University of Virginia Library

5. CHAPTER V.
CHARACTERISTIC LABOR SCENES AMONG THE YELLOW, BLACK AND RED RACES.

In the preceding chapters I have endeavored to describe the details of treatment habitual among various people, in the different stages of labor, especially the position occupied by the parturient; and as a fitting close to this little volume, I will now relate individual labor scenes among Mongolians, Indians and Negroes, which may be regarded as typical, so far as that is possible. And these will, I trust, serve for the better understanding of the peculiarities in the management of childbirth as customary among these races.

MONGOLIANS.

The Japanese and the Ainos, the aborigines of Japan, as well as the Kalmucks, must serve as a type of the yellow races: the obstetric customs of the former are so well described by my friend Dr. J. C. Cutter, of Kaita Kuschi, Lappou, Japan, in his kind response to my circular letter, that I can do no better than follow him verbatim, after picturing the treatment of the pregnant woman as detailed to me by Dr. N. Kauda, of Tokio.

JAPANESE.

Dr. Kauda says: "During the fifth month after conception the pregnant woman first consults a midwife, who binds her abdomen with a band of cloth, one foot wide and six and one-half feet long, which is never removed until the delivery of the child, although occasionally changed. This binding of the abdomen is for the purpose of preventing the growth of the child, in order that delivery may be made easy. About three times a month the midwife comes to rub the abdomen, and in the seventh month preparations are made for the approaching labor.''

In reference to the present inhabitants of Japan, Dr. Cutter says:

"With regard to the assistants who attend the parturient woman, I may state that it is very rare that a man is present during confinement; the lady (or coolie-woman) is assisted in her labor by a samba-san—i.e., a female in reduced circumstances. Usually this is not an educated midwife, but some elderly woman, or widow, who has been taught her duties by a former samba-san.

"At present there is a school at Tokio for the education of midwives; and at all of the hospitals in the empire instruction can be secured from the medical officers of the same, by women desirous of becoming midwives. The `Home Department Instructions,' issued in the 9th year of Meiji (1876) contains the following:

" `ART. 2. Anyone desirous to become an obstetrician, oculist or dentist, can obtain a license after he or she has satisfactorily passed an examination in the general principles of anatomy and physiology, and in the pathology of such parts of the body as he or she has to treat.'

"Such is the regulation; in Tokio its provisions may be insisted upon—in other parts of the empire I have doubts about its enforcement.

"The Japanese women are healthy, well formed, and well developed, as they have not been injured by the fashionable-torture apparatuses in use in Europe and America. Hence, in the majority of the cases, the samba-san has only to receive the child and to remove the placenta. The Japanese females all have roomy pelves, and naturally they do not look forward with dread to their confinement, having, moreover, implicit confidence in the powers of nature to do all that will be required in their case.

"When the time of confinement approaches, a thick, padded futon (i.e., a thin, cotton-filled mattress) is placed on the tatamé or straw matting. At one end a number of futon are rolled up and used as cushions, against which the parturient reclines, occupying the usual Japanese posture, i.e., as in the illustration. The knees are bent, the legs

under the thighs, and to the outside, the toes outwards; the knees are separated during the delivery of the child. Before the patient are often placed a pile of futon or a chair or

Fig. 56.

[Description: Woman in a kimona kneels on a futon, a pile of bedding supporting her back. Black and white illustration.]

peculiar stool, against which she leans; in other cases a female friend takes the usual posture in front of her, and another behind her to support the weary body, to hold her head, and even to exert a hugging pressure about the abdomen. The samba-san rubs the abdomen, lightly percusses it, and even exerts pressure. Later she receives the child as it presents and holds it up while being expelled. The uterus is not followed down by abdominal pressure.

"The placenta is obtained in the same posture; in almost all cases the samba-san puts two loops on the cord, severs it and waits for the placenta to appear. Occasionally she uses traction and abdominal pressure. After this a thick sash, or obé, is wound several times about the body, and the mother then reclines upon the futon.

"During pregnancy, the ladies avoid unpleasant sights, sounds and conversations. They will not eat of rabbit or hare, willingly, for fear of the production of `hare-lip:' in some provinces they will eat no flesh during this period, in others, during the last twenty-one days of the pregnancy, the woman withdraws to a separate room—a wealthy lady to a separate house. This seclusion is continued for twenty-one days after delivery; then she also has food prepared apart from that of the remainder of the household.

"Before confinement additional religious duties are not often undertaken: the patient rarely makes special visits to the temple, rarely enlarges her charitable duties. She merely takes several baths, changes all her garments, sets aside changes of under-wear, and now patiently and quietly awaits the workings of nature.

"After labor, as we should say during the period of child-bed, the Japanese mother keeps to her house twenty-one days. On the seventh day, if all is favorable, or later, on the twenty-first day after delivery, a dinner is given to all the relatives. If it is a boy, there are then great rejoicings and long-drawn out wordy congratulations; if a girl, all expressions are severely moderated.

"If a girl, on the thirty-first day, if a boy, on the fiftieth day, the mother, the child, and special female friends go to the temple. The Bonze recites special prayers, and gives the mother a special protecting prayer written on the temple paper, which is many times folded and then deposited in a girdle-bag.

"Some peculiar customs are observed with regard to the after-birth: the umbilical cord is severed from the placenta, wrapped in several thicknesses of white paper, then in a paper containing the father's and mother's names in full. Thus prepared it is laid aside with the family archives. If the child dies, it is buried with him; if he lives to adult age, he constantly carries it about with him, and at last it is buried with him.

"The placenta itself is taken from the room in an established form of earthen vessel: if it is a boy's, a stick of India ink and a writing brush are placed with it; if a girl's, nothing. In either case, the placenta is buried deep in the earth, beyond the reach of dogs.''

THE KARAFUTO AINOS, OF ISCHARI VALLEY OF HOKKAIDO (YEZO).

"Among these people, the original inhabitants and rulers of Japan, the parturient is assisted by an elderly female, who has had several children but is not specially

instructed for her office, nor especially selected for her intelligence. Other females, at times, come to the hut, but take no active part. If the labor is much delayed, and the woman becomes exhausted, her husband is called in to help support her; the priest is sent for, to prepare some white sticks, which are shaved down from one end to form an object not unlike a New England split wood broom, whose fibers have not been bent back to be confined by the cord; these latter are stuck into the ground about the hut, leaving the frayed edges upper-most. If an arm or a leg presents, the fetus, whole or part, is pulled away by sheer force, usually with fatal result, not only to the fetus, but to the mother. Their resorts in difficult cases are very limited, and it is not infrequent for the mother to perish from hemorrhage. The only instrument in use is a thong or cord for traction during impaction or mar-presentation.

"As the Ainos meuki not only spins and weaves the tree-fibers, but aids in hunting, fishing, bearing burdens and drawing loads, she is usually of a strong, vigorous frame, and of excellent development. She possesses a roomy pelvis with well proportioned adjuncts, and rarely suffers from disease, excepting syphilis, parasites, and occasional indigestion from gluttony.

"Position.—The houses in which the people live are very rude; sometimes a cave in the hill-side, with a hole in the roof for smoke; more often, a rude pole structure, thatched on roof and sides with long wild grass. In the center of the one large room is an open fire; at one end of the room may be a narrow board floor; around the sides are collections of straw and old garments, upon which men, women, children and dogs sleep promiscuously. The wealthy ones have a few blankets, an occasional futon, and now and then a tatamé. The majority live in a very wretched manner.

"Scanty preparations are made for approaching labor; shortly before full time the expectant mother gathers a small amount of a peculiar fine white grass, which is carefully

dried, and, on the day of the delivery, spread out on the floor or ground on one side of the fire. During the early part of the labor she attends to simple duties, or reclines at pleasure on the straw or mats. At the onset of active labor pains she approaches the fire, drops on her knees, then separates them, and rests back on her heels, while her toes are extended outwards. The midwife faces her; between them a rope with knots or cross sticks is suspended from the roof. This is seized by the parturient, who pulls lustily upon it. The midwife helps to sustain her in this position. The child is dropped on the straw between the mother's legs, and is not molested until the placenta appears. A noose is put about the cord, when the latter is cut. The midwife takes up the child, and spurts a mouthful of cold water upon its chest; if it screams lustily it is a good child, otherwise, not much is thought of it.

"Placenta.—The patient remains in her position, and the placenta usually appears in a short time; if not, the old woman pulls it out. From this latter procedure, hemorrhages are not infrequent. I have yet to learn that massage or pressure is used at this stage. A tree-fiber girdle is now assumed outside of the usual kimono, or flowing garment.

"The labor generally lasts from eight to forty-eight hours. The child is not washed, but is wrapped up in an old momu (a cloth made of the inner fibers of a yezo tree): it is allowed to suckle from three to five years, and even longer, and is carried about on its nurse's back under the outer garments and next to the skin.

"They have no obstetrical instruments. Abortion is practiced occasionally as well as feticide, which is usually brought about by blows, compression, and external violence. Infanticide is extremely rare, as the mothers have a tradition that the next child will be blind.

"The Ainos live as nearly as possible in a state of nature. They have little or no ceremony at child-birth; before labor, the mother pursues her ordinary avocations as long as she

can; after it is over, she considers it her duty to resume her work as soon as possible. The father and the friends often imbibe of rice saké too freely. I have learned of no religious or superstitious ceremony.''

KALMUCKS.

The Kalmucks, the most numerous of all the Mongolian people, may well serve as a type of the natural Mongolian, as they are nomads, without a fixed home, roaming over mountain and plain, unaffected by civilization; whether belonging to Europe or Asia, they inhabit only the most remote and inaccessible parts of either country, and yet they are far in advance of the nomads of the far north. For their medical knowledge the Kalmucks are indebted to the Buddhists, to the schools of Thibet, founded for the Lamas; among them medicine is a divine knowledge, and possesses its especial idol, Burchan. For the following excellent description of their obstetric customs I am indebted to Dr. Rudolph Krebel's work: Volksmedizin und Volksmittel verschiedener Völkerstämme Russlands. (Leipzig & Heidelberg. 1858.)

"As soon as labor begins, the friends of the patient assemble; their idol is brought forth, conspicuously placed above the sufferer's couch, and illuminated with a lamp. The parturient now takes to her bed in expectation of the coming pains, during which she squats, her buttocks resting upon her heels, grasping with her hands a pole, which is firmly attached to the chimney, and of sufficient length to afford her a comfortable support; behind her sits another woman, who compresses her body with both arms; but, if in better circumstances, the husband takes some vigorous young fellow into his `kibitke,' who, after being hospitably treated, takes his seat on the floor, with the parturient on his knees, and with his arms encircling her body, he compresses the abdomen and with the palms of his hands rubs the uterine surface, being careful to stroke it from above downward, and to exercise compression in the same direction. As soon as the female attendant observes the appearance

of the head in the vulva, she signals the crowd of men who have been waiting outside, who simultaneously fire their guns, in order to assist nature by the sudden fright which this will cause the patient. The poor either buckle broad leather belts around the abdomen of the patient as soon as labor begins, and try to hasten matters by pressure from above downward, or they press a cloth firmly over mouth and nose of the woman to try the effect of choking, so that the exertions of the struggling sufferer may possibly expel the tardy fetus.

"It is said that in difficult cases female assistants have for ages practiced version, and physicians among the Songars have performed embryotomy with the knife. We hardly need mention that superstitions play an important part in their management of labor.

"The young mother is looked upon as unclean for three weeks after confinement; she is never abed at anytime over seven days during the puerperal state. Immediately after delivery mutton is given the patient, but only a little at a time, whilst broth is given in considerable quantities; the amount of meat used is gradually increased.

"As soon as the child is born, the cord is tied and cut, and the placenta buried at a considerable depth within the `kibitke.' The child is washed in salt water and wrapped in furs. The remnant of the cord is carefully preserved, and kept as a charm, considered especially valuable in their petty lawsuits. Until the remnant of the cord separates from the child, the father does not permit fire from the hearth to be taken from his hut. The wealthy sometimes keep a wet nurse; the poor nurse their own children, not unfrequently up to the very time when prevented by a succeeding pregnancy. Additional nourishment is given the child during the first year. During the first days the infant is not given the breast, but a piece of raw mutton tallow to suckle. The mortality is great among children, especially during the second year, on account of coarse food and hereditary syphilis.''

NEGROES.
LOANGO-NEGROES.

I have chosen the Bafiotos, or negroes of Loango—a people of Central Africa—as representatives of the Blacks, as they are a fair type, somewhat above the majority of their neighbors; and because I am enabled to follow closely the excellent description of their traditions and customs by Dr. Peschuel-Loesche in the Zeitschrift fuer Ethnologie for 1878 (Inidiscretes aus Loango, p. 17). Menstruation seems to begin with the thirteenth, more rarely the twelfth year, and the cleanliness of the people does not permit an interruption of the daily bath, even during the continuance of the monthly flow. The idea of uncleanliness during the period, and during child-bed, prevails among the Loango women, as among most of their neighbors; and while menstruating a female must not approach or enter the huts of men. Woman, among the Loangos, ranks higher than among most African tribes, and instead of the long, pendent, breast which the negroes ordinarily cultivate, the Bafioto woman prides herself upon a firm mamma, and binds or straps the breast in case it threatens to drag; hence a Loango woman does not develop a long breast, and is never seen, like many of her black sisters, carrying on her back a suckling child, which is nursing the breast thrown over the shoulder.

They are a moral people; religious ceremonies, continuing many days, accompany the appearance of menstruation in the girl; for days she is isolated; strict laws govern the act of cohabitation, and the seduction of a maiden is looked upon as a misfortune which has befallen the entire land. They delight in children; hence abortion, as may be supposed, rarely occurs among this people, although sometimes practiced by elderly females of immoral character, who dread confinement; and they effect it by eating freely of red pepper, and by kneading and compressing the abdomen.

Twins and triplets are not killed; deformed children are quickly put aside; such as have only slight deformities are sometimes permitted to live; but even a mother's love cannot

save them in case that popular feeling should be such as to consider them, for some reason or other, as possessed of any witchcraft.

It depends merely upon an accidental combination of circumstances whether an ill-formed child is doomed as a "ndodschi'' (deformed bearer of misfortune), or simply as a "muana-mu-bi'' (ugly, bad child); no fault is found with the mother. This superstition may go so far as to accuse a still unborn child; the mother is then given a poison bark, which is used in the official test ordeals, in the firm belief that the "ndodschi,'' if such a one exists, will be rendered harmless by being aborted—in case the mother should die in the ordeal her guilt is thus proven.

The pregnant women is not forbidden to cohabit; she avoids garments of a red color, wearing white or blue, or simple native bark-fiber; she drinks no more rum lest the child should be marked, but this superstition is rapidly losing ground.[1] Charms favorable to women are erected in the hut, and worn upon the body—wise women, "ngangas'' and neighbors are of course consulted.

The act of parturition is not difficult as a rule, and within a few hours the mother is enabled to again take up her accustomed work. Skilled assistance of any kind is unknown—men are not permitted to be about. In difficult cases the neighboring huts, with a feeling of delicacy, are cleared; the children sent out of the village, and the assistants raise their voices in order to drown the lamentations of the patient in the general noise. Confinement takes place whilst the patient is standing, leaning against the wall, or kneeling, inclined forward, resting upon her arms, because the desired head-presentation is supposed to come about most readily in this position. The child is caught upon a bit of cloth or matting, that it may not touch the ground. If labor is retarded, the patient seeks her couch, casts herself down prone upon her stomach, and thus seeks to further labor by mechanical pressure. If expulsion is not furthered by these means, the assembled

women take charge of the case, especially if a primipara; arms and legs are seized, whilst some old woman, who squats down, takes the head of the patient upon her lap, presses a gag firmly upon mouth and nose in order to choke the sufferer, so that finally the child is forced out amid the spasmodic convulsions that follow. These means rarely fail—better ones at least are not known. Rupture of the perineum is not unfrequent. If a woman is overtaken with labor pains away from friends and help, she prevents at least that the child should fall to the ground and carries it home well covered.

The placenta is wrapt up and buried—secrecy of their labors seems to be entirely due to the prevalent feeling of modesty. The navel string is measured off to the double length of the first joint of the thumb, or to the knee, and is then cut, not with a knife, but with a sharp edge of a leaf-stalk of the oil palm. The assistants then seat themselves. about a fire which has been lighted in the hut, and pass the new born babe from lap to lap, whilst with well-warmed hands the navel string is compressed and its drying off thus greatly hastened. This object is attained within twenty-four hours; the parched and deadened remnant is thrust off with the thumb nail and cast into the fire, lest it should become food for the rats. If this should be devoured by them the child grows up wicked. Until the cord has been separated from the body and has been burnt, no male, not even the father, is admitted to the hut.

During the first days the child is not given the breast— the qualities of the colostrum seem recognized; at least this is called "tschida fuenna,'' and the milk later "tschiali.'' In order to further the flow of milk the young mother drinks hot water for many months, and washes herself with a decoction of the leaf of the castor-bean plant. The genitals are cleansed and rubbed with bunches of these same leaves, well soaked in water, until all secretions cease.

The young mother takes frequent baths in some secluded spot, not too far from her hut; she seats herself in a slight

excavation in the ground, which has been lined with mats, and whilst her assistants or friends are pouring hot and cold water alternately over her body, she is thoroughly kneaded and rubbed—massage. The child, especially in case that it should perspire, is bathed several times a day in cold water, into which charms have been dipped. The new born child remains within the hut for two or four months. The father and other men can only see it after the navel string has separated from the body, and even then only if they have not cohabited during the preceding night. The negroes themselves assign the suspicion of their wives as a reason for this exclusion, because they wish to retain control of them and prevent them from becoming dissolute, as mothers are prohibited from sexual intercourse during the period of lactation. This period averages twelve or fourteen months, but varies greatly, as some wean their children when the first teeth appear; others when they begin to talk. No Loango mother trusts her child to the care of another; they nurse the child just as civilized mothers do; they even hold down the breast with the fingers in the same manner. The breast is only given at certain times, no other food being offered in the intervals. The child seizes a part of the areola in addition to the entire nipple.

During the first months, while the child is carefully confined to the hut in which it was born, the mother goes out at will attending to her duties; but the homes of the men she dare not enter, not even that of her husband, whose visits she, however, receives, as the father loves to fondle his baby; later, the mother carries her baby in a cloth tied to her back, and even sometimes quite a large child is carried astraddle of her hips, a position in which the father is proud to carry about even his good-sized offspring. The Loango mother is very fond of her child, and it is no wonder, when we consider the attractive, oddly humorous, jolly appearance of the little negroes. Whilst the children are confined to the hut, two names are given them—a boy is called Nsau (elephant), a girl, Mputa (lovey, chickey). Their first appearance outside of the hut gives rise to a holiday;

the mother, in festive garments, receives the villagers and their congratulations, whilst seated in front of her hut with her child upon her arms. A name is given the newcomer with a kind of baptism by some relative, usually the uncle, and, if we may so express it, citizenship is thereby extended to him.

THE RED RACES.

Primitive customs among our North American Indians are rapidly disappearing. As the war-bonnet of eagle plumes has given way to the unromantic felt hat— the tomahawk and bow and arrow to the revolver and breech-loading rifle—so are the original obstetric customs, traditionary among the red people for ages, yielding to the influence of civilization: the few warlike tribes, who still retain the ways of their ancestors, are rapidly dying out; those who have quietly settled down upon the reservation are accepting the habits of the whites, and their parturient squaws are delivered as they have been taught by the agency-physician or the army-surgeon; in fact, primitive obstetric customs are so speedily passing away that more than one of the agency-physicians answered with some surprise to the circular, kindly sent among them, for me, by the Smithsonian Institute, that he had observed nothing peculiar; that the squaws of the tribe were delivered on the back, and their habits were the same as those of their white sisters. Many of the tribes, nevertheless, still retain their peculiar customs, but all of my informants unite in the statement that it is very difficult to obtain any information from them upon these points. It is rare that men are permitted to witness, or even be near a labor scene; and white physicians are not called in unless it be a desperate case. Indians are moreover very reticent upon this point and very unwilling to impart any information regarding their women or the functions peculiar to them;

this is strange, too, as they are by no means a modest people.

There are many points of resemblance in the obstetric customs of the various Indian tribes, and in many features

they differ. The kneeling posture, for instance, is the one most commonly assumed by the squaw in labor, and yet among certain tribes almost all the other positions can be found, though rarely that upon the lap of the husband; this is a trouble and indignity which the laziness and pride of the Indian-brave will not submit to.

As I cannot detail the customs of the various tribes, will confine myself to the obstetric practice of the Indians of the northwest, and of the more easterly prairie tribes. As regards the former I shall accept the statement of Dr. John Field, of Sheridan, Oregon, who has given the following very interesting account of his long stay among the tribes, especially while physician to the Grand Ronde Agency in Oregon; he says:

THE INDIANS OF THE PACIFIC COAST.

Women belonging to the Indian tribes on the northwest coast are attended in labor by a number of older squaws, as many as may be necessary. These attendants are not especially skilled midwives, but the mothers, if living near enough, or some other older friend and a few of the neighbors. It is among these people as it is among the whites, there is always some old woman in every tribe, band or settlement, who is looked upon as an authority in these cases, who is considered an expert manipulator and whose every order or suggestion is implicitly obeyed.

During the first stage of labor, the patient will usually keep on her feet, moving about the lodge, or now and then lying on her bed for a short period at a time. At the recurrence of each pain the parturient will frequently utter a plaintive cry. In this she differs somewhat from her white sister, who will most generally announce the occurrence of pain by a sound which has, by the old women, been determined "grunt,'' "grunting;'' the former gives vent to along, plaintive cry, which the word "wail'' or "whine'' seems to express more nearly than any other. When the parturient lies down she usually reclines upon her back, with the legs semi-flexed upon the thighs, the thighs likewise flexed upon the body.

No assistance is rendered at the time of a pain during the first stage, but the attendants are all ready, and willing to help when the proper time comes.

The patient takes to her bed and lies on her back—her head slightly elevated. This bed or pallet is universally on the floor, and near the fire if the weather is cold. Her legs are well flexed upon her thighs, and her thighs upon her abdomen; knees and feet are each supported by an assistant; she herself usually uses her hand to press against her thighs, or when the pains become severe, to compress her own abdomen over the fundus uteri.

The officiating accoucheur—if the term is allowable— crouches upon the pallet at the feet of the parturient, with her hands pressed upon the nates, perineum vulva or abdomen

of patient, as circumstances in her judgment may require.

She does not rely upon vaginal examination, nor indeed does she at all practice that means either of diagnosis or assistance to her patient.

As the case progresses, and the expulsive pains increase in severity, the abdomen of the parturient is firmly compressed over the fundus uteri by the hands of an assistant. She now uses her own hands to press upon her thighs, and does not pull at the hands of an attendant as so many white women do.

The abdominal manipulations before referred to are practiced by an assistant, kneeling by the side of the patient, with her face towards the patient's feet. She spreads her fingers in such a manner as to grasp the entire fundus uteri as nearly as possible. When the uterus is being contracted by the force of nature the assistant follows the fundus with her hands, firmly grasping the organ, and gently but firmly pressing downward. When the pain subsides, she still keeps her firm hold of the uterus, and does not allow it to relax, at least she does all she can to prevent this.

If the case is a tedious one, and the head is slow to pass, another method is resorted to in addition to the one mentioned.

The woman is seized by two attendants, who grasp her around the thorax, immediately under the arms, raise her body off the bed, and support her in an erect position, so far as her body is concerned. She is permitted to rest upon her knees or feet, according to the peculiar notion of the accoucheuse, or according to attending circumstances.

By these means, and in the position above mentioned, she is as firmly supported as is possible for the attendants to do.

The abdominal pressure is firmly kept up until the end of the labor.

The accompanying illustration, although a labor scene among the Mexican Indians in the vicinity of San Luis

Potosi, and there photographed for me by Dr. G. Barroeta, so well represents the relative position of patient and assistants, as here described, that I have inserted it.

FIG. 58.—Mexican Indians.

[Description: Woman kneels, holding onto overhead rope, while two assistants attend her. Black and white illustration.]

Towards the close, and while the woman is in the position last named, the accoucheuse remains crouched at the feet of the parturient, supporting the perineum and vulva with the palms of her hands. As soon as the head emerges fully through the vulva, the accoucheuse takes it between her hands and makes traction so that the shoulders and body of the child will be the more speedily delivered.

The child is received into the lap of the accoucheuse whether the mother is in the erect position or lying down.

The umbilical cord is tied and divided in a few moments after delivery, and the child is laid to one side out of the way. The delivery of the placenta is expected at once

after the birth of the child and without further trouble; in order to facilitate speedy expulsion the accoucheuse and assistants resort to certain manipulations.

This effort to assist the uterus in casting off the placenta is made immediately after the child is born, and stowed away in a safe place.

If the case has been an easy one, and the woman has not been raised from her couch, the first efforts to obtain the placenta are made as she lies there, the accoucheuse, making gentle but tolerable firm traction on the cord with one hand, manipulates the uterine globe with the other. At the same time, if thought necessary, an assistant will press (by spreading the fingers of both hands) and even kneed the abdomen, with the view of pressing the secundines out of the uterine cavity. If these efforts fail while the woman is in the recumbent posture, she is raised to the erect position, and thus supported, as in cases of difficult delivery of the child. The uterine globe is then firmly pressed and kneaded, whilst the accoucheuse makes more or less firm traction upon the cord.

But if the case should be one of abnormal attachment, or hour-glass contraction, they know no method of procedure that promises success. Frequently the patient will survive, escaping blood poisoning, and the secundines will be cast off in a state of disorganization.

By making persistent inquiries I learn that they seldom fail in sufficiently stimulating the uterus to cast off the placenta.

AFTER TREATMENT.

The treatment resorted to after delivery is not alike among all tribes. Some, with whom I have come in contact, require the puerpera to keep up on her feet during the greater part of the day—taking short walks about the camp, resting when weariness becomes oppressive; while walking she uses a staff, for the double purpose of support while upon her feet, and also as an instrument of relief; as she slowly steps about the body is frequently bent forward,

bringing the abdominal walls immediately over the uterus against the upper end of the staff, while the hand of the woman is upon the end of the stick in the same way as that of a man walking with a cane.

This practice is kept up for a period of three or four days, when the puerpera is thought to be well; the prescribed walks varying with periods of rest upon her couch.

The object—as I am informed by the old women of the tribe—is to facilitate the flow of the lochia.

They know that a certain amount of blood should escape, and think that if the patient should lie down in bed this would accumulate in the abdominal cavity, and cause death. From all I can learn, by inquiries of those of the tribes who are old enough to remember the practice among the Indians in this region before the time that the white man came among them, this procedure in the after-treatment was solely for the purpose of encouraging a free flow of the lochia, and I further learn that no case of death from hemorrhage had then been known to occur.

Some of the Indian tribes in this country follow a different course of after-treatment.

As soon as possible after delivery the puerpera is placed on a bed on the floor of the lodge, and securely wrapped in blankets, or whatever kind of covering they have. The bed is placed near the fire, if the weather is cool, and she is kept in this closely wrapped condition. When asking for an explanation of this method of treating their lying-in women, I was told that it was to keep the patient from taking cold, and having fever (somewhat like the Siamese). In this condition she is kept for the period of four or five days, except such times as she is compelled to attend the calls of nature. When freed from this restriction, she at once resumes the care of the babe as well as the duties naturally falling to the lot of an Indian squaw.

During the period that I was living among these Indians —two and one-half years—I neither saw or heard of a case of puerperal fever, eclampsia, or any other diseases peculiar to the lying-in woman. Neither did a death during

confinement come under my immediate observation, and but few Indian women have any mammary trouble after their confinement, notwithstanding the fact that they are exposed to the same cause that is a prolific source of such complications among whites.

EASTERN TRIBES.

As it is impossible for me to make use of all of the extremely valuable and interesting information received by kindly responses from the surgeons of the army and agencies among the various Indian tribes, I will close with a description of the obstetric customs among the more easterly tribes, the Cheyennes, Arapahoes, Kiowas, Comanches, and eastern Apaches, given me by Maj. W. H. Forwood, U. S. A., now stationed at Fort Omaha, Nebraska Maj. Forwood resided for over five years among these tribes, who are scattered over the plains of Kansas, Nebraska, Colorado and the Indian Territory, and constantly came in contact with them at Forts Larned and Sill, where they congregated and frequently applied for treatment. He says:

"The customs prevailing among the above named tribes are similar, and the following instance may well characterize them:

"In August, 1869, at Fort Sill, I. T., I was called upon by a few men and squaws of the Comanche tribe for the purpose of securing my services in the case of a patient who had born two children, and had had difficulty at both of her confinements. They anticipated difficulty again, and this was the reason for summoning me, which otherwise would not have been considered necessary. At the proper time I rode to the encampment on Cache Creek, a few miles from the Post, where I found the lodges pitched in a wide circuit on high open ground, near the stream. A short distance outside the camp, and in rear of the patient's family lodge, were arranged the accommodations for the confinement. A shelter had been constructed of green boughs six or seven feet high, by setting up brush or bushes, with the leaves on, around the circumference of a circle, about eight

feet in diameter. An entrance was provided by breaking the circle and overlapping the two unjoined ends. In a line outside the entrance were three stakes, ten paces apart, set firmly upright in the ground, four feet high, made from the stems of small saplings with the bark left on.

"Inside of this shelter were two holes for the reception of fluids of any kind and the steaming of the parts, and stakes for the support of the parturient. Three stakes were also planted outside of this enclosure, so that the patient, when surprised by a pain, as she walks about in the intervals, may at once kneel down and find a support. (See Fig. 15, and for full description p. 85. Posture.) So my patient was walking about with her assistant, a female relative, and as each pain came on she knelt down, grasping a stake, whilst the assistant, standing or kneeling behind her, seized her about the waist and kneaded and compressed the abdomen.

"She was a full Comanche squaw, aged about 20, of slight frame, in good general health; had given birth to two healthy children, but had suffered tedious labor with both, and some delay in the discharge of the placenta. Her dress consisted of a body, a skirt, and two leg pieces made of deer skin, and nicely ornamented with beads, silver shells, etc. The body was of one skin, with a hole in the middle for the head, the ends coming down in front and rear, fastened at the sides under the arms, making a sort of flowing sleeve, and reaching below the waist. The skirt piece was of about two skins, merely wound around, extending a little below the knees, and secured by a leather belt at the waist. The leggings were separate pieces, with moccasins attached, extending above the knees, fastened by a narrow strip at the outside to the waist-belt, colored, fringed and ornamented at the leg; flowing hair, beads at the neck, and a number of brass rings about the wrists.

"Examination, to which she had submitted with evident disgust and not without some persuasion, revealed the membranes ruptured, waters escaped, parts rather dry, but head presenting favorably, and pains moderately strong, so that

the labor was deemed practical within a reasonable time by the efforts of nature. Without making any suggestions or offering further interference, I sat down to "make medicine,'' as they thought, but in reality to improve the opportunity for observation. The patient was assisted by a woman of middle age and some experience in such cases, while a considerable number of other squaws of all ages thronged around, making suggestions, talking, singing, groaning and gesticulating, but no men came near.

FIG. 59.—Kiowa midwife blowing an emetic into patient's month.

[Description: Woman leans forward as another woman blows an emetic into her mouth. A woman standing behind her delivers the child, while another woman looks on. Black and white illustration.]

"She never assumed the recumbent position, nor did the assistant make any attempt at vaginal examination. There was no great effort on her part to restrain the feelings or submit patiently to suffering, and the throng of women inside and out kept up a continual noise and clatter. Meantime the chief medicine man of the tribe in a neighboring lodge was making strenuous exertions to help the patient by means which I was not permitted to see, but which could be plainly heard going on incessantly. The ceremony was

performed alone in a closed lodge, with fire, and consisted, so far as I knew, in drumming, singing, shouting, dancing, running round the fire, jumping over it, manœuvring with knives, and the like antics. Medicine making of this sort is very common among the Indians, and is always conducted with great solemnity and seriousness, and with full faith in its effect. The rationale is based on the idea that disease is an evil spirit entering the patient, and must by some magic influence be coaxed, scared or driven out. The internal administration of medicine, excepting emetics, is seldom practiced, and emetics are scrupulously avoided in cases of labor, owing to the direction in which they act. But in the midst of a vast amount of sheer nonsense they possess some good practical ideas, such as the buffalo hair pessary worn with benefit by many women, the hot stone in labor, which is sometimes modified into a steam bath by covering the shelter tightly with skins and pouring water on the stone. At a former confinement of the patient, a practical application had been made of the effect of fear in routing the child from its lodging place. She was brought out on the plain, and Eissehaby, a noted chief, mounted on his swiftest steed, with all his war paint and equipments on, charged down upon her at full speed, turning aside only at the last moment, when she expected to be pierced through the body and trampled under foot. This is said to have caused an immediate expulsion of the child.

"As the crisis was evidently approaching, another examination was made, with the patient on her back on a robe, and the child was soon born, the placenta following a few moments later. Immediately the greatest excitement prevailed, the monotonous songs and doleful cries were changed to sounds of rejoicing, and the noise and din were louder than ever, but of a far more pleasant character. The moment the placenta escaped the patient sprang up, buckled on a stout leather belt, mingled with the crowd and soon disappeared, without apparently taking the slightest notice of her child. I took up the baby and offered it to some of the bystanders, but each one shrank back and would not

even touch it. Presently a woman, whom I had not seen before, appeared and took charge of it. She was assigned to the duty of receiving and having the little stranger initiated into the world with proper ceremony. This, in case of a boy, would probably be some simple little nonsense performed by an old chief, and in case of a girl, by the squaw herself.

"An instance came under my notice once in which an imaginary object (a ball it was said to be) was blown into the mouth and placed down in the ribs somewhere about the heart, where it was to remain, the supposed effect being to give courage and protect against harm. The medicine chief approached, and placing his two hands in front of his chest and throat, made a gulping effort as though bringing something up out of his own body, leaned over and blew quickly into the patient's mouth, and the thing was done.

"The Indians tie the cord with one ligature and cut it almost a foot from the child's body. The placenta is then secretly and mysteriously disposed of in various ways not unlike those often practiced by old women among ourselves. Their resources in case of retained placenta, so far as I know, are limited to forcible compression of the abdomen, traction upon the cord, and efforts to reach it with the hand in the vagina, in which the patient as well as the assistant take part. They never neglect to pay the doctor his fee, lest he should become angry, and, by the power of his arts, bring some calamity upon the patient in future, and that ceremony was not overlooked in this instance. I was brought to the chief's lodge and formally presented with a pony of my own selection, but, as they feared the poor creature would be very lonely away from its companions, I was requested to let it run with the herd and consider it mine—with the herd of course it remained.''

A surgeon who has been stationed for some years at Camp Sheridan, in the Spotted Tail Indian Agency, in the midst of from seven to twelve thousand Sioux Indians, principally of the great Brulé branch of the nation, and who has carefully inquired into their customs, writes: "My inquiries into

their obstetric habits were attended with difficulties, as these Indians, never talkative, become quite reticent as soon as any questions are asked concerning their peculiarities. No very definite custom or practice seems to be followed; the most common is, that several matrons preside as midwives in the lodge of the parturient, which is, especially in delayed cases, filled to suffocation with indifferently solicitous(?) relations and friends.

"During the first stage the squaw sits or lies about grunting vociferously, but during the expulsion of the fetus her posture is erect, or nearly so, with her arms around the neck of a stout male support, mostly a young bachelor buck. The child is received by the attendant squaw, and the placenta promptly follows, as a rule. She is then put to bed, and the lochia received on old clothes, which are burned.

"These Indians, though nearly regardless of what we consider as modesty with regard to defecation and urination, are quite superstitious about the functions peculiar to women. On the first menstruation of a maiden quite a ceremonious feast is held, at which the relatives and attending friends congratulate the maiden, and her parents, on the dawn of her womanhood, for she is now a woman. During the whole of each menstrual period (or "moon in the ass,'' as they term it) the female is hedged about with restrictions. She is considered unclean, must refrain from certain things, and is disqualified from assisting or participating in any of the ceremonies of her tribe.

"Other of their customs, also, are quite peculiar. The female stands to urinate and sits during defecation, whilst the male sits on his haunches to urinate, and stands during defecation; the male mounts his horse from the right side, the female from the left.''

Among the Indians of Montana the usual name for a child for the first year or two, before a permanent name is bought of the medicine man, is "Mai, Tsä Barkea-Tsäcareash,'' which is a word applied to a spirit, and also to the gray-crowned finch (Leucosticte tephrocotis), into which bird young children are believed to enter on their death.

Twins cause their parents to be greatly envied; but if a squaw becomes pregnant while still nursing, the child at the breast is said to die in four cases out of five from diarrhea and marasmus.

Among the Modocs and Klamaths, the husband refrains from eating all flesh of fish or game for five days after the birth of a child, and the mother refrains from the same for ten days. At each menstrual period the woman refrains from flesh for five days and is more or less isolated from the male portion of the family, the same custom prevailing after an abortion.

These five and ten days periods are the same I have repeatedly spoken of among the natives of India and Africa.

Certain of the tribes demand that the father take to the woods and absent himself for some days from the family lodge and the encampment, and if it be his first child he caches himself until the child is a week old.

It is only the young men who practice this, as they are so ashamed of the occurrence.

At the end of this time, or as soon as the father is able, he calls all his relations and friends together and has a feast of boiled dog—provided the child be a male.

Much of this information, especially the last, regarding the O-g-a-l-la-l-la Sioux, comes from the well known Indian Scout, Will. E. Everett.

Although I should like to enter more fully into the customs of the various Indian tribes, the above will suffice to show the intimate relation between the obstetric customs among the yellow, black and red races.

I have made use of the last three illustrations, although not bearing directly upon the customs of the tribes here referred to, on account of their extreme interest.

Figures 57 and 59 I obtained through the kindness of Capt. M. Barber, surgeon U. S. A., of Fort Sill, who had them made by a Kiowa artist to illustrate the customs of his people.

Fig. 57 represents a labor scene in a Kiowa tepee. The

patient is on her knees, grasping a tent pole fastened at right angles to two upright ones; one assistant is kneading her back, whilst another is attending to the child which is in the act of being born. A gun, saddle and "G'' string, the peculiar articles of male apparel, are hung at the head of the couch to induce the birth of a boy.

Fig. 59 represents the midwife blowing something into the patient's mouth to make her vomit and strain, and thus assist the labor pains. She here rests herself upon the pole, which plays so important a role in their labors, sometimes serving as a support to the kneeling patient (fig. 57), sometimes as a means of expression when she leans upon it with her stomach. This scene is represented taking place in the "medicine lodge''—why, Dr. Barber could not inform me.

Fig. 58 is taken from a photograph secured for me by my friend Dr. G. Barroeta, of San Louis Potosi, Mexico, and well illustrates the posture of patient and assistants as assumed in labor by the Indians of that region. I have in an earlier chapter described the scene more in detail and pictured it so as to show the position of the assistant's hands; here they are concealed, as is customary, beneath the clothing, so as not to expose the person of the patient.