Chapter II: Introduction

Parturition, or the expulsion of the perfectly formed human being from the body of its mother, is a most wonderful natural function, for the complete and safe performance of which at the proper time, every requisite is found to exist. Notwithstanding the contrary experience of society, as it now exists, it is well known that extreme suffering, and danger to life, are not necessary nor even probable accompaniments to child-birth; for it is invariably found, when females live under circumstances favourable to their full physical development and health, that it occurs speedily, and with little or no difficulty or pain. Numerous proofs of this could be given in accounts of the Indians, and other uncivilized females, among whom parturition is regarded as an ordinary occurrence, for which no preparation need be made, and about which no apprehension need be felt; such facts, however, are so well known that they only need be referred to here.

As the organization and requirements of society changes, by the adoption of what is called civilization, the condition of woman becomes very different to what it was originally. In many respects her lot is much meliorated, and she has great reason to be pleased with the change, but in other respects she has not been so fortunate.

One great evil resulting from her altered position is, a neglect of proper physical education while young, and of the various requirements for bodily health in after life. In consequence of which she becomes constitutionally weaker, and more sensitive to various injurious influences, which she possesses diminished powers to withstand. This evil increases in proportion as civilization advances, until at last females become so imperfectly organized, and so enervated, that they are utterly unable to fulfil the duties assigned them, and they either die prematurely, or pass their whole lives in suffering and complaint. So universally is this the case at the present time, particularly in cities, that the exempt are very rare exceptions to a rule most lamentably general. Unfortunately, custom and false notions have given this melancholy state the stamp of propriety, and thrown around it the charm of fashion. The suffering invalid is called _interesting_, and the pale faced debilitated creature, scarcely able to crawl about, is styled _genteel_, while robust health and physical capability is termed _coarseness_ and _vulgarity_. So infatuated, and weak minded, have females been made on this point, that I have actually known some of them quite chagrined because people could see they were well and strong; and I have known others quite alarmed for fear that they should _look_ so. A short time ago I knew a lady who, by the adoption of a proper course of training and treatment, passed through her confinement so quickly, and with so little exhaustion, that she was up and travelling about in three days after, not only without inconvenience but with pleasure and advantage. But what was the impression made on her female friends by such a speedy recovery? did they feel quite pleased at it, and desirous that all others should be equally fortunate? No; but quite the contrary! She was actually thought deserving of _reprehension_, and was stigmatized as _vulgar_ in the extreme. One person even made the remark, that she must be _a very common person, and no Lady_! Now what a pitiable state of ignorance, and mental imbecility, these females must be in, to be actually _proud of their infirmities_; and yet they are but like the majority of their sex. If they were not so _unfortunate_ in not knowing their true interests, they would be highly culpable, but as it is they are truly deserving of our pity.

It must be admitted, however, that though civilization has, so far, entailed these evils on women, it has also done much to alleviate them. Many diseases are beneficially modified, and some are even _cured_, by medical treatment; surgical science has also attained a high point of perfection; and the difficulties attendant on child birth are overcome to a great extent by obstetrical skill. But notwithstanding all this alleviation, these evils are still deplorably great. The utmost scientific skill to which society can ever attain, will do but little towards effectually relieving human suffering, and removing disease, so long as it is entirely devoted to the mere art of _curing_ and _palliating_ as it chiefly is now. Our knowledge of the human system, and of the causes which produce in it disease and deterioration, must be universally disseminated, so that the whole people may see _how these evils arise_, and how they should live, and conduct themselves, so as to _avoid them altogether!_ or, in other words, science should teach us how to _prevent_ disease and suffering, instead of merely how to alleviate them. Eventually this will be done, and our females will then pass through their travail as easily as their savage sisters do now. Let us hope that time will soon come; and let every one esteem it his duty, who possesses the ability, to hasten its coming, by doing all he can to spread the necessary information to those who need it.

The happy exemption from difficulty and suffering which females enjoy in more uncultivated states of society, and which we believe they will ultimately enjoy universally, does not however obviate the necessity for assistance _now_, in our state of society, and we have therefore to explain how it can best be rendered.

It has often been a matter of dispute, both with medical men and with moralists, whether _Men_ or _Women_ ought to assist in child-birth. The discussion has called forth a great deal of declamation, but very little has been said to the point on either side. It appears to me, however, that the question may be very easily settled, if it be rightly considered. The first requisite, and the most indispensable, in those who are to assist in child birth is, that they should _know how to assist_. This is paramount to every thing else. Now, if females really did know what to do in such cases, and were fully competent to do it, I think there is no question but they would be the _best_ assistants, to say nothing of their being the most _proper_. There are many things experienced by females in such situations, which can never be understood by a man at all, though they are readily appreciated by one of their own sex, particularly if she has been a mother herself. With each other also there would be less disposition and less occasion for reserve in delicate communications, and less repugnance to necessary examination or manipulation, which could therefore be more efficiently practised. In short, if women were undoubtedly equally competent with men in this art, and full confidence was felt in them by their own sex, I think it is evident they would, in every respect, be the most fitting practitioners, and I have no doubt but they would be preferred. The question simply arises then, whether they are so competent? And every one able to judge, who speaks honestly, must admit that very few, if any of them really are so. It has not been possible for them to acquire the requisite information, nor to pursue the necessary investigations, and therefore we cannot expect that they can be equal to those who have. There are some women I know, who have been careful observers, and who have had great experience, that can render all needful help _in most cases_, but even they are apt to meet with difficulties, which require more skill than they possess to overcome; therefore very few like to depend upon them altogether. It is naturally argued that, as a physician _may_ be needed, it is better to have him at first, and so be ready for every contingency.

That females can make competent _Accoucheurs_ is proved by numerous well known instances, among which I need only refer to MADAME BOIVIN, and MADAME LACHAPELLE, both of whom, as practitioners and as authors, stand in the very highest rank. These ladies are referred to as authorities, and their works are quoted by the most eminent Professors of the day; in fact, on many points, they have surpassed all competitors. Further on in our work we shall have occasion to refer to their labours, the value of which will then be seen.

It is therefore evident that females can officiate, if they are properly instructed, which I think they ought to be, independent of the reasons already given. That they will eventually be competent I have no doubt, and I am proud to throw my mite of instruction in their way to assist in making them so.

In regard to the alledged _immorality_ resulting from the present system of men acting as Midwives, there is much exaggeration, and much unnecessary alarm. That it is, in some respects, indelicate, and only to be justified by necessity is true, but there is no foundation for saying, as some do, that it leads to wide spread Profligacy and Adultery. I should prefer to see females always able to assist each other; but I cannot nevertheless consider the present system a necessary cause of licentiousness.

That females were always depended upon in old times, and are now in certain rude communities, is true, but that is no reason why they should be depended upon under all circumstances. In our present highly artificial state there are numerous causes at work, and numerous difficulties experienced, unknown to more primitive times and conditions, and we therefore require greater skill and more extensive resources. Females have in fact become more in want of help, and less able to assist.

At what time, and in what country, men first began to assist in cases of labour is not recorded. They have done so however for a long time, much longer than most people suppose. In the time of _Hippocrates_, called the Father of Medicine, who lived _more than four hundred years before Christ_, it appears that physicians were commonly resorted to. In his writings we find cases described, which show that he was well acquainted with the process of parturition, and even with some of the most difficult operations now practised. The Israelites appear to have employed women, as most eastern nations in fact do at the present day.

Midwifery, however, did not attract much attention, nor make much progress, till about the middle of the sixteenth century, since when it has been studied and practised by the most eminent Physicians and Surgeons, and has arrived at great perfection.

Many new discoveries have been made lately, which enable us to facilitate delivery and ease its pains, so that it is now robbed of many of its former terrors and dangers. Some of these discoveries are of easy application, and promise much future good; I shall carefully describe them all, in the following pages.

F. H.

ILLUSTRATIONS.

FRONTISPIECE, Eve in the Garden of Eden.

PLATE I.--Lateral Section, of the Female Pelvis, to show the position of the Organs in their natural state, 5. PLATE II.--Front View of the Female Pelvis, with the External Walls removed, 9. PLATE III.--The Uterus and its Appendages, 13. PLATE IV.--Vertical Section of the Womb and Vagina, natural size, 18. PLATE V.--The Muscular Fibres of the Womb, 23. PLATE VI.--Muscular Fibres of the Womb, 27. PLATE VII.--Bones of the Pelvis, 33. PLATE VII.-_a._--Male Pelvis, to show the difference in structure, 35. PLATE VIII.--Section of the Pelvis, 37. PLATE IX.--Diameters of the Upper Strait, 41. PLATE X.--The Bones of the Pelvis viewed from below, 45. PLATE XI.--The Direction of the Pelvis, 49. PLATE XII.--Section of the Uterus, with the Ovum and appendages, at about one month, 65. PLATE XII.-_a._--Female Breast, 77. PLATE XIII.--Breast about the Fourth Month, 90. PLATE XIV.--Womb, at about the third, seventh and ninth months, 99. PLATE XV.--Primipara, or the First Pregnancy.--Woman who has borne children before, 101. PLATE XVI.--Mode of performing the Ballotment, to detect Pregnancy, 107. PLATE XVII.--At the end of the Fifth Month, 111. PLATE XVIII.--The neck of the Womb in a first pregnancy, and in a female who has borne children before, at the end of the seventh month, 116. PLATE XIX.--Fœtus in the most usual position, 121. PLATE XX.--Fœtus in the next most frequent position, 125. PLATE XXI.--Presentation of the Pelvis, or breech, 129. PLATE XXII.--The position of Twins, as most usually observed, 133. PLATE XXIII.--End of the Ninth Month, 135. PLATE XXIV.--The Fœtal head, 147. PLATE XXV.--Diameters of the Head, 151. PLATE XXVI.--Attitude of the Fœtus, 153. PLATE XXVII.--Head just entering the upper strait, 173. PLATE XXVIII.--Head lower in the Pelvis, 177. PLATE XXIX.--Head beginning to Rotate, 181. PLATE XXX.--Rotation of the Head, 183. PLATE XXXI.--Head in the _right_ anterior occipito iliac position, 187. PLATE XXXII.--Delivery in a breech presentation, 194. PLATE XXXIII.--Anterior posterior position of the head, 195. PLATE XXXIV.--The chin just passed in presentation of the face, 200. PLATE XXXV.--Presentation of right shoulder, 205. PLATE XXXVI.--Descent of shoulder, 206. PLATE XXXVII.--Descent of shoulder, 207. PLATE XXXVIII.--Trunk descended, 208. PLATE XXXVIII.-_a._--State of the parts at beginning of labor, 215. PLATE XXXIX.--Manner of supporting the perineum, 233. PLATE XL.--Standard form of Pelvis, 271. PLATE XLI.--Masculine Pelvis, 271. PLATES XLII, XLIII, XLIV, XLV.--Deformed Pelves, 275-279. PLATE XLVI.--Head fixed in a narrow pelvis, 282. PLATE XLVII.--Case of Tumor, 289. PLATE XLVIII.--Case of Polypus, 293. PLATE XLIX.--Limbs cut off by the Cord, 301. PLATE L.--Forceps, 346. PLATE LI.--Head extracted by Forceps, 353.

TABLE OF CONTENTS.

PART I.--MIDWIFERY.

Section I.

POSITION AND USES OF THE FEMALE ORGANS.

_Page_

CHAPTER I.--Position of the Organs and Parts, 13
Internal Organs, 14
External Organs, 16

CHAPTER II.--Structure of the Principal Organs and Parts, 18
The Womb, 19
The Vagina.--Vulva.--Perineum, 29
The Pelvis, 30

CHAPTER III.--Functions of the Principal Female Organs, 50
The Womb, 50
The Ovaries.--Menstruation, 51
Conception, 54

CHAPTER IV.--Fœtal Development, 57
Fœtal Nutrition, 67
Peculiarities of the Fœtal Circulation, 70
The Breast, 74

Section II.

SIGNS OF PREGNANCY, AND THE MEANS OF DETECTING IT; ITS DURATION,
AND THE PERIOD AT WHICH THE FŒTUS CAN LIVE.

CHAPTER V.--Presumptive Signs, 83
Probable Signs, 94

CHAPTER VI.--Duration of Pregnancy, 137

CHAPTER VII.--Period when the Child can live, 142

Section III.

THE FORM, SIZE AND POSITION OF THE FŒTUS, AND ITS APPENDAGES, AT
FULL TERM.

CHAPTER VIII.--Form and Size of the Body, 144
Size and Form of the Head, 144
Attitude of the Fœtus at Full term, 152

CHAPTER IX.--The Appendages of the Fœtus at term, 155

CHAPTER IX.--The Membranes, 155
The Placenta, 156
The Umbilical Cord, 157

Section IV.

THE MECHANISM OF DELIVERY IN ALL THE DIFFERENT PRESENTATIONS
AND POSITIONS OF THE FŒTUS.

CHAPTER X.--Presentations, 160
Positions, 161
Mode of ascertaining the Presentation and
Position, 164

CHAPTER XI.--The Mechanism of Delivery, in a Presentation
of the Head, 170
The Left Anterior Occipito Iliac Position, 170
Mechanism of Delivery in all other Positions
of the Head, 185
General Remarks on the Different Positions
of the Head, 189

CHAPTER XII.--Mechanism of Delivery in Presentations of
the Lower Extremities, 191
Delivery in a Breech Presentation in the left
Anterior Sacro-Iliac Position, 192
Delivery by the Breech in the Right Posterior
Sacro Iliac Position, 196
Delivery by the Breech in the Full Posterior,
or Sacro Sacral Position, 196
General Remarks on the Presentation of the
Lower Extremities, 197

CHAPTER XIII.--Mechanism of Delivery in Presentations of
the Face, 199
Delivery in the Right Posterior Mento Iliac
Position of the Face, 199
Delivery in other positions of the face, 200

CHAPTER XIV.--Mechanism of Delivery in Presentations of
the Trunk, 203
Mechanism of Delivery in Presentations of
the Trunk by Spontaneous Evolution, 204

Section V.

THE PHYSIOLOGY OF SPONTANEOUS DELIVERY, OR CHILDBIRTH, AND THE
MANNER OF CONDUCTING A NATURAL LABOR.

CHAPTER XV.--Of Delivery in General.--Different Kinds of
Delivery.--Causes of Labor, 211
Signs of Delivery, 212

CHAPTER XVI.--The Progress, Phenomena, and Duration of
Natural Labor.--First Period, 214
Second Period, 216
Duration of Natural Labor, 220

CHAPTER XVII.--The Conduct or Management of a Natural
Labor.--Preliminary Requisites, 222
Preliminary Proceedings, 223
Preparations for the Delivery, 226
Attendance after the Preparations are made,
and during the Delivery, 229

CHAPTER XVII.--Delivery of the After Birth, or Placenta and
Membranes, 239
Attentions to the Female after the Delivery
of the After Birth, 242
Attentions to the Child, 243
Accidents which may happen, 246
Subsequent Attentions to Mother and Child, 249
Concluding Remarks, 255

Section VI.

PROTRACTED AND DIFFICULT LABORS.

CHAPTER XVIII.--The Causes and Consequences of Prolonged
Labor to both Mother and Child, 259
The Consequences of Prolonged Labor, 259

CHAPTER XIX.--Causes connected with the Mother which
may impede labor, or make it difficult, 260
Inertia, or Want of sufficiently Powerful
Contraction in the Womb, 260
Rigidity of the Mouth of the Womb, Vagina
and Vulva, 264
Obliquities of the Womb, 266
Prolapsus Uteri.--Smallness or Deformity of
the Pelvis, 267
Tumors in the Pelvis, 286
Tumors externally.--Obstructions in the Vagina, 295

CHAPTER XX.--Causes connected with the child, or children,
which may impede delivery. 297
Procidentia of the Umbilical Cord, 297
Shortness of the Cord, 300
Descent of other parts with the head, 301
Twins and Triplets, 302
Excessive size of the Fœtus, or the diseased
development of certain parts, 304
Ossification of the Head, 305
Various presentations and positions of the
Fœtus, 306
Presentations of the Lower Extremities, 307
Presentations of the Shoulder, 311

Section VII.

ACCIDENTS DURING LABOR WHICH MAY COMPROMISE THE MOTHER'S LIFE.

CHAPTER XXI.--Uterine Hemorrhage, or Flooding, during
Labor, 315

CHAPTER XXII.--Eclampsia, or Convulsions during Labor, 336

CHAPTER XXIII.--Rupture of the Womb or Vagina, 341

Section VIII.

OPERATIONS WITH THE HAND AND WITH INSTRUMENTS.

CHAPTER XXIV.--Operations with Instruments.--The Forceps, 345
Other Instruments, 355

CHAPTER XXV.--Operations with the Hand.--Turning, 357

PART II.

THE DISEASES OF WOMEN DURING PREGNANCY, AND IN CHILDBED.

Section IX.

THE DISEASES OF PREGNANCY.