REPORT ON OBSTETRICS 
TO THE 
American institute of fjjommrpat^n, 
■' J 
HENRY N. GUERNSEY, M. D., 
Chairman of the Bureau of Obatetrics. 
PHILADELPHIA: 
KING & BAIRD, PRINTERS, GOT SAXSOM STREET. 
1 8G7. As Chairman of the Bureau of Obstetrics, I have endeav- 
ored to secure the co-operation of all its members, in the 
preparation of a report that should embody the views and 
suggestions of all. But having as yet received no communi- 
cation from any of my colleagues, they can, in no way, be 
considered as either responsible for, or even authorizing, any 
thing contained in this paper. 
And from the fact that I am thus compelled to act alone, 
and from the pressure of other duties, I have preferred, in- 
stead of making a formal and elaborate report, simply to 
invite the attention of the Institute to a few subjects con- 
nected with the general practice of Obstetrics, which have 
appeared to me to have been overlooked entirely, or, at least, 
to have failed to receive the consideration their importance 
demands. 
I. And, in the first place, I would invite attention to the 
great suspensory ligament of the uterus in its relation to 
uterine displacements. To every member of the profession 
it is well known that the peritoneum invests every viscus and 
organ in the abdominal cavity, and that it acts as the grand 
suspensory ligament to each and all of them. 
The peritoneum, passing down on the inner surface of the 
parietes of the abdomen, and over the fundus of the bladder 
to the lower fourth of the uterus, is reflected upon and covers 
all the superior three-fourths of the anterior surface of this 
organ, its fundus, and its entire posterior surface, and from 
thence extends to the rectum, &c. The uterus is thus seen 
to be enclosed in an almost complete fold of the peritoneum, 
which is itself firmly attached to the abdominal parietes in 
every direction. At the same time, from the peculiar char- 
acter and mode of arrangement of this means of support, the 
uterus itself is capable of moving in every direction, except 
downwards, with great freedom, and without experiencing 
either loss of tone in its attachment or becoming unstable. 
But it is certain that the uterus cannot sink below its proper 
level, either perpendicularly or by being anteverted or retro- 
verted, without injury to the natural tension or proper tonicity 
of its support. Consequently, the uterus cannot be displaced 
so long as the peritoneum is in a normal state. And in order 
to cause the displaced uterus to resume its natural position, 
we have but to administer such medicines as shall restore the 
normal condition of the peritoneum. When there are me- 4 
clianical obstructions, mechanical means must of course be 
employed to reduce the displacement. Thus, in retroversion, 
the fundus uteri may become so engaged beneath the prom- 
ontory of the sacrum, and in anteversion, beneath the pubic 
arch ; or otherwise so much displaced, as in extreme 'proci- 
dentia, that it may require the use of the finger, the hand, 
and even of an instrument, to restore it to its normal position. 
When this is done, we have but removed the mechanical hin- 
drances to a radical cure of the case. For the disease does 
not in any instance consist in the condition of the womb itself, 
which may be perfectly healthy, or in the displacement which 
we have already abolished, for the moment; but in the cause 
which originally produced the displacement, and which, if 
not remedied, will infallibly produce it again. This cause 
will be found in the loss of tone or other morbid state of the 
peritoneum, or great suspensory ligament. And the morbid 
state of this extensive and complicated organ, instead of 
being a mere local weakness, will, in the great majority of 
cases, be found to be either the natural consequence of general 
debility, or, as is still oftener the case, the express develop- 
ment of some chronic disease, of some constitutional dyscrasia. 
It is from such considerations we object in toto to the entire 
class of pessaries and abdominal and uterine supporters. The 
exhibition of massive doses of morphine, in our opinion, does 
not more effectually obscure the symptoms of a neuralgic 
affection, — which it might indeed palliate, but which it could 
never cure,—than does the use of pessaries, supporters, &c., 
render impossible the radical cure of uterine displacements in 
the great majority of cases. They have had their day, and 
in the clearer light of pure Homoeopathic treatment, they are 
cast into the shade, seen to be useless and even worse than 
useless. 
The philosophy of the above mode of treatment is beauti- 
fully exemplified in the cure of hernias, even when incarce- 
rated. By means of the indicated remedy, the inflammation 
is reduced, the peritoneum returns to its normal condition 
and position, carrying back with it the displaced portion of 
intestine. 
The same principles of strict Homoeopathic treatment 
apply also to all the various organic diseases of the uterus 
itself, and of its appendages. All the several forms of ulcer- 
ation of the cervix and of the vagina, and all the various 
leucorrheal discharges from these organs, are far more suc- 
cessfully treated by the exclusive use of the properly selected 
Homoeopathic remedy. No topical application of any kind 
or sort whatever should be used. Even the injection of simple 5 
cold water into the vagina for any purpose whatever is de- 
cidedly objectionable, and should not be allowed. The more 
strictly we rely upon the real Hahnemannian principles for 
the medical treatment of women, from birth to the climacteric 
period, the more comfortable shall we render the lying in 
chamber, and the more certaiidy shall we provide for the best 
good of their offspring. In illustration of these principles, 
and in confirmation of the strict observance of them here 
recommended, innumerable cases could be adduced in which 
the most extreme suffering in childbed, where such treatment 
had not been enforced, has been converted into easy ano almost 
painless deliveries by the careful employment of Homoe- 
opathic treatment from the commencement of pregnancy. 
II. Secondly, your committee take great pleasure in an- 
nouncing that it is becoming more and more apparent every 
day that entire reliance may be placed upon the properly 
selected medicines in all cases of retained placenta; and that 
this is equally true, whether the retention occur from want of 
contraction of the uterus, or from irregular, spasmodic or 
hour-glass contractions, — however painful and protracted 
these disorders may be. 
It has been confirmed, by much experience, that the hitherto 
frightful complication of puerperal convulsions is no longer 
to be feared by him who has learned to apply the properly 
selected Homoeopathic remedy. This, indeed, is a noblo 
triumph of our art. 
And in cases of puerperal hemorrhage, we are no longer 
reminded of the tampon, the cold douche, or the insertion of 
ice, as the most efficient agents; since we feel perfectly safe 
in our certainty of the efficiency of Ipecacuanha, Sabina, 
Clmmomilla, Belladonna, Secale c., Pulsatilla, China, or 
whatever other medicine may be indicated by the particular 
condition and symptoms of our patient. 
In placenta praevia,—that hitherto most fearful complication 
which can arise in the practice of Obstetrics,—the members of 
the Institute and of the profession at large, have reason to re- 
joice that the great boon, the ne plus ultra of a proper method 
of treatment, has at last been found and proved to be perfectly 
reliable. We allude to the method proposed by Dr. D. 
Wielobycki, as described in the fourth volume of the British 
Journal of Homoeopathy, pages 43 and 395. 
This method consists in simply puncturing the membranes, 
through the placenta, by means of a female catheter, thereby 
evacuating the liquor amnii. This is to be done when labor 
is really advancing, or when no more blood can be lost with- 
out compromising the life of the patient. The fearful liemor- 6 
rhage subsides from the moment the liquor amnii commences 
to flow, and in a few moments more it ceases entirely,—by 
reason of the uterus retracting upon itself, and thereby shut- 
ting up the patulous orifices of the blood-vessels. As labor 
advances the child is now forced through the placenta, and 
delivered as in all normal cases. 
If the woman is in labor at our first visit, we do not wait 
for the catheter, but, with the finger, seek out a sulcus be- 
tween the cotyledons of the placenta; and, during a pain, 
plunge through the membranes, taking care to allow the 
liquor amnii to pass off very slowly, in order that a prompt 
retraction of the uterine fibres may shut up the thousands of 
bleeding pores. By this simple means, all mothers are uni- 
versally saved, and nearly all the offspring. And we avoid 
the fatality of the old, painful and distressing method, that 
of forcing the hand between the placenta and the uterus for 
the purpose of seizing the feet—a fatality more fearful than 
that of the deadly yellow fever of Gibraltar, the malignant 
cholera, or the plague of Smyrna, even under the allopathic 
practice. 
III. Thirdly, your committee would beg leave to enter an 
earnest protest against the use of anaesthetics in labor, and 
to urge in support of this protest the following reasons': 
1. Parturition is the last act of the grand function of re- 
production. That parturition is functional no one will pre- 
tend to deny,—then why treat it as a mere surgical operation, 
and place the pretended subject under the influence of chloro- 
form, thus abusing and degrading one of the most exalted, 
one of the most sacred functions of humanity ? 
2. Whilst under the influence of anaesthesis, no opportunity 
is afforded for morbid conditions to become manifest in the 
fulfilment of this function, and, of course, no prescription can 
be made, no matter how much it really may be needed. The 
welfare of both mother and child may now be sacrificed, 
whereas under more favorable auspices the real condition 
becomes manifest, affording indications for Nux vomica, 
Chamomilla, Kali c., Ipecacuanha, Coffea, Pulsatilla, Opium, 
Belladonna, Gelseminum, or for some other medicine, which 
might contribute to save the lives of both mother and child. 
3. By careful study and observation of the parturient 
woman, much has been learned for her benefit respecting the 
administration of medicines, and we are only just upon the 
threshold of what may yet be discovered in this department 
of our most noble art. But the administration of anaesthetics 
strikes a death-blow at further improvement in this direction, 
and will evep cause what we already know to fall into disuse. 7 
IV. In the fourth place, your committee would remark that 
the custom of bandaging recently delivered women has been 
so long and so generally observed that it might seem out of 
the question to object to it; and yet I am fully convinced that 
it is a custom which is injurious rather than beneficial, and 
one which will ere long be abandoned by all thinking and 
practical physicians. 
The fact that many women make a good recovery in spite 
of the bandaging, by no means proves that this application 
is either necessary or even useful. 
Our reasons for believing it to be both unnecessary and in 
many cases absolutely injurious, will now be briefly stated : 
1. On reference once more to the natural position of the 
uterus and to its suspensory ligament, it will be observed 
that the bandage has the effect to so elevate the fundus as to 
threaten its retroversion, and at the same time to favor its 
more ready descent into the pelvic cavity, thus causing pro- 
lapsus and finally procidentia. 
2. The real object sought to be obtained in bandaging, viz., 
to lessen the size of the abdomen after parturition, is actually 
defeated by the means used. For the natural disposition of 
all muscular structures to contract is absolutely weakened 
and diminished by the introduction of artificial means, a fact 
generally admitted. Indeed, we know from observation on a 
large scale, that the “pot-bellied women ” are found mostly 
among those who have taken the most pains in bandaging 
during their lying-in period. 
3. But the most serious objection to the use of bandages 
for lying-in women is found in their tendency to cause irrita- 
tion and to impair the circulation. And we think that this 
influence may even lead to the establishment of puerperal in- 
flammation. What else could be expected, when the abdomen 
of the recently delivered woman—which, with all its con- 
tents, is in a bruised and tender condition—is compressed 
tightly together and so confined by a heavy and cumbersome 
bandage ? Is not such a method of procedure contrary to 
reason and incompatible with sound judgment ? 
By many, as well as by myself, this practice of dispensing 
with the bandage has been fully tested, found to be far more 
comfortable to the patient and promotive of a more rapid 
convalescence. In women heretofore troubled with prolapsus 
soon after rising from their lying-in period, no symptoms of 
the kind now manifest themselves, since, unrestrained by the 
bandage, and entirely uninterfered with, the uterus is allowed 
to resume its normal position in a perfectly natural manner.