: ~9$ 4 "r- * "*-->i.' V,r7T% .* V .'-4 ' i . C". %ffif.&>-%\,.':.ifrfc\ '±£.1*. m.» I L NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service I' '"■' % AK SHTRODUCTIOtf TO THE PRACTICE OB MIDWIFERY. BY THOMAS DENMAN, M. D. tlCENTIATE IN MIDWIFERY OF THE COLLEGE OF PHYSICIANS, AND HONORARY MEMBER OF THE ROYAL MEDICAL, SOCIETY AT EDINGBURGH. BRATTLEBOROUGH, (Vt.) PUBLISHED BY WILLIAM FESSENt)£N, AND SOXiD BY HIM AT THE BRATTLEBOROUGH BOOKSTOR1 1837. ■■■■' •» *■ ■ ■■ 'I*" ■ ' l» H HI— ■ -ff-* CONTENTS. Preface - CHAPTER I. ON THE PELVIS. Sect. I. On the bones of the pelvis - ~ 1 II. On the connexions of the bones of the pelvis 5 III. On the feparation of the bones of the pelvis & IV. On the reunion of the bones of the pelvis 13 V. On the pofition and ftrudture of the pelvis 14* VI. On the formation of matter between the loof- ened bones of the pelvis ir VII. On the form and dimenfions of the pelvis 18 VIII. On the dimenfions and ftructure of the head of the foetus - 19 IX. On the application of mechanical principles to midwifery 20 X. On diftortion of the pelvis 22 CHAP. II. ON THE EXTERNAL PARTS OF GENERATION. Sect. I. Defcription of the external parts 15 II. On tumours and excrefences of the external parts 26 III. On edamatofe fwellings of the external parts 27 IV. On the cohefion of the labia ib. V. On abfcefTes of the labia 28 VI. On laceration of the perinseum 29 VII. On a peculiar laceration of the perinseum. SI VIII. On the enlargement of the clitoris 32 IX. On the difeafes of the bladder and urethra iK X. On the pruritus or itching of the external parts ofgeneration 33 XL On the hymen 34 CHAP. III. ON THE INTERNAL PARTS OF GENERATION. Sect. I. Defcription of the internal parts ► 36 II. On the contraction of the vagina * - 41 IIL On the cohefion of the vagina - 42 IV. On the cicatrices of the vagina - - ib. V. On polypi - - 43 VI. On fluor albus - -51 VII. On prolapfus uteri *• 52 H COKTNTS; Sect. Page: VIII. On hydatids of the uterus - - 56 IX. On the dropfy of the uterus • - ib. X. On the tympany of the uterus - - 57 XI. Of moles' - ~ - 58 All. On the dropfy of the ovaries - - 59 XII. On inflammatory fcirrhus, and cancer of the ovaries G4 CHAP. IV. ON THE PARTS CONTAINED IN THE CAVITY OV THE PELVIS. Sect. I. On the retroverted uterus - 66 II. On the retroflected uterus - ~ 73 III. On the dropfy of the perinceum - ib. IV. On the clytroceley - 76 CHAP. V. ON MENSTRUATION. On the menftrual difeharge. - - ib. On the efficient caufes of menflruation 80 On the final caufes of menftruation - i:'J Qn the formation of a deciduous membrane 84* Oa obtlruction of the menies - - 85 On excefiive menftruation 88 On painful menftruation 89 On Live treatment which may be proper at the time of the final ceffation of the nienfes 90 CHAP. VI. ON CONCEPTION. T. I. On the different theories of conception 94 II. On the growth of minerals, vegetables, and an- imals - 97 in. On the ova of animals 101 IV. On the difference of the ftruclure of the uterus in different animals 102 V . Or. the iiiit ftage of conception 103 VI. On the formation and fauclure of the fcetus 105 VII. On the funis umbilicalis 108 VIII. On the placenta 109 IX. On the membranes 111 X. On th^ liquor amnii 112 XI. On the changes which the uterus undergoes in confequence of impregnation 114 IL III. IV. V. VI. VII. VIIL Contents. v t?HAP. VII. ON THE SIGNS OF CONCEPTION, AND THE DISEASES OF PREGNANCY. Sect. I. On the figns of conception 118 II. Oa quickening - - 122 III. On the iuppreffion of the menfes during preg- nancy V.IS IV. On the febrile difpofition attending pregnancy 124 V. On the ufe and abuie of exercife during preg- nancy - 125 VI. On vomiting - 126 VII. On indigeirion, and depravity or lofs of appe- tite. - l?S VIII. On heartburn 129 IX. On coftivenefs - 130 X. On collections of indurated feces in the intef- tines - 131 XL On the hemorrhoids 132 XII. On blotches of the fkin and jaundice 1I?3 XIII. On tenefmus, diarrhoea, and dyfenteric com- plaints ... ib. XIV. On the ftrangury and incontinence of urine 134 XV. On fiuor aibus 135 XVI. On erratic pains, cramp, and numbnefs of the inferior extremities ib. XVII. On varices of the legs, thighs, and abdomen 1SG XVIII. On inquietude and want of fleep ib. XIX. On the iblicitude and anxiety attending a ftate of pregnancy 137 XX. On headachs, drowfinefb, vertiginous complaints, and hemiphlegia 133 XXI. On anafarcous fvvellings of the inferior extremi- ties - 189 XXII. On afcites - tb. XXIII. On partial detention of the abdomen, and um- bilical hernise 140 XXIV. On the excellively diftended and pendulous ab- domen - ib. XXV. On the venereal difeafe 141 XXVI. On the fmall- pox.—General remarks on difeafes occurring during pregnancy 143 CHAP. VIII. ON UTERO-GESTATION. Sect. L On the fituationof the foetus in utero - 144 II. On the term of utero geftation - - 145 CONTENTS* III. On the caufes of labour - - 148 IV. On the predifpofing figns of labour - 150 V. On examination - - 1^2 CHAP. IX. ON LABOUR. Sect. I. Claflification of labours - - 155 II. On natural labour - - 156 III. On the fymptoms accompanying labour - 157 IV. On falfe pains - - - 163 V. Cautions again ft endeavoviring to promote the power and effects of pain - - 164 VI. Firft ftage of labour - ^G5 VII. Second itage of labour - - 169 VIIL Third ftage of labour - - 170 IX. On tying and cutting the navel firing - 177 X. On the exclufion of the plsecenta - 180 CHAP. X. ON DIFFICULT LABOURS. I. General reflections - - - 182 II. Equivocal ngns of difficult labours - 191 III. On the definition and diftinction of difficult labours - - 192 IV. On the firft order of difficult labours, - 194 V. On the fecond order of difficult labours 207 VI. On the third order of difficult labours 213 VII. On the fourth order of difficult labours 220 VIIL General obfervations on difficult labours 230 CHAP. XL Sect. I. On the fillet, forceps and vectis - 233 IT. On fillets - - - 236 JIL On the forceps - - - 237 IV. General obfervations on the ufe of in- itruments - - 240 V. On the application of the forceps - 243 VI. On the action with the forceps when ap- plied - - 244 VII. On the application of the forceps under btcr. various circumftances 247 VIIL On the vectis - 218 IX. On the different kinds of vec'Js 250 X. On the coaip.riiou oi the vectis with the forceps - - - 252 XI. Oi the manner of ufing the vectis CHAP. XII. 255 I. On leaning the head of the child 25T CONTENTS. viS II. On the figns of a dead child - - 260 III. On the caufes of the death of the child 266 IV, On the inftruments ufecl in the operation 26V V. On the manner of performing the operation 26S VI. On the perforation of the head - 269 VII. On the evacuation of the contents of the head.....270 VIII. On the extraction of the head - 271 IX. On the fubfequent treatment - - 275 X. On the propriety of bringing on prema- ture labour - 276 XL On the fection of the fymphyfis of the ofFa pubis - - ' 280 CHAP. XIII. Sect. I. On the Cefarean operation - - 283 II. On the general reafon for performing the oper- ation - 285 III. On the fuppofed reafons for performing the op- eration - ib. IV. On the actual reafons for performing the oper- ation ... - 287 V. On the caufes of death after the operation 290 VI. On the manner of performing the operation 29 i CHAP. XIV. Sect. I. On the diftinctions of preternatural labours 293 II. On the figns of preternatural prefentations 295 III. On the firft order of preternatural labours - 296 IV. On the diftinctions of the fecond order of pre- ternatural labours- - - - 301 V. On the firft diftinaion - 303 VI. On the fecond diftinaion * - 305 VII. On the third diftinaion - - - 307 VIIL On the evolution of the child" - - 311 IX. On the diftortion of the pelvis - - 315 X. On the feparation of the head - 318 CHAP. XV. COMPLEX LABOURS. Sect. I. On abortion, and labours attended with he- hemorrhage - - 320 II. On the frequency of abortion in women - 322 III. On the treatment of abortion - - 325 IV. On the fymptoms preceding and accompanying abortion - ^-■° •Viii CONTENTS. V. On liffiucrrhsse in the three laft months of pregnancy - - 33^ VI. On hemorrhages m which the placenta was attached over the os uteri - - 33S VII. On hemorrhages occafioned by the feparation of the placenta attached to any part of the uterus - - - 340 VIIL 0:i hemorrhages which come on after the birth of the child - - 342 IX. On the exclufion of the placenta - - 346 X. On the extraaion of the placenta - - 3.:0 XL On hemorrhages which follow the exclufion of the placenta - - 355 XII. On the inverfion of the uterus - - 360 CHAP. XVI. LABOURS ATTENDED WITH CONVULSIONS. Sect. I. General obfervations on labours attended with convolfioiis. - - 363 IT. On the reputed caufes of convulfions - 365 III. On the figns which precede convulfions - 369 IV. On the means of preventing convuUions - 370 V. On the treatment of convulfions - 372 VI. On the delivery by art - 375 CHAP. XVIL LABOURS WITH TWO OR MORE CHILDREN. Sect. I. General obfervations - - 379 II. On the figns of twins - - 381 III. On the management of twin cafe.? - 383 VI. On the management of the placentae - 386 CHAP. XVIII. LABOURS IN WHICH THERE IS A DESCENT OF THE FUNIS UMBILICALIS BEFORE ANY PART OF THE CHILD. Sect. I. General obfervations - - -387 II. On the defcenf of the funis when the os uteri is but little dilated - _ 389 III. When the os uteri is fully dilated » - ib. IV. Farther obfervations - _ 391 V. On monfters - „ ..~ f?92 VI. On the extrauterine foetus - „ 393 CHAP. XIX. Sect. I.' On the management of women in childbed 39S II. On mania ,.--.. 430 Hi. On the fwelled legs « - 434, fag*;, .fa...-^,,^....-^,, ......-...» i . ,.,_..„ (r». . ;,> . ■»..a...»-ili) ,. ,ag^ £ £ £ FA C & ■ BEFO&E the flrfl: appearance of thefe papers in two vohirhe^ji the greater part of them had been feparately printed, and of many of them there had been more than one impreffion. By this mode of publication I had an opportunity of /Correaing many errors, though, with all that I have been able to do for the amendment of the work in general, I am yet very fenfible of its deficiencies and imperfeaions. But the reader will difcover, that pains have been taken to render it lefs unworthy of his regard ; and the hope of being ufeful to thofe who are engaged in ftudies of this kind, has converted the trouble into pleafure. Very much ftill remains to be done for the perfeaion of this branch of the profeffion, not by the fpeculative and prefuming, who are ever rnifleading usj but by men of induftrious attention and refearch, capable of re- ducing into order the obfervations they will have many opportu- nities of making, and of converting them to praaical ufe and ad- Vantage. In medical writings, ftria veracity is above all othef things required ; and to this I have conftantly adhered, to ih£ beft of my knowledge and judgment. Of the medical treatment of the difeafes peculiar" to w-Om£hj and. of the praaice of midwifery in particular, we have no ac- counts from the earlieft writers, but fuch as are Very imperfect* and involved in works, which the life of one man would fcarcely be fufficient to glean ; while after all his labour, though his cu- riofity might be gratified, he probably would not, at this perioct of time, gain for himfclf, or afford to others, much fatisfaaiori* The cultivation of medicine at large, efpecially of that branch ol which we are about to treat, is of a recent date in Our own coun- try. This, to one glance of the eye, exhibits a view of the fteps by which human beings, in a courfe of years, emerge from a ftate of abfolute ignorance and barbarifm, become civilized, arid arrive at eminence in every art and fcience^ In what country medical knowledge was firft cultivated, Sndl reduced into fcientific order, cannot now be traced •, for, beyond a certain period, the records we have are crowded with fable, and being chiefly fupported by conjeaure, are by no mean's en- titled to unreferved confidence. But, long before the eftabllfh- ment of fyftems, there mull have been a time, when means were! Ufed for the cure of difeafes, and the relief of accidents, There,. sl''ft aifo kave beea a time, when the rude but well meaiit e«K :? PREFACE. djeavours of one friend to relieve another in diftrefs, ceafed, and application was made to thofe who were fuppofed to have more information, or greater ikiil. This would properly be the origin of the art. By what fteps or means the Greeks became fooner and better informed in all arts and fciences, than many other nations, we cannot now decide \ whether it depended upon the force of their own native genius, to which fomething muff, be granted,* or whether this knowledge were communicated by fome preceding or neighboring people. But it is probable that the Greeks were inftruaed by the Egyptians ; and thefe, as many contend, by the natives of India ; yet, by whatever means they acquired their information, to the Greeks the diftinguifhed glory is due of having conveyed, in their own language, the rudiments not only of medicine, but of almoft every art and fcience, to all the weftern world. Though the moderns have availed themfelves of every advantage they could obtain by the ftudy of the ancient writers, it may be truly faid, that they have not always been too liberal in their acknowledgments. But of this pofthumous repu- tation Hippocrates has had his full fhare, for his very name feems to have infpired with enthufiafm every fucceeding writer ; as all thofe of whom we have been accuftomed to think with venera- tion, or to fpeak with refpea, have mentioned him with admira- tion, and held him up to our view as an example to be imitated, or as a pattern to be exaaiy copied. Whether we confider hia writings with regard to the ftria morality which they inculcate, the liberal condua which they recommend, the ftrong and ex- tenfive obfervations with which they abound, or the order and method in which thefe are conveyed, it is not poffible to with- hold our efteem.f He had likewife the good fortune of writing in a language which was not only known, but fpoken with cla {Il- eal purity, for a linger time than any other ; for Hippocrates lived near five hundred years before the Chriftian 3era, yet the Grecian -^as the popular language at Conjlantincpley even at the time when this city was taken by Mahomet the fecond, in the fifteenth cen- iury. The Greeks alfo maintained an acknowledged fuperiority in literature and arts, for a long time after their political fovereignity was loft. But if there be any progreffive power in the human mind, if any advantage be obtained in the praaice of medicine by the knowledge of the circulation of the blood, or of an in- finitely more correa anatomy and phyfiology at large; by the Taft difcoveries, improvements, and application of chemiftry 5 by a more copious and move efficacious materia medica : by the * See Stuart's Antiquities of Athens. f See a short but elegant abstract of the medical observations and practise of Bipprccra.tes, win the Hippocrates Contractus of Us. Burnet. PREFACE, & recorded experience of fo many ages -, or by the feveral collateral trts, which medicine calls in to its aid; we may ftiirely be per7 mitted to fay, that Hippocrates ought not to be confidered as the guide of phyficians at the prefent time, or as having in any de- gree limited either the perfeaion or extent of the art, but as an illuftrious fpecimen of ancient medical knowledge and praaice. If this obfervation hold good with refpea to Hippocrates, it will have more force when applied to all his tranfcribers and com- mentaries, many of whom feem to have loft, in their attachment to him, the ufe of their own reafon and judgment •, conftantly praifing learning at the expenfe of knowledge, and rejecting every improvement, which could not be explained or juftified by his writings. To the Greeks we are indebted for the,works of Arif- totle in the time oi Alexander the Great: and it was'the firft ob- jea of the Romans, who fubdued them, to acquire a knowledge of their fciences, and to pofTefs themfelves of examples cf their arts. With information of almoft every other kind, the Greeks are to be confidered as the inftruaors of the Romans in medicine ; and, allowing for fome change in the arrangement,and ftrong in- telligence in his fele&ions, the addition of what he had colleaed from other writers, a few improvements in furgery, and the local application of principles before known, Celfus, who lived at Rome in the early part of the firft century, may be confidered as an in- ftruftive and elegant abridger of the wrkings of ffippocrates. The nourifhing ftate of the Romans was of fhort duration.' In the fourth century the empire was divided into the eaftern and weftern. Rome, which was the capital of the latter, was taken by Odoacer, king of the Heruli, under whofe fubjeaion it remain- ed ; and the Romans ceafed to fpeak the Latin language in the beginning of the feventh century. But neither the conqueft of Romeby Odoacer, that of Alexandria, under the Caliph Omar, nor the permanent fubjeaion of Confcantinople by Mahomet the fecond, in the fifteenth century, extinguifhed that knowledge, and thofe arts, which had been fo long and fo ftrenuouily cultivated and ex* ercifed. From, the deftruaion of the library at Alexandriaf which had many bad and fome good confequences, were produ- ced the fchools of Ahtioch and Haran, or what may be called the Arabian fchools, the principal medical writers of which were Rha-zes, Avicenna, Avenzoar, and Albucajis. The fentiments and manners of no people could be lefs favourable to learning than thofe of the Arabians ; and we accordingly find in every hiftory, that when they fpoiled Alexandria, the intention of their chiefs was to deftroy all kinds of fcience, by burning the magnificent libraries which had been there colleaed ; and every book which elcaped the general havoc, was preferved by the care or partiality cf private men. The writings of the Arabian phyficians weie 2rit tREfACfr. ehiefly, though lmperfe&ly, tranfcribed from the Greeks. Theft, it wili be allowed, are fcarcely ever read ; but they ^re faid to contain little of importance, except that the firft account of the fma)l pox, and of a few other difeafes of lefs confequtnce, was given by the Arabians ; and that Avicenna was the firft who de- scribed the forceps, an instrument contrived for the purpofe of de- livering women in cafes of difficult parturition, preferving at the fame time the life of the chi Id. After the deftruaion of the library at Alexandria, the Greciatt manufcripts, which were preferved, were tranflated into th# Sy- rian, Per/tan, and Indian languages ; and the learned were dif- perfed in different countries. For it appears, that, in the year 767, Almanzur, the founder and Caliph of Bagdat fent for a fkilful and learned phyfician from India -, which I mention, as it feems to explain an observation made by the Raja of Kishenagur, and reported by the learned Mr. Halkedin the preface to his Per/tin Grammar, without any violence to other chronologies. Thus wars and apparent devaftation, became, in the hands of Provi- dence, the means of diffufing learning over many countries, which might otherwife have remained in ignorance. But the firft fchools, from which the weftern part of Europe derived knowledge, were eftablifhed in Italy in the eighth cen- tury ; and the moft famous of thofe, in which the art of medicine was taught, were at Padua } whither all, who aimed at excel- lence, reforted, with the view of purfuing their ftudies, and of qualifying themfelves for praaice. From the contiguity of the two countries, from the frequent wars carried on between France and Italy, or from other caufes, the French had many opportuni- ties of acquiring knowledge. Schools were eftablifhed among them, encouragement was given to learning, many able men arofe, and France, by its more convenient fituation to Britain and the northern nations, fuccecded Italy in literary reputation 5 Paris and Montpellier being the places, to which ftudents in med- icine, as well as other arts, reforted for inftruaion, even down to» the beginning of this century. About fifty years before the birth of Chrijl, Julius Cafor made » defcent from G««/into Britain, a country then but little known, the inhabitants of which were in a very uncivilized ftate ; if we except thofe who lived on the fouthern coaft of the ifland, per- haps not on* degree more enlightened than the Indians, whom their pofterity afterwards difcovcred in America', The Romans continued long enough in Britain, to humble and render more sraaable the ferocious fpirit of the natives, to prepare them for civilization, and to teach fome of thofe arts, by which the evils of their ftate might be lefiened, and a portion of the comforts of ffe acquired. On th« retreat of tht Rtmc.ns frosa the iflan<4 PREFACE. *i£ about the year 4?6, fuch of the natives as, after an impotent op- pofition to their arms, and a rejeaion of their government, had been driven to the diftant parts, poured with irrefiftable fury on thofe who had fubmitted to the dominion of Rome. Thefe called in the Saxons, to ailift and to protea them, about the mid- dle of the fifth century. Subjeaion is ufualiy the lot of thofe who claim or receive political proteaion *, and the Saxons aliumed the government of Britain. Being but little more civilized than thofe they came to defend, they could furnifh few means of im- provement ; and the Danes, in their fubfequent invafions, checked and reduced the fmall advancement, which the Britons had made towards learning,notwithftanding the encouragement afforded by Alfred, about the year 900. The Norman conqueft took place in 1066, and the .change, with all is difadvantages, was produc- tive of fome general good to the nation : but the great profpeft of literary improvement arofe towards the conclufion of the twelfth century, when Richard the Firft undertook his crufade to the Holy Land. It appears, however, that there was not a fingle man in his whole army, who underftood the Grecian or Sy- rian language ; fo that, without any advantage to balance the lofs of his fubjea., or the expenditure of his wealth, in ali likelihood he and his people returned to England almoft as ignorant as they departed. During all this barren and dreary time, that is, for the fpace of nearly thirteen hundred years, the excellence of the Britons feems to have been in the ftrength of their arms, for they were conftantly engaged in wars foreign or domeftic, and men- tion is fcarcely made of any man, who had a claim to be confid- ered as learned in any fcience, before Roger Bacon, who lived in the thirteenth century. He was a man endowed with a very fuperior and excelling genius, who, among other branches of phylofophy, applied himfelf to chemiftry, which he carried to higher decrees of perfeaion than his predeceflbrs of any age or nation, as well as laid the foundation of many modern improve- ments. A few other names of medical men indeed are recorded, as Richardus Anglicus, Nicholus de Ferneham, Johannes de SanH» JEgidio or Giles, Hugh of Eve/ham, and Gilbertus Anglicus ,•* but John a Gaddefden was the fjrft Engiifhman, according to Dr. Friend, who acquired fufficient reputation to be appointed Phyfi. cian to the Court, which Gaddefd n was, in the reign of Edward the Second. His work, which he called the " Rofa Anglicana,** was never printed in England: and if it be compared with thofe of the Greeks, and perhaps of fome other phyficians of his time, he may deferve the feverity of that cenfure, which has been un- sparingly palled upon him. But furely much allowance k t© be * Sea Aiken's Biographical Memoirs. StlT FREEACE. made, and fome honor mud be given, to the firft man in any country, who, by diftinguifhing himfelf, was preferred to a place of fuch high truft and importance. About the fame time lived John Ardern, a Surgeon of great reputation at Newarke in Not- ttnghampjhire, who compofed many works, none of which have been printed, except his treatife on the « Fiftula in Ano." In every country knowledge muft be acquired by the mere in- duftry and genius of the natives; or by communication with other countries, in which it already exifts •, or the rudiments, de- rived from fome other nation, may be carried to greater perfeaion by the induftry and genius of thofe, who originally received their inftruaion from foreigners. If knowledge were conveyed from the Babylonians, or Indians to the Egyptians, thofe would probably afford an example of the firft ; the Greeks of the fecond \ and all Europe of the third. But the progrefs of knowledge would in the beginning be exceedingly flow, in every nation ; and even fup- pofing the powers of the mind were not diverted from the purfuit by more favorite objeas, it would be long before men thus cir- eumftanced could be put into competition with a people already informed. The abilities of particular men would very often be loft by their death j and, if they were difpofed to convey their knowl- edge by writing, the number of copies would be comparative- ly fmall, full of the errors of tranfcribers,and difficult to be under- stood, from unavoidable changes in the meaning of words, and the conftruaion of the language in which they might be written. Nor would a people deferve the name of fkilful and learned, be- caufe there were a few men of diftinguifhed abilities among them, but becaufe the generality were fo well informed, as to be able to execute with aptitude and intelligence what was required of them for the good of fociety. All or the greater part of the impediments to the acquifition or diffufion of knowledge in general, were happily removed in the fifteenth century, by the difcovery of the art of printing by John Fauji or Fuji, a German, about the year 1432. This art was initroduced into Britain in the year 1470, by William Gaxton, who h red himfelf as a fervant at Gologn, for the purpofe of qualifying hhrtfelf as a working printer. There are two books, which, it is faid, were printed by him before his return, of one of which we fhall have occafion to take notice. Another event, extremely favorable to the improvement of medicine, took place early in the next century, that is, in the year 1518. This was the eftablifh- ment of the College of Phyficians in London, by the charter of King Henry the Eighth. The words of the charter of the col- lege denote its view ; lmproborum hominurn qui medicinam, ^c, mudaciam compefcere; the kind of inftitution, inflitutarum civitatum in Italia exemplum imitatij and the perfons to whom it was grant- PREFACE. XI* itd,gravium virorum doBovum, &c. precibtts inclinati. For certaia purpofes, intending or promoting the good of fociety, thefe men were direaed to form a college, with powers for their internal regulation, as forcible as thofe ever granted to any .other univer- fity or college ; provided fuch regulations, and fuch only, were made and executed, as preferved and promoted thofe interefts of fociety, which were committed to their truft. I mention thefe circumftances, becaufe the feleaing power of the Fellows of this College, though allowed to all others, has been difputed by fome very able and worthy men, who, perhaps, did rot reflecT:, that before its eftablifhment, no fchool, or even leaurefhip for medi- cine, had been founded in this country, nor had a fingle book of any eftimation been written by a native of it, but that the art was then praaifed without reftraint, by men as bold as they were ignorant; or forefee, that if, the college were to be fuppreffed, or the exercife of its powers perpetually checked and conteftedj the art would, in all probability, decline into its primitive ftate of ignorance and confufion. It would, moreover, be eafily proved, that, fince the year 1518, there have been, at every pe- riod of time, phyficians of diftinguifhed abilities and eminence and that the general literature of this country has been in many inftances very effeaually affifted by the members of this college. There can fcarcely be a doubt, but that very important benefits have accrued to fociety from the eftablifhment of the College of phyficians, and that the rank and dignity of the profeffion have been raifed and fupported by it. A3 early proofs of the firft, I may mention the difcovery of the circulation of the blood, by Harvey ; the docfrine of irritability, firft cultivated by Glijfon - the reduaion into order, and more accurateanatomical knowledge of the brain and nervous fyftem by Willis; the difcovery, or at leaft the great improvement of our knowledge of the glandular and lymphatic fyftem, by Jollijfe, Wharton, Needham, Willis, and many other very able men of their time ; and the difcoveries o£ Mayoiv, whom I am proud of having contributed to refcue from oblivion. The feconu pofition is felf -evident. Even thofe whq are not members, eventually partaking of its advantages, and profiting by its eminence, are interefted in its fupport. In the courfe of time, the rules of this, like thofe of many other foun- dations of a fimilar kind, may require alterations, according to the progrefs and improvement of fcience : but the powers already granted might be effeaually exerted, to prevent the frauds, hinder the impofitions, and curb the audacioufnefs of ignorant and un- principled men; and the exercife of this authority was never more neceffary than at the prefent time. It is probable, that this im* portant purpofe would be anfwered, if no patent for any medi- cine were to be granted, or any noftrura allowed to be fold, with. xvi Fr.BFACE, out a testimonial of its efficacy and f.uety from the college of phyficians ; and by compelling every perfon praaifing medicine in any form, to become a member of the College of Phyficians, of the Co'lege of Surgeons, or the Company of Apothecaries. Nor does it feem difficult to make regulations fo ftria, that they ihould refiit any claims to the privileges of the college by the prefumr.ru ous, yet fo liberal as not to withhold them from the de- fending ; and thus improve both its public and profeffionaJ ben- efits. One of the firft books printed by Cux.'rn} was"*' Bartholomeua de Proprietatibus Rerum." He is named in the firft tranflation, which was made under the proteaion of one of the earls of Berkley, as B. Glanville \ but the title of the copy of the book which I have, probably Caxton'j, is this—" Incipit prohemium de propri-?!atibus rerum Fratris Bartholomei, Anglici, de Ordine Fratrum Minorum." This is in the nature of a C\c/opadJa ; and being a book not much known, I allow myfeif the liberty of making an extract from it, which will fhew the nature of the work. His obfervations on fire, which will exhibit his philofo- phy, are in this order-—De jorma—De elemento~De igv.e—De jlatnma—De junto—De carbone—De j'cintilla—D<; j'avilla—De einere. The following from his chapter, de infirmitatibus will fhew his medicine—De febre—De febre effymera—De ethicr.—De febre putrida—De fignis putrida febris—De febre cotiduina—De febreterciana et ejus fignis et cura—De guar tana et ejus fignis et remediis—De febreJhnplici et compfita. He has a chapter, deobfe- trice, and another de umbilico but they both relate almoft wholly to the management of the child. A book like this promifed to be of great fervice ; but, though the circle was comprehenfive and regular, it was filled, not with the obfervations of a man of real knowledge or experience, but with popular opinions ; and thefe colleaed without any difcrimination, frcm other writers. A tranflation of this work, by John Trevifa, was printed by Wynkin de Worde in 1507, another edition by Bertheht in 1535' and I believe fcveral others. Very few medical booko feem to have been printed about this time ; and, from the examples, their lofs is not to be regretted. The " Judycyall of Vryns,'' was printed in J 512—" A litel boke for the infirmities'and grete Sickneffe called Peftilence," which palled through many editions —and « A little treatyfe called the Gouemail of Helthe." But in the year 1522, Linacre, who was the firft prefident of the college publifhed, when fixty-two years of age, a tranflation of different parts of Galen, which he thought rroft ufeful to be known. The ability and elegance with which this tranflation was made, are univerfally acknowledged, and great honor was juftly given to Linacrej on this and many other occafions. But PREFACE* stvii the Englifh practitioner did not reap much advantage from the work; for, though there might not have been fix men in the nation at that time able to read or tranflate Greek, and probably fome hundreds who underftood Latin, yet the bulk of the people were ftrangers to both the languages ; and of this Linacre himfelf feems to have been fenfible, for he immediately afterwards pub- lifhed his " Rudimenta Grammatica Lingua Latina." Nor can I here help lamenting two defeas even in Linearis plan ; one, when the college was eftablifhed, that he did not encourage the publication of papers on medicine, under the aufpices of the col- lege ; a defea feen by the eftablifhers of the Royal Society, who publifhed fuch papers in their tranfaaions, a place not the mod proper for them j the other, that he did not print his works in Eng'ijh ; in which they would have been generally read, have af- forded immediate inftruaion, flood as good examples, and taught a proper method of writing. It is amongft the moft remarkable things I have met with, that no writer in any other language, than that of the country in which he lives, ever feems to be gen- erally underftood by the people of that country, of which I could adduce feveral proofs. But this not being done by Linacre, the Englifh medical writers returned to their former ftyle ; and foe many years little real progrefs in knowledge was made, or any ti- tles heard of but thofe of Urynals, Judgment of Urynes, Anatomies: efUrynes, Treafuries of Helth, Mirrours of Helth, Anthidotaries% Breuiaries of Helth, the Treafures of poor e Men, Herbals, and the like, by medycyiners and aftronomers. But about the year 1540 fome attempts were made to tranflate books of reputation into the Englifh language ; as Sir Ulrich Autten on the wood c ailed Gua iacum that healeth the French Pockers, b.y Paynell, Canon of Mar~ ten Abbey, who had alfo tranflated many other books about 1533 ; the Caflell of Helthe by Sir Tho. Elyot, who was not a phyfician ; Albertus Magnus ; Prognojlicacions out of the books of Tpocras9 Auicen, &c.and the Quejlionarie of Cyrurgyens, with the formu-m larie of lytell Guydo in Cyrurgie. In the year 1540 was alfo pub- lifhed the firft book on the fubjea of midwifery in England,* cal- led " The Byrth of Mankynde," otherwife named the " Wom- an's Book," by Thomas Raynold, Phyfition ; the fecon J ediuun o£ which was imprinted at London, by Thomas Ray, whoie name is not mentioned either by Ames or Herbert, in their hiftory of prin- ters. This was alfo the firft medical book which has prints rea- fonably well executed from neat drawings. As every one o£ * Dr. Combe has in his possession the identical manuscript cop/ of thia work, which was presented to Catherine, Queen of Henry the VHIih. Thifi eopy is signed with the name of------Jonas, but it does ngt appear v/by th.9 book was afterwards published in the name of Raynold, c ' !JCViM PREFACE. thefe books went through feveral editions, we may conclude they were in hi<nau- bitable marks of great learning, genius and induftry, but the/ are feldom ftudied. Perhaps his medical works may be too philu- fophical for pi actical phyficians, and his philofophical works too much blended with medicine, to pleafe philofophers ; and it does feem poffible, by the ftudy of arrangement and fubtleiies of fcience, to lofe fight of praaice, as by the prelent fyftems of botany, its relation to medicine is become almoft forgotten. But there is fcarcely a fubiea conneaed with the fcience or praaice of medicine, which has no been cultivated by Willis. His chap- ter on the puerperal fever, when fimply inflammatory, is judicious and good. He died in the year 1675, having founded a leaure- fhip in the church of St. Martin in the Fields, where prayers are read at an early hour chiefly for the convenience of medical men. His praaical works were badly rranflated into Englifh in 1685, and afterwards all hiswritings, but in a language never very good, and now become obfolete. Nathaniel Highmcre wrote his tl Difquifitiones Anatomicre," in 1651, and « A hiftory of the Generation of Plants and Animals," in which it appears, that he made many tlifcoveries, particularly of the antrum in the upper jaw, to which his name has ever fince been given. Contemporary with thefe was Walter Needham, educated at Cambridge, then appointed phyfician to the Charter-houfe in Lon- don, but who afterwards refided at Shrewfbury. He wrote " Dif- quifitio Anatomica de Formato Fsetu ;" a work of defervedly high eftimation, in which he takes the opportunity of treating not only upon the contents and economy of the gravi duterus, but up- on the laaeals and lymphatic fyftem, and many other anatomi- cal fubjeas. In the year 1656 Tnomas Wharton publifhed his " Adenogr?- phia j" a work of eftablifhed reputation, in which, among other things, he has obferved fome which relate to the gravid uterus. This work is quoted in the firft edition of Nuck. Ox the claims to the firft difcovery of the lymphatics there feem to have been early debater, and from the veries prefixed to Ib.ycb, who firft defcribed their valves, the difputes appear to be national. But if weconfider the labors of Dr. I/'iiram Hunter on this urbjeft, and above all the p;npicuous md conneaed arrangement he has made PREFACE. xxli* ©f the glandular and lymphatic fyftem, v:e muft be convinced that the principal merit in this part of anatomy is due to him. Nathaniel Ilnfhaw publifhed his " Aero-Chalinos" in the year 1677. This contains the five following traas—«« On Fermenta- tion—Chylification—Refpiration-Sanguification—The good ef- feas of changi:*:^ Air." About tne fi me time lived Walter Charlton, who publifhed " Onomafticon Zoicum." in the year 1668, and in the following year his " Econcmia Animalis," of which h-ir George Ent gave this charaaer—opus matnro ccnflio inchoatum, magna cura elabora- turn ingenio denique et docl rinafr, gulari perfetlum. Char lion wrote feveral other works, particularly " De caufis Catameniorum et Uteri Rheumatifmo." He alfo publifhed the "Works of Theodore Mayerne, to whom a vain monument was erected in the church of St. Martin in the Fields. In 1668 Dr. Mayoiv of Oxford publifhed his works, entitled9 « Opara omnia Medico-Phyfica," in the German edition, which is the only one I have feen. Thefe confift of the^ollowing effays : 1. De Sal-nirro et Spir- itu Nhro sereo.—2. De R.efpiratione.—3. De refpiratione foetus in utero & ovo.—4. De Motu Mufculari & Spiritibus Animalibu3 —5. De Rachitide. In thefe he treats of many other interefting and curious fubjeas, which have been lately brought into public notice and much approved, though Mayow feems to have been greatly megleaed ; but this may be accounted for by his dying at the age of thirty-five. Dr. Richard Lower, before mentioned, in the account of Willit in 1676 publifhed his " Traaus de Corde, item de motu et col- ore Sanguinis, et chyli in eum tranfitu." This celebrated work has many obfervations on the lymphatics and the receptaculum chyli, which he confidered as their general centre, as early as Pecquet. He alfo made many curious anatom- ical and phyfiological experiments, and in this work afferts his claim to the invention of the art of transfufing blood, to which he feems to have been very partial. The Chirurgical Treatifes of Richard Wifeman were dated in 1675, and allowing for the time when they were written, are acknowledged to have great merit. He may not unjuftly, per- haps, be efteemed the firft Englifh furgeon. " The Comes Chi- rurgorum," containing Dr. Read's Lectures was printed in 1686. But the improvements in furgery did not keep pace with thofe in phyfic, for in the laft, and even in the beginning of this century it wa; not unufual for foreign furgeons to come into this country to perform the nicer and more difficult operations, fuch as thofe V.MiV PREFACE. for lithotomy, all difeafes of the eyesj and every thing which rela- ted to the teeth. But Chefelden acquired fo much fame by his dex- terity in cutting for the ftone, that the King of Sweden lent his Secretary of State into England, for the exprefs purpofe of having that operation performed by Chefelden, who fuccefsfully extracted from him a ftone of an unufually large fize. Every operation appertaining to the eyes, is now performed with the moft con- fummate fkill and dexterity, and with correfponding fuccefs, by Wathen, Ware and Phipps; and thofe for the teeth, by the Spences, and many others. It is at the prefent time univerfally acknowledged, that the Englifh furgeons equal, in every refpea, if they do not exceed, thofe of any other nation. Dr. Nehemiah Grew publifhed feparately, though they were afterwards colleaed into one volume, his « Anatomy of Plants," in which there are many obfervations refpeaing the folutions of falts ; his « Anatomy of Roots—Comparative Anatomy^ of Trunks," between the year 1670 and 1680—« Cofmologia Sac- ra," and feveral other works. At the fame time lived John Ray, the celebrated Botanift. Clopflon Havers publifhed his « Ofteologia Nova," in 1690. In this work he defcribed the mucous glands of the joints, which he difcovered, and the internal ftructure and difeafes of the bones, cartilages, &c. . „ In the year 1695 Ridley publifhed his " anatomy of the Brain, of which he is faid to have difcovered the lymphatic veffels ; and his « Obfervations," in which he treats on feveral abftrufe parts of anatomy. Dr. Richard Morton publifhed his « Phthifiologia'' in 1689 ; hi9 " Phretologia feu de Morbis acutis univerfalibus" in 1691 ; and his work " De Febribus inflammatoriis" in 1694. ^ Sydenham's treatment of Fevers was almoft univerfally antiphlogiftic ; Mor- ton's, on the contrary, was cordial and fudorific •, but we have between thefe two writers, moft of the arguments which have been advanced in favor of both methods of praaice. The firft edition of Cowpers » Myotomia Reformata" was publifhed in 1695 ; and Keil's Anatomy in 1698. By the writings of thefe very eminent men, and of many others whom I might have named, particularly of the celebrated Robert Boyle, it appears, that the phyficians of this country were, from the beginning to the end of thelaft century, indefatigable In the acquifition and improvement of fcience ; that they were not only acquainted with the general knowledge of the Greeks, Romans, Arabians, Italians, and French, but might fairly be put in com- petition withthofe of any other nation, if they did not excel them j and that all the changes we have feen, were produced in lefs than two hundred years, that is from tlie time when the College o$ PREFACE* KkV Phyficians was eftablifhed, in the year 1518, to the termination Of the feventeenth century, Early in the eighteenth century, the benefits of medicine to fociety were rendered confpicuous by the introduaion into England of the praaice of inoculating for the fmall-pox, for the knowledge of which we were indebted to the fagacity and judgment of Lady M. W. Montague. The mortality- attending that difeafe in a natural way, was eftimated as one in eight ', but by inoculation it fcarce exceeds one in a hundred.-— Many objeaions were made to innoculation, when firft introduce ed ; but the praaice being conduaed with much caution and Underftanding, by able medical men, and proteaed by Queen Caroline, at length became general. It required, however, the experience of fifty or fixty years, to bring inoculation to its pref- rnt ftate of perfection, the merit of which is exclufively due td> Englifh phyficians and furgeons. Inoculation for the cow-pox, as a preventive of the fmall-pox, has been lately recommended and carried to a confiderable length by Dr. Jenner, a phyfician of great worth and abilities, to whom only we are alfo indebted for the firft account of the cow-pox, as a part of natural hiftory, and for our knowledge of the treatment of the difeafe when innocu- lated. As far as can be judged at prefent, Dr. Jenner's propofal, when carried into execution, will be the means of faving much anxiety, and many lives, and may perhaps lead to the extinaion of the fmall-pox. I muft in this place beg leave to make a digreffion. In the year 1668 Herman Boerhdave was born near Leyden. He was originally defigned for the church, but was led by inclination, and the ill ftate of his own health, to apply himfelf, when very young, to the ftudy of medicine. He graduated in the year 1633, was chofen Leaurer on the inftitutes of Medicine in 1701, and enjoyed all the honors, which the univerfity could beftow, Or the cicy of Leyden confer upon him. He raifed the reputation of this fchool of medicine beyond that of any other in Europe* The induftry of Boirhaave, in the purfuit of knowledge of every kind, is almoft incredible ; that of any other man, compared with his, may be called amufement ; the facility with which he communicated this knowledge to others, was beyond expreffion happy ; artd his whole condua in every religious, moral, and fcientific view, to the higheft degree laudable. He was honored in his life, and his memory is univerfally rcfpeaed. His hiftory which was writteh by Dr. Samuel Johnfon, muft ever remain a very ufeful ftudy to medical men, ^attd an example of fine com- pofition. Boerhaave dkd in the year 1738, in the 70:h year of his age. Among the favorite ftudents oi Boerhaave was Alexander Mon* D xxvi PREFACE. w, who in the year 1719 returned from Leyden to Edinburgh, a city at that time not diftinguifhed by any eminence in medicine^ But in the following year Dr. Monro being chofen profefTor of Anatomy and Surgery, and Dr. Alflon of Botany, they began to give Leaures, and by their abilities foon acquired that high rep- utation, which enabled them to eftablifh a fchool of medicine, which they had the very great fatisfaaion of raifing to an equal degree of honor with that of any preceding or prefent time. Dr. Monro died in the year 1767, leaving behind him many valuable works, which were afterwards colleaed into one volume, and publifhed by his fon Dr. Alexander Monro, who fuccceded his father as profefTor. By this eftablifhment, the further advantage was gained to Britain of having at Edinburgh a fucceffion of very able°and eminent men, who dedicated the chief part of "their time to ihe acquifition and improvement of medical fcience, and to the inftruaion of thofe who were intended for the profef- fion. Here I fhall conclude thefe general obfervations, and confine myfelf to fuch only as relate to the praaice of midwifery, prem- ifi'xr a fhort remark on a fubject, in which the interefts of focie- ty, aii i the claims of individuals, are deeply concerned. The ceconomy of the medical profefiion has, in this country, undergo ne many alterations, according to thofe of fociety at large. Phyficians who are called to take charge of all cafes of uncom- mon difficulty or danger, or of the lives of perfons of high rank and eminence, have generally fuch an education, as leads not on- ly to the acquifition of medical knowledge, but to the cultivation alfo, and higheft improvement, of all the powers of the mind. But the operative, and all the inferior parts of the profefiion, fall under the condua of thofe who were educated as furgeons, or a- pothecaries. By thefe are performed all the operations in furge- ry, many of which require an admirable combination of mental and perfonal qualities; and to their fkill and care the lives of the greateft part of the lower clafs of people, and of thofe who ferve in the army and navy, are almoft conftantly fubmitted. In order to their being duly qualified for thefe important duties, young men, having received a reafonable fhare of claffical education, are bound, for a certain term of years, to fome perfon, compe- tent to give them proper inftruaion and information. To fuch young men it can only be neceffary to obferve, that they will at fome future time be called upon, to take charge of the lives of men, for which they muft be refponfible, not only the laws of God, but to the law of the land ; which has the power of irdlic- ting fuch punifhment, as any particular inftance of ignorance or negligence may be proved to cicierve ', and, which J3 beyond all PREFACE. xxvii other punifhment, their name becomes ignominious. I may there- Fore be permitted to recommend the profefiion of any part of raed- icine, as a very fasred truft to thofe who engage in it; the neceffary and proper qualifications for which, demand all their attention,and the fober, conftant, and moft induftrious application of all their abilities. But it is very much to be doubted, whether fome of thofe, who, both as parents and mafters, take the charge of fuch young nen, are not fometimes felfifh, and negligent in the per- formance of that fhare of the duty which they undertake; and whether, having received the gratuity ufually paid, they give due attention either to the morals of the young men, or inftrua them properly in the knowledge of their profefiion. Through this negligence of the mafters, or the thoughtleffnefs and inattention of the young meny at the end of their fervitude they muft fre- quently be ignorant of many things which they ought to know, to their own misfortune and difgrace, and to the great prejudice of fociety. By the nature of one part of my employment, that of giving leaures, I have had too many opportunities of knowing the truth of this remark ; and, with the greateft unwillingnefs to give of- fence, I feel called upon to make the preceding animadverlions, in confirmation of which I beg leave to add the following quota- tion, from unexceptionable authority -,— " Clerks and apprentices ought to be employed entirely in the profefiion or trade, which they are intended to learn. Inftruc- tion is their hire ; and to deprive them of the opportunities of inftruaion, by taking up their time with occupations foreign to their bufinefi-, is to defraud them of their wages."f The " Byrth of Mankind, or theWoman's Book," with fket di- es not badly intended or engraved, was printed in the year 1540 : and as it went through many editions and as I find no other book of equal value publifhed about that time I confider it as having lpeen the popular book for near 100 years ; that is, till the year 1634, when all the works of Ambrofe Pare were tranflated into one volume. Pare was a man of much experience, fome erudition and not a little credulity ; but he made many ufeful obfervations relative to Midwifery. In theyear 1653 Harvey's Exercitations, were publifhed in Englifi, but whether tranflated or original I can- not decide. About the fame time alfo lived Dr. Chamberlen, a very celebrated phyfician, who applied himfelf to this branch of the profefiion.;{: He had three fons, who, with their father, t Paley's Mora! and Political Philosophy, Vol. I. * A very elegaoit monument was erected in Westminster Abbey to this Dr. ChamberleH by thk Duke of Buckingham, of whom he has aho in his Essays g iv en a vtry amiaiSle character. xxvm PREFACE. were fuppofed to have a better method of relieving women m cafes of difficult parturition than any other perfbn,by means of an inftrument faid to be the forceps, but which I believe to have been a vetlis ; or perhaps they had more than one inftrument. One of the fons went over to Paris, with a view of felling the fecret, or of making a fortune by praaice ; but being foiled in the firft: cafe to which he was called, and fuftering more obloquy than he deferved, he returned to England, and immediately publiflied a tranflation of Alauriceu's work which remained for many years in very high efteem, This was in the year 1672. Having been favored by the late Dr. JfLirlland with a manu- fcript written by Dr. Percival Willughby, who lived at Derby and afterwards in London, I am able to give the reader fome idea of the praaice of that time, many of the cafes being dated from 1640 to 1670. This work is entirely praaical and was intended to be publiflied for the ufe of midwives, there being a title page, and two copris with variations. His preface is in this manner ; " I haue read many bcokes, with all the late writers in mid- wifery, and I do perceiue that they all follow one common roade, taking their feueral fcheemes and figures one from another. " In feueral of thefe fcheemes uarious things may be perceiued, which will be trublefome to the labouring woman, which a judi- cious praaitioner will not follow. Let midwiues mark what hath been written in my obferuations, let them consider dillegently the feueral reportes not faigned, or the furmifed thoughtes, nuc- tors, or man's fantafie. fitting and meditating in his ftudye, but which haue really been performed in the trauailing woman's chambre, " Froin mine and their direaions let midwiues choofe the beft and facileft waies of relieuing women in afRiaion, and to decide all difputes, let reafon be the juege, let experience argue the du- bious paints of praaice, and, after a full debate, let unfpotted truth records to fucceedings times what is moft fitt to be followed and Ui'ed, See." This is a fpecimen of his illuftration—," Let midwiues obferuo the waies and proceedinges of nature for the produaion of her fruit on trees, or the ripening of walnutts and almondes, from theire firft knotting to the opening of the hulkes and falling of the nutt ; the greene hufkes flicking fo cloie that it is not pof-. fible tofeparate the hufkes from the fhell, whileft it is unripe ; but as the fruite ripeneth the hufke choppeth and with a fiiluro c.pcneth, and by degrees feparateth the fruite without any enforce- ment. if An egge reprefenteth the wombe; no'v the henne with PREPACE. xxix keeping the egge warme doth breed the chicken, which when it comes to maturitie both chip the fhell,and is by degrees hatched without injurie. Thefe fignatures may teach midwiues patience and perfuade them to let nature alone to perform her own worke, and not to difquiet women by their ftrugglings, for fuch enforce- ments rather hinder the birthe than any waie promote it, and of ruinate the mother and ufually the childe ; and let midwiues knowe that they be nature's fervants, &c." Willughby's praaice is not much different from that of the prefent time. He divides labors into two kinds only, natural and unnatural. The particular rules I cannot pretend to des- cribe in this place ; but the following letter, which he has quoted from a fcarce work, correfponds fo nearly with an obfervation it was my fortune to make fome years before I law this manufcript that I may be excufed relating it, " Referam hoc cafu,quid beta? mea? conjugi acciderit. Tertio foetu gravidam, nono pnegnationis menfe, labores parturientiurn arripiunt circa noaem. Mox rupta aqua (ut hie mulieres loqu amant) extra genitale, infantuli manus propendit. Ubi obftetrix advenifiet, uxorum meam in fedili collocavit, eamque ad continu- os conatus (me nolente nee inftigante natura) adegit. Cum vero res eo modo non fuccederet, meamque conjugem fupra fedem continuo detineret, ac diris cruciatibus illapfum ex uteri cervice manum brachiumque retrudere niteretur, quo fcetum ad exituni commodius dilponeret. Ego prae dolore charge mese conjugis impatiens, ab indenfinenter obftetricem admonens, ne quidem elapfi membri reduaionem in uterum congitaret poffibile, multo minus moliretur, fecundam obftetricem accerfiri juffii, praefertim cum uxor mihi nunciaret, quod obftetrix earn dilaceraret per il- lam prseconceptam ac miferam elapfi membri repulfionem. Cum infequenti die, obftetrix altera veniffet, ilia manus ad opus appli- cans remque diligentur explorans, uxorem meam in le£tum depo- fuit, mandavitque ut fe quietam deteneret, nullofque conatus ex- citaret, nifi quando natura earn fui admoneret officii. " Interim obftetrix ilia prudens et expertiffima przedixit mihi amicifqae praefentibus, uxorem meam non ante parturam, quam fcetus in utero ex indebito fitu, conatibus ftangulareter, quad e- ventus docuit. Multiplicati funt labores parturientis, et fcetus in- flexo .id dorfum capite, (falva matre) prodiit inlucem."* By a genealogical manufcript, written by the firft Duchefs of Chandos, in the poffeffion of Col. Kearney, it appears that this Dr. Wilhtgkb'j was one of the fix fons of Sir Percival Wilbughby, and grandfon of Sir Francis, fo famous in the time of Queen Eliza* beth. * Novus exovtus haaiinis et animalinra. aston everauxs. SJIX PREFACE. It is probable, that the fortune and evidence acquired'by the fuppofed advantages of the method of the Chambcrlens, which they referved as a fecret, might be the occafion, that many gen- tlemen engaged in praaice endeavored to eftablifh themfelves up- on the fame principles, that is, of concealing the inftruments they ufed ; of which clafs was Dr. Bamber. Others might at- tempt to gain epual reputation and fortune by the very contrary means, that is, by decrying the ufe of inftruments of every kind, on any occafion ; for about the year 172:5, Dr. John Maubray publiflied a volume upon this fubjea, called " The Female Phy- fician," or the " Whole Art of New Improved Midwifery," in which he exclaims with great vehemence againft their ufe, and the Book, though written in quaint language, has fome general merit. In the following year he alfo publiflied an appendix, un- der the title of « Midwifery brought to perfeaion," in which he demands great credit for the many improvements he had made. This appendix is in truth no more than a Syllabus of his Leaures, a courfe of which confifted of twenty, twelve anatomical and phyfiological, and eight praaical. I believe it would be unjuft, to deny to Maubray the credit of having been the firft public teacher of Midwifery in Britain. He gave his Leaures at his houfe in Bond- Street. In the year 1719 Dionis' Midwifery was tranflated into the Englifh language, ; and in the year 1729 Deventer's work was tranflated and publifhed ; and though it appears, that rather more tredit has been given to this author than he deferved, yet as he enters upon a difcuffion of the caufes of many difficulties which occur in praaice, and of the means of relieving them, and as he was generally avevfe to the ufe of inftruments, Deventer's work might be efteemed a confiderable addition to the flock of obfte- tric knowledge in this country. Deventer was originally a watch- maker. Dr. Siitfon, profefTor at St. Andrew's, publifhed in 1729, his *« Syftem of the Womb," a work of fufficient ingenuity, but not of much ufe in praaice, even if his theory had been true. About the year 1733, Edmund Chapman publifhed his " Trea- tife on the improvement of Midwifery," in whish there are fev- eral ufeful obfervations ; and other writings of temporary confe- qutnce only. Chapman was the fecond public teacher of Mid- wifery in London, and he was the firft alfo who defcribed the For- ceps, in the third volume of the Edinburg Medical FAUy:,. In the year 1734 Dr. Hody publiflied a « Collection of Cafes in Midwifery," written by Mr. 'William Giffard. Thefe cafes, two hundred and twenty-five in number, feem to be written with great fidelity ; and as they occurred in his own practice, they PREFA6E. xxxt were leffons of condua which was to be purfued in fimilar cafes, and may now be confidered as examples of the ftate of praaice at that time. Giffard alfo gave a plate reprefenting the Forceps^ and was, I believe, among the firft who afferted, that the placen- ta might be attached over the os uteri. " The Midwife rightly inftruaed," was publifhed in the year 1736 by Thomas Dawke ,• and the " Midwife's Companion," by Henry Bracken, in the following year, with feveral other things equally unimportant. About this time lived Richard Manningham, who quitted the profefiion of Pharmacy and applied himfelf with great affiduity to the praaice of Midwifery. In a controverfial pamphlet publifli- ed in the year 1730 he is mentioned as having been knighted. In the year 1739 he eftablifhed a ward, or fmall hofpital, in the parochial Infirmary of St. James, Weflminfler, for the reception of parturient women, which was the firft thing of the kind in the Britifj dominions. At this ward, which was fupported by pub- lic fubfcription, he gave leaures, and the ftudents had opportu- nities of being qualified for praaice. He publifhed a " Com- pendium Artis Obfetrica"; a " Treatife on the Febricula," on the " Ufe and abufe of phyfic," (i Aphorifmata medico," and many other Effays, relating chiefly to the praaice of Midwifery. Sir Richard Manningham was a man of much learning and informa- tion, eminent and fuccefsful in praaice, and very humane in the exercife of his art. He died about the year 1750. Before that time there had alfo been publiflied a tranflation of Heifer's Sur- gery, and this, containing not only a general outline of Midwife- ry, but many excellent praaical obfervations, muft have been a fource of great benefit in a country not then overftocked with in- formation. Sir Fielding Oulde, of Dublin, in the 1741, publifhed a " Trea- tife of Midwifery," the moft interefting parts of which are his obfervations on the continuance of the thickneis of the uterus during pregnancy, and his defcription of the manner in which the head of a child paffes through the pelvis at the time of birth ; the truth of which obfervations has fince been fully proved and ac- knowledged. Having taken this fhort and imperfea view of the progrefs of Midwifery in this country, from 1540 to the year 1740, it will be prudent to conclude, or this preface would be carried to an in- admiffible length. The Englifh might then be faid not only to have purfued, but to have been in full poffeffion of the fubjea \ all the books written in the neighbouring countries being tranf- lated, public leaures given, and, an hofpital eftablifhed for the farther improvement of the art, which was taught by men of ability and eminence in praaice. As all the books and papers XXXU PREFACE, printed fince that time may be readily procured, every gentle* man has an opportunity of forming his own opinion of their ref- peaive merits without any laborious rcfearch. But the College of Phyficians having been pleafed, in the year 1783, to form a rank, in which thofe who dedicate themfelves to the praaice of Midwifery fliould be placed, I truft that future accounts will be more appofiteand correa •, and that this meafure adopted by the College will promote the public benefit, by confining the induftry and abilities of one clafs of men to this branch of the profefiion. It is my earneft wifh, to fupport their views in this wife and be- nevolent arrangement, as the fruits of which, I do entreat Doc- tor Thomas G//2ww,Prefident of the college of Phyficians, rot lefs dignified by his teaming, and the integrity and liberality of his principles and condua, than by his rank in the profefiion, to ac- cept this volume, dedicated, with all refpea, by. his moft obedient and obliged fervant, THO. DENMAN. Le-vJwn. December 2, 1800. INTR 0 D UCTION TO THE PRACTICE OF MIDWIFERY: CHAPTER I. SECTION I. ON THE PELVIS. THE anatomical and phyfiological knowledge of all the part? concerned in parturition, is indifpenfably neceffary for thofe who mean to excel in the praaice of midwifery •, even that of the whole body may, on various occafions, be employed with ad- vantage. In the inveftigation of every fubjea there muft, how- ever, be fome point of commencement, and, as there is much ufe and propriety in the method hitherto purfued,by fyftematic writers, I fhall follow their example, and give, in the firft place, a defcription of the fituation, ftruaure, conneaion, ufe, and difeafes of thefe parts ; beginning with the pelvis, which is of great importance, on account of the direa influence which it has upon labors, and becaufe it may be efteemed the foundation on which all the other parts are fuftained. But this is only intend- ed fo far as may be requifite for the ftudy and praaice of mid- wifery. The term pelvis has been indifcriminately given to the inferior part 0/ the cavity of the abdomen, and to the bones which form the cavity ; but it appears more eligible to confine the term to the bones, and to call the fpace between them the cavity of the pelvis. The pelvis in the adult ftate is compofed of four bones ; the facrum, the os coccygis, and the offa innominata. The facrurn is fituated at the pofterior and inferior part of the trunk of the body, and ferves as a bafis for the fuppcrt of the fpine, of which it is an imperfea continuation. Its figure is *hat of an irregular triangle, with the fhorteft fide placed up- Vol. T F A INTRODUCTION TO MIDWIFERY. wards. The anterior furface is fmooth and flat, and has a con- fiderable degree of infleaion or curvature, called the hollow of the facrum, by which the cavity of the pelvis is much enlarged. The pofterior furface is convex and uneven, to which fome of the mufcles of the fpine and thigh are attached. In the infantile ftate, the facrum is compofed of five, and in fome fubjeas of fix bones, called falfe vertebra, cemented to- gether by intervening cartilages, which in the adult become bone; leaving little ridges or lines on the anterior furface, indicating. the parts where they had been feparate. Thefe bones diminifh in their fize as they defcend, fo that the loweft, which makes the' point of the facrum, fcarcely maintains the charaaer of one of the vertebra. The articulation of the upper part of the facrum, with the laft: of the lumbar vertebra, is fimilar to that of the vertebra with each other ; but, by the manner in which the facrum and vertebra are joined, the latter inclining over the former, an obtufe angle is* made, called the great :angle of the facrum. * Through the facrum there is a canal for the refidence and fe- curity of the lower part of the medulla fpirialis ,• but the pofterior part of the canal is incomplete below the third bone,aftrong ligamentous fubftance fupplying the place of bone. That part of the medulla which is contained in the facrum, is called the Cauda equina. On the anterior part of the facrum there are four pair of holes; or perforations, or more, according to the number of bones of which the facrum was originally compofed, through which large nerves pafs for the ufe of the parts contained in the pelvi- and of the inferior extremities. On the pofterior part of the facrum there is an equal number of perforations difpofed in the fame longitudinal order ; but they are lefs than thofe on the anterior part, and covered by membranes, which allow fmall nerves to pafs through them.' The facrum is of a very cellular texture, and is faid to be lighter than any other human bone of equal magnitude. The lateral parts of the facrum form a broad unequal furface, by which it is conneaed with intervening ligament and cartilage, to another uneven furface at the pofterior part of the ojfa innomi- nata. The inequalities of thefe furfaces, receiving and behi"- received by each other, contribute very much to the firmnefs of the union of thefe bones. An anchylfis is not unfrequentlv formed between the facrum and effa innominata j and fometimes', in conlequence of their feparation, an imperfea joint, which very much weakens that part, and impairs the manner of walk- ing, for the re.Viriiider of life. ON THE PELVtS. § To the inferior extremity or point of the facrum is fubjoined the os coccygis, which has by fome writers been confidered as a diftina bone, and by others as an appendage to thefacrum ; and thefe form, by the manner of their union, an obtufe angle, called the little angle of the facrum. In infancy the os coccygis is carti- laginous, but in adult age it is compofed of three, or, more fre- quently of four bones, conneaed by intermediate cartilages, the .uppermoft of which is fomewhat broader than the loyer part of the facrum. In fome fubje.as thefe bones coalefce and form a fingle bone ; and in others an anchylofis is formed between the far- trum and os coccygis va confequence of which the latter is fhort- ened and turned inwards, fo as to obftrua the head of the child in its paffage through the pelvis. But the impediment thereby occafioned at the time of labor, may be overcome by the force witli which the head of the child is propelled, and the os coccygis again feparated from the facrum with a noife loud enough to be diftinaiy heard, of which I have known more than one inftance. In general, however, between the bones of which the os coccygis is.compofed, fome regreffive motion is preferved; and that which is produced between the facrum and or coccygis, when the latter is prefled by the head of a child paffing through the pelvis, occa- fions a confiderable temporary enlargement of the inferior aper- ture of the pelvis.*' The infertion of the coccygai mufcles, of 3 part of the levatores ani, and of portions or flips of the facrofciatic ligaments into the fides of the os coccygis, keeps it fteady, and prevents any lateral motion.. The ojfa innominata are the broad large bones which form the fore part and fides of the pelvis, and the lower part of the fides of the abdomen. In children each of thefe bones is compofed of three ; and, though they afterward? become one, the lines of original diftinaion may be obferved at the acetabulum, or focket, which receives the head of the thigh bone. While the bones are diftina, they have peculiar names, the ilium, the ifchiuv:, and pubis, which names it is necefTary to retain in the adult ftate, that we may be able to defcribe with more accuracy each individual bone, or allude to it in the defcription of the adjoining parts, and on many other occafions. The ilium is the largeft and uppermoft of the bones which form the ojfa innominata. It is flat, broad, unequally convex and con- cave ; in fome parts round, and in others of an irregular fquare figure. It is divided by anatomifts into the crifla, bafts, anterior and pofterior edge, and the two fides, external and internal. * Os coccygis adeo extrersum s:;pe vrrtiiur, ul iiUegros deiu '■?annos conquer ranturde dolcrc, in partibus his rji duo. Raj-Fch, A;,.-c:"3. Dec. ?, 4, INTRODUCTION TO MIDWIFERY. The upper part, which has a thick arched border, is called the. crifla. The anterior and middle part of it is convex outwardly, and the pofterior fomewhat convex inwaidly. The crifla hag originally on its verge an epiphysis, of which there are often marks to an advanced age. The bafis or inferior part of the ilium is thick and narrow. I; forms anteriorly a portion of the acetabulum, or focket, which re- ceives the head of the thigh bone ; and pofteriorlv a large fhare of the circumference of the ifchiaticfmus, which is completed by the ifchium and facrofciatic ligaments. The anterior edge of the ilium has two eminences,called fpines, diftinguifhed as fuperior and inferior, between which there is an excavation or notch, and another below the inferior fpine. The pofterior edge is fliorter and thicker than the anterior, and terminates with two protuberances or fpines,between which there is alfo an excavation. The external fide of the ilium is convex on the fore, and con- cave on the back part. The internal fide is irregularly concave ; and upon that furface which is conneaed with the facrum there are feveral irregularities. From the upper part of this furface there runs a prominent line, which forms a margin, defining the upper aperture of the pelvis. The ifchium forms the loweft portion of the ojfa innominata. Its parts are defcribed under the names of body, tuberofity, or obtufe procefs, and ramus. The body of the ifchium forms the Ipweft and largeft part of the acetabulum, and fends out a fmall apophysis, which projeas back- wards and inwards, and is called the fpine or fpinous procefs of the ifchium. The tuberofity or obtufe procefs of the ifchium is very thick and uneven, and is turned downwards. As it is the part on which the body refts when we fit, it hath alfo been called os fedentarium. The convex portion was originally an epiphysis „• and, from the remains of the tendons and ligaments which were affixed to it, has, in the frefh fubjea, a cartilaginous appearance. The ramus is a flat thin procefs or apophysis, proceeding from the curvature of the tuberofity, afcending and joining to a fimilar but fhorter procefs, which fpringsfrom the anterior and infer it r part of the ojfa pubis. The ramus of the ifchium^ aided by this fhort procefs, form a large part of the outline of that opening called the foramen magnum ifehii. This opening, in the recent fubjea, is filled up by a ftrong ligamentous membrane, which gives rife to the external mufcles called obturatores. The offa pubis contribute the fmalleft fhare towards the forma- tion of the o^r innominata. Each of them has been defcribed kj three parts, the bcdy, the angle, and the ramus. ON THE PELVIS. 5 The body is that part which is placed tranfverfely before the .interior part of the ilium, to which it is united, forming by tins union the oblique eminence, which diftinguifhes on the inner part ofthe pelvis thefe two portions of the ojfa innominata. The body of the pubis contributes alfo to the formation of the acetabulum. The upper edge has on its inner part an oblique ridge, which is called the crifla, and is continuous with that of the ilium before- mentioned, as defining the margin of the pelvis. The anterior part of the pubis is called the angle,and conftitutes that furface, which being joined to the oppofite bone, forms the fymphyfts of the ojfa pubis. This part of the bone is flat and thin. The offapubis conneaed together form on the external or inferior fide an unequal concavity ; but on the internal or fuperior fur- face they are pretty equally convex, and both the edges have a fmall degree of flexure outwards. The ramus is a flat, thin, fhort apophyjis, which, running ob- lique downwards, unites with that of the ifchium. The two rami of the ifchium and of the ojfa pubis form ontheinterior and inferior part ofthe pelvis an arch, which is ufually called the arch of the pubis. This arch is much larger in women than in men •, which circumftance is favorable to the emergence of the head of the child at the time of birth, and conftitutes the moft diftinguifhing mark between the male and female pelvis. SECTION II. The advantage to be derived from the knowledge of the bones of the pelvis, in a dried or feparate ftate, is not very evident. But we may confider the previous intelligence of this and fome other parts of our fubjea, as effentially ufeful and neceffary, becaufe it comprehends the rudiments of a more perfea knowledge than can be otherwife acquired ; we fhall therefore proceed to examine the manner, in which thefe bones are conneaed. To the two lateral furfaces of the Jacrum are joined the pofte- rior furfaces of the ejfa innominata, and thefe are covered with a thin intervening cartilage, or ligamentous cartilage ; the inequali- ties, as was before obferved, contributing very much to the firrn- nefs of thejunaion. The ojfa innominata are alfo joined at thp anterior part by a thin cartilage, which covers the fcabrous end of each bone, and the fpace betweenthemis filled up with a Iigamcr- tous fubftance. This conneaion is called thefymphyfs of the of a pubis* * See a short but very precise account of the co..n::aon of the bones of tii; lie 1 vis, by Dr. William Hunter. Medical Observations and Inquiries, Vol. II. « INTRODUCTION TO MIDWIFERT. Within the circuit of the pelvis the periofleum is thickened at the parts where the ojfa innominata are joined to the fat rum, and at the fpnphyfis of the ojfapubus. Thefymphyfts has alfo been defcribed as conneaed by a thin tranfverfe ligament, or by ligaments which form what may be confidered as a capfular ligament, adhering to the part which it enclofeth, and to which it giveth the principal ftrength. Greatdr liability could not be procured by any internal mode of union, without a diminution of the cavity of the pelvis. But on the external parts of the pelvis, where the union of the bones could be more firmly eftablifhed by a ligament, there is ho point where one is omitted ; even the tendons of the mufcles in- ierted into the projeaing parts of the bones, though particularly defigned for other purpofes, eventually contributes to the ftrength ofthe pelvis. From the pofterior edges of thofe furfaces of the of a innominata which are joined to the facrum, ftrong ligaments pafs, which bind thefe bones firmly together ; and all that unequal fpace behind them is filled up with fmall mufcles, or tlie fmall parts of large mufcles, in fuch a manner as to give in the frefh fubjea, when covered by their tendinous expanfion, a furface almoft fmootn. From the outufe proceffes of the ofchia ftrong ligaments arife, which, expanding, pafs to the pofterior edges and apophy/is of the facrum, detaching in their paffages fmall portions to the ofcoccygis. Thefe ligaments are called the broad or external facrofciatic. From the fpinous proceffes of the ifchia ligaments arife, which, crofting and adhering to the ligaments before defcribed, pafs to the inferior and inner edge of the facrum and the upper part of the os coccygis, fending flips or fmall portions to the edges of this bone through its extent. Thefe are called the internal fafcrofci- atic ligaments. SECTION III. By the knowledge of the parts where and the manner in which, the bones of the pelvis are conneaed together, we are enabled to explain many uneafy fenlations which women have, and many in- firmities to which they are liable at the time of pregnancy and af7 ter their delivery. It was for many centuries a received opinion, that thefe bones, though joined together in fuch a manner as fcarcely to afford any fufpcion of a feparation, were always feparated at the time of par- turition ; or that there was a difpofition to feparate, and an adtual feparation, if the neceffity of any particular cafe required that en- largement of the cavity of the pelvis, which was confequcnt to it. The degree of feparation was alfo fuppofcd to be proportionate to fuch neceffity ; and if it did not take place, or not in fuch a dp- ON THE PELVIS* f g*rce as was required, diftending inftruments were contrived and ufed to produce or increafe it: and upon the fame principle the feaion of the fymphyfs ofthe ojfa pubis, of which we fhall hereafter fpeak, hath been lately recommended. This opinion ought probab- ly to be affigned as one reafon for the fuperficial notice taken by the early writers in midwifery of thofe difficulties which are fometimes found to occur at the time of parturition, from the fmallnefs or deformity of the pelvis.* To this may alfo be referred much of the popular treatment of women in child-bed, and many popular expreffions in ufe at the prefent time. But this opinion hath beea controverted by many writers who affert, that there is neither a feparation, nor a difpofition to feparate ; but that when either of them does happen, they are not to be efteemed as common effeas attendant on the parturient ftate, but as difeafes ofthe conneaing parts.f The difputants on each fide have appealed to prefumptive arguments, and to faas, proved by the examination of .the bodies of thofe who have died in child-bed, in justification of their feve- ral opinions. But, notwithftanding all that has been faid upon the fubjea, I know not that we are authorifed by the experience of the prefent time to fay that a feparation, or a difpofition to fepa- rate, prevails uniyerfalhy at the latter part of pregnancy, or at the tinie of labour •, yet that thefe effeas are often, if not generally, produced, may be gathered from the pain and weaknefs fo often mentioned and complained of, at the parts where the bones ofthe pelvis are joined to each other before and after delivery. In fome cafes pregnant women are alfo fenfible of a motion at the junaion ofthe bones, efpecialry at theftmphyfs of the ojfa pubis, and the noife which occafionally accompanies this motion, may be fre- quently heard by an attentive by-ftander. A ftrong prefumptive argument in favor ofthe feparation of the bones has been drawn from quadrupeds. In thefe the ligaments which pafs from the obtufe proceffes of the ifchia to the facrum, on which the firmnefs of the junaion ofthe bones very much de- pends, and which at all other times refift any impreffion attempt- ed to be made upon them, are for feveral days previous to parti:- * Edoctus assero, ossa pubis ssepeab invicem in partn laxaii, emollito eorimi cvtilaginoso connexu, totomque hypogastrii regionern, ad mir^c-ulum .usque arnpliari; npn quidernab aquosx substantias profubione, ted suasponte, ut fvacii_s niaturi excludendis suis seminibus solent hiscere. HaiV. Exeicitat. hiii. I n partu dirncili et laborioso ossa ischii aliquantulum ass imicem u/;,:;- liu.Ot. RuyscU. Adv. Dec. 2. f Les uns etles atitres disent, qui ces os que se separent ainsi a i'heure de F accouchment, y ont ete dispose/ peu a peu auparavant, pardeshiimiditex gl&ir- cUses qui s'ecoulent desenviron de la matrice, lesqucll