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Stockholm, where we shall take leave to bid him " good bye," assuring bim that we have been much amused with his very pleasant, lively, and intelligent manners as a traveller and a scholar. He may be at times, perhaps, prolix, and now and then disposed to rhapsodise, but be always writes with a warm interest in his subject; upon which he appears to have collected all the information that it was possible to acquire.
Art. II. Observations on the impropriety of Men being employed in the Business of Midwifery. 8vo. pp. 56. London: Hunt and Clarke, 1827.
It is astonishing at first sight, that such a thing as a man-midwife could be long tolerated in this country of modesty and morality. The exotic was derived by us from France; a country of which we may say, that its example never seems worthy of imitation in the eyes of our professional men, except on those occasions when it has neither reason nor nature on its side. But even there, the cultivation of man-midwifery has been materially checked: and the sages femmes are now rapidly increasing in number and repute.
We look on the man-midwife as neither more or less than an usurper: he has taken possession of the natural office of respectable old ladies: he subsists upon vulgar bugbears: he sits supreme arbiter of the puerperal chamber: he is no better than his name imports^ a mere menial old woman. He can boast of having expelled the whole race of matrons; a gentle and a genial craft, whose ministry was at once so safe and so soothing. What could be more decent than their attendance on the mother elect? Their "stealthy pace," as they glided from side to side, appearing in a moment at any part of the couch, where the patient might want their presence, would not have discomposed an eye-lash: ever ready with their word of sympathy or comfort; (haud ignarce mali miseris sucurrere discunt), forbearing to answer the frowardness of their pain-stricken companion, but taking all in gentleness, and waiting her humour through the long, long night, with unwinking vigilance. And then, when the danger is over, how their frown dissipates, and that low tender accent which seemed to be but the echo of the patient's sigh, is changed to a tone of congratulation: and in time, they ring out their grateful anecdote, or rally the new mother upon past perils and distresses, making the very bed-posts shiver with their modest mirth and simple pleasantries. Who is there that does not lament that any necessity should exist for the extinction of so amiable a race; ill-exchanged as we think they are for a succession of male functionaries?
Not only is the service of the one natural and desirable, but the attendance of the other is abhorrent, at least, to those whom cuscustom has not conciliated to the usage. Does then a real necessity exist for the employment of accoucheurs; or is not the plea for that necessity altogether delusive? Have they not, in good earnest, obtained possession of this branch of practice by stratagem; by working upon fear and ignorance in the first place, and establishing, by the most artful means, the example of a few, into the final custom for the many? We apprehend that the right of determining these questions must finally rest with medical men themselves: and we think that the testimony of one of the faculty, supposing him to be a person of the necessary degree of talent and experience to make his authority of sufficient value, against the expediency of male practitioners, is not far from being conclusive on the subject. We say so for this reason: It is a declaration made directly in the teeth of his own interests; and it is next to impossible, that such a man would hazard a proposition, which, if unfounded, would, he knows very well, tend to be very mischievous in practice. We allude to the recent letter of Sir Anthony Carlisle, which has created a strong sensation in the medical circles.
"Man-midwifery," he says, " has only been practised in England during the last hundred years, and it was introduced as a French fashion. From the beginning it has been strongly opposed, on the score of its indecency, by many distinguished and scientific medical men, and also, because the birth of mankind appeared to them to be a purely natural process, so wisely ordered, that it very rarely demands any other aid than experienced mothers can safely give. Even so late as the time of the illustrious mother of his present Majesty, that exemplary Queen was personally attended by good Mrs. Draper, without difficulties or misadventures; whereas the contrary result, under male management, in the fatal affair of the Princess Charlotte, and her infant, will be long remembered.
"If it should be asked why so many professional men addict themselves to a degrading vocation, it may be answered, that the practice of manmidwifery leads to unlimited power in every family, and thence to lucrative ends. Women, naturally timid, and ignorant of their own structure, are peculiarly exposed, during the most important office of their existence, to the persuasions or menaces of more knowing persons, and they are thence easily made to believe, that the natural and wholesome delays and pains of child-bed are within the control of medical or surgical art,—an assumption which is too generally acted upon, and with unvarying evil consequences, because it is a violation of the ways of nature.''
We do not understand the writer to propound, that in no case whatever is the assistance of a surgeon to be admitted, although we will venture to say that whenever his opinion comes to be combatted, the argument of his adversary will turn upon the assumption, that he had ventured upon that universal proposition. At least such has been the course pursued in the only deliberate notice of Sir Anthony Carlisle's opinion, which we have seen, proceeding from Dr. Jewell, a very eminent and esteemed professor of the obstetric art.
"If," he observes in reply, "the functions of parturition were never opposed by physiological difficulties, nor the system of the female affected by disease, midwifery would never have existed as a science; but it is these difficulties, and this aberration from healthy structure, which declare the necessity of midwifery as a science; and I would appeal to all unprejudiced practitioners, whether such do not impede the progress of labour oftener than once in " a thousand cases!" The register of every lying-in institution in the kingdom, will be a sufficient contradiction to this gratuitous assertion. Again, I would appeal to any man competent to a faithful discharge of his professional duties, whether circumstances as unforeseen as alarming, do not commonly arise, which, if not instantaneously controlled, prove destructive to the patient: and I would ask, whether there is a woman to be found possessed of sufficient nerve and capability to carry into effect those means upon which the safety of a patient so frequently depends.
"A strict knowledge of the anatomy and physiology of the parts, both in a healthy and morbid state, concerned in the process of parturition, is equally necessary for the operative practitioner in midwifery, as general anatomical and physiological knowledge is for an operative surgeon, from the acquirement of which, women are in a great measure precluded; besides, a woman, unfitted by nature, as she is, for scientific mechanical employment, can never possibly use obstetric instruments with advantage or precision, had she presumption enough to undertake their management. And I do maintain, that when difficulties, whether mechanical or otherwise, do present themselves, that practitioner will be able to render the most effectual assistance, who is most familiar with parturition in all its varieties, by attending upon all cases indiscriminately."
In this passage, we believe, is compressed the whole case of the accoucheurs. Because in one out of a vast number of cases, it is possible that a man-midwife may be of use therefore, say they, employ him in all instances. This is the reasoning of those gentlemen. Suppose that once in eight hundred times, it becomes necessary to perform such an operation in midwifery, as very dextrous and refined surgery is alone equal to; we ask, will the attendance of the operator in the other seven hundred and ninety-nine ordinary cases, fit and prepare him to execute his part in the difficult one? No such thing; but it is the art of the male midwives to diffuse an opinion that it will. To wield skilfully and successfully either forceps or crotchet, at a given time, depends on the experience a man has had in the actual use of those instruments before: indiscriminate acquaintance with midwifery cases avails nothing towards giving him a command of those revolting engines, which we have just named. Keep off the doctor, then, until the emergency arises, which calls for his interference: let him indeed be within summons, in case any lingering apprehensions disturb the sufferer: bat before this armed pacificator is introduced to the patient, let it be ascertained from the attending matron, that nature has committed a blunder, and that it is within the power of art to repair the fault. .
In those simple days, when man-midwifes were unknown amongst us, did we hear of such a thing as "alarming mortality," amongst the parturient? Was the process of giving birth to mankind dreaded like the small-pox, as an enemy of almost certain destruction? We are sure not. We are sure, also, that the proportion of prosperous labours has not been increased under the modern system; and we are further sensible, that we commit no breach of charity in asserting, that the lives which the presumption and ignorance of accoucheurs have been the means of abridging or destroying, are, at least, equal in amount to those which they have been instrumental in prolonging or preserving*. But let us look at the case more narrowly. Almost the only operations which, even admitting a great deal to the advocates for male interference, the ordinary experienced matron is not competent to execute, are those very processes, the morality, as well as legality, of which, are more than doubtful. To break the head of a living infant in utero; to lop it away, limb by limb, from the sacred resting-place, where nature had mysteriously enshrined it, even though such an operation were necessary to the preservation of the maternal life, are deeds which no law will tolerate, or religion sanctify; and which no human being, save a man-midwife, can hear of without indignation. And yet, such is the real tragedy which we find familiarly described, and coolly recommended and enjoined to be repeated in our books of midwifery cases+. This is an all important branch of the subject which, we do not despair, one day, of being able to bring before the country in all its frightful deformity.
The author of the work whose title stands at the head of this paper, objects to the employment of accoucheurs, on the score of the indecency of the custom; but more particularly on account of the enormous abuse, said to be committed by those men, of that
• In books of midwifery, we find frequently disclosures like the following :—" I recollect upon one occasion where, in my hurry to deliver the' patient, I omitted attending to this circumstance (namely, to perforate the child's head laterally), in consequence of which, the child receded into the cavity of the abdomen, where 1 was obliged to follow it, and deliver by the feet: an operation which, independent of the enlargement which it must have occasioned in the rent, put the patient to considerably more pain and distress than she otherwise would have had to encounter."— M'Keever, on Lacerations of the Uterus.
t " I turned the child," says Mr. M'Keever, describing one of his cases, "with great facility, and experienced but little difficulty until I came to the head, which I was obliged to perforate behind the ear, in consequence of some deformity in the bones of the pelvis. I employed all the force I thought justifiable, for the purpose of completing the delivery, but in vain; and I am satisfied that, had I continued my extracting efforts much longer, I should have separated the trunk from the head."— p. 14.
facility of intercourse with families which is inseparable from this line of practice. The picture of the abuses with which we are presented in these pages, is altogether extravagant; indeed, so mischievously exaggerated are its details, and so refined and sophistical its arguments, that we should not be surprised to discover in this forward railer at accoucheurs, a secret friend to their cause. At the same time we are fully persuaded, that man-midwives, much more frequently than is generally credited, make use of the opportunities and pretexts in their power to acquire influence in families, and to turn that influence to the basest purposes. Apart, however, from all this, we think there is a very decided objection to the employment of that particular class, who offer themselves for midwifery practice in the metropolis. It is necessary, for a moment, to look at the state of the profession, as it is now organised in the capital. The amount of sanatory aid, required for a given proportion of population is, we apprehend, best determined by a reference to places, where nothing hinders the demand and supply from accommodating themselves to each other. The city of Paris, where the equilibrium between those two principles is suffered to adjust itself, and which is also in circumstances very nearly alike to those of London, is the fairest example for the occasion. In Paris, the proportions of medical men (including every species of accredited dealers in medicine), to the inhabitants, is, as one to nine hundred.—In London, the proportion is, as one to three hundred and forty-five, being about the relative proportion of professional assistance, that is thought necessary for regiments going to battle, or to make a noiseless, . quite as perilous a campaign against the climate of Sierra Leone. Here is an alarming difference in the first place—this, however, might be endured—but who are the two-thirds of this superabundant proportion of medical men? They are surgeons and apothecaries, dispensers of drugs, who swarm about the metropolis, and who are encouraged to do so by a baneful system, which o: back the natural supply of regular respectable physicians. But where is the difference, it may be asked, if the apothecary cures as well as the physician? The obvious difference is this, that in the latter we have a man of generous education, of long professional preparation: but above all, we have a man who has only advice to give. He has nothing to do with the profits of drugs; and we may be sure that he will cease to recommend them, when they cease to be of any use. Now the other description of practitioner, whose caste, be it always remembered, is in possession of two-thirds of the actual practice of the town, has no mode of remuneration but the sale of medicines. He is not paid as the physician is, for attendance and counsel—he is paid for his drugs, and gives attendance gratis. In the Irish inns, formerly, the customer who called for a bottle of claret, had his dinner for nothing— We may easily believe that the wine was a profitable commodity. W. O. L. V. C