MIDWIFERY
AND THE
DISEASES OF WOMEN
=A Descriptive and Practical Work=
SHOWING THE SUPERIORITY OF WATER-TREATMENT IN MENSTRUATION AND ITS
DISORDERS, CHLOROSIS, LEUCORRHEA, FLUOR ALBUS, PROLAPSUS UTERI,
HYSTERIA, SPINAL DISEASES, AND OTHER WEAKNESSES OF FEMALES; IN PREGNANCY
AND ITS DISEASES, ABORTION, UTERINE HEMORRHAGE, AND THE GENERAL
MANAGEMENT OF CHILDBIRTH, NURSING, ETC., ETC.
=Illustrated with numerous Cases of Treatment.=
BY JOEL SHEW, M. D.,
AUTHOR OF VARIOUS WORKS ON HYDROPATHY.
NEW YORK:
FOWLERS AND WELLS, PUBLISHERS,
NO. 308 BROADWAY.
LONDON: 142 Strand.
BOSTON: │ 1856 │ PHILADELPHIA:
No. 142 Washington St. │ │ No. 231 Arch Street.
Entered, according to Act of Congress, in the year 1852, by JOEL SHEW,
in the Clerk’s Office of the District Court of the United States for the
Southern District of New York.
INTRODUCTION.
Concerning matters pertaining to midwifery, friends of Water-Cure
sometimes ask questions like the following:
1. What methods of treatment shall we adopt to enable us the better to
pass through the period of pregnancy?
2. What methods to aid in mitigating the pains and perils of childbirth?
3. Shall we employ a physician on such occasions?
4. If so, shall it be a male or female practitioner?
As regards the first and second of these queries collectively, I remark,
that in 1843 I commenced the practice of midwifery according to the
hydropathic plan, and have, from time to time since that period,
published articles on the subject of pregnancy and childbirth, and have
put forth, also, a small work which has had a wide circulation, and been
the means of doing some good. There is, doubtless, no branch or
department of the medical art in which a judicious regulation of water,
air, exercise, and diet, are more strikingly beneficial than in that now
under consideration. I would speak earnestly on this point, and as to
the truthfulness of what I affirm, I may confidently refer to the
experience of those who have a knowledge of the subject—_to those who
have themselves experienced the effects of hydropathy_. We do _not_ hear
persons say, “We have resorted to the water-treatment in childbirth and
have found it to be an injury to us;” but on the contrary, we _do_ hear
it said, “We had borne a number of children under the old methods,
suffering at each time more than mortal tongue can describe; but now,
since we have become informed on the subject of Water-Cure, we find
childbirth—hard as it necessarily is—a much more easy thing to bear.” I
repeat, the _uniformity of the testimony_ in favor of water-treatment
among those who have in their own persons tested it, is remarkable and
without parallel in the healing art.
But I must here allude to the fact, that different practitioners in the
new system must, some of them at least, entertain honest differences of
opinion in regard to the hydropathic uses of water in pregnancy and
childbirth. One tells us that too much bathing is usually practiced on
such occasions; another that too little is done. One tells us that water
patients are everywhere allowed to get up _too soon_ after childbirth;
another that they are kept in bed too long. One says that the vagina
syringe is almost the all in all for woman kind, and would almost make
us believe that women were made for syringes, and not syringes for
women. Another says that the vagina syringe, so far as labor and the
getting up are concerned, is at best comparatively only a poor affair;
that it is not in accordance with the principles of sound physiology or
pathology to throw _cold water_ upon any bleeding surface—external or
internal of the body; that the use of the vagina syringe is revolting to
the feelings of nine tenths of all midwifery patients who have had it
used; that so far as the limited experience of hydropathic practitioners
extends in this department, it would appear that those who have not in
their practice thus used cold water internally, have had, at least, as
good success as those who have.
In regard to preventing the “pains and perils” of childbirth, there
seems likewise to be some differences of opinion among the water
doctors, so called. Some who are, as it were, just commencing the
practice, and have more zeal than knowledge in the matter, would have us
believe that water almost wholly prevents the pains of parturition and
the perils thereof. But there are others who maintain, that do what we
will, labor must, as a general fact, be attended with severe suffering;
that as a mere palliative of pain at the time of labor, little can be
claimed for water; that labors are not, probably, on the whole,
shortened by the use of water either before or at the time; that very
short labors are not probably, more frequent in the new than in the old
way; that very quick labors are not desirable, since experience teaches
that they are not so safe as those which are more protracted. It is
maintained, too, that say what we may, childbirth is, and must
necessarily be, in all civilized societies, a serious thing to enter
upon. What woman who has ever passed through this ordeal does not regard
it so? and what physician, no matter how old, or experienced, or
skillful he may be, does not, every time he enters the lying-in chamber,
feel this responsibility to be a great and trying one? Admitting all
that can be done by the water-treatment in matters of midwifery, and
much, very much, certainly may be—childbirth is yet an agony, and must
ever continue so to be.
Various other points might be mentioned in which there is honest
disagreement of opinion among hydropathists. This must, in the nature of
the case, be so. Nor should such disagreements make us enemies toward
each other. One thing is remarkable, and speaks volumes for the new
method, namely, _the good success that everywhere attends it_.
Respecting our third question—Shall we employ a physician on occasions
of childbirth? I remark that people should, themselves, be the judges.
If you possess the courage that I have seen exhibited among the
peasantry of the Silesian mountains of Germany, you may get along almost
without an assistant of any kind. There childbirth is looked upon in a
light very different from what we see in our own country. If, moreover,
you can, by great and continuous effort, arrive at the degree of
physical hardihood and strength which is possessed by those vigorous,
out-of-door working females to whom I have referred, then you may, as a
general thing, get along safely without the aid of a physician. But
things are different with us here; we are not to expect that our females
will, for generations to come, be as hardy and enduring as the peasant
women of many parts of the old world.
In this country we find that the younger married people are more apt
than the older to resort to water-treatment in childbirth. I imagine I
am addressing myself to a young couple, who hope soon to become parents.
They have talked the matter over, and resolve that they will try to get
along without a doctor of any kind. I say to them, Young friends, you
are about to pass through a matter which you can know but very little
about beforehand. Would it not be safer to get a physician into your
house, at least? Pay him for his time accordingly as you are able, and,
mark my word, he will be very willing to stay in the parlor, kitchen,
anywhere, if you do not need him. If it be in the night, get him off to
bed, and tell him you will call him when needed. Thus you will both feel
safer than if he were away. You might need him very much before morning,
and possibly when it would be too late to get him from a distance. Once
the birth is over, and the mother rested a little, he will allow at
least a tepid sponging; and the word tepid allows a good deal of
latitude, so that the water may be taken quite cool. Besides, too, once
you have got the liberty to do it, you can repeat it often. By so doing
the doctor will be astonished to find how well you get along.
Should male or female physicians be employed in midwifery? This is a
bone of contention with many. The facts are these: the world got along
anciently very well without physicians, or, at most, with those only who
were rude and untaught in schools. I do not know that we have statistics
enough to prove much in regard to the question, as to whether the world
is more thriving with or without physicians; and as to whether male or
female midwives are more successful, the great Dr. Rush—who was
certainly a most candid and liberal-minded man, and in all particulars
not only in favor of human right, but of “woman’s rights,” of which we
nowadays hear so much—tells us “that it appears from the bills of
mortality in London and Dublin, that about one in seventy of those women
die in childbirth who are in the hands of female midwives; but from the
accounts of the lying-in-hospitals in those cities which are under the
care of man-midwives, only one in a hundred and forty perishes in
childbirth.” But admit that the female doctors in those cities are not
properly educated, or so well educated in their calling as the men are—a
thing, however, which does not appear—it is not yet proved to us that
males should not practice in this department.
The broad ground I take on this subject is this: educate THE PEOPLE in
all matters pertaining to health; let physiology and hygiene be taught
at the fireside and in the schools as much as any other science. At a
proper age let both sexes throughout be taught all that may be
concerning pregnancy and childbirth; and, all this accomplished, let
those of both sexes practice whom skill, talent, and experience dictate.
Educate the PEOPLE, and they will find out soon enough who are the most
competent, and who are not, to practice the healing art.
As to the talk we hear so much of at this day about _the indecency of
man-midwifery_, it is idle twattle, that scarce needs a remark. Indecent
for a man to get up of a cold, wet night, and attend a poor, suffering
woman in labor, and night after night, as not unfrequently happens!
Indecent for us to resort to the use of instruments with which to
destroy the life of the unborn child, in order to save that of the
mother, as must sometimes, with the best possible management, be done!
Away with all such foolishness, and the worse than false modesty which
dictates it! They ought to take shame on themselves who utter it.
Yes, friends, I will tell you in a word how I feel in this matter. When
I was born, my most worthy mother was very young. I was her first child.
And since I have come to years of understanding, and often when I have
attended women in childbirth, I have thought it was not possible for me
to be thankful enough to that good old man—and who is yet living—for
attending my mother at my birth, young and inexperienced as she was; and
although I know that I could now teach him some things, which in his
hoary age he does not at all understand, I have yet often felt in my
heart that I would go leagues long to take him by the hand, that I might
thank him for the good he had done.
Depend upon it, friends, there are only two things that can induce _men_
to practice midwifery; and these are, first, that it may be necessary
for a man so to do, in order to get his living; and, secondly, if he be
a benevolent man, he will most gladly relieve suffering, if he can be
the means of doing so. And do not physicians, almost to a man, the world
over, attend the poor in childbirth, gladly and willingly, when they
know they are to receive from them no pay whatever, except such as God
gives them?
Is it said that man-midwifery leads to licentiousness? I answer, go to
the veterans of the “godlike art”—those who have toiled long and hard in
their calling, and who will not consent to relinquish it so long as
their powers of body will allow them to pursue it, and ask them to tell
you candidly, if the practice of midwifery has made them bad and
unprincipled men? Mark, they will tell you, “No; but rather our
knowledge of woman’s sufferings, and the pains and perils which we have
but too well and sadly often learned that it is her lot to endure, have
chastened us, and made us more what we ought to be.”
Suppose that now and then it may happen—as a rare exception to the rule,
it is true—that a physician conducts himself in a lascivious way before
a patient, are we for this reason to call all physicians bad men? Do we
not also hear of bad men among clergymen? And because there is now and
then a bad one in the clerical profession, are we to scout them
altogether, and say they shall never preach to or converse with women?
I wish, therefore, to be understood, that I speak in strong terms
against the foolishness of the cry we so often hear against
man-midwifery. On the other hand, too, let it be understood, that I
never have and never shall object to female midwives; the more of them
the better, if they become properly qualified, and women choose. I know
something of the benevolence, sympathy, kindness, and assiduity of woman
in her care of the sick. We attend a man at a New York boarding house,
lonely in the world, without wife or children, or brother or sister to
console him in the day of his disease. Death lays hold of him in the
morning, and takes away his senses, and all the long day, as he still
breathes on, with the cold sweat upon him, the women of the house gather
about him, watching anxiously, tearfully, for the last death agony to
come. All this have I witnessed, here in this city of New York; and far
be it from _me_ to withhold from WOMAN any share which it may be her
duty or privilege to perform in that noblest of earth’s callings, the
attendance of the sick.
I do not, however, wish to conceal the fact, that I do not believe woman
will ever, as a general thing, in any well-regulated society, practice
the healing art. I give her all credit for her purer and more devoted
sympathy with the sick, for her kindness and benevolence, as well as for
her capability of acquiring science. But I do not believe that it is her
mission to pursue that toilsome and life-wearing calling, which
requires, oftentimes, the exercise of all the sterner faculties and
powers, mental and physical, of the stronger sex. In the city of Paris,
women, so far as I am acquainted, have had equal medical privileges to
those of men; and yet the great proportion of medical practice is done
by the latter.
In referring to the following letters it will be seen that I have
presented some very striking facts illustrative of the effects of water
in childbirth. But it may be asked—Do you have no _unfavorable_ cases in
water-treatment? I answer, yes. A few months ago it was my lot to advise
a most worthy lady, of active and industrious habits, in this city, in
her third pregnancy, and to attend her in childbirth. Owing to
mal-position of the child, the face presenting forward instead of
backward, as it should, to answer to the wider part of the pelvis, the
labor was a very severe and protracted one. She suffered incomparably
more than she had in both her former confinements. Expecting to have to
resort to the use of instruments, I went for them late in the night; but
before returning nature had done her own work. The child’s head,
however, was dreadfully misshapen in consequence of the wrong
presentation, and the result was, it soon had a sort of convulsions,
which, after some weeks of suffering, carried it off.
Another sad case, too, has happened while I am preparing these letters
for the press. A most estimable lady of this city, in whom I had for
years felt a deep interest, and who was one of the most devoted friends
the Water-Cure has ever had, was for the third time pregnant. She had
probably always been scrofulous, and a good deal subject to disease. She
had, moreover, an old rupture, which at this time was so bad she could
not sit up. Such, at least, was her state, for the most part, during the
last three or four months she lived. She became very weak, and at about
the end of the sixth month of her period she sank. I had not the whole
charge of her case, it is true, toward the last, for she was willing, at
the most urgent solicitation of her friends, to resort to means which I
could not approve of. My candid opinion is, that she would have died,
whatever treatment might have been pursued.
If my words are to be believed, it will be seen that I have very great
confidence in the Water-Cure. But if I know my own heart, I would in
nowise overstate the truth; nor would I knowingly, for my right hand and
my left, say that which would mislead either myself or my readers, or
make us presumptuous toward that Being who alone can sustain us, and
whose paternal care is ever over us, giving us every thing we
have—mercy, blessing, and health.
I have not in the following letters spoken particularly of the treatment
of spinal disorders. The subject is a most fruitful one, upon which a
volume might be written. You are already, many of you, aware of the
fact, that almost all of the young ladies who attend boarding-schools
nowadays are more or less crooked in the spinal column. The ill hygienic
management they receive from birth onward at home, and their too great
confinement in schoolrooms, too often badly ventilated, renders the
young and growing body of the girl too feeble to maintain itself in its
proper position. The brain is likewise too much drawn upon in the mental
exercises, which also causes debility of the bodily structures.
In after-life, as well, we see among females a great deal of complaining
nowadays in regard to the spine. How few of the sex, indeed, do not,
sooner or later, suffer with some form of spinal infirmity! True, in
many cases the difficulty at the vertebral column is only sympathetic
with some other disorder, as of the womb, stomach, bowels, etc. Yet
spinal disease, in some of its protean forms, is a very common
complaint.
In all cases of this kind, the water-treatment will be found an
invaluable remedy; not that all can be cured—for that is not possible by
any earthly means—but as a remedy for either cure, prevention, or
palliation, water is the greatest of all remedies for spinal disease. In
multitudes of instances, when the patient cannot walk, the new method
proves an effectual one. In other cases, palliation is all that can be
hoped for.
In multitudes of instances of so-called spinal disease, all that is
needed is to establish the general health. Patients have often wondered
how it is that by simply pursuing a course of _general_ treatment the
_local_ part becomes so much benefited. The reason why a weak spine is
often cured without any special applications to the part, appears
evident when we consider that the local weakness is merely symptomatic
of the general health.
J. S.
NO. 98 FOURTH AVENUE, NEW YORK, 1852.
CONTENTS.
INTRODUCTION Page v
LETTER I.
HISTORY OF MIDWIFERY.
The Art of Midwifery in Ancient and Modern Times—To what extent
may the Perils of Childbirth be Lessened? 19
LETTER II.
OF MENSTRUATION.
Puberty—The Menstrual Discharge—The Marriageable Age 34
LETTER III.
OF MENSTRUATION.
The Menses—Names—Source—Commencement—Periodicity—Nature—Quantity
of the Menstrual Discharge 40
LETTER IV.
OF MENSTRUATION.
Cessation of the Menses—Turn of Life—Management at this Period 49
LETTER V.
OF MENSTRUATION.
Tardy and Suppressed Menstruation—Chlorosis—Sudden Check of the
Menses 61
LETTER VI.
OF MENSTRUATION.
Menorrhagia and Dysmenorrhea—Their Nature and Treatment 81
LETTER VII.
SIGNS OF PREGNANCY.
Importance of the Subject—Difficulties of ascertaining Pregnancy
in some Cases—Means by which it is to be Known 92
LETTER VIII.
DURATION OF PREGNANCY.
Difficulties of Ascertaining it—Rules by which it is to be
Known—At what Age can a Fetus Live? 99
LETTER IX.
MANAGEMENT IN PREGNANCY.
Importance of Attention to the Health at this Period—Clothing,
and its Effects—How to Regulate it 108
LETTER X.
MANAGEMENT IN PREGNANCY.
Of Solar Light—Its Effects on Life and Health—Air and
Exercise—Rules of Management 118
LETTER XI.
MANAGEMENT IN PREGNANCY.
Of the Diet Proper in this Period—Animal and Vegetable
Food—Superiority of the latter—The Drink 123
LETTER XII.
DISORDERS OF PREGNANCY.
Nausea and Vomiting—Means of Prevention, and Cure Page 132
LETTER XIII.
DISORDERS OF PREGNANCY.
Fainting—Its Causes—Symptoms—Results—Treatment 139
LETTER XIV.
DISORDERS OF PREGNANCY.
Abortion—Its Nature and Ill Effects—Its Causes—Means of
Prevention 143
LETTER XV.
DISORDERS OF PREGNANCY.
The Evils of Abortion—The great Danger of bringing it on
purposely—Cases—Illustrations of the Methods of Cure—Uterine
Hemorrhage—Cases of Cure 152
LETTER XVI.
DISORDERS OF PREGNANCY.
Its Febrile Condition—Acute
Disease—Sleeplessness—Heart-burn—Constipation—Diarrhea—Piles
and Hemorrhoids—Their Treatment 165
LETTER XVII.
DISORDERS OF PREGNANCY.
Headache: the Nervous and the Plethoric kinds—Stye in the
Eye—Salivation—Hemorrhage from the Stomach—Cramp of the
Stomach—Toothache—Jaundice 179
LETTER XVIII.
DISORDERS OF PREGNANCY.
Difficulty of Breathing—Pain in the Right Side—Itching of the
Genitals—Swellings of the Limbs—Cramps of the lower
Extremities—Pain of the Breasts—Hysteria—Physical
Hindrances—Exposure to Disease 190
LETTER XIX.
DISORDERS OF PREGNANCY.
Nervousness—Mental Despondency—Longing—The Imagination—Effects
of Fright Page 200
LETTER XX.
DRUG-TREATMENT IN PREGNANCY.
Effects of Blisters—Emetics—Purgative Medicines—Bleeding 218
LETTER XXI.
STERILITY OR BARRENNESS.
Their Causes—The Catamenial Discharge as affecting it—Fluor
Albus—Corpulency—The Treatment appropriate in these Cases 224
LETTER XXII.
THE PELVIS AND ITS ORGANS
General Description—Differences between the Male and Female
Pelvis—The Bladder and Urethra—The Vagina—The Uterus and its
Appendages 229
LETTER XXIII.
ANATOMY OF THE FETUS.
Its Length and Weight—Its Osseous, Muscular, and Vascular
Systems—The Fetal Circulation—Nervous System—Organs of
Sense—Its Lungs, Heart, and other Internal Organs 243
LETTER XXIV.
PHENOMENA OF LABOR.
Meaning of the Term—Its Divisions—Duration—Is Pain a Natural
Condition of Labor?—Ether and Chloroform 253
LETTER XXV.
MANAGEMENT OF LABOR.
Its Premonitory Signs—Progress of Labor—Its Different Stages—Age
as Affecting it 260
LETTER XXVI.
MANAGEMENT OF LABOR.
The Placenta, or After-Birth—The Membranes—Management of the
After-birth—Rules for Extracting it—Of Flooding after Delivery
Page 272
LETTER XXVII.
ADVICE CONCERNING LABOR.
The Medical Attendant—State of Mind—The Room—State of the
Bowels—The Dress—The Bed—The Position, Exercise, Food, and
Drink 280
LETTER XXVIII.
MANAGEMENT AFTER DELIVERY.
Importance of Attention to this Period—Evils of too much
Company—Bathing—The Bandages, Compresses, etc.—Sleep—Sitting
up soon after the Birth—Walking about—The Food and Drink 285
LETTER XXIX.
MANAGEMENT OF THE CHILD.
Of Separating the Umbilical Cord—Practices of different
Nations—Of Still-Birth, and Resuscitation of the Child—Washing
and Dressing it 292
LETTER XXX.
HYGIENE OF NURSING.
Lactation a Natural and Healthful Process—Rules for Nursing—At
what time should Lactation cease?—Food and Drink proper during
the Period 308
LETTER XXXI.
OF TWINS, TRIPLETS, ETC.
Twins, Triplets, and Quadrigemini of comparatively rare
Occurrence—Of the Signs of two or more Children in the
Womb—Management of Twin and Triplet Cases—The Nursing of Twins 316
LETTER XXXII.
TREATMENT OF AFTER-PAINS.
The Nature of After-Pains—The different Kinds—Their
Causes—Treatment—The great Value of Water-Cure Page 328
LETTER XXXIII.
THE LOCHIAL DISCHARGE.
The Mosaic Law concerning Purification of Women—Nature of the
Lochia—Excessive and Offensive Discharge—Treatment of
Suppression of the Lochia 336
LETTER XXXIV.
OF CHILDBED FEVER.
Milk Fever as distinguished from Puerperal Fever—The great
Danger of Childbed Fever—Its Symptoms and Nature—Modes of
Treatment—Is it a Contagious Disease? 342
LETTER XXXV.
OF SORE NIPPLES.
This Complaint is a very common one—Its Causes—Methods of
Prevention and Cure 362
LETTER XXXVI.
INFLAMMATION OF THE BREAST.
Structure of the Mammary Gland—Nature and Causes of Inflamed
Breast—Means of Prevention and Cure 370
LETTER XXXVII.
CASES IN MIDWIFERY.
A Collection of Facts Illustrative of the Effects of
Water-Treatment before, during, and after Childbirth 383
LETTER XXXVIII.
CONCLUDING REMARKS.
Hysteria—Its Prevention and Cure—Leucorrhea, or Whites—Falling
of the Womb 428
LETTERS TO WOMEN
LETTER I.
HISTORY OF MIDWIFERY.
The Art of Midwifery in Ancient and Modern Times—To what extent may the
Perils of Childbirth be Lessened?
Midwifery is the art of aiding women in childbirth. In some mode—rude,
simple, or complex—it has been practiced in all ages of the world.
According to the records of medicine, however, the great mass of the
human family has been born and brought up without the aid of the
so-called obstetrical science of modern times. The ruder nations
anciently, as well as the savage nations in later times, appear to have
exhibited, practically at least, a much greater confidence in the
prophylactic and healing powers of nature than we see among the more
civilized and enlightened portions of our race.
But let us, for a little, glance at midwifery as it has existed at
different periods of the world.
We read in the Book of Genesis, chapter thirty-fifth, that as Jacob and
Rachel were journeying from Bethel, Rachel travailed, and had a hard
labor.
“And it came to pass, when she was in hard labor, that the midwife said
to her, Fear not, thou shalt bear this son also.
“And it came to pass, as her soul was departing (for she died), that she
called his name Ben-oni: but his father called him Benjamin.
“And Rachel died, and was buried in the way to Ephrath, which is
Bethlehem.”
In the twenty-fifth chapter of Genesis, Moses informs us that Rebekah,
who had been barren, conceived, being the wife of Isaac.
“And when her days to be delivered were fulfilled, behold, there were
twins in her womb.
“And the first was born red, all over like a hairy garment: and they
called his name Esau.
“And after that his brother was born, and his hand took hold on Esau’s
heel: and his name was called Jacob.”
The birth in this case appears to have been a natural one, in which the
children followed each other in quick succession.
We read also in the thirty-eighth chapter of Genesis, the case of Tamar,
who bore twins, being attended by a midwife.
“And it came to pass, in the time of her travail, that, behold, twins
were in her womb.
“And it came to pass, when she travailed, that the one put out his hand;
and the midwife took and bound upon his hand a scarlet thread, saying,
This came out first.
“And it came to pass, as he drew back his hand, that, behold, his
brother came out; and she said, How hast thou broken forth? this breach
be upon thee: therefore his name was called Pharez.
“And afterward came out his brother that had the scarlet thread upon his
hand; and his name was called Zarah.”
Some have supposed that this was a case of spontaneous evolution of the
fetus, a thing which has been known to occur in modern practice, proving
that nature sometimes works in a very wonderful manner in these
circumstances. It is certainly a very singular fact for the hand of one
child to recede after coming into the world, and the other child to be
born first.
The Hebrew women, when in captivity, had, as we read, two midwifes,
Shiphrah and Puah. These were commanded by Pharaoh, that when they did
the office of a midwife to the Hebrew women, if a son should be born,
they should kill him. But the midwives feared God, and did not as the
king of Egypt had commanded them, but saved the male children alive.
The period of suckling appears to have been prolonged, in Bible times,
to a much greater length than it is in modern times. In the Apocrypha,
the woman says to the son, “I, who gave thee suck _three_ years.”
Profane writers, prior to the time of Hippocrates, give little account
of the art of midwifery; and from the time in which the Father of
Medicine lived, down to a comparatively recent date, little was said or
known concerning it as an art.
Dr. Francis informs us, that toward the latter part of the sixteenth
century, a Dr. Raynald published in England a work, the first of the
kind that had appeared in that country, which he called the “Garden of
Lying-in Women and Midwives.” It was afterward translated into the
Latin, and most of the modern languages, and became the manual of
instruction for females. “The popular prejudice was so great at that
time in favor of female practitioners,” observes Dr. Francis, “that an
unfortunate physician of Hamburgh was publicly branded, whom curiosity
had induced to be present at a delivery, in female attire.”
Still quoting from Dr. Francis, we learn, concerning this old work, the
following particulars: “In his prologue to women readers, he states that
the byrth of mankynd doth mostly concern and touch only women, and that
he hath declined nothing at all from the steps of his Latin author, but
that many things are newly added to this boke. In his first part of the
work he gives the anatomy of the inward parts of women; in the second,
he declares the divers sorts and manners of the deliverance or birth of
mankind. In the third, he treats of the election and choice, by signs
and tokens, of a good nurse, which may foster and bring up the child,
being born. In the fourth and last, he communes of conception, with the
causes hindering or furthering the same, showing the councils and
remedies whereby the unfruitful may be made fruitful, and the
impediments of conception, by virtue of medicines, removed. He solicits
the favor of the reader to good acceptance of his labor and pains spent
in compiling these aforesaid matters. He invocates all the nine muses of
Helicon, with their poetical spirit, to breathe over this his boke,
against the strange, perverse, and wayward wits who would desire this
performance to be suppressed and kept in darkness, rather than that it
be sent forth into the light. There is nothing, he says, that may not be
abused and turned to evil, even meat and drink; but that to the good
every thing turneth to good. He is fearful that the medicines he
recommends may be abused; that light persons ought not to read his boke,
and some would that neither honest nor dishonest should have it. He
adds, every one may read it; because no one shall become by it either
lewd, unhappy, or knavish. The consideration which prompted the
publication he declares to be on account of the manifold, daily, and
imminent dangers, which all manner of women, of what estate or degree
soever they be, in their labors, do sustain and abide, even with peril
of their lives. He considers it to be a charitable and laudable deed,
and thankfully to be accepted of all honorable and other honest matrons,
if this little treatise were made to speak English, as it hath been long
taught to speak Dutch, French, Spanish, and divers other languages.
“He enjoins that ladies and gentlemen have this boke in their hands, and
cause such parts of it to be read before the midwife and the rest of the
women present in labor, whereby the laboring woman may be greatly
comforted and alleviated in her travail. And though some midwives would
have this boke forbidden, yet, he adds, the good need not be offended,
though the evil-hearted endeavored to make it that it was nothing worth,
and that he hath exposed the secrets and privities of women, so as that
even boys read his boke openly, as the tales of Robin Hood.
Notwithstanding all these accusations, he trusts that all good midwives
would be glad of his work, because of their familiar knowledge, and that
others of them such as could read, would read it themselves, and laud it
as its merits deserve.”
In regard to the employment of men as midwives in France, it appears
that in 1663, the Duchess de Villiers was delivered by the assistance of
Julien Clement, a professor of surgery in Paris. He was soon after
appointed to the office of midwife to the Princess of France.
The princess, it is said, had some scruples in regard to employing
Clement. As she desired it might be kept a profound secret, she sent for
him, he being a surgeon of great reputation; and he was conducted with
the greatest secrecy into a house where the lady was, with her head
covered with a hood. The same surgeon was employed in subsequent labors
of the same lady, and the princesses made use of surgeons on similar
occasions; and as soon as it became fashionable, the name of
_accoucheur_ was invented to signify that class of surgeons. Foreign
countries soon adopted the custom, and likewise the name of
_accoucheurs_, for they had no such term in their own language; but in
Great Britain they have more generally been termed midwives.
Dr. William Shippen, of Philadelphia, a very worthy citizen and
exemplary man, had the honor of being the first teacher of midwifery in
the United States. In London he enjoyed the advantages of the
instructions of the celebrated Dr. William Hunter, and on his return to
his native country he was chosen professor of anatomy in the earliest of
its medical schools, the University of Pennsylvania. His lectures on
obstetrics, like those upon anatomy and surgery, are said to have
evinced great ability and command over his auditory. His first course on
midwifery was delivered in 1762, and was attended by only ten pupils.
He, however, lived to give instructions to a class of two hundred and
fifty. This leads me to the reflection, will those who now advocate the
employment of females principally in midwifery, even when the country
has grown many times larger in numbers than it then was, meet with one
half the success that Dr. Shippen did? If so, may it be, and Heaven
speed the right.
In the year 1767 the first medical school of New York was founded, under
the auspices of Kings, now Columbia College. Among the appointments to
that institution was Dr. John V. B. Tennant as professor of obstetrics.
It is said that he was a very worthy man and of good reputation. He died
at an early age, of the yellow fever, in the West Indies, where he had
gone for his health. Since the time of Drs. Shippen and Tennant,
midwifery has been taught as an important part of medical education in
all of the medical colleges in the United States.
In China the practice of midwifery is regulated in a very good way
certainly; and on the whole, the Chinese custom is to be regarded as a
safe one. It, however, recognizes the superiority of man’s intellect,
nerve, mechanical skill, to that of woman’s, in scenes of trial and
danger. The custom is this: Female midwives attend in all ordinary
cases; but there is a class of obstetric surgeons which is devoted
exclusively to this department, is perfectly skilled in the use of
instruments, and the management of every possible difficulty. One of
these is located in each particular district, having a given number of
inhabitants, and after a woman has been a certain number of hours in
labor, the child not being yet born, the midwife is required by law to
call in the obstetric surgeon. Thus it is, I repeat, that man’s
superiority over woman’s, in ability to perform great and difficult
operations, is recognized even in China. Nor is it to be supposed that
it is in the most difficult cases only that the male practitioner is
called in that country, because many a woman has, on the whole, a safe
labor which is yet a good deal protracted.
It is said that in Russia the obstetric branch of the medical art is
practiced for the most part by females. They are educated at the
government’s expense, and are said to be very skillful in their art. We
are not, however, in the habit of looking to Russia as a country eminent
in civilization and the arts.
It is admitted that a great majority of the human family, from the
beginning of the world down, have been born by the aid of female
midwives only, or without there being any assistant whatever at the
birth, as is still the case with some of the savage tribes. At the
present day even, of all births that take place in the world at large,
probably not one out of twenty is superintended by a male practitioner.
But all of this proves nothing in regard to the question, as to whether
it is better for men or women to be employed in such practice. It proves
to us the competency of nature to do, as a general thing, her own work.
But to say that it proves that males should never practice midwifery,
would be as absurd as to affirm that railroads, steamships, and magnetic
telegraphs ought never to be brought into use. But I have already spoken
on this subject in my introductory letter, and need not here enlarge
upon it.
The question regarding the extent to which the pains and perils of
childbirth may be modified by the voluntary habits of individuals and
nations, and by the appliances of art, is one of the greatest importance
to society, a subject which has been probably more neglected than any
other in both medical and scholastic lore.
To prove that the evils and dangers attending child birth, even among
the most civilized and enlightened portions of the human family, may be
brought to a great extent within the range of man’s control, is the
object of the following remarks.
Let us look first at the habits and condition of the aborigines of our
own country.
The state of society among the Indians necessarily excludes the
influence of many of those passions which are known to cause bodily
derangement. If an Indian becomes angry, the turbulent effects of his
passion are hushed in deep and lasting resentment. Envy and ambition
also are, for the most part, excluded by the equality of savage life.
“The weakness of love,” says Dr. Adam Smith, “which is so much indulged
in ages of humanity and politeness, is regarded among savages as the
most unpardonable effeminacy. A young man would think himself disgraced
forever if he showed the least preference of one woman above another, or
did not express the most complete indifference, both about the time
when, and the person to whom he was to be married.” Thus the savage
state, although being in many respects far from a truly natural one,
exempts the individuals of both sexes from those violent and lasting
diseases which are well known to arise from excesses in matters
pertaining to the sexual and marital relations.
It is to be observed, also, that marriages do not, as a general fact,
take place among the aborigines before the period at which the body has
attained its full vigor. The men seldom marry before thirty, and the
women before twenty years of age. Abortion, one of the most frequent
mishaps with women of civilized life, is almost entirely unknown among
the Indians. They nurse their children for two years, and often longer,
and during this whole period they utterly refuse the embraces of the
opposite sex. The manual labor to which they are constantly subjected,
and their hardy habits generally, tend powerfully to invigorate their
bodies, and although they are, during pregnancy, exempted from the more
laborious parts of duty, they are always habitually active. Nature is
their only midwife; and according to Dr. Rush, “each woman is delivered
in a private cabin, without so much as one of her own sex to attend her.
After washing herself in cold water, she returns soon to the usual
employments of her station;” so that, according to the authority just
quoted, “she knows nothing of those accidents which proceed from the
carelessness or ill-management of midwives, or those weaknesses which
arise from a month’s confinement in a warm room.”
It is, indeed, said on good authority, that if, during journeys, the
Indian woman is taken in labor, she merely falls back for a little on
her way in the forest, delivers herself, and then shortly makes up to
her companions with her new-born child on her back.
The most natural state of the female constitution, and one which is
connected with the best and firmest health, is that of pregnancy and
nursing; and it is a remarkable fact, that there is seldom a period
during the interval between marriage and the cessation of the menstrual
function in which the Indian women are not either pregnant or giving
suck.
Among other nations than the aborigines of our own country, we find also
striking examples of the freedom from suffering with which childbirth is
endured. Thus, according to Stephenson’s “Twenty Years’ Residence in
South America,” “among the Araucanian Indians of South America, a
mother, immediately on her delivery, takes her child, and going down to
the nearest stream of water, washes herself and it, and returns to the
usual labors of her station.”
The women of Otaheite, according to “A Description of Pitcairn’s Island
and its Inhabitants,” have all learned the art of midwifery. Childbirth
generally takes place in the night time, labor lasting seldom more than
five hours. It is always safe, and no cases of twins occur.
Miscarriages, too, are unknown among them, except from accident. Infants
are generally bathed in cold water (which in that latitude must be only
moderately cool) three times a day, and are sometimes not weaned for
three or four years; and when they are taken from the breast they are
fed upon ripe plantains and boiled taroroot rubbed into a paste. Nothing
is more extraordinary in the history of the island than the uniform good
health of the children; the teething is easily got over; they have no
bowel complaints, and are exempt from those contagious diseases which
affect children in more civilized countries. Neither the young nor the
old are ever vaccinated. “The natives of Otaheite,” says Captain Cook,
“both men and women, constantly wash their whole bodies in running water
three times every day; once as soon as they rise in the morning, once at
noon, and again before they sleep at night, whether the sea or river be
near them or at a distance. They wash not only the mouth, but the hands,
at their meals, almost between every morsel; and their clothes, as well
as their persons, are kept without spot or stain.” “The women,”
according to a missionary writing of this people in 1797, “have black
and sparkling eyes, teeth white and even, skin thin, soft, and delicate,
limbs finely turned; their faces are never darkened with a scowl, or
covered with a cloud of sullenness or suspicion; their manners are
affable and engaging, they step easy, firm, and graceful, their behavior
free and unguarded; always boundless in generosity to each other and to
strangers; their tempers mild, gentle, and unaffected; slow to take
offense, easily pacified, and seldom retaining resentment or revenge,
whatever provocation they may have received. Their arms and hands are
very delicately formed, and though they go barefooted, their feet are
not coarse and spreading. In private life they are affectionate, tender,
and obedient to their husbands, and uncommonly fond of their children;
they nurse them with the utmost care, and are particularly attentive to
keep their infants’ limbs supple and straight; a cripple is hardly ever
seen among them in early life; a sickly child is never known; any thing
resembling it would reflect the highest disgrace on the mother.”
A very worthy medical friend who spent some time at New Zealand in 1839,
gave the writer lately the following particulars concerning midwifery,
as practiced among the inhabitants of that island.
Women (who generally followed out-door active employments a considerable
portion of the day), as soon as they experience the first symptoms of
labor, retire some little distance from the settlements, among the
_fern_ (a native growth resembling bushes in the United States), by the
side of a stream of pure water. Within about one hour not unfrequently
the mother returns with her new-born infant, both herself and it having
been previously washed in the pure stream. The child is never bound with
clothes or swathed, but for a few days at first it is dressed in one
light flaxen garment. This is placed loosely about the trunk of the
body, the extremities being left wholly free and exposed to the action
of air and light, and after a few days, they are left entirely naked,
being allowed freely to roll about and exercise their limbs upon a mat
of smooth texture. It is left much of the time in the open air, but not
exposed to the sun’s rays. At other times, when the mothers are at work,
planting or hoeing in the ground, they are allowed, even when not more
than one week old, to roll among the potatoes and corn. They are often
taken to the streams of pure water with which the island abounds, for
the purpose of being bathed. The mothers, in consequence of their almost
constant labor and exercise in the open air, and their simple habits
generally, are remarkably strong and muscular, and free from deformity
and disease. Their food, particularly of the inland parts (where the
finest specimens of physical development are to be found), consists
almost wholly of the vegetable productions of the earth, such as corn,
pumpkins, potatoes, common and sweet, peaches, and various other fruits,
all of which articles grow to great perfection on the island. The New
Zealanders wear but a single garment of flax, sometimes thrown loosely
over the shoulders, and sometimes only about the loins. They have a
great dislike to head-dresses, and never wear them.
In civilized countries, also, we find among the laboring classes, some
remarkable examples of the general safety with which childbirth is
endured; and it has often been remarked among the legal profession, that
in cases of concealment and child-murder, a most wonderful degree of
strength and capability of exertion is often exhibited. There is, it is
true, in cases of this kind, a powerful stimulant for extra exertion;
but even admitting this consideration in its full force, these examples
afford a striking proof of what the human constitution is able to
endure, even under many untoward circumstances.
Mr. Alison mentions the case of one Catharine Butler, or Anderson, of
Aberdeen, Scotland, who in the spring of 1829, walked in two or three
days after delivery, in a single day, with her child on her back, from
Inverury to Huntly, a distance of twenty-eight miles; and the same
author also remarks, “that it is not unusual to find women engaged in
reaping, retire to a little distance, effect their delivery by
themselves, return to their fellow-laborers, and go on with their work
during the remainder of the day, without any change of appearance but
looking a little paler and thinner. Such a fact,” Mr. Alison observes,
“occurred in the case of Jean Smith, of Ayr, in the spring of 1824.”
Among the peasant women of the mountains in Austrian Silesia, childbirth
is regarded in a very different light from that among the women of our
own country. They are exceedingly hardy and robust, and seem to care as
little about giving birth to a child as if it were an everyday
occurrence. Physicians are very rarely employed on such occasions in
that country, as I learned when there by frequent inquiries. In the
winter of 1848, when I was last at Graefenberg, the wife of the
proprietor of the _Hotel de Graefenberg_, a very good and worthy woman,
of the middling class, gave birth to her first child, without the aid of
any one save her husband and a female attendant; and, although the labor
was a severe and protracted one, lasting a day and a half, she preferred
to have no physician, although one of skill and experience lived next
door to them, and who was, moreover, a particular friend of the parties.
These German peasants appear to regard labor as it should be, a _natural
process_, and the degree of patience for which the German character is
noted, is nowhere more strikingly exemplified than in the matter of
childbirth.