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A. PERPENDICULAR OR UPRIGHT POSTURE.

Under this heading I shall discuss, individually, those positions in which the body is erect or almost so, and, in accordance with some slight variations, will distinguish: 1. The Standing, 2. The Partially Suspended, 3. The Entirely Suspended Positions.

1. STANDING.

We shall find this apparently uncomfortable position assumed even at the present day, and in our own country: Thus, Dr. H. F. Campbell, of Georgia, writes me that he has delivered a patient standing, clinging to the bed-post, who would rather dispense with his services than assume any other position. Among our Indians it is rarely observed, although I have been informed by a correspondent that the Sioux women are delivered standing erect; I think

that we shall find a partially erect, partially standing, position more frequent among them. The natives of the Antilles, if we may accept so venerable an authority as Fray Juan de Torquemada, are confined standing, but also at times assume the kneeling or recumbent postures. In France it seems to have been quite a common position in some of the interior departments, as Godefroy[7] warns his colleagues never to permit the women to be confined in a standing posture, as hemorrhage, prolapse of the uterus, and rupture of the perineum are more apt to ensue than in any other. During the past century it seems to have been the most common position among the Sclavonians in the mountainous regions of upper Silesia, where, in 1747, a physician, in his book on midwifery, even advises such patients as do not wish to be confined in bed to assume this position, with some strong person supporting them from behind and holding their arms, whilst others hold the separated legs, and the midwife sits comfortably in front.[8]

The Hindoos, especially upon the eastern coast of India and in the vicinity of Madras, are delivered in an erect, standing posture, supported by an assistant under each shoulder—the midwife attending to her duties, being seated in front of the patient,[9] and whether rare or not at the present day the position is certainly traditionary, as bas-reliefs still exist upon the ancient Indian monuments which represent the act of delivery in this very same way.

In Central Africa, and near the Cape, among the Boers, the standing posture is not uncommon. Among the Negritos, upon the Philippine Islands, the parturient woman assumes the standing position, but apparently bent forward a little, as she supports the abdomen against a bamboo cane planted in the ground, thus apparently exercising some pressure upon the uterus.[10] Among the Wakambas, in Africa,

the patient assumes the standing posture assisted by two friends, but bends over backwards, and a third is seated in front to receive the child.[11]

A similar position is shown in an old painting in the Academy of Medicine in New York. (See Fig. 5.) The

history of this picture, which represents some mythical or mythological scene, I cannot trace, but the artist has certainly depicted the custom of his period in the position assumed by the parturient. For this reason it has appeared to me of sufficient interest to place it side by side with the labor scene among the less fanciful Wakambas.

The Loangos, in Equatorial Africa, are delivered standing, leaning against the wall of the hut, or kneeling, the head resting upon the arms. The reason assigned for this procedure is that they expect to obtain the desired head presentation by assuming these positions. In difficult labor

the patient is placed upon her face and chest, and finally upon her back, and choked and kneaded until an expulsion in some direction is accomplished.[12]

2. PARTIALLY SUSPENDED.

Parturient women endeavor to assume this position of partial suspension in various ways. Some hang to the neck

of a husband or friend, others swing themselves by a rope from the branch of a tree, while some are tied up until the act is over, as if undergoing punishment. The squaws of the Brulé Sioux, the largest branch of the great Sioux Nation, are confined in the midst of a crowd of indifferently solicitous relatives and friends, one or more matrons always being present as midwives. In the first stage of labor, that is, prior to the expulsion of the liquor amnii, the squaw sits or lies upon the ground groaning vociferously; during the expulsion of the fetus, her posture is erect or nearly so, with her arms about the neck of a stout male supporter, and I am informed upon credible authority that the young bachelor bucks are most frequently chosen for this service.

The women of the Iroquois in Canada, are all

confined standing, generally leaning on a friend's shoulder, whilst the child is taken by the midwife behind the patient. The position is probably the same as described among the Sioux.

In Japan this position is resorted to in the attempt to correct malpositions in the earlier months of pregnancy. The Japanese medical man makes the patient stand up and put her arms around his neck; he then presses his shoulder against her breast, and his knees between hers in such a manner that she is firmly supported, and, while in this position he manipulates, performing lateral massage with his hands, beginning with the seventh cervical vertebra and bringing them downward and forward, snapping his

fingers to distract the attention of the woman. Finally, he rubs the nates and hips with the palms of the hands forwards, beginning at the sacrum, and repeating the movement sixty or seventy times. This process is repeated every morning after the fifth month.[13]

The "New York Medical Record'' adds, that the accoucheurs are, in Japan, as a rule, advanced in age. If this custom is found in our own country it certainly comes to us from some of the inland countries of Europe. Thus, Spence, in his "System of Midwifery,''[14] says that the position which is very frequently practiced in the northern portion of Scotland, is that of hanging about the neck of a person as tall, or, if possible, taller than herself, who gently supports the patient's back, and with her knees fixes the knees of the woman in labor. In Italy it was Savonarola, who died in Padua in 1460, who taught that in difficult labors the parturient woman should either hang to the neck of a stout person or assume the knee-elbow position.[15]

The practice in some Mexican families[16] is to keep the woman in an upright position, with the knees and thighs slightly flexed, the feet wide apart, while she supports herself by two ropes suspended from above. He adds that massage is very freely resorted to, but no binder is at any time used.

We find precisely the same position in Africa among several native tribes. Thus, the Somali women assume an erect posture, partially suspended by a rope during the expulsion of the child, which is received by a family attendant or midwife.[17] So, also, we find that the women of Dar Fur, on the Nile, are delivered standing, with the legs separated,[18] holding on to a rope.

A somewhat more barbarous custom is that followed by some of our North American Indians, and by the inhabitants of Ceram, an island north of Australia, namely: they tie the patient to a post or tree, with the hands above the head. The Coyoteros are in the habit of tying their women, in labor, to a tree, with the hands above the head,

and leave them in this position until the child is born. This cruelty does not appear to affect them in any perceptible manner, and they recover from it in a much shorter time, and resume their avocations sooner, than the most robust white women.[19] The natives of Ceram hastily construct a rude hut of leaves and brush for the parturient woman, and an old hag, who assists as midwife, ties the patient, with her arms as high as possible, to a tree, so that the balls of the feet barely touch the ground, whilst she herself takes a more comfortable position before the parturient and receives the child in a large leaf, a mat, or an old piece of cloth. Labor over, the young mother washes herself, or takes a bath, and immediately returns to her village and to work.[20]

3. SUSPENDED.

Not unfrequently the negroes in our southern States still follow the customs brought from their African homes, or merely handed down by tradition; in their method of delivery they do not vary from that of the tribe from which they sprang. Occasionally the erect posture is taken, and a graphic description of such a labor has been given me, as witnessed in Louisiana. A negress gave birth to a child while hanging on to the limb of a tree. She would raise herself from the ground during the pains, whilst the assistant who was with her took charge of the child after it was born.[21]

In some portions of Finland, among the Esthen, as well as in some portions of Russia, the women are delivered in a similar manner while hanging to a cross-bar; they attempt, as it were, to shake out the child.[22]

We have the authority of Father Och that, in Brazil, the parturient woman occasionally has her arms tied to a tree while she is waited on by some old hags until the delivery is completed.[23]

In some portions of Germany, though the instances are

rare, the woman is delivered suspended in the arms of her husband, who seizes her from behind and raises her up, so that she is bent backward to such a degree that the tips of the toes barely touch the ground.[24]

FIG. 8. Southern Negroes. Suspended.

[Description: Pregnant woman hangs by her hands from a tree branch. Black and white illustration.]

The Siamese, who use massage freely, are usually delivered in the dorsal decubitus; but in difficult cases, when even tramping upon the abdomen is not attended with success, as a dernier ressort, they suspend the patient by means

of a band beneath the arms, and one, sometimes two, of the attendants then clasp with their arms the body of the parturient, and suspend themselves also; this expedient seldom fails to produce a rupture in some direction, be it the uterus, the perineum, or the encephalon of the child.