Part 38

Of Delivery, or Child-birth.

Sec. 366. It has been observed that a greater Proportion of Women die in the Country in, or very speedily after, their Delivery, and that from the Scarcity of good Assistance, and the great Plenty of what is bad; and that a greater Proportion of those in Cities die after their Labours are effected, by a Continuance of their former bad Health.

The Necessity there is for better instructed, better qualified Midwives, through a great Part of Swisserland, is but too manifest an Unhappiness, which is attended with the most fatal Consequences, and which merits the utmost Attention of the Government.

The Errors which are incurred, during actual Labour, are numberless, and too often indeed are also irremediable. It would require a whole Book, expressly for that Purpose (and in some Countries there are such) to give all the Directions that are necessary, to prevent so many Fatalities: and it would be as necessary to form a sufficient Number of well-qualified Midwives to comprehend, and to observe them; which exceeds the Plan of the Work I have proposed. I shall only mark out one of the Causes, and the most injurious one on this Occasion: This is the Custom of giving hot irritating Things, whenever the Labour is very painful, or is slow; such as Castor, or its Tincture, Saffron, Sage, Rue, Savin, Oil of Amber, Wine, Venice Treacle, Wine burnt with Spices, Coffee, Brandy, Aniseed-Water, Walnut-Water, Fennel-Water, and other Drams or strong Liquors. All these Things are so many Poisons in this Respect, which, very far from promoting the Woman's Delivery, render it more difficult by inflaming the Womb (which cannot then so well contract itself) and the Parts, through which the Birth is to pass, in Consequence of which they swell, become more straitened, and cannot yield or be dilated. Sometimes these stimulating hot Medicines also bring on Haemorrhages, which prove mortal in a few Hours.

Sec. 367. A considerable Number, both of Mothers and Infants, might be preserved by the directly opposite Method. As soon as a Woman who was in very good Health, just before the Approach of her Labour, being robust and well made, finds her Travail come on, and that it is painful and difficult; far from encouraging those premature Efforts, which are always destructive; and from furthering them by the pernicious Medicines I have just enumerated, the Patient should be bled in the Arm, which will prevent the Swelling and Inflammation; asswage the Pains; relax the Parts, and dispose every thing to a favourable Issue.

During actual Labour no other Nourishment should be allowed, except a little Panada every three Hours, and as much Toast and Water, as the Woman chuses.

Every fourth Hour a Glyster should be given, consisting of a Decoction of Mallows and a little Oil. In the Intervals between these Glysters she should be set over a kind of Stove, or in a pierced easy Chair, containing a Vessel in which there is some hot Water: the Passage should be gently rubbed with a little Butter; and Stapes wrung out of a Fomentation of simple hot Water, which is the most efficacious of any, should be applied over the Belly.

The Midwives, by taking this Method, are not only certain of doing no Mischief, but they also allow Nature an Opportunity of doing Good: as a great many Labours, which seem difficult at time, terminate happily; and this safe and unprecipitate Manner of proceeding at least affords Time to call in further Assistance. Besides, the Consequences of such Deliveries are healthy and happy; when by pursuing the heating oppressing Practice, even though the Delivery be effected, both Mother and Infant have been so cruelly, though undesignedly, tormented, that both of them frequently perish.

Sec. 368. I acknowledge these Means are insufficient, when the Child is unhappily situated in the Womb; or when there is an embarrassing Conformation in the Mother: though at least they prevent the Case from proving worse, and leave Time for calling in Men-Midwives, or other female ones, who may be better qualified.

I beg leave again to remind the Midwives, that they should be very cautious of urging their Women to make any forced Efforts to forward the Birth, which are extremely injurious to them, and which may render a Delivery very dangerous and embarrassing, that might otherwise have been happily effected: and I insist the more freely on the Danger attending these unreasonable Efforts, and on the very great Importance of Patience, as the other very pernicious Practice is become next to universal amongst us.

The Weakness, in which the labouring Woman appears, makes the By-standers fearful that she will not have Strength enough to be delivered; which they think abundantly justifies them in giving her Cordials; but this Way of Reasoning is very weak and chimerical. Their Strength, on such Occasions, is not so very speedily dissipated: the small light Pains sink them, but in Proportion as the Pains become stronger, their Strength arises; being never deficient, when there is no extraordinary and uncommon Symptom; and we may reasonably be assured, that in a healthy, well formed Woman, meer Weakness never prevents a Delivery.

Of the Consequences of Labour, or Childbirth.

Sec. 369. The most usual Consequences of Childbirth in the Country are, 1, An excessive Haemorrhage. 2, An Inflammation of the Womb. 3, A sudden Suppression of the Lochia, or usual Discharges after Delivery. And, 4, the Fever and other Accidents, resulting from the Milk.

Excessive Bleedings or Floodings, should be treated according to the Manner directed Sec. 365: and if they are very excessive, Folds of Linen, which have been wrung out of a Mixture of equal Parts of Water and Vinegar, should be applied to the Belly, the Loins, and the Thighs: these should be changed for fresh moist ones, as they dry; and should be omitted, as soon as the Bleeding abates.

Sec. 370. The Inflammation of the Womb is discoverable by Pains in all the lower Parts of the Belly; by a Tension or Tightness of the whole; by a sensible Increase of Pain upon touching it; a kind of red Stain or Spot, that mounts to the Middle of the Belly, as high as the Navel; which Spot, as the Disease increases, turns black, and then is always a mortal Symptom; by a very extraordinary Degree of Weakness; an astonishing Change of Countenance; a light Delirium or Raving; a continual Fever with a weak and hard Pulse; sometimes incessant Vomitings; a frequent Hiccup; a moderate Discharge of a reddish, stinking, sharp Water; frequent Urgings to go to Stool; a burning kind of Heat of Urine; and sometimes an entire Suppression of it.

Sec. 371. This most dangerous and frequently mortal Disease should be treated like inflammatory ones. After Bleeding, frequent Glysters of warm Water must by no Means be omitted; some should also be injected into the Womb, and applied continually over the Belly. The Patient may also drink continually, either of simple Barley-Water, with a Quarter of an Ounce of Nitre in every Pot of it, or of Almond Milk No. 4.

Sec. 372. The total Suppression of the Lochia, the Discharges after Labour, which proves a Cause of the most violent Disorders, should be treated exactly in the same Manner: but if unhappily hot Medicines have been given, in order to force them down, the Case will very generally prove a most hopeless one.

Sec. 373. If the Milk-fever run very high, the Barley Ptisan directed Sec. 371, and Glysters, with a very light Diet, consisting only of Panada, or made of some other farinaceous Substances, and very thin, very generally remove it.

Sec. 374. Delicate infirm Women, who have not all the requisite and necessary Attendance they want; and such as from Indigence are obliged to work too soon, are exposed to many Accidents, which frequently arise from a Want of due Perspiration, and an insufficient Discharge of the Lochia; and hence, the Separation of the Milk in their Breasts being disturbed, there are milky Congestions, or Knots as it were, which are always very painful and troublesome, and especially when they are formed more inwardly. They often happen on the Thighs, in which Case the Ptisan No. 58 is to be drank, and the Pultices No. 59 must be applied. These two Remedies gradually dissipate and remove the Tumour, if that may be effected without Suppuration. But if that proves impossible, and Pus, or Matter, is actually formed, a Surgeon must open the Abscess, and treat it like any other.

Sec. 375. Should the Milk coagulate, or curdle as it were, in the Breast, it is of the utmost Importance immediately to attenuate or dissolve that Thickness, which would otherwise degenerate into a Hardness and prove a Scirrhus; and from a Scirrhus in Process of Time a Cancer, that most tormenting and cruel Distemper.

This horrible Evil however may be prevented by an Application to these small Tumours, as soon as ever they appear, For this Purpose nothing is more effectual than the Prescriptions No. 57 and 60; but under such menacing Circumstances, it is always prudent to take the best Advice, as early as possible.

From the Moment these hard Tumours become excessively and obstinately so, and yet without any Pain, we should abstain from every Application, all are injurious; and greasy, sharp, resinous and spirituous ones speedily change the Scirrhus into a Cancer. Whenever it becomes manifestly such, all Applications are also equally pernicious, except that of No. 60. Cancers have long been thought and found incurable; but within a few Years past some have been cured by the Remedy No. 57; which nevertheless is not infallible, though it should always be tried.

The Use of Hemlock, which has been tried at Lyons, by all who have had cancerous Patients, having been given in very large Doses, has been attended with no Effect there, that merited the serious Attention of Practitioners. Many were careful to obtain the Extract from Vienna, and even to procure it from Dr. Storck himself. But now it appears to have had so little Success, as to become entirely neglected. E. L.

Having exactly translated in this Place, and in the Table of Remedies, our learned Author's considerable Recommendation of the Extract of Hemlock in Cancers, we think it but fair, on the other Hand, to publish this Note of his Editor's against it; that the real Efficacy or Inefficacy of this Medicine may at length be ascertained, on the most extensive Evidence and Experience. As far as my own Opportunities and Reflections, and the Experience of many others, have instructed me on this Subject, it appears clear to myself, that though the Consequences of it have not been constantly unsuccessful with us, yet its Successes have come very short of its Failures. Nevertheless, as in all such Cancers, every other internal Medicine almost universally fails, we think with Dr. Tissot it should always be tried (from the meer Possibility of its succeeding in some particular Habit and Circumstances) at least till longer Experience shall finally determine against it. K.

Sec. 376. The Nipples of Women, who give Milk, are often fretted or excoriated, which proves very severely painful to them. One of the best Applications is the most simple Ointment, being a Mixture of Oil and Wax melted together; or the Ointment No. 66. Should the Complaint prove very obstinate, the Nurse ought to be purged, which generally removes it.

_Chapter XXVII._

Medical Directions concerning Children.

_Sect._ 377.