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Another sort of abuse, the ambition or desire of fame, which impels some accoucheurs to commence dangerous surgical operations, where nature is sufficient to complete her own works, as verified by an eminent member of the medical profession to be frequently practised, shall be reserved for especial notice, when discussing the injurious consequences to bodily health, and danger to life, proceeding from the various abuses before mentioned.
Having adverted to the abuses arising out of the present system of midwifery, I now come to a consideration, first, of the irremediable difficulties, in all cases, opposed to their suppression, under that system; and, secondly, of the character of these abuses, and of the immediate effects and remoter consequences produced by them.
There being more or less interference of the accoucheur with the female in every childbirth which he attends, there must always be a proportionate degree of indelicacy committed and suffered; and the moral evil of unlawful lust, on his part, may be considered to be in general co-extensive. The ordinary interference in common cases being considered requisite, and greater interference being required in every other case, it is obvious, that no remedy, except the subversion of man-midwifery, is applicable to any case. I will now examine, whether there is any remedy, except that, for extraordinary directly wanton abuses. The propriety or impropriety of any interference must depend in every case on the symptoms indicated, or the result of inquiry at the time, as to whether or not they induce a reasonable supposition, that the labor is so far advanced as to render some, be it more or less, assistance of the practitioner necessary. That by any human device the conduct of medical men could be universally and permanently restricted to a proper course in this respect is absolutely impossible. Aware, in a general point of view, of the natural forwardness peculiar to the male sex, yet naturally strangers in feeling to the impetuosity and extent of desire which prompts it, women are easily deceived by supposed necessity, or the pretences of the accoucheur. I am aware that females, to whom my remarks may be well known by information, and by whom they may be kept in mind, are competent to detect those extraordinary abuses, which are obviously without a good plea; but can this knowlege be made universal amongst them, and if it could, will not time eventually efface such knowlege in future generations? But in cases where the fact is ascertained by females, the only corrective to the accoucheur's misconduct, unless surgeons were discouraged from practising midwifery, would be a disclosure of a nature highly repugnant to the feelings of delicacy in the individual female, especially if young, whose modesty and general propriety of behavior might
intitle her to credit. The husband, if he should chance to be acquainted with the real circumstances, is mutually actuated by a sense of delicacy, as to the particular instance, with his wife. Delicacy, however, consequentially prompts her studiously to prevent his obtaining a knowlege of the actual circumstances, occurring even in the ordinary practice of the accoucheur. This feeling does not directly restrain her from communicating to him, who is her husband; but she is naturally conscious that to inform him would not only be the immediate cause of hurting his feelings, but, for reasons which I shall mention when treating of personal abasement, would occasion a risk of diminishing his love for her. She therefore conceals the case; instead of candidly and magnanimously informing him of it, and then trusting the event of her situation to Providence: she adopts a temporary expedient, instead of taking a step which, if often repeated, would be calculated to abolish all such evils in future, both in respect of herself and her sex in general. Her secrecy, however, originates in the anxiety of her conjugal love, and is such as to shelter her from meriting more than a small degree of blame. Delicacy generally prevents the neutral female spectator from owning to the particular instance of abuse, and silences the spontaneous complaints by women of general instances: it has these effects, as well in respect of communicating to an indifferent person, as because the notoriety of such abuses would lead husbands to inquire into circumstances connected with their respective wives. A public disclosure of a particular instance of extraordinary abuse would therefore rarely, if ever, be made; and even if it were made, and however true, it would not circulate far-would be liable to partial contradiction, disbelief, discountenance, suppression, or misconstruction, and would generally make only a slight impression on persons unaffected by it. Moreover, medical men are generally furnished with a plea. Thus, besides the almost universally insurmountable and unblamable aversion to making a public disclosure, for the sake of correction and reformation, it would be impossible for it, when made, to produce a general and lasting sensation in the community. This natural incompetency, to a great extent, in women to detect extraordinary abuse on the occasions of childbirth, their peculiar aversion to disclose, and the impossibility of the disclosure becoming effectual, considered with reference to the natural forwardness peculiar to the male sex, argues strongly in favor of midwives, and against surgeons, practising midwifery.
In reference to the observations which next follow, it will be well to premise, that some of them are not meant to be applicable to those persons whose habits or dispositions render them in a great degree insensible to decency, nor to husbands whose
affections have been seared by gross licentiousness in their wives: nor can many of them be expected to apply with proper force to those men, as husbands, whose matrimonial unions have been merely political, nor where through inveterate domestic strife their conjugal affections have subsided.
Without reference to the obvious criminality of lust arising out of the practice of man-midwifery, and therefore supposing it to be possible, that in any case the accoucheur should have interfered without having been excited by this passion, still it would unquestionably be indelicate for him to assist, as it is to be even simply present, at a childbirth; and more especially as many in the profession, for motives which are obvious after what I have before stated, are averse to the presence of the husband on such occasions. Surely, as far as delicacy is concerned, the presence of the husband, when a surgeon is attending on such an occasion, is, or at least may be, a restraint on extraordinary abuse, or affords better means of detecting it; and according to the free and unprejudiced feelings of our nature, when the occasion is in anticipation, and the husband's reasonable suspicions are aroused, is more congenial to both the husband and the wife.
Delicacy or modesty is an ideal instinct of our nature, and therefore in its origin wholly unconnected with the exercise of reason for we are prompted to it without reflection; we fix its extent by our natural feelings, and we determine the degree of its infraction by the same means. Though it is purely ideal, yet, as imposing a restraint on licentious actions, by the displeasure which the breach of it naturally creates in an unwilling passive party and a neutral person, and in exalting human nature through the loveliness we instinctively attach to it in respect of either sentiment or action, it is a positive moral good. Each sex, exclusively among themselves, are generally sensible to delicacy, as far as relates to a wanton infraction of it: but when one commits an act primarily indelicate before another of the same sex out of pressing necessity, the disgust arising is comparatively small, and may, in most instances, be easily and completely obviated by familiarity, common habit, or custom. Between two persons, one of each sex, there is mutually a much greater sense of delicacy; and the fair sex especially have a higher sense of this virtue than men, as it respects the actions or situation of the one sex being witnessed or known by the other; and in case of either sex, whether the action or situation was wanton, or arose out of unavoidable accident or indispensable necessity, yet in the instance of wantonness, the disgust to the world, in general, at the perpetrator of indelicacy, is greater than in that of accident or necessity. Men, too, have a higher sense of delicacy, as it respects the female sex, than them
selves. With these modifications, and subject to these restrictions, the infraction of delicacy usually creates disgust; except as to the party committing or suffering, when the breach is accompanied by more or less privacy and lustful ideas, as in the case of the accoucheur; and except as to a depraved person, when it is committed or viewed by him with malignity or advantage; and lastly, except in a party vulgarly enjoying comparatively trifling indecencies in action, or indecent expressions, as a subject of ridicule. This natural disgust may be partly or wholly obliterated, in particular instances, by the individual being habituated to the commission or suffering of the particular indelicacy, yet habit does not inevitably in all persons obliterate the disgust in such instances; or disgust may be obliterated, in a slight degree, by the novel adoption, in the particular instance, of a general custom. Nothing can wholly efface, in an individual of sound mind, natural disgust at indelicacy in general; for the commonest prostitute would inwardly feel indignant at the man, who would maliciously and forcibly expose her person publicly, in a much greater degree, than for a malicious assault, committed with equal violence, but without indelicacy.
By our natural instincts we determine that those actions, besides some others, are positively indelicate, which are calculated, in the direct instance, or by analogy, to excite in a party or other person, though in fact they may or may not excite, unlawful lust; and in proportion to the extent of their capacity to excite, is our sense of their indelicacy. This indelicacy, when wanton and unnecessary, is a positive moral evil, because it is thus calculated to incite an unlawful passion, and because in an unwilling passive party or a neutral disapproving person, it is injurious by wounding the feelings. As creating painful sensations in those who are not parties to it, yet conscious of it, and where others are unconscious of it, as debasing the nature of the parties individually, it is, beyond its capacity of exciting lust, morally criminal, as well in the party wilfully and directly permitting as in the party committing it. Absolute necessity, or an unavoidable incident, obviates the moral guilt of indelicacy. In reluctantly becoming personally the object of indelicacy by compulsion, stratagem, or necessity, and with or without lust in the perpetrator, though the passive party is morally innocent, yet Providence has wisely determined both sexes to abhor indelicacy in such a case, at the instant and retrospectively, as in other instances, even as it respects the sufferer; by means of our natural sensibility-on account of the ideal excellence of personal delicacy, and innocence therein, and of natural perfection; and of proximity to personal innocence and natural perfection. The disgust is equally great, both to the innocent sufferer and
the world, in respect of the indelicacy of the innocent sufferer, whether the indelicacy was, on the part of the perpetrator, wanton or necessary, or was the result of accident. A person would instinctively feel himself to be personally abased, though without self-reproach, or the reproach of the world, at becoming personally the unwilling object of indelicacy; and he would instinctively rate another morally innocent sufferer to be abased in person, without thinking that other liable to reproach, on witnessing or even at being credibly informed of the commission of indelicacy by compulsion or stratagem on him. The fair sex, having a higher sense of delicacy than the other, and men naturally esteeming delicacy in women more than in themselves, the sense of abasement arising from indelicacy in the two cases just mentioned, when applied to these positions, is then greater. The degree of abasement is of course proportioned to the extent of the indelicacy suffered. Experience fully supports this doctrine. I will instance a strong case, which will confirm it. A modest girl, or wife, is violated. The monster, who has committed the act, is apprehended, and meets with the fate he deserves. Why does he merit capital punishment; why is the case more than that of a heinous assault; why is the momentary commission of indelicacy and impartment of terror such an aggravation? Because she has been forcibly despoiled of her personal innocence, or proximity to personal innocence: that is, because the girl, or wife, and her friends, and the world, feel that she has received, not merely a transitory past, but a present personal injury of an ideal nature from the indelicacy, of which she was morally an innocent sufferer; and because lust, being the most powerful of all the passions, and readily to be gratified by violence, requires rigid laws to restrain the unlawful and forcible exercise of it. Legal punishment is not, or ought not to be, proportioned to the moral guilt of the offender; it is proportioned to the extent of the temporal injury, and the temptation and facility for committing it. The enduring injury, in this case, is obviously of the nature I have been describing. Moral innocence, however, in all cases, according to our natural instincts, instantaneously obviates a part of the disgust, arising from the indelicacy of the situation of the innocent sufferer.
In cases of man-midwifery, the accoucheur's assistance, when viewed abstractedly, and considered without the prejudices of custom, we instinctively determine to be an instance of the greatest indelicacy; we naturally feel that indelicacy cannot proceed much further, without at the instant changing the scene from a private to a public exposure. In the first place, the nature of the personal assistance is such, that a surgical operation necessarily performed by a surgeon even on a man, with comparatively equal bodily