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.

At the time of child-birth, there are some practices which are
extremely hurtful, and which cannot always be guided by professional
advice. And it would be well for ladies themselves to predetermine in
what manner these things should be regulated. The exhaustion consequent
to child-birth, has occasioned the pretty general custom of allowing
the patient to lay an hour undisturbed; but at the end of this hour,
it is often inevitable, whatever the degree of indisposition, that the
patient must be raised into an erect posture, before she can be placed
in bed, owing to the improper arrangement of dress and bed-clothes.

Hemorrhage, fainting, and many inconveniences under these
circumstances, are not unusual. Amongst the higher and more intelligent
nurses this practice certainly is nearly unknown. Where there is
time before-hand, dress and bed-clothes should be so managed, that
there shall be no occasion to raise the patient from the horizontal
posture. However trivial this may seem, it is, without the smallest
doubt, a frequent cause of very serious alarm; and no practitioner can
safely leave a house till this removal has been undergone. It would
be commendable if ladies themselves exercised their thoughts on this
subject, and on which they may take counsel, with great propriety,
previous to the commencement of indisposition.

We are not now presuming to address the members of the profession.
Yet, for the sake of female practitioners of midwifery, the unnatural
and improper custom of giving opiates immediately after every case of
parturition must be decried. The apology for this practice is to ease
the after-pains; that is, to counteract those contractions of the womb,
by which it regains its natural state.

Truly cases happen in which the constitution sympathizes so greatly
with these pains―the patient becomes so irritable, that an opiate,
seasonably interposed, acts almost as a charm; but when administered
through habit, it checks secretion―constipates the bowels―prolongs
the after-pains―and very seriously affects the head.

To practitioners of this description, I would also say, that especially
in lingering cases, the management of mind is truly important. The
mind is in the condition of the quickest sensibility. Every thing
transacted about the patient should be done openly. All whisperings
or attempts at secrecy, excite the utmost curiosity, and essays at
evasion only heighten the distress. All allusion to unfavourable cases
should be most sacredly avoided. Nothing should tempt the individual
on whom reliance is placed in these instances, to concede the truth―a
falsehood once detected, contravenes all future trust; and however
there may be exhibited the external signs of belief the mind will be
harassed with the most painful suspicion. A most guarded prognostic
too, not only in reference to the issue, but the duration, is
essentially requisite. The endurance of pain, ever raises more or less
anxiety for ease; and as in child-birth it is known there is a limit―a
period when the trouble shall instantly cease―there is peculiar
desire to ascertain the probable duration of suffering. The hopes
and wishes of practitioners often seduce them into a definition. The
period arrives, and is succeeded by disappointment―another is fixed,
which equally disappoints the expectation, and ceaselessly enervates
the patient. A disposition in the attendants to excite unwarrantable
expectation too, should be early checked. The solicitous inquiries of
the patient, must be met by a candid avowal of her situation―a decided
assurance, that although it is not possible to define the duration,
the procedure is perfectly safe. A distinct assurance should be given,
that although there are numerous little circumstances which retard
or expedite delivery, they do not affect the termination. That with
the prospect of a safe deliverance, a somewhat prolonged suffering
is comparatively trivial. And, in most cases, however serious, it is
easy to suggest some exemption, for the absence of which thankfulness
should be cultivated.

Varied as the cases of parturition are, if the _principle_ is kept in
view, an intelligent mind will supply the deficiency. And a female will
be conducted through a lingering labor with much less suffering, and
much less exhaustion than under more unguarded treatment. The choice of
food under these circumstances, certainly is not indifferent. In the
time of labor, all the functions are disturbed―not only by sympathy,
but by the positive influence of pain. Such diet should be adopted
as is least irritating, and with most facility is converted into
nutriment. Gruel, preparations of arrow-root, sago, &c., without wine
(except under peculiar circumstances) are best, and the patient should
be encouraged to take them at proper intervals.

After labor, quietude is the chief subsidiary; but some regard must
be had to the state of the patient. The sudden transition from
long-suffering to almost entire case, produces a striking moral effect,
and effusions of grateful expression generally succeed. The stimulus
of distension and pain, being withdrawn, a great degree of faintness
often supervenes. The administration of a small quantity of brandy
or wine in some gruel, is highly proper where this happens in any
threatening degree―but should only be continued till that sensation
is removed. Some ether in camphorated mixture, we have often seen very
speedily remove the faintness and agitation which succeed delivery.

Soon there is an adaptation to the change―the functions regain their
accustomed office―the palpitation of the heart subsides―the pulse,
which might have been fluttering and intermitting, becomes regular,
though still quick and full. Stimulant substances must be entirely
withdrawn, and gruel, or other simple articles of nutrition must be
substituted.

Often, early after labor, pain and throbbing in the head, aversion to
light and sound arise; attended sometimes with a quick, at others, a
very slow pulse; the latter, indicating a great degree of congestion,
or accumulation of blood in the head. In this case, medical advice
ought to be promptly solicited, especially if it has not subsided by a
gentle aperient―as castor oil. Powerful doses of purging medicine will
become necessary; and, perhaps, bleeding from the arm, or leeches to
the temples, may be required.

Whenever the body becomes sore and painful, especially if it be
attended with suppression of the discharge, constipated bowels, and
fever, no time should be lost in demanding medical assistance.

In child-bed fever, early and free employment of bleeding and purging,
with strict attention to low diet, will almost universally succeed.

In reference to the child, where there is no disease, the chief object
of attention should be, to secure it against unnecessary exposure. Too
much washing at first may be pernicious; and the practice of using
spirits in these ablutions, merits reprobation. By the celerity of
their evaporation, they produce a degree of cold much more intense than
would be produced by the application of cold water, which would be
universally condemned.

It would be totally incompatible with a small pamphlet, and with this
extemporaneous address, to trace and delineate all the varieties of
child-birth. Yet, we think enough has been suggested to secure as
much safety in the time of parturition, as is attainable amidst the
uncertainties of human life.

Perhaps, however, it is not proper to overlook some peculiarities in
premature birth.

Abortion or miscarriage, which usually is accidental, sometimes
becomes habitual; and at about the same period of conception, on many
successive occasions, this disappointment will happen.

If there is a strong claim in the ordinary occurrences of pregnancy,
for an attentive regard to the condition of _mind_ as well as body,
it acquires its utmost urgency in those conditions in which habitual
miscarriage happens. The claim is urgent in behalf of the unfortunate
individual, whose life is a perpetual series of suffering and anxiety,
who is not only subjected, perhaps, every six or eight months to
the debilitating effect of excessive hemorrhage, but whose mind is
oppressed by disappointment, arising out of domestic and conjugal
relationships, even more heavily than by the influence of personal
suffering.

Until our present knowledge is enlarged respecting the association
of mind and body, and the ultimate connexion of different systems of
structure, we cannot appreciate the extent of moral influence.

Blushing shews the influence of mind on the circulating system; loss of
appetite and sensation of stricture across the stomach, its influence
on that organ; and perhaps the diaphragm, palpitation on the heart.
Various phenomena indicate the influence of the mind and nervous system
on secretion and absorption. And although we may believe the mind to
act on the nervous system, that system on the vascular and absorbent,
we never shall fully understand the nature of most diseases till the
nature of this intercourse be more clearly developed. But if we allow
the ascendancy of mind, its agency becomes most powerful when most
sensitive; and when, with this morbid sensibility, it is most subjected
to molestation.

How interesting and impressive are the claims of a female under these
circumstances; and attempts to administer relief, by the unassisted aid
of medicine, will, not unfrequently, issue in disappointment.

The causes of miscarriage vary; and as various as are the causes, must
be the medical treatment. These causes primarily belong, in general, to
the parent; but they may exist independently in the _conception_. With
the former only we are interested at present. They may arise in the
parent from either _general_ or _local_ causes. Every thing affecting
the general circulation, deranges that of the womb in particular. But
there are cases, in which there appears congestion or accumulation in
the womb, without any manifest general disturbance. We must recur to a
former observation; for till we understand the manner by which mind and
the nervous system affect the general circulation of blood, we cannot
understand the phenomena of abortion. Yet, is it a fact, that sudden
mental affection, whether arising from excessive joy or sorrow, disgust
or fear,―will often speedily and inevitably produce it.

And in cases happening without any cognizable incident, analogy
justifies the inference of moral agency, as its predominance in
producing congestion, and in deranging action, in other parts is
perceptible.[5] It is not intended to deny, that mind is often affected
consecutively; and in these cases, there is a pernicious reflected
action on the body.

In the management of these cases, especially when they may be deemed
habitual, moral treatment is in the highest degree momentous. It is an
indispensable pre-requisite, that not only the judgment, but the candor
of the practitioner be fully appreciated, before perfect acquiescence
can be commanded in precautionary measures. Sacrifices of great
domestic interest must often be required.

It may be necessary to enjoin an almost constant observance of the
horizontal posture; almost total seclusion from social intercourse,
at least such intercourse as may disturb the circulation; and even of
separating, for a considerable time, from conjugal association. And
these measures will never be fully and perseveringly adopted, but when
the mind is satisfied that the advice results from knowledge, and when
the progress is watched by the assiduities of kindness.

Frequent recurrences of discharge and pain, threatening immediate
miscarriage, certainly should not discourage. We have frequently seen
pregnancy go on to its completion, notwithstanding these occurrences;
but a slight deviation from the precepts we have enjoined may undo
all that the efforts of weeks or months had accomplished. When once
the womb has admitted of a full developement, the change has often
been most salutary. The period of suckling―the lengthened period
of freedom from pregnancy, (which suckling will probably secure),
conduces greatly to restore the constitution, and to enable it to
sustain future pregnancies without inconvenience. In these protracted
cases, occasional interposition of medicine will be useful; but if a
protracted course of medicine be needful, it should be assimilated
as much as is practicable with domestic preparations, except in some
anomalous instances.

In the allusions we have made to medical character, let it not be
inferred that the slightest reflection on the Physicians of Her Royal
Highness is designed. Writers in some of the public papers have
cruelly animadverted on the conduct of one of them, at least, in this
momentous event; and the only apology which occurs to us is, that their
censures were the illegitimate though too often fertile offspring
of vehement sorrow. Had the influence of these remarks been limited
to the gentlemen whom more or less they were intended to reprehend,
they would have been comparatively unimportant; but they are scattered
through the kingdom, and, without the slightest authority, tend to
alloy unmingled and consecrated grief. To cherish the most latent doubt
that the illustrious Princess did not derive the utmost aid from human
experience, will heighten and pervert the general lamentation; and were
it possible the surviving Prince could be accessible to such a feeling,
how would it embitter future years, which, with undissembled sincerity,
we hope he will survive, in useful and happy life!

There are documents, however, before the public, from which
unfavourable inferences have been deduced; and our observations will be
impotent, unless the legitimate tendency of these documents be traced.

It must be conceded, that interested as we were in the life of Her
Royal Highness, and as we ever have been, and continue to be, in
the life of our truly revered but afflicted Monarch, the brevity of
official communication creates disappointment; but are we justified
in propagating the opinion, that what is withheld is necessarily
unfavourable?

We have been informed, that a respectful solicitation, presented to one
of the Physicians, to publish the Princess’s case, has been declined;
and the prudence of his decision is very perceptible.

It would demand an extraordinary coincidence of rare qualities to
communicate the full result of ocular and tangible observation. To
designate a disease is by no means difficult; but to describe on paper
all the distinctions of an experienced eye, and all the erudition of
habituated touch, and to impart to them the full energy of the original
source of demonstration, would require a power of delineation which
is unattainable. However explicit, therefore, an attempt might be to
detail so affecting a case as this, it is impossible the contumelious
should not find something to censure, and the wrangler something to
dispute; and a fountain of interminable and painful controversy might
be opened.

It seems ostensible, that the honor of attending Her Royal Highness
devolved on Sir Richard Croft by voluntary and personal choice; and
however deeply and mournfully he may review the fall of so illustrious
a personage beneath his own eye, it cannot but ever be a source of
grateful remembrance, that he was the subject of such distinction.
There would be the utmost inconsistency in assigning to patronage an
election like this. Dr. Croft has long occupied an eminent rank as an
accoucheur; and more unequivocal testimony to his qualification could
not be rendered, than that the most clamorous for public investigation
have paid to his talents the meed of praise.

Of the celebrated Dr. Baillie, who occupies pre-eminently the public
confidence, and whose contributions to medical knowledge will honour
his name to the latest posterity, it would be insulting to offer a
defence. Nor indeed are we aware of an implication that either his
conduct or that of the other respectable physician, Dr. Sims, was
deemed impeachable.

Doctors Baillie and Croft seem to have been in attendance early on
the first day, and, in the evening of that day, the latter judged it
expedient to have, at immediate command, the counsel of Dr. Sims.
This, as a precautionary step, is honorable to Dr. Croft, and will
ever shield him against a successful imputation of temerity. It seems
probable, however, that Dr. Sims was not introduced to the Princess
till after the _accouchement_; and upon this circumstance, much
severity of comment has been indulged.

Advocating, as we have, the moral management of child-birth, we
believe, without the slightest reservation, that the arrangements
which were made, were best adapted to sustain confidence and courage
in a protracted case of natural labor; and that the unnecessary
interference of another practitioner would have been improper. It is
not certain that Dr. Sims was held merely in reservation; but if he
were, on Dr. Croft alone the competency to judge could rest; and whilst
experience justifies his competency, a most striking pledge is given
that he was not actuated by rashness.

A painful reference was made to the preliminary arrangements; but
in us their simplicity excites admiration. There is a certain, and,
perhaps, indispensable attendance on the parturient royal female,
unknown in subordinate society; but irrespective of this, it seems
to have been efficient and not superfluous. Can it be supposed that
a privilege was denied to this amiable Princess, which is claimed by
every woman in the country; that of selecting her own attendants?―and
that no supernumerary solicitous matron should be in waiting―and
that no unnecessary fears should be created by needless medical
introduction, exhibits a regard to moral influence which should ever be
in requisition.

All the lucubrations of censoriousness have not been noticed:―because,
by establishing prudence as well as reputation in the more prominent
and responsible acts, it may safely be believed that objects of less
moment were not disregarded.

To illustrate the cause of death would be indelicate. It was one of
those uncontrolable incidents which characterize the precariousness
of human life, and which must be referred to the “_will of God_,” the
wisdom of whose providential administration will be developed in a
future world.


                              FOOTNOTES:

     [1] “Yesterday, Aug. 6, 1801,” (says the late excellent
         Bishop Porteus), “I passed a very pleasant day at
         Shrewsbury House, near Shooter’s Hill, the residence of
         the Princess Charlotte of Wales. The day was fine, and
         the prospect extensive and beautiful, taking in a large
         reach of the Thames, which was covered with vessels
         of various sizes and descriptions. We saw a good deal
         of the young Princess. She is a most captivating and
         engaging child, and, considering the high station she
         may hereafter fill, a most interesting and important
         one. She repeated to me several of her hymns with great
         correctness and propriety; and on being told that when
         she went to South-end, in Essex, as she afterwards did,
         for the benefit of sea-bathing, she would then be in
         my diocese, she fell down on her knees and begged my
         blessing.”―_Life of Porteus, by Hodgson_, p. 160.

     [2] We recollect a most striking instance of this
         dexterity. An elderly and most susceptible lady
         was under the management of a respectable country
         practitioner, for a complication of nervous diseases.
         On paying one of his accustomed visits, he was alarmed
         for the safety of his patient. She had passed a night
         of unspeakable agitation, and her irritability was
         then excessive. It was attributed to an idea of having
         been poisoned by the compounder of her medicine, and
         she believed herself in the embrace of death. “Madam,”
         said the gentleman peremptorily, “I was aware of the
         accident, and brought with me an antidote.” He had
         immediate recourse to her former medicine, with some
         little disguise, which she took, and soon became
         tranquil. It is highly probable, had not some such
         method been adopted, she might actually have perished.
         See also a very interesting case in the Quarterly
         Review for July, 1816, p. 397.

     [3] I do not think it inconsistent or irrelative to quote a
         passage from the Sermon of a celebrated preacher.

         “I am afraid that this unusual result should produce
         an unhappy effect upon the spirits of those who
         are approaching the hour of child-birth. Let them
         recollect, that it is promised, ‘the woman shall
         be saved in childbearing if she continue in faith,
         and charity, and holiness, with sobriety.’ And,
         although it cannot be concealed that some sink in the
         struggle, (and for unfathomable reasons, the blow
         has fallen upon that illustrious personage, whose
         memory is this day embalmed with a nation’s tears),
         yet such occurrences, rare as they comparatively are,
         should be no more brooded over, as bearing upon this
         particular situation, than any of those calamities
         which are usually termed the accidents of life, are
         considered to affect its ordinary tenour and duration.
         It would be ungrateful, it would be sinful, to draw
         unfavourable conclusions from circumstances so
         extraordinary, against His tenderness and providence,
         who hath hitherto delivered, and will still deliver.
         Such persons are earnestly and affectionately exhorted
         to ‘lift up their eyes unto the hills, whence cometh
         their help,’ remembering, that their help cometh from
         the Lord, who made the heaven and the earth. And under
         this and every other instance of human instability and
         calamity, one common principle remains as a hope which
         cannot be shaken. We can look from earth to heaven, and
         say, ‘Thou, O Lord, remaineth for ever, thy throne from
         generation to generation.’”―_Dr. Collyer’s Sermon,
         occasioned by the Death of the Princess Charlotte._

     [4] This caution against disgusting objects does not imply,
         that in consequence of mental impression natural
         deformities arise. This unquestionably is a popular
         error, and the tales in circulation to justify it are
         either totally unfounded, or assignable to other causes.

     [5] We believe, that in delicate females, unequal
         distribution of blood is the cause of that peculiar
         order of diseases, denominated _nervous_.




                               THE END.




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




                       _This Day are Published_,


                           DISAPPOINTED HOPE,
                               A SERMON,

                           on occasion of the

               FUNERAL OF HER ROYAL HIGHNESS THE PRINCESS
                           CHARLOTTE AUGUSTA,

     Consort of His Serene Highness Prince Leopold of Saxe Cobourg;
      preached in the Church of the United Parishes of St. Swithin
           and St. Mary Bothaw, Cannon Street, on Wednesday,
                           November 19, 1817.

                 By HENRY GEORGE WATKINS, M. A. Rector,
                           Price 1_s._ 6_d._




                          THE NATION IN TEARS,
                               A SERMON,

                           occasioned by the

                DEATH OF HER ROYAL HIGHNESS THE PRINCESS
                           CHARLOTTE AUGUSTA,

     Consort of His Serene Highness Prince Leopold of Saxe Cobourg;
           with interesting Anecdotes of Her Royal Highness.
    Delivered at Weston Green Chapel, near CLAREMONT, and at Esher.

         By the Rev. JAMES CHURCHILL, of Thames Ditton, Surrey.
                           Price 1_s._ 6_d._




                              TWO SERMONS,

                           occasioned by the

                DEATH OF HER ROYAL HIGHNESS THE PRINCESS
                           CHARLOTTE AUGUSTA.

     Consort of His Serene Highness Prince Leopold of Saxe Cobourg;
            preached at Lock’s-Fields Chapel, Nov. 9, 1817.

                        By the Rev. G. CLAYTON.


                                  ―――


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Transcriber’s Note:

Words may have multiple spelling variations or inconsistent hyphenation
in the text. Obsolete and alternative spellings were left unchanged.
Two misspelled words were corrected.

Words and phrases in italics are surrounded by underscores, _like
this_. Footnotes were renumbered sequentially and were moved to the end
of the work. Duplicate letters at line endings were removed.