Part 22

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.

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?”