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(d.) Semi-recumbent Position, Strictly Speaking.

Although I have grouped as semi-recumbent all the positions last spoken of, I will, in this subdivision, confine the use of the expression more closely, and will class as semi-recumbent, strictly speaking, only those positions in which the patient assumes the dorsal decubitus with the head and shoulders raised, the axis of the body inclined at an angle of about forty-five degrees.

Like many other of these curious positions, this one is found in our own States, but seems to have come to us from the French settlers in the north. In Vermont, some thirty years ago, a semi-recumbent position was customary, which may either be looked upon as a rude imitation of the obstetric chair, or as a semi-recumbent position, strictly

speaking, and probably the custom has not as yet entirely passed away; the women in the rural districts were confined upon a bed made of three chairs tied together, upon which a straw bed was placed, and covered with a sheet. In front of this couch sat two women, whose duty it was to take the feet of the parturient woman in their laps, whilst the accoucheur sat between them, in front of the patient, where he was supposed to remain for two or three hours during the latter part of labor, if he did his whole duty.[117] The Canadian French women are partial to the inclined

FIG. 59.—Favorite Posture of the French Canadian.

[Description: Pregnant woman reclines on an inclined surface created by propping an overturned chair against the wall and covering it with bedding.]

plane, made by turning forward and downward a high-backed chair, pressing it back against the wall of the room and making a bed upon it; though comfortable for the patient the legs of the attendant suffer from the stooping posture necessary.[118]

The custom in Japan, if I may judge from illustrations in a very complete "Japanese Midwifery,'' is a semi-recumbent position, on a mattress placed upon the floor, with the head and shoulders well elevated, so that the body is inclined at an angle of about forty or forty-five degrees. Precisely the same position is found among some of the Sioux nations,

and the Assneboine Indians, who, as I am told by the well-known Indian interpreter, F. F. Gerard, lie on their backs, the head and shoulders propped at an angle of forty or forty-five degrees. This is the position usually assumed by them, although they are sometimes confined in the kneeling posture, like most Indians.

The Ute, Comanche, Apache, Navajoe, and Nez-Percés woman is also confined in the semi-recumbent dorsal position, the head and shoulders of the patient being frequently supported in the lap of an attendant, while the patient has access to a rope or brace placed within reach.[119]

Among the Pahutes, the parturient woman is placed in her tent, on blankets and skins, in a semi-reclining position, with her hips firm on the couch; she is supported by an assistant, who sits behind her, and in whose arms she reclines; her legs are flexed, and additional assistants hold and steady the knees; a leather girdle is fastened about her above the womb, and, as expulsive pains come on, three or more women push the girdle down after the escaping child.[120]

The Comanche woman gives birth to her child in some

secluded spot not far from the camp, in the dorsal decubitus, on a low extemporized couch prepared for her under a tree. Upon this she is placed, with her feet against the trunk of a tree, lying on her back. A lariat, a small rope of buffalo or raw hide, is thrown over a branch and secured; one end of it is placed in the hands of the woman, and she is allowed to pull through as best she may.[121] This would prove that during the pains, and the expulsion of the child, the patient raises herself by the lariat, and thus assumes the semi-recumbent position.

The Hindoos seem to find the position convenient, as the

parturient woman is delivered while resting on her back in the lap of a female seated on the ground, while her knees are bent, and are supported by two other females, one sitting on either side. In order to facilitate labor the parts are lubricated with oil, and the "Dyhe,'' resting on her knees before the patient, instead of supporting the perineum, urges the patient to assist nature in expelling the child, while she introduces the fingers of her two joined hands in a conical figure into the vagina, and, by spreading them, stretches the external parts, thinking in this way to facilitate labor, whilst she unquestionably retards it.[122] I will call especial attention to the custom of the Hoopa, lower Klamath, and the Orleans-Bar tribes, as it is precisely the same as I have occasionally seen my patients occupy in the efforts of expulsion. Lying on the back, the elbows drawn upwards and resting on the ground, the knees flexed to a perpendicular, the legs more or less flexed, and the heels resting on the ground.

The dorsal decubitus, with the body at an angle of forty or forty-five degrees, was common among the Romans. Moschion describes it. Celsius[123] and Paul of Ægina[124] recommend

this position in certain obstetrical operations, and before the time of the obstetric chair it was commonly assumed in Germany. In some of the mountainous districts of Saxony the patient, semi-recumbent, shoulders elevated, is suspended during the pains and the expulsion of the child, upon a strong broad towel which is placed under the pelvis and seems to further labor most happily in many cases.[125] The Gurian women take the dorsal decubitus, but at the moment of expulsion seize a rope suspended above the bed and raise the body to the same angle which we have found among so many other people.[126] Most reasonable of all seems the semi-recumbent position as occasionally adopted in the rural districts of this country; the patient

FIG. 43.—Virginia. Semi-recumbent in bed.

[Description: Woman reclines in bed, her upper body propped up by an overturned chair covered with bedding. In each hand, she holds a rope tied to a bedpost at the foot of the bed. Black and white illustration.]

being upon a bed doubled up against inverted chairs, the feet resting against the foot board, sheets or towels being fastened to the bed posts.

A truly semi-recumbent position is that of the Boeathies[127] or red Indians of New Foundland, which is thus somewhat quaintly, but very well, described by Cormack, who says: "The patient is on her back, semi-recumbent on the ground, feet and knees against two cross stakes. There is a hole dug in the ground in front, and the chief accoucheur, a female, sits in the hollow, it being a mere convenience. Another hollow in the ground is made, a short distance beyond, for another female assistant to sit in for the purpose of

supporting the patient's head. After delivery the patient is turned around, and placed in a kneeling posture within the upright stakes. Her buttocks, too, rest on one cross stick and her body on another, which is placed under her breast; and in this position the patient remains three or four days until well, receiving the necessary attention from the female accoucheur during this time.''

Among the Turks, also, the semi-recumbent position prevails, but more erect, seated on ground, stool or chair.[128] Their customs are extremely interesting, as in many of the interior provinces they still cling to their primitive ways.

During the fifth or sixth month of pregnancy the abdomen is compressed by a firm bandage, and this pressure is kept up until full term to prevent the child from growing too large. Abortion is frequent, and is produced by breaking the membranes and allowing the water to escape. Delivery is always accomplished on the lap of an assistant, or seated in a semi-recumbent position on a bed or low stool, or even on the ground, leaning against the stump of a tree or the wall of a house, or some other convenient point. Thus we may say that it is always a sitting posture, either upon the lap of an assistant, upon the ground, or upon the obstetric chair.

Until recently, and even now in distant villages, it is still the custom for the midwife to carry with her the obstetric chair. This, according to my informant, is of a peculiar kind; a large, wooden seat, back chair with a circular opening cut into the front part of the seat, in this differing from all known forms of the obstetric chair, which consist of a mere semi-circular excavation in the seat, this, however, being a complete circle. This carrying about of the chair is the same custom which we have referred to in Syria and other Eastern countries, although the shape of the chair is different. In difficult labor the patient is placed upon a blanket held by four or six persons, and upon this she is rolled about, not tossed up and down as we have seen it customary in other countries.

During the earlier stages the patient lies at will, usually on her back, on a mattress placed on the ground; as labor advances, and the pains increase, one of the stronger of the women present takes the parturient on her lap, compresses the abdomen by her encircling arms, and urges the sufferer to bear down with all her weight. Various other methods are resorted to for the purpose of increasing the pains: thus the bent knees of the patient are constantly and severely jarred, or cold water is forcibly thrown upon the abdomen.

Their midwives are very fond of endeavoring to hasten labor by prematurely rupturing the membranes, cutting them with a sharp piece of salt—often cutting into the scalp as well.

The root of the Alizari (rubia tinctoria) is considered as an emenagogue by the nomadic Turucks, and during childbed the same remedy is resorted to to call forth the lochia when once checked.

In former times bleeding during pregnancy was resorted to with a view of preventing convulsions of the new-born, but is now pretty well given up.