation of all the abdominal -VISCERA: she ought to be perfectly mistress of the ART of EXAMINATION in -the time of labour”. - -HERE you have from an unsuspected authority a certainly not over-rated -importance of the expedience of preliminary TOUCHING. Now granting, only -for argument’s sake, what is assuredly false, that a man-practitioner -can be equal (superior he would not in this point, at least, have the -impudence to pretend himself) to a midwife; let a husband, let a wife, -but reflect on the difference, every thing else being equal, there must -be as to _modesty_, between the function of _touching_ being performed -by a man or by a woman. Let a husband, I say, for an instant figure to -himself what a figure he must make, what a figure his wife must make, -under such a ceremony performed by a lusty HE-MIDWIFE, exploring those -arcana of the female fabric, and especially to so little purpose, with -his natural disqualifications for so much as knowing what he is about. -Will the husband be present? What must be the wife’s confusion during so -nauseous and so gross a scene? Will he _modestly_ withdraw while his -wife is so _served_? What must be his wife’s danger from one of those -rummagers, if she should be handsome enough to deserve his attention, or -a compliment from him on such a visitation of her secret charms, the -more flattering from _him_, not only as he must be supposed so good a -judge from the frequency of his occasions of comparison, but as it must -imply a superior corporal merit in the woman so visited, as could -overcome that satiety which a fastidious plenty of patients might so -naturally be imagined to create in a man-midwife? Will any one say, that -these suppositions are over-strained, or out of Nature? I fancy, that if -the secret histories of many families were ransacked, of the practice on -which the men-midwives were in possession, it would not be always found, -that those preliminary visitations were not turned to some account of -interest or seduction. And yet an omission of that _touching_ might be -dangerous. How kind is it then in Nature, to have of herself so far -consulted the good and tranquility of society, in palpably bestowing -upon women a faculty, which she has as palpably refused to the men, in -whom the exercise of it would for obvious reasons be big with so many -inconveniences? Is there any breach of charity in the taking for granted -the existence of such inconveniences, unless indeed, all of a sudden, in -favor of this lucre-begotten sect, the men were ceased to be men, and -the women women? - -BUT allowing that nothing was to pass between a man-midwife and his -patient, in this _act_ of _touching_, beyond the necessity of the -practice, or in a merely technical sense, that in short no such -libertine impression should make itself be felt in the course of such -_touches_, as should discompose the good _Doctor_’s DIGNITY, and -endanger the patient’s honor, by present or future attempts derived from -such a strange privity; is it not to be feared, that a designing or -interested person may take other advantages besides that of gratifying -sensuality? May not a woman, the more attached she is to her modesty, -the greater sacrifice she has made of it, in her innocence of intention, -only imagine herself but the more subjected to a man, to whom she has -submitted in the manner she must do to a man-midwife, and let him take -an ascendant over her and her family, of which a midwife would not so -much as dream, from her office being so much in course, and too little -extraordinary for her to have any extraordinary pretentions or designs? -On the contrary, a man-midwife need scarce set any bounds to his. In any -differences in a family, especially between man and wife, must not a -man-practitioner, from such a familiarity with the wife’s person, have -such a footing in the confidence of the wife, as may enable him to -dispose of her will almost in any thing? He may be her apothecary, -physician, surgeon, privy-councellor, what not? What can a woman refuse -a man, to whom she is so deluded as to think she owes her own life, or -that of a darling child, all his merit, in which I have before -explained? What can a woman in short refuse a man, to whom nothing of -that has been refused, in which consist all the preliminaries of -granting every thing? She may indeed refuse him the sacrifice of her -virtue, if he should think it worth designing upon, but how few things -else could she refuse him? Once more the greater value she put on the -sacrifice of so much of her modesty, the less would she be able to deny -him any thing else, as any thing else must comparatively appear so -inconsiderable. - -BUT hitherto I have spoke only of those outrages and dangers to modesty -from the preparatory attendance of the man-midwife as occasion may -require, during the pregnancy. But as to his officiating in the crisis -of the labor-pains and delivery, there are two very essential points of -consideration. - -THE FIRST. The modesty of the women, unaccustomed to the approaches of -other men than a husband, must be in great sufferance in the moments of -their labor-pains. All Nature agonizes in them. They are at once -weakened in the flesh and in the spirit. The bare presence of a man to -officiate at such a time, may excite in them a revolution capable of -stopping the labor-pains caused by the expulsive efforts of delivery, -which thus becomes dangerously retarded, and may so overpower them, as -to put them in the greatest peril of their lives. This is what has often -happened. You may see frequent examples of this revolt of Nature against -the ministry of men-midwives in Dr. La Motte himself, a man-midwife. If -Nature then suffers so much in women at that juncture, when a person, -nay even of the same sex, offers her aid, in certain indispensable -occasions, to which humanity is subjected; how greatly must the presence -of a man increase their constraint and embarrassment, and rob them still -more of that so necessary freedom in the animal functions! But how -greatly ought the women to thank that their instinctive repugnance of -Nature to such a prostitution of their persons, if they consider those -tortures, which, by the listening to that same repugnance, may at once -be saved to their modesty, and to their personal feeling. Let them paint -themselves the following posture prescribed by a man-midwife. “_The -patient must be commodiously placed, that is to say, on the bed-side, -her thighs raised and expanded, her feet drawn up to her posteriors, and -kept steady in that posture by some trusty helpers._”[25] Levret, p. -161. _On the use of the new crooked forceps._ Here it may be said; “why -there is nothing in this attitude, however shockingly indecent, but what -may be sanctified by the extremities of necessity”. Very well. But what -must a husband, what must a wife think at her being _spread out_ in this -manner, under the hands and eyes of a man-practitioner, with his -helpers, perhaps his trusty apprentices, only for the experiment of a -_forceps_ of a new invention, the merit of which too is a so contested -an one, that Levret himself is forced to own that, “that same FORCEPS -_would be[26] an instrument of pure_ SPECULATION, _and not of_ PRACTICE, -IF (N. B. that IF) _a certain general precept should be true_,” which, -by the by, is most certainly so! So that, in this case, for example, you -see how a woman may be treated, only to ascertain the merit of some -new-fangled gimcrack of an instrument. But to how many occasions of as -little, or even less necessity than this, for putting a woman into -postures of this sort, might not wantonness, interest, or other motives -give birth? Or can pretexts for such insults to modesty be wanting to -designingness? - -THE SECOND consideration is this. Those moments of weakness of spirit, -and infirmity to which the labor-pains subject the women may, in some of -naturally the weakest of them be, liable to leave impressions in favor -of a man-midwife, the less suspected of harm, and consequently the more -dangerous for their being suggested by that gratitude for his -imaginary[27] contribution to their deliverance, which is itself a -virtue, though the object of it is so miserably mistaken by them. Let -any one image to himself what must often happen in Nature, a woman -sinking under her pains, her mind all softened and overpowered with her -present feelings, and looking up for _relief_ to the _man_, employed, as -she imagines, to procure it her, though the real fact oftenest is, that -he will not have enough prevented her pain, or perhaps greatly -occasioned its increase. Of this however she knowing nothing, sees him -in the amiable light of her deliverer from her actual and intolerable -state of pain. In the mean time, those aukward uncouth endeavours of his -to relieve and deliver her, even though they should aggravate her -torture, pass upon her for master-pieces of art or skill. “Who would be -without a man-midwife?” At length, Nature sometimes, even in spite of -all his omissions, or bungled operation, proceeds in her favorite task -of delivery, that is to say, if he has not hurried or made tragic work -of it, with his mispractice or his instruments. The patient then is rid -of her burthen, and what are then her feelings? Those of exquisite -delight, from the comparison with what she was induring but the instant -before. It is a transport of joy, not unmingled with gratitude, to the -person to whom she fancies herself in any measure obliged for it. The -ugliest wretch on earth, so he could but be imagined the cause of such a -delivery, would, in those instants, assume in her eyes the form of -Loveliness itself. Even with the greatest innocence of heart she could -hug, she could kiss him in the ebullitions of her joy and gratitude. Let -no one imagine these expressions are over-strained. Such a rapture of -felicity, in the sudden case of being taken as it were down from a rack, -is not of a Nature to know any bounds of moderation, nor can be -conceived but by those who have felt it. Her gratitude would even extend -to inanimate things, much more to the dear Doctor, to whom she conceives -she owes so much. She eyes him with all the intense eagerness of a -gratitude so fond, that its transiency into a passion of another nature -would not appear such a prodigy, to those who consider how apt passions -of tenderness are to confound motives and run into one another. The -melting-softness of those moments of infirmity and weakness of spirit, -affords a susceptibility of impressions, which may not afterwards be so -soon worn out, and of which the usual affection from the difference of -sexes, in the parties, may sooner or later come in for its share. Dr. -Smellie has, as I have before observed, implicitly allowed the -possibility of a temptation to men, and shall I not follow his laudable -example of candor, and confess that there may also be weak women? - -IT is indeed true that in cases of extremities, such as most certainly -are not the frequentest ones, any thought of immodesty may be intirely -out of the question. The sad and suffering state of a woman agonizing -with pain, at the gates one may say of death, leaves little room for -licentious temptations. But, once more, those cases are much the rarest: -and even in those, the greater the danger will have been, the greater -must the gratitude afterwards be for the imaginary service, that will be -supposed to have accomplished the deliverance. Let a midwife have really -rendered that service, the gratitude will scarce be so quick, so lively -or so lasting, only because she is not a man. - -IF it shall be here objected, that the men-midwives ought to be above -all suspicion or scandal of this sort; I shall only say, that at least -it is their interest to appear so. But they themselves will not pretend -to an exemption from temptation, nor can answer for themselves that such -a temptation may not come into existence, as that all their virtue, -fortified by the divine precept before quoted from Dr. Smellie, may not -defend them from yielding to it. They are not, or at least ought not to -be men in years for obvious reasons as to that manual practice of theirs -which at the best is so indifferent. Let any one then consider the -consequence of this worse than unnecessarily putting young women, in -such manner, into the hands of men in the vigor of their age. Let any -impartial person but reflect what barriers are thrown down, what a door -is opened to licentiousness, by the admission of this so perfectly -needless innovation. Think of an army, if but of barely Dr. Smellie’s -nine-hundred pupils, constantly recruiting with the pupils of those -pupils, let loose against the female sex, and of what an havock they may -make of both its safety and modesty, to say nothing of the detriment to -population, in the destruction of infants, and I presume, it will not -appear intirely in me a suggestion of private interest to wish things, -in this point, restored to the old course of practice of this art of -midwifery by women. A course which Nature has so self-evidently -established, in her tender regard to the female sex, and to its darling -offspring, and in which she has not less consulted one of her primary -ends, the Good of Society, in the greater security of the conjugal union -and property, which ought to be so sacred, and especially so, for the -honor of the human understanding, from the invasion of an upstart -profession, sordidly mean in its motives, infamously false in its -pretences, shamefully ridiculous in its practice, and yet dreadfully -serious in all its consequences. - - - CONCLUSION of the FIRST PART. - -In the foregoing part of this work I have contented myself with -asserting, in general, the perfect inutility of those instruments, of -which the male-practitioners themselves confess the danger, and use them -not a bit the less for that confession. It is then for the following and -second part, that I have reserved the entering into a more particular -discussion of them. Therein will appear, upon how false and slender a -foundation the gentlemen-midwives have insinuated themselves into a -business so little made for them. The truth is, that the pernicious -quackery of those same instruments has been artfully made the pretext, -and become the sanction of an innovation set on foot by Interest, -adopted by Credulity, and at length fostered by Fashion. The employing -of midwives was undoubtedly not long since, in this country, the General -Rule. The calling in of men-practitioners, upon very extraordinary -occasions, was an Exception, and a very rare one, to that General Rule. -But by a fatal inversion of the natural order of things, the Exception -is recently crept into the place of the General Rule. The point is to -consider, whether this palpable violence to Nature is of that benefit to -society which it is pretended to be. - -I HAVE already examined some of the arguments in favor of the -men-practitioners. But the principal one, deduced from the incapacity, -or rather aversion of the midwives, upon just grounds, from using -instruments, merits an ampler scrutiny. In proof of my candor in it, I -shall take most of my remarks on those instruments from what the -men-practitioners themselves say, and confess of them. This, I presume, -cannot be deemed unfair. - -UPON the whole, those parties whom the decision may concern, will please -to decide on which side the force of Reason and Truth shall appear the -greatest; and so deciding, it is, in fact, in their own favor, and in -one of their most capital concerns, that they will decide. - -THEY will decide, in short, whether, upon the whole, the plea of the -men-practitioners, founded upon the ignorance of a few midwives which, -bad as it is, is more than balanced by their incompetency in the manual -function, and to which a remedy might easily be found, is a valid one -for driving out of the practice of midwifery a sex, to which the faculty -of it is self-evidently the genuine gift of Nature herself, only to make -way for a set of interested male-practitioners, whose so boasted art is -oftenest signalized by the most barbarous and horrid outrages upon -Nature, with this aggravation, that they are needlessly committed under -the specious and plausible pretext of flying to her assistence. - - - The End of the FIRST PART. - -[Illustration] - - - - -[Illustration] - - - - - A - TREATISE - OF - MIDWIFERY. - PART the SECOND. - - Containing various observations on the labor and delivery of lying-in - women, including a discussion of the pretended necessity for the - employing instruments. - - - - - INTRODUCTION. - - -NOTWITHSTANDING the numerous productions of writers on the art of -succoring women in labor, all that has hitherto appeared on that -subject, still leaves the mind unsatisfied; not that it is so unjust as -to expect perfection in any human art, but from its feeling that, in -this particular one, too much is given to theory, and too little to the -practical part, or manual function. - -WHILE the causes of difficult labors are far from solidly or -sufficiently explained, and rather obscured by a cloud of scientific -jargon, than practically illustrated, they give us no tolerably sure -method for preventing or remedying those difficulties. On the contrary, -the whole boasted improvement of the art is reduced, to a pernicious -recourse to instruments, which cut at once the knot they cannot unty. - -IT is then no wonder that there should still, in all the books and -observations hitherto given on this matter, exist a void lamentably -unfilled; and as this void evidently consists less in the theory than -the practice, the superior qualifications, and natural endowments of the -women for the manual operation, point out the fitness of the greater -dependence on them for the filling up what, humanly speaking, can be -filled up of that void. - -LET the physicians, the surgeons instruct the midwives in so much of -anatomy as is necessary to their function; let them afford them, either -in writing or verbally, their guidance and direction in the consequences -or occasionally in the preliminaries of management of the lying-in; all -this is right, salutary, and in due course: but that men should pretend -to the manual operation in these cases, it certainly neither is nor can -be their business. Nor is this negation of propriety a reproach to them. -Will any man think it an indignity to be told, he cannot clear-starch, -hem a ruffle, or make a bed as handily as a woman? The exceptions are -the shame; and in this department of art it would be truer to say, that -there are no exceptions than that there are only a few. - -BUT can we wonder at the insufficiency of the lights thrown into the art -of midwifery by that cloud of writers who have treated of it, when so -few of them having had any other view than advertising themselves, and -being incapable of saying any thing to the purpose, of the art of -delivering the women, have filled up their books with insignificant -digressions, or things intirely foreign from the point? - -IN some you see all distempers of women collateral to their pregnancy, -which is certainly a very necessary and an infinitely extensive subject, -while on the practical article of the deliverance they give you nothing -but what is barren, jejune, or even false. Others, by way of filling up, -run digressively into a discussion of the methods of treating infants. -Others again have written only to recommend some pretended secrets, as -powders, preparations, &c. Some have swelled their volumes with the more -or less commodious structure of a couch, or the mechanism of a -close-stool, or the make of different sorts of syringes for anodine -injections. In others you meet with remedies for the deformities of the -human body, for the contractions or stiffnesses of the muscles of the -shoulders, arms, hands, legs, feet, thighs, haunches, &c. to straiten -the crooked, and even, in a treatise on midwifery, to extirpate a -polypus from the nose. Others, with all the parade of justly exclaiming -against nostrum-mongers, the plausible writing against which serves at -once to fill up, and give them an air of superiority to such trumpery, -substitute however nothing better of their own than the recommendation -of some instrument, which they give you for a master-piece of invention; -and to establish which, they cry down every instrument of other -practitioners, though not one jot inferior to it in any thing, but the -not being the newest. Thus, after having perused such a multiplicity of -authors, it is incredible to say how little true, or practically useful -knowledge is to be picked out of the whole mass of them. You find almost -every thing in them but what you are looking for. - -IN the mean time, the superficial examiner of things, who sees such a -number of volumes, furnished by these pretenders to the art of -midwifery, cannot conceive they contain matter so little essential as -they do. The scientific air diffused over them, not a little embellished -with pretty prints of machines, as of a windowed forceps, a stool, or of -a gravid uterus, all these contribute to throw the dust of erudition -into the eyes of those, who do not penetrate beyond the surface of -things. And thus the aids and appendages of the art, or what is yet -worse, even the abuses of it, pass for the art itself, the main of -which, as it undoubtedly consists in the expertness or dexterity of the -manual practice, can be so little and so imperfectly conveyed by -description. I am however far from denying the benefit which may result -to midwives, from consulting all that has been written on this subject. -I am far from encouraging ignorance in the women of this profession. -Their skill in the manual function cannot but be improved by the -addition of a sound and competent theory. But it should always be -remembered, that the very basis or capital point of the art is the -manual dexterity; and in that point, the most learned of the men must -yield to the most ignorant of the women. A point which the men -surpassing the women in every thing else can never compensate: no not -with all those dreadful “artificial hands”, of which they boast so much -their invention, in the room of the infinitely preferably _natural_ -ones, of which the use, in this office, becomes the men as little, as -their hands seem formed for it; and I might add, their heads, if they -themselves can possibly think otherwise. In such an opinion the -ignorance is theirs. - -AS to the treatise herein offered on the art of midwifery, as the object -of it is principally to attack particular abuses and dangerous -innovations in it, it will not be expected that the same should furnish -a compleat general course of practice. But this I dare aver that if I -should be induced to attempt such a work, it will not be the worse for -my consulting more the experience I have of Nature in her operations in -this one of her so capital concerns, than the authorities of men, who -seem or pretend to know so little of her, as to think of assisting her -with instruments, formed only for her destruction, or at least for doing -her more damage by their violence, than any reason to hope good from -them can justify. - -HERE I shall not offer any digressions on physic, anatomy, chemistry, or -pharmacy; I shall confine myself entirely to the points of my business -of the manual operation. Let the physician prescribe, the surgeon bleed, -the chymist contribute medicines, the apothecary make them up; with none -of these professions do I presume to interfere. But as to the -man-midwife, who not only so often presumes in some measure to represent -them all, but to join to them the exercise of an art so unnatural to his -sex, I should think myself wanting to my duty in my profession, if I did -not point out the mischief I apprehend to result from especially that -method of practice, on which he grounds the pretence of necessity for -his practising it at all; and this chiefly forms the object of this -second part, in supplement to my first. - - - Of DELIVERIES. - -WE understand, by deliveries, in general, the issue of the fœtus out of -the mother’s womb. - -THESE are distinguished into two kinds, the one natural, the other -preternatural. - -THE natural one, is that in which the fœtus comes out in the most -ordinary way, when it presents the head foremost. - -IT is deemed preternatural, when the fœtus presents in the passage any -other part than the head. - -THESE two kinds are again subdivided into two distinctions of labor, of -easy or difficult, because both the natural and preternatural mode of -delivery may be easy or difficult. - -THE delivery is termed easy when the fœtus comes out readily, and -without the aid of art. - -IT is termed difficult, when the labor of it is hard, and the fœtus does -not make its way out but with pain, and with the help and assistent -industry of the midwife. - -IN the cases of a natural and easy delivery, there is little or no -actual occasion for the presence of the midwife, beyond that of -receiving the fœtus, tying the navel-string, giving the child to be kept -warm, and then delivering the mother of the after-birth. The spirits of -the patient are then to be recomposed, her agitation calmed, a warm and -soft linnen cloth applied to the stomach; a warm shift and bed-gown put -on her; a linnen cloth to be laid on four-fold over the belly; a -double-napkin round her, and she to be placed in a bed well warmed. Such -is the summary of the process to be observed in those common cases. - -IN the deliveries, on a preternatural labor, when they are easy, the -same method takes place: there being no difference, but that in one the -child will have been received by the head, in the other by the feet. - -THESE kinds of labors are so easy, that there is no need of -demonstrating their being to be terminated without the aid of -instruments. When the fœtus presents itself promisingly, Nature is best -left to her own action, and nothing should be precipitated in the manual -function, unless some unexpected accident should intervene, and require -interposition, such as a great flooding, or other exigency. - -AS to the preternatural delivery, the better practice is not to delay -the extraction of the fœtus, after the discharge of the waters; nor stay -till her strength shall have been exhausted. On the presenting of a fair -hold, and a sufficient overture, no difficulty should be made of -extracting. - -ALL that is to be observed then, is not to prematurate this extraction: -not to proceed, in short, like those unskilful, or inconsiderate -practitioners, who are no sooner entered the patient’s room, but they -want to have their operation dispatched out of hand. Nothing can be more -important to the well-doing of the patient, than for no violence to be -used to Nature, who loves to go her own full time, without disturbance -or molestation. In this point then great caution and circumspection are -requisite. - -IT should also be observed, that it is wrong for the midwife to leave a -woman newly lain-in, however happily delivered. It is necessary to stay -by her for some hours afterwards, till she is in such a state of -tranquility and ease, as may leave nothing to fear of those -after-disasters which too often happen. - -SOME celebrated practitioners and authors upon midwifery have been -surprized to see women, after their going their time without -mis-adventure, and after having been readily and happily brought to bed -die suddenly. There are too many of both the female and the men-midwives -who have no notion of this misfortune till it is too late to prevent it. -The cause of this melancholic accident is unknown to many practitioners -of the art. Some have confessed their ignorance of it: others have -erroneously, others deficiently accounted for it. But all are surprized -when the patient is the victim of it: especially as it follows, in some -cases that afford the best grounded hopes. - -MESSIEURS MAURICEAU and De la Motte give us examples of these unexpected -deaths. The first, in his 230th observation, says, - -“I DELIVERED a woman of a very corpulent habit, aged about thirty-five -years, of her first child, which was a lusty girl, alive, and that came -naturally. This woman had been near two days in labor, with small slow -pains or throws, after which the waters having burst forth with a strong -throw, she had subsequently favorable ones, which made her bring forth -as happily as one could wish. I immediately delivered her: but to my -great surprize, scarce had she been a quarter of an hour after delivery, -that she of a sudden fell into violent faintings, with an oppression at -the breast, and a great agitation of the whole body, which was instantly -followed by a convulsion, caused by a loss of blood, of which she died a -quarter of an hour afterwards. - -“THIS (adds Mr. Mauriceau) was one of those kind of fatalities which no -human prudence can elude or parry.” - -LA MOTTE had the same case happened under his hands, which I need not -repeat here, being inserted in the first part of this work, where, p. -131, I ventured to promise an essay of mine, to give a less -unsatisfactory reason of such deaths, than what is to be found even in -those two celebrated authors whom our cotemporaries consider as their -masters in the art of midwifery. These impute those unforeseen deaths to -occult and inevitable _causes_. I own, I do not intirely think them -either occult or inevitable. I doubtless may be mistaken, but of this I -am sure, I shall advance nothing but what is authenticated to me by my -own observation and experience. - -AN over-repletion of blood, and a defect in the contraction of the -uterus, of which all the vessel being open are too slow in recovering -their occlusion, are generally speaking, the causes of these diseases. I -could support this opinion by some chirurgical axioms, but I presume it -will be thought more satisfactorily proved by the success of the method -of practice, which I would recommend to prevent or cure those dangerous -or rather fatal causes. - -AS to know that a woman may thus perish unexpectedly a quarter of an -hour after delivery, is enough to require the being on one’s guard for -using a salutary prevention; I would advise attention, especially to her -constitution. - -WHENEVER therefore a pregnant woman is observed to be remarkably -corpulent, and full of blood, with a good constitution, she should be -advised to lose some blood, once or twice during her pregnancy, by way -of precaution. This is of great service to rarefy the blood, and obviate -those excessive hemorrhages, which are to be dreaded on their lying-in. -Then nothing is to be precipitated during their labors, that Nature may -have full time to predispose the uterus to enter into contraction by due -degrees, that is to say, neither too quick, not too slow. But if, -notwithstanding these precautions, there should, after delivery, -supervene any considerable loss of blood, followed with faintings or -oppressions, the patient must be stirred, excited to cough and sneeze -contributively to the evacuation of the blood, which otherwise is apt to -clot in the uterus, and would suffocate her if not expelled. - -IF by this mean the evacuation does not naturally take place, which may -be perceived by the faintings of the patient, the midwife must, without -losing time, put her hand into the bowel, and extract all the clots of -blood she will not fail of finding there, and of which the presence, as -being extraneous matter, necessarily oppose the contraction of this -organ, and quickly suffocates the woman, if she is not timely relieved. - -THESE hemorrhages are but too frequent, especially with those women who -neglect the precautionary bleeding; and such sudden death too commonly -the consequence of neglecting, or of not knowing that the most salutary -practice, in these cases, is to well evacuate the uterus by the -operation of the hand, where Nature appears in the least tardy or -deficient. - -THE long experience I have of this manual help, which has never failed -of success with me, warrants my averring, that there is little or no -danger, in these cases, to women, provided the midwife employs herself -dextrously to clear them while time serves. Their relief is -instantaneous. They come to themselves presently: they are restored to a -freedom of respiration: nor will they have so much as been sensible of -this operation of the hand, which will nevertheless have saved their -lives. - -THERE have been men-midwives, that pass even for learned, but who from -their ignorance of this so simple and easy method of relief, have been -in the disagreeable circumstance of seeing many women perish under their -hands, though they had to all appearance been very happily delivered. - -WITH respect to pregnant women, there is again another point of great -consequence to ascertain. Great care must be taken not to mistake the -signs of delivery. This is a very essential matter. Nothing scarce can -be more dangerous, than to excite a woman to the last labor-pains, which -will not fail of exhausting that strength of her’s, in vain, which had -so much better be reserved for the support of her in the time she will -really need it. So that a midwife ought to make it her business clearly -to distinguish the spurious pains from the true ones. Where a woman near -her time feels pains in the belly, the loins, or even the sexual parts; -they are not always to be taken for the true labor-pains. In this point, -the _touching_ will be a great guidance. - -IF the fœtus is still high in the uterus, and the situation of it does -not indicate a readiness for extrusion; if the waters are not -sufficiently prepared, or their pressure down not in due forwardness, -the pains must be assuaged by some calming anodine remedies: the patient -must be left to her rest, till things declare themselves more openly; -and then, as she will not have been fruitlessly fatigued and tormented, -the labor may proceed happily. - -THERE have been men-practitioners so very unskilful, or at a loss for -delivering women by the operation of their _hands_, that they tortured -their _heads_ to discover _medicines_ to save themselves the tediousness -of Nature’s taking her own time, as if she was to do her work the better -for their hurrying her. Towards the atchievement of this end, they -brought into play certain drugs, to which they gave the appellation of -hysteric, and placed or pretended to place great confidence in them. - -EVEN some of our modern practitioners prove, at least, by their -practice, that they have faith in the virtue of such drugs, since they -continue to use them. They are still suffered to make a figure in many -of the Pharmacopœas, though no sure experience hitherto has verified -their efficacy. On the contrary, a thousand and a thousand examples -might be quoted in demonstration of their insufficiency and danger. I -shall content myself with producing here the testimony of Mr. De la -Motte, in the second book of his observations, and he is not the only -man-midwife that does such medicines the justice of disapproving them. - - - _Observation_ 174. - -“A CELEBRATED man-midwife of this town (says Mr. de la Motte) pretended -to have a marvellous powder to provoke labor-pains, and accelerate -parturition. This powder was composed of galbanum, myrrh, savin, rue, -and other drugs, of which he made the patient take a dose, to hasten a -delivery, when the labor was lingering, from half a drachm to a drachm, -and after the effect of this medicine, which ended commonly in leaving -the patient in a worse condition than before the taking it, he -substituted the use of the crotchet, which was indeed an infallible -method of putting a speedy end to the labor; and of which he as well as -his fellow-practitioners made such a murderous use, the aid of the hand -well conducted being unknown to them. - -“THE same operator (says Mr. de la Motte) was sent for to assist a lady -who had continued in labour for three days, to whom he proposed a dose -of his powders, to which she readily consented in the hopes of a speedy -delivery. Unluckily, not most certainly for the lady, but for the honor -of the powders, the operator, not having had the providence of having -them about him, was forced to go home for them. The lady, in the mean -while, was brought very happily to bed, just as he was re-entering the -room with his dose for her. What a pity this was! What would not have -been the boast of the virtue of those pretious powders, if the delivery -had waited for them but half a quarter of an hour, though they would not -have had the least share in it, since it would have been purely the work -of Nature and Time. - -“THIS celebrated man-midwife was called to two other women of my -acquaintance, of whom the labor somewhat resembled that of this lady, -but of which the consequences were very different: he had made them take -his powders to no manner of purpose, when seeing that a day had passed -without their producing the expected effect, he had recourse to his -_crotchet_, with which he quickly _dispatched_ both the deliveries.” - - - _Observation_ 174, of the same Mr. De la Motte. - -“A GENTLEMAN who lived upon his fortune, without professing surgery, -though he had served his time to it, and had even formerly exercised it, -not only in France, but in Italy, and in other foreign countries, told -me, in conversation, that he had an infallible remedy to make a woman -bring forth instantaneously, however lingering and difficult her labor -might naturally be. Of this, he said, he had made undoubted experiments, -and that he had obtained this secret from an Italian, under oath of not -disclosing it to any one. He was more than a little surprized at finding -me without curiosity to learn from him this pretended secret, which he -imagined must concern me so much, as one who made open prefession of the -obstetrical art; and still greater was his surprize at seeing me change -the subject, without any sign of attention to what he had been saying on -this head.” - -“IN process of time, he married, and his wife being pregnant was got -into the time of her labor-pains towards delivery. It became now -expedient for him to declare this famous secret to me, which was no -other than half a drachm of borax in a glass of any innocent liquid -agreeable to the palate of the patient. But as this dose happened to be -administered by one who had no sort of faith in it, it had no effect: -his wife lay four days and four nights in labor; the child died the -moment after it was born, and the mother narrowly escaped following it.” - - - _Observation_ 176, (of M. De la Motte) - -“AS I was at Caën, a town of Normandy, attending the lying-in of a lady -there, an old stander of a practitioner of that place, and a man of good -abilities, told me, that he had been lately sent for to a woman who had -continued several days in labor, with slow and moderate pains. As he -found the fœtus well situated, he made the patient take an infusion of -three drachms of sena in the juice of a Seville orange, in order to -quicken the throws and advance the delivery, which indeed came on ten or -twelve hours afterwards, but the woman died, one may say, immediately -after it. - -“TO this account (continues M. De la Motte) I opposed, for answer, that -being at Bayeux, on the like occasion, an old practitioner in surgery of -that place, in conjunction with whom I had been called to visit a -patient, told me, in conversation, that he understood midwifery very -well, that he had even, not long before terminated a delivery given over -by another surgeon; that the child, one arm of which hung out, was dead, -before he put his hand to it, and that the mother, though well -delivered, died soon after.” - -THESE examples may suffice to prove, that the notion of giving histeric -medicines, for which the inventors did not forget to make themselves be -well paid, existed in M. De la Motte’s time, who is not but a modern -author: nor are they even to this hour absolutely exploded, tho’ some of -the men-midwives themselves have joined Mr. de la Motte’s cry against -them. It gives however those men-practitioners, who exclaim against a -quackery in others, by which themselves get nothing, a good sort of an -air: it serves even to render that more pernicious quackery of their -instruments the less obnoxious to suspicion. Nothing is easier to give -up than that by which nothing is got. If the instruments were not a plea -for the very essence of such a thing as a man-midwife, they too would be -given up. However, it will hardly be denied, that those same pompous -histeric medicines were the invention of _learned_ men-practitioners, -and not of those poor ignorant midwives, who, with respect to women in -labor, are of opinion, that there can nothing be more effectual for -their well-doing, than in the first place giving Nature fair-play, and, -when requisite, to assist her with the management of _natural_ hands -skilfully conducted: always observing neither to lapse nor precipitate -the critical time of such assistence. In the mean time, let a humane -reader but reflect how many mothers and children must have been, and -perhaps still continue to be the victims of a reliance in such -medicines, and he will allow, that such errors of practice, tho’ not -capital in the intention, are too often deplorably so in the effect. Is -it not true to say, considering the havock of the human species, so -presumably made by quackery and empiricism in general, that the lives of -the subject are less sacred than their property? Surely they are less -guarded, either by the laws, or by common sense. - -AS to a fœtus that presents an arm, or any other part than the head or -feet, there is rarely any thing to do but to slide the hand all along -that arm, or other part it may present, to find out the feet, and -terminate the delivery; without its being necessary to attempt the -reduction of any part or member. - -MOST of the writers on midwifery often start difficulties where there -are really none. They often give us emphatical accounts of a head too -large, and a passage too narrow, in which they state them as -difficulties that are invincible, when the case is far from being so. -When the fœtus presents fair, and is in a good posture, our method of -practice is, to advise the patient to remain as quiet a-bed as possible, -avoiding every thing that may tend to fatigue her body, or hurry her -spirits, to reserve in short her strength as much as possible. With time -and patience the head of the fœtus scarcely ever fails of moulding -itself to the passage, through a particular providence of Nature, which -has so ordered it, that the parietal bones of the head of the fœtus, so -flexile as to ride over one another, form a kind of oval figure, which -facilitates the issue, and dispose it for making way for itself, through -the extrusive pressure of the labor-throws. Mean while nothing should be -done to irritate the pains; the membranes should not be unnecessarily or -untimely burst, which loses the benefit of the waters. You can hardly, -in this case, rely too much on the benevolent efforts of Nature: she is -constantly at work for the patient’s delivery. Interruptions sometimes -only serve to mar or retard a favorable crisis: but all abrupt force or -violence is carefully to be avoided. As to bad postures of children, I -shall treat of them in the sequel, and of the means to remedy them. - - - - - Of DIFFICULT and SEVERE Cases. - - -IF an easy delivery requires nothing of extraordinary assistence; it is -not so with a difficult one. All the knowledge, experience, dexterity, -strength, prudence, tenderness, charity, and presence of mind, of which -a woman is capable, are requisite to accomplish certain laborious -deliveries. - -IT has been, in all times, very well known, that the most natural -situation for the fœtus coming into the world, is that, in which the -head presents first, it being that which commonly makes way for the rest -of the body. Yet this delivery may become difficult, in proportion to -the obstacles incident to it: obstacles not always surmountable, without -great skill and industry employed in aid of Nature. - -ON the other hand, when it is felt that the fœtus presents any other -part than the head, this position, called preternatural, oftenest -occasions the delivery to be more laborious and hard to accomplish, in -proportion to the more or less trouble there may be to search and come -rightly at the feet. - -MANY English and French authors have given us a long enumeration of the -causes which may make deliveries difficult and laborious. The curious -may have recourse to them; as for me, who have not proposed to myself -here a treatise compleat on all points, I shall content myself with -setting forth only what tends to fullfil my proposed aim, that is to -say, to take notice of those principal points, which first moved -insufficient midwives to call in surgery to their assistence, to remedy -their blunders, to retrieve their mischief, or to repair their -omissions. I shall consider the kinds of exigencies, which the -men-operators seized for a pretext of employing their iron and -steel-instruments, the use of the natural hand, being yet more unknown -to them than to the meanest midwife, and by this means, for the cure of -confessedly a great evil, obtruded an infinitely greater one, and more -extensive, in every sense, and in every point of light, that of men -taking the practical part of midwifery into their own hands, or rather -into their artificial ones of iron and steel, from which they derive all -the authority of their introduction in the character of men-midwives. - -THE labors then which are generally speaking looked on the most nice, -and arduous, may be comprized under the following heads. - -1st. THE obliquity of the uterus or womb. - -2dly. THE extraction of the head of the fœtus severed from the body, and -which shall have remained in the uterus. - -3dly. THAT labor in which the head of the fœtus remains hitched in the -passage, the body being intirely come out of the uterus. - -4thly. WHEN the head of the fœtus presents itself foremost, but sticks -in the passage. - -TO these I shall add the case of the pendulous belly, which is not -without its difficulty. - -OF all these classes of labors I shall treat separately. But before I -proceed on them, I presume, that it may not be improper preliminarily to -corroborate what I have said of the intrusion of the men into the -practice of a profession, of the essential part of which they were so -ignorant and disqualified for it, by the testimony which one of the best -men-midwives in Europe has not refused to the truth. - -THIS is M. de la Motte, one of the ablest and most intelligent modern -writers on the subject of midwifery, of which his works form an -incontestable proof. The ingenuity and candor with which he has written, -must render him less suspected than any other. This is no midwife. He is -a man, and esteemed an able practitioner, who learned the principles of -the art from Madam la Marche, head-midwife of the Hôtel Dieu at Paris. -He made his advantage of the works of his predecessors Mauriceau, Peu, -and of all the best authors on this subject. All that was worth it in -them he has transfused into his own writings; and that in a very clear -manner. He collected whatever the best physicians had usefully said on -the diseases of mother and child: in short, he has added many good -observations and reflexions of his own, in the journals of his manual -practice: the reading of his works, with some precaution however, cannot -but be useful to the students of the art. - -I DO this writer this justice, with the more readiness and pleasure, -for, that though he himself exercised the profession of man-midwife, and -consequently in favor of his own practice, and of the pupils he was -bringing up, was not without the injustice of adopting the prejudices of -his cotemporaries too indiscriminately against the midwives; he does not -suppress any truth relative to the art itself. But even, as to the -midwives, the truth escapes him without any design on his side of its -coming out. But such is the force of truth. And thus it appears. M. De -la Motte wrote in a little sorry country-town at a great distance from -the capital, being at the very extremity of the kingdom of France, on a -sea-coast, where there were no other midwives than poor country-women, -without knowledge, without skill, or any other qualification, than a -little of the habit of attending women in labor. Yet with all these -deficiencies it will appear, that the men-practitioners were far more to -be dreaded than those poor ignorant creatures, who had scarce any thing -but Nature for their guide. - -I SHALL here give the substance of what he says in his preface, followed -by some examples of the unskilfulness, or rather of the most profound -ignorance of the most able men-midwives of his time, for forty leagues -round his place of residence in the country. - -“IT is (says M. De la Motte) astonishing, that the obstetrical art -should, until the beginning of the preceding age, have been left either -to ignorant women, or to surgeons, who had not (any more than too many -to this day) any other resource in difficult labors, than some -instrument guided by undextrous hands, always sure of killing the child, -and endangering the mother. Do not these poor innocents deserve -compassion for being exposed to operations of surgery, which one would -rationally think they could not need, till providence should have at -least given them leave to come into the world?” - -HERE be it observed, that by the word “ignorant,” M. De la Motte should -not intend the application of it to the midwives of the Hôtel Dieu at -Paris, since, by his own confession, it is the best school of midwifery -in Europe. Nor certainly is he in the wrong. Be it in honor of truth -allowed me to say, that I know of those women who have served their -apprenticeship in this hospital, who would think they made a wretched -bargain, if they exchanged the manner of operating they learned there, -for all the Latin, Greek, Arabic, or the iron and steel instruments of -the best man-practitioner in Europe; even though his excellence in the -manual function should be thrown into the scale for make-weight. The -most constant success justifies their practice. In whatever situation -the fœtus has presented, I have seen them, without having recourse to a -man-midwife, and consequently to instruments, procure a happy delivery -in very difficult labors. I have myself seen one deliver a child that -had been dead in the mothers womb for near six weeks, without -dismembering it; and though it was half-putrified, and the head so -rotten-tender as to have no solid consistence, I dare advance this, -without fear of being falsified, since I can name the mother, now alive -in London, the witnesses, the place and year. - -SUCH real midwives as I am here discribing, for I do not mean the -spurious nominal ones, only fit to _create_ work for the -instrumentarians, or whose cue of interest is to do so, have no reason -to apprehend, that in the numbers they have lain, there can be any -found, that can complain of having suffered, or of suffering any the -least damage or inconvenience, after their lying-in, that might be -imputed to ignorance or mispractice. - -ON the contrary, I dare aver, that such, genuine midwives have cured -many women who had received notable injury, before they came under their -hands, in their having passed through those of the men-practitioners. -Nothing being more agreeable to Nature, to Reason, to Experience, than -that the method of practice of a skilful midwife is not only the most -easy and gentle, the least painful, but assuredly the most safe both for -mother and child. This is what the most severe examination will to -those, who give themselves the trouble of making it, establish, in -contempt of that fashion, by which so pernicious an error, as that of -preferring men-practitioners, has acquired more credit and influence -than so salutary and demonstrable a truth, as that for which I am -contending. In the mean time, let us hear what M. De la Motte himself, a -man-midwife, says of those brethren of his, of whom heaven grant there -may not exist to this day too many resemblers! - -“TO the shame (says M. de la Motte) of the profession they exercise, -they have no guide but their avarice, while the grossest ignorance of -the art of midwifery itself is their lot. Such are much to be dreaded by -women in difficult labor; for (adds he) they having no help to offer -them but that of their instruments, they employ them indifferently in -all the situations in which the fœtus presents. Nay, even the hands of -some who will use their hands, are not less dangerous when misconducted. -The ignorant therefore should never meddle with lyings-in. It would save -them from the reproach they may incur of murder, in undertaking what -they cannot execute, and what surpasses their skill. They would not -furnish _scenes_ that make one _shudder_ with _horror_. - -“I SPEAK here of so many poor women, whose strength shall have been -exhaust—by a great loss of blood, caused by the violences which an -ignorant man-midwife shall have made them suffer, I speak of women, -whose parts shall have been all bruised, and so vilely treated and torn, -as in some to lay the anus and vagina into one, besides their children -being dismembered, some their arms or legs plucked off, others the whole -body, the head being left behind in the uterus.” - -THIS is the language of a man-midwife himself, who candidly declaims -against the errors of his fellow-practitioners, undoubtedly without -designing that such their errors should be wrested into an objection to -the practice of that art being committed to the men. Such a conclusion -would in me be unfair, and a vain attempt to impose on the reader the -laudable condemnation of an abuse, for an indiscriminate reproach to the -whole set of men-midwives. This would however be but a kind of -retaliative treatment of those, who, from the defective practice of the -ignorant and unskilful midwives, of which if there was no more than one -in the world, that one would be much too many, take the unjust handle of -inveighing against midwives in general. - -EVEN la Motte himself, who, as I have before with pleasure observed, was -really as capable a man in the profession of midwifery as a man can be, -at least to judge of him by his writings, has embraced every occasion of -boasting the superiority of the men to the women in the exercise of -midwifery. But while he taxes men of _scenes_ that make one _shudder_ -with _horror_, the mistakes he imputes to the women, which are bad -enough in all conscience, are not however of that atrocious nature, as -those he relates of the men. Nay, with all his desire of under-rating -the women, he falls into even pitiful contradictions. Let the reader -himself decide on the following one. - -UPON an article of practice, for which M. De la Motte blames the -midwives, and what an article? not such as he reproaches to the -men-practitioners, murdering, maiming the women, or tearing their -children limb from limb, but purely for their applying certain bandages -to the belly of women after their lying-in, in order to keep that part -smooth from wrinkles; this very author, I say, who allowed the Hôtel -Dieu at Paris, where the manual function is wholly confined to women, to -be the best school of midwifery in Europe, where he himself wished, and -wished in vain, to be admitted to practise, and, in short, from the -head-midwife, of which Madam de la Marche he himself probably learned -all that was worth any thing in his practice, thus speaks of the -midwives bred up in that hospital. - -“THIS prerogative of having served apprentice in the Hôtel Dieu at -Paris, is not for these women, an _indifferent_ matter, for though they -were to have no more than a _shadow_ of _sense_, they are persuaded, -that in setting themselves off with a _title_ that does not render them -more _capable_, they ought to be honored and respected above all others, -which they would not fail of being, if they were to give some marks of -sufficiency beyond what others can give.[28]” - -THE nonsense of this objection of Mr. De la Motte is too glaring to need -a comment. If an education in the best school of midwifery in Europe, -does not give a woman a right to plead it for a title to reliance on her -superior sufficiency, without any reason therefore to accuse her of -vanity, what can give her a title? - -BUT to return to M. De la Motte’s sentiments on the practice of the -men-midwives; it will easily be seen, that the horrors he objects to -their practice, and of which he himself undoubtedly endeavoured to steer -as clear as he could, were of a nature, without the least breach of -candor, to suppose liable to repetitions wherever so false a doctrine -and practice prevail as the substituting steel and iron-instruments, or -“artificial hands” to natural ones. - -LET us now see what Mr. De la Motte thinks of the use of the CROTCHET. - -“WHEN I settled in my province (says this author[29]) I found several -ancient master-surgeons, who pretended to help the women in their -difficult, or preternatural labors, solely with the use of the crotchet; -without ever, in their life having made any _delivery_, but in that -manner, and as soon as they had extracted the fœtus with their crotchet, -they left the rest or the after-birth to be brought away by a woman, as -they themselves knew nothing of the matter. When they were fetched to -help a woman in labor, they took their crotchet, went to the woman, whom -they put into posture, and whether the child presented the head, breech, -arm or leg, whether it was dead or alive, a woman’s having passed a day -and a half in labor was cue more than enough for them to go to work with -their crotchet.” - -THE following extracts from the same Mr. De la Motte, may serve to -confirm the foregoing observation. - -“OBSERVATION 187. I was sent for to lay Madam de ... about fifteen -leagues from Valognes, the place of my residence, and there was at the -same time a surgeon of the town where I then was, who had been fetched -to lay a woman that had been in labor from the day before, whose child -presented the vertex: he, without further examination, put her into a -convenient posture, and with his crotchet brought away the child at -several pulls, with much pain and labor, and threw it under the bed, -with the after-birth, in the most severe season of the year: after -which, the operator hugged himself prodigiously, for having so happily -accomplished so difficult a labor. Having rested a little, and just as -he was going, a woman curious, bethought herself of seeing whether it -was a boy or girl: she found the poor child yet alive, though so mangled -with the crotchet, and that after having remained, in this condition, an -hour and a half, without its having been in the power of so violent an -operation, or of the rigor of the weather to terminate a life which -seemed to have held out against so many barbarities, only to reproach -the detestable operator with the enormity of his crime. The child was -christened and died soon after. - -“REFLEXION. This is what may be called a cruel ignorance, &c.”——To the -which I add, that if this wretched operator had had the patience to wait -some time, the child would in all probability have come naturally with -any the least help of the hand at every throw of the mother: for she had -not been over-time in labor, and the head was not, it seems, stuck in -the passage. - -“OBSERVATION 196, p. 274. I was desired to go to Cherbourg to lay a poor -woman there, whom a surgeon and a man-midwife by profession, belonging -to that place, had given over.... I found the woman in a condition hard -to describe, with an arm and a leg of her child pulled off, and the -remainder of the body left behind in the mother’s womb. I put her into -posture, and instantly delivered her of one child (it seems she went -with twins) who had only an arm plucked off: I then sought out the -other, whose leg had been torn away. Strange and fatal sight, which was -seen by more than twenty women present, all ready to swear to the truth -of this! I left the woman to their care, after having delivered her of -the after-birth. She had been as much hurt as the children, of whom -nothing remained in the uterus, by the care I took to evacuate it. I -left the mother tolerably well considering her condition.” - -REFLEXION. This was the more surprizing, for that the first operator was -an old practitioner, who had been an out-surgeon to the Hôtel Dieu above -eight years, before M. De la Motte was apprentice there. Yet this man -neither was sensible of the being twins in the case, nor had dexterity -enough in the manual function. Here I ask, could the most ignorant -midwife have acquitted herself worse than this _man_? - -“OBSERVATION 185. A tradesman’s wife of Valognes being taken in labor -sent for a midwife. A little while after her coming, the membranes -burst, the waters were discharged, and the child presented an arm. The -midwife required help. (Probably she might be one of the ignorant and -unskilful ones) and two surgeons were sent for, who passed for being the -most expert ones in the town. They begun with plucking off the arm that -presented, though the child was _alive_. The other arm, as soon as they -got hold of it, underwent the same fate. After which they struck the -crotchet into a rib, which they brought away, then two, then three, and, -at length, struck the crotchet into the back-bone, and pulled so -cleverly together, that they brought the child away doubled up. The -midwife delivered her of the after-birth, and notwithstanding all this -ill usage, the woman recovered; but it was a long while first.” - -REFLEXION. (Mr. De la Motte’s own) “Was there ever a crueller operation -seen both for the mother and child; the first terribly torn, the other -barbarously dismembered?” - -“OBSERVATION 186. The wife of a tallow-chandler of this town was taken -in labor: the waters were discharged, after which an arm of the child -presented. Help was sent for; one of the two operators (mentioned in the -foregoing observation) came with his servant and crotchet. He began his -operation, by plucking off the arm of this certainly live child, then, -without further examination, he strikes the crotchet into its body, and -pulled, without being able to bring away any thing. The master, whose -strength was exhausted, made his pupil help him, and they both pulled as -hard as they could: still nothing came, and I verily believe that the -master would have called in some body else to his assistence, if the -handle of the crotchet had been long enough, or that the poor woman had -not given up the ghost under the cruel torments they made her suffer, to -such a degree that they forced her to part with her life, sooner than -with her child. - -“REFLEXION. Here was a _delivery_ in intention, but the execution had -something horrid, and perfectly odious in it. I never could have -imagined, that two men could have pulled in this manner, without -dislocating the bones of the woman into whom the crotchet had been -struck: for so it was shown to be, upon the body being opened, in which -the child was found with an arm plucked off, entangled in the umbilical -chord round its neck, without the least mark of the crotchet upon its -body: too plain a proof this of the crotchet having been struck into the -mother and not the child, and consequently of the little circumspection, -not to say rage, with which the surgeon had acted upon the body of this -unhappy creature: for surely it must be granted, that it could be no -part of the child that could have resisted the terrible efforts made -both by master and man, jointly to bring it away; and yet this was one -of the BEST[30] operators in the country for HELPING women in labor. - - -“I COULD make a VOLUME of these histories, if they were good for any -thing but to excite horror.” Such is the witness born by M. De la Motte, -as to the _ablest_ men-midwives of his time, in all his province. Now in -order to invalidate the conclusion, so natural to be drawn from so -unexceptionable an attestation, against the superiority of the practice -of the men to that of the women, will it be said, that the -men-practitioners, in this country, are in general better educated than -such operators as have been above shown? If so great a falsity should be -advanced, let the reader himself reflect on what he may easily find to -be the common method of training up of men-pupils in this art. I have in -the first part of this work, stated some reasons for their -insufficiency, both in study and practice; and the more this point is -examined, the more clear will that undoubted truth appear, that if the -ignorant midwives are, as they undoubted are, a great evil, they are -even blessings in comparison to the generality of the men-practitioners, -bred up with the help of artificial Dolls, pretty prints, or even of -their personal visitation of those miserable wretches hired, or under -the mask of charity, forced to undergo, from apprentices or pupils, so -many inhuman tortures and outrages in vain. - -IT will also perhaps be said, as to the examples I have just produced -from M. De la Motte, that since his time, that is to say, about the -beginning of this century, that the art of midwifery has received so -much improvement, as to cancel all impressions of fear from such -examples. Yes! It has received improvement with a vengeance. If a vain -endeavour to perfect instruments, impossible to be perfected, or against -common sense to suppose, even when perfected superior to skilful hands, -are an improvement, then the art may be called improved. In the mean -time, infinite is the mischief done by so many pretending operators, -with each his bag of hard-ware at hand, his only proof of superiority to -a woman, in practice, confiding in those instruments. Their negative -damage is almost as great as their actual one. For by occasioning the -men, and even ignorant midwives to trust to the calling in their help, -the methods of predisposing of the women to parturition, the proper -precautions, and actual manual function in the labor-pains, which is a -point of the utmost importance, are at best but slightly and -prefunctorily, consequently not sufficiently, performed, or perhaps -wholly neglected. And why? because the instruments, the _crotchet_, the -_tire-tête_, the _forceps_, are considered as sure reserves to remedy -such deficiencies. This, besides many other reasons, encourages the -indolence, carelessness, and inattention of the men-practitioners, and -even of the midwives, especially of those poor suborned creatures -recommended by the men-practitioners, paid, as one may say in some -sense, not to do their work so well, as that none should be left for -their honorable patrons. Thence it has happened, that where an ignorant -midwife has, through her unskilfulness, or for whatever other reason, -been wanting in predisposing the passage, or lapsed the critical moments -of the manual aid, so that she really is or pretends to be out of her -depth, by the exigence being beyond her ability; the man-midwife is -called in, who, with his instruments, forces that delivery, which might, -if justice had been done to the patient, have proceeded in a natural -way, with much less pain and danger. Be this remarked, without my -speaking here of the extraordinary tortures and outrages, such as M. De -la Motte himself has related. The woman then is, by the help of -instruments, delivered by the man-midwife so called in. “If he had but -staid a few minutes longer, both mother and child must have been lost”. -So believes the father of the child, so believes the mother, so believe -most of the parties concerned, and what is more, sometimes so believes -the man-midwife himself. Though the strict truth has been, that the -greatest part of the pain the mother endured, and every appearance of -danger, either to her or to her child, were positively owing to nothing -but the negligence and mispractice used, either by man or -woman-practitioner, in reliance, if matters should come to the worst, on -the supplemental aid or reparation of errors, by those miserable -instruments, which constitute all the boasted improvements of an art, -the true nicety and requisite accuracy of which they are so much more -calculated to banish or destroy. - -I HAVE however quoted the foregoing examples from M. De la Motte. - -FIRST, Because that he himself being a man-midwife, and greatly partial -to the practice being best in the hands of men, his attestation must be -the less suspicious: but especially, because he was a professed enemy to -instruments, and adhered as closely as Nature would allow him, to the -imitation of those midwives from whom he had received all his -_knowledge_, and abused them afterwards for their _ignorance_, as if -their communication to him of their knowledge could not have been, -without leaving themselves wholly destitute of it to enrich him. - -SECONDLY, Because, the stories which he relates upon his own knowledge, -leaving me the fairest room to infer the necessary repetition of the -like tragical wents wherever instruments are admitted, it became less -invidious to specify them, than incidents of the like nature here: -especially, I say here, in London, or in England, where the use of those -instruments grows every day more and more rife, and must consequently -furnish the more examples of pain, destruction and danger caused by them -to the women, weak or prejudice-ridden enough to prefer the men to the -women-practitioners. - -BOTH Charity then and Prudence prescribe to me the not pointing out -particular persons to whom I could impute mispractice. If any one will -affect to treat this suppression as not owing thereto, but purely to an -impossibility of specifying cases of that sort, and of proving them; I -appeal to the candid reader, whether the nature of the charge -considered, such a specification can be expected from me, since, from -the examples I have produced, I pretend to infer no more than a -probability, the grounds of which I submit to himself, of the repetition -of the like acts from the same, or even from increasing the same -practice. - -IT would not perhaps be otherwise impossible to give some instances. For -example, I could expand a hint before given, of a man-midwife of this -town, who passes for eminent in his profession, and who not above five -years ago, was called to deliver a woman in labor, whose child presented -an arm. This practitioner, instead of searching out for the feet, to -extract this fœtus, that was quite alive, first plucks off one arm, then -another, then, at length, gives over the job, and left the poor mother -in this condition, who was forced to have recourse to a midwife to -finish the delivery. - -MORE than one operator, as I have before observed, in very natural -deliveries, instead of bringing away the after-birth, tore out the body -of the uterus; for all their boasted anatomy. - -ANOTHER gentleman-midwife delivered a woman of a fine child, or rather -received it, for it came naturally and easily. Upon which, he took it -into his head that he would not deliver her of the after-birth, -proposing to defer this work till next day. And so he would have done, -if he had not casually met with a less senseless practitioner, who -represented to him the danger to which, by so doing, he exposed the poor -patient he had left, and advised him to go back as fast as he could to -deliver her.[31] - -I HAVE myself been not a little surprized at hearing lately some ladies -mention, with much approbation, the inimitable complaisance of certain -gentlemen-midwives, who have the patience, as they call it, to wait -five, six, seven hours by the clock, before they deliver of the -after-birth after the issue of the child, and that out of tenderness to -the patients, who, as they say, would be sadly off, if they fell into -hands more quick and expeditious. - -BUT while I am thus taking notice of the errors of practice in the -men-practitioners, it may be objected to me, that I deal unfairly with -my reader. - -FIRST, In not furnishing instances of male-practice of the midwives. - -SECONDLY, That whereas I have confessed the incapacity of some of the -midwives, without allowing inferences from them against all the -professors of the art who are of the female sex, I ought to make the -same equitable allowance as to the men-practitioners, and not condemn -all for the sake of those insufficient ones, which the capable ones -themselves candidly condemn, witness among others, M. De la Motte. - -NOW, as to my omitting such a specification of instances of mispractice -in my own sex, it is neither from partiality, nor affectation, that this -omission of mine proceeds. For could any one be so weak as retaliatively -to state cases, in the manner I have done, of mispractice of some -midwives; nothing could be more superfluous, nor less to the purpose. My -confession, my lamentation, that there are but too many ignorant -midwives, palpably obviate the necessity of proving what is granted. The -public would be very little the better for a truth, with which it cannot -but be too well acquainted, that there are ignorant midwives, and -insufficient men-practitioners. The truth then, for which I contend, is, -that the faults of the midwives, however it may be wished that they -could be prevented, are, comparatively speaking, neither so likely to -exist in Nature, nor of that horrid, atrocious kind, that are to be -found in the practice of the men-practitioners or instrumentarians. -There is nothing among the midwives of the puncturing, tearing with cold -pinchers, maiming, mangling, pulling limb from limb, disabling, as must -be inseparable in a greater or less degree from the use of those iron -and steel-instruments, which are so often and so unnecessarily employed. - -AS to the second objection, of my not making any distinction of the -capable from the incapable men-practitioners. The reason of that is -obvious. It results from the fairest comparison of the two sexes, in -respect to midwifery, independent of any such examples as have been -produced against any particular individuals of that profession in the -men. Nature has so favored the midwives, that among them the bad ones -are evidently an exception to the general rule, of the fitness of that -sex for the art: whereas among men, the bad practitioners are, and must -for ever be, the general rule, and the good ones the exception, if so it -is, that, in Nature, there can be such an exception: he that makes a -practice of using instruments can hardly be one. - -NOTHING however will more conduce to establish the natural -disqualification of the men for this art, than a fair consideration of -that capitally essential branch of it, the ART of TOUCHING, in order to -ascertain the state of pregnant women, and the difficulties so necessary -to be foreknown in order to be lessened or avoided. On due prevention -often depends the saving the life of both mother and child; it cannot -then be thought a digression, that I transiently give a summary account -of this great light or guidance to that prevention, even though this -work is nothing of a regular treatise of the art. - - - Of TOUCHING. - -CONDUCIVELY to a just idea of touching, there should be a just -foundation laid of a competent knowledge of the fabric of the sexual -parts, of the conformation of the _pelvis_, and of the bones which -constitute it. There requires no depth of anatomy to know, in general, -that the _pelvis_ is composed of that part of the back-bone called the -_os sacrum_, terminated at the bottom by the _coccyx_, of the _ilia_, -and the _os pubis_. In the cavity formed by the assemblage of these -bones is the _uterus_, suspended between the bladder and the _intestinum -rectum_, by four ligaments called broad and round. The two broad ones -are a production of the _peritonæum_, on the side of the _vertebræ_, and -terminate on each side of the uterus near the fallopian tubes. The round -issue on the side of the _fundus uteri_, immediately under the tubes, -and from thence passing through the _peritonæum_, and crossing the -muscles of the hypogastrium, are inserted at the pubis and common -membrane or integument of the fore-part of the thighs. I pretend here -nothing further, than to give a summary sketch of these parts, a more -particularized one being here needless. Suffize it to observe, that no -good midwife can be without a proper and distinct conception of their -position and conformation, not only for touching, but for operating with -success. - -TOUCHING, in the terms of art, consists in the introduction of one or -two fingers into the vagina, and thereby into the orifice of the uterus -of the person, whose state or situation requires to be known. There -scarcely needs admonishing on this occasion, a midwife, of the due care -of her hands, being properly prepared and guarded from the least danger -of hurting. Such a precaution recommends itself. - -THE touch then is the most nice and essential point of the art of -midwifery. Nor to acquire a sufficient degree of accuracy in it, can -there be too much pains taken, considering how much depends on it. -Midwives only of great practice, or lying-in hospitals, where there is -full liberty for the young female practitioners to make observations, -can render it familiar to the learner. I presume I may take for granted, -that such a practical study is not extremely decent, nor proper for -young lads. And yet, at their season of life it is, that this study -should be begun, if but to give expertness the necessary time to attain, -through habit, its full growth, against the age of exercising the manual -function. It must surely be rather too late, for a man to commence his -course of touching at the age of practising; as it must be too soon, at -a season of life, where his capital end of _touching_ will probably not -be the acquisition of the science. At whose expence then must the -rudiments of a man’s study of this branch of the art be? surely at that -of the unfortunate women, subjected to the annoyance of such nauseous -and profitless visitation. In short, this is ONE of the points of the -art, from the nature of which it may fairly, and without implication of -contradiction, be pronounced, that the greatest anatomist in Europe may -nevertheless be a very indifferent, not to say a miserable man-midwife: -or even that a very indifferent anatomist may for all that be an -excellent manual practitioner. - -A MIDWIFE, duly qualified by Nature and art, with a shreudness and -delicacy of the touch, is, when requisite, capable of giving, in virtue -thereof, a just account of a woman’s condition. She is enabled to make -faithful reports to the physician, and inform him of the needful -concerning the state of his patient, where any co-incidence of pregnancy -sollicits his attention. By the same means she can distinguish the true -labor-pains from the false ones; and when the term of delivery is at -hand, it may, by the touch, be discerned, whether the labor will be easy -or hard, whether the fœtus is well or ill situated. With other -precognitions, highly necessary for our taking proper measures both -obviative and actual. - -I SAY necessary, because it is from this practice of touching that we -draw our prognostics, both for the predisposition of the passage, in -order to save pain by proper anticipation, and to smooth or facilitate a -happy delivery. It is then the touch that serves us for a guide, and -certifies to us the situation of the uterus, its rectitude or its -obliquity, as well as what part the fœtus presents. - -IT is in short by the information we receive from the touch, that we are -enabled in good time to remedy, or at least to lessen all the obstacles: -so that by the very same means, by which we obviate any necessity of -recourse to instruments, we at the same time alleviate the pains and -sufferings of the party: which one would think no inconsiderable -advantage of the female over the male practice, which last is so -constitutionally more rough and more violent. - -SUCH is the capital importance of the TOUCH, undeniable, I presume even -by the men-practitioners. But will any of the hemidwives then, with -those special delicate soft hands of theirs, and their long taper pretty -fingers, pretend to vye with the women in the exquisite sense or faculty -of the touch, with which Nature herself has so palpably endowed and -qualified them for the necessary shreudness of discernment, that in them -it can scarcely be deemed an acquisition of art? If the encroachments -however of the male-practitioners proceed, under color of their vast -superiority, I should not be surprized at seeing, ere long, a grave set -of grey-bearded gentlemen-midwives impannelled in lieu of a jury of -matrons, on a female convict pleading her belly. What can hinder the -redress of such a grievance, as the law has authorized for so many ages, -but the object not being one of a pecuniary enough interest to tempt the -men to interfere in it? they would be in the wrong however not to apply -for the office, since it would not be one of the least innocent -occasions for them to improve their hand in the mistery of _touching_. - -BUT let them pretend what they will, so great is the advantage, so -liberal of her gift has Nature been to women, in that aptitude of -theirs, which may be termed a knack of touching, that the hand of a true -midwife will, at the deriving of indications from the report of its -touch, beat the most scientific head of a man-practitioner, though -stuffed never so full with Greek and Latin. Yes, an ignorant midwife, -without perhaps anatomy enough to know where the _pineal gland_ is, or -without so much as having heard the name of the _ossa innominata_, and -with purely her expertness, and with that sort of knowledge she has at -her fingers ends, will give you a more useful and practical account of -matters, as they go, where it is sometimes so infinitely important to -know how they go, than the most learned anatomist that ever dissected a -corpse, brandished a forceps, stuck a crotchet into a child’s brain-pan, -or tore open a living woman. - -UPON this point of touching there occurs a consideration, on which I -have before just transiently touched, and beg leave, for the sake of its -importance, to give it some expansion. - -IN my objection to a man’s practising this branch of art, TOUCHING, I -wave here the natural repugnance all the parties must have to it, even -the man-midwife himself, on any footing but of that of interest, -allowing an exclusion of any libertine design, I wave especially the -argument against it, from its being a kind of invasion of a husband’s -incommunicable prerogative; I even wave the breach of modesty, I suppose -all this to be answered by the plea of superior safety, however false -and imaginary that plea may be. But surely it will be allowed me to pity -the unfortunate condition of a woman, subjected to so disagreeable a -visitation; a visitation which, instead of being performed in the -gentle, congenial, and especially, as to the end, satisfactory manner, -of which the women alone are capable, must furnish a scene, not only -unprofitable, disgustfully coarse, and even ridiculous, but also most -probably a very painful one. Figure to yourself that respectable -personage a He-midwife, quite as grave and solemn as you please, with a -look composed to all that “DELICACY _of_ DECORUM,” recommended by Dr. -Smellie, and so suitable to the high DIGNITY of the _office_ he is -undertaking of _touching_ the unhappy woman, subjected to his -pretentions of useful discovery by it. What must not parts, which -dispute exquisiteness of sensibility with the eye itself, suffer from -hands, naturally none of the softest, and perhaps callous with handling -iron and steel instruments, from some hands, in short, scarce less hard -than the instruments themselves, boisterously grabbling and rummaging -for such nice indications, as their want of fineness in the touch must -for ever refuse them? what if they may possibly, by such coarse -_touching_, find some common, obvious signs presenting themselves, so -that the grossest touch cannot escape distinguishing them; does it -therefore follow, that the nicer points on which so much may depend for -preparatory disposal, will not escape hands, scarce not less -disqualified for the necessary discernment, than a midwife’s if she had -gloves on? in the mean while, what torture must not the poor woman -endure, in every sense, from the wounds of modesty, and even of her -person? and for what? that the doctor may, with a significant nod, or -silent shrug, give himself the false air of being satisfied about what -he was pretending to look for; or, if he speaks, come off with some -jargon, only the more respectfully received by the patient, for its -neither being common sense, nor intelligible to her; or perhaps, if he -has any by-ends in view, or is a man of gallantry, here is a fine -occasion for his placing a compliment. But for any essential advantage -to her, from such a quackery of painful perquisition, she need not -expect it. The infinitely important service of predisposing the -passages, and of obviating difficulties, to be only ascertained by that -faculty of touching, is palpably and peculiarly appropriated by Nature -to the women only; and it is from them alone that a woman must, -naturally and truly speaking, be the least shocked at receiving such -service. Whereas in being _touched_ by a man, besides, I once more say, -besides the revoltingness of Nature, and the protest of female modesty -against it, besides the pain inseparable from it, besides even its -insufficiency; the safety of the woman is destroyed to the very -foundations, by the negation of due foreknowledge and proper disposal, -against the actual crisis of danger or the real labor-pains, the -mitigation of which, and facilitating the delivery, depend so much on -the _accuracy_ of the _touch_. - -WHOEVER then will but consider that greater aptitude of organization in -the women for fineness of that sense of touching, will allow, that I beg -no question, when I aver, proverbially, but truly speaking, that if one -hundred points of qualification were requisite to constitute this -capital faculty of TOUCHING, a midwife already possesses, in the but -being a woman, ninety-nine of them, the sure and certain gift of Nature: -and the remaining one from Art, may with great ease, with a little -instruction and experience, be acquired. Whereas, the He-midwife, not -only, as not being a woman, wants the whole ninety-nine, but can never -receive the hundredth at the hands of Art, but in so imperfect a degree, -that his trusting it will make it worse to the unfortunate woman that -shall trust him, than if he was wholly without it. I might perhaps, not -without reason, extend this allegation of the superiority of the female -sex over the male in this point, and in the same proportion, to the -whole of the manual function, but that I am more afraid of exagerating, -than even of falling short of the truth. - -SURELY then, one might imagine, that the parties principally concerned -in liquidating this difference for the government of their decision, on -a point of such capital importance, would not do amiss to consider it, -before they suffer themselves to be imposed upon in the manner they are -by the men-pretenders to a purely female office. An imposition so very -gross, that instead of answering the end of those on whom it passes, -that of greater safety, only encreases the dreaded danger. And most -assuredly, the women who subject themselves to it, do so, if with no -scandal to their modesty at least to their understanding; for being sunk -to so low a degree of cheapness, as even to purchase, with a sort of -prostitution, innocent let it be, it is still a prostitution, after -which money is a consideration beneath mention, and to purchase what? -danger to their own life, danger to that of the pretious burthen within -them, and, at the very least, an increase of bodily pain to themselves. - -MR. De la Motte, in his 188th OBSERVATION, p. 265, _Leyden ed._ makes an -animadversion upon a midwife’s _touching_ a patient, which, unless he -was induced to it by that spirit of injustice to midwives in general, -against which injustice all his usual candor is sometimes not proof, -would persuade me, that he was more ignorant of the nature and ends of -_touching_, than what his works show him to have been in other parts of -the profession. - -IN that OBSERVATION he gives you the case of a woman in labor, to whom -he was called, whose membranes a midwife had prematurely broke, whom she -had actually over-fatigued with making her too often shift her posture, -and also with incessant and reiterated TOUCHINGS (_attouchemens qu’elle -reïteroit sans relâche_) and all this, from a principle of avarice, in -order to make the quicker riddance, for the sake of attending a richer -patient, where she expected greater gain; “as if (says Mr. De la Motte, -in words that ought to be engraved in every practitioners heart) a poor -woman was more to be neglected than a wealthy one, in the presence of a -God who judges all our actions.” - -FOR my quoting this case, especially as it regards the point of TOUCHING -now under discussion, my reason, from the considerations to which it -will give rise in the reader’s own mind, will probably appear so -satisfactory to him, that he will easily absolve me of any charge of -digression. - -AS to the midwife’s bringing on the premature discharge of the waters, -if the fact was true: it was very blameable practice. It is a practice -that all capable midwives reprove and forbid, as it is robbing the part -of the most natural and necessary lubrication for facilitating the -launch in due time of the fœtus. I have been assured, with what truth I -cannot well warrant, that the men-practitioners are commonly much too -precipitate in the breaking of the membranes. Be the practitioners then -of what sex they may, such practice is bad. - -BUT, as to the motive M. De la Motte attributes to the midwife, of -avarice for such a procedure, I should heartily join with him in -condemning her, if the mention he makes of the REITERATED TOUCHINGS did -not make me suspect not his sincerity but his knowledge. If the poor -midwife had been to write the case, I have the charity to think she -could, with truth, have given a better reason for her practice than a -suggestion of avarice. At the worst, however, so criminal a spring of -action in such a conjuncture, could only be personal to herself, not -affect the midwives in general. Mr. De la Motte himself would own this, -who, as the reader may see p. 286, does not spare the men-practitioners -on this head, without meaning, that he or his fraternity should be -involved in any sinister inference from thence. And, indeed, I should -have a right to laugh at men-practitioners reproaching the midwives with -interestedness. I fancy I can have few readers so ignorant, as not to -know by which of the two sexes the greater fees are expected; which sex, -in short, looks the most out of humor, when those same fees do not -amount to the practitioner’s idea of the DECORUM of his “DIGNITY.” - -BUT let that pass. I come now to the great point of the TOUCHINGS -complained of by M. De la Motte, and I sincerely believe unjustly -complained of. My cause of such belief is this: I am well grounded in my -averring, that in many labors much depends on the rectification of -things, (this will be hereafter more at large explained) by the act of -touching, not only reiterated, but sometimes even not to be discontinued -for hours together. And these _touchings_ are so far from fatiguing, or -vexing the patient, that they often prove her greatest relief from pain, -and even preservation from danger, by the facilitation they procure to -the issue of the fœtus, that is to say, if they are skilfully managed. - -I HAVE myself known women in pain, and even before their labor-pains -came on, find, or imagine they found, a mitigation of their complaints, -by the simple application of the midwife’s hand; gently chasing or -stroaking them: a mitigation which, I presume, they would have been -ashamed to ask, if they had been weak enough to expect it, from the -delicate fist of a great-horse-godmother of a he-midwife, however -softened his figure might be by his pocket-night-gown being of flowered -callico, or his cap of office tied with pink and silver ribbons; for I -presume he would scarce, against Dr. Smellie’s express authority, go -about a function of this nature in a full-suit, and a tie-wig. - -I AM also the more ready to believe, that these same _touchings_, with -which M. De la Motte, finds fault had in this case been really of -service, since he confesses, he found the child “_well situated, and_ -FAR ADVANCED _in the passage_”; and withal offers no reason to think, -but that it was so _far advanced_ from the _touchings_, not in spite of -the _touchings_. - -WE shall now see what followed. Mr. De la Motte, that despiser of -midwives; Mr. De la Motte, who so consistently regretted his not being -admitted to the Hôtel Dieu at Paris, and accuses the women, educated at -that Hospital, of vanity, for valuing themselves on that education, -behaved himself on this occasion, as indeed his merit was that on most -occasions he did so, like a true good midwife: he found things _far -advanced_ enough, for him to leave the rest very wisely to Nature, and -so he did. The consequence of which was, that the patient was soon -delivered of a fine boy, and both mother and child did well. - -SUCH was the result of Mr. De la Motte’s true midwifely proceeding. But -what would an instrumentarian have probably done? One of those, I say, -who, as to all the boasted improvement of the obstetrical art, produce -the stupendous inventions of those surely rather weapons of death, than -of life, which Dr. Smellie calls his REINFORCEMENTS, and is so good as -“_principally_” to recommend, “_namely the small forceps, blunt hook, -scissors, and curve crotchets_”, the unenviable privilege of using which -blessed substitutes to the soft fingers of women, being supposed -inherent to the men by right of superiority of skill, has so greatly -IMPROVED the art of midwifery, and thinned the number of good midwives, -by exploding their so much less painful, and certainly more safe method -of practice, both for mother and child? For after all, what can such -instruments be expected to do, but, instead of improving the art, to -multiply murders? if this should appear too severe, hear what Mr. De la -Motte himself says to the very case in point: to this very case, in -which himself, I repeat it, did no more than play the part of the good -midwife, and was only the more commendable for doing so. - -“IF the operator of the place had been called, he would DOUBTLESS have -proceeded in this delivery, as he had done in the other (see p. 292.) -that is to say, he would have _quickly_ dispatched it with his -_crotchet_: but on the contrary, if he had had any experience, he would -have conducted the other delivery as I did this, and thereby have -exempted himself from the reproach he must have made to himself, for -having killed a poor woman in the most _cruel_ manner.” - -HAPPY! thrice happy it is for the midwives, that, at least, if avarice -should tempt any of them to the injustice of hurrying a poor patient’s -delivery, in order to attend a rich one; a circumstance which, I fancy -however, does not more often occur to the female than to the -male-practitioners; the woman cannot, at least, use towards -precipitating such deliveries means so violent as the men. They appear -only in guise of peaceable simple seconds to Nature: the men take the -field, armed as combatants against her. The women can but prematurate -things by excitation of the hand; they may be guilty of reprehensible -negligence, they may be over curious in their bandages, by way of -smoothing wrinkles after delivery; in short, they may commit many -faults, which I am far from justifying, or even extenuating; but at the -very worst, I defy them to equal the instrumentarians in mischief; nor -can their practice abound with those horrors, of which a man-midwife -tells us he could furnish VOLUMES (p. 298.) horrors which must be so -greatly multiplied since his time, as the recourse to instruments is -more than ever pursued, in practice, though so fallaciously disowned in -the theory; under which disavowal the gentlemen midwives figuratively -conceal their bag of hard-ware, just as Dr. Smellie directs them -literally to do in their visits to patients. - -BUT to resume the subject of TOUCHING, I am to observe, that among its -essential services on many occasions, both during the pregnancy, and in -the actual labor-pains, there is one case, which, for its frequency and -importance, deserves a separate consideration: it is that of the -obliquity of the uterus, of which touching not only serves to inform, -but to rectify it. I shall therefore dedicate a section to the treating -of it. - - - Of the OBLIQUITY of the UTERUS. - -BY the obliquity of the uterus I mean its untoward situation. For either -the uterus preserves its natural direction, or does not preserve it. -Where the uterus preserves it, I call it well placed: the point of it is -turned directly to the cavity of the pelvis, and the _fundus uteri_ is -suspended in the space between the umbilical region and the vertebræ: if -the uterus does not preserve its natural direction, if it inclines too -much forwards, backwards, or towards either the right or the left side, -I call it oblique, or untowardly placed. All the other situations of the -uterus are reducible to these four, from which they differ no otherwise -than as its line that should naturally be perpendicular to that of the -vagina deviates more or less from it towards any of them. It is from -this obliquity, greater or less, that proceeds, by much the most often, -the greater or the less difficulty of the lyings-in. - -IT would be superfluous here to analise all the causes of such -obliquity, because, being mostly natural ones, there is no preventing -them. But there are some causes of it, or at least, that appear to me to -be sometimes the causes of it, that it cannot be improper for me to -premise here, for precaution-sake. - -I HAVE then some reason to think, that both here and in Holland the -stays contribute much to the obliquity of the uterus. For though women, -during their pregnancy, may perhaps wear them looser than at other -times; yet their natural hardness pressing on the belly, with the stiff -whalebones, always too many if there are any at all, cramp the fœtus and -the womb, to which the stays too often give a bad situation, according -to their motion or swagging more to one side than to the other, in their -state of looseness; and if they were laced tighter, that would be yet -more dangerous. - -I COULD wish then, that women with child would either content themselves -with wearing a bodice only, or stays without any whalebone, but at the -back just to serve the loins, and even those not to come so low down as -I have seen some. The obliquity of the uterus is much rarer in France -than it is here, for which I cannot account otherwise, than from the -women there avoiding any prejudice from their stays, during their -pregnancy. There is another cause, as I apprehend it, of the lateral -byass, which is the lying too constantly on either side, whence the -uterus contracts a habit of inclination to that side. The probability of -such an effect I submit to the anatomists, as I speak here only -conjecturally, and not with the presumption of certainty. - -THE obliquity of the uterus may be discerned from the difficulty there -will be, in touching, to come at its orifice. And it is by touching -alone that you can hope to discover which way its deviation points, -whether it is placed too high towards the _os pubis_, too much turned -towards the curve of the vertebræ, or in a lateral direction, towards -either the right or left _ilion_. But which ever way that mis-direction -points, the difficulty of the delivery is proportionable to the degree -of it: and the skill and knowledge of the midwife in not only the -reduction, but the keeping of the uterus to its due position, till the -delivery is accomplished, form one of those principal branches of the -art, for which the gentlemen-midwives must be naturally so unfit. - -THERE are very few authors who have treated of this obliquity of the -uterus. Some do not mention it at all, others speak of it, but so -slightly as to escape attention. - -DR. Smellie in his enumeration of the cases, by which laborious labors -are occasioned, which he ranges under seven heads, has intirely omitted -this case of obliquity. He has bestowed indeed a whole chapter on the -distortion of the pelvis, a case I take to be comparatively infinitely -rarer than an obliquity of the uterus. He might as well suppose a -frequent vitious conformation of the cheek-bones, as of those that form -the pelvis: which, were it so, must necessarily imply a constant -recurrence of hard labors in the same woman, which is not often the -case. Whereas the liableness of the uterus to an obliquity from various -accidents, principally accounts for the easiness of one labor in a -woman, being no argument for her not having a hard one in future, or -convertibly. I dare aver then, that in the course of my practice, which -is not the least extensive one, this very case of obliquity has occurred -to me oftener than all the others put together, and indeed caused me the -most pain to remedy or conquer. Why then such an omission by these -writers? I cannot conceive, unless that they were aware of the -consequence, obvious to be drawn from thence, that women, by the -superior fitness of their hands, must be the properest to apply the -topical remedy; and that their iron and steel instruments could not so -well be set to work in such a case, at least in due time. This is -absolutely so true, that in the case of this very obliquity, which -occasions most of the very lingering labors, for which the midwives, who -have not preventively exerted themselves to reduce it, and thereby to -clear the passage for the fœtus, have no remedy but patience; those very -lingering labors, I say, which shall have thus arisen from the want of -skill or prevention, furnish the men-practitioners with a pretence to -dispatch them with their instruments. Thus they, often murderously for -the child, and injuriously to the mother, terminate many a delivery, -which a gentle and constant reduction of the uterus would have so much -more safely and less painfully accomplished. And how accomplished? -evidently not by any violence to Nature, but purely by redressing the -wrong she is in, oftenest not by her own fault, but by some adventitious -cause, in which she has been rather a passive sufferer than originally -herself deficient. A justice this of distinction too often refused her, -and from which too many errors of practice arise, perhaps in more cases -than this. - -HOWEVER, this is certain, that this case of the obliquity of the uterus -deserves much more notice and attention than have been paid to it. It is -one of the most important difficulties of the art. - -HE who treats the most at large of this matter is Daventer, who, I have -strong reasons for believing, first took the hint from some midwife: but -a hint, which the usual imperfection of the manual function in men -hindered him from duly improving. For in the way he sets forth the -different inclinations of the uterus, and the methods of rectifying -them, instead of throwing a practical light upon the subject, he has -obscured it with errors, absurdities, and repetitions without number or -excuse. - -BUT that I may not appear to treat this author dogmatically, and -especially as he furnishes me with an occasion of further elucidating a -point of such great importance to the art of which I am treating, I must -here intreat the attention of those readers, especially who deign to -peruse me rather in the search of useful truth, than of amusement, of -which indeed so serious a matter is so little susceptible. - -LET us then examine some of Daventer’s methods of practice, so -inconsequential to so just a theory as that of the mis-direction -incident to the uterus. - -DAVENTER, chap. xlvi. p. 288, French edition, treating of the -rectification of an obliquity of the uterus fallen forwards, goes on -thus. “When the membrane is broke, and the vertex of the head partly -come forth, there is no longer occasion to support, as before, the -orifice of the uterus. It should be let fall with the head beyond the -curvature of the os sacrum. The head will make its way much more easily -than if it was still wrapped up in the uterus (_indeed!_) Now to make -the fœtus come forth, the midwife must, as she did at the beginning, -employ both her hands; the one internally applied, the other externally; -but take care so to do judiciously. Neither must she wait till the -labor-pains are over, before she sets her hands to work, as I have just -before observed. On the contrary, it is in the time of the throws that -she must operate, and when they are on the decline, terminate the -delivery. The midwife therefore should not barely content herself with -watching the time of the pains, but should also admonish, at every one -of them, her patient to second them with all her strength, in order that -the child may advance the more under their stronger protrusion. During -which, the midwife having her hand in the vagina, the back turned -towards the rectum is to advance the tip of her fingers, the most she -can, under the head of the child, taking care however not to overpress -them; and in this posture, she is to keep her hands unmoveable, till she -feels the labor-pains come on. The other hand she is to put on the -hypogastrium, nearly over the place answering to the _fundus uteri_; and -when the pains shall begin, she is to give her hands such action, that -that which is in the vagina shall push back the coccyx, and the other -applied externally shall push up gently the _fundus uteri_, and at the -same time determine its orifice towards the pelvis. I say gently. But -this is to be understood of the beginning of the throws, for in -proportion as they increase, the midwife must press the harder. - -“CARE must, in the mean time, be taken, that the pression made on the -belly must not be too violent but _very_ moderate: whereas that made on -the coccyx must be with the midwife’s whole strength, with this -attention however, _first_, that this great effort must not be made but -when the force of the throws obliges the woman strongly to contract the -muscles of the hypogastrium, and must cease with those throws. -_Secondly_, that the hand must be laid flat on the coccyx, not with the -fingers half-bent, least the joints should hurt the woman. _Thirdly_, -that the hand may be as much expanded as possible, that the pression may -be equal on all parts. Observing these three conditions, the midwife may -employ her _whole_ strength, without _fear_ of doing any harm to the -woman. On the contrary, she will greatly relieve her.” - -TO the which I have to say, that I should greatly pity a woman that -should fall under the hands of a woman that should receive such -directions from Monsieur l’Accoucheur, and much more yet, if she was to -be under his. A midwife to operate thus! with one hand in and the other -out, over the lower part of the belly, “gently” says Daventer, and yet -stronger in proportion as the throws increase: and a little after he -says, this pression on the belly must not be too violent, but _very_ -moderate. I confess, I do not understand, but that may be my fault, how -a pression can be stronger and stronger as the pains increase, without -ceasing to be gentle or very moderate. - -BESIDES; as to the pression of the midwife’s hand on the coccyx of the -patient, so violent as he advises it, with the whole strength of the -midwife, can this be executed without causing to the vagina or rectum a -contusion, very capable of bringing on a gangrene, of causing a -mortification, or, in short, the laceration of the frænum labiorum, -whatever he may say to the contrary? - -I OBSERVE, by the way, that in this very chapter Daventer supposes the -heads of children breaking themselves, sometimes against the os pubis, -or the vertebræ, as if these were bare bones, at least he is to me, in -these points, unintelligible. - -HE goes on to object, that if, through ignorance, Nature has been so far -left to herself, that the point of the uterus should be fallen into the -pelvis, that its orifice, and the head of the child, should be fallen -into the lower curve of the _os sacrum_, that the membrane should be -broke, and the child’s head a little discovered, and withal, the woman’s -strength much exhausted, - -“TO change, (says Daventer) this situation, thus you must proceed. The -woman must rest upon her knees and elbows, with her head low. And what -(adds he) determines the placing a woman in this posture, is, that the -weight of the uterus may impel it to the side of the diaphragma, and -consequently withdraw it from the sinuosity of the coccyx.” - -TO me it appears impossible, that a woman, whose strength shall have -been exhausted, or but much diminished, can put herself into such a -posture, which could only serve to make her lose any little strength she -might have left. - -AT the end of the said chap. xlvi. Daventer concludes in the following -terms. - -“HOWEVER, to say the truth, of whatever kind the obliquity of the uterus -may be, I hold, that the safest, the easiest, and the least painful -expedient, is the footling-extraction of the child, from the very -beginning of the labor, before or immediately after the discharge of the -waters, as soon as one can be assured that the pains the woman feels are -the labor-pains. If this method should be followed, which I hope (adds -he) it will one day be, it would preserve an incredible number of women -and children, the unhappy victims of a contrary practice.” - -HERE I must confess the shallowness of my understanding. Such a -reasoning as Daventer’s in this case passes my conception. He allows, -that in all the obliquities of the uterus, it is extremely difficult to -find the orifice, to come at it, and to introduce the fingers into it: -nay, he owns, that it is not without a great deal of trouble, that you -can get to touch but the surface of that orifice; and after that -confession, he tells you very gravely that, in such cases, you must -deliver the child by the feet, in the very beginning of the labor, -before even the discharge of the waters, or at least soon after. - -OUGHT then the translator of Daventer, who is at the same time his -apologist, in good conscience, boast so much the discoveries of this -author upon the obliquity of the uterus? is it possible for common sense -to give the approbation that he does to those easiest, safest, and least -painful methods, that he recommends for relieving the mother and child -in those cases of obliquity? - -I AM then too much prepared to be surprized, in the chapter following -that from which I have quoted, to find him, where treating of an uterus -too much inclined towards the vertebræ, not scruple to reason as -follows. - -“BUT if the child is too much compressed, or has a head over large, so -that it is not without much difficulty to the midwife, and pain to the -woman, that it can be hoped to bring the child into the pelvis, a state -of things which does not unseldom happen, I judge that, to prevent the -danger, the best method is the footling-extraction. But (adds our author -by way of reflexion) this work is more _befitting_ a _man_ than a -_woman_, unless she has a _quick_ judgment, and an _alert_ hand: a -man-midwife should therefore be called (_Doubtless!_) and he must lay -his account with having work enough, for it is not without a great deal -of trouble and difficulty, that he will accomplish the turning the -child, and that for _three_ reasons. - -“THE FIRST. Commonly, the orifice of the uterus in this situation is but -little open: it must be _violently_ dilated, that is to say, in -_forcing_ Nature, or _doing violence_ to her. Yet this must be done -slowly, for too much precipitation would cause to the woman _very acute -pains_. (_To be sure, a slow violence would not hurt her._) - -“REASON the SECOND. It is not more easy to penetrate to the bottom of -the uterus, of which the orifice already, narrow as it must be, is -moreover occupied by the head of the child, than to open the orifice. No -wonder then, that so much trouble and patience should be required to get -at the child’s feet. - -“THIRDLY, It will be found, that the distance there is between the -orifice of the vagina to the bottom of the uterus, must render the -_man-midwife’s_ work so much the more difficult for the sinuosity of it, -and his being forced to operate in a part so narrow and close, and in -which the hand is much cramped for room. It is obvious to sense, that a -place so oblique and streight must deny the liberty of passage.” - -THE advice which Daventer gives here of extracting the child by the feet -in the case he supposes, and, for that purpose, violently to dilate the -orifice of the uterus, appears to my weak mind such mad, such frantic -doctrine, as to be beneath refutation. The bare recital of his own -reasons, and of the difficulties there are to surmount, which he himself -confesses, abundantly demonstrate the impossibility and absurdity of the -method he proposes. - -BUT after taking the liberty of dissenting from that celebrated -man-midwife in cases of obliquity, as to the practical part, which I -take indeed to be his _own_ discovery, it is but just I should offer -what I conceive to be the true midwife’s practice, for terminating -happily the labor of a woman in the case of obliquity of the uterus: -submitting the same to better judgment. - -ALL the deflexions or byasses of the uterus, whatever they are, are to -be known by the touch. An expert and knowing hand will never fail of -ascertaining the discovery of them. I say, an expert and knowing hand, -for without an exact knowledge of the figure of the whole pelvis, the -situation of the bladder, of the rectum, the vagina, and the uterus, -before and after pregnancy, the situation of the orifice with respect to -the pelvis, there is no distinguishing for example, an over-elevated -orifice from one too low, nor a direct from an oblique one. In vain -would one conceive clearly what those terms signify, or have some -knowledge of the distinctive parts of the female sex, without one has at -the same time sufficient experience, and fineness of sense in the -touching part. Without these qualifications there is no proceeding but -darkling, and in danger of deception. - -THE orifice of the uterus is always diametrically opposite to the fundus -of it. When then you know what the situation of the orifice of the -uterus is, when in its due place, you may, if well versed in _touching_, -calculate any aberration from the right line, and by the situation of -the orifice giving that of the fundus, know how the rest is disposed. - -WHEN, by _touching_, I perceive, there is an obliquity of the uterus in -the case, in the proper time, I desire the patient to lay on her back, -and introducing my finger, endeavour to come at the orifice of the -uterus. Upon getting hold of it, I support it so long as the labor-throw -continues, and I take care the child should not engage itself too much. - -I AM obliged, with my hand, continually to repeat this service; and -after resting a little from the fatigue, whenever I can snatch a moment -safely for such relaxation, I re-introduce my finger, as before, in -order to prevent the pains, and hinder the orifice from falling, that is -to say, from sinking, so as to turn too much backwards, or from rising -too high, or, in short, from deviating towards the right or the left, -according to the circumstances or kinds of inclination that may present -themselves. I also take great care, that the child may not engage itself -too far under the os pubis. I do not discontinue these cares, these -attentions, until, whatever assiduity, length of time, or trouble it may -cost me, I shall have arrived at rectifying the wrong direction, by thus -constantly supporting the internal orifice, till, in short, I have -brought it, little by little, to turn and come directly on a line with -the external orifice. By this management of the hand, I procure the -child a fair opening, and its falling forward, without being wrapped up -or embarrassed in the uterus. - -AND yet, in certain cases of obliquity I sometimes find so great an -inversion of order, such an intanglement, that the child presents itself -in the vagina with the body of the uterus covering it wholly, and by its -volume totally impeding the coming at the orifice. - -I HAVE before observed, that I required my patients, in these cases, to -lye upon their backs, and this, because, if they set up straight, the -uterus would overset, and render the obstacle, if not invincible, at -least, much more hard to remove. - -HOWEVER, both to ease my patients, and to prevent the child’s ingaging -itself too far in the pelvis, I get them, according to the -circumstances, to keep still lain down, but to turn sometimes to one -side, sometimes to the other, without ceasing my attentions, without -discontinuing to rectify the turn of the internal orifice from over the -summit of the child’s head, and to uphold the said orifice, if it should -tend to turn backwards, to depress it downward, by a gentle pressure, if -it is inclined to rise towards the os pubis. This operation, this -support, this depression, ought always to be managed with as much -tenderness as skill, and there cannot be too much of both. - -CERTAIN it is, that the bad situation of the uterus often occasions a -severe and difficult labor. A midwife therefore, from the very first of -the labor-pains, cannot bestow too much attention to the giving such -preventive or actual aid as I have proposed. Nothing, on these -occasions, is more dangerous than delay. The pretious moments of -operation must not be lost, least the child, coming to engage itself, -should throw us into an embarrassment yet greater than the first. - -IN the beginning of the labor, it is no very great matter, to know -exactly, what part the child presents to the orifice of an oblique -uterus. It is enough to know, that it is not the head, in order to -determine you, in due time, to the footling-extraction. What I mean is, -that as soon as a good position shall have been procured to the orifice -of the uterus; if it is any other part but the head that presents itself -at that orifice, and that it is sufficiently dilated for the hand to get -by gentle degrees introduced, dilated, in short, to about the diameter -of a crown-piece, then, if the membranes do not break of themselves, the -midwife should pierce them, and search for the feet of the child, to -bring it away. But if the head it is that presents at the orifice, there -is no need of any hurry: it is even better to wait till the membranes -burst of themselves, unless they should be come out of the vagina, in -which case they are to be opened, in order to terminate the delivery, -not with scissors, but with the fingers alone. - -THE reader will here please to observe, that in these cases of -obliquity, almost every thing depends, as to the prognostication, and -prevention of difficulties, as well as to the relief in actual labor, on -the exploration of the touch, and consequently the manual function. The -last is especially and palpably indispensable. What can supply the place -of it? not surely those forcing medicines, which some ignorant -men-practitioners obtrude on the unhappy patient, and which only serve -to exasperate the pains in vain, and certainly not to accelerate that -parturition, which is retarded by the purely local indisposition of the -womb. An obstacle which a skillful, tender, experienced hand cannot but -be the fittest to remove. - -IN this case however it is, that Monsieur l’Accoucheur oftenest looks -extremely silly and disconcerted. Though the throws redouble, the child -is never the nearer coming out. On the contrary, till its passage is -franked by the reduction of the uterus, it bears in vain upon any part, -but that aperture, through which alone lies its issue: and, in fact, the -harder it bears, the more it obstructs its own deliverance, and damages -its mother. Monsieur l’Accoucheur stands by, does nothing, and can do -nothing, or worse than nothing, if he should pretend to it: if he had -the head, he has not the hand to give the patient any efficacious aid. -Then it is, that where thus incapable by Nature, for the manual -function, the men-practitioners abuse that excellent, that divine, but -here mistimed and misplaced maxim, of leaving things to Nature, of -trusting to Nature. The power of Nature is just then, all of a sudden, -acknowledged to be self-sufficient, when she really wants human help to -redress her wrong. She is then at her greatest need, left to shift for -herself. The fruitless pangs increase. Monsieur l’Accoucheur stands by -an idle spectator, or perhaps goes about his business. In the mean time -both mother and child, exhausted by fruitless efforts, for perhaps four, -five, or six days, perish for want of the proper and only relief. Thus -the ignorant operators abstain from interfering, when interfering, if -they were fit for it, might be of service, only because they cannot so -well in this case employ their iron or steel instruments: and as to -their hands, they would most probably indeed make sad bungling work of -it. Their action, in short, is, if that can be imagined, yet worse than -their inaction. - -SOME of them, in this case, content themselves with saying, that the -orifice is as yet too distant, and that nothing is urgent. They go away -then, and leave the patient in the hope of some favorable change which -is never to happen. They return, and find a strange disorder in the -state of things, the child is too far engaged: it is too late to -retrieve the damage, as they imagine, and I readily believe, when they -have lapsed the due time of operation, of which it is not only probable -they knew nothing, but, if they had known what to do, would have done it -very ill. Then the vast knowledge and learning of these disconcerted -instrumentarians can furnish them no better expedient, than that of -murdering the child (as they pretend) to save the mother, though it is -not always that the mother does not follow the fate of her poor infant. - -I KNOW, by my own experience, that often to make a happy end of such -deliveries, requires an extreme attention and indefatigable pains. But -practitioners should resolve, either to go through with the undertaking -as it should be, or not begin it, in such cases, especially where the -lives of mother and child depend upon their doing their duty, as they -will answer the contrary to God, to man, and to themselves. - -THESE cases are but too frequent in England. I have myself met with -several of them, and sometimes even in persons extremely well made, in -which I have been obliged to perform this manual aid, for many hours -together, ay, even for half-a-day and more by the clock; all my motions -keeping time with those of Nature narrowly watched, so as to rectify and -adjust the orifice and the uterus; constantly reducing any detortion, -and keeping things in their due direction, without tiring, or without -losing patience. - -HERE I ask of my reader, is such work as this, naturally speaking, the -work of a man, as Daventer would persuade us? - -IF the Monsieur l’Accoucheur is an ignorant, or rather not a very -intelligent one indeed, the mother, or the child, or perhaps both, will -probably be his victims. - -BUT you say, if he is an intelligent one all will be safe. No; he may -perhaps know what to do, but will he have the woman’s faculty of -acquitting himself of his duty? all the theory in the universe will not -do here without the practical part; and will the hands of a man in that -respect ever equal the suppleness, the dexterity, the tenderness of a -woman’s? once more, is a man made for such work? - -I SAY nothing here of the patience so remarkable in the true midwife on -such trying occasions. I will grant, that Monsieur l’Accoucheur may, in -the view of forty, fifty, or a hundred guineas perhaps, have enough of -it not to slacken an attendance on his part, so dangerous, so -insignificant, and often so pernicious; that it would be much better to -pay him for his absence: I grant then, that he may employ his divine -hippocratic fingers in such handy-work, for so many hours together, -without stepping into the next room for refreshment; or, in short, -without hazarding the lives of the mother and child, by a remission of -actual attention and manual assistence. But granting all this, can any -one, who has a respect for truth, a respect for his own knowledge and -sense of things, a respect, in short, for two such precious lives, as -those of mother and child, not, I may say, intuitively, perceive and -feel, the impropriety and danger of the practice, in such cases, being -committed to a man preferably to a woman? - -BUT would a woman especially, who loves herself, who loves the child in -her womb, and who is capable of thinking at all, sacrifice herself and -child to so palpable an imposition, as that of the pretended superiority -of the men to the women in this point? She cannot even, well, without -repugnance, submit, nor but for the indispensable necessity probably -would submit to receive such service even from one of her own sex, whose -tender, soothing, congenial softness, must make it more easy and -supportable. But what can she expect from a man’s clumsy, aukward, -unnatural, disgustful operation, but increase of danger, or of pain, -perhaps of both; while she and her child may not improbably be the -victims of the rudiments in the art of a man by Nature condemned for -ever to be a novice only, and who, for possibly a great hire to assist -her, earns it only, as I have before observed, by excluding that due -relief he is himself not capable of giving her; earns it by the not -preventing enough her pains, and even by increasing her torments; till -at length, not unfrequently, some infernal instrument is produced, like -the dagger, in the fifth act of a tragedy, and forms the catastrophe of -mother, or of child, or of both? - - Of the EXTRACTION of the head of the FŒTUS, severed from the BODY, and - which shall have remained in the UTERUS. - -I AGREE with our modern writers, that there can hardly exist a more -vexatious accident, than that of the head’s remaining in the uterus, -after the extraction of the body. There are many causes of this effect. -The death of the child for some time past, so that the waters may have -had time to relax, to macerate the fibres, and thereby to render them -incapable of resisting any efforts; there will result from thence a -great difficulty of procuring the total issue of the dead fœtus, without -dismembering it. - -SOME mis-conformation of parts in the mother may also contribute to it, -or the obliquity of the uterus, where the child is brought away by the -feet. - -INDEPENDENTLY of all these causes, this accident is almost always the -effect of unskilfulness; it is, in truth, so rare, that it will scarce -ever happen, where the delivery is conducted by an accurate and able -practitioner of the art. If we have some examples, that even under -skilful hands this case has come into existence, a thorough examination -of it would shew, that it was only owing to the cruel necessity the -practitioner may have been under, of being aided by persons not duly -qualified to afford the least effectual help, or to conceive what they -were directed to do. - -BUT, however that may be, the damage is not absolutely without remedy. -The great point is, without loss of time, to introduce the hand into the -uterus, which does not proceed in its contraction, but gradually and -leisurely enough, to give leave for the needful evacuation. It is true, -that this operation requires a very nice skilful hand; with which, where -it is found, surely no instrument, nor other invention, can come into -competition. - -THIS accident has appeared to occasion such severe labors, that many -practitioners, and Peu, among others, (page 308) have advised abandoning -the expulsion to Nature, rather than to fatigue the patient by fruitless -and torturous attempts, to the success of which such obstacles presented -themselves, as they looked upon to be unsurmountable. - -MAURICEAU (Aphor. 240) is of the same opinion, which he thus expresses. -“When the head of the fœtus shall have remained in the uterus, which is -no longer open enough to give it passage forth, it is better to commit -the expulsion to Nature, than to attempt the extraction with too much -violence.” - -THESE practitioners ground their opinion on that Nature, always wise and -intent on self-preservation, taking more care to expel a superfluity, -than even to attract the needful, often discharges herself, and that -without violence, if she is but ever so little assisted, of all -extraneous bodies, or other things retained in us against her intention. - -MESSIEURS de la Motte, Peu, and Viardel adduce examples of Nature’s -doing spontaneously, what some of our later moderns are for absolutely -doing themselves by means of those curious instruments, in which they -make such a parade of the rare inventiveness of their genius, -particularly in the extraction of a head remaining detached in the -uterus, on its contracting some hours after the unskilful operation of -some deficient practitioners. In such cases, I say, those gentlemen -furnish instances of Nature’s expelling the superfluous and extraneous -incumbrance, with only the help of some glysters, and other remedies -administered to the patient. - -NOW though no one can be more intimately convinced than I am, that -Nature, acting for ever upon surer principles than Art, possesses -resources which she often displays in the most desperate exigencies; I -own, that in this case I am not for totally relying upon her -beneficence[32]. Here is a wrong to redress, not owing to her, but to -deficient practice; and this wrong can hardly be repaired by her alone, -unless something of a better practice contributes to relieve her. That -practice is not, however, the less recommendable for being plain and -obvious. The most gentle, the most guarded, but withal the most -efficacious means must be tried, little by little, to insinuate the -fingers and hand into the uterus, how closely contracted soever it may -be; for yield it will; and then seize the head by the mouth, the -occipital cavity, or whatever other part affords the least slippery -hold, without waiting whole hours, as do certain ignorant or negligent -practitioners with respect to the after-birth, who give time to the -uterus to enter into too strong contraction. - -SOME authors, and other persons of much that depth of practical merit, -having learned solely by the experience of delaying to bring away the -after-birth, that, to abandon thus the head of a child remaining in the -uterus, was, at the same time, to expose the mother to the highest -danger, judged it expedient to have recourse to auxiliary methods. They -have therefore employed and directed for this purpose such edge-tools, -as instruments and crotchets of different figures, some to incide and -separate the bones of the skull; others to bring them away piece-meal, -or all together, according as they should find the operation the -easiest. [33] DYONIS and Mauriceau are of opinion, that the crotchet -should be thrust into the most convenient place of the head, such as the -mouth, one of the orbits of the eye, or the occipital cavity; after -which, you are to endeavour to bring away the head by redoubled efforts. -But if the crotchet slips, as the head is of a round figure, and may -turn like a ball, they direct you to thrust the crotchet into the hole -of the ear, then giving some one the handle to hold, you are to strike -another crotchet of the same figure in the other ear, and so pulling -with both crotchets at once, extract the head, that is to say, if -possible. - -AY, that “_if possible_,” is well added; for with infinite submission to -those very _learned_ gentlemen, nothing appears to me more -impracticable; and, I fancy, if they had ever made the experiment, they -would have found it so. What a blind operation, with such instruments, -and in such a place! - -GUILLEMEAU (Treat. of Mid. Book II. chap. 17.) remarks, that, in such -case, you should take the time that the woman has a labor-pain to -accomplish the extraction by this method, that is to say, to snatch that -moment to extract the head, when you BELIEVE you have got fast hold of -it. - -BUT if the woman is too badly conformed, Dyonis (Book II. page 287) -advises the use of the edged crotchets to cut the head to pieces, and -bring away, by parts, what you could not do whole. - -MAURICEAU (Book II. page 287) would have it so, that this sort of -crooked knife should have a long handle; and says, that Ambrose Paræus -and Guillemeau are for a short one to it. Doctors will disagree. They -all however give their respective reasons, and it is indeed hard to say -which does not give the worst. - -MR. De la Motte, in the like circumstances, made use of a bistory, or -incision-knife inserted in a sheath, open at both ends; of which he -gives the following account. (Observ. 259.) - -“I INTRODUCED, said he, into the uterus, my left hand, over which I -fixed the head; and with my right, I slipped in a sheath open at both -ends, in which was an incision-knife, that I applied to this head, and -made an opening in it capable of admitting my fingers. I widened it -afterwards, as much as I thought proper, and scooped out a part of the -brain; after which, I got hold sufficient to bring away the head, of -which the volume was considerably diminished.” - -AMBROSE PARÆUS (Book of Gener. chap. 33.) tells us he had, to his great -regret, a case of this sort fall to his share, the head of a fœtus -remaining in the uterus. To extricate himself from which, he proposes -much the same methods I have described after Dyonis and Mauriceau; and -advises, in the same case, that if they do not succeed, recourse should -be had to an instrument, called _pied de griffon_, (Griffin’s claw) -which he says he took from the French surgery of d’Alechamp. He gives -two forms of one, one of two branches, another of four. These -instruments, both the one and the other, are made on the principle of -the _Speculum Matricis_[34], of which the use is at once, so detestably -cruel, and so perfectly unavailing. The Griffin’s claw however differs -from the _speculum matricis_, in that the latter has its branches -elbowing in an angle, and that the former has its branches streight -a-top and at bottom, and arched in the middle, and furnished with -roughnesses to seize and keep hold of the head. - -THOSE who will take the trouble to see the delineation of these -instruments, in these authors, will, at the very first glance of the -eye, be convinced of their unserviceableness. So would they be of that -of another instrument of the like nature, invented some years ago, and -attributed to a surgeon of Rouen, which is composed of two crotchets, of -which the blades are arched, and their extremities claw-footed. - -THE horror which these means of extraction naturally inspire, the damage -and inconveniences inseparable from them, notwithstanding all the -improvements pretended to have been made, have engaged several authors -to imagine other less dangerous expedients. But before I mention them, I -cannot well avoid taking notice of a suggestion of _Celsus_, if but to -warn those whom it may concern, not to be too much carried away by the -authority of a great _name_. - -IN such a case the method Celsus recommends, is, for one of the -robustest men that may be got, to press strongly upon the belly of the -patient, with his heavy hands, inclining them downwards, so that such a -pressure may force out the head that shall have remained in the uterus. -Is not this a right _learned_, and especially a very tender expedient? - -MAURICEAU and Amand giving a loose to their genius have proposed less -perilous methods. - -_THE_ first tells us, that it came into his head, in this case, that a -fillet of soft linnen might be made, in from of a sling, to be slipped -over the head, and so bring it away. - -AMAND has imagined a silk caul, of net work, to wrap the head in. This -caul is to be pursed up by means of a string, that gathers four ribbons -fastened to four opposite points of the circumference, or opening of -this kind of purse, by which the head so wrapped up is to be extracted. - -MR. Walgrave professor at Copenhagen has improved on the first scheme of -a fillet, by stitching together the two extremities of a fillet of -linnen of about two yards long and four or five inches wide, in which he -makes three slits lengthways, to seize the head more firmly, and hinder -the fillet from slipping off the rounder parts of it. The figure of it -may be seen in a Latin work intitled, _Dissertation upon the separated -head of a child, and the different ways of extracting it from the -mother’s womb_. By Mr. John Voigt, at Giessen, 1749. - -MONSIEUR Gregoire, man-midwife at Paris, has disputed with Monsieur -Amand the glory of this invention of the caul. - -BUT if a reader will deign to consult his own reflexion, upon even these -last, less however injurious means than those of iron and steel -instruments, he will probably conclude, that if it is possible to come -at the head, so as to fix, for example, a caul over it, the same liberty -of access will serve to do all that can be necessary to secure a -sufficient hold and purchase for the naked hand to bring it away, -without such aids, as must necessarily suppose a free play of the hand -in the uterus. I own this requires great shreudness of discernment by -the touch, great expertness, great slight of hand and neat conveyance, -but these are all points of excellence which midwives should be -exhorted, encouraged, and even obliged to acquire: for acquire them they -may; which is more than the men, generally speaking, ever can, and are -therefore supplementally obliged to have recourse to such substitutes to -hands, as those horrid instruments or silly inventions of theirs, with -which, even at the best, they can never do so well as the women, who -understand their business, can do without them. - -LET it also be here remembered, what I observed at the beginning of this -section, that this case of a separated head, I might almost say, never, -no never comes into existence but through some previous neglect, error -or failure of practice: so that surely the preventing it must be rather, -preferable to the necessity of remedying it, either with crotchets, -fillets, or even with but the hand alone; the trusting to any of which -may make practitioners so often remiss, where remissness can hardly ever -be but of bad consequence, where no fault, in short, can be other than a -great one, and for which, the innocent patient it is that must most -commonly be the sufferer, both in her own person, and in that of her -child. - - - Of that labor in which the head of the fœtus remains hitched in the - passage, the body being entirely come out of the uterus. - -IT is here to be observed that though the body may be intirely free of -the uterus, some of the causes deduced in the precedent section, may -produce impediments or obstacles to the issue of the head. The head -never detaches itself from the body but in that labor where the feet of -the child come out first, and are too forcibly hauled by rash or -unskilful hands, by such in short as do not know how to disingage or -remove the let or obstacle to the issue of the head, with one hand, -while with the other they properly support the body of the child. As it -is then greatly to be wished that this accident might never happen, I -shall, to the means I have already indicated for preventing or remedying -it, add others coincidently with the design of this section, to prove -the inutility of instruments in the case of the title prefixed to it. I -shall then quote the practical tenets of the best authors upon this -point, together with reflexions, which my own experience and practice -have suggested to me. - -MAURICEAU explains this case tolerably justly, where he treats of the -footling-extraction. - -“CARE (says he) should be taken that the child should have its face and -belly directly downwards; to prevent, on their being turned upwards, the -head of it being, towards the chin, stopped by the os pubis. If -therefore it should not be so turned, it must be put into that posture. -This will easily be done if, as soon as you begin drawing the child out -by the feet, you incline and turn it little by little, in proportion as -your extraction of it proceeds, till its heels bear in a direct line -with the belly of the mother,” - -[_Here I must beg leave to interrupt Mr. Mauriceau, to observe, that it -is not enough to have hold of the child’s feet to begin turning it: but -the breech must have come out: then, if it is not well turned, by -placing one hand on the belly, and the other on the breech of the child, -there will be time enough easily to turn it immediately and naturally, -neither with too much precipitation, nor yet too leisurely, not little -by little, or by slow degrees. This last precaution being of no use but -to flag an operation, in which a delay may be fatal to the child, -without any service to the mother, it only keeping her the longer in -pain._] - -“THERE are (he goes on) however children with so large a head, that it -remains stopped in the passage after the body is intirely got out, -notwithstanding all the precautions that can be used to avoid it. In -this case, you must not stand amusing yourself with so much as -attempting to bring the child away by the shoulders, for sometimes you -will sooner part the body from the neck, than get the child out by this -means. But while some other person shall pull it by the two feet or -beneath the knees,” [_here Monsieur Mauriceau is much out: great care -should be taken not to have it pulled by any one, but purely to give the -body of the child to be supported by some discret person, while the -delivery proceeds as the author goes on to describe_] “the operator will -disingage little by little the head from between the bones of the -passage, which he may do by sliding softly one or two fingers of his -left hand into the mouth of the child, to disingage the chin in the -first place, and with his right hand, he will embrace the back of the -child’s neck, above the shoulders, to draw it afterwards, with the help -of one of the fingers of his left hand, employed, as I have just -observed, in disingaging the chin. For it is this part which the most -contributes to detain the head in the passage, whence it cannot be drawn -out before the chin shall have been intirely disingaged. Observe also, -that this is to be done with all possible dispatch for fear the child -should be suffocated, as would indubitably happen, were he to remain any -time thus held and stopped: because the umbilical chord, which will have -come out, being turned cold, and strongly compressed by the body or by -the head of the child, remaining too long in the passage, the child -cannot then be kept alive by means of the mother’s blood, whose motion -is stopped in that chord, as well by its cooling which coagulates it, as -by the compression which hinders it from circulating, for want of which -it is a necessity for the child to breathe, which he cannot do till his -head shall be intirely out of the uterus: therefore when once you have -begun the extraction of the child, you must try to procure the total -issue of it as quick as possible.” - -MONSIEUR Levret, who has wrote for no end on earth but to recommend his -_tire-tête_, seizes the occasion of the foregoing passage extracted from -Mauriceau to tell us, page 51, of the first part of his work. - -“MAURICEAU acknowledges here, that there are children who have the head -so large, as for it to remain stopped in the passage, after the body -shall have been wholly got out, notwithstanding all the precautions that -can be taken to avoid it.” - -FROM whence this zealous instrumentarian draws the following conclusion. -“Here (says he) is one of those cases, in which my _instrument_ may be -of great service.” - -THIS conclusion however does not to me at all appear a just one. - -FIRST, because Mauriceau, after those lines of his, just above quoted by -Levret, adds immediately the method of practice pursuable in this case, -to give a good account of it without the help of instruments. - -SECONDLY, because we are not at all to be concluded by what any author -says, any farther than the truth of things bears him out. Mauriceau[35] -might have explained himself better: he might have said, that, in this -case, the child should be pushed back a little into the uterus, to have -the freer play for its being more easily disingaged: he might have -advised, as I have before observed, rather a safer method of proceeding -than what he has done. Mr. Levret himself allows this p. 56. Then, still -with a view to recommend his forceps, his _tire-tête_, as being -absolutely necessary, he continues thus (p. 58.) - -“THOUGH every thing should apparently have been done that is above set -forth, still we are not always so happy as to accomplish the delivery. -It sometimes happens, that we cannot get the head of the child out of -the uterus. There are of this two examples in the treatise of M. De la -Motte, of which I do not think it here out of place to furnish an -extract. - -“MR. De la Motte, in his 253d. Observation, (goes on M. Levret) relates, -that in a case in which he was obliged to turn the child, in order the -better to finish the delivery, he turned it very easily; that having -brought it out as far as to the thighs ... it being alive, he gave its -body a half turn, so as to put its face downwards which it had upwards, -and that then he continued drawing out the child as far as to the -shoulders and neck. - -“AFTER that (says M. De la Motte) I gave it some gentle shakes, and even -pulled it pretty hard, and had several tugs at it, to make an end of a -delivery I had so happily begun; but all was in vain. This obliged me, -according to my usual method, to put my finger into its mouth. I was -mistaken, for what I took to be the mouth, I found to be the nape of the -neck, and that the neck, not having followed the motion of the body, was -twisted round, and consequently the face still remained turned upwards, -so that the chin it was that, being hitched at the os pubis, was the -obstacle to have been conquered to terminate the delivery.” - -MR. LEVRET here observes, there being a great probability that, when la -Motte turned the body of the child, he was pulling it towards him, and -that the mother was in a labor-throw: for it is well known, that then -the uterus contracts itself in all directions round the body it -contains: she was then compressing exactly the head of the child, which -must render it immoveable, while he was turning the body. These two -co-incidences must have contributed to twist the neck of the child, -consequently to make it lose its life. And to clench the misfortune, he -gave its little body to be held by the husband of the mother, while he -was pushing back the head with one hand, and with the other disingaging -the chin. He told the husband at the same time to pull softly; “but he -hauled with such violence, in the hope of easing his wife, that he fell -with a jerk six foot off the bed, with the body of the child, of which -the head had remained in the uterus.” - -LET us proceed to the second example. This is the fact. M. De la Motte -tells us, that he was called to assist a poor woman in labor, in which -she had been lingering for two days, that this patient was a very little -woman, and of about forty five years of age; the arm of a very small -child had come out the day before. - -“I SLIPPED (said he) my hand along this little arm, to go in quest of -the feet, which I presently found, and after having closed them -together, I brought them away out of the uterus. The body followed till -it came to the neck. The patient being on the edge of the bed, which was -very high from the ground, and where there was not room enough left to -support the child in proportion as I drew it out, I was obliged to give -it a woman to hold, while I proceeded gently to disengage the head which -was stopped in the passage. This was no wonder, considering the -streightness of it, being correspondent to the littleness of her size; -considering withal the advanced age of the patient, the length of time -since the discharge of the waters, during which the uterus being -irritated by the lingeringness of the labor, the presence of the arm in -the passage had caused an inflammation, consequently some induration, -all these joined to the time that the fœtus had been dead, which as -before observed was a very small creature, were reasons more than -sufficient to manage very tenderly with the child, so as to bring it -away whole. This (says M. De la Motte) induced me to introduce my hand -flat towards the _frænum labiorum_, and to put my middle finger into the -child’s mouth, while my other hand was over its neck. My measures being -thus taken, I desired the midwife, while I should disingage the parts, -to pull softly, for fear of an accident. But she nevertheless, -senselessly and foolishly, gave it much such a pull, as the woman’s -husband I have before mentioned. This indeed forced out the body of the -child, but severed from the head, which remained in the uterus.” - -HERE it may be observed that Monsieur Levret, by this preamble, on the -one hand prepares us for the necessity of his instrument, by a constant -supposition of cases, in which, notwithstanding all the precautions that -may be taken, it happens sometimes (as he says) “that it is not possible -to terminate happily the delivery, nor get the child’s head out of the -uterus;” to support which opinion he produces the two examples from De -la Motte, which I have just before quoted. - -ON the other hand, he owns, as it were, _en passant_, that there are -means, which he even explains of accomplishing successfully the -deliveries, in such labors, by solely the operation of the hands, -avoiding the faults committed by M. De la Motte, after which, as if -those faults were any proof in favor of his instrument, he concludes, -that, “if through any cause whatever, this case was not to be got over, -the child should be given to some one to be held, with the precautions -before set forth, and that then the operator was to proceed with his -instruments.” - -IN the first example we see that De la Motte was guilty of three -grievous errors. The first, in taking the nape of the neck for the -mouth: the second, in having taken the time of the mother’s throw, in -which the uterus must have contracted round the neck in all directions, -to turn the body of the child, which contributed to twist its neck: -thirdly, in having given the body of the child to the husband to hold, -with direction to pull it, even tho’ he cautioned him to do it gently. -He ought rather not to have trusted him with the body at all, or have -absolutely forbid him to make the least motion, his part being only to -support it. - -IN the second example, De la Motte committed no more than the last -fault, in trusting a midwife, of whom he might not know all the -stupidity: but this was sufficient to produce that accident; an accident -which it will not even be hard to avoid, with due management, or hands -skilfully conducted. - -WITH Mons. Levret’s leave (whom I ought to honor, since it is from him I -have chiefly taken what he has said against all instruments but his own) -I shall then say, that it is against the laws of candor, or of common -sense, to seek, from the faults which may be committed in the manual -practice, either through ignorance, inadvertence, or want of -circumspection, to infer the necessity of instruments. - -THE point here under discussion turns intirely upon a child extracted by -the feet. Now it is extremely rare, that in this case, the head does not -follow the body. But if, in exception to this general rule, the head -should be stopped in the passage, upon proceeding to disengage it, with -all the proper measures and precautions which I have added to those -above specified from Mauriceau, the sole aid of the hands will be full -sufficient to accomplish the total delivery. But if they were to be ill -managed, the risk would be evidently great of detaching the body from -the head; and this would change the case from that of the head stuck in -the passage, to the one of the head separated from the body, of which I -have treated in the preceding section. Without then multiplying cases -without necessity, as the reader will easily see, that the first is but -the consequence of a mis-treatment of the last, so that, by the same -rule, the right management of the last case is a sure prevention of the -first, I shall only observe, that it might be shewn, that capable, -well-conducted hands are sufficient to guard against both dangers, and -shewn, even by Mons. Levret’s own confession, which he so inconsistently -contradicts, in favor of his own instrument, without offering any thing -like a reason for such a contradiction. - -BUT if the damage in these cases resulting from an unskilful use of the -hands should be urged against me: I answer, in the first place, that I -am not arguing for any thing but what is to be effectuated by good -practice: my point, is only to establish the superiority of skilful -hands to the use of instruments: and in these cases, I aver, that even -the damages done by the mispractice of defective hands, may be better -repaired by sufficient ones, than by a recourse to instruments. How -often too are instruments used by such men-operators, as are to the full -as unfit to manage such instruments, bad as they are, as some women may -be to use their hands! But if I could give no better reason for the -rejection of instruments, than the abuse of them, even by the numbers of -ignorant superficial men-practitioners that employ them, I should not -expect to be heard; and yet the great argument against midwives is the -ignorance of a few of them: though that ignorance of theirs could never -produce such a multiplicity of horrors, of murders, injuries, tortures -of mothers, such mutilations and massacres of children, as the deep -learning of the instrumentarians! - -MY plea then is much more fair. The reader will be pleased to consider, -and decide upon his own reflexions, whether, it is not at least -probable, from what has been shewn in the cases of the obliquity of the -uterus, of a head separate from the body of the fœtus, or even of that -reputed most dangerous extremity, the head being hitched in the passage, -when the whole body shall have come out, that every thing may be at -least as hopefully attempted with the hands alone, as with those -instruments, the use of which forms the sole reason for a recourse to -men-practitioners; tho’, well considered, nothing could be a stronger -reason against such a recourse than their using them. But let us proceed -to the next case; - - - When the head of the fœtus presents itself foremost, but sticks in the - passage. - -FOR this section it is, that I have reserved to treat incidentally and -more at large of the objections to be made in general to all -instruments, and in particular to the principal ones. - -AMONG the severe labors, which give much trouble, and exact much -patience from all parties, from the patient, the midwife, and all the -assistence, this case may challenge a place. It is that, in which the -head of the child having presented itself foremost, and having ingaged -itself half way, or thereabouts, in the streight of the bones of the -pelvis, and of the orifice of the uterus, the labor-pains remit, -languish, and the progress of the labor becomes suspended. Whether there -be any mis-conformation of the bones of the pelvis, or whether (as our -practitioners are pleased to express it,) the head of the fœtus be too -large for the passage, or whether, in short, both these causes concur to -the formation of this obstacle, or exist in complication with other -circumstances; it is, in this case, we may say the head is hitched, -stuck or ingaged in the passage. - -MR. De la Motte, book the 3d. chapter the 20th, describes this state of -the fœtus. - -“WHEN (says he) the head has struck into the streight of the passage -which, at first, affords a great deal less room than were to be wished, -for its letting it pass, the head ingages itself as much forward as -possible, from the continual and violent pains the woman suffers, which -act upon the child, whose head lengthens and flattens, in such a manner, -to adjust and mould itself to the passage, that the hairy scalp becomes -quite tumefied, so as to make the head look almost like a double head, -which however remains stuck fast between the bones, without being able -to get out, and only ingages itself the more the more it advances ... -but growing larger as it advances, and the aperture which it obliged to -force diminishing more and more, makes it so that the head remains at -length so jammed in, that it cannot be drawn out without diminishing its -volume, which (as this author says) cannot be executed without -instruments: as I was obliged to do, to accomplish the following -delivery.” - -MR. De la Motte then proceeds to tell us, that he was called to lay the -wife of a laborer, the head of whose child was hitched in the passage. -After having well examined the state of the mother and child, and -ascertained as much as it is possible to ascertain the death of the -latter——“I determined, (says he) to finish the delivery, which I did by -opening the head of the child with my incision-knife, and scooped out -therewith part of the brain. After which, I made use of my hand, with -which I got hold of the inside of the skull, and in an instant drew the -child out, who appeared to have been dead a long time.” - -IT is not here that, in answer to M. De la Motte, I shall stop to -propose a more gentle and more natural method of giving a good account -of this case of a hitched head, than the cruel and dangerous expedients -suggested by the instrumentarians: I reserve the submission to better -judgment of my own ideas of practice, in this point, till after I shall -have quoted the notions of more authors. - -DAVENTER, p. 343, of his observations, supposes to us the case of a head -stuck in the passage, when the difficulty of the labor shall have been -increased, as well by the ignorance, as by the negligence of the -practitioner, male or female, that may not have given the proper aid in -due time, or not have foreseen the danger; he moreover supposes a -complication of obliquity, caused by the mis-conformation of the bones -in the patient. If this embarrassment then should not have been foreseen -or guarded against, he advises the opening of the head of the child. - -“THERE is, for this no occasion (says he) for any instruments of a -particular make; a common knife guarded as far as the point, a pair of -scissors, a pointed spatula do the business. The opening they make may -be dilated with the fingers, and the brain taken out; after which, you -seize the head with your hand, or with a linnen cloth, and try, in this -manner, to bring away the body. When I say you may draw the head out -with a linnen cloth, I mean a broad strip or fillet cut lengthways of -the cloth, and hemmed in the borders, or any piece of linnen that is -fine and strong, to be passed round the back of the head, and bringing -in under the chin, you twist the fillet, and draw out the child.”——He -then adds, that he much esteems this method; that those, whose hands are -_small_ enough to pass this linnen round the back of the head, without -opening it, are not obliged to open it, and have therein a great -advantage over others. - -THIS last method proposed by Daventer ought doubtless to be preferably -pursued, as being the less cruel. But, in the first place, it is utterly -impracticable. A head represented to be hitched or jammed, does not -leave the least hands that can be imagined room or liberty to pass a -fillet round the back of the head, in order to bring it under the chin. -But were it even practicable, it would be useless, and dangerous: -useless, in that the hands alone, so introduced, might of themselves, -little by little, disingage this head; dangerous, for that this fillet -might most likely produce the effect that fillets commonly do, strangle -the child. - -MAURICEAU, to conquer this obstacle of the head so stuck, proposes -several kinds of crotchets, to apply various ways, to the head of the -child, after having scooped out the brain, by means of an opening made -in the skull. He gives us several examples in his observations, but as -they are absolutely fit for nothing but to inspire horror, I shall -refrain from specifying them. Dyonis is of the same opinion with -Mauriceau. - -THOSE who will give themselves the trouble to peruse the authors who -have preceded thus, will find, that their method differs very little -from that of la Motte and Mauriceau, which most assuredly kills the -child if it is not dead: and the ascertainment of the death of a child -stuck in the passage is so difficult, that the ablest practitioners -cannot answer for not being mistaken in it. The reader will please to -apply here what I set forth, p. 139, and following, to which I beg leave -to refer. - -MAURICEAU, at length, imagined, that he had out-done all others, in his -invention of an instrument he calls a _tire-tête_. He specifies it in -his 26th observation. But it is as dangerous as the crotchets, since, in -order to use it, you must begin by opening the skull with an -incision-knife, or with a sort of steel spike, double-edged, which he -invented on purpose for the use of piercing the child’s scull at the -_fontanelle_, to admit a little round plate of steel of another -instrument. - -MONSIEUR Soumain, and other celebrated practitioners, have acknowledged -the insufficiency of this instrument of Mauriceau; but were it good for -any thing, as to drawing out the head so stuck, it would for ever be -fatal to those poor unfortunates, since it could not fail of killing -them if they were still alive. - -AFTER this we have the tire-tête of Mr. Fried, but it is as murderous as -that of Mauriceau, nor answers the intentions which its author had -proposed to himself. He has therefore himself had the candor to condemn -it, as may be seen p. 154. in a treatise of midwifery, published in -1746, by the care of Mr. Boëhmer, who has added two dissertations to the -treatise on this art by Dr. Manningham. - -MR. Menard, in his preface, p. 24, gives the figure of an instrument, of -which the idea seems to have been taken from a twibill, with a ducks -beak. Mr. Menard has endeavoured at perfecting it, by having it made -angular, shortened, and grooved. He has given it a figure of dented -pinchers, with curve claws. He gives us also the figure of an instrument -pointed and edged, made like the head of a spear, which he uses for -opening the scull, and introducing the pinchers, by means of which he -draws the child out by the head, as he keeps pinching the bones of the -scull and teguments. By this it is easy to conceive, that this -instrument has no advantage over that of Mauriceau, and has all its -inconveniences. - -MANY other modern practitioners advise the use of one or two crotchets, -be the child dead or alive, or of a tire-tête, made in form of strait -blades, with spoon-bills, to introduce them one after another into the -uterus; and after having placed them on each side of the child’s head, -and made them meet together, to try the extraction with them. - -THIS last contrivance, as ingenious as it may appear, does not save the -child’s life, as all these authors would insinuate. For these -instruments, wherever they are applied, must pierce to get a solid hold; -without which they could serve for nothing but to crush or lacerate the -teguments; so that they should not be used where the child is a live -one: and even when it’s dead, the mother is not absolutely safe from the -damage they may do, whatever precaution the operator may take, or -whatever may be his dexterity of hand. If one of the blades should slip, -which frequently happens, it will be difficult for him not to do the -mother a mischief. For as to the child, it is very rare that the -crotchet does not instantly destroy it. - -MENARD has again given us another figure of an instrument, to appearance -less dangerous; but the make of it sufficiently denotes its want of -power in the operation, which is also confirmed by the testimony of the -most celebrated practitioners. - -IT is now (1760) about forty years ago, that Palfin, a surgeon of Ghent -in Flanders, and demonstrator of anatomy in the same town, went to -Paris, and there presented to the academy of sciences an instrument for -extracting, by the head, children stuck in the passage. Gilles le Doux, -surgeon of the town of Ypres, put in his claim to the invention of this -curious instrument, which has however been ever looked upon as -insufficient, and to have too much bulge, to allow its introduction into -a place already so difficult by its being blocked up with the body that -requires the extraction. After at least a dozen of corrections of this -pretended tire-tête or forceps of Palfin, Gilles le Doux himself -corrected it, so did afterwards Messieurs Petit, Gregoire, Soumain, -Duffé, and I do not know how many more. - -IN short, one may say, that never did any instrument undergo more -alterations than this forceps has done. One of the greatest -improvements, according to the opinion at the time here in England, -which it received, was that given it by Dr. Chamberlain. Chapman, whose -treatise on midwifery is esteemed, to give this tire-tête the greater -lustre, tells us, that Dr. Chamberlain kept this instrument a long while -a secret; and that the Dr.’s father, his two brothers, and himself, used -it with good success. Mr. Boëhmer, public professor of physic and -anatomy at Hall, in the Lower Saxony, in the College Royal of Frederic, -and of the society of curious Naturalists, from whom I quote this, calls -this instrument, I am here speaking of, the English tire-tête, or -forceps. - -ALL due honor be to the original author of this sublime invention of the -forceps, whoever was the happy mortal! happy, I say, according to Dr. -Smellie, who calls it a “_fortunate contrivance_”[36]; though perhaps by -fortunate, he rather means its having been so to himself. For hitherto, -in all truth, I must own, that I do not find, even by the most -exagerated accounts of the learned men-midwives, that those poor -instruments of God’s making, the women’s fingers, would not much better, -and much safer, do every thing that is pretended to be done by that same -boasted instrument, or that can be done by any other human means. - -BUT let us suppose for an instant, what both my love and knowledge of -the truth would hinder me from granting, that instruments are at some -times, and in some sort necessary: in what case is it that they are -necessary? this is what hitherto I do not know. And which instrument is -it that a man-midwife must use? that is what I yet know less: nor do I -believe there is any practitioner so presumptuously silly, as to admit -any particular one, as the only one universally received and approved. -It will perhaps be said, that according to the circumstances, each -practitioner will, out of his bag of hard-ware, pick out that which will -be fit for the occasion. But then, a waggon would not carry their whole -armory, to calculate not only according to the various alterations made, -if but in the forceps, by whim, desire of getting a name, or of -increasing practice, but according to the various exigencies and -circumstances to which the form of the instrument ought to be peculiarly -adjusted. And upon every occasion, there is not the time for inventing, -directing, or making a new instrument. But if it is said, that for want -of such exactness, the general make of an instrument must do, in _all_ -cases: that general make is not at least to be looked for in any of the -kinds I have already quoted, by which such numbers of women and children -must have been tortured or sacrificed, before they were exploded and -given up, as good for nothing or insufficient, even by the -men-practitioners themselves, who however substituted no others to them -but what were rarely less exceptionable. They were only newer. Let us -then now proceed to pass in a summary review the later and pretended -improvements of this prodigious invention of the forceps, and candidly -examine the validity of their claim over the women’s hands. - -MR. Rathlaw, a famous surgeon of Holland, in his dissertation on the -means, or secret of Roger Roonhuysen, which was transmitted to his -heirs, for extracting (as was said) in a very little time, a child, -whose head should be embarrassed in the neck of the uterus, says thus, - -“TO me it appeared impossible, to establish an instrument, whose use -should be so certain, so general, so necessary, that one could not be a -man-midwife without having a knowledge of it.” - -THE same Mr. Rathlaw, in the same piece, exclaiming against the use of -the crotchets has this remark. - -“NO one (says he) can be ignorant of it’s being no longer the practice -in France, or in England, to employ crotchets, or murderous tire-têtes -(_would this were truth!_) in the deliveries, unless for a monstrous or -hydrocephalous head, when the bulk of it is so enormous, that there is -no possibility of getting it out whole, and especially if the child -should be dead.... In my time, (adds this author) every eminent -man-midwife had invented different means of extricating himself out of -the plunge of such a case, and their reputation grew in proportion to -their respective success. Yet, hitherto, I do not know, that either at -Paris or at London, they have got such a length, as to take any -particular instrument under their protection. Nine years ago, (Mr. -Rathlaw continues) I had made a forceps almost wholly of my own -invention to extract the fœtus by the head, and it often succeeded well -with me. It was, as to its make, a good deal resembling that which -Butter describes in the Edinburgh-acts, volume III. art. 20. But mine -(proceeds he) seem to possess better proportions, and is certainly of a -more handy use, than those which have hitherto appeared.” - -PLEASE to observe, that this forceps of Mr. Rathlaw is the same as -Palfin’s, or rather as that of Gilles le Doux, excepting only the -semilunar hollow cuts in the claws, which Monsieur Duffé, a surgeon of -Paris, had contrived in them. The author says, it had _often_ succeeded -well with him: he does not say _always_, and why? most probably because, -when he did so _often_ find it of service, that was, only whenever there -was no sort of occasion for using it at all. Do not let it here be -imagined, that I force an inference. I give my reason. Supposing that -such an instrument was necessary to every practitioner, the case for his -using it cannot but rarely occur. Now those rare cases where Rathlaw -judged his forceps necessary, and in which it failed him, were in all -likelihood the true tests of its merit: whereas those other cases, in -which he _often_ succeeded, may very well be taken for such as, with -hands and patience, might have afforded a better account of them, than -the silly superfluous quackery of employing a forceps, unless indeed his -hands were too clumsy to attempt it. Otherwise the using instruments, -where they sometimes do the work with so much more pain and danger, when -the bare hands well conducted would do so much better, remind me -naturally enough of what I have seen a pretty master do with a -steel-instrument called a zig-zag or fruit-tongs, when, to display it, -or out of wantonness, he has catched up fruit with it, that lay fully -within the reach of his hand. In this piece of childishness there is -however no mischief; whereas the man-midwife, for considerations of -lucre, dallies with two lives to pluck at a fruit that is never, I -repeat it, never, out of reach of the hand, where that steel-instrument -of his, a forceps, can bring it away. - -MR. Rathlaw also tells us of another instrument, of which he gives us an -account. He had got the secret from one Velsen, a physician at the -Hague. This Velsen had it of Vanderswam, who had been a pupil of -Roonhuysen, the inventor of this pretended nostrum, with which he always -helped the women in labor, snug under the bed-cloaths, the better to -conceal his miraculous secret. He had long promised his pupil to -discover it to him. - -“IN short (says Mr. Rathlaw) one day that Roonhuysen was returning from -laying a woman, a burgomaster of Amsterdam came to speak with him: in -the hurry Roonhuysen was to receive him, he hid his nostrum-instrument -in some apartment. His curious pupil (Vanderswam) who had for several -years been watching such an occasion with great eagerness, found it, and -took a draught of it. This instrument was in a case with two long steel -crotchets, and a piece of whalebone, in the shape of a pipe for -smoaking, only shorter, and at one of the ends of which was a piece of -steel, of the shape of an acorn, and there was no other instrument in -this case.” - -IF Mr. Velsen is to be believed, it seems, on the one hand, that -Roonhuysen made the whole science of midwifery consist in the knowledge -and use of this his instrument, since it is there said, that Roonhuysen -had promised this pupil of his to teach him the art of midwifery, but -taught him nothing of it; and indeed it does not appear, that he had -hidden any thing from Vanderswam but this wonderful instrument, with -which he used, under the bed-cloaths, to smuggle the child through the -difficult passage[37]. - -ON the other hand again, it may be judged, that this pretended -marvellous instrument was not of effectual enough service to its -inventor, unless in those cases where he might as well have done without -them, since this very same Roonhuysen made use of crotchets, doubtless, -when he found his instrument fail him. O women! women! thus it is that -your pretious lives, and that of your children (to say nothing of the -additional tortures you are put to, as if those of Nature’s own ordering -were not already enough) are trifled with, in practices being tried upon -you with such instruments, for which you are besides to pay -exorbitantly; and all for what? To increase the practice of some quack, -who raises into notice his worthless name, or perhaps swells some work -of his, published by way of advertising himself, with the rare boast of -having delivered you with an instrument, that has only, not murdered -some of you, though it may sometimes perhaps have done you irreparable -damage, and will have always occasioned you an unnecessary increase of -pain and danger. Is it possible to inculcate this truth too often or too -strongly to you? - -“THERE are many people, (adds Mr. Rathlaw) who make a doubt whether this -instrument is not the same as that with which the three Chamberlains, -brothers, acquired in Ireland and other countries the reputation of -being the most eminent men-midwives in the world. In those circumstances -in which others employed crotchets, they could, by their manual -operation, and with less labor, hasten the delivery of the women in less -time, and without the least danger to mother and child.” - -I AM not unwilling to believe that the three brothers, the Chamberlains, -might pass for the most eminent men-midwives in the world, especially in -Ireland, where before there never had, as I understand, been seen any -practitioners of midwifery but women. As to other countries, these -brothers might very easily surpass in skill those, who knew no gentler -way of terminating a delivery than by the means of crotchets. Therefore -it is that our author adds, that the Chamberlains only made use of the -manual operation; he does not add of other instruments. It is a great -pity however, that the surgeons of all countries have not yet got hold -of, and adopted this marvellous secret of Roonhuysen’s, which would -extricate them so gloriously, in their attendance on such difficult -labors. They would thereby greatly reduce their armory, from its complex -state at present of variety of crotchets, tire-tête, forceps, spoons, -blunt hooks, pinchers, fillets, lacs, scissors, incision-knives, and the -rest of their tremendous apparatus. - -ACCORDING then to Mr. Rathlaw, the forceps of Roonhuysen was the same as -that of the Chamberlains. How he got the secret from them matters not. -He only changed the figure of the blade-parts. In short, our author -adds, that to him it seems probable, that this instrument has been -brought to perfection by the continual experience of men-midwives, who -have successively employed it. He pretends himself to have made some -alterations in it for the better, but what they are he is not pleased to -tells us. - -THE illustrious Janckius, a great practitioner, mentions another -corrected forceps in his dissertation upon the forceps and pinchers, -instruments invented by Bingius, a surgeon of Copenhagen, and of their -use in difficult labors, printed at Leipsic, 1750, page 211. This -forceps resembles mostly that which the celebrated Monsieur Gregoire, -senior, first imagined upon the model of Palfin’s tire-tête. - -“Janckius, in the same dissertation, tell us, that it would be of -service to have spoons or blades of the forceps of various curvatures, -and of different lengths, for the shorter the arching, and more crooked -the blades or spoons are, the more difficult and dangerous will the -application be, according to Chapman and Boëhmer.” - -THENCE this consequence seems derivable, that to obviate these -difficulties and dangers, it would be requisite to have as many crooked -spoons as there are particular cases, as well as to take measure of the -heads that are stuck, which still would imply the introduction of the -hand, and, of course, the uselessness of instruments. - -MR. Levret, in his notes, p. 377, makes us observe, that the branches of -the forceps of Bingius, which are solid, being considerably more crooked -than the windowed forceps, the expansion of their middle part must be -too wide not to risque, in the extraction, the _tearing_ the perinæum, -which it is no such _indifferent_ matter as not to be remarked. - -THIS Janckius had, it seems, that bad habit of employing too _soon_ the -instrument of Bingius, which is extremely dangerous. This however, is -not seldom the case, when Monsieur l’Accoucheur is in a hurry. - -BOËHMER, in a dissertation on this subject, thus expresses himself, as -to the instrument of Levret, and the forceps of Bingius. - -“I shall only observe (says that learned physician) what Mr. Levret has -himself very justly remarked, that the application of the forceps is -dangerous, unless the head should have already descended low enough into -the pelvis for the orifice of the uterus to be effaced, and to make but -one and the same cavity with the vagina. This counsel is essential for -two reasons; - -“FIRST, for fear of hurting the orifice of the uterus which might easily -happen without this precaution. - -“SECONDLY, on account of the instrument itself, the blades of which -could not embrace more than a part, and not the whole of the head, which -remaining too high, they could not consequently compress it equally, nor -extract it. It is for the same reasons (continues he) that I rather -differ in opinion from the celebrated Janckius, who, as soon as the -waters are discharged, and he perceives that the head does not pass, has -instantly recourse to the instrument.... Some time (says he) should be -indulged to the action of Nature.... There is often more success -obtained by temporising, than by too early a recourse to instruments.” - -LITTLE by little the truth will come out. Little by little, even the -men-practitioners themselves, will be forced to allow, that the very -least imperfect of the instruments are prejudicial and dangerous: though -perhaps they will not speak out the whole truth, and confess that total -uselessness, which would, in so great a measure, imply their own. But -common-sense will inform whoever consults the light of it within -himself, that these instruments are of a nature so heterogeneous, from -the service expected from them, so impossible to be adapted to the -infinitely tender texture of the organ of gestation, that the very best -of them must occasion lacerations, especially by the opening of the -branches, the strain of which bears upon the mother’s body, and can -never but hurt the child, in crushing it’s head; as they make that to be -done precipitately, about which Nature has, for taking her own longer -time, no doubt a very good reason, if there was no more than that one of -gradually dilating the passage; but there are probably many others. - -ART should aim at imitating Nature: now Nature proceeds leisurely, -instead of which the forceps goes too quick to work. The action of it -depends on an artificial compression, which begins by moulding, or -rather crushing the child’s head, adaptingly to the figure of the -pelvis, to facilitate its extraction; and though the divine providence -has in its wisdom provided for the preservation of the human species, by -means of what is called the duramater, and by the void of the sutures in -the cranium of children, the manual compression of the instrument is -either too strong or too weak. If too strong, the child is lost; the -head being so compressed by the instrument, that the brain escapes -through the occipital cavity: if it is too weak, so that the head has -not been sufficiently compressed, nor it’s bulk competently diminished, -in attempting the extraction, not only the uterus can scarce escape the -being wounded, but the perinæum and the bladder the being torn: and -indeed in either case they hardly escape, the instruments occasioning -various inflammations and contusions, of the worst consequence, both in -the internal and external parts, besides the great danger of the blades -slipping and violently hurting the mother, not to mention the painful -divarications and shocking attitudes in order to the introduction. - -THE instrument used by Mr. Giffard, man-midwife, is supposed by Levret -and others to be nothing more than the windowed forceps, of which the -use had been long before known. But that appears as unsatisfactory as -others. Mr. Freke too, it seems, furnished a new kind of corrected -forceps, the chief merit pretended of which was, that the extremity of -one of the blades was curved in form of a crotchet, and that this -extremity might be _concealed_ when not employed as a crotchet, and -consequently helped to avoid the having a multiplicity of instruments, -as this new-fangled one might, upon an occasion, serve either for -crotchet or forceps.—What a prodigious strain of sublime invention is -this of death and wounds in various shapes! - -I FIND too that Chapman is blamed, for that, in his essay on the art of -midwifery, he very frankly condemns all the tire-têtes he had seen -employed till his time by all other practitioners, but he has not, it -seems, given a description of the one he himself used, nor doubtless the -method of using it, the one necessarily depending on the other. Nor -where that author speaks of passing a ribbon over the head of a child, -is he so good as to tell you how he managed to get it over. - -I MUST not here omit some mention of the forceps, pretended to be -improved by Dr. Smellie. Upon which, however, I shall spare the reader a -tedious minute discussion of its form, and of its advantages and -disadvantages, comparatively to other forceps calculated for the same -use. Levret may to the curious furnish sufficient satisfaction on that -head. He has examined it with great exactness and seeming candor, even -though he prefers his own to it. Nothing can be plainer, than its being -just as insignificant and foolish a gimcrack as any of the rest. But -there is one particularity, of which Levret takes notice, that I cannot -well omit mentioning. The Dr. has, it seems, whether to spare the women -the shock of the gleam from a polished steel instrument, or, whether to -defend them from the injury of that metalline chill, which is not well -to be cured by any warming at the fire, covered his instrument with -leather spirally wound round it. Levret upon this concludes his remarks -with the following one. “The ledges or roughness which the leather must, -_besides increasing its bulk_, create by those its spiral -circumvolutions, cannot but be such an obstacle to the introduction of -the instrument, as to let it be serviceable only in those cases where -(N. B.)—one may do _very well without it_. For it is well known, than in -those cases where recourse to it is requisite, the most polished, the -most smooth instrument often finds such great difficulties in its -intromission, that nothing but a hand, _consummately_ expert in the use -of this instrument[38] can, without damage, remove the impediments.” - -DR. Smellie has, however, himself salved one of Levret’s objections to -his instrument, as to any offensive smell or infection that might be -contracted by the use of it. (Treatise of Mid. p. 291.) “The blades of -the forceps ought to be _new covered_ with stripes of _washed_ leather, -after they shall have been used, especially in delivering a woman -suspected of having an _infectious_ distemper.” Certainly, certainly, -not only the Doctor’s nine hundred pupils, but all other practitioners, -that use this famous instrument, will do well to observe this -injunction. It is the very best thing they can do, next to never using -it at all. - -I COME now to the boasted instrument of Levret; who is the last, at -least that I know of, who has invented a new make of a tire-tête, or -forceps corrected, over all that have appeared since Palfin. He gives -us, in a book written on purpose to recommend it, a minute analysis of -it, and an ingenious delineation in some pretty prints of it. The work -is intitled, _Observations sur les causes et les accidens de plusieurs -accouchemens laborieux_. - -BUT to make use of the instrument or instruments which Levret -recommends, requires not only a hand consummately dextrous and skilful -in the art, but an infinite number of perplexing precautions, as may be -seen, p. 106, and seq. of his observations. - -I WILL not here undertake a circumstantial account, I shall content -myself with mentioning some of them. - -“There is here (says our author) a very important remark to be made, -when you are for using this forceps. It is absolutely necessary that the -orifice of the uterus should be, as it were, totally effaced or erased, -that is to say, that the vagina and the uterus should, in a manner, no -longer form other than one and the same cavity, from a sort of -uninterrupted continuity, because, without that, there would be a danger -of getting hold of the orifice of the uterus between the head of the -child and the instrument, which would be extremely hurtful. - -“I OUGHT (continues he) to add, that great attention should be given to -the attenuation of that orifice, for before it’s intirely disappearing, -it becomes sometimes so thin, and so exactly close fitted to the child’s -head, that, without a most scrupulous examination, one might commit a -mistake.” - -BESIDES the measures, observations and remarks this practitioner urges -in that place, which require infinite attentions, he adds to them the -following ones. - -“FIRST, when you introduce the instrument you are never sure of being in -the uterus, but, when, besides the precaution I have above recommended, -you feel that the axis of the instrument, or the extremity of the -branches, is in a kind of vacuum. This sign would I own be a very -equivocal one, for a person that should use this forceps without having -practised surgery[39]; but so it will not be for him, whose sense of the -touch is habituated to the feeling of instruments of different sorts, as -they enter into empty cavities of vessels or of hollow organs, or in -short of any cavity. - -“SECONDLY, when by drawing towards yourself the instrument, you are -assured of the preceding sign, you will feel a small resistence to a -certain degree. - -“THIRDLY, the blades of the instrument should suffer themselves to be -opened out with some sort of ease, and what is opened out should not -make resistence enough for the blades to return with any violence to the -place whence the opening out began. - -“FOURTHLY, the blades in the instrument should, as they open wider and -wider, rather tend to augment the diameter of the void of the instrument -than diminish it. - -“FIFTHLY, these same blades should, in their expansion, go a little -depth in the vagina. - -“IF the man-midwife, (says Levret) perceive, that _any_ of these -favorable signs should be _wanting_, he ought to _mistrust_ the -_success_, and to have recourse to his _sagacity_ for the remedying it.” - -THUS far as to the handling this forceps of Levret’s, to whom the -defectiveness of the English and French forceps had inspired an idea of -providing such a supplement to it, from the richness of his own -invention. - -I DO not wonder however at no instrument pleasing Mr. Levret so well as -his own. Nothing is more common among the instrumentarians, than their -disagreement about the make of their instruments. Some will have their -forceps long, others short, some strait and flat, others curve: in -short, there is no adapting the mechanism of it to their various -fancies, so apt too as they are to change. Levret complains bitterly of -the inability or injustice of the instrument-makers; but by what I -believe of them, very unjustly. The gift of the fault is not in the -instrument; it is in the use to which they are so often put of -attempting impossibilities. - -BUT now let us examine, what surely very competent judges have thought -of this famous new forceps of Mr. Levret, which he calls _his_ -instrument. - -WHEN the book and instrument were presented the Royal Society at London, -it appears by a quotation inserted by Mr. Levret himself, that his -instrument was allowed to be ingenious enough, but that “there was -_nothing extraordinary in it_.” - -PAGE the 10th of his preface, he has the candor to own, that he does not -absolutely pretend that success will always attend its application, even -in the cases he points out. - -PAGE the 36th, and seq. of his observations, after having exploded the -forceps, and other instruments of the authors who have preceded him; and -after having described the alterations and corrections made in the -English and French tire-têtes, he gives us indeed the better opinion of -his, by a fair confession of the insufficiency of them all without -exception, and even of his own: by which, however, it is plain, he can -mean no more than that, imperfect as they are, they all are still -preferable to the hands alone; but the question of this superiority is -as constantly as it is shamelessly begged by him, and all his fraternity -of instrumentarians. - -THUS however he expresses himself as to his own instruments. “This -instrument is actually, to all appearance, now at the very utmost degree -of perfection, to which it is possible for it to arrive, without however -having all the perfection that might be wished, for the most expert -practitioners in the use of it, agree in the opinion. - -“FIRST, of the difficulty of its introduction in certain cases. - -“SECONDLY, of its stubbornness as to the crossing of the blades. - -“THIRDLY, of its contributing to _tear_ the _fourchette_, or _frænum -labiorum_.” - -[OUR author is very angry, that Boëhmer, who, in his critical -objections, opposes those his own words to him, has not added the -subsequent lines.] - -“THE correction I have made in this instrument (continues Levret) by -means of the shifting axis, has rendered the difficulty of crossing the -blades _less_ considerable, and the two following reflexions may serve -_greatly_ to overcome the other two inconveniences.” - -BUT should it be granted to Levret, that the shifting axis somewhat -lessens the difficulty of crossing the blades of this instrument, it -would still remain too great an one, for all that correction. The -reflexions he adds, for the overcoming the other two inconveniences, -carry no conviction with them; and indeed he himself seems to think so, -by his adding afterwards (p. 99.) - -“TO obviate this inconvenience of tearing the _fourchette_, or the -perinæum, I caused to be made a _curve_ forceps, as to any thing else -not differing, in its dimensions, from the first. I took the idea of it -from the curve pinchers used in the operations of lithotomy. It will be -easier to conceive, than for me to describe the advantage it must gain -by it. That was not however the only end I proposed by it, as all the -good practitioners at present agree on the _small_ efficacy of the -common forceps, in the case of a head stuck in the passage when the face -is turned upwards.” - -IT is in consequence of this opinion that Levret, in the sequel to his -observations, p. 301, tells us. - -“I COULD (says he) answer Mr. Boëhmer, that all the most eminent -men-midwives are convinced, that when the child presents with the face -upwards, or turned forwards, that is to say, towards the os pubis, and -that in this position, the head sticks, the forceps commonly used can be -of _no_ service: I do not (adds he) even except the one I have had made -with a shifting axis. The defectiveness of these instruments, in these -particular cases, sufficiently proves, I should think on one hand, that -the English forceps is not so good as Mr. Boëhmer seems to believe; and -on the other, I presume, he will be convinced, that I am not more -servilely attached to my own productions, than those of others.” - -THIS insufficiency then of the common forceps has given rise to the -curve forceps of our author. Here follows what he further adds to what I -have above (p. 427) quoted from page 99 of his work. - -“THE form I have given to my forceps, renders it then very useful, -since, by means of the curve, it lays holds of the head with all the -efficaciousness that can be found in the use of the common forceps, -employed on the most advantageous position that the head can be -imagined.... Notwithstanding all the corrections made in the English and -French forceps (continues the other practitioners) if my instrument is -compared to all the other forceps it will appear; - -“FIRST, that it has none of their faults. - -“SECONDLY, that it is very feasible with it to extract the head of a -child separated from the body and remaining in the uterus. This is so -possible, that all those who have seen my instrument, are unanimously of -opinion, that no other forceps can do as much. - -“THIRDLY, with my instrument it appears to me possible to assist -powerfully the getting out the head of a child that shall have remained -in the uterus, the body being entirely come out, but of which a part is -still in the vagina. - -“FOURTHLY, my instrument has this in common with the ordinary forceps, -that it can extract a child by the head, when this part shall be stuck -in the passage.” - -IT may well be said here, that Mr. Levret attributes such excellent -qualities, and marvellous properties, to that same new forceps of his, -as ought to immortalize his memory, and render his forceps universal -over the whole earth,—if they were but proved. Ay! there lies the -difficulty. Messieurs Rathlaw, Boëhmer, Janckius, and the most notable -practitioners in England, do not believe a syllable of the matter. Even -Dr. Smellie, though I think he approves the crooked part of the forceps, -speaks slightly enough of it, and has even dared to falsify the -inventor’s assertion of the ne-plus-ultra of it, by altering the form, -as he tells us, p. 370. “in a manner that renders it more simple, more -convenient, and less expensive.” Mr. Levret cannot then expect we shall -take these advantages for granted upon his own bare assertion, in the -blind enthusiasm he manifests for this rare production of his genius. I -do not so much as believe, that he was even himself, at times, clearly -persuaded of its excellence. At least he, in several places, appears to -contradict himself. As it is then greatly of use to show into what a -maze of errors these are capable of falling, who neglecting the guidance -of judgment in the road of truth, wander into the wilds of imagination, -I shall just point out here some of Levret’s, at least, to me, seeming -inconsistencies with himself, but especially with plain reason and -common-sense. The reader will find the notice I take of them far from -digressive, serving as they do even for connexion, as well as -enforcement of my arguments. - -MR. Levret, p. 161, concludes the first part of his observation thus. - -“NOTA, some very intelligent persons have been pleased to charge me with -an opinion, which I have never had as to CURVE FORCEPS: they think, that -I believe it capable of going into the uterus in search of the child’s -head when it is not ingaged in the orifice: and yet I do not advise the -use of it, unless in those cases where the other (the common forceps) is -employed, over which it has essential advantages.” - -HERE the reader will please to observe, that all the wonders, just -before quoted from himself, are reduced only to the cases in which it -may be advantageously substituted to the common forceps. This, by the -by, is reducing it to less than nothing. But how is this consistent with -those same marvellous excellencies he displayed to us a little before, -to wit? “_It is very feasible with it to extract the head of a child -separate from the body, and remaining in the uterus._”——And again, -“_with my instrument it appears to me possible, to assist powerfully the -getting out the head of a child that shall have remained in the uterus, -the body being entirely come out, but of which a part is still in the -vagina_.” - -NOW these two cases clearly imply, that Mr. Levret’s curve forceps is -capable of going into the uterus in search of the child’s head, even -when it is not engaged in the orifice: for here the case meant, is -either that of a head remaining detachedly in the uterus, after having -been severed or torn away from its body: or of a head not separated, but -remaining in the uterus after the body shall have come out, and part of -it is still in the vagina. - -IF therefore Mr. Levret’s forceps had the advantage over the common -forceps, confessedly insignificant in these cases, of being able to lay -hold of these heads, he might be somewhat in the right to exalt it as he -has done. But at present he must be wrong, which ever side he takes. The -dilemma is self-evident. He is in the wrong to deny what he had -certainly said. He is in the wrong to complain of being taxed with an -opinion, which his own allegations prove he had entertained. I therefore -refer Mr. Levret from himself to himself. If he did not believe, that -his curve forceps had over all the rest the properties he sets forth, -why has he so confidently affirmed them? and after affirming them, why -would he hinder us from thinking that he believed what he affirmed? - -I AM here to observe, that if I have made use of the terms of “a head -not _separated but remaining in the uterus after the body shall have -come out, and part of it is still in the vagina_,” it is purely because -I would not change any thing in the expression of this celebrated -instrumentarian. It is this exactness of quotation, that has made me -conform myself to his manner of speaking, in my answer upon this -difficulty. Otherwise, I own, I do not apprehend the propriety of his -description of the case. It surprized me too the more, in so intelligent -a writer as Mr. Levret, that he should represent to us a body come out -of the uterus, and yet remaining in the vagina; as if, on such an -occasion, the vagina could be distinguished from the orifice of the -uterus. It is even stranger to me yet in Mr. Levret, for that he -himself, in a note, p. 106, of his observations (by me before quoted) -expressly says, that “when you are for using this forceps, it is -absolutely necessary that the orifice of the uterus should be, as it -were, totally erased or defaced;” so that the vagina and orifice should -be laid into one. (See p. 420.) - -HERE follows a much more material contradiction, rather however to -common sense than to Levret himself, to which I intreat the reader’s -particular attention. - -OBSERVATIONS, part the 2d, p. 160. Levret gives us the following -preliminary general precept. - -“THERE is, says he, a general precept by which it is established, that a -surgeon ought never to thrust instruments into deep places, without -guiding or conducting them with the hand, or with the extremity of the -fingers of that hand that does not hold the instrument.” - -IT is then to this general axiom strongly dictated by reason, and surely -in no case more obviously so, than where the exquisitely tender texture -of the uterus protests against committing its safety from the cruellest -injuries, to the necessarily blind random agency of an iron or steel -instrument, so palpably ungovernable in so remote, intricate, and -slippery a place by even the most skilful hand[40]; it is, I say, in -exception to this so salutary general precept, that Mr. Levret will have -it that there are exceptions, and in favor of what, do you think, not -surely of the poor woman who, is to be the subject, or rather the victim -of the experiment, but of——his most egregiously silly CURVE FORCEPS! -Yes; it is by way of trying practices with that same instrument, that -the patient is liable to be _spread out_, in that delicate attitude -which I have above, (p. 237) described from Levret, to the perusal of -whom, for a thorough conviction of the perfect insignificance of that -instrument, or indeed of any of that sort, I would recommend even the -most sanguine in favor of instruments, if they would but grant, to their -own reason, its just prerogative of a previous suspence of prejudice. - -IN these cases, however, for the which being exceptions to that -excellent general rule, Levret contends; and, to do him justice, -contends so auckwardly, that he rather provokes pity than indignation, -at his endeavouring to establish even so pernicious an error; let the -reader consider within himself the part into which this forceps is to be -thus blindly thrust, at the risque of so many almost inevitable dangers. -And for what?——In those cases it is either possible or not possible to -introduce the fingers. Where they absolutely cannot be insinuated, the -introduction of those instruments is in all human probability big with -the worst of mischiefs, where neither hand nor fingers can controul the -effects of the iron or steel: which, consequently, endanger more than -they can help, and are therefore not to be used. But if the hand or the -fingers can be insinuated, the hand or the fingers well conducted will -do the work without the help of instruments, which in this second -supposition become also useless. - -THIS brings me to this case particularly, the title of which is prefixed -to this section, that of a head stuck in the passage, which the -gentlemen-midwives may perhaps second Levret, in maintaining to be an -exception to that admirable axiom above quoted, and maintain it purely, -in evasion of the conclusion against their miserable instruments, which -I aver need never be resorted to, nor never are, but for want of -sufficient skill in the manual function to terminate such labors without -them. - -I ANSWER then to these instrumentarians, that an instrument, even, no -more dangerous than a probe, would in so tender a place as I am treating -of, not perhaps be quite enough exempt from a possibility of doing -mischief, to deserve an exception: but as to those instruments, which -are so palpably likely to hurt both mother and child, to injure, in -short, or even to destroy both the mould and the cast, they are all of -them within the case of exception, or rather exclusion. It is then, in -knowing what to do, and in the faculty of operating with the hand -according to that knowledge, that the art of midwifery principally -consists. If instruments are deemed ingenious, the doing without them is -surely not less so. - -NOW as to the case proposed in this section, that of a child’s head -stuck in the passage, I aver, that it is not absolutely impossible to -terminate this delivery by the hand. - -I AM even ready to demonstrate this before any competent judges. I speak -by experience. I have hitherto executed with all desirable success this -operation without any aid but that of the hand, with a little patience -and proper assiduity. I have many and many a time seen it practised at -the Hôtel Dieu, and elsewhere. I never in my whole course of practice -saw sufficient reason for attempting so hazardous an extraction, as that -which is executed by means of a tire-tête. Why then those needless -terrors, those superfluous tortures with instruments, to women already -in too much pain and anguish? care enough could not be taken to spare -those of the weaker-nerved sex in that condition such horrors, the very -idea of which, to say no more, is enough to put them into imminent peril -of their lives. All the forceps, and the rest of the chirurgical -apparatus, especially the more complex instruments, very justly frighten -the women, and their friends and assistents for them. Their introduction -requires at once a painful, a shocking, and a needless devarication. The -patients are put into attitudes capable of making them die with -apprehension, if not with shame, from that native modesty of theirs, -which, in these cases, may however be pronounced rather a wise instinct -than a virtue. - -HOW much preferable is the true midwife’s practice, who will have -oftenest prevented, by her knowledge and skill, this very situation! -That is to say, if she has been called in time. She knows how to -predispose the passages, and by gentle reductions to restore Nature to -her right road, where she has been through mispractice driven out of it, -or through negligence suffered to deviate from it, or not preventively -watched. - -I HAVE never but seen, with respect to the uterus in this case, that it -was possible to insinuate first one finger, then another, and little by -little the whole hand, not indeed a hard hand, as big as a shoulder of -mutton, the hand of some lusty he-midwife, but of a midwife, such as it -is commonly seen. - -WHEN Nature does not proceed as could be wished in her labor-pains, the -point is then to husband well the strength of the patient, to restore it -where it fails, by giving her good broths and corroboratives, that do -not heat, or cooling things, where heating ones have been injudiciously -administered. She is then to lie as composed and tranquil as possible; -to be cherished, comforted, inheartened. There is, humanly speaking, no -fear but her strength will return; her pains must not be irritated, nor -herself harrassed with ineffectual interference. Nature will come to -herself again: the situation will, by her benign energy, change for the -better, and become favorable enough, for the midwife to be able to -assist her in the due time with a manual operation, that will terminate -happily her delivery. It is at least, with this success, that I have -delivered many, who, by the unskilfulness of those who had attended -them, at the beginning of their pains, had been reduced to a deplorable -condition, by their labor lingering some for upwards of six days. - -IN short, it is extremely rare that this case of a head stuck in the -passage ever happens, unless under the hands of unskilful practitioners, -or of over-dilatory or neglectful midwives, who will not have duly -attended to the prognostics of this event; who will not have watched and -taken the benefit of the favorable critical moment; who give the head -time to engage itself, or get fast jammed, for want of their removing -the impediments to Nature’s doing the rest, or when help has been called -or come too late. It may also be owing to those who hasten too much, who -precipitate the women’s labor by forcing draughts, that heat, burn them -up, exhaust their strength, and prematurate the coming on of the -labor-pains. Some practitioners fatigue them, with making them walk, or -keep them up too much. - -BUT when the membranes are not too soon pierced and the waters let out, -when the pains are not provoked, when time is given to Nature to form to -herself a passage, not omitting the precautions I have summarily -intimated; when due care is taken to procure all possible ease of body -and mind to the patient; who may vary her posture, sometimes lying -along, sometimes sitting up, or well supported when she walks: little by -little the head will frank itself a passage with the weight of the body -acting by an innate energy, and with a little due assistence of the -midwife’s art: and with this practical advertence, that, in these -arduous cases, much may be safely left to Nature, but not every thing. -There are times in which she cannot bear neglect, but there are none in -which she can bear extreme violence. - -HERE the reader will not expect I should in a treatise, purely -calculated to expose the abuses of midwifery, attempt to particularize -either all the contingent cases, or all the modes of operation in them. -That would require a work a-part. I shall only then, to the four -principal cases, in which instruments are so falsely supposed necessary, -add a summary account of that of a _pendulous belly_, which is not -without its difficulty. - -AS to a PENDULOUS BELLY, madam Justine, midwife to the Electress of -Brandenbourg, remarks, in her Treatise of the Art, that she knows, by -experience, that some children turn upon their heads with their feet -upwards, in women who have a large and prominent abdomen; because, says -she, they are pitched too much into the fore-part of the belly, that is -become pendulous. But she does not explain the consequence of this -situation, which however does not fail of causing a severe and -troublesome labor; in that the uterus being fallen into the capacity of -the hypogastrium, and the child being got above the os pubis, there it -sticks, and the labor-pains are ineffectual, if proper assistence is not -given to Nature. - -THE practice which my success on experience encourages me to propose is, -to have the patient lye on her back, the belly to be braced upwards with -a large linnen-fold or roller, to reduce the uterus and fœtus to its -better position in the capacity of the pelvis; but if, notwithstanding -that help, the head of the child continues to rest on the os pubis, the -finger must be insinuated between those bones and the head, in order to -make, it, little by little, retrograde into the pelvis towards the -coccyx. - -IN every case then that can be imagined, so far as my own experience and -observation have reached, I am authorized to aver, that the gentleness -of the manual assistence to women is at once more agreeable to Nature, -and more salutary than the violence of the instrumental practice; which -not only conveys the idea, but the very reality of a butchery. While its -being sheltered under the plausible pretext of tenderness and pious -regard to the safety of the poor women and children, cannot but provoke -the greater indignation, at seeing vile interest trifling thus wantonly -with their lives, and add to the cruel outrages on the human person, the -greatest of insults on the human understanding. - -IT cannot however have escaped observation, that while I am, with the -utmost regard to truth, endeavouring to recommend the preference of the -hands to instruments, there is nothing I mean so little, as that some -deliveries may not be accomplished by instruments, and especially by -that divine invention of the forceps. What I presume to exclaim against, -is the needless torture to the mother, the needless increase of danger -to which she and her child both are exposed, for the sake of that -practice being tried upon them, with those instruments, when the bare -hands would be so much more safe and effectual. I could myself, no -doubt, in many cases, if I could be inhuman and wicked enough to dally -with any thing so sacred as the health or life of a woman and child, in -some measure, entrusted to me, give myself the learned air of delivering -with a CURVE FORCEPS. But in the very same cases, though at the hazard -of being called ignorant for my pains, I would always be sure to do it -more cleverly, less dangerously, less hurtfully, with only my hands. So -that, without straining any comparison, the forceps may deliver indeed, -but how? Why just as a man may, if he chuses it, hobble round St. -James’s Park, on a pair of those _artificial legs_[41] called stilts, -when one would imagine, that the mock-elevation from them could scarce -atone for their uncouth totteringness, and that he might full as well -deign to use his own _natural_ legs. - -IN the slighter cases then, that is to say, in those cases, where it is -a jest to doubt of the hands not being the preferable instrument, since -they may be truly averred to be so even in the most difficult ones, -instrumentarians commonly go to work, _only_ (please to mind that -_only_) with the forceps. So that it is _only_ in those slighter cases, -where, once more nothing is more certain than that no instrument is -wanted at all, that they find matter of triumph over their predecessors -in theory and practice, over common sense, and especially over humanity. -And this is that amazing, that FORTUNATE IMPROVEMENT, the superhuman -invention of the forceps, the philosopher’s stone of the modern art of -midwifery, found out by the male-practitioners. Yet, after all it -plainly appears, that even themselves do not rely on it in the more -difficult cases. They are then obliged to return to the _old_ crotchet, -or the like methods, which bad, very bad, and very inferior to the hands -as they are, never however are supposed to be resorted to, without an -appearance of extremities to afford some color, some plea of humanity to -employ them, in a kind of dernier resort, to prevent a greater evil by a -less one. Whereas, when the forceps is used, the cruelty of that torture -it cannot but create, must be greatly aggravated by the consideration of -its being perfectly needless. But in the case of using either crotchet -or forceps, or indeed any instruments at all, the truth is, that besides -the increase of danger and pain they bring, to the already too much -afflicted patients, they defraud them of the more efficacious, less -painful, and especially more safe help of the hands alone. - -THE instrumentarians all then agree on that insufficiency of this -precious forceps, which occasionally compels their recourse to the -crotchet so detested even by themselves. Levret, for example, confesses -this, p. 24, of the appendix to his observations. - -“THE crotchets (says he) are, generally speaking, instruments, the very -sight of which shocks and terrifies: but notwithstanding the repugnance -which all _good_ men-midwives ought to have to the using of them, there -are cases in which there is no doing without them.” - -NOW in these cases, that of the monster with two heads[42], is not meant -to be included, as Levret himself afterwards explains himself. If then -there are such cases as necessitate a recourse to crotchets, it will, I -presume, be allowed me, that they can be no other than those which -render the delivery the most laborious. What those cases are, I have, -from after the instrumentarians themselves reduced to the four capital -ones, I have above set forth, without reckoning the pendulous belly. At -least I know of no other situations than those, that can produce the -very severe labors, nor do I believe that the instrumentarians know any -other, or they would tell us so. Now if, in the more difficult of those -cases, there is no doing without the crotchet, what becomes of the -prodigious merit of the forceps, so insignificant in cases of the -greatest need, and so superfluous in those others, where there being no -occasion at all for it, it must be the most inhuman wantonness to employ -it? - -HERE can you be with too much insistence desired to observe the solemn -banter, in such a matter of life and death too, of these kind, -tender-hearted modern instrumentarians! they are so transported with -stark love and compassion to the poor women and children, that they do -not know what they are about; they fall into the most palpable -contradictions, and would have even Hippocrates, and the antients, -appear as so many bloody-minded Cannibals compared to them. Hippocrates, -it seems, and the antients, according to the best of their apprehension, -in points of midwifery, prescribed the crotchet, in no case however but -where the child was certainly dead, which, by the by, is next to the not -prescribing it at all, since the ascertainment of that death is scarce -not impossible. So because they recommended this practice in the last -necessity, the ingeniousness of the modern instrumentarians was -“[43]stimulated to contrive some _gentler_ method of bringing along the -head” —— without any necessity at all; that is to say, in the minor -difficulties, for the crotchet of the old practice is, to this instant, -even with them, left in possession of the greater ones. Thus was -produced the forceps, that prodigiously bright refinement upon the dull -antients, and goes on improving without end under the wise heads of our -gentlemen-midwives. But if the modern Genius of arts and sciences has no -better improvement than this to boast over Hippocrates and the antients, -may the instinct of self-preservation defend mothers, and, in them, -their children, from being the trophy-posts of their victorious -atchievements! may the midwives continue in their happy ignorance of -their curious devices! may they ever preserve a due aversion from indeed -all instruments whatever! for they are all needless and pernicious -substitutes to the hands. May none of them, especially in any labors -committed to their conduct, prove so criminally false to their sacred -trust, as through negligence, or through an interested designing -reliance upon instruments, to repair their failures or mispractice, -slacken their attention to their duty, or afford, by their defective -performance, an excuse, though a fallacious one, for resorting to -instruments, when skilful hands are incomparably more fit for a remedy -or retrieval! - -I CANNOT then too ardently wish, for the women not to be so cruel to -themselves, and to their so naturally dear children within them, as -inconsistently to suffer their aim at superior safety, to be the very -snare that betrays them into the greater danger, and often worst of -consequences, from those male-practitioners, to whom that aim drives -them for recourse; while that examination they owe to so interesting a -point would issue, or deserve to issue, in rescuing them from such a -shameful subjection of body and spirit to a band of mercenaries, who -palm themselves upon them, under cover of their crotchets, knives, -scissors, spoons, pinchers, fillets, _terebra occulta_, _speculum -matricis_, all which, and especially their _tire-têtes_, or _forceps_, -whether Flemish, Dutch, Irish, French or English, bare or covered, long -or short, strait or crooked, flat or rounding, windowed or not windowed, -are totally useless, or rather worse than good for nothing, being never -but dangerous, and often destructive. - -NATURE, if her expulsive efforts are but, in due time, and when -requisite, gently and skilfully seconded by the hands alone, will do -more, and with less pain than all the art of the instrumentarians, with -their whole armory of deadly weapons. The original and best instrument, -as well as the antientest, is the natural hand. As yet no human -invention comes near it, much less excells it: and in that part it is -that the women have incomparably and evidently the advantage over the -men for the operations of midwifery, in which dexterity is ever so much -more efficacious than downright strength. - -AND, indeed, let every requisite faculty for the assistence of lying-in -women be well considered, and the resulting determination cannot but be, -that in the common labors, where the men themselves are either simple -by-standers or receivers of the child, or operate with the hand only, -they are the very best of them, not comparable to a common midwife, and -in those cases, in which they pretend the use of instruments necessary, -hardly better than the worst one. So that, not less than justly -speaking, they are not receivable, either as substitutes, or even as -supplements to midwives. - -THE art of midwifery then, in its management by women, carries with it, -in the recommendation of order, modesty, propriety, ease, diminution of -pain and danger, all the marks of the providential care of Nature. It is -imaged by the incubation of a brood-hen, assiduously watching over her -charge, and tenderly hatching it with her genial heat. Whereas the -function of this art, officiated by men, has ever something barbarously -uncouth, indecent, mean, nauseous, shockingly unmanly and out of -character: and, above all, of lame or imperfect in it. It strongly -suggests the idea of the chicken-ovens in Egypt, kept by a particular -set of people, who make a livelihood of the secret, which they, it -seems, ingross of that curious art of hatching of eggs by a forced -artificial heat: a practice, which, like the other refinements of -dungbeds for the same purpose, or that of committing the rearing or -education of the chickens to[44]“_cocks_, to _capons_, or to _artificial -wooden mothers_,” may sound indeed vastly ingenious; but besides the -numbers that perish the victims of those experiments, many of the -productions of such methods of hatching are observed to be maimed, -wanting a leg or a wing, or some way damaged or defective. The -comparison breaks indeed in that, at least, the grown hens themselves -escape damage, which is not often the case of mothers under those -heteroclite beings the men-midwives; or, if they do escape, it is no -thanks to those operators, but to the prevalence of Nature over their -pragmatical intervention, so fit only to disturb, thwart, or oppose her -effects, and in every sense to deprive the unhappy women that trust them -of her common benefit. - -BUT while superior considerations of humanity so justly intercede for -the mothers, while I strenuously contend for the preference to be, -without hesitation, due to the mother over the child, especially in that -dreadful dilemma, where one must be sacrificed to the safety of the -other; supposing such a dreadful alternative ever to exist, which I much -doubt, or at least, not to exist so often as it is rashly taken for -granted, and even then, where the effects do not always follow the -resolution taken thereon, since, though the child is always certainly -lost, the mother is far from always saved, when, by a judicious -preventiveness in practice, neither of them might perhaps have been so -much as in jeopardy; while, I say, I plead for the preferable attention -to the mothers, I hope no mothers will think me the worse intentioned -towards them, for giving the lives of their children the second place in -my tender concern for the safety of both. - -AND surely never was a time, when children more required the -intercession of humanity in their favor. Mothers can speak for -themselves. But the poor infants, so often precluded, by violence, from -the pity-moving faculty of their own cry, have nothing but the cry of -Nature to plead for them. A cry, the listening to which is prevented by -those vain imaginary terrors, inspired by designing Art in the service -of Interest, through which Nature is seduced to act against herself, and -deliver herself up to her greatest enemies. - -IN short, one would imagine, that all the rage of cruelty was unchained, -and let loose against especially those tender innocents, born or unborn. - -AMONG the poor, particularly as to those infants cast upon the public -charity, a barbarously premature ablactation, under a pretext so easily -foreknown to be as false as it is fatal, of bringing them up by hand for -cheapness-sake, has destroyed incredible numbers. - -AMONG the rich, or those able enough to pay for the learned murder of -their offspring, how many of their children, even before they have well -got hold of life, in this, literally speaking as to them, iron age, -encounter their death or wounds, stuck in the brain by a crotchet, or -crushed by a forceps, to say nothing of their being now and then -ingeniously strangled in the noose of a fillet! - -AND those horrors proceed unchecked and unexploded, and in what a -nation? a nation, that values herself upon the distinction of profound -thinking: a nation that, besides that interest she has in common with -all other well-governed nations, to protect and promote population, -stands, be it said, in that true spirit of justice, which as much -disdains to pay a fulsome compliment, as good sense ever will to receive -it, moreover eminently distinguished above them all, for producing a -race of natives, one would think could hardly be too numerous, since -they are the most remarkable in the known world for courage, for -personal beauty, and for many other liberal gifts of Nature, among which -surely not the least is, that inborn spirit of liberty, to which they -owe the honorable acquisition of so many additional advantages. - -CAN it then be too strongly recommended to the women especially, at -least, to examine whether their notion of superior safety under the -hands of a man, in their lying-in, bears upon the solid foundation of -Nature, or merely on the treacherously weak one of a delusive opinion? -an opinion that owes its existence to fears cruelly played upon, and -turned to account by designing Interest. If those then of them who are -under the force of prejudice, or governed by habit, or by both at once, -would, on a point that concerns themselves and children so nearly, -assume liberty enough of mind to shake off the dangerous yoke, they -would undoubtedly find it better and safer to listen to that salutary -instinct of Nature so authorized by reason, which inspires them with -that repugnance to submit themselves in the manner they must do that -submit themselves to men-midwives, who have the impudence to call that -repugnance a “_false modesty_:” as if that Modesty could not be a true -one, a foolish one I am sure it could not be, that should murmur at -being so cruelly sacrificed to such a bubble’s bargain as it is, by -those innocents, who, over-persuaded by a deceitful promise of more -effectual aid, too often embrace a torturous and a shameful death, for -which, to add ridicule to horror, they are expected to pay their -executioners larger fees than to one of their own sex for a more decent, -a more safe, and always a less painful delivery. - -MAY the women then, for their own sakes, for the sake of their children, -cease to be the dupes, sure as they are to be in some measure the -victims of that scientific jargon, employed to throw its learned dust in -their eyes, and to blind them to their danger or perdition! may they, in -short, see through that cloud of hard words used by pedants, whose -interest it is to impose themselves upon them: a cloud, which is oftener -the cover-shame of ignorance, than the vehicle of true knowledge, and -perhaps oftener yet the mask of mercenary quackery, than a proof of -medical ability! - -AS to the writings of the men-midwives especially, I dare aver, that, -though there may be here and there some very just theoretic notions, -borrowed from able physicians and surgeons, nothing is more contemptible -than most of their practical rules; what is tolerable in them being most -probably got from midwives, but so disfigured with their own absurd -sophistications, that I should heartily pity any woman, subjected to -have her labor governed by such, as should have no better guidance than -their ridiculous instructions. - -THEN it is that a sensible woman would, in defence of her own life, or -of any life that she holds dear to her, in the case of needing the aid -of midwifery, view with equal disdain, with equal horror, either the -rough manly[45] he-midwife, that in the midst of his boisterous -operation, in a mistimed barbarous attempt at waggery or wit, will ask a -woman, in a hoarse voice, “if she has a mind to be rid of her burthen,” -or the pretty lady-like gentleman-midwife, that with a quaint formal -air, and a gratious smirk, primming up his mouth, in a soft fluted tone, -assures her, and lies all the while like a tooth-drawer, that his -instruments will neither hurt nor mark herself nor child but a little, -or perhaps not at all. (See p. 448.) - -THIS last character, if less brutal than the other, is not perhaps the -least dangerous, since the practice being at bottom the same, pregnant -consequently with the same mischief, the gentleness of the insinuation -gives the less warning, and paves the way for the admission of a -handling not the less rough for the smoothness of the address. But is -there any such thing as polite murder? is mischief the less mischief for -being perpetrated with an air of kindness? well considered it is but the -more provoking. The male-practitioners then are not quite in the wrong, -to presume as they do upon the weakness of the women’s understanding, -since they can so grossly pass upon them their needless cruelties, under -so inconsistent and false a color as that of a tender compassion. Thus -to all the rest of the shame to which they put them, they add that of so -palpable an imposition in that flimsy cover of the mean interest, which -is so probably the real motive at bottom of their taking up a function, -to which they were never called by Nature, nor by any necessity, unless, -perhaps, of their own. - -IN the mean time, the truth is, that, in vain, would the men, by way of -sparing the women the terror of their masculine figure, upon those -delicate occasions of officiating, and to appear the more natural in the -business, aim at an occasional effemination of their dress, manner and -air. They can never in essentials atone for their interested intrusion -into an office, so clearly a female one, that, if but only as to the -manual discharge of it, not even the qualifying them for the opera, -would, perhaps, sufficiently emasculate them. - - - CONCLUSION of the SECOND and LAST PART. - -HERE, confessing my just apprehensions of not having fulfilled the -promise of my title-page; there will not, I hope, to that reproach of my -deficient powers in the performance, be added the undeserved ones of -vanity or injustice in the design or conduct of my feeble essay. - -FOR as to vanity, or any presumption, on my part, of any thing so weak, -so unauthoritative as my representation, having any chance to remove the -abuses, not however the less existent for that incapacity of mine to -remove them, my knowledge of the world would alone defend me from so -ridiculously wild a thought. I am but too well aware of the -tenaciousness of especially false prejudice in most minds, where it has -once gained entrance, and with whom prepossession is ever eleven points -of the right. I have then purely had in view the discharge of that duty, -incumbent on every member of human society, to oppose such errors as -appear to be pernicious to the good of it. In that light I have beheld -the growing practice of the instrumentarians, and in that sincere belief -I have hazarded the publication of my sentiments, without surely -pretending to any authority over the opinion of others. That I -chearfully leave to every one’s reason, who is capable of reason. And to -write for others than the rational, would be only labor deservedly lost. - -AS to injustice, I am, at least, clear of that of partiality to my own -sex. I grant and lament as much as any one the incompetency of but too -many of the midwives. The number of such cannot be too little. But then -would the banishing them out of the practice be preferable to the having -them better taught, especially since there is nothing but what is so -much worse to put in their room, men and instruments? What occasion too -for such a dangerous extremity? For as the deficiency is evident, so are -the causes: which are not only the want of sufficient care in the -training and education of women to this profession, but the actual -discouragement, which must grow every day greater and greater, by the -encroachments of the instrumentarians, whose plea for supplanting them -will be consequently strengthened by that alarming scarcity of capable -midwives, which themselves will have so much contributed to create. -These being then the principal causes, and well known to be so, the -remedies are not obscure, nor hard to attain. - -A GOOD education especially is of great importance, to accomplish what -Nature has already gone so great a way in, by her giving in many -respects to the women such a superior aptitude for the business. Capable -midwives would much help to form good female pupils; and the lying-in -hospitals especially might be made highly useful to so desirable an end. -But surely as to the practical part of midwifery in these hospitals, it -ought not to be under the direction of men, whose interest it should be, -only to form the women so deficiently, as that themselves might be the -less unnecessary; to form them, in short, more for their own service, -than for that of the public. That temptation being removed, the -female-practitioners could not receive too respectfully from the -surgeons lectures or instructions, any lights in anatomy relative to -their theoretic proficiency. But to nothing should they be more -constantly and effectually excited, than to perfect themselves in the -manual operation; and indeed, in general, so to capacitate themselves -for their function, as to prove and establish the perfect inutility of -all instruments whatever. Nor will it be a difficult task for a woman to -acquire a superiority in her hands to the most boasted of those -unnatural substitutes. This is the true way of laudably disarming the -instrumentarians, and of thereby depriving them of the only shadow of a -pretence they have for supplanting the women, and invading the female -province, of which invasion it is so probable, that not the cause they -plead, but the pay they squint at, is the real motive. - -AS to the discouragement of proper women from applying themselves to the -profession, it can only cease by the concurring of those, on whom the -choice out of either sex occasionally depends, to restore things to -their antient channel: and that will in course, for their own sakes, -follow on their ceasing to be imposed upon by the false pretences of the -men-practitioners. But this is a point upon which I am too much a party -to be heard, though even as no more than an advocate, and much less as a -judge. All I shall then presume to say is, that I very readily leave the -decision of the question to Reason, that inward oracle in every one’s -breast; an oracle, which, in a cause so interesting to human Nature, can -never return a false answer, where consulted by those who deserve to -find the truth by sincerely seeking it, with a firm design to sacrifice -to it the poor vanity of defending a prejudice, or any other interest of -the passions. And surely there can hardly exist a point of more capital -importance to Society, than the determining, what however one would -imagine not very difficult to determine, on which side in this -profession of midwifery particularly, the superiority of auxiliary power -may be expected, on that, where there is evidently a great deal of -Nature, assisted with a little but a competency of Art, or on that, -where what there is of Art is most barbarously abused, and without any -Nature at all. - - - The END. - -[Illustration] - ------ - -Footnote 1: - - Exod. Chap. vii. and viii. - -Footnote 2: - - Diod. Sic. Herodotus. - -Footnote 3: - - The Commentator on Boerhave’s Lectures, vol. V. p. 252. or §. 694. - says, “_At Paris women are taken into the Hôtel Dieu, fifteen days - before their lying-in, at the public expence, so that the business of - midwifery can be no where better learn’d._” - -Footnote 4: - - _It is evidently this universal influence of the_ Uterus _over the - whole animal system, in the female sex, that Plato has in view in that - his description of it, which Mr. Smellie (introd._ p. 15_) calls_ odd - _and_ romantic, _from his not making due allowance for the figurative - stile of that florid author. Thus the diffusion of the energy of the_ - uterus, _Plato calls its_ “wandering up and down thro’ the body.” _A - power of activity which, towards conquering the otherwise natural - coldness of the female constitution, nature would hardly give to the_ - uterus _merely to excite in women a desire, sanctified under due - restrictions, by her favorite end, that of propagation, if she had - not, at the same time, endowed that uterus with an instinct, - beneficial by its influence in the preservation of the issue of that_ - desire. _And the real truth is, that there is something that would be - prodigious, if any thing natural could be properly termed prodigious, - in that supremely tender sensibility with which women in general are - so strongly impressed towards one another in the case of lying-in. - What are not their bowels on that occasion? It may not be here quite - foreign to remark, in support of the characteristic importance of the_ - uterus _or the_ womb, _that in the antient Saxon language the word_ - Man _or_ Mon _equally signified one of the male or female sex, as_ - Homo _in Latin. But for distinction-sake the male was called_ - Weapon-man, _(not however for any offensive weapon or_ instrument _in - midwifery;) and the female_ Womb-man, _or man with an_ uterus: _from - whence by contraction the word_ woman. - -Footnote 5: - - Smellie. Treatise of midwifery, p. 339. _where it appears, that the - above dress is reserved for a man-midwife’s masquerade-habit in - private practice, before ladies, not to frighten them; whereas to the - poor women in hospitals his looking like a butcher, is it seems - necessary, with bases and an apron; the_ steel _of course._ But if it - is not too presumptuous for me to offer so _learned_ a gentleman as - the Dr. a hint of improvement for his man-practitioner’s toilette, - upon these occasions, I would advise, for the younger ones, a - round-ear cap, with pink and silver bridles, which would greatly - soften any thing too masculine in their appearance on a function which - is so thoroughly a female one. As to the older ones, a double-clout - pinned under their chin could not but give them the air of very - venerable old women. - -Footnote 6: - - _If a man happens by great chance to have long taper fingers, it is a - circumstance so uncommon, that it is proverbially said of him, “He has - rare_ midwife’s _fingers.”_ Nor was it quite unhumorously observed of - one of the founders of the sect of instrumentarians in England, - remarkable for a raw-boned coarse, clumsy hand, that no forceps he - could _invent_ of iron or steel, being more likely to hurt than his - fingers, he had, at least, that excuse for recommending instruments. - -Footnote 7: - - _A la veritê_ Mauriceau _raporte cette mort inopineê à une_ CAUSE - OCCULTE, _puisqu’il dit expressement que_ “ce fut un de ces fortes de - malheurs de la destinée que toute la prudence humaine ne peut pas - eviter.” _C’est aussi l’opinion de_ la Motte. LEVRET, p. 272. - -Footnote 8: - - Levret, p. 269. - -Footnote 9: - - This will doubtless be laid hold of as one proof, that midwives have, - in cases where they are puzzled, been forced to have recourse to - men-practitioners: but I have no where said, there were not some - midwives unequal to their business. The sequel will shew, that this - most probably was one of them, and the case was not much mended by the - assistent she called in. A little more patience, though I confess - there is some room to think it in this so long lingering case - excusably exhausted, would have prevented the murder of the child: but - as the concomitant circumstances are not specified, I cannot pretend - to determine that point. All I shall say is, that there is not hardly - one case in a thousand, in which nature does not know her own time - best, and does not take it kindly to be hurried. It has been known, - that sometimes the quickest deliveries have been the most fatal, and - the most liable to sudden death, by consequent hemorrhages. - -Footnote 10: - - _Dr._ Smellie _has himself_ (p. 403.) _ranked among the causes of - sudden death to women by violent floodings after delivery the - following one; “if in separating the_ placenta _the_ accoucheur _has_ - scratched _or_ tore _the inner surface or membrane of the_ womb.” _But - if unpared nails, or the rough hands of a man, may cause such a - dreadful accident, what may not be dreaded from iron and steel - instruments, blindly thrust into parts of a scarce less tender texture - than the apple of the eye? But of that more hereafter._ - -Footnote 11: - - Levret’s words, p. 279. - -Footnote 12: - - _It is among the smaller mischiefs done to the mother, that I here - mention my having not unfrequently seen ruptures brought on by the - practice of men-midwives, upon patients in other lyings-in, - precedently to the one in which I attended them. These ruptures I have - sometimes been able to remedy by good management in my laying them._ - -Footnote 13: - - “Let the _forceps_ be unlocked, and the blade _cautiously_ disposed - under the cloaths, so as not to be _discovered_”. Smellie, p. 272. - -Footnote 14: - - See Smellie, p. 307. - -Footnote 15: - - Smellie, p, 291. “When the head presents, and _cannot_ be delivered by - the labor-pains; when all the _common methods_ have been used without - success, the woman being exhausted, and all her efforts vain; and when - the child cannot be delivered without such _force_ as will _endanger_ - the _life_ of the _mother_, because the head is too large, or the - _pelvis_ too narrow: it then becomes absolutely necessary to open the - head, and extract with the hand, forceps, or crotchet. Indeed this - last method formerly was the _common_ practice when the child could - not be _easily_ turned, and is still in use with _those_ who do not - know how to save the child by delivery with the _forceps_: for this - reason their chief care and study was to distinguish, whether the - _Fœtus_ was dead or alive; and as the _signs_ were _uncertain_, the - operation was often delayed until the woman was in the most imminent - danger; or when it was performed sooner, the operator was frequently - accused with _rashness_, on the supposition that the child _might_ in - time have been delivered _alive_ by the _labor-pains_: perhaps he was - sometimes conscious to himself, of the _justice_ of this _imputation_, - although what he had done was with an _upright_ intention.”—This last - indeed would be too uncharitable not to grant. - -Footnote 16: - - Smellie, p. 255. “In this case, we find, _by_ experience, that, unless - the woman has some VERY DANGEROUS SYMPTOM, the head will in time slide - _gradually_ down into the _pelvis_, even when it is too _large_ to be - _extracted_ with the _fillet_ or _forceps_, and the child be SAFELY - delivered by the _labor-pains_, although _slow_ and _lingering_, and - the mother seems _weak_ and _exhausted_, provided she be supported - with nourishing and strengthening cordials.” Now in this Dr. Smellie - is very right; his wrong consists in not making this conclusion more - extensive, as that of his fellow-practitioners too often does, in - fancying or exagerating _dangerous symptoms_: whereas for once that - nature really occasions them, they are incomparably oftener the - effects of the operator’s own mispractice: this observation I cannot, - for the truth and importance of it, too often repeat. - -Footnote 17: - - In honor to truth, be it here noted, that a few, and very few indeed - of the midwives, dazzled with that vogue into which the instruments - brought the men, to the supplanting themselves, attempted to employ - them, and though certainly they could handle them at least as - dextroussly as the men, they soon discover’d that they were at once - insignificant and dangerous substitutes to their own hands, with which - they were sure of conducting their operations both more safely, more - effectually, and with less pain to the patient. - -Footnote 18: - - At this day archbishop of Cambray. - -Footnote 19: - - By this interest, with respect to the mis-government of the infants - that fall upon the parish, I do not mean such a personal interest, as - that the super-intendants of the charity put a single farthing into - their own private pockets, out of the savings, by the with-holding or - grudging a proper provision for the children, but merely the interest - of a parish, or the public, in so false and inhuman an article of - parcimony. A consideration which, if that were possible, renders it - the more inexcusable from the temptation being so much the less. - -Footnote 20: - - I have somewhere read, that brutes have not been insensible of this - effect, on suckling animals, though even of so different a kind from - their own, that the most mortal enmity naturally existed between them: - such was the instance, transmitted from Pensylvania, of a cat so - softened towards a rat, by having accidentally given suck to it - amongst its own kittens, that it forbore exerting towards it its usual - hostility to that species. - -Footnote 21: - - The candid reader will please to observe, that in giving up so much as - I do of the argument from the prevalence of fashion, I do not give up - a little: since I might justly oppose to it the instances of our Royal - Family, in which we see so many happily living and florishing - monuments of the midwive’s capacity. _Accoucheurs_ had, I presume, no - _hand_ in delivering the greatest Lady in this kingdom. The - men-midwives will perhaps treat this as trifling. But what will they - say to so victorious a proof in favor of the female-practitioners, as - that taken from themselves, who, for the most part, were obliged to - the midwives for their ushering them into that world, of which they - are so much the light and ornament; and out of which world they are - rather not so gratefully employed in driving those, by whose function - they were helped into it? - -Footnote 22: - - Pray remark the following directions for the _choice_ of a midwife, - from Dr. Smellie, p. 448. - - “She (the midwife) ought to _avoid_ ALL _reflections_ upon - _men-practitioners_, and when she finds herself _at a loss_, candidly - have recourse to their assistence: on the other hand, this - _confidence_ ought to be _encouraged_ by the _men_, who, when called, - instead of openly condemning her method of practice (even though it - should be _erroneous_) ought to make allowance for the weakness of the - sex, and rectify what is amiss, without exposing her mistakes. This - conduct will as effectually conduce to the welfare of the patient, and - operate as a silent rebuke upon the conviction of the midwife, who, - finding herself treated so tenderly, will be more _apt_ to _call_ - necessary assistence on future occasions, and to consider the - ACCOUCHEUR as a MAN OF HONOR and a REAL FRIEND. These gentle methods - will prevent that calumny, which too often prevail among the male and - female practitioners; and redound to the ADVANTAGE of both: for no - ACCOUCHEUR is so _perfect_, but that he may err sometimes, and on such - occasions he must expect to meet with retaliations from those midwives - whom he may have roughly used.” - -Footnote 23: - - As the story is told in Hyginus, it should seem that the practice of - midwifery at Athens, was, on a season interdicted to the women, who, - by a fixt resolution to die rather than submit to be delivered by the - men, procured from the Areopagus the repeal of that statute, and the - saving from imminent condemnation one Agnodice, who had dressed - herself in men’s cloaths, to elude the cognizance of the law. The - great practice she had obtained by this means had alarmed the - physicians, who thereon accused her as a seducer of the women: against - which she easily defended herself by a declaration of her sex. But - this brought her under the penalty of the law against women exercising - the midwife’s profession. The story imperfectly related in Hyginus, at - the same time that it does honor to the modesty of the Athenian women, - that is to say, if modesty is not, according to the men-midwives, a - false honor, gives room to suspect, that the midwives themselves had - perhaps occasioned the promulgation of so absurd a law. It is well - known, that in those antient times, there were for female disorders - women-physicians in form. Perhaps their encroachments on the province - of the men, by exercising the art of physic in general, might make a - restraint necessary, which was only so far faulty as that the remedy - was in this, as it often is in other cases, carried into extremes. I - would no more justify the women overstepping their proper sphere of - employment into that of the men, than I would the men sinking into - that of women. They are both reprehensible, both dangerous, but - assuredly, the last must be the most ridiculous. - -Footnote 24: - - It is from this principle, that, with so fair a field for raillery, - often not the least forcible of arguments, I have, against those who - are such advocates for the use of _anatomy_ in _midwifery_, abstained - from laying any stress on the famous imposition of the Rabbet-woman of - Godalmin, upon professors of anatomy. I am so far from attacking - anatomy, that I aver, every good midwife ought to know _enough_ of it - to assist her practice. This would not however constitute her an - anatomist, nor is it requisite that she should be one. - -Footnote 25: - - “Il faut d’abord placer convenablement la malade, c’est-à-dire, sur le - bord de son lit; les cuisses élevées et écartées, les pieds rapprochés - des fesses, et maintenus en cette situation par des aides dont on soit - sûr.” _Levret_, UTILITÉ DU NOUVEAU FORCEPS COURBE, p. 161. - -Footnote 26: - - “Si on s’arrêtoit au précepte général, le _forceps_ seroit un - instrument de pure spéculation et non de pratique.” Lev. p. 161. - -Footnote 27: - - The term _imaginary_ is here far from an unjust one, and why should - not the honor of a deliverance, effectuated by Nature, be as well - given to a being of flesh and blood as to a stone? The virtue of the - _ætites_, or Eagle-stone, has currently passed for abridging the pains - of labor, and accelerating parturition. A French consul in Egypt, - ordered one of those stones to be tied to his wife’s thigh, who was in - a lingering labor. The stone in this case, more innocent than probably - a man-midwife would have been, who would have used means to hurry the - birth, or perhaps have gone to work with his _forceps_ at least, - suffered Nature quietly to go her own pace. What was the consequence? - The lady was soon after happily delivered, which there is no doubt but - she would equally have been if a brick-bat had been tied to her thigh. - But Nature lost the thanks so justly due to her: the stone ran away - with all her merit; and this case was added to the catalogue of the - miraculous operations of the stone. In how many cases might it be - said, that the stone here represents the man-midwife, if to the stone - it was not so much more innocent and less dangerous to have a - recourse? - -Footnote 28: - - See La Motte, p. 646, of the quarto edition, Leyden. - -Footnote 29: - - See La Motte, p. 262. lib. v. chap. 2. - -Footnote 30: - - If these _best_ operators had been examined touching their opinion of - midwives; they would most probably have told you, they were a parcel - of poor insignificant ignorant creatures. - -Footnote 31: - - Dr. Smellie seems to countenance this practice, where he says, p. 232. - “_We have already observed_, (p. 229) _that if there is no danger from - a flooding, the woman may be allowed to rest a little, in order to - recover from the fatigue she has undergone, and that the uterus may in - contracting have time to squeeze and separate the placenta from its - inner surface._” - -Footnote 32: - - It is but fair to observe, that M. De la Motte, (Obs. 248) instances, - from Peu, two patients perishing by the midwife’s trusting to the pure - actings of Nature in this very case. - -Footnote 33: - - Dyonis in his Treatise, book III. ch. 12. Mauriceau, book II. chap. - 14. - -Footnote 34: - - This instrument was once as much in vogue, as can be supposed of a - time, when instruments were not so common as they are now. But how - much torture in vain must it have given before it was discovered, that - “so far from answering the _supposed_ intention of it, namely, to - extend the bones of the Pelvis; it can serve no other purpose than - that of _bruising_ or _inflaming_ the parts of the woman.” SMELLIE, p. - 296. - - Possibly the more modern instruments, which have supplanted this now - exploded one, under the notion of improvement, will, in time be found - to be liable to as just objection. But in the mean while what lives - must be lost, what tortures endured, in the experiment! How many will - have been the victims, women and children! - -Footnote 35: - - Even this very Mauriceau allowed, by his brother practitioner M. De la - Motte, to have been an excellent man-midwife, is however very justly - animadverted upon by him for his weakness in giving into such - nonsense, as prescribing histeric medicines by way of hastening the - delivery. His capital receipt was the juice of a Seville orange in an - infusion of Sena. Let any one imagine, what an effect such a laxative - potion must have on a woman, commonly rather wanting to have her - strength recruited by proper restoratives, than diminished by purges, - on so senseless a view. But how many other instances might be brought - of these same most learned men-midwives, making almost as pitiful a - figure in the character of physicians, as they must for ever do in - that of manual practitioners of our art! Even the works of Daventer, - who has such glimpses of true theory, prove him not uninfected with a - spice of quackery. This is generally speaking so true of the - men-dabblers in practical midwifery, that one would imagine the - extension of that meanness of theirs, in putting their nose into such - a function, even to their collateral profession, whatever it be, of - physician, surgeon, chemist or apothecary, was the revenge of Nature, - for the outrages of their pretended art upon her. - -Footnote 36: - - Page 249, of his treatise of midwifery. - -Footnote 37: - - That is to say, if he touched the woman at all with it, and did not - sometimes, at least, _make believe_ that he delivered her with it - though Nature alone should have done the work. Sure I am that that - piece of quackery in him of pretending to hide the instrument, might - justify such a suspicion, of a less guilt however than that of really - applying an instrument insignificant to any purpose but that of - torture in vain. - -Footnote 38: - - How few are there such? consequently how great the danger of such - instruments, even if they were good for any thing, to be introduced - into _common_ practice? - -Footnote 39: - - As the practice of midwifery is, properly speaking, under no - regulation, may not this be too often the case? - -Footnote 40: - - If any one doubts of this, he, in order to settle his opinion, needs - but to peruse the instructions given by Levret, and other - instrumentarians, for the use especially of the forceps. He will find - such obscurity, such intrepidity of practices upon flesh not their - own, as would make one shudder. The very cautions against _locking in_ - a part of the uterus between the blades of the instrument, prove the - existence of a danger no caution can scarce answer for its being able - to avoid. What do you think of young or unskilful practitioners - thrusting up instruments at RANDOM into such a place? yet Dr. Smellie, - p. 288, expressly tells you, there is a case in which “_The forceps_ - MUST _be introduced at random_.” This however may give the - practitioner boldness, that whatever is his fault, the poor woman it - is that is sure to suffer for it, and how cruelly! - -Footnote 41: - - “The forceps may be introduced with great _ease_ and _safety_, like a - pair of _artificial hands_, by which the head is very _little_ (if at - all) _marked_, and the woman very _seldom tore_.” Smell. p. 257. - -Footnote 42: - - In this case of a monster of two heads, which happens so rarely as - that it might almost be reputed null or of no consideration, _once - more_, it is neither a midwife’s business, nor even of one of the - common men-practitioners of midwifery. Application should be instantly - made to one of the best and ablest surgeons procurable, for reasons - too obvious to need specification. - -Footnote 43: - - Smellie, p. 248. - -Footnote 44: - - See Reaumur’s art of hatching domestic fowls, &c. - -Footnote 45: - - If any of my readers imagine that I have, in my objection to the - men-midwives, exagerated matters, I intreat of them to consider the - following quotation from a _male-practitioner_, from Daventer, who - endeavoured, as much as Nature would allow him, to be a good midwife, - however he fell short of it. These are his own words translated, from - p. 11. of the French quarto edition. - - “Can any thing be more shocking to the mother, and to those about her, - than to see a man in liquor, scarce knowing what he is about, divested - of all compassion, of all sentiment of humanity, his hands _armed_ - with a _knife_, a _crotchet_, a _pair_ of _pinchers_, or other - _horrible_ instruments, come to the ASSISTENCE of a woman in agonies, - begin, for his first attestation of skill, by _wounding_ the _mother_, - then go on to _destroy_ the _child_, bring it away piece-meal, with - exquisite tortures to the woman, and, after all, grumble in the - notion, that he could not be PAID enough for such a fine spot of work? - had not such better at once take on to be _butchers_ or _hangmen_, - than treat thus the image of God, and render the profession odious?” - - Have I any where said any thing STRONGER than this? Daventer, however, - certainly did not mean by it to insinuate, that _all_ men-midwives - answered intirely this description; no, nor I neither. But leaving the - brutality out of the question, the mischief and mercenariness of them - all differ perhaps in no very considerable degree. Please to remark in - the following quotation, the DOCTRINE and practice of that famous - _man-midwife_ Peu. “He determines himself, without much ceremony, to - the _breaking_ a child’s _arm_ or a _thigh_, when he _imagines_ this - _operation_ will facilitate the delivery, and that, on the PRINCIPLE - of its being _easy_, to repair such _damages_ of _new-born_ infants. - For the same reason the luxation of a jaw-bone gives him no scruple.” - (Translator of Daventer’s Preface.) - ------------------------------------------------------------------------- - - - - - TRANSCRIBER’S NOTES - - - 1. P. 11, changed “at the mercy of these excutioners” to “at the mercy - of these executioners”. - 2. P. 19 and subsequent, changed “womens” to “women’s”. The authors - usage was inconsistent. - 3. P. 30 and subsequent, changed “it’s” to “its” where possesive was - intended. The authors usage was inconsistent. - 4. P. 156, changed “may be reduce” to “may be reduced”. - 5. P. 171, changed “during some lisgering labor” to “during some - lingering labor”. - 6. P. 173, changed “sometimes inseparably damaged” to “sometimes - irreparably damaged”. - 7. P. 175, changed “very uncautions of concealing them” to “very - uncautious of concealing them”. - 8. P. 208, changed “signs of abborrence” to “signs of abhorrence”. - 9. P. 216, changed “ames” to “âmes”. -10. P. 220, changed “than in those antient times” to “that in those - antient times”. -11. P. 237, changed “elevées et ecartées, les pieds rapprochés des - fesses, et maintenus en cette situation par des aides dont on soit - sur. Levret, Utilite” to “élevées et écartées, les pieds - rapprochés des fesses, et maintenus en cette situation par des - aides dont on soit sûr. Levret, Utilité”. -12. P. 237, changed “arrétoit au precepte general” to “arrêtoit au - précepte général”. -13. P. 241, changed “inaminate things” to “inanimate things”. -14. P. 246, changed “ballanced by their incompetency” to “balanced by - their incompetency”. -15. P. 250, changed “evidently consist less” to “evidently consists - less”. -16. P. 253, changed “they cry down every instrumen of other - practitioners” to “they cry down every instrument of other - practitioners”. -17. P. 347, changed “diamatrically opposite” to “diametrically - opposite”. -18. Silently corrected typographical errors and variations in spelling. -19. Retained anachronistic, non-standard, and uncertain spellings as - printed. -20. Footnotes have been re-indexed using numbers and collected together - at the end of the last chapter. -21. Enclosed italics font in _underscores_. - - - - - -End of the Project Gutenberg EBook of A Treatise on the Art of Midwifery, by -Elizabeth Nihell - -*** END OF THIS PROJECT GUTENBERG EBOOK A TREATISE ON THE ART OF MIDWIFERY *** - -***** This file should be named 60334-0.txt or 60334-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/6/0/3/3/60334/ - -Produced by Richard Tonsing 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. Special rules, set forth in the General Terms of Use part -of this license, apply to copying and distributing Project -Gutenberg-tm electronic works to protect the PROJECT GUTENBERG-tm -concept and trademark. Project Gutenberg is a registered trademark, -and may not be used if you charge for the eBooks, unless you receive -specific permission. If you do not charge anything for copies of this -eBook, complying with the rules is very easy. You may use this eBook -for nearly any purpose such as creation of derivative works, reports, -performances and research. They may be modified and printed and given -away--you may do practically ANYTHING in the United States with eBooks -not protected by U.S. copyright law. Redistribution is subject to the -trademark license, especially commercial redistribution. - -START: FULL LICENSE - -THE FULL PROJECT GUTENBERG LICENSE -PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK - -To protect the Project Gutenberg-tm mission of promoting the free -distribution of electronic works, by using or distributing this work -(or any other work associated in any way with the phrase "Project -Gutenberg"), you agree to comply with all the terms of the Full -Project Gutenberg-tm License available with this file or online at -www.gutenberg.org/license. - -Section 1. General Terms of Use and Redistributing Project -Gutenberg-tm electronic works - -1.A. By reading or using any part of this Project Gutenberg-tm -electronic work, you indicate that you have read, understand, agree to -and accept all the terms of this license and intellectual property -(trademark/copyright) agreement. If you do not agree to abide by all -the terms of this agreement, you must cease using and return or -destroy all copies of Project Gutenberg-tm electronic works in your -possession. If you paid a fee for obtaining a copy of or access to a -Project Gutenberg-tm electronic work and you do not agree to be bound -by the terms of this agreement, you may obtain a refund from the -person or entity to whom you paid the fee as set forth in paragraph -1.E.8. - -1.B. "Project Gutenberg" is a registered trademark. It may only be -used on or associated in any way with an electronic work by people who -agree to be bound by the terms of this agreement. There are a few -things that you can do with most Project Gutenberg-tm electronic works -even without complying with the full terms of this agreement. See -paragraph 1.C below. There are a lot of things you can do with Project -Gutenberg-tm electronic works if you follow the terms of this -agreement and help preserve free future access to Project Gutenberg-tm -electronic works. See paragraph 1.E below. - -1.C. The Project Gutenberg Literary Archive Foundation ("the -Foundation" or PGLAF), owns a compilation copyright in the collection -of Project Gutenberg-tm electronic works. Nearly all the individual -works in the collection are in the public domain in the United -States. If an individual work is unprotected by copyright law in the -United States and you are located in the United States, we do not -claim a right to prevent you from copying, distributing, performing, -displaying or creating derivative works based on the work as long as -all references to Project Gutenberg are removed. Of course, we hope -that you will support the Project Gutenberg-tm mission of promoting -free access to electronic works by freely sharing Project Gutenberg-tm -works in compliance with the terms of this agreement for keeping the -Project Gutenberg-tm name associated with the work. You can easily -comply with the terms of this agreement by keeping this work in the -same format with its attached full Project Gutenberg-tm License when -you share it without charge with others. - -1.D. The copyright laws of the place where you are located also govern -what you can do with this work. Copyright laws in most countries are -in a constant state of change. If you are outside the United States, -check the laws of your country in addition to the terms of this -agreement before downloading, copying, displaying, performing, -distributing or creating derivative works based on this work or any -other Project Gutenberg-tm work. The Foundation makes no -representations concerning the copyright status of any work in any -country outside the United States. - -1.E. Unless you have removed all references to Project Gutenberg: - -1.E.1. The following sentence, with active links to, or other -immediate access to, the full Project Gutenberg-tm License must appear -prominently whenever any copy of a Project Gutenberg-tm work (any work -on which the phrase "Project Gutenberg" appears, or with which the -phrase "Project Gutenberg" is associated) is accessed, displayed, -performed, viewed, copied or distributed: - - 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. - -1.E.2. If an individual Project Gutenberg-tm electronic work is -derived from texts not protected by U.S. copyright law (does not -contain a notice indicating that it is posted with permission of the -copyright holder), the work can be copied and distributed to anyone in -the United States without paying any fees or charges. If you are -redistributing or providing access to a work with the phrase "Project -Gutenberg" associated with or appearing on the work, you must comply -either with the requirements of paragraphs 1.E.1 through 1.E.7 or -obtain permission for the use of the work and the Project Gutenberg-tm -trademark as set forth in paragraphs 1.E.8 or 1.E.9. - -1.E.3. If an individual Project Gutenberg-tm electronic work is posted -with the permission of the copyright holder, your use and distribution -must comply with both paragraphs 1.E.1 through 1.E.7 and any -additional terms imposed by the copyright holder. Additional terms -will be linked to the Project Gutenberg-tm License for all works -posted with the permission of the copyright holder found at the -beginning of this work. - -1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm -License terms from this work, or any files containing a part of this -work or any other work associated with Project Gutenberg-tm. - -1.E.5. Do not copy, display, perform, distribute or redistribute this -electronic work, or any part of this electronic work, without -prominently displaying the sentence set forth in paragraph 1.E.1 with -active links or immediate access to the full terms of the Project -Gutenberg-tm License. - -1.E.6. You may convert to and distribute this work in any binary, -compressed, marked up, nonproprietary or proprietary form, including -any word processing or hypertext form. However, if you provide access -to or distribute copies of a Project Gutenberg-tm work in a format -other than "Plain Vanilla ASCII" or other format used in the official -version posted on the official Project Gutenberg-tm web site -(www.gutenberg.org), you must, at no additional cost, fee or expense -to the user, provide a copy, a means of exporting a copy, or a means -of obtaining a copy upon request, of the work in its original "Plain -Vanilla ASCII" or other form. Any alternate format must include the -full Project Gutenberg-tm License as specified in paragraph 1.E.1. - -1.E.7. Do not charge a fee for access to, viewing, displaying, -performing, copying or distributing any Project Gutenberg-tm works -unless you comply with paragraph 1.E.8 or 1.E.9. - -1.E.8. You may charge a reasonable fee for copies of or providing -access to or distributing Project Gutenberg-tm electronic works -provided that - -* You pay a royalty fee of 20% of the gross profits you derive from - the use of Project Gutenberg-tm works calculated using the method - you already use to calculate your applicable taxes. The fee is owed - to the owner of the Project Gutenberg-tm trademark, but he has - agreed to donate royalties under this paragraph to the Project - Gutenberg Literary Archive Foundation. Royalty payments must be paid - within 60 days following each date on which you prepare (or are - legally required to prepare) your periodic tax returns. Royalty - payments should be clearly marked as such and sent to the Project - Gutenberg Literary Archive Foundation at the address specified in - Section 4, "Information about donations to the Project Gutenberg - Literary Archive Foundation." - -* You provide a full refund of any money paid by a user who notifies - you in writing (or by e-mail) within 30 days of receipt that s/he - does not agree to the terms of the full Project Gutenberg-tm - License. You must require such a user to return or destroy all - copies of the works possessed in a physical medium and discontinue - all use of and all access to other copies of Project Gutenberg-tm - works. - -* You provide, in accordance with paragraph 1.F.3, a full refund of - any money paid for a work or a replacement copy, if a defect in the - electronic work is discovered and reported to you within 90 days of - receipt of the work. - -* You comply with all other terms of this agreement for free - distribution of Project Gutenberg-tm works. - -1.E.9. If you wish to charge a fee or distribute a Project -Gutenberg-tm electronic work or group of works on different terms than -are set forth in this agreement, you must obtain permission in writing -from both the Project Gutenberg Literary Archive Foundation and The -Project Gutenberg Trademark LLC, the owner of the Project Gutenberg-tm -trademark. Contact the Foundation as set forth in Section 3 below. - -1.F. - -1.F.1. Project Gutenberg volunteers and employees expend considerable -effort to identify, do copyright research on, transcribe and proofread -works not protected by U.S. copyright law in creating the Project -Gutenberg-tm collection. Despite these efforts, Project Gutenberg-tm -electronic works, and the medium on which they may be stored, may -contain "Defects," such as, but not limited to, incomplete, inaccurate -or corrupt data, transcription errors, a copyright or other -intellectual property infringement, a defective or damaged disk or -other medium, a computer virus, or computer codes that damage or -cannot be read by your equipment. - -1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right -of Replacement or Refund" described in paragraph 1.F.3, the Project -Gutenberg Literary Archive Foundation, the owner of the Project -Gutenberg-tm trademark, and any other party distributing a Project -Gutenberg-tm electronic work under this agreement, disclaim all -liability to you for damages, costs and expenses, including legal -fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT -LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE -PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE -TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE -LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR -INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH -DAMAGE. - -1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a -defect in this electronic work within 90 days of receiving it, you can -receive a refund of the money (if any) you paid for it by sending a -written explanation to the person you received the work from. If you -received the work on a physical medium, you must return the medium -with your written explanation. The person or entity that provided you -with the defective work may elect to provide a replacement copy in -lieu of a refund. If you received the work electronically, the person -or entity providing it to you may choose to give you a second -opportunity to receive the work electronically in lieu of a refund. If -the second copy is also defective, you may demand a refund in writing -without further opportunities to fix the problem. - -1.F.4. Except for the limited right of replacement or refund set forth -in paragraph 1.F.3, this work is provided to you 'AS-IS', WITH NO -OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT -LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE. - -1.F.5. Some states do not allow disclaimers of certain implied -warranties or the exclusion or limitation of certain types of -damages. If any disclaimer or limitation set forth in this agreement -violates the law of the state applicable to this agreement, the -agreement shall be interpreted to make the maximum disclaimer or -limitation permitted by the applicable state law. The invalidity or -unenforceability of any provision of this agreement shall not void the -remaining provisions. - -1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the -trademark owner, any agent or employee of the Foundation, anyone -providing copies of Project Gutenberg-tm electronic works in -accordance with this agreement, and any volunteers associated with the -production, promotion and distribution of Project Gutenberg-tm -electronic works, harmless from all liability, costs and expenses, -including legal fees, that arise directly or indirectly from any of -the following which you do or cause to occur: (a) distribution of this -or any Project Gutenberg-tm work, (b) alteration, modification, or -additions or deletions to any Project Gutenberg-tm work, and (c) any -Defect you cause. - -Section 2. Information about the Mission of Project Gutenberg-tm - -Project Gutenberg-tm is synonymous with the free distribution of -electronic works in formats readable by the widest variety of -computers including obsolete, old, middle-aged and new computers. It -exists because of the efforts of hundreds of volunteers and donations -from people in all walks of life. - -Volunteers and financial support to provide volunteers with the -assistance they need are critical to reaching Project Gutenberg-tm's -goals and ensuring that the Project Gutenberg-tm collection will -remain freely available for generations to come. In 2001, the Project -Gutenberg Literary Archive Foundation was created to provide a secure -and permanent future for Project Gutenberg-tm and future -generations. To learn more about the Project Gutenberg Literary -Archive Foundation and how your efforts and donations can help, see -Sections 3 and 4 and the Foundation information page at -www.gutenberg.org Section 3. Information about the Project Gutenberg -Literary Archive Foundation - -The Project Gutenberg Literary Archive Foundation is a non profit -501(c)(3) educational corporation organized under the laws of the -state of Mississippi and granted tax exempt status by the Internal -Revenue Service. The Foundation's EIN or federal tax identification -number is 64-6221541. Contributions to the Project Gutenberg Literary -Archive Foundation are tax deductible to the full extent permitted by -U.S. federal laws and your state's laws. - -The Foundation's principal office is in Fairbanks, Alaska, with the -mailing address: PO Box 750175, Fairbanks, AK 99775, but its -volunteers and employees are scattered throughout numerous -locations. Its business office is located at 809 North 1500 West, Salt -Lake City, UT 84116, (801) 596-1887. Email contact links and up to -date contact information can be found at the Foundation's web site and -official page at www.gutenberg.org/contact - -For additional contact information: - - Dr. Gregory B. Newby - Chief Executive and Director - gbnewby@pglaf.org - -Section 4. Information about Donations to the Project Gutenberg -Literary Archive Foundation - -Project Gutenberg-tm depends upon and cannot survive without wide -spread public support and donations to carry out its mission of -increasing the number of public domain and licensed works that can be -freely distributed in machine readable form accessible by the widest -array of equipment including outdated equipment. Many small donations -($1 to $5,000) are particularly important to maintaining tax exempt -status with the IRS. - -The Foundation is committed to complying with the laws regulating -charities and charitable donations in all 50 states of the United -States. Compliance requirements are not uniform and it takes a -considerable effort, much paperwork and many fees to meet and keep up -with these requirements. We do not solicit donations in locations -where we have not received written confirmation of compliance. To SEND -DONATIONS or determine the status of compliance for any particular -state visit www.gutenberg.org/donate - -While we cannot and do not solicit contributions from states where we -have not met the solicitation requirements, we know of no prohibition -against accepting unsolicited donations from donors in such states who -approach us with offers to donate. - -International donations are gratefully accepted, but we cannot make -any statements concerning tax treatment of donations received from -outside the United States. U.S. laws alone swamp our small staff. - -Please check the Project Gutenberg Web pages for current donation -methods and addresses. Donations are accepted in a number of other -ways including checks, online payments and credit card donations. To -donate, please visit: www.gutenberg.org/donate - -Section 5. General Information About Project Gutenberg-tm electronic works. - -Professor Michael S. Hart was the originator of the Project -Gutenberg-tm concept of a library of electronic works that could be -freely shared with anyone. For forty years, he produced and -distributed Project Gutenberg-tm eBooks with only a loose network of -volunteer support. - -Project Gutenberg-tm eBooks are often created from several printed -editions, all of which are confirmed as not protected by copyright in -the U.S. unless a copyright notice is included. Thus, we do not -necessarily keep eBooks in compliance with any particular paper -edition. - -Most people start at our Web site which has the main PG search -facility: www.gutenberg.org - -This Web site includes information about Project Gutenberg-tm, -including how to make donations to the Project Gutenberg Literary -Archive Foundation, how to help produce our new eBooks, and how to -subscribe to our email newsletter to hear about new eBooks. - |