Part 8

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.