Читать книгу Hints to Husbands: A Revelation of the Man-Midwife's Mysteries - George Morant - Страница 6

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“O shame! where is thy blush?”

It now becomes our most painful but necessary task to explain what that “process” is to which we have alluded, by giving some extracts from one of the principal works on midwifery, and in the very words of the treatise, to prove the gross outrages to which women are obliged to submit when “attended” by these male practitioners. Nothing but a sense of the enormity of this monster evil would induce us to contaminate our pages by the introduction of such garbage; but we are well aware that “general observations make little impression on the mind even of the most reflecting reader, if not attended with a detail of facts which proves that it is well founded; and one authentic example will produce a stronger conviction than whole chapters of assertion.”

EXTRACTS FROM DR. RAMSBOTHAM’S OBSTETRIC MEDICINE AND SURGERY.

“Duties of the Medical Attendant under Natural Labour.

“From the knowledge which the foregoing pages will afford of the beneficence displayed by nature throughout the processes of utero-gestation and labour, and of the admirable contrivances adopted by her to overcome difficulties and avert dangers, it will be evident that, in a very large proportion of cases, the duties of the obstetrician must be few and simple. Generally, indeed, no active assistance is necessary, until after the birth of the child; all that is required of the attendant being, that he should remain an observant, though unofficious spectator of the process, ready to exert himself with promptitude and energy on the first accession of any alarming symptoms, but equally or more ready to allow the changes necessary for the completion of nature’s object to proceed, uninterrupted by any meddlesome interference; for no maxim in obstetric science is of more universal application than that unnecessary ‘assistance,’ rendered with a view of expediting the termination of the case, or shortening the sufferings of the patient, is not only useless, but in the highest degree injurious, and directly calculated to defeat its own end.

“Let it not be supposed this declaration includes the admission, that a partial acquaintance with the obstetric branch of medicine is sufficient for the safe practice of the profession; for although, in thirty-nine cases out of forty, little is required to be done beyond protecting the extended structures from injury, separating the child, and extracting the placenta from the vagina after its total exclusion from the uterine cavity; still, in the fortieth danger may occur, only to be arrested by the promptest, the most decisive, and most judiciously directed help.

“Much knowledge[20] is necessary to discriminate the kind of cases in which assistance is proper, and determine the time at which that assistance ought to be employed, as well as the mode of its application. It is this which distinguishes the scientific from the ignorant obstetrician; it is this important knowledge on which the life, the future health and comfort of many a parturient woman must depend; which, nevertheless, has been held in such low estimation by some members of the profession, as to be thought unworthy of cultivation by the scientific and literary mind; unfit to be possessed by men of respectable station in society; and the adaptation of which knowledge to practice has been characterized, in an official document under the seal of the highest of our medical corporate associations, as ‘an art foreign to the habits of gentlemen of enlarged academical education.’[21] In the same communication it is asserted, ‘that the most successful practice of midwifery requires no such laborious preliminary study as is necessary for the practice of medicine, else discreet matrons, and plain uneducated men in the country, who frequently arrive at great notoriety in this calling, would not acquire that credit which they often attain.’ … nor, perhaps, are we generally expected to regulate the number of individuals to be present, though we may be called upon occasionally to exercise our authority in this respect. The only persons whom I would willingly admit are the nurse and some female married friend, the mother, or other near relation, or an intimate acquaintance, to act as confidante to the sufferer, into whose sympathizing ear she may whisper all her apprehensions and distresses, and from whom she may receive those numberless comforts and sustaining consolations of which she stands so eminently in need. Unmarried females are neither the most fit companions for the patient, nor the most useful assistants to the practitioner.[22]

“On being ushered into her chamber, we may engage her in some general conversation, which will give us an opportunity of observing the frequency, duration, strength, and character of the pains; and our conduct must be framed according. Should they be of trifling importance, we may content ourselves with giving some ordinary directions and retire from the apartment. But if they are returning with frequency and activity, we must not allow much time to elapse before we require to make an examination PER VAGINAM.[23] An objection may be raised by the patient to the necessary examination being then instituted, under the idea that no assistance can be rendered her so early in the labour. As I would regard the feelings of a parturient woman in a degree only secondary to her safety, I would by no means insist on putting her to this inconvenience, unless I thought it quite indispensable. But as much valuable information may be gained by this first examination, and as it is highly desirable to obtain that information during the progress of the first stage, it is right firmly, but gently, to urge its propriety. It is seldom, indeed, that she will not accede to the recommendation of her medical attendant, provided he possesses her confidence, and conveys his request with becoming delicacy.[24]

“Much knowledge must be acquired during the first vaginal examination. It is, first, whether the woman be pregnant;[25] secondly, if she be in labour; thirdly, whether the membranes have ruptured, or are still entire; fourthly, how the child is presenting; fifthly, how far the labour is advanced; and, sixthly, the state of the os uteri, vagina, and perineum, in regard to their distensibility. … She should be also covered by a light counterpane, or a blanket and a sheet. In this position (lying on her left side, with the nates brought to the edge of the bed) the vaginal examination is to be conducted in the following manner:—The attendant, sitting rather behind her, and having anointed the two first fingers of his right hand, with some unctuous substance, mostly in readiness, is to place them on the labia externa; then gently separating these organs, he must introduce the first finger into the vagina,[26] in the direction of its entrance, which is backwards and upwards: or he may take the perineum as his guide, and insinuate his finger within the genital fissure posteriorly, close to the fourchette. Having introduced it as high as he conveniently can, he must pronate his wrist, so that the junction of the first and second finger shall fit in under the symphysis pubis. In this way he will be able usually to reach the os uteri without difficulty. Should that organ, however, be situated so high that he cannot perfectly command it, rather than remain in ignorance of its condition, and of the presentation of the child, he may introduce the first two fingers of his left hand, and as these may be passed higher within the pelvis, they will give a greater facility for inquiry.

“These examinations are commonly made during the urgency of pain; and this has given rise to the phrase of ‘trying a pain.’ It is, however, desirable, on many accounts, that we should not introduce our finger up to the os uteri at the time when the uterus is acting strongly, because then the membranes are protruded into the vagina, and if we press against them at that moment, we may, probably, rupture the cyst, and lose its influence in the after progress of the labour. Besides, it is impossible, under such protrusion, to ascertain the presenting part of the fœtus with precision, because of the quantity of water which is then interposed between our finger and its person.

“Nevertheless, as it is expected that we should examine while the uterus is in action—and, indeed, as in many cases the patient would not allow us to pass our finger at all, were it not for the belief that we can ‘assist’ her—and that only in the time of pain, it is necessary that we should request her to inform us when there is a return, and take that opportunity of introducing our finger within the external parts. Having gained this advantage, we must allow it to remain inactive in the vagina while the pain continues; and upon its cessation, which we have seldom any difficulty in ascertaining, we may direct it up to the os uteri.

“Frequent examinations should not be made during the first stage of labour.

“We can do no good by such a practice after we have once gained the information we require. We cannot facilitate the descent of the child; we cannot dilate the parts; but we may do a great deal of injury, for we denude the vagina of that soft relaxing mucus which is designed by nature to protect it; and we, moreover, run the risk of destroying the integrity of the membranous cyst. We may, therefore, predispose the parts to inflammation, and retard the dilatation of the os uteri itself. As, however, it is a common idea among women that, under each examination, material assistance is rendered,[27] we shall frequently be urged, during the first stage, especially if the labour be rather slower than usual, to remain in close attendance on the patient’s person; and these solicitations are generally advanced with a degree of fervency, that it appears the extreme of cruelty not to accede to.

“Should this be the case, the finger may be introduced from time to time, with the greatest care and gentleness; more to pacify the patient’s mind, and assure her she is not neglected, than with any other view beyond that, and also watching the progress of dilatation. The more rigid the parts are, the more do they require the softening influence of the natural secretion, and the more careful must we be to preserve it. … In about an hour … we may see her again, and we may then, if we think it right, make another examination, to ascertain that the labour is proceeding satisfactorily.

Duties during the Second Stage.

“The second stage of labour having commenced, we are summoned to the patient’s room, if we have been absent, and told that ‘the waters have broken.’ She is most likely found reclining on the bed, and, probably, the pains are more urgent than they were before; or, perhaps, they are somewhat suspended. We now require to make another examination, because it is possible that the head may have fully entered the cavity, and may be soon expelled. Finding it low in the pelvis, finding the os uteri almost entirely dilated, the membranes broken, and the pains strong and coming on frequently, it is right not to leave the room; but unless the perineum is somewhat on the stretch, we need not yet take our post exactly by the bed-side. But as soon as the head has come to press upon the external parts—particularly when it has made its turn, and is beginning to extend the structures at the outlet of the pelvis, it becomes our duty to take our seat by the bed-side, and never to move from our position till the child has passed. This we do to protect the perineum, in order to prevent laceration.[28]

“For the purpose of supporting the perineum we sit rather behind the patient, and apply the palm of the left hand—guarded, for the sake of delicacy, cleanliness, and convenience, with a soft napkin—steadily and firmly against the perineal tumour. I have already mentioned that the thighs must be drawn up towards the abdomen, and the legs bent a little back upon the thighs, and the whole person lying on the left side; and the patient is usually placed so that her feet may rest against the bed-post.[29]

“We render the shoulders also another fixed point, so as to steady the upper part of the body, by tying a long napkin, or a round towel, to the same bed-post, and desiring her to hold it in her hand. We tell her, when the pain comes on to press with her feet against the bed-post, and pull gently at the towel, cautioning her against straining violently. The consequence is she so fixes her person as to render it almost impossible for her to jump away suddenly, or to recede to any distance from us. Independently of this little manœuvring, when the head is in any degree extending the vulva the nurse must be required to raise the right knee to some distance from the other, by which means the thighs are separated, and an increased facility given to the exit of the head through the external parts, as well as some control exerted over the patient’s movements. … After having examined the uterus through the parietes of the abdomen, we must make an internal examination, more perfectly to assure ourselves in what way the placenta is disposed of. Twisting the funis umbilicalis around the first two fingers of the left hand, and bringing it to its bearing, we pass the first finger of the right hand, previously anointed, into the vagina, as in a common examination. If the placenta be entirely in utero, which, as just remarked, is most commonly the case immediately after the child’s expulsion, we shall either not be able to touch it at all, or if it be within reach, we shall only detect a very small portion of it; we may just feel it offering itself at the os uteri; but we cannot surround its volume, nor can we probably discover the insertion of the funis.

“Removal of the Placenta.—There is no part of natural labour which requires so much judgment as the conduct of the third stage; for the slightest mismanagement of the placenta may be productive of most serious mischief, by converting a perfectly natural into a most dangerous and complicated case. As long, then, as the placenta remains in utero, so long we must wait, within a certain limit—provided there be no flooding—for those contractions which are to expel it from the uterus into the vaginal cavity, &c.; while we are thus watching, we shall most likely be informed of the return of uterine action, by the woman complaining of two or three comparatively trifling pains affecting the back and loins. As it is probable that under these pains the placenta may have somewhat descended, another examination may then be made per vaginam to satisfy ourselves on this point, &c.

“The removal of the placenta from the vagina is easily effected. Twisting the funis umbilicalis two or three times around the first and second finger of the right hand, we draw it down in a line tending towards the coccyx, and receive it in the left, placed under the perineum; or we may introduce the two first fingers and the thumb of the left into the vagina, embrace the mass between them, squeeze it as we would a sponge, and slowly extract it. …

“Having perfectly satisfied ourselves on this point, we may a second time take away the napkins soiled with the accumulated discharges, and envelope the lower part of the patient’s person in others that are warm and dry. Three will be sufficient: one must be partially slid under the left hip; another may be placed over and around the right hip; and the third carried between the thighs, directly on the vulva, &c. …

“Some practitioners adapt the bandage themselves, and apply it immediately after the placenta has been removed. I think it preferable, in common cases, to leave this duty to the nurse; and that it should not be put on until the body linen of the patient is shifted; because, in the first place, it appears to me more desirable that perfect quietness should be preserved until the first changes in the uterus consequent upon labour are effected, that no disturbance may interrupt their progress; and, in the second, I cannot help thinking that there is something highly indelicate in its being applied by a man—much more so, indeed, than any of the duties we are ordinarily called upon to perform under natural labour. It is of most service when next the skin. It must be sufficiently broad to reach from the pubes almost to the ensiform cartilage; and it cannot be properly adapted unless the abdomen be quite uncovered. In addition, I would remark that the nurse must know very little of her duties, if she cannot draw a properly contrived bandage round the person, and give it the due degree of tightness without incurring danger.”

The reader of the preceding extracts will have observed that they begin with a panegyric on the extraordinary powers of nature in adapting means to an end; which, nevertheless, the author forthwith proceeds to qualify, as if he had admitted too much, in giving nature credit for the due execution of her own work, and her capability for enforcing her own laws, by enlarging on the profound and scientific knowledge required in the man-midwife, the opinion expressed by the Royal College of Physicians to the contrary notwithstanding; and in effect impiously detracting the infinite power and wisdom of God, “who created man in his own image, in the image of God created He him; male and female created He them. And God blessed them, and God said unto them, be fruitful and multiply.”

“And God saw everything that He had made, and behold, it was very good.”

After descanting on the inutility, and even positively detrimental effects of active interference in natural labour, he warms with his subject, and, in the course of the three stages by which he limits and defines the operations of nature in introducing man into the world, enjoins, in language horribly disgusting from its technical obscenity, an amount of grossly indecent interference, only to be measured by the credulity and endurance of his miserable patient. If the maxim of non-interference which he inculcates holds good, he deceives and wrongs his patient to a most shameful extent, by permitting and encouraging the delusion that by these vaginal examinations he can render her “assistance,” or mitigate the sufferings which nature has ordained; and we assert, without fear of contradiction, that the man who should dare to practise upon the weakness of women in such a manner, and at a moment when they are least able to resist his solicitations, deserves the severest condemnation. In all this foul tissue of verbiage descriptive of the practice in natural labour there is nothing which a female attendant of the most ordinary intelligence could not accomplish with the greatest ease, and yet the nurse, who is generally a well instructed midwife, is scarcely mentioned at all, and her duties appear to be confined to a trivial and unimportant after-operation, which the conscientious and sensitive doctor deems an act of far greater indelicacy than those eight times repeated examinations per vaginam, and other contact with the patient’s person, so sedulously prescribed, and which, in truth, appear to constitute the whole “art,” so far as the treatment of natural labour is concerned. One more extract will more than suffice to show the nature of this abuse, which we fear is, from its daily increasing power and influence upon the female mind, becoming more and more difficult of cure; but which, when considered in all its hideous bearings, should arouse even the most callous and indifferent to a sense of its criminality, and cause the hearts of all who reverence modesty in woman to swell with righteous indignation at the insults which a vile custom has mercilessly heaped upon the sex:—

“She now, at length, submitted to an examination per vaginam, which I made from behind, as she stood erect by the bed. The finger failed at first to reach the os and cervix uteri, until, on pressing upwards, as far as possible, I found the uterus lying transversely, the os higher than the body, pointing to the right side, and the body of the uterus lodged in the left side of the pelvis, near the groin, where it seemed to be firmly fixed. I now made her kneel on the bed, with the head low, so as to elevate the nates, and cautiously tried through the rectum, as well as per vaginam, to raise the uterus from its position into the median line, but without success. An attempt on the following day was with no better result. … After the interval of a month, I made another examination per vaginam, also of the nipples, and found no change in either. After the interval of another month I found the nipples and areolæ precisely as at first; but, to my great satisfaction, the uterus had nearly righted itself in position, and the body of it was rounded and plainly enlarged. The lady also hinted a suspicion that she had quickened.” …

“In this instance my suspicion of pregnancy (which at first was very slight) rested on the interruption of menstruation alone. The health improved from the time of quickening, and the pregnancy went on. I may add that I have no doubt the latero-version of the womb occurred at the period of the miscarriage; … and that its righting itself, at length, was the consequence of its increasing bulk.”[30]

Such is the practice of man-midwifery! We observe that, in this revolting case, the disgrace, the shame, the infamy of the poor patient was endured in vain, and that after all the tentatives, and “manipulations,” and experiments, so perseveringly repeated by the accoucheur, without any beneficial result whatsoever, nature alone was the true physician.

We will conclude this chapter of horrors in the strong and earnest language of the late Sir Anthony Carlisle, with the conviction that his burning words will go right home to the hearts of those who may not hitherto have given a thought to this fearful violation of the rights of nature.

“The woman who sacrifices her modesty to fashion, her person to indignity, and her husband’s honour to the sneers and contempt of her male midwife, is below contempt. She is a disgrace to her sex!

“It is my firm opinion that the practice of man-midwifery compromises the character and morality of our country. It is demoralizing to society, an insult to virtuous women, and a foolscap to men. If not checked and abolished, the pretensions to female modesty, and a respect for the decorums of society, will eventually be altogether excluded from the female character.”