The Project Gutenberg EBook of The Province of Midwives in the Practice of their Art, by William Clark This eBook is for the use of anyone anywhere in the United States and most other parts of the world at no cost and with almost no restrictions whatsoever. You may copy it, give it away or re-use it under the terms of the Project Gutenberg License included with this eBook or online at www.gutenberg.org. If you are not located in the United States, you'll have to check the laws of the country where you are located before using this ebook. Title: The Province of Midwives in the Practice of their Art Instructing them in the timely knowledge of such difficulties as require the assistance of Men, for the preservation of Mother and Child; very necessary for the perusal of all the sex interested in the subject, and interspersed with some New and Useful Observations. Author: William Clark Release Date: May 16, 2016 [EBook #52086] Language: English Character set encoding: UTF-8 *** START OF THIS PROJECT GUTENBERG EBOOK MIDWIVES *** Produced by RichardW and the Online Distributed Proofreading Team at http://www.pgdp.net (This file was produced from images generously made available by The Internet Archive) The Province of Midwives in the Practice of their Art, by William Clark, M. D. 1698–ca. 1780. T HE P ROVI NCE OF MIDWIVES IN THE Practice of their ART: Instructing them in the timely Knowledge of such Dif​fi​cul​ties as require the As​sist​ance of MEN, For the Preservation of MOT HER and CHILD. Very nec​es​sary for the Per​us​al of ALL the SEX int​er​est​ed in the Sub​ject, And interspersed with some New and Useful OBSERVATIONS. By WILLIAM CLARK, M. D. And of the College of PHYSICIANS. Molliter Aufer Onus. OVID. FASTI. Printed for William Frederick, in BATH; and sold by M. Cooper, in Pater-Noster-Row, LONDON. MDCCLI. T ADVERT ISEMENT T O T HE READER. H E following small Tract will appear contemptible to those who judge of the Worth of Books by their Bulk; but the Author believes such as are practis’d in Mid‐ wif​ry will ack​now​ledge both the Want and Use​ful​ness of an Es​say of this Kind. The Division of the Chapters, naturally arising from the various Circumstances which are treated of, will rather assist than burden the Memory, and admit of a ready Recourse to the short Instructions, in the Knowledge and Practice absolutely necessary, given under each Head. The Reader will the more readily excuse any Defect in the Stile, when he considers the Necessity of a strict Expression on the Subject and the Difficulty a Man lies under, who writes not to the learned and experienced, but chiefly for the Sake of Persons ignorant in Anatomy and Philosophy, on a Subject which for the most Part excludes Information by Sight. On such a Subject it will not be imagined Vanity or Applause can incline a Man to write a Pamphlet, rather than a Volume; when the Author is not conscious of having omitted the Instruction to be found in any Book extant, within the Limits of his Design; and hopes Experience will teach its Value both to Midwives and Matrons; and that the Perusal will not at all injure, if it does not improve, the most knowing and experienced. P The READER is desir’d to correct the following ERRORS with the Pen. AGE 9, Line 16, read Pains about the Back, Navel, &c.—P. 33, l. 12. omit the Period after the Word Pain; and make a Semicolon, instead of the Comma, after touch’d it. T CHAPT ER I. The DESIGN. HE Case of Child-bearing Women is very lamentable, in the Country especially, by Reason of the Ignorance and Unskilfulness of Midwives; for by their Negligence and perverse Management, many Mothers and Children are destroyed, to the great Misfortune of particular Families, as well as of the Publick, at a Time when it suffers by the Loss of useful Hands, from too many other Causes. It were therefore to be wished, that all Midwives were so far appris’d of their Duty, as to be able to distinguish between Cases within their Abilities, and such Difficulties as may occasion the Loss of the Mother, or Child, or both, for Want of necessary Assistance. They who intend to practice Midwifry in PARIS, are oblig’d to attend anatomical Lectures and Dissections, that their Judgments may be inform’d, by the Knowledge of the Structure of the Body, for an Undertaking so hazardous in ignorant Hands. London, at present, affords equal Advantages of Information; for the anatomical Wax-work, with suitable Lectures, might furnish as good a Qualification, with less Offence than real Dissections; and there are not wanting those who professedly instruct both Sexes by mechanical Demonstrations. And for the future, it is to be hoped, there will be no Necessity for Men to have Recourse to PARIS for Observation, since we have Infirmaries at Home for the Accommodation of Women in Child-bed; and tho’ they are expos’d naked to the Eye in the Hotel de Dieu, it must be confess’d, that the fundamental Rules of the Art are not built on what the Eye of the Observer can possibly discover in the most expert Operators; but depend on Circumstances conceal’d from Sight, within the Body of the Patient. But whatever Advantages LONDON and WESTMINSTER afford for the Instruction of Midwives, the Country is entirely destitute of them; and the best Books on the Subject, adorn’d with elegant Figures, can give but a very imperfect Notion of the Parts they represent, to any who have not attended Dissections, or seen more natural Resemblances than Cuts. The Figures in Books, exhibit the Bones of the Pelvis, a Variety of Situations of the Infant, and Uterus, the Placenta and umbilical Vessels and Membranes, &c. whereas it would be no less serviceable to those, who assist Women in Travel, to be acquainted with the Viscera, liable to suffer by a difficult Labour; for the Liver, Spleen, Sweetbread and Kidneys, if not the principal Contents of the Chest, may be so injured by the ill Position of the Child, Compression of the Parts, and rash Assistance, as to prove fatal, more or lets immediately; occasioning Inflammations, Suppurations, Mortifications, Schirrhu’s, Cancers, or Consumptions. The best Writers of Midwifry, such as Mauriceau, Deventer, De la Motte, Heister and others, explain the Causes of difficult Births, and the proper Methods of Assistance; but instead of improving most Country Midwives, fill them with Conceits of what, it is impossible, they should understand, and thereby occasion the Loss of great Numbers of Women and Children. In order therefore that Midwives may acquit themselves with Reputation, and that Child- bearing Women may be the better Judges for themselves, or the charitable Part of the Sex, who are past these Dangers, the better able to assist their Friends and Neighbours, I shall endeavour to shew how far they may act with Safety under the Disadvantage of Country Practice, and describe those Symptoms, which for the most Part accompany hard Labours, very probably beyond their Abilities; when they will justly incur the Censure of Inhumanity and Rashness to depend upon their own Skill. I CHAPT ER II. N this Chapter I have avoided the Use of Terms of Art, or explain’d them, in Regard to those for whom I chiefly write, as far as my Regard to Decency admits; but if any Word should occur not easily understood by any of my Readers, almost any English Dictionary will explain its Meaning; and it cannot be expected that any Book can instruct those who cannot read, tho’ I am sorry to say too many such assume the Office of Midwives. As Curiosity may reasonably induce many of the Sex concern’d in the Subject of these Sheets, to be inform’d of somewhat of the Provision supreme Wisdom has made for the Existence of Children in the Womb, I shall briefly mention the most obvious Instruments relating to their Breeding and Birth, without puzzling my Readers with minute anatomical Descriptions. The Vagina, or Passage, lies between the Neck of the Bladder and the large or strait Gut; it is connected at the inward extreme to the Womb, and called the outward Orifice at its beginning. The Womb lies between the Bladder and Strait Gut, and is connected to both; during the Time of Breeding it increases in its Dimensions, and rising higher in the Body, by Reason of the Weight and Substance of it, with its Contents, at the Fund, or remote End of it, may be liable to swag too much forward or backward, or incline more or less to either Side, especially in such, as by their Occasions of Industry in Life are obliged to a Variety of indirect Situations; by which Means the inward Orifice is perverted from a direct Site with Respect to the Passage, and obstructs an easy Exclusion of the Infant in Travel. The Placenta or After-birth, adhering to the Fund of the Womb, receives the Mother’s Blood, by the Umbilical-Vessels, or Navel-String, conveys it to the Child for its Nourishment, and retransmits what is superfluous; maintaining by the Intercourse of Arteries and Veins, the Circulation of the Blood between Mother and Child. The Membranes closely connected to the Placenta, and the Fund of the Womb, between both which they seem to take their Rise, contain the Humours in which the Infant swims, the better to preserve it from Injuries, by its Pressure against unyielding Parts, and the Humours before, and after the Breaking of the Membranes, commonly call’d the Breaking of the Waters, in the Birth, very much facilitate it, by opening the inward Orifice of the Womb, and lubricating the Passage for the Child: These Membranes come away with the Placenta, under the Name of the After- birth, or Secundines, indifferently. The Pelvis or Bason, wherein the Uterus or Womb is seated, is form’d by the forward Bones, commonly call’d the Share-Bone, the Hip-Bones and their Continuation on each Side, and the lower Part of the Back-Bone, all which are so contiguous to each other, as to form this Cavity, generally much larger in Women than Men, cloathed with Muscles, between which the Vagina is inserted. The right Formation of the Pelvis, is of the greatest Consequence in Favour of an easy Birth; when the Bones forming it, forward and backward, and on each Side, both above and below, don’t too much approach each other, and prevent the Exclusion of the Child between, by a free Admission. I CHAPT ER III. The Symptoms preceeding Natural Labours. SHALL pass over the Symptoms of Pregnancy, and the Distinctions of true and false Conceptions, as Things of which Midwives can seldom be expected to be proper Judges, and proceed to their Business, Natural Labours; comprehending, under this Name, all such Cases, which require no further Assistance than Midwives, in a general Way, may easily give; or in their Absence a Nurse, or any sensible Woman, who has attended Deliveries. After the Woman has gone her due Time of Nine Months, the most usual Term; the Signs preceeding Labour are Pains about the Back, Navel and Loins; a considerable Falling of the Tumour of the Belly, by the Burden’s sinking lower; and incommoding the Woman in walking; a more frequent Inclination to make Water: These Symptoms increase in Proportion as the Birth approaches; but as the most certain Knowledge of natural Births, can only be obtained by Touching the Woman in Labour, after having premised some Things concerning her proper Situation; I shall direct how it ought to be done. M CHAPT ER IV. Of SITUATION. ANY in the Country choose to be on their Legs or Knees, supported by a Woman on each Side, or lean on a Chair or Bed, and pass well enough through the present Scene of their Miseries: But I would preferably advise a Posture between lying and sitting, on a Pallet or common Bed, the Head and Shoulders being rais’d by Bolsters or Pillows, the Feathers beat back from the Bed’s Feet, to support the hollow of the Loins, and prevent the Pressure of any Thing against the Bottom of the Back Bone, to obstruct the Passage of the Child. This Situation is most commodious, during Labour, for a Woman to assist her Pains with the greater Freedom of Respiration, and the least Fatigue and Expence of Spirits; especially if the labouring Woman lay hold of a folded Napkin, held stiffly for that Purpose, drawing her Feet upwards towards her Seat, separating her Knees, and fixing her Feet against something that will not easily give Way. If the Person in Labour will not be in Bed, the End may be answered by her sitting in another’s Lap, with the Bottom of her Back-Bone situate between the other’s Knees, with her own separated and supported, and Feet fixed as aforesaid, to favour her bearing down. ’Tis inconsistent with the Design of my Writing to describe all the convenient Situations, necessary in Cases of Difficulty, yet when the Operator has rectified all Obstructions to the Birth, the same Situation of the Body upon a Slope, from the Head downwards is most suitable, even altho’, for Conveniency, she should be deliver’d lying on one Side. I shall, on this Occasion, observe, what I have found Advantageous in my own Experience, as well as consonant to the Advice of the best Writers on the Subject: That the Delivery on the Back, by the Assistance of one placed on each Side, supporting her by the Hams, with her Knees separated, and raising her Back Bone a little from the Bed during the Activity of Pains, and the Midwife’s Assistance of either Sex, is vastly preferable to the Delivery on one Side, to which I impute the Loss of many Children brought by Turning, as well as a more tedious Labour in other Cases; because this Posture, in some Degree, contracts the Passage, and only admits the proper Separation of one Knee. T CHAPT ER V. Concerning TOUCHING. HIS ought to be put in Practice, as soon as, from the Symptoms given in the Third Chapter, it is reasonable to expect the Birth approaching; and a Child-bearing Person would be very much her own Enemy to refuse the only Means of giving a true Information of her Case, and the Knowledge how to do her the most effectual Service. The Midwife, having her Nails well pared, and very smooth, and her Fingers anointed with Oil or Lard, must introduce the two fore Fingers of either Hand into the Passage or Neck of the Womb, as far as its inward Orifice, directing them with a gentle and easy Motion, somewhat upwards, as it were with a Tendency through the Passage towards the Navel; in this Search she will find the internal Orifice, joining the Passage or Neck of the Womb more or less open, relaxed, and thinner than usual; and cautiously protruding her Fingers farther, she may possibly touch the Crown of the Child’s Head; she will easily, by the Sutures, or Opening between the Bones of the Skull, distinguish the Crown: Keeping her Fingers in this Situation, during the Beginning, and Continuance of strong Pains, she will observe the Waters contain’d in the Membranes including the Child, and After-birth forming within the inward Orifice, as if something like a Bladder blown, or distended with Water, presented to the Touch, dilating the Orifice with each Throw; these Appearances presage a speedy and easy Birth. A CHAPT ER VI. Of a natural Birth, and the Office of the Midwife. S the Birth approaches, the Woman grows hotter and red in the Face; the Pains bear more strongly down; the internal Orifice opens; the Vagina or Passage, at its Entrance, becomes more swell’d, as the Child’s Head advances; and the Membranes are more and more tensely stretched; before the Birth, the Person is often seized with a Vomiting, and universal Tremor, without the Coldness of an Ague; and very often a Humour, discolour’d with Blood, immediately preceeds the Breach of the Membranes; when these Symptoms, or several of them, become urgent, ’tis Time to put the Woman in a proper Situation, as describ’d in the preceeding Chapter: The Midwife ought by no Means to break the Membranes, but encourage the Woman now to make the best of her Pains, by strongly bearing down, as if going to Stool; the Midwife with her Fingers well anointed, putting them gently within the internal Orifice, may cautiously, by separating them, assist its opening, and Removing it more behind the Child’s Head, thereby gradually promote its more easy Transmission, and at the same Time prevent, if necessary, the Womb from being too far protruded: After the Waters are broke, as it is called, and the Head of the Child comes into the Passage, the Midwife may lay hold on each Side of it, taking Care not to bruise it by rough Handling, and drawing it, by Waving her Hands, if necessary, to loosen it, when fixed, rather than in a strait Line, assist the Birth; and if obstructed by the Shoulders in the Passage, inserting a Finger under each Arm-Pit, extricate them by the like Action. ’Tis true, it happens, tho’ unobserv’d by Writers, as far as I remember, that many Women have no Waters breaking away, either before or after the Birth; whether absorbed or not, in Time of Labour, I shall not at present determine; this is called, by the Country People, a dry Labour, and often attended with Difficulty; however, if the Crown appear forward, the Issue may nevertheless be favourable. The Child being born, the next Business is to tie the Navel-string with a waxed Thread, so doubled, as not to endanger cutting, about two Inches from the Child’s Body, making another Ligature near the Body of the Mother, so far distant from the former, as may be convenient for Cutting between both Ligatures, and separating the Infant from its After-birth. Midwives are too apt to leave a greater Length, which can be of no Service, but has been thought, on the contrary, by our Countryman CHAPMAN, to occasion Navel Ruptures. After the Separation of the Navel-string, the Care to get the After-birth succeeds; this will often come by the Assistance of Nature, with a gentle Motion of the Hand gradually drawing and loosening it, by the Navel-string: But if it adheres to the Fund of the Womb, which is frequently the Case, whether from the Waters being come away before the Birth or otherwise; it must cautiously be separated, and extracted by the Hand, to prevent the most mischievous and fatal Consequences. The Assistant holding the Navel-string with one Hand, must with great Caution introduce the other into the Womb, avoiding all Violence to any Part in the Way, ’till she reaches the After- birth, some Part of which probably, being loosened, will be found more forward than the rest; which taking between her Thumb and Fore-Fingers, she must, by an easy Motion of her other Fingers, between the Womb and After-birth, gradually separate the Parts adhering all round, ’till finding the whole free, before the Palm of the Hand and Fingers, she brings it intirely away; for should any Part remain, the poor Woman’s Labour would still continue, and occasion dangerous Floodings, requiring the immediate Assistance of an able Hand, to rescue the Patient from the immediate Hazard of Death. Sometimes when the Womb has discharged its Waters, and the Child, by Reason of a Defect of Pains, or otherwise, remains long very forward near the Birth, the Womb so contracts about the After-birth, as to make the Separation of it very difficult; in which case Assistance is requisite, from one well acquainted with the Structure of the Body; and the longer this is delay’d, the more Danger there will be of all the bad Consequences of the Retention, and Corruption of the After-birth in the Body. It requires great Care to prevent the Protrusion of the Womb in some Women of a large Pelvis, or Opening between the Bones; or if the After-birth remains closely fixed, the Womb, in a very open Pelvis, may be thrust by the Violence of the Pains; or drawn out of the Body by an unskilful Hand, which is commonly very soon fatal to the poor Woman; and I believe happens much oftner than is apprehended, tho’ industriously conceal’d, by guilty Midwives, under the Colour of the poor Woman’s dying in Child-bed, from some other Cause. DEVENTER says, he saw a sad Spectacle at the HAGUE, the Head of the Child excluded to the Shoulders quite without the Passage, when Three-fourth Parts of the Head were conceal’d within the Womb, the Crown appearing within its inward Orifice†. † See Chir. Op. Part ii. Page 32. A much worse Case happen’d in my Neighbourhood, Sept. 23, 1749. I was call’d to a Woman, whose Child, on the 21st came unexpectedly, without the least Assistance, in the Presence of an old Midwife of large Practice; she puzzled an Hour, as I was inform’d, to bring away the After-birth, which closely adhered to the Fund of the Womb; while the unfortunate Woman lay senseless, saving the Memory of being long expos’d to the Cold, when she came to herself; after which she continued in violent Labour-like Pains; upon Scrutiny, I found a large Substance in the Pelvis, of the Size of a Child’s Head, considerably resisting my Touch; I observ’d on Trial, a Part of the Woman’s Body every Way interposed between my Fingers and this Substance, by her Sensibility of my Touch; therefore contenting myself with giving her some palliative Medicines, and telling the Persons present, a Mole, as I thought, or Child still remain’d to come away, I for that Time, took my Leave: On the 24th, she was said to be much better; on the 29th, I was again call’d to this poor Woman, and inform’d, that upon her first going to Stool, since I had before seen her, which happen’d the same Day, the large Substance before- mention’d, came intirely out of her Body; to which it join’d by a thinner Substance, of some length: I now perceived it was no less than the Womb turned inside out, suspended by its Ligaments, and joining to the Vagina, but very much swell’d by the Obstruction of the circulating Humours; And an old Gentlewoman, who was present when the Child was born, inform’d me, she saw the Midwife draw this Body from the Woman, by the Navel-string, and indeed, the Impression of her Nails, in separating the After-birth, remain’d still visible at the Bottom of the Womb, and the Midwife having long expos’d the Patient, put this inverted Womb again into her Body. The Condition of the Part, after so long Delay, did not admit the Possibility of rightly reinstating it; I therefore return’d it, as well as I could, into the Pelvis, and introduc’d a Pessary to retain it; and as this Person had already contracted a Hectick, I charg’d her, as she valu’d her Life, to confine herself strictly to a cooling Milk, or vegetable Diet; she has since had large Discharges of a bloody Corruption, with Portions of a fleshy Confidence from the Parts affected. In April, 1751, she told me the Discharge coming from her had long been much abated in Quantity, and what remain’d was the Whites; that she had an inward Fever, and the Piles, for which I gave her my Advice; her Complexion was chang’d from the most florid to a languishing Paleness. My Brother, much better known in this Country, and longer practis’d in Midwifry, has been concern’d in furnishing Medicines for the Person, whose History I have given, altho’ by Means of his Absence, he did not attend her on the most emergent Occasions. I have since been call’d to the Assistance of the old Midwife, who attended, and she frankly told me, she had another Woman under the like Circumstance, who died the same Day. Having related such Things as occur in the most favourable Circumstances of Travil, about which all Midwives ought to be well inform’d, and those Injuries to which Women are sometimes liable, notwithstanding the most promising Appearances: In the next Place I proceed to shew, what are the Symptoms preceeding difficult Labours, which by timely Assistance, may be secured from the most dangerous, if not fatal Consequences, and are of great Moment to be known by Midwives, as well as Matrons and Child-bearing Women, to enable them to judge when it is absolutely necessary to recommend calling that Aid, which is beyond their Capacity to give.