University of Virginia Library

1. CHAPTER I.
PREGNANCY, PARTURITION AND CHILDBED.

As it shall be my endeavor to unravel the mysteries of the obstetric art among primitive peoples, to describe the peculiar features in the obstetric practice of the various savage races during every stage of labor, I will now, in this first chapter, for the better understanding of these details, completely describe that most interesting period in the life of woman, so important, socially as well as professionally—the time of pregnancy, labor and childbed.

We will find among the natural habits of primitive people many points of resemblance to the customs of our more advanced civilization. In their views, in their methods of treatment of the parturient, we see rudely depicted the lying-in chamber of to-day; indeed, many a labor in the cellar or the attic of a crowded city, or in the log cabin of a secluded country district, differs but little from that which we will find in the tepee of the Indian or the hut of the Negro; in fact, it is here that we often see customs which are rudely indicative of some of the very best of our modern improvements upon which obstetricians greatly pride themselves; observation has taught these children of nature many a lesson of which, in their natural shrewdness, they have profited.

PREGNANCY.

We can trace a certain resemblance throughout; thus a great deal of interest, and I may say of importance, attaches among many tribes to the pregnant state, be it in the jungles of India, in the wilds of Africa, or upon our own prairies. It is to the woman an eventful period of her life, and is appreciated as such by her tribe as important, not only for herself but for all her people. The Andamanese, for instance, are extremely proud of their condition, which in their native state

is of course very evident to any beholder, and if a stranger shows himself in their villages, they point with a grunt of satisfaction to the distended abdomen. Among the Hebrews and other people of ancient times, sterility was a disgrace (Gen. xi. 30; Exod. xxiii. 26; Kotelman), and the mother of many children was a greatly envied woman. Conception was favored, although no laws existed upon the subject, by coitus soon after the cessation of the menses, the act being forbidden only during religious service and upon the days of the high feasts.

Abortions as a rule are not numerous; the African tribes in the main are fond of children, and hence rarely destroy them. Among some of our Indians, especially those in closer contact with civilization, laxer morals prevail, and we find abortion quite frequent; some tribes have a reason for it, on account of the difficult labor which endangers the life of the woman bearing a half-breed child, which is usually so large as to make its passage through the pelvis of the Indian mother almost an impossibility.

In old Calabar, medicines are regularly given at the third month to prove the value of the conception. Three kinds of conception are deemed disastrous: first, if resulting in twins; second, in an embryo which dies in utero; third, in a child which dies soon after birth; and it is to avoid the further development of such products that the medicines are given; the idea being that, if the pregnancy stands the test of these medicines, it is strong and healthy. In case the ovum is expelled, it must have been one of these undesirable cases of which no good could have come. The medicines are first given by the mouth and the rectum, then per vaginam, and applied directly to the os uteri, provided that a bloody discharge follows the first doses. For this purpose they use one of three herbs: a Leguminosa, an Euphorbia, or an Amomum. The stalk of the Euphorbia with its exuding juice is pushed up into the vagina; on the same part of the leguminous plant is placed some Guinea pepper, chewed into a mass with saliva: in a few days the abortion takes place. The measures employed are frequently too severe, as constitutional disturbance, and sometimes death follows. Among Indians and Negroes abortion is now and then practiced if a suckling mother conceives, as they

reason that the living child is the more important and would be harmed by the drain which the new pregnancy necessarily exerts on the strength of the mother.

The seventh month is not unfrequently regarded as dangerous, as many abortions then occur. For this reason, in Old Calabar, the patient is generally sent away, as pregnancy advances, to a country place where she can live quietly and free from the excitement and bustle of the town; and above all where she can be out of the way of witch-craft. A great many superstitions exist among all peoples in reference to this important epoch, more especially among some tribes of the Finns, for instance the Esthonians; one of the most amusing of these ideas is the weekly changing of shoes customary among pregnant women, which is done in order to lead the devil off the track, who is supposed to follow them constantly that he may pounce upon the new-born at the earliest moment.

The same great wish prevails for a boy among savage races as among our own people, even to a much greater extent, and naturally so, as in the male child the warrior of the future is looked for; our own Indians, as well as the Negroes of Africa, have numerous ceremonies by the faithful observance of which they hope to produce the desired sex; but, however interesting they may be, we cannot now enter upon their further consideration.

Here and there signs of pregnancy are carefully observed: in Old Calabar, as well as in the interior of Africa, pregnancy is counted from the suspension of the menses, and the time is reckoned by lunar months; among Sclavonians the appearance of freckles is looked upon as a safe sign of pregnancy.

The care which is taken of pregnant women depends, of course, greatly upon their surroundings and increases with the civilization of the people. We see this best illustrated among the North American Indians: very little or no distinction is made among the nomadic tribes, but as soon as we come to a more sedentary population, such as the Pueblos, or the natives of Mexico, we see that they become more considerate. No over-exercise is permitted, warm baths are frequently taken, and the abdomen is regularly kneaded in order to correct the position of the child. This is also the case in Japan, and whether the diagnosis of a malposition is made

in the early stages of pregnancy or not, it is a fact that the abdomen is subjected to this treatment, and, unquestionably, in many instances, the position is thus rectified. This is done by massage and manipulation among these somewhat more advanced people, whilst the nomadic Indians of the prairie accomplish the same end by hard work and horse-back riding. The great danger in labor, and to the savage woman the one great danger, is a transverse position of the child. This they must use every means to avoid, as with them death is certain if labor is inaugurated with the child in such a position.

I have already described in full the method of rectifying malpositions as practiced in Japan, in my paper on "Posture,'' and will only say that the process, mainly massage, is repeated every morning after the fifth month, the practitioner making the patient stand up and put her arms around his neck. The Andamanese and the Wakamba of Africa, many of the nomadic Indians, and undoubtedly almost all of the women of savage tribes work up to the very hour of labor. Rigby states that he finds the easiest labors, and the best results, when the women work or continue their wonted employments until labor pains are upon them; it always goes worse with those who idle beforehand, with the view of saving themselves and making labor easier. This statement we find constantly verified in our ordinary practice; we know that the working women—and we have many such—who continue their wonted employments until the very moment of delivery, have the easiest labor. It is the lady who is so conservative of her strength and anxious to do everything in her power to promote her health and the welfare of her offspring, who suffers most. At all events we shall not fear evil, and the pregnant woman will fare best in the coming labor, if she will continue as long as possible in the exercise of her usual duties, whatever they may be.

In Mexico, as the old histories tell us, the pregnant woman was forbidden to yield too freely to the desires of the husband, although coitus was indeed ordered to a certain extent, so that the offspring might not prove weakly. In Loango coitus is not forbidden. Some regulations with regard to the act exist among other tribes, and the too free exercise of matrimonial rights is often cautioned against.

The well regulated government of old Mexico was careful of pregnant woman in many ways; the Burmese women wear a tight bandage about the abdomen after the seventh month of pregnancy, to prevent the ascent of the uterus, under the idea that the higher the child ascends in the abdomen the farther it will have to travel in labor when it descends, and hence the more painful the delivery will be. In Japan, the midwife is consulted at about the fifth month, and she then binds the abdomen with a cloth which is not removed until labor begins, it being kept there so that the child should not grow too large. It is the same procedure which is followed in India, although the underlying idea is different, and three times a month the abdomen is rubbed. The Nayer women bathe a great deal during pregnancy, taking good care of body and soul. In fact, the frequent bathing of pregnant women is common also to all the higher castes of India. The Nayer perform a ceremony during the first month of pregnancy, but as it so frequently happens that a woman erroneously considered herself in that condition, this ceremony for the preservation of the pregnant woman against the wiles of the devil is usually delayed until the fifth or even the seventh month; and upon the following morning she very properly drinks the juice of tamarind leaves mixed with water.

Here and there some preparation is made to ease the intensity of the coming labor pains. Upon the isle of Jap, in West Mikronesia, they begin to dilate the os uteri at least one month before delivery is expected; the leaves of a certain plant, tightly rolled, are inserted into the os, moistened by the uterine secretion they distend, and when fully dilated a thicker roll is introduced. They are to act upon the principle of laminaria or sponge tent, slowly dilating the mouth of the womb and making labor more speedy and less painful.

A very pretty idea exists among the Pahutes with regard to the coming of the child; they recognize the approaching time for the addition to their household and tribe, and seek to make preparation for the advent of the young stranger; that is to say, they endeavor to make his journey easy and expeditious with the least possible pain to the mother. Their ideas are crude and fallacious, yet to them sufficiently convincing to be universally practiced. They consider the sojourn of the off-spring

in utero as a voluntary matter, and after a given length of time, say nine moons or the lapse of certain seasons of the year, the child is to be starved out of its maternal quarters as a wood-chuck or other game is to be forced out of its hiding place; hence, for weeks before the expected event a fast begins with the mother, which becomes almost absolute as the time approaches, so that by the end of the allotted period of gestation the fetus will not only be ready, but anxious to come to the world in order to reach the supply of milk which the mother has now in waiting for the child starved in the womb. They of course act on the presumption that the child is nourished by ingestion from the mother. But another reason or object they have in view is, that this treatment, this fasting, reduces the maternal tissue over the genital organs and thus opens a wider door for the exit of the fetus. After this preparation, when labor has actually begun, they regard its phenomena as due to voluntary efforts on the part of the child to leave its inhospitable quarters for exterior life, and everything in their rude philosophy is done to facilitate and help the little fellow along on his journey.

Similar ideas prevail among other peoples as well, and it seems innate to natural man to accord a certain independence to the fetus while in the womb of the mother, and that according to his own will he takes his position in utero and leaves it when he chooses.

The Chinese believe that pregnancy can last two or three years, because the child does not wish to leave the womb; and even in a legal Mussulman treatise it is stated that the maximum term of gestation may attain four or five years. Like the Pahutes, the Chinese lay great stress upon the voluntary action of the child in his departure from the womb; thus the parturient is advised to remain quiet, especially not to lie upon her belly before the head presses upon the perineum; the belief being that the fetus executes every movement voluntarily and by his own force, and every motion of the mother, especially every compression, interferes. A foot presentation is attributed to the fact that the mother has turned upon her belly before the child commenced to make his escape; shoulder and other presentations,

to the fact that the woman has turned upon her belly during the escape.

Even in France the time is not long passed when the voluntary motions of the fetus were spoken of, and when the cause of labor pains and expulsion of the child was looked for in the desire of the fetus to change its condition of life. —(Corre.)

Here and there we find peculiar customs with which the initiation of labor is greeted; in certain Persian villages when the woman feels the first pain the schoolmaster is asked to excuse the scholars, and birds held in cages until then are freed—apparently to afford quiet to the sufferer.

In Morocco five little boys are taken from school and are sent to run through the streets holding a cloth, in the corners of which four eggs are attached, and upon which grown people spit and throw bottles; finally they all come together with kettles and pans, and make a terrible noise to frighten the devil and the bad spirits.—(Corre.)

This is not unlike the noise the Indian medicine man makes in his tent, or the negro relatives about the lying-in couch, to deaden the cries of the patient.

LABOR.

Among primitive people, still natural in their habits and living under conditions which favor the healthy development of their physical organization, labor may be characterized as short and easy, accompanied by few accidents and followed by little or no prostration; the squaw of the Modoc Indians —a tribe which has been but little affected by the advance of civilization—suffers but an hour or even less in the agony of childbirth; the Sioux, the Kootenais, and the Santees are somewhat longer in labor, not, however, over two or three hours; two hours being about the average time among the North American Indians. The period of suffering is very much the same among the natives of Africa and of Southern India, the inhabitants of the Antilles and the Caribbees, of the Andaman and the Australian islands, and other savage people.

What little fear exists as to the occurrence of this event, which is so much dreaded by many of our delicately constituted ladies, may be judged from the instances of speedy and unexpected delivery so often related by those in contact with

the Indians. Dr. Faulkner, who spent some years among the Sioux tribes, tells me that he has known a squaw to go for a pack of wood in mid-winter, have a child while gone, wrap it up, place it on the wood and bring both to the lodge, miles distant, without injury. Dr. Choquette says, that two or three years ago, an Indian party of Flat Heads and Kootenais, men, women, and children, set out for a hunting trip; on a severely cold winter's day, one of the women, allowing the party to proceed, dismounted from her horse, spread an old buffalo robe upon the snow, and gave birth to a child which was immediately followed by the placenta. Having attended to everything as well as the circumstances permitted, she wrapped up the young one in a blanket, mounted her horse, and overtook the party before they had noticed her absence.

It seems to be an equally easy process among all people who live in a perfectly natural state. As civilization is approached, the time of labor is more extended. The Mexican Indians, half-civilized, require three to four hours for delivery, and the same is true for all such tribes as are in closer contact with the whites, as well as of other half-civilized people. Accidents rarely occur; thus a physician tells me that during a residence of eight years among the Canadian Indians, he knew of no accident, and heard of no death in childbed. Another professional brother, who lived four years with the Oregon Indians, was not aware of any irregularity occurring in that time, nor was he ever called upon to perform a more serious operation than the rupture of the membranes.

This may be accounted for by the active life which women lead among these people; all the work is done by them, so that the frame and the muscular system are developed, and the fetus, by constant motion, may be said to be shaken into that position in which it best adapts itself to the maternal parts into the long diameter, and once in such a position it is held there by the firm walls of the maternal abdomen, and the birth becomes easy. Moreover, they do not marry out of their own tribe or race, and the head of the child is adapted to the pelvis of the mother through which it is to pass.

As soon as there is any deviation from these natural conditions, trouble results. Positive statements from several of the Indian tribes indisputably prove the truth of this rule; thus

many of the Umpqua squaws die in childbed with half-breed children, whose large-sized heads do not permit of their exit. The Umpqua mother will be easily delivered of an offspring from an Umpqua father, but the head and body of a half-breed child is apt to be too large to pass through her pelvis. Unquestionably this is the case also among other savage tribes.

We can then readily account for the rapid and easy delivery of savage women who live in a natural state, and the rarity of accidents from these facts: First, they marry only their kind, and thus the proportions of the child are suited to the parts of the mother; secondly, their more healthy condition and vigorous frames; while, thirdly, from the active life they lead, head or breech presentations result. Should this latter fact not occur, the mother is generally doomed, or at best, the labor is extremely prolonged and fatiguing. If the child lie transversely in the pelvis, it cannot be born, and death follows.

The nearer civilization is approached, the more trying does the ordeal of childbirth become, as in the case of the Umpquas just cited. I am told that among the women of the Green Bay Indian Agency many deaths take place, and yet a physician states that he does not know of monstrosities or deformed pelves, but attributes the misfortune to malpositions; a greater number of half-breeds is to be found among them, and the resulting disparity between the child and its mother may be a cause of the trouble; again it may be the less active lives which they are supposed to lead, and the consequent cross-births. Dr. Williams has observed that the Pawnees are more exempt from accidents than the Mnemonees, and inquires whether it is on account of the squatting posture assumed by the Pawnee women in labor; I should rather ascribe it to the more active life led by the Pawnees, and the less frequent intercourse of their squaws with the whites.

We see then certain differences and an increase of the difficulties of labor as civilization is neared. How different are the conditions upon which I have laid stress as existing among savage tribes, from those which we find in our centres of luxury! People intermarry regardless of difference in race or frame of body, and the consequence is the frequent disproportion between the head of the child and the pelvis of the

mother. In addition, the system suffers from the abuses of civilization, its dissipations, and the follies of fashion. On account of the idle life led, and the relaxed condition of the uterus and abdominal walls, there is a greater tendency to malpositions; additional difficulties are presented by the weakened organization, and the languid neurasthenic condition of the subjects in civilized communities. We do, however, sometimes find in our cities, more frequently in our rural districts, strong hardy women, who lead more active lives, and who pass through labor with an ease and rapidity much more like that displayed by their savage sisters.

I can hear but little of labor troubles from physicians who are in contact with our Indians, as they rarely have the opportunity of witnessing a confinement, it is only in the most desperate cases, and hardly then, that even the Agency Physician is called in, and Indians are extremely reticent upon such topics; but I should judge from the robust health and hardiness of their squaws that mishaps are few. The most serious accident which occurs is the shoulder presentation, and that must necessarily prove fatal. This rarity of accidents is most fortunate, since neither our own Indians nor other savage tribes have any means of meeting them, save incantations or the howling of the medicine men.

The Papagos and some other tribes seem to have a philosophical way of regarding accidents in labor; they think that the character of the fetus has a good deal to do in causing the obstruction, and the more severe the latter the worse the former; hence, they deem it better for mother, child, and tribe that the mother and child should perish, than that so villainous an offspring should be born and grow up to do injury to his people.

Rigidity of the perineum has been occasionally mentioned, and in a case of this kind among the Dakotas the attending squaw relieved her patient by inserting her open hands, placed palm to palm, within the vulva, and making forcible dilatation, an assistance which few other uneducated people seem to have the knowledge of rendering. No attention being paid to the perineum, rupture is probably frequent; I know this to be a fact only of the negroes of Loango, as the information gathered by travellers does not usually extend to these subjects.

The prolapse of an arm is managed, among the Nez-Percés, and undoubtedly among other tribes also, just as it is by some of our midwives, by pulling upon it, as they do upon any part which chances to present.

Prolapse of the uterus is not unusual in Mexico and quite frequent in the interior of Russia. The Sclavonians, for instance, who are not unlike some of our Indians, endeavor to shake the child out of the womb in cases of prolonged labor; the natural consequence is that both the child and placenta drop out, to be followed not unfrequently either by prolapse or inversion of the uterus. In Russia, these accidents are so common that people are always prepared to correct them; the poor sufferer is at once brought into the bath-room and stretched upon a slanting board, the feet higher than the head; then the board with the patient upon it is successively raised and lowered in order to shake the uterus back into the pelvis, precisely as one would shake a pillow into its cover.

Hemorrhage, of which I do not often hear, is treated in some instances by sousing the patient into the nearest stream, or rather more tenderly by the Santees, where the attendant gives the patient a shower-bath by filling the mouth with water and blowing it over the abdomen with as much force as possible until the flow of blood ceases.

Whatever may be their social condition, primitive people preserve a certain superstition as regards woman and the functions peculiar to her sex. In many tribes it is customary to set apart a hut or lodge to which the woman is banished during the period of the menstrual flow; so also the child-bearing woman, as a rule, seeks a quiet nook away from the camp, or if the habits of the people are more sedentary, she is confined in a separate lodge a short distance from the one occupied by the family. Sometimes a house is erected for this special purpose, common to the entire village. Again, if better situated, she may have a separate room in her own house, sacred for these occasions.

On the Sandwich Islands, on the contrary, the confinement is more public and the performance is witnessed by all who happen to be about. The same lack of privacy prevails among the Mohammedans of India, who are as careless of the privacy of their confinements as they are of their copulations.

The wilder tribes of Southern India allow female relatives and friends to crowd around the woman as do the Aborigines of the Andaman Islands. The Pahutes, the Brulé-Sioux, and the Umpquas conduct the labor in the family lodge, and the sympathizing as well as the curious crowd around at will. A very good idea of such a scene is given me by Dr. Ed. V. Vollum, Surgeon U. S. A., who attended the wife of an Umpqua chief. He states that he found the patient lying in a lodge, rudely constructed of lumber and driftwood; the place was packed to suffocation with women and men; the stifling odors that arose from their sweating bodies, combined with the smoke, made it impossible for him to remain in the apartment longer than a few moments at a time. The assembly was shouting and crying in the wildest manner, and crowding about the unfortunate sufferer, whose misery was greatly augmented by the apparent kindness of her friends. Not much better were the half-civilized Mexican inhabitants of Monte Rey in early days: but even in these cases where such publicity is permitted, men are, as a rule, excluded.

Commonly labor is conducted most privately and quietly; the Indian squaw is wont to steal off into the woods for her confinement. Alone or accompanied by a female relative or friend she leaves the village, as she feels the approach of labor, to seek some retired spot; upon the banks of a stream is the favorite place the world over, the vicinity of water, moving water, if possible, is sought, so that the young mother can bathe herself and her child and return to the village cleansed and purified when all is over. This is true of the Sioux, the Comanches, the Tonkawas, the Nez-Percés, the Apaches, the Cheyennes, and other of our Indian tribes.

In winter, a temporary shelter is erected in the vicinity of the family lodge by those who make the solitude of the forest their lying-in chamber in milder weather.

The Chippewas, as well as the Winnebagos, also follow this custom. The natives of the Caucasus, the Dombars and other tribes of Southern India, those of Ceram, the inhabitants of Loango, of Old Calabar, and many of the African races, are delivered in this quiet way, and the women are not only kept apart from their husbands and the villagers during their confinement, but for weeks afterwards. The reason why we know

so little of Indian labor is the great secrecy which they observe regarding such matters, and their extreme reluctance to speak to inquisitive whites of these subjects which are to them enshrouded in a veil of superstition and mystery.

Some of the Sioux tribes, the Blackfeet and the Uncapapas, are in the habit of arranging a separate lodge, generally a temporary one, for the occasion, as also do the Klamaths, the Utes, and others. The Comanches construct a shelter for parturient women a short distance outside of the camp and in the rear of the patient's family lodge. This is made of brush or bushes, six or seven feet high, stuck into the hard ground, the branches intertwining so as to form a circular shelter about eight feet in diameter, an entrance is provided by breaking the circle and overlapping the two unjoined ends. In

a line outside the entrance are placed three stakes made from the stems of small saplings with the bark left on, these are set ten paces apart and are four feet high. Inside the shelter are made two rectangular excavations in the soil, ten to eighteen inches in width, with a stake at the end of each. In one hole is placed a hot stone, in the other a little loose earth to receive any discharges from the bowels or the bladder. The ground is strewn with herbs. This is their usual mode of constructing a shelter when in camp, and at other seasons, when boughs fail them, pieces of cloth are used to cover up the gaps, or else the leafless brush is covered with skins; but on the march some natural protection is usually sought, or one is hastily extemporized out of robes with, perhaps, a lariat attached to the nearest tree for the woman to seize during the pains.

The Indians of the Uinta Valley Agency observe a similar custom. At the first indication of labor-pains, the parturient leaves the lodge occupied by her family, and a short distance from it erects for herself a small "wick-e-up,'' in which to remain during her confinement, first clearing the ground and making a slight excavation in which a fire is kindled; rocks are placed around the fire and heated, and a kettle of water is kept hot, from which copious draughts are frequently taken. The "wick-e-up'' is made as close as possible, to prevent exposure to changes of temperature, and to promote free perspiration. Assistance is given by squaws living in the neighborhood, but no particular one is chosen, nor is any medicine-man called in to render aid. In Ceram, a temporary hut is hastily built in the woods, and in some parts of the interior of Russia a separate house is provided, as among our own Indians; such is also the custom of the Samojedn. The Gurians make use of a special room in the house; the apartment set aside for this purpose has no flooring, but the ground is plentifully strewn with hay, upon which the bed is made; above this a rope is fastened to the ceiling for the woman to grasp when in pain. The usual and favorite place of confinement for the Laps and other polar tribes is the bath-room.

As the place of confinement varies, so does the couch upon which the labor occurs. Some care is devoted to its preparation by all people, even the Susruta, that ancient system of midwifery, tells us that "the parturient should lie on her back upon a carefully spread couch, that a pillow should be given her, the thighs should be flexed, and that she should be delivered by four aged and knowing midwives, whose nails were well trimmed.''

The women of ancient Greece were delivered upon stools; the large arm-chair is still at home in the East, while in Syria a rocking obstetrical chair is used. The Kootenais employ a box covered with buffalo robes; the Sandwich Islanders, a stone; and certain of the tribes of Finns and Mongols, as well as many of our Caucasian race, look upon the lap of the husband as the best obstetrical couch. Many of our Indians use nothing but the bare ground, others a buffalo robe or old

blanket spread upon the floor of the tepee, or else some dried grass and weeds; in one way or other, however, they make a soft and comfortable couch upon the ground. A common method is to place a layer of earth beneath the buffalo robe upon which they are confined. Thus F. F. Gerard tells me that the Rees, the Gros-Ventres, and the Mandans, lay a large piece of skin on the ground, over which is strewn a layer of earth three to four inches deep, and upon this is spread the blanket or skin on which the parturient kneels.

The Japanese make their preparations for the coming event in the seventh month, so as to be sure of being in time. The bed which they then provide consists of a mat of straw about three feet square, on which is spread a layer of cotton or cloth. This simple arrangement upon which the patient is to be delivered is then set aside to be available at any emergency.

The above figure represents this mat, together with the mattress upon which it is laid, and the cushions used to support the back during the puerperal state. I need enter no further into this subject, as I have frequently referred to it, and have treated of it fully in my paper on Posture.

With regard to the assistants who aid the parturient woman, there is some difference in the customs of the various races. In many cases she has no help of any kind. As a rule, the assistants, if any, are females, relatives, or neighbors, and the

aid they give the sufferer is about the same as that which is too commonly obtained by her more civilized sisters, the world over, often worse than none at all. Occasionally they have professional midwives, whose qualifications depend chiefly upon their age or the number of children they have borne. In case that the patient is a lady of quality, the wife perhaps of a chief, or if the labor prove a very difficult one, the prophet or medicine man is summoned. The physician is mistrusted and is only consulted in the most desperate cases; the medicine man is aware that the forceps of his white brother are more efficacious than the rattling of the tum-tum, and, actuated by that same professional jealousy which is occasionally observed in more civilized communities, ho uses his influence to malign the stranger, and glorify himself.

In Siam and in Ceram, in parts of Africa and South America, among the Indians of Canada and some of our own—the Tonkawas, the Cheyennes and allied tribes, the Arrapahoes, and the Cattaraugus, there is no class corresponding to our midwives, and the patient has no help whatsoever; but usually relatives and friends aid each other, or there is some assistance rendered by the habitual old woman. This is true of the savage tribes of the vast Russian empire; each village or settlement has an old crone who possesses the power of second sight, and by this gift and other similar means drives away disease; but above all haunts the lying-in room, where she causes much harm to both mother and child by her rude and ill-timed manipulations. Other tribes have their particular old women, who, for various reasons, are supposed to be specially skilled. Thus the Navajos and the Nez-Percés have their sages femmes, and in Mexico there are midwives who are acquainted with medicinal herbs and their properties. The Indians of the Quapaw Agency, those in some parts of Mexico, and many of the Pueblos have women who make this a specialty. So also the Klatsops, the Klamath, the Rees, the Gros-Ventres, and the Mandans.

Whenever a midwife or some other old woman assists the progress of labor, one or more younger women are always on hand to perform the actual work, whilst the midwife sits in front of her charge to receive the child. In Syria, the assistant is an old woman who learned her trade by practicing with

her mother who was a midwife before her; it is necessary for a woman there to practice for a long time before she thoroughly gains the confidence of the people. We find midwives also in Japan, in parts of India, where in ancient times only women assisted the parturient, whilst in ancient Egypt difficult cases were attended by surgeons specially skilled in midwifery, as it will be remembered that they had their specialists as well as we of the present day. Susruta speaks of midwives attending his patient, and the mention of midwives in Exodus i. 19 implies that these good women were as unskillful thirty-five centuries ago as they can still be found at the present day. From all that we have seen it appears that the Yi of India, the Dye of Syria, the herb-knowing hag of Mexico, and the midwife of the Bible are very much the same in their habits, their qualifications, and their knowledge. It is the same habitual old woman who figures in all countries and at all times, and with whose peculiar qualifications we are quite familiar. In cases where the midwife is at a loss, the aid of the medicine man is sought. The Baschkirs rely upon their "devil-seer'' who discovers the presence of the evil spirit and drives him away if rewarded by the present of a sum of money or a fat sheep. Among others a priest is called who hastily mumbles a few verses of the Koran, spits into the patient's face, and leaves the rest to nature.

The assistance which is rendered to the parturient woman is very simple and consists entirely of external manipulations, support of the patient in whatever position she may be confined, together with compression of the abdomen for the purpose of expressing the child: in addition to this, the incantations of the medicine men as well as other means, by which they endeavor to act upon the imagination of the patient, must not be forgotten. How little actual help the lying-in women receives, and how limited is their knowledge of correcting malposition or other of the accidents of labor, will be readily perceived if we state that but few of those primitive people, whose habits we have so far considered, ever manipulate within the vagina. I have positive statements to this effect from the Indians of the Pacific coast, the Umpquas, the Pueblos, as well as the natives of Mexico. The introduction of the hand into the vagina or into the uterus for any definite purpose is a manipulation

unknown to the natives of other countries as well. At least I never see it referred to unless it be in a few instances for the purpose of distending the perineum or of removing the placenta from the vagina, which must remain if retained in utero. The midwife or older woman in attendance, as we have seen, usually receives the child, whilst the younger women support the patient, steadying the pelvis, resting her head and shoulders, and holding her arms and legs according to the position which she assumes. The younger women also compress the abdomen and rub the body wherever directed. The most reasonable of all their means of assisting the patient in her labor is the steady compression of the abdomen and the following down of the child in its descent. This is a feature common to the red, yellow, and black races, be it by compression of the fundus, by the encircling arms of the husband upon whose lap the patient rests; be it by the hands of one of the female assistants sometimes from behind, sometimes from the front; or by a broad cloth or binder (California Indians and the natives of Southern India) which an assistant tightens during each pain—a treatment which has not yet lost the favor of obstetricians and was once quite popular. There are some who still place a towel about the abdomen of their patients, thinking to assist the descent of the child by the pressure exercised; it serves both to correct the direction of the child's descent and to hasten its passage. In its extreme and worst feature we see this method of treatment exemplified by the Siamese who seek to force the expulsion of the fetus in difficult cases by permitting the attendant to trample upon the abdomen of the patient who is lying prone upon her back.

All primitive people resort to expression in one way or another. The Finns, in tedious cases, compress the abdomen by a belt or binder of some kind or by holding the patient up, suspended, and shaking her as they would a pillow out of its case—a proceeding which is more efficient than mild, and serves as a last resort to the natives of Mexico as well as other far distant people. In Syria, some effort is made to support the perineum in the same manner as is usual with us. In Mexico, as I have already said, they seek to overcome the tension by the introduction of the hands, and in India the parts are carefully anointed, as it is done by some of our Western

tribes. The description of an Indian labor, as given me by Dr. McCoy from his experience at the Nisqually agency, will give an excellent idea of the assistance which is tendered the Indian woman in her confinement. "The midwives, of whom there are two in attendance, call upon the Great Spirit for help in a muttering tone, and in the same tones name over the parts immediately connected with the parturient effort, and often all the joints and limbs of the body. By applying their hands to the abdominal walls they try to ascertain the position of the fetus in utero and usually to correct malpresentation. They use oil to anoint the parts, and just before the expulsion of the child give medicines to increase the pains.''

Somewhat similar was the experience of Dr. Shortt among the natives of Southern India. He says: "When the woman is taken with labor pains, her relatives and family friends come in and crowd around the sufferer, who is directed to walk about. The midwife, an old woman of experience, rubs her with oil and bathes her back, loins, and lower extremities in warm water; if the pains are false, the woman may partake of food, but after the commencement of labor nothing is given. She is made to sit with her legs extended, one assistant supporting her back, whilst the nurse shampoos back and loins, and her friends keep up a constant noise by talking. Prior to the rupture of the membranes, the nurse places a bag filled with ashes under the perineum as a support and to prevent the clothes being stained. The pelvis and abdomen are rubbed with a limpid oil and shaken several times to promote delivery. The membranes are not ruptured; this is left to nature; when the head protrudes the nurse supports it with her hands and directs the woman to lie on her back.''

Little is known to these people of the assistance given by the abdominal muscles, a help which has been recognized even in ancient times and so judiciously advocated by Susruta, who limits the efforts of the patient to the expulsive pains and advises more or less use of the abdominal muscles according to the progress made by the head of the child. The influence of the emotions is, however, thoroughly recognized, as is evident by the incantations to which the prophets of the tribe resort. In Russia, in India, and America, a sudden shock is often made use of and proves a

wonderful help in hastening the expulsion of the child; it is appreciated as such by the Kalmucks who always have a number of men, with their guns in readiness, waiting near the bed of the patient; as soon as the midwife perceives the head distending the perineum she signals the men who fire simultaneously, thinking to assist nature by the sudden fright which the noise must cause. A similar practice is occasionally resorted to among the Comanches, and Dr. Forwood, who attended a Comanche squaw in a difficult labor, told me that at a former confinement of the same patient, a practical application had been made of the effect of fright. She was brought out on the plain and Essehaby, a noted warrior, mounted on his fleetest 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 terrible ordeal is said to have been followed by the immediate expulsion of the child.

Besides the incantations which are customary as a last resort in difficult cases, there are a great many ridiculous superstitions in regard to labor, and much nonsense is practiced with the view of making labor easy. Thus in the middle ages the stars were consulted. Some of the most northern of the Russian tribes think to make labor easy by obliging the parturient to give the names of such men, besides her husband, with whom she has cohabited, and he, by a messenger, informs the midwife of his own misdeeds in that direction. Should the labor prove a difficult one, notwithstanding this important proceeding, it is ascribed to a false statement on the part of husband or wife. The Finns kill a chicken and hold the animal struggling in the agony of death before the pudenda of the mother. Another custom of theirs is to ply the husband with beer, mixed with Ledum palustre, upon the eve of his wedding day, in order to produce deep sleep, during which the wife crawls through between the husband's legs without his noticing it. But no more of this. All of these various superstitions are equally as efficacious as the incantations of the Klamath squaw who tells the child, as she anxiously watches the progress of the labor, that a rattlesnake was coming to bite it, if it does not hurry into the world and leave its present abode.

Although most savage tribes have roots and herbs to which

they resort in various diseases, they rarely seem to make use of them during labor. We have just seen that the Indians of Washington Territory give some medicine just before the expulsion of the child, and that Uva ursi is used by others. The tribes of Russia use a decoction of Artemesia vulgaris to increase the pain; in the same way Achillea millefolium is used, and this latter is universally resorted to in all uterine troubles. In the government Riäsan, Comarum palustre is used. The Esthonians give the patient a decoction of valerian with beer. Those who have no medicines, or cannot afford them, in the interior of Russia, let the patient blow with all her force into an empty bottle, or place a vessel or pot, like a surgical cup, upon the abdomen, or they make the poor woman swallow some ashes or a few lice in place of other medicine.

We have seen that the Indians of the Uinta Valley Agency drink a good deal of hot water during labor. The Crow Indians of Montana drink tea made of various roots and leaves, the kind preferred being made from the root of a plant called E-say, said to resemble the tobacco plant, with a root about as large as a turnip. Small quantities of whiskey are also frequently given during labor, and so much importance is attached to this that any price will be paid for a pint or two which is frequently carried about for months before it is to be used. The Winnebagos and Chippewas give the patient, just before the delivery of the child, a drink from a root steeped in hot water which is supposed to relax the system and make delivery quick and easy. The Indians of the Skokomish agency use a tea made from the leaves of Uva ursi which they believe from their own experience to possess oxytocic properties. In India, it is considered very dangerous for the patient to drink water during labor. In ancient Mexico, a decoction of the root of a plant called civapacthi, which possessed some oxytocic properties, was given, but if the pains were too severe, a small piece of the tail of an opossum, carefully rubbed down in water, had to be taken. However ridiculous this may seem, it is not more so than a prescription given by the court physician in Siam to a lady of high rank at the time of her confinement: "Rub together shavings of sapan wood, rhinoceros blood, tiger's milk (a fresh deposit found on certain leaves in the forest), and cast-off skins of spiders.'' The Sandwich Islanders

drink freely, before confinement, from a mucilage prepared from the inner bark of the halo or hibiscus tree. Susruta advises the parturient to drink quantities of sour rice gruel. In southern India, it is still customary to take some food in the early stages of labor, but as soon as the pains distinctly set in, no more is permitted. Where labor is so short, there is little opportunity to take food, hence little can be said of the customs of primitive people during labor in this respect.

Whatever villianous decoctions the lying-in woman may be obliged to take, her labor, as we have seen, is, as a rule, an easy one, and if we consider in connection with this the stoic character of the Indian, we will not be astonished that during the throes of labor the mother is usually dumb and patient, and willing that the child should inflict any pain to accomplish the delivery. Although comparatively quiet, at the recurrence of each pain the parturient woman will frequently utter a plaintive cry, and in this she differs somewhat from her white sister; the latter will most frequently announce the occurrence of pain by a sound which by the old women has been determined "grunt,'' the former gives vent to a low plaintive cry, best expressed perhaps, by the words "wail'' or "whine.'' but sometimes the Indian squaw gets noisy and restless in her suffering, and a description which is given of a laboring woman in the days of the ancient Hebrews, some thirty-five centuries ago, appears much more natural to us and is much more in accord with the sufferings which we suppose a woman to undergo. It is said of the parturient that "she trembles and writhes in her pain'' (1 Sam. iv. 19). Her face is all aglow, she sees and bears nothing in her anxiety, especially the primipara cries out aloud and says, with extended hands, "Woe unto me, for my soul succumbs to the murderers'' (Gen. iii. 16). And for men there seems to be no greater threat than "the heroes of Moab will upon that day show a bravery equal to that of a woman in labor pains''[1] (Jer. xlviii. 41; xlix. 29).

CHILDBED.

As I have treated fully of the third stage of labor in my last paper, I shall in no way here refer to it, but will at once pass to the consideration of the puerperal stage, and as so

little attention is paid to the treatment of the patient during that period, I shall confine myself to the treatment immediately after delivery, as she is then for a few moments still under the control of the midwife or attendant, and something is always done before she is permitted to go to her home or her place of retirement through the period of uncleanliness that follows.

Among the Apaches, it is deemed very essential that, as soon as the placenta is expelled, the woman should be kept on her feet, walking about for half an hour or more, so as to favor a free discharge of all retained blood and prevent its coagulation in the womb. The same custom is observed among the Dakotas, among the Flat-Heads, Pend-d'oreilles, Kootenais, and among other of the Indians of the Pacific coast, and wherever it is not especially mentioned I should suppose that the custom was at least unconsciously observed, because it is rarely the case that the Indian squaw remains abed after her confinement; she certainly moves about sufficiently to accomplish the end desired, even if it is not done with the purpose definitely in view. It will be remembered that upon the banks of a stream was the place usually sought by the laboring woman among primitive people the world over for her solitary confinement; delivered of her child she bathes in the cleansing waters—this is done by most of our Indians, by some of the natives of Africa, the inhabitants of Ceram, the still savage tribe of the Yurakere, by the natives of Bolivia, the Sandwich Islands, the Antilles, and of India. It is everywhere the same; the mother, usually with her babe in her arms, plunges into the stream to cleanse herself; or, if the labor is conducted by a midwife, she leads the patient to the water where she is washed secundem artem, redressed, and then allowed to return to her place of seclusion or to her home, and very frequently to work, according to the varying customs among different tribes.

Among many of the tribes of the Sclavonians, several buckets of warm water are poured over the patient's abdomen; the Klamaths steam themselves—a custom which they continue for several days after delivery. The Pahutes also continue their ablutions frequently for days after confinement, mother and father both indulging in frequent washings in imitation of some original first parents,

whom tradition informs them were very cleanly. The Siamese cleanse themselves with still greater thoroughness, but with fire instead of water; "with the expulsion of the child begins a month of penance for the mother—exposure to true purgatorial fires. It is ingrown into the native female mind in Siam that the most direful consequences to both mother and child will ensue, unless for thirty days after the birth of her first child—a period diminished five days at each subsequent birth —she exposes her naked abdomen and back to the heat of a blazing fire, not two feet distant from her, kept up incessantly day and night. They think the due quantity, quality, and duration of the lochial discharge depends on their exposure to the fire. And this is done in the following way: A fire place is brought in or extemporized on the floor of the lying-in chamber, by having a flat box or a simple rectangular framework of planks or trunks of banana trees, some three feet by four, filled in with earth to the depth of six inches. On this the fire is built with sticks of wood nearly or quite as large as one's wrists. By the side of this oblong frame, and in contact with it, raised to a level with the fire, a piece of board six or seven feet in length is placed, and on this a coarse mat spread; upon this, or on the bare plank itself the unfortunate woman lies quite nude, save with a narrow strip of cloth about her hips; with nothing else to secure her from a fire hot enough to roast a duck. Then, acting as her own turnspit, she exposes front and back to this excessive heat—an experience not to be coveted in any land, but in that burning clime of perpetual summer a fiery trial indeed. The husband or nurse is ever hard by, like her evil genius, to stir up and replenish the fire by night and by day. True, if it blazes up too fiercely for flesh and blood to endure, there is at hand a basin containing water and a small mop with which to sprinkle it on the flames and keep them in check; hot water alone is allowed to quench the patient's thirst. Those whom lack of merit causes to die in childbirth are buried, not cremated as is the rule with nearly all others who die in Siam. It is a custom almost universal on the entire peninsula of Indo-China and Bangkok; not only the Siamese, but the Laos, Burmese, Malays, and others practice it. The women of the Combodians improve upon the experience of those of other nationalities, for they place their couch of repose, the bench of bamboo slats on which they lie, not alongside of, but actually directly over the fire, so that the smoke and heat ascending do their full work, and they see their thirty days and nights drag slowly along, broiling on this Montezuma bed of misery The Mohammedan Malays are as observant of this custom as are the Buddhist Siamese, so that it does not seem to be of religious origin. Sir John Bowing suggests there may be some vague idea of pacification or purification connected with it (certainly purification). There is one compensation to offset the mischievous consequences of this practice: it makes the woman of that land escape the evils that result in other countries so often from resuming household duties too soon after the birth of the child. The Siamese mother is guaranteed by this custom one month at least the fullest liberty and undisturbed rest by her own fireside.''[2]

The Binder, which is now gradually passing away among civilized people, has its representative among some of the savage races: the squaw belt is used among most of the Sioux tribes, and is applied by them during confinement, either before the expulsion of the child or before the expulsion of the placenta, and is worn until the next day. It is a leather belt about four inches wide with three buckles. The Kiowas, Comanches and Wichitas use a broad bandage of buckskin, ornamented with beads, which they buckle tightly around the abdomen of the mother immediately after the completion of labor, and this bandage is thus worn for about a month. Some of the Sioux tribes use a broader belt, with a compress underneath, which is worn for a length of time. The Klatsops also make use of a squaw belt, retaining it as long as convenient to the wearer. Of some of our Indians, especially the Yumas, I am expressly told that they wear no bandage; and in old Calabar a handkerchief simply is tied around the abdomen and twisted so as to make it more like a cincture than a bandage; it is placed right over the hard contracting womb. In Syria the regular broad bandage is worn.

With regard to the time of the puerperium, or the time of rest which is given the woman in childbed, there is a greater

variation among the customs of the different tribes and people than in almost any other feature of that great physiological function of woman. Some observe no period of rest, but resume their ordinary occupation as soon as they have had their plunge in the water after the birth of the child. But among many people there is a certain time of rest and isolation which is governed more particularly by their religious beliefs of their uncleanliness; and very likely some wise law-giver infused this idea into the unwritten laws of the people, with the view of necessitating a period of rest for the young mother. We find this custom as far back as we have record, and it seems that in the period of seven and of thirty days the two periods of childbed are exemplified, first that of the lochia rubra, and secondly that of the lochia alba. With regard to the first period the puerpera should be as unclean during the time of the bloody flow as she is during the menstrual flow, and this period after the birth of a male child is fixed at seven days, but after the birth of a female at two weeks.[3]

Similar beliefs existed among many ancient people: in Athens the puerpera was considered unclean, and whoever touched her was forbidden to visit an altar; even the midwife who was present at the confinement was obliged to perform a religious cleansing of her hands at the feast of the Amphidromies, when the new-born child was carried about the family altar. When the Isle of Delos was to be made a sacred island it was forbidden that a confinement should take place within its shores.

It is evident enough why the ancient Israelites considered the puerpera unclean during the first days after childbirth, but it seems difficult to explain why this uncleanliness should have lasted seven days after the birth of a male and fourteen after that of a female child. Kotelman believes that it was because the female sex was considered the weaker, the most despised, and the one which would cause the most uncleanliness. It is remarkable that among the Greeks the same idea was prevalent.

In the second period, during the white flow, the puerpera was obliged to remain at home for thirty-three days for a boy and sixty-six days for a girl baby, but was no longer considered

unclean. We have already seen that some of our Indians seek to cleanse and purify themselves by frequent steaming, others by washing, and the Siamese by a purification of fire through a period of thirty days, which is diminished by five days for each succeeding child. According to other statements, and possibly in other parts of Siam, seven days of this fiery ordeal suffice to purify the unfortunate woman. Among the Kalmucks, a woman is regarded as unclean for three weeks after delivery, but never is she permitted to remain on her bed longer than seven days. The northern tribes of Russia, the Samojedes and others, consider the puerpera unclean for several months after confinement; her husband is very careful not to approach her, and she remains in her hut isolated, often very badly taken care of, so much so that mother and child may succumb to this neglect; only after the expiration of two months is she herself, and the tent in which the confinement took place, thoroughly smoked, and from that time on considered as clean. Ten days is the period of uncleanliness among the tribes of Alaska. In Egypt, those who are in easy circumstances remain abed for three to six days, but poor women resume their ordinary occupations, if not severe, in a day or two; in Syria, a rest of about six days in bed is permitted. In Japan, the puerpera is not placed in the usual recumbent position, but sits propped up by pillows, the mat upon which she was confined being left in place. In this upright position the woman remains for about three days, when gradually the prop behind is removed, till finally she is lying with her head on a high pillow, and at the end of three weeks she gets up and the customary congratulatory feast is given to the relations of the family. Another authority states that the patient retains the recumbent position until the twenty-first day, and then, if all has gone well, takes a bath and resumes her duties. The Yenadies of Southern India ordain a period of isolation of ten days, after which the mother returns to her household and its duties. The same is true of the Vedas, also of Southern India; the first five days after confinement are spent by the puerpera in a hut within call of the Konan, together with mother and sister or assistants; on the sixth day, she is moved to a shelter nearer to the Konan, in which she remains isolated for another five days. After the tenth day she washes with warm water and turmeric, anointing herself with oil; washing is continued for one month, when she resumes work. Dr. Shortt makes a similar report of other tribes of Southern India; he says that the woman lives in strict seclusion in a small lodge ten or twelve paces from the family home for thirty days after childbirth, frequently washing; before joining the others she has to wash all her clothes and undergo a general purification.

The Wakamba of Africa put their parturient to work four to six days after confinement. The Wazegua alone permit the woman to rest abed for fourteen days. Most of these tribes also purify by washing with hot water. The Abyssinians and the Somali use slack lime. The women of the Waswaheli sometimes insert the juice of a lemon into the vagina to hasten contraction. The Wakamba ordain a coitus about the third day, and after this the puerpera is considered clean. Among some of the African tribes the women carry an ebony staff for forty days after confinement, for the purpose of keeping off the devil.

The North American Indians seem to be less careful of their women. I am positively informed of the Sioux, the Santees, the Apaches, the Indians of the Neah-Bay Agency, as well as the natives of Ceram and of the Antilles, and the Yuricaria of Bolivia, that they practically observe no period of childbed, but go to work upon the same day or the day after that of their confinement. Other of our Indian tribes observe a certain period of rest; those of the Uinta valley take up their abode in the "wick-e-up'' in which they are confined, and return to the lodge occupied by the family after from two to four weeks, and during this period they are considered to a certain extent unclean. The women of the Laguna Pueblo remain unwashed and in bed for four days; very early on the fifth the puerpera is washed and dressed under the superintendence of a Sheaine or priest, who walks out, followed by the women, to see the sun rise and to render thanks for her safe delivery. As she walks after the Sheaine she throws corn blossoms into the air and blows them around as an offering of thanks. Thirty days after the child is born, the woman is clean and her husband returns to her, but some prefer to wait thirty-six, and others forty days. A good many

of these Indians, however, have abandoned the fifth-day superstition, the sun worship, and are cleaned or washed at once and get up as soon as they feel able to go about their work. The native Mexican woman remains abed three days; on the third day she gets up and for the first time since her confinement changes her clothing. The lochial discharge is usually abundant and continues for a long time, seldom less than forty days. At any rate it is only after a period of forty days that the woman ventures to bathe herself. After that she drinks freely of a decoction of some native plant for the purpose of increasing the discharge and bringing it to a speedy close.

Very little or no attention is paid to the food which women receive after childbirth, yet some tribes make a reasonable change in their diet. The Kalmucks feed the puerpera mainly on broth during the first days, giving her but very little mutton, the quantity of meat being gradually increased. Among other of the Russian tribes, as I have already stated, the isolation of the patient is so complete that she is but scantily nourished and glad to get anything she can, and often, together with her offspring, suffers actual want. In Syria, mutton or chicken broth is given on the first and second days, then carminative drinks, cinnamon tea and so on, for six days, after which the quantity of food is gradually increased. In Old Calabar, the patient is allowed a pot full of chop, which her husband has prepared during the labor, to be given her, and she is expected to eat a quantity of it immediately after confinement. In southern India, the natives seem to pay greater attention to the diet of the puerperal woman than in almost any other country. Certain of the native tribes live for three days after delivery on the tender leaf bud or cabbage of a kind of date palm, Phœnix sylvestris, after which rice or other food, to which they are accustomed, is partaken of. The Domber give her plain rice on the first day, and on the second chillie powder and curry-pillay is mixed with the rice. Among the Kanikars the puerpera receives as a tonic for the first day a kari (ragout) seasoned with turmeric pepper and tamarind.

The negroes of Africa, as a rule, make very little change. The Waswaheli and Nyassa give the puerpera food highly seasoned with Cayenne pepper and other spices. The Wakamba, like the natives of the Andaman islands, make

almost no change. The same I may say of our own Indians, with the exception of the Yumas, of whom I see it stated that the puerpera and the murderer are treated to the same diet; neither are allowed to eat either meat or salt for one month, for the purpose of purification. The Basuthos treat the patient cruelly in refusing her water for three days after confinement, the idea being probably the fear of too great a quantity of milk oppressing the breast. The Loango woman drinks quantities of hot water for several months in order to increase the flow of milk, and she also washes herself with a decoction of the leaves of Ricinus communis. With leaves of the same plant steeped in water, the genitals are rubbed and cleansed until the secretion ceases. The young mother, moreover, takes a great many baths in some secluded spot in a slight excavation made in the ground and laid out with mats, where cold and hot water is alternately poured over her and the body is kneaded, rubbed, and anointed.

Of the medicines used in the puerperal condition, I can only learn that in Mexico teas from native herbs are given to increase the discharge of the lochia; the same is accomplished in southern India by the use of saffron and neem leaves. In Syria, carminative drinks are given. In Siam, hot water has eased the thirst produced by the parching fire; whilst in Africa it is given to increase the flow of milk. Among the natives of Russia many of the stronger and more aromatic herbs are used in the various diseases, and many methods of treatment are resorted to in mammary affections, which seem to be very common in the puerperal state, as the remedies are so numerous. I will mention but one, on account of its peculiarity. In case of hardening of the breast, the patient places herself in front of the heated stove in order to warm the diseased part as thoroughly as possible. In the mean time some other person heats a woollen sock, which has been moistened with the urine of the patient, places it as hot as it can be borne upon her breast and attempts to keep the breast as well as the sock hot and moistened with urine; then some iron utensil, a knife or horse-shoe, chilled in ice, is placed upon the affected breast. The hotter and more moist the breast is, and the colder the iron, the more certainly will the cure be effected. I will not refer to any of the ceremonies which are here and there observed,

either upon the birth of the child, especially if a male, or upon the return of the mother from her isolated state, when cleansed and purified, to her home and her family, but will simply call attention to a remarkable feature common to the natives of the coast of Borneo and to some of our Indians. For instance, among the land Dayokas of Borneo the husband is always treated badly after the birth of the child, when he is dieted on rice and salt, and for a few days forbidden to bathe or show his face out of doors; whilst among some of our Indian tribes the father, after calling his relations and friends together and having a feast of boiled dog and other Indian delicacies spread for them, goes off and cachés himself until the child is a week old. This practice, however, is only observed by the young men who are so ashamed of the occurrence that they go to some friend and stay until they summon sufficient courage to come back, when the wife presents the child for the first time to its father. The management of the puerperal stage by the Indians of the Pacific coast has been so well described by Dr. J. Fields, formerly of the Grand Ronde Agency, Oregon, that I will quote verbatim that part of his letter referring to this subject. He says:

"The treatment resorted to is not alike in all the tribes; some with whom I have come in contact require the woman to keep on her feet the greater part of the day, taking short walks around the camp and resting only when she becomes very weary; as a support she uses a staff, an instrument through the aid of which relief comes, as the body is frequently bent forward which brings the abdominal walls immediately over the uterus against the upper end of the stick, on which she also holds her hand, as a man walks with a cane; for a period of three or four days the woman continues the prescribed walks, with an occasional hour in a reclining posture to rest her feet; then she is considered well. The object of this, as old women of the tribe informed me, is to facilitate the flow of the lochia; they think that should the woman lie in bed the blood would accumulate in the abdominal cavity and she must die.

From all I can learn about the practice of the Indians here before the white men came among them, their procedure in the after-treatment was solely for the purpose of encouraging a

free flow of the lochia, and I hear of no death from hemorrhage.

Those tribes of Indians on the Pacific coast who follow a different course of treatment, place the woman on a bed as soon after delivery as possible, securely wrap her in a blanket or some covering, and place her near the fire, where she is kept in a closely wrapped condition to escape taking cold and having fever; here she is kept for four or five days, when she at once takes charge of the babe and resumes all the duties that fall to the lot of an Indian woman.

During two and a half years' life among the Indians I neither saw nor heard of a case of puerperal fever, puerperal eclampsia or any diseases peculiar to lying-in women. Neither did a death in labor come under my observation; few women have any mammary trouble, notwithstanding their being exposed to the same cause that is a prolific source of mammary complication among white women.''

The absence of mammary trouble, as observed by Dr. Field among the Indians of the Pacific coast, is true of most peoples living in a comparatively natural state, as the chest is either exposed or only loosely draped, so that the gland is not irritated by closely fitting garments; on the contrary, it is hardened by exposure, the muscular and glandular system is strengthened, or rather allowed to develop naturally; the shape of the breast is not artificially altered, and no artificial support is given it, but the muscles are allowed to perform their functions, which is the case among civilized women only during the period of nursing, when the weakened, atrophied fibres are at once called upon to perform this service in case of a temporary hypertrophied gland, which was never asked of them under ordinary circumstances.

All parts of the organ remain more fully developed and more hardy, less liable to inflammation than among those races accustomed to the laces, straps and stays of civilization and fashion.

Among some of these people peculiarly situated, such as the Arabs (Corré), fissure of the nipples is said to be frequent, owing to a lack of care of the breasts and exposure to external violence, perhaps to the irritating sands of the desert: the usual consequences follow—inflammation, induration, and

even degeneration of the gland. They treat the fissure with a fine powder of henna, or by alum powder; in the Moorish villages a few drops of orange flower essence are added to this.

Corré observes a fact, well known in this Mississippi Valley, that the breasts in lactation, just as the uterus in its condition of activity in pregnancy and in the puerperium can, allow a local center for malarial irritation; malaria is as much at home in the vast valleys and deltas of the great rivers of Asia and Africa as it is in our own Mississippi, and milk fevers with malarial types are frequently observed, and yield as readily to quinine among the Negroes, Hindoos or Arabs as among our own people.

As our civilization suffers in comparison with the primitive state in so many of the features of generation, so it does in the nursing of the new-born. One sentence in La Mere et l'Enfant tersely states a very sore point; he truly says: "Among all people except the most civilized the mother's milk is considered the proper nourishment for the children.''

The husband, at all other times the lord and master, is placed in rather a peculiar, sometimes ludicrous position, as we have just related, among certain peoples; if ever, it is during the period of recent maternity, in child-birth and childbed, that a certain amount of regard is involuntarily paid the wife by savage peoples, and I would take issue with Corre,[4] who claims that the exclusion of men from the lying-in-room is not the result of modesty. He says: "Our feeling of shame and modesty is a refinement entirely unknown to many people, and shown by others in the most peculiar ways. Among many a woman in labor can only be attended by one of her own sex; this is because among savages woman is a most inferior being, despised and dare not aspire to the assistance of men. She is worth so little and so easily replaced; she is good for the bearing of children, to look after them, and to give satisfaction to her master, but especially to do the rough work in the fields As soon as she is a nuisance she is left, she is sold, she is killed, and sometimes she is eaten for fear of letting a good piece of meat escape.''

During this trying period at least a better feeling prevails, as is proven by many of the instances related; and Corre himself, in his extremely valuable and interesting work, tells us how the sufferings of the parturient, in Old Calabar, are concealed by the laughter and conversation of surrounding relatives, that not a cry be heard, as it would dishonor her and cause the family to repudiate her; at the same time the husband is clothed like a woman, put to bed and sighs terribly, as if he was enduring great suffering.

A similar custom formerly existed in Greenland and still prevails in Guiana, among certain Canadian tribes and the Caribeans: while the woman who has been delivered attends to her household duties in the interior of the house, her husband goes to bed and receives in her place the visits of condolence from friends and relatives. Among the ancient Corsicans a similar custom existed, and is still observed in our day in some of the regions of the Pyrenees. It is also found among certain African tribes.

This peculiar comedy is doubtless for the purpose of causing the woman to forget her trouble and give her an innocent revenge for the suffering which she alone has supported in the work of reproduction.—(Corre.)

It certainly does appear to be a certain acknowledgement of her fortitude and suffering, and shows a certain amount of respect, however passing it may be.

I have treated more particularly of the puerperium among the red races, and will add some interesting facts from the work above referred to.

In the Antilles and Guiana hemorrhages are severe, prolapses frequently caused by brutal intervention of the negroes. As soon as delivery is effected food is offered, meat or some mixture of milk, palm oil and tamarind, and after a few hours the usual labors in the house are again taken up, without going outside during six or seven days.

In China more pains are taken, but with little more understanding; the patient is put to bed but not permitted to sleep, because this might weaken her and prevent the proper circulation of the blood. She must rest upon a high bed, lie

upon her side, the knees bent, and take a cup of the urine of a child; during the first three days she must take three or four times a day a mixture of whiskey and child's urine, taking care not to take too much whiskey. Pork she must not take for six days, and no eggs for a month, because they might disturb the vessels.

Many peoples have a superstitious faith in the use of heat immediately after confinement, some instances of which I have already cited: so among the Rouconyennes a steam bath is taken in a hammock under which a large stone heated by the fire is placed; upon this water is thrown. In a few hours the usual occupations are again taken up. When the Anamite is delivered a vessel filled with hot coals is placed under her bed, and the fire kept going night and day; the stomach is rubbed twice a day with a vessel filled with hot coals. Dry food is given, spiced and very dry. At the door of the house, at the end of a long pole, a pot of charcoal is placed as a sign of labor, and that the entry is forbidden to such whose labors have been difficult or followed by death; when the lighted end of the charcoal is turned towards the interior of the house, a boy is born; if turned outwards, a girl is born. It is a custom throughout Annam that the puerpera must take a medicine consisting of a decoction of laxatives and purgatives. During the month of her child-bed her husband abstains from all work, and must give all his care to his wife and child and to make the necessary preparation for this. The mother cannot leave the house before four weeks, and in order to preserve her from the evil influences of the air she is bandaged, head and feet, with saffron. In Siam the woman is placed before the fire after delivery, and if you ask: where is so and so, the answer is given: she is before the fire.

The Hindoo woman suffers likewise; when labor is over she is placed in a small, ill ventilated room, without any other opening except the door, which is usually closed, and smoked by a wooden fire, which is constantly kept up, and condemned to isolation in a terrible atmosphere; she is, moreover, obliged to abstain from food: during the first three days she must take a powder composed of stimulating spices, and during

the next three days the same spices with certain substances boiled in water in the form of a paste; at the eleventh day only does the woman begin to live somewhat like the rest of the family, but she does not leave the room for a month.

This frequent resort to fire seems to arise from an instinctive idea to protect the puerpera from cold, but it certainly is beneficial in so far as it allows her a certain period of rest, and may it not hasten uterine contraction and prevent hemorrhage? The amount of heat applied is at least equal to that of hot water, which we now resort to for the purpose of arresting hemorrhage.

However little apparent, good reasons exist for many of these seemingly ludicrous customs, and good results often follow; harmful as they appear to us, they are probably necessitated by the peculiar customs of the people, and greater havoc among them would follow their neglect.

Management of the Child.

The management of the new-born child is so intimately connected with the treatment of the mother in the pueperal state that the subject would not seem complete without a brief consideration of the treatment of the babe. Although the savage mother is not wanting in love for her offspring, the treatment of the child from the very first moment is one well suited to fit it for the hardships of its future life. Even among those people where kindness is shown the little stranger, where he is well cared for, and not left to starve in isolation with the mother, as among some of the Russian tribes, he receives at once a hint of the exposure to which he may be subjected in the future. As an ancient chronicle and "Early History of Virginia'' says, in speaking of the original inhabitants of that country: "The manner in which they treat their young children is very strange, for instead of keeping them warm at their first entry into the world, and wrapping them up in I don't know how many cloths, according to our fond custom, the first thing they do is to dip the child over head and ears in cold water, and then to bind it naked to a convenient board, having a hole fitly placed for evacuation, but they always put cotton wool or other soft things for the body to rest on between

the child and the board. In this posture they keep it several months, till the bones begin to harden, the joints to knit, and the limbs to grow strong. Then they loosen it from the board, and suffer it to crawl about, except when they are feeding or playing with it. While the child is thus on the board, they either lay it flat on its back, set it leaning on one end, or hang it up by a string fastened to the upper end of the board, the child and board being all the while carried about together. As our women undress their children to clean and wash their linen, so they do theirs to wash and grease them. The method the women have of carrying their children after they are suffered to crawl about is very particular. They carry them at their backs in summer, taking one leg of the child under their arm, and the counter-arm of the child in their hand over the shoulder, the other leg hangs down, and the child all the while holding fast with its other hand. But in winter they carry them in the hollow of their match-coat at their back, leaving nothing but the child's head out.'' The child is tucked away in an equally peculiar manner by some of the Polar tribes of Russia; until it begins to crawl it is placed in a fur sack, and carried by a strap about the mother's forehead. Later it is sewed up in a fur garment of one piece; for the sake of cleanliness a doorway is left in the posterior portion, which is opened from time to time as necessity demands, but the garment is not once removed or changed until outgrown by the child.

Among the Sioux, Crows, Creeks, and other of our Indians, the mother plunges into the stream with her child immediately after delivery, or, if no running water is at hand, at least dips the child in cold water as soon as it is born; salt water is used by some people who live upon the sea shore, also by the Kalmucks, who wrap the child in furs as soon as it has had a salt-water bath. A cold-water bath seems to be the customary initiation of the new-born child into the troubles of this world; it is the case among most of the Negro tribes, among the people of Bolivia, of Ceram, and of the Andaman Islands, and in some parts of India; in others, in Southern India, for instance, the child is washed in tepid water; so also in Syria, and, as a rule, by those people who are advanced in civilization.

Usually the child is bathed immediately after delivery, but

in Southern Arabia at least two hours are permitted to pass by, during which the child is wrapped in soft warm cloths, then it is washed and anointed. This is also the custom of numerous African tribes, some waiting for several hours, others performing the ceremony at once; some use fat, others, such as the Wakamba, Somal, Wanika, and other tribes use fresh butter. The Masai and the Waswaheli throw a slightly acid and astringent powder, made from the fruit of the adansonia tree, over the child, to facilitate cleansing, just as we use oil or fat. The Cheyennes and Arapahoes envelop the child as soon as it is born in dry horse manure, and do not wash it for several days. The Umpquas wrap it in dirty rags, and also put it away without washing. In India, in Africa, and among the American Indians, there are many tribes who bathe their children for at least one year. In Syria, in India, and in Africa, there are many who anoint the children regularly, often after every bath, and great attention is paid to the kneading and stretching of the limbs and joints, with the view of making the child straight and strong, and stimulating the healthy development of the muscles. Some strap the child or have various methods of bundling it, so as to carry it conveniently. Some, like the Chinooks, of Oregon, compress the head to shape it in a peculiar way. This method of kneading and stretching the child is well described in a paper on the inhabitants of the Andaman Islands (Zeitschft. für Ethnologie, 1877, p. 51). There it is usually done by the father, who warms the palm of his right hand, presses firmly upon the temples and upon the base of the nose, whilst the left hand fixes the lower jaw; then the wrists and elbows and the septum of the nose are compressed between the thumb and index finger, and so on quite a number of manipulations are performed.

It is interesting to see that the same variations exist in regard to their customs as to the time of applying the child to the breast which we find among civilized people. Thus among the Kanikars and several other tribes of Southern India the child is applied at once to the breast, as is done by some of our Indians. In Alaska it is customary to suckle the child as soon as it has vomited for the first time; among the Kalmucks the new-born is given a piece of raw mutton to suck, and is not permitted to take the breast for several days. Upon the Andaman Islands it is customary for any neighbor or

friend who is suckling to nurse the new-born child for a day or two until its mother's milk appears. In Southern India, the child is fed on boiled honey until the third day, and not until then is the mother allowed to suckle it. In Transvaal, a soft mush is fed to the child for the first three days, and in Loango the same custom prevails, and the people seem to know the qualities of colostrum, at least they make a difference between the milk of the first days and that which afterwards serves for the nourishment of the child. The negroes of Loango hold a suckling child just as the Caucasian mother does, and it seems that the breast is only given at certain times.

As regards the period of suckling, the time seems to vary greatly, yet it is governed by about the same circumstances among all primitive people as it is among our Indians. As a rule, the child is nursed as long as the mother's milk lasts, or until another conception takes place; at all events, the children are nursed unreasonably long. Thus the Kanikars suckle the child for three to five years; the inhabitants of the Sierra Leone often until the child can walk; those of Australia, from one to three years, according to circumstances; the Alaskans, from ten to thirty months; the Tartars and Esthonians, for a very long period, not only limited as it is among our Indians by another conception, but they suckle the child until the next confinement forces them to make room for a younger offspring. The Arabians seem to nurse for a period of perhaps two years; the Waswaheli, from one to two years; in the eastern portions of Africa, it is the custom to nurse as long as the mother's milk will last, and often during the next pregnancy. A child which is nursed during such a period is called an external twin.

For the purpose of weaning the child, it is customary in Southern Arabia to smear myrrh or asafetida upon the nipple. The Somal use the fresh juice of aloe leaves for the same purpose, and in Zanzibar, cayenne pepper or the gum of the aloe is applied. In case that the breasts are inflamed during the process of weaning, the natives of Southern Arabia press out the accumulated milk and cover the breasts with a poultice of soft mud or clay.

I have already remarked that insufficient or inferior food is frequently a source of injury to the puerperal woman when isolated during her period of uncleanliness, as it is often the

cause of sickness and death of the child. This is especially the case among some of the Russian tribes. Convulsions occur frequently among the children who are partially fed with heavy bread which has been first chewed by the mother; then berries of various kinds are given the infants, not even always ripe; they are kept in a filthy condition, and take frequent colds by the use of the steam baths so common among those people. Coarse food and constitutional syphilis are the causes of early death among many of the Tartars. In Alaska, the fat of some sea animal is the first food which is given the infant. The Masai and several other tribes of Africans put a little fresh butter, which is especially prepared for this purpose, into the child's mouth after the second day. Among the Wakikuyu the child, after the tenth day, receives chewed bananas, which have been mixed with the saliva of the mother, in addition to the butter. The Wakamba give the infant, very soon after birth, a little mush, and the Somal make them take a little of the juice of the myrrh daily after the sixth month has been reached. In case of the death of the mother, the Wakikuyu and Waswaheli raise the child upon goat's milk; other tribes employ nurses, others feed the child upon mush and other food common among them. The Kossacks think wine a necessary addition to the food, even of suckling infants. In Siam, honey and rice-water is given from the first days, and the soft pulp of the banana is crammed into the little mouth. Dr. Shortt tells us that, in Southern India, the child is fed on boiled honey after the third day, when the mother is allowed to suckle it, and if the external parts are cold, five drops of the milk hedge (Euphorbia Firucalli) are given it. On the third day, it is rubbed with sweet oil, bathed in warm water, and half a pie-weight of garlic, one-quarter pie-weight of black pepper heated in a kin-weight of castor oil is given, and repeated every second day. Some give castor oil every morning for the first, once a day for the second, and every other day for the third month. From the third day the mother suckles the child; if unable to do so, it is brought up on goats', cows', or asses' milk.

The Villees, another of the tribes of Southern India (Transacts. London Ethnolog. Soc., 1865, III.), give the child for the first two or three days a preparation of black pepper, neem bark, jaggery, garlic and onions, several pots full of which are made at once and slowly dished out. In Old Calabar, the child

is first rubbed over with fine sand, then with soap and water; the acid juice of an Ammomum is squeezed into its mouth, and a supply of tepid water follows, and for the first three days, during which it is not allowed to suck, it gets nothing but water, and later, although the mother has an abundance of milk and the child is well able to suck, a large quantity of water is given at least once a day. Every morning whilst the child is washed, water is thrown into its mouth continually for several minutes, the child gasping and struggling. This, they say, is done to distend the abdomen and make it capacious to take plenty of food, to hasten growth. If the mother is away, the child is kept quiet by filling with water, and they deem this cheap liquid very useful in this respect; although too much water is rarely taken, it may prove injurious, and possibly the enlarged spleen, which is very common among children in this country, and not among adults, may be traced to the over-dose of water.

The Kanikars begin to give rice-water the third month. The child which is nursed from three to five years, gradually, from the third month on, receives other food, but it is not until its seventh year that it eats with the rest of the family. The Vedas simply suffer the child to die if the mother's milk does not suffice, as no other woman dare nurse it, and cow's milk rarely succeeds. After the daily bath, the babe is anointed with oil and turmeric, and rubbed and kneaded in accordance with certain rules, as we have related of other tribes.

Just as adults are treated with the herbs of the country in their various diseases, so the children are made to put up with them. Teething is furthered in Russia by the use of the fresh juice of the lemon sweetened with sugar, or the gums of the child are smeared with the blood which comes from the comb of a black rooster which has been repeatedly scratched and irritated with a comb. In case of restlessness, a decoction of poppy seed is given the child after it has been carried to the ordinary roosting-place of the chickens and kept there for a while. In case of convulsions, a decoction of Gentiana pneumonanthe or the root of Valeriana phec is used. The powder of Origanum, starch, or lint is applied in case of soreness of the skin, and there are many other equally efficacious remedies in use, many of them most amusing and of extreme interest to the ethnologist, but beyond this of little or no value.

These, and many other practices and remedies which I have described, are peculiar, many are more or less efficacious, most of them harmless, few injurious: some are amusing—I can safely say amusing in speaking of such simple, ignorant people, but they should not be too severely condemned for their child-like beliefs, and we can little afford to cast ridicule upon them if we reflect but a moment upon the many equally silly remedies, still firmly believed in by so many, in the midst of our boasted civilization and the wonderful development attained by medical science. Every physician, to his intense disgust, now and then meets with the wonderful concoctions or mystic devices of some sage and knowing old dame, who confides them to her suffering friends: teas and herbs innumerable; an onion carried in the pocket until shriveled to cure a corn; half a potato carefully buried in the ground to destroy warts; a sheet of paper worn upon the chest for the relief of rail-road sickness. In Germany, whilst stationed in a small village as surgeon during the Franco-Prussian war, I was called by a wealthy family to see the driver, who was lying abed, suffering intensely from a fall from a tree, with possible fracture of the femur.

Unwillingly he submitted to an examination; but although a devoted family servant, the authority of his mistress was not sufficient to force him to follow any of my directions, and upon returning on the following day I found that a shepherd had been called from a village miles away. Peasants from near and far sought the advice of this shepherd, who had inherited his gifts from his father and grandfather, who had been shepherds before him, and had practiced the healing art. A red string had been tied about the contused limb, and within a certain time this was to be removed and the broken limb would be healed! Fortunately it was but a contusion, and the man suffered no serious consequences.

Prayers to certain saints will cure sterility: others heal broken and rheumatic limbs: the chapels sacred to particular saints, in the churches of Italy, Spain, many parts of France and southern Germany, are frequently decorated with splints,

crutches and other appliances used by the sick, which have been thrown aside by the suffering owners, and there preserved as a token of gratitude to the saint by whose intercession they have been cured. Other cures are performed by the relics of saints, by miraculous waters; we all remember the waters of Lourdes, and the intense excitement created by their wonderful qualities; among others their healing powers, for which they were sought by innumerable pilgrims.

In New Caledonia the sterile woman buys from the medicine man some shapeless puppet, destined to share her couch and to exert its influence in favor of her pregnancy; in Brittany (Corré) a statue of Saint Quignole still exists, in front of which such women as are desirous of children are accustomed to strike their stomachs. Whom shall we ridicule?

These simple people have many laughable customs—so have we, in the midst of this era of enlightened progress—but many of the curative means adopted by primitive people are so simple, sound and rational, that we learn to respect them and to study their methods with more than idle curiosity: thus, among the Arabs the colicky baby is given, not some narcotic soothing syrup, but oil, or the breast of a neighbor who is in better condition, until mother and child have improved; in India, where, as well as in all southern climates spasmodic nervous affections are frequent, especially tetanus neonatorum, the entire body of the child is thoroughly anointed for nine days after birth with an oily, greasy, substance in order to avoid the evil effects of cold air or sudden atmospheric change; to escape these dangers they also cover the umbilical with a certain adhesive plaster, after cutting the cord.

Every people has its own idea of beauty, and in accordance with this they endeavor to mould the body of the newborn: his head is flattened, his nose slit or the ears elongated, to conform to the æsthetic views of the particular people.

The Flathead mother begins to compress the yielding cranium of the infant from the very first, that he attain the type of beauty which is the standard of this particular tribe of Indians. Similar customs prevailed among the ancient

Peruvians, where, however, a high, conical skull was produced, as well as the flat and narrow long head. Among the Caraïbes, and upon some of the Polynesian islands, the custom still prevails.

The Oriental races prefer a well rounded head, as shaped by a tightly encircling band, so as better to fit the turban. The Arabs give a globular form to the head of the new-born by compressing and kneading the lateral regions, from below upward, with the palm of the hand. Even in France the remnants of a similar custom, which but recently was practiced in Normandy, still exist; it is the high, circular constriction of the child's head formerly also found in the vicinity of Toulouse.

The Chinese mother of the upper classes begins early to compress the feet of her girl baby, that their diminutive proportions may enforce her claims to beauty and society fame. "The result of this persistent pressure[5] is the atrophy of the bones and soft parts of the foot; the forcing upwards and backwards of the tarsus, the displacing of the calcaneus, whose axis approximates to that of the tibia.''—(Corre.)

The Slavonian women, of Russia, give their babies a more general stretching and rectifying of all organs: upon the second or third day the nurse takes the little body to the oven or the bath room, and switches it well, then soaps it, whilst a wise woman presses the head to rights by working it from all sides, cleanses the skin with salt water, puts the nose in good shape, stretches hands and feet, seizing the little victim by the left hand and right foot and vice versa; finally he is seized by both feet, suspended head down, and well shaken so as to get the intestines in place, and take internal ruptures away from the kidneys.

Few peoples are so general in their efforts, as almost all have some peculiar organ which they seek to develop in accordance with their particular æsthetic craze. Most African tribes affect long pendulous breasts; some constrict the mammæ just below the areola, so as to give the appearance

of a small hemisphere superimposed upon a larger one. Some like a long pendulous lower lip, and others a thick upper lip; whilst the natives of Madagascar affect excessively long nymphæ.

These types of beauty are attained by tedious, long-continued efforts, whilst others are produced more rapidly; such as opening in nose and ears and lips for ornaments, tattooing, and various marks and incisions upon the body common among different tribes and peoples.

Other mutilations to which the infant is subjected are dictated by religious superstition; yet the original cause is often long forgotten, and custom alone remains to account for the practice. Among the most ancient of these is circumcision, which has been in use by the laws of Judaism and Islamism; but it is a biblical error to suppose that it existed among all people. Certain traces of this operation have indeed been observed among the Mexicans-a simple incision upon one side of the fraenum. The incision of the prepuce is practiced among the Milanesians, New Caledonians and the Polynesians. Partly inaugurated for hygienic purposes, and perhaps desirable on account of the considerable development of the prepuce of the Semitic races, circumcision, which was considered a symbol of the alliance with the Almighty, has finally degenerated among the Jewish people into a routine practice not always exempt from danger— infection may follow, hemorrhages and malformation. I have myself seen an infection of this kind, accompanied by well marked shankers, and followed by serious constitutional disturbances.

Among Mussulman people circumcision is obligatory, although the Koran says nothing of it. The Arabs of Algiers practice it towards the fifth year; the Kabyles towards the sixth or eighth year; the Turks towards the eighth. In Africa it exists here and there, but is not universal. In Rio Nunez circumcision has been practiced at twenty-five and thirty years, and an old inhabitant gives a curious explanation of the reason for the operation, which is that the gland, always uncovered and exposed to continual irritation, loses

its sensibility, which necessitates a lengthening of the act of copulation and the enjoyment of the pleasure. This is a peculiar view, in opposition to the belief of those who advise the operation for the sake of morality—in opposition to St. Jerome, who teaches that the removal of the prepuce, in diminishing the voluptuous sensation, preserves man from too great an abandonment to sexual pleasures—in opposition to Moses, who by this operation endeavors to prevent the results of too ardent an imagination.

Circumcision, if we may so call it, among girls consists in several operations:

First, a simple excision of the clitoris, at the eighth or ninth year, upon the coast of Guinea; at the first appearance of the courses in old Calabar.

The child is placed upon the knees of a woman, the legs are well separated, the labia separated, and the slightly developed clitoris seized between two pieces of bamboo used like forceps, drawn forward and cut off with a razor; hemorrhage is slight, and, if necessary, is stopped by the alternate use of hot and cold water.

Second, excision of the nymphæ, only practiced on account of hypertrophy or degeneration, to which the negress is subject.

Third, excision of the nymphæ and the clitoris upon the adult; and, influenced by the belief that it is a guarantee of chastity, done upon such women as are proud of or anxious for a proof of their virtue.

Fourth, the excision of the large lips, alone or with the preceding operations.

The Hottentots remove a testicle from boys at the ninth or tenth year, with the idea of preventing the conception of twins. The Mika operation among Australians is peculiar, performed for the purpose of limiting the number of productive males. This consists in an incision in the lower part of the urethra, near the scrotum, so that the spermatozoa are ejected through this opening, outside the vagina, and not within the canal.—(Corre.)

Ethnological differences in regard to the growth and development

of the child I have not been able to determine, with the material at my disposal, notwithstanding the variety of statements made. I can hardly venture an assertion more definite than this, that the new-born among primitive peoples seem, if anything, more inclined to preserve and develop hereditary taints and diseases by reason of the long period of nursing, which, as I have previously stated, varies from two to three and even five years, and is evidently a matter which has attracted the attention of ancient lawgivers, by reason of its marked effect upon the development of the race. Upon the Slave-Coast the nursing mother is sent for three years away from her husband into the interior, to avoid cohabitation and properly raise her child. Should she approach a male, it is supposed that the evil spirit will carry away the milk and kill the babe. In Rio-Nunez the banished wife, knowing the path her faithful spouse will take, selects herself a substitute to fill her place in the heart of her loving lord during the period of nursing.

The Arabs are not so careful as to avoid cohabitation completely while nursing, nor has the Prophet expressly forbidden it, although he intimates that sexual congress is not compatible with healthy nursing. Their law renders the suckling of the babe obligatory for the mother, except in case of sickness, or absence of milk, even after repudiation by her husband; it is so unjust as to oblige her to keep a wet nurse in case of her own inability to nurse, without allowing her any claims upon the father of the child.

The dread of an increase in the family, misery, poverty, and the difficulty of obtaining food, explains the long period of nursing among all these peoples; the child is suckled for years beyond the time indicated by nature, in the hope of thereby preventing a farther conception, or because food for one more mouth cannot be provided. The child is scantily fed upon an inferior milk, draining away the mother's strength and energy, whilst a little properly prepared food, animal or vegetable, would rapidly build up the skinny little one and save the mother.

It is this long continued assimilation of a tainted mother's

milk which enfeebles the nursling, and makes him an easy victim to any one of the numerous diseases which endanger the earlier years of life.

In Chayenne white women often take black nurses, and it is well known that the children nursed by them frequently become thin, feeble and languishing, and above all are much more subject to disease; this is undoubtedly due to the fact that the negress of Chayenne so frequently carries the germs of one or more of the constitutional diseases to which the blacks are subject. If the child of a healthy mother is so affected by this necessity of life, how much more fatal a carrier of disease must it be for the nurse's own child!

Mortality among the negroes is great; many die upon the first day from hemorrhage from the navel, or from exposure to cold.[6] In Darien, families are often scarcely able to raise one child out of twelve: in China and Japan the death rate is terrible. Rachitis is not known in the warmer climates: scrofula seems to exist among the Africans, and more so among the blacks of the Antilles; in China and Japan it is very common; among the Malay and Indo-Chinese races scrofula is common, also in the Algerian and Moorish villages; the Arabs treat the disease by encircling the neck with brier leaves, or a mixture of grenate bark and clean barley. At Tonga terrible lacerations upon the neck, also seen upon the Oceanic Islands, syphilis, lepra and small-pox are common among the people.

The Arabs pay more attention than most others to their children, but how do they endeavor to strengthen them? By all sorts of odd brewings, such for instance as (the only nourishment in three or six days) an egg cooked an entire night in vinegar, and so on. In Spetza and Hydra a peculiarly painful, feverish disease, named ponos (pain), which has for its basis consumptive tendencies, appears towards the end of the first year, rarely towards the third or fourth,

more common among boys than girls, seizing more particularly upon the children of consumptive parents with lymphatic, weak constitutions. Typhoid fever, yellow fever, cholera, malaria, all exist.

Among all races the young seem particularly given to the eruptive fevers. Variola—which is particularly bad for children, removes a terrible number among the North American Indians, Arabs, Persians, Chinese and Japanese; many even fight against it by inoculation with matter from already affected subjects, as has often been seen by Dr. Corre upon the eastern coast of Africa. In Arabia the virus, which is an object of public sale, is inoculated by an ordinary needle; and in all nations it seems to have been observed that inoculated variola is always less severe than the spontaneous variety. The Arabs see an especial advantage in the fact that it is accompanied by a much smaller number of pustules. In India the English have again brought among the natives the ancient practice of inoculation, known to the ancient inhabitants and described in a Sanscrit book. The Chinese have accepted vaccination; and also the Japanese. In Boke the French surgeons have not been able to establish vaccination, having attempted it with tubes imported from France, as the natives compared these negative results with the beautiful pustules which resulted from their own inoculation of variola matter, not considering that the effect was as good with much slighter annoyance. The Arabs did not take kindly to vaccination, believing that it was merely a means of marking their children with the insignia of their conquerors, declaring that they would rather cast their babes into the sea than allow the sign to be impressed on them, so that they might be known at any time, to be taken away from their family for baptism.

An ethnological influence upon the appearance of the pustule, and its shape, form and size, seems hardly possible; excepting the difference in thickness of the skins of various races; the pustules develop in the same manner when they are under the same climatic influences, still some believe that they are smaller among the blacks than the whites. Climatic influences

are greater and the pustules are smaller in hot climates than in temperate or cold. In Cochin China the pustule presents upon the fifth day the appearance it has with us upon the eighth, and gives an excellent lymph upon that day. In India, and especially in Indo-China, it has been remarked that at certain periods of excessive dryness, or excessive humidity, the vaccination would not succeed. Strange to say, the author has vaccinated unsuccessfully a large number of children in one village, and upon the following day with good success children of the same age and kind with the same matter in another. Could it be possible that these children could have acquired an immunity from the fact that an epidemic of variola had existed in the village upon the preceding year?

Scarlatina is common among other races. Grippe is rare in hot climates. Diphtheritis, however, is frequent there; in Algeria it is very common. Umbilical hernia is common among the new-born of the black races; if it does not exist at the moment of birth it appears soon afterwards: possibly a persistence of the embryonic state. Convulsions and eclampsia are very common. Vertigo, congenital and accidental, is very common among all colored races. The same is true of cicatricia and hypertrophy