Part 16

BUT notwithstanding all This, an extravagant _Price_ is not to be arbitrarily demanded, nor ought the Reward to exceed the _Ability_ of the _PATIENT_; neither are _Those_ to be forsaken or left destitute of _Help_, and expos’d to imminent _Danger_, at all Hazards of _Life_, who cannot afford us MONEY: But rather (on the contrary) they are to be forthwith taken in Hand chearfully, attended by Night or Day diligently, and a trifle of MONEY _given_ (by us) rather than _taken_ from them, when our _Fellow-Christian_’s Circumstances so require it. For _this_ is the right way to secure GOD’S _Blessing_ to _Ourselves_, and _Success_ to all our _Endeavours_.

AND, in short, I humbly pray, that HE may (out of his infinite _Goodness_ and _Mercy_) always enable ME, according to my best Inclinations, faithfully to perform these good _Offices_, which I know to be so much my indispensible and incumbent _Duty_, in that _STATION_, his All-wise _Providence_ hath allotted me, as to the Affairs of LIFE.

WHENCE I come, in the next Place, by due Order, to treat particularly of the _Contents_ of the preceding _Chapter_; and, _First_, to set forth an _Anatomical Description_ of the several PARTS of _Generation_ in manner following.

CHAP. V. _Of the External Parts of GENERATION._

THESE _Parts_ are generally so well known, that I would not so much as mention them, out of _Modesty_, were it not, that, I presume, the _young MIDWIFE_ may find something in the ensuing _Description_ worth her singular _Notice_; which however, I shall not so much insist upon: But succinctly——

BEGINNING with the _First_, call’d the VULVA or PUDENDUM; we find it situated below the OS PUBIS, having a great _Chink_ or _Fissure_ in the _Middle_, as it has the FRÆNULUM and PERINÆUM in the _lower Part_. And above the _Chink_ there is a little _Protuberance_ occasioned by _Fat_ under the Skin, call’d MONS VENERIS.

THE two LABIA VULVÆ being a little separated, the NYMPHÆ appear, join’d one to each interior Side of them: _They_ are two small Pieces of red _Membranous Flesh_, much resembling _Pullet’s Gills_: _They_ encrease the Pleasure of _Copulation_, and direct the Course of the _Urine_.

IN the upper Part of the _Chink_, next to the OS PUBIS, are several little round _Substances_; which the most ingenious _Fallopius_ call’d the CLITORIS, almost hid under the _Skin_ denominated the PRÆPUTIUM.

A little deeper, or straight below the CLITORIS, is the URETHRA, or _Orifice_ of the Neck of the Bladder; being a little _Hole_ as big as a _Goose-Quill_; which discovers itself by a small Eminence, and is about two _Inches long_.

BETWIXT the _Muscle_, call’d SPHINCTER URETHRÆ, and the inner _Membrane_ of the VAGINA, are several small _Glands_; whose excretory _Ducts_ are the _Holes_ observable about the _URETHRA_, call’d[153]_LACUNÆ GRAFFI_; which discharge a _Liquor_ for lubricating or making the VAGINA slippery, and encreasing the _Venereal Titillation_.

IN the _Orifice_ of the VAGINA, there is a slender subtile _Membrane_ situated a-cross, which is call’d the HYMEN, of a different _Form_ in different _Women_; being sometimes _Annular_, and sometimes _Semilunar_: It is almost always to be found in _young Girls_, having a small _Hole_ into the VAGINA; which _Hole_ in ADULTS is somewhat larger. In the first _Act_ of _COPULATION_ this _Membrane_ is torn, which generally occasions an Effusion of a little _Blood_; but this may also happen by many other _Procatarctick Causes_[154], and accidental Occasions.

THE _GLANDULÆ_ or _CARUNCULÆ Myrtiformes_ are constituted of the contracted _Fibres_ of the dilacerated _HYMEN_; and are situated on the Side opposite to the _URETHRA_, next the _ANUS_, in the _FOSSA Magna_, or _Navicularis_; being the same Place where the _HYMEN_ was at first established. _These_ are small fleshy _Eminences_, and are sometimes _Two_ or _Three_, and sometimes _Four_ or _Five_ in Number: _They_ are deficient in _GIRLS_, and _defaced_ in _those WOMEN_ who have had _CHILDREN_.

THE _VAGINA_ or _Neck_ of the WOMB, is a long and round _Canal_, reaching from these _Caruncles_ to the _Orifice_ of the WOMB; not very unlike a _strong small Gut_: Its _Orifice_ is narrow in _Virgins_, and in _All_ Women much narrower than its _other_ Parts: It’s _Substance_ (according to _Ruysche_’s Observations) is _membranous_, _nervous_, _papillary_, and _wrinkled_ WITHIN; which consequently must be of an _exquisitive_ SENSE: In _Virgins_ the _WRINKLES_ are very _Large_, especially in the _Fore-Part_; but after frequent _Embraces_ they are _Less_, and after repeated _BIRTHS_, they entirely _disappear_.

THE _VAGINA_ lies betwixt the _Bladder_ and the _strait Gut_, or RECTUM; with which last it is wrapt up in the same common _Membrane_, from the _PERITONÆUM_, adhering to it, all its _Length upwards_, from its _Orifice_ to that of the WOMB, and quite round on the _lower Side_, as it does to the Neck of the _BLADDER_ _above_.

IN MAIDS, the _VAGINA_ is about Five Inches _Long_, and one and a half _Wide_: But in _CHILD-BEARING-WOMEN_, it cannot be determin’d; because it _lengthens_ in the time of _PREGNANCY_, and _dilates_ in time of _BIRTH_; having likewise (in all) some little _Holes_ or _Ducts_ in it, which discharge a _mucous Liquor_. The _VAGINA_ Serves also, in fine, for a necessary _Conduit_ to the _MENSTRUA_ and _LOCHIA_, as it does for a proper _Passage_ to the _INFANT_, &c.

THESE are, in short, all the _external Parts_ of _GENERATION_ in _Women_; and _these_ have all their proper respective _Functions_ assign’d them by NATURE; contributing conjunctly and severally to the _Charms_ of _COPULATION_: Which _ACTION_ alters the very _Course_ of the BLOOD, and _Motion_ of the _Animal SPIRITS_; and consequently sets all the describ’d _Parts_ in full _AGITATION_. Namely, thus

THE LABIA dilate: the ORIFICE swells: the NYMPHÆ give way: the CLITORIS (of exquisite Sensibility) erects: The GLANDS (by a _Protuberancy_ of the Parts) yield their _succous Contents_: The VAGINA draws close: The _Fibres_ of the WOMB complicate to open its _Orifice_: The _Branches_ of the _Spermatick_ ARTERY contract to draw the Extremities of the _Tubes_ to the _OVARIA_, as they carry the SEED to them: The SEED circulating in the _Veins_, which open in the _Cavity_ of the _VAGINA_ and _MATRIX_, it ferments immediately with the _Mass of Blood_: This _Fermentation_ swells the _Membranes_ of the TUBES, opens the _Cavity_ of the WOMB, and disposes _All_ perfectly for the right Reception of the _impregnated_ EGG.

FROM hence we may plainly see, in what a miraculous _Order_ and _Manner_, all _These Parts_ minister, and are subservient unto that (yet more) admirable and wonderful _Body_ the WOMB. Which being thus in brief _anatomically_ described, I come next in Course to

CHAP. VI. _Of the Internal Parts of GENERATION._

IN discoursing of _These_, I shall begin with the chief _Part_, to which the rest are but _Subservients_.

_FIRST_ then, the _MATRIX_ or _Womb_, is situated in the upper Part of the Cavity of the _PELVIS_, or _Bason_, between the _Bladder_ and _Streight Gut_. It is placed there in the Middle of the _HYPOGASTRIUM_, for the Convenience of COPULATION, and the more easy and ready _Extrusion_ of the INFANT.

_SECONDLY_, The _Bones_ of the _PELVIS_ (as described hereafter below) stand as a _Rampart_, fencing it against all external _Injuries_; That is to say, the _OS PUBIS_ protects it _before_; the _SACRUM behind_; and the _ILIUM_ on _each Side_: Like as the _BLADDER_ and _RECTUM_ on the other Hand defend this Noble _Part_ again from the _Rigidity_ of these BONES.

_THIRDLY_, the _Figure_ of the WOMB, from its internal _Orifice_ to its Bottom, in a _Natural State_, resembles a large compress’d _PEAR_. Its _Length_ is about three Inches; its _Breadth_ two in the _Hinder_, and one in the _Fore-Part_; its _Thickness_ half an Inch large: But I take the _Dimensions_ of it, in general, to differ accord-to the _Age_ and _Constitution_ of the BODY.

IN _MAIDS_ however its _Cavity_ is much _less_, and can scarcely contain the Bigness of a BEAN: whereas in _Women with Child_, the _Dimensions_ and _Figure_, as well as the _Cavity_ itself differs, according to the different _Times_ of _GESTATION_.

AS I have said before, its _Anterior Part_ coheres _above_ with the _BLADDER_, _below_ with the _RECTUM_; the _Hinder Part_ being free: But the _lateral Parts_ are tied by _Four Ligaments_ of different Sorts; whereof _Two_ are placed _Above_, and _Two Below_; the _Superiors_ are called LIGAMENTA LATA, or broad; the _Inferiors_ ROTUNDA, or round _Ligaments_.

THE _two broad Ligaments_ are _Membranous_, and call’d ALÆ VESPERTILIONUM; which spring from the PERITONÆUM, and join the WOMB on each Side to the _OSSA ILIA_: So that the _OVARIA_ are fasten’d to _one End_ of them, and the TUBÆ _Fallopianæ_ lie along the _Other_.

THE _two round Ligaments_ arise from the _Fore_ and _lateral Part_ of the Bottom of the WOMB, and pass thro’ the Rings of the _Muscles_ of the ABDOMEN, terminating in _Fat_ near the GROINS. _They_ are of a hard _Substance_, pretty _Big_ at the Bottom of the WOMB; but _smaller_ and _flatter_, as they approach the _OS PUBIS_. Now Those _Four Ligaments_ serve to keep the WOMB streight, steady, and firm in its proper Place _before BIRTH_, and to restore it to its natural _Position_, by the Help of CONTRACTION, _After_.

THE _Orifice_ of the WOMB opening into the _VAGINA_, is of the same _Figure_ with the _Nut_ of the _PENIS_: This in _VIRGINS_ is very _small_, scarcely admitting a _Specillum_ or _Probe_; in OTHERS it is much _larger_; but in _Women with Child_, several small _Ducts_ or Vesicles open among the RUGÆ, which discharge a _Glutinous Liquor_ to close and seal up this _Orifice_, till the Time of _BIRTH_.

THE _Substance_ of the WOMB is _Solid_ and _Muscular_, composed of a various PLEXUS, or Web of fleshy _Fibres_, woven like a NET, with the Interposition of innumerable _Vessels_, of _ARTERIES_, _VEINS_, _NERVES_, &c. _Without_, it is surrounded with a _Thin_ and _Smooth Membrane_ from the PERITONÆUM; and _within_ its _Cavity_, furnished with a _Thick_, _Porous_, and _Nervous one_, call’d the proper _Membrane_ of the WOMB.

THE _Veins_ and _Arteries_ of the WOMB, proceed from the _Spermatick Vessels_, and HYPOGASTRICKS; which _Vessels_ are all inserted in the proper _Membrane_. The _Arteries_ convey the BLOOD for its Nourishment; which accumulating and abounding there in _great Quantity_, at _Maturity_ of Years (when no _more_ is requir’d for the _Encrease_ or _Growth_ of the Body) it distends the _Vessels_, and distills into the Bottom of the WOMB: Whence proceeds the _Blood_ which nourisheth the FOETUS in the _Pregnant Woman_, and the _Monthly Terms_ or MENSTRUA in the _Woman not with Child_; which _Evacuation_, MEN Themselves are also subject to in a great Measure; (notwithstanding their inconsiderate _Detractions_ and vain _Talk_ on this Head) save only that in THEM the _Redundant Humour_ passes off a different Way by _Urine_, by the _Nose_, and sometimes by the _Hemorrhoidal Veins_, &c.

THE _VEINS_ Serve only to reconduct to the _Heart_, the BLOOD which is neither wholly evacuated nor consum’d, as I observed more at large _Before_. But the NERVES arise from the _Intercostals_, and those of the OS SACRUM; remarkable _Branches_ of which run along the Back of the _Clitoris_, from whence this _Part_ is susceptible of the very slightest _Impression_.

THERE are moreover other small _Vessels_, springing one from another, which tend to this _Orifice_, and serve in _Plethorick Women_ with _CHILD_, to carry off the Superfluity of the _Humours_. And, in short, prudent _Nature_, seems to have so ordered _These_ to prevent _ABORTION_, which might easily happen, if the _pregnant_ WOMB was too much expos’d, or was to open itself for this Purpose.

THE _Seminal_ or _Spermatick Vessels_ are _Four_, like as they are computed to be also in MEN, and differ only in being _shorter_. The _Blood Vessels_ are very winding; and the _Spermatick Arteries_ arising with a narrow Origin from the _Aorta_, form various _Plexus’s_, and _Inosculations_, as _These_ do: And the _Spermatick Veins_ (tho’ without _Valves_) have the like _Inosculations_ with the _Arteries_, which however in _These_ are more conspicuous.

THE _OVARIA_, or _TESTICLES_, are _Two Bodies_, on each Side _One_, annexed to the Bottom of the WOMB, at about Two Fingers Distance, near the _broad Ligaments_: _They_ are fixed to the PERITONÆUM at the ILIA, nigh the _Spermatick Vessels_: Their _Figure_ is almost _Oval_, a little depressed on the _Upper Part_, where the SPERMATICKS enter.

THEIR _SIZE_ is generally about half as _Big_ as _MEN_’s are; but _this_ differs according to the _Age_ and _Constitution_ of Persons: Their _Surface_ is smooth, and even in _Virgins_; but wrinkled, uneven, and dry in _old Women_: They are encompass’d with a proper strong _Membrane_, deriving its _Original_ from the _PERITONÆUM_; which also covers all the _Spermatick Vessels_.

THEIR _Substance_ is Membranous and Fibrous, interwoven with a vast Number of _Vessels_; among which are some round _Vesicles_, containing a viscous HUMOUR, when boil’d, of the _Colour_, _Consistence_, and _Taste_ of the boil’d _White of an Egg_: From whence they are call’d EGGS, because of this _Analogy_. _These_ also differ in _Size_ and _Number_, according to _Age_ and _Constitution_, although (ordinarily) the _Biggest_ of them scarcely equals a PEA; and there are in _some_ Persons 10 or 12 of them, in _others_ (perhaps) but _One_ or _Two_ discernible.

THE TUBÆ FALLOPIANÆ, are _Two winding Canals_, resembling _Two Trumpets_, situated on the _Right_ and _Left_ Side of the WOMB, annexed close to its _Bottom_, by their double _Membrane_; which is only a Continuation of the _exterior_ and _interior Membranes_ of the WOMB: They in _SIZE_ equal a little _Finger_ about the Middle; tho’ the _Cavity_ opening into the WOMB, will scarce admit a _Hog’s Bristle_; but the _other Extremity_, floating loose in the ABDOMEN, will admit the Point or Tip of a little _Finger_: They are of a Membranous and Cavernous _Substance_, about 5 or 6 Inches long, and have the same _Veins_, _Arteries_, and _Nerves_, as the _OVARIA_.

THESE _Tubes_, to be brief, (in time of _COITION_) are erected by a copious Influx of _Blood_ and _Spirits_; which also, by the Assistance of their _muscular Fringes_, embrace the _OVARIUM_, transmit the _prolifick Masculine_ SEED, afterwards receive the _impregnated_ EGG, and at last convey it thence into the WOMB. In fine, these are all the _internal Parts_, as I conceive, tending to _GENERATION_. But more particularly, to proceed to

CHAP. VII. _Of the PELVIS._

THIS being that _Cavity_ in which the WOMB is placed, and through which the _INFANT_ passes in time of _BIRTH_; it is my Opinion that a distinct _Knowledge_ of it is highly necessary for all _MIDWIVES_ to accomplish their _Practice_: For without that _Qualification_, they cannot help committing a great many _Blunders_, and being guilty of innumerable _Mistakes_; since they must proceed upon gross _Uncertainties_, and use their _Hands_ like _MEN_ groping in the _Dark_, as hereafter will more plainly appear.

THIS is that _Cavity_ betwixt the OSSA INNOMINATA and OS SACRUM; which join themselves in the _Posterior Part_ of it on each side, by _Cartilages_ and _Ligaments_: so that they, forming there a strong and firm _Juncture_, compose this _Cavity_ of the _PELVIS_, which is vulgarly call’d the _Bason_ of the WOMB.

THE upper Part of the OSSA PUBIS forms the _Borders_ of this CAVITY _before_, and the Hanging forwards or bending down of the OS SACRUM makes _Those_ of it _behind_; as the OSSA ILIA compose the _same_ on each side.

THESE OSSA ILIA are (by _some_) call’d the _Wings_ and _Bounds_ of the _PELVIS_; but they are mightily mistaken, who imagine that they surround or encompass the _PELVIS_: For they are only annexed to it on _each side_, and more extended towards the _Back_ than the _Forepart_. As they are also very much in the _wrong_, who think that the _Cavity_ of the _PELVIS_ extends in its _Length_, according to the _Length_ of the BACK-BONE: since it rises from the _Bottom_ obliquely, ascending _Forwards_, and so proceeds, as if a Person might, through its _Passage_, easily touch the NAVEL.

IN fine, it is here Remarkable also, that we do not always find the largest _PELVIS_ in _Women_ of the largest SIZE, but often the quite _contrary_; for it differs as the _INFANT_ does in _Bulk_, exactly answering to the _Bigness_ of its HEAD: And in some _Women_ it is _Deeper_, in some _Larger_, in some _Broader_, in some _Flatter_, in some more _Oval_, and in some at last _Rounder_. From whence arise sundry _Observations_ both useful and necessary, for the better _Information_ of _MIDWIVES_.

CHAP. VIII. _Of the BONES of the PELVIS._

I Doubt not in the least but _This_ and the _proceeding Chapter_ will seem needless, and appear superfluous to some Persons, in the _Practice_ of _MIDWIFERY_; namely, to such as know not the _New Improvements_ of this ART: But especially to such as are accustom’d to the _Use_ of INSTRUMENTS, they’ll appear altogether _Useless_ and _Vain_; since such _Practitioners_ can easily (upon any Occasion, without the curious _Anatomical Knowledge_ of _these Parts_) first slay the _INFANT_, and then either _deliver_ or _kill_ the _WOMAN_, as _Chance_ may _direct_ their _SHARPS_.

BUT for my Part, because I have no Notion of such sort of WEAPONS, I shall endeavour to acquit my self more _honourably_, and teach my _Followers_ another way, and _That_ without BLOOD-SHED; as I hope will hereafter more amply appear.

AND FIRST therefore in speaking of the _Bones_ of the _PELVIS_, I shall begin with the _OSSA Innominata_; which are _two_ large _Bones_ joined to the _Sides_ of the _OS SACRUM_. _They_ are compos’d of _Three_ distinct _Pieces_, each of which has its respective _Name_: The FIRST and _superior_ is call’d OS ILIUM; because the _Guts_ ILIA lie upon it directly. It is _Large_ and almost of a _Semicircular Figure_, a little _Convex_ and _Uneven_ on its _External Side_; as it is _Concave_ and _Smooth_ on the _Internal_. In short, it is join’d to the _Sides_ of the _three Superior_ VERTEBRÆ of the OS SACRUM, and is _Larger_ in _WOMEN_ than in _MEN_.

THE SECOND and _Anterior_ is call’d OS PUBIS; which is united in the _Forepart_ to its _Fellow-BONE_ of the _other Side_, by an intervening _Cartilage_: By the Extension of which _Cartilage_, the OSSA PUBIS in _Young Women_, sometimes recede a little from _One another_, to facilitate a difficult BIRTH.

THE THIRD is the _Inferiour_ and _Posteriour_, call’d OS ISCHIUM, or COXENDIX, which has a large _Cavity_ call’d _Acetabulum Coxendicis_; and This receives the _Head_ of the OS FEMORIS; the _Supercilium_ or _Top_ of which _Cavity_ joins the OS PUBIS.

THESE _Three Bones_, until the Age of _Puberty_, may be seen distinctly, tho’ afterwards they grow together, and become _one BONE_, without leaving any Mark of _Division_. They adhere on each _side_ to the OS SACRUM by _two Strong Ligaments_; the _Upper_ of which passes from the _Posteriour Acute Process_ of the ISCHIUM to the SACRUM; as the _Lower_ joins the _Tuberculum_ ISCHII to the SACRUM.

THESE _Bones_ in _WOMEN_ are more distant or separated from _One another_, and are _smaller_ than in _MEN_; especially the OS PUBIS, to the end that the _Cavity_ of the _PELVIS_, and the _Angle_ betwixt the OS PUBIS and ISCHIUM, may be the _Larger_, for the more commodious _Bearing_ of the INFANT, and the more easy _Exclusion_ of it in BIRTH. But from hence I would no ways infer, that the OSSA PUBIS and ILIA sever themselves in time of _LABOUR_; (notwithstanding the _Opinion_ of _some Authors_) for I am fully satisfied of the _contrary_: Because I have conducted more than one _Woman_ in my Time, upon walking out of _one Chamber_ into _another_, immediately after _DELIVERY_; which could never have happen’d in _Case_ of such a distant or dislocated _Separation_.

THESE _Bones_ call’d _Innominata_ are of wonderful _Use_ and _Service_: For besides that they form the _PELVIS_, and defend every Part of its _Contents_, they also give _Connexion_ and _Juncture_ of the rest of the Body, to the _Thigh-Bones_; as they likewise give _Rise_ and _Origin_ to many MUSCLES, and are the _Basis_ of Support of the SPINE of the _Back_, as well as of all the _Superior Parts_. Whence I come _à propos_ to descant a little upon this particular _Part_, as far as concerns our present Purpose.

THE SPINE then is that _Bony Column_ or _Ridge_, which extends itself down the _Back_ from the HEAD to the _Fundament_, containing the _Spinal Marrow_, and resembling the _Letter_ S in figure.

IN This SPINA therefore we must consider its _Fivefold Division_; namely, into NECK, BACK, LOINS, OS SACRUM, and OS COCCYGIS. The First _Three_ consist of 24 VERTEBRÆ; whereof the _Neck_ has 7, the _Back_ 12, and 5 belong to the _Loins_. _Those_ of the NECK bend _inwards_; those of the BACK _outwards_, for enlarging the _Cavity_ of the THORAX; _Those_ of the LOINS bend _inwards_ again; and _Those_ of the OS SACRUM _outwards_, to enlarge the _Cavity_ of the _PELVIS_.

THE VERTEBRÆ of the _two last_ concern us most in this Place; wherefore I shall say no more of the _rest_, save only by the By, or coincidently, as they fall in my way. _Those_ of the LOINS then are the _Thickest_ and _Broadest_, and the _Last_ of them is the _Largest_ of all the VERTEBRÆ; as their _Cartilages_ are thicker and stronger than any of the _Others_, and their _Acute Processes_ are at a greater _Distance_ from one another. From whence it comes to pass, that the greatest _Motion_ of the BACK is perform’d by the VERTEBRÆ of the LOINS.

THE VERTEBRÆ of the OS SACRUM grow so close together in _Adults_, that they make but one large solid _BONE_, of a _Triangular Figure_; and yet not without the _Mark_ of a four or five-fold _Division_: As in CHILDREN, it consists of many more _Pieces_ or _Divisions_. However, its _Basis_ is tyed to the last VERTEBRÆ of the LOINS, and the _Upper part_ of its _Sides_ to the ILIA; as its _Point_ is to the OS COCCYGIS.

THE OS COCCYGIS is also in _Adults_, for the most part, but one entire _BONE_; tho’ in _younger Persons_ it is compos’d of 3 or 4 small _Divisions_; Of which the _Lower_ is still less than the _Upper_; till the _Last_ ends in a small _Cartilage_. It is join’d in its _Glenoide Cavity_ to the Extremity of the OS SACRUM; being short and bent _inwards_: It supports the INTESTINUM RECTUM, and yields to the _Pressure_ of the _INFANT_ in _Travail_: But _MIDWIVES_ ought not to thrust it back or repel it with _Violence_; No, they should rather handle it _gently_, if they would prevent dangerous _Consequences_, as well as great _Pain_ to the _Woman_ in _LABOUR_.