IN CASES OF EXTREMITY, WHAT OUGHT TO BE DONE.
The woman being across the bed, let the operator put up his or her hand,
if the neck of the womb be dilated, and remove the contracted blood that
obstructs the passage of the birth; and having by degrees gently made
way, let him tenderly move the infant, his hand being first anointed
with sweet butter or a harmless pomatum. And if the waters be not come
down, then without difficulty may they be let forth; when, if the infant
should attempt to break out with the head foremost or cross, he may
gently turn it to find the feet; which having done, let him draw forth
the one and fasten it to the riband, then put it up again, and by
degrees find the other, bringing them close and even, and let the woman
breathe, urging her to strain, in helping nature to perform the birth,
and that the hold may be surer, wrap a linen cloth about the child’s
thighs observing to bring it into the world with its face downwards.
In case of a flux of blood, if the neck of the womb be open, it must be
considered whether the infant or secundine come first, which the latter
sometimes happening to do, stops the mouth of the womb, and hinders the
birth, endangering both the woman and child; but in this case the
secundine must be removed by a swift turn; and they have by their so
coming down deceived many, who feeling their softness supposed the womb
was not dilated, and thus the woman and child have been lost. The
secundine moved, the child must be sought for, and drawn forth; and in
such a case if the woman or child die, the midwife or surgeon is
blameless, because they did their best.
If it appears upon inquiry that the secundine comes first, let the woman
be delivered with all convenient expedition, because a great flux of
blood will follow.
In drawing forth a dead child, let these directions be carefully
observed by the surgeon, viz. If the child be found dead, its head being
foremost, the delivery will be more difficult; for it is an apparent
sign, by the woman’s strength beginning to fail her that the child being
dead, and wanting its natural force, can be no ways assisting to its
delivery; wherefore the most safe way for the surgeon is to put up his
left hand, sliding it as hollow in the palm as he can into the neck of
the womb, and into the lower part thereof towards the feet, and then
between the head of the infant and the neck of the matrix; then having a
hook in the right hand couch it close, and slip it up above the left
hand, between the head of the child, and the flat of his hand, fixing it
in the bars of the temple towards the eye. For want of a convenient
coming at these in the occiputal bone, observe still to keep the left
hand in its place, and with it gently moving and stirring the head, and
so with the right hand and hook draw the child forward, admonish the
woman to put forth her utmost strength, still drawing when the woman’s
pangs are upon her. The head being drawn out, with all speed he must
slip his hand under the arm-holes of the child, and take it quite out;
giving these things to the woman, viz. a toast of fine wheaten bread in
a quarter of a pint of Ipocras wine.
ARISTOTLE’S WORKS.
THE MIDWIFE.
GUIDE TO CHILD-BEARING WOMEN.
BOOK I.—CHAPTER I.
SECT. I. _Of the Womb._
In this Chapter I am to treat of the womb, which the Latins call matrix.
Its parts are two; the mouth of the womb, and the bottom of it. The
mouth is an orifice at the entrance into it, which may be shut together
like a purse. When a woman is not pregnant, it is a little oblong, and
of substance very thick and close; but when she is pregnant it is
shortened, and its thickness diminisheth proportionably to its
distension: and therefore it is a mistake of anatomists, who affirm that
its substance waxeth thicker a little before a woman’s labour; for any
one’s reason will inform him, that the more distended it is, the thinner
it must be; and the nearer a woman is to the time of her delivery, the
shorter her womb must be extended.
The Author of Nature has placed the womb in the belly, that the heat
might always be maintained by the warmth of the parts surrounding it: it
is therefore seated in the middle of the hypogastrium (or lower part of
the belly,) between the bladder and the rectum (or right gut) by which
also it is defended from any hurt through the hardness of the bones: and
it is placed in the lower part of the belly for the conveniency of a
birth being thrust out at the full time.
It is of a figure almost round, inclining somewhat to an oblong, in part
resembling a pear; for, being broad at the bottom, it gradually
terminates in the point of the orifice, which is narrow.
The length, breadth, and thickness of the womb differ according to the
age and the disposition of the body. For in virgins not ripe it is very
small in all its dimensions; but, in women whose terms flow in great
quantities, it is much larger; and if they have had children, it is
larger in them than in such as have had none; but, in women of a good
stature, and well shaped, it is, (as I have said before), from the entry
of the privy parts to the bottom of the womb, usually about eight
inches; but the length of the body of the womb alone does not exceed
three; the breadth thereof is near about the same, and of the thickness
of the little finger, when the womb is not pregnant; but, when the woman
is pregnant, it becomes of a prodigious greatness, and the nearer she is
to her delivery the more is the womb extended.
It is not without reason, then, that nature (or the God of Nature) has
made the womb of a membranous substance; for thereby it does the easier
conceive, is gradually dilated by the growth of the fœtus, or young one,
and is afterwards contracted and closed again, to thrust forth both it
and the after-burden, and it is to retire to its primitive seat. Hence
also then enabled to expel any obnoxious humours which may sometimes
happen to be contained within it.
Before I have done with the womb, which is the field of generation, and
ought therefore to be the more particularly taken care of, I shall
proceed to a more particular description of its parts, and the uses for
which nature hath designed them.
The womb then is composed of various similar parts, that is, of
membranes, veins, arteries, and nerves. Its membranes are two, and they
compose the principal parts of the body; the outermost of which ariseth
from the peritoneum, or caul, and is very thin; without smooth, and
within equal, that it may the better cleave to the womb, as it is
fleshier and thicker than anything else we meet with in the body when
the woman is not pregnant, and is interwoven with all sorts of fibres
and small strings, that it may the better suffer the extension of the
child and the waters caused during pregnancy, and also that it may the
easier close again after delivery.
The veins and arteries proceed both from the hypogastrics and the
spermatic vessels, of which I shall speak by and by; all these are
inserted and terminated in the proper membrane of the womb. The arteries
supply it with food for nourishment, which, being brought together in
too great a quantity, sweats through the substance of it, and distils as
it were a dew at the bottom of the cavity; from hence do proceed both
the terms in ripe virgins, and the blood which nourisheth the embryo in
enceinte women. The branches which issue from the spermatic vessels are
inserted on each side of the bottom of the womb, and are much less than
those which proceed from the hypogastrics, those being greater, and
bedewing the whole substance of it. There are yet some other small
vessels, which, arising the one from the other, are conducted to the
internal orifice, and by these, those that are pregnant do purge away
the superfluity of the terms, when they happen to have more than is used
in the nourishment of the infant; by which means nature hath taken such
care of the womb, that during its pregnancy it shall not be obliged to
open itself for the passing away those excrementitious humours, which,
should it be forced to do, might often endanger abortion.
As touching the nerves, they proceed from the brain, which furnishes all
the inner parts of the lower belly with them, which is the true reason
it hath so great a sympathy with the stomach, which is likewise very
considerably furnished from the same, part; so that the womb cannot be
afflicted with any pain but the stomach is immediately sensible thereof,
which is the cause of those loathings or frequent vomitings which happen
to it.
But, besides all these parts which compose the womb, it hath yet four
ligaments, whose office is to keep it firm in its place, and prevent its
constant agitation, by the continual motion of the intestines which
surround it; two of which are above, and two below. Those above are
called the broad ligaments, because of their broad and membranous
figure, and are nothing else but the production of the peritoneum, which
growing out of the side of the loins, towards the reins, come to be
inserted in the sides of the bottom of the womb, to hinder the body from
bearing too much on the neck, and so from suffering a precipitation, as
will sometimes happen when the ligaments are too much relaxed; and do
also contain the testicles, and as well safely conduct the different
vessels as the ejaculatories to the womb. The lowermost are called round
ligaments, taking their original from the side of the womb near the
horn, from whence they pass the groin, together with the production of
the peritoneum, which accompanies them through the rings and holes of
the oblique and transverse muscles of the belly, by which they divide
themselves into many little branches, resembling the foot of a goose, of
which are some inserted into the os pubis, and the rest are lost and
confounded with the membranes that cover the upper and interior parts of
the thigh; and it is that which causeth the numbness which pregnant
women feel in their thighs. These two ligaments are long, round, and
nervous, and pretty big in their beginning, near the matrix, hollow in
their rise, and all along to the os pubis, where they are a little
smaller, and become flat, the better to be inserted in the manner
aforesaid. It is by their means the womb is hindered from rising too
high. Now, although the womb is held in its natural situation by these
four ligaments, it has liberty enough to extend itself when pregnant,
because they are very loose, and so easily yield to its distension. But
besides these ligaments, which keep the womb as it were in a poise, yet
it is fastened, for greater security, by its neck, both to the bladder
and rectum, between which it is situated.—Whence it comes to pass, that
if at any time the womb be inflamed, it communicates the inflammation to
the neighbouring parts.
Its use or proper action, in the work of generation, is to receive and
retain the seed, and deduce from its power and action, by its heat for
the generation of the infant; and is therefore absolutely necessary for
the conservation of the species. It also seems by accident to receive
and expel the impurities of the whole body, as when women have abundance
of whites; and to purge away, from time to time, the superfluity of the
blood, as when a woman is not pregnant.
SECT. II.—_Of the Difference between the Ancient and Modern Physicians,
touching the Woman’s contributing Seed to the Formation of the Child._
Our modern anatomists and physicians are of different sentiments from
the ancients touching the woman’s contributing of seed for the formation
of the child, as well as the man; the ancients strongly affirming it,
but our modern authors being generally of another judgment. I will not
make myself a party in this controversy, but set down impartially, yet
briefly, the arguments on each side, and leave the judicious reader to
judge for himself.
Though it is apparent, say the ancients, that the seed of man is the
principal efficient and beginning of action, motion, and generation, yet
that the woman affords seed, and contributes to the procreation of the
child, it is evident from hence, that the woman has seminal vessels,
which had been given her in vain if she wanted seminal excrescence; but
since nature forms nothing in vain, it must be granted they were made
for use of seed and procreation, and fixed in their proper places, to
operate, and contribute virtue and efficiency to the seed.
But against all this, our modern authors affirm, that the ancients are
very erroneous, inasmuch as the testicles in woman do not afford seed,
but are two eggs, like those of fowls and other creatures; neither have
they any such offices as in men, but are indeed an ovarium, or
receptacle for eggs, wherein these eggs are nourished by the sanguinary
vessels dispersed through them; and from thence one or more, as they are
fecundated by the man’s seed, are conveyed into the womb by the
ovaducts. And the truth of this, say they, is so plain, that if you boil
them, the liquor will have the same taste, colour, and consistency, with
the taste of birds’ eggs. And if it be objected, that they have no
shells, the answer is easy; for the eggs of fowls, while they are in the
ovary, nay, after they have fallen into the uterus, have no shell; and
though they have one when they are laid, yet it is no more than a fence
which nature has provided for them against outward injuries, they being
hatched without the body; but those of women being hatched within the
body, have no need of any other fence than the womb to secure them.
They also further say, there are in the generation of the fœtus, or
young ones, two principles, _active_ and _passive_; the _active_ is the
man’s seed elaborated in the testicles, out of the arterial blood and
animal spirit; the _passive_ principle is the ovum, or egg, impregnated
by the man’s seed: for to say that women have true seed, say they, is
erroneous. But the manner of conception is this: the most spirituous
part of man’s seed, reaching up to the ovarium or testicles of the woman
(which contains divers eggs, sometimes more, sometimes fewer),
impregnates one of them; which being conveyed by the ovaducts to the
bottom of the womb, presently begins to swell bigger and bigger, and
drinks in the moisture that is plentifully sent thither, after the same
manner that the seeds in the ground suck in the fertile moisture
thereof, to make them sprout.
Having thus laid the foundation of this work. I will now proceed to
speak of conception, and of those things that are necessary to be
observed by women from the time of their conception to the time of their
delivery.
CHAPTER II.
OF CONCEPTION; WHAT IT IS; HOW WOMEN ARE TO ORDER THEMSELVES AFTER
CONCEPTION.
SECT. I. _What Conception is._
Conception is nothing else but an action of the womb, by which the
prolific seed is received and retained, that an infant may be engendered
and formed out of it. There are two sorts of conception: the one
according to nature, which is followed by the generation of the infant
in the womb; the other false, and wholly against nature, in which the
seed changes into water, and produces only false conceptions, moles, or
other strange matter.
SECT. II. _How a Woman ought to order herself after Conception._
My design in this treatise being brevity, I shall bring forward a little
of what the learned have said of the causes of twins, and whether there
be any such things as superfœtations, or a second conception, in a
woman, (which is yet common enough) when I come to show you how the
midwife ought to proceed in the delivery of the women that are pregnant
with them. But, having already spoke of conception, I think it now
necessary to show how such as have conceived ought to order themselves
during their pregnancy, that they may avoid those inconveniences which
often endanger the life of the child, and many times their own.
A woman, after conception, during the time of her being pregnant, ought
to be looked upon as indisposed or sick, though in good health: for
child-bearing is a kind of nine months’ sickness, being all that time in
expectation of many inconveniences which such a condition usually causes
to those that are not well governed during that time; and therefore
ought to resemble a good pilot, who, when sailing on a rough sea, and
full of rocks, avoids and shuns the danger, if he steers with prudence;
but if not, it is a thousand to one but he suffers shipwreck. In like
manner, a pregnant woman is often in danger of miscarrying and losing
her life, if she is not very careful to prevent those accidents to which
she is subject all the time of her pregnancy: all which time her care
must be double, first of herself, and secondly, of the child she goes
with; for otherwise, a single error may produce a double mischief; for,
if she receives a prejudice, her child also suffers with her. Let a
woman, therefore, after conception, observe a good diet, suitable to her
temperament, custom, condition, and quality: and if she can, let the air
where she ordinarily dwells be clear and well tempered, free from
extremes either of heat or cold; for being too hot it dissipateth the
spirits too much, and causeth many weaknesses; and by being too cold and
foggy, it may bring down rheums and distillations on the lungs, and so
cause her to cough, which, by its impetuous motion, forcing downwards,
may make her miscarry. She ought always to avoid all nauseous and ill
smells; for sometimes the stench of a candle, not well put out, may
cause her to come before her time; and I have known the smell of
charcoal to have the same effect. Let her also avoid smelling of rue,
mint, pennyroyal, castor, brimstone, &c.
But, with respect to their diet, pregnant women have generally so great
loathings, and so many different longings, that it is very difficult to
prescribe an exact diet for them. Only this I think advisable, that they
may use those meats and drinks which are to them most desirable, though
perhaps not in themselves so wholesome as some others, and, it may be,
not so pleasant; but this liberty must be made use of with this caution,
that what they desire be not in itself unwholesome: and also, that in
every thing they take care of excess. But, if a pregnant woman finds
herself not troubled with such longings as we have spoken of, let her
take simple food, and in such quantity as may be sufficient for herself
and the child, which her appetite may in a great measure regulate; for
it is alike hurtful for her to fast too long, or eat too much; and,
therefore, rather let her eat a little and often; especially let her
avoid eating too much at night; because the stomach being too much
filled, compresseth the diaphragm, and thereby causeth difficulty of
breathing. Let her meat be easy of digestion, such as the tenderest
parts of beef, mutton, veal, sows, pullets, capons, pigeons, and
partridges, either boiled or roasted, as she likes best; new-laid eggs
are also very good for her; and let her put into her broth those herbs
that purify it, as sorrel, lettuce, succory, and burrage; for they will
purge and purify the blood. Let her avoid whatever is hot seasoned,
especially pies and baked meats, which, being of hot digestion,
overcharge the stomach. If she desires fish, let it be fresh, and such
as is taken out of rivers and running streams. Let her eat quinces of
marmalade, to strengthen her child; sweet almonds, honey, sweet apples,
and full ripe grapes, are also good. Let her abstain from all sharp,
sour, bitter, and salt things; and all things that tend to provoke the
terms—such as garlic, onions, mustard, fennel, pepper, and all spices
except cinnamon, which in the last two months is good for her. If at
first her diet be sparing, as she increases in bigness let her diet be
increased; for she ought to consider she has a child as well as herself
to nourish. Let her be moderate in her drinking; and if she drinks wine,
let it be rather claret than white, (which will make good blood, help
the digestion, and comfort the stomach, which is always weakly during
her pregnancy); but white wine being diuretic, or that which provokes
urine, ought to be avoided. Let her have a care of too much exercise;
let her avoid dancing, riding in a coach, or whatever else puts the body
into violent motion, especially in her first month. But to be more
particular, I shall here set down rules proper for every month for the
child-bearing woman to order herself, from the time she has first
conceived to the time of her delivery.
_Rules for the First Two Months._
As soon as a woman knows (or has reason to believe) she hath conceived,
she ought to abstain from all violent motions and exercises; whether she
walks on foot, or rides on horseback, or in a coach, it ought to be very
gently. Let her beware she lift not her arms too high, nor carry great
burdens, nor repose herself on hard and uneasy seats. Let her use
moderately good juicy meat, and of easy digestion; and let her wine be
neither too strong nor too sharp, but a little mingled with water; or if
she be very abstemious, she may use water wherein cinnamon is boiled.
Let her avoid fastings, thirst, watchings, mourning, sadness, anger, and
all other perturbations of the mind. Let none present any strange or
unwholesome thing to her, nor so much as name it, lest she should desire
it, and not be able to get it, and so either cause her to miscarry, or
the child to have some deformity on that account. Let her bowels be kept
loose with prunes, raisins, or manna, in her broth; and let her use the
following electuary, to strengthen the womb and the child:—
“Take conserve of burrage, buglos, and red roses, each two ounces; of
balm an ounce; citron peel and shreds, myrobalans candied, each an
ounce; extract of wood aloes, a scruple; pearl prepared, half a drachm;
red coral, ivory, each a drachm; candied nutmegs, two drachms; and with
syrup of apples and quinces make an electuary.”
_Let her observe the following._
“Take pearls prepared, a drachm; red coral prepared and ivory, each half
a drachm; yellow citron peel, mace, cinnamon, cloves, each half a
drachm; saffron, a scruple; wood aloes, half a scruple; ambergris, six
drachms; and with six ounces of sugar dissolved in rose-water, make
rolls.” Let her also apply strengtheners to the navel, of nutmeg, mace,
mastich, made up in bags, or a toast dipped in malmsey, sprinkled with
powder of mint. If she happens to desire clay, chalk, or coals, (as many
pregnant women do), give her beans boiled with sugar; and if she happens
to long for any thing she cannot obtain, let her drink a large draught
of pure cold water.
_Rules for the Third Month._
In this month and the next, be sure to keep from bleeding; for though it
may be safe and proper at other times, yet it will not be so to the end
of the fourth month; and yet if blood abound, or some incidental disease
happen, which requires evacuation, you may use a cupping-glass, with
scarification, and a little blood may be drawn from the shoulders and
arms, especially if she has been accustomed to bleed. Let her also take
care of lacing herself too straitly, but give herself more liberty than
she used to do; for, inclosing her abdomen in too strait a mould, she
hinders the infant from taking its free growth, and often makes it come
before its time.
_Rules for the Fourth Month._
In this month also you ought to keep the child-bearing woman from
bleeding, unless in extraordinary cases; but when the month is past,
bloodletting and physic may be permitted, if it be gentle and mild; and
perhaps it may be necessary to prevent abortion. In this month she may
purge, in the acute disease; but purging may be used only from the
beginning of this month to the end of the sixth: but let her take care
that in purging she use no vehement medicine, nor any bitter, as aloes,
which is disagreeable and hurtful to the child, and opens the mouth of
the vessels; neither let her use coloquintida, scammony, nor turbith;
she may use cassia, manna, rhubarb, agaric, and senna: but dyacidodium
purgans is best, with a little of electuary of the juice of roses.
_Rules for the Fifth, Sixth, and Seventh Months._
In these months child-bearing women are troubled with coughs,
heart-beating, fainting, watching, pains in the loins and hips, and
bleeding. The cough is from a sharp vapour that comes to the jaws and
rough artery from the terms, or the thin part of that blood gotten into
the veins of the breast, or falling from the head to the breast; this
endangers abortion, and strength fails from watching; therefore purge
the humours that come to the breast with rhubarb and agaric, and
strengthen the head as in a catarrh, and give sweet lenitives, as in a
cough. Palpitation and fainting arise from vapours that go to it by the
arteries, or from blood that aboundeth, and cannot get out at the womb,
but ascends, and oppresseth the heart; and in this case, cordials,
should be used both inwardly and outwardly. Watching is from sharp dry
vapours that trouble the animal spirits, and in this case use frictions,
and let the woman wash her feet at bed-time, and let her take syrup of
poppies, dried roses, emulsions of sweet almonds, and white poppy seed.
If she be troubled with pains in her loins and hips, as in these months
she is subject to be, from the weight of her child, who is now grown big
and heavy, and so stretcheth the ligaments of the womb, and parts
adjacent, let her hold it up with swathing bands about her neck. About
this time also the woman often happens to have a flux of blood; either
at the nose, womb, or hemorrhoids, from plenty of blood, or from the
weakness of the child that takes it not in; or else from evil humour in
the blood, that stirs up nature to send it forth. And sometimes it
happens that the vessels of the womb may be broken, either by some
violent motion, fall, cough, or trouble of mind, (for any of these will
work that effect); and this is so dangerous, that in such a case the
child cannot be well; but if it be from blood only, the danger is less,
provided it flows by the veins of the neck of the womb; for then it
prevents plethory, and takes not away the nourishment of the child; but
if it proceeds from the weakness of the child, that draws it not in,
abortion of the child often follows, or hard travail, or else she goes
beyond her time. But if it flows by the inward veins of the womb, there
is more danger by the openness of the womb, if it come from evil blood;
the danger is alike from cacochimy, which is like to fall upon both. If
it arises from plethory, open a vein, but with great caution, and use
astringents, of which the following will do well:—Take pearls prepared,
a scruple; red coral, two scruples; mace, nutmeg, each a drachm;
cinnamon, half a drachm; make a powder: or, with sugar, make rolls. Or
give this powder in broth: “Take red coral, a drachm; red sander, half a
drachm; bole, a drachm; sealed earth, tormentil roots, each two
scruples, with sugar of roses, and manus Christa; with pearl, five
drachms; make a powder.” You may also strengthen the child at the navel;
and if there be a cacochimy, alter the humours; and if you may do it
safely, evacuate: you may likewise use amulets in her hands and about
her neck. In a flux of hemorrhoids wear off the pain; and let her drink
hot wine with a toasted nutmeg. In these months the bowels are also
subject to be bound; but if it be without any apparent disease, the
broth of a chicken, or veal sodden with oil, or with the decoction of
mallows, or of marshmallows, mercury, or linseed, put up in a clyster,
will not be amiss, but in less quantity than is given in other cases:
viz. of the decoction five ounces, of cassia fistula one ounce. But if
she will not take a clyster, one or two yolks of new-laid eggs, or a
little peaspottage warm, a little salt and sugar, supped a little before
meat, will be very convenient. But if her bowels be distended and
stretched out with wind, a little fennel seed and aniseed reduced into a
powder, and mingled with honey and sugar, made after the manner of an
electuary, will do very well. Also, if the thighs and feet swell, let
them be anointed with exphrodinum (which is a liquid medicine made with
vinegar and rose-water, mingled with salt.)
_Rules for the Eighth Month._
The eighth is commonly the most dangerous, therefore the greatest care
and caution ought to be used; the diet better in quality, but no more,
nor indeed so much in quantity as before; but she must abate her
exercise: and because then pregnant women, by reason that sharp humours
alter the belly, are accustomed to weaken their spirit and strength,
they may well take before meat an electuary of diarrhaden or aromaticum
rosatum, or diamagarton; and sometimes they may lick a little honey: as
they will loath and nauseate their meat, they may take green ginger
candied with sugar, or the rinds of citron and oranges candied; and let
them often use honey for the strengthening of the infant. When she is
not far from her labour, let her eat every day seven roasted figs before
her meat, and sometimes let her lick a little honey. But let her beware
of salt and powdered meat, for it is neither good for her nor the child.
_Rules for the Ninth Month._
In the ninth month let her refrain from lifting any great weight; but
let her move a little more, to dilate the parts and stir up natural
heat. Let her take heed of stooping, and neither sit too much, nor lie
on her sides; neither ought she to bend herself much, lest the child be
unfolded in the umbilical ligament, by which means it often perisheth.
Let her walk and stir often, and let her exercise be rather to go
upwards than downwards. Let her diet, now especially, be light and easy
of digestion; and damask prunes with sugar, or figs with raisins, before
meat; as also the yolks of eggs, flesh and broth of chickens, birds,
partridges and pheasants; astringent and roasted meats, with rice, hard
eggs, millet, and such like other things, are proper. Baths of sweet
water, with emollient herbs, ought to be used by her this month with
some intermission; and after the baths, let her belly be anointed with
oil of violets; but for her privy parts it is better to anoint them with
the fat of hens, geese, or ducks, or with oil of lilies, and the
decoction of linseed and fenugreek, boiled with oil of linseed and
marshmallows, or with the following liniment:—
“Take of mallows and marshmallows, cut and shred, of each an ounce; of
linseed one ounce; let them be boiled from twenty ounces of water to
ten; then let her take three ounces of the boiled broth; of oil of
almonds and oil of flower-de-luce, of each one ounce; of deer’s suet
three ounces.” Let her bathe with this, and anoint herself with it warm.
If for fourteen days before the birth she do every morning and evening
bathe and moisten her belly with muscadine and lavender water, the child
will be much strengthened thereby. And if every day she eat toasted
bread, it will hinder any thing from growing to the child. Her privy
parts may be gently stroked down with this fomentation.
“Take three ounces of linseed, and one handful each of mallows and
marshmallows sliced, then let them be put into a bag and immediately
boiled.” Let the pregnant woman, every morning and evening, take the
vapour of this decoction in a hollow stool, taking great heed that no
wind or air come to her in-parts, and then let her wipe the parts so
anointed with a linen cloth, and she may anoint the abdomen and groin as
at first.
When she is come so near her time as to be within ten or fourteen days
thereof, if she begins to feel any more than ordinary pain, let her use
every day the following:—“Take mallows and marshmallows, of each one
handful; camomile, hard mercury, maiden-hair, of each a handful; of
linseed, four ounces; let them be boiled in a sufficient quantity of
water as to make a bath therewith.” But let her not sit too hot upon the
seat, nor higher than a little above the navel; nor let her sit on it
longer than about half an hour, lest her strength languish and decay;
for it is better to use it often than to stay too long in it.
And thus have I shown how a child-bearing woman ought to govern herself
each month during her pregnancy. How she must order herself at her
delivery, shall be shown in another chapter, after I have first shown
the intended midwife how the child is first formed in the womb, and the
manner of its decumbiture there.
CHAPTER III.
_Of the Parts proper to a Child in the Womb. How it is formed there, and
the Manner of its Situation therein._
In the last chapter I treated of conception, showing what it was, how
accomplished, its signs, and how she who has conceived ought to order
herself during the time of her pregnancy. Now, before I come to speak of
her delivery, it is necessary that the midwife be first made acquainted
with the parts proper to a child in the womb, and also, that she be
shown how it is formed; and the manner of its situation and decumbiture
there; which are so necessary to her, that without the knowledge
thereof, no one can tell how to deliver a woman as she ought. This,
therefore, shall be the work of this chapter. I shall begin with the
first of these.
SECT. I. _Of the Parts proper to a Child in the womb._
In this section I must first tell you what I mean by the parts proper to
a child in the womb; and they are only those that either help or nourish
it, whilst it is lodged in that dark repository of nature, and that help
to clothe and defend it there, and are cast away, as of no more use,
after it is born; and these are two: viz. the umbilicurs, or navel
vessels, and the secundinum. By the first it is nourished, and by the
second clothed and defended from wrong. Of each of these I shall speak
distinctly: and, first,
_Of the Umbilicurs, or Navel Vessels._
These are four in number: viz. one vein, two arteries, and the vessel
which is called the urachos.
1. The vein is that by which the infant is nourished, from the time of
its conception till the time of its delivery; till, being brought into
the light of this world it has the same way of concocting its food that
we have. This vein ariseth from the liver of the child, and is divided
into parts when it has passed the navel; and these two are divided and
subdivided, the branches being upheld by the skin called _chorion_ (of
which I shall speak by and by), and are joined to the veins of the
mother’s womb, from whence they have their blood for the nourishment of
the child.
2. The arteries are two on each side, which proceed from the back
branches of the great artery of the mother; and the vital blood is
carried by those to the child, being ready concocted by the mother.
3. A nervous or sinewy production is led from the bottom of the bladder
of the infant to the navel, and this is called _urachos_; and its use is
to convey the urine of the infant from the bladder to the alantois.
Anatomists do very much vary in their opinions concerning this; some
denying any such thing to be in the delivery of the woman; and others,
on the contrary, affirming it: but experience has testified there is
such a thing; for Bartholomew Carbrolius, the ordinary doctor of anatomy
to the College of Physicians at Montpelier, in France, records the
history of a maid, whose water, being a long time stopped, at last
issued out through the navel. And Johannes Fernelius speaks of the same
thing that happened to a man of thirty years of age, who, having a
stoppage at the neck of the bladder, his urine issued out of his navel
many months together, and that without any prejudice at all to his
health; which he ascribes to the ill lying of his navel whereby the
urachos was not well dried. And Volchier Coitas quotes such another
instance in a maid of thirty-four years of age, at Nuremberg, in
Germany. These instances, though they happen but seldom, are sufficient
to prove that there is such a thing as an urachos in men.
These four vessels before-mentioned, viz. one vein, two arteries, and
the urachos, do join near to the navel, and are united by a skin, which
they have from the chorion, and so become like a gut or rope, and are
altogether void of sense, and this is that which women call the
navel-string. The vessels are thus joined together, that so they may
neither be broken, severed nor entangled; and when the infant is born
are of no use, save only to make up the ligament which stops the hole of
the navel, and some other physical use, &c.
_Of the_ SECUNDINE, _or After-Birth_.
Setting aside the name given to this by the Greeks and Latins, it is
called in English by the name of secundine, after-birth, or
after-burden; which are held to be four in number.
I. The _first_ is called placentia, because it resembles the form of a
cake, and is knit both to the navel and chorion, and makes up the
greatest part of the secundine, or after-birth. The flesh of it is like
that of the melt, or spleen, soft, red, and tending something to
blackness, and hath many small veins and arteries in it; and certainly
the chief use of it is, for containing the child in the womb.
2. The _second_ is the chorion. This skin, and that called the amnios,
involve the child round, both above and underneath, and on both sides,
which the alantois doth not. This skin is that which is most commonly
called the secundine, as it is thick and white, garnished with many
small veins and arteries, ending in the placentia before named, being
very light and slippery. Its use is not only to cover the child round
about, but also to receive and safely bind up the roots of the veins and
arteries or navel vessels before described.
3. The _third_ thing which makes up the secundine is the alantois, of
which there is a great dispute among anatomists. Some say, there is such
a thing, and others that there is not. Those that will have it to be a
membrane, say it is white, soft, and exceeding thin, and just under the
placentia, where it is knit to the urachos, from whence it receives the
urine; and its office is to keep it separate from the sweat, that the
saltness may not offend the tender skin of the child.
4. The _fourth_ and last covering of the child is called amnios; and it
is white, soft, and transparent, being nourished by some very small
veins and arteries. Its use is not only to enwrap the child, but also to
retain the sweat of the child.
Having thus described the parts proper to a child in the womb, I will
next proceed to speak of the formation of the child therein, as soon as
I have explained the hard terms of this section, that those for whose
help it is designed, may understand what they read. A _vein_ is that
which receives blood from the liver, and distributes it in several
branches to all parts of the body. _Arteries_ proceed from the heart,
are in continual motion, and by their continual motion quicken the body.
_Nerve_ is the same with _sinew_, and is that by which the brain adds
sense and motion to the body. _Placentia_ properly signifies a _sugar
cake_; but in this section it is used to signify a spongy piece of
flesh, resembling a cake, full of veins and arteries, and is made to
receive the mother’s blood appointed for the infant’s nourishment in the
womb. The _chorion_ is the outward skin which compasseth the child in
the womb. The _alantois_ is the skin that holds the urine of the child
during the time that it abides in the womb. The _urachos_ is the vessel
that conveys the urine from the child in the womb to the _allantois_. I
now proceed to
SECT. II. _Of the Formation of the Child in the Womb._
The woman having conceived, the first thing which is operative in the
conception is the spirit whereof the seed is full, which nature
quickening by the heat of the womb, stirs up to action. The internal
spirits therefore, separate the parts that are less pure, which are
thick, cold and clammy, from those that are more pure and noble. The
less pure are cast to the outside, and with these the seed is circled
round, and the membranes made, in which that seed which is most pure is
wrapped round, and kept close together, that it may be defended from
cold and other accidents, and operate the better.
The first thing that is formed is the amnios; the next the chorion; and
they enwrap the seed round like a curtain. Soon after this (for the seed
thus shut up in the woman lies not idle) the navel vein is bred, which
pierceth those skins, being yet very tender, and carries a drop of blood
from the veins of the mother’s womb to the seed: from which drop the
vena cava, or chief vein, proceeds, from which all the rest of the veins
which nourish the body spring; and now the seed hath something to
nourish it, whilst it performs the rest of nature’s work, also blood
administered to every part of it, to form flesh.
This vein being formed, the navel arteries are soon after formed; then
the great artery, of which all the others are but branches; and then the
heart; for the liver furnisheth the arteries with blood to form the
heart, the arteries being made of seed, but the heart and the flesh of
blood. After this the brain is formed, then the nerves to give sense and
motion to the infant. Afterwards the bones and flesh are formed; and of
the bones, first the vertebræ or chine bones, and then the skull, &c. As
to the time this curious part of workmanship is formed, having already
in the preceding Chapter, spoken distinctly and at large upon this
point, and also of the nourishment of the child in the womb, I shall
here only refer the reader thereto, and proceed to show the manner in
which the child lies in the womb.
SECT. III. _Of the manner of the Child’s lying in the Womb._
This is a thing so essential for a midwife to know, that she can be no
midwife who is ignorant of it: and yet even about this, authors
extremely differ; for there are not two in ten that agree what is the
form that the child lies in the womb, or in what fashion it lies there;
and yet this may arise in a great measure from the different figures
that the child is found in, according to the different times of the
woman’s pregnancy; for near the time of its deliverance out of the
winding chambers of nature, it oftentimes changes the form in which it
lay before for another.
I will now show the several situations of the child in the mother’s
womb, according to the different times of pregnancy, by which those that
are contrary to nature, and are the chief cause of all ill labours, will
be more easily conceived by the understanding midwife. It ought,
therefore, in the first place, to be observed, that the infant, as well
male as female, is generally situated in the midst of the womb; for
though sometimes, to appearance, a woman’s belly seems higher on one
side than another, yet it is so with respect to the belly only, and not
to her womb, in the midst of which it is always placed.
But, in the second place, a woman’s great belly makes different figures,
according to the different times of pregnancy; for, when she is young
with child, the embryo is always found of a round figure, a little
oblong, having the spine moderately turned inwards, the thighs folded,
and a little raised, to which the legs are so raised, and her heels
touch the buttocks; the arms are bending, and the hands placed upon the
knees, towards which the head is inclining forwards, so that the chin
toucheth the breast; in which posture it resembles one sitting to ease
nature, and stooping down with the head to see what comes from him. The
spine of its back is at that time placed towards the mother’s, the head
uppermost, the face downwards; and proportionably to its growth, it
extends its members by a little and little, which were exactly folded in
the first month.
In this posture it usually keeps till the seventh or eighth month; and
then by a natural propensity and disposition of the upper part of the
body, the head is turned downwards toward the inward orifice of the
womb, tumbling as it were over its head, so that then the feet are
uppermost, and the face towards the mother’s great gut; and this turning
of the infant in this manner, with its head downwards, towards the
latter end of a woman’s reckoning, is so ordered by nature, that it may
be thereby the better disposed for its passage into the world at the
time of its mother’s labour, which is not then far off (and, indeed,
some children turn not at all until the very time of birth); for in this
posture all its joints are most easily extended in coming forth; for, by
this means the arms and legs cannot hinder its birth, because they
cannot be bended against the inward orifice of the womb; and the rest of
the body being very supple, passeth without any difficulty after the
head which is hard and big, being past the birth. It is true, there are
divers children that lie in the womb in another posture, and come to
birth with their feet downwards, especially if there be twins; for then
by the different motions they do disturb one another, that they seldom
come both in the same posture at the time of labour, but when one will
come with the head, and another with the feet, or perhaps lie across;
and sometimes neither of them will come right. But, however the child
may be situated in the womb, or in whatever posture it presents itself
at the time of birth, if it be not with its head forwards, as I have
before described, it is always against nature, and the delivery will
occasion the more pain and danger, and require greater care and skill
from the midwife, than when the labour is more natural.
CHAP. IV.
_A Guide to Women in Travail, showing what is to be done when they fall
in Labour, in order to their Delivery._
The end of all that we have been treating of is, the bringing forth a
child into the world with safety both to the mother and infant, as the
whole time of a woman’s pregnancy may very well be termed a kind of
labour; for, from the time of her conception to the time of her
delivery, she labours under many difficulties, is subject to many
distempers, and in continual danger, from one effect or other, till the
time of birth comes; and when that comes, the great labour and travail
come along with it, insomuch that then all the other labours are
forgotten, and that only is called the time of her labour; and to
deliver her safely is the principal business of the midwife; and to
assist her therein, shall be the chief design of this chapter. The time
of the child’s being ready for its birth, when nature endeavours to ease
it forth, is that which is properly the time of a woman’s labour; nature
then labouring to be eased of its burden. And since many child-bearing
women (especially the first child) are often mistaken in their
reckoning, and so, when they draw near their time, take every pain they
meet with for their labour, which often proves prejudicial and
troublesome to them, when it is not so; I will in the first section of
this chapter, set down some signs, by which a woman may know when the
true time of her labour is come.
SECT. I. _The Signs of the true Time of a Woman’s Labour._
When pregnant women, especially of their first, perceive any
extraordinary pain in the abdomen, they immediately send for their
midwife, as taking it for their labour; and then if the midwife be not a
skilful and experienced woman, to know the time of labour, but takes it
for granted without further inquiry (for some such there are), and so
goes about to put her into labour before nature is prepared for it, she
may endanger the lives of both mother and child by breaking the amnios
and chorion. These pains, which are often mistaken for labour, are
removed by warm cloths laid to the abdomen, and the application of a
clyster or two, by which those pains which precede a true labour are
rather furthered than hindered. There are also other pains incident to a
woman in that condition from a flux of the abdomen, which are easily
known by the frequent stools that follow them.
The signs, therefore, of labour, some few days before, are, that the
woman’s abdomen, which before lay high, sinks down, and hinders her from
walking so easily as she used to do; also there flows from the womb
slimy humours, which nature has appointed to moisten and smooth the
passage, that its inward orifice may be the more easily dilated when
there is occasion; which beginning to open at this time, suffers that
slime to fall away, which proceeds from the glandules, called
_prostata_. These are signs preceding the labour; but when she is
presently falling into labour, the signs are, great pains about the
region of the reins and loins, which, coming and retreating by
intervals, are answered in the bottom of the abdomen by congruous
throes, and sometimes the face is red and inflamed, the blood being much
heated by the endeavours a woman makes to bring forth her child; and
likewise, because during these strong throes her respiration is
intercepted, which causes the blood to have recourse to her face; also
her privy parts are swelled by the infant’s head lying in the birth,
which, by often thrusting, causes those parts to descend outwards. She
is much subject to vomiting, which is a sign of labour and speedy
delivery, though by ignorant people thought otherwise; for good pains
are thereby excited by the sympathy there is between the womb and the
stomach. Also when the birth is near, women are troubled with a
trembling in the thighs and legs, not with cold, like the beginning of
an ague fit, but with the heat of the whole body; though, it must be
granted, this does not happen always. Also, if the humours which then
flow from the womb are discoloured with blood, which the midwives call
_shows_, it is an infallible mark of the birth being near. And if then
the midwife puts up her fingers into the neck of the womb, she will find
the inner orifice dilated; at the opening of which, the membranes of the
infant, containing the water, present themselves, and are strongly
forced down with each pain she hath; at which time one may perceive them
sometimes to resist, and then again press forward the finger, being more
or less hard and extended, according as the pains are stronger or
weaker. These membranes, with the waters in them when they are before
the head of the child, which the midwives call _the gathering of the
waters_, resemble to the touch of the finger those eggs which have no
shell, but are covered only with a simple membrane. After this, the
pains still redoubling, the membranes are broken by a strong impulsion
of the waters, which flow away, and the head of the infant is presently
felt naked, and presents itself at the inward orifice of the womb. When
these waters come thus away, then the midwife may be assured the birth
is very near, this being the most certain sign there can be; for the
_amnios alantios_, which contained those waters, being broken by the
pressing forward of the birth, the child is no better able to subsist
long in the womb afterwards, than a naked man in a heap of snow. Now,
these waters, if the child comes presently after them, facilitate the
labour, by making the passage slippery; and, therefore, let no midwife
(as some have foolishly done) endeavour to force away the water, for
nature knows best when the true time of the birth is, and therefore
refrains the water till that time. But if by accident the water breaks
away too long before the birth, then such things as will hasten may be
safely administered, and what these are I will show in another section.
SECT. II. _How a woman ought to be ordered when the Time if her Labour
is come._
When it is known that the true time of her labour is come by the signs
laid down in the foregoing section, of which those that are most to be
relied on are pains and strong throes in the abdomen, forcing downwards
towards the womb, and a dilation of the inward orifice, which may be
perceived by touching it with the finger, and the gathering of the
waters before the head of the child, and thrusting down of the membranes
which contain them; through which, between the pains, one may in some
manner with the finger discover the part which presents (as we said
before), especially if it be the head of the child, by its roundness and
hardness; I say, if these things concur and are evident, the midwife may
be sure it is the time of the woman’s labour; and care must be taken to
get all things necessary to comfort her in that time. And the better to
help her, be sure to see she be not strait-laced: you may also give her
one strong clyster or more, if there be occasion, provided it be done at
the beginning, and before the child be too forward; for it will be
difficult for her to receive them afterwards. The benefit accruing
thereby will be, that they excite her gut to discharge itself of its
excrements, that so, the rectum being emptied, there may be more space
for the dilation of the passage; likewise to cause the pains to bear the
more downward, through endeavours she makes when she is at stool; and in
the meantime, all other necessary things for her labour should be put in
order, both for the mother and the child. To this end, some get a
midwife’s stool; but a pallet-bed, girded, is much the best way, placed
near the fire, if the reason require; which pallet ought to be placed,
that there may be easy access to it on every side, that the woman may be
more readily assisted as there is occasion.
If the woman abounds with blood, to bleed her a little may not be
improper, for thereby she will both breathe better, and have her breasts
more at liberty, and likewise the more strength to bear down her pains;
and this may be done without danger, because the child being about that
time ready to be born, has no more need of the mother’s blood for its
nourishment: besides, this evacuation does many times prevent her having
a fever after delivery. Also, before her delivery, if her strength will
permit, let her walk up and down her chamber; and that she may have
strength so to do, it will be necessary to give her some good
strengthening things, such as jelly, broth, new-laid eggs, or some
spoonfuls of burnt wine; and let her by all means hold out her pains,
bearing them down as much as she can at the time when they take her; and
let the midwife from time to time touch the inward orifice with her
finger, to know whether the waters are ready to break, and whether the
birth will follow soon after. Let her also anoint the woman’s privities
with emollient oil, hog’s grease, and fresh butter, if she find they are
hard to be dilated. Let the midwife likewise be all the time near the
labouring woman, and diligently observe her gestures, complaints, and
pains; for by this she may guess pretty well how her labour advanceth,
because when she changes her ordinary groans into loud cries, it is a
sign the child is very near the birth; for at that time her pains are
greater and more frequent. Let the woman, likewise, by intervals rest
herself on the bed, to regain her strength, but not too long, especially
if she be little, short, and thick; for such women have always worse
labour, if they lie long on their beds in their travail. It is better,
therefore, that she walk about her chamber as much as she can, the woman
supporting her under the arms, if it be necessary; for by this means,
the weight of the child causeth the inward orifice of the womb to dilate
the sooner than in bed; and if her pains be stronger and more frequent,
her labour will not be near so long.
Let not the labouring women be concerned at those qualms and vomitings
which perhaps she may find come upon her, for they will be much for her
advantage in the issue, however uneasy she may be for the time, as they
further her throes and pains by provoking downwards.
When the waters of the child are ready and gathered (which may be
perceived through the membranes to present themselves to the inward
orifice) to the bigness of the whole dilation, the midwife ought to let
them break of themselves, and not, like some hasty midwives, who being
impatient of the woman’s long labour, break them, intending thereby to
hasten their business, when instead thereof they retard it; for, by the
too hasty breaking of these waters (which nature designed to cause the
infant to slide forth more easy) the passage remains dry, by which means
the pains and throes of the labouring woman are less efficacious to
bring forth than they would otherwise have been. It is therefore much
the better way to let the waters break of themselves; after which the
midwife may with ease feel the child by that part which first presents,
and thereby discerns whether it comes right, that is, with the head
foremost, for that is the most proper and natural way of its birth. If
the head comes right, she will find it round, big, hard, and equal; but
if it be any other part, she will find it unequal, rugged, and soft or
hard, according to the nature of the part it is. And this being the true
time when a woman ought to be delivered, if nature be not wanting to
perform its office; therefore, when the midwife finds the birth thus
coming forward, let her hasten to assist and deliver it, for it
ordinarily happens soon after, if it be natural.
But if it happens, as sometimes it may, that the waters break away too
long before the birth, in such a case those things that hasten nature
may be safely administered. For which purpose, make use of pennyroyal,
dittany, juniper-berries, betony, and feverfew, boiled in white wine,
and give a draught of it; or it would be much better to take the juice
of it when it is in its prime, which is in May, and having clarified it,
make it into syrup, with double its weight of sugar, and keep it all the
year, to use when occasion calls for it: mugwort used in the same
manner, is also good in this case; also, a drachm of cinnamon powder,
given inwardly, profits much in this case; and so does tansey, boiled,
and applied to the privities; or an oil of it, so made and used, as you
were taught before. The following prescriptions are very good to speedy
deliverance to women in travail.
1. A decoction of white wine made in savory, and drank.
2. Take wild tansey, or silver weed, bruise it, and apply it to the
woman’s nostrils.
3. Take date stones, and beat them to powder, and let her take half a
drachm of them in white wine at a time.
4. Take parsley and bruise it, and press out the juice, and dip a linen
cloth in it, and put it up so dipped into the mouth of the womb: it will
presently cause the child to come away, though it be dead, and will
bring away the after-burden. Also, the juice of parsley is a thing of so
great virtue (especially stone parsley) that being drunk by a pregnant
woman it cleanseth not only the womb, but also the child in the womb, of
all gross humours.
5. A scruple of castorum in powder, in any convenient liquor, is very
good to be taken in such a case; and so also is two or three drops of
spirit of castorum in any convenient liquor; also eight or nine drops of
spirit of myrrh, given in any convenient liquor, gives speedy
deliverance.
6. Give a woman in such a case another woman’s milk to drink: it will
cause speedy delivery, and almost without pain.
7. The juice of leeks, being drunk with warm water, highly operates to
cause speedy delivery.
8. Take peony seeds, and beat them into powder, and mix the powder with
oil, with which oil anoint the loins and privities of the woman and
child; it will give her deliverance speedily, and with less pain than
can be imagined.
9. Take a swallow’s nest, and dissolve it in water, strain it, and drink
it warm; it gives delivery with great speed and much ease.
Note this also in general, that all things that move the terms, are good
for making the delivery easy; such as myrrh, white amber in white wine,
or lily-water, two scruples or a drachm; or cassia lignea, dittany, each
a drachm; cinnamon half a drachm, saffron a scruple; give a drachm: or
take borax mineral a drachm; and give it in sack: or take cassia lignea
a drachm: dittany, amber, of each a drachm; cinnamon, borax, of each a
drachm and a half; saffron a scruple; and give her half a drachm: or
give her some drops of oil of hazel in convenient liquor; or two or
three drops of oil of cinnamon in vervain water. Some prepare the
secundine thus:—Take the navel-string and dry it in an oven, take two
drachms of the powder, cinnamon a drachm, saffron half a scruple, with
juice of savin make trochisks; give two drachms: or wash the secundine
in wine, and bake it in a pot; then wash it in endive water and wine;
take half a drachm of it: long pepper, galangal, of each half a drachm:
plantain and endive seed, of each half a drachm; lavender seed four
scruples; make a powder: or take laudanum two drachms; storax, calamile,
benzoin, of each half a drachm; musk ambergris, each six grains; make a
powder, or trochisks for a fume. Or use pessaries to provoke the birth;
take galbanum dissolved in vinegar, an ounce; myrrh two drachms; with
oil of oats make a pessary.
_An Ointment for the Navel._
Take oil of keir two ounces, juice of savin an ounce, of leeks and
mercury each half an ounce; boil them to the consumption of the juice;
add galbanum dissolved in vinegar half an ounce; myrrh two drachms,
storax liquid a drachm; round bistort, sowbread, cinnamon, saffron a
drachm; with wax make an ointment, and apply it.
If the birth be retarded through the weakness of the mother, refresh her
by applying wine and soap to the nose; confect. alkermas diamarg.
These things may be applied to help nature in her delivery, when the
child comes to the birth the right way, and yet the birth be retarded:
but if she finds the child comes the wrong way, and is not able to
deliver the woman as she ought to be, by helping nature, and saving both
mother and child (for it is not enough to lay a woman, if it might be
done any other way with more safety and ease, and less hazard both to
woman and child), then let her send speedily for better and more able
help; and not as I once knew a midwife do, who, when a woman she was to
deliver had hard labour, rather than a man-midwife should be sent for,
undertook to deliver the woman herself (though told it was a man’s
business), and in her attempting it brought away the child but left the
head in the mother’s womb; and had not a man-midwife been presently sent
for, the mother had lost her life as well as the child: such persons may
rather be termed butchers than midwives. But supposing the woman’s
labour be natural, I will next show what the midwife ought to do, in
order to her delivery.
CHAPTER V.
OF NATURAL LABOUR; WHAT IT IS; AND WHAT THE MIDWIFE IS TO DO IN SUCH A
LABOUR.
SECT. I. _What Natural Labour is._
There are four things which denominate a woman’s natural labour; the
first, that it be at the full time; for, if a woman comes before her
time, it cannot be termed natural labour; neither will it be easy as
though she had completed her nine months. The second thing is, that it
be speedy and without any ill accident: for, when the time of her birth
is come, nature is not dilatory in the bringing of it forth, without
some ill accident intervene which renders it unnatural. The third is,
that the child be alive; for all will grant that the being delivered of
a dead child is very unnatural. The fourth thing requisite to a natural
birth is, that the child come right: for if the position of the child in
the womb be contrary to what is natural, the event will prove it so, by
making that which should be a time of life, the death of both the mother
and the child.
Having thus told you what I mean by natural labour, I shall next show
how the midwife is to proceed therein, in order to the woman’s delivery.
When all the foregoing requisites concur, and after the waters be broke
of themselves, let there rather be a quilt upon the pallet bedstead than
a feather bed, having thereon linen, and cloths in many folds, with
other such things as are necessary, and that may be changed according to
the exigency requiring it, so that the woman may not be incommoded with
the blood, waters, and other filth which are voided in labour. The bed
ought so to be ordered, that the woman, being ready to be delivered,
should lie on her back upon it, having her body in a convenient posture;
that is, her head and breast a little raised, so that she be between
lying and sitting; for being so placed, she is best capable of
breathing, and likewise will have more strength to bear her pains than
if she lays otherwise, or sunk down in bed. Being so placed, she must
spread her thighs abroad, folding her legs a little towards her loins,
somewhat raised by a small pillow underneath, to the end her groin
should have more liberty to retire back; and let her feet be stayed
against some firm thing: besides this, let her take hold of some of the
good women attending her with her hands, that she may the better stay
herself during her pains. She being thus placed at the side of her bed,
having her midwife at hand the better to assist as nature requires, let
her take courage, and help her pains the best she can, bearing them down
when they take her, which she must do by holding her breath, and forcing
them as much as possible, in like manner as when she goes to stool; for
by such straining, the diaphragm, or midriff, being strongly thrust
downwards, necessarily forces down the womb and the child in it. In the
meantime, let the midwife endeavour to comfort her all she can,
exhorting her to bear her labour courageously, telling her it will be
quickly over, and that there is no fear but she will have a speedy
delivery. Let her midwife also, having no rings on her fingers, anoint
them with oil of fresh butter, and thereby dilate gently the inward
orifice of the womb, putting her finger ends into the entry thereof, and
then stretch them one from the other, when her pains take her; by this
means endeavouring to help forward the child, and thrusting, by little
and little, the sides of the orifice towards the hinder part of the
child’s head, anointing it with fresh butter, if it be necessary.
When the head of the infant is a little advanced into the inward
orifice, the midwife’s phrase is, “It is crowned;” because it girds and
surrounds it just as a crown; but when it is so far that the extremities
begin to appear without the privy parts, then they say, “The child is in
the passage;” and at this time the woman feels herself as it were
scratched, or pricked with pins, and is ready to imagine that the
midwife hurts her, when it is occasioned by the violent distention of
those parts, and the laceration which the sometimes bigness of the
child’s head causeth there. When things are in this posture, let the
midwife seat herself conveniently to receive the child, which will come
quickly, and with her finger ends (which she must be sure to keep close
pared) let her endeavour to thrust the crowning of the womb (of which I
have spoken before) back over the head of the child; and as soon as it
is advanced as far as the ears, or thereabouts, let her take hold of the
two sides with her two hands, that when a good pain comes she may
quickly draw forth the child, taking care that the navel-string be not
entangled about the neck, or any other part, as sometimes it is, lest
thereby the after-burden be pulled with violence, and perhaps the womb
also, to which it is fastened, and so either cause her to flood, or else
break the strings, both which are of bad consequence to the woman, whose
delivery may thereby be rendered the more difficult. It must also be
carefully observed, that the head should not be drawn forth straight,
but shaking it a little from one side to the other, that the shoulders
may sooner and easier take their place immediately after it is past,
without losing any time, lest the head being past, the child be stopped
there by the largeness of the shoulders, and so come in danger of being
suffocated and strangled in the passage, as it sometimes happens, for
the want of care therein. But as soon as the head is born, if there be
need, she may slide her fingers under the arm-pits, and the rest of the
body will follow without any difficulty.
As soon as the midwife hath in this manner drawn forth the child, let
her put it on one side, lest the blood and water which follow
immediately, should do it an injury, by running into its mouth and nose,
as they would do if it lay on its back, and so endanger the choaking of
it. The child being thus born, the next thing requisite is, to bring
away the after-burden: but before that, let the midwife be very careful
to examine whether there be more children in the womb; for sometimes a
woman may have twins that expected it not; which the midwife may easily
know, by the continuance of the pains after the child is born, and the
bigness of the mother’s abdomen. But the midwife may be sure of it, if
she puts her hand up the entry of the womb, and finds there another
watery gathering, and a child in it presenting to the passage; and if
she finds it so, she must have a care of going to fetch the after-birth,
till the woman be delivered of all the children she is pregnant with.
Wherefore the first string must be cut, being first tied with a thread
three or four double, and fasten the other end with a string to the
woman’s thighs; and then removing the child already born, she must take
care to deliver her of the rest, observing all the circumstances as with
the first; after which it will be necessary to fetch away the
after-birth or births. But of that I shall treat in another section; and
first show what is to be done to the new-born infant.
SECT. II. _Of the Cutting of the Child’s Navel-String._
Though this is accounted by many but a trifle, yet great care is to be
taken about it; and it shows none of the least art and skill of a
midwife to do it as it should be; and that it may be so done, the
midwife ought to observe, 1. The time. 2. The place. 3. The manner. 4.
The event.
1. The time is, as soon as ever the infant comes out of the womb,
whether it brings part of the after-burden with it or not; for sometimes
the child brings into the world a piece of the amnios upon its head, and
is what midwives call the _caul_, and ignorantly, attribute some
extraordinary virtue to the child that is so born: but this opinion is
only the effect of their ignorance; for when the child is born with such
a crown (as some call it) upon its brows, it generally betokens
weakness, and denotes a short life. But to proceed to the matter in
hand. As soon as the child is come into the world, it should be
considered whether it is weak or strong; and if it be weak, let the
midwife gently put back part of the vital and natural blood into the
body of the child by its navel; for that recruits a weak child (the
vital and natural spirits being communicated by the mother to the child
by its navel-string); but if the child be strong, the operation is
needless. Only let me advise you, that many children that are born
seemingly dead, may be soon brought to life again, if you squeeze six or
seven drops of blood out of that part of the navel-string which is cut
off, and give it to the child inwardly.
2. As to the place in which it should be cut, that is, whether it should
be cut long or short, it is that which authors can scarcely agree in,
and which many midwives quarrel about; some prescribing it to be cut at
four fingers’ breadth, which is, at best, but an uncertain rule, unless
all fingers were of one size.
3. As to the manner in which it must be cut, let the midwife take a
brown thread, four or five times double, of an ell long or thereabouts,
tied with a single knot at each of the ends, to prevent their
entangling; and with this thread so accommodated (which the midwife must
have in readiness before the woman’s labour, as also a good pair of
scissors, that no time may be lost) let her tie the string within an
inch of the abdomen with a double knot, and, turning about the end of
the thread, let her tie two more on the other side of the string,
reiterating it again, if it be necessary; then let her cut off the navel
another inch below the ligatures, towards the after-birth, so that there
only remains but two inches of the string, in the midst of which will be
the knot we speak of, which must be so close knit as not to suffer a
drop of blood to squeeze out of the vessels; but care must be taken, not
to knit it so strait as to cut it in two, and therefore, the thread must
be pretty thick, and pretty strait cut, it being better too strait than
too loose; for some children have miserably lost their lives, with all
their blood, before it was discovered, because the navel-string was not
well tied; therefore great care must be taken that no blood squeeze
through; for if there do, a new knot must be made with the rest of the
string. You need not fear to bind the navel-string very hard, because it
is void of sense, and that part which you leave falls off in a very few
days, sometimes in six or seven, or sooner, but never tarries longer
than eight or nine.
4. The last thing I mentioned was the event or consequence, or what
follows cutting the navel-string. As soon as the navel-string is cut
off, apply a little cotton or lint to the place to keep it warm, lest
the cold enter into the body of the child, which it most certainly will
do, if you have not bound it hard enough. If the lint or cotton you
apply to it be dipped in the oil of roses, it will be the better; and
then put another small rag three or four times double upon the abdomen:
upon the top of all, put another small bolster; and then swathe it with
a linen swathe, four fingers broad, to keep it steady, lest by moving
too much, or by being continually stirred from side to side, it comes to
fall off before the navel-string which you left remaining is falling
off. It is the usual custom of midwives to put a piece of burnt rag to
it, which we commonly call tinder; but I would advise them to put a
little ammoniac to it, because of its drying quality.
SECT. III. _How to bring away the After-burden._
A woman cannot be said to be fairly delivered, though the child be born,
till the after-burden be also taken from her; herein differing from most
animals, who, when they have brought forth their young cast forth
nothing else but some water, and the membranes which contained them. But
women have an after-labour, which sometimes proves more dangerous than
the first: and how to bring it safely away, without prejudice to her,
shall be my business to show in this section.
As soon as the child is born, before the midwife either ties or cuts the
navel-string, lest the womb should close, let her take the string and
wind it once or twice about one or two of the fingers of her left hand
joined together, the better to hold it, with which she may draw it
moderately, and with the right hand she may only take a single hold of
it above the left near the privities, drawing likewise with that very
gently, resting the while the fore-finger of the string towards the same
hand, extended and stretched forth along the entrance of the vagina,
always observing, for greater facility, to draw it from the side where
the burden cleaves least; for, in so doing, the rest will separate the
better: and special care must be taken that it be not drawn forth with
too much violence, lest by breaking the string near the burden the
midwife be obliged to put the whole hand into the womb to deliver the
woman; and she need to be a very skilful person that undertakes it, lest
the womb, to which this burden is sometimes very strongly fastened, be
drawn away with it, as it has sometimes happened. It is, therefore, best
to use such remedies as may assist nature. And here take notice, that
what brings away the birth, will also bring away the after-birth. And
therefore, for affecting this work, I will lay down the following rules.
1. Use the same means in bringing away the after-birth that you made use
of to bring away the birth; for the same care and circumspection are
needful now that were then.
2. Considering the labouring woman cannot but be much spent by what she
has already undergone in bringing forth the infant; be therefore sure to
give her something to comfort her. And in this case good jelly broths,
also a little wine and toast in it, and other comforting things, will be
very necessary.
3. A little hellebore in powder, to make her sneeze, is in this case
very proper.
4. Tansey and the stone ætites, applied as before directed, are also of
good use in this case.
5. If you take the herb vervain, and either boil it in wine, or make a
syrup with the juice of it, which you may do by adding to it double its
weight of sugar, (having clarified the juice before you boil it), a
spoonful of that given to the woman is very efficacious to bring away
the secundine; and featherfew and mugwort have the same operation, taken
as the former.
6. Alexander boiled in wine, and the wine drank, also sweet servile,
sweet cicily, angelica roots, and muster-wort, are excellent remedies in
this case.
7. Or, if this fail, the smoke of marigolds, received up a woman’s
privities by a funnel, has been known to bring away the after-birth,
even when the midwife let go her hand.
8. Boil mugwort in water till it be very soft; then take it out, and
apply it in the manner of a poultice to the navel of the labouring
woman, and it instantly brings away the birth and after-birth. But
special care must be taken to remove it as soon as they come away, lest
by its longer tarrying it should draw away the womb also.
SECT. IV. _Of Laborious and Difficult Labours, and how the Midwife is to
proceed therein._
There are three sorts of bad labours, all painful and difficult, but not
all properly unnatural. It will be necessary therefore to distinguish
these.
The _first_ of these labours is that wherein the mother and child suffer
very much by extreme pain and difficulty, even though the child come
right; and this is distinguishably called the laborious labour.
The _second_ is that which is difficult, and differs not much from the
former, except that, besides those extraordinary pains, it is generally
attended with some unhappy accident, which by retarding the birth,
causes the difficulty: but these difficulties being removed, it
accelerates the birth, and hastens the delivery.
Some have asked, what is the reason that women bring forth their
children with so much pain? I answer, the sense of feeling is
distributed to the whole body by the nerves; and the mouth of the womb
being so strait that it must of necessity be dilated at the time of the
woman’s delivery, the dilating thereof stretches the nerves, and from
thence comes the pain. And therefore the reason why some women have more
pain in their labour than others, proceeds from their having the mouth
of the matrix more full of nerves than others. The best way to remove
those difficulties that occasion hard pains and labour, is to show first
from whence they proceed. Now the difficulty of labour proceeds either
from the mother, or child, or both.
From the mother, by reason of the indisposition of the body, or from
some particular part only, and chiefly the womb, as when the woman is
weak, and the mother is not active to expel the burden, or from weakness
or disease, or want of spirits; or it may be from some strong passion of
the mind with which she was once possessed; she may be too young, and so
may have the passage too strait; or too old, and then, if it be her
first child, because her pains are too dry and hard, and cannot easily
be dilated, as happens also to them which are too lean; likewise those
who are either small, short or deformed, as crooked women, who have not
breath enough to help their pains, and to bear them down, and persons
that are crooked having sometimes the bones of the passage not well
shaped. The cholic also hinders labour, by preventing the true pains;
and all great and active pains, as when the woman is taken with a
violent fever, a great flooding, frequent convulsions, bloody flux, or
any other great distemper. Also, excrements retained cause much
difficulty, and so does a stone in the bladder or when the bladder is
full of urine, without being able to void it; or when the woman is
troubled with great and painful piles. It may also be from the passages,
when the membranes are thick, the orifice too strait, and the neck of
the womb not sufficiently open, the passages pressed and strained by
tumours in the adjacent parts, or when the bones are too firm, and will
not open, which very much endangers the mother and child; or when the
passages are not slippery, by reason of the waters being broke too soon,
or the membranes being too thin. The womb may also be out of order with
respect to its bad situation, or conformation, having its neck too
strait, hard, and callous, which may easily be so naturally, or may come
by accident, being many times caused by a tumor, an imposthume, ulcer,
or superfluous flesh.
As to hard labour occasioned by the child it is when the child happens
to stick to a mole, or when it is so weak it cannot break the membranes;
or if it be too big all over, or at the head only, or if the natural
vessels are twisted about its neck; when the belly is hydropical; or
when it is monstrous, having two heads, or joined to another child;
also, when the child is dead, or so weak that it can contribute nothing
to its birth; likewise when it comes wrong; or when there are two or
more. And to all these various difficulties there is oftentimes one
more, and that is, the ignorance of the midwife, who, for want of
understanding in her business, hinders nature in her work instead of
helping her.
Having thus looked into the cases of hard labour, I will now show the
industrious midwife how she may minister some relief to the labouring
woman under these difficult circumstances. But it will require judgment
and understanding in the midwife, when she finds a woman in difficult
labour, to know the particular obstruction, or cause thereof, that so a
suitable remedy may be applied; as, for instance, when it happens by the
mother’s being too young or too strait, she must be gently treated, and
the passages anointed with oil, hog’s lard, or fresh butter, to relax
and dilate them the easier, lest there should happen a rupture of any
part when the child is born; for sometimes the peritoneum breaks, with
the skin from the privities of the fundament.
But if the woman be in years with her first child, let her lower parts
be anointed to mollify the inward orifice, which, in such a case being
more hard and callous, does not easily yield to the distention of
labour, which is the true cause why such women are longer in labour, and
also why their children, being forced against the inward orifice of the
womb (which, as I have said, is a little callous) are born with great
humps and bruises on their heads.
Those women that are very small and misshapen, should not be put to bed,
at least, till their waters are broke, but rather kept upright, and
assisted to walk about the chamber, by being supported under the arms;
for, by that means, they will breathe more freely, and mend their pains
better than on the bed, because there they lie on a heap. As for those
that are very lean, and have hard labour from that cause, let them
moisten the parts with oil and ointments, to make them more smooth and
slippery, that the head of the infant and the womb be not so compressed
and bruised by the hardness of the mother’s bones which forms the
passage. If the cause be weakness, she ought to be strengthened, the
better to support her pains; to which end give her good jelly broths,
and a little wine with a toast in it. If she fears her pains, let her be
comforted, assuring her that she will not endure many more, but be
delivered in a little time. But if her pains be slow and small, or none
at all, they must be provoked by frequent and pretty strong clysters;
let her walk about the chamber, that so the weight of child may help
them forwards. If she flood, or have strong convulsions, she must be
then helped by a speedy delivery; the operation I shall relate in the
section of unnatural labours. If she be costive, let her use clysters
which may also help to dispel the cholic, at those times very injurious,
because attended with useless pains, and because such bear not downward,
and so help not to forward the birth. If she find an obstruction or
stoppage of the urine, by reason the womb bears too much on the bladder,
let her lift up her abdomen a little with her hand, and try if she
receives any benefit; if she finds she does not, it will be necessary to
introduce a catheter into her bladder, and thereby draw forth her urine.
If the difficulty be from the ill posture of the woman, let her be
placed otherwise, in a posture more suitable and convenient for her;
also if it proceed from the indisposition of the womb, as from its
oblique situation, &c. it must be remedied, as well as it can, by
placing her body accordingly; or, if it be a vicious conformation,
having the neck too hard, too callous, and too strait, it must be
anointed with oils and ointments, as before directed. If the membranes
be so strong as that the waters do not break in due time, they may be
broken with the fingers, if the midwife be first well assured that the
child is forward in the passage, or else, by breaking the waters too
soon, the child may remain in danger of remaining dry a long time; to
supply which defect, you may moisten the parts with fomentations,
decoctions, and emollient oils: which yet is not half so well as when
nature does her work in her own time, with the ordinary slime and water.
These membranes sometimes do press forth with the waters three or four
fingers’ breadth out of the body before the child, resembling a bladder
full of water; but there is then no great danger to break them, if they
be not already broken; for when the case is so, the child is always in
readiness to follow, being in the passage; but let the midwife be very
careful not to pull it with her hand, lest the after-burden be thereby
loosened before its time, for it adheres thereto very strongly. If the
navel-string happen to come first, it must presently be put in again,
and kept so, if possible, or otherwise the woman must be immediately
delivered. But if the after-burden should come first, it must not be put
up again by any means; for the infant having no further occasion for it,
it would be but an obstacle if it were put up; in this case it must be
cut off, having tied the navel-string, and afterwards draw forth the
child with all the speed that may be, lest it be suffocated.
SECT. V. _Of Women labouring with a dead Child._
When the difficulty of labour arises from a dead child, it is a case of
great danger to the mother, and great care ought to be taken therein;
but before any thing be done, the midwife ought to be well assured the
child is dead indeed, which may be known by these signs.
1. The breast suddenly slacks, or falls flat, or bags down. 2. A great
coldness, possesses the abdomen of the mother, especially about the
navel. 3. Her urine is thick, and a filthy stinking settles at the
bottom. 4. No motion of the child can be perceived; for the trial
whereof, let the midwife put her hand in warm water, and lay it upon the
abdomen; for that, if it is alive, will make it stir. 5. She is very
subject to dream of dead men, and be affrighted therewith. 6. She has
extravagant longings to eat such things as are contrary to nature. 7.
Her breath stinks, though not used so to do. 8. When she turns herself
in bed, the child sways that way like a lump of lead.
These things being carefully observed, the midwife may make a judgment
whether the child be alive or dead, especially if the woman take the
following prescription: “Take half a pint of white wine and burn it, and
add thereto half an ounce of cinnamon, but no other spice whatever; and
when she has drank it, if her travailing pains come upon her the child
is certainly dead; but if not, the child may possibly be either weak or
sick, but not dead; this will bring her pains upon her, if it be dead,
and will refresh the child, if it be living; for cinnamon refresheth and
strengtheneth the child.”
Now, if upon trial, it be found that the child is dead, let the mother
do all she can to forward the delivery, because a dead child can be
nowise helpful therein. It will be necessary, therefore, that she make
some comfortable things to prevent her fainting, by reason of the putrid
vapours ascending from the dead child. And in order to her delivery, let
her take the following herbs boiled in white wine, (or at least as many
of them as you can get), viz. dittany, betony, pennyroyal, sage,
featherfew, centuary, ivy leaves, and berries. Let her also take sweet
basil, in powder, and half a drachm at a time, in white wine; let her
privities be also anointed with the juice of the garden-tansey. Or take
the tansey in the summer, when it can be most plentifully had, and
before it runs up to the flower, and having bruised it well, boil it in
oil till the juice of it be consumed. If you set it in the sun, after
you have mixed it with oil, it will be more effectual. This an
industrious midwife, who would be prepared against all events, ought to
have always by her. As to the manner of her delivery, the same methods
must be used as are mentioned in the section of natural labour. And here
again I cannot but commend the stone ætites, held near the privities,
whose magnetic virtue renders it exceedingly necessary on this occasion,
for it draws the child any way, with the same facility that the
loadstone draws iron.
Let the midwife also make a strong decoction of hyssop with water, and
let the woman drink it very hot, and it will in a little time bring away
the dead child.
If, as soon as she is delivered of the dead child, you are in doubt that
part of the after-birth is left behind in the body (for in such cases as
these, many times, it rots, and comes away piecemeal), let her continue
drinking the same decoction till her body be cleansed.
A decoction made of the herb muster-wort, used as you did the decoction
of hyssop, works the same effect. Let the midwife also take roots of
pollodum, and stamp them well; warm them a little, and bind them on the
soles of her feet, and it will soon bring away the child, either dead or
alive.
The following medicines likewise are such as stir up the expulsive
faculty; but in this case they must be stronger, because the motion of
the child ceaseth.
Take savin, round birthwort, trochisks of myrrh, afaran roots, cinnamon,
saffron, each half a drachm; make a powder, give a drachm.
Or she may purge first, and then apply an emollient, anointing her about
the womb with oil of lilies, sweet almonds, camomile, hen and goose
grease. Also foment, to get out the child with a decoction of mercury,
orris, wild cucumbers, sæcus, broom flowers. Then anoint the privities
and loins with ointment of sowbread. Or, take coloquintida, birthwort,
of each a drachm; make a powder; add ammoniacum dissolved in wine,
ox-gall, each two drachms; with oil of keir make an ointment. Or this
pessary:
Take birthwort, orris, black hellebore, coloquintida, myrrh, each a
drachm; powdered ammoniacum dissolved in wine, ox-gall, each two
drachms. Or make a fume with an ass’s hoof burnt, or gallianum, or
castor, and let it be taken in with a funnel.
To take away pains, and strengthen the parts, foment with the decoction
of mugwort, mallows, rosemary, with wood myrtle, St. John’s wort, each
half an ounce, spermatic two drachms; deer’s suet an ounce; with wax
make anointment. Or,
Take wax six ounces, spermaceti an ounce; melt them, dip flax therein,
and lay it all over her abdomen.
If none of these things will do, the last remedy is to use surgery, and
then the midwife ought without delay to send for an expert and able
man-midwife, to deliver her by manual operation; of which I shall treat
more in the next chapter.
CHAPTER VI.
_Of unnatural Labour._
In showing the duty of a midwife, when the child-bearing woman’s labour
is unnatural, it will be requisite to show, in the first place, what I
mean by unnatural labour; for that women do bring forth children in pain
and sorrow is natural and common to all. Therefore that which I call
unnatural is, when the child comes to the birth in a contrary posture to
that which nature ordained, and in which the generality of children come
into the world.
The right and natural birth is, when the child comes with its head
first; and yet this is too short a definition of a natural birth: for if
any part of the head but the crown comes first, so that the body follows
not in a straight line, it is a wrong and difficult birth, even though
the head comes first. Therefore, if the child comes with its feet first,
or with the side across, it is quite contrary to nature, or, to speak
more plainly, that which I call unnatural.
Now, there are four general ways a child may come wrong. 1. When any of
the fore parts of the body first present themselves. 2. When, by an
unhappy transportation, any of the hinder parts of the body first
present themselves. 3. When either of the sides, or, 4. the feet present
themselves first. To these the different wrong postures that a child can
present itself may be reduced.
SECT. I. _How to deliver a Woman of a Dead Child, by Manual Operation._
When manual operation is necessary, let the operator acquaint the woman
of the absolute necessity there is for such an operation; and that, as
the child has already lost its life, there is no other way left for the
saving of hers. Let him also inform her, for her encouragement, that he
doubts not, with the divine blessing, to deliver her safely; and that
the pain arising thereby will not to be so great as she fears. Then let
him stir up the woman’s pains by giving her some sharp clyster, to
excite her throes to bear down and bring forth the child. And if this
prevail not, let him proceed with the manual operation.
First, therefore, let her be placed across the bed that he may operate
the easier, and let her lie on her back, with her hips a little higher
than her head, or at least the body equally placed, when it is necessary
to put back or turn the infant to give it a better posture. Being thus
situated, she must fold her legs so as her heels be towards her body,
and her thighs spread, and held so by a couple of strong persons: there
must be others also to support her under her arms, that the body may not
slide down when the child is drawn forth; for which, sometimes, a great
strength is required. Let the sheets and blankets cover her thighs, for
decency’s sake, and with respect to the assistance, and also to prevent
her catching cold; the operator herein governing himself as well with
respect to his convenience, and the facility and surety of the
operation, as to other things. Then let him anoint the entrance of the
womb with oil or fresh butter, if necessary, that so with more ease he
may introduce his hand, which must also be anointed; and having, by the
signs before-mentioned, received satisfaction that the child is dead, he
must do his endeavours to fetch it away as soon as he possibly can. If
the child offer the head first, he must gently put it back, until he
hath liberty to introduce his hand quite into the womb; then sliding it
along to find the feet, let him draw it forth by them, being very
careful to keep the head from being locked into the passage, and that it
be not separated from the body; which may be effected the more easily,
because the child being very rotten and putrefied, the operator needs
not be so mindful to keep the breast and face downwards as he is in
living births. But if, notwithstanding all these precautions, by reason
of the child’s putrefaction, the head should be separated and left
behind in the womb, it must be drawn forth according to the directions
which have been given in the third section of this chapter. But when the
head, coming first, is so far advanced that it cannot well be put back,
it is better to draw it forth so, than to torment the woman too much by
putting it back to turn it and bring it by the feet: but the head being
a part round and slippery, it may so happen that the operator cannot
take hold of it by reason of its moisture, nor put them up to the side
of it, because of its bigness; he must therefore take a proper
instrument, and put it up as far as he can, without violence, between
the womb and the child’s head, observing to keep the point of it towards
the head (for the child being dead before, there can be no danger in the
operation,) and let him fasten it there, giving it hold of the bones of
the skull, that it may not slide; and after it is well fixed in the
head, he may therewith draw it forth, keeping the ends of his left hand
flat upon the opposite side, the better to help to disengage it, and by
wagging it a little, to conduct it directly out of the passage, until
the head be quite born; and then taking hold of it with the hands only,
the shoulders may be drawn into the passage, and so sliding the fingers
of both hands under the arm-pits, the child may be quite delivered; and
then the after-burden fetched, to finish the operation, being careful
not to pluck the navel-string too hard, lest it break, as often happens,
when it is corrupt.
If the dead child comes with the arms up to the shoulder so extremely
swelled that the woman must suffer too great violence to have it put
back, it is then (being first well assured that the child is dead) best
to take it off by the shoulder points, by twisting three or four times
about, which is very easily done by reason of the softness and
tenderness of the body. After the arm is so separated, and no longer
possesses the passage, the operator will have more room to put up his
hand into the womb, to fetch the child by the feet and bring it away.
But although the operator be sure the child is dead in the womb, yet he
must not therefore presently use instruments, because they are never to
be used but when hands are not sufficient, and there is no other remedy
to prevent the woman’s danger, or to bring forth the child any other
way; and the judicious operator will choose that way which is the least
hazardous and most safe.
SECT. II. _How a Woman must be Delivered, when the Child’s Feet come
first._
There is nothing more obvious to those whose business it is to assist
labouring women, than that the several unnatural postures in which
children present themselves at their birth, are the occasion of most of
the bad labour and ill accidents that happen unto them in that
condition.
And since midwives are very often obliged, because of the unnatural
situations, to draw the children forth by the feet, I conceive it to be
most proper first to show how a child must be brought forth that
presents itself in that posture, because it will be a guide to several
of the rest.
I know indeed in this case it is the advice of several authors to change
the figure, and place the head so that it may present to the birth; and
this counsel I should be very inclinable to follow, could they but also
show how it may be done. But it will appear very difficult, if not
impossible, to be performed, if we would avoid the danger that by such
violent agitations both the mother and the child must be put into; and
therefore my opinion is, that it is better to draw forth by the feet,
when it presents itself in that posture, than to venture a worse
accident by turning it.
As soon, therefore, as the waters are broken, and it is known that the
child comes thus, and that the womb is open enough to admit the
midwife’s or operator’s hand into it, or else by anointing the passage
with oil or hog’s grease, to endeavour to dilate it by degrees, using
her fingers to this purpose, spreading them one from the other, after
they are together entered, and continuing to do so till they be
sufficiently dilated, then, taking care that her nails be well pared, no
rings on her fingers, and her hands well anointed with oil or fresh
butter, and the woman placed in the manner directed in the former
section, let her gently introduce her hand into the entrance of the
womb, where, finding the child’s feet, let her draw it forth in the
manner I shall presently direct; only let her first see whether it
presents one foot or both; and if but one foot, she ought to consider
whether it be the right foot or left, and also in what fashion it comes:
for, by that means, she will soon come to know where to find the other,
which, as soon as she knows and finds, let her gently draw it forth with
the other; but of this she must be especially careful, viz. that the
second be not the foot of another child; for, if so, it may be of the
utmost consequence, for she may sooner split both mother and child, than
draw them forth: but this may be easily prevented, if she but slide the
hand up by the first leg and thigh to the twist, and there find both
thighs joined together, and descending from one and the same body. And
this is also the best means to find the other foot, when it comes but
with one.
As soon as the midwife has found both the child’s feet, she may draw
them forth, and holding them together, may bring them by little in this
manner; taking afterwards hold of the arms and thighs, as soon as she
can come at them, drawing them so till the hips come forth. While this
is doing, let her observe to wrap the parts in a single cloth, that so
her hands, being always greasy, slide not on the infant’s body, which is
very slippery, because of the vicious humours which are all over it;
which being done, she may take hold under the hips, so as to draw it
forth to the beginning of the breast; and let her on both sides with her
hand bring down the child’s hand along its body, which she may easily
find; and then let her take care that the belly and face of the child be
downwards: for, if they should be upwards, there would be some danger of
its being stopped by the chin, over the share-bone; and therefore, if it
be not so, she must turn it to the posture; which may easily be done, if
she takes proper hold of the body when the breast and arms are forth, in
the manner as we have said, and draws it, turning it in proportion on
that side which it most inclines to, till it be turned with the face
downwards; and so, having brought it to the shoulders, let her lose no
time, desiring the woman at the same time to bear down, that so drawing
the head at that instant may take its place, and not be stopped in the
passage. Some children there are whose heads are so big, that when the
whole body is born, yet that stops the passage, though the midwife takes
all possible care to prevent it. And when this happens, she must
endeavour to draw forth the child by the shoulders, taking care that she
separate not the body from the head, (as I have known it done by the
midwife,) discharging it by little and little from the bones in the
passage with the fingers of each hand, sliding them on each side
opposite the other, sometimes above and sometimes under, till the work
be ended; endeavouring to despatch it as soon as possible, lest the
child be suffocated, as it will unavoidably be, if it remain long in
that posture; and this being well and carefully effected, she may soon
after fetch away the after-birth, as I have before directed.
SECT. III. _How to bring away the Head of the Child, when separated from
the Body, and left behind in the Womb._
Though the utmost care be taken in bringing away the child by the feet,
yet if it happen to be dead, it is sometimes so putrefied and corrupt,
that with the least pull the head separates from the body, and remains
alone in the womb, and cannot be brought away but with a manual
operation and great difficulty, it being extremely slippery, by reason
of the place where it is, and from the roundness of its figure, on which
no hold can be taken; and so very great is the difficulty in this case,
that sometimes two or three able practitioners of midwifery have, one
after the other, left the operation unfinished, as not able to effect
it, after the utmost industry, skill and strength; so that the woman,
not being able to be delivered, perished. To prevent which fatal
accident, let the following operation be observed.
When the infant’s head separates from the body, and is left alone
behind, whether through putrefaction or otherwise, let the operator
immediately, without any delay, whilst the womb is still open, direct up
his right hand to the mouth of the head (for no other hole can there be
had), and having found it, let him put one or two of his fingers into
it, and the thumb under its chin; then let him draw it by little and
little, holding it by the jaws: but if that fails, as sometimes it will,
when putrefied, then let him pull out the right hand, and slide up his
left with which he must support the head, and with the right let him
take a narrow instrument called a _crotchet_, but let it be strong, and
with a single branch, which he must guide along the inside of his hand,
with the point of it towards it, for fear of hurting the womb; and
having thus introduced it, let him turn it towards the head, to strike
either in an eye-hole, or the hole of an ear, or behind the head, or
else between the sutures, as he finds it most convenient and easy; and
then draw forth the head so fastened with the said instrument, still
helping to conduct it with his left hand; but when he hath it brought
near the passage, being strongly fastened to the instrument, let him
remember to draw forth his hand, that the passage, not being filled with
it, may be larger and easier, keeping still a finger or two on the side
of the head, the better to disengage it.
There is also another method, with more ease and less hardship than the
former: let the operator take a soft fillet or linen slip, of about four
fingers’ breadth, and the length of three quarters of an ell, or
thereabouts, taking the two ends with the left hand, and the middle with
the right, and let him so put it up with his right as that it may be
beyond the head, to embrace it as a sling doth a stone, and afterwards
draw forth the fillet by the two ends together; it will thus be easily
drawn forth, the fillet not hindering the least passage, because it
takes up little or no space.
When the head is fetched out of the womb, care must be taken that not
the least part of it be left behind, and likewise to cleanse the womb of
the after-burden, if yet remaining. If the burden be wholly separated
from the side of the womb, that ought to be first brought away, because
it may also hinder the taking hold of the head. But if it still adheres
to the womb, it must not be meddled with till the head be brought away;
for if one should endeavour to separate it from the womb, it might then
cause a flooding, which would be augmented by the violence of the
operation; the vessels to which it is joined remaining for the most part
open as long as the womb is distended, which the head causeth while it
is retained in it, and cannot be closed till this strange body be
voided, and this it doth by contracting and compressing itself together,
as has been more fully before explained. Besides, the after-birth
remaining thus cleaving to the womb during the operation prevents it
from receiving easily either bruise or hurt.
SECT. IV. _How to deliver a Woman when the Child’s Head is presented to
the Birth._
Though some may think it a natural labour, when the child’s head comes
first; yet, if the child’s head present not the right way, even that is
an unnatural labour; and therefore, though the head comes first, yet if
it be the side of the head instead of the crown, it is very dangerous
both to the mother and child, for the child’s neck would be broken, if
born in that manner; and by how much the mother’s pains continue to bear
the child, which is impossible unless the head be rightly placed, the
more the passages are stopped. Therefore, as soon as the position of the
child is known, the woman must be laid with all speed, lest the child
should advance further into this vicious posture, and thereby render it
more difficult to thrust it back, which must be done, in order to place
the head right in the passage, as it ought to be.