Lectures on midwifery

[From Femehs

Universa Medicina, Geneva, 1679.1

BOOKSHELF

BROWSING

LECTURES BY THOMAS

ON MIDWIFERY YOUNG,

M.D.,

THURSTON SCOTT WELTON, BROOKLYN,

0

NE day PauI Hoeber and I were having a three hour luncheon. We had repaired to a reformed speakeasy in order to engage in a long taIk concerned with manuscripts, cuts, editoria1 poIicies, and the numerous other matters that are intimateIy a part of editing and pubIishing. However, not a word of shoptaIk passed our Iips. Instead, we deIved into everything eIse under the sun. We taIked of an expedition to Tibet that came a cropper in Pekin, of water coIors, of a certain gentIeman at the Academy of Medicine, of a book caIIed “Tia Barbarita,” of bath-room pIumbing, of medica writers who wiI1 Iet you have the manuscript provided you pubIish it in the next issue, of why U. S. SteeI wiI1 go up if the automobiIe industry gets prosperous, of guppies, and of twenty other unreIated but fascinating topics, when I observed, “My grandmother died in rgr I at the age of aImost ninety, and among her effects was a box of oId Ietters in their envelopes which she had saved for sentimenta reasons. They were written to her by friends and reIatrves between the years I 835 and I 870.” “What did you do with them?” from Hoeber.

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“ Read enough of them to Iearn they were of no interest and then threw the whoIe mess into the furnace.” Hoeber toyed with a pencil and Iooked into space, a wistfu1 expression in his eyes. “You may have thrown away a smaI1 fortune.” Hoeber among other avocations coIIects stamps. I have never coIIected stamps. Therefore, I had no idea that those old enveIopes with their stamps and cancehation marks couId be either interesting or vaIuabIe. Another reIative of mine, after a grandfather in the country had died, spent severa days cIeaning up the pIace before cIosing it, and reIated to me how she had found gIass bottIes and gIass containers of weird and bizarre shapes sufficient to fiI1 a coupIe of barreIs. “And such terribIe gIass Iike the cIear crystaI gIass . . . nothing she remarked, “it positiveIp of to-day,” looked hand-made.” “What did you do with it?” I asked, for I had a vague suspicion grandfather and his father had something in that country ceIIar worth good American dollars. “Busted them up and, with two wagon Ioads of other junk, burried the whoIe mess down in the pond.”

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I did not know stamps. My reIative did not know oId gIass. And this proves the adage that knowIedge is weaIth. Sometimes

FIG. I. Title page.

oId books are vaIuabIe. We must confess we know IittIe or nothing about oId or rare books. One must either be born with a desire to coIIect them or, Iike eating oIives, acquire the taste. It is a disease that is never cured. It takes time and certain funds are an essentia1 in order to satisfy this hobby. Also, one must possess an encycIopediac mind and have spent many years Iearning about such books before he is out of the amateur cIass. The true bibIiophiIe may want to possess a book either because it is the onIy known copy with the titIe Iine printed upside down but in perfect condition; or, because it is one of only eIeven copies known to be in

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existence. He, as a ruIe, cares not a tinker’s damn for the information the book contains. Anyway, he cannot read Latin or meadieva1 German or French, and if some frowzy professor of Ianguages wants to transIate these tomes, a11 right and good. But for him, the true bibIiomaniac, he mereIy wants to possess the book, to own it, to Iock it in his safe, to show it off to a seIect audience, perhaps purposeIy to arouse a covetous and bitter envy in a Iess fortunate brother coIIector’s heart. Not being in the remotest sense a coIIector, but mereIy a diIettante interested in the printed page, I do not beIong to this tribe. My pubIisher friend has many sheIves of oId and rare books. Often, when I drop in to see him, he is busiIy engaged with one of the many who must iyerview him on business. I wait in the Iibrary. AIways, I drift over to the oId-book section. I Iook at the row of backs. I pull a book out here and there. I find one I can read. I note it was written in 1699. I start at the beginning and read unti1 a secretary ushers me into the inner sanctum. But whiIe reading I try to picture the times when the author wrote, how he Iived, how his neighbors Iived, other countries of that period, how many owned the book, how many read it, how many copies have was it popuIar, survived, and I get no end of a thriI1 from the text. I teI1 the pubIisher what I’ve been reading. “Oh . . . that!” he exclaims, “That has no vaIue. Just a IittIe oId, that’s aI1.” And so, if you shouId happen to be a rea1, Iive, breathing bibIiophiIe you wiI1, I’m sure, turn your nose up at the book to which, presentIy, 1’11 devote the remainder of my space. And yet, to me it has a two-foId fascination: it provides interesting reading; it, no doubt, is a fourth known copy. If you, too, are Iike me and have onIy a superficia1 knowIedge of this subject, read on and Iet me teI1: How my good friend and cIassmate,

NED

Stoles

VOL. XXIV,

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WeIton-Lectures

Robert Barber, came up to me during the holidays. He exuded an inner excitement. “I have something that wiII fascinate you, ” he cried. “An oId book. It’s a book on midwifery. Three hundred odd pages written in Ionghand by a student. A Dr. Thomas Young of Edinburgh gave the Iectures. I sat for hours Iast night reading it. You’11 get a kick reading the scientific ideas of that day.” “Where’d you get it?” I asked. “Friend of mine studying in England had a book-seIIer pick it up in London . . . it probabIy cost ten shiIIings . . . and he sent it to me as a Christmas present . . . 1’11 have it here in the morning.” Robert was as good as his word. The next morning at the college he Ieft the book in my hands. I observed a book 44’i by 7 inches in size. It is bound in boards, the back in Leather. In faded goId Ietters I read: “Young’s Midwifery,” and beIow it the numera1 “ I.” So, evidentIy it was the first of two or more voIumes. On the second ffy-Ieaf, written in the bird-Iike, scroIIied penmanship of that day we read: Lectures on Midwifery-By Thomas Young, M.D., VOI. I, 1774, and in a different script, in the Iower right hand corner, is written “ Edinboro.” I turned the page and observed: “Contents---VoI. 1st.” The contents and page numbers offered are: Introduction (Page 1st) ; History of Midwifery (Page 4): History of the Authors (Page I I) ; Theory of Midwifery (Page 39); The Difference betwixt the Pelvis of a MaIe & Female SkeIeton (Page 48) ; Of the Narrow and Deformed PeIvis (Page 49); Of the Parts of Generation proper to Women (Page 57); Of the Diseases of the Parts of Generation (Page 69); The Use of the Parts of Generation (Page 108); The S ize of the Foetus in the Uterus (Page 124) ; The Difference betwixt a Foetus and AduIt (Page 129); The Changes that the Uterus undergoes from Pregnancy (Page 144); The use of these

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Changes in the Practice of Midwifery (Page 149); The Connection between the Mother and the Foetus (Page I 73) ; The Figure and Shape of the PIacenta in different animals (Page 186) ; The Uses of the PIacenta (Page 202); The Use of difl’erence of Structure between the Foetus 8i Adult (Page 206); MenstruaI FIux (Page 208); The Causes to which the Menstrua,I Flux has been ascribed (Page 2 14); CbIorosis (Page 227); Obstructed Menses (Page 232); Immoderate Flux of the Menses (Page 237); FIuxor AIbus (Page 244); Symptoms of Pregnancy (Page 256); Of the Diseases Incident to Pregnancy (Page 266); Nausea and Vomiting (Page 269); Suppression of Urine and Costiveness (Page 27;); Hemorrhoides or PiIes ((Page 282); Swelling of the Legs, Thighs and parts adjacent (Page 286); ConvuIsions (Page 288); Palsy iPage 296); Lues Venerea (Page 298); Vomiting (Page 299); DiffcuIty of Breathing and Cough (Page 300) ; VioIent Cramp pains of the Abdomen and Legs (Page 301); FIoodings (Page 305) ; Prognosis (Page 310). At home that evening I began to read the unknown student’s notes. I, too, Iike Barber, read far into the night. MereIy to give one an idea of what fascinated me, aIthough it is of IittIe scientific worth, I wiI1 quote at random from the yeIIowing pages : The word midwifery is generally taken in two senses, the one limited and the other very extensive. The first is the simple operation used in the practice of deIivering women. The 2nd what depends on the Physician with respect to the Diseases both of the Mother and Child, and in these to give directions. Long and Sad Experience shows the usefuIness of this art, as in the preturnatural Births and FIoodings where both the hIother and ChiId were often destroyed. One may apply to the study of nlidwifery at any time of their studies, and it is only necessary to observe, that Gentlemen should take it when attending the Infirmary, by which means they have an opportunity of attending the Lying-in Ward without being at the expence of two tickets . . .

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This part of the Introduction tant, as we’11 discover.

is impor-

. . . and other means of acquiring knowIedge in Mid-wifery is by the PerusaI of Books, as in anatomy one shouId read HalIer before WinsIow. So in Midwifery one shouId not read SmeIIie, in the first course, as he wiI1 be better understood in the second. . . . In this City (viz: Edin.6) they began to see the advantages of having Midwifery taught, Accordingly in the year 1726 Mr. Gibson was chosen City Professor, after which no woman was aIIowed to practice Midwifery without having first attended him, and undergone an Examination before the CoIlege of Physicians. . . . That he intended to teach Midwifery is clear from his having pubIished a SyIIab’. . . . ShortIy after he died. . . . at which time Dr. SmeIIies Machines were kept a Secret, for which reason I was obliged from mere necessity to form them with my own hands, a task I found very diffIcuIt in executing. In the year 175 I the King of Prussia Iikewise became sensibIe of the necessity of cultivating midwiferv . . . and for this purpose he got a CoIIege erected and appointed Theodore, professor and teacher of Midwifery, . . . In order to render this more usefuI1 he Erected an HospitaI where they had two Wards, the one for Male, the other for femaIe students. . . . GuiIIeman Succeeded Ambrose Parey. he wrote a treatise which he caIIed the Happy DeIivery of Woman this is one of the First Books transIated that we had at time in English. . . . Dr. Chamberlain pretended to have a method of DeIivering the chiId in Laborious Births, which he kept a Secret, but he was unabIe to put it in practice in Paris, where he tried it. . . . Anatomists and men Midwives differ concerning the motions of the Bones of the PeIvis . . . When women Iabour under a Suppression of Urine it is sometimes DiffIcuIt to Introduce the Catheter. . . . . . . the woman arrived at 14, 15 or 16 years of age when the menstrua1 Aux appears this not getting passage occasions a Tumour of the part, that aIways gives more or Iess uneasiness to the Woman, you can very easiIy distinguish this disease for the woman wiI1 have no menses. She wiI1 fee1 a pain and uneasiness about the part, and when you attempt to examine her in

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the common way, it u-i11 be impossibIe to introduce your finger into the vagina. The onIy cure here is to make an Incision tho [sic] the hymen, and this for the most part gives immediate relief. You wiI1 find some cases of this kind in Ambrose Parey, and GuiIIeman, and Dr. SmeIIie gives three Instances of an imperforated Hymen, in a11 which one woman was compIeteIy cured by one simpIe incision. ’ ‘The 0 varia are IiahIe to a variety of diseases particuIarIy dropsy. . . . In the memoirs of the Academy of Sciences of Surgery, and in Dr. HaIIers Thesis you wiI1 find many instances of a Dropsy of the Ovarium. It is perfectly incurable except when the water is coIIected in such a quantity as to appear outwardIy for it is entireIy out of the Laws of CircuIation . . . There is one in the Philosophica Transactions by Dr. Hewson. The water was 13 years in coIIecting. He made an incision into the most protuberant part of the Tumour but there was no discharge from it. However on enIarging the Wound a Great quantity of GeIIatinous matter was Evacuated. . . . Generation is a subject so Mysterious that ages have made tho peopIe in Different Experiments reIating to this yet we are stiI1 in the dark as to our origin. . . . Hippocrates and GaIen imagined that generation was owing to a mixture of the male and femaIe semen in the uterus. . . . They imagined that the Ovaria answered the same purpose in Women that the Testes did in Men, and that the Iigament which connected these with the womb was a Vas Deferens, by means of which the femaIe Semen was brought from the ovarium to the uterus, but we shall have occasion to see afterwards that this system was at fauIt, as many other Subsequent ones that have been adopted since. The first objection is that there is no communication between the uterus and ovarium. But we find that at particuIar times the FaIIopian tubes embracing the Ovarium this sometimes Bursted open, and we can press a Liquor out of it which contains AnimaIcuIes, simiIar to these found in the MaIe Semen. The foIIowing quotation under the chapter heading : “The Use of These Changes in the Practice of Midwifery” is significant, as we shaI1 learn.

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It is of great consequence to determine from the different changes made on the neck and Bottom of the Womb whether the Woman is with Child or not. This can onIy be done with the touch which is of two kinds viz: ExternaI & IntcrnaI. The first is onIy the fee1 with the hands on the ExternaI parts of the Abdomen by which you may often have a pretty good guess whether the woman is with chiId or not. If she is not with chiId you cannot fee1 any tumour or hardness of the abdomen, but if she is you wiII fee1 a hard, circumscribed tumour within it. In five months of Pregnancy you can for the most part fee1 this rising above the OS pubis, in the sixth it gets halfway between the OS pubis and the naoil [itaIics mine], in the eighth you may fee1 it haIf way between the . . . ScorbicuIis [this word is not very IegibIe] Cordis and the NaviI, and in the Ninth it reaches up as high as the former, but this is different in different Women . . . We wiII end these quotations, though the temptation is to quote at Iength, by copying parts from this unknown student’s Iecture on the MenstruaI FIux: The MenstruaI FIux is not sufficiently understood as we do not know properIy the Structure of the Uterus. . . . Weak women Ioose a greater quantity of bIood than those who are strong and heaIthy. . . . The Cause to which the MenstruaI FIux has been Ascribed: Erasistratus and severa of the Ancients thought it was owing to the Influence of the Moon, because it returned reguIarIy every 28 or 29 clay, and this opinion seems to have been adopted by some of the Moderns particuIarIy by Dr. Mead [of The GoId Headed Cane] in his treatise De imperic SoIis at Lune. . . .

This gives one an idea of a student hurriedly writing the Iectures, often misspelling terms and his grammar a jumble of words. To get back to our story. After we had read this voIume of student notes we thought a profitabIe articIe for this section of the JournaI would be attained by copying the Chapter on the History of Midwifery. To do such an article one must teI1 his readers something about the teacher, Dr.

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to the Thomas Young. So we repaired Library of the Medical Society of the County of Kings and went through the cards in the Index. We found Young’s and Young’s but not the Young we were after. It was a fruitIess day. The next morning the Iibrarian, Mr. Frankenberger, teIephoned saying he had some material that might be of some aid. From Dr. Herbert R. Spencer’s, “The History of British Midwifery-1630--r 800,” I Iearned that Thomas Young was the third professor of midwifery at Edinburgh and the first in the British IsIes to give a course of Iectures on the subject. Young heId the chair from 1756 to 1780 when he was succeeded by AIexander HamiIton. “Young was the first in Edinburgh to give reguIar courses in midwifery to medicaI students, and it was through his exertions that a Iying-in ward was opened in the attic story of the RoyaI Inhrmary, fitted up at Dr. Young’s expense for four Iying-in women, or as many as Dr. -Young couId accommodate.” Thus, the first maternity ward in the hospita1 was started. We now see the significance of the student’s notes in the Introduction when Dr. Young said, “ . . . that GentIemen shouId take it [study of midwifery] when attending the Infirmary, by which means they have an opportunity of attending the Lying-In Ward without being at the expence of two tickets.” We quote further from Spencer’s book: “They [the Iectures] contain nothing of but externa1 abdomina1 specia1 interest; examination is mentioned, and the statement made that at the 6th month of pregnancy the uterus ‘is halfway pubis and the navil.’ ”

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Dr. Young, at the time of his appointment to the chair of midwifery, had not the degree of doctor of medicine. He was a member of the CoIIege of Surgeons. Young took the degree of Doctor of Medicine from the University of Edinburgh in 1761. Imagine the thriI1 that we experienced when our eyes read:

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Young . . . has Ieft no printed work except his graduation thesis “dissertatio de lacte” (1761), but there are two MS. copies of his Iectures in the library of the Royal Society of Medicine containing the book-pIate and notes of Samuel Merriman. (Another copy is in the Library of the Medical Society of London.) One of these copies is dated 1767 & 1768; the other which consists of 41 lectures, is undated. A great Iight dawned upon us. In our amateurish researches we concIuded that in our hands was the first voIume of a two or three voIume series of Iectures by Thomas Young written in his cIassroom by a student. For a century and a haIf this voIume has knocked around oId bookshops, perhaps has been handIed by in-

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numerabIe peopIe, gIanced at, fingered and thrown aside. I, too, wouId have done such. But, as I have stated, I have no knowledge of oId and rare books. If any who may have chanced to have opened this voIume during the past one hundred and fifty years knew that in EngIand but three copies of Young’s Iectures are known, then this copy wouId have had a specia1 interest to them. I am returning this voIume to its owner, Dr. Robert Barber. I have toId him its story. He owns what to date seems to be the fourth known copy of these Iectures. Barber teIIs me that soon he wiI1 present it to the Iibrary, in which he has heId severa1 offrces, the Library of the MedicaI Society of the County of Kings.