Part 3

Men of understanding, experience, and observation, know, that the benignant hand of providence continues to anticipate in a variety of instances the interpositions of art; and nature would, upon many occasions, entirely effect her own work, if not so frequently interrupted and retarded by the officious hands and interested experiments of professional jugglers.

TO THE ACCOUCHER,

OR,

MAN-MIDWIFE.

You fortunately make your appearance upon the boards of public patronage, under the most striking advantages; the prevalence of fashion has exceeded every consideration of decency and discretion, and you are become (by the influence of pride and imitation) as necessary to the comfort of a cottage, as the happiness of a court. From the nature of your professional destination, a pleasing exterior, and an accomplished person, are invariably expected; necessarily blending (from your intended intercourse with the purer part of the creation) the precision of taste, with the perfection of the scholar.

The certificate granted you by that elaborate lecturer, the obstetric professor, proclaims you qualified in the very minutiæ of this mysterious art. The parts, externally and internally, necessary to generation, are so perfectly familiar to your “mind’s eye,” that you can extemporaneously delineate the ovariæ, the “fallopian tubes,” the fimbriæ, and the very act of conception, from the “animalculæ” in “semen masculino,” to the last stage of gestation; the gradual expansion of the uterus, the dilatation of the os uteri, the progress of labour, and all the methods of extraction.

You can clearly define the classes as natural, laborious, and preternatural; the use of the forceps, scissars, crotchet, and blunt hook; the introduction of the catheter, the extraction of the placenta, and the separation of the funis; in fact, all the et ceteras are so perfectly clear to you in theory, that it is almost treason to suppose you can err in the practice.

But, Sir, ripe as you are in these advantages, the harvest of universal applause, and the sweets of emolument, are scarcely to be acquired even by time, labour, and the most indefatigable industry. You have in the practice of midwifery, all the ills of Pandora’s box to encounter, and after twenty years practice may be left to exclaim most emphatically,

“Vain his attempt who strives to please you all.”

The only consolation you have, is, that you are destined to cooperate with subjects, whose smiles render some degree of compensation for the incessant fatigue dependant upon the practice. Under these considerations, in the full career of your expectations, it can never prove inapplicable to prepare your mind for some of the rebuffs and disappointments that inevitably ensue. I conclude you are possessed of youth, health, diligence, and constitutional stamina; but there are other requisites, equally necessary for the performance of professional duties, to which by election you dedicate the store of knowledge you have so industriously acquired. The indispensible qualifications, for the successful execution of the arduous task you are undertaking, may be comprised in very few words, and those few exceedingly expressive and readily understood; without sobriety, fortitude, judgment, and patience, you never can expect to attain the summit of excellence, or obtain admission to those families whose patronage will contribute most to both credit and emolument. But admitting you possessed of all the requisites for mere manual operation, the process of delivery, and consistency of conduct, yet there are a multiplicity of embellishments, that nothing but previous information, private instruction, or experimental practice, can sufficiently recommend to your attention.

In the awful minute of your introduction to a scene of excruciating agony and eager expectation, where the hope of a mother, and the anxiety of friends, all center in you, as the messenger of peace, throw off the ostentatious air of self-importance, exerted over those patient paupers upon whom you practised in the days of your initiation, and recollecting yourself the humble solicitant of public opinion and private favour, display your tenderness and civility, as no bad harbinger of your better qualifications. Strengthen such favourable impression by every degree of delicacy and attention to the suffering expectant, who imploring assistance from the interposition of your art, hails you as “the god of her idolatry,” by whom she is to receive an early acquittal from all her sufferings.

As this is not often to be instantly expected, and many tedious hours frequently intervene between the hope and execution, it will be necessary (exclusive of your periodical consolations to the patient’s inspiring resignation) you address yourself to the passions and foibles of the gossips, with whom you will in general be too numerously attended, and whose clamours upon many occasions are not easily to be subdued.—Notwithstanding this, the good opinions and recommendations of these motley visitors (of all ages and constitutions) are the very materials to form the foundation of report, upon which the superstructure of your reputation and future practice is to be raised.—Although gravity, even to a certain degree of solemnity, is a characteristic of your professional practice, yet there are times when you must unavoidably come forward to enliven the good ladies with a specimen of your volubility, and variegate the natural extremities of pain with the applicable insinuations of mirth. Jocular inuendoes and double entendres are not only expected, but courted in the intervals of ease, or, as the good women generally term it, “when the business stands still.”

The introduction of the tea-table and the joke are always considered equally promoters of mirth and the delivery; the practitioner is expected to be well stocked with the most fashionable recitals of seduction, rapes, fornication, and adultery, which, if well told, and applicably introduced, insures him to a certainty the future interests of his company. It will be absolutely necessary for you to fall into all the opinions of the table, except the glass of brandy repeatedly pressed upon you by the nurse (as a specific, or grand arcana, for every ill) with the very expressive plea of its not doing you any harm; and “besides, Sir, what’s good for the goose is good for the gander.”

After such casual respites (which frequently happen) when the progress of labour calls you again to your chair of office, resume the language of commiseration, giving your patient every alleviation of hope for a speedy deliverance, at the very time you are impressing (by significant looks and emphatic gestures) the attendants and friends with an idea of great difficulty and impending danger. In the alternate moments of respiration, evade every retrospective allusion to the length of the labour, by frequent insinuations that it advances rapidly, that you have great reason to hope every obstacle will be soon surmounted; but you are afraid the consolation you administer, and the pain she suffers, will take but little hold of the memory, if you may be permitted to judge from the declaration of a very pretty woman you delivered during your attendance at the Lying-in Hospital, who, in reply to your tender admonitions of fortitude and patience, said, “She was very much obliged to you for your kindness, but she was very certain it would be just the same again by that time twelvemonth.”—This will make way for any thing applicable of your own collection, but they must be all bordering upon the original cause of the scene before you; for although the patient is in extreme pain, it is not so with the attendants; they consider it a matter of course, and feel no disgust but from fatigue, which they very justly conceive they have a right to alleviate with occasional mirth—tea, and a little good brandy.

To the nurse, great part of your attention must be directed; for she, like a bellows blower to the organist at a cathedral, will expect to be included and constitute WE in all the merit of your execution.—The rapidity, or gradual progress of labour, at length closes your complicated scene of mirth and anxiety; you deliver your patient, and proceed to the subsequencies (secundem artem) all which having concluded to general admiration, and received ten thousand thanks and blessings from your subject, you convey a pecuniary hope for future services into the hand of the nurse, take a tender leave of your patient, with a promise of seeing her again in proper time, drop an attracting nod of obedience to the surrounding females, and meeting the husband at the bottom of the stairs, congratulate him upon his son or his daughter; slightly hint the difficulty of the case, the danger you apprehended, the fatigue you had undergone, all which is not worthy a thought, perfectly happy in an event that contributes so largely to the happiness of him and his family.

That part of the work being completed, that most depended upon the efforts of Nature, it becomes your duty to promote your own interest by every exertion of art. Should, after your departure, any hemorrage ensue, inevitable danger will be apprehended, the patient will be reduced, the friends alarmed, and you, in the moments of dreadful anxiety, be immediately sent for; this lucky circumstance will operate to your earnest wish; it will afford ample scope for your most fertile invention, and happily introduce a long list of styptics, anodynes, and all those necessary concomitants that give a profitable complexion to the business, by enlarging your hopes, protracting the case, and encreasing the danger.

However, should this favourable circumstance not occur, your privilege is by no means curtailed; you immediately commence your previous intentional operation of dispatching a sufficiency of balsamic anodyne draughts, “to promote and mitigate the severity of after pains, that very much distress the patient.” These draughts should be continued every four hours at least, and as a sufficient quantity of that excellent (and cheap) medicine, spermacæti, cannot be well dissolved in each draught, without rendering it too viscid in consistence, it will be peculiarly advantageous to you (as well as the patient) to let them be accompanied with boluses to be taken at the same time, composed of pulv. sperma—confect. alkermes, &c.—Let the administration of these medicines be entirely regulated by the temper, docility, and recovery of your subject; having it ever in mind, that it is neither your duty or interest to make the least observation upon their being no longer necessary, till their frequent use is complained of by the patient sufferer; and even then you are favoured by fortune in a plea, that you “are now under the absolute necessity of making unavoidable alterations for the prevention of the milk, or puerperal fever, which you very much apprehend may ensue.” That it is an invariable rule with you, never to recommend the use of medicines, but where they are highly necessary; in the present instance, it is your duty, from the motive of gratitude, to be equally circumspect, for the promotion of her health and your own reputation.

To effect every desirable purpose, a gentle diaphoresis must be supported, to prevent obstructions and promote the necessary excretions; to procure which, you must entreat most earnestly an implicit obedience to your directions, which from a variety of unpleasant symptoms becomes indispensible. To carry which point in a still greater degree, renew, at every visit, your attentions to the nurse (who in your absence is a vortex of knowledge, in your presence all obedience) her approbation of your conduct, and good opinion of your practice must be obtained at any price; it becomes with you a consideration of greater magnitude than your patient’s recovery; for should death no longer permit her presence in the scene of sublunary events, you lose one patient only; but with the good opinion and recommendation of the nurse, vanishes hundreds of patients in embryo, to be brought forth by the influence of her exaggerated reports of your incredible abilities.

The nurse once secured and attached to your interest, becomes an admirable instrument for the promotion of all your designs, she embraces every opportunity to strengthen your directions, and urges (as you have done) the continuation of medicine, “till, with the blessing of God, her mistress is quite set up and upon her legs again.” A proper reflection upon these subjects will convince you (even in the infancy of your embarkation) that a midwifery case in a good family is no bad thing, and made the most of, with the occasional aid of perpetual cardiacs,—balsamics,—carminatives, and anodynes, to ease and “quiet the child,” every time it coughs, or belches, constitutes a harvest of industry and political necessity, that the world in general is very little acquainted with.

Previous to the closing of the curtain, you have still an additional chance for more depredations upon the unfortunate husband; should stagnant milk occasion a coagulum in the lacteals, constituting a turgency of the breasts, threatening a formation of matter, suppuration becomes almost unavoidable, and you promote it accordingly; this leads to certain operation, daily dressings, &c. all tend to encrease your interest, and give you the enjoyment of a temporary monopoly in the joint practice of midwifery, surgery, and physic.

TO THE APOTHECARY.

The varieties of your past, as well as the personal requisites for your future destination, are of such a pantomimic and party-coloured complexion, that I cannot proceed to a recital so truly risible, without first offering you, in the lines of Woty, a predominant trait in my own character,

“I love to laugh, though Care stand frowning bye, And pale Misfortune rolls her meagre eye.”

Thus happily disposed to those brilliant sallies of mirth, that almost renovate life, and set melancholy at defiance, you will be the less liable to surprise, that I shall descend to the very minutiæ of your necessary qualifications, for the support of so arduous and complicated a character as you are now going to perform upon the theatre of life.

It is very natural to conclude you have, during the tedious years of initiation as an apprentice, and your more mature services as a journeyman, (politely ycleped assistant) whether in the metropolis, or the country, gone through every degree of drudgery, and feelingly experienced every indignity, that insolent pride could bestow, or patient merit receive. Not an inferior trust (of the inferior part of the faculty) but you have carried into execution, from the injection of an enema in a garret, to the separation of an emplastrum vesicatorium in a workhouse. These are offices of humanity and service to your fellow creatures, that do you immortal honour; they are retrospectives that form an epoch in the mind of every practitioner, and afford him the powerful consolation of sacred truth, “He that humbleth himself,” &c. by which rule, and the force of a fertile imagination, any apothecary may conceive himself a physician, even in the administration of a glyster. In this hospitable execution (taken metaphorically) there cannot be supposed the least indignity; for it is universally known the greatest and most prudent generals are in the rear during the heat of battle; and we are again taught seriously to believe “the last shall be first,” &c. so that you have every way, (by both faith and services) insured a religious and prophetic hope of preferment.

Having for many years encountered the worst, you are now prepared for the best; and bidding adieu to the rigid rules of austere masters, embark upon your own foundation, qualified for every medical consultation, from the bedchamber of a duchess dowager to the subterraneous residence of her chairman. You have, at this period, not only shaken off the shackles of servitude, but the very recollection of your long standing culinary connections. In your various changes of residence, tedious peregrinations, and medical observations, it is natural to conclude, you have acquired by care, study, and attention, a competent knowledge of almost every tint in the picture of life; which, with embellishments, derived from a few courses under some of the metropolitan lecturers, and hospital attendance, to qualify you for the complication of country practice, there is no doubt but you come from the forge properly formed, to make wrong appear right, and right wrong, in the face of every old woman in the county where you are going to reside.

Exclusive of these qualifications, and the many instructions already introduced under the two preceding heads (to which you may occasionally refer) there are a great variety that must be advanced for your particular use, and to those you will, no doubt, pay every proper attention, if you indulge the least desire to become a popular member of the faculty. In respect to personal appearance, former distinctions and peculiarities are in some degree levelled, the world is very much relaxed in its severities, and the apothecary mixes with the general herd of mankind, without those distinguishing exteriors that were his professional characteristics. The gilt-headed cane and enormous tassel are no longer in use; the full-bottom wig, that so universally ornamented the os frontis of the faculty in general, is now almost laid aside with inferior classes, and engrossed by the college. The apothecary (particularly in the country) is in every respect free from the illiberal censure of former times, and treading close upon the heels of the parson and the lawyer, enjoys, without restraint, the chace, the gun, the bottle, and bona-roba. These, if you are of a volatile disposition and amorous constitution, afford (at seasonable opportunities) a happy and high relished relaxation from the many severities of medical practice.

Having fixed upon your intended spot for embarkation, let every thought be employed to display an attracting uniformity in the disposition of your apparatus, for the claptrap of public approbation; and though that great investigator of human nature has beautifully portrayed “a beggarly account of empty boxes,” yet they become immediately necessary to your present purpose; it not being his business to explain the folly and extravagance of your placing any thing of consequence there, before you was experimentally convinced you should have occasion for its use. Let there be a profusion of appearance; the shell of a shop is not very expensive, and druggists are so numerous, that you may be expeditiously supplied whenever circumstances require it.—The bottles (being transparent) become more immediately in need of something in each, particularly a few of those articles (as hartshorn, lavender, &c.) that are in common request. The lower drawers (within reach) may be labelled with obsolete titles, and in each placed various paper parcels of bran or saw-dust, to avoid a chance of the sarcasm upon the faculty by a countryman, who happened to be left alone some time in the shop of an apothecary, and whose curiosity being excited by the great number of drawers, was powerfully prompted to open one labelled “Thus,” which finding empty, he was induced to try a second, still the same; a third, the same also.—Oh! oh! says he, “I see plain enough how it is, they are all Thus.” Your shop being at length finished in a stile modern and striking, let a green silk curtain (with brass rods and rings) be affixed to your window; it is an excellent method of conveying an idea of internal mystery, and inspiring proportionate external curiosity. Let no paltry diffidence appear in the board over your door, announcing your name and qualifications; there are great numbers that can’t distinguish small letters at a distance, to avoid which inconvenience, let the capitals be as conspicuous as the canvas figures at a country puppet-shew.