of some perverse _Form_ of the _PELVIS_, in these Respects; as by its
being either too _Large_, too _Narrow_, or too _Smooth_. But that I may
be the better understood in this Matter: _FIRST_, by a _PELVIS_ too
_large_, I mean such an _One_, as is so in comparison with the WOMB or
INFANT; in which _Condition_, as the Womb can neither be firmly _fix’d_,
compactly _inclos’d_, or duly supported, so neither can the HEAD of the
_Infant_ and the _WATERS_ be exactly depressed upon the _Orifice_: Hence
it often happens, that (besides the MIDWIFE’S careful _Hand_) the
_Privities_ are the best, if not the only _Defence_, against both the
WOMB and the CHILD’S falling out of the Body.
SECONDLY, By a _PELVIS_ too _small_, I mean, _such_ an _One_ as is so,
in Consideration of the SIZE of the whole Body; in which _Condition_,
the _INFANT_ commonly answering to that _Proportion_, its _Head_ can by
no Possibility pass thro’ the _PELVIS_, in a WOMB well seated, without
great _Force_, by which Means the WOMB may be easily turn’d _obliquely_:
And thus consequently the _Smallness_ of the _PELVIS_, may sometimes
prove the _Cause_ of a _Preternatural_, as well as of a _Difficult
BIRTH_; and not only so, but also the _Death_ of both the _MOTHER_ and
_CHILD_ may ensue thereupon, unless timely deliver’d by an _Artful
Hand_.
THIRDLY, By a _PELVIS_ too _smooth_, I mean such an _One_, whose
_Distance_ betwixt the _OSSA PUBIS_ and the prominent Part of the _OS
SACRUM_ is too _narrow_; in which _Condition_, tho’ the WOMB be well
placed, it cannot admit the _Head_ (especially if large and well-grown)
without great _Difficulty_: And this _smooth PELVIS_ may also very
easily turn the WOMB (either way) _obliquely_, and consequently prove of
the same dangerous consequential _Effect_ with the preceeding _Case_.
HENCE (I think) it evidently appears, how necessary it is that all
_MIDWIVES_ should not only know the _Form_ and _Size_ of the _PELVIS_,
but also the _Situation_ and _Connexion_ of its BONES, as already
describ’d at large[167], that _she_ may thereby the better distinguish
the _Circumstances_ by plainly discerning the _Causes_, and judge
accurately of the _Position_ of both the _WOMB_ and the _INFANT_; so
that in the beginning of the LABOUR, she may immediately discover how
the PELVIS and its _Entrance_ is form’d, whether _Large_ or _Narrow_,
_Smooth_ or _Round_.
FOR this Reason, the _first Thing_ that the _MIDWIFE_ ought to do, when
she comes to a _Woman_ in LABOUR, is to try by the TOUCH, how all is
circumstantiated, with respect to these Things; and _This_ is to be done
before the _WOMB_ and the _CHILD_ are fallen down into the PELVIS, that
she may contrive her _Work_ accordingly. Because sometimes the
_Exclusion_ of the _INFANT_, is to be hoped for, from the PAINS only;
sometimes _Nature_ is to be prudently assisted; sometimes there is an
absolute Necessity for _extracting_ the CHILD (without loss of Time) by
an _Artful Hand_, as will hereafter more clearly appear; and sometimes
again the same Necessity obliges us to _protract_ the _BIRTH_, than we
may save _One_ or _Both Lives_: As in the _Case_ of a _smooth_ PELVIS,
the OS PUBIS and the VERTEBRÆ of the SACRUM being but little distant,
the CHILD’s _Head_ is stopped; when if the MOTHER should labour much, or
endeavour to force an expeditious _BIRTH_, its tender _Head_ (of course)
must suffer in proportion; Or perhaps the BRAIN may break, by so hard a
_Pressure_ against the _Bones_; or, finally (which is worse) it may be
so closely squeez’d between the _Bones_, that both the _MOTHER_ and the
_INFANT_ may peradventure die, before any _BIRTH_ can possibly succeed
or come happily into the World.
BUT in this critical _Condition_, the WOMAN is to _labour_ gently, and
bear her _PAINS_ (how violent soever) patiently; the _MIDWIFE_ always
directing the _Head_, at the same time by her safe _Hand_, into the
_larger Space_; by which _Means_ at last, it passes gradually through
that _narrow Passage_ without the least _Danger_.
THE same also is the _Condition_ when the _PELVIS_ is too _small_ or
_narrow_; for by the _Woman_’s labouring gently and deliberately, the
_Head_ is depressed softly into an _oblique Figure_, and passes easily
by Degrees: Whereas, on the other hand, if it is forced by _Violence_,
it becomes _flat_ and _broad_, and consequently incapable of _Passing_,
if not also _dash’d to Pieces_, as aforesaid.
HENCE we clearly see, how easily _Ignorance_ in this Point, may lead
common MIDWIVES into the grossest of _Mistakes_; For what is more
ordinary with them, even in all _Cases_, than to advise the WOMAN to
_strong Labour_, and to force her to _violent Depressions_: Insomuch
that SOME have _Arrogance_ enough to carry their BOTTLES or POWDERS
about them, of which they neither know the _Quality_ nor _Virtue_;
taking them only as they are told (by the confident QUACKS or _Mercenary
Hands_ which vend them) that they may encrease and promote the PAINS of
Labour, and _This_ without having any regard to the _Form_ of the
PELVIS, or the _Position_ of either the _WOMB_, or the _INFANT_.
IN short, the mature _Consideration_ of this very CASE, was not the
least _Motive_ which induced me to the WORK in Hand; since I cannot but
heartily commiserate so many fine delicate WOMEN, as are _thus_ every
day miserably handled, tormented, and exhausted, by the _preposterous
Management_ of such indiscreet and imprudent _MIDWIVES_. I may well say
_exhausted_, or _worn-out_; _This_ being too evident, from the vast
Number of most beautiful _Women_, who, by this ill-manag’d _Condition_,
(notwithstanding they have all along heretofore, enjoy’d a good State of
_Health_, together with the _Affluence_ of other Worldly _Blessings_)
have been more dejected and broken both in _Complexion_ and
_Constitution_, after _one_ or _two BIRTHS_, than some _others_
(judiciously and expertly _delivered_) have been after _Twenty_: Such is
the great _Difference_ betwixt the unskilful _Hands_ or _Conduct_ of
common MIDWIVES, and those Dextrous TOUCHES or ingenious _Operations_ of
the more judicious _Andro-Boethogynists_. Whence I come in Course to——
[Illustration]
CHAP. IX.
_Of Difficult BIRTHS, proceeding from Causes of the Bones of the
PELVIS._
THE READER may easily conceive, by the way, that _these_ are neither to
be made _bigger_ or _lesser_ by ART; notwithstanding which, by using
them _Skilfully_, and treating them _Judiciously_, many a _Difficult
BIRTH_ may not only be prevented, but also many a LIFE saved, as will
manifestly appear from what follows.
NOW the _Bones_, upon which the Success of the _BIRTH_ chiefly depends,
are the OS COCCYGIS, and the Point of the SACRUM; which sometimes bend
too much _inwards_, and thereby obstruct and render the PASSAGE so
_narrow_, that no _BIRTH_ can possibly succeed. And again, It sometimes
happens, that the _INFANT_ falling down into the _PELVIS_, and
presenting itself _Head foremost_, is oppos’d and stopped there by the
OS COCCYGIS: As it also sometimes falls out, that the _Shoulders_ stick
fast against the _Edge_ of these BONES; or the _Buttocks_ falling down
and offering themselves _first_, may be so fastened or affixed to them,
that they can never be _extracted_.
THESE Misfortunes may proceed from _Either_ of these two different
_Causes_; viz. Either from the _Grossness_ or large _Size_ of these
_Parts_ of the INFANT, or from the _Narrowness_ of the _PELVIS_,
occasion’d by an ill _Position_ of its _Bones_, particularly of the OS
COCCYGIS; which _Bone_ when the _Head_ cannot make it yield or move,
neither can it then possibly reach the _Orifice_ of the WOMB, to dilate
it sufficiently: And, in short, if the _Head_ cannot effect this
_essential Point_, much less can the _Buttocks_, or any other _Part_ be
supposed capable of doing it.
BUT in all the above-mentioned _Cases_, I am sensible, that most
_MIDWIVES_ (not knowing better) ascribe the whole _Difficulty_ to the
_Orifice_ of the WOMB and the VAGINA; upon which they ignorantly fall
atearing and dilating both the _One_ and the _Other_, (never minding the
_Point_ of the SACRUM); and finding _these Orifices_ but little
_open’d_, notwithstanding the frequent _Repetition_ of very severe
_PAINS_, they imagine that their substantial _Hardness_ or _Thickness_
is the only CAUSE: So that therefore (without regarding any _adjacent
Part_) they go on violently dilacerating sometimes the _Mouth_ of the
WOMB, and sometimes _That_ of the _PRIVITIES_, (as I have found it by
Experience) quite to the RECTUM. For such is their _Stupidity_ in this
Condition of LIFE (as _Daventer_ well observes) that whilst they _thus_
tear and rend the WOMAN to _Pieces_ in a manner, they allow her to sit
over and above with the _Point_ of the OS SACRUM, upon her _Seat_ or
_Bed_; or in some other wrong _Posture_, which so presses and confines
the OS COCCYGIS at the same Time, that neither of _these_ can move: Not
minding at all that the chief _Pressures_ and _Impulses_ of the HEAD,
must first bear upon the OS COCCYGIS in order to remove it, before it
can effect the _Dilatation_ of the _Orifice_ or _Mouth_ of the WOMB.
Thus they spend the WOMAN’s _Strength_ in vain, break her _Spirits_, and
ruin her _Constitution_ thro’ Ignorance; whilst a capable _Person_,
administring seasonable and judicious _Help_, according to the
Circumstances of the _Case_, refreshes _Nature_, renews _Strength_,
gives _Courage_, and fills the (otherways languishing and despairing)
_WOMAN_, with _Hopes_ and _Assurances_ of a happy _DELIVERY_.
IN short, the True _Method_ of _Delivering_ and helping the WOMAN
conveniently, in the different _Conditions_ contain’d in this _Chapter_,
depends entirely upon _repelling_ or thrusting back the _Point_ of the
OS SACRUM, together with the OS COCCYGIS. I say (therefore) the whole
_Point_ of the OS SACRUM, and that _Fleshy Part_ lying about it, is to
be _thrust back_ and _dilated_, so that the _Passage_ may be
sufficiently opened for the INFANT to pass through; which patent
_Dilatation_ is to be promoted by _pressing_ also _back_ the OS
COCCYGIS. Now these Things, in short, may be all done cautiously without
creating any intense _Pain_, or the least Damage; and _thus_ the
obstructed _Passage_ being clear’d and open’d, the BIRTH advances
regularly of Course, and the _CHILD_ is born with the greatest _Ease_,
in the Space of a few Minutes: Whereas otherways (without the Use of
these _Means_) both its _Own_ and the MOTHER’s _Destiny_ may be
precarious or uncertain after some _Days_ LABOUR.
THUS it is certain, that by assisting a _Woman_ in LABOUR seasonably and
skilfully, her _PAINS_ are happily excited and encreased; whereas, on
the contrary, by _imprudent Treatment_ they unhappily cease and vanish,
to her great Prejudice. Moreover, daily _Experience_ teaches us, that
the very _different_ TOUCHING of Things, occasions different
_Sensations_; and from thence it is, that the _dextrous MIDWIFE_ knows
by _one_ way of TOUCHING, how to promote the _PAINS_ of _Labour_; and by
_another_, how to retard or put them off according as the Necessity of
the _Case_ requires; which hereafter will appear more at large.
BUT that we may more particularly satisfy such _MIDWIVES_, of our
_Method_ of repressing these BONES, and _Delivering_ the _WOMAN_ in the
abovesaid _Cases_; I must add, that, after placing the _PATIENT_ in the
most convenient _Posture_ for a _WOMAN_ in _Labour_, as before fully
enjoin’d[168], I would direct _Her_ to be _supported_ by two Women, and
mov’d so far off the BED or COUCH, that the _Point_ of the OS SACRUM may
be free to yield or give way _backwards_, without any the least
_Impediment_: Then I would pass my whole _Hand_ at once (being first
well anointed or dipp’d in _Oil_) into the _VAGINA_, and from thence (if
the _Head_ will admit it) into the _WOMB_, as occasion should require:
where, upon opening my _Hand broad_, that it may press equally every
where, I turn the _PALM upwards_, and the _BACK downwards_ against the
_RECTUM_, and the _OS SACRUM_: Thus I extend my _Fingers_ as far as
possible to the _Head_, thrusting it a little _backwards_, rather than
hinder my _Hand_ from being firmly placed against the OS COCCYGIS: Upon
my _Hand_ being thus properly placed, as soon as the _PAIN_ begins to
threaten (which I commonly perceive before the _WOMAN_) I advise her, to
make good Use of the approaching _Pains_, in order to _Labour_ mutually,
and depress with all her Power, promising her my most faithful
_Assistance_: By which Time, as soon as the PAINS have seiz’d her, and
she doing her _Part_, I press my HAND _backwards_, first _softly_, and
by degrees more _strongly_, against the _Point_ of the SACRUM, bringing
it at the same time gradually _downwards_, that I may thereby make Room
for the _Head_ sliding the same way; so that the more _severe_ the
_PAINS_ are, the more I depress still, and the _harder_ I press down
with _Effectual PAIN_, the more vigorously and successfully the _WOMAN_
is able to _Labour_.
THUS I enlarge the _Passage_ with great Moderation, so that the INFANT’s
_Head_ succeeds or follows my _Hand_, as I bring it by little and little
_back_ again; and this adviseable _Method_ I would reiterate as often as
the _Case_ should require, always encouraging my _WOMAN_, by the most
obliging Words: Upon which _She_ suffering no _PAIN_ in vain, finds
immediate _Relief_, recovers her _Strength_, recollects her _Spirits_,
and by jointly _labouring_ her _Best_ with all her Force and Might, at
last produces her CHILD with Comfort and Satisfaction, whilst I
congratulate her upon the Success of being a _joyful MOTHER_.
BUT supposing by the way, that the _INFANT_ offers its _Buttocks_ first,
they being neither so _round_ nor _hard_ as the _HEAD_, I would then
intrude all my _Fingers_ into the WOMB more easily; some of which (or
sometimes _All_) I would pass into the _Orifice_ of the WOMB under the
_Buttocks_ as before into the _VAGINA_. Now my _HAND_ being placed
there, I intently observe the _PAINS_ as they come on; then inviting the
_Woman_ to _Labour_, I gradually press _backwards_ as hard as I can
conveniently, drawing my _HAND downwards_ as before: But if in
attracting it so, the _HAND_ should slide too much out of the WOMB,
(which however I endeavour to prevent) while the _PAINS_ are yet upon
her; then as soon as they are over, I pass it up again, that I may be
ready against their _Return_. And _this_ I would reiterate upon every
_PAIN_, so that the CHILD (guided by my _HAND_) may slide down at every
Turn, until at last the _Passage_ is so dilated, that it may advance
gradually with _ease_ into the World.
BY these judicious _Means_; forcing back the _OS COCCYGIS_ by the
_Pressure_ of the _HAND_, as the _PAINS_ come on, I may not only dilate
the _Passage_, and enlarge the _Orifice_ of the WOMB; but also upon
retracting the _HAND_ by degrees, I can gradually attract the _CHILD_
out of the WOMB, through the _Narrowness_ of the _PELVIS_: And thus, by
this curious ART, (which I take to be one of the chief _Points_
belonging to MIDWIFERY) I do fairly _deliver_ the WOMAN, who by no other
_Means_ whatsoever, could be preserved, together with her _INFANT_, in
all Probability.
HOWEVER, tho’ I have candidly laid down this _Method_, (conformable to
the Doctrine of the most excellent and ingenious _Instructers_) yet I
would not advise every coarse _Clumsy HAND_ to undertake it, nor _such_
as are not thoroughly acquainted with the _Parts_ of Generation: For
this _Performance_ requires _Judgment_ and _Prudence_, as well as ART
and _Experience_. But however yet in _Case_ of _Necessity_, where no
_Extraordinary Person’s Assistance_ can be had, as it often happens in
the _Country_, the _Ordinary MIDWIFE_ ought not to neglect her _Duty_:
nevertheless, before she offers to attempt this piece of extraordinary
_Skill_, she ought to be very certain that these _BONES_ are the great
_Impediment_ and _Difficulty_ of the Delivery.
[Illustration]
CHAP. X.
_Of Difficult BIRTHS, proceeding from Causes of the BLADDER and RECTUM_.
DIFFICULTY in _BIRTH_ may also proceed from the _BLADDER_, as (in like
manner) it may from the _RECTUM_ or _Strait Gut_.
I. FROM the _BLADDER_, when affected with _Tumours_, _Ulcers_, or
_Glands_, obstructing the _Passages_; which however is more frequently
occasioned by _Stones_ lodged in the _BLADDER_, or in its _Neck_: In
either of which _Conditions_, the MIDWIFE, by dilating the _Passage_
with a subtile _HAND_, must repel the _OS COCCYGIS_ according to ART (as
taught in the preceeding _Chapter_) that the _HEAD_ in falling down, may
the less offend the _BLADDER_.
II. THE same _Difficulty_ may arise from the _RECTUM_, when it happens
in the same _Manner_, to be affected with such obdurated _Glands_,
_Tumours_, &c. for the _Consequence_ is the same in shutting up the
_Passages_: In which _Case_ the _MIDWIFE_ is to depress gently such
_Excrescences_, of what kind soever, with her cautious _HAND_, and
consequently to dilate the _Passages_ by degrees (how much soever
obstructed) for receiving the _Head_ of the _INFANT_; always having a
respect to the _affected Parts_, and bearing no harder upon them than
Necessity requires.
MOREOVER sometimes it happens, that the only _Difficulty_ in _LABOUR_
proceeds from _hardened Excrements_ in this _Gut_, which may as
effectually stop or shut up the _Passage_, as any thing else, until duly
voided and evacuated by _one_ or _more_ proper _CLYSTERS_, as Occasion
directs.
BUT sometimes it also happens, that such _Difficulties_ arise from the
falling out of the _Fundament_ by the strong and violent _THROWS_ that
the _Woman_ Suffers in LABOUR: In which _Condition_, if the _CHILD_ is
very forward in the _Passage_, before it _happens_, it may be prevented
by dissuading or hindering the WOMAN from _Labouring_ so vehemently; but
if it happen’d before that time, it must be left so until the _BIRTH_ be
accomplished; after which time, it is to be put up exactly, and reduced
to its proper _Place_, in the same manner as the WOMB might be (in Case
of its _Prolapse_, as mentioned in the following _Chapter_) after duly
_fomenting_ and _bathing_ it with proper _Applicatives_: advertising
always to use no _CLYSTERS_, in time of CHILD-BED; because such Means
would readily excite it again to a slippery _Relapse_.
[Illustration]
[Illustration]
CHAP. XI.
_Of Difficult BIRTHS proceeding from the Causes of the VAGINA._
DIFFICULTY likewise in _LABOUR_ may also arise from the _VAGINA_, or
_Neck_ of the WOMB; this _Part_ being no less liable to the Affection of
_Tumours_, _Glands_, _Ulcers_, &c. than any _Other_ before-mentioned: In
_Either_ of which _Cases_, my above-mentioned _Method_ in the foregoing
_Chapter_, shall suffice for the _MIDWIFE_’s _Instruction_; as also in
_Case_ of an _Inflation_ or _Inflammation_ of the _Pudendum_.
BUT sometimes also this _Difficulty_ happens from the falling down of
the _VAGINA_; which _Accident_ may as well precede as follow after the
BIRTH, and _that_ by the _Orifice_ of the WOMB pressing _hard_ into that
of the _Privities_: So that sometimes, when the _MEMBRANE_ is _broke_,
the _Head_ of the _INFANT_, as well as the _Orifice_ of the WOMB, slides
down so far, as to hang out of the _Body_; whereby the stressed
_Ligaments_ (being too much relaxed) give way to the falling down not
only of the _VAGINA_, but also of the WOMB it self.
IN this sad _Condition_ the WOMAN must keep her BED, and her _Body_
equally situated, that either the fallen _VAGINA_ or _WOMB_, may recover
and be immediately restored to its _proper Place_; which being done,
other Matters may be easily prevented by the _Care_ and Diligence of the
prudent _MIDWIFE_, stopping and restraining the _Orifice_ of the WOMB
before it comes so far to that Extremity: Wherefore _she_ ought to keep
it up in the _VAGINA_ (as much as possible) with her HANDS, until the
WOMAN has happily extruded both the _CHILD_ and the _AFTER-BIRTH_.
UPON This afterwards, _she_ is to use her best Endeavours, to restore
both the WOMB and _VAGINA_ to their due _Situation_; laying the
_Wrinkles Smooth_ in their proper _Order_, not one upon another, then
placing the WOMAN conveniently in BED, with her _Head_ and _Shoulders_
declining, _Exsiccant_ or _drying MEDICINES_ are to be judiciously
applied, and _Strengthening_ or _Astringent Fomentations_ often used;
whereby (in good Time) _both_ may be again confirmed in their proper
Natural _Places_.
NOW having thus, in fine, candidly explained the _Different Causes_ of
all _Difficult BIRTHS_, and carefully laid down the _genuine Methods_ of
correcting and removing them, and consequently of _Delivering_ the good
WOMAN successfully in all such nice _Cases_, it remains now in Course
that I proceed to——
[Illustration]
CHAP. XII.
_Of Preternatural BIRTHS._
SUCH _BIRTHS_, (properly speaking) are only _Preternatural_, which
degenerate from the _Natural_, in respect either to the _Situation_ of
the INFANT, or the WOMB, or of _both_ these jointly: Such (I say) may be
well call’d _Preternatural_, because of the imminent Danger that (in
these _Conditions_) threatens both the MOTHER and the CHILD.
HENCE we find the Difference between _This_ and the _Natural BIRTH_; in
as much as the _One_ depends entirely upon ART, and the _Other_ merely
upon NATURE: In _That_ the _INFANT_ is artificially extracted by the
_Hand_, but in _this_ it is naturally extruded by the _PAINS_.
_HIPPOCRATES_ gives[169] us a _Two-fold-Cause_ or Reason of a
_Preternatural BIRTH_; to wit, the _Amplitude_ of the WOMB, and the
_inordinate Motion_ of the Woman about the Time of _LABOUR_: Who,
because of her afflicting _PAINS_ and great _Ailments_, keeps her Body
in a restless and unsteady _Posture_, throwing herself sometimes _here_,
and sometimes _there_, sometimes on _One side_, and sometimes on
_Another_ through Uneasiness. By which means it cannot be otherways, but
that the _INFANT_ may be easily turn’d into some _Preternatural
Situation_.
AND to _These Causes_, _Senertus_, _Rodericus à Castro_, &c. add the
_Two_ following; namely, the _Solidity_ of the _MEMBRANES_, and the
_Debility_ of the _Head_ of the _CHILD_: Because (as they well observe)
when _This_ is not strong enough to break through _Those_, the _INFANT_
endeavouring it otherways, (with _Feet_ or _Hands_) may readily fall
into some _Preternatural Position_.
BUT because I find, that _Preternatural BIRTHS_ deviate in different
Degrees, and vary in many respects from the _Natural_, and _that_ also
according to a great Variety of _CAUSES_ (no ways known to those most
_Learned Authors_) but only of late discovered; I shall now again reduce
the different _Species_ of _Preternatural BIRTHS_ to four _Classes_;
namely, _Preternatural BIRTHS_ on Part of the _INFANT_, on Part of the
WOMB, on Part of _Both_ those jointly, and lastly on Part of some
_intervening Accidents_.
IN treating of which, I shall according to my best Judgment, _state_
these respective _HEADS_ in due Order, and assign each its proper
_Branches_; which I shall particularly discuss in brief _Terms_, for the
Facility and Benefit of the _Candid READER_, whether _MAN_ or
_Woman-Midwife_; That they may (by this plain and easy Method) be
enabled the more readily to judge of, and distinguish the several
Circumstances, and consequently the better discharge their Duties (upon
Occasion) to the Comfort and Satisfaction of those _PATIENTS_ concerned,
and the Honour of their own ingenious _Profession_.