The English midwife enlarged containing directions to midwives; wherein is laid down whatever is most requisite for the safe practising her art. Also instructions for women in their conceiving, bearing and nursing of children. With two new treatises, one of the cure of diseases and symptoms happening to women before and after child-birth. And another of the diseases, &c. of little children, and the conditions necessary to be considered in the choice of their nurses and milk. The whole fitted for the meanest capacities. Illustrated with near 40 copper-cuts.

SECT. XXXII. Of the extracting of a mola and false conception.

DR. We have hitherto Mrs. Eutrapelia discoursed of births natural and un∣natural; there is somewhat more, not like these, but often with them, and without them, which Physitians call a Mola, but you call it a false Conception: I pray, Mrs. therefore, what is that Mola, or false Con∣ception?

Mid. A Mola, Sir is a hard, inform tumor∣full of pores, (like so many ugly eyes) scarce to be cut by a knife, of a stony substance to touch, and round, appearing sometimes at the entrance of the Womb, sometimes over the whole Womb, and is thought (by very Learned Doctors) to be begotten by the wo∣man her self without the help of a man, (though some affirm it cannot be with∣out the seed of the man.) and there∣fore inanimate, because not generated by

two; without the help of a man (I say) by the force of her own seed, mixing it self with much menstruous blood, reteined in the Womb, which by immoderate heat is chang∣eth into the shape of flesh, and that altoge∣ther unnatural, as is the stone in the bladder, and in the fingers of gouty persons, &c.

Dr. Well, Mrs, since 'tis so (tell me, I pray, wherein it differs from a true Conception?

Mid. It may, Sir, be like a true Concepti∣on in three respects, yet differ in six. As first, 'Tis true that a false conception stop∣peth the monthly terms as doth the true.

Secondly, The belly also doth swell, and the breasts grow big.

Thirdly, There is an alteration both in the color and appetite; but yet they differ in these six following ways; as,

First, A false conception hath no ordinary nor periodical motion, neither doth it stir from side to side, except it be pressed.

Secondly, In a false conception the belly is harder, and the feet are much more swelled.

Thirdly, The woman is more heavy and unweeldy, and not so nimble as with a true conception.

Fourthly, The breasts swell not so much as in a true conception.

Fifthly, The whole body grows soft, and consumes away in a false conception.

Sixthly, a false conception may be moved in three months, but the Child stirreth not till after three months, or usually in the fourth month: And again, the birth of an Infant never exceeds the eleventh month, whereas a false conception may continue for fourteen years, or as long as they live.

Moreover, there may be a Tympany caused by air included in the Womb. Or else there may be a Dropsie, by reason of the many hu∣mors contained in the Womb, both which may give a false supposition of being with Child; but these also are easily distinguish'd from a false conception. A Tympany may be moved from place to place, but not the other: A Tympany will sound, if lightly strucken, but not the other: and a Dropsie, caused by those many humors as aforesaid, will shew some marks, being depressed with the fingers, whereas a Mola is hard, and yield∣eth not to the pulsation or depression of the fingers. And lastly, in both these most com∣monly the Thighs swell, but in a false con∣ception or Mola the Thighs wither, and are lesser.

Dr. Thus far have you extreamly inge∣niously, Mrs. Eutrapelia exprest your self con∣cerning a Mola; and now you have done, I pray you give me leave to lay you down my sentiments concerning both a Mola, and a

false conception and the safest and best way to draw them forth of the Womb with safe∣ty.

First of all then Mrs. you must know that there are several sorts of great bellies be∣longing to Women, as hath been said before; there are your natural big bellies which con∣tain a living Child, and those may be called true ones, and others unnatural, or against nature, in which, in lieu of a Child, is engen∣dred nothing but strange matters, as wind mixed with waters, which may be called drop∣sies of the Womb, and false conceptions, and Moles or Membranes full of blood and cor∣rupted seed; for which reason they are called false great bellies.

Now you must know that among the signs of a true great belly, one is the stirring of the Child in the Womb; but here you are to observe that it is very fit we should be al∣ways careful not to be deceived, by what we feel to stir in the Womb; inasmuch as the Infant of it self, is endued with 2 sorts of motions in its Mothers Womb, that is to say, a total motion, and a partial motion; the total motion is when it removes the whole body, and that is when it moves only but one part at a time, as the Head, Arms, or Legs, all the rest of its body lying unmoved; now the Womb blown up in fits of the Mo∣ther,

yea and some moles have, by accident, a kind of total motion, but never a partial one; for that motion of a mole is rather a falling down then otherwise, to wit, a motion by which heavy things do use to fall downwards: for a Woman who hath a mole of any consi∣derable bigness, whatsoever side she turns her self to, her belly will fall the very self same way immediately, even like unto an heavy bowl.

Then again you may remember that ano∣ther sign of a great belly, was the stopping of the courses, and withal a little qualmishness, which is not always true, and women who daily use copulation are very often subject to be deceived hereby thinking that then they are with child, whenas indeed false concepti∣on shall cause you almost the same accidents as true ones, the which cannot easily be distin∣guished but by its consequences.

For this false great belly is often caused by wind, which blows up and stretcheth out the womb, like a bladder, the which women often discharge with as much noise as if it came from the fundament; and sometimes tis no∣thing but water which is gath'red there in such abundance, as some women have been known to void a pail-ful without any child, though they veryly believed they had been with child; Now your moles always proceed

from some false conceptions which continu∣ing in the womb grow there by the blood that flows to them and by the accumulation of which they are by little and little encreas∣ed: and if the womb chance to expell it be∣fore 2 months, it may be called a false con∣ception; and some of them are only but as it were the seed involv'd in a membrane, the others are alittle more solid and fleshy; resem∣bling, in some sort, the Gizard of a foul, and are greater or less according to the time they remain in the womb, and also according to the quantity of blood with which they are always soaked: and women expell these false conceptions sooner or later according as they cleave to the womb, the which makes them almost always to flood in great quantity at those times, but for your moles they often continue in the womb after the ordinary time of labor; some women having had them a whole year, yea many years, as happened to a certain Peuterors wife, of whom the great Chirurgion Ambrose Parry makes makes men∣tion in his book of generation, who had a mole 17 years, and at last dyed of it; for if they keep it so long they go in danger of their lives; for their long or short continu∣ance is according as they are more or less ad∣hering to the inward parts of the womb, and are there entertained and nourished by the blood that flows thither.

And here I pray you note that it is of great importance to distinquish well betwixt a true and a false great belly; for the faults com∣mitted by a mistake are always very conside∣rable: forasmuch as in a true great belly the child ought to continue in the womb till na∣ture endeavors to expell it by a natural la∣bor, but contrarily the false great belly dict∣ates to us to procure the expulsion of what it conteins as soon as may be, wherefore we ought to be very careful. And if there be a∣ny occasions wherein the Physitians and Chi∣rurgions and Midwives ought to be more pru∣dent and to make more reflections upon their prognostics for an affair of so great an impor∣tance as this is, it is in this which concerns their judgments as to conceptions and wo∣mens being with child; to the intent that they may avoid the great accidents and mis∣fortunes, which they may cause which are too precipitate in it without a certain knowledge. Now the faults which are and may be com∣mitted at such a time through too much fear, are in some sort excusable and to be pardo∣ned, but not those caused by rashness which are incomparably greater.

And now to return to my discourse of moles, I take a mole to be nothing elce but a fleshy substance, without bones, or joynts, or distinction of members; without form or

figure, regulated and determined; engen∣dred against nature in the womb, after copu∣lation, out of the corrupted seed both of the man and the woman; notwithstanding there are some sometimes which have some linea∣mens of a rought form.

And here I take it to be very certain that a woman never engenders a mole with∣out the use of copulation, both seeds being required to it, as well as for a true generati∣on, though it may be otherways imagined, as you said, by very learned Drs. for truely though there may be some women, who though never having carnally had to do with any man, yet do naturally cast forth some strange bodies, after a flooding, which in a appearance seems to be flesh; yet notwith∣standing if you shall take more diligent and special notice thereof, you will find it to prove to be but some clods of blood coagulated, either without consistance or fleshy texture, or any ways membranous, as are your moles and false conceptions; and that stony hard∣ness was caused through its long stay in the womb being there baked as in an hot oven.

Now as to the manner of the engendring of moles I take it to be ordinarily this, that it is when either the mans or the womans seed or both together are weak or corrupted, the womb not laboring for a true conception, but

by the help of the spirits with which the seed ought to be replenished; but so much the easier as that small quantity found in it is ex∣tinguished, and as it were choaked, and drown∣ed by an abundance of the gross and corrupt∣ed menstruous blood, which sometimes flows thither, soon after conception, and gives not leisure to nature to perfect, what she hath, with great pains, begun; and so troubling its work, bringing thither confusion and dis∣order, there is made of the seeds and blood; a mere Chaos, called a Mole, not usually engen∣dred but in the Womb of a Woman, and ne∣ver or very rarely found in that of other ani∣mals, by reason that they have no menstruous blood as a woman that divine creature hath.

A mole, moreover you are to note, hath no burthen, nor navil-string fastned to it, as a childs always hath, for as much as the mole it self sticks close to the womb, by which means it receives nourishment from its vessels, it is also likewise usually clothed with a kind of skin, in which is formed a piece of flesh con∣fusedly interlaced with many Vessels; it is of a bigness and consistence more or less accord∣ing to the abundance of blood it receives, and according to its disposition, and also accord∣ing to the temperature of the Womb, and the time it remains there. For the most part there is but one, yet sometimes there are more,

whereof some cleave very strongly to the Womb, others very slightly: if women mis∣carry of them before the 2d Month, as I said before, they are call'd false Conceptions; and when they keep them longer, and that this strange body begins to grow bigger, then they are called Moles: and here you must know that your false Conceptions are more Membranous, and sometimes full of corrupt∣ed Seed, but your Moles are altogether fleshy; they cleave to the Womb almost always, and are sustained by the blood, with which it is always furnished, just as plants are by the moisture of the Earth. Sometimes there is a Child together with a Mole, from which it is sometimes divided and sometimes cleaving to its body, which puts it in great danger of being Monstrous or mishaken, because of the Compression which this strange body causeth to the little Infant, as yet being but very tender.

Thus having at large given you my Opi∣nion concerning Moles and false Concepti∣ons, their causes signs and differences; there remains now nothing more concerning this matter, to be demonstrated, but the manner how they ought to be drawn forth of the Womb.

And now seeing that these things contain∣ed in the Womb, are wholly unnatural, their expulsion must be procured as soon as possi∣ble may be, the which is very difficult to be performed, when these strange Bodies cleave so fast to the Womb, and especially the Mole; therefore to avoid the abundance of acci∣dents and inconveniences, as near as may be, that these unnatural things will produce, they must be endeavoured to be expell'd as soon as may be; and for the Mola you must, before you come to the Manual Operation, try if by any means you can to cause the Woman to expel it of her self; to the which purpose you are to administer to her strong and sharp cly∣sters, to stir up throws, for to open the Womb to give way to it; moistning also and loosening the Womb, with softening Oyntments, Oyls and Grease, not omitting bleeding in the foot, if there be occasion: Now the Mole will certainly be excluded by these means, provided it be but of an indif∣ferent bigness, or that it cleave but very lit∣tle or not at all to the Womb; but if it shal•• stick strongly to the bottom of the Womb▪ or that it be very big, the Womam wil•• hardly be rid of it without the help of a Phy¦sitian, Chyrurgions or Midwifes hand; i•• which case after that you have placed th•• Woman conveniently, as if you were to fetc••

a dead Child, then slide up your hand into the Womb, and therewith draw forth the Mole; but if it be so big that it cannot be brought forth whole, then 'tis wholly the man's work; who for this purpose use your crotchet or knife, but this is very rare, be∣cause it is of a tender soft substance, much more plyable then a Child's; but if you find it be only joyned to the Womb, and close fasten'd, you must separate it gently with your fingers ends, your Nails being paired, by putting them by little and little, between the Mole and the Womb, beginning on that side where it doth not stick so fast to the Womb, and so pursuing it until it be quite loosened; being mighty careful, if you find it grow to too fast, of rending or bursting the proper substance of the Womb, and pro∣ceeding as hereafter I shall speak of for the extraction of a Burthen staying behind in the Womb when the string is broken off.

For these same Moles never have any string fastened to them, nor any burthen from whence they should receive their nourish∣ment, but they do of themselves immediate∣ly draw their nourishment from the Vessels of the Womb, to which they are almost all∣ways joined and sticking in some place: and as for the substance of their flesh, 'tis also

much more hard then that of the burthen; and sometimes Schyrrhous, which is the cause why it is difficult to be separated from the Womb.

As to a false Conception, although it be much less then a Mole yet it often puts a wo∣man in hazard of her Life, by reason of great fluddings, which very often happens, when the Womb would discharge it self of it, and endeavours to expel it, the which seldom cease till it be come away, because it doth con∣tinually endeavour to exclude it, whereby the blood is excited to flow away, and in a man∣ner squeesed out of the open Vessels.

Now the safest and best way and remedy for a Woman in this case is to fetch away the false Conception, as soon as may be, because the Womb can very hardly avoid it of its own nature without artificial help; for it being very small, the Womans impulse in bearing downwards cannot be so effectual when the Womb is but little distended by so small a body, as when it contains a consi∣derable bulk in it, for then it is the more strongly compressed with the throws. Many times 'tis very difficult to fetch away these false Conceptions because the Womb doth not open and dilate it self, ordinarily, be∣yond

the proportion of what it contains, and that being but very little so is its opening; which is the reason why the Midwife is some∣times so far from introducing her whole hand, that she can scarce get in a few Fin∣gers, with which she will be obliged to finish the Operation, as well as she may or can, by proceeding in the following manner, when she hath introduced them.

Having then very well anointed her hand, she must slide up the neck of the Womb into the inward Orifice, the which she will find sometimes to be but very little dilated, and then very gently put in one of her Fingers, the which she must presently turn and bend on every side, until that she hath made way for a second, and afterwards for a 3d or more if it may be done without violence; but many times she hath enough to get in but 2, be∣tween which she must take hold of the false Conception (as Crabs do with their claws, when they fasten upon any thing) and then she must gently draw it forth, as also the clodded blood which she there shall find; and then afterwards undoubtledly the fludding will cease, if no part of the Conception be left behind: but if the inward Orifice cannot be more dilated then to admit of one Fin∣ger, and that the fludding is so violent as to

endanger the Womans life; then is matter and manner to be wholly committed to care and artful industry of the skilful Physitian or Chirurgeon.

Mid. Now Sir, having discoursed so learnedly of these things, let us in the next place if you please, discourse of the After∣bith.