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_-mid_wife_, 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.
OBJECTION the Twelfth.
IT is not probable, that the men-practitioners would have come into the
vogue in which we see them, if numbers of instances were not to be
produced in their favor, of their having terminated happily many labors,
in which they have been preferably employed, and to the exclusion of the
midwives.