I shallhere select one of perhaps the most excusable examples from the circumstances accompanying it, or it would probably not have been produced by the author a man-midwife, to shew, by the confession of the men-midwives themselves, the insufficiency of their discernment, whether a child is dead or not.
“Edge-toolsand crotchets naturally inspire horror, and though theyoughtnot to be employed unless on a dead child, it is well known the mother is not alwayssafefrom the effect of them. Besides there areno signsof the death of a child, though he should have stuck in the passage for several days ...certain enoughto authorize a recourse to a method which infalliblykillsit, if it is not dead before. This is so true, that whoever will turn over the authors antientand modern, on this subject, there is notoneof them that gives ussatisfactionon this point. On the contrary, theyallseemagreedon theinsufficiencyof these signs, and there are evenfewof them who do not bring examples to support this uncertainty.
“Herefollows one taken from the observations of Saviard, p. 367. This author says, that a chirurgical operator, whose name heprudentlysuppresses, being sent for in aid of a midwife[9], toextract a child that had stuck six days in the passage, and which hethoughtdead, from several of the signs most essential to conviction, it happened however, that having opened with hisbistorythe teguments and membranes which occupy the as yet unossified space, at the commissure of the parietal bones with the fontanelle, it happened (said he) that on opening this place with his bistory, introducing his crotchet at this opening, and having fixed it in one of the parietals, he drew out the child, who began to crypiercingly, all hurt as he was by solargeawound, that there came out of it more than an egg full of itsbrains, which made acruelsight in the eyes of the by-standers, and a very mortifying one for the operator.
“Itwere to be wished that this was theonlyexample: but I will not relate anymore; it is easy to think one cannot be toocircumspectin the matter of such relations. Levret, p. 77.”
NowI, who have not the same reason forcircumspectionin this case, as Monsieur Levret, with strict regard both to matter of fact and to candor,agreewithhim, in averring, that this is not theonlyexample perhaps, by thousands, of the rash resort to the expedient ofopeningthe head, and extracting the child with the crotchet; an expedient which, as Dr. Smellie observes, (p. 248.) “produced aGENERAL CLAMORamong the women, who observed, that when recourse was had to the assistance of a man-midwife, either the mother or child, or both were lost.” Now of not filling up the cry of those women, I must own I should be most ashamed. Especially when the good Dr. by way of curing our fears andweakapprehensions, and of shewing the nonsensicalness of them, first very gravely tells you the insufficiency ofallhitherto invented instruments, and only modestly concludes, that the forceps of his own ingenious contrivance, is indeed the best, but still imperfect. His homage to truth would however not have been so imperfect as it is if he had said that instruments may be totally left out of good practice, and that no“artificial hands”, as he calls them, can, in any case, constitute a worthy supplement to thenaturalones; no not even to his own, supposing iron and steel to be ever so little less tender than his fingers.[10]Butwhy do these gentry then so much insist on the absolute necessity there is ofsometimeshaving recourse to instruments?——Why? The motive for that insistence is so transparent, that not to see through it would indeed be blindness. It is the capital, and perhaps the only plea that has the least shadow of plausibility for the men to intrude themselves into the women’s business of midwifery. The women do not pretend to the art of handling those instruments, and would be very sorry to pretend to it. Nor do those midwives,who are sufficiently skilled in their art, ever need the supplemental aid of them: whatever is done with them is as well, and infinitely more safely done without them: so that the only grounds of introducing men into that female practice is essentially false. The making then the surgeons art a pandar to a sordid interest, by the incorporation of midwifery with it, is, in fact, engrafting on a noble stock, a scion of another one, both which would bear very well separate, but, thus joined, can produce nothing but a vile poisonous fruit.
Ifthere could be such a thing as laughing in a matter of such general importance to human kind as the fixing of this point, there could hardly be any refraining from it, with regard to the conduct of the men-midwives, especially in Paris. There the novices of them, sensible of the natural defect there must be in men-practitioners, apply for improvement to the regular midwives. There is particularly, among others, one Madam Clavier, who, when I knew her, lived in the Rue de St. André, that gave lessons, at so much a-head, tothe men-students of midwifery. Yet these same men have no sooner got a smattering of all that is valuable in the profession, for beyond a practical smattering at most nature refuses them further progress; they, I say, have no sooner acquired a little useful insight from these laudably communicative midwives, but they are the first to swell the cry against them of, “oh theseignorant midwives!”——or “what can be expected from a woman?” And what is more yet, among women it is, that they can make this equally ungrateful and false clamor prevail. And women, in a point of the utmost importance to themselves, prove that the men have, in fact, not quite a wrong idea of their weakness, since they are weak enough to countenance a notion, that so unjustly dishonors them in every sense. But that is not enough. What one should imagine, women especially would consider, is that this notion received with its consequential exclusion of those of their own sex, tends to have their own pains aggravated, and the safety not only of themselves but of their so naturally dear children, yet more endangered.
Forthe truth of this increase of pain and danger from the practice of the instrumentarians, it is not to any representations from me only, who may be supposed too interested a party, but to reason, and even to reason’s best mistress, Nature herself, that I appeal. I appeal even to the very writings of the most celebrated men-midwives themselves, to which I would refer all who are sincere enough with themselves to be resolved to embrace truth when discovered to them. It is then even in the writings of those men-practitioners, that a lover of truth might find enough to satisfy himself, that all the mighty pretences of the men-midwives to superiority of skill and practice to the women are false and absurd. Look intoDeventer,Peu,La Motte,Mauriceau,Levret,Smellie, &c. and you will find that, except their accounts of theinnocentmanual function, in which midwives must so much excel them; excepttheirpernicious practical part, on which they so tediously insist, by way of recommending each some particular instrument that is tousherhim into employment, and increase his profit, in whichnoble view he takes care to decry the instruments of all others, or at least prefer his own; except the scientific jargon of hard Latin and Greek words, so fit to throw dust in the eyes of the ignorant, and give their work an air of deep learning; except what they have pillaged from regular physicians and surgeons, who have treated upon these matters: except in short all the quacking verboseness of the various histories of their exploits and deliverances of distressed women, and you will find the merit of their whole works shrink to little or nothing, under the appraisement of common sense and true practical knowledge. The most that you will find in them, is, hard or lingering labors, oftenest precipitated fatally to the mother, or at least to the child; they hardly, you may be sure, carrying their candor so far, as always to mention when it has proved so toboth; of which however the tenor of their practice with instruments gives you but too much room to presume the probability. In short those cases, of which their works are chiefly patched up, are little better than so many quack-advertisements; and their best exploitstherein recounted not a whit preferable; nor indeed so practically just, as what would appear in the common daily practice of a regular well-bred midwife, that should keep a register of her deliveries. There might not indeed appear so much anatomy in her descriptions, but, I am very sure, there would be couched in them much more solid instruction. Not that I therefore have not the highest deference to the true physicians, the true surgeons. But as far as I can presume to judge, it is not in the works of the men-midwives, that the best lights in midwifery are to be looked for. They are themselves for every thing that is worth reading in their writings indebted, both to the physicians and surgeons, whose arts they have despised enough to think, they may be well enough learnt collaterally and subordinately to the mechanical operation of midwifery, as well as obliged to the midwives, to whom theyoughtat least to go to school, tho’ sure to rail at theirignorancethe minute after being taught by them. In short, the most valuable lights thrown into this subject are undoubtedly furnished by those great menBoerhave, Haller, Heister, the great Harvey, and other the like excellent physicians and surgeons, not one of whom however, I presume, in the way of making a trade of it, ever delivered a woman in his life.
Nay!was any accident requiring a chirurgical operation to befall a pregnant woman, I should think the application would be more safely made to a thorough regular-bred surgeon, than to one of the common run of these men-midwives; and the exceptions are so few, they are hardly worth making. The reason too for such a preference is obvious and natural. A regular surgeon probably would not only be more consummately skilful and expert in his general notions, both theoretical and practical, so far as surgery was in the question, but would not, from any thing onlypartialin his profession, have the same temptation of bringing into play a horrid apparatus of murderous instruments, to show the importance and utility of that anatomical midwifery of theirs, all the art of which consists in the violences it offers toNature. What would be to be done, the true surgeon could hardly do worse than the pragmatical man-midwife, and most probably would perform it much more artistlike, except perhaps in the sole point of striking a crotchet into the brain-pan of a live-child, or needlessly tearing open, with iron and steel, parts so tender and so delicate, as hardly to bear the touch of even the softest hand, guarded with all precaution. He would not, in short, be so forward to use means destructively dangerous to both mother and child, and at the best often to ruin a woman for being a mother for ever after.
Uponthe whole then, if any one will dare give his own understanding fair play, against the powers of prejudice and interested imposition, it cannot but, on a fair examination satisfy him, that that strange anomalous complex creature of the three arts, physic, surgery and midwifery, is most likely to excel in neither.Itmay by great chance be an indifferent physician;ITmust be in this respect a dangerous surgeon, butITcan never be any thingbut a despicable midwife; or if that favorite name ofaccoucheur,ITis so fond of assuming, should not be popular enough from its gallicism, letITchange it for the Latin one ofPudendist: a word of not one jot a more pedantic coinage thanDentist, orOculist, but of which moreover the propriety of the sound may somewhat atone for the pitiful play of words it contains, and which can yet scarcely be more pitiful than the object of its application.
Itis not probable, that the men-practitioners would have come into the vogue in which we see them, if numbers of instances were not to be produced in their favor, of their having terminated happily many labors, in which they have been preferably employed, and to the exclusion of the midwives.
Thisonly proves, what none in their senses will deny, that the greater part of the cases of labor are so mild, that noteven that faultiness of the men-practitioners, which is palpably owing to an incurable imperfection of Nature, not, in short, all that is bungling or deficient in their preliminary disposition and manual operation, can absolutely frustrate the kindness of that Nature, of which these intruders are not ashamed of assuming the honor. But that inference of the men in favor of themselves is as ridiculous as it is false. In those cases of labor, which are much the less frequent, and require no extraordinary assistence, the utmost of the real merit of these bunglers is only of the negative kind: that is to say, they have not destroyed the mother nor the child; and indeed, every thing considered, great is the praise to them thereof. It is not always, even in naturally easy labors, that the women who employ men to lay them have not a harder bargain of them.
Buteven in these propitious labors, the mischief done to a lying-in woman, by employing of a man to the exclusion of a midwife, is not a small one, if pain is an evil, and the lessening that evil a desirablegood. For certainly there can hardly be a case of lying-in supposed, in which somelabor-painsare not felt. The bringing forth children in pain, stands hitherto the irreversible decree of nature, from which few women can promise themselves a total exemption. But these pains, if they cannot be entirely spared, to the lying-in woman, will always admit of actual or preventive alleviation. That alleviation can be no inconsiderable object to women, who are by their nature so tender and so impatient of pain. Even then in the prospect and presence of the very gentlest labors, there are two natural points to be respectively attended to. The one is the predisposition of every thing, according to art, so as to render the expected labor-pains as moderate as possible. The second is in the manual function, at the actual crisis of the delivery. Now, in both these points, for reasons above-deduced of the superior aptitude in women derived to them from Nature herself, a woman may reasonably depend not only on a more simpathizing cherishment, but a more efficacious assistence from those of her own sex. Thereare a thousand little tender attentions suggested by nature, and improved by experience, that a midwife can employ both preventively and actually to the mitigation of her charge’s pain; attentions which, if even they ever entered into a man-midwife’s head, could not be accepted but with repugnance, I will not say only by a modest woman, but by any woman at all. And the truth is, that there can be few men in the world, but what, the more tender lovers they are of the women, but must be only the more disgusted, the more impatient of the midwife’s preparatory part of her office, which is however the most important one, both as to the prevention of pain, and to the safety of the delivery.
Buteven where those preparatory offices have been omitted, or at best perfunctorily performed by a man-midwife, and where the actual function in the crisis of labor has been deficient, or at best indifferent, the labor may still have proceeded, and the patient delivered with only more pain, than she would probably have sufferedunder a good midwife’s hands. What follows then? Why this; that the patient in the transport of joy at her delivery from pains which are hardly ever but great, even though much less than her fear had magnified them to her; instead of gratitude to that Nature, which can constitute to her only a vague object of the mind, her weak imagination gives to the assistent man-midwife, a more palpable being, as he is of flesh and blood, the merit of a deliverance, in which he had most probably no other share, than its being his fault that it was not yet less painful than she has found it. But this is not at all. What sounds towards a paradox, and yet is strictly true, is, that the more pain the patient has endured, through the man-midwife’s fault, the greater will her gratitude be to him. The reason is as obvious as it is natural. Herself not knowing, nor having perhaps any idea of what ought to have been done for her more perfect relief, she will have no conception that the man has omitted any thing: she will give him credit for what he hasappearedto do for her; and measure her sense of acknowledgement bythe pain from which she will suppose he has helped to rid her; and in her joy at her delivery would think it even an ingratitude to listen to suggestions from others, or even from herself, that should tend to diminish, explain away, or may be reducedto less than nothing, the benefit she so vainly imagines was his work.
Yetnothing is more true, nor indeed more likely to be true, than that besides the natural pains of labor not having been obviated by a due preventive method of assuagement; besides their having been unskilfully attended to in the article of the delivery, through the natural unhandiness of the men-midwives, it does not unrarely happen, that their defective practice, not only occasions to the women much greater pains, but even much greater danger than would probably have been the case, I will not say if a midwife, but even if Nature had barely been left to herself, that is to say, if nature had been neither injured by a clumsy aukward attempt to help her, nor injudiciously interrupted, nor prematurely forced or cruelly hurried. The patientis however delivered, and delivered so that, if she was better informed, or less blinded with joy, instead if thanking the operator, to whom she attributes her deliverance, she would have to impute to him all the increase of pain she had unnecessarily suffered, all the increase of danger of which this man so thanked was himself the author. Then it is, that even in a subject so serious, a judicious by-stander might give himself the comedy of observing the airs of consequence, which an operator assumes for a woman under his casenotlosing the life, of which but for him she would most probablynothave been in the least danger. Thus a man, whose all of merit well weighed, is no more than not having been able to consummate the destruction of mother and child, in spite of the kindness of nature, shall for that negative merit be allowed the positive one of having performed wonders of art. Then it is that the mother naturally in a rapture of joy at her deliverance, in which she never remembers but with a gratitude, of which she only mistakes the object, by paying to the operator, what in fact wasdue to nature; then it is, I say, that the mother, father or parties concerned, for want of making due allowances in a point they are so excusable for not understanding, cordially join the self-applause of the man-midwife. Nor does it unfrequently happen, that one of these instrumentarians, after an operation, for which he deserves the severest censure, and of which, whatever necessity he had to plead was originally owing to his own unskilfulness or omission, shall strut about the room, and florishing his butcher’ssteel, sing anIo Peeanto himself, “for that his victorious art had saved nature as it were by enchantment”[11]. Then it is, that in full chorus the deluded parties, in the innocence of their heads and hearts, hold up their hands to heaven, and piously exclaim, “what a narrow escape the patient had, thanks to the learned Dr. and what a mercy it was she had not been trusted to such an ignorant creature as a midwife must be.”
Thisfolly has even sometimes gone so far, that when a woman has, through a man-midwife’s mispractice, suffered perhaps a wrong, so deep as to be disqualified for ever after for being a mother, or had a fine child, literally speaking, murdered (secundum artemindeed) he has, what with scientific jargon, through the cloud of which it was impossible for persons unversed in the matter to discern the truth, what with an air of importance, and what with especially her own weak prepossession in favor of the superiority of men to women-practitioners, known how to impose on her the most atrocious injury for so great a service as that of saving life is for ever held. The deceived patient then thinks she cannot thank him too much, nor reward him sufficiently for what he could be scarce punished enough, if proportionably to the mischief he had done; and to which his mis-representations have perhaps even made herself innocently an accomplice.
Thisindeed is easily to be accounted for. A pregnant woman must especially, in the moment of her labor-pains, thinkherself too much in the power of the operator, to whom she has trusted herself, to dispute his judgment. She may even, and that is probably oftenest the case, have too good an opinion of it, to dispute it. Her labor is severe, and, as before observed, severe, or at least the more so, very likely from some fault of his. Her deliverance lingers; Nature, from some vice of conformation, or defect of art in her assistent, appears faint, remiss, insufficient, in short, in her expulsive efforts; in the mean time, the pains of the patient grow more and more intense and intolerable: the man-midwife, either perplexed or impatient, or not knowing what better to do, has recourse to those fatal instruments, with which the odds are so great, that he will gall, bruise, or irreparably wound the child, or the mother[12]. Insome cases indeed, he may take the dreadful advantage of the mother’s agonies of pain, to use those instruments, and do her a mischief she may not just then feel, from the pain of the operation being absorbed in the greater one; to use them, I say, unobserved by her[13].
Butwhere the exigency appears yet greater, where, in short, the operator imagines, as he too often imagines such an extremity where it does not exist, as that either the mother or the child must perish, it is his maxim, and certainly a very just one, to consider the mother’s safety, as the preferable object. Of this preference then he makes a merit, so much the more acceptable to the mother for her own self-preservation being so palpably concerned, and so much the less disputable for her not knowing but he may be in the right, as to the reality of the fatal dilemma. In such a doubt, if nature takes the part ofthe child’s life, which is at stake in the decision, she also much more strongly and reasonably takes the part of the mother’s own existence in the mother’s own breast. She cannot then deny the premisses, of which she is no judge, when the inference is not only in favor of her life, but even a very just one upon the admission of those premisses. The temptation also of a quick riddance from a violent state of pain, is too great a temptation for a weak woman, overpowered with her actual feelings in that rack of nature, to resist: she acquiesces then, or perhaps her husband, her friends, equally ignorant with herself of the truth of things, and duly simpathizing with her in her impatience of her longer suffering, even virtuously, even piously acquiesce in the recourse to these instruments, which are so sure of destroying the child, and hardly ever fail of doing the mother great and sometimes irreparable mischief.
Whenthen the child has been destroyed, the mother damaged; in satisfaction for all this tragic-work, what have youbut perhaps the learned Doctor’s assertion, “[14]that if this force had not been used, the mother must have been lost as well as the child.”
Nowgranting what is the utmost that candor can be expected to grant, that in but the doubt of the mother’s life, it is right to sacrifice the life of the child to that doubt, and much more to the certainty of the mother’s life not to be otherwise saved, than by these fatal instruments, I beg and entreat all fathers and mothers, or who are likely to be so, to consider with themselves whether:
Inthe first place, an experienced midwife is not more likely to prevent such an extremity by previous management, proper anticipations, and actual handiness during the labor-pains, than the aukward man-practitioner (as most of them evidently are) who must, naturally speaking, be so much her inferior in those points of her art, which conduce essentially to thesmoothing the way for, and effectuating a delivery; and from the defect of which points that necessity which, is pleaded of a recourse to instruments, originally takes its rise. So that in fact they who are the authors of the danger, pretend to remove it, and how? by an evil only inferior to death itself, from which however those are not always safe, to whose safety so much is sacrificed in vain.
Inthe next place, it may well be recommended to consideration, whether, as thecommon methods[15]confessedly allowedby the men-midwives to be thepreferableones, since the recourse to instruments is not even by themallowed, until thecommon methodsare exhausted, there is not great reason, without breach of charity, to imagine that the natural unfitness of the men for thecommon methodsdoes not determine especially the common men-midwives to an over-hasty recourse to theextraordinaryones, and make them see verydangerous symptoms, where they are no better than phantoms of their own creation; so that by their eagerness to embrace them for an excuse, they lose to the patient that benefit of patience in general, which Dr. Smellie himself allows in aparticular case[16]. To which patience the midwives are so much more inclined than the men, as indeed they may well be, since, should that even be exhausted, they have no instruments to fly to for the abridgment of a labor: and where they understand their business, not only every thing is best done without them, but the want of them is prevented.
Butbesides the common motive of impatience in the men-practitioners for resortingto that dangerous expedient of making short work, of which the women are unhappily incapable[17], or at least which the good artists among them hold in the contempt and detestation it deserves; are there no other motives from which recourse may be had to the instruments? I have hinted at some: but as the matter is of infinite importance, from the use made of these instruments, in introducing men into the practice of an art so appropriated to the women, it cannot but be of service even to the public, to discuss the justice at least of some of those hints, and examine whether there is any farther foundation for my fears, that the precipitancy of the men in their resorting to instruments, or to the prematurely forcing a delivery, tothe utmost danger if both mother and child, whether, in short, the pretence of extremities may not, in some cases, have even other causes, than a natural incapacity for thecommon method, an ignorance of better practice, or their impatience.
I havebefore remarked what I here repeat, and repeat it without the least apprehension of being justly taxed with breach of charity, that a mere sordid view of lucre, of supplementing, in short, deficiencies of success in other professions, was originally the foundation in this country of that novel sect of men-midwives, which we have in our days seen so much multiplied. If any can imagine that the instrumentarians, with their crotchets, their forceps, and the rest of their iron or steel apparatus, had more in view the relief of the distressed females, from the dangers to them in the ignorance of the midwives, than they had their own interest, in the stepping into the place of those they so injuriously decried; if any, I say, can believe that sheer humanity, and not sordid gain, was their view, I can onlypity a credulity, that must proceed more from a goodness of the heart, than of the head. But to whoever will deign to consult his own reason, exercised upon facts and the nature of things, may easily satisfy himself, that interest, and interest only, inspired and actuated these intruders into a province so little made for them, of which there can hardly be a stronger presumption than the very recommendation of instruments, of which not one of them but must know the perniciousness, though they make it the capital handle of the introduction of themselves. Not one of them but rails at them, and uses them. Now, as I may safely take it for granted, that interest is at the bottom of this innovation, where that same interest is the principle, it will hardly be denied me, that it is generally speaking the leading or the governing one. It is rarely contented with acting a second part. It often exacts sacrifices, but is rarely itself one. All the actions and procedure of its votaries take the tincture of it. Humanity and all the virtuous or tender passions are either totally excluded, or exist with little or no efficacy in a heart enslaved by interest.
In virtue of this reasoning, and I should be much more glad of finding myself mistaken (knowingly I am sure I am not so) than that it should be but too much verified by matter of fact, I shall here submit a case to the reader for his own decision on the probability, and I dare swear, that among the female readers especially, I may chance to have, there will be more than one, who, on her own personal experience, could attest the existence of such a case, or at least has the strongest grounds of presumption of it.
A Womanthen, lingering in a severe labor, and urged by her pains naturally to wish the speediest end of them, is yet by another superior promptership of nature desirous of meriting the sweet name of mother, and is inclined of herself not to think it over-purchased by a little more patience. In this crisis, much must depend on the judgment, and consequently on the advice of the assistent practitioner, male or female. If a midwife, besides the tenderness constitutional to her sex, her naturalfears for the mother especially, not without a due share of concern for the child, where there is a possibility of saving it without too great a risk to the parent, besides the superior execution of her art in points of the manual function, she is moreover bound in all duty to see one labor come to its issue before she undertakes another; for the sake of which, she cannot well, if she would, without instruments, prematurely force a delivery by such violent, dangerous and so often destructive means. She will then in course encourage and inspirit her charge with patience, and use all the blandishments, soothing methods imaginable to comfort, relieve, and strengthen the resolution and spirit of the lying-in-woman. Now, a man-midwife,well paid, will perhaps in that cold unaffectionate manner, with which a duty that has no foundation but in interest is ever performed, exhort to endurance that patient whom his dexterity is insufficient to relieve, that patient whose pains are perhaps for the greatest part his own fault. But should he, during some lingeringlabor, be called elsewhere, to a more rich employer,or should one from whom he has greater expectations, require an attendance from him incompatible with his duty to his prior employer, is not here a temptation to make a quick dispatch with his instruments? A temptation to which it is at least doubtful whether a man, actuated by interest, may not be over-inclined to yield. It may even byass him, without his perceiving it himself. A man’s determining motive, when it is not of a very justifiable nature, is often skreened even from himself by a more specious one. Such, in the present case, is the saving the mother, oftenest by destroying, and sometimes by only galling, bruising, or maiming the child, when the mother rarely escapes her share of the suffering. How many mothers have pathetically interceded, and interceded in vain, for a respite of execution, when the operator has in a peremptory tone cut short their instances, by telling them in a magisterial way, that he knew best what to do, and could not answer for the patient’s life, if the operation was longer delayed! What reply has a poor woman, weak by nature, oppressed by pain, and subduedby her prepossession to oppose to such an argument of necessity, of which her own life appears to be the favored object? What husband, what friends, but must unhesitatingly subscribe to so just a preference as that of the mother and the child? Not that I would insinuate here, that such a dilemma does not sometimes though certainly very rarely exist: but is it not to be feared, that it is too often rather lightly taken for granted that it does exist? May it not be presumed, that the instruments are brought oftener into use than is necessary, for the sake of a dispatch, of which the child is almost ever the victim, and not unseldom the mother herself, who is always hurt, and sometimes irreparablydamaged? May it not be justly suspected, that the abuses of Art have occasioned to many women an appearance of barrenness, from the reality of which kinder Nature had in fact exempted them?
Butas if ignorance, inability, impatience, interestedness, were not all of them sufficient motives for the forcing use of these instruments, Dr. Smellie has unmeaninglyadded another, which alone must, to the greatest number of the men-practitioners, prove a greater excitement than all the others put together, if it be true, that Vanity has so great a predominancy over the human heart as it is generally imagined to have. But let us first quote him: the inference will follow.
“(P. 265.)at any rate, aswomenare commonlyfrightenedat the verynameof aninstrument,it is adviseable toconcealthem as much as possible, untill (mind pray thatUNTILL)thecharacterof theoperatorisestablished.”
(P. 273.) “Though theforcepsare covered with leather, andappearsosimpleandinnocent,I have given directions forconcealingthem, thatyoung practitionersBEFOREtheircharactersarefully established,may avoid the calumniesandmis-representations of those people who are apt to prejudice the ignorant and weak-minded against the use of any instrument, though never so necessary, in this profession; and who taking the advantage of unforeseen accidentswhich may afterwards happen to the patient, charge the whole misfortune to theINNOCENT OPERATOR.”
HereI appeal to every reader of common-sense, to every reader who knows any thing of the human heart, whether it can be imagined that any man-midwife, who is called in to the aid of a lying-in woman, will choose to appear in the character of ayoung practitioner, or of such an one, as that hischaracteris not enoughestablishedtodareto use instruments, for fear of after-reflexions. Is not there, if but in this lesson of the Doctor’s, couched a strong temptation for a man-practitioner not indeed to produce openly and barefacedly his apparatus of instruments, but to be very uncautiousof concealing them? Since the reason for concealing them, that of the women being apt to be frightened at them, stands coupled with another reason, the fittest in the world to work a contrary effect to both; by piquing the vanity of the operator to suffer them to be seen, and what is worse yet, to the using them only that they might beseen, especially if to this motive of ostentation you add, that ifthese instruments being the verygrandandcapitalpoint of their imaginarysuperiorityto the women-practitioners; over whom every occasion of using them seems to the men a kind of triumph.
Butwhile it is to the novices in the art, that Dr. Smellie recommends more especially the concealment of these same terrifying instruments, the good Dr. does not seem aware, that an advice much more honest and humane might be given to the women, for whosebenefitthe instruments are supposed to be invented, which is, not to employyoung practitionersor novices, not in short to employ those whose character was notfullyestablished, since they might, in order to pass for adepts, or at least for no novices, be too apt to embrace occasions of florishing those same instruments with less necessity, if possible, than thegreat menthemselves of the profession.
Inthe mean time, this curious injunction to theyoungpractitioners, while theoldones are by that distinction implicitly allowed more openness in using the instruments,reminds me of the caution of the Regent-duke of Orleans, who taking monsieur de St. Albin[18], a natural son of his, that was in priest’s orders, to task, for some irregularities, of which certain bishops had complained, said to him in their presence, “Sirrah, could not you stay till you were a bishop?”
Butwhatever may be the motives of recourse to instruments, and there are other possible ones which I have omitted, certain it is, that in this nation they are more frequently employed than even in France, where that pernicious fashion first took birth. And yet in this very nation it is, that the men-practitioners themselves own, that the less they are used the better. Now will they, to solve this contradiction of their practice to their doctrine, plead that the labors of the women here are, in general, more difficult than they are in France? Common sense and truth will however furnish a juster solution: men-midwives are more employedherethan inFrance, where the women-practitioners are still respected, and less driven out of practice, consequently instruments are less frequently used. For I will not pay the men-operators of this country so ill a compliment, as to excuse them, by saying they are less dexterous at the manual function than those of France, and therefore the more obliged to have recourse to those instruments, of which they themselves have so ill an opinion, though indeed not a so thoroughly bad one as they deserve.
Inthe mean while they may well proceed triumphing in their career, notwithstanding all the fatal trips they make in it, while, if they did not even run it in the dark, they have so much learned dust ready to throw into the peoples eyes whom it is so much their interest to blind. No wonder then, that since, in the more severe cases, in the preternatural labors, they so often receive from well-meaning employers both pay and thanks for the greatest mischiefs, owing to their errors both of omission and commission, they should, in the less difficult, and which are by muchthe most frequent ones, where no tragic accidents have happened, have credit given them for a merit, to which their pretentions are so little examined. For this they are indebted to the overflow of a gratitude at a loss for a living object and from an impatience of doubt mistaking that object so grosly, as well as to that same prepossession’s continuing, from which they were preferably employed. Hence it is, that one might often hear women, who had not even suffered a little by their practice, from the want of knowing, that by their practice it was they did not suffer less, very sincerely say, “Dr. such an one attended me in my lying-in —— He delivered me very well.” —— Or, “I have been lain for four or more children by a man-midwife, and never had room to complain.” All which proves no more than what may very well have happened, that Nature has been too favorable to them, for even the untoward assistence of a man, in the office of a midwife, entirely to frustrate her beneficence. I do not here add the weight thatfashionthrows into the scale of prejudice, reserving to treat of that separately.
Butto that conclusion in favor of the men-midwives, from the supposed superiority of their success to that of the women-practitioners, contained in the objection I am now answering, I have further to oppose an argument drawn frommatter of fact, to which I should imagine it difficult to find a satisfactory reply. This argument then consists in a fair appeal to Experience herself.
I havebefore observed, that in the Hôtel-Dieu at Paris, there are no men-practitioners suffered, for I do not include the surgeon-major, who is absolutely no more than an officer for the form-sake. Consequently there are no instruments ever employed in the delivery of the women admitted to that hospital. It is true they are extremely well taken care of; all necessaries are found them by that noble charity; but yet it cannot be thought, that the same abundance of ease and conveniences can be afforded, as by those persons, generally speaking, who employ men-midwives. This distinction I mention for thesake of the allowance justly to be made in the calculate I am about to propose. Notwithstanding however the superiority in this point on the side of men-midwives practice, notwithstanding the grief of mind from various causes, as well as the bad constitution of the bodies of many of those indigent wretches, prior to the reception into that hospital, notwithstanding other easily conceivable disadvantages; notwithstanding all these, I say, take any given number of patients, delivered purely by the midwives of that hospital, without the intervention of one man-practitioner, and especially without instruments, and to that given number, oppose an equal one of women attended from the first of their labor to their delivery by the men-midwives, and see on the side of which sex, in the operators, there will be found the greater number of those who shall have done well, or suffered least.
I amthe more emboldened to propose such an experiment from my own certain knowledge. I have seen more than two thousand women delivered under my eyes, at the Hôtel-Dieu at Paris, some of whosecases must be readily imagined to have been severe or preternatural ones. Yet all of them were delivered by our midwives and apprentices without the aid of a man-practitioner; nor an instrument so much as thought of. And in all this number I can safely aver, there were but four who died upon their lying-in; and that not from any fault of the midwife’s art; but one from the complication of a dropsy, the other three, who were daughters to honest tradesmen, sunk under the shock of grief and shame at the being deserted by the men who had brought them into that condition. They died, in short, of their desire to die. Yet the children all did well.
Thisis a fact that does not require the being believed upon my word. The known practice at that hospital, and the registers regularly kept, will attest the truth of this computation. And here, I appeal to every intelligent reader’s own sense, to his own knowledge of things, whether it is unfairly presumed, that in the same number of two thousand women, delivered by the men-practitioners, theycould show a roll so innocent, so free from fatal mischief or damage to their patients, to mother and to child. Let any parents, or who may hope to be parents, or are concerned but for the interest of mankind in population, weigh but the force of this argument, purely drawn from a matter of fact, of which there can be so few who are not, in some measures, judges enough to decide upon their own knowledge, or at least on strong grounds of belief or conjecture. In such a number as two thousand women delivered by the men-operators, how many, by what I know, and by what many others must know as well as I, must have perished, or been torn, ruptured, grievously hurt, or irreparably damaged! How many innocent infants must have lost their little lives, in proof of that superiority of practice in the men to the women! Or rather, in proof of that infatuate credulity, which has prevailed in favour of an innovation so unauthorized by nature, by common sense, or by experience!