Part 17

FROM hence it is manifest, that _they_ are mistaken who imagine that the _Opening_ and _Enlargement_ of the _PELVIS_, in making way for the _INFANT_, does depend upon the _Separation_ of the OSSA PUBIS: For it much more depends upon the _yielding_ of the OS SACRUM, or its giving way naturally; especially _This Part_ of it call’d OS COCCYGIS. Neither doth the _Straitness_ of the _Upper Part_ of the _PELVIS_ so much occasion a difficult _BIRTH_, as the _small Distance_ that is betwixt the _Points_ of the OSSA PUBIS, call’d OSSA SEDENTARIA or _Seat-Bones_, and the OS COCCYGIS: No indeed, neither of _These_ can be any great _Hindrance_ to the Passage of the INFANT; since all BONES, never so closely knit together with LIGAMENTS, may be moved _extensively_ upon occasion, by carefully and gently _stretching_ the said LIGAMENTS. But, in short, it most commonly happens, that the _Ill Position_ of the INFANT itself, or the bad _Condition_ and _Situation_ of the WOMB, or _Both_, occasion a difficult or preternatural BIRTH.

BUT I would here farther observe yet, that as these BONES differ frequently both in _Form_ and _Size_, according to the different _Constitution_ of the Body; so neither are _they_ always of the _same Substance_: For in _some Women_, we find a great many _Nervous_ and _Cartilaginous_ LIGAMENTS, which penetrate into the _solid Substance_ of the BONES themselves; in which the LIGAMENTS are so fast bound together, that it is hard to distinguish whether they are _One_ or _More_ BONES. From whence, however, it will hereafter appear, that _One Woman_ is more easily delivered than _Another_; the BONES in _One_ being more firm and immoveable, altogether resisting any _Relaxation_; which in _Another_ are more loose and pliable, easily give way and yield freely to the _Force_ of the Endeavouring and Struggling _INFANT_.

THE _Contents_ of this SECTION will appear more evident, by looking curiously upon a _Female SKELETON_: In which (for Distinction’s-sake I recite _This_) that the lower Parts of the _Seat-Bones_, are generally more _distant_, and not so much bent _inwards_, down towards the Point of the OS COCCYGIS, as in a _Male SKELETON_. Which Difference, in short, the Omniscient CREATOR has so order’d, for preventing difficult _BIRTHS_; and yet, notwithstanding all this wise Provision of Nature, they happen too often in the World. However, having thus, in fine, described the PELVIS and its BONES, as far as is requisite for _MIDWIVES_, I come next, more particularly to describe that astonishing _Piece_ of GOD’S _Handy-work_, to which all the afore-mention’d _Parts_ are ordain’d to _minister_, and that both _conjunctly_ and _severally_, without any _Exception_: viz.

CHAP. IX. _Of the WOMB._

I Say this is that _Body_, which the _Learned Great Men_ of all Ages have esteem’d and look’d upon as the most wonderful MIRACLE of _Nature_, not only because of its singular _Substance_ and _Structure_, but also of its peculiar _Qualities_ and _Faculties_.

AS to the _Substance_ and _Structure_, I have before observed in _Chap. 6._ of this SECTION, that it is singularly composed, of an innumerable Multitude of _Fibrous Vessels_ and _Muscular Parts_; which being _All_ most curiously interwoven, are admirably form’d together in its Constitution.

BUT how particular soever I have been on this _Head_, in _Chap. 5_, and _6_. I must resume this _Topick_ here, and add, that the WOMB, and its _Vagina_ or _Neck_, are closely join’d together: For it terminates in a POINT near its _Orifice_, intrudes itself into the _Vagina_, and hangs so down, that in _Women not with_ CHILD, and sometimes also in the first Months of _Pregnancy_, This sharp POINT may be perceiv’d by the _Touch_.

AND how closely soever this _Orifice_ of the WOMB is shut after _Conception_ or during _Pregnancy_; yet in a _BIRTH_ it is so expanded, that the WOMB and _Vagina_ both seem to have but _One_ and the _same Cavity_, like a BAG of equal Dimensions; there being then no Difference perceivable between that _Orifice_ and the _Vagina_, excepting that the _VAGINA_ is _Softer_ and _Thinner_.

THE WOMB may be otherwise aptly compar’d to the EARTH; because the same Degree of _Affinity_ that the EARTH has to the _Seed of Plants_, the WOMB bears to the _Seed of Men_: It being the very _Secundary Cause_ in the _Constitution_ of the _Human Conception_; not indeed the _Instrumental_ only, but also the _Active Cause_: For whereas the _Instrument_ takes _Motion_ from, and _operates_ by Virtue of _Another_, the WOMB only _acts_ of _itself_ and _operates_ by Virtue of its own _Active Faculties_.

BUT more particularly, the WOMB has sundry proper _Actions_ in this _Constitution_, which are peculiarly dependent of, and accordingly discharged by ITSELF only; and therefore it is not the sole or pure Instrumental _Agent_. But the Reason that I call it the _Secundary_ or _Disponent_, not the _Primary Cause_, in constituting the FOETUS, is, because the _Actions_ of the WOMB do not precisely terminate in this _Constitution_, but chiefly in disposing the _Causes_ constituting the MAN. And as (I think) there are _Eight_ such _Actions_ belonging to the WOMB, I shall undertake to define them all particularly in a few Words. And,

I. THE _FIRST Action_ of the WOMB is, that by its _attractive Faculty_, it may allure the _Masculine Seed_ infus’d by Coition into the FUND of its _Capacity_, after the same manner as a _famishing Stomach_ snatches at the Victuals by the _Gullet_ from the _Mouth_ of the Eater.

II. THE _SECOND_ is like unto the _FIRST_, and consists in _attracting_ (after the same manner) the _Muliebrian_ SEED from the Vessels of the TESTICLES, into the same _Cavity_.

III. THE _THIRD Function_ of the WOMB, is the _Copulation_ and mutual _Conjunction_ of the SEEDS of both Parents; which it prepares and perfects by its innate _Power_, constricting itself in all Parts: And this _Action_, I do not (in this place) call a _Permistion_ of these SEEDS, as it is generally term’d, because a _Mixture_ is properly perform’d only by the concording _Qualities_ and mutual _Actions_ of two or more miscible _Copulatives_, without any _Assistance_ of the _Thing Containing_.

IV. THE _FOURTH Office_ of the WOMB, is an _Effusion_ of the _Menstruous Blood_ upon the aggregated _Seed_, from a Relaxation of the little _Orifices_ of the VEINS terminating in its interiour _Surface_.

V. THE _FIFTH Action_ of the WOMB, is, the _Retention_ of those three conjoin’d _Bodies_; to effect which _Work_, the WOMB contracts itself on all sides, and shuts up all its _Orifices_, even to the sensible Animadversion of the WOMAN.

VI. THE _SIXTH Function_ of the WOMB, is to excite the Virtue of the _Torpent Lifeless_ SEED, and rouze it up from _Idleness_ to _Activity_; as the latent Virtue of PHYSICK in the Body is _excited_ to Operation by the _natural Heat_ of the VISCERA.

VII. THE _SEVENTH Office_ of the WOMB, is (after the FOETUS is Form’d and Organiz’d) the _Attraction_ of the BLOOD from the _Maternal Veins_, into the _Umbilical Vessels_, for its _Nutrication_ and Growth.

VIII. THE _EIGHTH_ and last _Function_ of the WOMB, is _Birth_, which I shall remember to speak more particularly of in its proper Place.

FROM all which we may easily collect the sundry proper _Uses_ of the WOMB, and readily comprehend that it is not only destin’d by _Nature_ to admit the SEED, and receive the _impregnated_ EGG from the OVARIUM and the _Fallopian Tube_; but also to contain the _Organizing Matter_, and all necessary _Principles_ (_Active_ and _Passive_) for constituting the _Conception_; fomenting the receiv’d SEEDS, by its natural _Calidity_, preserving the same, and preparing the _Maternal Blood_ by its inherent _Temperament_, for the Use of the FOETUS: Which FOETUS it surrounds and defends from external _Accidents_, by its Substantial _Corpulency_; containing and nourishing the INFANT, about the Space of 9 or 10 _Months_, by its Faculties of _Extension_ and _Attraction_; and at last forcing it into the World, by _that_ of _Expulsion_.

UPON which Occasion, that the _MIDWIFE_ may the better discharge her _Duty_, and assist the _Labouring Woman_ more effectually, without Fear or Danger, and without committing any Blunder or Mistake; as I have already taught her in what _Place_ the WOMB is seated, to what _Parts_ it tends, and how it is _annexed_, &c; so I shall now proceed to describe its _Qualities_ and _Faculties_, so far as is necessary, and absolutely requisite in the _Practice_ of _MIDWIFERY_. And, FIRST, then——

CHAP. X. _Of the Extensive Faculty of the WOMB._

NATURE has endued the WOMB with this _Faculty_, to the end that it may (in _Pregnancy_) extend and dilate itself Day by Day, in _Proportion_ to the _Growth_ of the INFANT, _Secundine_, and _Humours_.

NOW the WOMB in its _lower Part_ being straitly tied to the _Intestinum Rectum_ and _Bladder_; it is to be understood that the _Distention_ happens mostly in its superiour Part or _Bottom_: Which is not only most _Free_ and at greatest _Liberty_, but also _Thickest_ and aptest for _Dilatation_.

THIS will appear more evident, when we consider how the INFANT adheres to that Part, the _Bottom_, by means of the _Secundine_: How the INFANT also as it grows, begins to separate the _Humours_ in the _Secundine_, which (of consequence) encrease as the _Infant_ does: And how again the Encrease of the _Humours_ fill up the _Chinks_ and VACUUMS, as I may call them, which the INFANT cannot possess. From hence it is that the WOMB extends itself in the _Form_ of a PEAR, only a little _Plainer_ at Both Ends.

THUS the _Secundine_ adhering[155] to the _Bottom_ of the WOMB, by its _thicker Part_ (call’d the PLACENTA,) thence it is that the WOMB encreases and extends itself more in its _Bottom_, than in any _inferiour Part_.

WHEREFORE the WOMB being most extended in its upper Part, call’d the _Bottom_; and both the _Bladder_ and RECTUM below being soft loose _Parts_, it necessarily follows, that the WOMB may freely _ascend_ and _descend_ upon Occasion, as we often find it in the _Cavity_ of the _Belly_; which, however, does not happen to All _Women_ alike.

BUT, in short, these _extensive_ and _ascensive Faculties_ of the WOMB, chiefly residing in its _Bottom_; I would have it laid down for a certain _Maxim_ of Truth, that _These_ exert themselves, without any the least _Extenuation_ to the _Uterine Substance_: Which Position leads me directly to consider——

CHAP. XI. _Of the Substantial Density of the WOMB._

TOUCHING the _Thickness_ of the _Pregnant_ WOMB, _Authors_ have differ’d extremely: _Some_ thinking, that as the WOMB grows _Larger_, it grows _Thicker_; and _Others_ the _Reverse_, that as it _extends_, it grows _Thinner_.

NOW these _Opinions_ being both diametrically opposite _One_ to the _Other_, as _Both_ (perhaps) may be contrary to _Truth_, I shall freely and ingenuously offer my _Sentiments_ in a few Words; not that I vainly desire to engage myself in any _Controversy_: Save only, because the true _Knowledge_ of this Point, is so Material and Consequential for all _MIDWIVES_, especially in _Cases_ of difficult and preternatural BIRTHS, that I cannot well excuse myself, should I pass it by with _Silence_ in this Place.

MR. _MAURICEAU_, in his _Book_ of the _Diseases_ of Women, contradicting the Authority of _Riolanus_, _Bartholinus_, and the whole Body of the most Renown’d and Ingenious _Anatomists_, both _Ancient_ and _Modern_, is at great Pains to make us believe, that the _impregnated_ WOMB is (like the _Bladder_) in this Case; _the more it is extended, the thinner it grows_.

BUT as his quoted Authority of _Galen_ and _Carol_. _Stephanus_ cannot be sufficient against so many good _Authors_ of the _contrary Opinion_; so neither will his _Demonstrations_ of WAX, nor _Comparisons with the_ WOMBS of _Animals_, be sufficient to make out his _Argument_, against confirm’d _Experience_, common _Sense_, and current _Reason_. Which Point of _Experience_ I judge this _Author_ to have been deficient in, otherwise he would certainly have given us some _particular Instance_ or other of it, and not had _Recourse_ to _Inconsistencies_ for supporting his new-fashion’d unreceiv’d _Notion_. For what _Comparison_ can there be betwixt an _Animate_ and _Inanimate Body_? Or what _Affinity_ betwixt the _WOMB_ of _Animals_ and that of _Women_, who are form’d after the _Image_ of GOD, and (by a _Prerogative_ above all other _Creatures_) are furnished with a _WOMB_ very _different_ from them?

I ingenuously acknowledge, when I first met with this _Author’s Works_, not daring then to be too _Positive_ in this _Point_, I was put into some _Suspence_ of Judgment; which made me not only consult with the best of _Authors_ and _Professors_ of ANATOMY, but also induc’d me to embrace every Opportunity of satisfying myself otherways to a full _Conviction_.

WHEREFORE at all _Dissections_ of _pregnant Women_, where I have been present, I carefully observed and took notice of this particular _Point_; upon which I must needs affirm, that I always found the _WOMB_ (however _Big_ or _Little_) of its _natural Thickness_, and rather _thicker_ than _thinner_: For tho’ _It_ is expanded by the _growing Infant_, &c. yet _it_ may (most probably) be equally condensed, by the Imbibition of the _fluent Humours_, which consolidate into _itself_ by the _Pores_ of its _Plexus Body_. Nay, I have not only satisfy’d myself in _dead_, but also in _living Bodies_, with respect to this Matter; for by passing _One Hand_ into the _WOMB_ to take away the _Secundine_, when the _Other_ laid upon the BELLY, I clearly discerned the _Truth_ by SENSE, and have sometimes found the _WOMB_ not only incredibly _Thick_, but also RIGID withal: And in this Matter, I have not been singular; for I find the _ingenious Daventer_ writes to the same purpose, upon this _Head_, in his Book of _Midwifery_. Having therefore thus, in short, perceiv’d the _Thickness_ of the _WOMB_, both with my _Hands_ and _Eyes_, I must trust my SENSES, and prefer my _Experience_ before any _Man’s bare Conjecture_; for tho’ I often _see not_ those Things which I _believe_, yet I must still _believe_ those Things which I _see_.

WHENCE I conclude, that the _WOMB_, tho’ of a different _Bigness_ from the _Conception_ to the BIRTH, is always, at least, of one _Thickness_ with the _unconceiv’d_ WOMB: Which the _Divine Wisdom_ (no doubt) has so ordered for the _Preservation_ of the MOTHER and INFANT; for if the _WOMB_ in Time of _Pregnancy_ did grow _Thinner_, according to its _Extension_, it must of Consequence grow _Weaker_, and, in that _Case_ the INFANT would be liable to perforate it with _Foot_ or _Hand_, which would infallibly terminate in the _Loss_ of both their LIVES.

BUT besides, if the _WOMB_ was so _Thin_ and _Weak_ as Mr. _Mauriceau_ imagines; as the _Pregnant Woman_ would be liable to imminent _Danger_ every Moment _Before_, as well as _In Time_ of LABOUR; so the MIDWIFE would be expos’d to the greatest of _Difficulties_: For who then durst, without _Horror_, offer to turn the INFANT, so closely compress’d in those _thin Membranes_ of the _WOMB_? Or who could have _Resolution_ enough to separate and pull away the AFTER-BIRTH?

HOWEVER, I could produce innumerable _Instances_ of most Learned and Ingenious _Men_ to support my above-mentioned _Opinion_; but I shall content myself now with ONE, who (I think) is of sufficient Authority: For hearing lately that Mr. _Mauriceau_’s mention’d Book (which I had only read before in its _Original French_) was translated by Dr. _Chamberlain_, I doubted not but I should fully discover that Eminent TRANSLATOR’S _Sentiment_ upon this single _Point_; whereupon this most famous _Physician_ and _Boethogynist_ marks by way of Observation or a _Bene Notandum_, that his _Charity_ for his _Author_ makes him believe that _French-Women_ differ in this _Point_ from _Our English_, with whom it is apparently otherwise order’d. And in the farther Explication of his _Author’s Opinion_ on this _Head_, he adds, That _Experience_ will convince any inquisitive Person of the _Contrary_.

TO which I reply, in short, with all due Submission, that the _French-Women_ do not differ one Jot in this respect from _Ours_, nor _Ours_ from any _Others_: Which (no doubt) the worthy _Doctor_ was very sensible of, notwithstanding his great _Complaisance_ to his _Author_.

CHAP. XII. _Of the various Local Motion of the WOMB._

ALTHOUGH the _Ligaments_ are fixed to the _WOMB_ on each side, under the _Tubes_, near the _Bottom_, on purpose to keep it duly in the _Middle_, from falling to either _Side_; yet we may easily perceive, FIRST, That the _Pregnant WOMB_, as it dilates and extends itself most (in the _Bottom_) above the _Ligaments_, so it rises _Highest_ and becomes _Heaviest_ in that Part; by which means it cannot always be contained in the _narrow Compass_ of the PELVIS, and the _Larger_ the _INFANT_ is, the _Higher_ the _WOMB_ rises (above the _Ligaments_) in the BELLY. Insomuch that when the _Cavity_ of the PELVIS is not sufficient to contain a large _WOMB_, fill’d with _One_ or _more_ well-grown _INFANTS_, together with the _Secundines_ and _Humours_, it must (of necessity) ascend into the _Cavity_ of the BELLY; as is evident from _Chap. 10_.

SECONDLY, The _WOMB_ being in Form of a PEAR, much larger _above_ than _below_ the _Ligaments_, and that _superiour Bulk_ being only sustain’d at the _lower Part_ by subtile _Ligaments_ apt to extend, as well as supported near the _Orifice_ by the _Bladder_ and RECTUM, which are soft, loose, and _extensive Parts_: Hence, I say, we may easily conceive, that as _These_ are not sufficient to hinder a large WOMB from ascending above the Borders of the PELVIS into the _Cavity_ of the BELLY; so neither are _they_ able to keep it from leaning or inclining _this_ or _that way_, by reason of its _Weight_ in the _Bottom_, which is always the farther distant from the _Ligaments_, the more it is _extended_: And the _extended_ WOMB being not of the same _Firmness_ and _Solidity_ with THAT in a _natural State_, is the more apt and ready to move _aside_, either on the Right or the Left Hand.

NOW this various _Motion_ of the WOMB, in short, will appear more manifestly _Probable_, when we consider how variously _Women_ with CHILD move their _Bodies_, bending them every way for _Relief_, when oppress’d with _Pain_; both _sitting_ and _lying_ in different _Postures_: All which may easily give the WOMB a _Tendency_ this or that way, sliding either _Forwards_ or _Backwards_, to the right or the left _Side_ of the Person.

CHAP. XIII. _Of the Oblique Situation of the WOMB._

I Doubt not in the least but among the _Many_, some will reject _this_ THESIS as _False_ or _New-fangled_; but _They_ who are _Ignorant_ of it, are meer blind _Novices_ in the _Art_ of MIDWIFERY: For repeated _Experience_ has taught _Myself_ and many _Others_ the Certainty of this _Truth_; as will more amply appear from the following Discourse.

THE _Womb_ having then ascended into the _Cavity_ of the BELLY, if its _pointed Parts_ tend perpendicularly into the PELVIS, so as that its _Orifice_ may be easily touch’d on every _Side_ with the Fingers, its _Bottom_ is placed about the NAVEL; and _This_ I call a right or _natural Situation_: But when otherways, the _Posture_ is changed, inclining _this_ or _that way_, and the _Orifice_ suspended so _High_, that it can scarce or not at all be touch’d, I call _That_ a wrong and _preternatural Position_, or _oblique Situation_ of the WOMB; which may not only be occasion’d (as is said) by the _Weight_ and _Bulk_ of its _Bottom_, above the extended and relaxed _Ligaments_, but also by many other different _Causes_; such as an obdurated _Gland_, a _Cicatrix_, an _Ulcer_, an _Obstruction_ of the _Vessels_ in the _Ligaments_ or adjacent _Parts_, &c.

HENCE it is that the _wrong Positions_ of the _WOMB_ are manifold, which would be very tedious to enumerate exactly here; but only, that I may not pass by what is so _material_, I shall reduce them to a _Four-fold Difference_; as the _Ancients_ did the _Winds_, because of the _Four Regions_ or _Limits_ of the Heavens. And _Those Four_ will (I hope) comprehend all other _wrong Situations_ of the _WOMB_, not very improperly or _mal-à-propos_, as _Ovid_[156] has comprehended _These_ in the following elegant _Verses_, viz.

_“Eurus ad Auroram Nabathæáq; regna recessit, “Persidáq; & radiis Juga subdita matutinis. “Vesper & Occiduo quæ littora sole tepescunt, “Proxima sunt Zephyro, Scythiam septémque triones “Horrifer invasit Boreas. Contraria Tellus “Nubibus assiduis, pluvióq; madescit ab Austro._

THE _first_ bad _Position_ of which is, when the _Bottom_ of the _WOMB_ is placed on the _left Side_ of the Woman, a little raised or depress’d; the _Orifice_ being turn’d towards the SPINE of the right OS ILIUM or OS PUBIS, against which the INFANT in time of BIRTH commonly pushes its _Head_, beats out its Brains, and sticks there to Death: Or else passing the said SPINE, it lies _a-thwart_ the PELVIS.

THE _Second_ ill _Position_ of the _WOMB_ is, when the _Bottom_ is seated on the _right Side_; the _Orifice_ being turn’d towards the _left Part_ of the PELVIS, directly opposite to the _other Position_, and attended with the same _Inconveniencies_.

THE _Third_ is, when, in _Women_ having large _Bellies_, the _WOMB_ hangs too much _Forwards_; the _Orifice_ being turn’d towards the OS SACRUM: So that the INFANT falls down by the _Head_ into the Bent, or crooked _Cavity_ of the OS COCCYGIS, where it fatally sticks fast.

THE _fourth Oblique Situation_ of the _WOMB_ is, when its _Bottom_ is press’d too near the DIAPHRAGMA, and its _Body_ too near the VERTEBRÆ of the _Loins_; the _Orifice_ being elevated, is thereby turned too near the _OS PUBIS_, where the INFANT striking its _Head_ against these _Bones_, remains immoveable and perishes: Or, (which is worse) sliding with its _Head_ upon the _OSSA PUBIS_, it is turn’d on one or other _Side_ or _Backwards_; when (commonly with _Hand_ or _Arm_ out of the Body) it lies _a-thwart_ the Passage, and infallibly occasions its OWN or its MOTHER’S _Death_, or _Both_; unless (as in the _three_ preceding _Cases_) it be in due time prevented by the _Assistance_ of some very skilful HAND.

THOSE are the _Four_ most difficult and principal wrong, or chief _preternatural Situations_, of the _WOMB_; from whence we may easily frame a competent Conjecture of the _Rest_; to wit, when the _Bottom_ of the _WOMB_ is more or less turn’d to the _right_, or the _left Side_, or _forwards_, or _backwards_: Since as _that_ differs more or less from the _natural Position_, so the BIRTH in like manner is (of consequence) the more or less _Difficult_, as will hereafter manifestly appear.

CHAP. XIV. _Of TOUCHING or HANDLING the Woman._

THE _Midwife_ ought to have a special _Knowledge_ in _This_ Matter, since a Thing of so much Moment as LIFE itself often depends upon it; yea, and _this Knowledge_ is of absolute Necessity to all Persons practising MIDWIFERY, because many different Points of the greatest _Importance_, are thereby plainly discover’d: But before I enter upon these Things, I would have it rightly understood, that nothing else is meant here by the _Performance_ of the TOUCH, than (upon having first pared the _Nails_ short, equal, and smooth) _passing the two Fore-fingers of either Hand, (previously well anointed with Fat or Butter, when proper Oils are not to be had) through the_ VULVA _into the_ VAGINA, _in order to reach the Orifice of the WOMB_, and to discern its FORM, by feeling it on each Side.