AN ESSAY &c.
[]SECTION I. On the Diſeaſes of early Pregnancy.
THIS Section may deſerve the attention of women who are conſtitutionally afflicted with troubleſome complaints in the firſt months of preg⯑nancy. The moſt common ſymptoms of breeding are, ſickneſs, loathing, vomiting, giddineſs, drowſi⯑neſs, heartburn, diarrhoea, a painful fulneſs of the breaſts, nervous fits, faintings, &c. If the patient is healthy, or of a full habit, it may be uſeful for her to let blood repeatedly, in ſmall quantities, not exceeding ſix or ſeven ounces at a time, eſpecially if the ſickneſs is attended with fluſhings, parched mouth, or any other feveriſh ſymptoms; larger evacuations are not ſafe. The bowels in ſuch caſes ought to be kept ſoluble by ripe fruits, cooling diet, magneſia, cream of tartar whey, ſoluble tar⯑tar, [10]manna, or ſuch gentle things, and yet more advantageouſly by oily or emollient clyſters; an uſeful domeſtic injection may be made in a few minutes thus:—Take of ſtrained gruel, about three quarters of a pint, brown ſugar, one ounce, Caſtile ſoap, half an ounce, ſalad oil, two ounces; this, or ſomething like it, may be thrown up occaſionally. If frights or falls have done harm, the ſame treatment is recommended. When vomiting is troubleſome, I have frequently known this ſymptom carried off by drinking chamomile tea, or giving two or three grains of ipeca⯑cuanha, to cauſe a diſcharge of the offending matter from the ſtomach. It may be remembered, as a general rule, that all ſtrong or violent remedies are hurtful, therefore, we caution againſt antimonials, mercurials, cathartics, jalap, aloes, or even rhubarb, becauſe it often cauſes griping pains. When ner⯑vous complaints come on, the moſt effectual relief may be obtained from gentle opiates. If the pa⯑tient is delicate or weak, bleeding may do harm; but an invigorating diet in ſmall quantities, and a little pure old wine, taken from time to time, may be uſeful. Much more may be ſaid to make up a [11]book; if more is wanted, we recommend the advice of an experienced phyſician; let it be remembered, I do not propoſe to trouble my readers with a large volume; my intention is only to give uſeful hints in a ſhilling pamphlet; it is not neceſſary to ſay more on this part, but come in courſe to our Second Section.
SECTION II. On the Diſeaſes of advanced Pregnancy.
[12]THE diſeaſes of advanced pregnancy ought to be well underſtood by every midwife; for if ill treated, may be attended with the worſt conſequences. As pregnancy advances, the uterus increaſes in ſize, and preſſes more and more heavily on the bowels, by which their important functions are impaired, the circulation of the blood, and the nervous in⯑fluence, are materially obſtructed, what wonder then if diſagreeable effects often come from ſuch cauſes?
Let us now mention ſome of the complaints that take place, and the beſt means of removing them. When the gravid uterus riſes higher up into the abdomen, in the fifth, ſixth, or ſeventh month of pregnancy, then commonly commences the com⯑plaints of advanced pregnancy, ſuch as colics, cramps, hyſteric fits, pains in the back, difficulty of breathing, oedematous or watery ſwelling of the [13]legs, &c. vomitings, convulſions, difficulty or ſup⯑preſſion of urine, micturition, haemorrhoids, varicous ſwellings in the veins of the legs, beſides ſome others we ſhall not mention. If colic torments the patient, let her have the inteſtines moderately emptied by gentle laxatives, lubricating clyſters, or blood⯑letting, according to circumſtances, in caſe ſhe is ſtrong or feveriſh, and coſtiveneſs ought to be guarded againſt. If cramps are frequent, the ſame treatment may be uſeful; if they are ſlight, we have frequently known walking barefooted on the cold floor to give ſpeedy relief; when more uneaſy, the following liniment will afford caſe: take of tincture of opium, one ounce, of camphorated ſpirit of wine, ſix drams, oil of amber, two drams, ſpirit of ammonia, four drams, mix them, and let ſome of it be well rubbed occaſionally on the parts affected. If piles are painful, the body muſt be kept open as above, but we recommend caſtor oil, if not offenſive, for this purpoſe, one or two ſpoonsful is a moderate doſe; if the haemorrhoids are very un⯑eaſy, we recommend ſtrongly the following mixture and ointment: take of balſam capivi, two drams, mucilage of gum arabic, one ounce, tincture of [14]columbo root, one ounce, ſimple cinnamon water, two ounces, ſirup of ginger, one ounce, mix them and give a deſert ſpoonful thrice a day. The oint⯑ment may be depended on: take of gall nuts in fine powder, one ounce, pure verdigriſe powdered, two drams, hog's lard, two ounces, mix them to make an ointment, which may be applied to the ſwelled parts occaſionally. When great difficulty of breathing attacks the patient, great relief may be procured from bleedings, and keeping the body ſoluble. When a dropſy of the whole body, called anaſarca, comes on, it may proceed from laxity, and ought if poſſible to be removed, without loſs of time; we have little experience of this complaint, it ſeldom occurs, yet we have heard much, but we believe that a ſtrengthening and warm ſtimulating diet is uſeful, with generous wine, but ſpirits, watery meats, or fluids, are hurtful; after a ſafe delivery, much may be done. If the fluor albus comes on, the ſame mode of treatment as in the dropſy may be recommended.
The oedematous, or watery ſwellings of the lower extremities, ſeldom come from the ſame cauſe as the [15]general dropſy, but entirely from the preſture of the gravid uterus, and though they are of little im⯑portance, yet it may be proper to diminiſh them, by bleeding, laxatives, a ſpare opening diet, friction, and a horizontal poſture. If the patient is weakly, cordials and a comfortable diet may be uſeful. Delivery contributes more than any thing to the cure. When varicous or diſtended ſwellings of the veins become large and painful, they may be made eaſier, by taking away occaſionally ſmall quantities of blood from the arm, and keeping the body open, becauſe they come from the preſſure of the gravid uterus. The beſt application to the parts is a ſtyptic or aſtringent water, which a venerable phyſi⯑cian of great experience aſſures me is often very uſeful in varicous dilatations: take of blue vitriol and alum, of each three ounces, of water, two pints, boil them till the ſalts are diſſolved, then filter the liquor, and add one ounce and a half of the vitriolic acid, and two drams of pure or refined verdigriſe, lay on the ſwelled veins compreſſes of linen, and bind them on with a tightiſh roller, and keep theſe compreſſes conſtantly moiſt with this ſolution.
[16]We have ſtrongly recommended the frequent uſe of injections, to keep the body ſoluble, and if we could perſuade thoſe for whom this little Eſſay is intended, to uſe the ſelf-ſyringe with their own hands, without any aſſiſtant, it might prevent the trouble of taking medicines, it would be leſs un⯑eaſy, leſs painful, leſs expenſive, or diſagreeable, at the ſame time more delicate; but theſe are not all the advantages, a ſyringe throws the clyſter farther up than any other contrivance into the colon or great gut, where all the obſtructed matter is de⯑tained, by the preſſure of the diſtended uterus on the os ſacrum or rump bone.
We earneſtly recommend the introduction of the ſelf-ſyringe into every houſe, for the uſe of thoſe who have complaints in their bowels, about the anus, or are troubled with coſtiveneſs. They may be purchaſed in every conſiderable pewterer's ſhop. I have been told, and I believe it implicitly, that there are many perſons of both ſexes, who with ſome heſitation took theſe machines into their houſes, that now they underſtand how to uſe them, they would not part with them on any conſideration.
SECTION III. The Qualities neceſſary in an Accoucheur and an Accoucheuſe.
[17]HERE we will offer a few remarks on the quali⯑fications neceſſary for an accoucheur, or rather let me deſcribe the ſort of accoucheur I would recom⯑mend. A man-midwife ought to be not younger than forty, not talkative, poſſeſſing much ſagacity and prudence, naturally modeſt, benevolent and humane; in ſhort, a gentleman, and withal have the reputation of being well educated. A midwife ought to be turned of thirty, clean, and neat in her perſon, pleaſant in her manners, gentle, at⯑tentive, and kind to her patients, by ſupporting their ſpirits in diſtreſs, civil to ſervants, but no⯑thing of a goſſip, healthy and active, never taking ſnuff, fond of children, ſkilful and tender in handling new born infants, capable and ready to teach awkward nurſes how to dreſs or clean them, qualified to write ſafe and uſeful preſcriptions for a morbid mother, or an ailing child; ſhe ought [18]to be a woman that hath been well inſtructed, that hath had much practice, not conceited, nor proud, nor vain, nor ſuperſtitious, but firm in her mind, plain, diſcreet, and honeſt; a ſincere friend in every family, always diſpoſed to call in to her aſſiſtance a phyſician, or an experienced accoucheur, whenever there is any neceſſity, or even a diſtant deſire of ſome kind relation, for this will raiſe her reputation, prevent reflections, and demonſtrate her diſcretion.
The faſhion of latter years hath taken the practice of midwifery almoſt entirely out of the hands of women, and placed it into thoſe of the men, and the reaſons for it were obvious. Formerly every conceited goſſiping woman that choſe to act as a midwife, began this profeſſion, without inſtruction, I had almoſt ſaid without common ſenſe, or any one requiſite for ſuch an important employment, and many notorious evils enſued. Then the phyſicians and ſurgeons, being men ſkilled in phyſiology, reſcued many unfortunate patients from the fangs of igno⯑rant women, and it becoming a lucrative branch of buſineſs, they kept it ſnug, till a numerous body in [19]the inferior departments, deſiring to ſhare the pro⯑fits, came forth, like a hord of hungry untaught men, from the labours of the peſtle and mortar, with a few hooks, forceps and crotchets, in a bag, like Dr. Slop, they call themſelves accoucheurs, or men-midwives, but for obſtetric knowledge, we have ſeen ſome of them as ignorant as meſſengers of the contents of their diſpatches, yet ſome of theſe men have arrived at eminence, or rather have ac⯑quired extenſive practice and fortunes, but in caſes of difficulty, they are as awkward as any of the moſt ignorant female practitioners. Women often em⯑ploy men to act as midwives, from a ſuppoſition that they muſt know more than the women mid-wives; but this, like many other ſuppoſitions, may frequently have no real foundation in truth.
SECTION IV.
[20]LET us attempt to remark the difference betwixt the Accoucheur and the Midwife.
Compariſon of an Accoucheur with a Midwife.
| I. | I. |
| The adroit accoucheur is a perſon that can foreſee and often prevent all the evils of difficult labours, with as little hurry or un⯑neceſſary delay as poſſible, and to aſſiſt, can ſometimes uſe the forceps, or other inſtruments contrived to re⯑move the obſtructions to delivery. | The inſtructed accou⯑cheuſe is one who is not ignorant of all the natural or preternatural cauſes of danger that can happen, nor of the means of removing them, yet never uſeth any artificial inſtrument; but in preternatural caſes, when patience and the hopes of parturition are loſt in fruit⯑leſs endeavours, before it is too late, ſhe calls in an approved accoucheur, to aſſiſt her. N. B. It is a certain truth, that inſtruments, the catheter excepted, are very ſeldom wanted, perhaps ſel⯑domer than they are uſed. |
| II. | II. |
The uninſtructed accou⯑cheur is commonly in too great a hurry to exhibit his dexterity in uſing his iron inſtruments, and thereby often doth miſchief, it would be horrible to relate. ☞ The moſt intelligent of the faculty ſeldom or ne⯑ver uſe inſtruments. | The ignorant midwife knows not when to aſſiſt or to leave the buſineſs to nature; ſo blunders on, till ſometimes both mother and infant are loſt, where there was in reality no danger. |
| III. | III. |
| The accoucheur in great practice cannot in lingering labours afford to loſe ſo much of his time in waiting for ſlow operations of na⯑ture, therefore hurries on delivery, or leaves the pa⯑tient till he can call again, when he can find time, par⯑ticularly if his patient is not opulent. | The accoucheuſe can ſit more patiently among fe⯑males in a lying-in room, where ſhe is looked up to every moment for aſſiſtance; ſhe can better ſooth impa⯑tience, by recalling hope; ſhe can more properly con⯑tinue in the room conſtantly, and delicately give direc⯑tions about what is neceſ⯑ſary, ſo is not ſo eaſily tired out with attendance. |
| IV. | IV. |
| The accompliſhed ac⯑coucheur hath a more ge⯑neral and liberal knowledge of things, by his ſtudy in phyſiology. All the parts of animal bodies are known to him, and he can reaſon better on cauſe and effect, than women who have amuſed themſelves with faſhions, dreſs, taſte, or ap⯑pearance; but ſuch men I have obſerved are ſoon fa⯑tigued with the converſa⯑tions of us poor women. | The ſenſible and ſaga⯑cious midwife may make herſelf more agreeable, though ſhe is leſs learned; and as to her neceſſary knowledge in anatomy, ſhe may learn it and all the technical terms in a few months; learning is not difficult to thoſe who love ſtudy, but knowledge is only uſeful when we poſſeſs ſagacity or ſenſe to apply it properly. We have all ſeen learned fools. |
| V. | V. |
| Men in high practice ſeldom know how to handle new born children; they often touch them with diſ⯑like, as they would toads or young ſnakes. What is then to be done when the nurſe is awkward, or at a loſs how to manage the infant, which is too fre⯑quently the caſe? | Women have commonly a great ſuperiority over men in the care of infants, it is more in their province, and a ſenſible midwife thinks ſhe ſhould qualify herſelf for every adverſe accident that may happen. In this reſpect women are prefera⯑ble to men. |
Seme Reaſons offered why Women are preferable to Men as Midwives.
[23]There are many women who cannot converſe eaſily or freely with a man, on many circumſtances that happen about the time of parturition, or even on ſome ſexual diſorders, this may be called falſe mo⯑deſty, but ſtill it exiſts and cauſes many evils; here we ſuppoſe ſkilful women might be more agree⯑able and uſeful. One of the firſt phyſicians in the city, who I believe to be my friend, ſaid to me one day, lately, that if clever women would dili⯑gently ſtudy to accompliſh themſelves in midwifery, he would wiſh for the ſake of propriety, and the good of mankind, that this profeſſion was again reſtored to female hands. It is the opinion of many learned phyſicians, that the advantages to the ſex are ſmall, if any, by the over grown number of male practitioners, at the ſame time, they are clearly of opinion, that a number of eminent accoucheurs ſhould be ſelected and appointed to give advice both to ordinary men and women midwives in difficult and preternatural caſes. It is fortunate for us, few, very few parturient females, not one in [24]many hundreds, need be under the neceſſity of calling in an accoucheur. Indeed, the numbers of women who are delivered with little aſſiſtance, may convince us how much nature acteth in theſe caſes for our advantage. In the obſtetric art, as well as in other branches of the ſcience of healing, it might be better if we could wait patiently, and would humbly rate ourſelves as the handmaids of nature. Premature practitioners, are apt, like the philoſo⯑pher in Raſſelas, to ſuppoſe they can govern the na⯑tural courſe of things, but after a few trials, they muſt find out their incapacity; a little modeſty and common ſenſe, may point out their errors, but con⯑ceited young men and ignorant women are ſeldom eaſily reclaimed from forwardneſs, therefore, pru⯑dence ought to induce us to have recourſe when we can, to intelligent practitioners.
SECTION V. On the Care of Children.
[25]INFANTS often ſuffer much from the careleſſneſs, ignorance, or officiouſneſs of nurſes; to prevent this, it is the duty of an intelligent midwife to caſt a careful eye over their conduct, a little conſcientious pains ought to be beſtowed upon it; cleanlineſs is a moſt important article, the infant ought to be waſhed twice a day in lukewarm water; it is the conſtant cuſtom in the South of Europe, even in ſummer, for if perſpiration or any other excrementi⯑tious matter is left on their tender ſkins, it will ſoon become acrid, cauſe inflammation, excoriation, and conſequently much uneaſineſs; this is not writ⯑ten from a fine ſpun theory, but is the reſult of ex⯑perience. We are of opinion, that waſhing of ten⯑der infants in lukewarm water, is greatly preferable to cold water, and that the theory of relaxation is here more imaginary than real, and that experience confirms this doctrine. If from neglect, the ſkin of infants becomes inflamed or excoriated, let the [26]parts be well waſhed, and made dry, then duſt on a little powdered white lead from a muſlin cloth, this is ſimple but effectual, but let the ceruſſa, or powder of lead, be removed ſo as not to go near their victuals.
An intelligent midwife that hath as much, perhaps more experience, and I believe hath had better opportunities of inſtruction, than any other in this city, from the repetition of lectures, hath emphatically deſired me to mention, in my pamphlet, that if infants are kept dry and clean, their tempers and diſpoſitions will be more plea⯑ſant; they will ſeldom be liable to rickets, or any of thoſe diſorders that affect the bones, ſo as to cauſe bandy legs, &c. and that when female in⯑fants are neglected in theſe articles, the bones of the pelvis, or loweſt part of the body, are often ſoftened and diminiſhed in their natural capacity, ſo as when adults, the diſtorted pelvis cannot admit a child to paſs eaſily, and from thence proceedeth the reaſon for inventing of ſo many iron inſtruments to faciliate difficult labours, and to give occaſion to bold operators to try their hands; moreover, this gentlewoman adds, that if it were not for the [27]neglect of cleanlineſs in infancy, many men and women would be ſtronger in their loins, better pro⯑portioned in their limbs, more healthy, and move more gracefully, but above all, there would be rarely any cauſe to call in even the prudent and experienced accoucher to aſſiſt in parturition; let me add, that theſe obſervations are confirmed by the opinions of practical men, whoſe judgments are not apocryphal. An attention to this doctrine can never do harm, and nurſes, who conſcientiouſly diſcharge their duty, deſerve rewards and friendſhip.
It ſometimes happens, that wet nurſes have not enough of milk for their nurſelings, and make up their food with bread, tapioca, or Indian arrow root, and the common milk of this town; we be⯑lieve, that in general, beef tea, mutton or veal broth, mixed with them, is preferable. Infants are liable to acidity in the ſtomach and guts, which often occaſions griping, purging, &c. a little magneſia given occaſionally is the beſt domeſtic re⯑medy. If coſtiveneſs at any time comes on, a little manna, or, when very young, a few tea-ſpoonsful of equal parts of freſh oil of almonds and ſyrup of [28]violets, repeated occaſionally, is a ſafe and uſeful laxative. If vomiting from foul matter in the ſto⯑mach is troubleſome, one or two grains of the pow⯑der of ipecacuan may be given as an emetic, with ſafety, and ſometimes, two or three tea ſpoonsful of wine, and ſome warm water, by way of aſſiſting the evacuation, will anſwer the purpoſe; if more is wanted, the beſt way is to apply ſoon for proper advice.
In childrens diſeaſes, much may be done by li⯑beral well informed women; in diſeaſes of the bow⯑els, diarrhoea, or flux of the belly, vomitings, worms, hooping coughs, &c. rational women may be more in the way of examining their evacuations, and prying into particular complaints, and naturally attend more to their diſorder, than either the learned phyſician, or the ſkilful apothecary, whoſe longeſt viſits laſt only a few minutes, and then are told the ſymptoms and circumſtances by ſome indiſtinct at⯑tendant, that knows leſs than ſhe pretends to do; thus a child is often loſt in the hands of able men. Even, when children are ill in the ſmall-pox, meaſles, fever, fits, &c. they are often totally truſted [29]to the care of very ignorant, pretending old women, who know as little of theſe diſorders, as I do of the French Directory, or the Iriſh Rebellion. Would it not be better, to find out ſome intelligent perſon, who can and will give attention to them? It is true, ſome do recover in ſpite of bad treatment, but, if they die, are not the parents blameable for over⯑looking ſo important a concern? If ſome women can be found fit for all the important duties of a midwife, and of giving ſound advice in ſexual diſorders, or in thoſe of children, why heſitate to employ them? Are women by nature incapable of inſtruction, or are they deficient in ſagacity to be uſeful? Cuſtom or faſhion govern the world, and often deprives us of that judgment, or common ſenſe, that would be more advantageous to ſociety. Let it not be ſuppoſed, I wiſh to reject the advice of able men, far from it, I wiſh only to demonſtrate that women may be capable of being very uſeful in ſexual diſorders, as well as in thoſe of children; it ſeems to me as if nature had allotted this part of the healing art to females, becauſe we have better opportunities of inveſtigating the real ſtate of the illneſs, and if benevolently aſſiſted by ſagacious phyſicians, might ſave many lives.
[30]There hath been ſome conjectures agitated among men of no mean conſideration, falſe or true, I leave to others to determine; they have ſuppoſed, ſince women of all ranks, gave themſelves up to men⯑midwives, they have loſt much of that delicacy, which before rendered them ſo amiable, and in loſing delicacy, ſay they, may not chaſtity itſelf be eaſily violated? If we loſe poſſeſſion of either, or both, what are we? Others ſuppoſe, ſince that period, more elopements, trials for crim. con. divorces, pri⯑vate intrigues among married women, have been com⯑mon, and that we have acquired more of a maſcu⯑line ſwing in our gait. Some men of gallantry have not ſcrupled to ſay, that women who employ men⯑midwives, are in general, an eaſier prey than thoſe who do not. It is ſtep by ſtep, or ſlow advances, that women commonly arrive at vice, juſt ſo, do thoughtleſs boys become cruel, by being ſuffered to torment birds, beaſts, reptiles, inſects, &c. by and by, they loſe every feeling of humanity, and can murder men without horror. If we could but be cautious to defend ourſelves againſt the approach of all impropriety, the ladies of Britain would be as ſuperior in virtue as they are in beauty. [...]
A comparative Review of Male and Female Temperaments.
[31]Females, when young, may at leaſt claim equal eſteem with their brothers, the lords of creation, for filial affection, and all the virtues of parental obedience; as wives, men of great obſervation have given teſtimony in their writings, that we are by no means inferior to our huſbands in conjugal duties.
As mothers, I have ſtill the teſtimony of men, that we are full as tender and careful of our chil⯑dren as their fathers are; as miſtreſſes of fami⯑lies, are we not equally economical, as kind to our ſervants, and benevolent to the poor? Authors of the moſt eminent abilities, after a comparative review of both ſexes, have candidly declared, upon the whole, we are by no means inferior, or rather we are ſuperior, in acting our parts in all the con⯑cerns of life. All theſe commendations we can re⯑ceive with conſcious pride, while we merit them, but when we part with delicacy or modeſty, alas! how are we fallen! even, like a flower after it is cropt, ſoon loſeth all its ſweetneſs, and is caſt like a loathſome weed away. I wiſh my amiable readers [32]may conſider here what I have ſaid, both in a moral, and a religious point of view; it can do them no harm, and if the thinking part of men can alſo agree with me, it may be an object worthy of their atten⯑tion, to leſſen, or do away one of the greateſt cauſes of our misfortunes and unhappineſs.
I could wiſh that female education was more ſo⯑licitouſly attended to. When young, we often have a bad education, which is worſe than none; ſo by imitation, from bad examples, of eaſe, free⯑dom, faſhion, grace, &c. inſenſibly we loſe the elegant ſweetneſs of female delicacy and reſerve. I am always happy to ſee young ladies exhibit ex⯑cellence in the dance, to hear the charms of muſic from their well-toned inſtruments, or tranſported by the melting ſounds of the voice, and to behold their taſte in drawing; but I am ſometimes ſorry to find, that theſe accompliſhed young ladies are ignorant of the grammar of their own language, that they are deficient in underſtanding the firſt principles of virtue, and that they have had no inſtruction on the holy ſcriptures; the firſt of theſe two laſt, may ſhew them the beauty and felicity of moral conduct, and [33]the ſecond, the eternal bliſs, that is promiſed us, in ſtudying the laws of our Almighty Cre⯑ator, or Redeemer; and I will venture to aſſure my fair readers, that by ſtudying carefully theſe ſacred laws, ſo as to practiſe them as ſtrictly as poſſible, they will find continually that ſatisfaction in their minds, that will give cheerfulneſs to their features, that will beautify their beauty; beſides, if the day of adverſity ſhould overtake us, the conſciouſneſs of having done our duty, will feel to afflicted minds as a ſource of celeſtial conſolation.
I am a mother myſelf, and it is on theſe prin⯑ciples I endeavour to inſtruct my children. If I dared, as a female writer, I would venture to re⯑commend to young ladies of faſhion, ſome attention to hiſtory, geography, botany, natural hiſtory, mo⯑ral and natural philoſophy, &c. theſe might occupy any blank in their minds, and make them capa⯑ble to carry on agreeable converſations on any ſub⯑ject; this would make them admired by all their ac⯑quaintances, and adored by their huſbands, it would render their actions more graceful, and their beauty more pleaſing; it would make religion more rational, by opening their eyés to the power and goodneſs of the Almighty in all his works.