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"These examinations are commonly made during the urgency of pain; and this has given rise to the phrase of 'trying a pain.' It is, however, desirable, on many accounts, that we should not introduce our finger up to the os uteri at the time when the uterus is acting strongly, because then the membranes are protruded into the vagina, and if we press against them at that moment, we may, probably, rupture the cyst, and lose its influence in the after progress of the labour. Besides, it is impossible, under such protrusion, to ascertain the presenting part of the foetus with precision, because of the quantity of water which is then interposed between our finger and its person.
"Nevertheless, as it is expected that we should examine while the uterus is in action--and, indeed, as in many cases the patient would not allow us to pass our finger at all, were it not for the belief that we can 'assist' her--and that only in the time of pain, it is necessary that we should request her to inform us when there is a return, and take that opportunity of introducing our finger within the external parts. Having gained this advantage, we must allow it to remain inactive in the vagina while the pain continues; and upon its cessation, which we have seldom any difficulty in ascertaining, we may direct it up to the os uteri.
"We can do no good by such a practice after we have once gained the information we require. We cannot facilitate the descent of the child; we cannot dilate the parts; but we may do a great deal of injury, for we denude the vagina of that soft relaxing mucus which is designed by nature to protect it; and we, moreover, run the risk of destroying the integrity of the membranous cyst. We may, therefore, predispose the parts to inflammation, and retard the dilatation of the os uteri itself. As, however, it is a common idea among women that, under each examination, material assistance is rendered, we shall frequently be urged, during the first stage, especially if the labour be rather slower than usual, to remain in close attendance on the patient's person; and these solicitations are generally advanced with a degree of fervency, that it appears the extreme of cruelty not to accede to.
"Should this be the case, the finger may be introduced from time to time, with the greatest care and gentleness; more to pacify the patient's mind, and assure her she is not neglected, than with any other view beyond that, and also watching the progress of dilatation. The more rigid the parts are, the more do they require the softening influence of the natural secretion, and the more careful must we be to preserve it.... In about an hour ... we may see her again, and we may then, if we think it right, make another examination, to ascertain that the labour is proceeding satisfactorily.
"The second stage of labour having commenced, we are summoned to the patient's room, if we have been absent, and told that 'the waters have broken.' She is most likely found reclining on the bed, and, probably, the pains are more urgent than they were before; or, perhaps, they are somewhat suspended. We now require to make another examination, because it is possible that the head may have fully entered the cavity, and may be soon expelled. Finding it low in the pelvis, finding the os uteri almost entirely dilated, the membranes broken, and the pains strong and coming on frequently, it is right not to leave the room; but unless the perineum is somewhat on the stretch, we need not yet take our post exactly by the bed-side. But as soon as the head has come to press upon the external parts--particularly when it has made its turn, and is beginning to extend the structures at the outlet of the pelvis, it becomes our duty to take our seat by the bed-side, and never to move from our position till the child has passed. This we do to protect the perineum, in order to prevent laceration.
"The removal of the placenta from the vagina is easily effected. Twisting the funis umbilicalis two or three times around the first and second finger of the right hand, we draw it down in a line tending towards the coccyx, and receive it in the left, placed under the perineum; or we may introduce the two first fingers and the thumb of the left into the vagina, embrace the mass between them, squeeze it as we would a sponge, and slowly extract it....
"Having perfectly satisfied ourselves on this point, we may a second time take away the napkins soiled with the accumulated discharges, and envelope the lower part of the patient's person in others that are warm and dry. Three will be sufficient: one must be partially slid under the left hip; another may be placed over and around the right hip; and the third carried between the thighs, directly on the vulva, &c....
"Some practitioners adapt the bandage themselves, and apply it immediately after the placenta has been removed. I think it preferable, in common cases, to leave this duty to the nurse; and that it should not be put on until the body linen of the patient is shifted; because, in the first place, it appears to me more desirable that perfect quietness should be preserved until the first changes in the uterus consequent upon labour are effected, that no disturbance may interrupt their progress; and, in the second, I cannot help thinking that there is something highly indelicate in its being applied by a man--much more so, indeed, than any of the duties we are ordinarily called upon to perform under natural labour. It is of most service when next the skin. It must be sufficiently broad to reach from the pubes almost to the ensiform cartilage; and it cannot be properly adapted unless the abdomen be quite uncovered. In addition, I would remark that the nurse must know very little of her duties, if she cannot draw a properly contrived bandage round the person, and give it the due degree of tightness without incurring danger."
The reader of the preceding extracts will have observed that they begin with a panegyric on the extraordinary powers of nature in adapting means to an end; which, nevertheless, the author forthwith proceeds to qualify, as if he had admitted too much, in giving nature credit for the due execution of her own work, and her capability for enforcing her own laws, by enlarging on the profound and scientific knowledge required in the man-midwife, the opinion expressed by the Royal College of Physicians to the contrary notwithstanding; and in effect impiously detracting the infinite power and wisdom of God, "who created man in his own image, in the image of God created He him; male and female created He them. And God blessed them, and God said unto them, be fruitful and multiply."
"And God saw everything that He had made, and behold, it was very good."
"In this instance my suspicion of pregnancy rested on the interruption of menstruation alone. The health improved from the time of quickening, and the pregnancy went on. I may add that I have no doubt the latero-version of the womb occurred at the period of the miscarriage;... and that its righting itself, at length, was the consequence of its increasing bulk."
Such is the practice of man-midwifery! We observe that, in this revolting case, the disgrace, the shame, the infamy of the poor patient was endured in vain, and that after all the tentatives, and "manipulations," and experiments, so perseveringly repeated by the accoucheur, without any beneficial result whatsoever, nature alone was the true physician.
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