A Treatise on the Art of Midwifery: Setting Forth Various Abuses Therein, Especially as to the Practice With Instruments: the Whole Serving to Put All Rational Inquirers in a Fair Way of Very Safely Forming Their Own Judgement Upon the Question; Which It Is Best to Employ, in Cases of Pregnancy and Lying-in, a Man-midwife

In Short

This book is a polemical treatise written in 1760 by a practicing midwife who seeks to protect expectant mothers from the growing trend of male-dominated obstetric practices. It argues that the interventionist, instrument-heavy approach of male practitioners—such as the use of forceps, crotchets, and scissors—is often driven by professional vanity, greed, and a lack of patience rather than clinical necessity. By championing the natural, non-invasive methods of experienced midwives, the work serves as a foundational critique of early medicalization and the dangerous arrogance of "learned" practitioners.

The Story

The narrative arc of the book is a sustained, logical assault on the legitimacy of the "man-midwife." It opens with an appeal to parents, urging them to bypass the "blind implicit confidence" they place in fashionable doctors and instead rely on their own common sense to judge who is best suited for the delivery room. The author establishes the central conflict: a battle between the gentle, patient, and manual techniques of traditional midwives and the brutal, mechanical interventions favored by men who treat the process of birth as a surgical problem to be solved with iron tools.

As the argument progresses, the author methodically dismantles the professional reputation of famous obstetricians like Dr. William Smellie and André Levret. She catalogs the horrific outcomes of their methods, describing how they tear, rend, and mutilate both mother and child in their rush to finish a delivery. She frames these men not as healers, but as "executioners" whose primary goal is often profit or convenience. Throughout, she highlights the hypocrisy of these men who, in their own writings, often acknowledge that their instruments are unnecessary and harmful, yet continue to use them to secure their professional status.

The middle portion of the text delves into the anatomy of the "abuses." The author explains that the "man-midwife" uses complex, "learned" language to mask his ignorance and to intimidate families into compliance. She argues that the physical act of "touching" and the intimate, prolonged nature of the attendance allow these men to exert an unhealthy, manipulative influence over a household, often subverting the authority of the husband and the comfort of the wife. She contrasts this with the professional distance and reliability of the midwife, whose office is part of the established order of nature.

The argument reaches its climax as the author dissects the specific instruments of the trade—the crotchets, forceps, and various "tire-têtes"—demonstrating that they are inherently dangerous and frequently used in situations where nature would have safely resolved the birth if given time. She concludes with a fervent call for legislative reform to regulate the profession and protect society from the "Herods" who destroy the very lives they are hired to preserve. The final takeaway is a sobering warning: that "fashion" in medicine is a deadly force, and that the "great and opulent" are often the most easily duped by the very practitioners who endanger their lives.

How It Unfolds

The appeal to reason The author addresses fathers and mothers directly, imploring them to exercise their own judgment rather than blindly trusting the credentials of fashionable men. She insists that nature has provided common sense as a sufficient guide for understanding the needs of a mother in labor.

The indictment of violence Moving into the clinical evidence, the text details the horrific physical trauma inflicted by instruments like hooks and scissors. The author describes the "tearings and rendings" caused by these devices, framing the practitioners as men with "hard words and harder hearts."

The critique of professional vanity The author exposes the hypocrisy of famous practitioners who claim to have invented superior tools while simultaneously admitting in their own texts that these tools are often useless. She argues that these men are more concerned with their reputations than with the health of their patients.

The danger of influence The argument shifts to the social implications of male presence in the birth chamber, suggesting that the "man-midwife" uses his position to gain undue control over a family's affairs. This psychological and moral encroachment is presented as a secondary, yet equally dangerous, abuse of the profession.

The call to reform The concluding section demands that the state intervene to stop the "ignorant pretenders of either sex." The author leaves the reader with the firm belief that the current trend of using male interventionists is a destructive fashion that must be resisted to preserve the human species.

The People

Elizabeth Nihell, the author, acts as the central voice of reason. She positions herself as a "professed midwife" who possesses the clinical experience that the male theorists lack. She is observant, deeply skeptical of academic jargon, and fiercely protective of the dignity and safety of her patients.

The "Man-Midwife" represents the antagonist, appearing as a composite of various historical figures. Driven by "interest," this figure is portrayed as cold, ambitious, and fundamentally lacking in the patience required for natural birth. Whether he is the "rough" practitioner who makes crude jokes or the "pretty lady-like" gentleman who uses soft words to hide his destructive intent, he is defined by his reliance on instruments and his disregard for the natural process.

The Parents are the intended audience, portrayed as vulnerable, well-meaning individuals who are misled by the prestige associated with male doctors. The author’s goal is to transform them from passive victims of "fashion" into critical, informed decision-makers who recognize that their family's safety lies in rejecting the "learned" violence of the medical elite.

In Its Own Voice

One, upon some most learnedly erroneous hypothesis, pulls and hauls the arm of an innocent infant yet living, so that he plucks it off; or repels it with such violence, that he breaks it: another unmercifully opens the infant’s head, and takes the brain out.

(In this passage, the author describes the brutal, physical reality of the "surgical" interventions commonly practiced by men in the mid-eighteenth century.)

A midwife, with less learning and more patience than those gentlemen, and well acquainted with the power and custom of Nature to operate in some subjects, sometimes more slowly, and in all ever more safely and gently than art, would have left to nature, not without her tenderest assistance of that nature, the expulsion of the child.

(Here, the author defends the traditional, slower, and more observant approach of the female midwife as the superior path to a safe delivery.)

What It's Really About

At its core, this book is a protest against the hubris of Enlightenment-era medical science. The author argues that the rise of the male-dominated obstetric profession is a triumph of vanity and commercial interest over the wisdom of nature. She questions the assumption that "scientific" progress is always beneficial, suggesting that in the realm of midwifery, the introduction of invasive technology has caused more death and suffering than it has prevented. The text challenges the reader to consider whether a "specialist" whose methods are fundamentally unnatural can ever be as effective as a practitioner who works in harmony with the body's natural rhythms. It is a fundamental question about the cost of modernizing traditions that have served humanity for millennia.

Why Read It Today

Readers interested in the history of medicine and the origins of the gendered divide in healthcare will find this a fascinating, if sometimes harrowing, primary source. The prose is fiery, intelligent, and remarkably accessible for a mid-eighteenth-century text, making the author’s indignation feel startlingly immediate. She does not mince words, and her descriptions of eighteenth-century surgical practices are explicit and chilling, which may be difficult for sensitive readers.

What stays with you is the author's consistent focus on the "human" element of care—her insistence that patience and physical touch are more effective than iron tools. While the language of the period is formal, the author's voice is vibrant and urgent. She effectively demonstrates how social "fashion" and the pursuit of status can override common sense and lead to widespread, avoidable tragedy. For those who enjoy reading arguments that challenge the status quo, this book offers a unique, sharp-tongued perspective from a woman who was at the front lines of a major cultural shift. It is a reminder that the loudest, most "learned" voices in a room are not always the ones that best understand the realities of life and death.