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THE MIDWIVES MONITOR, AND MOTHERS MIRROR: BEING THREE CONCLUDING LECTURES OF A COURSE OF INSTRUCTION ON MIDWIFERY. CONTAINING DIRECTIONS for pregnant Women; RULES for the Management of natural Births, and for early discovering when the Aid of a Physician is necessary; AND CAUTIONS FOR NURSES, RESPECTING BOTH THE MOTHER AND CHILD. TO WHICH IS PREFIXED, A Syllabus of Lectures on that Subject.

BY VALENTINE SEAMAN, M. D. One of the Surgeons of the New-York Hospital, and Physician Extraordinary to the Lying-in Ward in the Alms-House.

NEW-YORK: Printed by ISAAC COLLINS, No. 189, Pearl-Street. 1800.

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PREFACE.

HAVING frequently had to wit­ness the accidents attendant upon mis­management, in the practice of Mid­wifery, and having, with pain, re­flected upon the limited knowledge of that business among most of the fe­male practitioners, I have, for a con­siderable time past, had a wish, that some means might be adopted for the better information of those necessary, though too much neglected, members of the community.

I consider midwives as necessary, and, not only necessary, but indispen­sably [Page iv] so, notwithstanding the abun­dance of physicians, because some wo­men, absolutely refuse having a man to attend them in their labours, or at least not till they are convinced of be­ing in a critical or dangerous situation, and oftentimes not until they are be­yond the reach of the greatest skill. However indiscreet and ill-sounded this prejudice may be considered, let it be called whim, a false delicacy or what we will, it matters nought to me, existing distress, whether it arises from reason or folly, equally demands our attention; and if we cannot af­ford relief by one method, it behoves us to attempt it by another. If wo­men cannot be persuaded to submit themselves to the care of male prac­titioners, it is our duty to instruct fe­males how to give them the necessary aid. That this prejudice does exist, and that some women will have none but their own sex to assist them upon such [Page v] occasions, every day's experience teaches us: and that this disposition is firm and not to be overcome, the arbitrary decrees of the government of Athens clearly demonstrate; for while with them midwives were prohibited from practising, the fatal sufferings of many of their women, fully proved the futility of attempting to confine that business entirely in the hands of the men.

However sufficient in itself this reason may be, it is by no means the only or the greatest one for encou­raging the study of Midwifery with women: for even were there no ob­jections in the mind of any to the em­ployment of male practitioners, still the nature of the practice of physic, in this country, is such, that physici­ans cannot afford to give up so much of their time from their other busi­ness, as would be necessarily employed [Page vi] upon such occasions, for the small compensation, that the greater pro­portion of citizens are able, without distressing their families, to make them. What then must be done? The only means to relieve the major part of the community, both from op­pression and from danger, in such cases, is the judicious establishment of regularly instructed midwives.

Besides these reasons, which are of a general application, there is an ad­ditional one for their establishment in the country. In cities a physician often may, in lingering cases, steal time enough from them to visit his other patients; but, in more thinly settled places, the necessary distance of their patients is such, as to render it impossible for a physician to practise midwifery with prudence, and to do justice to his other practice: in this respect, then, the assistance of mid­wives [Page vii] is not merely convenient, but indispensably necessary.

So forcibly has the propriety of in­structing females in the art of mid­wifery, impressed the liberal minded in Europe, that their most celebrated physicians have not failed to express an "ardent wish that schools might be erected in their principal cities for that purpose." And the committee, in their proposals for regulating and im­proving the practice of Medicine in France, have carefully recommended measures to that effect: considering it as an object deserving their particu­lar attention.

Whatever may have been the de­sire, and whatever may have been done elsewhere, no plan of the kind, as far as I can learn, has heretofore been established in America: conse­quently the midwives, with a very [Page viii] few exceptions, are as ignorant of their business as the women they deli­ver: and I much doubt whether one out of twenty of them have ever seen the bones that support and protect the womb: indeed I cannot but suspect whether some even know, that, in be­ing born, a child has to pass through a bony passage. The greater part of them, at least as far as my enquiries have reached, having taken up the business by accident, having first been catched, as they express it, with a woman in labour, they were forced to receive the child. Attendant suc­cess inspiring confidence, they without more ado, consider themselves compe­tent, and become immediately establish­ed in the profession. But the more diffident and considerate, those who seek further information, have not ge­nerally been much better off: Books were their only helps, and books, of themselves, are but dim lights indeed; [Page ix] generally rendered still more gloomy by the cloud of technical obscurity in which they are involved. To learn such a handicraft business by reading alone, is like learning ship-building without touching timber. Can we expect, but that such workers, in ei­ther occupation, must destroy more ma­terials than their good work will ever pay for?

How, it may be asked, in the pri­mitive times, did they do? We have no account of obstetrical schools, nor hear any complaint of ignorant mid­wives; children were born then as well as now; why may not women, without so much study and instruction, attend one another as well now as then? or, is child-birth a disorder, that women must always have a skil­ful person to assist them? Probably in the early ages, before the pamper­ing stews of luxury had taken the [Page x] place of the salutary calls of nature in diet, and before the warping tram­mels of fashion had taken the lead of comfort and convenience in dress, sel­dom, very seldom, was there any dis­ease in child-bearing, or difficulty in travail. Delivery is certainly a na­tural process, and so far am I from considering assistance as always neces­sary, that I doubt whether the whole art of midwifery will ever compen­sate for the mischief arising from the officious interference of ignorance in its practice.

Under the impression of the forego­ing considerations, in the fore part of the last winter, I proposed to the fe­male practitioners in this city, and such other women as wished informa­tion in the art of midwifery, to deli­ver them a course of instruction in that business, connected with the pri­vilege of their attending the practice [Page xi] of the lying-in ward in the Alms-House. And altho' it must be regret­ted that a great proportion of them, either from an idea of self-sufficiency, from not duly appreciating the import­ance of their profession, from indo­lence, or, possibly, from a dread of the retrospect, that opening their eyes might present to their senses, still chose to grope on in their original darkness. Yet, to their credit be it said, a num­ber, and those also who appeared to be among the most considerate and better informed, embraced the proposition with alacrity, and have since attended to the establishment with a punctuality and attention, worthy the high object of their pursuit.

The following sheets, besides a short syllabus of the lectures, contains the substance of the three concluding ones, being a short recapitulation of the parts most material to midwives; with [Page xii] directions and cautions respecting their conduct in the practice of their pro­fession; published by the particular request of the class.

The author has consented to their publication, not from a pretension of the new light that they may throw up­on the art of widwifery, but with the hope of their serving as a medium through which, as far as they go, to transmit its present perfection to the attention of those to whom they are directed: should be thereby promote a more general spirit of enquiry among the female practiti­oners, his purposes will be fully an­swered; should he not, he rests upon his intentions as a security from censure.

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A SYLLABUS OF A COURSE OF LECTURES ON THE THEORY AND PRACTICE OF MIDWIFERY.

LECTURE I. INTRODUCTION.

A SHORT account of the origin and progressive im­provement of the Art of Midwife­ry. Its practice at first confined to women. Luxurious refinement of society, with its concomitant [Page 14] dieases, probably the cause of its devolving so much into the hands of physicians, midwives not hav­ing like advantages of instruction. Midwives present neglect of the opportunities that do offer for their improvement, renders their very name almost a disgrace. The ad­vantages of their being regularly instructed, as it relates to the wel­fare of those entrusted to their care; as it respects their own repu­tation and emolument; and as it secures that peace of mind result­ing from the heart-felt convic­tion of having done well.

LECTURE II. OBSERVATIONS UPON THE ANI­MAL ECONOMY.

On the Mind, and five auxiliary sen­ses, viz. Seeing, Hearing, Smell­ing, [Page 15] Tasting and Feeling, with their organs.

THE necessity in those who ope­rate upon the human body of being well acquainted with its make and functions, since misteps are often so dangerous in their con­sequences. The brain and head. Spinal marrow and backbone. The Eyes; their secure situation in a bony cavity, composed of three humors, which are contained in three coverings. Their muscles, nerves and appendages, eye-lids, &c. The Ears. Their external and internal parts: the drum and internal communication with the mouth. The Nose, lined by the expansion of a nervous coat, the organ of smelling, moistened by the tears, &c. Mouth, compre­hending lips, cheeks, teeth, roof, palate, pap of the palate, tongue, [Page 16] glands, &c. Skin, divided into scarf and true skin, with an inter­vening jelly-like colouring matter: composition, nerves, and appen­dages.

LECTURE. III.

On the nerves, muscles, circulation of the blood, secretion, digestion, and absorption, and on the nature of the animal fluids.

NERVES, their appearance, nature, and distribution, con­vey sensation to the mind, and car­ry her will to the muscles. Mus­cles or flesh, are the instruments by whose contraction every mo­tion is produced. Generally un­der the command of the will, ex­cepting those particularly essential to life, viz. those subservient to the circulation, secretion, and to breathing. Circulation through the [Page 17] heart, arteries and veins. The for­mation and functions of the Heart, &c. The nature and com­position of the Blood. Glands, their composition and use: man­ner in which they perform secre­tion. Of the Gall, Urine, Spittle, &c. The Stomach, situation, juice, nerves, &c. Digestion how per­formed. The Bowels. Absorbents divided into milk vessels, or lacteals and lymphatics; their action and communication with the heart.

LECTURE IV.

On Respiration and the Organs sub­servient thereto.

THE Chest formed by the ribs, breast and back bones; it is sepa­rated from the belly by the midriff: contains the heart and lungs and their appendages, &c The mo­tions [Page 18] of the ribs and midriff di­lating the chest, causes an inspira­tion of air; their relaxation, dimi­nishing its cavity, affects the dis­charge of air or expiration: these alternate motions constitute breath­ing or respiration. The blood, as it passes through the lungs, receives life from the air: the air at the same time undergoing a change in its nature, in the same manner as it is changed by the burning of combustible bodies, thence pro­ducing animal heat, &c.

Of the superiority of animal bodies over the most complete arti­ficial machine. Their power with­in themselves of repairing injuries: Casting out what is superfluous or hurtful; accommodating themselves to losses, as of blood, &c. calling for supplies, by appetite; accom­modating themselves to differ­ent degrees of heat, keeping an [Page 19] equal temperature in a burning or freezing atmosphere: and to crown all, they are endowed with power to make other machines like them­selves, which again possess the like power of propagating their species to the end of time.

LECTURE V.

The Bones forming the Pelvis or Bason.

IMPORTANT organs securely lodged in boney cavities, as brain in the head, heart and lungs in the chest, &c. so also the womb and its appendages, are supported and protected by the pelvis or ba­son. Pelvis rests upon the thigh bones and supports the back: it is composed of the sacred and rump bones behind, and the nameless bones on the sides and before; their par­ticular [Page 20] description: nameless bones divided into haunch, seat and share bones. Peculiarities of the female bason. Brim of the bason is of an oval shape, about five and a quarter inches from side to side, and four and a quarter across from sacred to share bones: in its lower opening this proportion reversed, being longest from fore to hind part, and shortest from side to side. Depth six inches behind, four at the sides, and two before. Dimensions of the child's head and shoulders, and the turns they take in delivery. Distortion or crookedness of the bones of the bason, and the man­ner in which they affect delivery: how discovered: causes. Motions of the bones in labour, and whe­ther the share bones separate or not.

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LECTURE. VI.

Female organs of generation.

THE mons veneris. External labiae. Clitoris, Nymphae. Open­ing of the urethra, method of in­troducing a catheter. The peri­neum. Vagina or passage to the womb. Hymen. Of the womb, lying between the urinary bladder and straight gut, divided into body, neck and mouth: supported by the round and flat ligaments, which last contain in their double the fal­lopian tubes, which originate from the bottom of the womb on each side, and terminating in loose jag­ged ends. They also contain the ovariae.

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LECTURE VII.

Diseases of the aforementioned organs. Their causes, prevention and cure.

REASONS why midwives should have a knowledge of the diseases of the sex, notwith­standing a physician should in most cases be called upon for their relief. Watery swellings, abcesses and adhesions of the external parts. Stones in the bladder and urinary canal. Excrescences about the ori­fice of the canal. Imperforated hy­men, contraction and adhesions of the vagina. Polypusses in the pas­sage. Whites. Falling down and falling out of the womb. Hydatids or collections of bladders of water in the womb. Dropsy of the womb. Wind in the womb. Moles, their different kinds. Dropsy of the ovariae. Retroversion or falling backward of the womb.

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LECTURE VIII.

Of the Menses, and their irregula­rities.

PERIODICAL discharge from the womb necessary to every woman, who is not pregnant, or does not nurse. Exceptions. Time of appearance differs from cli­mates, with us from the thirteenth to the eighteenth year. General change in the system at that time. Quantity discharged various from clime and constitution. With us generally ceases between the forty­fifth and fiftieth year. Final cause, necessary to generation. Obstruc­tion and suppression, their various causes, symtoms, effects and cure. Profusion; causes, cure. Painful menstruation, and remedy. Treat­ment to follow about the time of their final cessation.

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LECTURE IX.

On Conception.

THEORIES of different authors. Anatomy proves the course of conception from the ovariae through the fallopian tubes to the womb. Nutrition and growth of the child in the womb. Pecu­liarities of the child, its connecti­on by the cord to the placenta or cake: of the size, composition and circulation in the placenta. Of the membranes that include the child. The Waters, their nature and use. Position of the child; head generally first presents to the birth, and reasons why. Changes of the womb; at the third month rises above the brim of the bason. State of the womb at the different periods, reasons for its continuing of nearly an equal thickness, dur­ing [Page 25] the whole time of pregnancy. Of the size of the child at different periods.

LECTURE X.

Of the signs of Conception, and con­sequent diseases.

WOMEN do not conceive be­fore their menses appear, nor after their final cessation; their ob­struction or profusion impedes im­pregnation. Causes of barrenness may be imperforations of the va­gina, orifice of the womb, or fallo­pian tubes and diseases of the ova­riae. First signs of conception ob­struction of the periodical discharge, hardness of the breasts and colouring of the rings around the nipple; nausea, drowsiness, lividness under the eyes, tooth-ache, head-ache, &c. these however not certain. About [Page 26] the third month, the womb may be felt above the share bones. Motion of the child between the fourth and fifth months, the most un­doubted sign: caution against deception on this head. Nausea and vomiting in the morning. Suppression of Urine. Costiveness, Piles. Swelled legs and enlarge­ment of their veins. Difficulty of breathing and vomiting in the last stages. Frequent desires to void urine. Irregular discharges of the menses in the first months. The particular causes of the foregoing diseases explained, and the means for relieving them. Of gravel, dropsy and hernia, and their treat­ment.

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LECTURE XI.

Directions for preventing the many disorders incident to the pregnant state.

THIS particularly to be attend­ed to by midwives. These diseases generally, though very erroneously, attributed to too much blood. The whole weight of what would otherwise have been discharged by the periodical eva­cuations, not nearly equal to that of the child and its appendages. Of miscarriages, their causes and means of prevention: of exercise, elixer of vitriol, cold bath, bleeding, dress, diet, &c. Of the imagination and peculiar unnatural cravings.

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LECTURE XII.

On Labour.

THIS takes place at or about the thirty-ninth week from conception. Signs. False pains, how distinguished; cause and re­medy. True pains, how known. Shews, what. Of the touch: its use, in determining a state of pregnan­cy or not, in ascertaining the ap­proach of real labour, and in dis­covering the presentation. La­bours divided into natural, difficult, preternatural and complicated. Pro­per position of the woman. Of standing on her knees, sitting in the lap of another, resting on their backs on a Pallet, and lying on their side in bed: change some­times necessary. Management as it relates to dress, the state of the bowels, and the bed. Progress of [Page 29] labour; waters gathering; head presenting, its turns; distention of the perineum: the necessary care. Turns of the shoulders and final ex­pulsion; how to be managed. When to cut the cord. Of the ex­pulsion of the afterbirth, when ne­cessary to assist it and how. Of the irregular contraction of the womb. Floodings. Inversion of the womb.

LECTURE XIII.

RECAPITULATION of the foregoing, with a full exempli­fication of every circumstance, up­on the Machine.

LECTURE XIV.

Of difficult Labours.

IN these the head presents, but is not delivered within twenty­four [Page 30] hours, or requires aid. They may arise from too great distention of the womb, its irregular contrac­tion, from firmness of the membranes containing the waters, much oft­ener from their too early rupture, shortness of the cord, or its being entangled; from fever, inflammation of the parts, want of irritability, debilitation passions, difficulty of breathing; from its being a first child, particularly with women ad­vanced in years, rigidity of the orifice of the womb, of the exter­nal parts, smallness of the bason or its crookedness, largeness of the child's head, or the growing together of its bones, or its enlargement by disease; improper presentation as face to share bones, face to the birth, head with the arms; difficulties may also arise from suppression of urine, stone in the bladder, scars or adhesions in the sides of the vagina [Page 31] and rupture of the womb. Of the aid necessary to be given in all these cases of difficulty. Instru­ments seldom required. The assist­ance of a physician always advise­able.

LECTURE XV.

Further attention to difficult births.

THEIR various causes, and the means generally sufficient for relieving them, exhibited upon the Machine.

LECTURE XVI.

On the use and abuse of instruments.

INSTRUMENTS sometimes not to be dispensed with. Fil­lets justly discarded. Of the forceps and vectis: cannot be used till the second stage of labour, and when [Page 32] the ear of the child can be felt. Only to be used when the woman is unequal to the expulsion of the child, and one or other of them are in danger. How to apply them in the different presentations, and of the necessary positions of the woman. The scissars and crotchet: in what cases only they can be ad­mitted. Of the symptoms of a dead child; of the method of using these dreadful instruments.

LECTURE XVII.

Practical recapitulation.

BY performing on the machine every operation with the instru­ments, in the various cases that may require them.

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LECTURE XVIII.

Preternatural labours.

THESE are when any other part than the head, first pre­sents. They vary in regard to the presenting part. Difficult in pro­portion to the time elapsed, since the breaking of the waters, and the degree of contraction of the womb. How to discover the pre­senting part. Head round, hard, and hairy: Breech soft, with a di­vision of the buttocks: Back by the back bone, ribs and shoulder­blades: Loins by the back bone without ribs: Breast by the breast bone and ribs: Belly by its soft­ness and navel string: Hand by being thinner than the foot, fin­gers longer than the toes and the thumb standing out: Foot by the heel. When Breech or inferior ex­tremities [Page 34] present, help seldom ne­cessary till the hips are born: when necessary and how to be giv­en. Child always to be brought with its face to the back of the mother. When the circulation in the cord is obstructed by the pres­sure of the upper part of the child's body or its head, in passing the bones, if delivery is not soon ef­fected by nature, we must assist. In cross cases support the body; seek for and deliver by the feet. When the Arm presents with the head and the head is right, slip the arm up over it and deliver natu­rally, otherwise turn it and deliver by the feet. When head and arm are wedged immovably in the pel­vis and cannot otherwise be deliv­ered, instruments become necessa­ry. In cases of distorted or crooked bason, never turn the child.

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LECTURE XIX.

RECAPITULATION of the foregoing, with a practical illustration upon the machine, of the various preternatural presentations and modes of managing them.

LECTURE XX.

Complicated labours, floodings, miscar­riages, convulsions, and twins.

INSTANCES of menses having continued in small quantity for a few months after conception. Floodings with pain and weight in the lower part of the body, espe­cially if attended with a discharge of the waters, generally followed by miscarriage. Predisposition by previous miscarriages, by full ha­bit, by the use of spirits, by strong purges, great exertion, passions of the mind, costiveness, heat, cold, [Page 36] external injuries, &c. Danger, in proportion to the advanced stage of pregnancy, unless it be near full time. Remedies: of bleed­ing, opiates, rest, cold air, and drinks, astringents, cold vinegar and water to the back, &c. elixir of vitriol: in what instances wine. After fifth or sixth month, some­times necessary to promote delive­ry; how done. Convulsions caus­ed, by habit, suppression of urine, passions, &c. remedied by bleed­ing, opiates, delivery, &c. Cau­tions to be observed during the fits. Twins discovered by swel­ling continuing after the birth of the first child, in which case tie the navel string. Nature generally sufficient: where otherwise, be governed as in other cases.

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LECTURE XXI.

Treatment of the woman during the month.

To be put in dry linen and bed, in an airy temperate apart­ment. Caution respecting heat, ei­ther from fires, confined air, ac­cumulated clothing, or hot drinks. Belly not to be bound over tight. No unnecessary disturbance by early visitors, &c. Drinks to be cooling, and diet mild, as gruel, panado, sago, tapioca, chocolate, ripe fruits, &c. afterwards white meats, &c. Do not induce sweat­ing; change linen often, get out of bed soon and frequently. Bowels to be regulated by mild injections, or castor oil, manna, rochelle salts or rheubarb. Child to breast in a few hours. Breasts to be drawn four or five times a day. Short or depressed nipples, how drawn out. [Page 38] Means of preventing their becom­ing sore: of wax rings, &c. When the mother does not intend to nurse, live sparingly and seldom draw the breasts. Caution against sudden exposure to cold, after hav­ing been imprudently heated.

LECTURE XXII.

Of the Diseases in the month.

AFTER-PAINS, their causes and remedies, when any ne­cessary. Inflammation of the parts, causes, consequences and treat­ment. Falling down, of the vagi­na, of the womb, and of the end of the bowels; their causes and method of reducing them. In­version of the womb or the turning of it inside out, the consequence of rashness in delivering the after­birth. Laceration of the perine­um, [Page 39] means of prevention. Im­moderate after-discharges; causes, treatment as in other cases of flooding; their obstruction, how re­established. Milk fever. Hard­ness of the breasts, relieved by mild warm oily applications or lead water, cooling purges. Sore nipples, mucilaginous and unctuous applications, leaden caps, &c.

LECTURE XXIII.

Of the management of Infants, and of their diseases and remedies.

WASHING of the child, management of the cord. Observations on cleanliness, dress, air, exercise and diet. Of the swel­lings of their heads from the cir­cumstances of the birth. Bruises of the face. Injuries of their genitals in breech presentations. [Page 40] Fractures of their extremities. Of apparently still born children. Of the swelling of their breasts. Ob­struction of the natural passages. Tied tongue. Ruptures. Gum. Cos­tiveness. Yellow gum. Sprue. Ex­coriations. Cholic. Observations re­specting the medicines, recommend­ed in the course of the foregoing Lectures.

LECTURE XXIV XXV and XXVI.

A SHORT Recapitulation of such parts of the foregoing Lectures, as are considered more especially deserving the attention of Midwives, together with cauti­ons and rules for their conduct in practice.

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CONCLUDING LECTURES ON A COURSE OF INSTRUCTION TO MIDWIVES, &c.

LECTURE XXIV.

Of the peculiarities of the sex, and of new-born children. Of con­ception.

RECAPITULATION.

IN the course of instruction, that we are now about closing, I have endeavoured, in the most simple manner, to make the art of Midwifery, which, unfortunate­ly, [Page 42] like the other branches of our profession, has till of late been too much cloaked by the mystic rub­bish of technical phraseology, fa­miliar to your comprehensions. I must now further beg your atten­tion to a short recapitulation of the subject, wherein the most essen­tial parts will be particularly at­tended to, accompanied with such cautions as in my opinion should be attended to by every Midwife who would wish to practise with safety and satisfaction to their pa­tients, or reputation to themselves.

The four first Lessons, as you may recollect, and will find by adverting to the Syllabus, were chiefly confined to observations on the system at large, and the animal economy in general; and this subject, I again repeat it, you cannot too much attend to, as no [Page 43] workman can be too well acquaint­ed with the machine whereon and wherewith he operates. Then we attended to the peculiarities of the female system, of whom in gene­ral we observed that they were of a smaller size, and more delicate and sensible habit than men. Af­ter which we noticed the particular peculiarities of the sex, viz. their breasts and uterine system, con­sisting of the womb and its ap­pendages.

The Breasts were observed to be large globular bodies of glands, intermingled with fat; formed of a great number of blood-vessels, which send off many little tubes to carry the milk that is strained into them; these uniting as they pass along, at length end in six or eight tubes, which, by an irregu­lar, convoluted course, finally ter­minate [Page 44] in about as many openings on the point of the nipple. The nipple is of a spungy nature, sub­ject to be distended or relaxed, sometimes prominent and pointed, at other times flattened and even dented inwards. It is covered only by a thin skin, and is fur­nished with numerous little glands, which secrete an oily glutinous matter to defend it from being fretted by the child's sucking, and also to close up the mouths of the milk ducks, thus aiding their crim­pled form, in preventing the milk from constantly draining off.

In regard to the system of the womb, in the first place we ob­served of the bones, upon which the body rests, and which form its lower part, and constitute what is called the pelvis or bason, were composed of the nameless bones, the [Page 45] sacred bone, and the rump bone. The nameless bones were again subdivided into the wings or haunch, seat or hip, and fore part or share bones, the fore part of which last are joined together by an intervening gristly substance.

The sacred bone forms the back part of this compages of bones, and seems to be a continuation of the back bone. It is of an irre­gular triangular shape, with its point downwards, hollowed, and comparatively smooth on its inner surface, but rough and rounding on its outside. Upon its upper part the back bone rests, and from its point is continued the little mov­able rump bone.

The sacred bone joined to the hinder edge of the nameless bones, forms the bason, a just knowledge [Page 46] of which we esteemed as highly interesting to every one concerned in the practice of Midwifery. The ridge at the upper broad part of the sacred bone, where it joins the nameless bones, is met by a ridge at the base of the wings or flaring parts of the haunch bones, this ridge is continued to the an­terior part or junction of the share bones, where they meet and form a regular oval margin called the brim of the bason. The longest diameter of this oval brim is from side to side, the shortest from fore to back part, the former being about five inches and a quarter, the latter an inch less. The bones below this ridge all combine in forming the hollow cavity in which the womb and its appenda­ges, the bladder and lower end of the intestines, are lodged. This is called the bason. Observation of [Page 47] the dry bones gives but a very in­adequate idea of the regularity of this cavity, but when we see the ligaments stretched from the ex­tremities and corners of the sacred and rump bones to the seat bones, and its whole inner surface lined by its proper membrane, we can­not but admire its smoothness and regularity, so well adapted to the important purposes it is intended to answer. This one circumstance of it is highly worthy of our at­tention, that, as was just observed, the longest diameter of this cavity at its brim was from side to side, and the shortest from fore to hind part; in the lower aperture we find these proportions reversed, here the longest diameter being from fore to hind part, and the shortest from side to side, or from seat bone to seat bone.

[Page 48] Of the bason it was further ob­served, that its depth was also ir­regular, being about six inches behind, four at the sides, and two at its anterior part.

Having fixed the size of the bason, as it most generally exists in females, subject however to some little variation; we proceeded to examine the size and shape of the child's head and shoulders, and found the greatest diameter to be from the hind to the fore­head, the shortest from side to side, while the greatest diameter of the body was across the shoulders. Hence, then, we should suppose, what indeed happens in natural labours, that the child's head, at its first presentation, would lie with its forehead and hind head to the haunch bones, while the ears lie to the sacred and share bones. [Page 49] But as the labour advances, the head, favouring the passage it has to pass through, naturally turns so, that, as it gets to the inferior opening of the bones, its forehead is sunk into the hollow of the sa­cred bone, while its hind head is presented to the junction of the share bones. And further, as the depth of the bason is by far the least at its anterior part, the hind head naturally rises from under these bones as it comes into the world. By the time the head is born, the shoulders being the wid­est part of the body, are fixed across the longest diameter of the bason, till a succeeding pain pro­pelling it forward, it takes the turn and the child is born on its side.

We then considered the questi­on, whether the share bones ever separate from each other in time [Page 50] of labour? And concluded that, from their firm adhesion to each other by their cementing gristle, rendered doubly strong by the surrounding ligaments, the whole power of the womb, with the aid of the muscles of the belly, did not appear adequate to that effect; and that if we should admit that they possessed strength sufficient, the child's head was so composed, of various unconnected bones, as by no means to be able to over­come the powerful resistance that their firm connexion would make; we might almost as well conceive of a knurly log's being split by a wedge of cork:—We finally con­cluded that, except in cases of dis­ease, none of the bones of the ba­son had any motion upon one another, during labour, excepting the rump bone, which is generally straightened out, nearly upon a [Page 51] line with the back, by the pressure of the child's head.

The bones of the bason we mentioned were sometimes de­formed and crooked, diminishing in some way or other the natural size of this cavity; we observed that this happened by the upper part of the sacred bone being pres­sed inwards, thereby lessening the shortest diameter of the brim of the bason; but that in some in­stances the fault laid in the share bones being pressed inwards, in other cases in the seat bones or lower part of the sacred bone be­ing projected upwards and in­wards. These deformities were said sometimes to be owing to rheu­matic affections, and that even in women who may have previously borne children through a capaci­ous bason; but that generally the [Page 52] cause of them were laid in early years, and was owing to rickety complaints: the bones thereby be­coming softened, there appeared no difficulty in accounting for the variety of crookedness, from the various pressure of the superin­cumbent body upon them in the states of standing, of sitting, and of lying. It was further remark­ed that this deformity was often accompanied by like affections in the other bones, so that when, with a curved back bone, the legs and thighs were also crooked, there was great reason to suspect this complaint; and if delivery should go on laboriously, it should be par­ticularly attended to.

After having fully attended to the bones of the bason, both in their separate and in their con­nected state, and after having [Page 53] viewed the difference between the aperture of a natural and of a de­formed bason, and observed the great difficulty that consequently must take place in labour from that circumstance, we proceeded to examine the parts of generation in women, which, to be enabled more perfectly to describe, we di­vided into external and internal parts.

The EXTERNAL PARTS were discoverable without the aid of dissection, and consisted of the mons veneris, which is a fatty substance lying upon the junction of the share bones covered with the com­mon integuments, skin, &c. Con­tinued down from this on each side were the labiae pudendi, form­ed of fat covered by a doubling of the skin, which externally were like the surface of the mons, but [Page 54] internally were smooth and red; these joining together again be­low, entirely surrounded the en­trance of the passage to the womb.

Between the two labiae pudendi, about an inch below their separa­tion at the mons, is situated the Clitoris, which resembles, in some degree, the end of a finger; it is said to have been very much en­larged in some instances, whence originated the idea of hermaphro­dites. From this, on each side, are continued down, doublings of the skin which are called the Nymphae; they lie in the direction of the la­biae, and are generally concealed by them, though sometimes they are very inconveniently elongated; they serve to direct the course of the urine, and to favour the dila­tation of these parts in time of delivery.

[Page 55] A little below the clitoris, and between the nymphae, we observed a small projecting opening evident to the touch, which is the orifice of the Urethra, or termination of the canal which leads the urine from the bladder.

The orifice of the vagina, or the opening of the passage to the womb, is situated immediately be­low the orifice of the urethra; this opening in girls is surrounded and nearly closed by a membrane cal­led the Hymen, which in some instances has been found entirely to close the passage, and to pro­duce complete obstruction to the discharge of the menses.

The part which lies between the junction of the labiae pudendi be­low, and the opening of the bow­els, is called Perinaeum, which [Page 56] is naturally small, but is greatly stretched and enlarged during de­livery. To prevent this being torn, we observed, was the chief aid ne­cessary in a natural labour.

Of the INTERNAL PARTS, we first noticed the Vagina or passage to the womb, leading from its opening just described, about six or seven inches up to the womb; it is of a muscular nature, capa­ble of great dilatation in time of labour, and of contracting again after delivery; this, as well as the inner surfaces of all the other parts just described, is furnished with little glands for excreting a mucus substance for lubricating them.

The Womb resembles a bell-pear, but is flattened; it is situated be­tween the bladder of urine and the [Page 57] lower part of the intestines. It is supported and joined to the sides of the bason by two broad and two round ligaments; in the doublings of the former the blood-vessels and nerves run; the round ligaments also run in the duplicature of the broad ones, and pass over the brim of the bason, to be inserted into the groin.

The womb we divided into ori­fice, neck, and body. Its orifice, we observed, hung in the vagina look­ing rather towards its back part: neck half the length of the womb. Around the neck the vagina is at­tached, but much nearer its orifice on its fore than on its back part, giving rise to its position as just mentioned. The cavity of the neck of the womb is very small at both ends; it is furnished with glands for excreting a matter to [Page 58] close the womb immediately after conception.

The body of the womb is some­what triangular; its cavity is hard­ly as large as to contain an almond; its inner surface, to the eye, ap­pears perfectly smooth, with no observable opening of the vessels that discharge the periodical eva­cuation. The blood-vessels of the womb greatly enlarge after im­pregnation, so that at their open­ings, where the Placenta or cake adheres, they equal the size of a quill.

The substance of the womb we found to be of a firm, compact nature; formed, as we observed, of muscular fibres running in every direction, of blood-vessels, nerves and lymphatics.

[Page 59] From the upper corners of the womb arise the Fallopian tubes, which are continued, in the dou­ble and along the upper part of the flat ligaments for about three inches, when they terminate in ragged ends, which hang loose in the cavity of the belly. The ca­vities of these tubes are somewhat trumpet-shaped, being very small at their origin in the womb, but enlarge considerably towards their termination.

About an inch from the womb, on each side, a little below and be­hind the fallopian tubes, are two small, flatish, oval bodies called ovariae. They are also suspended in the broad ligaments.

Having particularly examined and described these parts, we af­terwards attended to the Diseases [Page 60] to which they were subject, but as it always will be most prudent to refer these things to the atten­tion of a physician, it may not, perhaps, be any way profitable now, to repeat any thing then said, in regard either to their symptoms, causes or cure.

It was observed to you, that every healthy woman, who was not pregnant and did not suckle, had a regular discharge from her womb, called, from the term of its period, Menses, from the latin word signifying month. This dis­charge makes its first appearance at different ages in different coun­tries; for, like their fruits, it ap­pears early in proportion to the heat of their climates: thus in southern latitudes it often appears as early as the eighth or ninth year, whereas in the northern ones [Page 61] it is deferred to a much later pe­riod: with us it generally appears between the thirteenth and eight­eenth years. Not only the time of its first appearance is affected by the climate, but the frequency of its return, the quantity dis­charged, and the time of its final cessation, are also all influenced thereby, it being more frequent, more profuse, and sooner ceasing in proportion to the warmth of the country: with us the discharge is, generally, about six ounces, con­tinues from three to six days, re­turns monthly, and finally ceases between the forty-fifth and fiftieth year.

The use of this discharge ap­pears to be for keeping the womb in a proper state for conception, since that cannot take place either before its appearance, during its [Page 62] obstruction, nor after its cessation. Another use is to afford by its sus­pension, during pregnancy, a ne­cessary supply of nourishment for the child.

The Diseases attending their ir­regularity, as well as those occur­ing at the time of their final cessa­tion, I shall wave the re-considera­tion of here; for notwithstanding the particular attention we paid to that subject, still I would never advise you to venture to prescribe for them, when a physician can be procured.

OF CONCEPTION.

THE peculiar manner in which conception takes place, being a matter more of curiosity than of real utility, we shall omit at pre­sent any attempt to investigate: [Page 63] thus far, however, it may not be improper to remark, that the child receives some essential original principles from both parents; else why should it in some instances bear so strong a resemblance to the father, and in others to the mo­ther? And that the woman by no means stands in that secondary order, in this wonderful transac­tion, as she is stated to do by some; for did she only furnish a safe re­ceptacle for the protection, and proper nourishment for the growth of the child, why should it car­ry the traits of her features in its countenance, or the colour of her skin upon its surface? Might we not as well expect horns to sprout out on the forehead of an infant that has been brought up upon the milk of a cow, or a woolly skin upon him who had always been wrapped in flannel?

[Page 64] In whatever way conception is performed, anatomy assures us, That it first takes place in the ova­ria, from whence it is taken up by the loose open ends of the fallopi­an tubes, and conveyed through them to the womb. That it takes this route is proved, first, by conception never being effected after the ovariae have been taken out, as has frequently been done by farmers on some of their ani­mals: secondly, by certain marks discoverable in these bodies corre­sponding to the number of con­ceptions the person has had; and lastly, by the rudiments of chil­dren having actually been found enclosed in them, which, from some obstruction, had never got into their proper place. That from the ovariae it passes into the open end of the fallopian tubes, and thence conveyed into the womb, [Page 65] we conclude, firstly, from not hav­ing discovered any other commu­nication between them; secondly, from children having been found in the tube itself, which never had reached their destined place; and, finally, from children having been found in the cavity of the belly, which must have been dropped between the ovariae and the mouths of the tubes. Generally the con­ception passes into and adheres to a part of the womb, where it is nourished and grows, so as in about ten weeks to be as large as a hen's egg. Within the cavity of this substance, the child is discovera­ble, suspended in water by a small thread inserted into its navel.

As the conception enlarges, the part adhering particularly to the womb becomes of a spongy na­ture, seemingly well calculated to [Page 66] draw blood from it. This cake (placenta) becomes, at full time, from six to eight inches in diame­ter, composed of a great number of blood-vessels; these uniting to­gether on one side, form the navel string, which is in fact nothing but three blood vessels twisted to­gether, serving to convey nourish­ment to the child, and to keep up a circulation between it and the mother.

With the growth of the child, the womb also enlarges; the mem­branes containing the waters, stretch more and more; the waters themselves accumulating, protect the child from injuries, favor its regular growth and formation, at the same time that they guard the mother from the pain its move­ments would otherwise occasion.

[Page 67] The child thus confined in the womb, differs in several respects from children somewhat advanced in age, but in none more particu­larly than in the circulation of their blood, the state of the lungs, and structure of the head.

In persons who have breathed, the whole mass of blood passes regularly through the lungs and then through the body, but in an unborn child, the heart and blood vessels are so modified, as not to send more blood to the lungs than is just sufficient for their nourish­ment: hence they are much firm­er than the lungs of those who have once breathed, and will ge­nerally sink in water: after birth, the lungs being expanded by res­piration, the blood is freely trans­mitted through them, and all these peculiarities of the circulation are [Page 68] soon obliterated, with a cessation of the passage of the blood, through the navel string.

The bones of the head not be­ing joined together, and indeed not being fully formed, admit of a degree of motion, and are fre­quently lapped over each other, and moulded in a surprising man­ner in laborious deliveries.

As the womb increases during the time of pregnancy, it first en­larges at its body, and, from its increased weight, sinks down into the cavity of the bason: hence, if a woman is examined during this period, the mouth of the womb will be discovered lower than na­tural, and will feel heavier to the touch: at or about the third month, the womb becoming too large to be confined within the [Page 69] cavity of the bason, rises up above its brim, and then its orifice being higher is more difficultly felt: this difficulty increases as the woman advances till labour comes on. During this enlargement of the womb, its neck becomes entirely obliterated, it being all stretched out into the general distention. A remarkable circumstance of the womb is, that notwithstanding its great distention, it suffers no di­minution in its thickness, it being no thinner at the time of delivery than before impregnation: this is owing to its becoming much more spongy, by the general enlarge­ment of its vessels. The sudden contraction of the womb makes its sides considerably thicker soon after delivery, the vessels not hav­ing yet returned to their original size; in a little time, however, it returns to its natural thickness.

[Page 70]

LECTURE XXV.

Of the symptoms of conception. Di­rections for avoiding many diseases during pregnancy; and the me­thod of conducting natural births.

A Married woman, who is other­wise healthy, being affected with an obstruction of her menses, has good reason to suppose herself pregnant.

From the great sympathy subsist­ing between the womb and differ­ent parts of the body, any material change taking place therein, will often be felt elsewhere: hence swel­ling and shooting pains through the breasts, as well as sickness at stomach, longings and unnatural appetites, have been considered, and frequently are signs of pregnancy: all these, [Page 71] however, with head-achs, tooth-achs, lividness under the eyes, &c. fre­quently fail, as they may all be induced by an obstruction of the periodical discharges from disease: nevertheless, when their obstruc­tion and these symptoms arise from pregnancy, the person gene­rally enjoys better health, in other respects, [...] when they originate from other causes.

These smpathetic affections ge­nerally subside, or at least consi­derably abate, about the third month, when the womb may be distinctly felt rising above the share bones: this also, as well as the be­fore mentioned symptoms, is by no means a sure test of pregnancy, and indeed there appears to be no unequivocal sign, whereby that state can with certainty be deter­mined, till between the fourth and [Page 72] fifth months, when the child quick­ens, that is, when its motions are distinctly felt.

For the Diseases of pregnancy, it certainly would be very impro­per for midwives to be too free in prescribing: that belongs to the province of the physician, never­theless the means of preventing the many disorders incident to that state cannot be too fully understood by you; for, by your friendly inter­ference, many vulgar errors may be timely counteracted, and much comfort enjoyed by the sex during their nine months journey. No error has perhaps more generally crept in with the sex, than the belief of all their disorders in that state, being owing to too great a quantity of blood, from the ob­struction of its usual evacuation; hence blood-letting has been so uni­formly [Page 73] advised for their relief, and by many thought necessary even when no complaint existed: no­thing however can be more ab­surd; for the loss of appetite, so common in the early stages, very little favours the redundance of blood; besides, when we calculate the whole quantity of the menses that would have been discharged for nine months, (which cannot be estimated above sixty or seven­ty ounces) and compare it with the weight of the child and its appendages, (which is, at least, to three times that amount) we should rather suppose that women wanted more, instead of less, blood than they have. It was a max­im with old Hippocrates, that "Bleeding produces miscarriag­es." I do not pretend to say that bleeding is never necessary during pregnancy: its indiscrimi­nate [Page 74] use is what I wish to be dis­countenanced, and that it never should be performed but by the particular advice of a skilful phy­sician.

The Bowels of pregnant women should always be kept regular; and if they are costive, which is very apt to be the case, from the pressure of the womb upon the lower part of the intestines, it ge­nerally may be remedied or pre­vented, by the free use of vegeta­bles and ripe fruits, and occasion­ally, if necessary, by administering a mild injection.

Instead of tight lacing, which has been done by some, with an expectation that, by pressing the child down, they would ensure to themselves a more easy delivery, women should be advised to wear [Page 75] jumps or straps to their petticoats, going over their shoulders, to pre­vent them from hanging too hea­vily upon the womb: they serve not only to afford a present com­fort, but to prevent the womb from being pressed down over the share bones, causing what is called a pen­dulous belly, which always tends to induce difficulty in delivery. When the belly does become pen­dulous, it ought to have a swathe secured around its lower part, and be supported by straps going over the shoulders.

Women with child should live upon a light diet, but eat fre­quently; they do not, however, appear to be hurt by satisfying even their absurd and extravagant appetites; still we need not appre­hend any bad consequences from crossing them. In the advanced [Page 76] stages, they ought to lie down to rest themselves frequently in the course of the day.

Whether the Imagination of a woman can have any effect upon the child, or not, is still a question. Whether it has or not, it becomes our duty to discourage the idea; for in not fearing its effects, we deprive it of its greatest influence, (if it has any) and at least save women from many an anxious thought, and many an hour of distress.

In the early months, before the womb has arisen above the brim of the bason, its pressure, not un­commonly, produces a suppression of urine; this also sometimes aris­es from the urine being too long retained, whence the bladder, be­ing overstretched, looses its power [Page 77] of contracting: in either case, if a change of posture does not re­move the difficulty, the water should be drawn off by the cathe­ter; and I see no reason why this instrument may not as well be in­troduced by a woman, when there is no other disease attending, as by a physician: the operation is very simple; the patient being ei­ther seated, or laid on her side, with the knees separated, the in­strument made blood warm and dipped in [...]eet oil, is to be care­fully insinuated into the orifice of the canal, and gently pressed for­ward in the course of it till it reaches the bladder, when the urine immediately follows with­out any more trouble; but should any impediment to the easy entrance of the instrument occur, immedi­ately desist and call in the aid of a physician.

[Page 78] At the end of the thirty-ninth week, the womb, from some un­accountable law of nature, exerts itself to get rid of its contents, not only by its own contraction, but also by the assisting power of the whole of the surrounding muscles of the belly, &c.

When women come near to the time when they expect to lie in, they are apt to consider every lit­tle uneasiness in the bowels, or pains in the back, as approaching labour: hence you often will be sent for when there is no real oc­casion for you. There are some false pains so nearly resembling the true pangs of labour, as to re­quire some judgment to distin­guish them. In real pains the bel­ly generally flattens, and there is a sense of weight and bearing down upon the neck of the womb, [Page 79] accompanied with the shews, a glu­tinous, slimy discharge from the parts, sometimes streaked with blood: these circumstances seldom or never attend the false pains. False pains are, very often, almost continual, or at least very irregu­lar, and seldom have intervals of complete ease between them; whereas true pains, which gene­rally begin in the back, and af­terwards seem to surround the whole of the lower part of the body, and frequently shoot down the thighs, have regular intermis­sions, and come on harder and stronger as the labour advances: and, if the patient is examined, the mouth of the womb will be found settling down and gradual­ly dilating, the membranes con­taining the waters, bulging for­wards, &c.

[Page 80] When false pains originate from costiveness, that must be obvia­ted by mild injections, and after­wards, in case they should conti­nue, they should be allayed by twenty or thirty drops of lauda­num, as the case may require: if they arise from gripings in the bowels, the anodine alone will be sufficient.

LABOURS may be divided into four classes; first, natural, where the head presents first to the birth and is delivered without any arti­ficial assistance, within twenty-four hours: second, laborious, when the head presents, but the delivery is protracted beyond twenty-four hours, or assistance becomes neces­sary: third, preternatural, when any other part except the head pre­sents to the birth; and fourth, [Page 81] complicated, when attended with floodings, convulsions, &c.

Before we proceed to the ma­nagement of Labour, we should attend to the dress of our patient. Her hair should be put up snug and tight; her clothes so fixed, that the part exposed to get wet may be removed soon after deli­very without much exertion or fatigue; and she should have on stockings, that she may sometimes walk about between her pains. Her bowels ought also to be at­tended to: if she has not lately had any thing pass them, she should have an injection imme­diately given to her; this will not only favour the relaxing of the parts, but prevent unpleasant occurrences that might otherwise happen during the progress of delivery.

[Page 82] Women have been delivered in a variety of positions, such as stand­ing, lying on their backs, sitting, and standing on their knees: the most common position, however, is, either that between sitting and lying on their backs, or lying on their side: when they are in the former posture, the only movable bone of the whole bason, the rump bone, is so much pressed upon by the weight of the wo­man's body, as must certainly tend to retard delivery. The most easy situation, and that which is also most convenient for the operator, appears to be for her to lie on her left side, with her back near the edge of the bed, and her knees drawn up and separated by a pil­low. It would be adviseable to have her delivered on a separate bed from the one she is to lay in, so that she may be removed, im­mediately [Page 83] after, into a dry, com­fortable situation: for this purpose, then, a little cot ought always to be procured, if possible.

In the beginning of labour, the contraction of the womb, which accompanies every pain, pressing generally upon its contents, natu­rally bears hardest upon the least resisting parts; hence the mouth of the womb is gradually dilated: as this dilatation is encreased by a repetition of pains, part of the bag, containing the fluid in which the child floats, is pressed, in form of a bladder of water, into the opening, stretching it in the man­ner of a wedge, acted upon by the superincumbent power of the pains; preparing the way (in a natural case) for the bulky and more resisting head of the child.

[Page 84] As the labour advances, the wa­ters gather more and more, and usually, by the time the mouth of the womb is fully dilated, the membranous bag breaks by the force of the pains, and the waters are discharged by a sudden gush. This terminates what is called the first stage of labour.

Frequently a remission of the pains follows the discharge of the waters, but this is of but short duration. The pains soon return, but often somewhat different from what they were at the commence­ment; for now, in place of gene­ral distressing pain in the lower part of the body, seemingly unfix­ed as to any end, they assume a more encouraging and determi­nate nature, bearing down and attended with a sense of a dispo­sition [Page 85] in the womb to get rid of its contents.

The membranes being broken, and the waters evacuated, the head now falls down into the cavity of the bason, and by the continua­tion of the pains, is forced for­ward, taking its natural turns, till at length it passes through the bones, and presses hard upon the external soft parts, which, gradu­ally dilating, permit its passage through them; when, usually, af­ter a short respite, another pain expells the shoulders, and the body and hips soon follow.

The course of a natural labour, as here described, you will not find to hold good in every case, but diversified in a variety of par­ticulars: thus instead of the wa­ters being preserved till the full [Page 86] dilation of the orifice of the womb, you will often find them spontaneously discharged long be­fore that period: and at other times, (though very seldom) you will find the membranes, with the waters, not ruptured even after the head has passed through the mouth of the womb. Instead of a temporary suspension of pain upon the discharge of the waters, you sometimes will find the child expelled by the continuation and force of the same pain whereby they were broken: in other cases when the child does not immedi­ately follow the flow of the waters, yet the body will be born by the power of the same pain whereby the head is freed from the exter­nal parts; and in other cases again, where there has been some little respite after the birth of the head, it not unfrequently happens, that [Page 87] the shoulders and body are dis­charged at once.

The womb having now got rid of so great a proportion of its contents, generally is free from pain for a little while, but in con­tracting itself to its former size, it meets at length with a still fur­ther impediment to its reinstate­ment; its powers again are called into action; pains return which soon effect an expulsion of the af­ter-birth: this ending the third stage, terminates the labour.

Here a question naturally aris­es, What are we to do all this while? How are we to conduct ourselves, what attention must we pay our patient, and what assistance can we afford her?

Having prepared the bed, &c. [Page 88] as directed, our patient's pains becoming considerably hard; she naturally will be led to lie down while they are upon her, at which time it will be proper for us, when the pain is going off, to ascertain, by a careful examination, the state of the labour, how far the orifice of the womb is dilated, the for­wardness of the waters, and whe­ther the head of the child (known by its roundness, hardness, and firm resistance to the touch, dis­coverable even before the waters are pressed forward or the womb opened) is the presenting part: if it is, every encouragement should be given, that all things appear to be doing well: but we should be very cautious how we give encou­ragement of a speedy delivery, lest thereby we wear out the woman's patience before the process has gotten through with: indeed our [Page 89] greatest care must here be directed towards keeping up our patient's spirits and preventing her from looking out too soon for an end of her distresses; and we may assure her, as in truth it is the case, that generally, the longest labours have the shortest gettings-up, and that short labours give long afterpains. Upon these principles, we ought not to hurry the woman into bed, but as long as she finds herself able to be about, let her keep up.

The pains continuing, after some little time, more or less, ac­cording as they may be, it will be prudent to examine again, to find how matters are going on; but we should be careful not to ex­amine, at least not very critically, during the continuance of a pain, for fear of rupturing the mem­branes, whereby the opening of [Page 90] the womb would have to be dila­ted by the pressure of the child's head, which, from its bulk, pres­sing upon the orifice, would not answer the purpose so easily and quickly as the bag with the wa­ters that are insinuated into it, and enlarging during every pain. A premature breaking of the waters always portends a more tardy de­livery.

The first stage of the labour having considerably advanced, and the pains becoming more severe, it will be prudent for the woman to be fixed in a proper position for delivery, viz. lying on her left side, with her back near the edge of the bed, and her knees drawn up and separated as before direct­ed. She should be properly sup­ported by some of her female friends, a few of whom are always [Page 91] welcome companions upon such occasions, not only on account of the assistance they afford in ena­bling her to bear her pains to more advantage, but also as their cheerful conversation supports her spirits, and inspires her with con­fidence. There is nothing, how­ever, for us to do, but like dutiful handmaids of nature, to wait with patience till the breaking of the waters, announcing the end of the first stage, calls upon us for fur­ther attentions.

But not always upon the break­ing of the waters, is our immediate interference necessary: it will, however, be advisable for us then to attend to the progress of the head, and when we find it has passed through the bones and pres­ses hard upon the external soft parts, putting the perinaeum upon [Page 92] the stretch; then, and not till then, is our assistance required, and here the only aid that we can give is, gently to support the pe­rinaeum with the palm of the hand, or the two thumbs, left the head should be pushed forward so fast as to endanger its tearing. When the pains are very strong, and the head appears to be rapidly advancing, we should make a con­siderably firm resistance to its pro­gress, and instead of urging the woman to make use of extraor­dinary exertions to forward the birth, as is too often the case, we should rather dissuade her from it, by warning her of the consequen­ces that may follow: nor even where the business goes on more slowly, should our attention to this part be neglected; since a lace­ration of it is one of the most unfortunate accidents that could [Page 93] happen, particularly as a reunion thereof can never after be effected.

A few pains, at most, now will clear the head from these parts; when after, perhaps, a little abate­ment, they are renewed and soon force out the shoulders, during which also, we must not neglect the perinaeum, which still will be much upon the stretch and in some danger of being injured. After the shoulders are born, we are not (as some are too apt to do) to lay hold of the child and ex­tract it, but with becoming pa­tience still wait till nature shall deliver it into our hands: we may, and indeed it will be proper for us, to support the body of the child, so as, when it is naturally expelled, to be ready to take it, and directly to turn its face from towards the mother, to prevent its [Page 94] being suffocated, by having its lit­tle mouth filled with the discharg­es that sometimes follow immedi­ately upon its birth.

The child being wrapped in a warmed flannel, and a flannel cap put on (to protect its head from the too sudden impression of the cold air, which otherwise is very apt to give it the snuffles) it should be permitted to lay, without being separated from the mother, till we have a full evidence of the change in the circulation of the blood be­ing completely made; not merely by the child's crying, but by the pulsation in the navel string en­tirely ceasing: then the cord may be firmly tied with a waxed thread in two places; one, about three fingers breadth from the navel, the other an inch further up: the child may then be separated by [Page 95] cutting between the ligatures; the first of these secures the child from the loss of blood in case the circulation should return in the cord; the other is to prevent its bleeding to the detriment of a se­cond child in case of twins, whose afterbirths are sometimes united.

Some advise tying the cord and separating the child immediately after it is born, particularly if it cries heartily; but surely these must have but a very limited idea of the great change that takes place in the body of their little charge, when it first begins to breathe, or they cannot believe but that it must require some little time for its establishment: indeed the gra­dual cessation of the circulation in the cord after a few minutes, proves nature to be as fully ade­quate to the accomplishment of this [Page 96] as of the other part of her work; nor ought we more to presume upon regulating her movements. It is very true that children gene­rally survive such treatment. This indeed proves the powers of na­ture in bearing up against injuries, but to me affords no arguments for our inflicting them. If many lives are not lost, it is highly pro­bable that the foundation of many diseases is laid by such premature conduct.

The child being separated, we must apply our hand upon the wo­man's belly, to ascertain whether there is not another child, if there is not, the womb will be felt low down in the body, contracted in the form of a hard, round ball; but if there is, the swelling will not be much less than before the birth of the first child.

[Page 97] In case of twins, after the deli­very of the first, the head of the other child, generally, soon falls down into the bason, and follows the same course as the first, and should be managed in the same way.

After the division of the navel string, our next attention is to be turned towards the expulsion of the afterbirth, (this is considered as the third stage of labour) and often, by this time, we will find it either discharged, or separated and laying loose in the vagina; if not, we may leave it entirely to nature, or at most to pull but very gently upon the cord in time of a pain. When it appears to lie in the pas­sage and not to come forward easi­ly, we may introduce a finger, and bring its edge down, whereby it may be extracted without any dif­ficulty. [Page 98] It should be drawn away with the greatest caution, to pre­vent part of the membranes being left behind, and also to bring away the clots of blood, which other­wise might be the cause of trou­blesome afterpains.

Nothing can be more hazardous than attempting to hurry away the afterbirth, by pulling hard upon the cord, for we thereby not only risk breaking the cord, thence losing a proper conductor, in case manual aid should after­wards become necessary to bring it away, but we may produce a partial separation of the cake, with a rupture of the vessels, inducing a dangerous flooding, or else, as has sometimes happened, we may pull the womb down through the external parts, turning it inside outwards.

[Page 99] The woman having got through with her labour, is to have her wet clothes removed, and to be put in to a dry bed, have a warm cloth applied to her to absorb the discharges that follow, and have a napkin bound around her; but great care should be taken that it be not drawn too tight; a slight pressure, to support the now relax­ed muscles, is all that is needful.

LECTURE XXVI.

Of laborious, preternatural, and com­plicated labours. Of the treat­ment of the woman and child du­ring the month, and of still-born children.

THE observations upon labour, made at our last meeting, ap­ply strictly to what are called na­tural [Page 100] cases, those where the head presents, and delivery is accom­plished within twenty-four hours, without artificial aid. Instances now and then occur, in head pre­sentations, where it is protracted beyond that period: this may be owing to a variety of circumstan­ces, all which, and the means of relieving them, have been particu­larly pointed out to you, but as it would be advisable, in all such cases, to call in the aid of a phy­sician, I shall omit repeating them here. You may startle at the ideal loss of reputation that you may sustain by thus calling for assist­ance, when perhaps nothing but time is required for the accom­plishment of the business: but you may rely upon its being to your advantage in the end. You should remember, that prudence is the ground-work or a midwife's repu­tation. [Page 101] If you do not now request assistance, and any unfavourable circumstances occur, you are sure to meet with blame; but even should all go well without help, you may be reputed for your hardiness, you will not be com­mended for your care.

When upon your early examin­ation, in the commencement of labour, instead of the head, known by the marks before-mentioned, you find some other part present­ing to the birth, you should im­mediately refer the case to the care of a physician. Notwith­standing, when on that subject, I was particular in directing the manner of conducting every pre­ternatural case, and you perform­ed on the machine every variety of operation; still you may recol­lect, I considered this as a part of [Page 102] the business, well for you to know but not politic for you to practise; I shall therefore wave any re-con­sideration of it at this time.

Preternatural adhesions of the af­terbirth, floodings, miscarriages, and convulsions, are all to be consider­ed as diseases, and out of your province; therefore, notwithstand­ing what may have been said and what you may know about them, you are by no means to prescribe for. I cannot however omit again enforcing it upon you, to aid physi­cians (when occasion may require) to overcome the prejudices of wo­men against cold applications in certain cases of flooding, the whole principle of their opposition to this remedy being founded merely up­on its efficacy. They are fearful of its suddenly checking the dis­charge, when that is the very [Page 103] object aimed at. Did my limits admit, I could repeat a number of cases, in support of what the ge­neral experience of others have proved, that they may be used with as much safety, and often-times with much more success, than any others means. If women have a dread of water, there can be no great objection to a small proportion of spirits or of vinegar being added; but by all means let it be cold.

I cannot conclude without re­peating, in short, a few remarks upon the management of women du­ring the month, so as to avoid many of the diseases incident to that period.

In the first place, the women, ought, if possible, to lye-in, in a lofty, airy apartment, remote from the noise of the street. She should [Page 104] (after having been put into a dry bed as before directed) be permit­ted to have a few hours quiet re­pose, unmolested by the visits of either friends or formal acquaint­ances. After a few hours, the child should be applied to the breasts, to draw off the milk if they have any in them, or to so­licit its gradual secretion, if it has not yet come, thereby preventing the many inconveniences arising from the sudden flood of a great quantity at once into the breasts. The mother should always set up in bed while suckling, and when­ever she eats: by this means she will favour the natural discharges from the womb, which when per­mitted to stagnate, are often the cause of the most distressing dis­eases. With the same intentions, she should also get out of bed, within twenty-four hours, or at [Page 105] furthest two days after delivery; (if nothing in particular should render it improper) at which time her bed is to be made up and sheets changed. Her cloths should be frequently changed, and every care taken to remove all the offen­sive matters which seems so dispos­ed to accumulate about lying-in women. Her drinks should be of the mildest, cooling kind, such as gruel, toast-water, barley-water, tea, &c. her diet chiefly of vege­tables, as panado, sago, tapioca, chocolate, &c. with ripe fruits, but with very little if any wine or spices:—After some few days, she may indulge in boiled meats, and so gradually resume her for­mer diet. Her bowels should be kept regular; something should pass them every day, which, if it does not take place naturally, must be promoted by mild injections, [Page 106] as of warm water with a little sweet-oil or hogs-lard and molas­ses; or if injections are objected to, she may take a little castor-oil, manna, or rochelle salts. The room should be kept temperate, and by no means over-warm. All heat­ing drinks, or an accumulation of bed-cloaths, and indeed every thing that would heat her or pro­mote a sweating should be care­fully avoided: upon the same account, the curtains should be drawn up, so as to let her have every advantage of fresh, free air. By these means she will go clear from many of the inconveniences common within the month. The manner in which many women are cooped on these occasions, leaves no difficulty in accounting for the many diseases, child-bed fevers, agues in the breast, &c. [Page 107] with which they are so often af­flicted.

When women, by a kind of false tenderness, are carefully pent up within close-drawn curtains, and kept in a constant perspira­tion, who can be surprised, that they should often be taking cold? for even turning in bed then must be dangerous; the necessary ex­posures from sitting up, in attend­ing to the calls of nature, or for suckling their child, must always be a great risk; the getting out of bed, the height of imprudence; and the least breath of cold air will almost certainly disorder them.

When the woman's after-dis­charges are moderate, or even very scanty, no disorder attending, no means should be used to increase them, excepting the getting up [Page 108] often, and continuing longer and longer out of bed each time; this will favour their evacuation when accumulated in the womb; their stagnation there, and not their suppression, being the source of danger. When they are copious, the woman continuing well, they need no remedy; but when they are in excess and appear to induce weakness, and do not moderate by keeping in a horizontal position; apply immediately for medical aid.

The milk ought not to be per­mitted to stagnate in the breasts, but should be drawn off as often as four or five times a day. In case the breasts should become hard or knotted, they may be rubbed with warm olive oil or goose grease, and afterwards covered with a plaister composed of oil and bees­wax; [Page 109] or, those failing, they may have a cool poultice, made with bread and lead-water, or cloths wetted with lead-water, constantly applied to the part till the com­plaint is removed.

The nipples are sometimes so pressed in, as not to be taken hold of by the child. They may be drawn out by cupping-glasses, or, what generally answers the pur­pose equally well is, to take a com­mon black bottle, with a smooth mouth, fill it with warm water, then empty it, and immediately apply the mouth of the bottle over the nipple; as it cools, the nipple will gradually be drawn out, so as to be laid hold of without any more difficulty. Women's nipples being drawn out by sucking, at the same time losing, in a degree, the matters wherewith they are [Page 110] naturally covered and protected, and being afterwards, again pres­sed down by the women's cloaths, are very apt to crack open in dif­ferent places: this is often avoid­able, and frequently cured by care­fully wiping them dry, after the child has done sucking, and wear­ing a wax ring, or leaden cap* upon them, so as to permit them to retain their shape; having them at the same time, either covered with a solution of the cooling emollient seeds, particularly of quinces, or anointed with a little [Page 111] beef's marrow, or an ointment made by melting equal parts of white wax and spermaceti with as much sweet oil as to make it of a proper consistence.

Having thus followed the wo­man through the month, let us return to the child. We left it wrapped up in warm flannel till the woman could be first accom­modated: now our little prize must be attended to; it must be washed with warm water and soap, have its navel string wrapped up in a piece of dry linen rag and laid upon its belly, where it must be secured by a flannel belly-band, bound only moderately tight around the body of the child. The child must, in other respects, be warm­ly and comfortably dressed.

In regard to the dress of chil­dren, [Page 112] this one principle should always be had in view, that the looser and easier it is, the better; and that every binding that tends to cramp their motions or oppress their bodies, equally tends to in­jure their health. There cannot, however, be any great objection to securing their little hands from rubbing their eyes; and trick that many of them are very much giv­en to. In fixing on their cloaths, as few pins should be employed as possible; and indeed in no case should they be used where strings can as well be substituted in their place.

The first washing, it was ob­served, should be with warm wa­ter. In the after-washings, which should be at least once every day, the heat of the water should be gradually diminished, so as by the [Page 113] third week at furthest to make it evidently cooler than the child's body; and, after a little while, if we would secure it against the vi­cissitudes of weather in our varia­ble climate, we should have it dip­ped in cold water every morning. By this treatment, two great points in preserving the health of chil­dren are obtained at once, viz. cleanliness and hardiness. Man may truly be said to be the crea­ture of habit; by use he may be brought to take even poisons with impunity; so, by a careful grada­tion, may infants be rendered, in a great degree, proof against the usual hurtful effects of cold.

This inestimable preservative, however, requires some caution in its application, to obtain its best [Page 114] effects. Children should be mere­ly dipped in the water, but not continued in it for any length of time, (and if they are very weak, the water should have a proportion of common salt, as three or four ounces to a gallon, dissolved in it) and upon their coming out, they should be wrapped in a flannel, and have their bodies well rubbed before they are dressed.

Besides the general bath, the folds in the skin, as of the neck, the arm-pits, the groins, behind the ears, &c. should be washed out several times in the course of the day, with cold water, to pre­vent their chafing, particularly in fat children. If, notwithstanding, these parts should chafe, instead of simple water, they may be washed [Page 115] frequently with cold hyson tea, or a weak solution of sugar of lead, or of white vitriol, (in the propor­tion of fifteen or twenty grains to half a pint of rain water) and have them dusted with a little dry flour or calamine powder.

Another main article in preserv­ing the health of children, is, the early habituating them to exercise and free air. If grown persons can hardly support themselves without exercise and fresh air, how can it be supposed that tender infants (whose growth is to be expanded, and circulation extended, by the sole power of their own strength) can possibly prosper without them? Their constant uneasiness when kept still, and the agreeable satis­faction they express upon being [Page 116] dandled about, fully prove the utility of that measure; while the great and partial mortality among them in crowded places, clearly shews their necessity of the purest atmosphere.

In respect to the diet of chil­dren, there is nothing equal to their mother's milk, and where any substitute or addition thereto is wanted, that which approaches the nearest to it, is the best: none, perhaps, is better than cows milk, diluted with water and sweetened, or a little salted when it appears to curdle much upon the stomach. Bread and every other more sub­stantial food in any form, requires a degree of digestion which the stomachs of infants, in their early days, are no ways calculated to [Page 117] perform; hence, when they are stowed with pap or panado, &c. they are so often afflicted with a train of complaints in their little bowels.

It is a common thing with nurs­es, almost immediately upon the birth of the child, to give it some purgative to carry off the black matter contained in its bowels, and if its mother's first milk does not answer that purpose, or if she has not yet got any, or the child sucks an older milk of a nurse, this certainly is a very proper step. With this intention, a little manna and water, molasses or syrup of roses, may be repeatedly given till it has its effect, or the babe may take a teaspoonful of a weak infu­sion of rheubarb in water every [Page 118] hour till it purges. Costiveness, that may occur afterwards, will be best relieved by suppositories or mild glysters.

The treatment of the diseases of infants being the proper business of physicians, I shall pass by no­ticing here. But, as in cases of apparently still-born children, the necessary means of their recovery would often come in too late, were you to wait till a physician could be procured, I cannot omit again calling your attention to them.

It not unfrequently happens, that children do not, for some lit­tle time after they are born, shew any signs of life by crying or even breathing. Upon such occasions, [Page 119] I have often set their respiratory organs in motion, by blowing a sudden blast of air into their mouths. Should this not succeed, the child should be immersed in a bowl of warm water, and have its body rubbed over with the hand, while the circulation in the cord should be supported or pro­moted (if it should have stopped) by wrapping it in a warm flannel. These means being continued for a few minutes, without any ap­pearance of life, and the pulsation in the navel string appearing to be entirely and irrecoverably stop­ped, it may be tied and cut. The child still continuing in the warm bath, is, by your blowing through a quill fixed into one of its nos­trils, while the other and its mouth are kept perfectly closed, to have [Page 120] its little lungs dilated; then by pressing on its belly and breast, the air must be driven out again, when, in like manner, they may be filled and discharged repeated­ly, imitating natural breathing as near as you can; this should be continued for a long time, unless the child should sooner show some signs of life, by gaping &c. after which signs, if it should not still breathe freely, it may be excited by a little spirits or snuff applied to its nostrils, or by slapping it on its buttocks.

It sometimes happens with still­born children, that their counte­nances are of a dark livid colour, from a stagnation of blood; in these cases it is necessary to divide the navel string immediately, and [Page 121] let it bleed a little before tying it; if this does not revive it, its lungs must then be inflated as above di­rected; by a perseverance in which, many children have been recover­ed, to the no less astonishment of despairing friends than enjoyment of their disconsolate mothers.

Before we part, let me caution you against that scandalous dispo­sition to defamation, so prevalent among persons of the same pro­fession. Whatever may be your opinion of those, who have not had like advantages with your­selves, still they are entitled to your compassion and tenderness; your mild carriage will ensure their affections, your instructive conversations may improve their practice, and excite in them a [Page 122] laudable spirit of further enqui­ry. In regard to yourselves, would you be respected by others, shew a deserving claim thereto, by your respect one towards another; if you speak lightly one of another, wherefore can ye expect the world to speak well of you.

Permit me to recommend to your particular attention, the calls of the poor, ‘He that hideth his face (from them) shall have many a curse.’ It was a saying of a ce­lebrated physician, that the ‘poor were his best patients, because God was their paymaster.’ They are said to be the footsteps whereby to ascend to the apartments of the rich; but let not this sordid mo­tive be the predominating princi­ple of your actions; let that be fix­ed [Page 123] upon a more noble, a more so­lid basis, the desire of doing good, and you will have abundant cause to acknowledge that ‘He that giv­eth unto the poor shall not lack.’

FINIS.

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