Part 6
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.