Secondly, That whereas I have confessed the incapacity of some of the midwives, without allowing inferences from them against all the professors of the art who are of the female sex, I ought to make the same equitable allowance as to the men-practitioners, and not condemn all for the sake of those insufficient ones, which the capable ones themselves candidly condemn, witness among others, M. De la Motte.
Now, as to my omitting such a specification of instances of mispractice in my own sex, it is neither from partiality, nor affectation, that this omission of mine proceeds. For could any one be so weak as retaliatively to state cases, in the manner I have done, of mispractice of some midwives; nothing could be more superfluous, nor less to the purpose. My confession, my lamentation, that there are but too many ignorant midwives, palpably obviate the necessity of proving what is granted. The public would be very little the better for a truth, with which it cannot but be too well acquainted, that there are ignorant midwives, and insufficient men-practitioners. The truth then, for which I contend, is, that the faults of the midwives, however it may be wished that they could be prevented, are, comparatively speaking, neither so likely to exist in Nature, nor of that horrid, atrocious kind, that are to be found in the practice of the men-practitioners or instrumentarians. There is nothing among the midwives of the puncturing, tearing with cold pinchers, maiming, mangling, pulling limb from limb, disabling, as must be inseparable in a greater or less degree from the use of those iron and steel-instruments, which are so often and so unnecessarily employed.
As to the second objection, of my not making any distinction of the capable from the incapable men-practitioners. The reason of that is obvious. It results from the fairest comparison of the two sexes, in respect to midwifery, independent of any such examples as have been produced against any particular individuals of that profession in the men. Nature has so favored the midwives, that among them the bad ones are evidently an exception to the general rule, of the fitness of that sex for the art: whereas among men, the bad practitioners are, and must for ever be, the general rule, and the good ones the exception, if so it is, that, in Nature, there can be such an exception: he that makes a practice of using instruments can hardly be one.
Nothing however will more conduce to establish the natural disqualification of the men for this art, than a fair consideration of that capitally essential branch of it, the ART of TOUCHING, in order to ascertain the state of pregnant women, and the difficulties so necessary to be foreknown in order to be lessened or avoided. On due prevention often depends the saving the life of both mother and child; it cannot then be thought a digression, that I transiently give a summary account of this great light or guidance to that prevention, even though this work is nothing of a regular treatise of the art.
Of Touching.
Conducively to a just idea of touching, there should be a just foundation laid of a competent knowledge of the fabric of the sexual parts, of the conformation of the pelvis, and of the bones which constitute it. There requires no depth of anatomy to know, in general, that the pelvis is composed of that part of the back-bone called the os sacrum, terminated at the bottom by the coccyx, of the ilia, and the os pubis. In the cavity formed by the assemblage of these bones is the uterus, suspended between the bladder and the intestinum rectum, by four ligaments called broad and round. The two broad ones are a production of the peritonæum, on the side of the vertebræ, and terminate on each side of the uterus near the fallopian tubes. The round issue on the side of the fundus uteri, immediately under the tubes, and from thence passing through the peritonæum, and crossing the muscles of the hypogastrium, are inserted at the pubis and common membrane or integument of the fore-part of the thighs. I pretend here nothing further, than to give a summary sketch of these parts, a more particularized one being here needless. Suffize it to observe, that no good midwife can be without a proper and distinct conception of their position and conformation, not only for touching, but for operating with success.
Touching, in the terms of art, consists in the introduction of one or two fingers into the vagina, and thereby into the orifice of the uterus of the person, whose state or situation requires to be known. There scarcely needs admonishing on this occasion, a midwife, of the due care of her hands, being properly prepared and guarded from the least danger of hurting. Such a precaution recommends itself.
The touch then is the most nice and essential point of the art of midwifery. Nor to acquire a sufficient degree of accuracy in it, can there be too much pains taken, considering how much depends on it. Midwives only of great practice, or lying-in hospitals, where there is full liberty for the young female practitioners to make observations, can render it familiar to the learner. I presume I may take for granted, that such a practical study is not extremely decent, nor proper for young lads. And yet, at their season of life it is, that this study should be begun, if but to give expertness the necessary time to attain, through habit, its full growth, against the age of exercising the manual function. It must surely be rather too late, for a man to commence his course of touching at the age of practising; as it must be too soon, at a season of life, where his capital end of touching will probably not be the acquisition of the science. At whose expence then must the rudiments of a man’s study of this branch of the art be? surely at that of the unfortunate women, subjected to the annoyance of such nauseous and profitless visitation. In short, this is ONE of the points of the art, from the nature of which it may fairly, and without implication of contradiction, be pronounced, that the greatest anatomist in Europe may nevertheless be a very indifferent, not to say a miserable man-midwife: or even that a very indifferent anatomist may for all that be an excellent manual practitioner.
A midwife, duly qualified by Nature and art, with a shreudness and delicacy of the touch, is, when requisite, capable of giving, in virtue thereof, a just account of a woman’s condition. She is enabled to make faithful reports to the physician, and inform him of the needful concerning the state of his patient, where any co-incidence of pregnancy sollicits his attention. By the same means she can distinguish the true labor-pains from the false ones; and when the term of delivery is at hand, it may, by the touch, be discerned, whether the labor will be easy or hard, whether the fœtus is well or ill situated. With other precognitions, highly necessary for our taking proper measures both obviative and actual.
I say necessary, because it is from this practice of touching that we draw our prognostics, both for the predisposition of the passage, in order to save pain by proper anticipation, and to smooth or facilitate a happy delivery. It is then the touch that serves us for a guide, and certifies to us the situation of the uterus, its rectitude or its obliquity, as well as what part the fœtus presents.