It is then in those cases where nature is slow, as she sometimes is, in her operation, and often so, for the greater good of the patient, so conformed perhaps, that a quicker expulsion would only destroy her, that the midwife, not only uses all patience consistent with safety of life to the mother especially, but inculcates patience to her suffering charge. Whereas the men, from their natural impatience, or from whatever other motives their precipitation may arise, having those infernal iron and steel instruments at hand, are but too often tempted to make use of them, not only without necessity, but against all the indications of nature, pleading for a just indulgence to her of her own time in her own work. In vain then do too many of them declaim as loudly as can be wished, or as the thing deserves, against all recourse to instruments, but in extremities which, they pretend, justify them. In the first place, those extremities are often the fault of deficient and unskilful practice. The precious moments of the assistence due to nature have been lapsed, or there has been some failure of preliminary treatment; or what is worse yet, extremities are rashly taken for granted when they are not existing.
Here, in the history of one single woman, I give the history probably of thousands.
A healthy woman, about twenty five years of age, and remarkably robust, was in labor of her second child. Her first had come in that natural smooth way, as had given the same man-midwife, who was now to lay her again, not the least trouble, as often happens. In this second labor, however, the head of the child stuck in the passage; and was so far advanced, that the Doctor told her, whether in jest or earnest I cannot say, that he could discern the color of its hair. Her pain, though extremely great, had not however hindered her observing the Doctor rummaging for his instruments; her frightful apprehension, of which, she had all the reason to imagine, did not a little contribute to retard her throws. She taxed him with his intention to use them, and he did not deny it. Upon this she used the most moving fervorous entreaties for a respite of execution; but all in vain; he told her, with a resolute tone, that he knew surely better what was for her good than she did, that he had even already waited longer than he could justify; and that her life was absolutely desperate if the child was not instantly extracted, of the which being dead, he was sure from many incontestable symptoms. Her thorough confidence in a man, whom she had often heard declaim vehemently against the use of instruments unless in extremities, and which she understood in the most literal sense, without considering, or perhaps knowing that, on too many occasions, nothing is so different as words and actions; her thorough confidence in him, I say, joined to a natural love of life, and to her present feelings of exquisite pain, determined her to an acquiescence. The fatal instrument was struck into the brain-pan of the child, who at the instant gave the lie to the first part of the Doctor’s asseveration as to its death, by such a strong kick inwards as had almost killed her, and convinced her not only of its being alive but lively. This did not, you may be sure, add to her belief of the second part of his averment, that waiting any longer for the operation of nature, would infallibly have been her death. It might be so: yet surely there are strong reasons for concluding, that a little more patience might have saved a fine boy, and yet not have destroyed, or even hazarded the destroying the mother, whose life is certainly the preferable object. But how cruel to state the dreadful alternative where it does not exist! And how easy, in the presumption of that alternative, to extort the dreadful consent from a weak woman, yet more weakened by her condition, and naturally determined by her present feelings, to embrace the appearance of an immediate relief, presented to her in the form of salvation of life! However, scenes similar or a-kin to this, may, without breach of charity, be presumed too frequent, especially under those superficial men-midwives, whom the facility of forming, in the manner they are generally formed, renders so suspicious as to their ability, and who for so many reasons, both of nature and interest, are but too liable to the murderous want of that patience, for which the women are but the more remarkable in this case, for their not being perhaps so capable of it in any other. But here their duty is even their nature; as if in so capital a point, she would trust it to nothing but herself.
If it should be here to this objected that the women may, through that very spirit of patience, wait too long, or overstay the time of saving the patients life, for want of calling in proper assistence; I have already implicitly obviated this objection, by remarking before, that a true thorough midwife, from her quickness of apprehension, and knowledge of the danger, will ever be readier to call in the assistence and advice of a physician, than the common men-midwives, who are ever in proportion to their ignorance the more rash, the more fearless, and consequently averse to calling in that help, of which they will be ashamed to confess their want, and thus cruelly, though with impunity, lose the opportunity of others endeavouring at least to repair those damages, of which themselves are oftenest the authors. Now a midwife has no such shame; she pretends to no extraordinary skill in physic or surgery; she knows her art, and will not presume to transgress its bounds; she would think herself accountable if she did: and even that very tenderness and sensibility, upon which nature has founded her patience, will make her cautious how she pushes that patience too far. She may easily see, feel and discern those cases in which nature calls the physician in aid to the midwife; nature, who seems to have placed such boundaries between those professions, as nothing but interest, presumption, or ignorance of nature, could ever render their union in one person supposable: tho’ the quality of physician may not indeed exclude that of the surgeon, but rather implies, at least, the theory of surgery. For I presume anatomy is the great basis of true rational physic, though it can very little assist practical midwifery, which depends so much upon purely manual operation, and needs only a sufficient general idea of the structure of the sexual parts in woman, the conceptacle, and passages of the delivery.
This is so true, that any impartial observer of the male and female practitioners in midwifery, will easily distinguish the characteristic difference of the sexes, in their respective manner of operation.
In the men, with all their boasted erudition, you cannot but discern a certain, clumsy untowardly stiffness, an unaffectionate perfunctory air, an ungainly management, that plainly prove it to be an acquisition of art, or rather the rickety production of interest begot upon art.
In women, with all their supposed ignorance, you may observe a certain shrewd vivacity, a grace of ease, a handiness of performance, and especially a kind of unction of the heart, that all evidently demonstrate this talent in them to be a genuine gift of nature, which more than compensates what she is supposed to have refused them, in depth of study, though even of that they are not so unsusceptible, as some men detractingly think; and in midwifery, most certainly they attain all that they need of learning to perfect them, with a facility the greater for nature, having collaterally endowed them with an organization of head, heart and hand, obviously adapting them to this her most capital mystery. This will be denied by none who have any regard for truth, and who do them justice, as to the keenness of their apprehension, as to that simpathizing sensibility which supplies them with the needful fund of patience, and tender attention; and as to that peculiar suppleness of the fingers, as well as slight of hand, in a function which rather exacts a kind of knack or dexterity, than mere strength, of which they have also a competency. Nor can it be quite without weight, that the midwives, besides their personal experience, being sometimes themselves the mothers of children, have a kind of intuitive guide within themselves, the original organ of conception, itself pregnant, in more cases than that, with a strong instinctive influence on the mind and actions of the sex; an influence not the less certainly existing, for its being undefinable and unaccountable, even to the greatest anatomists[[4]].
The men, it will be said, have many or all of these qualifications, except indeed the last. Granted that they have: but how very few are there of the men that possess the most essential ones to a degree comparable to that of the women: or rather not so imperfectly, as that all their boasted skill in literary theory and anatomy, cannot supplement or atone for the deficiency? Nor theory, nor all the books that ever were written on that subject from the divine Hippocrates, who understood so much of physic, and so little of midwifery, down to Dr. Smellie, who is so great a man in both, will ever amount to so much as the practical experience of a regular bred midwife.
As to that superior skill of the men in anatomy which is sounded so high, against the women, I shall not imitate the men in their want of candor towards the female-sex in their availing themselves of false arguments. I will not then take the benefit of the slight opinion which Celsus and Galen had of the depths of anatomy; they who contented themselves with a gross superficial notion of the principal viscera. I will not even desire to countenance that contempt by the example of that great philosopher Mr. Lock, the intimate friend, and even the counsellor of the British Esculapius Sydenham, who paid a great deference to his physical knowledge; and yet this very Mr. Lock wrote an ingenious treatise (though not published by him) upon the insignificance of the refinements of anatomy in the practice of physic. Neither will I here insist on the absurdities into which even the greatest anatomists have fallen; as for example, Pecquet, the famous discoverer of the thoracic duct in the human body, who nevertheless adopted so extravagant a notion, as that digestion of food ought not to be promoted by exercise, but by drinking spirituous liquors, a practice to which himself fell a victim, dying suddenly at the anatomical theatre. It is only for those who have a false cause to defend to shut their eyes against those truths which seem against them. Those on the contrary who defend purely the truth, know that one truth cannot hurt or exclude another truth, and that all truths may very well coexist. It may be true that anatomy, though it does not give the nature of the elementary composition of parts intrinsic and too minute for the human sense, since a new incision only presents a new surface, much conduces however to ground the student in mechanical principles of great assistence to him in practice, of which they are doubtless the most solid foundation: yet that truth is not incompatible with another quite as much a truth, that midwifery can have no occasion but for a general notion of the configuration of those parts upon which it is exercised. A midwife, for example, may be a very safe and a very good one, without knowing whether the uterus is a hollow muscle, or purely a tissue of membranes, arteries and veins: but if that ascertainment is necessary, she must wait for it till the anatomists have settled among them that point, which, like many other capital points of anatomy, is not however yet done. In short, once more, a woman in labor requires a midwife to lay her, not an anatomist to dissect her, or read lectures over the corpse, he will be most likely to make of her, if he depends more on the refinements of anatomy, than on the dexterity of hand, and the suggestions of practical experience and common sense.
If then, there are who can examine things fairly and with a sincere desire of determining according to the preponderance of reason, they cannot but on their own sense of nature, on their own feelings, in short, discern that no ignorance, of which the women are undistinguishingly taxed, can be an argument for the men’s supplanting them in the practice of midwifery, on the strength of that superiority of their learning, so rarely not perfectly superfluous, and often dangerous, if not even destructive both to mother and child. Consult nature, and her but too much despised oracle common sense; consult even the writings of the men-midwives themselves, and the resulting decision will be, that great reason there is to believe, that the operation of the men-practitioners and instrumentarians puts more women and infants to cruel and torturous deaths, in the few countries where they are received, than the ignorance of the midwives in all those countries put together where the men-practitioners are not yet admitted, and where, for the good of mankind, it is to be hoped they never will.