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.

PART. III. Of Diseases and Symptoms happening to Women after Child-birth.

SECT. I. Of Remedies for the Brests and lower parts of the Belly of Women newly delivered, and how to draw back the Milk.

Mid. AS soon Sir as the Woman is deli∣ver'd, and burthen come away, I see that a fludding follow not its loosening, if not, apply presently a soft closure 5 or 6 double to the Womb, that done carry her to Bed, removing all foul Linnen, a little rai∣sing her Head and Body, putting down her Legs and Thighs with a small pillow if she

will, under her hands, lying on her back. Then the best thing under the Sun to give her is a good broth, and so leave her to sleep; waking apply this pultis over the bottom of her Belly and Privities, take 2 ounces of Oil of Sweet Almonds, 2 or 3 new laid Eggs, stir them together in a pipkin over hot Embers, when 'tis thick apply it indifferently warm, taking away the closures and clods of blood; renew this if need be after 5 or 6 hours, then make a decoction of Barley, Linseed and Chervil, or Marsh-Mallows and Violet leaves, adding an ounce of honey of Roses to a pint; and foment the bearing place Lukewarm 3 or 4 times a day, for the first 5 or 6 days: some use only milk; and others Barley wa∣ter. After 10 or 12 days fortifie the parts with a decoction of Province Roses, Plantan leaves and roots, and Smith's water. The 2d day use loose swaths with a large square bol∣ster, over the Belly, till the 8th day, taking it off; i'th mean time, often to anoint her Belly, if it be sore, with Oil of sweet Al∣monds, and St. John's wort mixt; then be∣gin to swaith her streighter.

If she will not be a Nurse, apply remedies to the Breasts to drive back the Milk; if she will Nurse them, keep her warm with soft clothes; and if you fear too much blood car∣rying

to them, anoint them with Oil of Ro∣ses and a little Vinegar beat together, and lay on fine Linnen dipt in't; let her not suck the Child the same day she's deliver'd, but stay 6 or 7 days.

In driving back the Milk some remedies hinder flowing of humors to the Breasts, o∣thers scatter, and, in part, dissolve the Milk therein. Of the first sort are the last oint∣ment, or unguentum populeon and unguentum al∣bum, equally mixt, spread upon Linnen, and applied. Of the 2d is a Pultis made of Lin∣seed, Fenugreek, Beans, and Vetches pow∣der'd, boiled with the decoction of Chervil, or Sage, with Honey and Saffron: some ap∣ply Honey only; others rub the Breasts with Honey, and lay on a red Cabbage leaf, a lit∣tle dryed, the stalks taken away; having great care she take not cold; and above all, pro∣cure ample voiding of the clensings, by keep∣ing the belly open, by Clysters provoking them; then the Milk will soon vanish.

SECT. II. Of Fludding after Child-birth.

OF that preceding Labor before: this blood now flows more abundantly, by how much 'tis hotter, or mov'd by a long and hard Labor, and the Wo∣man's full of blood; and besides what's said, note, sometimes this blood continu∣ing to flow, and remaining i'th bottom oth' Womb becomes clotted, which cau∣seth a new Flud, and continues by Fits, and i'th intervals there comes away some wheyishness of the imprison'd blood, which dissolves, and makes some ignorant People think the Flux is stop'd, tho it continue flowing within, wherein it stops only by the clotted blood, when which comes away it begins a fresh. This is a more dangerous accident then any can happen to one newly lay'd, which dispat∣ches her so soon, if in great quantity▪ that there's often scarce time to remedy it, so that you are immediately to apply remedies, both to stop, and turn back from

the places whence it flows; to which end if it be a false Conception, piece of the burthen, or clotted blood, use all di∣ligence to fetch them away, or cause them to be speedily expell'd; but if it flows and nothing remain, bleed her i'th Arm, not so much to empty the fulness, as to turn the course; lay her body equally flat, not raised, and keep quiet without turning from side to side: nor must the upper part of her Belly be swath'd or bolstered; keep her Chamber a little cool, and not too warm in Bed: All forbid Clysters lest they say, humors be cal'd down; but the contrary hath been expe∣rimentally found, that great fluddings have been stopt by pretty strong clensing ones.

But if for all this the Flud continues, then to the last Remedy, which is to lay her upon fresh Straw, with a single cloth upon it and no Quilt, applying cloths wet in Vinegar and water along her Loins, and if in the Winter a little warm; give every half hour a little strong broth, with a few spoonfuls of Gelly, and between whiles the yelk of a new laid Egg; give her not too much food at a

time; drinking red Wine with a little water wherein Iron hath been quenched; If all this prevail not she will be in dan∣ger of her life.

SECT. III. Of the bearing down and falling out of the Womb and Fundament of a Wo∣man newly layd.

ANd here I shall make 2 sorts of Bearing down, and 2 sorts of falling forth; which differ but in degree, for the first is when the Womb only bears down and comes not forth, the 2d when it comes out of the Body.

The first sort of bearing down, is when the full body of the Womb falls into the Neck, in such manner as putting up a Finger you may feel the Orifice very near; the 2d when the Womb being yet lower, one can clearly perceive this Orifice quite with∣out.

The falling out is twofold too; in one the Womb comes quite forth, but is not turn'd inside out, nor can its inside be seen, only its orifice; which appears at the end of a great fleshy Mass, which makes the body of

the Womb; and this is cal'd a falling forth of the Womb; the other is cal'd a perversion or turning inside out, most dangerous; for you may perceive all even and without any Orifice; and thus it seems to be only a great piece of bloody flesh, almost like a Mans Cod, which hangs between her Thighs; and that which is wonderful, in this case, is, the Womb, the infants house, goes forth at the Gate, which is the inner Orifice.

A loosening or breaking of the Cords cau∣ses the bearing down, which comes from hard Labor: who have many whites are sub∣ject to it, and heavy Children, Coughing, Sneezings, a fall, going in a Coach or Horse∣back, great lifts, burdens, lifting the Arms too high, and putting them over their head; looseness, great pains and needings, all which shake and thrust the Womb downwards, when with Child, and the cords being loose∣ned or broken cannot keep it up, so that a bearing down doth easily follow the Birth of a Child; but the most ordinary cause is vio∣lent travel when a Child cometh wrong, and cannot be born so, or hath too big an head, or the inner Orifice not enough opened, for the Womb is violently forced down, and yet the Child can't advance into the passage, be∣cause the cords are so rent or loosen'd; or

when the Secondine sticking close to the bot∣tom is pul'd away on a sudden, or too vio∣lently, and much sooner if putting up the hand, as when the String's broke, one pulls the body of the Womb instead of the After∣birth; but your directions will prevent this.

She feels a great weight at the bottom of her Belly, extream pain i'th Reins and Loins; and a bloodish moisture passes through this Mass of Flesh hanging between her Legs. A loosening may happen to all Women, a fall∣ing out but seldom, a perfect perversion never but upon or immediately after a delivery; because the inner Orifice is then almost as wide as its bottom; but not at other times; when closed there is no possibility of its turn∣ing inside out; how to remedy it, I have told you.

If she be young and disease new, easily ex∣pect a cure, for a loosening or falling out, but if she old, and of a long standing, 'tis so much the more incurable.

Here do two things. 1. reduce the Womb to its place. 2. strengthen it and keep it there; for the first, if it be quite out or turned, first make her render Urine, and give

a Clyster, if necessary to empty the Guts; then lay her on her back, her Hips raised a little higher than her Head, foment all with a little wine and water luke-warm, and with a soft rag put it up, wagging it little and lit∣tle from side to side; and if this be too pain∣ful anoint it with Oil of sweet Almonds, wiping off the Oil as much as may be after.

As to the keeping it in its place, and strengthening it after; let her keep in Bed on her back, her Hips a little raised, Legs something crossed, Thighs joined; but the best is to put a pessary up the neck of the Womb; the Figures of which you may see; some of the Figure of an Egg, of the length and bigness of the Womb's neck; but these are Subject to fall out, and so are not so con∣venient as those made of a piece of Cork; they are to be of a thick circular figure, like a small wreath, and peirc'd i'th middle with a pretty big hole; they must be cover'd with white wax, and pretty large, pull them out with a Finger to clear them; they may be made some round, others somewhat square, or trianguler, the corners must be blunted or rounded.

While the Lochia flow use nothing else to strengthen, and above all swath not her belly,

but only for a stay; for many Midwifes by a strong compression force it more down: use a Bed-pan, and ly along, if possible, when she goes to stool; keeping her hand all the while on the bottom of her Belly; but have∣ing cleansed well, then use astringent injecti∣ons, and respect must be had to the whole habit of body to dry up the humors by a course of Physick, and she must keep her Bed for 5 or 6 weeks.

Sometimes by the great throws she endures in Labor the fundament falls out; now if the Child be very forward i'th passage, 'twill be enough to hinder it if possible before it happens, perswading her not to help her throws so much; but if it be down, she must stay till the Child be born; for it will be dif∣ficult before without bruising the Gut, then reduce it as the Womb; giving no Clysters, for straining will cause it.

SECT. IV. Of the bruises and rents of the outward parts of the Womb, caused by La∣bors.

THese happen from the bigness of the Child's head, which makes her cry in her first-Labor, that the Midwife scratches those parts when 'tis the head makes a sepa∣ration of the parts, and bruises and somtimes rents them; of which they are not insensible after Labors. These must not be neglected least they turn to malignant Ulcers; then as soon as she's lay'd, if there be only simple bruises, apply the Pultis before directed, to those parts to ease pain, very warm for 5 or 6 hours, then lay some few rags dipt in Oil of St. John's wort, on each side, and renew∣ing them twice or thrice a day, foment with Barley water and Honey of Roses, and when she makes water defend them with fine rags.

If the bruises be great, and inflam'd, and an Impostume follows, it must be open'd and

cur'd by the Chyrurgeon; as also when by an unlucky accident the Privity and Fundament is rent in one; which when cur'd she will be oblig'd, if she happen to be with Child, to prevent the like, to anoint the parts with soft'ning Oils and Ointments, and forbear helping her throws too strongly at once; but usually when these parts have been once rent, 'tis very difficult to prevent the like, because the scar streightens the parts. Last∣ly if by neglecting such a rent, the Lips be cicatriz'd and the cure be desired; 'tis the Chyrurgeons business.

SECT. V. Of the After-pains.

IF these come from wind i'th Bowels, it runs from side to side, and sometimes to∣wards the Womb; to prevent this some give of Oil of sweet Almonds, and syrup of Mai∣den-hair, each 2 ounces, immediately after Child-birth; and to those that loath Oil I prefer warm broth, or caudle, and give a Clyster, and repeat it as need is; if it cease not thus 'tis maintained by some other cause.

If from some strange body i'th Womb, see to cast it out. If her clensings be suddenly stop'd, give Clysters to draw down; use hot foments to the bearing place; bleed i'th Foot, and if full, i'th Arm first: Rest alone, will fortifie and unite the stretching or breaking o'th Womb's cords; but never forget in all pains to mind the Lochia.

SECT. VI. Of the Lochia, whence they come, if good or bad, their stopping, and what ensues.

THere flows waterish humors from the Womb as soon as the Child is born, besides those before, when the Skins break which are often bloody, because mostly blood's mixt with them, but immediately af∣ter the burden is loosen'd there flows pure blood, but after the 1st day there comes wa∣terish humors, when the Vessels close; then they become thickish by heat, more or less as they come in greater or lesser quantity, and the length of time they stay there, and then they resemble troubled milk, which makes People believe 'tis Breast milk.

Now I believe the cause of their change of colour, consistance, and diminution of ••heir quantity, to be no other then that in ••he suppuration of a great wound; as soon ••s 'tis made it bleeds fresh, and much but ••fter it yeilds only bloodish humors, then a

white matter; so you must imagine there is a kind of wound made by loosening the bur∣den from the Womb, and what comes from it is the Lochia: so that they are not what hath stay'd in and about the Womb, during all the time of Child-bearing; for that's the Secundine; neither is their any certain rule for their quantity and continuance, being ac∣cording to the Season, Country, Age, Tem∣per more or less, hot, or moist, the habit more or less full, and Vessels remaining long or short time open: but 'tis finish'd com∣monly in 15 or 20 days; but after a mis∣chance the less the fetus is, and the less time she is gone with Child, the less are the Lo∣chia.

If they be fresh but the 3 or 4 first days they are good, else 'tis a pure bloody flux, which will be very dangerous; if of no ill scent, without sharpness, so we know the Womb's without inflammation or corruption, and if they flow in so great quantity as to cause Faintings or Convulsions she's in danger of death, or very much weaken'd, grows lean, and pale, Legs and Thighs swell, and be∣comes Dropsical.

The diseases ensue upon their stopping are almost innumerable, so that to bring

them down let her avoid all troubles of Spi∣rit, lye quiet, with her Head and Breast a lit∣tle rais'd; if Feaverish use only broths with a little gelly, above all shun cold drink; give Clysters, and foment her lower parts rub her Thighs and Legs downwards, and bath them too, and apply large Cupping-Glasses, to the uppermost part of the inside of her Thighs; bleed i'th Arm first; if very full of humors, for i'th Foot would draw too much to the Womb.

SECT. VII. Of the Inflammation &c. of the Womb.

THis is very dangerous, and the death of most; caused from the Lochia stopt, or bruise; by two hard swathes, falling out o'th Womb, &c. an Impostume or Cancer fol∣lows a bruise, if not death; wherefore tem∣per the heat and humors (first extracting or causing the expulsion of strange things re∣maining i'th Womb; using not the least violence) with Veal or Pullet broth, with Lettice, Purselan, Succory, Sorrel; abstain from Wine, keep quiet in Bed, with anodine Clysters, and bleed i'th Arm, not i'th Foot; reiterate it, because 'tis very pressing, till the greatest part of fulness be a little evacua∣ted, an inflammation diminished, then i'th Foot if need; injecting in the Womb Barley water with Oil of Violets, or milk. An A∣postume, Schyrrhus or Cancer is the Physiti∣ans or Chyrurgions work.

SECT. VIII. Of the Inflammation and Aposte∣mation of the Breasts.

THe Breasts being made of a spungy sub∣stance, easily receive in too great abun∣dance, the humors flowing to them from all parts by blood; being over-heat by throws and pains in travel, and so are soon inflam'd; being then painfully stretch'd; to which helps the suppression of the Lochia, and a fulness of the whole Body; or it may happen from having been too streight lac'd, some blow, or bruise by lying upon them, or for not give∣ing the Child milk.

Now convenient remedies are speedily to be applied lest dangerous symptoms fol∣low; wherefore the certainst means to hin∣der the Flux of so great quantity of blood to the Breasts, is to procure a large evacuation of the Lochia; the habit of the body is to be emptied by bleeding i'th the Arm; after i'th Foot; chasing into the breasts Oil of Roses and Vinegar beat together, laying upon them unguentum refrigerens Galeni, or unguentum al∣bum,

and a 3d part of populeon mixt, or a pultis of the setlings in a Cutler's Grinstone-trough, Oil of Roses and a little Vinegar mixt together. If the pain continue great, take the crums of white bread and milk with Oil of Roses and the yelks of raw Eggs, upon all these may compresses be laid dipt in Vi∣negar and water, or plantain water.

When you have emptied the greatest part of the humors, and the height of the Inflam∣mation is past, then draw the milk; or else, unless it be turn'd to matter, pure Honey laid to them resolves milk; or a Cabbage leaf anointed therewith being first a little wither'd and the hard stalks and veins taken away; lace not too streight, nor apply course clothes. A whole red Cabbage boil'd in Ri∣ver water to a pap, and well bruised in a wooden or Marble Mortar, and pulp'd through a Sieve, adding Oil of Comomil, is a very good pultis.

Let her dyet be cool, not very nourishing, keep her body open, lying on her Back in Bed, all the while; stir her Arms as little as may be, and after the 14th or 15th day of her delivery, being sufficiently cleansed, and in∣flammation abated, and no longer Feaverish, purge her once or twice; and if for all these

the swelling goes not down, but she feels great beating and pain, a hardness more in one place then another, of a livid color and soft i'th middle 'tis certain 'twill apostemate: then apply ripening Medicines, as a pultis of Mallows, Marsh-Mallows with their roots, Lilly roots and Linseed bruis'd, boil'd to pap, and pulp'd through a sieve, then add a good quantity of Hogs Grease or Basilicon, laying a little cloth thick spread with Basilicon upon the place where 'tis likely soonest to break, and the pultis all over it, renewing it 12 hours after, continuing till it be full ripe; then if it open not of it self, it must be open'd by a Lancet or Incision knife, which being the Chirurgeon's work, he is to do it.

SECT. IX. Of the curdling of the Milk in the Breasts.

BEcause her Body was much mov'd dure∣ing Labor; in the beginning of Child∣bed her Milk is not well purified, and is mixt with many other humors, which, if 01 they are then sent to the Breasts in too great quantity, cause an Inflammation, but when the Child hath suck'd 15 or 20, or more days, then only the Milk, without other mixture contain'd there; which sometimes curdles, and the Brests become hard and rugged, without any redness, and the separation of all the kernels fill'd with curdled Milk may easily be perceived; she finds a great pain, and cannot milk them; with a shivering, chiefly about the middle of her Back, like Ice; which is usually follow'd by a Feaver of 24 hours long, and sometimes less; if it do not turn in∣to an Inflammation of the Breasts, which it will undoubtedly do, if it be not em∣••ied, scater'd and dissolv'd.

This clodding comes mostly because the Breasts are not fully drawn; either for that she hath too much Milk; or the Child is too weak to such all, or because she doth not desire to be a Nurse: for the Milk staying in the Breasts looseth its sweetness, and by sowring curdles. This may also happen from taking cold, or not covering her Breasts.

The readiest and surest remedy, from what cause soever, is speedily to draw the Breasts, till they be empty'd, and if the Child cannot, because she is hard milched, let a Woman, till it comes freely, and then the Child will; and that she may not after breed more Milk then the Child can draw, let her dyet breed but little nourishment, and keep her body always open. But when she neither can nor will be Nurse, then her Breasts must not be drawn; for drawing more humors, the Disease will return, if not again emptied. Wherefore 'tis necessary to prevent come∣ing of any more Milk, and to scatter that which is there; by empting the fulness of the body by bleeding i'th Arm and Foot; and strong Clysters, and purging if need∣full; and to resolve the curdled Milk, ap∣ply

a pultis of pure Honey; or of pow∣der of Linseed, Fenugreek, Beans and Vet∣ches, boild in a decoction of Sage, Smal∣lage, Fennel, Milk, adding Oil of Camomil; anointing with the Oil first.

SECT. X. Of Choping &c. and loss of the Nipples.

WOmen are subject the first time to have their Niples chop'd, which is unsufferable, and the more if hard milch'd, as the first time, when the Milk hath not yet made way through the small holes of the Niples, which are not yet thorowly open'd, and then the Child takes more pains to suck; and sometimes these chops do so encrease by the Childs sucking, that the Niple's taken quite off the Breast, and there rests an Ulcer very hard to be cur'd. This may happen from the Childs being so dry and hungry that it hath not patience to suck softly, but finding the Milk not speedily to follow as they de∣sire, bite and pinch the Niple so hard that it becomes raw, and at last take it quite away. This happens also when Infants have hot mouths, or thrushes, or the pox soonest.

These must not be neglected, as well be∣cause of the great pain, as to avoid their growing worse and worse. Therefore as

soon as they begin forbear giving suck, keep∣ing back her milk for a small time; and if but one Niple be sore, she may suckle with the other; Applying Allum or Lime-water, or only bath them with Plantain water, put∣ing soft rags dipt in any of them or a ceruse plaister, or Diapompholigos, or a little starch powdred; but chiefly take care that nothing be apply'd to distate the Child; wherefore many use only Honey of Roses. Softening remedies are fit to preserve from chops, but when they are already made, dryers are best, and to prevent her from hurts in these parts, and that the rags may not stick to them, put upon them a little Wax, or wooden caps, or leaden ones, they being more drying, like these in the Figure; having several small holes on their tops, as well to give issue to the matter, as that the Milk may pass away.

If the Nipples are wholly suck'd off, then dry the Milk up; and if the Child have the pox, put it to another who must use preser∣vatives against it: but if they be only small, simple Ulcers i'th Mouth without any Ma∣lignity, wash them only with Barley water with a little juice of Citrons or Lemons; and let the Nurse use a cooling dyet, and bleed and purge if necessary.

The Child can take no hold when the Nipples are quite gone, and the small holes are closed up; but if she shall desire to give suck, let Woman by degrees make her new Nipples (after the Ulcer's perfectly heal'd) and unstop the root of the old ones: or using an Instrument of Glass, as in the Figure, she may suck them her self 5 or 6 times a day; and to preserve them, and shape them, thus drawn out, from sinking into the Breasts a∣gain, let her put a small cap upon them as before, and so by degrees she may give suck again.

Dr. Thus far good Mrs. Eutrapelia, have you expressed your self very knowingly in your Art, as to what we have hitherto treat∣ed of concerning Women; there now re∣mains something that I would be satisfied of how far your skill consists in, and that is con∣cerning the Diseases of little Children; be∣cause you coming often to visit the Mother, if any thing be a miss about her Infant, it is a common custome to desire the advice of the Midwife in such cases, rather then run presently to the Physitian or Chirurgion. But first let me hear your opinion about the choice of a Nurse.

Mid. Sir as I have been very happy to have satisfied you to the best of my know∣ledge in what concerns Women, before, in, and after their Lying in Child-bed; so like∣wise shall I answer your request as to what concerns little Children and the Distempers and Symptoms happening to them, and first of the nature and qualities of the Nurse; and if the Mother be the fittest Nurse?