OBSTETRICS.

PRELIMINARY OBSERVATIONS.

I HAVE called this work Obstetrics; the Science and the Art, because while I look upon Obstetricy as a real Science, I consider Midwifery to be merely an Art founded upon a truly scientific basis.

OBSTETRICY comprises the several sciences of Anatomy, Physiology, and Pathology, in so far as they relate to the structure, the functions, and the diseases of the reproductive organs; it also includes the whole of Embryogeny, together with the Therapeutics and Surgery of sexual diseases and accidents, and the disorders of new-born children. Hence "it seems just to regard an Obstetrician as a physician, who, to the general qualifications of men of his class, joins all the peculiar information and skill that are required in a person having special charge to treat the sexual affections, whether as arising in the Department of Midwifery proper, or as occurring independently of pregnancy, labor, or the lying-in state. Obstetricy, therefore, is the science of woman's nature, diseases, and accidents, and is a copious and comprehensive science; while MIDWIFERY is the art of assisting women in labor, and of guiding their conduct throughout the following confinement. This art, which has existed from the earliest periods, though rude and imperfect in its beginnings, has, with the lapse of ages, and through oft-repeated experiences, and much philosophical examination of the principles that should govern its ministrations, come to such a high degree of perfection in its rules and observances, that the medical student ought to find it not only an easy study, but one interesting and pleasing to the mind; for all studies are the more agreeable, in proportion as they lead to sure results, inspiring confidence in the student, and convincing him that he is continually augmenting by his scientific attainments his power to do good unto his fellow-creatures. I think there is no study in Medicine, that leads so certainly to useful executive

power under well conceived rules of action as that now under consideration.

Some of my readers might be disposed to call in question the claim of Obstetricy to be classed among the Sciences, and to look upon it as a sort of collections or fascicles of various sorts of knowledge rather 'than as a real science; and here I may remark, that knowledge of things is not science, and that any conceivable amount of information that any man can acquire would, by no means, entitle him to be considered as a man of science unless the items of his knowledge should prove to be methodized or classified; because science is classified or methodized knowledge, and nothing more nor less. If a man could be supposed to know every member of the zoological series, or every plant, shrub, or tree in the universe, he could not pretend to be a scientific man unless he should have a methodical knowledge of them all: nor would his knowledge be of any use to himself or to mankind, since he would know nothing of the relations of animals to each other, nor have any conception of the resemblances or differences, which enable scientific zoologists and botanists to know, almost at sight, where to collocate any newly discovered thing, whether of the animal or the vegetable kingdom. He would neither know where to find anything, nor where to place it if it should come in his way.

Our obstetricy has gone so far that it certainly is possible to methodize or classify all the items of it, and enable the student at once to seize upon the connection of any one thing or idea with any others, or with the whole of the science. But it is only of late that such a scientific character could be justly attributed to it. Any person at all familiar with the medical writings of the Greeks, the Romans, or the Arabians, will acknowledge that their midwifery productions ought not to rank among the sciences, however highly we may prize them as the expositors of opinion and practice in their several eras. In like manner, it is impossible to say that the works of Paré, of Guillemeau, and Lamotte are truly scientific productions. Even Mauriceau may be questionable on this point, though he is, in some respects, quite methodical. So with the earlier English writers, Rainald, Chap.man, Giffard, and Burton, who do not rise to the height of science, because they had, in their day, no classification or method. Dr. Denman, however, Prof. Davis, Dr. Robert Lee, Dr. Ramsbotham, and many other distinguished English writers, with a host of French and German authors, have so methodized or classed the various integral portions of obstetrics, that it has now a fair title to be called the science of obstetrics, on which is founded the art of Midwifery.

I do not suppose that any person will object to a division of the

subjects to be treated of in this volume, into the two departments of Obstetrics the Science, and Midwifery the Art because it is a difficult thing to discover a truly natural method of our obstetrical knowledge. It is, perhaps, not easy to find out a natural method of its study; and yet it is true that the whole matter is comprised in what relates to the female pelvis, to the sexual organs, and to the new-born child. To me it seems clear that, in the above three divisions or classes I have places in which to collocate every individual item of the information I do now possess, or may hereafter acquire concerning obstetrical and midwifery matters, and that it serves me as the basis of a sufficiently natural method of arrangement. In his Introduction to the Regne Animal, M. Cuvier said: "There can be only one perfect method, and that is a natural method. This is the title given to an arrangement in which beings (subjects) of the same genus are placed nearer to each other than to beings (subjects) of any other genera; those of the same order nearer together than those of any other orders, and so on throughout the arrangement. This is the ideal method, to which everything in natural history should tend; for it is evident, if it could be attained, we should be in possession of an exact and complete expression of all nature. In a word, a natural method would be the whole science, and every step towards it carries the science nearer to perfection." A natural method of obstetricy is the desideratum, and to get at a natural method here, it is only necessary to treat in succession,

I. Of the Anatomy of the parts concerned in the acts of Reproduction.

II. The Physiology of Reproduction.

III. The Therapeutics and Surgery of Midwifery and Obstetricy. IV. The History and Diseases of the new-born Child.

These four divisions, classes, or departments of obstetrics, though each suitable to be treated of in a separate book or volume, yet they give us a classification easy to be remembered and referred to, and I could doubtless follow it out rigorously in these pages, though I may occasionally prefer to transpose the various opinions, facts, or precepts that follow, from one department to another without an unvarying adherence to this exact order or method. Such an arrangement shows our obstetricy to be a real science, in so far as method is a condition of it; and we can, by dividing our subjects in the manner proposed, reduce to classes, genera, and species, the various topics or facts that are to be exposed, and so, with due pains-taking, make of this book a kind. of ledger, in which shall be posted up at page, line, and column, all the particulars we may think fit to enter into its paragraphs.

This work, which first appeared under the title of the Philadelphia Practice of Midwifery, a small 8vo. volume of 370 pages, was printed by James Kay, Jr. & Brother, in 1838. Since that time it has undergone many changes, and, as appears at the end, now comprises about 750 large octavo pages. As I have superintended several editions of the work, which has appeared in various forms, I have felt privileged to adopt the advice of Horace, in his tenth satire of the first book:"Sæpe stylum vertas, iterum, quæ digna legi sint Scripturus;"

and I fervently desire that the labor of writing might prove as he says

"Denique sit quod vis, simplex duntaxat et unum."

Following out the design I had formed, so many years ago, of improving this American work, as I should gain greater ability by increase of knowledge of these matters, I have considerably altered the present edition.

As to the osteological portion of the treatise, I may say that it is almost wholly re-written; and I have introduced considerable portions of text relative to the reproductive organs, changes which I venture to hope will be found both beneficial to the student, and interesting to the older reader. In many places I have altered the expression, and in some of them have suppressed passages or transposed them in a way calculated to improve the treatise.

So many copies of the work have been taken by the country, that I have the greatest cause to be thankful to my medical brethren for so undeniable an evidence, and indeed proof of their kind acceptance of my labors. The descending path of life in which I now walk, is made more cheerful by the conviction that, unaided by fortune or early patronage, I have been so far favored by the medical men of America as to bring this volume, and others that I have written, to repeated editions. There is not among the thousands of United States physicians a man to be found who is more profoundly sensible than I am of the social importance of our pursuits, of their indispensable necessity for the well-being of society, or of the stern duty incumbent on every one of us to do something to render it both more clinically useful, and socially reputable.