AN ANSWER TO THE Author of the CRITICAL REVIEW, For March, 1760, &c. By Mrs. NIHELL. [Price One Shilling.] AN ANSWER TO THE Author of the CRITICAL REVIEW, For March, 1760, Upon the ARTICLE of Mrs. NIHELL’S TREATISE ON THE ART of MIDWIFERY. By Mrs. ELIZABETH NIHELL, PROFESSED MIDWIFE. LONDON: Printed for A. MORLEY, at Gay’s-Head, near Beaufort Buildings, in the Strand. MDCCLX. AN ANSWER, &c. ON seeing the strange attack made in the Critical Review for the month of March, 1760, upon a treatise offered by me to the Public, with the best intention imaginable for its service, upon the subject of midwifery, which is my profession, I can safely, and with the greatest regard for truth, aver, that if the manner in which I found myself there treated, gave me any pain, that pain was not for myself. I was even sorry to observe any gentleman of letters stoop- ing so low, as to the poorest buffoonry, and to the so little respecting the Public and him- self as to play upon names; a circumstance of no-wit, which I have so favorable an o- pinion of him, as to presume he would have B treated [2] treated with all the scorn it deserves, if em- ployed against himself. But the reason he gives for this punning is in truth an admirable one. He assumes the subject discussed to be a ludicrous one. A ludicrous one! what! can the subject of dis- cussion, which is palpably neither more nor less than the greater safety of the lives of women and children, be deemed, by any construction or intendment, a ludicrous one? But at this I am not indeed surprized, when I consider, that in this every candid article of Review, the writer is not contented with poisoning and distorting a most innocent and inoffensive application from a woman to one of her own sex, for her hand to chase the hypogastrium, into a suit for “titillation", but he must grossly and unprovokedly insult the women with the assurance, that if they were to be pleased with titillation, the art of it was better understood by the men than by the women. If this to husbands, to fathers, to relations, is defending the use of he-midwives, I leave to their own consideration. I leave it also to their consideration, whether their understanding can be more shamelessly insult- ed, than by that averment of the Reviewer; "that [3] “that the business (of midwifery) is carried on “with much more EASE and DECORUM by “the men than by the women-practitioners, “excepting such of these last as have been EDU- “CATED under MALE-ARTISTS.” That is to say, educated to cut out WORK for their INSTRUMENTS, without which the male- artists are so sensible they would be so per- fectly insignificant. The reflections upon this are so obvious, that to dwell upon it would imply my taking husbands, fathers, and relations for rank ideots; and it is not for such that reasoning is made. But before I proceed any further in my defence, I must beg leave to remark, that my candid critic seems to have over-stepped his province of a Reviewer into that of a controversist; which certainly cannot be fair, unless he gives warning to his reader, that he is laying aside the character of the judge for that of a party. He cannot surely consist- ently with the laws of candor or common- sense be both at once. Even but as a Reviewer he is doubtless at li- berty to give his opinion of my book as un- favorably as he pleases. He may condemn the stile of an essayist, who sets out with a B2 solemn [4] solemn profession of a disclaimer of all pre- tentions to stile; he may, as he has done, emphatically assure the reader, that a trea- tise of midwifery professedly wrote to expose the errors introduced into the art, does not itself give a regular Sistem of the art; he may, in short, in virtue of his office of Re- viewer, issue out his censure of a book that has, it seems, the honor to displease him; but surely, all this liberty does not warrant its extention not only to miserably low scurrility, but even to a most unfair wresting of quotations, and to an acrimony, which rather denotes a party interested and hurt, than an impartial Reviewer. For example, he attempts to palm on the reader a most strained and false construction of a passage he quotes from my work (p. 90) where I speak, and very justly speak of the fatigue I have often undergone, of keeping my hands "fixedly employed for many hours “together, in reducing and preserving the “uterus in a due position.” The critic here exclaims against this as cruelty. Now, if there was any cruelty in this fixed position, it could at worst be only a less cruelty than that which it is meant to prevent, the cruel and [5] and dangerous use of iron or steel instru- ments. But the truth is, there is not, in this point of practice, so much as the shadow of cruelty, or indeed of any prejudice whatever to the woman in labor, whose safety both of herself and child is consulted by it. If the reader deigns to consult the passage con- nected as it is, in that page 90, he will rea- dily, if he has any the least share of candor, admit, that in that place particularly, the word "hands" is indefinitely employed; a whole for the part; there being in that pas- sage no particular instruction of management proposed to be conveyed. But where that management requires specification, the dis- tinction is duly made, as the reader may easily satisfy himself, p. 348, where it will appear how perfectly inoffensive, and even salutary that employ of the midwife’s hands must be where the case requires it. Doubtless a forceps or a crotchet are infinitely tenderer. Of this I am clearly sure, that any reader of candor and humanity will, on perusal of that passage, feel a just indignation at the unfair treatment both of himself and me, in the use attempted to be made of that quotation against me from p. 90, the expression in which [6] which might however have been more clear, if I could have imagined that it could have given rise to a construction so shocking to common-sense, as that on which the critic has founded his pathetic exclamation of a midwife’s two hands in the vagina! if he really understood me so, I heartily pity him: if he has designedly given me that meaning, I have a right to pity him yet more, as disin- genuity is surely more pitiful than only mis- apprehension. To the question the Reviewer asks me, relative to the vitious conformation of the pelvis, and concerning which he accuses me of flagrant ignorance, “whether I have ever “seen a collection of skeletons?” I answer, that I have occasionally seen skeletons, but without the least, reason to retract what I have said of the almost universal care of Na- ture in the due conformation of the pelvis. It is also true, that I have cast around my eyes, and observed a number of rickety chil- dren and crooked women, both in this me- tropolis and elsewhere; but I never had rea- son either from sense, or especially from my own experience, to form the Reviewer’s con- clusion from such ricketiness to the distortion of [7] of the pelvis. On the contrary, I have de- livered many richety women, many outward- ly distorted women, whose deformity was even legible in their faces, but never found that it in the least affected the bones of the pelvis. One would even think, that Nature had indemnified them in that particular, for her irregularities in other respects. I have no reason, from my own practice, but to think them, in proportion to their number, blessed with easier deliveries than the very best shaped, who have sometimes such dif- ficult labors, notwithstanding the most ex- cellent outward conformation: nor do I con- ceive those diffcult labors of theirs to be owing to any bad conformation of the pelvis, or at least infinitely less often than to that obliquity of the uterus, which I have so tru- ly stated in that work so abused by the Re- viewed. I own then, that without the least pretention to more anatomy than is compe- tent to my profession, I look on that ingeni- ous argument, in the Reviewer, of bones softened by a rickety disorder, and necessa- rily giving way or suffering distortion by a super-incumbent pressure, to be absolutely void of foundation, and to be even as false in [8] in theory, as I have ever found it in practice. For the truth however of this, I appeal with due submission to surgeons, not men-mid- wives. My critic states the case of a child’s head being more than five inches diameter, and the distance between the jetting in of the os sacrum and the bones of the pubis to be but two inches: upon which he asks how can five pass through two. I reply to this, that knowing very well, that the disproportion of the head to the passage, is sometimes a- mazingly great, though scarce ever so great as that, I have already answered the objection founded thereon. I repeat my answer here, that Nature, or in other words, the Divine Providence, has so ordered it, that the child’s head moulds itself to this narrow- ness, by the parietal bones sliding the one o- ver the other, and thus their heads come into the world somewhat of a conic form; espe- cially the first-born. But where a few lines afterwards he ob- jects another difficulty of a middle-sized child, where the distance between the os sacrum and the os pubis is but an inch; in which he also asks what I would do; I candidly an- swer, in the first place, that I do not believe the [9] the possibility of such a case, or believe at least that it is one of those so monstrous, so prodigious rare ones, as that it would be the falsest of all reasoning to draw any practical inference therefrom. Till I then see such a case, as that of only one inch distance be- tween the os sacrum and the os pubis, I humbly beg leave to rank it among those sil- ly bug-bears, with which the men-midwives frighen the ignorant into the admission of their being necessary: and I dare say, they might as justly ask of me what I would do, if I met with my grandmother’s ghost, as what I would do if I met with such a case. But, at the worst, I would undertake, even in such a case, supposing its existence, for argument-sake, to do what was to be done as well with my long, sensitive, shrewd taper fingers, as they would do with their blessed crotchet, or forceps. And here I just transi- ently reply to the critic’s charge of my not knowing the difference between those in- struments. For the truth of this charge I appeal to the work itself; with this further animadversion, that my doctrine for the utter rejection of instruments in general is certainly C no [10] no proof that I do not know them perfectly well. But to return to our facetious critic. “We apprehend (says he) this learned mid- “wife has forgot herself in the following “paragraph. “As to the preternatural delivery, the better “practice is not to delay the extraction of the “fœtus, after the discharge of the waters, nor “stay till her strength shall be exhausted, on the “presenting a fair hold, and a sufficient over- “ture, no difficulty should be made of extracting; “but suppose (continues the critic) a fair “hold does not present, what is then to “be done? Truly, Mrs. Nihell, we cannot “see through what overture you will deliver “yourself from this dilemma, unless you “have recourse to the man-midwife’s bag “of hardware.” Heavens forbid! the remedy would be worse than the disease. But what a strange ignorance does such an objection betray! all who have but a competent knowledge of the art of midwifery will acknowledge, that if a child does not present in the natural manner, whatever posture besides it presents itself in, it must be extracted footling, as soon as the waters [11] waters are discharged, and on a sufficient dilatation of the os internum. In these cases, as in truth in all others, the crotchets or forceps are absolutely execrable practice. The manual method I propose will, with incom- parably more safety and case, bid fair to pre- serve the lives of mother and child: and in- deed, in these preternatural labors, the mo- ther suffers, generally speaking, less then when the child comes by the head. The midwife it is that has the most fatigue. I know Dr. Smellie’s method leads more to the extremity pleaded by him and his resemblers, in apology for severing heads, and pulling off arms. But if instead of rejecting, or at least not resorting so often as he should to this foot- ling extraction, he had adopted my method, he might, in the course of his practice, have had perhaps to reproach himself with fewer sacrifices of mothers and children to his learn- ed errors. As to the case of a monster of two heads, I have already answered it, in my treatise: to which I add the following inforcement. I admit, that in twenty millions of persons, once in fifty years, such a birth as that of a child with two heads, may, by great chance, C2 happen. [12] happen. But what then? is the existence of barely such a possibility to be offered as a reason, for its being necessary to incou- rage a set of men, whose practice palpably tends, in such a given number as that of twenty millions, to destroy mothers and children by thousands? but further, though I have proved, that a woman big with such a monster, might and was delivered by a midwife, without recourse to a man, with safety to her life, yet I wave that example; I candidly confess, that such a delivery is not what is called womans work; but then neither is it more a man-midwife’s, unless he should be also a surgeon of such consummate skill, as I believe is rarely met with in the com- mon run of men-midwives. But as to the hydrocephalous head objected to me with such an air of defiance; how shall I answer it? Why, by facts, undenia- ble facts. I dare affirm, that I have myself delivered numbers without needing any re- course to men-midwives, or to instruments, It is not above four years ago that I delivered Mrs. Compagnon, a tradesman’s wife in Brownlow-street, within two doors of the lying in hospital, whose child was one of the lustiest [13] lustiest I ever saw, and the greatest hydro- cephale. It had been before I delivered her dead, at least a month before, from a porter having unmercifully pushed her against a post, as she was going along. As soon as the head came out of the os externum, it ex- tended as large as a calf’s liver, without soli- dity or consistence, to the astonishment of the by-standers. I then got it out intire by the shoulders, but quite putrified. In the month of February last I delivered a poor woman, a soldier’s wife, over against where I live, by name Knowles, of such a- nother hydrocephalous child, without dis- membering it, or without any laceration or damage to the mother. These childern are commonly so macerated in the waters, so soft, so flexible, that they easily yeild to the contraction of the hypogastric muscles in the expulsive efforts. And here, for my having quoted these two examples, among many others I could produce from my own practice, I gladly throw myself on the reader’s candor for his distinguishing, upon his considering the pro- vocation, between the designingness of quack- ery in self-recommendation, and the obvious necessity [14] necessity of self-defence, where so cruelly and so dis-ingenuously attacked. Among other instances of the Reviewer’s disingenuity of treatment, the following one is not perhaps the least. It is where he im- putes a point of erroneous doctrine to me, in prescribing in case of considerable loss of blood after delivery, followed with faintings and oppressions, that the patient should be stirred, excited to cough and sneeze, contri- butively to the evacuation of the blood, which otherwise is apt to clot in the uterus, and would suffocate her if not expelled. Upon which a reference to the book itself, p. 264. will plainly show, that I speak there not of all hemorrhages indistinctly, in which I would be so far from tormenting or endangering the patient by excitals, that I would rather re- commend quiet with sub-astringent draughts, that should strengthen without heating: but there I speak purely and solely of those he- morrhages, which form clots of blood in the uterus, and sometimes the vagina, which ob- struct them in such a manner, that the circu- lation being stopped, the woman loses all sense, faints and dies, if on failure of those gently encouraged pre-excitals, she is not instantly [15] instantly disembarassed from the clotted blood, which is then become an extraneous body. This is done by introducing the hand (is this a man's handy-work?) and clearing this bowel or uterus of all its incumbrance. The patient immediately comes to herself again, without having so much as felt the operation of the hand. It is these concretions of blood that are commonly called, bleeding inwardly. Numbers of women lose their life in these cases if not instantly relieved. Yet is this accident much neglected, and even little understood by many men-practi- tioners, and even by some midwives. Thence those deaths imputed to OCCULT CAUSES, as may be seen, p. 128 and 265 of my book. The Reviewer makes a great crime to me, of having substituted a word of a new coin- age pudendist to the term of accoucheur. I hope however it will be some mitigation of the violent offence given him in it, that it was taken from a word often and certainly always innocently repeated by Dr. Smellie. He may find not only pudendi (with the word labia that governs it) occasionally used, and to which I have only added the two innocent let- ters, s and t, but the occupation of a pudendist in [16] in curing the maladies incident to the pudenda, in more cases than one: for I presume the maladies of that part are not intirely confin- ed to that against which the washing of the leather-wrappers of the forceps is recom- mended. For example; what does he think of the following quotation from Dr. Smellie, p. 151? “If the skin of the legs and PUDENDA is “excessively stretched, so as to be violently pain- “ed, the patient will be greatly relieved by “PUNCTURING the parts occasionally." Upon which I cannot help observing, that this pretended relief is oftenest attended with worse consequences to those parts, than suf- fering a little temporary uneasiness; since that same puncturing produces much more painful sores, or at least sores of longer con- tinuance afterwards. The best practice, I humbly apprehend, being to leave those se- rosities to the course of Nature, since they infallibly vanish after delivery. The scheme of puncturing the pudenda, however, must be a pretty amusement for a pudendist, whatever is the greater suffering for it afterwards to the deluded woman, that will submit to it. Do [17] Do I then deserve, from this pretended critic, such an insulting reproach of immo- desty, for giving to the he-midwives (so hard as they are driven for a name, that they are forced to run to France for the French one of accoucheur) an appellation which seems to me not to characterise them amiss, and be- longs to them at least as justly, as those of dentist or oculist to those artists respectively, who take under their protection any parti- cular part of the human body? is it my fault, if men will so pitifully mistake their occupations, and voluntarily, for the sake of a dirty lucre, degrade themselves to offices so shameful, that the very properest name of them puts the modesty of our Reviewer to the blush? As for me who have professedly treated of midwifery, I hope no person of any candor will find, that I have offered, or at least meant to offer any offence to decency in the terms I have been forced to employ in the course of my subject. A physician, a sur- geon, an anatomist, may, and ever do, un- impleaded of immodesty, use words that would be liable to objection, on any other footing, than that obvious utility which even D sanctifies [18] sanctifies their use. I presume there will not, in the whole essay, be found one such barbarous attempt upon wit, humor, or common decency, as that contained in the following quotation from the so squeamishly affected critic I am now answering. Crit. Rev. p. 196. “How far Mrs. Ni- “hell’s shreud, supple, sensitive fingers may “be qualified for the art of titillation, we “shall not pretend to investigate; but those “women that are pleased with this operation “before the pains come on, may certainly “chuse their own operator, without affecting “the art of midwifery; we cannot help “thinking, that in this case, the male-prac- “titioner would not be the most disagreea- “ble, unless our author has talents that way “which we cannot conceive.” In which passage I own I cannot well pro- nounce which is the greatest, the modesty of it, or the delicacy of compliment to the women. But as the Reviewer, in more places than this, harps, no doubt with great pleasantry and humor, upon the poor midwife’s “long, “nimble, taper, shreud, sensible, palpating fin- “gers:" by way, I presume, of preferring, highly to them the short, stubbed, clumsy rough [19] rough, callous ones of a he-midwife, I must tell him, there is one use to which I hope a true midwife will, for her own sake, as well as for that of her patient, never put her fin- gers, though the practice of it is recommen- ded by Dr. Smellie, in more parts than one of his work, I mean, the practice of running the fingers up the fundament or anus. For ex- ample, p. 212. He says, “when the head “is therefore drawn back by any of these “obstacles, and the delivery hath been re- “tarded during several pains, one or two fin- “gers being introduced into the Rectum “before the pain goes off, ought to press “upon the forehead of the child at the root “of the nose, great care being taken to avoid “the EYES.” As to taking such care of the eyes I highly commend the caution, but cannot well conceive how such an operation can well be insured against poking them out, considering how the operator must grope darkling. But how such a thought could en- ter into a man’s head I cannot conceive, as thrusting his fingers there, for any beneficial purpose. In the first place, it can be abso- lutely of no service, and may do infinite mis- chief: to say nothing of the torture to which D2 it [20] it must put a woman, especially if she should happen to have, what is very frequently the case in that juncture, the hemorrhoids. In short, I do not conceive that there can be imagined a more nauseous, ridiculous, cruel, absurd management; and if such are the triumphs of the men’s learning over the wo- men’s ignorance, may the women continue their ignorance still of such curious prac- tice! In the mean while the Reviewer accuses me, very unjustly of pecking, as he is pleased to term it, particulary at Dr. Smellie. I solemnly declare, nothing could be further from my intention. He is a gentleman from whom I never have or could receive the least injury. Every thing that I have mentioned relative to him, even to clumsiness of fin- gers, which I rather suppose, on his being a man, than imagine particular to him, has been intirely on the account of my objecti- ons, to the practice of the art of midwifery by men, and no-wife out of any particular personality against himself. I could even ask his pardon for any such cause of offence, so abhorrent from my way of thinking, if I had been betrayed into it by the heat of op- position. [21] position. But I hope I have not so much as incurred the least danger of blame on that account. I have not once, like the Review- er, stated any doubt about the book that goes under his name being of his own writ- ing or not. It would have been, perhaps, less a shame in me, who am purely by pro- fession a midwife and no author, to avail myself of the assistence of my friends, in the composition of my work, than in the learned Dr. Smellie; but certainly, even with his borrowing such help, neither the Public nor I have any concern. It is with his doctrine, and points of practice, that I have only a right to meddle. Neither do I attack his stile or his manner of composition: on the contrary, if my opinion was worth offering, I should candidly give it highly in favor of both language and method. I sin- cerely think the workmanship is infinitely too good for such vile matter. I do not ei- ther rake together a parcel of words, by way of exposing them for hard words, which for what appears to the contrary in the Review, may, where properly connected and employ- ed, afford not the least idea of that pedantry they do, when industriously assembled toge- ther [22] ther out of above five hundred pages through which they were innocently scattered. I have not chicaned Dr. Smellie on the tech- nical terms he has used. Some of them per- haps as harsh, as novel, as affected, and as uncouth, as those he has been pleased to ob- ject to in me. I repeat those unfortunate words of mine here, torturous, palpation, sexu- al parts, conceptacle, promptership, cherishment, transitoriness, instinctive repugnance, instru- mentarian, occlusion, shreudness of fingers, re- voltingness, deflexions of the uterus, aberration from the right line, detortion, divarication, the head retrograding into the pelvis, premature ab- lactation, effemination, &c. Now, if it appears that any of these words are ridiculously or affectedly used, I am far from defending them: all I shall say is, that the quotation of them in that accumulative unconnected manner does not at least sup- port that charge: and for my own part, I have so bad a taste, as to think the single word of accoucheur big with more ridicule and absurdity than all of them put together. Opinions being free, the Reviewer is ex- tremely welcome to treat this with as much contempt as he pleases. But [23] But can any thing be more cruelly unfair, than the quotation he has so gravely given, of my answer to Dr. Smellie’s bringing in Plato by the head and shoulders, as if I had lain any further stress on it, than just as it came in my way to take notice of the Dr’s abuse of the definition of the uterus from that celebrated antient? would not any one believe, that I had rested the issue of the cause upon a point only transiently intro- duced, and confessed to be unaccountable? a reference to the passage itself, as it stands connected in the book, not unfairly detach- ed, as it is given in the Reviewer’s extract of it, would, most probably, be exempt from ridicule, even from those to whom no occasion for ridicule hardly can come amiss. The Reviewer is pleased, from his own imagination, to accuse me of treating the men-practitioners as a band of ruffians. I have made use of no such term; but that I may not be suspected of prevarication, I ac- knowledge the having put the equivalent of that appellation into my charge against them of innumerable Murthers in the DARK, proved against them, by themselves. And [24] And certainly of a piece with all the un- fairness of that detraction, employed to pre- judice the public against a work purely calculated for the public’s own discovery of a truth too much concealed from it, is that suppression of the justest and greatest apo- logy for any harshness in my suggestions a- gainst the men-midwives, in that the very worst of those suggestions are taken and quoted chapter and verse from the men- midwives themselves. I repeat here my solemn defiance to their advocates, to point out one passage in my whole book, so full of severe, though just accusations, as are contained in my quotation from Daventer, a man-midwife, p. 463, of my treatise.—Since whence then is it unpardonable for a midwife to say less ill of the men-practitioners than what they say of one another? or was it fair, in giving the public what the public has a right to expect should be an impartial account of a book received, to suppress so material a circumstance in favour of a work condemn- ed by the Reviewer for abusiveness? The Critical Reviewer arraigns me of ig- norance, for saying that instruments are un- necessary. I have done more than denied it. If [25] If justice was as dear to him, as the error he has taken under his protection, he would confess, that I have unrefutably proved it. The sacred truth is, that is I am culpable, it is rather for not saying half the horrors that I know or firmly believe of that exe- crable practice with them, which, I repeat here, what I have said in that work, the men-midwives do not the less use for their pretending to condemn them. To say no- thing of the mothers and children murdered by them, there are living monuments of the rage of the men-practitioners in using that wretched forceps, on which they value them- selves so much: persons of both sexes, who will carry to their graves such indelible marks of the crush of the forceps, as would never have taken place, but for the pragma- tical outrages to Nature, in the attempt to precipitate her work. It is not then out of obstinacy, nor from the false shame of owning an error, but purely from my better knowledge of expe- rimental practice, that I venture to treat with the contempt I unaffectedly do that ignorant attack of the Reviewer’s on my method of manual operation, in the redress of the uterus, E from [26] from the circumstance of a wrong direction. Upon which I beg leave to observe, FIRST, that in my practice, I take great previous care not to suffer the uterus ever to ingage itself, in a dangerous or scarce retrie- vable manner. The pains I take, which he turns into ridicule, for want of understanding either the nature or the drift of them, in watch- ing and reducing the opposition of the uterus, not with my legs, nor with the tip of my ear he may be sure, but with my hands, or the fingers of my hands, are the very pains that prevent this ingaging or intangling of the uterus, that is to say, when the internal ori- fice is either wholly, or too much in part so ill-situate, as not to leave outlet enough for the child. This is that obliquity of the uterus, of which neither Dr. Smellie, nor the Reviewer seem to have any notion, or at least any adequate one; and surely that wo- man can little expect, that the man who does not so much as know or admit the obli- quity of the uterus, so as to regulate the ma- nual operation by it, must be very little capa- ble of preventing those extremities, which are his plea for his resorting to that bag of hardware the Reviewer would condemn me to [27] to apply to, who always take care that it shall not be wanted. And SECONDLY, that even in the worst cases, when the mis-practice, negligence, and ignorance of the men-midwives have occa- sioned those severe dilemmas, in which the Reviewer supposes I could not do without recourse to men or instruments, I not only tell him here, but am ready to demonstrate before any assembly of physicians or surgeons, that there is more chance for saving the life both of mother and child, by gentle me- thods, by the management with the hand in aid of Nature, than by resorting to the violence of those murderous instruments. But as I have at large explained myself in my treatise, upon this head of severe labors, it would be superfluous to enter into repeti- tion here. As to the Reviewer’s want of conception how the child can get ingaged too much, where he says, “engage itself, where? in the “uterus, where it is already, or in the passage “where it ought to be.” Which he is much at liberty to treat as nonsense, since that nonsense is perfectly of his own making: I shall only observe, for the satisfaction of E2 those [28] those unversed in the art of midwifery, in- cluding the Reviewer, and without except- ing Dr. Smellie, that by the child’s getting ingaged, I mean that situation of it, when, while still in the uterus, its passage out is blocked up by its own weight, bearing down the uterus under the os pubis, so as that the inward orifice does not present in a due line with the external one, but is either totally hid, or presents only an insufficient segment of the circle of the orifice. A case always difficult, but which oftenest might have been prevented in due time by the midwife’s pro- per care and unremitting attention. Where- as the men-midwives, in such cases, either resort to the utmost extremities, killing ei- ther the mother, the child, or both; or if the overture admits of a dilatation, do such dreadful violence to that part with instru- ments, that if even the woman’s life or her child’s is saved, it is never without great da- mage to both. Callosities are at best not unseldom the consequence of this practice, which at least cause difficult labors in future. Sometimes the procidentia uteri, or relaxation of the vagina, are the effects of the men- practitioner’s management in this case. But [29] But let any husband, who values the life of his wife and child; let any woman, who values her own life, and that of her infant, stop an instant here, and reflect on the con- sequences of being misled by one, I mean, Dr. Smellie, who scarcely seems to know the existence of such a case as the obliquity of the uterus; or by the Reviewer, who not denying it, is not ashamed of flying in the face of common-sense in his assertion, that the supposing the uterus to be so apt to return to its obliquity, is ridiculous and unnecessary. Whereas nothing is more true, nor more likely to be true, that at least nine in ten of the severe labors are specifically owing to this very obliquity, and that there is not one of those cases of obliquity, but what requires more or less of that attention and care to reduce and fix it, which are called ridiculous and unnecessary, though the two lives of mo- ther and child so often depend on it. But why is so obvious a point of manual operation suppressed, denied, or exploded? The rea- son is as obvious for its being suppressed, denied, or exploded. It is not man's work: though the neglect of it will surely cut out what is commonly understood by man's work; deli- [30] delivering with instruments, or, in other words importing the same effect, murdering or maiming. It would be here superfluously tedious to proceed animadverting upon all the absurdities and false criticisms of the Reviewer on this article, having noted what I take to be the principal ones, so that any silence of mine on the rest, being really occasioned by contempt, will not, I hope, be mistaken for any ac- quiescence in what I think either beneath refutation; or out of respect to my readers, not to need refutation; for after all, railing can never be supposed to pass for reasoning. However, I will give the Critical Reviewer this satisfaction: I assure him of my sincere- ly believing, that the cause of which he makes himself an advocate will triumph over the right of mine. His clients have got a foot- ing, which they are too powerful and too interested not to maintain. By getting in- to the secrets, and into the most intimate confidence of so many families, their ascen- dant seems too rivetted for Truth and Rea- son, with their cold and timid friends, to overcome, in an age, when almost universal indolence seems to exclude the examination, of [31] of points of the utmost importance to be examined, and therefore the most neglected. The men-midwives, in short, seems to be a kind of formidable phalanx of mercenaries, with influence enough to brave all endea- vours to establish the renounced laws of even Nature herself, where they clash with their interest. By dint of inculcating the falsest fears they have accomplished their great point of admission from society, that groans under an oppression, of which it cannot but see and feel the horrid ridicule, and yet wants spirit and resolution enough to shake it off. In the mean time, the men who like their wives to be lain by the he-midwives, and the women who chuse that he-midwives should lay them, especially as their superior art of titillation is so well vouched by their advocate, will certainly not ask my leave nor probably take my advice about it, while, on my part, my worst wish to them is that, in consequence of such a choice, they may never meet with reason to repent it! But as the impartial author of the Critical Review has been so candidly pleased to re- present that work of mine as a pitiful pro- duction, without method, or knowledge of my [32] my subject, a mere abusive libel on the gen- tlemen-midwives, a piece of absurdity, des- titute of common-sense, a mixture, in short of malice and presumption, I hope none will impute it to me as an author’s vanity, if in my endeavour to cancel impressions so unfairly attempted to be given, I present the reader here with a succinct analysis of a book, which has been happy enough to deserve the wrath of that candid critic. I have therein stated the several objections on behalf of the men-midwives, of which the following is the summary. That the men it is who were the first in possession of the art of midwifery, because they were the inventors of all arts: That the nobility of this art intitles them to the preference in it: That the works which the men have composed on this subject demonstrate the antiquity of their making a profession of it: That all the manual operations are man's work: The [33] That anatomy is absolutely requisite in this art, and that instruments can only be used by men: That it is only the ignorant who exclaim against instruments: That it is in women a great presumption to enter into competition with the men in this profession: That it is a truth now universally well- known, that there is more safety in the ly- ings-in being managed by the men than by the women: That the women are ignorance itself in- carnate: That the men who apply themselves to one branch are the best artists, as the den- tists, the oculists, &c. That the men-midwives accomplish the most difficult deliveries: That Fashion and custom have at length decided the point clearly in favor of the men: That, in short, it can only be a false modes- ty, that opposes the women submitting to be lain by men-midwives. F To [34] To these objections I have endeavoured to oppose and establish the following reflex- ions: That the women have a prior title to the office of a midwife, as may be demonstra- ted from the most antient and most authentic annals of the world: That if this profession appears, at present, so noble an one to the men, the greater is the honor to the women, from whom they have learned all the best that they know of it: That the books in which they have treat- ed of it go no higher than Hippocrates, granting that those books upon midwifery are his, for they are certainly unworthy of a man so great in other points; but that the women exercised this art thousands of years before him: That the manual operation of the men- midwives being by no means necessary, while all that can ever be wanted may be better done without them; this objection falls to the ground of itself. That anatomical knowledge is not requi- site, at most, beyond a certain moderate de- gree, [35] gree, for the practice of midwifery; the midwives having, ever since the first ages of the world, done very well with that small competency of knowledge of the female body to which they pretend; their business not being to diffect women, but to lay them; an operation which commonly does not need more than a dextrous expert hand, and a very small insight into anatomy; that besides, several women have written with great prac- tical propriety on this subject, such as Cleo- patra Queen of Egypt, Aspasia, and others, among the antients; among the moderns, Justine, midwife to the Electress of Brande- bourg; and many more of the female pro- fessors of that art, from the Hôtel-Dieu at Paris:* That the instruments invented by the gen- tlemen-midwives are in truth fit to be used by none but themselves, whose hands, callous * This is that Hôtel-Dieu, which Boerhave’s Com- mentator. La Motte a man-midwife himself, and all au- thors in general who mention it, do the justice of allow- ing to be the best school of midwifery in all Europe. But alas! what are such paultry authorities to that of the critic of this work, who calls it "the most dirty, slovenly, "inconvenient, indecent, shocking, receptacle for the sick in "all Europe?" F2 with [36] with handling them, are barely more tender, and whose hearts can only dispute hardness with them; that Nature herself shudders at the idea of those barbarous implements, and that it must only be an inconceivable blind- ness, which without the least necessity, can suffer such a number of innocent victims to be sacrificed to the experiments made with them. That ignorance must conspire with the most iniquitous keenness for fees to forge the necessity of those murderous instruments, since experience demonstrates, not only such a rarity of extraordinary cases, as might very well dispense from a body of men be- ing kept up armed with those instruments of pretended aid, but that even in those extra- ordinary cases, the midwives have accom- plished the most difficult deliveries without the help of them, as I have proved it by ex- amples of my own knowledge, and from what others may, on any the least inquiry, find to be true, of the practice by women only at the Hôtel-Dieu at Paris: That in women it is certainly no presump- tion to undertake the disputing excellence with men in this profession; that on the contrary, [37] contrary, it is great rashness as well as great meanness of spirit, in men, so disqualified as they are by Nature for it, to incroach on a purely female function, and for want of natural requisites, to introduce supplemental- ly their inhuman and murderous instruments; that in women, in short, this art is manifest- ly the vocation of Nature; in men, as mani- festly the instigation of Interest. That it is a most impudent falsity to aver, that the greater safety for the women is on the side of the men-practitioners; for that, in any given number of women lain by those of their own sex, and of those lain by men, reason, nature and experience all concur to give the preference to the women in point of safety; the murders of mothers and children being necessarily and infinitely oftener the consequence of employing men and instru- ments, than in trusting even to the most ig- norant of the women, which ought also to be avoided: That the pretended ignorance of the wo- men-professors, speaking of such in general, is a pitiful pretext and a ridiculous accusati- on, since daily and common experience shows, that [38] that they know enough to do their business competently and artistly, while the preten- ded knowledge and boasted improvements of the men-midwives have made no further progress in that art, unless the killing and massacring an infinite number of women and children, by their auckwardness, and espe- cially by their diabolical invention of their instruments, may be termed a progress: That nothing can be worse supported than that superiority which the men-midwives pretend to derive from their addicting them- selves solely and particularly to the study of the art of midwifery, since that superiority can have no relation but to their superior skill in handling instruments, forever dange- rous, and forever useless; what there is ever required of surgeon’s work being better trust- ed to compleat surgeons, than to a common man-midwife, who now-a-day is not con- tent with giving himself out for a man-mid- wife only, which by the by he never can be, but he must be surgeon and phisician with all, and by pretending to so much, is rarely above a dangerous smattering in any of those branches. That [39] That the argument drawn from the pre- valence of the fashion proves nothing, more than that the public often suffers itself to be imposed upon by the most flagrant quackeries and pretences, and that it may, for a time, yeild to the contagious torrent of prejudice and example. Notwithstanding which, the modesty of the English women, still keeps numbers of them from making use of men to conduct their lyings-in, while in almost all the other parts of the world, the employ- ing of women in exclusion of the men still prevails, most undoubtedly not to the detri- ment of population: That even among the women who em- ploy the gentlemen-midwives, there are ma- ny, who, not without the justest and the sensiblest repugnance, employ them in com- pliance with husbands, fathers, or relations, weak enough to sacrifice their honor to the most indecent and the most pernicious of all fashions: That the scandalous touchings of men, who can scarce be thought proof against sensuali- ty, their frequent or superfluous inspections, their secret and repeated examinations, the reciprocal attraction of the two sexes, the temptations so likely to occur in the course of [40] of such practical interviews, prove at least a great easiness and faith in a husband, silly enough to let himself be carried away by this torrent of prejudice. Thus Modesty, with- out incurring the charge of being false, and much less of being foolish, may very well murmur at such privacies and approaches in any other man than a husband, especially to no purpose but that of increasing pain and danger, which they are so impudently pleaded to be designed to lessen; while, in short, the insult offered to the persons of the women, in the immodesty to which they are subject- ed by the practice of men-midwives, can only be matched by the insult offered to their understanding, in the pretence of service of assistence to them. These reflexions compose the first part of my book. I employ the second in mak- ing observations on the labor and delivery of women, and in putting every candid inqui- rer into a way of satisfying himself, by the clearest matters of fact, and inferences there- from, of the uselessness and danger of in- struments in lyings-in, in proving, in short, that they are only made use of as stales and blinds by designing men to countenance their intrusion [41] intrusion into a business so little made for them, no matter how much humankind suf- fers by the murderous consequences of their miserable pretence and imposition. I have set forth all the rare and difficult cases in which those same instruments are by the men-midwives themselves pretended indis- pensable, and shown how a delivery might be more safely and more happily effectuated without them. I have quoted, from the men-midwives themselves, many murders, with shocking and unheard of circumstances of cruelty, which, to every thinking reader, will appear the unavoidable consequences of using instruments; so that they have not to plead, that those cases were purely accidents imputable to particular practitioners, and not to be drawn into consequence against the practice itself. Such is the work, the advocate for the men-midwives in the character of a Review- er has treated in a manner, for which how- ever I have no right to complain of him; since having left me all that I pretend to, truth and argument unimpeached by any- thing he has brought against me, I can ea- sily forgive him his by me unenvied superi- F ority [42] ority in wit, where I aimed only at reason; and in personal abuse, while I never design- edly transgressed that general raillery, of which the matter I was treating afforded me so ample a field; and which was never le- velled against the writer nor the man, but purely against the man-MIDWIFE, whom there can be no-one that considers the object, but must allow to be fair game. FINIS.