University of Virginia Library

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.''