A practical treatise on parturition, comprising the attendant circumstances and diseases of the pregnant and puerperal states

Front matter

Vb aleh eg eo Be eo aes eee eo ‘pe.

ay

| Lita ON Tee any en ’ Vobe Mey P et; my i [ J aM Lie 84 Wie ty ve if tok oe sey i, ae a eM: PN

Chapter I

Section I. Explanation of the Pelvis - - - - - - - - - - 33 II. Of the Separation of the Bones of the Pélyie = —\2.-. spasia)- isso wes E12 = 25 Al Hil. Of the Pelvis considered in relation to the Practice of Midwifery ------------ 44 IV. Of the Deformity of the Pelvis - - - -- -- - 55 V. Of the soft Parts contained within the Pelvis: 3 vi SERB mo oo 8 | = ee 74

VI. Of Pelvimeters, or the Examination ne- _cessary to ascertain whether the Pelvis be well or ill formed - - ----------- "ate lv CONTENTS.

CHAP. II. *. Page Secr. I. Of the Héad' of the Child } 2--------- 81 Il. Of Deviations from the Standard Head --- 85 PART II.

Compristnc MENSTRUATION, THE DESCRIPTION OF THE GRAVID UrTerus, witH THE Doctrines OF CONCEPTION, STERILITY,

AND THE SIGNs AND DISEASES OF PREGNANCY.

Chap. I

Sect. I. Of Menstruation ----------------- 89 II. Of diseased States of the Catamenial Secre-

IV. Of Dysmenorrhea or painful Menstruation- 115

Chap. II

Sect. I. Of the Gravid Uterus - -------------- 120 II. Of the Umbilical Cord - - ----------- 139 Ij I.- -Of the Placenta 34 Societe ~ ee < 143 IV.. Of the Membranes « ----<---+-50--+- 147 CHAP. III.

~

CONTENTS.

CHAP. IV. Or THE SicNns AND DisEasEs oP PREGNANCY

Sect. I. Of the signs of the Early Months - - - - - - IT. Of Quickening - ----------+---.-.- III. Of the Signs and Complaints of advanced Pregnancy - -----------------

PART III. Or PARTURITION IN ALL ITS VARIETIES

CLASS I.

Or Natura LABour.

Ser nee: Chis LaNO tie: oe teat a ee wes ce ise D Classification of Parturition - - ---- - --- - - Of Natural Labour's. = 75----+---=- -=--- Of the Changes immediately previous to ParlJ. Of Delivery ------------- acre eee- Description of the Stages of Nattral Delivery ----------- (secrre reece

III. Observations on Natural Labour - - - - - - - IV. Of Lingering Labour - - - -----------

V. Of Twin Labour - - - ---------------- Of the various Complications of Natural Labour 22 ss.) is aa ee = HS vi

CONTENTS.

CLASS IT.

Or Dirricutt Lasour.

IV

Sect. I.

I.

Of the Presentation of the Nates --- - - - - - Of the Presentation of the Feet - - --- - - ---

Of the Presentation of the superior Extremi-

Of the Forceps - -------------—------ Of the Long Forceps --------------- Of the Vectis'- ------------------- Of the Short Forceps ------------- = Of the -Perforatar ‘cieies- 6! ei-e~ <ie - S Of the Cesarian Operation - - - - - - -- - -

CLASS IIIf.

Or Freopinc LasBour.

CHAP. I.

General Observations on Uterine Hemorrhage ---------------------- Of Hemorrhage, occurring previously to the completion of the Sixth Month, which may or may not be accompanied by Abortion, and which rarely requires HAVUAL IG oe ee te ee ci

Page

331 343 348

CONTENTS. Vil

Page Ill. Of Hemorrhage, occurring after the Sixth Month, and before the Birth of the Child, including partial and entire presentations of the Placenta - - - - - -- 420 IV. Of Hemorrhage, occurring subsequently to the Birth of the Child, and before the exclusion of the Placenta - - - --- --- 429 V. Of Hemorrhage, occurring after the expulsion of the Placenta - - - - --- ----- 440

Part IV

Or THE DISEASES WHICH BELONG TO THE PUERPERAL STATE.

CHAP. I.

Of the Occurrences of the Natural Puerperal State - - -- - ---------------- 451

CHAP. IT.

Of the Morbid Occurrences of the Puerperal State - ------------------- 465 Sect. I. Of the Condition of the Stomach and Bowels: - - -- ----4--«-- ----.--- 467 “II. Of the Effects of the Loss of Blood - - - - - - 473 CHAP. III.

Of Puerperal Peritonitis - - - - --------- 478

Vill CONTENTS.

CHAP. IV.

Or Mixep CasEs.

Page Sect. I. Of Puerperal Irritability ------ ------ 483 II, Of Puerperal Mania -4-~- <4" 59)----- 489 CHAP. V.

Of Epidemic Puerperal Peritonitis - - - - - - 493 APPENDIX,

ContTarninc Dr. BLUNDELL’s Two PapErs.

I. On some points relative to the Surgery of the Abdomeni== -< SSS 95 © a lear a ee ee 495 II. On Transfusion - - - - - - - - - --------------- 520

ERRATA.

Page 41, for systems, read symptoms. 152, for Chap. II. read Chap, ITI. 309, for child, read chin. 384, for present, read prevent.

TO

JAMES BLUNDELL, M.D.

LECTURER ON PHYSIOLOGY AND MIDWIFERY AT GUY’S

HOSPITAL.

My pear Sir,

THERE is no one whose name I can with so much pleasure and propritey prefix to the following pages as yours. To the valuable and justly celebrated instructions of your uncle, Dr. Haicuton, I am indebted for the first principles of obstetric science; and to your own liberality, and the extensive opportunities which since that period your class has afforded me, I owe a knowledge of many of the real difficulties of parturition. Were these circumstances in

B ny DEDICATION.

themselves insufficient, your zeal and distinguished talent in the revival of the operation of transfusion in an improved form, and your successful labours in abdominal surgery, would especially point you out as the individual to whom a practical work on

Midwifery should be dedicated.

I am, my dear Sir, With every feeling of personal friendship,

Yours truly,

SAMUEL ASHWELL.

Lime Street Square, Sept. 1828.

Ir is not my intention to trespass on the patience of my readers by a long explanation of the causes which gave rise to this treatise. It is sufficient perhaps to observe, that having been employed for some time in the collection and arrangement of materials, and having been requested to furnish the article on Midwifery for the London Encyclopedia, I felt persuaded, as I proceeded in the task, that a work on the plan of the present, might be rendered generally acceptable to the profession.

My design has been to steer a middle course, between the large and comprehensive B 2 iv INTRODUCTION.

systems of Baudelcoque, Denman, and Burns, and the mere outlines and manuals upon the obstetric art. Thus, while the voluminous details of the former works are avoided, practical utility is not sacrificed to the concise brevity necessary. to the latter class of publications. It is intended to present, in a compendious form, to the students in Midwifery as well as to those actually engaged in its practice, much that will really avail them at the bed-side of the patient. And while it is readily allowed, that the study of first principles can alone constitute the basis of good practice, it is by the application of these principles to the management of all the varieties of labour, that this work will be principally distinguished.

If an apology be required for the intrusion of a new book, it will be found in the increasing attention bestowed on obstetric science, and in the simplicity and certainty of its now established precepts; creating a necessity for some work, which, while it re-

INTRODUCTION, . Vv tains the useful results of ancient research, shall simplify and improve them by an association with the more certain and correct practice of modern times.

I am also persuaded that the unmerited disfavour in which this department of the practice of physic has been so long held by some ranks in the profession, must eventually yield to the great and important benefits it confers upon mankind. Norcan I perceive that there is less skill, courage, or judgment required to conduct a patient safely through the dangerous processes of a difficult, preternatural, or flooding labour, than in the performance of a surgical operation, or the treatment of an internal disease. I can scarcely conceive a situation in which a greater demand is made on the - mental resources of the practitioner, than in cases where two lives are dependent on his unaided exertions; or where his most prompt and momentary efforts are called forth to extricate a patient from the alarming consevil INTRODUCTION.

quences of a large and unexpected hemorthage. Neither is it less difficult to determine the precise period when a protracted labour, involving the life both of the mother and the child, can no longer be safely trusted to the natural powers. I feel confident that none who have witnessed these circumstances, and they alone are capacitated to express an opinion, will underrate either the talent or the high respectability of a department of the profession which can enumerate amongst its members, in former times such men as Harvey and Smellie, and at a later period Hunter,

Denman, and Haighton.

I am greatly indebted to the many valuable publications now in existence on this subject, nor is it to any want of high appreciation of these established productions, that this treatise is to be attributed; but to the desire I have long entertained to combine, in a condensed and yet efficient form, the principles, but more especially the practice, of the obste-

INTRODUCTION. Vii tric art. It is not to be expected in so advanced a stage of this branch of professional knowledge, that many new opinions will be brought forward; a revision, and in some Instances, perhaps, a clearer and more natural exposition of facts and modes of procedure already known, falls more within my design ; and I am particularly anxious not to incur even an apparent liability to the imputation of appropriating, without acknowledgment, the labours of other men.

To many of my professional friends I am deeply indebted. To Dr. BLUNDELL, not only for many valuable suggestions, and for the uncontrolled use of his extensive museum, but for the substance of the two interesting papers at the end of the volume.

To Dr. MarsHatyu Hatt, for the communication of some most important facts, and for the careful examination of that part of the work which treats of puerperal diseases.

Vlil INTRODUCTION.

To Dr. E. J. Hopkins and to Dr. Francis Ramsporuam, as well as to many others of my professional brethren, my acknowledgments are not less due for the valuable assistance they have afforded me.

HISTORY OF MIDWIFERY.

Mipwirery, in the present and extended import of the term, includes not only the assistance directly afforded to women in the act of child-birth, but the relief of the diseases connected with their sexual system, as well as those of their infants during the period of lactation.

We shall endeavour to present to our readers a brief, yet a connected sketch, of this branch of medical science; dwelling very slightly on the early periods of its history, when the notions of the ancients were so erroneous, and their practices so absurd, as scarcely to reward the trouble of investigation. The practice of midwifery, or rather the bestowment of help on parturient women, was almost co-existent with the human species. ‘There must have been a time,’ says Dr. Denman, ‘when the rude but well-meant endeavours of one friend to relieve another in distress ceased, and application was made to those who were supposed to have more information or greater skill. This would properly be the origin of the art.’

From all the passages of Scripture where midwives are mentioned, it is plain that women were the only practitioners of this art among the Hebrews and Egyptians; and it is equally certain that the Greeks and the Romans confided this most important branch of medicine to women. Rachael, the wife of Jacob, and Thamar, who was delivered of twins, were assisted by midwives. Pharaoh, king of Egypt, commanded the midwives to destroy all the male children of the Hebrew women; but they nobly disobeyed. Phana-. rete, the mother of Socrates, was a midwife ; and Plato explains the functions, and regulates the duties undertaken by these females. He remarks that at Athens they had the right of proposing and making marriages. Hippocrates, Aristotle, Galen, and /Etius, allude to midwives in their works; and Aspasia, who was probably celebrated amongst the women of this order, is not unfrequently cited by AAtius.

These instances are interesting, inasmuch as they prove that a distinct class of females was employed to render assistance in labour. In these early ages every circumstance would favour the health and energies of the species ; and where the difficulties of parturition were trivial, not arising from malformation or a debilitated system, a little longer time, and the encouragement of the midwife, associated perhaps with manual help, more apparent than real, would be amply sufficient to overcome every obstacle. Im other instances, as we cannot suppose they enjoyed an entire exemption from pelvic deformity and extensive hemorrhage, more especially at Athens and Rome, where luxury and voluptuous dissipation were widely prevalent, such assistance as the imperfect state of their knowledge on this subject enabled them to bestow, could not have prevented a most painful mortality amongst parturient women. It ought, however, to be remembered, that the warmth of the climate would exert a genial influence and very much facilitate the progress of labour To this circumstance we may perhaps fairly attribute a great portion of that success, which to us, at this period, appears to have exceeded any reasonable expectation.

Hippocrates, who practised medicine in Greece 460 years before the Christian era, is styled by some authors the father of midwifery as well as of physic. It is needless to dwell on the unbounded veneration with which his name has been regarded by succeeding ages. His works will ever excite the highest admiration, as carrying with them indubitable proofs of profound and laborious research. His sagacity and experience fully entitle him to our praise; and yet, by only glancing at his obstetric views, we shall afford our readers ample means to estimate the very little progress which the science had then made. To female diseases, not immediately associated with parturition, he evidently paid much attention; there was little or no difficulty in the way of personal observation, and _his opinions and method of treatment are to this day, in some measure, the objects of enquiry.

In midwifery, on the.contrary, he had no

HISTORY OF MIDWIFERY. ie such opportunities ; his information was not gained at the bed-side of the patient. The precise character of the circumstances to be remedied; and the ‘ratio medendi’ of the means proposed, came to him through the medium of persons incapable of forming a correct opinion, and of making a just report. It is not wonderful, therefore, that we now.smile at his notions, and hold in little estimation his uncouth and curious remedies. Hippocrates was acquainted with no other kind of natural labour than that in which the head presents. Here, if the progress was slow and difficult, he recommended sternutatories ; and, if these failed, the patient was to be held by the shoulders, and gently shaken at intervals till her pains expelled the child. He represents presentations of the feet as generally fatal; and in these, as well as where the arm, leg, or side presents, he recommends to return them as soon as possible into the uterus, and to bring down the head. If from any untoward circumstance, as the death of the child, or the swelling of its body, its delivery cannot be effected, he directs that it shall be brought away piece-meal. His injunctions relative to the management of the placenta are replete with danger. Its immediate extraction is recommended ; and pulling at the funis, in various ways, is the principal method of procedure. From this period till after the commencement of the Christian era, midwifery made no progress. Celsus, who flourished in the reign of the emperor Tiberius, A.D. 37, although an ardent admirer and a close copyist of Hippocrates, threw some new light on parturition.

He recommended, in the case of a dead child, the antroduction of the hand; and the delivery by the feet in cases where the arm presented ; and was of course aware of the error of Hippocrates in attaching such fatal consequences to footling cases. He also recommends the dilatation of the os uteri, from which, however, little benefit and much injury may often arise. This emproved method of delivery did not meet with all the credit and support which it deserved; for Galen, who lived A.D. 131, about 600 years after Hippocrates, condemned it as decidedly as his great predecessor had done. Pliny too, who lived under Vespasian and Titus, accords with Galen; and, although not a physician himself, attests the opinions of the physicians of his time. He asserts the difficulty attendant on labour where the feet present, denominates it preternatural, and adds, that children coming into the world in this manner were called agrippa, that is to say, born with much difficulty. This opposition to delivery by the feet was not easily overcome; for, although men of reputation approved and recommended it, we find that, as late as the middle of the seventeenth century, Riverius publicly condemned /footling labour; and Mauriceau remarks, in the first edition of his book printed in 1664, that many authors were still of opinion that, in such cases, it would be better to turn, and bring down the head of the child. After having, however, observed that it is difficult, if not impossible, to execute this, he concludes, ‘it is much better to extract the child by its feet, when they present, than to run the hazard of doing worse by turning it.’ The advantages of this first great improvement in obstetric science are so apparent, and the principle on which it proceeds is so simple,—so superior to the laborious, and in many cases insuperably difficult and dangerous practice of bringing down the head, that we are filled with surprise at the hostility opposed to its adoption. It is impossible to place in a clearer light, the ignorance and irresponsibility of the writers and practitioners of midwifery at this period _ they propose almost as a universal remedy a procedure which can rarely be adopted with safety, and the employment of which must have been attended, in the majority of instances, with the most calamitous results. Turning a child, by the most skilful practitioner, and in the most favourable circumstances, is a truly undesirable occurrence ; we can, therefore, easily conceive its consequences in such a rude and undigested condition of the principles and practice of the art.

It would serve no useful purpose to dwell on the series of writers who succeeded Celsus ; they were, for the most part, devoted followers of Hippocrates; and, where this was not the case, they were little more than transcribers of each other. Amongst the number may be mentioned Meoschion, in the reign of Nero; Rufus, Ephesius, Galen, in the reign of the emperor Adrian; Oribasius, and Paulus /Egineta, who closes the list of ancient Greek writers on medicine. Le Clerc, in whose History of Physic much curious and very interesting matter will be found, places Paulus at the end of the fourth or the beginning of the fifth century ; about which period the western Roman empire had been overturned by the Goths and Vandals. Le Clerc supposes that the celebrity of Alexandria, for centuries the chief seat of philosophy and science, though now past the meridian of its splendour, had induced him to prosecute his studies in that city ; to have done which, according to Ammianus Marcellinus, in the time of the emperor Valens, was a sufficient pretence for any one to commence the practice of physic. Soon afterwards the library of Alexandria was burned, its scientific treasures were dispersed, and its learned men driven into exile by the ruthless hand of Mahometan intolerance; thus terminating the splendor of the last of the ancient schools. But the Saracens were happily destined in their turn to carry forward philosophical and intellectual enquiries; and in Arabia, astronomy, geometry, and medicine, were cultivated with great zeal and no small success. Nor can we forget that to them we are indebted for the use of numerical characters, and that their physicians first presented to the world an account of the small-pox. Yet our notices of the C

18 HISTORY OF MIDWITFERY.

medical writers of this school must necessa- _rily be brief; although as they devoted themselves in some degree to midwifery, our history would be imperfect were we not to present to our readers some short abstract of their labours. |

Serapion treats, at some length, of the diseases of pregnant women, with the method of cure.

Rhazes follows in the same course, and advises the membranes to be ruptured by the nail, or by a small knife, when, by their toughness, they impede the labour.

Avicenna, who lived at Ispahan about the year 1000, possessed amazing celebrity, and his writings maintained their fame till the restoration of learning. It was he who gave the first description of the forceps, an instrument to be employed in difficult parturition, with the double purpose of saving the life both of the: mether and the’ child. “In all preternatural cases, Avicenna adheres to the erroneous practice of reducing the head to the natural position; but where this is impossible, he enjoins delivery by the feet, and pronounces it the safest of the preternatural presentations.

HISTORY OF MIDWIFERY. ae 2)

Albucasis, the last Arabian writer to be mentioned here, lived in the eleventh century at Cyropolis, on the Caspian Sea; and, according to Dr. Smellie, to whom we are indebted for some valuable facts introduced in this sketch, ‘is the same person who was also known by the name of Alsaharavius, at least so it appears from an» Arabian manuscript now in the ‘Bodleian library.’ | Albucasis merely followed his predecessors, annexing a more particular description of the instruments then used in midwifery.

Having thus briefly traced the progress. of medical science, so far as midwifery is concerned, from the earliest ages, we must remark, that about this period (the twelfth century) the study of physic began to decline in the . east. We have already seen that the destruction of the Alexandrian library, and the dispersion of the learned in different countries was productive of good. By these events, in themselves so disastrous, science was diffused: over many parts of the world, which otherwise might have remained in darkness and error. After the conquest of Rome -by Odoacer, the eastern part of this vast empire survived for many centuries. Con-

C3 stantinople, its capital, was distinguished not only by its splendour and magnificence, but by its cultivation of the arts. Men, devoted to science, here found an asylum, till its final subjugation by the Turkish arms, under Mahomet the Second. But the religion and manners of the Turks were most unfavourable to literature; they were led to circumscribe all philosophy and knowledge within the narrow limits of their own intolerant ‘and fanatical faith. It is, therefore, naturally to be supposed that individuals devoted to literary pursuits would seek elsewhere the tranquillity which the barbarity of their conquerors denied.

Many of these individuals would doubtless repair to the schools which had been established in Italy since the eighth century, from which western Europe first derived its knowledge ; and amongst these, Padua was especially famous for the cultivation of medicine. It must also be remembered that the darkness of the middle ages was now passing away ; that the dawn of that day had appeared, which, in its full splendour, was to enlighten the whole of Europe, and to create a period distinguished by historians, as ‘the revival of letters.’ The minds of men, too, were arising, perhaps for ever, from the ignorance and degradation in which they had been so long lost; and the art of printing, now fully established, had removed every serious impediment to the attainment and distribution of human learning. The accumulated stores of ' the ancients were exposed to observation and enquiry throughout Europe; and the Greek MSS. preserved after the destruction of Alexandria, and which had been already translated into the Syriac, Persian, and Indian lan- | guages, were brought from Constantinople by the learned Greeks, after the taking of that city in the year 1453. The universities of Paris and Montpelier succeeded those of Italy, and continued, till the eighteenth century, to attract not only the students of medicine, but those also who were desirous of improvement in general literature and science.

It is now time to direct the attention of our readers nearer home, and to trace before them the progress which medicine, and more especially midwifery was destined to make in England. It would be very easy to show that our own country has afforded no pleasing exception to that slow and very gradual atvy HISTORY OF MIDWIFERY.

tainment of knowledge which has marked the early history of all nations. The wars in which the Britons were so frequently engaged were little conducive to scientific attainments; and perhaps no individual before Roger Bacon, who flourished in the thirteenth century, ought to be considered as at all learned. This enquiry is, however, foreign to our purpose. The establishment of the College of Physicians in London, by the charter of king Henry VIII. in 1518, may be considered almost the first event directly favourable to the improvement of medicine. Linacre, a man, according to Dr. Freind, of a bright genius and clear understanding, as well as unusual knowledge in different parts of learning, was its first president, and remained so till his death. He published a translation in Latin of different parts of Galen, of which it has been remarked that, from the exactness and propriety of the style, it might be supposed to have been written in aclassicalage. Dr. Freind in eulogising Linacre, more especially for the foundation of the college, observes, ‘The wisdom of such an institution speaks for itself. His scheme, without doubt, was not only to create a good understanding and unanimity among his own profession (which of itself was an excellent thought), but to make them more useful to the public; and he imagined that by separating them from the vulgar empirics, and setting them upon such a reputable foot of distinction, there would always arise a spirit of emulation among men liberally educated, which would animate them in pursuing their enquiries into the nature of diseases, and the methods of cure for the benefit of mankind.’ In proof of this statement we may refer to the discovery of the circulation of the blood by Harvey, to the labours of Glisson on irritability, to those of Willis on the brain and the nervous system, and to the ereat improvement of our. knowledge of the glandular and lymphatic systems by Joliffe, Wharton, and Needham, and more especially in later times by Dr. W. Hunter.

Dr. Denman laments that Linacre did not print his works in English, in which language they would have been generally read, _ have afforded immediate instruction, stood as good examples, and taught a proper method of writing. He attributes to this defect of Linacre the continuance of English medical writers in their former style; and for many years little real progress in knowledge was made, or any titles heard of but those of Urinals, Judgment of Urynes, Anatomy of Urynes, Treasures of Health, Mirroures of Health, &c. In 1540 was published the first book on the subject of midwifery in England, entitled the Byrth of Mankynde, otherwise named the Woman’s Book, by Thomas Raynold, physician ; it underwent a second edition by Thomas Ray, a printer, whose name is not much known. It was illustrated with prints, and was held in high estimation. Dr. Raynold informs his readers that this book had been translated from the original Latin some years before by a studious and learned clerk ; who having performed the task incorrectly, he, Dr. Raynold, had been at great pains to revise and enlarge it in another translation. Its original author, according to Dr. Smellie, was Eucharius Rhodion, whose book was in great esteem all over Germany ; and in the year 1532, being translated into Latin and other languages, from the original high Dutch, became universally the Woman’s Book over all Europe, and was introduced into England, when it was translated by this Dr, Raynold.

In the year 1578 the celebrated Harvey was born at Folkstone in Kent, and, having completed his studies at Cambridge, he went to, Padua, where he graduated in 1602. In 1603 he published his treatise on generation ; and afterwards engaging in the practice of midwifery, he published his Exercitatio de partu. Sydenham also soon afterwards noticed the diseases incident to childbed women, and those of young children.

It is now proper to remark, that more general attention began to be bestowed on midwifery; its great importance, as a part of the healing art was fully appreciated; and the example of Harvey, who had personally engaged in its practice, was followed by the calling in of men practitioners in all difficult cases. Astruc assures us that the epoch of the employment of men-midwives goes no farther back than the first lying in of madame de la Valiere, mistress of Louis XIV. in 1663. She sent for Julian Clement, a surgeon of high reputation. He was conducted with great secrecy to the house, the lady’s face was covered with a hood, and the king is supposed to have been concealed in the curtains, The same surgeon was employed in the subsequent labours of this lady, and as he was very successful, men-midwives afterwards came into repute; the name of accoucheur being given them. | It is then the fact that obstetric science made but little progress in Europe till the seventeenth century. The very reverse of this appears to be the case in China.. In that empire, according to the latest accounts, both physic and surgery are still in a state of the utmost degradation; but, for some hundred years, the art of midwifery has been practised by a set of men destined to the purpose by order of government. These men, who hold in society the same rank which lithotomists formerly did in this country, are called in whenever a woman has been a certain number of hours in labour, and employ a mechanical contrivance for completing the delivery, without injury to the infant. Acertain number of these individuals is allotted to each district of a certain population. It is said that the Chinese government was led to make this provision in consequence of many women dying undelivered, and that, in the majority of cases, the obstacles might have been removed by very simple mechanical expedients.