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The Province of Midwives in the Practice of their Art, by William Clark, M. D. 1698–ca. 1780.
THE PROVINCE OF MIDWIVES
Practice of their ART:
Instructing them in the timely Knowledge of such _Difficulties_ as require the Assistance of MEN,
For the Preservation of
MOTHER and CHILD.
Very necessary for the Perusal of ALL the SEX interested in the Subject,
And interspersed with some
_New_ and _Useful_ OBSERVATIONS.
_By_ WILLIAM CLARK, _M. D._
_And of the_ College _of_ PHYSICIANS.
_Molliter Aufer Onus._ OVID. FASTI.
Printed for _William Frederick_, in BATH; and sold by _M. Cooper_, in _Pater-Noster-Row_, LONDON.
ADVERTISEMENT TO THE READER.
_The following small Tract will appear contemptible to those who judge of the Worth of Books by their Bulk; but the Author believes such as are practis’d in Midwifry will acknowledge both the Want and Usefulness of an Essay of this Kind._
_The Division of the Chapters, naturally arising from the various Circumstances which are treated of, will rather assist than burden the Memory, and admit of a ready Recourse to the short Instructions, in the Knowledge and Practice_ absolutely necessary, _given under each Head._
_The Reader will the more readily excuse any Defect in the Stile, when he considers_ _the Necessity of a strict Expression on the Subject and the Difficulty a Man lies under, who writes not to the learned and experienced, but chiefly for the Sake of Persons ignorant in Anatomy and Philosophy, on a Subject which for the most Part excludes Information by Sight._
_On such a Subject it will not be imagined Vanity or Applause can incline a Man to write a Pamphlet, rather than a Volume; when the Author is not conscious of having omitted the Instruction to be found in any Book extant, within the Limits of his Design; and hopes Experience will teach its Value both to Midwives and Matrons; and that the Perusal will not at all injure, if it does not improve, the most knowing and experienced._
* * * * *
The READER is desir’d to correct the following ERRORS with the Pen.
Page 9, Line 16, _read_ Pains about the Back, Navel, _&c._—P. 33, l. 12. omit the Period after the Word Pain; and make a Semicolon, instead of the Comma, after touch’d it.
The Case of _Child-bearing_ Women is very lamentable, in the Country especially, by Reason of the Ignorance and Unskilfulness of _Midwives_; for by their Negligence and perverse Management, many Mothers and Children are destroyed, to the great Misfortune of particular Families, as well as of the _Publick_, at a Time when it suffers by the Loss of useful Hands, from too many other Causes. It were therefore to be wished, that all Midwives were so far appris’d of their Duty, as to be able to distinguish between Cases within their Abilities, and such Difficulties as may occasion the Loss of the Mother, or Child, or both, for Want of necessary Assistance.
They who intend to practice Midwifry in PARIS, are oblig’d to attend _anatomical_ Lectures and _Dissections_, that their Judgments may be inform’d, by the Knowledge of the Structure of the Body, for an Undertaking so hazardous in ignorant Hands.
London, at present, affords equal Advantages of Information; for the _anatomical_ Wax-work, with suitable Lectures, might furnish as good a Qualification, with less Offence than real Dissections; and there are not wanting those who professedly instruct both Sexes by _mechanical Demonstrations_.
And for the future, it is to be hoped, there will be no Necessity for Men to have Recourse to PARIS for _Observation_, since we have _Infirmaries_ at Home for the Accommodation of Women in Child-bed; and tho’ they are expos’d naked to the Eye in the _Hotel de Dieu_, it must be confess’d, that the fundamental Rules of the _Art_ are not built on what the Eye of the Observer can possibly discover in the most expert _Operators_; but depend on Circumstances conceal’d from Sight, within the Body of the Patient.
But whatever Advantages LONDON and WESTMINSTER afford for the Instruction of Midwives, the Country is entirely destitute of them; and the best Books on the Subject, adorn’d with elegant Figures, can give but a very imperfect Notion of the Parts they represent, to any who have not attended _Dissections_, or seen more natural _Resemblances_ than Cuts.
The Figures in Books, exhibit the _Bones_ of the _Pelvis_, a Variety of _Situations_ of the Infant, and _Uterus_, the Placenta and umbilical Vessels and Membranes, _&c._ whereas it would be no less serviceable to those, who assist Women in Travel, to be acquainted with the Viscera, liable to suffer by a difficult Labour; for the _Liver_, _Spleen_, _Sweetbread_ and _Kidneys_, if not the principal Contents of the Chest, may be so injured by the ill _Position_ of the Child, Compression of the Parts, and rash Assistance, as to prove fatal, more or lets immediately; occasioning _Inflammations_, _Suppurations_, _Mortifications_, _Schirrhu’s_, _Cancers_, or _Consumptions_.
The best Writers of Midwifry, such as _Mauriceau_, _Deventer_, _De la Motte_, _Heister_ and others, explain the Causes of difficult Births, and the proper Methods of Assistance; but instead of improving most _Country_ Midwives, fill them with Conceits of what, it is impossible, they should understand, and thereby occasion the Loss of great Numbers of Women and Children.
In order therefore that Midwives may acquit themselves with Reputation, and that _Child-bearing_ Women may be the better Judges for themselves, or the charitable Part of the Sex, who are past these Dangers, the better able to assist their Friends and Neighbours, I shall endeavour to shew how far they may act with Safety under the Disadvantage of Country Practice, and describe those Symptoms, which for the most Part accompany hard Labours, very probably beyond their Abilities; when they will justly incur the Censure of Inhumanity and Rashness to depend upon their own Skill.
In this Chapter I have avoided the Use of Terms of Art, or explain’d them, in Regard to those for whom I chiefly write, as far as my Regard to Decency admits; but if any Word should occur not easily understood by any of my Readers, almost any _English_ Dictionary will explain its Meaning; and it cannot be expected that any Book can instruct those who cannot read, tho’ I am sorry to say too many such assume the Office of _Midwives_.
As Curiosity may reasonably induce many of the Sex concern’d in the Subject of these Sheets, to be inform’d of somewhat of the Provision supreme Wisdom has made for the Existence of Children in the Womb, I shall briefly mention the most obvious _Instruments_ relating to their Breeding and Birth, without puzzling my Readers with minute _anatomical_ Descriptions.
The Vagina, or Passage, lies between the Neck of the _Bladder_ and the large or strait Gut; it is connected at the inward extreme to the _Womb_, and called the _outward Orifice_ at its beginning.
The _Womb_ lies between the _Bladder_ and _Strait Gut_, and is connected to both; during the Time of _Breeding_ it increases in its _Dimensions_, and rising higher in the Body, by Reason of the Weight and Substance of it, with its Contents, at the Fund, or remote End of it, may be liable to swag too much _forward_ or _backward_, or incline more or less to either Side, especially in such, as by their Occasions of Industry in Life are obliged to a Variety of _indirect_ Situations; by which Means the _inward_ Orifice is perverted from a _direct Site_ with Respect to the Passage, and obstructs an easy Exclusion of the Infant in Travel.
The _Placenta_ or _After-birth_, adhering to the _Fund_ of the _Womb_, receives the _Mother_’s Blood, by the _Umbilical-Vessels_, or _Navel-String_, conveys it to the Child for its Nourishment, and retransmits what is superfluous; maintaining by the Intercourse of _Arteries_ and _Veins_, the Circulation of the Blood between Mother and Child.
The _Membranes_ closely connected to the _Placenta_, and the _Fund_ of the _Womb_, between both which they seem to take their Rise, contain the _Humours_ in which the Infant swims, the better to preserve it from Injuries, by its Pressure against _unyielding_ Parts, and the _Humours_ before, and after the _Breaking_ of the _Membranes_, commonly call’d the _Breaking of the Waters_, in the Birth, very much facilitate it, by opening the _inward Orifice_ of the _Womb_, and lubricating the _Passage_ for the Child: These _Membranes_ come away with the _Placenta_, under the Name of the _After-birth_, or _Secundines_, indifferently.
The _Pelvis_ or _Bason_, wherein the _Uterus_ or _Womb_ is seated, is form’d by the _forward_ Bones, commonly call’d the _Share-Bone_, the _Hip-Bones_ and their Continuation on each Side, and the lower Part of the _Back-Bone_, all which are so contiguous to each other, as to form this Cavity, generally much larger in Women than Men, cloathed with Muscles, between which the _Vagina_ is inserted.
The right Formation of the _Pelvis_, is of the greatest Consequence in Favour of an _easy_ Birth; when the _Bones_ forming it, _forward_ and _backward_, and on _each_ Side, both above and below, don’t too much approach each other, and prevent the Exclusion of the Child between, by a free Admission.
_The Symptoms preceeding_ Natural Labours.
I shall pass over the Symptoms of Pregnancy, and the Distinctions of true and false Conceptions, as Things of which Midwives can seldom be expected to be _proper_ Judges, and proceed to their Business, _Natural Labours_; comprehending, under this Name, all such Cases, which require no further Assistance than _Midwives_, in a general Way, may easily give; or in their Absence a Nurse, or any sensible Woman, who has attended Deliveries.
After the Woman has gone her due Time of Nine Months, the most usual Term; the Signs preceeding Labour are Pains about the Back, Navel and Loins; a considerable Falling of the Tumour of the Belly, by the Burden’s sinking lower; and incommoding the Woman in walking; a more frequent Inclination to make Water: These Symptoms increase in Proportion as the Birth approaches; but as the most certain Knowledge of _natural_ Births, can only be obtained by _Touching_ the Woman in Labour, after having premised some Things concerning her _proper_ Situation; I shall direct how it ought to be done.
Many in the Country choose to be on their _Legs_ or _Knees_, supported by a Woman on each Side, or _lean_ on a Chair or Bed, and pass well enough through the present Scene of their Miseries: But I would preferably advise a Posture between _lying_ and _sitting_, on a _Pallet_ or _common_ Bed, the _Head_ and _Shoulders_ being _rais’d_ by Bolsters or Pillows, the Feathers _beat back_ from the Bed’s Feet, to support the hollow of the Loins, and prevent the Pressure of any Thing against the _Bottom_ of the Back Bone, to obstruct the Passage of the Child.
This _Situation_ is most commodious, during Labour, for a Woman to _assist_ her Pains with the greater Freedom of Respiration, and the least Fatigue and Expence of Spirits; especially if the _labouring_ Woman lay hold of a _folded_ Napkin, held stiffly for that Purpose, drawing her Feet _upwards_ towards her Seat, _separating_ her Knees, and _fixing_ her Feet against something that will not easily give Way.
If the Person in Labour will not be in Bed, the End may be answered by her _sitting_ in _another_’s Lap, with the _Bottom_ of her Back-Bone situate between the other’s Knees, with her _own_ separated and supported, and Feet fixed as aforesaid, to favour her bearing down.
’Tis inconsistent with the Design of my Writing to describe all the _convenient_ Situations, necessary in Cases of Difficulty, yet when the Operator has rectified all Obstructions to the Birth, the same Situation of the Body upon a _Slope_, from the Head downwards is most suitable, even altho’, for Conveniency, she should be deliver’d lying on one Side.
I shall, on this Occasion, observe, what I have found Advantageous in my own Experience, as well as consonant to the Advice of the best Writers on the Subject: That the Delivery on the _Back_, by the Assistance of one placed on _each Side_, supporting her by the _Hams_, with her Knees _separated_, and raising her _Back Bone_ a little from the Bed during the _Activity_ of Pains, and the _Midwife_’s _Assistance_ of either Sex, is vastly preferable to the Delivery on _one Side_, to which I impute the Loss of many Children brought by _Turning_, as well as a more _tedious_ Labour in other Cases; because this Posture, in some Degree, _contracts_ the _Passage_, and only admits the proper Separation of _one_ Knee.
This ought to be put in Practice, as soon as, from the Symptoms given in the Third Chapter, it is reasonable to expect the Birth approaching; and a _Child-bearing_ Person would be very much her own Enemy to refuse the only Means of giving a _true_ Information of her Case, and the Knowledge how to do her the most effectual Service.
The Midwife, having her Nails well pared, and very smooth, and her Fingers anointed with Oil or Lard, must introduce the two _fore Fingers_ of either Hand into the _Passage_ or _Neck_ of the _Womb_, as far as its _inward_ Orifice, directing them with a _gentle_ and _easy_ Motion, somewhat upwards, as it were with a Tendency through the _Passage_ towards the _Navel_; in this Search she will find the _internal_ Orifice, joining the _Passage_ or _Neck_ of the _Womb_ more or less open, relaxed, and thinner than usual; and cautiously protruding her Fingers farther, she may possibly touch the _Crown_ of the Child’s Head; she will easily, by the _Sutures_, or _Opening_ between the Bones of the Skull, distinguish the _Crown_: Keeping her Fingers in this Situation, _during_ the Beginning, and Continuance of _strong_ Pains, she will observe the _Waters_ contain’d in the _Membranes_ including the Child, and After-birth _forming_ within the _inward_ Orifice, as if something like a Bladder _blown_, or _distended_ with Water, presented to the _Touch_, dilating the _Orifice_ with each _Throw_; these Appearances presage a _speedy_ and _easy_ Birth.
_Of a natural_ Birth, _and the_ Office _of the Midwife._
As the _Birth_ approaches, the Woman grows _hotter_ and _red_ in the Face; the Pains bear more _strongly_ down; the _internal_ Orifice _opens_; the _Vagina_ or _Passage_, at its _Entrance_, becomes more swell’d, as the Child’s Head advances; and the _Membranes_ are more and more _tensely_ stretched; before the _Birth_, the Person is often seized with a _Vomiting_, and _universal_ Tremor, without the Coldness of an _Ague_; and very often a _Humour_, _discolour’d_ with _Blood_, immediately preceeds the _Breach_ of the _Membranes_; when these Symptoms, or several of them, become urgent, ’tis Time to put the Woman in a proper Situation, as describ’d in the preceeding Chapter: The Midwife ought by no Means to break the _Membranes_, but _encourage_ the Woman now to make the best of her Pains, by _strongly bearing down_, as if going to Stool; the Midwife with her Fingers well anointed, putting them gently within the _internal_ Orifice, may cautiously, by separating them, assist its _opening_, and Removing it more behind the Child’s Head, thereby gradually promote its more easy Transmission, and at the same Time prevent, if necessary, the Womb from being too far protruded: After the _Waters_ are _broke_, as it is called, and the _Head_ of the Child comes into the _Passage_, the Midwife may lay hold on each Side of it, taking Care not to bruise it by rough Handling, and drawing it, by _Waving_ her Hands, if necessary, to loosen it, when fixed, rather than in a strait Line, assist the Birth; and if obstructed by the Shoulders in the Passage, inserting a Finger under each Arm-Pit, extricate them by the like Action.
’Tis true, it happens, tho’ unobserv’d by Writers, as far as I remember, that _many_ Women have no _Waters breaking away_, either before or after the Birth; whether absorbed or not, in Time of Labour, I shall not at present determine; this is called, by the Country People, a _dry_ Labour, and often attended with Difficulty; however, if the _Crown_ appear _forward_, the Issue may nevertheless be favourable.
The Child being born, the next Business is to tie the _Navel-string_ with a _waxed_ Thread, so _doubled_, as not to endanger _cutting_, about _two_ Inches from the Child’s Body, making another Ligature near the Body of the Mother, so far distant from the former, as may be convenient for _Cutting_ between _both_ Ligatures, and separating the Infant from its _After-birth_. Midwives are too apt to leave a greater Length, which can be of no Service, but has been thought, on the contrary, by our Countryman CHAPMAN, to occasion _Navel_ Ruptures.
After the _Separation_ of the _Navel-string_, the Care to get the _After-birth_ succeeds; this will often come by the Assistance of Nature, with a gentle Motion of the Hand gradually drawing and loosening it, by the Navel-string: But if it adheres to the _Fund_ of the _Womb_, which is frequently the Case, whether from the _Waters_ being come away before the Birth or otherwise; it must cautiously be separated, and extracted by the Hand, to prevent the most mischievous and fatal Consequences.
The Assistant holding the _Navel-string_ with _one_ Hand, must with great Caution introduce the _other_ into the _Womb_, avoiding _all Violence_ to any Part in the Way, ’till she reaches the _After-birth_, some Part of which probably, being loosened, will be found more _forward_ than the rest; which _taking_ between her _Thumb_ and _Fore-Fingers_, she must, by an easy Motion of her other Fingers, between the _Womb_ and _After-birth_, gradually _separate_ the Parts adhering all _round_, ’till finding the whole free, before the Palm of the Hand and Fingers, she brings it intirely away; for should any Part remain, the poor Woman’s Labour would still continue, and occasion _dangerous_ Floodings, requiring the immediate Assistance of an able Hand, to rescue the Patient from the immediate Hazard of Death.
Sometimes when the _Womb_ has discharged its _Waters_, and the _Child_, by Reason of a Defect of Pains, or otherwise, remains _long_ very _forward_ near the _Birth_, the _Womb_ so _contracts_ about the _After-birth_, as to make the _Separation_ of it very difficult; in which case Assistance is requisite, from one well acquainted with the Structure of the Body; and the longer this is delay’d, the more Danger there will be of all the bad Consequences of the Retention, and Corruption of the _After-birth_ in the Body.
It requires great Care to prevent the _Protrusion_ of the _Womb_ in some Women of a _large Pelvis_, or _Opening_ between the _Bones_; or if the _After-birth_ remains closely fixed, the _Womb_, in a very _open Pelvis_, may be _thrust_ by the Violence of the Pains; or _drawn_ out of the Body by an _unskilful_ Hand, which is commonly very soon fatal to the poor Woman; and I believe happens much oftner than is apprehended, tho’ industriously conceal’d, by _guilty_ Midwives, under the Colour of the poor Woman’s dying in Child-bed, from some other Cause. DEVENTER says, he saw a sad Spectacle at the HAGUE, the _Head_ of the Child excluded to the _Shoulders_ quite without the _Passage_, when Three-fourth Parts of the _Head_ were conceal’d within the _Womb_, the _Crown_ appearing within its _inward Orifice_†.
† See Chir. Op. Part ii. Page 32.
A much worse Case happen’d in my Neighbourhood, _Sept._ 23, 1749. I was call’d to a Woman, whose Child, on the 21st came unexpectedly, without the least Assistance, in the Presence of an _old_ Midwife of _large_ Practice; she puzzled an Hour, as I was inform’d, to bring away the _After-birth_, which closely adhered to the _Fund_ of the _Womb_; while the _unfortunate_ Woman lay senseless, saving the Memory of being long expos’d to the Cold, when she came to herself; after which she continued in violent _Labour-like_ Pains; upon Scrutiny, I found a large _Substance_ in the _Pelvis_, of the Size of a Child’s Head, considerably resisting my Touch; I observ’d on Trial, a Part of the Woman’s Body every Way _interposed_ between my Fingers and this _Substance_, by her Sensibility of my _Touch_; therefore contenting myself with giving her some palliative Medicines, and telling the Persons present, a Mole, as I thought, or Child still remain’d to come away, I for that Time, took my Leave: On the 24th, she was said to be much better; on the 29th, I was again call’d to this poor Woman, and inform’d, that upon her first going to Stool, since I had before seen her, which happen’d the same Day, the large _Substance_ before-mention’d, came intirely out of her Body; to which it join’d by a thinner Substance, of some length: I now perceived it was no less than the _Womb_ turned _inside out_, suspended by its _Ligaments_, and joining to the _Vagina_, but very much swell’d by the Obstruction of the circulating Humours; And an old Gentlewoman, who was present when the Child was born, inform’d me, she saw the Midwife draw this _Body_ from the Woman, by the _Navel-string_, and indeed, the Impression of her _Nails_, in separating the _After-birth_, remain’d still visible at the _Bottom_ of the _Womb_, and the Midwife having long expos’d the Patient, put this _inverted Womb_ again into her Body.
The Condition of the Part, after so long Delay, did not admit the Possibility of rightly reinstating it; I therefore return’d it, as well as I could, into the Pelvis, and introduc’d a Pessary to retain it; and as this Person had already contracted a Hectick, I charg’d her, as she valu’d her Life, to confine herself strictly to a _cooling Milk_, or _vegetable Diet_; she has since had large Discharges of a _bloody_ Corruption, with Portions of a fleshy Confidence from the Parts affected. In _April_, 1751, she told me the Discharge coming from her had long been much abated in Quantity, and what remain’d was the Whites; that she had an inward Fever, and the Piles, for which I gave her my Advice; her Complexion was chang’d from the most florid to a languishing Paleness.
My Brother, much better known in this Country, and longer practis’d in Midwifry, has been concern’d in furnishing Medicines for the Person, whose History I have given, altho’ by Means of his Absence, he did not attend her on the most emergent Occasions.
I have since been call’d to the Assistance of the _old_ Midwife, who attended, and she frankly told me, she had another Woman under the like Circumstance, who died the same Day.
Having related such Things as occur in the most favourable Circumstances of Travil, about which all Midwives ought to be well inform’d, and those Injuries to which Women are sometimes liable, notwithstanding the most _promising_ Appearances: In the next Place I proceed to shew, what are the Symptoms preceeding _difficult_ Labours, which by timely Assistance, may be secured from the most dangerous, if not fatal Consequences, and are of great Moment to be known by Midwives, as well as Matrons and Child-bearing Women, to enable them to judge when it is absolutely necessary to recommend calling that Aid, which is beyond their Capacity to give.
_The Difficulty from the_ Membranes.
An _unforeseen_ Difficulty may occur, when Appearances are otherwise favourable, from the Strength of the _Membranes_, obstructing the _Birth_, and requiring great Caution to prevent; for in this Case, the Operator must break the _Membranes_, in order to promote the _Birth_; and as the _Waters_, they contain, are a Means to open the _internal Orifice_, lubricate the _Passage_, and facilitate the _Birth_; the _breaking_ the _Membranes_ too soon, will render the Labour more _tedious_; and should it be too long delay’d, the Patient’s Misery would be _prolonged_; wherefore the Midwife must not break _them_, before the _Orifice_ is sufficiently _open_ to admit the Head, when she may tear them with her _Nails_, but by no Means pull them, for as they adhere to the _After-birth_, she might by that Means separate it, and bring on a Flooding.
_Difficulties occasion’d by the_ Navel-String.
The _Navel-string_, by a Variety of Convolutions, sometimes obstructs the Birth, for being shortned, by its Contortions about the Neck, or any Part of the Body, the _Labour_ will become _unnatural_, by Reason tho’ the Pains are _strong_, the _Navel-string_, by its _shortness_, will pull the Child back with each Pain; and here an unskilful Management may break the String, and occasion a dangerous Flooding; but as the Woman’s Pains will prove _ineffectual_, notwithstanding their Strength and Force, the Midwife will, by this Means, find the Case out of her Province; I mean, where the _Navel-string_ is very much _abbreviated_.
If the _Navel-string_ comes forward before the Child’s Head, it will seldom remain, when put backward by the Hand; therefore, if the Midwife has any Regard for the Life of the Child, she ought to call for Assistance, before the Birth is further advanc’d, or it will be extremely difficult, if not impossible, to save the Infant; and she would probably be foil’d for want of sufficient Strength, had she Skill to save it.
_Difficulties from the_ Placenta _or_ Secundines.
The _Placenta_ or _After-birth_, being from any violent Shock or Accident, more or less, _separated_ from its Seat, during any Time of Breeding, will produce a Flooding, in Proportion to its Quantity, _dangerous_, which is sometimes so violent, as to occasion Death in an Hour’s Time; and nothing but _instant_ Delivery can prevent it. When the Case is not so desparate, as all the _Blood_ in the Mother’s Body, necessary to support her own and Infant’s Life, may be drain’d away, the Consequence may be equally fatal in a more lingering Way.
The 26th _Feb._ 1748, I was sent for to a Woman at MOUNTAIN-DEVEREL, within about Five Weeks of her Time, in a violent Flooding; her Midwife gave her an Opiate, which she thought check’d her Flooding, excepting that once a Week, it became very violent, for about three Weeks past; when I came, the Neighbours told me she had lost a Pail full of Blood; the poor Woman was so weak, that her Pulse were scarcely perceptible, and her Voice but a Whisper; I was unwilling to meddle, for fear she should die under my Hands, but yielded to the Importunity of her Friends: It was with great Difficulty I introduced the _Tops_ of my two Fore-fingers and Thumbs into the _internal Orifice_, which I gradually dilated, ’till I could pass my Hand, when by _turning_, I brought away a _dead_ Child, depriv’d of its Nutriment by the great Loss of its _maternal_ Blood; but had considerable Trouble in getting the _After-birth_, by Reason of its _Adhesion_: After Delivery, the Flooding immediately very much abated, the poor Woman reviv’d to Admiration, and I left her the next Day, as well as could be expected in so low a Circumstance, tho’ dubious of her Recovery: I heard she died five or six Weeks after; but I am well satisfied, had she had an earlier Recourse for Assistance, she might have recover’d.
In these Cases, Midwives are too apt to trust to their own Judgments, instead of calling for better Assistance; and tho’ they have Recourse to external _Applications_, _Ligatures_, and _Opiates_, these Things, injudiciously practis’d, are frequently more detrimental than beneficial: For Instance, should the _Arteries_ be compress’d by too tight a Ligature of the _Arms_ and _Legs_, the _Flooding_ would become more violent.
When ignorant Midwives, by rashly pulling the _Navel-string_, break it, or by the Adhesion of the _After-birth_, find it out of their Power to bring it away, they are apt to persuade People, it will come without further Help, which seldom happens; on the Contrary it most frequently occasions Death, more or less suddenly, or Hecticks and Consumptions, when left to corrupt in the Body: The _Uterus_ sometimes so strongly contracts about, and embraces it, that it may be impossible, after a few Hours Delay, to procure it, as I found in a Case that occur’d to me at COLEHORN, the 30th _Sept._ 1748, tho’ little more than four Hours passed, from the Time the Midwife broke the _String_ close to the _Placenta_, for the Part of the _Uterus_ next the _Placenta_ was so contracted, as barely to admit the _Tops_ of my two Fore-fingers; I endeavour’d, with all possible Caution, to make a larger Aperture, but in the ill _Situation_ of the _Uterus_, at the Extent of my Reach, all my Attempts were in Vain; this Woman rested well the succeeding Night, and had no extraordinary Complaints when I left her in the Morning, first prescribing what I thought most suitable to her Condition: I afterwards heard she died with a Frenzy, succeeding a _Suppression_ of the _usual_ Purgations; where the Corruption of the _Placenta_ takes Place, the Case is, at least, more Chronical, and the _Secundines_, gradually wasting, come away Piece-meal, the Patient labouring under a Hectick from the Contagion of putrid Humours, mixing with the circulating Fluids.
I have at other Times, after a longer Delay, been more successful; the 28th _December_, the same Year, I was call’d, by Order of the late Lord WEYMOUTH, to the Assistance of a poor Woman at HORNISHAM, whose _After-birth_ had been retain’d three Days; she had contracted a Fever from its Putrefaction, which was so great, that scarcely any Body could bear the Room, and had lost a great deal of Blood by Flooding; the poor Woman soon recover’d after her Delivery, in the Use of a little Medicine, from his Lordship’s House: I have seldom found the Business difficult, when speedily call’d in the like Cases.
_Difficulties attending the Contraction, or Ill-site of the_ Inward Orifice.
In the Fifth Chapter I have told, how the Midwife may judge, by touching, of an easy Birth; carefully introducing her two Fore-fingers into the Passage, to find the internal Orifice of the Womb in the Beginning of Labour; now, in doing this, if the Orifice, she is in Search for, does not readily occur, she has great Reason to apprehend Difficulty; and if not well acquainted with the Parts she handles, by rude Usage, piercing through any Part of the _Vagina_, which presents to the _Touch_, may do Mischief. Such an Injury was done to one of Box, where I was called _Sept._ 21, 1748. This Woman had been in Labour several Days; the Midwife having, the last Time, been with her eighteen Hours, the Pole of the Child’s Head lay upon the Share-bone, which was rectifyed by one Limb of the Extractor and brought into the Passage; the other Limb being joined, the Infant was soon born; but what before surprized me, was to find a _Passage_, for my Fingers, considerably remote from the _internal Orifice_, with great Complaints of a smarting Pain when I touch’d it; a Suppuration follow’d, but the Woman soon recover’d, after the frequent Use of an emollient and discutient Fomentation.
When the _Orifice_ presents rightly, and is easily found, it is next of Consequence to observe, whether the Pains _relax_, _open_ and _enlarge_ it; for should it remain _thick_ and _contracted_, instead of relaxing and growing thinner, if the Infant comes rightly directed, the Woman’s Pains are not _genuine_ but _spurious_; it will then be proper to give an emollient and carminative Glyster, and probably the false Pains will be reliev’d, and the true succeed; or some Time may intervene, before her true Labour, especially if the full Time of Breeding should not be expired.
If the Midwife cannot reach the _internal Orifice_, and the Child’s Head lays _high_, the Orifice may possibly lay _high_, _backwards_ or _forwards_, or more or less so, inclining _Sideways_; the Reason of which may be apprehended, from the brief Account of the _Womb_, and the _Pelvis_, in the Second Chapter. In this Case it may be with great Difficulty, the Assistant can reach the nearest Margin of the _internal Orifice_, tho’ well instructed and experienced, and it will often require the Hand of an expert Artist, early in Labour to rectify it, or turn the Child, when Travil is advanced; or if too long neglected may occasion the Death of one, or both Mother and Child.
_Difficulties attending a wrong Position of the_ Child_’s_ Head.
If in the Progress of Travil, the Midwife perceives any Part of the Head, besides the _Crown_, discoverable by its _Sutures_, presenting, and it appear _broad_, and very _hard_ to the _Touch_: If the _Waters_ may be _felt_ descending in a _long_ Form through the _internal Orifice_, somewhat like a Piece of a Gut distended with Water: These Appearances presage the utmost Difficulty and Danger, commonly owing to the small Distance between the _forward_ and _back_ Bones; an ill Situation of the _internal Orifice_; the _comparative Largeness_ of the Child’s Head; or the _ill_ Site of the _Womb_; whereby the Head may be pressed against the Bones _forward_ or _backward_, or somewhat inclined to _either_ Side, in a wrong Direction for the _Passage_. These Causes, singly or concurring, render the Case much beyond the Skill, and very often the Strength, of a Midwife to redress.
When unqualified Midwives observe the Head present to the inward Orifice, they are too apt to promise good Success, and behave with the utmost Confidence, wherein they are often egregiously mistaken; for there cannot be a more difficult Birth, than frequently happens, when any other Part, instead of the Crown, offers; and the Misfortune is, the longer Recourse to proper Assistance is delay’d, the greater the Difficulty becomes every Moment; and the poor Woman may think herself happy, if she escapes with her Life, the Danger of a most _fatiguing_ and _tedious_ Labour, succeeded, perhaps, by such a Relaxation of the _Vagina_ or _Passage_, as will occasion great Uneasiness in going, or being in an _upright_ Posture, without the immediate Help of Medicines, both externally and internally; or wearing a _Pessary_ for its Support, during Life.
Whereas ’tis certain, that if the Mother’s Pains, _strongly bearing down_, the Muscles of the Belly contracting and becoming sensibly _hard_ to the _Touch_, don’t manifestly promote the Birth, it must needs be owing to some Obstruction beyond the Midwife’s Skill; who in this Circumstance is apt to complain, the Pains are not sufficiently _strong_, ’till the poor Woman is ready to expire, from the Loss of her Strength, by her long Suffering under them; and told she must patiently wait God’s Time, who in Case he miraculously interpos’d, wants not the Midwife’s Assistance: And what still adds to this deplorable Calamity, ’tis likely she is put upon exerting her utmost Strength, assisted by Cordials; when _encouraging_ her _Labour_ and _provoking_ her _Pains_, ’till the Obstructions in the Way of the _Birth_ are remov’d, contribute still further to the Danger attending.
I don’t deny but that in some Cases, a _tedious_ Labour may be owing to a Defect of _sufficiently_ strong Pains; but as this often proceeds from _Circumstances_ obstructing the _Birth_, true Labour naturally takes Place, when they are remov’d; and, by a right Management of the Hand, is more _effectually_ promoted, without Cordials or _forcing_ Medicines, where the Pains are deficient.
Under this Sort of unnatural Birth, may very well be enumerated, the _Face_ presenting _towards_ the Mother’s Belly, or the _Side_ of the Head coming _Foremost_, for its Passage must be extreamly difficult in these Postures; as well as when the _Face_ comes _forward_; for then by Reason of the great Tumour, about the _Head_, _Face_, _Eyes_, and _Mouth_, from Lodging between the Bones, the Infant expiring in the Birth, has been often taken for a Monster. I have often been so happy, when the Head has long remain’d, wedg’d between the Bones, as to bring the Child alive, by the _Forceps_, in a few Minutes, if seasonably call’d, when the Woman in Travil has been in the utmost Danger of Death.
The 5th of _May_, 1751, I met with as bad a Case, as most of this Kind at WIGGLETON: This Woman, by the Midwife’s Account, seem’d to be in _Labour_ at Times near a Month, and for a Week last, almost in continual Pain, with her first Child: as I was call’d late to her Assistance, I could not judge, by early Appearances, of the Situation of the _Uterus_, or _Infant_; this is most commonly only in the Power of the Midwife to observe; her _Waters_ had gradually drain’d away above a Week, and there still remain’d some Part of the _Membranes_ depending like a _Gut_ in the _Vagina_, the _Head_ offer’d, firmly wedg’d in the _Pelvis_; the Part most obvious to the _Touch_, by its Softness and fleshy Consistence, seem’d to be the _Cheek_: The poor Woman’s Pains, for some Hours, were _ineffectual_ for want of Strength, her Spirits being exhausted, by a Labour so fatiguing; there was no Possibility of _turning_ the Child; I endeavour’d, with some Success, to promote the _Birth_, by bearing _strongly_ against the inferior Part of the _Os-sacrum_, but her Weakness, depriving me of the small Benefit of her Pains, I had for a Time; there was an absolute Necessity for a speedy Delivery, for the Mother’s Sake: ’Twas with some Difficulty I overcame her Prejudice, and those Present against the Use of any Instrument, tho’ at length they yielded; when introducing a _Limb_ of the Extractor on each Side of the Head, and Co-operating with a small Pain, encouraging the Woman to bear down as strongly as she could, I immediately brought a Daughter, with a monstrous long Head alive.
I HAVE, however, met with some Cases, which I could relieve by no better Method, than lessening the Head; but considering for whose Benefit I am chiefly Writing, and how dangerous the Use of Instruments may be in injudicious Hands, I rather choose to advise Women not to meddle with them, than pretend to relate the Method of using them.
_Difficulties from other_ ill Positions _of the Infant._
The _Arm_ or _Shoulder_ presenting, is so well known to be attended with Difficulty, that few Women will attempt such Deliveries, unless they are so very ignorant, as to imagine they can bring the Child by _pulling_ at an _Arm_.
As our Miscarriages, or rather Misfortunes, in Practice, may no less contribute to the Information of others, by Caution, than our Success, by Example; I shall not scruple to give a candid Relation of the most fatal Occurrence, which ever fell to my Lot.
The 12th _September_, 1748, I was called to a Woman at TROUBRIDGE, her _Matrix_ lay _forward_ in a _prominent Abdomen_ hanging very low, the _Os-uteri Internum_ lay very much _backward_, _both_ Hands _presented_ to it, this Woman had been very ill the preceeding Week, and in extreme Misery the last Twenty-four Hours; with a great deal of Trouble, I got and drew towards me one _Foot_, with the _Heel turn’d towards the Mother’s Belly_; in drawing the _Infant_ so far as the _Arm-pits_, I found the _Face_ of the Child did not _turn_ so readily as I expected towards the Mother’s _Back_; as soon as I had brought the _Feet_ some Distance without the _Vagina_, while I endeavour’d to extract the Child by hold of its _Thighs_, the Midwife, unknown to me, officiously laying hold of the Infant’s _Feet_, exerted her Strength at the same Time with mine; I intended to leave the _Arms_ according to DEVENTER, as a Security to the more safe Transmission of the _Head_; and while our united Strength was exerted, I found the _Neck_ gave way, with something of an _audible_ Crack; and with some Surprize, looking about me, saw the Midwife _labouring_ at the Child’s _Feet_, and check’d her, as acting very rashly, without my Direction; thus we had really separated the _Spine_ of the _Neck_, and the _Head_ only adhering to the _Body_ by the _Skin_, was with little or no Force separated from it: In passing my Hand, after a tye on the _Navel-string_, I found the _Head_ fell _back_ into the prominent Part of the _Abdomen_, insomuch that I could only reach the separated Part of the _Neck_, and I endeavour’d, in vain, to get hold of the _Head_ by the _Crotchet_: While I was thus employ’d, a _Flooding_ came on, by the Separation of the _Placenta_, which quick’ned my Endeavours, from the Apprehensions of her sudden Death, if she was not immediately deliver’d; but the poor Woman, much spent with Fatigue and Loss of Blood, begg’d I would desist, preferring Death to Life; in which being join’d by the People present, and not a little exhausted of Spirit and Strength myself, I was, much against my Will, obliged to leave her to her Fate.
Here I would observe, it appear’d the _Body_ was that of a large Boy, and tho’ I find GIFFARD and others made no Scruple of leaving the _Arms_ of a small Child, I must join with them in advising not to bring a _large one_, without first _procuring_ the _Arms_; tho’ I will not say, whether the Method of delivering on one Side instead of the _Back_, the lower Part somewhat _raised_ from the Bed, at the same Time _encouraging_ Labour with Hopes of immediate Delivery, recommended by DEVENTER, may not occasion the Danger of leaving the _Arms_.
There are Variety of other wrong _Situations_, and _Cases_ of Difficulty, which I could illustrate by Examples in my own Practice, and may be found in the Observations of MAURICEAU DE-LA-MOTTE, GIFFARD and others, for the Information of such as practise Midwifry, that have no Relation to the Information of Midwives, either in their own Practice, or Occasions of Assistance.
The Case of _Twins_ may, in many Country Places, be esteemed beyond the Skill of Women _practicing_ Midwifry; but as they are not alike ignorant, and this Delivery, with a right Management, is attended with no great Difficulty, I shall describe it as plainly as I can.
If a Child comes naturally by the Force of the _Mother_’s Pains, and the _After-birth_ does not easily follow, the Midwife, by passing her Hand to separate its Adhesion as directed in the sixth Chapter, will readily find whether _another_ Child still remains to be born, by the Appearance of other _Membranes_, including _Waters_, &c. And as where more than one is to be born, they are generally proportionably smaller, and tho’ the first Child comes naturally, the second may not, she need not wait for the _Birth_ of the other, by the meer Force of Nature, for this would greatly hazard the Life of the Child, and sometimes of the Mother, by a Flooding; but ought to break the _Membranes_, and search for the _Feet_, carefully preventing their being intangled with the _Navel-string_; and having got both in her Hand, draw them into the _Passage_; if the Child’s _Toes_ point to the _Mother’s Back_, there will be no Danger of the _Chin_ or _Nose_ being hung on the _Bones_ before, and she may draw the _Feet_ forth with the rest of the _Body_, without delaying to bring down the _Arms_, encouraging the Mother to assist in the mean Time, by _bearing down with or without Pains_.
In Case the _Child’s Toes_ should point to the _Mother’s Belly_, the Midwife, in drawing the Child forth from the _Hips forward_, must gradually _turn_ the _Belly_ of the Child towards the _Mother’s Back_, by the Assistance of the other Hand in the proceeding.
If the Woman be straiter, or the Child larger, than ordinary, when she has brought the Infant into the _Passage_ somewhat short of the _Arm-pits_, she must, by introducing her Fingers, first over one _Shoulder_, cautiously bring down one _Arm_, and then in like Manner the _other_, and drawing the Child forward, she must make Use of both Hands to extricate the _Head_; the _Fingers_ of one Hand between the _Mother’s Back_ and _Child’s Jaws_, bearing and drawing them from the _Back-bone_, and with the Fingers of the other Hand over the _Shoulders_, and the _flat_ against the _Child’s Back_, draw it forth, the Mother as aforesaid assisting all the while.
Writers advise putting two Fingers into the _Child’s Mouth_; but as great Injury has often been done that Way, it is much safer to bring the Child by _bearing_ with the Fingers against its _Jaws_. If an _Arm_ should be broke in _bringing down_, let it be spliced with thin Paste-board, and bound at its full Extent to preserve its right Shape.
In fetching an Infant by _turning_, ’tis necessary to draw its _Feet_ into the _Passage_, with the _Toes situate_ towards the _Infant’s Belly_, for it may be extreamly difficult, if not impossible, to draw it backwards, contrary to the natural _Bent_ of its _Thighs_ and _Back_; and a _Limb_ may sometimes as easily be pull’d off, as the Child brought to the _Birth_ this Way; the Midwife must therefore make Use of the _right_, or _left_ Hand in doing it, which happens to be most convenient, to the natural _bending_ of the Infant’s Body.
I THINK it cannot be safe for a Woman to _turn_ a Child upon ether Occasions requiring it; their Strength, as well as Skill being frequently inferior to the Task; besides, there may be great Danger of injuring the Vitals of the Mother in other Cases, especially after the Operation is unseasonably delay’d.
As each Child has a Navel-string, as well as After-birth belonging to it (tho’ both _Placenta_’s are sometimes so joined as easily to be distinguished) the Care respecting the _Navel-string_, already related in the Sixth Chapter, must of Course be taken for the First-born, and its _Secundines_ left, ’till after the Birth of the Second, when both, if necessary, must be separated and brought away, as there advis’d, with Regard to one alone, and the _Navel-string_ of the last Infant tied after the same Manner as in the Birth of one Infant.
_Of a_ Dead Child.
A Dead Child is often born with abundantly more Difficulty than a _living_ one, for the last by its Struggles considerably promotes its own Birth; whereas, the first lies _immoveably_ in the _same_ Posture, without changing Situation by its own Activity.
When the Death of the Child proceeds from any _accidental_ Injury, the _breeding_ Woman commonly knows it, by the Perception of a _Weight_ within her, in the Part where it lies, instead of its _usual_ Motions, which from that Time cease, and occasion, not without Reason, a Solicitude for the best Assistance.
One of my Neighbours, whom I lately deliver’d, had the Misfortune to fall flat on her Face, between the 7th and 8th Month of her Pregnancy; from which Time to that of her Labour, above three Weeks after, she had a continual Sensation of a Weight within her, without _any_ of the Child’s Motions, as before this Accident, although it was not succeeded by a _Flooding_, as is common upon a _partial_ or _total Separation_ of the _Placenta_: She had frequently been attacked with Pains resembling Travil, for above two Weeks before it came on effectually; in this Case after I had brought the Child by _turning_, I found the Secundines extremely offensive, by Reason of their Putrefaction.
From Causes less manifest, ’tis a Thing more precarious to judge of the Infant’s Death; the Woman in Travil has not perceived the _Motion_ of the Child for some Days, while it was yet living; a _cadacerous_ Smell is not infallible; the coming away of the Child’s _Excrement_, may proceed from the _Compression_ of its Abdomen in the _Birth_, especially when the _Buttocks_ present; these Appearances therefore can only be a Foundation at best for _probable_ Conjecture; nothing short of the Peeling of the Cuticle or Scarf-Skin of the Child upon _Touching_ it, can be a _certain_ Token of its Death.
_The necessary Care of a_ Mother _and_ Child.
After Delivery, tis too universal a Practice to palliate the After-pains by _Opiates_, which if given beyond the Proportion, necessary to take off the Spasms attending, are mischievous, tending to obstruct the natural Cleansings, so absolutely necessary to succeed; and as these Pains cease of Course for the most Part in two or three Days, it were much better to have recourse to _Sperma Ceti_ dissolv’d with the Yolk of an Egg in a Draught of Caudle, or a Linctus of Sallad Oil and Sugar, if Oil of Sweet Almonds cannot be had fresh, as often as the Pains are violent.
Particular Occasions may indeed require other Methods, but then ’tis best to be well advis’d, whether _Opiates_, or other _Medicines_ are necessary. During their Purgations, the Woman, in Child-bed, ought to be kept warm, from all Danger of taking cold, to a Degree of sensible Perspiration, and if she has no Stool by the third Day, which commonly brings, with the Milk, a feverish Heat, a Kitchen Glyster ought to be given and repeated in costive Habits, as there is Occasion.
I SHALL conclude with some Things of the Care of Infants newly born; a Subject the more interesting, as our Natives are known greatly to decrease from the free Use of Spirituous Liquors; which Loss might in some Degree be repaired by a better Care of their Offspring, who are not only expos’d to suffer by the Ignorance of Midwives, but must undergo a second Martyrdom from swadling and cramming.
Their fond Nurses greatly contribute to the general Cause of all their Distempers, _Indigestion_, frequently feeding them ’till they return it by the Mouth, which under these Circumstances, unless supply’d by a Looseness, is the only Means of their Preservation from more immediate Death.
This Overcharge of their Stomachs, producing Crudities, gives them the most excruciating Pains in their Bowels; occasioning very often Fevers and Convulsions, and yet their Cries are customarily appeas’d by more Food, furnishing an Encrease of sharp Crudities in their Bowels; and ’tis well if Syrup of Poppies, _Godfrey_’s Cordial, or some other Opiate, be not given to stifle their Complaints, but in Effect to encrease the Mischief, by confining the Acrimony of an Overload within them.
Infants are born with their Stomachs and Intestines charged with the Recrements of the Humours in which they swim, before Birth, and the glandular Secretions within them, which will naturally purge away with the first Milk they draw from the Mother’s Breast; and they would sleep, were they not too soon fed, ’till this Provision of Nature is ready for them, as Dr. CADOGAN found from Experience in his own Family; but as the Humour of Feeding them sooner generally obtains, and the Mother too often is not the Nurse; Half a Drachm of _Castile_ Soap diffolv’d in a Spoonful or two of thin Caudle, and sweetened with Honey, would cleanse the Child, and prevent many Distempers, owing to a Retention of Impurities within them before the Birth, if given soon after.
’Tis well worth remarking, that the Food the Nurse takes communicates its Nature to the Milk, so that the Child may be intoxicated by her giving Suck too soon after strong Drink or Spirituous Liquors, by which Means many are destroy’d; it is likewise well known, if the Nurse takes a Purge, her Milk will purge the Child.
This informs us, that when the Child is troubled with Gripes, attended with green, sour-smelling Stools, the Mother, or Nurse, by being confin’d to an Animal Diet, will, in a great Degree, prevent the Gripes, Looseness, or Convulsions, occasion’d by the Acidities of the Child’s Stomach and Bowels, from the contrary Qualities communicated to her Milk. On the Contrary, a vegetable Diet will greatly relieve the same Complaints, attended with strong smelling Stools, and a Tendency to the Putrefaction of the Humours, and the Child’s Spoon-meat, when any Thing is given besides the Mother’s Milk, may be regulated accordingly: In the mean Time, in both Cases, these Indigestions ought to be purged off with a few Grains of Rhubarb, or double the Quantity infus’d at Night in a Spoonful of common Drink, strain’d and sweetened with Honey.
This, with a suitable and commodious Dress, leaving them Freedom for all their Motions, taking Care not to fill them with Crudities, by over-charging their Stomachs, would preserve the Health of young Children, they would then sleep away most of their Time, without those continual Cries of Misery, calling on the Compassion of all about them, whereby abundance of Trouble to their Nurses, and the continual Occasion of Medicines, to sweeten and purge away the Effects of Indigestion, would be prevented.
Original spelling and grammar were generally retained. The following two corrections were made in conformance with the spirit of the list of errata on page vi.
Page 9, l. 16. “Pains about the Navel and Loins” was changed to “Pains about the Back, Navel and Loins”.
Page 33, l. 12. Changed “great Complaints of a smarting Pain; when I touch’d it a Suppuration” to “great Complaints of a smarting Pain when I touch’d it; a Suppuration”. This correction is not quite what the erratum on page vi recommends—but the recommendation is not quite correct.
Page 21. Changed “which happpen’d the same Day” to “which happen’d the same Day”.
Page 49. Changed “and its _Secondines_ left” to “and its _Secundines_ left”.