74 



OBSTETRICS. 



ercn where portions had been ejected from (lie stomach 

 One would have npfOMd that a M. > much 



inip.irt.in. c, OIK- connected wi immediately uith the 

 irruwth -f nations, would have attracted marked study 

 . ry quarter ; hut when we reflect ii| <m ilic Very 

 low estimate plwi-d U|HJII women by barbarous nations. 

 Uiih of ancient and modern bBM. we liml I. 

 cam* fur surprise. Slowly, as civilization progressed, 

 M the mean* for learning were multiplied, we find a 

 gradual advance in the .-mdy of obstetrics. 



IVrhapH one reason for the apparent neglect of tins 

 ini|'rtant branch of medical science is to DC found in 

 the ta.-t that delayed, tedious labors are so exceptional, 

 au rare that, except where disease or injury has caused 

 deformity, but little aid would seem to be demanded. 

 V't more than one case in every hundred can truly 

 be regarded as other than a strictly natural easy labor, 

 and this small number of cases are only delayed by 

 causes generally capable of 11 natural solution. When 

 we come to those which may be regarded as tedious or 

 obstructed !al>oi-s and those jiositivcly dcmandim. in- 

 stnimenta. interference, the proportion ranges notably 

 greater, to one in 1(KK) or ever. more. This proportion 

 is even greater in the case of nations where females 

 jve according to the laws of hygiene. Much of the 

 obstruction, the delay in delivery, is due to the artificial 

 ni'.de o. living among civilized nations, producing loss 

 i't L'eneral ner\e power, exhaustion, and even deformity 

 of organs, and thus destroying that wonderful exact 

 broportion which always exists in the healthy female 

 between the measurements of her organs and those of 

 her child. Hence we see that us nations advance in 

 the so-called arts of civilization they otter, degenerate 

 at least bodily, and there arises a need tor the -MM;, 

 of methods by which to counteract the evil resu'is 

 which are sure to follow. Of these obstructions in 

 labor we may instance cranial disproportions either by 

 reason of deficiency of the mother or by excess of tne 

 child, requiring tor delivery a resort to the cperat:on 

 called craniotoiiiy or destruction of the child's head in 

 order to reduce its size so that it may pass through the 

 unyielding parts of the mother. This was spoken of 

 by Hippocrates, and undoubtedly for many years was 

 performed under circumstances where the child's lite 

 might have been preserved; Perhaps the greatest im- 

 provement in the obstetric art at any time was the 

 invention of the forceps, which occurred alioiit the mid- 

 dle of the seventeenth century. Undoubtedly the in- 

 troduction of fhis instrument aided greatly in the prac- 

 tical instruction of physicians in the art of delivery, and 

 at first it was regarded as the means by which every life 

 was to be saved and every labor abridged. Indeed its 

 use became universal, and at one time bid fair to do as 

 much harm as good, in consequence of the utter ig- 

 ii'ir.uice on the part of the profession as to the proper 

 employment of this aid and the appropriate cases in 

 which to invoke it. 



Now, we find the whole range of obstetrics enlarged ; 

 it was found necessary to study the development of 

 the ovum, to follow it from the period of impregna- 

 tion down to the moment of delivery; then came the 

 anatomy of the (.arts, their relations to each other and 

 to the tootus ; the physiological action of all the organs 

 which were associated in the functions of child-bear- 

 ing; finally, the pathological conditions of those organs 

 and their interference whether in delivery' or in the 

 process of gestation. These studies need to be re- 

 I as incident to the life of woman during her 

 entire procreative period, which is generally regarded 

 as ranging from the 15th to the 45th year. These 

 limit* have been ascertained as the avenge of an im- 

 incrise number of observations, although, as in other 

 MCII!H, we have exceptions either way. Inci- 

 ' record of the delivery of a girl at her I Ith 

 year, and on the other hand of a woman at her Mth 

 year. The most prolific period is from the 25th to the 

 .VHh year. Nor are we to regard cessation of the vis- 

 nation, as u proof that the woman has 



the age of becoming pregnant. Instances 



constantly occur where, owim: to this cessation for a 

 number of year-, women have bmi announced as suf- 

 fering with a tumor when the event proved that they 

 were pregnant 



In consequence of such occurrences as this, and also 

 because, at many times necessity would arise to demand 

 a positive knowledge as to whether a woman was preg- 

 nant or the reverse, the study of the signs of preg- 

 nancy has occupied all practitioners of u*idwil'ery_ for 

 many centuries, and perhaps we may say for all time. 

 Air.iin and again has an infallible sign been announced, 

 only to be shown as entirely wit houi value. One of 

 the most pronounced of these was the peculiar sub- 

 stance found in the urine of pregnant women and 

 railed Kiesteine. This was known as early as 1839. 

 and for a time there existed no doubt that the needed 

 test was at last discovered, but when other investi- 

 gators found it in the urine of women who were not 

 pregnant and finally in that of men, the fabric dis- 

 solved as in ,i dream and (his test is now entirely aban- 

 doned. The only positive sign, and one which once 

 heard is conclusive, is the sound of the firtal heart. 

 This unfortunately can rarely if ever be heard until 

 after quickening has occurred, and in many cases owing 

 t.> other causes cannot be heard ; hence, while its 

 presence is positive, its absence is not a negative sign. 

 The absence of the menstrual flow is usually a sign 

 which leads to the search for contributory evidence, 

 but this is very unreliable, as in some women menstru- 

 ation never recurs during the period of chi)d!>caring ; 

 in there it may continue until the close of the latter 

 months of pregnancy. Any one symptom then is not 

 to be relied upon, but the presence of a number or 

 the absence of others may be regarded as significant. 

 Thus, when a woman of proper age is in apparent 

 good health, the cessation of the menstrual flow, a 

 gradual enlargement of the abdomen, with sickness or 

 nausea in the morning, and a darkening of the areola 

 around the nipple, would be symptoms to cause a 

 strong belief that she was pregnant. If later, about 

 H months from the inception of these signs, there oc- 

 curred at irregular intervals a peculiar feelim: of flut- 

 tering or movement within the abdominal walls, known 

 to women as the Quickening, additional stim-tli would 

 be given to this belief. Another symptom of preg- 

 nancy which is regarded by many authorities as of 

 special value is that of contraction of the womb at ir- 

 regular intervals. This is noticed often at a very early 

 period, and to many women is a positive proof that 

 they are in the pregnant state. In the case of women, 

 the Walls of whose abdomen are not too much loaded 

 with fat. this may be recognized by the physician by 

 placing the hand upon the abdomen, and letting it re- 

 main for a short time. The sensation is then observed 

 as though the uterine tumor slowly contracted beneath 

 l IK- hand. No decision should ever l>e made upon a 

 few of these signs only, and it is always best to err on 

 the safe side and act as though pregnancy were pres- 

 ent than the reverse, as a number of unfortunate in- 

 stances arc on record when- a. failure to do this has 

 been productive of mortifying results both to patient 

 and physicians, and even death has followed. 



The duration of pregnancy has been regarded by 

 even learned authorities as very variable, but it is now 

 generally conceded that about 300 days is the real 

 limit, and by some governments this is the period 

 allowed by law. where it may be necessary' to decide 

 the question. 



I hiring the first 15 or Ifi weeks the cessation of preg- 

 nancy by the extrusion of the tietus is called an alior- 

 tion, after that it is a miscarriage. A belief which 

 formerly was very common w;us that the frrlus was not 

 endowed with life prior to the period of quickening 

 In fact, the eredulou- believed that this was the sign 

 of the-entrance of the soul, and that a delivery before 

 that time was of no importance, and no criminality 

 attached to any means which might be employed to 



