SECT. II.—How a Woman ought to be ordered when the time of her labour is come.

When it is known that the true time of her labour is come by the signs laid down in the foregoing, of which those most to be relied upon are pains and strong throes in the belly, forcing downwards towards the womb, and a dilation of the inward orifice, which may be perceived by touching it with the finger, and the gathering of the waters before the head of the child, and thrusting down the membranes which contain them; through which, between the pains, one may in some manner with the finger discover the part which presents itself (as we have said before), especially if it be the head of the child, by its roundness and hardness; I say, if these things concur and are evident, the midwife may be sure it is the time of the woman's labour, and care must be taken to get all those things that are necessary to comfort her at that time. And the better to help her, be sure to see that she is not tightly laced; you must also give her one strong clyster or more, if there be occasion, provided it be done at the beginning, and before the child be too forward, for it will be difficult for her to receive them afterwards. The benefit accruing therefrom will be, that they excite the gut to discharge itself of its excrements, so that the rectum being emptied there may be the more space for the dilation of the passage; likewise to cause the pains to bear the more downward, through the endeavours she makes when she is at stool, and in the meantime, all other necessary things for her labour should be put in order, both for the mother and the child. To this end, some get a midwife's; but a pallet bed, girded, is much the best way, placed near the fire, if the season so require, which pallet ought to be so placed, that there may be easy access to it on every side, that the woman may be the more easily assisted, as there is occasion.

If the woman abounds with blood, to bleed her a little more may not be improper, for thereby she will both breathe the better, and have her breasts more at liberty, and likewise more strength to bear down her pains; and this may be done without danger because the child being about ready to be born, has no more need of the mother's blood for its nourishment; besides, this evacuation does many times prevent her having a fever after delivery. Also, before her delivery, if her strength will permit, let her walk up and down her chamber; and that she may have strength so to do, it will be necessary to give her good strengthening things, such as jelly, broth, new laid eggs, or some spoonfuls of burnt wine; and let her by all means hold out her pains, bearing them down as much as she can, at the time when they take her; and let the midwife from time to time touch the inward orifice with her finger, to know whether the waters are ready to break and whether the birth will follow soon after. Let her also anoint the woman's privities with emollient oil, hog's grease, and fresh butter, if she find they are hard to be dilated. Let the midwife, likewise, all the time be near the labouring woman, and diligently observe her gestures, complaints, and pains, for by this she may guess pretty well how far her labour advanceth, because when she changeth her ordinary groans into loud cries, it is a sign that the child is near the birth; for at the time her pains are greater and more frequent. Let the woman likewise, by intervals, rest herself upon the bed to regain her strength, but not too long, especially if she be little, short and thick, for such women have always worse labour if they lie long on their beds in their travail. It is better, therefore, that she walk about her chamber as long as she can, the woman supporting her under the arms, if it be necessary; for by this means, the weight of the child causes the inward orifices of the womb to dilate the sooner than in bed, and if her pains be stronger and more frequent, her labour will not be near so long. Let not the labouring woman be concerned at those qualms and vomitings which, perhaps, she may find come upon her, for they will be much for her advantage in the issue, however uneasy she may be for a time, as they further her pains and throes by provoking downward.

When the waters of the child are ready and gathered (which may be perceived through the membranes presenting themselves to the orifice) to the bigness of the whole dilatation, the midwife ought to let them break of themselves, and not, like some hasty midwives, who being impatient of the woman's long labour, break them, intending thereby to hasten their business, when instead thereof, they retard it; for by the too hasty breaking of these waters (which nature designed to make the child slip more easy), the passage remains dry by which means the pains and throes of the labouring woman are less efficacious to bring forth the infant than they would otherwise have been. It is, therefore, much the better way to let the waters break of themselves; after which the midwife may with ease feel the child by that part which first presents, and thereby discern whether it comes right, that is, with the head foremost, for that is the proper and most natural way of the birth. If the head comes right, she will find it big, round, hard and equal; but if it be any other part, she will find it rugged, unequal, soft and hard, according to the nature of the part it is. And this being the true time when a woman ought to be delivered, if nature be not wanting to perform its office, therefore, when the midwife finds the birth thus coming forward let her hasten to assist and deliver it, for it ordinarily happens soon after, if it be natural.

But if it happens, as it sometimes may, that the waters break away too long before the birth, in such a case, those things which hasten nature may safely be administered. For which purpose make use of pennyroyal, dittany, juniper berries, red coral, betony and feverfew, boiled in white wine, and give a drachm of it, or it would be much better to take the juice of it when it is in its prime, which is in May, and having clarified it, make it into a syrup with double its weight of sugar, and keep it all the year, to use when occasion calls for it; mugwort used in the same manner is also good in this case; also a drachm of cinnamon powder given inwardly profits much in this case; and so does tansey broiled and applied to the privities; or an oil of it, so, made and used, as you were taught before. The stone aetites held to the privities, is of extraordinary virtue, and instantly draws away, both child and after-burden; but great care must be taken to remove it presently, or it will draw forth womb and all; for such is the magnetic virtue of this stone that both child and womb follow it as readily as iron doth the load-stone or the load-stone the north star.

There are many things that physicians affirm are good in this case; among which are an ass's or horse's hoof, hung near the privities; a piece of red coral hung near the said place. A load-stone helps very much, held in the woman's left hand; or the skin cut off a snake, girt about the middle, next to the skin. These things are mentioned by Mizaldus, but setting those things aside, as not so certain, notwithstanding Mizaldus quotes them, the following prescriptions are very good to speedy deliverance to women in travail.

(1) A decoction of white wine made in savory, and drank.

(2) Take wild tansey, or silver weed, bruise it, and apply to the woman's nostrils.

(3) Take date stones, and beat them to powder, and let her take half a drachm of them in white wine at a time.

(4) Take parsley and bruise it and press out the juice, and dip a linen cloth in it, and put it so dipped into the mouth of the womb; it will presently cause the child to come away, though it be dead, and it will bring away the after-burden. Also the juice of the parsley is a thing of so great virtue (especially stone parsley) that being drank by a woman with child, it cleanseth not only the womb, but also the child in the womb, of all gross humours.

(5) A scruple of castorum in powder, in any convenient liquor, is very good to be taken in such a case, and so also is two or three drops of castorum in any convenient liquor; or eight or nine drops of spirits of myrrh given in any convenient liquor, gives speedy deliverance.

(6) Give a woman in such a case another woman's milk to drink; it will cause speedy delivery, and almost without pain.

(7) The juice of leeks, being drunk with warm water, highly operates to cause speedy delivery.

(8) Take peony seeds and beat them into a powder, and mix the powder with oil, with which oil anoint the privities of the woman and child; it will give her deliverance speedily, and with less pain than can be imagined.

(9) Take a swallow's nest and dissolve it in water, strain it, and drink it warm, it gives delivery with great speed and much ease.

Note this also in general, that all that move the terms are good for making the delivery easy, such as myrrh, white amber in white wine, or lily water, two scruples or a drachm; or cassia lignea, dittany, each a drachm; cinnamon, half a drachm, saffron, a scruple; give a drachm, or take borax mineral, a drachm, and give it in sack; or take cassia lignea, a drachm; dittany, amber, of each a drachm; cinnamon, borax, of each a drachm and a half; saffron, a scruple, and give her half a drachm; or give her some drops of oil of hazel in convenient liquor; or two or three drops of oil of cinnamon in vervain water. Some prepare the secundine thus:—Take the navel-string and dry it in an oven, take two drachms of the powder, cinnamon a drachm, saffron half a scruple, with the juice of savin make trochisks; give two drachms; or wash the secundine in wine and bake it in a pot; then wash it in endive water and wine, take half a drachm of it; long pepper, galangal, of each half a drachm; plantain and endive seed, of each half a drachm; lavender seed, four scruples; make a powder, or take laudanum, two drachms; storax, calamite, benzoin, of each half a drachm; musk, ambergris each six grains, make a powder or trochisks for a fume. Or use pessaries to provoke the birth; take galbanum dissolved in vinegar, an ounce; myrrh, two drachms, with oil of oat make a pessary.



An Ointment For the Navel.

Take oil of keir, two ounces, juice of savine an ounce, of leeks and mercury, each half an ounce; boil them to the consumption of the juice; add galbanum dissolved in vinegar, half an ounce, myrrh, two drachms, storax liquid a drachm, round bitwort, sowbread, cinnamon, saffron, a drachm, with wax make an ointment and apply it.

If the birth be retarded through the weakness of the mother, refresh her by applying wine and soap to the nose, confect. alkermas. diamarg.

These things may be applied to help nature in her delivery when the child comes to the birth the right way, and yet the birth be retarded; but if she finds the child comes the wrong way, and that she is not able to deliver the woman as she ought to be, by helping nature, and saving both mother and child (for it is not enough to lay a woman if it might be done any other way with more safety and ease, and less hazard to woman and child), then let her send speedily for the better and more able to help; and not as I once knew a midwife do, who, when a woman she was to deliver had hard labour, rather than a man-midwife should be sent for, undertook to deliver the woman herself (though told it was a man's business), and in her attempting it, brought away the child, but left the head in the mother's womb; and had not a man midwife been presently sent for, the mother had lost her life as well as the child; such persons may rather be termed butchers than midwives. But supposing the woman's labour to be natural, I will next show what the midwife ought to do, in order of her delivery.

* * * * *



CHAPTER V

Of Natural Labour; What it is and what the Midwife is to do in such Labour.

SECTION I.—What Natural Labour is.

There are four things which denominate a woman's natural labour; the first is, that it be at the full time, for if a woman comes before her time, it cannot be termed natural labour, neither will it be so easy as though she had completed her nine months. The second thing is, that it be speedy, and without any ill accident; for when the time of her birth come, nature is not dilatory in the bringing it forth, without some ill accident intervene, which renders it unnatural.

The third is, that the child be alive; for all will grant, that the being delivered of a dead child is very unnatural. The fourth is, that the child come right, for if the position of the child in the womb be contrary to that which is natural, the event will prove it so, by making that which should be a time of life, the death both of the mother and the child.

Having thus told you what I mean by natural labour, I shall next show how the midwife is to proceed therein, in order to the woman's delivery. When all the foregoing requisites concur, and after the waters be broken of themselves, let there rather a quilt be laid upon the pallet bedstead than a feather bed, having there-on linen and cloths in many folds, with such other things as are necessary, and that may be changed according to the exigency requiring it, so that the woman may not be incommoded with the blood, waters and other filth which are voided in labour. The bed ought to be ordered, that the woman being ready to be delivered, should lie on her back upon it, having her body in a convenient posture; this is, her head and breast a little raised, so that she may be between lying and sitting, for being so placed, she is best capable of breathing, and, likewise, will have more strength to bear her pains than if she lay otherwise, or sunk down in her bed. Being so placed, she must spread her thighs abroad, folding her legs a little towards her buttocks, somewhat raised by a little pillow underneath, to the end that her rumps should have more liberty to retire back; and let her feet be stayed against some firm thing; besides this, let her take firm hold of some of the good women attending her, with her hands, that she may the better stay herself during her pains. She being thus placed at her bed, having her midwife at hand, the better to assist as nature may require, let her take courage, and help her pains as best she can, bearing them down when they take her, which she must do by holding her breath, and forcing them as much as possible, in like manner as when she goes to stool, for by such straining, the diaphragm, or midriff, being strongly thrust downward, necessarily forces down the womb and the child in it. In the meantime, let the midwife endeavour to comfort her all she can, exhorting her to bear her labour courageously, telling her it will be quickly over, and that there is no fear but that she will have a speedy delivery. Let the midwife also, having no rings on her fingers, anoint them with oil of fresh butter, and therewith dilate gently the inward orifice of the womb putting her finger ends into the entry thereof, and then stretch them one from the other, when her pains take her; by this means endeavouring to help forward the child, and thrusting by little and little, the sides of the orifice towards the hinder part of the child's head, anointing it with fresh butter if it be necessary.

When the head of the infant is a little advanced into the inward orifice, the midwife's phrase is:—"It is crowned"; because it girds and surrounds it just as a crown; but when it is so far that the extremities begin to appear without the privy parts, then they say, "The infant is in the passage"; and at this time the woman feels herself as if it were scratched, or pricked with pins, and is ready to imagine that the midwife hurts her, when it is occasioned by the violent distension of those parts and the laceration which sometimes the bigness of the child's head causeth there. When things are in this posture, let the midwife seat herself conveniently to receive the child, which will come quickly, and with her finger ends (which she must be sure to keep close pared) let her endeavour to thrust the crowning of the womb (of which I have spoken before), back over the head of the child, and as soon as it is advanced as far as the ears, or thereabouts, let her take hold of the two sides with her two hands, that when a good pain comes she may quickly draw forth the child, taking care that the navel-string be not entangled about the neck or any part, as sometimes it is, lest thereby the after-burden be pulled with violence, and perhaps the womb also, to which it is fastened, and so either cause her to flood or else break the strings, both which are of bad consequence to the woman, whose delivery may thereby be rendered the more difficult. It must also be carefully observed that the head be not drawn forth straight, but shaking it a little from one side to the other, that the shoulders may sooner and easier take their places immediately after it is past, without losing time, lest the head being past, the child be stopped there by the largeness of the shoulders, and so come in danger of being suffocated and strangled in the passage, as it sometimes happens, for the want of care therein. But as soon as the head is born, if there be need, she may slide her fingers under the armpits, and the rest of the body will follow without any difficulty.

As soon as the midwife hath in this manner drawn forth the child, let her put it on one side, lest the blood and water which follows immediately, should do it any injury by running into its mouth and nose, as they would do, if it lay on its back; and so endanger the choking of it. The child being thus born, the next thing requisite is, to bring away the after-burden, but before that let the midwife be very careful to examine whether there be more children in the womb; for sometimes a woman may have twins that expected it not; which the midwife may easily know by the continuance of the pains after the child is born, and the bigness of the mother's belly. But the midwife may be sure of it, if she puts her hand up to the entry of the womb, and finds there another watery gathering, and the child in it presenting to the passage, and if she find it so, she must have a care of going to fetch the after-birth, till the woman be delivered of all the children she is pregnant with. Wherefore the first string must be cut, being first tied with a thread three or four times double, and fasten the other end with string to the woman's thighs, to prevent the inconvenience it may cause by hanging between the thighs; and then removing the child already born, she must take care to deliver her of the rest, observing all the circumstances as with the first; after which, it will be necessary to fetch away the after-birth, or births. But of that I shall treat in another section, and first show what is to be done to the new-born infant.



SECT. II.—Of the Cutting of the Child's Navel String.

Though this is accounted by many but as a trifle, yet great care is to be taken about it, and it shows none of the least art and skill of a midwife to do it as it should be; and that it may be so done, the midwife should observe: (1) The time. (2) The place. (3) The manner. (4) The event.

(1) The time is, as soon as ever the infant comes out of the womb, whether it brings part of the after-burden with it or not; for sometimes the child brings into the world a piece of the amnios upon its head, and is what mid wives call the caul, and ignorantly attribute some extraordinary virtue to the child so born; but this opinion is only the effect of their ignorance; for when a child is born with such a crown (as some call it) upon its brows, it generally betokens weakness and denotes a short life. But to proceed to the matter in hand. As soon as the child comes into the world, it should be considered whether it is weak or strong; and if it be weak, let the midwife gently put back part of the natural and vital blood into the body of the child by its navel; for that recruits a weak child (the vital and natural spirits being communicated by the mother to the child by its navel-string), but if the child be strong, the operation is needless. Only let me advise you, that many children that are born seemingly dead, may soon be brought to life again, if you squeeze six or seven drops of blood out of that part of the navel-string which is cut off, and give it to the child inwardly.

(2) As to the place in which it should be cut, that is, whether it should be cut long or short, it is that which authors can scarcely agree in, and which many midwives quarrel about; some prescribing it to be cut at four fingers' breadth, which is, at best, but an uncertain rule, unless all fingers were of one size. It is a received opinion, that the parts adapted to the generation are contracted and dilated according to the cutting of the navel-string, and this is the reason why midwives are generally so kind to their own sex, that they leave a longer part of the navel-string of a male than female, because they would have the males well provided for the encounters of Venus; and the reason they give, why they cut that of the female shorter is, because they believe it makes them more acceptable to their husbands. Mizaldus was not altogether of the opinion of these midwives, and he, therefore, ordered the navel string to be cut long both in male and female children; for which he gives the following reason, that the instrument of generation follows the proportion of it; and therefore, if it be cut too short in a female, it will be a hindrance to her having children. I will not go about to contradict the opinions of Mizaldus; these, experience has made good:—That one is, that if the navel-string of a child, after it be cut, be suffered to touch the ground, the child will never hold its water, either sleeping or waking, but will be subjected to an involuntary making of water all its lifetime. The other is, that a piece of a child's navel-string carried about one, so that it touch his skin, defends him that wears it from the falling sickness and convulsions.

(3) As to the manner it must be cut, let the midwife take a brown thread, four or five times double, of an ell long, or thereabouts, tied with a single knot at each of the ends, to prevent their entangling; and with this thread so accommodated (which the woman must have in readiness before the woman's labour, as also a good pair of scissors, that no time may be lost) let her tie the string within an inch of the belly with a double knot, and turning about the end of the thread, let her tie two more on the other side of the string, reiterating it again, if it be necessary; then let her cut off the navel-string another inch below the ligatures, towards the after-birth, so that there only remains but two inches of the string, in the midst of which will be the knot we speak of, which must be so close knit, as not to suffer a drop of blood to squeeze out of the vessels, but care must be taken, not to knit it so strait, as to out it in two, and therefore the thread must be pretty thick and pretty strait cut, it being better too strait than too loose; for some children have miserably lost their lives, with all their blood, before it was discovered, because the navel-string was not well tied, therefore great care must be taken that no blood squeeze through; for if there do, a new knot must be made with the rest of the string. You need not fear to bind the navel-string very hard because it is void of sense, and that part which you leave, falls off in a very few days, sometimes in six or seven, or sooner, but never tarries longer than eight or nine. When you have thus cut the navel-string, then take care the piece that falls off touch not the ground, for the reason I told you Mizaldus gave, which experience has justified.

(4) The last thing I mentioned, was the event or consequence, or what follows cutting the navel-string. As soon as it is cut, apply a little cotton or lint to the place to keep it warm, lest the cold enter into the body of the child, which it most certainly will do, if you have not bound it hard enough. If the lint or cotton you apply to it, be dipped in oil of roses, it will be the better, and then put another small rag three or four times double upon the belly; upon the top of all, put another small bolster, and then swathe it with a linen swathe, four fingers broad, to keep it steady, lest by moving too much, or from being continually stirred from side to side, it comes to fall off before the navel-string, which you left remaining, is fallen off.

It is the usual custom of midwives to put a piece of burnt rag to it, which we commonly call tinder; but I would rather advise them to put a little ammoniac to it, because of its drying qualities.



SECT. III.—How to bring away the After-burden.

A woman cannot be said to be fairly delivered, though the child be born, till the after-burden be also taken from her; herein differing from most animals, who, when they have brought forth their young, cast forth nothing else but some water, and the membranes which contained them. But women have an after-labour, which sometimes proves more dangerous than the first; and how to bring it safely away without prejudice to her, shall be my business to show in this section.

As soon as the child is born, before the midwife either ties or cuts the navel-string, lest the womb should close, let her take the string and wind it once or twice about one or two fingers on her left hand joined together, the better to hold it, with which she may draw it moderately, and with the right hand, she may only take a single hold of it, above the left, near the privities, drawing likewise with that very gently, resting the while the forefinger of the same hand, extended and stretched forth along the string towards the entrance of the vagina, always observing, for the greater facility, to draw it from the side where the burden cleaves least; for in so doing, the rest will separate the better; and special care must be taken that it be not drawn forth with too much violence, lest by breaking the string near the burden, the midwife be obliged to put the whole hand into the womb to deliver the woman; and she need to be a very skilful person that undertakes it, lest the womb, to which the burden is sometimes very strongly fastened, be drawn away with it, as has sometimes happened. It is, therefore, best to use such remedies as may assist nature. And here take notice, that what brings away the birth, will also bring away the after-birth. And therefore, for effecting this work, I will lay down the following rules.

(1) Use the same means of bringing away the after-birth, that you made use of to bring away the birth; for the same care and circumspection are needful now that there were then.

(2) Considering that the labouring woman cannot but be much spent by what she has already undergone in bringing forth the infant, be therefore sure to give her something to comfort her. And in this case good jelly broths, also a little wine and toast in it, and other comforting things, will be necessary.

(3) A little hellebore in powder, to make her sneeze, is in this case very proper.

(4) Tansey, and the stone aetites, applied as before directed, are also of good use in this case.

(5) If you take the herb vervain, and either boil it in wine, or a syrup with the juice of it, which you may do by adding to it double its weight of sugar (having clarified the juice before you boil it), a spoonful of that given to the woman is very efficacious to bring away the secundine; and feverfew and mugwort have the same operation taken as the former.

(6) Alexanders[10] boiled in wine, and the wine drank, also sweet servile, sweet cicily, angelica roots, and musterwort, are excellent remedies in this case.

(7) Or, if this fail, the smoke of marigolds, received 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) Boil mugwort in water till it be very soft, then take it out, and apply it in the manner of a poultice to the navel of the labouring woman, and it instantly brings away the birth. But special care must be taken to remove it as soon as they come away, lest by its long tarrying it should draw away the womb also.



SECT. IV.—Of Laborious and Difficult Labours and how the Midwife is to proceed therein.

There are three sorts of bad labours, all painful and difficult, but not all properly unnatural. It will be necessary, therefore, to distinguish these.

The first of these labours is that when the mother and child suffer very much extreme pain and difficulty, even though the child come right; and this is distinguishably called the laborious labour.

The second is that which is difficult and differs not much from the former, except that, besides those extraordinary pains, it is generally attended with some unhappy accident, which, by retarding the birth, causes the difficulty; but these difficulties being removed, it accelerates the birth, and hastens the delivery.

Some have asked, what is the reason that women bring forth their children with so much pain? I answer, the sense of feeling is distributed to the whole body by the nerves, and the mouth of the womb being so narrow, that it must of necessity be dilated at the time of the woman's delivery, the dilating thereof stretches the nerves, and from thence comes the pain. And therefore the reason why some women have more pain in their labour than others, proceeds from their having the mouth of the matrix more full of nerves than others. The best way to remove those difficulties that occasion hard pains and labour, is to show first from whence they proceed. Now the difficulty of labour proceeds either from the mother, or child, or both.

From the mother, by reason of the indisposition of the body, or from some particular part only, and chiefly the womb, as when the woman is weak, and the mother is not active to expel the burden, or from weakness, or disease, or want of spirits; or it may be from strong passion of the mind with which she was once possessed; she may also be too young, and so may have the passage too narrow; or too old, and then, if it be her first child, because her pains are too dry and hard, and cannot be easily dilated, as happens also to them which are too lean; likewise those who are small, short or deformed, as crooked women who have not breath enough to help their pains, and to bear them down, persons that are crooked having sometimes the bones of the passage not well shaped. The colic also hinders labour, by preventing the true pains; and all great and active pains, as when the woman is taken with a great and violent fever, a great flooding, frequent convulsions, bloody flux, or any other great distemper. Also, excrements retained cause great difficulty, and so does a stone in the bladder: or when the bladder is full of urine, without being able to void it, or when the woman is troubled with great and painful piles. It may also be from the passages, when the membranes are thick, the orifice too narrow, and the neck of the womb not sufficiently open, the passages strained and pressed by tumours in the adjacent parts, or when the bones are too firm, and will not open, which very much endangers the mother and the child; or when the passages are not slippery, by reason of the waters having broken too soon, or membranes being too thin. The womb may also be out of order with regard to its bad situation or conformation, having its neck too narrow, hard and callous, which may easily be so naturally, or may come by accident, being many times caused by a tumour, an imposthume, ulcer or superfluous flesh.

As to hard labour occasioned by the child, it is when the child happens to stick to a mole, or when it is so weak it cannot break the membranes; or if it be too big all over, or in the head only; or if the natural vessels are twisted about its neck; when the belly is hydropsical; or when it is monstrous, having two heads, or joined to another child, also, when the child is dead or so weak that it can contribute nothing to its birth; likewise when it comes wrong, or there are two or more. And to all these various difficulties there is oftentimes one more, and that is, the ignorance of the midwife, who for want of understanding in her business, hinders nature in her work instead of helping her.

Having thus looked into the cause of hard labour, I will now show the industrious midwife how she may minister some relief to the labouring woman under these difficult circumstances. But it will require judgment and understanding in the midwife, when she finds a woman in difficult labour, to know the particular obstruction, or cause thereof, that so a suitable remedy may be applied; as for instance, when it happens by the mother's being too young and too narrow, she must be gently treated, and the passages anointed with oil, hog's lard, or fresh butter, to relax and dilate them the easier, lest there should happen a rupture of any part when the child is born; for sometimes the peritoneum breaks, with the skin from the privities to the fundament.

But if the woman be in years with her first child, let her lower parts be anointed to mollify the inward orifice, which in such a case being more hard and callous, does not easily yield to the distention of labour, which is the true cause why such women are longer in labour, and also why their children, being forced against the inward orifice of the womb (which, as I have said, is a little callous) are born with great bumps and bruises on their heads.

Those women who are very small and mis-shaped, should not be put to bed, at least until the waters are broken, but rather kept upright and assisted to walk about the chamber, by being supported under the arms; for by that means, they will breathe more freely, and mend their pains better than on the bed, because there they lie all of a heap. As for those that are very lean, and have hard labour from that cause, let them moisten the parts with oil and ointments, to make them more smooth and slippery, that the head of the infant, and the womb be not so compressed and bruised by the hardness of the mother's bones which form the passage. If the cause be weakness, she ought to be strengthened, the better to support her pains, to which end give her good jelly broths, and a little wine with a toast in it. If she fears her pains, let her be comforted, assuring her that she will not endure any more, but be delivered in a little time. But if her pains be slow and small, or none at all, they must be provoked by frequent and pretty strong clysters; let her walk about her chamber, so that the weight of the child may help them forward. If she flood or have strong convulsions she must then be helped by a speedy delivery; the operation I shall relate in this section of unnatural labours. If she be costive, let her use clysters, which may also help to dispel colic, at those times very injurious because attended with useless pains, and because such bear not downward, and so help not to forward the birth. If she find an obstruction or stoppage of the urine, by reason of the womb's bearing too much on the bladder, let her lift up her belly a little with her hands, and try if by that she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her; also if it proceeds from indispositions of the womb, as from its oblique situation, etc., it must be remedied, as well as it can be, by the placing her body accordingly; or, if it be a vicious conformation, having the neck too hard, too callous, too straight, it must be anointed with oil and ointments, as before directed. If the membranes be so strong that the waters do not break in due time, they may be broken with the fingers, if the midwife be first well assured that the child is come forward into the passage, and ready to follow presently after; or else, by the breaking of the waters too soon, the child may be in danger of remaining dry a long time; to supply which defect, you may moisten the parts with fomentations, decoctions, and emollient oils; which yet is not half so well as when nature does her work in her own time, with the ordinary slime and waters. The membranes sometimes do press forth with the waters, three or four fingers' breadth out of the body before the child resembling a bladder full of water; but there is no great danger in breaking them, if they be not already broken; for when the case is so, the child is always in readiness to follow, being in the passage, but let the midwife be very careful not to pull it with her hand, lest the after-burden be thereby loosened before its time, for it adheres thereto very strongly. If the navel-string happen to come first, it must presently be put up again, and kept so, if possible, or otherwise, the woman must be immediately delivered. But if the after-burden should come first, it must not be put up again by any means; for the infant having no further occasion for it, it would be but an obstacle if it were put up; in this case, it must be cut off, having tied the navel-string, and afterwards draw forth the child with all speed that may be, lest it be suffocated.



SECT. V.—Of Women labouring of a dead Child.

When the difficulty of labour arises from a dead child, it is a great danger to a mother and great care ought to be taken therein; but before anything be done, the midwife ought to be well assured that the child is dead indeed, which may be known by these signs.

(1) The breast suddenly slacks, or falls flat, or bags down. (2) A great coldness possesses the belly of the mother, especially about the navel. (3) Her urine is thick, with a filthy stinking settling at the bottom. (4) No motion of the child can be perceived; for the trial whereof, let the midwife put her hand into warm water, and lay it upon the belly, for that, if it is alive, will make it stir. (5) She is very subject to dreams of dead men, and affrighted therewith. (6) She has extraordinary longings to eat such things as are contrary to nature. (7) Her breath stinks, though not used so to do. (8) When she turns herself in her bed, the child sways that way like a lump of lead.

These things being carefully observed, the midwife may make a judgment whether the child be alive or dead, especially if the woman take the following prescription:—"Take half a pint of white wine and burn it, and add thereto half an ounce of cinnamon, but no other spices whatever, and when she has drunk it, if her travailing pains come upon her, the child is certainly dead; but if not, the child may possibly be either weak or sick, but not dead. This will bring her pains upon her if it be dead, and will refresh the child and give her ease if it be living; for cinnamon refresheth and strengtheneth the child.

Now, if upon trial it be found the child is dead, let the mother do all she can to forward the delivery, because a dead child can in no wise be helpful therein. It will be necessary, therefore, that she take some comfortable things to prevent her fainting, by reason of the putrid vapours arising from the dead child. And in order to her delivery let her take the following herbs boiled in white wine (or at least as many of them as you can get), viz., dittany, betony, pennyroyal, sage, feverfew, centaury, ivy leaves and berries. Let her also take sweet basil in powder, and half a drachm at a time in white wine; let her privities also be anointed with the juice of the garden tansey. Or take the tansey in the summer when it can most plentifully be had, and before it runs up to flower, and having bruised it well, boil it in oil until the juice of it be consumed. If you set it in the sun, after you have mixed it with oil, it will be more effectual. This, an industrious midwife, who would be prepared against all events, ought to have always by her. As to the manner of her delivery, the same methods must be used as are mentioned in the section of natural labour. And here again, I cannot but commend the stone aetites, held near the privities, whose magnetic virtue renders it exceedingly necessary on this occasion, for it draws the child any way with the same facility that the load-stone draws iron.

Let the midwife also make a strong decoction of hyssop with water, and let the woman drink it very hot, and it will in a little time bring away the dead child.

If, as soon as she is delivered of the dead child, you are in doubt that part of the afterbirth is left behind in the body (for in such cases as these many times it rots, and comes away piece-meal), let her continue drinking the same decoction until her body be cleansed.

A decoction made of herbs, muster-wort, used as you did the decoction of hyssop, works the effect. Let the midwife also take the roots of pollodum and stamp them well; warm them a little and bind them on the sides of her feet, and it will soon bring away the child either dead or alive.

The following medicines also are such as stir up the expulsive faculty, but in this case they must be stronger, because the motion of the child ceases.

Take savine, round birthwort, trochisks of myrrh, castor, cinnamon and saffron, each half a drachm; make a powder, give a drachm.

Or she may purge first, and then apply an emollient, anointing her about the womb with oil of lilies, sweet almonds, camomiles, hen and goose-grease. Also foment to get out the child, with a decoction of mercury, orris, wild cucumbers, saecus, broom flowers. Then anoint the privities and loins with ointment of sow-bread. Or, take coloquintida, agaric, birthwort, of each a drachm; make a powder, add ammoniacum dissolved in wine, ox-gall, each two drachms. Or make a fume with an ass's hoof burnt, or gallianum, or castor, and let it be taken in with a funnel.

To take away pains and strengthen the parts, foment with the decoction of mugwort, mallows, rosemary, with wood myrtle, St. John's wort, each half an ounce, spermaceti two drachms, deer's suet, an ounce; with wax make an ointment. Or take wax six ounces, spermaceti an ounce; melt them, dip flux therein, and lay it all over her belly.

If none of these things will do, the last remedy is to try surgery, and then the midwife ought without delay to send for an expert and able man-midwife, to deliver her by manual operation, of which I shall treat more at large in the next chapter.



FOOTNOTES:

[10] Horse-parsley.

* * * * *



CHAPTER VI

Of Unnatural Labour.

In showing the duty of a midwife, when the child-bearing woman's labour is unnatural, it will be requisite to show, in the first place, what I mean by unnatural labour, for that women do bring forth in pain and sorrow is natural and common to all. Therefore, that which I call unnatural is, when the child comes to the birth in a contrary posture to that which nature ordained, and in which the generality of the children come into the world.

The right and natural birth is when the child comes with its head first; and yet this is too short a definition of a natural birth; for if any part of the head but the crown comes first, so that the body follows not in a straight line, it is a wrong and difficult birth, even though the head comes first. Therefore, if the child comes with its feet first, or with the side across, it is quite contrary to nature, or to speak more plainly, that which I call unnatural.

Now, there are four general ways a child may come wrong. (1) When any of the foreparts of the body first present themselves. (2) When by an unhappy transposition, any of the hinder parts of the body first present themselves. (3) When either of the sides, or, (4) the feet present themselves first. To these, the different wrong postures that a child can present itself in, may be reduced.



SECTION I.—How to deliver a Woman of a Dead Child by Manual Operation.

When manual operation is necessary, let the operator acquaint the woman of the absolute necessity there is for such an operation; and that, as the child has already lost its life, there is no other way left for the saving hers. Let him also inform her, for her encouragement, that he doubts not, with the divine blessing, to deliver her safely, and that the pains arising therefrom will not be so great as she fears. Then let him stir up the woman's pains by giving her some sharp clyster, to excite her throes to bear down, and bring forth the child. And if this prevails not, let him proceed with the manual operation.

First, therefore, let her be placed across the bed that he may operate the easier; and let her lie on her back, with her hips a little higher than her head, or at least the body equally placed, when it is necessary to put back or turn the infant to give it a better posture. Being thus situated, she must fold her legs so as her heels be towards her buttocks, and her thighs spread, and so held by a couple of strong persons, there must be others also to support her under her arms, that the body may not slide down when the child is drawn forth; for which sometimes great strength is required. Let the sheets and blankets cover her thighs for decency's sake, and with respect to the assistants, and also to prevent her catching cold; the operator herein governing himself as well with respect to his convenience, and the facility and surety of the operation, as to other things. Then let him anoint the entrance to the womb with oil or fresh butter, if necessary, that with so more ease he may introduce his hand, which must also be anointed, and having by the signs above mentioned, received satisfaction that the child is dead, he must do his endeavours to fetch it away as soon as he possibly can. If the child offer the head first, he must gently put it back until he hath liberty to introduce his hand quite into the womb; then sliding 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 into the passage; and that it be not separated from the body; which may be effected the more easily, because the child being very rotten and putrefied, the operator need not be so mindful to keep the breast and face downwards as he is in living births. But if notwithstanding all these precautions, by reason of the child's putrefaction, the head should be separated and left behind in the womb, it must be drawn forth according to the directions which have been given in the third section of this chapter. But when the head, coming first, is so far advanced that it cannot well be put back, it is better to draw it forth so, than to torment the woman too much by putting it back to turn it, and bring it by the feet; but the head being a part round and slippery, it may also happen that the operator cannot take hold of it with his fingers by reason of its moisture, nor put them up to the side of it, because the passage is filled with its bigness; he must, therefore, take a proper instrument, and put it up as far as he can without violence, between the womb and the child's head (for the child being dead before, there can be no danger in the operation), and let him fasten it there, giving it hold upon one of the bones of the skull, that it may not slide, and after it is well fixed in the head, he may therewith draw it forth, keeping the ends of the fingers of his left hand flat upon the opposite side, the better to help to disengage it, and by wagging it a little, to conduct it directly out of the passage, until the head be quite born; and then, taking hold of it with his hands only, the shoulders being drawn into the passage, and so sliding the fingers of both hands under the armpits, the child may be quite delivered, and then the after-burden fetched, to finish the operation, being careful not to pluck the navel-string too hard lest it break, as often happens when it is corrupt.

If the dead child comes with the arm up to the shoulders so extremely swelled that the woman must suffer too great violence to have it put back, it is then (being first well assured the child is dead) best to take it off by the shoulder joints, by twisting three or four times about, which is very easily done by reason of the softness and tenderness of the body. After the arm is so separated, and no longer possesses the passage, the operator will have more room to put up his hand into the womb, to fetch the child by the feet and bring it away.

But although the operator is sure the child is dead in the womb, yet he must not therefore presently use instruments because they are never to be used but when hands are not sufficient, 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 choose that way which is the least hazardous, and most safe.



SECT. II.—How a Woman must be Delivered when the Child's Feet come first.

There is nothing more obvious to those whose business it is to assist labouring women, than that the several unnatural postures in which children present themselves at the birth are the occasions of most of the bad labours and ill accidents that happen to them in that condition.

And since midwives are often obliged, because of their unnatural situations, to draw the children forth by the feet, I conceive it to be most proper first to show how a child must be brought forth that presents itself in that posture, because it will be a guide to several of the rest.

I know indeed in this case it is the advice of several authors to change the figure, and place the head so that it may present to the birth, and this counsel I should be very much inclined to follow, could they but also show how it may be done. But it will appear very difficult, if not impossible to be performed, if we would avoid the danger that by such violent agitations both the mother and the child must be put into, and therefore my opinion is, that it is better to draw forth by the feet, when it presents itself in that posture, than to venture a worse accident by turning it.

As soon, therefore, as the waters are broken, and it is known that the child come thus and that the womb is open enough to admit the midwife's or operator's hand into it, or else by anointing the passage with oil or hog's grease, to endeavour to dilate it by degrees, using her fingers to this purpose, spreading them one from the other, after they are together entered, and continue to do so until they be sufficiently dilated, then taking care that her nails be well pared, no rings on her fingers and her hands well anointed with oil or fresh butter, and the woman placed in the manner directed in the former section, let her gently introduce her hand into the entrance of the womb, where finding the child's feet, let her draw it forth in the manner I shall presently direct; only let her first see whether it presents one foot or both, and if but one foot, she ought to consider whether it be the right foot or the left, and also in what fashion it comes; for by that means she will soon come to know where to find the other, which as soon as she knows and finds, let her draw it forth with the other; but of this she must be specially careful, viz., that the second be not the foot of another child; for if so, it may be of the utmost consequence, for she may sooner split both mother and child, than draw them forth. But this may be easily prevented if she but slide the hand up by the first leg and thigh to the waist, and there finding both thighs joined together, and descending from one and the same body. And this is also the best means to find the other foot, when it comes but with one.

As soon as the midwife has found both the child's feet, she may draw them forth, and holding them together, may bring them little by little in this manner, taking afterwards hold of the arms and thighs, as soon as she can come at them, drawing them so till the hips come forth. While this is doing, let her observe to wrap the parts in a single cloth, so that her hands being always greasy slide not in the infant's body, which is very slippery, because of the vicious humours which are all over it; which being done, she may take hold under the hips, so as to draw it forth to the beginning of the breast; and let her on both sides with her hand bring down the child's hand along its body, which she may easily find; and then let her take care that the belly and face of the child be downwards; for if they should be upwards, there would be the same danger of its being stopped by the chin, over the share-bone, and therefore, if it be not so she must turn it to that posture; which may easily be done if she takes a proper hold of the body when the breasts and arms are forth, in the manner we have said, and draw it, turning it in proportion on that side it most inclines to, till it be turned with the face downwards, and so, having brought it to the shoulders, let her lose no time, desiring the woman at the same time to bear down, that so drawing the head at that instant may take its place, and not be stopped in the passage, though the midwife takes all possible care to prevent it. And when this happens, she must endeavour to draw forth the child by the shoulders (taking care that she separate not the body from the head, as I have known it done by the midwife), discharging it by little and little from the bones in the passage with the fingers of each hand, sliding them on each side opposite the other, sometimes above and sometimes under, till the work be ended; endeavouring to dispatch it as soon as possible, lest the child be suffocated, as it will unavoidably be, if it remain long in that posture; and this being well and carefully effected, she may soon after fetch away the after-birth, as I have before directed.



SECT. III.—How to bring away the Head of the Child, when separated from the Body, and left behind in the Womb.

Though the utmost care be taken in bringing away the child by the feet, yet if it happen to be dead, it is sometimes so putrid and corrupt, that with the least pull the head separates from the body and remains alone in the womb, and cannot be brought away but with a manual operation and great difficulty, it being extremely slippery, by reason of the place where it is, and from the roundness of its figure, on which no hold can well be taken; and so very great is the difficulty in this case that sometimes two or three very able practitioners in midwifery have, one after the other, left the operation unfinished, as not able to effect it, after the utmost industry, skill and strength; so that the woman, not being able to be delivered, perished. To prevent which fatal accident, let the following operation be observed.

When the infant's head separates from the body, and is left alone behind, whether owing to putrefaction or otherwise, let the operator immediately, without any delay, while the womb is yet open, direct up his right hand to the mouth of the head (for no other hole can there be had), and having found it let him put one or two of his fingers into it, and the thumb under its chin; then let him draw it little by little, holding it by the jaws; but if that fails, as sometimes it will when putrefied, then let him pull off the right hand and slide up his left, with which he must support the head, and with the right hand let him take a narrow instrument called a crochet, but let it be strong and with a single branch, which he must guide along the inside of his hand, with the point of it towards it, for fear of hurting the womb; and having thus introduced it, let him turn it towards the head to strike either in an eyehole, or the hole of the ear, or behind the head, or else between the sutures, as he finds it most convenient and easy; and then draw forth the head so fastened with the said instrument, still helping to conduct it with his left hand; but when he hath brought it near the passage, being strongly fastened to the instrument, let him remember to draw forth his hand, that the passage not being filled with it, may be larger and easier, keeping still a finger or two on the side of the head, the better to disengage it.

There is also another method, with more ease and less hardship than the former; let the operator take a soft fillet or linen slip, of about four fingers' breadth, and the length of three quarters of an ell or thereabouts, taking the two ends with the left hand, and the middle with the right, and let him so put it up with his right, as that it may be beyond the head, to embrace it as a sling does a stone, and afterwards draw forth the fillet by the two ends together; it will thus be easily drawn forth, the fillet not hindering the least passage, because it takes up little or no space.

When the head is fetched out of the womb care must be taken that not the least part of it be left behind, and likewise to cleanse the womb of the after-burden, if yet remaining. If the burden be wholly separated from the side of the womb, that ought to be first brought away, because it may also hinder the taking hold of the head. But if it still adheres to the womb, it must not be meddled with till the head be brought away; for if one should endeavour to separate it from the womb, it might then cause a flooding, which would be augmented by the violence of the operation, the vessels to which it is joined remaining for the most part open as long as the womb is distended, which the head causeth while it is retained in it, and cannot be closed until this strange body be voided, and this it doth by contracting and compressing itself together, as has been more fully before explained. Besides, the after-birth remaining thus cleaving to the womb during the operation, prevents it from receiving easily either bruise or hurt.



SECT. IV.—How to deliver a Woman when the child's head is presented to the birth.

Though some may think it a natural labour when the child's head come first, yet, if the child's head present not the right way, even that is an unnatural labour; and therefore, though the head comes first, yet if it be the side of the head instead of the crown, it is very dangerous both to the mother and the child, for the child's neck would be broken, if born in that manner, and by how much the mother's pains continue to bear the child, which is impossible unless the head be rightly placed, the more the passages are stopped. Therefore, as soon as the position of the child is known, the woman must be laid with all speed, lest the child should advance further than this vicious posture, and thereby render it more difficult to thrust it back, which must be done, in order to place the head right in the passage, as it ought to be.

To this purpose, therefore, place the woman so that her buttocks may be a little higher than her head and shoulders, causing her to lean a little to the opposite side to the child's ill posture; then let the operator slide up his hand, well anointed with oil, by the side of the child's head; to bring it right gently, with his fingers between the head and the womb; but if the head be so engaged that it cannot be done that way, he must then put up his hand to the shoulders, that by so thrusting them back a little into the womb, sometimes on the one side, and sometimes on the other, he may, little by little, give a natural position. I confess it would be better if the operator could put back the child by its shoulders with both hands, but the head takes up so much room, that he will find much ado to put up one, with which he must perform this operation, and, with the help of the finger-ends of the other hand put forward the child's birth as in natural labour.

Some children present their face first, having their hands turned back, in which posture it is extremely difficult for a child to be born; and if it continues so long, the face will be swelled and become black and blue, so that it will at first appear monstrous, which is occasioned as well by the compression of it in that place, as by the midwife's fingers in handling it, in order to place it in a better posture. But this blackness will wear away in three or four days' time, by anointing it often with oil of sweet almonds. To deliver the birth, the same operation must be used as in the former, when the child comes first with the side of the head; only let the midwife or operator work very gently to avoid as much as possible the bruising the face.



SECT. V.—How to Deliver a Woman when the Child presents one or both Hands together with the Head.

Sometimes the infant will present some other part together with its head; which if it does, it is usually with one or both of its hands; and this hinders the birth, because the hands take up part of that passage which is little enough for the head alone; besides that, when this happens, they generally cause the head to lean on one side; and therefore this position may be well styled unnatural. When the child presents thus, the first thing to be done after it is perceived, must be, to prevent it from coming down more, or engaging further in the passage; and therefore, the operator having placed the woman on the bed, with her head lower than her buttocks, must guide and put back the infant's hand with his 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 side, it must be brought into its natural posture in the middle of the passage, that it may come in a straight line, and then proceed as directed in the foregoing section.



SECT. VI.—How a Woman ought to be delivered, when the Hands and Feet of the Infant come together.

There are none but will readily grant, that when the hands and feet of an infant present together, the labour must be unnatural, because it is impossible a child should be born in that manner. In this case, therefore, when the midwife guides her hand towards the orifice of the womb she will perceive only many fingers close together, and if it be not sufficiently dilated, it will be a good while before the hands and feet will be exactly distinguished; for they are sometimes so shut and pressed together, that they seem to be all of one and the same shape, but where the womb is open enough to introduce the hand into it, she will easily know which are the hands and which are the feet; and having taken particular notice thereof, let her slide up her hand and presently direct it towards the infant's breast, which she will find very near, and then let her gently thrust back the body towards the bottom of the womb, leaving the feet in the same place where she found them. And then, having placed the woman in a convenient posture, that is to say, her buttocks a little raised above her breast (and which situation ought also to be observed when the child is to be put back into the womb), let the midwife afterwards take hold of the child by the feet, and draw it forth, as is directed in the second section.

This labour, though somewhat troublesome, yet is much better than when the child presents only its hands; for then the child must be quite turned about before it can be drawn forth; but in this they are ready, presenting themselves, and there is little to do, but to lift and thrust back the upper part of the body, which is almost done of itself, by drawing it by the feet alone.

I confess 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 first. But those that have written thus, are such as never understood the practical part, for if they had the least experience therein, they would know that it is impossible; at least, if it were to be done, that violence must necessarily be used in doing it, that would probably be the death both of mother and child in the operation. I would, therefore, lay down as a general rule, that whenever a child presents itself wrong to the birth, in what posture so ever, from the shoulders to the feet, it is the way, and soonest done, to draw it out by the feet; and that it is better to search for them, if they do not present themselves, than to try and put them in their natural posture, and place the head foremost; for the great endeavours necessary to be used in turning the child in the womb, do so much weaken both the mother and the child, that there remains not afterwards strength enough to commit the operation to the work of nature; for, usually, the woman has no more throes or pains fit for labour after she has been so wrought upon; for which reason it would be difficult and tedious at best; and the child, by such an operation made very weak, would be in extreme danger of perishing before it could be born. It is, therefore, much better in these cases to bring it away immediately by the feet, searching for them as I have already directed, when they do not present themselves; by which the mother will be prevented a tedious labour, and the child be often brought alive into the world, who otherwise could hardly escape death.



SECT. VII.—How a Woman should be delivered that has twins, which present themselves in different postures.

We have already spoken something of the birth of twins in the chapter of natural labour, for it is not an unnatural labour barely to have twins, provided they come in the right position to the birth. But when they present themselves in different postures, they come properly under the denomination of unnatural labours; and if when one child presents itself in a wrong figure, it makes the labour dangerous and unnatural, it must needs make it much more so when there are several, and render it not only more painful to the mother and children, but to the operator also; for they often trouble each other and hinder both their births. Besides which the womb is so filled with them, that the operator can hardly introduce his hand without much violence, which he must do, if they are to be turned or thrust back, to give them a better position.

When a woman is pregnant with two children, they rarely present to the birth together, the one being generally more forward than the other; and that is the reason that but one is felt, and that many times the midwife knows not that there are twins until the first is born, and that she is going to fetch away the afterbirth. In the first chapter, wherein I treated of natural labour, I have showed how a woman should be delivered of twins, presenting themselves both right; and before I close the chapter of unnatural labour, it only remains that I show what ought to be done when they either both come wrong or one of them only, as for the most part it happens; the first generally coming right, and the second with the feet forward, or in some worse posture. In such a case, the birth of the first must be hastened as much as possible and to make way for the second, which is best brought away by the feet, without endeavouring to place it right, because it has been, as well as the mother, already tired and weakened by the birth of the first, and there would be greater danger to its death, than likelihood of its coming out of the womb that way.

But if, when the first is born naturally, the second should likewise offer its head to the birth, it would then be best to leave nature to finish what she has so well begun, and if nature should be too slow in her work, some of those things mentioned in the fourth chapter to accelerate the birth, may be properly enough applied, and if, after that, the second birth should be delayed, let a manual operation be delayed no longer, but the woman being properly placed, as has been before directed, let the operator direct his hand gently into the womb to find the feet, and so draw forth the second child, which will be the more easily effected, because there is a way made sufficiently by the birth of the first; and if the waters of the second child be not broke, as it often happens, yet, intending to bring it by its feet, he need not scruple to break the membranes with his fingers; for though, when the birth of a child is left to the operation of nature, it is necessary that the waters should break of themselves, yet when the child is brought out of the womb by art, there is no danger in breaking them, nay, on the contrary it becomes necessary; for without the waters are broken, it will be almost impossible to turn the child.

But herein principally lies the care of the operator, that he be not deceived, when either the hands or feet of both children offer themselves together to the birth; in this case he ought well to consider the operation, of whether they be not joined together, or any way monstrous, and which part belongs to one child and which to the other; so that they may be fetched one after the other, and not both together, as may be, if it were not duly considered, taking the right foot of one and the left of the other, and so drawing them together, as if they both belonged to one body, because there is a left and a right, by which means it would be impossible to deliver them. But a skilful operator will easily prevent this, if, after having found two or three of several children presenting together in the passage, and taking aside two of the forwardest, a right and a left, and sliding his arm along the legs and thighs up to the wrist, if forward, or to the buttocks, if backwards, he finds they both belong to one body; of which being thus assured, he may begin to draw forth the nearest, without regarding which is the strongest or weakest, bigger or less, living or dead, having first put aside that part of the other child which offers to have the more way, and so dispatch the first as soon as may be, observing the same rules as if there were but one, that is keeping the breast and face downwards, with every circumstance directed in that section where the child comes with its feet first, and not fetch the burden till the second child is born. And therefore, when the operator hath drawn forth one child, he must separate it from the burden, having tied and cut the navel-string, and then fetch the other by the feet in the same manner, and afterwards bring away the after-burden with the two strings as hath been before showed. If the children present any other part but the feet, the operator may follow the same method as directed in the foregoing section, where the several unnatural positions are fully treated of.

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CHAPTER VII

Directions for Child-bearing Women in their Lying-in.

SECTION I.—How a Woman newly Delivered ought to be ordered.

As soon as she is laid in her bed, let her be placed in it conveniently for ease and rest, which she stands in great need of to recover herself of the great fatigue she underwent during her travail, and that she may lie the more easily let her hands and body be a little raised, that she may breathe more freely, and cleanse the better, especially of that blood which then comes away, that so it may not clot, which being retained causeth great pain.

Having thus placed her in bed, let her take a draught of burnt white wine, having a drachm of spermaceti melted therein. The best vervain is also singularly good for a woman in this condition, boiling it in what she either eats or drinks, fortifying the womb so exceedingly that it will do it more good in two days, than any other thing does in double that time, having no offensive taste. And this is no more than what she stands in need of; for her lower parts being greatly distended until the birth of the infant, it is good to endeavour the prevention of an inflammation there. Let there also be outwardly applied, all over the bottom of her belly and privities, the following anodyne and cataplasm:—Take two ounces of oil of sweet almonds, and two or three new laid eggs, yolks and whites, stirring them together in an earthen pipkin over hot embers till they come to the consistence of a poultice; which being spread upon a cloth, must be applied to those parts indifferently warm, having first taken away the closures (which were put to her presently after her delivery), and likewise such clots of blood as were then left. Let this lie on for five or six hours, and then renew it again when you see cause.

Great care ought to be taken at first, that if her body be very weak, she be not kept too hot, for extremity of heat weakens nature and dissolves the strength; and whether she be weak or strong, be sure that no cold air comes near her at first; for cold is an enemy to the spermatic parts; if it get into the womb it increases the after pains, causes swelling in the womb and hurts the nerves. As to her diet, let it be hot, and let her eat but little at a time. Let her avoid the light for the first three days, and longer if she be weak, for her labour weakens her eyes exceedingly, by a harmony between the womb and them. Let her also avoid great noise, sadness and trouble of mind.

If the womb be foul, which may easily be perceived by the impurity of the blood (which will then easily come away in clots or stinking, or if you suspect any of the after-burden to be left behind, which may sometimes happen), make her drink a feverfew, mugwort, pennyroyal and mother of thyme, boiled in white wine and sweetened with sugar.

Panado and new laid eggs are the best meat for her at first, of which she may eat often, but not too much at a time. And let her nurse use cinnamon in all her meats and drinks, for it generally strengthens the womb.

Let her stir as little as may be until after the fifth, sixth, or seventh day after her delivery, if she be weak; and let her talk as little as possible, for that weakens her very much.

If she goes not well to stool, give a clyster made only of the decoction of mallows and a little brown sugar.

When she hath lain in a week or more, let her use such things as close the womb, of which knot-grass and comfrey are very good, and to them you may add a little polypodium, for it will do her good, both leaves and root being bruised.



SECT. II.—How to remedy those Accidents which a Lying-in Woman is subject to.

I. The first common and usual accident that troubles women in their lying-in is after-pains. They proceed from cold and wind contained in the bowels, with which they are easily filled after labour, because then they have more room to dilate than when the child was in the womb, by which they were compressed; and also, because nourishment and matter, contained as well in them as in the stomach, have been so confusedly agitated from side to side during the pains of labour, by the throes which always must compress the belly, that they could not be well digested, whence the wind is afterwards generated and, by consequence, the gripes which the woman feels running into her belly from side to side, according as the wind moves more or less, and sometimes likewise from the womb, because of the compression and commotion which the bowels make. This being generally the case, let us now apply a suitable remedy.

1. Boil an egg soft, and pour out the yolk of it, with which mix a spoonful of cinnamon water, and let her drink it; and if you mix in it two grains of ambergris, it will be better; and yet vervain taken in anything she drinks, will be as effectual as the other.

2. Give a lying-in woman, immediately after delivery, oil of sweet almonds and syrup of maiden-hair mixed together. Some prefer oil of walnuts, provided it be made of nuts that are very good; but it tastes worse than the other at best. This will lenify the inside of the intestines by its unctuousness, and by that means bring away that which is contained in them more easily.

3. Take and boil onions well in water, then stamp them with oil of cinnamon, spread them on a cloth, and apply them to the region of the womb.

4. Let her be careful to keep her belly warm, and not to drink what is too cold; and if the pain prove violent, hot cloths from time to time must be laid on her belly, or a pancake fried in walnut oil may be applied to it, without swathing her belly too strait. And for the better evacuating the wind out of the intestines, give her a clyster, which may be repeated as often as necessity requires.

5. Take bay-berries, beat them to a powder, put the powder upon a chafing-dish of coals, and let her receive the smoke of them up her privities.

6. Take tar and bear's grease, of each an equal quantity, boil them together, and whilst it is boiling, add a little pigeon's dung to it. Spread some of this upon a linen cloth, and apply it to the veins of the back of her that is troubled with afterpains, and it will give her speedy ease.

Lastly, let her take half a drachm of bay-berries beaten into a powder, in a drachm of muscadel or teat.

II. Another accident to which women in child-bed are subject is haemorrhoids or piles, occasioned through the great straining in bringing the child into the world. To cure this,

1. Let her be let blood in the saphoena vein.

2. Let her use polypodium in her meat, and drink, bruised and boiled.

3. Take an onion, and having made a hole in the middle, of it, fill it full of oil, roast it and having bruised it all together, apply it to the fundament.

4. Take a dozen of snails without shells, if you can get them, or else so many shell snails, and pull them out, and having bruised them with a little oil, apply them warm as before.

5. If she go not well to stool, let her take an ounce of cassia fistula drawn at night, going to bed; she needs no change of diet after.

III. Retention of the menses is another accident happening to women in child-bed, and which is of so dangerous a consequence, that, if not timely remedied, it proves mortal. When this happens,

1. Let the woman take such medicines as strongly provoke the terms, such as dittany, betony, pennyroyal, feverfew, centaury, juniper-berries, peony roots.

2. Let her take two or three spoonfuls of briony water each morning.

3. Gentian roots beaten into a powder, and a drachm of it taken every morning in wine, are an extraordinary remedy.

4. The roots of birthwort, either long or round, so used and taken as the former, are very good.

5. Take twelve peony seeds, and beat them into a very fine powder, and let her drink them in a draught of hot cardus posset, and let her sweat after. And if the last medicine do not bring them down the first time she takes it, let her take as much more three hours after, and it seldom fails.

IV. Overflowing of the menses is another accident incidental to child-bed women. For which,

1. Take shepherd's purse, either boiled in any convenient liquor, or dried and beaten into a powder, and it will be an admirable remedy to stop them, this being especially appropriated to the privities.

2. The flower and leaves of brambles or either of them, being dried and beaten into a powder, and a drachm of them taken every morning in a spoonful of red wine, or in a decoction of leaves of the same (which, perhaps, is much better), is an admirable remedy for the immoderate flowing of the term in women.

V. Excoriations, bruises, and rents in the lower part of the womb are often occasioned by the violent distention and separation of the caruncles in a woman's labour. For the healing whereof,

As soon as the woman is laid, if there be only simple contusions and excoriations, then let the anodyne cataplasm, formerly directed, be applied to the lower parts to ease the pain, made of the yolks and whites of new laid eggs, and oil of roses, boiled a little over warm embers, continually stirring it until it be mixed, and then spread on a fine cloth; it must be applied very warm to the bearing place for five or six hours, and when it is taken away, lay some fine rags, dipped in oil of St. John's wort twice or thrice a day; also foment the parts with barley water and honey of roses, to cleanse them from the excrements which pass. When the woman makes water, let them be defended with fine rags, and thereby hinder the urine from causing smart or pain.

VI. The curding and clotting of the milk is another accident that happens to women in child-bed, for in the beginning of child-bed, the woman's milk is not purified because of the great commotions her body suffered during her labour, which affected all the parts, and it is then affected with many humours. Now this clotting of the milk does, for the most part, proceed from the breasts not being fully drawn, and that, either because she has too much milk, and that the infant is too small and weak to suck it all, or because she doth not desire to be a nurse, for the milk in those cases remaining in the breasts after concoction, without being drawn, loses its sweetness and the balsamic qualities it had, and by reason of the heat it requires, and the too long stay it makes there, is sours, curds and clots, in like manner as we see rennet put into ordinary milk to turn it into curds. The curding of the milk may also be caused by having taken a great cold, and not keeping the breasts well covered.

But from what cause so ever this curding of the milk proceeds, the most certain remedy is, to draw the breasts until it is emitted and dried. But in regard that the infant by reason of weakness, cannot draw strength enough, the woman being hard marked when her milk is curded, it will be most proper to get another woman to draw her breasts until the milk comes freely, and then she may give her child suck. And that she may not afterwards be troubled with a surplus of milk, she must eat such diet as give but little nourishment, and keep her body open.

But if the case be such that the woman neither can nor will be a nurse, it is necessary to apply other remedies for the curing of this distemper; for then it will be best not to draw the breasts, for that will be the way to bring more milk into them. For which purpose it will be necessary to empty the body by bleeding the arms, besides which, let the humours be drawn down by strong clysters and bleeding at the foot; nor will it be amiss to purge gently, and to digest, dissolve and dissipate the curded milk, four brans dissolved in a decoction of sage, milk, smallage and fennel, mixing with it oil of camomile, with which oil let the breasts be well anointed. The following liniment is also good to scatter and dissipate the milk.



A Liniment to Scatter and Dissipate the Milk.

That the milk flowing back to the breast may without offence be dissipated, you must use this ointment:—"Take pure wax, two ounces, linseed, half a pound; when the wax is melted, let the liniment be made, wherein linen cloths must be clipped, and, according to their largeness, be laid upon the breasts; and when it shall be dispersed, and pains no more, let other linen cloths be laid in the distilled water of acorns, and put upon them.

Note.—That the cloths dipped into distilled water of acorns must be used only by those who cannot nurse their own children; but if a swelling in the breast of her who gives such do arise, from abundance of milk, threatens an inflammation, let her use the former ointment, but abstain from using the distilled water of acorns.

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CHAPTER VIII

Directions for the Nurses, in ordering Newly-born Children.

When the child's navel-string hath been cut according to the rules prescribed, let the midwife presently cleanse it from the excrements and filth it brings into the world with it; of which some are within the body, as the urine in the bladder, and the excrements found in the guts; and the others without, which are thick, whitish and clammy, proceeding from the sliminess of the waters. There are sometimes children covered all over with this, that one would think they were rubbed over with soft cheese, and some women are of so easy a belief, that they really think it so, because they have eaten some while they were with child. From these excrements let the child be cleansed with wine and water a little warmed, washing every part therewith, but chiefly the head because of the hair, also the folds of the groin, and the cods or privities; which parts must be gently cleansed with a linen rag, or a soft sponge dipped in lukewarm wine. If this clammy or viscous excrement stick so close that it will not easily be washed off from those places, it may be fetched off with oil of sweet almond, or a little fresh butter melted with wine, and afterwards well dried off; also make tents of fine rags, and wetting them in this liquor, clear the ears and nostrils; but for the eyes, wipe them only with a dry, soft rag, not dipping it in the wine, lest it should make them smart.

The child being washed, and cleansed from the native blood and impurities which attend it into the world, it must in the next place be searched to see whether all things be right about it, and that there is no fault nor dislocation; whether its nose be straight, or its tongue tied, or whether there be any bruise or tumour of the head; or whether the mold be not over shot; also whether the scrotum (if it be a male) be not blown up and swelled, and, in short, whether it has suffered any violence by its birth, in any part of its body, and whether all the parts be well and duly shaped; that suitable remedies may be applied if anything be found not right. Nor is it enough to see that all be right without, and that the outside of the body be cleansed, but she must also observe whether it dischargeth the excrements contained within, and whether the passage be open; for some have been born without having been perforated. Therefore, let her examine whether the conduits of the urine and stool be clear, for want of which some have died, not being able to void their excrements, because timely care was not taken at first. As to the urine all children, as well males as females, do make water as soon as they are born, if they can, especially if they feel the heat of the fire, and also sometimes void the excrements, but not so soon as the urine. If the infant does not ordure the first day, then put into its fundament a small suppository, to stir it up to be discharged, that it may not cause painful gripes, by remaining so long in the belly. A sugar almond may be proper for this purpose, anointed all over with a little boiled honey; or else a small piece of castile-soap rubbed over with fresh butter; also give the child for this purpose a little syrup of roses or violets at the mouth, mixed with some oil of sweet almonds, drawn without a fire, anointing the belly also, with the same oil or fresh butter.

The midwife having thus washed and cleansed the child, according to the before mentioned directions, let her begin to swaddle it in swathing clothes, and when she dresses the head, let her put small rags behind the ears, to dry up the filth which usually engenders there, and so let her do also in the folds of the armpits and groins, and so swathe it; then wrap it up warm in a bed with blankets, which there is scarcely any woman so ignorant but knows well enough how to do; only let me give them this caution, that they swathe not the child too tightly in its blankets, especially about the breast and stomach, that it may breathe the more freely, and not be forced to vomit up the milk it sucks, because the stomach cannot be sufficiently distended to contain it; therefore let its arms and legs be wrapped in its bed, stretched and straight and swathed to keep them so, viz., the arms along its sides, and its legs equally both together with a little of the bed between them, that they may not be galled by rubbing each other; then let the head be kept steady and straight, with a stay fastened each side of the blanket, and then wrap the child up in a mantle and blankets to keep it warm. Let none think this swathing of the infant is needless to set down, for it is necessary it should be thus swaddled, to give its little body a straight figure, which is most proper and decent for a man, and to accustom him to keep upon his feet, who otherwise would go upon all fours, as most animals do.

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CHAPTER IX

SECTION I.—Of Gripes and Pains in the, Bellies of Young Children.

This I mention first, as it is often the first and most common distemper which happens to little infants, after their birth; many children being so troubled therewith, that it causes them to cry day and night and at last die of it. The cause of it for the most part comes from the sudden change of nourishment, for having always received it from the umbilical vessel whilst in the mother's womb, they come on a sudden not only to change the manner of receiving it, but the nature and quality of what they received, as soon as they are born; for instead of purified blood only, which was conveyed to them by means of the umbilical vein, they are now obliged to be nourished by their mother's milk, which they suck with their mouths, and from which are engendered many excrements, causing gripes and pains; and not only because it is not so pure as the blood with which it was nourished in the womb, but because the stomach and the intestines cannot make a good digestion, being unaccustomed to it. It is sometimes caused also by a rough phlegm, and sometimes by worms; for physicians affirm that worms have been bred in children even in their mother's belly.

Cure. The remedy must be suited to the cause. If it proceed from the too sudden change of nourishment, the remedy must be to forbear giving the child suck for some days, lest the milk be mixed with phlegm, which is then in the stomach corrupt; and at first it must suck but little, until it is accustomed to digest it. If it be the excrements in the intestines, which by their long stay increase their pains, give them at the month a little oil of sweet almonds and syrup of roses; if it be worms, lay a cloth dipped in oil of wormwood mixed with ox-gall, upon the belly, or a small cataplasm, mixed with the powder of rue, wormwood, coloquintida, aloes, and the seeds of citron incorporated with ox-gall and the powder of lupines. Or give it oil of sweet almonds and syrup of roses; if it be worms, lay a cloth, dipped in oil of wormwood mixed with ox-gall, upon the belly, or a small cataplasm mixed with the powder of rue, wormwood, coloquintida, aloes, and the seeds of citron incorporated with ox-gall and the powder of lupines. Or give it oil of sweet almonds with sugar-candy, and a scruple of aniseed; it purgeth new-born babes from green cholera and stinking phlegm, and, if it be given with sugar-pap, it allays the griping pains of the belly. Also anoint the belly with oil of dill, or lay pelitory stamped with oil of camomile to the belly.



SECT. II.—Of Weakness In Newly-born Infants.

Weakness is an accident that many children bring into the world along with them, and is often occasioned by the labour of the mother; by the violence and length whereof they suffer so much, that they are born with great weakness, and many times it is difficult to know whether they are alive or dead, their body appearing so senseless, and their face so blue and livid, that they seem to be quite choked; and even after some hours, then-showing any signs of life is attended with weakness, that it looks like a return from death, and that they are still in a dying condition.

Cure. Lay the infant speedily in a warm blanket, and carry it to the fire, and then let the midwife take a little wine in her mouth and spout it into its mouth, repeating it often, if there be occasion. Let her apply linen dipped in urine to the breast and belly, and let the face be uncovered, that it may breathe the more freely; also, let the midwife keep its mouth a little open, cleanse the nostrils with small linen tents[11] dipt in white wine, that so it may receive the smell of it; and let her chafe every part of its body well with warm cloths, to bring back its blood and spirits, which being retired inwards through weakness, often puts him in danger of being choked. By the application of these means, the infant will gradually recover strength, and begin to stir its limbs by degrees, and at length to cry; and though it be but weakly at first, yet afterwards, as it breathes more freely, its cry will become more strong.



SECT. III.—Of the Fundament being closed up in a newly-born Infant.

Another defect that new-born infants are liable to is, to have their fundaments closed up, by which they can neither evacuate the new excrements engendered by the milk they suck, nor that which was amassed in their intestines before birth, which is certainly mortal without a speedy remedy. There have been some female children who have their fundaments quite closed, and yet have voided the excrements of the guts by an orifice which nature, to supply the defect, had made within the neck of the womb.

Cure. Here we must take notice, that the fundament is closed two ways; either by a single skin, through which one may discover some black and blue marks, proceeding from the excrements retained, which, if one touch with the finger, there is a softness felt within, and thereabout it ought to be pierced; or else it is quite stopped by a thick, fleshy substance, in such sort that there appears nothing without, by which its true situation may be known. When there is nothing but the single skin which makes the closure, the operation is very easy, and the children may do very well; for then an aperture or opening may be made with a small incision-knife, cross-ways, that it may the better receive a round form, and that the place may not afterwards grow together, taking care not to prejudice the sphincter or muscle of the rectum. The incision being thus made, the excrements will certainly have issue. But if, by reason of their long stay in the belly, they become so dry that the infant cannot void them, then let a clyster be given to moisten and bring them away; afterwards put a linen tent into the new-made fundament, which at first had best be anointed with honey of roses, and towards the end, with a drying, cicatrizing ointment, such as unguentum album or ponphilex, observing to cleanse the infant of its excrement, and dry it again as soon and as often as it evacuates them, that so the aperture may be prevented from turning into a malignant ulcer.

But if the fundament be stopped up in such a manner, that neither mark nor appearance of it can be seen or felt, then the operation is much more difficult, and, even when it is done, the danger is much greater that the infant will not survive it. Then, if it be a female, and it sends forth its excrements by the way I mentioned before, it is better not to meddle than, by endeavouring to remedy an inconvenience, run an extreme hazard of the infant's death. But when there is no vent for the excrements, without which death is unavoidable, then the operation is justifiable.

Operation. Let the operator, with a small incision-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 intestines, let him thrust it forward, that it may be open enough to give free vent to matter there contained, being especially careful of the sphincter; after which, let the wound be dressed according to the method directed.



SECT. IV.—Of the Thrush, or Ulcers In the Mouth of the Infant.

The thrush is a distemper that children are very subject to, and it arises from bad milk, or from foul humour in the stomach; for sometimes, though there be no ill humour in the milk itself, yet it may corrupt the child's stomach because of its weakness or some other indisposition; in which, acquiring an acrimony, instead of being well digested, there arise from it thrice biting vapours, which forming a thick viscosity, do thereby produce this distemper.

Cure. It is often difficult, as physicians tell us, because it is seated in hot and moist places, where the putrefaction is easily augmented; and because the remedies applied cannot lodge there, being soon washed with spittle. But if it arises from too hot quality in the nurse's milk, care must be taken to temper and cool, prescribing her cool diet, bleeding and purging her also, if there be occasion.