:r- ft* 1: i\ .fe-' Surgeon General's Olfice ^>7I\J ' ' •■_, —H|H— i A NEW EDITION. PHILADELPHIA. Printed for the BOOKSELLERS. 1799. O Tj» SJiP »fC >|5 '.\ '(> • ;•» T H E EXPERIENCED MIDWIFE. p«ooeoo»aoooeooooooe*oo6ccoo?oco"'oooooooocc« PART I. Bcoccoc^oooeoooooeeeooo^oso A GUIDE FOX CHILD-BEARING WOMEN. Introduction. I HAVE riven this book the title oi'Tbe Complete J'id Experi- enced Midwife,both becaufe it is chiefly dtiigned for thole that profefs midwifery, and contains whatever is neceflr.ry for them to know in the practice thereef,andalfo becaufe it is the remit r-fnvny years experience, and that in the m»ft difficult cafes, and h therefore the more 10 be depended v.p•>!■>. A midwife is the moft receflVy 8c honaraUe ofnee, being in.leed a helper of nature ; which therefore makes it neceffary for her to be well acquainted with all tr.s opem* tbns of nature in the work of generation,andinftrumeats wuh wbich fhe works ; for (he that knows sot the operations of nature, nor with •»i>i>. r~o!s meworks, fhe rnuft needs be at a tofshow to afTift therein. And feeing the inftruments of operation both in men and women are thofe things by which mankind is produced, it is very neoefTary that all midwives fhould be well acquainted with them, that they may the better underftand their bisfirefs, ar.d affift nature as there (ball be <~c« cauon. The firft thing then necenary, as introductory to thistreatife is, an Anatomical Defcription of the feveral parts of generation bith in men and women ; and having defigned throughout to com- prebend much in a little room, 1 /hall avoid all unneceffiry and impertinent matters wkh whichbsoks of this nature are for the moft part too much clogged, and which are more curious than needful. And though I fhould be-neceiTitated to fpeak plaiftly, that fo I may be underftood, yet I lhall do it with that mode ft y that none ihall have need to bluJh, imlefs it be from foinething in themfelves, rather than from what they fhall lmd here, having the motto of the roy-il garter f';r mv defence, which is, u Honifcit qui maly penje »'_' or> Evil to him that evil thinks. CHAP. I. An Anatomical Dejcrip'ion of tbe inftruments oj Generation m Man and Woman. Section I. Of the parts of Generation in Man. \ S the generation of mankind is procured by the coition of bothi t \. frxes, *Jt necefiarily fallows that the inftruments of generation are of two forts, to wit, nn'e and female; the operation of which ar*; "4 THE EXPERIENCED MIDWIFE. by acticn .>H paiRon, and herein the agent is the feed, ar.d the pa- tient blood; whence we may eafily collect, that the body of man be- 'uig generated by sftion and p?ifion, he muft needs be fubject there- uiito d'-.rhig his life. Now iince the infiruments of generation are r.ale and f-male, it will be jjeceCary to treat of them both diftinctly, that tbe chfc.ee1- midwife may be well acquainted wirh their feveral port-., and their various operations, as tl.ey contiibute to the workj M-'ger.eiauon.. A\ i i-i -Jcing this, I fhall give the honor of pn-ee- »,e:-ce to my own fex, ".nd fpeak firft of the parts of generation in mr.v, which [ball he (> Thefe, though at their firft dcfcenlion th*y keep a*, a fmalldi'bnce the one from the other, vet before the enter the ftones they make an admirable intermix^ . Hire of twilling t!u one from the other, lb that fometimes the veins go into the arteiies, and fometimes the arteries into the veins"; the iabftance of which is very bard and h.-rg. n*t much unlike * pyra- mid in form without and fenlible holhvnefs : The ufe is to make one lx i/ of the blood and vital fpirits, which they both mix and change the colour of, from red to white, f© that the ftones mrv ooth have a fit matter to work upon, and do their work more ealily, for which reafon, the i uetv.eaviua; rcacheth down to the very flones,and jiierceth in their fubfhnce. }. The ftcnes are the third thing to be lpoken of, called alfo tefticksj in Latin, tejits, that is, witueffes,becaule they wiunefs one THE EXPERIENCED MIDWIFE, £ tobea mail. As to thefe I need not tell you their number, nor whs'r nature has placed them,for that is obvious to thee) c Their fubfh:ice' h foft, wiiite and fpungy,full offmall veins and arteries, which is the reafon they fwelitofuch a bignefs upon the flowing down of the hu-' mour in them. Their form is oval, but moft authors rre of opinio:! that their bignefsis notequul,but that the iight is the biggelt, the hot- teft, and breeds the beft and ftrongeft feed/Each of thefe Clones hath a inufcle,c?l!ed, cren.ajier,\wh\ch fignifies to hoidup,becaufe they puil up the ftones in the act of coition, that lb the v.iL-Is being fhiclcencd may the better void the feed. Thefe mufcles are weakened both, by age and fieknefs ; and theftones then hang down lower than in youtii and health. Thefe ftones are of great ufe, for they convert the blood and vital fpirits into feed for the procreation of man: but this mail not be undeiftood as if they converted all the blood that comes into them into feed, for they keep fome for their own nourishment. But befides this, they add ftrength and courage to the body ; which is evident from this, that eunuchs-are never fo hot, ftrong no; valient, as other men, noris an ox fo hot or valiant as a bull. 4. The next in order are the vafa defercntia, which are the vef-- fels that carry tbe feed from the ftones-to the fem'mal vefftls which is kept there till its expulfion.- Thefe are in number two, in coloir white, and in fubftance nervous or fincwy ; and from a certain hoi-- lbwnefs which they have in them are alfo called fpermatic pores, they rife not far from the preparing veiTels;. and "when they come in- to the cavity of the belly they turn back again and pafs into the "backlide of the bladder, between it and the right gut; and when they come near the neck of the bladder they ?.re joined to the femi- nal galls, which fomewhat refembles the cells-of'• an honey comb ; which cells contains an oily fubftance, for they draw the fatty fill- - fiance from the feed which they emp:v into the u-rial pa'.Tcge, which is done for the moft part in the act of copulation, that fo the thin internal fkin of the yard fnffers not through the acrimony or fbarpnets oi the feed. And when the vafa deferentir, has paffed as before declared, they fall into the glandula poftrata which are tbe vefftls ordained to keep the feed, and which are next to be fpoken oh 5.-The feminafveiTels, called glandiUum feminale, are certain kernels placed between theneckof the biadJer, and the rirht "uf. compafling about the vafa deferentia, the urethra, or common vjf- fage for feed and urine, palling through the midft of it, and maypro- perly enough be called the conduit of the yard. At the n;«uth of tl,e urethra, where it meets with the vafa deferentia, thercis a thick fkin, whofe office is to hinder the feminal veffels, which are of fpongy nat«re, from fhedding their feed aguinfI their will ; the fkin G 2 6 THE EXPERIENCED MIDWIFE. is very full of pores, and through the heat ©f the al fo give pafiage to the-feed, which being of a ve- ry fubtile {pit-it, and especially being moved will pafs thro' the ca- runcle or fkin as quickfilver through leather ; and yet the pores of this fkin are not difcemable unlefs in the anotomy of a man, who. h*d fome violent running in the reins when he died, and then they are confpicuous, thole veffels being the proper feat of that difeafe. 6. The laft of the parts of generation in man to be fpoken of, is the yard, which has a principal fliare in the work of generation ; and is called Penis, from its hanging without the belly ; and it confifts of fkin, vtendons, reins, arteries, fiuews and great ligaments, and is long and round, be'iHg ordained by nature both for the pafiage of the urine, and for the conveyance of feed into the matrixi It hath fome parts common with it to the reft of the body, as the fkin, or the Memorana Garnofa and fome parts it has peculiar to itlelf, as, the two nervous bodies, the Septum, the Urethra, the Glans, the four mufcle?,. and the veffels. The fkin, which the Latins called Cutis, is full of pores, through which the fweat and fuliginous or feoty black vapours of the third concosticn (which concocts the blood into flefh) pafs out -t thefe pores are very many and thick but -ardly vifible to the eye ; and when the yard ftands not, it is flaggy;. but when it (lands, it is ftifT: The fkin is very fenfible, fo&eaufe.- the nerves concur to make up its being ; for the brain gives fenfe t©. the body by the nerves. As to the (Camus Membrana, or fiefhy ikin, it is fo called, not becaufe its body is rkfhy fkin, but becaufe- it lies between the flelh, and pafleth into other parts ©f the body underneath the fat, and fticks dole to the mufcles : but in the yard there is no fat at all, only a few fuperficial veins and arteries. pafs betwee-i the former fkin and this, which when the yard ftands. are vifible to the eye ; Theie are the parts common both to the \ ard and the reft of the body. I; will now fpeak of thofe parts of the yard which are peculiar to itfelf, and to no other part of the- body : and thofe are likewife fix, as lias been already faid, of which it will alfo.neceflr.ry to fpeak particularly. And. i. Of the Nervous bodies : Thefe are two, the' joined together,, and are hard, 'ong and fme.vy, they are fpongy within and. full of i,lack blood ; the fpongy fubftance of the inward part of it feems to. be ;v3>ven together like a net, confuting of innumerable twigs of veins V"d arteries. Tbe black blood? contained therein is very full 0''ipirits\an<* the flights or defire of Venus, add heat to thefe,, which cauls'" the }'arcl t0 ftant* ' ancl tliat ls the reafon that both THE EXPERIENCED MIDWIFE. 7 this hollow, fpungy intei mixture or weaving was fo ordered by na- ture, on purpofe to contai'n the fpiritof venereal heat, that the yard may not fall before it has done its work.. Thefe two fide ligaments of the yard, where they are thick and round, ariie from the lower part of the {hare-bone, and at the beginning are feparated the one from the other, refembling a pair of horns, or the letter V. where the Urethra,or common pafiage of urine and feed, paffsth between them. 2. Thofe nervous bodies of which I havefpoken, fo ibon as they come to the joining ot tbe fhare-bona, are joined by the Sceptum Lucium, which is the fecond internal part, to be defcribed, which in fubftance is white and nervous, or finewy, and its ufe is to uphold the two fide ligaments and .the Urethra. 3. The third thing in the internal part of the yard is the Urethra, which is the pafiage or channel bv which both the feed and urine is conveyed out thro' the yard. The fubftance of it is finewy, thick, fbft and loofe as the fide ligaments are ; it begins at the neck of the bladder, and, being joined to it, paffeth to the glans, It has in the beginning of it three hales, of which the largeft of them is- in the midft, which receives the urine into it, the other two are fmaller,, by which if receives the feed from each feminal veflel. 4. The yard has four mufcles : on each fide two: Thefe mufcles are inftruments of voluntary notion, without which no part of the body can move itfelf. It confifts of fibrous jflefti to make itsbody* of nerves for its fenfe, of veins for its nouriftiment, of arteries for its vital heat, of a membrane or flcin to knit it together, and to dif- tingaifhing ontt mufcle from another, and all of them from the flefh ^ Of thefe mufcles, as 1 faid before, the yard has two of each fide,. and the ufe of them is to erect the yard, and make it ftand, and therefore they are alfo called Erectors: But here you rouft note that of the two on each fide the one is (barter and thicker than tbe other; and thefe are they that do erect the yard, and fo are called: Erectors : but the two other being longer and fmaller, their office is to dilate the lower part of Urethra, both for making water and emitting the feed; upon which account they are called Accelerators. 5. That which is called the Clans is the extreme part of the yard,, which is very foft, and of a moft exquifite feeling, by reafon of the thinnefs ef the fkin wherewith it is covered : this is covered with the Praeputium, or fore-fkin, which in fome men covers the top of the yard quite dofe, but in others it doth not; which fkin moving up and down in the'act of copalation, brings pleafure both to man? and woman : this outer fkin is that which the Jews were command- ed to cut off on the eighth day : this Prceputium, or fore-fki-n,' is tied to the glans by a ligament or bridle, whic'a is called Fr'anum* 6« The laft internal part of the yard are the veffels thereof, veins. 8 THE EXPERIENCED MIDWI1-E. nerves and arteries. Of thefe fome pafs by the fkin, and are vifibl to the eye when the yard (lards ; others pafs by the inward part o* tbe yaad ; the arteries are wonderfully difperfed thro' the body o* the yard, much exceeding the difperfnn of the veins ; for the rig-h* arttrv is difperfed to the left fide, and the left to the right fide. It hath two nerves, the letter whereof is beftowed upon the fkin, the greater upon the mufcles and body of the yard. Put thus much *...' (ball fufhxe to be faid in describing the parts of generation in men : and fiial'l, thereto)e, in the next place, proceed to defcr'rbe thofe of women, that lb tee bidaftrious midwife may know how to help them. in their extremeties. Sec. II.. Defcribing tbe Parts of Generation in Women. h *tsver ignorant peribns may imagine, or fome good women' think, they are unwilling thofe private parts which nature his given them, (hculd be expofed, yet it is in this cafe abfolutely necef--; fary ; for I do pjfitivtly aifiim, that is itimpoffible trulyto appre-' . bend what a r.aiwife ought to do, if thefe parts are nat perfectly ur.derftocd by them, nor do I know any reafon they have to be aftnm-- ed to fee or hear a particular defcription of what Cod and nature hrth given them, fince it is not the having thefe parts, but the un-- lawful ufe of them that caufes fhame. To proceed thfn, in this defcription more regular! v, Ifhall fpeak: in order of,thefe following principal parts; ift. Of the Privy P„U- fage ; 2d ly. Of the Womb: ^dly : Of the Teftacles, or Stones:. 4thlv. Of the Spermatic Veflels. ift. Of the Privy I'affage. Under this head I (hall coniider the fix following parts. 1. The lips, which are viable to the eye, and are defigned by na- ture as a cover to the Fifura Magna, or great orifice : The'e are framed of the body, and have pretcy (lore of fpungy fat: and their u.e is to keep the internal parts from cold and dull. The'e are the only things that are obvious to the fight; the left art concealed, and: cannot be feen, unlets the two lips are ftreiched afimder, and the entry of the privities-opened. 2. When the lips are fevered, the next thing that appears is the/ Nymphas or wings; they are ibrmed of foft and fpungy fiefli, and. are in form and colour like the comb of a cock. 3. In the uppermoft part, juft above tbe urinary paffige, may be • obferved the Clitoris, which is a finewy and hard body, full of fpungy and black matter within, like the fide ligament of the yard : repre-- fenting hi form thevardof a man, andluffers erection and filling as that doth : and it grows bard, and becomes creeled as a man's • yard, in proportion to the defire a woman hath in copulation : and' this alTo is that which gives a woman delight in copul-atioa; for w THE EXPERIENCED MIDWIFE. 9 - without this a woman h?.th neither a defire tocopulaticn. and delight in it, nor can conceive by it. And I have heard that fome women have had their Clitoris fo long, that they have abi'fed ether women therewith : Nay, fome have gene fo frr.as to fay, that thofe pet fens that have been reported to be Hermaphrodites, as having the geni- tals both of men and women, are only fuch wemen in whom the Clitoris hangs out externally, i efembling tV,e form of a yard. But though I will not be poiiti\e in that, yet it is certain, that the lar- ger the Clitoris is any woman, the more luftful fhe is. 4. Under the Clitoiis, and above the neck, appears the Orifice, or urinary pafiage, which is much larger in women than men, and caufes their water to come from them in a great dream. On both i cies the urinary pafiage may be fecn two final I memhrvuous appendices, a little broader above than below, ifTuing. forth of the inward parts of tbe great lips, immediately under the Clitoris; the ufe whereof is ta cover the orifice of the urine, and defend tbe bladder from the cold air: So that when a woman plffeth, (he contracts herfelf fo, that (he conducts eut the urine without fuffering it to (bread along the privi- ties, and often without fo much as wetting the lips ; and therefore thefe fmall membraneous wings are called the Hymphtf, becaufe long, that tfeey have been neceflitated to cut ciFfo much ss list ex- ceeded and grew without the lips. 5. Near this are four Carunchs, or flef'iy Vr.o'-z, conrr.o.r.'y rriled Caruncles Myrtiformes; thefe are placed, on each fide two, and a fmall one above, juft under the urinary pafiage, and in virgins are red- difh, plump and round, but hang flagging when virginity is loft.: In virgins they are joined together by a thin and fmewy (kin or mem- brane, which is called the Hymen, and keeps them in fubjeftion, and makes them refemble a kind or rofe-tad half blown. Tul-difpc-Qtioa of the Caruncles is the only certain :: v.rk of virginity, it being in v?.i>; to fearch for it elfawhere, or h- re to ^e informed of it any other way : And 'tis from theprefTing'-nd bruifing thefe Caruncles, and forc- ing and breaking the little membranes (which is done by tie yard in the firft act of copulation) that there happens an effufion of blood ; after which they remain feparated, and never recover their firft figure, but become more and more flat as the acts ef copulation are ir. created; and in thofe that have children they are almoft totally defaced, by reafon of the great diftention thefe parts fuffer in the time of their labour. Their ufe is to wraiten the ;i?rk of the womb, to hinder the cold air from incommoding it, and likewife to incrpafe mutual pleafure in the act. of coition: for the Carui cles being then extremly fwelled, and filled with blood and ipirits, they clofe with more plea- fure upon the yard of the man, whereby the woman is much j; -re io THE EXPERIENCED MTDWlFE. delighted. What I have faid of the efFufion of blood which hap" pens in the firft act of copulation, tho' when it happens it is an un- deubted fign of virgiuity, (hewing the Caruncles Myrtiformes have never been preffed till then ; yet when there happens no blood, it is not always a fign that virginity is loft before ; for the Hymen may be broken without copulation, by the defluxion of fharp humours, which fometimes happen to young virgins, becaufe in them it is thin- ned: It is alfo done by the unfkilful applying of beftaries to provoke the terms, &c. But the'e things happen fo rarely, that thofe virgins do thereby bring themfelves under a juft fufpicion. 6. There is next to be fpoken of, the neck ef the womb, which ij nothing elfe but the diftance between the privy pafiage and the month of the womb, into which the man's yard enters in the act of copula- tion : and in women of reafonable ftature is about eight inches in length. 'Tis of a membraneous fubftance, flefhy without,fkinny, aiv.1 very much wrinkled within ; and that it may both retain the feed caft into it in the act of copulation, and alfo that it may dilate and extend itfelf to give fufficient paffage to the infant at its birth. It is comrofed of two membranes, the innermoft of them being white,. nervous and circularly wrinkled much like the palate of an ox, that fo it might either Coiietncl &f dime itieif Rccoramrj r.» mt bigneis or length of the man's yard: and tothe end, that by the collifion, fqueez- ii.g, orpreffing made by the yard is copulation, tiie pieafure may be mutually augmented. The external or outmeft membrane is red'and flefhy like the mufcle of the Fundament, furrounding the firft, to the end the yard may le the better clofed within it; and it is by means of this membrane that the neck adheres the fti or.ger to both the blad- der and the right gats. The internal membrane in young girls is very lb ft and delicate, but in women much addicted to copulation it grows harder ; and in thofe that are grown aged, if they have been given much to venery, it is almoft become grifly. Having fpoken of the privy paffage, I come now to fpeak of the womb or matrix, its parts are two; the mouth of the womb,and the bottom of it. The mouth is an orifice at the entrance into which may be dilated and fhut together like a purle ; for though ia. the act of copulation it be big enough to receive the glans of the vad, yet after conception it is fo clofe (hut, that it will not admit the poiut of a bodkin to enter; and yet again at the time of the wo- man's delivery, it is opened fo extraordinary, that the infant palfeth thro' it into the world; at which time this orifice wholly difappears, and the womb teems to have but one great cavity from its bottom to tbe very entrance of the neck. When a woman is not with child it is a little oblong, and of a fubftance very thicK. and clofe ; but ^liwii Ihe is with child, it is fliortened, and its thisknefsdimmi.hetls THE EXPERIENCED MIDWIFE. i, proportionably to its d'ftention: And therefore it is a miftake o* fome anotomifts to affirm, that its fubftance waxeth thicker a little before a woman's labour; for.any one's reafon will inform them, that the more diftended it is, the thiimerit muft be, and the nearer a woman is to the time of her delivery, the fhorter her womb muft be extened. As to the action by which this inward- orifice of the womb is opened and (hut, it is purely natural; for were it other- wife, there would not be fo many baftards gotten as there are; nor would fome married women have fo many children were it at their -own choice, but they would hinder conception, tkough they would be -willing enough to ufe copulation ; for nature has attended that action with fomething fo pleafmg, and delightful, that they are wil- ling to indulge thernfelves in the ufe thereof, notwithstanding the pains that they-afterwards endure, and the hazard of their lives, which often follow it; And this comes to pais not fo much from any inordinate luft in womea, as for that the Great Director of Na- ture, for the increafe and multiplication of mankind, and even for all other fpecies in the elementary world, hath placed fuch a mag- netic virtue in the womb, that it draws the feed to it as the load- ftone draws iron. The Author of nature has placed the wombin the belly, that the htxc might always be maintained" by the warmth of the pans fur- rounding it; it is therefore feated in the middle of the Hypogaftrum { or the lower part of the belly) between the bladder and the rectum f or right gut) by which alfo it is defended from any hurt through the hardnefs of the bones; and it is placed in the lower part of the belly for the convenjence of copulation, and of a buth's being thruft out at the full time. It is of figure almpft round, inclining fomewhat to an oblong, in , .part refembling a pear, for, from being broad at the bottom, t gra- dually terminate? in. the. pointof the orifice which is harrow. The length, breadth and thicknefs of the wombdifter according to the age and difpofition of the body ; for, in virgins not ripe his very fmall in all its dimenfions, but in women whofe terms flow in great quantities, and fach as, frequently ufe copulation; it is much larger ; and if they havejjad.children, it is larger in them than in fuch ashave none; but in women.of a good ftature,and well fhiped (it is as I have faid. before) from the entry pf the privy parts to the bottom of the .. .womb, ufually about eight, bu,t the length of trie body ot the womb alone does not exceed three inches, and breadth... thereof is nearly ., about the fame, and of a thicknefs of the little finger, when the wo- . .man r not pregnant; but whep the woman is with child, it becomes of a prodigious greatnefs, and the rjearer foe is to her delijrtry, the more js the womb,expended. *2 THE EXPERIENCED MIDWIFE. It is not without reafon then that nature (or the God ofnatu'-t ra thcr) has made the vvcmb of a membraneous fubftance ; for thereby it does the eufier open to conceive, and i> gradually dilated from the growth of the Fcstusor young one, and is aftei wards contracted and doted again, to thrufl forth both it and tke after-burden, and then to retire to its primit'ne feat. Hence alfo it isenabted to expel any i:b*x- ious humours which may fometimes hapj en to be contained in it. Before I hare clone with the womb, which is tbe field of generation, and ought therefore to be the more particularly taken care of ( for as the feed ot plants can produce no fruits, nor fpring unlefs fown in ground proper to waken and excite their vegetative virtue, fo like- wife the feed of a man, though potentially containing all the parts of a child, would never produce fo admirable an effect, if it were not caft into tbe fruitful field of nature, tbe womb) I fhall proceed to a more particular defcription of the parts thereof, and the ufes to which nature has defigned them. The womb then is competed of various fimilary parts, that is, ef membranes, veins, arteries and nerves. Its membranes are two, and they compote the principalpaitsof its body ; the outmoftef which ari- feth from the Peritoninm, orcawl, and is very thin, without finooth, but within equal,that it may the better cleave to the womb, asitwere fielhy and thicker than any elfe we meet within the body when a woman is not pregnant, and is interwoven with all forts of fibres or fmall firings, that it may the better fuffir theextenfion of the child, and the waters caufed during the pregnancy, and alfo that it may the eafier clofe again after delivery. The veins and arteries proceed bothfrorn the Hypogaftricks and the Spermatic Veffels, of which I fhall fpeak by aud by ; all thefe are in- ferted and terminated in the proper membrane of the womb. The ar- teries fupply it with blood for its nourifhment, whieh, being brought thither in too great a quantity, fweats thro' the fubftance ©f it, and diftils as it were dew into the bottom of its cavity ; from whence do proceed both the terms in ripe virgins, and tbe bloed which nourifh- eth the embryo in breeding women. Tbe branches which iflue from the Spermatic Veffels, are in each fide of the bottom of the womb, and are much lefs than thofe which proceed from the Hypo- gaftricks, thofe being greater, and bedewing the whole fubftance of it. There are yet fome other fmall veffels, which, arifing the one from the other, are conducted to the internal orifice, and by thefe, thofe that are pregnant, do purge away the fuperfluity of their terms, when they happen to have more than is ufed in the nourifhment of the infant; by which means nature has taken fuch e feed, and to reduce it from powder to action by its beat for the generation of the infant, and is therefore abiblutely neceffary for the confevration of the fpecies. It alfo teems by accident ta receive and expel the impurities of the whole body, as when women havea- bundance of whites and to purge away from time to time the fuper- fluity of the blood,as itdotbeverr month by the evacuation of blood, as when a'woman'is not with child. And thus much (hall fuffice for , the defcription of the womb, in which I have been the larger, be-' eaufe, as I have faid before, it is the field of generation. 3d. The next thing to be defcribed in the genitals of women is the tefticles or ftoftes, for fuch women have as well as men, but are not for the fame ufe, and indeed are different from thofe in men in fede- ral particulars ; as iff, in place being within the belly, whereas, in men they are without. 2dly,In figure, being uneven in women, but fmaotbin men. 3dly, In magnitude, being leffer in women than in men. 4thly,They are not fixed in women by mufcles, but by ligature s 5thly, They have no proftrates or kerrals as men have. 6thly, They differ in form, being deprefledor flattifh in women, but oval in men. 7thly, They have but one fkin, whereas men have four ; for the ftones of rnenbeing more expoted, nature has provided tor them accordingly. f8tMv, Their fubftance is more foft than in men. Aad othly, Their temperature is colder than men. And as they differ in all thefe reC- pects, fo do they alio in their ufe, for they perform not the iame ac- tions as men's, as 1 fhall Ihew pretently. As for their feat, it is in hollow nefs of the Abdomen, and therefore not extremely pendulous, but reft upo-« the ova or egg. Tis true Galen and Hypocrites did errmeeuily imagine that the ftones in women did both contain and elaborate the feed as thofe do in men, but it is a great miftake: For •the tefticles of a woman are as it were no more than two clufters of .e»es, which lie there to be impregnated by the moift fpinr»*ous parti- cles or anirrtatiHC-tfauvia conveyed out of the womb throughthe two tube's or different veffels : But however the ftones in women areve- ■ rv ufefuljfef where they are defective, generation work isat anend. Far though thefe little bladders, which are on their fuperfices, eon- t-V nothing of feed, yet they contain feveral eggs (commonly to the number of twenty in each teftick) one of which bemg impregnated ic the s& of coition, bv the moft fpirituous part of the, feed of the ;hian;~delcendsthrt>i»gh'the ovidn&s into tfcc womb, and therein procefs of time, becomes a living child. * " /th. I am- now to fpeak of the .fpermatic veffels in women, which rre'two, and are faltehed in their whole extent by a membraneous 4-Vr>en:ix to the broad ligament of tbe womb : Thefe do not proceed :-om t:-.t tefucles as 'in men, but. are ciiftant from them a finger's ' -.Uu> at kaft ; T~nd being difpofed after tie manner of the miteraic THE EXPERIENCED MIDWIFE. 15: veins, are trained along the membraneous diftance between the dif- ferent veffels and the tefticles. Their fubftance is, as it were nervous and moderately hard; they are round, hollow, big, and broad enough at their end, joining to the horn of the womb. Some authors affirm that by thefe, women difcharge their feed into the bottom of the womb; but the whole current of our modern authors run quite ano- ther way, and are pofitive that there is no feed at all in their veffels; but that after the egg or eggs in the ovarie or tefticles are impregna- ted by the feed of the man, they defcend through thefe two veffejs into the womb, where being placed, tbe embryo isnourifhed. Thefe veffels are (horter in wmnca than they a,-e in men ; tor the ftones of a woman lying within the belly, their paffage muft needs be (hprter; but their various wreathings and windings in and out, make amends for the fhortnefs of their paffage. Thefe veffelsare not united before they come to the ftcnes, but oivide themtelves into two branches, the largeft whereof only paifes through the tefticles, tbe leffer to the womb, both for the nonrifhment of itfelf and the infant in it. 1 further obferve, That thefe fpermatic veins receives the arteries as they pafs by the womb, and-fo there is a mixture between natu- ral and vital blood, that fe the work might be the better wrought, aad that it is fo, appears by this, That if you blow up the fperma- tic vein, you may perceive the right and left veffel of the womb, blown up : from whence alfe the communication of all the veffels of the womb mav be eafily perceived. Tbe deferentia or carrying veffels fpring from tbe lower partof- the tefticles, and are in colour white, and in fubftance iinewy, and pais not the wosab ftraight, but wreathed with fi-veral- turnings and' windings, as was faid of the fpermatic veffels, that fo the fnoitnefs of tlr? way may belikewife recompenfed by their winding.meanders; yet near the womb they, beco v.e broad again. They proceed in two parts from the womb, which refemble herns, and are therefore call- ed the horns of the womb. Aid this is all that is "reed ful to be known or treated of coBcerning the parts of generation both in men and women. Or.ly fince our modern anatomiftsand phyficians are of different fentiments from the ancients, touching the woman's contributing of teed for the formation of the child as well as the man ; the ancients ftrongly affirming it, bat our modern authors being generally of a- nother judgement; I will here declare the feveral reafons for their different opinions, and fo pafs on. Sectiok III. Of tbe differences between tbe modem Pbyjicians, touebing tbe Woman's contributing Seed to tbe formation oj tbe child. *5 THE EXPERIENCED MIDWIFE. 1WILL not make myfelf a party in this controverfy,but fetdowrr impartially, yet briefly, the arguments on each fide, leaving the judicious reader to judge fur himtelf. Though it is apparent, fay the ancients, that the feed of manisths principal efficient and beginning of action, motion and generation, yet it is evident that the woman doth afford feed, becaufe fire hath luminal veffels, which eife had been given her in vain ; but finc2 n.iture foims nothing in vain, it muft be granted they were made f r the ufe of feed and procreation, and fixed in their proper places t-> contribute virtue and efficacy to the feed: and this, fay they, is farther proved from hence. That if women at years of maturity u!e not copulation to object their feed, they often fid! ii.to ftrange difc.dls, Rid i: is apparent, that women are mver better pleated than when they- are often fa tinned this way,which argues the plcafine & delight t: ey tr.be therein ; which pltafure, fay they, is d uble isi won.en to vh,nit is'in men ; for, as the delight of men in copulation confift t'.-hfiy intl t emifiion of the feed, fo won en are delighted .both in liciihor. of their own, and the re'eeption of the man'-. t at a-.'aii':ft all tiiis,our modern authors tffirm, That the ancients v .?re ve'y errofit. us ; for as r« ich as the tefticles in women do not afford fittd, but are two eggs, like thofe of fowls and other creatures, i.oithu have they any fuch offices as men, but indeed are an Ovari- um, cr r-.cepticle for eggs, wherein thefe eggs are ncuiUhed by the fimguinary veffels difperfed through them ; and from thence,one or r, ore ay they are fcecundated by t!< man's feed, are conveyed into '"''- womb by the ov-ichicts. Ami the truth c:f tlfe:, fay they,is plain, L-.iat if you boil diem their liquor will have the fame tafte, colour ind eenfiftency, with the ta.fie of bird's ere/. -A nd if it be objected, t'.'at they havejiO fhells, the a f./eris f>?ry ; for the eggs cf fowl:, vhife they are in ovary, nav, after they are falfen into the uteni', have no ft.ell; and though tl.ey have one whe" t'-ey are laid, yet ■ v. is no more than a fence which r.-.t'ire I».as provided fbr ihem againft • outward iijuric-, they beirg hatched without the b.ady ; but thofe of women b-drg hatched within the bsciy, have no need cf any o- t'-'f r fcif than the womb to feevre them. They alfo further fay, there an? in the. generation of the fcetus, or young ones, two prmciples, active & paffive : the active is the man'i feed, el a.b crated in the tefticles, out ofthe arterial blood and animal feirits ; the pa.TiTe principle is the ovum or egg impregnated by the man's iced-; for to fay that women have true feed (fay they) is erro- neous. But the maimer of conception is this : The moft fpirituous . part of man's feed, in the act of copulation, reaching up to the ova- * num or tefticles of the woman (which .contains divers eggs, fome- ti.nes more, fometimes fewer) impregnates of them, which being THE EXPERIENCED MIDWIFE. ry conveyed by the oviducts to the bottom of the wdmb, prefently begins to fwell bigger and bigger, and drinks in the moifture that is fent thither, after the fame manner that the feeds in the ground fuck the fertile moifture thereof to, make them fprout. But, notwkhftardmg what is here urged by our modern anatomifts, there are fome late writers of the opinion of the ancients, viz. that women have both,.and emit feed in the act of copulation ; and the good women themfehes take it ill to be thought merely pa (live in thofe wars wherein they make fuch vigorous enceunters, and pofi- tively affirm they are fenfibleef the emifiion of their feed in thefe en- gagements, and that a great part of the delight they take in that act confifls in it. I will not therefore go about to take any oftheir happi- pinefs away from them, but leave them in poffeffion of their imagi- ned felicity. Having thus laid the foundation of this work, in the defcription I have given cf the parts dedicated to the work of generation both in man and woman, I will now proceed to fpeak of conception, and of thofe things that are neceffary to be obterved by women from the time of their conception to the time of their delivery. CHAP. HI. Of Conception ; what it- is; tbe Signs thereof whether ccn-> ceived of a Male c Female ;: bow Women are to order them-- felv.'s after conception Section L What Conception is, and the ®ualijications requi- Jite thereto. CONCEPTION is nothing elfe but an action of the womb, by which the prolific feed is leceived and retained, that an infant may be engendered and formed out of it. There are two forts of con- ception ; tbe one acccoding to nature, which is followed by the ge- r.aration of the infant in the womb; the other is falfe, and wholly againft nature, in which the feed changes into water, and produces only falfe conception, moles or ether ftrange matter. Now thee are three things principally neceffary in order to a true conception, fo that generation may follow; to wit, diverfity of tex, congreffioHj and emiffion of feed. Without cVverfity of fexes, there can be no conception: For, tho'fome will have a woman to be an animal that can engender of herfelf, it is a gieat miftake; there can oe no conception without a n an to difcharge his feed into her womb. What they al ledge of pullets laying eggs without a cock's treading them, is nothing to the purpofe ; for thofe eggs>, fliould they be fet under a hen, will never become chickens, becaufe they never re- ceived any prolific virtue from the male; which is abfohitely necef- f try to this purpofe,, and is fufficient to convince lis that diverfity of ftx is neceflary even to thofe animals, as well as to the generation 18 THE EXPERIENCED MIDWIFE. of man. But diverfity of fex, tho' it be neceffary to conception, yet it will not do alone ; there muft alfo be a congreffion of thofe different fexes : for diverfi-y of fex would profit little, if copulation did not follow. I confefs I have heard of fome fubtle women, who, to cover their iin and lhame, have endeavoured to perfuade fome perfons that they were never touched by men, to get them with child; and that one in particular pretended toco; cepve, by going inte a bath where a man had walhed himfelf a little before, and fpent his feed into it, which was drawn and fucked into her womb, as lhe pre- tended : But fuch (lories as thofe are only fit to amufe them that know no better—Now that thefe different fexes fihould be obliged to come to the touch, which we call copulation or coition, befides the natural defire of begetting their like, which ftirs up men and women to it, the parts appointed for generation are endowed by na- ture with a delightful and rxutual itch, which begets in them defire to the action ; without which it would not be very eafy for a man born for the contemplation of divine myfteries, to join himfelf by the way of coition to a woman, in regard of the uncleannefs of the part, and of the action ; and on the other fide, if women did but think of thofe pains and inconveniencies to which they are fubject h/.their great bellies, and thofe hazards even of life itfelf, befides the unavoidable pains that attend their delivery, it is reafonable to believe they would be affrighted from it. But neither fex make thefe reflections, till after ths action is over, confidering nothing ' before hand but the pleafure of enjoyment. So that it is from this voluptuous itch that nature obligeth both fexes to this congreffion. Upon which the third thing followeth of courfe, to wit, the emif- fi ;n of teed into the womb in the act of copulation. For the woman having received this prolific feed into her womb, and retained it there, the womb thereupon becomes oomprefled, and embraces ths teed fo clotely, that being clofed, the point of a needle, as faith Hippocrates, cannot enter into it without violence ; and now the wf.nut-n may be faid to have conceiveti; the feveral faculties which are in the feed it contains, being reduced by its heat from power into action! making ufe of the fpirits with which the feed abounds, and which a.e the. inftruments by which- it begins co trace out the firft lineaments ofallthe parts; ta which afterwards, of making ufe of the menftruous blood flowing to it, it gives in time growth and final perfection. And thus much (hall luffi.ce to fhew what conception is. I lhall now proceed ts> fhew Section II. Tbe Signs if Conception. rSPHERE are many prognoftichs or iigns, of conception: I wilt JL name fome of the chief, which ate the raoft certain, and let alore the reft. THE EXPERIENCED MIDWIFE. r9 i. If a woman has been more than ordinary defirous of copula- tion, and hath taken more pleafure than ufual therein (which upon recollection fhe may eafily know) k is a fign of conception. 2. If (he retain the feed in her womb after copulation, which fhe may know if fhe perceives it n®t to flow down from the womb as it ufed t© do before, for that is a fure fign the womb has received it. into the inward orifice, and there retains i:. 3. If fhe fin^s a coldnefs and chillnefs after copulation, it fhews the heat is retired to make conception. 4. if after this Ihe begins to have loathings to thofe things which fhe loved before, and this attended with a lots of appetite, and' a de- lire after meats, to which (lie was not affected before, and hath ofteft naufeatings and vomitings, with four bekhings, and exceeding weak- net's of ftomach. 5. After conception tbe belly waxeth very flat, beeaufe the womb clofetb itfelf together, to nouriffi and cherilh the feed, contracting itfelf fo as to leave no empty fpace. 6. If the veins of the breaft are more clearly feen than they were wont to be, it is a fign of conception. 7. So it is, if the tops on the nipples look redder than formerly, and the breads begin to fwell, and griw harder than ufual, efpeci- ally if this be attended with pain and forenefs. 8. If a woman hath twilling and griping pains, mueh like thofe- of the cramp in the belly,, and about, the navel, it is,a fign fhe has conceived. 9. If under the lower eve-lid the veins- be fwelled, and'appear clearly, a«d tbe eye be fome thing clirconloiiFed, it ia a certain -fig . or that fhe has fat up the night before. This fign has never failed. 10. S*ome alfo make this trial of conception : they flop the wo- man's urine in a glafs or phial for three days, and then ftrain it through a fine linen cloth, and if they find fmall living creataros in it, they conclude that the woman has certainly-conceived. 11. There alfo is another eafy trial : let t:*e woman that fhppo- frs (he has conceived, take a green nettle, and put it into her urine^ cover it clcfe, and let it remain therein a whole night: if tbe wo- man be with child, it will be full of re I fpats on the mo-row; but if fhe be not with child, it will be black Kb*. 11. The laft fign I (hall mention is that which is moft obvious to every woman, which is the fupprfcflion of the terms: For, after conception, nature makes ufe of that bHod for the nouriftnnent of the embryo, which before was caft out by nature, be*eaufe it was too great in quantity. For it is an error to think that the menftrual blood, fimply in itfelf confidered, ..is bad ; becaufe if a woman's bo- ao THE EXPERIENCED MIDWIFE. dv be in good temper, the blood muft needs be good: and that it is voided monthly is becaufe it offends in quantity, but not in quality. But tho' the fuppreihon of the term* is generally a fure ugu of conception to fuch perfons as have bad them orderly btf.re, yet is not theh i ring them always a fign there is no conception : Foralmuch as many that have been with chili have had their terms, and fome even until the fifth or fixth month, which happen> according to the woman's being more orlefs fanguine; for if a woman has more blood than will fiiffice for the nourifhment of the embryo, nature contin- ues to vsid it in the ufual way. Whence the experienced mid- wife may learn there are few general rules which do not fometimes admit of an exception.. But this (hall fuffice to be fpoken of the figns and prognofticks of conception. Section III. Whether Conception be of a Male or Female. AUTHORS give us feveral prognofticks of this: though they are not all to be trufted, yet there is fome truth among them ; the figns of a male child conceived are. i. When a woman at her riling up is more apt t® flay herfelf up- on her right hand than her left. 2. Her belly lies rounder, aaddiigher than>when fhe has conceived cf a female. 3. She firft feels the child to beat on the right fide. 4. She carries her burden more light, and vvith lefs pain than when it is a female. 5. Her right nipple is redder than the left, and her right bread; karder and more plump. 6. Her colour is more clear, nor is fl»e ■ f» fwar .hy as when fhe has conceived a female. 7. Obferve a circle under her eye, which is a pale and bluifh. colour; and if that under her right eye be moft apparent, and moft difcoloured, fhe hath conceived a fon. 8. If fiie would know whether (he hath conceived a fon or &■ daughterdet her milk a drop of her milk into a bafon of fair water;, if it fpreads and fwims at top, it certainly is a boy ; but if it is round as it drops in, and finks, to the bottom, it is a girl. This Lift is an infallible rule. And in all it is to be noted, that what is a fign of a male conception, the contrary holds good of a female. Sec IV. How a woman ought to order herfelf ajter conception. MY defign in this treatife being brevity,1 fhall pretermit all that others fay in the caufe of twins; and whether theie be any. fuch thing as fuperfcetations, or a fecond conception in woman,. which is yet common enough, wfien I come to Ihevv you how the midwife ought to proceed in the delivery of thefe women which are pregnant with them. But having alr.ady fjnken of conception, I THE EXPERIENCED MIDWIFE. »i think it sew mceffary to (how how fuch as have conceived ought t° order themftlves during their pregnancy, that thev may avoid thof* inconveniencies which often endanger the life of the child, and ma- ny times their own. A woman after her conception, during the time of her being with child, ought to be looked on as indifpofed or fick, tho' in good health; for child bearing is a kind of nine-months fickne fs, being all that time in expectation of many ir-conveniencies, which tech aeon- d'-tion ufually caules to thole who are not well governed during that time; and therefore ought to refemble a good pilot, who, when fail- ing in a rough fea and full of rocks, avoids and flmns the danger, if he fleers with prudence; but if not, it is a tboufanu to one,but he fi ffers fliipwreck. In like maimer, a woman with child is often in dinger of mifcarrying and lofing her lite, ii (lie is not very Careful rf her'elf, and fecondly of the child Ihe sroes with, for otherwife a tingle error may produce a double mifchicf; for if fhe receives any pejudice her child alfo fuffers with her. Let a woman therefore after conception, obferve a good diet, fui- uble toher temperament, cuftom, condition and quality ; and if die Cm, let the air where (he ordinarily dwells be clear and well tem- pered free from extremes either of heat or cold ; for being too hot, it diffipateth the fpirits too much, and cauteth many wewkneffes, and by being too cold and foggy, it may bring down rheums and dif- tiilations on the lung?, and fo caufe her te cough, which by its im- petuous motions forcing downwards, rr.ay make her mifearry ; She ought alfo to avoid all naufeous and ill fmells, for foaietimes the fink of a candle not well put ont may caute her to come before her time; and I have known the fineil of charcoal to have the fame effect. Let her alfo avoid fmdling of rue, mint, pennyroyal, caf- tor, brimftor.e, &c. But with refpect to her diet, women with child have generally fo great loathings, and fo many different longings, that it is \try difficult to prefcribe an exact diet for them. Only this I think ad- vifeable, that thev may ufe of chefe meats and drinks which are to t'tem moft defirable. tho' perhaps not in themfelves fo wbokfome as fome others, and it may not be fo pleafant; but this i'terty muft he made ufe of with this caution, that wlvt .'he fo defines be not in itfelf ablblutely unwhnh fome; and alfo *»:.t in every thing they take care of exeef. But if a child-bearing woman finds herfelf not troubled with fuch longings as we have fpoken cf, and in fuch quan- tity as may be fufficient for her and the child, which her appetite may in a great meafure regulate ; f»r it is alike hurtful for her to faft too long as to eat too much, and therefore ratherlet her e-it a little and often, efpecially let her avoid eating too much k night5 22 THE EXPERIENCED MIDWIFE. becaufe the ftomach being too much filled, compreffeth the dia- Phragm, and thereby caufes difficulty of breathings. Let her meat "e eafy of concoction, fuch as the tendered parts of beef, mutton, veal, fowls, pullets, capons, pidgeons and partridges, either boiled of '"oafted, as fhe likes beft ; new laid eggs are alfo very good for her; andletherput into her broths thofe herbs which purify it, as forrel, lettuce, fuccory and burrage ; for they will purge and purify the blood; let her avoid whaifoever is hot feafoned, efpcc ally pies and baked meats, which being of hot digeftion, overcharge the ftomach. If (he defires fifh, let it be frefii, and fuch as is taken out cf rivers and running flreams. Let her eat quinces, or-marmalade, to ftrengthen the child; for which purpofe fweet almonds, homy, fweet apples, and full ripe grapes, are alfo good. Let her abftain from all (harp, lour, bitter, and fait things^and all thingstbat tend to pro- voke the terms, fuch as garlick, onions, olives, milliard, fennel, with pepper, and all fpices, except cinnamon, which in the lad three months is good for her. If at firft her diet be (paring as fhe increafes in bignefs let her diet be in created for (he ought to con- fider fhe ha* a child as well as herfelf to nourflh. Let her be mod- erate in her drinking; and if (lie drinks wine, let it be rather claret tham white (which will breed good blood, help, the digeftion, and comfort the ftovnach, which is always but weakly during her preg- nancy) but white wine being diuretic, or that which provokes urina cugVtto be avoided. Let her have a care of too much exercife , and let her avoid dancing, riding in a coach, or whatever tlfe puts the body into violent motion, especially in her firft month. But to be more particular I fhall here let down lu'.es proper for every month for the chdd-bear'mg woman to order herfelflrom the time fhe has firft conceived to the time of her delivery. Rules for the firft two months. AS foon as a woman knows or has reafon to believe"flie hath conceived,fiie ought to abftaia from all violent motion or ex- ercife, whether in walking, riding on horleback, or in a coach. Let her alfo abftain from venery, to which after conception, flie has ufually no great inclination, left there be a mole or fisperfatation ; which is the adding of one embryo to the other. Let her beware (lie lilt not hrr arms too high, nor carry great burdens, nor repofe her- felf on hard and unea'y feats. Let her ufe moderately meats of good juice and eafy concoction, and let wine be neither too ftrong nor too fliarp, but a little mingled with water ; or, if fhe be very abftemious, (he may ufe water wherein cinnaman is boiled. L^t her avoid fallings, third, watching, mourning, fadnefs, anger and all otner perturbations ^f the mind. Let none pre tent any ftrangc or armhotefbtie things to her, no; fo njuch as name it, left flie Should THE EXPERIENCED MIDWIFE. 2^ defire it, and not be able to get it, and fo either eaufe ker to mifcar- ry, or the child have fome deformity on that account. Keep her belly loofe with prunes, raifins, or manna, in her broth; and let hor ufe the following electuary to ftrengthen the womb and the child. " Take conferve of burrage, buglofs, and red rotes, two ounces each; balm, citron peel, and maribolans, candied, each an ounce ; extract of wood aloes a fcruple: pearl prepared half a dram ; red carol, ivory each a dram ; precious ftones each a fcruple ; candied nutmegs two drams ; and with fyrup of apples and quinces make an electuary. Let her ufe the following rules. " Take pearls prepared a dram; red carol prepared with ivory each half a dram, precious fh nes, each a fcruple; yellow citron peels, mace, cinnamon, cloves, each half a dram, faffron a fcruple, wood aloes half a fcruple ; ambergreafe fix drains, and with fix ounces of fugar diffolved in rofe water, make rouls." Let her alfo apply ftrengtheners to the naval, of nut megs,mace, maftic, made up in bags, or a toaft dipped in marafey, fprinkled in powder of mint. If flie happens to defire clay, chalk or coal (as many women with child do) give her beans boiled with fugar: and if flie long for any thing which fhe cannot obtain, let her prefently drink a large draught of pure cold water. s Rules for the third month. In this month and the next, be fure to keep from bleeding; for though it may be fafe at other times, it will not be fo until the endjof the fourth month; and yet if too much blood abound, or fome irt cident diteafe happen, which requires evacuation,you may ufe a cup- ping gtafs, with Scarification, and a little blood may-be drawn from the Ihoulders and arms,efpecially if flie has been accuftomed to bleed. Let her alfo take care of lacing herfelf too itraightly, but give her- felf more liberty than flie ufed to do; for inclofing her belly in too ftraight a mould, fhe hinders the infant from taking its free growth, and often makes it come before its time. • Rules for the fourth month. In this month you ought alfo to keep the child-bearing woman from bleeding, unlefs in extraordinary cafes; but when jthismonth is paft, blood-Jetting and phytic may be permitted, if it be gentle and mild; and perhaps it may be neceffary to prevent abortion. In this month (he may purge in acute difeafe?; but purging may be only ufed from the beginning of this month to the end of the fixth: tut let her take care that in purging ihe ufes no vehement medi cine, not very bitter, as aloes, which is an enemy to the ofes,emul- fions of fweet almonds and white poppy feeds. If the be troubled with pains in her loins and hips, as in thefe months flie is Subject to be from the weight of her child, who is now grown big and heavy, and fo ftretcheth the ligaments of the womb, and parts adjacent, let her hold it up withfwathing bands about her neck. Aboat this time alfo the woman often happens to have a flux of blood, either at the Bofe, womb, or hemorrhoids, from plenty of blood, or from the weaknefsof f>e child that takesit not in, or eli'e from evil humours in the blood , that itirs up nature to fend it forth. And fometimes it happens that the veffels of the womb may be broken, either by fome violent motion, fall, cough or trouble of mind ; (for any of thefe will work that effect) and this is fo dangerous, that in fuch a cafe the child cannot be well ; bat if it be from blood only, the danger is no lefs, provided it flows by the veins of the neck of the womb, for then it prevents pletbory, and takes away the nourishment of tlie child ; but if it proceeds from the weaknefs of the child that draws it not; abortion of the child often follows, or hard travail, or elfe die goes beyond her time : But if it flows by the inward veins of her w»mb, the;.? is more dangerby the opennefs of the womb, if it comes from evil blood; th= d-mger is alike from cacochimy, which is like to fall upon both. If it arifes from plethory, open a vein, but with very great caution, and give her aftringents, fuch as the following; " Take pearl prepared a fcruple ; red coral two fcruples, mace, nut- megs, each a dram ; cinnamon, half a dram ; make a powder, or with fugar, rouls." Or, give this.powder inbioth: " Take red c»- ral a dram ; precious ftones half a fcruple : red fanders half a dram.; i HE EXPERIENCED MIDWIFE. J? H-aled earth, and tormentil roots, each two fcruples, vvith fugar of rofes, andmanus Chrifti, with pearl five drams, make a powder."— You may alfo ftrengthen the child at the na^eI; and if there be a cacochimy, alter the humours, and evacuate, if you may do itfafe- ly. You may like wife ufe amulets on her hands, and about her neck. In a flux of hemorrhoids, let "her drink hot wine with a toafted nut- meg. In thefe months the belly is alfo fubject to be bound; but if it be without any apparent difeafe, the broth of a chicken, or of veal fodden with oil, or w ith the decoction of mallows, mercury, and lintfeed put up in a clyfter, will not be amifs, but in lefs quantity than is given in other cafes; to wit, of the decoction five ounces, of common oil three ounces, of fago, two ounces, of caflia fiflula one ounce. But if (he will not take a clyfier,one or two yokls of new laid eggs ; or a few peafe pottage warm, with a little fait and fugar, flipped up a little before meat, will be very convenient: But if her belly {hall be diftended, and ftretched out with wind, a little fennel feed and annifeed reduced into powder, and mingled with feoney and fugar, made after the mannerof an electuary, will do very well* Alfo, if the thighs and feet fwell, let them be anointed with ex- phrodium (which is a liquid medicine made with vinegar and rofe water) mingled with a little fait. Rules for the Eighth Month. The eighth iscommonly the moft dangerous, and therefore the greateft care and caution ought to be ufed ; and her diet ought to be better inqualitv, but not more, nor indeed fo much in quantity as before ; but as fhe muft abate her diet, fo fhe muft increafe her ex- ercife : And bec?.ufe then women with child, by reafon of the fharp humours, alter the bellv, are accKftomed to weaken their fpii its and ftrength, they may well take before meat an electuary of diarrho- don or aromaticum rofatum, or diamargarton ; and as they will loath and nauteate their meat they may take green ginger condited with fugar, or the rinds of citrans and oranges conclittd ; and often ufe honey for the ftrengtheningoftheinfant. When (he is not far from her labour, let her u!c every day feven roafted fig» before meat and ibmetimes lick a little honey ; outlet her beware of fait, and pow- der meat, for it is neither good for her nor tbe child. Rules for the Ninth Month. In the ninth month let her have a rare of lifting any great weight; but let her move a little mate to dilate the parts, and ftir up natural heat. Let her take heed of Hooping, and neither fit too much nor lie on her fides ; neither ought (he to bend herfelf much, left the chiULbe unfelded in the umbilical ligament, by which means it of- ten perilhes. Let her v\nlk and ftir often, and 1st her excrciie be a6 THE EXPERIENCED MIDWIFE. rither tq go upwards than downwards : Let her diet now efpecially be light and eafy of digeftion ; as damallc prunes with fugar, or figs f and raifins, before her meat; as alfo the yolk of eggs, flefh and ■fer6th of chickens, birds, patridges, and pheafants ; aftringent and roafted meats, vvith rice, and hard eggs, millet, and fuch like other things are proper; baths of weet water, with emollient herbs,ought to be uted by her this month without inteimiffion. And after the bath, let her belly be anointed with the oil of roi'es and violets ; but ] for her pi ivy parts, it is litter to anoint them with the fat of lien*, geete, or ducks, or with oil of lilies, and the decoction ©f lintfeed and fenugreek, boiled wi.h oil of lintfeed and maifh mallows, or -\ with the following liniment. " Take of mallows and marlh mallows, cut and fined, of each an ounce ;of lintfeed one ounce ; let them be boiled from twenty ounces of water to ten^ then let her take three ounces of the boiled broth: ef oil of almonds, and oil of flour-de-luce, of each one ounce ; of deer's fuet three ounces j let Iter bathe with this, and anoint her- felf with it warm." It for fourteen days i.-e fere the birth il.c do every morning and e- vening bathe and moiftcn her belly vvith mafcudiue and lavender water, the child will be much ftrengthensd thereby. And if eveiy day fhe eat toafied bread, it will hinder any thing from growing "to the child. Her privy p ♦ ts may be a fo gently llr.aked down vvith this fomentatior. " Take three ounces of lintfeed ; of mallows and marm mallows hfeed, of each erne handful; let them be put into a bag, and boiled immediately : and let the woman with child every morning and e- vcumg take the vapcur of this decoction in a hollow f loci,taking great heed that no wind or air come to her in auy part, and then let her tvfee tbe part fo anointed vvith a linen cloth, that ft,e may anoint the belly and groins as at firft, When {he is ccme fo near ht r time as to be within ten or fourteen days thereof, if fhe begins to feel a- *$ ny more than ordinary pain, let! er ufe every day the following : " Take mallows, and marfi'iraallows, of each one handful: camo- mile, herd wercury, maiden hair, cf each half a -handful: of lintfeed Iovj ounces; let them be boiled in fuch a fufficient quantity ef wa- terasniay make a broth therewith." But let her not fit too hot up- on the feat, nor higher than a little'" above her navel ; nor Jet 1-er lit onit longer thanabrt.thnU'an hour,teft her ftrength lan«i:ifh ai.d fiecav, for it is bttter to ufe it offen, than to day too long in it.— And thus 1 have (hewn h ■ - -*>■ - THE EXPERIENCED MIDWIFE. 27 the womb, and the manner of its pecumbiture there. CHAP. I. Of tbe Parts proper to a Child in tbe Womb; bzvj it is formed there, and tbe Manner *f its Situation there. IN the 1 aft chapter I (hewed what conception was, how accomplifli- ed, its figns, and how die who hath conceived ought to order her- felf during the time »f her pregnancy. Now, before 1 fpeak of her delivery, it is neceffary that the midwife be firft acquainted with the parts proper to a child in the womb, and alfo how it its formed, and the manner of its fituation and decumbiture there ; without the knowledge of which, no one can tell how to deliver a woman as die ouTht. This therefore (hah ^e the work of-this chapter. I fhall begin with the firft of thefe. Section I. Of tbi parts proper to a Child in the Womb. IN this fection I muft firft ted you what I mean by the parts pro- per to a child in the.womb, vtA they are only thofe that either help or nourilh it, wl.ilft it is lodged in thr.t dark repofitory of na- ture, and that help to clothe and defend it there, and are cat away as of no more ufe, after it is born, a::d thefe are two, viz. the urn- bilicum, or *avel veffels, and the fecimdium : by the fii.ft il is ncr- ri.'htd, and.by the fecond clothed and offended from w.c::g. Of each of tfc J'e 1 fhall fpeak diftinctiy, and, firft, Of tbe Umbilkum cr Navel V;fA:. Thefe are four in number, viz. one vein, two aite.fes, and the veffel which is called urachos: 1. The vein is that by wh.-.h the i.ifant is nourifhed, from the time of its conception, tt) the time of its delivery ; till being brought into the light of this world, it has the fame wav of concocting its feof that we have. This vein ari-- . feth from the liver of the chill, and is divided into two parts when it hath paffed the navel ; and thefe two are again divided and fubdi- vided, the branches being upheld by the fkin called chorion (of which 1 diall fpeak by and by) are joined to the veins of the mo- ther's womb, from thence they have their blo»d for the nourifhment of the child. 2. The arteries are two on each fide, which proceed from the back branches of the great artery of the mother; and the vital blood is carried by thefe to the child, being ready concocted by the mother. 3. A pervous or finewy production is led from the bottom of the bladder of the infant to the navel, and this is c.die-i urachos; and its ufe is to convey the urine of the infant from the - alantois. Anatomifts do very much vaiy in their opinions concern- ing this ; fome denyi'-g any fuch thing to be in the delivery of women, and others «fiirndng it: but experience teftifies there is fuch a thing: For Bartholomew Cabrolius, the ordinary doctor of anatomy to the college ai phyficians at Montpelier in Fiance, n> 28 THE EXPERIENCED MIDWIFE. cords the hiftory of a maid, whofe water being a long time flopped' at laft iffued out thro' her navel. And Johannes Fernelius fpealu ©f the fame thing that happend ta a man of thirty years of age, who having a ftoppage in the neck of the bladder, his urine iffued out of his navel many monci.s, together, without any prejudice at all to his health, which he afcribes to the ill lying of his navel whereby the urachos was not well dried. And Volchier Coitas quotes fuch another inftance in a maid of thirty-four years, at Nmemberg in Germa'.y. Thefe inftances, though they happen but feldom, are fufficient to prove that there is fuch a thing as an urachos in men. 1 nefe four veffels before mentioi ed, viz. one vein, two arteries, and the. urachos, do join to the navel, and are united by a fkin which they have from the chorion, and fo become like a gut or rope, and are altogether void of fenfe; and this is that which the good women call the navel firing. Thefe veffels are joined together, that fo thev may neither be broken, fevered, nor entangled : and, when the in- fant is born, are of no ufe, fave only to make up the ligament, which flops the whole cf the navel and fome other phyfical ufe, &e. Of the Sccundinc, or After-Birth. Setting afide the name given to this day by the Greeks and La- tins, it is called in Englifh by the name of Secundine, After-birth, and After-burden, which art* held to be four in number. i. The fuft i; called Placenta, becaufe it refembles the form of a cake, and is knit both to the navel and chorion, and make» up the greateft part of the tecundine or after-birth. The fielh of it is like thar of the milt, or fpleen, foft, red, and tending fomething to black- nefis, and hath many fmall veins and arteries in it; and certainly the chief ufe cf it is lor containing the child in the wnmb. 2. The fecor.d is the chorion. This (kin, and that called the Am- nios, involve tbe child round, b ;th above and underneath, and on both fides, which the Alantois doth not: '(his (kin is that which is moil commonly called the tecundine, as it is thick and white, ^amifhed with many fmall veins and arte:ies, ending in the Placenta befote named, being very light and flippery. Its ufe is not only to caver the child round about, but alfo to receive and fafely bind up the rco.s and tl'.e veins and arteries, or naval veffels before deferibed. 3, Tie third thing which makes up the tecundine, is the Alantois, of which there is a great difpute among anatomifts ; feme faying there is fuch a thing, and otheis that there is not : Thofe that vill have it to be a membrane, fay, it is white, foft, and exceeding thin, and jnft under the Placenta, where it is knit to the Urachos, from whence it receives the urine ; and its office is to keep it feparate from the fweat, that the faltnels of it may nst offend the tender {kin of the child. THE EXPERIENCED MiDWIFEv zif 4. The fourth andlaft covering of the child is called Amnois, and1 it is white, foft, and rranfparent, being noHriftied by fome very fmaH veins and arteries. Its ufe is not only to enwrap the child round, but alfo to retain the fweat of the child. Having thus deferibed the parts proper for a child in the womb, I will next proceed to fpeak of the formation of the child therein, as foon as I have explained the hard terms in this lection, that thofe for whole help this isdefigned, may underftand what they read. There is-none- fo ignorant as not to know that a vein is that which receives blood from the iiver, anddiftributes it in fevend branches to all parts of the body. Arteries proceed from the heart, are in continual-mo- tiin, and by that motion quicken the body.- Nerve is the fame", with finew, and is that by which the brain adds fen.'e and motion to the body. Placenta properly fignifies a fugar-cake ; but in this fec- tion i: is ufed to iignify a fpungy piece of flefh, refembli.ig a cake, full of v?4ns and arteries, and is m ide to receive the mother's blood, - appointed for the infant's nourilhraent in the womb. Chorion is the outward fkin which cempaffeth the child in the womb. The Am- rois is the inner fkin which compaffeth tbe child in the womb. The Alantois is the fkin that holds the urine of the child during the time ttat it abides in the womb. Trie Urachos is the velfel which conveys the mine from the child in the womb to the Alantois. I now proceed t:>. Section J.Of tbe Formation of tbe Child in tbe Womb. ■ '" TO fpeak of the Formation of the child in the womb, we muft begin where nature begins; and that is, at the a& of coition1, in which the womb having received the genetative feed, without which there can be no conception, the womb immediately fhuts up itfelf fo clofe that not the point of a needle can enter the inward orifice ; and this it does partly to hinder the iffuing out of the feed ■ again, and partly toeherifh it by an inbred heat, the- better to pro^J vokc* it to action ; whkh is one reafon wVy women's bellies are fo lank at their firft conception. The woman hiving thus conceired', ^ the firft thing which is operative in the conception, is the fpirit', whereof the feed is full, which, nature, quickenteg by the heat of the womb, ftirs it up to action.- This feed corriifts of very different parts, of which feme are more, and fome-are lefs pure.- The inter- nal Ipirits therefore feparateth thofe parts that are lefs pure, which are thick, cold, a:.id clammy, fr>ui them that are pure and noble. 1 he lefs pure are call to the'oudides, and with them the feed is cir>- - cled round, and of them the membranes are made, in which that - feed which is the moft pure is wrapped round, and kept cijfe tOge- - tlier, that it may be defended from cold and other accidents,- ai\t»i operate the beiter. - I z $t> THE EXPERIENCED MIDWIFE. Tlie firft that is formed is the amnois, the next tlie chorion; and they enwrap the feed round as it were a curtain. Soon alter this (for the feed thus fiiut up in the woman lies not idle) the navel vein is bred, which pierceth thofe fkins, being yet very tender, and car- ries a drop of blood from the veins of the mother's womb to the feed ; from which drop is formed the liver, from which Iiver.there is quickly bred the vena cava, or chief vein, from vhich all the reft of the veins that nourifli the body fpring ; and now tlie feed hath fomething to nourifli it, whilft it performs the reft of nature's work, and alfo blood aduoiniftered to every part of it to form fiefh. This vein being formed, the navel arteries are foon after formed, then tbe great artery, of which all others are but branches, and then the heart; for the liver furnilheth the arteries with blood to form the heart, the arteries being made of feed, but the heart and the #e£i of blood. After this the brain is formed, and then the nerves to give ferjfe and motion to the infant, Afterwards the bones and fiefh are formed, and of the bones, firft Use vetebr« Qr chine bones, and then the ikull, &c. As to the time in which this curious part of nature's workman- ship is formed, phyficians aflign four different feafons wherein th^s microcofm is formed, and its formation perfected in the womb: Tlie firft is immediately after coition ; the fecond time of forming, fay they,, is when the womb, by the force of its own innate power aad virtue, makes a manifeft mutation or coagulation in the feed, fo that all the fubftance thereof feems coagulated #efh and blocd, which happens about the twelfth or fourteenth day after copulation; and though this concretion of fie (by mats abounds w»th fpbits, yet it jeniains undiftinguifliable without any form, and may be called a rough draught of the fee'us or embryo. Tlie third time in which Jtb'is fabrick is come to fome furl her maturity is, when t'.e principal flarts may be in fome meafiue diftinguilhed, and .one may difcern the liver, umbellical veins, arteries, nerves, brain and heart : and this is about eighteen days after conception. The fourth and laljt time afiigned by phyficians for the formation cf the child, is about fhe thirtieth day after conception for a male ; but, for a female) they tell us forty-two or firty-five days are required, though for what reafon I know not, nor does it appear by the birth ; for if the jnaale receives its formation fifteen days fooiier than tbe female, why Jhould it not fee bom fo much fooner too ? But as to that, every dav^s experience flie,\vs us tl(e contrary ; for worcen go the full tune #f nine months both with inafe and female. But at this time of .ihirtydays (or feme will have it forty-five) the outward parts may l>e alfo feen exquifitely elaborate, and diftinguifhed by joints; and ironi this time tlie child btgjns to be animated, though as yet there THE EXPERIENCED MIDWIFE. 3i is no fenfible motion ; and has all the parts of the body, though fmall and very tender, yet intirely formed and figured, although not longer in the whole tkan.one's middle finger : and from thence forward, the blood flowing every day more and more to the wemb, not by intervals like their courtes, but continually, it grows bigger and ftronger to the end of nine raeiuhs, being the full'time of a Wo- man's ordinary iabour. Very great have been the difputes among both philofophers and phyficicians about the nourishment of the child in the womb, both as to what it is, and which way it receives it. Almseon was of opi- nion that the infant drew in its nourifliment by its whole body, be- caufe it is rare ana fpungy, as a fpunge fucks in water on every fide>« and fo he thought the infant feckeo blood, not only from its mo- ther's veins, but alfo from the womb. Democritus hf?ld that the child fucked in the nourifliment at its mouth. Hippocrates affirms that the child fucks in both nourifliment and breath by itj, mouth from the mother, for which he gives two reafons : i. That it will fuck as feon as it is born, and there muft have learnt to fuck before.. 2. Becaufe there are excrements found in the guts as fqon as it is born. But neither of thefe reafons are fufficient tp prove his affej- tion : For, as to the firft, " That the child will fuck as feon as it is born," it is from a natural inftinct; for take a young cat that never faw her dam catch a moufe, and yet flie will catch mice as feon as (lie is able. And as to his fecond reafon, it is a fufficient anfwer to fay, that the excrements found in the guts of an infant new born are not excrements of the firft concoction, which is evident, becaufe they don't flink, but are the thickeftpirt of the blood, which is. conveyed from the veffels ©f the fpleen to the guts. Having there- fore faid enough to confute the opinion of the child's receivu;^ the jiourifiiment by th,e mouth, I ttc affirm that the chiid. receives rs, nourifliment in the womb by the navel; and, that it fhould be fe Js rmifth more confonant to truth and reafon; which, being granted,. it will eafily follow, that the npuriftiment the child receives is the pure blood conveyed into the liver by the nave! vein, which is a branch of the vena porta, or great vein, and paffes to the fmall veins of the liver. Here this blood is niade moft pure, and the thick- er and rawer part of it is conveyed to the fpleen and kidneys, aid the thick fediment of it to the guts, which is that, excrement f urd there fo fi?on as they are born. The pure part is conveyed to .the ,yena cava, and by it diftributed throughout the body by the fmall veins, which like fo many fmall rivulet.s, pafs to every part of iv This blood is accompanied (as all blood is) with a certain watejy jfiibftance, the better to convey it through the paffage it is to run ir, yiiich as in .ipen, is breathed out by fwealing, and contained in the? 3 2 THE EXPERIENCED MIDWIFE. amnios, as I have already faid. Section III. Of the Manner cftbe Child's lying in tbe Womb. I COME now to fhew after what manner the chilu lies in the womb, a thing fo effential for a midwife to know, that fhe can be no widwife who is ignorant of it; and yet, even about this au- thors extremely differ: For there is not two in ten that agree what is the form the child lies in the womb, or in what falhion it lies there ; and yet this may arite in a great meafure from the different figures that the child is found in, according to the different times of the woman's pregnancy: For near the time of its deliverance out rf thole winding chambers of nature, it oftentimes changes the form in which it lay before, for another. Hippocrates affirms the child- is fo paced in the womb as to have its hands, its knees, and its head • i bent down towards its feet, fo that it lies round together, its hands imon both its knees, and its face between them ; fo that each eye toucheth each thumb, and its nofe betwixt its knees : And Bartho- linus was alfe of the fame opinion. Columbusdefcribes the pdfture j of the child thus :' " fhe right arm bowed, the fingers whereof un- der the eir and absve the neck ; the bead bowtddown, fo that the ' chin toucheth the bread, the left arm bowed above both bread asid face, and tbe left arm is propped up by the bending of the right ef- bow ; the legs are lifted upwards, the right of which is fo lifted up j that the thigh toucheth the belly, the knees the navel, the heel the feft buttock, and the foot is turned back and covereth the fecrets; the left thigh toucheth the belly, and the leg is lifted up to the breaft, the back lying outward. And thus much fhall fufiice con- cerning the opinion of authors. I will row Ihew the feveral fituations of the child in the womb,ac- cording to the different times of pregnancy, by which thofe that are contrary to nature, and are thecaufes of all hard labours, will be the more eafily conceived by the underftanding midwife : It ought there- fore, in the firft place, to be obferved, that the infants, as well male * as female, are generally fituated in the midft of tl.e w«mb; for though feme times to appearance a woman's belly feems higher on one fide than the other, yet it is fo with refpcct to her belly only,, and not of her womb, in the midft of which it always placed. But in the fecond place, a vv©man'sgreat belly makes different fi- gures, according to the different times cf pregnancv ; for when flie is young with child,theembryoisal ways found of around fig me,a little oblong, having t1 e fpine moderately turned inwards, tbe thighs folded and a little raited to which the legs are fejrined that the heels touch thebtittocks ; the arm. a e bending, and the hsnls plated uponi the. ] 'knees ; towards which the head is inclining forwards, fo that the chin touched) the' breaft ; in which poftv.r: it refembk oue fitting to THE EXPERIENCED WIDWIFE. 33 eafe nature and, {loopingdown with the head to fee what comesfrom him. The fphieof its back is at that time placed towards the mother's and the head uppermoft, the face forwards, and the feet downwards proportionably to its growth, it extends its members by little and little, which were exactly folded the firft month In this pofture it ufually keeps till the feventhor eight months, and then by a natural propewfity and disposition of the upper part of the body, ths head is turned downwards towards the inward orifice of the vv •mb,tnmbling as if it were over its hcad,,i'o that then the feet are uppermoft, and the face towards the mo-ther'sgrcit gut; and >his tu:-«ir,£ cf the infant in this manner, with his head downwards, towards the latter end of a woman's reckoning is fo ordered by nature, that it may thereby bs the better ditpofed for its paifege into t •. j world at the time of its mothei's labour which is then not i'.-.roff; (and indeed fevcral chil- dren turn not at all until the very time of birth) for in this pofture all its joints are moft eafily extended in coning forth ; for by this means the arms and lags cannot hinder lis birth becaufe they cannot be bended againft the inward ovinra of the wemb ; and the reft of the bodv: being very fupple paffcth without any difficulty after the head, which is hard and big, being paft the birth. It is true, there are divers children that lie in the womb in another pofture, and come to the birth with their feet downwaids, efipecially if there be twins; for then by their different motions tl.ey fo diftuib one an- other, that they feldoirt come both in th. dules called Proftratae. Thefe are figns preceding labour; but when j fiie is prefently falling into labour, the.figns art great pains abont' tbe region of the reins and loins, which, coming and reiterating by intends, anfwer to the bottom of the belly by congruous throes, and fometimes the face is red and inflamed, the blood being much • heated by the endeavours a woman makes to bring forth her child ; and likewite, becaufe during thefe ftrong throes her refpiration is intercepted, which caufes -the blood to have recourfe to her face : alfo her privy parts are fwelled by the infant's head lying in the birth, which by often thrufting, caufes thofe pains to defcend out- wards. She is mu«h fubject to vomiting, which is a fign of good la* beur and fpeedy delivery, «hough by ignorant women thought other- , w THE EXPERIENCED MIDWIFE. 35 wife, for good pains are thereby excited and redoubled; which vom- iting is occafioned by the fympathy there is between the womb and the ftomach. Alfo, when the birth is near, women are troubled with a trembling in the thighs and legs, not with cold, like the be- ginning of an ague fit, but with the heat of the whole body, tho' this does not always happen. When the humours which flow from the womb are difcoloured with blood, the midwives call it Shows, a?.d it is an infallible mark of the birth's being near : and if then t]*: midwife put up her fingers into the neck of the womb, (be will find the inner orifice dilated : at the opening of which, the membranes ef the infant containing the waters prefent themfelvas, and are itrongly forced downwards with each pain (lie hath; at which time one may perceive them fometimes to refift, and then again prefs for- ward the finger, being more or lefs hard and extended, according as the pains are Irronger or weaker, Thefe membranes, with the waters in them, when they are before the head of. the child, which the mid- wives call the Gathering of the Waters, referable, to the touch ot the finger, thofe eggs which have no fhell, but are covered only with a fingle membrane. After this, the pains ftill redoubling, the mem- branes are broken by a ftrong impulfion of the waters, which pre- fently flow away, and then the head of the infant is prefently felt na- ked, and prefents itfelf at the inward orifice of the womb: when thefe waters come thus away, then the midwife may be allured the birth is very near, this being the moil certain fign that can be ; for the Amnios and alantois being broken, which contain thofe waters, by preffing forward of the birth ; tlie child is no better able to fubfilt long in the womb afterwards, than a naked man in a heap of fnevv. Now, thefe waters, if the child comes prefently after them, facili- tate the labour, by making the paffage ilippery ; and therefore let nomidwife(as fome have fooliftdy done) endeavour to force away the water, for nature knows beft when the true time of the birth is, and therefore retains the water till that time. But if by accident the wa- ter breaks away too long before the birth, then fuch things as will haftten it, may be fafely admitted; and what thofe are, I lhall (hew in another feftion. Sec III. How a Woman a:zbt to bs ordered when the tint: oj her Labour i> come. WHEN it is tnown that the true time of a woman's labour is come, by tbe figns laid down in the foregoing fection, of which-, thofe that are moft to be.relied on are pains and ftrong throes in the'belly, forcing downwards, towards the womb, and a dilation of the'inwaTdorifice, which may be perceived by touching it vvith the finger, and the gathering of the waters before the head of the *hild, andthrcfling down /&£ the membranes which contain them ; 36 THE EXPERIENCED MIDWIFE. through which, between die pains, one may with the finger difcover the part which patents, as faid before, especially if it be the head of the child, by its roundiiefs and hardnefs. If thefe things concur, and are evident, tlie midwife may be fure it is the time of her La- bour ; and care muft be taken to get all things ready that are necef- fary to comfort the worrfan in that tune. And the better to help her, be fure to fee flie be not ftrait-laced : You may alfo give her a pretty ftrong clyfter, or more, if there be crcafion, provided it be done at the beginning, and before the child be too forward. , The benefit accruing hereby will be, to excite the gut to difchaige itfelf of its excrements, that fo the rectum being emptied, there may be more fpac for the dilation of the paffage ; Iikewife to caufe the pains to bear the more downward, through the endeavours flie makes when fhe is at ftool ; and, in the mean time, all other neceffary things for her labaur ftiould be put in order, both for tbe midwife and the child. 'Fo this end fome get a midwife's ftool, but a pallet bed girted is much the beft way, placed near the fire, if the feafon fo require : which pallet ought to be fo placed, that there mav be ealy accefs to it on ever) fide, that the woman may be the more readily aflifted, as there is occafion. If the woman abounds with blood, to bleed her a little may not be improper, for hereby flie will both breathe the better, and have her breads more at liberty, and Iikewife more ftrength to bear down the pain; and this flie may do without danger, becaufe the child being about that time ready to be born, has no more need ci the mother's blood for its nourishment: Befides, this evacuation does many times prevent her having a fever after her delivery. Alfo, be- fore her delivery, if her ftrength will permit , let her walk up and down her chamber; and that fhe may have ftrength fo todo, it will be neceffary to give her feme good ftrengthemng things, fuch as jel- ly bFoth, new-laid eggs, or fome fpoonfuls of burnt wine. And let her, by all mean"!, holdout her pains, bearing them down as much as flie can at the time when they take her ; and let the midwife from tiwe to time touch the inward orifiee vvith tke finger, to know whether the waters are ready to break, and whether the birth will follow foon after ; let her alfo anoint the woman's privities with emollient oil, hog's greafe, and freth butter, if fhe finds they are hard to be dilated. Let tlie midwife be all the white near the la- bouring womMi, and diligently obferve her geftures, complaints, and pains, for by this (lie may guefs pretty well how her labour advanc- ' eth; l>ecaufe when flie changeth her ordinary groans iuto long cries, ■ it is a fign the child ' beft capable of breathing, and Iikewife will have more'ftrength to bear her pains, than if fhe lay otherwife, or funk down in her bid. Being fo placed flie muft fpread her thighs abroad, folding her tegs a little towards her buttocks, fomewliat raited by a fmall pillow underneath, to the end her rump fhould have no liberty to retire back ; and let her feet be ftaid againft fome firm things: Befides THE EXPERIENCED MIDWIFE. 4*' this, let her take hold rf fome of the good women attending ker vvith her hands, that (he may tbe better flay herfelf during herpains.- She being thus placed near the fide of her bed, having her midwife by, the better to affiftupon occafion, lethfer take courage, and help her pains the beft Ihe can, bearing them down when they take her,' which (lie muft do by holding in her breath, and forcing herfelf as much as poifible, in like manner as when flie goes to ftool ; fer by fuch draining, the diaphragms, or midriff, being ftrongly thruft down- wards, neceffarily forces down the womb, and the childin it. Inthe mean time, let the midwife endeavour to comfort her ail flie can, exhorting her to bear the labour couiage-oufly, telling her it will be quickly over, and that there is no fear but (he will have a fpeedy delivery. Let the midwife alfo, having no rings on her hand, anoint it with oil or frefti butter, and therewith dilate gently the inward orifice ot the v»omb, putting her finger-ends into the entry thereof, aad then ftretch them one from tneother, when her pains take her ; by this means endeavouring to help forward the child, and thruft- • ing, by little and little, thefides of the orifice towards the hinder part of the child's head, anointing the parts alio with fiefli butter, if it be neceffary. - When the headof tV-e infant is fomewhat advanced into this in- ward orifice, the midwife's phrate is, It is crowned, becaufe it girds and furrounds it juft as a crown ; but when it is fo far that the ex- tremities begin to app:ar without the privy parts, then fay they, 'Tbe- child is in the paffage ;' and at this time the woman feels her- felf as it were feratchei, or prickled with pins, and is ready to ima- gine that the 'midwife hurts her, when it is occalioned by tbe violent diftention of thofe parts, and the laceration which, at fome times, < the bignefs of tiie child's head caufeth there. • When things are in this pofture, let the midwife feat herfelf conveniently to receive the chili, which will now come quickly,and with her finger-ends (which fiie muft be fure to keep clofe pared) let her ende-svour tothruft th- crowning of the womb (of which 1 have fpoken before.) back ever the head of tbe child. - Aud as foon as it is advanced as fir as-theears, or thereabouts, let her take hold of the two flies w«ith her two hards, that when a good pain comes flie may quickly draw forth tlie child, -■ taking care that the navel ftringbenot then entangled about the neck, or any other part, as ibmttimes it is, ted thereby the after- burden be pulled with violence, and perhaps< the womb alfo, *.o which it is fattened, and fo either caufe her to flood, or e'te break the firing, both which are of badconfequer-.ee t© the woman, whofe ' ddiverr may thereby be rendered the more difficult. It muft alfo bo carefully heeded that the head be not drawn cut ftraight, bus-- 4e- THE EXPERIENCED MIDWIFE. ihakingit a little from tlie oi>3 fide to the other, that the (hautders may.fooner andeafier take their place immediately after it be pa ft, without loofing any time, left the head being paft, the child be ftopt there by the largenefs of the Ihoulders, and fo come in danger of being fu(located and ftrangled in the paffage, as it femetimes hap- pens for the want of care therein. But as toon as the head is born, it there be need, (he may Aide in her fingers under the arm pit;, and the reft of the body will follow without difficulty. As fo&n as the midwife kath in this manner drawn forth the child, let her put it on one fide, left the blood and water which follow immediately,: fhould do it an injury, by running into its mouth and note, as it wosll do if it lay on its bac^, and fo endanger the choak- ing it. The child being thus born, the next thing requifite is to bring away the after-burden ; but before that, let the midwife be very caieful to examine whether there be more children in the womb ; for fometimes a woman may have twias that expected it not; whieh the midwife may eafily know by tbe continuance of the pRins after the child is born, and the bignefs of the mother's belly. But the midwife may be more fure of it if flie puts her hand up the entry of the womb, and finds there another water gathering, and a c-hild in it prefenting to the paffage ; and if fhe finds fo, (he muft have a care of going about to fetch away the after birth, till the wo- man be delivered of all the children fhe is pregnant with. Where- fore the firft ftring muft be cut, being firft tied with a thread three or four times doubled and tlie other end fattened with a ftring to tlie woman's thigh, to prevent the inconvenience itroaycaute by hang- ing between her thighs ; and then removing the child already born, flie muft take care todeliverher of the reft, whether more or lefs, obferving all tlie fame circismftances as the firft; after which it will. be rjeceflary to fetch away the after-birth or births. But of that ia another fection ; after firft hie wing wh<*t is to be done to the new born infant. ■ Section IT. Of the cutting off tbe Child's Navel firing. THOUGH this is by many accounted but a trifle, yet great- care is to, be taken about it; and (hews none of the leuft art and (kill cf a midwife to do it as it fhould be ; Jn doing this the midwife ought to obferve, u The time; 2.. The place; 3. The manner;- 4. Tlie event. The time is, as foon as ever the infant comes out of the womb, whether it brings parr of the after-bwthwith-it or not ; for fome- times '-be child brings into tbe world a piece of the amnois upon its heap, and is what rhe good woman calls the caul, and ignorantlv attributes feme extraordinary virtue to the child that is fo born'; fcut this opinion is only the effect cf their ignorance ; fer when flich THE EXPERIENCED MIDWIFE.: " .43, a child is born (as feme Call it) upon its brows it generally betokens weaknefs,and denotes a fliort life. But to the matter in hand. As foon as the child iscotne into the world, confider whether it be weak or ftrong : and if it be weak, let the midwife gently put back part of the vital and natural Wood into the body of the child by its navel ;, for that recruits a weak child ; but if die child be ftrong, the opera- tion isneedlefs. Gidv' let me advife you that many children tlait are born feemin^lv dead, may be foon brought to life again if you fqueeze fix or fev-en drops of blood out of that part of tbe navel ftring; which is cut off, find give it to the child inwardly.. Authors can fearee agree whether tbe navel ftring fhduld be cut long or (hort; tome prescribing, it to be cut off at four finger's breadth, which is at bed but an uncertain rule, unlets all fingers were of one fbe. It is a received opinion that the parts adapted to generation are either contracted or diluted according to the cutting of the navel ftring ; and. therefore midwivas generally leave a longr er part of it to a male than to a female, becaufe they wosald have tlie mates well provided for the encounters of Venus ; and tbe rea- fon thev give why they cut that of the females fhorter, is, becaufe they beiieve it makes them mod^ft, and their privities narrower, which makes them more acceptable to their hufbands. Mizaldus was not of this opinion, and there fere he crtene?1 the navel ftring to be cut long both in male snd female children ; becaufe, faid he,the inftrurrrent of generation follows the proportion of it, and therefore if it be cut too fhort in a female, it will be a hinderance to her hav- ing children. 1 will not rontnidict thefe opinionsof MizalJus, that experience has made good. The one is, that if the navel firing of a ■child, after it is cut, befuffercd to touch the ground, the child will mtver hold its water, neither deeping or waking, but will be fubjexft- to an involuntary making of water all it3 life time. The ether is,. that a piece of the child's navel ftring carried about one, fe that it touch his fkin, defends him that, wears from the falling ficknefe and coiivulfions,. As to the manner how it muft be cuft : Let the midwife take a 'hroWn thread four or five time double, of an ali long, or thereabouts, tied with a fingle knot at each of the ends, to prevent their entang- ng; and with this thread fo accommodated ('-*hich the midwife. friutt have in readinefs before the woman's labour, as alfo a good ^pair of feiffors, that fo no time may be loft ) let her tie the firing ■within an inch of the. belly with a double knit, & turning about tlve ends of the thread let her tie two more on the other fide of the ftrrng reiterating it again, if it be neceffary ; then let her cut of the navel another inch below the ligature, towards tbe after-birth, (b thn -there only ceraa"a»« two ircbes Wthe-firing, -ki the midft of w%i're4\ 44 THE EXPERIENCED MIDWIFE. will be the knot we fpeak of, which muft be fo ftrait knit as not to fuffer a drop of blood to fqueeze out of the veffels; but care muft be taken not to knit it fo ftrait as to cut it in two, and therefore the thread muft be pretty thick, and pretty ftrait knit, it being better too ftrait than too loofe ; for Ibme children have niilerably loft their lives, with all their blood, before it was difcovered, becaufe the na- vel ftring was not well tied. 1 herefore great care muft betaken that no blood fquseze through, for if there does, a new knot muft be made with the reft of the ftring.. You need not fear to bind the navel ftring very hard, becaufe they are void of fenfe, and that part of it which you leave on falls off of its own accord, in a very few days, fometimes fix or feven, and fometirnes fooner ; but rarely tar- ries longer than the eight or ninth. When you have thus cut th« navel firing, then take care the piece that falls off touch not die ground, for the reafond told you Mizaldus gave, whick experience has juftiried. As to the laft thing I mentioned, which is the event or confe- quence, of wh;.t follows cutting of the navel ftring: As feon as the navel ftring is cut eff, apply a little cotton or lint to the place to keep it warm, left the cold enter into the body of the child, which it will moft certainly do if you have not bound it clofe enough. If the lint or cotton you apply to it be dipped in the oil of roles, it will be the better; and then put another fmall rag three or four times double upon the belly. Upon the top of all put another fmall bolfter, and then fwadie it with a linen fwathe four fingers broad, to keep it fteady, left by rolling too much, or being continually ftirri 1 from fide to fide, it comes to fall off before the navel ftring, which you left remaining, is fallen off. It is the.ufual cuftou of rnidwive; to put a piece of tinder t-t it: but I would rather advii'e them to put a little of armoniac to it, becaufe of its drying quality. But hit this fhall ftiftitc to be fpoken as to the cutting .of the navel '• firing' Sec. III. How to bring away the ajter-burden. ■ A Woman cannot be faid fairly to be delivered, tho' the child be born, t:A the aftir burden alfo be taken from her; herein differing from moft animals, who, when they have brought fourth their young, caft forth nothingelfe but fome waters, and the mem- branes w!rich contui: e-i them. , But women have an after labour which fometimes proves more dangerous than the finl: and how v> bring it fately away, without prejudice to her, (hill be my bufinefs tj (hew in this feet ion. . As foon as the child is born, bef re vhe midwife either ties or cuts the naval ftring, left the .womb (hould cloie, let her take the ftrin^ aad. wind it once ©r twice about one or two of the fingc-i of h^-feU - THE EXPERIENCED MIDWIFE. 45 hand joined together the better to hold it, with which die may draw it moderately, and vvith the right hand fhe may only take a (ingle hold of it above the left near the privities, drawing Iikewife vvith that very gently, refting the while the fare finger e-f" the fame hand, extended and ftretched forth along the ftring towards the entry of the vagina ; always obferving, for the more facility, to draw it from the fide where the burden cleaves leaft, for in fo doing the reft will feparate the better: and efpecially, care muft be taken that it be not drawn forth with too much violence, left by breaking the ftring near the burden, the midwife will be obliged to put the whole hand into the womb to deli, er the woman; and fhe had need be a very (kilful woman who undertakes it, left the womb to which this bur- den is fometimes very ftrongly feftened, be not drawn vvith it, as it has fometimes happened. It is therefore beft to ufe fuch remedies as may aflift nature. And hers take notice, that what brings away the birth will alfo bring away the after-birth. And therefore, for the effecting this work, I will lay down the following rules : 1. Ufe the fame means in bringing away the after-birth that you moke ufe of to bring away the birt-; for tbe fame care and circum- fpection is needful now that was then. 2. Confider the labouring woman cannot but be much (pent by what (he has already undergone in bringing forth the infant; and therefore be fare to take care,to give her fometh'uig to comfort her. And in this caie good jelly broths,alfo a little white wine and toaft in it, and other comforting things will be meceftary. 3. A little white hellebore iu powder to make her fneeze, in this cafe is very proper. 4. Tanfy and the ftone jEtites, applied as before directed, is alfo of good ufe in this cafe. 5. If you take the herb vervain, and either boil it in wine crmake a fyrup of tVie juice of it, which you may do, by adding to it dou- ble its weight of fugar (having tlarified the juice before you boil it) and a fpoonful or two cf it given to the woman is very efficacious to bring away the tecundine ; and feverfew and fnugwort, "have the fame operation taken as the former. 6. Alexander boiled in wine, and the wine drank ; alfo fweetfer- vile, fweet cicdy, angelica roots and matter wort, are excellent re- medies in this cafe. 7. Or if thefe fail, the fmoke of marygolds receivad up a woman s privities by a funnel have been known to bring away the after-birth, even when the midwife let go her hold. 8. Which is all 1 fhall fay in thit cafe. Boil mugwort in water till it be very foft ; then take it out and apply it in manner o.t a peuitice to the navel of the labouring woman, and it inftantly brings 4'j THE FXPERIENChD MIDWIFE. a nay the birth and after-birth : but fpecial care muft be taken t<»; remove it as f,.;u.astliey come awav, left, by its longer tarrying, it fhould draw away the womb alfo. Bit this much fhall TurKce to be fpoken of in-.-bringing,away the afrer-biude i in all natural labours. S„c. FV. OflabzurLusand difiicult labours, and bow tbe i;;'ife 1$ to proceed therein. r jHO proceed in this TeCtioH the more regularly, it will be ueccf. JL farytu acquaint the reader that there are three forts of buf labours, all painful and difiicult, but Recall properly unnatural. It v. ill be neceffary therefore to diftinguilh thefe. Tne firft of thefe bad labours is that wh .rein the mother and child fuffer very m (cri by extreme pain an! diri:aky , even though th^ child come right ; and this isdift'mguifhably called 1 ib rious labour. The fecond is that which is ditlicult, and differs not much from ■the former, except that befide thofe extraordinary pains, it is gene- rdly attended with fome uhappy accident, which, by retarding the birth, caufes the difficulty ; and thefe difdeukies being removed, atj- cekrates the birth and hafte-us-the. deli very. Some have afked whit the reafon is that women bring forth thei* children with fo much pain ? I anfwer, the fenfe of feeling is diltri- Luted to the ., 'vote body by the- nerves, and the mrnith of the womb being fo ftrait that it muft of neceffi.ty be dilated at the time of t'',e woman's delivery, the dilating thereof .flu-etches- the nerves, and from thence comes the pais. And therefore the-reafon why fome wome*1 rave mere pain in their labour tkm eUiers, proceeds fr^m tiieir'having, the moetli of the matrix more full of nerves than o- fliers, as fkilful anatomifts do eafily difcover. Put to.pscceed, the beft way to remove thefe difficulties that er- cafion fuch hard pains and labours as I am here to treat of, is to fhew f-omjvvhtnfe thvy proceed, for the cause of any diftemper being known,- is as much-.as half tlie cure. Now the difficulty of labour proceeds either from the mother or child), or both. From the Hiother, by reafon of the indifpoficioii of her body, ojf may befrqai. fome particular part enly, and chiefly the womb, as, when the woman is weak, and the womb is not active to expel the harden, or from weaknefs or" difeafe, or want of fpirifcs; or it may be from iomc ftrong pafliort cf the mind with which Hie was before pof- fi-ffed ; it mav be alfo becaufe (lie hath been too young, and fo mfry have the paffage too ftrait; or toe old, and then, if it be her firft child, becavde her prnts are too dry and too hard, and cannot be fe tahir dilated, as happe ns alfo to them who are too lean. Likewife, thefe who are either fmall, or (ho; t, or defermed, as crooked women, who have not a breath ftrong enough to help, their pains, and to bear fem: down ;. and per feus that are crooked having fometimes the; THE EXPERIENCED MIDWIFF. , 47 fccr.es of the paffage not well fiiaped ; thecholic alfo hinders labour, by preventing the true pains, and all great and acute pains, as when the woman, i; taken with a vicfent, fever, great flooding, freqiaert convulfions, bloody flux, or any other great diftemper. Alfo excrements retained caufe much difficulty, and fo does a ftone in the bladder : or when the bladder is full of urine, without be- ing able to void it; or when the woman is tro.ubLd with great and painful biles. It may alfo.be. from the-pafiages, when the mem- branes are thick, the orifice too ftrait, and the neck of the womb is not diffidently open, the paffages are pre Bed and ftrai used by tu- mours in the adjacent parts, or when the bones are coo firm, and will not open, which very much endangers mother and child ; or whsc the paffages are not ffpery, by reafon.of the water's, having broke too foon,or the membranes' being too thin. Tlie womb may .alfo be out of order with re rpcct to its bad fituation, or conformation, having its neck too ftrait, hard or callous; which may eafily be fo naturally, or may come by accident, being many times caufed by a tumour, a poftbume, ulcer, or fuperfiuous flfclb. As to hard labour occafionedby the child,it is whemthe child hap- pens to flick to a mole, or when it is fo weak that it cannot break the membranes, or if it be too big ?11 over, or hi the,head only, or if the navel veffels are twifted about its neck, when the belly is hydro- pical, or when it is monllrous, having two. heads, ar being joined to another child: alfo when the child is dead, or fo weak that it can contribute nothing to its birth, Iikewife when it conies wrong, or when there are one or two more. And in all thefe various difficul- ties there is oftentimes one more, and that is the ignorance, ®f the midwife ; for want of underftanding her bufinefs hinders nature in her work, inftead of helping her. Flaving thus looked into.the caufe of hard labour, I will now fliew the iiiduftrious midwife how (lie may miniftei fome relief to the la- bouring woman under thefe circumftances. But it will require ur- dfrftanding and judgement in the midwife, when die finds a woman in difficult labour, to know the particular obftruction, or caufe there- of, andfofuitable an remedy may be applied ; as for inftance, when it happen's by the mother's being too young and toQ ftrait, fhe muft be gently treated,.and the paffages.anointed with oil, hogs lard, or frefh butter, to relax ard uilate them the eafier, left there fhould hap- pen a rupture of any part when the child is bom; for fometimes the peritoi.amm breaks with the fkin from the privities to the fundament. But if a woman be in years with her firft child, let her lower parts be anouited to-mollify the inward orifice, which in fuch a cafe being more hard and callous, dpth noteafily yield to the diftention of la. h.yjr. -which is the true caufe why fuch women are longerin labour^ 48 THE EXPERIENCED MIDWIFE. and alfe wliy th«ir children, bei.ig forced againft the inward r.nfi> e of the womo (which as I have faid, is a littlle callous) are born with great !«umps and bruites on their heads. Thofe women that are ve- ryfmall and misfhapen fhould not be put to bed, at leaft till her wa- ters are broke, but rather kept upright, and affifted to walk abm.it the chamber,'by being fupported under their arms : for by that imians they will breathe more freely, and bear their pains better than on the bed, becaufe there they lie all on a heap. As for thofe that are very lean, and have hard labour, from that caufe, let them moiften the parts, with oils and ointments, to make them more fmooth and flippery, that the head of the infant and the womb be not fo com- paffed and bruited by the hardnefs of the mother's bones which form the paffi.ge. If the caufe be weaknefs, (he ought to be ftrengthen- ed, tlie better to fupport her pains ; to which end give her good jel- ly broths, and a little wine w tha toaft in it. If fhe fears her pains, fetherbeco.mfortecl,affuring her that (lie will not bear many more, but be delivered in a little time. But if her pains be flow arid fmall, or none at all, they muft be provoked by frequent and pretty ftrong clyft.ers, that fo they may be excited thereby ; after which, let her walk about the chamber, that fo the weight of the child may hdp them forward. But if fhe flood or have convulfions ; Ihe muft then be helped by a fpeedy delivery; the operation whereof I (hall relate in the fection of unnatural labours. If (he be coftive, let her ufe clyfters, which may alfo help todifpelthe cholic, at thofe times ve- ry injurious, becaufe attended with utelefs pains, and becaufe fuch bear not downwards, and fo help ndt to forward the birth. If fhe finds an obftruction or ftoppage of the urine, 'by reafon the womb bears too much on tbe bladder, let ber lift up her b*lly a little with her hand,& try ifbythatfhe receives any benefit; if (lie finds fliedoes not, it will be neceffary to introduce a catheter in the bladder, and hereby draw forth her urine. If the difficulty be frowi the ill pof- ture of a woman, let her be placed otherwife, in a pofture morefuit- able and convenient for her; alfo .if it proceed from the indifpofiti- ©ns of the womb, as from its obliqne fituation, &c. it muft be reme- died, as well as can be, by the placing of her body accordingly ; or if be a vicious conformation, having the neck too hard, too callous, and too ftrait, it muft be anointed with oils and ointments, as before directed. If the membrane be fo ftrong as that the v/aters don't break in due time, they maybe broken with the fingers, if the mid- wife be firft well affured that the child is come forward into the paf fage, and ready t« follow after, or elfe by the breaking of the waters top, foon, the child may be in danger of remaining dry a long time $ to fupply which defect you may moiften the parts with fomentati- ,tions, decoctions, and emollient oils ; which yet is not half fo wtllas THE EXPERIENCED MIDWIFE. 49 when nature does the work in her own time, vvith the ordinary (lime and waters, which do beft when they come in their own proper time and place. But thefe membranes do foretimes prefs forth with the waters three or four fingers breadth out of the body before the child retembling a bladder full of water; but there is then no great danger to break them, if they benotalready bioken,for when the cafeisfo the child is always in readinefsto follow, being in the paffage 4 but let the midwife be very careful not to pull it with her hand, left the after-burden be thereby loofened before itstime, for it adheres there- to very ftrongly. If the navel ftring happens to come firft, it muft prefently be put up again and kept too, ifpoflible, or otherwife the woman muft be immediately delivered. But if the af.er-burden fliould come firft it muft not be put up again by no means ; for the infant having no further occafion for it, it would be but an obftacle if it were put up ; in this cafe it muft be cut off, having tied the navel ftring, and afterwards drawn forth the child with all the fpeed that may be, left it be fuffocated. Section V. Oj Women labouring with a dead child. HEi>T the difficulty of labeur antes from a dead child, it is a cafe of great danger to the mother, and great care ought to be taken therein ; but before anv thing be done, the midwife ought to be well affured the child is dead indeed, which may be known by thefe figns. 1. The bread fuddealy flacks, or fdls flat, or bags dovv.i.. a. A great coldnefs poffeffes the bread of the mother, efpecially about the navel. 3. Her urine is thick, a filthy finking fettling at the bottom. 4. No motion of the child can be perceived.; for the trial where- of, let the midwife put her hand in warm water, and lay it upon her belly ; for that, if it be alive, will make it ftir. 5. She is very fubject to dream of dead men, and be affrighted therewith. 6. She has extravagant longings to eat fuch things as are againft nature. 7. Her breath (links though not ufedfo to do. 8. When fhe turns herfelf in her bed, or rifes up, the child fways that way like a lump of lead. But thefe dings carefully obferved, the midwife may make a judgment whether the child be alive or dead ; efpecially if the wo- man takes the following prefcription ; "Take half a pint of white wine, and burn it, and add thereto half an ounce of cinnamon, but no other fpice whatever " and when flie has drank it, if her travailing pains come upon her, the child is L w 50 TAE EXPERIENCED MIDWIFE. certainly dead ; but it not, the child may poffibly be either fick <$r weak,but not dead ; and in this cafe, it will refrefh the child, and give her eafe: for cinnamon refrefheth and ft.engtheweth the child in the womb. Now if upon trial, it be found the child is dead, let the mother do all fhe can to forward her delivery, becaufe a dead child can be no ways helpful therein. It will be neceffary therefore that (he take fome comfortable things to prevent her fainting, by reafon of tkofe putrid vapours afeending from the dead child. And in order to her delivery, let her take the followiBgberbs boiled in white wine, (or as many of them as you-can get) viz. Dittany, betony, pen- nyroyal, fage, feverfew, century, ivy leaves and berries. Eetber alfo take fweetbafil in powder, half a drackvi at a time, in white wine ; and her privities be anointed with tbe juice of garden tan- fy ; or, ifyou take tanfy in the fummer, when it may be moft plen- tifully had, and before it runs up to the flower, and having bruited it well, boil it in oil till the juice of it be confumed. Ifyou tet it in the fun, after you have mixed it with oil, it will be more effectual. This a careful midwife ought to have always by her. As to the manner of her delivery, the fame methods muft be ufed as are men- tioned in the fection of naturd labour. And here I caiuaot but again commend the. ftone dEtites, held near tbe privities, whofe magnetic virtue draws the child any way, with the fame facility as the load- ftone draws iron. Ect the midwife alfo make a ftrong decoction of hyfop with wa- ter, and give the woman to drink it very hot, and it will, in a little lime, bring away the dead child. A decoction of the herb mafter- wort, ufed as the above, works the fame effects. The roots of po- lipodium damped well, warmed a little, and bound on the fides of her feet, will foon bring away the child either alive or dead. If, as foon as (he is delivered of tlie dead child, you are in doubt part ef the after-birth is left behind, for in'fuch cafes being rotten, it mav come away piece-meal, let her -continue 'drinking the fame decoction till her body is cleanfed. The following medicines ftir up alfo tbe expulfive faculty ; but in this cafe they muft be made ftronger, becaufe |he motion of the child ceafeth. Take favin, round birthwert, troches of myrrh, afaram roots, cinnamon half an ounce, faffron a fcruple ; give a dram vvith favin water. Or, Take borax, favin. dittany, each an ounce ; myrrh, afaram roots, cinnamon, faftion, each half a dram ; make a powder, give a dram. But fhe may purge firft, and put her in an enaollient bath, anoint- ing her round about the womb with oil «f lilies, fweet almonds, THE EXPERIENCED MIDWIFE. 51 oamomile, hen and goofe greafe. Alfo, foment to get out the child with a decoction of mercury, orris, wild cucumbers, faechus, broom flowers. Then anoint the privities and loins with ointment of fow- bread. Or, Take coloquintida, agarick, birthwort, each a dram, make a pow- der, add arrnoniac diffolved in wine, ox gall, each two drams, with oil of keir make an ointment. Or, make a fume with affs' hoofs burnt, or gallianum, or c.tftor, and let it be taken in with a funnel. To take away pains and ftrengthen the parts, foment with tbe decoction of mugwort, mallows, rofemary, woodmyrtle, St. John's wort, each half an ounce ; fpermaceti two drams, deer's feet an ounce, with wax make an ointment. Or, take wax four ounces, fpermaceti an ounce, melt them, dip flax therm, and lay it all over her belly. If none of thete things will do, the laft remedy is to ufe forgery, and then the widwife ought, without delay, to fend for an expert and able man midwife, to deliver her by manual operation ; of which Itlull treat more at large in the next chapter. CHAP. VI. IN (hewing the duty of a midwife, when the woman's .labour is unnatural, id will be requifite, to ilisw i:i the firft place, what I mean by unatural labour ; for it is natural to a woman to bring forth children in pain ancFforrow. That which I call unnatural, is when the child comes to the birth in a contrary pofture to that which nature ordained, and in which the generality cf children come into the world. Now, as truth is sat one. bat error dilates itfelf into infinite variety ; fo there is but one proper, light and natural pofture in which children come to the birth; but there aie as Tany wrong and unnatural ways, as there are different pjftures of children when they are come to be born. The right and natu- ral birth is when the child comes with i's head firft, and yet even this is too fiiort a definition ef a natural birth ; for if any part t.f the head but the crown comes firft, fo that the body follow not ia a flraight line it is a wrong and difficult birth Now, there are four general ways a child may come wrong; ift, When any of the fore parts of the body prefent themielves. 2dly, When by an unhappy tranfpofition, any of the hinder parts firft prefent them- felves. 3clly, When either of the fides. Or, 4thly, When the feet prefent themftdves firft. To thefe four, all the particular and different wrong poftures that a child can prefent itfelf in, for the birth may be reduced ; and therefore I fhall confine myfelf only to treat of thefe four more general wrong ways. Section I. How to deliver a Woman of a dead Child by unna- tural Operation. 52 THE EXPERIENCED MIDWIFE. rT"*HE laft lection of the laft chapter treated of the delivering 1 of a woman of a dead child, and feveral things were direc- ted to be applied in order to facilitate the delivery ; but when all thefe fail, a manual operation is abfolutely neceffary : In order thereto, let the operator acquaint the woman with the abfolute neceffity there is of fuch .an operation ; and that as the child has already loft its life, there is no other way left for the faving of her's : Eet him alfo tell her, for her encouragement, that he doubts not, with the Divine blefung, to deliver her fafely, and that the pains arifing thereby, will not be fo great as die fears. And then let him endeavour to ftir up the woman's pains, by giving her fome fharp clyfter, to excite her throes to bear dnwn and bring forth the child ; and if this prevail not, let him proceed with his manual operation. Firft, Let her be placed acrofs the bed, that he may operate the eafier; and let her lie 011 her back, with her hips a little higher than her head, or at leaft the body equally placed, when it is neceffary to pat backer turn tbe infant to give it a better pofture: Being thus iituated,lhe muft fold her legs fo as her heels be towards her buttocks, and her thighs fpread, and held by a couple of ftrong perfons; there muft be others alfo to fupport her under her arms, that the body may not Aide down when the chdd is drawn forth, for which fome- times a great ftrength is required ; let the (beets and blankets cover her thighs for decency's fake, and alfo to prevent her catching coid. Then let him anoint the entrance of the womb with oil or frefh but- ter, if neceffary,. that fo he may with more eate introduce his hand, which muft alfo be anointed ; and having by figns before mentioned, received fatidaction that it is a dead child, he muft do his endeavour to fetch it awa/ as foon as poffible ; and if the child oilers the head firft, he muft gently put it back, u.-ttil he hath 1 inert/ to introduce his hand quite into the womb: then Aiding it along under the belly to find the feet let him draw it forth by them, being very careful to keep the head from being locked in the paffage, that it be not feparated from the body; which may be effected the more eafily, becaufe the child being very rotten and putrified the operator is not fo mindful to keep the breaft and face do.vnwards as he is in living births. But if, notwithftanding all thefe precautions, by reafon of the child's putre- faction, the head fhould be feparated, and left behind in the womb, it muft be drawn forth according to the directions which fhall be given in tec. 3. of this chapter for that purpofe. But when the head coming firft, is fo far advanced that it cannot well be put back, it is better to draw it forth fo, than to torment the woman too much by patting it back to turn it, and bring it by the feet ; but the head be- ing a part round and flippery, it may fo happen that the operator can. THE EXPERIENCED MIDWIFE. 53 not take hold of it with his fingers, by reafon of its moifture, nor put them up to the fide of it, becaufe .the paffae e is filled with its big- nefs, he muft take a proper inftrumert, and put it up as far as he can without violence, between the womb and the child's head, ob- ferving to keep the point of it towards the head, and let him fallen it there, giving it a good hold upon one cf the bones of the fkull, that it may not Aids : and, after it is well fixed, he may therewith draw it forth, keeoing the ends of the fingers of his left hand, flat upon the oppofite. fide, the better to help to difengage it, and by fli»king it a little to Gonduct it directly out of the paffage, until the bead be quite bona, and then taking hold of it with the hands . only, the fhoulders may be drawn into the paffage, and fo Aiding the fingers of both hands under the armpits, the"cn~ild may be quite delivered : and then the after-burden fetched, being careful not to pluck the navel-ftring too hard, left it break, as often happens, when it is corrupted If the dead chi^d come'with the arm up to the fhoulders fo ex-- tremely fwelled that the- woman muft fuffer too great a violence to have it put back, 'tis then the bed to take it off at the fboulder joints . by twifting three or four times about, which is very eafily done, . by reafon of the foftnefs and tendernefs of thebody: After the arm is fo feparated, and no longer poifeffiRg the paffage, the operator will have more room to put up his hand if«to the womb, to fetch the , child by the feet and bring it away, - But although the operator be fure the'child is dead in the womb, yet he muft not therefore prefently ufe inftruments, becaufe they are never to be ufed but when hands are1 not fufficient; and there is no other remedy to prevent the woman's danger, or to bring forth the child any other way: and the judicious operator will chute that way which is the leaft hazardous and moft fafe. SfecTiON II. • How a Woman muff be delivered when tbe Child's- Feet come firft. ■ THERE is nothing more obvious tothofe whofe bufinefs it is to aflift'labouring women, thaw that the feveral unnatural po- fliires in which children prefent themfelves at their births, are the occafion of the moft bad labours and all accidents 'that happen unto .. womevi in fuch a condition. ■; And fince-midwiveb are very often obliged, becaufe of the unna- , tilral fituation?, to draw the children firth by the feet, I conceive it to be meft proper to ihew firft, how a child muft be brought forth that prefents itfelf in that pofture, becaufe it will be a guide to fer t , verd of tie reft. ■ I know indeed that in tT.Li cafe 'tis the advice of feveral authors to > L z. 54 THE EXPERIENCED MiDWIFE. change the figure, and place the head fo, that it may prefent the birth ; a»id this council I ftiould be very inclinabte to follow, could. they but alfo Ihew how it mufl be done : But it will appear very difficult, if not impoflible to be performed, if we will avoid the dan- gers that by fuch violent agitations both the mother and the c hild muft be put into, and therefore my opinion is, That it is better to draw it forth by the feet, when it pretenrs itfelf in that pofture, than tp venture a worfe tccident by turning it. As foon therefore as the waters are broke, and it is known that the child comes thus, and that the womb is open enough to admit the midwife's or operator's hard into it, or elte by anointing the paflages vvith oil or hog'g greafe, to endeavour to dilate by degrees, vfing her fingers to this purpofe, fpreading them one from the other, after they are together entered, ard continuing to de fo till it be fufficiently dilated, then taking care that her na'ffs are well pared, and no rings on her fingers, and her hands well anointed with oil or frefli buttet, ard the woman placed in the manner directed in the former fedtion, let her gently introduce her hand into tlie entry of the womb, where finding the child's feet, let it draw it forth in. , the manner I will prefently direct; only let her firft fee whether it i prefents one loot, or both, and if it be but one foot, fhe ought to confider whether it is the right foot cr the left, and alfo in what fafliion it comes: for by that means flie will fooneft come to knew where to find the other, which as foon as flie knows aid Ends, let her gently draw it forth with the ether; but of this lie muft be efpecially careful, viz. that this fecond be not the foot of another child ; for if fo, it may be of the moft fatal confequence, for Ihe mav fooner fplit both mother and child than draw them forth ; but this may be eafily prevented, if (he does but hide her hand up the. firft Kg and thigh to. the twill, and there find both thighs joined together, and defcecding from one and the fame body. And this is alfo the beft means to find the other foot when it comes with ib«t one. As ifoon as the mjdwifeliath found both the child's feet, flie may draw the ri forth, and holding them together, ma; bring them by little and little in this manner, taking afterwards hold of the legs . and thighs as foon as (he can come at them, drawing them fo till the , hips-be come forth. Whiht this is doing, let her ouferve te wrap the parts in a fingle cleth, that fo her hands being already greafy, Aide not on the infant's body, which is flippery, becaufe of tlie vif- . cious humours which are all over it, and prevent one's taking good hold of it, which being dowe, Ihe may take hold under the hips, fo . to draw it forth to the beginning of the breaft ; and let her on both fides with her hand bring down the arms along the child's body, THE EXPERIENCED MIDWIFE. 55 which (lie may then eafily find ; and then let her take care that the belly and face of the child be downwards, for il it ftiould be up- wards, there would be feme danger of its being ftopt by the chin over the fliare bone ; and therefore, if it be not fo, muft turn it to that pofture ; which may be eafily done if fhe take hold en the bo- dy when the breaft and arms are forth in the manner we have faid, and draws it with turning it in proportion on that fide which it moft- inclines to, till it be turned with the face downwards, and fo ha« ving brought it to the fhoulders, let her fete no time, ard defire the woman at the fame time to bear down, that fo at drawing, the head at that inftant, may take its place, aiid not t© be ftopt in the paffage Some children there are, whote heads are fo big, that when the whole body is born, yet that flops in the paffage, though the midwife takes all pofiible care to prevent it. And when this happens fhe muft not endeavour only to draw forth. the child by the fhoulders, laft flie fometime* feparate the body from the head, as I have known it done by the^ midwife, but flie, muft difebarge it by little and little from the bones in the pafiages with the fingers of each hand, Aiding them on each liete oppofite the one to the other, fometimes above, ainvforoetimes under, until the work be ended, endeavouring to difpatch it as foon as pofiible, left the child be tuffocated, as it will unavoidably be, if it fhould, remain long in that pofture: and this being .well aad carefully >. eSeeded, flie may foon after fei*cli away the after-birth, as I have- before directed.. Sectign 111. Hqw ta bring away ike ?Ua4-qf the Child when,,. feparated from tbe bvdy, and left behind in the Womb. rTf MdO' the utmoft care be taken in bringing away tlie cbild by JL die feet, yet if the child happens to be dead, it is fome times fo putrefied and corrupted, tbat with the halt pull the body fepa- ratesfrom the head, and remains alone in the womb, and cannot be brought away but with a manual operation and difficulty, it being extremely flippery, by reafon of the place where it is, and from the, roundiiefs of its figure, on which no hold can be well-taken : And fo very great is the difficulty in this cafe, that fometimes two or three able practitioners in the art of midwd'ery, have, one after the other, left the operation unfiniflied, as not abfe to effect it, after the utmoft efforts of their induftry, flcjll and ftrength : fo that the woman not being able to bedelivered, perifheth. To prevent which ■ fatal accidents, for the time to come, let the following operation be - obterved : When the infant's head feparates from the body, and is left be- hind, whether through putrefaction, at otherwife, let the operator immediately, wbUft the.womb is yet open, direct up his righthsaiiL 56 THE EXPERIENCED W1DW1FE. to the mouth, for no other hold can there be had; and having found it, let him put one or two of his fingers into it, and his thumb under the chin, and then let him draw it by little and little, holding it fo by the jaw ; but if that fails, as fometimes it will, when putrified, then let him pull fonh his right hand, and fli.te up his left, with which he muft fupport the head,.aid with the right let him take, a harrow inftrument called a crotchet : but let it be ftrong and with a fingle branch, which he muft guide along the in- fide of his hand, with the point of it towards it, for fear of hurtii-g the womb; and having thus introduced it, let him turn it towards the head, for to ftrike either into an eye hole, or the hole of an ear, or behind the head, or elfe between the flature, as he finds it moft convenient and eafy ; andtheivdraw forth the head fo fafbned wi.fi' the faid inftruraent, flill helping to conduct it with his left hand ; but when he hath brought it near thjarpaffage, being ftrongly fatten- ed to the inftrument, let him remember to draw forth his hand, that the paffage, not being filled with it, may be the larger and eafier, keeping (till a finger or two on the fide of the head, the better to difengage it. There it alfo another vfay to this, with more safe and lefs hardfhip than the former ; which is this : let the operator take a foft linen or fillet flip of above four fingers breadth, and the length ®fthree quar- ters of an ell or thereabouts, taking the two ends with the left hand, - and the middle with the right, and let them fo pin it up with his right as that it may br; beyond tj»e head, to embrace it as a fling doth a ffbne ; and afterwards draw forth the fillet by the two ends together, it will be eafily drwn forth, tbe fillet not hindering the leaft paf- fage, becaufe it takes up little or no fpace. When the head is thus fetched out of the womb, care muft be ta- ken that not the leaft part of it be left behind, and Iikewife tocleanfe the woman well of her after-burden, if yet remaining, Some have qutftioned whether the child's head remaining yetrin the womb, or the after-birth ought to be brought away firft? Tbe anfwer to which queftion may be by way of difunction ; that is to fay, if theftxirden be vvhally feparated from the fides of the: womb, that ought to be firft brought away, becaufe it may alfo hinder the taking hold of tbe head; but if it ftill adheres to the womb, it muft not be meddled with till the head be brought away ; for if one (heuld then go abaut ' to teparate itfrom the womb, it might then caufe a flooding, which would be augmented by the vioteneeef-the operation ; the veffels to • which it is joining remaining for the mod part open as long as the ' womb is diftended, which the head caufeth while it is retained in it, and cannot clofe till this ft range body be voided, and then it doth by ' contraction and comprefTing itfelf together, as has been more fully.;- THE EXPERIENCED MIDWIFE. 5 7 before explained. Befides the after-birth remaining thus cleaving to the womb during the operation, prevents it from receiving eafily either bruife or hurt. Section IV. How to deliver a Woman when tbe fide of the Child's Head is prefented to the Birth. rTPHOUGH fome may think it a natural labour when the child's _L _ head may come firft, but yet if the child's head prefents not the right way, even that is an unnatural labour, and therefore tho' the head comes firft, yet it it be the fide of the head inftead ®f the crown, it is very dadgerous both to die mother and child, for the child may fooner break its neck than be bsrn in that manner; and by how much the mother's pains continue to bear the child, which it is im- poffible, tinlefs the head be rightly placed, the more the paffages are ftopt; therefore as foon as the poiition of the child is known, the woman muft be laid with all fpeed, left the child fhould advance further in this vicious pofture, and therefore render it more difiicult to thruft it back, which muft be done in order to place the head in the paffage right as it ought to be. To this purpofe therefore place the woman fo that her hips may be a little higher than^her head and fhoulders, caufing her 'to lean a little upon the oppofite fide to the child's ill pofture ; then let the operator Aide up his hand, well anointed with oil, by the fide of the child's head, to bring it right, gently with his fingers between the head and the womb; but if the head be fo engaged that it cannot be done that way, he muft then put up his hand to the Ihoulders, that fo by thrufting them back a little into the womb, fometimes on the one fide, and fometimes on the other, he may by little and lit- tle give it a natural pofition. 1 confeis it would be better if the operator could put back the child by its fhoulders with both his hands; but the head takes up fo much room, that he will find much ado to put up one, with which he muft perform his operation, with the help of the finger ends of the other hand, put forward the child's birth, as when the labour is natural. Some children prefent their face firft, having their heads turned back, in which pofture it is extremely difficult that a child fhould be born ; and if it coiitinne fo long, the face will be fwelled, and withal black and blue, that it will at firft teem monftrous, which is occafionec' as well by the compreflion of it in that place, as by the midwife's fingers handling it too readily, in order to place it in a better pofture. But thisblacknefs will wear away in three or four days time, anointing it often with, the oil of fweet almonds. To de- liver the birth, the fame operation muft be uted as in the former, when a child comes with the fide of the head ; only let the midwife or operator work mere gently to avoid as much as poflible the brui- Ung of the face. s& THE EXPERIENCED MIDWIFE. Section V. How to deliver a Woman when a Child prtfentt one or both Hands together with the Head. SOMETIMES the infant will prefent fome other part together with its httad, which if it does, it is ufually one or both its- hands, and this hinders the birth, becaufe the hands take up part of that paffage which is little enough for the head alone. ; befides, that when this happens, they gnerally caufe the head to lean on one fide; aud therefore this potition may be very well (tiled unnatural. When the child prefents thus, the firft thing to be done, after it is perceived, niuft be to prevent it from coining down more, or engaging further m the paffage, and therefore the operator, having placed the woman on the bed a little lower than her hips, muft put and guide back the infant's hand with hh own, as much as may be, or both of them, if they both come down, to give way to the child's head ; and this being done, if the head be on one fide, it muft be brcugkf into its natural pofture, in the middle, of the paffage, that it may c*me in a ftrait line, aud then proceed as directed in the foregoing fection. Section VI. Hew a Woman is to be delivered when tbe Hand* or feet of tba Infant come together. THE1\E is none but will readily grant, that when the hands and feet of an infant pretest together, the labour muft be unnatural, becaufe It is impoflibte a child fliould be born in that manner. In this therefore, when the midwife guides her hand to- wards the orifice of the womb, flie will perceive only many fingers- clofe together ; and if it be not fufiieienlly dilated, it will be a gocd while before tbe hands and feet will be exactly cliftinguiflied ; for they are fometimes fo (hut and preffed together, that they teem to be all of xme and the fame fhape ; but where the womb is open enough to introduce the hand into it, fhe will eafily know which are tiie hands, and which are the feet; and having well taken notice thereof, let her Aide her hand, and prefently direct it towards the i ifant's breaft, which (he will find very near, and then let her very gently thruft back the body towards the bottom of the womb, leav- ing the feet in the fame place where fhe found them ; and then ha- ving placed the woman in a convenient pofture, that is to fay, her hips a little raited above her breaft and head (which fituation ought always te be obferved when the child is to be put back into the- womb) let the midwife afterwards take hold of the child by the feet aud draw it forth, as is directed in the fecond fection. This labour, though fomewhat troublefome, yet is much better than when the child prefents only its hands; for the child muft be qpte turned about before it can be drawn forth j but in this, they THE EXPRTEENCED MIDWIFE. 59 *re ready, prefenting themfelves, and in this there is not fo much to do, but to lift and thruft back a little the upper part of the body, which is almoft done of itfelf by drawing it along by the feet. I confefs there are many authors that have written of labours, who would have all wrong births reduced to a natural figure ; which is to turn it, that it may come with the head firft ; but thofe that have thus written, are fuch as never underftood the practical part ; for if they had the leaft experienceherein, they would know that it is very often impoflible, at leaft if it were to be done, that violence muft neceffarily be ufed in doing it, that would very probably be the death of mother and child in the operation. I would therefore lay down as a general rule, that whenfoever an infant prefents itfelf wrong to the birth, in what pofture foever from the fhoulders to the feet, it is the beft way, and fooneft done, to draw it out by the feet: and that it is better fearching for them, if they do not pre- fent themfelves, rather than try to put it in the natural pofture, and place the head foremoft; for the great endeavours neoeffary to be ufed in turning the infant in the womb, do fo much weaken both mother and child, that there remains not afterwards ftrength enough to commit the operation to the works of nature, for ufually the wo- man hath no more throes or pains fit for labour, after flie has been fo wrought upon ; for which reafon it would be very difficult and tedious at beft : and the child, by fuch an operation, made very weak, would be in extreme danger of perifliing before it could be born. It is therefore much better in thefe cafes, to bring it away ■ immediately by the feet, fearching for them, as I have already directed, when they do not prefent themfelves : by which the mo- ther will be prevented of a tedious labour, and the child be often brought alive into the world, who otherwife would hardly efcape death. And thus much fhall fuffice to be faid of unnatural labours: dor by the rule already given, a fkillful artift will know how to pro- ceed in any pofture in which the child (hall prefent itfelf. Section VII. How a ffoman ftmll be delivered that has Twins which prefent themfelves in different poflures. WE have alreadfy fpoken fomething of the birth of twins in the chapter of unnatural labour ; for it is not an unnatural k&our bandy to have twins, provided they come in a right portion to the birth. But when they (hall prefent themfelves in divers poftures, they come properly under the denomination of unnatural labours; and if when one child prefents itfelf in a wreng figure, it makes it much worle fo when there are feveral, and renders it not only more painful to the mother and children, but to the operator •«lfo; for they often trouble each other, and hinder both their births, iefides which, tlie womb is then fo filled with them, that the ope„ 60 THE EXPERIENCED MIDWIFE. rator can hardly introduce his hand without much violence, which he muft Jo, if they be to be turned to thurft back, to give them a better pofition. When a woman is pregnant with two children, they rarely pre- fent to the birth together, the one being generally more forward than the other, and that is tbe reafon that but one is felt; that ma- ny times the midwife knows not that there are twins, till the firft is born, and that flie is going to fetch away the after-birth. Ia the 5th chapter, wherein I treated of natural labour, I (hewed how a woman (hould be delivered of twins, prefenting themfelves both right: and therefore, before I clofe this chapter of unnatnral labour, it only remains that I fhew what ought to be done, when they ei- ther both come wroHg, or one of thera only, as for the moft part it happens; the firft generally coming right, and the fecond with the feet forward, or in fome worfe pofture. In fuch a cafe, the birth of the firft muft be haflened as much as poflible, to make way for the fecond, which is beft brought away by the feet, without endea- vouring to place it right, even though it was fomewhat inclining to- wards it, becaufe it has been already tired and weakened by the birth of the firft, as well as its mother, that there would be greater danger of its death, than likelihood cf its coming out of the womb that way. But if, when the firft child is born naturally, the fecond fhould Iikewife offer its head to the birth, it would be then bell leaving na* ture to finfli what fhe has fo well begun ; and if nature fhould be too flow in her work, fome of thofe things mentioned in the fourth chapter to accelerate the birth, may be properly enough applied ; and if, after that, the fecond birth fhould be yet delayed, let a ma- nual operation bs deferred no longer : but the woman being pro* perly placed, as has been before directed, let the operator direct his hand gently into the womb to find the feet, and fo draw forth tlie fecond child, which will be the more eafily effected, becaufe there is way made fufficient by die birth of the firft; and if the wa- ters of the fecond child be not broke, as it often happens, yet in- tending to bring it away by the feet, he need not fcruple to break Pre membranes with his fingers: for though when the birth of a child is left to the operation of nature, it is neceffary that the waters fhould break of themfelves ; yet when the child is brought out of the womb by art, there is no danger in breaking of them ; nay, on on the contrary, it becomes neceffary; for without the waters are broke, it weuld be almoft impoflible to turn the child. But herein principally lies the care of the operator tint he is not deceived, when either tf!e hands or the feet of both children offer themfelves together to the birth ; in this cafe he ought well to con- THE EXPERIENCED MIDWIFE.- 61 aer the operation, as whether they be not joined together, or any way monftrous; and whch part belongs to one child and which to the other, that fo they may be fetched one after the other^ and not both together, as might be, if it were not duly confidered, taking the right foot of the one and the left foot of the other, and fo draw- ing them together, as if they belonged to one body, becaufe there is a left and a right, by which means it would be impoffible ever to de- liver them ; Butafkilful operator will eafily prevent this, if hav- ing found two or three feet of feveral children, prefenting together in a paffage, and taking a fide two of the forwarded, a right and a left, and Aiding his hands along the legs and thighs up to the twift, if forwards, or the buttocks, if backwards, he finds they both belong to one body ; of which being thus affured, he may begin to draw forth the nearerl, without regarding which is ftrongeft or weakeft, bigger or lefs, living or dead, having put firft a little afide that part of the other child which offers to have the more way, and fo dif- patch the firft, wherever it is, as foon as may be, obferviug the fame rules, as if there were but one, that is, keeping the breaft and face downwaids, with every circumftance directed in that fection. where the child comes with its feet firft : and not fetch the burthen till the fecond child is born. And therefore when the operator hath drawn forth one child, he muft feparate it from the burden, having tied and cut the navel ftring, and then fetch the other by the feet in the fame manner, and afterwards, bring awav the after-burden with the two firings, as have been before (hewed. If the children prefent any other part than the feet, the operator may follow the fame me- thod as is directed in the foregoing fection, where the feveral unna- tural pofitions are carefully treated of. CHAP. viir. Directions for Child-bearing Women in their lying-in. IN-the fourth, fifth, and fixth chapters, we have treated at large of women's labour, and how they may be fafely delivered both in natural and unnatural labours. Having therefore thus brought the go»d woman to bed, I will in this chapter direct how fhe ought to-be ordered in her lying-in. Section I. How a Woman newly delivered ought to be ordered. AS foon as die is laid in bed, let her be placed in it conveni- ently for eafe and reft, which flie (lands in great need of, " to recover herfelf of the great fatigue (lie underwent during her travial ; and, that fhe may lie the more eafy, let her head and body be a little raifed, that fhe may breatlie the more freely, and cleanfia the better, efpecially of that blood which then comes away, that fo it may Hot clot, which being retained, caufeth, very great pain. *z THE EXPERIENCED MIDWIFE. Having thus placed her in bed, let her drink a draught of burnt •white wine, when you have firft melted therein a dram of fperma- ceti. The herb vervain is alfo a moft Angular herb for a woman hi this condition, boiling it in what (lie either eats or drinks, fortify- ing the womb fo exceedingly, that it will d» it more good in two diys, having no offenfive tafte, thowgh very pleafant virtues. And this is no more than what fhe flands in need of, for her lower part? being fo greatly diftended to the birth of the infant, it is good to endeavour the prevention of an inflammation there. Let therefore be outwardly applied all over the bottom of the belly dnd privities, the following anodyne or cataplafm. Take two ounces of oil of fweet almonds, and two or three new laid eggs, yollls and whites ftirring them together in an earthen pipkin over hot embers, till it comes to the confidence of a poultice ; which being fpread upon a doth, muft be applied ta thofe parts indifferently warm, having firft taken away the clofures (which were put to her prefently aftCr her delivery) awl Iikewife Inch clots of blood as were then left. Let this lie on five or fix hours, and then renew it again as you fee «aufe. Great Care ought to be taken at firft, that if her body be verv weak, (he be not kept too hot, for extremity of heat weakens na- ture and diffolves the flrength ; and whether (he be weak or ftrong, be fure that no cold air conies near her at firft; for cold is an ene- my to the fpermatic part", and if it gets into the wpmb, it increafes t-he after-pains, caufes fwellings in the womb, and hurts the nerves. As to her diet, let it be hot, and let Inereat but a little at a tine. Lether avoid the light for three or four da)s, and longer if fhe be weak, for her labour weakens her eyes exceedingly, by a harmony between the womb and them. Let her avoid great noifes, fadnefo and troubles of mind. If the womb be foul, which may be eafily perceived by the im- purity of the blood (which will then either come away in clots or ftinking, or ifyou fufpect any of the after-burden to be left behind, which may fometimes happen) make her drink of featherfew, mug- wort, pfnnyroyal and mother of thyme, boiled in white witie, fweet- ened with fugar. Panada r.nd new laid eggs is the beft meat for her at firft, of which fhe may eat often, but not too much at a time. And let her ufe cinnamon in &U her meat and drink, for it is a great ftrenjthener to the womb. Let her fir as little as may be, till after the fifth, fixtb, or fe- venth days of her delivery, if fhe be weak. And lether talk as little as may Le, for that weakens her. If die goes not well to ftool, give a clyfter made only with th* THE EXPERIENCED MIDWIFE. 63 decoction of mallows and a little brown fugar. When fhe hath laid-in a week or more, let her ufe fuch things as clofe the womb, of which knot grafs and comfrey are very good : and to them you may add a little polypodium, for it will do her good, both leaves and roots being bruifed. Sec II. How to remedy thofe accidents which a lying-in Wo- man is fubjeSl to. i« r I MfE firft commota and ufual accident that troubles women, X in their lying-in, is after-pains ; the caufe whereof, fome affirm to be one t'-.ing, and fome another ; but it is moft certain that they proceed from cold and wind contained in the bowels with which they are filled after lab®ur, becaufe when .they have .more room to dilate, than when the child was in the womb, by which they we-r« eorapreffed, and alfo becaufe the nourifliment and matter contained. in them and the ftomach, has been confufedly agitated from fide to fide, during the pains of labour, and could not be wed digefted, whence thi3 .wind is afterwards generated, and by confequence, the gripes which the woman feels running into her belly from fide to fide* according as the wind moves, and fometimes from the wombj becaufe of the compreflion and commotion which the bowels make. Thefe being generally the caufe, let us now apply a fuitable re- medy. 2. Boil an egg foft, and pour out the yolk cf it, with which Biix a fpoonful of cinnamon .water, and let her drink it; and if you mix in it two grains cf ambergreafe, it will be the better; and vet vervain taken in any thing flie drinks, will be as effected as the other. 3. Give the lying-in woman, immediately after delivery, oil of foeet almonds and fyrup of maidenhair mixed together; fome prefer oil of walnuts, provided it be made of nuts that are very good, but if. taftes worte than the other. This will lenity the infide of the in- teftines by its unctuoufnefs, and by that means bring away that which is contained in them more eafily. 4. Take and boil onions very well in water, then ftarnp them Vrith eil and cinnamon and feed in povvdeiyfpread them upon a clqth, iind apply them to the region of the womb. 5. Let her be careful to keep her belly very hot, and not to drink y.'hat is too cold : and if they prove very violent, hot cloths, fiom time to time, muft be laid to her belly, or a pancake fried in wal- But oil, may be applied to it, without fwathing her belly fo ftrait ; aud, for the better evacuating the wind out of the inteftines, give her a cKfter, repeating it as often as necefiity requires. 6. Take bayberries, beat them to powder, put the powder upor* .| chaffing difh of coals, and let her receive the ("moke of the a: up 6.4 THE EXPERIENCED MIDWIFE. her privities. Take tar and barrows greafe, of each an equal quantity, boil them together, and, whilft it is boiling, add a little pigeon's dung to it. Spread fome of this upon a linen cloth, and apply it to the reins of her back, and it >vill give her fpeedy eate. Laftly, let her take half a dram of bay berries beaten into a pow- der, in a draught of milliard or tent. II. Another accident to which women in child-bed are fubjedt, is the bemorrhoides, or piles, oceafioned through their {training in bringing ikt child into tbe. world. To cure this, i. Let her be let blood in the vein faphsena. 2. Let her ufe poiypodium in her meat and drink, bruited and boiled. 3. Take an onion, and, having made an hole in the middle of it, fill it full of oil, toaft it, and having bruited it all together, apply it to the fundament. 4. Take as many weed lice as you can get, and bruife them, and having mixed them with a little oil, apply them warm as be- fore. 5. If fh<* go well to ftool, let her take an ounce of caflia fiftula drawn at night going to bed; flie need no change of diet after. III. Retention of the menflrues is another accident happening to women in child-bed; and, which is of fo dangerous confequence, that, if not timely remedied it proves i^crtuli Wher° 'JIUS hap- pens. 1. Let the woman take fuch medicines as ftrongly provoke the terms, fuch as .dittany, betony, pennyroyal, favory, featherfew, centaury, juniper berries, piony roots. 2. Let her take two or three fpopnfuls of briony water each mor- ning, 3. Gentian roots beaten into a powder, and a dram of it taken every morning in wine, is an exrraordinary remedy. 4. The root of birthwort, either long or round, fo ufed and taken as the former, is very good. 5. Take twelve piony feeds, and beat them into very fine powder, and let her drink them in a draught of h»t carduus poffet, and let her fweat after- And if this li»ft medicine don't bring them down the firft time flie taftes it, let her take as much more three hours after, and it feldom fails. IV. Overflowing of the merifes is another accident incidental to child-bed women. 1. Take {hepderds' purfe, either boiled in any convenient 1L quor, or dried, and beaten into powder, and it will be an admira- ble remedy to (top them, this being efpecially appropriated to the THE EXPERIENCED- MIDWIFE. % privities. ^ 2. The flowers ar?d leaves of brambles, or either of them, being dried and beaten into powder, and a dranrof them taken every morn- ing- in a fpooKful of red wine, or in the decoction of the leave* of' the fame (which perhaps is much better) is a» admirable remedy for the immoderate flowing of theterras in women. V. Excoriations, bruifes, and rents of the lower part of the womb, are often occafioned by the violent diftention and repara- tion of the four caruncles in a woman's labour- Eor the healing whereofo As foon as the vjoman is laid, if there be only fiiBple contufi- ens and excoriations, let the anodyne cataplafm, formerly directed,. be applied to the lower parts, to eate the pain, made of the yolks and whites of new laid eggs, and oil of rotes, boiled a little over warm embers, continually ftirring it till it be equally mixed, and then fpread upon a fine cloth, it muft be applied very warm to the bearing place for five or fix hours, and when it is taken away, lay fome rags, dipped in 4>il of St. John's wort twice or thrice a dayv alfo fome foment the parts with barley water and honey ®f refes to gleanfe them from the excrements which pafs. When the woman: makes water, let them be defended with fine rags, and-thereby hin- der the urine from caufing fmart and pain. VI. The curdling and elottiag of the milk is another accident that often happens to women in child-bed ; for, in the beginning of child bed, the woman's milk is not purified, becaufe of thofe great commotions her body foffered during her labour^ which affec- ted all the parts, and it is then mixed with maay other humours. Now this clotting of milk does, for the moft part, proceed fr®m the breads not being fully drawn, and that either becaufe (he hath too much milk, and that the infant is too fmalf and weak, to fuck all, or becaufe fhe doth not defire to be a nurfe, for- die milk m jdiofe cafes, remaining in the breaft after concoction, without being drawn, lofeth the fweetnefs and.the balfamic quality it had, and, by reafon of the heat it acquires, and: the too long, flay it makes there, it fours, curdles, and clots, as vve fee runnet put into crdi- nary milk turns into curds* This cardling of the milk may be alio eaufed by having, taken-a great, cold, and, not keeping the breaftg well covered. But from what caufes foever this curdling of the milk proceed^, the moft certain remedy is, fpeedily to draw the breads until they are emitted and dried. But in regard of the infant, by reafon of its weaknefs, cannot draw ftrong enough, it will fee proper te £et another woman to draw her breafts, until the jnUk correff M x '66 THE EXPERIENCED MIDWIFE. *rcely, and then fhe may give her child fuck. And, that flie may not afterwards be troubled with a furplufage of milk, fhe muft eat foch diet as gives but a little nourifliment, and keep her body open. But if the cafe be fuch that the woman neither can nor will be a rurfe, it is then neceffary t® empty the body by bleeding in the arm.; befides drawing down the humours, by ftrong clyders, and bleeding in the foot, nor will it be amifs to purge gently ; and to diged, dif- folve and diflipate the curdled milk, apply the cataplafm of pure fioney, or ufe the following liniment : A Liniment to tcatter and diflipate the Milk. That the milk flowing back to the breads, may without offence be diffipated, ufe this ointment: " Take pure wax two ounces, lint- feed oil half a pound ; when the wax is melted, let the liniment be made, wherein linen cloths mud be dipped, and laid upon the bread; and when it fhall be difcufftd, and pains no more, let other linen cloths be dipped in the diftilled water of acorns, and put upon them." Note, That the cloths dipped in the diftilled water of aeorns, muft be ufed only by thofe who cannot nurfe their own children ; but if a fwelling in the breafts of thofe who give fuck, arifes from abundance of milk, and threatens an inflammation, ufe the former ointment, but abftain frdin ufing tlie diftilled water of acorns. C H A P. VIII. DircBiont for nurfes in ordering uew-born children. HAVING in the foimer chapter fiiewn how the lying-in wo- man fhould be ordered, it is now high time to take care of the infant, to whom the firft fervice that fhould be performed for it, is the cutting of the navel-firing, of which 1 have fpokem at large be- fore- Section I. What is to be done to-the new-born infant after cutting tbe navel-firing. HEN the child's navel-ftring has been cut, according to the rules before prefcribed, let the midwife prefently cleanfe it. from the excrements and filth it brings into the world with it; of which fome are within the body, as the urine in the bladder, and the (excrement found in the .guts;; and others without, which are "thick, whitiTh and c ammy, proceeding from the iliminefs of the waters: There are children fometitnes fo covered over with this, that one wauld fay they are rubbed over with foft cheefe and fome :,women are of fo eafy a belief, that they really tliinki * fo, becaufe 'they had eaten fome while they were withxhild. -From thefe ex- (Cjem?nt.s let the- child he eleanfed with wine & water a little warm- «d#w-afld:ig every part there with but chiefly the head, becaufe of w THE EX PER IE N CED M ID WIFE. % **be hair, alfo the folds of the groins, armpits, and the cods or privi- ties ; which parts muft be gently cleanfed with a linen rag, or a foft Ipunrre dipped in this lukewarm wine. If this clammy or vifeious excrements (lick fo clofe that it will not be eafily wailied off from thofe places, it may be fetched off vvith die oil of fweet idmcnds, or a little frefli butter melted w ith wine, and afterwards vvcdl dried off. She muft alfo make tent of fine rags, and, wetting them in this liquor, clear the ears and noftrils ; but for the eyes, wipe them ouly with a dry foft rag, not dipping it in the wine, left it fhould make them lmart. The child being thus waflied and cleanfed from its native blood and impunities which attended it into the world it muft, in the next place be fearchedto fee whether all things be right about it, and that there is no fault or didocation ; whether its nofe be ftraight, ov its tongue tied, whether there be. any bruife or tumour on the head, or whether the mould be not overfhotten ; alfo whether the terotum, if a boy, be not blown and fwelled ; and in fliort, whether it has foffered any violence in any part of the body, and whether all the parts be well aad duly fliaped, that fuitablc remedies may be appli- ed, if any part be found not right. Nor is it-enough that all be right without, and the outfide of the body cleanfed, bat fhe muft •chiefly obferve whether it difehargeth the excrements retained with- in, and whether the paffages be open for fome have been born without having them perforated ; therefore let her examine whether the conduits of the urine and ftool be clear, for want of which fome have died, not being able to avoid theh excrements, becaufe timely care was not taken at firft. As to the urine, all children, males. and females, do make water as foon as they are born, if they can, efpecially when they feel the beat of the fire, and fometimes alfo the excrements, but not fo foon as the urine. If the infant does not ordure the firft day, then put ap into its fundament a fmall fup- pofitory, to ftir it up to be discharged, that it may not caufe pain- ful gripes by remaining fo long in its belly. A fugar almond may be proper tor this purpofe, anointed over with a little boiled honey, -or elfe a fmall piece of caftile foap rubbed over with frefh butter ; (he may alfo give the child, to this purpofe, a little fyrup of vio- lets at the mouth, mixed with fome oil of fweet almonds drawn witnout a fire, anointing the belly alfo with the fame oU or a little frefh butter. The midwife having thus wafned and cleanfed the child, accord- ding to the before mentioned directions, let her begin to fwaddle in fwathing clothes, and when fhe dreffes the'head, let her put fmalj rags behind the ears to dry up the filth which ufually engenderg Xheze, and alfo in the folds of the armpits and groins, and fo fwatl^ 68 THE EXPERIENCED MIDWIFE. it, havin-r wrapped it up warm in bed and blankets ; oaly take care that they fwathe not the child too ftrait, efpecially about the breaft ard ftomach, that it may breath the mere freely, and not be forced to vomit up the milk it fecks, becaufe the ftomach cannot be fiiiffi- cientiy extended to contain it ; therefore, let its arms and legs be wrapped in its bed ftretched and ftraight, and fwathed to keep them fo, viz. the arms along its fides, aHd its legs equady both together, with a little of the bed between them, that they may not be galled by rubbing each other; let the head be kept fteady and ftraight, with a (lay fattened on each fide the blanket, and then wrap the -child up in mantles and blankets to keep it warm. This fwathing ©f the infant is very neceffary to give its body a ftraight figure, which is moft decent and proper for a man, and to accuftom him to keep upon his feet, and not walk on all-four, as moft other aid* mals do. CHAP. IX. NE W-B ORN children are fubject to fo many diftempers that daily experience (hews us, there are not above half the children that are born who live till they are three years old ; which is occaiioned by the tendemefs of their bodies, and feeblenefs of their age, which hinders them from exprefling the incommodities they labour under, any otherwife than by their cries. The bufi- ne*e of this chapter therefore wid be to difcover the indifpofitions to- which they are fubject, with the remedies proper them. Section 1. Of Gripes and Pains in the Bellies sf young Children* TpIIS I mention firft, as it is often the firft and common dif- temper which happens to little infants after their birth, many children being fo troubled and pained therewith, that they cry night and day, and at laft die of it. This comes, for the moft part, from the fudden change of their nourifliment, for having always received it from the umbilical veffels, whilft in their mother's womb, they come to change, on a hidden, not only the manner of receiving it,. but the nature and quality of what they receive, as foon as they are born : for inftead of purified blood only, conveyed to them by means of the umbilical vein, they are now obliged to be nourifhed with their mother's breaft milk, which they fuck with their mouths,. and from which are engendered many excrements, ca-ufing gripes and pains, and that not only becaufe it is net fo pure as the blood with which it was nouriflied in the womb, but becaufe the ftomach and inteftines cannot yet make a good digeftion. It is alfo caufed fometimes by a tough phlegm, and fometimes by the worms; for. phyficians affirm, that worms have been bred in childi.en even ia, their mother's belly. THE EXPERIENCED MIDWIFE. 69 The remedy therefore mud be fuited to the caufe ; if it proceed from the toofudden changes of nourifliment, the remedy mult be to forbear to give the child fuck for fome days, left the milk be mixed with phlegm ; and at firft it muft fuck but little, until it be accuftemed to digeft it- If it be the excrements in the inteftines, which by their long flay increale their pains, give them at the mouth a little oil of fweet almonds, and fyrup of rotes. If it be worm?, lay a cloth dipped in oil of wormwood, mixed with ox-gall^ upon the belly ; for a fmall cataplafm, the powder of rue, wormwood, coloquintida, aloes, the feeds of citron, incorporated with ox-gall, and the powder of lupines. Or, give it oil of fweet almonds, with fugar candy, and a fcruple of aids teed ; it purges new-born babes from green dialer and flanking phlegm, and -if it be given with fu- gar pap it allays the griping pains of the belly. Alfo anoint the belly with od of dill, or pellitory ftamped with oil of camomile to the belly. Section II. Ofweaknefs in new-born infants. WEAKN ESS Is an accident that many children bring into the world along with them, and is often occafioned by the la- bour of the mother, by the violence and length whereof they fuffer fo much, that they are born with great weaknefs, and many times it. is difficult to know whether they are alive orjdead, theirbody appear- ing fo fenfefefs, and their face fo blue and livid, that they fesm to be rqnite chdaked ; and, even after fome hours, their fhe.ving figns of life is attended with lo much weaknefs, that it looks like a return from death, and that they are ftill upon the borders cf that king- dom. Iu this cafe, the beft way to help the infant is to lay him fpeedily in a warm bed and blankets, and carry him to the fire, and then let the midwife i'up a little wine, andfpout it into his mouth, repeating it often, if there bs occafion. Let her apply linen to the breaft and belly dipped in wine, and theivlet the face be uncovered that'he may breathe the more freely ; alfo let the midwife keep its mouth a lit- tle open, cleanfe the noftrils with fmall linen tents dipped in white wine, thatfo he may receive the fmel-1 of it" and let her chafe every part of his body wed w th warm cloths, to bring hack the blood and foirits, which being retired inward through weaknefs often pntshirn in danger of being choaked. By the application of thefe means the infant will infenlibly recover ftrength, and begin to ftir his limbs by degrees, and at length to cry, which though it be but weakly at firft, yet afterwards as he breathes more freely, he will cry ftronger and itronger. 7© THE EXPERIENCED MIDWIFE. Section III. Of tbe Fundament being clof$d up in a ncwbor Infant. ANOTHER effect that new-born infants are liable to, is to have their fundaments chded up, by means whereof they can nei- ther evacuate tbe new excrements engendered by the miik they fuck; nor that which was amaffed in their inteftines whillt in tieir mo- ther's belly, which is certainly mortal without a fpeedy remedy— 'i here have been fome femalechildren who have had their fundament quite clofed, and yet have avoided the excrements ef the guts by an orifice, which nature, to fapply that defect, had made within the neck of the wemb. F.,r the cur.'; or remedy cf this, we muft notice that the fundament is doled two ways ; either by a fingle fkin, through which cue may difcover fome black .and blue marks, proceeding from the excrements retained, which of one touch with the finger, there is a foftnefs felt within, and thereabouts it ought to be pierced : or clfe it is quite flop- ped by a thick fielhy fubftance, in fuch fort that there appears, no- thing without by which its true fituation may be known. When there is nothing but the fingle fkin which makes the olofure,the ope- ration is very eafy, and the child may do very well : for then an «.- pertion or opening may be made with a fmall incifion knife, crofs ways, that it may the better receive a round form, and that the place afterwards may not grow together, taking great care not to prejudice the fphincter or mufcle of the Rectum. The incifiori be- ing thus made, the excrements will certainly have iffne. But if, by reafon of their long ftay in the bedy, they are become fo dry that the infant cannot void them, then let a fmall elyfter be given to moiften and bring them away ; afterwards put a linen tent into the new-made fundament, which at firft had beft be anointed with honey rf rotes, and towards the end with a drying cicatrizing ointment, foch as Unguentum, Album, &r Pomphtlix, obferving to eleanfethe infant of his-excrements, and dry it again as foon and as often as he ( vacuates them, that fo.the aperrion may be prevented from turn- ing into a malignant ulcer. But now if the fundament be topped uo in fuch a manner, that neither mark nor appearance can be either teen or felt, then the ope- ration is more difficult ; and even when it is done, the danger is much more of the infant's efcaping it. And then if it be a female, and that it fends forth its excrements by the way I have mentioned before, it is better not to meddle, than by endeavouring to remedy an inconvenience, to run an extreme hazard of the infant's death. But when there is no vent for the excrements, without which death is unavoidable, there the operation is juftifiable. The operation in this cafe muft be thus; let the operator, with a THE EXPERIENCED MIDWIFE. 7* fmall incifion knife that hath but one edge, enter into the void place, and turning the back of it upwards within half a finger's breadth of the child's rump, which is the place where he will certainly find the inteftine, let him thruft it forward, that it may be open enough to give free vent to the matters there contained, being efpecially care- ful of the fphincter; after which, let the wound be dreffed according to the method directed. Section IV. Of tbe TbrtiJh,or Ulcers in tbe mouth of an Injant. THE thrulh is a diftemper thatchildren are very often fubject to, and it arifes from bad milk, or from foul humours in the ftom- ach ; for fometimes, though there be no illjjuality in the milk itfelf, yet it may corrupt in the child's ftomach becaufe of its weaknefs, or fome other indilpofition, in which, acquiring an acrimony inftead of being well digefted, there arifes from thence biting vapours, which forming a thick vifcofity, do thereby produce this diftemper. It is often difficult, as phyficians tell us, becaufe it is feated in hot and moid places, where the putrefaction is eafily a igmcnted, and for that the remedies applied cannot ledge there, being foon wafl>ed a- way by fpittle. But if they arile from too hot a quality in the nurfe's milk, care muft be taken to temper and cool, prefcribing her cool diet, blooding and purging her alfo, if there be occafion. Take lentiles hufked, powder them and lay it upon the child's gums ; or take melidium in flower,half an ounce, and with oil of rotes make a liniment. Alfo wafti the child's mouth with barley and plantain water,and honey of rofes,or fyrup of dry rofes, mixing them with a little verjuice, or juice of lemons as well to loofen and cleanfe the vifcious humours which cleave to the infide of the child's mouth, as to cool thole parts which are already over-heated. This may be done by means of a fmall fine rag faftened to the end ot a little flick, and dipped therein, wherewith the ulcers may be gently rub- bed, being careful not to put the child to toe much pain, left an in- ftamation make the diftemper worfe. The child's body muft be al- io kept open, that the humours being carried to the lower parts, the vapours may not afeend, as it it ufual for tl em to do, v. hen the bo- dy is coftive, and the exrrements too long retained. It the ulcers appear malignant, let fuch remedies be uted as do their work fpee- dily, that the evil qualities that caufe them beingthereby inftantly corrected, their malignity may be prevented ; and in this cafe touch the ulcers with plantain waters fharpened wirii the fpirits of vitriol, for the remedy muft be made frnrp, according to the malignity of the diftemper. It will not be unneceffary topurge thefe ill humours out of the whole habit cf the child, by giving half an ounce of foe? eery with rhubarb. -2 THE EXPERIENCED MIDWIFE. Section V. OJ Pain in tbe Ears, Inflamation, Moifture, fcrV THE brain in infants is very moift, and hath many excrements which nature cannot fend out at its proper paffages ; they get often to the ears, and there caufe pains, flux of blood, with inflamati- on, and matter with pain : and in children is hard to be known, ha- ving no other way to make it ki*own but by conftant crying ; you will alfo perceive them ready to feel their ears themfelves, but will not let others touch them if they could- help it: and fometimes you may difcern the parts about the ears to be very red. Thefe pains, if let alone, are of dangerous coRlequences, bccawfe they bring forth watching and epilepfy, for the moifture breeds worms there, aad fouls the fpongy bones, and by degrees incurable deafnefs. To prevent all thofe illconfequences, allay the pain with all con. venient fpeed, but have a care of uling ftrong remedies. Therefore only ufe warm milk about the ears, with the decoction of poppy tops, or oil of violets : to take away the moifture, ufe haney of rofes, and let acquamellis be dropped into their ears; or take virgin honey half an ounce, red wine two ounces, all urn, faffron, fahpetre,eacha dram; mix them at the fire ; or drop in hempfeedoil with a little wine. Section VI. Ofrednefs and inflammation of the buttecks,groin and thighs of an infant. IF there be net great care taken to change ahid wafli the child's beds as foon as they are fouled with the excrements, and to keep the child very clean, their acrimony will be fure to caufe redneis, and beget a fmaring in the. buttocks, groin and thighs of the child, which by reafon cf the pain, will afterwards be fubject to inflamma- tions, which follow the fooner, through the delicacy and tendernefs of their fkin, from which the outward fkin of the body in a fliort time feparated and worn away. The remedy of this is twofold; tkat is to fay, firft, to keep the child cleanly, and in the fecond place, to take off the (harpnefs of its urine. As to keeping it cleanly, (he muft be a forry nurfe that needs to be taught how to do it, for if die lets it but have dry, clean and warm beds and clouts, as often and foon as it has fouled and wet them, either by its urine or excrements, it will be fufficient ; and, as to the fecond, the taking off the fliarpnefs of the child's urine, that muft be done by the nurfe's keeping a cooling diet, that her milk may have the fame quality ; and therefore (he ought to ab- ftain from all things that may heat it. But befides thefe, cooling anddrying remedies are requifite to be applied to the inflamed part*; therefore, let the parts be bathed with plantain water, with a fourth f jiine water added to it, each time the child's excrements are wiped off; and if the pain be very great, let it only be fomented ^h lukewarm milk. The powder of a poffcto dry it, or a little mill THE EXPERIENCED MIDWIFE. 73 duft flrewei upon the parts affedted, may be proper enough : and it is ufed by feveral women. Alfo Ungnentiim Album, or Diapam- pholigos, fpread upon a fmall piece of feather in form of a plaifler, will not be amifs. But the chief thing muft be the nurfes taking great care to wrap the inflamed parts with fine rags when fhe opens the child, that thofe parts may not be gathered and pained by rubbing them together. Sec. VI I. Of vomiting in young children. VOMl FING in children proceeds fometimes from too much milk, and fometimes from bad milk, and is often from a moift loofe ftomach ; for as drynefs retains, fo loofnefs Jets go. This is for the moft part, without danger in children ; and they that vomit from their birth are the luflieft ; for the ftomach, not being ufed to meat, and milk being taken too much, crudities are eafily bred, or v>r the milk is corrupted ; and is better to vomit thefe up than to keep them in ; but if vomiting laft long, it will caufe an atrophy or cooiumption for want of nourifliment. To remedy this, if from too much milk, that which is emitted is yellow and green, or otherwife ill coloured ; in this cafe, mend the milk, as has been lhewed before ; cleanfe the child with honey of rotes, and ftr.engthen its ftomach with fyrup of milk and quinces made into an eludtuary. If the humour be hot and (harp, give the fyrup of pomegrantes, currants and coral; and apply to the bel- ly the plaifter of bread, the ftomach create, or bread dipped in hot wine ; or take oil of maftic, quinces, mint, worm wood, each half an ownce ; of nutmegs by expreffion, half a drachm, chyraical oil of min, three drops. Coral hath an occult property to prevent vomit- ing, and is therefore hung about their necks. Sec V II. Of breeding teeth in young children. 1"^HIS is a very great, and yet neceffary evil in all children, . having variety effymptoras joined with it; they begin to come forth, not all at a time, but one after another, about the fixth and feyesdi month ; the fore teeth coming firft, then the eye teeth and at laft of all tbe grinders ; the eye teeth caufe m^re pain to tke child than any of the reft, becaufe they have a very deep root, and a fmall nerve, which hath communication to that which makes the: eye move. In the breeding of their teeth, firft they feel an Itdi- ing in their gums, when they aie pierced as with a needle, and prick- ed by the diarp bones, whence piocerd great pains, watching, an! inflammation of the gums, fever, h-fnefs, andconvulfionn, efpecial- ly when they breed their eye teeth. The figns when children breed their teeth, are thefts r. Iti s known by their time, which is m'ualiy about, the feventli month. 2 V 74 THE EXPERIENCED MIDWIFE. Their gums are fwelled, and they feel a great heat there, with a« itching, which makes them put their fingers in their mouth to rub them, from whence a moifture diftils down into the mouth, becaufe of the pain they fetl tnere. 3. They hold the nipple fafter than before. 4. Tie gum is white where the tooth begins to ccme ; and the nurte in giving them fuck finds the mouth hotter, and that they are much charged, crying evei»y moment, and cannot deep, or but very little at a time. The fever that follows breeding of teeth c« mes fi > m cholcrick humours, inflamed by watching, pain and heat. And the longer teeth are breeding, the more dangerous it is, fo that many in the bi.-eding of them die of fevers and convullions. For remedy, two things are to be regarded ; one is, to preferve the child from the evil accidents that may happen to it by reafon of the great pai.i ; the other, to aflift as much as may be the cutting of the teeth, when they can hardly cut the gums tl emfelves. For the firft of thefe, i. e. the preventing thefe accidents to the child, the mirfe ought to take great cafe to keep a good diet, and to ufe all things that may cool and temper her milk, that fo a fever may not follow the pain of the teeth. And to prevent the humour from falling too much upon the inflamed gums, let the child's belly le kept always loofe by gentle clyfters, if it be bound ; though of- tentimes there is no need of them, becaufe they are at thofe times ufually troubled with a loofnefs, aid yet for all that, clyfte rs may not be imprcper neither. As to the other, wide!'.'is to affift in cutting off the teeth, that the rurfe muft do from,time to time, molifv'mg and loofening them, by rubbing them with her finger dipped in butter or honey, to let the i.hild have a virgin w?x candle to chew upon ; or anointthe gums with the mucilage of quince made with, mallow water, or with tbe brains of a hare ; alfo foment the cheeks with the. decoction of AU tiiea, aid c amine mile dower ?i.d dill, or with the juice of mallow 9 and frefh 1 utter. If the gums are. inflamed, and juice of night- (hade and lettuce. I have already faid the nurte ought to keep a temperate die*. I will now add, that barley broth, water gruel, raw egg?, prunes, lettuce and endive, are good for her: but let her r.void fait, (harp, bitirg, and peppered meats, and wine. ?.lc. IX. ')f ibe flux cf the belly, or loofnefs in infants. iT is very commen for infants to have the flux of the belly, or loc.fi:net's, efpecially upon \he leaft irdifpofirion ; ne r is it co be wondered at teeing their natural moiftnefs contributes fo much there- to : ai.d if it be not extraordinary violent, fuch are in a better ftate 'i heal.h than thofe that are bound. This flux, if violent proceeds from d'/.ers cauf.s ? as, 1. From breeding teeth, and is then com- monly attended with a fever; in w'-ich :he concoction t; hindered THE EXPERIENCED MlDWIFE. 75 , • and tbe nourifliment corrupted. 2. From watching. 3. From pain 4. From ftirring of the humours by a fever. Somettimes they hav« a flux without breeding of,teeth, from outward cold in the guts or ftomach, that obftr.icti concoftion. If it be from teeth it is eafily known, for the figns in breeding of teeth will difcover it. If it be from external cold, there are figns of other caufes. If from a hu- mour flowing from the head, there are ffons of a catarrh, and the excrements are frothy. If crude and 1 aw humours are voided, there ■ is wind, belching, and phlegmatic excrements. If they be yellow, green and ftink, the flux is from a hot and (harp humour. It is beft in breeding of teeth when the belly is loofe, as I have faid before ; but if it be too violent, and you are afraid it may end in a confump.- ,tion,it muft be flopped ; and if the excrements tlrat are voided be black, attended with 3 fever, k is very bad. , The remedy in this cafe has a principal refpect to the nurfe, and I the oondirion of the milk, muft chiefly be obfi-rved ; the nurfe muft be cautioned that flie eat no green fruit, nor things of a hard con- coction. If the child fuck not, remove the flux with purges, fuch as leave a blooding quality behind them : As fyrup of honeyj of rofes, or a clyfter. Take tT e decoction of milliuni, myrobdans, each two or tWee ounces, with a? ounce or two of fyrup of rofes, and make a ,- Clyflcr. After cteanfing, if ft proceed from a hot caufe, give fsrup of; dried rotes, quinces, myrtle?, coral, mr.ftic, harts-hor 1, red rofes, or powder of myrtles, with a fotle Sanguis Draconis. Alfo anoint wrdi oil of rofes, myrtles, maftic, eich two drachms, with nil of myr- tle; and wax, unke an ointment. Or, take red rofes, mnriin, each a handful, cvprefs roots, two drachms : make a bag, boil it in red wine and apply -it to the belly. Or, ufe the plaifler of bread or i; ftomach ointment. >f the caufe be cold, and the excrements white, give fyrup of miftic, and the quinces, with mint water. Ufe out- , wardly mint, maftic, cummin : or, take rofe feeds an ounce, cummin ^ and amiis-feed, each two drachms ; with qil of maftic, wormwood, and wax, make an ointment. Section X. Oftkeepilcpfy aad convulfions in children THIS is a diftemper that is the death of many young children, and proceeds from the brain firft, as when the humours are bred in the brai 1 that eauie it, either from the parents, or from v a- 1 pours, or bad hupmurs that twitch the membranes of the brain ; it is alfo fometimes caufed from other diftempers, and from bad diet ; Iikewife the toothach, when the brain contents, caufes it, and fo doei i fodden flight. As to the diftemper itfelf, it is manifeft, and well enough known where it is; and as to the caufe whence it comes, you mvy know by the tig.is of the diteafe whether it comes from bad mi!!:, or worms, or teeth; if thefe are all abtent, it is eertaia 76 THE EXPERIENCED MIDWIFE. that the brain is firft affected; if it comes with the fmall pox or iseafles, it ceafethwhen they come forth if nature be ftrong enough. For the remedy of this grievous and often mortal diftemper, give the following powder to prevent it, to a child a^ (uon as it is born : Take male piony roots, gathered in the decreafe of the moon, a fcru- ple, with leaf gold make a powder ; or, take piony roots a drachm, piony feeds, mifletoe of the oak, elk's hoof, man's fkull, amber, each a fcruple, raufk two grains ; make a powder. The beft part of the cure is taking care of the nurfe's diet, which muft not be diforderly by any means. If it be from corrupt milk, provoke a vomit, to do which, hold down the tongue, and put a quill dipped in fweet almonds down the throat. If it comes from worms give fuch things as will kill the worms. If there be a fever refpect that alfo, and give coral fmaraged, j:id elk's hoof. In the fit give epileptic water, as laven- der water, and rub vvith oil of amber, or hang a piony root, elk's hoof, and fmaraged coral, about the neck. As to a convuldon, it is when the brain labours to caft out that vyhieh troubles it; the matter is in the marrow of tk« back, and* fountain of the nerves ; it is a ftubbora difeafe and often kills. tor the remedy whereof in thefitwafh the body, efpecially the back bone, with decoction of althae, lily roots, piony and carom *- mile flowers, and anoin tic with man's and goofe greafe,oil«of worms orris lilies, turpentine, maftic, ftorax and calamint. 'Fhe fun flow- er is alfo very good, boiled in water, to wafli the child. THE Experienced Midwife. PART II Containing proper and fafe Remedies for tbe curing oj all thofe Difterpers that are peculiar to tbe Female Sex, and efpeci- ally thofe that have ObJlrucHions to tie bearing of Children. HAVING- finidied the firft part of this book, and I hope therein amply made good my promife to the reader. 1 am now come to treat of tbe dlftempers peculiar to the female fex : in which it is not my defign to enlarge, or to treat of all the diftempers they are incident to, but thofe only to which they are moft lubject, when in a breeding, condition, and that keep them frem being fo : for each of which diftempers I have laid down foch proper and fafe re- medies, as, with the Divine blefling, may be fufficient to repel them ; and fince as amongft all the difeafes to which human nature THE EXPERIENCED MIDWIFE. 77 is fiibje&j there is none that more d'nmetricalfy oppofes the very end of our creation, and the de-fign of nature in the formation of different fexes', and the po*er thereby given us for tlie work of ge- neration, than that of fteri'ity or barr So THE EXPERIENCFD MIDWIFE. der men from fruitfuli.efs, and make them unfit for generation.. But among other caufes of barrenncls in men, this alfo is one that makes them barren, and almoft of the nature of eunuchs, and that is the incition, or the cutting of their vcics behind their ears, which, in czfe cf diftempers, is oftentimes done ; for according to the opinion of moft ph>ficians and anatomifts, the feed flows from the brain by th'ofe veins behind the ears, more than from any Other part of the body. From whence it is very probable, that the trahf- mifliofl of the feed is hindered by tbi cutting of the veins behirul the ears, fo that it cannot dcfcend at all tft tbe tefticles, or come thither very crude and raw. And thus much fw the fign* and caufes •f .barrennefs of men. Section III. Signs and Caufes of lnfufticisncy, or Barren- nefs in Women. ALTHOUGH there are many caules of the barrennefs of wo- - men, yet the chief and principal are internal, refpeiting ei* thtr the privy parts, the womb, er menftruous blood. Therefore, Hippocrates faith (fpeaking of either eafy or difficult conception of women) the firft conlideration is to be had oi their fbecies, for little wo>:en are more apt to conceive than great; (ten- der than grofs; white and fair, than ruddy and high coloured; black than wane ; thofe that have their veins confpicuoils are more apt to conceive tbim others; but to b« very tlelhy is evil; to have great fwelled breads is good. The next thing to be confidered, is the monthly purgations, whe- ther tliey have been regular every month, ami whether they flow plentifully, and are of good colour, and whether they have been equal every month. Then the womb or place of Conception is to be coniidti ed, it ought to be clean, found, dry and foft: not retracted or drawn up: not prone, nor defcending downwards, nor the mouth thereof turned awry, nor too clofe (hut. But to fpeak more particularly : The firft parts to be fpoken of are the pudenda, or privities, and the womb ; which parts are fliut and inclofed, either by nature or againft nature ; and from hence fuch women are called imperfores -r and in fome women the mouth of their womb continues compreff- ed, or clofed up, frem the time of their birth, until the coming. down of their courfes, and then, on a fiadden, when their tefina prefs forward to purgation, they are mokfted with great and unu- fual pains ; fome of thefe break of tlieir owa accord, othera are de- fected and opened by phyfiektns, others never oreak at all, ai^ it brings death. And all the% Aetiusparticularly handles?, (hewing that the womb- is (hut three manner of ways, which binderi conception. And th* THE EXPERIENCED MIDWIFE. 8r fii ft is, when the lips of the pudenda grows or cleave together; the fecond is, when there are certain membranes growing in the middle part of the matrix withjn ; the third is, when (tho* the lips and bo- fom of the pudenda may appear fair and open) the mouth cf the womb may be quite (hut up ; all which are oecafior.s of barrennefs in that they hinder buth tlie ufe of man, the monthly courfes, and conception. But among all the caufes of barrennefs in women,the greateft is ia the womb, Which is the field of generation ; and if this field be corrupt, it is vain to tacpect any fruit, let it be ever fo well fown ; for it may be unfit rOT generatior, by reafon of many diftempers to which it is fubject : as for inftance, over-much heat and over-much cold : for women, whole wombs are too diick and cold, cannot con- ceive, becaufe cold extinguiihes the heat of the human feed. Im- moderate moifture of the womb alfo deftroys the feed of man, and makes it ineffectual, as corn fown m ponds and mai flies ; and fo does ovei-much dryuefs in the womb, fo the feed perifhes for want of nutriment. Immoderate heat of tbe womb is alfo a caufe of baiTennefs, for it fcorcheth up the feed, as corn fown in the drougKt of fummer ; for immoderate heat hurts all the parts r the fpice of twenty-four hours, and then take it out, and fet^he man's by itfelf, and the woman'* by itfelf, in a flowerpot, or fome other thing ; wa- ter the man's every miming with his own urine, and the woman's with hers, and that which .grows firft, is the moft fruitful; and if t-ne grow not at all, that party is naturally barren, But now having fpoken enough of the difeafe, it is high time to affign the cure. • ■ If barrennefs proceeds from flappage of the menfes, let the woman fweat, for that opens the parts ; and the.beft way to fweat is in a hot-houfe. Then let the womb be ftreiigthened by drinking a draught of white wine, wherein a hrndful of ftinkiug arrack, .tint bruited, has been boiled. For bvafecret magnetic virtue it ftrength-' ens the'womb, and by a fympathetic quality removes any difeafe thereof. To which add alfo a haudfol of vervain, which is very. good to flrengthen both the woaib and head, which are commonly a-fflicted together by lympathv.' Having ufed thefe two or three days, if they come not down ; take of calac, mint, pemiyroy J, thyme, be tony, dittany, feverfew, burnet, mugwort, fiige, piony roots, juniper berries,hdf a handful of each, or fo many as can be got, let all thefe be biiled in beer,-and drank for her ordinary drink. 'Fake one part of the.gentian root, two parts of century, diftil them with ale in anafembic, after you have bruifed the gentian roo'S and info fed them well. This water is an admirable reme-dv topra- voke the terms. But ifyou have not this water, in readinefs, take s drachm of century, and half a drachai.of gentian roots brnited, boiled in poffet drink, and drink a draught of it at night g'-ing to bed. Seed of wild natew beaten t"> powder, and a drarlun cf it tak- en in the morning in white wine, alfo is very good ; but if it do not do, yon muft be tet blood in the legs. And be for,e you adminifter your mediiines a little before the full of the moon, or between a cew and full moon, by no means in the wane of the moon ; if you do, you will find them ineffectual. If barrennefs proceed from the overflowing of the menflrues, then fyengthen die womb, as you were taught, and afterward; a:ioiu: THE EXPERIENCED MIDWIFE. 83 tbe reins of the back with oil of rotes, oil of myrtle, oil of quinces, every night, and then wrap a piece of white baize about your rein?, the cotton fide ne>>t the flan, and keep tbe fame alwa\s to it. But above all, I recommend this medicine to yen. Take Con.frey leaves or roots, and blown woundwort, of each a handful: biuife them well, and boil them in ale,and drink a good draught of it now and then : 0:, take cinnamon, caflia lignea, opium, of each two drachms : myrrh, white pepper galbanum, of each one drachm : dif« folve the gum and opium fo white wine and beat the reft into pow- der ; then make it into pills, by mixing them together exactly, and let the patient take nvo pills every night going to bed, but let not the pills exceed fifteen grains. If barrennefs proceed from a flux of the womb, the cure muft be according to the caufe producing it, which may be known by its figr.s : for a flux of the womb being a continual diftillation from it for a long time together, the colour of what is voided (*iews what humour it is that o ppy feed, each an handful ; boil thefe in white wine till one half be wafted; let her drink half a pint every morning, to which add fyrup of peach flowers, and fyrup ofchicony, of each an ounce, with a littte rhubarb, and this will gently purge her. If it proceeds from putrified blood, let her be blooded in the foot, and then ftrengthew the womb as I have direct- ed in '(topping of the menfes. If barrennefs be occafioned by the felling out of the womb, as fometimes happens, let her apply fweet fcents to her nofe, foch ass civit, grdbum", llorax, cd.ur.itis, wood of aloes and other things of tlp.t nature; and ,':t her lay (linking things to the womb, fuch a^ 84 THE EXPERIENCED MIDWIFF. «[fetes:ida, oil of amber, or cf the fmoke of her own hair burnt ; for this a cert?'m truth, that the womb flies from all ftiriking; and cleaves to all fweet things. But the moft infallible cure is this, Take a commen burduick leaf.(which yon may keep dry all the year) apply this to her head, and ir will draw the womb upwards. In fits of the mother apply it to tbe fetes of her feet, and it will draw the womb downwards. Burteed beaten into powder draws the womb which way you pleafe according as it is applied. If barrewnefs proceed from a'hot caufe, let th« party take whey, and clarify it; then boil plantain leaves and rojts in it, and drink it for her ordinary drink. Let her alfo inject the mice of plantain into the womb with a fyringe ; it it be in wiater when you cannot get the juice, make a ftrong decoction of the leaves and roots in water, and inject that up with a fyringe ; but let it be but blood warm,and you will find this medicine of great efiicacy. And further, take often conferve of rofes, cold lozenges made of tragacanth, the confections of traifantali, frequently fmell camphire, rofe water and launders. It is alfo good to bleed the balilica, or liver vein, and take four or five ounces of blood, and then ufe this purge. Take electuaiurn de epithimo, de focco rofarum, of each two drains and a half, clarified whey four ounces ; mix them well together and take it in the morn- ing fading; fleep after it about an hour and an half, and faft four hours after it. And, about an hour before you eat any thing drink a good draught of whey; Alfo, t^ke lily water four ounces, man- drogory one ounce, faifroii half a ferupte ; beat the faffron to powder und mix it with the waters, and drink them warm in the morning. Ufe this eight days together. Seme excellent Remedies againft Barrennefs, find to caufi Fruit- ful nefs. ■ T^AKF. broom flowers, fmallage, parfley feed, cummin, mug- worth, fetherfew, of each half a fcruple; aloes, half an ounce ; India fait, faffron, of each half a dram; beat and mix them well to- gether, and put to it five, punces of featherfew water .warm, flop it up dole, and let it ftand and dry in a warm place, and thus do two or three times one after another ; them make each dram into fix pills, and take one of them every other day before flipper. For a purging medicine againft barrenrcte: "Fake conferve ofbe- nedicta }ax, one quarter of .in ounce; dipfillo three drams; electua- ry cfe fneeo rofarum, one dram ; mix them together with featherfew water and drink it in the morning betimes. About three days after the patient hath taken the purge, let her be let blood four or five ounces in the median or common black vein in the right foot; an 1 then take, for five days one after another, fi'ed ivory a dram and a half in featherfew water; and during the time let her fit in b - ml- THE EXPERIENCED MIDWIFE. 85 lowing bath an hour together morning and night: take wild yellow rapes, daucus, balfam wood and fruit, aftikeys, ol each two handfuls; red and white been, broom flowers, of each a handful; mufk three grains, amber, faffron, of each one fcruple; boil all in water fuffi- ciently; but the mufk, faffron, amber, and broom flowers, muft be put in the decoction after it is boiled and (trained. A confection very good againft barrennefs: Take piftachia,ptngtes, cringoes, of each half an ounce, faffron one dram, lignum aloes, gal- lingade, mace, balm flowers, red and white been, each four fcruples ; (haven ivory, caflia bark, each two fcruples; fyrup of confected gin- ger twelve ounces, wfiite fugar fix ounces; decoct all thefe well to- gether in twelve ounces of balm water, and ftir it well together; then put to it mufk and amber each a fcruple: take thereof the quantity of a nutmeg three times a day, in the morning, an hour before nooa, and an hour after fupper. But if the caufe of barrennefs either in man or woman be thio' fcarcity or diraunition of the natural feed, then fuch things are to be taken as dofocreafe the feed, and incite or ftir up to venery, and further conception, which I fhall here let down, and conclude this chapter of barrennefs. For this, yellow rape feed baked in bread is very good ; alfo young fat ftefti not too much falted ; alfo faffrort,the fnails ftincus, and long pepper preprared in wine. But avoid four, (harp, doughy and dimy meats, long fleep after meat, with forfeiting and Jrunkennefs, an! as much as they can, keep themfelves from lorrow. Thefe things following increafe the natural feed and ftir up venz- jy, and recover the feed again when it is loft, viz. eggs, milk, rice boded in milk, fparrow's brains, flelh, bones and all ; the bones and pizzles of bulls, bucks, rams, and bears ; alfo cock (tones, lamb (banes partridges, quails, and pheafants eggs.; fortius is an undeniable a- phorifm, that whatever any creature is addicted unto, they move or incite the woman or man that eats them to the like; and therefore partridges, quails, fparrows, Sec. being extremely addicted to venery, they work the fame effect in thofe men and women that eat them. Alfo take notke that in what parts of the body the facultity which yau would ftrengthen liis, take the fame parts of another creature, in whom the faculty is ftrong as a medicine. As for inftance, the procreative faculty lies in the tefticles, therefore cock ftones, lamb ftones, &c. are proper to ftir up venery. I will alfo give yoy another general rule : all creatures that are fruitful being eaten, make them fruitful that eat them : as crabs, lobfters, prawns, pigeons; &c. The ftones ef a fox dried and beaten to powder, and a drachm taken in the morning in (heap's milk, and the ftones of a boar taken in the like manner, are very good. Tbe heart of a mail quail carried a £6 THE EXPERIENCED MIDWIFE. bout the man, and the heart of a female quail carried about the wo- man, caufeth natural love and fruitfulrefs. Let them alfo that would increafe their feed, eat and drink of the beft as near as they can : forf nee cerere et libera jrigit Venusfis an old proverb,which is, Without good meat and good drink, Venus will be frozen to death. Pottages are good to increafe the feed, fuch as are made of beans, peafe and lupines, and mix the reft with fugar. French beans, wheat fodden in broth, annis feeds, alfo onionstlewed, gar- licks, feeks, yellow rapes, frelh bugwort roots, ,01 inge roots conltc- ted, ginger csnfected, &c. Of fruits ; hazel nuts, Cyprefs nuts, piftachia almonds, and marinapune made thereof. Spices good to increafe feed, are cinnamon, cardanum, galengal, long pepper,cloves, ginger, faffron, affafoerida, take a dram and a half in good wine, is very good for this purpofe. The weaknefs and debility of a man's yard being a great hin- drance to procreation, let him to ftrengthea it, ufe the following ointments : Take wax, oil of bevercod, marjoram gentle, add oil of coflus, of each a like quantity, mix it into an ointment, and put to it a little mufk, and with it anoint the. yard, cods, &c. Take of lioufe emmets three drams, oil of white fefanum, oil of lilies of t^ach an ounce; pound and bruite the ants, and put them to the oil, and let then* ftand in the fun fix days, then (train out the oil, and add to it euphorbium one fcruple, pepper and rue,ef each one dram; muftard teed half a dram. Set this again all together in the fun two or three days, then anoint the inftruments of geneiation there- with, So much for this chapter. CHAP. II. Difeafes oj the Womb. I HAVE already faid, that the womb is the field of generation, and if this field be corrupted, it is in vain to expect any fruit, though it be never fo well fown ; it is therefore not without reafon that I intend in this chapter to fet down the feveral diftempers to which the womb is obnoxious, and proper and fafe remedies againft them. Section I. Of tbe hot Diftemper of tbe Womb. ^f^HIS diftemper confifts in the excels of heat; for the heat of _L the womb is neceflaiy for conception, but if it be too much, it nourifiieth not the feed, but difperfcth its heat, and hinders the conception : this preternatural heat is fometimes from the birth, and makes them barren ; but, if it be accidental, it is from hot caufes that bring the heat and the blood tp the womb : it arifes alfo from internal and external medicines, and from too much hot meat, drinks P?Jd exercife. Thofe that are troubled with this diftemper, have The experienced midwife. sy but few courfes, and thofe yellow, black, burnt or fharp, and.have hair betimes on their privities ; they are very prone toduft, and are fubject to the head ach, and abound withcholer. And when the diftemper is ftrong .upon them, they have bat few terms, and out of order, being bad and hard to flow, and hi time they become hy-* pochondriacs, and for the moft part barren, having fometimes a fren- zy of the womb. « The remedy is to ufe coollers, fo that they offend not the vef- fels that muft be open for the flux of the terms. Fherefore invvaid- ly ufe coolers, fuch as fuccory, endive, violets, water lilies, forrel, lettuce, fenders, and fyrups and eonferves made thereof.. Alfo take conferve of fuccory, violets, water lilies, burrage, each an ounce; conferve of rofes half an ounce, diamartagon frigid, diatriafcantal,- each half a dram; and with fyrup of violets, or juice of citrons, make an electuary. For outward applications, make ufe of oint- ment of rotes, violets, ■ water lilies, gourds, Venus-narvel applied to" the back and loins. Let the air he cool, her garments thin, and her meat endive, let- tuce, fuccory and barley. Give her no hot meats, nor ftrong wine, unlefs mixed with water. Reft is good for her, but fhe maft\abftaiu from copulation, though flie may fleep as long as fhe will. Section IL Of the cold Diftemper of tbe Womb. THIS diftemper is the reverfe of the foregoing, and equally an enemy to generation, being coufed by cold quality abound- ing to exeefs, and proceeds from too cold air, reft, idlenefs and cool- ing medicines. It maybe known by an avefton to letchery, and taking no pteajure in the act of copulation, when they fpend their feed. Their terms are phlegmatic, thick, and flimv, and do not flow as they fhould. The womb is windy, and the feed crude and waterilh. It is the caufe of obftructions and barrennefs, and is hard to be cured. For the cure of this diftemper, ufe this water: Take galengal^ cinnamon, nutmeg, mace, cloves, each two drams; ginger cubebs, zedory, cardamum, each an ounce ; grains of Paradife, long pep-- per, each half an ounce : beat them and put them into fix quarts of wine for eight days ; then add fage, mint, balm, motherwort, each three handfuls. Let them ftand eight days more, then pour off the wine, and beat the herbs and the (pices, and then pour on the wine, and diftil them Or you may ufe this: Take cinnamon, nutmegs, cloves, mace, ginger ct:ijebs,,cardaniums, grains of Paradife, each an ounce and zn half, gslergd fix drams, of long, pepper half an ounce, zedory five drams, Uruife them, and add fix quarts of wine ; put them into a cellar for nine days, daily ftirring them : then add f mint two handfuls, and then let them ftand for fourteen days ; 88 THE EXPERIENCED MIDWIFE. pour off the wine and bruife them, and then p ber-greate four grains, mufk half a. fcruple; make two round plan- ters to be laid on each fide of the- naval; make a fume of fnail lkins f: Led, or of garlic, and let it be taken in the funnel. Life alio aftrin- gent fomentations of bramble leaves, plantain, hortetail, myrtles, each two handfuls, wormteed two pugils, pomegranate flowers half an ounce, boil them in wine and water. For an injection take com- frey roots an ounce, rupture wort two drams,yarrow, mugwort each half an ource, boil them in red wine and inject it with a fyringe. To ftrengthen the womb, take haitlhorn, bays, cf each a dram, f}j yrhh half a dram; make a powder for two defes, and give it with THE EXPERIENCED MIDWIFE. 9„ fliarp wine. Or, Take zedoary, parfnip feed, crabs-eyes prepared, each a drain ; nutmeg half a dram, and give a dram in powder : but aftringents muft be ufed with great caution, leaft by flopping the courfes a worfe mifchief follow. To keep it in its place, make rollers and ligatures as for the rupture ; and put peflaries into the bottom of the womb, that may force it to remain. I know fo ne phvficians object againft this, and fay they hinder conception ; but others in my opinion, much more jnflly affirm, that they neither hinder conception, nor bring any inconveKience ; nay, fo far from that, they help conception, and retain it, and cure the diteafe par- fedtlv. Let the diet be foch as is cf drying, aftringent, & glewing qualities, fuch as rice, ftaich, quinces, pears, and green cheefe: but let fummer fruits be avoided, and let her wine be aftringent and red. CHAP. III. Of Difeafcs relating to Women's Monthly Courfes. Section I. Of Womin's Monthly Courfes in general. DIVINE Providence, who, with a wifdom worthy of himfelf, has appointed woman to conceive by coition with the man, ai d to bear and bring forth children, has provided for the nourifliment of children during their recefs in the womb of their mother, by that redundancy of the blood which is natural to all women, and which flowing out at certain periods of time (when they are not pregnant J are from thence called terms snd menfes from their monthly flux of" excrementitious and unprofitable blood ; which is only to be under- flood with refpect to the redundancy thereof, being an excrement only vvith refpect to its quantity, for as to its quality it is as pure and incorrupt as any blood in the veins ; and this appears from the final caufe of r, which is the propagation and confervation of mankind ; and alfo from the generation of it, it being tbe fuperfluity of the laft aliment of the flefhy parts. If any afk, If the menfes be not of a hurtful'quality, how can it have fuch venomous effects, as if it fall upon trees and herbs, it makes the one barren, and mortifies the other ? I anfwer, This malignity is contracted in the womb; for the woman wanting native heat to digeft this fuperfluity, fends it to the matrix, where feating itfelf till the mouth of the womb be dilated, it becomes corrupt and mortified, which may eafily be, eonfiderin? the heat and moiftnefs of the place ; and fo this blood being out of its proper veffels, and too long retained, offends hi quality. But if rigidity be the caufe why women cannot dig«ft all their laft nou- ■filhmt nt, and by confequence have thefe monthly pargations, how comes it to pafs, may fome fay, that they are of fo cold a conftitu-, tion more than man ? Of this I have already fpoken in the chapter ot barrennefs; It is chiefly thus: The Author of our being has kid an injunction upon men and women to propagate their kind, hath 96 THE EXPERIENCED MIDWIFE. alfo wifely fitted them for that work; and feeing that in the act of coition there muft be an agent and a patient (for if they be of one conflitution, there can be no propagation) therefore the man is hot and dry, and the woman cold and moid. It is therefore neceffary that the woman fhould be of a cold conflitution, becaufe in her is required a redundancy ot matter for the nourifliment of the infant depending on her. And this is wifely ordained by nature, for other- wife the child would detract from and weaken the principal parts of the mother; which would n.oft unnaturally render the provilion of the infant to be the deftruction of the parent. Now, thefe month- ly purgations ufually begin about the 14th year, and continue till the 46th or 50th year : yet not fo conftantly, but that oftentimes there happens a fuppreflibn, which is fometimes natural, and fome- times morbifical. Wltcn they are naturally foppieft, it is either in breeding women, or foch as give fuck ; but that which is morbi- fical, muft be the fubject of the following fubject. Section II. Of the Supprefflon of the Monthly Courfes. THE fuppreflion of the terms, which is morbific, is an intercep- tion of that accuftomary evacuation of blood which fhould come from the matrix every month, and which proceeds from the matter vitiated The caufe of this fuppreflicn is either internal or external : The internal caufe is either inftrumental or material, in the blood or in the womb. The blood may be faulty two ways, in quantity or quility; in quantity, when it is fo confunaed that there is no overplus left, as in vigaroes, and all virile women, who through their heat and ftrength of nature digeft and confume all their beft nourifliment; but women of this conflitution are rather to be accounted anthropophageaj, that is women eaters, than women breeders ; becaufe they confume one of the principles of genera- tion, which gives a being to the world, i. e. the menflruous blood. The blood may alfo be con fumed, and the terms flayed, by too much bleeding at the nofe, and Iikewife by a flux ot the hemorr- bpides, or by a dyfenteria, evacuations, chronical and continueddiC- eates. But-fecondly, the matter may be vicious in quality, as if it be fanguineous phlegmatical, melancholic; each of thefe, if they of- fend ia groflhefs, will caufe an obftruction in the veins. The womb alfo may be in fault divers ways ; as by the narrow- nefsof the veins and paffages, by apofthumes, tumours, ulcers, and by overmuch heat or cold, the one vitiating the action, and the o- ther confuming the matter; alfo, by an evil coinpofition of the uter rine parts by the neck of the womb being turned afide; and fome- times, though but rarely, by a membrane or excreffence of flefli growing about the womb. The external caufe may be heat, pi^ drynefs of the air, iuimode. THE EXPERIENCED MIDWIFE. ff 'ate watching, great labour, violent motion, whereby the mattet u fo confumed, and the budy is Ta exhausted,, that there is no redun- dant blood remaining to be expelled ; whence it is recorded of the Amazons, that being active, and always .in motion, they had little ^or no monthly fluxes, it may alfo be canted from cofd ; and moft frequently is fo, making the blood vicious and grofs, condenfing and binding the paffages, that it cannot flow forth. The figns of the diteafe are pains hi the head, neck, back, and loins,- with weariuefs of the whole body, but efpecially of the hips and legs, by leafon of a c«nfinity which the womb hath in thofe parts ; if the fuppreflion proceeds from cold, it caufeth a heavy fluggilh difpolition, a pale colour, a flow pulfe, the urine crude, waterilh, and much in quan- tity, and no defire to copulation, the excrements of the guts being ufually retained: but if it proceeds from heat, the figns are contra- ry. If it be natural, or caufed by conception, it may be known by drinking water and honey after fuppers, going to bed; for if after the taking it it caufeth the woman to feel a bearing pain about the navel and lower parts of the belly, it is a fign fhe hath conceived, and the fuppreflion is natural, if not, then it is vicious, and ought medicinally to be taken away, otherwife many dangerous difeafes will follew, fuch as fwoonings, fiintings, intenniflion of pulfe, . ©bftrudtions, epilepfier, apoplexes, frenzies, melancholty, paflions/ ■( &c. which makes it highly neceffary to fay fomething now of the cure. , The cure of this cfiffernper muft be by evacuation, for this fop-" t-, preflion is a phlethorick effect, it will therefore be beft in the midff [ of the mcnftrual period to open the liver vein : and for the rever- flon of the humour two days before the wonted evacuation, open the faphasna veins' of both feet:- and if the repletion be nor great,- '- apply cupping glaffes to the legs and thigs, after Jetting blood, the ' humour muft be prepared and made flexible with fyriip of flfichus, horehound, hyfop, betony, maden Hair, of each one handful, make a decoction, andtake thereof three ounces of lyrup Of mugwort, ! .fuccory, maiden hair,-mix each half an ounce; and after fhe conies 1 outof the bath, let her drink it offi- Then purge pil. de Agarick, Elephang, Coch ; Fcedit. Galen in this cafe commends Pilula de Hiera cum c ^loquifit da; for as they are proper to purge the hu- mour offending, fo they open the paffage of the womb. If the- fto- j|*iach be overcharged, let aertake a vomit, but let it be fo prepar- ; ed as to act both waysj left the lmniOiirs Ihouldbe too much turned back-bv working only upwards-; to which end, take" trockifk of an- garia two drachms, infufe them in three ounces of ox mel, in whicii* diffblve benedict. lax.it. half an ounce, and of the electuary diaf**-' S-8 THE EXPERIENCED MIDWIrF. nm one fcruple; and let her take it after the manner of a purge. When 6he homour has been thus purged, you'may.proceed to more proper and for- cible remedies. Take extract of mugWort one fcruple and a half, rinds of caflia, parfley feed, eaftor, of each a fcruple ; and with juice of fmallage, af- ter fupper going to bed. Alfo, admiailter to the lower parts fuffumigations of ambers unclions, inlections and uiceffions; make fufFcmgations of amber, galbanum, melanthum, bay-berries, mugwort, cinnamon, nutmegs, dove?, oce. Make ptfiaries of figs, and the leaves of mercury bruifed, and rolled up with liHt. Make injections of the decodtion of mercury, betony, origin, mugwort and figs, and inject it into the womb by an inftrument fit for that purp«fe. For unction, take ladant, oil of niirrh, of each two drachms : oil of lUlies, almonds, capers, camomile, of each half an ounce, and with wax make an unguent, with which let the place be anointed. Let the air be hot and dry, her fleep fhorter than ordinary, let her ufe moderate cxercifc before meals, and let her meat and drink be attenuating. Section III. Of the overflowing of the monthly courfes. THIS diftempe* is directly contrary to that of which 1 have fpoken, in the foregoing fection, and is no lefs dangerous than the other, and there- fore recyvir-es to be fpoken of next in order. This diftemper is a fanguine- »us eotcrement, proceeding from the womb and exceeding in time and qua- lity. I call it fanguineons, becatife there are two ways by which the blood flows forth, one is by the internal veins in the body of the womb, which is properly called the monthly flux; the ether is, by thofe veins which are terminated in the neck of the matrix, which Jbmephyfieians call the hemor- *idcs of the womb; and that it exceeds in quantity, when they flow about three <;ay.*; hut this is the moft certain fign of their excefs inflowing, when tjiey flow fo long that the faculties of the body are thereby weakened ; for in bodies abounding with grofs humours, this immoderate flux does fome- times unburden nature of her load, and is not to be ftopt without advice horn a phyfician. The cauft of this immoderate flowing is either external or internal.. The external caufe may be the heat of the air, lifting and carrying heavy bur- dens, unnatural child-births, falls, &c. The internal caufe may be three- fold, in the matter, inftrument or faculty : the matter, which is the blood, nay be vicious two ways; firft, in quantity being fo much that the veins arc not able to contain it : fecondly, in quality, being adnft, fharp, waterifli, or unconnected. The inftrument, viz. the veins arefaulty by the dilation of the -orifice, which maybe caufed two ways i firft, by the heat of the con-« ftitution, climate, or feafon, heating tbe blood, whereby the paffages are di- luted, and the faculty weakened, that it cannot retain the blood i fecondly, by falls, blows, violent motion, breaking ot a vein, &c. This inerdinate flux may beknown by the appetite being decayed, the con- toctin depraved, and all the actions of the body weakened; the feat fwelled, the cole ur of the face changed, and a general feeblenefs poffeffetb the whole body. If k comes by the breaking of a vein, the body is fometimes cold, :the blood flows forth on heaps, and that fudderily, with great pain : if it tomes through beat, the orifice of the veins heipg dilated then -there is little or no pain, yet the blood flow* faftxr than it doth in a-erofion ^ and not fo faft as in .a rupture. ]f by erofion, or fharpncls of blood, ike feels a great beat folding the .paffage it differs from rhe other two, in that it flows not fo ftiddciiiyj nor fo oopioufly as rhcy do. ff it be by weaknefs of tho womb, the has £.11 averfk n to c ip'ilation^_if if proceeds from the bl^od, drop fame THE EXPERIENCED MIDWIFE. 99 oi it on a cloth, and when it is dry, you may judge of the quality by the co" lour ; if it be choleric, it will be yellow, if melancholy, black, if phlegiua," tick, waterifli and whitifh. 1'he cure of this confifts in three particulars. Firft, in repelling and car- rying back the blood: fecondly, in correcting and taking away the fluxibi!- ity of the matter : and thirdly, iu corroborating the vein or faculties. For the firft, to caufe a regreflitm of the blood, open a vein in her arm, and draw- out fo much blood as the ftrength of the patient will permit, and that not an ounce, but at feveral times, for thereby the fpirits ;.relefs weakened, and the retraction fo much the greater, ^pply the aipping-glafs to the liver, that the reverfion may be in the fountain. To correct the fluxibility of the matter, cathartics moderated with aftridlories may be ufed. if it be caufed by fharpnefsof blood, confider whether the corfofion be by fait phlegm, or adult cholar ; if by fait phlegm,prepare with fyrup of violets, wormwood, lofes, citron peels,fuccory, &.c. then take this purgation : M.irobolans, cher- vil, half an ounce, trochilks of agaric one drachm, with plantain wat»r make a decoction, add thereto fyr. rofar lux. three ounces, and make a potion. If by an aduft chelar, prepare the body with fyrup of rofe6, myrtles, forrel, purflain, mixed with water of plantain, knot-grafs, and endive, then purge with this potion : Take rinds ©fmirobolana, rhubarb, of each one drachm, cinnamon fifteen grains, infufe them one night in endive water, add to it the {trained pulp of tamarinds, caflia, of each half an ounce, fyrup of rofts one ounce, and make a potion. If the blood be waterifh and unconnected, as it is in hydropical bodies, and flows forth by reafon of the tenuxy, to draw «ff the water will be profitable, to which end purge with agaric, elateriumj and coloquintida. Sweatings is alfo very proper in this cafe, for by it the matter offending is taken away, and the motion of the blood is carried to the outward parts. To procure fweat,ufe cardanum water with mithridate or the decoction of guiacum, failafras, fanfaparilla: gum of guiacum does alfo greatly provoke fweat i and pills of iaifapanlla, taken every night at going to bed, are worthily commended. If tbe blood flows forth from the opening or breaking of a vein, without any evil quality of itfelf, then eught xorroberatiyes only fo be applied, which is the thing to be done in this in- ordinate fluic; boiearmeniac one fcruple, London treacle one drachm, old cenfr.rve of rofes, half an ounce, with fyrup of myrtles, make an electuary. Or, if the flux has continued long, take of maftich two drachms, olibani. tinct. de-careble, of each one drachm, balanftium one fcruple, make a pow- der ; with fyrup of quinces make it into pills, and take one always before meals. Section IV. Of terms coming out of order, either before or after the ufual time. BOTH thefe fhew an ill conftitution of body. Every thing is beautiful ia its order, in nature as well as in morality, and if the order of nature hs NATIONAL LIBRARY OF MEDICINE NLM D1DD1DE2 7 NLM010010227