In more populous parts of the country, and in large cities where a more artificial manner of living is pursued; and among the higher classes of Hindoos and Mahommedans the form of body, and strength of constitution is enfeebled by ease and luxury; and the want of healthy exercise renders parturition more difficult and dangerous. In those periods of suffering and anxiety, the assistance of their elderly and experienced friends might be supposed to be sufficient, were they not prevented by the pernicious influence of caste. By Asiatics, parturition is a period of impurity, and this seems to be strongly impressed on the Mahommedans by the prejudices of the Hindoos. The important and most difficult art of midwifery among the Asiatics is considered degrading; and low caste, feeble, and ignorant women are alone employed, by whom the processes of nature are interrupted, and the most pernicious method of treatment is followed to the great danger of the mother and child. Women have been employed to assist in parturition from the earliest ages. These females appear in some countries to have been of some rank and weight in society, as we find in Egypt they resisted the cruel order of Pharaoh, who commanded the midwives to kill all the male children of the Hebrew women. Among the Greeks and Romans women alone were employed. Phanareto, the mother of Socrates, was a midwife; and Plato, Hippocrates, Galen, and Acteus mention midwives. They were likewise employed to negociate marriages, a duty they still perform in Bengal. The same system was pursued in Europe after the fall of the Roman empire till the seventeenth century, when medical men were employed as accoucheurs. From a very early period practitioners were consulted in difficult cases of labour, as is mentioned in the second labour of Rachel, the wife of Jacob; and, again, when Tamar was delivered of twins, and they are likewise mentioned in Exodus. The same practice is still pursued in Hindostan when females are employed in ordinary cases, and practitioners are called to assist in cases of difficulty and danger. The midwives in Hindostan are named dyhs, and are of the lowest castes (Haree and Chunar); while the Mahommedan midwives are usually the wives of religious mendicants, named tizoáns. All these midwives are extremely ignorant and superstitious; so that even considerable experience is usually of little use in improving their opinions and method of proceeding. In the ninth lunar month the pregnant female is placed under the care of these dyhs; when the Hindoo female is removed to the temporary shed, which is erected without the dwelling-house, or to a low, damp, unwholesome room, where she is to be confined, as her person, during the period of uncleanness, would defile the dwelling-house. At this period of anxiety and suffering, she is separated from her friends, and placed under the charge of this ignorant and degraded midwife, with whom, on any other occasion, she would not asso ciate. A month before pregnancy is expected, a teaspoonful of almond oil is taken daily, and the warin hip-bath is frequently used, and warm water is thrown over the patient's head, while oil is applied to the abdomen, loins, and the external parts of generation to relax the parts, and thus to accelerate labour. With the same intention, in many parts of India, after the seventh month the woman's clothes are bound tightly above the fœtus, from a fancied advantage in keeping it down in the abdomen, which is further promoted by pressing it frequently downwards. To promote labour the patient is made to walk about, she is directed to inhale the smoke of burnt horns, and the eyes of salt-water fish; holding the nose and mouth in the act of sneezing, is likewise considered of use in promoting delivery, and in producing abortion. This is a crime of frequent occurrence in Hindostan, and the midwives are frequently aware that they can produce it by separating the membranes round the mouth of the uterus, by which means the person often avoids the shame of being proved to have indulged in illicit intercourse. The Hindoo female thus leaves her comfortable and warm dwelling for a 1854.] THE HINDOO PRACTICE OF MIDWIFERY. damp and cold hut, which is rendered still more dangerous by the hot drinks she is required to take, and the large fires continually burning to keep away evil spirits; while the matted hut allows the free ingress of the night air, which blows upon the heated body of the female extended on the cold and damp earth, often without the necessary clothing, and at a time when she is so subject to disease. The ignorant Hindoos suppose that devils take advantage of this period of weakness to enter into the body of the mother and child; to prevent which large fires are kept burning before the door of the hut, in which the parings of leather are burnt, and persons must walk over and shake their clothes to prevent the passage of any devils. In other houses, a plate of rice and cowries are placed on each side of the door to propitiate the same per sonages. The patient is delivered while resting on her back, in the lap of a female sitting on the ground, while her knees are bent and separated by two other females, one sitting on each side. To facilitate labour the parts are lubricated with oil, and the dyhe, resting on her hams before the patient, instead of supporting the perineum, urges the female to assist nature in expelling the child; while she introduces the fingers of her two joined hands in a conical figure, The mechanical and by separating the palms, stretches the external parts, and thus, they facilitates labour. This, however, is not the case. suppose, violence irritates and swells the parts, diminishes the relaxing influence of the mucous secretion, and thus retards labour, and increases the suffering and This is likewise produced by rupturing the danger of the patient's life. membranes at an early stage of the delivery, by which the natural soft wedge, which facilitates so much labour, is removed, and a natural becomes a case of lingering labour, which, with the regimen and exposure, endangers the lives of the mother and infant. The poorer classes When the infant has been delivered, the cord is tied near the abdomen of the infant with a piece of lint, catgut, or silk thread. divide the cord with a piece of broken earthen vessel, while others use a sharp piece of bamboo for this purpose. Among the Hindoos the dyhs perform this simple operation; but among the Mahommedans a violent controversy has long existed as to the person who should divide the cord. The orthodox declare that the low caste Chunar midwife should do it, as she is considered unclean. In many Mahommedan families experienced matrons are employed for delivering the female, and the low caste dyhe is only sent for to divide the naval string, and to remove the secondines, for which she receives a few pence, up to a couple of shillings, according to the circumstances of the family. When in good circumstances, the midwife is often retained with the female as a sick-nurse, and attends to the regimen of the mother and infant during one lunar month, or in some cases forty days, during which she remains in this stifling atmosphere, and is supposed to be unclean. During this time a good deal of the nurse's time is passed in warming the hand and pressing the palm upon the bodies of the mother and child, which, it is said, strengthens and warms. It is likewise supposed to hasten the completion of the bony union, gives compactness to the parts, and prevents boils and other complaints. The infant is soothed by the warm application, and remains asleep. This application is continued for many days, for half an hour evening and morning. In other respects, they too often neglect, or follow the dictates of superstition, exposing them to the most pernicious A new sect of Mahominfluence of cold. For this period of attendance the nurse usually gets eight shillings, or the wages of a common workman. medans (Ferazees) declare that, it is improper to employ a low caste woman to divide the cord, and as it does not render the person unclean, it should be performed by the father, or one of the relations of the child. The pertinacity with which this question is discussed shows the superstitious ignorance of the people, while the modification proposed proves that more rational views are beginning to be held on the subject. For unnatural presentations very considerable variation exists in their method of proceeding, in different parts of Asia. Face, head, and knee pre sentations are left to nature, and medicines are only given to promote delivery. The more intelligent Hindoo authors recommend, in the two last varieties, that the presenting parts be pushed up, and delivery accomplished by the feet. Nothing is done in arm presentations, but dragging it downward, in the vain hope of completing delivery. In the Hindoo writings it has been recommended to push up the arm, and bring down the head; and when this is not sufficient to save the mother, a hook is used to remove the dead foetus, as otherwise the mother will soon die if undelivered. The other means employed are emolients externally, and stimulants internally. In rare cases an abscess has formed in the parietes of the abdomen, and the dead fœtus is thus expelled. Such cases afforded a hint to practitioners to perform the Cesarean operation when the mother had been killed, near the termination of pregnancy, and the foetus was alive. In the East this operation has been employed from a very early age; and so apparent and necessary is it in certain cases, that I have known a case in Bengal in which two ignorant persons performed the Cesarean section with a razor, in a case of great deformity, and thus saved the life of the mother and child. In another case delivery could not be accomplished, and a native practitioner of Bengal told the husband that unless a dangerous operation was performed, both the mother and child must die. It was referred to the mother, who replied, "Do not mind my life, but save that of my child." The operation was performed, and both recovered. When the infant has been removed the dyhe generally introduces her hand into the uterus, seizes the placenta round its circumference, which she presses towards its centre, and it is thus detached and removed. When there is any difficulty in removing the secondines, the patient is supported so as to rest on her arms and knees, when it is removed by the hand of the dyhe. A quantity of oil is poured into the external parts, and she is placed on her left side, when the delivery is considered completed. In consequence of the barbarous method of interfering with the natural labour, the infant is often born very weak, or in a state of asphyxia, when they chew a peppercorn, and put it in the mouth of the infant. In other cases besides this, they remove the placenta, strip the cord towards the body of the infant, and place the placenta in a new earthen vessel with water, which is placed on the fire until the water boils. The cord is then divided in the usual manner, and the infant placed in cotton. This peculiar custom has the advantage of retaining the infant near the fire, which will have a favourable tendency. During labour, it is considered most dangerous to allow the female to drink water, or any cooling liquid. Should she be thirsty, a little warm milk may be given. After delivery, she is kept on her left side by the fire with her head towards it. This artificial and distressing heat is continued night and day during her period of uncleanness, as it is considered that the patient should be kept warm both outside and inside. On this account her diet consists of boiled rice, with highly spiced fish broth, and she is obliged to sleep, but to speak as little as possible during the first seven days after delivery. With the same intention she is rubbed over with warm oil and turmerick, and washed with warm water, to remove the pent-up blood, which is supposed to produce fever, etc. Different hot infusions are kept in readiness in certain druggists' shops, which are considered very efficacious for women after delivery. They are usually composed of a great variety of spices, such as pepper, cloves, cardamum seeds, ginger, etc. These are given occasionally during the first two days; in other cases warm water, ghee, and in less scrupulous families, wine or brandy are given after delivery, as by this means diseases are supposed to be prevented and cured. One of the most famous of these receipts now before me consists of twenty-five heating medicines, which are directed to be infused in water, and given occasionally warm. By such a heating regimen the female is subject to floodings, tetanus, convulsions, puerperal fever, and rheumatism, which frequently occurs from their exposure during or soon after parturition, when the female is under the care 1854.] ACTION OF BELLADONNA AND OPIUM. of the dyhe, who is altogether unfit for the charge either of the mother or child. When assailed with sickness, this ignorant nurse attributes it to the patient's not having been sufficiently heated, and tries to increase this intolerable evil. In all eastern countries, the female, after the expiration of the period of uncleanness, is obliged to observe certain customs respecting their purification, which are of a very old date; so that the Jews (see Leviticus xii. 4), like the Hindoos, were considered unclean for the same period, and were, like them, purified by washing and expiatory offerings, when they were restored to their family and caste. Dr Wise's paper led to various remarks on the customs of other tribes in regard to the treatment of women during pregnancy and parturition. (Society's proceedings to be continued.) PHYSIOLOGICAL SOCIETY OF EDINBURGH. MEETING VI.-January 28, 1854.-Professor BENNETT, President, in the Chair. DR THOMAS ANDERSON ON THE INFLUENCE OF BELLADONNA IN COUNTERACTING THE Dr Graves had first suggested, that in continued fever, with protracted pupils and coma, if an agent administered internally would occasion dilatation of the pupils, it might also relieve the other symptoms of cerebral derangement. Dr Anderson, acting on this theory, administered large doses of belladonna in two cases of poisoning by opium, which he related as follows: A patient, of whom I had charge, and labouring under delirium tremens, having received an over-dose of a solution of the muriate of morphia, became comatose. He had taken, in thirty-six hours, two ounces of the solution of the muriate of morphia, and it had been continued by the attendant after sleep was procured. When I saw him he was in profound coma, his breathing was stertorous, amounting to no more than four or five per minute, and his pupils were contracted to mere points. His pulse was excessively weak, and rather slow; it was quite impossible to rouse him. I ordered him immediately the following mixture-Tincture of belladonna six drachms, in five and a half ounces of water, of which an ounce was to be given every half hour. Three ounces of the mixture were administered with great caution, after which his pupils began to dilate. The six drachms of the tincture of belladonna were taken, and in four and a half hours after the first dose of it was given, the patient was in the following condition :-The coma was entirely gone, respirations were between twenty-two and twenty-five per minute, the pupils were much dilated, the pulse had risen to nearly one hundred and twenty in the minute, and was also He replied increased in strength. His countenance, also, from being cold and pallid, had He continued to improve for three become much flushed, and the whole body was much warmer. readily and coherently to all my questions. days after, when rising suddenly to stool, he fainted, and before the assistance of the nurse could be procured he was dead. A fortnight afterwards a woman, about fifty years of age, took, at 4 o'clock to rouse her from the coma, by walking her about, etc., the stomach-pump was NEW SERIES.-NO. LII. APRIL 1854. At that time her pupils were contracted to mere points, her respiration was stertorous, ten per minute, the pulse was feeble, and the extremities rather cold. Between 9 and half-past 9, I gave her one ounce of tincture of belladonna in three ounces of water, which was all swallowed, but with difficulty. In the course of the next half hour two drachms more were administered. At 11 F.M. the first alteration on the size of the pupil was observed; the respirations had also then increased to twelve or thirteen in the minute, and the pulse was much stronger. The symptoms continued to improve till 2 A.M., when all indications of opium poisoning had disappeared. The woman was then sitting up in bed talking to the nurses, with pupils dilated to a little more than their natural size, and still slightly sensible to light. The extremities were quite warm, the pulse was about 100, and of good strength. She gave me a coherent account of her motives for taking the poison, of the amount of money she had spent in purchasing the laudanum, and the names of the druggists where it had been procured. She also replied sensibly to questions about her family, and the age and occupations of her children. She continued awake till nearly 4 o'clock A.M., after which she slept till 9 A.M. In the morning I found her pretty well, her pupils being no more dilated than they were four hours after the first administration of the belladonna. She complained, however, of nausea, but unaccompanied with vomiting. This symptom, along with the dilated pupils, had entirely disappeared in the course of two days. She was kept in the hospital, under observation, for ten days after the accident, at the end of which time she was dismissed, perfectly well. The tincture of belladonna, used in both these cases, was of the strength of four ounces of the leaves to two pints of rectified spirit, and prepared by percolation. Half a drachm is considered a full dose. I have seen dilatation of the pupil produced by a drachm given at once. The committee on Dr T. Anderson's communication reported, that they had designed to test Dr A.'s views by experiments on animals, but had found, on inquiry, that the animals commonly used for experiment were almost entirely insusceptible of the poisonous action of opium or belladonna. Where the effects were so different from those observed in man, it was obviously impossible to pursue the investigation which they had intended. The committee, therefore, while recognising that Dr A.'s views require more extended observations in order to confirm them, deemed them worthy of the attentive consideration of the Society. Dr W. T. Gairdner read a communication on THE CHEMISTRY OF THE LIVER, IN HEALTH AND DISEASE. (This paper will be inserted in full in the next number of the Journal.) Dr Bennett made remarks, in which he directed the attention of the Society to Virchow's recent discovery of a substance presenting the chemical reactions of cellulose in the corpora amylacea of the human brain, and spinal cord, and, more recently, in the Malpighian bodies of the spleen affected by the waxy degeneration. Dr Chaumont observed that, by the addition of the elements of water to the formula of fibrine, it could be converted into the equivalents of cellulose, ammonia, and fat. MEETING VII.-February 11, 1854.-Professor BENNETT, President, in the Chair. The Committee on Dr Cartwright's communications reported, that after an impartial consideration of the subject, and after repeated experiments, the resultsof several of which had already been related to the Society, the Committee were of opinion, that the facts observed by them were decidedly opposed to Dr Cartwright's views of the heart's action, and were confirmatory of the doctrines usually received. At the same time, the Committee highly appreciated the ingenuity and research displayed in Dr C.'s communications and experiments. |