Objection the Eleventh.
In like manner, as there are particular parts of the human body which have their appropriate undertakers or protectors under their proper distinctive names, as oculists, dentists, and corn-cutters, who by making respectively one part their particular care and study, arrive at a greater perfection, at least in the practical operations on it, than regular physicians or surgeons, whose object is the whole fabric; Why, by parity of reasoning, should not the men-practitioners in midwifery be preferable to the midwives, since a man has to his manual function superadded a theory superior to that of the women, who, it is confessed, stand sometime in need of calling in the physician to their assistence? As a man then will have laid in a stock of medical knowledge, peculiarly adapted to the exigencies and disorders incident to women during their pregnancy and lying-in, he must consequently excel the midwife, or the physician singly considered; he who with so much greater convenience will have united in one person both their faculties, besides that of the surgeon.
ANSWER.
That certain parts of the human body enjoy the protection of practitioners, who respectively devote themselves to their service, I confess. Such appropriations may also be beneficial, at least, to the practitioners. I can even conceive, that a professed dentist may clean, scale, and draw teeth, or an oculist couch a cataract, better than either a physician or surgeon. These may in their respective practice be excelled by those partial artists. But I much doubt, even as to these, whether their trusting too much to that partial excellence, does not sometimes do more mischief than good, for want of duly consulting the relation of such parts to the universal fabric, of which physicians and surgeons must be so much better judges. Galen does not appear in contradiction to common sense, where he observes, that to rectify a disorder of the eye, the head must be rectified, which cannot well be done without rectifying the whole body. In confirmation of which, I once myself knew a gentleman, whom a professed oculist, at Paris, assured of the loss of his eyes being infallible; and who upon his despondingly consulting a regular physician, was by him as positively assured, that those very condemned eyes might be saved by a proper regimen. The gentleman happily believed him, and his eye-sight was not only saved, but perfectly restored.
Another instance of the like nature occurs to me, which seems applicable to the dentist, and which I quote here from a translation of the learned and ingenious Dr. Huxham’s observations on the constitution of the air.
“Many years ago I knew a gentleman of a hale, robust habit of body, who, from being too much addicted to the drinking of brandy, fell into a violent jaundice, from which however he would have recovered well enough, would he have conformed himself to the advice of his physicians: but he on the contrary, because his gums were very apt to bleed, and his teeth stunk from the scorbutic taint, put himself into the hands of an ignorant pretender to physic for the cure of these inconveniencies. This fellow immediately set about scaling his teeth, and rubbing his gums with his famous teeth-powder, till at last, by perpetually fretting and irritating the loose texture, he brought on such a hemorrhage, that baffled all the stiptics that could be invented by the most expert surgeons, and continuing to spout forth in small streams from the little arteries of the gums, which were now every where divided: in the space of sixteen hours the poor man died through mere loss of blood.”
These instances are however only adduced to justify that doubt which I expressed of these partial artists being always to be beneficially consulted in those local affections, to which their talent is supposed exclusively appropriated.
Corn-cutter is indeed a homely plain English term, but if the teeth give from the Latin the appellation of dentist, as the eye that of oculist, what name, taking it from the part in question, will remain for that language, to give the men-practitioners of midwifery, in substitution to that hermaphrodite appellation, that absurd contradictory one in terms, of man-midwife, or to that new-fangled word accoucheur, which is so rank and barefaced a gallicism? But let what name soever be given them, it can hardly be too burlesque an one, considering the gross revolting impropriety of men, addicting themselves to a profession naturally so little made for them.
Paint to yourself one of these sage deep-learned Cotts, dressed for proceeding to officiate[[5]], and presenting himself with his pocket-nightgown, or loose washing wrapper, a waistcoat without sleeves, and those of his shirt pinned up to the breasts of his waistcoat; add to this,[[6]]fingers, if which not the nicest paring the nails will ever cure the stiffness and clumsiness; and you will hardly deny its being somewhat puzzling, the giving a name to such an heteroclite figure? Or rather can a too ludicrous one be assigned it?
Those however who will consider this grave Doctor in his margery field-uniform, this ridiculous piece of mummery, in a light of seriousness, such as the matter perhaps more justly deserves, especially combining with all the rest, the idea of his crotchets, forceps, and the rest of his bag of instruments, may think he less resembles a priestess of Lucina, than the sacrificer, in a surplice, with his slaughtering-knife, to one of those heathen deities whose horrid worship required human victims, which the poor lying-in women but too nearly resemble.
But whether or not, in imitation of the dentist, or oculist, he receives his title from the particular part he has taken under his protection, so much is certain, that the same arguments, which militate for those partial artists claiming their respective departments of the human body, will not avail the man-midwife. An oculist, a dentist, a corn-cutter, have no operations to perform but those of which disorders equally incident to both sexes are the object. There is nothing in their practice repugnant to the nature of the male-sex, nor to that reasonable decency, which only requires that no sacrifices of it should be made in vain, or at least not made to no better a purpose than to increase at once the danger and the pain of both mother and child, in whose favor it is sacrificed, as it may be clearly proved to be oftenest the case. But of the chirurgical part of the man-midwife’s pretention, I reserve to treat after considering him in the capacity of a physician; in which a man may indeed be wanted, but in that of surgeon never, or at least so very rarely, as not to atone for the dangers which attend the men forming themselves into a set under the name of men-midwives.
Where there is no complication of any collateral disorder with the gestation and parturition of women, it is even a jest for men to pretend the necessity of any study or practice to which women may not arrive, and even much excel them.
But where there exists the case of a singular constitution, or of symptoms declarative of other help being necessary than just the common one, that quickness of discernment, that peculiar shrewdness of the women, in distinguishing what is relative to their art from what is foreign from it, gives them the alarm in time, and if they have a just sense of their duty, or but common sense, they must know that such disorders cannot be partial, cannot therefore be considered as they are by the man-midwife, as subordinate to his particular province, relative as they are to the whole fabric or system. All partial practice then is here absolutely out of the question, and now what help can, consistently with good sense, be expected from a man-midwife, who, under a natural impossibility of ever acquiring the female dexterity in the manual operation, cannot however, be supposed to attain even that imperfect degree of skill, without sacrificing to the endeavours at it the time and pains in study and practice, which are requisite to form the able physician?
But, in fact, the men, that is to say, those of that sex who have the best understood all the refinements of anatomy, all the variety of female distempers, never that I can learn, attempted to invade the practical province of midwifery. The immortal Harvey, Sydenham, the great Boerhave, Haller, and numbers of others who have written so usefully upon all the objects of midwifery, have never pretended or dropped a hint of the expedience of substituting men-midwives to the female ones. They contented themselves with lamenting the ignorance of some midwives, from which has been drawn a very just inference of the necessity of their being better instructed; but even those great men never chose the character of practitioners themselves, nor probably would have thought it any detraction from their merit to have it said, they might make a bad figure in the function of delivering a woman.
Whoever then will consider but how the common run of men-midwives actually are and must be formed, and assuredly the number of exceptions to the general insufficiency cannot oppose the inference, must allow that, where a woman has distempers collateral to her pregnancy, with which they must also become dangerously complicated, she must expose herself to the utmost hazard, in any confidence she may place in a man-midwife.
The truth is, that most of the dangerous lyings-in are so far from being likely to be relieved by a man-midwife, that it is often to the having relied upon his medical judgment, and especially to his manual skill they are owing. But of the first only it is we are now here speaking.
The women captivated by that assiduity of the men-midwives, of which they only fail when they are not paid or likely to be paid, in some form or other, up to the value they set upon themselves, lightly take for granted, that, as men, they are also capable physicians. It is enough, in short, for these practitioners not to be women; for the women to think they can prescribe for them in all disorders. A mistake this, often big with the utmost danger to them.
The men-midwives, in general, have never, at the most, carried their studies beyond the disorders commonly incident to pregnant women: the knowledge of all the other possibly collateral ones, is what even the least modest of them will hardly claim, unless to the profoundly ignorant, and is in fact scarce less than impossible to one who has applied himself essentially to the manual function. In such cases the ignorance of a midwife can hardly be greater than that of the men-practitioners, and must be less dangerous from her less of pretention. Her consciousness of her own want of sufficient light, will engage her readily to state the exigency to some able and experienced physician, whom she must allow, in such cases, to be her superior judge: whereas the other, the man-midwife, acknowledges no greater authority than that with which he is pleased to invest himself. He stands, in virtue of a distinct business, and a business for which he never was made, of a sudden the self-constituted sovereign dictator and inspector-general of all female disorders whatsoever, where the woman is with child, that is to say, where the case is only thereby rendered much the more nice and difficult, and, not rarely, does he continue under the same pretext, to extend his practice to where there is no pregnancy at all in the case. And yet ask him for his titles, they are all implicitly dependent on or subordinate to that same midwifery, for which he is so naturally unqualified, even if a due study and exercise of it would permit those avocations, that would contribute to accomplish him in the so necessary general knowledge of physic. But indeed why need he acquire it, since it is so commonly taken for granted, or that he is believed upon his own word, especially if he is backed with a diploma, for form’s sake, that may have cost him little or nothing of medical study, or indeed of any thing but the amount of the fees for it?
Yet how serious, how important is it for women, if they tender their own lives, and that of the precious burthen of which they are the depositaries, to make that distinction between the physician and the midwife, which they seem so little to make! How little do they consider, what nevertheless is strictly true, that a man can never at the best be but an indifferent practitioner of midwifery, though he may be an excellent one in physic; but that as bad a midwife as he can be, he must be yet, if possible, a worse physician, if he attempts to throw both professions into one, and exercise them jointly! They are incompatible, from the justly presumable impossibility of one man doing justice to the practice of the one, unless at the expence of the study of the other: by which other, to obviate cavils, I repeat it, I mean the general practice of physic, which comprehends the speculative part of midwifery, as well as all other branches understood to be the province of the physician. This distinction then I make, because, as to the diseases purely incident to pregnant women, experimental practice will rather assist the medical study of them: and it is in that part only the men-midwives can make any figure at all, and that not a superior one to midwives who are regularly bred, and who have, in their favor, their excellence in the manual function besides.
Once more, in complicated cases, the most dreadful mistakes are to be dreaded from those common-men-midwives, who so groundlessly erect themselves into physicians on those occasions. A purge, a venesection, or any other prescription injudiciously ordered, may be the occasion proximate or remote of death to both mother and child; yet a woman, at least, ought not to expect better from one of these practitioners who, for the most part, has neither study nor experience in general physic; nor more than a smattering of anatomy, joined to the index-learning of dispensatories. Such a man-midwife can never have thoroughly made himself master of the course of the fluids, nor of the order of their circulation. Their relation to the solids, and the efficacy of medicines upon both, can hardly be sufficiently known to a man, who must have been too much employed in trying to form a hand never to be formed, and in attendances on the practice of his midwifery, to acquire those collateral requisites for the effectual multiplication of his professions.
Yet this man void of knowledge, experience, observation, and, in consequence, of physical ability, shall boldly decide on the expedience of an internal remedy, of which he does not know the power or operation; of a venesection, of which he can but guess at the consequence; and of a narcotic, of which he is unaware of the danger. In all which, observe, he may possibly sometimes be tolerably right, in cases where there is no complication; that is to say, in cases when a midwife, duly bred, is as sufficient as the best man-practitioner. But then she is moreover not only quicker of apprehension, as to danger, where the case appears complicated, but readier to call in proper help where she discerns it to be above her reach, and consequently above that of the man-midwife, who must be equally or rather more at a loss, because his boasted theory will serve only to puzzle him, or what is worse yet, since a shew must be made of doing something, will most probably determine him improperly, if not fatally, to random prescriptions, in points out of his sphere of knowledge, or rote of practice.
Many a man who to-day undertakes prescribing for a fever, for a fit, a convulsion in a lying-in woman, only because he appears in the character of a man-midwife, would have been ashamed the day before he had taken up that business to give himself out for a physician. He would have been afraid of ordering any thing for her if she was not his patient, as to lying-in, and would not, even after assuming the profession of midwifery, perhaps order any thing for the same woman, out of the time in which his office is supposed necessary. This plainly proves, that many of those gentlemen are weak enough to imagine, that the man-midwife implies the physician, though the greatest physicians that ever were never dreamt of such an absurdity, as that the physician implied the midwife, whose master and instructor he rather is, in points highly useful indeed at times to her profession, but in which that profession does not consist.
I do not however charge all the men-midwives with so much modesty, as to confine their striking out of midwifery into physic, to the women lying-in, or to the time of their lying-in, since there have not been wanting some who, with equal ignorance, but superior effrontery, have intrepidly hoisted, the standard of a general knowledge of physic, and having originally insinuated themselves into families in the character of men-midwives, have easily maintained their ground in them afterwards on the foot of physicians. A circumstance not much to be wondered at, considering the endearment of such an office as that of a man-midwife, and the ascendant it must serve to give them over the heads of families, even in points where a midwife can have no shadow of pretention, for interfering. In the mean time, let any one of sense or common humanity consider but the consequences of this dangerous admission of the sufficiency of a man-midwife in those complicated cases, which require the consultation of a regular physician; to say nothing, for the present, of the other objections already mentioned, or which I shall hereafter more at large discuss, and the result must be, to allow that the medical pretentions, or indeed any pretentions, of these men-practitioners, cannot be too much discouraged, nor confidence more misplaced than in them. For once that they may hit the mark by chance, they will often take the part of the distemper instead of that of the patient; they will do what they have only a gross guess of being the right, not what they know to be so: and physic, at best, but a conjectural science, must in them want even the common grounds of conjecture.
Instead then of the dangerous self-sufficiency of these complex smatterers, you have in a plain midwife, supposing her regularly bred, and duly qualified for her profession (for I am no more an advocate for ignorance in the women than in the men) one, who, being called in time, will duly consider, and observe the constitution of the person that wants her assistence. If nothing appears extraordinary, or out of the common-rules in her patient’s constitution and conformation, she needs only lay down for her the previous course of management, and as the hour of delivery approaches predispose her properly: a point in which the men must be grossly deficient, for want of that skill of prognostic inherent to the women, from their particular delicacy and shrewdness in the faculty of touching; upon which more depends than can be well imagined. Wherever a case occurs to a midwife, so complicated as to be above her reach, her interest, her reputation, her duty, all conspire to prescribe to her a timely application to a regular physician. She communicates her doubts or difficulties to him, who, at the same time that he receives a just information from her of the state of things, combines it with his own knowledge of the human constitution. He does not confound, as the man-midwife does, ideas so different as those of the manual operation, and the medicinal prescription. The object of the physician, being the same as that of the midwife, the prevention or alleviation of pain to the mother, and the greatest safety to the mother and child, but preferentially that of the mother; there is this advantage to both mother and child, that all harshness of practice, all the violenter remedies will be as much corrected as can be done, consistent with the safety of mother and child, by the midwife’s tenderness, by which the physician will at the same time be above the being misled into omissions of any thing absolutely requisite. In short, on such occasions, they serve to temper one another. A truly great physician will not disdain the lights furnished him by her practical experience, and she knows the bounds of her mechanical duty and profession too well, to interfere with his superior intellectual province, in those points submitted to it. A pragmatical man-midwife, on the strength of his miserable half-learning, would think it a derogation from his character, to call in a physician in supplement to his deficiency, of which he is always ashamed, though indeed he has sometimes the excuse of himself not knowing it. Then when a fatal accident has happened, under his hands, against which, with more knowledge he might have guarded, or which with less of presumption or dependence on himself he might have prevented, by procuring previous or collateral advice; he thinks himself abundantly acquitted by laying the blame on occult causes. Even the great man-midwife, Mauriceau himself, has made use of that trite exploded apology[[7]]: where he expressly says, “that a sudden unexpected death of his patient was one of those FATALITIES, that not all the human prudence can prevent.”
But that I may not here incur the least charge of unfairness, as if I meant by this quotation any thing so absurd or unjust, as that in the labors of pregnant women, as well as in other diseases unconnected with them, there may not sometimes happen accidents impossible to be foreseen, as well under the care of the best physician, called in by the very best midwife, as under the most ignorant assuming man-midwife, I shall here introduce another quotation from the same Levret, that will especially shew the ladies, and all parties concerned, to what an imaginary safety, so much, and even the very point sought for, is sacrificed as is sacrificed, in preferring the men-practitioners to the midwives. [[8]] “M. de la Motte says, that for the fifth time he laid the wife of a glover of Valogne, the 16th of March, 1704; that the woman was but an hour in her labor-pains, and that he delivered her with all the facility imaginable; that he left her upon the couch till he had given her some broth, after which he recommended her to the care of the nurse, and went where his business called him. He adds, that he had time but just to bleed two persons in the neighbourhood, before he was fetched away in haste to see the patient he had just laid, whom he found dead upon the bed. The cause of this death was instantly manifest to him from the stream of blood, which ran about the floor, and even penetrated to the apartment beneath, after soaking through the bed itself, in which there remained clots of blood of an extraordinary size.
“This author adds, in the reflexions at the end of this observation, that this delivery had been both more easy and more expeditious than any this woman had precedently had: and he notes, that these melancholic accidents are not without example, since such ladies as the princess of ... and madam la Presidente de —— with numbers of others, have, on the like occasion, undergone the same fate, as her he here treats of. These are, according to him, proofs that all human science and dexterity often cannot prevent the like misfortunes, since these great ladies had been lain by the most celebrated men-midwives.”
Now I might here, without much probability of being contradicted, aver, that where such accidents, said to happen so frequently and inevitably, should happen under the hands of midwives, there would be but one voice among the men-practitioners and their credulous adherents, to impute them to the ignorance and malpractice of the women. The plea of occult causes would be hooted at in them, tho’ receivable, it seems, from the men.
Not however to imitate what I condemn in them, a gross want of candor to the women, of whom, by the by, the very best of the men-practitioners have learnt all the laudable part of practice, I shall allow that among those frequent examples, of sudden deaths upon delivery, some few might perhaps be of those unaccountable surprizes with which nature mocks human ignorance; but then it must be allowed too, that not all of them admit of that favorable solution. The truth is that nature, to those who have studied her course, and watched her motions with a due spirit of practical observation, hardly ever but gives warning enough to prepare proper obviative methods. It is not here the place to enter into the discussion of those deaths by sudden hemorrhage upon delivery, of which I shall hereafter attempt to give a more satisfactory account, as well as of the measures of prevention, than Levret. My end in the preceding quotation is to show;
First, that by the confession of the men-midwives themselves, the most fatal accidents frequently, and inevitably happen under them in spite of all their science and dexterity!
Secondly, to offer to the reader a reflexion for himself to judge of the validity of it, to wit, that, not only in the cases of the hemorrhage, but in many others, where there is a complication of disorders with the state of pregnancy and parturition, much of the safety of mother and child must depend on that general medical knowledge, to which the men-midwives have so little grounds of pretention. Nor indeed, for the symptoms of necessity for resorting to medical help, have they the same shrewd prognostic or acute sense as the experienced women, who much sooner perceive the danger before it is too late, and are neither with-held by a false shame, nor by a criminal or senseless presumption, from calling in proper assistence. Such at least has been and still is their practice in all ages, and in all countries, where the matters of pregnancy and lyings-in are committed to them. The great object of the man-midwife is to impose so false a notion on his patient, as that his partial knowledge is sufficient to every thing. The consequence of which is, that if he is not too officious, too pragmatical, by way of ostentation of his art, in common cases, that is to say, where there is no complication of disorders, every thing may pass off tolerable well, till the crisis of labor-pains. And in that crisis I defy him, with all his learning, to equal the female skill and cleverness, not only for lessening the sufferings of the patient, but for facilitating the happy issue of her burden.
But where there is a complicated case, dependent on the physician’s art, then the trusting to those men-dabblers in midwifery is a folly that may be fatal to both mother and child, or, at the best, the delivery will have been rendered more painful, more laborious, more big with danger, for those precautions having been neglected, which can be so little supposed to occur to the common run of men-midwives in cases foreign from their rote of practice. Yet it is precisely in those disorders collaterally contingent to pregnancy, and no disorder does that state exclude, that the greatest skill and knowledge of physic are required. Then it is, that not only the preservation of the mother claims regard, and certainly the preferable one, but even that of the child is no indifferent point. And to save both, the state of the mothers constitution must be carefully considered. Thus the combination of the disease with the pregnancy, the due regard to the mother as well as that to the child, form a triple object that takes in a compass of comprehension to which no midwife will pretend, nor can be imagined to exist in the mere man-practitioner of midwifery. Such a nicety of observation does not seem to be the province of a manual operator, and indeed useless to him in that character. And as he will be more likely to trust to conjectures, which no sufficient grounds of study will have justified his presuming to trust, he must oftener take the part of the disease than of the patient. It is well if sometimes, disconcerted at the excess of a danger of which he does not understand the origin or nature, he does not, in default of the head, employ the hand, and engage the mother in a premature or forced delivery of the child, to the imminent hazard of the lives of both. Now comes the chirurgical operation in play; and we shall now see, that the ingraftment of the surgeon upon the midwife, deserves equally at least reprobation with that of the physician.
But before I enter on this disquisition, I am to observe, that this objection to the surgeon’s commencing midwife, does not in the least attack the merit of that respectable body of men, the surgeons. No one can honor their profession more than I do: I even readily grant, that their skill in anatomy is of service to midwifery itself, into which it throws a great light. It would be easy for me to name, if requisite, several surgeons, who are not only an honor to their country, from their excellence in an art so beneficial to mankind, but an ornament to society, from their extensive humanity and charity. These, I am so far from thinking, will hold themselves honored by the men-midwives attempting to make a common-cause with them, that I rather depend on their bearing witness on the part of the women in this cause, which is indeed the cause of Nature, of that Nature which they study so practically, consequently so usefully, and with which they are so conversant. I am persuaded they can even furnish me with arguments, from their superior store of knowledge, in supplement to my deficiencies. The surgeons must look on these professors of midwifery as a kind of amphibious beings, hard to define, whose claim exhibits rather the deformity of a preternatural excrescence, or wen growing out of the chirurgical art, than the becomingness of a natural member of it. Most of the first founders of this new sect of instrumentarians in this country were, or I am greatly misinformed, neglected physicians, or surgeons without practice, who in supplement to their respective deficiencies, greedily snatched at the occasion at that time of a prevailing whim in France, of employing men-midwives, with just such a rage of fashion, as some of the ladies there prefer valet-de-chambres to waiting maids. This novelty then appeared to practitioners despairing of business enough in their own way, an excellent scheme for eking out their scanty cloth with this bit of a border, of which by degrees they have made to themselves a whole cloak. In short novelty joined, to the much exagerated objections to perhaps a few insufficient midwives, brought in and established a remedy yet worse than the disease. Their success encouraged others; and now behold swarms of pupils pullulating, and forming on the models before-mentioned. Thus two or three maggots have produced thousands. Iron and steel are not tender: and yet it was by the pretended necessity of resorting to instruments made of these metals, that these out-casts of either profession effectuated their introduction into a business so little made for them. Then it was, that not with the least squinting view to filthy lucre, but purely out of stark love and kindness to the women, that these redressers of wrongs, armed with their crotchets, and other weapons of death, took the field on the hardy adventure of rescuing the fair sex out of the dreadful hands of the ignorant midwives. But as to the validity of that plea of theirs, of the necessity of employing instruments, I reserve to treat of it at large in its place in my second part.
Here I shall only request the reader to remember, what has been said of the indecent, superficial, and even cruel method of training up pupils in this upstart profession. But if I was to add here my having been credibly informed, that there are novices who watch the distresses of poor pregnant women, even in private lodgings, where, under a notion of learning the business, they make those poor wretches, hired for their purpose, undergo the most inhuman vexation, in a condition so fit to inspire compassion, and where those scenes must be rather a school of brutality than of art: if I was to urge, what from the great probability of the thing I firmly believe, that more than one unhappy creature has fallen a victim to the rudiments of these novices; that especially not long ago, one of them in a hurry and confusion of presumption and ignorance, instead of the after-birth from a woman, tore away, by mistake, her womb itself, which occasioned, of all necessity, the poor creature’s dying in unutterable agonies of torture: if I was yet to go farther and assert, that even not one of the least eminent men-midwives pulled off the arms of a child in his attempt to extract it, and very gravely laid them upon the table; what would be replied to me? It would be said I had invented these horrors, or forged such raw-head and bloody-bones stories, purely in favour of my own cause. And to this objection, while I produce no proof, and for my producing no proof other reasons may be obviously assigned, besides that of those cases being non-existent, some of which I am very certain are true, and firmly believe all the rest; to this objection then I say, I make no reply. The reader, who will have considered this matter, may easily decide within himself the degree of probability in such allegations. But what objection will stand good against authorities of reasonings and facts, produced from the writings of the men-midwives themselves? Will they be suspected of partiality or aggravation of things against themselves?
I shall here select one of perhaps the most excusable examples from the circumstances accompanying it, or it would probably not have been produced by the author a man-midwife, to shew, by the confession of the men-midwives themselves, the insufficiency of their discernment, whether a child is dead or not.
“Edge-tools and crotchets naturally inspire horror, and though they ought not to be employed unless on a dead child, it is well known the mother is not always safe from the effect of them. Besides there are no signs of the death of a child, though he should have stuck in the passage for several days ... certain enough to authorize a recourse to a method which infallibly kills it, if it is not dead before. This is so true, that whoever will turn over the authors antient and modern, on this subject, there is not one of them that gives us satisfaction on this point. On the contrary, they all seem agreed on the insufficiency of these signs, and there are even few of them who do not bring examples to support this uncertainty.
“Here follows one taken from the observations of Saviard, p. 367. This author says, that a chirurgical operator, whose name he prudently suppresses, being sent for in aid of a midwife[[9]], to extract a child that had stuck six days in the passage, and which he thought dead, from several of the signs most essential to conviction, it happened however, that having opened with his bistory the teguments and membranes which occupy the as yet unossified space, at the commissure of the parietal bones with the fontanelle, it happened (said he) that on opening this place with his bistory, introducing his crotchet at this opening, and having fixed it in one of the parietals, he drew out the child, who began to cry piercingly, all hurt as he was by so large a wound, that there came out of it more than an egg full of its brains, which made a cruel sight in the eyes of the by-standers, and a very mortifying one for the operator.
“It were to be wished that this was the only example: but I will not relate any more; it is easy to think one cannot be too circumspect in the matter of such relations. Levret, p. 77.”
Now I, who have not the same reason for circumspection in this case, as Monsieur Levret, with strict regard both to matter of fact and to candor, agree with him, in averring, that this is not the only example perhaps, by thousands, of the rash resort to the expedient of opening the head, and extracting the child with the crotchet; an expedient which, as Dr. Smellie observes, (p. 248.) “produced a GENERAL CLAMOR among the women, who observed, that when recourse was had to the assistance of a man-midwife, either the mother or child, or both were lost.” Now of not filling up the cry of those women, I must own I should be most ashamed. Especially when the good Dr. by way of curing our fears and weak apprehensions, and of shewing the nonsensicalness of them, first very gravely tells you the insufficiency of all hitherto invented instruments, and only modestly concludes, that the forceps of his own ingenious contrivance, is indeed the best, but still imperfect. His homage to truth would however not have been so imperfect as it is if he had said that instruments may be totally left out of good practice, and that no “artificial hands”, as he calls them, can, in any case, constitute a worthy supplement to the natural ones; no not even to his own, supposing iron and steel to be ever so little less tender than his fingers. [[10]] But why do these gentry then so much insist on the absolute necessity there is of sometimes having recourse to instruments?——Why? The motive for that insistence is so transparent, that not to see through it would indeed be blindness. It is the capital, and perhaps the only plea that has the least shadow of plausibility for the men to intrude themselves into the women’s business of midwifery. The women do not pretend to the art of handling those instruments, and would be very sorry to pretend to it. Nor do those midwives, who are sufficiently skilled in their art, ever need the supplemental aid of them: whatever is done with them is as well, and infinitely more safely done without them: so that the only grounds of introducing men into that female practice is essentially false. The making then the surgeons art a pandar to a sordid interest, by the incorporation of midwifery with it, is, in fact, engrafting on a noble stock, a scion of another one, both which would bear very well separate, but, thus joined, can produce nothing but a vile poisonous fruit.
If there could be such a thing as laughing in a matter of such general importance to human kind as the fixing of this point, there could hardly be any refraining from it, with regard to the conduct of the men-midwives, especially in Paris. There the novices of them, sensible of the natural defect there must be in men-practitioners, apply for improvement to the regular midwives. There is particularly, among others, one Madam Clavier, who, when I knew her, lived in the Rue de St. André, that gave lessons, at so much a-head, to the men-students of midwifery. Yet these same men have no sooner got a smattering of all that is valuable in the profession, for beyond a practical smattering at most nature refuses them further progress; they, I say, have no sooner acquired a little useful insight from these laudably communicative midwives, but they are the first to swell the cry against them of, “oh these ignorant midwives!”——or “what can be expected from a woman?” And what is more yet, among women it is, that they can make this equally ungrateful and false clamor prevail. And women, in a point of the utmost importance to themselves, prove that the men have, in fact, not quite a wrong idea of their weakness, since they are weak enough to countenance a notion, that so unjustly dishonors them in every sense. But that is not enough. What one should imagine, women especially would consider, is that this notion received with its consequential exclusion of those of their own sex, tends to have their own pains aggravated, and the safety not only of themselves but of their so naturally dear children, yet more endangered.
For the truth of this increase of pain and danger from the practice of the instrumentarians, it is not to any representations from me only, who may be supposed too interested a party, but to reason, and even to reason’s best mistress, Nature herself, that I appeal. I appeal even to the very writings of the most celebrated men-midwives themselves, to which I would refer all who are sincere enough with themselves to be resolved to embrace truth when discovered to them. It is then even in the writings of those men-practitioners, that a lover of truth might find enough to satisfy himself, that all the mighty pretences of the men-midwives to superiority of skill and practice to the women are false and absurd. Look into Deventer, Peu, La Motte, Mauriceau, Levret, Smellie, &c. and you will find that, except their accounts of the innocent manual function, in which midwives must so much excel them; except their pernicious practical part, on which they so tediously insist, by way of recommending each some particular instrument that is to usher him into employment, and increase his profit, in which noble view he takes care to decry the instruments of all others, or at least prefer his own; except the scientific jargon of hard Latin and Greek words, so fit to throw dust in the eyes of the ignorant, and give their work an air of deep learning; except what they have pillaged from regular physicians and surgeons, who have treated upon these matters: except in short all the quacking verboseness of the various histories of their exploits and deliverances of distressed women, and you will find the merit of their whole works shrink to little or nothing, under the appraisement of common sense and true practical knowledge. The most that you will find in them, is, hard or lingering labors, oftenest precipitated fatally to the mother, or at least to the child; they hardly, you may be sure, carrying their candor so far, as always to mention when it has proved so to both; of which however the tenor of their practice with instruments gives you but too much room to presume the probability. In short those cases, of which their works are chiefly patched up, are little better than so many quack-advertisements; and their best exploits therein recounted not a whit preferable; nor indeed so practically just, as what would appear in the common daily practice of a regular well-bred midwife, that should keep a register of her deliveries. There might not indeed appear so much anatomy in her descriptions, but, I am very sure, there would be couched in them much more solid instruction. Not that I therefore have not the highest deference to the true physicians, the true surgeons. But as far as I can presume to judge, it is not in the works of the men-midwives, that the best lights in midwifery are to be looked for. They are themselves for every thing that is worth reading in their writings indebted, both to the physicians and surgeons, whose arts they have despised enough to think, they may be well enough learnt collaterally and subordinately to the mechanical operation of midwifery, as well as obliged to the midwives, to whom they ought at least to go to school, tho’ sure to rail at their ignorance the minute after being taught by them. In short, the most valuable lights thrown into this subject are undoubtedly furnished by those great men Boerhave, Haller, Heister, the great Harvey, and other the like excellent physicians and surgeons, not one of whom however, I presume, in the way of making a trade of it, ever delivered a woman in his life.
Nay! was any accident requiring a chirurgical operation to befall a pregnant woman, I should think the application would be more safely made to a thorough regular-bred surgeon, than to one of the common run of these men-midwives; and the exceptions are so few, they are hardly worth making. The reason too for such a preference is obvious and natural. A regular surgeon probably would not only be more consummately skilful and expert in his general notions, both theoretical and practical, so far as surgery was in the question, but would not, from any thing only partial in his profession, have the same temptation of bringing into play a horrid apparatus of murderous instruments, to show the importance and utility of that anatomical midwifery of theirs, all the art of which consists in the violences it offers to Nature. What would be to be done, the true surgeon could hardly do worse than the pragmatical man-midwife, and most probably would perform it much more artistlike, except perhaps in the sole point of striking a crotchet into the brain-pan of a live-child, or needlessly tearing open, with iron and steel, parts so tender and so delicate, as hardly to bear the touch of even the softest hand, guarded with all precaution. He would not, in short, be so forward to use means destructively dangerous to both mother and child, and at the best often to ruin a woman for being a mother for ever after.
Upon the whole then, if any one will dare give his own understanding fair play, against the powers of prejudice and interested imposition, it cannot but, on a fair examination satisfy him, that that strange anomalous complex creature of the three arts, physic, surgery and midwifery, is most likely to excel in neither. It may by great chance be an indifferent physician; IT must be in this respect a dangerous surgeon, but IT can never be any thing but a despicable midwife; or if that favorite name of accoucheur, IT is so fond of assuming, should not be popular enough from its gallicism, let IT change it for the Latin one of Pudendist: a word of not one jot a more pedantic coinage than Dentist, or Oculist, but of which moreover the propriety of the sound may somewhat atone for the pitiful play of words it contains, and which can yet scarcely be more pitiful than the object of its application.