THE DISEASES OF VVomen with Child, AND In Child-bed: AS ALSO, The beſt Directions how to help them in Natural and Unnatural Labours.
With fit Remedies for the ſeveral Indiſpoſitions of New-born Babes.
Illuſtrated with divers fair Figures, newly and very correctly engraven in Copper.
A Work much more perfect than any yet extant in Engliſh: being very neceſſary for all Chirurgeons and Midwives that practiſe this Art.
Written in French by FRANCIS MAƲRICEAƲ. Tranſlated, and enlarged with ſome Marginal-Notes, by HƲGH CHAMBERLEN, M. D. and Phyſician in Ordinary to his Majeſty.
LONDON, Printed by John Darby in St. Bartholomew-Cloſe; to be ſold by R. Clavel in Croſs-keys-Court, and W Cooper at the Pelican in Little-Britain; by Benj. Billingſly at the Printing-Preſs in Cornhil near the Royal Exchange, and W. Cadman at the Popes-head in the lower Walk of the New-Exchange. 1672.
HAving need of a firm and ſolid Prop for the weakneſs of my Conceptions, I ſhall imitate moſt Authors, who ordinarily chooſe the protection of ſome Perſon of Credit, under whoſe Names they publiſh their Works to the World: But I ſhall not follow the cuſtom of many, who dedicate them for the moſt part to perſons who have no manner of knowledge of the matter of which they treat; induced thereto, rather in hopes of ſome mercinary recompence, than any other motive. This is, Gentlemen, that which obligeth me to addreſs my ſelf to you (as to thoſe who alone are fit Judges of it) and to offer you the firſt fruits of my Labours, which might run the hazard of being gnawed by the Worm of Envy, if not put into your hands to protect. I offer it to you, in acknowledgment of the honour you did me, when ſome time ſince you received me into your famous Company; and to acquit my ſelf of the Obligation I owed you: for, being a Member of your Body, all my pains ought to be for you. This is the reaſon why I could not preſent it to any other perſon, without being guilty of a domeſtick larciny. By giving it you, I am liberal of your proper Goods; or rather I render you an account only of the Talent you entruſted me with to improve: I mean the true Precepts of this noble Art of Chirurgery, of which you have a knowledge and experience ſo perfect, that every one is obliged openly to confeſs, that you are alone, amongſt all the Chirurgeons of Europe, of whom it may be juſtly ſaid, Vos Sol, alios umbra regit.
I ſhall refrain, Gentlemen, to praiſe you upon this ſubject; for (beſides that it deſerves a Pen more able than mine, to acquit it ſelf according to your merits) I may fear, that I ſhould be ſilenced by ſuch, as would alledge to me for ſo doing, that with which he once was reproached, who undertook to praiſe Hercules in publiſhing his Heroick Actions to the People of Lacedemonia: Who (an•wered one) is he that knows him not? 〈◊〉•…th not eſteem him to be in the number of the immortal Gods? So likewiſe may it be ſaid to me; Who is he that knoweth not the Maſter-Chirurgeons of Paris Is it not manifeſt that you are that fruitful Spring, to which they come from all places of Europe to draw the perfection of ſo fair an Art? and whither many Princes and Princeſſes of ſtrange Countries are obliged to have recourſe for the preſervation and recovery of their health, which they believe cannot be obtained ſo eaſily, and with ſo much aſſurance from any other as from you? Is it not known likewiſe, that our puiſſant Monarch hath this many years entruſted wholly his Sacred Perſon into the hands of him, who through his merits is at preſent the Head of your illuſtrious Body? Neither can it be forgotten, that this great King did, through a fatherly goodneſs which he had for the preſervation of all the Nobility, that accompanied him the laſt year in his Conqueſts in Flanders, command three or four of you to ſtanch the blood which was ſpilt before that mighty City de L'Iſle, which he brought under his obedience? Was it not then ſeen, how divers perſons of great quality (who were mortally wounded in ſignalizing themſelves at the Attaque of that ſtrong Place) ſeem'd wholly reviv'd at the inſtant they received the news of the arrival of theſe excellent Chirurgeons, upon the confidence they had to receive from them a ſpeedy and a certain help? One might at the ſame time likewiſe perceive the Generoſity of others extraordinarily augmented through the Confidence they had in their ſafe hands. Let us therefore treat no longer of that, of which none are ignorant; but rather make ſome few reflections on your Charity (which renders you every-where ſo famous) in aſſiſting gratis with your ſage and prudent Counſels an infinity of Sick, who meet from all parts at St. Come, the firſt Monday of every Month in the year, to conſult with you upon many Diſeaſes, to all others (except you) incurable; deſpairing ever to obtain a cure for their Maladies, if it do not deſcend from your famous Magazine. This Charity alſo plainly appears in the Inſtruction you beſtow gratis upon all Students in Chirurgery, appointing ſome from amongſt you, to make them Demonſtrations in Anatomy, and teach them the true Method how well to perform all the Operations of Chirurgery; of which Commiſſion I have had the honour to acquit my ſelf, as well as it was poſſible for me, during three years, in purſuance of the Order you gave me to that purpoſe: But (ſince in thoſe Exerciſes, ſo ordered by you, we do not uſually diſcourſe of Women with Child, nor of their different Labours) I have thought, that, to diſcharge my ſelf intirely of my duty, you will not judge amiſs, my publiſhing this Book to the world, which I preſent you; in which I endeavour to demonſtrate exactly the means of remedying many Indiſpoſitions of Women with Child and in Childbed, with an exact Method of well-practiſing the Art of Midwifery, being perſwaded that it may be very profitable to many young Chirurgeons, who live in the Country, where but very few ſufficiently inſtructed in all things neceſſary to be known, can be met with; I have alſo the rather undertaken this, that the Midwives may finde in it that which they ought to know, to enable them the better to exerciſe their Ar, and undergo the Examination, which at preſent they are obliged to before you for their Reception: I hope likewiſe (Gentlemen) you will have the goodneſs to excuſe it, though it hath not ſo fair a form as the matter requires, and though I do not expreſs the contents ſo perfectly as you conceive them; for I have (I confeſs with a little too much confidence) undertaken to open divers ſecrets of Nature, which (being very abſtruſe, and as difficult to be comprehended) create yet incomparably more trouble to explain them ſignificantly, to be well underſtood: notwithſtanding, as it is often ſeen, that a dark body reflects the light which it receives; ſo likewiſe I hope, that this ſmall Work may (by the reflection of the Sun of your Doctrine, of which I have received many rayes) enlighten the young Chirurgeons and Midwives in the difficulties which they often meet with at Labours.
Accept then (Gentlemen) this ſmall Production of one of your Children, who conjures you, by the love of Fathers, (that never diſown their Children, how deformed ſoever) to defend it againſt Envy and Detraction, which will never dare to attaque it, when you have vouchſafed it your Protection; which is the Favour deſired from you by
VVEE under-written, Sworn Provoſts and Wardens of the Maſter-Chirurgeons of the City of Paris, do certifie that we have ſeen and examined a Book, compoſed by FRANCIS MAURICEAU, ſworn Maſter-Chirurgeon of Paris, intituled, The Diſeaſes of Women with Child, and in Child-bed; With a true Method of aſſiſting them in their natural Labours; and the means of remedying all thoſe contrary to Nature; and the Diſeaſes of Infants new-born: Likewiſe an exact Deſcription of all the Parts of a Woman deſtin'd to generation; together with many Figures ſuitable to the ſubject. Which Book We eſteem very profitable for the Publick, and neceſſary for young Chirurgeons, and all Midwives, to learn perfectly the practice of the Art of Deliveries: in confirmation of which we have ſigned this preſent Certificate. Paris the 15th of March, 1668.
BY the Grace and Priviledge of the King, given at St. Germans the 10th day of June 1668. ſigned Le Groſs, it is granted to Francis Mauriceau, ſworn Maſter-Chirurgeon of Paris, to print, ſell and diſtribute, by ſuch Printers and Bookſellers as he ſhall think good, a Book, compoſed by him, entituled, The Diſeaſes of Women with Child, and in Childbed, &c. With expreſs Injunction and Prohibition to all perſons of what quality or condition ſoever, not to print the ſaid Book; nor to ſell, nor vend any other Impreſſion than this which the ſaid Mauriceau hath cauſed to be made, or ſuch as he hath authorized; nor likewiſe, to copy or counterfeit any of the Figures of the ſaid Book for the ſpace of Ten years, commencing from the time that the Impreſſion ſhall be compleated, Upon pain of Confiſcation of the Counterfeit Copies, and of 300 l. and reimburſing all charges and damages whatſoever, as it is more amply recited in the ſaid Priviledge, of which this preſent Extract ſhall ſerve for ſufficient notice.
SInce in the Age we live in, we ſee, that moſt people are govern'd rather by Opinion than Judgment, I deſire, that, if you mean to profit by reading my Book, you will reade and examine it without any critical Envy, and free from all ſort of preoccupation, which may obſcure your Judgment, and hinder you from acknowledging the Truth of thoſe Things I pretend to teach. Therefore be not of their humour who condemn a Conception when they underſtand it not; and believe it falſe, becauſe 'tis new; neither imitate ſuch, who ſeeking alone to carp at words, neglect the ſenſe of the Diſcourſe: For, even as it happens very often, that Purging, though proper for a Diſeaſe, doth no good to a Patient, when his Body is not well prepared, and diſpoſed for its Operation: ſo the Doctrine of Books, which is one of the moſt wholſom effectual Remedies we have to chaſe away ignorance, is wholly uſeleſs to mens wits, if they are not diſpoſed to receive it. I believe I may hope you will eaſily grant me this requeſt, becauſe it is for your advantage: In the mean time, though I deſign to inſtruct you here in whatſoever concerns Women with Child, or in Labour, yet I would not divert you from reading of many learned Authors who have treated of it, but only adviſe you that the moſt part of them, having never practiſed the Art they undertake to teach, reſemble (in my opinion) thoſe Geographers, who give us the deſcription of many Countries which they never ſaw, and (as they imagine) a perfect accompt of them; which makes it very difficult (not to ſay impoſſible) they ſhould ever obtain their end: For it is certain (as Plutarch hath very well noted) that the ſpeculative part of Arts is improfitable, and unfruitful, when deſtitute of the practice. You may then, as to this ſubject, relye on the Method I ſhow you, ſince, to conduct you in it, I faithfully recite what I have with very happy ſucceſs obſerved theſe many years in the practice of Deliveries.
Furthermore, blame me not for being of a Judgement different from the common opinion of many; for I declare I have only bound my ſelf to acquaint you with the truth, of which, I hope, you will have more Satisfaction, and be better pleaſed, than if I had always blindly followed the thoughts of others; having likewiſe endeavoured, not to extend my ſelf in ſuperfluous diſcourſe, to the end I might be more intelligible to yong Chirurgeons, and Midwives, to whom this Book (if I be not miſtaken) will be as uſefull as any, to teach them the ſafe practice of the Art of Deliveries. I have not ſtuft it with a great number of long Receipts, which ſerve only to ſwell a Volumn, and confound their Wits in the uncertainty of the choice of ſo many different Remedies, compoſed of Drugs which very often are unknown to them; but ſingly contented my ſelf to teach them the beſt, and principally ſuch as we ordinarily uſe in our practice. But if in all this you find ſome of my Opinions not wholly Satisfactory, or that others (according to your Opinion) are not fully agreeing with the Truth; remember, that as amidſt the beſt Corn, there alwayes ſpring Tares, or ſome other Weeds; ſo in like manner you meet with few Books, whoſe doctrine is ſo pure, as not to find ſomething in them to reject: and if I may hope for any reſpect from you in recompence of my pains, it will be but proportionable to what you may have for many others, who never had, in this occaſion, a greater deſire than my ſelf to render you ſervice.
HAving long obſerved the great want of neceſſary directions how to govern Women with Child and in Childbed, and alſo how new-born Babes ſhould be well ordered, I deſigned a ſmall Manual to that purpoſe, but•…ing ſometime after in France with this Treatiſe of Mauriceau, (which, in my opinion, far exceeds all former Authors, eſpecially Culpeper, Sharp, Speculum Matricis, Sermon, &c. being leſs erronious, and inriched with divers new Obſervations) I changed my reſolution into that of tranſlating him; whom I need not much commend, becauſe he is fortified with the approbation of the Wardens of the Chirurgeons Company of Paris.
His Anatomy, at the beginning of the Book, I have omitted, there being already ſeverall in Engliſh; as alſo here and there a paſſage that might offend a chaſt Engliſh Eye; and being not abſolutely neceſſary to our purpoſe: the reſt I have, as carefully as I could, rendred into Engliſh for the benefit of our Midwives; ſome of whom may yet very well admit of an additional Knowledge. The principal thing worthy their obſervation in this Book, is, accurately to diſcover what is properly their work, and, when it is neceſſary to ſend for advice and aſſiſtance, that ſo, many Women and Children may be preſerved, that now periſh for want of ſeaſonable help. My Author marks out the breaking of the right Waters, for the proper ſeaſon of a naturall Delivery, and (when ever a Child is not born thou, or ſoon after) Nature is ſo much ſhort of performing her office. This is certainly a great truth; and all wrong births ſhould never be longer delaied; and for the moſt part Floodings and Convulſions not ſo long, leſt the Woman loſe her life before ever the Water breaks: but if no dangerous Accident intervene, in a right labour, one may lengthen out their expectation to 12 hours after; and, though ſome may have been happily delivered 24 hours, or two dayes after, yet ſhould I not adviſe any to run that hazard, provided they can have an expert Phyſician to deliver them, without deſtroying the Child; becauſe many have periſhed in that caſe; and it is not prudent to venture, where but one of many eſcapes: for the longer the Labour continues after the Watters are broke, the weaker both Woman and Child grow, and the drier her bodie, which renders the birth the more difficult; and 'tis over good taking time by the fo•e•…p.
And that Midwifes skill is certainly the greatest, and ſhe deſerves moſt commendation, who can ſooneſt diſcover the ſucceſs of the Labour, and accordingly either wait with patience, or timely ſend for advice and help. Nor can it be ſo great a diſcredit to a Midwife (let ſome of them imagine what they pleaſe) to have a Woman or Child ſaved by a Man's aſſiſtance, as to ſuffer either to die under her own hand, although delivered: for, that Midwife miſtakes her office, that thinks ſhe hath performed it, if ſhe do but lay the Woman; becauſe her principal duty is to take care that ſhe and her Child be well, with ſafety and convenient ſpeed parted; and, if this be impoſſible for her, and feaſible by another, it will juſtifie her more to wave her imaginary Reputation, and to ſend for help to ſave the Woman and Child, than to let any periſh, when poſſibly to be prevented; As in the caſe of my Author's Siſter in the 20th Chapter of his firſt Book. Yet, in Countries and places, where help and good advice is not ſeaſonably to be had, Midwives are compelled to do their beſt, as God ſhall enable them; which dangerous and uncertain tryals would not become them to put in practice upon Women, where no timely aſſiſtance need be wanting. Moſt wrong Births, with or without pain; all Floodings with Clods, though little or no pain, whether at full time, or not: all Convulſions; and many firſt Labours; and ſome others, though the Child be right, if little or no pain, after the breaking of the Waters, and the Child's not following them in ſome ſix or ten houres after, requires the good advice of, and, peradventure ſpeedy delivery by thoſe Phyſicians that are expert in this practice: for, though ſome few may eſcape in theſe caſes, yet far the greater number would periſh, if not aided by them. And let me therefore adviſe good Women, not to be too ready to blame thoſe Midwives skill, who are not backward in dangerous caſes to deſire advice; leſt it coſt them dear by diſcouraging them, and forcing them to preſume beyond their knowledge, or ſtrength especially, there being already but too-too-many over confident.
Thoſe few things wherein I diſſent from my Author, if of dangerous conſequence, I note in the Margent; if not, I paſſe it by, leaving it to the election of the Reader.
I muſt confeſs he is in many places too prolix; a fault that many of the French affect; however, I choſe rather to tranſlate him according to his own ſtile, than contract him; and alſo to leave unaltered ſome things not very well expreſſed, being of no great moment. I find alſo that he doth not diſtinguiſh between the words Plaiſter and Ointment, but uſeth them promiſcuouſly one for the other.
In the 17 Chap. of the ſecond Book, my Author juſtifies the faſtning Hooks in the head of a Child in a difficult Labour, where it comes right; which I confeſſe hath been and is the practice of the moſt expert Artiſts in Midwifry, not onely in England, but throughout Europe; and hath very much cauſed the report, that where a man comes, one or both muſt neceſſarily dye; and makes many for that reaſon forbear ſending, untill either be dead or dying. But I can by no means approve of that practice, or thoſe delaies; becauſe my Father, Brothers, and my Self, [though none elſe in Europe that I know] have by Gods bleſſing, and our induſtry, attained to, and long practiſed a way to deliver a Women in this caſe without any prejudice to her or her Infant; though all others, (being reduced, for want of ſuch an expedient, to imploy the common way) do, and muſt endanger, if not deſtroy one or both, by the uſe of theſe Crochets. By this manuell operation we can alſo both ſhorten the time, and leſſen the number of pains in a right Labour, (if there be the least difficulty) without danger, and with advantage to both Woman and Child. If therefore the uſe of Hooks by Phyſicians and Chirurgeons, be condemned (without thereto neceſſitated through ſome monſtrous birth) we can much leſſe approve of a Midwifes uſing them, as ſome here in England boaſt they do; which raſh preſumption, in France would call them in queſtion for their lives.
In the 15th Chapter of this Book my Author propoſeth the conveying ſharp Inſtruments into the womb, to extract a head; which is a dangerous operation, and may be much better done by our fore-mentioned Art, as alſo the inconvenience and hazard of a Child dying thereby prevented, which he ſuppoſeth in the 27th Chapter of this 2d Book.
I will now take leave to offer an Apology for not publiſhing the ſecret I mention we have to extract Children without hooks, where other Artiſts uſe them, which is, that there being my Father and two Brothers living, that practiſe this Art, I cannot eſteem it my own to diſpoſe of, nor publiſh it without injury to them; and think I have not been unſerviceable to my Country, although I do but inform them that the forementioned three perſons of our family and my ſelf, can ſerve them in theſe extremities with greater ſafety than others.
The Reader alſo may pleaſe to know that ſome explanations in the Margent, as lovingly, p. 6. and untimely, & unſeaſonably, p. 22. with ſome others, were never intended to have been inſerted, but left for the Printer to make choice of the most familiar of them, which (he miſtaking) was, to prevent further trouble, ſuffered to be ſo printed.
I do not intend this work to incourage any to practiſe by it, who were not bred up to it; for it will hardly make a Midwife, though it may eaſily mend a bad one. Yet notwithſtanding I do recommend it to the peruſall of all ſuch women as are carefull of their own and their friends ſafeties, there being many things in it worthy their noting: And deſigning it chiefly for the female ſex, I have not troubled my ſelf to oppoſe or comment upon any Phyſical or Philoſophical Poſition my Author propoſeth. I hope no good Midwives will blame me or my Author for reprehending the fault of bad ones, who are onely aimed at, and admoniſhed in this work; and I am confident none but the guilty will be concerned, and take it to themſelves, which I deſire they may, and amend.
PAge 8. line 8. for Inteſtin, read Inteſtinum. Pag. 13. lin. 1. r. ſuch as. P. 19. l. 3. f. upper parts, r. Nipples. l. 19. r. Womb is free. P. 58. l. ult. r. that miſcarried. P. 63. l. 24. r. Hypogaſter. P. 95. l. 9. r. Corroberatives. P. 96. l. 4. r. a Wafer will be very fit. P. 101. l. 18. f. Iorn, r. Iron. P. 132. l. 11. the Comma behind together, muſt be before it. P. 133. l. 15. f. the, r. a. l. 28. f. which it yet does, r. as it alſo doth. P. 213. l. 1. f. capable, r. able. P. 224. l. 24. f. marked D. r. C. and the ſame in pag. 236. l. 9. P. 287. l. 1. f. an, r. a. P. 301. l. 3. f. brannes, r. meales. P. 430. r. CHAP. XXXVI. l. 24. r. requiſite.
Aurora Chymica: or, A rational way of preparing Animals, Vegitables and Minerals for a Phyſical uſe, &c. Authore Edw. Bolneſs, Med. R. Ord.
A Philoſophical Eſſay; Declaring the probable Cauſes whence Stones are produced in the greater World; as alſo the Cauſes and Cure of the Stone in the Kidnies and Bladders of Men, &c. By Dr. Thomas Shirley, Phyſician in Ordinary to his Majeſty. Sold by W. Cadman, at the Popes-head in the lower Walk of the New-Exchange.
Praxis Medicorum Antiqua & Nova: The Antient and Modern Practice of Phyſick examined, ſtated and compared. By E. Manwaringe, Dr. in Phyſick. Sold by Tho. Archer Bookſeller, under St. Dunſtans-Church in Fleetſtreet.
MAny Indiſpoſitions may arrive to Women from the time of Conception to the full term of Labour, becauſe they are then not only ſubject to thoſe which are cauſed by pregnancy, but to thoſe alſo which happen at other times. It is not my deſign ſo to enlarge as to examine all, but onely to enquire into the principal and moſt uſual Maladies that accompany Great-Bellies, and have, during their courſe, ſome particular Indications for their Cure; for as for thoſe which have only general Indications, and may happen indifferently to a Woman at any time, they may eaſily be known and redreſſed by the ordinary means, provided that you have all the while regard to the diſpoſition of the Great-Belly.
It would be ſufficient to my purpoſe, of a through examination (in purſuance of my intention) of every circumſtance of a Great-Belly, to begin with2 the explication of a Conception, which muſt precede it: but, ſince that cannot happen but to a fruitfull Woman, I will, before I diſcourſe of it, that you may the better underſtand it from its original, give you ſome conſiderable Obſervations concerning the Fruitfulneſs and Barrenneſs of Women; for Barrenneſs proceeds oftner from Women than Men: for there are many conditions required in a Woman, which Men have no occaſion of, who only need to provide a ſmall quantity of their Seed, and that at once, to generate; but Women, beſides their Seed, muſt have a fit place to receive both, as the Womb is when well diſpoſed; and matter appointed for the Child's nouriſhment, during its whole ſtay there, as is the menſtruous blood: This is the cauſe, that for one impotent Man, there may be above thirty barren Women found. Let us therefore firſt of all ſee what are the ſigns of Fruitfulneſs and Barrenneſs in Women.
By the Fertility of a Woman, I underſtand a natural diſpoſition of her Body, by means of which, with the aſſiſtance of a Man, ſhe may engender her like: And by Sterility, which is directly contrary, I intend an**Incapacity. Impotency, which proceeds from ſome vice or fault either of her whole body, or of ſome particular part. We muſt how3 make ſome enquiries after the moſt notable ſigns of the one and the other, and chiefly of thoſe which may be perceived by our ſight or touch, by which we may better judge than by many others, that for the moſt part are uncertain: For thoſe which are taken from different temperaments, may eaſily deceive us, foraſmuch as we may often find Women of a very ill habit, and full of ill humours, notwithſtanding fruitful.
Firſt, therefore, we affirm the Womb to be a part abſolutely neceſſary to fertility, and the principal object to be repreſented and examined to make a judgment of it: but as we find not every Ground proper to yeeld Fruit, and that ſome are ſo ungrateful as to produce nothing; ſo likewiſe it is not enough, for a Woman to have a Womb to be capable of Conception, ſince we find divers that have them, barren.
We have already**In his Anatomy not yet printed ſhewed you exactly what the compoſition and natural ſtructure of it ought to be, for to ſerve to ſo admirable an end as generation: Wherefore we will now ſpeak no further of that, but refer you to that place to be informed.
You muſt know then in general that the ſigns of fecundity in a Women are, that her Womb be well diſpoſed, that ſhe be at leaſt thirteen or fourteen years of age, and at moſt but 45 or 50 generally and for the moſt part (though ſome, yet very rarely, conceive ſooner or later according to their different natures and diſpoſitions) that they be of a good temperament and indifferently ſanguine, that they have their Courſes in due time, of good blood and laudable in coulour, quantity, quality, and conſiſtance, and regularly every month, at once, without4 interruption, from the time they begin to flow till the time the evacuation is compleated.
We ſay that the bloud ought to be good and laudable, becauſe it is a regurgitation and natural evacuation only of what is ſuperfluous in Women not with Child, and yet of age capable of Conception; which hath no malignity in it ſelf, as many falſly imagine: for in healthful women it hardly differs either in colour, conſiſtence, or quality from that which remains in the veſſels, except in the ſmall alteration, which is cauſed by the heat of the place whence it proceeds, and by the mixture of ſome humours with which the womb is alwayes plentifully furniſht.
This evacuation (if in order) ought to be every month but once, though ſome have them every fourtnight, or at the end of three weeks, according as they are more or leſs ſanguine, or cholerick, or have their blood heated: and to continue two or three days together, or ſix at moſt, and that by little and little, conſtant without interruption, and alſo more or leſs according to the difference of their particular temperaments. If a Woman have few of them, as when ſhe grows in years, ſhe becomes barren, foraſmuch as this blood ſeems to nouriſh the Child in the Womb: and likewiſe if ſhe have too many, becauſe the Woman thereby grows too weak and the Womb too cold. There are notwithſtanding ſome Women who void more of them in two days, than others in eight. They muſt flow by little and little without interruption, and not all at once; for great and ſudden evacuations cauſe great diſſipation of ſpirits, of which abundance are neceſſary for generation; and the interruption of theſe evacuations5 ſhews ſome impediment in nature, or ſome vice or evil diſpoſition of the Womb.
If all theſe ſigns concur, we may very probably judge the Woman fruitful; I ſay probably, becauſe there are many who have them all, and yet cannot conceive, though they do their endeavours, and obſerve thereto all the requiſite and neceſſary circumſtances which we ſhall hereafter mention: There are likewiſe others, who, notwithſtanding they have not all theſe conditions, are fruitful. Now if all the above named patticulars are found in a Woman that is barren, and that you deſire to inquire more narrowly, and to be informed more certainly whether ſhe be capable of conception, Hippocrates teacheth a way to know it, to which I give little credit, becauſe the reaſons of it are very obſcure. It is in his 59 Aphoriſm of his 5th Book, where he ſaith, Si mulier non concipiat, & ſcire placet an ſit conceptura, veſtibus undique obvolutam ſubter ſuffito: ac ſi odor corpus pervadere videatur, ad nares & os uſque, non ſua culpa ſterilem eſſe ſcito. If a Woman doth not conceive, and you are deſirous to know whether ſhe is capable, or no; wrap her cloſe round with clothes, and put a perfume under her; and if ſhe perceive the ſent to paſs through her body to her noſe and mouth, be aſſured (ſaith he) it is not her fault ſhe is barren.
Fertility was anciently ſo eſteemed by our fore-fathers, that they believed Barrenneſs to be a mark of reprobation; by reaſon of which the fruitfull Servant deſpiſed her barren Miſtreſs; as we reade in the 16th Chapter of Geneſis, where mention is made of Sarai, Abraham's Wife, who, ſeeing that ſhe could have no Children, and being paſt the age6 of hoping for any, and that her Husband was diſpleaſed at it, bid him take her Aegyptian Chamber-maid, named Agar, to lie with him, that by her means the might give him lineage, which good Father Abraham quickly did, and had by her afterwards a Son, which was called Iſhmael: but from the time this Maid had conceived, ſhe began to deſpiſe her Miſtreſs Sarai, who was as yet barren. The Women of our times are not ſo earneſt to have lineage after this faſhion, there being but few that will ſuffer their Husbands to careſs their Chamber-maids, much leſs**Lovingly. charitably to excite them to follow this example, which cuſtom is aboliſhed amongſt us.
I alſo admire the great paſſion which many have, who complain of nothing with greater regret than to the without Children, eſpecially without Sons. For my part, I believe they that deſcend from Caeſar, or the Family of Bourbons, may with ſome reaſon be led away with this ſuperſtitious and common inclination of preſerving their kind, and be vexed with theſe ſorts of inquietudes, which no wayes become ordinary people; though excuſable, and may be permitted to great Monarchs and illuſtrious men.
When we perfectly underſtand the natural diſpoſitions, we may the eaſier diſcern thoſe contrary to nature; wherefore the ſigns of fruitfulneſs eaſily teach us thoſe of barrenneſs. The ſigns and cauſes of barrenneſs proceed either from the age, or evil temperature and vicious conformation of the Womb, and parts depending on it, or the indiſpoſition and intemperature of the whole habit. The evil conformation of the Womb renders Women7 barren, when its neck (called the Vagina) is ſo narrow, that it cannot give way to penetration; and when it is wholly or in part cloſed by ſome external or internal membrane, (which is very rare, if at all) or by any tumour, calloſity, or cicatrice, which may hinder the Woman from the free uſe of copulation.
But it is not ſufficient that the Man's Yard enter the Vagina, which is the anti-chamber to the Womb: for, if in the act of copulation, he knocks at the door, which is the internal orifice, and it be not opened, all is to no purpoſe. This orifice is likewiſe hindred from opening by ſome calloſity, proceeding from abundance of ill humours, which uſually ſlow down from the Matrix, or by ſome tumour which may happen to it; or alſo, by ſome part, which may ſo compreſs it, that it cannot dilate to receive the Seed, as doth the Epiploon (or cawl) in fat Women, according to the opinion of Hippocrates in his 46th Aphoriſm of his 5th Book, where he ſaith, Quae praeier naturam craſſae, non concipiunt, iis os uteri ab omento comprimitur, & priuſquam extenuentur, non concipiunt. Women exceeding fat do not conceive, becauſe the Cawl compreſſeth the orifice of their Womb, neither can they till they grow lean. I do not willingly admit amongſt the cauſes of barrenneſs, this compreſſion of the inward orifice by the Epiploon, foraſmuch as Aritin hath very well remedied it, by ſome of the poſtures invented by him, by which this orifice need not be ſo compreſſed in the action.
The moſt frequent reaſon why this orifice opens not in this act to receive the Man's Seed, is the inſenſibility of ſome Women, who take no pleaſure in the venerial act; but when they have an appetite,8 the Womb deſirous and covetous of the Seed, at that inſtant opens it ſelf to receive it, and be delighted with it. But though the Vagina, or neck of the Womb, and the inward orifice opens to give paſſage to the Seed; yet may they very often continue barren, if the ſcituation of this orifice be not rightly placed, but either backwards towards the**Great, or right Gut. Inteſtin rectum, or towards either ſide; all which hinders the Man from††ſhooting. darting his Seed directly into it, and conſequently the Woman from conceiving.
Hippocrates ſeems to have noted all the ſigns and cauſes of barrenneſs, which uſually proceed from the evil temper of the Womb, in his 62 Aphoriſm of the 5th Book, where he ſaith, Quae frigidos & denſos habent uteros, non concipiunt, & quae praehumidos habent uteros, non concipiunt: extinguitur enim in ipſis genitura. Et quae plus aequo ſiccos & adurentes: Nam alimenti defectu ſemen corrumpitur. Quae vero ex utriſque nactae ſunt moderatam temperiem, eae faecundae evadunt. All ſuch Women whoſe Womb is cold and cloſe, cannot conceive; nor they who have it too moiſt: becauſe the Seed is extinguiſhed in it. And likewiſe ſuch who have it too dry and hot; becauſe, for want of aliment the Seed corrupts: but ſuch as are of a moderate temperament are fruitful. Of all theſe which Hippocrates recites in this Aphoriſm, the moſt common, according to my opinion, is the continual Humidity of the Womb, fed by an abundance of the Whites, with which many are very much inconvenienced, the humours of the whole Body being accuſtomed to ſteer their courſe this way, which9 can very hardly be turned away when inveterate, and the Womb being imbued with theſe vicious moiſtures, becomes inwardly ſo unctuous and ſlippery, that the Seed (though viſcous and glutinous) cannot cleave to it, nor be retained within it, which is the cauſe that it ſlips immediatly away, or in ſome ſhort time after it is received.
Barrenneſs may alſo proceed from the whole habit of the Body, as when a Woman is too old, or too young: for the Seed of the young is not yet prolifick, neither have they the menſtruous blood; which two things are requiſit to fruitfulneſs: and that of the aged is in too ſmall a quantity, and too cold, who likewiſe want the menſtruous blood. An univerſal intemperature (though the Woman be of convenient years) renders them however barren, as it happens when they are hectick, hydropick, feaveriſh and ſickly, and eſpecially ſo much the more as the noble parts are fallen from their temperament and natural conſtitution: There are however many Women which ſeem barren for a long time, becauſe of ſome of the fore-mentioned Reaſons, yea, till they are thirty five or forty years old, and ſometimes longer, who yet at laſt conceive, being cured of the indiſpoſitions which hindred them, and having changed their temperament by their age, of which we have had a remarkable example in the perſon of Queen-mother, lately deceaſed, who was above two and twenty years married, and without Children, and yet afterwards, to the great joy and content of all France, ſhe had our invincible Monarch Lewis the 14th, now reigning, to whom God grant a long and happy life.
10Some of theſe Barrenneſſes may ſometimes be cured by removing their cauſes, and procuring the diſpoſitions we have ſaid are neceſſary to fruitfulneſs; yea, of thoſe which proceed from an univerſal intemperament, by reducing the Body with a good and convenient regimen to a good order, and this according to their reſpective indiſpoſitions. Wherefore if a Woman have naturally the Vagina too narrow, and not from ſome of the cauſes abovementioned, ſhe ought to be joyned to a Man whoſe Member is proportionable, if poſſible: and if that will not do, (which happens very ſeldom) ſhe muſt endeavour to relax it and dilate it with emolient Oyls and Oyntments; if the neck of the Womb be compreſſed by any humour, it muſt be reſolved and ſuppurated according to its nature and ſcituation, having alwayes care to prevent the corruption of theſe parts, which being hot and moiſt, are very ſubject to it; becauſe the womb ſerves as a ſink by which all the ill humours of the body are purged; ſo that you muſt take great care, that theſe kind of Tumours turn not to a Cancer, which is a very miſchievous malady, and cauſeth the poor Women miſerably to languiſh which are afflicted with it, and which after many inſupportable pains, brings them almoſt alwayes to an inevitable death.
When the Vagina is not clear in its capacity, becauſe of any ſcar after a rent, cauſed by ſome force or violence to the Woman, or of ſome hard labour, or after an ulcer which cauſed the two ſides to be agglutinated, whether inwardly or outwardly, it muſt be ſeparated the beſt that may be with a**A kind of large Inciſion-knife. Biſtory, or ſome other Inſtrument, according as11 the caſe requires, hindring, by interpoſed Linnen, that it do not again agglutinate.
When a Woman hath no Vulva, or outward entry of the Womb pierced, which is very rare, it muſt be opened by making a long Inciſion.
Fabricius recites the like caſe in a Girl of thirteen years of age, who was like to die of it, becauſe her Terms could not come down, there being no perforation, wherefore he did the like operation, which ſucceeded very well, and made her by that means capable of generation. As to the inward orifice of the Womb, if it be diſplaced either towards the back or ſides, it may be in ſome ſort remedied, by making the Woman to obſerve, in the act of generation, a convenient poſture, that the Man's Seed may be ejaculated towards the orifice; and if the Whites, or other Impurities of the Womb cauſe barrenneſs, as it is for the moſt part by the diſcharge of the whole habit on this place; it muſt be helped by Evacuations, Purgations, and a regular Diet, according to their different cauſes, and qualities of theſe ill humours.
Having thus diſcovered the moſt certain ſigns of Fertility, and the marks of Sterility, I will now (the better to purſue the order I have propoſed) treat of Conception.
IT is moſt certain, according to the Rule of Nature, that a Woman is incapable of conceiving, if ſhe have not the conditions requiſit for fruitfulneſs: we have mentioned them in the foregoing chapter: let us now examine in this, what is Conception, and how it is cauſed. Conception is nothing elſe, but an action of the Womb, by which the prolifick ſeeds of the Man and Woman are there received and retained, that an infant may be engendred and formed out of it. There are two ſorts of Conceptions; the one true, according to Nature, to which ſucceeds the generation of the Infant in the Womb: the other falſe, which we may ſay is wholly againſt Nature, and there the ſeeds change into water, falſe-conceptions, moles, or any other ſtrange matter.
The qualifications requiſit, for a Woman to conceive according to Nature, are, that the Woman receive and retain in her Womb the Mans and her own prolifick ſeed, without which it cannot come to paſs; for it is neceſſary that both ſeeds ſhould be there; nor is it at all true, what Ariſtotle and ſome other of his followers affirm, that the Woman neither hath nor can yeeld any ſeed, a great abſurdity to believe: for the contrary may eaſily be diſcovered, by ſeeing the Spermatick Veſſels and Teſticles of a fruitful Woman, appointed for this uſe, which are wholly filled with this ſeed, which13 in coition they diſcharge as well as Men. Such a will not open their eyes to behold a verity ſo clear, may make reflection on the reſemblance of Infants to their Mother, which could not be unleſs her ſeed had been more praedominant than the Fathers, when he begot them; which likewiſe happens after the ſame manner when the Fathers hath more force and vertue. Which may evince, that the Womens ſeed contributes as well to the formation of the Infant as the Fathers. If they will not agree to a thing ſo common, let them make another reflection on the generation of certain Animals, which participate of the nature of the Male and Female (of which they are engendred) though of different kind; as we daily ſee Aſſes and Mares produce by their coupling Mules, which are Animals of a middle nature reſembling both the one and the other, that produced them. We may then learn by this, that both Seeds are neceſſary for a true Conception, provided they be prolifick, that is, containing in them the Idea of all the parts of the body, and then the Womb being greedy of it, delights it ſelf in it, and eaſily retains it when received, elſe it ſoon afterwards rejects it.
It is not abſolutely neceſſary, that both the Seeds be received and retained intire, without the loſs of ſome part; for, provided there be a moderate quantity of it, 'tis ſufficient: Nor muſt we imagin, that (though all of it be not received into the Womb) the Child, formed out of it, will want ſome limb, as an arm, a leg, or other member, for want of ſufficient matter: inaſmuch as the forming faculty is whole in every part of the Seed, of which the leaſt drop contains in it potentially the idea and form of14 all the parts, as we have lately made appear: but indeed when the Seeds are received but in ſmall quantity, the Child may be the leſs & weaker for it: Or if either or both of them have not the requiſit qualities; or, though well enough conditioned, if the Womb be imbued and ſtuft with ill humours, as the menſtrues, whites, and other filth, or any other fault; if then there be a conception, it will be contrary to Nature, and there will be ingendred falſe births, Moles, or dropſies of the Womb, mixed with ſome other ſtrange bodies, which are very troubleſome to Women, till they void them.
It is therefore without cauſe, that many Women are blamed, when their children are born with red and livid ſpots, which very much disfigure the faces of ſome of them: It is uſually ſaid (but without reaſon) that this proceeds from the mothers longing to drink Wine; for, though ſome have, by chance, been in effect harraſſed (as they affirm) with theſe paſſionate deſires during their being with child, yet we muſt not ſuperſtitiouſly believe (as many do) that theſe ſpots are ſo cauſed, but rather from ſome other cauſe, which muſt be ſearcht for elſewhere: And that which makes it appear, it cannot proceed from hence, is, that almoſt throughout all Italy, where nothing but white wine is drunk, as alſo in Anjou in France, I have ſeen divers perſons marked with theſe red ſpots: and in caſe it proceeded from their Mothers longing to drink Wine, they ought to be white ſpots, or of an Amber colour, being the colour of the wine of theſe Countries: but we ought rather to conclude that they are cauſed, from ſome extravaſated blood, at the time the Infant is formed; which marks the skin, yet very tender with theſe15 ſpots, and colours it in whatſoever part it toucheth, much after the ſame manner as we ſee it marked with Gunpouder, or ſome waters producing the like effect when it is waſht and bathed with them. I will not however deny that the imagination hath a power to imprint on the body of the Infant, marks of this nature; but that can only be when young with Child, and principally at the very moment of conception; for when the Child is compleatly formed, the imagination can in no wiſe change its firſt figure, and Women muſt wean themſelves from theſe vain apprehenſions, which they ſay they have to ſuch things (every moment) and ſerves ſome of them for a pretext to cover their liquoriſhneſs.
Since my diſcourſe is fallen upon this ſubject of Marks, with which oft times the bodies of Infants are ſpoted in their birth, and which comes, as is ordinarily believed, from the imagination of their Mother, it ſeems to me not much from my purpoſe, to recite you a circumſtance very particular ſound on Me, when I came into the world, as my Father and Mother have often told me, which is, that my Mother being with Child of me, and almoſt at the end of her reckoning, as it appear'd afterwards, the eldeſt of her three Sons (which ſhe then had of ſix years old, and her firſt-born, whom ſhe loved with an extraordinary tenderneſs and paſſion) dyed in ſeven dayes of the ſmall Pox, all which time ſhe continned night and day by his bed ſide tending him in all his neceſſities, not ſuffering any other to do it, whatſoever deſires were made to her, not to weary and trouble her ſelf, as ſhe did, for the Childs ſickneſs, alledging that in her preſent condition, ſhe ought to be careful of her ſelf, and not be the cauſe16 of death to the Infant ſhe went with; in fine, at the end of ſeven dayes her Son dyed, upon which the next day ſhe was delivered of me, who brought effectively into the world with me ſix or ſeven of the ſmall Pox. Now it is certain, that it would be irrational to ſay, that I had then contracted theſe ſmall Pox in my Mothers Womb, by her ſtrong immagination: But if I were asked whence they proceeded? I ſhould anſwer, that the contagious air ſhe breathed without diſcontiuuance, during the whole ſickneſs of her deceaſed Son, had ſo infected the maſs of her blood, with which at that time I was nouriſhed, that I, rather than ſhe, eaſily received the impreſſion of this contagion, becauſe of the tenderneſs of my body. Let us therefore aſſert, that the imagination cannot produce any of the above mentioned effects, but at the moment of conception, or within few dayes after, and that we ought for the moſt part to ſearch elſewhere (if we deſire the truth of it) the cauſe of moſt of theſe Spots, Marks, and Signes with which many Infants are born.
AS it is very hard and belonging only to expert Gardeners to know Plants as ſoon as they begin to ſpring forth of the Earth; ſo likewiſe there are none but expert**Chirurgeons onely practiſe Midwifery in France. Chirurgeons can give a Woman certain aſſurance of Conception from its beginning: although ſome of theſe ſigns, reſembling thoſe of the ſuppreſſion of the Terms and other maladies in Women, cauſe many to be deceived in it.
I will not trouble my ſelf to make a recital of a great number of ſigns of conception, which rather tend to ſuperſtition, than an effective verity: but only the moſt eſſential and ordinary, by which a Chirurgeon may be aſſured of it; of which ſome may preſently be perceived, others not till afterwards. He ſhall firſt examine and inform himſelf, whether the Woman hath all or moſt part of the ſigns of fertility, which are already named in the diſcourſe of them, if not, he muſt impute them to ſome other cauſe; and ſuppoſing ſhe be fruitful, you may then know whether ſhe have conceived, by their agreement, and more then ordinary delight in the act.
It is not enough for a Woman to be certain ſhe hath conceived, and to yeeld and receive her ſeed with the Mans into her Womb, unleſs it cloſe at that inſtant, and retain it. There is an Article amongſt the cuſtoms of Paris, in which it is ſaid,18 that to give and keep is not good: but it is not ſo in Conception; for a Woman gives and caſts her Seed into her Womb, and there retains it. She may know whether ſhe retains the Seeds, if ſhe perceives nothing flow down from the Womb after Copulation: The Woman ſome few months after perceives alſo ſome ſmall pain about her Navel, and ſome little commotions in the bottom of her Belly, cauſed by the Womb's cloſing it ſelf to retain the Seeds, and contracting it ſelf ſo as to leave no empty ſpace, the better to contain them, and embrace them the cloſer. The light pain of the Navel comes from the Blader of the Urine (from the bottom of which proceeds the Urachus, which is faſtened to the Navel) which is a little agitated by that contraction and kind of motion that happens to the Womb, when it is cloſed to retain the Seeds, and from the like agitation comes alſo thoſe little commotions of the Belly.
Theſe are the ſigns of Conceptions, which may be known at the moment they happen, and may be yet more certainly known if you perceive the inward Orifice exactly cloſe. Beſides theſe ſigns, there are others which cannot be known till ſome time after, as when the Woman begins to have loathings, having no other Diſtemper, loſeth her appetite to meats which ſhe did love: longs to eate ſtrange things, to which ſhe was not accuſtomed, which happens according to the quality of the humours predominating in her, and with which her ſtomach abounds: She hath often nauſeatings and vomitings, which continue a long time: the Tearms ſtopping, no other cauſe appearing, having alwayes before been in good order: her Breaſts19 ſwell, wax hard, and cauſe pain, from the flowing of the blood and humours to them, wanting their ordinary evacuation, their upper parts are firmer and larger, becauſe of the repletion; the Navel ſtarts: her Nipples are very obſcure or dark coloured, with a yellowiſh livid circle round about: her Eyes are dejected and hollow, the whites of them dull and troubled: her blood, when ſhe hath conceived ſome time, is alwayes bad, becauſe the ſuperfluities of it not being then purged, as accuſtomed, is altered and corrupted by their mixture. Moreover, there is a ſign, which all the Women eſteem and hold in this doubtful caſe for very certain, which is, en ventre plat enfant y a, in a flat Belly there is a Child. Indeed there is rime in this proverb, and ſomething of reaſon, but not as they imagin, that the Womb cloſing it ſelf after Conception draws in a manner the Belly inwards and flatten's it, which cannot be; becauſe the Womb free and wavering, not faſtened forwards to the Belly, whereby to draw it back after that manner: but it may poſſibly be by reaſon that Women grow lean by the indiſpoſitions of their pregnancy, and wax thinner and ſmaller, not only in their Belly, but alſo throughout their whole body, as may be known the two firſt months of their pregnancy, during which time that which is contained in the Womb, is yet very ſmall; but when the Womans blood begins to flow to it in abundance, then the Belly waxeth daily bigger and bigger afterwards, until her reckoning be out.
All theſe ſigns concurring in a Woman who hath uſed copulation, or the moſt part of them together and ſucceſſively, according to their ſeaſons;20 we may paſs our judgment, that ſhe hath conceived, notwithſtanding that many of them may happen upon the ſuppreſſion of the Terms, which uſually produce the like: for every one knows, that it cauſeth alſo in Virgins, diſguſts, nauſeatings and vomitings, but not ſo frequently; the ſwelling, hardneſs, and pains of the breaſts, as alſo extravagant appetites, a livid colour of the Eyes, and others, to which you muſt have regard. The Matrix may be yet exactly cloſe, and the Woman not conceived: Yea there are ſome, in whom they almoſt never open, unleſs very little to give paſſage to the Tearms; which happens to ſome naturally, to others by accident, as by ſome calloſity proceeding from an Ulcer, or other malady.
If all theſe ſignes of Conception (which ſometimes may deceive us, though rarely, if they concur together) do not give us a ſufficient aſſurance of it, and that we deſire a better, Hippocrates teacheth us a way to know it, which I believe to be no more certain than the reſt: it is in his 42d Aphoriſm of his 5th Book; where he ſpeaks in this ſort, Si velis noſcere, an conceperit mulier, dormiturae, aquam mulſam potui dato: & ſi ventris tormina patiatur, concepit; ſin minus, non concepit: If you deſire to know whether a Woman hath conceived or no, give her, going to reſt, a draught of Metheglin; and if afterwards ſhe feels pains in her Belly, cauſed by wind ſhe hath conceived; if none, ſhe hath not, as he ſaith. Which is grounded (as I believe) upon the ſuppoſition that Metheglin breeds wind, which cannot paſs eaſily downwards, becauſe the Womb (being full) compreſſeth with its greatneſs21 the**The great Gut. Inteſtin rectum, on which it is ſcituated, and cauſeth thoſe winds to rumble, which are conſtrained to recoyl back into the other Inteſtines.
If there be any occaſion where Phyſicians or Chirurgeons ought to be more prudent, and to make more reflections upon their Prognoſticks for an affair ſo important as this is, it is in this which concerns their Judgments as to conception and Womens being with child, to avoid the great accidents and misfortunes, which they cauſe who are too precipitate in it without a certain knowledge. The faults which are committed through too much fear at ſuch a time, are in ſome ſort excuſable and to be pardoned; but not thoſe cauſed by temerity, which are incomparably greater. There are but too many poor Women who have been cauſed to miſcarry by Medicines and bleeding, not beleiving they were with Child, which are ſo many murders they are guilty of who cauſed it, either through ignorance or raſhneſs: beſides the death which they bring to thoſe little innocent creatures, by deſtroying them in their Mothers belly, they often thereby put the Mothers into great danger. We have lately had in Paris, in the year 1666, a miſerable example of this kind, in a Woman hanged, and afterwards publickly diſſected, near the Kitchen-Court of the Louvre, who was found four months gone with Child, notwithſtanding the report of ſuch perſons as had viſited her by the Judges Order before her Execution, who affirmed, contrary to the Truth, that ſhe was not with Child. That which deceived them was, the Woman's having effectually her Courſes, though with Child. Wherefore22 'tis not good to be too confident, foraſmuch as there are many with Child who have their Courſes; and I have known ſome who have had them all the time of their Great-Belly till the fifth or ſixth month, which happens according to the Womans being more or leſs ſanguine; though the greateſt number uſually have them not: but there are very few general rules, which may not ſometimes be excepted againſt.
This accident made ſuch a noiſe in Paris, that it quickly came to the knowledge of the King and all his Court, who very much blamed thoſe perſons, that by their ignorance had cauſed the**Untimely or unſeaſonable. precipitated Execution of this poor unfortunate Creature, with whom periſhed the Infant, innocent of the Mothers crimes. Nor muſt the Chirurgeon much truſt to what theſe ſort of Women may tell him concerning it, for, being afraid of the puniſhment of their crime, to delay it, do almoſt all ſay they are with child, which is a reaſon very conſiderable, why the perſons, to whom ſuch matters are committed, ſhould be very knowing. There are yet another ſort of Women, who having been ill treated, ſend for the Chirurgeon that he may give them a Certificate, the better to be revenged on their adverſary; which that they may the eaſier obtain, they alſo affirm themſelves with child, and having received blowes on their Belly, feign that they find their great pain, and if by chance they have at that time their Courſes, they endeavour to perſwade that it is a flooding, or ſhowes, wherefore he muſt be careful not to be deceived: and yet, that he may not be eſteemed ignorant, nor fall into23 the like diſgrace, when there is any cauſe of doubt, it is better to delay a little, then raſhly to pronounce his prognoſtick at a venture; for as there are Women, who would be thought to be with Child, though they are not; ſo there are others who will deny it, till they are brought to bed, as in this following example. About the year 1654, being in the Citty of Saumur, there was near my Lodging a young and very handſom Daughter of a Citizen, who was five whole months under a Phyſician's and Apothecaries hands, to be cured of a Dropſie which ſhe complained of: at length after ſhe had taken many violent Remedies they had ordered her, ſhe was cured in a moment, by bringing forth a Child at its full time, notwithſtanding all they had given her; which much aſtoniſhed the Phyſician and Apothecary, who were ſo groſly deceived, in truſting to the Maids relation, who counterfeited the Dropſie ſo well, that they could never perceive the truth till ſhe was brought to bed.
Some Women themſelves are deceived in their being with Child, as lately the Wife of a Counſellour of the Court, who after having been in a courſe of Phyſick of ſix or ſeven whole months for the Dropſie, under an eminent Phyſician, was at length brought to bed of a Child.
I knew another Woman, a Merchant of Squared-Timber at Paris, who never had a Child, though ſhe ſo paſſionately deſired it, as to be at the point of hoping for one at 55 years of age, under the colour that ſhe had ſtill her Courſes. This Woman was once perſwaded (upon the recital of ſuch ſigns as ſhe ſaid ſhe had) for the ſpace of ten whole months, that ſhe was with Child, of which the Midwife and24 many others aſſured her, and ſhe her ſelf likewiſe believed it (for it is eaſie to be perſwaded to believe what one hopes for with a ſtrong paſſion) ſhe had a big-belly, and ſaid alſo that ſhe felt the Child ſtir; and believed it ſo truly, that finding her ſelf one day worſe than ordinarily (after having prepared very fine neceſſaries for the Child ſhe imagined ſhe went with) ſhe ſent for the Midwife, who when ſhe was come, aſſured her it was her Labour: but the next day (having alwayes till then expected a Child) ſhe voided only a quantity of Water, with ſome Wind from the Womb, and nothing elſe: after which ſhe was forced to fold up her fine Toilets again which ſhe had provided. By theſe Examples we may learn not to be too ready to rely upon Womens Relations, if there be no other Reaſon, which may be known by the Examination of the Signs already declared.
Now ſince after Conception (of which we have juſt done ſpeaking) there follows Generation, let us conſider what it is, and how it is performed.
IT is a very great Truth, and generally known, That whatſoever is in this lower World, is ſubject to corruption, and at length conſtrained to ſuffer death: which hath obliged Nature, provident and careful of its preſervation, to endue all things with a certain deſire of eternizing themſelves,25 which not being poſſible in individuals, becauſe mortal by an indiſpenſible neceſſity, is therefore done by the propagation of their forms and kinds. She obtains her end, in reſpect of Animals, by the means of Generation ſucceſſively reiterated: for ſo all creatures ſeem to immortalize themſelves, in ſome ſenſe, by producing their like. And Fathers imagin themſelves not quite dead, if they leave their like behind them after their death, to wit, their Children.
By Generation, we underſtand generally, a progreſs of that which is, to that which is not. But this definition is a little too ample for to come to the knowledge of what we deſire concerning the generation of perfect Animals, and chiefly of Mankind; wherefore that our intention may be the eaſier conceived, we muſt ſearch ſome other, or rather a deſcription, which may more exactly diſcover the thing: to this purpoſe we ſay that by the generation of Mankind, we mean a proper and particular action of the Womb; by which working upon both ſeeds there retained, it forms and ſhapes a body out of them, compoſed of divers parts, which it diſpoſeth in order, to become in time the Organ of the Soul, which muſt be infuſed into it. There are many things requiſit to make the Generation perfect, without which it would be wholly and abſolutely impoſſible: there are uſually three principally reckoned, to wit, diverſity of ſex, their congreſſion, and the mixture of both Seeds, which we will a little particularly examine. Although ſome define a Woman to be an Animal which can engender in it ſelf, and that this may be true; yet it is moſt certain, that ſhe cannot engender without26 a Man that hath diſcharg'd his Seed into her womb. And though we daily ſee Pullets have Eggs, and other Fowl, without the Cocks treading them, yet of thoſe Eggs there will never come Chickens, becauſe the Male never had made an impreſſion on them, nor given them this prolifick vertue, which is abſolutely neceſſary to this purpoſe. This may convince us that diverſity of ſex is neceſſarily requiſit, as well to thoſe Animals, as to the more perfect, which is Man.
Diverſity of ſex would profit little, if copulation did not likewiſe follow; though ſome ſubtile Women, to cloak their ſhameleſneſs, would perſwade one that they were never touch'd by any Man who could get them with Child, as ſhe of whom Averroes ſpeaks, who conceived in a Bath in which a Man had waſht himſelf a little before, and had caſt forth his Seed into it, which was drawn and ſuckt in (as he ſaith) by the Womb of this Woman: but this is a ſtory fit to amuſe little children.
Now to the end theſe different ſexes ſhould be obliged to come to this touch, which we call Copulation, beſides the deſire of begetting their like, which naturally incites them to it, the parts of Men and Women deſtined to Generation, are endued with a delightful and mutual itch, to ſtir them up to the action, without which it would be impoſſible for a Man (ſo divine an Animal) born for the contemplation of heavenly things, to joyn himſelf to a Woman, in regard of the uncleanneſs of the parts, and of the act. And on the other ſide; If Women did but think of a thouſand pains and inconveniences which their great Bellies cauſe them, of the pains they endure, and the hazard27 of their lives when they are in labour, to which may be added the loſs of their beauty, which is the moſt precious gift they have, and which makes them be beloved by thoſe that poſſeſs them, certainly it might alſo afright them from it: But neither the one nor the other make theſe reflections till after the action (whence comes the ſaying, Poſt coitum omne animal triſte) conſidering nothing before but the mutual pleaſure they receive by it. It is then from this voluptuous Itch, and the deſire of begetting their like, that Nature obligeth both theſe ſexes to this congreſſion.
As to the mixture of both ſeeds; it is certain that the diverſity of ſexes and their congreſſion, are but for this end, without which Generation cannot be; though ſome would have Womens ſeed ſerve to no purpoſe; yea, that they neither have any, nor eject any, as Ariſtotle ſaith: but we have proved the contrary in the Chapter of Conception, by the example of daily experience, to which you may have recourſe, to avoid repetition.
All theſe three Circumſtances, to wit, the diverſity of ſexes, their congreſſion, and the mixture of their matters, which is called Seeds, muſt precede Conception, to which ſucceeds Generation, on this faſhion: As ſoon as the Woman hath conceived, that is, hath received and retained in her Womb the two prolifick ſeeds, it is every way compreſſed to imbrace them cloſely, and is ſo exactly cloſed, that the point of a Needle (as ſaith Hippocrates) cannot enter it without violence; after which it reduceth by its heat, from power into action, the ſeveral faculties, which are in the ſeeds it contains, making uſe of the Spirits with which28 theſe frothy and boyling ſeeds abound, and are as inſtruments with which it begins to trace out the firſt lineaments of all the parts, to which afterwards (making uſe of the menſtruous blood flowing to it) it gives in time growth, and the laſt perfection.
Generation may be divided into three different ſeaſons, which are, the beginning, middle, and the end. The beginning is, when there is no other matter in the Womb but the two ſeeds, which continue ſo to the ſixth day, as Hippocrates notes; and calls them for that time the geniture, as much as to ſay, from whence generation muſt proceed: he ſpeaks of it in his Book De Natura Pueri: and he ſaith, that by the experiences he brings of it, one may judge of the other times. He relates a ſtory of a Woman, which at ſix dayes end caſt forth with a noiſe at once out of her Womb the ſeeds ſhe had conceived, reſembling a raw egg, without a ſhell, having only the ſmall skin over it; or, to the abortive eggs, which have no ſhell: which little membrane was on the outſide a little coloured with red, and involved in it this ſeed, which was of a round figure: in the internal part might be ſeen white and reddiſh fibres, with a thick humour, in the midſt of which was found ſomething like the umbilick veſſels. Hippocrates calls this firſt time of generation, Geniture, as is already mentioned, during which time neither figure nor diſtinction can be obſerved, but only ſome beginning of a diſpoſition to receive the form of the parts; after which follows the ſecond time, which begins where the firſt ends, that is, at the ſixth day, and laſts to the 30th. The time that the ſame Hippocrates aſſures us the males are compleatly29 formed, and the females not till the 42d. After the firſt ſix dayes are paſt, and the Womb hath wrought, according to the faſhion we have explained, upon the ſeeds, which are there yet without any mixture of blood, having diſpoſed them to receive it; it is brought thither, in ſome ſooner, in ſome later, according to the Womans being nearer to or further from her time of having her Courſes when ſhe conceived, which produceth effects according to theſe different diſpoſitions: for if they flow too ſoon, or in too great abundance, as it befals ſuch as conceive at the point of having their purgations, the ſeeds are drowned and corrupted by it, which often cauſeth a flooding, or at leaſt the generation of a falſe-conception; but if they are far from their having them, the conception is ſo much the more ſtable. Now then, this blood diſtilling by little and little into the Womb of the Woman, who hath ſometime ſince conceived, ſerves as a fit matter to form and figure out all the parts of the Infant, which was only traced out by the ſeed; and yet doth it (according to my opinion) much like a Painter, who after he hath drawn the out-lines with a chauk upon his cloth, begins to lay colour upon colour, to paint by degrees all the parts of the perſon whoſe picture he draws. Some little ſpace after the beginning of this ſecond time, appears as it were the figure of thoſe three bubbles, of which Hippocrates ſpeaks, or rather three maſſes of this matter, which groſly repreſent the three parts called principal, the firſt of which compoſeth the Head; the ſecond, in the middle, the Heart; and the other the Liver: there may be likewiſe ſeen the after birth, with the umbilick veſſels faſtened to it,30 and the membranes which wrapt up the whole; after which from day to day all the other parts of the body are figured in ſuch ſort, that at thirty dayes end the males are compleatly formed, and the females the 42th day ordinarily, which is about the time the Faetus begins to be animated, though as yet there is no ſenſible motion.
Hippocrates ſeems by theſe different terms to be of an opinion that the Males have ſooner life than the Females, becauſe (he ſaith) their heat is greater: but for my part I do not beleive that the Male is ſooner formed than the Female, and that which thus perſwades me, is, becauſe, if it were ſo, the Male muſt likewiſe be at its full term, ſooner than the Female, proportionable to the ſame time, that the one is animated ſooner than the other; which wee ſee the contrary, in that the Women are brought to Bed indifferently both of Sons and Daughters at the ordinary terme of nine months. Let us therefore ſay, that towards the fifth or ſixth week, as well Males as Females have all the parts of their body (though ſmall and very tender) entirely formed and figured, at which time it is not longer than a finger, and from thence afterwards, which is our third time, the blood flowing every day more and more to the Womb (not by Intervals, as the Courſes, but continually) it daily grows bigger and ſtronger to the end of the ninth month, which is the full term of ordinary labour. Having explicated Conception and Generation, let us now conſider great Bellies and their differences.
THE great Belly of a Woman properly taken, is a tumour cauſed by the Infants ſcituation in the Womb. There are natural great Bellies, which contain a living Child, and theſe we call true; and others againſt nature, in which, inſtead of a Child, is ingendred nothing but ſtrange matter, as Wind mixed with Waters, which are called Dropſies of the Womb, Falſe-Conceptions, Moles, or Membranes full of blood and corrupted ſeed; for which reaſon they are called falſe great Bellies. We have already, where we treated of Conception and Generation, mentioned the cauſes and ſigns of a great Belly in its beginning, notwithſtanding we will again repeat the moſt certain and ordinary of them, which are nauſeouſneſs, vomittings, loſs of appetite to things the Woman was accuſtomed to eat and like; longings for ſtrange and naughty things; ſuppreſſion of the Terms, without Feaver or Shiverings, or other cauſe; pains and ſwelling of the Breaſts: all which may be found in Virgins, by the retention of their Courſes: but the moſt certain is, if putting the finger into the Vagina, you perceive the inward Orifice exactly cloſe, as alſo the diſtention of the body of the Womb conſiderable, more or leſs, according to the time the Woman is gone with Child, and the Childs ſtiring32 in the Womb, gives us indubitable proofs of it. It is fit we ſhould be alwayes careful not to be deceived by what we feel ſtir in the Womb, foraſmuch as the Infant of it ſelf hath a total and a partial motion; the total is, when it removes the whole body, and the partial is when it moves but one part at a time, as the Head, Arm, or Leg, the reſt of the body lying ſtill: but the Womb blown up in fits of the Mother, yea, and ſome Moles have by accident a kind of total motion, but never a partial one. That of a Mole is rather a motion of falling down than otherwiſe, to wit, a motion by which heavy things fall downwards: for a Woman who hath a Mole of any bigneſs conſiderable, whatſoever ſide ſhe turns her ſelf to, her belly falls immediatly the ſame way, like a heavy bowl. About the time (or very near) when the Infant quickens, if the Woman be certainly with Child, theſe humors (which are carried to the Breaſts by the ſtoppage of her Courſes) are turned to Milk, which when it happens, is uſually an aſſured teſtimony of pregnancy; though ſome Women have been found with Milk in their Breaſts (but rarely) and yet not with Child, nor ever having had any: which Hippocrates alſo confirms in his 39th Aphoriſm of his 5th Book, where he ſaith, Si mulier quae nec praegnans, nec puerpera eſt, lac habet, ei menſtrua defecerunt. If a Woman hath milk in her Breaſts, and is neither with Child, nor ever had any, it comes from the ſtoppage of her Courſes. But it is rather whey than milk, which in that caſe hath not the conſiſtence as the Milk of a Woman in Childbed, nay the Milk of a Woman with Child is yet but wateriſh, and becomes neither thick nor33 very white, till after labour ſhe begins to ſuckle her Child.
The Infant moves it ſelfe manifeſtly about the fourth month: or ſooner or later according as it is more or leſs ſtrong: ſome Women feel it from the ſecond, others about the third month, yea ſome before that time. In the beginning theſe firſt motions are very ſmall, and very like to thoſe of a little Sparrow when firſt hatched, but grow greater, proportionably as the Infant grows bigger and ſtronger, and at laſt are ſo violent, that they force the Womb to diſcharge its ſelf of its burden, as in Travail. The common opinion is, that the Males quicken before the Females, becauſe their heat is greater, but that is almoſt equal; for there are ſome Women perceive their Daughters, others their Sons ſooneſt, which happens indifferently to Males and Females, according as there was a more or leſs vigorous diſpoſition at their Generation. Very often Women who daily uſe Copulation, are ſubject to be deceived; for they uſually believe they are with Child if their Courſes ſtop, and withal are a little qualmiſh, which is not always true, for falſe conceptions cauſe almoſt the ſame accidents as true; which cannot eaſily be diſtinguiſhed but by its conſequences. This falſe great-Belly is, as we have already ſaid, often cauſed by wind, which blows up and diſtends the Womb, and which Women oft-times diſcharge with as much noiſe as if it came from the Fundament: ſometimes 'tis nothing but water which is gathered there in ſuch abundance, as ſome Women have been ſeen to void a pail full without any Child; though they verily believed they were with Child, as did that Wood-Merchant,34 whoſe ſtory you have in the end of the third Chapter, who did not void it till the end of the tenth mouth, till when ſhe alwayes believed her ſelf with Child. There are others who conceive only falſ-conceptions and Moles, which may be known by the Infants different motions, already mentioned, and by the Moles continuing in the Womb often after the ordinary time of labour, ſome Women having them a whole year, yea many years, according as theſe Moles are more or leſs adhering to the inner parts of the Womb, and are there entertained and nouriſhed by the blood that flows thither.
Moles alwayes proceed from ſome falſe-conceptions, which continuing in the Womb, grow there by the blood that flows to them, by the accumulation of which they are by little and little augmented: if the Womb expels it before two months, it's call'd a falſ-conception, & ſome are only but as it were the Seed involved in a membrane, like that geniture which that Woman voided after ſix or ſeven dayes, of whom Hippocrates ſpeaks in his Book, De natura Pueri. The others are a little more ſolid and fleſhy, reſembling in ſome ſort the Gizard of a Foul, and are greater or leſs, according to the time they ſtay in the Womb, and alſo according to the quantity of blood with which they are alwayes ſoaked. Women expel theſe falſ-conceptions ſooner or later, according as they cleave to the Womb, which makes them almoſt alwayes flood in great quantity at thoſe tunes.
It is of great importance to diſtinguiſh well between a true and a falſe Belly; for the faults committed by a miſtake, are ever very conſiderable:35 foraſmuch as in a true great Belly the Child ought to continue in the Womb, till Nature**This excludes not Art to aſſiſt Nature, if not able to perform its duty in due ſeaſon. expels it by a natural labour: but contrarily, the falſe great-Belly indicates to us, to procure the expulſion of what it contains as ſoon as may be: Wherefore we ought to be very careful.
IF prudence be neceſſary to enable a Chirurgeon or Midwife to aſſure a Woman that ſhe is with Child, or not, and of a true or a falſe-conception; it is likewiſe as much requiſite for them to know how far ſhe is gone, to the end they may be certain whether the Infant be yet quick or no, which is of great moment: becauſe, according to the Law, if a big-bellied Woman miſcarry by a wound, he that ſtruck her, deſerves Death, in caſe the Child were quick, otherwiſe he is only condemned in a pecuniary puniſhment: they ought likewiſe to take heed leſt they cauſe the death of the Infants, and ſometimes of their Mother, by haſtening**To be underſtood by Medicines, as appears by the word [miſcarry] following. their labour before its time, by imagining that when the big-bellied Woman complains of great pains in her Back and Belly, they are the36 pains of her Labour, and inſtead of endeavouring to hinder them, they contrarily provoke them, and cauſe them to miſcarry unfortunately before their time, I knew a Woman called Martha Rolet, who being ſix months gone with Child or thereabouts, was ſurprized with great pains, much like throws of Labour, which made her ſend for her Midwife, who as ſoon as ſhe was come, and underſtanding the caſe no better than they uſe to do, endeavoured all ſhe could to bring her to bed, augmenting her pains, by ſharp Clyſters, making her walk about her Chamber, as if ſhe had been at her full time; but finding at two dayes end no forwardneſs, notwithſtanding the continual pains, ſhe ſent for me to know what was fit for her to do in that caſe: I went to the Woman, and found the inward orifice of the Womb dilated enough for the top of my little Finger to enter into its inward part, and yet wider towards the outward part; but conſidering that ſhe had no other accident but thoſe pains, I cauſed her immediatly to go to bed, where ſhe continued eight or nine dayes, in which time her pains ceaſed, the Womb cloſed exactly, as I found ſome dayes after, and ſhe went on with her Child three full months longer, and was then brought to bed of a Daughter at the full time, ſtrong and robuſt, which is yet living, and now five years old or thereabouts. Now had I purſued what they began, this Woman without doubt would have miſcarried at ſix months, which would have**Implies Medicines, as before. killed the Infant in her Belly, and ſoon after ſhe ſhould have miſcarried. It is fit to follow37 this example in the like occaſion, provided the pains are not accompanied with accidents, which may endanger the life of the Mother if not preſently delivered; as frequent Convulſions, conſiderable floodings, of which we ſhall ſpeak in its place.
To be well informed of the different times of pregnancy, the Womans own relation may ſometimes ſerve turn, yet 'tis not fit alwayes to truſt it; it may help to conjecture, becauſe many Women are themſelves deceived, concluding themſelves with Child, from the ſtaying of their Courſes, or from their quickning, which is not alwayes a certain rule. We uſually judge of it by the bigneſs of the Belly: but more ſurely by touching the inward orifice of the Womb. When they are young with Child, we can only know it by the ſigns of conception, becauſe what is then in the Womb is of no conſiderable bigneſs to ſwell a Belly; but rather on the contrary, at that time it grows ſlatter, for the reaſons before recited: but after the ſecond month the Belly begins by degrees to wax bigger, till the ninth month. At the beginning, in touching the inward orifice, you find it exactly cloſe and ſomewhat long, reſembling the muzzle of a Puppy new pup'd; and is then very thick: but by little and little, through the extenſion of the Womb, it diminiſheth ſo in all its proportions, that when the Woman cometh near her reckoning, it is perfectly flat, and almoſt equal with the globe of the Womb, and in that manner, that it becomes like a ſmall circle, a little thick at its entry, where the Garland is made at the time of Labour.
Neither may the time of pregnancy be alwayes judged by the great ſwelling of the Belly; becauſe38 ſome Women are bigger when they are half gone, than others are at their reckoning; it depending much on the bigneſs of the Infant, and alſo on their number; and yet again, according as there is more or leſs water incloſed with them in the Womb; but much rather by the internal Orifice, which grows daily thinner and flatter, and ſo much the more by how much the Women come nearer their reckoning: much in the ſame manner as we ſee a tender skin diminiſh in thickneſs, according as it is extended and dilated; even ſo this orifice grows thinner by the extenſion which the head of the Infant cauſeth to it, which uſually preſſeth hard againſt it in the laſt months. This remark is often uſeful to us in the admiſſion of big-bellied Women, that deſire to lie in in the**An Hoſpital ſo called, in Paris. Hoſtel de Dieu at Paris, which I very often obſerved in my practiſe there of Deliveries in the year 1660, through the permiſſion which my Lord, the firſt Preſident, was pleaſed to give me, (for there is no place ſo fit to perfect one in a ſhort time, in the practice of ſo neceſſary an operation, becauſe of the great number which are there daily delivered of all ſorts) the order is, that any Women with Child ſhall be there charitably received fifteen dayes, or thereabouts, before their reckoning; to which purpoſe they are ſearcht before they are admitted, becauſe many, glad of a good entertainment for nothing preſent themſelves there two or three months before they ſhould, ſaying and affirming they are near their time; but by the above-mentioned conſiderations, one may eaſily judge and know within a very little, who are fit to be received and who not,39 that is, when they are near their time; and by this means may likewiſe know when 'tis neceſſary to forward Labour, or retard it, as much as ought to be, when Women are not yet gone their full time.
As to what reſpects the ſeveral terms, to which a Woman may go with Child; there is a great controverſie amongſt Authors, but all agree that the moſt ordinary terms are either the ſeventh or the ninth month, which is known and alſo approved by all. Hippocrates is of an opinion that the Child born in the eight month cannot live, becauſe he cannot ſupport two ſuch puiſſant endeavours ſo near one to another, having already endeavoured to be born the ſeventh month, which is (as he ſaith) the firſt legitimate term of Labour; and failing then, if, reiterating the ſame endeavours the eighth month, he be born, he is thereby ſo weakned, that he ſeldom lives, as he often doth, when born by the firſt endeavours in the ſeventh month, his ſtrength not being before exhauſted by vain attempts. This ſeems very likely to many: but if they that practiſe Deliveries, make a true reflection on it, they will find, that it is the Matrix alone, aſſiſted with the compreſſion of the muſcles of the lower Belly and Diaphragma, which cauſe the expulſion of the Child, being ſtirred up by it's weight, and not able to be further extended to contain it; and not, as is ordinarily believed, that the Infant (being no longer able to ſtay there for want of the nouriſhment and refreſhment) uſeth his pretended indeavours to come forth thence, and to that purpoſe kicking ſtrongly, he breaks with his feet the membranes which contain40 the waters, inaſmuch as when the Child is naturally born, the membranes are alwayes rent before the head, which preſſing and thruſting each throw the waters before it, cauſeth them to burſt out with force. The ſame Hippocrates likewiſe admits the tenth month, as alſo the beginning of the eleventh, at which time he ſaith the Children live: but he will by no means that Children can live if born before the ſeventh, foraſmuch as they are then too feeble, and not capable to ſupport the external injuries, as indeed we ſee and find it every day.
I do boldly affirm, and it is alſo very true, that the ordinary term of going with Child is nine whol months: but I cannot conſent that Children born in the ſeventh month, do oftner live than thoſe of the eighth; but much to the contrary I believe, that the nearer they approach to the natural term of nine months, the ſtronger they are; and therefore that Children born in the eighth month rather live than thoſe of the ſeventh: which is wholly contrary to the opinion of many perſons, who blindly follow in this the ſenſe of Hippocrates and all Authors, without making any reflection upon the thing, for to diſabuſe themſelves of this vulgar belief, founded upon the pretended vain endeavours, which (they ſay) are made by the Infant in the ſeventh month: for, as we ſee, not only in the ſame Country and Field, but alſo on the ſame Vine-Grapes, ſometimes ſix weeks ripe before their ordinary ſeaſon, and others not till above a month after, which happens according to the Territories, the different regards of the Sun, and according as the Vine is cultivated: So likewiſe we ſee Women41 brought to bed of their Children ſix weeks and two months before, and ſometimes as long after their ordinary tearm; If it be not, that the Womb not being capable of an extention beyond a certain degree, cannot bear its burden, but a little while aftet the reckoning is out, although there have been Women, as Hippocrates acknowledgeth, who have gone ten or eleven whole months with Child, which notwithſtanding is ſo much the more rare, by how much it exceeds its limits. Theſe things happen alſo to Women according to the different diſpoſitions either of their whole body, or of their Womb alone, or as well according to their rule of living, and the greater or leſſer exerciſe they uſe, and may likewiſe happen on the Childs part: for by example, if at ſeven months he is ſo big, that the Womb can no longer contain him, nor dilate it ſelf more without burſting, it is then provoked by the pain which this violent extention cauſeth, to diſcharge it ſelf of him; and ſo likewiſe in the eighth month, if there be the ſame reaſon, and ſome weeks ſooner or later, according to a multitude of other circumſtances; or alſo by any outward cauſe, as a violent ſhaking of the whole body, blow, fall, leap, or any other cauſes whatſoever, haſtening the pains of Delivery; that which makes theſe Children live a longer, or a leſſer while, is, according as they are at that time more ſtrong and perfect, and the Woman nearer her time, which is at the end of the ninth month.
There are many Women that believed they were brought to bed at the 7th and 8th month; as likewiſe others, that they went 10 or 11 whole months42 with Child (which may ſome times be) when notwithſtanding they are effectively delivered at the due time. That which deceives them, uſually is, their believing (as we have already ſaid) themſelves with Child from the time of the retention of their courſes, having had them during the two firſt months of their pregnancy, yea and ſometimes longer; and others alſo miſreckon themſelves, when their courſes are ſtopped two months before they conceive. It is alſo eaſie to know that a Woman, though well regulated, cannot exactly know by the ſuppreſſion ſingly, the certain time of her being with Child: for example, if ſhe lies with her Husband upon the point of the coming down of her terms, and ſhe conceives upon it, then ſhe may make her reckoning from the time of their ſuppreſſion, which may be very near the truth: but if ſhe conceives immediatly after ſhe hath had them (which happens ofteneſt) and that all along the whole month ſhe daily copulates with her Husband, at the end of which time her courſes not coming down, ſhe may very well reckon her ſelf with Child; yet for all this ſhe cannot know by this ſign which night ſhe conceived; and ſo for three weeks or a month more or leſs ſhe may be miſtaken in the time.
As we have ſaid, that Children are more or leſs long-lived, according as they approach nearer the ninth month; ſo we may eaſily know, that they of ſix months, and much leſs thoſe that are younger, cannot be long-lived, becauſe they are yet too weak to reſiſt the outward injuries. There hath often been great conteſtations amongſt the Phyſitians, to determine, whether a Child born the eleventh or43 twelfth month after its pretended Fathers death, can be legitimately born, and conſequently admitted to Inheritance, or rather diſinherited as a ſuppoſed Child.
This queſtion hath been well debated ſometimes by the Romans as well as by us, and there have been parties both for and againſt this opinion; as for my part I will, to avoid prolixity, leave it undecided, and add nothing upon this point to what I have mentioned before.
IT is no great matter to ſatisfie the curioſity and diſquiet of a Woman, who deſires often to know whether ſhe be with Child or no; but there are many, and almoſt all, that would have one proceed further, and tell them whether it be a Boy or a Girl, which is abſolutely impoſſible; though there is hardly a Midwife which will not boaſt her ſelf able to reſolve it (in effect it is eaſier to gueſs, than to find the truth) for when it happens, it is certainly rather by chance, than by any knowledge or reaſon they could have to enable them to foretell it. But ſometimes one is ſo preſſed and importuned to give judgment, chiefly by Women who never had Children, and often by their Husbands, who are not leſs curious, that one is obliged to ſatisfie44 them as much as poſſible in that caſe, by the examen of ſome ſigns very incertain.
There are many ſigns upon which this knowledge is grounded (if there can be any, which I do not believe) of which the two principal are taken out of Hippocrates; the firſt is in his 42th Aphoriſm of the fifth book, which is, Mulier gravida, ſi marem gerit, bene colorate eſt; ſi vero faeminam, male calorata: A Woman with Child of a Boy is well coloured; but of a Girl, ill coloured. And the other is in his 48th Aphoriſm of the ſame book, which is, Faetus mares dextra uteri parte, faeminae finiſtra magis geſtantur: For the moſt part the Male Children lye in the right ſide, and the Females in the left. Moreover, they ſay, a Woman with Child of a Boy, is more merry and jockond, goes with it much better, is not ſo diſguſted, finds it quicken ſooner, and her right Breaſts fill before the left, and is alſo more firm, and that all the right parts of her body are ſtronger and more active; as for example, if ſhe ſate, kneeled, or ſtood upright, ſhe would make her ſelf firſt ſtep with her right foot; but if it be a Girl, ſhe would have all the ſigns contrary to theſe above mentioned.
There are ſome perſons pretend to know it by inſpecting of Urines, which is as uncertain; for we daily find Women well coloured, and they have all the ſigns of being with Child of a Boy, and yet are brought to bed of Girles, contrary to the hopes given them: And others, though they have ſigns directly oppoſit, bring forth Boys. Some believe they underſtand it better than any other, by conſidering the time of conception; for ſay they, if the Woman conceives at the increaſe of the4 Moon, ſhe ſhall have a Boy, and contrarily a Girl, if at the decreaſe: but this falls out as ſeldom, as may eaſily be known, by the obſervation I have made of it at the Hoſtel de Dieu at Paris, and may be daily obſerved by others as wel as my ſelf; which is, that having in one and the ſame day delivered 11 Women there, all at their full time, five of them had Boys, and the other ſix Girls. Now we may well judge that they all conceived at one time, becauſe all were brought to bed at the ſame time; and ought (if this rule were true, and that they were all governed by this Planet) to have had either all Boys, or all Girls; and not ſome Boys, and ſome Girls, as here it happened, and doth every day in the ſame place; whereas in all other places are indifferently born both Boys and Girls.
Others again believe the Males to be begotten of the Seed which comes rather from the right Teſticle than the left, eſteeming it hotter and not ſo wateriſh, becauſe the right Spermatick vein comes from the trunck of the Vena cava; and that of the left ſide takes its riſe from the Emulgent; but if they know after what manner the blood is circulated, they would find that the blood of the emulgent is not more ſerous, than that of the vena-cava, foraſmuch as it is purged of its ſuperfluous ſeroſity by the Reines, before it enters this emulgent; they would likewiſe know that the Seed of both Teſticles is the ſame exactly, being made of the ſame blood, brought to them not by the Reins, but only by the two Arteries, which ariſe out of the trunck Aorta, otherwiſe called the great Artery; wherefore the left is as well diſpoſed to produce Males as Females; and therefore thoſe Husbandmen abuſe46 themſelvs, in knitting up one of the teſticles of their Bulls according as they deſire either Males or Females. I knew an Italian at Rome who had but only his left Teſticle, having loſt the right upon a good occaſion, who after that accident married, and begat two Children, which I ſaw alive, and very well, one of which was a Boy and the other a Girle; beſides all thoſe he may have begotten ſince that time: nor needed he to ſuſpect his Wife had the aſſiſtance of any other in that buſineſs, as it very often happens in this Country.
Such perſons as deſire to foretell before the Child be born, whether it will be Boy or Girl, do uſually adhere by complacency, to the deſires of the big-bellied Woman and her Husband in this caſe; for if the Midwife knows they deſire a Boy, ſhe will aſſure them it will be a Boy, and ſwear to it alſo; And if they wiſh for a Girl (as it alſo happens to ſome Women, who love Girls beſt) they will ſay it ſhall be a Girl, and lay wagers of it too. If this happens luckily according to her pronoſtick, ſhe will not be backwards to affirm ſhe knew it very well: but when it happens contrary to her prediction, ſhe makes her ſelf reputed ignorant and preſumptuous, and remains aſhamed.
For my part I ſhould do quite otherwiſe: for knowing beforehand the deſires of the perſons, I ſhould give my advice alwayes quite contrary to them; becauſe if it happen to be true (although by chance) what was foretold, they will then conclude me to be knowing, and to have ſaid well: and if otherwiſe (which may be once in twice) the Woman and her Husband obtaining what they deſired, will not take ſo much notice of it, becauſe47 one alwayes receives with a good welcom what they deſire, though unhoped for.
Having ſhewed that it is impoſſible to know whether a big-bellied Woman ſhall have a Boy or Girl, becauſe of the uncertainty of the ſigns, upon which they ground their predictions; We will aſſert that it is not the ſame in the knowledge one may have, whether a Woman is conceived of more than one. There are many Authors who have affirmed that a Woman cannot bring forth above two Children at once, becauſe they have but two Breaſts; as alſo, becauſe that there are but two cavities in the Womb, different from moſt other Animals, which hath many little cells in it, and alſo many teats, wherefore they bring forth many young ones, who uſually anſwer the number of the little cells of their Womb: this is very true in reſpect of other Animals, but the Womb of a Woman hath but one only cavity (unleſs they would have the two ſides taken for cavities) for there is in the Womb only a ſimple long line, without any other ſeparation.
We ſee daily Women brought to bed of two Children at once, ſometimes of three, and very rarely of four. Yet I knew one Mr. Hebert, Couverer of the King's Buildings, who was ſo good a Couverer, that his Wife about ſeventeen years ſince brought forth four living Children at a birth; which the Duke of Orleans deceaſed coming to hear of, to whom (becauſe of his jovial humour) he was very welcom; the Duke asked him (in the preſence of divers Perſons of Quality) whether it were true, that he was ſo good a Fellow as to get his Wife with Child of thoſe four at one bout? He anſwered very48 coldly, Yes; and that he had certainly begat at the ſame time half a dozen, if his foot had not ſlipt; which made them all laugh very heartily.
But I eſteem it either a Miracle, or a Fable, what is related in the Hiſtory of the Lady Margaret, Counteſs of Holland, who in the year 1313 was brought to bed of 365 Children at one and the ſame time; which happened to her (as they ſay) by a poor Womans Imprecation, who asking an Alms of her, related to her the great miſery ſhe was in by reaſon of thoſe Children ſhe had with her: To which the Lady anſwered, She might be content with the inconvenience, ſince ſhe had had the pleaſure of getting them.
Now ſince the moſt uſual number is two, that Women have at once, (who have more than one Child at a time) We will give the ſigns of it, which do not appear in the firſt months, nor ſometimes till they are quick. There is ſome likelihood of it, if the Woman be extraordinary big, and yet ſuſpects no Dropſie; and more, if there be on each ſide of the Belly a little riſing, and as it were a line a little depreſſed, or not ſo elevated about the middle; and moſt of all, if at the ſame time one feels many and different motions on both ſides; and if theſe motions are more frequent than uſually, which is, becauſe the Infants being ſtraitned, inconvenience one the other, and cauſe each other to move in that faſhion: If all theſe ſigns concur, 'tis then very probable the Woman goes with more than one Child.
THere is a great diſpute, whether a Woman (who hath two or more Children at once) conceived of them at one, or at ſeveral Coitions. We ſee indeed daily that Bitches, Sows, and Rabits have divers young with but once copulating, which may very well make us judge the ſame of a Woman. Some will have this to be by Superfaetation: but there are ſigns by which we may know the difference, whether both Children were begotten at once; or ſucceſſively one after the other.
Superfaetation, according to Hippocrates, in his Book which treats of it, is a reiterated conception, when a Woman being already with Child, conceives again the ſecond time. That which makes many beleive there can be no Superfaetation, is; becauſe, as ſoon as a Woman hath conceived, her Womb cloſeth and is exactly firm, ſo that the Seed of the Man, abſolutely neceſſary to conception, finding no place nor entry, cannot (as they ſay) be received, nor contained in it, ſo to cauſe this ſecond conception. To this may be added, that a pregnant Woman diſchargeth her Seed (which is as neceſſary for it as a Mans) by a veſſel which terminates on the ſide of the exteriour part of the inward orifice; which Seed by this means is ſhed into the Vagina, and not into the bottom of the Womb, as it ſhould for this purpoſe. However, it may be50 ſaid in anſwer to theſe objections, which are very ſtrong, that (though the Womb be uſually exactly ſhut and cloſe when a Woman hath conceived, and beſides, that ſhe then ſheds her Seed by another conveyance) yet this general rule may have ſome exceptions, and that the Womb, ſo cloſed, is ſometimes opened to let paſs ſome ſerous ſlimy excrements, which by their ſtay offend it; or principally, when a Woman is animated with an earneſt deſire of copulation, in the heat of which action ſhe ſometimes diſchargeth by the paſſage that terminates in the bottom of the Womb, which being dilated and opened by the impetuous endeavour of the Seed, agitated and over-heated more than ordinary, and this orifice being at the ſame time a little opened, if the Mans Seed be darted into it at the ſame moment, it is thought a Woman may then again conceive, which is called Superfaetation. This is confirmed by a Hiſtory of a Servant, related by Pliny, who having the ſame day copulated with two ſeveral perſons, brought forth two Children, the one reſembling her Maſter, the other his Proctor. And alſo of another Woman, who likewiſe had two Children, the one like her Husband; and the other like her Gallant: but this different reſemblance doth not altogether prove Superfaetation, becauſe ſometimes different imaginations may cauſe the ſame effect.
This ſecond conception is effectively as rare, as we find the deciſion of it uncertain; nor muſt we imagine that alwayes, when a Woman brings forth two Children or more at once, there is a Superfaetation; becauſe they are almoſt alwayes begot in the ſame act, by the abundance of both Seeds received51 into the Womb: nor believe neither, that it may be at all times of a Womans being with Child: for when it happens, it cannot be either the firſt or ſecond day of conception; becauſe, if the laſt Seed be received into the Womb, it would make a mixture and confuſion with the firſt, which is not yet involved with this little pellicle, that might otherwiſe ſeparate it; nor is it formed perfectly till the ſixth or ſeventh day, as Hippocrates ſaw in a Woman, who about that time expelled this geniture: Beſides, the Matrix again opening it ſelf, could not hinder the firſt Seed from ſlipping out, being not as yet wrapt up in this little membrane, which could preſerve it. This makes me not believe the Hiſtory of the Woman, whom Pliny mentions, that it happened for the reaſons alledged by him, to wit, that ſhe uſed copulation the ſame day with two ſeveral perſons: for the laſt would certainly have cauſed this confuſion of Seed, as I have ſaid, and ſo deſtroyed the work begun; but I rather believe, that this Superfaetation may happen from the ſixth day of conception, or thereabouts, till the thirtieth or fourtieth at the moſt; becauſe then the Seeds are covered with membranes, and that which is contained in the Womb is not yet of a conſiderable bigneſs: but after this time, it is impoſſible, or at leaſt very difficult, becauſe the Womb being extended more and more by the growth of the Child, can hardly receive new Seed, and as hardly retain it, or hinder it from being caſt forth by reaſon of its fulneſs, having received it in that eſtate.
When a Woman brings forth one or more Children at a birth, begotten at once, which uſually52 are called Twins, (and differs from Superfaetation) 'tis known by their being both almoſt of an equal thickneſs and bigneſs, and having but one only and common after-birth, not ſeparated the one from the other, but by their membranes, which wrap each apart with their waters, and not both in the ſame membrane and waters, as ſome have believed, contrary to the truth: but if there are ſeveral Children, and a Superfaetation, they will be alſo ſeparated by their membranes, but not have a common burthen, but each his apart; neither will they be of an equal bigneſs, for that which is the Superfaetation, will alwayes be leſſer and weaker, than that which was engendred at firſt; who, becauſe of its force and vigor, draws to it ſelf the greateſt and beſt part of the nouriſhment: Juſt as we find in fair and great Fruit, that have often near them very little ones; which happens, becauſe thoſe that are firſt knotted and faſtned to the Tree, take away all the nouriſhment from their neighbours, who did but bloſſom when the firſt had already acquired ſome bigneſs. Sometimes Twins are not of an equal bigneſs, which happens according as the one or the other hath more ſtrength to draw to it in greater abundance the beſt part of the common nouriſhment.
Six years ſince I layed a Woman at her full time, whom I delivered of a very great living Girl by the feet, which firſt came to the birth; and fetching the after-birth, I brought with it another Child, a dead Boy, as little again as the firſt Girl; and which ſeemed not to be, reſpecting his bigneſs, above five or ſix months; although they were both begotten at one and the ſame act of Copulation, as was manifeſt by their both having but one and the ſame53 burthen, which is the true ſign of it, as I have already ſaid; and this ſecond Child was ſo little, that it came together with the burthen, and wrapt up in the membranes; which I preſently opened, to ſee whether it were alive; but it had been a long time dead, as appeared by its corruption.
I am not willing to ſay that there never is any Superfaetation, but I ſay, that it happens very rarely; for of an hundred Women that have Twins, ninety of them have but one burthen common to both; which is a very certain ſign they had no Superfaetation, and much more certain than the Indications taken from the greatneſs or ſtrength of the Child, which is but conjectural.
OF all the ſeveral ſorts of Great-Bellies in Women, there remains that yet to be examined which is cauſed by a Mole, of which we muſt alwayes endeavour the expulſion aſſoon as we come to know it, being altogether contrary to nature. The Mole is nothing elſe but a fleſhy ſubſtance, without bones, joynts, or diſtinction of members; without form or figure, regulated and determined; engendred againſt Nature in the Womb, after Copulation, out of the corrupted Seed of both the Man and Woman. Notwithſtanding, there are ſometimes ſome that have ſome rudiments of a rough form.
It is very certain, Women never engender Moles54 without the uſe of copulation, both Seeds being required to it, as well as for a true generation. There are ſome, truly, who never having had to do with a Man, do naturally caſt forth, after a flouding, ſome ſtrange bodies, which in appearance ſeem to be fleſh; but if one take ſpecial notice thereof, they will find it but clods of blood coagulated, without conſiſtence or fleſhy texture, or membranous, as are the Moles and falſe-Conceptions.
Moles are ordinarily engendred, when either the Man or the Womans Seed, or both together, are weak, or corrupted, the Womb not labouring for a true conception, but by the help of the Spirits with which the Seed ought to be repleniſhed: but ſo much the eaſier, as the ſmall quantity found in it is extinguiſhed, and as it were choaked, or drowned by abundance of the groſs and corrupted menſtruous blood, which ſometimes flows thither ſoon after conception, and gives not leiſure to Nature to perfect, what ſhe hath with great pains begun, and ſo troubling its work, bringing thither confuſion and diſorder, there is made of the ſeeds and blood a meer Chaos, call'd a Mole, not uſually engendred but in the Womb of a Woman, and never or very rarely found in that of other Animals, becauſe they have no menſtruous blood, as ſhe hath.
A Mole hath no burthen, nor navel-ſtring faſtned to it, as a Child alwayes hath; foraſmuch as the Mole it ſelf adheres to the Womb, by which means it receives nouriſhment from its veſſels: it is likewiſe cloathed uſually with a kind of membrane, in which is found a piece of fleſh confuſedly interlaced with many veſſels; it is of a bigneſs and conſiſtence more or leſs according to the abundance55 of blood it receives, according to its diſpoſition, and alſo according to the temperature of the Womb, and the time it ſtayes there; for the longer it ſtayes, the harder it grows, and becomes ſchirrous, and difficult to be expell'd. For the moſt part there is but one, yet ſometimes more; of which, ſome cleave very ſtrongly, others very ſlightly to the Womb. When Women miſcarry of them before the ſecond month, they are called falſe-Conceptions: when they keep them longer, and that this ſtrange body begins to grow bigger, they are called Moles. Falſe-Conceptions are more membranous, and ſometimes full of corrupted Seed; but Moles are altogether fleſhy. One may find in a Woman that hath a Mole, almoſt all the ſigns of Conception, and of a Woman with Child; but there are likewiſe ſome other which differ, becauſe her belly is harder and ſorer, than when ſhe is with Child. The Mole being contrary to Nature, is very troubleſome to a Woman: and as it hath no true life, nor animal motion; ſo it is very painful to go with: for the Mole falls on whatſoever ſide ſhe turns, when ſhe is a little big, juſt like a heavy Bowl: She hath a great wearineſs in her legs and thighs, and ſuppreſſion of urine from time to time, and finds a great heavineſs in the bottom of her belly, foraſmuch as this maſs of fleſh by its weight weighs down the Womb, which compreſſeth the bladder of urine: her breaſts are not ſo ſwell'd, neither have they any, or very little milk. It may be yet eaſier known, if with all theſe ſigns ſhe finds no motion after the 4th or 5th month of her Great-Belly; and certainly, if after her reckoning is out, all the aforeſaid ſigns remain and continue in the ſame manner.
56Theſe Moles are nouriſhed in the womb, to which they almoſt alwayes adhere, and are ſuſtained by the blood with which it is alwayes furniſhed, juſt as Plants are by the moiſture of the Earth. Sometimes there is a Child together with a Mole, from which it is ſometimes divided, and ſometimes cleaving to its body; which puts it in great danger of being miſhapen or monſtrous, becauſe of the compreſſion which this ſtrange body cauſeth to the Infant yet very tender. In the year 1665, being at Mr. Bourdelots, Doctor in Phyſick of the Faculty of Paris, where was every Monday held Academical Conferences: As they fell upon the diſcourſe of the Circulation of the Blood, which I explained according to my opinion, they brought thither the Infant of a Woman newly brought to bed at her full time, which wanted all the upper part of the head, having no skull, no brain, no nor any hairy ſcalp; but had only, in lieu of all thoſe parts, a Mole, or fleſhy maſs flat and red, of the thickneſs and bigneſs of an after-burthen, covered with a ſimple membrane ſtrong enough: This Infant had however all the other parts of the body fat, and well compoſed and ſhap'd. This monſtrous diſpoſition was the cauſe of its death aſſoon as it was born, and yet it was very wonderful and aſtoniſhing to conſider, how it could live ſo without brain; as alſo very difficult to underſtand, how this fleſhy maſs could ſerve in ſtead of it, whilſt it was in the Mothers belly. It was interwoven with many veſſels, like a kind of**The fleſhy part of the burthen. Placenta, yet of a more firm ſubſtance. Mr. Clerk and Mr. Juillet, my Brethren and good Friends,57 were then preſent, and ſaw this Prodigy as well as my ſelf.
A Woman having a Mole, hath a much worſe colour, and is every way more inconvenienced, than a Woman with Child; and if ſhe keeps it long, ſhe lives all the while in danger of her life. Some have them two or three years, and ſometimes all the reſt of their lives: As hapned to a Peuterer's Wife, of whom Ambroſe Paré makes mention in his Book of Generation, who had one ſeventeen years, and at laſt died of it. We will declare the Remedies convenient for it in another place, where we ſpeak of its extraction.
A Woman with Child in reſpect of her preſent diſpoſition, although in good health, yet ought to be reputed even as though ſhe were ſick, during that neuter eſtate (for to be with Child, is alſo vulgarly called a ſickneſs of nine months) becauſe ſhe is then in daily expectation of many inconveniences, which pregnancy uſually cauſes to thoſe that do not govern themſelves well.
She ſhould in this caſe reſemble a good Pilot, who being imbarqued on a rough Sea, and full of Rocks, ſhuns the danger, if he ſteers with prudence; if58 not, 'tis by chance, if he eſcapes Shipwrack: So a Woman with Child is often in danger of her life, if ſhe doth not her beſt endeavour to ſhun and prevent many accidents to which ſhe is then ſubject; all which time there muſt be care taken of two, to wit, her ſelf, and the Child ſhe goes with: for from one ſingle fault reſults double miſchief, inaſmuch as the Mother cannot be any wayes inconvenienced, but the Child partakes with her.
Now to the end ſhe may maintain her ſelf in good health, as much as can be in that condition, which alwayes keeps a middle ſtate, let her obſerve a good dyet, ſuitable to her temperament, cuſtom, condition and quality, which the right uſe of all the ſix non-natural doth effect.
The Air, where ſhe ordinarily dwells, ought to be well temper'd in all its qualities: if it be not ſo naturally, it muſt be corrected as much as may be by different means; ſhe muſt avoid that which is too hot, becauſe it often cauſeth, by diſſipating too much the humours and ſpirits, many weakneſſes to Women with Child, & particularly alſo that which is too cold and foggy; for, cauſing great Rhumes and diſtillations upon the lungs, it exciteth a cough, which by its ſudden and impetuous motions, forcing downwards, may make the Woman miſcarry. She ought not to dwell in narrow Lanes very dirty, nor near common Dunghils. For ſome Women are ſo nice, that the ſtink of a Candle not well extinguiſht, is enough to bring them before their time, as Liebaut aſſures us he himſelf had ſeen: which likewiſe may be cauſed, if not ſooner, by the ſmell of Charcoal, as hapned once to a Laundreſs, whom I knew, hat miſcarried the fourth mouth; being in extream59 haſte to finiſh ſome Linen on a Saturday night, ſhe had not patience to kindle the Charcoal in the Chimney, but in the Room in a Chafingdiſh, which flew up into her head, and made her miſcarry the ſame night, and in danger of dying. Let the Woman therefore endeavour, as much as her convenience will permit, to live in an Air free from theſe inconveniencies.
The greateſt part of Women with Child have ſo great loathings, and ſo many different longings, and ſtrong paſſions for ſtrange things, that it is very difficult to preſcribe an exact dyet for them: but I ſhall adviſe them in this caſe to follow the opinion of Hippocrates, in his 38th Aphoriſm, 2d Book, where he ſaith, Paulo deterior & potus & cibus, ſuavior tamen, melioribus quidem, ſed inſuavioribus, praeferendus. Meat and Drink though not ſo wholſome, if it be but pleaſant, is to be preferred before that which is wholſom, if not ſo pleaſant: which in my opinion is the rule they ought to obſerve, provided what they long for, is commonly uſed for dyet, and not ſtrange and extraordinary things; and that they have a care of exceſs. If the Woman be not troubled with theſe loathings, let her then uſe ſuch a dyet, which breeds good juyce, and in quantity ſufficient for her and her Child: her appetite may regulate that. She muſt not then faſt nor be abſtemious, becauſe overheating the Mothers blood thereby, renders it unfit to nouriſh the Child, which ought to be ſweet and mild, and makes it tender and weak, or conſtraius it to come before its time, to ſearch what is fit for it elſewhere: ſhe muſt not eat too much at a time, and chiefly at nights, becauſe the Womb by its extent60 poſſeſſing a great part of the belly, hinders the ſtomach from containing much, which cauſeth thereby a difficulty of breathing, becauſe it compreſſeth the Diaphragma, which as then hath not an intire liberty to be moved. Wherefore let her rather eat a little and often; let her bread be pure Wheat, well baked and white, as is that of Goneſſe at Paris, or the like; and not courſe houſhold Bread or Bisket, which ſwells up the ſtomach, nor any other of the like nature that's very ſtuffing. Let her eat good nouriſhing meat, as are the tendereſt parts of Beef and Mutton, Veal, Fowl; as fat Pullets, Capons, Pidgeons and Partridge, either roaſt or boyled as ſhe likes beſt; freſh Egs are alſo good: And becauſe big-bellied Women have never good blood, let her put into her Broths thoſe herbs which purifie it, as Sorrel, Lettice, Succory, and Borrage; ſhe muſt avoid hot-ſeaſoned Pyes and baked Meats, and eſpecially Cruſt, becauſe being hard of digeſtion, it extreamly overchargeth the ſtomach: If ſhe hath a mind to Fiſh, let it be new, and not ſalted; Fiſh of Rivers and running ſtreams, foraſmuch as Pond-Fiſh taſts of mud, and breeds ill juyce. But if big-bellied Women cannot abſolutely refrain their extravagant longings, it is better (as we have already ſaid) to ſuffer them to deviate a little from this rule or dyet (provided it be moderate) than too much to oppoſe their appetites. They may drink at their meals a little good old Wine well temper'd with Water, and rather Claret than White-wine; which will help make a good digeſtion, and comfort the ſtomach, which is alwayes weak during prenancy; and if they were not uſed to drink it before, let them accuſtom themſelves to it by degrees;61 and as well in drinking as eating, they muſt ſhun all things hot and diurectick, becauſe they provoke the courſes, which is very prejudicial to the Child.
By moderate ſleep, all the natural functions of a Woman are fortified, and particularly the concoction of food in the ſtomach, which then is very ſubject to loathings and vomitings. We ſay, it muſt be moderate; becauſe, as exceſſive watchings diſſipate the Spirits, ſo too much ſleep choak them. Let therefore Women with Child ſleep nine or ten hours at leaſt in four and twenty, and twelve at moſt; and let it be rather in the night-time, as moſt fit for reſt, than in the day, as perſons of quality are accuſtomed, who frequenting the Court, ordinarily turn night into day. However they who have gotten this ill habit, had better continue it than change too ſuddenly, becauſe this cuſtom is become natural to them.
For what reſpects exerciſe and reſt, let them govern themſelves according to the different time of their being with Child; for at the beginning of the conception (if the Woman perceives it) ſhe ought (if ſhe can) to keep her bed, at leaſt till the fifth or ſixth day, and by no means to uſe copulation all the time; foraſmuch as the Seeds being not yet covered with the membrane, which is formed in that time (as we have ſaid already) are in the beginning, by the agitation of the body, very apt in ſome perſons to ſlip forth. She ought neither to go in Coach, Chariot or Waggon, nor on Horſeback, whilſt with Child; and much leſs the nearer ſhe comes to her time: becauſe this kind of exerciſe doubles the weight of what is contained in the62 Womb, by the jolts ſhe receives, and often makes her miſcarry: But ſhe may walk gently, go in a Sedan or Litter; She ought neither to carry or lift heavy burdens, nor lift up her arms too high: and therefore ſhe ought not to dreſs her own head, as ſhe uſed to do, becauſe it cannot be done without ſtretching her arms too much above her head, which hath cauſed many to miſcarry before their time; becauſe the ligaments of the Womb are at once looſned by theſe violent extenſions. Let her exerciſe be gentle walking, and the heels of her ſhoes low; becauſe Women cannot, for the bigneſs of their bellies, ſee their feet, and ſo are ſubject to ſtumble and fall: In ſhort, ſhe muſt govern her ſelf in theſe exerciſes, rather to err in too much reſt, than in too much exerciſe; for the danger is greater by immoderate motion, than in too much reſt. It is impoſſible for me in this point to be of the opinion of all Authors, although all the World follows them in this their evil and dangerous counſel, who would have a pregnant Woman exerciſe her ſelf more than ordinary toward the latter end of her reckoning, that ſo, as they ſay, the Child may ſink lower: But if they conſider the point well, they would without doubt find it to be the cauſe of more than half of the hard Labours; and that on the contrary, reſt would be more advantagious to them, as I ſhall prove by the following explication.
Firſt, We muſt know and take for granted that the birth of a Child ought to be left to the work of Nature well regulated, and not to provoke it, by ſhaking it with this exerciſe, for to diſlodge it before its full time: which hapning (though it be but ſeven or eight dayes ſooner) proves ſometimes as prejudicial63 to the Infant, as we ſee it is ſometimes to Grapes, which we find four or five dayes before they are full ripe, to be yet almoſt half Verjuice. But to explain more clearly than by this compariſon, that theſe kind of exerciſes often cauſe hard labours, (as we have already ſaid) conſider that the Infant is naturally ſcituated in the Womb with the head uppermoſt, and the feet downwards, with its face towards the Mothers belly, juſt till it hath attained to the eighth month; at which time, and ſometimes ſooner, and ſometimes alſo later, his head being very great and heavy, he turns over, his head downward and his heels upwards, which is the ſole and true ſcituation, in which he ought to come into the World, all other poſtures being contrary to Nature. Now juſt when the Child is about to turn according to cuſtom into his intended poſture, Inſtead of giving her ſelf reſt, ſhe falls a jumping, walking, running up and down ſtairs, and exerciſing her ſelf more than ordinary, which very often cauſes it to turn croſs, and not right as it ought to be; and ſometimes the Womb is depreſſed ſo low, and engaged in ſuch ſort towards the laſt month, in the cavity of the Hypagaſtres, by theſe joltings, that there is no liberty left the Infant to turn it ſelf naturally; wherefore it is conſtrained to come in its firſt poſture, to wit, by the feet, or ſome other worſe. Moreover, it would be very convenient that the Woman to this end ſhould abſtain from Coition, during the two laſt months of her reckoning, foraſmuch as the body is thereby much moved, and the belly compreſſed in the action, which likewiſe cauſeth the Child to take a wrong poſture. I believe that they that will ſeriouſly64 reflect on theſe things, will make no difficulty to quit this old error, which hath certainly cauſed the death of many Women and Children, and much pain to divers others, for the reaſons above-mentioned.
Some Women have miſcarried only with the noiſe of a Cannon; as alſo with the ſound of a great Bell; but eſpecially with a clap of Thunder, when of a ſudden it ſurpriſeth them, and frights them.
Big-bellied Women are ſometimes ſubject to be coſtive, becauſe the Womb by its weight preſſing the Rectum; hinders the Belly from diſcharging its excrements with eaſe. They that are troubled with this inconvenience may uſe Damask-Prunes ſtewed, Veal-Broth, and Herb-Pottage, with which they may gently moiſten and looſen the Belly. If theſe things are not ſufficient, they may give her gentle Clyſters of Mallows, Marſh-mallows, Pellitory and Aniſe-ſeeds, with two ounces of brown Sugar diſſolved in it, adding a little Oyl of Violets, or elſe a Decoction made with a handful of Bran, two ounces of Honey of Violets, and a piece of freſh Butter; or any other as occaſion might require: but there muſt be great care taken that no ſharp Clyſters be given her to this purpoſe, nor other Drugs to cauſe a looſneſs, or too great an evacuation, leſt it endanger her to miſcarry: as Hippocrates very well warns us in the 34th Aphoriſm of his fifth Book, where he ſayes, Mulieri in utero gerenti ſi alvus plurimum profluat, periculum eſt ne abortiat. If a big-bellied Woman have a violent looſneſs, ſhe will be in danger of miſcarrying.
If ſhe ought to govern her ſelf well in the obſervation of what we have lately mentioned, ſhe ought65 no leſs to be careful to overcome and moderate her paſſions, as not to be exceſſive angry; and above all, that ſhe be not afrighted; nor that any melancholly news be ſuddenly told her: for theſe paſſions, when violent, are capable to make a Woman miſcarry at the moment, even at any time of her going with Child; as it hapned to my Couſins Mother, named Mris Dionis, a Merchant, dwelling in the Street Quinquampois, whoſe Father being ſuddenly killed with a Sword by one of his Servants, who meeting him in the Street traiterouſly run him through out of ſpite and rage, becauſe he had ſome few dayes before turned him out of doors: they brought immediatly this ill news to his Wife, then eight months gone, and preſently after brought her dead Husband; at which ſudden fright ſhe was immediatly ſurpriſed with a great trembling, ſo that ſhe was preſently delivered of the ſaid Dionis, who is to this day (which is very remarkable) troubled with a ſhaking in both hands, as his Mother had when ſhe was delivered of him, having yet no other inconvenience, notwithſtanding he was born in the eighth month by ſuch an extraordinary accident; nor doth he ſeem to be above fourty years old, though near fifty. When he ſigned his Contract of Marriage, they who knew not the reaſon of it, when they ſaw his hands ſhake, thought it was through fear of his ill Bargain, of which they were diſabuſed when they had heard the Cataſtrophe that haſtened his birth. Wherefore if there be any news to tell a big-bellied Woman, let it rather be ſuch as may moderately rejoyce her, (for exceſſive joy may likewiſe prejudice her in this condition) and if there be an abſolute neceſſity to acquiant66 her with bad news, let the gentleſt means be contrived to do it by degrees, and not all at once.
Aſſoon as a Woman finds her ſelf with Child, or miſtruſts it, let her not lace her ſelf ſo cloſe, as ſhe ordinarily doth, with Bodies ſtifned with Whalebone, to make her Body ſhapely, which very often injures her Breaſt, and ſo incloſing her Belly in ſo ſtrait a mould, ſhe hinders the Infant from taking its free growth, and very often makes it come before its time, and misſhapen. Thoſe Women are ſo fooliſh as not to mind, that making themſelves ſlender when they are with Child, quite ſpoils their Belly, which therefore after Childbed remains wrinkled, and pendent as a Bag, and then they cry, It is the Midwife or Nurſe that did them that miſchief, in not ſwathing and looking to them as they ought to do; not conſidering that it came by their ſtrait lacing whilſt they were big upwards, which cauſeth the Belly, finding no place to be equally extended on all ſides, to dilate it ſelf onely downwards, whither all the burthen is in that manner thruſt and carried: to avoid which, let them uſe habits more large and eaſie; and wear no Busks, with which they preſſe their Bellies to bring them into ſhape. Let them alſo forbear Bathing in any manner, after they know they have conceived, leſt the Womb be excited to open before the time. Almoſt all big-bellied Women are ſo infatued with the cuſtom to bleed when they are half gone, and in the ſeventh month, that if they ſhould neglect it, (although they were otherwiſe well) they vvould never believe they could be well delivered. I will not in the mean time juſtifie and67 make them believe by that, what Hippocrates ſaith in his 31th Aphoriſm of his 5th Book, Mulier in utero ferens, ſecta vena abortit, eoque magis ſi ſit faetus grandior. If (ſaith he) a Woman be blooded, ſhe miſcarries; and the rather, if ſhe be far gone. This Aphoriſm muſt not prohibit us the uſe of bleeding when the caſe requires, but only warns us to uſe it with great prudence; foraſmuch as ſome Women want bleeding three or four times, yea, and oftner ſometimes, whilſt they are with Child, when twice may be ſufficient to others: For as there have been ſome that have been blooded nine or ten times for diſeaſes during their pregnancy, and yet go on with their Infant to their full account; ſo others have miſcarried by bleeding but once a little too copiouſly, as in this Aphoriſm ſpeaks Hippocrates. Now ſince all are not of the ſame nature, they muſt not be all governed after the ſame manner, nor believe that it is neceſſary to bleed all big-bellied Women; one may judge of the neceſſity according as they are more or leſs ſanguine. It is the ſame in purging, which ought to be prudently adminiſtred as well as bleeding, according to the exigency of the caſe, uſing alwayes gentle and benign remedies when they are neceſſary; as Caſſia, Rhubarb, Manna, with the weight of a dram or two at moſt of good Senna. Theſe Purgatives may ſerve turn for a Woman with Child, ſhe ought not to uſe others more violent: If ſhe obſerves all that we have above mentioned, ſhe may then hope for a good iſſue of her great-Belly.
Having amply enough declared, how a Woman with Child ſhould be governed when accompanied with no ill accident, and given the Rules ſhe ought68 to keep to prevent them, We will now examine ſeveral Indiſpoſitions, to which ſhe is ſubject particularly during her pregnancy.
VOmiting, with the ſuppreſſion of the Terms, is for the moſt part the firſt Accident which happens to Women, and the means by which they themſelves perceive their pregnancy. It is not alwayes cauſed, as is believed, from ill humours collected in the ſtomach, becauſe of this ſtoppage of their Courſes: theſe corrupted humours do often cauſe a depraved appetite in pregnant Women, when either they flow thither, or are there engendred; but not this Vomiting which happens immediately after Conception, and which comes by ſucceſſion: it cannot be meant of thoſe which are there afterwards corrupted; but theſe firſt Vomitings proceed from the ſympathy between the Stomach and the Womb, becauſe of the ſimilitude of their ſubſtance, and by means of the Nerves inſerted in the upper orifice of the Stomach, which have communication by continuity with thoſe that paſs to the Womb, being portions of the ſixth pair of thoſe of the Brain. Now the Womb, which hath a very exquiſite ſenſe, becauſe of its membranous compoſition, beginning to wax bigger,69 feels ſome pain, which being at the ſame time communicated by this continuity of Nerves to the upper orifice of the Stomach, cauſe there theſe nauſeatings and vomitings which ordinarily happen. And to prove that it is thus in the beginning, and not by pretended ill humours, appears, in that many Women vomit from the firſt day of their being with Child, who were in perfect health before they conceived, at which time the ſuppreſſion of the Terms could not cauſe this Accident, which proceedeth from this ſympathy in the very ſame manner; as we ſee thoſe that are wounded in the Head and Bowels, and that have the Stone-Cholick, are troubled with Loathings and Vomitings, and yet have no corrupt humours in the ſtomach. Loathings and Vomitings, which are motions of the ſtomach contrary to nature, happen to big-bellied Women from the beginning, for the reaſons above recited.
Loathing or Nauſeouſneſs, is nothing but a vain deſire to vomit, and a motion by which the Stomach is raiſed towards the upper orifice, without caſting up any thing. And Vomiting is another more violent endeavour, by which it caſts forth of the mouth what humour ſoever is contained in its capacity. In the beginning Vomiting is but a ſingle ſymptom not to be feared; but continuing a long time, it weakens the ſtomach very much, and hindring digeſtion, corrupts the food inſtead of concocting it, whence afterwards are engendred thoſe ill humours, which need purging. Theſe Vomitings ordinarily continue to the third or fourth month of being with Child, which is the time the Child appears manifeſtly to quicken in, after which it begins to ceaſe, and Women to recover the appetite they70 had loſt during their being young with Child; becauſe the Infant growing ſtronger and bigger, having need of more nouriſhment, conſumes abundance of humours, which hinders the flowing of ſo much ſuperfluity to the ſtomach; beſides, at that time the Womb is by degrees accuſtomed to extention: It continues in ſome till they are delivered, which often puts them in danger of miſcarrying, and the rather, the nearer the Woman is to her full time. Others again are more ſometimes tormented with it towards the end of their reckoning than at the beginning: becauſe the ſtomach cannot then be ſufficiently widened to contain eaſily the food, being compreſſed by the large extention and bigneſs of the Womb. Such a Vomiting which comes about the latter end of the reckoning to Women whoſe Children lie high, ſeldom ceaſeth before they are brought to bed.
You need not wonder, or be much troubled at the Vomitings in the beginning, provided they are gentle and without great ſtraining, becauſe they are on the contrary very beneficial to Women; but if they continue longer than the third or fourth month, they ought to be remedied, becauſe the Aliment being daily vomited up, the Mother and the Child, having need of much blood for their nouriſhment, will thereby grow extreamly weak, beſides the continual ſubverſion of the ſtomach, cauſing great agitation nd compreſſion of the Mothers Belly, will force the Child before its time, as is already mentioned.
To hinder this Vomiting from afflicting the Woman much or long (it being very difficult to hinder it quite) let her uſe good food, ſuch as is71 ſpecified before in the Rules or Diet; but little at a time, that the ſtomach may contain it without pain, and not be conſtrained to vomit it up, as it muſt when they take too much, becauſe the big-belly hinders the free extenſion of it; and for to comfort and ſtrengthen it (being alwayes weak) let her ſeaſon her meat with the Juice of Orenges, Lemons, Pomegranets, or a little Verjuce or Roſe-Vinegar, according to her appetite. She may take likewiſe a Decoction made of French-Barleyflower, or good Wheat-flower, having dryed the flower a little before in an Oven, mixing the yolk of an Egg with it, which is very nouriſhing and of eaſie digeſtion: ſhe may likewiſe eat after her meals a little Marmalade of Quinces, or the Jelly of Goosberries; let her Drink be good old Wine, rather Claret than White, being well mixed with good running Fountain-Water, and not that which hath been long kept in Ciſterns, as is moſt of the Water of our Fountains of Paris, which acquire by that ſtay an evil quality: If ſhe cannot get ſuch freſh Waters, let her rather uſe River-Water taken up in a place free from filth, in which ſhe may ſometimes quench hot Iron: Above all, let her forbear all fat Meats and Sauces, for they extreamly moiſten and ſoften the Membranes of the Stomach, which are already weak enough, and relaxed by the Vomitings, as alſo all ſweet and ſugered Sauces, which are not convenient for her, but rather ſuch as are a little ſharp, with which it is delighted and comforted.
But if notwithſtanding theſe Precautions, and this regular Dyet, the Vomiting (as it ſometimes happens) continues ſtill, although the Woman72 be above half gone, it is a clear ſign there are corrupt humours cleaving to the inward ſides of the Stomach, which being impoſſible to be evacuated by ſo many preceding Vomitings, becauſe they adhere ſo faſt, muſt be purged away by Stool, to effect which they need a Diſſolvent, which may be a gentle Purge, made by infuſing half a dram of Rhubarb, a dram or two at moſt of good Senna, and an ounce of Syrup of Succory; which Purge diſſolves the humours, and in evacuating them, comforts the parts: Or, it may be made with young Mallows, Caſſia, Tamarinds, or any other gentle Purgers, according as the caſe requires, alwayes adding a little Rhubarb, or compound Syrup of Succory; obſerving likewiſe what humours ought to be purged: For, as Hippocrates ſaith, in the 12th Aphoriſm of his firſt Section, In perturbationibus ventris, & vomitibus ſponte evenientibus, ſi quidem qualia oportet purgari, purgentur, confert & facile ferunt: ſin minus contra, &. In perturbations and dejections of the Belly, and in ſpontaneous Vomitings, if the matter be purg'd away, which ought to be, the Patient finds eaſe and comfort: if not, the contrary. Therefore we are to conſider, that it is not enough to purge, unleſs we evacuate the peccant humours; for otherwiſe purging more weakens the Stomach, which it would not if it were well ordered, and convenient to evacuate the vicious humour. If once be not ſufficient, it may be repeated, giving the Woman ſome few dayes reſpit between both; if the Vomiting continues daily, almoſt without intermiſſion, although the Woman obſerves a good dyet, and after that ſhe hath been reaſonably well purged, we muſt reſt there, leſt ſomething worſe73 happen, of which we may incur the blame; for ſhe is then in great danger of miſcarrying: and when the Hiccough takes them through emptineſs, proceeding from too much evacuation, cauſed by theſe continual vomitings, it is very bad, as the third Aphoriſm of the ſecond Book teacheth us, A Vomitu ſingultus malum.
Some adviſe, that after all theſe things have been tryed in vain, great Cupping-glaſſes ſhould be applyed to the region of the ſtomach, to keep it firm in its place: but I believe it to be a Chip in Pottage, which doth neither good nor hurt; becauſe the ſtomach is looſe, and no wayes adhering to this upper part of the belly: but ſince theſe Vomitings cool it, and daily weaken it, I ſhould adviſe a big-bellied Woman to wear in the Winter, upon its region, a good piece of warm Serge, or ſoft Lambskin, which would a little warm thoſe parts, and help digeſtion, which is alwayes weak. The Italians have a Cuſtom, which is not bad; they wear to the ſame purpoſe a fair piece of Stuff under their Doublets upon the region their ſtomach, of which they are ſo careful, that if they ſhould leave it off but two dayes in the Winter, nay even in the Summer, they would think themſelves ſick; and they are ſo grear lovers, and ſo curious of it, that this Stomacher is often their greateſt bravery, enriching it with Gold and Silver Embroidery, and Ribonds of very fine colours.
We have diſcourſed enough about Vomiting cauſed by Pregnancy, wherefore we will paſs forwards to ſome other Accidents.
ALL theſe Accidents are but the effects of the dilatation of the Womb, and the compreſſion it makes by its greatneſs and weight on the neighbouring parts; which are much greater the firſt time the Woman is with Child than afterwards, when the Womb only receives the ſame dimenſions it had already before: but when it hath not yet been dilated, it is more ſenſible of this extention, and the ligaments, which hold it in its natural ſcituation, ſuffer a greater ſtreſs in the firſt pregnancy, having never before been forced to lengthen to anſwer the extent of the Womb, than in the following Great-Bellies, to which it obeys more eaſily the ſecond time.
Theſe ligaments, as well round as large, cauſe theſe pains, being much ſtraitned and drawn by the bigneſs and weight of the Womb, which contains a Child, to wit, the large ones, thoſe of the back and loyns, which anſwer to the reins, becauſe theſe two ligaments are ſtrongly faſtened towards theſe parts; the round ones cauſe thoſe of the groins, ſhare, and thighs, where they terminate. They are ſometimes ſo violently extended by this extream bigneſs and great weight of the Womb, eſpecially of the firſt Child (as I ſaid before) that they are lacerated and torn, being not able to yeeld or ſtretch any farther, and chiefly if the Woman in that condition makes a falſe ſtep, which cauſeth in75 them almoſt inſupportable pains, and other worſe accidents; as it happened two years ſince to a near Kinſwoman of mine, who being ſix months gone, or thereabouts, of her firſt Child, felt the like after ſhe had ſtumbled, and perceived at the ſame moment ſomething crack in her Belly towards the region of the Reins and Loins, which was one of theſe large ligaments, with a kind of noiſe, by the ſudden jolt ſhe received. At the ſame inſtant ſhe felt extream pains in her Reins and Loins, and all the one ſide of her Belly, which made her immediately vomit very often with much violence, and the next day ſhe was taken with a great continued Feaver, which laſted ſeven or eight dayes, without being able to ſleep or reſt one hour, all which time ſhe continued to vomit all ſhe took, with a ſtrong and frequent Hiccough, having alſo great pains, which ſeemed as if they would haſten her Labour, which (for her ſake) I was very apprehenſive of, as alſo of her death: but with the help of God, having put her immediatly to bed, where ſhe continued twelve whole dayes, in which time I bled her thrice in her Arm on ſeveral dayes, and made her take at two ſeveral times a ſmall grain of Laudanum in the yolk of an Egg, a little to eaſe her violent pains by giving her reſt, alwayes ordering her from time to time good ſtrengthning Cordials; all theſe ſymptoms, which at firſt ſeemed deſperate, ceaſed by little and little, and ſhe went on her full time, when ſhe was happily delivered of a Son, which lived fifteen months notwithſtanding all thoſe miſchievous accidents ſhe met with, which were enough to have kill'd half a dozen others: but God ſometimes is pleaſed to work Miracles by Nature, aided with76 Remedies fit for the purpoſe, as well as by his Grace.
This Hiſtory informs us (I think) very well how theſe Pains of the Loins, Back, and Reins come; and the pregnant Womb cauſeth alſo thoſe of the Hips by its greatneſs and weight, in compreſſing them, and bearing too much upon them. There is nothing will eaſe all theſe ſorts of Pains better, than to reſt in Bed, and bleed in the Arm, if there were any great extenſion or rupture of any ligament of the Womb, as was in the caſe recited: And when the Womb bears and weighs too much upon the Hips, if the Woman cannot keep her Bed, ſhe ought to ſupport and comfort her Belly with a broad Swaith well fitted for the purpoſe, and to bear it as patiently as ſhe can to the time of her Labour, which will free her from all theſe accidents.
AS ſoon as a Woman conceives, her Tearms wanting the ordinary evacuation, the paſſages being ſtopt, and the Woman breeding daily blood, there is a neceſſity, ſhe conſuming but little whilſt young with Child, the fruit being yet very little alſo, that the veſſels which are too full, ſhould diſgorge part, as it doth upon the parts diſpoſed to receive it, ſuch as are the kernels, and glandulous parts, eſpecially the Breaſts, which imbibe and receive a great quantity of it, which filling and extreamly77 ſwelling them, cauſeth this Pain in them, which Women feel when they are with Child, and happens alſo to thoſe whoſe Terms are only ſuppreſſed.
In the beginning we ought to leave the whole work to Nature, and the Woman muſt only have a care ſhe receives no blows upon thoſe parts, which are then very tender, nor be ſtraight laced with her Bodies, or other ſtiff Waſtcoats, that might bruiſe and wound her; upon which follow Inflamations and Abſceſs: But after the third or fourth month of going with Child, the blood being ſtill ſent to the Breaſts in great abundance, 'tis much better to evacuate it by bleeding in th'Arm, than to turn or drive it back on ſome other part of the Body by repercuſſive or aſtringent Medicines; becauſe it cannot flow to any part, where it can do leſs hurt, than in theſe. Wherefore I ſhould rather prefer the Woman being very plethorick, to evacuation, by bleeding in the Arm, than any other way, becauſe of ſhunning thereby the Accident, of which ſpeaks Hippocrates in his 40th Aphoriſm of the 5th Book, Quibus Mulierilbus in Mammas ſanguis colligitur, furorem ſignificat: If the blood be carried in too great abundance to the Breaſts, it ſignifies that the Woman is in danger of being frantick, becauſe of the tranſport which may be made thence to the Brain; which accident is avoided by moderate bleeding in the Arm, as alſo by a regular cooling dyet, moderately nouriſhing, for to diminiſh the quantity, and temper the heat of the humours of the whole habite.
THe ſcituation of the Bladder, which is placed juſt upon the Womb, is ſufficient to inſtruct us wherefore pregnant Women are ſometimes troubled with difficulty of urine, and the reaſon why they cannot often hinder, nor ſcarce retain their water; which is cauſed two wayes: 1. Becauſe the Womb with Child by its bigneſs and weight compreſſeth the Bladder, ſo that it is hindred from having its ordinary extenſion, and ſo incapable of containing a reaſonable quantity of urine: Which is the cauſe that the bigger the Woman grows, and the nearer her time ſhe approaches, the oftner ſhe is compelled to make water, which for that reaſon they cannot keep. 2. If the weighty burden of the Womb doth very much compreſs the bottom of the Bladder, it forceth the Women to make water every moment: but contrarily, if the neck of it be preſſed, it is filled ſo extreamly with urine, which ſtayes there with great pain, being not able to expel it, foraſmuch as the Sphincter, becauſe of this compreſſion, cannot be opened to let it out. Sometimes alſo the urine by its acrimony excites the Bladder very often by pricking it, to diſcharge it ſelf; and ſometimes by its heat it makes an inflamation in the neck of the Bladder, which cauſeth its ſuppreſſion. It may be likewiſe that this Accident is cauſed by ſome Stone contained in the Bladder; then the pains of it are almoſt79 inſupportable, and much more dangerous to Woman with Child, than to one that is not; becauſe the Womb by its ſwelling cauſeth perpetually the ſtone to preſs againſt the Bladder; and ſo much the violenter are theſe pains, as the ſtone is greater, or the figure of it unequal and ſharp.
It is of great conſequence to hinder theſe violent and frequent endeavours of a big-bellied Woman to make water, and to remedy it, if poſſible, both in one and the other indiſpoſitions; becauſe by long continuance of alwayes forcing downwards to make water, the Womb is looſned and bears very much down, and ſometimes is forced (the inconvenience not ceaſing) to diſcharge it ſelf of its burden before the ordinary time. This is that ſhould be endeavoured to be hindred, having reſpect to the different cauſe of the diſtemper; as when it comes from the bigneſs and weight of the Womb, preſſing the Bladder, as it is for the moſt part: the Woman may remedy it, and eaſe her ſelf, if when ſhe would make water, ſhe lift up with both her hands the bottom of her belly: ſhe may wear a large Swaith accommodated to this uſe, which will bear it up if there be occaſion, and hinder it from bearing too much upon the Bladder; or, to do better, ſhe may keep her Bed.
If it be the acrimony of the urine that makes the inflammation on the neck of the Bladder, it may be appeaſed by a regular cooling dyet, drinking only Ptiſan, and forbearing the uſe of Wine, and all ſorts of Purgations, becauſe they ſend the filth of the whole body to the part affected, and by their heat do yet more augment the acrimony and inflammation: but ſhe will do well to uſe, mornings and80 evenings, Emulſions made with the cold Seeds, or Whey mixt with Syrup of Violets. This Remedy is proper, by refreſhing gently, to cleanſe the urinary paſſages, without prejudicing either the Mother or Infant. If the inflammation and acrimony of the Urine be not removed by this Rule of Dyet, they may let her blood a little in the Arm, to prevent, any ill accident that may happen: they may likewiſe bath her outward entry of the neck of her Bladder with a Decoction of emollient and cooling Herbs, as the leaves of Mallows, Marſh-mallows, Pellitory, and Violets, with a little Linſeed, which being viſcous, will help the conduit of the Urine to dilate it ſelf the eaſier; there may be alſo Injections given into the Bladder of the ſame Decoction, to which may be added Honey of Violets, or elſe of lukewarm Milk.
But if the Woman, notwithſtanding ſhe obſerves theſe Directions, cannot make water, recourſe muſt be had to the laſt remedy, which is, to draw it forth by a Catheter, repreſented and marked with the Letter M in the Table of Inſtruments, at the end of the ſecond Book, which being anointed with Oyl Olive, or ſweet Almonds, having firſt lifted up and thruſted the Belly a little upwards, muſt be gently introduced by the urinary paſſages into the very hollow of the Bladder, and then the Urine will immediately paſs away; which being finiſhed, the Catheter muſt be taken forth, and if the ſuppreſſion continues, it may be uſed again in the ſame manner until the accident quite leave her, and then they may try whether ſhe can urine naturally. If ſhe be in very great extremity, ſhe may uſe an half-Bath luke-warm, provided ſhe be not too much81 moved by this Remedy, abſtaining alſo from all Diureticks, which are very prejudicial to big-bellied Women, becauſe they provoke abortion. If on the other ſide, this evil ariſes from the Stone, which preſenting it ſelf to the neck of the Bladder, ſtops the urinary paſſage, whilſt with Child; ſhe muſt be contented to have it only thruſt back with a Catheter: but if it be ſmall, one may try to draw it forth with a ſmall Probe fit for the purpoſe, putting the fore-finger into the Vagina, to keep it in ſubjection that it recoyl not back towards the Bladder, which is only to be done to the ſmall ones; for ſhe muſt be delivered before the great ones can be drawn forth, it being better to leave her in that condition, than to endanger her life or the Childs, by drawing it.
WOmen whoſe Children lie low, are oftener troubled with difficulty of Urine (as we have mentioned in the foregoing Chapter) than they whoſe Children lie higher, who are indeed exempted from this and the like inconvenience, but are then more ſubject to a Cough and difficulty of breathing than the former.
A Cough, if violent, as ſometimes, even to vomiting, is one of the moſt dangerous accidents, which contributes to Abortion, becauſe it is an eſſay by which the Lungs endeavour to caſt forth of82 the Breaſt that which offends them, by a compreſſion of all its Muſcles, which preſſing all the incloſed air inwards, with which the Lungs are much extended, thruſts alſo by the ſame means with a ſudden violence the Diaphragma downwards, and conſequently all the parts of the lower Belly, but particularly the Womb of the pregnant Woman, which accident continuing long and violent, often cauſeth her to come before her time.
This Cough proceeds ſometimes from ſharp and biting rheumes, which diſtill from the brain upon the ſharp Artery and the Lungs, and ſometimes from a blood of the like nature, which flowes from the whole habit towards the Breaſt, upon the ſuppreſſion of the Terms; as alſo from having breathed in too cold an air, which irritates the parts, and excites them to move in that manner; but being begun by theſe cauſes, it is very often augmented by the compreſſion the Womb of the pregnant Woman makes upon the Diaphragma, which cannot have its free liberty in thoſe that bear their Children high, becauſe by its great extenſion it bears up almoſt all the parts of the lower Belly towards the Breaſt, and principally the Stomach and Liver, forcing them againſt the Diaphragma, which is thereby compreſſed, as we have ſaid.
This may be remedied by the Womans obſerving a good diet ſomething cooling: if ſharp humours cauſe it, avoiding all meats ſalted, ſpiced, or hautgouſt; ſhe muſt forbear ſharp things, as Orenges, Citrons, Pomgranats, Vinegar, and others of the like nature, becauſe they yet more and more by their pricking quality excite the Cough: but ſhe may make uſe of Lenitives and ſuch as ſweeten the83 paſſages, as juice of Liquoriſh, Sugarcandy, and Syrup of Violets, or Mulberries, of which they may mix ſome ſpoonfuls with a Ptyſan made with Jujubes, Sebeſtens, Raiſons of the Sun and French Barly, alwayes adding a little Liquoriſh to it: It may not likewiſe be amiſs to turn the abundance of theſe humours, and draw them downwards by ſome gentle Clyſter. If this regimen prevails nothing, and that there appears ſigns of fulneſs of blood, it will be neceſſary, at whatſoever time it be of her going with Child, to bleed her in the Arm, and though this remedy be not uſually practiſed when they are young with Child, yet in this caſe it muſt: for a continual Cough is much more dangerous than moderate bleeding. If the Cough comes of cold, let her be kept in a cloſe Chamber with a Napkin three or four times double about her Neck, or a Lambſkin, that it may keep her warm; and going to bed let her take three or four ſpoonfuls of Syrup of burnt Wine, which is very pectoral, and cauſeth a good digeſtion, if it be made in the following manner:
Take half a pint of good Wine, two drams of good Cinamon bruiſed, half a dozen Cloves, with four ounces of Sugar; put them together in a Silver Porenger, and cauſe them to boil upon a Chafindiſh of coals, burn it, and afterwards boil it to the conſiſtence of a Syrup, which let the Woman take at night, an hour or two after a light ſupper. It muſt alwayes be obſerved from whatſoever cauſe the Cough proceeds, that the Woman go looſe in her clothes, for being ſtrait-laced, the Womb is the more thruſt down, by the endeavours the Cough cauſeth it to make. And becauſe ſleep is very proper to ſtay defluxions, it may be procured (if there84 be occaſion) by ſome ſmall Julip uſing by no means the ſtrong Stupeſactives, which are dangerous to a Woman with Child, if there be not a very great nece•ſity, as there was in my Kinſwoman, who had furious accidents by the hurt ſhe got from the ſtumble, of which I gave you an account in the 12th Chapter of this Book.
There are Women that carry their Children ſo high (eſpecially their firſt, becauſe the large Ligament, which ſupport the Womb are not yet relaxed) that they think them to be in their Breaſt, which cauſeth ſo great an oppreſſion and difficulty of breathing, that they fear they ſhall be choaked aſſoon as they have either eaten a little, walked, or gone up a pair of Stairs: which comes (as I ſaid before) by reaſon the Womb is much enlarged, and greatly preſſeth the Stomach and the Liver, which forces the Diaphragma upwards, leaving it no free liberty to be moved, whence is cauſed this difficulty of breathing. Sometimes alſo their Lungs are ſo full of blood, which is driven thither from all parts of the body when with Child, that it hardly leaves paſſage for the air: if ſo, they will breath more eaſily as ſoon as a little blood is taken from the Arm, becauſe by that means the Lungs are emptied and have more liberty to be moved: But if this difficulty of breathing comes from a compreſſion made by the Womb againſt the Diaphragma, in forcing the parts of the lower Belly againſt it; the beſt remedy is to wear their clothes looſe about them; and rather eat little and often, than to fill their Bellies too much at once: becauſe it is thereby more preſſed againſt the Diaphragma, and ſo augments the accident. Neither muſt ſhe uſe any viſcous or windy85 meats, as Peaſe, &c. but only ſuch as are of an eaſie digeſtion: ſhe muſt all the while avoid any occaſion of grief and fear, becauſe theſe two paſſions drive the blood to the Heart and Lungs in too great abundance, ſo that the Woman, who can hardly already breath, and hath her Breaſt ſtuft, will be in danger of being ſuffocated: for the abundance of blood filling at once and above meaſure the Ventricles of the Heart, hinders its motion, without which one cannot live.
IT is very eaſie for them that are acquainted with the Circulation of the Blood, to conceive the reaſon why many big-bellied Women have their Legs and Thighs ſwelled and pained, and ſometimes full of red ſpots, from the ſwelling of the Veins, all along the inſide of them, which extreamly hinders their going. Many think (which is in ſome meaſure true) that the Woman having more Blood than the Infant needs for its nouriſhment, Nature, by vertue of the expulſive faculty of the upper parts, which are alwayes moſt ſtrong, drives the ſuperfluity of it upon the lower, which are the Legs, as moſt feeble and apteſt to receive it, becauſe of their ſcituation: to explain it thus is ſomething to purpoſe; but I think the Circulation. of the Blood will teach us better how this comes, than that we need to have recourſe to this expulſive faculty.
86It is then thus, according to my opinion, Following the ordinary motion of the Blood, the Crural and the Saphene Veins receive into them what is brought to the lower parts by the Arteries, and convey it along the Leg and Thigh, aſcending ſtill by the Iliacks towards the Heart, which are emptied, into the Cava, to aſcend again by it to the Heart, and ſo ſucceſſively. This being ſo de facto (as need not be doubted, ſince it is a verity founded upon experience) when a Woman is with Child, and chiefly towards the laſt months, and the Womb is much extended, and poſſeſſeth a great part of the lower Belly, then it begins to preſs the Iliack Veins by its greatneſs and heavineſs, and ſo hinders the Blood, from following its courſe, and having its motion ſo free, as before ſhe was with Child; which being ſo, the inferior parts, which are the Crural and Saphene Veins, become ſwelled, much in the ſame manner as the Veins of the Arm do upwards when bound with a Ligature for bleeding, or by any ſtrong compreſſion upon the upper parts; which happens, becauſe the Veins being compreſſed, the Blood is there ſtopt, finding its paſſage more difficult. The Iliack Veins being then ſo preſſed by the bigneſs and heavineſs of the Womb, all thoſe of the Legs and Thighes ſwell in ſuch a manner, as that they empty themſelves into the ſubſtance of the parts, and throughout the five Coverings, which thence become ſwelled; yea and theſe Veins, and amongſt the reſt the Saphenes, dilated and become varicoſe, ſometimes from the inward and upper parts of the Thigh to the very extremity of the Foot, in which the Blood ſtagnating without its free circulation, is altered and corrupted, which cauſeth great87 pains and ſwellings in all theſe parts. This oftner befalls Women that are very ſanguine, walk much, and uſe great exerciſe, which aided with a fulneſs of the Vein, makes a rupture of the Valvules, which ſerve to facilitate the motion of the Blood; as the ſuckers of a Pump, which retain the water when it is raiſed thither: which Blood falling down again, not being ſo ſupported, cauſeth by its quantity and ſtay, theſe dilatations of the Veins, which are called Varices.
For to remedy this, when a Woman hath her Veins dilated, let her only uſe, whilſt ſhe is with Child, a palliative cure, in ſwaithing this Varicos-part with a ſwaith three or four fingers broad, according to the bigneſs of it, beginning to ſwaith from the bottom, and conducting it upwards to the beginning of the Varices, that by this means theſe varicos Veins, which are alwayes outward, being moderately cloſed, ſhould be hindred by this compreſſion from further dilating, and the Blood not be corrupted by the ſtay it makes there, which after this will not want its circular motion, becauſe the greateſt part of it paſſeth then by the Veſſels deeper placed. A Woman in this condition ſhould likewiſe keep her bed, if ſhe can, becauſe by this ſcituation, her body being equally layed, the Blood circulates much the eaſier, and is not then ſo much troubled to return by theſe Veins to the Heart, as when it muſt aſcend by them, the Woman ſtanding upright; which is the cauſe the Legs alwayes are more ſwell'd at night than mornings: if there be in any other parts of the Body ſigns of plenitude and abundance of Blood, they may bleed her without danger.
88There are other Women, whoſe Legs only ſwell becauſe of their weakneſs, and not for the reaſon juſt above mentioned, and are ſo oedematous, that when you preſs them with your Finger, the print of it remains there; which is, becauſe they want natural heat ſufficient to concoct and digeſt all the nouriſhment, ſent to them, and to expell the ſuperfluities of it, which by that means remaining there in great quantity, leaves them ſo oedematous. For, to reſolve theſe ſort of Tumours, you may uſe a Lee made with the Aſhes of Vines, and the Decoction of Melilot, Camomile and Lavender; afterwards they may be ſomented with Aromatick Wine, in which they may moiſten their compreſſes to be laid upon them, repeating them three or four times a day to fortifie them; which may be made with Roſemary, Bayes, Tyme, Marjoram, Sage, and Lavender, of each an handful; of Province-Roſes half a handful, Pomegranat flowers and Alum, each an ounce; boil them together in ſtrong Red-Wine, three pints, to the conſumption of a third part, ſtrain it, and keep it for the uſe above mentioned. But ſince Pregnancy for the moſt part cauſeth theſe tumours, they likewiſe ordinarily ceaſe when the Woman is brought to bed, becauſe then ſhe purgeth forth the ſuperfluity of her whole habit by means of her Lochia.
THe menſtrous Blood, that uſed to be purged away every month, being collected in a great quantity near the Womb (which permits it not now to be evacuated by the uſual paſſage, being ſo exactly cloſed during Pregnancy) is forced to flow back into the whole habit, and chiefly upon the neighbouring parts of the Womb, and cauſeth in many the Hemorrhoids both internal and external. All the ſeveral ſorts of them, which we ſhall not deſcribe, may as well happen to them at this time as at another: but we will only ſpeak of that ſort which is cauſed by pregnancy, becauſe our deſign is only to make known ſome particulars of the maladies Women are in this condition ſubject to.
Hemorrhoids are tumours and painful inflammations, ingendred by a flux of humours upon the extremities of the Hemorrhoid Veins and Arteries, and are cauſed in great-bellied Women by the abundance of Blood which is caſt upon theſe parts, becauſe the body at this time is not purged of its ſuperfluities, as it was accuſtomed before: It is likewiſe very often cauſed by the great endeavours that Women ſometimes make to go to ſtool when they are coſtive; becauſe the Womb being placed upon the Rectum, hinders by preſſing it, the excrements contained in it from being eaſily extruded; and by theſe endeavours the Blood, which is in the neighbouring Veſſels, being likewiſe expreſſed, ſwells and90 blows up their extremities, upon which comes theſe painful inflamations, call'd Hemorrhoids, of which ſome are internal, ſome external, ſome ſmall and with little or no pain, and ſome extreamly big and painful. This may ſuffice for their general differences, without coming to their particulars, which would require a more ample explication.
If they are ſmall and without pain, either internal or external, it is eaſie enough to prevent their further growth, by Remedies, which hinder and turn the flux from thoſe parts: but there is more reaſon to cure the great and painful ones, by eaſing firſt the great pain, for as long as that continues the Flux is ever augmented. To this purpoſe, if the big-bellied Woman have in the reſt of her body other ſigns of repletion, ſhe may ſafely be once let blood in the Arm, and ſometimes (if there be great neceſſity) twice, for to turn away the humours, and to evacuate the fulneſs, by which the pain will likewiſe be appeaſed: If the groſs excrements retained in the right Gut be the cauſe of it, and that ſhe be coſtive, let her take an emollient Clyſter of the Decoction of Mallows, Marſhmallows, Pellitory, and Violets, with Hony of Violets, to which may be added, Oyl of ſweet Almonds, or ſweet Butter; being careful to add nothing that may irritate, leſt it augment the Diſeaſe, eſpecially when they are inward Piles: And to the end the Women may then the better receive the Clyſter, tis fit that a ſmall end of a Pullets gut be put upon the end of the pipe, to cover it on the outſide, that ſo it may be put up the Fundament with leſs pain, afterwards let her keep a moderate and cooling diet, and continue in bed till this flux of humours be paſſed, and the mean91 time anoint the Piles with hot ſtroakings from the Cow, or foment them with the Decoction of Marſhmallows, White-broth, and Linſeed: Oil of ſweet Almonds, Poppies, and Water-Lillies well beaten together with the yolk of an Egg, and ground in a leaden Mortar, are very anodine and proper to eaſe pain; and if the inflammation be great, anoint it a little with Uuguentum Refrigerans Galeni, and Populean, equally mixed.
After a good diet, bleeding, and the application only of theſe cooling and anodine Remedies (Repercuſſives being not then to be uſed, leſt they repel the impure Blood, or harden the Piles) if their ſwelling doth not abate, Leeches muſt be applied, to draw and empty the Blood there gathered; or they may be opened with a Lancet, if ſoft, or any kind of inundation: but Leeches is more proper for hard Piles, and as it were fleſhy, becauſe they do not put one to ſo much pain as the Lancet: Although ſome men by the help of theſe Piles, have an evacuation, almoſt natural, being relieved by it when they bleed moderately, Nature being accuſtomed to it: yet it is not ſo in Women, but alwayes contrary to Nature; becauſe the evacuation which happens to thoſe men by the Piles, ought always to be made by the Womb in Women, if not with Child: but if they are, it may in ſome manner, in caſe the Woman be plethorick, ſupply alſo the defect of the natural; for, provided they bleed moderately and without pain, ſhe may thereby be alſo relieved: but if they flow in too great quantity, there is danger that both Mother and Infant will be weakened by it; and to avoid it, 'tis convenient to make aſtringent Fomentations with92 the Decoction of Granat flowers, the rinds of Pomegranates and Province-Roſes, made with Smithswater and a little Alum; or this Cataplaſm may be applyed to it, made with Bole-armonack, Dragonsblood, and Terra Sigillata, with the white of an Egg: As alſo to turn back the Blood from theſe parts by bleeding in the Arm, and by dry cupping-glaſſes, applied to the region of the Reines, and other remedies convenient for this diſtemper, and ſuch as the accident requires.
THree ſeveral Fluxes may befall a great-bellied Woman, to wit, the Flux of the Belly, the Flux of the Terms, and Floodings. We ſhall firſt ſpeak of the Flux of the Belly, and afterwards we will examine the other two, in the two following Chapters.
There are ordinarily reckoned three ſorts of Looſneſſes, which in general is a frequent dejection of what is contained in the Guts, by ſtool: the firſt is called Lienteria, by which the Stomach and the Guts, not having digeſted the nouriſhments received, lets it paſs almoſt quit raw. The ſecond is called Diarrhaea, by which they ſimply diſcharge the humours and excrements which they contain. And the third, which is the worſt, is Dyſenteria, by which the Patient, together with the humours and excrements, voids Blood with violent pains, cauſed by the ulceration of the Guts.
93Of what kind ſoever the Flux is, if it be great, and continue long, it puts the Woman in great danger of miſcarrying; which Hippocrates tells us in the 34th Aphoriſm of his 5th Book: Mulieri in utero gerenti, ſi alvus plurimum profluat, periculum eſt ne abortiat. For, if it be a Lienteria, the Stomach not containing the Food received, and letting it immediatly paſs away before it be turned into Chyle, of which Blood ought to be made for the nouriſhment of Mother and Child, it is not poſſible but they muſt be both thereby extreamly weakned for want of nouriſhment: If it be a Diarrhaea, and continues long, it will occaſion the ſame accident; becauſe there is a great diſſipation of the Spirits, together with the evacuation of humours: But the danger is much greater when a Dyſenteria, foraſmuch as the Woman hath then great pains and gripes in the Guts cauſed by their ulceration, which excites them continually by conſtant ſtimulations to diſcharge themſelves of the ſharp and bilious humours, with which they are extreamly annoyed; which cauſeth a great diſturbance and violent commotion of the Womb, being placed upon the right Gut; and to the Child contained in it, and by the compreſſion which the Muſcles of the Belly make on all ſides, as alſo thoſe that are made by them of the Diaphragma, which force themſelves downwards in the endeavours a Woman makes ſo often to go to ſtool with pain, the Child is conſtrained becauſe of this violence to come before its time, which arrives ſo much the oftner, by how much theſe ſtimulations and needings are greater, as the ſame Hippocrates notes in the 27th Aphoriſm of his 7th Book, Mulieri utero gerenti, ſi tentio ſupervenerit,94 facit abortum. If there happens a teneſme (ſaith he) to a Woman with Child, it make her miſcarry. This teneſme is a great paſſion of the right Gut, which forceth it to make theſe violent endeavours to diſcharge it ſelf, without being able to avoid any thing, but cholerick humors mixt with Blood, with which it is continually irritated.
When this Flux of the Belly happens to a bigbellied Woman, it is ordinarily, becauſe they have alwayes the digeſtion of their ſtomach weak, by reaſon of their bad dyet, which their ſtrange appetites cauſe them often to long for: by the continual uſe of which being at length weakned, it ſuffers the food to paſs immediately without digeſtion; or if it ſtay longer, it is converted into a corrupted Chyle, which deſcending into the Guts, irritates them by its acrimony to diſcharge themſelves as ſoon as they can.
Now to proceed ſafely to the cure of theſe different Fluxes of the Belly (to which 'tis fit care ſhould be taken in good time, leſt the Woman miſcarry, as we have already ſaid) the nature of it muſt be conſidered, to the end the cauſe, which maintains it, ſhould be remedied. If it be a Lienteria following (as is uſual) continual Vomitings, which have ſo debilitated the Stomach, and relaxed its membranes, that having no longer ſtrength to vomit up that food, it ſuffers it to paſs downwards without digeſtion: In this caſe a Woman muſt abſtain from all thoſe irregular appetites, and accuſtom her ſelf to good food of eaſie digeſtion, and little at a time, that ſo her Stomach may be able the eaſier to concoct and digeſt it; ſhe ſhould drink a little deep Claret-Wine, mixed with Water in which Iron hath been95 quenched, inſtead of Ptyſan, which is not proper in this caſe, provided ſhe have not a ſtrong Feaver; for if it be but a ſmall Feaver, Wine on this manner is to be preferred, foraſmuch as the fewer ſhe hath at that time, is but ſymptomatick, cauſed by this debility of Stomach, and will vaniſh as ſoon as this is fortified; which will be yet more promoted, if the Woman before and after meals takes ſome Corroberatives, as a little of that Burnt-Wine we mentioned for the Cough in the 15th Chapter of this Book; or a little good Hippocras, or right Canary, of any of them according to her pallat; neither will it be amiſs if ſhe eats a little good Marmalade of Quince before meals: She may likewiſe wear upon the pit of her Stomach a Lamb-skin with the wool, for to preſerve it, and augment its natural heat, which is very neceſſary to digeſt food; obſerving above all, to give no purging Medicine, when this Flux is only cauſed by weakneſs, leſt it be thereby augmented.
If it be a Diarrhaea, and only an evacuation ſimply of ſuch excrements as are retained in the Guts, and ſome ſuperfluous humours, which Nature hath ſent thither to be expelled, and that it continue no long time, and is gentle; the Woman will find no inconvenience by it; nor is ſhe in that danger as when it paſſeth thoſe bounds; and therefore 'tis good to leave the operation to Nature, without interrupting it in the beginning: but if it continues above four or five days, it is a ſign then, that there are ill humours contained and cleaving to the inſide of the Guts, which provoke them often to be diſcharged, and ought to be removed with ſome purging Medicine that may looſen and evacuate them,96 after which the Flux will certainly ceaſe, ſome light infuſion of Senna and Rubarb, with Syrup of Succory, or an ounce of Diacatholicon, with a little Rubarb for a Bolus, to be taken in a Waſer.
But if, notwithſtanding fit purges and a regular diet, this flux continues, and changes into a Dyſenteria, the Patient voiding every moment bloody ſtools, with much pain and needing, ſhe is then in great danger of miſcarrying, & its prevention ought it be endeavoured, if poſſible. Therefore, after having purged away the ill humour, (with the Medicines above mentioned) which were in the Guts, and hindering, by a good dyet, that no more be engendred; to which purpoſe let her uſe good broths made of Veal or Chicken, with cooling Herbs, temper the acrimony of theſe hot humours; let her eat Pap with the yolk of an Egg new layed, being well boiled: ſuch dyet ſoftens and ſweetens the Guts within. Let her drink be Water, in which Iron or Steel was quenched, with a little Wine, if ſhe be not feveriſh, for then half a ſpoonful of Syrop of Quince or Pomegranats is better to mix with the foreſaid Water; She may likewiſe eat a little Marmalade of Quince, or other aſtringents and ſtrengtheners, provided her body was well purged before: and becauſe there is always in theſe Fluxes great pains and gripes all over the Belly and Guts, and chiefly the Rectum, all the humours being diſcharged upon it, which irritating it extreamly, cauſeth continual ſtimulations, that ought to be appeaſed (if poſſible) to prevent Abortion, and may be effected by Clyſters made of the Broth of a Calves-head, or Sheeps-head well boyled, mixing it with two ounces of the Oyl of Violets, or elſe97 of good Milk, mixed with the Yolk of a freſh Egg. After the uſe of theſe ſtrengthening and anodine Clyſters, as long as is judged neceſſary, which the Patient ought to keep as long as ſhe can, the better to appeaſe theſe pains, you muſt proceed to the uſe of Deterſives, made with the Decoction of Mallows and Marſh-mallows, with Honey of Roſes; and afterwards Aſtringent Clyſters, in which muſt be neither Oyl nor Honey mixed, becauſe they relax inſtead of binding; beginning firſt with the gentleſt, made with Roſe-water, mixed with Lettice and Plantain-water; afterwards to ſtronger, compoſed with the Decoction of the Roots and Leaves of Plantain, Tapſus Barbatus, Horſe-tail, with Provence-Roſes, the rind of Pomegranats in Smiths-water; to which may be added, of Terra Sigillata, and Dragons-blood, each two drachms: You may likewiſe foment the Fundament; but there muſt be care, before you come to uſe the ſtrong Aſtringents, that the Woman be firſt well purged with the Remedies before mentioned, leſt (as the Proverb is) the Wolf be ſhut in with the Flock; and, endeavouring to prevent Abortion, the death of the Mother, and conſequently of the Child, be cauſed by a greater miſchief; retaining within abundance of ill Humours, of which Nature would willingly be diſcharged: All which may be avoided, if what I have ſaid be well obſerved.
HIppocrates, in the 60th Aphoriſm of his 5th Book ſaith, Si Mulieri utero gerenti Purgationes prodeant, impoſſibile eſt foetum eſſe ſanum; If a big-bellied Woman have her Courſes, it is impoſſible the Infant can be in health. This Aphoriſm muſt not be taken literally, but muſt be underſtood when they come down immoderately: for though, according to the moſt general and natural rule, the Courſes ought not to flow when a Woman is with Child, becauſe their ordinary paſſage is ſtopt, and alſo becauſe the Blood is then imployed for the nouriſhment of the Infant, of which, if it flows away, it is defrauded, and conſequently much weakened: Yet there are ſome Women, who notwithſtanding they are with Child, have their Courſes till the 4th or 5th month; about which time, the Infant being already pretty big, draws a good quantity of blood for its nouriſhment; wherefore there cannot ſo eaſily remain a ſuperfluity, as when young with Child. I knew one that had four or five living Children, and had, of every Child, her Courſes duly from month to month, as at other times, onely in a little leſs quantity, and was ſo till the 6th month; yet notwithſtanding, ſhe was alwayes brought to bed at her full time. I likewiſe ſaw another, who not believing ſhe was with Child, becauſe ſhe had her Courſes; and99 finding her ſelf out of order, becauſe ſhe had conceived, imagining it was ſome other Diſtemper, prevailed with her Phyſitian to bleed and purge her very often, which he did, till he had indeed cured her; but 't was after ſhe had miſcarried, being three months gone. This evacuation uſually befalls very Sanguine or Phlegmatick Women, who breeding more blood than the Infant hath need of for its nouriſhment at the beginning, diſcharge themſelves at thoſe times of that ſuperfluous quantity, more or leſs, according to their diſpoſitions, but not by the bottom of the Womb, as formerly when they were not breeding, becauſe thoſe paſſages are effectually cloſed by the after-birth which adheres to it, and the Womb is then exactly cloſe; but by a couple of Branches which Nature (provident and careful of the preſervation of Individuals, as well as of the Kind) hath deſtined to this uſe, which proceed from the Spermatick Veſſels, and (beſides thoſe they ſend to the Teſticles and other parts) before they arrive at the Womb, divide themſelves on each ſide into two Branches very conſiderable; of which, the one terminates in the Fund of the Womb, by which the Courſes paſs, when the Woman is not with Child; and the other, not entering there, couching along the body of it, is terminated in the ſide of the neck of the Womb, by which the Courſes are diſcharged, whilſt they are breeding, in caſe the Woman be Plethorick.
When a Woman voids blood downwards, it muſt carefully be conſidered whence it proceeds, and in what manner; whether it is the ordinary Courſes, or a real Flooding: If it be the ordinary Courſes, the blood comes away periodically at the100 accuſtomed times, and flows by degrees from the neck, near the inward Orifice of the Womb, and not from its Fund; as may be diſcovered, if trying with a finger one finds the inward Orifice exactly cloſed; which could not be, if the blood proceeded from the bottom, as alſo if it proceeds without pain; all which circumſtances do not meet in a flooding, but others very different, as will appear in the following Chapter. It muſt likewiſe be conſidered, whether theſe Courſes flow, onely becauſe of the ſuperfluity, or becauſe of the acrimony of the Blood, or the weakneſs of the Veſſels which contain it, that ſo fit Remedies may be applyed. If they proceed from the ſole abundance, being more than the Fruit can conſume for its nouriſhment, it is ſo far from hurting either Mother or Child, that being moderate, it is very profitable to them; becauſe, if the Womb were not diſcharged of this ſuperfluous blood, the Fruit which is as yet but little, would be drowned by it, or, as it were, ſuffocated: And if it ſhould chance that they were unduely ſtopt or retained, bleeding will ſupply the defect of the natural evacuation, which ought to have been; but if there be no ſign of abundance or plenitude; and that before ſhe was with Child, ſhe had her Courſes in a ſmall quantity, which ſtill continue to flow, after ſhe hath conceived, it is a ſign that the flux proceeds from the heat and acrimony of the blood, or the weakneſs of the Veſſels appointed to receive it. It is of this ſort of Women that Hippocrates pretends to ſpeak, in the 6th Aphoriſm before mentioned, whoſe Children cannot be healthful, when their Courſes flow, whilſt they are breeding; becauſe there remains not blood101 enough behind for her, and the nouriſhment of her Infant, which puts her in great danger of miſcarrying, for as the proverb ſaith, Hunger drives the Wolf out of the Wood; ſo likewiſe want of nouriſhment forceth the little priſoner out of his hidingplace before his time.
To hinder this Flux from effecting ſo evil and ſiniſter an accident, the Woman muſt keep her ſelf very quiet in bed, abſtaining from all things that may heat her Blood, ſhunning Choler above all the paſſions of the mind, uſing a ſtrengthening and a cooling diet, feeding on meat that breeds good Blood, and thickens it; as are good broths made with Poultry; necks of Mutton, knuckles of Veal, in which may be boiled cooling Pot-herbs; newlayd Eggs, Gelly's, Rice-milk, Barly-broths, which are proper for her: let her Drink be Water in which Iorn is quenched, with a little Syrup of Quince: ſhe muſt refrain from Copulation, becauſe by heating the Blood it excites it to flow more. If notwithſtanding all this the Flux continues, ſome commend large cupping-glaſſes under the Breaſts to make a revulſion, and to turn the Blood: according to Hippocrates Aphoriſm 50 of the 5th Book, Mulieri ſi velis menſtrua ſiſtere, cucurbitulam quam maximam ad Mammas appone: but it will do no great matter; however, to ſatisfie the Patient, and to ſhew that nothing is omitted that may make for her cure, they may be applied. I ſhould rather chooſe to make this Revulſion by bleeding in the Arme, if her ſtrength permitted: And becauſe in this condition the Child is very weak through this great evacuation, it muſt be fortified by applying to the Mothers Belly about the region of the Womb,102 Compreſſes ſteeped in ſtrong Wine, in which is boyled a Pomegranat, with its peel, Provence-Roſes, and a little Cinamon: but the beſt way to ſtrengthen it, is to correct the Mothers Blood, and hinders its evacuation.
THere is a great difference between the menſtruous Blood, of which we have diſcourſed in the preceeding chapter, which happens ſometimes to Women with Child, and this Flooding which we have now in hand: for (as I have ſaid) the Courſes come periodically at the times accuſtomed, without pain, deſtilling by little and little from the neck of the Womb, during pregnancy, after which it totally ceaſeth: but much the contrary, this loſs of Blood comes from the bottom of the Womb, with pain, and almoſt of a ſudden, and in great abundance, and continues flooding daily without intermiſſion, except that ſome clods (formed there) which ſeem ſomtimes to leſſen the accident, by ſtopping for a little time the place whence it flows; but ſoon after it returns with greater violence, after which follows death both to Mother and Child, if not timely prevented, by delivering the Woman, as ſhall be hereafter declared.
If this Flooding happens when young with Child, it is uſually becauſe of ſome Falſ-conception, or Mole, of which the Womb endeavours to diſcharge it ſelf, by which it opens ſome of the103 Veſſels in the bottom of it, from whence the Blood ceaſeth not to flow, until in hath caſt forth the ſtrange bodies it contained in its capacity: and the hotter and ſubtiller the Blood is then, the more abundantly it flows. But when this Flouding happens to a Woman truly conceived, at whatſoever time it be, it proceeds likewiſe from the opening of the Veſſels of the fund of the Womb, cauſed by ſome blow, ſlip or other hurt, and chiefly becauſe the Secundine in ſuch caſes, and ſometimes in others, ſeparating in part, if not totally, from the inſide of the bottom of the Womb, to which it ought to adhere, that it might receive the Mothers Blood, appointed for the Infants nouriture, by which ſeparation it leaves open all the orifices of the veſſels where it was joyned, and ſo follows a great flux of Blood, which never ceaſeth (if ſo cauſed) till the Woman be brought to bed: for the Secundine being once looſened, although but part of it, never joyns again to the Womb to cloſe thoſe Veſſels, which can never ſhut till the Womb hath voided all that it contained: for then compreſſing and cloſing its ſelf, and as it were entering within it ſelf (as it happens preſently after delivery) the orrifices of the veſſels are cloſed and ſtopt up by this contraction, whereby alſo this flooding ceaſeth, which alwayes continues as long as the Womb is diſtended by the Child, or any thing elſe it contains, for the reaſon aforeſaid: much like to a Spunge, whoſe pores or holes being very large when ſwelled, diſappear and cloſe with their own ſubſtance when ſqueezed and compreſſed; ſo likewiſe by this contraction of the Matrix (which during pregnancy became as it were ſpongeous) in the place whence the Secundine was104 ſeparated, the orifices of the veſſels are cloſed, aſſoon as it is cleanſed from whatſoever it contained in its capacity.
Although I have ſaid that a Woman in this condition, for the reaſons alledged, muſt neceſſarily be delivered, that the Flooding may be ſtopt; I do not intend it ſhould be done aſſoon as perceived: becauſe ſome ſmall Floodings have ſometimes been ſuppreſſed by keeping quietly in bed, bleeding in the Arme, and the uſe of the Remedies ſpecified in the precedent Chapter; it may likewiſe be but an ordinary and menſtruous Flux. If then the Blood flows but in ſmall quantity, and continues a little while, 'tis good leaving the labour to the work of nature, provided the Woman hath ſufficient ſtrength, and that it be accompanied with no other evil accident: but when it flows in ſo great abundance, that ſhe falls into Convulſions and Faintings, then the operation muſt not be defer'd; and 'tis abſolutely neceſſary ſhe ſhould be delivered whether ſhe be at her reckoning or no, whether ſhe have pains or throws, or not; becauſe there is no other way to ſave her life, and the Childs, then preſently to do it. Extreman fundet cum ſanguine vocem; ſhe caſts forth with her Blood her laſt breath. Hippocrates knew very well the danger of it, when he ſaid in his 56th Aphoriſm of the 5th Book, In fluxu muliebri ſi convulſio & animi defectus advenerit, malum: If Convulſions and Faintings follow Floodings, it is a bad ſign.
There muſt not alwayes in theſe unfortunate accidents be expected pains and throws to force and bear down to forward labour; for though they come at the beginning, they uſually ceaſe aſſoon as105 the Flooding comes to Syncope's and Convulſions; neither muſt it be defer'd, till the Womb be enough opened, foraſmuch as this effuſion of Blood very much moiſtens it, and the weakneſs relaxeth it, ſo that it may be then as eaſily dilated as if there had been abundance of ſtrong throws. Wherefore, having placed the Woman in the ſituation we ſhall direct when we treat of deliveries, let the Chirurgeon, having his hands anointed with Oyle or freſh Butter, introduce his Fingers joyned together, by degrees into the Matrix, and ſpread them open the one from the other when they are in the entry, for to dilate it ſufficiently by little and little, without any violence, if poſſible; which being done, and his hand quite within, if he finds the Waters not broke, let him break them, and then, whatſoever part of the Child preſents, though the Head (provided it be not juſt in the Birth) let him ſearch for the Feet, and draw it forth by them (obſerving every curcumſtance, that ſhall be ſhewen in the 14th Chapter of the ſecond Book, where is deſcribed the way how to deliver a Woman, the Child coming with the Feet firſt) becauſe there is better hold, and more eaſie to deliver by them, than by the Head or any other part of the body. Wherefore if the Feet lie not ready, the Chirurgeon muſt ſeek for them, which at that time is eaſier done than at another, becauſe the great Flooding makes the Womb looſe and ſlippery by its humidity, ſo that it will not be difficult for him to turn the Child and bring it by the Feet, as we have even now ſaid; after which he muſt fetch the after-burthen, which in theſe caſes cleaves but little, being careful not to leave ſo much as a clod in the Womb, leſt it ſtill continue the Flooding,106 which being done, it will ſoon after ſtop with all the accidents, if too much time was not ſpent before the operation.
Many Women and Children have periſhed for want of this operation in this ill accident; and many others have eſcaped death, (which elſe moſt certanly had followed) by being timely ſuccored.
Guillimen in Chap. 13 of his 2d Book of happy Deliveries, makes mention of ſix or ſeven Hiſtories to confirm this verity, in ſome of which we may find the Women and their Children bloody victims of it, for not having been in the like caſe delivered, which others, by a ſeaſonable delivery, eſcaped: and the better to confirm it by my own experience, I will recite you one amongſt the reſt, very remarkable, of the remembrance of which I am ſo ſenſible, that the Ink I write with at preſent to publiſh it to the World for their propfit, ſeems to me to be Blood, becauſe in this ſad and fatal occaſion, I ſaw part of my ſelf expire.
About three years ſince one of my Siſters, not yet one and twenty years of age, being about eight months and a half gone with her fifth Child, and then very well in health, was ſo unfortunate as to hurt her ſelf (though at firſt ſmall in appearance) by falling on her Knees, her Belly a little touching the ground by the fall, after which ſhe paſſed a day or two without perceiving any great alteration, which made her neglect to repoſe her ſelf, being very neceſſary for her; but the third day, or thereabouts, after her hurt, about eleven in the morning, ſhe was ſuddenly ſurpriſed with ſtrong and frequent pains in the Belly, which were immediatly followed with Floodings; this made her107 preſently ſend for her Midwife, who no better underſtanding her Office, told her ſhe muſt have papatience, till the Womb had dilated it ſelf by the pains, before ſhe could be delivered, aſſuring her further that ſhe had no reaſon to be afraid, and that ſhe ſhould be quickly freed from the danger, becauſe her Child came right: ſhe made her thus hope in vain three or four hours, until, the Flooding ſtill continuing violently, the pains began to ceaſe, and the poor Woman fell into frequent faintings, and then the Midwife deſired a Chiurgeon to adviſe with in this caſe: they immediately ſent to my houſe for me, but unfortunately miſſing of me, they ſent for him, whom they judged the ableſt of all the Chirurgeons that practiſed Midwifery in Paris, and immediatly conducted him to my Siſters, where he arrived about four in the afternoon, and having ſeen her,**It were to be wiſh'd rather than hoped for, that Practitioners in this and other the like dangerous caſes (whereof they have no certain knowledge) would conſult, and not deſtroy one or more, by undertaking what they cannot well perform, or diſcourage Patients from ſending for other help and advice; putting Life in ballance with their Reputation. contented himſelf with only ſaying, ſhe was a dead woman, and that nothing was to be done to her, but to give her all the Sacraments, and that abſolutely ſhe could not be delivered; which likewiſe the Midwife joyntly concluded, who believed that the opinion of a Man ſo authentickly eſteemed of all, muſt be infallible. Aſſoon as he had delivered this Prognoſtick, he immediately returned home, and would by no means ſtay any longer, but left this young Woman in that deplorable condition without any ſuccour, whoſe life he had certainly ſaved108 with her Childs, if he at that time had delivered her, which was very eaſie to be done, as will plainly appear by the ſequel of the Hiſtory. After the advice of a perſon of ſo great reputation, together with that of the Midwife, ſince Monſieur N.**The great miſchiefs which happen by the Prognosticks of ſuch who have the luck, though they want the merit to be eſteemed. could do nothing, there was no other remedy for ſo great a danger, but to hope in God alone, who was Almighty. They therefore endeavoured to comfort my poor Siſter as well as they could, who longed for nothing more then to ſee me, to know whether I would paſs the ſame ſentence, and whether her danger, which ſtill augmented more and more, was without remedy (for her Blood flowed away continually in great abundance) At length I returned home, where they had been long before to tell me this bad news, though by misfortune could not find me (as I ſaid before) which as ſoon as I underſtood, I immediately haſtened to her with all poſſible ſpeed, where I ſaw aſſoon as I came in, ſo pittiful a ſpectacle, that all the paſſions of my Soul were at the inſtant agitated with many and different commotions; having afterwards a little recovered my ſenſes, I drew near to my Siſters Bed, where they had juſt given her the laſt Sacraments, and ſhe conjured me very often to give that ſuccour, which ſhe ſaid ſhe only expected from me. After that I had underſtood from the Midwife all that had paſſed, and the opinion of the Chirurgeon, that had ſeen her above two hours before (for it was then ſix a clock) I perceived the Blood109 to flood continually in great abundance and without intermiſſion, of which ſhe had already loſt above**French quarts are Engliſh pottles. three quarts: and which was very remarkable, above twelve ſmall Porengers, in the two hours after the Chirurgeon was returned, as it ſeemed to me by the number of Napkins and other Clothes, which were all muck wet with it; which Blood had ſtayed in her body and ſaved her life, if ſhe had been then delivered: I ſaw likewiſe that ſhe grew every moment weaker and weaker, which convinced me that ſhe was then in more danger than ſhe would have been if they had not let ſlipt the opportunity of delivering her two or three hours before, as it was poſſible and eaſie; becauſe ſhe had then almoſt all her ſtrength, which ſhe afterwards loſt with the reſt of her Blood, which all along flooded away; and deſirous to know whether they could have delivered her, I found, by trying her body, that the inward orifice of the Womb was dilated in ſuch ſort that I could eaſily introduce two or three fingers, and having marked it, I made the Midwife try again to ſee whether the orifice was ſo diſpoſed when the Chirurgeon ſaid that ſhe could not be delivered, and whether ſhe was of his opinion. She told me it was ſo, and that it had been alwayes in the ſame condition from the time of his departure. Aſſoon as ſhe had made me this declaration, I eaſily perceived his ignorance, and where the ſhoe wring'd him.
Wherefore I told her, that I woundred much they were both of that opinion, ſeeing that in truth it ſeemed quite contrary to me, becauſe it was at that time moſt certainly very eaſie for him to have110 delivered her, if he had pleaſed, as it ſtil was, & what indeed I would have done at that very moment, if it had been poſſible for me to have had power enough over my Spirit, which wavered a long while about the reſolution I was conſtrained to take, after I had loſt the hopes of all other help. That which hindered me, was not ſo much the Prognoſtick, that ſo famous a Chirurgeon had made, in perſwading all the Aſſiſtants, that ſhe could not be delivered, (though it might ſeem raſh to oppoſe the ſayings of ſuch as are eſteemed Oracles) neither was it the little ſtrength the Patient had then left: but it was chiefly the relation of the Perſon, being my Siſter, whom I tenderly loved, which troubled my ſpirits with ſuch different paſſions, to ſee her before me ready to expire through the prodigious loſs of blood, which proceeded from the ſame ſpring as mine own, that it was impoſſible for me at that moment to reſolve, and obliged me to ſend again to the Chirurgeon (who was long ſince returned home) to entreat him to come back again to the Houſe, that (my ſelf demonſtrating to him the facility I found for the operation, and making him underſtand and confeſs that in thoſe caſes there is no hope, unleſs it be undertaken as ſoon as may be) I might perſwade him to deliver her, rather than to abandon the Mother, ſo to the diſpair of her life, as he had done, and to ſuffer the Infant to periſh with her unbaptized; which had been prevented if he had done what Art required, which is at leaſt (when both cannot be ſaved) to ſave the Child, if poſſible, without prejudice to the Mother, which was very eaſie, as you ſhall preſently underſtand: But no prayers nor ſollicitations could ever prevail with him111 to return, excuſing himſelf that it was impoſſible for him to do any thing in the caſe. When this was related to me, I ſent yet again to another Chirurgeon, one of my Companions, being a little more obliging and ſerviceable, whom, if he had come time enough, I would have convinced of the neceſſity of the operation, and made him acknowledge the facility of it: but by misfortune he was abroad. During all theſe goings and comings, there was an hour and half ſpent, which time ſhe flooded without intermiſſion, and her weakneſs grew more and more: wherefore ſeeing my ſelf without hopes of getting the perſons I ſent for, I reſolved to deliver her preſently, which before was beyond my power, for the reaſons recited, and indeed was now a little too late for the Mother; for, if I could have commanded my paſſions to have done it at the inſtant I arrived, there would then have been great bopes to have ſaved her, as well as I did the Child: After I had thus prepared my ſelf for it, that is, having directed two of my fingers into the inner orifice of the Womb, being open enough to admit them into it, I did in a little while after introduce a third, and by degrees the ends of all the five of my right hand, with which I dilated the orifice ſufficiently to admit it quite in, as it is very eaſie in the like caſes, becauſe the abundance of Blood moiſtens and relaxeth extreamly (as is already mentioned) the whole Womb, into which having ſo gently entred my hand, I found the Child came right, and the Waters not yet broken; wherefore I preſently broke the membranes with my nails and fingers, and then turning the Child, I took it by the feet, and brought it forth very eaſily, after the112 manner I ſhall teach in the forementioned 14th Chapter of the 2d Book, all which I finiſhed in leſs time than a hundred could be counted, and do conſcientiouſly proteſt never to have delivered a Woman ſooner in all my life, of thoſe whoſe Children came againſt Nature, nor eaſier, and with leſs violence to the Mother, who did not in the leaſt complain during the Operation, although ſhe had her ſenſes very well, and exactly knew all I did to her, and found her ſelf very much comforted as ſoon as ever ſhe was delivered, and immediately after the flooding began to ceaſe: As to the Child I brought it alive, and it was preſently baptized by a Prieſt that was in the Chamber. The poor Patient, and all the company preſent (which were in great number) found then manifeſtly that the Chirurgion and Midwife, who ſaid ſhe could not be delivered, had but little reaſon to aſſure any ſuch thing.
The Operation was finiſhed time enough for the Childs baptiſm, which (praiſed be God) it received; but too late to ſave the Mothers life, who (having before loſt all her Blood) dyed an hour after ſhe was ſo delivered, by the ſame weakneſs that ſhe often fell into before ſhe was delivered. The flooding indeed ceaſed preſently, but ſhe had not Blood enough left to enable her to reſiſt thoſe frequent faintings, which ſhe might have done, as may probably be conjectured, if the Chirurgion that firſt ſaw her had delivered her three long hours before, as without doubt he might as eaſily have done as I; in which time ſhe loſt above twenty**each Porenger contains about four ounces. ſmall porengers of Blood, of which four or five poſſibly might have been113 ſufficient to have ſaved her life, ſhe being a young Woman of a very good conſtitution, having no inconvenience or ſickneſs when ſhe was ſurpriſed with this fatal accident, which befel her (as aforeſaid) about eleven in the morning, and ſhe was delivered about ſeven at night; and becauſe ſhe had loſt ſo much Blood before the Operation, it proved unprofitable, ſhe dying an hour after, having her perfect ſenſes to the moment ſhe expired, which was about eight the ſame night.
I will upon this lamentable Subject (to the end more care may be taken in the like caſes) examine by way of digreſſion, what might be the motive of this proceeding of the Chirurgeon, and of ſome others of the ſame humour. It muſt neceſſarily be agreed, that it was for one or more of theſe three cauſes, why either he would not, or could not lay this Woman when he ſaw her two hours before me, which (as I noted before) might eaſily have been done: It was either through Ignorance, Malice, or Policy: To imagine it his Ignorance, I cannot perſwade my ſelf, becauſe he hath too great Reputation for that, although many perſons that underſtand the Art very well, eaſily agree with me, that he is of the number of thoſe, of whom may juſtly be ſaid, Minuit praeſentia famam. That it was through Malice, who can imagine a man of ſo deteſtable a reſolution could be found! but if it were neither Ignorance nor Malice, it is eaſy to gueſs it a damnable Policy, qualified by ſome with the name of Prudence;**A good Warning not to rely too much upon the advice of ſuch famous Practitioners, or Midwives, that prefer their Reputations above their Conſciences. this falſe Prudence they114 ordinarily uſe, that are in great reputation, ever endeavouring to their utmoſt to ſhun dangerous Cures, leſt they that underſtand not the Art, ſhould quit the good opinion they had of them, when it happens that the Patient dies under their hands, although they were carefully and duly delivered. This was juſt our misfortune; for this Chiurgeon, who was very much eſteemed by many Women of quality whom he delivered, avoided, all he could, dangerous labours, ſubject to ill ſucceſs, as this was; and the rather then, becauſe there was in my Siſters Chamber a Lady of quality, Wife to one of the chief Captains of the Guards, who dwelt in the ſame houſe, and whom he ordinarily delivered; which was the cauſe, that, believing the iſſue of the Operation doubtful, he choſe rather to preſerve the eſteem of his ancient practice, amongſt ſuch as underſtood not the buſineſs well enough to be judge of his proceedings, than to do in this caſe his Chriſtian duty; to which one ought alwayes to have more regard, than to all theſe Intereſts of vain Reputation, which uſually corrupts the Conſcience. They that make uſe of this Policy are often acceſſory to the death of poor Women who call for their aſſiſtance, and of their Children alſo.
I was willing to recite every circumſtance of this Tragedy, that one may know in the like caſe the neceſſity of a ſpeedy delivery. I have ſince that had many in the ſame caſe, to whom (by the aſſiſtance of God) I warranted the lives of the Women, and ſaved the Children; of which I had in my ſelf more ſatisfaction, than I could have gained by all the honour the World could procure me by ſo wicked a policy; which neither Chirurgeon nor115 Midwife of an upright Conſcience will ever uſe.
Now ſince in all floodings, there ever follows weakneſs and faintings, we muſt endeavour to preſerve that little ſtrength the Patient hath left, and augment it if poſſible; that ſo they may have ſufficient to endure the operation, and to eſcape afterwards: to which purpoſe there ought to be given her, from time to time, good ſtrengthening Broths, Gelly's, and a little good Wine: ſhe muſt alwayes ſmel to Roſe-vinegar, and have a warm toaſt dipt in Wine and Cinamon, applied to the region of her Heart; which will do her more good than ſolid food: for, as Hippocrates ſaith in the eleventh Aphoriſm of his ſecond Book, Facilius eſt potu refici, quam cibo, one is ſooner nouriſhed by drink than meat; becauſe the liquid aliments are much ſooner diſtributed than the ſolid: And to prevent the Blood from flooding in great abundance till ſhe can be delivered,**Rather Ligatures above the elbows, becauſe too much Blood is already loſt. a Vein in her Arm may be opened, to turn a little the courſe backwards; and apply all along her Reins, Napkins wet in Water and Vinegar. But if the flooding proceds from the ſeparation of the after-burthen from the Womb, as my Siſters was, all theſe things are to little purpoſe; and the beſt expedient is to deliver the Woman aſſoon as may be, though ſhe were but three or four months gone with Child, or leſs; becauſe all ought as well to be brought away, whatever is within the Womb, whether it be Falſ-conception, Mole, or Child, without leaving any thing behind, which when it is quite cleared, cloſing and contracting it ſelf, ſtops the flooding, for the reaſons above alledged,116 and all accidents which were cauſed by it; wherby the Woman afterwards recovers, if there be but ſufficient ſtrength remaining after delivery, as certainly will be, if not delayed too long.
MAny Women with Child find an extraordinary weight at the bottom of their Bellies; which comes, becauſe the Womb, by the weight it contains in its capacity, bears down upon the neck, and ſometimes ſo low that they cannot walk without pain and ſtradling; at which time alſo they cannot uſe copulation but with great inconvenience.
The bearing down of the Womb, is when it only falls into the Vagina, without coming in the leaſt without the Privities, for then it is called the falling-out, or Praecipitation; which is a more troubleſom and dangerous Diſeaſe, and doth not uſually befal Women with Child, becauſe the extent and bigneſs of the Womb hinders it, that it cannot fall out, but only bears down. The Precipitation is diſcerned by the view; and the bearing down eaſily, by puting up a Finger into the Vagina; for there the Womb will be ſoon met with, and its inner Orifice, which is very near the Privities, eſpecially when the Woman ſtands upright.
117This bearing down, is often cauſed by the relaxation of the ligaments of the Womb, and chiefly the large ones, which ought to faſten it on each ſide towards the loins, to prevent it; which relaxation comes either from the weight of the burthen it bears and contains within, which conſtrains theſe ligaments to be extended more than ordinary; or from ſome fall, which by much ſhaking of it produceth the ſame effect, and ſo much the eaſier, by how much the burthen is greater; and likewiſe from ſome great pains or bad labour which preceeded the preſent pregnancy: or very often it is cauſed, or at leaſt facilitated by abundance of humours, which moiſtening the ligaments, relax them in that manner, to which the phlegmatick are very ſubject, who uſually are much troubled with the Whites.
Beſides the hinderance which the bearing down of the Womb cauſeth to the Womans walking and uſe of coition (as we have above mentioned) it cauſeth likewiſe by its weight, principally towards the latter end of her reckoning, a numneſs in her Hips, ſleepineſs in her Thighs, as alſo difficulty of Urine, and going to ſtool: becauſe by bearing down it preſſeth down the Bladder and the great Gut, between both which it is ſcituated. The Patient may be much eaſier cured of this bearing-down, after ſhe is brought to bed, than whilſt ſhe is with Child; for being freed from its burthen, its ligaments will be the eaſier fortified: beſides ſhe may then uſe peffaries to keep it in its place, which cannot ſo well be done when ſhe is with Child.
From what cauſe ſoever this bearing-down proceeds, the beſt remedy for a big-bellied Woman is to keep her bed, becauſe the weight of it doth more118 and more relax the ligaments when ſhe is up: And if ſhe have neither the means nor convenience ſo to take her reſt, at leaſt let her, if her belly be big enough, as it is towards the later end of her reckoning, wear a Swaith very broad and fit for the purpoſe, that by this means the burthen being a little ſupported, the ligaments may not be ſo much ſtretched and lengthened; and if ſhe have a difficulty in making water, let her when ſhe would do it, help her ſelf by lifting up with both hands her Belly before, which will be a great eaſe, and hinder the neck of the Bladder from being ſo much compreſſed: but if the humours cauſe this relaxation of the ligaments of the Womb, ſhe muſt keep her ſelf to a drying dyet, her food being rather roſted than boiled, and muſt refrain from copulation. The Woman muſt not be ſtraight laced, becauſe that alſo forceth down the Matrix: and above all, when ſhe is in labour, care muſt be taken that neither by means of the throwes, which ſtrongly force down the Womb, nor by the birth of the Child, nor the violent extraction of the burthen, ſhe gets a precipitation inſtead of a bearing down; which is ſoon done, as is ſeen often, when the method I teach in the 16th chapter of the ſecond Book (where I treat of this Labour) is not well obſerved.
THere are many phlegmatick Women, who certainly believe themſelves with Child, void nothing but water, which was collected together in their Womb, and called the Dropſie of the Womb. It hath often happened that ſuch a Diſeaſe hath deceived the Midwives as well as the Patient, who having a long time hoped, and been made to hope for a Child, at length inſtead of it, finds nothing but clear waters; as it once did to that Woodmerchant (I mentioned in the 13th chapter of this firſt Book) who at the end of nine or ten months, of ſuch a falſe Belly, voided a quantity of theſe waters, which was all that was contained and incloſed in the Womb. Guillemeau in the firſt chapter of his firſt Book of Labours, makes mention of the like Hiſtory, of one named Madam du Peſcher, who voided a pailfull of it, certainly believing her ſelf to be with Child: And Fernelius in the 15th chapter of his 6th Book of Pathologie, recites a caſe much more wonderful concerning theſe Dropſies. He tells us that he ſaw a Woman who at the times of her purgations caſt forth, by the neck of the Womb, ſo great a quantity of water, very hot and yellowiſh, that ſhe filled ſix or ſeven Baſins, and voided ſo much of it that her Belly grew quite flat, after which her Courſes came immediatly in order; and that the following months the like quantity was again120 amaſſed, which afterwards came away as before, and that this Woman (which is moſt notorious) being cured of this indiſpoſition, became with Child, and was brought to bed of a living Child.
Theſe Waters are either bred in the Womb, or brought thither from ſome other part, as in the dropſie of the Belly it paſſeth by tranſudation through the porous ſubſtance of the membranes of the Womb. They are bred in the Womb, when it is too cold, or too much debilitated by an ill and violent Labour preceeding; or, becauſe the filth, as Whites, or other ſuperfluities which it was accuſtomed to diſcharge it ſelf of, hath a long time been ſuppreſſed. When the Waters contained in the capacity of the Womb have been ſent thither from elſewhere, they are then never wrapt in a particular membrane, but only retained by the exact cloſure of its Orifice, and flows away as ſoon as it begins to open: but when they are bred in the Womb (which is for the moſt part after copulation, if the Seed be either too cold, wateriſh, or corrupted) they are then ſometimes contained within membranes, which hinders the Patient from a ſpeedy diſcharging of it, ſhe going with it as long almoſt as with a Child: and this is the Dropſie which perſwades them ſometimes they are with Child.
'Tis eaſie to avoid being deceived by taking the Dropſie of the Womb for a Child, if one takes but good notice of all the ſigns mentioned, in treating of a true Conception, which concur not in this diſeaſe. The Patient hath indeed her Belly ſwell'd, and her Courſes ſtopt in this caſe as well as if ſhe were with Child, but there are many things which will diſcover to us the difference; for in the Dropſie, her121 Breaſts are flabby ſoft and fallen, ſhe will have no Milk in them, nor find her ſelf quicken at the ordinary time, but only as it were a bubbling of agitated Waters; ſhe will have a greater pain and weight in her Belly, which is likewiſe more equally in its circumference extended, than if there were a Child; ſhe will alſo have the Lips of the Womb, her Thighs and Legs ſwell'd & aedematous; and a worſe colour in her Face, than when ſhe is with Child. Now as this Dropſie may come alone, ſo likewiſe may often happen together with a true Conception, theſe Waters being then contained without the membranes of the Child in the capacity of the Womb; for though there may be much Water within theſe membranes, it is not properly the Dropſie of the Womb, becauſe there muſt ever naturally be ſome, in the midſt of which the Faetus is contained: Notwithſtanding, ſometimes there is ſuch a quantity of them, which doth ſo prodigiouſly ſwell the Womans Belly, that one would believe ſhe had two or three Children, when ſhe hath but only one, which is much weakned by it, becauſe the greateſt part of its nouriſhment is reſolved into theſe Waters, which almoſt extinguiſheth and ſuffocates that little natural heat which is there. Some Women have evacuated three or four quarts above two months before they were brought to bed; when this happens, they are then contained in the Womb without the Membranes; for elſe the Child would be neceſſitated to be born preſently after theſe Evacuations,**That being the right time of Labour. if it were the Waters (that ought naturally to be contained in the membranes) that came away.
122The beſt Remedy for this kind of Dropſy, the Woman being vvith Child, is to vvait vvith patience the hour of her delivery, obſerving the mean time a drying dyet: but vvhen it is only Water contained in the Womb, ſhe muſt uſe Diureticks to cauſe the Womb to open to evacuate them; and her Courſes muſt be endeavoured to be provoked, having alwayes a care to deſtroy by convenient Purges, the cauſe of the generation of ſuch ſuperfluities.
The Womb is ſometimes ſo full of theſe humours, that it diſchargeth ſome on the outward parts, and principally upon thoſe vvhich are near, as the lips of the Privities, vvhich often are thereby ſo ſwelled, that they become quite blown up; and ſometimes in ſome Women are ſo big and ſwelled, that they cannot cloſe their Thighs together for them, vvhich hinders their vvalking, unleſs vvith pain and great inconvenience. This Swelling is then livid, and almoſt tranſparant, even as a Hydrocele; becauſe of the quantity of clear Water vvhich filled it: and becauſe it may be painful and inconvenient to the Woman during her labour, by reaſon they ſtraiten the paſſages, it vvill be neceſſary to remedy it before; vvhich, for the greater certainty, muſt be done by the operation of the hand, making many ſcarrifications vvith a Lancet all along the lips, vvhereby the humours will ſweat out and diſtil forth by little and little; after vvhich Compreſſes dipt in Aromatick and Aſtringent Wine, muſt be put upon it to prevent Relapſes, by fortifying the parts, cauſing the Patient to obſerve all the vvhile a good dyet fit for the Dropſie. Some vvould apply Leeches, to avoid the pain of the Lancet: but they are not ſo proper,123 becauſe the ſmall orifices they make, aſſoon as they are taken off, immediately cloſe again, which happens not ſo ſoon to the Scarrifications, made as big or little as one will, and may be kept open by oyntments applied to them, as long as may be thought fit or neceſſary.
IT is not very hard to imagine, how a breeding-Woman, that hath the Pox, can communicate it to a Child in her belly, becauſe this contagious diſeaſe corrupting all the maſs of the Mothers blood, it is neceſſary the Infant, which hath then no other ſuſtenance, ſhould be infected with it, converting this bad blood into its own ſubſtance, the acrimony of which Blood eaſily cauſeth in an Infants tender body thoſe malignant ulcers, which all ſuch, whoſe Mothers are contaminated with it, uſually bring with them at their birth.
The Pox which in its eſſence is of the ſame ſpecies, and is only diſtinguiſhed by degrees according as it is greater or leſs, communicating it ſelf by the means of the Mothers blood, will make more or leſs impreſſion on the Infants body according to its ſtrength or weakneſs; and if the big-bellied Woman have Ulcers very near the Womb, as in the neck and neighbouring parts, by this proximity the venom will be very eaſily conveyed to it.
I do not deſign here to enquire into the bottom124 of this Venereal Diſeaſe, nor to write particularly of the cure of it: but intend only to ſhew vvhether the Woman may undergo the Cure vvhilſt with Child, or ought therefore to defer it till after they are brought to bed. That this may be the better determined, we muſt make ſome diſtinction; for, when the Woman is towards the end of her Account, it ought to be deferred till after ſhe is brought to bed, when both ſhe and the Child, if infected, may be taken in hand; becauſe the labour coming on, when the Woman is in the midſt of her Cure, ſhe may run the hazard of her life: and beſides, if the Child ſhould be then ſtill-born, one would be apt to think it was killed by the violence of the Medicaments, and blame the Chirurgeon of raſhneſs.
When the Pox is but in the firſt degree, and hath cauſed no great accidents, one ought then likewiſe to remit the eradicating Cure till after Childbed, and be contented only with the palliating by a convenient dyet and gentle purgers from time to time, to prevent the evils encreaſing: but if the Woman when young with Child, hath the Pox in the higheſt degree, accompanied with very great and continual accidents, which threaten danger, if her Cure be protracted till after Delivery; becauſe in ſo long a time theſe accidents augmenting more and more, it would be impoſſible but her Fruit ſhould be corrupted, and very hard if ſhe did not miſcarry: that the greateſt of theſe two evils be avoided, ſhe having ſtrength enough, ought to be taken in hand; for, to imagine the worſt, that the Remedies make her miſcarry, it is no more than the greatneſs of the Diſeaſe would otherwiſe certainly do. Let her then125 be taken in hand, without ſuffering the accidents longer to augment, vvhich by continuance render themſelves much more dangerous both to her and her Child, being careful to give her the gentleſt Remedies, and with more preparation and circumſpection, ſo that the Evacuation procured to her by Salivation, be rather by little at a time, and the longer, than too great and ſudden; and above all, that it be rather by anointing the upper parts only with**As Unguentum Neapolitanum. Mercurial Oyntments, and not by Perfumes, which ſooner endanger miſcarrying, by opening the Womb; beſides, that they ſooner cauſe the Fruit to periſh if it had life. For the ſame reaſon alſo, no Mercurial Medicine muſt be taken in at the mouth: vvherefore frictions of the upper parts are to be preferred, endeavouring alwayes, as much as may be, to be Maſters of the Evacuation, and to hinder it from cauſing a Looſneſs; for that is more dangerous than Salivation, becauſe of the continual forcing downward in going to ſtool, by which the Womb receives great commotion, and is extreamly agitated.
I know very well that many will not eaſily be perſwaded, but that either it is impoſſible to cure a Woman of the Pox whilſt ſhe is with Child, or that ſhe and her Child cannot undergo the Remedies without inevitable danger of death: however, the experience I have had of it my ſelf, makes me to be of another opinion, which I am vvilling to communicate for an example in the like caſe. In the Year 1660, when I practiſed Midwifery in the Hoſtel de Dieu at Paris, a young Wench, not above twenty years old, came thither to lie-in of her ſecond126 Child, that had had the Pox before ever ſhe conceived the firſt time, and after miſcarried of a dead Child, rotten with the Pox; therefore being big this ſecond time, and perceiving the accidents of ber diſeaſe to augment more and more, ſhe concluded there was no hopes this great Belly would ſucceed any better than the firſt, becauſe ſhe had all over her Body, eſpecially upon both her Breaſts, very many malignant Ulcers, which encreaſed day by day, and fearing it might turn to a Cancer before her Reckoning was compleat, being but three months gone, ſhe reſolved to ſubmit to a thorough-Cure then, and to hazard her life in that condition to ſave her Child's, having no other hopes to effect it, nor being able her ſelf to reſiſt the growing diſeaſe. She acquainted three or four Chirurgeons both vvith her diſeaſe and deſign, not at all concealing her great-belly; who for that cauſe would not undertake her, (although ſhe was fully reſolved upon it, and promiſed to pay them vvell) telling her that their Conſcience would not ſuffer them to do it in the condition ſhe was in, and that it would be better ſhe would patiently ſubmit to it aſwell as ſhe could till ſhe was brought to bed, and then they vvould very vvillingly undertake her: But when ſhe found none would undertake her, unleſs ſhe concealed her great-belly, vvhich was not hard to be done being but three months gone, and believing there was no better an expedient; She met with another (to whom ſhe mentioned nothing of her great Belly) that put her into the ordinary courſe, as if there had been no Conception; and, beſides the common Remedies uſed in this diſeaſe, he gave her a Salivation by five or ſix reiterated Frictions of the127 Oyntment, vvhich followed her very plentifully five vvhole vveeks, ſo that ſhe vvas vvell and perfectly cured, without leaving the leaſt ill accident behind of her diſeaſe. When ſhe was almoſt recovered, and that all had ſucceeded wel, ſhe told her Chirurgeon ſhe was four months & a half gone with Child, (for ſhe was three months when ſhe came to him, where ſhe lodged ſix weeks intire, without having it in the leaſt perceived) which at firſt he could hardly believe, but perceiving her Belly rather grown bigger than leſſer during the Evacuation the Phyſick had made, he was immediately aſſured of the truth of it: She informed him that the reaſon why ſhe had concealed her great-Belly, was, the refuſal four Chirurgions (to whom ſhe had confeſt it) made to take her in hand. From the time ſhe was cured ſhe ſuffered not the leaſt inconvenience during all the remainder of her time, except a little want, becauſe all the money ſhe had was given the Chirurgeon for her Cure, which made her come to the Hoſtel de Dieu to lie-in, where I delivered her of a Child at the full time, as big, fat and healthy, as if the Mother never had had the leaſt touch of that diſeaſe in her whole body; and which was very remarkable, the Burthen (which is a part very ſuſceptable of the leaſt impreſſion of a Woman's corrupt humours) was as neat, fair and ruddy as could be imagined.
This example, which is very true, may convince us, that a big-bellied Woman may be taken in hand for the Pox; and more ſafely, if the Precautions noted above be carefully obſerved: For it is without contradiction, that if this Woman had not been cured, ſhe had this ſecond time been brought to bed128 of a rotten Child, as before. Relating once this Hiſtory to a Chirurgion, a Friend of mine; he told me, that himſelf twice, in two different perſons, had the ſame ſucceſs, who were very well cured, and their Children likewiſe well born at the full time, without having the leaſt impreſſion of the venom in any part of their Body. Varandaeus confirms to us this truth in the ſecond Chapter of his ſecond Book of Womens Diſeaſes, where he preciſely tells us, that he had ſeen big-bellied Women who had had this diſeaſe eradicated by anointings with Mercury and Salivation preſcribed by Empericks; which may convince us that this Cure will eaſily have a better ſucceſs, when governed and managed by a knowing and methodical perſon.
In a word, 'tis eaſie to be perſwaded that they can endure it, although with Child, becauſe many very often have continual Feavers for twelve or fifteen dayes, and other acute diſtempers, for which they have been neceſſited to be nine or**Such frequent bleeding Women with Child in ſo ſhort a ſpace, is not approved in England. ten times blooded, and yet notwithſtanding have ofttimes gone through with their Children to their full account, and been delivered of them as well as if they never had had any ill accident.
WHen a Woman caſts forth in the beginning what ſhe had retained by conception in the Womb, 'tis called an Effluxion, or a ſliding away of the Seeds, becauſe they have not yet acquired any ſolid ſubſtance; if they miſcarry of a falſe-conception, which is ordinarily from the later end of the firſt to the end of the ſecond month, it is called an Expulſion; but when the Infant is already formed, and begins to live, if it comes before the time ordained and preſcribed by Nature, it is an abortion: which may happen from the ſecond to the beginning of the ſeventh month, for afterwards it is accounted a Birth, becauſe the Infant being ſtrong enough, and having all its perfections, may then live, which is impoſſible, if he comes before. Theſe things thus underſtood, we then ſay, that an Abortion is an iſſuing forth of the Child, yet imperfect, out of the Womb contrary to Nature, before the term limited; which is the cauſe, that for the moſt part it is dead, or if ſometimes alive, it dies in a ſhort time after.
We may in general aſſert, that every acute Diſeaſe eaſily makes a Woman miſcarry; becauſe they deſtroy her fruit, which being dead, never ſtayes long in the Womb; and alſo puts the Woman in great hazard of her life, as ſaith Hippocrates in the 30th Aphoriſm of his 5th Book, Mulierem gravidam morbo quopiam acuto corripi, lethale. The particular130 cauſes of Abortion, are all the accidents mentioned in the preceding chapters; as violent and frequent vomitings; becauſe there is not only want of ſufficient nouriſhment for Mother and Child, when the food is ſo continually vomited up, but alſo great reachings and endeavours, by which the Womb being often compreſſed, and as it were ſhaken, is at laſt conſtrained to diſcharge it ſelf before its time. Pains of the Reins, great Cholicks and Gripes may likewiſe cauſe the ſame accident, as the Strangury alſo; for there are then made ſtrong compreſſions of the Belly every moment to expel the Urine. Great Coughs by their frequent agitation, ſuddenly thruſting the Diaphragma with force downwards, give alſo violent ſhocks to the Womb. Great Looſneſſes endanger a Woman to miſcarry, according to the 34th Aphoriſm of the 5th Book; and ſooner if a Teneſmus follows, which is great needings, whereby the right Gut ſeeks to expel the ſharp humours that irritate and provoke it. This makes us take notice of the 27th of the 7th Book, Mulieri utero gerenti, ſi tenſio ſupervenerit, facit abortum: for in this caſe the Womb, which is ſcituated upon the Rectum, receives a great commotion by its continual needings. If a Womans Courſes flow immoderatly, it is impoſſible her Fruit can be in health, as it is in the 60th Aphoriſm of the 5th Book; for beſides, that the Infant is not ſufficiently nouriſhed, the Womb alſo by being too much moiſtened, is eaſily relaxed and opened. Letting Blood immoderately doth the ſame for the ſame reaſon, eſpecially if the Child be great, according to the 31th Chapter of the ſame Book.
But one of the worſt accidents which cauſe Abortion,131 is that Flooding, which proceeds from the ſeparation of the After-birth from the Womb, of which we treated in the 20th Chapter of this firſt Book.
The Dropſie of the Womb hinders the Child from growing to perfection, for the great abundance of Water extinguiſheth the natural heat which is already at that time much debilitated; and the Pox in the Mother infects the Child, and often Kills it in her Belly, as we have demonſtrated in the preceeding Chapter; and whatever very much agitates and ſhakes the big-bellied Womans body, is capable of making her miſcarry; as great labour, ſtrong contorſions, or violent motions, of what manner ſoever, in falling, leaping, dancing, and running or riding, going in a Coach or Waggon, crying aloud, or laughing heartily, or any blow received on the Belly; becauſe that by ſuch agitations and commotions, the ligaments of the Womb are relaxed, yea and ſometimes broken, as alſo the After-birth and Membranes of the Faetus are looſned. A great noiſe ſuddenly and unexpectedly heard may make ſome Women miſcarry; as the noiſe of a Cannon, and chiefly Thunderclaps; and yet more eaſily, if to this noiſe be added the fear they uſually have of ſuch things, which happens rather to the young than elderly Women; becauſe their bodies being more tender and tranſpirable, the air, which is ſtrongly forced by that noiſe, being introduced into all her pores, offers a great violence by its impulſion on the Womb, and on the Child within it; which the elder being more robuſt, thicker and cloſer, reſiſt with more eaſe. Great watchings, cauſing a diſſipation of the Womans132 ſtrength, and much faſting for want of food, hinders the Infant from acquiring its perfection; fetid and ſtinking ſmells do much contribute to abortion, and amongſt others the ſmell of Charcoal, as appears by the Hiſtory recited in the 10th Chapter of this Book.
The indiſpoſitions of the Womb produce the ſame effect, as when it is callous, or ſo ſmall, or ſo much compreſſed by the Epiploon, that it cannot be extended, as it ought to be, ſufficient to contain the Child and Burthen with eaſe together, with the Waters, which may likewiſe happen, if the Woman be too ſtrait laced, or keeps in her Belly with ſtrong and ſtiff Busks for to be well ſhap'd; or by this ſubtilty to conceal a great-belly, as ſome do; frequent copulation, eſpecially towards the end of her reckoning, may effect the ſame thing, becauſe then, the Womb being very full, bears much downwards, and its inward orifice being very near, is ſubjected to violence.
If a Woman miſcarries, without any of theſe accidents, and that one deſires to know the cauſe of it, Hippocrates explains it in his 46th Aphoriſm of the 5th Book, where he ſaith, Quae veró mediocriter corpulentae abortum faciunt ſecundo menſe, aut tertio, fine occaſione manifeſta, iis acetabula uteri mucoris ſunt plena, nec prae pondere faetum continere poſſunt ſed abrumpuntur: any Woman indifferently corpulent, that miſcarries the ſecond or third month, without manifeſt or apparent cauſe, it is, becauſe the Cotyl•dons of the Womb (which are the inward cloſures of its veſſels) are full of viſcous filth, by reaſon of which they cannot retain the weight of the Faetus, which is looſened from it. To133 this accident phlegmatick Women are very ſubject, and thoſe who have the Whites exceedingly, which by their continual affluence, moiſten, and make the Womb within ſo ſlippery that the After-burthen cannot adhere to it, which alſo relaxeth it and its inward orifice, that the leaſt occaſion cauſeth abortion.
But if the paſſions of the body cauſe ſo much hurt to a big-bellied Woman, thoſe of the mind do no Ieſs, and ſpecially Choler, which agitates, inflames, diſperſes and troubles all the Spirits, and maſs of Blood, by which the Child ſuffers extreamly, becauſe of the tenderneſs of its body; but above all, ſudden fear, and the relation of bad news, are capable to make the Women miſcarry at that inſtant; (as it happened to the Mother of that Couſin of mine, whom I mentioned in the 10th Chapter of this firſt Book) which likewiſe the other paſſions may cauſe, according as they are more or leſs violent, but not ſo eaſily. There are yet other cauſes of miſcarrying which may be ſaid to proceed from the Infant, as when they are monſtrous, becauſe they do not then follow the rule of Nature; as likewiſe when they have an unnatural ſcituation, which makes them torment themſelves becauſe of their incommodity, and they oblige the Womb to expel them, not being able to endure the pains they cauſe, which it yet does, when it is ſo great that it cannot contain it to the full time, nor the Mother furniſh it with ſufficient nouriſhment.
If we find one or more of the above ſpecified accidents, and that the Woman withall hath a great heavineſs in her Belly, ſo that it falls like a ball on her ſide when ſhe turns, and that there proceeds134 out of her Womb ſtinking and cadaverous humors, it is a ſign ſhe will ſoon miſcarry of a dead Child: moreover, her Breaſts will confirm it, if having been hard and full in the beginning, they become afterwards empty and flabby, as is ſpecified in the 37th Aphoriſm of the 5th Book; and the 38th of the ſame Book, ſaith, That if one of a big-bellied Womans Breaſts, who hath two Children, begins to flag, it is a ſign ſhe will miſcarry of the Child of that ſide; and of both, if both flag in the ſame manner.
It is moſt certain, a Woman is in more danger of her life when ſhe miſcarries, than at her full time; becauſe (as we have ſaid before) abortion is wholly contrary to Nature, and very often accompanied with flooding: and in more danger of miſcarrying alwayes, if ſhe miſcarries of the firſt; and ſome apprehend then an impoſſibility of ever having Children after, to which, young married people are very ſubject, becauſe of the violent emotion and perturbation of the whole body, excited by ardent and frequent copulations: but notwithſtanding, they may preſerve their fruit, when their greater vigour is over, and their loves a little moderated.
We have taught in each of the foregoing Chapters, how to prevent all the accidents before recited, any of which is ſufficient to make her miſcarry; and the eaſier, if many are complicated: wherefore to avoid a troubleſome and needleſs repetition, you may have recourſe to the Remedies there taught, by which both Women and Children may eſcape the danger of death.
They that are ſubject to abortion, ought above all to take their eaſe, and keep in bed if they can,135 obſerving a good diet, and refraining copulation aſſoon as ſhe believes her ſelf to be with Child; avoiding the uſe of all Diureticks and Aperitives, which are very pernicious; as alſo violent paſſions of the mind, becauſe they are very prejudicial. She ought likewiſe to be looſe in her dreſs, that ſhe may breath the freer, and not ſtrait laced, and rackt, as moſt of them are ordinarily with their Busks under their cloths, to make their bodies ſtrait; and amongſt other things, they had need take heed of ſlipping and falling in their walking, to which big-bellied Women are very ſubject, becauſe the bigneſs of their Bellies hinders them from ſeeing their way: they will therefore do well to wear low-heeld ſhoos with large ſoals, to prevent hurting themſelves, as too many daily do. I admire in this caſe the ſuperſtition of many Midwives, and ſome Authors, who order a Woman with Child, to take, aſſoon as ſhe hath hurt her Belly with a fall, ſome Crimſon Silk, ſmall minced in the yolk of an Egg, or the grains of**Kermes. Scarlet, and treddles of ſeveral Eggs put into the yolk of one; as if that entring the ſtomach, were able to fortifie the Womb and the Child in it, and to keep it there, for which there is no appearance of reaſon or truth: but quiet reſt indeed contributes much to it, which for this reaſon is uſually directed for nine dayes; although ſuch a one hath need of 15 dayes, or more, for her hurt or commotion; and to others, five or ſix is ſufficient; during which time may be applied hot to the Belly, Compreſſes ſteeped in Aromatick and Aſtringent Wine. But becauſe there are many Women ſo infatuated with this ſuperſtitious cuſtom, that they would not believe themſelves out136 of danger, if they took not that Crimſon Silk, or the Treddles of the Eggs (which is a pure conceit) one may give it to thoſe that deſire it to content them, becauſe theſe Remedies, though uſeleſs, can yet do no hurt. It is now time to make an end of this firſt Book, in which I have only mentioned the moſt ordinary diſtempers, which have ſome particular indications in their cure, during the Womans being with Child; of which I have not treated very exactly, becauſe it may be ſuppoſed that one may elſewhere have a more perfect knowledge of them, with all their circumſtances: let us now paſs to the ſecond Book, to treat of Deliveries, not only the natural, but likewiſe all that are contrary to nature, it being the principal motive that induced me to write, and to teach as well as I can, the beſt and moſt methodical deportment in it.
AS it is very unprofitable to thoſe that imbark on the Sea for a long Voyage, (as for example, to the Indies, or the like) if after having by their prudence eſcaped all the dangers they could meet with in ſo long a Voyage, they are ſhipwrackt in the Haven: So likewiſe it is not ſufficient that a great-bellied Woman ſhould be preſerved from all the Diſeaſes mentioned in the preceding Book, for nine whole months, if at the end of that time ſhe be not well delivered of it by a happy Labour. This therefore ſhal be the whole ſubject of this ſecond Book, where we will treat as well of the Natural as Unnatural Labours, and teach the manner of aiding and comforting Women in the firſt, and the means to remedy all the reſt,
BY a Delivery we underſtand either an emiſſion or extraction of the Infant, at the full time, out of the Womb. This definition may, comprehend as well the Natural, which is accompliſhed by emiſſion, when the Infant coming in a commodious and natural Figure, the Womb ſends it forth without extraordinary violence: as the delivery contrary to Nature, which we are often obliged to perform, extracting it by manual operation.
Every time the Womb lets paſs, or ſends forth, whatſoever it had retained and formed after conception, muſt not be call'd a labour; for, obſerving what I have already noted above, and what I will here again repeat, that it may be more plain, If a Woman voids by the Womb what is contained in the beginning after ſhe had conceived, it is properly called an effluxion or ſlip: becauſe at that time, there is nothing formed or figured, neither have the Seeds yet any firm conſiſtence, which is the cauſe why it flips away ſo eaſily with the leaſt opening of the Womb, as often happens between the firſt conceiving and the ſeventh and eight day only; after which, until the end of the ſecond month, the Woman ſomtimes lets ſlip falſe-conceptions, which turn to Moles, if they continue any longer in the Womb; which is then called an Expulſion: And if after the third month or thereabouts, the time139 when the Faetus is wholly formed and animated, it is ſent forth before the ſeventh, in that caſe it is an Abortion, which is alwayes the cauſe, either that the Infant comes dead into the World, or dies ſoon after. But we properly call Labour, or Delivery, every iſſuing forth of an Infant which happens after the end of the ſeventh month to all the remaining part of the time afterwards; becauſe there is then a ſufficient perfection, as alſo ſtrength enough, to come into the World, and live in it afterwards.
As to the general differences of Labour, we muſt take notice, that the one is legitimate or natural, the other illegitimate or againſt nature. To come to the knowledge of each, we ſay, that four conditions muſt abſolutly be found in a Delivery that it may deſerve to be called legitimate or natural: firſt, that it be at full time; ſecondly, that it be ſpeedy, without any conſiderable accident; thirdly, that the Child be living; and fourthly, that he comes right in a good poſture or ſcituation: for if any of theſe four are wanting, the delivery is againſt nature; and the more, by how much there are more of them wanting.
As to the due time of Labour, moſt Authors aſſert that Nature hath appointed to all other Animals a certain limited time of going with young, and bringing them forth: but that Women only, by a particular favour of the ſame nature, have none prefixt, neither for conceiving, going with Child, nor bringing forth. And as to conception, 'tis moſt certain, that a Woman can conceive at any time night or day, ſummer or winter, or any other ſeaſon whatſoever; becauſe ſhe can copulate when ſhe pleaſeth, which few other Animals can, who couple140 but at certain ſeaſons when they become luſtful but as to the time they are accuſtomed to go with young, it is no more preciſely determined to them, than to a Woman; for as ſhe may be brought to bed either in the ſeventh, eighth, ninth, tenth, yea and ſometimes the eleventh month (which happens very rarely) but for the moſt part in the ninth month. So likewiſe for example, though the ordinary time for a Bitch to puppy is the fourth month or thereabouts, ſo ſome puppy ſooner and ſome later: and Sheep which yean their Lambs at the end of five months, advance or recede from that ordinary term, according to the ground where they ſeed, and the quallity of their paſture, to which contributes many particular diſpoſitions of each of theſe Animals; which likewiſe happens to all others, as well as to Women. We may perceive the ſame alſo in Fruit, for the ſeaſons and different Climats always more or leſs aſſiſt their ſpeedy maturity, which depends likewiſe very much on good Husbandry. The firſt time that a Child may live, when born, is the ſeventh month compleat, and it may better from that till the end of the ninth month, but aſſoon as that time is paſſ'd, the ſtay it makes after in the Womb, is no wayes beneficial to it, becauſe it hath then acquired all neceſſary perfection and ſtrength ſufficient to reſiſt all outward injuries. The Child born before the ſeventh month cannot live long, as we ſaid before, becauſe of its weakneſs: but he that is born in the eighth month may very well live, yea, and more likely than born in the 7th month (which is contrary to the opinion of all the world); becauſe it is more perfect, as I ſhall demonſtrate afterwards in the fifth Chapter of this141 ſecond Book, where I will particularly ſhew the cauſe of this error.
Now as we ſometimes ſee Children born two months before the ordinary time of nine months, do live notwithſtanding; ſo there are ſome Women not brought to bed till towards the 10th month, and ſometimes not till the beginning of the 11th: although this may happen in ſome, yet there are many who deceive themſelves in their reckoning, believing that they are gone but ſeven or eight months, and ſometimes ten or more, when they are but juſt nine; that which thus abuſeth them, is their imagining themſelves with Child preciſely from the ſuppreſſing of their Courſes, though it be not alwayes true; becauſe ſome have wanted their Courſes two months before they became with Child; and others have them, on the contrary, two or three months after, on the uſual manner: which daily happens according to their different conſtitutions and temperaments, more or leſs Sanguine.
If (as we have ſaid) the intire and perfect term be neceſſary to the legitimate and natural birth; a good figure and ſcituation of the Child is no leſs, which ought to come with the head firſt, in a ſtrait line, having the face turned downwards, that is, towards the Mothers back, the arms couched along its ſides, and the thighs ſtretcht upwards. This figure is much the better and convenient, becauſe after the head (which is the biggeſt part of the Child) is paſſed, all the reſt coms forth eaſily, and that being ſo, none of the joynts of its body can be turned to hinder its paſſage forth: but any other part that may firſt preſent to the Labour, makes it unfortunate, and againſt Nature, in which caſe there is142 often great danger to Mother or Child, and ſometimes to both, if not ſuddenly and duely ſuccour'd.
They who have no perfect knowledge of the parts of a Womans body, aqcuired by Anatomy, are contented to admire, and cannot (as they ſay) conceive how it is poſſible, that an Infant ſo big, can paſs in time of Labour through an opening of the Womb ſo ſmall; at which Galen, and many other Authors, have much admired; many of whom are of opinion that the Womans os pubis is ſeparated to inlarge the paſſage at that time, without which it would be impoſſible for the Infant to have room enough to be born; and therefore Women a little antiquated, ſuffer more in their firſt Labours than others, becauſe their os pubis cannot be ſo eaſily ſeparated, which often kills their Children in the paſſage. Others are of the opinion that it is the Os ilium which is disjoynted from the Os ſacrum to the ſame purpoſe; and ſay, both the one and the other of them, that theſe bones thus ſeparated at the hour of Labour, are thereto by degrees a little before diſpoſed by the ſlimy humours, which flow forth from about the Womb, and then mollifie the cartilage, which at other times joyn them firmly. But theſe two opinions are as far from Truth as Reaſon; for Anatomy convinceth us clearly, that the Womb by no means toucheth theſe places, whereby to mollifie them by its humours; as alſo, that theſe bones are ſo joyned by the cartilage, that it is very difficult to ſeparate them with a Knife, eſpecially the ilium from the ſacrum, and almoſt impoſſible in ſome elderly Women, without great violence, although Ambroſe Paré (citing many witneſſes then preſent at the thing) reports the Hiſtory of a Woman, in143 whom (having been hanged fourteen dayes after ſhe was brought to bed) he found (as he ſaith) the os pubis ſeparated in the middle the breadth of half a finger, and the oſſa illia themſelves disjoynted from the os ſacrum. I will not in this caſe accuſe him of impoſture, for I have too much reſpect for him, and eſteem him too ſincere for it; but I indeed believe that he was miſtaken in this ſeparation; for there is no likelihood that being ſo at the time of her Labour, it would remain ſo a fourtnight after the breadth of half a finger; for then they ſhould have been obliged to carry this Woman to Execution: for ſhe would not have been able to have ſupported her ſelf to climb the Ladder of the Gibbet, and to keep her ſelf on her legs, according to the cuſtom of other Malefactors; becauſe the Body is only ſupported by the ſtability of theſe Bones: wherefore we muſt rather believe, as moſt probable, that ſuch a disjunction and ſeparation was cauſed either by the falling of this Womans Corps from the high Gibbet to the ground after execution; or rather by ſome impetuous blow on that place, received from ſome hard or ſolid thing. If we examine well the different figure and ſtructure of theſe Bones between a Man and a Womans Sceleton, we ſhall find a larger empty ſpace and diſtance between theſe Bones, much more conſiderable in Women than Men, and that to this purpoſe the leaſt Women hath the Bones of the Iſchion more diſtant the one from the other, than the biggeſt Man: they have all likewiſe the os ſacrum more outwards, and the pubis flatter, which makes the paſſage from this capacity, larger, and more able to give iſſue to the Child at the time of Labour; they have beſides this, the144 Bones illia much more turned outward, that the Womb being impregnated, may have more room to be extended on the ſides, and be more at eaſe ſupported by ſuch a diſpoſition as is here repreſented.
Theſe two Figures of Bones repreſent the Bones that form the whole capacity of the Hypogaſtrium.
A ſhews the Mans Bones. B the Womans, for to know the difference, that the Womans is more capacious and ſpacious than the Mans: for C & C, D & D, E & E, are at a larger diſtance, one from the other in the Womans than they are in the Mans; and beſides, that Women have the Coccyx, marked F, more turned outwards, than the Men, which gives way to the Infants Head to paſs without great difficulty through the large paſſage there is between the two Bones of the Iſchion, marked E & E, without any neceſſity for the ſeparation of the Os pubis, as ſome have imagined contrary to truth.
Moreover, having often ſeen and diſſected Women dead a few dayes after delivered, I found it very difficult to ſeparate theſe bones with a ſtrong ſharp Penknife, where I could never find the leaſt appearance of any preceding ſeparation: And if the advanced in years have more pain with the firſt Children than younger Women, it doth not proceed from the difficulty of the ſeparation of theſe bones (which never is for the reaſons above) but becauſe the membranes of their Womb are dry, hard, and146 callous; and particularly its internal orifice, which therefore cannot ſo eaſily be dilated as young Womens, being more moiſt.
Having ſufficiently explained what is Delivery, and all its differences, we muſt now examine what ſigns uſually precede, and what accompany a natural Delivery, and an unnatural, which ſhall be the ſubject of the next Chapter.
WHen Women with Child, chiefly of their firſt, perceive any extraordinary pains in their Belly, they immediately ſend for their Midwife, taking it for their Labour; who when ſhe is come, ought to be well informed of the matter, and careful not to put her in Labour before there is a diſpoſition to it; for many times both Mother and Child loſe their lives, when it is excited before the due time. Thoſe pains which may be called falſe, are uſually cauſed by a Cholick proceeding from Wind, which come and go, griping the whole Belly, without any forcing downwards or into the Womb, as thoſe do which proceed or accompany Labour; and this Cholick is diſſipated by warm clothes applied to the Belly, and a Clyſter or two, by which true Labour-pains are rather furthered than hindered. A Woman may feel other kind of pains coming from an emotion cauſed by the Flux of147 the Belly, which are eaſily known by the frequent ſtools that follow.
The ſigns preceding a natural Labour few dayes before, are, that the Belly which before lay high, ſinks down, & hinders a Woman at that time from walking as eaſie as ſhe uſed; and there flows from the Womb ſlimy humours, appointed by nature to moiſten and ſmooth the paſſage, that its inward orifice may the more eaſily be dilated when it is neceſſary; which beginning to open a little at that time, ſuffers that ſlime to flow away, which proceeds from the humours that ſtrain through the thin ſubſtance of the Infants membranes, and acquires a viſcous conſiſtence by the heat of the place.
The ſigns accompanying preſent Labour, (that is, ſhewing, that the Woman is effectively in Labour) are, great pains about the region of the Reins and Loins, which coming and redoubling by intervals, anſwers in the bottom of the Belly with reiterated throws: The face red and inflamed, becauſe the Blood is much heated by the continual endeavours a Woman makes to bring forth her Child; as alſo, becauſe that during theſe ſtrong throws her reſpiration is ever intercepted, for which reaſon much Blood hath recourſe to the Face: Her privy parts are ſwell'd, becauſe the Infants Head (lying in the Birth) often thruſts and cauſeth the neighbouring parts to diſtend outwards, which thence appear ſwelled in this manner: She is often ſubject to vomitting, which makes many believe, who know not the cauſe of it, that the Women to whom it happens, are in danger: but on the contrary it is ordinarily a ſigne of ſpeedy delivery, becauſe the good pains are then excited and redoubled every148 moment until the buſineſs be finiſhed. This Vomitting comes from a ſympathy, between the Womb and Stomach by reaſon of the ramifications of the nerves of the ſixth pair of the Brain, which are diſtributed to both the one and the other, and by which it communicates the pain it feels at that time, ariſing from the agitation the violent and frequent motions of the Child cauſeth, and the ſtrong compreſſion the muſcles of the lower Belly makes during the throws, for to help the iſſue of the Child: beſides, when the birth is very near, Women are troubled with an univerſal trembling, and principally of the Legs and Thighs; not with cold, as at the beginning of an Ague-fit, but with the heat of the whole body, and the humours, which then flow from the Womb, are often diſcoloured with Blood, which with the ſigns above mentioned, is an infallible mark of the nearneſs of the birth, 'tis that the Midwives uſually call Shows; and if one then puts up their finger into the neck of the Womb, they will find the inner Orifice dilated, at the opening of which the membranes of the Infant, containing the Waters, preſent themſelves, and are ſtrongly forced downwards with every pain the Woman hath; at which time one may perceive them to reſiſt and appear to the finger, ſo much the more or leſs hard and extended as the pains are ſtronger or weaker. Theſe membranes with the waters in them, when gathered (that is, when they are advanced before the head of the Child, which makes the Midwives call it the gathering of the waters) preſenting themſelves at this inward Orifice, do then reſemble very well to the touch of the finger, the abortive Eggs which have yet no ſhell, but are14 only covered with a ſimple membrane: after this the pains redoubling continually, the membranes are broken by the ſtrong impulſion of the waters, which incontinently flow away, and then the head of the Child is eaſily felt naked, and preſented at opening of the inward Orifice of the Womb: Now, all theſe, or the greateſt part of them met together, at what time ſoever of a Womans going with Child it be, whether full time or no, one may be aſſured ſhe will ſoon be delivered; but great care muſt be taken not to haſten her Labour, before the neceſſity of it be known by theſe ſigns, for that would but torment the Woman and Child in vain, and put them both in danger of their lives, as that Midwife did, whom I found endeavouring to put the above named Martha Rolet in Labour at ſix months end, becauſe of ſome pains ſhe had in her Belly and Reins, without any other accident anſwering them downwards; which Hiſtory is at large in the ſixth Chapter of the firſt Book, to ſhew that in ſome caſes we muſt make no more haſte than good ſpeed.
Labour contrary to Nature is when the Child comes in an ill Figure and ſcituation; as when it preſents any otherwiſe than the Head firſt, as alſo when the Waters flow away along time before it is born, becauſe it remains dry in the Womb, and they are abſolutely neceſſary to moiſten the paſſage, and render it more ſlippery. When the After burthen comes firſt, it is an accident which renders the Labour always dangerous, by reaſon of the great flux of Blood uſually following, of which the Mother may die in a few hours, and the Infant (becauſe it receives no more nouriſhment) is quickly ſmotherd in the Womb, for want of reſpiration, which it then148〈1 page duplicate〉14〈1 page duplicate〉148needs, if it ſtay never ſo little after. The Labour is alſo grievous, when accompanied with a Feaver, or any other conſiderable Diſtemper, which may deſtroy the Child in the Womb, as alſo when pains are ſmall, and come ſlow with long intervals, and little profit, by reaſon of which a Woman is extreamly tyred: but the difficulty moſt frequent and ordinary comes from the Infant's wrong poſture. We ſhall ſpeak more particularly of the ſigns of all theſe different Deliveries, in treating of them ſeverally hereafter: and now come to the inquiry of ſome particulars, without which it is impoſſible to aſſiſt a Woman ſafely in her natural Labour, or to help her in the unnatural ones: and therefore we will examine every thing that is in the Womb with the Infant during pregnancy, and firſt deſcribe thoſe that firſt offer themſelves to paſs the Orifice, when the Woman is neer her delivery, which are the membranes of the Infant, and the waters contained in them.
This Figure repreſents the Membranes of the Infant, wholly ſeparated from the Womb, in which it is contained with the Waters. Theſe Membranes in ſome manner reſemble a great Bladder, through which the figure of the Infant may be a little perceived: there is likewiſe ſeen on the upper part, the After-burthen, marked A, on that ſide, which is faſtened to the bottom of the Womb.
AS ſoon as the two Seeds have been confuſedly mixed, and retained by conception, the Womb immediately after, by means of its heat**Extrieates, diſentangles. ſeparates this Chaos, for to make out of it the delineation and formation of all the parts, and begins to work upon theſe Seeds, which though to the ſight they appear ſimilar and uniform, yet in effect contain in them many diſſimilar parts, all which it ſeparates and diſtinguiſheth one from the other, incloſing the moſt noble, and on the**Covering. outſide the moſt glutenous and viſcous, of which firſt the Membranes are formed for to hinder the Spirits, wherewith the•…mous Seed abounds, from being then diſſipated to ſerve afterwards to contain the Infant〈◊〉Waters, in the midſt of which it ſwims, that they may not ſtream away.
As the Membranes of the Faetus are the firſt parts formed, ſo are they with the Waters the firſt th•…in time of Labour preſent themſelves to the pa••age before the Infants Head. Moſt Authors are ſo dark in the deſcriptions they make of theſe Membranes, that it is very hard to conceive them as they are, by the explication they make of them. They do not ſo much as agree in the number of them, ſome account three as well for a Child as a Beaſt, to wit,152 the Chorion, the Amnios, and the Allantoides; others account but two, becauſe there is no Allantoides in a humane Faetus; but to ſpeak properly (if it be ſtrictly examined) what there is, (as I have often done) there will be never found but two, which are ſo joyned and contiguous the one to the other, that it may be ſaid to be but a double one, which may indeed be ſeparated and divided into two. I will explain it on ſuch wiſe, as may be beſt underſtood by thoſe that are ignorant of it: for there are many, who think with Galen, that theſe Membranes are ſeparated and diſtant the one from the other, and that the one ſurrounds only the Infant, and the other receives the Waters, which are partly engendred from ſweat, and partly from the urine, (as they imagine); and believe further, that theſe Waters themſelves are ſeparated the one from the other by theſe Membranes, which is quite contrary: for they are both ſo joyned the one to the other, that they compoſe as it were but the ſame body and involver, which ſerves (as we have already ſaid) to contain the Infant with the Waters, which are all of a nature, and ſhut up in the ſame Membranes, as I ſhall make appear hereafter in ſpeaking of their original): it matters not to the truth, after what manner this be explained, provided it may be underſtood as it is.
The exteriour part of this Membrane, or double**Covering Involver; or, if it be eſteemed two, the firſt Membrane preſented without, is called Chorion, from the Greek word〈…〉〈 in non-Latin alphabet 〉, ſignifying to contain, becauſe it immediately contains〈◊〉•…ons the other, which is153 called Amnios, that is a little Lamb, becauſe it is ſo ſmall and thin. Galen in his 15th Book of the uſe of parts, calls the burthen Chorion. But to render this more, intilligible, we ſhall take this firſt Membrane for the Chorion, which may be again ſeparated and divided into two, though effectively it be but one. The Chorion is a little rough, and unequal throughout the whole outſide of it, in which many ſmall capillary veſſels may be obſerved, running quite round, as alſo many little fibres by which it cleaves to every ſide of the Womb: but it is a little more ſmooth within, where it joyns everywhere, and unites with the Amnios, in ſuch a manner as that it appears (as we have already declared) but as one and the ſame Membrane. This Chorion covers the Placenta, and cleaves cloſe to the forepart of it, which reſpects the Infant, by means of the interlacings of an infinity of Veſſels: it is alſo principally faſtened to the Womb by the whole circumference of the Placenta, in which part this Membrane is a little thicker.
The Amnios, which is the ſecond Membrane, is three times thiner than the Chorion: and is very ſmooth within, but not juſt ſo much where 'tis joyned and united to the Chorion. This Membrane is ſo thin, that it is quite tranſparent; and hath no veſſels in it, which makes it ſo thin, as cannot be imagined without ſeeing. This Amnios doth in no wiſe touch the Placenta, though it covers it, but it lines only all the inner part of the Chorion, which is between, and from which it may be wholly ſeparated, if it be done with care.
The better to conceive this as it is, and after what manner theſe Membranes are in the Womb, conſider154 the compoſition of a Foot-bal, imagining the Leather which covers it, to be the Womb of a pregnant Woman, and the Bladder blown up with wind, within the Foot-ball, to be this double Membrane of the Chorion and Amnios, in which are contained together the Child and the Waters; and even as the outſide of this Bladder toucheth every where (becauſe it is blown up) the Leather of the Foot-bal: ſo likewiſe the Membranes of the Faetus are joyned on all ſides to the Womb, except where the Burthen cleaves to it, in which place it paſſeth above it.
As to the 3d (or rather pretended) Membrane, which Authors name Allantoide, & ſay is like a Sauſage or Girdle, which ſurrounds & clothes the Infant from the cartilage X•phoide, to juſt below the Flanks only; it is moſt certain, there never was any ſuch thing in any of theſe Animals whoſe Dams have but one young at a time no more than Women, as Sheep, Cows, Mares, ſhe Aſſes, nor any other for ought I could ever learn after many curious inquiries.
Sometimes Infants at their birth, bring forth theſe Membranes upon their head, and then 'tis ſaid they will be fortunate: which is meerly ſuperſtitious, becauſe it happens by the ſtrength of their ſubſtance, ſo that they cannot burſt by the impulſe of the Waters, or the Womens throws in Labour; or becauſe the paſſages being very large, and the Infant very little, it paſſeth very eaſie without violence: in truth in this reſpect they may be ſaid to be fortunate, for having been born ſo eaſily; and the Mother alſo for being ſo ſpeedily delivered; for in difficult Labours, Children are never born with ſuch caps, becauſe being tormented and preſſed in155 the paſſage, theſe Membranes are broken and remain ſtill there.
Within the Infants Membranes (diſpoſed as I have explicated) are contained the Waters, in the midſt whereof he ſwims, and is ſcituated; the original of which ſeems very incertain, if the different opinions of Authors upon this ſubject be regarded. Some will have them to be the Urine emptied out of the Bladder by the**Urachus. Ouraque, becauſe they cannot find a true and eaſie way for it; and becauſe their colour and ſavour much reſembles the Urine contained in the Bladder: but it is very certain, it cannot be ſo as they ſay, becauſe the Urachus is not perforated in the Faetus, and it comes not forth of the Navel; for the place where it is faſtened, is alwayes tendinous, and very like a ſmall Luteſtring, through which, it is moſt certain, nothing can paſs, how ſubtil ſoever; as I have often obſerved and ſeen Mr. Gayant to note, who is, with univerſal Approbation, the moſt exact and expert Anatomiſt, that hath been this long time in Paris: for whoſe merit, his Majeſty hath done him the honour to chooſe him before all others to make thoſe curious Inquiries and many fair Experiments, in which many choiſe and knowing Perſons are continually imployed, who are of the Royal Academy. Now this natural conformation doth clearly manifeſt that Laurentius was abuſed, when he ſaith, that he had ſeen a Man, whoſe Oraque was not cloſed, to void a quantity of Water by the Navel; inferring thence, that it came from the Bladder by this Urachus; and that which is contained within the Infants Membranes, is amaſſed after the ſame manner. I doubt not but156 he ſaw a Man void Water by the Navel, as he ſaith; but it did certainly proceed from the capacity of the lower Belly, where he had a Dropſie, and not from the Bladder; for there is no cavity in the Urachus, as we have ſaid, at leaſt not, except it be againſt the order of Nature; upon which, in this caſe, we muſt not rely ſo, as to affirm it ought to be ſo in all other ſubjects.
There are others, who will alſo have theſe Waters to be the Urine: but they are of an opinion that it paſſeth through the Yard, whoſe paſſage is alwayes open, and not by the Urachus which never is hollow.
For my part, as it appears to me, with more reaſon, and as indeed it is, theſe Waters are only generated out of vaporous humidities, which tranſude and exhale continually out of the Infants body, and meeting theſe Membranes, through which they cannot paſs, becauſe they are too thick and cloſe, are turned into Water, which is thus by little and little collected, as well during the firſt months of Conception, the Child not yet quick, as all the remaining part of the time, after it is: for vapours paſs forth and exhale out of all porous bodies that are hot and moiſt, as is that of an Embrio; and the reaſon is very weak, by which they maintain theſe Waters to proceed from the Urine, becauſe they are ſalt, as the Urine is; for Sweat, Tears, and other humours, which diſtill and tranſude out of the body, are as well ſalt as the Urine, of which the Infant, whilſt it is in the Womb, cannot have much, no more than ordeur in the Guts, becauſe at ſuch time it receives no nouriſhment by the mouth, and that all its ſuperfluous humours may157 eaſily paſs away by tranſpiration, through the ſubſtance of all the parts of its body, which is very tender: wherefore I cannot conceive any neceſſity to oblige them more to empty the Urine, which is in a ſmall quantity in the Bladder, than the Excrements which are in the Guts; which is not then done in any manner, but only after the Child is born. Bartholinus and others would however have the Infant to render its Urine through its Yard, and that theſe Waters proceed from thence: but there is a greater probability it ſhould come by tranſpiration, as I have ſaid; for before it is yet fully ſhaped, and quick, there is notwithſtanding found a proportionable quantity of theſe Waters to the bigneſs of his body: which makes it manifeſt, that it is then neither the Urine rendered by the Urachus nor the Yard, as all the world imagine: and that which proves it more plainly, is the example of ſome Children born with their Yards not perſorated, who notwithſtanding have theſe Waters, whilſt they are in their Mothers Womb.
It muſt be obſerved, that when there is more than one Child, they are never in the ſame Membrane, unleſs their bodies are joyned and adhering together (which is rare and monſtrous when it happens) but each of them have their Membranes and Waters apart and ſeparated, in which they are each wrapt up by themſelves.
Theſe Waters thus collected within theſe Membranes have divers very conſiderable uſes. They ſerve the Infant to move it ſelf the more eaſily, as it were by ſwimming from one ſide to the other, and that it may not hurt the Womb by its frequent motions in ſtriking dry againſt it, which would158 cauſe great pain and often excite to abortion: they ſerve alſo very much to facilitate its paſſage in the Birth, making the way very ſlippery, and by that means the orifice of the Womb being moiſtened, is better widened and yeelding when they break,**Right time of good Labour. juſt when the Child is ready to follow, or a little before: for elſe, remaining dry, it is born with greater difficulty, and the Mother alſo more tormented by it.
John Claudius de la Corveé, Phyſitian to the late Queen of Poland, in his Book intituled De Nutritione Faetus, would have theſe Waters to ſerve the Infant chiefly for nouriſhment, and that it ſucks them by his mouth, and ſwallows them (as he imagins) whilſt he continues in the Womb: but the truth of the contrary being known to the leaſt Scholar, it would be but labour in vain to refute all the reaſons he brings to prove and ſupport his ſaying; for they deſtroy themſelves, and do all of them correſpond to the falſhood of their principle.
Having thus ſufficiently explained the Membrans and Waters of the Faetus, we muſt in order inquire after the parts, by means of which it is nouriſhed whilſt in the Womb, which ſhall be our following diſcourſe.
Theſe three Figures repreſent the Placenta, or After-birth, and the umbilical veſſels of the Infant.
The firſt ſhews the ſhape of the Burthen, to the159 midſt of which is faſtened the Navel-ſtring, & round it may be diſcerned the**Skins. Membranes of the Infant, which remain thus wrinkled when the Child is come forth of it.
The ſecond Figure ſhews the Burthen turned on the outſide, and the Childs belly opened, that the diſtribution of the umbilical veſſels may be then conſidered.
The third Figure ſhews the burthen of Twins, where each Child hath his ſeveral Navel-ſtring and Membranes apart.
As to the ſtrings, which are double to this After-burthen, that on the right is diſſected at the end, to ſhew that there are but three veſſels only in it.
The other ſtring cut on the other end, where are only ſeen the orifices of the veſſels.
SInce the Infant is only nouriſhed with the Mothers blood whilſt it is in the Womb, and that big-bellyed Women never have any that is fair or good; provident Nature hath formed the Placenta to ſerve it for a Magazin, that it may alwaies have ſufficient, and be there again elaborated and perfected, to render it more convenient for its nouriſhment; for without doubt, ſo groſs a blood as the Mothers cannot poſſibly be converted into its delicate ſubſtance, if it were not firſt purified in the Placenta, which is afterwards ſent to it by meanes of the Umbilical vein, and brought back, as we ſhall ſhew hereafter, by the Arteries, which are the conduits of which the the Navelſtring is compoſed. We ſay then that the Placenta is nothing but a ſpongy and fleſhy maſs, ſomewhat like the ſubſtance of the Spleen, woven and interlaced with an infinity of Veins and Arteries, which compoſe the greateſt part of its body, made to receive the Mothers blood, appointed for the Infants nouriſhment, which is in the Womb. This maſs of ſpongious fleſh is thus called, becauſe it reſembles in figure a Cake; ſome call it the Delivery, becauſe being come forth after the Child is born, the Woman is quite delivered of the burthen of her great-belly: It is likewiſe called162 the After-burthen, becauſe it is as a ſecond labour, of which the Woman is not diſcharged till**Sometimes in flouding it comes before the Child. after the Child is born: there are ſome which give it the name of the Uterine Liver, becauſe they ſay it ſerves as a Liver to prepare the blood appointed for the Infants nouriſhment: and Laurentius likes rather to call it the**Sweetbread. Pancreas of the Womb, and appoints the ſame uſe for it, as for the Pancreas of the lower belly, to wit, for a reſt and ſupport to the veſſels of the Navel, which diſperſeth an infinite number of branches throughout all its ſubſtance.
This Placenta is made of the menſtruous blood of the Mother, which flowes into the Womb, by the accumulation of which is formed this Parenchymatous maſs; the ſhape of it is flat and round, of about he bigneſs of a Trencher, and two fingers breadth thick towards the middle of it, where the umbilical veſſels are faſtned: but it is thinner towards the edges of all its whole circumference. It is covered with the Chorion and Amnios on the ſide next the Infant, and on the other ſide it is joined and faſtened to the bottom on the inſide of the Womb: It is ſtrongeſt faſtened to the Womb (with its circumference) by means of the Chorion, as we have hinted already in the preceding Chapter, which cleaves ſo cloſe to it, by the interlacings of an infinity of Veſſels, which appear very large in its ſurface, that it cannot be ſeparated from it without laceration of its ſubſtance.
163If one conſiders diligently, as I have done, the Placenta on that ſide which joyns to the Mother, they may perceive that it is alſo indued with a kind of light membrane, which is ſo frail and ſmall, that it is almoſt imperceptible: however, it may manifeſtly be diſcerned by wiping away the blood with which it is alwaies coloured.
There may be again obſerved, that all the ſuperficies on this ſide is as it were much interlined, not unlike in ſome meaſure thoſe of an Oxes reins: and there appears likewiſe many ſmall out-lets, by which the blood, that tranſudes through the p•rous ſubſtance of the Womb, diſtills into this fleſhy maſs.
Although there be two Children in the Womb, nay three, if twins, that is to ſay, begotten in the ſame act, they have uſually but one common After-burthen: which hath as many Navel-ſtrings faſtened to it, as there are Children; which notwithſtanding are ſeparated one from the other by their ſeveral membranes, in each of which the Children are apart with their Waters; if at leaſt (as I have ſaid in the precedent Chapters) their bodies be not joyned and adhering one to the other; in which caſe the Twins of this kind have as well their Waters in common, as that they are involved in the ſame membranes: but if they be ſuperfetations, there will be as many burthens as Children: and as ſuperfetation (if there are as many as may poſſibly be) happen but very rarely, ſo there are few Women that have their burthens ſeparated, when they are delivered of ſeveral Children.
We ſcarce find any creature but a Woman, that164 hath an After-burthen, like what we have deſcribed, and diſchargeth it as uſeleſs, aſſoon as the Child is born; for moſt other Animals caſt forth nothing after their young, except the waters only and ſome ſlime, with the membranes which ſurround them; and inſtead of this fleſhy maſs, thoſe, which ordinarily, as a Woman, bring forth but one young at a time, have only ſome Cotyledons, which are many ſpongious kernells, joyned inwardly to the proper ſubſtance of their Womb, where terminates all the branches of the Umbilical veſſels of their young; which kernells, as I have often obſerved in the diſſecting of ſheep, are not bigger than Hemp ſeed, when they are not with young; but when they are with young, they ſwell extremely, and become of the bigneſs of a thumb, the one bigger, the other leſſer: they then reſemble much the Figure of a round Muſhroom, not yet ſpread, on the wrong ſide, after it be cut from its ſtalk; and to each of thoſe Cotyledons, or kernels, are faſtened the ramifications of the umbilical Veſſels: however it is certain, that the Animals which have ordinarily more than one at a time; as Bitches, Rabbits and others, have no Cotyledons, inſtead of which each young hath in its Cellule a kind of particular Placenta, which the dam eats aſſon as ſhe voids it, after ſhe hath gnawed and cut off with her teeth the Umbelical veſſel which held it.
When a big-bellyed Woman hath the leaſt indiſpoſition of her whole habit, there is almoſt ever ſome mark and impreſſion either in colour or ſubſtance on the after-burthen, which ſhe voids in her labour; becauſe, it being of a very ſoft ſubſtance,165 eaſily imbibes the ill humours of the body, which uſed to be voided by the Womb. Its natural colour ought to be red, and ſo much the fairer and better coloured, as the Woman is in good health; its ſubſtance muſt be whole and equally ſoft, without the leaſt ſchirrous hardneſs.
From the midſt of the Burthen proceeds a ſtring, compoſed of many veſſels joined together, which ſerve to conduct the blood appointed for the Infants nouriture; the number of them is diſputed amongſt Authors: ſome reckon four, that is, two Veins and two Arteries; others five, adding the Ourachus to them; but it is very certain that there are but three only in a humane Foetus, as I have found by many diſſections; to wit, one Vein and two Arteries: the vein having ſent forth into the Placenta an infinity of branches, like to the roots of a tree, is conducted by a ſingle channel all along the ſtring to the Infants navel, which it paſſeth, to be at laſt terminated in the midſt of the Fiſſure, which is in the inferiour part of the Liver; and the two Arteries taking their riſe out of the ſame Placenta, from a great number of the like roots, paſs along the ſame ſtring by two conduits, piercing alſo the Infants Navel, and end in its Iliac Arteries, and ſometimes in the Hypogaſtricks. The Vein is much bigger than the Arteries; its cavity is capable to admit a writing-quil into it, and thoſe of the Arteries only a ſmall bodkin about half the bigneſs of the Vein.
Theſe three Veſſels compoſing the ſtring, are wrapt up in one Membrane thick and ſtrong enough, proceeding from the Chorion, which likewiſe is clothed about with a production from the166 Amnios, and may eaſily be ſeparated: but beſides that this firſt ſerves them as a ſheath, in which they are all three lodged, it ſeparates them again one from the other by its duplications; When the veſſels of the ſtring are full of blood, it is then of about the bigneſs of a finger, and ordinarily of the length of a good half Ell, and ſometimes of two thirds, or three quarters. It is neceſſary it ſhould be of this length, that the Infant may have liberty to move it ſelf in the Womb, and to go forth of it at its birth without tearing the After-burthen, to which it is fixed: There are many very plain inequalities, like unto knots, which only proceed from the dilatation of the Veſſels, which being varicoſe and fuller of blood in one place than another, cauſeth theſe eminences. Some Midwives believe ſuperſtitiouſly, or would make others believe, that the number of theſe pretended knots, anſwers the number of Children the Woman ſhall have afterwards, which is without reaſon; becauſe Women delivered at forty years of age, and of their laſt Child, as we find by daily experience, have as many knots on the Navel-ſtring, as a Woman of twenty years, who may yet have a dozen Children: they ſay further, That if the firſt knot be red, the next Child the Woman ſhall have, will be a Boy; if white, a Girl: but this Propoſition is as ill grounded, as the other; for theſe Knots appear only red, or to ſpeak more properly, of a dark blew, according as the Veſſels are more or leſs full of blood, and eſpecially the Vein which gives it that colour, and is ſo much the more apparent, as it is ſuperficial in that place.
There are many Authors admit, as we have167 ſaid, the Ourachus into the number of theſe Umbilical veſſels, ſaying that it ſerves to empty the Childs urine into its Membranes: however, experience ſhewes us it is no veſſel, and that it paſſeth not forth of the Navel; but that it is only a ligament in a Child, as it is in a Man, which coming from the bottom of the Bladder, terminates at the Navel, without traverſing it, as they have hitherto miſtaken it. I have opened and diſſected above thirty Foetus's, in none of which did I ever find it hollow, but alwaies very ſolid and tendinous, towards the place where it it faſtned to the Navel; and very like, as I have already ſaid, to a ſmall Lute ſtring: Notwithſtanding I ever found it manifeſtly hollow in an Ewe, which was terminated with their other Umbilical veſſels, at their Cotyledons; in which Animals are alſo two Umbilical veins to be ſeen, going both near one the other to the Liver, which makes that their Navel-ſtring conſiſts of five Veſſels; but it is not the ſame in a human Foetus, for there is but one onely Umbilical Vein, and two Arteries.
To underſtand well how the nouriſhment is conveyed to the Infant by the Umbilical veſſels, it is very neceſſary to conceive and know, in what manner the Blood circulates; which is after this manner. The blood having been conveyed by the mothers Arteries, which end at the bottom of the Womb in the Placenta, which is there faſtned, makes a natural transfuſion through the Umbilical Vein into the Childs Liver, after which it is carried into the Vena cava, and thence to the Heart, whence it is ſent to all the parts by means of the Arteries, and very near a like portion in quantity168 being in the Iliac Arteries, is conducted into the Umbilicals, which are there terminated, for to be carried back into the Placenta, where this blood being again elaborated, returns to make the ſame journey by the Umbilical Vein, paſſing again to the Childs Liver, and thence to the Heart, and ſo alwayes ſucceſſively, without the leaſt intermiſſion. But to be able to conceive eaſily how the blood circulates in the Placenta, and how by the help of that part is made a mutual transfuſion from the one to the other, as well in reſpect of the Mother, as of the Child; we need but imagine it to be a common part, and depending on both their bodies: for as to the Mother, the circulation is there made juſt as in her Arm, or any other part of her whatſoever; and as to the Child, it is even the ſame.
There are no Valvules found in the Umbilical Vein, though I have curiouſly examined it, nor are any neceſſary: theſe Valvules ar every frequent in the Veins of the Arms and Legs; becauſe theſe parts are obliged to make different motions, which compreſſing the Veſſels would trouble thoſe of the blood, if it were not ſo ſuſtained and hindered from recoiling; but the Umbilical Vein hath no need of any, becauſe the Navel-ſtring is looſe and floting in the midſt of the waters, where it cannot be compreſt; and therefore the motion of the Blood cannot be there intercepted, as it is ſometimes in the Arms and Legs, or other parts where there are ſtrong contractions.
Aſſoon as the Child is born, theſe Veſſels, which are bigger in a Foetus, becauſe of their cavity, than they are in a Man, dry up; and that part of them169 which is without the belly, falls off, and is ſeparated cloſe to the Navel five or ſix days after; for which reaſon they loſe their firſt uſe, and begin afterwards to degenerate into ſuſpending Ligaments, to wit, the Vein into that of the Liver, and the two Arteries ſerve to extend and ſuſtain the Bladder by the ſides where they are joyned to it, the bottom of which is yet ſuſpended by the Ourachus, which comes not through the Navel, as hath been ſaid, but remains ſo pendant all the reſt of its life. We have hithereo made mention of all thoſe things which are found with the Child in the Womb, let us now ſhow what are the different ſcituations of it in the Womb, according to the different times of Pregnancy: It is a thing of very great conſequence, and deſerves ſome reflections.
The three following Figures repreſent the different natural ſcituations of the Child in the Womb.
Explication of all the Wombs, in which are contained all the Children repreſented in different poſtures, as well in this place, as in all the following.
WHen we ſhall have explained the ſeveral natural ſcituations of an Infant, thoſe contrary to Nature, cauſing for the moſt part all ill labours, will eaſily be conceived.
It may be conſidered that generally the Infants, as well Male as Female, are uſually ſcituated in the midſt of the Womb; for though ſometimes a Womans great Belly is a little higher on the one ſide than the other, yet that is, becauſe the globe of the Womb inclines more that way, and this ſcituation on the ſide muſt be underſtood only in reſpect of the Mothers belly, and not of her Womb, in the midſt of which it is alwaies placed;171 becauſe there is but one only cavity in a Womans Womb, marked with a ſmall line in its length, without having two or more ſeparations; as is ſeen in thoſe of other Animals.
There are ſome who would have theſe two imaginary cavities to be the cauſe why Women ſometimes bear Twins, yea and ſometimes more; and that the Males are rather engendered on the right, and Females on the left ſide, which is Hypocrates's opinion in the 48th Aphoriſme of his 5th Book, where he ſaith, Foetus Maris dexträ uteri parte, Foeminae ſiniſträ magis geſtantur, but without any certain reaſon for it; becauſe ſome Women have the Males on the left-ſide, others the Females on the right; and when there are Twins, ſometimes both are of the ſame Sex, ſometimes not, and indifferently ſcituated on the right or the left. This is all can be ſaid in general of the ſcituation of Children in the Womb.
But in particular, when we conſider the ſeveral Figures it makes, it differs according to the different times of Pregnancy; for when the Woman is young with Child, the little Foetus, called Embryo, is alwaies found of a round Figure a little oblong, having the Spine moderately turned inwards, the Thighs folded and a little raiſed, to which the Legs are ſo joined, that the Heels touch the Buttocks; the Arms are bending, and the Hands placed upon the Knees, towards which the Head is inclining forwards, ſo that the Chin toucheth the Breaſt. It reſembles, in this poſture very well, one ſitting to void his Excrements, and ſtooping down his head to ſee what comes from him. The Spine of its Back is at that time placed towards the Mothers,172 the head uppermoſt, the face forwards, and the feet downwards; and proportionable to its growth and grandeur, it extends by little and little its members, which were exactly folded in the firſt months. It keeps uſually this poſture till the ſeventh or eighth month, at which time the head being grown very big, is carried downwards by its weight, towards the inward orifice of the Womb, tumbling as it were over its head, ſo that then the feet are uppermoſt, and the face towards the Mothers great gut. Some believe that only Males are ſo turned downwards when they are born, and that the Females are with their face upwards; but both the one and the other are alwaies turned downwards, with their face towards the Rectum of their Mother, as is aboveſaid, and when it happens otherwiſe, it is unnatural, for the Childs face coming upwards will be extremely bruiſed, and the noſe wholly flatted, becauſe of the bones hardneſs in the paſſage.
It may be noted, that when the Child hath thus changed its firſt ſcituation, being not yet accuſtomed to this laſt, it ſtirs and torments it ſelf ſo much ſometimes, that the Woman, by reaſon of the pains ſhe feels, is apt to believe it her Labour: And if this circumſtance be well conſidered, they will find it to be that firſt pretended endeavour which Authors imagine the Child makes for to be born in the Seventh moneth, and not being able to accompliſh, it remains ſo till the Ninth, and that reiterating it in the eighth, if it be born, it lives not long, becauſe it was not able to endure two ſuch puiſſant endeavors ſo near together. But it is a meer abuſe, for if the Child turnes it ſelf ſo173 with the head downwards, or rather is turned, it is but by a natural diſpoſition of the weight of the upper parts of the body, and if it ſtirs much at that time and ſoon after, it is not from a deſire to be born, but from the inconvenience it receives from this new poſture, to which it was not before accuſtomed, as already hath been mentioned: And it begins to turn thus ſometimes from the Seventh month, rarely before but by accident, ofteneſt about the eighth Moneth, and ſometimes in the ninth only, and at other times alſo it doth not turn at all, as we way eaſily perceive in thoſe that come in their firſt ſcituation, that is, with their feet foremoſt. From whence it is eaſie to conjecture, and I hold it for a certain truth, that the Children are the more ſtrong and robuſt, and conſequently may more likely live, by how much the nearer they approach to the more natural and perfect time, which is at the end of the ninth Month.
The Infant then is turned on this manner with his Head downwards towards the latter end of the Reckoning, to the end only that he may be the better diſpoſed for its eaſier paſſage into the world at the time of Labour, which is not then far off: For in this poſture all its joints are eaſily extended in comming forth, and the Arms and Legs cannot hinder its birth; becauſe they cannot be bended againſt the inward orifice of the Womb; and the reſt of the body, which is very ſupple, paſſeth very eaſily, after the Head, which is hard and big, be once quite born.
When there are many Children, they ought, if it be natural, to come in the ſame Figure, as when174 there is but one: but uſually by their different motions they do ſo incommode one the other, that almoſt alwaies one of them preſents wrong at the time of Labour, yea and before; which is the cauſe that one comes often with the Head, the other with the Feet, or any other worſe poſture, and ſometimes both come wrong.
However the Infant may be ſcituated in the Mothers belly, or in whatſoever faſhion it be that it preſents at the birth, if it be not according to the poſture above deſcribed, it is alwaies againſt Nature: and the natural ſcituation is ſo neceſſary to a good and legitimate Delivery, that thoſe which are againſt nature, do cauſe for the moſt part bad Labours.
When a big-bellyed Woman is happily arrived near her haven, ſhe ought then to take great care ſhe ſuffers not ſhipwrack there; which ſhe will avoid, if ſhe obſerves exactly at the end of her reckoning the Rules which follow.
I Am not of the opinion of moſt Mid-wives, who adviſe Women with Child (that they may, as they ſay, have the better labour) to uſe more than ordinary exerciſe towards the end of their reckoning, as Liebaut alſo directs, who orders them to ride in Coaches, or trotting Horſes, which is a very175 dangerous advice, and cauſeth daily many wrong Births; for, as we ſaid in the precedent Chapter, 'tis about that time that ordinarily the Child turns its head downwards, and its heels upwards, for to be born right, and the poor Women often believing they may procure an eaſie labour, make it by this extraordinary exerciſe very unhappy, which becauſe of the agitation and commotion of the body, cauſeth the Child to take a wrong poſture, or makes the Womb ſo to bear down and be engaged in the cavity of the Hypogaſtrium, that afterwards it hath not at due time liberty to be turned; which is often the reaſon, why it comes in its firſt poſture, that is, with the feet, beſides that labour (which ought to be Natures work, if the Child come right) is thereby excited before the full time, and though it were but four or five days, it hinders not, as I have ſaid elſewhere, from being as prejudicial to them, as we ſee it is to the taſte, goodneſs, and conſervation of Fruit gathered but few days before its perfect maturity.
Wherefore I counſel a Woman (though almoſt contrary to the unreaſonable opinion of every one) to keep her ſelf more quiet than ordinary, when ſhe draws near her time, that ſo her Child may be able to turn it ſelf directly right, and that ſhe by all means avoids being ſtrait laced, that ſo it may have more ſpace to be turned into a fit poſture to be born; ſhe muſt then likewiſe obſerve a good diet of meat, of good juyce and eaſie digeſtion, rather boiled than roſted, to moiſten the better, and keep the body thereby open, rather than by Clyſters, which may haſten labour; ſhe may about eight or ten days before Labour anoint176 her privities with Gooſe, Capon, or Hogs Greaſe or freſh Butter: or foment thoſe parts with fomentations, which may by mollifying and looſening, render thoſe paſſages more ſmooth and ſlippery. This ought principally to be done by thoſe that go with their firſt Child; becauſe their paſſages are more ſtrait than others who have had Children already: but they who are a little in years, have much more pain, and are longer in Labour of their firſt Child, than others who are indifferent young; becauſe the Membranes of their Womb are harder and dryer; wherefore they cannot yeeld ſo well, nor the inward Orifice be ſo eaſily dilated.
Some Authors commend bathing, the better to relax thoſe parts; but it is dangerous, leſt by their too much moiſtneſs, and the emotion they cauſe to the whole Body, they make her come a little before her time. Many Women bleed by way of prevention, when they are, or believe themſelves to be at their full time; which cuſtom I cannot approve, if it be only for prevention; but I do, in caſe ſome other neceſſity require it, provided they abſtain from it after the ſeventh Moneth; becauſe the ſtirring of the Child, cauſed by bleeding, is ſometimes ſo vehement, that the Womb is conſtrained to open, before its time to be rid of the Child. If a Woman with Child obſerves theſe Rules, ſhe will have reaſon to hope for a good iſſue of her Labour: in the mean time let her provide her ſelf of a good Midwife or an expert and handy**Chyrurgeons onely Practiſe in France, as noted before. Chyrurgeon, to attend upon her aſſoon as ſhe perceives177 the leaſt pain or throw, of what kind ſoever; for as a ſmall wind, or ſhake, will ſerve turn to make ripe fruit fall, ſo the leaſt Cholick, or any other falſe pain, may bring forward her Labour, and ſurpriſe her unprovided of help: Let us now ſee what is neceſſary when ſhe is effectively in Labour.
A Womans travel is only many pains with reiterated Throws, by which ſhe endeavours to bring forth her Child: It is ſo called, becauſe both Mother and Child ſuffer and take much pains in this action. Moſt people believe that there is no other reaſon for the cauſe of this evil, but becauſe God hath ſo ordained it, and that Woman, according to his Word, muſt bring forth with pain, becauſe of her ſin, according to what is written in the 3d. Chap. of Geneſis, I will greatly multiply thy ſorrow and thy conception, in ſorrow thou ſhalt bring forth Children, and thy deſire ſhall be to thy Husband — This curſe was indeed very great, becauſe it hath extended to all Women that have brought forth Children ſince that time, and will continue to all that ſhall come hereafter. However we find that all the Females of other Animals ſuffer as much, and are in as great danger of their lives as a Woman, when they bear their young. This perſwades us, that,178 beſides this preciſe will of God in reſpect of a Woman, there muſt be yet a natural reaſon, wherefore it cannot happen otherwiſe, and that is, That it is impoſſible the Womb, being very ſtrait in compariſon of the Childs bigneſs, and very ſenſible, becauſe of its Membranous compoſition, ſhould receive a neceſſary dilatation for the Childs birth, and ſuch great violence, without ſuffering conſiderable pains for it. Now ſince a Woman, for this cauſe, cannot ſhun theſe pains, ſhe muſt endeavour to endure them with patience, in the hope of being ſuddenly delivered from them by a fortunate labour.
Aſſoon as it is known that the Woman is certainly in Labour, by the ſigns mentioned in the Second Chapter of this Book, where both thoſe preceding and thoſe accompanying Labour are recited; of which the principal are, Pains and ſtrong Throws in the Belly, forcing downwards towards the Womb: the dilatation of the inward Orifice, perceived by touching it with the finger: as alſo the gathering of the Waters, which come before the Head of the Child, and thruſting down the Membranes which contain them, through which between the Pains one may in ſome manner with the Finger diſcover the part which preſents, eſpecially if it be the Head of the Child, by its roundneſs and hardneſs: Then muſt all things neceſſary to comfort the Woman in her Labour be go ready; and the better to help her, care muſt be taken, that ſhe be not ſtrait-laced; a pretty ſtrong Clyſter may be given her, or more than one, if there be occaſion; which muſt be done at the179 beginning and before the Child be too forwards, for afterwards it is very difficult for her to receive them, becauſe the Gut is too much compreſſed: they ſerve to excite it to diſcharge it ſelf of its excrements, that ſo the Rectum being emptied, there may be more ſpace for the dilatation of the paſſage, as alſo to ſtirr up the pains to bear the better downwards, through the endeavours ſhe makes when ſhe is at ſtool, and the while all neceſſary things for her Labour ſhould be put in order, as well for the Woman, as the Child, a Midwifes ſtool, or rather a Pallet-Bed girted, placed cloſe by the fire, if the ſeaſon require it; which Pallet ought to be ſo diſingaged, as to be turned round about, the better to help the Woman when there is occaſion.
If the Woman be**full of blood. Plethorick, it may be convenient to bleed her a little, for by this means, her Breaſt being diſingaged, and her reſpiration free, ſhe will have more ſtrength to bear down her pains, which ſhe may do without danger, becauſe the Child being about that time ready to be born, hath no more need of the Mothers blood for its nouriſhment; which I have often practiſed with good ſucceſs: beſides this evacuation often hinders her having a Fever after Delivery, in expectation of which hour ſhe may walk about her Chamber, if her ſtrength permits; and to preſerve her ſtrength, it will be convenient to give ſome good gelly broths, new-laid eggs, or ſome ſpoonfuls of burnt or brewed Wine, from time to time, or a Toſt dipt in Wine, avoiding at that time ſolid food. Above all ſhe muſt be perſwaded to hold out her pains,180 bearing them down as much as ſhe can, at the inſtant when they take her: The Midwife muſt from time to time taſte the inward orifice with her finger, to know whether the Waters are ready to break, and whether the Birth will ſoon after follow: ſhe muſt likewiſe anoint all the bearing place with emollient Oyles, Hogs-greaſe, or freſh Butter, if ſhe perceive that they can hardly be dilated, and all the while ſhe muſt be near her Woman, to obſerve her geſtures diligently, her complaints and pains, for by this they gueſs pretty well, how the Labour advanceth, without being obliged to taſte her body ſo often.
Mr. de la Cuiſſe deceaſed, who often ſlept near the Woman in Labour, was ſo uſed to it, that he never awaked till juſt the Child was in the paſſage, at which time the Woman changeth her moans into loud cries, which ſhe ſtrongly repeats, becauſe of the greater and more frequent pains which ſhe then feels: the Patient may likewiſe by intervals reſt her ſelf on her bed, for to regain her ſtrength: but not too long, eſpecially little, or ſhort thick Women, for they have alwaies worſe Labours if they lye much on their beds in their Travail, and yet much worſe of their firſt Children, than when they are prevailed with to walk about the Chamber, ſupporting them under their arms, if neceſſary; for by this means, the weight of the Child (the Woman being on her Legs) cauſeth the inward orifice of the Womb to dilate ſooner than in bed; and her pains to be ſtronger and frequenter, that her Labour be nothing near ſo long.
281Qualms and Vomitings, which often happen to Women in Labour, ought not to amaze any, for on the contrary, it furthers the Throws and Pains provoking downwards: we ſhewed the cauſe of this Vomiting in the Second Chapter of this Book, and the reaſon why it is not dangerous.
When the Waters of the Child are ready and gathered, which may be perceived through the Membranes to preſent themſelves to the inward orifice, of the bigneſs of the whole dilatation, the Midwife ought to let them break of themſelves, and not as ſome, that impatient of the long Labour, break them; intending to haſten their buſineſs, which on the contrary they retard by ſo doing, before the Infant be wholly in the paſſage; for by the too haſty breaking of theſe Waters, which ought to ſerve him to ſlide forth with greater facility, he remains dry, which hinders afterwards the Pains and Throws from being ſo effectual to bring forth the Infant, as elſe they would have been; it is therefore better to let them break of themſelves, and then the Midwife may eaſily feel the Child bare, by the part which firſt preſents, and ſo judge certainly whether it comes right, that is with the Head, which ſhe ſhall find hard, big, round, and equal; but if it be any other part, ſhe will perceive ſomething inequal, and rugged, and hard or ſoft, more or leſs according to the part it is. Immediately after**That being the right time when all Women ought to be delivered, if nature perform its office. let her diſpatch to deliver her Woman, if ſhe be not already, and aſſiſt the Birth, which ordinarily happens ſoon after, if natural, and182 may be done according to the directions in the next Chapter: But if ſhe finds the Child to come wrong, and that ſhe is not able to deliver the Woman**Mark, 'tis not enough to lay a Woman, if it might be done by another, with more ſafety and caſe to either or both. as ſhe ought to be, by helping Nature, and ſo ſave both Mother and Child, who both are in danger of their lives, let her ſend ſpeedily for an expert and dextrous Chyrurgeon in the practice, and not delay as too many of them very often do, till it be reduced to extremity.
There are many Midwives, who are ſo afraid that the Chirurgeons ſhould take away their practice, or to appear ignorant before them,**Good avoiding ſuch Midwives if Women value their lives. that they chuſe rather to put all to adventure, then to ſend for them in neceſſity: others are ſo preſumptuous, as to believe themſelves as capable as the Chirurgeons to undertake all. And ſome there are indeed, who are not ſo wicked, yet for want of knowledg and experience in their Art, hope ſtill in vain, that the Child in time may change to a better poſture, and that the accidents will ceaſe (if it pleaſe God, as they ſay); and ſome do maliciouſly put ſuch a terrour and apprehenſion of the Chirurgeons in the poor Woman,**For the moſt part undeſervedly. characterizing them like butchers and hangmen, that they chooſe rather to dye in Travail with the Child in their Womb, than to put themſelves into their hands: But indeed ſuch Midwives do183 more juſtly deſerve this fair title, unleſs they behave themſelves with more prudence and equal conſcience in ſo important an occaſion, and ſend**A neceſſary note. in time for ſome help in their buſineſs, before the Child be (as very often) engaged in a wrong poſture in the paſſage, ſo as it is almoſt impoſſible to give it a better, without extream violence to the Woman, which is alſo the cauſe of the death of the Child; and they would be ſo far from loſing their reputation, that they would augment it, becauſe by ſo doing, it would be manifeſt they were not ignorant of the danger both of time and place; and the Chirurgeon being called, aſſoon as neceſſity required it, could have no juſt cauſe to impute any ill conſequence of the Labour to them, though it ſhould ſo fall out, and rheir conſcience would be diſcharged of it: for in this caſe (as we have ſaid) both the Mothers and Childs life is at ſtake.
Aſſoon then as the Waters are broke, and the Midwife finds the Child to come wrong, ſhe muſt adviſe the Woman not to forward her Pains, leſt by bearing down ſhe engage the Child too much in the paſſage, and ſo give the Chirurgeon more pains to turn it, and muſt ſend for him aſſoon as may be, for to deliver her as occaſion requires, and according as ſhall be directed hereafter in this Book. It is now time, after having declared what muſt be done whilſt the Woman is in Labour, to ſhew how ſhe muſt be helped and comforted in a natural Delivery.
184This Figure doth very well repreſent the globe of the Womb, which is opened but in part, to ſhew in what manner the Child is brought forth in a natural Labour.
The Bed muſt be ſo made, that the Woman being ready to be delivered, ſhould lye on her back upon it, having her body in a convenient Figure, that is, her Head and Breaſt a little raiſed, ſo that ſhe be neither lying nor ſitting; for in this manner ſhe breathes beſt, & will have more ſtrength to help her Pains, than if ſhe were otherwiſe, or ſunk down in her Bed. Being in this poſture, ſhe muſt ſpread her Thighs abroad, folding her Legs a little towards her Buttocks, ſomewhat raiſed by a ſmall Pillow underneath, to the end that the Coxcyx, or Rump, ſhould have more liberty to retire back, and have her Feet ſtayed againſt ſome firm thing; beſides this, let her hold ſome perſons with her hands, that ſhe may the better ſtay her ſelf during her Pains. She being thus placed near the ſide of her Bed (with her Midwife by, the better to help upon occaſion) muſt take courage and help her Pains the beſt ſhe can, bearing them down when they186 take her, which ſhe may do by holding her breath, & forcing her ſelf all ſhe can, juſt as when ſhe goeth to Stool; for by ſuch endeavors, the Diaphragma being ſtrongly thruſt downwards, doth force down the Womb and Child in it; in the mean time the Midwife muſt comfort her, and deſire her to endure her Labour bravely, putting her in hopes of a ſpeedy Delivery. Some would have another Woman at that time to preſs the ſuperior parts of her Belly, and ſo to thruſt gently the Child downwards; but I am not of their opinion, becauſe ſuch compreſſions will rather hurt then profit, by indangering the bruiſing of the Womb, which is extream ſore at that time; and I have ſeen ſome Women, very ill afterwards, for having been uſed in this manner. But the Midwife may content her ſelf only (having neither Ring nor Bracelet on, and her Hand anointed with Oyl or freſh Butter) to dilate gently the inward orifice of the Womb, putting her Fingers ends into its entry, and ſtretching them one from the other, when the Pains take her, for to endeavour to forward the Child, & thruſting by little and little the ſides of the Orifice, towards the hinder part of the Childs Head, anointing theſe parts alſo with freſh Butter, if it be neceſſary.
When the Infants Head begins to advance into this inward Orifice, tis commonly ſaid it is crowned, becauſe it girds and ſurrounds it, juſt as a Crown, and when it is ſo far that the extremity begins to appear manifeſtly without the Privy-parts, it is then ſaid that the Child is in the Paſſage, and the Woman in Travail imagines (although untruly, and it may be is not ſo much as touched by187 her) that her Midwife hurts her with her Fingers, finding her ſelf as it were ſcratched and pricked with pins in thoſe parts, becauſe of the violent diſtention and ſometimes Laceration, which the bigneſs of the Childs head cauſeth there.
When things are in this poſture, the Midwife muſt ſeat her ſelf conveniently to receive the Child, which will ſoon come, and with her Fingers ends, her Nails being cloſe pared, endeavour to thruſt (as aboveſaid) this crowning of the Womb back over the Head of the Child, and aſſoon as it is advanced as far as the Ears, or thereabouts, ſhe may take hold of the two ſides with her two hands, that when a good Pain comes ſhe may quickly draw forth the Child, taking care that the Navelſtring be not then intangled about the Neck, or any other part, leſt thereby the After-burthen be pulled with violence, and poſſibly the Womb alſo to which it is faſtened, and ſo cauſe flooding, or elſe break the ſtring, whereby the Woman may come to be more difficulty delivered. It muſt alſo be obſerved that the Head be not drawn forth ſtrait, but ſhaking it a little from one ſide to the other, that the Shoulders may the ſooner and eaſier take its place, immediately after it be paſt, which muſt be done without loſing any time, leſt the Head being paſt, the Child be ſtopt thereby the bigneſs and largeneſs of the Shoulders, and be in danger of being ſuffocated and ſtrangled in the paſſage: but aſſoon as the Head is born, if there be need, ſhe may ſlide in her Fingers under the Arm-pits, and the reſt of the Body will follow without any difficulty.
Aſſoon as the Midwife hath in this manner188 drawn forth the Child, ſhe muſt put it on one ſide, leſt the Blood and Waters, which follows immediatly after, ſhould incommode it, or it may be choak it, by falling into its Mouth or Noſe, as it would do, if it were laid on the back; after which there remains nothing but to free her from the After-burthen, which I will ſhow how in the next Chapter: but before that, let her be very careful to examine, whether there be no more Children in the Womb; for it happens very often that there are two and ſometimes more, which ſhe may eaſily know, by the continuance of the Pains after the Child is born, and the bigneſs of the Mothers belly; beſides this ſhe may be very ſure of it, if ſhe puts her Hand up the entry of the Womb, and finds there another Water gathering, and a Child in it preſenting to the paſſage; if it be ſo, ſhe muſt have a care not to go about to fetch the After-birth, till the Woman be delivered of all her Children, if ſhe have never ſo many, becauſe Twins never have but one Burthen, to which there are faſtned as many Strings and diſtinct Membranes as there are Children; and if one ſhould go to draw it forth aſſoon as the firſt is born, the reſt would be in danger of their lives, becauſe that part is very neceſſary to them, whilſt they are in the Womb, and beſides it endangers a flooding. Wherefore the firſt String muſt be cut, being firſt tyed with a thread three or four double, as we ſhall ſhew more exactly hereafter, and faſten the other end with a ſtring to the Womans Thigh, not ſo much for fear that the String ſhould enter again into the Womb, as to prevent the inconvenience it may cauſe to the Woman by hanging between her189 Thighs; afterwards, this Child being removed, they muſt take care to deliver her of the reſt, obſerving all the ſame circumſtances as was to the firſt; which being done, it will be then convenient to fetch the After-birth, as we ſhall ſhew in the following Chapter.
MOſt Animals, when they have brought forth their young, caſt forth nothing elſe but ſome Waters, and the Membranes which contained them; but Women have an After-birth, of which after Labour they muſt be delivered, as of a thing uſeleſs and inconvenient: Wherefore aſſoon as the Child is born, before they do ſo much as tye or cut the Navel-ſtring, leſt the Womb cloſe, they muſt without loſing time free the Woman from this fleſhy maſs, which was deſtined to furniſh the Infant with Blood for its nouriſhment, whilſt it was in the Womb, and which at that time is called with much reaſon the After-birth, becauſe it follows the Child, and is to the Woman like another Birth; for being brought forth, ſhe is totally delivered.
To perform this, the Midwife having taken the ſtring, muſt winde it once or twice about one or two of her Fingers of her left Hand joyned together, the better to hold it, with which ſhe may then draw it moderately, and with the right hand190 ſhe may only take a ſingle hold of it above the leſt near the Privities, drawing likewiſe with that very gently, reſting the while the Fore-finger of the ſame hand extended and ſtretched forth along the String towards the entry of the Vagina, as may be ſeen in the annexed Figure; alwaies obſerving, for the more facility, to draw it from the ſide where the Burthen cleaves leaſt, for in ſo doing the reſt will ſeparate the better; juſt as we ſee a Card which is glewed to any thing, is better ſeparated from the place where it begins to part, then where it is cloſe joyned.
Aſſoon as the Woman is delivered of both Child and Burthen: it muſt then be conſidered, whether there be all, and care had that not the leaſt part of it remain behind, not ſo much as the Skirts or any Clods of Blood, which ought all to be brought away with the firſt; for otherwiſe, being retained, they cauſe great Pains: all which being done, things fit for Mother and Child, in this condition, muſt be provided, which we will mention in their place.
When a Woman hath two Children, ſhe muſt be delivered in the ſame manner as if ſhe had but one, obſerving only, for the reaſons given in the precedent Chapter, not to fetch the Burthen, till all the Children are born; and then it may be done without danger, ſhaking and drawing it alwaies192 gently, ſometimes by one String, ſometimes the other, and ſometimes by both together, and ſo by turns till all is come, proceeding in it according to the directions already given.
When the Infant comes right and naturally, the Woman is brought to Bed and delivered with little help, obſerving what hath been taught in the two laſt Chapters, of which the meaneſt Midwives are capable, and oft times for want of them, a ſimple Nurſ-keeper may ſupply the place: but when it is a wrong Labour, there is a greater myſtery belongs to it, for then the skill and prudence of a Chirurgeon is for the moſt part requiſite. Which we intend now in the remaining part of this Book to treat of.
FOr the eaſier and better explaining theſe things, we ſay, that there are three ſorts of bad Labours: to wit, the Painful or Laborious; the Difficult; and that which is altogether contrary to Nature.
The Laborious is a bad Labour, in which the Mother and Child (though it comes right) ſuffer very much, and are haraſſed more than ordinary:
The Difficult is not much unlike the firſt, but193 beſides is accompanied with ſome accident which retards it, and cauſeth the difficulty: but the wrong Labour, or that againſt Nature, is cauſed by the bad ſcituation of the Child, and can never be helped but by manual Operation, or the Chirurgeons hand. In the laborious and difficult Labours, Nature alwaies doth the Work, being a little aſſiſted: but in that contrary to Nature, all its endeavors are vain and uſeleſs, and there is then no help but in an expert Chirurgeon, without whom ſhe muſt certainly periſh.
The Difficulties of Labour proceed either from Mother, Child, or both.
From the Mother, by reaſon of the indiſpoſition of her Body; or it may be from ſome particular part only, and chiefly the Womb: or alſo from ſome ſtrong paſſion of the Mind, with which ſhe was before poſſeſt.
In reſpect of her Body, either becauſe ſhe may be too Young, having the Paſſages too ſtrait, or too old of her firſt Child; becauſe her parts are too dry and hard, and cannot be ſo eaſily dilated, as happens alſo to them, which are too lean: they who are either ſmall, ſhort, or miſhapen, as crooked Women, have not a Breaſt ſtrong enough to help their Pains, and to bear them down; nor thoſe that are weak, whether naturally or by accident; and crooked perſons have ſometimes the Bones of the Paſſage not well conformed: the tender and too apprehenſive of Pain, have more trouble than others, becauſe it hinders them from doing their endeavour: and they likewiſe who have ſmall Pains and ſlow, or have none at all. Great Cholicks hinder Labour alſo, by preventing the true194 Paius: all great and acute diſeaſes make it very troubleſome and of a bad conſequence, according to Hippocrates's opinion in the 30th Aphoriſm of the Fifth Book; Mulierem gravidam morbo quopiam acuto corripi, lethale. As when ſhe is taken with a violent Feaver, a great Flooding, frequent Convulſions, Dyſentery, or any other great diſtemper. Excrements retained, cauſe much difficulty, as a Stone in the Bladder, or when it is full of Urine, without being able to void it; or when the great Gut is repleted with hard Ordure, or the Woman troubled with great and painful Piles, and their ill ſcituation ſometimes retard it extremely.
As touching the difficulty proceeding from the Womb only, it muſt either be from its bad Scituation or Conformation, having its Neck too ſtrait, hard, or callous, whether naturally, or by any accident, as having had there a Tumor, Apoſtume, or Ulcer, or Superfluous fleſh, whether on the Neck, or inward Orifice: or becauſe of any Cicatrice cauſed by a preceding bad Travail.
Beſides theſe, thoſe things which are or may be contained in the Womb with the Child, do alſo cauſe difficult Travail; as when the Membranes are ſo ſtrong, that they cannot be broken, which ſometimes hinders them from advancing into the Paſſage; or ſo tender, that the Waters break too ſoon, for then the Womb remains dry: When there is a Mole; or the After-burthen comes firſt, which alwaies cauſeth flooding, and certainly the death of the Infant, if the Woman be not preſently delivered of them by Nature or Art; yea and when the Navel-ſtring comes firſt, the Child is ſuffocated, if not ſpeedily after born; ſtrong Paſſions195 of the Mind do likewiſe contribute much to it, as Fear, Sorrow, and others the like. The Woman that miſcarries hath more pain than a Woman at her full time, as alſo than one that is hurt, although ſhe be very near her time.
As to the hinderances cauſed by the Infant, they are, when either its Head or whole Body are too large; when the Belly is Hydropical; when it is monſtrous, having two Heads, or being joyned to another Child, Mole, or any other ſtrange thing; when it is dead, or ſo weak, that it contributes nothing to its Birth; when it comes wrong; or when there are two or more: beſides all theſe different difficulties of Labour, there is yet one cauſed by the Midwife's ignorance, who for want of underſtanding her buſineſs, inſtead of helping, hinders Nature in its work.
Let us now treat of the means, by which all theſe may be prevented, and the Woman ſuccoured in her bad and difficult Labour, as may eaſily be done, if we perfectly know the cauſes of all theſe difficulties; as when it happens by the Mothers being too young and too ſtrait, ſhe muſt be gently treated, and the paſſages anointed with Oyl, Greaſe, and freſh Butter, uſing theſe things a long time before the Hour of Labour, to relax and dilate them the eaſier, leſt there ſhould happen a rupture of any part, when the Child is born: for ſometimes there happens a dilaceration to the Fundament, by which both are rent into one outwardly. If a Woman be in years of her firſt Child, let her lower parts be likewiſe anointed to mollify the inward orifice, and the Vagina or Neck of the Womb, which being more hard and callous, do196 not eaſily yield to the neceſſary diſtenſion of Labour; which is the cauſe why ſuch Women are longer in Labour than others, and why their Children (being forced againſt the inward orifice of their Womb, which is, as we have ſaid, a little callous, and alſo for remaining long in the paſſage) are born with great Bumps and Bruiſes on their Heads: Small and miſhapen Women ſhould not be put to Bed, till at leaſt their Waters be broke; but rather kept upright and walking about the Chamber, if they have ſtrength, being ſupported under the Arms; for in that manner they will breath more freely, and mend their Pains better, than on the Bed, where they lye all on a heap. Let thoſe that are very lean, alſo moiſten theſe parts with Oyls and Oyntments, to make them more ſmooth and ſlippery, that the Head of the Infant and the Womb be not ſo compreſſed and bruiſed by the hardneſs of the Mothers bones, which form the Paſſage.
The weak Woman ſhould be ſtrengthened, the better to ſupport her Pains, giving her good jelly Broths, with a little Wine and a Toſt in it, or other good things as the caſe requires.
If ſhe fears the Pains, let her be comforted, aſſuring her, that ſhe will not endure many more, but be ſpeedily delivered: On the contrary, if her Pains be ſlow and ſmall, or none at all, they muſt be provoked by frequent Clyſters a little ſtrong, that ſo they may be excited by the needings at Stool, and afterwards let her walk about her Chamber, that the weight of the Child may alſo help a little. If the Woman floods, or hath Convulſions,197 (which is by many too long neglected) ſhe muſt be helped by a ſpeedy Delivery, as we have already declared, and ſhall repeat hereafter in its proper place. If ſhe be coſtive, let her uſe Clyſters, which likewiſe may diſſipate a Cholick, at thoſe times very troubleſome, cauſing great and uſeleſs Pains, very hurtful, becauſe they fleet to and again through the Belly, without bearing down, as they ſhould do. If ſhe cannot make water, becauſe the Womb bears too much on the Bladder, let her try, by lifting up her Belly a little, or elſe by introducing a Catheter into her Bladder, draw forth her Urine.
If the difficulty or ſlowneſs of the Labour comes from the ill Poſture of the Woman, let her be placed in a better, more convenient to her Habit and Stature, obſerving the circumſtances given in the Firſt Chapter of this Second Book. If ſhe be taken with any diſtemper, ſhe muſt be treated for it according to its nature, with more caution than at another time, having alwaies regard to her preſent condition. If it proceed only from the indiſpoſitions of the Womb, either from its oblique ſcituation, it muſt be remedied as well as can be, by the placing of her Body accordingly. If it be by its vitious conformation, having the Neck too hard, and too callous, and too ſtrait, it muſt be anointed with Oyls and Ointments, as above directed.
If it come from a ſtrong Cicatrice, which cannot be mollified, of a preceding Ulcer, or a Rupture of a former bad Labour ſo agglutinated, it muſt be ſeparated with a fit Inſtrument, leſt another Laceration happen in a new place, and leave198 the Woman in a worſe condition than before; it muſt be made in that place where the caſe moſt requires it; taking care that it be not upwards, becauſe of the Bladder. If the Membranes be ſo ſtrong, as that the Waters do not break in due time, they may be broken with the Fingers,**Let the Midwife be firſt well aſſured. provided the Child be come very forward into the Paſſage, and ready to follow preſently after; for otherwiſe there is danger, that by breaking theſe Waters too ſoon, the Child will remain dry a long time; and to ſupply that defect, you muſt moiſten the parts with Fomentations, Decoctions and Emollient Oyls; which can never be ſo well, as when Nature doth its own work with the Waters and ordinary Slime, which alwaies happen well when they come in time and place.
Sometimes theſe Membranes with the Waters preſs three or four Fingers breadth out of the body before the Child, reſembling a Bladder full of Water; there is then no great danger to break them, if they be not already: for when it ſo happens, the Child is alwaies ready to follow being in the Paſſage: but above all be careful not to pull it with your Hand, leſt thereby you looſen, before its time, the After-burthen, to which it adheres very ſtrongly. If the Navel-ſtring comes firſt, it muſt be preſently put up again, and kept up if poſſible, or elſe the Woman muſt be immediately delivered: But if the After-burthen comes firſt, it muſt never be put up again; for being come forth, it is altogether uſeleſs to the Infant, and would be but an obſtacle and hinderance in the way; if it were put199 up in this Caſe, it muſt be cut off, having tyed the Navel-ſtring, and afterwards draw forth the Child aſſoon as may be, leſt that he be ſuffocated.
If the Woman hath fallen, or is hurt, let her immediately keep her Bed and take her reſt: If it be any Paſſion that retards the Labour, and cannot totally be overcome, let them endeavour to moderate it: If it be Shamefaſtneſs or Modeſty, the perſons who are the cauſe of it muſt quit the Chamber; and if timidity and fear of Pain, ſhe muſt be adviſed, that it is the will of God it ſhould be ſo, and that her Labour will not be ſo bad as ſhe imagines, perſwading her to ſubmit to the neceſſity, by the conſolation of the unfortunate, whoſe pain ſeems always more ſupportable by the conſideration that it is common; ſo ſhe muſt be informed that others endure the ſame Pain, and greater than hers: if ſhe be melancholy, let her be diverted by ſome good news, promiſing her ſuch a Child as ſhe deſires; and in a word (though ſhe ſuffer much) ſhe muſt conſider it but as a bad journey, which one quarter of an hour of good Weather makes one forget all paſt, as ſhe will, when ſhe is brougt to bed, aſſuring her chiefly that ſhe is in no danger, eſpecially when it is not very apparent, for then one ought to acquaint her with it, that ſhe may ſettle both her temporal and ſpiritual affairs.
When the difficulty is only cauſed by a dead Child, the method mentioned in the natural Labour muſt be obſerved; and beſides, the Woman muſt do all ſhe can to further her Delivery, becauſe the Child can do nothing, nor can it when it is very weak: She muſt take the while ſome Comfortatives to prevent fainting, becauſe of the200 putrid vapours aſcending from the dead Child; but when it hath ſo great a Dropſy, either in the Head or Belly, as that it cannot be born, becauſe of the great diſtenſion and bigneſs of theſe parts, then we are obliged to open theſe parts to let out the Water: And if it be of ſuch enormons bigneſs, either Head or Body, or that it have two Heads, or is joined to another Child, or to a big Mole, there is a neceſſity for to ſave the Mother, either to dilate the paſſage proportionable to the bigneſs of the monſtrous Child (if it be poſſible) or elſe, which is better, to draw forth the Child by pieces, to prevent the Mothers periſhing together with the Child, which elſe would certainly happen, if this courſe be not taken: And if there be two Children, the Rules given in the Eighth Chapter of this Second Book muſt be obſerved. But if the Midwife cannot remedy all theſe accidents, ſhe muſt then readily ſend for*By all which may be learnt, That if the Midwife cannot lay the Woman aſſoon as, or ſoon after the Water is broke, ſhe ought in time to ſend for advice and help. an expert Chirurgeon for his advice, or to do what he thinks fit. Let us now paſs to Labours contrary to Nature, which can never be done without Manual Operation, and ſhow what is then to be done.
THoſe Labours which abſolutely require Manual Operation are, when the Child comes wrong. Hippocrates in his Book, De Naturâ Pueri, and in that De Superfoetatione, admits but of three general ways for a Child to be born; to wit, with the Head firſt, which is the ſole**For if any part but the Crown, ſo that the Body follow not in a ſtrait line, 'tis a wrong & difficult Birth, though the Head preſents firſt. natural Figure, when it comes right; the ſecond with the Feet; and the third with the Side or acroſs: which two laſt are quite contrary to Nature. But to make it more plain, we ſay, That a Child may come wrong four ſeveral general waies, which are; Firſt, any of the fore-parts of the Body. Secondly, any of the hinder-parts. Thirdly, either ſide. And Fourthly, the Feet. Now juſt as there are four Cardinal points, to which all the reſt of the thirty two Winds may be reduced on the Compaſs, and to one of the four more than to the other, according as they participate of more or leſs of that Point: ſo likewiſe all the particular and different wrong Poſtures, that a Child may preſent,202 can be reduced to the abovenamed four general waies, according as they approach more to the one than the other of them. And as the number of the ſeveral wrong Births is very great, we will be contented only to treat particularly of each of the principal of them; becauſe if one be well informed of theſe, they may eaſily remedy the reſt, which are of no great conſequence: but before we mention the means how, it will be convenient to ſhew what conditions are requiſite in a**Phyſician or any elſe that practiſeth this art. Chirurgeon, that would apply himſelf to this Operation, and the obſervations he ought to make before he undertakes it.
Theſe conditions either reſpect his Body or his Mind; in reſpect of his perſon, he muſt be healthful, ſtrong and robuſt; becauſe this is the moſt laborious and painful of all the operations of Chirurgery; for it will make one ſometimes ſweat, that he ſhall not have a dry thread, though it were the coldeſt day in Winter, becauſe of the great pains and difficulty he ordinarily meets with, as Fabricius of Aquapendente teſtifies; confeſſing that he hath often been ſo weary and tired, as that he hath been forced to leave the work for his men to finiſh. He ought to be well ſhaped, at leaſt to outward appearance; but above all, to have ſmall hands, for the eaſier introduction of them into the Womb when neceſſary; yet ſtrong, with the Fingers long, eſpecially the Forefinger, the better to reach and touch the inner Orifice: He muſt have no Rings on his Fingers, and his Nails well pared, when he goeth about the work, for fear of hurting203 the Womb: He ought to have a pleaſant countenance, and to be as neat in his clothes as in his perſon, that the poor Women who have need of him, be not affrighted at him. Some are of opinion that a Practitioner of this Art ought on the contrary to be ſlovenly, at leaſt very careleſs, wearing a threat Beard, to prevent the occaſion of the Husbands jealouſy that ſends for him. Truely ſome believe this policy augments their practice, but 'tis fit they ſhould be diſabuſed; for ſuch a Poſture and Dreſs reſembles more a Butcher than a Chirurgeon, whom the Woman apprehends already too much, that he needs not ſuch a Diſguiſe: above all, he muſt be ſober, no Tipler, that ſo he may at all times have his wits about him; he muſt be diſcreet, modeſt, and ſecret, never diſcovering to ſtrangers thoſe incommodities and diſeaſes of Women which come to his knowledge; He muſt be ſage, prudent, and judicious, to conduct him alwayes in his Operations, with good reaſon: He muſt be pittiful, yet not ſo as to diſtract or hinder him from his duty, when the caſe requires; as alſo ſo patient, as not to precipitate any thing, but taking time ſufficient to conſider what is fit to be done. He muſt not be angry with the poor Woman, though ſhe exclaims againſt him, or the other Women during the Operation; for the Pains of the one, and the compaſſion of the reſt, oblige them to it without other cauſe. He ſhould be a good Chriſtian, of a well regulated Conſcience, and do his beſt endeavour to bring the Children*And therefore undertake what he can ſafely perform; and what he cannot, leave to others that may, for life is not to be played with. alive:204 He muſt deliver poor Women gratis, and treat them as tenderly and with as much humanity as the Rich, extorting nothing from them, but be content with reaſonable ſatisfaction, as they are willing and able to give, and not uſe them like a Turk or Arab, as ſome do, who aſſoon as they have done their work, whether well or ill, will be paid without delay, and that with ſo much ill manners and importunity, that they force the poor people preſently to borrow the money, when they have not enough to ſatisfie their deſires, and take from them to the laſt Penny, to ſatisfie their tyrannical avarice: which proceedings are very unworthy an honeſt man.
In fine, a Chirurgeon indued with all theſe good qualities muſt be for his accompliſhment and intire perfection, very knowing and expert in his Art, and chiefly in theſe Operations.
There are many who believe it an eaſie matter to deliver a Woman, becauſe Women uſually practiſe it. In effect, there is no great myſtery, when all things come right and well: But when they come wrong and contrary to Nature, it is moſt certain that it is the moſt difficult and laborious of all Chirurgical Operations, as is well known to ſuch as practiſe it. It is very good to conſider the conſequences of it; for in all others, for which recourſe is had to a Chirurgeon, the ſingle life of the Patient only is under his care; but in Deliveries, there is the Mothers, and one Childs life at leaſt, and ſometimes more at ſtake: And it hath been often ſeen, that one ſingle fault in this Operation hath cauſed many diſorders at one time; ſo that one may ſay very juſtly touching delivering of205 Women in wrong Labours, Hoc opus, hic labor eſt.
Now the Chirurgeon qualified as aboveſaid, who is only fit for the work (to behave himſelf as he ought) muſt make ſome Obſervations before he undertakes it; firſt, whether the Woman hath ſtrength enough to endure the Operation, which he may gueſs by the Pulſe, if ſtrong or weak, unequal or intermittent: Whether her Face and chiefly her Eyes be dejected, her Speech faint, the extremities of her Body cold; Whether ſhe often faints away with cold Sweats, hath Convulſions with loſs of ſence; in ſhort, If every circumſtance perſwades that the Operation would be in vain, 'tis better to let it alone, than ſhe ſhould dye under his hand, and he be blamed for it, and incur the name of Butcher, as is moſt certain when ſuch a misfortune happens: however if there be any hope, though never ſo little, either for Mother or Child, we are obliged in Conſcience to do what Art commands, and not as ſome Politicians, who will rather ſuffer a poor Woman to dye without aſſiſtance, than undertake a doubtful Operation. Wherefore 'tis better to attempt an Operation of an incertain conſequence, than to abandon the Sick to a certain deſpair,**A ſufficient juſtification for conſcientious Practiſers, againſt the malignant tongues of the ignorant. for ſometimes Nature recovers beyond hope; but before the Chirurgeon undertakes it, let him give his Prognoſtick of the great danger of death, both Woman and Child is in, which he muſt acquaint the Husband and Friends with, and the Woman her ſelf, if he thinks that ſhe is able to bear it, that ſo ſhe may06 receive the Sacrament before the Operation, leſt ſhe be not capable of it afterwards; becauſe of the laboriouſneſs of the Operation, in which ſhe may poſſibly dye; as it hath ſometimes happened; but when the Woman hath ſtrength enough, the Chirurgeon muſt not delay his help, for fear it abate, or be totally diſſipated. To which purpoſe, being well aſſured of her ſtrength, he muſt enquire of the Woman, her Midwife and Friends, Whether ſhe be at her full time; or hath received any hurt, which he may alſo perceive by the Signs, obſerving in what poſture the Child preſents, & what circumſtances, Whether alive or dead; and but one or more? all which being examined, he muſt try to perſwade the Woman of the impoſſibility of her being delivered without his help; and to reſolve to put her ſelf into his hands, which he may do by fair words without frighting of her, perſwading her that the Operation is nothing ſo painful as ſhe may imagine, and in fine that for Gods ſake, her own, and the Childs, ſhe is obliged to ſuffer it, for elſe ſhe and her Child may both periſh
The Woman being thus reſolved, he muſt place her croſs the Bed, that he may operate the eaſier, ſhe muſt lie on her Back, with her Hips raiſed a little higher than her Head, or at leaſt the Body equally placed, when it is neceſſary to put back or turn the Infant, to give it a better poſture; but if he reſolves to draw it forth, he muſt place the Woman ſo as we have directed in the natural Labour, which is with her Head and Breaſt a little elevated above the reſt of her Body, that ſhe may fetch her breath with more facility, and help to the excluſion of the Infant by bearing down, when the207 Chirurgeon bids her. Being thus ſcituated, ſhe muſt fold her Legs ſo as her Heels be towards her Buttocks, and her Thighs ſpread, and held ſo by a couple of ſtrong perſons. There muſt be likewiſe others to ſupport her under her Arms, that her Body may not ſlide down, when the Child is drawn forth, for which ſometimes a great ſtrength is required; the Sheet and Blankets muſt cover her Thighs for decency ſake, in reſpect of the Aſſiſtants, and alſo to prevent her catching cold, the Chirurgeon herein governing himſelf as well with reſpect to his own convenience, the facility and ſurety of his Operation, as to theſe things.
Some would have the Woman bound in this poſture, that (as they ſay) ſhe being more firm and ſtable, the work may be done with greater certainty: but ſuch Ligatures are ſo far from that, that on the contrary they are very prejudicial; for the Woman being ſo fixed, and conſtrained as on a Rack, ſhe cannot raiſe her ſelf, nor ſlide down, or be lifted up, when the Chirurgeon finds occaſion for it, to render his Operation leſs difficult, which uſually he doth by partly putting back, partly drawing forth, ſometimes directly, ſometimes obliquely, for which reaſon her Body ought to be at liberty, only held in a poſture convenient to theſe ſeveral intentions by her Friends, according to his directions: but if ſhe muſt needs be bound, let it be with good reaſons to perſwade her patiently to endure her Labour, and to contribute her whole ſtrength to the Operation, promiſing her the ſpeedieſt Delivery poſſible.
Let the Chirurgeon then anoint the entrance of the Womb with Oyl or freſh Butter, if it be neceſſary,208 that ſo he may with more eaſe introduce his hand, which muſt likewiſe be anointed, having the conditions above ſpecified: after which he muſt manage his Operations after the manner I ſhall direct in each of the following Chapters, having firſt recited the marks by which may be known whether the Child be alive or dead.
IF there be any Caſe, wherein a Chirurgeon ought to make the greateſt reflection, and uſe moſt precaution in his Art, it is this,**This is not ſo neceſſary to thoſe Practitioners which can fetch a Child coming right, or with the arm, without hooks or ſharp inſtruments, as the Tranſlator of this Book and his Father and Brother can. to know whether the Infant in the Womb be alive or dead; for there have been many deplorable examples of Children being drawn forth alive, after they have been thought to be dead, with both Arms or ſome other Limb lopt off, and others miſerably killed by the uſe of Crochets, which might have been born alive, if they had not been miſtaken. Wherefore before he reſolves on the manner of laying the Woman, to avoid the like misfortune, and the diſgrace of being author209 of ſuch a pittiful ſpectacle, let him do his utmoſt endeavour not to be ſo deceived, and to be fully ſatisfied, whether the Child be alive or dead; alwaies remembring that in this caſe timidity is more pardonable than temerity; that is, it is better to be deceived in treating a dead Infant, as if it were alive; than a living one, as if it were dead.
The Child may be known to be alive, if it be at the full reckoning; if the Woman hath received no hurt; if ſhe hath had her health well all her going with Child; if ſhe be at that preſent in good health, and very ſure if ſhe feels it ſtir, which may be known by the Mothers relation: and the Chirurgeon may be better aſſured of it, if he feels it ſtir himſelf, laying his Hand on the Mothers Belly, to whoſe relation he muſt not alwaies truſt; for I have ſometimes delivered Women, whoſe Children had been dead above four days (as may eaſily be judged by their corruption) who notwithſtanding affirmed (although untruly) that they felt them ſtir but a little before they were delivered; and others again, who were alive, yet they never perceived them to ſtir in three or four days before, as they confeſſed. If the Chirurgeon cannot be aſſured by the Infants motion that it is alive, he may, aſſoon as the Waters are broke, gently put up his hand into the Womb, to feel the pulſation of the Navel-ſtring, which he will find ſtronger the nearer he feels it to the Infants Belly; or if he meets with a Hand, he may feel the Pulſe, but their Pulſation is not ſo ſtrong as the Navelſtrings, by which it is beſt to be known: if then he finds thus the beating of the210 Pulſe, he may be confident the Child is alive; as alſo if by putting his Finger into its Mouth, he perceives it to ſtir its Tongue, as if it would ſuck.
But on the contrary the Child is dead, if it hath not a long time ſtirred; if there flowes from the Womb ſtinking and cadaverous humours; if the Woman feels great pains, and a great weight in her Belly; if it be not ſupported, but tumbles alwaies on that ſide as ſhe layes her ſelf: if ſhe ſaints**Not alwaies a ſign. or hath Convuſions; if the Navel-ſtring or Secondine hath been a good while in the world; or if by putting his Hand into the Womb, he finds the Child cold, and the Navel-ſtring without Pulſe, and its Tongue immoveable; and feeling the Head he finds it very ſoft, chiefly towards the Crown, where likewiſe the Bones are open, and riding the one upon the other at the Sutures, becauſe the Brains ſhrink, and are without Pulſe when the Child is dead; which corrupts more in two days in the Womb than it doth in four after it is born; which the Heat and Moiſtneſs of the place cauſeth, the two principles of Corruption.
But one may only conjecture it, if the Woman hath been hurt, or floods much, & be not at her full time; if her Waters broke four or five days before; if her Breaſts flag; if her Complexion be of a lead colour, her Countenance languiſhing and dejected, and if her Breath ſtinks. We ſay that theſe things may only make us conjecture it, but not, as the reſt, certainly conclude it; many of which happening together in one perſon, aſſures us that the Child is dead, for want of which it cannot be very certain;211 wherefore (as I have ſaid) 'tis good to be very careful before they undertake it, that ſo they may avoid the aboveſaid ſcandals.
WE have placed the preſent way of extracting the Afterbirth amongſt unnatural Deliveries, becauſe 'tis not ſufficient to eſteem it a good Labour, that the Child be well born, unleſs alſo the Afterbirth be well come away. In reſpect of the Child it may be called natural; becauſe after his Birth, it hath no more need of the Burthen: but in reſpect of the Woman, it is very unnatural. I would therefore firſt treat of this bad Labour; becauſe it participates of a natural Labour in reſpect of the Child, who is in no danger being born. After that I will come to thoſe in which both Mother and Child are in very great danger, if not ſpeedily and skillfully helped.
I have already ſhewed in the Ninth Chapter of this Book, how a Woman muſt be delivered in a natural Labour, where you may find the means; but ſometimes the Midwife by endeavouring it, breaks the String with pulling too ſtrongly, or becauſe it is very weak; or elſe ſo putrified when the Child is dead, that the leaſt pull breaks it off cloſe at the Burthen, which by that means is left behind212 in the Womb, or becauſe it cleaves too ſtrongly, or the Woman is weak and cannot expel it, being much tired by a long Labour; or becauſe it was not ſpeedily after Labour drawn forth, the Womb cloſeth ſo, as leaves it no paſſage, nor can it without much difficulty be again dilated to have it fetch'd, becauſe it remains dry, after the natural ſlime and humidities, which uſually flow in Labours, are ſometimes paſt.
Since it is a verity indubitable, that the Afterbirth remaining behind after the Child is born, becomes an uſeleſs Corps, capable of deſtroying the Woman, we muſt take care that it be never left, if poſſible. Wherefore having endeavoured to bring it away, as we have directed in the aforenamed Chapter, and the Navel-ſtring happen to break near the Burthen, you muſt immediately, before the Womb cloſeth, introduce your Hand into it, being well anointed with Oyl or freſh Butter, your Nails cloſe pared, for to ſeparate it from the Womb gently, and draw it forth together with the Clods of Blood that are there. When the Navel-ſtring is not broken, it will eaſily conduct the Hand by following of it to the place, where the Burthen is ſcituated; but when it is broken, we have no longer this guide, wherefore you muſt be then very careful, that you be not deceived in taking one part for another; as I once ſaw a Midwife pull the Womb near the inward Orifice, inſtead of the Burthen which was behind: but when ſhe perceived all her endeavours vain, except it were to make the poor Woman to ſuffer extremely, ſhe yeelded her up to me, confeſſing her incapacity, although ſhe213 had vaunted*It ſeems Midwives in other Countries, as well as ſome in England, have that dangerous vanity. before, that ſhe was more capable in her Art than any Chirurgeon.
Aſſoon then as you have introduced your Hand into the Womb towards its Fund, or bottom, you will find the Burthen; which you may know by a great number of little inequalities, which are always made there by the roots of the Umbilical Veſſels, on the ſide where they terminate, which makes it to be eaſily diſtinguiſhed from the Womb; if it yet cleave to it, notwithſtanding that it is then a little wrinkled and uneven; becauſe its Membranes, which were very much enlarged, contract themſelves immediatly after the Child and its Waters which kept them extended, are excluded:**Be careful of thoſe that are not. but they that are expert in this Art can eaſily judge of it. If you find the Burthen wholly looſened from the Womb, it will not be difficult to draw it forth, when you have got it in your Hand: but if it cleaves, finding the ſide where it ſticks leaſt, begin there to ſeparate it gently, by putting ſome of your Fingers between it and the Womb, continuing by little and little to do ſo, till it be quite looſe, and afterwards to draw it forth very carefully; obſerving the whilſt (if it cannot be otherwiſe) rather to leave ſome part of it behind, than to ſcrape or ſcratch the leaſt part of the Womb, for fear of a flooding, inflammation, or Gangrene, which cauſe death:214 being alſo careful not to draw it forth till it be wholly or the moſt part of it ſeparated, for fear of drawing forth the Womb with it, and preſerving it as whole as theſe reflections will permit, becauſe of ſhewing it to the company, that they know the Operation is well done.
When the Chirurgeon finds not the Womb open enough for to direct his hand immediatly into it, let him**Danger in delays. preſently anoint all the Womans Privities with Hogs-greaſe, that they may be dilated with more eaſe, afterwards let him by little and little put up his Hand, but without much violence: the Woman may likewiſe contribute to this dilatation, as alſo to the excluſion of the Burthen, if ſhe bears ſtrongly down, holding her Breath, and exciting her ſelf to vomit, or ſneeze, and do thoſe other things directed in the above mentioned Chapter; but if notwithſtanding all this ſhe cannot void the Afterbirth, and if the Womb cannot be dilated enough to fetch it, or that it cleaves ſo faſt, as it cannot be ſeparated, then to avoid a greater miſchief, we muſt leave it to Nature, aſſiſting her with remedies, which ſuppurates; wherefore Injections into the Womb are proper, made of Mallows, Marſh-mallows, Pellitory, and Linſeed, in which is mixed a good quantity of Oyl of Lillies, or freſh Butter. This injection ſoftens and tempers, and by moiſtning and mollifying, makes the Orifice to be the eaſier dilated, and helps by Suppuration the looſenings of the Burthen. And to haſten the expulſion of it, give her a ſtrong Clyſter, that ſo, by the motions to go to Stool, it215 may cauſe it to be voided, as it hath arrived to many, that have rendered it in the Bed-pan, and ſometimes when they have leaſt expected it.
One may at the ſame time, to prevent a Fever and many other accidents which uſually happen, bleed her in the Arm, or Foot, according as it may be neceſſary and convenient, and ſtrengthen her, that the Foetus and cadaverous Vapours, coming from the putrifaction of the Burthen, aſcend not to the Noble parts, which may be done by good Cordials often uſed, not ſuch as are made of Theriacle, Mithridate, or the like, for which no reaſon can be given, but their ſpecifick or rather imaginary Faculties, and are fitter to cauſe Vomiting than comfort the Heart: but true Cordials are ſuch as yeeld good nouriſhment, and at the ſame time comfort the Stomach, without nauſeating it, as thoſe Drugs do which are only good for them that ſell them.
Wherefore let her have good Broaths and Gellies; ſhe may drink Limonade or Orengade, or have in her Ptiſan Syrup of Limons or Pomgranats, or from time to time (if ſhe be weak and free from a Fever) a little Wine and Water mixed, which we ſay is the beſt, (in ſome caſes, but not alwaies) and moſt natural of all Cordials; beſides other Remedies may be provided, according to the accidents which happen, by reaſon of the ſtaying behind of the Burthen, always endeavouring to bring it away aſſoon as poſſible, for as long as it ſtays in the Womb, the Woman feels continually great Pains, almoſt like to them before her Child was born, although there remained but a ſmall piece of it, and until the whole be voided, the216 Pains will ſtill be repeated, although in vain, unleſs the matter be well diſpoſed before; but the leſſer the piece is of the Burthen retained, the more difficult it is ſometimes to be expelled; becauſe the impulſes, which the Woman can make by helping her Throwes, are not ſo great, when the matter contained in the Womb is ſmall, as when it is of a conſiderable bigneſs; for then it is more ſtrongly thruſt and compreſſed: which is the reaſon why a Woman miſcarries with greater difficulty, than when brought to Bed at her full time.
There are many Midwives, who having broken the Navel-ſtring, as**This may happen to a good Midwife, but the fault is when they do not diſcover it, that ſeaſonable help may be applied. aboveſaid, leave their work imperfect, and commit the reſt to Natures work; but very often the poor Woman dies, becauſe of the great miſchiefs which happen uſually before the ſuppuration of the Burthen ſo retained: To avoid which, aſſoon as they meet with the like caſe, they muſt endeavour to fetch it, according as we have directed; or if they find themſelves not capable to do it, becauſe the Hand muſt be put up into the Womb, which is more properly the work of a Chirurgeon expert in thoſe caſes, let them preſently ſend for one, that ſo he may be yet able, before the Womb cloſeth, to introduce his hand; for the longer it is deferred, the more difficult will be the work.
There are other Midwives bold enough to undertake this Operation, but for want of induſtry or neceſſary knowledg they cannot effect it, and217 leave the Woman oftentimes in a worſe condition than if they had never medled with it; as happened about a year or little more ſince to a poor Woman in the Fauxbourgh S•. Marcel, whom I helped three days after ſhe was delivered; being half gone, by a Midwife of the ſame Fauxbourgh, at the deſire of Mr. Beſſier a Chirurgeon and my good Friend, who conducted and accompanied me to her, where I found her in continual pain all over her Belly, which held her like throws of another Travail, voiding black humours extremely ſtinking and offenſive, with which ſhe had alſo a great pain in her Head, and a Fever, which in a ſhort time would without doubt have augmented, if I had not preſently fetched what remained: wherefore having enquired of the perſons preſent in her Chamber, how ſhe was delivered, and when; they told me not yet three whole days, but that the Midwife not being able to fetch all, did only bring away ſome ſmall pieces of the Burthen, & told them,**An excuſe of ſome of our Midwives. that they need not be troubled at what remained, perſwading them alwaies that it would come away of it ſelf, and that nothing more was to be done but patience. Truly ſhe was not ſo much to be blamed, for not having delivered this Woman, as ſhe was in not acquainting her that ſhe needed more help, when ſhe found that it was beyond her skill.
After this information, having put up two of my Fingers into the Vagina, to underſtand the preſent eſtate of things, I found the inward orifice of her Womb almoſt quite cloſed, into which however I got my Fore-finger, where by moving it to218 and again without taking it away, by little and little I dilated her Orifice, ſo as to introduce another Finger, with which two alone, being not able to get in the reſt, I brought away three pieces of the Afterbirth, of the bigneſs of a Walnut, which were left behind, taking them one after the other with my two fingers, as Crabs do when they gripe any thing with one of their forked Claws; by which means in a ſmall time I delivered this Woman quite, who immediatly after felt no more pain, and recovered ſoon after: but otherwiſe ſhe had certainly been in danger of her life, becauſe of the great corruption of what was left behind in the Womb: for that which I fetcht away, ſmelt ſo ill, that my Hands ſtank of it above two days after, although I waſhed them three or four times with Vinegar.
This Chapter may ſuffice to ſhow how one ſhould behave himſelf in this Caſe. We will now teach what is fit to be done in each of the other Labours againſt Nature.
Now ſince he is obliged very often, becauſe of theſe ill ſcituations, to draw the Children forth by the Feet; I am therefore reſolved, before I ſpeak of the reſt, (to moſt of which that muſt be a guide) to ſhow how a Child muſt be brought forth, which comes either with one or both Feet firſt.
Moſt Authors adviſe in this caſe to change the Figure, and place the Head ſo, as it may preſent firſt to the Birth; but if they would ſhow, how it ſhould be done, we might follow their counſel, which is very difficult, if not altogether impoſſible to be performed, if we deſire to avoid the dangers that by ſuch violent endeavors the Mother and Child muſt neceſſarily be put in; wherefore 'tis better to draw it forth by the Feet, when it comes Footling, than to venture a worſe accident by turning it.
**That is, aſſoon as the Waters are broke.Aſſoon then as 'tis known the Child comes thus, and the Womb is open enough to admit the Chirurgeons hand into it, or elſe by anointing the Paſſages with Oyl or Hogs greaſe, to endeavour to dilate it by little and little, uſing to this purpoſe his Fingers, ſpreading them one from the other after they are together entred, and continuing ſo to do, 'till it be ſufficiently dilated; then, having his Nails well pared, and no Rings on his Fingers, his Hands well anointed with Oyl or freſh Butter, as alſo the Woman placed after the manner as we have already often directed, let him gently introduce his Hand into the entry of the Womb, where finding the Childs220 Feet, let him draw it forth in that poſture we ſhall now direct: but if it preſents but one Foot, he ſhould conſider, whether the right or left, and in what faſhion it comes; for theſe reflexions will eaſily inform him, on what ſide the other may be; which aſſoon as he knows, let him ſeek it, and gently draw it forth together with the firſt, but let him alſo be very careful that this ſecond be not the Foot of another Child; for if ſo, he may ſooner ſplit both Mother and Children then draw them forth; which may eaſily be prevented, if having ſlid his hand up the firſt Leg and Thigh to the Twiſt, he finds both Thighs joined together, and depending from one and the ſame Body; which is likewiſe the beſt means to find the other Foot, when it comes but with one.
All Authors, for fear of loſing hold of the firſt Foot, adviſe to faſten a Ribban to it with a running knot, that ſo it may not be ſought a ſecond time, when the other is found: but that is not abſolutely neceſſary, becauſe uſually when one hath hold of one,**Not alwaies. the other is not far off: they that will may uſe this precaution; but ſuch as are expert, uſe it but ſeldom.
Aſſoon then as the Chirurgeon hath found both the Childs feet, he may draw them forth; holding them together, he may bring them by little and little in this manner, taking afterwards hold of the Legs and Thighs aſſoon as he can come at them; and drawing them ſo till the Hips be come forth: the whilſt let him obſerve to wrap the parts in a ſingle Napkin, to the end that his Hands, being already greaſy, ſlide not on the Infants body,221 which is very ſlippery, becauſe of the viſcous humours, which are all over it, and hinder that one cannot take good hold of it, which being done, he may take hold under the Hips to draw it ſo forth, to the beginning of the Breaſt, and then let him on both ſides with his hand bring down the Arms along the Childs body, which he may then eaſily find, and be careful that the Belly and Face be downwards, leſt being upwards, the Head be ſtopt by the Chin over the Share-bone; wherefore if it be not ſo, he muſt turn it to that Poſture; which is eaſily done, if taking hold on the body, when the Breaſt and Arms are forth in the manner we have ſaid, he draws it, with turning it in proportion, on that ſide which it moſt inclines to, till it be as it ſhould be, that is, with the Face downwards, and having brought it to the Shoulders, let him loſe no time, (deſiring the Woman at the ſame time to bear down) that ſo in drawing, the Head at that inſtant may take its place, and not be ſtopt in the paſſage. Some Authors, to prevent this inconvenience, adviſe that one Arm only ſhould be drawn forth, and the other left to prevent the cloſing of the Womb on the Neck of the Child: this reaſon is plauſible, yet if the Chirurgeon knows how to catch his opportunity, he will not need this ſhift to prevent this accident, which may ſooner happen when one Arm is left above; for beſides that by its bigneſs it would take up ſo much place, which is already too little, cauſing the Head to lean more on one ſide than the other, it will ſtop it certainly on that ſide where there is no Arm; and when I have ſometimes tryed to deliver a Woman, leaving one of the Arms above with the Head, I could not222 till I fetched both Arms, and then I finiſhed my operation with more eaſe.
There are indeed ſome Children that have their Head ſo big, that when the whole Body is born, yet that ſtops in the Paſſage, notwithſtanding all the care to prevent it: in this caſe he muſt not endeavour only to draw forth the Child by the ſhoulders, leſt he ſometimes ſeparates the Body from the Head, but he muſt diſengage it, by little and little, from the bones in the Paſſage with the fingers of each Hand, ſliding them on each ſide oppoſite the one to the other, ſometimes above and ſometimes under, until the work be ended, endeavouring to diſpatch it aſſoon as poſſible, leſt the Child be ſuffocated; as it will certainly be, if he ſhould remain long in that Poſture, which being well and duly effected, he may ſoon after fetch the After-birth as above directed.
NOtwithſtanding all the care poſſible had in the fetching a Child by the Feet, yet ſometimes one meets them ſo putrified and corrupted, that with the leaſt pull the Body ſeparates from the Head, which remains alone in the Womb, and cannot be extracted but with much difficulty, foraſmuch as it is extremely ſlippery, by reaſon of the place where it is, and of a round Figure, on which no hold can be taken. The difficulty uſually met with upon the like occaſion hath been ſo great, that ſometimes two or three Chirurgeons one after the223 other have forſaken the Operation, not being able to accompliſh it, after all their induſtry in vain employed, together with their ſtrength, ſo that neceſſarily the death of the Woman enſued: but I am of opinion they had eſcaped this misfortune, if they had done what I ſhall now direct.
When then the Infants Head, ſeparated from its Body, remains alone behind, whether becauſe of putrifaction or otherwiſe, let the Chirurgeon immediatly without delay, whilſt the Womb is yet open, direct up his right Hand to find the Mouth of this Head (for there is then no other hold) and having found it, let him put one or two of his Fingers into it, and his Thumb under the Chin, and then by little and little let him draw it, holding it ſo by the Jaw; but if that fails, as it often will when putrified, then let him pull forth his right Hand and ſlide up his left, with which he muſt ſupport the Head, and with the right let him take a narrow Crochet, but ſtrong and with a ſingle branch, which he muſt guide along the inſide of his other Hand, keeping the point of it towards it, for fear of hurting the Womb, and having thus introduced it, let him turn it towards the Head, for to ſtrike it into either an Eye-hole or the hole of an Ear, or behind the Head, or els between the Sutures, as he finds it moſt eaſie and convenient, and then draw forth the Head ſo faſtened with the Crochet, ſtill helping to conduct it with his left Hand, but when he hath brought it near the Paſſage, being ſtrongly faſtened to the Crochet, (as is already directed in one of the mentioned places) let him remember to draw forth his Hand, that the Paſſage being not filled with it may be the larger224 and eaſier, keeping ſtill a Finger or two on the ſide of the Head, the better to diſengage it.
You may try for the ſame purpoſe an**Doubtful expedient. expedient (which appears to me very ingenious) and (thinking on this ſubject) came lately into my mind, by which, without doubt, one may effect this painful and laborious Operation, without tormenting the Woman ſo much as ſhe is, when either the Crochet or crooked Knife are uſed; which is a ſoft Fillet, or linnen ſlip, of the breadth of four Fingers, and the length of three quarters of an Ell or thereabouts, and taking the two ends with the left Hand, and the middle with the right, let him ſo put it up with his right, as that it may be beyond the Head to embrace it, as a ſling doth a ſtone, and afterwards drawing the fillet by the two ends together, it will eaſily be drawn forth, the fillet not hindering in the leaſt the paſſage, becauſe it takes up little or no place.
But if the Chirurgeon cannot by either of theſe different means draw forth the Head, becauſe 'tis too big, he will be neceſſitated (if he will finiſh his work) to leſſen it with a crooked knife, marked D. in the repreſentations of the inſtruments, at the end of the Second Book. For to do this, let him ſlide up his left hand into the Womb, and with his right guide up the Knife, always obſerving that the point be turned towards the inſide of the left hand, for fear of hurting the Womb, and afterwards let him turn*A dangerous Operation, not raſhly to be undertaken. it to the Sutures of the Head, and chiefly223 the Crown, where he muſt make the inciſion with this Inſtrument, that having ſeparated ſome pieces, he may the eaſier draw forth the Head, or at leaſt having emptyed ſome part of the Brain, by the Orifice ſo made, the bigneſs of the Head will be much diminiſhed by it, and conſequently the extraction of it leſs painful.
The left hand being thus in the Womb, will be very uſefull to help ſtrike the knife into the Head, for to divide and ſeparate its parts, as the Chirurgeon judges neceſſary, as alſo to hinder that by inadvertancy the Womb receive no hurt; and the right without, for to hold the handle of this inſtrument, which therefore muſt be long enough, and will ſerve him to move and guide it on which ſide he pleaſeth; in turning, thruſting, drawing, or ſlanting it as the caſe requires. Ambroſe Parè and Guillemeau would have this Knife to be ſo ſhort, as to be hid in the right Hand, for to do the Operation, after it is ſo introduced into the Womb; but it is certain, that when it is filled with a monſtrous Child, or a Head, as aboveſaid, the Chirurgeons hand will be ſo preſſed in the Womb, that it will be very difficult for him to uſe it skilfully with one Hand alone, and do no violence to the Womb; which is the reaſon why (if I may be credited) this inſtrument ought to have a long Handle, that being introduced the Womb, it may be conducted to do the Operation with the left Hand within, as we have mentioned, and governed by the right which holds the Handle of it without, which ought to be as long as the handle of an ordinary Crochet. They that will take the pains to conceive my Arguments, and try this Inſtrument when they have occaſion,224 will confeſs it to be much more uſeful and commodious, being thus long, than ſo ſhort as the ſaid Parè and Guillemeau recomend. For my part, having cauſed one to be made of that faſhion, I found it very convenient when I had the like occaſion to uſe it.
Now when the Head is thus fetcht out of the Womb, care muſt be taken, that not the leaſt part of it be left behind, as alſo to cleanſe the Woman well of her After-birth, if yet remaining. But a queſtion of great conſequence and much to the purpoſe may be here ſtarted, Whether the Childs Head yet remaining ſo in the Womb, and the Burthen alſo, the Head ought to be extracted before the Burthen; to which may be anſwered with diſtinction, that if the Burthen be wholly ſeparated from the ſides of the Womb, it ought to be firſt brought away; becauſe it may hinder the taking hold of the Head, but if it be ſtill adhering, it muſt not be medled with, till the Head be brought away; for if one ſhould then go about to ſeparate it from the Womb, it would cauſe a flooding, which would be augmented by the violence of the Operation; for the Veſſels to which it is joined, remain for the moſt part open, as long as the Womb is diſtended, which the Head cauſeth whilſt it is retained in it, and cannot cloſe till this ſtrange body be voided, and then it doth by contracting and compreſſing it ſelf together, as I have heretofore more exactly explained: beſides, the Afterbirth remaining thus cleaving to the Womb, during the Operation, prevents it from receiving eaſily either bruiſe or hurt. This inſtruction may ſuffice for this Chapter, let us paſs to the reſt.
IF we only reſpect the figure the Child comes in in this Labour, we may ſay it is natural; but when we conſider the diſpoſition of the Womb, which is in danger of coming quite forth of the Paſſage; or the extraction of the Infant, we ſhall find it not ſo altogether, for its Head thruſting it forcibly before it, may eaſily cauſe a falling out of the Womb, if the Woman be not skilfully ſuccoured in time: here may be ſeen the Vagina or neck of the Womb bear forth before in great wrinkles, according as the Child advanceth.
Women troubled with a bearing down of the Womb before they conceive, and whoſe Womb is very moiſt, are much ſubject to this accident; becauſe of the relaxation of the Ligaments. The ſame Method we have taught in the natural Travail muſt not now be obſerved; for in this caſe the Woman muſt neither walk, nor ſtand upright; but keep her Bed, with her body equally at leaſt ſcituated, and not raiſed a little, as is requiſite in a natural Labour: She muſt by no means uſe ſtrong or ſharp Clyſters, leſt they excite too great Throws, neither ſo much humect the Womb, which is already too much relaxed: but to aid her at the moment each Pain takes her, when the Child begins to advance his Head, and conſequently the226 Neck of the Womb, let the Midwife keep her hands on each ſide of the Head, to thruſt back, by reſiſting the Womans pains, the Womb only, giving way in the mean time for the Child to advance, doing the like at every Throw, continuing it till the Woman of her ſelf hath forced the Child quite into the world: for one muſt by no means draw it by the Head, as is mentioned in the natural Labour, for fear of cauſing the Womb to fall out at the ſame time, to which it is then very apt.
If notwithſtanding the Infant having the Head born, and yet ſtops there ſo long as to indanger its ſuffocation, then the Midwife muſt call a ſecond perſon to her aſſiſtance, to draw it gently forth by the Head, whilſt ſhe keeps back the Womb with both her Hands, to prevent its following the Infants body ſo drawn forth. After the Woman is thus delivered, her Afterbirth muſt be fetched as is above directed, being ſtill careful for the ſame reaſon not to ſhake or draw it forth too rudely, and then let it be placed up in its natural ſcituation, if it bears down.
THere are ſome Women, whoſe Children (notwithſtanding they come right) remain ſometimes four, five, and ſix whole days in the Paſſage, and would continue there longer, if they were left alone, without being able to be born, unleſs aſſiſted by Art; to which we are obliged, if we deſire to ſave the Mothers life: this happens ofteneſt to little Women of their firſt Children, and chiefly if a little too much in years; becauſe their Womb being very dry, cannot be ſo eaſily dilated, as others, who already have had Children, or are not ſo old. When this happens, after that the Chirurgeon hath done his endeavour to relax and dilate the parts, for to facilitate the Childs birth, and that he finds all in vain, becauſe the Head is much bigger than it ſhould be, and that beſides, it is certainly dead (as it for the moſt part is, when it hath continued four or five days in this condition, after the Waters are broke) which he may be more exactly aſſured of by the ſigns already deſcribed in the 12th Chap. of this Book,*This may be connived at when the Child is dead, but becauſe the moſt careful may ofttimes be miſtaken, it cannot be approved of, as appears in the Tranſlators Epiſtle to the Reader. he need then228 make no ſcruple to faſten a Crochet to ſome part of the Childs head, and rather about the hinder part than any other, for to draw it forth by this means directly, if poſſible; if not, let him make an inciſion with a ſtrait or little crooked Knife, which is beſt, about the Sutures, for to empty thence ſome of the Brains, and ſo leſſen the bigneſs of this Head, and immediatly after fix his Crochet faſt to the Skull in the ſame place, whereby he will eaſily extract the Infant.
It is very certain when the Child is dead, one ought to do according to my direction, to ſave the Mothers life: but it is a very great**This queſtion is out of doors, for the reaſon given in the foreſaid Epiſtle. queſtion, Whether a live Child ought to be ſo dealt with to ſave the Mothers life, after there is no more hopes that it can be born any otherwayes, becauſe of the narrowneſs of the Paſſage, which cannot poſſibly be ſufficiently dilated for its Birth; or whether one ought to defer the Operation, untill there is a perfect aſſurance that 'tis dead? In this caſe I am apt to believe, that, ſince the Infant cannot avoid death neither one way nor the other, (for ſtaying in the Paſſage, without being able to be born, it muſt dye, and being drawn forth by Crochets, it is killed) one muſt and ought fetch it out alive or dead, aſſoon as there is opportunity to do it, and when all hope is loſt that it can come any otherways, thereby to prevent the Mothers death, which could by no other means be avoided. Tertullian (as Riolanus very well notes in his 38th Chap. of the 12th Book of his Anatomical
229 Manual) ſaith upon this ſubject,That it is a neceſſary cruelty, to kill the Child in this caſe, rather than to ſave it from the danger it is in of dying, and ſo certainly cauſe the Mothers death.Notwithſtanding this muſt not alwaies be put in practice by the Chirurgeon, but in ſuch an extremity, and then he may do the work as dextrouſly as he can. For my part I had rather do this in the like occaſion, than reſolve upon that cruelty and barbarouſneſs of the Caeſarean Section, in which 'tis abſolutely impoſſible (though many Impoſtures, whom Rouſſet favours, aſſure the contrary) that a Woman ſhould ever eſcape, as I ſhall make more particularly appear hereafter, when I come to it; for by this Operation I can ſave the Mother, who would periſh with the Child: And as it is always better of two evils to chooſe the leaſt, ſo we ought always to prefer the Mothers life before the*This Chapter might be very well ſpared, if every Practitioner had the art the Tranſlator profeſſeth in his Epiſtle, of fetching a Child when it comes right, without hooks or turning it. Childs.
WHen the Child preſents the ſide of the Head, though it ſeems a natural Labour, becauſe230 the Head comes firſt, yet 'tis very dangerous both to Child and Mother, for he ſhall ſooner break his Neck, than ever be born in that faſhion; and by how much the Mothers pains continue to bear him, which is impoſſible unleſs the Head be firſt right placed, the more the Paſſages are ſtopt up.
**A good Note, for though ſome poſſibly, not unlike this Birth may in time be born, yet 'tis for the moſt part dangerous delaying it, becauſe many Children and ſome Women have been ſo loſt.Therefore aſſoon as it is known, the Woman muſt be laid with all ſpeed, leſt the Child advancing further in this vicious Poſture, it prove more difficult to thruſt him back, which muſt be done when we would place the Head right in the Paſſage, as it truly and naturally ſhould be.
For to effect this, place the Woman that her Hips be a little higher than her Head and Shoulders, cauſing her to lean a little upon the oppoſite ſide to the Childs ill poſture, then let the Chirurgeon ſlide up his Hand, well anointed with Oyl, by the ſide of the Childs head, for to bring it right, gently with his Fingers between the Head and the Womb; but if the Head be ſo engaged that it cannot be eaſily done that way, he muſt then put his Hand up to its Shoulders, that ſo by thruſting them back a little in the Womb, ſometimes on the one ſide, and ſometimes the other, as he ſees occaſion, he may give it a natural and convenient Poſition.
It were to be wiſhed that the Chirurgeon could put back the Infant by the Shoulders with both his231 Hands in this manner; but the Head doth then take up ſo much room, that he hath much ado to introduce but one, with which he muſt do his Operation, with the help of the Fingers ends of the other Hand put up as far as neceſſary, afterwards let him excite and procure the Childs birth, as directed in the natural Labour.
At other times a Child comes with the Face firſt, having its Head turned back, in which Poſture it is very difficult it ſhould be born, and if it remain ſo long, the Face will be ſo black and blew, and ſwelled, that at firſt ſight it will appear monſtrous; which comes as well by the compreſſion of it in that place, as by the Midwifes fingers handling it too rudely, when ſhe would place it in a better Poſture.
I remember about ſix years ago, in the like Caſe, a Woman whoſe Child came with the Face ſo black and miſhapen aſſoon as it was born (as uſually in ſuch caſes) that it lookt like a Blackmoor, however I delivered her of it alive: aſſoon as the Mother ſaw it, ſhe told me, that ſhe always fear'd her Child would be ſo monſtrous; becauſe when ſhe was young with Child of it, ſhe fixed her looks very much upon a Blackmoor belonging to the Duke de Guiſe, who alwaies kept ſeveral of them; wherefore ſhe wiſhed, or at leſt cared not though it dyed, rather than to behold a Child ſo disfigured, as it then appeared: But ſhe ſoon changed her mind, when I ſatisfied her that this blackneſs was only becauſe it came Faceling, and that aſſuredly in three or four days it would wear away; as it happened, having often anointed it with Oyl of ſweet Almonds by expreſſion; and232 when I ſaw the Child about a year after, me thought I had not ſeen a fairer. Now to deliver this Birth, the ſame manner, as when a Child comes with the ſide of the Head, muſt be obſerved, being careful to work gently, to avoid as much as may be the bruiſing of the Face.
THe Child comes naturally with the Head firſt, becauſe that by the hardneſs and bigneſs of it, the Paſſage might be the better made and opened for the other parts of the Body, which uſually paſs afterwards without pain: but notwithſtanding ſometimes the Head is ſo ſmall, and the Shoulders ſo large, that without a very great difficulty, they cannot paſs; which makes the Child remain often in the Paſſage after the Head is born. This accident may likewiſe happen ſomtimes, for not having been careful to loſe no time to draw forth the Child by the Head, as directed in the Diſcourſe of natural Labours, to the end the Shoulders might at the ſame inſtant ſucceed in the place the Head poſſeſt.
In the year 1660, whilſt I practiſed Midwifery in that Hoſpital, it happened that the Deputy had a Woman whoſe Child ſhe could not poſſibly bring into the world further than its Head, where it ſo remained, and ſeing ſhe could not after all her endeavours finiſh the work, ſhe called the Midwife of the place to her aid, which was then Madam de France, who likewiſe uſed her utmoſt skill, but in vain, and when they were both thus tired in234 pulling the Head (ſo as the Vertebra's of the Neck were ſeparated, and that it hung only by a little of the Skin) I came in the interim, when they deſired me to examine the buſineſs, and to find the cauſe why the Child could not be drawn forth with all their ſtrengths, which was ſufficient to have drawn forth the Shoulders, if they had been as big again as they were; which having conſidered, I immediatly conceived the difficulty to proceed from ſomething elſe: wherefore I put my hand into the Womb up to the Childs ſhoulders, which ſeemed not too big to paſs with eaſe, therefore I concluded that the hinderance was not there. After that I put my hand further up, directing it all along his Breaſt, at the bottom of which, near the griſle Xiphoïde, I found his Belly hydropical and full of Water, ſo that it was impoſſible ever to deliver the Woman, until the Water was emptied by piercing the Belly: but there wanting a fit inſtrument for the purpoſe, I immediatly ſent to advertiſe one of the Chirurgeons of the ſame Hoſpital, to whom I declared the caſe as I found it, adding withal that the Child could not be born, unleſs an orifice was made to empty the Belly: but he would by no means follow my opinion, whether it was out of policy, believing it may be, that he very well underſtood his buſineſs without needing my advice, or that he would not or could not believe the Child to be hydropical, as I informed him; wherefore he contented himſelf, without an exact examination of the caſe, to endeavour only the extraction of it after his manner; and, to effect it, he immediatly pulled and ſeparated the Head wholy from the Body, which hung235 then but by a skin; becauſe the Midwives, as I ſaid before, had pulled it with ſo much violence. Afterwards with his Crochets he pull'd away both the Arms, and ſome of the Ribs, part of the Lungs and the Heart, one piece after another for above three quarters of an hour, that he was very wet with Sweat, although it were cold weather; and having thus tired both his mind and body, he was conſtrained to quit the work, to reſt a while, leaving the Midwife to endeavour what ſhe could the whilſt, who wearied her ſelf alſo in vain, as well as he had done, by pulling ſome of the Childs Ribs with her hands only (**Though ſome here in England blindly adventure on the uſe of them, to the loſs of many lives, which cannot be approved, for the reaſon given in the Tranſlators Epiſtle to the Reader. for it is not a Midwifes work to uſe Crochets.) After this he returns the ſecond time with all his ſtrength to the work, without effecting any more, becauſe he had not yet opened the lower belly, nor the Diaphragma, nor would not, as I adviſed him every moment, without which it was abſolutely impoſſible to draw forth the reſt of the Body.
When he ſaw that his ſecond endeavors were as ineffectual as his firſt, he gave me at length his Crochet, telling me that I might weary my ſelf as well as the others, which I willingly and with joy accepted (for I was very certain I could finiſh the operation) knowing very well, that inſtead of amuſing my ſelf as they had done, about pulling of it, I ought only to pierce the Infants belly to236 let out the Waters, after which all the reſt would very eaſily follow. For which purpoſe I put up my left Hand into the Womb, juſt to the right ſide of the ſwelled Belly, and then with my right Hand I guided the Crochet (like to that marked A, amongſt the repreſentation of the Inſtruments at the end of this Second Book, inſtead of which it were better to uſe the crooked Knife, marked there D) along my left hand into the Womb, and then I turned the point of it towards the Infants Belly, in which I ſtruck it, ſo that I made a hole big enough to receive two of my Fingers ends, (which I put into it after it was in the world) and then ſtretching it a little, all the Waters were immediatly emptied; ſo that with one Hand I eaſily drew forth the reſt of the Body, to the aſtoniſhment of this Chirurgeon, whom I could never perſwade that the Infant was ſo full of the Dropſy.
After it was thus drawn forth, I had the curioſity to fill up the Belly with Water, by the hole I had made, to the end we might ſee what quantity of Water had been there contained, and of what bigneſs it might be when filled: I poured in, without lying, above five Quarts, which I ſhould hardly have believed, if I had not ſeen it my ſelf; and when the Belly was filled with Water, it was of the bigneſs and figure of a very great Foot-ball. I have ſet down here all the circumſtances of this Hiſtory, that the Chirurgeon may know how to behave himſelf on the like occaſion.
FOr the moſt part when an Infant preſents any part of his Body together with the Head, it is uſually one or both the Hands rather than any other, which hinders its Birth; becauſe the Hands take up part of the Paſſage, and for the moſt part they cauſe the Head to lean on one ſide. When the Child comes thus, it is quite contrary to Nature.
To remedy this, aſſoon as 'tis perceived that one Hand preſents together with the Head, it muſt be prevented from coming down more, or ingaging further in the Paſſage; wherefore the Chirurgeon having placed the Woman on the Bed, with her Head a little lower than her Hips, muſt put and guide back the Infants Hand with his own as much as may be; or both of them, if they both come down, for to give way to the Childs Head; which having done, if the Childs Head be on one ſide, it muſt be brought into its natural Poſture in the middle of the Paſſage, that it may come in a ſtrait line, proceeding further as I have directed before in the 18th Chap. of this Book, which treats of the Childs Head coming on one ſide.
WHen an Infant preſents only one or both Hands to the birth, or an Arm ſometimes out to the Elbow, and many times to the Shoulder, it is one of the worſt and moſt dangerous Poſtures a Child can come in, as well for himſelf as for his Mother; becauſe of the violent force the Chirurgeon is**Not alwaies, though often times. alwaies obliged to uſe both to the one and the other in ſearching for the Feet, which are very far off, by which he muſt alwaies in theſe Caſes, turn and draw him forth; which will often make him ſweat in the midſt of Winter, becauſe of the difficulty in this Labour more than in all the reſt, though ſome others of them indeed are more dangerous for the Infant; as when it preſents the Belly, and the Navel-ſtring comes forth: but not ſo painful for the Chirurgeon, becauſe the Feet of the Infant being near the Paſſage, are not ſo hard to be found, as when he comes with a Hand; for then they are high, at the very bottom ſometimes of the Womb, where he muſt ſeek them, for to turn it and draw it forth, as I am going to direct.
But above all when the diſmembring of an Infant is thus intended, or to draw it forth with a Crochet,**This caveat unneceſſary to thoſe who underſtand the Art aright. let the Chirurgeon take great care that he be not deceived, well conſidering, whether it be aſſuredly dead, and not to operate on this wiſe, unleſs he be very certain of it, by all the ſigns mentioned in the 12th Chap. of this Book; for what a horrible ſpectacle would it be, to bring (as ſome have ſometimes done) a poor Child yet living, after the Arm hath been cut off, or any other part of the Body; wherefore let him make a double reflection on his work, before he goeth about it.
IF the Infant preſents both Hands and Feet together at the Birth, it is altogether impoſſible it ſhould be born ſo: the Chirurgeon therefore guiding his Hand towards the orifice of the Womb will perceive nothing but a many Fingers cloſe together,242 and if it be not ſufficiently dilated, he will be a good while before he can exactly diſtinguiſh between the Hands and Feet, by reaſon they are ſometimes ſo ſhut and preſt together, that they ſeem to be all of one and the ſame ſhape: but when the Womb is open enough for to introduce the Hand into it, he will eaſily know which are the Hands, and which the Feet; and having well taken notice of it, let him ſlide his Hand, and preſently direct it towards the Infants Breaſt, which he will find very near, and by that**Unneceſſary. let him gently thruſt back the Body towards the bottom of the Womb, leaving the Feet in the ſame place where he found them; having therefore placed the Woman in a convenient Poſture, that is, her Hips a little raiſed above her Breaſt and Head, which ſcituation ought alwaies to be obſerved when the Child is to be put back into the Womb, let him afterwards take hold of him by the Feet, and draw him forth according to the way before directed in its proper Chapter.
This Labour truly is a little troubleſome, but nothing near ſo much as that we have mentioned in the preceding Chapter, where the Child preſents only his Hands: for in that the Feet muſt be ſearched a great way off, and it muſt be quite turned about, before it can be drawn forth; but in this, they are ready, preſenting themſelves, and there is not much to do, but to lift and thruſt back a little the upper part of the Body, which is almoſt done of it ſelf**Sufficient, and the beſt way in this Birth. by drawing it alone by the Feet.
243Thoſe Authors that have written of Labours, and never practiſed them, as many Phyſicians have done, do order all by the ſame precept often reiterated, that is, to reduce all wrong Births to a natural Figure; which is to turn it, that it may come with the Head firſt: but if they themſelves had ever had the leaſt experience, they would know that it is very often impoſſible; at leaſt if it were to be done, by the exceſs of violence, that muſt neceſſarily be uſed to effect it, it would go near to deſtroy both Mother and Child in the operation: a Fiat in this Caſe is ſoon ſaid and ordered; but it is not ſo eaſily executed as pronounced. For my part I am of an opinion cleer contrary to theirs, and ſuch as are skilfull in the Art will ſurely agree with me in it, that is, that (whenſoever the Infant comes wrong in what Poſture ſoever from the Shoulders to the Feet) it**A good note. is the beſt way, and ſooneſt done, to draw it forth by the Feet; ſearching for them, if they do not preſent themſelves, rather than to try to put it into a natural Poſture, and place the Head foremoſt: for the great endeavours often neceſſary to be uſed in turning the Infant in the Womb (which is a little harder than to turn a Pancake in a frying Pan) doth ſo weaken both Mother and Child, that there remains not afterwards ſtrength enough for to commit the Operation to the work of Nature, and uſually the Woman hath no more Throwes nor Pains fit for Labour, after ſhe hath been ſo wrought upon; for which cauſe it would be very tedious and difficult, as alſo the Infant, which is already very weak, would certainly periſh in the Paſſage, without244 being able to be born. Wherefore it is much better in theſe caſes immediatly to fetch it by the Feet, ſearching for them as I have already directed, when they do not preſent themſelves, by which a tedious Labour will be prevented to the Mother, and the Child will be often brought alive, who without it will ſcarce eſcape death before he can be brought forth by the ſtrength of Nature.
WHen an Infant (not being turned towards the latter moneths, as he ought, to come with his Head foremoſt, as is mentioned in the 5th Chap. of this Book) preſents the Knees to the Birth, having the Legs folded towards the Buttocks, one may eaſily be deceived touching but one of them, becauſe of their hardneſs and roundneſs, and take it for the Head, eſpecially when being ſcituated a little high, it can be reached but with the end of a Finger only; but if it be touched and handled a little better, the Infant being fallen a little lower, it will eaſily be diſtinguiſhed.
Aſſoon then as it is perceived, it muſt not be ſuffered to advance further in this Poſture; but having placed the Woman, the Knees muſt gently be put back, for to have the more liberty to unfold the Legs one after the other, which the Chirurgeon
245 may do, by putting one or two of his Fingers under the Hamm, directing them by little and little all along behind the Leg until he meets the Foot, and drawing alwaies a little obliquely, for to come the eaſier to the end of it, that ſo having diſengaged one, he may do the ſame to the other, proceeding in the ſame manner as with the firſt; after which having brought them together, he may finiſh the work, as when a Child comes Footling; alwayes obſerving to bring the Face of it downward, and ſuch circumſtances as are noted where we treat of that Labour.
THe moſt difficult of theſe three ſorts of Figures and Scituations, in which Infants ſometimes come, is that of the Shoulders; becauſe it is furtheſt from the Feet of the Infant, and the Chirurgeon muſt find them, for to draw it forth. The next is the Back: and the Breech, for the ſame reaſon, cauſeth leaſt trouble, not only becauſe the Feet are nearer, but alſo becauſe by this Figure, the Head and Neck of the Infant is not ſo conſtrained and lockt, as in the other ſcituations.
For to remedy this Birth of the Shoulder, ſome adviſe that it ſhould be put back, to make way for the Head of the Infant, that ſo it may be reduced to a natural Birth: but it is much better, for the246 reaſons above alledged in the 22th Chap. of this Book, to try to bring it by the Feet; for to effect which, the Chirurgeon muſt thruſt the Shoulder a little back with his Hand, that ſo he may have more liberty to introduce it into the Womb, and ſliding it then along the Childs body, either by the Belly or ſide, as he finds it eaſieſt, he ſhall fetch the Feet, and turning it, bring them to the Paſſage, and ſo deliver the Woman, as is already directed.
If it be the Back, which preſents to the Birth, it is alſo impoſſible to be born in that Poſture, what Pains ſoever the Mother endures; and beſides the Child having the Body folded inwards and almoſt double, his Breaſt and Belly are ſo preſt together, that he uſually wants little of being ſuffocated: to avoid which, the Chirurgeon muſt quickly ſlide up his Hand, along the Back towards the inferiour parts, until he meets the Feet, for to bring it forth the ſame way as if it came Footling.
But when the Child comes with the Breech, if it be ſmall, and the Mother big, having the Paſſages very large, he may ſometimes with a little help be born ſo; for though he comes double, yet the Thighs being folded towards the Belly, which is ſoft and gives way, it paſſeth without much trouble. Aſſoon as the Chirurgeon finds the Child to come with the Buttocks foremoſt, he muſt not permit it to engage lower in the Paſſage; for it will not come ſo, unleſs it be very ſmall, and the Paſſage very large, as we have already ſaid. This being then in good time perceived, he muſt, if he can, thruſt back the Breech, and ſliding up his Hand along the Thighs to the Legs and Feet of247 the Child, he muſt bring them gently one after the other forth of the Womb, by folding, ſtretching, wagging, and drawing them gently towards the ſide, being careful not to winde them too much, or cauſe a diſlocation; and then let him draw forth the reſt of the Body, as if it came with the Feet foremoſt.
I have ſaid that the Chirurgeon perceiving the Child to come with the Breech foremoſt, ought to put it back, if he can; for ſometimes he will be advanced ſo forward in the Paſſage, that you may ſooner deſtroy both Mother and Child, than reduce it back, when once ſtrongly engaged: When this happens, he cannot hinder it from coming in this Poſture, in which his Belly is ſo preſſed, that he often voids the**Childs ordure. meconium by his Fundament. However he may much help this Birth, by ſliding up one or two Fingers of each Hand on each ſide of the Buttocks, for to introduce them into the Groins, and having crooked them inward, he muſt draw the Breech juſt out to the Thighs, & then by drawing and wagging it from ſide to ſide, he will diſengage them from the Paſſage, as alſo the Feet and Legs one after the other, being careful of diſlocating any part, and then he may extract the reſt as before, when coming with the Feet. The firſt Woman I ever layd, was of a Child which I drew††This way ought to be avoided if poſſible. thus forth with the Buttocks foremoſt; being conſtrained to it, becauſe aſſoon as ever the Waters broke (which happened before I could arrive to hinder it) they were ſo forward, that it was impoſſible to do it248 otherwiſe, which I performed very well and in ſhort time, without prejudice to the Mother or Child, doing as I have directed.
THe Back-bone may eaſily be bent and turned forwards a little, but by no means backwards without exceſſive violence. Wherefore the worſt and moſt dangerous Figure that a Child can offer in the Womb to the Birth, is the Belly or the Breaſt; for then its Body is conſtrained to bend backwards, and whatever Throws or endeavours the Woman makes to bring it forth, it will never be accompliſhed, for ſhe will ſooner periſh with her Child, than ever advance it in this poſture into the Paſſage, wherefore it is in great danger, if not timely ſuccoured. And in caſe it ſhould eſcape, which would be very ſtrange, it would be a long while after its birth weak in the Back. But that which augments the danger much more is, that for the moſt part the Navel-ſtring comes forth when the Child comes with the Belly. Therefore aſſoon as it is diſcovered to be ſo, the Chirurgeon muſt apply the ſole remedy of drawing it forth by the Feet as ſpeedily as may be, in the following manner.
When a Child comes with Breaſt or Belly, the Chirurgeon muſt always proceed after the ſame manner in both, inaſmuch as they require the ſame circumſtances. An Infant may likewiſe come with the Side, which way it is as impoſſible to paſs as the two former: but it is not ſo much tormented, nor is this ſcituation ſo cruel; for it may remain in it a longer time without dying, than in the two former, wherein it is much more racked than in this, in which the Body may be bended forward, and not backward, as in the other; neither doth the Navel-ſtring come forth ſo eaſy, as when it comes with the Belly firſt. In this, as in the other two Births, the Chirurgeon muſt draw the Child forth by the Feet on this faſhion; having placed the Woman as ſhe ought to be, he may puſh back a little with his hand the Infants body, the better to introduce it, which he may ſlide along the Thighs, till he finds the Legs and Feet, by which he muſt turn it, and afterwards draw it forth, juſt in the ſame manner as before, with250 the ſame obſervations. Nor ought he to amuſe himſelf in any of theſe three Births, for to place the Head right, that it might come naturally; becauſe it is in great danger of dying in theſe unnatural Poſitions, if not drawn forth with ſpeed; which can never be effected, unleſs it be by finding the Feet, as I have directed.
IF all the unnatural Figures and Scituations which we have hitherto deſcribed, that a ſingle Child may come in, do cauſe thoſe many difficulties and dangers mentioned; ſurely the Labour wherein ſeveral together come in theſe bad ſcituations muſt be much more painful, not only to the Mother and Children, but to the Chirurgeon alſo; for they are then ſo conſtrained and preſſed, that for the moſt part they trouble each other, and hinder both their births: beſides, the Womb is then ſo filled with them, that the Chirurgeon can ſcarce introduce his Hand without much violence, which he muſt do, if they are to be turned or thruſt back, for to give them a better poſition than wherein they preſent.
Sometime ſince I delivered two Women within a Week one of the other, both of Twins, one of each being dead, and the other living: the living Child of the firſt Woman was born before the dead: and the dead of the ſecond was expelled before the living. And the ſame thing happens every day in reſpect of ſtrong and weak Children: for that which is neareſt the Birth, whether alive or dead, ſtrong or weak, is always firſt born, or muſt be brought firſt, if it cannot come of it ſelf; otherwiſe the difficulty of the Labour would yet be augmented as well in length of time to the Mother, as the violence done to the firſt Child, in putting it back, for to fetch the ſecond firſt.
In the 8th Chap. we ſhewed, ſpeaking of natural Labours, how a Woman ſhould be delivered of Twins, coming both right: it now remains to direct what ought to be done, when they come either both wrong, or one of them only, as it is for the moſt part: the firſt coming right, the ſecond252 Footling, or any other worſe Poſture: and then muſt the Birth of the firſt be haſtened as much as may be, that ſo there may be preſently way for the ſecond (which hath ſuffered much by this unnatural Poſition) to fetch it by the Feet, without trying to place it right, although it were ſomewhat inclined to it; becauſe it hath been already ſo tired and weakened, as alſo the Woman by the Birth of the firſt, that there would be more danger, that it would ſooner dye, than come of it ſelf.
Sometimes when the firſt is born naturally, the ſecond offers the Head likewiſe to the Birth: in this Caſe, 'tis good committing a work ſo well begun, to Nature to finiſh, provided ſhe be not too ſlow; for a Child may dye although right, by lying too long in the Birth; and the Woman, who hath been much tormented with bearing the firſt, is uſually ſo tyred and diſcouraged, when ſhe thinks that but half her work is over, that ſhe hath no more Pains, or very few and ſlow, nor any conſiderable Throws to bear the Second as ſhe had done the Firſt. Wherefore if the birth of the Second proves tedious, and the Woman grows weaker, let the Chirurgeon defer it no longer, but direct his Hand gently into the Matrix, to find the Feet, and ſo draw forth the ſecond Child; which will eaſily be effected, becauſe there is way made ſufficient by the birth of the firſt: and if the ſecond Waters be not broke, as it often happens, yet intending to fetch it Footling, he need not ſcruple to break**Skins or skirts. the Membranes with his Fingers, although elſwhere we have forbidden it; but that muſt be underſtood with diſtinction: for when a253 Labour is left to Natures work, they muſt break of themſelves; but when a Child ſhall be extracted by Art, there is no danger in breaking them; nay contrarily they muſt be broke, that the Child may be the eaſier turned, which elſe would be almoſt impoſſible.
Above all, the Chirurgeon muſt be careful not to be deceived, when both Children together offer to the Birth either their Hands or Feet, and muſt well conſider in the Operation, whether they be not joined together, or any otherways monſtrous; as alſo which part belongs to one Child, and which to the other, that ſo they may be fetcht one after the other, and not both together, as would be if it were not duely conſidered, taking the right Foot of the one, and the left of the other, and ſo drawing them together, as if they belonged both to one Body, becauſe there is a left and a right, by which means it would be impoſſible ever to deliver them: but it may eaſily be prevented, if having found two or three Feet of ſeveral Children preſenting together in the Paſſage, and taking aſide two of the forwardeſt, a right and a left, and ſliding his Hand along the Legs and Thighs up to the Twiſt, if forwards; or to the Buttocks, if backwards, he finds they both belong to one Body; and being certain of it, he may then begin to draw forth the neareſt, without regard which is ſtrongeſt or weakeſt, bigger or leſs, living or dead, having firſt put a little aſide that part of the other Child which offers, to have the more way, and ſo diſpatch the firſt whatever it is, aſſoon as may be; obſerving the ſame Rules, as if there were but one, that is, keeping the Breaſt and254 Face downwards, with every circumſtance directed where the Child comes Footling, and not fetch the Burthen, till the ſecond Child be born; becauſe there is commonly but one for both, which if it were looſened from the ſides of the Womb, would cauſe a flooding, for the reaſons already alledged, that the orifices of the Veſſels to which it was joined would continue open by this ſeparation, as long as the Womb was dîſtended by the other Child, yet within it, and never cloſe (as it often happens) till being quite emptied of all, it begins to contract it ſelf, and retire (as a man may ſay) within it ſelf.
When therefore the Chirurgeon hath drawn forth one Child, he muſt ſeparate it from the Burthen, having tyed and cut the Navel-ſtring, and then fetch the other by the Feet in the ſame manner; and afterwards bring the Burthen with the two ſtrings, as hath been ſhewed in the proper place. If the Children offer any other part than the Feet, the ſame courſe muſt be taken as is directed in the foregoing Chapters, where the ſeveral unnatural Figures are diſcourſed of, alwayes obſerving for the reaſons abovementioned to begin the Operation with the Child that is loweſt in the Paſſage, and in the moſt commodious Figure for extraction.
AN Infant doth not alwaies preſent with the Belly when the Navel-ſtring comes firſt: for though he preſents naturally as to the Figure of his Body, that is with the Head firſt, yet ſometimes the Navel-ſtring falls down and comes before it; for which cauſe the Child is in much danger of death, at leaſt if the Labour be not very quick, becauſe the Blood (that ought to paſs and repaſs through thoſe Veſſels which compoſe it, for to nouriſh and enliven the Child, whilſt he continues in the Womb) being coagulated, hinders the circulation wh ch ought to be there made; which happens as well by the contuſion, as the cold thoſe Veſſels receive, being much preſſed in the Paſſage, when it comes together with the Head or any other part, as alſo becauſe the Blood doth there coagulate (as is ſaid) by reaſon of the cold which it takes by the coming forth of the Navel-ſtring.
But though this accident may cauſe the Infants ſuddain death, 'tis not ſo much for wart of nouriſhment, without which he might paſs a day or more, there being blood enough in his Body for that purpoſe: but becauſe the Blood can be no longer vivified and renewed by Circulation, as it hath continual need, which being obſtructed, alwaies cauſeth the creatures ſudden death, ſooner256 or later, according as it is more or leſs obſtructed.
I know it may be objected, that though the Circulation be ſo hindered and intercepted by the coming forth of the String, it need not therefore cauſe ſuch a ſudden death to the Child, becauſe the Blood may notwithſtanding circulate in all the other parts of the body: to which I anſwer, that in reſpect to the Infant, 'tis either abſolutely neceſſary that the Blood, for want of reſpiration, ſhould be elaborated or prepared in the**Thick part of the Burthen. Placenta, and therefore there muſt be a free communication, or for want of it, that the Infant muſt immediatly breath by the mouth, as well to be refreſhed, as to drive forth by exſpiration the fuliginous vapours, which not being poſſible whilſt in the Womb, it muſt unavoidably be choaked and dye in a very ſmall time, if it wants both together. Wherefore in this caſe the Woman muſt without any delay be delivered, which if Nature doth not ſpeedily perform, the Child muſt be drawn forth by the Feet.
Women that have great Waters and a long ſtring to the Burthen are very ſubject to this miſchief; for the Waters coming forth in great abundance at the breaking of the Membranes, do often at that inſtant draw the ſtring which ſwims in the midſt, forth along with them, and much the eaſier if the Infants Head be not advanced very forward into the Paſſage, for to hinder the coming forth of it in this manner.
Aſſoon as 'tis perceived, you muſt immediatly257 endeavour to put it back, to prevent the cooling of it, behind the Childs head, leſt it be bruiſed as we have already noted, whereby the blood may coagulate there; keeping it in that place where it was thruſt back, until the Head being fully come down into the Paſſage, may hinder the coming down of it again: which may be effected by holding it up with the Fingers of one hand on that ſide it comes down, until the Head be advanced as aboveſaid; or in caſe the hand be taken away, to put a piece of fine ſoft rag between that ſide of the Head and the Womb, for to ſtop up the way it came down by, alwaies leaving an end of the rag without the body, for to draw it forth by at pleaſure.
But ſometimes, notwithſtanding all theſe cautions and the putting back of it, it will yet come forth every Pain: then without further delays the Chirurgeon muſt bring the Child forth by the Feet, which he muſt ſearch for, though the Infant comes with the Head; for there is but this only means to ſave the Childs life, which it would certainly loſe by the leaſt delay in this caſe. Wherefore having placed the Woman conveniently, let him gently put the Head, which offers, back; (provided it be not engaged too low among the bones of the Paſſage, and that it may be done without too great violence to the Woman, for in that caſe**See the Preface. it will be better to let the Child run the hazard of dying, than to deſtroy the Mother) and then ſlide up his Hand well anointed under the Breaſt and Belly to ſearch for the Feet, by which he muſt draw it forth according to former directions; this being diſpatched,258 let him immediatly take great care of the Infant, which is ever in this caſe very feeble.
THe coming forth of the Navel-ſtring before the Infant, of which we have treated in the foregoing Chapter, is often cauſe of his death, for the reaſons there given: but the coming firſt of the Burthen, is yet much more dangerous; for beſides that the Children are then ordinarily Still-born, if they be not aſſiſted in the very inſtant, the Mother likewiſe is often in very great peril of her life; becauſe of her great floodings, which uſually happen, when it is looſened from the Womb before its due time, becauſe it leaves all the Orifices of the Veſſels open, to which it did cleave, whence flowes inceſſantly Blood, until the Child be born: becauſe the Womb, whilſt any thing continues there, doth every moment ſtrongly endeavour to expel it, by which means it continually voids and epreſſeth the blood of the Veſſels, which are always open (as we have already often explained) when the Burthen is ſo ſeparated, as long as the Womb remains extended and cannot be cloſed, until it hath voided all that it did contain, and comes by the contraction of its membranous ſubſtance to ſtop them, by preſſing them together. Wherefore if we ought to be vigilant to ſuccour an Infant259 when the String comes firſt, we ought much more to be ſo when the Burthen comes forth firſt, and the leaſt delay is ever cauſe of the Infants ſudden death, if the Woman be not ſpeedily delivered; becauſe the Infant cannot ſtay then long in the Womb without ſuffocation, ſtanding then in need of breathing by the Mouth (as is explained in the foregoing Chapter) the Blood being no longer vivified by the preparation made in the Burthen, the uſe and ſunction of which then ceaſeth, from the inſtant it is ſeparated from the Veſſels of the Womb, to which it was joined, for which reaſon there immediatly follows a great flooding, which is ſo dangerous for the Mother, that without ſpeedy help, ſhe ſoon loſeth her life by this unlucky accident.
When the Burthen is not wholy come forth, but lies in the Paſſage, ſome adviſe to put it back before the Child be fetcht; but I am not of that opinion, for when it comes into the Paſſage before the Infant, it is then totally divided from the Womb, at the bottom of which it ought ordinarily to be ſcituated and faſtened, until the Child be born: but, becauſe (aſſoon as it is wholly looſened, as it alwaies is when it comes firſt) it becomes a Body altogether unnatural; it muſt never be thruſt back, but contrarily be ferched away, and at the very moment after bring the Child by the Feet, although it came naturally with the Head firſt: for what reaſon can there be to put it back, ſince it is of no uſe to the Infant, from the moment it is ſeparated from the Womb, as cannot be denied? And ſuch a proceeding is ſo farr from being uſeful, that this Burthen would much hinder the260 Chirurgeon from being able to turn the Child, as he ought, for to bring it by the Feet.
Wherefore when it preſents in the Paſſage, which may be ſoon perceived if they find every where a ſoft ſubſtance, without the leaſt reſiſtance to the touch of any ſolid part; finding likewiſe the String faſtened to the middle of it, and the Woman flooding extremely, as is ordinary at ſuch times: then, inſtead of thruſting it back, the Burthen muſt be brought away, that ſo there may be more liberty and room to extract the Child, according to former direction.
The Burthen, being quite looſened from the Womb, and coming firſt in the Paſſage, muſt not be thruſt back into it again, much leſs muſt it be put back, when is is quite come forth of the Body: Care muſt be only taken not to cut the String till the Child be born, not out of hopes of any benefit from it to the Infant during the Delivery, but that ſo much time may not be loſt before the Infant be fetcht, which is then ever in great danger, as alſo the flooding may be the ſooner ſtopt, which happens for the moſt part aſſoon as the Woman is delivered, for which reaſons it muſt be with all poſſible ſpeed diſpatched.
Sometimes, notwithſtanding this dangerous accident, the Child may be born alive, if timely ſuccoured: but it is then ſo weak, that 'tis hard to diſcover at firſt, whether it be living or dead.
When it ſo happens, the Midwives do ordinarily before they ſeparate the Burthen put it into a skellet of hot Wine, and imagine, with no ſmall Superſtition, that in caſe it comes to it ſelf, the vapours of the warm Wine was the cauſe of it, being conveyed261 by means of the String into the Infants Belly, and ſo giving it vigour: but it is more credible, that being almoſt ſuffocated for want of reſpiration aſſoon as it needed it, it begins now by means of it to recover from that fainting: but nevertheleſs, there is no hurt in keeping the cuſtome, though ſuperſtitious, ſince it can do no prejudice, and may ſatisfie preoccupied ſpirits, provided neceſſaries be not neglected, in being blindly carried away with this conceipt.
THe beſt expedient and ſafeſt remedy for Mother and Child in this caſe, who are both in great danger, is to deliver the Woman preſently, without any delay, fetching the Child away by the Feet, at what time ſoever of the Womans being with Child, whether at full reckoning or no.
I have at large directed in the 20th Chap. of the firſt Book, ſpeaking of Floodings, what ought to be done in theſe Caſes, where I related the ſad Story of one of my Siſters, which I ſhall not again repeat, being too ſadly affected with it; but refer the Reader to that Chapter for ſufficient directions in theſe dangerous accidents.
A Child may in the Womb have either the Dropſy of the Head, called Hydrocephale, or of the Breaſt, or of the Belly: And when theſe parts are ſo filled with Water (as I have ſometimes met with) that they are much too big for the Paſſage through which the Child muſt iſſue; then, notwithſtanding any Throws or Endeavors the Woman may attempt to bring it forth, 'tis impoſſible ſhe ſhould effect it without the help of Art: as likewiſe when the Child is monſtrous, either by being only too big in the whole Body, or in any particular part, or by being joined to another Child.
If the Child be living that hath the Dropſy, when the Woman is in Labour, it muſt be deſtroyed to ſave the Mother, by making a hole in either the Head, Breaſt or Belly of it, where the Waters are contained, that being emptied by the apertion ſo made, the Child may the eaſier be drawn forth, or elſe he muſt neceſſarily dye in the Womb, not being able to be born, and remaining there will alſo kill the Mother; wherefore to ſave her life, the Infant muſt be by an**See the Preface. indiſpenſable neceſſity brought forth by Art, ſince 'tis impoſſible it ſhould come of it ſelf, which may263 be done with a crooked Knife ſharp at the very point, like that marked C, among the Inſtruments at the end of the Second Book, the Chirurgeon proceeding in the following manner.
After••at the Woman is placed conveniently for the Operation, he muſt ſlide up his left Hand on the right ſide of the interiour part of the Infants Head, if the Waters be continued therein, which he will perceive by the extraordinary bigneſs and extent of it, the Sutures much ſeparated, and the Bones of it far diſtant one from the other, by reaſon of the diſtenſion made by the incloſed Waters, of which being very certain, let him ſlide with his right Hand along the inſide of his left this crooked Knife, taking care that the point of it in introducing it, be alwaies towards his left Hand, for fear of wounding the Womb, and having conducted it cloſe up to the Head, againſt one of the Sutures, let him turn the Knife towards it, and make an apertion large enough to let out the Water, and then it will be very eaſie to bring forth the Child; foraſmuch as the other parts are then uſually ſmall and much conſumed.
If theſe Waters were contained in the Breaſt or Belly, then the Childs Head, being no bigger than ordinary, may be born; but the Body being exceedingly ſwelled with the Waters will ſtay behind, as it happened to that Child that had a Dropſy of the Belly, which I mentioned in the 19th Chap. of this Book, to which I refer you, becauſe 'tis much to this purpoſe.
The caſe being thus, let the Chirurgeon ſlide up his left Hand, as aforeſaid, and the inſtrument with the right, juſt to the Breaſt or Belly, for to264 make an Inciſion, juſt as I did in the ſame caſe related in the ſaid 19th Chap. for to let out the Waters, after which he may with much eaſe finiſh the Operation.
You muſt know, that 'tis much more difficult to deliver a Monſtrous Birth, or two joined together, than one that hath the Dropſy: becauſe the bigneſs of the Hydropick parts may be eaſily leſſened by a ſingle inciſion, which is ſufficient to let out the Waters which diſtend, and then 'tis eaſie to diſpatch the reſt.
But when a monſtrous Child is to be extracted, or a double one, a ſingle apertion is not enough, but ſometimes 'tis neceſſary to take off whole members from thoſe Bodies, which makes the Operation much more painful and laborious, and requires more time and skill to effect it; in which caſe the left Hand muſt be introduced into the Womb, and the ſharp Knife of the right juſt to the parts that are to be divided and ſeparated, and there with all the care that may be, the member of the monſtrous Child muſt, if poſſible, be taken off juſt at the Joint; and when there are two Children joined together, the Separation muſt be made juſt in the place where they join, and afterwards they may be delivered one after the other; always taking them by the Feet; and if it hath but one, the ſame thing may be accompliſhed, after having leſſened the bigneſs of it, by cutting off ſome one of the Members.
I have already ſhown in the 15th Chap. of this Book, ſpeaking of the extraction of a Childs Head left alone behind in the Womb, of what faſhion this Inſtrument ought to be, that the Operation may265 be conveniently performed, and that it ſhould be as long as an ordinary Crochet, for the more ſurety and facility; becauſe that holding the handle of it with the right Hand, it may be thruſt, drawn, ſloaped and turned without pain to any ſide at pleaſure; and with the left, which is within the Womb, it may be guided for to cut and diſmember more skilfully and eaſily thoſe parts which muſt be ſeparated. Wherefore it ought to have a Handle ſo long, that the Chirurgeons right Hand without the Womb may hold and govern it as aboveſaid, and conduct it the better in the Operation, which could not be ſo ſafely and conveniently done, if this inſtrument were ſo very ſhort, as all other Authors recommend: becauſe in this occaſion the Chirurgeons hand is ſo conſtrained and preſſed in the Womb, that he can hardly there have the liberty to move his Fingers ends, which is the cauſe why he cannot without much difficulty govern ſuch an Inſtrument with one Hand only, unleſs he would very much force and offer violence to the Womb, and exceedingly endanger thereby the poor Womans life. Let us now come to the extraction of a dead Child, and ſhow the ſeveral ways of doing it.
WHen the Infant is dead in the Mothers Belly, the Labour is ever long and dangerous, becauſe266 for the moſt part it comes wrong; or, though it comes right with the Head, the Womans Pains are ſo weak and ſlow in theſe caſes, that ſhe cannot bring it forth, and ſometimes ſhe hath none at all; foraſmuch as Nature half overthrown by the death of the Child, which cannot help it ſelf, labours ſo little, that many times it cannot finiſh the buſineſs it hath begun, but muſt yeeld without the help of Art, of which at that time it hath great need: However, before you come to Manual Operation, endeavour to ſtir up the Womans Pains with ſharp and ſtrong Clyſters, for to bring on Throws to bear down and bring forth the Child: but if this prevails not, ſhe muſt be deliverd by Art.
We have declared in the 12th Chap. of this Book the ſigns to know a dead Child in the Womb, of which the chief are; if the Woman perceives it not to ſtir, nor hath a long time before; if ſhe be very cold, much pain and heavineſs in the bottom of her Belly; if the Child be not ſupported, but always falls like a maſs of Lead to that ſide on which the Woman lies, if the Burthen or Navelſtring hath been a long time in the World; and if no Pulſation be there felt, and that dark and ſtinking putrid matter comes away from the Womb. All theſe ſigns together, or moſt of them, ſhew the Child is aſſuredly dead; which when the Chirurgeon is certain of, he muſt do his endeavour to fetch it aſſoon as poſſibly he can, and having placed the Woman according to former directions; if the Child offers the Head firſt, he muſt gently put it back until he hath liberty to introduce his Hand quite into the Womb, and ſliding it all along under267 the Belly to find the Feet, let him draw it forth by them, as is formerly taught; being very careful to keep the Head from being lockt in the Paſſage, and that it be not ſeparated from the Body, which may eaſily be done when the Child being very rotten and putrified, the Chirurgeon doth not obſerve the circumſtances often repeated by us, that is (in drawing it forth) to keep the Breaſt and Face downwards: And if, nothwithſtanding all theſe precautions, the Head, becauſe of the great putrifaction, ſhould be ſeparated and remain behind in the Womb, it muſt be drawn forth according to the directions formerly given in the proper Chapter.
But when the Head coming firſt is ſo far advanced and engaged among the Bones of the Paſſage, that it cannot be put back, then being very ſure by all the Signs together, or moſt of the chief of them, that the Child is certainly dead, 'tis better to draw it ſo forth, than to torment the Woman too much by putting it back, for to turn it and bring it by the Feet: but becauſe it being a part round and ſlippery, by reaſon of the moiſture, the Chirurgeon cannot take hold of it with his Fingers, nor put them upon the ſide of it, becauſe the Paſſage is filled with its bigneſs, he muſt take a*Though this Crochet cannot hurt a dead Child, yet it may endanger the Woman, by ſlipping: Wherefore the Tranſlator of this Treatiſe cannot approve of it, having an eaſier and ſafer way to do this Operation, as he mentions in his Preface to this Book. Crochet268 like one of thoſe marked A and B, amongſt the Inſtrument at the end of this Second Book, and put it up as far as he can without violence between the Womb and the Childs Head, obſerving to keep the point of it towards the Head, where he muſt faſten it, endeavouring to give it good hold upon one of the Bones of the Skull, that it may not ſlide, forcing in the point of it, which muſt be ſtrong, that it may not turn; and after the Crochet is well fixed in the Head, he may therewith draw it forth, keeping the ends of the Fingers of his left Hand flat upon the oppoſite ſide, the better to help diſengage it, and by wagging it by little and little, to conduct it directly out of the Paſſage.
•he dead Child (of which above all there muſt•d aſſurance) comes with the Arm up to the•lers ſo extreamly ſwelled, that the Woman•aſſer too much violence to have it put back,•ſt then to take it off at the Shoulder-joint,•ſting it three or four times about, as we have•y taught in another place, by which means〈◊〉is no need of either Knives, Sawes or ſharp•rs, as ſome Authors will have it; it being〈◊〉eaſily performed without all that proviſion,•de of the ſoftneſs and tenderneſs of the Body:〈◊〉that, the Arm ſo ſeparated and no longer•ing the Paſſage, the Chirurgeon will have〈◊〉room to put up his Hand into the Womb to〈◊〉the Child by the Feet, and bring it away as〈◊〉been directed.
Although the Chirurgeon be ſure the Child is•…ad in the Womb, and that it is neceſſary to fetch〈◊〉by Art, he muſt not therefore preſently uſe his Crochets, becauſe they are never to be uſed but when Hands are not ſufficient, and that there is no other remedy to prevent the Womans danger, or to bring the Child any other way; becauſe, very often, though he hath done all that Art directs; perſons preſent, that underſtand not theſe things,270 will believe that the Child was killed with the Crochets, although it had been dead three days before, and without other reaſonings or better underſtanding of the matter, for recompenſe of his ſaving the Mothers life, requite him with an Accuſation of which he is altogether innocent; and, in caſe the Mother by misfortune ſhould afterwards dye, lay her death alſo to his charge, and inſtead of praiſe and thanks treat him like a Butcher or Hangman; to which divers Midwives are uſually very ready to contribute, and are the firſt that make the poor Women, that have need of the Men, afraid of them. So much they are in fear of being blamed by them, for having themſelves been the cauſe (as ſome of them often are) of the death of Infants, and many ill accidents which after befal the poor Women, not cauſing them to be helped in due time, and from the moment they perceive the difficulty of the Labour to paſs their underſtandings.
To avoid therefore theſe calumnies, let the Chirurgeon never uſe the Crochets but very rarely, and when there is no other way, as alſo to endeavour his utmoſt (as much as the caſe will permit) to bring the Child whole although dead, and not by bits and pieces, to give the wicked and ignorant no pretence of blame; I ſay, as much as the caſe will permit, that is with reſpect to the Woman under his Hands: for to ſave her, he had better ſometimes bring the dead Child with*Thoſe Inſtruments very unſafe for the Woman, and having a better way, cannot paſs them without manifeſting my diſlike. Inſtruments,271 than kill her, by tormenting her with exceſſive violence for to bring it whole: but in a word, we muſt in conſcience do what Art commands, without heed to what may be ſpoken afterwards, and every Chirurgeon, that hath a well ordered conſcience, will ever have a greater regard to his duty than reputation; in performing of which let him expect his reward from God.
HAving at large ſpoken in another place of the Cauſes, Signs and Differences of Mola's and falſe Conceptions, and ſhewed that a Mola alwaies ariſeth from a falſe Conception, there remains nothing to be demonſtrated but the manner how it ought to be extracted. Now ſince theſe things contained in the Womb, are totally preternatural, their expulſion muſt be procured aſſoon as poſſible, which is very difficult, when theſe ſtrange Bodies cleave to it, and eſpecially the Mola, which not being drawn forth, will often continue ſo faſtened two or three whole years, nay ſometimes the whole remaining part of the Womans life, as Paré tells us in the Story of the Pewterers wife that had one ſeventeen years, whom he opened after her death.
To avoid the like accident and abundance of inconveniences which a Mola brings, it muſt be endeavoured to be expelled aſſoon as may be, trying, before you come to Manual Operation, to cauſe272 the Woman to expel it of her ſelf: to which purpoſe give her ſtrong and ſharp Clyſters, to ſtir up Throwes for to open the Womb to give way to it, relaxing and moiſtening it with emollient Ointments, Oyls and Greaſe, not omitting bleeding in the Foot, and half Baths, if there be occaſion. The Mola will certainly be excluded by theſe means, provided it be but of an indifferent bigneſs, or that it adheres little or not at all to the Womb; but if it cleaves very ſtrongly to the bottom of the Womb, or that it be very big, the Woman will hardly be rid of it without the help of a Chirurgeons hand; in which caſe, after that he hath placed the Woman conveniently, as if he were to fetch a dead Child, let him ſlide his Hand into the Womb, and with it draw forth the Mola, uſing (if it be ſo big as that it cannot be brought whole, which is very rare, becauſe it is a ſoft tender body, much more plyable than a Child) a Crochet or Knife to draw it forth, or divide it into two or more parts, as the caſe ſhall require. If the Chirurgeon finds it joined and faſtened to the Womb, he muſt gently ſeparate it with his Fingers ends, his Nailes being well pared, putting them by little and little between the Mola and the Womb, beginning on that ſide where it doth not ſtick ſo faſt, and purſuing it ſo until it be quite looſened; being very careful, if it grows too faſt, not to rend nor hurt the proper ſubſtance of the Womb, proceeding according to the directions we have given for the extraction of a Burthen ſtaying behind in the Womb when the String is broke off.
This Mola never hath any String faſtened to it,273 nor any Burthen from whence it ſhould receive its nouriſhment: but it doth of it ſelf immediatly draw it from the Veſſels of the Womb, to which it is almoſt alwaies joined, and ſticking in ſome place. The ſubſtance of its Fleſh is alſo much more hard than that of the Burthen, and ſometimes it is ſchirrous, which is the cauſe, why it is not ſo eaſily ſeparated from the Womb.
As to a falſe Conception, though it be much leſs than a Mola; yet it often puts a Woman in hazard of her life, becauſe of great Floodings, which very often happens, when the Womb would diſcharge it ſelf of it, and endeavors to expel it: which ſeldom ceaſeth until it be come away; becauſe it doth ſtill endeavour to exclude it, by which the Blood is excited to flow away, and in a manner ſqueeſed out of the open Veſſels.
The beſt and ſafeſt remedy for the Woman in this caſe, is to fetch away the falſe Conception aſſoon as may be, becauſe the Womb can often very hardly void it without help; for it being very ſmall, the Womans impulſe in bearing downwards cannot be ſo effectual when the Womb is but little diſtended by ſo ſmall a body, as when it contains a conſiderable Bulk in it; for then it is more ſtrongly compreſſed with the Throws. Many times 'tis exceeding difficult to fetch theſe falſe Conceptions, becauſe the Womb doth not open and dilate it ſelf ordinarily beyond the proportion of what it contains, and that being very little, ſo is its opening; which is the reaſon why the Chirurgeon ſometimes is ſo far from introducing his whole Hand, that he can ſcarce put in a few Fingers, with which he is obliged to finiſh the Operation,274 as well as he can, proceeding in the following manner when he hath introduced them.
Having well anointed his Hand, he muſt ſlide it up the Vagina unto the inward Orifice, which he will find ſometimes but very little dilated, and then very gently put in one of his Fingers, which〈◊〉muſt preſently turn and bend on every ſide, un•…•e hath made way for a ſecond, and afterwards third, or more if it may be done without violence; but many times one hath enough to do to get in but two, between which he muſt take hold (as Crabs do with their Claws when they take any thing) of the falſe Conception, which he muſt gently draw forth, and alſo the clodded Blood which he there finds; afterwards the Flooding will undoubtedly ceaſe, if no part of this Conception be left behind, as I have often found by experience when I have taken the ſame courſe: but if the inward Orifice cannot be more dilated than to admit but one Finger, and that the Flooding is ſo violent as to endanger the Womans life, the Chirurgeon then having introduced his Fore-finger of his left Hand, muſt take with his right an Inſtrument, called a Cranes-bill, or rather a Forceps (like that marked G, among the Inſtruments at the end of this Second Book,) and guide the end of it along his Finger, for to fetch with this Inſtrument the ſtrange Body out of the Womb, taking heed not to pinch the Womb, and that the Inſtrument be alwaies conducted by the Finger firſt introduced, which will judg and diſtinguiſh by the touch between this Conception and the ſubſtance of the Womb: in doing which, there being no other way, he will certainly accompliſh his buſineſs.
275I thought of cauſing ſuch an Inſtrument to be made upon an occaſion, where it would have ſtood me in good ſtead, if I had had it, with which I have ſince (proceeding according to the directions I have juſt now given) lately drawn forth a falſe Conception of the bigneſs of a Walnut, which without doubt had elſe that day been the death of one named Madam le Roy, dwelling near the great Stairs at the place Maubert, by reaſon of the horrible loſs of Blood which it occaſioned, and which ceaſed aſſoon as I had drawn forth this Conception; which I could never have done any other way, becauſe the inner Orifice of the Womb was not open, nor could be dilated more than for one Finger alone, after the manner I have declared: beſides the preſſing danger of the accident, the delay of the Operation had indubitably been the death of this Woman, who, thanks be to God, is ſince well recovered.
WHen a big-bellyed Woman is effectively in Labour, 'tis very rare but that an expert Chirurgeon can deliver the Child dead or alive, whole or in pieces; in a word, that he may do the work completely, if he behaves himſelf as the caſe requires, and according to the directions given in each particular Chapter foregoing, treating of the ſeveral unnatural Labours, without being276 neceſſitated in a very inhuman, cruel and barbarous manner to have recourſe to the Caeſarean Operation during the Mothers life, as ſome Authors have too inconſideratly ordered, and ſomtimes practiſed themſelves.
In truth there would ſeem ſome pretext of a lawful excuſe to make Martyrs of theſe poor Women, if it were to bring a ſecond Caeſar from them, whom they ſay was born in that manner, or ſome great and new Prophet. In the times of the ancient Pagans they did uſe to ſacrifice innocent Victims for the publick good, but never for a private. I know very well that they palliate it with a pretence of baptizing the Infant, which elſe would be deprived of it, becauſe the Mothers death is for the moſt part cauſe of the Childs: but I do not know that there ever was any Law, Chriſtian or Civil, which doth ordain the martyring and killing the Mother, for to ſave the Child: 'Tis rather to ſatisfie the avarice of ſome people, who care not much whether their Wives die, provided they have a Child to ſurvive them; not ſo much for the ſake of Children, but to inherit by them afterwards; for which cauſe they do eaſily conſent to this cruel Operation, which is a damnable policy. If they ſay, to render the fact leſs horrible in appearance, that it muſt never be undertaken but when the Woman is reduced to the utmoſt extremity; to that I anſwer, that a Woman often recovers beyond hope or probability: And, if they object that ſhe may likewiſe eſcape after this Operation; I do utterly deny it, by the teſtimony of the moſt expert Chirurgeons that have practiſed it, who alwaies had bad ſucceſs, all the Women ever dying in a277 ſhort time after. I do highly commend Guillemeau, who to diſabuſe the world for ſuch a wicked and pernicious practiſe, confeſſeth, ſpeaking of this fatal Operation, and ownes (by way of repentance) that he did himſelf twice in the preſence of Ambroſe Parê put it into practiſe, and ſaw it thrice done more by three ſeveral very expert Chirurgeons, who omitted never a circumſtance to make it ſucceed well, and notwithſtanding all the Women died.
As for Parê, he will not acknowledg that he ſaw thoſe two Operations of Guillemean, becauſe he will not have Poſterity know that he was able to conſent to ſo great a cruelty; but contents himſelf with adviſing only, that it ſhould never be undertaken till the Woman is dead; becauſe there is no poſſibility ſhe ſhould eſcape it, not only becauſe of the irregular wound, which is convenient to make for this purpoſe in the Belly, but chiefly for that in the Womb, and for the exceſſive Flux of Blood which will immediatly follow. However, contrary to the opinion of two ſuch famous Chirurgeons, there are ſome raſh perſons, who do obſtinately maintain (though with but as little reaſon as Rauſſet) that it is not impoſſible for a Woman to eſcape, becauſe they have ſeen ſome that have had the Bones of their dead Children come forth by an abſceſs of the Belly, after that the Fleſh of them had paſſed the natural way in Sup•uration, which Bones by little and little had pierced the Womb and the Belly alſo, and after that they were ſo drawn forth, yet the Women recovered. As alſo others did not dye, whoſe Wombs after Precipitation and perfect putrefaction278 and Gangrene, was totally cut away. Indeed we muſt acknowledg what experience hath many times taught us, as it hath theſe things, which I believe have happened, and may again as well as thoſe (though rarely): but it doth not follow, that this Caeſarean Operation muſt needs ſucceed as well; becauſe here is made at one ſtroak a very great wound in the Belly and Womb, which is ever the death of the poor Woman immediatly, or ſoon after.
But when Nature it ſelf begins to ſeparate and pierce theſe parts, by means of theſe Bones, to caſt them forth by ſome new way which it makes, not being able to do it by the common and natural, for want of the help in due time of skilful perſons, it doth it by degrees and not all at once; and according to the meaſure it drives theſe preternatural Bodies forth of the Womb, ſo it reunites and rejoins it at the ſame time proportionably, and without the leaſt Flux of Blood, which happens quite otherwiſe in the artificial Operation: and if it be true, that ſome Women have ever eſcaped it, we muſt believe it a Miracle, and the expreſs hand of God, (who can when He pleaſeth raiſe the dead, as he did Lazarus, and change the courſe of Nature, when 'tis his good pleaſure) rather than an effect of humane prudence.
There are many good Women who, for having only heard ſome Goſſips ſpeak of it, are very confident that they know ſuch and ſuch yet living, whoſe ſides had been ſo opened to fetch the Child ſo out of their Belly. Nay more, there are ſome that affirm they know thoſe that have had this Operation practiſed on them three or four times279 ſucceſſively, and yet alive; and the better to confirm ſo notable a lye, which they had only heard recited by others, and after having three or four times told it, believe it themſelves for truth, as much as if they had ſeen it with their own eyes, will tell ſo many circumſtances and particulars, that they eaſily perſwade thoſe that do not underſtand the impoſſibility of it.
There are others agin, who ſhewing the ſcars of ſome abſceſs they have had in their Belly, would perſwade that a Child hath been taken out there; to which purpoſe I will relate what I once ſaw my ſelf, concerning a big-bellyed Woman that was in the Hôſtel de Dieu at Paris, when I there practiſed Deliveries. This Woman, whether through cunning, feigning to believe the thing, or through ignorance, really beleeving it, did teſtify to all the Women who were then in the ſaid Hôſtel de Dieu, as alſo to an infinite of other perſons, and amongſt the reſt to a good old Nun that governed all, whom they called Mother Bouquet, (and at that time did preſide in the Hall of Deliveries, like another goddeſs Lucina) that ſhe was very much afraid, that they muſt open her ſide to deliver her, as it had been two years before; in all which time ſhe had made the ſame relation to above a thouſand ſeveral perſons, each of which, it may be, had again related it to as many more, ſhewing to all of them a great Skar, by which ſhe ſaid the Chirurgeons had drawn the Child out of her Belly. Wherefore ſhe prayed Mother Bouquet to recommend her to me, deſiring rather to be delivered by me who was a Chirurgeon, becauſe ſhe might be more ſafely helped in ſuch a buſineſs, than by a280 Midwife. This good Nun giving me this account, which ſhe verily beleeved according to the relation; I told her, that not having faith enough to imagine it, I could not believe the Caeſarean Section had been made on that Woman, as ſhe had perſwaded her. If you do not beleeve it, replied ſhe, I will fetch her preſently to you, and ſhe her ſelf ſhall tell you every circumſtance. And immediatly ſhe cauſed her to be fetch'd; who told me the ſame ſhe had told her: but having particularly examined her from what part the Child was ſo drawn forth, and whether ſhe felt any great pain in the Operation. She anſwered me, None; becauſe ſhe was then ſenſeleſs, and remained ſo five or ſix days after: I asked her then, how ſhe was certain that the Child was brought away by inciſion in her Belly, being ſhe was not at that time ſenſible? She anſwered, the Chirurgeons aſſured her it was ſo; and at the ſame time ſhe ſhewed me a great Skar, ſcituated juſt on the right ſide of her Breaſt, about the middle of the Ribs, where ſhe had a great abſceſs, of which this Skar remained; and when I had told her, that the Breaſt was not the place whence a Child ſhould be fetcht, and that I had with my arguments convinced her of the impoſſibility of what ſhe had believed and made others to believe, as the women of the Hoſtel de Dieu and Mother Bouquet alſo; they began to be diſabuſed and continued ſo, when three days after this conference, I had delivered her with the greateſt facility, although it was a very great Child, which came quickly. If one ſhould examine well the beginning of all the Stories of this Operation, ſtrictly weighing them, as I did upon this occaſion,281 they would be found to be meer fables, and that that which Rouſſet reports of his Caeſarean Labours, is nothing but the ravings, capriciouſneſs and impoſture of their Authors.
Now if, becauſe of all theſe reaſons, a Chirurgeon muſt never practiſe this cruel Operation whilſt the Mother is alive, although the Child be certainly ſo (which for all that may ſomtimes he very doubtful) I pray what infamy would it be for him, if having ſo killed the Mother, the Child ſhould alſo be found dead, after it was thought to be alive? much more ought he to abſtain from it, when he is well aſſured it is dead; wherefore he had better pull it in pieces and bits (if it cannot be otherwiſe) by the natural way, than ſo to butcher the Mother for to have it whole; and if the Womb were ſo little open, that he could not have liberty to work there, nor introduce any inſtrument into it, he had better wait a little, alwaies trying to dilate the Paſſages by Art, as we have formerly directed, than to caſt her down almoſt in an inſtant, with ſuch a blow of deſpair, as the making of this Caeſarean Operation, which for this reaſon is never to be undertaken, till immediatly after the Mothers death, when the Chirurgeon muſt be preſent for to act according to the following directions, as well in hopes of finding the Child living, as to obey an Ordinance which expreſly forbids the burying a Woman with Child before it is taken out of her Belly. To accompliſh which as it ought to be, when he perceives the Woman in the agony, he muſt quickly make ready all things neceſſary for his work, to loſe no time, becauſe delay will certainly be the death of the Infant, which elſe a282 few moments before might have been brought alive: there are ſome, that when the Woman is juſt a dying, would have ſomewhat put between her Teeth to keep her Mouth open, and likewiſe in the outward part of the Womb: to the end the Infant receiving by this means ſome little air and refreſhment, may not be ſo ſoon ſuffocated: but all this myſtery will avail but little; becauſe the Child lives only by the Mothers blood, whilſt it is in the Womb; but if he will needs do ſo, it is rather to content the company, than out of any belief of the good it will do. Aſſoon then as the Woman hath breathed her laſt, and that ſhe is dead (to which all the company muſt agree) he ſhall begin his Operation, which the Greeks call Embriulcie. Moſt Authors would have it made on the left ſide of the Belly, becauſe it is more free from the Liver, which is on the right; but if my opinion may be authentick, it will be better and more skilfully made juſt in the middle of the Belly, between the two right Muſcles; becauſe in this place there is only the Coverings and the white Line to cut, when on the ſide it cannot be done without cutting the two oblique and croſs Muſcles, which being couched one under the other, makes a conſiderable thickneſs, beſides that it bleeds more than towards the middle of the Belly; not that the loſs of blood is of any moment (which will flow when the Woman is but juſt dead) but becauſe it hinders by its flowing, the ſeeing diſtinctly how to make the Operation as it ſhould be. To diſpatch then with more eaſe and ſpeed, the Chirurgeon having placed the dead Body that the Belly may be a little raiſed, let him take a good ſharp283 inciſion Knife, very ſharp of one ſide, like that marked E in the table of Inſtruments at the end of this Chap. with which he muſt quickly make, at one ſtroak, or at two or three at moſt (if he will for the greater ſurety) an inciſion juſt in the middle of the Belly, between the two right Muſcles unto the Peritoneum, of the length and extent of the Womb or thereabouts; after that he muſt only pierce the Peritoneum with the point of his Inſtrument, to make an orifice for one or two of the Fingers of his left Hand, into which he muſt immediatly thruſt them, for to cut it (lifting it up with them, and conducting the inſtrument for fear of pricking the Guts) in proportion to the firſt inciſion of the**Skins. Coverings, which having done, the Womb will ſoon appear, in which he muſt make an inciſion in the ſame manner as he did in the Peritoneum; being careful not to thruſt his inſtrument at once too far in, thinking to find the Womb a finger or two thick, as all Authors affirm contrary to truth, in which he would be deceived, as thoſe are that never well conſidered it; for it is very certain, that at the time of Labour, whilſt it contains the Child and Waters in it, it is not above a ſingle line thick; or the thickneſs of half a Crown, although they have all ſang to us, that by divine Providence and a Miracle, the more 'tis extended with the Child, the thicker it grows, which is abſolutely falſe; it being only true, that it is at that time a little thicker at the place where the Burthen cleaves, where its ſubſtance is then as it were ſpongious; but every where elſe it is very thin, and becomes the more ſo by how much it is more extended, until284 being emptied by the Birth of the Child, it begins to grow thicker in contracting and gathering to it ſelf all its ſubſtance, which was before very much extended. It being juſt like the Bladder which being full is very thin, and being empty appears to us of half a Fingers thickneſs, which filling again waxeth thinner in proportion to the Urine that flows to it: having then ſo opened the Womb, he muſt likewiſe make an inciſion in the Infants Membranes, taking care not to wound it with the inſtrument, and then he will ſoon ſee it, and muſt immediatly take it out with the Burthen, which he muſt nimbly ſeparate from the bottom of the Womb; and finding it to be yet living, let him praiſe God for having ſo bleſſed and proſpered his Operation.
But the Children ſo delivered in theſe caſes are uſually ſo weak, (if not quite dead, as it often happens) that 'tis hard to know, whether 'tis alive or dead. Yet one may be confident the Child is living, if by touching the Navelſtring the Umbilical Arteries are perceived to move, as alſo the Heart, by laying the Hand on the Breaſt; and if it prove ſo, means muſt be uſed to fetch it to it ſelf, ſpouting ſome Wine in the Noſe and Mouth, warming it until it begins to ſtir of it ſelf. Midwives uſually lay the Burthen very hot on the Belly of ſuch weak Children; if that helps, 'tis rather becauſe of the temperate heat of it, than for any other cauſe: for 'tis impoſſible the Infant ſhould receive any ſpirits from it, after it is once ſeparated from the Womb, and yet leſs when the Woman is dead. As to the heat of it, it can no wiſe hurt, but the weight of this maſs layed on the Belly, may rather285 choak it, by the compreſſion it makes, than do it any good; beſides, when the Burthen is grown cold, they put it in a Skellet of hot Wine, from whence they think the Spirits renew, which being conveyed through the String into the Childs Belly, gives it new force: but as I have ſaid already, that is very uſeleſs, and the beſt and ſpeedieſt remedy is immediatly to ſeparate it, and open the Childs Mouth, cleaning and unſtopping alſo the Noſe, if there be any filth, to help it ſo to breath freely, keeping it all the while near the Fire, until it hath a little recovered its weakneſs, ſpouting ſome Wine into the Noſe and Mouth of it, that he may a little taſt and ſcent it, which can not hurt it in this juncture, if one obſerves ſome moderation in the thing.
Having now at large treated in this Second Book as well of natural as unnatural Labours, and given ſufficient inſtructions to a Chirurgeon to enable him to help Women in the firſt, and to remedy all the different accidents of the latter, to which he may be dayly called, there reſts nothing now to finiſh it, but to repreſent the Inſtruments proper to this Art. And then we will paſs to the Third Book, where we muſt handle many things, which they muſt neceſſarily know that intend to practiſe Deliveries.
GOing with Child is an rough Sea, on which a big-bellyed Woman and her Infant floats the ſpace of nine Months: And Labour, which is the only Port, is ſo full of dangerous Rocks, that very often both the one and the other, after they are arrived and diſembarked, have yet need of much help to defend them againſt divers inconveniences, that uſually follow the Pains and Travail they have undergone in it.
We have directed in the Firſt Book, treating of the Diſeaſes which are incident to Women with Child, how to prevent their ſuffering ſhipwrack in this Sea during ſo long a Voyage. In the Second we have taught, how they may enter this Port, and diſimbarque there with ſafety by Delivery: It remains then to compleat our work, that we expound in this Third and laſt, how the Mother and Child muſt afterwards be ordered, and declare how at this time to prevent and remedy divers Indiſpoſitions288 which often happen to them both. Let us firſt conſider thoſe that arrive to a Woman new layd, and then we ſhall paſs to thoſe that regard a new-born Infant.
IMmediatly after the Woman is delivered, and the Burthen come away, care muſt be taken that the looſening of it be not followed with a Flooding, which if it be not, a ſoft Cloſure to the Womb muſt immediatly be applied, five or ſix double, to prevent the cold Air by entring in, from ſudden ſtopping the Veſſels, by which the Woman ſhould cleanſe by degrees, whereby there would certainly happen many ill accidents, as great Pains and Gripes of the Belly, Inflammation of the Womb, and divers others which we ſhall mention hereafter particularly, and which may eaſily be the cauſe of her death.
When the Womb is ſo cloſed, if the Woman was not delivered upon her ordinary Bed, let her be preſently carried into it by ſome ſtrong body, or more if there be need, rather than to let her walk thither; which Bed muſt be firſt ready warmed and prepared as is requiſite, becauſe of the cleanſings; but if ſhe were delivered on it (which is beſt and ſafeſt to prevent the danger and trouble289 of carrying her to it) then all the ſoul linnen and other things put there for the receiving the Blood, Waters, and other Filth which comes away in Labour, muſt be preſently removed, and ſhe muſt be placed conveniently in it for her eaſe and reſt, which ſhe much wants, to recover her of the Pains and Labour ſhe endured during her Travail; that is, with her Head and Body a little raiſed, for to breath the freer and cleanſe the better, eſpecially of that Blood which then comes away, that ſo it may not clod, which being retained cauſes very great Pains. All this will happen, if they have not liberty to come freely by this convenient ſcituation, in which ſhe muſt put down her Legs and Thighs cloſe together, having a ſmall Pillow (for her greater eaſe if ſhe deſire it) under her Hams, upon which they may reſt a little: being ſo put to Bed, let her lye neither of one ſide nor the other, but juſt on the middle of her back, that ſo the Womb may repoſſeſs its natural and proper place.
It is an ordinary cuſtom to give the Women, aſſoon as they are delivered, two Ounces of Oyl of ſweet Almonds, drawn without fire, and as much Syrup of Maiden-hair, mixed together, which is as well for to ſweeten and temper the inſide of the Throat, which was heated and hoarſe by her continual Cries, and holding her Breath to bear down her Throws during her Labour, as alſo to the end that her Stomach and Inteſtines being lined with it, ſhould not be ſo much afflicted with dolorous Gripes: But this Potion goes ſo much againſt the Stomachs of ſome Women, that being forced to take it with an averſion and diſguſt, it may do them rather more hurt, than any wiſe comfort290 them. Wherefore let none have it but thoſe that deſire it, and have no averſion to it. I approve rather in this caſe of a good Broth to be given her, aſſoon as ſhe is a little ſetled after the great commotion of Labour; becauſe it will be both more pleaſing and profitable than ſuch a Potion. And, having thus accommodated her, and provided for her Belly, Breaſts and lower parts, after the manner we ſhall direct in the next Chapter, leave her to reſt and ſleep if ſhe can, making no noiſe, the Bed-curtains being cloſe drawn, and the Doors and Windows of her Chamber ſhut, that ſo ſeeing no light, ſhe may the ſooner fall aſleep. If ſhe had endured a hard Labour, ſhe muſt be then ordered as the caſe requires, and as ſhall be hereafter declared: but what we have here directed, is only for a natural Labour, and where no extraordinary difficulty happens.
SInce the lower parts of a Woman are greatly diſtended by the birth of an Infant, it is good to endeavour therefore the prevention of an inflammation there: wherefore aſſoon as the Bed is cleanſed from the foul linnen and other impurities of the Labour, and that the Woman is therein291 placed, according to the direction of the preceding Chapter, let there be outwardly applied all over the bottom of her Belly, and Privities, the following Anodine Cataplaſm, made of two Ounces of Oyl of ſweet Almonds, with two or three new-laid Eggs, Yolks and Whites, ſtirring them together in an earthen Pipkin over hot Embers, till it comes to the conſiſtence of a Pultiſs, which being ſpread upon a Cloth, muſt be applied to thoſe parts, indifferently warm, having firſt taken away the Cloſures, which were put to her preſently after her Delivery, and likewiſe ſuch clods of Blood as were there left.
This is a very temperate remedy, and fit to appeaſe the Pains which Women ordinarily ſuffer in thoſe parts, becauſe of the violence then endured by the Infants Birth: it muſt lie on five or ſix Hours, and then be renewed a ſecond time if there be occaſion, afterwards make a Decoction of Barley, Linſeed, and Chervil; or with Marſhmallows and Violet leaves, adding to a Pint of it, an ounce of Honey of Roſes, with which, being luke warm, foment three or four times a day (for the firſt five or ſix days of Child-bed) the bearing-place, cleanſing it very well from the Blood, Clods and other Excrements which are there emptied. This Stupe is likewiſe very good to temper and appeaſe the Pains of thoſe parts. Some perſons only uſe to this purpoſe luke-warm Milk; and many Women, only Barley-water. Great care muſt be taken at the beginning that no ſtopping things be given to hinder the cleanſings, but when ten or twelve days are paſt, and that ſhe hath cleanſed very ſufficiently, Remedies may then be292 uſed to fortifie the parts, to which purpoſe a Decoction is very proper, made of Provence-Roſes, Leaves and Roots of Plantane, and Smiths water that Iron is quenched in; and when ſhe hath ſufficiently and fully done Cleanſing, which is uſually after the 18th or 20th day, there may be made for thoſe that deſire it, a very ſtrong aſtringent Lotion, to fortifie and ſettle thoſe parts, which have been much relaxed, as well by the great extenſion they received, as by the humours with which they have been ſo long time ſoaked. This Remedy may be compoſed with an Ounce and an half of Pomegranate Peel, an Ounce of Cypreſs Nuts, half an Ounce of Acorns, an Ounce of Terra Sigillata, a Handful of Provence-Roſes, and two drachms of Roch-Allum: all which being infuſed a whole night in five half Pints of ſtrong red Wine, or (that it may not be too ſharp) a quantity of Smiths water mixed with that Wine; afterwards boil it well to a Quart, then ſtrain it, ſqueezing of it ſtrongly, and with this Decoction foment thoſe inferiour parts Nights and Mornings, to the end they may as much as poſſible be ſtrengthened and confirmed: I ſay as much as poſſible; becauſe there is no probability that they can ever be reduced to the ſame eſtate they were in before ſhe had Children. So much for this: Wee'l now paſs to convenient Remedies for the Belly of a new-laid Woman.
All Authors do appoint, immediatly after Delivery, the skin of a black Sheep ſlaid alive, for this purpoſe, to be laid all over her Belly, and to lie on four or five Hours; others will have a Hare-skin. Truly I believe that by reaſon of the natural heat of ſuch Skins, the remedy is not bad: but I alſo fear293 leſt in ſome ſmall time after it may do the Woman more hurt than good, and that by its Moiſtneſs, cooling of her, it may make her to ſhake, which would be very prejudicial in ſtopping her Cleanſings, which ought to flow; beſides it is a remedy or too much trouble; for there muſt always be a Butcher ready for every Woman that is laid, or ſome other perſon that can do it as readily, who muſt be for this purpoſe in the very Chamber, or at leaſt in the Houſe, that ſo they may have the Skin very hot according to directions.
They likewiſe direct a ſmall Plaiſter of Galbanum, with a little Civet in the middle, to be applied to the Womans Navil, which as they imagine is very proper to keep the Womb in its place, becauſe being delighted with that ſmell, it drawes neer to it of its ſelf, but this remedy is a little**Practice and ſucceſs commends it, nor is there reaſon wanting to defend it: wherefore notwithſtanding the Authors ſenſe, it may be ſucceſsfully continued. Superſtitious: wherefore I am not for it, it being ſufficient to keep the Belly very warm, in the ſituation we have directed, and prevent the leaſt cold.
As for Swaths convenient to a Woman new laid, they need not be us'd the firſt day, or at leaſt but very looſely, eſpecially when there hath been a hard Labour; becauſe the leaſt compreſſion of the Womans Belly, which is then very ſore, as the Womb alſo is, having been much harraſſed, proves a great inconveniency to her, wherefore let her not be ſwathed until the Second day, and that very gently at the beginning. Midwives believe that they ſerve inſtead294 of Boulſter, as well for the keeping the Womb up in its place, as to ſqueeze out from all parts the Cleanſings which are neceſſary to be evacuated: And Nurſekeepers, abuſed with this belief, do ſometimes ſwath their Bellies ſo ſtrait, that they do bruiſe the Womb, which is very painful in the beginning of Child-bed, and from whence often follows very dangerous Inflamations.
Theſe Swaths and Boulſters can have no hold to ſupport the Womb as they imagine, foraſmuch as its**Bottom of the Womb. Fund, which is the principal part being flitting in the Cavity of the††Lower Belly. Hypogaſter, cannot be kept ſtable and firm by that which is applied upon the Belly, and beſide the interpoſition of the Bladder which is upon it, will not permit it.
As to their opinion that ſuch Swathings help to cleanſe the Womb, 'tis fit they ſhould be diſabuſed of this Error; for it is not the ſame thing in theſe Cleanſings, as preſſing the juice out of boil'd meat in a Napkin, for theſe are wholly a work of Nature which a ſtrong compreſſion (inſtead of helping) hinders, by the pain it cauſes to the Womb, and the Inflamations that follow. Without dwelling then upon the ordinary manner of Swathing, let us be guided according to the dictates of Reaſon, and not according to the Nurſ-keepers naughty Cuſtoms, whoſe Method is firſt to put upon the Belly a Swath four or five double, of a triangular Figure, to ſupport (as they pretend) the Womb, and ſometimes two others Roulers very ſtrait, on each ſide towards the Groine, to keep it in its place, leſt it be ſhaken, and encline more to one ſide than295 t'other, with yet another broad ſquare Swath for the whole Belly, which they put upon the firſt, afterwards they make a Swath of a Napkin folded two or three double, of the breadth of a quarter of an Ell, with which they do very much girt and compreſs the Belly.
I do very well approve of the uſe of theſe Swaths, and of a good large ſquare Boulſter over the whole Belly, provided they be very looſe the firſt ſeven or eight daies, only to keep it a little ſteady, obſerving in the mean time to take it off, and remove it often, to anoint the Womans Belly all over (if it be ſore, and that ſhe have After-Pains) with Oile of ſweet Almonds and St Johns Wort mixed together, which may be done every day: But after that time, they may by degrees begin to ſwath her ſtraighter, to contract and gather together the parts, which were greatly extended during her going with Child, which may be then very ſafely done; becauſe the Womb by thoſe former cleanſings is ſo diminiſhed and leſſened, that it cannot be too much compreſſed by the Swaths. Let us now ſee what is fit to be done to the Breaſts.
Proper Remedies may be applied to them, for to drive back the Milk, if the Woman will not be a Nurſe, of which we ſhall ſpeak hereafter; but if ſhe intends to be a Nurſe, 'twill be ſufficient to keep her Breaſts very cloſe, and well covered with gentle and ſoft Clothes, for to keep them warm, leſt the Milk curdle in them; and if there be danger of too much Blood being carried thither, anoint the Breaſts with Oile of Roſes, and a little Vinegar beat together, and put upon them ſome fine Linnen dipt in it, obſerving that if the Woman296 do ſuckle her Child, ſhe gives it not the Breaſt the ſame day ſhe is brought to Bed, becauſe then all her Humours are extremely moved with the Pains and agitation of the Labour; wherefore let her defer it at leaſt till next day, and it would be yet better to ſtay four or five days, or longer, to the end the fury of the Milk and the abundance of humours, which flow to the Breaſts in the begining, may be ſpent, in which time another Woman may give it ſuck. Let us now diſcourſe of a fit Diet for the Woman to keep, during her whole Child-bed.
ALthough a Woman be naturally delivered, yet notwithſtanding ſhe muſt obſerve a good Diet, to prevent many ill accidents, which may happen to her during her Child-bed; at the begining of which ſhe muſt be directed in her Meat and Drink, almoſt as if ſhe had a Fever, that ſo it may be prevented, inaſmuch as ſhe is then very ſubject to it; ſo likewiſe it often happens to her by the leaſt neglect committed towards her in her tending.
For this Reaſon one muſt not be of the opinion297 of many Nurſe-keepers, who will have a new-laid Woman to be well fed, as well to reſtore her loſt ſtrength, by the tediouſneſs of the Labour, and by the quantity of Blood then evacuating, for which cauſe they believe the Woman muſt be well nouriſhed to make more Blood, as alſo to fill up her Belly, which is very much emptied by the Birth of the Child: but it is much better to follow in this the counſel which Hippocrates gives us in his Tenth Aphoriſm of the Second Book, where he ſaies, Impura corpora quo plus nutriveris, eo magis laeſeris; The more you nouriſh impure Bodies, the more you hurt them. Now it is certain that a Woman newly delivered is of this ſort, as you may know by the quantity of Cleanſings and Superfluities which flow from her Womb at this time, when for this reaſon they muſt be very regular in their Diet, eſpecially the three or four firſt daies, in which time ſhe muſt be nouriſhed only with good Broaths, new laid Eggs, and Jellies, without uſing at the beginning more ſolid Meats; but when the great abundance of her Milk is a little paſt, ſhe may with more ſafety eat a little Broath at her Dinner, or a ſmall piece of boil'd Chicken, or Mutton, as ſhe likes beſt; afterwards, if no accident happens, they may by degrees nouriſh her more plentifully, provided in the mean time, that it be a third part leſs than ſhe was accuſtomed to take in her perfect Health, and that her Food be of good and eaſie digeſtion; not ſuffering her to eat any of thoſe Cakes, Tarts, or other Paſtries, which are uſually provided at the Childs Baptiſm. As for her Drink, let it be Ptyſan, [which is Liquoriſh, Figs and Aniſeeds boiled in Water] or at leaſt boil'd298 Water, being careful not to give it her too cold; ſhe may alſo (provided ſhe be not Feaveriſh) drink a little white Wine, well mixed with Water, but not till after the firſt Five or Six days.
Although I preſcribe this Rule in general for all thoſe who are newly brought to Bed; yet there are ſome who muſt not obſerve it ſo exactly as laborious Women, who being of a very ſtrong and rebuſt conſtitution, require a more plentiful feeding, to whom notwithſtanding, if they do not change the quality, they muſt at leaſt retrench the quantity of their ordinary food, having alwaies reſpect to what every perſon accuſtom themſelves to, which the ſame Hippocrates doth likewiſe teach us in the 17th Aphoriſm of the firſt Book, where he ſaith, Animadvertendi ſunt quibus ſemel aut bis, & quibus copioſior aut parcior aut per partes Cibus eſt offerendus, dandum verò aliquid tempori, regioni, aerati, & conſuetudini. Great care and notice muſt be taken to whom to give meat once only or twice; as alſo to whom to give more, or to whom leſs, or by little and little; but ſome allowance muſt be made in reſpect of Time, Countrey, Age and Cuſtome.What we have already ſaid ſhall ſuffice for direction in their Meat and Drink.
The Child-bed Woman muſt likewiſe keep her ſelf very quiet in her Bed, lying on her Back, with her Head a little raiſed, and not turning often from ſide to ſide, that ſo the Matrix may be the better ſetled in its firſt Scituation: ſhe muſt free her ſelf at that time from all care of buſineſs, leaving it to the management of ſome of her Kindred or Friends; let her talk as little as may be, and that with a low voice, and let no ill news be brought299 to her, which may affect her; becauſe all theſe things do cauſe ſo great a commotion or perturbation of her Humours, that Nature not being able to overcome them, cannot make the neceſſary evacuation of them, which hath been the death of many.
The Citizens Wives have a very ill Cuſtom, which they would do very well to refrain, that is, they cauſe their Children to be baptized the ſecond or third day after their Labour; at which time all their Relations and Friends have a Collation in the Child-bed Room, with whom ſhe is obliged to diſcourſe, and make anſwers to the Goſſips and all Comers a whole After-noon together, with the uſual Complements of thoſe Ceremonies, enough to diſtract her; and though there is ſcarce any of the Company which do not drink her Health, yet by the noiſe they make in her Ears, ſhe loſes it: beſides all this, ſhe is often conſtrained, out of reſpect, to forbear the uſe of her Bed-pan and other neceſſaries, which are very prejudicial to her: and this happens juſt at the time when ſhe ought to have moſt reſt; becauſe about the third day the Milk flowes in greateſt quantity to the Breaſts; this is the reaſon why ordinarily the next day they have a very great Feaver. She ought alwaies to keep her Body open with Clyſters, taking one once in two daies, which not only evacuate the groſs Excrements, but alſo by drawing downwards cauſe her to cleanſe the better. When ſhe hath obſerved this Rule a fortnight or three weeks, which is very near the time of having cleanſed ſufficiently, that thoſe parts may be throughly cleanſed before ſhe goes abroad, and300 begins upon a New ſcore; let her take a gentle Purge made of Senna, Caſſia, Syrup of Succory with Rhubarb, which is good to purge the Stomach and Bowels of thoſe ill Humours, Nature could not evacuate by the Womb, as it did the other Superfluities; this Purge may be repeated if neceſſary: all which being done, and that no indiſpoſition remain, ſhe may bath once or twice, or to waſh and cleanſe her Body, and afterwards ſhe may govern her ſelf according to her former Cuſtome.
THere are many Remedies uſed to this purpoſe, ſome of which hinder the afflux of humours to the Breaſt, and others diſſipate and in part diſſolve the Milk therein contained.
Thoſe which hinder the Humours from plentifully flowing thither, are Oile of Roſes well mixt with Vinegar, with which the Breaſts are to be anointed all over; or Unguentum Populeum, with Ceratum refrigerans Galeni, equally mixt and extended upon a piece of Linnen, or gray Paper, and ſo applyed to the Breaſts. Others uſe Linnen dipt in luke-warm Verjuce, in which a little Allom is diſſolved, that ſo it may be more Aſtringent; and others lay to them the Lees of Red Wine alone, or mixt with Oyl of Roſes.
301Thoſe Remedies which diſſolve and diſſipate the Milk from the Breaſt is a Cataplaſme of the four**Of Linſeed Fenugreek, Beans, and Fitches. Branns, Honey and Saffron, boiled with the Decoction of Chervil or Sage.
Others apply Honey only, and ſome others rub the Breaſt alone with Honey, and put upon it the Leaves of Red-Cabbadg, the great Stalks firſt being taken away, and they a little deadned before the fire; this remedy doth very readily drive away the Milk.
There are ſome which boil Sage and Box Leaves in Urine, with which they do foment the Breaſts pretty warm, and lay a Cloth upon them dipt in it. But great care muſt be taken in the application and change of theſe things, that the Woman catch not the leaſt cold, as alſo that no Inflammation or Impoſtumation be cauſed, inſtead of driving back the Milk: Wherefore ſuch Remedies are to be choſen as are reſtraining, repercuſſive, or reſolving, according to the different diſpoſitions required.
I know ſome Women who hold it for a very great ſecret, and moſt certain and fit to drive the Milk effectually back; and that is to put on her Husbands ſhift yet warm, immediatly after he hath taken it off, and wear it until the Milk be gone: but in caſe the Milk doth in the mean time vaniſh, 'tis ſuperſtitious to believe that this Shirt is the cauſe of it, and that it can produce ſuch an effect; it happens rather, becauſe all the humours of the Body of their own accord taking another courſe than to the Breaſts, do not daily flow in ſo great abundance to them: Wherefore in the uſe of302 all theſe Remedies, the principal muſt not be forgotten, which is, to take care that they tend downwards, procuring to that purpoſe a good and ample evacuation of the**Cleanſings. Lochia, which is much furthered by keeping the Belly open by Clyſters provoking them, in doing whereof the Milk will ſoon vaniſh.
All that we have ſaid in the former Chapters of this Third Book, is only to be obſerved when the new-laid Woman hath no manner of Indiſpoſition, for in caſe that any happen, ſhe muſt be governed in another manner, and according as the Accidents require, of which we intend now to treat in the following Chapters.
WE have elſewhere mentioned the Flooding which precedes Labour, and ſhewed the only means to remedy it, which is to deliver the Woman aſſoon as poſſible; let us now ſee what is fit to be done to that which happens immediatly, or in a little time after, proceeding from the late opening of the orifices of the Veſſels of the Womb, by the looſening of the Secondine which cleaved to it: this Blood flowes then ſo much more abundantly,303 by how much it is ſubtiler and hotter, or by the agitation of a long and hard Labour, and beſides when a Woman is Sanguine or Plethorick.
This Accident may often happen by a too ſudden or violent pulling away of the After-Burthen, and ſometimes from ſome part of it being left behind in the Womb, or elſe ſome falſe Conception; which then endeavouring to expel, it preſſes and forceth forth the Blood out of the Veſſels newly opened, and ſometimes a great Clod of Blood remaining in the bottom of the Womb will produce the ſame effect, which by reaſon of the diſtention it often cauſes, excites Pains like to thoſe a Woman endures before Labour, and doth not ceaſe tormenting her, until ſhe hath voided it, and then ſhe is at eaſe; but ſometimes the Blood continuing ſtill to flow, and remaining in the bottom of the Womb, becomes new Clods; which is the cauſe why the accident renews again as before, and continueth ſo by fits, in the intervals of which there comes away ſome Seroſities of the Blood retained, which diſſolves; and makes ſome perſons, ignorant of the Art, to think that the Flux is ſtopt, although it ſtill continues flowing within, where it ſtops only by ſome blood ſo coagulated; but when this Clod comes away the Flooding begins again, pure Blood and in great abundance.
Flooding is a more dangerous Accident than any other which may happen to a Woman newly laid, and which diſpatches her ſo ſoon, if it be in great quantity, that there is not often time to prevent it. Wherefore in this caſe convenient Remedies muſt be ſpeedily applied, as well to ſtop it, as to turn it back from the places whence it flowes.
304To which purpoſe 'tis fit to conſider what cauſeth this Flooding, and if it be a falſe Conception, piece of the Burthen, or clodded Blood remaining behind, all diligence muſt be uſed to fetch them away, or to cauſe a ſpeedy expulſion of them; but if when nothing remains behind in the Womb, the Blood doth notwithſtanding continue to flow, you muſt bleed the Woman in the Arm, not ſo much thereby to empty the fulneſs, as to make diverſion; let her Body be laid equally flat, and not raiſed, that ſo the Blood may not be ſent down to the lower parts; let her keep her ſelf very quiet, without turning from ſide to ſide, that ſo the Humours may not be ſtirred, the upper part of her Belly muſt likewiſe not be ſwathed or boulſtered, for ſuch ſtraitneſs augmens the evil; let her Chamber be kept a little cool, and let her not be too warm covered in her Bed, that ſo the flooding through Heat may not be continued. All the world forbids Clyſters in this caſe, leſt, as they ſay, the humours be drawn down in great abundance; but I have twice experimentally found the contrary, where great Floodings have been ſtopt by Clyſters, of which I will give you a particular account, that ſo it may be uſeful on the like occaſion.
I was three years ſince called to a Woman, who was ſurprized with a very great Flooding immediatly after the Midwife had delivered her, which ſhe had done with too much violence, as the good Woman aſſured me; who told me, She felt a very great pain at the inſtant ſhe pull'd away the Afterbirth, and that ſhe perceived at the looſening of it a Crack: Now from the moment that ſhe was ſo305 delivered, ſhe loſt, for five or ſix daies continually, ſo great abundance of Blood, that I could ſcarce believe ſhe could without dying, had I not ſeen it my ſelf: during all this time they had to no purpoſe uſed all the means they could imagine to ſtop this accident, and becauſe with it ſhe complained of great pains in her Belly, they gave her Anodine and cooling Clyſters, for fear leſt giving her others more ſtrong, the Flooding would be more and more excited: She had taken ſo four or five Clyſters, which came away as they were given, without any Excrement; which ſeeing, and judging that aſſuredly ſome groſs Excrements (being retained in the Inteſtines from before the time of her Labour, which could not be evacuated by theſe Anodine Clyſters) did cauſe ſo great a Chollick, which ſhe felt all over her Belly, which appeared puft up; I cauſed her to take one common and one pretty ſtrong Clyſter, contrary however to the opinion of moſt perſons, who not knowing the cauſe of the diſtemper, bade me have a care leſt it ſhould, as they ſaid, cauſe a greater Flooding; but the iſſue of it was quite otherwiſe than they expected; for the good Woman voided with this Clyſter a Pan full of groſs Excrements, which having ſtaid there a long time, and being thereby hardened, had ſtopt the Paſſage of much Wind, which paſſed away at this time. Now the Inteſtines full of this groſs matter, being every moment agitated by this Wind, did likewiſe agitate and continually compreſs the Womb, by means of which the Flooding was always maintained, which did ceaſe immediatly after this Chollck was diſſipated by the evacuation of theſe Excrements; and306 ſince that time being again called upon the like occaſion of loſs of Blood, proceeding from the ſame cauſe, and having taken the ſame courſe, the iſſue of it was likewiſe the ſame. Wherefore if there be the leaſt appearance of Excrements contained in the Inteſtines, make no ſcruple to give Clyſters to evacuate them, forbearing in this caſe thoſe that are Aſtringent, becauſe they harden and retain yet more that which augments the diſtemper.
Theſe three Figures repreſent ſeveral Peſſaries fit for the ſupporting and keeping up of the Womb, that it may not fall out, as it doth in a bearing down.
I Shall, the better to explain the thing, make two ſorts of Bearings down or Relaxations, as alſo two ſorts of Fallings forth, or Precipitations of the Womb; all which differ but in the degree, according as they fall down more or leſs: for the Relaxation is when the Womb only bears down and comes not forth; and the Precipitation is, when it comes out of the Body.
The firſt ſort of Bearing down is that, in which the whole body of the Womb falls into the Vagina, in ſuch manner, that putting up the Finger, one may feel the orifice very neer. The ſecond ſort of Bearing down is, when the Womb being yet lower, one can manifeſtly perceive this Orifice quite without.
The Falling-out is alſo of two ſorts; in the firſt the Womb comes quite forth, but is not turned inſide out, nor can the inſide of it be ſeen, but308 only its Orifice, which appears at the end of a great fleſhy maſs, which makes the body of the Womb; and this is called Prolapſus Uteri, that is, A falling forth of the Womb. And the other falling out, of all is moſt dangerous, and is called Perverſio, or turning inſide out; for then it is not only fallen forth, but the bottom of it is turned quite out, that ſo you may perceive it all even, and without an Orifice; becauſe it is ſo turned. The Womb turned on this faſhion appears to be only a great piece of bloody fleſh, (and almoſt like the**A mans Cod. Scrotum) which hangs between the Womans Thighs; and that which is wonderful in this caſe is, that the Infants houſe, which is the Womb, goes forth at the Gate, which is the inner Orifice.
The Bearing down of the Womb proceeds either from a Relaxation or Ruption of the Ligaments. Women that have abundance of the Whites, are ſubject to theſe Relaxations, and the Ligaments are extended or broken by hard and violent Labour, as alſo by too frequent bearing of great and heavy Children, ſometimes by a great Cough, by ſtrong and frequent Sneezings, or having leaped or fallen from high places, by going in a Coach, Cart, on Horſ-back, or in other rude and ſhaking Carriages; by having lifted up beyond their ſtrength heavy burthens, by lifting up the Arms too much, and putting them over the Head; by a tedious looſneſs, with great Pains and Needing; foraſmuch as all theſe things do ſhake and extremely thruſt the Womb downwards when it is with Child, and the Ligaments being by this means looſened or broken309 cannot keep it up any longer, which is the cauſe that a bearing down doth eaſily follow the birth of a Child; but the moſt ordinary cauſe of theſe Bearings down, or fallings out of the Womb, is violent and hard Travails, which uſually happens when a Child comes wrong, ſo that it cannot be born, and when it hath too big a Head, or when the inner Orifice is not dilated ſufficiently for to give it paſſage at that time, for the Womb is then forced down with ſo much violence, and yet the Child cannot advance into the Paſſage, becauſe the Ligaments are extremely rent or looſened, and likewiſe when the Secondine cleaving cloſely to the bottom of the Womb is pulled away of a ſudden, or with too much violence, and much the ſooner, if that putting up the Hand into it (as it is neceſſary when the String is broke) one takes hold and pulls the body of the Womb itſelf, inſtead of the After-birth. We have, in the 13th Chap. of the Second Book, given ſuch directions as will prevent this miſtake, and bring it away ſafely.
A Woman troubled with this falling out of the Womb feels a great weight at the bottom of her Belly, with an extreme pain in her Reins and Loins towards the place where theſe Ligaments are faſtned, and a reddiſh bloody moiſture is perceived to paſs through this maſs of Fleſh which hangs between her Legs. A Relaxation may happen to all ſorts of Women from any of the cauſes above mentioned; but a falling out but ſeldom, and a perfect Perverſion never but upon a Delivery, or immediatly after; becauſe then the inner Orifice is almoſt as wide as the bottom of it, which is not ſo at other times, when being cloſed, there is no poſſibility310 for it to be thus turned inſide out. I have ſhown in the 16th Chap. of the Second Book, how to prevent this Accident at the time of Labour in a Woman that is ſubject to it; to which place you may have recourſe to avoid repetition.
If a ſpeedy remedy be applied to the Relaxation and falling out of the Womb, by reducing and remitting it into its natural place, a Cure may be eaſily expected; and ſo much the rather, by how much the Woman is young, and the Malady freſh: but if ſhe be old, and this Diſeaſe be already of a long ſtanding, ſhe is ſo much the more incurable.
For the Cure of this diſtemper regard muſt be had to two things; the Firſt is, to reduce the Womb into its natural place, and the Second is to ſtrengthen it, and keep it there.
For the execution of the firſt, which is to reduce it, if the Womb be quite out, or turned, the Woman muſt firſt of all be made to render her Urine, and a Clyſter muſt be given her, if it be neceſſary, for to empty the groſs Excrements that are in the Rectum, that ſo the reduction may be the eaſier performed; then place her on her Back, with her Hips raiſed a little higher than her Head, and then foment all that is fallen forth with a little Wine and Water luke-warm, and having taken a ſoft Rag, put it up into its proper place, thruſting it back, not all at once, but wagging it by little and little from ſide to ſide; and in caſe this be too painful, becauſe it is already too big, and ſwelled, anoint it with Oile of ſweet Almonds, for the more eaſie reduction of it, being careful aſſoon as it is reduced, to wipe off the Oile as much as may be, to311 avoid a Relapſe. But if notwithſtanding all this the Womb cannot be put up, becauſe it is very much enflamed and tumefied, which happens when it hath been a long time ſo, without the uſe of neceſſary means, during which time it is continually moiſtened with Urine and other Excrements, which contribute very much to its corruption; in this caſe there is great danger that it will gangrene, and be afterwards the death of the Woman. There have however ſome Women eſcaped this accident; Pareus recites the Hiſtory of ſuch an one, which Rouſſet doth alſo amongſt his Caeſarean-births; but this happens very rarely.
As to the ſecond part of this Cure which conſiſts in the retention of the Womb in its place, and the ſtrengthening of it ſo reduced, it will be done by a convenient ſcituation. Let the Woman for this purpoſe keep her ſelf in Bed on her back, having her Hips a little raiſed, her Legs ſomething croſſed, and her Thighs joined together, to prevent the falling of it out again; but the beſt way is to put up a Peſſary into the Neck of the Womb, for to keep it firm. There are two or three ſorts made for this purpoſe, the ſeveral Figures of which are at the beginning of this Chapter. Some are round and a little longiſh, of the figure of an Egg, and of the length and bigneſs of the Neck of the Womb, where it muſt be left after that it is introduced into it; but theſe are often ſubject to fall out again, and are not ſo uſeful and convenient as the other, which are made of a piece of Cork, that they may be light. They ought to be of a thick circular figure, like to a ſmall wreath, and pierced with a pretty big hole in the middle, which ſerves312 aſwel for the lodging, ſupporting and receiving of the inner orifice of the Womb, as for the giving paſſage to the ſuperfluous humours, which are thence evacuated. Theſe kind of Peſſaries muſt be covered with white Wax, that they may be more ſmooth and incapable of hurting the Woman that uſeth them: they muſt be pretty large, that they may be the eaſier kept when they are put up: they may alſo have a ſmall String faſtened to them, to pull them out at any time to clean: But this String is not ſo very neceſſary, becauſe they may be eaſily enough taken out with one Finger: they may be made ſome of them exactly round, and others ſomething of a ſquare Figure or triangular: the corners muſt be rounded or blunted. Theſe ſometimes hold better, and fall not ſo eaſily forth as the round; but either the one or the other may be uſed, as ſhall be thought moſt fit.
During the flowing of the Lochia from the Womb, nothing els muſt be uſed to ſtrengthen, but only to keep it ſo in its natural place; for aſtringent Remedies proper for the prevention of the Relaxation of it will very much prejudice the Woman, by ſtopping of theſe evacuations; and above all it muſt be obſerved in this diſtemper, that the Womans Belly be not ſtrait ſwathed any more than for a ſtay only, in which many Midwives are deceived, believing they keep it the better in its place by how much they ſwath the Belly the ſtraiter, for by this ſtrong compreſſion of it they force the Womb yet more down. She muſt uſe the Bedpan in Bed, & lying along if poſſible when ſhe goes to Stool, keeping her hand all the while on the bottom of her Belly, to bear it up. But when the time of313 her Purgations is fully over, and that ſhe hath cleanſed very well, aſtringent Injections may be then uſed without danger; reſpect muſt likewiſe be had to the whole habit of the Body, to dry up the humours by an univerſal courſe; and the Woman muſt not riſe out of her Bed in at leaſt five or ſix Weeks time, that ſo the Womb and its Ligaments may be reſtored and fortified in their natural Scituation.
It happens alſo ſometimes that by the great Throwes the Woman endures at her Labour, the Fundament falls quite out; in this caſe, if the Child be very forward in the Paſſage, 'twill be ſufficient before this accident happens to hinder it if poſſible, perſuading the Woman not to help her Throwes ſo ſtrongly; but if it be already fallen down, they muſt ſtay till the Child be born ere it can be put up; for before that it will be difficult to do without much bruiſing the Inteſtine. Aſſoon then as the Woman is delivered, let it be reduced in the ſame manner as that of the Womb, after having fomented, bathed and anointed it, if neceſſary, forbearing afterwards during her Childbed the giving of her Clyſters, becauſe the force ſhe uſeth in rendring of them, will again cauſe the falling down of the Fundament.
IT is no wonder that often, and eſpecially in firſt Labours, there happens bruiſes amd rents in the lower parts of a Woman; the cauſe of which is eaſily known, if the bigneſs of the Childs Head be but conſidered, which muſt needs make a great diſtention of thoſe ſtrait parts, by paſſing and coming forth of the Womb; which parts, being thereby extremely preſſed againſt the hardneſs of the bones thar ſurround it, are eaſily bruiſed, and when they are not able to be ſufficiently dilated, they muſt neceſſarily be torn aſunder.
Almoſt all Women in their firſt Labours do very much complain when the Child is in the Paſſage, that the Midwives prick and ſcratch thoſe parts, and do believe that the hurts and bruiſes which are there, after Labour, do happen becauſe the Midwives handled them too roughly; but they are very much miſtaken, for this comes becauſe the Childs Head in paſſing makes a violent diſtention and ſeparation of the four Caruncles and other adjacent parts which are bruiſed, and ſometimes rent by it; from hence ſpring the pains of which they then complain, as if they were pricked and ſcratched, whereof they are never after ſenſible in their following Labours, becauſe thoſe parts having once given way to an Infant, are ever after very315 eaſily relaxed and extended, and every Travail with leſs Pain than other.
Theſe contuſions and rents muſt never be neglected, leſt they degenerate into malignant Ulcers; for the Heat and Moiſture of theſe parts, beſides the filth which continually flows thence, doth eaſily contribute towards it, if convenient Remedies be not timely applyed: Wherefore aſſoon as a Woman is laid, if there be only ſimple Contuſions and Excoriations, apply the Cataplaſme formerly directed to thoſe lower parts to eaſe pain, made of the Yolks and Whites of new-laid Eggs and Oyl of Roſes ſeeth'd a little over warm Embers, continually ſtirring it till it be equally mixt, and then ſpread upon fine Cloth; it muſt be applyed very warm to the bearing-place for five or ſix hours; when, being taken away, lay ſome fine Rags dipt in Oyl of St Johns-wort on each ſide the bearing-place, and renewing them twice or thrice a day, foment theſe parts with Barley Water and Honey of Roſes, to cleanſe them from the Excrements which paſs; and when the Woman makes Water, let them be defended with fine Rags, to hinder the Urine from cauſing ſmarting and pain by touching them.
Sometimes the Bruiſes are ſo great, that the Bearing-place is inflamed, and a very conſiderable Abſceſs follows, which I have met with; in which caſe it muſt be opened juſt below the ſwelling, in the moſt convenient place; and after the matter is evacuated, a Deterſive Injection muſt be injected into the Cavity, with the ſame Fomentation above-mentioned; viz. Barley-water and Oyl of Roſes, which may be a little heightned with Spirit of Wine, if there be any danger of Corruption, and316 afterwards the Ulcer muſt be dreſſed according to Art.
But ſometimes it happens by an unlucky and deplorable accident, that the Perinaeum is rent, ſo that the Privity and Fundament is all in one; if it were ſo let alone without reunion, the Woman afterwards happening to be with Child would indeed be delivered with more eaſe, and without danger of ſuffering the ſame again, as is uſual when healed after ſuch an accident; but likewiſe if it remains in this manner, 'tis ſo great an inconvenience, that her Ordure comes both waies. Wherefore having cleanſed the Womb, from ſuch Excrements as may be there, with red-Wine, let it be ſtrongly ſtitched together with three or four ſtitches or more, according to the length of the ſeparation, and taking at each ſtitch good hold of the fleſh, that ſo it may not break out, and then dreſs it with an agglutinative Balm, ſuch as is Linimentum Arcei, or the like, clapping a Plaiſter on, and ſome linnen above it, to prevent as much as may be the falling of the Urine and other Excrements upon it; becauſe their acrimony would make it ſmart, and put it to pain: and, that theſe parts may cloſe together with more eaſe, let the Woman keep her Thighs cloſe together, without the leaſt ſpreading, until the cure be perfected. But if afterwards ſhe happen to be with Child, ſhe will be obliged, to prevent the like miſchief, to anoint thoſe parts with emollient Oyls and Ointments; and when ſhe is in Labour, ſhe muſt forbear helping her Throws too ſtrongly at once, but leave Nature to perform it by degrees, together with the help of a Midwife well inſtructed in her Art, who being warned by the firſt diſgrace,317 will do her beſt to avoid a ſecond; for uſually when theſe parts have been once rent, it is very difficult to prevent the like in the following Travail; becauſe the Scar there made doth ſtraighten the parts yet more; wherefore it were to be wiſhed for greater ſecurity againſt the like accident, that the Woman ſhould have no more Children.
Now if by neglecting ſuch a rent, the Lips of it be cicatriced, and that Cure be deſired, you muſt with a good pair of Sciſſers cut off thoſe Scars in the ſame manner as is done in a Hare-lip, and it muſt afterwards be dreſt accordingly, or as if it newly happened.
THe moſt common accident that uſually troubles moſt Women during their lying in, is after-Pains.
We have formerly ſhewed how they are accuſtomed to be prevented in giving the Woman immediatly after ſhe is laid two Ounces of Oyl of ſweet Almonds, drawn without fire, with as much Syrup of Maiden-hair; but ſince notwithſtanding this Remedy the Woman is much pained in her Belly, let us enquire what may be the cauſe of all theſe gripes, which are uſually called without diſtinction After-pains, and are ſometimes felt about the Reins, Loins, and Groins, ſometimes in the318 Womb only, and ſometimes about the Navel and all over the Belly, either continually, or by fits with ſome remiſſion, in a certain place, or ſometimes on one ſide and ſomtimes on another; all which reflections teach exactly their ſeveral cauſes, and accordingly the Remedies muſt be varied.
The Pains of the Belly for the moſt part proceed from one only of theſe four cauſes, or ſeveral of them together; the firſt is by Wind contained in the Bowels, by which they are eaſily filled after Labour, as well becauſe they have more room to dilate then when the Child was in the Womb, by which they were compreſt, as alſo becauſe the nouriſhment and matter contained as well in them as in the Stomach, have been ſo confuſed and agitated from ſide to ſide, during the pains of Labour, by the frequent Throws which alwaies much compreſs the Belly, that they could not be well digeſted, whence this wind is afterwards generated, and conſequently the Gripes which the Woman feels running in her Belly from ſide to ſide, according as the Wind moves more or leſs, and ſometimes alſo towards the Womb, becauſe of the compreſſion and commotion which the Bowels make, being extremely thereby agitated.
The Second Cauſe of theſe Gripes which torments the Woman as much as the former, is that which proceeds from ſome ſtrange body reſting in the Womb after Labour, which it endeavors to expel by continual Throws, and it is ſometimes a falſe Conception, or a piece of the Burthen, and very often clodded Blood which cauſe this torment, and never ceaſe til what is ſo contained in the Womb be come319 away, theſe Pain•are very like the ſame that a Woman endures before ſhe is delivered, and are not abated by Clyſters, as thoſe are that proceed from Wind; but on the contrary are rather thereby excited and augmented.
Thirdly, Theſe Pains are often cauſed by the ſudden ſuppreſſion of the**Childbed cleanſing. Lochia, which abundantly filling the whole ſubſtance of the Womb, cauſeth a great diſtention, and by its long ſtay an inflammation, which is communicated by means of the Peritonaeum to all the parts of the lower Belly, by eaſon whereof it ſwells, and is extended, and grows extreamly hard, which accident continuing, very often kills the Woman in a ſhort time after.
The Fourth and laſt cauſe of theſe Pains, is the great extenſion of the Ligaments of the Womb, by reaſon of a hard Labour; here they remain more fixt about the Reins, Loins and Groins than any other part; becauſe they are the places where theſe Ligaments are faſtened, however theſe Pains do ſometimes communicate themſelves by continuity to the whole Womb, and the rather when it hath been bruiſed by a violent Labour.
'Tis commonly held, that a Woman is not troubled with theſe Pains ſo much of her firſt Child, as of the following; but daily experience confirms us, that it happens indifferently, according as the preſent and various diſpoſitions contribute to it, either more or leſs, there being no certain rule in reſpect either to firſt or laſt Labours.
All theſe Pains muſt be cured according to their ſeveral cauſes, and to prevent thoeſ which we ſay are excited by wind, give the Woman immediatly320 after Delivery, Oyl of ſweet Almonds, and Syrup of Maiden-hair mixt together; ſome do more eſteem Oyl of Walnuts, provided it may be made of good Nuts, but this hath a worſe taſte than the other. This remedy ſerves to lenify and line the inſide of the Inteſtines with its Unctuouſneſs, by means whereof that which is contained within them paſſeth away the eaſier; but, as we have ſaid elſewhere, this mixture is ſo nauſeous, that it doth often for that reaſon more hurt than good: wherefore I prefer a good warm Broth for thoſe who have an averſion to the Oyl. Others give half a glaſs of good Hippocras, but that (in the condition the Woman is in) may do more hurt, by cauſing a Fever. Now for the better preventing theſe kind of Pains, let the Woman keep her Belly very hot, and be careful not to drink her Drink too cold; and if they torment her very much, hot Clothes from time to time muſt be laid on her Belly, or a Pan-cake fryed with Walnut-oyl may be applied to it, without ſwathing her Belly too ſtrait: And for the better evacuating the wind out of the Inteſtines, give her a Clyſter, which may be repeated as often as neceſſity requires: but if by this means the pains of the Belly are not appeaſed, 'tis certain they are maintained by ſome other cauſe.
If it be known that ſome ſtrange body is retained in the Womb, the expulſion of it muſt be procured, or it muſt be fetcht away by putting the Fingers into the Entry of it, according to the direction already given for the extracting of a falſe Conception; and if it be great Clods which (retained) do alſo cauſe theſe pains, they will not fail to ceaſe aſſoon as they are fetcht away; but alſo the ſame accident321 will ſoon return, if new Blood flowes into the cavity of the Womb, and coagulates there again, as it often happens; for it cannot endure to keep any thing in its capacity after the Childs birth.
If the Womans Cleanſings be ſuddenly ſtopt, which a little before came down in great abundance, you need not ſearch for any other cauſe of the pains ſhe endures; and the ſpeedieſt remedy is to bring them down, which is effected by Clyſters that draw downwards, by hot and aperitive Fomentations to the bearing place, and by bleeding in the Foot, preceded by that of the Arm, if the caſe require it.
As to the Pains the Woman feels in her Loins and Groins, which come by reaſon of the great diſtention, or in part ruption of the Ligaments of the Womb thereabouts faſtened, reſt alone, and a good ſcituation of the body, will be ſufficient to fortifie and reunite them without greater Medicines, becauſe they cannot be actually applied to the part affected, alwaies obſerving a good Diet; and not forgetting, in all theſe ſeveral ſorts of pains, to provide for the natural evacuation of the Lochia, for 'tis one of the principal means to obtain a good iſſue.
I Do not find that Authors have ſo ſufficiently enquired into the cauſe of the Lochia which are evacuated in Child-bed, as to make us truly underſtand what they are, either in reſpect of their Nature, affirming it to be the blood uſually purged away every Moneth before they were with Child, which being collected about the Womb, flowes away when it opens after the birth of the Child; or in reſpect of the quantity of this evacuation, and the length of time it ought to continue. Hippocrates in his Book, De Naturâ Pueri, would have at the beginning an Hemine and an half a day; of which meaſure, though common in his time, we have no certain knowledg; for ſome will have it to be our half Pint, others a Pint or therebouts, and that they continue for a Male-child thirty daies, for a Female fourty, diminiſhing every day by little and little, until there comes no more, and the evacuation is compleated. Galen ſaies that theſe Lochia are only vitious humours, and the reſidue & ſuperfluity of the Blood with which the Child was nourisſhed in the Mothers Womb. But I will, as near323 as I can, here deſcribe to you the manner how I conceive this evacuation to be made, and the reaſon why they diminiſh day by day, and change their colour, conſiſtence and quality according to the ſeveral times.
Aſſoon as the Child is born, there flowes away from the Womb, at the ſame moment, ſome wateriſh humours, beſides thoſe which came away before at the breaking of the Membranes. Theſe Waters then are very often bloody, not that they are ſo by Nature, but becauſe there is for the moſt part Blood mixed with them, which comming from the Veſſels of the Womb, becauſe of the agitation and commotion they received in the Birth, become ſo reddiſh; but immediatly after the Burthen is compleatly looſened, then pure blood flows away; and the reaſon why theſe Lochia flow freely and are very red the firſt day, is, becauſe the Veſſels againſt which the Burthen was faſtened in the Womb are but newly opened; but the Blood flowing by little and little in leſs abundance, becauſe the greateſt plenitude hath been at firſt evacuated, doth clod in ſmall drops on the extremitie; of all thoſe Veſſels whereby they are ſtop'd, and then there comes away onely the moſt ſeroſe part of it; and therefore the Lochia begin the ſecond and third day to be more pale and leſs coloured, and after that the colour of them is leſs bloody every day, as the Veſſels cloſe, until they are at length very pale; which happens when the Veſſels being almoſt perfectly reunited, there diſtills only the meer moiſture of them, as alſo of the whole ſubſtance of the Womb, through which a quantity of it doth324 likewiſe tranſude. Now theſe ſeroſe Humidities acquire by the heat of theſe places a conſiſtence ſomewhat thick, and that more or leſs, according as they come away in greater or leſſer quantity, and according to the length of time they ſtay there. And then the Lochia do almoſt reſemble, in colour and conſiſtence, troubled Milk, which makes the World believe it is Breaſt Milk which is in that manner emptied downwards; but in truth it is an Abuſe as great as common.
For my part I know no other cauſe of this ordinary change of the colour and conſiſtence of the Lochia, nor of the diminution of their quantity, than that which we daily find in the Suppuration of a great wound ſomewhat incarnated: for aſſoon as the wound is firſt made, it bleeds, freſh, and in good large quantity, becauſe the Veſſels are then open; but a little after, during the firſt and ſecond daies, it yields only bloody Seroſities; foraſmuch as ſome ſmall portions of the Blood being clodded about the mouths of the Veſſels do in part ſtop them, and afterwards ſtopping them more, it yeilds a white**Mater. Pus, which proceeding from the moiſture, ſweats through the ſubſtance of the fleſh, and of theſe Veſſels which have been but newly cloſed, acquires a thick and whitiſh conſiſtence by the heat of the part, and the ſtay it makes there. Now the better to conceive this by a compariſon, you muſt imagine that there is a kind of a wound made by the looſening of the Burthen from the Womb, by reaſon of which there happens, if it may be ſo ſaid, a kind of Suppuration, the Pus, and excretions of which are the Lochia.
325They which believe that when the Lochia ar•pale, it is the Milk of the Breaſts which flowes by the Womb, judge ſo, becauſe the Milk uſually abates in proportion to this evacuation, and ſay beſides, that by the Colour and Conſiſtency it muſt needs be Milk: but if they were acquainted with Anatomy, they would know that there was no paſſage which hath to this purpoſe a communication from the Breaſts to the Womb, unleſs they think it is done by the means of this imaginary**The communication of Veins without Arteries, whereby they help one another. Anaſtomoſis of the††Belonging to the Breaſts. Mamillary Veins with the**Belonging to the Flanks. Epigaſtrick; which cannot poſſibly be, becauſe neither of them have any tendency either to the Breaſts or the Womb, as Anatomy makes manifeſt; for the Mamillar comes from the Subclavicular under the Sternum without yielding any ſign to the Breaſts, nor ſo much as touching them, and the Epigaſtrick ariſeth from the Iliacks, without having the leaſt communication with the Womb.
Laurentius, who knew very well it was for this reaſon impoſſible Milk ſhould paſs from the Breaſts to the Womb by this paſſage, finds out another way, which is as far from the truth as the firſt. His opinion (as he ſaith) is that the Milk and Blood flow back from the Veins of the Thorax, which bedew the Breaſt to the Axillary Veins, and from thence to the Trunk of the Vena-cava, by the continuity of which they flow down into the Hypogaſtrick Branch, and from thence finally into the326 Womb: but beſides, that it would be very difficult for the Milk, after ſo long a way to come forth, without being perfectly mixed with Blood; the Circulation of the Blood, which he knew not, ſhewes us plainly that it is impoſſible, becauſe it doth mount back by the lower parts of the Body from the Vena cava to the Heart, without a poſſibility of carrying any thing into the Womb; whence it appears that he is as far as others from informing us how it can be done.
For my part I believe with much more reaſon, and I think that it is not Breaſt milk which is thus evacuated by the Lochia, but this abundance and ſuperfluous humidity which diſtills from and tranſudes the Veſſels and ſubſtance of the Womb, as I have explained, by means of which the whole habit of body being much emptied, there remains not ſufficient to be carried to the Breaſts, and little or none flowing to them; that which is contained in them is diſſipated by tranſpiration, and digeſted by the natural heat of the parts: Now the Milk by this evacuation is dried up, juſt as we ſee a Pond is that one would drain, out of which it is not abſolutely neceſſary to let the water run which fills it, but it ſufficeth to turn back the ſtream that feeds it to another place, which being done, and no more new water falling into the Pond, it will ſoon be dried up; as well becauſe the water is diſſipated in Vapours, as drunk in by the Earth which contains it. And for the ſame reaſon when we ſee Milchnurſes want their ordinary courſes