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MANAGEMENT OF THE UMBILICAL CORD.

The Indian midwives, as well as learned obstetricians, differ in their views with regard to the proper time for cutting the funis, but, as a rule, we find that the cord is not severed until labor is completed and the secundines are expelled; this practice we find among the Sandwich Islanders and among most of our Indians; the child remaining on the ground in front of the mother until the placenta is delivered; among the Kiowas, Comanches, and Wichitas, it is customary, after the placenta is delivered, that the assistant should take the cord between her fingers and squeeze such blood as may remain in it back toward the placenta, and not until then the cord is cut and tied. So also the Blackfeet, Uncapapas, Lower and Upper Yankton-ans of the Sioux nation do not sever the funis until the placenta has been expelled, while the Flatheads and Kootewais, Crows and Creeks, cut the cord at once, and I may here add that, as soon as the cord is tied and cut and the child is

removed, the parturient cautiously takes hold of the placental end of the funis, believing that, if she should let it go, it would return into the uterus. The natives of Syria wait from twenty to thirty minutes before cutting the cord, but if the afterbirth is not expelled by that time, it is severed and the patient put to bed.

Some difference also seems to exist, and probably with reason, for the methods of each, as to the distance from the child at which the funis should be tied. The Wakamba, in Africa, use threads of the best of the adansonia or monkey-bread tree, and tie the funis tightly two or three inches from the navel, the Mexicans some three inches. The Japanese tie the funis in two places, about one inch apart, close to the child's body; the Comanches, on the contrary, using only one ligature, tie the cord about a foot from the body of the child, and in Africa we find one of the tribes, the Waswahili, where the cord is also left very long and slowly dries; the navel in later years being often found the size of a fist. The Loango, of Middle Africa, on the contrary cut the cord short and dry it rapidly; it is severed at double the length of the first joint of the thumb, or is measured off to the knee, then the child is taken to the fire and the remnant of the funis is steadily pressed by the warmed fingers of the numerous attendants so as to hasten its drying, which is completed in twenty-four hours; then the withered mass is forced off with the thumb nail and burnt (Indiscretes aus Loango; Dr. Peschuel-Loesche, Ztschrft. f. Ethnolog., 1878, X., p. 29).

The Syrians tie both sides; the Catarangut Indians ligate only one end, the child's end; so also the Blackfeet, who, however, take the precaution to pinch the protruding placental end of the funis with the fingers, so as to prevent oozing.

Certain superstitions also exist in regard to the method of cutting the funis, a dull instrument being frequently used, probably on the principle of the modern saw-knife, as bruising and crushing rather than cutting, and thus preventing hemorrhage. Some of the African tribes, the Wakambi for instance, make use of their ordinary knives; the Loango, however, would deem it a misfortune to the new-born babe to use anything but the edge of the stem of a palm leaf; the Papagos of Brazil cut the cord with a sharp fragment of a vessel or a shell. The

Hoopas, Klamaths, and other of the Indian tribes chew off the cord. The Klatsops, as we have seen, pinch one end with their fingers. These various procedures, now traditional superstitions, have, probably, originated in some thinking mind and good reasons have existed for their use.

So far my observations have been confined almost exclusively to the management of the third stage of labor among the American Indians, on account of the amount of valuable original material at my disposal; for the sake of comparison I will now add such data as I have been able to gather with regard to the treatment customary among other peoples. Some of these facts are referred to in other parts of this volume, but the greater part I owe to an instructive paper by Dr. H. H. Ploss, of Leipzig (Historisch-ethnographische Notizen zur Behandlung der Nachgeburts-Periode).

The same customs, often somewhat modified, will be found to predominate.

In Old Calabar,[1] the child, as soon as it is born, is placed between the thighs of the mother and remains there until the placenta is expelled, however long this may be. In Surinam,[2] the placenta follows the child very quickly, and little help seems to be needed. The Australian woman squats down in a small excavation in the ground prepared for that purpose, and as soon as the child has been expelled she awaits the coming of the afterbirth; the position is that as in defecation. It seems that this is a favorite position, and it seems reasonable, as many of the same muscles come in play which serve in defecation. In New Caledonia, as well as upon other Oceanic Islands, a number of old women assist the parturient, cut the cord with a shell or splint of bamboo, and tie the placental end of the navel string to the mother's toe, leaving, the expulsion to nature.

A German physician had an opportunity to observe a native of Sumatra, who, following her instincts, had the abdomen anointed with oil after the expulsion of the child, and, after some pressing, expelled the placenta with a few clots of

blood. The Tartars of Astrakan are said to leave the expulsion of the placenta to nature, while the Russian women of the same country wrap up the child as soon as it is expelled, place it between the mother's thighs and leave it there until the afterbirth follows, and then cut the cord.

This leaving of the expulsion to nature has found many advocates in the last century, and a few still persist. It seems that in some of the eastern provinces, as in Galicia, the midwives do not bother about the afterbirth, and cases of retention and putrefaction are common. In Persia traction upon the navel string is said to be common. The same is said to be the case in Palestine, where, as Dr. Rosen writes, it the placenta does not rapidly follow the birth of the child, the midwife passes her well oiled fingers into the vagina to seize the placenta. If it does not approach the orifice, she ties the cord with the aid of a string to the patient's toe, and the child is wrapped up and kept warm until the placenta appears. The Chinese follow a similar method; as they attach the cord with a string to the patient's hip in order to prevent the return of the placenta. Some rest is then given the patient, after which the placenta is slowly pulled out; if it does not follow, the hand or a blunt hook is introduced. In New Caledonia the same method of tying the navel string to the patient's toe is followed, as they think the stretching of the foot will end the business. Among all people where the management of this third stage depends upon a vis a fronte, a pulling out of the placenta, the manipulation and methods of hastening its expulsion are more severe and more dangerous.

Chinese physicians advise an expectant method, and seem to consider the remaining of the placenta as less harmful than the active interference.

Chinese midwives tickle the fauces with a feather to produce vomiting, and then forcibly drag out the placenta, which is the death of many women.[3]

Inversion and prolapsus are frequent in Russia, according to Dr. Kreble, on account of the methods of dragging out the

placenta; here the expulsion is hastened by the drinking of warm water. In France the placenta is frequently dragged out by midwives.

The customs in Germany are less harmful, but often foolish enough. In the Palatinate, midwives urge the patient to cough or breathe into the hand; others rub the abdomen after pouring a few drops of spirits upon it. In Suavia it is believed that the broth of three crawfish well mashed up will expel the afterbirth.[4]

In the Bavarian Palatinate, the patient is urged to stand up in case of tardy expulsion of the placenta, take in hand her husband's walking stick, put his hat upon her head, and then she is again put to bed, almost like the trotting about of the Indian women to expel the placenta, but not quite as effective.

Dr. Damianius Georgin says that expert midwives in Greece express the afterbirth by pressure upon the abdomen, at the same time nausea is induced by placing a finger, or the braided hair of the patient, into her mouth. She is also induced to blow into an empty bottle. Others have seen[5] the Greek mother raised by her assistant several times in succession over a tripod, which serves as an obstetric chair, and suddenly dropped down upon it, continuing these shocks until the placenta is expelled. The informant states that this proceeding is quite harmless. In Jaffa, upon the coast of the Mediterranean, Dr. Tobler says that after the parturient has received a swallow of brandy the midwife forces out the placenta by a firm pressure upon the navel.

Whatever individual differences may exist, the various tribes of North American Indians demonstrate most of these methods, but as a rule are more practical.

A rather surprising conclusion is forced upon us by the study of these various methods of treatment resorted to in the third stage of labor: the untutored, simple-minded savage, although crude in the methods he pursues, obeys a correct, even if we should term it an animal, instinct, and approximates more closely to the teachings of the science of to-day—

his practice resembles that of civilization more closely—than does that of the semi-civilized, or of the ignorant of the enlightened communities of the present.

Instinct has taught these peoples the necessity of expelling the placenta, and they attain this object by the correct means, by a vis a tergo, by expression—the Makah Indians even leaving this important duty to a specially skilled person.

Among peoples of a certain civilization a more harmful method is resorted to: it is among the Chinese, Persians, the common people of Russia, and such, that we find it customary to drag out the after-birth by the funis—whilst the more ignorant of the midwives of our great cities either follow the same pernicious habit or do worse (like those of Galicia and such border provinces), leave it in altogether, if nature, or their own dangerous traction, does not readily produce it.

The same class of people, even when pursuing correct methods, appear less reasonable, more brutal, than their more primitive brethren. Thus the Arabs, at times when impatient at the tardy progress of labor, suspend the parturient by the arms from one of the tent poles, to constrict the abdomen so as to force the fœtus down upon the perineum, whatever be the position. Others place a plank, or other large flat piece of wood, upon the belly of the mother, and place upon it a sufficient number of women to achieve the pressure necessary to expel the child: a small portable mill used for grinding barley may serve the same purpose. Should the presentation seem at fault, the patient is held up by the feet and shaken, or rolled over and over on the ground.

It is unquestionably to these rough means, more particularly traction upon the funis, that the women of these peoples are indebted for the existence and even the frequence of prolapse, the one uterine disease to which they are most subject. Although other uterine diseases undoubtedly exist, they are not so apparent to the observer, perhaps not even known to the sufferer herself, whilst prolapse above all other disturbances makes itself known; still it does not affect the nervous and physical organization of these stronger and less delicately constituted women as it does that of the ladies reared amid luxuries and excitements in the whirl of our civilization.

These accidents are probably more common upon the borders of civilization than among savages.

A partial civilization seems destructive to the natural and usually correct instinct of man, and in the relative methods of different peoples in managing this important stage of labor we find a striking expression of this fact.