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CONCLUSIONS.

The same doubts as to the proper management of the third stage of labor which have annoyed our obstetricians seem to have arisen in the savage mind. We find various customs existing among the different tribes and people, and, right or wrong, they cling to them with the pertinacity of the modern writer, well satisfied with the correctness of his own view. We find the same methods and the same errors, an occasional yielding to the same temptations which beset the midwife of our advanced civilization, but in the main a correct practice predominates, and the untutored savage, guided by instinct and observation, pursues the very course which is now considered the most advantageous and scientific among our leading obstetricians.

I cannot refrain from quoting some points from the excellent remarks of Playfair upon the management of the third stage of labor in order to show how well his teachings are borne out by the instinctive practice of the savage. He says: "There is unquestionably no period of labor where skilled management is more important, and none in which mistakes are more frequently made.... The general practice as to the management of this stage is opposed to the natural mechanism of placental expulsion, and is far from being well adapted to secure the important advantages which we ought to have in view.'' The objections he makes to the ordinary practice are: "That it inculcates the common error of relying on the binder as a means of promoting uterine contraction, advising its application before the expulsion of the placenta; that it teaches that traction on the cord should be used as a means of withdrawing the placenta, whereas the uterus itself should be made to expel the afterbirth. This may seem an exaggerated statement to those who have accustomed themselves to resort to the method of pulling on the placenta, but I feel confident that all who have learned the method of expression of the placenta would certify to its accuracy. The cardinal point to bear in mind is that the placenta should be expelled from the uterus by a vis a tergo, not drawn out by a vis a fronte.... The distinct enunciation of the doctrine that the placenta should be pressed and not drawn out of the uterus we owe to Credé and other German writers, but it is only of late years that this practice has become at all common. Those who have not seen placental expression produced, find it difficult to understand that, in the great majority of cases, the uterus may be made to expel the placenta out of the vagina, but such is unquestionably the fact.'' Is this not the practice most commonly followed among our Indian tribes? And is not, in consequence of this method of treatment, the placenta, as a rule, rapidly expelled, and its retention a matter of very rare occurrence?

As a rule the patient retains the position in which the child is expelled, usually one most favorable for the use of the abdominal muscles, kneeling or squatting. Steady pressure is kept up upon the contracting uterine globe, and if its contractions cease, they are stimulated by massage, by a kneading, churning of the tumor, and aided by slight traction on the cord, the placenta is

expelled. Moreover, we have seen that the Makah Indians, of the Neah Bay agency, are the only people who make a specialty of the third stage of labor; they require no assistance in the delivery of the child, but after it has been expelled an experienced woman comes to assist in the delivery of the placenta by expert manipulations of the abdomen with her hands. The North American Indians and the African negroes, undoubtedly other tribes also, have for ages followed a practice so perfect that only within the last few years the most alert of our obstetricians are in a position to compare with them; within the last decade, of this advanced awe, constant scientific research has finally placed us upon a level with our less favored brethren.