OBSTETRIC PROCEDURES AMONG THE ABORIGINES OF NORTH AMERICA. By e. McClellan, ASSISTANT SURGEON UNITED STATES ARMY. READ BEFORE THE KENTUCKY STATE MEDICAL SOCIETY. April, 1873. LOUISVILLE: PRINTED BY JOHN P. MORTON AND COMPANY. 1873. OBSTETRIC PROCEDURES AMONG THE ___ By e. McClellan, ASSISTANT SURGEON UNITED STATES ARMY. READ BEFORE THE KENTUCKY STATE MEDICAL SOCIETY, April, 1873. LOUISVILLE: PRINTED BY JOHN P. MORTON AND COMPANY. 1873. OBSTETRIC PROCEDURES AMONG THE ABORIGINES OF NORTH AMERICA. The American Journal of Obstetrics for February, 1872, contains an elaborate and learned paper on “Some Ancient Methods of Delivery,” from the pen of Goodell, one of the most successful and accomplished gynecologists of the present, who has abstracted from the works of the ancients some notable points of obstetric practice, which, although unknown to the mass of the profession at the present day, are duplicated in the methods still in vogue among some of the inhabitants of the North American Continent. During a tour of duty in the valley of the Rio Grande del Norte, which extended from the year 1867 to 1871, I was frequently called into positions wherein the peculiar thera- peutic notions of the inhabitants were exhibited. In addition to my own experience, that of many intelligent white and native residents were collated, with special reference to the gynecologic history of the Mexicans and aboriginal tribes of this most interesting portion of our country. The facts whereon this paper is based have been collected from 1. The New Mexicans, who are the descendants of the Spanish conquerors of America, intermixed with all races and nationalities, who, inheriting the vices and retaining the therapeutic lore of their ancestors, look with suspicion and distrust upon “ Gringo Medicine.” With them the ad- mixture of Americans has produced no elevating influences 4 OBSTETRICS AMONG ABORIGINES OF AMERICA. (I note the majority of instances), for the vast majority of white men who drift before the tide of civilization and swell the sum of frontier settlements, although swift and strong to strike when their sexual rights with wife or mistress are tampered with, are morally and physically debased, and in their progeny is shown the effect of procreating in defiance of hygienic laws. The civilization of the Atlantic and that of the Pacific has been divided by a terra incognita in which ignorance and vice held high carnival; but into this region, beautiful as any lighted by God’s sun, the flood of civilization has turned, and the converging lines of march from the east, from the south, and from the west meet in the wondrous parks and sunny slopes of the Sierra Madre. Under the mighty sway of that true pioneer of civilization, the hardy American frontiersman, present usages will soon be numbered with the past. From the necessities of their lives, among which mutual protection from Indian incursions and the irrigation of their grain-fields are conspicuous, the native inhabitants of Uew Mexico live in settlements along water-courses. Outlying farms until recently were unknown, and are now chiefly occupied by American settlers accustomed to depend upon themselves alone in any emergency. The villages are ar- ranged around an open square or plaza; otherwise no attempt is made at order, each family locating their house (a hut) how and where it pleases them best. These houses are but one story in height, plastered and floored with mud. In the interior the vegas or rafters are exposed, and the roof, which is formed of boards, poles, or rushes, is covered from twelve to eighteen inches with earth. They contain one or more rooms, ill lighted, badly venti- lated, and heated by a small, peculiarly-constructed fire-place and chimney wThich stands out into the room. In one of these rooms the family live, eat, and sleep. Separate sleep- ing apartments are unknown. Adults and children, married OBSTETRICS AMONG ABORIGINES OF AMERICA. 5 and single, servants and visitors, occupy colchons (the most comfortable and luxurious of beds), which are spread upon the floor of the common room. Strange that in this nineteenth century the New Mexican host and his family are conscious of no impropriety in thus admitting strangers. The only outrage to sentiment they would be conscious of would be in the guest manifesting the least interest in what might transpire around him during the night. An indolent, sensuous race, of inferior intellect from faulty forebears, it it is scarcely to be wondered that vice abounds. The men are lazy and licentious to such a degree that it is a common saying, “I love not my own wife, but all other wives.” They are courteous and hospitable to a fault. “This house and all that it contains is yours” comes from the heart of your host at the moment of utterance, no matter what may be his designs upon you at a later hour. In the outward life of the female the utmost decorum prevails. If the morals of the community are impaired, it is long before a stranger can avail himself of it. Liaisons are surrounded with difficulties and must be negotiated. A woman of the country living as the mistress of a compartiot or of an American considers herself his wife, and for the time devotes her person to him alone. Among the lower classes the degradation of woman is an accomplished fact. The Spanish conquerors held their female captives as slaves for their sexual purposes, not infre- quently adding the indignity of branding them with their owner’s mark. Succeeding generations have but partially improved her condition; she is still the slave of her father, brother, or husband, who not infrequently prostitute her for their profit; and it is only in the present decade that efforts at her social improvement have been made. Among the better classes promiscuous sexual intercourse, as far as the unmarried are concerned, is almost entirely un- known. While parents upon one hand expose their children 6 OBSTETRICS AMONG ABORIGINES OF AMERICA. to imaginative excitation, they guard their persons with considerable care. Except in the larger towns, defiant prostitution is unknown. Menstruation is established between the thirteenth and fifteenth year among those who constitute the better class; but among the lowest—those in whose lives scenes are con- stantly being enacted which rival in iniquity those reported by Cobden or Mayhew, or, lacking the refinements of vice, equal those of Constantinople or other Mahommedan cities— it occurs from one to two years earlier. Among such people additional arguments may be found to favor the theory “that precocious menstruation” is influenced more by licentious practices than climatic influences or hereditary peculiarity. Nor in this case can the argument against such theory be advanced “that the utter depravity and promiscuous co- habitation of the lowest English peasantry and the lewdest classes in such cities as London, Liverpool, Manchester, and Birmingham does not induce precocious menstruation.” It must be borne in mind that female children in such condition are both underfed and overworked, while among the New Mexicans the children lead an idle life, with naught to dis- tract them from their natural inclinations; that at an early age they become addicted to the use of tobacco; and that chile or pepper, green or dried, is an invariable condiment of all meals, and used to an excess that rivals the Indian use of curry. Marriages occur at an early age, often before the men- strual functions have been established. Subjected thus early to the incidents of matrimony, the early menstrual months are periods of irregularity and suffering. Diseases of the uterus and its appendages are developed at an early period. More than one instance came to my knowledge in which ovulation was followed by impregnation, but the wife never menstruated until one or more children had been borne. The disorders to which these females are liable can in part be attributed to the neglect of hygienic laws and the OBSTETRICS AMONG ABORIGINES OF AMERICA. 7 indolent life which they lead. The surface of their body is rarely protected, save by a chemise, skirt, and shawl. Under- garments are almost unknown. The extreme altitude of the territories occupied by their race, the sudden and great varia- tions of temperature to which they are exposed, are fruitful sources of uterine diseases, while the peculiar domestic relations and the stimulating diet which have already been noted, combined with the erotic imaginations of indolent vice, co-operate. “To excite, but always in vain, is to pro- voke disease, irritate the body, and desiccate the soul.” Abortions are rarely procured; sexual frauds (so-called) are never attempted; infanticide is almost unknown. Mas- turbation prevails to some extent among both sexes. 2. The Pueblo, Apache, Navajoe, and Ute Indians.— In the year 1540 the Mexican Viceroy Mendoza, attracted by the wondrous stories of the Indians of Mexico, dispatched Coro- nada with an army to invade “the country of the seven cities.” The Spanish commander crossed the Rio Grande, the deserts of New Mexico, wandered through the “ Cibola or Buffalo Country,” and, led on by the delusive stories of his guides, even crossed the mountain-chain to the headwaters of the Arkansas. Retracing his steps, at last upon the banks of the Rio Puerco of the West he came upon the Seven Pueblos of the Moqui Indians, so numerously inhabited that in 1850 they are reported as containing 10,850 souls. He here found a race identical with the Indians, who had been already conquered in Mexico, living in towns peculiar in their con- struction, and from whence their name was derived. It is these Indians, of whose forcible conversion the ro- mantic histories of the Spanish conquest teem, who once and again arose in strength and all but exterminated their oppressors. They still live in permanent settlements, culti- vate farms, and, although baptized in the ritual of the Roman Church, retain the language, dress, and traditions of their ancestors. They mix constantly with the other inhabitants of the country, but instances of intermarriage are rare. OBSTETRICS AMONG ABORIGINES OF AMERICA. 8 The early history of the Apache Indians is involved in great obscurity. Their ancient lines of depredation corre- spond with those of to-day; and authorities make no doubt that to them should be attributed the destruction of that semi-civilization of which traces are to be found on the Rio Gila. Coronada found them to be as tierce, sanguinary, and treacherous as do the frontiersmen of to-day. Living in huts made of brush, they range through the headwaters of the Gila, in the Sierra del Mogoyen, where their rancheries are almost impregnable to their enemies, and where by a series of signal-tires they muster bands of marauders. Promiscuous sexual intercourse among the unmarried of the tribe is common. They are polygamists. The women are unclean and debased. The Havajoes are undoubtedly a branch of the Apache tribe, although the date of separation is unknown, occupying a rugged, mountainous region, living, in the rudest of huts, a drunken, worthless life. From a brave and warlike race they have degenerated morally and physically. The women are debased and prostituted to the vilest purposes. Syphilitic diseases abound. The Utes, inhabiting the elevated plains of New Mexico and Colorado, are brave and warlike, but suspicious and perfidious. Polygamy exists among them. Their females are rigidly secluded from strangers, and they compare most favorably with those of the other tribes. These Indian tribes, having been always hostile to other residents of the country, as well as to each other, have been accustomed to make an occasional truce with Mexican settle- ments, from whom they receive many of the necessities of their lives, and for years a trade was carried on in the sale of peons or slaves of those unfortunates captured from each other. The female peon invariably became the mistress as well as the drudge of the Mexican. She was held in per- petual bondage, save when a raid of her tribe might be made upon the settlement in which she was held, when possibly OBSTETRICS AMONG ABORIGINES OF AMERICA. 9 she might escape, taking with her all the impressions of her captivity. A female captive of the whites or Mexicans rarely escaped. Should she survive the first atrocious sexual indignities to which she was subjected, she became the wife of some “buck” and the mother of his children. In these tribes menstruation is established at from the fourteenth to the sixteenth year. Menstrual disorders are common, but they seldom reach the eye of intelligence. Menstrual superstitions abound. At this period the woman is “ unclean; ” “she must not remain in camp, but must live apart.” They are married young, without reference to men- struation; pregnancies are delayed, and families rarely con- tain over three children. Twins, triplets, or monstrosities are almost unknown. Among Indians pregnancy and parturition are fraught with the same dangers as they are to civilized women, although the exposed lives they lead prepare them to brave and overcome perils to which delicate women succumb. That easy and unassisted labors occur there is no attempt to deny. Indian women do step out from the line of march into the brush and at night come into camp with a new-born child. Authentic instances are in our possession of delivery being effected in strange positions and under curious sur- roundings. One in which a Blackfoot woman, taken in labor at a frontier house, went out of doors to a sheltered position on a snow-bank, there delivered herself of the child, and returned to the house; another, of an Osage, who was taken in labor while on horseback and on the march; she delivered herself and dressed the baby, although her pony never left the trail; but it must be known that she was riding upon a large, broad pack, upon which she could re- cline. These cases, however, for heroism do not compare with the young woman whose case is related by Dr. Bassett, who unassisted performed the cesarian section upon herself while lying upon a snow-drift. 10 OBSTETRICS AMONG ABORIGINES OF AMERICA. The fact having been established that the destinies of these four families or races were at an early day influenced by the Spanish conquerors of America, who brought with them the practices and superstitions of the mother country; and who, to preserve the object of their lewd desires, if not actuated by sentiments of affection, would afford them assist- ance during parturition; it will not he wondered that we shall find among their notions of obstetric aids many simi- larities to the procedures which Goodell has collated from the ancients, even to the Homeric version of the posture assumed during labor by the mother of Apollo and Diana. To the Mexican female parturition is attended with greater danger than it is to those of more civilized races, on account of the extraordinary manipulations to which they are sub- jected by their attendants. The fact has already been noted that in the houses inhabited by them the rafters are in- variably uncovered. In commencing housekeeping their arrangements would he incomplete without two strong iron hooks, which are driven into said rafters about two and a half or three feet apart. The location selected is generally a little off the center of the roof and toward the fire-place and chimney, said hooks being destined to play an important part in the obstetric history of the family. The patient having declared the occurrence of labor-pains, all the near friends of the family are summoned, male as well as female. Two stout ropes are secured to the afore- mentioned hooks, the floor beneath them is covered with undressed sheep-skins, and upon these the patient kneels, with her thighs widely separated, her body maintained in its upright posture by aid of the ropes. A male, selected on account of his strength, and to whom the term “el tenador” (the one who holds) is applied, now places himself on the floor behind the patient, encircles her waist with his arms, so/ that her buttocks rest upon his abdomen, and commences a steady, constant, and oftentimes violent pressure upon the uterine tumor. The midwife stations herself upon the floor, OBSTETRICS AMONG ABORIGINES OF AMERICA. 11 but in front of the patient. Her duty now is to knead, and, if too long a period occurs between the pains, to seize the abdomen with both hands and execute a series of spasmodic jerks. When not thus employed she constantly manipulates in order to soften the genitalia. In this position and thus assisted the patient is kept until nature, assisted by the strength and awkwardness of the attendants, effects the delivery, or they become convinced that some other procedure must be resorted to. During all this time “el tenador” keeps up his pressure, increased when the pain conies on, and if possible never relaxed, so that the advance gained may not be lost. No care is taken of the perinseum, nor does the idea occur to them that this may be necessary; they expect it to “ rip,” and if an unusual laceration occurs the patient suffers in silence. The child having been delivered, the patient is placed upon her back and allowed to rest for a time. If the placenta be not expelled, they proceed to effect its delivery by strongly compressing the abdominal walls, by traction on the funis, and by shifting the patient from one side to the other. When successful the woman is placed upon her bed with unchanged clothing, a long, narrow woolen band is wrapped many times around her abdomen, her head is bound with linen cloths, and she is ready to receive the congratulations of her friends. As to the child, a rather curious custom prevails as to the treatment of the cord. It is cut from three and one half to four inches in length, a stout ligature is applied about one inch and a half from the umbilicus, when the midwife with a brand of fire proceeds to char and roast all that portion beyond the ligature. Many superstitions exist by which different communities are influenced as regards the treat- ment of the cord. All unite in affirming the necessity of adopting measures which will prevent the cord from ascend- ing within the maternal abdomen, thus becoming lost; and once lost the only guide to the “after-birth” is gone. Some 12 OBSTETRICS AMONG ABORIGINES OF AMERICA. midwives will not sever the cord until the placenta is ex- tracted; others make hold to do so, hut always adopt the precaution of attaching the placental extremity hy a stout cord to the thigh of the patient. So much for cases in which nature asserts her power and delivers the unhappy woman from her tormenters. In cases where much delay occurs, or where after the labor has progressed a considerable time the midwife can not feel the descending head, although profoundly igno- rant of presentations and positions, she announces that some other procedure must he resorted to. Before adopting the more complicated of their devices they endeavor to soften the parts by applications of steam and smoke. To accom- plish this a basin is filled with glowing embers, upon which is sprinkled a powdered aromatic root, the basin is placed between the thighs of the kneeling woman, and its exhibi- tion is continued from twenty to thirty minutes; or a large vessel of water in which is placed certain herbs is caused to boil and the vapor to arise to the person of the patient. These simple means being ineffectual, the patient is caused to stand upright, when, several of the strongest persons present taking her by the shoulders and knees, she is vio- lently shaken, which exercise is closed by a series of short, sharp, wrenching jerks. She is then placed again in the “ ropes,” and the squeezing process is resumed. Being still unable to deliver the child, the operation is repeated, and if still unsuccessful it is varied by suspending the patient head downward, her person being held as in the preceding maneuver. Should these efforts be still unsuccessful, the midwife announces that it is necessary to change the position of the child. She proceeds to remove all articles of cloth- ing from the lower portion of the patient’s person. A large, shallow wooden bowl is placed over her abdomen and turned quickly from right to left with a grinding motion. Should this still prove ineffectual, a horseman is dispatched for the nearest American doctor, a rosary is placed about the OBSTETRICS AMONG ABORIGINES OF AMERICA. 13 patient’s neck, and all present join in commending her to the saints. San Ramon or La Nina (the Virgin) are the most powerful to whom recourse can now be had; and as the doctor often lives fifty, sixty, or more miles away, ample time is afforded for their intervention. If one will not help, in spite of candles or other offerings, the other will surely take ad- vantage of his or her colleague, and lend his or her most efficient aid. But saints, even the best, seem at times disin- clined to aid humanity, or they may be too much occupied with other affairs, when the only recourse the poor mortals can have is to discover the particular saint on duty at that particular time. A large candle is notched with the thumb- nail to ten, fifteen, or more equal spaces; each space is designated by the name of some saint; the candle is lighted, and as soon as it burns down to the allotted portion of the then well-inclined saint he will help right willingly, and try his best to effect delivery before his short time melts away. But with the passing light of the candle wanes the strength and life of the poor patient, buffeted and distressed, rent by useless, senseless torture; and not unfrequently she passes to her final rest with a smile at last upon her tired, weary face, while the earnest, anxious doctor is galloping weary miles, trusting he may yet be in time to afford her some relief. Of our professional brethren, he who devotes himself to the relief of suffering humanity in frontier settlements surely earns the brightest crown. The remarks of the President of the American Medical Association, at its last meeting, on the “ pine-board hut” which served as home and office for the doctor of a Rocky Mountain railroad station, apply with equal cogency to hundreds of our profession. To our mind arises the face of a valued friend, a pupil of the illustrious Niemeyer, who devotes his life to an almost missionary work among the Mexicans. Separated from his home and kins- men, undeterred by the pangs of hunger or fatigue, undis- 14 OBSTETRICS AMONG ABORIGINES OF AMERICA. mayed by the dangers of field or flood, by day and by night, he renders to the ignorant and superstitious inhabitants pro- fessional services which in older countries would secure to him the smiles of fame and fortune. The description which has been given is the modern prac- tice of obstetrics among these people. Until quite recently the obstetric chair or stool was in vogue among them. Of what the ancient stool consisted we have been unable to learn; the modern was a large chair, in which “ el tenador ” first seated himself; then the patient squatted upon his knees, with the inevitable arm and rope accompaniment. The obstetric customs of the Pueblo Indians closely fol- lows that of the Mexicans, if they are not in all points identical. The Apache woman when labor commences is placed in a small hut and left to herself. Should her band be upon the move, sufficient food is left with her, and she is aban- doned to her fate. If the labor terminates favorably, as it most always does, she regains her party. But instances are known in which scouts through the country infested by these Indians have discovered the remains of mother and child in these isolated huts. The Navajoes, from being many years in a state of sub- jection, have adopted many of the customs of the Mexicans. A fatal termination of labor is rare. The parturient female assumes the posture of the Mexican in similar cases, and is supported by a lariat thrown over a limb of a tree, or she supports herself from a low branch. But the assistant is now in front, and aids the woman during pains by a finger inserted at the umbilicus, from which point pressure is made steadily upon the fundus uteri. The Ute female in summer accomplishes her labor in the open air, squatting or kneeling by a tree which they may conveniently grasp. They are assisted by a band passed around their abdomen, and which is managed by an old woman. Lingering labors are treated as by the Mexicans, OBSTETRICS AMONG ABORIGINES OF AMERICA. 15 with the exception of rapid and violent changes of position, the patient being suspended in a blanket or robe. To what accident may not a parturient female of these nations be subjected? To them the promise is indeed ful- filled : “ I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children.” But the same almighty power to whom the devout Arabian physician ascribes the determining cause of labor—“At the appointed season labor comes on by the command of God”—carries the majority successfully through their trials. A friend, who has acquired a considerable obstetric ex- perience among their people, remarks: “ It is suprising with how little difficulty girls of fourteen or fifteen years of age are delivered in childbirth. It is by no means an unusual occurrence for a labor to be terminated in six or less hours, and the only difficulty experienced is in persuading them to remain recumbent a sufficient time.” Hemorrhagic labors are frequent. The American physi- cian is most frequently called from that cause; and also to deliver the placenta. Nor is it surprising that inertia or irregular contractions should succeed the treatment to which the patient has been subjected. Thrombi of the labia and vulva are frequently met with; while ruptures of the uterus, situated fortunately most fre- quently at the cervix, are by no means rare. Two cases of fracture of the ribs from the violence of attendants came under our notice. For retained placenta the midwife has no remedy save binding a cord around the abdomen of the patient, and this, with an occasional dose of a powder obtained by burning the ears of a freshly-killed hare, is the only means at her command for arresting hemorrhage. Tradition, in the set- tlement of points to an old woman who was taught by a Padre to taKe the after-birth by the hand; but she was probably a myth. At all events she has left no successor.