Cartilla nueva para las matronas (Madrid, 1750): the examination manual for midwives
In 1750 the Real Tribunal del Protomedicato had a manual written for the women it was about to begin examining again. The prologue says why: the examination of midwives had been suspended in Castile alone by a royal pragmática, and study had stopped with it. The King, on the Council of Castile's advice, ordered every woman living by the office examined in theory and practice — and a cartilla made so that they could prepare for it.
Why this wins its question: General accounts of eighteenth-century midwifery reach for France and England, and where Spain appears it is as a laggard. The 1750 Cartilla is the document that complicates that in both directions, and it is almost never quoted. Quoted here from the Madrid sheets: the Tribunal's own admission that the examination of midwives had been suspended in Castile alone and that study had stopped with it; the royal resolution that made examination compulsory for women already in practice as well as for new entrants; the decision to confine the book to the easiest matter because it was addressed to women who barely read and write; and the manual's own rule that the difficult birth belongs to a "Cirujano Perito" and not to the midwife — each with its printed page.
Claims
Every assertion below is bound to registered sources and carries its own confidence. Weight them; do not treat the page as uniformly authoritative.
The title page reads "CARTILLA NUEVA, UTIL, Y NECESSARIA para instruirse las Matronas, que vulgarmente se llaman Comadres, en el oficio de Partear", and states that it was "MANDADA HACER POR EL REAL TRIBUNAL del Protho-Medicato, AL DOCTOR DON ANTONIO MEDINA, Medico de los Reales Hospitales, de la Real Familia de la Reyna nuestra Señora, y Examinador del mismo Tribunal". The imprint is "En Madrid: En la Oficina de Antonio Sanz, Impressor del Rey N.S. y su Real Consejo, Año de 1750". The book is therefore not a private treatise but a text commissioned by the licensing tribunal from one of its own examiners.
The prologue states the failure that prompted it, and states it against Castile. For the instruction of midwives, it says, rules were anciently established and books published, by the study of which they might be made fit to be approved; and the Tribunal observed "que solo en Castilla se havia por una Real Pragmatica suspendido el examen, y con este motivo omitido todo estudio, y aplicacion, como si fuesse Arte que no lo necessitasse". The reform of 1750 is thus presented by its own authors as the repair of a Castilian lapse, not as an advance on a general practice.
The consequence named is unlicensed entry to the trade by both sexes: the suspension facilitated "la introduccion à exercerlo, assi à hombres, como à mugeres, que casi del todo carecian de las condiciones necessarias para tan delicado exercicio". On that ground the Tribunal went to the King, "haciendole presentes las infaustas consequencias de tan perniciosa tolerancia".
The royal resolution is quoted in the prologue and is the operative act behind the book. Having taken the opinion of his Supreme Council of Castile, the King "ha resuelto, que todas las Mugeres, que viven de este oficio, y las que en adelante le huviessen de exercer, sean examinadas, assi en Theorica, como en Practica, por el Protho-Medicato: y que para este efecto se forme una Cartilla, por la qual se instruyan para el examen; y no mereciendo en este la aprobacion, queden privadas con graves penas de exercer dicho oficio." The examination is compulsory and retrospective — it reaches the women already in practice, not only new entrants.
The book states that it is the execution of that order: "En cumplimiento de esta Real resolucion, ha mandado el Tribunal publicar esta Cartilla, que contiene lo mas principal que debe saber una Matrona, las circunstancias que deben assistirla, y la obligacion en que por razon de oficio se constituye. Toda en methodo de preguntas, y respuestas, y con la possible brevedad, y claridad."
The prologue then says, in its own words, what the book is not, and why — the most candid page in it. Addressing itself to women "que apenas saben leer, y escrivir, y que hasta aora, por no haverse sujetado à estudio alguno, se les ha de hacer muy ardua qualquier literaria enseñanza", it was thought convenient "ceñirse à lo mas facil", leaving the extension of this or another cartilla "à todo lo demàs, que complete un Arte de Partear" until they should have laid aside "la repugnancia à la aplicacion estudiosa". The stated hope is that "recobren nuestras Matronas Españolas aquel famoso credito, que tuvieron en lo antiguo".
The text is catechetical throughout, and opens by defining its own subject. Printed page 1, Capitulo proemial: "Preg. Què se debe entender por Arte de Partear? R. Aquella doctrinal instruccion, que enseña las cosas necessarias para el conocimiento del objeto de este Arte; y un methodo para dirigirlo, y socorrerlo en los trabajos, y riesgos de sus partos."
The manual draws the midwife's competence with an explicit stopping point. Printed page 47, on a case beyond her: she is to "Disponer que sin dilacion se avise al Medico, y Cirujano, para que consultado el verdadero juicio que se debe hacer, dèn las providencias para el remedio; pues este caso trae dificultades, que no las puede superar la Matrona, y complicacion de accidentes, en que no tiene la inteligencia necessaria." Immediately after it, Capitulo IV, "EN QUE SE TRATA DEL Parto", begins: "Preg. Què es Parto? R. La salida de la criatura fuera de la matriz en su debido tiempo."
The same boundary governs the obstetric emergency. Printed page 60 lists the signs of a normal presentation — among them the waters felt flattened or forming a bag between the child's head and the membranes — and rules that where these are wanting in due time "debe la Matrona sospechar un parto preternatural, y como tal advertirlo con recato de la doliente à los interessados, para que llamen Cirujano Perito, que providencie el auxilio, ò maniobra correspondiente à la variedad de causas en los dificultosos partos". The midwife is to recognise the malpresentation and to warn discreetly, out of the labouring woman's hearing; the manoeuvre belongs to the surgeon.
The manual also settles the sacramental questions the midwife had to decide at the bedside without a priest. Printed page 37 distinguishes the true fetus from a mole, and rules that products of conception which have a determinate figure and some likeness to a rational or irrational body, and which "se mueven con vida puramente sensitiva", are "indignas del Bautismo". The obstetric and the theological are taught in the same question-and-answer sequence and by the same authority.
The reform put the licensing of a trade practised by women in the hands of a tribunal of male physicians and surgeons, and the pages read place the blame for the preceding ignorance on the women rather than on the absence of instruction offered to them: the remedy is deferred until they have set aside their own "repugnancia à la aplicacion estudiosa", and no school, teacher, stipend or place of instruction is named anywhere in the pages read. What was provided was an examination, a hundred-page booklet and a penalty.
What this printing establishes and what it does not are different things. It establishes what was ordered, by whom and in what year, and what the Tribunal thought a midwife should know. It carries no register of women examined, no count of licences granted or refused, no figures of any kind on maternal or infant death, and no evidence that the examination was enforced. It is also, on the pages read, wholly peninsular: nothing in them refers to the Indies, and this object makes no claim that the Cartilla was used, reprinted or received in Spanish America.