Early English Books Online 2 All Digital Collections spacer Login Home Search Browse Bookbag Help The diseases of women with child, and in child-bed:: as also, the best directions how to help them in natural and unnatural labours. : With fit remedies for the several indispositions of new-born babes. : Illustrated with divers fair figures, newly and very correctly engraven in copper. : A work much more perfect than any yet extant in English: being very necessary for all chirurgeons and midwives that practise this art. Mauriceau, François, 1637-1709., Chamberlen, Hugh. Table of contents | Add to bookbag | How to cite Page [unnumbered] Page [unnumbered] THE DISEASES OF VVomen with Child, AND In Child-bed: AS ALSO, The best Directions how to help them in Natural and Unnatural Labours. With fit Remedies for the several Indis∣positions of New-born Babes. Illustrated with divers fair Figures, newly and very correctly engraven in Copper. A Work much more perfect than any yet extant in English: being very necessary for all Chirur∣geons and Midwives that practise this Art. Written in French by FRANCIS MAƲRICEAƲ. Translated, and enlarged with some Marginal-Notes, by HƲGH CHAMBERLEN, M. D. and Physician in Ordinary to his Majesty. LONDON, Printed by John Darby in St. Bartholomew-Close; to be sold by R. Clavel in Cross-keys-Court, and W Cooper at the Pelican in Little-Britain; by Benj. Billingsly at the Printing-Press in Cornhil near the Royal Exchange, and W. Cadman at the Popes-head in the lower Walk of the New-Exchange. 1672. Page [unnumbered] Page [unnumbered] The Author's Epistle Dedicatory. To all my dear Brethren, the Sworn Ma∣ster-Chirurgeons of the City of Paris. GENTLEMEN, HAving need of a firm and so∣lid Prop for the weakness of my Conceptions, I shall imitate most Authors, who ordinarily choose the pro∣tection of some Person of Credit, under whose Names they publish their Works to the World: But I shall not follow the custom of many, who dedi∣cate them for the most part to persons who have no manner of knowledge of the mat∣ter of which they treat; induced thereto, rather in hopes of some mercinary recom∣pence, than any other motive. This is, Gentlemen, that which obligeth me to ad∣dress my self to you (as to those who alone are fit Judges of it) and to offer you the Page [unnumbered] first fruits of my Labours, which might run the hazard of being gnawed by the Worm of Envy, if not put into your hands to protect. I offer it to you, in acknow∣ledgment of the honour you did me, when some time since you received me into your famous Company; and to acquit my self of the Obligation I owed you: for, being a Member of your Body, all my pains ought to be for you. This is the reason why I could not present it to any other person, without being guilty of a domestick larci∣ny. By giving it you, I am liberal of your proper Goods; or rather I render you an account only of the Talent you entrusted me with to improve: I mean the true Pre∣cepts of this noble Art of Chirurgery, of which you have a knowledge and experi∣ence so perfect, that every one is obliged openly to confess, that you are alone, a∣mongst all the Chirurgeons of Europe, of whom it may be justly said, Vos Sol, alios umbra regit. I shall refrain, Gentlemen, to praise you upon this subject; for (besides that it de∣serves a Pen more able than mine, to ac∣quit it self according to your merits) I may fear, that I should be silenced by such, as would alledge to me for so doing, that Page [unnumbered] with which he once was reproached, who undertook to praise Hercules in publishing his Heroick Actions to the People of Lace∣demonia: Who (an•wered one) is he that knows him not? 〈◊〉•…th not esteem him to be in the number of the immortal Gods? So like∣wise may it be said to me; Who is he that knoweth not the Master-Chirurgeons of Paris Is it not manifest that you are that fruitful Spring, to which they come from all places of Europe to draw the per∣fection of so fair an Art? and whither many Princes and Princesses of strange Countries are obliged to have recourse for the preservation and recovery of their health, which they believe cannot be ob∣tained so easily, and with so much assurance from any other as from you? Is it not known likewise, that our puissant Monarch hath this many years entrusted wholly his Sacred Person into the hands of him, who through his merits is at present the Head of your illustrious Body? Neither can it be forgotten, that this great King did, through a fatherly goodness which he had for the preservation of all the Nobility, that ac∣companied him the last year in his Con∣quests in Flanders, command three or four of you to stanch the blood which was spilt Page [unnumbered] before that mighty City de L'Isle, which he brought under his obedience? Was it not then seen, how divers persons of great quality (who were mortally wounded in signalizing themselves at the Attaque of that strong Place) seem'd wholly reviv'd at the instant they received the news of the arrival of these excellent Chirurgeons, upon the confidence they had to receive from them a speedy and a certain help? One might at the same time likewise per∣ceive the Generosity of others extraordi∣narily augmented through the Confidence they had in their safe hands. Let us there∣fore treat no longer of that, of which none are ignorant; but rather make some few reflections on your Charity (which renders you every-where so famous) in assisting gratis with your sage and prudent Counsels an infinity of Sick, who meet from all parts at St. Come, the first Monday of every Month in the year, to consult with you upon ma∣ny Diseases, to all others (except you) incurable; despairing ever to obtain a cure for their Maladies, if it do not descend from your famous Magazine. This Cha∣rity also plainly appears in the Instruction you bestow gratis upon all Students in Chi∣rurgery, appointing some from amongst Page [unnumbered] you, to make them Demonstrations in Anatomy, and teach them the true Me∣thod how well to perform all the Opera∣tions of Chirurgery; of which Commission I have had the honour to acquit my self, as well as it was possible for me, during three years, in pursuance of the Order you gave me to that purpose: But (since in those Exercises, so ordered by you, we do not usually discourse of Women with Child, nor of their different Labours) I have thought, that, to discharge my self intirely of my duty, you will not judge a∣miss, my publishing this Book to the world, which I present you; in which I endeavour to demonstrate exactly the means of re∣medying many Indispositions of Women with Child and in Childbed, with an exact Method of well-practising the Art of Mid∣wifery, being perswaded that it may be very profitable to many young Chirurge∣ons, who live in the Country, where but very few sufficiently instructed in all things necessary to be known, can be met with; I have also the rather undertaken this, that the Midwives may finde in it that which they ought to know, to enable them the better to exercise their Ar, and under∣go Page [unnumbered] the Examination, which at present they are obliged to before you for their Recep∣tion: I hope likewise (Gentlemen) you will have the goodness to excuse it, though it hath not so fair a form as the matter requires, and though I do not express the contents so perfectly as you conceive them; for I have (I confess with a little too much confidence) undertaken to open divers secrets of Nature, which (being very abstruse, and as difficult to be com∣prehended) create yet incomparably more trouble to explain them significantly, to be well understood: notwithstanding, as it is often seen, that a dark body reflects the light which it receives; so likewise I hope, that this small Work may (by the reflection of the Sun of your Doctrine, of which I have received many rayes) en∣lighten the young Chirurgeons and Mid∣wives in the difficulties which they often meet with at Labours. Accept then (Gentlemen) this small Production of one of your Children, who conjures you, by the love of Fathers, (that never disown their Children, how deformed soever) to defend it against En∣vy Page [unnumbered] and Detraction, which will never dare to attaque it, when you have vouch∣safed it your Protection; which is the Favour desired from you by (Gentlemen) Your very affectionate Brother, and Companion, Francis Mauriceau. Page [unnumbered] The Approbation of the four Sworn Pro∣vosts and Wardens of the Master-Chirurgeons of Paris. VVEE under-written, Sworn Pro∣vosts and Wardens of the Ma∣ster-Chirurgeons of the City of Paris, do certifie that we have seen and examined a Book, composed by FRANCIS MAU∣RICEAU, sworn Master-Chirurgeon of Paris, intituled, The Diseases of Women with Child, and in Child-bed; With a true Method of assisting them in their natural La∣bours; and the means of remedying all those contrary to Nature; and the Diseases of In∣fants new-born: Likewise an exact Descrip∣tion of all the Parts of a Woman destin'd to generation; together with many Figures sui∣table to the subject. Which Book We e∣steem very profitable for the Publick, and necessary for young Chirurgeons, and all Midwives, to learn perfectly the practice of the Art of Deliveries: in confirmation of which we have signed this present Cer∣tificate. Paris the 15th of March, 1668. Le Filastre. Vivien. L'Escot. L'Eaulte. Page [unnumbered] An Extract of the Kings Priviledge. BY the Grace and Priviledge of the King, given at St. Germans the 10th day of June 1668. signed Le Gross, it is granted to Francis Mauriceau, sworn Ma∣ster-Chirurgeon of Paris, to print, sell and distribute, by such Printers and Booksellers as he shall think good, a Book, composed by him, entituled, The Diseases of Women with Child, and in Childbed, &c. With ex∣press Injunction and Prohibition to all persons of what quality or condition so∣ever, not to print the said Book; nor to sell, nor vend any other Impression than this which the said Mauriceau hath caused to be made, or such as he hath autho∣rized; nor likewise, to copy or counter∣feit any of the Figures of the said Book for the space of Ten years, commencing from the time that the Impression shall be compleated, Upon pain of Confiscation of the Counterfeit Copies, and of 300 l. and reimbursing all charges and damages whatsoever, as it is more amply recited in the said Priviledge, of which this pre∣sent Extract shall serve for sufficient no∣tice. Page [unnumbered] The Author to the Reader. Friendly Reader, SInce in the Age we live in, we see, that most people are govern'd ra∣ther by Opinion than Judgment, I desire, that, if you mean to profit by reading my Book, you will reade and examine it without any critical Envy, and free from all sort of preoccupation, which may obscure your Judgment, and hinder you from acknowledging the Truth of those Things I pretend to teach. There∣fore be not of their humour who condemn a Conception when they understand it not; and believe it false, because 'tis new; nei∣ther imitate such, who seeking alone to carp at words, neglect the sense of the Dis∣course: For, even as it happens very of∣ten, that Purging, though proper for a Disease, doth no good to a Patient, when his Body is not well prepared, and dispo∣sed for its Operation: so the Doctrine of Page [unnumbered] Books, which is one of the most whol∣som effectual Remedies we have to chase away ignorance, is wholly useless to mens wits, if they are not disposed to receive it. I believe I may hope you will easily grant me this request, because it is for your advantage: In the mean time, though I design to instruct you here in whatsoever concerns Women with Child, or in Labour, yet I would not divert you from reading of many learned Authors who have treated of it, but only advise you that the most part of them, having never practised the Art they undertake to teach, resemble (in my opinion) those Geographers, who give us the description of many Countries which they never saw, and (as they imagine) a perfect ac∣compt of them; which makes it very difficult (not to say impossible) they should ever obtain their end: For it is certain (as Plutarch hath very well noted) that the speculative part of Arts is im∣profitable, and unfruitful, when destitute of the practice. You may then, as to this subject, relye on the Method I show you, since, to conduct you in it, I faithfully recite what I have with very happy suc∣cess Page [unnumbered] observed these many years in the practice of Deliveries. Furthermore, blame me not for being of a Judgement different from the com∣mon opinion of many; for I declare I have only bound my self to acquaint you with the truth, of which, I hope, you will have more Satisfaction, and be better pleased, than if I had always blindly fol∣lowed the thoughts of others; having likewise endeavoured, not to extend my self in superfluous discourse, to the end I might be more intelligible to yong Chirur∣geons, and Midwives, to whom this Book (if I be not mistaken) will be as usefull as any, to teach them the safe practice of the Art of Deliveries. I have not stuft it with a great number of long Receipts, which serve only to swell a Volumn, and confound their Wits in the uncertainty of the choice of so many different Reme∣dies, composed of Drugs which very of∣ten are unknown to them; but singly contented my self to teach them the best, and principally such as we ordinarily use in our practice. But if in all this you find some of my Opinions not wholly Sa∣tisfactory, or that others (according to Page [unnumbered] your Opinion) are not fully agreeing with the Truth; remember, that as amidst the best Corn, there alwayes spring Tares, or some other Weeds; so in like manner you meet with few Books, whose doctrine is so pure, as not to find something in them to reject: and if I may hope for any respect from you in recompence of my pains, it will be but proportionable to what you may have for many others, who never had, in this occasion, a greater desire than my self to render you service. F. M. Page [unnumbered] The Translator to the Reader. Courteous Reader, HAving long observed the great want of neces∣sary directions how to govern Women with Child and in Childbed, and also how new-born Babes should be well ordered, I designed a small Manual to that purpose, but •…ing sometime after in France with this Treatise of Mauriceau, (which, in my opinion, far exceeds all former Au∣thors, especially Culpeper, Sharp, Speculum Matricis, Sermon, &c. being less erronious, and inriched with divers new Observations) I changed my resolution into that of translating him; whom I need not much com∣mend, because he is fortified with the approbation of the Wardens of the Chirurgeons Company of Paris. His Anatomy, at the beginning of the Book, I have omitted, there being already severall in English; as also here and there a passage that might offend a chast English Eye; and being not absolutely necessary to our purpose: the rest I have, as carefully as I could, rendred into English for the benefit of our Midwives; some of whom may yet very well admit of an additional Knowledge. The principal thing worthy their obser∣vation in this Book, is, accurately to discover what is properly their work, and, when it is necessary to send for advice and assistance, that so, many Women and Children may be preserved, that now perish for Page [unnumbered] want of seasonable help. My Author marks out the breaking of the right Waters, for the proper season of a naturall Delivery, and (when ever a Child is not born thou, or soon after) Nature is so much short of performing her office. This is certainly a great truth; and all wrong births should never be longer delaied; and for the most part Floodings and Convulsions not so long, lest the Woman lose her life before ever the Wa∣ter breaks: but if no dangerous Accident intervene, in a right labour, one may lengthen out their expecta∣tion to 12 hours after; and, though some may have been happily delivered 24 hours, or two dayes after, yet should I not advise any to run that hazard, pro∣vided they can have an expert Physician to deliver them, without destroying the Child; because many have perished in that case; and it is not prudent to venture, where but one of many escapes: for the lon∣ger the Labour continues after the Watters are broke, the weaker both Woman and Child grow, and the drier her bodie, which renders the birth the more difficult; and 'tis over good taking time by the fo•e•…p. And that Midwifes skill is certainly the greatest, and she deserves most commendation, who can soonest discover the success of the Labour, and accordingly ei∣ther wait with patience, or timely send for advice and help. Nor can it be so great a discredit to a Midwife (let some of them imagine what they please) to have a Woman or Child saved by a Man's assistance, as to suffer either to die under her own hand, although de∣livered: for, that Midwife mistakes her office, that thinks she hath performed it, if she do but lay the Wo∣man; because her principal duty is to take care that she and her Child be well, with safety and convenient speed parted; and, if this be impossible for her, and Page [unnumbered] feasible by another, it will justifie her more to wave her imaginary Reputation, and to send for help to save the Woman and Child, than to let any perish, when possibly to be prevented; As in the case of my Author's Sister in the 20th Chapter of his first Book. Yet, in Coun∣tries and places, where help and good advice is not sea∣sonably to be had, Midwives are compelled to do their best, as God shall enable them; which dangerous and uncertain tryals would not become them to put in practice upon Women, where no timely assistance need be wanting. Most wrong Births, with or without pain; all Floodings with Clods, though little or no pain, whe∣ther at full time, or not: all Convulsions; and many first Labours; and some others, though the Child be right, if little or no pain, after the breaking of the Waters, and the Child's not following them in some six or ten houres after, requires the good advice of, and, peradventure speedy delivery by those Physicians that are expert in this practice: for, though some few may escape in these cases, yet far the greater number would perish, if not aided by them. And let me therefore advise good Women, not to be too ready to blame those Midwives skill, who are not backward in dangerous cases to desire advice; lest it cost them dear by discouraging them, and forcing them to presume beyond their knowledge, or strength especially, there being already but too-too-many over confident. Those few things wherein I dissent from my Author, if of dangerous consequence, I note in the Margent; if not, I passe it by, leaving it to the election of the Reader. I must confess he is in many places too prolix; a fault that many of the French affect; however, I chose rather to translate him according to his own stile, Page [unnumbered] than contract him; and also to leave unaltered some things not very well expressed, being of no great mo∣ment. I find also that he doth not distinguish between the words Plaister and Ointment, but useth them pro∣miscuously one for the other. In the 17 Chap. of the second Book, my Author ju∣stifies the fastning Hooks in the head of a Child in a difficult Labour, where it comes right; which I confesse hath been and is the practice of the most ex∣pert Artists in Midwifry, not onely in England, but throughout Europe; and hath very much caused the report, that where a man comes, one or both must neces∣sarily dye; and makes many for that reason forbear sending, untill either be dead or dying. But I can by no means approve of that practice, or those de∣laies; because my Father, Brothers, and my Self, [though none else in Europe that I know] have by Gods blessing, and our industry, attained to, and long practised a way to deliver a Women in this case with∣out any prejudice to her or her Infant; though all o∣thers, (being reduced, for want of such an expedient, to imploy the common way) do, and must endanger, if not destroy one or both, by the use of these Crochets. By this manuell operation we can also both shorten the time, and lessen the number of pains in a right Labour, (if there be the least difficulty) without danger, and with advantage to both Woman and Child. If there∣fore the use of Hooks by Physicians and Chirurgeons, be condemned (without thereto necessitated through some monstrous birth) we can much lesse approve of a Midwifes using them, as some here in England boast they do; which rash presumption, in France would call them in question for their lives. Page [unnumbered] In the 15th Chapter of this Book my Author pro∣poseth the conveying sharp Instruments into the womb, to extract a head; which is a dangerous operation, and may be much better done by our fore-mentioned Art, as also the inconvenience and hazard of a Child dying thereby prevented, which he supposeth in the 27th Chapter of this 2d Book. I will now take leave to offer an Apology for not publishing the secret I mention we have to extract Children without hooks, where other Artists use them, which is, that there being my Father and two Bro∣thers living, that practise this Art, I cannot esteem it my own to dispose of, nor publish it without injury to them; and think I have not been unserviceable to my Country, although I do but inform them that the fore∣mentioned three persons of our family and my self, can serve them in these extremities with greater safety than others. The Reader also may please to know that some ex∣planations in the Margent, as lovingly, p. 6. and untimely, & unseasonably, p. 22. with some others, were never intended to have been inserted, but left for the Printer to make choice of the most familiar of them, which (he mistaking) was, to prevent further trouble, suffered to be so printed. I do not intend this work to incourage any to pra∣ctise by it, who were not bred up to it; for it will hardly make a Midwife, though it may easily mend a bad one. Yet notwithstanding I do recommend it to the perusall of all such women as are carefull of their own Page [unnumbered] and their friends safeties, there being many things in it worthy their noting: And designing it chiefly for the female sex, I have not troubled my self to oppose or comment upon any Physical or Philosophical Position my Author proposeth. I hope no good Midwives will blame me or my Author for reprehending the fault of bad ones, who are onely aimed at, and admonished in this work; and I am confident none but the guilty will be concerned, and take it to themselves, which I desire they may, and amend. Farewell. Hugh Chamberlen. From my House in Prujeans-Court in the Old-Baily, London, this 15th of May, 1672. Page [unnumbered] ERRATA. PAge 8. line 8. for Intestin, read Intestinum. Pag. 13. lin. 1. r. such as. P. 19. l. 3. f. upper parts, r. Nipples. l. 19. r. Womb is free. P. 58. l. ult. r. that miscarried. P. 63. l. 24. r. Hypogaster. P. 95. l. 9. r. Corroberatives. P. 96. l. 4. r. a Wafer will be very fit. P. 101. l. 18. f. Iorn, r. Iron. P. 132. l. 11. the Comma behind together, must be before it. P. 133. l. 15. f. the, r. a. l. 28. f. which it yet does, r. as it also doth. P. 213. l. 1. f. capable, r. able. P. 224. l. 24. f. marked D. r. C. and the same in pag. 236. l. 9. P. 287. l. 1. f. an, r. a. P. 301. l. 3. f. brannes, r. meales. P. 430. r. CHAP. XXXVI. l. 24. r. requisite. Books newly printed. Aurora Chymica: or, A rational way of prepa∣ring Animals, Vegitables and Minerals for a Phy∣sical use, &c. Authore Edw. Bolness, Med. R. Ord. A Philosophical Essay; Declaring the probable Causes whence Stones are produced in the greater World; as also the Causes and Cure of the Stone in the Kidnies and Bladders of Men, &c. By Dr. Thomas Shirley, Physician in Ordinary to his Ma∣jesty. Sold by W. Cadman, at the Popes-head in the lower Walk of the New-Exchange. Praxis Medicorum Antiqua & Nova: The An∣tient and Modern Practice of Physick examined, stated and compared. By E. Manwaringe, Dr. in Physick. Sold by Tho. Archer Bookseller, under St. Dunstans-Church in Fleetstreet. Page 1 The First Book. Of the Diseases, and different Dispositions of Women with Child, from the time of Con∣ception to the full time of Reckoning. MAny Indispositions may arrive to Women from the time of Con∣ception to the full term of La∣bour, because they are then not only subject to those which are caused by pregnancy, but to those also which happen at other times. It is not my design so to enlarge as to examine all, but onely to enquire into the principal and most usual Maladies that accompany Great-Bellies, and have, during their course, some particular Indica∣tions for their Cure; for as for those which have only general Indications, and may happen indiffe∣rently to a Woman at any time, they may easily be known and redressed by the ordinary means, provided that you have all the while regard to the disposition of the Great-Belly. It would be sufficient to my purpose, of a through examination (in pursuance of my intention) of eve∣ry circumstance of a Great-Belly, to begin with Page 2 the explication of a Conception, which must precede it: but, since that cannot happen but to a fruitfull Woman, I will, before I discourse of it, that you may the better understand it from its original, give you some considerable Observations concerning the Fruitfulness and Barrenness of Women; for Barrenness proceeds oftner from Women than Men: for there are many conditions required in a Wo∣man, which Men have no occasion of, who only need to provide a small quantity of their Seed, and that at once, to generate; but Women, besides their Seed, must have a fit place to receive both, as the Womb is when well disposed; and matter ap∣pointed for the Child's nourishment, during its whole stay there, as is the menstruous blood: This is the cause, that for one impotent Man, there may be above thirty barren Women found. Let us therefore first of all see what are the signs of Fruitfulness and Barrenness in Women. CHAP. I. Of the signs of Fertility and Sterility in Women. By the Fertility of a Woman, I understand a natural disposition of her Body, by means of which, with the assistance of a Man, she may en∣gender her like: And by Sterility, which is di∣rectly contrary, I intend an* Im∣potency, which proceeds from some vice or fault either of her whole body, or of some particular part. We must how Page 3 make some enquiries after the most notable signs of the one and the other, and chiefly of those which may be perceived by our sight or touch, by which we may better judge than by many others, that for the most part are uncertain: For those which are taken from different temperaments, may easily deceive us, forasmuch as we may often find Wo∣men of a very ill habit, and full of ill humours, not∣withstanding fruitful. First, therefore, we affirm the Womb to be a part absolutely necessary to fertility, and the prin∣cipal object to be represented and examined to make a judgment of it: but as we find not every Ground proper to yeeld Fruit, and that some are so ungrate∣ful as to produce nothing; so likewise it is not e∣nough, for a Woman to have a Womb to be ca∣pable of Conception, since we find divers that have them, barren. We have already* shewed you exactly what the composition and natural structure of it ought to be, for to serve to so admirable an end as generation: Wherefore we will now speak no further of that, but refer you to that place to be informed. You must know then in general that the signs of fecundity in a Women are, that her Womb be well disposed, that she be at least thirteen or fourteen years of age, and at most but 45 or 50 generally and for the most part (though some, yet very rarely, conceive sooner or later according to their different natures and dispositions) that they be of a good temperament and indifferently sanguine, that they have their Courses in due time, of good blood and laudable in coulour, quantity, quality, and consi∣stance, and regularly every month, at once, with∣out Page 4 interruption, from the time they begin to flow till the time the evacuation is compleated. We say that the bloud ought to be good and lau∣dable, because it is a regurgitation and natural eva∣cuation only of what is superfluous in Women not with Child, and yet of age capable of Conception; which hath no malignity in it self, as many falsly imagine: for in healthful women it hardly differs either in colour, consistence, or quality from that which remains in the vessels, except in the small alteration, which is caused by the heat of the place whence it proceeds, and by the mixture of some hu∣mours with which the womb is alwayes plentifully furnisht. This evacuation (if in order) ought to be every month but once, though some have them every fourtnight, or at the end of three weeks, according as they are more or less sanguine, or cholerick, or have their blood heated: and to continue two or three days together, or six at most, and that by little and little, constant without interruption, and also more or less according to the difference of their par∣ticular temperaments. If a Woman have few of them, as when she grows in years, she becomes bar∣ren, forasmuch as this blood seems to nourish the Child in the Womb: and likewise if she have too many, because the Woman thereby grows too weak and the Womb too cold. There are notwithstand∣ing some Women who void more of them in two days, than others in eight. They must flow by little and little without interruption, and not all at once; for great and sudden evacuations cause great dissipa∣tion of spirits, of which abundance are necessary for generation; and the interruption of these evacuati∣ons Page 5 shews some impediment in nature, or some vice or evil disposition of the Womb. If all these signs concur, we may very probably judge the Woman fruitful; I say probably, because there are many who have them all, and yet cannot conceive, though they do their endeavours, and observe thereto all the requisite and necessary cir∣cumstances which we shall hereafter mention: There are likewise others, who, notwithstanding they have not all these conditions, are fruitful. Now if all the above named patticulars are found in a Woman that is barren, and that you desire to inquire more narrowly, and to be informed more certainly whether she be capable of conception, Hippocrates teacheth a way to know it, to which I give little credit, because the reasons of it are very obscure. It is in his 59 Aphorism of his 5th Book, where he saith, Si mulier non concipiat, & scire pla∣cet an sit conceptura, vestibus undique obvolutam sub∣ter suffito: ac si odor corpus pervadere videatur, ad nares & os usque, non sua culpa sterilem esse scito. If a Woman doth not conceive, and you are desirous to know whether she is capable, or no; wrap her close round with clothes, and put a perfume under her; and if she perceive the sent to pass through her body to her nose and mouth, be assured (saith he) it is not her fault she is barren. Fertility was anciently so esteemed by our fore-fathers, that they believed Barrenness to be a mark of reprobation; by reason of which the fruitfull Servant despised her barren Mistress; as we reade in the 16th Chapter of Genesis, where mention is made of Sarai, Abraham's Wife, who, seeing that she could have no Children, and being past the age Page 6 of hoping for any, and that her Husband was dis∣pleased at it, bid him take her Aegyptian Chamber-maid, named Agar, to lie with him, that by her means the might give him lineage, which good Father Abraham quickly did, and had by her af∣terwards a Son, which was called Ishmael: but from the time this Maid had conceived, she began to despise her Mistress Sarai, who was as yet barren. The Women of our times are not so earnest to have lineage after this fashion, there being but few that will suffer their Husbands to caress their Chamber-maids, much less* charitably to excite them to follow this example, which custom is abolished amongst us. I also admire the great passion which many have, who complain of nothing with greater regret than to the without Children, especially without Sons. For my part, I believe they that descend from Cae∣sar, or the Family of Bourbons, may with some rea∣son be led away with this superstitious and com∣mon inclination of preserving their kind, and be vexed with these sorts of inquietudes, which no wayes become ordinary people; though excusable, and may be permitted to great Monarchs and il∣lustrious men. When we perfectly understand the natural dis∣positions, we may the easier discern those contrary to nature; wherefore the signs of fruitfulness easi∣ly teach us those of barrenness. The signs and causes of barrenness proceed either from the age, or evil temperature and vicious conformation of the Womb, and parts depending on it, or the indis∣position and intemperature of the whole habit. The evil conformation of the Womb renders Women Page 7 barren, when its neck (called the Vagina) is so nar∣row, that it cannot give way to penetration; and when it is wholly or in part closed by some external or internal membrane, (which is very rare, if at all) or by any tumour, callosity, or cicatrice, which may hinder the Woman from the free use of copulation. But it is not sufficient that the Man's Yard enter the Vagina, which is the anti-chamber to the Womb: for, if in the act of copulation, he knocks at the door, which is the internal orifice, and it be not opened, all is to no purpose. This orifice is like∣wise hindred from opening by some callosity, pro∣ceeding from abundance of ill humours, which usu∣ally slow down from the Matrix, or by some tu∣mour which may happen to it; or also, by some part, which may so compress it, that it cannot di∣late to receive the Seed, as doth the Epiploon (or cawl) in fat Women, according to the opinion of Hippo∣crates in his 46th Aphorism of his 5th Book, where he saith, Quae praeier naturam crassae, non concipi∣unt, iis os uteri ab omento comprimitur, & prius∣quam extenuentur, non concipiunt. Women ex∣ceeding fat do not conceive, because the Cawl com∣presseth the orifice of their Womb, neither can they till they grow lean. I do not willingly admit a∣mongst the causes of barrenness, this compression of the inward orifice by the Epiploon, forasmuch as Aritin hath very well remedied it, by some of the postures invented by him, by which this orifice need not be so compressed in the action. The most frequent reason why this orifice opens not in this act to receive the Man's Seed, is the in∣sensibility of some Women, who take no pleasure in the venerial act; but when they have an appetite, Page 8 the Womb desirous and covetous of the Seed, at that instant opens it self to receive it, and be de∣lighted with it. But though the Vagina, or neck of the Womb, and the inward orifice opens to give passage to the Seed; yet may they very often con∣tinue barren, if the scituation of this orifice be not rightly placed, but either backwards towards the*Intestin rectum, or towards either side; all which hinders the Man from† darting his Seed directly into it, and consequently the Woman from conceiving. Hippocrates seems to have noted all the signs and causes of barrenness, which usually proceed from the evil temper of the Womb, in his 62 Aphorism of the 5th Book, where he saith, Quae frigidos & densos habent uteros, non concipiunt, & quae praehu∣midos habent uteros, non concipiunt: extinguitur enim in ipsis genitura. Et quae plus aequo siccos & adurentes: Nam alimenti defectu semen corrumpi∣tur. Quae vero ex utrisque nactae sunt moderatam temperiem, eae faecundae evadunt. All such Women whose Womb is cold and close, cannot conceive; nor they who have it too moist: because the Seed is extinguished in it. And likewise such who have it too dry and hot; because, for want of aliment the Seed corrupts: but such as are of a moderate temperament are fruitful. Of all these which Hip∣pocrates recites in this Aphorism, the most common, according to my opinion, is the continual Humi∣dity of the Womb, fed by an abundance of the Whites, with which many are very much incon∣venienced, the humours of the whole Body being accustomed to steer their course this way, which Page 9 can very hardly be turned away when inveterate, and the Womb being imbued with these vicious moistures, becomes inwardly so unctuous and slip∣pery, that the Seed (though viscous and glutinous) cannot cleave to it, nor be retained within it, which is the cause that it slips immediatly away, or in some short time after it is received. Barrenness may also proceed from the whole ha∣bit of the Body, as when a Woman is too old, or too young: for the Seed of the young is not yet prolifick, neither have they the menstruous blood; which two things are requisit to fruitfulness: and that of the aged is in too small a quantity, and too cold, who likewise want the menstruous blood. An universal intemperature (though the Woman be of convenient years) renders them however bar∣ren, as it happens when they are hectick, hydro∣pick, feaverish and sickly, and especially so much the more as the noble parts are fallen from their temperament and natural constitution: There are however many Women which seem barren for a long time, because of some of the fore-mentioned Reasons, yea, till they are thirty five or forty years old, and sometimes longer, who yet at last conceive, being cured of the indispositions which hindred them, and having changed their tempera∣ment by their age, of which we have had a remar∣kable example in the person of Queen-mother, lately deceased, who was above two and twenty years married, and without Children, and yet after∣wards, to the great joy and content of all France, she had our invincible Monarch Lewis the 14th, now reigning, to whom God grant a long and happy life. Page 10 Some of these Barrennesses may sometimes be cu∣red by removing their causes, and procuring the dispositions we have said are necessary to fruitful∣ness; yea, of those which proceed from an uni∣versal intemperament, by reducing the Body with a good and convenient regimen to a good order, and this according to their respective indispositions. Wherefore if a Woman have naturally the Vagina too narrow, and not from some of the causes above∣mentioned, she ought to be joyned to a Man whose Member is proportionable, if possible: and if that will not do, (which happens very seldom) she must endeavour to relax it and dilate it with emolient Oyls and Oyntments; if the neck of the Womb be compressed by any humour, it must be resolved and suppurated according to its nature and scitua∣tion, having alwayes care to prevent the corruption of these parts, which being hot and moist, are very subject to it; because the womb serves as a sink by which all the ill humours of the body are purged; so that you must take great care, that these kind of Tumours turn not to a Cancer, which is a very mischievous malady, and causeth the poor Women miserably to languish which are afflicted with it, and which after many insupportable pains, brings them almost alwayes to an inevitable death. When the Vagina is not clear in its capacity, be∣cause of any scar after a rent, caused by some force or violence to the Woman, or of some hard labour, or after an ulcer which caused the two sides to be agglutinated, whether inwardly or outwardly, it must be separated the best that may be with a*Bistory, or some other Instrument, according as Page 11 the case requires, hindring, by interposed Linnen, that it do not again agglutinate. When a Woman hath no Vulva, or outward entry of the Womb pierced, which is very rare, it must be opened by making a long Incision. Fabricius recites the like case in a Girl of thirteen years of age, who was like to die of it, because her Terms could not come down, there being no per∣foration, wherefore he did the like operation, which succeeded very well, and made her by that means capable of generation. As to the in∣ward orifice of the Womb, if it be displaced either towards the back or sides, it may be in some sort remedied, by making the Woman to observe, in the act of generation, a convenient posture, that the Man's Seed may be ejaculated towards the orifice; and if the Whites, or other Impurities of the Womb cause barrenness, as it is for the most part by the discharge of the whole habit on this place; it must be helped by Evacuations, Purgations, and a regu∣lar Diet, according to their different causes, and qualities of these ill humours. Having thus discovered the most certain signs of Fertility, and the marks of Sterility, I will now (the better to pursue the order I have proposed) treat of Conception. Page 12 CHAP. II. Of Conception, and the conditions ne∣cessary for it. IT is most certain, according to the Rule of Na∣ture, that a Woman is incapable of conceiving, if she have not the conditions requisit for fruitfulness: we have mentioned them in the foregoing chapter: let us now examine in this, what is Conception, and how it is caused. Conception is nothing else, but an action of the Womb, by which the prolifick seeds of the Man and Woman are there received and retained, that an infant may be engendred and for∣med out of it. There are two sorts of Conceptions; the one true, according to Nature, to which suc∣ceeds the generation of the Infant in the Womb: the other false, which we may say is wholly against Nature, and there the seeds change into water, false-conceptions, moles, or any other strange matter. The qualifications requisit, for a Woman to con∣ceive according to Nature, are, that the Woman receive and retain in her Womb the Mans and her own prolifick seed, without which it cannot come to pass; for it is necessary that both seeds should be there; nor is it at all true, what Aristotle and some other of his followers affirm, that the Woman neither hath nor can yeeld any seed, a great absur∣dity to believe: for the contrary may easily be dis∣covered, by seeing the Spermatick Vessels and Testicles of a fruitful Woman, appointed for this use, which are wholly filled with this seed, which Page 13 in coition they discharge as well as Men. Such a will not open their eyes to behold a verity so clear, may make reflection on the resemblance of Infants to their Mother, which could not be unless her seed had been more praedominant than the Fathers, when he begot them; which likewise happens after the same manner when the Fathers hath more force and vertue. Which may evince, that the Womens seed contributes as well to the formation of the Infant as the Fathers. If they will not agree to a thing so common, let them make another reflection on the generation of certain Animals, which participate of the nature of the Male and Female (of which they are engendred) though of different kind; as we daily see Asses and Mares produce by their coupling Mules, which are Animals of a middle nature resem∣bling both the one and the other, that produced them. We may then learn by this, that both Seeds are necessary for a true Conception, provided they be prolifick, that is, containing in them the Idea of all the parts of the body, and then the Womb being greedy of it, delights it self in it, and easily retains it when received, else it soon afterwards rejects it. It is not absolutely necessary, that both the Seeds be received and retained intire, without the loss of some part; for, provided there be a moderate quan∣tity of it, 'tis sufficient: Nor must we imagin, that (though all of it be not received into the Womb) the Child, formed out of it, will want some limb, as an arm, a leg, or other member, for want of suffi∣cient matter: inasmuch as the forming faculty is whole in every part of the Seed, of which the least drop contains in it potentially the idea and form of Page 14 all the parts, as we have lately made appear: but indeed when the Seeds are received but in small quantity, the Child may be the less & weaker for it: Or if either or both of them have not the requisit qualities; or, though well enough conditioned, if the Womb be imbued and stuft with ill humours, as the menstrues, whites, and other filth, or any other fault; if then there be a conception, it will be contrary to Nature, and there will be ingendred false births, Moles, or dropsies of the Womb, mixed with some other strange bodies, which are very troublesome to Women, till they void them. It is therefore without cause, that many Women are blamed, when their children are born with red and livid spots, which very much disfigure the faces of some of them: It is usually said (but without reason) that this proceeds from the mothers longing to drink Wine; for, though some have, by chance, been in effect harrassed (as they affirm) with these passionate desires during their being with child, yet we must not superstitiously believe (as many do) that these spots are so caused, but rather from some other cause, which must be searcht for elsewhere: And that which makes it appear, it cannot pro∣ceed from hence, is, that almost throughout all Italy, where nothing but white wine is drunk, as also in Anjou in France, I have seen divers persons marked with these red spots: and in case it proceeded from their Mothers longing to drink Wine, they ought to be white spots, or of an Amber colour, being the colour of the wine of these Countries: but we ought rather to conclude that they are caused, from some extravasated blood, at the time the Infant is form∣ed; which marks the skin, yet very tender with these Page 15 spots, and colours it in whatsoever part it toucheth, much after the same manner as we see it marked with Gunpouder, or some waters producing the like effect when it is washt and bathed with them. I will not however deny that the imagination hath a power to imprint on the body of the Infant, marks of this nature; but that can only be when young with Child, and principally at the very moment of conception; for when the Child is compleatly for∣med, the imagination can in no wise change its first figure, and Women must wean themselves from these vain apprehensions, which they say they have to such things (every moment) and serves some of them for a pretext to cover their liquorishness. Since my discourse is fallen upon this subject of Marks, with which oft times the bodies of Infants are spoted in their birth, and which comes, as is ordinarily believed, from the imagination of their Mother, it seems to me not much from my purpose, to recite you a circumstance very particular sound on Me, when I came into the world, as my Father and Mother have often told me, which is, that my Mother being with Child of me, and almost at the end of her reckoning, as it appear'd afterwards, the eldest of her three Sons (which she then had of six years old, and her first-born, whom she loved with an extraordinary tenderness and passion) dyed in seven dayes of the small Pox, all which time she continned night and day by his bed side tending him in all his necessities, not suffering any other to do it, whatsoever desires were made to her, not to weary and trouble her self, as she did, for the Childs sickness, alledging that in her present condition, she ought to be careful of her self, and not be the cause Page 16 of death to the Infant she went with; in fine, at the end of seven dayes her Son dyed, upon which the next day she was delivered of me, who brought effectively into the world with me six or seven of the small Pox. Now it is certain, that it would be irrational to say, that I had then contracted these small Pox in my Mothers Womb, by her strong im∣magination: But if I were asked whence they pro∣ceeded? I should answer, that the contagious air she breathed without discontiuuance, during the whole sickness of her deceased Son, had so infected the mass of her blood, with which at that time I was nourished, that I, rather than she, easily recei∣ved the impression of this contagion, because of the tenderness of my body. Let us therefore assert, that the imagination cannot produce any of the above mentioned effects, but at the moment of con∣ception, or within few dayes after, and that we ought for the most part to search elsewhere (if we desire the truth of it) the cause of most of these Spots, Marks, and Signes with which many In∣fants are born. Page 17 CHAP. III Of the Signs of Conception. AS it is very hard and belonging only to expert Gardeners to know Plants as soon as they be∣gin to spring forth of the Earth; so likewise there are none but expert* Chirurgeons can give a Woman certain assu∣rance of Conception from its begin∣ning: although some of these signs, resembling those of the suppression of the Terms and other maladies in Women, cause many to be deceived in it. I will not trouble my self to make a recital of a great number of signs of conception, which rather tend to superstition, than an effective verity: but only the most essential and ordinary, by which a Chirur∣geon may be assured of it; of which some may pre∣sently be perceived, others not till afterwards. He shall first examine and inform himself, whether the Woman hath all or most part of the signs of fertility, which are already named in the discourse of them, if not, he must impute them to some other cause; and supposing she be fruitful, you may then know whether she have conceived, by their agreement, and more then ordinary delight in the act. It is not enough for a Woman to be certain she hath conceived, and to yeeld and receive her seed with the Mans into her Womb, unless it close at that instant, and retain it. There is an Article a∣mongst the customs of Paris, in which it is said, Page 18 that to give and keep is not good: but it is not so in Conception; for a Woman gives and casts her Seed into her Womb, and there retains it. She may know whether she retains the Seeds, if she per∣ceives nothing flow down from the Womb after Copulation: The Woman some few months after perceives also some small pain about her Navel, and some little commotions in the bottom of her Belly, caused by the Womb's closing it self to retain the Seeds, and contracting it self so as to leave no em∣pty space, the better to contain them, and embrace them the closer. The light pain of the Navel comes from the Blader of the Urine (from the bottom of which proceeds the Urachus, which is fastened to the Navel) which is a little agitated by that con∣traction and kind of motion that happens to the Womb, when it is closed to retain the Seeds, and from the like agitation comes also those little com∣motions of the Belly. These are the signs of Conceptions, which may be known at the moment they happen, and may be yet more certainly known if you perceive the in∣ward Orifice exactly close. Besides these signs, there are others which cannot be known till some time after, as when the Woman begins to have loathings, having no other Distemper, loseth her appetite to meats which she did love: longs to eate strange things, to which she was not accustomed, which happens according to the quality of the humours predominating in her, and with which her stomach abounds: She hath often nauseatings and vomitings, which continue a long time: the Tearms stopping, no other cause appearing, having alwayes before been in good order: her Breasts Page 19 swell, wax hard, and cause pain, from the flowing of the blood and humours to them, wanting their or∣dinary evacuation, their upper parts are firmer and larger, because of the repletion; the Navel starts: her Nipples are very obscure or dark coloured, with a yellowish livid circle round about: her Eyes are dejected and hollow, the whites of them dull and troubled: her blood, when she hath conceived some time, is alwayes bad, because the superfluities of it not being then purged, as accustomed, is altered and corrupted by their mixture. Moreover, there is a sign, which all the Women esteem and hold in this doubtful case for very certain, which is, en ventre plat enfant y a, in a flat Belly there is a Child. Indeed there is rime in this proverb, and something of reason, but not as they imagin, that the Womb closing it self after Conception draws in a manner the Belly inwards and flatten's it, which cannot be; because the Womb free and wavering, not fastened forwards to the Belly, whereby to draw it back after that manner: but it may possibly be by reason that Women grow lean by the indispositions of their pregnancy, and wax thinner and smaller, not only in their Belly, but also throughout their whole body, as may be known the two first months of their pregnancy, during which time that which is contained in the Womb, is yet very small; but when the Womans blood begins to flow to it in abundance, then the Belly waxeth daily bigger and bigger afterwards, until her reckoning be out. All these signs concurring in a Woman who hath used copulation, or the most part of them to∣gether and successively, according to their seasons; Page 20 we may pass our judgment, that she hath conceived, notwithstanding that many of them may happen upon the suppression of the Terms, which usually produce the like: for every one knows, that it cau∣seth also in Virgins, disgusts, nauseatings and vo∣mitings, but not so frequently; the swelling, hard∣ness, and pains of the breasts, as also extravagant appetites, a livid colour of the Eyes, and others, to which you must have regard. The Matrix may be yet exactly close, and the Woman not conceived: Yea there are some, in whom they almost never open, unless very little to give passage to the Tearms; which happens to some naturally, to others by accident, as by some callosity proceeding from an Ulcer, or other malady. If all these signes of Conception (which some∣times may deceive us, though rarely, if they concur together) do not give us a sufficient assurance of it, and that we desire a better, Hippocrates teacheth us a way to know it, which I believe to be no more certain than the rest: it is in his 42d Aphorism of his 5th Book; where he speaks in this sort, Si ve∣lis noscere, an conceperit mulier, dormiturae, aquam mulsam potui dato: & si ventris tormina patiatur, concepit; sin minus, non concepit: If you desire to know whether a Woman hath conceived or no, give her, going to rest, a draught of Metheglin; and if afterwards she feels pains in her Belly, caused by wind she hath conceived; if none, she hath not, as he saith. Which is grounded (as I believe) upon the supposition that Metheglin breeds wind, which cannot pass easily downwards, because the Womb (being full) compresseth with its greatness Page 21 the*Intestin rectum, on which it is scituated, and causeth those winds to rumble, which are constrained to recoyl back into the other Intestines. If there be any occasion where Physicians or Chi∣rurgeons ought to be more prudent, and to make more reflections upon their Prognosticks for an af∣fair so important as this is, it is in this which con∣cerns their Judgments as to conception and Womens being with child, to avoid the great accidents and misfortunes, which they cause who are too precipi∣tate in it without a certain knowledge. The faults which are committed through too much fear at such a time, are in some sort excusable and to be pardoned; but not those caused by temerity, which are incomparably greater. There are but too ma∣ny poor Women who have been caused to miscarry by Medicines and bleeding, not beleiving they were with Child, which are so many murders they are guilty of who caused it, either through igno∣rance or rashness: besides the death which they bring to those little innocent creatures, by destroy∣ing them in their Mothers belly, they often there∣by put the Mothers into great danger. We have lately had in Paris, in the year 1666, a miserable example of this kind, in a Woman hanged, and af∣terwards publickly dissected, near the Kitchen-Court of the Louvre, who was found four months gone with Child, notwithstanding the report of such persons as had visited her by the Judges Or∣der before her Execution, who affirmed, contrary to the Truth, that she was not with Child. That which deceived them was, the Woman's having ef∣fectually her Courses, though with Child. Where∣fore Page 22 'tis not good to be too confident, forasmuch as there are many with Child who have their Cour∣ses; and I have known some who have had them all the time of their Great-Belly till the fifth or sixth month, which happens according to the Wo∣mans being more or less sanguine; though the greatest number usually have them not: but there are very few general rules, which may not some∣times be excepted against. This accident made such a noise in Paris, that it quickly came to the knowledge of the King and all his Court, who very much blamed those persons, that by their ignorance had caused the* precipitated Execution of this poor unfortunate Creature, with whom perished the Infant, innocent of the Mothers crimes. Nor must the Chirurgeon much trust to what these sort of Women may tell him concerning it, for, being afraid of the punish∣ment of their crime, to delay it, do almost all say they are with child, which is a reason very conside∣rable, why the persons, to whom such matters are committed, should be very knowing. There are yet another sort of Women, who having been ill treated, send for the Chirurgeon that he may give them a Certificate, the better to be revenged on their adversary; which that they may the easier obtain, they also affirm themselves with child, and having received blowes on their Belly, feign that they find their great pain, and if by chance they have at that time their Courses, they endeavour to perswade that it is a flooding, or showes, where∣fore he must be careful not to be deceived: and yet, that he may not be esteemed ignorant, nor fall into Page 23 the like disgrace, when there is any cause of doubt, it is better to delay a little, then rashly to pro∣nounce his prognostick at a venture; for as there are Women, who would be thought to be with Child, though they are not; so there are others who will deny it, till they are brought to bed, as in this following example. About the year 1654, be∣ing in the Citty of Saumur, there was near my Lodging a young and very handsom Daughter of a Citizen, who was five whole months under a Phy∣sician's and Apothecaries hands, to be cured of a Dropsie which she complained of: at length after she had taken many violent Remedies they had or∣dered her, she was cured in a moment, by bringing forth a Child at its full time, notwithstanding all they had given her; which much astonished the Physician and Apothecary, who were so grosly de∣ceived, in trusting to the Maids relation, who coun∣terfeited the Dropsie so well, that they could never perceive the truth till she was brought to bed. Some Women themselves are deceived in their being with Child, as lately the Wife of a Coun∣sellour of the Court, who after having been in a course of Physick of six or seven whole months for the Dropsie, under an eminent Physician, was at length brought to bed of a Child. I knew another Woman, a Merchant of Squared-Timber at Paris, who never had a Child, though she so passionately desired it, as to be at the point of hoping for one at 55 years of age, under the colour that she had still her Courses. This Woman was once perswaded (upon the recital of such signs as she said she had) for the space of ten whole months, that she was with Child, of which the Midwife and Page 24 many others assured her, and she her self likewise believed it (for it is easie to be perswaded to believe what one hopes for with a strong passion) she had a big-belly, and said also that she felt the Child stir; and believed it so truly, that finding her self one day worse than ordinarily (after having prepa∣red very fine necessaries for the Child she imagined she went with) she sent for the Midwife, who when she was come, assured her it was her Labour: but the next day (having alwayes till then expected a Child) she voided only a quantity of Water, with some Wind from the Womb, and nothing else: af∣ter which she was forced to fold up her fine Toilets again which she had provided. By these Examples we may learn not to be too ready to rely upon Womens Relations, if there be no other Reason, which may be known by the Examination of the Signs already declared. Now since after Conception (of which we have just done speaking) there follows Generation, let us consider what it is, and how it is performed. CHAP. IV. What Generation is, and what is necessa∣ry to it. IT is a very great Truth, and generally known, That whatsoever is in this lower World, is subject to corruption, and at length constrained to suffer death: which hath obliged Nature, provi∣dent and careful of its preservation, to endue all things with a certain desire of eternizing themselves, Page 25 which not being possible in individuals, because mortal by an indispensible necessity, is therefore done by the propagation of their forms and kinds. She obtains her end, in respect of Animals, by the means of Generation successively reiterated: for so all creatures seem to immortalize themselves, in some sense, by producing their like. And Fathers imagin themselves not quite dead, if they leave their like behind them after their death, to wit, their Children. By Generation, we understand generally, a progress of that which is, to that which is not. But this definition is a little too ample for to come to the knowledge of what we desire concerning the generation of perfect Animals, and chiefly of Man∣kind; wherefore that our intention may be the easier conceived, we must search some other, or ra∣ther a description, which may more exactly discover the thing: to this purpose we say that by the ge∣neration of Mankind, we mean a proper and par∣ticular action of the Womb; by which working upon both seeds there retained, it forms and shapes a body out of them, composed of divers parts, which it disposeth in order, to become in time the Organ of the Soul, which must be infused into it. There are many things requisit to make the Gene∣ration perfect, without which it would be wholly and absolutely impossible: there are usually three principally reckoned, to wit, diversity of sex, their congression, and the mixture of both Seeds, which we will a little particularly examine. Although some define a Woman to be an Animal which can engender in it self, and that this may be true; yet it is most certain, that she cannot engender without Page 26 a Man that hath discharg'd his Seed into her womb. And though we daily see Pullets have Eggs, and other Fowl, without the Cocks treading them, yet of those Eggs there will never come Chickens, be∣cause the Male never had made an impression on them, nor given them this prolifick vertue, which is absolutely necessary to this purpose. This may convince us that diversity of sex is necessarily re∣quisit, as well to those Animals, as to the more per∣fect, which is Man. Diversity of sex would profit little, if copulation did not likewise follow; though some subtile Wo∣men, to cloak their shamelesness, would perswade one that they were never touch'd by any Man who could get them with Child, as she of whom Averroes speaks, who conceived in a Bath in which a Man had washt himself a little before, and had cast forth his Seed into it, which was drawn and suckt in (as he saith) by the Womb of this Wo∣man: but this is a story fit to amuse little children. Now to the end these different sexes should be obliged to come to this touch, which we call Co∣pulation, besides the desire of begetting their like, which naturally incites them to it, the parts of Men and Women destined to Generation, are en∣dued with a delightful and mutual itch, to stir them up to the action, without which it would be impossible for a Man (so divine an Animal) born for the contemplation of heavenly things, to joyn himself to a Woman, in regard of the unclean∣ness of the parts, and of the act. And on the o∣ther side; If Women did but think of a thousand pains and inconveniences which their great Bellies cause them, of the pains they endure, and the hazard Page 27 of their lives when they are in labour, to which may be added the loss of their beauty, which is the most precious gift they have, and which makes them be beloved by those that possess them, cer∣tainly it might also afright them from it: But nei∣ther the one nor the other make these reflections till after the action (whence comes the saying, Post coitum omne animal triste) considering nothing before but the mutual pleasure they receive by it. It is then from this voluptuous Itch, and the desire of begetting their like, that Nature obligeth both these sexes to this congression. As to the mixture of both seeds; it is certain that the diversity of sexes and their congression, are but for this end, without which Generation cannot be; though some would have Womens seed serve to no purpose; yea, that they neither have any, nor eject any, as Aristotle saith: but we have proved the contrary in the Chapter of Conception, by the ex∣ample of daily experience, to which you may have recourse, to avoid repetition. All these three Circumstances, to wit, the di∣versity of sexes, their congression, and the mixture of their matters, which is called Seeds, must pre∣cede Conception, to which succeeds Generation, on this fashion: As soon as the Woman hath con∣ceived, that is, hath received and retained in her Womb the two prolifick seeds, it is every way com∣pressed to imbrace them closely, and is so exactly closed, that the point of a Needle (as saith Hip∣pocrates) cannot enter it without violence; after which it reduceth by its heat, from power into action, the several faculties, which are in the seeds it contains, making use of the Spirits with which Page 28 these frothy and boyling seeds abound, and are as instruments with which it begins to trace out the first lineaments of all the parts, to which after∣wards (making use of the menstruous blood flow∣ing to it) it gives in time growth, and the last per∣fection. Generation may be divided into three different seasons, which are, the beginning, middle, and the end. The beginning is, when there is no other mat∣ter in the Womb but the two seeds, which conti∣nue so to the sixth day, as Hippocrates notes; and calls them for that time the geniture, as much as to say, from whence generation must proceed: he speaks of it in his Book De Natura Pueri: and he saith, that by the experiences he brings of it, one may judge of the other times. He relates a story of a Woman, which at six dayes end cast forth with a noise at once out of her Womb the seeds she had conceived, resembling a raw egg, without a shell, having only the small skin over it; or, to the abor∣tive eggs, which have no shell: which little mem∣brane was on the outside a little coloured with red, and involved in it this seed, which was of a round figure: in the internal part might be seen white and reddish fibres, with a thick humour, in the midst of which was found something like the umbilick ves∣sels. Hippocrates calls this first time of generation, Geniture, as is already mentioned, during which time neither figure nor distinction can be observed, but only some beginning of a disposition to receive the form of the parts; after which follows the second time, which begins where the first ends, that is, at the sixth day, and lasts to the 30th. The time that the same Hippocrates assures us the males are com∣pleatly Page 29 formed, and the females not till the 42d. After the first six dayes are past, and the Womb hath wrought, according to the fashion we have ex∣plained, upon the seeds, which are there yet with∣out any mixture of blood, having disposed them to receive it; it is brought thither, in some sooner, in some later, according to the Womans being nearer to or further from her time of having her Courses when she conceived, which produceth effects ac∣cording to these different dispositions: for if they flow too soon, or in too great abundance, as it be∣fals such as conceive at the point of having their pur∣gations, the seeds are drowned and corrupted by it, which often causeth a flooding, or at least the generation of a false-conception; but if they are far from their having them, the conception is so much the more stable. Now then, this blood di∣stilling by little and little into the Womb of the Woman, who hath sometime since conceived, serves as a fit matter to form and figure out all the parts of the Infant, which was only traced out by the seed; and yet doth it (according to my opinion) much like a Painter, who after he hath drawn the out-lines with a chauk upon his cloth, begins to lay colour upon colour, to paint by degrees all the parts of the person whose picture he draws. Some little space after the beginning of this second time, appears as it were the figure of those three bubbles, of which Hippocrates speaks, or rather three mas∣ses of this matter, which grosly represent the three parts called principal, the first of which composeth the Head; the second, in the middle, the Heart; and the other the Liver: there may be likewise seen the after birth, with the umbilick vessels fastened to it, Page 30 and the membranes which wrapt up the whole; after which from day to day all the other parts of the body are figured in such sort, that at thirty dayes end the males are compleatly formed, and the females the 42th day ordinarily, which is about the time the Faetus begins to be animated, though as yet there is no sensible motion. Hippocrates seems by these different terms to be of an opinion that the Males have sooner life than the Females, because (he saith) their heat is greater: but for my part I do not beleive that the Male is sooner formed than the Female, and that which thus perswades me, is, because, if it were so, the Male must likewise be at its full term, sooner than the Female, proportionable to the same time, that the one is animated sooner than the other; which wee see the contrary, in that the Women are brought to Bed indifferently both of Sons and Daughters at the ordinary terme of nine months. Let us therefore say, that towards the fifth or sixth week, as well Males as Females have all the parts of their body (though small and very tender) en∣tirely formed and figured, at which time it is not longer than a finger, and from thence afterwards, which is our third time, the blood flowing every day more and more to the Womb (not by Intervals, as the Courses, but continually) it daily grows bigger and stronger to the end of the ninth month, which is the full term of ordinary labour. Having expli∣cated Conception and Generation, let us now con∣sider great Bellies and their differences. Page 31 CHAP. V. Of big Bellies, and their differences; with the signs of the true and false great Bellies. THE great Belly of a Woman properly taken, is a tumour caused by the Infants scituation in the Womb. There are natural great Bellies, which contain a living Child, and these we call true; and others against nature, in which, instead of a Child, is ingendred nothing but strange matter, as Wind mixed with Waters, which are called Drop∣sies of the Womb, False-Conceptions, Moles, or Membranes full of blood and corrupted seed; for which reason they are called false great Bellies. We have already, where we treated of Conception and Generation, mentioned the causes and signs of a great Belly in its beginning, notwithstanding we will again repeat the most certain and ordinary of them, which are nauseousness, vomittings, loss of appetite to things the Woman was accustomed to eat and like; longings for strange and naughty things; suppression of the Terms, without Feaver or Shiverings, or other cause; pains and swelling of the Breasts: all which may be found in Vir∣gins, by the retention of their Courses: but the most certain is, if putting the finger into the Vagina, you perceive the inward Orifice exactly close, as also the distention of the body of the Womb consi∣derable, more or less, according to the time the Woman is gone with Child, and the Childs stir∣ing Page 32 in the Womb, gives us indubitable proofs of it. It is fit we should be alwayes careful not to be de∣ceived by what we feel stir in the Womb, foras∣much as the Infant of it self hath a total and a par∣tial motion; the total is, when it removes the whole body, and the partial is when it moves but one part at a time, as the Head, Arm, or Leg, the rest of the body lying still: but the Womb blown up in fits of the Mother, yea, and some Moles have by accident a kind of total motion, but never a partial one. That of a Mole is rather a motion of falling down than otherwise, to wit, a motion by which heavy things fall downwards: for a Woman who hath a Mole of any bigness considera∣ble, whatsoever side she turns her self to, her belly falls immediatly the same way, like a heavy bowl. About the time (or very near) when the Infant quickens, if the Woman be certainly with Child, these humors (which are carried to the Breasts by the stoppage of her Courses) are turned to Milk, which when it happens, is usually an assured testi∣mony of pregnancy; though some Women have been found with Milk in their Breasts (but rarely) and yet not with Child, nor ever having had any: which Hippocrates also confirms in his 39th Apho∣rism of his 5th Book, where he saith, Si mulier quae nec praegnans, nec puerpera est, lac habet, ei men∣strua defecerunt. If a Woman hath milk in her Breasts, and is neither with Child, nor ever had any, it comes from the stoppage of her Courses. But it is rather whey than milk, which in that case hath not the consistence as the Milk of a Woman in Childbed, nay the Milk of a Woman with Child is yet but waterish, and becomes neither thick nor Page 33 very white, till after labour she begins to suckle her Child. The Infant moves it selfe manifestly about the fourth month: or sooner or later according as it is more or less strong: some Women feel it from the second, others about the third month, yea some before that time. In the beginning these first mo∣tions are very small, and very like to those of a lit∣tle Sparrow when first hatched, but grow greater, proportionably as the Infant grows bigger and stronger, and at last are so violent, that they force the Womb to discharge its self of its burden, as in Travail. The common opinion is, that the Males quicken before the Females, because their heat is greater, but that is almost equal; for there are some Women perceive their Daughters, others their Sons soonest, which happens indifferently to Males and Females, according as there was a more or less vigorous disposition at their Generation. Very often Women who daily use Copulation, are subject to be deceived; for they usually believe they are with Child if their Courses stop, and withal are a little qualmish, which is not always true, for false con∣ceptions cause almost the same accidents as true; which cannot easily be distinguished but by its consequences. This false great-Belly is, as we have already said, often caused by wind, which blows up and distends the Womb, and which Women oft-times discharge with as much noise as if it came from the Fundament: sometimes 'tis nothing but water which is gathered there in such abundance, as some Women have been seen to void a pail full without any Child; though they verily believed they were with Child, as did that Wood-Mer∣chant, Page 34 whose story you have in the end of the third Chapter, who did not void it till the end of the tenth mouth, till when she alwayes believed her self with Child. There are others who conceive only fals-conceptions and Moles, which may be known by the Infants different motions, already mentioned, and by the Moles continuing in the Womb often after the ordinary time of labour, some Women having them a whole year, yea many years, according as these Moles are more or less adhering to the inner parts of the Womb, and are there entertained and nourished by the blood that flows thither. Moles alwayes proceed from some false-con∣ceptions, which continuing in the Womb, grow there by the blood that flows to them, by the ac∣cumulation of which they are by little and little augmented: if the Womb expels it before two months, it's call'd a fals-conception, & some are on∣ly but as it were the Seed involved in a membrane, like that geniture which that Woman voided after six or seven dayes, of whom Hippocrates speaks in his Book, De natura Pueri. The others are a little more solid and fleshy, resembling in some sort the Gizard of a Foul, and are greater or less, according to the time they stay in the Womb, and also ac∣cording to the quantity of blood with which they are alwayes soaked. Women expel these fals-con∣ceptions sooner or later, according as they cleave to the Womb, which makes them almost alwayes flood in great quantity at those tunes. It is of great importance to distinguish well between a true and a false Belly; for the faults committed by a mistake, are ever very considerable: Page 35 forasmuch as in a true great Belly the Child ought to continue in the Womb, till Nature* expels it by a natural labour: but contrarily, the false great-Belly indicates to us, to procure the expulsion of what it contains as soon as may be: Wherefore we ought to be very careful. CHAP. VI. How to know the different times of Pregnancy. IF prudence be necessary to enable a Chirurgeon or Midwife to assure a Woman that she is with Child, or not, and of a true or a false-conception; it is likewise as much requisite for them to know how far she is gone, to the end they may be cer∣tain whether the Infant be yet quick or no, which is of great moment: because, according to the Law, if a big-bellied Woman miscarry by a wound, he that struck her, deserves Death, in case the Child were quick, otherwise he is only condemned in a pecuniary punishment: they ought likewise to take heed lest they cause the death of the Infants, and sometimes of their Mother, by hastening* their labour before its time, by imagining that when the big-bellied Woman complains of great pains in her Back and Belly, they are the Page 36 pains of her Labour, and instead of endeavouring to hinder them, they contrarily provoke them, and cause them to miscarry unfortunately before their time, I knew a Woman called Martha Rolet, who being six months gone with Child or there∣abouts, was surprized with great pains, much like throws of Labour, which made her send for her Midwife, who as soon as she was come, and under∣standing the case no better than they use to do, endeavoured all she could to bring her to bed, aug∣menting her pains, by sharp Clysters, making her walk about her Chamber, as if she had been at her full time; but finding at two dayes end no for∣wardness, notwithstanding the continual pains, she sent for me to know what was fit for her to do in that case: I went to the Woman, and found the inward orifice of the Womb dilated enough for the top of my little Finger to enter into its inward part, and yet wider towards the outward part; but considering that she had no other accident but those pains, I caused her immediatly to go to bed, where she continued eight or nine dayes, in which time her pains ceased, the Womb closed exactly, as I found some dayes after, and she went on with her Child three full months longer, and was then brought to bed of a Daughter at the full time, strong and robust, which is yet living, and now five years old or thereabouts. Now had I pursued what they began, this Woman without doubt would have miscarried at six months, which would have* killed the Infant in her Belly, and soon after she should have miscarried. It is fit to follow Page 37 this example in the like occasion, provided the pains are not accompanied with accidents, which may endanger the life of the Mother if not presently delivered; as frequent Convulsions, considerable floodings, of which we shall speak in its place. To be well informed of the different times of pregnancy, the Womans own relation may some∣times serve turn, yet 'tis not fit alwayes to trust it; it may help to conjecture, because many Women are themselves deceived, concluding themselves with Child, from the staying of their Courses, or from their quickning, which is not alwayes a certain rule. We usually judge of it by the bigness of the Belly: but more surely by touching the inward ori∣fice of the Womb. When they are young with Child, we can only know it by the signs of concep∣tion, because what is then in the Womb is of no considerable bigness to swell a Belly; but rather on the contrary, at that time it grows slatter, for the reasons before recited: but after the second month the Belly begins by degrees to wax bigger, till the ninth month. At the beginning, in touch∣ing the inward orifice, you find it exactly close and somewhat long, resembling the muzzle of a Puppy new pup'd; and is then very thick: but by little and little, through the extension of the Womb, it diminisheth so in all its proportions, that when the Woman cometh near her reckoning, it is perfectly flat, and almost equal with the globe of the Womb, and in that manner, that it becomes like a small cir∣cle, a little thick at its entry, where the Garland is made at the time of Labour. Neither may the time of pregnancy be alwayes judged by the great swelling of the Belly; because Page 38 some Women are bigger when they are half gone, than others are at their reckoning; it depending much on the bigness of the Infant, and also on their number; and yet again, according as there is more or less water inclosed with them in the Womb; but much rather by the internal Orifice, which grows daily thinner and flatter, and so much the more by how much the Women come nearer their reckon∣ing: much in the same manner as we see a tender skin diminish in thickness, according as it is extend∣ed and dilated; even so this orifice grows thinner by the extension which the head of the Infant caus∣eth to it, which usually presseth hard against it in the last months. This remark is often useful to us in the admission of big-bellied Women, that desire to lie in in the*Hostel de Dieu at Paris, which I very often observ∣ed in my practise there of Delive∣ries in the year 1660, through the permission which my Lord, the first President, was pleased to give me, (for there is no place so fit to perfect one in a short time, in the practice of so necessary an operation, because of the great number which are there daily delivered of all sorts) the order is, that any Women with Child shall be there charitably received fifteen dayes, or thereabouts, before their reckoning; to which pur∣pose they are searcht before they are admitted, be∣cause many, glad of a good entertainment for no∣thing present themselves there two or three months before they should, saying and affirming they are near their time; but by the above-mentioned con∣siderations, one may easily judge and know within a very little, who are fit to be received and who not, Page 39 that is, when they are near their time; and by this means may likewise know when 'tis necessary to forward Labour, or retard it, as much as ought to be, when Women are not yet gone their full time. As to what respects the several terms, to which a Woman may go with Child; there is a great controversie amongst Authors, but all agree that the most ordinary terms are either the seventh or the ninth month, which is known and also approved by all. Hippocrates is of an opinion that the Child born in the eight month cannot live, because he cannot support two such puissant endeavours so near one to another, having already endeavoured to be born the seventh month, which is (as he saith) the first legitimate term of Labour; and fail∣ing then, if, reiterating the same endeavours the eighth month, he be born, he is thereby so weak∣ned, that he seldom lives, as he often doth, when born by the first endeavours in the seventh month, his strength not being before exhausted by vain attempts. This seems very likely to many: but if they that practise Deliveries, make a true reflection on it, they will find, that it is the Ma∣trix alone, assisted with the compression of the mus∣cles of the lower Belly and Diaphragma, which cause the expulsion of the Child, being stirred up by it's weight, and not able to be further ex∣tended to contain it; and not, as is ordinarily believed, that the Infant (being no longer able to stay there for want of the nourishment and re∣freshment) useth his pretended indeavours to come forth thence, and to that purpose kicking strongly, he breaks with his feet the membranes which con∣tain Page 40 the waters, inasmuch as when the Child is na∣turally born, the membranes are alwayes rent be∣fore the head, which pressing and thrusting each throw the waters before it, causeth them to burst out with force. The same Hippocrates likewise admits the tenth month, as also the beginning of the eleventh, at which time he saith the Children live: but he will by no means that Children can live if born before the seventh, forasmuch as they are then too feeble, and not capable to support the external injuries, as indeed we see and find it every day. I do boldly affirm, and it is also very true, that the ordinary term of going with Child is nine whol months: but I cannot consent that Children born in the seventh month, do oftner live than those of the eighth; but much to the contrary I believe, that the nearer they approach to the natural term of nine months, the stronger they are; and there∣fore that Children born in the eighth month rather live than those of the seventh: which is wholly contrary to the opinion of many persons, who blindly follow in this the sense of Hippocrates and all Authors, without making any reflection upon the thing, for to disabuse themselves of this vulgar belief, founded upon the pretended vain endea∣vours, which (they say) are made by the Infant in the seventh month: for, as we see, 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 above a month after, which happens according to the Territories, the different regards of the Sun, and according as the Vine is cultivated: So likewise we see Women Page 41 brought to bed of their Children six weeks and two months before, and sometimes as long after their ordinary tearm; If it be not, that the Womb not being capable of an extention beyond a certain de∣gree, cannot bear its burden, but a little while af∣tet the reckoning is out, although there have been Women, as Hippocrates acknowledgeth, who have gone ten or eleven whole months with Child, which notwithstanding is so much the more rare, by how much it exceeds its limits. These things hap∣pen also to Women according to the different dis∣positions either of their whole body, or of their Womb alone, or as well according to their rule of living, and the greater or lesser exercise they use, and may likewise happen on the Childs part: for by example, if at seven months he is so big, that the Womb can no longer contain him, nor dilate it self more without bursting, it is then provoked by the pain which this violent extention causeth, to discharge it self of him; and so likewise in the eighth month, if there be the same reason, and some weeks sooner or later, according to a multi∣tude of other circumstances; or also by any out∣ward cause, as a violent shaking of the whole body, blow, fall, leap, or any other causes what∣soever, hastening the pains of Delivery; that which makes these Children live a longer, or a lesser while, is, according as they are at that time more strong and perfect, and the Woman nearer her time, which is at the end of the ninth month. There are many Women that believed they were brought to bed at the 7th and 8th month; as like∣wise others, that they went 10 or 11 whole months Page 42 with Child (which may some times be) when not∣withstanding they are effectively delivered at the due time. That which deceives them, usually is, their believing (as we have already said) them∣selves with Child from the time of the retention of their courses, having had them during the two first months of their pregnancy, yea and sometimes lon∣ger; and others also misreckon themselves, when their courses are stopped two months before they conceive. It is also easie to know that a Woman, though well regulated, cannot exactly know by the suppression singly, the certain time of her being with Child: for example, if she lies with her Husband upon the point of the coming down of her terms, and she conceives upon it, then she may make her reckoning from the time of their suppressi∣on, which may be very near the truth: but if she conceives immediatly after she hath had them (which happens oftenest) and that all along the whole month she daily copulates with her Hus∣band, 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; and so for three weeks or a month more or less she may be mistaken in the time. As we have said, that Children are more or less long-lived, according as they approach nearer the ninth month; so we may easily know, that they of six months, and much less those that are younger, cannot be long-lived, because they are yet too weak to resist the outward injuries. There hath often been great contestations amongst the Physitians, to determine, whether a Child born the eleventh or Page 43 twelfth month after its pretended Fathers death, can be legitimately born, and consequently admit∣ted to Inheritance, or rather disinherited as a sup∣posed Child. This question hath been well debated sometimes by the Romans as well as by us, and there have been parties both for and against this opinion; as for my part I will, to avoid prolixity, leave it unde∣cided, and add nothing upon this point to what I have mentioned before. CHAP. VII. Whether it may be known that a Woman is with Child of a Boy, or a Girl, and the signs whether she shall have many Children. IT is no great matter to satisfie the curiosity and disquiet of a Woman, who desires often to know whether she be with Child or no; but there are many, and almost all, that would have one proceed further, and tell them whether it be a Boy or a Girl, which is absolutely impossible; though there is hardly a Midwife which will not boast her self able to resolve it (in effect it is easier to guess, than to find the truth) for when it happens, it is cer∣tainly rather by chance, than by any knowledge or reason they could have to enable them to foretell it. But sometimes one is so pressed and importuned to give judgment, chiefly by Women who never had Children, and often by their Husbands, who are not less curious, that one is obliged to satisfie Page 44 them as much as possible in that case, by the exa∣men of some signs very incertain. There are many signs upon which this knowledge is grounded (if there can be any, which I do not believe) of which the two principal are taken out of Hippocrates; the first is in his 42th Aphorism of the fifth book, which is, Mulier gravida, si ma∣rem gerit, bene colorate est; si vero faeminam, male calorata: A Woman with Child of a Boy is well coloured; but of a Girl, ill coloured. And the other is in his 48th Aphorism of the same book, which is, Faetus mares dextra uteri parte, faeminae finistra magis gestantur: For the most part the Male Children lye in the right side, and the Fe∣males in the left. Moreover, they say, a Woman with Child of a Boy, is more merry and jockond, goes with it much better, is not so disgusted, finds it quicken sooner, and her right Breasts fill before the left, and is also more firm, and that all the right parts of her body are stronger and more active; as for example, if she sate, kneeled, or stood upright, she would make her self first step with her right foot; but if it be a Girl, she would have all the signs contrary to these above mentioned. There are some persons pretend to know it by in∣specting of Urines, which is as uncertain; for we daily find Women well coloured, and they have all the signs of being with Child of a Boy, and yet are brought to bed of Girles, contrary to the hopes given them: And others, though they have signs directly opposit, bring forth Boys. Some believe they understand it better than any other, by considering the time of conception; for say they, if the Woman conceives at the increase of the Page 4 Moon, she shall have a Boy, and contrarily a Girl, if at the decrease: but this falls out as seldom, as may easily be known, by the observation I have made of it at the Hostel de Dieu at Paris, and may be daily observed by others as wel as my self; which is, that having in one and the same day delivered 11 Women there, all at their full time, five of them had Boys, and the other six Girls. Now we may well judge that they all conceived at one time, be∣cause all were brought to bed at the same time; and ought (if this rule were true, and that they were all governed by this Planet) to have had either all Boys, or all Girls; and not some Boys, and some Girls, as here it happened, and doth every day in the same place; whereas in all other places are indifferently born both Boys and Girls. Others again believe the Males to be begotten of the Seed which comes rather from the right Testi∣cle than the left, esteeming it hotter and not so wa∣terish, because the right Spermatick vein comes from the trunck of the Vena cava; and that of the left side takes its rise from the Emulgent; but if they know after what manner the blood is circula∣ted, they would find that the blood of the emulgent is not more serous, than that of the vena-cava, for∣asmuch as it is purged of its superfluous serosity by the Reines, before it enters this emulgent; they would likewise know that the Seed of both Testicles is the same exactly, being made of the same blood, brought to them not by the Reins, but only by the two Arteries, which arise out of the trunck Aorta, otherwise called the great Artery; wherefore the left is as well disposed to produce Males as Fe∣males; and therefore those Husbandmen abuse Page 46 themselvs, in knitting up one of the testicles of their Bulls according as they desire either Males or Fe∣males. I knew an Italian at Rome who had but only his left Testicle, having lost the right upon a good occasion, who after that accident married, and begat two Children, which I saw alive, and very well, one of which was a Boy and the other a Girle; besides all those he may have begotten since that time: nor needed he to suspect his Wife had the assistance of any other in that business, as it very often happens in this Country. Such persons as desire to foretell before the Child be born, whether it will be Boy or Girl, do usu∣ally adhere by complacency, to the desires of the big-bellied Woman and her Husband in this case; for if the Midwife knows they desire a Boy, she will assure them it will be a Boy, and swear to it also; And if they wish for a Girl (as it also hap∣pens to some Women, who love Girls best) they will say it shall be a Girl, and lay wagers of it too. If this happens luckily according to her pronostick, she will not be backwards to affirm she knew it ve∣ry well: but when it happens contrary to her prediction, she makes her self reputed ignorant and presumptuous, and remains ashamed. For my part I should do quite otherwise: for knowing beforehand the desires of the persons, I should give my advice alwayes quite contrary to them; because if it happen to be true (although by chance) what was foretold, they will then con∣clude me to be knowing, and to have said well: and if otherwise (which may be once in twice) the Woman and her Husband obtaining what they de∣sired, will not take so much notice of it, because Page 47 one alwayes receives with a good welcom what they desire, though unhoped for. Having shewed that it is impossible to know whether a big-bellied Woman shall have a Boy or Girl, because of the uncertainty of the signs, upon which they ground their predictions; We will assert that it is not the same in the knowledge one may have, whether a Woman is conceived of more than one. There are many Authors who have affirmed that a Woman cannot bring forth above two Children at once, because they have but two Breasts; as also, because that there are but two cavities in the Womb, different from most other Animals, which hath many little cells in it, and also many teats, wherefore they bring forth many young ones, who usually answer the number of the little cells of their Womb: this is very true in re∣spect of other Animals, but the Womb of a Wo∣man hath but one only cavity (unless they would have the two sides taken for cavities) for there is in the Womb only a simple long line, without any other separation. We see daily Women brought to bed of two Children at once, sometimes of three, and very rarely of four. Yet I knew one Mr. Hebert, Couverer of the King's Buildings, who was so good a Couverer, that his Wife about seventeen years since brought forth four living Children at a birth; which the Duke of Orleans deceased coming to hear of, to whom (because of his jovial humour) he was very welcom; the Duke asked him (in the presence of divers Persons of Quality) whether it were true, that he was so good a Fellow as to get his Wife with Child of those four at one bout? He answered ve∣ry Page 48 coldly, Yes; and that he had certainly begat at the same time half a dozen, if his foot had not slipt; which made them all laugh very heartily. But I esteem it either a Miracle, or a Fable, what is related in the History of the Lady Margaret, Countess of Holland, who in the year 1313 was brought to bed of 365 Children at one and the same time; which happened to her (as they say) by a poor Womans Imprecation, who asking an Alms of her, related to her the great misery she was in by reason of those Children she had with her: To which the Lady answered, She might be con∣tent with the inconvenience, since she had had the pleasure of getting them. Now since the most usual number is two, that Women have at once, (who have more than one Child at a time) We will give the signs of it, which do not appear in the first months, nor sometimes till they are quick. There is some likelihood of it, if the Woman be extraordinary big, and yet suspects no Dropsie; and more, if there be on each side of the Belly a little rising, and as it were a line a little depressed, or not so elevated about the middle; and most of all, if at the same time one feels many and different motions on both sides; and if these motions are more frequent than usually, which is, because the Infants being straitned, inconvenience one the other, and cause each other to move in that fashion: If all these signs concur, 'tis then very pro∣bable the Woman goes with more than one Child. Page 49 CHAP. VIII. Of SuPERFAETATION. THere is a great dispute, whether a Woman (who hath two or more Children at once) conceived of them at one, or at several Coitions. We see indeed daily that Bitches, Sows, and Ra∣bits have divers young with but once copulating, which may very well make us judge the same of a Woman. Some will have this to be by Superfae∣tation: but there are signs by which we may know the difference, whether both Children were be∣gotten at once; or successively one after the other. Superfaetation, according to Hippocrates, in his Book which treats of it, is a reiterated conception, when a Woman being already with Child, con∣ceives again the second time. That which makes many beleive there can be no Superfaetation, is; because, as soon as a Woman hath conceived, her Womb closeth and is exactly firm, so that the Seed of the Man, absolutely necessary to conception, finding no place nor entry, cannot (as they say) be received, nor contained in it, so to cause this second conception. To this may be added, that a preg∣nant Woman dischargeth her Seed (which is as necessary for it as a Mans) by a vessel which termi∣nates on the side of the exteriour part of the inward orifice; which Seed by this means is shed into the Vagina, and not into the bottom of the Womb, as it should for this purpose. However, it may be Page 50 said in answer to these objections, which are very strong, that (though the Womb be usually exactly shut and close when a Woman hath conceived, and besides, that she then sheds her Seed by ano∣ther conveyance) yet this general rule may have some exceptions, and that the Womb, so closed, is sometimes opened to let pass some serous slimy ex∣crements, which by their stay offend it; or prin∣cipally, when a Woman is animated with an ear∣nest desire of copulation, in the heat of which acti∣on she sometimes dischargeth by the passage that terminates in the bottom of the Womb, which be∣ing dilated and opened by the impetuous endea∣vour of the Seed, agitated and over-heated more than ordinary, and this orifice being at the same time a little opened, if the Mans Seed be darted into it at the same moment, it is thought a Woman may then again conceive, which is called Superfae∣tation. This is confirmed by a History of a Servant, related by Pliny, who having the same day copu∣lated with two several persons, brought forth two Children, the one resembling her Master, the other his Proctor. And also of another Woman, who likewise had two Children, the one like her Hus∣band; and the other like her Gallant: but this different resemblance doth not altogether prove Su∣perfaetation, because sometimes different imaginati∣ons may cause the same effect. This second conception is effectively as rare, as we find the decision of it uncertain; nor must we imagine that alwayes, when a Woman brings forth two Children or more at once, there is a Superfae∣tation; because they are almost alwayes begot in the same act, by the abundance of both Seeds recei∣ved Page 51 into the Womb: nor believe neither, that it may be at all times of a Womans being with Child: for when it happens, it cannot be either the first or second day of conception; because, if the last Seed be received into the Womb, it would make a mixture and confusion with the first, which is not yet involved with this little pellicle, that might otherwise separate it; nor is it formed perfectly till the sixth or seventh day, as Hippocrates saw in a Woman, who about that time expelled this geni∣ture: Besides, the Matrix again opening it self, could not hinder the first Seed from slipping out, being not as yet wrapt up in this little membrane, which could preserve it. This makes me not be∣lieve the History of the Woman, whom Pliny men∣tions, that it happened for the reasons alledged by him, to wit, that she used copulation the same day with two several persons: for the last would cer∣tainly have caused this confusion of Seed, as I have said, and so destroyed the work begun; but I ra∣ther believe, that this Superfaetation may happen from the sixth day of conception, or thereabouts, till the thirtieth or fourtieth at the most; be∣cause then the Seeds are covered with membranes, and that which is contained in the Womb is not yet of a considerable bigness: but after this time, it is impossible, or at least very difficult, because the Womb being extended more and more by the growth of the Child, can hardly receive new Seed, and as hardly retain it, or hinder it from being cast forth by reason of its fulness, having received it in that estate. When a Woman brings forth one or more Chil∣dren at a birth, begotten at once, which usually Page 52 are called Twins, (and differs from Superfaetation) 'tis known by their being both almost of an equal thickness and bigness, and having but one only and common after-birth, not separated the one from the other, but by their membranes, which wrap each apart with their waters, and not both in the same membrane and waters, as some have believed, contrary to the truth: but if there are several Chil∣dren, and a Superfaetation, they will be also sepa∣rated by their membranes, but not have a common burthen, but each his apart; neither will they be of an equal bigness, for that which is the Superfae∣tation, will alwayes be lesser and weaker, than that which was engendred at first; who, because of its force and vigor, draws to it self the greatest and best part of the nourishment: Just as we find in fair and great Fruit, that have often near them very little ones; which happens, because those that are first knotted and fastned to the Tree, take away all the nourish∣ment from their neighbours, who did but blossom when the first had already acquired some bigness. Sometimes Twins are not of an equal bigness, which happens according as the one or the other hath more strength to draw to it in greater abundance the best part of the common nourishment. Six years since I layed a Woman at her full time, whom I delivered of a very great living Girl by the feet, which first came to the birth; and fetching the after-birth, I brought with it another Child, a dead Boy, as little again as the first Girl; and which seemed not to be, respecting his bigness, above five or six months; although they were both begot∣ten at one and the same act of Copulation, as was manifest by their both having but one and the same Page 53 burthen, which is the true sign of it, as I have already said; and this second Child was so little, that it came together with the burthen, and wrapt up in the membranes; which I presently opened, to see whether it were alive; but it had been a long time dead, as appeared by its corruption. I am not willing to say that there never is any Superfaetation, but I say, that it happens very rare∣ly; for of an hundred Women that have Twins, ninety of them have but one burthen common to both; which is a very certain sign they had no Superfaetation, and much more certain than the Indications taken from the greatness or strength of the Child, which is but conjectural. CHAP. IX. Of a MOLE, and its Signs. OF all the several sorts of Great-Bellies in Wo∣men, there remains that yet to be examined which is caused by a Mole, of which we must al∣wayes endeavour the expulsion assoon as we come to know it, being altogether contrary to nature. The Mole is nothing else but a fleshy substance, without bones, joynts, or distinction of members; without form or figure, regulated and determined; engendred against Nature in the Womb, after Co∣pulation, out of the corrupted Seed of both the Man and Woman. Notwithstanding, there are sometimes some that have some rudiments of a rough form. It is very certain, Women never engender Moles Page 54 without the use of copulation, both Seeds being re∣quired to it, as well as for a true generation. There are some, truly, who never having had to do with a Man, do naturally cast forth, after a flouding, some strange bodies, which in appearance seem to be flesh; but if one take special notice thereof, they will find it but clods of blood coagulated, without consistence or fleshy texture, or membra∣nous, as are the Moles and false-Conceptions. Moles are ordinarily engendred, when either the Man or the Womans Seed, or both together, are weak, or corrupted, the Womb not labouring 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 the small quantity found in it is extinguished, and as it were choaked, or drowned by abundance of the gross and corrupted men∣struous 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 disorder, there is made of the seeds and blood a meer Chaos, call'd a Mole, not usually engendred but in the Womb of a Woman, and never or very rarely found in that of other Animals, because they have no menstruous blood, as she hath. A Mole hath no burthen, nor navel-string fast∣ned to it, as a Child alwayes hath; forasmuch as the Mole it self adheres to the Womb, by which means it receives nourishment from its vessels: it is likewise cloathed usually with a kind of mem∣brane, in which is found a piece of flesh confusedly interlaced with many vessels; it is of a bigness and consistence more or less according to the abundance Page 55 of blood it receives, according to its disposition, and also according to the temperature of the Womb, and the time it stayes there; for the longer it stayes, the harder it grows, and becomes schirrous, and difficult to be expell'd. For the most part there is but one, yet sometimes more; of which, some cleave very strongly, others very slightly to the Womb. When Women miscarry of them before the second month, they are called false-Conceptions: when they keep them longer, and that this strange body begins to grow bigger, they are called Moles. False-Conceptions are more membranous, and sometimes full of corrupted Seed; but Moles are altogether fleshy. One may find in a Woman that hath a Mole, almost all the signs of Conception, and of a Woman with Child; but there are likewise some other which differ, because her belly is harder and sorer, than when she is with Child. The Mole be∣ing contrary to Nature, is very troublesome to a Woman: and as it hath no true life, nor animal motion; so it is very painful to go with: for the Mole falls on whatsoever side she turns, when she is a little big, just like a heavy Bowl: She hath a great weariness in her legs and thighs, and sup∣pression of urine from time to time, and finds a great heaviness in the bottom of her belly, foras∣much as this mass of flesh by its weight weighs down the Womb, which compresseth the bladder of urine: her breasts are not so swell'd, neither have they any, or very little milk. It may be yet easier known, if with all these signs she finds no motion after the 4th or 5th month of her Great-Belly; and certainly, if after her reckoning is out, all the afore∣said signs remain and continue in the same manner. Page 56 These Moles are nourished in the womb, to which they almost alwayes adhere, and are sustained by the blood with which it is alwayes furnished, just as Plants are by the moisture of the Earth. Some∣times 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 mishapen or monstrous, because of the compression which this strange body causeth to the Infant yet very tender. In the year 1665, being at Mr. Bourdelots, Doctor in Physick of the Facul∣ty of Paris, where was every Monday held Aca∣demical Conferences: As they fell upon the dis∣course of the Circulation of the Blood, which I ex∣plained according to my opinion, they brought thither the Infant of a Woman newly brought to bed at her full time, which wanted all the upper part of the head, having no skull, no brain, no nor any hairy scalp; but had only, in lieu of all those parts, a Mole, or fleshy mass flat and red, of the thickness and bigness of an after-burthen, covered with a simple membrane strong enough: This In∣fant had however all the other parts of the body fat, and well composed and shap'd. This monstrous disposition was the cause of its death assoon as it was born, and yet it was very wonderful and a∣stonishing to consider, how it could live so with∣out brain; as also very difficult to understand, how this fleshy mass could serve in stead of it, whilst it was in the Mothers belly. It was interwoven with many vessels, like a kind of*Placenta, yet of a more firm substance. Mr. Clerk and Mr. Juillet, my Brethren and good Friends, Page 57 were then present, and saw this Prodigy as well as my self. A Woman having a Mole, hath a much worse colour, and is every way more inconvenienced, than a Woman with Child; and if she keeps it long, she lives all the while in danger of her life. Some have them two or three years, and sometimes all the rest of their lives: As hapned to a Peuterer's Wife, of whom Ambrose Paré makes mention in his Book of Generation, who had one seventeen years, and at last died of it. We will declare the Reme∣dies convenient for it in another place, where we speak of its extraction. CHAP. X. In what manner a Woman ought to govern her self during her being with Child, when it is not accompanied with other considerable accidents, to endeavour to prevent them. A Woman with Child in respect of her present disposition, although in good health, yet ought to be reputed even as though she were sick, during that neuter estate (for to be with Child, is also vulgarly called a sickness of nine months) because she is then in daily expectation of many inconveni∣ences, which pregnancy usually causes to those that do not govern themselves well. She should in this case resemble a good Pilot, who being imbarqued on a rough Sea, and full of Rocks, shuns the danger, if he steers with prudence; if Page 58 not, 'tis by chance, if he escapes Shipwrack: So a Woman with Child is often in danger of her life, if she doth not her best endeavour to shun and pre∣vent many accidents to which she is then subject; all which time there must be care taken of two, to wit, her self, and the Child she goes with: for from one single fault results double mischief, inasmuch as the Mother cannot be any wayes inconvenienced, but the Child partakes with her. Now to the end she may maintain her self in good health, as much as can be in that condition, which alwayes keeps a middle state, let her observe a good dyet, suitable to her temperament, custom, condition and quality, which the right use of all the six non-natural doth effect. The Air, where she ordinarily dwells, ought to be well temper'd in all its qualities: if it be not so naturally, it must be corrected as much as may be by different means; she must avoid that which is too hot, because it often causeth, by dissipating too much the humours and spirits, many weaknesses to Women with Child, & particularly also that which is too cold and foggy; for, causing great Rhumes and distillations upon the lungs, it exciteth a cough, which by its sudden and impetuous motions, forcing downwards, may make the Woman miscarry. She ought not to dwell in narrow Lanes very dirty, nor near common Dunghils. For some Women are so nice, that the stink of a Candle not well extinguisht, is enough to bring them before their time, as Lie∣baut assures us he himself had seen: which likewise may be caused, if not sooner, by the smell of Char∣coal, as hapned once to a Laundress, whom I knew, hat miscarried the fourth mouth; being in extream Page 59 haste to finish some Linen on a Saturday night, she had not patience to kindle the Charcoal in the Chimney, but in the Room in a Chafingdish, which flew up into her head, and made her miscarry the same night, and in danger of dying. Let the Wo∣man therefore endeavour, as much as her conveni∣ence will permit, to live in an Air free from these inconveniencies. The greatest part of Women with Child have so great loathings, and so many different longings, and strong passions for strange things, that it is very difficult to prescribe an exact dyet for them: but I shall advise them in this case to follow the opinion of Hippocrates, in his 38th Aphorism, 2d Book, where he saith, Paulo deterior & potus & ci∣bus, suavior tamen, melioribus quidem, sed insuavio∣ribus, praeferendus. Meat and Drink though not so wholsome, if it be but pleasant, is to be preferred before that which is wholsom, if not so pleasant: which in my opinion is the rule they ought to ob∣serve, provided what they long for, is commonly used for dyet, and not strange and extraordinary things; and that they have a care of excess. If the Woman be not troubled with these loathings, let her then use such a dyet, which breeds good juyce, and in quantity sufficient for her and her Child: her appetite may regulate that. She must not then fast nor be abstemious, because overheating the Mothers blood thereby, renders it unfit to nou∣rish the Child, which ought to be sweet and mild, and makes it tender and weak, or constraius it to come before its time, to search what is fit for it else∣where: she must not eat too much at a time, and chiefly at nights, because the Womb by its extent Page 60 possessing a great part of the belly, hinders the stomach from containing much, which causeth thereby a difficulty of breathing, because it com∣presseth the Diaphragma, which as then hath not an intire liberty to be moved. Wherefore let her rather eat a little and often; let her bread be pure Wheat, well baked and white, as is that of Go∣nesse at Paris, or the like; and not course hous∣hold Bread or Bisket, which swells up the stomach, nor any other of the like nature that's very stuffing. Let her eat good nourishing meat, as are the ten∣derest parts of Beef and Mutton, Veal, Fowl; as fat Pullets, Capons, Pidgeons and Partridge, either roast or boyled as she likes best; fresh Egs are also good: And because big-bellied Women have never good blood, let her put into her Broths those herbs which purifie it, as Sorrel, Lettice, Succory, and Borrage; she must avoid hot-seasoned Pyes and baked Meats, and especially Crust, because being hard of digesti∣on, it extreamly overchargeth the stomach: If she hath a mind to Fish, let it be new, and not salted; Fish of Rivers and running streams, forasmuch as Pond-Fish tasts of mud, and breeds ill juyce. But if big-bellied Women cannot absolutely refrain their extravagant longings, it is better (as we have al∣ready said) to suffer them to deviate a little from this rule or dyet (provided it be moderate) than too much to oppose their appetites. They may drink at their meals a little good old Wine well temper'd with Water, and rather Claret than White-wine; which will help make a good digestion, and com∣fort the stomach, which is alwayes weak during prenancy; and if they were not used to drink it before, let them accustom themselves to it by de∣grees; Page 61 and as well in drinking as eating, they must shun all things hot and diurectick, because they provoke the courses, which is very prejudicial to the Child. By moderate sleep, all the natural functions of a Woman are fortified, and particularly the con∣coction of food in the stomach, which then is very subject to loathings and vomitings. We say, it must be moderate; because, as excessive watchings dissi∣pate the Spirits, so too much sleep choak them. Let therefore Women with Child sleep nine or ten hours at least in four and twenty, and twelve at most; and let it be rather in the night-time, as most fit for rest, than in the day, as persons of quality are accustomed, who frequenting the Court, ordinarily turn night into day. However they who have got∣ten this ill habit, had better continue it than change too suddenly, because this custom is become natural to them. For what respects exercise and rest, let them govern themselves according to the different time of their being with Child; for at the beginning of the con∣ception (if the Woman perceives it) she ought (if she can) to keep her bed, at least till the fifth or sixth day, and by no means to use copulation all the time; forasmuch as the Seeds being not yet co∣vered with the membrane, which is formed in that time (as we have said already) are in the beginning, by the agitation of the body, very apt in some per∣sons to slip forth. She ought neither to go in Coach, Chariot or Waggon, nor on Horseback, whilst with Child; and much less the nearer she comes to her time: because this kind of exercise doubles the weight of what is contained in the Page 62 Womb, by the jolts she receives, and often makes her miscarry: But she may walk gently, go in a Sedan or Litter; She ought neither to carry or lift heavy burdens, nor lift up her arms too high: and there∣fore she ought not to dress her own head, as she used to do, because it cannot be done without stretching her arms too much above her head, which hath caused many to miscarry before their time; because the ligaments of the Womb are at once loosned by these violent extensions. Let her exer∣cise be gentle walking, and the heels of her shoes low; because Women cannot, for the bigness of their bellies, see their feet, and so are subject to stumble and fall: In short, she must govern her self in these exercises, rather to err in too much rest, than in too much exercise; for the danger is greater by immoderate motion, than in too much rest. It is impossible for me in this point to be of the opinion of all Authors, although all the World follows them in this their evil and dangerous counsel, who would have a pregnant Woman exercise her self more than ordinary toward the latter end of her rec∣koning, that so, as they say, the Child may sink lower: But if they consider the point well, they would without doubt find it to be the cause of more than half of the hard Labours; and that on the con∣trary, rest would be more advantagious to them, as I shall prove by the following explication. First, We must know and take for granted that the birth of a Child ought to be left to the work of Nature well regulated, and not to provoke it, by shaking it with this exercise, for to dislodge it before its full time: which hapning (though it be but se∣ven or eight dayes sooner) proves sometimes as pre∣judicial Page 63 to the Infant, as we see it is sometimes to Grapes, which we find four or five dayes before they are full ripe, to be yet almost half Verjuice. But to explain more clearly than by this comparison, that these kind of exercises often cause hard labours, (as we have already said) consider that the Infant is naturally scituated in the Womb with the head uppermost, and the feet downwards, with its face towards the Mothers belly, just till it hath attained to the eighth month; at which time, and sometimes sooner, and sometimes also later, his head being very great and heavy, he turns over, his head downward and his heels upwards, which is the sole and true scituation, in which he ought to come in∣to the World, all other postures being contrary to Nature. Now just when the Child is about to turn according to custom into his intended posture, Instead of giving her self rest, she falls a jumping, walking, running up and down stairs, and exer∣cising her self more than ordinary, which very of∣ten causes it to turn cross, and not right as it ought to be; and sometimes the Womb is depressed so low, and engaged in such sort towards the last month, in the cavity of the Hypagastres, by these joltings, that there is no liberty left the Infant to turn it self naturally; wherefore it is constrained to come in its first posture, to wit, by the feet, or some other worse. Moreover, it would be very convenient that the Woman to this end should ab∣stain from Coition, during the two last months of her reckoning, forasmuch as the body is thereby much moved, and the belly compressed in the action, which likewise causeth the Child to take a wrong posture. I believe that they that will seri∣ously Page 64 reflect on these things, will make no diffi∣culty to quit this old error, which hath certainly caused the death of many Women and Children, and much pain to divers others, for the reasons a∣bove-mentioned. Some Women have miscarried only with the noise of a Cannon; as also with the sound of a great Bell; but especially with a clap of Thunder, when of a sudden it surpriseth them, and frights them. Big-bellied Women are sometimes subject to be costive, because the Womb by its weight pressing the Rectum; hinders the Belly from discharging its excrements with ease. They that are troubled with this inconvenience may use Damask-Prunes stewed, Veal-Broth, and Herb-Pottage, with which they may gently moisten and loosen the Belly. If these things are not sufficient, they may give her gentle Clysters of Mallows, Marsh-mallows, Pellitory and Anise-seeds, with two ounces of brown Sugar dissolved in it, adding a little Oyl of Violets, or else a Decoction made with a handful of Bran, two ounces of Honey of Violets, and a piece of fresh Butter; or any other as occasion might require: but there must be great care taken that no sharp Clysters be given her to this purpose, nor other Drugs to cause a loosness, or too great an evacua∣tion, lest it endanger her to miscarry: as Hippo∣crates very well warns us in the 34th Aphorism of his fifth Book, where he sayes, Mulieri in utero gerenti si alvus plurimum profluat, periculum est ne abortiat. If a big-bellied Woman have a violent loosness, she will be in danger of miscarrying. If she ought to govern her self well in the obser∣vation of what we have lately mentioned, she ought Page 65 no less to be careful to overcome and moderate her passions, as not to be excessive angry; and above all, that she be not afrighted; nor that any melan∣cholly news be suddenly told her: for these passi∣ons, when violent, are capable to make a Woman miscarry at the moment, even at any time of her go∣ing with Child; as it hapned to my Cousins Mo∣ther, named Mris Dionis, a Merchant, dwelling in the Street Quinquampois, whose Father being sud∣denly killed with a Sword by one of his Servants, who meeting him in the Street traiterously run him through out of spite and rage, because he had some few dayes before turned him out of doors: they brought immediatly this ill news to his Wife, then eight months gone, and presently after brought her dead Husband; at which sudden fright she was immediatly surprised with a great trembling, so that she was presently delivered of the said Dionis, who is to this day (which is very remarkable) troubled with a shaking in both hands, as his Mother had when she was delivered of him, having yet no o∣ther inconvenience, notwithstanding he was born in the eighth month by such an extraordinary acci∣dent; nor doth he seem to be above fourty years old, though near fifty. When he signed his Con∣tract of Marriage, they who knew not the reason of it, when they saw his hands shake, thought it was through fear of his ill Bargain, of which they were disabused when they had heard the Catastro∣phe that hastened his birth. Wherefore if there be any news to tell a big-bellied Woman, let it ra∣ther be such as may moderately rejoyce her, (for excessive joy may likewise prejudice her in this con∣dition) and if there be an absolute necessity to ac∣quiant Page 66 her with bad news, let the gentlest means be contrived to do it by degrees, and not all at once. Assoon as a Woman finds her self with Child, or mistrusts it, let her not lace her self so close, as she ordinarily doth, with Bodies stifned with Whalebone, to make her Body shapely, which very often injures her Breast, and so inclosing her Belly in so strait a mould, she hinders the Infant from taking its free growth, and very often makes it come before its time, and misshapen. Those Women are so foolish as not to mind, that making themselves slender when they are with Child, quite spoils their Belly, which therefore after Childbed remains wrinkled, and pendent as a Bag, and then they cry, It is the Midwife or Nurse that did them that mischief, in not swathing and looking to them as they ought to do; not considering that it came by their strait lacing whilst they were big upwards, which causeth the Belly, finding no place to be e∣qually extended on all sides, to dilate it self onely downwards, whither all the burthen is in that manner thrust and carried: to avoid which, let them use habits more large and easie; and wear no Busks, with which they presse their Bellies to bring them into shape. Let them also forbear Ba∣thing in any manner, after they know they have conceived, lest the Womb be excited to open before the time. Almost all big-bellied Women are so infatued with the custom to bleed when they are half gone, and in the seventh month, that if they should neglect it, (although they were otherwise well) they vvould never believe they could be well delivered. I will not in the mean time justifie and Page 67 make them believe by that, what Hippocrates saith in his 31th Aphorism of his 5th Book, Mulier in utero ferens, secta vena abortit, eoque magis si sit fae∣tus grandior. If (saith he) a Woman be blooded, she miscarries; and the rather, if she be far gone. This Aphorism must not prohibit us the use of bleed∣ing when the case requires, but only warns us to use it with great prudence; forasmuch as some Women want bleeding three or four times, yea, and oftner sometimes, whilst they are with Child, when twice may be sufficient to others: For as there have been some that have been blooded nine or ten times for diseases during their pregnancy, and yet go on with their Infant to their full account; so others have miscarried by bleeding but once a little too copiously, as in this Aphorism speaks Hippocra∣tes. Now since all are not of the same nature, they must not be all governed after the same man∣ner, nor believe that it is necessary to bleed all big-bellied Women; one may judge of the neces∣sity according as they are more or less sanguine. It is the same in purging, which ought to be prudent∣ly administred as well as bleeding, according to the exigency of the case, using alwayes gentle and be∣nign remedies when they are necessary; as Cassia, Rhubarb, Manna, with the weight of a dram or two at most of good Senna. These Purgatives may serve turn for a Woman with Child, she ought not to use others more violent: If she observes all that we have above mentioned, she may then hope for a good issue of her great-Belly. Having amply enough declared, how a Woman with Child should be governed when accompanied with no ill accident, and given the Rules she ought Page 68 to keep to prevent them, We will now examine se∣veral Indispositions, to which she is subject parti∣cularly during her pregnancy. CHAP. XI. The means to prevent the many Accidents, which happen to a Woman during the whole time of her being with Child; and first of Vomitings. VOmiting, with the suppression of the Terms, is for the most part the first Accident which happens to Women, and the means by which they themselves perceive their pregnancy. It is not al∣wayes caused, as is believed, from ill humours col∣lected in the stomach, because of this stoppage of their Courses: these corrupted humours do often cause a depraved appetite in pregnant Women, when either they flow thither, or are there engen∣dred; but not this Vomiting which happens im∣mediately after Conception, and which comes by succession: it cannot be meant of those which are there afterwards corrupted; but these first Vomit∣ings proceed from the sympathy between the Sto∣mach and the Womb, because of the similitude of their substance, and by means of the Nerves in∣serted in the upper orifice of the Stomach, which have communication by continuity with those that pass to the Womb, being portions of the sixth pair of those of the Brain. Now the Womb, which hath a very exquisite sense, because of its mem∣branous composition, beginning to wax bigger, Page 69 feels some pain, which being at the same time com∣municated by this continuity of Nerves to the upper orifice of the Stomach, cause there these nauseatings and vomitings which ordinarily happen. And to prove that it is thus in the beginning, and not by pretended ill humours, appears, in that many Wo∣men vomit from the first day of their being with Child, who were in perfect health before they con∣ceived, at which time the suppression of the Terms could not cause this Accident, which proceedeth from this sympathy in the very same manner; as we see those that are wounded in the Head and Bowels, and that have the Stone-Cholick, are troubled with Loathings and Vomitings, and yet have no cor∣rupt humours in the stomach. Loathings and Vo∣mitings, which are motions of the stomach con∣trary to nature, happen to big-bellied Women from the beginning, for the reasons above recited. Loathing or Nauseousness, is nothing but a vain desire to vomit, and a motion by which the Sto∣mach is raised towards the upper orifice, without casting up any thing. And Vomiting is another more violent endeavour, by which it casts forth of the mouth what humour soever is contained in its capacity. In the beginning Vomiting is but a single symptom not to be feared; but continuing a long time, it weakens the stomach very much, and hindring digestion, corrupts the food instead of con∣cocting it, whence afterwards are engendred those ill humours, which need purging. These Vomitings ordinarily continue to the third or fourth month of being with Child, which is the time the Child ap∣pears manifestly to quicken in, after which it begins to cease, and Women to recover the appetite they Page 70 had lost during their being young with Child; because the Infant growing stronger and bigger, having need of more nourishment, consumes abun∣dance of humours, which hinders the flowing of so much superfluity to the stomach; besides, at that time the Womb is by degrees accustomed to exten∣tion: It continues in some till they are delivered, which often puts them in danger of miscarrying, and the rather, the nearer the Woman is to her full time. Others again are more sometimes tormented with it towards the end of their reckoning than at the beginning: because the stomach cannot then be sufficiently widened to contain easily the food, being compressed by the large extention and big∣ness of the Womb. Such a Vomiting which comes about the latter end of the reckoning to Women whose Children lie high, seldom ceaseth before they are brought to bed. You need not wonder, or be much troubled at the Vomitings in the beginning, provided they are gentle and without great straining, because they are on the contrary very beneficial to Women; but if they continue longer than the third or fourth month, they ought to be remedied, because the Aliment being daily vomited up, the Mother and the Child, having need of much blood for their nourishment, will thereby grow extreamly weak, besides the continual subversion of the stomach, cau∣sing great agitation nd compression of the Mothers Belly, will force the Child before its time, as is already mentioned. To hinder this Vomiting from afflicting the Woman much or long (it being very difficult to hinder it quite) let her use good food, such as is Page 71 specified before in the Rules or Diet; but little at a time, that the stomach may contain it without pain, and not be constrained to vomit it up, as it must when they take too much, because the big-belly hinders the free extension of it; and for to comfort and strengthen it (being alwayes weak) let her season her meat with the Juice of Orenges, Lem∣ons, Pomegranets, or a little Verjuce or Rose-Vi∣negar, according to her appetite. She may take likewise a Decoction made of French-Barley∣flower, or good Wheat-flower, having dryed the flower a little before in an Oven, mixing the yolk of an Egg with it, which is very nourishing and of easie digestion: she may likewise eat after her meals a little Marmalade of Quinces, or the Jelly of Goosberries; let her Drink be good old Wine, rather Claret than White, being well mixed with good running Fountain-Water, and not that which hath been long kept in Cisterns, as is most of the Water of our Fountains of Paris, which acquire by that stay an evil quality: If she cannot get such fresh Waters, let her rather use River-Water taken up in a place free from filth, in which she may sometimes quench hot Iron: Above all, let her for∣bear all fat Meats and Sauces, for they extreamly moisten and soften the Membranes of the Stomach, which are already weak enough, and relaxed by the Vomitings, as also all sweet and sugered Sau∣ces, which are not convenient for her, but rather such as are a little sharp, with which it is delighted and comforted. But if notwithstanding these Precautions, and this regular Dyet, the Vomiting (as it some∣times happens) continues still, although the Wo∣man Page 72 be above half gone, it is a clear sign there are corrupt humours cleaving to the inward sides of the Stomach, which being impossible to be evacuated by so many preceding Vomitings, because they ad∣here so fast, must be purged away by Stool, to effect which they need a Dissolvent, which may be a gentle Purge, made by infusing half a dram of Rhubarb, a dram or two at most of good Senna, and an ounce of Syrup of Succory; which Purge dissolves the hu∣mours, and in evacuating them, comforts the parts: Or, it may be made with young Mallows, Cassia, Tamarinds, or any other gentle Purgers, according as the case requires, alwayes adding a little Rhu∣barb, or compound Syrup of Succory; observing likewise what humours ought to be purged: For, as Hippocrates saith, in the 12th Aphorism of his first Section, In perturbationibus ventris, & vomi∣tibus sponte evenientibus, si quidem qualia oportet purgari, purgentur, confert & facile ferunt: sin mi∣nus contra, &. In perturbations and dejections of the Belly, and in spontaneous Vomitings, if the matter be purg'd away, which ought to be, the Pa∣tient finds ease and comfort: if not, the contrary. Therefore we are to consider, that it is not enough to purge, unless we evacuate the peccant humours; for otherwise purging more weakens the Stomach, which it would not if it were well ordered, and convenient to evacuate the vicious humour. If once be not sufficient, it may be repeated, giving the Woman some few dayes respit between both; if the Vomiting continues daily, almost without in∣termission, although the Woman observes a good dyet, and after that she hath been reasonably well purged, we must rest there, lest something worse Page 73 happen, of which we may incur the blame; for she is then in great danger of miscarrying: and when the Hiccough takes them through emptiness, pro∣ceeding from too much evacuation, caused by these continual vomitings, it is very bad, as the third Aphorism of the second Book teacheth us, A Vomitu singultus malum. Some advise, that after all these things have been tryed in vain, great Cupping-glasses should be ap∣plyed to the region of the stomach, to keep it firm in its place: but I believe it to be a Chip in Pottage, which doth neither good nor hurt; because the sto∣mach is loose, and no wayes adhering to this upper part of the belly: but since these Vomitings cool it, and daily weaken it, I should advise a big-bellied Woman to wear in the Winter, upon its region, a good piece of warm Serge, or soft Lambskin, which would a little warm those parts, and help digestion, which is alwayes weak. The Italians have a Cu∣stom, which is not bad; they wear to the same pur∣pose a fair piece of Stuff under their Doublets upon the region their stomach, of which they are so care∣ful, that if they should leave it off but two dayes in the Winter, nay even in the Summer, they would think themselves sick; and they are so grear lovers, and so curious of it, that this Stomacher is often their greatest bravery, enriching it with Gold and Silver Embroidery, and Ribonds of very fine co∣lours. We have discoursed enough about Vomiting caused by Pregnancy, wherefore we will pass for∣wards to some other Accidents. Page 74 CHAP. XII. Of Pains of the Back, Reins, and Hips. ALL these Accidents are but the effects of the dilatation of the Womb, and the compres∣sion it makes by its greatness and weight on the neighbouring parts; which are much greater the first time the Woman is with Child than after∣wards, when the Womb only receives the same di∣mensions it had already before: but when it hath not yet been dilated, it is more sensible of this ex∣tention, and the ligaments, which hold it in its na∣tural scituation, suffer a greater stress in the first pregnancy, having never before been forced to lengthen to answer the extent of the Womb, than in the following Great-Bellies, to which it obeys more easily the second time. These ligaments, as well round as large, cause these pains, being much straitned and drawn by the bigness and weight of the Womb, which con∣tains a Child, to wit, the large ones, those of the back and loyns, which answer to the reins, because these two ligaments are strongly fastened towards these parts; the round ones cause those of the groins, share, and thighs, where they terminate. They are sometimes so violently extended by this extream bigness and great weight of the Womb, especially of the first Child (as I said before) that they are lacerated and torn, being not able to yeeld or stretch any farther, and chiefly if the Woman in that condition makes a false step, which causeth in Page 75 them almost insupportable pains, and other worse accidents; as it happened two years since to a near Kinswoman of mine, who being six months gone, or thereabouts, of her first Child, felt the like af∣ter she had stumbled, and perceived at the same mo∣ment something crack in her Belly towards the re∣gion of the Reins and Loins, which was one of these large ligaments, with a kind of noise, by the sudden jolt she received. At the same instant she felt ex∣tream pains in her Reins and Loins, and all the one side of her Belly, which made her immediately vo∣mit very often with much violence, and the next day she was taken with a great continued Feaver, which lasted seven or eight dayes, without being able to sleep or rest one hour, all which time she continued to vomit all she took, with a strong and frequent Hiccough, having also great pains, which seemed as if they would hasten her Labour, which (for her sake) I was very apprehensive of, as also of her death: but with the help of God, having put her immediatly to bed, where she continued twelve whole dayes, in which time I bled her thrice in her Arm on several dayes, and made her take at two several times a small grain of Laudanum in the yolk of an Egg, a little to ease her violent pains by giving her rest, alwayes ordering her from time to time good strengthning Cordials; all these symp∣toms, which at first seemed desperate, ceased by little and little, and she went on her full time, when she was happily delivered of a Son, which lived fifteen months notwithstanding all those mischievous acci∣dents she met with, which were enough to have kill'd half a dozen others: but God sometimes is pleased to work Miracles by Nature, aided with Page 76 Remedies fit for the purpose, as well as by his Grace. This History informs us (I think) very well how these Pains of the Loins, Back, and Reins come; and the pregnant Womb causeth also those of the Hips by its greatness and weight, in compressing them, and bearing too much upon them. There is nothing will ease all these sorts of Pains better, than to rest in Bed, and bleed in the Arm, if there were any great extension or rupture of any ligament of the Womb, as was in the case recited: And when the Womb bears and weighs too much upon the Hips, if the Woman cannot keep her Bed, she ought to support and comfort her Belly with a broad Swaith well fitted for the purpose, and to bear it as patiently as she can to the time of her Labour, which will free her from all these accidents. CHAP. XIII. Of the Pains of the Breasts. AS soon as a Woman conceives, her Tearms wanting the ordinary evacuation, the passages being stopt, and the Woman breeding daily blood, there is a necessity, she consuming but little whilst young with Child, the fruit being yet very little also, that the vessels which are too full, should dis∣gorge part, as it doth upon the parts disposed to receive it, such as are the kernels, and glandulous parts, especially the Breasts, which imbibe and re∣ceive a great quantity of it, which filling and ex∣treamly Page 77 swelling them, causeth this Pain in them, which Women feel when they are with Child, and happens also to those whose Terms are only suppres∣sed. In the beginning we ought to leave the whole work to Nature, and the Woman must only have a care she receives no blows upon those parts, which are then very tender, nor be straight laced with her Bodies, or other stiff Wastcoats, that might bruise and wound her; upon which follow Inflamations and Abscess: But after the third or fourth month of going with Child, the blood being still sent to the Breasts in great abundance, 'tis much better to eva∣cuate it by bleeding in th'Arm, than to turn or drive it back on some other part of the Body by repercus∣sive or astringent Medicines; because it cannot flow to any part, where it can do less hurt, than in these. Wherefore I should rather prefer the Wo∣man being very plethorick, to evacuation, by bleed∣ing in the Arm, than any other way, because of shunning thereby the Accident, of which speaks Hippocrates in his 40th Aphorism of the 5th Book, Quibus Mulierilbus in Mammas sanguis colligitur, furorem significat: If the blood be carried in too great abundance to the Breasts, it signifies that the Woman is in danger of being frantick, because of the transport which may be made thence to the Brain; which accident is avoided by moderate bleeding in the Arm, as also by a regular cooling dyet, moderately nourishing, for to diminish the quantity, and temper the heat of the humours of the whole habite. Page 78 CHAP. XIV. Of Incontinence, and difficulty of Urine. THe scituation of the Bladder, which is placed just upon the Womb, is sufficient to instruct us wherefore pregnant Women are sometimes troubled with difficulty of urine, and the reason why they cannot often hinder, nor scarce retain their water; which is caused two wayes: 1. Because the Womb with Child by its bigness and weight compresseth the Bladder, so that it is hindred from having its ordinary extension, and so incapable of containing a reasonable quantity of urine: Which is the cause that the bigger the Woman grows, and the nearer her time she approaches, the oftner she is compelled to make water, which for that reason they cannot keep. 2. If the weighty burden of the Womb doth very much compress the bottom of the Bladder, it forceth the Women to make water every moment: but contrarily, if the neck of it be pressed, it is filled so extreamly with urine, which stayes there with great pain, being not able to expel it, forasmuch as the Sphincter, because of this compression, cannot be opened to let it out. Sometimes also the urine by its acrimony excites the Bladder very often by prick∣ing it, to discharge it self; and sometimes by its heat it makes an inflamation in the neck of the Blad∣der, which causeth its suppression. It may be like∣wise that this Accident is caused by some Stone con∣tained in the Bladder; then the pains of it are al∣most Page 79 insupportable, and much more dangerous to Woman with Child, than to one that is not; be∣cause the Womb by its swelling causeth perpetually the stone to press against the Bladder; and so much the violenter are these pains, as the stone is greater, or the figure of it unequal and sharp. It is of great consequence to hinder these violent and frequent endeavours of a big-bellied Woman to make water, and to remedy it, if possible, both in one and the other indispositions; because by long continuance of alwayes forcing downwards to make water, the Womb is loosned and bears very much down, and sometimes is forced (the inconvenience not ceasing) to discharge it self of its burden be∣fore the ordinary time. This is that should be en∣deavoured to be hindred, having respect to the different cause of the distemper; as when it comes from the bigness and weight of the Womb, pressing the Bladder, as it is for the most part: the Woman may remedy it, and ease her self, if when she would make water, she lift up with both her hands the bottom of her belly: she may wear a large Swaith accommodated to this use, which will bear it up if there be occasion, and hinder it from bearing too much upon the Bladder; or, to do better, she may keep her Bed. If it be the acrimony of the urine that makes the inflammation on the neck of the Bladder, it may be appeased by a regular cooling dyet, drinking only Ptisan, and forbearing the use of Wine, and all sorts of Purgations, because they send the filth of the whole body to the part affected, and by their heat do yet more augment the acrimony and inflamma∣tion: but she will do well to use, mornings and Page 80 evenings, Emulsions made with the cold Seeds, or Whey mixt with Syrup of Violets. This Remedy is proper, by refreshing gently, to cleanse the urina∣ry passages, without prejudicing either the Mother or Infant. If the inflammation and acrimony of the Urine be not removed by this Rule of Dyet, they may let her blood a little in the Arm, to pre∣vent, any ill accident that may happen: they may likewise bath her outward entry of the neck of her Bladder with a Decoction of emollient and cooling Herbs, as the leaves of Mallows, Marsh-mallows, Pellitory, and Violets, with a little Linseed, which being viscous, will help the conduit of the Urine to dilate it self the easier; there may be also Injections given into the Bladder of the same Decoction, to which may be added Honey of Violets, or else of lukewarm Milk. But if the Woman, notwithstanding she observes these Directions, cannot make water, recourse must be had to the last remedy, which is, to draw it forth by a Catheter, represented and marked with the Letter M in the Table of Instruments, at the end of the second Book, which being anointed with Oyl Olive, or sweet Almonds, having first lifted up and thrusted the Belly a little upwards, must be gently introduced by the urinary passages into the very hollow of the Bladder, and then the Urine will immediately pass away; which being finished, the Catheter must be taken forth, and if the sup∣pression continues, it may be used again in the same manner until the accident quite leave her, and then they may try whether she can urine naturally. If she be in very great extremity, she may use an half-Bath luke-warm, provided she be not too much Page 81 moved by this Remedy, abstaining also from all Diureticks, which are very prejudicial to big-bellied Women, because they provoke abortion. If on the other side, this evil arises from the Stone, which presenting it self to the neck of the Bladder, stops the urinary passage, whilst with Child; she must be contented to have it only thrust back with a Ca∣theter: but if it be small, one may try to draw it forth with a small Probe fit for the purpose, putting the fore-finger into the Vagina, to keep it in sub∣jection that it recoyl not back towards the Bladder, which is only to be done to the small ones; for she must be delivered before the great ones can be drawn forth, it being better to leave her in that condition, than to endanger her life or the Childs, by draw∣ing it. CHAP. XV. Of the Cough, and difficult breathing. WOmen whose Children lie low, are oftener troubled with difficulty of Urine (as we have mentioned in the foregoing Chapter) than they whose Children lie higher, who are indeed exempt∣ed from this and the like inconvenience, but are then more subject to a Cough and difficulty of breathing than the former. A Cough, if violent, as sometimes, even to vo∣miting, is one of the most dangerous accidents, which contributes to Abortion, because it is an es∣say by which the Lungs endeavour to cast forth of Page 82 the Breast that which offends them, by a compressi∣on of all its Muscles, which pressing all the inclosed air inwards, with which the Lungs are much ex∣tended, thrusts also by the same means with a sud∣den violence the Diaphragma downwards, and con∣sequently all the parts of the lower Belly, but par∣ticularly the Womb of the pregnant Woman, which accident continuing long and violent, often causeth her to come before her time. This Cough proceeds sometimes from sharp and biting rheumes, which distill from the brain upon the sharp Artery and the Lungs, and sometimes from a blood of the like nature, which flowes from the whole habit towards the Breast, upon the sup∣pression of the Terms; as also from having breathed in too cold an air, which irritates the parts, and excites them to move in that manner; but being be∣gun by these causes, it is very often augmented by the compression the Womb of the pregnant Wo∣man makes upon the Diaphragma, which cannot have its free liberty in those that bear their Chil∣dren high, because by its great extension it bears up almost all the parts of the lower Belly towards the Breast, and principally the Stomach and Liver, forcing them against the Diaphragma, which is thereby compressed, as we have said. This may be remedied by the Womans obser∣ving a good diet something cooling: if sharp hu∣mours cause it, avoiding all meats salted, spiced, or hautgoust; she must forbear sharp things, as Oren∣ges, Citrons, Pomgranats, Vinegar, and others of the like nature, because they yet more and more by their pricking quality excite the Cough: but she may make use of Lenitives and such as sweeten the Page 83 passages, as juice of Liquorish, Sugarcandy, and Sy∣rup of Violets, or Mulberries, of which they may mix some spoonfuls with a Ptysan made with Juju∣bes, Sebestens, Raisons of the Sun and French Barly, alwayes adding a little Liquorish to it: It may not likewise be amiss to turn the abundance of these hu∣mours, and draw them downwards by some gentle Clyster. If this regimen prevails nothing, and that there appears signs of fulness of blood, it will be necessary, at whatsoever time it be of her going with Child, to bleed her in the Arm, and though this remedy be not usually practised when they are young with Child, yet in this case it must: for a continual Cough is much more dangerous than mo∣derate bleeding. If the Cough comes of cold, let her be kept in a close Chamber with a Napkin three or four times double about her Neck, or a Lamb∣skin, that it may keep her warm; and going to bed let her take three or four spoonfuls of Syrup of burnt Wine, which is very pectoral, and causeth a good digestion, if it be made in the following manner: Take half a pint of good Wine, two drams of good Cinamon bruised, half a dozen Cloves, with four ounces of Sugar; put them together in a Sil∣ver Porenger, and cause them to boil upon a Chafin∣dish of coals, burn it, and afterwards boil it to the consistence of a Syrup, which let the Woman take at night, an hour or two after a light supper. It must alwayes be observed from whatsoever cause the Cough proceeds, that the Woman go loose in her clothes, for being strait-laced, the Womb is the more thrust down, by the endeavours the Cough causeth it to make. And because sleep is very pro∣per to stay defluxions, it may be procured (if there Page 84 be occasion) by some small Julip using by no means the strong Stupesactives, which are dangerous to a Woman with Child, if there be not a very great nece•sity, as there was in my Kinswoman, who had furious accidents by the hurt she got from the stum∣ble, of which I gave you an account in the 12th Chapter of this Book. There are Women that carry their Children so high (especially their first, because the large Liga∣ment, which support the Womb are not yet relax∣ed) that they think them to be in their Breast, which causeth so great an oppression and difficulty of breathing, that they fear they shall be choaked as∣soon as they have either eaten a little, walked, or gone up a pair of Stairs: which comes (as I said before) by reason the Womb is much enlarged, and greatly presseth the Stomach and the Liver, which forces the Diaphragma upwards, leaving it no free liberty to be moved, whence is caused this difficul∣ty of breathing. Sometimes also their Lungs are so full of blood, which is driven thither from all parts of the body when with Child, that it hardly leaves passage for the air: if so, they will breath more easi∣ly as soon as a little blood is taken from the Arm, because by that means the Lungs are emptied and have more liberty to be moved: But if this diffi∣culty of breathing comes from a compression made by the Womb against the Diaphragma, in forcing the parts of the lower Belly against it; the best re∣medy is to wear their clothes loose about them; and rather eat little and often, than to fill their Bellies too much at once: because it is thereby more pressed against the Diaphragma, and so augments the acci∣dent. Neither must she use any viscous or windy Page 85 meats, as Pease, &c. but only such as are of an easie digestion: she must all the while avoid any occasion of grief and fear, because these two passions drive the blood to the Heart and Lungs in too great abun∣dance, so that the Woman, who can hardly alrea∣dy breath, and hath her Breast stuft, will be in dan∣ger of being suffocated: for the abundance of blood filling at once and above measure the Ventricles of the Heart, hinders its motion, without which one cannot live. CHAP. XVI. Of the swelling and pains of the Thighs and Legs. IT is very easie for them that are acquainted with the Circulation of the Blood, to conceive the reason why many big-bellied Women have their Legs and Thighs swelled and pained, and sometimes full of red spots, from the swelling of the Veins, all along the inside of them, which extreamly hinders their going. Many think (which is in some measure true) that the Woman having more Blood than the Infant needs for its nourishment, Nature, by vertue of the expulsive faculty of the upper parts, which are alwayes most strong, drives the superfluity of it upon the lower, which are the Legs, as most feeble and aptest to receive it, because of their scituation: to explain it thus is something to purpose; but I think the Circulation. of the Blood will teach us better how this comes, than that we need to have recourse to this expulsive faculty. Page 86 It is then thus, according to my opinion, Follow∣ing the ordinary motion of the Blood, the Crural and the Saphene Veins receive into them what is brought to the lower parts by the Arteries, and convey it along the Leg and Thigh, ascending still by the Iliacks towards the Heart, which are empti∣ed, into the Cava, to ascend again by it to the Heart, and so successively. This being so de facto (as need not be doubted, since it is a verity founded upon experience) when a Woman is with Child, and chiefly towards the last months, and the Womb is much extended, and possesseth a great part of the lower Belly, then it begins to press the Iliack Veins by its greatness and heaviness, and so hinders the Blood, from following its course, and having its motion so free, as before she was with Child; which being so, the inferior parts, which are the Crural and Saphene Veins, become swelled, much in the same manner as the Veins of the Arm do upwards when bound with a Ligature for bleeding, or by any strong compression upon the upper parts; which happens, because the Veins being compressed, the Blood is there stopt, finding its passage more diffi∣cult. The Iliack Veins being then so pressed by the bigness and heaviness of the Womb, all those of the Legs and Thighes swell in such a manner, as that they empty themselves into the substance of the parts, and throughout the five Coverings, which thence become swelled; yea and these Veins, and amongst the rest the Saphenes, dilated and become varicose, sometimes from the inward and upper parts of the Thigh to the very extremity of the Foot, in which the Blood stagnating without its free circu∣lation, is altered and corrupted, which causeth great Page 87 pains and swellings in all these parts. This oftner befalls Women that are very sanguine, walk much, and use great exercise, which aided with a fulness of the Vein, makes a rupture of the Valvules, which serve to facilitate the motion of the Blood; as the suckers of a Pump, which retain the water when it is raised thither: which Blood falling down again, not being so supported, causeth by its quantity and stay, these dilatations of the Veins, which are called Varices. For to remedy this, when a Woman hath her Veins dilated, let her only use, whilst she is with Child, a palliative cure, in swaithing this Varicos-part with a swaith three or four fingers broad, ac∣cording to the bigness of it, beginning to swaith from the bottom, and conducting it upwards to the beginning of the Varices, that by this means these varicos Veins, which are alwayes outward, being moderately closed, should be hindred by this com∣pression from further dilating, and the Blood not be corrupted by the stay it makes there, which af∣ter this will not want its circular motion, because the greatest part of it passeth then by the Vessels deeper placed. A Woman in this condition should likewise keep her bed, if she can, because by this scituation, her body being equally layed, the Blood circulates much the easier, and is not then so much troubled to return by these Veins to the Heart, as when it must ascend by them, the Woman stand∣ing upright; which is the cause the Legs alwayes are more swell'd at night than mornings: if there be in any other parts of the Body signs of plenitude and abundance of Blood, they may bleed her with∣out danger. Page 88 There are other Women, whose Legs only swell because of their weakness, and not for the reason just above mentioned, and are so oedematous, that when you press them with your Finger, the print of it remains there; which is, because they want natu∣ral heat sufficient to concoct and digest all the nou∣rishment, sent to them, and to expell the superfluities of it, which by that means remaining there in great quantity, leaves them so oedematous. For, to resolve these sort of Tumours, you may use a Lee made with the Ashes of Vines, and the Decoction of Melilot, Camomile and Lavender; afterwards they may be somented with Aromatick Wine, in which they may moisten their compresses to be laid up∣on them, repeating them three or four times a day to fortifie them; which may be made with Rosemary, Bayes, Tyme, Marjoram, Sage, and Lavender, of each an handful; of Province-Roses half a handful, Pomegranat flowers and Alum, each an ounce; boil them together in strong Red-Wine, three pints, to the consumption of a third part, strain it, and keep it for the use above mentioned. But since Pregnancy for the most part causeth these tu∣mours, they likewise ordinarily cease when the Woman is brought to bed, because then she purgeth forth the superfluity of her whole habit by means of her Lochia. Page 89 CHAP. XVII. Of the Hemorrhoids. THe menstrous Blood, that used to be purged away every month, being collected in a great quantity near the Womb (which permits it not now to be evacuated by the usual passage, being so exact∣ly closed during Pregnancy) is forced to flow back into the whole habit, and chiefly upon the neigh∣bouring parts of the Womb, and causeth in many the Hemorrhoids both internal and external. All the several sorts of them, which we shall not de∣scribe, may as well happen to them at this time as at another: but we will only speak of that sort which is caused by pregnancy, because our design is only to make known some particulars of the maladies Women are in this condition subject to. Hemorrhoids are tumours and painful inflamma∣tions, ingendred by a flux of humours upon the ex∣tremities of the Hemorrhoid Veins and Arteries, and are caused in great-bellied Women by the a∣bundance of Blood which is cast upon these parts, because the body at this time is not purged of its superfluities, as it was accustomed before: It is like∣wise very often caused by the great endeavours that Women sometimes make to go to stool when they are costive; because the Womb being placed upon the Rectum, hinders by pressing it, the excrements contained in it from being easily extruded; and by these endeavours the Blood, which is in the neigh∣bouring Vessels, being likewise expressed, swells and Page 90 blows up their extremities, upon which comes these painful inflamations, call'd Hemorrhoids, of which some are internal, some external, some small and with little or no pain, and some extreamly big and painful. This may suffice for their general differen∣ces, without coming to their particulars, which would require a more ample explication. If they are small and without pain, either inter∣nal or external, it is easie enough to prevent their further growth, by Remedies, which hinder and turn the flux from those parts: but there is more reason to cure the great and painful ones, by easing first the great pain, for as long as that con∣tinues the Flux is ever augmented. To this purpose, if the big-bellied Woman have in the rest of her bo∣dy other signs of repletion, she may safely be once let blood in the Arm, and sometimes (if there be great necessity) twice, for to turn away the humours, and to evacuate the fulness, by which the pain will like∣wise be appeased: If the gross excrements retained in the right Gut be the cause of it, and that she be costive, let her take an emollient Clyster of the De∣coction of Mallows, Marshmallows, Pellitory, and Violets, with Hony of Violets, to which may be added, Oyl of sweet Almonds, or sweet Butter; be∣ing careful to add nothing that may irritate, lest it augment the Disease, especially when they are in∣ward Piles: And to the end the Women may then the better receive the Clyster, tis fit that a small end of a Pullets gut be put upon the end of the pipe, to cover it on the outside, that so it may be put up the Fundament with less pain, afterwards let her keep a moderate and cooling diet, and continue in bed till this flux of humours be passed, and the mean Page 91 time anoint the Piles with hot stroakings from the Cow, or foment them with the Decoction of Marsh∣mallows, White-broth, and Linseed: Oil of sweet Almonds, Poppies, and Water-Lillies well beaten together with the yolk of an Egg, and ground in a leaden Mortar, are very anodine and proper to ease pain; and if the inflammation be great, anoint it a little with Uuguentum Refrigerans Galeni, and Populean, equally mixed. After a good diet, bleeding, and the application only of these cooling and anodine Remedies (Re∣percussives being not then to be used, lest they re∣pel the impure Blood, or harden the Piles) if their swelling doth not abate, Leeches must be applied, to draw and empty the Blood there gathered; or they may be opened with a Lancet, if soft, or any kind of inundation: but Leeches is more proper for hard Piles, and as it were fleshy, because they do not put one to so much pain as the Lancet: Al∣though some men by the help of these Piles, have an evacuation, almost natural, being relieved by it when they bleed moderately, Nature being ac∣customed to it: yet it is not so in Women, but al∣wayes contrary to Nature; because the evacuati∣on which happens to those men by the Piles, ought always to be made by the Womb in Women, if not with Child: but if they are, it may in some man∣ner, in case the Woman be plethorick, supply al∣so the defect of the natural; for, provided they bleed moderately and without pain, she may there∣by be also relieved: but if they flow in too great quantity, there is danger that both Mother and In∣fant will be weakened by it; and to avoid it, 'tis convenient to make astringent Fomentations with Page 92 the Decoction of Granat flowers, the rinds of Pome∣granates and Province-Roses, made with Smiths∣water and a little Alum; or this Cataplasm may be applyed to it, made with Bole-armonack, Dragons∣blood, and Terra Sigillata, with the white of an Egg: As also to turn back the Blood from these parts by bleeding in the Arm, and by dry cupping-glasses, applied to the region of the Reines, and other remedies convenient for this distemper, and such as the accident requires. CHAP. XVIII. Of the several Fluxes which may happen to a Woman with Child, and first of a Loosness. THree several Fluxes may befall a great-bellied Woman, to wit, the Flux of the Belly, the Flux of the Terms, and Floodings. We shall first speak of the Flux of the Belly, and afterwards we will examine the other two, in the two following Chap∣ters. There are ordinarily reckoned three sorts of Loos∣nesses, which in general is a frequent dejection of what is contained in the Guts, by stool: the first is called Lienteria, by which the Stomach and the Guts, not having digested the nourishments received, lets it pass almost quit raw. The second is called Diarrhaea, by which they simply discharge the hu∣mours and excrements which they contain. And the third, which is the worst, is Dysenteria, by which the Patient, together with the humours and excrements, voids Blood with violent pains, caused by the ulceration of the Guts. Page 93 Of what kind soever the Flux is, if it be great, and continue long, it puts the Woman in great danger of miscarrying; which Hippocrates tells us in the 34th Aphorism of his 5th Book: Mulieri in utero gerenti, si alvus plurimum profluat, periculum est ne abortiat. For, if it be a Lienteria, the Stomach not containing the Food received, and letting it im∣mediatly pass away before it be turned into Chyle, of which Blood ought to be made for the nourish∣ment of Mother and Child, it is not possible but they must be both thereby extreamly weakned for want of nourishment: If it be a Diarrhaea, and con∣tinues long, it will occasion the same accident; be∣cause there is a great dissipation of the Spirits, toge∣ther with the evacuation of humours: But the dan∣ger is much greater when a Dysenteria, forasmuch as the Woman hath then great pains and gripes in the Guts caused by their ulceration, which excites them continually by constant stimulations to dis∣charge themselves of the sharp and bilious humours, with which they are extreamly annoyed; which causeth a great disturbance and violent commotion of the Womb, being placed upon the right Gut; and to the Child contained in it, and by the com∣pression which the Muscles of the Belly make on all sides, as also those that are made by them of the Diaphragma, which force themselves down∣wards in the endeavours a Woman makes so often to go to stool with pain, the Child is constrained because of this violence to come before its time, which arrives so much the oftner, by how much these stimulations and needings are greater, as the same Hippocrates notes in the 27th Aphorism of his 7th Book, Mulieri utero gerenti, si tentio superve∣nerit, Page 94 facit abortum. If there happens a tenesme (saith he) to a Woman with Child, it make her miscarry. This tenesme is a great passion of the right Gut, which forceth it to make these violent endea∣vours to discharge it self, without being able to avoid any thing, but cholerick humors mixt with Blood, with which it is continually irritated. When this Flux of the Belly happens to a big∣bellied Woman, it is ordinarily, because they have alwayes the digestion of their stomach weak, by reason of their bad dyet, which their strange appe∣tites cause them often to long for: by the continual use of which being at length weakned, it suffers the food to pass immediately without digestion; or if it stay longer, it is converted into a corrupted Chyle, which descending into the Guts, irritates them by its acrimony to discharge themselves as soon as they can. Now to proceed safely to the cure of these diffe∣rent Fluxes of the Belly (to which 'tis fit care should be taken in good time, lest the Woman miscarry, as we have already said) the nature of it must be con∣sidered, to the end the cause, which maintains it, should be remedied. If it be a Lienteria following (as is usual) continual Vomitings, which have so debilitated the Stomach, and relaxed its membranes, that having no longer strength to vomit up that food, it suffers it to pass downwards without di∣gestion: In this case a Woman must abstain from all those irregular appetites, and accustom her self to good food of easie digestion, and little at a time, that so her Stomach may be able the easier to concoct and digest it; she should drink a little deep Claret-Wine, mixed with Water in which Iron hath been Page 95 quenched, instead of Ptysan, which is not proper in this case, provided she have not a strong Feaver; for if it be but a small Feaver, Wine on this man∣ner is to be preferred, forasmuch as the fewer she hath at that time, is but symptomatick, caused by this debility of Stomach, and will vanish as soon as this is fortified; which will be yet more promoted, if the Woman before and after meals takes some Corroberatives, as a little of that Burnt-Wine we mentioned for the Cough in the 15th Chapter of this Book; or a little good Hippocras, or right Ca∣nary, of any of them according to her pallat; nei∣ther will it be amiss if she eats a little good Marma∣lade of Quince before meals: She may likewise wear upon the pit of her Stomach a Lamb-skin with the wool, for to preserve it, and augment its natural heat, which is very necessary to digest food; observing above all, to give no purging Medicine, when this Flux is only caused by weakness, lest it be thereby augmented. If it be a Diarrhaea, and only an evacuation sim∣ply of such excrements as are retained in the Guts, and some superfluous humours, which Nature hath sent thither to be expelled, and that it continue no long time, and is gentle; the Woman will find no inconvenience by it; nor is she in that danger as when it passeth those bounds; and therefore 'tis good to leave the operation to Nature, without in∣terrupting it in the beginning: but if it continues above four or five days, it is a sign then, that there are ill humours contained and cleaving to the inside of the Guts, which provoke them often to be dis∣charged, and ought to be removed with some purg∣ing Medicine that may loosen and evacuate them, Page 96 after which the Flux will certainly cease, some light infusion of Senna and Rubarb, with Syrup of Suc∣cory, or an ounce of Diacatholicon, with a little Ru∣barb for a Bolus, to be taken in a Waser. But if, notwithstanding fit purges and a regular diet, this flux continues, and changes into a Dysen∣teria, the Patient voiding every moment bloody stools, with much pain and needing, she is then in great danger of miscarrying, & its prevention ought it be endeavoured, if possible. Therefore, after having purged away the ill humour, (with the Medicines above mentioned) which were in the Guts, and hindering, by a good dyet, that no more be engendred; to which purpose let her use good broths made of Veal or Chicken, with cooling Herbs, temper the acrimony of these hot humours; let her eat Pap with the yolk of an Egg new layed, being well boiled: such dyet softens and sweetens the Guts within. Let her drink be Water, in which Iron or Steel was quenched, with a little Wine, if she be not feverish, for then half a spoonful of Syrop of Quince or Pomegranats is better to mix with the foresaid Water; She may likewise eat a little Marmalade of Quince, or other astringents and strengtheners, provided her body was well purged before: and because there is always in these Fluxes great pains and gripes all over the Belly and Guts, and chiefly the Rectum, all the humours being discharged upon it, which irritating it extreamly, causeth continual stimulations, that ought to be appeased (if possible) to prevent Abortion, and may be effected by Clysters made of the Broth of a Calves-head, or Sheeps-head well boyled, mixing it with two ounces of the Oyl of Violets, or else Page 97 of good Milk, mixed with the Yolk of a fresh Egg. After the use of these strengthening and anodine Clysters, as long as is judged necessary, which the Patient ought to keep as long as she can, the better to appease these pains, you must proceed to the use of Detersives, made with the Decoction of Mallows and Marsh-mallows, with Honey of Roses; and afterwards Astringent Clysters, in which must be neither Oyl nor Honey mixed, because they relax instead of binding; beginning first with the gent∣lest, made with Rose-water, mixed with Lettice and Plantain-water; afterwards to stronger, com∣posed with the Decoction of the Roots and Leaves of Plantain, Tapsus Barbatus, Horse-tail, with Provence-Roses, the rind of Pomegranats in Smiths-water; to which may be added, of Terra Sigilla∣ta, and Dragons-blood, each two drachms: You may likewise foment the Fundament; but there must be care, before you come to use the strong Astrin∣gents, that the Woman be first well purged with the Remedies before mentioned, lest (as the Pro∣verb is) the Wolf be shut in with the Flock; and, endeavouring to prevent Abortion, the death of the Mother, and consequently of the Child, be caused by a greater mischief; retaining within a∣bundance of ill Humours, of which Nature would willingly be discharged: All which may be avoid∣ed, if what I have said be well observed. Page 98 CHAP. XIX. Of the Menstruous Flux. HIppocrates, in the 60th Aphorism of his 5th Book saith, Si Mulieri utero gerenti Purga∣tiones prodeant, impossibile est foetum esse sanum; If a big-bellied Woman have her Courses, it is impossible the Infant can be in health. This Apho∣rism must not be taken literally, but must be under∣stood when they come down immoderately: for though, according to the most general and natural rule, the Courses ought not to flow when a Woman is with Child, because their ordinary passage is stopt, and also because the Blood is then imployed for the nourishment of the Infant, of which, if it flows away, it is defrauded, and consequently much weakened: Yet there are some Women, who notwithstanding they are with Child, have their Courses till the 4th or 5th month; about which time, the Infant being already pretty big, draws a good quantity of blood for its nourishment; where∣fore there cannot so easily remain a superfluity, as when young with Child. I knew one that had four or five living Children, and had, of every Child, her Courses duly from month to month, as at other times, onely in a little less quantity, and was so till the 6th month; yet notwithstanding, she was alwayes brought to bed at her full time. I likewise saw another, who not believing she was with Child, because she had her Courses; and Page 99 finding her self out of order, because she had con∣ceived, imagining it was some other Distemper, pre∣vailed with her Physitian to bleed and purge her very often, which he did, till he had indeed cured her; but 't was after she had miscarried, being three months gone. This evacuation usually befalls ve∣ry Sanguine or Phlegmatick Women, who breed∣ing more blood than the Infant hath need of for its nourishment at the beginning, discharge themselves at those times of that superfluous quantity, more or less, according to their dispositions, but not by the bottom of the Womb, as formerly when they were not breeding, because those passages are effe∣ctually closed by the after-birth which adheres to it, and the Womb is then exactly close; but by a couple of Branches which Nature (provident and careful of the preservation of Individuals, as well as of the Kind) hath destined to this use, which pro∣ceed from the Spermatick Vessels, and (besides those they send to the Testicles and other parts) before they arrive at the Womb, divide themselves on each side into two Branches very considerable; of which, the one terminates in the Fund of the Womb, by which the Courses pass, when the Woman is not with Child; and the other, not entering there, couching along the body of it, is terminated in the side of the neck of the Womb, by which the Courses are discharged, whilst they are breeding, in case the Woman be Plethorick. When a Woman voids blood downwards, it must carefully be considered whence it proceeds, and in what manner; whether it is the ordinary Courses, or a real Flooding: If it be the ordinary Courses, the blood comes away periodically at the Page 100 accustomed times, and flows by degrees from the neck, near the inward Orifice of the Womb, and not from its Fund; as may be discovered, if try∣ing with a finger one finds the inward Orifice ex∣actly closed; which could not be, if the blood proceeded from the bottom, as also if it proceeds without pain; all which circumstances do not meet in a flooding, but others very different, as will ap∣pear in the following Chapter. It must likewise be considered, whether these Courses flow, onely because of the superfluity, or because of the acri∣mony of the Blood, or the weakness of the Vessels which contain it, that so fit Remedies may be ap∣plyed. If they proceed from the sole abundance, being more than the Fruit can consume for its nou∣rishment, it is so far from hurting either Mother or Child, that being moderate, it is very profitable to them; because, if the Womb were not discharged of this superfluous blood, the Fruit which is as yet but little, would be drowned by it, or, as it were, suf∣focated: And if it should chance that they were unduely stopt or retained, bleeding will supply the defect of the natural evacuation, which ought to have been; but if there be no sign of abundance or plenitude; and that before she was with Child, she had her Courses in a small quantity, which still continue to flow, after she hath conceived, it is a sign that the flux proceeds from the heat and acri∣mony of the blood, or the weakness of the Vessels appointed to receive it. It is of this sort of Wo∣men that Hippocrates pretends to speak, in the 6th Aphorism before mentioned, whose Children can∣not be healthful, when their Courses flow, whilst they are breeding; because there remains not blood Page 101 enough behind for her, and the nourishment of her Infant, which puts her in great danger of miscar∣rying, for as the proverb saith, Hunger drives the Wolf out of the Wood; so likewise want of nourish∣ment forceth the little prisoner out of his hiding∣place before his time. To hinder this Flux from effecting so evil and si∣nister an accident, the Woman must keep her self very quiet in bed, abstaining from all things that may heat her Blood, shunning Choler above all the passions of the mind, using a strengthening and a cooling diet, feeding on meat that breeds good Blood, and thickens it; as are good broths made with Poultry; necks of Mutton, knuckles of Veal, in which may be boiled cooling Pot-herbs; newlayd Eggs, Gelly's, Rice-milk, Barly-broths, which are proper for her: let her Drink be Water in which Iorn is quenched, with a little Syrup of Quince: she must refrain from Copulation, be∣cause by heating the Blood it excites it to flow more. If notwithstanding all this the Flux continues, some commend large cupping-glasses under the Breasts to make a revulsion, and to turn the Blood: according to Hippocrates Aphorism 50 of the 5th Book, Mu∣lieri si velis menstrua sistere, cucurbitulam quam maximam ad Mammas appone: but it will do no great matter; however, to satisfie the Patient, and to shew that nothing is omitted that may make for her cure, they may be applied. I should rather choose to make this Revulsion by bleeding in the Arme, if her strength permitted: And because in this condition the Child is very weak through this great evacuation, it must be fortified by applying to the Mothers Belly about the region of the Womb, Page 102 Compresses steeped in strong Wine, in which is boyled a Pomegranat, with its peel, Provence-Roses, and a little Cinamon: but the best way to strengthen it, is to correct the Mothers Blood, and hinders its evacuation. CHAP. XX. Of Floodings. THere is a great difference between the menstru∣ous Blood, of which we have discoursed in the preceeding chapter, which happens sometimes to Women with Child, and this Flooding which we have now in hand: for (as I have said) the Courses come periodically at the times accustomed, without pain, destilling by little and little from the neck of the Womb, during pregnancy, after which it to∣tally ceaseth: but much the contrary, this loss of Blood comes from the bottom of the Womb, with pain, and almost of a sudden, and in great abun∣dance, and continues flooding daily without inter∣mission, except that some clods (formed there) which seem somtimes to lessen the accident, by stop∣ping for a little time the place whence it flows; but soon after it returns with greater violence, after which follows death both to Mother and Child, if not timely prevented, by delivering the Woman, as shall be hereafter declared. If this Flooding happens when young with Child, it is usually because of some Fals-concepti∣on, or Mole, of which the Womb endeavours to discharge it self, by which it opens some of the Page 103 Vessels in the bottom of it, from whence the Blood ceaseth not to flow, until in hath cast forth the strange bodies it contained in its capacity: and the hotter and subtiller the Blood is then, the more abundantly it flows. But when this Flouding hap∣pens to a Woman truly conceived, at whatsoever time it be, it proceeds likewise from the opening of the Vessels of the fund of the Womb, caused by some blow, slip or other hurt, and chiefly because the Secundine in such cases, and sometimes in others, separating in part, if not totally, from the inside of the bottom of the Womb, to which it ought to ad∣here, that it might receive the Mothers Blood, ap∣pointed for the Infants nouriture, by which separa∣tion it leaves open all the orifices of the vessels where it was joyned, and so follows a great flux of Blood, which never ceaseth (if so caused) till the Wo∣man be brought to bed: for the Secundine being once loosened, although but part of it, never joyns again to the Womb to close those Vessels, which can never shut till the Womb hath voided all that it contained: for then compressing and closing its self, and as it were entering within it self (as it happens presently after delivery) the orrifices of the vessels are closed and stopt up by this contraction, where∣by also this flooding ceaseth, which alwayes con∣tinues as long as the Womb is distended by the Child, or any thing else it contains, for the reason aforesaid: much like to a Spunge, whose pores or holes being very large when swelled, disappear and close with their own substance when squeezed and compressed; so likewise by this contraction of the Matrix (which during pregnancy became as it were spongeous) in the place whence the Secundine was Page 104 separated, the orifices of the vessels are closed, as∣soon as it is cleansed from whatsoever it contained in its capacity. Although I have said that a Woman in this con∣dition, for the reasons alledged, must necessarily be delivered, that the Flooding may be stopt; I do not intend it should be done assoon as perceived: because some small Floodings have sometimes been suppressed by keeping quietly in bed, bleeding in the Arme, and the use of the Remedies specified in the precedent Chapter; it may likewise be but an ordinary and menstruous Flux. If then the Blood flows but in small quantity, and continues a little while, 'tis good leaving the labour to the work of nature, provided the Woman hath sufficient strength, and that it be accompanied with no other evil acci∣dent: but when it flows in so great abundance, that she falls into Convulsions and Faintings, then the operation must not be defer'd; and 'tis absolutely necessary she should be delivered whether she be at her reckoning or no, whether she have pains or throws, or not; because there is no other way to save her life, and the Childs, then presently to do it. Extreman fundet cum sanguine vocem; she casts forth with her Blood her last breath. Hippocrates knew very well the danger of it, when he said in his 56th Aphorism of the 5th Book, In fluxu muliebri si convulsio & animi defectus advenerit, malum: If Convulsions and Faintings follow Floodings, it is a bad sign. There must not alwayes in these unfortunate ac∣cidents be expected pains and throws to force and bear down to forward labour; for though they come at the beginning, they usually cease assoon as Page 105 the Flooding comes to Syncope's and Convulsions; neither must it be defer'd, till the Womb be enough opened, forasmuch as this effusion of Blood very much moistens it, and the weakness relaxeth it, so that it may be then as easily dilated as if there had been abundance of strong throws. Wherefore, ha∣ving placed the Woman in the situation we shall di∣rect when we treat of deliveries, let the Chirurge∣on, having his hands anointed with Oyle or fresh Butter, introduce his Fingers joyned together, by degrees into the Matrix, and spread them open the one from the other when they are in the entry, for to dilate it sufficiently by little and little, without any violence, if possible; which being done, and his hand quite within, if he finds the Waters not broke, let him break them, and then, whatsoever part of the Child presents, though the Head (pro∣vided it be not just in the Birth) let him search for the Feet, and draw it forth by them (observing eve∣ry curcumstance, that shall be shewen in the 14th Chapter of the second Book, where is described the way how to deliver a Woman, the Child coming with the Feet first) because there is better hold, and more easie to deliver by them, than by the Head or any other part of the body. Wherefore if the Feet lie not ready, the Chirurgeon must seek for them, which at that time is easier done than at another, because the great Flooding makes the Womb loose and slippery by its humidity, so that it will not be difficult for him to turn the Child and bring it by the Feet, as we have even now said; after which he must fetch the after-burthen, which in these cases cleaves but little, being careful not to leave so much as a clod in the Womb, lest it still continue the Flooding, Page 106 which being done, it will soon after stop with all the accidents, if too much time was not spent before the operation. Many Women and Children have perished for want of this operation in this ill accident; and ma∣ny others have escaped death, (which else most cer∣tanly had followed) by being timely succored. Guillimen in Chap. 13 of his 2d Book of hap∣py Deliveries, makes mention of six or seven Histo∣ries to confirm this verity, in some of which we may find the Women and their Children bloody victims of it, for not having been in the like case delivered, which others, by a seasonable delivery, escaped: and the better to confirm it by my own experience, I will recite you one amongst the rest, very remark∣able, of the remembrance of which I am so sensible, that the Ink I write with at present to publish it to the World for their propfit, seems to me to be Blood, because in this sad and fatal occasion, I saw part of my self expire. About three years since one of my Sisters, not yet one and twenty years of age, being about eight months and a half gone with her fifth Child, and then very well in health, was so unfortunate as to hurt her self (though at first small in appearance) by falling on her Knees, her Belly a little touching the ground by the fall, after which she passed a day or two without perceiving any great alteration, which made her neglect to repose her self, being very necessary for her; but the third day, or thereabouts, after her hurt, about eleven in the morning, she was suddenly surprised with strong and frequent pains in the Belly, which were imme∣diatly followed with Floodings; this made her Page 107 presently send for her Midwife, who no better un∣derstanding her Office, told her she must have pa∣patience, till the Womb had dilated it self by the pains, before she could be delivered, assuring her further that she had no reason to be afraid, and that she should be quickly freed from the danger, be∣cause her Child came right: she made her thus hope in vain three or four hours, until, the Flooding still continuing violently, the pains began to cease, and the poor Woman fell into frequent faintings, and then the Midwife desired a Chiurgeon to advise with in this case: they immediately sent to my house for me, but unfortunately missing of me, they sent for him, whom they judged the ablest of all the Chirurgeons that practised Midwifery in Paris, and immediatly conducted him to my Sisters, where he arrived about four in the afternoon, and having seen her,* contented him∣self with only saying, she was a dead woman, and that nothing was to be done to her, but to give her all the Sacraments, and that ab∣solutely she could not be de∣livered; which likewise the Midwife joyntly con∣cluded, who believed that the opinion of a Man so authentickly esteemed of all, must be infallible. Assoon as he had delivered this Prognostick, he immediately returned home, and would by no means stay any longer, but left this young Woman in that deplorable condition with∣out any succour, whose life he had certainly saved Page 108 with her Childs, if he at that time had delivered her, which was very easie to be done, as will plain∣ly appear by the sequel of the History. After the advice of a person of so great reputation, together with that of the Midwife, since Monsieur N.* could do nothing, there was no other remedy for so great a danger, but to hope in God alone, who was Almighty. They therefore endeavoured to comfort my poor Sister as well as they could, who longed for nothing more then to see me, to know whether I would pass the same sentence, and whether her danger, which still augmented more and more, was without remedy (for her Blood flowed away continually in great a∣bundance) At length I returned home, where they had been long before to tell me this bad news, though by misfortune could not find me (as I said before) which as soon as I understood, I immediately ha∣stened to her with all possible speed, where I saw as∣soon as I came in, so pittiful a spectacle, that all the passions of my Soul were at the instant agitated with many and different commotions; having after∣wards a little recovered my senses, I drew near to my Sisters Bed, where they had just given her the last Sacraments, and she conjured me very often to give that succour, which she said she only expect∣ed from me. After that I had understood from the Midwife all that had passed, and the opinion of the Chirurgeon, that had seen her above two hours before (for it was then six a clock) I perceived the Blood Page 109 to flood continually in great abundance and with∣out intermission, of which she had already lost above* three quarts: and which was very remarkable, above twelve small Porengers, in the two hours after the Chirurgeon was returned, as it seemed to me by the number of Napkins and other Clothes, which were all muck wet with it; which Blood had stayed in her body and saved her life, if she had been then delivered: I saw likewise that she grew every moment weaker and weaker, which convinced me that she was then in more danger than she would have been if they had not let slipt the opportunity of delivering her two or three hours before, as it was possible and easie; because she had then almost all her strength, which she afterwards lost with the rest of her Blood, which all along flooded away; and desirous to know whether they could have delivered her, I found, by trying her body, that the inward ori∣fice of the Womb was dilated in such sort that I could easily introduce two or three fingers, and ha∣ving marked it, I made the Midwife try again to see whether the orifice was so disposed when the Chi∣rurgeon said that she could not be delivered, and whether she was of his opinion. She told me it was so, and that it had been alwayes in the same condi∣tion from the time of his departure. Assoon as she had made me this declaration, I easily perceived his ignorance, and where the shoe wring'd him. Wherefore I told her, that I woundred much they were both of that opinion, seeing that in truth it seemed quite contrary to me, because it was at that time most certainly very easie for him to have Page 110 delivered her, if he had pleased, as it stil was, & what indeed I would have done at that very moment, if it had been possible for me to have had power enough over my Spirit, which wavered a long while about the resolution I was constrained to take, after I had lost the hopes of all other help. That which hin∣dered me, was not so much the Prognostick, that so famous a Chirurgeon had made, in perswading all the Assistants, that she could not be delivered, (though it might seem rash to oppose the sayings of such as are esteemed Oracles) neither was it the little strength the Patient had then left: but it was chiefly the relation of the Person, being my Sister, whom I tenderly loved, which troubled my spirits with such different passions, to see her before me ready to expire through the prodigious loss of blood, which proceeded from the same spring as mine own, that it was impossible for me at that mo∣ment to resolve, and obliged me to send again to the Chirurgeon (who was long since returned home) to entreat him to come back again to the House, that (my self demonstrating to him the facility I found for the operation, and making him understand and confess that in those cases there is no hope, unless it be undertaken as soon as may be) I might perswade him to deliver her, rather than to abandon the Mo∣ther, so to the dispair of her life, as he had done, and to suffer the Infant to perish with her unbap∣tized; which had been prevented if he had done what Art required, which is at least (when both cannot be saved) to save the Child, if possible, without prejudice to the Mother, which was very easie, as you shall presently understand: But no prayers nor sollicitations could ever prevail with him Page 111 to return, excusing himself that it was impossible for him to do any thing in the case. When this was related to me, I sent yet again to another Chi∣rurgeon, one of my Companions, being a little more obliging and serviceable, whom, if he had come time enough, I would have convinced of the ne∣cessity of the operation, and made him acknow∣ledge the facility of it: but by misfortune he was abroad. During all these goings and comings, there was an hour and half spent, which time she flooded without intermission, and her weakness grew more and more: wherefore seeing my self without hopes of getting the persons I sent for, I resolved to de∣liver her presently, which before was beyond my power, for the reasons recited, and indeed was now a little too late for the Mother; for, if I could have commanded my passions to have done it at the instant I arrived, there would then have been great bopes to have saved her, as well as I did the Child: After I had thus prepared my self for it, that is, having directed two of my fingers into the inner orifice of the Womb, being open enough to admit them into it, I did in a little while after in∣troduce a third, and by degrees the ends of all the five of my right hand, with which I dilated the orifice sufficiently to admit it quite in, as it is very easie in the like cases, because the abundance of Blood moistens and relaxeth extreamly (as is already mentioned) the whole Womb, into which having so gently entred my hand, I found the Child came right, and the Waters not yet broken; wherefore I presently broke the membranes with my nails and fingers, and then turning the Child, I took it by the feet, and brought it forth very easily, after the Page 112 manner I shall teach in the forementioned 14th Chapter of the 2d Book, all which I finished in less time than a hundred could be counted, and do con∣scientiously protest never to have delivered a Wo∣man sooner in all my life, of those whose Children came against Nature, nor easier, and with less vio∣lence to the Mother, who did not in the least com∣plain during the Operation, although she had her senses very well, and exactly knew all I did to her, and found her self very much comforted as soon as ever she was delivered, and immediately after the flooding began to cease: As to the Child I brought it alive, and it was presently baptized by a Priest that was in the Chamber. The poor Patient, and all the company present (which were in great num∣ber) found then manifestly that the Chirurgion and Midwife, who said she could not be delivered, had but little reason to assure any such thing. The Operation was finished time enough for the Childs baptism, which (praised be God) it received; but too late to save the Mothers life, who (having before lost all her Blood) dyed an hour after she was so delivered, by the same weakness that she of∣ten fell into before she was delivered. The flooding indeed ceased presently, but she had not Blood enough left to enable her to resist those frequent faintings, which she might have done, as may pro∣bably be conjectured, if the Chirurgion that first saw her had delivered her three long hours before, as without doubt he might as ea∣sily have done as I; in which time she lost above twenty* small porengers of Blood, of which four or five possibly might have been Page 113 sufficient to have saved her life, she being a young Woman of a very good constitution, having no in∣convenience or sickness when she was surprised with this fatal accident, which befel her (as aforesaid) about eleven in the morning, and she was delivered about seven at night; and because she had lost so much Blood before the Operation, it proved un∣profitable, she dying an hour after, having her perfect senses to the moment she expired, which was about eight the same night. I will upon this lamentable Subject (to the end more care may be taken in the like cases) examine by way of digression, what might be the motive of this proceeding of the Chirurgeon, and of some others of the same humour. It must necessarily be agreed, that it was for one or more of these three causes, why either he would not, or could not lay this Woman when he saw her two hours before me, which (as I noted before) might easily have been done: It was either through Ignorance, Malice, or Policy: To imagine it his Ignorance, I cannot perswade my self, because he hath too great Reputation for that, although many persons that understand the Art ve∣ry well, easily agree with me, that he is of the number of those, of whom may justly be said, Minuit praesentia famam. That it was through Malice, who can imagine a man of so detestable a resolution could be found! but if it were neither Ig∣norance nor Malice, it is easy to guess it a damnable Policy, qualified by some with the name of Prudence;* this false Prudence they Page 114 ordinarily use, that are in great reputation, ever endeavouring to their utmost to shun dangerous Cures, lest they that understand not the Art, should quit the good opinion they had of them, when it happens that the Patient dies under their hands, al∣though they were carefully and duly delivered. This was just our misfortune; for this Chiurgeon, who was very much esteemed by many Women of quality whom he delivered, avoided, all he could, dangerous labours, subject to ill success, as this was; and the rather then, because there was in my Sisters Chamber a Lady of quality, Wife to one of the chief Captains of the Guards, who dwelt in the same house, and whom he ordinarily delivered; which was the cause, that, believing the issue of the Operation doubtful, he chose rather to preserve the esteem of his ancient practice, amongst such as un∣derstood not the business well enough to be judge of his proceedings, than to do in this case his Chri∣stian duty; to which one ought alwayes to have more regard, than to all these Interests of vain Re∣putation, which usually corrupts the Conscience. They that make use of this Policy are often accesso∣ry to the death of poor Women who call for their assistance, and of their Children also. I was willing to recite every circumstance of this Tragedy, that one may know in the like case the necessity of a speedy delivery. I have since that had many in the same case, to whom (by the assist∣ance of God) I warranted the lives of the Women, and saved the Children; of which I had in my self more satisfaction, than I could have gained by all the honour the World could procure me by so wicked a policy; which neither Chirurgeon nor Page 115 Midwife of an upright Conscience will ever use. Now since in all floodings, there ever follows weakness and faintings, we must endeavour to pre∣serve that little strength the Patient hath left, and augment it if possible; that so they may have suffi∣cient to endure the operation, and to escape after∣wards: to which purpose there ought to be given her, from time to time, good strengthening Broths, Gelly's, and a little good Wine: she must alwayes smel to Rose-vinegar, and have a warm toast dipt in Wine and Cinamon, applied to the region of her Heart; which will do her more good than solid food: for, as Hippocrates saith in the eleventh A∣phorism of his second Book, Facilius est potu refici, quam cibo, one is sooner nourished by drink than meat; because the liquid aliments are much sooner distributed than the solid: And to prevent the Blood from flooding in great abun∣dance till she can be delivered,* a Vein in her Arm may be opened, to turn a little the course backwards; and apply all along her Reins, Nap∣kins wet in Water and Vinegar. But if the flooding proceds from the separation of the after-burthen from the Womb, as my Sisters was, all these things are to little pur∣pose; and the best expedient is to deliver the Wo∣man assoon as may be, though she were but three or four months gone with Child, or less; because all ought as well to be brought away, whatever is with∣in the Womb, whether it be Fals-conception, Mole, or Child, without leaving any thing behind, which when it is quite cleared, closing and contracting it self, stops the flooding, for the reasons above alledg∣ed, Page 116 and all accidents which were caused by it; wher∣by the Woman afterwards recovers, if there be but sufficient strength remaining after delivery, as cer∣tainly will be, if not delayed too long. CHAP. XXI. Of the weight, bearing down, or relaxation of the Matrix, which hinders a Woman with Child in her walking, and the freedom of coition. MAny Women with Child find an extraordi∣nary weight at the bottom of their Bellies; which comes, because the Womb, by the weight it contains in its capacity, bears down upon the neck, and sometimes so low that they cannot walk with∣out pain and stradling; at which time also they cannot use copulation but with great inconvenience. The bearing down of the Womb, is when it on∣ly falls into the Vagina, without coming in the least without the Privities, for then it is called the falling-out, or Praecipitation; which is a more troublesom and dangerous Disease, and doth not usually befal Women with Child, because the extent and bigness of the Womb hinders it, that it cannot fall out, but only bears down. The Precipitation is discerned by the view; and the bearing down easily, by puting up a Finger into the Vagina; for there the Womb will be soon met with, and its inner Orifice, which is very near the Privities, especially when the Woman stands upright. Page 117 This bearing down, is often caused by the relaxa∣tion of the ligaments of the Womb, and chiefly the large ones, which ought to fasten it on each side to∣wards the loins, to prevent it; which relaxation comes either from the weight of the burthen it bears and contains within, which constrains these liga∣ments to be extended more than ordinary; or from some fall, which by much shaking of it produceth the same effect, and so much the easier, by how much the burthen is greater; and likewise from some great pains or bad labour which preceeded the present pregnancy: or very often it is caused, or at least facilitated by abundance of humours, which moistening the ligaments, relax them in that man∣ner, to which the phlegmatick are very subject, who usually are much troubled with the Whites. Besides the hinderance which the bearing down of the Womb causeth to the Womans walking and use of coition (as we have above mentioned) it caus∣eth likewise by its weight, principally towards the latter end of her reckoning, a numness in her Hips, sleepiness in her Thighs, as also difficulty of Urine, and going to stool: because by bearing down it presseth down the Bladder and the great Gut, be∣tween both which it is scituated. The Patient may be much easier cured of this bearing-down, after she is brought to bed, than whilst she is with Child; for being freed from its burthen, its ligaments will be the easier fortified: besides she may then use peffaries to keep it in its place, which cannot so well be done when she is with Child. From what cause soever this bearing-down pro∣ceeds, the best remedy for a big-bellied Woman is to keep her bed, because the weight of it doth more Page 118 and more relax the ligaments when she is up: And if she have neither the means nor convenience so to take her rest, at least let her, if her belly be big enough, as it is towards the later end of her reckon∣ing, wear a Swaith very broad and fit for the pur∣pose, that by this means the burthen being a little supported, the ligaments may not be so much stretch∣ed and lengthened; and if she have a difficulty in making water, let her when she would do it, help her self by lifting up with both hands her Belly before, which will be a great ease, and hinder the neck of the Bladder from being so much compressed: but if the humours cause this relaxation of the ligaments of the Womb, she must keep her self to a drying dyet, her food being rather rosted than boiled, and must refrain from copulation. The Woman must not be straight laced, because that also forceth down the Matrix: and above all, when she is in labour, care must be taken that neither by means of the throwes, which strongly force down the Womb, nor by the birth of the Child, nor the violent ex∣traction of the burthen, she gets a precipitation in∣stead of a bearing down; which is soon done, as is seen often, when the method I teach in the 16th chapter of the second Book (where I treat of this Labour) is not well observed. Page 119 CHAP. XXII. Of the Dropsie of the Womb, and the oedemi∣tous Tumours of the Lips of the Privities. THere are many phlegmatick Women, who certainly believe themselves with Child, void nothing but water, which was collected together in their Womb, and called the Dropsie of the Womb. It hath often happened that such a Disease hath deceived the Midwives as well as the Patient, who having a long time hoped, and been made to hope for a Child, at length instead of it, finds no∣thing but clear waters; as it once did to that Wood∣merchant (I mentioned in the 13th chapter of this first Book) who at the end of nine or ten months, of such a false Belly, voided a quantity of these waters, which was all that was contained and inclosed in the Womb. Guillemeau in the first chapter of his first Book of Labours, makes mention of the like History, of one named Madam du Pescher, who voided a pailfull of it, certainly believing her self to be with Child: And Fernelius in the 15th chap∣ter of his 6th Book of Pathologie, recites a case much more wonderful concerning these Dropsies. He tells us that he saw a Woman who at the times of her purgations cast forth, by the neck of the Womb, so great a quantity of water, very hot and yellowish, that she filled six or seven Basins, and voided so much of it that her Belly grew quite flat, after which her Courses came immediatly in order; and that the following months the like quantity was a∣gain Page 120 amassed, which afterwards came away as be∣fore, and that this Woman (which is most notori∣ous) being cured of this indisposition, became with Child, and was brought to bed of a living Child. These Waters are either bred in the Womb, or brought thither from some other part, as in the dropsie of the Belly it passeth by transudation through the porous substance of the membranes of the Womb. They are bred in the Womb, when it is too cold, or too much debilitated by an ill and violent Labour preceeding; or, because the filth, as Whites, or other superfluities which it was ac∣customed to discharge it self of, hath a long time been suppressed. When the Waters contained in the capacity of the Womb have been sent thither from elsewhere, they are then never wrapt in a par∣ticular membrane, but only retained by the exact closure of its Orifice, and flows away as soon as it begins to open: but when they are bred in the Womb (which is for the most part after copulati∣on, if the Seed be either too cold, waterish, or cor∣rupted) they are then sometimes contained within membranes, which hinders the Patient from a speedy discharging of it, she going with it as long almost as with a Child: and this is the Dropsie which per∣swades them sometimes they are with Child. 'Tis easie to avoid being deceived by taking the Dropsie of the Womb for a Child, if one takes but good notice of all the signs mentioned, in treating of a true Conception, which concur not in this disease. The Patient hath indeed her Belly swell'd, and her Courses stopt in this case as well as if she were with Child, but there are many things which will dis∣cover to us the difference; for in the Dropsie, her Page 121 Breasts are flabby soft and fallen, she will have no Milk in them, nor find her self quicken at the ordi∣nary time, but only as it were a bubbling of agitat∣ed Waters; she will have a greater pain and weight in her Belly, which is likewise more equally in its circumference extended, than if there were a Child; she will also have the Lips of the Womb, her Thighs and Legs swell'd & aedematous; and a worse colour in her Face, than when she is with Child. Now as this Dropsie may come alone, so likewise may often happen together with a true Conception, these Wa∣ters being then contained without the membranes of the Child in the capacity of the Womb; for though there may be much Water within these membranes, it is not properly the Dropsie of the Womb, because there must ever naturally be some, in the midst of which the Faetus is contained: Notwithstanding, sometimes there is such a quantity of them, which doth so prodigiously swell the Womans Belly, that one would believe she had two or three Children, when she hath but only one, which is much weak∣ned by it, because the greatest part of its nourish∣ment is resolved into these Waters, which almost extinguisheth and suffocates that little natural heat which is there. Some Women have evacuated three or four quarts above two months before they were brought to bed; when this happens, they are then contained in the Womb without the Mem∣branes; for else the Child would be necessitated to be born presently after these Evacuations,* if it were the Waters (that ought natu∣rally to be contained in the membranes) that came away. Page 122 The best Remedy for this kind of Dropsy, the Woman being vvith Child, is to vvait vvith patience the hour of her delivery, observing the mean time a drying dyet: but vvhen it is only Water contain∣ed in the Womb, she must use Diureticks to cause the Womb to open to evacuate them; and her Courses must be endeavoured to be provoked, ha∣ving alwayes a care to destroy by convenient Pur∣ges, the cause of the generation of such superflui∣ties. The Womb is sometimes so full of these humours, that it dischargeth some on the outward parts, and principally upon those vvhich are near, as the lips of the Privities, vvhich often are thereby so swelled, that they become quite blown up; and sometimes in some Women are so big and swelled, that they cannot close their Thighs together for them, vvhich hinders their vvalking, unless vvith pain and great inconvenience. This Swelling is then livid, and al∣most transparant, even as a Hydrocele; because of the quantity of clear Water vvhich filled it: and because it may be painful and inconvenient to the Woman during her labour, by reason they straiten the passages, it vvill be necessary to remedy it before; vvhich, for the greater certainty, must be done by the operation of the hand, making many scarrifica∣tions vvith a Lancet all along the lips, vvhereby the humours will sweat out and distil forth by little and little; after vvhich Compresses dipt in Aromatick and Astringent Wine, must be put upon it to pre∣vent Relapses, by fortifying the parts, causing the Patient to observe all the vvhile a good dyet fit for the Dropsie. Some vvould apply Leeches, to avoid the pain of the Lancet: but they are not so proper, Page 123 because the small orifices they make, assoon as they are taken off, immediately close again, which hap∣pens not so soon to the Scarrifications, made as big or little as one will, and may be kept open by oynt∣ments applied to them, as long as may be thought fit or necessary. CHAP. XXIII. Of the Venereal Disease in Women with Child. IT is not very hard to imagine, how a breeding-Woman, that hath the Pox, can communicate it to a Child in her belly, because this contagious dis∣ease corrupting all the mass of the Mothers blood, it is necessary the Infant, which hath then no other su∣stenance, should be infected with it, converting this bad blood into its own substance, the acrimony of which Blood easily causeth in an Infants tender bo∣dy those malignant ulcers, which all such, whose Mo∣thers are contaminated with it, usually bring with them at their birth. The Pox which in its essence is of the same species, and is only distinguished by degrees according as it is greater or less, communicating it self by the means of the Mothers blood, will make more or less impres∣sion on the Infants body according to its strength or weakness; and if the big-bellied Woman have Ulcers very near the Womb, as in the neck and neighbouring parts, by this proximity the venom will be very easily conveyed to it. I do not design here to enquire into the bottom Page 124 of this Venereal Disease, nor to write particularly of the cure of it: but intend only to shew vvhether the Woman may undergo the Cure vvhilst with Child, or ought therefore to defer it till after they are brought to bed. That this may be the better determined, we must make some distinction; for, when the Woman is towards the end of her Ac∣count, it ought to be deferred till after she is brought to bed, when both she and the Child, if infected, may be taken in hand; because the labour coming on, when the Woman is in the midst of her Cure, she may run the hazard of her life: and besides, if the Child should be then still-born, one would be apt to think it was killed by the violence of the Medicaments, and blame the Chirurgeon of rashness. When the Pox is but in the first degree, and hath caused no great accidents, one ought then likewise to remit the eradicating Cure till after Childbed, and be contented only with the palliating by a con∣venient dyet and gentle purgers from time to time, to prevent the evils encreasing: but if the Woman when young with Child, hath the Pox in the highest degree, accompanied with very great and continual accidents, which threaten danger, if her Cure be protracted till after Delivery; because in so long a time these accidents augmenting more and more, it would be impossible but her Fruit should be cor∣rupted, and very hard if she did not miscarry: that the greatest of these two evils be avoided, she ha∣ving strength enough, ought to be taken in hand; for, to imagine the worst, that the Remedies make her miscarry, it is no more than the greatness of the Disease would otherwise certainly do. Let her then Page 125 be taken in hand, without suffering the accidents longer to augment, vvhich by continuance render themselves much more dangerous both to her and her Child, being careful to give her the gentlest Remedies, and with more preparation and circum∣spection, so that the Evacuation procured to her by Salivation, be rather by little at a time, and the longer, than too great and sudden; and above all, that it be rather by anointing the upper parts only with* Mercurial Oyntments, and not by Per∣fumes, which sooner endanger miscarrying, by opening the Womb; besides, that they sooner cause the Fruit to perish if it had life. For the same reason also, no Mercurial Medicine must be taken in at the mouth: vvherefore fricti∣ons of the upper parts are to be preferred, endea∣vouring alwayes, as much as may be, to be Masters of the Evacuation, and to hinder it from causing a Loosness; for that is more dangerous than Sali∣vation, because of the continual forcing downward in going to stool, by which the Womb receives great commotion, and is extreamly agitated. I know very well that many will not easily be perswaded, but that either it is impossible to cure a Woman of the Pox whilst she is with Child, or that she and her Child cannot undergo the Reme∣dies without inevitable danger of death: however, the experience I have had of it my self, makes me to be of another opinion, which I am vvilling to com∣municate for an example in the like case. In the Year 1660, when I practised Midwifery in the Hostel de Dieu at Paris, a young Wench, not above twenty years old, came thither to lie-in of her se∣cond Page 126 Child, that had had the Pox before ever she conceived the first time, and after miscarried of a dead Child, rotten with the Pox; therefore being big this second time, and perceiving the accidents of ber disease to augment more and more, she con∣cluded there was no hopes this great Belly would succeed any better than the first, because she had all over her Body, especially upon both her Breasts, very many malignant Ulcers, which encreased day by day, and fearing it might turn to a Cancer be∣fore her Reckoning was compleat, being but three months gone, she resolved to submit to a thorough-Cure then, and to hazard her life in that condi∣tion to save her Child's, having no other hopes to effect it, nor being able her self to resist the grow∣ing disease. She acquainted three or four Chirur∣geons both vvith her disease and design, not at all concealing her great-belly; who for that cause would not undertake her, (although she was fully resolved upon it, and promised to pay them vvell) telling her that their Conscience would not suffer them to do it in the condition she was in, and that it would be better she would patiently submit to it aswell as she could till she was brought to bed, and then they vvould very vvillingly undertake her: But when she found none would undertake her, unless she concealed her great-belly, vvhich was not hard to be done being but three months gone, and believing there was no better an expedient; She met with an∣other (to whom she mentioned nothing of her great Belly) that put her into the ordinary course, as if there had been no Conception; and, besides the common Remedies used in this disease, he gave her a Salivation by five or six reiterated Frictions of the Page 127 Oyntment, vvhich followed her very plentifully five vvhole vveeks, so that she vvas vvell and per∣fectly cured, without leaving the least ill accident behind of her disease. When she was almost reco∣vered, and that all had succeeded wel, she told her Chirurgeon she was four months & a half gone with Child, (for she was three months when she came to him, where she lodged six weeks intire, without having it in the least perceived) which at first he could hardly believe, but perceiving her Belly ra∣ther grown bigger than lesser during the Evacuation the Physick had made, he was immediately assured of the truth of it: She informed him that the rea∣son why she had concealed her great-Belly, was, the refusal four Chirurgions (to whom she had confest it) made to take her in hand. From the time she was cured she suffered not the least in∣convenience during all the remainder of her time, except a little want, because all the money she had was given the Chirurgeon for her Cure, which made her come to the Hostel de Dieu to lie-in, where I delivered her of a Child at the full time, as big, fat and healthy, as if the Mother never had had the least touch of that disease in her whole body; and which was very remarkable, the Burthen (which is a part very susceptable of the least impression of a Woman's corrupt humours) was as neat, fair and ruddy as could be imagined. This example, which is very true, may convince us, that a big-bellied Woman may be taken in hand for the Pox; and more safely, if the Precautions noted above be carefully observed: For it is with∣out contradiction, that if this Woman had not been cured, she had this second time been brought to bed Page 128 of a rotten Child, as before. Relating once this History to a Chirurgion, a Friend of mine; he told me, that himself twice, in two different persons, had the same success, who were very well cured, and their Children likewise well born at the full time, without having the least impression of the venom in any part of their Body. Varandaeus confirms to us this truth in the second Chapter of his second Book of Womens Diseases, where he precisely tells us, that he had seen big-bellied Women who had had this disease eradicated by anointings with Mer∣cury and Salivation prescribed by Empericks; which may convince us that this Cure will easily have a better success, when governed and managed by a knowing and methodical person. In a word, 'tis easie to be perswaded that they can endure it, although with Child, because many very often have continual Feavers for twelve or fifteen dayes, and other acute distempers, for which they have been necessited to be nine or* ten times blooded, and yet not∣withstanding have oft∣times gone through with their Children to their full account, and been delivered of them as well as if they never had had any ill accident. Page 129 CHAP. XXIV. Of Abortion, and its Causes. WHen a Woman casts forth in the beginning what she had retained by conception in the Womb, 'tis called an Effluxion, or a sliding away of the Seeds, because they have not yet acquired any solid substance; if they miscarry of a false-concepti∣on, which is ordinarily from the later end of the first to the end of the second month, it is called an Ex∣pulsion; but when the Infant is already formed, and begins to live, if it comes before the time or∣dained and prescribed by Nature, it is an abortion: which may happen from the second to the beginning of the seventh month, for afterwards it is accounted a Birth, because the Infant being strong enough, and having all its perfections, may then live, which is impossible, if he comes before. These things thus understood, we then say, that an Abortion is an issuing forth of the Child, yet imperfect, out of the Womb contrary to Nature, before the term limited; which is the cause, that for the most part it is dead, or if sometimes alive, it dies in a short time af∣ter. We may in general assert, that every acute Dis∣ease easily makes a Woman miscarry; because they destroy her fruit, which being dead, never stayes long in the Womb; and also puts the Woman in great hazard of her life, as saith Hippocrates in the 30th Aphorism of his 5th Book, Mulierem gravidam morbo quopiam acuto corripi, lethale. The particu∣lar Page 130 causes of Abortion, are all the accidents mention∣ed in the preceding chapters; as violent and frequent vomitings; because there is not only want of suffi∣cient nourishment for Mother and Child, when the food is so continually vomited up, but also great reachings and endeavours, by which the Womb be∣ing often compressed, and as it were shaken, is at last constrained to discharge it self before its time. Pains of the Reins, great Cholicks and Gripes may like∣wise cause the same accident, as the Strangury also; for there are then made strong compressions of the Belly every moment to expel the Urine. Great Coughs by their frequent agitation, suddenly thrust∣ing the Diaphragma with force downwards, give also violent shocks to the Womb. Great Loos∣nesses endanger a Woman to miscarry, according to the 34th Aphorism of the 5th Book; and sooner if a Tenesmus follows, which is great needings, whereby the right Gut seeks to expel the sharp hu∣mours that irritate and provoke it. This makes us take notice of the 27th of the 7th Book, Mulieri utero gerenti, si tensio supervenerit, facit abortum: for in this case the Womb, which is scituated upon the Rectum, receives a great commotion by its conti∣nual needings. If a Womans Courses flow immo∣deratly, it is impossible her Fruit can be in health, as it is in the 60th Aphorism of the 5th Book; for be∣sides, that the Infant is not sufficiently nourished, the Womb also by being too much moistened, is easily relaxed and opened. Letting Blood immode∣rately doth the same for the same reason, especially if the Child be great, according to the 31th Chap∣ter of the same Book. But one of the worst accidents which cause A∣bortion, Page 131 is that Flooding, which proceeds from the separation of the After-birth from the Womb, of which we treated in the 20th Chapter of this first Book. The Dropsie of the Womb hinders the Child from growing to perfection, for the great abundance of Water extinguisheth the natural heat which is already at that time much debilitated; and the Pox in the Mother infects the Child, and often Kills it in her Belly, as we have demonstrated in the pre∣ceeding Chapter; and whatever very much agi∣tates and shakes the big-bellied Womans body, is capable of making her miscarry; as great labour, strong contorsions, or violent motions, of what manner soever, in falling, leaping, dancing, and running or riding, going in a Coach or Waggon, crying aloud, or laughing heartily, or any blow received on the Belly; because that by such agita∣tions and commotions, the ligaments of the Womb are relaxed, yea and sometimes broken, as also the After-birth and Membranes of the Faetus are loos∣ned. A great noise suddenly and unexpectedly heard may make some Women miscarry; as the noise of a Cannon, and chiefly Thunderclaps; and yet more easily, if to this noise be added the fear they usually have of such things, which happens ra∣ther to the young than elderly Women; because their bodies being more tender and transpirable, the air, which is strongly forced by that noise, being in∣troduced into all her pores, offers a great violence by its impulsion on the Womb, and on the Child within it; which the elder being more robust, thicker and closer, resist with more ease. Great watchings, causing a dissipation of the Womans Page 132 strength, and much fasting for want of food, hin∣ders the Infant from acquiring its perfection; fetid and stinking smells do much contribute to abortion, and amongst others the smell of Charcoal, as ap∣pears by the History recited in the 10th Chapter of this Book. The indispositions of the Womb produce the same effect, as when it is callous, or so small, or so much compressed by the Epiploon, that it cannot be ex∣tended, as it ought to be, sufficient to contain the Child and Burthen with ease together, with the Waters, which may likewise happen, if the Wo∣man be too strait laced, or keeps in her Belly with strong and stiff Busks for to be well shap'd; or by this subtilty to conceal a great-belly, as some do; frequent copulation, especially towards the end of her reckoning, may effect the same thing, because then, the Womb being very full, bears much down∣wards, and its inward orifice being very near, is subjected to violence. If a Woman miscarries, without any of these accidents, and that one desires to know the cause of it, Hippocrates explains it in his 46th Aphorism of the 5th Book, where he saith, Quae veró medio∣criter corpulentae abortum faciunt secundo mense, aut tertio, fine occasione manifesta, iis acetabula uteri mucoris sunt plena, nec prae pondere faetum continere possunt sed abrumpuntur: any Woman indifferent∣ly corpulent, that miscarries the second or third month, without manifest or apparent cause, it is, because the Cotyl•dons of the Womb (which are the inward closures of its vessels) are full of viscous filth, by reason of which they cannot retain the weight of the Faetus, which is loosened from it. To Page 133 this accident phlegmatick Women are very subject, and those who have the Whites exceedingly, which by their continual affluence, moisten, and make the Womb within so slippery that the After-burthen cannot adhere to it, which also relaxeth it and its inward orifice, that the least occasion causeth abor∣tion. But if the passions of the body cause so much hurt to a big-bellied Woman, those of the mind do no Iess, and specially Choler, which agitates, inflames, disperses and troubles all the Spirits, and mass of Blood, by which the Child suffers extreamly, be∣cause of the tenderness of its body; but above all, sudden fear, and the relation of bad news, are ca∣pable to make the Women miscarry at that instant; (as it happened to the Mother of that Cousin of mine, whom I mentioned in the 10th Chapter of this first Book) which likewise the other passions may cause, according as they are more or less vio∣lent, but not so easily. There are yet other causes of miscarrying which may be said to proceed from the Infant, as when they are monstrous, because they do not then follow the rule of Nature; as like∣wise when they have an unnatural scituation, which makes them torment themselves because of their in∣commodity, and they oblige the Womb to expel them, not being able to endure the pains they cause, which it yet does, when it is so great that it cannot contain it to the full time, nor the Mother furnish it with sufficient nourishment. If we find one or more of the above specified ac∣cidents, and that the Woman withall hath a great heaviness in her Belly, so that it falls like a ball on her side when she turns, and that there proceeds Page 134 out of her Womb stinking and cadaverous humors, it is a sign she will soon miscarry of a dead Child: moreover, her Breasts will confirm it, if having been hard and full in the beginning, they become after∣wards empty and flabby, as is specified in the 37th Aphorism of the 5th Book; and the 38th of the same Book, saith, That if one of a big-bellied Womans Breasts, who hath two Children, begins to flag, it is a sign she will miscarry of the Child of that side; and of both, if both flag in the same manner. It is most certain, a Woman is in more danger of her life when she miscarries, than at her full time; because (as we have said before) abortion is wholly contrary to Nature, and very often accompanied with flooding: and in more danger of miscarrying alwayes, if she miscarries of the first; and some apprehend then an impossibility of ever having Children after, to which, young married people are very subject, because of the violent emotion and perturbation of the whole body, excited by ardent and frequent copulations: but notwithstanding, they may preserve their fruit, when their greater vigour is over, and their loves a little mode∣rated. We have taught in each of the foregoing Chap∣ters, how to prevent all the accidents before reci∣ted, any of which is sufficient to make her miscarry; and the easier, if many are complicated: where∣fore to avoid a troublesome and needless repetiti∣on, you may have recourse to the Remedies there taught, by which both Women and Children may escape the danger of death. They that are subject to abortion, ought above all to take their ease, and keep in bed if they can, Page 135 observing a good diet, and refraining copulation as∣soon as she believes her self to be with Child; avoid∣ing the use of all Diureticks and Aperitives, which are very pernicious; as also violent passions of the mind, because they are very prejudicial. She ought likewise to be loose in her dress, that she may breath the freer, and not strait laced, and rackt, as most of them are ordinarily with their Busks under their cloths, to make their bodies strait; and amongst other things, they had need take heed of slipping and falling in their walking, to which big-bellied Women are very subject, because the bigness of their Bellies hinders them from seeing their way: they will therefore do well to wear low-heeld shoos with large soals, to prevent hurting themselves, as too many daily do. I admire in this case the superstiti∣on of many Midwives, and some Authors, who order a Woman with Child, to take, assoon as she hath hurt her Belly with a fall, some Crimson Silk, small minced in the yolk of an Egg, or the grains of* Scarlet, and treddles of several Eggs put into the yolk of one; as if that entring the stomach, were able to fortifie the Womb and the Child in it, and to keep it there, for which there is no appearance of reason or truth: but quiet rest indeed contributes much to it, which for this reason is usually directed for nine dayes; although such a one hath need of 15 dayes, or more, for her hurt or commotion; and to others, five or six is sufficient; during which time may be applied hot to the Belly, Compresses steeped in Aromatick and Astringent Wine. But because there are many Women so infatuated with this superstitious cu∣stom, that they would not believe themselves out Page 136 of danger, if they took not that Crimson Silk, or the Treddles of the Eggs (which is a pure conceit) one may give it to those that desire it to content them, because these Remedies, though useless, can yet do no hurt. It is now time to make an end of this first Book, in which I have only mentioned the most ordinary distempers, which have some particu∣lar indications in their cure, during the Womans being with Child; of which I have not treated very exactly, because it may be supposed that one may elsewhere have a more perfect knowledge of them, with all their circumstances: let us now pass to the second Book, to treat of Deliveries, not only the natural, but likewise all that are contrary to nature, it being the principal motive that induced me to write, and to teach as well as I can, the best and most methodical deportment in it. The End of the first Book. Page 137 BOOK II. Of Labours Natural, and Unnatural; with the way how to help Women in the first, and the right means of remedying the rest. AS it is very unprofitable to those that imbark on the Sea for a long Voy∣age, (as for example, to the Indies, or the like) if after having by their prudence escaped all the dangers they could meet with in so long a Voyage, they are ship∣wrackt in the Haven: So likewise it is not sufficient that a great-bellied Woman should be preserved from all the Diseases mention∣ed in the preceding Book, for nine whole months, if at the end of that time she be not well delivered of it by a happy Labour. This therefore shal be the whole subject of this second Book, where we will treat as well of the Natural as Unnatural Labours, and teach the manner of aiding and com∣forting Women in the first, and the means to remedy all the rest, Page 138 CHAP. I. What Labour is, and the diffenrences of it, toge∣ther with its different terms. BY a Delivery we understand either an emission or extraction of the Infant, at the full time, out of the Womb. This definition may, comprehend as well the Natural, which is accomplished by emissi∣on, when the Infant coming in a commodious and natural Figure, the Womb sends it forth without extraordinary violence: as the delivery contrary to Nature, which we are often obliged to perform, extracting it by manual operation. Every time the Womb lets pass, or sends forth, whatsoever it had retained and formed after concep∣tion, must not be call'd a labour; for, observing what I have already noted above, and what I will here again repeat, that it may be more plain, If a Woman voids by the Womb what is contained in the beginning after she had conceived, it is pro∣perly called an effluxion or slip: because at that time, there is nothing formed or figured, neither have the Seeds yet any firm consistence, which is the cause why it flips away so easily with the least opening of the Womb, as often happens between the first conceiving and the seventh and eight day only; after which, until the end of the second month, the Woman somtimes lets slip false-conceptions, which turn to Moles, if they continue any longer in the Womb; which is then called an Expulsion: And if after the third month or thereabouts, the time Page 139 when the Faetus is wholly formed and animated, it is sent forth before the seventh, in that case it is an Abortion, which is alwayes the cause, either that the Infant comes dead into the World, or dies soon after. But we properly call Labour, or Delivery, every issuing forth of an Infant which happens af∣ter the end of the seventh month to all the remain∣ing part of the time afterwards; because there is then a sufficient perfection, as also strength enough, to come into the World, and live in it afterwards. As to the general differences of Labour, we must take notice, that the one is legitimate or natural, the other illegitimate or against nature. To come to the knowledge of each, we say, that four condi∣tions must absolutly be found in a Delivery that it may deserve to be called legitimate or natural: first, that it be at full time; secondly, that it be speedy, without any considerable accident; third∣ly, that the Child be living; and fourthly, that he comes right in a good posture or scituation: for if any of these four are wanting, the delivery is a∣gainst nature; and the more, by how much there are more of them wanting. As to the due time of Labour, most Authors assert that Nature hath appointed to all other Ani∣mals a certain limited time of going with young, and bringing them forth: but that Women only, by a particular favour of the same nature, have none prefixt, neither for conceiving, going with Child, nor bringing forth. And as to conception, 'tis most certain, that a Woman can conceive at any time night or day, summer or winter, or any other sea∣son whatsoever; because she can copulate when she pleaseth, which few other Animals can, who cou∣ple Page 140 but at certain seasons when they become lustful but as to the time they are accustomed to go with young, it is no more precisely determined to them, than to a Woman; for as she may be brought to bed either in the seventh, eighth, ninth, tenth, yea and sometimes the eleventh month (which happens very rarely) but for the most part in the ninth month. So likewise for example, though the ordi∣nary time for a Bitch to puppy is the fourth month or thereabouts, so some puppy sooner and some la∣ter: and Sheep which yean their Lambs at the end of five months, advance or recede from that ordina∣ry term, according to the ground where they seed, and the quallity of their pasture, to which contri∣butes many particular dispositions of each of these Animals; which likewise happens to all others, as well as to Women. We may perceive the same also in Fruit, for the seasons and different Climats al∣ways more or less assist their speedy maturity, which depends likewise very much on good Husbandry. The first time that a Child may live, when born, is the seventh month compleat, and it may better from that till the end of the ninth month, but as∣soon as that time is pass'd, the stay it makes after in the Womb, is no wayes beneficial to it, because it hath then acquired all necessary perfection and strength sufficient to resist all outward injuries. The Child born before the seventh month cannot live long, as we said before, because of its weakness: but he that is born in the eighth month may very well live, yea, and more likely than born in the 7th month (which is contrary to the opinion of all the world); because it is more perfect, as I shall de∣monstrate afterwards in the fifth Chapter of this Page 141 second Book, where I will particularly shew the cause of this error. Now as we sometimes see Children born two months before the ordinary time of nine months, do live notwithstanding; so there are some Women not brought to bed till towards the 10th month, and sometimes not till the beginning of the 11th: although this may happen in some, yet there are many who deceive themselves in their reckoning, believing that they are gone but seven or eight months, and sometimes ten or more, when they are but just nine; that which thus abuseth them, is their imagining themselves with Child precisely from the suppressing of their Courses, though it be not alwayes true; because some have wanted their Courses two months before they became with Child; and others have them, on the contrary, two or three months after, on the usual manner: which daily happens according to their different constitutions and temperaments, more or less Sanguine. If (as we have said) the intire and perfect term be necessary to the legitimate and natural birth; a good figure and scituation of the Child is no less, which ought to come with the head first, in a strait line, having the face turned downwards, that is, to∣wards the Mothers back, the arms couched along its sides, and the thighs stretcht upwards. This fi∣gure is much the better and convenient, because af∣ter the head (which is the biggest part of the Child) is passed, all the rest coms forth easily, and that being so, none of the joynts of its body can be turn∣ed to hinder its passage forth: but any other part that may first present to the Labour, makes it unfor∣tunate, and against Nature, in which case there is Page 142 often great danger to Mother or Child, and some∣times to both, if not suddenly and duely succour'd. They who have no perfect knowledge of the parts of a Womans body, aqcuired by Anatomy, are con∣tented to 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; at which Galen, and many other Authors, have much admired; many of whom are of opini∣on that the Womans os pubis is separated to inlarge the passage at that time, without which it would be impossible for the Infant to have room enough to be born; and therefore Women a little antiquated, suffer more in their first Labours than others, be∣cause their os pubis cannot be so easily separated, which often kills their Children in the passage. O∣thers are of the opinion that it is the Os ilium which is disjoynted from the Os sacrum to the same pur∣pose; and say, both the one and the other of them, that these bones thus separated at the hour of La∣bour, are thereto by degrees a little before disposed by the slimy humours, which flow forth from about the Womb, and then mollifie the cartilage, which at other times joyn them firmly. But these two opinions are as far from Truth as Reason; for A∣natomy convinceth us clearly, that the Womb by no means toucheth these places, whereby to mollifie them by its humours; as also, that these bones are so joyned by the cartilage, that it is very difficult to separate them with a Knife, especially the ilium from the sacrum, and almost impossible in some elder∣ly Women, without great violence, although Am∣brose Paré (citing many witnesses then present at the thing) reports the History of a Woman, in Page 143 whom (having been hanged fourteen dayes after she was brought to bed) he found (as he saith) the os pubis separated in the middle the breadth of half a finger, and the ossa illia themselves disjoynted from the os sacrum. I will not in this case accuse him of imposture, for I have too much respect for him, and esteem him too sincere for it; but I indeed believe that he was mistaken in this separation; for there is no likelihood that being so at the time of her La∣bour, it would remain so a fourtnight after the breadth of half a finger; for then they should have been obliged to carry this Woman to Execution: for she would not have been able to have supported her self to climb the Ladder of the Gibbet, and to keep her self on her legs, according to the custom of other Malefactors; because the Body is only sup∣ported by the stability of these Bones: wherefore we must rather believe, as most probable, that such a disjunction and separation was caused either by the falling of this Womans Corps from the high Gibbet to the ground after execution; or rather by some impetuous blow on that place, received from some hard or solid thing. If we examine well the different figure and structure of these Bones between a Man and a Womans Sceleton, we shall find a larger empty space and distance between these Bones, much more considerable in Women than Men, and that to this purpose the least Women hath the Bones of the Ischion more distant the one from the other, than the biggest Man: they have all likewise the os sacrum more outwards, and the pubis flatter, which makes the passage from this capacity, larger, and more able to give issue to the Child at the time of Labour; they have besides this, the Page 144 Bones illia much more turned outward, that the Womb being impregnated, may have more room to be extended on the sides, and be more at ease sup∣ported by such a disposition as is here represented. These two Figures of Bones represent the Bones that form the whole capacity of the Hypoga∣strium. A shews the Mans Bones. B the Womans, for to know the difference, that the Womans is more capa∣cious and spacious than the Mans: for C & C, D & D, E & E, are at a larger distance, one from the other in the Womans than they are in the Mans; and besides, that Women have the Coccyx, marked F, more turned outwards, than the Men, which gives way to the Infants Head to pass without great difficulty through the large passage there is between the two Bones of the Ischion, marked E & E, without any ne∣cessity for the separation of the Os pubis, as some have imagined contrary to truth. The Bladder and Rectum being emptied of the Excrements they contain, hinder in no wise but that the Womb, expresly made membranous, can dilate it self as it doth, to let the Infant pass in La∣bour, by this great empty space sufficient for it, without any necessity that these Bones should be disjoynted and separated; for if it should so hap∣pen, Women could not keep themselves on their legs, as many of them do, immediatly after they are brought to bed; because it is instead of a support to them, as is already said, and of a middle juncture to all the rest, as well of the upper as the nether parts of the body: I noted that very well in the Page [unnumbered] [illustration] Chap: I. lib. 2. pag. 144. Page [unnumbered] Page 145 Hostel Dieu of Paris in the many Women I have layed there. When Women, that are there to be brought to bed, begin to be in Labour, they go into a little room called the Stove, where all are deli∣vered upon a little low bed made express, where they put them before the fire; afterwards, assoon as it is over, they conduct them to their bed, which sometimes is a good way off from this little Cham∣ber, whether they walk very well; which they could never do, if their Os Pubis, or those of the Ilia, were separated the one from the other: be∣sides, we often see Maids that conceal their Labour, put themselves (the better to hide their faults) im∣mediately to their ordinary business, as if they ailed nothing: and in all that I have delivered, I could never perceive this pretended disjunction, putting my hand on the Pubis when the Child was in the passage; but I have indeed found the Coccyx, which is joyned with a loose joynt to the inferiour extre∣mity of the Os sacrum, to bend outwards during Labour, in which part the Women feel sometimes much pain, because the coming forth of the Child offers it a great violence, and because its head then doth much press the Rectum against it. Moreover, having often seen and dissected Wo∣men dead a few dayes after delivered, I found it very difficult to separate these bones with a strong sharp Penknife, where I could never find the least appea∣rance of any preceding separation: And if the ad∣vanced in years have more pain with the first Chil∣dren than younger Women, it doth not proceed from the difficulty of the separation of these bones (which never is for the reasons above) but because the membranes of their Womb are dry, hard, and Page 146 callous; and particularly its internal orifice, which therefore cannot so easily be dilated as young Wo∣mens, being more moist. Having sufficiently explained what is Delivery, and all its differences, we must now examine what signs usually precede, and what accompany a natu∣ral Delivery, and an unnatural, which shall be the subject of the next Chapter. CHAP. II. The Signs that precede and accompany aswel a natural as an unnatural Delivery. WHen Women with Child, chiefly of their first, perceive any extraordinary pains in their Belly, they immediately send for their Mid∣wife, taking it for their Labour; who when she is come, ought to be well informed of the matter, and careful not to put her in Labour before there is a dis∣position to it; for many times both Mother and Child lose their lives, when it is excited before the due time. Those pains which may be called false, are usually caused by a Cholick proceeding from Wind, which come and go, griping the whole Bel∣ly, without any forcing downwards or into the Womb, as those do which proceed or accompany Labour; and this Cholick is dissipated by warm clothes applied to the Belly, and a Clyster or two, by which true Labour-pains are rather furthered than hindered. A Woman may feel other kind of pains coming from an emotion caused by the Flux of Page 147 the Belly, which are easily known by the frequent stools that follow. The signs preceding a natural Labour few dayes before, are, that the Belly which before lay high, sinks down, & hinders a Woman at that time from walking as easie as she used; and there flows from the Womb slimy humours, appointed by nature to moisten and smooth the passage, that its inward orifice may the more easily be dilated when it is ne∣cessary; which beginning to open a little at that time, suffers that slime to flow away, which pro∣ceeds from the humours that strain through the thin substance of the Infants membranes, and acquires a viscous consistence by the heat of the place. The signs accompanying present Labour, (that is, shewing, that the Woman is effectively in Labour) are, great pains about the region of the Reins and Loins, which coming and redoubling by intervals, answers in the bottom of the Belly with reiterated throws: The face red and inflamed, because the Blood is much heated by the continual endeavours a Woman makes to bring forth her Child; as also, because that during these strong throws her respi∣ration is ever intercepted, for which reason much Blood hath recourse to the Face: Her privy parts are swell'd, because the Infants Head (lying in the Birth) often thrusts and causeth the neighbouring parts to distend outwards, which thence appear swelled in this manner: She is often subject to vo∣mitting, which makes many believe, who know not the cause of it, that the Women to whom it hap∣pens, are in danger: but on the contrary it is or∣dinarily a signe of speedy delivery, because the good pains are then excited and redoubled every Page 148 moment until the business be finished. This Vo∣mitting comes from a sympathy, between the Womb and Stomach by reason of the ramifica∣tions of the nerves of the sixth pair of the Brain, which are distributed to both the one and the o∣ther, and by which it communicates the pain it feels at that time, arising from the agitation the violent and frequent motions of the Child causeth, and the strong compression the muscles of the lower Bel∣ly makes during the throws, for to help the issue of the Child: besides, when the birth is very near, Women are troubled with an universal trembling, and principally of the Legs and Thighs; not with cold, as at the beginning of an Ague-fit, but with the heat of the whole body, and the humours, which then flow from the Womb, are often discoloured with Blood, which with the signs above mentioned, is an infallible mark of the nearness of the birth, 'tis that the Midwives usually call Shows; and if one then puts up their finger into the neck of the Womb, they will find the inner Orifice dilated, at the opening of which the membranes of the Infant, containing the Waters, present themselves, and are strongly forced downwards with every pain the Woman hath; at which time one may perceive them to re∣sist and appear to the finger, so much the more or less hard and extended as the pains are stronger or weaker. These membranes with the waters in them, when gathered (that is, when they are ad∣vanced before the head of the Child, which makes the Midwives call it the gathering of the waters) presenting themselves at this inward Orifice, do then resemble very well to the touch of the finger, the abortive Eggs which have yet no shell, but are Page 14 only covered with a simple membrane: after this the pains redoubling continually, the membranes are broken by the strong impulsion of the waters, which incontinently flow away, and then the head of the Child is easily felt naked, and presented at opening of the inward Orifice of the Womb: Now, all these, or the greatest part of them met together, at what time soever of a Womans going with Child it be, whether full time or no, one may be assured she will soon be delivered; but great care must be taken not to hasten her Labour, before the necessi∣ty of it be known by these signs, for that would but torment the Woman and Child in vain, and put them both in danger of their lives, as that Midwife did, whom I found endeavouring to put the above named Martha Rolet in Labour at six months end, because of some pains she had in her Belly and Reins, without any other accident answering them downwards; which History is at large in the sixth Chapter of the first Book, to shew that in some cases we must make no more haste than good speed. Labour contrary to Nature is when the Child comes in an ill Figure and scituation; as when it presents any otherwise than the Head first, as also when the Waters flow away along time before it is born, because it remains dry in the Womb, and they are absolutely necessary to moisten the passage, and render it more slippery. When the After burthen comes first, it is an accident which renders the La∣bour always dangerous, by reason of the great flux of Blood usually following, of which the Mother may die in a few hours, and the Infant (because it receives no more nourishment) is quickly smotherd in the Womb, for want of respiration, which it then Page 148 〈1 page duplicate〉 Page 14 〈1 page duplicate〉 Page 148 needs, if it stay never so little after. The Labour is also grievous, when accompanied with a Feaver, or any other considerable Distemper, which may destroy the Child in the Womb, as also when pains are small, and come slow with long intervals, and little profit, by reason of which a Woman is ex∣treamly tyred: but the difficulty most frequent and ordinary comes from the Infant's wrong posture. We shall speak more particularly of the signs of all these different Deliveries, in treating of them sever∣ally hereafter: and now come to the inquiry of some particulars, without which it is impossible to assist a Woman safely in her natural Labour, or to help her in the unnatural ones: and therefore we will examine every thing that is in the Womb with the Infant during pregnancy, and first describe those that first offer themselves to pass the Orifice, when the Woman is neer her delivery, which are the membranes of the Infant, and the waters contained in them. This Figure represents the Membranes of the In∣fant, wholly separated from the Womb, in which it is contained with the Waters. These Membranes in some manner resemble a great Bladder, through which the figure of the In∣fant may be a little perceived: there is likewise seen on the upper part, the After-burthen, marked A, on that side, which is fastened to the bottom of the Womb. Page [unnumbered] Page [unnumbered] [illustration] Chap: II. lib. 2 pag: 150 Page 151 CHAP. III. Of the Membranes of the Infant, and the Waters. AS soon as the two Seeds have been confusedly mixed, and retained by conception, the Womb immediately after, by means of its heat* separates this Chaos, for to make out of it the delineation and formation of all the parts, and be∣gins to work upon these Seeds, which though to the sight they appear similar and uniform, yet in effect contain in them many dissimilar parts, all which it separates and distinguisheth one from the other, inclosing the most noble, and on the* outside the most glutenous and vis∣cous, of which first the Membranes are formed for to hinder the Spirits, wherewith the •…¦mous Seed abounds, from being then dissipated to serve afterwards to contain the Infant 〈◊〉 Waters, in the midst of which it swims, that they may not stream away. As the Membranes of the Faetus are the first parts formed, so are they with the Waters the first th•… in time of Labour present themselves to the pa••age before the Infants Head. Most Authors are so dark in the descriptions they make of these Membranes, that it is very hard to conceive them as they are, by the explication they make of them. They do not so much as agree in the number of them, some ac∣count three as well for a Child as a Beast, to wit, Page 152 the Chorion, the Amnios, and the Allantoides; others account but two, because there is no Allantoides in a humane Faetus; but to speak properly (if it be strictly examined) what there is, (as I have often done) there will be never found but two, which are so joyned and contiguous the one to the other, that it may be said to be but a double one, which may indeed be separated and divided into two. I will explain it on such wise, as may be best under∣stood by those that are ignorant of it: for there are many, who think with Galen, that these Mem∣branes are separated and distant the one from the other, and that the one surrounds only the Infant, and the other receives the Waters, which are partly engendred from sweat, and partly from the urine, (as they imagine); and believe further, that these Waters themselves are separated the one from the other by these Membranes, which is quite contrary: for they are both so joyned the one to the other, that they compose as it were but the same body and involver, which serves (as we have already said) to contain the Infant with the Waters, which are all of a nature, and shut up in the same Membranes, as I shall make appear hereafter in speaking of their original): it matters not to the truth, after what manner this be explained, provided it may be understood as it is. The exteriour part of this Membrane, or double* Involver; or, if it be esteemed two, the first Membrane pre∣sented without, is called Chorion, from the Greek word 〈 in non-Latin alphabet 〉, signifying to contain, because it imme∣diately contains 〈◊〉•…ons the other, which is Page 153 called Amnios, that is a little Lamb, because it is so small and thin. Galen in his 15th Book of the use of parts, calls the burthen Chorion. But to render this more, intilligible, we shall take this first Mem∣brane for the Chorion, which may be again sepa∣rated and divided into two, though effectively it be but one. The Chorion is a little rough, and un∣equal throughout the whole outside of it, in which many small capillary vessels may be observed, run∣ning quite round, as also many little fibres 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 that it appears (as we have already de∣clared) but as one and the same Membrane. This Chorion covers the Placenta, and cleaves close to the forepart of it, which respects the Infant, by means of the interlacings of an infinity of Vessels: it is al∣so principally fastened to the Womb by the whole circumference of the Placenta, in which part this Membrane is a little thicker. The Amnios, which is the second Membrane, is three times thiner than the Chorion: and is very smooth within, but not just so much where 'tis joyn∣ed and united to the Chorion. This Membrane is so thin, that it is quite transparent; and hath no ves∣sels in it, which makes it so thin, as cannot be ima∣gined without seeing. This Amnios doth in no wise touch the Placenta, though it covers it, but it lines only all the inner part of the Chorion, which is be∣tween, and from which it may be wholly separa∣ted, if it be done with care. The better to conceive this as it is, and after what manner these Membranes are in the Womb, consi∣der Page 154 the composition of a Foot-bal, imagining the Leather which covers it, to be the Womb of a preg∣nant Woman, and the Bladder blown up with wind, within the Foot-ball, to be this double Mem∣brane of the Chorion and Amnios, in which are con∣tained together the Child and the Waters; and even as the outside of this Bladder toucheth every where (because it is blown up) the Leather of the Foot-bal: so likewise the Membranes of the Faetus 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) Membrane, which Authors name Allantoide, & say is like a Sau∣sage or Girdle, which surrounds & clothes the Infant from the cartilage X•phoide, to just below the Flanks only; it is most certain, there never was any such thing in any of these Animals whose Dams have but one young at a time no more than Women, as Sheep, Cows, Mares, she Asses, nor any other for ought I could ever learn after many curious inquiries. Sometimes Infants at their birth, bring forth these Membranes upon their head, and then 'tis said they will be fortunate: which is meerly supersti∣tious, because it happens by the strength of their substance, so that they cannot burst by the impulse of the Waters, or the Womens throws in Labour; or because the passages being very large, and the In∣fant very little, it passeth very easie without vio∣lence: in truth in this respect they may be said to be fortunate, for having been born so easily; and the Mother also for being so speedily delivered; for in difficult Labours, Children are never born with such caps, because being tormented and pressed in Page 155 the passage, these Membranes are broken and remain still there. Within the Infants Membranes (disposed as I have explicated) are contained the Waters, in the midst whereof he swims, and is scituated; the ori∣ginal of which seems very incertain, if the different opinions of Authors upon this subject be regarded. Some will have them to be the Urine emptied out of the Bladder by the*Ou∣raque, because they cannot find a true and easie way for it; and because their colour and savour much resembles the Urine contained in the Bladder: but it is very certain, it cannot be so as they say, because the Urachus is not perforated in the Faetus, and it comes not forth of the Navel; for the place where it is fastened, is alwayes tendi∣nous, and very like a small Lutestring, through which, it is most certain, nothing can pass, how subtil soever; as I have often observed and seen Mr. Gayant to note, who is, with universal Approbati∣on, the most exact and expert Anatomist, that hath been this long time in Paris: for whose merit, his Majesty hath done him the honour to choose him before all others to make those curious Inquiries and many fair Experiments, in which many choise and knowing Persons are continually imployed, who are of the Royal Academy. Now this natural con∣formation doth clearly manifest that Laurentius was abused, when he saith, that he had seen a Man, whose Oraque was not closed, to void a quantity of Water by the Navel; inferring thence, that it came from the Bladder by this Urachus; and that which is contained within the Infants Membranes, is amassed after the same manner. I doubt not but Page 156 he saw a Man void Water by the Navel, as he saith; but it did certainly proceed from the capacity of the lower Belly, where he had a Dropsie, and not from the Bladder; for there is no cavity in the Ura∣chus, as we have said, at least not, except it be against the order of Nature; upon which, in this case, we must not rely so, as to affirm it ought to be so in all other subjects. There are others, who will also have these Wa∣ters to be the Urine: but they are of an opinion that it passeth through the Yard, whose passage is alwayes open, and not by the Urachus which never is hollow. For my part, as it appears to me, with more reason, and as indeed it is, these Waters are only generated out of vaporous humidities, which tran∣sude and exhale continually out of the Infants bo∣dy, and meeting these Membranes, through which they cannot pass, because they are too thick and close, are turned into Water, which is thus by little and little 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: for vapours pass forth and exhale out of all porous bodies that are hot and moist, as is that of an Embrio; and the reason is very weak, by which they maintain these Waters to proceed from the Urine, because they are salt, as the Urine is; for Sweat, Tears, and other humours, which distill and transude 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 than ordeur in the Guts, because at such time it receives no nourishment by the mouth, and that all its superfluous humours may Page 157 easily pass away by transpiration, through the sub∣stance 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, than the Ex∣crements which are in the Guts; which is not then done in any manner, but only after the Child is born. Bartholinus and others would however have the Infant to render its Urine through its Yard, and that these Waters proceed from thence: but there is a greater probability it should come by transpi∣ration, as I have said; for before it is yet fully shaped, and quick, there is notwithstanding found a proportionable quantity of these Waters to the bigness of his body: which makes it manifest, that it is then neither the Urine rendered by the Ura∣chus nor the Yard, as all the world imagine: and that which proves it more plainly, is the example of some Children born with their Yards not perso∣rated, who notwithstanding have these Waters, whilst they are in their Mothers Womb. It must be observed, that when there is more than one Child, they are never in the same Mem∣brane, unless their bodies are joyned and adhering together (which is rare and monstrous when it happens) but each of them have their Membranes and Waters apart and separated, in which they are each wrapt up by themselves. These Waters thus collected within these Mem∣branes have divers very considerable uses. They serve the Infant to move it self the more easily, as it were by swimming 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 Page 158 cause great pain and often excite to abortion: 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 yeelding 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 al∣so more tormented by it. John Claudius de la Corveé, Physitian to the late Queen of Poland, in his Book intituled De Nutriti∣one Faetus, would have these Waters to serve the Infant chiefly for nourishment, and that it sucks them by his mouth, and swallows them (as he ima∣gins) whilst he continues in the Womb: but the truth of the contrary being known to the least Scho∣lar, it would be but labour in vain to refute all the reasons he brings to prove and support his saying; for they destroy themselves, and do all of them correspond to the falshood of their principle. Having thus sufficiently explained the Membrans and Waters of the Faetus, we must in order inquire after the parts, by means of which it is nourished whilst in the Womb, which shall be our following discourse. These three Figures represent the Placenta, or After-birth, and the umbilical vessels of the Infant. The first shews the shape of the Burthen, to the Page 159 midst of which is fastened the Navel-string, & round it may be discerned the* Membranes of the Infant, which remain thus wrinkled when the Child is come forth of it. A A A, Shews the body or cake of the Burthen. B B B, The Skins fastened round about it. C C C, The Navel-string, which contains the In∣fants umbilical vessels, and proceeding from his Navel, are inserted in the midst of the burthen, where they produce an infinity of branches. D D, Certain eminencies, called knots, found on the string, proceeding from the dilatation of the um∣bilical vessels more in one place than in the other. The second Figure shews the Burthen turned on the outside, and the Childs belly opened, that the distribution of the umbilical vessels may be then considered. E E E, Shows the Burthen on that side which cleaves to the Womb: on this side there appears no ves∣sels as there doth on the other; but only some simple interlinings and small outlets, by which the Blood that transudes the Womb, may distil into this parenchymatous mass. F F F, The Membranes, Skin, or Skirt. H, A portion of the Amnios separated from the Cho∣rion, marked I. G, A part of the Chorion, separated from the Amnios, marked H. I I I, The Navel-string, in which are many knots. K, The Navel where the vessels enter. Page 160 L, The umbilical veine, which enters into the fissure of the Liver. M, The two umbilical Arteries, which being con∣ducted along the side of the Bladder, are inserted into the Iliac Arteries, and sometimes into the Hypogastricks. N, The Urachus, which from the bottom of the Bladder, couching between the two umbilical Arteries, is fastened in the Navel, without pas∣sing forth, in which place it is not hollow in the least, and is extreamly small. The third Figure shews the burthen of Twins, where each Child hath his several Navel-string and Membranes apart. O O O O, The fleshy substance or body of the Bur∣then, common to both Children. P P P, The Skirt or Membranes, which wrap up the Child on this side apart. Q Q Q, The other Membranes, which contains the other Child apart. As to the strings, which are double to this Af∣ter-burthen, that on the right is dissected at the end, to shew that there are but three ves∣sels only in it. R R, Shews a strong Membrane, in which these three umbilical vessels are inclosed. S. The Veine which is very big. T T, The two Arteries, much less than the Vein. The other string cut on the other end, where are only seen the orifices of the vessels. Page [unnumbered] Page [unnumbered] [illustration] Chap. III. lib. 2. pag: 159. & 160. Fig. II Page [unnumbered] Page 161 CHAP. IV. Of the Placenta, and Umbilical Vessels of the Child. SInce the Infant is only nourished with the Mothers blood whilst it is in the Womb, and that big-bellyed Women never have any that is fair or good; provident Nature hath formed the Pla∣centa to serve it for a Magazin, that it may alwaies 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 Mothers cannot possibly be converted into its delicate substance, if it were not first pu∣rified in the Placenta, which is afterwards sent to it by meanes of the Umbilical vein, and brought back, as we shall shew hereafter, by the Arteries, which are the conduits of which the the Navel∣string is composed. We say then that the Placenta is nothing but a spongy and fleshy mass, somewhat like the substance of the Spleen, woven and inter∣laced with an infinity of Veins and Arteries, which compose the greatest part of its body, made to receive the Mothers blood, appointed for the Infants nourishment, which is in the Womb. This mass of spongious flesh is thus called, because it resembles in figure a Cake; some call it the Delivery, because being come forth after the Child is born, the Woman is quite delivered of the burthen of her great-belly: It is likewise called Page 162 the After-burthen, because it is as a second labour, of which the Woman is not discharged till* after the Child is born: there are some which give it the name of the Uterine Liver, because they say it serves as a Liver to prepare the blood appointed for the Infants nourishment: and Laurentius likes ra∣ther to call it the*Pan∣creas of the Womb, and ap∣points the same use for it, as for the Pancreas of the lower belly, to wit, for a rest and support to the vessels of the Navel, which disperseth an infinite number of branches through∣out all its substance. This Placenta is made of the menstruous blood of the Mother, which flowes into the Womb, by the accumulation of which is formed this Parenchy∣matous mass; the shape of it is flat and round, of about he bigness of a Trencher, and two fingers breadth thick towards the middle of it, where the umbilical vessels are fastned: but it is thinner to∣wards the edges of all its whole circumference. It is covered with the Chorion and Amnios on the side next the Infant, and on the other side it is joined and fastened to the bottom on the inside of the Womb: It is strongest fastened to the Womb (with its circumference) by means of the Chorion, as we have hinted already in the pre∣ceding Chapter, which cleaves so close to it, by the interlacings of an infinity of Vessels, which appear very large in its surface, that it cannot be separated from it without laceration of its sub∣stance. Page 163 If one considers diligently, as I have done, the Placenta on that side which joyns to the Mother, they may perceive that it is also indued with a kind of light membrane, which is so frail and small, that it is almost imperceptible: however, it may manifestly be discerned by wiping away the blood with which it is alwaies coloured. There may be again observed, that all the su∣perficies on this side is as it were much interlined, not unlike in some measure those of an Oxes reins: and there appears likewise many small out-lets, by which the blood, that transudes through the p•∣rous substance of the Womb, distills into this fleshy mass. Although there be two Children in the Womb, nay three, if twins, that is to say, begotten in the same act, they have usually but one common After-burthen: which hath as many Navel-strings fastened to it, as there are Children; which not∣withstanding are separated one from the other by their several membranes, in each of which the Children are apart with their Waters; if at least (as I have said in the precedent Chapters) their bo∣dies be not joyned and adhering one to the other; in which case the Twins of this kind have as well their Waters in common, as that they are in∣volved in the same membranes: but if they be superfetations, there will be as many burthens as Children: and as superfetation (if there are as ma∣ny as may possibly be) happen but very rarely, so there are few Women that have their burthens separated, when they are delivered of several Chil∣dren. We scarce find any creature but a Woman, that Page 164 hath an After-burthen, like what we have de∣scribed, and dischargeth it as useless, assoon as the Child is born; for most other Animals cast forth nothing after their young, except the waters only and some slime, with the membranes which surround them; and instead of this fleshy mass, those, which ordinarily, as a Woman, bring forth but one young at a time, have only some Cotyledons, which are many spongious kernells, joyned inwardly to the proper substance of their Womb, where terminates all the branches of the Umbilical vessels of their young; which kernells, as I have often observed in the dissecting of sheep, are not bigger than Hemp seed, when they are not with young; but when they are with young, they swell extremely, and become of the bigness of a thumb, the one bigger, the other lesser: they then resemble much the Figure of a round Mushroom, not yet spread, on the wrong side, after it be cut from its stalk; and to each of those Cotyledons, or kernels, are fastened the ramifications of the umbi∣lical Vessels: however it is certain, that the Ani∣mals which have ordinarily more than one at a time; as Bitches, Rabbits and others, have no Coty∣ledons, instead of which each young hath in its Cellule a kind of particular Placenta, which the dam eats asson as she voids it, after she hath gnawed and cut off with her teeth the Umbelical vessel which held it. When a big-bellyed Woman hath the least in∣disposition of her whole habit, there is almost ever some mark and impression either in colour or substance on the after-burthen, which she voids in her labour; because, it being of a very soft sub∣stance, Page 165 easily imbibes the ill humours of the body, which used to be voided by the Womb. Its natural colour ought to be red, and so much the fairer and better coloured, as the Woman is in good health; its substance must be whole and e∣qually soft, without the least schirrous hardness. From the midst of the Burthen proceeds a string, composed of many vessels joined together, which serve to conduct the blood appointed for the Infants nouriture; the number of them is disputed amongst Authors: some reckon four, that is, two Veins and two Arteries; others five, adding the Ourachus to them; but it is very certain that there are but three only in a humane Foetus, as I have found by many dissections; to wit, one Vein and two Arteries: the vein having sent forth into the Placenta an infinity of branches, like to the roots of a tree, is conducted by a single channel all along the string to the Infants navel, which it passeth, to be at last terminated in the midst of the Fissure, which is in the inferiour part of the Liver; and the two Arteries taking their rise out of the same Placenta, from a great number of the like roots, pass along the same string by two conduits, piercing also the Infants Navel, and end in its Iliac Arteries, and sometimes in the Hypo∣gastricks. The Vein is much bigger than the Ar∣teries; its cavity is capable to admit a writing-quil into it, and those of the Arteries only a small bod∣kin about half the bigness of the Vein. These three Vessels composing the string, are wrapt up in one Membrane thick and strong e∣nough, proceeding from the Chorion, which like∣wise is clothed about with a production from the Page 166 Amnios, and may easily be separated: but besides that this first serves them as a sheath, in which they are all three lodged, it separates them again one from the other by its duplications; When the vessels of the string are full of blood, it is then of about the bigness of a finger, and ordinarily of the length of a good half Ell, and sometimes of two thirds, or three quarters. It is necessary it should be of this length, that the Infant may have liberty to move it self in the Womb, and to go forth of it at its birth without tearing the After-burthen, to which it is fixed: There are many very plain inequalities, like unto knots, which only proceed from the dilatation of the Vessels, which being varicose and fuller of blood in one place than another, causeth these eminences. Some Mid∣wives believe superstitiously, or would make others believe, that the number of these pretended knots, answers the number of Children the Woman shall have afterwards, which is without reason; because Women delivered at forty years of age, and of their last Child, as we find by daily experience, have as many knots on the Navel-string, as a Wo∣man of twenty years, who may yet have a dozen Children: they say further, That if the first knot be red, the next Child the Woman shall have, will be a Boy; if white, a Girl: but this Proposition is as ill grounded, as the other; for these Knots appear only red, or to speak more properly, of a dark blew, according as the Vessels are more or less full of blood, and especially the Vein which gives it that colour, and is so much the more apparent, as it is superficial in that place. There are many Authors admit, as we have Page 167 said, the Ourachus into the number of these Umbili∣cal vessels, saying that it serves to empty the Childs urine into its Membranes: however, experience shewes us it is no vessel, and that it passeth not forth of the Navel; but that it is only a ligament in a Child, as it is in a Man, which coming from the bottom of the Bladder, terminates at the Navel, without traversing it, as they have hitherto mi∣staken it. I have opened and dissected above thirty Foetus's, in none of which did I ever find it hollow, but alwaies very solid and tendinous, towards the place where it it fastned to the Navel; and very like, as I have already said, to a small Lute string: Notwithstanding I ever found it ma∣nifestly hollow in an Ewe, which was terminated with their other Umbilical vessels, at their Cotyle∣dons; in which Animals are also two Umbilical veins to be seen, going both near one the other to the Liver, which makes that their Navel-string consists of five Vessels; but it is not the same in a human Foetus, for there is but one onely Umbili∣cal Vein, and two Arteries. To understand well how the nourishment is conveyed to the Infant by the Umbilical vessels, it is very necessary to conceive and know, in what manner the Blood circulates; which is after this manner. The blood having been conveyed by the mothers Arteries, which end at the bottom of the Womb in the Placenta, which is there fastned, makes a natural transfusion through the Umbilical Vein into the Childs Liver, after which it is carried into the Vena cava, and thence to the Heart, whence it is sent to all the parts by means of the Arteries, and very near a like portion in quantity Page 168 being in the Iliac Arteries, is conducted into the Umbilicals, which are there terminated, for to be carried back into the Placenta, where this blood being again elaborated, returns to make the same journey by the Umbilical Vein, passing again to the Childs Liver, and thence to the Heart, and so alwayes successively, without the least intermission. But to be able to conceive easily how the blood circulates in the Placenta, and how by the help of that part is made a mutual transfusion from the one to the other, as well in respect of the Mother, as of the Child; we need but imagine it to be a common part, and depending on both their bo∣dies: for as to the Mother, the circulation is there made just as in her Arm, or any other part of her whatsoever; and as to the Child, it is even the same. There are no Valvules found in the Umbilical Vein, though I have curiously examined it, nor are any necessary: these Valvules ar every frequent in the Veins of the Arms and Legs; because these parts are obliged to make different motions, which compressing the Vessels would trouble those of the blood, if it were not so sustained and hindered from recoiling; but the Umbilical Vein hath no need of any, because the Navel-string is loose and floting in the midst of the waters, where it cannot be comprest; and therefore the motion of the Blood cannot be there intercepted, as it is some∣times in the Arms and Legs, or other parts where there are strong contractions. Assoon as the Child is born, these Vessels, which are bigger in a Foetus, because of their cavity, than they are in a Man, dry up; and that part of them Page 169 which is without the belly, falls off, and is sepa∣rated close to the Navel five or six days after; for which reason they lose their first use, and begin afterwards to degenerate into suspending Liga∣ments, to wit, the Vein into that of the Liver, and the two Arteries serve to extend and sustain the Bladder by the sides where they are joyned to it, the bottom of which is yet suspended by the Oura∣chus, which comes not through the Navel, as hath been said, but remains so pendant all the rest of its life. We have hithereo made mention of all those things which are found with the Child in the Womb, let us now show what are the different scituations of it in the Womb, according to the different times of Pregnancy: It is a thing of very great consequence, and deserves some reflections. The three following Figures represent the different natural scituations of the Child in the Womb. That which is marked B, shews how it is scituated the seven first months of Pregnancy. That which is marked A, shews the same scituation on the back-side. And the third, marked C, shews in what fashion it is scituated towards the end of a Womans reckoning, and at the time that it is disposed to be born. Explication of all the Wombs, in which are contained all the Children represented in different postures, as well in this place, as in all the follow∣ing. A A A A, Shews the substance of the Womb. Page 170 B, The Membrane called Chorion, which lines the Womb within. C C C C, The membrane Amnios, which is so u∣nited and joyned to the Chorion, that both of them seem to be but one single Membrane. D D D D, Shews all the space which is filled with waters, in the midst of which the Infant flotes and is scituated. E E, The After-birth fastened to the bottom of the Womb. F F F, The Navel-string, which fluctuates hither and thither in the waters. CHAP. V. Of the several natural scituations of an Infant in the Mothers Womb, according to the different times of Pregnancy. WHen we shall have explained the several natural scituations of an Infant, those contrary to Nature, causing for the most part all ill labours, will easily be conceived. It may be considered that generally the Infants, as well Male as Female, are usually scituated in the midst of the Womb; for though sometimes a Womans great Belly is a little higher on the one side than the other, yet that is, because the globe of the Womb inclines more that way, and this scituation on the side must be understood only in respect of the Mothers belly, and not of her Womb, in the midst of which it is alwaies placed; Page 171 because there is but one only cavity in a Womans Womb, marked with a small line in its length, without having two or more separations; as is seen in those of other Animals. There are some who would have these two ima∣ginary cavities to be the cause why Women some∣times bear Twins, yea and sometimes more; and that the Males are rather engendered on the right, and Females on the left side, which is Hypocrates's opinion in the 48th Aphorisme of his 5th Book, where he saith, Foetus Maris dexträ uteri parte, Foeminae sinisträ magis gestantur, but without any certain reason for it; because some Women have the Males on the left-side, others the Females on the right; and when there are Twins, sometimes both are of the same Sex, sometimes not, and in∣differently scituated on the right or the left. This is all can be said in general of the scituation of Children in the Womb. But in particular, when we consider the several Figures it makes, it differs according to the diffe∣rent times of Pregnancy; for when the Woman is young with Child, the little Foetus, called Embryo, is alwaies found of a round Figure a little oblong, having the Spine moderately turned 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. It resembles, in this posture very well, one sitting to void his Excrements, and stooping down his head to see what comes from him. The Spine of its Back is at that time placed towards the Mothers, Page 172 the head uppermost, the face forwards, and the feet downwards; and proportionable to its growth and grandeur, it extends by little and little its members, which were exactly folded in the first months. It keeps usually this posture till the seventh or eighth month, at which time the head being grown very big, is carried 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. Some believe that only Males are so turned downwards when they are born, and that the Females are with their face up∣wards; but both the one and the other are alwaies turned downwards, with their face towards the Rectum of their Mother, as is abovesaid, and when it happens otherwise, it is unnatural, for the Childs face coming upwards will be extremely bruised, and the nose wholly flatted, because of the bones hardness in the passage. It may be noted, that when the Child hath thus changed its first scituation, being not yet ac∣customed to this last, it stirs and torments it self so much sometimes, that the Woman, by reason of the pains she feels, is apt to believe it her Labour: And if this circumstance be well considered, they will find it to be that first pretended endeavour which Authors imagine the Child makes for to be born in the Seventh moneth, and not being able to accomplish, it remains so till the Ninth, and that reiterating it in the eighth, if it be born, it lives not long, because it was not able to endure two such puissant endeavors so near together. But it is a meer abuse, for if the Child turnes it self so Page 173 with the head downwards, or rather is turned, it is but by a natural disposition of the weight of the upper parts of the body, and if it stirs much at that time and soon after, it is not from a desire to be born, but from the inconvenience it receives from this new posture, to which it was not before accustomed, as already hath been mentioned: And it begins to turn thus sometimes from the Se∣venth month, rarely before but by accident, oftenest about the eighth Moneth, and sometimes in the ninth only, and at other times also it doth not turn at all, as we way easily perceive in those that come in their first scituation, that is, with their feet foremost. From whence it is easie to conjecture, and I hold it for a certain truth, that the Children are the more strong and robust, and consequently may more likely live, by how much the nearer they approach to the more natural and perfect time, which is at the end of the ninth Month. The Infant then is turned on this manner with his Head downwards towards the latter end of the Reckoning, to the end only that he may be the better disposed for its easier passage into the world at the time of Labour, which is not then far off: For in this posture all its joints are easily extended in comming forth, and the Arms and Legs cannot hinder its birth; because they cannot be bended against the inward orifice of the Womb; and the rest of the body, which is very supple, passeth very easily, after the Head, which is hard and big, be once quite born. When there are many Children, they ought, if it be natural, to come in the same Figure, as when Page 174 there is but one: but usually by their different motions they do so incommode one the other, that almost alwaies one of them presents wrong at the time of Labour, yea and before; which is the cause that one comes often with the Head, the other with the Feet, or any other worse posture, and sometimes both come wrong. However the Infant may be scituated in the Mo∣thers belly, or in whatsoever fashion it be that it presents at the birth, if it be not according to the posture above described, it is alwaies against Na∣ture: and the natural scituation is so necessary to a good and legitimate Delivery, that those which are against nature, do cause for the most part bad Labours. When a big-bellyed Woman is happily arrived near her haven, she ought then to take great care she suffers not shipwrack there; which she will avoid, if she observes exactly at the end of her reckoning the Rules which follow. CHAP. VI. What a Woman ought to do, when she hath gone her full time. I Am not of the opinion of most Mid-wives, who advise Women with Child (that they may, as they say, have the better labour) to use more than ordinary exercise towards the end of their reckon∣ing, as Liebaut also directs, who orders them to ride in Coaches, or trotting Horses, which is a very Page 175 dangerous advice, and causeth daily many wrong Births; for, as we said in the precedent Chapter, 'tis about that time that ordinarily the Child turns its head downwards, and its heels upwards, for to be born right, and the poor Women often be∣lieving they may procure an easie labour, make it by this extraordinary exercise very unhappy, which because of the agitation and commotion of the body, causeth the Child to take a wrong po∣sture, or makes the Womb so to bear down and be engaged in the cavity of the Hypogastrium, that afterwards it hath not at due time liberty to be turned; which is often the reason, why it comes in its first posture, that is, with the feet, besides that labour (which ought to be Natures work, if the Child come right) is thereby excited before the full time, and though it were but four or five days, it hinders not, as I have said elsewhere, from be∣ing as prejudicial to them, as we see it is to the taste, goodness, and conservation of Fruit gathered but few days before its perfect maturity. Wherefore I counsel a Woman (though almost contrary to the unreasonable opinion of every one) to keep her self more quiet than ordinary, when she draws near her time, that so her Child may be able to turn it self directly right, and that she by all means avoids being strait laced, that so it may have more space to be turned into a fit posture to be born; she must then likewise observe a good diet of meat, of good juyce and easie digesti∣on, rather boiled than rosted, to moisten the better, and keep the body thereby open, rather than by Clysters, which may hasten labour; she may about eight or ten days before Labour anoint Page 176 her privities with Goose, Capon, or Hogs Grease or fresh Butter: or foment those parts with fo∣mentations, which may by mollifying and loosen∣ing, render those passages more smooth and slippery. This ought principally to be done by those that go with their first Child; because their passages are more strait than others who have had Chil∣dren already: but they who are a little in years, have much more pain, and are longer in Labour of their first Child, than others who are indiffe∣rent young; because the Membranes of their Womb are harder and dryer; wherefore they can∣not yeeld so well, nor the inward Orifice be so easily dilated. Some Authors commend bathing, the better to relax those parts; but it is dangerous, lest by their too much moistness, and the emotion they cause to the whole Body, they make her come a little before her time. Many Women bleed by way of prevention, when they are, or believe themselves to be at their full time; which custom I cannot approve, if it be only for prevention; but I do, in case some other necessity require it, provided they abstain from it after the seventh Moneth; because the stirring of the Child, caused by bleeding, is sometimes so vehement, that the Womb is constrained to open, before its time to be rid of the Child. If a Woman with Child ob∣serves these Rules, she will have reason to hope for a good issue of her Labour: in the mean time let her provide her self of a good Midwife or an ex∣pert and handy* Chy∣rurgeon, to attend upon her assoon as she per∣ceives Page 177 the least pain or throw, of what kind soever; for as a small wind, or shake, will serve turn to make ripe fruit fall, so the least Cholick, or any other false pain, may bring forward her Labour, and surprise her unprovided of help: Let us now see what is necessary when she is effectively in La∣bour. CHAP. VII. What is to be done when the Woman first falls in Labour. A Womans travel is only many pains with rei∣terated Throws, by which she endeavours to bring forth her Child: It is so called, because both Mother and Child suffer and take much pains in this action. Most people believe that there is no other reason for the cause of this evil, but be∣cause God hath so ordained it, and that Woman, according to his Word, must bring forth with pain, because of her sin, according to what is written in the 3d. Chap. of Genesis, I will greatly multiply thy sorrow and thy conception, in sorrow thou shalt bring forth Children, and thy desire shall be to thy Husband — This curse was indeed very great, because it hath extended to all Wo∣men that have brought forth Children since that time, and will continue to all that shall come hereafter. However we find that all the Females of other Animals suffer as much, and are in as great danger of their lives as a Woman, when they bear their young. This perswades us, that, Page 178 besides this precise will of God in respect of a Woman, there must be yet a natural reason, wherefore it cannot happen otherwise, and that is, That it is impossible the Womb, being very strait in comparison of the Childs bigness, and very sensible, because of its Membranous composition, should receive a necessary dilatation for the Childs birth, and such great violence, without suffering considerable pains for it. Now since a Woman, for this cause, cannot shun these pains, she must endeavour to endure them with patience, in the hope of being suddenly delivered from them by a fortunate labour. Assoon as it is known that the Woman is cer∣tainly in Labour, by the signs mentioned in the Second Chapter of this Book, where both those preceding and those accompanying Labour are recited; of which the principal are, Pains and strong Throws in the Belly, forcing downwards towards the Womb: the dilatation of the inward Orifice, perceived by touching it with the finger: as also the gathering of the Waters, which come before the Head of the Child, and thrusting down the Membranes which contain them, through which between the Pains one may in some manner with the Finger discover the part which presents, especially if it be the Head of the Child, by its roundness and hardness: Then must all things ne∣cessary to comfort the Woman in her Labour be go ready; and the better to help her, care must be taken, that she be not strait-laced; a pretty strong Clyster may be given her, or more than one, if there be occasion; which must be done at the Page 179 beginning and before the Child be too forwards, for afterwards it is very difficult for her to receive them, because the Gut is too much compressed: they serve to excite it to discharge it self of its ex∣crements, that so the Rectum being emptied, there may be more space for the dilatation of the passage, as also to stirr up the pains to bear the better downwards, through the endeavours she makes when she is at stool, and the while all necessary things for her Labour should be put in order, as well for the Woman, as the Child, a Midwifes stool, or rather a Pallet-Bed girted, placed close by the fire, if the season require it; which Pallet ought to be so disingaged, as to be turned round about, the better to help the Woman when there is occasion. If the Woman be* Plethorick, it may be convenient to bleed her a little, for by this means, her Breast being dis∣ingaged, and her respiration free, she will have more strength to bear down her pains, which she may do without danger, because the Child being about that time ready to be born, hath no more need of the Mothers blood for its nourishment; which I have often practised with good success: besides this evacuation often hinders her having a Fever after Delivery, in expectation of which hour she may walk about her Chamber, if her strength permits; and to preserve her strength, it will be convenient to give some good gelly broths, new-laid eggs, or some spoonfuls of burnt or brew∣ed Wine, from time to time, or a Tost dipt in Wine, avoiding at that time solid food. Above all she must be perswaded to hold out her pains, Page 180 bearing them down as much as she can, at the instant when they take her: The Midwife must from time to time taste the inward orifice with her finger, to know whether the Waters are ready to break, and whether the Birth will soon after fol∣low: she must likewise anoint all the bearing place with emollient Oyles, Hogs-grease, or fresh Butter, if she perceive that they can hardly be dilated, and all the while she must be near her Woman, to ob∣serve her gestures diligently, her complaints and pains, for by this they guess pretty well, how the Labour advanceth, without being obliged to taste her body so often. Mr. de la Cuisse deceased, who often slept near the Woman in Labour, was so used to it, that he never awaked till just the Child was in the passage, at which time the Woman changeth her moans into loud cries, which she strongly repeats, be∣cause of the greater and more frequent pains which she then feels: the Patient may likewise by inter∣vals rest her self on her bed, for to regain her strength: but not too long, especially little, or short thick Women, for they have alwaies worse Labours if they lye much on their beds in their Travail, and yet much worse of their first Chil∣dren, than when they are prevailed with to walk about the Chamber, supporting them under their arms, if necessary; for by this means, the weight of the Child (the Woman being on her Legs) caus∣eth the inward orifice of the Womb to dilate sooner than in bed; and her pains to be stronger and frequenter, that her Labour be nothing near so long. Page 281 Qualms and Vomitings, which often happen to Women in Labour, ought not to amaze any, for on the contrary, it furthers the Throws and Pains provoking downwards: we shewed the cause of this Vomiting in the Second Chapter of this Book, and the reason why it is not dangerous. When the Waters of the Child are ready and gathered, which may be perceived through the Membranes to present themselves to the inward ori∣fice, of the bigness of the whole dilatation, the Midwife ought to let them break of themselves, and not as some, that impatient of the long La∣bour, break them; intending to hasten their bu∣siness, which on the contrary they retard by so doing, before the Infant be wholly in the passage; for by the too hasty breaking of these Waters, which ought to serve him to slide forth with greater facility, he remains dry, which hinders after∣wards the Pains and Throws from being so ef∣fectual to bring forth the Infant, as else they would have been; it is therefore better to let them break of themselves, and then the Midwife may easily feel the Child bare, by the part which first pre∣sents, and so judge certainly whether it comes right, that is with the Head, which she shall find hard, big, round, and equal; but if it be any other part, she will perceive something inequal, and rugged, and hard or soft, more or less accord∣ing to the part it is. Immediately after* let her dispatch to deliver her Woman, if she be not already, and assist the Birth, which ordinarily happens soon after, if natural, and Page 182 may be done according to the directions in the next Chapter: But if she finds the Child to come wrong, and that she is not able to deliver the Woman* as she ought to be, by helping Nature, and so save both Mother and Child, who both are in danger of their lives, let her send speedily for an ex∣pert and dextrous Chyrurgeon in the practice, and not delay as too many of them very often do, till it be reduced to extremity. There are many Midwives, who are so afraid that the Chirurgeons should take away their pra∣ctice, or to appear ignorant before them,* that they chuse rather to put all to adventure, then to send for them in necessity: others are so presumptuous, as to believe themselves as capable as the Chi∣rurgeons to undertake all. And some there are indeed, who are not so wicked, yet for want of knowledg and experience in their Art, hope still in vain, that the Child in time may change to a better posture, and that the accidents will cease (if it please God, as they say); and some do malici∣ously put such a terrour and apprehension of the Chirurgeons in the poor Woman,* characterizing them like butchers and hangmen, that they choose rather to dye in Travail with the Child in their Womb, than to put themselves into their hands: But indeed such Midwives do Page 183 more justly deserve this fair title, unless they be∣have themselves with more prudence and equal conscience in so important an occasion, and send* in time for some help in their busi∣ness, before the Child be (as very often) en∣gaged in a wrong posture in the passage, so as it is almost impossible to give it a better, without ex∣tream violence to the Woman, which is also the cause of the death of the Child; and they would be so far from losing their reputation, that they would augment it, because by so doing, it would be manifest they were not ignorant of the danger both of time and place; and the Chirurgeon be∣ing called, assoon as necessity required it, could have no just cause to impute any ill consequence of the Labour to them, though it should so fall out, and rheir conscience would be discharged of it: for in this case (as we have said) both the Mothers and Childs life is at stake. Assoon then as the Waters are broke, and the Midwife finds the Child to come wrong, she must advise the Woman not to forward her Pains, lest by bearing down she engage the Child too much in the passage, and so give the Chirurgeon more pains to turn it, and must send for him assoon as may be, for to deliver her as occasion requires, and according as shall be directed hereafter in this Book. It is now time, after having declared what must be done whilst the Woman is in Labour, to shew how she must be helped and comforted in a natural Delivery. Page 184 This Figure doth very well represent the globe of the Womb, which is opened but in part, to shew in what manner the Child is brought forth in a natural Labour. A A A, Shews the body of the Womb. B B, A part of the Vagina, or neck of the Womb, opened just at the inward orifice. C C, The inward orifice, which surrounds the Childs head like a Crown, wherefore it is called the crowning, or garland. CHAP. VIII. Of a natural Labour, and the means of helping a Woman therein, when there is one, or more Children. WE have already taught that there are four things requisite to a truly legitimate and natural Labour: to wit, That it be at full time. That it be speedy, without any ill accident; That the Child be alive; And that he comes right; all which being found to be so, and after the Waters be broke of themselves, as abovesaid, let the Wo∣man be presently placed on the Pallet-bed, pro∣vided for her to this purpose near the fire; or she may, if she likes it better, be delivered in her or∣dinary bed: for all Women are not accustomed to Page [unnumbered] [illustration] Chap: VII. lib: 2. pag: 184. Page [unnumbered] Page 185 be delivered in the same posture; some will be on their Knees, as many in Country Villages; others standing upright, leaning with their Elbows on a Pillow upon a Table, or the side of a Bed; and o∣thers lying upon a Quilt in the midst of the Cham∣ber: but the best and surest is to be delivered in their Bed, to shun the inconvenience and trouble of being carried thither afterwards; in which case it ought to be furnished rather with a Quilt than a Feather-bed, having upon it Linnen and Clothes in many folds, with other necessaries to be changed according to necessity, for to hinder the Blood, Waters and other Filth which is voided in Labour, from incommoding the Woman after∣wards. The Bed must be so made, that the Woman be∣ing ready to be delivered, should lye on her back upon it, having her body in a convenient Figure, that is, her Head and Breast a little raised, so that she be neither lying nor sitting; for in this manner she breathes best, & will have more strength to help her Pains, than if she were otherwise, or sunk down in her Bed. Being in this posture, she must spread her Thighs abroad, folding her Legs a little towards her Buttocks, somewhat raised by a small Pillow underneath, to the end that the Coxcyx, or Rump, should have more liberty to retire back, and have her Feet stayed against some firm thing; besides this, let her hold some persons with her hands, that she may the better stay her self during her Pains. She being thus placed near the side of her Bed (with her Midwife by, the better to help up∣on occasion) must take courage and help her Pains the best she can, bearing them down when they Page 186 take her, which she may do by holding her breath, & forcing her self all she can, just as when she goeth to Stool; for by such endeavors, the Diaphragma being strongly thrust downwards, doth force down the Womb and Child in it; in the mean time the Midwife must comfort her, and desire her to endure her Labour bravely, putting her in hopes of a speedy Delivery. Some would have an∣other Woman at that time to press the superior parts of her Belly, and so to thrust gently the Child downwards; but I am not of their opinion, be∣cause such compressions will rather hurt then pro∣fit, by indangering the bruising of the Womb, which is extream sore at that time; and I have seen some Women, very ill afterwards, for having been used in this manner. But the Midwife may content her self only (having neither Ring nor Brace∣let on, and her Hand anointed with Oyl or fresh Butter) to dilate gently the inward orifice of the Womb, putting her Fingers ends into its entry, and stretching them one from the other, when the Pains take her, for to endeavour to forward the Child, & thrusting by little and little the sides of the Orifice, towards the hinder part of the Childs Head, anointing these parts also with fresh Butter, if it be necessary. When the Infants Head begins to advance into this inward Orifice, tis commonly said it is crown∣ed, because it girds and surrounds it, just as a Crown, and when it is so far that the extremity begins to appear manifestly without the Privy-parts, it is then said that the Child is in the Passage, and the Woman in Travail imagines (although un∣truly, and it may be is not so much as touched by Page 187 her) that her Midwife hurts her with her Fingers, finding her self as it were scratched and pricked with pins in those parts, because of the violent di∣stention and sometimes Laceration, which the big∣ness of the Childs head causeth there. When things are in this posture, the Midwife must seat her self conveniently to receive the Child, which will soon come, and with her Fingers ends, her Nails being close pared, endeavour to thrust (as abovesaid) this crowning of the Womb back over the Head of the Child, and assoon as it is ad∣vanced as far as the Ears, or thereabouts, she may take hold of the two sides with her two hands, that when a good Pain comes she may quickly draw forth the Child, taking care that the Navel∣string be not then intangled about the Neck, or any other part, lest thereby the After-burthen be pulled with violence, and possibly the Womb also to which it is fastened, and so cause flooding, or else break the string, whereby the Woman may come to be more difficulty delivered. It must also be observed that the Head be not drawn forth strait, but shaking it a little from one side to the other, that the Shoulders may the sooner and easier take its place, immediately after it be past, which must be done without losing any time, lest the Head being past, the Child be stopt thereby the bigness and largeness of the Shoulders, and be in danger of being suffocated and strangled in the passage: but assoon as the Head is born, if there be need, she may slide in her Fingers under the Arm-pits, and the rest of the Body will follow without any difficulty. Assoon as the Midwife hath in this manner Page 188 drawn forth the Child, she must put it on one side, lest the Blood and Waters, which follows immediatly after, should incommode it, or it may be choak it, by falling into its Mouth or Nose, as it would do, if it were laid on the back; after which there remains nothing but to free her from the After-burthen, which I will show how in the next Chapter: but before that, let her be very careful to examine, whether there be no more Children in the Womb; for it happens very often that there are two and sometimes more, 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 puts her Hand up the entry of the Womb, and finds there another Water gathering, and a Child in it presenting to the passage; if it be so, she must have a care not to go about to fetch the After-birth, till the Woman be delivered of all her Children, if she have never so many, because Twins never have but one Burthen, to which there are fastned as many Strings and distinct Membranes as there are Children; and if one should go to draw it forth assoon as the first is born, the rest would be in danger of their lives, because that part is very necessary to them, whilst they are in the Womb, and besides it endangers a flooding. Wherefore the first String must be cut, being first tyed with a thread three or four double, as we shall shew more exactly hereafter, and fasten the other end 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 between her Page 189 Thighs; afterwards, this Child being removed, they must take care to deliver her of the rest, ob∣serving all the same circumstances as was to the first; which being done, it will be then convenient to fetch the After-birth, as we shall shew in the following Chapter. CHAP. IX. How to fetch the After-burthen. MOst Animals, when they have brought forth their young, cast forth nothing else but some Waters, and the Membranes which contained them; but Women have an After-birth, of which after Labour they must be delivered, as of a thing useless and inconvenient: Wherefore assoon as the Child is born, before they do so much as tye or cut the Navel-string, lest the Womb close, they must without losing time free the Woman from this fleshy mass, which was destined to furnish the Infant with Blood for its nourishment, whilst it was in the Womb, and which at that time is called with much reason the After-birth, because it fol∣lows the Child, and is to the Woman like ano∣ther Birth; for being brought forth, she is totally delivered. To perform this, the Midwife having taken the string, must winde it once or twice about one or two of her Fingers of her left Hand joyned toge∣ther, the better to hold it, with which she may then draw it moderately, and with the right hand Page 190 she may only take a single hold of it above the lest near the Privities, drawing likewise with that very gently, resting the while the Fore-finger of the same hand extended and stretched forth along the String towards the entry of the Vagina, as may be seen in the annexed Figure; alwaies observing, for the more facility, to draw it from the side where the Burthen cleaves least, for in so doing the rest will separate the better; just as we see a Card which is glewed to any thing, is better separated from the place where it begins to part, then where it is close joyned. Above all things care must be taken, that it be not drawn forth with too much violence, lest by breaking the String near the Burthen, as some∣times happens, you* be obliged to put up the whole Hand into the Womb, to deliver the Woman; or that the Womb, to which this Burthen is sometimes very strongly fastened, be not drawn forth with it, as hath been done to some that I knew: As also in drawing it forth with too much violence, there may happen a very great flooding, which would be of a dangerous consequence: Wherefore for these reasons it must be carefully shaken, and gently drawn forth by little and little after the manner we have just now described; and to facilitate the better its expulsion, the Woman may blow strongly the whilst into her Hands shut, just as one would into the mouth of a Bottle to know whether it be broke; or she may put her Finger into her Throat, as if she would excite vomiting; or else strive as if she were going Page [unnumbered] [illustration] Chap: IX. lib. 2. pag: 190 Page [unnumbered] Page 191 to Stool, bearing alwaies down, and holding her Breath, as she did to bring forth her Child: All these motions and different agitations produce the same effect, and loosen and expel the After-birth out of the Womb. When all these circumstances have been observed, if notwithstanding you meet with difficulty, you may, if need be, after that you know on which side the After-birth is scituated, command an experienced Nurs-keeper to press the Belly lightly with the flat of her Hand, directing it gently downwards by way of friction, above all being careful not to do it too boisterously. But if all this be in vain, then must the Hand be di∣rected into the Womb, to loosen it and separate it after the manner hereafter mentioned in the thir∣teenth Chapter of this Book, where we show the way how to draw it forth when the String is broke. Assoon as the Woman is delivered of both Child and Burthen: it must then be considered, whether there be all, and care had that not the least part of it remain behind, not so much as the Skirts or any Clods of Blood, which ought all to be brought a∣way with the first; for otherwise, being retained, they cause great Pains: all which being done, things fit for Mother and Child, in this condition, must be provided, which we will mention in their place. When a Woman hath two Children, she must be delivered in the same manner as if she had but one, observing only, for the reasons given in the precedent Chapter, not to fetch the Burthen, till all the Children are born; and then it may be done without danger, shaking and drawing it alwaies Page 192 gently, sometimes by one String, sometimes the other, and sometimes by both together, and so by turns till all is come, proceeding in it according to the directions already given. When the Infant comes right and naturally, the Woman is brought to Bed and delivered with little help, observing what hath been taught in the two last Chapters, of which the meanest Midwives are capable, and oft times for want of them, a simple Nurs-keeper may supply the place: but when it is a wrong Labour, there is a greater mystery belongs to it, for then the skill and prudence of a Chirur∣geon is for the most part requisite. Which we in∣tend now in the remaining part of this Book to treat of. CHAP X. Of laborious and difficult Labours, and those against Nature, their Causes and Differen∣ces, together with the means to remedy them. FOr the easier and better explaining these things, we say, that there are three sorts of bad La∣bours: to wit, the Painful or Laborious; the Difficult; and that which is altogether contrary to Nature. The Laborious is a bad Labour, in which the Mother and Child (though it comes right) suffer very much, and are harassed more than ordinary: The Difficult is not much unlike the first, but Page 193 besides is accompanied with some accident which retards it, and causeth the difficulty: but the wrong Labour, or that against Nature, is caused by the bad scituation of the Child, and can never be helped but by manual Operation, or the Chi∣rurgeons hand. In the laborious and difficult La∣bours, Nature alwaies doth the Work, being a little assisted: but in that contrary to Nature, all its endeavors are vain and useless, and there is then no help but in an expert Chirurgeon, without whom she must certainly perish. The Difficulties of Labour proceed either from Mother, Child, or both. From the Mother, by reason of the indisposi∣tion of her Body; or it may be from some parti∣cular part only, and chiefly the Womb: or also from some strong passion of the Mind, with which she was before possest. In respect of her Body, either because she may be too Young, having the Passages too strait, or too old of her first Child; because her parts are too dry and hard, and cannot be so easily dilated, as happens also to them, which are too lean: they who are either small, short, or mishapen, as crooked Women, have not a Breast strong enough to help their Pains, and to bear them down; nor those that are weak, whether naturally or by accident; and crooked persons have sometimes the Bones of the Passage not well conformed: the tender and too apprehensive of Pain, have more trouble than o∣thers, because it hinders them from doing their endeavour: and they likewise who have small Pains and slow, or have none at all. Great Cho∣licks hinder Labour also, by preventing the true Page 194 Paius: all great and acute diseases make it very troublesome and of a bad consequence, according to Hippocrates's opinion in the 30th Aphorism of the Fifth Book; Mulierem gravidam morbo quopiam acuto corripi, lethale. As when she is taken with a violent Feaver, a great Flooding, frequent Con∣vulsions, Dysentery, or any other great distemper. Excrements retained, cause much difficulty, as a Stone in the Bladder, or when it is full of Urine, without being able to void it; or when the great Gut is repleted with hard Ordure, or the Woman troubled with great and painful Piles, and their ill scituation sometimes retard it extremely. As touching the difficulty proceeding from the Womb only, it must either be from its bad Scitua∣tion or Conformation, having its Neck too strait, hard, or callous, whether naturally, or by any ac∣cident, as having had there a Tumor, Apostume, or Ulcer, or Superfluous flesh, whether on the Neck, or inward Orifice: or because of any Cica∣trice caused by a preceding bad Travail. Besides these, those things which are or may be contained in the Womb with the Child, do also cause difficult Travail; as when the Membranes are so strong, that they cannot be broken, which sometimes hinders them from advancing into the Passage; or so tender, that the Waters break too soon, for then the Womb remains dry: When there is a Mole; or the After-burthen comes first, which alwaies causeth flooding, and certainly the death of the Infant, if the Woman be not presently delivered of them by Nature or Art; yea and when the Navel-string comes first, the Child is suffocated, if not speedily after born; strong Passi∣ons Page 195 of the Mind do likewise contribute much to it, as Fear, Sorrow, and others the like. The Wo∣man that miscarries hath more pain than a Woman at her full time, as also than one that is hurt, al∣though she be very near her time. As to the hinderances caused by the Infant, they are, when either its Head or whole Body are too large; when the Belly is Hydropical; when it is monstrous, having two Heads, or being joyned to another Child, Mole, or any other strange thing; when it is dead, or so weak, that it contributes nothing to its Birth; when it comes wrong; or when there are two or more: besides all these different difficulties of Labour, there is yet one caused by the Midwife's ignorance, who for want of understanding her business, instead of helping, hinders Nature in its work. Let us now treat of the means, by which all these may be prevented, and the Woman succoured in her bad and difficult Labour, as may easily be done, if we perfectly know the causes of all these difficulties; as when it happens by the Mothers being too young and too strait, she must be gently treated, and the passages anointed with Oyl, Grease, and fresh Butter, using these things a long time before the Hour of Labour, to relax and dilate them the easier, lest there should happen a rupture of any part, when the Child is born: for some∣times there happens a dilaceration to the Funda∣ment, by which both are rent into one outwardly. If a Woman be in years of her first Child, let her lower parts be likewise anointed to mollify the in∣ward orifice, and the Vagina or Neck of the Womb, which being more hard and callous, do Page 196 not easily yield to the necessary distension of La∣bour; which is the cause why such Women are longer in Labour than others, and why their Children (being forced against the inward orifice of their Womb, which is, as we have said, a little callous, and also for remaining long in the passage) are born with great Bumps and Bruises on their Heads: Small and mishapen Women should not be put to Bed, till at least their Waters be broke; but rather kept upright and walking a∣bout the Chamber, if they have strength, being supported under the Arms; for in that manner they will breath more freely, and mend their Pains better, than on the Bed, where they lye all on a heap. Let those that are very lean, also moisten these parts with Oyls and Oyntments, to make them more smooth and slippery, that the Head of the Infant and the Womb be not so com∣pressed and bruised by the hardness of the Mothers bones, which form the Passage. The weak Woman should be strengthened, the better to support her Pains, giving her good jelly Broths, with a little Wine and a Tost in it, or other good things as the case requires. If she fears the Pains, let her be comforted, as∣suring her, that she will not endure many more, but be speedily delivered: On the contrary, if her Pains be slow and small, or none at all, they must be provoked by frequent Clysters a little strong, that so they may be excited by the needings at Stool, and afterwards let her walk about her Chamber, that the weight of the Child may also help a little. If the Woman floods, or hath Con∣vulsions, Page 197 (which is by many too long neglected) she must be helped by a speedy Delivery, as we have already declared, and shall repeat hereafter in its proper place. If she be costive, let her use Cly∣sters, which likewise may dissipate a Cholick, at those times very troublesome, causing great and useless Pains, very hurtful, because they fleet to and again through the Belly, without bearing down, as they should do. If she cannot make water, because the Womb bears too much on the Bladder, let her try, by lifting up her Belly a little, or else by introducing a Catheter into her Bladder, draw forth her Urine. If the difficulty or slowness of the Labour comes from the ill Posture of the Woman, let her be placed in a better, more convenient to her Habit and Stature, observing the circumstances given in the First Chapter of this Second Book. If she be taken with any distemper, she must be treated for it according to its nature, with more caution than at another time, having alwaies regard to her pre∣sent condition. If it proceed only from the in∣dispositions of the Womb, either from its oblique scituation, it must be remedied as well as can be, by the placing of her Body accordingly. If it be by its vitious conformation, having the Neck too hard, and too callous, and too strait, it must be anointed with Oyls and Ointments, as above di∣rected. If it come from a strong Cicatrice, which can∣not be mollified, of a preceding Ulcer, or a Ru∣pture of a former bad Labour so agglutinated, it must be separated with a fit Instrument, lest ano∣ther Laceration happen in a new place, and leave Page 198 the Woman in a worse condition than before; it must be made in that place where the case most re∣quires it; taking care that it be not upwards, be∣cause of the Bladder. If the Membranes be so strong, as that the Waters do not break in due time, they may be broken with the Fingers,* provided the Child be come very forward into the Passage, and ready to follow presently after; for otherwise there is danger, that by breaking these Waters too soon, the Child will remain dry a long time; and to supply that defect, you must moisten the parts with Fomentations, Decoctions and Emollient Oyls; which can never be so well, as when Nature doth its own work with the Waters and ordinary Slime, which alwaies happen well when they come in time and place. Sometimes these Membranes with the Waters press three or four Fingers breadth out of the body before the Child, resembling a Bladder full of Wa∣ter; there is then no great danger to break them, if they be not already: for when it so happens, the Child is alwaies ready to follow being in the Pas∣sage: but above all be careful not to pull it with your Hand, lest thereby you loosen, before its time, the After-burthen, to which it adheres very strongly. If the Navel-string comes first, it must be presently put up again, and kept up if possible, or else the Woman must be immediately delivered: But if the After-burthen comes first, it must never be put up again; for being come forth, it is altoge∣ther useless to the Infant, and would be but an obstacle and hinderance in the way; if it were put Page 199 up in this Case, it must be cut off, having tyed the Navel-string, and afterwards draw forth the Child assoon as may be, lest that he be suffocated. If the Woman hath fallen, or is hurt, let her immediately keep her Bed and take her rest: If it be any Passion that retards the Labour, and can∣not totally be overcome, let them endeavour to moderate it: If it be Shamefastness or Modesty, the persons who are the cause of it must quit the Chamber; and if timidity and fear of Pain, she must be advised, that it is the will of God it should be so, and that her Labour will not be so bad as she imagines, perswading her to submit to the necessity, by the consolation of the unfortunate, whose pain seems always more supportable by the consideration that it is common; so she must be informed that others endure the same Pain, and greater than hers: if she be melancholy, let her be diverted by some good news, promising her such a Child as she de∣sires; and in a word (though she suffer much) she must consider it but as a bad journey, which one quarter of an hour of good Weather makes one forget all past, as she will, when she is brougt to bed, assuring her chiefly that she is in no danger, e∣specially when it is not very apparent, for then one ought to acquaint her with it, that she may settle both her temporal and spiritual affairs. When the difficulty is only caused by a dead Child, the method mentioned in the natural La∣bour must be observed; and besides, the Woman must do all she can to further her Delivery, be∣cause the Child can do nothing, nor can it when it is very weak: She must take the while some Comfortatives to prevent fainting, because of the Page 200 putrid vapours ascending from the dead Child; but when it hath so great a Dropsy, either in the Head or Belly, as that it cannot be born, because of the great distension and bigness of these parts, then we are obliged to open these parts to let out the Water: And if it be of such enormons bigness, either Head or Body, or that it have two Heads, or is joined to another Child, or to a big Mole, there is a necessity for to save the Mother, either to dilate the passage proportionable to the bigness of the monstrous Child (if it be possible) or else, which is better, to draw forth the Child by pieces, to prevent the Mothers perishing together with the Child, which else would certainly happen, if this course be not taken: And if there be two Children, the Rules given in the Eighth Chapter of this Se∣cond Book must be observed. But if the Mid∣wife cannot remedy all these accidents, she must then readily send for* an expert Chirurgeon for his advice, or to do what he thinks fit. Let us now pass to Labours contrary to Nature, which can never be done without Manual Operation, and show what is then to be done. Page 201 CHAP. XI. Of unnatural Labours, where Manual Operation is absolutely necessary, and what Observa∣tions the Chirurgeon must make before he goeth about it. THose Labours which absolutely require Ma∣nual Operation are, when the Child comes wrong. Hippocrates in his Book, De Naturâ Pu∣eri, and in that De Superfoetatione, admits but of three general ways for a Child to be born; to wit, with the Head first, which is the sole* natural Figure, when it comes right; the second with the Feet; and the third with the Side or across: which two last are quite contrary to Na∣ture. But to make it more plain, we say, That a Child may come wrong four several general waies, which are; First, any of the fore-parts of the Body. Secondly, any of the hinder-parts. Thirdly, ei∣ther side. And Fourthly, the Feet. Now just as there are four Cardinal points, to which all the rest of the thirty two Winds may be reduced on the Compass, and to one of the four more than to the other, according as they participate of more or less of that Point: so likewise all the particular and different wrong Postures, that a Child may pre∣sent, Page 202 can be reduced to the abovenamed four gene∣ral waies, according as they approach more to the one than the other of them. And as the number of the several wrong Births is very great, we will be contented only to treat particularly of each of the principal of them; because if one be well in∣formed of these, they may easily remedy the rest, which are of no great consequence: but before we mention the means how, it will be convenient to shew what conditions are requisite in a* Chirurgeon, that would apply himself to this Operation, and the ob∣servations he ought to make before he undertakes it. These conditions either respect his Body or his Mind; in respect of his person, he must be health∣ful, strong and robust; because this is the most la∣borious and painful of all the operations of Chi∣rurgery; for it will make one sometimes sweat, that he shall not have a dry thread, though it were the coldest day in Winter, because of the great pains and difficulty he ordinarily meets with, as Fabricius of Aquapendente testifies; confessing that he hath often been so weary and tired, as that he hath been forced to leave the work for his men to finish. He ought to be well shaped, at least to outward appearance; but above all, to have small hands, for the easier introduction of them into the Womb when necessary; yet strong, with the Fingers long, especially the Forefinger, the better to reach and touch the inner Orifice: He must have no Rings on his Fingers, and his Nails well pared, when he goeth about the work, for fear of hurting Page 203 the Womb: He ought to have a pleasant counte∣nance, and to be as neat in his clothes as in his person, that the poor Women who have need of him, be not affrighted at him. Some are of opi∣nion that a Practitioner of this Art ought on the contrary to be slovenly, at least very careless, wearing a threat Beard, to prevent the occasion of the Husbands jealousy that sends for him. Truely some believe this policy augments their practice, but 'tis fit they should be disabused; for such a Po∣sture and Dress resembles more a Butcher than a Chirurgeon, whom the Woman apprehends alrea∣dy too much, that he needs not such a Disguise: above all, he must be sober, no Tipler, that so he may at all times have his wits about him; he must be discreet, modest, and secret, never disco∣vering to strangers those incommodities and diseases of Women which come to his knowledge; He must be sage, prudent, and judicious, to conduct him alwayes in his Operations, with good rea∣son: He must be pittiful, yet not so as to distract or hinder him from his duty, when the case re∣quires; as also so patient, as not to precipitate any thing, but taking time sufficient to consider what is fit to be done. He must not be angry with the poor Woman, though she exclaims against him, or the other Women during the Operation; for the Pains of the one, and the compassion of the rest, oblige them to it without other cause. He should be a good Christian, of a well regulated Conscience, and do his best endeavour to bring the Children* alive: Page 204 He must deliver poor Women gratis, and treat them as tenderly and with as much humanity as the Rich, extorting nothing from them, but be content with reasonable satisfaction, as they are willing and able to give, and not use them like a Turk or Arab, as some do, who assoon as they have done their work, whether well or ill, will be paid without delay, and that with so much ill manners and im∣portunity, that they force the poor people pre∣sently to borrow the money, when they have not enough to satisfie their desires, and take from them to the last Penny, to satisfie their tyrannical ava∣rice: which proceedings are very unworthy an honest man. In fine, a Chirurgeon indued with all these good qualities must be for his accomplishment and intire perfection, very knowing and expert in his Art, and chiefly in these Operations. There are many who believe it an easie matter to deliver a Woman, because Women usually practise it. In effect, there is no great mystery, when all things come right and well: But when they come wrong and contrary to Nature, it is most certain that it is the most difficult and laborious of all Chi∣rurgical Operations, as is well known to such as practise it. It is very good to consider the con∣sequences of it; for in all others, for which re∣course is had to a Chirurgeon, the single life of the Patient only is under his care; but in Delive∣ries, there is the Mothers, and one Childs life at least, and sometimes more at stake: And it hath been often seen, that one single fault in this Opera∣tion hath caused many disorders at one time; so that one may say very justly touching delivering of Page 205 Women in wrong Labours, Hoc opus, hic labor est. Now the Chirurgeon qualified as abovesaid, who is only fit for the work (to behave himself as he ought) must make some Observations before he undertakes it; first, whether the Woman hath strength enough to endure the Operation, which he may guess by the Pulse, if strong or weak, un∣equal or intermittent: Whether her Face and chief∣ly her Eyes be dejected, her Speech faint, the ex∣tremities of her Body cold; Whether she often faints away with cold Sweats, hath Convulsions with loss of sence; in short, If every circumstance perswades that the Operation would be in vain, 'tis better to let it alone, than she should dye under his hand, and he be blamed for it, and incur the name of Butcher, as is most certain when such a misfortune happens: however if there be any hope, though never so little, either for Mother or Child, we are obliged in Conscience to do what Art com∣mands, and not as some Politicians, who will ra∣ther suffer a poor Woman to dye without assistance, than undertake a doubtful Operation. Wherefore 'tis better to attempt an Operation of an incertain consequence, than to abandon the Sick to a certain despair,* for sometimes Nature re∣covers beyond hope; but before the Chi∣rurgeon undertakes it, let him give his Prognostick of the great danger of death, both Woman and Child is in, which he must acquaint the Husband and Friends with, and the Woman her self, if he thinks that she is able to bear it, that so she may Page 06 receive the Sacrament before the Operation, lest she be not capable of it afterwards; because of the la∣boriousness of the Operation, in which she may possibly dye; as it hath sometimes happened; but when the Woman hath strength enough, the Chirurgeon must not delay his help, for fear it abate, or be totally dissipated. To which purpose, being well assured of her strength, he must enquire of the Woman, her Midwife and Friends, Whether she be at her full time; or hath received any hurt, which he may also perceive by the Signs, observing in what posture the Child presents, & what circum∣stances, Whether alive or dead; and but one or more? all which being examined, he must try to perswade the Woman of the impossibility of her being delivered without his help; and to resolve to put her self into his hands, which he may do by fair words without frighting of her, perswading her that the Operation is nothing so painful as she may imagine, and in fine that for Gods sake, her own, and the Childs, she is obliged to suffer it, for else she and her Child may both perish The Woman being thus resolved, he must place her cross the Bed, that he may operate the easier, she must lie on her Back, with her Hips raised a little higher than her Head, or at least the Body equally placed, when it is necessary to put back or turn the Infant, to give it a better posture; but if he resolves to draw it forth, he must place the Wo∣man so as we have directed in the natural Labour, which is with her Head and Breast a little elevated above the rest of her Body, that she may fetch her breath with more facility, and help to the exclu∣sion of the Infant by bearing down, when the Page 207 Chirurgeon bids her. Being thus scituated, she must fold her Legs so as her Heels be towards her Buttocks, and her Thighs spread, and held so by a couple of strong persons. There must be likewise others to support her under her Arms, that her Body may not slide down, when the Child is drawn forth, for which sometimes a great strength is re∣quired; the Sheet and Blankets must cover her Thighs for decency sake, in respect of the Assistants, and also to prevent her catching cold, the Chirur∣geon herein governing himself as well with respect to his own convenience, the facility and surety of his Operation, as to these things. Some would have the Woman bound in this posture, that (as they say) she being more firm and stable, the work may be done with greater certain∣ty: but such Ligatures are so far from that, that on the contrary they are very prejudicial; for the Woman being so fixed, and constrained as on a Rack, she cannot raise her self, nor slide down, or be lifted up, when the Chirurgeon finds occasion for it, to render his Operation less difficult, which usually he doth by partly putting back, partly drawing forth, sometimes directly, sometimes obliquely, for which reason her Body ought to be at liberty, only held in a posture convenient to these several intentions by her Friends, according to his directions: but if she must needs be bound, let it be with good reasons to perswade her patiently to endure her Labour, and to contribute her whole strength to the Operation, promising her the speedi∣est Delivery possible. Let the Chirurgeon then anoint the entrance of the Womb with Oyl or fresh Butter, if it be ne∣cessary, Page 208 that so he may with more ease introduce his hand, which must likewise be anointed, having the conditions above specified: after which he must manage his Operations after the manner I shall di∣rect in each of the following Chapters, having first recited the marks by which may be known whe∣ther the Child be alive or dead. CHAP. XII. The Signs to know whether the Child be alive or dead. IF there be any Case, wherein a Chirurgeon ought to make the greatest reflection, and use most precaution in his Art, it is this,* to know whether the Infant in the Womb be alive or dead; for there have been many deplorable examples of Children being drawn forth alive, after they have been thought to be dead, with both Arms or some other Limb lopt off, and others miserably killed by the use of Cro∣chets, which might have been born alive, if they had not been mistaken. Wherefore before he re∣solves on the manner of laying the Woman, to avoid the like misfortune, and the disgrace of being au∣thor Page 209 of such a pittiful spectacle, let him do his ut∣most endeavour not to be so deceived, and to be fully satisfied, whether the Child be alive or dead; alwaies remembring that in this case timi∣dity is more pardonable than temerity; that is, it is better to be deceived in treating a dead Infant, as if it were alive; than a living one, as if it were dead. The Child may be known to be alive, if it be at the full reckoning; if the Woman hath received no hurt; if she hath had her health well all her going with Child; if she be at that present in good health, and very sure if she feels it stir, which may be known by the Mothers relation: and the Chirur∣geon may be better assured of it, if he feels it stir himself, laying his Hand on the Mothers Belly, to whose relation he must not alwaies trust; for I have sometimes delivered Women, whose Children had been dead above four days (as may easily be judged by their corruption) who notwithstanding affirmed (although untruly) that they felt them stir but a lit∣tle before they were delivered; and others again, who were alive, yet they never perceived them to stir in three or four days before, as they confessed. If the Chirurgeon cannot be assured by the Infants motion that it is alive, he may, assoon as the Wa∣ters are broke, gently put up his hand into the Womb, to feel the pulsation of the Navel-string, which he will find stronger the nearer he feels it to the Infants Belly; or if he meets with a Hand, he may feel the Pulse, but their Pulsation is not so strong as the Navelstrings, by which it is best to be known: if then he finds thus the beating of the Page 210 Pulse, he may be confident the Child is alive; as also if by putting his Finger into its Mouth, he perceives it to stir its Tongue, as if it would suck. But on the contrary the Child is dead, if it hath not a long time stirred; if there flowes from the Womb stinking and cadaverous humours; if the Woman feels great pains, and a great weight in her Belly; if it be not supported, but tumbles alwaies on that side as she layes her self: if she saints* or hath Convusions; if the Navel-string or Secon∣dine hath been a good while in the world; or if by putting his Hand into the Womb, he finds the Child cold, and the Navel-string without Pulse, and its Tongue immoveable; and feeling the Head he finds it very soft, chiefly towards the Crown, where likewise the Bones are open, and riding the one upon the other at the Sutures, because the Brains shrink, and are without Pulse when the Child is dead; which corrupts more in two days in the Womb than it doth in four after it is born; which the Heat and Moistness of the place causeth, the two principles of Corruption. But one may only conjecture it, if the Woman hath been hurt, or floods much, & be not at her full time; if her Waters broke four or five days before; if her Breasts flag; if her Complexion be of a lead colour, her Countenance languishing and dejected, and if her Breath stinks. We say that these things may only make us conjecture it, but not, as the rest, certainly conclude it; many of which happening to∣gether in one person, assures us that the Child is dead, for want of which it cannot be very certain; Page 211 wherefore (as I have said) 'tis good to be very care∣ful before they undertake it, that so they may a∣void the abovesaid scandals. CHAP. XIII. How to fetch the After-burthen when the string is broke. WE have placed the present way of extracting the Afterbirth amongst unnatural Deliveries, be∣cause 'tis not sufficient to esteem it a good Labour, that the Child be well born, unless also the After∣birth be well come away. In respect of the Child it may be called natural; because after his Birth, it hath no more need of the Burthen: but in respect of the Woman, it is very unnatural. I would therefore first treat of this bad Labour; because it participates of a natural Labour in respect of the Child, who is in no danger being born. After that I will come to those in which both Mother and Child are in very great danger, if not speedily and skillfully helped. I have already shewed in the Ninth Chapter of this Book, how a Woman must be delivered in a natural Labour, where you may find the means; but sometimes the Midwife by endeavouring it, breaks the String with pulling too strongly, or be∣cause it is very weak; or else so putrified when the Child is dead, that the least pull breaks it off close at the Burthen, which by that means is left behind Page 212 in the Womb, or because it cleaves too strongly, or the Woman is weak and cannot expel it, being much tired by a long Labour; or because it was not speedily after Labour drawn forth, the Womb clo∣seth so, as leaves it no passage, nor can it without much difficulty be again dilated to have it fetch'd, because it remains dry, after the natural slime and humidities, which usually flow in Labours, are sometimes past. Since it is a verity indubitable, that the Afterbirth remaining behind after the Child is born, becomes an useless Corps, capable of destroying the Wo∣man, we must take care that it be never left, if possi∣ble. Wherefore having endeavoured to bring it away, as we have directed in the aforenamed Chapter, and the Navel-string happen to break near the Burthen, you must immediately, before the Womb closeth, introduce your Hand into it, be∣ing well anointed with Oyl or fresh Butter, your Nails close pared, for to separate it from the Womb gently, and draw it forth together with the Clods of Blood that are there. When the Navel-string is not broken, it will easily conduct the Hand by following of it to the place, where the Burthen is scituated; but when it is broken, we have no lon∣ger this guide, wherefore you must be then very careful, that you be not deceived in taking one part for another; as I once saw a Midwife pull the Womb near the inward Orifice, instead of the Bur∣then which was behind: but when she perceived all her endeavours vain, except it were to make the poor Woman to suffer extremely, she yeelded her up to me, confessing her incapacity, although she Page 213 had vaunted* before, that she was more capable in her Art than any Chirurgeon. Assoon then as you have introduced your Hand into the Womb towards its Fund, or bottom, you will find the Burthen; which you may know by a great number of little inequalities, which are al∣ways made there by the roots of the Umbilical Vessels, on the side where they terminate, which makes it to be easily distinguished from the Womb; if it yet cleave to it, notwithstanding that it is then a little wrinkled and uneven; because its Membranes, which were very much enlarged, con∣tract themselves immediatly after the Child and its Waters which kept them extended, are excluded:* but they that are expert in this Art can easily judge of it. If you find the Burthen wholly loosened from the Womb, it will not be difficult to draw it forth, when you have got it in your Hand: but if it cleaves, finding the side where it sticks least, begin there to sepa∣rate it gently, by putting some of your Fingers be∣tween it and the Womb, continuing by little and little to do so, till it be quite loose, and afterwards to draw it forth very carefully; observing the whilst (if it cannot be otherwise) rather to leave some part of it behind, than to scrape or scratch the least part of the Womb, for fear of a flooding, inflammation, or Gangrene, which cause death: Page 214 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 preserving it as whole as these reflections will permit, because of shewing it to the company, that they know the Operation is well done. When the Chirurgeon finds not the Womb open enough for to direct his hand immediatly into it, let him* presently anoint all the Womans Privities with Hogs-grease, that they may be di∣lated with more ease, afterwards let him by little and little put up his Hand, but without much vio∣lence: the Woman may likewise contribute to this dilatation, as also to the exclusion of the Burthen, if she bears strongly down, holding her Breath, and exciting her self to vomit, or sneeze, and do those other things directed in the above mentioned Chapter; but if notwithstanding all this she can∣not void the Afterbirth, and if the Womb cannot be dilated enough to fetch it, or that it cleaves so fast, as it cannot be separated, then to avoid a greater mischief, we must leave it to Nature, assist∣ing her with remedies, which suppurates; where∣fore Injections into the Womb are proper, made of Mallows, Marsh-mallows, Pellitory, and Lin∣seed, in which is mixed a good quantity of Oyl of Lillies, or fresh Butter. This injection softens and tempers, and by moistning and mollifying, makes the Orifice to be the easier dilated, and helps by Suppuration the loosenings of the Burthen. And to hasten the expulsion of it, give her a strong Clyster, that so, by the motions to go to Stool, it Page 215 may cause it to be voided, as it hath arrived to ma∣ny, that have rendered it in the Bed-pan, and sometimes when they have least expected it. One may at the same time, to prevent a Fever and many other accidents which usually happen, bleed her in the Arm, or Foot, according as it may be necessary and convenient, and strengthen her, that the Foetus and cadaverous Vapours, coming from the putrifaction of the Burthen, ascend not to the Noble parts, which may be done by good Cordials often used, not such as are made of Theriacle, Mithridate, or the like, for which no reason can be given, but their specifick or rather imaginary Faculties, and are fitter to cause Vo∣miting than comfort the Heart: but true Cordials are such as yeeld good nourishment, and at the same time comfort the Stomach, without nauseating it, as those Drugs do which are only good for them that sell them. Wherefore let her have good Broaths and Gel∣lies; she may drink Limonade or Orengade, or have in her Ptisan Syrup of Limons or Pomgranats, or from time to time (if she be weak and free from a Fever) a little Wine and Water mixed, which we say is the best, (in some cases, but not alwaies) and most natural of all Cordials; besides other Remedies may be provided, according to the acci∣dents which happen, by reason of the staying be∣hind of the Burthen, always endeavouring to bring it away assoon as possible, for as long as it stays in the Womb, the Woman feels continually great Pains, almost like to them before her Child was born, although there remained but a small piece of it, and until the whole be voided, the Page 216 Pains will still be repeated, although in vain, un∣less the matter be well disposed before; but the lesser the piece is of the Burthen retained, the more difficult it is sometimes to be expelled; because the impulses, which the Woman can make by helping her Throwes, are not so great, when the matter contained in the Womb is small, as when it is of a considerable bigness; for then it is more strong∣ly thrust and compressed: which is the reason why a Woman miscarries with greater difficulty, than when brought to Bed at her full time. There are many Midwives, who having bro∣ken the Navel-string, as* abovesaid, leave their work imperfect, and com∣mit the rest to Natures work; but very often the poor Woman dies, because of the great mischiefs which happen usually before the suppuration of the Burthen so retained: To avoid which, assoon as they meet with the like case, they must endeavour to fetch it, according as we have directed; or if they find themselves not capa∣ble to do it, because the Hand must be put up into the Womb, which is more properly the work of a Chirurgeon expert in those cases, let them presently send for one, that so he may be yet able, before the Womb closeth, to introduce his hand; for the longer it is deferred, the more difficult will be the work. There are other Midwives bold enough to un∣dertake this Operation, but for want of industry or necessary knowledg they cannot effect it, and Page 217 leave the Woman oftentimes in a worse condition than if they had never medled with it; as happened about a year or little more since to a poor Woman in the Fauxbourgh S•. Marcel, whom I helped three days after she was delivered; being half gone, by a Midwife of the same Fauxbourgh, at the de∣sire of Mr. Bessier a Chirurgeon and my good Friend, who conducted and accompanied me to her, where I found her in continual pain all over her Belly, which held her like throws of another Travail, voiding black humours extremely stinking and offensive, with which she had also a great pain in her Head, and a Fever, which in a short time would without doubt have augmented, if I had not presently fetched what remained: where∣fore having enquired of the persons present in her Chamber, how she was delivered, and when; they told me not yet three whole days, but that the Midwife not being able to fetch all, did only bring away some small pieces of the Burthen, & told them,* that they need not be troubled at what remained, perswading them alwaies that it would come away of it self, and that nothing more was to be done but patience. Truly she was not so much to be blamed, for not having delivered this Woman, as she was in not acquainting her that she needed more help, when she found that it was beyond her skill. After this information, having put up two of my Fingers into the Vagina, to understand the pre∣sent estate of things, I found the inward orifice of her Womb almost quite closed, into which how∣ever I got my Fore-finger, where by moving it to Page 218 and again without taking it away, by little and little I dilated her Orifice, so as to introduce an∣other Finger, with which two alone, being not able to get in the rest, I brought away three pieces of the Afterbirth, of the bigness of a Walnut, which were left behind, taking them one after the other with my two fingers, as Crabs do when they gripe any thing with one of their forked Claws; by which means in a small time I delivered this Woman quite, who immediatly after felt no more pain, and recovered soon after: but otherwise she had certainly been in danger of her life, because of the great corruption of what was left behind in the Womb: for that which I fetcht away, smelt so ill, that my Hands stank of it above two days after, al∣though I washed them three or four times with Vinegar. This Chapter may suffice to show how one should behave himself in this Case. We will now teach what is fit to be done in each of the other Labours against Nature. CHAP. XIV. To deliver a Woman, when the Child comes footling. IT is an undoubted truth, and well known to all such as lay Women, that the several unnatural Postures, wherein Children present themselves at their Birth, are the cause of most of the bad La∣bours Page [unnumbered] [illustration] Chap: XIV. lib. 2. pag: 218 Page [unnumbered] Page 219 and ill accidents there met with, for which usually recourse is had to Chirurgeons. Now since he is obliged very often, because of these ill scituations, to draw the Children forth by the Feet; I am therefore resolved, before I speak of the rest, (to most of which that must be a guide) to show how a Child must be brought forth, which comes either with one or both Feet first. Most Authors advise in this case to change the Figure, and place the Head so, as it may present first to the Birth; but if they would show, how it should be done, we might follow their counsel, which is very difficult, if not altogether impossible to be performed, if we desire to avoid the dangers that by such violent endeavors the Mother and Child must necessarily be put in; wherefore 'tis better to draw it forth by the Feet, when it comes Footling, than to venture a worse accident by turn∣ing it. * Assoon then as 'tis known the Child comes thus, and the Womb is open enough to admit the Chirurgeons hand into it, or else by anointing the Passages with Oyl or Hogs grease, to endeavour to dilate it by little and little, using to this purpose his Fingers, spread∣ing them one from the other after they are together entred, and continuing so to do, 'till it be sufficiently dilated; then, having his Nails well pared, and no Rings on his Fingers, his Hands well anointed with Oyl or fresh Butter, as also the Woman placed after the manner as we have already often directed, let him gently introduce his Hand into the entry of the Womb, where finding the Childs Page 220 Feet, let him draw it forth in that posture we shall now direct: but if it presents but one Foot, he should consider, whether the right or left, and in what fashion it comes; for these reflexions will easily inform him, on what side the other may be; which assoon as he knows, let him seek it, and gently draw it forth together with the first, but let him also be very careful that this second be not the Foot of another Child; for if so, he may sooner split both Mother and Children then draw them forth; which may easily be prevented, if having slid his hand up the first Leg and Thigh to the Twist, he finds both Thighs joined together, and depending from one and the same Body; which is likewise the best means to find the other Foot, when it comes but with one. All Authors, for fear of losing hold of the first Foot, advise to fasten a Ribban to it with a running knot, that so it may not be sought a second time, when the other is found: but that is not absolutely necessary, because usually when one hath hold of one,* the other is not far off: they that will may use this precaution; but such as are expert, use it but seldom. Assoon then as the Chirurgeon hath found both the Childs feet, he may draw them forth; holding them together, he may bring them by little and little in this manner, taking afterwards hold of the Legs and Thighs assoon as he can come at them; and drawing them so till the Hips be come forth: the whilst let him observe to wrap the parts in a single Napkin, to the end that his Hands, be∣ing already greasy, slide not on the Infants body, Page 221 which is very slippery, because of the viscous hu∣mours, which are all over it, and hinder that one cannot take good hold of it, which being done, he may take hold under the Hips to draw it so forth, to the beginning of the Breast, and then let him on both sides with his hand bring down the Arms along the Childs body, which he may then easily find, and be careful that the Belly and Face be down∣wards, lest being upwards, the Head be stopt by the Chin over the Share-bone; wherefore if it be not so, he must turn it to that Posture; which is easily done, if taking hold on the body, when the Breast and Arms are forth in the manner we have said, he draws it, with turning it in proporti∣on, on that side which 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 him lose no time, (desiring the Woman at the same time to bear down) that so in drawing, the Head at that instant may take its place, and not be stopt in the passage. Some Authors, to prevent this inconve∣nience, advise that one Arm only should be drawn forth, and the other left to prevent the closing of the Womb on the Neck of the Child: this reason is plausible, yet if the Chirurgeon knows how to catch his opportunity, he will not need this shift to prevent this accident, which may sooner happen when one Arm is left above; for besides that by its bigness it would take up so much place, which is already too little, causing the Head to lean more on one side than the other, it will stop it certainly on that side where there is no Arm; and when I have sometimes tryed to deliver a Woman, leaving one of the Arms above with the Head, I could not Page 222 till I fetched both Arms, and then I finished my operation with more ease. There are indeed some Children that have their Head so big, that when the whole Body is born, yet that stops in the Passage, notwithstanding all the care to prevent it: in this case he must not en∣deavour only to draw forth the Child by the shoul∣ders, lest he sometimes separates the Body from the Head, but he must disengage it, by little and little, from the bones in the Passage with the fingers of each Hand, sliding them on each side opposite the one to the other, sometimes above and sometimes under, until the work be ended, endeavouring to dispatch it assoon as possible, lest the Child be suf∣focated; as it will certainly be, if he should remain long in that Posture, which being well and duly effected, he may soon after fetch the After-birth as above directed. CHAP. XV. How to fetch the Head when separated from the Body, & it remains behind in the Womb. NOtwithstanding all the care possible had in the fetching a Child by the Feet, yet sometimes one meets them so putrified and corrupted, that with the least pull the Body separates from the Head, which remains alone in the Womb, and cannot be extracted but with much difficulty, for∣asmuch as it is extremely slippery, by reason of the place where it is, and of a round Figure, on which no hold can be taken. The difficulty usually met with upon the like occasion hath been so great, that sometimes two or three Chirurgeons one after the Page 223 other have forsaken the Operation, not being able to accomplish it, after all their industry in vain employed, together with their strength, so that necessarily the death of the Woman ensued: but I am of opinion they had escaped this misfortune, if they had done what I shall now direct. When then the Infants Head, separated from its Body, remains alone behind, whether because of putrifaction or otherwise, let the Chirurgeon im∣mediatly without delay, whilst the Womb is yet open, direct up his right Hand to find the Mouth of this Head (for there is then no other hold) and having found it, let him put one or two of his Fingers into it, and his Thumb under the Chin, and then by little and little let him draw it, hold∣ing it so by the Jaw; but if that fails, as it often will when putrified, then let him pull forth his right Hand and slide up his left, with which he must support the Head, and with the right let him take a narrow Crochet, but strong and with a single branch, which he must guide along the inside of his other Hand, keeping the point of it towards it, for fear of hurting the Womb, and having thus in∣troduced it, let him turn it towards the Head, for to strike it into either an Eye-hole or the hole of an Ear, or behind the Head, or els between the Su∣tures, as he finds it most easie and convenient, and then draw forth the Head so fastened with the Crochet, still helping to conduct it with his left Hand, but when he hath brought it near the Pas∣sage, being strongly fastened to the Crochet, (as is already directed in one of the mentioned places) let him remember to draw forth his Hand, that the Passage being not filled with it may be the larger Page 224 and easier, keeping still a Finger or two on the side of the Head, the better to disengage it. You may try for the same purpose an* expedient (which appears to me very ingenious) and (thinking on this subject) came lately into my mind, by which, without doubt, one may effect this painful and laborious Operation, with∣out tormenting the Woman so much as she is, when either the Crochet or crooked Knife are used; which is a soft Fillet, or linnen slip, of the breadth of four Fingers, and the length of three quarters of an Ell or thereabouts, and taking the two ends with the left Hand, and the middle with the right, let him so put it up with his right, as that it may be beyond the Head to embrace it, as a sling doth a stone, and afterwards drawing the fillet by the two ends together, it will easily be drawn forth, the fillet not hindering in the least the passage, because it takes up little or no place. But if the Chirurgeon cannot by either of these different means draw forth the Head, because 'tis too big, he will be necessitated (if he will finish his work) to lessen it with a crooked knife, marked D. in the representations of the instruments, at the end of the Second Book. For to do this, let him slide up his left hand into the Womb, and with his right guide up the Knife, always observing that the point be turned towards the inside of the left hand, for fear of hurting the Womb, and afterwards let him turn* it to the Sutures of the Head, and chiefly Page 223 the Crown, where he must make the incision with this Instrument, that having separated some pieces, he may the easier draw forth the Head, or at least having emptyed some part of the Brain, by the Ori∣fice so made, the bigness of the Head will be much diminished by it, and consequently the extraction of it less painful. The left hand being thus in the Womb, will be very usefull to help strike the knife into the Head, for to divide and separate its parts, as the Chirur∣geon judges necessary, as also to hinder that by in∣advertancy the Womb receive no hurt; and the right without, for to hold the handle of this instru∣ment, which therefore must be long enough, and will serve him to move and guide it on which side he pleaseth; in turning, thrusting, drawing, or slant∣ing it as the case requires. Ambrose Parè and Guillemeau would have this Knife to be so short, as to be hid in the right Hand, for to do the Opera∣tion, after it is so introduced into the Womb; but it is certain, that when it is filled with a monstrous Child, or a Head, as abovesaid, the Chirurgeons hand will be so pressed in the Womb, that it will be very difficult for him to use it skilfully with one Hand alone, and do no violence to the Womb; which is the reason why (if I may be credited) this instrument ought to have a long Handle, that being introduced the Womb, it may be conducted to do the Operation with the left Hand within, as we have mentioned, and governed by the right which holds the Handle of it without, which ought to be as long as the handle of an ordinary Crochet. They that will take the pains to conceive my Arguments, and try this Instrument when they have occasion, Page 224 will confess it to be much more useful and commodi∣ous, being thus long, than so short as the said Parè and Guillemeau recomend. For my part, having caused one to be made of that fashion, I found it very convenient when I had the like occasion to use it. Now when the Head is thus fetcht out of the Womb, care must be taken, that not the least part of it be left behind, as also to cleanse the Woman well of her After-birth, if yet remaining. But a question of great consequence and much to the purpose may be here started, Whether the Childs Head yet remaining so in the Womb, and the Bur∣then also, the Head ought to be extracted before the Burthen; to which may be answered with di∣stinction, that if the Burthen be wholly separated from the sides of the Womb, it ought to be first brought away; because it may hinder the taking hold of the Head, but if it be still adhering, it must not be medled with, till the Head be brought away; for if one should then go about to separate it from the Womb, it would cause a flooding, which would be augmented by the vio∣lence of the Operation; for the Vessels to which it is joined, remain for the most part open, as long as the Womb is distended, which the Head causeth whilst it is retained in it, and cannot close till this strange body be voided, and then it doth by con∣tracting and compressing it self together, as I have heretofore more exactly explained: besides, the Afterbirth remaining thus cleaving to the Womb, during the Operation, prevents it from receiving easily either bruise or hurt. This instruction may suffice for this Chapter, let us pass to the rest. Page 225 CHAP. XVI. How to help a Woman inher Labour, when the Childs Heed thrusts the Neck of the Womb forth before it. IF we only respect the figure the Child comes in in this Labour, we may say it is natural; but when we consider the disposition of the Womb, which is in danger of coming quite forth of the Passage; or the extraction of the Infant, we shall find it not so altogether, for its Head thrusting it forcibly before it, may easily cause a falling out of the Womb, if the Woman be not skilfully succour∣ed in time: here may be seen the Vagina or neck of the Womb bear forth before in great wrinkles, according as the Child advanceth. Women troubled with a bearing down of the Womb before they conceive, and whose Womb is very moist, are much subject to this accident; be∣cause of the relaxation of the Ligaments. The same Method we have taught in the natural Travail must not now be observed; for in this case the Woman must neither walk, nor stand upright; but keep her Bed, with her body equally at least scituated, and not raised a little, as is requisite in a natural Labour: She must by no means use strong or sharp Clysters, lest they excite too great Throws, neither so much humect the Womb, which is al∣ready too much relaxed: but to aid her at the moment each Pain takes her, when the Child be∣gins to advance his Head, and consequently the Page 226 Neck of the Womb, let the Midwife keep her hands on each side of the Head, to thrust back, by resisting the Womans pains, the Womb only, gi∣ving way in the mean time for the Child to ad∣vance, doing the like at every Throw, continu∣ing it till the Woman of her self hath forced the Child quite into the world: for one must by no means draw it by the Head, as is mentioned in the natural Labour, for fear of causing the Womb to fall out at the same time, to which it is then very apt. If notwithstanding the Infant having the Head born, and yet stops there so long as to indanger 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 In∣fants body so drawn forth. After the Woman is thus delivered, her Afterbirth must be fetched as is above directed, being still careful for the same reason not to shake or draw it forth too rudely, and then let it be placed up in its natural scituation, if it bears down. Page 227 CHAP. XVII. How to fetch a Child, when coming right it cannot pass, either because it is too big, or the Passages cannot be sufficiently dilated. THere are some Women, whose Children (not∣withstanding they come right) remain some∣times four, five, and six whole days in the Passage, and would continue there longer, if they were left alone, without being able to be born, unless assist∣ed by Art; to which we are obliged, if we desire to save the Mothers life: this happens oftenest to little Women of their first Children, and chiefly if a little too much in years; because their Womb being very dry, cannot be so easily dilated, as o∣thers, who already have had Children, or are not so old. When this happens, after that the Chi∣rurgeon hath done his endeavour to relax and di∣late the parts, for to facilitate the Childs birth, and that he finds all in vain, because the Head is much bigger than it should be, and that besides, it is certainly dead (as it for the most part is, when it hath continued four or five days in this condition, after the Waters are broke) which he may be more exactly assured of by the signs already described in the 12th Chap. of this Book,* he need then Page 228 make no scruple to fasten a Crochet to some part of the Childs head, and rather about the hinder part than any other, for to draw it forth by this means directly, if possible; if not, let him make an in∣cision with a strait or little crooked Knife, which is best, about the Sutures, for to empty thence some of the Brains, and so lessen the bigness of this Head, and immediatly after fix his Crochet fast to the Skull in the same place, whereby he will easily extract the Infant. It is very certain when the Child is dead, one ought to do according to my direction, to save the Mothers life: but it is a very great* question, Whether a live Child ought to be so dealt with to save the Mothers life, after there is no more hopes that it can be born any otherwayes, because of the narrowness of the Passage, which cannot pos∣sibly be sufficiently dilated for its Birth; or whe∣ther one ought to defer the Operation, untill there is a perfect assurance that 'tis dead? In this case I am apt to believe, that, since the Infant can∣not avoid death neither one way nor the other, (for staying in the Passage, without being able to be born, it must dye, and being drawn forth by Crochets, it is killed) one must and ought fetch it out alive or dead, assoon as there is opportunity to do it, and when all hope is lost that it can come any otherways, thereby to prevent the Mothers death, which could by no other means be avoided. Tertullian (as Riolanus very well notes in his 38th Chap. of the 12th Book of his Anatomical Page [unnumbered] Page [unnumbered] [illustration] Chap: XVIII. lib. 2 pag.•…9 Page 229 Manual) saith upon this subject, That it is a ne∣cessary cruelty, to kill the Child in this case, ra∣ther than to save it from the danger it is in of dy∣ing, and so certainly cause the Mothers death. Notwithstanding this must not alwaies be put in practice by the Chirurgeon, but in such an extre∣mity, and then he may do the work as dextrously as he can. For my part I had rather do this in the like occasion, than resolve upon that cruelty and barbarousness of the Caesarean Section, in which 'tis absolutely impossible (though many Im∣postures, whom Rousset favours, assure the contrary) that a Woman should ever escape, as I shall make more particularly appear hereafter, when I come to it; for by this Operation I can save the Mother, who would perish with the Child: And as it is al∣ways better of two evils to choose the least, so we ought always to prefer the Mothers life before the* Childs. CHAP. XVIII. How to deliver a Woman when the Child pre∣sents the side of the Head to the Birth, or the Face. WHen the Child presents the side of the Head, though it seems a natural Labour, because Page 230 the Head comes first, yet 'tis very dangerous both to Child and Mother, for he shall sooner break his Neck, than ever be born in that fashion; and by how much the Mothers pains continue to bear him, which is impossible unless the Head be first right placed, the more the Passages are stopt up. *Therefore assoon as it is known, the Wo∣man must be laid with all speed, lest the Child advancing fur∣ther in this vicious Posture, it prove more difficult to thrust him back, which must be done when we would place the Head right in the Passage, as it truly and naturally should be. For to effect this, place the Woman that her Hips be a little higher than her Head and Shoul∣ders, causing her to lean a little upon the opposite side to the Childs ill posture, then let the Chirur∣geon slide up his Hand, well anointed with Oyl, by the side of the Childs head, for to bring it right, gently with his Fingers between the Head and the Womb; but if the Head be so engaged that it can∣not be easily done that way, he must then put his Hand up to its Shoulders, that so by thrusting them back a little in the Womb, sometimes on the one side, and sometimes the other, as he sees oc∣casion, he may give it a natural and convenient Position. It were to be wished that the Chirurgeon could put back the Infant by the Shoulders with both his Page 231 Hands in this manner; but the Head doth then take up so much room, that he hath much ado to introduce but one, with which he must do his Operation, with the help of the Fingers ends of the other Hand put up as far as necessary, after∣wards let him excite and procure the Childs birth, as directed in the natural Labour. At other times a Child comes with the Face first, having its Head turned back, in which Posture it is very difficult it should be born, and if it remain so long, the Face will be so black and blew, and swelled, that at first sight it will appear monstrous; which comes as well by the compression of it in that place, as by the Midwifes fingers handling it too rudely, when she would place it in a better Posture. I remember about six years ago, in the like Case, a Woman whose Child came with the Face so black and mishapen assoon as it was born (as usually in such cases) that it lookt like a Black∣moor, however I delivered her of it alive: assoon as the Mother saw it, she told me, that she always fear'd her Child would be so monstrous; because when she was young with Child of it, she fixed her looks very much upon a Blackmoor belonging to the Duke de Guise, who alwaies kept several of them; wherefore she wished, or at lest cared not though it dyed, rather than to behold a Child so disfigured, as it then appeared: But she soon changed her mind, when I satisfied her that this blackness was only because it came Faceling, and that assuredly in three or four days it would wear away; as it happened, having often anointed it with Oyl of sweet Almonds by expression; and Page 232 when I saw the Child about a year after, me thought I had not seen a fairer. Now to deliver this Birth, the same manner, as when a Child comes with the side of the Head, must be observed, being careful to work gently, to avoid as much as may be the bruising of the Face. CHAP. XIX. How to deliver a Woman when the Head of the Child is born, and the Womb closeth a∣bout the Neek. THe Child comes naturally with the Head first, because that by the hardness and bigness of it, the Passage might be the better made and open∣ed for the other parts of the Body, which usually pass afterwards without pain: but notwithstanding 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. This acci∣dent may likewise happen somtimes, for not having been careful to lose no time to draw forth the Child by the Head, as directed in the Discourse of natural Labours, to the end the Shoulders might at the same instant succeed in the place the Head possest. When the Chirurgeon meets with this case, he must speedily deliver the Child out of this pri∣son, or rather this Collar in which he is caught; for a small delay may there strangle the Child: to avoid which, let him endeavour to cause the Shoulders to follow by gentle drawing its Head, sometimes by the sides of it, sometimes with one Page [unnumbered] [illustration] Chap: XIX. lib. 2. pag: 232. Page [unnumbered] Page 233 hand under the Chin, the other behind the Head, and so doing by turns on the one side and the other, to facilitate the Operation the better, be∣ing very careful the Navel-string be not entangled about the Neck; as also not to draw it forth with too much violence, for fear lest it may happen, as I once saw the Head pulled from the Shoulders. If the Shoulders pass not with gentle pulling, slide up your Fingers on both sides under the Arm-pits, with which turning them inwards, you may by little and little draw forth the Shoulders; but when they are in the Passage and totally disingaged, if he cannot then draw the rest forth, still keeping his Fingers under the Arm-pits, he may be confi∣dent there is some other hinderance, and that it is certainly monstrous in some part of its Body; or, as it for the most part happens in this Case, that 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 'twill easily be accomplished, as I have done in the like case, of which I will give you the particulars, and how we behaved our selves; for we were two Chirurgeons, one Midwife, and a Deputy be∣longing to the l'Hôstel de Dieu to do the work. In the year 1660, whilst I practised Midwifery in that Hospital, it happened that the Deputy had a Woman whose Child she could not possibly bring into the world further than its Head, where it so remained, and seing she could not after all her en∣deavours finish the work, she called the Midwife of the place to her aid, which was then Madam de France, who likewise used her utmost skill, but in vain, and when they were both thus tired in Page 234 pulling the Head (so as the Vertebra's of the Neck were separated, and that it hung only by a little of the Skin) I came in the interim, when they desired me to examine the business, and to find the cause why the Child could not be drawn forth with all their strengths, which was sufficient to have drawn forth the Shoulders, if they had been as big again as they were; which having considered, I immediatly conceived the difficulty to proceed from something else: wherefore I put my hand into the Womb up to the Childs shoulders, which seemed not too big to pass with ease, therefore I concluded that the hinderance was not there. Af∣ter that I put my hand further up, directing it all along his Breast, at the bottom of which, near the grisle Xiphoïde, I found his Belly hydropical and full of Water, so that it was impossible ever to deliver the Woman, until the Water was emptied by piercing the Belly: but there wanting a fit in∣strument for the purpose, I immediatly sent to advertise one of the Chirurgeons of the same Hospi∣tal, to whom I declared the case as I found it, adding withal that the Child could not be born, unless an orifice was made to empty the Belly: but he would by no means follow my opinion, whe∣ther it was out of policy, believing it may be, that he very well understood his business without needing my advice, or that he would not or could not believe the Child to be hydropical, as I in∣formed him; wherefore he contented himself, without an exact examination of the case, to en∣deavour only the extraction of it after his manner; and, to effect it, he immediatly pulled and sepa∣rated the Head wholy from the Body, which hung Page 235 then but by a skin; because the Midwives, as I said before, had pulled it with so much violence. Afterwards with his Crochets he pull'd away both the Arms, and some of the Ribs, part of the Lungs and the Heart, one piece after another for above three quarters of an hour, that he was very wet with Sweat, although it were cold weather; and having thus tired both his mind and body, he was constrained to quit the work, to rest a while, leaving the Midwife to endeavour what she could the whilst, who wearied her self also in vain, as well as he had done, by pulling some of the Childs Ribs with her hands only (* for it is not a Midwifes work to use Crochets.) After this he returns the second time with all his strength to the work, without effecting any more, because he had not yet opened the lower bel∣ly, nor the Diaphragma, nor would not, as I ad∣vised him every moment, without which it was ab∣solutely impossible to draw forth the rest of the Body. When he saw that his second endeavors were as ineffectual as his first, he gave me at length his Crochet, telling me that I might weary my self as well as the others, which I willingly and with joy accepted (for I was very certain I could finish the operation) knowing very well, that instead of amusing my self as they had done, about pulling of it, I ought only to pierce the Infants belly to Page 236 let out the Waters, after which all the rest would very easily follow. For which purpose I put up my left Hand into the Womb, just to the right side of the swelled Belly, and then with my right Hand I guided the Crochet (like to that marked A, amongst the representation of the Instruments at the end of this Second Book, instead of which it were better to use the crooked Knife, marked there D) along my left hand into the Womb, and then I turned the point of it towards the Infants Belly, in which I struck it, so that I made a hole big e∣nough to receive two of my Fingers ends, (which I put into it after it was in the world) and then stretching it a little, all the Waters were imme∣diatly emptied; so that with one Hand I easily drew forth the rest of the Body, to the astonish∣ment of this Chirurgeon, whom I could never perswade that the Infant was so full of the Dropsy. After it was thus drawn forth, I had the curio∣sity to fill up the Belly with Water, by the hole I had made, to the end we might see what quantity of Water had been there contained, and of what bigness it might be when filled: I poured in, with∣out lying, above five Quarts, which I should hardly have believed, if I had not seen it my self; and when the Belly was filled with Water, it was of the bigness and figure of a very great Foot-ball. I have set down here all the circumstances of this History, that the Chirurgeon may know how to behave himself on the like occasion. Page [unnumbered] [illustration] Chap: XX. lib. 2. pag: 237. Page [unnumbered] Page 237 CHAP. XX. How to help a Woman when the Child comes with one or both Hands together with the Head. FOr the most part when an Infant presents any part of his Body together with the Head, it is usually one or both the Hands rather than any other, which hinders its Birth; because the Hands take up part of the Passage, and for the most part they cause the Head to lean on one side. When the Child comes thus, it is quite contrary to Na∣ture. To remedy this, assoon as 'tis perceived that one Hand presents together with the Head, it must be prevented from coming down more, or ingaging further in the Passage; wherefore the Chirurgeon having placed the Woman on the Bed, with her Head a little lower than her Hips, must put and guide back the Infants Hand with his own as much as may be; or both of them, if they both come down, for to give way to the Childs Head; which having done, if the Childs Head be on one side, it must be brought into its natural Posture in the middle of the Passage, that it may come in a strait line, proceeding further as I have directed before in the 18th Chap. of this Book, which treats of the Childs Head coming on one side. Page 238 CHAP. XXI. How to deliver a Woman when the Child pre∣sents one or both Hands foremost, without any other part. WHen an Infant presents only one or both Hands to the birth, or an Arm sometimes out to the Elbow, and many times to the Shoulder, it is one of the worst and most dangerous Postures a Child can come in, as well for himself as for his Mother; because of the violent force the Chirurgeon is* alwaies obliged to use both to the one and the other in searching for the Feet, which are very far off, by which he must alwaies in these Cases, turn and draw him forth; which will often make him sweat in the midst of Winter, because of the difficulty in this Labour more than in all the rest, though some o∣thers of them indeed are more dangerous for the Infant; as when it presents the Belly, and the Navel-string comes forth: but not so painful for the Chirurgeon, because the Feet of the Infant be∣ing near the Passage, are not so hard to be found, as when he comes with a Hand; for then they are high, at the very bottom sometimes of the Womb, where he must seek them, for to turn it and draw it forth, as I am going to direct. When therefore it presents with one Hand only, Page [unnumbered] [illustration] Chap: XXI. lib. 2. pag: 238. Page [unnumbered] Page 239 or a whole Arm first; it must by no means be pulled forth by that part; for it will sooner be se∣parated and rent from the Body, than so brought forth, by reason a Child is pluckt obliquely and cross. And when both Arms present, if pluckt together, there would not be place for the Head to pass, which would by that means be turned quite back. Wherefore having placed the Woman as is requi∣site,* one must put back the Infants Hand or Arm, which comes forth, into the Womb again. Some Midwives dip it in cold water, or touch it with a wet Cloth, saying, that the Infant will presently draw it in, if he be living; but he is usually so prest and ingaged in the Passage by this bad Posture, that he hath not liberty enough to draw back his Hands so easily, being once come forth; wherefore the Chirurgeon must guide them* back with his own, which he must afterwards slide into the Womb under the Childs Breast and Belly, so far, till he finds the Feet, which he must gently pull towards him, for to turn it and draw it forth by them, as hath been already directed; observing to do it with as little violence as may be, which is much more easie, sure and safe, than to busie ones self in putting it into a natural scituation. Assoon as he shall have so turned the Child by the Feet, if he hath hold but of one, he must search for the other, that so he may bring it to the first; when holding them both, he must govern himself afterwards in the bringing the Child, as Page 240 we have formerly shewed in the Fourteenth Cha∣pter of the Second Book, speaking of those La∣bours where the Feet come first: but if the Arm be so far advanced (almost to the Shoulder)* and so big and swelled († as it happens when it hath been a long time forth) that it cannot at all, or without great dif∣ficulty be reduced. Am∣brose Paré in this case| di∣rects (provided the Child be certainly dead) to cut off that Arm as high as may be, first making an incision round the flesh, and then cutting off the bone a little higher, with a pair of sharp Pinsers, that so the flesh may be left longer to cover the sharpness and end of the bone, to prevent hurting the Womb, when the Infant is turned, to draw it afterwards forth by the Feet as it should be: Notwithstanding if the Chirurgeon, not being able to put it back, is ab∣solutely constrained to cut it off (which must not be done but in such extremity) he may effect it without so much ceremony, by* twisting it twice or thrice about; for by reason of its tenderness he will easily sepa∣rate Page [unnumbered] Page [unnumbered] [illustration] Chap: XXII. lib. 2. pag: 241. Page 241 it from the Body, iust in the joint of the Shoulder with the Shoulder-blade, by which means he will need neither sharp Pinsers nor other instruments to cut the Bones and Flesh, as the said Paré teacheth, neither will there remain any sharpness, by reason the separation will be just in the joint. But above all when the dismembring of an In∣fant is thus intended, or to draw it forth with a Cro∣chet,* let the Chirurgeon take great care that he be not deceived, well con∣sidering, whether it be assuredly dead, and not to operate on this wise, unless he be very certain of it, by all the signs mentioned in the 12th Chap. of this Book; for what a horrible spectacle would it be, to bring (as some have sometimes done) a poor Child yet living, after the Arm hath been cut off, or any other part of the Body; wherefore let him make a double reflection on his work, before he goeth about it. CHAP. XXII. How to deliver a Woman when Hands and Feet come together. IF the Infant presents both Hands and Feet to∣gether at the Birth, it is altogether impossible it should be born so: the Chirurgeon therefore guiding his Hand towards the orifice of the Womb will perceive nothing but a many Fingers close to∣gether, Page 242 and if it be not sufficiently dilated, he will be a good while before he can exactly distinguish between the Hands and Feet, by reason they are sometimes so shut and prest together, that they seem to be all of one and the same shape: but when the Womb is open enough for to introduce the Hand into it, he will easily know which are the Hands, and which the Feet; and having well taken notice of it, let him slide his Hand, and presently direct it towards the Infants Breast, which he will find very near, and by that* let him gently thrust back the Body towards the bottom of the Womb, leaving the Feet in the same place where he found them; having therefore pla∣ced the Woman in a convenient Posture, that is, her Hips a little raised above her Breast and Head, which scituation ought alwaies to be observed when the Child is to be put back into the Womb, let him afterwards take hold of him by the Feet, and draw him forth according to the way before directed in its proper Chapter. This Labour truly is a little troublesome, but nothing near so much as that we have mentioned in the preceding Chapter, where the Child pre∣sents only his Hands: for in that the Feet must be searched a great way off, and it must be quite turned about, before it can be drawn forth; but in this, they are ready, presenting themselves, and there is not much to do, but to lift and thrust back a little the upper part of the Body, which is almost done of it self* by drawing it alone by the Feet. Page 243 Those Authors that have written of Labours, and never practised them, as many Physicians have done, do order all by the same precept often reite∣rated, that is, to reduce all wrong Births to a natural Figure; which is to turn it, that it may come with the Head first: but if they themselves had ever had the least experience, they would know that it is very often impossible; at least if it were to be done, by the excess of violence, that must necessarily be used to effect it, it would go near to destroy both Mother and Child in the ope∣ration: a Fiat in this Case is soon said and ordered; but it is not so easily executed as pro∣nounced. For my part I am of an opinion cleer contrary to theirs, and such as are skilfull in the Art will surely agree with me in it, that is, that (whensoever the Infant comes wrong in what Po∣sture soever from the Shoulders to the Feet) it* is the best way, and soonest done, to draw it forth by the Feet; searching for them, if they do not present themselves, rather than to try to put it into a natural Posture, and place the Head fore∣most: for the great endeavours often necessary to be used in turning the Infant in the Womb (which is a little harder than to turn a Pancake in a frying Pan) doth so weaken both Mother and Child, that there remains not afterwards strength enough for to commit the Operation to the work of Nature, and usually the Woman hath no more Throwes nor Pains fit for Labour, after she hath been so wrought upon; for which cause it would be very tedious and difficult, as also the Infant, which is already very weak, would certainly perish in the Passage, with∣out Page 244 being able to be born. Wherefore it is much better in these cases immediatly to fetch it by the Feet, searching for them as I have already direct∣ed, when they do not present themselves, by which a tedious Labour will be prevented to the Mother, and the Child will be often brought a∣live, who without it will scarce escape death be∣fore he can be brought forth by the strength of Nature. CHAP. XXIII. How to deliver a Woman, when the Child comes with the Knees. WHen an Infant (not being turned to∣wards the latter moneths, as he ought, to come with his Head foremost, as is mentioned in the 5th Chap. of this Book) presents the Knees to the Birth, having the Legs folded towards the Buttocks, one may easily be deceived touching but one of them, because of their hardness and round∣ness, and take it for the Head, especially when be∣ing scituated a little high, it can be reached but with the end of a Finger only; but if it be touched and handled a little better, the Infant being fallen a little lower, it will easily be distinguished. Assoon then as it is perceived, it must not be suffered to advance further in this Posture; but ha∣ving placed the Woman, the Knees must gently be put back, for to have the more liberty to unfold the Legs one after the other, which the Chirur∣geon Page [unnumbered] [illustration] Chap: XXIII. lib. 2. pag: 2•… Page [unnumbered] [illustration] Chap: XXIV. lib. 2 pag: 245. Page 245 may do, by putting one or two of his Fingers under the Hamm, directing them by little and little all along behind the Leg until he meets the Foot, and drawing alwaies a little obliquely, for to come the easier to the end of it, that so having disengaged one, he may do the same to the other, proceeding in the same manner as with the first; after which having brought them together, he may finish the work, as when a Child comes Footling; alwayes observing to bring the Face of it down∣ward, and such circumstances as are noted where we treat of that Labour. CHAP. XXIV. Of a Delivery where the Child comes with Shoulder, Back, or Breast. THe most difficult of these three sorts of Figures and Scituations, in which Infants sometimes come, is that of the Shoulders; because it is fur∣thest from the Feet of the Infant, and the Chirur∣geon must find them, for to draw it forth. The next is the Back: and the Breech, for the same rea∣son, causeth least trouble, not only because the Feet are nearer, but also because by this Figure, the Head and Neck of the Infant is not so con∣strained and lockt, as in the other scituations. For to remedy this Birth of the Shoulder, some advise that it should be put back, to make way for the Head of the Infant, that so it may be reduced to a natural Birth: but it is much better, for the Page 246 reasons above alledged in the 22th Chap. of this Book, to try to bring it by the Feet; for to effect which, the Chirurgeon must thrust the Shoulder a little back with his Hand, that so he 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 he finds it easiest, he shall fetch the Feet, and turning it, bring them to the Passage, and so deliver the Woman, as is already directed. If it be the Back, which presents to the Birth, it is also impossible to be born in that Posture, what Pains soever the Mother endures; and besides the Child having the Body folded inwards and almost double, his Breast and Belly are so prest together, that he usually wants little of being suffocated: to avoid which, the Chirurgeon must quickly slide up his Hand, along the Back towards the inferiour parts, until he meets the Feet, for to bring it forth the same way as if it came Footling. But when the Child comes with the Breech, if it be small, and the Mother big, having the Pas∣sages very large, he may sometimes with a little help be born so; for though he comes double, yet the Thighs being folded towards the Belly, which is soft and gives way, it passeth without much trou∣ble. Assoon as the Chirurgeon finds the Child to come with the Buttocks foremost, he must not permit it to engage lower in the Passage; for it will not come so, unless it be very small, and the Pas∣sage very large, as we have already said. This being then in good time perceived, he must, if he can, thrust back the Breech, and sliding up his Hand along the Thighs to the Legs and Feet of Page 247 the Child, he must bring them gently one after the other forth of the Womb, by folding, stretching, wagging, and drawing them gently towards the side, being careful not to winde them too much, or cause a dislocation; and then let him draw forth the rest of the Body, as if it came with the Feet foremost. I have said that the Chirurgeon perceiving the Child to come with the Breech foremost, ought to put it back, if he can; for sometimes he will be advanced so forward in the Passage, that you may sooner destroy both Mother and Child, than re∣duce it back, when once strongly engaged: When this happens, he cannot hinder it from coming in this Posture, in which his Belly is so pressed, that he often voids the*me∣conium by his Fundament. How∣ever he may much help this Birth, by sliding up one or two Fingers of each Hand on each side of the Buttocks, for to introduce them into the Groins, and having crooked them inward, he must draw the Breech just out to the Thighs, & then by draw∣ing and wagging it from side to side, he will dis∣engage them from the Passage, as also the Feet and Legs one after the other, being careful of dis∣locating any part, and then he may extract the rest as before, when coming with the Feet. The first Woman I ever layd, was of a Child which I drew† thus forth with the Buttocks fore∣most; being constrained to it, because assoon as ever the Waters broke (which happened before I could arrive to hinder it) they were so forward, that it was impossible to do it Page 248 otherwise, which I performed very well and in short time, without prejudice to the Mother or Child, doing as I have directed. CHAP. XXV. Of those Births, wherein the Infant presents Belly, Breast, or Side. THe Back-bone may easily be bent and turned forwards a little, but by no means back∣wards without excessive violence. Wherefore the worst and most dangerous Figure that a Child can offer in the Womb to the Birth, is the Belly or the Breast; for then its Body is constrained to bend backwards, and whatever Throws or endea∣vours the Woman makes to bring it forth, it will never be accomplished, for she will sooner perish with her Child, than ever advance it in this po∣sture into the Passage, wherefore it is in great danger, if not timely succoured. And in case it should escape, which would be very strange, it would be a long while after its birth weak in the Back. But that which augments the danger much more is, that for the most part the Navel-string comes forth when the Child comes with the Belly. Therefore assoon as it is discovered to be so, the Chirurgeon must apply the sole remedy of draw∣ing it forth by the Feet as speedily as may be, in the following manner. Having placed the Woman, let him gently slide up his flat Hand (being well anointed for the easier Page [unnumbered] [illustration] Chap: XXV. lib. 2. page 248. Page [unnumbered] Page 249 entrance) towards the middle of the Childs Breast, which he must thrust back, for toturn it; this scituation being already half turned, the Feet being as near to the Passage as the Head, when it presents the middle of the Belly; then he must flip up his Hand under the Belly till he finds the Feet, which he must bring to the Passage, for to draw it forth in the same manner as if it had come Footling, being careful to keep the Breast and Face downwards, which must alwaies be observed before the Head can be drawn forth, for the rea∣sons often already given, which must never be forgotten. When a Child comes with Breast or Belly, the Chirurgeon must always proceed after the same manner in both, inasmuch as they require the same circumstances. An Infant may likewise come with the Side, which way it is as impossible to pass as the two former: but it is not so much tor∣mented, nor is this scituation so cruel; for it may remain in it a longer time without dying, than in the two former, wherein it is much more racked than in this, in which the Body may be bended forward, and not backward, as in the other; nei∣ther doth the Navel-string come forth so easy, as when it comes with the Belly first. In this, as in the other two Births, the Chirurgeon must draw the Child forth by the Feet on this fashion; ha∣ving placed the Woman as she ought to be, he may push back a little with his hand the Infants body, the better to introduce it, which he may slide a∣long the Thighs, till he finds the Legs and Feet, by which he must turn it, and afterwards draw it forth, just in the same manner as before, with Page 250 the same observations. Nor ought he to amuse himself in any of these three Births, for to place the Head right, that it might come naturally; because it is in great danger 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. CHAP. XXVI. Of Labours wherein several Children present together in the different Postures above named. IF all the unnatural Figures and Scituations which we have hitherto described, that a single Child may come in, do cause those many difficulties and dangers mentioned; surely the Labour where∣in several together come in these bad scituations must be much more painful, not only to the Mo∣ther and Children, but to the Chirurgeon also; for they are then so constrained and pressed, that for the most part they trouble each other, and hin∣der both their births: besides, the Womb is then so filled with them, that the Chirurgeon can scarce introduce his Hand without much violence, which he must do, if they are to be turned or thrust back, for to give them a better position than wherein they present. When a Woman hath two Children, they do not ordinarily both present to the Birth together; Page [unnumbered] [illustration] Chap: XXVI lib. 2. pag: 250. Page [unnumbered] Page 251 but the onc is often more forward than the other, which is the cause why but one is felt, and that sometimes 'tis not discovered that the Woman will have Twins, till going to fetch the Afterbirth, the first being born, the second is then perceived. When there are Twins, 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 convenient, that is to say, When one is strong and the other weak, the strongest comes first; as also when one is dead and the other li∣ving, the living drives forth the dead: For it is apparent that there is no certain rule, of which behold an Example. Sometime since I delivered two Women within a Week one of the other, both of Twins, one of each being dead, and the other living: the living Child of the first Woman was born before the dead: and the dead of the second was expelled be∣fore the living. And the same thing happens every day in respect of strong and weak Children: for that which is nearest the Birth, whether alive or dead, strong or weak, is always first born, or must be brought first, if it cannot come of it self; o∣therwise the difficulty of the Labour 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 second first. In the 8th Chap. we shewed, speaking of na∣tural Labours, how a Woman should be delivered of Twins, coming both right: it now remains to direct what ought to be done, when they come either both wrong, or one of them only, as it is for the most part: the first coming right, the se∣cond Page 252 Footling, or any other worse Posture: and then must the Birth of the first be hastened as much as may be, that so there may be presently way for the second (which hath suffered much by this un∣natural Position) to fetch it by the Feet, without trying to place it right, although it were somewhat inclined to it; because it hath been already so tired and weakened, as also the Woman by the Birth of the first, that there would be more danger, that it would sooner dye, than come of it self. Sometimes when the first is born naturally, the second offers the Head likewise to the Birth: in this Case, 'tis good committing a work so well be∣gun, to Nature to finish, provided she be not too slow; for a Child may dye although right, by lying too long in the Birth; and the Woman, who hath been much tormented with bearing the first, is usually so tyred and discouraged, when she thinks that but half her work is over, that she hath no more Pains, or very few and slow, nor any con∣siderable Throws to bear the Second as she had done the First. Wherefore if the birth of the Se∣cond proves tedious, and the Woman grows weak∣er, let the Chirurgeon defer it no longer, but di∣rect his Hand gently into the Matrix, to find the Feet, and so draw forth the second Child; which will easily be effected, because there is way made sufficient by the birth of the first: and if the se∣cond Waters be not broke, as it often happens, yet intending to fetch it Footling, he need not scruple to break* the Membranes with his Fingers, al∣though elswhere we have forbidden it; but that must be understood with distinction: for when a Page 253 Labour is left to Natures work, they must break of themselves; but when a Child shall be extracted by Art, there is no danger in breaking them; nay contrarily they must be broke, that the Child may be the easier turned, which else would be al∣most impossible. Above all, the Chirurgeon must be careful not to be deceived, when both Children together offer to the Birth either their Hands or Feet, and must well consider in the Operation, whether they be not joined together, or any otherways monstrous; as also which part belongs to one Child, and which to the other, that so they may be fetcht one after the other, and not both together, as would be if it were not duely considered, taking the right Foot of the one, and the left of the other, and so drawing them together, as if they be∣longed both to one Body, because there is a left and a right, by which means it would be impossi∣ble ever to deliver them: but it may easily be prevented, if having found two or three Feet of several Children presenting together in the Passage, and taking aside two of the forwardest, a right and a left, and sliding his Hand along the Legs and Thighs up to the Twist, if forwards; or to the Buttocks, if backwards, he finds they both belong to one Body; and being certain of it, he may then begin to draw forth the nearest, without regard which is strongest or weakest, bigger or less, li∣ving or dead, having first put a little aside that part of the other Child which offers, to have the more way, and so dispatch the first whatever it is, assoon as may be; observing the same Rules, as if there were but one, that is, keeping the Breast and Page 254 Face downwards, with every circumstance directed where the Child comes Footling, and not fetch the Burthen, till the second Child be born; be∣cause there is commonly but one for both, which if it were loosened from the sides of the Womb, would cause a flooding, for the reasons already alledged, that the orifices of the Vessels to which it was joined would continue open by this separation, as long as the Womb was dîstended by the other Child, yet within it, and never close (as it often happens) till being quite emptied of all, it begins to contract it self, and retire (as a man may say) within it self. When therefore the Chirurgeon hath drawn forth one Child, he must separate it from the Bur∣then, having tyed and cut the Navel-string, and then fetch the other by the Feet in the same man∣ner; and afterwards bring the Burthen with the two strings, as hath been shewed in the proper place. If the Children offer any other part than the Feet, the same course must be taken as is di∣rected in the foregoing Chapters, where the seve∣ral unnatural Figures are discoursed of, alwayes observing for the reasons abovementioned to begin the Operation with the Child that is lowest in the Passage, and in the most commodious Figure for ex∣traction. Page [unnumbered] Page [unnumbered] [illustration] Chap: XXVII. lib: 2. pag: 255. Page 255 CHAP. XXVII. Of a Labour when the Navel-string comes first. AN Infant doth not alwaies present with the Belly when the Navel-string comes first: for though he presents naturally as to the Figure of his Body, that is with the Head first, yet sometimes the Navel-string falls down and comes before it; for which cause the Child is in much danger of death, at least if the Labour be not very quick, be∣cause the Blood (that ought to pass and repass through those Vessels which compose it, for to nourish and enliven the Child, whilst he continues in the Womb) being coagulated, hinders the circu∣lation wh ch ought to be there made; which hap∣pens 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 o∣ther part, as also because the Blood doth there coa∣gulate (as is said) by reason of the cold which it takes by the coming forth of the Navel-string. But though this accident may cause the Infants suddain death, 'tis not so much for wart of nou∣rishment, without which he might pass a day or more, there being blood enough in his Body for that purpose: but because the Blood can be no longer vivified and renewed by Circulation, as it hath continual need, which being obstructed, al∣waies causeth the creatures sudden death, sooner Page 256 or later, according as it is more or less obstru∣cted. I know it may be objected, that though the Circulation be so hindered 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 notwithstanding circulate in all the other parts of the body: to which I answer, that in respect to the Infant, 'tis either absolutely ne∣cessary that the Blood, for want of respiration, should be elaborated or pre∣pared in the*Placenta, and therefore there must be a free communication, or for want of it, that the Infant must immediatly breath by the mouth, as well to be refreshed, as to drive forth by exspiration the fuliginous vapours, which not being possible whilst in the Womb, it must unavoidably be choaked and dye in a very small time, if it wants both together. Wherefore in this case the Woman must without any delay be de∣livered, which if Nature doth not speedily per∣form, the Child must be drawn forth by the Feet. Women that have great Waters and a long string to the Burthen are very subject to this mischief; for the Waters coming forth in great abundance at the breaking of the Membranes, do often at that instant draw the string which swims in the midst, forth along with them, and much the easier if the In∣fants 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 immediatly Page 257 endeavour to put it back, to prevent the cooling of it, behind the Childs head, lest it be bruised as we have already noted, whereby the blood may coa∣gulate there; keeping it in that place where it was thrust back, until the Head being fully come down 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, until the Head be advanced as abovesaid; or in case the hand be taken away, to put a piece of fine soft rag between that side of the Head and the Womb, for to stop up the way it came down by, alwaies leaving an end of the rag without the body, for to draw it forth by at pleasure. But sometimes, notwithstanding all these cauti∣ons and the putting back of it, it will yet come forth every Pain: then without further delays the Chirurgeon must bring the Child forth by the Feet, which he must search for, though the In∣fant comes with the Head; for there is but this only means to save the Childs life, which it would certainly lose by the least delay in this case. Wherefore having placed the Woman conveniently, let him gently put the Head, which offers, back; (provided it be not engaged too low among 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 de∣stroy the Mother) and then slide up his Hand well anointed under the Breast and Belly to search for the Feet, by which he must draw it forth ac∣cording to former directions; this being dispatch∣ed, Page 258 let him immediatly take great care of the In∣fant, which is ever in this case very feeble. CHAP. XXVIII. Of a Labour wherein the Burthen either first offers, or first comes quite forth. THe coming forth of the Navel-string before the Infant, of which we have treated in the fore∣going Chapter, is often cause of his death, for the reasons there given: but the coming first of the Burthen, is yet much more dangerous; for besides that the Children are then ordinarily Still-born, if they be not assisted in the very instant, the Mother likewise is often in very great peril of her life; because of her great floodings, which usually happen, when it is loosened from the Womb before its due time, because it leaves all the Orifices of the Vessels open, to which it did cleave, whence flowes incessantly Blood, until the Child be born: because the Womb, whilst any thing continues there, doth every moment strongly en∣deavour to expel it, by which means it continually voids and epresseth the blood of the Vessels, which are always open (as we have already often explain∣ed) when the Burthen is so separated, as long as the Womb remains extended and cannot be closed, un∣til it hath voided all that it did contain, and comes by the contraction of its membranous substance to stop them, by pressing them together. Wherefore if we ought to be vigilant to succour an Infant Page 259 when the String comes first, we ought much more to be so when the Burthen comes forth first, and the least delay is ever cause of the Infants sudden death, if the Woman be not speedily delivered; because the Infant cannot stay then long in the Womb without suffocation, standing then in need of breathing by the Mouth (as is explained in the foregoing Chapter) the Blood being no longer vivi∣fied by the preparation made in the Burthen, the use and sunction of which then ceaseth, from the instant it is separated from the Vessels of the Womb, to which it was joined, for which reason there immediatly follows a great flooding, which is so dangerous for the Mother, that without speedy help, she soon loseth her life by this unlucky ac∣cident. When the Burthen is not wholy come forth, but lies in the Passage, some advise to put it back before the Child be fetcht; but I am not of that opinion, for when it comes into the Passage before the Infant, it is then totally divided from the Womb, at the bottom of which it ought ordina∣rily to be scituated and fastened, until the Child be born: but, because (assoon as it is wholly loose∣ned, as it alwaies is when it comes first) it becomes a Body altogether unnatural; it must never be thrust back, but contrarily be ferched away, and at the very moment after bring the Child 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 separated from the Womb, as cannot be de∣nied? And such a proceeding is so farr from being useful, that this Burthen would much hinder the Page 260 Chirurgeon from being able to turn the Child, as he ought, for to bring it by the Feet. Wherefore when it presents in the Passage, which may be soon perceived if they find every where a soft substance, without the least resistance to the touch of any solid part; finding likewise the String fastened to the middle of it, and the Woman flooding extremely, as is ordinary at such times: then, instead of thrusting it back, the Burthen must be brought away, that so there may be more liberty and room to extract the Child, according to former direction. The Burthen, being quite loosened from the Womb, and coming first in the Passage, must not be thrust back into it again, much less must it be put back, when is is quite come forth of the Body: Care must be only taken 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 fetcht, which is then ever in great danger, as also the flooding may be the sooner stopt, which happens for the most part assoon as the Woman is delivered, for which reasons it must be with all possible speed dispatched. Sometimes, notwithstanding this dangerous ac∣cident, the Child may be born alive, if timely succoured: but it is then so weak, that 'tis hard to discover at first, whether it be living or dead. When it so happens, the Midwives do ordinarily before they separate the Burthen put it into a skellet of hot Wine, and imagine, with no small Super∣stition, that in case it comes to it self, the vapours of the warm Wine was the cause of it, being con∣veyed Page 261 by means of the String into the Infants Bel∣ly, and so giving it vigour: but it is more cre∣dible, that being almost suffocated for want of respiration assoon as it needed it, it begins now by means of it to recover from that fainting: but ne∣vertheless, there is no hurt in keeping the custome, though superstitious, since it can do no prejudice, and may satisfie preoccupied spirits, provided ne∣cessaries be not neglected, in being blindly carried away with this conceipt. CHAP. XXIX. Of Floodings or Convulsions in Labour. THe best expedient and safest remedy for Mo∣ther and Child in this case, who are both in great danger, is to deliver the Woman presently, without any delay, fetching the Child away by the Feet, at what time soever of the Womans being with Child, whether at full reckoning or no. I have at large directed in the 20th Chap. of the first Book, speaking of Floodings, what ought to be done in these Cases, where I related the sad Story of one of my Sisters, which I shall not again repeat, being too sadly affected with it; but refer the Reader to that Chapter for sufficient directions in these dangerous accidents. Page 262 CHAP. XXX. How to deliver a Woman when the Child is Hydropical, or Monstrous. A Child may in the Womb have either the Dropsy of the Head, called Hydrocephale, or of the Breast, or of the Belly: And when these parts are so filled with Water (as I have sometimes met with) that they are much too big for the Pas∣sage through which the Child must issue; then, notwithstanding any Throws or Endeavors the Woman may attempt to bring it forth, 'tis impossi∣ble she should effect it without the help of Art: as likewise when the Child is monstrous, either by being only too big in the whole Body, or in any particular part, or by being joined to another Child. If the Child be living that hath the Dropsy, when the Woman is in Labour, it must be destroy∣ed to save the Mother, by making a hole in either the Head, Breast or Belly of it, where the Waters are contained, that being emptied by the apertion so made, the Child may the easier be drawn forth, or else he must necessarily dye in the Womb, not being able to be born, and remaining there will also kill the Mother; wherefore to save her life, the Infant must be by an* indispensable necessity brought forth by Art, since 'tis impossible it should come of it self, which may Page 263 be done with a crooked Knife sharp at the very point, like that marked C, among the Instruments at the end of the Second Book, the Chirurgeon proceeding in the following manner. After ••at the Woman is placed conveniently for the Operation, he must slide up his left Hand on the right side of the interiour part of the Infants Head, if the Waters be continued therein, which he will perceive by the extraordinary bigness and extent of it, the Sutures much separated, and the Bones of it far distant one from the other, by rea∣son of the distension made by the inclosed Waters, of which being very certain, let him slide with his right Hand along the inside of his left this crooked Knife, taking care that the point of it in introdu∣cing it, be alwaies towards his left Hand, for fear of wounding the Womb, and having conducted it close up to the Head, against one of the Sutures, let him turn the Knife towards it, and make an apertion large enough to let out the Water, and then it will be very easie to bring forth the Child; forasmuch as the other parts are then usually small and much consumed. If these Waters were contained in the Breast or Belly, then the Childs Head, being no bigger than ordinary, may be born; but the Body being ex∣ceedingly swelled with the Waters will stay be∣hind, as it happened to that Child that had a Dropsy of the Belly, which I mentioned in the 19th Chap. of this Book, to which I refer you, because 'tis much to this purpose. The case being thus, let the Chirurgeon slide up his left Hand, as aforesaid, and the instrument with the right, just to the Breast or Belly, for to Page 264 make an Incision, just as I did in the same case re∣lated in the said 19th Chap. for to let out the Waters, after which he may with much ease finish the Operation. You must know, that 'tis much more difficult to deliver a Monstrous Birth, or two joined together, than one that hath the Dropsy: because the bigness of the Hydropick parts may be easily lessened by a single incision, which is sufficient to let out the Waters which distend, and then 'tis easie to di∣spatch the rest. But when a monstrous Child is to be extracted, or a double one, a single apertion is not enough, but sometimes 'tis necessary to take off whole mem∣bers from those Bodies, which makes the Operation much more painful and laborious, and requires more time and skill to effect it; in which case the left Hand must be introduced into the Womb, and the sharp Knife of the right just to the parts that are to be divided and separated, and there with all the care that may be, the member of the mon∣strous Child must, if possible, be taken off just at the Joint; and when there are two Children joined together, the Separation must be made just in the place where they join, and afterwards they may be delivered one after the other; always taking them by the Feet; and if it hath but one, the same thing may be accomplished, after having les∣sened the bigness of it, by cutting off some one of the Members. I have already shown in the 15th Chap. of this Book, speaking of the extraction of a Childs Head left alone behind in the Womb, of what fashion this Instrument ought to be, that the Operation may Page 265 be conveniently performed, and that it should be as long as an ordinary Crochet, for the more surety and facility; because that holding the handle of it with the right Hand, it may be thrust, drawn, sloaped and turned without pain to any side at pleasure; and with the left, which is within the Womb, it may be guided for to cut and dismember more skilfully and easily those parts which must be separated. Wherefore it ought to have a Han∣dle so long, that the Chirurgeons right Hand with∣out the Womb may hold and govern it as above∣said, and conduct it the better in the Operation, which could not be so safely and conveniently done, if this instrument were so very short, as all other Authors recommend: because in this occa∣sion the Chirurgeons hand is so constrained and pressed in the Womb, that he can hardly there have the liberty to move his Fingers ends, which is the cause why he cannot without much diffi∣culty govern such an Instrument with one Hand only, unless he would very much force and offer violence to the Womb, and exceedingly endanger thereby the poor Womans life. Let us now come to the extraction of a dead Child, and show the several ways of doing it. CHAP. XXXI. Of delivering a dead Child. WHen the Infant is dead in the Mothers Belly, the Labour is ever long and dangerous, be∣cause Page 266 for the most part it comes wrong; or, though it comes right with the Head, 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, labours so little, that many times it cannot finish the busi∣ness it hath begun, but must yeeld without the help of Art, of which at that time it hath great need: However, before you come to Manual Ope∣ration, endeavour to stir up the Womans Pains with sharp and strong Clysters, for to bring on Throws to bear down and bring forth the Child: but if this prevails not, she must be deliverd by Art. We have declared in the 12th Chap. of this Book the signs to know a dead Child in the Womb, of which the chief are; if the Woman perceives it not to stir, nor hath a long time before; if she be very cold, much pain and heaviness in the bottom of her Belly; if the Child be not supported, but al∣ways falls like a mass of Lead to that side on which the Woman lies, if the Burthen or Navelstring hath been a long time in the World; and if no Pulsation be there felt, and that dark and stinking putrid matter comes away from the Womb. All these signs together, or most of them, shew the Child is assuredly dead; which when the Chirur∣geon is certain of, he must do his endeavour to fetch it assoon as possibly he can, and having placed the Woman according to former directions; if the Child offers the Head first, he must gently put it back until he hath liberty to introduce his Hand quite into the Womb, and sliding it all along un∣der Page 267 the Belly to find the Feet, let him draw it forth by them, as is formerly taught; being very careful to keep the Head from being lockt in the Passage, and that it be not separated from the Bo∣dy, which may easily be done when the Child be∣ing very rotten and putrified, the Chirurgeon doth not observe the circumstances often repeated by us, that is (in drawing it forth) to keep the Breast and Face downwards: And if, nothwithstanding all these precautions, the Head, because of the great putrifaction, should be separated and remain be∣hind in the Womb, it must be drawn forth ac∣cording to the directions formerly given in the proper Chapter. But when the Head coming first is so far ad∣vanced 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 certainly dead, 'tis better to draw it so forth, than to torment the Woman too much by putting it back, for to turn it and bring it by the Feet: but because it being a part round and slippery, by reason of the moisture, the Chirur∣geon cannot take hold of it with his Fingers, nor put them upon the side of it, because the Passage is filled with its bigness, he must take a* Crochet Page 268 like one of those marked A and B, amongst the Instrument at the end of this Second Book, and put it up as far as he can without violence between the Womb and the Childs Head, observing to keep the point of it towards the Head, where he must fasten it, endeavouring to give it good hold upon one of the Bones of the Skull, that it may not slide, forcing in the point of it, which must be strong, that it may not turn; and after the Cro∣chet is well fixed in the Head, he may therewith draw it forth, keeping the ends of the Fingers of his left Hand flat upon the opposite side, the better to help disengage it, and by wagging it by little and little, to conduct it directly out of the Passage. It were to be wished that it were possible to introduce the* Crochet so far, that one might fix it (for the better hold) in one of the Eye-holes, or cavities of the Ears; but very often there is not room at first to carry them beyond the middle of the Head, and then they must be fastened according to our directions, and rather if possible on the hin∣der part than any other, that so it may be drawn forth in a straight line; and when by the first fastening of the Crochet the Head is drawn lower, and begins to be disengaged, you may loosen it out of the first place, for to fasten it farther up, to take stronger hold,* and so successively removing and Page [unnumbered] Page [unnumbered] [illustration] Chap: IIII. lib. 2. pag: 169 Page 269 fastening of it until the Head be quite born, and then taking hold of it immediatly with the Hands only, the Shoulders may be drawn into the Passage, 〈◊〉 so-sliding the Fingers of both Hands under the 〈◊〉•ts, the Child may be quite delivered, and 〈◊〉•he Burthen fetched to finish the Operation 〈◊〉•ing to knowledge; being careful not to pull 〈◊〉•vel-string too hard, lest it break, as it often 〈◊〉•s when it is corrupted. •he dead Child (of which above all there must •d assurance) comes with the Arm up to the •lers so extreamly swelled, that the Woman •asser too much violence to have it put back, •st then to take it off at the Shoulder-joint, •sting it three or four times about, as we have •y taught in another place, by which means 〈◊〉 is no need of either Knives, Sawes or sharp •rs, as some Authors will have it; it being 〈◊〉 easily performed without all that provision, •de of the softness and tenderness of the Body: 〈◊〉 that, the Arm so separated and no longer •ing the Passage, the Chirurgeon will have 〈◊〉 room to put up his Hand into the Womb to 〈◊〉 the Child by the Feet, and bring it away as 〈◊〉 been directed. Although the Chirurgeon be sure the Child is •…ad in the Womb, and that it is necessary to fetch 〈◊〉 by Art, he must not therefore presently use his Crochets, because they are never to be used but when Hands are not sufficient, and that there is no other remedy to prevent the Womans danger, or to bring the Child any other way; because, very often, though he hath done all that Art directs; persons present, that understand not these things, Page 270 will believe that the Child was killed with the Crochets, although it had been dead three days before, and without other reasonings or better understanding of the matter, for recompense of his saving the Mothers life, requite him with an Accusation of which he is altogether innocent; and, in case the Mother by misfortune should after∣wards dye, lay her death also to his charge, and instead of praise and thanks treat him like a Butcher or Hangman; to which divers Midwives are usual∣ly very ready to contribute, and are the first that make the poor Women, that have need of the Men, afraid of them. So much they are in fear of being blamed by them, for having themselves been the cause (as some of them often are) of the death of Infants, and many ill accidents which after befal the poor Women, not causing them to be helped in due time, and from the moment they perceive the difficulty of the Labour to pass their under∣standings. To avoid therefore these calumnies, let the Chi∣rurgeon never use the Crochets but very rarely, and when there is no other way, as also to endea∣vour his utmost (as much as the case will permit) to bring the Child whole although dead, and not by bits and pieces, to give the wicked and ignorant no pretence of blame; I say, as much as the case will permit, that is with respect to the Woman under his Hands: for to save her, he had better sometimes bring the dead Child with* Instruments, Page 271 than kill her, by tormenting her with excessive violence for to bring it whole: but in a word, we must in conscience do what Art commands, with∣out heed to what may be spoken afterwards, and every Chirurgeon, that hath a well ordered con∣science, will ever have a greater regard to his duty than reputation; in performing of which let him expect his reward from God. CHAP. XXXII. Of extracting a Mola and false Conception. HAving at large spoken in another place of the Causes, Signs and Differences of Mola's and false Conceptions, and shewed that a Mola al∣waies ariseth from a false Conception, there remains nothing to be demonstrated but the manner how it ought to be extracted. Now since these things contained in the Womb, are totally preternatural, their expulsion must be procured assoon as possible, which is very difficult, when these strange Bodies cleave to it, and especially the Mola, which not being drawn forth, will often continue so fastened two or three whole years, nay sometimes the whole remaining part of the Womans life, as Paré tells us in the Story of the Pewterers wife that had one seventeen years, whom he opened after her death. To avoid the like accident and abundance of in∣conveniences which a Mola brings, it must be endeavoured to be expelled assoon as may be, try∣ing, before you come to Manual Operation, to cause Page 272 the Woman to expel it of her self: to which pur∣pose give her strong and sharp Clysters, to stir up Throwes for to open the Womb to give way to it, relaxing and moistening it with emollient Oint∣ments, Oyls and Grease, not omitting bleeding in the Foot, and half Baths, if there be occasion. The Mola will certainly be excluded by these means, provided it be but of an indifferent big∣ness, or that it adheres little or not at all to the Womb; but if it cleaves very strongly to the bot∣tom of the Womb, or that it be very big, the Woman will hardly be rid of it without the help of a Chirurgeons hand; in which case, after that he hath placed the Woman conveniently, as if he were to fetch a dead Child, let him slide his Hand into the Womb, and with it draw forth the Mo∣la, using (if it be so big as that it cannot be brought whole, which is very rare, because it is a soft ten∣der body, much more plyable than a Child) a Crochet or Knife to draw it forth, or divide it into two or more parts, as the case shall require. If the Chirurgeon finds it joined and fastened to the Womb, he must gently separate it with his Fingers ends, his Nailes being well pared, putting them by little and little between the Mola and the Womb, beginning on that side where it doth not stick so fast, and pursuing it so until it be quite loosened; being very careful, if it grows too fast, not to rend nor hurt the proper substance of the Womb, proceeding according to the directions we have given for the extraction of a Burthen staying behind in the Womb when the String is broke off. This Mola never hath any String fastened to it, Page 273 nor any Burthen from whence it should receive its nourishment: but it doth of it self immediatly draw it from the Vessels of the Womb, to which it is almost alwaies joined, and sticking in some place. The substance of its Flesh is also much more hard than that of the Burthen, and some∣times it is schirrous, which is the cause, why it is not so easily separated from the Womb. As to a false Conception, though it be much less than a Mola; yet it often puts a Woman in hazard of her life, because of great Floodings, which very often happens, when the Womb would discharge it self of it, and endeavors to expel it: which seldom ceaseth until it be come away; because it doth still endeavour to exclude it, by which the Blood is excited to flow away, and in a manner squeesed out of the open Vessels. The best and safest remedy for the Woman in this case, is to fetch away the false Conception assoon as may be, because the Womb can often ve∣ry hardly void it without 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 considerable Bulk in it; for then it is more strongly compressed with the Throws. Many times 'tis exceeding difficult to fetch these false Conceptions, because the Womb doth not open and dilate it self ordinarily beyond the proportion of what it contains, and that being very little, so is its opening; which is the reason why the Chi∣rurgeon sometimes is so far from introducing his whole Hand, that he can scarce put in a few Fin∣gers, with which he is obliged to finish the Ope∣ration, Page 274 as well as he can, proceeding in the fol∣lowing manner when he hath introduced them. Having well anointed his Hand, he must slide it up the Vagina unto the inward Orifice, which he will find sometimes but very little dilated, and then very gently put in one of his Fingers, which 〈◊〉 must presently turn and bend on every side, un∣•…•e hath made way for a second, and afterwards third, or more if it may be done without vio∣lence; but many times one hath enough to do to get in but two, between which he must take hold (as Crabs do with their Claws when they take any thing) of the false Conception, which he must gently draw forth, and also the clodded Blood which he there finds; afterwards the Flooding will undoubtedly cease, if no part of this Conception be left behind, as I have often found by experience when I have taken the same course: but if the in∣ward Orifice cannot be more dilated than to admit but one Finger, and that the Flooding is so violent as to endanger the Womans life, the Chirurgeon then having introduced his Fore-finger of his left Hand, must take with his right an Instrument, cal∣led a Cranes-bill, or rather a Forceps (like that mar∣ked G, among the Instruments at the end of this Second Book,) and guide the end of it along his Finger, for to fetch with this Instrument the strange Body out of the Womb, taking heed not to pinch the Womb, and that the Instrument be al∣waies conducted by the Finger first introduced, which will judg and distinguish by the touch be∣tween this Conception and the substance of the Womb: in doing which, there being no other way, he will certainly accomplish his business. Page 275 I thought of causing such an Instrument to be made upon an occasion, where it would have stood me in good stead, if I had had it, with which I have since (proceeding according to the directions I have just now given) lately drawn forth a false Conception of the bigness of a Walnut, which with∣out doubt had else that day been the death of one named Madam le Roy, dwelling near the great Stairs at the place Maubert, by reason of the hor∣rible loss of Blood which it occasioned, and which ceased assoon as I had drawn forth this Conception; which I could never have done any other way, be∣cause the inner Orifice of the Womb was not open, nor could be dilated more than for one Finger a∣lone, after the manner I have declared: besides the pressing danger of the accident, the delay of the Operation had indubitably been the death of this Woman, who, thanks be to God, is since well recovered. CHAP. XXXIII. Of the Caesarean Section. WHen a big-bellyed Woman is effectively in Labour, 'tis very rare but that an ex∣pert Chirurgeon can deliver the Child dead or a∣live, whole or in pieces; in a word, that he may do the work completely, if he behaves himself as the case requires, and according to the directions given in each particular Chapter foregoing, treating of the several unnatural Labours, without being Page 276 necessitated in a very inhuman, cruel and barba∣rous manner to have recourse to the Caesarean Ope∣ration during the Mothers life, as some Authors have too inconsideratly ordered, and somtimes practised themselves. In truth there would seem some pretext of a lawful excuse to make Martyrs of these poor Wo∣men, if it were to bring a second Caesar from them, whom they say was born in that manner, or some great and new Prophet. In the times of the an∣cient Pagans they did use to sacrifice innocent Vi∣ctims for the publick good, but never for a private. I know very well that they palliate it with a pretence of baptizing the Infant, which else would be deprived of it, because the Mothers death is for the most part cause of the Childs: but I do not know that there ever was any Law, Christian or Civil, which doth ordain the martyring and kill∣ing the Mother, for to save the Child: 'Tis rather to satisfie the avarice of some people, who care not much whether their Wives die, provided they have a Child to survive them; not so much for the sake of Children, but to inherit by them afterwards; for which cause they do easily consent to this cruel Operation, which is a damnable policy. If they say, to render the fact less horrible in appearance, that it must never be undertaken but when the Woman is reduced to the utmost extremity; to that I answer, that a Woman often recovers beyond hope or probability: And, if they object that she may likewise escape after this Operation; I do ut∣terly deny it, by the testimony of the most expert Chirurgeons that have practised it, who alwaies had bad success, all the Women ever dying in a Page 277 short time after. I do highly commend Guille∣meau, who to disabuse the world for such a wic∣ked and pernicious practise, confesseth, speaking of this fatal Operation, and ownes (by way of re∣pentance) that he did himself twice in the presence of Ambrose Parê put it into practise, and saw it thrice done more by three several very expert Chi∣rurgeons, who omitted never a circumstance to make it succeed well, and notwithstanding all the Women died. As for Parê, he will not acknowledg that he saw those two Operations of Guillemean, because he will not have Posterity know that he was able to consent to so great a cruelty; but contents him∣self with advising only, that it should never be undertaken till the Woman is dead; because there is no possibility she should escape it, not only be∣cause of the irregular wound, which is conveni∣ent to make for this purpose in the Belly, but chiefly for that in the Womb, and for the excessive Flux of Blood which will immediatly follow. However, contrary to the opinion of two such famous Chirurgeons, there are some rash persons, who do obstinately maintain (though with but as little reason as Rausset) that it is not impossible for a Woman to escape, because they have seen some that have had the Bones of their dead Children come forth by an abscess of the Belly, after that the Flesh of them had passed the natural way in Sup•uration, which Bones by little and little had pierced the Womb and the Belly also, and after that they were so drawn forth, yet the Women recovered. As also others did not dye, whose Wombs after Precipitation and perfect putre∣faction Page 278 and Gangrene, was totally cut away. Indeed we must acknowledg what experience hath many times taught us, as it hath these things, which I believe have happened, and may again as well as those (though rarely): but it doth not fol∣low, that this Caesarean Operation must needs suc∣ceed as well; because here is made at one stroak a very great wound in the Belly and Womb, which is ever the death of the poor Woman immediatly, or soon after. But when Nature it self begins to separate and pierce these parts, by means of these Bones, to cast them forth by some new way which it makes, not being able to do it by the common and natural, for want of the help in due time of skilful persons, it doth it by degrees and not all at once; and accor∣ding to the measure it drives these preternatural Bodies forth of the Womb, so it reunites and re∣joins it at the same time proportionably, and without the least Flux of Blood, which happens quite otherwise in the artificial Operation: and if it be true, that some Women have ever escaped it, we must believe it a Miracle, and the express hand of God, (who can when He pleaseth raise the dead, as he did Lazarus, and change the course of Na∣ture, when 'tis his good pleasure) rather than an effect of humane prudence. There are many good Women who, for having only heard some Gossips speak of it, are very con∣fident that they know such and such yet living, whose sides had been so opened to fetch the Child so out of their Belly. Nay more, there are some that affirm they know those that have had this Operation practised on them three or four times Page 279 successively, and yet alive; and the better to con∣firm so notable a lye, which they had only heard recited by others, and after having three or four times told it, believe it themselves for truth, as much as if they had seen it with their own eyes, will tell so many circumstances and particulars, that they easily perswade those that do not under∣stand the impossibility of it. There are others agin, who shewing the scars of some abscess they have had in their Belly, would perswade that a Child hath been taken out there; to which purpose I will relate what I once saw my self, concerning a big-bellyed Woman that was in the Hôstel de Dieu at Paris, when I there practi∣sed Deliveries. This Woman, whether through cunning, feigning to believe the thing, or through ignorance, really beleeving it, did testify to all the Women who were then in the said Hôstel de Dieu, as also to an infinite of other persons, and amongst the rest to a good old Nun that governed all, whom they called Mother Bouquet, (and at that time did preside in the Hall of Deliveries, like ano∣ther goddess Lucina) that she was very much a∣fraid, that they must open her side to deliver her, as it had been two years before; in all which time she had made the same relation to above a thousand several persons, each of which, it may be, had a∣gain related it to as many more, shewing to all of them a great Skar, by which she said the Chirur∣geons had drawn the Child out of her Belly. Wherefore she prayed Mother Bouquet to recom∣mend her to me, desiring rather to be delivered by me who was a Chirurgeon, because she might be more safely helped in such a business, than by a Page 280 Midwife. This good Nun giving me this account, which she verily beleeved according to the relati∣on; I told her, that not having faith enough to imagine it, I could not believe the Caesarean Secti∣on had been made on that Woman, as she had perswaded her. If you do not beleeve it, replied she, I will fetch her presently to you, and she her self shall tell you every circumstance. And imme∣diatly she caused her to be fetch'd; who told me the same she had told her: but having particularly examined her from what part the Child was so drawn forth, and whether she felt any great pain in the Operation. She answered me, None; because she was then senseless, and remained so five or six days after: I asked her then, how she was certain that the Child was brought away by incision in her Belly, being she was not at that time sensible? She answered, the Chirurgeons assured her it was so; and at the same time she shewed me a great Skar, scituated just on the right side of her Breast, about the middle of the Ribs, where she had a great abscess, of which this Skar remained; and when I had told her, that the Breast was not the place whence a Child should be fetcht, and that I had with my arguments convinced her of the impossi∣bility of what she had believed and made others to believe, as the women of the Hostel de Dieu and Mother Bouquet also; they began to be disabused and continued so, when three days after this con∣ference, I had delivered her with the greatest faci∣lity, although it was a very great Child, which came quickly. If one should examine well the beginning of all the Stories of this Operation, strict∣ly weighing them, as I did upon this occasion, Page 281 they would be found to be meer fables, and that that which Rousset reports of his Caesarean Labours, is nothing but the ravings, capriciousness and im∣posture of their Authors. Now if, because of all these reasons, a Chirur∣geon must never practise this cruel Operation whilst the Mother is alive, although the Child be certainly so (which for all that may somtimes he very doubt∣ful) I pray what infamy would it be for him, if ha∣ving so killed the Mother, the Child should also be found dead, after it was thought to be alive? much more ought he to abstain from it, when he is well assured it is dead; wherefore he had better pull it in pieces and bits (if it cannot be otherwise) by the natural way, than so to butcher the Mother for to have it whole; and if the Womb were so little open, that he could not have liberty to work there, nor introduce any instrument into it, he had better wait a little, alwaies trying to dilate the Passages by Art, as we have formerly directed, than to cast her down almost in an instant, with such a blow of despair, as the making of this Cae∣sarean Operation, which for this reason is never to be undertaken, till immediatly after the Mothers death, when the Chirurgeon must be present for to act according to the following directions, as well in hopes of finding the Child living, as to obey an Ordinance which expresly forbids the bu∣rying a Woman with Child before it is taken out of her Belly. To accomplish which as it ought to be, when he perceives the Woman in the agony, he must quickly make ready all things necessary for his work, to lose no time, because delay will certainly be the death of the Infant, which else a Page 282 few moments before might have been brought alive: there are some, that when the Woman is just a dy∣ing, would have somewhat put between her Teeth to keep her Mouth open, and likewise in the out∣ward part of the Womb: to the end the Infant receiving by this means some little air and refresh∣ment, may not be so soon suffocated: but all this mystery will avail but little; because the Child lives only by the Mothers blood, whilst it is in the Womb; but if he will needs do so, it is rather to content the company, than out of any belief of the good it will do. Assoon then as the Woman hath breathed her last, and that she is dead (to which all the company must agree) he shall begin his Operation, which the Greeks call Embriulcie. Most Authors would have it made on the left side of the Belly, because it is more free from the Liver, which is on the right; but if my opinion may be authentick, it will be better and more skilfully made just in the middle of the Bel∣ly, between the two right Muscles; because in this place there is only the Coverings and the white Line to cut, when on the side it cannot be done without cutting the two oblique and cross Muscles, which being couched one under the other, makes a considerable thickness, besides that it bleeds more than towards the middle of the Belly; not that the loss of blood is of any moment (which will flow when the Woman is but just dead) but because it hinders by its flowing, the seeing distinctly how to make the Operation as it should be. To dis∣patch then with more ease and speed, the Chirur∣geon having placed the dead Body that the Belly may be a little raised, let him take a good sharp Page 283 incision Knife, very sharp of one side, like that marked E in the table of Instruments at the end of this Chap. with which he must quickly make, at one stroak, or at two or three at most (if he will for the greater surety) an incision just in the middle of the Belly, between the two right Muscles unto the Peritoneum, of the length and extent of the Womb or thereabouts; after that he must only pierce the Peritoneum with the point of his Instrument, to make an orifice for one or two of the Fingers of his left Hand, into which he must immediatly thrust them, for to cut it (lifting it up with them, and conducting the instrument for fear of pricking the Guts) in proportion to the first incision of the* Coverings, which having done, the Womb will soon appear, in which he must make an incision in the same manner as he did in the Peritoneum; being careful not to thrust his instrument at once too far in, thinking to find the Womb a finger or two thick, as all Authors affirm contrary to truth, in which he would be deceived, as those are that ne∣ver well considered it; for it is very certain, that at the time of Labour, whilst it contains the Child and Waters in it, it is not above a single line thick; or the thickness of half a Crown, although they have all sang to us, that by divine Providence and a Miracle, the more 'tis extended with the Child, the thicker it grows, which is absolutely false; it being only true, that it is at that time a little thicker at the place where the Burthen cleaves, where its substance is then as it were spongious; but every where else it is very thin, and becomes the more so by how much it is more extended, un∣til Page 284 being emptied by the Birth of the Child, it be∣gins to grow thicker in contracting and gathering to it self all its substance, which was before very much extended. It being just like the Bladder which being full is very thin, and being empty ap∣pears to us of half a Fingers thickness, which filling again waxeth thinner in proportion to the Urine that flows to it: having then so opened the Womb, he must likewise make an incision in the Infants Membranes, taking care not to wound it with the instrument, and then he will soon see it, and must immediatly take it out with the Burthen, which he must nimbly separate from the bottom of the Womb; and finding it to be yet living, let him praise God for having so blessed and prospered his Operation. But the Children so delivered in these cases are usually so weak, (if not quite dead, as it often hap∣pens) that 'tis hard to know, whether 'tis alive or dead. Yet one may be confident the Child is living, if by touching the Navelstring the Umbili∣cal Arteries are perceived to move, as also the Heart, by laying the Hand on the Breast; and if it prove so, means must be used to fetch it to it self, spout∣ing some Wine in the Nose and Mouth, warming it until it begins to stir of it self. Midwives usually lay the Burthen very hot on the Belly of such weak Children; if that helps, 'tis rather because of the temperate heat of it, than for any other cause: for 'tis impossible the Infant should receive any spirits from it, after it is once separated from the Womb, and yet less when the Woman is dead. As to the heat of it, it can no wise hurt, but the weight of this mass layed on the Belly, may rather Page 285 choak it, by the compression it makes, than do it any good; besides, when the Burthen is grown cold, they put it in a Skellet of hot Wine, from whence they think the Spirits renew, which being conveyed through the String into the Childs Belly, gives it new force: but as I have said already, that is very useless, and the best and speediest remedy is immediatly to separate it, and open the Childs Mouth, cleaning and unstopping also the Nose, if there be any filth, to help it so to breath freely, keeping it all the while near the Fire, until it hath a little recovered its weakness, spouting some Wine into the Nose and Mouth of it, that he may a little tast and scent it, which can not hurt it in this juncture, if one observes some moderation in the thing. Having now at large treated in this Second Book as well of natural as unnatural Labours, and given sufficient instructions to a Chirurgeon to enable him to help Women in the first, and to re∣medy all the different accidents of the latter, to which he may be dayly called, there rests nothing now to finish it, but to represent the Instruments proper to this Art. And then we will pass to the Third Book, where we must handle many things, which they must necessarily know that intend to practise Deliveries. Explication of the Instruments. A, A Crochet or Hook to draw forth a dead Child. B, Another Crochet for the same purpose, according as the case requires, either bigger or less; both Page 286 of them must be strong enough, and very smooth and equal, that the Womb may not be hurt in the Operation, and above ten large Inches long, or thereabouts, and their Handles must be of a mo∣derate bigness, for the firmer holding of them. C, A crooked Knife, equal in length to the Cro∣chets, fit for the separating a monstrous Child, or piercing of the Belly of an hydropical Infant, or opening the Head to empty the Brains, or to divide it in pieces, when because of its bigness or mon∣strousness, it remaines behind in the Womb, sepa∣rated from the Infants Body. D. Another small crooked Knife for the same pur∣pose, but not so convenient, because it cannot be guided but with one Hand. E. A sharp Incision-knife fit for the Caesarean Secti∣on, soon after the Mothers death. F, A Cranes bill, fitted for the drawing forth of the Womb any strange Body, or false Conception, when the whole Hand cannot be introduced. G, Another Instrument for the same purpose. H, A Speculum Matricis with three branches to open the Womb, for to discover Ulcers or other Mala∣dies, sometimes there deeply scituated. I, Another of two Branches, for the same purpose. K, Another yet more commodious. L, A Catheter to let out the Urine, when the Woman cannot make Water. M, A Syringè for injections into the Womb. End of the Second Book. Page 287 The Third Book. Treating of Women in Child bed, and of the Diseases and Symptomes befalling them at that time; Of Children new born, and their ordinary Distempers, together with neces∣sary directions for to choose a Nurse. GOing with Child is an rough Sea, on which a big-bellyed Woman and her In∣fant floats the space of nine Months: And Labour, which is the only Port, is so full of dangerous Rocks, that very often both the one and the other, after they are arrived and disem∣barked, have yet need of much help to defend them against divers inconveniences, that usually follow the Pains and Travail they have undergone in it. We have directed in the First Book, treating of the Diseases which are incident to Women with Child, how to prevent their suffering shipwrack in this Sea during so long a Voyage. In the Second we have taught, how they may enter this Port, and disimbarque there with safety by Delivery: It remains then to compleat our work, that we ex∣pound in this Third and last, how the Mother and Child must afterwards be ordered, and declare how at this time to prevent and remedy divers In∣dispositions Page 288 which often happen to them both. Let us first consider those that arrive to a Woman new layd, and then we shall pass to those that regard a new-born Infant. CHAP. I. What is fit to be done to a Woman new-laid, and naturally delivered. IMmediatly after the Woman is delivered, and the Burthen come away, care must be taken that the loosening of it be not followed with a Flood∣ing, which if it be not, a soft Closure to the Womb must immediatly be applied, five or six double, to prevent the cold Air by entring in, from sudden stopping the Vessels, by which the Woman should cleanse by degrees, whereby there would certainly happen many ill accidents, as great Pains and Gripes of the Belly, Inflammation of the Womb, and divers others which we shall mention hereafter particularly, and which may easily be the cause of her death. When the Womb is so closed, if the Woman was not delivered upon her ordinary Bed, let her be presently carried into it by some strong body, or more if there be need, rather than to let her walk thither; which Bed must be first ready warmed and prepared as is requisite, because of the cleansings; but if she were delivered on it (which is best and safest to prevent the danger and trouble Page 289 of carrying her to it) then all the soul linnen and other things put there for the receiving the Blood, Waters, and other Filth which comes away in Labour, must be presently removed, and she must be placed conveniently in it for her ease and rest, which she much wants, to recover her of the Pains and Labour she endured during her Travail; that is, with her Head and Body a little raised, for to breath the freer and cleanse the better, especially of that Blood which then comes away, that so it may not clod, which being retained causes very great Pains. All this will happen, if they have not liberty to come freely by this convenient scituation, in which she must put down her Legs and Thighs close together, having a small Pillow (for her greater ease if she desire it) under her Hams, upon which they may rest a little: being so put to Bed, let her lye neither of one side nor the other, but just on the middle of her back, that so the Womb may repossess its natural and proper place. It is an ordinary custom to give the Women, assoon as they are delivered, two Ounces of Oyl of sweet Almonds, drawn without fire, and as much Sy∣rup of Maiden-hair, mixed together, which is as well for to sweeten and temper the inside of the Throat, which was heated and hoarse by her con∣tinual Cries, and holding her Breath to bear down her Throws during her Labour, as also to the end that her Stomach and Intestines being lined with it, should not be so much afflicted with dolorous Gripes: But this Potion goes so much against the Stomachs of some Women, that being forced to take it with an aversion and disgust, it may do them rather more hurt, than any wise comfort Page 290 them. Wherefore let none have it but those that desire it, and have no aversion to it. I approve rather in this case of a good Broth to be given her, assoon as she is a little setled after the great com∣motion of Labour; because it will be both more pleasing and profitable than such a Potion. And, having thus accommodated her, and provided for her Belly, Breasts and lower parts, after the manner we shall direct in the next Chapter, leave her to rest and sleep if she can, making no noise, the Bed-curtains being close drawn, and the Doors and Windows of her Chamber shut, that so seeing no light, she may the sooner fall asleep. If she had endured a hard Labour, she must be then ordered as the case requires, and as shall be hereafter de∣clared: but what we have here directed, is only for a natural Labour, and where no extraordinary difficulty happens. CHAP. II. Of convenient Remedies for the lower parts of the Belly and Breasts of Women newly de∣livered. SInce the lower parts of a Woman are greatly di∣stended by the birth of an Infant, it is good to endeavour therefore the prevention of an in∣flammation there: wherefore assoon as the Bed is cleansed from the foul linnen and other impurities of the Labour, and that the Woman is therein Page 291 placed, according to the direction of the preceding Chapter, let there be outwardly applied all over the bottom of her Belly, and Privities, the follow∣ing Anodine Cataplasm, made of two Ounces of Oyl of sweet Almonds, with two or three new-laid Eggs, Yolks and Whites, stirring them toge∣ther in an earthen Pipkin over hot Embers, till it comes to the consistence of a Pultiss, which being spread upon a Cloth, must be applied to those parts, indifferently warm, having first taken away the Closures, which were put to her presently after her Delivery, and likewise such clods of Blood as were there left. This is a very temperate remedy, and fit to ap∣pease the Pains which Women ordinarily suffer in those parts, because of the violence then endured by the Infants Birth: it must lie on five or six Hours, and then be renewed a second time if there be occasion, afterwards make a Decoction of Barley, Linseed, and Chervil; or with Marsh∣mallows and Violet leaves, adding to a Pint of it, an ounce of Honey of Roses, with which, being luke warm, foment three or four times a day (for the first five or six days of Child-bed) the bearing-place, cleansing it very well from the Blood, Clods and other Excrements which are there em∣ptied. This Stupe is likewise very good to temper and appease the Pains of those parts. Some per∣sons only use to this purpose luke-warm Milk; and many Women, only Barley-water. Great care must be taken at the beginning that no stopping things be given to hinder the cleansings, but when ten or twelve days are past, and that she hath cleansed very sufficiently, Remedies may then be Page 292 used to fortifie the parts, to which purpose a De∣coction is very proper, made of Provence-Roses, Leaves and Roots of Plantane, and Smiths water that Iron is quenched in; and when she hath suf∣ficiently and fully done Cleansing, which is usually after the 18th or 20th day, there may be made for those that desire it, a very strong astringent Lotion, to fortifie and settle those parts, which have been much relaxed, as well by the great extension they received, as by the humours with which they have been so long time soaked. This Remedy may be composed with an Ounce and an half of Pome∣granate Peel, an Ounce of Cypress Nuts, half an Ounce of Acorns, an Ounce of Terra Sigillata, a Handful of Provence-Roses, and two drachms of Roch-Allum: all which being infused a whole night in five half Pints of strong red Wine, or (that it may not be too sharp) a quantity of Smiths water mixed with that Wine; afterwards boil it well to a Quart, then strain it, squeezing of it strongly, and with this Decoction foment those inferiour parts Nights and Mornings, to the end they may as much as possible be strengthened and confirmed: I say as much as possible; because there is no pro∣bability that they can ever be reduced to the same estate they were in before she had Children. So much for this: Wee'l now pass to convenient Reme∣dies for the Belly of a new-laid Woman. All Authors do appoint, immediatly after Deli∣very, the skin of a black Sheep slaid alive, for this purpose, to be laid all over her Belly, and to lie on four or five Hours; others will have a Hare-skin. Truly I believe that by reason of the natural heat of such Skins, the remedy is not bad: but I also fear Page 293 lest in some small time after it may do the Woman more hurt than good, and that by its Moistness, cooling of her, it may make her to shake, which would be very prejudicial in stopping her Cleansings, which ought to flow; besides it is a remedy or too much trouble; for there must always be a Butcher ready for every Woman that is laid, or some o∣ther person that can do it as readily, who must be for this purpose in the very Chamber, or at least in the House, that so they may have the Skin very hot according to directions. They likewise direct a small Plaister of Galba∣num, with a little Civet in the middle, to be ap∣plied to the Womans Navil, which as they imagine is very proper to keep the Womb in its place, be∣cause being delighted with that smell, it drawes neer to it of its self, but this remedy is a little* Supersti∣tious: wherefore I am not for it, it being sufficient to keep the Belly very warm, in the situation we have directed, and prevent the least cold. As for Swaths convenient to a Woman new laid, they need not be us'd the first day, or at least but very loosely, especially when there hath been a hard Labour; because the least compression of the Womans Belly, which is then very sore, as the Womb also is, having been much harrassed, proves a great incon∣veniency to her, wherefore let her not be swathed until the Second day, and that very gently at the beginning. Midwives believe that they serve in∣stead Page 294 of Boulster, as well for the keeping the Womb up in its place, as to squeeze out from all parts the Cleansings which are necessary to be eva∣cuated: And Nursekeepers, abused with this be∣lief, do sometimes swath their Bellies so strait, that they do bruise the Womb, which is very painful in the beginning of Child-bed, and from whence often follows very dangerous Inflamations. These Swaths and Boulsters can have no hold to support the Womb as they imagine, forasmuch as its* Fund, which is the principal part being flitting in the Ca∣vity of the†Hypogaster, cannot be kept stable and firm by that which is applied upon the Belly, and beside the interposition of the Bladder which is upon it, will not permit it. As to their opinion that such Swathings help to cleanse the Womb, 'tis fit they should be disabused of this Error; for it is not the same thing in these Cleansings, as pressing the juice out of boil'd meat in a Napkin, for these are wholly a work of Na∣ture which a strong compression (instead of help∣ing) hinders, by the pain it causes to the Womb, and the Inflamations that follow. Without dwel∣ling then upon the ordinary manner of Swathing, let us be guided according to the dictates of Reason, and not according to the Nurs-keepers naughty Customs, whose Method is first to put upon the Belly a Swath four or five double, of a triangular Figure, to support (as they pretend) the Womb, and sometimes two others Roulers very strait, on each side towards the Groine, to keep it in its place, lest it be shaken, and encline more to one side than Page 295 t'other, with yet another broad square Swath for the whole Belly, which they put upon the first, afterwards they make a Swath of a Napkin folded two or three double, of the breadth of a quarter of an Ell, with which they do very much girt and compress the Belly. I do very well approve of the use of these Swaths, and of a good large square Boulster over the whole Belly, provided they be very loose the first seven or eight daies, only to keep it a little steady, ob∣serving in the mean time to take it off, and remove it often, to anoint the Womans Belly all over (if it be sore, and that she have After-Pains) with Oile of sweet Almonds and St Johns Wort mixed together, which may be done every day: But after that time, they may by degrees begin to swath her straighter, to contract and gather together the parts, which were greatly extended during her go∣ing with Child, which may be then very safely done; because the Womb by those former clean∣sings is so diminished and lessened, that it cannot be too much compressed by the Swaths. Let us now see what is fit to be done to the Breasts. Proper Remedies may be applied to them, for to drive back the Milk, if the Woman will not be a Nurse, of which we shall speak hereafter; but if she intends to be a Nurse, 'twill be sufficient to keep her Breasts very close, and well covered with gentle and soft Clothes, for to keep them warm, lest the Milk curdle in them; and if there be dan∣ger of too much Blood being carried thither, anoint the Breasts with Oile of Roses, and a little Vine∣gar beat together, and put upon them some fine Linnen dipt in it, observing that if the Woman Page 296 do suckle her Child, she gives it not the Breast the same day she is brought to Bed, because then all her Humours are extremely moved with the Pains and agitation of the Labour; wherefore let her defer it at least till next day, and it would be yet better to stay four or five days, or longer, to the end the fury of the Milk and the abundance of humours, which flow to the Breasts in the begin∣ing, may be spent, in which time another Woman may give it suck. Let us now discourse of a fit Diet for the Woman to keep, during her whole Child-bed. CHAP. III. What Diet a Woman in Child-bed ought to observe during the whole time of her lying-in, when it is accompanied with no ill accident. ALthough a Woman be naturally delivered, yet notwithstanding she must observe a good Diet, to prevent many ill accidents, which may happen to her during her Child-bed; at the be∣gining of which she must be directed in her Meat and Drink, almost as if she had a Fever, that so it may be prevented, inasmuch as she is then very subject to it; so likewise it often happens to her by the least neglect committed towards her in her tending. For this Reason one must not be of the opinion Page 297 of many Nurse-keepers, who will have a new-laid Woman to be well fed, as well to restore her lost strength, by the tediousness of the Labour, and by the quantity of Blood then evacuating, for which cause they believe the Woman must be well nou∣rished to make more Blood, as also to fill up her Belly, which is very much emptied by the Birth of the Child: but it is much better to follow in this the counsel which Hippocrates gives us in his Tenth Aphorism of the Second Book, where he saies, Impura corpora quo plus nutriveris, eo magis laese∣ris; The more you nourish impure Bodies, the more you hurt them. Now it is certain that a Woman newly delivered is of this sort, as you may know by the quantity of Cleansings and Super∣fluities which flow from her Womb at this time, when for this reason they must be very regular in their Diet, especially the three or four first daies, in which time she must be nourished only with good Broaths, new laid Eggs, and Jellies, with∣out using at the beginning more solid Meats; but when the great abundance of her Milk is a little past, she may with more safety eat a little Broath at her Dinner, or a small piece of boil'd Chicken, or Mutton, as she likes best; afterwards, if no ac∣cident happens, they may by degrees nourish her more plentifully, provided in the mean time, that it be a third part less than she was accustomed to take in her perfect Health, and that her Food be of good and easie digestion; not suffering her to eat any of those Cakes, Tarts, or other Pastries, which are usually provided at the Childs Baptism. As for her Drink, let it be Ptysan, [which is Liquorish, Figs and Aniseeds boiled in Water] or at least boil'd Page 298 Water, being careful not to give it her too cold; she may also (provided she be not Feaverish) drink a little white Wine, well mixed with Wa∣ter, but not till after the first Five or Six days. Although I prescribe this Rule in general for all those who are newly brought to Bed; yet there are some who must not observe it so exactly as laborious Women, who being of a very strong and rebust constitution, require a more plentiful feeding, to whom notwithstanding, if they do not change the quality, they must at least retrench the quan∣tity of their ordinary food, having alwaies respect to what every person accustom themselves to, which the same Hippocrates doth likewise teach us in the 17th Aphorism of the first Book, where he saith, Animadvertendi sunt quibus semel aut bis, & qui∣bus copiosior aut parcior aut per partes Cibus est offe∣rendus, dandum verò aliquid tempori, regioni, aerati, & consuetudini. Great care and notice must be taken to whom to give meat once only or twice; as also to whom to give more, or to whom less, or by little and little; but some allowance must be made in respect of Time, Countrey, Age and Custome. What we have already said shall suffice for direction in their Meat and Drink. The Child-bed Woman must likewise keep her self very quiet in her Bed, lying on her Back, with her Head a little raised, and not turning often from side to side, that so the Matrix may be the better setled in its first Scituation: she must free her self at that time from all care of business, leaving it to the management of some of her Kindred or Friends; let her talk as little as may be, and that with a low voice, and let no ill news be brought Page 299 to her, which may affect her; because all these things do cause so great a commotion or perturba∣tion of her Humours, that Nature not being able to overcome them, cannot make the necessary eva∣cuation of them, which hath been the death of many. The Citizens Wives have a very ill Custom, which they would do very well to refrain, that is, they cause their Children to be baptized the second or third day after their Labour; at which time all their Relations and Friends have a Colla∣tion in the Child-bed Room, with whom she is obliged to discourse, and make answers to the Gossips and all Comers a whole After-noon toge∣ther, with the usual Complements of those Cere∣monies, enough to distract her; and though there is scarce any of the Company which do not drink her Health, yet by the noise they make in her Ears, she loses it: besides all this, she is often constrained, out of respect, to forbear the use of her Bed-pan and other necessaries, which are very prejudicial to her: and this happens just at the time when she ought to have most rest; because about the third day the Milk flowes in greatest quantity to the Breasts; this is the reason why ordinarily the next day they have a very great Feaver. She ought alwaies to keep her Body open with Clysters, taking one once in two daies, which not only evacuate the gross Excrements, but also by drawing downwards cause her to cleanse the better. When she hath observed this Rule a fort∣night or three weeks, which is very near the time of having cleansed sufficiently, that those parts may be throughly cleansed before she goes abroad, and Page 300 begins upon a New score; let her take a gentle Purge made of Senna, Cassia, Syrup of Succory with Rhubarb, which is good to purge the Stomach and Bowels of those ill Humours, Nature could not evacuate by the Womb, as it did the other Super∣fluities; this Purge may be repeated if necessary: all which being done, and that no indisposition remain, she may bath once or twice, or to wash and cleanse her Body, and afterwards she may govern her self according to her former Custome. CHAP. IV. How to drive back the Milk in those Women who are not willing to give suck. THere are many Remedies used to this purpose, some of which hinder the afflux of humours to the Breast, and others dissipate and in part dissolve the Milk therein contained. Those which hinder the Humours from plenti∣fully flowing thither, are Oile of Roses well mixt with Vinegar, with which the Breasts are to be anointed all over; or Unguentum Populeum, with Ceratum refrigerans Galeni, equally mixt and ex∣tended upon a piece of Linnen, or gray Paper, and so applyed to the Breasts. Others use Linnen dipt in luke-warm Verjuce, in which a little Allom is dissolved, that so it may be more Astringent; and others lay to them the Lees of Red Wine alone, or mixt with Oyl of Roses. Page 301 Those Remedies which dissolve and dissipate the Milk from the Breast is a Cataplasme of the four* Branns, Honey and Saffron, boiled with the Decoction of Chervil or Sage. Others apply Honey only, and some others rub the Breast alone with Honey, and put upon it the Leaves of Red-Cab∣badg, the great Stalks first being taken away, and they a little deadned before the fire; this remedy doth very readily drive away the Milk. There are some which boil Sage and Box Leaves in Urine, with which they do foment the Breasts pretty warm, and lay a Cloth upon them dipt in it. But great care must be taken in the applica∣tion and change of these things, that the Woman catch not the least cold, as also that no Inflamma∣tion or Impostumation be caused, instead of driv∣ing back the Milk: Wherefore such Remedies are to be chosen as are restraining, repercussive, or re∣solving, according to the different dispositions re∣quired. I know some Women who hold it for a very great secret, and most certain and fit to drive the Milk effectually back; and that is to put on her Husbands shift yet warm, immediatly after he hath taken it off, and wear it until the Milk be gone: but in case the Milk doth in the mean time vanish, 'tis superstitious to believe that this Shirt is the cause of it, and that it can produce such an effect; it happens rather, because all the humours of the Body of their own accord taking another course than to the Breasts, do not daily flow in so great abundance to them: Wherefore in the use of Page 302 all these Remedies, the principal must not be for∣gotten, which is, to take care that they tend down∣wards, procuring to that purpose a good and ample evacuation of the*Lochia, which is much furthered by keeping the Belly open by Clysters provoking them, in doing whereof the Milk will soon va∣nish. All that we have said in the former Chapters of this Third Book, is only to be observed when the new-laid Woman hath no manner of Indisposition, for in case that any happen, she must be governed in another manner, and according as the Accidents require, of which we intend now to treat in the following Chapters. CHAP. V. Of several Diseases and Symptomes which happen to a Woman new laid, and first of Flooding. WE have elsewhere mentioned the Flooding which precedes Labour, and shewed the only means to remedy it, which is to deliver the Woman assoon as possible; let us now see what is fit to be done to that which happens immediatly, or in a little time after, proceeding from the late opening of the orifices of the Vessels of the Womb, by the loosening of the Secondine which cleaved to it: this Blood flowes then so much more abun∣dantly, Page 303 by how much it is subtiler and hotter, or by the agitation of a long and hard Labour, and besides when a Woman is Sanguine or Plethorick. This Accident may often happen by a too sud∣den or violent pulling away of the After-Burthen, and sometimes from some part of it being left be∣hind in the Womb, or else some false Conception; which then endeavouring to expel, it presses and forceth forth the Blood out of the Vessels newly opened, and sometimes a great Clod of Blood re∣maining in the bottom of the Womb will produce the same effect, which by reason of the distention it often causes, excites Pains like to those a Woman endures before Labour, and doth not cease tor∣menting her, until she hath voided it, and then she is at ease; but sometimes the Blood continuing still to flow, and remaining in the bottom of the Womb, becomes new Clods; which is the cause why the accident renews again as before, and con∣tinueth so by fits, in the intervals of which there comes away some Serosities of the Blood retained, which dissolves; and makes some persons, ignorant of the Art, to think that the Flux is stopt, although it still continues flowing within, where it stops only by some blood so coagulated; but when this Clod comes away the Flooding begins again, pure Blood and in great abundance. Flooding is a more dangerous Accident than any other which may happen to a Woman newly laid, and which dispatches her so soon, if it be in great quantity, that there is not often time to prevent it. Wherefore in this case convenient Remedies must be speedily applied, as well to stop it, as to turn it back from the places whence it flowes. Page 304 To which purpose 'tis fit to consider what causeth this Flooding, and if it be a false Conception, piece of the Burthen, or clodded Blood remaining behind, all diligence must be used to fetch them away, or to cause a speedy expulsion of them; but if when nothing remains behind in the Womb, the Blood doth notwithstanding continue to flow, you must bleed the Woman in the Arm, not so much thereby to empty the fulness, as to make di∣version; let her Body be laid equally flat, and not raised, that so the Blood may not be sent down to the lower parts; let her keep her self very quiet, without turning from side to side, that so the Humours may not be stirred, the upper part of her Belly must likewise not be swathed or boul∣stered, for such straitness augmens the evil; let her Chamber be kept a little cool, and let her not be too warm covered in her Bed, that so the flood∣ing through Heat may not be continued. All the world forbids Clysters in this case, lest, as they say, the humours be drawn down in great abun∣dance; but I have twice experimentally found the contrary, where great Floodings have been stopt by Clysters, of which I will give you a particular account, that so it may be useful on the like oc∣casion. I was three years since called to a Woman, who was surprized with a very great Flooding imme∣diatly after the Midwife had delivered her, which she had done with too much violence, as the good Woman assured me; who told me, She felt a very great pain at the instant she pull'd away the After∣birth, and that she perceived at the loosening of it a Crack: Now from the moment that she was so Page 305 delivered, she lost, for five or six daies continually, so great abundance of Blood, that I could scarce believe she could without dying, had I not seen it my self: during all this time they had to no pur∣pose used all the means they could imagine to stop this accident, and because with it she complained of great pains in her Belly, they gave her Anodine and cooling Clysters, for fear lest giving her others more strong, the Flooding would be more and more excited: She had taken so four or five Cly∣sters, which came away as they were given, with∣out any Excrement; which seeing, and judging that assuredly some gross Excrements (being re∣tained in the Intestines from before the time of her Labour, which could not be evacuated by these Anodine Clysters) did cause so great a Chollick, which she felt all over her Belly, which appeared puft up; I caused her to take one common and one pretty strong Clyster, contrary however to the opinion of most persons, who not knowing the cause of the distemper, bade me have a care lest it should, as they said, cause a greater Flooding; but the issue of it was quite otherwise than they expected; for the good Woman voided with this Clyster a Pan full of gross Excrements, which having staid there a long time, and being thereby hardened, had stopt the Passage of much Wind, which passed away at this time. Now the In∣testines full of this gross matter, being every mo∣ment agitated by this Wind, did likewise agitate and continually compress the Womb, by means of which the Flooding was always maintained, which did cease immediatly after this Chollck was dissipa∣ted by the evacuation of these Excrements; and Page 306 since that time being again called upon the like oc∣casion of loss of Blood, proceeding from the same cause, and having taken the same course, the issue of it was likewise the same. Wherefore if there be the least appearance of Excrements contained in the Intestines, make no scruple to give Clysters to evacuate them, forbearing in this case those that are Astringent, because they harden and retain yet more that which augments the distemper. But if notwithstanding all this the Blood flowes continually, then the last remedies must be tried, which is to lay the Woman upon fresh Straw, with a single Cloth upon it, and no Quilt, that so her Reins may not be heated, applying along her Loins Clothes wet in cool*Oxycrate, provided it be not in the Winter, for then it must be a little warmed: by this refreshing, the impetuosity of the Blood will be a little stop'd, and the heat of it qualified, as also by this means, that little of it which remains in the Womans bo∣dy shall be concentred towards the principal part; and to the end her Strength may be preserved, which is extreamly wasted by the evacuation of this treasure of Life, let her take every half hour a little good strong Broath, with a few Spoonfuls of Jelly, and between whiles the Yolk of a new-laid Egg, without giving her too much food at a time, because her Stomach cannot digest it; and let her drink be red Wine, with a little Water wherein Iron hath been quenched: but if notwithstanding all this the Blood continues flooding, then the Woman will have often Fainting-fits, and be in great danger of losing her life; because one cannot Page [unnumbered] Page [unnumbered] [illustration] Chap: VI. lib. 3. pag: 307. Page 307 apply in those places the Remedies fit for to stop the opening of the Vessels as we can in another. These three Figures represent several Pessaries fit for the supporting and keeping up of the Womb, that it may not fall out, as it doth in a bearing down. CHAP. VI. Of the bearing down, and falling out of the Womb and Fundament of a Woman new-laid. I Shall, the better to explain the thing, make two sorts of Bearings down or Relaxati∣ons, as also two sorts of Fallings forth, or Precipi∣tations of the Womb; all which differ but in the degree, according as they fall down more or less: for the Relaxation is when the Womb only bears down and comes not forth; and the Precipitation is, when it comes out of the Body. The first sort of Bearing down is that, in which the whole body of the Womb falls into the Vagina, in such manner, that putting up the Finger, one may feel the orifice very neer. The second sort of Bearing down is, when the Womb being yet lower, one can manifestly perceive this Orifice quite without. The Falling-out is also of two sorts; in the first the Womb comes quite forth, but is not tur∣ned inside out, nor can the inside of it be seen, but Page 308 only its Orifice, which appears at the end of a great fleshy mass, which makes the body of the Womb; and this is called Prolapsus Uteri, that is, A falling forth of the Womb. And the other falling out, of all is most dangerous, and is called Perversio, or turning inside out; for then it is not only fallen forth, but the bottom of it is turned quite out, that so you may perceive it all even, and without an Orifice; because it is so turned. The Womb turned on this fashion appears to be only a great piece of bloody flesh, (and almost like the*Scro∣tum) which hangs between the Womans Thighs; and that which is wonder∣ful in this case is, that the Infants house, which is the Womb, goes forth at the Gate, which is the inner Orifice. The Bearing down of the Womb proceeds either from a Relaxation or Ruption of the Ligaments. Women that have abundance of the Whites, are subject to these Relaxations, and the Ligaments are extended or broken by hard and violent La∣bour, as also by too frequent bearing of great and heavy Children, sometimes by a great Cough, by strong and frequent Sneezings, or having leaped or fallen from high places, by going in a Coach, Cart, on Hors-back, or in other rude and shaking Car∣riages; by having lifted up beyond their strength heavy burthens, by lifting up the Arms too much, and putting them over the Head; by a tedious loos∣ness, with great Pains and Needing; forasmuch as all these things do shake and extremely thrust the Womb downwards when it is with Child, and the Ligaments being by this means loosened or broken Page 309 cannot keep it up any longer, which is the cause that a bearing down doth easily follow the birth of a Child; but the most ordinary cause of these Bearings down, or fallings out of the Womb, is violent and hard Travails, which usually happens when a Child comes wrong, so that it cannot be born, and when it hath too big a Head, or when the inner Orifice is not dilated sufficiently for to give it passage at that time, for the Womb is then forced down with so much violence, and yet the Child cannot advance into the Passage, because the Ligaments are extremely rent or loosened, and like∣wise when the Secondine cleaving closely to the bottom of the Womb is pulled away of a sudden, or with too much violence, and much the sooner, if that putting up the Hand into it (as it is necessary when the String is broke) one takes hold and pulls the body of the Womb itself, instead of the After-birth. We have, in the 13th Chap. of the Second Book, given such directions as will prevent this mistake, and bring it away safely. A Woman troubled with this falling out of the Womb feels a great weight at the bottom of her Belly, with an extreme pain in her Reins and Loins towards the place where these Ligaments are fast∣ned, and a reddish bloody moisture is perceived to pass through this mass of Flesh which hangs be∣tween her Legs. A Relaxation may happen to all sorts of Women from any of the causes above mentioned; but a falling out but seldom, and a perfect Perversion never but upon a Delivery, or immediatly after; because then the inner Orifice is almost as wide as the bottom of it, which is not so at other times, when being closed, there is no pos∣sibility Page 310 for it to be thus turned inside out. I have shown in the 16th Chap. of the Second Book, how to prevent this Accident at the time of Labour in a Woman that is subject to it; to which place you may have recourse to avoid repetition. If a speedy remedy be applied to the Relaxation and falling out of the Womb, by reducing and remitting it into its natural place, a Cure may be easily expected; and so much the rather, by how much the Woman is young, and the Malady fresh: but if she be old, and this Disease be already of a long standing, she is so much the more incura∣ble. For the Cure of this distemper regard must be had to two things; the First is, to reduce the Womb into its natural place, and the Second is to strengthen it, and keep it there. For the execution of the first, which is to reduce it, if the Womb be quite out, or turned, the Woman must first of all be made to render her Urine, and a Clyster must be given her, if it be necessary, for to empty the gross Excrements that are in the Rectum, that so the reduction may be the easier performed; then place her on her Back, with her Hips raised a little higher than her Head, and then foment all that is fallen forth with a little Wine and Water luke-warm, and having taken a soft Rag, put it up into its proper place, thrusting it back, not all at once, but wagging it by little and little from side to side; and in case this be too painful, because it is already too big, and swelled, anoint it with Oile of sweet Almonds, for the more easie reduction of it, being careful assoon as it is reduced, to wipe off the Oile as much as may be, to Page 311 avoid a Relapse. But if notwithstanding all this the Womb cannot be put up, because it is very much enflamed and tumefied, which happens when it hath been a long time so, without the use of ne∣cessary means, during which time it is continually moistened with Urine and other Excrements, which contribute very much to its corruption; in this case there is great danger that it will gangrene, and be afterwards the death of the Woman. There have however some Women escaped this accident; Pareus recites the History of such an one, which Rousset doth also amongst his Caesarean-births; but this happens very rarely. As to the second part of this Cure which consists in the retention of the Womb in its place, and the strengthening of it so reduced, it will be done by a convenient scituation. Let the Woman for this purpose keep her self in Bed on her back, having her Hips a little raised, her Legs something crossed, and her Thighs joined together, to prevent the falling of it out again; but the best way is to put up a Pessary into the Neck of the Womb, for to keep it firm. There are two or three sorts made for this purpose, the several Figures of which are at the beginning of this Chapter. Some are round and a little longish, of the figure of an Egg, and of the length and bigness of the Neck of the Womb, where it must be left after that it is intro∣duced into it; but these are often subject to fall out again, and are not so useful and convenient as the other, which are made of a piece of Cork, that they may be light. They ought to be of a thick circular figure, like to a small wreath, and pierced with a pretty big hole in the middle, which serves Page 312 aswel for the lodging, supporting and receiving of the inner orifice of the Womb, as for the giving passage to the superfluous humours, which are thence evacuated. These kind of Pessaries must be covered with white Wax, that they may be more smooth and incapable of hurting the Woman that useth them: they must be pretty large, that they may be the easier kept when they are put up: they may also have a small String fastened to them, to pull them out at any time to clean: But this String is not so very necessary, because they may be easily enough taken out with one Finger: they may be made some of them exactly round, and others something of a square Figure or triangular: the corners must be rounded or blunted. These some∣times hold better, and fall not so easily forth as the round; but either the one or the other may be used, as shall be thought most fit. During the flowing of the Lochia from the Womb, nothing els must be used to strengthen, but only to keep it so in its natural place; for astrin∣gent Remedies proper for the prevention of the Re∣laxation of it will very much prejudice the Wo∣man, by stopping of these evacuations; and above all it must be observed in this distemper, that the Womans Belly be not strait swathed any more than for a stay only, in which many Midwives are de∣ceived, believing they keep it the better in its place by how much they swath the Belly the straiter, for by this strong compression of it they force the Womb yet more down. She must use the Bed∣pan in Bed, & lying along if possible when she goes to Stool, keeping her hand all the while on the bot∣tom of her Belly, to bear it up. But when the time of Page 313 her Purgations is fully over, and that she hath cleansed very well, astringent Injections may be then used without danger; respect must likewise be had to the whole habit of the Body, to dry up the humours by an universal course; and the Wo∣man must not rise out of her Bed in at least five or six Weeks time, that so the Womb and its Liga∣ments may be restored and fortified in their na∣tural Scituation. It happens also sometimes that by the great Throwes the Woman endures at her Labour, the Fundament falls quite out; in this case, if the Child be very forward in the Passage, 'twill be sufficient before this accident happens to hinder it if possible, persuading the Woman not to help her Throwes so strongly; but if it be already fallen down, they must stay till the Child be born ere it can be put up; for before that it will be difficult to do without much bruising the Intestine. Assoon then as the Woman is delivered, let it be reduced in the same manner as that of the Womb, after ha∣ving fomented, bathed and anointed it, if ne∣cessary, forbearing afterwards during her Child∣bed the giving of her Clysters, because the force she useth in rendring of them, will again cause the falling down of the Fundament. Page 314 CHAP. VII. Of the bruises and rents of the outward parts of the Womb caused by Labour. IT is no wonder that often, and especially in first Labours, there happens bruises amd rents in the lower parts of a Woman; the cause of which is easily known, if the bigness of the Childs Head be but considered, which must needs make a great distention of those strait parts, by passing and com∣ing forth of the Womb; which parts, being thereby extremely pressed against the hardness of the bones thar surround it, are easily bruised, and when they are not able to be sufficiently dilated, they must necessarily be torn asunder. Almost all Women in their first Labours do very much complain when the Child is in the Passage, that the Midwives prick and scratch those parts, and do believe that the hurts and bruises which are there, after Labour, do happen because the Mid∣wives handled them too roughly; but they are very much mistaken, for this comes because the Childs Head in passing makes a violent distention and separation of the four Caruncles and other ad∣jacent parts which are bruised, and sometimes rent by it; from hence spring the pains of which they then complain, as if they were pricked and scratched, whereof they are never after sensible in their following Labours, because those parts having once given way to an Infant, are ever after very Page 315 easily relaxed and extended, and every Travail with less Pain than other. These contusions and rents must never be ne∣glected, lest they degenerate into malignant Ulcers; for the Heat and Moisture of these parts, besides the filth which continually flows thence, doth easily contribute towards it, if convenient Remedies be not timely applyed: Wherefore assoon as a Woman is laid, if there be only simple Contusions and Exco∣riations, apply the Cataplasme formerly directed to those lower parts to ease pain, made of the Yolks and Whites of new-laid Eggs and Oyl of Roses seeth'd a little over warm Embers, continually stirring it till it be equally mixt, and then spread upon fine Cloth; it must be applyed very warm to the bearing-place for five or six hours; when, be∣ing taken away, lay some fine Rags dipt in Oyl of St Johns-wort on each side the bearing-place, and renewing them twice or thrice a day, foment these parts with Barley Water and Honey of Roses, to cleanse them from the Excrements which pass; and when the Woman makes Water, let them be de∣fended with fine Rags, to hinder the Urine from causing smarting and pain by touching them. Sometimes the Bruises are so great, that the Bearing-place is inflamed, and a very considerable Abscess follows, which I have met with; in which case it must be opened just below the swelling, in the most convenient place; and after the matter is evacuated, a Detersive Injection must be injected into the Cavity, with the same Fomentation above-mentioned; viz. Barley-water and Oyl of Roses, which may be a little heightned with Spirit of Wine, if there be any danger of Corruption, and Page 316 afterwards the Ulcer must be dressed according to Art. But sometimes it happens by an unlucky and de∣plorable accident, that the Perinaeum is rent, so that the Privity and Fundament is all in one; if it were so let alone without reunion, the Woman after∣wards happening to be with Child would indeed be delivered with more ease, and without danger of suffering the same again, as is usual when healed after such an accident; but likewise if it remains in this manner, 'tis so great an inconvenience, that her Ordure comes both waies. Wherefore having cleansed the Womb, from such Excrements as may be there, with red-Wine, let it be strongly stitched to∣gether with three or four stitches or more, accord∣ing to the length of the separation, and taking at each stitch good hold of the flesh, that so it may not break out, and then dress it with an aggluti∣native Balm, such as is Linimentum Arcei, or the like, clapping a Plaister on, and some linnen above it, to prevent as much as may be the falling of the Urine and other Excrements upon it; because their acrimony would make it smart, and put it to pain: and, that these parts may close together with more ease, let the Woman keep her Thighs close toge∣ther, without the least spreading, until the cure be perfected. But if afterwards she happen to be with Child, she will be obliged, to prevent the like mischief, to anoint those parts with emollient Oyls and Ointments; and when she is in Labour, she must forbear helping her Throws too strongly at once, but leave Nature to perform it by degrees, together with the help of a Midwife well instructed in her Art, who being warned by the first disgrace, Page 317 will do her best to avoid a second; for usually when these parts have been once rent, it is very difficult to prevent the like in the following Travail; be∣cause the Scar there made doth straighten the parts yet more; wherefore it were to be wished for greater security against the like accident, that the Woman should have no more Children. Now if by neglecting such a rent, the Lips of it be cicatriced, and that Cure be desired, you must with a good pair of Scissers cut off those Scars in the same manner as is done in a Hare-lip, and it must afterwards be drest accordingly, or as if it newly happened. CHAP. VIII. Of after-Pains which happen to a Woman new∣laid, and of their several causes. THe most common accident that usually trou∣bles most Women during their lying in, is after-Pains. We have formerly shewed how they are accu∣stomed to be prevented in giving the Woman im∣mediatly after she is laid two Ounces of Oyl of sweet Almonds, drawn without fire, with as much Syrup of Maiden-hair; but since notwithstanding this Remedy the Woman is much pained in her Belly, let us enquire what may be the cause of all these gripes, which are usually called without di∣stinction After-pains, and are sometimes felt about the Reins, Loins, and Groins, sometimes in the Page 318 Womb only, and sometimes about the Navel and all over the Belly, either continually, or by fits with some remission, in a certain place, or some∣times on one side and somtimes on another; all which reflections teach exactly their several cau∣ses, and accordingly the Remedies must be va∣ried. The Pains of the Belly for the most part proceed from one only of these four causes, or several of them together; the first is by Wind contained in the Bowels, by which they are easily filled after Labour, as well because they have more room to dilate then when the Child was in the Womb, by which they were comprest, as also because the nou∣rishment and matter contained as well in them as in the Stomach, have been so confused and agitated from side to side, during the pains of Labour, by the frequent Throws which alwaies much compress the Belly, that they could not be well digested, whence this wind is afterwards generated, and consequently the Gripes which the Woman feels running in her Belly from side to side, according as the Wind moves more or less, and sometimes al∣so towards the Womb, because of the compression and commotion which the Bowels make, being ex∣tremely thereby agitated. The Second Cause of these Gripes which torments the Woman as much as the former, is that which proceeds from some strange body resting in the Womb after Labour, which it endeavors to expel by continual Throws, and it is sometimes a false Con∣ception, or a piece of the Burthen, and very often clodded Blood which cause this torment, and never cease til what is so contained in the Womb be come Page 319 away, these Pain• are very like the same that a Woman endures before she is delivered, and are not abated by Clysters, as those are that proceed from Wind; but on the contrary are rather thereby ex∣cited and augmented. Thirdly, These Pains are often caused by the sudden suppression of the*Lo∣chia, which abundantly filling the whole substance of the Womb, causeth a great distention, and by its long stay an inflam∣mation, which is communicated by means of the Peri∣tonaeum to all the parts of the lower Belly, by eason whereof it swells, and is extended, and grows ex∣treamly hard, which accident continuing, very often kills the Woman in a short time after. The Fourth and last cause of these Pains, is the great extension of the Ligaments of the Womb, by reason of a hard Labour; here they remain more fixt about the Reins, Loins and Groins than any o∣ther part; because they are the places where these Ligaments are fastened, however these Pains do sometimes communicate themselves by continuity to the whole Womb, and the rather when it hath been bruised by a violent Labour. 'Tis commonly held, that a Woman is not trou∣bled with these Pains so much of her first Child, as of the following; but daily experience confirms us, that it happens indifferently, according as the present and various dispositions contribute to it, ei∣ther more or less, there being no certain rule in respect either to first or last Labours. All these Pains must be cured according to their several causes, and to prevent thoes which we say are excited by wind, give the Woman immediatly Page 320 after Delivery, Oyl of sweet Almonds, and Syrup of Maiden-hair mixt together; some do more esteem Oyl of Walnuts, provided it may be made of good Nuts, but this hath a worse taste than the other. This remedy serves to lenify and line the inside of the Intestines with its Unctuousness, by means whereof that which is contained within them pas∣seth away the easier; but, as we have said elsewhere, this mixture is so nauseous, that it doth often for that reason more hurt than good: wherefore I pre∣fer a good warm Broth for those who have an aver∣sion to the Oyl. Others give half a glass of good Hippocras, but that (in the condition the Woman is in) may do more hurt, by causing a Fever. Now for the better preventing these kind of Pains, let the Woman keep her Belly very hot, and be careful not to drink her Drink too cold; and if they tor∣ment her very much, hot Clothes from time to time must be laid on her Belly, or a Pan-cake fryed with Walnut-oyl may be applied to it, without swath∣ing her Belly too strait: And for the better evacu∣ating the wind out of the Intestines, give her a Clyster, which may be repeated as often as necessi∣ty requires: but if by this means the pains of the Belly are not appeased, 'tis certain they are main∣tained by some other cause. If it be known that some strange body is retained in the Womb, the expulsion of it must be procured, or it must be fetcht away by putting the Fingers into the Entry of it, according to the direction al∣ready given for the extracting of a false Conception; and if it be great Clods which (retained) do also cause these pains, they will not fail to cease assoon as they are fetcht away; but also the same accident Page 321 will soon return, if new Blood flowes into the ca∣vity of the Womb, and coagulates there again, as it often happens; for it cannot endure to keep any thing in its capacity after the Childs birth. If the Womans Cleansings be suddenly stopt, which a little before came down in great abun∣dance, you need not search for any other cause of the pains she endures; and the speediest remedy is to bring them down, which is effected by Clysters that draw downwards, by hot and aperitive Fo∣mentations to the bearing place, and by bleeding in the Foot, preceded by that of the Arm, if the case require it. As to the Pains the Woman feels in her Loins and Groins, which come by reason of the great distention, or in part ruption of the Ligaments of the Womb thereabouts fastened, rest alone, and a good scituation of the body, will be sufficient to for∣tifie and reunite them without greater Medicines, because they cannot be actually applied to the part affected, alwaies observing a good Diet; and not forgetting, in all these several sorts of pains, to pro∣vide for the natural evacuation of the Lochia, for 'tis one of the principal means to obtain a good issue. Page 322 CHAP. IX. Of the Lochia which flow from the Womb in Child-bed. Whence they come, and the Signs when they are good or bad. I Do not find that Authors have so sufficiently en∣quired into the cause of the Lochia which are evacuated in Child-bed, as to make us truly un∣derstand what they are, either in respect of their Nature, affirming it to be the blood usually purged away every Moneth before they were with Child, which being collected about the Womb, flowes away when it opens after the birth of the Child; or in respect of the quantity of this evacuation, and the length of time it ought to continue. Hip∣pocrates in his Book, De Naturâ Pueri, would have at the beginning an Hemine and an half a day; of which measure, though common in his time, we have no certain knowledg; for some will have it to be our half Pint, others a Pint or therebouts, and that they continue for a Male-child thirty daies, for a Female fourty, diminishing every day by little and little, until there comes no more, and the evacu∣ation is compleated. Galen saies that these Lochia are only vitious humours, and the residue & super∣fluity of the Blood with which the Child was nou∣risshed in the Mothers Womb. But I will, as near Page 323 as I can, here describe to you the manner how I conceive this evacuation to be made, and the rea∣son why they diminish day by day, and change their colour, consistence and quality according to the several times. Assoon as the Child is born, there flowes away from the Womb, at the same moment, some wa∣terish humours, besides those which came away be∣fore at the breaking of the Membranes. These Waters then are very often bloody, not that they are so by Nature, but because there is for the most part Blood mixed with them, which comming from the Vessels of the Womb, because of the agi∣tation and commotion they received in the Birth, become so reddish; but immediatly after the Bur∣then is compleatly loosened, then pure blood flows away; and the reason why these Lochia flow freely and are very red the first day, is, because the Vessels against which the Burthen was fastened in the Womb are but newly opened; but the Blood flowing by little and little in less abundance, be∣cause the greatest plenitude hath been at first eva∣cuated, doth clod in small drops on the extremitie; of all those Vessels whereby they are stop'd, and then there comes away onely the most serose part of it; and therefore the Lochia begin the second and third day to be more pale and less coloured, and after that the colour of them is less bloody every day, as the Vessels close, until they are at length very pale; which happens when the Vessels being almost per∣fectly reunited, there distills only the meer moi∣sture of them, as also of the whole substance of the Womb, through which a quantity of it doth Page 324 likewise transude. Now these serose Humidities acquire by the heat of these places a consistence somewhat thick, and that more or less, according as they come away in greater or lesser quantity, and according to the length of time they stay there. And then the Lochia do almost resemble, in colour and consistence, troubled Milk, which makes the World believe it is Breast Milk which is in that manner emptied downwards; but in truth it is an Abuse as great as common. For my part I know no other cause of this ordi∣nary change of the colour and consistence of the Lochia, nor of the diminution of their quantity, than that which we daily find in the Suppuration of a great wound somewhat incarnated: for assoon as the wound is first made, it bleeds, fresh, and in good large quantity, because the Vessels are then open; but a little after, during the first and second daies, it yields only bloody Serosities; forasmuch as some small portions of the Blood being clodded about the mouths of the Vessels do in part stop them, and afterwards stopping them more, it yeilds a white*Pus, which proceeding from the moisture, sweats through the substance of the flesh, and of these Vessels which have been but newly closed, acquires a thick and whitish consistence by the heat of the part, and the stay it makes there. Now the better to conceive this by a comparison, you must imagine that there is a kind of a wound made by the loosen∣ing of the Burthen from the Womb, by reason of which there happens, if it may be so said, a kind of Suppuration, the Pus, and excretions of which are the Lochia. Page 325 They which believe that when the Lochia ar• pale, it is the Milk of the Breasts which flowes by the Womb, judge so, because the Milk usually abates in proportion to this evacuation, and say be∣sides, that by the Colour and Consistency it must needs be Milk: but if they were acquainted with Anatomy, they would know that there was no passage which hath to this purpose a communication from the Breasts to the Womb, unless they think it is done by the means of this imaginary*Anastomosis of the†Mamillary Veins with the*Epigastrick; which cannot possibly be, because neither of them have any tendency either to the Breasts or the Womb, as Anatomy makes manifest; for the Ma∣millar comes from the Sub∣clavicular under the Sternum without yielding any sign to the Breasts, nor so much as touching them, and the Epigastrick ariseth from the Iliacks, without having the least communication with the Womb. Laurentius, who knew very well it was for this reason impossible Milk should pass from the Breasts to the Womb by this passage, finds out another way, which is as far from the truth as the first. His opinion (as he saith) is that the Milk and Blood flow back from the Veins of the Thorax, which bedew the Breast to the Axillary Veins, and from thence to the Trunk of the Vena-cava, by the con∣tinuity of which they flow down into the Hypoga∣strick Branch, and from thence finally into the Page 326 Womb: but besides, that it would be very diffi∣cult for the Milk, after so long a way to come forth, without being perfectly mixed with Blood; the Circulation of the Blood, which he knew not, shewes us plainly that it is impossible, because it doth mount back by the lower parts of the Body from the Vena cava to the Heart, without a possi∣bility of carrying any thing into the Womb; whence it appears that he is as far as others from informing us how it can be done. For my part I believe with much more reason, and I think that it is not Breast milk which is thus evacuated by the Lochia, but this abundance and superfluous humidity which distills from and tran∣sudes the Vessels and substance of the Womb, as I have explained, by means of which the whole ha∣bit of body being much emptied, there remains not sufficient to be carried to the Breasts, and little or none flowing to them; that which is contained in them is dissipated by transpiration, and digested by the natural heat of the parts: Now the Milk by this evacuation is dried up, just as we see a Pond is that one would drain, out of which it is not ab∣solutely necessary to let the water run which fills it, but it sufficeth to turn back the stream that feeds it to another place, which being done, and no more new water falling into the Pond, it will soon be dried up; as well because the water is dissipated in Vapours, as drunk in by the Earth which contains it. And for the same reason when we see Milch∣nurses want their ordinary courses, it is because that all the redundant humours in their body be∣ing sent to the Breasts, and emptied by the sucking of the Infant, there remains no superfluities for Page 327 matter for the Terms: and for this cause it is not necessary that the Menstrual blood should be car∣ried from the Womb to the Breast, for Nurses Milk to be made of it, but it is enough that the humours flow towards them, without going at all to the Womb; so likewise it is not necessary the Breast Milk should be sent to the Womb, to be evacuated with the Lochia, it being sufficient that the humours are drawn towards it without going to the Breasts. We must not think, as some imagine, that the Blood flowing after Labour is bad and corrupted, and the reliques of that good which the Infant hath taken for his Nourishment, nor that it hath re∣mained in and about those places during the whole time of being with Child; for this Blood coming immediatly out of the Vessels, opened by the sepa∣ration of the Burthen from the Womb, is the very same with all the rest of the body, in which im∣mediatly after Labour no great change is observed, unless it be by so much alteration as the disposition of the place from whence it proceeds may cause, and according as it flowes abundantly or slowly, and as it is mixt with other impurities which are emptied at that time, or that it makes some stay in the Womb after it is out of the Vessels: and if it had so staid in and about the Womb, as some would have it, without Circulation during the whole time of Pregnancy, 'tis most certain it would have putrified; even as we see the water of a Lake, for want of Agitation and Motion is infected and cor∣rupted; but there is no other superfluity nor re∣lique of the Childs nourishment, but the gross blood with which the whole mass of the Secondine is re∣plenished. Page 328 After having considered the nature and quality of these evacuations, we say that for their quantity and time of continuance there is no certain and particular Rule; for some Women have many a long time, and others but few and of a short continuance, which usually happens accord∣ing to the Season, Country and Age, according to the Temperament more or less Hot, or Moist, the Habit more or less replete, and according to the Vessels remaining a long or a short time open. But in general this Evacuation is for the most part finished in fifteen or twenty days, and sooner or later according to the circumstances lately men∣tioned, and indifferently the same to a Woman delivered of a Boy or a Girl; during which time the Lochia diminish in quantity from day to day, until they totally cease at the end of the same; afterwards the parts remain yet somewhat moist, without any manifest evacuation, except in Women subject to the Whites. This discourse must be understood of Labours at full time; for after a Mischance, the less the Foetus is, and the less time the Woman is gone with Child, the less ordinarily are her Evacuations. The Signs when the Lochia are good and com∣mendable, are, that they be fresh the three or four first days, and that they lose this bloody tincture by degrees, and become pale, that they be of an equal consistence without any curdled or clotted Blood, that they have no ill Scent, that they be without Acrimony, and that they flow in a mode∣rate quantity. We say that they must not be fresh but the four first days, because they will not be else the true Page 229 Lochia, but a pure flux of Blood, which will be very dangerous; and that they must lose by de∣grees this reddish colour to become pale; this sign teacheth us; that the Vessels which have been open∣ed are by degrees closed again; that they be of an equal consistence without curdled or clodded Blood: by this means we are assured that there is no mixture of any strange matter, and that they are governed and regulated by Nature, they must have no Foetor, or ill scent, and be without Acri∣mony; in this case we know that there is no dan∣ger of corruption or inflammation in the Womb; they must flow in a moderate quantity, that so the superfluous humours may be evacvated: for if the Lochia flow in so great an abundance as to cause Fainting or Convulsions, the Woman will be in danger of death, as Hippocrates in the six and fiftieth Aphorism of his Fifth Book assures us; Si Muliebri profluvio convulsio & animi defectus superveniunt malo est: "If, saies he, Faintings and Convulsions follow the Lochia, it is dangerous: and he adds in the following Aphorism; Menstruis abundanti∣bus Morbi eveniunt, & subsistentibus accidunt ab utero Morbi: If the Courses or Lochia flow too much, Diseases follow, and if they stop, Diseases happen from the Womb. Diseases proceeding from too great abundance of the Lochia are, as we have said in the first Apho∣rism, Convulsions and Syncopes, or Faintings; and if they do not kill the Woman, they weaken her very much; she grows lean, she remains a long time pale, her Legs and Thighs swell, and after∣wards she becomes Hydropick. As to the distempers which follow the suppres∣sion Page 330 of the Lochia, we will mention them in the next Chapter. CHAP. X. Of the suppression of the Lochia, and the Ac∣cidents which follow thereupon. THere is so great a flux of Humours from all parts to the Womb, when a Woman is with Child, and during the commotion in her Labour, that in case there be not afterwards sufficient evacua∣tion of them, the Woman is in great danger of very ill Accidents, and sometimes of death it self; because these humours, corrupting by their stay there, will certainly cause a great inflammation; and this is the reason why the suppression of the Lochia is one of the worst and most dangerous Symptoms which can befall a Woman after Deli∣very, especially if they happen to be totally and suddenly stopt, the first three or four days, which is the time when they should come down plentifully; for then follows an acute Fever, great pains in the Head, pains in the Breast, Reins, and Loins, suffocation of the Mother, and an Inflammation which is suddenly communicated all over the lower Belly, which becomes very much swelled and blown up; there happens also a great difficulty of Breathing, Choakings, Palpitations of the Heart, Syncopes and Faintness, Convulsions, and often Death if the suppression continue; or if the Wo∣man escapes it, she is in danger of an Abscess in Page 331 the Womb; yea, and afterwards a Cancer: or there may happen great Imposthumes in the lower Belly, which is usual, because of the nearness of the place; as also Gouts, Sciaticas and Lameness, or Inflammation or Abscess in the Breast, if the Hu∣mours be carried towards those parts. The C•uses of the stoppage of the Lochia proceed either from a great Loofness, because a great Evacu∣ation that way, turns the Lochia, and makes them stop; or any strong Passions of the Mind, as great Fear, or Grief, or any Anger, or Soundings, for these things do cause the humours to retire sudden∣ly inwards, and by this quick motion they often cause Suffocations. Great Cold stops the Lochia, because it closes the Vessels and Pores of the Womb: the use of astringent Remedies produces the same effect, as also cold Drink; because by condensing and thickning the humours, they hinder their easie flowing; strong and frequent agitations of the Body, by rarifying and dispersing them throughout every part, doth likewise not permit them to be e∣vacuated by the Womb. To bring the Lochia well down, let the Wo∣man avoid all perturbations of spirit which may stop them; let her lye in Bed with her Head and Breast a little raised, keeping her self very quiet, that so the Humours may be the easier carried down∣wards by their natural tendency; let her observe a a good Diet, somewhat hot and moist; let her rather use boiled Meats than roast: and if she be any thing feaverish, let her use Broaths only with a little Jelly; let her avoid all binding things; let her Ptysan be made with Aperitives, such as are the Roots of Succory, Dogs-grass and Asparagus with a Page 332 little Aniseed and Hops, and every other time let her take a little Syrup of Maiden-hair in a glass of this Ptysan; and above all let her carefully shun cold Drink: Clysters may likewise be given her to draw the Humours downwards; and her lower parts may be fomented with an emollient and aperi∣tive Decoction made with Mallows, Marshmallows, Pellitory of the wall, Camomil, Melilot, the roots of Asparagus and Linseed; with which Decoction the Womb may likewise be injected, and with the Herbs, being well boiled and strained through a very course Cloth, let a Cataplasme be made with the addition of Oyl of Lillies, or Hogs-grease, and applyed very hot to the lower Belly: together with these let her Thighs and Legs be strongly rub'd downwards, bathing them very hot with the same Emollient Decoction; there may be likewise apply∣ed large Cupping-glasses to the uppermost part of the inside of her Thighs. It would not be much a∣miss to use an Aromatick Perfume, if it were not that it caused a heaviness of the Head, as Hippo∣crates notes in the 28th Aphorism of the Fifth Book, where he saith; Sufficus Aromatum muliebria edu∣cit: saepius verò & ad alia utilis esset, nisi Caepitis induceret gravitatem. Now whilst all these things are put in practice, bleeding in the Foot or Arm must not be forgot, according as the accidents caused by this suppression of the Lochia require: neither must we blindly follow the opinion of many Women, who believe that bleeding in the Arm in this case is very per∣nicious. This Imagination is so firmly rooted in the heads of almost all of them, that if in case a Child-bed Page 333 Woman happens to dye after bleeding in the Arm, they sail not absolutely to condemn that as the cause: But this their opinion is not according to knowledg, for sometimes Bleeding in the Arm is better than in the Foot; and at other times that in the Foot is more certain than bleeding in the Arm: As for example, suppose a Woman be very full of Humours throughout the whole habit of her Body, and her Lochia be supprest, by reason of which there happens an Inflammation in her Womb, and be∣sides a great Fever and difficulty of Breathing as it ordinarily arrives in these Cases. 'Tis most certain that if she were immediatly blooded in the Foot, being very Plethorick as we have supposed, there would be so great abundance of Humours drawn down into the Womb, that the Inflammation would be thereby much augmented, and consequently all the Accidents of the Distemper; but 't would be much better in this case rather to alter the Habit, first by bleeding in the Arm, and afterwards the most pressing Accident being partly diminished, it will be very much to the purpose to bleed in the Foot: for by this means Nature (which was almost overcome under the burthen of these redundant humours) being eased of some part of them, doth the more easily command and govern the rest: but on the other side, if there be a stop∣page without the appearance of a great plenitude in the Body, and without any notable accident, Bleeding in the Foot, if it be desired, may be then presently put in practice. However I think it most convenient that it should* alwaies be preceded with bleeding in one of the Arms. Page 334 CHAP. XI. Of the Inflammation which happens to the Womb after Delivery. VEry often the stopping of the Lochia, (of which we have lately discoursed, and especially at the beginning of Child-bed) doth cause an inflam∣mation to the Womb, which is a very dangerous Disease, and the death of most of the Women to whom it happens. It is also very often caused from some hurt or bruise of the Womb by any Blow or Fall, and e∣specially for having been too rudely handled in a bad and violent Labour; or by the falling out of the Womb after Labour; or else because of some false Conception, or other strange Body remaining be∣hind in it, which corrupts there; and likewise because it might have been too much compressed in the beginning of the Labour by the great Swathes and Napkins wherewith the Midwives and Nurs-keepers usually swathe the Belly of a new-laid Wo∣man, to keep it (as they say) in its place: which happens also very often when the Blood being stir∣red and over-heated by the agitation of a rude Travail, is carried thither in too great abundance, and there stays without evacuation. An Inflammation of the Womb may be known by being much more swelled after Labour than is requisite, and when the Woman feels very great heaviness in the bottom of her Belly, and that it Page 335 is swelled, and blown up almost as big as before De∣livery; if she have a difficulty in making Water and going to Stool; or that she perceives her pain aug∣ment when she is voiding her Excrements, because the Womb presses the right Gut upon which it is placed, and to which by its proximity it commu∣nicates the Inflammation, as well as to the Bladder; she hath then also, besides a great Fever with a very great difficulty of Breathing, a Hiccough, Vomi∣ting, Convulsions, and in the end Death, if the Disease be not soon cured. A Woman that hath received a bruise or any violent compression of the Womb, is in great danger, that after the Inflamma∣tion, if she do no die of it, an Abscess will be there made, or that there will remain some Scir∣rhous Tumour, and it may be an incurable Cancer, which will make her lead a miserable and langui∣shing life the rest of her daies. Wherefore assoon as an Inflammation is per∣ceived, the Cure of it must be endeavoured, by tempering the heat of the humours, and turning and emptying the superfluities of them assoon as may be, first extracting or procuring the expulsion of such strange things as may remain in the Womb after Labour, according to the directions given in its proper place, and above all treating her at this time with very great tenderness, using not the least violence, for fear the evil may be thereby augmen∣ted. The Humours may be tempered by a cooling Diet, using food that nourishes little, wherefore let her be contented with only Broath for her nourish∣ment made of Veal or Pullet, but not too strong of the Flesh, together with cooling Herbs, such as Page 336 Lettice, Purslane, Succory, Borrage, Sorrel and the like; let her abstain from Wine, and drink Ptysan made of the roots of Succory and Dogs-grass, Barley, and Liquorish; let her keep her self very quiet in her bed; let her not be swathed too strait, and let her body be kept open with simple Anodine Clysters; because if there be any Acrimony in the humours they will cause Throwes, which extream∣ly pains the inflamed Womb; and amongst all the passions of her mind let her especially avoid An∣ger. The redundancy of Humours may be evacuated and diverted by Bleeding, which at first must be in the Arm, and not in the Foot, for the reasons given in the foregoing Chapter, reiterating it without loss of much time, for the accident is very pressing, until that the greatest part of the plenitude be a little evacuated, and the Inflammation something diminished, and then bleeding in the Foot will not be amiss, if the case require it. It may be convenient to anoint the Belly with Ʋnguentum refrigerans Galeni, or Oyl of Roses, or Oyl of sweet Almonds mixt with a little Vinegar. Injections may likewise be given into the Womb, provided they be not Restringent, lest making a greater stoppage of the Lochia, which alwaies flow a little in this case, the distemper be not augmented; for which reason let temperate Medicines be only used, without any manner of astriction, as Barley water with Oyle of Violets, or luke-warm Milk. Sometimes an Inflammation of the Womb con∣verts into an Aposthume, which yeilds a great quantity of matter; there is then much danger of corruption in that part, as well by reason of its Page 337 Heat and Moisture, which are the principals of it' as because no proper Remedies can be applied, or easily kept to it; since therefore nothing else can be done, we must be contented with an universal Re∣gimen and Detersive Injections to cleanse off the matter, that so the corruption be not augmented by its long stay there, which may be effected by a Decoction of Barley and Agrimony mixt with Oyle of Roses and Syrup of Wormwood, and heightned with some Spirit of Wine, if there be a great putri∣faction. But if the Imposthume turnes to an ulce∣rous Cancer, then, notwithstanding the use of any Remedies whatsoever, this mischeivous disease will endure 'till death; wherefore we must be con∣tented with Palliative Medicines, a good Diet: and in this follow the precept of Hippocrates in the 38th Aphorisme of his Eighth Book; Quibus oc∣culti Cancri fiunt, non curare melius: curati enim citius intereunt, non curati vero longius vitam tra∣hunt. It is better, saies he, not to take an occult and hidden Cancer in hand, for it hastens the death of the Patient, and they which let it alone live longest. Now he means by an occult Cancer, that which breeds within the Body, and especially that in the Womb. Page 338 CHAP. XII. Of the Inflammation of the Breasts of the new-laid Woman. UNtil of late it was alwaies believed that the Blood was the matter whereof the Milk was made in the Breasts; but it is much more pro∣bable that the Chyle onely, and not the Blood, is destined to its generation, as well as it is the true matter out of which all the Blood of the Body is made. That which easily makes us judg so, is the new discovery of the Channel of the Tho∣rax, which conveighs the Chyle into the Subclavian Vein, found out by Monsieur Pecquet Physician of the Faculty of Montpelier, to whom all posterity will be eternally indebted, for having means here∣by of being disabused of several notable Errors, which for want of so fair and necessary a knowledg was slid and entertained into the Practice of Phy∣sick until this time. However since the Vessels which may for this purpose conveigh part of this Chyle to the Breasts are not yet manifestly known, we will content our selves to explain after the fol∣lowing manner the cause of the Inflammation of the Breasts, which doth very often happen to Women newly delivered. All the Blood and Humours are so heated and agitated during Travail, by the Pains and Throws of Labour, that the Breasts composed of glandu∣lous and spongious bodies, easily receiving in too Page 339 great abundance of these Humours, which flow to them from all parts, are soon inflamed thereby; because this Repletion doth very sensibly and pain∣fully distend them: to this contributes very much the suppression of the Lochia, and an universal ful∣ness of the Body. This Inflamation may likewise happen by the Womans having been too strait laced; by some blow received upon the Breasts; or for having lain upon them, which easily bruise them, as also for want of having given Milk to the Child: in as much as by this means the Milk, which is in great quantity in the Breasts, not being evacua∣ted, is overheated, & corrupts by too-long stay there. But from whatsoever cause this Inflamation of the Breasts in a Woman new-laid may proceed, con∣venient Remedies must be speedily applyed, lest it afterwards aposthumates; or else that not suppu∣rating, there remains a scirrhous hardness, which in time may degenerate into a Cancer, a very perni∣tious Malady, and for the most part incurable when confirmed. Besides the danger that an In∣flamation of the Breasts may be converted into these dangerous distempers, there happens usually to the Woman in those parts, which are very sen∣sible, an extream pain, which often causeth shak∣ing Fits, and afterwards a Fever, with so great a burning of the whole Body, that she can scarce en∣dure any Cloaths upon her; and when she doth never so little uncover her self, or put her Arms out of the Bed, she hath new shaking fits, which afterwards augment the heat of her Feaver: it is no great wonder that a Feaver soon happens upon this occasion, because the Breasts by their nearness, to the Heart do easily communicate their Inflama¦tion, Page 340 which sometimes excite Fury and Phrenzy, if the Blood be suddenly and in great abundance carried thither; as Hippocrates assures us in the 40th Aphorism of his 5th Book; Quibuscunque Mulieribus ad Mammas sanguis colligitur, furorem significat. If (saies he) the blood be carried to, and in great abundance collected in the Breasts, it signifies that Fury and Phrenzy will follow. Now the principal and most certain means to hinder the afflux of so great a quantity of Humours to the Breasts, and prevent the coming of an In∣flamation there, is to procure a good and ample evacuation of the Locbia by the Womb. Where∣fore if they are supprest, they must be provoked by the means elswhere directed, for by this evacu∣ation all the Humours will take their course to∣wards the lower parts. The whole habit of Body may be emptied by bleeding in the Arm; after∣wards for a greater diversion, and the better to bring down the Lochia, bleed in the Foot; during which, Topical Remedies to the Breast must not be forgot, as in the beginning, to chase well into them Oile of Roses and Vinegar beat together, laying upon them afterwards Unguentum refrigerans Ga∣leni, and a third part of Populion mixt with it; or a Cataplasme made of the setlings found in a Cutlers Grin-stone-Trough, Oile of Roses and a little Vinegar mixt together: if the pain continue very great, another Cataplasm may be made of the Crum of white Bread, and Milk mixt with Oile of Roses, and the Yolks of raw Eggs, upon all these may be laid Compresses dipt in Vinegar and Water, or in Plantane Water; but great care must be taken that these Remedies applied to the Breast be only Page 341 cooling and repressing, without any great Ad∣striction, for it may cause a scirrhous tumor, which would remain a long time, and it may be a worse distemper. After the height of the Inflammation shall be past, and the greatest part of the antecedent Hu∣mours evacuated and turned aside, let Medicines a little resolving be used, to digest, resolve and con∣sume the Milk which abounds in the Breasts, to prevent corruption by its stay; wherefore let them be drawn by the Child, or some other person, or else resolved, unless that it be suppurated: It may be resolved by the application of pure Honey to the Breasts, which in this case is very effectual, or else a red Cabbadg-leaf may be anointed with it, and applyed to the Breasts, having first withered it a little before the Fire, and all the hard Stalks and Veins taken out: do not lace the Breasts too strait, nor apply any course or rough Clothes to them, that they may not be therewith scratched and bruised. A very good remedy for the same is, a whole red Cabbage boiled in River water to a Pap, and then well bruised in a wooden or marble Mortar, and pulp'd through a Sieve, which mixt with Oyle of Camomil may be applied as a Poultis to the Breasts, In the use of all these means, let the Woman ob∣serve a cooling Diet, not very nourishing, that too much Blood and Humours may not be engendered, of which there is already too great a quantity; she must alwaies keep her Body open, that the Hu∣mours may be so much the more carried down∣wards, and consequently turned from the Breasts. During the whole time the Inflammation continues, Page 342 let her keep her Bed, lying on her back, that she may have the more ease; for being raised, the Breasts which are gross and heavy, because of the abundance of humours, with which they are re∣pleted, do very much pain her when they hang down; let her stir her Arms as little as may be; and after the fourteenth or fifteenth day of her Child-bed, when she hath sufficiently cleansed, and the Inflammation is abated, and she no longer Feverish, purge her once or twice, as the case shall require, to empty the ill humours which remain in the whole habit of her Body. If, notwithstanding all these Remedies, the swelling of the Breast doth not go down, and that she still feels much pain, and a great Pulsation, with a hardness more in one place than another, is is certain it will aposthumate there, of which we will treat hereafter. CHAP. XIII. Of the Curdling and Clodding of the Milk. IN the beginning of Child-bed the Womans Milk is not well purified, because of the great commotion her Body suffered during Labour, and it is then mixt with many other Humours; now if they are then conveyed to the Breasts in too great abundance, they cause an Inflammation treated in the foregoing Chapter; but when the Infant hath already sucked fifteen or twenty days or more, the Milk then only without this mixture of humours is Page 343 contained there, and sometimes curdles and clods. And then the Breasts, which before were soft and even, become hard, uneven and rugged, without any redness; and the distinction and separation of all the Kernels fill'd with curdled Milk, may easily be perceived. The Woman finds a great pain there, and cannot milk them as before; she finds a shivering, especially about the middle of her Back, which seems to her like Ice. This Shivering is usually followed by a Fever of four and twenty Hours continuance; and sometimes less, if the clodding of the Milk do not turn to an Inflamma∣tion of the Breasts, which will undoubtedly hap∣pen, if it be not emptyed, or dissipated and re∣solved. This Clodding of the Milk for the most part proceeds, because the Breasts are not fully drawn; either for that she hath too much Milk, or the Infant is too small and weak to suck all, or because she doth not desire to be a Nurse; for the Milk in these cases remaining in the Breasts, after concoction, without being drawn, loseth the Sweetness and Be∣nignity it had, and by means of the Heat that it there acquires, and the too long stay it there makes, sowring, it curdles and clods; just as we see Rennet put into ordinary Milk, turneth it into Curds: this accident may likewise happen from having taken a great Cold, or keeping the Breasts not well covered. From whatsoever cause this Curdling proceeds, the readiest and most certain Remedy is, speedily to draw the Breasts, until they are emptied and dried; but because the Infant being weak and small cannot draw strong enough, by reason the Woman Page 344 is not soft milcht: when the Milk is so curdled, let another Woman draw them, until the Milk comes freely, and then she may give the Child suck: and to the end she may not afterwards breed more Milk than the Child can draw, let her use Diet that gives but little nourishment, and keep her body alwaies open. But when it happens that the Woman neither can nor will be a Nurse, 'tis ne∣cessary to use other means for the curing of this distemper: Then her Breasts must not be drawn; for attracting more humours, the disease will ever recur if they be not again emptied. Wherefore 'tis necessary to prevent the coming of any more Milk into them, and to resolve and dissipate that which is there: for this purpose the plenitude of the Body must be emptied by bleeding in the Arm; and be∣sides this evacuation, let the Humours be drawn down by strong Clysters, and bleeding in the Foot, purging also if it be necessary; and to resolve, di∣gest and dissipate the curdled Milk, apply the Gata∣plasme which we said was proper, as that of pure Honey; or that of the four Brans boiled in a De∣coction of Sage, Milk, Smallage and Fennel, mix∣ing with it Oile of Camomil, with which Oile the Breasts may likewise be well anointed. I have sometimes seen Women apply to their Breasts, with no small success, the Linnen-covers of Salt-butter-pots; it is a drying Remedy, and lie to soak up the moisture of these parts, and may be used; provided the Remedies before mentioned have discuss'd the Milk: but it notwithstanding all this it cannot be dissipated nor resolved, there is great danger by its long stay there, that it will cause an Inflammation of the Breasts: Page 345 If it so happen, it may be remedied according to the directions of the foregoing Chapter: Let us now treat of Aposthumes of the Breasts, which often follow their inflammation. CHAP. XIV. Of Aposthumes of the Breasts of a Woman new-laid. THere may at all times happen to Maids as well as Wives Aposthumes of the Breasts, either hot or cold, the cure of which doth not differ, as saith Guido; except that too strong Repercussives must not be used, because of their nearness to the Heart, and that the retention of the Courses, con∣tributes much to the breeding of them, and their provocation to their Cure, as also bleeding in the Saphaena: but our intention is only to treat of those which happen to a new-laid Woman, and ordina∣rily succeeds an Infiammation of the Breasts, caused by corruption of the Milk, and too great abun∣dance of Blood and Humours conveighed thither. After all possible endeavours have been used to cause this Inflammation to cease, whether by uni∣versal evacuation of the Body, as well by bleeding in the Arm and Foot, as the provocation of the Lochia, or also by Medicines restraining, repel∣ling, or simply-dissolving applyed to the Breasts; if the Woman still suffers great pain there, and hath Page 346 astrong Pulsation more in one place than another, where a hardness of a livid colour may also be per∣ceived, and soft in the middle, 'tis a sign that they will aposthumate. Then the application of all the former Topicks must be forborn, and ripening Me∣dicines applyed; it being much better to make a perfect Suppuration, than longer to use Repellers or Resolvers, lest the matter be more confirmed, in driving back and only resolving the more subtile parts, leaving the thicker behind in the Breasts, which will become scirrhous, and be very difficult to dissipate, or by its long continuance, as it often happens, may turn to a Cancer. To suppurate the Aposthume, put an emollient and ripening Poultis upon the Breasts, such as that made of Mallows and Marsh-mallows with their Roots, Lilly-roots, and Linseed bruised, boiled to a Pap, that it may be pulp'd through a Sieve, that so no hardness may be left to hurt the Breasts, which are then in great pain; afterwards mix a good quantity of Hogs-grease or Basilicon with it, and lay a little Cloath, thick spread with the same Basi∣licon upon the place where it is likely soonest to break, and the Poultis all over it, nenewing it twelve hours after, or at furthest next day, con∣tinuing this Remedy 'till the Aposthume be fully ripe. It is much better to use this Cataplasme, or the like, than Plaisters; for a Poultis closeth better by its softness, and is more equally applyed to the Breasts; it mollifies it also, and keeps it much more supple; besides it is easier changed and clean∣sed than Plaisters, which by their sticking do very much incommode these parts. Page 347 Assoon as the Aposthume is ripe, it must be opened, if it open not of it self. The time when it is fit, may be known, by the ceasing of the beating the Woman felt before in her Breasts, and that the pain and Fever is much diminished; and then besides, the middle of the Aposthume is a little elevated to a point and very soft, and the contained matter may by the Finger be perceived to fluctu∣ate. When these signs shall appear, the Aposthume must be opened in the fittest place, to give issue to this matter; being careful not to do it too soon, and before the matter is fully ripe, because of too much pain: for the Breasts are very sensible parts, and easily receive a Defluxion, because of their thin and spongious substance, interlaced with an infinite number of Vessels. Wherefore it must be per∣mitted to ripen, yet not suffered to stagnate there too long. This apertion may be made with a Lan∣cet, or with a grain of potential Cantery, making it large enough to evacuate such Clods, as are there usually met with: but it is best to use the Lancet, because there is no loss of substance, and the Scar is not so deformed, as that which succeeds the appli∣cation of a Cautery. Guido would have this Incision made in the form of an Half-moon, to follow the round Figure of the Breast; but it is no matter of what fashion it is, provided it be in a place convenient for the empty∣ing the matter, and that care be taken that some great Vessels be not opened, the principal of which are towards the Arm-pits. After that all the mat∣ter and putrified clodded Milk there found be emptied, the Aposthume after the usual manner Page 348 must be cleansed and mundified, observing not to make the Tents too long nor too hard, but only very soft pledgits of Lint, without thrusting them too deep in, fastening a Thread to the first, if there be occasion, the better to draw it out, because these Aposthumes ordinarily are hollow. If there be much pain dip the Boulsters in Oile of Eggs, or Basilicon mixt with a Digestive, if there remain any thing yet to Suppurate; afterwards use Detersives and Mundifiers, as Honey of Roses, or Unguentum Apostolorum, according as the case requires, laying upon it a good Plaister de Mucilaginibus, to soften that hardness which may yet remain. Sometimes the Breasts do not Aposthumate only in one place, but often each of their principal Kernells comes to Suppuration, and makes so many Aposthumes, so that they break sometimes in five or six places, all yeelding matter; in this case you need not lay open every of these small Holes, but it will be sufficient to make one or two in the most depending part; for all the matter (which hath an easy communication within from one part to ano∣ther, because the Breasts are spongious) will soon be emptyed, and the making of one or two large Orifices in a commodious place, will quickly dry up all the rest: But the certainest Remedy to cure an Imposthume of the Breasts after the matter is emptyed, and to prevent the Orifices for being too long time fistulous, is quite to drive back the Milk, according as we have taught in its place, not only of the aposthumated Breast, but of both, though both be not affected, because there alwaies remains communication; by this means the Ulcers will be Page [unnumbered] Page [unnumbered] [illustration] Chap: XV. lib. 3. pag: 349 Page 349 much sooner and easier dried up, and for this cause the Womans body must be kept open by Clysters, if she goeth not to Stool naturally, and she must be now and then purged, to evacuate the Humours, and drive them downwards, using also a slender Diet. CHAP. XV. Of Excoriation, and loss of the Nipples. VEry often Women that are Nurses, and espe∣cially the first time, are subject to have their Nipples, which are endued with an exquisite sence, (because that many small nervous Filaments do there terminate) chopped and excoriated; which is very painful to them, and insupportable, when not∣withstanding this indisposition they give suck to their Children, and so much the more, by how much they are hard milch't, as it happens the first time, the Milk not yet having made way through the small Holes of the Nipples, which are not yet throughly opened, and then the Child takes more pains to suck, than when the Breasts do almost run of themselves; and sometimes these Chops and Ex∣coriations do so encrease by the Childs continual sucking, that in the end it takes the Nipple quite off from the Breasts, and the Woman is no longer capable of giving suck, and there remains some∣times an Ulcer very hard to be cured. This may sometimes happen from Childrens be∣ing so dry and hungry, that they have not patience Page 350 to suck softly, and finding the Milk not speedily to follow as they desire, they do bite and mump the Nipple so strongly (thinking to draw Milk down the better,) whether they have Teeth or no, that they become raw, and in fine still continuing it, they are quite taken away, as we have said. It happens also that other Infants have their Mouths so hot, that they make the Nipples sore, as when the Children have those little Ul∣cers, called*Apthae, and much sooner if they have the Pox, with which also they may infect the Nurses, and then those Ulcers so caused do not easily yield to ordi∣nary Remedies, but on the contrary grow daily worse and worse. These Chops and Excoriations must not be neg∣lected, as well by reason of the great pain they put the Woman to, when she gives suck, as to avoid their dayly growing worse and worse; and at length their turning to malignant Ulcers: Where∣fore assoon as they begin, let the Woman forbear giving her Child suck, until they are quire cured; for with continual sucking it will be very difficult to hinder its return by irritating of them, during which the Milk must for a small time be kept back; lest by being no longer drawn, it cause an Inflam∣mation in the Breast through its great abundance. However if but one Nipple be sore, she may give suck with the other: to these sore Nipples Desicca∣tive Medicines may be applyed, as Allum, or Lime∣water; or they may be only bathed with Plantain water, putting upon them small soft Rags dipped in any of them; or use a small Ceruse Plaister, or some Ointment, as Dia Pompholygos, or a little powder Page 351 Amylon; but especially care must be taken, that nothing be applyed to disgust the Child, wherefore many content themselves to use only honey of Roses. Some will instead of Desiccatives use Emolients, but there must be a distinction, for Emollients are fit to preserve from such Fissures; but when they are already made, Desiccatives are best: and to pre∣vent the Woman from hurts in these parts, which are very painful, and that the Rags may not stick to them, one ought to put upon them a little Wax, or Wooden Caps, or Leaden ones, they being more Desiccative, like to those represented in the be∣gining of the Chapter, which must have several small holes on the tops of them, as well to give issue to the Sanies, which proceeds from the small Ul∣cers, as that the Milk, which often distills out of the Nipples, may by this means pass away. If the Child hath wholly suck'd off the Nipples, the Milk must then be quite dried away, that so the Ulcers which remain may be the sooner healed, for else one shall hardly obtain their end, and in time they may become callous and malignant: and if the Child hath the Pox, it will be very difficult to heal those Ulcers of the Nurses Nipples, if it con∣tinues to suck: wherefore the Child must be put to another, who must use Preservatives against this Malady; but if they be only small simple Ulcers in the Mouth, without any malignity, 'tis enough to wash them with Barley-water, mixt with a little Juice of Citrons; and the better to temper these Humours, which are over-heated, let the Nurse take a cooling Diet, that her Milk may become of Page 352 the same temperament, and let her be blooded and purged, if it be necessary. When the Nipples are quite lost, it is very diffi∣cult to give a Child longer suck; because it can take no hold to suck the Milk, and also the small holes of the Nipples are closed up by the Ulcers. But if notwithstanding she shall desire to give suck, another Woman must by degrees make her new Nipples, after the Ulcer shall be perfectly healed, whose sucking with her mouth will draw them out, and by this means unstop the root of the old Nipples; or using a fit Instrument of glass, such as is figured at the begining of this Chapter, with which the Woman her self, may also suck them five or six times a day; and to shape them, and so preserve them, being thus drawn out, from sinking into the Breasts again, let her put upon them a small Cap of wood, or other matter, such as is abovementioned, and doing so by degrees after the Nipples are quite form'd and unstop'd, she may again give her Child suck. What we have hitherto writ in this third Book, shall suffice for directions concerning a new-laid Woman, and also for the knowledg and cure of distempers which usually happen to them, upon which we need not further enlarge, for if any other happen than what we have mentioned, and which do not properly belong to the care of a Chirurgeon, a Physitian must be sent for, to remedie them by his prudence, and according as Art requires. Let us now treat of Infants new-born, and run through the Diseases they are most subject to. Page 353 CHAP. XVI. Of tending Children new-born, and first how to bind, cut, and swath the Navel-string. IF the Infant (as we have said before discoursing of Deliveries) hath often need whilest he is in his Mothers belly, of the good conduct and dex∣terity of a Chirurgeon, or Midwife, to deliver him and bring him happily forth out of that Dun∣geon, wherein he hath been a long time inclosed, their assistance is nothing less necessary to him assoon as he is born, as well to remedy such indispositions which sometimes he brings into the world, as to defend him from many infirmities, to which the weakness of his Age and tenderness of his Body renders him subject. We have in the whole fore∣going-Book very particularly shown how to help him in his coming into the world, there remaines now only directions what is to be done afterwards, to this purpose we will first shew how to tye, cut and bind up the Navel-string. There are some persons who assoon as the In∣fant is come into the World, do bind and cut the Navel-string, before the burthen be come away; but it is better, if possible without too-long stay, to deser it until the Secondine be likewise drawn forth; for the Womb, which is extreamly wide and open after the coming forth of the Child, would be in danger of taking cold by the outward aire, during the delay made for the Ligature of the Umbilical Page 354 Vessel; besides that the Orifice closeing a little, it would afterwards be more difficult to bring the After-birth away. To make this Ligature as it behooveth, let the Midwife do as followeth; assoon then as all is come away from the Woman, she must immediately close up the Womb with clouts, according to di∣rections already given, and then carry away the Child and Burthen to the fire; having put it into a warm Bed and Blancket, let her take a brown Thread four or five double, of a quarter of an Ell long or thereabouts, tyed with a single knot at each of the ends, to prevent their entangling, and with this thread so accommodated (which the Midwife must have in a readiness before Labour, as also a good pair of Scissers, that so no time may be lost) let her tye the string within an Inch of the Belly, with a double knot, and turning about the ends of the thread, let her tye two more on the other side of the string, reiterating it again, if it be necessa∣ry, for greater surety; then let her cut off the Navel-string another Inch below the Ligature, towards the After-birth, so that there only remain but two inches of the string, in the midst of which will be the knot we speak of, which must be so strait knit, as not to suffer a drop of blood to squeez out of the Vessels, but not so strait as to cut it in two. For which reason the Thread must be pretty thick and pretty strait knit, it being better too-strait than too-loose: for some Children have miserably lost their lives with all their blood before it was disco∣vered; because the Navel-string was not well tyed. Now that so great a Mischief may not happen, great care must be taken after it is cut, that no blood Page 355 squeez through; for if there do, new knots must be made with the rest of the string, (which for this reason must be left a little long) to close it more ex∣actly; this being done, wrap up the end of the String thus cut and tyed three or four times about with a small rag, drie, or dipt in Oile of Roses, if you please; then having put another small Rag three or four double upon the Belly of the Child above the Navil, lay the String so wrapp'd up upon it, that it may not touch the naked Belly; on the top of all put another small Boulster, and then swathe it with a linnen Swath four Fingers broad to keep it steady, lest by rowling too much, or by being continually stirr'd from side to side, by the motion of the Belly, it comes to fall off, before the Ves∣sels be quite closed up and healed. 'Tis very convenient, as we have said, to lay the remaining part of the String on the upper part of the Belly, that so, if by chance the Vessels be not sufficiently closed, the Blood may not so soon slide away, as if it were turned downwards; for we find sometimes this String to be so great in some Chil∣dren, that although it were very close tyed at first, yet coming afterwards to wither and dry, the Li∣gature is rendred looser, by means of which 'twill afterwards easily bleed, if care be not taken. This Ac∣cident hapned lately to a poor Child, who died the twelfth day by such a flux of Blood, although the Midwife protested to me, that she had tyed the String very exactly; and being astonished how that could happen: she told me, that it must assu∣redly be, (which indeed was the truth) because the Knot was loosened in proportion to the withering of the String; wherefore to avoid such a Mis∣fortune, Page 356 let a new Knot be knit the first time the Child is opened. The String thus tyed begins daily to dry away, and is separated from the Belly at the end of the sixth or seventh day ordinarily, and sometimes sooner, but rarely longer than the eighth or ninth; it must alwaies fall off of it self without any pro∣vocation, lest that being separated too soon, and before the Vessels shall be entirely closed and healed up, a flux of Blood follow, which is very dange∣rous, as we have said, or that it cause an Ulcer very hard to be cured. There are some good Gossips, who are a little superstitious in the tying of this String longer or shorter, according to the difference of the Sex, for some pleasant reasons they give, but it is a meer abuse; for at whatsoever distance they tye the Knot, either nearer or further, though half a foot from the Belly, yet it will alwaies be separated in the very same place, just close to the Belly, because it is a part which remains wholly* inanimate, after the Child is come into the World; where∣fore, whether Boies or Girles, let the Knot be made at least an inch from the Belly, as we have already directed; and not nearer, lest it pain or inflame the Childs Navel. It will not be from the purpose to mention here a business of great consequence, which is sometimes capable to kill the new-born Babe, without almost knowing the cause of it; 'tis a very bad custome some Midwives have, before they make the Knot, they drive all the blood out of the String into the Infants Belly, believing that by this means they Page 357 fetch it to it self, and strengthen it when it is weak: but 'tis no such matter, for assoon as these Vessels are never so little cooled, the blood it contains quickly loses its spirits, and is half coagulated in an instant, which is the reason, that being driven back into the Infants Liver, it is e∣nough to cause very great Accidents; not be∣cause of its abundance, but because having quite lost its natural heat, it is afterwards soon corrupted, and changeth and spoileth the Childs Blood, with which it comes to mix. They commonly put this ill custome in practice when the Child is weak; but this doth sooner suffocate them, for if they need Blood to give them vigour, it must be good and laudable, and not that which is half clodded, and destitute of its natural heat. Wherefore whe∣ther the Child be strong or weak, if you will not put it in danger of its life, or at least cause to him great oppressions, pains and gripes, forbear driving his blood thus out of the String into the Infants body. Now having thus tyed and cut the String, wash the Child presently all over, for to swaddle it afterwards, as we shall direct. Page 358 CHAP. XVII. Hôw a new-born Babe must be washed and cleansed from the Excrements, as also how it ought to be wrapped up in swadling Cloaths. WHen the Midwife hath ordered the Childs Navel-string, just as we have directed in the foregoing Chapter, let her presently cleanse it from the Excrements it brings with it into the world; of which some are within the body, as the Urine in the Bladder, and the Moeconion found in the Guts and others without, which are thick, whi∣tish and viscous, proceeding from the slimyness of the Waters: there are Children sometimes so co∣vered all over with this, that one would say, they were rubbed over with soft Cheese; and certain Women, of easie belief, do really imagine it was, because they had often eaten some while they were with Child, that their Infants are thus full of this thick white Excrement, which in colour and con∣sistence is not unlike white Cheese. Let the Child then be cleansed from all these Ex∣crements with Wine and Water a little warmed, and every part of his body where this Excrement is; as principally the Head, because of the Hair, and the folds of the Groins, and Arm-pits, and the Cods; which parts must be gently cleansed with a soft Rag, or a soft Spung dipt in this luke-warm Wine. If this viscous Excrement stick so close, that Page 359 it will not easily be wash'd off of these places, it may be fetcht off with Oile of sweet Almonds, or a little fresh Butter melted with the Wine, and after∣wards well dried off; one must also cleanse and unstop with tents of fine Rags, wet in this liquour, the Ears and Nostrils; for the Eyes, they may be wiped with a soft dry rag, not dipt in this Wine, that it may not pain them and make them smart. After the Child is thus washed and cleansed from these Impurities and Blood which comes away in the Labour, with which sometimes its whole Body is besmeared, all the parts of it must be visited, to see if there be any fault or dislocation, whether the Nose be straight, or its Tongue tyed, whether there be no bruise or tumor of the Head, or whether the Mould be not overshotten, or whether the Scrotum, in case it be a Male, be not blown up and swelled; in short, whether it suffered any vio∣lence in any part of its Body, and whether they be well and duely shaped, that so Remedies may be used according to the nature of the indisposition discovered. But as it is not sufficient to cleanse the outside of the Childs body; you must above all ob∣serve, that it must discharge the Excrements re∣tained within: wherefore examine whether the Conduits of the Urine and Stool be opened, for some have been born without having them perfo∣rated, who have died for want of voiding their Ex∣crements, because timely care was not taken of it: as to the Urine, all Children as well Males as Fe∣males, do render it assoon as they are born, espe∣cially when they feel the heat of the fire, and sometimes also the Maeconion of the Guts, but ne∣vertheless usually a little after. If the Infant doth Page 360 not render it the first day, that it may not remain too long in his Belly, and cause very painful Gripes, put up into his fundament a small Suppo∣sitory, to stir it up to be discharged; to this pur∣pose a sugar'd Almond may be used, anointed over with a little boiled Honey, or else a small piece of Castile-soap, rubb'd over with fresh Butter; you may also give the Child to this purpose at the Mouth a little Syrup of Roses, or Violets, mixt with some Oyl of Sweet Almonds drawn without fire, anoint∣ing the Belly also with the same Oyl or a little fresh Butter. It may be known when the Child hath voided all its Maeconion, if the Stools change from black and become pale, which is about the second or third day, losing by degrees this tincture in proportion to the generation of new Excrements from the Milk, which about this time mixes with the first. As to the Maeconion, which is an Excrement in colour and consistence like to the Pulp of Cassia, found in the Childs Guts when it comes into the World, 'twill be enough to the purpose to examine what it is, and from whence it proceeds; where∣fore without dwelling upon the different explicati∣ons of Authors touching its generation, I will in∣geniously give my thoughts of it; which is, that it comes from the superfluous Blood daily discharged, as it doth in all persons and of all ages, by means of the Hepatick channel, which coming from the hollow of the Liver, goeth and emptyeth into the Intestine Duodenum, out of which is formed the Moeconion, which afterwards serves to keep the In∣testines of the Foelus open and dilated, that so they may the better perform their office after its birth; Page 361 and to make it appear that it is truely thus made, and that the superfluous Blood is continually dis∣charged by the Hepatick channel into the Duode∣num, as I do say, there are some people of Four∣score years of age, that were never let Blood, nor never lost any outwardly, who nevertheless do and have bred some every day, as must necessarily confest. Now if they did not void it this way, they must soon be suffocated by its too-great abundance. I know that many may answer me, that it is more credible that this discharge is made by the branches of the Vena porta, distributed throughout the Me∣sentery: but such as are acquainted with the Circula∣tion of the Blood, know that naturally it cannot well be so, & I believe they would soon be of my opinion, if they did but well consider it; and it is not sufficient to refute me, by objecting, that if the superfluity of Blood be thus daily voided, one would alwaies have bloody Stooles; because it is not unknown that this portion of superfluous Blood, which is very small in comparison of the other Excrements proceeding from the Aliment with which it is mixt, doth easily there receive a change of colour, by the alteration and kind of concoction there made, whence it happens that it is not so easily perceived in a Man as a Child, in whom the Moe∣conion being yet without any mixture, retaines more of the colour; as also because 'tis engendered of Blood only, which hath been separated as use∣less to its nourishment, and is after this manner ex∣pelled. Now forasmuch as there is but little su∣perfluous Blood in an Infants body, whilest it is in the Womb, because it consumes a great deal of it for its nourishment and growth; besides that it hath Page 362 been purified by the Mother, before it is conveyed to him; so likewise there is but little Moeconion ingendred during the whole time of Praegnancy; for which reason also the Infant doth not void any during its stay in the Womb; but it doth when it is born, for then it receives nourishment by the Mouth, of which plenty of other Excrements are made, which forceth him to cast forth the first: and although the Moeconion hath continued in the Infants Guts, during the whole time it was in the Mother's Belly, nevertheless, which is very ad∣mirable, it hath nothing neer so ill a scent as the new Excrements have, which are engendred out of the nourishment taken in at the Mouth after it is born, although they make but a very small stay there, and are daily discharged. Assoon then as the Midwife hath washed and cleansed the Child according to directions, and that she hath viewed every part of its Body, let her begin to swaddle it in its Swathing-Cloaths, begining first to cover the Head with a small linnen Biggen,* putting a woollen Cap upon it, having first put upon the mould of the Head a fine Linnen rag, three or four double, and four Fingers broad; which that it may not stir, pin to the Biggen with a small Pin on the outside, that it may not prick the Child: this double Rag serves to defend the Childs Brain (which is not as yet co∣vered over in this place with a Bone) as well from cold, as other injuries: Let her put small Rags be∣hind the Ears, to dry up the filth which usually is there ingendred; this done, let her put other rags, as well upon the Breast, as in the folds of the Page 363 Arm-pits and Groyns, and so swathe it, having wrapped it up in beds and warm blankets. It is not necessary to give a particular direction how this ought to be done, because it is so common, that there is scarce a Woman but knowes it, but wee'l only say in general, that a Child must not be swathed too-strait in his Blankets, especially about the Breast and Stomach, that so he may breath the freelier, and not be forced to vomit up the Milk he sucks, because the Stomach cannot be sufficiently extended to contain it; and such a practice may possibly in time, converting this vomiting into an habit, prove a very great prejudice to the Child: Wherefore to avoid it, let his Arms and Legs be wrapped in his bed, and stretched strait out, and swathed to keep them so, viz. his Arms along his sides, and his Legs equally both together, with a little of the bed between them, that so they may not be galled by rubbing one another; after all this, the Head must be kept steady and strait, with a stay fastned on each side the Blancket, and then wrap the Child up in Mantles or Blankets to keep it warm. He must be thus swaddled to give his little body a strait Figure, which is most decent and convenient for a Man, and to accustom him to keep upon the Feet, for else he would go upon all four, as most other Animals do. Besides all these Excrements mentioned, the Child hath yet a certain clammy Phlegme remaining in its Stomach, which he pukes up some few daies after he is born: to remedy this, you must give the Child a small Spoonful of sugared Wine, twice or thrice the first day together, making him to swallow it, and by no means give it suck until it Page 364 be most part evacuated, or digested and consumed by the Stomach, for fear lest the Milk mixing with this viscous humour should corrupt, as it would do, if you gave it presently suck; some gives them for this purpose a little Oyl of sweet Almonds, drawn without fire, and a little Sugar-candy: The Jews are accustomed to give their Children a little Butter and Honey, which doth almost produce the same effect; and this they do to follow what is said in the 7th Chap. of Isaiah, the 14, and 15 Verses: Be∣hold, a Virgin shall conceive & bear a Son, and shall call his name Emanuel; Butter & Honey shall he eat, that he may know to refuse the Evil, and chuse the Good. But Wine is much better, because it doth better cut and loosen this Phlegme, and helps to concoct and digest that which remains, and the Sugar sweetens its Acrimony, and helps to purge it away. Now having given it this Medicine, lay it quietly to rest on his side, that the Excrements may be the better evacuated and cast forth at the Mouth: for if the Child lyes on the back, it would be in danger that remaining in its Mouth, a part of it would fall upon his Breast, which might choak him, or at least very much offend him. Let us now see how he must be fed and ordered hereafter. CHAP. XVIII. Of Dieting and Ordering a new-born Babe. A Child, which during its stay in the Mothers Belly, had no other nourishment but the blood Page 365 it receives by the Umbilical Vessels, hath for want of that, after its Birth, need to take some by the Mouth, and suck Breast-milk: However it is not good to give it suck assoon as it is born, to pre∣vent that so sudden a change, as well in respect of the difference of nourishment, as the manner of re∣ceiving it, lest it cause some alteration in its health. First therefore empty the Phlegm out of his Stomach, giving him, as we have said, the first three or four daies, some Wine and Sugar, to cut and loosen it, to prevent the Milk he shall take from corrupting, being mixt with this viscous Phlegme; wherefore it is best to stay until the next day before you give it suck, that so it may be wholly evacuated, or di∣gested and consumed, and then you may safely give him the Breast. It were to be wished that the Mother should not give it suck, until the eighth day of her Child-bed at soonest, if not three Weeks or a Month; that so all the humours of her Body, being well tempered, and having recovered the agitation they received in the Travail, as also their Superfluities having been wholly purged by means of the Lochia, her Milk be thereby so much the more purified; besides this the small holes of the Nipples not yet being suffici∣ently opened, a new-born Babe cannot ordinarily at first easily draw her Breasts; during that time therefore let a Woman suck her. But often poor people cannot observe so many Precautions, and such Mothers are obliged to give their Children suck from the first day: and like∣wise others will not suffer any but themselves to do it: in this case, let their Breasts be a little drawn by some old persons, or some lusty sucking Child; Page 366 or they may draw them themselves with a Glass, figured like that in the beginning of the 15th Chap. and afterwards they may give their Children suck when the Milk is a little brought down; let them continue to do thus, 'till the Milk be easy for the new-born Child to draw. There are some who believe that the Milk of a Woman new-laid is better at the beginning than when it is purified, and that it opens the Belly and purgeth the Moeconion from the Guts; but the gripes, which this overheated and foul Milk also causeth in him, is much more prejudicial than the good it otherwise doth; wherefore it is best not to give it such new-milk, if possible. As to the fittest time then of giving the Breast to the new-born Babe, it must not be till after the first day, for the reasons above given; and to make him take it, because there are some that will not in three or four daies, the Nurse must milk a little into his Mouth and upon his Lips, that so he may by degrees taste it, then let her put the Nipple dropping into its Mouth, and squeeze her Breast with her Hand when he hath fastened, that the Milk may come down the easier, and that the Infant who hath yet but small strength, may not take too much pains to draw and suck it, doing thus dy degrees, until he is well accustomed to suck. If the Nurse hath much Milk, she must not give the Child any thing else, at least the first two Months; Beasts do shew us, that Milk alone is sufficient to nourish an Infant, since that they do suckle five or six of their young ones, and sometimes more, without their taking any other food for a long time after. As to the quantity of Milk a Child Page 367 ought to suck, it must be proportionable to his Age and Strength; in the beginning he must not have too much, nor too often, that his Stomach not yet ac∣customed to concoct it, may the better digest it; afterwards let it daily by little and little be aug∣mented, until he may take his fill: As to the time and hour it needs no limits, for it may be at any time, night or day, when he hath a mind; but let him have it rather little and often, than too-much at a time, that his little Stomach may the better concoct and digest it without Vomiting, as it often doth when it cannot easily contain it. After the Child hath suck'd Milk alone for two or three Months, more or less, according as one finds he needs stronger nourishment, give him then Pap, made of Flower and Milk, though but little at first, and not too thick, lest his Stomach be soon overcharged by not being used to it; or (that it may be of easier digestion) put the Meal in an earthen Pan, into an Oven assoon as the bread is drawn, stirring it often, to dry it equally. Pap made of this Flower, besides that it is sooner concocted, is much better than the ordinary, which is heavier, clammier, and not so easy of digestion; for being made with raw Flower, 'tis very difficult to boil it well, without consuming the best part of the Milk, leaving only the grossest part behind, and losing by the long boiling both its goodness and taste. When the Child hath taken Pap thus made, which must be but once a day, especially in the morning, or twice at most, the Nurse may give it a little suck, to the end that being washed down into the Sto∣mach, the digestion may be the better and easier made. Page 368 There are many Women who give Pap to their Children assoon as they are born, and Nurses who have little Milk ordinarily do so, to hinder their crying as they will do when they are hungry; but somtimes this only is enough to kill them, because of the indigestion and obstruction it causeth, which by reason of its gross and viscous consistence, can hardly find passage through the Stomach and Guts, which at the beginning are but weak, and not suf∣ficiently opened and dilated, whereby there hap∣pens to the Children great oppressions, and difficulty of Breathing, Gripes, Swellings, pains of the Bel∣ly, and often Death; wherefore do not give it the Child 'till after the first or second Moneth at soonest, and if you forbore it three or four whole Moneths, he would thrive the better, provided the Nurse wants no Milk. When the Child hath sucked its fill, let the Nurse lay it to rest and sleep, not in the same Bed she lies in, lest unawares she overlay it; as I knew one that did and killed her Child, whether wicked∣ly to be freed from it, or innocently, she alone knoweth: but to avoid this mischief, let her lay it in a Cradle close by the Bed-side, and put a Mantle over the head of the Cradle to prevent the falling of dust on its Face, and that the Day-light, Sun∣shine, Candle, or Fire in the Chamber, may not offend it. Lay him to sleep upon his Back, with his Head a little raised upon a Pillow; and to make him sleep the sooner, let the Nurse rock him gently with an equal motion, without too-great shaking; lest that hindering the digestion of the Milk in his Stomach, provoke him to vomit it up, just as persons do that are at Sea; not because of the scent of Page 369 the Salt-water, but the shaking and tossing of the Ship wherein they are; and as it happens to many Women only by riding in a Coach, when they are not used to it. But that you may not be forced thus to rock a Child every time you would have him sleep, it is good not to use him to it at first, but let his sleep come naturally of it self. There needs no certain limited time for his rest, for he may sleep at any time night or day when he hath a mind to it, and ordinarily the better he is, the more he sleeps; however, if his sleep be very immoderate, it may be a little broken; to which purpose let his Nurse carry him in her Arms to the light, singing with a soft and sweet voice, shewing him some glistering thing to please his sight, and dancing him a little to awake him out of his drowsiness; for by too long Sleep, the natural Heat doth so retire inwards, that it is as it were buried there, by means of which all the Body, and chiefly the Brain, is so cooled, that the Infants Senses are thereby quite dull, and their functions languishing and stupified. When he is in the Cradle, let it be so turned as it may be towards the Fire, the Candle, or the Chamber Window, that having the light directly in its Face, he may not be allured to look continu∣ally on one side; for doing so often, his sight will be so perverted, that he will grow squint-eyed: Wherefore for the better security, throw some Co∣vering over the head of the Bed, as we have said, to hinder him from seeing the light; because by this means, his sight being staied from rouling from side to side, will be the better fortified. Let us now see how a Nurse must daily cleanse her Child from the Excrements. Page 370 As the young of all other Animals have their bodies free, without the trouble of any coverings, so they easily discharge themselves of their Excre∣ments, without being befouled; and they no sooner empty their Belly, but their Dam (if they cannot do it themselves) perceiving it, casts it forth of their Nest, or at lest rangeth it in some one part, where it cannot hurt them: but it is not the same with Infants, who (for being bound and swathed with Swathes and Blankets, as we are forced, to give them a strait Figure only suitable to mankind) can∣not render their Excrements, but at the same time they must be befouled, and in which, (because it cannot be perceived for their Clothes) they often re∣main, until the ill scent of it offends the Nurses nose; or that she doubts it, because of the Cryes and Tears of the Child, which is incommoded by the Moistness and Acrimony of it; to avoid which let the Child be opened and changed, at least twice or thrice a day, and also sometimes in the night, if necessary, to cleanse him from his Excrements, and change the bed, which ought to be well washed, and not slightly, as most part of hired Nurses do, which causeth a great itching, and galleth the Childs body, because of a certain salt coming from the Ex∣crements, and not easie to be dissolved when the Blanket hath once imbued it, but by putting it into a Bucking-tub. The best time to shift the Child is immediatly after the Excrements are rendred, with∣out suffering him to lye longer in them, than 'till he awakes, if he were then asleep. Now since he may render them at any hour in∣differently, no other time can be appointed to do it, Page 371 but when there is no need, that is, as often as it is necessary to keep him alwaies clean. The Child must alwaies be opened before the fire, and his Beds and Clouts well warmed and dried, before he be put into them, lest their coldness and moisture cause a Cholick and Gripes; the Nurse likewise must be careful from time to time to put soft Rags behind the Ears and under the Arm-pits, to dry up the moisture there found, being very careful, during the first four or five daies, not to make the remaining part of the Navel-string fall off too soon, and before the Vessels of it be perfectly closed. Let her likewise see every time she opens him, whether the Navel, for want of being well tyed at first, do not bleed, or because the thread is loosened; and after the end is quite fallen off, let her still for some time swath the Navel, ever laying a boulster on the top of it, until it be well cicatriced and wholly depressed, and as it were sunk inwards. Besides this, let her put upon the Mould of the head, under the Biggen, another Compress, as well to keep the Brain warm, as to defend it from outward Injuries which might easily hurt it, because of the tenderness of that place not yet covered over with any bone; let her also be very careful not to let the Child cry too-much, especially at first, lest the Navel be forced outwards, and that there happen to him by its dilatation an Exomphale, or a rupture in the Groine; nor must she hearken to the sayings of some good people, who affirm it necessary a Child should sometimes cry, to discharge its Brain: the two best waies to quiet him when he cryes, is to give him suck, and lay him clean and dry; 'tis likewise good to present to his sight things that rejoyce him, Page 372 and to remove what may affright, or grieve him. All these directions in this present Chapter, con∣cerning the Diet and Order of a new-born Babe, must be understood for one in health; for if he be any waies indisposed, he must be treated according as the case requires. This is what we intend to examine in all the remaining part of the Book. CHAP. XIX. Of the Indispositions of little Children, and first of their weakness. YOung Trees are scarce raised out of the Earth, which is their Mother, but often many of them soon after dye; because their small bodies, by reason of the tenderness of their substance, easily re∣ceive alteration, and cannot without great diffi∣culty resist the smallest opposition, until they be∣come a little bigger, and have taken stronger and deeper root: So likewise we see daily above half of the young Children dye, before they are two or three years old; as well because of the tenderness of their Bodies, as by reason of the feebleness of their Age, they cannot otherwise express the in∣commodities they suffer within, but by their cryes. We have heretofore discovered how they ought to be governed in the beginning for the preservation of a good health; we will now discourse of the in∣dispositions to which they are subject, principally from their birth, 'till they are seven or eight Page 373 Months old. Let us first mention some they are born with, and then wee'l entertain you with those that usually happen to them afterwards. The first Accident to be remedied is the weak∣ness many Children bring into the world with them; which often happens, not because they are so by Nature, but by the violence of a bad Labour, or the length of it, during which they suffer so much, that sometimes after they are born they are so weak, that it is hard to be discovered whether they are dead or alive, not any part of their Body being perceived to stir, which sometimes is so blew and livid, especially the Face, that one would think they were quite choaked. And many times, after they have been thus for whole hours, they re∣cover by little and little from their weakness, as if they revived, and were returned from Death to Life. One may guess that the Child is not effectually dead, although at first it doth in some sort appear so to be; if the Woman but a little before she was brought to Bed felt it to stir strongly; if she did not flood much, and if she had no very hard Labour: but 'tis very certain he is yet living, although he do not cry, nor move any part of his Body after he is born; if laying the hand upon his Breast the mo∣tion of the Heart be felt; or touching the Navel-string near the Belly, there is yet perceived a small pulsation of the Arteries: Then all sorts of means must be used to recover him out of this weak∣ness. Now the best help in this case is, to lay him speedily in a warm Bed and Blanket, and carry him to the fire, and there let the Midwife sup some Page 374 Wine, and spout it into his Mouth, repeating it often if there be occasion; let her likewise lay Linnen, dipt in warm Wine, to the Breast and Belly; let the Face be uncovered, that he may draw breath the easier; and to be yet more helpfull to him, let the Midwife keep his Mouth a little open, and cleanse the Nostrils with small linen tents, also dipt in white Wine, that so he may receive the smell of it; let her chafe every part of his Body well with warm Clothes, to bring back the Blood and Spirits, which for being retired inwards through weakness, put him in danger of being choaked: in doing thus by little and little, the Infant recovering his strength, will insensibly come to stirr his Limbs one after another, and so at first cry but weakly, which afterwards, as he breaths freer, will augment and become stronger. Besides these helps we have mentioned, which certainly are the best and most certain for the weakness of a new-born Babe, Midwives ordinarily make use of others, which I do not approve of, not only because they are useless, but because some of them are very dangerous to the Child. Some lay the After-burthen, being very warm, to the Belly, and leave it there 'till it is cold. I have elsewhere declared, that the Burthen, by reason of its heat, may be something serviceable; but notwithstanding, because of its weight, being so placed upon the Childs Belly, which wanting a support is ea∣sily compressed, it doth very much hinder his respiration, which at that time is most necessary for him. Others cast the Secondine into the Fire be∣fore it be parted, and some put it in warm Wine, believing that by this means the strength of the Wine Page 375 conveighed through the Umbilical Vessels, is able to give him new vigour: But as this fleshy Mass, and these Vessels, are dead parts assoon as they are out of the Womb, so there remains in them no spirits which can be communicated to the Infant: And if this practice be continued, it must rather be to sa∣tisfie custome, than for any hope of benefit to be thereby received. If these things do no good, yet do they no great hurt, but are only useless; but this which follows is capable to suffocate a Child immediately, that is, when some do thrust back, and make the Blood which is in the Umbilical Vessels to enter into the Body, believing that it fortifies and recovers the Child out of its weakness; but we have elsewhere declared, that the Blood contained in these Vessels lose their spirits assoon as the Secondine is separated and come forth of the Womb; nay, it is there im∣mediatly after, half congealed: Now if it be thus thrust back into a weak Childs Liver, it remains there, being no longer animated with any spirits, and instead of giving him new strength, it overcomes that little which remains, and compleats the extinction of his languishing natural heat: to avoid this, be care∣ful not to force back the Blood thus into the Infants Belly, for besides in these weaknesses, (unless it should be otherwaies by the Mothers flooding be∣fore she was brought to Bed) there is alwaies too much of it in the Infants body, and instead of send∣ing more to it, there must be some drawn back from it towards the extremities, that so its Ventricles be∣ing a little discharged, may have afterwards a more free motion to send back the spirits to all parts, which are deprived of them by these faintings: Page 376 Wherefore since the Child must receive nothing from the Ʋmbilical Vessels after its Birth, let them be tyed assoon as may be, and then ordered accord∣ing as we have directed. Very often the Children which are weak at their Birth, are so by nature; as when they come before their time, and are so much the weaker, by how much they want to compleat the end of the ninth Moneth, and also when they are begotten by infirm and sick parents. These are hard to remedy, and there is nothing more to be done, but to nourish and order them well according to our former directions; but it will be rare for them to be long-lived, and it is much if they do not dye by the least indisposition that befalls their natural weakness. CHAP. XX. Of Contusions, or Bruises of the Head, and other parts of the Body of a new-born Babe. THe Bodies of new-born Children, are, as we have said, so tender and delicate, that they are easily bruised and hurt; and sometimes in a bad Labour their Members are dislocated, either be∣cause it remained long in an unnatural Posture; or because they were handled too rudely in the Opera∣tion: the most usual and frequent bruise is for the most part on the top of their Head, where some∣times at their Birth, they have a Knob, as big as Page 377 half an Egg, if not bigger, as is usually seen in first Labours; and which happens the sooner, ac∣cording as the Woman is advanced in Age; because the inward orifice of the Womb, called the Gar∣land, being more callous, doth not dilate without much difficulty; for which reason, the Childs head pressing against it, and the upper part of it (which naturally presents first to the Passage) being begirt with it as with a Garland, is puft up and swelled (because of the Blood and Humours which fall down, and are retained in this part) by the great compression which this inward orifice makes round about, especially when the Throwes begin to be strong, and the Child comes but slowly forward, after the Waters, which did a little defend it, are broke away; the Midwife also may do much ill in it, if she toucheth it too-often, or too-roughly with her Fingers, when it lyes in the Birth; but many times they are in this case wrongfully accused; because for the most part the single compression this orifice makes in form of a Garland about the Childs Head is the cause of this kind of bruised Tumours. This part swells after the same manner as we see all others, which are either too-strongly prest, bound, or lased; for by this means, the Blood which cannot circulate, being stopt in great abun∣dance in one part, obligeth it to swell and be blown up; and, by the repletion it makes, renders it livid, as if it were bruised: Now this compression is much greater in respect of the Veins, which are alwaies more outward, and ought to carry back the Blood to the Heart, than of the Arteries, by means of which it is carried to all the parts; for besides Page 378 that the Arteries lye deeper, they have also a con∣tinual Pulsation, by the favour of which a little Blood ever slides away; and this is the reason that in all Compressions or Ligatures of parts, pro∣vided they be not too-hard, the Blood is easily carried into them by the Arteries, and but very hardly, or not at all, carried back by the Veins; which is the reason that the part receiving much more than it sends back or consumes for its nourish∣ment, must needs swell on this fashion by Reple∣tion. If they that practise Midwifery do but well consider what I have said, when occasion offers, which is very often, they will find that these kind of Knobs or Tumours, which many Children have on their Head at their birth, proceed ordi∣narily from no other cause than what I have here explained. These Tumours many times are so great and high, that (the Woman not being yet delivered, nor having the inner Orifice of the Womb well dilated) they do hinder the discovery of the part the Infant first presents, making Midwives sometimes to ima∣gine, not being able to feel any bone of the Head with their Finger, that it is the Childs Shoulder, or some other part, nay some of them cannot tell what that swelling is they feel: but they may soon know it, by reason these Tumours, though feeling very fleshy at the touch, are notwithstanding harder than any Shoulder, or Buttock of a Child, which parts are alwaies more soft and without hair, as the Head hath, the Bones of which may also be easily perceived, if having the Finger anointed with Oyl or fresh Butter, it can be introduced in∣to Page 379 the inner orifice, for the parts of the Head with∣in the Womb, are not swelled, 'tis only this which offers to the Orifice, and is prest and begirt by it, as we have said. If a Child comes with any other part besides the Head, as an Arm or a Leg, and that these parts likewise remain a long time prest in the Passage, and in a posture much con∣strained, or that they be come forth, they likewise swell for the same reason. There must not only be Remedies applied to these Knobs and Bruises of young Childrens Heads, but endeavours must be to prequent them, or at least to hinder them from becoming so big: the means to prevent them, is to procure the Delivery assoon as may be, that the Infants Head may not rest so too long, and be straitned by the Garland of the inner orifice of the Womb, which must be well anointed with Oile, or Emollient Ointment, as well to further its dilatation, as that the Head may the sooner and the easier pass. Some may object, That if these Tumours happen, from the cause I have mentioned, they would dis∣appear assoon as the Infant is born, because then the Head being no longer prest, nothing hinders the Blood, which had rumefied the part, from return∣ing, having its motion free: But they must know, that by its too long stay it makes in one part, it looseth the spirits which are there suffocated, of which being destitute, it can no longer move, and being extravased without the Vessels, out of its na∣tural place, (as it will be, when the Vessels con∣taining it are too full) it slides into all the little vacuities of the part, for which cause it cannot af∣terwards Page 380 return by the ordinary waies; wherefore there is a necessity in this case, either that it be resolved through the part, or if it stay any time, that it comes to Suppuration; which however must be avoided, if it be possible, because of the near∣ness of the Brain, which in Infants is not covered over with the Skull at the Sutures, which are alwaies very open, especially towards the Mould. To resolve these Tumours then, assoon as the Child is born, foment them with warm Wine, or Aquavitae, and wetting a Compress in it, put it upon them; some Mid-wives only dip a Compress in Oyl and Wine beat together; others in Oyl of Roses onely, having first fomented them with Wine: but if, notwithstanding this, they come to Suppuration, the matter must not be suffered to re∣main there too long, for fear lest the bones of the Head (which are very tender and thin in new-born Children) become altered and soule; in this case, it must be opened with a Lancet in a proper place, according to Art, putting upon it after∣wards a Plaister of Bettony; if a Leg or an Arm be thus swelled, it must likewise be wrap'd up with Compresses dipt in Wine, wherein Provence-Roses, Camomil-Flowers and Melilot have been boyled. Sometimes also Male-children have the Scrotum very much swelled, which may happen to them by reason of some Waters contained in their Mem∣branes; or because they were bruised, or too rude∣ly handled by the Chirurgeon, or Midwife, in the Labour. In these cases, Compresses dipt in Wine with Roses, are very proper to both. But the greatest mischief is, when the Chirur∣geon Page [unnumbered] Page [unnumbered] [illustration] Chap: XXI. lib: 2 pag: 381 Page 381 (being either inexpert and unhandy in such an Operation, or because of a bad Labour it could not possibly be otherwise) breaks or dislocates a Leg or an Arm of the Child in extracting of them: if it thus happens, you must afterwards help it, by putting together the parts, and keeping them so with fit Boulsters, or Splinters, in their natural scituation, until they shall be well closed and for∣tified. CHAP. XXI. Of the Mould of the Head, and of the Su∣tures being too open. VEry often Children, who come before their time, not having yet acquired their full perfection, as also they which are by nature weak, have the Mould of their Head, and the Su∣tures so open, by the distance and separation of the Bones one from another, that it is very soft and almost without any support, because the Bones easily yeild to every side; these Children are not usually long-lived. One must not think then to bring the bones close together, by binding the Head strait, for this would so presse the Brain, which is very tender, that it would cause a worse Ma∣lady, in taking away the liberty of its motion, whereby its functions would be depraved, and after∣wards totally abolished. It will be sufficient to bind them softly with a small Cross-cloth, lest they should be too unsteady, and commit the rest Page 382 to Natures work, which by degrees will close up these Sutures (in finishing to ingender) and dry up and unite these bones of the Head, which were not hitherto perfectly formed. The place where the Sagittal Suture joins and terminates, in the midst of the Coronal, which it alwaies in every Child divides in two, continuing to the very root of the Nose, is called* the Fountain of the Head, because 'tis the softest and moistest part of it, which for this reason is the last dryed and closed up. The Figure of it is represented in the Head, placed at the beginning of this Chapter. There are Children who have it sometimes open 'till they are three years old, if not longer, which is a great sign of the weakness of their natural Heat. It is usually quite closed up at the end of two years, and sooner or later, according as the Infant is more or less moist, or more or less strong. Until these Bones are entirely closed, 'tis conve∣nenient to lay upon that place (as we have already elsewhere directed) a Linnen Compress three or four double, to defend the Head, as well from Cold, as other external injuries. Some Women keep a piece of Scarlet cloath a long time to it, thinking that it doth strengthen the part more; 'tis no matter what one uses, provided it will keep the Brain warm, and hinder any hurt in that place, which is not as yet covered over with any bone. It happens sometimes, that although the bones of the Head be big enough to unite in all parts, if they were not hindred, they are however extream∣ly distant one from the other in the place of the Page 383 Sutures; because of the quantity of Waters con∣tained between them and the Dura Mater: this Malady is called Hydrocephale, of which there are many sorts, according as the Waters are nearer, or further from the Brain, or that they are contained within its Ventricles. When the Waters are be∣tween the Skin and the Pericranium, or between the Pericranium and the Skull; the Children may be cured of it, if the Tumour be not too great, by resolving of these Waters, or emptying them by an Incision: but if they are in great abundance, un∣der the Bones, between them and the Dura Mater, thrusting them so outwards, and enlarging the Sutures, the Children cannot escape it; which is yet so much the more impossible, if the Waters are contained between the dura and the pia mater, or within the Brain. CHAP. XXII. Of a new-born Babes Fundament being closed up. IT happens sometimes that young Children, as well Male as Female, are born with the Funda∣ment close stopt up; for which reason they cannot render nor evacuate neither the new Excrements engendred by the Milk they suck, nor the Moeco∣nion, which was amassed in their Intestines, whilst they were in the Mothers Belly; of which Disease they certainly dye, if not speedily remedied. Page 384 There have likewise sometimes been Girles, who, having the Fundament closed, yet voided the Ex∣crements of the Guts by an orifice, which nature, to supply its defect, had made within the Vagina, or Neck of the Womb. Now the Fundament is closed two waies; either by a simple Membrane, as the single Skin, through which one may perceive some livid marks, pro∣ceeding from the retained Excrements; and touch∣ing it with a Finger, there is felt a softness within, whereabouts it ought to be pierced: or elss it is quite stopt up by a thick fleshy substance, and in such sort, that there appeares nothing without by which its true scituation may be denoted. When there is nothing but the single Skin which makes this closure, the operation is very easy, and the Children may escape. Then an apertion may be made with a small Incision-knife, cross-waies rather than simple or long, that it may the better receive a round form; and that the place may not afterwards grow together, being very careful not to hurt the Sphincter of the Rectum. The Incision being thus made, the Excrements will certainly have issue: but if because of their long stay in the Belly being become dry, the Infant cannot void them, some small Clyster must be given it to moi∣sten and bring them away; afterwards put a linnen tent into the new made Fundament, lest it close again, which must be at first anointed with Honey of Roses, and towards the end with a drying and cicatrizing Ointment, as Ʋnguentum album, or Pompholix; observing to cleanse the Infant of his Excrements, and dress it again assoon and as often as he renders them, for fear lest their staying too Page 385 long there, may turn the Apertion into a ma∣lignant Ulcer. If the Fundament be so stopt up, that neither marke, nor appearance is seen or felt, then the Operation is much more difficult; and although it be done, it is a great hazard if the Infant escapes it: wherefore if it be a Girl, which empties her Excre∣ments by the Vagina, as it sometimes happens, 'tis better not to meddle with it, than by endeavouring to help an inconvenience, cause the Childs death; but when there is no vent for the Excrements, there is a necessity to come to the Operation, though it be very perillous, without which death would un∣doubtedly follow. To do this well, although there be no outward marks of a fit place, because of the thickness of the flesh which is upon the Intestine, let the Chirur∣geon with a small Incision-knife, that hath but one edge, enter into the void place, and turning the back of it upwards, within half a Fingers breadth of the Childs Rump, which is the place where he will certainly find the Intestine, let him thrust it so forward, that it may be open enough to give free vent to the matters there contained; being alwaies very careful of the Sphincter, after which let the wound be dressed according as we have above directed, having regard to the Acci∣dents which may follow. When it happens, as it is very possible, that the Urinary passage, as well of Male as Female, is stopt up, the like Apertion must be made to give passage to the Urine contained in the Bladder, and afterwards a small Leaden pipe must be introduced into it, to keep the passage open until the Incision Page 386 there made by a Lancet be cicatrized: but as it is very difficult to have such a Pipe retained in a little Boys yard, which because it is so short, will ad∣mit of no proper swathing, it may be let alone, since the Urine which he renders at all hours, will hinder the Apertion from closing. CHAP. XXIII. Of cutting the Tongue, when Tongue-tyed. THe Tongue is naturally tied with a Ligament sufficiently strong, fastened just underneath in the middle of it, to be in stead of a support; upon which being sustained, it may make all its different motions on either side: this Ligament ought to leave it an entire freedom, of being carried and supported in all places of the Mouth: wherefore it must not be so short nor so fastened, but at a con∣venient distance from its extremity, which must be perfectly free on all sides: But often new-born Babes have before it a small membranous producti∣on, usually called the String, which is continued almost to the end of their Tongue, and taking away the liberty of its motion, hinders them from sucking with ease; because the Tongue, being kept down and as it were bridled with this thread, the Infant cannot move it upwards (as it is necessary) to press the Nipple with it against the Pallat, and to suck it to draw the Milk, neither can it move it commodiously to swallow it afterwards. To remedy this inconvenience, you must not Page [unnumbered] [illustration] Chap: XXIII lib. 3. pag. 386 Page 387 do as some Women do, and tear this Thread with your Nails; for that may make an Ulcer there, which afterwards would be hard to cure: but carry the Child to a Chirurgeon, and he will cut as much or as little of it as he thinks needful, with sharp Scissers, cutting at the point, being careful not to cut the proper Ligament of the Tongue, nor to open the Vessels which are under it: to do this Operation handsomely, let him heave up the Childs Tongue with one or both of his Fingers, which he must put under and on the sides of it, that he may discover what is necessary to be cut. But since new-born Children have often their Mouths so little, that it is very difficult so to lift up their Tongue with your Fingers, which being within the Mouth, doth likewise hinder you from seeing what is fit to be done, let the Chirurgeon for this purpose make use of an Instrument, made like a small Forke, as is represented in the begin∣ing of the Chapter of which let him put the two small branches (which must be blunt at the points) underneath the middle of the Tongue on each side of the String, and then lifting it strait up, he will easily command it, by means of which he will make his Operation more commodiously and certainly. This Instrument, because it is little, will not hinder the inspection into the Mouth, as the Fin∣gers which are too-big will do. After that the Tongue is thus dexterously cut, the Nurse must every day twice or thrice pass her Finger, being very clean underneath it, to prevent its growing together again, doing it very gently, for fear of irritating the small wound, that it may not be in∣flamed; which will be a greater hinderance to the Page 388 Childs sucking, and that it turn not into an ill na∣tured Ulcer. CHAP. XXIV. Of Gripes and Pains of the Belly of a young Child. MAny Children are so griped, that they cannot forbear crying night nor day, for the great pains they feel in their Belly, with which some are so vext and tormented that they dye of it. 'Tis very often the first and most common distemper which happens to little Infants after their Birth; which in general and for the most part comes from the sudden change of their nourishment, forasmuch as having alwaies received it by the Umbilical Vessels, whiles they were in their Mothers Belly, they come to change it of a sudden, not only the manner of receiving it, but the nature and quality of it assoon as they are born; for instead of puri∣fied Blood only, which was conveyed to them by means of the Umbilical Vein, they are obliged for want of it to be nourished with their Mothers Breast-milk, which they suck with their Mouth, and from which are engendered many Excrements, causing the Gripes, as well because it is not so pure as the Blood with which it was fed in the Womb; as because the Stomach and Intestines cannot yet make a good Digestion, nor an easie Distribution, being not accustomed to it. Page 389 The particular causes of these Gripes are, either when the Moeconion (amassed during all the time of Pregnancy) is not evacuated soon after the Infants birth, and that by its too-long stay in the In∣testines, it acquires a sharp and pricking Acrimo∣ny; or that becoming hard, the Infant cannot void it, nor the new Excrements which proceed from the Milk, which he hath taken at the first: 'tis also sometimes because the Child not being able to suck with ease, he swallows, in sucking the Milk with difficulty, much air and wind, which being retained in the Stomach, and sliding into the Intestines, doth painfully distend them. This Wind sometimes is caused, when a Child takes a greater quantity of Milk than he can digest; or be∣cause of its ill quality, as when the Woman gives her Breast-milk assoon as she is delivered, with∣out staying to have it purified: Cold may also make it suffer the same. But very often it is for giving him Pap too soon, as also when it is not e∣nough boiled; because this nourishment, which is gross and viscous, cannot be easily digested by a new-born Babe, whose Stomach is not yet accu∣stomed to it; and Worms, that are engendred in the Intestines, by their stirring and biting do also much torment them. Besides all these things already mentioned, the Midwife also may cause great pains in the Childs Belly, by driving back into it the cold and clodded Blood out of the Navel-string before it be tyed. For to remedy all these pains in the Belly, which Women usually call all by one common name of Gripes, respect must be had to their different causes: as to that which is the general cause, the Page 390 too sudden change of the nourishment. To avoid it, one must forbear giving the Child suck, until the next day, lest the Milk being mixt with the Phlegm which is then in the Stomach, corrupt; and at first it must suck but little, until it be accustomed to digest it. If it be the Moeconion of the Inte∣stines which by its long stay causeth these pains; for to help to discharge them of it, give them at the Mouth a little Oyl of sweet Almonds, and Syrup of Roses, as we have directed before; and to provoke it further, give it Beets-stalk, covered over with Honey, for a Suppository; or a sugar'd Al∣mond also dipt in common Honey: or one may give it a small Clyster. If a Child cannot suck with ease, regard must be had to that which hinders it; for if it be Tongue-tyed, it must be cut, as is above directed; and if it be because the Nurse is hard milcht, change her for one whose Milk is better purified; and let her rather suckle it a little and often, than more at once than the little Stomach can easily digest at a time. And above all whiles the Child is griped give it no Pap; because this food, by its viscosi∣tie, doth easily cause obstructions, which after∣wards engender Wind. If it be Wormes, lay a cloath, dipt in Oyle of Wormwood mixt with Ox-gall, upon the Belly; or a small Cataplasme mixt with Powders of Rue, Wormwood, Coloquint, Aloes, and the seed of Citrons, incorporated with Ox-gal and flower of Lupines; and to draw & drive them more downwards, if the little Infant can take any thing by the Mouth, give it a small infusion of Rhubarb, or half an Ounce of compound Syrup of Succory; having before given it a small Clyster of Page 391 sugar'd Milk: for by this means the Wormes, which shun the bitterness of the Medicines, and seek after the sweetness of the Milk, are easily brought away by Stool. When these Gripes are caused by Wind, as it often happens, or by any sharp Humours in the Intestines, anoint the Childs Belly all over with Oyl of Violets, or with Oyl of sweet Almonds, or else with Oyl of Walnuts, Camomil, and Melilot mixt together, having first warm'd them, in which also a Cloath may be dipt to lay upon it; or a small Pancake may be made with an Egg or two fried in Oyl of Walnuts, for to be applied to it; and they may take a little Anodine or Carminative Clyster, according as the cause of the Gripes is known; above all, ever keeping the Child very warm. CHAP. XXV. Of the Inflamation, Ulceration, or shooting forth, or rupture of the Navel of a young Infant. THe continual cries of little Children, because of the Pains and Gripes which they feel at the beginning, doth somtimes cause such an agi∣tation of the Belly, that the Navel-string falling off too soon, and before it be entirely closed and cicatrized, there happens there an Inflammation and Ulceration; at other times also for the same Page 392 reason, although it be outwardly healed, not being so within, it is dilated and thrust outward the bignesse of a small Egg, and sometimes bigger, which is usually called Exomphale, or shooting forth of the Navel. There are some who imagine when it is so in∣flamed and ulcerated, that it was because the String was tied too-near the Belly, which caused a great pain and inflamation to follow: Others say that Nature having used to discharge the Urine by this part, during the Childs being in the Mothers Belly, doth at first still continue to send it this way, and that it causeth this Accident by its acri∣mony, for which there is no reason: for 'tis im∣possible the Urine should regorge from the Bladder to the Navel by the Urachus; forasmuch as it is not hollow in an humane Foetus, as we have else∣where made appear. And how near the Belly soever the Navel-string is tied, and how hard (pro∣vided some of the true skin, which is sensible, be not also tied with it) it can cause no manner of pain to the Child; because it is a dead and inani∣mate part assoon as a Child is born, and likewise insensible; because there is no Nerve distributed into it. But this Inflamation usually comes, as I have mentioned, because the Infant, feeling the great pains and gripes in his Belly, doth continually cry, and thereby hinders the Navel from healing: it may likewise be caused by a violent and frequent Cough, because by these efforts, the Blood is for∣ced back into the remaining end of the Umbilical Vein, which it alwaies keeps dilated, and being corrupted by its stay there, failes not to make an inflammation of the Navel, and that which was Page 393 tyed coming to fall off before it was perfectly heal∣ed, there remains a very bad Ulcer, upon which sometimes follows great loss of Blood, and it may be Death. The principal thing to be observed in the cure of this Malady, is to appease the Cough, and quiet the Childs crying, respecting that which causeth it, without which it would daily increase; and if it were the Gripes, it must be remedied, as is di∣rected in the foregoing Chapter: as to the rest, if the Navel be inflamed, one must lay upon it Ʋn∣guentum refrigerans Galeni, mixt with as much Populeon; or a small Boulster dipt in Oyl of Roses with a little Vinegar: Unguentum Rosatum & Al∣bum, mixt together, is also good for it. If the Navel continues ulcered, after the String is fallen off, Deficcative and Astringent Medicines must be ap∣plied to it, such as is small Rags dipt in Lime water which is not too strong, or Plantane water where∣in a little Allom hath been dissolved. If the Ulcer be small, a Pledgit of dry Lint will be sufficient. Many put to it only a little powder of a Post. These things are better for this purpose than Plaisters, which are never so drying, because of the Oyles and Grease which enter into their composition. But if notwithstanding one would use them, he may take Desiccativum rubrum, or Diapompholigos; par∣ticularly observing to put a good linnen Compress on the top of these Remedies, with a Swath to keep them fast, until the Navel be ciccatrized and perfectly healed; lest besides its Ulceration, it be forced outwards, and that its Vessels open by the violence of a great Cough, or by the agitation which the Gripes cause in the Childs Belly. Page 394 As to the rupture of the Navel in young Chil∣dren, whether great or little, the cure of it must not be otherwise undertaken than by Swathes and Compresses fitted for the purpose, 'till they have acquired a more reasonable Age, when, if the Malady be not cured by the Swathes, the Opera∣tion may be done if desired: But if after the in∣flamation there growes an Imposthume, which causeth the shooting forth of the Navel, and that the tumor of it be very great, then it ever kills the Children, and if it be opened, the matter indeed may be emptied, but there is great danger that to∣gether with it, the Guts come forth in the same place the first time the Child cries, which may afterwards persuade those that understand not the Art, that this accident happened through the Chirurgeons ignorance. For this reason Ambrose Parè in his 94th Chapter of his Book of Generation, adviseth you not to meddle with it, but rather to let the Child die, without doing any thing to it, as he saith he did himself, when he was sent for by a Taylor in the like case. He recites in the same place a story of a Chi∣rurgeon of his time, called Mr. Peter de la Rock, who was in very great danger of his life, for ha∣ving opened an Impostume of the Navel of a Child of Monsieur de Martigues, which being done, the Intestines came forth by the orifice, and soon after the Child died, which the servants of the house reported was thereby caused, and therefore (al∣though without reason) they would have killed him, if the said Monsieur de Martigues had not hindered them: but I believe the Chirurgeon had shunned the danger they put him in, and that Page 395 disgrace, if he had before made a good Progno∣stick of what would follow, and the danger wherein the Infant was; for it may be, resembling many of our time (who undertake such things that they may be thought more able than others, and being but simple fellows, boast themselves capable to work miracles) he had promised speedily to cure the Child of this Maladie, which was incureable, that (under so fair hopes) he might have a good summe in hand paid him. In this we must fol∣low Parey's advice with some distinction; for, if the Impostume be small, and the Child strong, one must not forbear, having first made a good Pro∣gnostick, to open it; and when there is never so little hopes, 'tis better to practise what Art com∣mands, than to forsake the sick in a certain de∣spair. CHAP. XXVI. Of the Smartings, Redness and Inflammation of the Groin, Buttocks, and Thighs of the Infant. IF the Nurse doth not keep the Child very clean∣ly, not changeing the Beds, or washing them each time; or assoon as they are fouled with their Excrements, their acrimony will not fail to cause redness and smartings in the Groins, Thighs and Buttocks; and afterwards, because of the pain, these parts will inflame, which easily happens by rea∣son Page 396 of the tenderness and delicacy of their Skin, from which the*Epider∣mis is at length separated and worn away, if timely care be not taken. The cure of these Indispositions is twofold; (that is) first to keep the Child cleanly: and secondly to take off the sharpness of its Urine. As to the first, the Nurse must cleanse the Child of his Ex∣crements assoon as he hath voided them, shifting it each time with a clean bed, washed in the Buck: as to the second thing to be observed, of tempering the Childs Urine, that cannot be executed but by the Nurses keeping a cooling Diet, that so her Milk may have the same quality; wherefore let her ab∣stain from all things that may heat her. Besides these two generals, cooling and drying Remedies must be applyed to the inflamed parts. Wherefore each time the Childs excrements are wip'd off, let the parts be bathed with Plantane water, mixt with a fourth part of Lime-water; and if the pain be very great, let it only be fo∣mented with luke-warm Milk. Many Women ordinarily use the powder of a Post to drie it, or a little Mill-dust, which they strew upon it. Unguentum Album, or Diapompholigos, spread upon a small rag, in form of a Plaister, will not be amiss: above all, when the Nurse opens the Child, let her be very careful to wrap the in∣flamed parts with fine white rags, that those parts may not, by rubbing together, be more galled and pained. Page 397 CHAP. XXVII. Of the Ulcers (or Thrush) of the Mouth of an Infant. VEry frequently the Milk of a Nurse, that is Red-haired, given to Wine, or very amo∣rous, may by its heat and acrimony cause small Ulcers in an Infants Mouth, which are called Aphthae, and vulgarly Cancers; sometimes also though the Milk have no ill quality in it self, it may however corrupt in the Childs Stomach, be∣cause of its weakness, or for some other indisposi∣tion, in which acquiring an acrimony, instead of being well digested, there ariseth thence biting Vapours, which forming a thick Viscosity, sticking like a kind of white Soot all over the Mouth, doth easily cause and engender these small Ulcers, by reason of the tenderness and delicacy of it. This, Guido makes us take notice of, when he saies, that these Ulcers for the most part happen to Children by the badnesse of the Milk, or by its ill digesti∣on. Of these Ulcers, some are benigne, as they that are caused by a simple heat of the Nurses Milk, or by the Childs blood and humours being a little overheated; or also for having had a small fit of a Feaver, and they are then very superficial, of small continuance, and easily yeilding to Remedies; O∣thers are malignant, such as are caused by a vene∣real Vnome, or that happen after a malignant Page 398 Feaver, and are Scorbutick, which are putrid, corrosive, and spreading, and do not only possess the superficies of the membranes, which covers the roof of the Mouth and Tongue; but making its Scabs deeper, is communicated to all the internal parts of the Throat, as the Venereal ones especi∣ally, which can never be cured by ordinary Reme∣dies, but must be handled with Specificks, with∣out which they ever augment, and soon kill little Infants, who are too weak to undergo the Reme∣dies fit for their cure. The Ulcers of the Mouth, according to Galen, are of difficult Cure; because they are in hot and moist places, where easily Putrefaction and Cor∣rosion is augmented; besides the Remedies applied cannot lodg there, being soon washed away with Spittle. To cure these Ulcers when they are small and without malignity, you must take care to temper and cool the Nurses milk, prescribing her a cooling Diet, bleeding and purging her also, if there be occasion; wash the Childs mouth with Barley or Plantane-water, and Honey of Roses, or Syrup of drie Roses, mixing with them a little Verjuice, or juice of Lemmons, as well to loosen and cleanse the viscous Humours which cleave to the inside of the Childs mouth, as to cool those parts which are already overheated; this may be done by means of a small fine Rag fastened to the end of a little stick, and dipt in this Remedy, wherewith the Ulcers may be gently rubbed, being careful not to put them to too much pain, lest irritating of them, an Inflammation be caused to augment the malady. The Childs body must not be kept open, that the Page 399 Humours being carried to the lower parts, so many vapors may not ascend, as usually do when the Excrements of the Belly are too-long retained. If the Ulcers participate of any malignity, let Topical Remedies then be used, which do their work speedily, and as it were in an instant, for to correct the evil qualities of the humours that cause them, and prevent their further augmentation; for it being impossible if they should remain long in these parts, but their effect and vertue would be hindered, or much diminished by the moisture of the Mouth. For this purpose touch the Ulcers with Water of Plantane sharpned with Spirit of Vitriol, taking great care that the Infant swallows none of it; and the Remedy must be so much the stronger and sharper, as the Ulcers are profound and malignant; assoon as they have been cauterized with this Wa∣ter, by only touching them once or twice with it, according to their bigness, depth, or corruption, that no sharp serosities may distill upon the places not yet ulcered, and upon the Infants Throat, wash its Mouth with Plantane water, or with a Decoction of Barley, Agrimony, and Honey of Ro∣ses, continuing to touch and wash the ulcers as it may be judged convenient, and until you find that they spread no further. To prevent that in the use of these sharp Medicines, not the least por∣tion of them may fall upon the Childs Throat, and that by swallowing of them he may receive no great prejudice, some chuse rather to cauterize these Ul∣cers with small Linnen tents, dipt in boiling Oyl, which though afterwards swallowed, cannot in the least prejudice him. It will also not be amiss to purge the ill Humours out of the whole habit of Page 400 the Child, giving him half an Ounce of Syrup of Succory with Rhubarb. If these Ulcers are maintained by a Venereal venome, these Remedies may for some time hinder their increase; but they will never be cured, un∣less such as are more specifick to that Malady be applied, as we shall hereafter direct. CHAP. XXVIII. Of the pain in breeding the Teeth. THe Teeth which were hidden in the Jaws, usually begin to come forth, not all at a time, but one after another, towards the fifth or sixth Month, sometimes sooner and sometimes also later; for to effect which, they cut the Gums wherewith they were covered. Then because of the exquisite sence of those parts, there happens so great pains to the Children, that many who hitherto were very well, are now in great danger of their life, and often die, by reason of many mischievous accidents which happen to them at that time. Hip∣pocrates names the principal of them in the 25. A∣phorism of his Third Book. In progressu verò quum •am dentire incipiunt, gingivarum prurigines, febres, convulsiones, alvi profluvia, & maximè quum caninos edunt dentes, & his praesertim pueris, qui crassissimi sunt, & alvos duras habent. When, saies he, Chil∣dren begin to breed their Teeth, they are troubled with ching of their Gums, Feavers, Convulsions and Loosnesses, and principally when they breed Page 401 their Tusks, or Dog-teeth, especially those Chil∣dren who are fat (or full of Humours) and bound. The Dog-teeth, commonly called the Eye∣teeth, cause more pain to the Child than any of the rest; because they have a very deep root, and a small Nerve more considerable, which, 'tis said, hath communication with that, that makes the Eye move: and as Hippocrates also saith, Those Chil∣dren which are very gross and bound in their body, are upon this account in much more danger than others; because the pains in these causeth a much greater sluxion of humours upon the diseased part, with which their bodies alway abound when they are costive. The Teeth which are first bred, are the cutting, or fore-teeth, as well because they are sooner perfect, as because, being smaller and sharper, the Gums are easier pierced through, and also with less pain, than by the rest, which are softer at the begining, and being larger cannot so soon make their way, at least not without greater efforts. Signs when Children will breed their Teeth, are when the Gumms and Cheeks are swelled, they feel a great heat there, with an itching, which often makes them put their Fingers in their Mouths to rub them, from whence much moisture distills down into the Mouth, because of the pain they feel there; the Nurse in giving them suck finds the Mouth hotter, they are much changed, and cry every moment, and cannot sleep, or but very little at that time; and one may feel and see small points of the Teeth through the Gums, which ap∣pear thin and pale on the top, and swelled and red on the sides; and if it happens that the Teeth are a Page 402 long time ere they are cut, or that too many of them cut at a time, there is great danger the Children will fall into those accidents mentioned by Hippo∣crates in the aforesaid Aphorisme, and if it do not quickly cease, they'l die of it, as many do. In this case two things must be regarded; the first to preserve the Child from the evil Accidents that may happen to it, because of the great pain; and the second, to assist as much as may be, the cutting of the Teeth, when they can hardly cut the Gums themselves. To prevent these Accidents to the Child, the Nurse must keep a good Diet, and use all things that may cool and temper her Milk, that a Fever may not follow the pain of the Teeth; and to hin∣der that the Humours may not fall too-abundantly upon the inflamed Gums, keep the Childs Belly alwaies loose, to empty them downward, to which purpose give him gentle Clysters, if he be bound; but there is often no need of them, be∣cause at that time they are usually troubled with a Loosness. As to the second, which helps the cutting of the Teeth, that the Nurse must do from time to time, who must pass her Finger upon the Childs Gums, gently rubbing them, that being thereby rarefied, they may be the easier penetrated, and cut by the Teeth, which are ready to come forth; to which also the Child may it self be helpful, if they give it a little stick of Liquorice to champ, or a little end of a small new wax-candle, which is very good to soften the Gum. There is ordinarily made use of a Silver Coral, furnished with small Bells, to di∣vert the Child from the pain it then feels. Some∣times Page 403 instead of Coral, they put a Wolfs tooth in. One must not however believe that these things have any peculiar property, as many Women imagine; but if they are helpful in this case, it is because of their solidity, evenness and smoothness; for the Child rubbing the Gums with it, to ease the itching which it feels there, doth by degrees di∣minish the thickness of them, and so they are at length insensibly cut by the Teeth which are un∣der. If these things do no good, because the Gums are either too-hard or too-thick, that the Child may not suffer so much, nor, by reason of the great pain, fall into those accidents by us above∣mentioned, let the Gums be cut with a Lancet, where the Teeth are ready; Nurses use to do it with their Nails, but 'tis better to be done with* a Lancet, because 'tis not so painful. There are many Remedies, which divers per∣sons assert have a peculiar property to help the cut∣ting of the Teeth, as rubbing them with Bitches milk, Hares or Pigs brains, and hanging a Vipers tooth about the Neck of the Child, and other such like trifles; but since they are founded more on Superstition, than any reason, I will not trouble my self to enlarge upon what is so useless. Page 404 CHAP. XXIX. Of the Loosness of an Infant. ASsoon as little Infants are in the least indispo∣sed, they very ordinarily get a Loosness, to which their natural Moistness very much contri∣butes, as is taught in the 53th Aphorism of the Second Book; Quicunque alvos humidas habent, siquidem juvenes fuerint melius degunt his quae siccas habent, &c. They, saith Hippocrates, who have a loose Belly in their youth, are in better health than those that are bound. Besides that all Children are of a moist nature, and usually, du∣ring their sucking, fed with Spoon-meats, which easily and readily flow from the Stomach and the Guts. For the most part the Loosnesses happen to them by reason of the great pain they have at the cutting their Teeth; for all the Humours are so over∣heated, that they are then very thirsty, which makes them, endeavouring to extinguish it, draw more Milk than their weak Stomachs can digest, which corrupting there, a Loosness certainly follows. It may also happen by the vitiousness of the Nurses Milk, which may be too hot, (as a new-laid Wo∣mans also is) being ever impure, especially the first five or six daies. If the Loosness be not accompanied with a Fever or some other accident, it is not dangerous, be∣cause it is an indisposition convenient to a Childs Page 405 nature and moist habit, as also to the food where∣with it is nourished. Hippocrates assures us as much in the four and thirtieth Aphorism of his second Book. In morbis minus periclitantur quorum naturae, aut aetati, aut tempori morbus magis cognatus fuerit, quam quibus in nullo horum cognatus fuerit. They, saies he, are in less danger, whose mala∣dies are more familiar and convenient to their Nature and Temperament, or their Age, Custom of living, or the Season, than they whose Dis∣ease hath no respect to any of these things. But however, if it continues too-long it will not be amiss to remedy it, lest the Child composed of a tender and soft substance (easie upon this account, if one may so say, to be melted) be not too-much en∣feebled by it, because of the great dissipation of spirits, which the continual evacuation of humours flowing through the Belly effects. For this purpose let it suck well purified Milk, giving it but little at a time, to the end it may the better digest it; and to cleanse his Stomach and Guts of the ill humours, which being contained in, and cleaving to them, will yet so much the more hinder the digestion, give it a flight Infusion of Rhubarb, or a little compound Syrup of Suc∣cory: gentle Anodine Clysters may likewise be gi∣ven, made with Milk, Yolks of Eggs, and Honey of Violets; and after purging, let them be made with Plantane water. One may then also mix the Yolk of an Egg in the Pap he eats; rub the Belly with Oile of Quinces, and lay upon his Stomack Compresses dipt in Red-wine, wherein Provence-Roses are boiled; ever having respect above all to the cause of the Loosness, and the Accidents com∣plicated Page 406 with it, and using Remedies convenient to their nature. CHAP. XXX. Of Vomitings in Children. ONe need not wonder at the Vomiting of little Children, because 'tis an accident more or∣dinary and common to them than any other; nor need one be very careful to stop it, unless it be con∣tinual, and a little excessive; in which case 'tis fit to remedy it, to prevent the consequents of a worse Malady. Vomiting usually happens to Children, because they often draw more Milk than their little Sto∣mach can easily contain or digest, with which be∣ing over-charged, they are obliged to cast it up: it may also happen to them, because 'tis bad Milk. The efforts of a violent Cough may cause the same thing, which also may be effected by their Nurses too rude dancing them in their arms, shaking them too much by violent rocking their Cradle; foras∣much as by those motions the Milk, being too-much agitated and disturbed in the Stomack, can∣not be well digested; but very often also, because it cannot be well contained in it, the Infants Belly being too much compressed and swathed with his Swathes and Blankets in which he is swadled, which makes him throw it up, because of the pain he feels. To all these causes the sweetness and Page 407 luke-warmness of the Milk, wherewith the Infant is nourished, contributes much. When the Vomiting is too-frequent, 'tis fit it should be stop'd, lest by the Infants continual rejection of the Nourishment, he becomes extream∣ly weakned for want of Food; and possibly the action of the Stomach so perverted, that it can hardly be re-established after that this Action is turned into an habit. To cure this Vomiting, regard must be had to that which causeth it: as, when the Child sucks more than it should, the Nurse must not give it so much, and but little at a time, that the Sto∣mach may the easier contain and digest what it receives: if it be the ill quality of the Milk, the Nurse must be changed for a better; if by a Cough, it must be helped by things fit to appease it, according to the different causes wherewith it is excited. The Nurse must not dance it so rudely, nor rock it so fiercely after it hath sucked, that the digestion of the Milk may not be hindered by these agitations. Care must likewise be taken, that it be not too close wrapped and swathed upon the Stomach, but that it may be freely extended ac∣cording to the quantity of Milk received; and be∣sides all this, if any ill humours be contained in it, it will be very convenient to purge the Infant with a gentle infusion of Rhubarb, or half an Ounce of compound Syrup of Succory, and after that it hath been thus purged, if judged to the pur∣pose, it may take a little Syrup of Quinces to for∣tifie the little Stomach, having also upon the re∣gion of it for the same purpose, Compresses wet in Page 408 Red-wine, in which Provence-Roses, Cinamon and Cloves have been boiled. CHAP. XXXI. Of a Hernia, or Rupture in Children. TO the end we may not deviate too much from our undertaking, which is only to observe some particulars concerning Infants maladies, we will not stay to explain, nor throughly to treat of all the different kinds of Hernia's, but be con∣tented slightly to examine those which usually happen to them, as the Intestinal; sometime as compleat in Children as men, as when the In∣testine falls into the bottom of the Scrotum, at other times incompleat when it doth not pass the Groine: It may be likewise some∣times, though rarely, the*Epi∣ploon, which makes the Rupture, and falls down alone as the Intestine doth; and sometimes both the one and the other are there found together. The most frequent causes of Ruptures in little Children are their fierce Cries and violent Coughs, to which the Moistness and Softness of their Bodies doth not a little contribute; and also when they are too-straitly swathed, because their Belly (not being able to be sufficiently enlarged, when they cry or cough much) is strongly forced downwards, by reason of which these Hernias, or Ruptures, are easily made. Page 409 This mischief must be remedied assoon as disco∣vered; for the longer it is neglected, the harder it is to be cured: because by the continual falling of the Intestine, the place through which it falls, is every day more and more dilated. But as Her∣nias easier happen to Children, because of the ten∣derness of their Bodies, so likewise are they sooner cured than in antient persons, because the parts dilated are easier reunited, as well by reason of their tenderness, as that the Intestine (being re∣duced and contained in its natural place whilst the Child is growing) is enlarged in proportion to all the other parts of the body, and the place di∣lated lessens by little and little, and closeth by the compression of the Truss or Swath rightly applied upon it. Whilest Children are in Swadling-Clouts, the cure of true Ruptures, which happen to them, must not be undertaken, but by a Swath-band, which alone is capeable to cure both the perfect and imperfect: and is effected by a Rouler, put∣ting a Compress or Truss just upon the Rupture, after having first reduced into their natural scitua∣tion the Intestine and Epiploon likewise, if it were fallen down: To do this, you must lay the Child with the Head low, then with both Hands reduce it by degrees, and thrusting with one the Tumor very gently, and causing with the other the In∣testine to re-enter, just at the dilatation, and keep∣ing in with it that which re-entred, to hinder its coming forth again, continuing to do thus, until the reduction be compleated, after which one must lay a Compress or Truss thick enough upon the di∣lated place, then swathe it on this manner: Take Page 410 a Rouler of breadth and length proportionable to the bigness of the Child, so that it may go three or four times about, lay then the first end upon the Childs Belly, towards the side opposite to that where the Hernia is, afterwards guide it under the Buttock, then conduct it in bringing it upwards over the applicated Compresse, bring it thence un∣der the Reins on the same side quite round the Bo∣dy, afterwards pass it as at first, continuing to do so 'till you come to the end of it, ever observing that the circumvolutions which pass over the Groin, be brought from below upwards, to keep it the better up, and to fasten them all with small Pins a top of the Compress, that so the swathing may be more firm. It will be very convenient that the Nurse carry the little Infant to a Chirurgeon, to learn the manner of reducing the Rupture, and exactly using the Swath, instead of which a small Truss may be had, which will be yet better for this purpose, because there is not so much trouble in removing and undoing it so often as there is in a Swath; for which purpose it ought to be waxed, or oiled on each side, that the Childs excrements may not rot it. Now if one would have these Swathes or Trusses speedily to cure the Rupture, 'tis very fit the Child should keep its Bed, at least fourty daies, or more according to the bigness of the dilatation: let care be taken to prevent its Crying and Coughing as much as may be, and that the Belly be not swathed too strait, lest those things do again force the In∣testine to come forth. Some before they apply the Swath, foment the part with Smiths-water, and then lay the Plaister of contra Rupturam upon it; Page 411 but this is not necessary, when a Truss or Swath may be sufficient, provided it be well applied. Besides these true Hernia's, of which we have just spoken, there may be also false ones, wherein no part falls down, but only there is a distention of the Membranes of the Scrotum and Testicles, caused by some matter there collected, as well through the natural weakness of those parts, as with being bruised and pressed in a bad Labour, amongst which the watry and windy happen oftenest, for as for the fleshy and varicose, they happen never, or but very rarely in little Infants. For the cure of the watry, called Hydrocele, which is caused by waters contained in the com∣mon or proper membranes of the Testicles, apply to the swelling Remedies that may resolve and dry up the Waters therein, and dissipate the wind, and afterwards fortifie the parts. They may be resolved with Fomentations of the Decoction of Camomil, Melilot, Rue, Majoram and Fennel, in which also the Compresses to lay upon them may be dipt; they may be dried with Lime-water, wherein a little Allom is dissolved; and after that the greatest part of Waters are resolved and dried away, let the parts be fortified, lest others be there ingendred, by putting to it Compresses wet in red Wine, wherein Roses and Allum have been boiled, ever having respect to the cause of the Hydrocele, and that which feeds it; but if these Remedies prove in vain, the Tumour must be opened, to evacuate the Waters by a single prick of a Lancet, with which one must be satisfied in little Infants, who for the weakness of their Age, tenderness of their Bodies, and want of the use of their reason, cannot Page 412 then undergo a greater Operation for the Cure of an Hydrocele. CHAP. XXXII. Of the Scabs which are upon the Head and Face of young Children. WE intend to treat here only of such Scabs as have no malignity, and are only caused by the supurfluity of some Humors, which for be∣ing simply over-heated, are easily conveighed to the Head and Face, where they make little Pim∣ples, in which these humours continuing are cor∣rupted and converted into matter, which after eat through and ulcerates the simple superficies of the Skin, and drying round about the place where it came out, make those crusts there, usually called Scabs, with which some Childrens Head and Faces are every where so covered, that they seem to have a Cap and a Mask of a piece, for which nothing can be seen, but only the Eyes and edges of the Lips, which are exempt from it. Many persons will have these Scabs, aswell as the Meazels and Small-pox, to proceed for the most part from some superfluity and residue of the men∣struous blood, from which the Infant purgeth it self after it is born; which because it cannot be well rectified, is so driven out that it may be cast off as useless: but it is often from the ill nourish∣ment of the Children, who sometimes suck more Page 413 Milk than they can digest, as also from the ill qua∣lity of it, whence is engendred a quantity of viscous and corrupt humours, causing these Scabs, which come most upon the Head and Face, because they are moister, especially in Children, than any other part of the body. These Scabs may be known not to be malignant, when they are superficial, moist and yellowish, and when the Scabs being taken off, the Skin appears red and crimson, without being deeply ulcered. The course of these humours must by no means be hindered, by driving them inwards, because their evacuation defends little Infants from many ill Dis∣eases; and we ordinarily see them, whose Bodies have a long time purged away such superfluities, to be in better health after they have cast forth all this kind of corruption: and as Guido saith very well, Though to the sight these Scabs are ill, yet in respect of their cause they may be very good; be∣cause nature is thus accustomed to purge the Infants bodies in thrusting out these excrements, but endea∣vours must only be used to hinder the generation of more of these ill humours in the Child; wherefore a healthful Nurse must be provided for it, whose Milk is perfectly purified, and very cool; the Childs Belly must ever be kept open, and purged if necessary with a little Syrup of Roses or Succory, that so the humours may not be sent in too great abundance to the Head, nor the sanies under the Scabs may not, eating and corroding the Skin, cause deep Ulcers; it will not be amiss also to make the Scabs fall off, that there may be a freer vent or issue, for which fresh Butter is ordinarily made use of, rubbing them therewith to moisten Page 414 them, or with the Liniment of Oile of sweet Al∣monds, laying afterwards a Cabbadg or Beet-leafe upon it, changing them twice or thrice a day, to avoid the offence and corruption of the moisture which these things draw forth. These things ought to be continued till the Child be perfectly cured, and no other, because they do very much suppurate the Scabs; and only draw away the superfluous humours, which should in no wise be retained within, for fear lest a worse malady happen after the evacuation, of which the places will dry, and heal of themselves; all this while the Childs hands must be pinned down, lest by rubbing and scratching the Scabs when they itch, should by irritating these parts cause an in∣flammation, whereby a yet greater abundance of humours will flow thither. CHAP. XXXIII. Of the small Pox and Meazels in Infants. THe small Pox is a contagious Disease to little Infants; which somtimes also happen, though more rarely, to persons already advanced in age, in which abundance of Pustules all alike do break forth throughout the superficies of the Skin, en∣gendred from the impurity of the Blood and other Humours which nature there casts out, as an uni∣versal emunctory to cleanse the whole body of them. Many antient as well as modern Physicians at∣tribute Page 415 the cause of this disease to the residue of the menstruous blood, wherewith the Infant was nou∣rished in the Mothers Womb, which after its birth coming to be heated, and to boil in the Ves∣sels, is separated from the whole Mass of Blood which hath been since engendred, and is spread throughout all the superficies of the Body, to be in that manner rejected and expelled. This rea∣soning (according to my opinion) is not very probable, for we daily see many Men and Women, who though very aged, have never had this Malady, which they could never have avoided, if it proceed∣ed from the remainder of the menstruous Blood, wherewith every one without exception is nou∣rished in their Mothers Womb. They which main∣tain this opinion, reply, that though some persons be exempted from this Disease, 'tis because their strong and robust nature could digest and consume those superfluities, or else purge them off by other wayes, as by a Loosness, or in some manner more insen∣sible: However they must confess and agree, that this menstruous Blood (if it were that) could not remain hid and quiet in the Body for 30, 40, or 50 years after Birth, without producing its effects, as we see in several that have not this disease 'till those years; but 'tis much more credible, that the cause of the small Pox is the corruption of a contagious Air, which doth principally infect and spoil the blood of Infants and Youth, who are more disposed to it than they that are further ad∣vanced in years, because of the tenderness and softness of their Bodies, and more at certain years and some seasons than at others, as it may easily be perceived every day; for in pestilential times, the Page 416 small Pox is much more common in the Spring and Summer, than at the end of Autumn or in Win∣ter. The small Pox doth differ from the Meazels, though they are so like in the beginning, that often it is difficult to distinguish them one from the o∣ther 'till after the second or third day, when the small Pox, which at first appeared like the Mea∣zels, begins to rise into Pustules, and to whiten. The Meazels are caused of a Blood bilious and over∣heated, which only makes red spots throughout the Skin, without or with but very little elevati∣on, which comes soonest and principally on the Face; but the small Pox proceeds from a sanguine and pituitous matter, which being more thick and viscous, produceth many Pustules rising high, and by degrees growing white and ripening, after which their matter drying away, they are con∣verted into Scabs. Of the Signs of the small Pox, some precede and others accompany them; they that precede are a Fever, Sottishness, Dizziness and Pain in the Head, very troubled Urine, wea∣riness and pains in the Reins and Loins, reachings and vomitings, difficulty of breathing, frequent Yawnings, Sneezing, itching of the Nose, redness of the Eyes, and universal weariness all over the Body: but when the small Pox begins to come forth, there appears about the third or fourth day many Pimples rising every where, which grow and augment as well in bigness as number, 'till the eighth or ninth day, during which time they ripen and whiten by degrees, the Head and Face swells, the Eyes are closed by a great flux of hu∣mours Page 417 thither, the Nose is stopped with excrements which there dry, the Patient is troubled with a hoarse Voice, a dry Cough, sore Throat and great difficulty to breath; and then all the parts of the Body are so swelled through the abundance of Pimples, that it appears blown up and monstrous. There may be two kinds of small Pox, according as it is more or less malignant; the first is that which is accompanied with but a simple emotion of a Fever, only stirred up by an ebullition of Blood and Humours, soon ceasing from the beginning without any evil accident, which ripens, suppu∣rates, and is easily and speedily cured; the Pu∣stules of these do rise full, and the matter is white, smooth and well concocted, and the Infants easily escape it, if they are but well tended. But the other sort of small Pox, totally malignant, is that which is caused from some contagious and pestilential humour; where the Pustules are flat, brown, obscure or livid, having small black spots in their middle, they come forth but slowly, and no Suppuration follows, or 'tis very bad, sanious, watry, and accompanied with pernitious accidents, as a malignant Feaver, Phrenzy, great difficulty of Breathing, Faintness, Dysenterie, and others which often are mortal, or at least malignant Ul∣cers, foulness of the bone, loss of sight, disfigure∣ment and great deformity of the Face, or lameness of some member, according to the places where these vitious humours are conveyed and retained. These havocks are caused by that which all Women call usually the Master-pock, which is nothing else but many Pimples, by their neerness and bigness joining together, and mixing their matter, which Page 418 being thus in great quantity amassed into one place, gnawes and corrodes the part deeper, than if they were spread and disperst in many distinct Pustules; for which cause its cavity remains much more hol∣low and deformed, by reason of the great loss of substance there usually made, and depositing or transporting this villanous matter upon the Bones or other parts, it foules them, or causes their other accidents, as we have recited. The Prognostick is drawn from the different nature, which we have now explicated: for if the Fever be small, and that it ceases proportionably to the coming forth of the Pimples, if they be not in too great quantity, and that they ripen and whiten speedily, it is a good sign; but if the Feaver be violent in the beginning, and augments every day with difficulty of Breathing and other acci∣dents, according as the Pimples come forth; if they are in great number, black, flat, dry, and without Suppuration, it is a sign of death: besides Infants are not in so great danger as elder persons, in as much as this Disease is more agreeable to their Age and Nature, and that they also have a thinner and softer Skin, through which this matter is easier expelled than through theirs that is harder, and whose Pores are less open. As to the Meazels, they are never so dangerous as the small Pox, because its matter being more sub∣tile, is much easier and sooner evaporated, which usually terminates in three or four daies, at the end of which sometimes follows the small Pox, which often makes some, as we have said, take them one for another in the beginning, at which time they appear almost the same. Page 419 The Cure of the small Pox particularly consists in the force and vertue of nature, that endeavours to expel these malignant humours; wherefore it must be assisted to overcome them as much as may be, and fortified that it may be able to finish the work it hath undertaken, being very careful not to di∣vert it from its operation by an untimely bleeding, or a Medicine unseasonably given. To remedie this Malady, keep the Child to a good diet, avoiding solid meats all the time, giving it only Spoon∣meats, as Broaths made with Veale and Fowl, or a little of a good Jelly; let his drink be Ptysan, made with cleansed French-Barly, the roots of Dogs-grass and Liquorice, and a few Raisons of the Sun. If it be a sucking Infant, he must have no Pap 'till he be perfectly cured; and since then by reason of his age he cannot receive Remedies often enough, nor other food at the Mouth than Nurses milk, let her observe a good Diet her self, to re∣fresh and temper her Milk, as much as may be; let her not carry the Child into the Aire, but keep it in a close Room neither too hot nor cold: for too hot Air weakens it extreamly, by greatly resol∣ving and dissipating the spirits; and a too cold Air drives the Humours back into the Body, and hin∣ders the coming forth of the small Pox. Some ad∣vise it to be kept in a Bed hung round with Red Curtains, because this Colour doth ordinarily move the Humours from the Centre outwards; but this often hurts the Eyes, and inflames them by its vivacity, to which also in this disease there happens a great flux; wherefore I believe a softer Colour, what ever it be, ought to be preferred; but custome will have it so. The Infants sleep must be Page 420 moderate, that the Humours being thereby better concocted and digested, the coming forth of the Pustules may be the freer; it ought not to be to a Stupidity, for that would be a sign nature were opprest; let the Belly be kept moderately open with gentle Clysters, that the Excrements may be thence evacuated, if too long retained. But when the Small Pox is in the beginning ac∣companied with a great Fever, difficulty of Breath∣ing and other Accidents, the principal Remedy is Bleeding, although most Women not understand∣ing the Case do condemn it, and will not suffer it to be done to their Children, imagining that it would hinder the coming forth of the small Pox; and if it happens that the Children after bleeding die, although it be through the greatness and ma∣lignity of the Disease, they will not fail to impute it to Bleeding: but it is very certain this is a pro∣fitable Remedy in the beginning of this Disease, for by this means all the Humours are cooled, and the fulness of them being evacuated, Nature easily comands and overcomes the rest. As to purging, it ought not to be used in the beginning, lest by the agitation it makes in the humours, Nature be hindered and diverted from doing its work; but towards the end it will be very convenient to empty the remaining impurities, lest these reliques fall∣ing upon some parts should spoil them. All this while such things must be used as may fortifie the Heart; as Cordials, not of the sort of those pretended Cordial and Threacle Waters, which ordinarily are made use of, and rather cause one to vomit, than fortifie the Heart; nor those powders of Pearl and Bezoar, and other such like Page 421 trifles, which many superstitiously believe, with∣out any reason, to have a specifick quality to this purpose; but the truer and more salutary Cordials are, the breathing of sweet and clear Air, and wholesom diet, with the moderate use of things agreeable to the Stomack, and which please and comfort it; such as are Syrup of Lemmons and Pome-granats, mixed with the Childs Ptysan; or a little Wine well allayed with Water, which is the Cordial of Cordials: if the Fever be not great, and that it is a sucking Child, the Nurses Milk ought to be sufficient for all. As to outward Remedies, or application to the Pustules, 'tis best to leave it to Nature, only assist∣ing it as we have said. And to the end they may ripen easier, assoon as they begin to appear, which is about the third or fourth day, anoint them, principally those of the Face, with oile of sweet Almonds, rubbing them with a Feather dipt in it: some mix a little Cream with it, others use only a a little fresh Butter, and others again old Hogs∣grease melted, and often washed in Rose-water, and well beaten in a marble Mortar, with which they anoint them 'till they are perfectly healed: and when the Pustules are ripe enough, which is known by the whiteness and itching that follows, and is usually about the ninth day, the biggest of them may then be pierced to empty the matter, lest by its too long stay there it ulcerates and cor∣rodes the parts too deeply. This may be done with a gold or silver Needle, or by cutting off the tops with Scissers; afterwards to dry them up, anoint the Face with a Liniment made with fresh Cream mixed with white Chalk, continuing this Remedy Page 422 'till the Scabs be quite fallen off, using it Nights and Mornings; or else with Ointment of Roses mixed with a little fine powdred Ceruse. To hinder that the small Pox do not cause too great a flux of humours upon the Eyes, 'tis good using from the beginning some cooling Remedies, that, by moderately driving back, may hinder it. There is ordinarily used Rose-water and Plantane-water mixed together, with which they bathe them from time to time; most Women steep a little Saffron in it; but because of its strong scent, I chuse rather the Waters alone: The Nurses Milk is likewise very good to appease the pain. Care must be also taken from time to time to unstop the Infants Nostrils, that he may breath the freer, which may be done with small linnen tents; and to help the Throat, which is alwaies hoarse, a lit∣tle Syrup of Violets mixed with his Ptysan may be used; and to cut the phlegm that sticks there, give it a little Syrup of Lemmons or Pomegranats, or a Gargarism of Vinegar and Water; but the Milk only is sufficient for sucking Children. Let us now see how a sucking Child must be governed in the French Pox. CHAP. XXXIV. How to cure the Venereal Lues in Infants. IF the small Pox, of which we have lately dis∣coursed, be a contagious malady, it is not so ordinarily but in respect to Infants, for it is hardly Page 423 communnicated by frequentation to elder persons; but it is not the same in the great Pox, the venome of which is so pernitious and susceptible, that a single Child that hath this Disease is capeable to communicate it, as it hath been very often seen, to whole families, and as well to old as young. 'Tis a sad thing to see poor small sucking Innocents afflicted with so ill a Disease, which besides that it makes them suffer the pain of a sin of which they are innocent, it makes them also very often be abandoned by every one, and deserted in this de∣plorable state by their own Mother her self. Those that have this Disease so young, either bring it with them into the world from their Mo∣thers Womb, which may be known if she were infected with it; or if it had at its birth Pustules and Ulcers in divers parts of its Body, and prin∣cipally about the Belly, towards the Fundament, and on the inside of the Thighs, as also on the Head: or else they got it since, and took it from their Nurse, who is in like manner infected with it; then the first impressions will appear about the Mouth of the Child, where Ulcers will breed, be∣cause of the acrimony of the ill Milk it sucks, which being its nourishment, will not fail to communicate its venom to all the parts of the Body. 'Tis very hard to cure Children that are born with this disease, for they very soon die after; be∣cause their whole substance cannot be reestablished, having for its foundation had so bad a principle, as the Mothers Blood infected with such a venome, wherewith they have been engendred, formed and nourished: but as to those who have received it from their Nurses only, there is much more hope Page 424 of, and less difficulty in their cure; because the venom of the bad Milk not communicating it self immediatly with its whole substance in the Vessels of the Infants Body, doth not there make so great a spoil as in the other, where the Blood, with which it is only nourished whilst it is in the Mo∣thers Womb, is conveighed to him and spreads, such as it is, throughout all the parts of its Body: for then there is only the purest of this Pockey milk, or to say better, the less impure, which (being changed into Chyle in the Stomach, and purged by the Intestines of the greatest part of its Excre∣ments) can by mixing afterwards with the mass of Blood, alter and corrupt it by the ill quality that alwaies remains in it, notwithstanding the diffe∣rent preparations it hath received; however the Child infected by the Nurse can never be cured, so long as she suckes it, forasmuch as her Milk is ever infected with that corruption and venome; and the worst is, that changing her for another, as one is obliged to do to cure it, 'tis a very great hazard if it doth not communicate this contagious malady to her. It may be said in general, that the cure of the great Pox is very difficult in little sucking Chil∣dren; for by reason of the feebleness of their age, they cannot then neither take nor support without great danger of their life, the violence of Remedies convenient for it; wherefore it were to be wished, that by a palliative Cure one might delay a com∣pleat one, until they be three or four years old; but since there are very many who would perish before they were so much as a year or two old, because this filthy disease doth ever increase, and Page 425 the symptomes of it do much easier make impressi∣ons upon their Bodies, because of the delicacy and tenderness of them, than upon such who are more advanced in years; therefore one is somtimes obliged to undertake the cure, though the Child be yet sucking. This enterprise is then in truth very perillous, but one is constrained to resolve on it, when there is no appearance or hope that the Child can otherwaies escape. Wherefore the means follow. First therefore change the Nurse, if she be in∣fected, for one whose Milk is well purified; and if it be not so, let her be blooded and purged, as the case requires. Most would have her, during the whole course (that her Milk may be very Physical) use a Treacle-water and a Sudorifick decoction; but besides that I think these things will be very in∣effectual, I fear lest by heating her Milk, it may prejudice instead of profiting the Child; and I should advise her rather to keep a temperate and cooling diet; and that she may not herself receive any hurt, it will not be amiss for her to wash her Nipple with Wine, every time she gives the Child suck; and that she now and then take a Purge, to keep her Body clean and less disposed to receive this infection. But very often these poor little Children thus afflicted, are so unhappy, that they cannot find any Nurse, that will by giving them suck, expose themselves to the hazard of getting the disease: in this case we must choose one that hath abundance of Milk, and is soft milcht, to the end that by gentle squeezing of it, there may fall enough into the In∣fants Mouth for its nourishment: or that by ha∣ving milked some in a glass, they may feed it with a Page 426 Spoon; or else they may dip a piece of Linnen rolled up in it, and give it to suck. But the best way to avoid the Childs spoiling any Nurse, and to ex∣empt it from such a subjection, is to let it suck a young Goat, fed on purpose with good Hay and other convenient things, that so the Milk of it may be very good. As to the Child, it is most certain it can never be cured of a confirmed Pox but by the use of Medi∣cines wherein Mercury is mixed, which hitherto is esteemed the proper Antidote to the poison of this Disease: wherefore after bleeding and purging him with Syrup of Roses, or of Succory, let him, if his strength permit, be a little anointed with a Mercu∣rial Ointment, wherewith only the Pustules and Ulcers must be rubbed, in doing which by de∣grees, reiterating the unctions, a small Flux will be raised, which must be almost insensible, lest the Humours being stirred and conveighed in too great abundance to the Mouth, cause it not to swell too much, and breed there naughty Ulcers, which may hinder the Sucking of it: Wherefore but a small quantity of Mercury must be mixed with the Ointment, being better to be a longer time a curing, than too precipitate: for this cause having used a small Friction or two at the most, forbear five or six daies, to mark to what degree the Infant will be moved with it; and then by the effects of the first, you may judge whether it is necessary to re∣iterate them, and with what dose, which can ne∣ver be precisely directed; because all the habits of Infants are as well different as those of men, a∣mongst whom some will spit sooner with one Fri∣ction, than others with six immediatly after one Page 427 another. But in this case there is nothing near so great danger of hurting by too little, as there is by too much: it being more easie to repeat and aug∣ment the dose when not strong enough at first, than to stop the effects when it exceeds. One may, instead of Frictions, or together with them, wrap the Infant in a bed lightly perfumed with Mercury; and as to the Ulcers which breed in the Mouth, let the Nurse wash them with Barley-water boiled with Agrimony, adding to it a little Honey of Roses, or Syrup of Worm-wood with white-Wine, wherewith also the Nurse may often wipe off the froth which is usually there ga∣thered; which, that he may void the easier, let him lye upon his side, and not upon his back, lest the flime falling into the Stomach, or upon the Lungs, should choak it. Let him alwaies be kept warm, without carrying him to the Air, watching diligently the effect of the Remedy, which in this case ought to be managed by a prudent and expert Chirurgeon, and not left to the discretion of every one. The common way to make this Ointment is to take half an Ounce of Mercury, which must be well cleansed from its filth, by passing several times through a double Linnen, afterwards beat it well in a Mortar with four Ounces of Hogs-grease, so much and so long 'till it is wholly incorporated; which being done, take two drachms of this Oint∣ment for each friction, and more or less according as the Infant appears to be strong and disposed to be moved by it, of whom chiefly the Pustules and Ulcers must be anointed, as we have said. Pigray affirms, that he hath seen Infants cured by being Page 428 rubbed with Hogs-grease, only stampt in a leaden Mortar; but it is ever by reason of the Mercury, from whence the Lead derives all its quality. CHAP. XXXV. How to hinder Childrens growing squint-eyed, awry, crooked, or lame. THe Bodies of little Children, by reason of their tenderness are like soft wax, or young Trees, to which 'tis easie to give such a Figure, as is in the begining desired; wherefore one must be then very careful that the good conformation of their small Members be not vitiated for want of pru∣dent conduct, or else being so, they may be by a diligent care reduced to their natural state; now amongst other things, endeavour to prevent the Childs squinting, growing awry, crooked or lame, and to redress any of these whatsoever, as much as possible. To prevent its Squinting, chuse a Nurse whose sight is stable and right, lest by her ill example he gets an ill habit; and as we have said elsewhere, let the Cradle be ever so placed, that being laid in it, he may alwaies see the light directly before him, either of day, candle, or fire, lest by be∣ing on one side, he come to turn continually his Eyes that way, whereby he will be in great danger of growing asquint: Paulus Aeginetus and Pa∣reus also would have a squint-eyed Infant's sight redressed, by putting a Mask upon his Face, with Page 429 only two small holes right against the Eyes to see through; which will cause him, perceiving no light but through those holes, to hold his Eyes ever that way, by means whereof they will be esta∣blished in a right scituation, and by degrees quit the ill habit they had gotten of looking aside. This counsel seems good in appearance, but I believe it will be very inconvenient for a Child to follow it: besides that the least removing of the Mask, on which side soever, the little holes not corresponding perfectly in a direct line to the middle of the Eyes, the sight will be thereby more perverted. To prevent a Childs growing crooked, awry, or lame, the Nurse must swaddle its Body in a strait scituation, equally extending the Arms and Legs, and swathing the Child sometimes one way, some∣times another, lest swadling it alwaies one way, the parts should take an ill habit. When he is laid in the Cradle, he must be streight on his back, and not bending; and above all when the Nurse holds him in her Arms, let her carry him sometimes upon one, and sometimes upon the other; for holding the Childs Legs alwaies on the same fa∣shion, it would be a great hazard if they did not at length grow crooked: and it is often the only reason, that so many Children have crooked Legs, especially about the Knees, and this few Nurses take notice of, which notwithstanding is of great consequence. When these parts have an evil conformation in their Figure, they must be helpt with Swathes and Boulsters conveniently placed, to keep the parts in a good posture whiles the Child is in swadling Clothes, afterwards being grown a little Page 430 bigger, one may use little leather Boots, somewhat stiff, with which the Legs must be straitned; and if the Foot be only awry, Shoes underlaid of one side higher than the other, will serve the turn. When the Breast or Back-bone are in fault, it must be helped if possible, or at least hindered from growing worse, and the fault may be hid, by or∣dering the Childs clothes with Past-board, Whale-bone, and Tinne, placed where the Chirurgeon shall think fit, to reduce the mishapen part to a better Figure. Having hitherto mentioned the most ordinary Diseases befalling little Infants, 'tis not necessary here to make a larger description of them; for as for those that we have not treated of, since they may indifferently happen to all sorts of ages, they have nothing peculiar in respect of Children, as to the knowledg or cure of them, but only for the tenderness and delicacy of their Body. There now remains only for to finish our under∣taking, that we give necessary directions in the choice of a good Nurse. CHAP. XXXIV. Of the requisites and necessary conditions in the choice of a good Nurse. THe first and principal of all the qualities in a good Nurse is, that she be the own Mother of the Child, as well because of the mutual agree∣ment Page 431 of their tempers, as that having much more love for it, she will be much more careful than an hired Nurse, who ordinarily loves her Nurse-child but with a feined and seeming love, having no other end or foundation but the hope of her recompence she expects for her pains by a mercenary hire. Wherefore the true Mother, though not the best Nurse, should ever be preferred before a Stranger. But because there are several that either will not, or cannot suckle their own Children, whether it be to preserve their beauty, as all persons of quality, and most of the Citizens do; or that their Hus∣bands will not suffer them, nor be troubled with such a noise; or that being ill or indisposed, they cannot, there is then an obligation to provide an∣other Nurse, which should be chosen as convenient for the Child as may be. Now even as we see Trees, though of the same kind, & growing in the same place, being afterwards transplanted into another soil produce fruits of a different taste, by reason of the nourishment they draw thence; Even so the health of Children, and sometimes their manners, depends on the nourish∣ment they receive at the beginning: for as to the health of the Body, 'tis well known it answers the Humours that all the parts are nourished and maintained with, which Humours ever retain the nature of the food whereof they are engendred: As for the Manners, they ordinarily follow the Temperament, which also proceeds from the qua∣lity of the Humours, and the Humours from the Food. By this consequence, as the Nurse is, so will the Child be, by means of the nourishment which it draweth from her; and in sucking her, it Page 432 will draw in both the vices of her Body and Mind. This appears very easily in Animals that suck a strange Dam, for they alwaies partake something of the creature they suck; being accordingly either of a mild or fiercer nature, or of a stronger or weaker Body; which may be noted in the example of young Lions, tamed by sucking a domestick Animal, as a Cow, Asse, or Goat; and on the contrary a Dog will become more furious or fierce if it sucks a Wolf. The necessary conditions in a good Nurse are usually taken from her Age, the time and manner of her Labour, the good constitution of all the parts of her Body, and particularly of her Breasts, from the nature of her Milk, and in fine from her good Manners. As to her Age, the most convenient is from twenty five to thirty five years of age, because that during this space the Woman is most healthy, strong and vigorous: she is not fit before five and twenty, because her Body not having yet acquired all its dimensions, cannot be so robust; nor after thirty five, because not having Blood enough in so great abundance, she cannot have Milk enough for the nourishment of the Child. However some Women are indifferent good Nurses from twenty to fourty, but very rarely before or after. As to the time and manner of her Labour, it must be at least a Month or six Weeks after it, that so her Milk may be throughly purified; because at that time her Body is usually cleansed of the Lo∣chia, which follows Labour, and the Humours are no longer disturbed with it, nor must it be above five or six Months, that so she may be able Page 433 to make an end of nursing the Child, that there may be no necessity to change her afterwards for another; she must not have miscarried, but have been brought to Bed at her full time of a health∣ful Son, for 'tis a mark of a good constitution; and it must be her second or third Child, that she may by experience know the better how to tend her Nursery. As to the healthful constitution of her Body, 'tis the principal thing, and on which almost all the rest depends. In general she must be very health∣ful and of a good habit, not subject to any distem∣per; that she come of Parents that never had the Stone in the Reins or Bladder, not subject to Gout, Kings-evil, Falling-sickness, or any other heredi∣tary disease; that she hath no Spot, nor the least suspicion of any Venereal Distemper; that she have no Scab, Itch, Scald, or other filth of the like nature; that she be strong, the better to watch and tend the Child in all things necessary for it; that she be of a middle Stature, neither too tall nor too low, too fat nor too lean; because a person of such a natural Symmetry performs all the functions more perfectly, and as is usually said, In medio consistit Virtus. But above all she must not be with Child; let her be of a Sanguine com∣plexion, which may be known by her Vermilion, colour, not altogether so red, but inclining to white; of a firm flesh, not soft; she must not likewise have her Courses, for that's a sign that her Blood is too hot, either because her Temperament is such, or from some amorous passion or otherwaies; neither must she be subject to the Whites, for such superfluities are a sign of a bad habit; she must not Page 434 be red haired, nor marked with red Spots; but her Hair must be black, or of a Chesnut brown; she must be well shaped, neat in her Cloaths, and comely in her Face, having a sprightly Eye, and a smiling Countenance; she must have good Eyes, sound and white Teeth, not having any rotten or spoiled, lest her Breath should smell; she ought to have a sweet voice to please and rejoyce the Child, and likewise ought to have a clear and free pronun∣tiation, that he may not learn an ill accent from her, as usually red-hair'd have, and sometimes also those that are very black-hair'd and white skins; for their Milk is hot, sharp and stinking, and also of an ill taste; she must not have a strong Breath, as they who have a stinking Nose, and bad Teeth, as we have said before; because the Nurse that constantly kisses the Child, would in∣fect its Lungs by often drawing in her corrupted Breath: her Breasts ought to be pretty big, to re∣ceive and concoct there a sufficient quantity of Milk, but not big to excesse; they must be sound and free from Scars proceeding from former Im∣postumes; they must be indifferent firm and fleshy, and not flaggy and hanging, that their natural hear may be the stronger. The Nurse must be broad breasted, that her Milk may have more place to be prepared and digested in, and because 'tis a sign of abundance of vital heat: As to the Nipples, they must be well shaped, that is, not too big, nor too hard, nor grifly, nor sunk in too deep; but they must be a little raised, and of a moderate big∣ness and firmness, well perforated with many little holes, for to be soft milcht, that the Child may not take too much pains to draw the Milk by Page 435 sucking and pressing them with its Month. If a Nurse hath all these recited good qualities respecting all the parts of her Body, there is reason to presume her Milk will be well conditioned, which may be known first by its quantity, which ought to be sufficient for the Childs nourishment; nor must it be too much, lest that not being all drawn forth, it curdles and inflames the Breast by its too long stay there; but however it is better to have too much than too little, for she may give the overplus to another Child. It must be of a middle con∣sistence, neither too waterish nor too thick; which may be easily judged, if the Nurse milking some into her hand, and turning it a little on one side, it immediately runs off; but if it remains fixt, without running by the turning of the Hand, 'tis a mark it is too thick and viscous: The good is of a consistence between both, which slides off gently in proportion to the turning of the Hand, leaving the place whence it slid a little stained. As to the colour, the whitest is the best, and the lesser white it is, so much the worse; it must be of a sweet and pleasant smell, which is a testimony of a good tem∣perament, as may be seen in red-haired Women, whose Milk hath a soure, stinking and bad scent: and to be compleat in every quality, it must be well tasted, that is, sweet and sugared, without any acrimony or other strange taste. We must not forget the principal and best Con∣ditions of a Nurse, which consists in her good manners: wherefore let her be vigilant and careful to cleanse the Child assoon as there is occasion; let her be wise and prudent, not subject to choler nor quarrelsome; as well because in the beginning Page 436 it may make bad impressions on the Child, as be∣cause this passion doth extraordinarily heat the Milk; she must not be melancholy, but merry and cheerful, smiling often to divert it; she must be sober and not given to Wine, and yet less to the excess of Venus; but she may moderately use the first, and not totally abstain from the second, if her nature require it, provided it be with her Husband, which liberty is freely given them by Jubertus in his seventh Chapter of his fifth Book of popular Errors, founded upon the experience of all poor Women, who bring up their Children very well, notwithstanding they lie every night with their Husbands; and of his own alledging that his Wife had nursed his Children all very well, al∣though he lay with her every night, and caressed her (as he said) like a good and faithful Husband; but she must forbear at least an hour or two after to give the Child suck. If a Nurse hath all or most part of these con∣ditions here specified, as well respecting her per∣son as manners, and that she maintaines this con∣dition by a Diet fit for the Childs temperament, and not contrary to her own, there is then great reason to believe she is fit to make a very good Nurse, and to bring up in perfect health the Son of a Prince. In fine, loving Reader, I believe I have now acquitted my self of my duty towards the Publick, in communicating the knowledg that God hath graciously bestowed on me concerning the Diseases of Women with Child and in Child-bed: I pray God, the fountain of all Science, that he will vouchsafe to teach you the right way of helping Page 437 them, and their Children in these cases, and make you yet better able to conceive these things than I have here explained them, and that all may be for ever to his greater glory. The End of the Third and last Book. Page [unnumbered] A Table of the Chapters. The First Book. OF the Diseases and different dispositions of Wo∣men with Child, from the time of Conception to the full time of Reckoning, pag. 1. Chap. 1. Of the Signs of Sterility and Fertility in Women. p. 2 Chap. 2. Of Conception, and the conditions necessary to it, 12 Chap. 3. Of the signs of Conception, 17 Chap. 4. What Generation is, and what is necessary to it, 24 Chap. 5. Of Big-bellies and their differences, with the signs of the true and false great Bellies, 31 Chap. 6. How to know the different times of Pregnancy, 35 Chap. 7. Whether it may be known that a Woman is with Child of a Boy or Girl, and the signs whether she shall have many Children, 43 Chap. 8. Of Supersoetation, 49 Chap. 9. Of a Mole, and its signs, 53 Chap. 10. In what manner a Woman ought to govern her self during her being with Child when it is not accompanied with other considerable accidents to endeavour to prevent them, 56 Chap. 11. The means to prevent the many accidents which happen to a Woman during the whole time of her being with Child; and first of Vomitings, 68 Chap. 12. Of the pains of the Back, Reins and Hips, 74 Chap. 13. Of the pains of the Breasts, 76 Page [unnumbered] Chap. 14. Of Incontinence and difficulty of Urine, 78 Chap. 15. Of the Cough, and difficulty of of Breathing, 81 Chap. 16. Of the swelling and pains of the Thighs and Legs, 85 Chap. 17. Of the Hemorrhoides, 89 Chap. 18. Of the several Fluxes which may happen to a Woman with Child, and first of a Loosnesse, 92 Chap. 19. Of a Menstruous Flux, 98 Chap. 20. Of Floodings, 102 Chap. 21. Of the weight bearing down, or relaxation of the Matrix, which hinders a Womon with Child in her walking, and the freedom of coition, 116 Chap. 22. Of the Dropsie of the Womb, and oedemitous tumours of the lips of the Privities, 119 Chap. 23. Of the Venereal Disease in Women with Child, 123 Chap. 24. Of Abortion, and its Causes, 129. The Second Book. Of Labours natural and unnatural, with the way how to help Women in the first, and the right means of remedying the rest. p. 137 Chap. 1. What Labour is, and the difference of it, together with its different termes, 138 Chap. 2. The Signs which precede and accompany as well a natural as an unnatural Delivery. 146 Chap. 3. Of the Membranes of the Infant, and the Wa∣ters, 151 Chap. 4. Of the Placenta, and Umbilical Vessels of the Child, 161 Chap. 5. Of the several natural scituations of an Infant in Page [unnumbered] the Mothers Womb, according to the different times of Pregnancy, 170 Chap. 6. What a Woman ought to do, when she is gone her full time, 174 Chap. 7. What is to be done when the Woman first falls in Labour, 177 Chap. 8. Of the natural Labour, and the meanes of help∣ing Women when there is one or more Children, 184 Chap. 9. How to fetch the After-burthen, 189 Chap. 10. Of laborious and d fficult Labours, and those against Nature, their Causes and Differences, together with the means to remedy them, 192 Chap. 11. Of unnatural Labours, where manual Opera∣tion is absolutely necessary, what Observations the Chirurgeon must make before he goeth about it, 201 Chap. 12. The signs to know whether the Child be alive or dead, 208 Chap. 13. How to fetch the After-burthen when the String is broke, 211 Chap. 14. To deliver a Woman when the Child comes Footling, 218 Chap. 15. How to fetch the Head when separated from the Body, and it remains behind in the Womb, 222 Chap. 16. How to help a Woman in her Labour, when the Head of the Child thrusts the Neck of the Womb forth before it, 225 Chap. 17. How to fetch a Child when coming right it can∣not pass, either because it is too big, or the Pas∣sages cannot sufficiently be dilated, 227 Chap. 18. How to deliver a Woman when the Child pre∣sents the side of the Head to the Birth, or the Face. 229 Chap. 19. How to deliver a Woman when the Head of the Page [unnumbered] Child is born, and the Womb closeth about the Neck, 231 Chap. 20. To deliver a Woman when the Child comes with one or both Hands together with the Head, 232 Chap. 21. How to deliver a Woman when the Child pre∣sents one or both Hands foremost, without any other part, 237 Chap. 22. How to deliver a Woman when Hands and Feet come together, 241 Chap. 23. How to deliver a Woman when the Child comes with the Knees, 244 Chap. 24. Of a Delivery, when the Child comes with Shoulder, Back or Breast, 245 Chap. 25. Of those Births wherein the Infant presents the Belly, Breast or Side, 248 Chap. 26. Of Labours wherein several Children present together in the different Postures abovenamed, 250 Chap. 27. Of a Labour when the Navel-string comes first, 255 Chap. 28. Of a Labour wherein the Burthen either first offers, or first comes quite forth, 258 Chap. 29. Of Floodings and Convulsions in Labour, 261 Chap. 30. How to deliver a Woman when the Child is Hy∣dropical, or Monstrous, 262 Chap. 31. Of delivering a dead Child, 265 Chap. 32. Of extracting of a Mola, and a false Con∣ception, 271 Chap. 33. Of the Caesarean Section, 275. Page [unnumbered] The Third Book. Treating of Women in Child-bed, and of the Diseases and Symptomes befalling them at that time: Of Children new-born, and their ordinary Distempers, together with necessary directions, for to chuse a Nurse. Chap. 1. What is to be done to a new-laid Woman, and naturally delivered, 288 Chap. 2. Of convenient Remedies for the lower parts of the Belly and Breasts of a Woman newly delivered, 290 Chap. 3. What Diet a Woman in Child-bed ought to ob∣serve, during the whole time after lying in, when it is accompanied with no ill accident, 296 Chap. 4. How to drive back the Milk in those Women who are not willing to give suck, 300 Chap. 5. Of several Diseases and Symptomes which happen to a Woman newly laid; and first of Flooding, 302 Chap. 6. Of the bearing down and falling out of the Womb and Fundament of a Woman new-laid, 307 Chap. 7. Of Bruises and Rents on the outward parts of the Womb caused by Labour, 314 Chap. 8. Of After-pains which happen to a Woman new-laid, and of their several Causes, 317 Chap. 9. Of the Lochia which flow from the Womb in Child-bed, whence they come, and the signs when they are good or bad, 322 Chap. 10. Of the suppression of the Lochia, and the acci∣dents which follow thereupon, 330 Chap. 11. Of the Inflammation which happens to the Womb after Delivery, 334 Page [unnumbered] Chap. 12. Of the Inflammation of the Breasts of the new-laid Woman, 338 Chap. 13. Of the clodding and curdling of the Milk, 342 Chap. 14. Of Imposthumes of the Breasts of Women new-laid, 345 Chap. 15. Of excoriation and loss of the Nipples, 349 Chap. 16. Of tending Children new-born, and first how to bind, cut and swath the Navel-string, 353 Chap. 17. How a new-born Babe must be washed and clean∣sed from the Excrements, as also how it ought to be wrapped up in Swadling-Cloaths, 358 Chap. 18. Of Dieting and Ordering a new-born Babe, 364 Chap. 19. Of the Indispositions of little Children, and first of their weakness, 372 Chap. 20. Of Contusions, or bruises of the Head, and o∣ther parts of toe Body of a new-born Babe, 376 Chap. 21. Of the Mould of the Head, and of the Sutures being too open, 381 Chap. 22. Of a new-born Babe's Fundament being closed up, 385 Chap. 23. Of cutting the Tongue when Tongue-ty'd, 386 Chap. 24. Of Gripes and Pains of the Belly of a young Child, 388 Chap. 25. Of the Ulceration, or shooting forth, or rupture of the Navel of a young Infant, 391 Chap. 26. Of the Smartings, Redness and Inflamation of the Groin, Buttocks, and Thighs of the Infant, 395 Chap. 27. Of the Ulcers (or Thrush) of the Mouth of an Infant, 397 Chap. 28. Of the pain in breeding the Teeth, 400 Chap. 29. Of the Loosness of an Infant, 404 Chap. 30. Of Vomitings in Children, 406 Chap. 31. Of a Hernia, or Rupture in Children, 408 Page [unnumbered] Chap. 32. Of the Scabs which are upon the Head and Face of young Children, 412 Chap. 33. Of the Small Pox and Meazels in Infants, 414 Chap. 34. How to cure the Venereal Lues in Infants, 422 Chap. 35. How to hinder Childrens growing squint∣eyed, 428. Chap. 36. Of the requisites and necessary conditions in the choice of a good Nurse, 430. FINIS. Page [unnumbered] Back to Top Powered by DLXS To comment or inquire about content, contact eebotcp-info@umich.edu To report errors, contact DLPS Help