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(c.) Kneeling, with the body erect, inclined backward, or partially suspended.

This, like other of those apparently peculiar positions which are fast yielding to the westward march of civilization and scientific medicine, was at one time not unusual in our States, and I will cite the early experience of Dr. Reamy in Ohio as characteristic of the practice thirty years ago; he says: "I have found in my practice ten or twelve different women, who had frequently borne children, before, who insisted, with a perseverance and determination that I dared not resist, in being out upon the floor, down upon their knees, leaning backward so that the buttocks almost touched the heels. The husband knelt behind the wife, with his arms around her, his broad strong hands acting as a pad for the abdomen, and making pressure during pains—à la Crédé—her shoulders resting against the man's chest. These women insisted that this was the only position in which they could be comfortably and successfully delivered.'' The same position, practically, is found among the Papagos. Among these Indians, "the position of the squaw, from the time the labor pains commence until the expulsion of the fetus and placenta, is a kneeling one, with the knees sufficiently spread to furnish comfortable lateral support to the body, which is erect. In the interval between the pains she is allowed to move about according to her inclination. In ordinary labors two women assist her. One of them places herself in a kneeling position behind the parturient woman, and with one knee pressing firmly in the lumbar region, she grasps with both hands the body of the patient immediately under the ribs in front. The other assistant places herself in a kneeling position in front of the woman, and with the palms of both hands rubs the abdominal wall down from the spine of the ilium to the pubes. It is interesting to note that they seem to appreciate the necessity and advisability of time and patience with primiparæ, as they do not resort to the same degree of pressure and friction which they employ in assisting multiparæ.[76]

The Yuma Indians vary this position somewhat.[77] The parturient woman is assisted by two others of long experience in the business. One of these kneels behind her, supporting her body in nearly an upright position, her arms passing under those of the patient and pressing or smoothing down the abdomen. The other assistant squats in front, between the feet of the patient, with her ankles crossed, and her shins pressed against those of the parturient woman, whilst she holds her by the hands or wrists. The posture of the patient is, therefore, with the shoulders high, the legs and thighs strongly flexed and abducted, which position is retained until the expulsion of the placenta. No bandage is used.

The Upper Klamath and nearly related Modocs of Oregon are usually delivered in a small lodge some distance away from the other houses. The parturient also assumes a kneeling position, supported by one old squaw, whilst another keeps kneading and rubbing her abdomen. Sometimes she varies her posture by sitting and pressing her feet against some support, while she bears down. If labor is tedious, they often sit over warm stones moistened with water, or, in other words, take a steam bath to relax the system. They also steam themselves occasionally for several days after the birth of the child.[78]

Precisely this same position is found among many of the Mongolians, especially the Tartars, if we may accept the authority of Hureau de Villeneuve.[79] The parturient moves about during the early pains, sometimes standing with her hands above her head, but as soon as the bearing-down pains begin she assumes the kneeling position last described, almost erect, supporting her body upon the hands, which rest upon the separated knees or thighs; the assistant behind supports her by seizing her under the arms, whilst the midwife rests upon one knee in front of the patient.

The author seems to think that the advantages of this position are greater than its disadvantages, that the abdominal muscles come more freely into play, and that there is less danger of rupture of the perineum, as the head of the child, following the pelvic axis, tends by its own weight towards the vaginal orifice, and not towards the perineum, which in this way escapes the pressure necessarily bearing upon it in any other position. Prolapse is not known among them. While writing this my attention is called to a circular just received, giving the titles of papers entered to be read before the subsection of Anthropology, at the coming meeting of the American Association for the Advancement of Sciences, to be held in Boston, August, 1880. I find that a paper is announced entitled, "Parturition: Kneeling Posture as practiced by the Women of the Mound Builders and Stone Grave Races,'' by Rev. C. Foster Williams of Ashwood, Maury Co., Tenn. In answer to an inquiry, Mr. Williams states that he has in his collection of Mound Builder relics an earthen vessel, which he supposes to represent a woman in labor: the right knee on the ground, with the right hand resting on that knee; the left foot on the ground, the left hand resting on the left knee.[80] Although sorry to disabuse Mr. Williams of his belief, I must state that this position cannot possibly be assumed by a parturient woman, as the muscles would not be relaxed, and proper space would not be given for the passage of the child.

My attention once called to the subject, I examined my own collection, and found in it two images representing a woman in the erect kneeling posture, the knees somewhat separated, the hands resting upon the knees or thighs in precisely the same position as that assumed by the Mongolians, and probably the Yumas. It is not unlikely that these figures represent parturient women, and it is highly probable that the mythical Mound Builders, be they predecessors of our Indians, or older tribes of the same stock,

were delivered of their young in the same position as the red squaws of the present day. Hence we may take the testimony of these vessels, relics of a former civilization, that the position assumed by the Mound Builder race in parturition was the erect kneeling one.

The kneeling, partially suspended, position is found among the Indians and lower classes of Mexicans in the neighborhood of San Luis Potosi. The labor is conducted in the following way: a round stick of pine wood, eighteen or

twenty feet long, and half a foot in diameter, is placed against the head of the bed or the wall, its other end resting upon the floor at an angle of about forty-five degrees; to this beam a cord is tied, knotted at one end, and covered with soft cloths. The parturient woman kneels upon a sheep-skin spread upon the floor, seizes the knotted end of the cord in her hands, and is delivered in a kneeling, semi-suspended position, by the partera or midwife.[81] Dr. Barroeta says also that prolapse and displacement of the uterus are not uncommon, and does not know why they are not still more frequent. From other sources I also hear that the lower orders of Spanish women nearly always take the kneeling position, and, as Dr. Coates writes me from Pueblo, Col., "if the placenta is tardy they always drink a cupful of soapsuds, which produces vomiting, followed by the immediate expulsion of the afterbirth.''

The lower classes of Northern Mexico speak the Spanish language and profess the Catholic faith, but in all other respects are Indians, and retain many Aztec customs; so

the accouchement, which is described to me by Surgeon George W. Adair, U. S. A., precisely as we have seen it among the Indians near San Luis Potosi, the patient kneeling, grasping a rope pendent from the ceiling, and assisted by tendera and pertera, "the tendera fixing the knees, and holding the upper portion of the trunk, as in a vice, pulls the pelvis forward, hinged as it is upon the acetabulum, and thus overcomes the dip of the plane of the superior strait, and straightens the passage with greater efficacy and certainty.''

The American Indians on the frontier of Mexico follow the same traditional method of delivery, hanging on a rope suspended from a rafter, with the knees bent and just off the ground. The rope, which is wrapped with cloths or towels so as to make it softer, usually hangs at the edge of the bed, so that the patient can stand on her feet or sit or

recline on the bed during the intervals between the pains. The partera introduces her hand and presses on the perineum, not making a steady pressure, but during the entire time of the pain she jolts the patient up and down, imagining that she is shaking the child out.[82]

The Coyotero Apaches place the parturient in a similar position, suspending her a good deal more, in difficult cases

if she does not succeed in expelling the child in the squatting posture customary among them. "A rope or lariat is tied around the woman's chest just beneath her arms, and the other end thrown over a stout limb of an adjacent tree, while two or three squaws draw upon this until the woman's knees barely touch the ground; others, generally two, encircle the body with their arms, and `strip' down with considerable force, a kind of `all pull together,' as it were. This energetic manœuvre generally suffices for prompt uterine work.''[83]

The Santee Indians are almost invariably delivered in a kneeling posture on the floor, with a bench or chair in front of them upon which they rest their arms, while sometimes they have a rope attached above by which they partially suspend themselves, just as the Mexican Indians and half-breeds do.[84]