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. I. Of the True generation of it Parts, and Increase of the Infant in the Womb, according to the daies and times, till the time of the Birth.

WHen the Womb (whose pro∣perty it is naturally to receive seed for generation, as a Loadstone attracts iron, or Jeat straws or feathers) hath received the seed, and by its virtue hath shut it up for generation; Pre∣sently, from the first day until the sixth or seventh, there grow and arise very many and very small fibres or hairs, beginning with a hot motion; by which vital heat the Liver, with its chiefest organs are ge∣nerated, as this following Figure may the more illustrate.

[illustration] depiction of the womb in the first few days after conception

The small Fibres.

For the vital spirits, giving down seed to∣wards conception, forms and distinguishes the chiest members by the tenth day, being let in by certain veins of the secundine, to which the matrix is fixed, and by which the blood is imported, and of which the navil is generated. And at the very same time three smal spots (not unlike to curds of milk) arise,

where the liver, the heart, and the brain have their places; and then presently a vein di∣rected by the navil, attracts the thicker blood confused with the seed, and maks it fit for nourishment: from whence also ariseth a vein with two forks, which is generated ac∣cording to the form of this figure

[illustration] depiction of the womb and developing embryo at about 10 days after conception

In the one of which branches there is a collection of blood, of which first the liver is generated. From whence it easily appears,

the liver is a congealed and concrete blood: and also it may be manifest, how many and various veins it hath prepared and fitted, for the attractive and expulsive virtue. But in the other branch are generated those webs o•• veins, with the dilatation of other veins, as o•• the stomach, spleen, and intestines, in the lo∣wer part of the belly. And from hence im∣mediately all veins are collected together, as so many branches into one trunk, in the upper web of the liver towards the hollow vein•…•… and this trunk by and by sends down branche•• to make the midriff, and directs not a few branches to the lower parts, even to the ve∣ry thighs: and then the heart, with its ar∣teries extended into seed from the navil, i•• generated by a vital virtue, and is directe•• towards the spine of the back, as is demon¦strated in this figure, 3.

[illustration] depiction of the womb and developing embryo at more than 10 days after conception

But those do attract the hottest and more subtile blood, of which the heart is genera∣ted, incased in a membrane, naturally fleshy and thick, necessary upon the account of so ••ot a member. But the hollow vein extend∣••ng it self, and penetrating the inward con∣••avity of the right side in the heart, &c. de∣••ives thence blood for the nourishment of the ••eart. From the same branch also of this

his vein, and in the same part another vein ariseth, called, by some, the immoveable, or quiet vein; because, according to the account of the pulsation of other veins it beats not at all, but lies quiet; ordained for this end, that it should let go the purest blood to the Lungs, being vested with a double tunicle like an Arterie, from whence it is called the Arterial vein. But in the left concavity of the heart there are two Arteries, that is to say, the Venal Arterie, and the Great Arte∣rie, which carries a great pulse with it, and diffuseth the vital Spirits by the blood of the heart into all the Arteries of the Body. For, as the hollow vein is the original of all veins, by which the Body doth attract its whole nourishment of blood; so, from the Aorta (or great Arterie) all pulsatile veins are derived, diffusing the vital Spirits through the whole Body. For the heart is the foun∣tain and original of vital heat, without which no creature or member can thrive.

Under the abovesaid Arterie in the left concavity of the heart, another vein ariseth called the Venal Arterie: And, although that be really a pulsatile vein, and doth direct the vital Spirits, yet, according to the man∣ner of all pulsatile veins that have blood, it hath but one coat, and therefore made for that end, that it should derive the cold air

from the Lungs to refresh the heart, as also to attemper its over-much heat.

And veins issuing out from both the cavi∣ties of the heart, are inserted into the Lungs, of which they are formed; for the vein that proceeds from the right cavity of the heart produceth the most subtile blood, which, by small fibres, dispersed here and there, is changed into the fleshy substance of the lungs. But from the great vein of the Liver, (viz. the Vena Cava, or hollow vein) the whole brest is generated, and so successively the Arms and Thighs.

[illustration] depiction of the womb and developing embryo at more than 10 days after conception, showing the development of the brain

Within the time aforesaid also is genera∣ted the highest and chiefest part of this noble structure, the Brain; in the third Region of this mass; for the whole mass of seed is filled with the animal Spirits, that contracts a great part of the genital moysture, and concludes it in a certain cavity wherein the brain may be formed: but, as to the out-fide, it is in∣veloped with a certain covering, which being dried with heat, is brought into a boney sub∣stance, and becomes a scull, as appears by this precedent figure.

But the brain is so formed, that it may con∣ceive, retain, and change the natures of all the vital Spirits, from whence also proceed the beginnings of all Reason, and of the Senses: For, as veins have their original from the Liver, and as arteries have their rise from the heart; so also nerves being of a softer and milder natural existence, arise from the brain, and are not hollow as the veins are, but solid; for they are the first and chiefest instruments of all the senses, by which the motions of all the senses, by reason of the vi∣tal spirit, are justly made.

After the nerves, from the brain also, is formed the pith of the back-bone, not of an unlike nature from the brain, so that it scarce can be called marrow because it hath no likeness to marrow, either by sight, or in

substance; for the marrow is a kind of su∣perfluous aliment, arising from the blood of the members, appointed to moisten and make the bones of the body grow; but the brain and pith of the back have their original from the seed, not deputed for the nourishment and growth of the other members, but that by themselves they might make private parts of the body, for the use and motion of the Senses, that from thence all the other nerves may take their rise. For, from the pith of the back many nerves arise, from which the body hath sense and motion, as may appear by the difference betwixt the vital and ani∣mal faculties, as hath been before hinted.

Moreover, here it is to be observed, that from the seed it self gristles, bones, coats of the veins of the Liver, and of the arteries of the heart, the brain with the Nerves, and again the tunicles, and as well other panni∣cles or membranes as those that wrap up the infant, are generated; but from the proper blood of the infant is the flesh it self ingen∣dred, and all those parts that are of a fleshy substance; as the Heart, the Liver, and Lungs: And then at length all these grow together by the menstruous blood, attracted by the small veins of the Navil, which are observed to be directed with their orifices into the Womb. All which are distinctly

made by the eighteenth day of the first month, from the very conception, at which time it may be called seed, but afterwards it becometh to be, and is called a child; which the Ancients have comprehended in these two verses,

Six daies in milk, thrice three the seed's in blood; Twice six makes flesh, thrice six makes mem∣bers good.

[illustration] depiction of the womb and developing embryo at about 18 days after conception

The lesser figure denotes the Nerves derived frō the Back and dispersed through the whole.

The explanation of the larger figure see in the following page.

• FF Sheweth a young one of 18 daies (though some hold it but 14 dayes in which all the members may be discerned apart,)
• GG The four Umbilical Vessels meeting in one.
• HH How the Umbilical Vessels become thick by degrees, that that doubt amongst some may be resolved, whether they spring from the Womb, or no.
• III Sheweth how the Umbilical veins and arteries are spread throughout the Chorion by infinite branches.
• KKK Sheweth the membrane called Am∣nios, in which sweat and urine are gathered together, in which the Infant swimmeth, and sits as safe as in a Bath.

SECT. II. Of the signs of Conception, and whe∣ther the Child thrive in the Womb.

DR. Good Mrs. Eutrapelia, vouchsafe me your observations about Conceptions, and let me understand what are the signs of Conception in general; and what signs di∣stinguish the Sexes?

Mid. Although, Sir, 'tis hard to know whether a woman hath conceived yea or no, yet it may be conjectured by many experien∣ced Arguments; as, for instance,

First, it is thought a credible sign of Con∣ception, if a woman either the tenth day af∣ter coition, or sooner, perceive not, by rea∣son of any humors, any of her terms, be they whites, or reds. And, though the stopping of those be accounted for a sign, yet that fails often, because it may be as well before conception as after. But, waving this, let us find out other marks and prognosticks of a true conception, gathered from the state and condition of the woman her self, being seriously examined from head to foot.

Secondly; pains and giddiness in the head, and a mist over the sight, if they meet toge∣ther, these portend conception.

Thirdly, the apples of the Eyes are lessen∣ed, the Eyes swell, and become swarthy; the veins of the Eyes grow red, and are full with blood; the Eyes sink, the Eye-lids are re∣miss; divers colors are seen in the Eyes, and are observed in a looking-glass; the veins betwixt the Eyes and the Nose are swoln with blood, and are seen clearer; the veins under the Tongue are somewhat green∣ish.

Fourthly, the chest is warm, and the back cold.

Fifthly, the Veins and Arteries are swoln, and the pulse easier; the veins in the breast are first black, then either yellow or blew.

Sixthly, The breasts grow big, and hard with pain; the nipple grows red; if she drinketh that which is cold, she feels cold in her breast.

Seventhly, there is a great loathing of meat and drink, and destruction of the natu∣ral appetite, with longings after various meats, with an absurd appetite, a continual vomiting, and weakness of stomach, sower belching, loathing of wine, an inordinate pul∣sation of the heart, sudden joy, and after that, as sudden grief; pains about the navil, hea∣viness

about the loins, swelling towards the bottom of the belly; inward prick∣ing in the body; chilness of the outward parts, after coition; retention of the seed seven daies after copulation; about the be∣ginning of conception a shooting pain about the back and belly. The courses are stop'd; for those veins from which they flow carry the blood (through certain holes that are at the end of them) for the nourishment of the infant by the navil; and part of it is conveyed upwards into the breasts, and there is prepa∣red for milk.

Eightly, the thighs swell with pain, but the body is weaker, and the face pale.

Ninthly; the belly is costive, by reason of the compressure of the intestines. The urine is white, with a cold swimming at the top, wherein are to be seen many atomes, like those observable in the beams of the sun: but, when in the first Month many of these sink to to the bottom, the vessel in which it is, be∣ing shaken, it seems to be drawn out like to wooll. In the later months the urine is red∣rish, or yellow, it becomes blackish, with a red cloud at the top. I will here-with re∣late to you two experiments, by which it may be known whether or no a woman hath con∣ceived. And the first is this; Stop up a womans urine three daies in an urinal, at the

end of which strain it (or, rather drop it through fine linnen,) and if she hath con∣ceived, you shall see little creatures like to lice; if these be red, 'tis a token of a male; but if white, they say portend a female. If a womans urine be put in a brass Bason, and stand there one night; if you put into it a bright needle, if she hath conceived, that needle will be bespeckled with red spots; but if otherwise, it will be rusty all over.

The Signs whereby most pretend to know, whether Male or Female be conceived, being altogether Falacious and Ridiculous, I have wholly omitted.

Dr. Since you have given such signs of Conception, let me know by what signs you apprehend the Infant to be well, and thrive in the Womb, or not.

Mid. I shall, Sir. And first, if it be well, the breasts will be hard; but if otherwise, they will be flaccid, and a waterish humor will flow out of them (like to milk) of its own accord.

Secondly, if the courses flow too often out of the Womb in the time of child-bearing, it is an argument of an unhealthy Child, And, moreover, the fattest Women com∣monly bring forth the weakest Infants.

Thirdly, if a woman bring Twins, the one a Male, the other a Female, there is great

danger of the Female, because they are nou∣rished by a different aliment in the Womb: but if they be both Females, there is the less danger.

Fourthly, if the Child be gotten in the time of the monthly terms, they are mixed with untoward humors; from whence it is experienced that many leprous Infants are be∣gotten.

Fifthly, if there be superfaetation, the last conception seldom liveth. Now, superfaeta∣tion is, when a Woman having once con∣ceived, conceiveth again after a certain time, which sometimes happeneth.

Sixthly, if a Dropsie overtake the big∣bellied Woman, and that her Nose, Ears, and Lips look red; it is a sign of a dead Child.

Seventhly, if the infant come forth after the ninth month, 'tis oftentimes very weak.

Eightly, if a virgin conceive before her first flowers, it proves lusty and perfect child.

Dr. So much for Conception. Tell me now somewhat of the nourishing of the Child in the Womb, &c.

SECT. III. Of the Nutriment of the Child in the Womb, and by what nourishment it is preserved, and when it groweth up to be an Infant.

WHilest the young one is in the womb, it is nourished by blood attracted by the navil; by which it is, that women af∣ter they have conceived have their terms stop'd; for then the infant begins to crave, and attracts much blood. For the blood, pre∣sently after-conception, is discerned by a three-fold difference. The first and purest part of it the young one attracts for nourish∣ment. The second, less pure and thin, the wombforceth upwards by certain veins to the breasts, where it becomes milk, by which the infant is nourished so soon as it is born. The third, and more impure part of the blood, remains in the womb, and floweth out with the secundine, both in the birth, and after the birth: Hence it is that Hippocates saith; there is much affinity betwixt the flowers and the milk, since the one happeneth to be made out of the other. And Galen also, by reason

of this thing, elegantly adviseth, that the in∣fant hath more from the mother than from the father; for this reason, because the seeds are first increased by the menstruous blood, and then by these the Infant is presently nou∣rished in the Womb; and again, being new∣ly born, it is nourished with milk: And, as roots have more nourishment from the earth than the plant from whence they came: so also Infants receive more from the Mother than from the Father. And hence he saith that it comes to pass, that so much more is attributed to the Mother, by how much more She contributeth more towards generation.

But the Infant being now formed, and per∣fected in the Womb, in the first month the young one sends forth Urine by the passages of the Navil; but that Conduit being shut in

[illustration] representation an infant-like embryo in the womb at about 45 days after conception

the last month, it vents it by the Privities; (of which more when we come to treat of the Secundine (or after burden, with its coats.) Whilest the Infant is in the Womb, it avoids nothing at the Fundament, because hitherto it hath sucked in nothing by the mouth. After the 45th day, as Hippocrates tells us, it receiveth life, and together with that a Soul (according to the opinion of ma∣ny)

divinely infused, for that then it begins to be sensible, and from that time it may no more be called a young one, but an Infant, ac∣cording to the precedent Figure. And, though at this time it may have sense, yet it wants motion, being as yet very tender; but of the time of the motion, Hippocrates gives this account, viz. If you account the days dou∣ble from the time of Conception, you will find them quicken; and the time of quicken∣ing being tripled, makes up the day of the birth. As for example,

If the Infant be formed in 45 days, it will stir in 90 days, which is the middle time that it lies hid in the Womb; for in the ninth month it will come forth, and make haste to the birth; although Females are oftentimes born in the tenth Month. And so much for the formation, increase, and perfection of the Infant, according to the account of days and times.

SECT. IV. How the Infant doth in the Womb the fifth, the sixth, the seventh, and eighth month; and of the due time and form of the Birth; and causes of pain in Child-birth.

AFter the third and fourth month the In∣fant useth a more plentiful nourish∣ment, by which it groweth more and more until the time of Birth shall come: There∣fore it is to be understood, that when it is born in the sixth month, it cannot, in nature, live; because, though it be formed distinct∣ly, yet it is not arrived to its just perfection. But if it be born in the seventh month, it may easily live, because then it is sufficiently per∣fect. And, whereas 'tis a common opinion those born in the eighth month can rarely live; but such as are born in the seventh are often times living, because on the seventh month the Infant is ever moving towards the Birth, at which time, if it be strong enough, it comes to the Birth, but if not, it remain∣eth in the Womb till it groweth stronger,

(viz.) the other two Months. After the mo∣tion at seven Months end if it be not born, it removes it self into some other place of the Womb, and is so weakned by that motion, that should it come to the birth in the follow∣ing eighth Month, it cannot live by reason of that motion.

This seems very probable to many, but if they that practise deliveries make a rational reflection thereon, they shall find that 'tis the Matrix alone assisted with the compression of the Muscles of the lower belly and Midriff, which cause the expulsion of the Child; be∣ing stirred up by its weight, and not able to be farther extended to contain it: and not the Infant for want of nourishment is not able to stay any longer there, and so useth its pretended endeavours to come forth; and to that purpose kicking strongly it, breaks the Membranes with its Feet which contain the waters, insomuch as when the Child is natu∣rally Born the skins are alwaies torn before the Head; which pressing and thrusting each through the waters before it, causeth them to burst out with force. Hippocrates admits the 10 month, and beginning of the 11. And here, I do acknowledge for truth that the or∣dinary term of going with Child is 9 months; but I cannot consent that Children born in the 7 month do oftener live than those born

in the 8, but on the contrary, I believe the nearer they approach to the term of 9 months the stronger they are, and therefore rather live then those born in the 7th, which is wholly contrary to the other opinion which they have from Hippocrates; and in Egypt and Spain and other places Children born in the 8th month live. But they should have considered there may be some difference a∣bout Hippocrates's Months, viz. whether they were Solar or Lunar, a Solar consisting of 30 or 31 days throughout the year, and a Lunar of 27 days and some odd Hours and odd Mi∣nutes.

And then again the Women might be mi∣staken in their reckoning. And do we not know not only in the same Country and Field but also on the same Vine, grapes sometimes six weeks ripe before their ordinary Season; and others not till a month after? which happens according to the Territories, diffe∣rent influence of the Sun, and as the Vine is ordered. So do we see Women brought to bed six weeks and 2 months before, and some∣times as long after their ordinary term; if it be not that the Womb not being capable of an extension beyond a certain degree, can∣not bear its burden, but a little while after the account is out; although there have been Women as Hippocrates acknowledgeth who

have gone 10 or 11 whole Months with Child, which is so much the rarer, by how much it exceeds its limits.

These things happen also to Women ac∣cording to the different dispositions, either of their whole body, or Womb alone, as well as according to their rule of living, and more or less exercise they use, and may also happen on the Childs part, as if at 7 months it be so big that the Womb can no longer contain it, nor stretch it self more without bursting, it is then provoked by the pain which this violent extention causeth to dis∣charge it self of it; and so in the 8th month if there be the same reason, and some weeks sooner or later according to many other cir∣cumstances; as also by an outward occasion, as a violent shaking of the whole body, blow, fall, leap, &c. hasting the pains; and that which makes these Children live a longer or shorter time, is according as they are at that time more strong and perfect, and the Wo∣man nearer her time which is at the end of the 9th month.

There have been many Women that have believed they were brought to bed at the 7th and 8th Month; and others that they went 10 or 11 whole Months; which may some∣times be when notwithstanding they are ef∣fectively delivered at the due time: that

which deceives them usually is their believing themselves with Child from the retention of their Courses, having had them the 2 first Months, yea and sometimes longer, and o∣thers misreckon when their Courses are stopt 2 Months before they conceive: And a Wo∣man, though well regulated, cannot exactly know by the suppression singly the certain time of her being with Child; as for exam∣ple, if she lye with her Husband upon the coming down of her Courses, and she con∣ceive upon it, then she may make her account from their suppression, which may be very near the truth; but if she conceive immedi∣ately after she hath had them, which happens oftnest, and that during the Month she Copu∣lates with her Husband, at the end of which time her Courses not coming down, she may very well reckon her self with Child, yet for all this she cannot know by this sign which Night she conceived on, and so for 3 weeks or a Month, more or less, she may be mista∣ken in the time.

Here note there hath often been great con∣tests amongst Physitians, whether a Child born the 11th or 12th Month, after its pre∣tended Fathers death, can be legitimately born, and so admitted to inherit, or be disin∣herited, as a supposed Child; but this having been debated by the Romans as well as us, and

being parties for and against, I shall leave it undecided, and shall not add any thing more concerning this point to what I have said be∣fore.

And now the Midwife is to take care, that she be timely prepared for the reception of any birth, with all her necessary conveniences and instruments, as with a fit stool, a sharp knife, astringent powder, a spunge, swathes, &c. warm oyl of Lillies, with which she may aptly anoint both the Womb of the Woman and her own hands, but of that more here∣after.

And now in the next place let us make en∣quiry for the fittest and best Midwife, for this great work, and now I remember my self there was a good Woman call'd Mrs. Eu∣trapelia with me last night, for my advice and counsel in a very difficult concern, whom I found by that little discourse I had with her to be a very rational and understanding and expert woman in her art, and one that was not self conceited of her self, like many of her Sisters, that think they know all, and be∣lieve 'tis below them to ask any advice of the learned Physitian or Chyrurgion, when in∣deed they are oftenest the most ignorant; for 'tis the Physitian and Chyrurgion that they must be obliged to for the chief part of their Art, and in France 'tis the Chyrurgions

employ to help Women in Child-birth, an•• she promised to be with me very early th•• morning to give me account how it fare•• with her Patient, and of the success of m•• directions, and heark I believe 'tis she knock¦ing at the door at this instant.

Here note by the by, that 'tis romantic▪ to say, that the Males are generated in th•• right side of the Matrix, but Females in th•• left, out of the left Testicle; for the righ•• side, by reason of the Liver, is hotter, bu•• the left cooker; for when there are Twins▪ sometime they are of the same Sex, but prin¦cipally the abundant heat of Seed is the caus•• of the generation of Males.

[illustration] depiction of the baby in the womb, and the surrounding anatomy, near to the time of birth

This figure sheweth the Womb Anatomized and how the Infant lyeth in it.

The parts are descri∣bed in the following page.

• CC Denotes the Kidneys of each side.
• DD The emulgent Veins on the righ•• side.
• EE The emulgent Arteries on the righ•• side.
• F The trunck of the hollow vein.
• HH The emulgent Arteries on the left side.
• LL The Spermatick Veins on the right side.
• K The Spermatick Arterie on the right side.
• M The Spermatick Veins on the left side.

• aa The Ureters cut off.
• oo The Feminine Testicles.
• PP The broad ligament like Batts wings.
• qq The trunck of the great Arterie.
• BB Vessels like Vine-branches.
• Y The shaft of the Womb.
• R The bottom of the Womb where the Infant lieth.

SECT. V. Rules for Child-bearing Women, and how to prevent Abortion.

MId. According to your promise, I be∣seech you, Doctor, lay me down some Rules to be observed by Child-bearing Wo∣men.

Dr. Good Midwife, I shall, and that very necessary ones too, that she may know how to go on safely through (by Gods blessing) to the last hour, or by neglecting them, may make her delivery the harder: and I shall re∣duce them under ten heads.

First, let her be chearful; for this doth ex∣hilarate the Infant, and stirs up all the facul∣ties, and confirms it in its parts and Mem∣bers.

Secondly, let her avoid all violent moti∣on, and ahstain from all hard labours, not rising up too hastily, not leaping, running, dancing, riding; not lacing her self too streight, or carrying too heavy a burden; but surely moderate sleep and rest, is very fit for her. And all this especially toward the lat∣ter end of her reckoning; for though it be

allowed them by most Authors to facilitate the Birth, yet if we well consider the point we shall without doubt find it to be the cause of miscarryings, and hard labors, and death of many Women and Children. For you must know that the Birth of a Child ought to be left to the work of Nature well regulated, and not to provoke it, by shaking and jolting, as in a Coach, or by a trotting Horse, and to dislodge it before its full time, which happen∣ing though it be but 7 or 8 days sooner proves sometimes as prejudicial to the Infant, as we see it sometimes to Grapes which we find 4 or 5 days before they are full ripe, to be yet almost half verjuice; But to explain this more clearly, consider the Infant is na∣turally seated in the Womb, with Head up∣permost and the Feet downwards, with its Face towards the Mothers belly, just till it hath attained the 8th Month; at which time and sometimes sooner, and sometimes later, its head being very great and heavy, it turns over its Head downward and its heels up∣ward; which is the sole and true posture in which it ought to come into the World. Now just when the Child is about to turn according to custome into its intended po∣sture, instead of giving her self rest, she fall a jumping, walking, running up and down staires, and exercising her self more then or∣dinary,

which very often causes it to turn cross, and not right, as it ought to be; and sometimes the Womb is depressed to low, and engaged in such sort towards the last Month, in cavity of the flanks by those jolt∣ings, that there is no liberty left the Infant to turn it self naturally; wherefore it is con∣strained to come in its first posture, to wit by the Feet, or some other worser: more∣over it would be very convenient that the Woman should abstain from having to do with a Man carnally, during the 2 last months of her reckoning, forasmuch as the body is thereby much moved, and the belly pressed in the action, which likewise causeth the Child to take a wrong posture. Now I believe that those that will seriously reflect and confider of these things, will be ready to quit this their old error, which hath certainly caused the death of many Women and Children, and much pain to divers others.

Thirdly, let her beware of sharp and cold winds, of excessive heat, anger, troubles of the mind, affrights and terrors, over-much venery, and of intemperancy of eating and drinking.

Fourthly let her diet be frugal, and mode∣rate, abstaining from gross meats, hard of di∣gestion; let her eat Eggs, Chickens, Land∣fowl, birds of the Mountains, &c. variety

of broths, grewels, panadoes, Mutton, Veal, Lamb, Kid, Rabbets; she may use in her meats Nutmeg and Cinnamon; she may drink wine moderately.

Fifthly, in the first four Months let her open no vein, use no cupping or scarrificati∣ons, fontanells, nor use any pills, or other Physick, without the advice of a prudent Physitian; for in these Months the liga∣ments of the Child are very tender, soft, and feeble; and therefore the easier destroyed, and the nourishment kept from it.

Sixthly, if it shall happen that the Woman be too costive (by which many miscarry) let her boyl Spinage, and Lettuce, in Veal broth well buttered, with salt, or wine; which, if they will not move the belly, let her use suppositories, with honey and salt, or of Castile-soap: and if these common things will not do, let her advise with an expert Physitian.

Seventhly, if it happen that she conceive with grievous symptoms, and after concep∣tion is troubled with faintings, let her take this Cordial following. Take of Sorrel-wa∣ter, and red-Rose-water, of each one ounce; of Cinamon-water one ounce; of Manus Christi pearled, half an ounce, or as much Diamargariton: this may be taken as need requires.

Eighthly, if she fear that she may come (be∣fore her time) as in the seventh Month, or some other unseasonable time, and feels throws, as of Child-bearing, let her sit over a fume of Frankincense; for that contributes no small strength both to the Womb, and to the Infant also.

Ninthly, if she nauseate her meat, she may use a plaister of Mastich to her Stomach, and take this following Cordial every morning, fasting, to strengthen her Stomach.

Take Syrup of Pomegranates one ounce and half; of Mosch and Ambergreece, of each two grains; of Lignum Aloes finely powdered, one scruple; of Cinamon half a scruple; the water of Sorrel three ounces; let these be mingled, and drank off blood-warm.

Lastly, if, whilst she go with Child, she per∣ceive her terms, let her eat milk, made boyl with red-hot steel, and in that let Plantain and Comfrey be boyled. But, in all these cases, let her advise with learned Physitians, which will direct her with medicines from time to time.

I shall hereafter treat of some distempers incident to Child-bed; and leave you some choice Remedies in the following Sections; and then wind up all.

SECT. VI. A Dialogue between the Midwife, and the Doctor, concerning Midwifes and the delivery of Women in Child∣birth.

MId. A good morning to you good Mr. Dr. Sir I am come according to my promise, to give you an account of the event of the directions you was pleased to give me last Night concerning Mrs. Styles, the which indeed Sir have succeeded marveilous prospe∣rously, and she now thinks her self in Para∣dise to what she was before, and hath sent you Sir a small gratuity according to her a∣bility, in acknowledgment of the great bene∣fit she hath received by your Counsel. And for my own part Sir I so well approve of your last Nights discourse, that I must hum∣bly entreat you, that you would be pleased to afford me your Instructions in the safe per∣formance of my Art.

Dr. Very willingly good Mrs. and truly your name bespeaks you a fit Woman for your Employ, as being a well bred Woman;

therefore I shall in the first place take occa∣sion to tell you what kind of person a Mid∣wife ought to be, and that in the subsequent description.

The best Midwife is she that is ingenious, knowing letters, and having a good memory, is studious, neat and cleanly over the whole body, healthful, strong, and laborious, and well instructed in Womens conditions: not soon angry, nor turbulent, or hasty, unsober, unchaste; but pleasant, quiet, prudent; not covetous, but like the Hebrew Midwives, such as fear God, that God may deal with them, and that people may multiply and increase af∣ter their hands, and that the Lord may build them Houses.

By this description I tell you only how the best Midwife must be qualified; now let me hear somewhat of your skill, that I may the better judge thereof. First, then let me know how Women are delivered?

Mid. Women are variously delivered, some on their bed, that is to say, o'rethwart the hardest bed, with their Faces upward, with their Feet closed, doubled, and covered. But if she be not so tired out that of necessi∣ty she must be delivered on the bed, remove her to the stool: now the stool must be strong, and cut with a hole, in the shape of the moon, as high as a Barbers chair, that the

[illustration] depiction of the baby in the womb before and after turning to the natural position for birth

A Naturall Birth.

Midwife sitting upon a lower stool, may the better bring the Infant from the upper parts; the Womans face being still from her. Then let her attend with her finger dipped in warm oyl of sweet Almonds, or Lillies, moved a∣bout the orifice of the Womb, that the se∣cundine (called the afterburden) may the ea∣sier fall out. Then let those that are about her (which need not be above three at a time, that is to say, on each side one; and one at her back) persuade her not to cry out, but to keep in her breath what she may, that the spirits may descend, and be exposed downwards, to depress the Midriff, especially when her throwes are upon her. If the se∣cundine be not broken after a long while, it may be broken, carefully, with the nail of the finger, and thrusting the finger in by degrees. But oftentimes the orifice openeth naturally, by reason of the humors that flow out by it. But always this caution must be observed by the Midwife, that the Infant fall not sudden∣ly out, lest that endanger too sudden a shaking both of the head and shoulders. But the hu∣mors flowing, and the orifice so open, the Midwife may take hold of it, and moving it to and fro, bring it to the birth (according to the natural posture described before in the fourth Section) which must be done at such a time when the orifice of the Womb open∣eth

it self, and not otherwise; lest with ha∣stiness the flux of blood (which always at∣tends the birth) be too immoderate, and so the Womb it self come forth. When the In∣fant begins to come forth, let the Midwife take and receive it in a cloth in her hands, and let it come down together with the Se∣cundine. After the Child hath rested a while, the Navil must be cut four inches in length, with a sharp pen-knife, being suffi∣ciently tied with a strong double silk in two places, and cut betwixt the knots, to prevent as well a flux of blood in the Infant as in the Mother. After it is cut off, dry up the coa∣gulated blood, with some astringent powder, as Thuraloes at the Apothecaries.

As to the washing of the Child, and swa∣thing, I need not give you any account, I sup∣pose you take it for granted, that most wo∣men understand that. I only here shew you the shape of the stool I use, which, I hope, you will not disapprove of, though few Midwives have them, or use them.

Dr. I like, Mrs. the use of your stool, as being most useful, and especially by reason of the skirt of cloth that usually ought to be a∣bout it, to keep away the air, which gives me occasion to give you one necessary Admoni∣tion by the way. That all Midwives take heed that they expose not their Women, that

[illustration] depiction of the midwife's stool

• B. the Back of the Stoole
• oooo. the feete
• aa. rests for the hands
• rr. the ring in shape like the Moone
• cccc. the Cloth round the ring to keepe out the Aire etc:

are in labour, to the cold Air, but rather that they cover the Privities with the secundine also whilest it is yet hot, or else with warm clothes presently after the birth. For, be∣lieve me, (neither is it only my opinion, but also the opinion of the most Learned Do∣ctors) that there is nothing worse to child-bearing Women than the cold air, because that entring into the Womb, the Womb it self is distended, waxeth cold, and swelleth, and its orifices are shut; through which pas∣ses the menstruous matter; and then arise grievous symptoms, and often times death it self. But as to the suppression of them, and their cure, we shall speak more hereafter.

This precedent Figure is the form of a Child lying in the Womb (according as cut in Tho. Bartholinus, in Page 197.) naked, and out of all its coats both proper and common. The description of it appears by the explana∣tion of these letters in it, viz.

[illustration] depiction of the baby in the womb in a natural position for birth

• AA Shews the parts of the Chorion dis∣sected, and removed from their proper place.
• B a Portion of the Membrane Amnios.
• CC The Membrane of the Womb dissect∣ed.
• DD The placenta Ʋteri, or hepar uteri∣num, being a fleshy substance full of many Vessels, by which the Infant receives its nou∣rishment.
• E The varication of the Vessels which makes up the Navil string.
• FF The Navil string by which the Ʋmbi∣lick vessels are carried from the placenta to the Navil.
• GG The Infant, as it lies perfect in the Womb near the time of Travel.
• H How the umbilical vessels are inserted into the Navil of the Infant.

SECT. VII. Of the several natural situations of the Infant in the Mothers Womb, ac∣cording to the different times of Child-bearing.

WHen the Woman is young with Child, the little creature call'd the Embryo is always of a round Figure, a little longish, having the back-bone moderately turn'd inwards, the thighs folded and a little raised, to which the legs are so joined, that the heels touch the buttocks; the arms are bending and the hands placed upon the knees, towards which the head is inclining forwards, so that the chin toucheth the breast; In this posture it resembles one sitting to void his excrements, and stooping down his head to see what comes from him. Its back bone is at that time placed towards the Mothers, the head uppermost, the face forward, and the feet downward; and proportionably to its growth, it extends its members by little and little; which were exactly folded in the first Month; This posture it usually keeps till the

7th or 8th month, at which time the head be∣ing grown big is carryed downwards by its weight, towards the inward orifice of the Womb, tumbling as it were over its head, so that then the Feet are uppermost, and the Face towards the Mothers great gut; when the posture happens otherwise, 'tis unnatu∣ral; (and both Male and Female lie thus;) because the Child's face coming upwards will be extreamly bruised, and its Nose who∣ly flatted, because of the bones hardness in the passage.

Note further, when the Child hath chang∣ed its first Situation being not yet accustomed to this last, it stirs and torments it self so much sometimes, that the woman, by reason of the pain she feels, is apt to believe she is in labor, and if this circumstance be well con∣sider'd, you will find it to be that first pre∣tended indeavour, which Authors imagine the Child makes to be born the 7th month; and not being able to accomplish it, it stays till the 9th &c. But this is a great mistake, for if the Child turns it self so with the head downwards, or rather is turned, it is but by a natural disposition of the weight of the up∣per parts of the body; and if it stir much at that time and soon after, it is not from a de∣sire to be born, but from the inconvenience it receives from this new posture, to which

it was not before accustomed: and it begins to turn thus sometimes from the 7th month, rarely before, but by accident; often about the 8th and sometimes the 9th only, and at other times also it doth not turn at all, as we may easily perceive in those that come in their first Situation, that is with their Feet fore∣most.

When there are many Children they ought to come in the same Figure if it be a natural Birth, as when there is but one; but usually by their different motions they incommode one another, that for the most part one pre∣sents wrong in time of labour; yea and be∣fore, which is the cause that one comes often with the head, the other with the feet, or some worse posture, and sometimes both come wrong. However the Infant may be settled in the Mothers belly, or in whatever fashion it represents it self at the birth, if it be not according to the posture before said, it is always against nature.

SECT. VIII. Of difficult births, whether they pro∣ceed from Causes external or inter∣nal.

DIfficult births from external causes may be either, first, from excessive heat, dis∣solving the strength of the women; or se∣condly, excessive cold, condensing the womb; or thirdly, from sweet things, often applied to the nostrils of the woman, that by smelling to sweet things she may recover her strength and faintings; for sweet smells do attract the womb upwards, and so render the birth more difficult.

Difficult birth from internal causes may be either, first, from the woman; secondly, from the womb; thirdly, from the infant; fourthly from the membranes of the womb. 1. From the woman, as when she is too an∣gry, too fearful, or too modest; or if she be in age above 40 years, from whence the mus∣cles of the womb may be concluded to be dry, and so the less extenfible; or when she is so thick and fat, that the passages be narrow:

Or, 2. From the womb it self, as, when it is so small, and nature so weak and feeble that it cannot expell the birth: Or, if there be any inflammation; or unnatural affect in the pri∣vities, be it the stone, or piles, or extraordi∣nary costiveness; all which may so compress the womb with their weight, that it cannot expel the birth. 3. Is from the infant it self, as if it be of an unusual bigness, of a great head, or a monstrous birth, hydropical, full of wind, dead in the womb, or lying there in a posture beyond nature; as when it comes overthwart, with the feet forward, and not the head, or if the thigh before the head. 4. From the membranes of the womb, as when they are so forcibly broken by the child in the womb that the moysture floweth thence, leaving the infant behind, that when the child should come forth, that moysture fail∣eth, and so the membranes being dryer, mak∣eth the birth the more difficult; or when it is firm and solid that it is broken with much difficulty, and so makes the labour the har∣der.

And here we cannot but take notice how those Authors, who have not the perfect knowledge of the parts of a Womans body, attained to by Anatomy, do admire and cannot as they say, conceive how it is possible that an Infant so big can pass, in time of labour,

through an opening of the Womb so small; some of them being of opinion that the Wo∣mans share-bone is seperated at that time, to enlarge the passage; without which it would be impossible for the Infant to have room e∣nough to be born; and therefore Women that are a little antiquated suffer in their first labors more than others, because their share∣bone cannot so easily be seperated, which often kills their Children in their passage: others again are of opinion that it is the flank-bone, which is disjointed from the hoop-bone for the same purpose; and say both the one and the other of them, viz. That these bones thus separated at the hour of labor, are thereto so disposed by degrees, a little before, by the fly my humors which flow forth from about the Womb, and then mollifie the grisles and cords which at other times join them firmly together. But both these opinions are as different from truth as reason; for Anato∣my convinceth us clearly that the Womb by no means toucheth these places; whereby to moisten and soften them by its humors; as likewise that these bones are so joined by the gristle that it is very difficult to seperate them with a knife, especially the flank-bone from the hoop-bone, and almost impossible in some elderly Women without great violence; although Ambrose Parry, a most famous Chi∣rurgion

in his time at Paris, (quoting many witnesses to the thing) gives us an History of a Woman in whom (having been hang'd 14 days after she was delivered in Child-birth,) he found (as he saith) the share bone separated in the middle the bredth of half a finger, and the flanck-bones them∣selves disjointed from the hoop-bone. But we will not in this matter accuse him of an imposture as having too much respect, and a better opinion of so worthy a person, and believing him to be too sincere as to commit such a crime; but do indeed believe the good man might be mistaken in this separation; for we cannot probably conceive that being so at the time of her labor it would remain so a fortnight after, the breadth of half a finger; for then they would have been forc'd to carry this Woman to execution; (for they are ex∣ecuted at Paris within the City or Suburbs,) because she would not have been able to have supported her self, or climbe the ladder of the Gibbet; and keep her self on her Legs according to the custome of other Malefa∣ctors; because the body is only supported by the stability of these bones; wherefore we must believe, as most probable, that such a disjunction and separation was caused either from the falling of this Womans body from the high Gibbet to the ground after executi∣on;

or from some blow on that place from some hard thing. And if we thoroughly exa∣mine the different Figure and Structure of these bones between a Mans and a Womans Sceleton, we shall find a larger empty space and distance between these bones much more considerable in women then in men; and that to this purpose the least women have the bones of the hip more distant the one from the other, than the biggest man; and they have also the crupper-bone more outwards, and the sharebone flatter, which makes the passage from this capacity larger, and more able to give issue to the child at the time of labour: moreover they have besides this the flank bones much more turned outward, that the womb being filled may have more room to stretch it self out on the sides, and more at ease supported by such a disposition; as you will see explain'd in the figure.

A shews the Man's bones. B the Womans; for to know the difference that the Womans is more capacious then the Mans, for C and C, D and D, E and E are at a larger distance one from another, in a Woman than in a Man. And be∣sides that Women have the rump bone marked F. more turned outwards than Men, which gives way to the head to pass through the large passage be∣tween the 2 Hip-bones, marked E and E, without great difficulty; and without any necessity for the separation of the share-bone.

The bladder and great gut being emptyed of the excrements they contein hinder, in no wise but that the womb, made membranous or skinny for that purpose, can stretch forth it self as it doth to let the infaut pass in la∣bour, by this great empty space sufficient for it whithout any necessity that these bone-should be disjointed or separated; for if it should so fall out indeed women could not sustain themselves on their legs; as many of them do immediately after that they are brought to bed; because they are instead of a support to them, as is already exprest, and of a middle joincture to all the other, as well of the upper as the lower parts of the body. Which the learned and judicious and experi∣enced Chirurgion Mr. Francis Moriceau very well noted, when he lay'd so many Women in the Hostel de dieu in Paris; for when Wo∣men that are there to be brought to bed be∣gin to be in labor, they go into a little room call'd the stove, where all are delivered upon a little low bed made expresly, where they place them before the fire, afterwards as soon as they are delivered they conduct them to their bed, which sometimes is a good way off from this little chamber, whither they walk very well, which they could never do were their share-bone, or their flanck-bone separa∣ted the one from the other. Besides we of∣ten

see young Women that have concealed their labour, put themselves (the better to hide their faults,) immediately to their ordi∣nary business as if they had ailed nothing: neither could this ingenious Chyrurgion, in all women that ever he delivered, ever perceive this pretended disjunction, though he put his hand on the share bone when the child was in passage; but he sayes that indeed he hath found the hip-bone which is joyned with a loose Joint, to the lower extremity of the hoop-bone to bend outwards during labour: in which part the women feel sometimes much pain because the coming forth of the child of∣fers it a great violence, and because its head at that time doth much press the great gut against it.

Moreover having often seen and dissected women, being dead a few days after their de∣livery, it hath been found a very difficult mat∣ter to seperate these bones with a strong sharp Pen-knife; where could not be found any the least appearance of any forgoing separation: and if those advanced in years have more pain with their first children than the younger women, it doth not proceed from the difficul∣ty of the seperation of these bones (which never is, from the reason aforesaid) but be∣cause the membranes of their womb are dry, and hard; and particularly its internal orifice,

cannot therefore so easily be stretched open as young womens, which in them is much moister.

SECT. IX. Of the Fashions, and Figures of the birth, and how Children are born or may be born.

THE postures of the infant in the womb are generally four: First, they offer to come with their heads forward (which is the natural birth.) Secondly, with the feet for∣wards. Thirdly, overthwart. Fourthly, doubled; to all which the Midwives care and skill is required, but especially in the three later. But many other postures have been ob∣served, in practice; for that child that comes with his head forward, sometimes hath his head right, as to the orifice of the matrix, but the rest of the body crooked, and sometimes overthwart: and sometimes the infant pitch∣eth his head, either in the former part from the orifice, or backward, or comes crooked; and sometimes also it is whithout any tye, as to the bottom of the matrix, and sometimes with it; sometimes also it puts forth one hand, or both, so as that they are twisted above the head: sometimes it cometh forward, with its

feet asunder, and those fixed in the parts of the womb; sometimes the feet being doubled, it endeavours to come forth with the knees forward; sometimes it is so doubled, that it shews forth its little buttocks like one that is sitting; or contrarily may be so doubled, that you may find the soles of the feet joyned to the head in the orifice of the matrix; but those that lye o'rethwart, somtimes lye on one side, and sometimes with the face upwards, and somtimes downwards: But if there be twins, then that which presenteth it self fair∣rest, must be laid hold on, and the other put back. As to all which, the next following Sections will not only furnish you with fi∣gures, but with directions. Hitherto having described the Midwife and her office, togeth∣er with the site of the infant in the womb, as natural; together with difficult births in ge∣neral, and their causes. It is reasonable, (good Mrs. Eutrapelia) that we discourse of unnatu∣ral births, because those bring the greatest danger with them, both to the mother and infant.

SECT. X. Figure the first. Of unnatural Births.

DR. Courteous Mrs. Eutrapelia, If you perceive a child come with its feet for∣wards, and the hands drawn downwards to the thighs, according to the next ensuing form, How will you deliver the woman?

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the feet, with the arms pointing downwards

Mid. In this, I will take care to be fur∣nished with Oyles, and convenient liniments, and only to help the coming forth of the in∣fant, by anointing and cherishing it, lest it go back again, but that it may come forth the same way as it began. But first of all I shall take care, that both arms of the infant so stretched downwards, be so secured by me,

that the infant may not have power to draw them back again, but that I may compel it to come forth, after the very same manner: But if the infant breaking forth after this manner, and by reason of its bigness as well as his arms drawn down, be so streightned by the nar∣rowness of the matrix, that of it self it cannot wholly come to the birth; then the womb of the woman is to be anointed with oyl of Lil∣lies, or sweet Almonds, or hogs grease, & some sneezing Powder, blowed up he nose, to help the sending forth of the birth; and the womb gently to be compressed with both hands, that it tend not upwards, but downwards, as it ought, until it come forth entirely.

Here most Authors advise to change the Figure and place the head so that it may pre∣sent it self first to the birth; which is very difficult and almost altogether impossible to be performed; if we desire to avoid the dan∣gers that by such violent endeavours both the Mother and the Child must inevitably be put into; and I wish they would have shown us any way how it might be safely acted; that we might have followed their examples wherefore 'tis better to draw it forth by the feet, then to venture a worse accident by turning it.

Now to perform this the Midwife must have her Nails well pared and no rings on her

fingers, but her hands well anointed with Oyl or fresh Butter; then the woman being seat∣ed to the best advantage let her gently put her hand into the entry of the Womb, which if it be not wide enough let her open it a lit∣tle and little by degrees, with her fingers by spreading them one from the other after they are entred together, so continuing to do till it be sufficiently enlarged, then finding the Child's feet let her draw it forth in this po∣sture following; but if there shall but one foot present it self, then she shall consider whether it be the right or the left, and in what fashion it comes; for thefe reflections will be a means to inform her, on what side the other may be, which as soon as she knows let her seek for it, and then gently draw it forth together with the first; and then also let her be very careful and well assured that this 2d be not the foot of another Child; for if it should chance to prove so, she may soon∣er split both Mother and Children then draw them forth: the which she may easily pre∣vent it by sliding her hand up the first leg and thigh to the twist, she find both thighs joined together, and depending from one and the same body; and which is likewise without doubt the best means to find the other foot, when it comes but with one.

Being then secured of both the Childs feet, she may draw them forth, and holding them together, she may bring them by little and little in this manner, by taking hold of the Legs and Thighs aftewards, as soon as she can come at them and drawing them so till the hips be come forth: in the mean time let her observe to wrap the parts in a single nap∣kin, to the intent that her hands being alrea∣dy greasy slip or slide nor from the Infants body, which is very slippery, because of the slimy humors which are all over it; and hin∣der her from taking fast hold of it; which being done she may on both sides, with her hand, bring away the arms, being careful that the Belly and Face be downwards; lest being upwards the Head be stopt by the chin over the share-bone; so that if it be not so she must turn it to that posture; which is easily done if by taking hold of the body, when the breast and arms are forth, she shall draw it with turning it in proportion, on that side it most inclines to, till it be as it should be, that is with the Face downwards, and having brought it to the shoulders, let her lose no time, (desiring the Women at the same in∣stant to bear down) that so in drawing, the head at that very moment may take its places and not be stopt in its passage.

There are indeed some Children that have their Head so big, that when the whole body is born, yet that stops in the passage, not∣withstanding all the care that can be used to prevent it; in this case the Midwife must not only endeavour to draw forth the Child by the shoulders, least she sometimes separates the body from the Head, but she must disin∣gage it by little and little, from the bones in the passage, with the fingers of each hand, sliding on each side oppofite the one to the other, sometimes above and sometimes under until the work be ended; endeavouring to dispatch it as soon as possible, least the Child be cloaked or stifled; as it will certainly be if it remain long in that posture; w••ich be∣ing artificially and well effected; she may soon after fetch away the after-birth.

SECT. XI. Figure the Second.

DR. But, tell me, I pray, Mrs. Eutrapelia; What if an infant come with the feet forward, and the hands lifted above the head, and not drawn downwards to the thighs, (as in the follwing figure) what course will you take with most safety.

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the feet, with the arms pointing upwards

Mid. Sir, I am not at all to receive it so lying, except the Infant be very small and lit∣tle, and the Womb so extensive, and open, that it may be hoped a safe delivery, both to the Woman and to the Child; neither must I receive it before the Womb and the Infant be diligently anointed. But it were much better to thrust back the Infant into the Womb, and to turn it to the right form,

which may be done after this manner. Let the woman lye on her back upon a bed, with her buttocks raised higher, and her head low∣er; which done, I must swathe her belly upward gently, that I may drive back the In∣fant again into the Womb, by which means it may give an occasion of coming in another form; but above all, I must take care to turn the face of the Infant toward the back of the Mother, and then I must lift up the buttocks and things of the Infant toward the Navil of the Mother, that it may hasten toward a law∣ful birth: and there cannot be a safer experi∣ment in this case, (as I conceive) which is also most useful in such births as come unna∣turally.

Dr. Those Authors indeed Mrs. that have written of labors and never practised them as many Physitians and Chirurgions have done, do order all by the same precept often repeat∣ed, that is to reduce all unnatural and wrong births to a natural and right posture; which is to turn it that it may come with the Head first; but as I have said before, if they them∣selves had ever had the least experience, they would have known that it is very often im∣possible, at least, if they shall attempt to do it by the excess of violence, that must necessa∣rily be offer'd to effect it; it will go near to hazard the destruction both of Mother and

Child, in the operation. A fiat in this case ••s soon said, but not so easily executed as pro∣nounced; and for my part I am of a clear contrary opinion to theirs, and such as are ••kilful in the art, will certainly acquiesce with me in this, that is, that whensoever the ••nfant comes wrong in what posture soever ••rom the shoulders to the feet, it is the best ••nd safest way and soonest perform'd to draw ••t forth by the Feet; diligently searching for ••hem as is before directed if they do not pre∣••ent themselves, rather then to make an at∣••empt to put it into a natural posture, and ••lace the head foremost; for the great endea∣••ors often necessary to be used in turning the ••nfant in the Womb, (which is a little more ••ifficult business then to turn a pancake in a ••rying-Pan;) do so weaken both Mother and Child, that there remains not afterwards ••trength enough to commit the operation to ••ork of Nature; and usually the Woman ••ath no more throws nor pains fit for labor, ••fter she hath been so wrought upon; for ••hich cause it must needs be very tedious and ••ifficult; as also the Infant, which is already ••ery weak, will certainly perish in the pas∣••age, without being able to be born.

SECT. XII. Figure the Third.

DR. Now I pray you Mrs. tell me, If the Infant happen to come forth but with one foot, and the arms let down to the sides, but the other foot turned backwards; How will you help?

Mid. In this case worthy Sir what hath been said before, concerning the first Figure, being punctually observed, there will no dif∣ficulty at all remain in the operation; only alwaies remembring, when there is occasion, to refresh the Woman in labor with such Me∣dicinal means as may be proper for her in he condition.

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of one foot, with the other foot pointing backwards, and the arms pointing downwards

SECT. XIII. Figure the Fourth.

DR. If an Infant comes with the Shoulder first, or lye a-cross on its back, or with its buttocks, with the hands and feet up; how will you help it?

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the shoulder, back, or buttocks

Mid. The most difficult of these three sorts of figures and situations, in which Infants sometimes come, is that of the shoulders, be∣cause it is farthest from the Infant's feet; and the Midwife must find them, to draw it forth; the next is the back, and the breech for the same reason causeth it least trouble; not only because the feet are neerer, but also because by this figure, the Infant's head and neck is not so lock'd as in the other postures.

Now to remedy this birth of the shoulders some advise that it should be put back, to make way for the Infants head, that thereby it may be reduced to a natural birth, but it is much better, for the reasons before alledged, to endavour to bring it by the Feet; the which dextrously to effect, the Midwife must thrust the shoulder back a little with her hand, that so she may have more liberty to introduce it into the Womb, and sliding it then along the Childs body either by the belly or side, as she shall find it easiest, she shall fetch the feet; and turning it bring them to the passage, and so she shall deliver that Woman as is before directed.

If it be the back that presents to the birth, it is likewise impossible it should be born in in that posture, what pains soever the Mother endures; and besides the child having the bo∣dy folded inwards, and almost double, its

brest and belly are so press'd together, that i•• usually wants very little to be choak'd or stif¦led; to avoid the which dangerous inconve¦nience, the Midwife must quickly slide up he•• hand along the back towards the inferio•• parts, until she meets with the feet, to th•• intent she bring it forth the same way as if i•• came footling.

But when the Child comes with the Breech forward, if it be small, and the Mother big, having the passages very large, it may some∣times, with a little help, be born so; for al∣though it comes double, yet its Thighs be∣ing folded towards its belly, which is soft and gives way, it passeth without much trou∣ble.

Now as soon as the Midwife finds the Child to come with the Buttocks formost she must not suffer it to engage lower in the pas∣sage; for it will not come after that manner, unless it be very small; and the passage very large as we have said; This being then in good time perceived, the Midwife must, if she can thrust back the breech, and sliding up her hand along the thigh to the legs and feet of the Child, she must bring them gently, one after another, forh of the Womb, by folding, stretching, wagging, and drawing them gent∣ly towards the side; being careful not to wind them too much, or cause a distocation,

and then let her draw forth the rest of the body, as if it came with the feet formost.

I said, Sir that the Midwife, perceiving the Child to come with its breech formost, ought to put it back, if she can, for some∣times it will be so far advanced, in the passage, that she may sooner destroy both Mother and Child then reduce it to the posture aforesaid, it being once so strongly engaged; when this happens she cannot by any means hinder it from coming in this posture, in which its bel∣ly is so pressed, that it often voids its ordure by its Fundament: however she may much help this birth, by sliding up one or 2 fingers of each hand on each side of the buttocks, for to introduce them into the groins; and having crooked them inward, she must draw the breech just out to the thighs, and then by drawing it, and wagging it from side to side, she will disingage them from the passage; as also the feet and legs one after the other; be∣ing very careful of putting any part out of joint; and then she may draw forth the rest, as before is taught when it come with its feet foremost.

SECT. XIV. Figure the Fifth.

DR. Tell me, Mrs, Eutrapelia, what if the Infant happen to hasten to the birth with his armes and legs distorted and crook∣ed, according to this figure; How then will you help?

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the legs bent at the knees, with the arms pointing downwards bent at the elbows

Mid. As things so stand, Sir, I must not endeavour the birth of the child, but must bring her from the stool to the bed, where I must press back the womb as before-said, or must desire her to roul her self about, till the Infant is turned to a more commodious po∣sture: And if this course prevail not, I must endeavour to joyn both feet together, and, if

possible, must bring down the hands so to the sides, that I may direct it to the birth. But the safest and best way in my weak judgement Sr. must needs be that which you have taught me in the foregoing births.

SECT. XV. Figure the Sixth.

DR. Tell me, Midwife what if the Infant fall down with both the knees bent, and the hands hanging down to the thighs; How will you go to work?

Mid. Here, Sr. when an Infant (not being turned, towards the latter months, as it ought, to come with its head foromost) pre∣sents its self with the knees to the birth, hav∣ing its legs folded towards its buttocks, one may easily be deceivad touching one of them, because of their hardness and roundness, and take it for its head; especially when being seated a little high, it can be reached but with the end of a singer only, but if it be touched and handled a little better, the In∣fant being fallen a little lower it will be easily distinquished.

Assoon therefore Sr. as such birth is per∣ceieved, I must not suffer it to advance fur∣ther in such a posture, but having placed the woman, must gently put back the childs knees to the intent that I may have the more liberty

to unfold the legs one after another, th•…•… which dextrously to effect, I must put one o•• two of my fingers under the child's hams d••¦recting them by little and little all along b••¦hind the leg until I meet with the foot an•• drawing alwayes a little obliquely, for t•• come the easier to the end of it, that so hav¦ing disengaged one, I may do the same to th•• other, proceeding after the same manner a•• with the first, after which having brough•• them together, I must finish the work, a•• when a child comes with its feet foremost▪ and hands downwards to the things.

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the knees, with the arms pointing downwards

SECT. XVI. Figure the Seventh.

DR. But, Mrs. Eutrapelia, what if the In∣fant come out hastily with one hand, and the other hand down towards the side, and the feet stretched out streight into the womb, according to this figure; How will you re∣ceive it.

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of one hand, with the other hand pointing sidewards

Mid. May it please you, Sir, I am not at all to receive it so, nor to suffer it to proceed farther toward the birth; but must bring her to the bed, where her head must lye lower than her buttocks; then I must swathe her belly gently, that the Infant may fall back a∣gain into the womb: but if it fall not back of its own accord, I must put in my hand, and press back the shoulders, and must reduce the the arm that hanged out to the side, that it may be disposed of to a natural from in the Womb, and so may come forth easily.

Dr. Very well Mrs. Eutrapelia, this is your way; but now give me leave I pray you to give you my method in this case; when an Infant therefore presents only one or both hands to the birth, or an arme sometimes out to the Elbow, and many times to the shoulder, it is of the worst and most dangerous postures a child can come in, as well for its self as its mother; by reason of the violence the mid∣wife is forced to use both to the one and the other, in searching for the feet, which are very far off, by which I would always, in these cases, have it turn'd and drawn forth; the which to do will often make the midwife sweat in the midst of winter, because of the difficulty in this labor more then all the rest, though some other of them are indeed more dangerous for the Infant, as when it presents

the belly, and the Navil string comes forth, but it is not so painful for the Midwife, be∣cause the feet of the Infant, being near the passage, are not so hard to be found, as when it comes with a hand forward, for then they are high, and at the very bottom sometimes of the womb; where the midwife must seek them to turn it and draw it forth as I shall now direct.

When therefore it presents with one hand only, or a whole arm first it must by no means be pulled forth by that part, for it will be sooner separated and rent from the body then so brought forth; by reason a child is pluck'd obliquely and a cross-way; where∣fore having placed the woman as is requisite, the midwife must put back the Infants hand or arm, into the womb again: some Mid∣wives dip in cold water, or wash it with a wet cloth, saying that the Infant will presently draw it in, if it be living; but it is usually so prest and ingag'd in the passage, that this bad posture, that it hath not liberty enough to draw back its hands so easily, being once come forth; wherefore the midwife must guide them back with her own, which she must afterwards slide into the womb, under the child's brest and belly so far till she finds the feet, which she must gently pull towards her, to turn it and draw it forth by them as

before I directed; always remembring to act with as little violence as may be, which is much more easy, sure and safe then to busy ones self in putting it to a natural situation.

As soon therefore as she hath turn'd the child to the feet, if she hath hold but of one, she must search for the other, that so she may bring it to the first, when holding them both she must govern herself afterwards in bring∣ing the child into the World, as we directed you before when the child comes with its feet foremost.

But if the Arm be far advanced almost to the shoulder, and so big and sweld as it will be if it be along while forth, that it cannot at all, or with out great difficulty be put back, then she herself, or a Chirurgion being im∣mediately sent for, if the child be certainly dead, must twist the arm twice or thrice a∣bout, till it be wholly seperated from the body, which it will easily be by reason of its tender∣ness, and that just in the joint of the shoulder with the shoulder blade; but be sure the child be dead; elce what an horrible spectacle will it be to bring, as some have done, a poor child yet living into the World after the arm hath been cut off?

SECT. XVII. Figure the Eighth.

DR. But, Mrs, Suppose the Infant come forth with both hands stretched forth above the head, and the feet streight stretch∣ed into the Womb, which is here figured and is much more dangerous than the for∣mer?

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of both hands together

Mid. 'Tis true, Sir, this posture is much more dangerous than the former; but I shall take all the care I can to bring back again this birth into the womb wholly. And first of all, I shall anoint my hands, and the womb of the woman, with oyles for this purpose, (for this requires no small labour) then, if pos∣sible, with my other hand shall drive it back so by the shoulders, that it may wholly fall back into the womb: And again, lest the Infant should return to the same form of birth, I must put in my hands, and bring down the arms of the Infant to the sides, and by that means bring it to the form of a natu∣ral birth. If this course take not, I must bring the woman to bed, where, after she hath lain quiet a while, I must proceed after the same manner as I have before delivered: and if this also be to no purpose, and that it neither be changed to another form, she must be brought to the stool; and the womb, by the help of the women that are assistants, must be depressed on both sides, and downwards: And (my hands being annointed as be∣foresaid, together with the Womb, and both the arms as they come) I must do what I can to joyn them together, and so re∣ceive it as it comes forth. And in this birth, there is the less danger, if that I or any other Midwife do our duties with all possi∣ble

diligence, and in case the Infant be not too weak.

Dr. Very well Mrs. your way, but I take mine which I mentioned in the former Secti∣on to be the safer of the two, but you may use which you think best.

SECT. XVIII. Figure the Ninth.

DR. But I pray you, Mrs. Eutrap. How will you deliver a woman of a child that falls down with its buttocks forwards, and the hands spread over the head, according to this figure.

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the buttocks

Mid. Here, Sir, I must annoint my hands as above-said, and putting it up, must lift up the fundament of the child, and turn the head to the Birth. But, in this case I must not make too much haste, lest it fall into a worser form; neither is it possible that a child should be so born, without great loss to the Mother and Infant; therefore, if it cannot be turned with the hand, she must be brought to the bed, where, if she be very weak, she may be refreshed with convenient meats and cordi∣als, and then often proceeded with as is said before, until the Infant shall come to a more commodious form of birth.

Dr. Your observations and apprehensions of danger in this operation are very good; so that when the next opportunity presents you will find my former directions to be best and safest.

SECT. XIX. Figure the Tenth.

DR. But sometimes (Mrs.) it happens that it offers it self with its shoulders forwards, and the head turned backwards, but the feet and hands lifted up, as in the en∣suing figure; How will you help here?

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the shoulders

Mid. In this case, Sir; I must in the first place move backward the shoulders of the In∣fant, that it may first appear with the head forward; and this may easily be done, be∣cause the shoulders being but a little up, the head of it self will fall down to the orifice of the womb, as being nearest to it. But if there must be any other way attempted, she must be brought back to the bed, and then so stir∣red and rouled, and used according to those directions formerly hinted.

SECT. XX. Figure the Eleventh.

DR. Mrs, I fear I trouble you with many Questions; be pleased to satisfie me in this, and four or five more, and I shall for∣bear. What then if the Infant incline to the birth with the hands and feet together, as if it stood upon all four, with the back upward into the womb; (as in this figure) What, I say, will you do?

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of both hands and feet together

Mid. Here, Sir, I must take care, lest some danger happen from this difficult and unshape∣ly figure; therefore I must do thus. I must so move the feet of the Infant, that I may hand∣le the head, and do what I can to direct that first to the birth: I must also move up the arms, lest of their own accord they fall down to the sides of the womb. And if this way succeed not, she must be brought back to the bed, and the same means used for the turning of the Infant as hath been formerly descri∣bed.

SECT. XXI. Figure the Twelfth.

DR. Sometimes, Mrs. it falls out, that (contrary to the former shape) the In∣fant falls down upon its breast, with the hands and feet cast backward into the Womb, as in this figure; what will you do in such a condition?

[illustration] depiction of the baby in the womb in an unnatural position for birth: presentation of the chest

Mid. Truly, this case is the most dange∣rous of all hitherto proposed. First, there∣fore, I must carefully annoint both my hands, and also the womb of the woman; which done, I must feel for the arms of the Infant, and lay hold of them so, till I can lay hold of the head also, and with all care hold it so fast, that I may direct the head first to the birth; next I must dispose of them to the sieds; for this done, the birth will come forth the soon∣er, and with less danger; but if this succeed not, it will be safest to bring the woman to the bed, and to proceed as formerly shewed; that, if perhaps, by this kind of delay, the In∣fant may accommodate it self to a more fit posture for the birth.

SECT. XXII. Of a birth wherein the Infant presents the belly.

DR. In the next place Mrs. Midwife, let me hear from you how you will help a woman in labour of a child when it presents its belly first?

Mid. That you shall Sr. very willingly to the utmost of my skill.

And here Sr. I must note that the back-bone may easily be bent and turned forwards alit∣tle, but by no means backwards without ex∣cessive violence. Wherefore the worst and most dangerous figure that a child can offer to the birth, is the belly, or the breast, for then its body is constreined to bend back∣wards, and what ever throws or endeavours a woman makes to bring it forth it will never be accomplish'd; for she will sooner perish with her child then ever advance it in this posture into the passage, wherefore 'tis in great danger if not timely succourd; and in case it should escape, which would be very strange, it would be weak in the back along time after its birth: but that which aug∣ments

the danger much more is that for the most part the Navil-string comes forth when the Child comes with the belly; Therefore as soon as 'tis discover'd to be so, the Midwife must use the sole remedy of drawing it forth by the feet, as speedily as may be, in this fol∣lowing manner.

Having placed the woman I must gently slide up my flat hand, being well anoint∣ed for the easier entrance, towards the midle of the childs breast, which I must thrust back to turn it, this situation being already half turn'd, the feet being as neer to the passage as the head, when it represents the midle of the belly; then I must slip up my hand un∣der the belly till I find the feet, which I must bring to the passage, to draw it forth in the same manner, as if it came with the feet fore∣most; being very careful to keep the Face downwards which must alwaies be observed before the head can be drawn forth, for the reasons before given which must never be forgotten.

And here likewise is to be noted that the Midwife must alwaies prooceed after one and the same manner in the deliveries when a Child comes with the breast, or belly.

But on the other hand I would have it re∣mark'd, that when at any time an Infant comes with its side, it is impossible to be de∣livered

as the two former; but yet it is not so much tormented, nor is its situation so cruel; for it may remain in it a longer time without dying, than in the two former, wherein it is much more as it were upon the rack than in this, in which posture the body may be bended forwards, and not backwards, as in the other; but the Navil string doth not come forth so easily, as when it comes with the belly first. And in this as in the other 2 births, the Midwife will find it the safest way to draw it forth by the feet; by pushing back a little the Infants body with her hand, the better to introduce it, which she may slide along its thighs till she find the legs and feet by which she must turn it, and afterwards draw it forth, as I said even now: nor ought she to amuse her self, in any of these 3 births, to place its head right, that it may come naturally, because 'tis in great dan∣ger of dying in these unnatural positions, if not drawn forth with speed, which can never be effected unless it be by finding the feet, as I have directed.

SECT. XXIII. How to help a Woman in her Labor, when the Childs head thrusts the neck of the Womb forth before it.

DR. Now Mrs. Eutrapelia, I have ano∣ther question to ask you, and that is this; suppose you were call'd to deliver a Woman in labor where you find the Childs head to thrust forth the neck of the Womb before it, how would you go to work in such a case, and what art would you use to deliver the Child with safety?

Mid. Why surely Sir, if we only have re∣spect to the Figure the Child comes in in this labor, we may call it a natural one; but if we shall, on the other hand, consider either the disposition of the Womb, which is in danger of coming quite forth of the passage, or the manner of drawing forth of the Infant, we shall find it to be not so altogether: for its head thrusting it forceably before it may ea∣sily cause a falling out of the Womb, if the Woman be not skilfully succoured in time, here may be seen the neck of the Womb

bear forth before in great wrinkles according as the Child advanceth.

Now Women troubled with their bearing down of their Womb before they conceive, and those whose Womb is very moist, are much subject to this accident, because of the looseness of the strings.

The same method must not be observed here, as in the natural birth; for in this case the Woman must neither walk nor stand up∣right; but she must keep her bed with her body equally at least situated, and not raised a little as is requisite in a natural labor. She must by no means use strong or sharp clysters, lest they procure too great throws, neither must her Womb be moistned, because 'tis al∣ready too much loosened; but she must be aided at the moment each pain takes her, when the Child begins to advance its head, and consequently the neck of the Womb, and let the Midwife keep her hands on each side of its head, to thrust back by resisting the Womans pains, the Womb only giving way in the mean time for the Child to advance, doing the like at every throw; continuing therein till the Woman of her self hath for∣ced the Child quite into the World, for we must by no means draw it by the head, as in a natural labor, for fear of causing the Womb to fall out at the same time, to which it is then very apt.

Now if notwithstanding the Infant having the head born, and yet stops there, so long as to endanger its suffocation, then the Midwife must call a second person to her assistance, to draw it gently forth by the head, whilst she keeps back the Womb with both her hands, to prevent its following the Infants body so drawn forth. After the Woman is thus de∣livered, and her. Afterbirth fetch'd away gently; and not shaking or drawing it away too rudely, then let the Womb be placed up in its natural situation if it bears down.

SECT. XXIV. How to deliver a Woman when the Child presents the side of the Head, to the birth, or its Face.

DR. Good Mrs. Eutrapelia, I do very well approve of this your answer to my last quere; now in the next place I would know of you how you would bring a Woman to bed when the Child shall present it self with the side of its Head first, or its Face.

Mid. When the child Sir presents it self in this posture, as with the side of the head though it seems a natural labor, because the head comes first, yet 'tis very dangerous both to child and mother, for the child shall sooner break its neck than ever be born in this fashi∣on, and by how much the mothers pains con∣tinue to bear it which is impossible unless the head be first right plac'd, the more the pas∣sages are stopt up.

Therefore as soon as 'tis known the woman must be lay'd with all speed, lest the child ad∣vancing farther in this vicious posture, it prove more difficult to thrust it back; which

must be done when we would place the head right in the passage as it truely and naturally should be.

Now to effect this I must place the woman that her hips be a little higher than her head and shoulders, causing her to lean a little upon the opposite side to the childs ill posture; then I must slide up my hand being well anointed with oil, by the side of the child's head, for to bring it right gently with my fingers be∣tween the head and the womb: but if the head be so engaged that it cannot be easily done that way, I must then put my hand up to its shoulders, that so by thrusting them back in the womb, sometimes on the one side, and sometimes on the other; as I see occasion, so shall I give it a natural and convenient po∣sition.

And here it were to be wished that the midwife could put back the Infant by the shoulders with both her hands in this man∣ner; but the head doth take up so much room that she hath much ado to introduce one only with which she must do her operation, with the half of the fingers ends of the other hand put up as far as necessary, afterwards let her excite and procure the childs birth, as direc∣ted before.

Then sometimes the child comes with its face first, having its head turn'd back; in

which posture it is very difficult it should be born; and if it long remain so, the face will be so black and blew, and swell'd that at first sight it will appear monstrous, which comes as well by the compression of it in that place as by the Midwives fingers handling it too rudely, when she endeavor'd to place it in a better posture.

There was a certain Woman whose Child came with its Face so black and mishapen as soon as it was born, as is usual in such cases, that it looked like a black Moor; as soon as the Mother saw it, she said she alwaies fear'd her Child would be so monstrous, because when she was young with Child of it she fixt her looks very much upon a black moor; wherefore she wished or at least wise car'd not though it dyed, rather than she said she should behold a Child so monstrously disfigu∣red, as it then appear'd; but she soon chang'd her mind when she was made sensible, that this blackness was occasion'd only by reason that it came into the World with its face forwards, and that assuredly in three or four days it would wear away; as accordingly it happen'd; having often anointed it with oyl of sweet Almonds, as she was order'd; and when the Child came to be about a 12 month old, you could have scarcely seen a fairer. Now to deliver this birth the Midwife must

observe the same manner, as in that whe•…•… the Child comes with the side of the head▪ being careful to work gently to avoid bruising the Face.

But here note that if it should chance tha•• the Childs hand or hands should come with either of these births, which for the mos•• part happens, rather than any other part, i•• will hinder the birth by reason it takes up part of the passage, and for the most par•• cause the head to lean on one side.

To remedy this as soon as 'tis preceived that one hand presents together with the head, it must be prevented from coming down more, or ingaging farther in the passage▪ wherefore the Midwife having plac'd the Woman on the bed, with her head a little lower than her hips, must in the next place, put and guide back the Childs head with her own, as much as may be; or both hands i•• they came both down for to give way to the Childs head, which done she must proceed a•• before.

SECT. XXV. How to deliver a Woman when the Childs Head is born, and the Womb closeth about its Neck.

DR. Very well Mrs. Eutrapelia, you have now given us a farther account of your very good judgment in your Art, in your dextrous & ingenious way of bringing a Wo∣man to bed in the last posture. But now I would desire you to let me know how you will deliver a Woman of her Child, when its head is born, but yet the Womb closeth a∣bout its Neck.

Mid. Truely Sir to deliver this Woman is not so easie abusiness as may be imagin'd, by reason that a small delay herein may cause the strangling of the Child.

And here you must observe that the Child comes naturally with the Head first, because by its bigness and hardness the passage might be the better made and opened, for the other parts of the body; the which usually pass af∣terwards without pain; but yet notwith∣standing sometimes the Head is so small and

the shoulders so large, that without a very great difficulty they cannot pass, which makes the Child remain often in the passage after the head is born. And this accident may likewise happen sometimes for not having been careful to lose no time in drawing forth the Child by the head, to the end the shoul∣ders might, at the same instant, follow in the same place the head possest.

Now when I meet with this Figure, I must by all possible means seek speedily to deliver the poor Child out of this prison, or rather snare, or collar in which it is caught, for fear as I said before, it come by delay to be strangl'd: to prevent which I must endea∣vour to cause the shoulders immediately to follow by gently drawing its Head, sometimes by the sides of it, and some∣times with one hand under the chin, and the other behind its head, and so doing by turns, on the one side and the other, to facilitate the operation the better, being very careful and circumspect that the Navil-string be not en∣tangled about its Neck; as also not to draw it forth with too much violence, for fear least it may happen, as I once saw, the Head to be pulled from the Shoulders. But if the Shoulders come not with gentle pulling, then I must slide up my fingers on both sides under the Arm-pits, with which turning them in∣wards,

I may by little and little, draw forth the Soulders; but if when they are in the passage and totally disengaged, if I cannot get the rest forth by still keeping my fingers un∣der the Arm-pits, I may be very confident there is some other hindrance, and that it is certainly monstrous in some part of its body; or that, as it for the most part happens in this case, it is hydropical in the belly; for which cause it is impossible it should be born, before the belly be pierced to evacuate the waters; and then it will easily be accomplish'd; but this being the expert Physitian or Chirur∣gion's parts to perform, I shall leave it wholly to them.

SECT. XXVI. When the Navil-string comes first.

DR. Now Mrs. Eutrapelia, I would know of you how you behave your self when you have a labor presented to you wherein the Childs Navil-string comes first?

Mid. Here Sir you must note, That an In∣fant doth not always present with the belly when the navil-string comes first; for though it presents naturally as to the Figure of its body, that is with its Head first, yet some∣times the Navil-string falls down and comes before it; for which cause the Child is in much danger of death, especially if the labor be not very quick, because the blood that ought to pass and repass, through those Ves∣sels which compose it, for to nourish and keep the Child alive, whilst it continues in the Womb, being coagulated hinders the circu∣lation which ought to be there made, which happens as well by the contusion, as the cold those Vessels receive, being much pressed in the passage when it comes together with the Head, or any other part; as also because the blood doth there coagulate as is said, by rea∣son

of the cold which it takes by the coming forth of the Navil-string.

But though this accident may cause the In∣fants sudden death, 'tis not so much for lack of nourishment; without which it may pass a whole day or more, there being blood e∣nough in its body for that purpose: but be∣cause the blood can be no longer enliven'd and renewed by circulation, as it hath conti∣nual need; which being obstructed always causeth the creatures sudden death, sooner or later according as it is more or less ob∣structed.

I know it may be objected that though the circulation be so hindred and intercepted by the coming forth of the string it need not therefore cause such a sudden death to the Child, because the blood may notwithstand∣ing circulate in all the other parts of the bo∣dy: To which I answer that in respect to the Infant 'tis either absolutely necessary that the blood, for want of respiration, should be elaborated or prepared, in the thick part of the burthen call'd the placenta, and there∣fore must be a free communication, or for want of it that the Infant must immediately breathe at the mouth, as well to be refreshed, as to drive out the fuliginous or sooty Va∣pors by expiration, which not being possible whilst in the Womb, it must unavoidably be

choaked, and dye in a very short time, if it wants both together.

Wherefore in this case the Woman must, without any delay, be deliver'd, the which if nature doth not speedily perform, the Child must be drawn forth by its feet.

Women that have great waters and along string to the burthen, are very subject to this mischief; for the waters coming forth in great abundance at the breaking of the skins, or membranes, do often at that instant, draw the string which swims in the midst, forth along with them; and much the easier if the Infants head be not advanced very forward into the passage, for to hinder the coming forth of it in this manner.

Assoon as 'tis perceived you must imme∣diately endeavor to put it back, to prevent the cooling of it, behind the Childs head, least it be bruised, as we have already noted, whereby the blood may coagulate there keep∣ing it in that place where it was thrust back, until the head being fully come forth into the passage may hinder the coming down of it again; which may be effected by holding it up with the fingers of one hand, on that side it comes down, untill the head be advanced as aforesaid; or in case the hand be taken away to put a piece of fine soft rag between the side of the head and the Womb, to stop up

the way it came down by, always leaving an end of the rag without the body to draw it forth by at pleasure.

But sometimes notwithstanding all these cautions and the putting of it back, it will for all that come forth every pain; and then with∣out any more delays at all the Midwife must bring the Child forth by the Feet, which she must make a diligent search and enquiry af∣ter, although the Infant comes with the head foremost; for there is but this only means left remaining to save the Childs life, which it would certainly lose by the least delay in such a case.

Wherefore having placed the Woman conveniently, let her gently put back the Head which offers, provided it be not engag∣ed too low amongst the bones of the passage, and that it may be done without too great violence to the Woman; for in that case it will be better to let the Child run the hazard of dying, than to destroy the Mother; for Tertullian, as my learned Mr. Riolanus very well observes, upon a like Subject, saith That it is a necessary cruelty, to kill the Child in such a case, rather then to save it from the danger it is in of dying, and so certainly cause the Mo∣thers death; and then let her slide up her hand, being well anointed, under the breast and belly to search for the Feet, by which she

must draw it forth according as hath been formerly discoursed; the which being per∣form'd let her immediately take care, of the Infant, which is ever in this case very fee∣ble.

SECT. XXVII. Wherein the Burthen either first offers it self or comes first quite forth.

DR. Very well, and excellently have you given us demonstrations of your skill and knowledge hitherto, good Mrs. Eutrape∣lia, now pray will you inform me how you act your part in a Labor wherein the burthen either first offers, or else comes first quite forth.

Mid. That I shall Sir to the best of my Talent and therefore first of all Sir I must note that the coming forth of the Navil-string before the Infant, whereof we dis∣coursed in our foregoing Section, is often∣times the cause of its death, for the reason there alleadged; but the coming forth of the burthen first, is yet much more dangerous; for that besides that the Children are then commonly Stil-born, if they be not assisted in the very instant, the Mother likewise is in great peril of her life also, because of her great floodings, which usually happen, when it is loosened from the Womb before its due

time; by reason that it leaves all the orifices of the Vessels, to which it did cleave, open, whence incessantly flows blood until the Child be born; by reason that the Womb, as long as any thing continues there, doth every moment strongly endeavour to expell it, by which means it continually voids and expresseth the blood of the Vessels, which are alwaies open (as we have already explained) when the burthen is so separated; as long as the Womb remains extended and cannot be closed, until it hath voided all that it did contain, and comes, by the contraction of its Membranous substance, to stop them by pres∣sing them together; wherefore if the Mid∣wife ought to be vigilent and diligent to suc∣cour an Infant when the Navil-string comes first, how much more ought she to be so when burthen comes forth first, and wherein the least delay is ever the cause of the Infants sudden death, if the Woman be not speedily delivered? because the Infant cannot then remain long in the Womb without being choaked or stifled, being it stands in need at that time of breathing at the mouth, (as we explain'd the foregoing discourse,) the blood being no longer enlivened by the preparation made in the burthen, the use and function of which then ceasing, from that very instant that it is separated from the Vessels of the

Womb, to which it was joined; for which reason there immediately follows a great fludding which is so dangerous for the Mo∣ther, that without speedy help, she quickly looseth her life by this unlucky accident.

Now when the Burthen is not wholly come forth but lies in the passage, some ad∣vise to put it back before the Child be fetch'd; but I am not of their opinion; for when it comes into the passage before the In∣fant; it is at that time totally divided from the Womb, at the bottom whereof it ought to be commonly situated and fastened, until the Child be born: but because as soon as it is wholly loosened, as it always is when it comes first, it becomes a body altogether un∣natural; therefore it is never to be thrust back, but contrarywise be fetch'd away, and at that very moment after bring the Child away by the Feet, although it came naturally with the Head first: for what reason can there be to put it back, since it is of no use to the Infant, from the moment it is separa∣ted from the Womb, as cannot be denied? And such a proceeding is so far from being useful, that this burthen would much hinder the Midwife from being able to turn the Child, as she ought, in bringing it forth by the Feet.

Wherefore when it presents it self in the passage, which may soon be perceived if the Midwife find every where a soft substance, without the least resistance of any solid part to the touch; and finding likewise the string fastned to the middle of it, and the Woman fludding extreamly as is ordinary at such times; then in lieu of thrusting it back, the burthen must be brought away, that so there may be the more liberty and room to draw forth the Child, according as hath been be∣fore directed.

The Burthen then being quite loosened from the womb, and coming first in the pas∣sage must not be thrust back again into it, much less must it be put back when it is quite come forth of the body. The midwife must only take care not to cut the string till the child be born, not out of hopes of any benefit from it to the Infant during the delivery, but that so much time may not be lost before the Infant be fetch away, which is then ever in great danger, as also the flooding may be the sooner stopt, which happens. for the most part as soon as the woman is delivered, for which reasons it will be dispatched with all possible speed.

Sometimes notwithstanding this dangerous accident the child may be born alive, if timely succoured, but it is then so weak that it is

hard to discover at first, whether it be alive or dead.

When it so happens some midwies do or∣dinarily, before they seperate the burthen, put it into a Skillet of hot wine, and imagine, with no small superstition, that in case it it comes to it self, the vapours of the warm wine was the cause of it, being conveyed by means of the string into the Infants belly, and so giving vigor; but it is more credible that be∣ing almost stifled for want of breathing as it needed it, it begins now, by means of it, to recover from that fainting: but nevertheless there may be no hurt in continuing the old custom, since it can do no perjudice, and may satisfie fine occupied Spirits, provided neces∣saries be not neglected, in being blindly car∣ried away with this conceit.

SECT. XXVIII. Figure the Thirteenth.

DR. There being the same reason in twins as in a single birth, except that the sin∣gle birth is natural, and the twins not so, certainly the same method must be observed (Mrs.) Tell me then, if there be two or more, and and all come fair with their heads toward the birth; What is to be done?

[illustration] depiction of twin babies in the womb in the natural position for birth: presentation of the head

Mid. Here, Sir, I must observe that which lyeth readiest and fittest in the Womb, and first receive that, and not to let the other go till the first is born, lest it turn into another shape by sliding back again into the Womb; but the one being born, I must presently lay hold on the other. Now, this birth will be easier, and without danger, because the first birth hath made the way for the second so plain, that it may come forth without any

difficulty at all. But in this birth I must take care that I bring forth the after-burden timely enough, lest that the Womb, being freed from her Infants, presently fall down, and so keep in the after-burden with great danger.

SECT. XXIX. Figure the Fourteenth.

DR. But, Mrs. What if there be Twins, and they both come unnaturally with their Feet forward, as in this Figure; what course will you take?

[illustration] depiction of twin babies in the womb in an unnatural position for birth: presentation of the feet

Mid. This birth, Sir, is dangerous enough and yet it is to be mended by the prudence of a discreet Midwife. Wherefore, I must anoint the womb of the woman, that the pas∣sages may be the easier for the Infant; which being done, I must take care to lay hold of the arms of one of them, and bringing them down to the sides, secure them so, that I may lightly promote the head to the birth; and the first being born, I must presently proceed with the other after the same manner: but if I can lay hold of neither of their arms, so that there is no good hopes of a happy birth, I must have recourse to the former method; if at least the Infants may come into the World by that pains and conversion which is wrought upon the bed.

SECT. XXX. Figure the Fifteenth.

DR. I come now to my last unnatural birth of Twins. If then there be Twins, (these forms being compound as of a natural and unnatural birth) the one come∣ing down with the Feet, what is to be done in this case?

[illustration] depiction of twin babies in the womb in an unnatural position for birth: presentation of one head and one foot together

Mid. Where Infants offer themselves af∣ter this manner; I must first bring forth that which presents it self with a natural form, and must move up the other which is with the Feet forward, and if possible, cause it so to return into the Womb, that that form al∣so may be disposed of to a natural birth; but if it cannot be turned to be in a better po∣sture, I must lay hold presently on the hands, and encourage it to the birth. But it were safer that this should be brought to a natural

form; to which end I must diligently endea∣vour it, by anointing, directing, moving it, tumbling and rouling the Woman, lest per∣haps the Womb be hurt by the form of such an unnatural birth, and the privities swell with wind, from whence the birth cannot come forth without danger, or be hindred too long: All which danger may with pro∣vident care be avoided, or at the least very much corrected and amended.

Dr. So far concerning your way and me∣thod of Labors wherein several Children in different postures present themselves toge∣ther; but now good Mrs. Eutrapelia, I would have you to hear a little what I have to offer you concerning these deliveries; and first of all be pleased to consider seriously with me, that if all those unnatural Figures and Situa∣tions which we have hitherto described, that a single Child may come in do cause those many difficulties, and dangers mentioned, certainly the Labor wherein several come to∣gether in those bad Situations must be much more painful, not only to the Mother and Children, but also to the Midwife, for they are then so pressing that for the most part they trouble and hinder one another; more∣over the Womb is so filled with them that the Midwife can scarce introduce her hand without much violence, which she must do if

they are to be turned or thrust back to the end that she may give them a better position then that wherein they present.

Where note then, that when a Woman hath 2 Children they do not ordinarily both present to the birth together, but one is of∣tentimes more forward then the other, which is the cause why but one is felt, and that 'tis sometimes not discovered that the Woman will have Twins, till going to fetch the after∣birth, the first being born, the 2 d is then per∣ceived.

When there are Twins Mrs. Eutrapelia one must not think that Nature is orderly in causing one to be born before the other, the first or last, according as it may be most con∣venient, that is to say when the one is strong and the other weak, that the strongest comes first; as also when one is dead and the other living, that the living one drives forth the dead one: for I can assure you there is no cer∣tain or infallible rule in these cases; of which I can give you an example; there were once 2 women deliver'd within a week of one ano∣ther, and both of Twins, the one of each be∣ing dead and the other living, the living Child of the first Woman was born before the dead one, and the dead one the 2d was expelled before the living one. And the same thing we see happens very often in respect of

strong and weak Children; for that which is nearest the birth whether alive or dead, strong or weak, is always the first born, or must be brought into the World the first, if it cannot come of it self; otherwise the difficulty of the Labor would yet be augmented as well in length of time to the Mother, as the violence done to the first Child, in putting it back, for to fetch the 2d first.

Now the Midwife must always remember to have a care in all natural births, to examine diligently whether there be no more Children in the Womb after the first is delivered, which she may easily know by the continuance of the pains after the Child is born, and the bigness of the Mothers belly; besides this she may be very sure of it, if she shall put her hand up the entry of the Womb, and shall there find another water a gathering, and a Child in it presenting to the passage; and if this shall be so, the Midwife is not to fetch away the after-birth till the Woman be de∣livered of all her Children, if she chance to have never so many, because Twins never have but one burthen, to which there are fastened as many strings and distinct Mem∣branes as there are Children, and if one should go to draw it forth as soon as the Birth is born, the rest would be in danger of their lives, because that part is very necessary to

them whilest they are in the Womb, and be∣sides more then that it endangers a flooding. Wherefore the first string must be cut, being first tyed with three or four double, and the other end must be fastened, with a string to the Womans thigh; not so much for fear that the string should enter again into the Womb, as to prevent the inconvenience it may cause to the Woman by hanging be∣tween her thighs; afterwards this Child be∣ing removed, the Midwife must take care to deliver her of the rest, observing all the same circumstances as were belonging to the first, the which being done it will be then conve∣nient and necessary to fetch away the After∣birth; as we shall discourse the manner how by and by.

SECT. XXXI. Figure the Sixteenth.

DR. Courteous Mrs. Eutrapelia, I have hitherto troubled you with many Questi∣ons, that I might not only be sure of your abilities, but also give testimony of your suf∣ficiency, if need require. I have now only one Question more, and then I have done, as to these postures and fashions: And this, though the last, surely is a miraculous pos∣ture. What if the Infant be so involved in the womb (the head and the neck being of such a length) that it is so bent back, that the face lyeth betwixt the buttocks, the right hand to the left region of the reins, but the left hand to the knee of the same side; the right legg being across the left, in form of the letter X, and both leggs bent up to∣ward the breast?

[illustration] depiction of the baby in the womb in an unnatural position for birth: deformed, doubled over and twisted

Mid. Worthy Dr. This case is the hard∣est of any that hitherto you have propounded to me; and though it may never fall out to be so in one amongnst 5000, yet (because, in your description of the best Midwife, you tell me that a Midwife must have a good memo∣ry) I remember a learned Doctor, not long since acquainted me with such a posture, which he told he had from the hands of an ex∣pert Chirurgeon and Physitian, whose wife

also was an expert Midwife; and the course the Midwifed took in such a case, he told me was this, which must serve also for my an∣swer, because I think there cannot be a bet∣ter. After the woman had been eight daies in labour, and given over by all Midwives as desperate, being in a violent Fever., with no throws, but very weak, and (by reason of hot medicines given to expel the birth, and strong wines given to support the spirits) those humors, that usually accompany the In∣fant had so flown out, that the genitals were so dry and closed, that they would scarce ad∣mit the probation of two fingers. This me∣thod was used: First, instead of wine, she gave her good store of Almond-milk; and be∣cause her belly was very costive, she gave her Clysters; and to keep up her spirits she gave her Cordials, (of which in their order.) She laid plaisters to her hands wrists, and anoin∣ted the whole region of the belly, hips, loins, the rump-bone, and privities with Oyles to ap∣pease her pain and with softning Unguents; and then she made a triangular bagg stuff'd with emollient and relaxing herbs, boyled in water, according to this description, (and of which more hereafter.)

[illustration] depiction of a triangular bag to be filled with emollient and relaxing herbs and applied to the genital area to ease childbirth

The description of the Bagg.

It was of such a bigness, as that it might cover the lower part of the bel•…•… and the pri∣vities, and with tapes fitted to the corners was applyed hot, and continued on some hours; after which, though her hand were well anointed, she could scarce thrust in the top of her finger into the orifice of the womb, the womb was so closed, and the Infant so de∣pressed toward the share-bone, by reason of

the precedent throws and pangs. But at length, when with much labour and industry the genitals were somewhat dilated, that she could get in her fingers farther, she found the loyns and the right hand of the child first of∣fer it self to the birth: that therefore she might correct this monstrous and so inverted posture of the Infant so doubled and twisted, and either perswade the head or the feet to come forward, she used the best of her skill, but to little purpose, the genitals were so nar∣row and streight. But yet not giving off her endeavours, she did deliver her within eight hours after she came to her assistance; but the child was dead.

Dr. Mrs. You give a very good account of an expert Midwives practice, which you may follow with safety, expecting the suc∣cess from Heaven; but it is no wonder the child should be still-born, (as you phrase it;) for being so turned and doubled, the child must of necessity be strangled in the womb.

Having t•…•…s run through births, as well natural as unnatural, I shall give you the rea∣son (and that in my own opinion) why these births are of so various and different postures in the womb, observing not alwaies the same posture: and 'tis because the Infant swiming in water, and moving it self, sometimes this way sometimes that way or moy'd by its mo∣ther

as you have heard before, is bent and tumbled several waies; insomuch, that some∣times it is strangely entangled with its own navil-cord, which I am confident you have seen in your own experience oftentimes, and shall now in the next place desire you to let me know which way you use to go to work, when a dead Child is to be delivered from its Mother and she alive.

SECT. XXXII. Of delivering of a Woman of a dead Child.

MId. Sir I shall most willingly consent to your demand, as far as I shall be able, in this always so long and dangerous a Labor; which is because for the most part it comes wrong; or though it comes right with the Head, yet the Womans pains are so weak and slow in these cases that she cannot bring it forth, and sometimes she hath none at all, forasmuch as nature, half overthrown by the death of the Child, which cannot help it self, labors so little, that many times it cannot fi∣nish the business it hath begun, but must yeild, without the help of art, of which at such a time it hath great need: However before ever I may settle to your work, I'll endeavor to stir up the Womans pains with strong and sharp clysters, to bring on her throws, and to bear down and bring forth the Child; and if these means prevail not she must then be delivered by the help of art.

Now if there be any case wherein a Mid∣wife ought to make the greatest reflection and

use most precaution in her Art it is this, that is to know whether the Infant in the Womb be living or dead; for there have been ma∣ny deplorable examples of Childrens being drawn forth alive, after they have been thought to have been dead, with both Arms or some other limb lopt off, and others mise∣rably kill'd by the use of crotchets which might have been born alive if they had not been mistaken: wherefore before the Mid∣wife resolves on the manner of laying the Woman, to avoid the like misfortune, and the disgrace of being author of such a pitiful spectacle let her do her utmost endeavour not to be so deceiv'd and to be wholly satisfied whether the Child be alive or dead; always remembring in this case that timidity is more pardonable then temerity, that is, it is bet∣ter to be deceived in treating a dead Infant, as if in case it were a live, then a living one as if it were dead.

Now besides what hath been said before concerning knowing whether the Child be alive or not; you must not always put your whole confidence, in the first place, in the Womans telling you that the Child is cer∣tainly alive because it stirs, and though to be the better assur'd the Midwife may lay her hand on the Mothers belly, for there have been Women sometimes delivered whose

Children had been dead about 4 days, as might be easily judged by their corruption, who notwithstanding have affirmed, though untruly, that they felt them stir but a little before they were delivered; and others a∣gain whose Children were alive, and yet their Mothers never perceived them to stir in three or 4 days before, as they confessed:

Now if the Midwife cannot be assured by the Childs motion that it is alive, she may assoon as the waters are broke, gently put up her hand into the Womb, to feel for the breaking of the Navil-string, the which she will find to be stronger, the nearer she feels it to the Infants belly; or if she meets with in hand she may feel the pulse; but their pulses, you must know are not so strong as their Navil-strings, therefore the best to be known by it; if then also by putting her fin∣ger into the Childs mouth she perceive it to stir its Tongue, as if it would suck; and on the contrary, if no such signs, and the Mother feel a great weight, and great pains in her belly, and it be not supported but tumbles always on the side she lays her self; if she faints and have Convulsion Fits, if the Navil-string or secondine hath been a good while in the World, and if the Midwife by putting her hand into the Womb, finds the Child cold, and feeling she finds that very soft,

chiefly towards the crown where likewise th•• bones are open, and riding one upon the o¦ther at the clefts, or Sutares, because th•• brain shrinks, which corrupts more in 2 day•• in the Womb, than it doth in 4 after it i•• born, which is caused by the heat and moist¦ness of the place, the 2 principals of corrup¦tion; and if there comes a dark and stinking putrid matter from the Womb; all thes•• signs together, or most of them demonstrat•• to the ingenious Midwife that the Child i•• assuredly dead; the which when she is cer¦tain of, she must do her endeavor to fetch i•• away as soon as possibly she can, and having placed the Woman conveniently, if th•• Child offers its head first, she must gently pu•• it back, until she hath liberty to introdu•…•… her hand wholly into the Womb, and sliding it all along under the belly to find the Feet▪ let her draw it forth by them, being ver•• careful to keep the head from being lock'•• in the passage, and that it be not separate•• from the body, which may easily happe•• when the Child being very rotten and putri∣fi'd, she doth not observe the circumstance•• that we spake of before, that is, in drawing forth the Child, to keep its breast and face always downwards; And if notwithstanding all these precautions, the head, because of the great putrefaction, should be separated and

left behind in the Womb; it must be left to be drawn forth by the expert Physitian or Chyrurgion. The same also is to be said when the Head is so far advanced coming first, and engaged among the bones of the passage, that it cannot be put back, then being very sure by all the signs together or most of the chief of them, that the Child is dead cer∣tainly, 'tis better to let the Surgeon draw it so forth, it being a round slippery part, with crotchets, then torment the Woman to put it back. Now if the dead Child (whereof above all there must be good assurance,) comes with its arms up to it shoulders so ex∣treamly swelled that the Woman must suffer too much violence to have it put back, 'tis best then, as was said before, to take it off at the shoulder joint, by twisting it 3 or 4 times about; then afterwards the Midwife will have more room to put up her hand into the Womb, the arm being so separated and no longer possessing the Womb, and so fetch away the Child by the Feet.

For indeed although it be certain that the Child be quite dead in the Womb, and other circumstances that will demonstrate that there is need of a Physitian or Surgeons Art, yet he must not therefore presently use his crotchets; because they are never to be used but when hands are not sufficient, and that

there is no other remedy to prevent the Wo∣mans danger, or to bring away the Child any other way: for very often, though all hath been done that art directs, some persons pre∣sent that understand not these things will be∣lieve that the Child was kill'd with the crot∣ches although it had been dead 3 days before, and without other reasonings and better un∣derstanding of the matter for his recompence, in saving the life of the Mother, requite him, with an accusation of which he is altogether innocent, and in case the Mother should af∣terwards dye, by misfortune, lay her death also to his charge, and instead of praise and thanks treat him like a Butcher, or Hang∣man; to which divers Midwifes are com∣monly very ready to contribute, and are the first that make the poor Women, that have need of the Men, afraid of them. Insomuch that they are afraid of being blamed by them for having themselves been the cause, (as some of them often are) of the death of In∣fants, and many ill accidents which often be∣fall the poor Women, for not causing them to be helped in due time, and from the very instant that they perceive the difficulty of the labor to pass their understandings. I speak this by way of caution on both sides.

Now therefore for the Physitian or Chi∣rurgion to avoid these calumnies, let him ne∣ver

use his crotchets, but very rarely when there is no other way; as also to endeavor his utmost, as much as the case will permit, to bring the Child whole into the World al∣though it be dead, and not by bits and peice-meals, to give the ignorant not any pretence of blame; I say as much as the case will per∣mit, that is, with respect to the Woman un∣der his hands; for to save her he had better sometimes to bring forth the Child with In∣struments, then to kill her, by tormenting her with excessive violence to bring it forth whole: for in a word, he must and ought to do, in his conscience, what his Art commands, with∣out taking heed to what may be spoken after∣wards: and every Physitian or Chirurgion that hath a well regulated conscience, will always have a greater regard to his duty, then his reputation, in such a case; in per∣forming of which let him expect his reward from God.

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.

SECT. XXXIV. Of the Secundine, or Afterburden, and the best and safest way to draw it forth.

DR. Come then, Mrs. if you please, tell me what the Secundine is.

Mid. The Secundine is that in which the Infant lyeth in the Womb, and may be call∣ed a second house, or covering, made by the Womb for a receptacle of the Infant; and it hath with it three membranes; but how Phy∣sitians name them, I know not.

Dr. I will inform you then, if you please, with their names and uses; and describe them to you in these two figures following, which are explained by letters also, as may appear.

[illustration] depiction of the secundine or afterbirth

The Explanation of the first Figures

• BBB Signifies that part of the Secundine called the Chorion, which is the prop of all the Vessels of the young one.
• CCC Denotes the branches of the Umbi∣lical Veins and Arteries dispersed through the Chorion.
• EEE The Membrane called Amnios, and is the thinnest of all the Membranes, and is white, soft, and shining, with few (and those very small) Veins and Arteries dispersed a∣mong the folds; and this is the very next coat to the Infant, and is the receptacle for sweat and Urine; that Membrane called Al∣lantois not to be found in men, though an Ʋrachus may be found.
• DD Denotes all the Vessels meeting about the Navil, by which the Infant is nourished.

[illustration] depiction of the newly born baby before the navel string, or umbilical cord, is cut

Chorion

Amnios

• P. Q Denotes the Membrane called Am∣nios, and is the first that involveth the In∣fant.
• RRRR The Liver, or cake of the womb, or after-burden, by which the Infant receives nourishment, and this is fastned to the Womb.
• SS The inward and outward Veins.
• m. m. m. The Umbilical vein, with its branches dispersed into the after-burden, by which the Child is nourished, and upon which it lyeth, as upon a pillow, though in the Am∣nios it swimeth as in a bath.
• VV How all the Vessels meet about the Navil.
• b.b.b Denotes the Infant newly born, an∣nexed to the secundine, the Navil-string not cut.

Dr. You see, Mrs. these Figures, with their uses and explanation; I shall now dis∣course more particularly of the membranes themselves. The after-burden, commonly called the secundine, is so named, either be∣cause it is as it were a second place, mansion,

and receptacle of the Infant from the Womb; or else, because this Membrane is called the after-birth, or second birth, as coming forth after the Infant, which, if it stay behind, brings great mischief, as shall be spoken to at the latter end of this Treatise and Secti∣on.

The first membrane is called Amnios, and this membrane covers the Infant from the head to foot; insomuch, that part of it sticks to the head of the Infant when it is born, which they call a helmet, though not always, being left behind with the secundine in diffi∣cult labours: this is so called from its soft∣ness and thinness; others resemble it to white Paper, or a shirt, and is the thinnest of all, in which is found great plenty of hu∣mors, caused of urine and sweat, in which the Infant swimeth as in a bath, and lyeth so easie and secure, lest it should fall foul against those neighbouring parts that are harder; and besides that, when the membrane is bro∣ken in the birth, this water breaking out, may make the passages by the neck of the Womb more plain and slippery for the In∣fant; and this membrane also is every where included within the second, which is called Chorion, because it wraps the Infant like a ring; and this immediately compasseth the former, to which it is joyned as it were in a

round figure, like to a cake, whose inward and hollow part it covers and involves, and doth extend it self to its dimensions, and can scarce be separated from it, but doth firmly knit and bear up the vessels of the afterbur∣den, which immediately sticks to the womb by a certain fleshy mass that is formed, being round, and of somewhat a ruddy colour, not compassing the whole infant, by reason of in∣numerous springs of veins and atteries by which the blood is interwoven, as if it were poured in, and by which the infant is nou∣rished. This towards the infant is smooth, but that part which is towards that fleshy round mass, is rougher.

This round fleshy substance is called the liver of the womb, or the cake of the womb; which, having such a substance as the liver hath, no wonder if it should make and pre∣pare blood for the nourishment of the infant. On that side towards the womb it is rough, and unequal, like clefts in a bak'd cake; and being cut in this part, it sheweth an infinite company of hairs, which, if you trace, they will bring you to the orifice of the veins themselves. And, although there be twins, or more, yet there is but one cake; for into one cake so many navil strings are inserted (in divers places) as there are young ones; though it may differ as to the bigness, accord∣ing

to the body and condition of the infant, yet the ground is still the same in the diame∣ter. This serves as a support of the umbili∣cal vessels, like a pillar; it is also called the secundine. The third is called Allantoides; 'tis a coat betwixt the Chorion and Amnios; 'tis very thin, weak, and narrow; it covers but half the young one: this is properly like a swathe or girdle; and some say it is the recep∣tacle of urine; but it being not to be found in mankind (there may be an Ʋrachus found instead of it) I say no more of it.

Dr. These are the opinions of Physitians, good Mrs. Eutrapelia that have written of these things; now if you please I will tell you candidly and freely what my opinion is con∣cerning these things.

As soon as the 2 seeds have been confused∣ly mixt and retained by conception, the Womb immediately after, by means of its heat, separates this Chaos, to make out there∣of the delineation and formation of all the parts, and begins to work upon these Seeds, which though to the sight they may appear of a like nature and uniforme, notwith∣standing in effect they contain many dissimi∣lar parts in them, which it separates and di∣stinguisheth one from another, inclosing the noblest, and on the outside the most glutinous, of which first are formed the Membranes, to

hinder the Spirits, wherewith the frothy Seeds abound, from being at that time dissipated, and afterwards to serve to contain the Infant and the waters therein, in the midst whereof it swims that they may not stream away.

Now as the Membranes of the Infant are the first part formed, so are they with the waters, the first that present themselves to the passage in time of labour, before the In∣fants head.

Concerning these Membranes and the de∣scriptions most Authors have made of them, I find them to be so dark therein that me∣thinks 'tis an hard matter to conceive them, as they are, by the explication they make of them: for in the first place they do not agree in the number of them, some accounting 3, as well for a Child as a Beast, to wit the Cho∣rion the Amnios and the Alantoides; Others accounting but 2, because there is no Alan∣toides in an humane fetus.

But if this matter shall be strictly examin∣ed, as hath been often done, there will never be found any more then 2, the which being so closely joyned the one to the other, they may be said to be but a double one, the which in∣deed may be divided and separated into 2, and this I will explain, to you and others, on such a manner, as may be best understood by such as are ignorant of this matter; For

there are many who think with Galen that these Membranes are separate and distant, the one from the other, and that the one sur∣rounds only the Infant, and the other receives the waters, the which are partly engendred from sweat, and partly from the Urine, as they imagine; and believe farther that these waters themselves are separated the one from the other, by these Membranes: the which is quite contrary, for they are joyned so close the one to the other, that they compose as it were but the same body and invelloper, the which serves as we have said, to contain the Infant with the waters, which are all of a na∣ture, and shut up in the Membranes, as I shall make appear in speaking of their original; but it matters not as to the truth after what manner this be explained, provided it may be understood as it is.

The outward part then of this Membrane or double covering, or involver, call it what you please, or if it be esteemed 2, the first Membrane presented without, is called Cho∣rion from the Greek word Chorein, which sig∣nifies to contain, because it immediately en∣virons the other, which is called Amnios, that is a little lamb, because 'tis to small and thin. Galen, in his 11th book of the use of the parts, calls the Burthen Chorion. But to ren∣der this more intelligible we shall take this

first Membrane for the Chorion, the which may again be separated into 2; though ef∣fectively it be but one. This Chorion is a little rough and unequal throughout the whole outside of it, in which many small captillary Vessels may be observed running quite round, as also many little strings by which it cleaves to every side of the Womb: but it is a little more smooth within, where it joyns every where, and unites with the Amnios, in such a manner, as it appears, as we said, but as one and the same Membrane. This Chorion covers the placenta and cleaves close to the fore part of it, which respects the Infant, by means of the interlacing of an in∣finity of Vessels, and 'tis also principally fast∣ned to the Womb by the whole circumfe∣rence of the placenta, in which part this Mem∣brane is a little thicker.

Then the Amnios, which is the 2d Mem∣brane is 3 times thinner then the Chorion, and is within very smooth, but not just so much where 'tis joyned to the Chorion, This Mem∣brane is so thin that 'tis quite transparent, and hath no Vessels in it, the which makes it so thin, as cannot be imagined without seing. This Amnios doth no ways touch the placenta, though it covers it, but it only lines all the inner part of the Chorion, which is between, and from which it may be wholly separated if it be done with care.

The better to conceive this as it is, and af∣ter what manner these Membranes are in the Womb, consider the composition of a foot-ball; imagining the leather which covers it to be the Womb of a pregnant Woman, and the bladder blown up with wind, within the foot-ball, to be this double Membrane of the Chorion and Amnois, in which are contained together the Child and the waters; and even as the outside of this bladder toucheth every where, because 'tis blown up, the leather of the foot-ball; so in like manner the Mem∣branes of the fetus are joyned on all sides to the Womb; except where the burthen cleaves to it, in which place it passeth above it.

As to the 3d or rather pretended Mem∣brane which Authors call Alantoides, and say 'tis like, a sausage or girdle which surrounds and clothes the Infant from the sword-like gristle to just below the flanks only; 'tis very certain there never was any such thing in any of those Animals whose dams have but one young at a time, no more then Women, as Sheep, Cows, Mares, Asses, nor any other for ought could ever be learned from many curious enquiries.

Sometimes Infants, at their birth, bring forth these Membranes upon their head, and then 'tis said they will be fortunate: which

is a mere kind of superstition, because it hap∣pens from the strength of their substance, so that they cannot break by the impulse of the waters, or the Womens throws in Labor, or because the passages being very large, and the Infant very little, it passeth easily without any violence: and in this respect they may be said to be fortunate, in being born so easi∣ly, and the mother also for being so speedily delivered: For in difficult Labors Children are never born with such caps, because be∣ing tormented and pressed in the passage, these Membranes are broken and remain still there.

Within the Infants Membranes, thus dis∣posed as I have said, are the Waters con∣tained, in the midst whereof it swims, and is seated; the original of which seems very incertain, if we regard the different opinions of Authors upon this subject, some will have them to be the Urine emptied out of the Bladder by the Ʋrachus, because they cannot find the true and easie way for it, and be∣cause their color and savor much resembles the Urine contained in the Bladder. But 'tis very certain that it cannot be so as they aver; because the Ʋrachus is not perforated in the fetus, and it comes not forth of the Navil; for the place where 'tis fastened, is always very like a small Lute-string, through

which it is most certain nothing can pass though never so subtile.

There are others also that will have these waters to be the Urine; but they are of an opinion that it passeth through the Yard whose passage is always open, and not by the Ʋrachus which is never hollow.

Now for my part as it appears to me, with more reason, and as indeed it is, these waters are only generated out of vaporous humidi∣ties, which sweat out and exhale continually out of the Infants body, and meeting these Membranes through which they cannot pass, because they are too thick and close, are turn∣ed into water, which is thus by little and lit∣tle collected, as well during the first months of Conception, the Child not yet quick, as all the remaining part of the time, after it is quick; for vapors pass forth and exhale out of all porous bodies that are hot and moist, as is that of an Embrio; and the reason is ve∣ry weak by which they maintain these wa∣ters to proceed from the Urine, because they are salt as the urine is; For sweat, tears, and other humors which distill and sweat out of the body are as well salt as the Urine; of which the Infant whilst it is in the Womb, cannot have much, no more then dung in the Guts; because it receives no nourishment at the mouth at that time, & that all its superflu∣ous

humors may easily pass away by transpi∣ration, through the substance of all the parts of its body, which is very tender; wherefore I cannot conceive any necessity to oblige them more to empty the Urine, which is in a small quantity in the Bladder, then the excrements which are in the Guts, which is not then done in any manner, but only after the Child is born. Bartholinus and others would have the Infant however to empty its Urine through its Yard, and that these waters pro∣ceed from thence; but there is a greater probability it should be vented by transpira∣tion; for before it is yet fully shaped and quick, there is notwithstanding found a pro∣portionable quantity of these waters to the bigness of its body: which makes it appear that it is then neither the Urine rendred by the Ʋrachus nor Yard, as all the World ima∣gine; and that which proves it more plainly is the example of some Children born with their Yards imperforated, who notwith∣standing have these waters, whilst in the Womb,

And here it must be observed that when there is more then one Child, they are never in the same Membrane, unless their bodies are joined together, which is rare and mon∣strous, but each have their Membranes and waters, apart.

Now these waters thus collected within these Membranes have divers very considera∣ble uses; First, They serve the Infant to move more easily, as it were by swiming from one side to the other, and that it may not hurt the Womb by its frequent motions in striking dry against it, which would cause great pain, and often excite to Abortion; and they serve also very much to facilitate its passage in the birth making the way very slippery, and by that means the orifice of the Womb being moistened is better widened and yielding when they break, just when the Child is ready to follow, or a little before: for else remaining dry it is born with greater difficulty and the Mother also more torment∣ed by it.

And now Mrs. Eutrap. having thus suffici∣ently as I hope, explained the Membranes of the fetus, and the waters contained in them. I think it may not be amiss to say something, in order of inquiring after the parts by which it is nourished whilst in the Womb: and and here Mrs. Eutrap. since, as was said in the beginning that it is only nourished by its Mothers blood; and that I am of opinion that big-bellied Women have none that is fair or good; provident nature hath formed the placenta to serve it for a Magazine, that it may always have sufficient, and be there

again elaborated and perfected, to render it more convenient for its nourishment; for without doubt so gross a blood as the Mo∣thers cannot possibly be converted into its substance, if it were not first purified in the placenta, which is afterwards sent to it by means of the umbelical veins and brought back, as we shall shew hereafter, by the Arte∣ries, which are the conduits of which the Navil-string is composed. We say then that the placenta is nothing but a spungy and fleshy mass somewhat like the substance of the spleen, woven and interlaced with an infi∣nite number of Veins and Arteries, which compose the greatest part of the body, made to receive the Mothers blood appointed for the Infants nourishment.

This mass is so called, because it resembles a cake, also it may be call'd the delivery, be∣cause being come forth after the Child is born the Woman is quite delivered of her burthen, it is also call'd the after-burthen, because it is as a 2d Labor, of which the Woman is not discharged till after the Child be born: some give it the name of liver of the Womb, be∣cause they say it serves as a liver, to prepare the blood appointed for the Infants nourish∣ment, and Laurentius calls it the sweet bread of the Womb, and appoints it the same use, as that of the lower belly, to wit for a rest

and support to the Vessels of the Navil which disperseth an infinite number of branches throughout all its substance.

Now this placenta is made of the menstru∣ous blood of the Mother, which flows into the Womb, by the accumulation of which it is formed; its shape is flat and round, about the bigness of a Trencher, and 2 fingers breadth thick about the middle, where the umbilical Vessels are fastened, but is thinner towards the edges. It is covered with the Chorion and Amnios on the side next the Infant, and on the other side 'tis joined and fastned to the bottom on the inside of the Womb; It is strongest fastned to the Womb (with its cir∣cumference) by the Chorion, which cleaves so close to it by the interlacings of an infinity of Vessels, which appear very large in its sur∣face, that it cannot be separated from it with∣out tearing its substance.

Though there be 2 or 3 Children in the Womb begot in the same act, they have usu∣ally but one common after-burthen, which hath as many Navil-strings as Children, which are notwithstanding separated from one another by their several Membranes, in each being the Children and waters: but if they be superfetations there will be as many burthens as Children; and as superfetations happen but rarely, so there are few Women

that have their burthens separated when they are delivered of several Children.

We scarce find any Creature but a Wo∣man that hath an Afterburthen, like this de∣scribed, and dischargeth it as useless as soon as the Child is born; for most other Animals cast forth nothing after their young, except the waters only and some slimes with the skins which surround them, and in lieu of this fleshy mass, those which, as a Woman, have but one at a time, have only some cotyle∣dones, or many spungy kernels joyn'd inward∣ly to the proper substance of their Womb, which terminates all the branches of the um∣belical Vessels of their Young; which Ker∣nels as I have often observed in cutting up Sheep, when they were not with young, are not bigger then hemp-seed; but when they were with young, they swell'd as big as one thumb, one bigger, and one lesser; and then they resembled the Figure of a round mush∣rome, on the outside, not yet spread after it's cut from its stalk; and to each of these ker∣nels, are fastned the branches of the umbili∣cal Vessels: however those that have more then one at a time, as Bitches, Rabbits, &c. have no kernels; instead of which each young hath in its celule a kind of particular placenta, which the dam eats as soon as she voids it, after she hath knawn off the umbili∣cal

Vessels that hold it. But these thing be∣ing fitter for Physitians and Chyrurgions to be contemplated on, I shall proceed no farther to discourse thereon; and shall only desire you to note, that those Vessels appointed for the nouriture of the fetus are bigger then they are in Men, because of their hollowness, and as soon as the Child is born, dry up, and that part of them which is without the belly falls off, and is separated close to the Navil 5 or 6 days after; for which reason they lose their first use, and begin after to degenerate into suspending ligaments, to wit, the vein into that of the liver, and the 2 Arteries serve to extend and sustain the bladder, by the side, where they are joined to it; the bot∣tom of which is yet suspended by the Ʋrachus, which comes not through the Navil, as hath been said, but remains so pendent all the rest of its life: and now Mrs. I come to know how you use to fetch away the after-burthen, with the string and when 'tis broken.

Mid. That I shall freely do Sir, withal my heart; and therefore Sir you must note that the afterbirth being a useless thing to the Woman when the Child is born, she must im∣mediately after be freed of that also; where∣fore as soon as the Child is born, before I do so much as tye or cut the Navil-string, lest the Womb close, I must without time loose∣ing

ease the Woman of this fleshy mass; To perform which having taken the string, I must wind it once or twice about one or 2 of her fingers of her left hand joyn'd together, the better to hold it, with which she may then draw it moderately, and with her right hand she may only take a single hold of it a∣bout the left, near the Privities, drawing like∣wise with that very gently, resting the while the fore finger of the same hand stretched forth along the string towards the entry of the sheath of the Womb, as may be seen in the annexed Figure, always observing, for the more facility, to draw it from the side where the burthen cleaves least, for in so do∣ing the rest will separate the better; as we see a card which is glewed to any thing is bet∣ter separated from the place where it begins to part then where it is close joyned. But above all things care must be had that it be not drawn forth with two much violence, lest breaking the string near the burthen, I be oblig'd to put up my whole hand into the Womb, to deliver the Woman; or that the Womb, to which it is very strongly fastned sometimes be not drawn forth with it; or a very great flooding be caus'd: wherefore for these reasons it shall be gently shaken and drawn forth by little and little, and to faci∣litate the better its expulsion, the Woman

may the whilst blow strongly into her hands shut, as one does into the mouth of a bottle, to know if it be broke; or put her finger into her Throat, as if she would cause vomiting, or strive as if she were going to stool; bear∣ing always down and holding her breath as she did to bring forth her Child; and if after all this I meet with difficulty, you may, if need be, after you know on which side it is seated, desire an experienced Nurse keeper to press the belly lightly with her flat hand, directing it gently downwards by way of chaffing, not too boistrously.

But if all this be in vain then I must direct my hand into the Womb; to separate it, as you shall hear anon.

Then I must consider if there be all, and take care that the least part remain not, not so much as the skirts, or any clods of blood; and this is the way to deliver a woman of her after-birth; but sometimes the Midwife by endeavouring it breaks the string by pulling too strongly, or because 'tis very weak; or else so putrified when the Child is dead that the least pull breaks it off close to the bur∣then, the which by that means is left behind in the Womb, or because it cleaves to strong∣ly, or the Woman is weak, and cannot ex∣pell it, being much tired by a long Labor, or because it was speedily drawn forth after La∣bor,

the Womb closeth so as it leaves it no passage, and cannot without much difficulty be dilated to fetch it away, because it remains dry after the natural slime and humidities are past: and seeing that if it remain behind 'tis capable of destroying the Woman, we must see to get it away as before, and if the Navil-string happen to break near the burthen, I must immediately introduce my hand into the Womb before it close, being anointed with oyl or fresh butter, to separate it from the Womb gently and draw it forth with the clods of blood that remain. When the Na∣vil string is not broken, it will easily conduct the hand, but when 'tis we have no longer this guide; wherefore I must be then very careful that I be not deceived in taking one part for another; as I once saw a Midwife pull the Womb near the inward orifice in lieu of the burthen.

Assoon then as I have introduced my hand into the Womb towards its bottom, I shall find the burthen which I shall know by a great number of little inequalities, which are al∣ways made there, by the roots of the umbili∣cal Vessels, on the side where they terminate, which makes it to be easily distinguished from the Womb; if it yet cleave to it, notwith∣standing 'tis then a little wrinkled and une∣ven; because its Membranes which were ve∣ry

much inlarged contract themselves imme∣diately after the Child and its waters which kept them extended are excluded, and they that are expert can easily judge of it.

Now if I find the burthen wholly loosen'd from the Womb, it will be easy to draw it forth, when I have got it into my hands, but if it cleaves, finding the side to which it sticks least, I must begin there to separate it gently, by putting some of my Fingers be∣twixt it and the Womb; continuing by lit∣tle and little to do so, till it be quite loose, and then draw it forth very carefully; ob∣serving the whilst, if it cannot be otherwise, rather to leave some part thereof behind, than to scrape or scratch the least part of the Womb, for fear of a flooding, inflammation, or Gangrene, which cause death; being also careful not to draw it forth, till it be wholly or the most part of it separated, for fear of drawing forth the Womb with it, and to pre∣serve it as whole as these cautions will per∣mit, because of shewing it to the company, that they may know I have performed my of∣fice well.

But if the Midwife shall not find the Womb open enough to direct her hand im∣mediately into it, let her presently anoint the Womans Privities with hogs grease then by little and little put up her hand, and let

the Woman contribute as before; but if for all this she cannot void the After-birth, to a∣void a greater mischief I must leave it to na∣ture, assisting her with remedies which sup∣purate: wherefore injections into the womb are proper, made of Mallows, Marsh-mallows, Pellitory of the Wall, and Linseed, in which is to be mixed a good quantity of Oil of Lil∣lies or fresh butter; and to hasten the work give her a strong Clyster, that so by the Mo∣tions to go to stool, it may cause it to be voided, as it hath arrived to many that have rendred it in the Bed-pan; and sometimes when they have least expected it.

At the same time, to prevent a Feaver or many other accidents which usually happen, she may be let blood in the Arm or Foot, ac∣cording as it shall be convenient; and strengthen'd, that the cadaverous vapors coming from the putrifaction of the burthen ascend not to the heart and noble parts, which must be done by good cordials often used, not such as are made of Treacle and Methri∣date, &c. for which no reason can be given, but their specific, or rather imaginary Facul∣ties, and are fitter to cause vomiting, then comfort the heart: But with true Cordials which are such as yield good nourishment, and at the same time comfort the stomach, without offending it, as those drugs do

which are only good for those that sell them.

Wherefore I must order her good broths and gellies; and to drink Orengade or Li∣monade, or to put some Syrup of Lemons in her refreshing Liquors; or if she be free from a Feaver a little wine and water mixed; which is the best and most natural of all Cor∣dials. Besides other remedies must be pro∣vided, according to the accidents that hap∣pen by reason of the staying behind of the burthen; always remembring to bring it a∣way as soon as possible, for as long as it stays in the Womb the woman feels great pains continually, almost like them before her Child was born; and until the whole be void∣ed, the pains will still be repeated although in vain, unless the matter be well disposed before; but the lesser the piece is of the re∣tained burthen, the more difficult 'tis many times to be expelled; because the impulse, the woman can make by helping her throws, are not so great, when the matter contained in the Womb is small, as when 'tis of a con∣siderable bigness; for then 'tis more strong∣ly thrust and compress'd; which is the rea∣son why a woman miscarries with greater difficulty then when brought to bed at her full time.

And here you must know there are divers Midwifes, who having broken the Navil-string as before said, leave their work im∣perfect; and commit the rest to nature's work; but very often the poor woman dyes, because of the great mischiefs which usually happen before the suppuration of the burthen so retained: The which to avoid when they meet with the like case, I would advise them to fetch it away, as I have directed: or if they find themselves uncapable to do it, be∣cause the hand must be put up into the Womb, which is more properly the work of a Physitian or Chyrurgion, expert in those cases; then let them immediately send for one, that so he may be able, before the Womb closeth to introduce his hand, for the longer 'tis deferr'd the more difficult will the work be.

Dr. Hitherto very well Mrs. Eutrap. have you exprest your knowledge and experience in your Art even from the first generation and formation of the Child in the Womb to the bringing of it safely forth into the world; But yet good Mrs. Eutrapelia, there are di∣vers Women that will many times be asking you your advice concerning other distempers that usually attend them, both before Child∣birth, as Barreness &c. and also after they are delivered of their Child, both inward and

outward, because their modesty prompts them, rather to come to you than to the Physitian or Chyrurgion; therefore I would have you to let me know how far your skill and knowledge extends as to these matters; because that if you should at any time be mistaken in your measures in the cure of any of those diseases, I shall freely and candidly assist you with the best of my directions to set all right and streight, as they say, and in good order.

Mid. Honoured Sir, I am so extreamly oblig'd to you, for this kind offer that I know not which way to express my acknowledg∣ment, and I shall most readily answer your request, and therefore shall first begin with a discourse of Barrenness.