Conclusion of the Second and Last Part.
Here, confessing my just apprehensions of not having fulfilled the promise of my title-page; there will not, I hope, to that reproach of my deficient powers in the performance, be added the undeserved ones of vanity or injustice in the design or conduct of my feeble essay.
For as to vanity, or any presumption, on my part, of any thing so weak, so unauthoritative as my representation, having any chance to remove the abuses, not however the less existent for that incapacity of mine to remove them, my knowledge of the world would alone defend me from so ridiculously wild a thought. I am but too well aware of the tenaciousness of especially false prejudice in most minds, where it has once gained entrance, and with whom prepossession is ever eleven points of the right. I have then purely had in view the discharge of that duty, incumbent on every member of human society, to oppose such errors as appear to be pernicious to the good of it. In that light I have beheld the growing practice of the instrumentarians, and in that sincere belief I have hazarded the publication of my sentiments, without surely pretending to any authority over the opinion of others. That I chearfully leave to every one’s reason, who is capable of reason. And to write for others than the rational, would be only labor deservedly lost.
As to injustice, I am, at least, clear of that of partiality to my own sex. I grant and lament as much as any one the incompetency of but too many of the midwives. The number of such cannot be too little. But then would the banishing them out of the practice be preferable to the having them better taught, especially since there is nothing but what is so much worse to put in their room, men and instruments? What occasion too for such a dangerous extremity? For as the deficiency is evident, so are the causes: which are not only the want of sufficient care in the training and education of women to this profession, but the actual discouragement, which must grow every day greater and greater, by the encroachments of the instrumentarians, whose plea for supplanting them will be consequently strengthened by that alarming scarcity of capable midwives, which themselves will have so much contributed to create. These being then the principal causes, and well known to be so, the remedies are not obscure, nor hard to attain.
A good education especially is of great importance, to accomplish what Nature has already gone so great a way in, by her giving in many respects to the women such a superior aptitude for the business. Capable midwives would much help to form good female pupils; and the lying-in hospitals especially might be made highly useful to so desirable an end. But surely as to the practical part of midwifery in these hospitals, it ought not to be under the direction of men, whose interest it should be, only to form the women so deficiently, as that themselves might be the less unnecessary; to form them, in short, more for their own service, than for that of the public. That temptation being removed, the female-practitioners could not receive too respectfully from the surgeons lectures or instructions, any lights in anatomy relative to their theoretic proficiency. But to nothing should they be more constantly and effectually excited, than to perfect themselves in the manual operation; and indeed, in general, so to capacitate themselves for their function, as to prove and establish the perfect inutility of all instruments whatever. Nor will it be a difficult task for a woman to acquire a superiority in her hands to the most boasted of those unnatural substitutes. This is the true way of laudably disarming the instrumentarians, and of thereby depriving them of the only shadow of a pretence they have for supplanting the women, and invading the female province, of which invasion it is so probable, that not the cause they plead, but the pay they squint at, is the real motive.
As to the discouragement of proper women from applying themselves to the profession, it can only cease by the concurring of those, on whom the choice out of either sex occasionally depends, to restore things to their antient channel: and that will in course, for their own sakes, follow on their ceasing to be imposed upon by the false pretences of the men-practitioners. But this is a point upon which I am too much a party to be heard, though even as no more than an advocate, and much less as a judge. All I shall then presume to say is, that I very readily leave the decision of the question to Reason, that inward oracle in every one’s breast; an oracle, which, in a cause so interesting to human Nature, can never return a false answer, where consulted by those who deserve to find the truth by sincerely seeking it, with a firm design to sacrifice to it the poor vanity of defending a prejudice, or any other interest of the passions. And surely there can hardly exist a point of more capital importance to Society, than the determining, what however one would imagine not very difficult to determine, on which side in this profession of midwifery particularly, the superiority of auxiliary power may be expected, on that, where there is evidently a great deal of Nature, assisted with a little but a competency of Art, or on that, where what there is of Art is most barbarously abused, and without any Nature at all.
The END.
[1]. Exod. Chap. vii. and viii.
[2]. Diod. Sic. Herodotus.
[3]. The Commentator on Boerhave’s Lectures, vol. V. p. 252. or §. 694. says, “At Paris women are taken into the Hôtel Dieu, fifteen days before their lying-in, at the public expence, so that the business of midwifery can be no where better learn’d.”
[4]. It is evidently this universal influence of the Uterus over the whole animal system, in the female sex, that Plato has in view in that his description of it, which Mr. Smellie (introd. p. 15) calls odd and romantic, from his not making due allowance for the figurative stile of that florid author. Thus the diffusion of the energy of the uterus, Plato calls its “wandering up and down thro’ the body.” A power of activity which, towards conquering the otherwise natural coldness of the female constitution, nature would hardly give to the uterus merely to excite in women a desire, sanctified under due restrictions, by her favorite end, that of propagation, if she had not, at the same time, endowed that uterus with an instinct, beneficial by its influence in the preservation of the issue of that desire. And the real truth is, that there is something that would be prodigious, if any thing natural could be properly termed prodigious, in that supremely tender sensibility with which women in general are so strongly impressed towards one another in the case of lying-in. What are not their bowels on that occasion? It may not be here quite foreign to remark, in support of the characteristic importance of the uterus or the womb, that in the antient Saxon language the word Man or Mon equally signified one of the male or female sex, as Homo in Latin. But for distinction-sake the male was called Weapon-man, (not however for any offensive weapon or instrument in midwifery;) and the female Womb-man, or man with an uterus: from whence by contraction the word woman.
[5]. Smellie. Treatise of midwifery, p. 339. where it appears, that the above dress is reserved for a man-midwife’s masquerade-habit in private practice, before ladies, not to frighten them; whereas to the poor women in hospitals his looking like a butcher, is it seems necessary, with bases and an apron; the steel of course. But if it is not too presumptuous for me to offer so learned a gentleman as the Dr. a hint of improvement for his man-practitioner’s toilette, upon these occasions, I would advise, for the younger ones, a round-ear cap, with pink and silver bridles, which would greatly soften any thing too masculine in their appearance on a function which is so thoroughly a female one. As to the older ones, a double-clout pinned under their chin could not but give them the air of very venerable old women.
[6]. If a man happens by great chance to have long taper fingers, it is a circumstance so uncommon, that it is proverbially said of him, “He has rare midwife’s fingers.” Nor was it quite unhumorously observed of one of the founders of the sect of instrumentarians in England, remarkable for a raw-boned coarse, clumsy hand, that no forceps he could invent of iron or steel, being more likely to hurt than his fingers, he had, at least, that excuse for recommending instruments.
[7]. A la veritê Mauriceau raporte cette mort inopineê à une Cause occulte, puisqu’il dit expressement que “ce fut un de ces fortes de malheurs de la destinée que toute la prudence humaine ne peut pas eviter.” C’est aussi l’opinion de la Motte. Levret, p. 272.
[8]. Levret, p. 269.
[9]. This will doubtless be laid hold of as one proof, that midwives have, in cases where they are puzzled, been forced to have recourse to men-practitioners: but I have no where said, there were not some midwives unequal to their business. The sequel will shew, that this most probably was one of them, and the case was not much mended by the assistent she called in. A little more patience, though I confess there is some room to think it in this so long lingering case excusably exhausted, would have prevented the murder of the child: but as the concomitant circumstances are not specified, I cannot pretend to determine that point. All I shall say is, that there is not hardly one case in a thousand, in which nature does not know her own time best, and does not take it kindly to be hurried. It has been known, that sometimes the quickest deliveries have been the most fatal, and the most liable to sudden death, by consequent hemorrhages.
[10]. Dr. Smellie has himself (p. 403.) ranked among the causes of sudden death to women by violent floodings after delivery the following one; “if in separating the placenta the accoucheur has scratched or tore the inner surface or membrane of the womb.” But if unpared nails, or the rough hands of a man, may cause such a dreadful accident, what may not be dreaded from iron and steel instruments, blindly thrust into parts of a scarce less tender texture than the apple of the eye? But of that more hereafter.
[11]. Levret’s words, p. 279.
[12]. It is among the smaller mischiefs done to the mother, that I here mention my having not unfrequently seen ruptures brought on by the practice of men-midwives, upon patients in other lyings-in, precedently to the one in which I attended them. These ruptures I have sometimes been able to remedy by good management in my laying them.
[13]. “Let the forceps be unlocked, and the blade cautiously disposed under the cloaths, so as not to be discovered”. Smellie, p. 272.
[14]. See Smellie, p. 307.
[15]. Smellie, p, 291. “When the head presents, and cannot be delivered by the labor-pains; when all the common methods have been used without success, the woman being exhausted, and all her efforts vain; and when the child cannot be delivered without such force as will endanger the life of the mother, because the head is too large, or the pelvis too narrow: it then becomes absolutely necessary to open the head, and extract with the hand, forceps, or crotchet. Indeed this last method formerly was the common practice when the child could not be easily turned, and is still in use with those who do not know how to save the child by delivery with the forceps: for this reason their chief care and study was to distinguish, whether the Fœtus was dead or alive; and as the signs were uncertain, the operation was often delayed until the woman was in the most imminent danger; or when it was performed sooner, the operator was frequently accused with rashness, on the supposition that the child might in time have been delivered alive by the labor-pains: perhaps he was sometimes conscious to himself, of the justice of this imputation, although what he had done was with an upright intention.”—This last indeed would be too uncharitable not to grant.
[16]. Smellie, p. 255. “In this case, we find, by experience, that, unless the woman has some VERY DANGEROUS SYMPTOM, the head will in time slide gradually down into the pelvis, even when it is too large to be extracted with the fillet or forceps, and the child be SAFELY delivered by the labor-pains, although slow and lingering, and the mother seems weak and exhausted, provided she be supported with nourishing and strengthening cordials.” Now in this Dr. Smellie is very right; his wrong consists in not making this conclusion more extensive, as that of his fellow-practitioners too often does, in fancying or exagerating dangerous symptoms: whereas for once that nature really occasions them, they are incomparably oftener the effects of the operator’s own mispractice: this observation I cannot, for the truth and importance of it, too often repeat.
[17]. In honor to truth, be it here noted, that a few, and very few indeed of the midwives, dazzled with that vogue into which the instruments brought the men, to the supplanting themselves, attempted to employ them, and though certainly they could handle them at least as dextroussly as the men, they soon discover’d that they were at once insignificant and dangerous substitutes to their own hands, with which they were sure of conducting their operations both more safely, more effectually, and with less pain to the patient.
[18]. At this day archbishop of Cambray.
[19]. By this interest, with respect to the mis-government of the infants that fall upon the parish, I do not mean such a personal interest, as that the super-intendants of the charity put a single farthing into their own private pockets, out of the savings, by the with-holding or grudging a proper provision for the children, but merely the interest of a parish, or the public, in so false and inhuman an article of parcimony. A consideration which, if that were possible, renders it the more inexcusable from the temptation being so much the less.
[20]. I have somewhere read, that brutes have not been insensible of this effect, on suckling animals, though even of so different a kind from their own, that the most mortal enmity naturally existed between them: such was the instance, transmitted from Pensylvania, of a cat so softened towards a rat, by having accidentally given suck to it amongst its own kittens, that it forbore exerting towards it its usual hostility to that species.
[21]. The candid reader will please to observe, that in giving up so much as I do of the argument from the prevalence of fashion, I do not give up a little: since I might justly oppose to it the instances of our Royal Family, in which we see so many happily living and florishing monuments of the midwive’s capacity. Accoucheurs had, I presume, no hand in delivering the greatest Lady in this kingdom. The men-midwives will perhaps treat this as trifling. But what will they say to so victorious a proof in favor of the female-practitioners, as that taken from themselves, who, for the most part, were obliged to the midwives for their ushering them into that world, of which they are so much the light and ornament; and out of which world they are rather not so gratefully employed in driving those, by whose function they were helped into it?
[22]. Pray remark the following directions for the choice of a midwife, from Dr. Smellie, p. 448.
“She (the midwife) ought to avoid ALL reflections upon men-practitioners, and when she finds herself at a loss, candidly have recourse to their assistence: on the other hand, this confidence ought to be encouraged by the men, who, when called, instead of openly condemning her method of practice (even though it should be erroneous) ought to make allowance for the weakness of the sex, and rectify what is amiss, without exposing her mistakes. This conduct will as effectually conduce to the welfare of the patient, and operate as a silent rebuke upon the conviction of the midwife, who, finding herself treated so tenderly, will be more apt to call necessary assistence on future occasions, and to consider the ACCOUCHEUR as a MAN OF HONOR and a REAL FRIEND. These gentle methods will prevent that calumny, which too often prevail among the male and female practitioners; and redound to the ADVANTAGE of both: for no ACCOUCHEUR is so perfect, but that he may err sometimes, and on such occasions he must expect to meet with retaliations from those midwives whom he may have roughly used.”
[23]. As the story is told in Hyginus, it should seem that the practice of midwifery at Athens, was, on a season interdicted to the women, who, by a fixt resolution to die rather than submit to be delivered by the men, procured from the Areopagus the repeal of that statute, and the saving from imminent condemnation one Agnodice, who had dressed herself in men’s cloaths, to elude the cognizance of the law. The great practice she had obtained by this means had alarmed the physicians, who thereon accused her as a seducer of the women: against which she easily defended herself by a declaration of her sex. But this brought her under the penalty of the law against women exercising the midwife’s profession. The story imperfectly related in Hyginus, at the same time that it does honor to the modesty of the Athenian women, that is to say, if modesty is not, according to the men-midwives, a false honor, gives room to suspect, that the midwives themselves had perhaps occasioned the promulgation of so absurd a law. It is well known, that in those antient times, there were for female disorders women-physicians in form. Perhaps their encroachments on the province of the men, by exercising the art of physic in general, might make a restraint necessary, which was only so far faulty as that the remedy was in this, as it often is in other cases, carried into extremes. I would no more justify the women overstepping their proper sphere of employment into that of the men, than I would the men sinking into that of women. They are both reprehensible, both dangerous, but assuredly, the last must be the most ridiculous.
[24]. It is from this principle, that, with so fair a field for raillery, often not the least forcible of arguments, I have, against those who are such advocates for the use of anatomy in midwifery, abstained from laying any stress on the famous imposition of the Rabbet-woman of Godalmin, upon professors of anatomy. I am so far from attacking anatomy, that I aver, every good midwife ought to know enough of it to assist her practice. This would not however constitute her an anatomist, nor is it requisite that she should be one.
[25]. “Il faut d’abord placer convenablement la malade, c’est-à-dire, sur le bord de son lit; les cuisses élevées et écartées, les pieds rapprochés des fesses, et maintenus en cette situation par des aides dont on soit sûr.” Levret, Utilité du nouveau forceps courbe, p. 161.
[26]. “Si on s’arrêtoit au précepte général, le forceps seroit un instrument de pure spéculation et non de pratique.” Lev. p. 161.
[27]. The term imaginary is here far from an unjust one, and why should not the honor of a deliverance, effectuated by Nature, be as well given to a being of flesh and blood as to a stone? The virtue of the ætites, or Eagle-stone, has currently passed for abridging the pains of labor, and accelerating parturition. A French consul in Egypt, ordered one of those stones to be tied to his wife’s thigh, who was in a lingering labor. The stone in this case, more innocent than probably a man-midwife would have been, who would have used means to hurry the birth, or perhaps have gone to work with his forceps at least, suffered Nature quietly to go her own pace. What was the consequence? The lady was soon after happily delivered, which there is no doubt but she would equally have been if a brick-bat had been tied to her thigh. But Nature lost the thanks so justly due to her: the stone ran away with all her merit; and this case was added to the catalogue of the miraculous operations of the stone. In how many cases might it be said, that the stone here represents the man-midwife, if to the stone it was not so much more innocent and less dangerous to have a recourse?
[28]. See La Motte, p. 646, of the quarto edition, Leyden.
[29]. See La Motte, p. 262. lib. v. chap. 2.
[30]. If these best operators had been examined touching their opinion of midwives; they would most probably have told you, they were a parcel of poor insignificant ignorant creatures.
[31]. Dr. Smellie seems to countenance this practice, where he says, p. 232. “We have already observed, (p. 229) that if there is no danger from a flooding, the woman may be allowed to rest a little, in order to recover from the fatigue she has undergone, and that the uterus may in contracting have time to squeeze and separate the placenta from its inner surface.”
[32]. It is but fair to observe, that M. De la Motte, (Obs. 248) instances, from Peu, two patients perishing by the midwife’s trusting to the pure actings of Nature in this very case.
[33]. Dyonis in his Treatise, book III. ch. 12. Mauriceau, book II. chap. 14.
[34]. This instrument was once as much in vogue, as can be supposed of a time, when instruments were not so common as they are now. But how much torture in vain must it have given before it was discovered, that “so far from answering the supposed intention of it, namely, to extend the bones of the Pelvis; it can serve no other purpose than that of bruising or inflaming the parts of the woman.” Smellie, p. 296.
Possibly the more modern instruments, which have supplanted this now exploded one, under the notion of improvement, will, in time be found to be liable to as just objection. But in the mean while what lives must be lost, what tortures endured, in the experiment! How many will have been the victims, women and children!
[35]. Even this very Mauriceau allowed, by his brother practitioner M. De la Motte, to have been an excellent man-midwife, is however very justly animadverted upon by him for his weakness in giving into such nonsense, as prescribing histeric medicines by way of hastening the delivery. His capital receipt was the juice of a Seville orange in an infusion of Sena. Let any one imagine, what an effect such a laxative potion must have on a woman, commonly rather wanting to have her strength recruited by proper restoratives, than diminished by purges, on so senseless a view. But how many other instances might be brought of these same most learned men-midwives, making almost as pitiful a figure in the character of physicians, as they must for ever do in that of manual practitioners of our art! Even the works of Daventer, who has such glimpses of true theory, prove him not uninfected with a spice of quackery. This is generally speaking so true of the men-dabblers in practical midwifery, that one would imagine the extension of that meanness of theirs, in putting their nose into such a function, even to their collateral profession, whatever it be, of physician, surgeon, chemist or apothecary, was the revenge of Nature, for the outrages of their pretended art upon her.
[36]. Page 249, of his treatise of midwifery.
[37]. That is to say, if he touched the woman at all with it, and did not sometimes, at least, make believe that he delivered her with it though Nature alone should have done the work. Sure I am that that piece of quackery in him of pretending to hide the instrument, might justify such a suspicion, of a less guilt however than that of really applying an instrument insignificant to any purpose but that of torture in vain.
[38]. How few are there such? consequently how great the danger of such instruments, even if they were good for any thing, to be introduced into common practice?
[39]. As the practice of midwifery is, properly speaking, under no regulation, may not this be too often the case?
[40]. If any one doubts of this, he, in order to settle his opinion, needs but to peruse the instructions given by Levret, and other instrumentarians, for the use especially of the forceps. He will find such obscurity, such intrepidity of practices upon flesh not their own, as would make one shudder. The very cautions against locking in a part of the uterus between the blades of the instrument, prove the existence of a danger no caution can scarce answer for its being able to avoid. What do you think of young or unskilful practitioners thrusting up instruments at RANDOM into such a place? yet Dr. Smellie, p. 288, expressly tells you, there is a case in which “The forceps MUST be introduced at random.” This however may give the practitioner boldness, that whatever is his fault, the poor woman it is that is sure to suffer for it, and how cruelly!
[41]. “The forceps may be introduced with great ease and safety, like a pair of artificial hands, by which the head is very little (if at all) marked, and the woman very seldom tore.” Smell. p. 257.
[42]. In this case of a monster of two heads, which happens so rarely as that it might almost be reputed null or of no consideration, once more, it is neither a midwife’s business, nor even of one of the common men-practitioners of midwifery. Application should be instantly made to one of the best and ablest surgeons procurable, for reasons too obvious to need specification.
[43]. Smellie, p. 248.
[44]. See Reaumur’s art of hatching domestic fowls, &c.
[45]. If any of my readers imagine that I have, in my objection to the men-midwives, exagerated matters, I intreat of them to consider the following quotation from a male-practitioner, from Daventer, who endeavoured, as much as Nature would allow him, to be a good midwife, however he fell short of it. These are his own words translated, from p. 11. of the French quarto edition.
“Can any thing be more shocking to the mother, and to those about her, than to see a man in liquor, scarce knowing what he is about, divested of all compassion, of all sentiment of humanity, his hands armed with a knife, a crotchet, a pair of pinchers, or other horrible instruments, come to the ASSISTENCE of a woman in agonies, begin, for his first attestation of skill, by wounding the mother, then go on to destroy the child, bring it away piece-meal, with exquisite tortures to the woman, and, after all, grumble in the notion, that he could not be PAID enough for such a fine spot of work? had not such better at once take on to be butchers or hangmen, than treat thus the image of God, and render the profession odious?”
Have I any where said any thing STRONGER than this? Daventer, however, certainly did not mean by it to insinuate, that all men-midwives answered intirely this description; no, nor I neither. But leaving the brutality out of the question, the mischief and mercenariness of them all differ perhaps in no very considerable degree. Please to remark in the following quotation, the DOCTRINE and practice of that famous man-midwife Peu. “He determines himself, without much ceremony, to the breaking a child’s arm or a thigh, when he imagines this operation will facilitate the delivery, and that, on the PRINCIPLE of its being easy, to repair such damages of new-born infants. For the same reason the luxation of a jaw-bone gives him no scruple.” (Translator of Daventer’s Preface.)