Part 15
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.”