PART III.

THE THERAPEUTICS AND SURGERY OF

MIDWIFERY.

CHAPTER IX.

LABOR.

IN coming now to this third division of his subject, or Midwifery proper, the Student ought to understand that the practice of this art is one requiring not only a large amount of obstetrical or scientific information, but also a great deal of prudence and delicacy, as well as some knowledge of the world; without which he will scarcely attain to any considerable eminence or happiness in the practice of it. Even the foregoing imperfect statement of the Anatomy and Physiology of Midwifery, subjects which, to be well described, would require several volumes rather than a few short chapters in this one, might serve sufficiently to show him, that a great variety of considerations must precede the study of Midwifery proper; and that those considerations relate not only to the structure and functions of the living body, but also to every step in the development of that body, from the earliest dawn of its existence, up to the complete maturity of its powers and faculties.

There have not been wanting very good writers to show that the whole of this study and practice ought to be confined to persons of the tender sex; asserting that the differences between the sexes ought not to warrant those impudicities that are supposed inseparable from the practice of the Art of Midwifery by men; and, in the world, at the present day, though it is admitted that the Surgeon-accoucheur is an indispensable person in society, he is by many looked upon with a sort of doubt and distrust, on account of the very peculiar nature of his pursuits.

On this question, however, I think any man's mind may arrive at a satisfactory conclusion, if it be only considered that a person with a pure heart and righteous purposes may be safely confided in, as far as relates to the morals of the profession of an obstetrician; and I will add that the objectors to the practice of Obstetrics by males, are perhaps of more impure minds than the accoucheur himself; who, if he be actuated by the laudable motives that ought to rule the life and conversation of every medical man, may retort upon his opponent honi soit qui mal y pense, or shame on him who evil thinks. In Midwifery there is much to disgust and nothing to demoralize. The man who practices the art, sacrifices himself.

It ought to be evident to the intelligent and ingenuous Student, that some fit preparation of the mind to the discipline of this Art is required as an introduction to the exercise of it; since, to go at once from the College into the very delicate positions in which he is about to be placed, shows, to say the least, a great want of prudence and forethought. Many clever men have made shipwreck of their hopes by the want of a little reflection as to the course they should pursue; or by early abandoning themselves to professional habits, which, without the least intention on their part, have gradually assumed a tone. of familiarity, that has been construed into impertinence, or downright insult.

No woman can be placed in a sanitary condition compelling her to appeal to the aid of the accoucheur, without some sense of a mortified delicacy, and it is quite clear that. the only reparation for, or the only means of obviating this unpleasing impression, consists in the exhibition to her-wards, of the most profound respect and sympathy, and that, too, proffered with a sincere conviction of the painful nature of her position, as well as the indispensable propriety and necessity of her submission to it. A female possessed of ordinary sensibility will be less affected by the sacrifice of feeling she is thus compelled to make, if she be treated as an object of respectful consideration, than if approached with a light and indifferent address; and while she finds her own pride less wounded, will be both more confiding in the wisdom of her physician, and more grateful for his counsel or service, as well as respectful to and considerate of his calling and profession.

The occurrences that befall in the course of an accoucheur's professional life are many times of a nature to require at his hands secrecy and good faith; for he cannot but become the depository of many informations in which are involved the reputation and even honor of persons, and the safety of important private interests.

Let the Student, then, before he goes any farther, take a firm

resolution to guard with good faith those secrets with which he may become acquainted as physician or Surgeon-accoucheur. He ought beforehand to consider the meaning of the term professional secrets, and know that they are either accidental revelations, or homage due to his station as physician, and not to himself as person; for of the vast number of those which may be hereafter communicated to him, or discovered by him, not a tithe or hundredth part of them would ever be his but for his professional position. If a man, therefore, is dishonored who reveals a secret communicated by a friend, how far more base is he who takes advantage of his professional standing to make public circumstances that have been intrusted, so to speak, not to himself alone, but to the sacred character of the Iatrist! He disgraces his calling in disgracing himself.

It is not in regard to grave and serious matters only that he is called upon to be silent, prudently abstaining from acquiring for himself and his brethren the unenviable character of the babbler; even the most inconsiderable circumstances as to the sick are confidences that ought not to be disappointed and betrayed. This is a just and true remark, and it is a rule that ought to be followed in all circumstances and ages.

The Caliph Al-Mamun, as we are informed by Abul-Pharajïus in his History of the Dynasties, was a friend of science, and exhibited his patronage of learning by fostering many learned men, among whom were some of our own profession. Among others of his numerous medical favorites was John Ocularius, the oculist, whose duty it was to visit the Commander of the Faithful every day, and that in his most private apartment, alone. The Caliph gave him great honor, and for his services allowed him a monthly stipend of a thousand gold sequins.

Upon one occasion, as the physician came out of his master's apartment, while passing through an anteroom, he was asked by one of the servants: "What is the Caliph doing?" "He is sleeping," was the incautious reply. Unhappily for the Doctor, this reply was overheard by the successor of Mohammed, whereupon the culprit was sent for, and brought before the chief of Islam. "What!" said he to the offender, "have I employed you as my physician and admitted you to my intimacy in order that you should report to my servants as to my private occupations? Go out of my house!"

The poor medico, in telling this story, to account for his fall, added. the Caliph never afterwards would admit him into his presence, which was but the just punishment of a professional indiscretion. Let the Student reflect upon the punishment deserved by those who babble

the concerns of families or individuals. John Ocularius was turned out of the court of Al Mamun for merely saying that his master was asleep! suppose the young doctor should say: "My mistress has a sore leg!"

But, in addition to the quality of discreetness above insisted upon, the Midwifery Student should firmly resolve to merit the appellation of Scholar, a title far more honorable than that of knight, nobleman, or minister of state, for it is to the Scholar that the world is indebted for its preservation from its own violence and vices. It is to the Scholar that it is indebted for laws, for science, and for all the arts. The Scholar is the promoter of virtue, and decency, and good conduct, both by his precept and his example; for it is to him that mankind turn their eyes to see what is wisdom, what is virtue, and what is true liberty. All those who are not, by education, brought out of the bondage of ignorance are slaves indeed-slaves of lust, superstition, and ignorance. Hence, it is evident that the Scholar is the only real nobleman, and his nobility becomes more and more exalted in the ratio of his elevation in virtue and knowledge towards the fountain and source of all knowledge and all virtue. Let him aim, therefore, to become a Scholar indeed, not only that he may embellish his understanding with every ornament of learning, but that he may become able also to minister to those who may be committed to his care, tost, seurement, et sans douleur, as old Fournier says in his Accoucheur Méthodique.

The Student ought not to rest satisfied with the bare intention to make himself equal in skill and dexterity to the common midwives of the country. He ought to be resolved to become fully acquainted with the dynamics of the generation-sphere, by the irregular operation of which, as Wigand says, the power of the uterus in labors is so often baffled, and its energies misdirected. If he studies well the therapeutics of midwifery, and practices them well, there will be no occasion to twit him with the reproach so commonly cast on the accoucheur, that when he is called in, "one or the other, mother or child, goes to the grave," to use the words of Wigand, which I cannot but quote in this place. "Gibt es keine gegend, keine stadt mehr, wo das Publikum es nicht anders weiss und gewohnt ist als dass, wo ein accoucheur sein hand anlegt, wenigstens eins von beiden, das Kind oder die Mütter darauf gehen müsse ? Kennen, wir jetzt keine Geburtshelfer mehr, die, wo sie hinzugerufen werden, keine andere Indication zu machen im Stande sind, als augenblicklich mit Zange oder Faust, über den unschuldigen Uterus herzufallen, und ihn, wie einem Dieb und Spitzbuben der das Kind gestohlen hat, zu mishandeln?" "Are there not any districts or cities to be found, in which the public generally sup

pose that where a physician is called in, one of the two, mother or child, must be sacrificed? and are there no accoucheurs at the present day, who, being called to a case of labor, can discover no other indication of treatment than that of instantly, with fists or tongs, falling upon the innocent womb to abuse and maltreat it as a thief or robber that has stolen the child?"

These words of Wigand are strong words; let them sink deep into the heart of the Student, for they are from the lips of as true and noble a Scholar as has in any age graced the annals of Medicine. Let the Student also enter upon his pursuit with a good resolution to add something to the value of the art he is about to practise during his future life; let him leave to the brethren and to the world some fruit or fruits of his observation, his reflections, or his experience. He is about to enter upon a course of life singularly arduous and toilsome, and involving sudden and most painful responsibilities to individuals, and to society at large. He is doomed to sacrifice himself for his station. There are no vacations or holidays for him; and night itself is turned into day, for his occupations cease not with the setting sun; his task is never done. More labors occur at night than during the day, a circumstance that adds greatly to the onerous and distressing duties of the Accoucheur.

Labor is the process by which the contents of the gravid womb are expelled; and the word is highly expressive of the fatiguing, violent, and painful struggles and efforts of the woman to overcome the obstacles to her deliverance from the uterine burden.

Labor should commence, as we have already seen, at or about the two hundred and eightieth day from the last show of the menses, or the one hundred and fortieth day after quickening; and it may, in general, be expected to terminate without any artificial power or assistance, after a few hours of travail-the time being greater or less, according to the amount of the power employed, or the resistance to be overcome. The average duration of labor has been stated at four hours; I should think it greater. There are many examples of women in labor who are completely delivered in ten minutes from the first perception of the signs of parturition; very numerous cases occur in which labor is protracted during twenty-four hours; while some of the patients are occupied three, four, and even five days, with continuous efforts to bring the child into the world. I have witnessed one labor of nine days' duration, and many of from three to five days. The essential element of labor is the contraction of the muscular fibres of the womb, the end or object of which is the evacuation of the