NOTWITHSTANDING the numerous productions of writers on the art of
succoring women in labor, all that has hitherto appeared on that
subject, still leaves the mind unsatisfied; not that it is so unjust as
to expect perfection in any human art, but from its feeling that, in
this particular one, too much is given to theory, and too little to the
practical part, or manual function.
WHILE the causes of difficult labors are far from solidly or
sufficiently explained, and rather obscured by a cloud of scientific
jargon, than practically illustrated, they give us no tolerably sure
method for preventing or remedying those difficulties. On the contrary,
the whole boasted improvement of the art is reduced, to a pernicious
recourse to instruments, which cut at once the knot they cannot unty.
IT is then no wonder that there should still, in all the books and
observations hitherto given on this matter, exist a void lamentably
unfilled; and as this void evidently consists less in the theory than
the practice, the superior qualifications, and natural endowments of the
women for the manual operation, point out the fitness of the greater
dependence on them for the filling up what, humanly speaking, can be
filled up of that void.
LET the physicians, the surgeons instruct the midwives in so much of
anatomy as is necessary to their function; let them afford them, either
in writing or verbally, their guidance and direction in the consequences
or occasionally in the preliminaries of management of the lying-in; all
this is right, salutary, and in due course: but that men should pretend
to the manual operation in these cases, it certainly neither is nor can
be their business. Nor is this negation of propriety a reproach to them.
Will any man think it an indignity to be told, he cannot clear-starch,
hem a ruffle, or make a bed as handily as a woman? The exceptions are
the shame; and in this department of art it would be truer to say, that
there are no exceptions than that there are only a few.
BUT can we wonder at the insufficiency of the lights thrown into the art
of midwifery by that cloud of writers who have treated of it, when so
few of them having had any other view than advertising themselves, and
being incapable of saying any thing to the purpose, of the art of
delivering the women, have filled up their books with insignificant
digressions, or things intirely foreign from the point?
IN some you see all distempers of women collateral to their pregnancy,
which is certainly a very necessary and an infinitely extensive subject,
while on the practical article of the deliverance they give you nothing
but what is barren, jejune, or even false. Others, by way of filling up,
run digressively into a discussion of the methods of treating infants.
Others again have written only to recommend some pretended secrets, as
powders, preparations, &c. Some have swelled their volumes with the more
or less commodious structure of a couch, or the mechanism of a
close-stool, or the make of different sorts of syringes for anodine
injections. In others you meet with remedies for the deformities of the
human body, for the contractions or stiffnesses of the muscles of the
shoulders, arms, hands, legs, feet, thighs, haunches, &c. to straiten
the crooked, and even, in a treatise on midwifery, to extirpate a
polypus from the nose. Others, with all the parade of justly exclaiming
against nostrum-mongers, the plausible writing against which serves at
once to fill up, and give them an air of superiority to such trumpery,
substitute however nothing better of their own than the recommendation
of some instrument, which they give you for a master-piece of invention;
and to establish which, they cry down every instrument of other
practitioners, though not one jot inferior to it in any thing, but the
not being the newest. Thus, after having perused such a multiplicity of
authors, it is incredible to say how little true, or practically useful
knowledge is to be picked out of the whole mass of them. You find almost
every thing in them but what you are looking for.
IN the mean time, the superficial examiner of things, who sees such a
number of volumes, furnished by these pretenders to the art of
midwifery, cannot conceive they contain matter so little essential as
they do. The scientific air diffused over them, not a little embellished
with pretty prints of machines, as of a windowed forceps, a stool, or of
a gravid uterus, all these contribute to throw the dust of erudition
into the eyes of those, who do not penetrate beyond the surface of
things. And thus the aids and appendages of the art, or what is yet
worse, even the abuses of it, pass for the art itself, the main of
which, as it undoubtedly consists in the expertness or dexterity of the
manual practice, can be so little and so imperfectly conveyed by
description. I am however far from denying the benefit which may result
to midwives, from consulting all that has been written on this subject.
I am far from encouraging ignorance in the women of this profession.
Their skill in the manual function cannot but be improved by the
addition of a sound and competent theory. But it should always be
remembered, that the very basis or capital point of the art is the
manual dexterity; and in that point, the most learned of the men must
yield to the most ignorant of the women. A point which the men
surpassing the women in every thing else can never compensate: no not
with all those dreadful “artificial hands”, of which they boast so much
their invention, in the room of the infinitely preferably _natural_
ones, of which the use, in this office, becomes the men as little, as
their hands seem formed for it; and I might add, their heads, if they
themselves can possibly think otherwise. In such an opinion the
ignorance is theirs.
AS to the treatise herein offered on the art of midwifery, as the object
of it is principally to attack particular abuses and dangerous
innovations in it, it will not be expected that the same should furnish
a compleat general course of practice. But this I dare aver that if I
should be induced to attempt such a work, it will not be the worse for
my consulting more the experience I have of Nature in her operations in
this one of her so capital concerns, than the authorities of men, who
seem or pretend to know so little of her, as to think of assisting her
with instruments, formed only for her destruction, or at least for doing
her more damage by their violence, than any reason to hope good from
them can justify.
HERE I shall not offer any digressions on physic, anatomy, chemistry, or
pharmacy; I shall confine myself entirely to the points of my business
of the manual operation. Let the physician prescribe, the surgeon bleed,
the chymist contribute medicines, the apothecary make them up; with none
of these professions do I presume to interfere. But as to the
man-midwife, who not only so often presumes in some measure to represent
them all, but to join to them the exercise of an art so unnatural to his
sex, I should think myself wanting to my duty in my profession, if I did
not point out the mischief I apprehend to result from especially that
method of practice, on which he grounds the pretence of necessity for
his practising it at all; and this chiefly forms the object of this
second part, in supplement to my first.
Of DELIVERIES.
WE understand, by deliveries, in general, the issue of the fœtus out of
the mother’s womb.
THESE are distinguished into two kinds, the one natural, the other
preternatural.
THE natural one, is that in which the fœtus comes out in the most
ordinary way, when it presents the head foremost.
IT is deemed preternatural, when the fœtus presents in the passage any
other part than the head.
THESE two kinds are again subdivided into two distinctions of labor, of
easy or difficult, because both the natural and preternatural mode of
delivery may be easy or difficult.
THE delivery is termed easy when the fœtus comes out readily, and
without the aid of art.
IT is termed difficult, when the labor of it is hard, and the fœtus does
not make its way out but with pain, and with the help and assistent
industry of the midwife.
IN the cases of a natural and easy delivery, there is little or no
actual occasion for the presence of the midwife, beyond that of
receiving the fœtus, tying the navel-string, giving the child to be kept
warm, and then delivering the mother of the after-birth. The spirits of
the patient are then to be recomposed, her agitation calmed, a warm and
soft linnen cloth applied to the stomach; a warm shift and bed-gown put
on her; a linnen cloth to be laid on four-fold over the belly; a
double-napkin round her, and she to be placed in a bed well warmed. Such
is the summary of the process to be observed in those common cases.
IN the deliveries, on a preternatural labor, when they are easy, the
same method takes place: there being no difference, but that in one the
child will have been received by the head, in the other by the feet.
THESE kinds of labors are so easy, that there is no need of
demonstrating their being to be terminated without the aid of
instruments. When the fœtus presents itself promisingly, Nature is best
left to her own action, and nothing should be precipitated in the manual
function, unless some unexpected accident should intervene, and require
interposition, such as a great flooding, or other exigency.
AS to the preternatural delivery, the better practice is not to delay
the extraction of the fœtus, after the discharge of the waters; nor stay
till her strength shall have been exhausted. On the presenting of a fair
hold, and a sufficient overture, no difficulty should be made of
extracting.
ALL that is to be observed then, is not to prematurate this extraction:
not to proceed, in short, like those unskilful, or inconsiderate
practitioners, who are no sooner entered the patient’s room, but they
want to have their operation dispatched out of hand. Nothing can be more
important to the well-doing of the patient, than for no violence to be
used to Nature, who loves to go her own full time, without disturbance
or molestation. In this point then great caution and circumspection are
requisite.
IT should also be observed, that it is wrong for the midwife to leave a
woman newly lain-in, however happily delivered. It is necessary to stay
by her for some hours afterwards, till she is in such a state of
tranquility and ease, as may leave nothing to fear of those
after-disasters which too often happen.
SOME celebrated practitioners and authors upon midwifery have been
surprized to see women, after their going their time without
mis-adventure, and after having been readily and happily brought to bed
die suddenly. There are too many of both the female and the men-midwives
who have no notion of this misfortune till it is too late to prevent it.
The cause of this melancholic accident is unknown to many practitioners
of the art. Some have confessed their ignorance of it: others have
erroneously, others deficiently accounted for it. But all are surprized
when the patient is the victim of it: especially as it follows, in some
cases that afford the best grounded hopes.
MESSIEURS MAURICEAU and De la Motte give us examples of these unexpected
deaths. The first, in his 230th observation, says,
“I DELIVERED a woman of a very corpulent habit, aged about thirty-five
years, of her first child, which was a lusty girl, alive, and that came
naturally. This woman had been near two days in labor, with small slow
pains or throws, after which the waters having burst forth with a strong
throw, she had subsequently favorable ones, which made her bring forth
as happily as one could wish. I immediately delivered her: but to my
great surprize, scarce had she been a quarter of an hour after delivery,
that she of a sudden fell into violent faintings, with an oppression at
the breast, and a great agitation of the whole body, which was instantly
followed by a convulsion, caused by a loss of blood, of which she died a
quarter of an hour afterwards.
“THIS (adds Mr. Mauriceau) was one of those kind of fatalities which no
human prudence can elude or parry.”
LA MOTTE had the same case happened under his hands, which I need not
repeat here, being inserted in the first part of this work, where, p.
131, I ventured to promise an essay of mine, to give a less
unsatisfactory reason of such deaths, than what is to be found even in
those two celebrated authors whom our cotemporaries consider as their
masters in the art of midwifery. These impute those unforeseen deaths to
occult and inevitable _causes_. I own, I do not intirely think them
either occult or inevitable. I doubtless may be mistaken, but of this I
am sure, I shall advance nothing but what is authenticated to me by my
own observation and experience.
AN over-repletion of blood, and a defect in the contraction of the
uterus, of which all the vessel being open are too slow in recovering
their occlusion, are generally speaking, the causes of these diseases. I
could support this opinion by some chirurgical axioms, but I presume it
will be thought more satisfactorily proved by the success of the method
of practice, which I would recommend to prevent or cure those dangerous
or rather fatal causes.
AS to know that a woman may thus perish unexpectedly a quarter of an
hour after delivery, is enough to require the being on one’s guard for
using a salutary prevention; I would advise attention, especially to her
constitution.
WHENEVER therefore a pregnant woman is observed to be remarkably
corpulent, and full of blood, with a good constitution, she should be
advised to lose some blood, once or twice during her pregnancy, by way
of precaution. This is of great service to rarefy the blood, and obviate
those excessive hemorrhages, which are to be dreaded on their lying-in.
Then nothing is to be precipitated during their labors, that Nature may
have full time to predispose the uterus to enter into contraction by due
degrees, that is to say, neither too quick, not too slow. But if,
notwithstanding these precautions, there should, after delivery,
supervene any considerable loss of blood, followed with faintings or
oppressions, the patient must be stirred, excited to cough and sneeze
contributively to the evacuation of the blood, which otherwise is apt to
clot in the uterus, and would suffocate her if not expelled.
IF by this mean the evacuation does not naturally take place, which may
be perceived by the faintings of the patient, the midwife must, without
losing time, put her hand into the bowel, and extract all the clots of
blood she will not fail of finding there, and of which the presence, as
being extraneous matter, necessarily oppose the contraction of this
organ, and quickly suffocates the woman, if she is not timely relieved.
THESE hemorrhages are but too frequent, especially with those women who
neglect the precautionary bleeding; and such sudden death too commonly
the consequence of neglecting, or of not knowing that the most salutary
practice, in these cases, is to well evacuate the uterus by the
operation of the hand, where Nature appears in the least tardy or
deficient.
THE long experience I have of this manual help, which has never failed
of success with me, warrants my averring, that there is little or no
danger, in these cases, to women, provided the midwife employs herself
dextrously to clear them while time serves. Their relief is
instantaneous. They come to themselves presently: they are restored to a
freedom of respiration: nor will they have so much as been sensible of
this operation of the hand, which will nevertheless have saved their
lives.
THERE have been men-midwives, that pass even for learned, but who from
their ignorance of this so simple and easy method of relief, have been
in the disagreeable circumstance of seeing many women perish under their
hands, though they had to all appearance been very happily delivered.
WITH respect to pregnant women, there is again another point of great
consequence to ascertain. Great care must be taken not to mistake the
signs of delivery. This is a very essential matter. Nothing scarce can
be more dangerous, than to excite a woman to the last labor-pains, which
will not fail of exhausting that strength of her’s, in vain, which had
so much better be reserved for the support of her in the time she will
really need it. So that a midwife ought to make it her business clearly
to distinguish the spurious pains from the true ones. Where a woman near
her time feels pains in the belly, the loins, or even the sexual parts;
they are not always to be taken for the true labor-pains. In this point,
the _touching_ will be a great guidance.
IF the fœtus is still high in the uterus, and the situation of it does
not indicate a readiness for extrusion; if the waters are not
sufficiently prepared, or their pressure down not in due forwardness,
the pains must be assuaged by some calming anodine remedies: the patient
must be left to her rest, till things declare themselves more openly;
and then, as she will not have been fruitlessly fatigued and tormented,
the labor may proceed happily.
THERE have been men-practitioners so very unskilful, or at a loss for
delivering women by the operation of their _hands_, that they tortured
their _heads_ to discover _medicines_ to save themselves the tediousness
of Nature’s taking her own time, as if she was to do her work the better
for their hurrying her. Towards the atchievement of this end, they
brought into play certain drugs, to which they gave the appellation of
hysteric, and placed or pretended to place great confidence in them.
EVEN some of our modern practitioners prove, at least, by their
practice, that they have faith in the virtue of such drugs, since they
continue to use them. They are still suffered to make a figure in many
of the Pharmacopœas, though no sure experience hitherto has verified
their efficacy. On the contrary, a thousand and a thousand examples
might be quoted in demonstration of their insufficiency and danger. I
shall content myself with producing here the testimony of Mr. De la
Motte, in the second book of his observations, and he is not the only
man-midwife that does such medicines the justice of disapproving them.
_Observation_ 174.
“A CELEBRATED man-midwife of this town (says Mr. de la Motte) pretended
to have a marvellous powder to provoke labor-pains, and accelerate
parturition. This powder was composed of galbanum, myrrh, savin, rue,
and other drugs, of which he made the patient take a dose, to hasten a
delivery, when the labor was lingering, from half a drachm to a drachm,
and after the effect of this medicine, which ended commonly in leaving
the patient in a worse condition than before the taking it, he
substituted the use of the crotchet, which was indeed an infallible
method of putting a speedy end to the labor; and of which he as well as
his fellow-practitioners made such a murderous use, the aid of the hand
well conducted being unknown to them.
“THE same operator (says Mr. de la Motte) was sent for to assist a lady
who had continued in labour for three days, to whom he proposed a dose
of his powders, to which she readily consented in the hopes of a speedy
delivery. Unluckily, not most certainly for the lady, but for the honor
of the powders, the operator, not having had the providence of having
them about him, was forced to go home for them. The lady, in the mean
while, was brought very happily to bed, just as he was re-entering the
room with his dose for her. What a pity this was! What would not have
been the boast of the virtue of those pretious powders, if the delivery
had waited for them but half a quarter of an hour, though they would not
have had the least share in it, since it would have been purely the work
of Nature and Time.
“THIS celebrated man-midwife was called to two other women of my
acquaintance, of whom the labor somewhat resembled that of this lady,
but of which the consequences were very different: he had made them take
his powders to no manner of purpose, when seeing that a day had passed
without their producing the expected effect, he had recourse to his
_crotchet_, with which he quickly _dispatched_ both the deliveries.”
_Observation_ 174, of the same Mr. De la Motte.
“A GENTLEMAN who lived upon his fortune, without professing surgery,
though he had served his time to it, and had even formerly exercised it,
not only in France, but in Italy, and in other foreign countries, told
me, in conversation, that he had an infallible remedy to make a woman
bring forth instantaneously, however lingering and difficult her labor
might naturally be. Of this, he said, he had made undoubted experiments,
and that he had obtained this secret from an Italian, under oath of not
disclosing it to any one. He was more than a little surprized at finding
me without curiosity to learn from him this pretended secret, which he
imagined must concern me so much, as one who made open prefession of the
obstetrical art; and still greater was his surprize at seeing me change
the subject, without any sign of attention to what he had been saying on
this head.”
“IN process of time, he married, and his wife being pregnant was got
into the time of her labor-pains towards delivery. It became now
expedient for him to declare this famous secret to me, which was no
other than half a drachm of borax in a glass of any innocent liquid
agreeable to the palate of the patient. But as this dose happened to be
administered by one who had no sort of faith in it, it had no effect:
his wife lay four days and four nights in labor; the child died the
moment after it was born, and the mother narrowly escaped following it.”
_Observation_ 176, (of M. De la Motte)
“AS I was at Caën, a town of Normandy, attending the lying-in of a lady
there, an old stander of a practitioner of that place, and a man of good
abilities, told me, that he had been lately sent for to a woman who had
continued several days in labor, with slow and moderate pains. As he
found the fœtus well situated, he made the patient take an infusion of
three drachms of sena in the juice of a Seville orange, in order to
quicken the throws and advance the delivery, which indeed came on ten or
twelve hours afterwards, but the woman died, one may say, immediately
after it.
“TO this account (continues M. De la Motte) I opposed, for answer, that
being at Bayeux, on the like occasion, an old practitioner in surgery of
that place, in conjunction with whom I had been called to visit a
patient, told me, in conversation, that he understood midwifery very
well, that he had even, not long before terminated a delivery given over
by another surgeon; that the child, one arm of which hung out, was dead,
before he put his hand to it, and that the mother, though well
delivered, died soon after.”
THESE examples may suffice to prove, that the notion of giving histeric
medicines, for which the inventors did not forget to make themselves be
well paid, existed in M. De la Motte’s time, who is not but a modern
author: nor are they even to this hour absolutely exploded, tho’ some of
the men-midwives themselves have joined Mr. de la Motte’s cry against
them. It gives however those men-practitioners, who exclaim against a
quackery in others, by which themselves get nothing, a good sort of an
air: it serves even to render that more pernicious quackery of their
instruments the less obnoxious to suspicion. Nothing is easier to give
up than that by which nothing is got. If the instruments were not a plea
for the very essence of such a thing as a man-midwife, they too would be
given up. However, it will hardly be denied, that those same pompous
histeric medicines were the invention of _learned_ men-practitioners,
and not of those poor ignorant midwives, who, with respect to women in
labor, are of opinion, that there can nothing be more effectual for
their well-doing, than in the first place giving Nature fair-play, and,
when requisite, to assist her with the management of _natural_ hands
skilfully conducted: always observing neither to lapse nor precipitate
the critical time of such assistence. In the mean time, let a humane
reader but reflect how many mothers and children must have been, and
perhaps still continue to be the victims of a reliance in such
medicines, and he will allow, that such errors of practice, tho’ not
capital in the intention, are too often deplorably so in the effect. Is
it not true to say, considering the havock of the human species, so
presumably made by quackery and empiricism in general, that the lives of
the subject are less sacred than their property? Surely they are less
guarded, either by the laws, or by common sense.
AS to a fœtus that presents an arm, or any other part than the head or
feet, there is rarely any thing to do but to slide the hand all along
that arm, or other part it may present, to find out the feet, and
terminate the delivery; without its being necessary to attempt the
reduction of any part or member.
MOST of the writers on midwifery often start difficulties where there
are really none. They often give us emphatical accounts of a head too
large, and a passage too narrow, in which they state them as
difficulties that are invincible, when the case is far from being so.
When the fœtus presents fair, and is in a good posture, our method of
practice is, to advise the patient to remain as quiet a-bed as possible,
avoiding every thing that may tend to fatigue her body, or hurry her
spirits, to reserve in short her strength as much as possible. With time
and patience the head of the fœtus scarcely ever fails of moulding
itself to the passage, through a particular providence of Nature, which
has so ordered it, that the parietal bones of the head of the fœtus, so
flexile as to ride over one another, form a kind of oval figure, which
facilitates the issue, and dispose it for making way for itself, through
the extrusive pressure of the labor-throws. Mean while nothing should be
done to irritate the pains; the membranes should not be unnecessarily or
untimely burst, which loses the benefit of the waters. You can hardly,
in this case, rely too much on the benevolent efforts of Nature: she is
constantly at work for the patient’s delivery. Interruptions sometimes
only serve to mar or retard a favorable crisis: but all abrupt force or
violence is carefully to be avoided. As to bad postures of children, I
shall treat of them in the sequel, and of the means to remedy them.
Of DIFFICULT and SEVERE Cases.
IF an easy delivery requires nothing of extraordinary assistence; it is
not so with a difficult one. All the knowledge, experience, dexterity,
strength, prudence, tenderness, charity, and presence of mind, of which
a woman is capable, are requisite to accomplish certain laborious
deliveries.
IT has been, in all times, very well known, that the most natural
situation for the fœtus coming into the world, is that, in which the
head presents first, it being that which commonly makes way for the rest
of the body. Yet this delivery may become difficult, in proportion to
the obstacles incident to it: obstacles not always surmountable, without
great skill and industry employed in aid of Nature.
ON the other hand, when it is felt that the fœtus presents any other
part than the head, this position, called preternatural, oftenest
occasions the delivery to be more laborious and hard to accomplish, in
proportion to the more or less trouble there may be to search and come
rightly at the feet.
MANY English and French authors have given us a long enumeration of the
causes which may make deliveries difficult and laborious. The curious
may have recourse to them; as for me, who have not proposed to myself
here a treatise compleat on all points, I shall content myself with
setting forth only what tends to fullfil my proposed aim, that is to
say, to take notice of those principal points, which first moved
insufficient midwives to call in surgery to their assistence, to remedy
their blunders, to retrieve their mischief, or to repair their
omissions. I shall consider the kinds of exigencies, which the
men-operators seized for a pretext of employing their iron and
steel-instruments, the use of the natural hand, being yet more unknown
to them than to the meanest midwife, and by this means, for the cure of
confessedly a great evil, obtruded an infinitely greater one, and more
extensive, in every sense, and in every point of light, that of men
taking the practical part of midwifery into their own hands, or rather
into their artificial ones of iron and steel, from which they derive all
the authority of their introduction in the character of men-midwives.
THE labors then which are generally speaking looked on the most nice,
and arduous, may be comprized under the following heads.
1st. THE obliquity of the uterus or womb.
2dly. THE extraction of the head of the fœtus severed from the body, and
which shall have remained in the uterus.
3dly. THAT labor in which the head of the fœtus remains hitched in the
passage, the body being intirely come out of the uterus.
4thly. WHEN the head of the fœtus presents itself foremost, but sticks
in the passage.
TO these I shall add the case of the pendulous belly, which is not
without its difficulty.
OF all these classes of labors I shall treat separately. But before I
proceed on them, I presume, that it may not be improper preliminarily to
corroborate what I have said of the intrusion of the men into the
practice of a profession, of the essential part of which they were so
ignorant and disqualified for it, by the testimony which one of the best
men-midwives in Europe has not refused to the truth.
THIS is M. de la Motte, one of the ablest and most intelligent modern
writers on the subject of midwifery, of which his works form an
incontestable proof. The ingenuity and candor with which he has written,
must render him less suspected than any other. This is no midwife. He is
a man, and esteemed an able practitioner, who learned the principles of
the art from Madam la Marche, head-midwife of the Hôtel Dieu at Paris.
He made his advantage of the works of his predecessors Mauriceau, Peu,
and of all the best authors on this subject. All that was worth it in
them he has transfused into his own writings; and that in a very clear
manner. He collected whatever the best physicians had usefully said on
the diseases of mother and child: in short, he has added many good
observations and reflexions of his own, in the journals of his manual
practice: the reading of his works, with some precaution however, cannot
but be useful to the students of the art.
I DO this writer this justice, with the more readiness and pleasure,
for, that though he himself exercised the profession of man-midwife, and
consequently in favor of his own practice, and of the pupils he was
bringing up, was not without the injustice of adopting the prejudices of
his cotemporaries too indiscriminately against the midwives; he does not
suppress any truth relative to the art itself. But even, as to the
midwives, the truth escapes him without any design on his side of its
coming out. But such is the force of truth. And thus it appears. M. De
la Motte wrote in a little sorry country-town at a great distance from
the capital, being at the very extremity of the kingdom of France, on a
sea-coast, where there were no other midwives than poor country-women,
without knowledge, without skill, or any other qualification, than a
little of the habit of attending women in labor. Yet with all these
deficiencies it will appear, that the men-practitioners were far more to
be dreaded than those poor ignorant creatures, who had scarce any thing
but Nature for their guide.
I SHALL here give the substance of what he says in his preface, followed
by some examples of the unskilfulness, or rather of the most profound
ignorance of the most able men-midwives of his time, for forty leagues
round his place of residence in the country.
“IT is (says M. De la Motte) astonishing, that the obstetrical art
should, until the beginning of the preceding age, have been left either
to ignorant women, or to surgeons, who had not (any more than too many
to this day) any other resource in difficult labors, than some
instrument guided by undextrous hands, always sure of killing the child,
and endangering the mother. Do not these poor innocents deserve
compassion for being exposed to operations of surgery, which one would
rationally think they could not need, till providence should have at
least given them leave to come into the world?”
HERE be it observed, that by the word “ignorant,” M. De la Motte should
not intend the application of it to the midwives of the Hôtel Dieu at
Paris, since, by his own confession, it is the best school of midwifery
in Europe. Nor certainly is he in the wrong. Be it in honor of truth
allowed me to say, that I know of those women who have served their
apprenticeship in this hospital, who would think they made a wretched
bargain, if they exchanged the manner of operating they learned there,
for all the Latin, Greek, Arabic, or the iron and steel instruments of
the best man-practitioner in Europe; even though his excellence in the
manual function should be thrown into the scale for make-weight. The
most constant success justifies their practice. In whatever situation
the fœtus has presented, I have seen them, without having recourse to a
man-midwife, and consequently to instruments, procure a happy delivery
in very difficult labors. I have myself seen one deliver a child that
had been dead in the mothers womb for near six weeks, without
dismembering it; and though it was half-putrified, and the head so
rotten-tender as to have no solid consistence, I dare advance this,
without fear of being falsified, since I can name the mother, now alive
in London, the witnesses, the place and year.
SUCH real midwives as I am here discribing, for I do not mean the
spurious nominal ones, only fit to _create_ work for the
instrumentarians, or whose cue of interest is to do so, have no reason
to apprehend, that in the numbers they have lain, there can be any
found, that can complain of having suffered, or of suffering any the
least damage or inconvenience, after their lying-in, that might be
imputed to ignorance or mispractice.
ON the contrary, I dare aver, that such, genuine midwives have cured
many women who had received notable injury, before they came under their
hands, in their having passed through those of the men-practitioners.
Nothing being more agreeable to Nature, to Reason, to Experience, than
that the method of practice of a skilful midwife is not only the most
easy and gentle, the least painful, but assuredly the most safe both for
mother and child. This is what the most severe examination will to
those, who give themselves the trouble of making it, establish, in
contempt of that fashion, by which so pernicious an error, as that of
preferring men-practitioners, has acquired more credit and influence
than so salutary and demonstrable a truth, as that for which I am
contending. In the mean time, let us hear what M. De la Motte himself, a
man-midwife, says of those brethren of his, of whom heaven grant there
may not exist to this day too many resemblers!
“TO the shame (says M. de la Motte) of the profession they exercise,
they have no guide but their avarice, while the grossest ignorance of
the art of midwifery itself is their lot. Such are much to be dreaded by
women in difficult labor; for (adds he) they having no help to offer
them but that of their instruments, they employ them indifferently in
all the situations in which the fœtus presents. Nay, even the hands of
some who will use their hands, are not less dangerous when misconducted.
The ignorant therefore should never meddle with lyings-in. It would save
them from the reproach they may incur of murder, in undertaking what
they cannot execute, and what surpasses their skill. They would not
furnish _scenes_ that make one _shudder_ with _horror_.
“I SPEAK here of so many poor women, whose strength shall have been
exhaust—by a great loss of blood, caused by the violences which an
ignorant man-midwife shall have made them suffer, I speak of women,
whose parts shall have been all bruised, and so vilely treated and torn,
as in some to lay the anus and vagina into one, besides their children
being dismembered, some their arms or legs plucked off, others the whole
body, the head being left behind in the uterus.”
THIS is the language of a man-midwife himself, who candidly declaims
against the errors of his fellow-practitioners, undoubtedly without
designing that such their errors should be wrested into an objection to
the practice of that art being committed to the men. Such a conclusion
would in me be unfair, and a vain attempt to impose on the reader the
laudable condemnation of an abuse, for an indiscriminate reproach to the
whole set of men-midwives. This would however be but a kind of
retaliative treatment of those, who, from the defective practice of the
ignorant and unskilful midwives, of which if there was no more than one
in the world, that one would be much too many, take the unjust handle of
inveighing against midwives in general.
EVEN la Motte himself, who, as I have before with pleasure observed, was
really as capable a man in the profession of midwifery as a man can be,
at least to judge of him by his writings, has embraced every occasion of
boasting the superiority of the men to the women in the exercise of
midwifery. But while he taxes men of _scenes_ that make one _shudder_
with _horror_, the mistakes he imputes to the women, which are bad
enough in all conscience, are not however of that atrocious nature, as
those he relates of the men. Nay, with all his desire of under-rating
the women, he falls into even pitiful contradictions. Let the reader
himself decide on the following one.
UPON an article of practice, for which M. De la Motte blames the
midwives, and what an article? not such as he reproaches to the
men-practitioners, murdering, maiming the women, or tearing their
children limb from limb, but purely for their applying certain bandages
to the belly of women after their lying-in, in order to keep that part
smooth from wrinkles; this very author, I say, who allowed the Hôtel
Dieu at Paris, where the manual function is wholly confined to women, to
be the best school of midwifery in Europe, where he himself wished, and
wished in vain, to be admitted to practise, and, in short, from the
head-midwife, of which Madam de la Marche he himself probably learned
all that was worth any thing in his practice, thus speaks of the
midwives bred up in that hospital.
“THIS prerogative of having served apprentice in the Hôtel Dieu at
Paris, is not for these women, an _indifferent_ matter, for though they
were to have no more than a _shadow_ of _sense_, they are persuaded,
that in setting themselves off with a _title_ that does not render them
more _capable_, they ought to be honored and respected above all others,
which they would not fail of being, if they were to give some marks of
sufficiency beyond what others can give.[28]”
THE nonsense of this objection of Mr. De la Motte is too glaring to need
a comment. If an education in the best school of midwifery in Europe,
does not give a woman a right to plead it for a title to reliance on her
superior sufficiency, without any reason therefore to accuse her of
vanity, what can give her a title?
BUT to return to M. De la Motte’s sentiments on the practice of the
men-midwives; it will easily be seen, that the horrors he objects to
their practice, and of which he himself undoubtedly endeavoured to steer
as clear as he could, were of a nature, without the least breach of
candor, to suppose liable to repetitions wherever so false a doctrine
and practice prevail as the substituting steel and iron-instruments, or
“artificial hands” to natural ones.
LET us now see what Mr. De la Motte thinks of the use of the CROTCHET.
“WHEN I settled in my province (says this author[29]) I found several
ancient master-surgeons, who pretended to help the women in their
difficult, or preternatural labors, solely with the use of the crotchet;
without ever, in their life having made any _delivery_, but in that
manner, and as soon as they had extracted the fœtus with their crotchet,
they left the rest or the after-birth to be brought away by a woman, as
they themselves knew nothing of the matter. When they were fetched to
help a woman in labor, they took their crotchet, went to the woman, whom
they put into posture, and whether the child presented the head, breech,
arm or leg, whether it was dead or alive, a woman’s having passed a day
and a half in labor was cue more than enough for them to go to work with
their crotchet.”
THE following extracts from the same Mr. De la Motte, may serve to
confirm the foregoing observation.
“OBSERVATION 187. I was sent for to lay Madam de ... about fifteen
leagues from Valognes, the place of my residence, and there was at the
same time a surgeon of the town where I then was, who had been fetched
to lay a woman that had been in labor from the day before, whose child
presented the vertex: he, without further examination, put her into a
convenient posture, and with his crotchet brought away the child at
several pulls, with much pain and labor, and threw it under the bed,
with the after-birth, in the most severe season of the year: after
which, the operator hugged himself prodigiously, for having so happily
accomplished so difficult a labor. Having rested a little, and just as
he was going, a woman curious, bethought herself of seeing whether it
was a boy or girl: she found the poor child yet alive, though so mangled
with the crotchet, and that after having remained, in this condition, an
hour and a half, without its having been in the power of so violent an
operation, or of the rigor of the weather to terminate a life which
seemed to have held out against so many barbarities, only to reproach
the detestable operator with the enormity of his crime. The child was
christened and died soon after.
“REFLEXION. This is what may be called a cruel ignorance, &c.”——To the
which I add, that if this wretched operator had had the patience to wait
some time, the child would in all probability have come naturally with
any the least help of the hand at every throw of the mother: for she had
not been over-time in labor, and the head was not, it seems, stuck in
the passage.
“OBSERVATION 196, p. 274. I was desired to go to Cherbourg to lay a poor
woman there, whom a surgeon and a man-midwife by profession, belonging
to that place, had given over.... I found the woman in a condition hard
to describe, with an arm and a leg of her child pulled off, and the
remainder of the body left behind in the mother’s womb. I put her into
posture, and instantly delivered her of one child (it seems she went
with twins) who had only an arm plucked off: I then sought out the
other, whose leg had been torn away. Strange and fatal sight, which was
seen by more than twenty women present, all ready to swear to the truth
of this! I left the woman to their care, after having delivered her of
the after-birth. She had been as much hurt as the children, of whom
nothing remained in the uterus, by the care I took to evacuate it. I
left the mother tolerably well considering her condition.”
REFLEXION. This was the more surprizing, for that the first operator was
an old practitioner, who had been an out-surgeon to the Hôtel Dieu above
eight years, before M. De la Motte was apprentice there. Yet this man
neither was sensible of the being twins in the case, nor had dexterity
enough in the manual function. Here I ask, could the most ignorant
midwife have acquitted herself worse than this _man_?
“OBSERVATION 185. A tradesman’s wife of Valognes being taken in labor
sent for a midwife. A little while after her coming, the membranes
burst, the waters were discharged, and the child presented an arm. The
midwife required help. (Probably she might be one of the ignorant and
unskilful ones) and two surgeons were sent for, who passed for being the
most expert ones in the town. They begun with plucking off the arm that
presented, though the child was _alive_. The other arm, as soon as they
got hold of it, underwent the same fate. After which they struck the
crotchet into a rib, which they brought away, then two, then three, and,
at length, struck the crotchet into the back-bone, and pulled so
cleverly together, that they brought the child away doubled up. The
midwife delivered her of the after-birth, and notwithstanding all this
ill usage, the woman recovered; but it was a long while first.”
REFLEXION. (Mr. De la Motte’s own) “Was there ever a crueller operation
seen both for the mother and child; the first terribly torn, the other
barbarously dismembered?”
“OBSERVATION 186. The wife of a tallow-chandler of this town was taken
in labor: the waters were discharged, after which an arm of the child
presented. Help was sent for; one of the two operators (mentioned in the
foregoing observation) came with his servant and crotchet. He began his
operation, by plucking off the arm of this certainly live child, then,
without further examination, he strikes the crotchet into its body, and
pulled, without being able to bring away any thing. The master, whose
strength was exhausted, made his pupil help him, and they both pulled as
hard as they could: still nothing came, and I verily believe that the
master would have called in some body else to his assistence, if the
handle of the crotchet had been long enough, or that the poor woman had
not given up the ghost under the cruel torments they made her suffer, to
such a degree that they forced her to part with her life, sooner than
with her child.
“REFLEXION. Here was a _delivery_ in intention, but the execution had
something horrid, and perfectly odious in it. I never could have
imagined, that two men could have pulled in this manner, without
dislocating the bones of the woman into whom the crotchet had been
struck: for so it was shown to be, upon the body being opened, in which
the child was found with an arm plucked off, entangled in the umbilical
chord round its neck, without the least mark of the crotchet upon its
body: too plain a proof this of the crotchet having been struck into the
mother and not the child, and consequently of the little circumspection,
not to say rage, with which the surgeon had acted upon the body of this
unhappy creature: for surely it must be granted, that it could be no
part of the child that could have resisted the terrible efforts made
both by master and man, jointly to bring it away; and yet this was one
of the BEST[30] operators in the country for HELPING women in labor.
“I COULD make a VOLUME of these histories, if they were good for any
thing but to excite horror.” Such is the witness born by M. De la Motte,
as to the _ablest_ men-midwives of his time, in all his province. Now in
order to invalidate the conclusion, so natural to be drawn from so
unexceptionable an attestation, against the superiority of the practice
of the men to that of the women, will it be said, that the
men-practitioners, in this country, are in general better educated than
such operators as have been above shown? If so great a falsity should be
advanced, let the reader himself reflect on what he may easily find to
be the common method of training up of men-pupils in this art. I have in
the first part of this work, stated some reasons for their
insufficiency, both in study and practice; and the more this point is
examined, the more clear will that undoubted truth appear, that if the
ignorant midwives are, as they undoubted are, a great evil, they are
even blessings in comparison to the generality of the men-practitioners,
bred up with the help of artificial Dolls, pretty prints, or even of
their personal visitation of those miserable wretches hired, or under
the mask of charity, forced to undergo, from apprentices or pupils, so
many inhuman tortures and outrages in vain.
IT will also perhaps be said, as to the examples I have just produced
from M. De la Motte, that since his time, that is to say, about the
beginning of this century, that the art of midwifery has received so
much improvement, as to cancel all impressions of fear from such
examples. Yes! It has received improvement with a vengeance. If a vain
endeavour to perfect instruments, impossible to be perfected, or against
common sense to suppose, even when perfected superior to skilful hands,
are an improvement, then the art may be called improved. In the mean
time, infinite is the mischief done by so many pretending operators,
with each his bag of hard-ware at hand, his only proof of superiority to
a woman, in practice, confiding in those instruments. Their negative
damage is almost as great as their actual one. For by occasioning the
men, and even ignorant midwives to trust to the calling in their help,
the methods of predisposing of the women to parturition, the proper
precautions, and actual manual function in the labor-pains, which is a
point of the utmost importance, are at best but slightly and
prefunctorily, consequently not sufficiently, performed, or perhaps
wholly neglected. And why? because the instruments, the _crotchet_, the
_tire-tête_, the _forceps_, are considered as sure reserves to remedy
such deficiencies. This, besides many other reasons, encourages the
indolence, carelessness, and inattention of the men-practitioners, and
even of the midwives, especially of those poor suborned creatures
recommended by the men-practitioners, paid, as one may say in some
sense, not to do their work so well, as that none should be left for
their honorable patrons. Thence it has happened, that where an ignorant
midwife has, through her unskilfulness, or for whatever other reason,
been wanting in predisposing the passage, or lapsed the critical moments
of the manual aid, so that she really is or pretends to be out of her
depth, by the exigence being beyond her ability; the man-midwife is
called in, who, with his instruments, forces that delivery, which might,
if justice had been done to the patient, have proceeded in a natural
way, with much less pain and danger. Be this remarked, without my
speaking here of the extraordinary tortures and outrages, such as M. De
la Motte himself has related. The woman then is, by the help of
instruments, delivered by the man-midwife so called in. “If he had but
staid a few minutes longer, both mother and child must have been lost”.
So believes the father of the child, so believes the mother, so believe
most of the parties concerned, and what is more, sometimes so believes
the man-midwife himself. Though the strict truth has been, that the
greatest part of the pain the mother endured, and every appearance of
danger, either to her or to her child, were positively owing to nothing
but the negligence and mispractice used, either by man or
woman-practitioner, in reliance, if matters should come to the worst, on
the supplemental aid or reparation of errors, by those miserable
instruments, which constitute all the boasted improvements of an art,
the true nicety and requisite accuracy of which they are so much more
calculated to banish or destroy.