Part 19

HOWEVER, I know beforehand, that my Method of performing this Work, which I am about to lay down, will be thought a strange _Innovation_ in _Midwifery_; but without any regard to that, in speaking to this _Point_, I shall _First_ suppose this _Body_ to be already loosen’d from the WOMB; in which _Case_ the MIDWIFE has nothing to do, but to draw the _STRING_ gently, which she holds in _One Hand_, twisted twice or thrice around one or more of her _Fingers_, while she passes the _Other Hand_ into the WOMB, following always the _STRING_ (as her _Guide_) to the Place where the BURTHEN lies: And where, as in this _Case_, it naturally presents itself to the ORIFICE, _She_ stretches her _Hand_ up length-ways, taking hold of it betwixt her _Fingers_; and thus, by the Assistance of the _other Hand_ always attracting softly the _STRING_, she brings it at last most commodiously away.

SECONDLY, I shall suppose, in the mean Time, this _Body_ to continue _fixed_ to the WOMB, either in _Part_ or in _Whole_: In which _Case_, if in _Part_, the MIDWIFE finding by the TOUCH the other _Loose Part_, moves her _Hand thither_ betwixt _That_ and the WOMB, shaking or stirring it gently _backwards_ and _forwards_, until such time as it is entirely _loosen’d_, when she proceeds as _Before_: But if in _whole_, and that it sticks very _Fast_, then the _MIDWIFE_ places her _Hindmost Fingers_ on its _Exteriour Part_ against the WOMB, and her _Fore-Fingers_ against the _Inside_; so that thus by pulling softly on all _Sides_ quite round, it is easily _loosen’d_ and _extracted_ as Above.

THIRDLY, I shall suppose this _SECUNDINE_ also (tho’ loosen’d successfully) to be so very _Large_, that it cannot pass through the _ORIFICE_: In this _Case_, I only desire my _deliver’d Woman_ to concur with me, and behave herself as if she was forcing or expelling the _CHILD_; for then whilst I at the same time gently attract the _STRING_, it immediately follows.

I very well know that Mr. _Mauriceau_ and all _others_ either _in_ and _before_ his Time, teach quite different _Methods_ of extruding the _AFTER-BIRTH_; such as are by the _WOMAN’s blowing in her Fist, putting her Finger in her Throat, and the like_; which when the _poor Patient_ has done, and stood them All out _ineffectually_, together with their many other various _uncertain Experiments_ to no _Purpose_, and none of them have succeeded (as it has often happen’d): Then at last, and not till then, they direct the aforesaid _Method_ of the _HAND_ to be used. But now-a-days, we know better Things than to run such indiscreet _Risques_, when we may go a safer Way to work; or to make use of _Uncertainties_, when we know more _Infallible Means_. As I shall, I hope, make this _Method_ plainly appear to be; notwithstanding all the great _Cautions_ of those Authors publish’d, and the Difficulties they make of it in our Practice of _MIDWIFERY_: And that I will endeavour to do from the following _Considerations_, viz.

I. IF after the BIRTH of the INFANT, the _Hand_ be presently pass’d into the WOMB, it slips in together with Part of the _Arm_, as far as is needful, without the least _Trouble_ or _Inconvenience_ to the WOMAN; the WOMB as well as its ORIFICE continuing always, so long as _this_ may be done, sufficiently _Open_: And thus the BIRTH maybe skilfully accomplished or perfected, as it were, in an _Instant_; while _others_ (trying their vain _Projects_) spend many trifling _Hours_ about it, and it is _ten to one_, if at last they succeed.

II. BY these means, moreover, I presently know whether there be _One_, _Another_, or _More INFANTS_ to follow; whether there be a _dead CHILD_, _false CONCEPTION_, or any _Foreign Body_ whatsoever, lodged in the WOMB; whether any _Part_, or _Pieces_ of the SECUNDINE, or _Membranes_, or _Lumps_ of _Clotted Blood_, be left behind and retain’d: All which I propose to bring away either _before_, or _after_ the SECUNDINE, as Occasion serves, with the greatest _Safety_ as well as _Expedition_.

III. AFTER having thoroughly searched on all _Sides_, and thus duly cleans’d the WOMB, by continuing my _Hand_ in it, until it contracts about that _Hand_, first _above_ towards the _Bottom_, and then _below_ towards the _Orifice_, which happens very quickly: I find myself _then_, by great Experience, able to rectify all _Oblique_ and _Preternatural Situations_ of the WOMB; as in _Case_ of a PROLAPSUS, (or _Falling down_) I can hereby move it carefully _Up_ again: If it lies too much _Backwards_, by elevating it while it gradually contracts, I can easily bring it _Forwards_, to its _Natural Position_: If it hangs too much _Forwards_, I can quickly reduce it _Backwards_: If it tends to _either Side_, I can directly move it to its Center. And thus, in short, I hope I may be allow’d gently and gradually to restore the WOMB to its _Natural Place_ and _Posture_, how _Preternaturally_ and _Obliquely_ soever its _Situation_ may happen to be disorder’d.

NOW This being so successfully done, I can, in fine, assure and secure any _Lying-in-Woman_, that her WOMB is both duly _purg’d_, and naturally _shut_ again as it ought to be; which I take to be the greatest _Satisfaction_ the CHILD-BED-WOMAN can conceive in her Condition. Whereas,

IV. THEY who leave all these Things to mere NATURE, risque their PATIENT’S future _Welfare_, and very often her _Life_ too, as innumerable _Tragical Examples_ witness: For NATURE itself most particularly requires our special _Assistance_ in this _Case_. But (according to their indifferent _Notions_) it is _Time_ enough to assist NATURE, when it is found _Deficient_; and then, in _Case_ of EXTREMITY, they unanimously agree that there is no other way to help or save the _Woman’s_ LIFE, but by this METHOD of _Manual Operation_. To which I answer, that NATURE operates not in an _Instant_, but (in all _Cases_) requires a competent _Time_, to discharge its respective _Functions_; and being left too long to itself, for want of Help, is many a-time (by intervening _Accidents_) found at last _Incapable_: Upon which, then _They_, beginning their Endeavours to _second it_, generally come too late. For if the _Case_ does not prove to be past all _Remedy_, it is at least (by this _Protraction of Time_) often rendred not only _difficult_, but also _desperate_; as will evidently appear in the _Case in hand_, from what follows, _viz._

I. WHILE _They_ (conformable to the general and universal _Practice_ of common _MIDWIVES_) expect the _Performance_ of NATURE, or the _Success_ of their _trifling Means_, in the mean time, the _Orifice_ of the WOMB is so _closely shut up_, that in the space of an Hour or two, it cannot be _penetrated_, without renovating the most severe racking PAINS to the _Woman_, who (perhaps) has been sufficiently spent before, by the DELIVERY of her INFANT, and is _now_ consequently incapable of standing out the renew’d PANGS: whereby of course _She_ must succumb at last, and _give up_ the _Ghost_, for want of _Timely Help_; as innumerable _Instances_ confirm for an undeniable Truth. But,

II. SUPPOSING the _Woman_ to be able to undergo the _PAINS_, yet the WOMB is however contracted, and the _SECUNDINE_ bound so close up, that this _Body_, which before adher’d _Cake-ways_ to its _Bottom_ in a _smooth_ and _broad Form_, is now so squeez’d into a _small_ and _long Figure_, that it is even now a _Difficulty_ next to Impossible, to reach the _Bottom_ of the WOMB, and still a _harder Task_ to extract an entire _Secundine_, without prejudicing the WOMB.

III. THEY who altogether neglect _Manual Operation_, may (I confess) sometimes _deliver_ their WOMAN, when _Success_ accidentally answers their WISH: But without this _Mean_, they cannot possibly restore a _prolaps’d_, _fallen-down_, or an _obliquely situated_ WOMB, to its _natural Position_. No, to the Contrary, Nothing is more common among ignorant unwary _MIDWIVES_, than to _invert_ and _draw down_ the _Bottom_ of the WOMB itself, by pulling the _Navel-String_, as they foolishly intend by _means_ of it only to extract the _SECUNDINE_. Neither does the _Mischief_ always end here, but mistaking this _Body_, when so found by their TOUCH, they immediately imagine it to be the _Head_ of another INFANT; and persevering in this _false Conjecture_, they manifestly expose the poor WOMAN to the Hazard of her _Life_. Neither,

IV. POSSIBLY can _They_, without the _Use_ of the HAND, so cleanse the WOMB of the _Reliques_ of the _SECUNDINE_, which may stick up and down to the WOMB; or of the _Pieces_ or _Parts_ of the _Membranes_, which may remain there; or of the _clotted Blood_, which commonly stays behind. From hence therefore it necessarily follows, that (without the _Means_ of the HAND) _They_ cannot be Positive or Certain in any _Circumstance_, relating to the _True State of the Woman_. _They_ can neither assure Herself, nor those concern’d, that her WOMB is duly purged; if (perchance) of the _SECUNDINE_, which they may guess at by the _Sight_, yet not of the _Fragments_ of the _Membranes_, nor of the _clotted Blood_, which they can never be certain of, but by this METHOD. I mention these _Things_, because the _least Part_ of EITHER being retain’d, or left _Behind_ in the WOMB, may cost the WOMAN her _Life_, as innumerable _Precedents_ do testify. Nor,

V. CAN they possibly secure the _Woman_, that her _WOMB_ is _duly shut and contracted_; much less can they (without these _Means_) affirm that it is orderly _situated_ in its _proper natural_ CENTER: By the Neglect or Fault of which _Condition_, she is not only rendred _Barren_ afterwards, but also most infirm all the Days of her _Life_.

BUT notwithstanding how _plain_ and _easy_ soever, I have endeavour’d to make out the above-mention’d METHOD, I would over and above recommend _It_ only to the _judicious_ and _well-qualify’d MIDWIFE_; by no Means to those that are _ignorant_ in the _Parts_ of _GENERATION_, nor to any _stiff clumsy-fisted Person_: And that for the _Two following Reasons_; viz.

I. LEST the STRING (by some _Accident_ or other) should break, and she, missing this _Guide_ to the _SECUNDINE_, should take _One Part_ for _Another_, and consequently _dislodge_ the WOMB instead of the AFTER-BIRTH; which has undoubtedly often happen’d by such blind DOINGS, notwithstanding this very remarkable _Difference_ between _Them_, that the _SECUNDINE_ distinguishes itself from the _Other_, by a great many little _Inequalities_ on the Outside, occasion’d by the ROOTS of the _Umbilical Vessels_. And,

II. LEST _she_ should unwarily either _break_, _tear_, or _scratch_ the WOMB, with her _thick_, _fleshy_, _rough_, and _rigid_ HAND, or with her _stiff_ and _crooked_ FINGERS: _Either_ of which _Accidents_, may give ORIGIN to various _Misfortunes_; such as a PROLAPSUS, or _Falling-down_, a _preternatural Flooding_, an _Inflammation_, or _Gangrene_, &c.

BUT we will now, in fine, suppose that the _Ingenuous MIDWIFE_ has after All discharged her faithful _Duty_ in these Respects, with _Care_, _Lenity_, and good _Conduct_, as well as with great _Art_ and _Judgment_: In which _Case_, it only remains, that _she_ take the necessary and usual _Care_ of the CHILD-BED-WOMAN and INFANT; as hereafter will be directed in the respective _Chapters_ of _SECTION_ VIth, to come.

IN the mean Time, these curious _Things_ being thus amply premised in this Place, the READER has no more superfluous _Repetitions_ to expect concerning _them_ in the following _Performance_: And therefore with these _Preliminaries_ I conclude my _Fourth SECTION_.

SECT. V.

CHAP. I. _Of BIRTH._

MAN’s appointed Time may as reasonably allude to his _BIRTH_, as to his _DEATH_: His _Days_ and his _Months_ (mentioned by holy JOB[158]) being as much determin’d, _naturally_ speaking, in the _One_, as in the _other Case_.

THE _INFANT_ thus being thoroughly ripen’d, and arrived to full _Perfection_ of MATURITY, the _Hour_ approaches, in which it scorns any longer _Confinement_ to such narrow Bounds. For the _Animal Spirits_ being discontented, for want of due _Liberty_ and free _Motion_; the _Vitals_, for want of _Refrigeration_ and _Refreshment_; and the _Natural Spirits_, for want of sufficient _Respiration_ and _Nutrition_: _They_ all concur to make a _Commotion_, and (as it were) a victorious _Revolt_ or an _Effort_ pushing for _CONQUEST_.

THE _INFANT_ being thus irritated, immediately shakes off its _Fetters_, breaks the _Ligaments_, rents the _Membranes_, thrusts through the _Enclosures_, and makes its most vigorous _Attempts_ to enlarge itself from the _Prison_ of the WOMB, into that of the WORLD.

WHICH _Enlargement_ depends very much indeed upon _NATURE_, but more particularly on the _Strength_ and _Vigour_ of the _INFANT_, seconded by a peculiar _Faculty_ of the WOMB, that by degrees is drawn-in to _Consent_, and _Endeavour_ to dislodge and expel its troublesome and obstreperous _GUEST_.

NOW the _INFANT_, during the whole Time of _Gestation_, adhering to the _WOMB_, by the _Umbilicals_, as the _Fruit_ does to the TREE by the _Stalks_, upon this Occasion distends the _WOMB_, and having valiantly turn’d itself, breaks the _Membranes_, and dissolves the _Acetabula_: When also the _Orifice_ of the _WOMB_ is competently open’d; and _That_ (in _Avicenna_’s memorable Words[159]) at the Command of the great GOD. Upon This the _Waters_ flow; the _Umbilicals_ parting from the _WOMB_ and their proper _Vessels_, and the _Veins_ and _Arteries_ of the _SECUNDINE_ severing themselves, in like manner; As ripe _Fruit_, or the _Leaves_ of TREES in _Autumn_ fall-off naturally, or break from their proper _Stalks_.

THUS the _WOMB_, exerting its extensive and expulsive _Faculties_, excludes the Legitimate _INFANT_: To which great _Work_ also, the _Painful Labours_, and _Labouring Pangs_ of the _MOTHER_ (in the manner they happen with the contracted _Spirits_, depress’d _Midriff_, and compress’d _Muscles_ of the ABDOMEN) contribute not a little _Help_. And, in short, this stupendous _Work_ or _Action_ is called _BIRTH_; and is nothing else, but an _Exclusion_ of the _mature CHILD_.

WHICH _BIRTH_ proceeds either from _Causes_ of the _INFANT_, or from _Causes_ of the _WOMB_: Of the _INFANT_, because through the strict _Confinement_ of a narrow Place, and Defect[160] of _Aliment_, and _Refrigeration_, It kicks and spurns for its EXIT: Of the _WOMB_, because about that _Time_, being overloaded and aggrieved by the _Bulk_ and _Weight_ of the CHILD, it endeavours, by its own expulsive _Faculty_, to disburthen itself, and propel or drive it forth to the utmost of its Power. For——

AS it is the proper _Function_ of the STOMACH, to eject the _noxious Humours_ by Vomit, and deject the _Natural Excrements_ into the _INTESTINES_; as it is also the _Office_ of the _RECTUM_ to evacuate the _Fæces_; as likewise the _Profusion of the Urine_ is the _Action_ of the BLADDER; as again the _Extrusion_ of all _fuliginous Matters_ is the _Work_ of the HEART and LUNGS; and as, at last, the _Effusion_ of the _Genital_ SEED (in _Venery_) is the _Operation_ of the _Virile_ TESTICLES: So the _Exclusion_ of the _Mature FOETUS_ is the _Eighth_[161] and last proper _Action_ of the _WOMB_; which is justly deem’d the only _Primary Agent_ and _Active Cause_ of _BIRTH_, as the excluded _FOETUS_ is the _Passive_.

BUT this _BIRTH_ is not always _Uniform_; for as it differs in _Time_, so it does also in _Manner_: From hence we have with respect to the TIME, _Legitimate_ and _Illegitimate BIRTHS_, which being already discuss’d[162], I shall resume nothing by way of _Repetition_ in this Place: And with respect to the MANNER, we have also two general SORTS, namely, _Natural_ and _Preternatural BIRTHS_; which together with their particular _Branches_, I am now to enter upon, without any farther Digression.

CHAP. II. _Of Natural BIRTHS._

BY a _Natural BIRTH_, I mean nothing else, but that which is perform’d without any _ART_ or _Artificial Means_; which _BIRTH_ (of itself) strictly observes the Order and Appointment of _Nature_: That is, in the _INFANT_’s coming _Head foremost_, _Face downwards_, _Arms following_, extended (along the _Sides_) strait _upwards_, towards the _Thighs_.

_HIPPOCRATES_’s _Reason_[163], in short, for the _CHILD_’s thus turning and presenting itself, is very good; _viz._ Because of all the _Parts_, the HEAD is the Heaviest about the Time of _BIRTH_, as appears more at large from _Sect._ I. _Chap._ 10.

BUT besides this Argument, I believe Wise _Nature_ has also order’d it _thus_; because _This_ indubitably is the most _safe_ and _easy Manner_ of _EXITION_ both for the _Mother_ and _Infant_: Insomuch that by all other _Methods_ of _EXTRACTION_, _One_ or the _Other_, and sometimes _Both Lives_ are, or may be, endanger’d, if not very dextrously perform’d, according to the best Laws of Art and Judgment, as by and by will more manifestly appear.

BUT because I have generally observ’d most _Authors_ to treat promiscuously of _BIRTHS_, not only accounting some, which are really _Natural_, to be _Preternatural_; but also both handling and writing of them as _such_, only because attended with some difficult Circumstances: I shall (in this place) take Leave to make an agreeable _Distinction_ betwixt the _different Sorts_ of _Natural BIRTHS_, in order to make every thing the more clear and obvious to the _Conception_ of the READER. Upon which Account therefore, I shall reduce _These_ to _two Heads_, and that under the TITLES of _Natural Easy_, and _Natural Difficult BIRTHS_.

THE _FIRST_ of which I include in this _Chapter_; but because in this _Case_ (which I call a _Natural Easy BIRTH_), _Nature_ alone always performs the _Work_, without any Help of _ART_ or _Artful Means_; and because also the MIDWIFE (upon this Occasion) has but little or nothing to do, save only to observe the concluding _Chapters_ of the last preceding SECTION; and upon receiving the CHILD, immediately to manage and provide both for the MOTHER and the INFANT according to their several _Necessities_, as hereafter shall be inculcated in the respective _Chapters_ of the next following SECTION: I say, for these _Reasons_, I have no Room here to insist farther on this present HEAD; wherefore I proceed in course to the _SECOND Sort_ of these _BIRTHS_. Namely——

CHAP. III. _Of Natural Difficult BIRTHS._

THO’ indeed every _difficult Expulsion_ of the _INFANT_, from whatsoever _Cause_ it may proceed, is verily a _Difficult BIRTH_; yet I shall here distinguish a _difficult One_ from a _preternatural BIRTH_; not only that I may thereby, the better avoid the _Confusion_ which others have led themselves into, by treating of BOTH promiscuously, but also that my _Method_ may tend the more to the peculiar Benefit and Advantage of the Ingenious READER.

WHEREFORE I call that a _Difficult BIRTH_; where, notwithstanding the _Figure_ and _Dimensions_ of the _CHILD_, answer in all respects to its proper _natural Posture_, in a _Perpendicular_ WOMB, duly situated, yet the _Exclusion_ of the _INFANT_, is retarded, by some certain _Opposition_ or _Difficulty_. From hence proceeds the real _Difference_ between _This_ and the _Natural Easy BIRTH_, forasmuch as _This_ always requires _less_ or _more_ skilful _Assistance_, according to various Circumstances, and _That_ but _Little_ or _none at all_.

NOW the _Causes_ of _Difficult BIRTHS_ are very various, and according to the _Nature_ of them, _This_ sometimes proves equally as dangerous as the _Preternatural_; but when so it happens, I have commonly observed the _Fault_ to be, for the most Part wholly owing to the arrogant _MIDWIFE_, who either knew not how to remove the _Cause_ and facilitate the _BIRTH herself_, or delay’d applying betimes to some _Abler Person_, for the _Relief_ and _Safety_ of her Labouring _WOMAN_.

HENCE arises a Fundamental MAXIM, which I would lay down for a memorable _Rule_ to all such IGNORANTS; that no _MIDWIFE_ ought to keep a WOMAN in this Condition under her _Hands_ (especially in a _Place_ where extraordinary _Help_ is to be had) any _longer_, than she finds the _Advances_ of _BIRTH_ answer to the Proportion of _Time_ spent about it: But forthwith she ought to deliver her up to the _Care_ of the more Skilful and Judicious _Practiser_ in this ART. In which _Case_, of _Compliance_ and _Condescension_, she is to be highly commended for her tender _Care_, and cautious _Concern_; whereas upon acting contrary to this good _Rule_ out of Pride or Obstinacy, and the _fatal Accident_ ensuing, I have known the _MIDWIFE_ to have been try’d for her _Life_ in the City of _Venice_.

BUT that I may render every thing _Plain_ and _Easy_ to the _Apprehension_ of the weakest READER, by reason that the _Causes_ of _Difficult BIRTHS_ are both _different_ and _numerous_, I shall again reduce them to _Two_ CLASSES; namely, _External_ and _Internal_: The _External_, I shall include in the next following _Chapter_; but the _Internal Causes_, requiring a more Curious and Extensive _Dilucidation_, may (I hope) be pertinently divided into a _Three-fold Difference_; viz. _Causes_ of the MOTHER, of the INFANT, and of the PASSAGES; which I propose to handle particularly, all in their due _Order_. But _First_,

CHAP. IV. _Of Difficult BIRTHS, proceeding from External Causes._

IN all _difficult Cases_, the CURE or _Remedy_ chiefly depends upon the certain _Knowledge_ of the _Nature of the Case_, and the _Cause_ of the _Difficulty_: Since (according to _Celsus_[164], that noble _Roman Physician_) it is not to be suppos’d that _He_ should know how to _remedy Diseases_, who knows not their _Original Causes_.

FOR as in other _Cases_, so also in _MIDWIFERY_, the _Cause_ being known, the _Difficulty_ is easily remov’d; but especially when it only proceeds from _External Causes_, it requires no great ART, save only the _MIDWIFE_’S particular _Notice_ and discreet _Animadversion_.

AS, _FIRST_, for Instance, in _Case_ of any _Difficulty_, occasion’d by an _Intemperature_, or inclement _Constitution_ of WEATHER and AIR; the more adverse or inclement the WEATHER is, the more tender _Care_ ought to be taken of the _Labouring Woman_: Namely, in SUMMER, when the _Heat_ scorches so much as to dissipate the _Woman’s Strength_, she ought to LABOUR in a _Ground-Chamber_ backwards, which may be strewed (for the Purpose) with _Vine_ or _Willow-Leaves_, _Rose-Water_, and a little _Vinegar_; as it is customary in _hot Countries_.

IN WINTER, when the _Cold_ pinches so as to condense and astringe the WOMB and the _Passages_, she ought to LABOUR in an _Upper-Room_, kept moderately warm with one continued _Fire_; the _MIDWIFE_ rubbing gently the _Hypogastrick_ and _Ischiatick Regions_ every now and then with hot _Cloathes_.

IN SPRING and FALL, when parching dry _Weather_, with _North_ and _East Winds_ most abound, the _MIDWIFE_ ought not only to rub these _Inferiour Regions_ with hot _Cloaths_; but also to qualify the _Influences_ of the _Siccid AIR_, by anointing the _Passages_ with proper _Unguents_.