Part 1

AN ADDRESS

TO

BRITISH FEMALES

ON

THE MORAL MANAGEMENT

OF

PREGNANCY AND LABOUR,

AND SOME CURSORY

OBSERVATIONS ON MEDICAL DEPORTMENT.

SUGGESTED BY

The Death

OF HER ROYAL HIGHNESS PRINCESS

CHARLOTTE AUGUSTA OF WALES.

WITH

A VINDICATION

OF

HER ROYAL HIGHNESS’S PHYSICIANS,

SIR RICHARD CROFT,

DR. BAILLIE, AND DR. SIMS.

BY WILLIAM COOKE,

SURGEON-ACCOUCHEUR.

“To enjoy Happiness is a great blessing:―to confer it, a greater.”

LONDON:

PRINTED FOR E. COX AND SON,

ST. THOMAS’S STREET, BOROUGH.

1817.

J. M‘Creery, Printer, Black-Horse-Court, London.

ADVERTISEMENT.

From the first intimation of the death of Her Royal Highness Princess Charlotte, the general sensation heightened daily, till the climax was completed on the melancholy day of interment. Within this interim it was scarcely possible, without a surreptitious effort, either to speak or think on any other topic.

The prevalence of this acute sensibility―the daily intelligence of consecutive evils―and the relief obtained by fixing the attention on some specific object, gave origin to this pamphlet.

Whatever belongs to moral agency, as well as to the preceptive and practical portions, is the result of previous observation; and for them the Author solicits no other concession than is due to the circumscription of his plan. The style and arrangement he is aware are exceptionable. He pleads in extenuation that the address is extemporaneous:―suggested by a high degree of social feeling with his interesting countrywomen, and under circumstances that forbade the delay which much emendation would have occasioned.

Should it be imagined that the specification of certain incongruities is too severe, the Author solicits credence for an assurance that he has exclusively referred to the excrescence and not the character. There is not an individual in the world whom he has intended to deride.

The vindication he has offered in the sequel is totally disinterested; the persons referred to are entirely unknown to him.

The term Moral prefixed to this Address, may appear disingenuous.―Much difficulty arose in fixing on a single appellation which should embrace a _distinguished_ feature in the address, and yet contra-distinguish it from one _purely_ medical.

Should any hint he has dropt prove useful in quieting unwarrantable fear, or in establishing more safe and happy arrangements in child-birth, or in conducing to a more generous and comprehensive treatment of female diseases or diseases in general, the Author will be most amply recompensed.

_Great Prescot-Street, Nov. 24, 1817._

AN ADDRESS.

There is not an event within the recollection of the British nation, which has called forth more universal and unfeigned sorrow than the death of Her Royal Highness the Princess Charlotte Augusta of Wales.

The earliest indications of her character,[1] as well as its progressive developement, concurred to mark a strong and independent mind; yet did she also afford a striking example of the compatibility of a cultivated mind and uncontrolled judgment, with that purely feminine delicacy of manner, which designates the sex, and constitutes one of its peculiar excellences. Although she occupied a station which denied the accustomed facilities of appreciating human excellence, yet the agreement of testimony, passing through diverse channels, fully authenticates the inference, that she was not merely elevated by royal ancestry, but was distinguished by superiority of natural faculties and intellectual attainments, and by a decided attachment to the Protestant religion. Nevertheless she did not degenerate into masculine habits―a degeneracy, which not unfrequently renders unamiable, a female enriched with uncommon mental endowments.

Having chosen retirement, with her excellent consort, His Serene Highness Prince Leopold, we had probably long been ignorant of the prospective blessings which awaited our favoured land, had it not pleased Him who regulates the world by his providence, to transplant her hence, at a time the most unexpected, and in a manner the most interesting. At this moment her virtues shine with an almost overwhelming lustre; and whilst every eye fixes itself on her pre-eminent station, and the imagination brings to the present hour future years of sorrow, we hear an almost consentaneous exclamation―_the Hope of England is departed!_

Deeply participating, however, as we do in the general grief for the death of an amiable Princess, and sympathizing with the sorrowful illustrious family, it is not within our province to eulogize the deceased, nor can we hope to console the surviving relatives; yet there is one class of mourners that demands commiseration, and whose claims will be more particularly directed to the practitioners of medicine.

If it be within the department of a medical practitioner to soothe the afflictions of mankind, unquestionably a large portion of his attention and kindness is demanded at the present time. Whilst almost every occupation is more or less suspended, as a tribute to departed excellence, and as a token of loyal sympathy, it would be disreputable to a profession, so important to the welfare of mankind, to withhold its share in the general emotion.

The public feeling of sorrow is honorable to the British nation, and illustrates the superior sensibility and the moral pre-eminence derived from the diffusion of Christian principles. Where these principles are adopted and diffused, men cannot circumscribe within their own bosoms, or within the bosom of their families, those sources of pleasure or grief which the Creator has bestowed indiscriminately. We ought to participate in each other’s pleasures, and to sympathize is mutual sorrow.

Duties often devolve on a practitioner of surgery, which demand the control of his feelings; and this has elicited the popular charge, that sensations, common to the rest of mankind, are to him unknown. Surely we are traduced―and on an occasion like this it will neither be thought unphilosophical, nor unworthy the attention of a scientific mind, to incline itself to an event which has agitated the country, and which especially fills the bosom of every female in the land.

Collectively, it is impracticable to exhibit their interest on the occasion, but as individuals there is an important niche which they, and none else can occupy. It would neither be wise nor honorable to extinguish sensibility, nor to suppress the salutary eloquence of social grief; but to counteract the indulgence of excessive passion, and to guard against the fruitful evils to which there is a consequent and perpetual tendency, is perfectly consistent both with wisdom and honor; and a prompt and generous effort to accomplish purposes so desirable, must be a pleasing tribute to the illustrious House, by whose afflictions these passions have been created.

It redounds to the credit of the clergy, not only in the established church, but equally of all denominations, that the mournful event has been observed in the most obvious and impressive manner, and their office been made subservient to the condolence and moral improvement of society. Yet is there one class of persons, most interesting from their sex, from their condition in life, and from their extraordinary participation in the event, owing to peculiar circumstantials of coincidence, which, though accessible to the ordinary means of consolation, demands the most solicitous and encouraging attention. It is unnecessary here to observe, that the persons alluded to are females in the state of pregnancy, and more particularly those, who, like Her Royal Highness, are anticipating the first parturition.

They cannot but discern that the persons most competent to administer encouragement, are those to whose management their health is entrusted; and upon their accoucheur it unequivocally devolves not only to assist in the moments of child-birth, but to use every precaution to conduct to that period in safety. Timidity and apprehension often modify the nature of child-birth, without any extraordinary occurrence. Instances of predicted death, and predicted suffering, have been fully authenticated; and those, who have attributed the prescience to supernatural agency, have been misled. Persons who die at a predicted time, die not in consequence of the thing portended:―if the prediction rest upon some imaginary omen, or unwarrantable timidity, death is the punishment of their superstition, or their fears.

Sympathetic sorrow and fear must be distinguished. Who would interdict at the present a moderate indulgence in the former? but, for inordinate fear, this fatal instance of child-birth does not supply the least well-grounded occasion. It cannot, however, be averted, that females thus delicately situated, will be the subject of needless apprehension, and may become enslaved by unwarrantable anxiety and terror; and which it is the duty, and will I am persuaded, be within the power, of a conscientious man, nearly, if not wholly, to suppress.

It would be a dereliction from my present feelings, nor do I think it incompatible with the design, to ask, if practitioners in Midwifery, and of Medical Science in general, in their attachment to the custom of administering drugs, and in their repugnance to a species of fanatical empiricism, do not too much disregard the _moral treatment_ of disease?

Let it not be supposed that I would question the efficacy of Medicine, or that I would tolerate the chicanery or chimeras of _Tractorism_ or _Magnetism_; for though it would be well if the articles of our Materia Medica were reduced to at least one twentieth of their present number, I cannot hesitate to aver, that some drugs are capable of acting specifically on the animal frame. Must it not also be admitted, that although, upon every genuine principle of philanthropy, we would sweep imposture “with the besom of destruction,” the audacious empiric has produced effects well adapted to astonish the vulgar, and to claim for himself a large portion of ephemeral reputation?

The scientific mind ought to appreciate the influence which one human being is capable of exerting over another; and by reflecting on it, the most available line of conduct in the removal of disease will be discovered. It is true, artifice has often taken precedence of merit. Attractive as popularity undeniably is, the practitioner who solicits the aid of artifice to rise into notice, not only forfeits his character, but hazards the sacrifice of future professional honor and success, on the altar of a most precarious goddess:―

“To seek honor, is to lose liberty.”

Recently the most strenuous efforts have been made to render the medical profession more worthy of public confidence, but the appropriation of means has surely been surprisingly perverted. It cannot be questioned, that a youth intended for this department of human labor, ought to be liberally educated, and that he present his testimonials to an accredited and competent tribunal is perfectly laudable; but that after five years apprenticeship, and after an extended durance at a recognised medical school, he should be submitted to the investigation of a trading company, is totally repugnant to every principle of science, and is calculated to divert the attention from those generous and enlightened principles, which should actuate the members of a profession often denominated _learned_ and _liberal_.

It is not the knowledge of ancient and modern languages, of mathematics or moral philosophy, of chemistry, or pharmacy, or botany, or even of anatomy, physiology, and nosology, however important or essential, which can fully qualify a man for the honorable discharge of the arduous and responsible duties of his station. He must be a philanthropist. However extensive and useful his knowledge, if he has not a _zest_ for the alleviation of human suffering, he incalculably circumscribes the usefulness of his acquisitions. There are men, indeed, who have pursued science with abstracted ardor; and there is indubitably something fascinating in those sciences, which are accessible to a medical student. But if there is an universality in Bacon’s maxim, that “_knowledge is Power_,” in what does the power of knowledge consist, but its direction to some useful purpose?

Some men have directed all their time and talents to insulated departments of medical or surgical practice. Does not this make them pedantic? Although they have risen high in these departments, yet having but partially appreciated other objects, they are contemned, notwithstanding they are effecting equal good by different agency. Division of human labor has its advantages; but, if frittered into needless division, it injures the whole.

Some distinguished men too have become so notorious in their tenets, that it is difficult to ascertain whether their reputation be that of paradox or merit.

There are others also, who seem to think it honorable to be eccentric; and, to increase the anomaly, have chosen an eccentricity, which ordinarily is esteemed disgusting. Abruptness, rudeness, insensibility, coarseness of manner, vulgarity, or obsequiousness, may be found in men, whose minds are far superior to mediocrity; and although nature or education might have been somewhat defective, it is not difficult to recognise the features of some pernicious habit. We have seen striking indications of disregard to human suffering in our hospitals; and often has it called forth a disgusting expression of risibility amongst the students. Painful, indeed, is it to observe the mistaken excellence attached to an apparent disregard of human suffering: it seems to be thought, that there is something philosophical in conquering the common sympathies of human life, although it is by them society is cemented.

Although no personal graces―no urbanity―no kindness, can be substituted for unremitting study, and discriminating observation, yet it is practicable to adopt a deportment equally remote from pliancy and barbarity.

For what beneficial end, many will exclaim, are these observations made? and had I not drawn for myself the line of demarcation, I would gladly meet the inquiry in an attempt to prove that some men of superior knowledge, and of eminent rank, would have greatly extended their benefits to human nature had not their manners been repulsive:―that the extraneous habits of these men are borrowed, by an aspiring race of students, who appear in plumes of fancied beauty; whose affected air justifies the suspicion that the art of medicine is not _merely_ conjectural:―and that by ingenuousness, candour, kindness, and an attentive regard to mental phenomena, united certainly with a competency of knowledge, not only the honor of the profession is enhanced, but its utility promoted. If there are no diseases of mind independently of body, which we are willing to admit, the influence of mind on body must be allowed. The popular belief in the salutary influence of _faith_, is well founded―the opposite feeling of _distrust_, will act perniciously. The man whose mind is properly furnished will dexterously seize occasions of alleviating distress, which another, who may be almost exclusively watching for diseased structure, would not easily comprehend.[2]

An attempt to make chronic cases of disease subservient to any mercenary purpose, is an entire perversion of the liberal dictates of science; and often renders the most assiduous exertions unavailing. Where there is scarcely sufficient disease to impose bodily restriction, it cannot be expected that protracted courses of medicine can be endured, unless it be administered in the most simple and unobjectionable form. Nevertheless, it is a duty to subdue chronic diseases; and often it can only be done by a persevering management of diet, aided by medicine.

We return from this digression to the condition of our interesting countrywomen; and, as a tribute of respect to the memory of her Royal Highness, would endeavour to direct to their advantage the preceding observations.

It is almost peculiar to the females of this happy land, that they occupy that station in society for which they were designed. Regard is paid to their education―their intellects are cultivated―whilst they retain that modesty and refinement which should ever designate them.

How much of our personal happiness do we owe to them!―are we not indebted to them for the sweetness and chastity of social intercourse―for the cheerfulness of domestic life―for the solace of times of sickness and sorrow―for the building up of our families, and the perpetuation of our names in human existence? Their claims are innumerable, and as cogent as the happiness and welfare of men can suggest.

Every expression of regard to their comfort and happiness is demanded; and when they are subjected to inordinate care, the token should be _peculiar_ and _spontaneous_. It is unpardonable, that in the treatment of female diseases there should be either rudeness or indecency.

The express object of this paper is to check a disposition to draw illegitimate and unfavourable conclusions from recent circumstances―to divert their thoughts from fear. Yet, as they are capable of reasoning, and, indeed, will not be satisfied, without a rational demonstration, that there is no ground for evil forebodings; we shall endeavour to meet them on this fundamental principle. And, first, we shall attempt to evince that the death of the Princess Charlotte, neither indicates a condition more precarious than heretofore, nor does it detract from the efficient aid which art is adequate to afford at this interesting moment. In the second place we shall point out some circumstances in natural and premature labour, on which recovery greatly depends.

In the case before us there is nothing peculiar. Royalty has no exemptions from disease; nor is there any royal exoneration from the contingencies of human life. If a female, in ordinary rank, die of fever, it is not brooded over to excess; and if one in these subordinate walks fall in the hour of child-birth, soon its influence subsides. But illustrious station gives unparalleled horror to death; not because it differs abstractedly from the death of others, but, because in the fall of persons eminent in rank or office, the relationships of life are more deranged, and even the interests of a country may be affected. Yet is the article death the same. Truly a life so valuable to the country, as that of her Royal Highness, did not exist in Britain. Yet this does not modify the event itself, for death recognizes no distinctions; and so rarely does it happen in these circumstances, that there are persons who have practised midwifery for a series of years without meeting with such an occurrence. The very circumstance that encircles that event with peculiar mystery and solemnity, is calculated to impart to those we are now addressing, the greatest encouragement―_it was unexpected_. Were it not uncommon, it would not have been unlooked for; and the public are incompetent judges of the unfrequency: for the unfavourable instances, which are _rare_, are, on this account, topics of popularity; whilst the thousands of _happy_ results, which happen every week, pass unobserved.[3]

In the management of pregnancy, the treatment should commence with the earliest period. To regulate the condition of mind is important; to avoid the sight of disgusting objects,[4] and other circumstances likely to evolve any strong emotion. To live temperately; to avoid stimulating diet; to regulate the bowels by some unirritating aperient, and to use but moderate exercise.

In the arrangements preparatory to parturition, the objects which present themselves are two-fold. First, to secure efficient aid; and, secondly, such attendance as may be most likely to keep the mind comfortable, and which shall carry into full effect every means devised at the time of child-birth as well as subsequently. On the former topic it is neither proper nor necessary to speak. The selection of persons to attend, in parturition, is unquestionably momentous. The nearest relatives are often the most unsuitable. Kindness and sympathy exhibited with confidence inspire courage and patience; but if they are associated with anxiety and impatience, their usefulness is completely frustrated. If relatives are chosen, they should be such as know how to regulate their feelings―when to withhold, as well as when to impart. On the other hand, those who have no feeling, no commiseration, (and there are such among women), should be fully excluded from such an occasion, and there should not be one person present as a mere spectator. But of ordinary attendants, the selection of a good nurse is of chief importance. It should be essential that she have discharged maternal duties; that she be experienced―good tempered―moderately active―of good understanding―modest, not forward; and not loquacious. She should know how to discharge the duties of her office without stepping beyond it. She should have judgment enough to buoy up the spirits when they needlessly flag, and caution enough not to permit unusual symptoms to arise without the cognizance of those on whom that responsibility more particularly rests.

Persons whose minds have been little cultivated, are apt to seek undue commendation, and to gain by improper means the confidence of their employer. However well disposed and well informed the lady, perhaps her knowledge of parturition may be circumscribed by her personal experience. But the nurse is supposed to have gained much knowledge, beyond the immediate obligations of her own station, by her intercourse with medical practitioners. She thinks herself competent to the comparison of the different methods of management which may consist in mere circumstantial differences, but which by her are made important. She thinks herself competent to change diet, to administer medicine, to regulate the time of rising and sitting up, in the absence of the practitioner, and often even contrary to his orders. Because they have seen spirituous liquor given in some cases without actual injury, they think it may be given in all; and it is often only by a positive injunction this can be counteracted. They propagate unnecessary follies respecting the peculiar dangers of certain days. And if the patient be dejected, they rally them, and often urge the necessity of premature rising to dinner or tea, to promote cheerfulness. Within the last few weeks, though spirits had been decidedly prohibited in a case of first parturition, as soon as the practitioner had left, the nurse so boldly urged some brandy, that the lady could not refuse compliance. The obtrusiveness and loquacity of this person very materially affected the recovery of an interesting woman. We express ourselves strongly and decidedly on this point, because we pity a delicate inexperienced female, who happens at so critical a moment to be managed by an ignorant or obtrusive nurse; and because we have no question that most of the evils which spring up subsequently to parturition, arise from the contravention of proper orders, either respecting quietude or diet. During the first few days or week in all cases the entire regulation of even minute particulars should be under the direction of the medical attendant; and in some cases this attention must be carried farther. It must not be tolerated that a woman who shall have had the longest experience, and who may even be able to detect striking differences, should prescribe either counter to established regulations, or when medical advice is accessible. There certainly are instances of sudden transition, in which the nurse must act according to her best judgment, and in which, if wrong, she is not blame-worthy. When on this topic, I cannot totally exonerate the accoucheur from some connivance in the assumed importance of the nurse; and through a want of explicitness and decision, she has often been left either to the selection of her own plans, or plans have been so carelessly or loosely suggested, that it may justly be questioned whether it was intended they should be enforced.

It would indeed be a great advantage to society, if persons of this description were not permitted to assume the office of nurse without testimonials: but as the field is now open, not only should ladies be circumspect in the selection, but it behoves the guardians of the public health, even if it be unsolicited, to counsel their friends in the choice. In their intercourse with nurses, they are best qualified to assert their respective merits, and _they_ ought to distinguish between the meritorious and the ignorant or froward.