ATREATISEONMIDWIFERY.
Whoeverconsiders the absolute necessity of the art of midwifery, will readily allow it a place among the capital ones in the primeval times of the world. All the other arts are no further necessary to man, than to procure him the conveniencies or luxuries of life; that of midwifery is of indispensable necessity to his living at all, imploring as he does its aid for his introduction into life. Without this art the earth itself must soon become dispeopled and a desert,whereas by means of it men have been multiplied, with inconceivable rapidity.
Inconformity to its claim of importance, this art appeared in all its lustre among the Jews, the Egyptians, the Athenians and Romans, and indeed in all nations during thousands of ages. Nor was the confinement of the exercise of it to women deemed any derogation to it. It even gave honor to its professors of that sex. Socrates, so ennobled by his character of being the greatest philosopher in all antiquity, did not disdain to boast himself the son of a very able midwife Phanarete, as may be seen in Plato’s book on science, in Diogenes Laertius and others.
Amongthe Egyptians and the Greeks it cannot be hard to conceive what emulation, what ardor it must have excited among the women of that profession, the custom of distributing prizes to those of the greatest merit in it, in the face of the people. No one is ignorant of the power of honors and distinction to bring arts to perfection.
Butfrom the instant the midwives sunk into dis-esteem, and wherever that has happened, it will be found by woeful experience, that not only the art itself has suffered in the very midst of the most falsely boasted improvements, but that human-kind itself has much and very justly to complain of the change.
Thenative inconstancy and levity of the French nation opened the first inlet, in these modern-times, to men-practitioners. In antient history we meet with but one feeble attempt of that sort, which however soon gave way to the united powers of modesty and common sense. In France, and may it not be the same case soon here! the women of a competent class of life and education, begin to decline forming themselves for this profession, as beneath them, considering the slight put upon those women who exercise it.
Norhas this injustice remained unpunished. Many women have found, by severeexperience, their having been enemies to themselves, in abandoning or slighting those of their own sex, from whom, at their greatest need, they used to receive the most effectual service, and who alone are capable of discharging their duty by them, with that sympathy for their pains, that tender affectionate concern, which may so naturally be expected from those who have been, are, or may be subject to the same infirmities.
Manyout of a distrust inspired them of midwives, have thrown themselves into the hands of men, who have promised them infinitely more than they were able to perform; and who behind all the tender alluring words, of superior skill and safety in the employing of them, conceal the ideas with which they are full, of cutting, hacking, plucking out piece-meal, or tearing limb from limb.
Themurder of so many children, the fruits of their bowels, might, one would imagine, have induced mothers to considerthis point a little more carefully. Yet, through the prevalence of groundless fears, and of imaginary dangers they have run into real ones, and have sometimes found their death precisely where they sought their life; and not seldom where nature has even favored them enough in their labor, for them not to need any extraordinary ministry of art, the men have put them to cruel and dangerous tortures.
Notwithstandingsome examples, and many violent presumptions of such mal-treatment, too many women have been so miserably misled by fashion, as to prefer the betraying the cause of their own sex, and the subjecting themselves to those who deceive them with false hopes, to the entrusting their preservation to those of their own sex, in the hands of which the care of it has been for so many ages, with so much reason, and such little cause of complaint.
Yetwe do not see that any of these men-midwifes have been capable of forming a good midwife. On the contrary, we see,that in order to remedy the abuses, or rather to prevent the fatal accidents which every day occur in the practice of a profession so necessary to the preservation of the human species, they were in France obliged to have recourse to one of the ablest midwives in that kingdom, who was placed at the head of the practice in the Hôtel Dieu at Paris, to preside over the lyings-in there, and to found and cultivate that inexhaustible seminary of excellent female practitioners, who have actually restored the art to its antient degree of esteem, with all fair judges. These worthy proficients have been so public-spirited, as to communicate their talents and knowledge to a number of surgeons, who never had any reason to be ashamed of the lessons they assiduously took from the midwives, unless indeed for themselves not being able to come up to them in the practice, so true it is, that the business is not at all natural to them.
Yethave even many of those very men-practitioners, influenced by that self-interest which has such a power in all humanaffairs, revolted against their mistresses in the art, and their benefactresses. They have, at various times, commenced lawsuits, about the Hôtel Dieu at Paris, in order to get the lyings-in there committed to them: but the administrators, the persons of a just sense of things, together with the parliament of that town, ever attentive to decency, without excluding the due regard to the preservation of the subjects, have constantly opposed and frustrated the pretentions of these innovators. These again thus disappointed, were forced to content themselves with practising upon some women of quality, under the favor and protection of some of the old ladies of the court of Lewis XIV. who had their reasons for propagating this fashion. And now these innovators, not without a due proportion of ingratitude to the injustice, began to run down the midwives, and exalt themselves. The novelty prevailed, and the contagion of example soon communicated itself to the provinces, and thence into neighbouring nations. A few men perhaps of real abilities, but governed by the most sordid interest, associatedto their party a number of the most ignorant and unexpert practitioners, but who served to fill up the cry, and made a common cause against the midwives, whose pretended insufficiency was now to be pleaded in favor of themselves being admitted to supplant them. Nor was the concurrent attestation in their favor, of so many ages, during which the practice was entirely in female hands, to weigh any thing against the boasts of their own superior ability. They picked up and sounded loud a few real instances perhaps, and undoubtedly many false ones of faults of practice in women: though were the numbers of human creatures, who have barbarously perished by the unskilfulness of the practitioners, to be fairly liquidated, it would appear that fewer have been the victims of female ignorance, than of the presumption and indexterity of the men. The women are undoubtedly liable to error: there have even been monsters of iniquity among them, but certainly in no number to form a general prejudice against them: but as to the men they are all of them, as will be more fully demonstrated hereafter, naturally incapable of the exerciseof this profession. A history of their murders might even be collected out of the books written by them to establish their superiority over the women. From Deventer, Mauriceau, and the most celebrated of their writers, amongst many excellent observations in the way of the chirurgical art, many of the grossest absurdities have escaped, where they transgress its bounds and go into that of midwifery. Some of those absurdities too are so glaring, that they have not even been overlooked by themselves.
Manypersons in Holland, having set up for men-midwives, without being duly qualified, the government thought proper to interfere, and consequently there was an ordinance issued on the 31st of January, 1747, by which it was enjoined, that no one should practise in the quality of man-midwife, or exercise this art, unless he were especially authorized for this function, by a certificate of his having undergone a sufficient examination before capable and intelligent judges for that purpose appointed.
Itwill appear, in the sequel of this work, that it were to be wished, for the sake of the good that would redound from it, to the preservation of the human species, both in parent and child, that those who are entrusted with the public welfare, would establish the same regulation in the British dominions, to expel and exclude from the art all the ignorant pretenders of either sex, who are, in fact worse than the Herods of society. The cruelty of Herod extended to no more than to the infants; not to the mothers; that of such pretenders to both.
Iftheir conduct was to be examined with attention, how many fatal mistakes would be discovered in the practitioners of both sexes? But I dare aver it more in the men than in the women-practitioners. With what horror would not there in these be remarked, tearings, rendings, and tortures of no use to which they put both the mother and the child? One, upon some most learnedly erroneous hypothesis, pulls and hauls the arm of an innocent infantyet living, so that he plucks it off; or repels it with such violence, that he breaks it: another unmercifully opens the infant’s head, and takes the brain out: some bring the whole away piece-meal: operations often to be defended only by hard words and harder hearts.
Norneed this procedure astonish. Every thing is at the disposal, I had almost said, at the mercy of these executioners:but have they any? all their handy-work is transacted in private, and remains buried in the tomb of oblivion. The parents suspecting nothing, think every thing has been done, according to art, that is to say, very right. The operator thinks he has done nothing but his duty, and is highly satisfied with himself, after he has ordered some draughts for his patient. The magistrate knows no injury done to the subject, or is insensible to the consequences from the same spirit of confidence. In the mean time, a husband loses a fine child, or a beloved wife, perhaps both; children, a tender mother, and if they are of the same sex, have the same fate to dread for themselves. Theman-midwife is clear, for only saying, that he has done all for the best. But this is probably true too, as to the intention; but as to the fact, it shall be shewn that there is often great reason to doubt it.
Bethis observed, without offence to the few able men-midwives who are masters enough of the business, not to deserve the reproaches due to by much the greater number of rash and ignorant pretenders to it: whose practice, well examined, would bring to light such terrible truths, as would alarm even the legislature to provide a remedy against the danger.
Incontradiction to this, it may be urged, that the practice by women is susceptible upon that account, of superior objections. That remains now to be examined. The chief object of this work being a fair discussion, which of the two sexes is the most appropriated by nature and art, to the exercise of this function.
Tothis end, I shall present, in a candid view, the two opinions which, on this point, divide the English yet more thanthey do the French. Most of the surgeons, all the men-midwives, no doubt, many apothecaries, a number of women and nurses maintain, that midwifery is the business of the men: whilst on the other hand, the best part of the able physicians, with many other persons of both sexes, defend the contrary side of the question, and insist on this art being, for many invincible reasons, solely the province of female practitioners.
Notto lose sight of the fundamental arguments and proofs brought to support respectively these two opinions, I shall place them in parallel with one another, in form of objections and answers. The objections made to women-practitioners precede the answers. If the men-midwives, or their partizans, shall think I have omitted any thing that makes for them, or against us, or have any stronger or more essential arguments to oppose, I shall endeavour to satisfy them.
Objectionthe First.
Regardought to be paid to prior possession. The art of midwifery being a branch of the art of physic, must have been originally in the hands of man, the inventor of all arts.
Thejust deference so universally paid to holy writ will, I presume, allow no prejudice to be found against my availing myself of those inferences and decisions to be drawn from it, which are so agreeable to the eternal laws of common sense.
Ifthe arts and sciences, acquired by experience, and by acts often repeated, had, as they certainly were not invented by men only, that could not at least be said of those acts of the human life, which are indispensably necessary to its preservation. Such faculties may with more propriety be termed instinctive, than invented ones. The faculties of eating, of drinking, oflying down to rest, common to both sexes, are not perhaps more natural, more matter of instinct, than the faculty of one woman assisting another in her labor-pains being appropriated to the female sex.
Thereis no occasion to give one’s imagination the torture to account for Eve’s delivering herself of her first children. There is no reason to establish it as an absolute necessity that Adam should have assisted Eve in her first lyings-in; whose labor-pains might not only be less severe, than they afterwards became in accomplishment for the curse pronounced on the human race for the sin of those first parents, but also more consonant to piety, to believe that God, being the best of fathers, infused into Eve knowledge sufficient of the manner of delivering herself; a manner more natural and more conformable to the ideas of that decency imprinted with his own hand in the human heart, in no point more strongly, nor more universally, than in this matter of the women lying-in, when both men and women have an equal repugnance to the interposition of any assistance, but that of the femalesex, to which the faculty of ministering in that case seems innate.
Butadmitting even that Adam, for the want of females for that function, before the daughters of Eve were grown up to a capacity of it, actually did assist Eve, in the seasons of her delivery; that would establish no inference of right for the future: since we know that their children and descendents in time following did not make use of men to lay the women.
InGenesis, chap. xxxv. ver. 17. there is mention made of Rachel’s midwife. In the same book, chap. xxxviii. ver. 27, and 28. we see they were intelligent midwives. Thamar being with child. “It came to pass in the time of her travail, that behold, twins were in her womb.”
Ver.28. “And it came to pass that when she travailed, that the one put out his hand, and theMidwifetook and bound upon his hand a scarlet thread, saying, this came out first.”
Andhere I intreat the reader not to impute to me any idea so absurd as that of meaning to defend an erroneous practice solely from the antiquity of it; I intend nothing further by this citation, than to prove the antiquity itself, which if not decisive in favor of the practice by women, can at least be no prejudice against it.
Theart of midwifery being equally noble for its subject as for its end, since it is the only one which enjoys the prerogative of saving, at one operation of the hand, more than one individual at once; ought the less noble sex to dispute pre-eminence in it with the men? On tracing things back to the remotest distance of times, it must be allowed, that if the women, through a mistaken modesty, in those times of ignorance and simplicity, commonly made use of midwives, it may be presumed there were also men-practitioners employed in difficult cases.
ANSWER.
Readilygranting that the art is a noble one; noble in its subject and ends: all that I am surprised at is, that the men did not find it out sooner. Probably the nobility of this art is only begun to be sounded so high by the men, till they discovered the possibility of making it a lucrative one to themselves. Then indeed the ignorance and incapacity of the poor women for it, came all of a sudden to be doubted and despised. The art with all its nobility was for so many ages thought beneath the exercise of the noble sex: it was held unmanly, indecent, and they might safely have added impracticable for them. But had even any of the medical profession not thought so, there is great reason to think the rest of mankind would have viewed their interested endeavors to usurp this province from the female sex, in the light they deserve. It was only for the eternal fondness which prevails among the French for novelties, that paved the way for the admission of so dangerous and indecent an one, as that of men making a common practice of midwifery, and takingit out of the women’shands, to which it was so much more natural.
I amhere far from wishing to enter into a contest with the men, on the superiority and excellence they assume over the women; though not quite so indisputable perhaps as is commonly imagined. All that I contend for, to the purpose of the present question, is, that there are certain employments and vocations, which are generally and naturally more proper for one sex than for another. A woman would seem to aim at something above her sex, that would set up an academy for teaching to fence, or ride the great horse: but a man sinks beneath his sex, who interferes in the female province. It is not with quite so good a grace as a woman that he would spin, make beds, pickle and preserve, or officiate as a midwife. Be this observed without impeachment of the superiority of men.
Openbooks, sacred and profane, you will find that the Egyptians were not so simple as Dr. Smellie would give us to understandthey were; when in the beginning of his introduction, pages 1st and 2d, he grants us, out of his special grace and favor, “that in the first ages the practice of the art of midwifery wasaltogetherin the hands of women, and that men were never employed but in the utmost extremity: indeed (says he) it is natural to suppose, that while thesimplicityof the early ages remained, women would have recourse to none but persons of their own sex, in diseasespeculiarto it: accordingly we find that in Egypt midwifery was practised by women.”
Accordingto scripture, however, the sorcerers of Egypt were not so very simple neither, since they had art enough to imitate some of the miracles of Moses, in transforming their rods into serpents, blood into water, and covering the land with frogs[1]. All this did not favor of simplicity.
TheEgyptians[2]have ever passed for the most intelligent and enlightened of all the other nations of the earth, who respected them as oracles of wisdom and sound philosophy. They are the first people who established systematically rules of good government. This profound and serious nation saw early the true end of human policy; and virtue being the principal foundation and cement of all society, they industriously cultivated it. At the head of all virtues they placed that of gratitude. The honor attributed to them of being the most grateful of men, shews that they were also the most social. They had an inventive genius: their Mercuries, who filled Egypt with surprizing discoveries, scarce left any thing wanting to the perfection of their understanding, or to the convenience and happiness of life. The first people among whom libraries were known to exist, is that of Egypt. In short, so far from being simple or ignorant, they excelled in all the sciences. There were indeed among themnomen-midwives; but to make up for this deficiency, they had, it seems, excellent midwives.
Besidesit is even ridiculous to confine the practice of midwifery by females only to early ages. Who does not know, that it was so in all ages, and in all countries, till just the present one, in which the innovation has crept into something of a fashion into two or three countries. The exceptions before, or any where else, to the general rule, are so few, that they are scarce worth mentioning.
Butto return to the sosimpleEgyptians. We read in Exodus, chap. i. v. 15. and following, that Pharaoh said to the midwives, “When ye do the office of midwife to the Hebrew women, and set them upon the stools, if it be a son then ye shall kill him, but if it be a daughter she shall live.
“17. But the midwives feared God, and did not as the king of Egypt commandedthem, but saved the men-children alive.”
Theking reproached them, as may be seen in the same place.
Whydid not Pharaoh give the same order to the men-midwives, if there had been any such employed in difficult or extraordinary pains? (as Mr. Smellie supposes.) Or rather, if the king had not thought it too unnatural for women to be delivered by men, he certainly would not have failed to have commanded it, especially on perceiving that the midwives had deceived him. This would have been a fine occasion to have forbidden them their function, and for the men-practitioners to have come into vogue. The men would certainly have been of the two not the improperest to have executed the intentions of the tyrant: as tender-heartedness is surely not more the character of their sex, than of the women. Besides, their instruments would have served admirably to have thinned the species, without distinction of the sexes. They might alsohave concealed the barbarity of the murders by such instruments, under the pretext of their necessity from hard-labors, as the midwives excused their disobedience under that of easy ones, which had rendered their aid superfluous.
Somany authors as have wrote on the art of midwifery, from the age in which Hippocrates florished, whom we look on as the first and father of the men-midwives, with the disciples whom he formed, and their successors, do not they satisfactorily prove the antiquity of man-midwives?
Asfor satisfactorily, no. It can only be concluded from this objection, that the ignorance of the pretended men-midwives is very antient: and yet posterior by much to the function of the midwives, since that is coeval with the world itself, embraces all times, extends through all parts of the earth, whereas we hear nothing of the other till the times of Hippocrates.
NeverthelessI greatly respect Hippocrates, and all the authors who have treated of this art. Some thanks are due to them, though but from those whom they have set to work in our days. Consider but the most celebrated authors among them down to our times, there may be found in them great progresses by degrees, especially in our modern writers on this subject. Yet the most intelligent of them feel and confess that the matter is yet far from exhausted. For after having studied all the treatises we have upon it, there may, there must be perceived an aberration and emptiness with which the understanding remains unsatisfied, and feels that much is yet wanting to the requisite perfection.
Notwithstandinglikewise the veneration confessedly due to Hippocrates, I cannot dispense myself from saying the truth; he might be and doubtless was an excellent physician: he has wrote upon all the female disorders, and on the means of delivering them; he may have been consultedin his time, but he can never pass for an able man-midwife. His writings contain some violent remedies and strange prescriptions for women in labor, which must be the produce of the most dangerous ignorance of what is proper for them in that condition.
Thisauthor was also evidently ignorant of what concerns preternatural deliveries, as indeed were his successors till the beginning of the last century.
Toprove what I advance, there needs no recourse back to very remote times: it will be sufficient to peruse the treatises of Ambrose Paræus, Jacques Guillemeau, Peter-Paul Bienassis, printed 1602, and even that of De la Motte, who is of this century, to own, that the practice of the men-midwives was far from having attained any degree of perfection.
Themanner in which the antients proceeded, when the child presented in an untoward situation, is a fully convincingproof thereof; since they obstinately, in such cases, continued their efforts to reduce it to its natural situation, in spite of a thousand difficulties and dangers, instead of bringing it away footling, as is now done by all who understand the right practice.
Hippocratesis the first who discovered that wonderful secret of killing the child, and bringing it away piece-meal from the mother’s womb. He advises it, in the manner taken notice of by Dr. Smellie, in his introduction, (page 10. & seq.) I do not know whether it is from that branch of practice that he adopts him for “the father of midwifery” (p. 4.) but, what is certain is, that Galen, and all the successors of Hippocrates, till towards the end of the last century, exactly followed his method of not delivering women in hard labors, but by the means of murderous instruments. I shall not here detain myself with rehearsing the long legend Mr. Smellie gives us of all the authors who have written on this subject tothe time of Ambrose Paræus; time when to the progresses made by the midwives of the Hôtel Dieu at Paris in the art of midwifery, it was owing, that the surgeons, guided by their superior lights, made some greater progress towards perfection.
Thatthe reader however may not suspect me of exaggeration, or over-straining points, I request of him to suspend his judgment, to have the patience to hear me out to the end, and he will find, that I have here advanced nothing but what in the sequel stands clearly and manifestly proved.
Ina word, the manual operation of midwifery is an art, a science, and as such consequently more competently to be professed by men, than by women. It is making the art cheap, say the moderns, to allow the practice of it to women.
ANSWER.
I agreewith you in the first part of your objection: but I absolutely deny the consequences.
Thereare women, who, besides the gifts received from nature, are improved by study, by reading, and experience, who succeed much more easily than men in the practice. To say the truth, nature has, in this point, been even lavish to the women, for this art is a gift innate to them.
I willhowever own, that not all women indistinctly are proper for this business; that there must be natural dispositions cultivated by art; that a purely speculative knowledge is not sufficient; that there are required good intellects, memory, strength of body and mind, sentiments, some taste, and practice joined to theory; so that when I say that the women are born with dispositions for this art; this can only be understood in general, and relatively to the men, among whom thosedispositions are more rare, because they are less natural to them in this branch.
Wouldit not be a sort of blasphemy against the divine providence to maintain, that what God has placed and left in possession of the women, was fitter for the men? the attentive, beneficent, and tender manner with which he governed his people elect, obliges us to believe that he omitted nothing of what was necessary or advantageous to it; since he regarded that people as his own particular dominion and appendage; honoring it with his presence, like a master in his dwelling-house, or a father in his family. He had taken pleasure in the forming and instructing it from itsinfancy. He put the women in possession of the art of midwifery, he blessed, approved, and recompenced the midwives. It is but just, that men should hear and keep silence where God speaks. They may think themselves happy, to learn from him the true secrets of nature, and not from those pretended doctors who abandon the rules of truth to cleave to themselves; who, instead of her, present us with aphantom of their own creation, who, in short, would make us the worshippers of their dreams and imaginations.
Thewomen have for them the authority of God, who has declared himself in their favor; they have for them the authority of men from one pole to the other, who have in all ages made use of the female ministry in this art. Such a plurality of votes has surely some claim to prevalence, especially, since it is founded upon the natural order of things, upon truth and reason supported by experience. This experience we have on our side: none can deny it, without denying self-evidence.
Onewould think there is a kind of curse attends the operations of men-practitioners, as I dare aver it for a truth, that difficult and fatal labors have never been so rife, or so frequent, as since the intermeddling of the men. Whereas, God has ever so blessed the work of the midwives, that never were lyings-in so happily conducted, nor so successful, as when the practice was entirely in their hands.
Openthe book of Numbers, you will observe, that God having ordered Moses to number his people: out of seventy individuals of the family of Jacob, who had come to dwell in Egypt, two hundred and forty years before, there had issued above six hundred thousand men fit to carry arms, without taking into the account an almost infinite multitude of children, of youths under twenty years of age, of women, of old men, besides a whole tribe, that of Levi, which was entirely set apart for the divine worship.
Thereis no such thing as being a good practitioner of midwifery without understanding anatomy: now this science is the province of a man, of a physician, or surgeon, not of a woman.
Itis sufficient that a woman understands and knows the structure and mechanical disposition of the internal parts whichmore particularly distinguish her sex; that she can discern the container from the contents, what belongs to the mother from what belongs to the child, as well as what is foreign to both. In short, she ought to be skilled enough to give full satisfaction to all questions that the most able anatomist could put to her, in respect to that part purely necessary to the art of midwifery, and to its operations with mastery and safety.
Nowthe midwife, especially one instructed in hospitals, ought to be well acquainted with all that is essential and necessary to that effect; and she cannot but be so, unless she is of herself incapable, or that those who are charged with the instruction of pupils, wrong the confidence of the public.
I myselfknow more than one midwife, so well educated as to be able to give demonstrations on this subject, to analyze things by their names, either upon drawings of them, upon skeletons, or upon the originals themselves. It is true, that these poor midwives do not understandanatomy enough to make dissections; but I fancy that the ladies who want assistence in their lyings-in, are not very curious of having one that can dissect instead of delivering them.
Prophanehistory has preserved to us the names and talents of a number of illustrious women who have distinguished themselves in all kinds of arts. Cleopatra queen of Egypt, is one of the first ladies that have written on the art of midwifery. Mr. Smellie, in his introduction, endeavours to render doubtful this quality of queen and princess, with a design, probably to weaken the credit of it, or rather out of contempt to the women; but as all those who have made collections of antient history, assure us, that notwithstanding the wars in which this princess was engaged, she did not neglect an assiduous application to physic, I had rather adhere to their authority, than to that of Mr. Smellie.
InGreece, Aspasia, and a number of other celebrated women, quoted by variousauthors, have applied themselves to our profession, and have left behind them valuable works on the method of delivering women, and of managing them both before and after their lying-in.
MadamJustin, midwife to the Electress of Brandenbourg, has also given us a very good treatise. Several professed midwives appointed to form the apprentices of the Hôtel Dieu at Paris, have written very clearly on the same subject, without however being mistresses of any more anatomy, than what was sufficient for their business.
Thedifferent instruments which the men have invented in aid of, and supplement to the deficiency of nature, and of which they are frequently obliged to make use in different labors, ought not to be put into the hands of midwives: and were it but for this reason alone, they ought to be excluded from the practice of this art. As, why multiply attendants unnecessarily?A man-midwife, with his instruments which he ought always to have about him, is enough for every thing: whereas a midwife, if the case requires instruments, will be obliged to have recourse to a man: consequently double embarrassment, double expence.
Thekeen instrumentarians bring an argument they imagine capable of banishing or exterminating all the midwives. The men, they say, enjoy alone the glorious privilege of using instruments, in order, as they pretend, to assist nature. But let them, I intreat of them, answer, whether if the question could be decided by votes, where is the kingdom, where is the nation, where is the town, where, in short, is the person that would prefer iron and steel to a hand of flesh, tender, soft, duly supple, dextrous, and trusting to its own feelings for what it is about: a hand that has no need of recourse to such an extremity as the use of instruments, always blind, dangerous, and especially for ever useless?
Whathas engaged men to invent and bequeath to their successors so many wonderful productions, for such they imagine them? Is it not the thirst of fame and money? These gentry have judged, that they ought to spare no lucubrations, no labor of the head, no efforts of the tongue and pen to procure themselves a strange reputation, supported by these horrible instruments. But these lucubrations, this labor of the head, would have been much better employed in seeking for the means of absolutely doing without them, as our good female practitioners have ever done, and as those of them still do, who are instructed in the right practice.
Weare no longer in the times of the Pharaohs and the Herods, who mercilessly massacred the innocents; we are no longer in the times of those pure Arabs, who were the inventors of a number of cruel operations, and of several instruments, which often cause more apprehension and terror to a woman in labor, though concealedfrom her light, but never from her imagination, than the actual presence of all the apparatus of the rack, where that torture is in use.
Itwere to be wished, that all the men-midwives, who had wrote on this matter, had suppressed the mention of their instruments; for as their books often fall into the hands of women, so deeply interested as the sex is in that subject, it is not to be imagined what bad effects they have. Their variations among themselves would be sufficient to frighten the women: you meet with authors condemning in the morning the over-night’s sentiment. I can observe them losing their way in systematical errors, which explain nothing to me, and in which nothing can be discovered but disagreement with one another, and with themselves. The wisest and most able of them, after having well examined all the kinds of instruments hitherto invented, have doubtless seen and been convinced of their ridiculousness and usefulness, but all of them have not hitherto dared to speak out and say as much.
Themost interested of them would fain persuade us, that, in their display of a whole armory of instruments, they have discovered the philosopher’s stone of midwifery, in virtue of which they have a right to wrest out of the women’s hands, the practice of an art, which nature has appropriated to them. But certainly the point, and the whole point is, to find an expert dexterous hand, the sex is out of the question, provided it is but a human hand, and provided the work is done to the satisfaction of society, it seems to me that nothing more need be required.
Itis only for the ignorant to be so rash as to raise an out-cry against the use of all instruments; people who do not know the absolute necessity there is for employing them on certain occasions. This clamor must proceed “from the interested views of some low, obscure and illiterate practitioners, both male and female, who think that they find their account in decryingthe practice of their neighbours.” Such is the objection in the words of Dr. Smellie, in his Treatise on Midwifery (page 241.) and for this panegyric, he prepares us in his Introduction (page 55.) where, speaking of the midwives of the Hôtel Dieu of Paris, he first indeed tells us, that the surgeons had, in that hospital, perfected themselves in the art of midwifery; but then for fear that from thence occasion might be taken of saying, that to women it was they were beholden for that perfection; he takes care immediately after to add, that what “got the better of those ridiculous prejudices which the fair sex had used to entertain,” was, that the women or midwives of this hospital “had recourse to the assistance of men in all difficult cases of midwifery.”
Thesegentlemen will permit me to tell them that they make great pretentions, and prove little or rather nothing. Calling hard names with a disdainful tone, and with airs of triumph, are not overwhelming reasons.
Butto the point. Those who reject instruments, say you, do not know what they are: they reject them from ignorance. This is soon said. Nevertheless a number of authors, much more experienced and versed in the matter than Dr. Smellie, are of this opinion. Deventer exclaims against instruments; Viardel does the same; Levret admits none but those of his own invention, and rejects universally all others; and well might he except his own, since he wrote only to recommend them. Delamotte was not very fond of instruments: he tells us in his preface, that in a course of thirty years practice, he had not twice made use of the crotchet, though he had an extent of country forty leagues round, in which he regularly exercised his profession, insomuch as to have four lyings-in in a day under his management.
I havevery exactly read almost all the modern authors who have written on this art; and have been surprized to observe that whilst, on one hand, they agree, they own, that in England, France, and Holland,people are much come off, or undeceived, as to all those dangerous or mortal instruments of which the antients made use, such as the short broad-bladed knife, (call it, if you please, a pen-knife) the bistory, the crotchets, &c. especially since the invention of the new forceps, or tire-tête: on the other hand, these same doctors tell you, that recourse must be had to crotchets, or to the Cæsarean operation, when the new forceps will not do. A comfortable resource this, in an instrument so boasted as the best discovery that has been made since the creation of the world, and for which we are indebted to the moderns!
I havealso scrupulously examined all that authors have been pleased to say of great, wonderful and magnificent, with regard to the new forceps of Palfin, as it now stands after infinite corrections, as well in foreign countries, as in this one, which have dignified it with the name of the English forceps; and I find all these great elogiums reduced, at the most, to no more than the proving, as clear as the sun, that it is allowable for an operator,extremely able and extremely prudent, to make use of it, when the business might be perfectly well done without it.
Fromthence I deduce my demonstration directly opposite to the pretentions of Dr. Smellie and of his followers. According to the instrumentarians, and according to certain doctors, there are certain occasions, certain cases, in which there is an absolute necessity for employing the forceps. If we will hearken to and follow other doctors of more celebrity and credit, it is not right to make use of it, but when one may very well do without it: for example, after the having obviated all the obstacles which retard the delivery, after having, with the hands only, dis-engaged the head or the shoulders of the child, without which (say these same writers) the instrument would be found insufficient or useless; this palpably implies the being able to do without it. Now since it is not allowable, in good practice, to make use of it, but when it is perfectly needless to use it at all, there is then no absolute necessity for it; as surely, what can bedone without, is not absolutely necessary. Be this only transiently remarked. For I reserve most convincingly to prove this proposition in the second part of this work. There I shall treat of all the instruments of our antients and our moderns, and besides an enumeration of them shall demonstrate their danger and uselessness. In the mean time, it must be owned, that either Mr. Smellie has been much misinformed of what passes at the Hôtel Dieu of Paris, in the ward of the lying-in women, or else, which I the least believe, is not sincere in the account he gives us, that the women of that hospital “had recourse to the assistence of men, in all the difficult cases of midwifery;” which, he observes, “got the better of those ridiculous prejudices the fair sex had been used to entertain.” That is to say, in preference of midwives to men-practitioners.
I frequentedthis Hôtel Dieu two whole years, before being received an apprentice-midwife, which I accomplished with great difficulty, on account of being born a subject of England, and consequentlya foreigner there: my admission, however, I gained at length, through the favor, protection, and special recommendation of his royal highness the duke of Orleans. Now, I dare aver, that in all the time before, and after I was admitted there, I never but once saw Mr. Boudou, surgeon-major called, who did nothing more than to make us, one after another,touchthe patient, about whom we had been embarrassed; and as he interrogated, he made us discover anuterusfull of schirrous callosities, which joined to its obliquities, impeded the palpation of it properly with the hand, the orifice being very difficult to come at. Every thing, however, was done without his help, and very successfully. And most certainly we should have spared him the trouble of coming at all into our ward, if the head-midwife, who was a little capricious in her temper, had not taken it into her head to keep us in our perplexity, which engaged us to send for Mr. Boudou without her knowledge, and for which she was afterwards heartily angry with us.
I neveronce saw an occasion in which there was any necessity for using instruments, though in my time we had, at least, five or six hundred women a month to deliver.
Veryfar then are the midwives from having often occasion of recourse to the assistence of the men, in difficult cases; and indeed to those prejudiced in favor of men-practitioners, it may, though true, appear strange, that in a place where there are every year so many thousand women delivered, and consequently many difficult labors amongst them, and even cases of monsters, there is no recourse to the surgeon-major but in the last occurence, which falls out very rarely.
Abouteighteen or twenty years ago, Madam Poor, head-midwife of this hospital, delivered a woman of a monster with two heads, with no help but only her fingers and a young prentice. Not an instrument was employed: no man assistedher. The child was christened, and died presently after. The mother remained some months upon recovery, and did perfectly well. This fact requires no proofs, being of such public notoriety. The monster was carried to St. Cosmo’s, where any surgeon may see it. I served my time with this same mistress some years after this kind of prodigy had happened.
Asto what I have advanced concerning the procedure in the wards of the lying-in women, should my testimony appear in the least suspicious, I appeal to the justice and veracity of all the doctors in England, who have been at the Hôtel Dieu at Paris, who cannot but confirm what I have said. In the mean time Mr. De la Motte, who passes for an author of credit may certify, the same. Here follows what he says in his preface to his observations, page 2.
“Onewould think (says this author) from reading the books of Messieurs Mauriceau and Peu, that it was impossibleto succeed in the practice of midwifery, without having operated at Paris in the lying-in ward of the Hôtel Dieu. It is true, that this hospital is the best school in Europe, and that I would have ardently wished to have been admitted to the operations of midwifery during the five years I staid in that hospital: but as there is no more thanonesurgeononly, who is in charge to attend when he is called to consultation with the midwives, and that it is a place which goes only by favor, I was forced to content myself with following in quality of topical surgeon, to the physicians who performed their visits there. So that I followed only, for six months, three physicians in their rounds there, during which time I applied myself to examine the conduct observed by those gentlemen, to preserve the women after their lying-in from the accidents which follow thereon. By this means I made myself amends for my want of recommendation; but I can safely say, that during the six months I was admitted in the above-mentioned quality, there wasno more than one extraordinary labor, which was that of a child engaged in the passage, where the presence of a surgeon was required, and which however was terminated without any other help than that of patience. And yet there were (so far back as then) from three hundred and fifty, to four hundred pregnant women, who were all delivered by the apprentices and rarely by the Dame De la Marche, at that time, head midwife of the hospital: so that I am persuaded, that those who boast of having lain a great many women there, exaggerate furiously.”
Forme, I dare yet go farther, and will maintain it, that those persons impose upon the public in such boasts: since the naturalized surgeons, those of the nation, those of Paris itself, have no right to come into our ward. There is no one admitted but the surgeon-major, whose place is a place of favor, and rather matter of form than any thing else. Much more then are strangers excluded, and the truth is, that they never did, nor ever do operate there.
Asto the reproach which Mr. Smellie makes to us of being interested, I can, for myself, prove that I have delivered gratuitously, and in pure charity, above nine hundred women. I doubt much, whether our critic can say as much, unless he reckons it for a charity, that which he exercised on his automaton or machine, which served him for a model of instruction to his pupils. This was a wooden statue, representing a woman with child, whose belly was of leather, in which a bladder full, perhaps, of small beer, represented the uterus. This bladder was stopped with a cork, to which was fastened a string of packthread to tap it, occasionally, and demonstrate in a palpable manner the flowing of the red-colored waters. In short, in the middle of the bladder was a wax-doll, to which were given various positions.
Bythis admirably ingenious piece of machinery, were formed and started up an innumerable and formidable swarm of men-midwives, spread over the town andcountry. By his own confession, he has made in less than ten years nine hundred pupils, without taking into the account the number of midwives whom he has trained up, and formed in so miraculous a manner. See the preface of this author. He speaks of hismachinein the first page, and p. 5, of the number of his pupils.
Nowas to these worthy pupils, must not they be finely enabled to judge of the situation of women with child, and of that of their fœtus? Must not they be deeply skilled in that branch of anatomy? Must not they acquire a habit of the touch exquisitely nice, exquisitely just, for discerning the proportion and analogy between a mere wooden machine, and a body, sensible, delicate, animated, and well organized?
I hopetoo that it is an injustice done to that doctor, by those who say that his pupils have too often a way of hurrying out the waters, which can only serve to render the labor more dry, consequently more laborious, and by that means furnisha handle for setting their instruments to work. If this should be so, as once more I hope it is not, may not the bad habit they will have contracted during their pupilship, of drawing the small-beer out of their wooden-woman, have contributed to this method of practice?
Inthe mean time, does it become a doctor to call us interested, who himself, for three guineas in nine lessons, made you a man-midwife, or a female one, by means of this most curious machine, this mock-woman?
Butyou who come so late (it will be said) What new discoveries do you bring us? Can you imagine you will, with one dash of the pen, cancel the impression of so many excellent works as have appeared before you? Do you believe a woman can have more ability than so many men of letters, who have labored all their life-time in perfecting the art, and who so strongly recommend the use of instruments,as the most expeditious method of extricating one self, in all the cases they specify, and where there is a necessity for recourse to extremities? Can you think, that these personages have all spent their time in vain?
Almostall the sciences and arts attain to perfection, in process of time, through the experience and assiduous attention of those who cultivate them. We owe the most of our rare and precious inventions to the ages of barbarism, in which as yet reigned that brutality and ignorance which the irruption of the northern swarms had diffused over all Europe. This invention and perfection of arts cannot be attributed to merely human industry; but, with more probability, to a particular over-ruling providence, which commonly concealing itself under what seems to us the weakest, and under occurrences which appear to us the effect of chance, have guided men to wonderful discoveries. Do not we owe to a fair Circassian the art of inoculating children? And surely the art of midwifery,perhaps more than any other, stands the fairest chance of being improved by women.
Formy part, I dare maintain it, that the surgeons, in form of men-midwives, have been the death of more children, with theirspeculum matricis, theircrotchets, theirextractorsorforceps, theirtire-têtes, &c. than they have preserved. If in killing the children, they have saved the lives of some mothers, they have hurt and damaged, not to say murdered, a number of others. Their faults ought to set us upon searching out for a better way of going to work; a more easy, a more safe one. This fatal operation by instruments might even be pronounced absolutely useless in the profession. There is no inveighing severely enough against so dangerous a doctrine as that which recommends them. Even common humanity requires an endeavour to open the eyes of those, who imagine they cannot do better than blindly to assent, in every point, to authors recommendable, it is true, by a number of good things, but whose authenticity in those points procures them but the more dangerouslycredit in erroneous ones. Good sense does not dictate undistinguishingly receiving all that is advanced even by the best authors. As they may have been themselves deceived, they may also deceive us. The sacrifice of our reason is what we owe to nothing but to revelation. Books written by men have no title to it. As their understanding is not above the impositions of others, or errors of their own, they may adopt falsities, through ignorance, through prejudice, for want of examination, or of right reasoning. Their heart may also have been byassed or corrupted by views of interest or of ambition. I may therefore, without over-presumption aver, that with regard to instruments, it is wrong to lay any stress on the authority of others. For, with all the respect due to some illustrious writers in these modern times, who defend the party opposed to ours, it may be assuredly said, that either they have not known the art of midwifery, or that they have formed their judgment of it by nothing but the abuses of the antients, who practiced it without knowing it. Is it not a crying shame, that operators, who in their life-time massacredsuch numbers of human creatures, should still retain, after death, credit enough to assassinate common sense? Faith is given to unskilful authors, who have deceived their cotemporaries, posterity, and perhaps themselves: ignorance admires, enthusiasm protects them. But what a cruel and mean policy must be that of supposing, that the knowledge of truth ought not to have a clearer title to dominion than the illusions of imposture? I hope however, that, when the eyes of the public shall, in this point, come to be opened, and opened they will be, if true physicians will give themselves the trouble to enlighten it, that public will at length see, that an approbation, unpreceded by a due examination, does it as little honor as service.
Lying-inwomen principally require an early assistence. For unless they are pregnant of a monster with two heads (a case so rare, that in the practice of a thousand surgeons, in their whole life, it may not twice, nor perhaps once fall in their way) there need never be an occasion of recourse to a surgeon: for in this case, of a monster, it must be the affair of a mostprofoundly skilled operator and not of merely a common man-midwife.
Runover all the authors who have written on this matter, and you will find that the men-midwives, for want of right, and of true knowledge of the profession, have introduced themselves by force and violence, as one may say, sword in hand, with those murderous instruments: read the ancients, it will appear, that they cut their way in, with iron and steel, forerunners of murders. Our moderns to palliate these violences and injustices, agree on one hand, that the common and gentlest methods are to be preferred: but, on the other hand, when you tell them, that the common and gentlest methods are the hands of women, who ought therefore to be preferred to the men, and to be restored to their antient and rightful possession; then you will see the whole pack open in full cry: to arms! to arms! is the word: and what are those arms by which they maintain themselves, but those instruments, those weapons of death! would not one imagine, that the art of midwifery was an art-military?
Asfor we women, we can but in our weakness groan under this tyranny. Our protest, joined to that of reason and experience, avails little. Our wise innovators have a great deal more wit than we have; but it is not a wit of which we would be ambitious: for it serves them no better, than under the pretence of saving to be paid for destroying: at least it is not unfrequently so.
Opinionoften makes a stronger impression on us than truth. Whatever you may say to the contrary, the imagination will prevail of life, being safer in the hands of a man than of a woman. For, in short, of what importance can a woman be, who, after all, is but a woman? This is so true, that most of our women now a-days will have a man-midwife, some through prejudice, others through good œconomy, because if there are any prescriptions necessary for the patient, the man-midwife, who is also stiled the doctor, will write for them; whereas, if there is a midwife, a physicianmay moreover be requisite: this is an additional charge.
A happinessfounded on opinion only, is rather too slightly founded, especially in a point where not less than life is at stake. I know there are women so obstinately wedded to their opinion of certain pretended doctors, that they would not look upon it to be a good office done them, though certainly it would be one, to undeceive them. I also know that the title of doctor is so common in this country, that it ought to be very cheap.
Mostof the women in labor, (you say) will have men to assist them, as thinking their life more in safety with them, than in the hands of women. May be so. But what does that prove but the deplorable blindness, the weakness of the human understanding, and the silly prejudices in favor of novelty? Is it then the instruments of these men-midwives that give this confidence or this security? As if a king, a queen, or princess dangerously ill, could bedefended from death, by doubling their guards.
Thewomen have on this occasion the delicacy not to suffer even their husband to assist at their labor, and this out of decency. This is very well for those who are contented with midwives; but as for those who will be attended by men to lay them, it is very wrong in them not even to insist on their husband to stay by them. For this preference of men to deliver them, comes either from a greater inclination to the men, or from a greater confidence in them than in the women, or, in short, from the pure necessity they imagine themselves under to employ a man. If it is from inclination, or from necessity, it will be always proper for the husband to stay, to contain the man-midwife, as much as possible, within the bounds of modesty. If the man-practitioner is preferred by them, out of the great confidence they have in men: in what man can they place more confidence than in a tender husband: who more than he can interest himself in the man-midwife’s acquitting himself duly of his office?
I wonderthat this great confidence which is reposed in the male sex should be limited to the man-midwife only. I promise the women, that they may with equal justice imagine a greater handiness about them in men-attendants than in women; they may just as well have men-nurses as men-midwives: the convenience will be as much greater in the one, as the safety will be in the other. Away then with all the women, who croud round to comfort and relieve a woman in labor: away with your mothers, sisters, aunts or female acquaintance: in consequence to the preference due to the male-sex, let the patient’s labor be attended by fathers, brothers, uncles, or men-acquaintance.
Butlet common opinion lower women as much as it will, so much is certainly and experimentally true, that, notwithstanding the prejudice and superiority of the men, the judgments and decisions of the women are often more shrewd, more exact than theirs. Women have a certain delicacy of mind, which, not being spoiltby undigested studies, renders their taste much more quick, and more to be depended on, than that of the half-learned.
Thedistribution of merit and talents is entirely in the hands of divine providence, that gives what and to whom it pleases, without respect to the quality of persons; forming out of the assemblage of sciences of all sorts, a sort of empire, which, generally speaking, embraces all ages, and all countries, without distinction of age, sex, condition or climate. The rightful claim to solid praise in this empire, is for every one to be contented with his place, without bearing envy to the glory of others. These he ought to look on as his colleagues, destined as well as himself to enrich society, and become its benefactors. As this providence places kings on the throne for nothing but the good of the people, neither does it distribute different talents to men but for the public utility. But, as in states it has been seen, that tirants and usurpers have sometimes got the upper-hand, so, amongst men of talents there may, if I dare so expressmyself, creep in a sort of tyranny, which, in the present case for example, consists in looking on the women with a jealous eye, especially those who from an eminence of talents might dispute precedence with them. Thence it is that they are, as it were, hurt by their successes, and by their reputation, and that they endeavour to depreciate their merit, in order to establish the sole dominion in themselves. A hateful defect this, and entirely contrary to the good of society.
Thisis nevertheless the defect of most of our young men-midwives. But when I consider the mercenary interest by which they are guided, I am far from wondering at their inveteracy against those midwives, especially who are distinguished for their merit and science. The objects of this malignity of theirs are principally those, who have a reputation they fear may enable them to be their competitors in practice. From this mean jealousy of profession, they warmly inveigh against its being trusted in our sex. This is a doctrine they spread every where, and the stale burthen of their abuse is ever, “What is awoman? What effectual service can be expected from a woman?” And thus, by dint of this repetition and of clamor, they come at length to accomplish the persuading an over-credulous public. The common people have in all ages been easily seducible, open to imposition, and when once an error has got full possession of them, it is a miracle if it does not maintain itself in it. They love novelty, are readily taken with striking objects, and stop at the surface of things, which they eagerly seize. Singularity especially moves them. Reason alone, and divested of chimeras, appears too naked to them. They must have something that borders upon the marvellous. Is it not from thence that the dreams of the poets found faith among the Heathens, or that the fables of the Coran pass for so many truths among the Mahometans? To the same weakness in favor of every thing that will make one stare, is owing that silly credulity, which so often leads men to the swallowing the grossest absurdities. One would think fictions had peculiar charms for them.
Nothinghowever can be more pitiful, than the injustice of running down a sex, which has, in this very matter of midwifery, served the whole earth through all ages, till just the present one, that a small part of the world, becomes in imagination, all of a sudden a land of Goshen, or the only enlightened spot, and takes the ignis fatuus of a mercenary presumption for the sun-shine of sound reason. But after this injustice, where will the men stop? What profession will they leave to the women? It will at last be discovered, that the men can spin, raise paste, cut out caps, pickle and preserve better than we do. After all, is it not even ridiculous to see a custom, established for above five thousand years, universally approved by great and little, fall into disgrace, I will not say by the opinion, but by the whim of a handful of people, most of whom too are, most probably, perfectly sensible of the nonsense and absurdity of that whim, but defend it from a spirit that can hardly not be suspected of interestedness, which indeed will make men defend any thing?
Andafter all, even common decency and common gratitude might engage the men-midwives to speak less slightingly of the women of that profession; since of whom is it, that the most famous of our present master-men-midwives of London have learned their science but of the women? Do not even the principal ones of them make it their boast to have served a kind of apprenticeship under those midwives, who had served theirs in the Hôtel Dieu at Paris?
Butsurely the reader will not think it here impertinent to observe, that the wise administrators of that famous hospital, would hardly have failed establishing men-midwives in it, if the safety of the subject had had any thing to fear in the hands of women. But women alone it is that preside at all the lyings-in there, be they never so extraordinary or laborious. The men-midwives have never yet been able to extend their footing within that place. Their emissaries can gain no admission, nor are any proficients trained up there butwomen only. Notwithstanding which, all the women who are there delivered are satisfactorily and skilfully assisted. Vexatious accidents are less frequent there, in proportion to the numbers, than elsewhere, under the eyes and operation of the men-midwives. Mother and child are both more in safety under the hands of those dextrous matrons, than in those of the most renowned men-practitioners[3].
Tothose then, who with a contemptuous tone ask what is a woman but a woman? I shall with equal modesty and truth answer, that generally speaking women are inferior to men in most public services. They are scarcely so fit to head armies, to navigate ships, break horses, or the like manly employs: but there are certainly domestic branches, in which theyrather make a better figure than the men. Midwifery seems their appropriate lot: and rather a gift than an acquisition. They hold from nature herself, in this matter, a certain expertness and dexterity, to which not all the more abstruse refinement of art can ever conduct the men. Nor will the operation of iron and steel instruments ever equal the suppleness, safety and effectual ministry of the fingers of an expert midwife, who understands her business.
Letme then be permitted to ask retortingly in my turn, What is, at the best, a man-midwife? Is not he one of a new set of operators unknown to our ancestors? A creature in short hard to be defined? In no original or primitive language is there so much as a word to express one of this profession. The common word for him in the English language is a contradiction in terms, a monstrous incongruity; aMAN-mid-WIFE. Sensible of the ridiculous sound of this expression, scarcely less so than that of awoman-coach-man, they have, by way of remedy, borrowed the term ofaccoucheurfrom that nation whence the fashionwas unhappily borrowed, among many other fashions, so many of which are however rather ridiculous, than like this onebigwith danger, added to the ridicule of it. But even that affected French wordaccoucheuris of a very recent date in France. No French authors employ it, who are not themselves of a more modern date than the word itself, which has not above the antiquity of a century to boast. The name and vocation of a midwife are found in the most primitive languages, being, in fact, coeval with mankind itself.