Five Points—Visceral List—Care in Treating the Spinal Column—Most Important Chapter—Perfect Drainage—A Natural Cure.
Five Points—Visceral List—Care in Treating the Spinal Column—Most Important Chapter—Perfect Drainage—A Natural Cure.
The five points of observation will cover easily the whole body, and we cannot omit any one of them, and successfully examine any disease of the system. Local injuries are, however, an exception to this rule, and even a local hurt often causes general effect. Suppose a fall should jar the lumbar vertebra, and push it at some articulation, front, back, or laterally; say the lumbar, with one or two short ribs turned down against the lumbar nerves with a prolapsed and loosened diaphragm, pressing heavily on the abdominal aorta, vena cava, and thoracic duct; have you not found cause to stop or derange the circulation of blood in arteries, veins, lymphatics and all other organs below diaphragm? Then heart trouble would be the natural result. Fibroid tumors, painful monthlies, constipation, diabetis, dyspepsia or any trouble of the system that could come from bad blood would be natural results, because lymph is too old to be pure when itenters the lungs for purifying. If blood or chyle is kept too long below the diaphragm, it becomes diseased before it reaches the lungs, and after renovation, but little good blood is left. Then the dead matter is separated from blood and blown out at the lungs while in vapor. Thus nutriment is not great enough to keep up normal supply. In this stage the patient is low in flesh and feeble generally, because of trouble with blood and chyle to pass normally through the diaphragm.
The failure of free action of blood produces general debility, congestion, low types of fever, dropsy, constipation, tumefaction and on to the whole list of visceral of diseases.
From this we are called to the pelvis. If the innominate bones are twisted on sacrum or are driven too high or too low, an injury to the sacral system of blood and nerves would be cause equal to congestion, inflammation of womb or bladder-diseases, with a crippled condition of all the spinal nerves. This would be cause enough to produce hysteria, and on to the whole list of diseases to spinal injuries. The Osteopath has great demands for his powers of reason when he considers the relation of diseases generally to the pelvis; and thisknowledge he must have before his work can be attended with success.
As I said, five points comprise the fields in which the Osteopath must search. I have given you quite pointedly and at length, hints on spine and sacrum which cover the territory below the diaphragm. In conclusion I will simply refer you to the chest, neck and brain, and say, "let your search light ever shine bright on the brain." On it we must depend for power. About all nerves do run through the neck and branch off to supply both above and below, to do their parts in animal life, to the heart, brain and sum total of man and beast. Search faithfully for cause of diseases in head, neck, chest, spine and pelvis; for all organs, limbs and parts are directly related to and depend on these five localities to which I have just called your attention.
With your knowledge of anatomy, I am sure you can practice and be successful, and should be in all cases over which Osteopathy is supposed to preside.
I want to offer you the facts, not advice, but pure and well sustained facts, the only witnesses that ever enter the courts of truth. A spinal cord is a fact; you see it—thus a fact. That which youcan see, feel, hear, smell or taste is a fact, and the knowledge of the ability of any one fact to accomplish any one thing, how it accomplishes it and for what purpose, is a truth sought for in philosophy. The spinal cord is the present fact for consideration. You see it, you feel it, thus you have two facts with which you can start to obtain a knowledge of the use of this spinal cord. In it you have one common straight cylinder which is filled with an unknown substance, and by an unknown power wisely directed. It is wisely formed, located, and protected. It throws off branches which are wisely located. They have bundles, many and few; they are connected to their support, which is the brain, by a continuous cord in length and form to suit. After it has concluded throwing off branches at local places for special purposes, then like a flashlight, it throws off a bundle of branches called horse-tail plexus,caudae equinae, which simply signifies the many branches that convey fluids and influences to the extremities, to execute the vital work for which they are formed and located. While the laws of life and their procedure to execute and accomplish the work designed by nature for them to do, is mysterious and to the finite mind incomprehensible, you can only see what they do or perform, after the work is done and ready for your inspection.
Now as we are dealing with the omnipresent nerve principle of animal life, I will tell you this one serious truth, and support it by the fact of observation. To treat the spine, and thereby irritate the spinal cord oftener than once or twice a week will cause the vital assimilation to be perverted, and become the death-producing excretor, by producing the abortion of the living molecules of life, before fully matured, while in the cellular system, which lies immediately under the lymphatics.
Your patients will linger long from the change of the nutrient ducts to throw off their dead matter into the excretories, which death was caused by the undue, or too many treatments of the spinal cord. If you will allow yourself to think for a moment, or think at all of the spinal cord being irritated, and what effect it will have on the uterus you will realize that I have told you a truth, and produced an array of facts to stand by that truth. Many of your patients are well six months before they are discharged. They are kept on hands because they are weak, and they are weak, because you keep them so from irritating the spinal cord. Throw off your goggles and receive the rays of the sunlight which forever stand in the bosom of reason.
This is the most important chapter of this book, because at this point the engine of life is turned over to you as an engineer and by you it is expected to be wisely conducted on its journey.
Your responsibility here is doubled. Your first position is that of a master mechanic, who is capable of drawing plans and writing minutely a specification whereby the engineer may know what a well constructed machine is in every particular. He knows the parts and relations of both as constructor and operator, and you are supposed to be the foreman in the shop of repairs. The living person is the engine, nature the engineer, and you the master mechanic.
This being your position it is expected that you will carefully inspect all parts of the engines run into your repair shop, note all variations from the truly normal, and adjust from those variations as nearly as possible to the conditions of the true specimen that stands in the shop.
At this point it will be proper to suppose a case by way of illustration. Suppose by some accident the bones of the neck should be thrown at variance from the normal to a bend or twist. We may then expect inharmony in the circulation of theblood to the head and face with all the organs and glands above the neck. We will find imperfect supply of blood and other fluids to the head. We may expect swelling of head and face with local or general misery. Thus you have a cause for headache, dizziness, blindness, enlarged tonsils, sore tongue, loss of sight, hearing, memory, and on through the list of head diseases, all because of perverted circulation of the fluids of the brain proper of any local division. It is important to have perfect drainage, for without it, the good results from a treatment cannot be expected to follow your efforts to relieve diseases above the neck.
Here I want to emphasize that the word treat has but one meaning, that is to know you are right, and do your work accordingly. I will only hint, and would feel embarrassed to go any farther than to hint to you, the importance of an undisturbed condition of the five known kinds of nerves, namely: sensation, motion, nutrition, voluntary and involuntary, all of which you must labor to keep in perpetual harmony while treating any disease of the head, neck, chest, abdomen, pelvis, spine and limbs.
If you would allow yourself to reason at all, you must know that sensation must be normal andalways on guard to give notice by local or general misery, of unnatural accumulation of the circulating fluids. Each set of nerves must be free to act and do their part. Your duty as a master mechanic is to know that the engine kept is in so perfect a condition that there will be no functional disturbance to any nerve, vein, or artery that supplies and governs the skin, the fascia, the muscle, the blood or any fluid that should freely circulate to sustain life and renovate the system from deposits that would cause what we call disease.
Your Osteopathic knowledge has surely taught you, that with an intimate acquaintance with the nerve and blood supply, you can arrive at a knowledge of the hidden cause of disease, and conduct your treatment to a successful termination. This is not by your knowledge of chemistry, but by the absolute knowledge of what is in man. What is normal, and what abnormal, what is effect and how to find the cause. Do you ever suspect renal or bladder trouble without first receiving knowledge from your patient, that there is soreness and tenderness in the region of the kidneys at some point along the spine. By this knowledge you are invited to explore the spine for the purpose of ascertaining whether it is normal or not. If by your intimate acquaintance and observance of a normal spine you should detect an abnormal form although it be small, you are then admonished to look out for disease of kidneys, bladder or both, from the discovered cause for disturbance of the renal nerves by such displacement, or some slight variation from the normal in the articulation of the spine. If this is not worthy of your attention, your mind is surely too crude to observe those fine beginnings that lead to death. Your skill would be of little use in incipient cases of Bright's disease of the kidneys. Has not your acquaintance with the human body opened your mind's eye to observe that in the laboratory of the human body, the most wonderful chemical results are being accomplished every day, minute and hour of your life? Can that laboratory be running in good order and tolerate the forming of a gall or bladder stone? Does not the body generate acids, alkalies, substances and fluids necessary to wash out all impurities? If you think an unerring God has made all those necessary preparations, why not so assert, and stand upon that stone?
You cannot do otherwise, and not betray your ignorance to the thinking world. If in the human body you can find the most wonderful chemical laboratory mind can conceive of, why not give more of your time to that subject, that you mayobtain a better understanding of its workings? Can you afford to treat your patients without such qualification? Is it not ignorance of the workings of this Divine law that has given birth to the foundationless nightmare that now prevails to such an alarming extent all over civilization, that a deadly drug will prove its efficacy in warding off disease in a better way than has been prescribed by the intelligent God, who has formulated and combined life, mind and matter in such a manner that it becomes the connecting link between a world of mind, and that element known as matter? Can a deep philosopher do otherwise than conclude that nature has placed in man all the qualities for his comfort and longevity? Or will he drink that which is deadly, and cast his vote for the crucifixion of knowledge?
The Vermiform Appendix—Operating for Appendicitis—Expelling Power of the Vermiform Appendix—Care Exercised in Making Assertions—Reasoning Tests—A List of Unexplained Diseases—Concluding Remarks.
The Vermiform Appendix—Operating for Appendicitis—Expelling Power of the Vermiform Appendix—Care Exercised in Making Assertions—Reasoning Tests—A List of Unexplained Diseases—Concluding Remarks.
At the present time more than at any other period since the birth of Christ, the medical and surgical world have centralized their minds for the purpose of relieving locally inside, below the kidney of the male or female, excruciating pain, which appears in both sexes in the region above described.
From some cause, possibly justifiable, it has been decided to open the human body and explore the region just below the right kidney in search of the cause of this trouble. Such explorations have been made upon the dead first. Small seeds and other substances have been found in the vermiform appendix, which is a hollow tube over an inch in length. These discoveries, as found in the dead subject, have led to explorations in the same location in the living. In some of the cases, though very few, seeds and other substances have beenfound in the vermiform appendix, supposed to be the cause of local or general inflammation of the appendix. Some have been successfully removed, and permanent relief followed the operation. These explorations and successes in finding substances in the vermiform appendix, their removal, and successful recovery in some cases, have led to what may properly be termed a hasty system of diagnosis, and it has become very prevalent, and resorted to by the physicians of many schools, under the impression that the vermiform appendix is of no known use, and that the human being is just as well off without it.
Therefore it is resolved, that as nothing positive is known of the trouble in the location above described, it is guessed that it is a disease of the vermiform appendix. Therefore they etherize and dissect down for the purpose of exploring, to ascertain if the guess is right or wrong. In the diagnosis this is a well-defined case of appendicitis; the surgeon's knife is driven through the quivering flesh in great eagerness in search of the vermiform appendix. The bowels are rolled over and around in search of the appendix. Sometimes some substances are found in it; but often to the chargrin of the exploring physician, it is found to be in aperfectly healthy and natural condition, and so seldom is it found impact with seeds or any substance whatever, that as a general rule it is a useless and dangerous experiment. The per cent of deaths caused by the knife and ether, and the permanently crippled, will justify the assertion that it would be far better for the human race if they lived and died in ignorance of appendicitis. A few genuine cases might die from that cause; but if the knife were the only known remedy, it were better that one should occasionally die than to continue this system, at least until the world recognizes a relief which is absolutely safe, without the loss of a drop of blood, that has for its foundation and philosophy a fact based upon the longitudinal contractile ability of the appendix itself, which is able to eject by its natural forces any substances that may by an unnatural move be forced into the appendix.[8]
To a philosopher such questions as this must arise: Has the appendix at its entrance a sphincter muscle similar in action to that of the rectum and œsophagus? Has it the power to contract and dilate?—contract and shorten in its length and eject all substances when the nerves are in a normal condition? And where is the nerve that failed to execute the expulsion of any substance that may enter the cavity of the appendix? Has God been so forgetful as to leave the appendix in such condition as to receive foreign bodies without preparing it by contraction or otherwise to throw out such substances? If He has He surely forgot part of His work. So reason has concluded for me, and on that line I have proceeded to operate for twenty-five years without pain or misery to the patient, and given permanent relief in all cases that have come to me. With the former diagnosis of doctors and surgeons that appendicitis was the malady, and the choice of relief was the knife or death, or possibly both, many such cases have come for Osteopathic treatment, and examination has revealed that in every case there has been previous injury to someset of spinal nerves, caused by jars, strains or falls. Every case of appendicitis, gall or renal stones can be traced to some such cause. These principles I have proclaimed and thought for twenty-five years.
We should use much caution in our assertions that nature had made its work so complete in animal forms and furnished them with such wisely prepared principles that they could produce and administer remedies to suit, and not leave the body to find them. Should we so conclude and find by experiment that man is so arranged, and wisely furnished by deity as to ferret out disease, purify and keep the temple of life in ease and health; we must use great care when we assert such is not undeniably true up to the present. The opposite opinion has had full sway for twenty centuries at least, and man has by habit, long usage, and ignorance so adjusted his mind to submit to customs of the great past that should he try, without previous training, to reason and bring his mind to such altitude of thought of the greatness and wisdom of the infinite, he might become insane or fall back in a stupor, and exist only as a living mental blank in the great ocean of life, where beings dwell without minds to govern their actions. It would be a great calamity to have all the untrained minds shocked so seriously as tocause them to lose the mite of reason they now have, and be sent back once more to dwell in Darwin's protoplasm. I tell you there is danger, and we must be careful and show the people small stars, and but one at a time, till they can begin to reason and realize that God has done all that the wisest can attribute to Him.
There is but one method of reasoning. That method is by the laws governing the subject to be reasoned upon.
Reasoning is the action of the mind while hunting for truths.
As we are about to camp close to the abdomen for a season of explorations and a more reasonable knowledge of its organs and their functions, we will search its geography first, and find its location on the body or globe of life. We find a boundary line established by the general surveyor, about the middle of the body, called the diaphragm. This line has a very strong wall or striated muscle that can and does dilate and contract to suit for breathing, and quantities of food that may be stored for a time in stomach and bowels for use. The abdomen is much longer than wide. In short, it is a house or shop builded for manufacturing purposes. In it wefind the machinery that produces rough blood or chyle, and sends it to heart and lungs to be finished to perfect living blood, to supply and sustain all the organs of this division. This diaphragm or wall has several openings through which blood and nutriment pass to and from abdomen to heart, lungs and brain. I want to draw your special attention to the fact that this diaphragm must be truly normal. It must be anchored and held in its true position without any variation, and in order that you shall fully understand what I mean, I will ask you to go with me mentally to all the ribs, beginning with the sternum, see attachments, follow across with a downward course to the attachments of this great muscular septum to the lower lumbar region, where the right crus receives a branch or strong muscle from the left side, and the left crus receives a muscle from the right which becomes one common muscle known as the left crus, the same of the right crus receiving a muscle or tendon from the left, which you will easily comprehend from examining descriptive cuts in Gray, Morris, Gerrish, or any well illustrated work of anatomy. You see at once a chance for constriction of the aorta by the muscles under which it passes, causing without doubt much of the disease known as palpitation of the heart, which is only a bouncing back of the blood that has been stopped at thecrura. Farther away from the spine near the center of the diaphragm we find the return opening through this wall, provided to accommodate the vena cava. To the left a few inches below the vena cava we find another opening provided for the œsophagus and its nerves; like the aorta, it has two muscles of the diaphragm crossing directly between œsophagus and the aorta, in such shape as to be able to produce powerful prohibitory constriction to normal swallowing.
At this point I will draw your attention to what I consider is the cause of a whole list of hitherto unexplained diseases, which I think are only effects, caused by the blood and other fluids being prohibited from doing normal service by constrictions at the various openings of the diaphragm. Thus prohibition of free action of the thoracic duct would produce congestion of receptaculum chyli, because of not being able to discharge its contents as fast as received. Is it not reasonable to suppose a ligation of the thoracic duct at the diaphragm would retain this chyle until it would be diseased by age and fermentation, and be thrown off into the substances of other organs of the abdomen and set up new growths, such as enlargement of the uterus, ovaries, kidneys, liver, spleen, pancreas, omentum,lymphatics, cellular membranes, and all that is known as flesh and blood below the diaphragm? Have you not reason to explore and demand a deeper and more thorough anatomical knowledge of the diaphragm and its power to produce disease while in an abnormal condition, which can be caused by irritations, wounds or hurts, from the base of the brain to the coccyx? Remember this is an anatomical and philosophical question that will demand your attention to the mechanical formation, physiological action and the unobstructed privileges of fluids when prepared in the laboratory of nature, to be sent at once to their ordained destination, before such substances are diseased or dead with age. You must remember that you have been well drilled, or talked out of patience in the room of symptomatology and all you have learned is, something ails the kidneys, and are told their contents when analyzed are not normally pure urine. In urinalisis you are told "here is sugar," "here is fat," "here is iron," "here is pus," "here is albumen," and this is diabetis, this is Bright's disease, but no suggestion is handed to the student's mind to make him know that these numerous variations from normal urine are simply effects, and the diaphragm has caused all the trouble, by first being irritated from hurts, by ribs falling, spinal strains, wounds and on from the coccyx to the base of thebrain. Symptomatology is very wide and wise in putting this and that together and giving it names, but fails to give the cause of all these abdominal lesions. Never for once has it said or intimated that the diaphragm is prolapsed by misplaced ribs to which it is attached, or that it is diseased by hurts of spine and nerves above its own location. Allow yourself to think of the universality of the distribution of the superior cervical ganglion and other nerves which are of such great importance that I will by permission insert in the last chapter of this book a description of that great system of the sympathetic nerves by Dr. Wm. Smith, whose superior knowledge of anatomy makes him eminently qualified to describe the location and uses of this great sympathetic system of the nerves of life.
As you read his able essay remember there are four other sets of nerves equal to, and just as important in their divisions of life, which are the motor, nutrient, voluntary and involuntary. All of which you as an engineer must know, and by proper adjustment of the body give them unlimited power to perform their separate and united parts in sustaining life and health. Now as I have tried to place into your hands a compass, flag and chain that will lead you from effect to cause of disease inany part or organ of the whole abdomen I hope that many mysteries which have hung over your mental horizon will pass away, and give you abiding truths, placed upon the everlasting rock of cause and effect. You have as little use for old symptomatology as an Irishman has for a cork when the bottle is empty. Osteopathy is knowledge, or it is nothing.
Overloading—Similarity of Stomach and Womb—Births—Preparation for Delivery—Caution—Lasceration Need Not Occur—Care of Cord—Severing Cord—Putting on Belly Band—Delivery of Afterbirth—Preparing for Mother's Comfort—Post-Delivery Hemorrhage—Treatment for—Food for Mother—Treatment for Sore Breast.
Overloading—Similarity of Stomach and Womb—Births—Preparation for Delivery—Caution—Lasceration Need Not Occur—Care of Cord—Severing Cord—Putting on Belly Band—Delivery of Afterbirth—Preparing for Mother's Comfort—Post-Delivery Hemorrhage—Treatment for—Food for Mother—Treatment for Sore Breast.
When in the course of human events and actions of life, a woman disregards the laws of nature to such an extent as to overload the stomach beyond its powers and limits; or another way to present the thought, we will say, if you fill the stomach so full as to occupy all space, or so much of the space as to cripple the laws of digestion and retain the food, the decomposition sets up an irritation of the nerves of mucous membrane to such a degree as to cause sickness and vomiting, or any other method of disgorging the stomach, which is the natural process to unload an overloaded vessel. When the nerves cannot take up nutrition, they will then take up destruction and other elements which are detrimental to the process of nutrition, and there is no other process for relief but to unload. The loading that has been deposited in the stomach was for the purpose of sustaining a being. The stomach itself is a sack. When filled to its greatest capacity, it irritates all the surroundings, and in return they irritate the stomach. Thus it unloads naturally for relief. Now we wish to treat of another vessel similar in size, similar in all its actions, which receives nourishment for a being, which nourishment is contained in the blood, and conveyed from the channels commonly known as uterine arteries. To all intents and purposes this nourishment is taken there to sustain animal life, after having constructed the machinery then it appropriates the blood to the growth and existence of a human being. One is the womb, the other the stomach. The placenta in the womb is provided with all the machinery necessary to the preparation of blood, such as is used for all purposes in forming and developing a child. Which is the stomach? Which is the womb? and what is the difference? Both receive and distribute nourishment to sustain animal life. Both get sick, both vomit when irritated and discharge their loading by the natural law of "throw up" and "throw down." Now note the difference and govern yourselves accordingly. One is mid-wifery, or treatment of the lower stomach during gestation and delivery. The other is the upper stomach that takes coarser material and refines the unrefined substances, keeps the outer man in form and being; the other contains the inner man or child, and by the law of ejection, when it becomes an irritant, it is thrown out by the nerves that govern the muscles of ejection.
To illustrate: I will say, just as long as digestion and assimilation keep in harmony and the mother generates good blood in abundance, the child grows, and by nature the womb is willing to let the work of building the body of the child go on indefinitely; but nature has placed all the functions of animal life under laws that are absolute and must be obeyed. We by reason are asked to note the similarity of the stomach and the womb, as both receive and pass nutriment to a body for assimilation and growth. When a stomach gets overloaded, sickness begins, as digestion and assimilation has stopped, then the decaying matter is taken up by the terminal nerves, and conveyed to the solar plexus, and causes the nerves of ejection, to throw the dying matter out of the stomach which is above. Try your reason and see the stomach below sicken and unload its burden. Is this sickness natural and wisely caused? If this is not the philosophy of mid-wifery what is? As soon as a being takes possession of its room, the commissary of supplies beginsto furnish rations for that being, who has to build for itself a dwelling place. The house must be built strictly to the letter of the specifiction. Much bone and flesh must be put into the house of life, and some of all elements known to the chemist, must be used and wisely blended to give strength; also all material to be used in the house must be exact in form and given strength equal to all forces, that may be necessary to execute the hard and continued labors of the machinery that may be used in all transactions and motions of mind and body. Now we must go to the manufacturing chief, and have him through the quartermaster deliver and keep a full supply of all kinds of material for the work, and when the engine is done, put it on an inclined plane and cut the stay-chains and let it run out of the shop. Be careful and not let the engine deface nor tear the door as it comes out. A question is asked: On what road does the quarter-master send the supplies? As there is but one system over which an engine can bring supplies, we will call that road the uterine system of arteries. The mechanic reports that he will open the door of this great shop of manufacturing, and let it roll out the engine by the power and methods prepared to run out finished work. First you see a door open because the lock is taken off by a key that opens all mysteries; and the greatropes that have been far inferior to the force of resistance, that has held the door shut, are all sufficient in power. By getting sick, muscles become convulsed to rigidity of great strength with force enough to push the new engine of life out into open space easily, by nature's team that never fails to obey orders to deliver all goods intrusted to its care.
A student of mid-wifery can only learn a few general principles, before he gets into the field of experience. Actual contact with labor teaches him that much that he has read and had told to him by professors of mid-wifery in the lectures, is of but little use to him at the bedside. What he needs to know is, what he will have to do after he gets there. He must know the form and size of the bones of a woman, how large a hole the three bones of the pelvis make, for the reason that the child's head will soon come through that hole. He must know a normal head cannot come through a pelvis that has been crushed in so much as to bring the pubis within one and one-half to two and one-half inches of the sacrum. He must examine and know, and do this soon after he is called, for the reason, that he will have to use instruments in such deformities, and may wish the counsel of an older and moreexperienced doctor. And this precaution will give him time to be ready for any emergency.
But more than ninety per cent of all cases are of a very simple nature. The mother is warned by pains in back and womb, coming and repeating at intervals of one-half hour to less time. When by the finger the doctor can tell the mouth of the womb has opened to the size of a quarter or half dollar, he then may know that labor will soon start in good earnest, and at this time it is well to call for a twine, cut two strings about a foot long, to tie around the navel cord.
The first duty of the obstetrician is to carefully examine the bones of the pelvis and spine of the mother, to ascertain if they are normal in shape and position. If there is any doubt about the spine and pelvis being in good condition for the passage of the head, through the bones, and you find pelvic deformity enough to prohibit the passage of the head, notify the parties of the danger in the case at once, and that you do not wish to take the responsibility alone, as it may require instruments to deliver the child, as there is danger of death to the child and mother also, but less danger to the mother than to the child. Now you have done that whichis a safeguard against all trouble following criminal ignorance.
I will give you a condensed rule of procedure in all normal cases of obstetrics. With index finger, examine os uteri; if closed and only backache, have patient turn on right side, and press hand on abdomen above pelvis, and gently press or lift belly up just enough to allow blood to pass down and up pelvis and limbs. Relax all nerves of the pelvis at pubes.
Caution: Wait a few hours; examine os again. If still closed and no periodical pains are present, you are safe to leave case in the hands of the nurse, instructed to send for you if regular pains return at intervals. On your return, explore os again, if found to open as large as a dime, you are by this notified that labor has begun its work of delivery. You now place patient on her back, propped to an easy angle of near thirty degrees, with rubber blanket in place. After you find os, dilated to nearly the size of a dollar, then relax nerves at pubes. Soon you will find in mouth of womb an egg-shaped pouch of water, which you must not press with fingers till very late in labor, for fear of stopping labor for perhaps many hours. Rememberthe head can and does turn in pelvis to suit the easiest passage through the bones, while in the fluids of the amniotic sack. Now, as you know why not to rupture sack and spill fluids, you are prepared to proceed to other duties, which are to prevent rupture of perineum. Place the left hand on the belly, about two inches above symphesis and push the soft parts down with the left hand; support the perineum with the right hand until head passes over. This is necessary to prevent rupture of perineum.
If you follow this law of nature, lasceration may occur in one out of a thousand cases, and you will be to blame for that one, and may be censured for criminal ignorance. Now you have conducted head safely through pelvis and vagina to the world. You will find pains stop right short off for about a minute, which is the time to learn whether the navel cord is wrapped around the child's neck.
If it is found all around the neck once or more, you must slip finger down neck and loosen cord to let blood pass through the cord till next pain comes,in order to ward off asphyxia of child.
When pain comes, gently pull child's head down toward the bed. There is no danger of hurting the perineum now since the head has passed the soft parts. At this time the danger is suffocation of child. Never draw child too far away from mother's birth place by force, as you may tear navel string from the child and cause it to bleed to death. If you value the life of the child, then you must be careful not to place the navel end of the string in any danger of being torn off. Now you have made a good job for both mother and child so far. The child is in the world; and you want to show the mother a living baby for her labor and suffering of the past nine months. The baby is born and the mother is not torn, but the baby has not yet cried. Turn it on its side, face down, run your finger in its mouth and draw out all fluids, thick or thin, to let the breath pass to the lungs. Then blow cold breath on its face and breast to cause its lungs to act.
Baby cries, all is safe now. Baby is born safely and cries nicely, but still has cord fastened to afterbirth. It has no further use for cord, as life does not depend upon blood from the afterbirthany longer. Take the cord about three inches from the child's belly, between thumb and finger, and strip towards child to push bowels out of the cord if there should be any in it, as a safeguard for bowels, then tie a strong string around cord, first three inches from child's belly, second, four inches; take the cord in your hand and look what you are doing. If baby's hand should fall back to cord, you might cut off one or two fingers, or wound the hand or arm very seriously. Cut cord between the two ties just made on navel string. Look out for your scissors; pass the child over to the nurse to be washed and dressed, while you deliver the afterbirth from pelvis or womb.
When the child's shirt is on, cut a hole the size of your thumb in a doubled piece of cloth, five inches long by four wide, put the hole two inches from one end, and run the cord through the hole. Lay the cloth across the child's belly, then fold the cloth lengthwise over the cord, which must lie across the child so it will not stretch cord by handling or straightening child out. Now you are ready to finish the delivery of the afterbirth. You have a plug of soft and tender flesh to get out of the womb and vagina.
As the afterbirth has been grown tight to the womb during all the days of mother's pregnancy, and furnished all the blood to build and keep the child alive in the womb for nine months, it has done all it can do for the child, and is now ready to leave the womb.
You are there to assist it to get out of the place it has occupied so long. You must begin first to rotate or roll the placenta first one way and then another, up, down and across the vagina, by gently pulling the cord. Look out or you will pull the cord loose from the placenta; then you will have made your first blunder,—no cord to pull placenta with, and the mother bleeding and faint from loss of blood. Now is the time and place to save life. Pass your hand forward into the soft parts to get your fingers behind the placenta; now give a rolling pull and bring it out with the hand. You will find it an easy matter to get your hand into the vagina and womb after the birth of the child. Get all the placenta out, then take a wad of cloth or rags as large as the child's head, and press it under the cross bone of the pelvis; push the cloth under and up, so as to completely plug the pelvis. Now pull the hair gently over the symphesis, which will cause the womb to contract by irritation.
All is now done but to provide for the mother's comfort, which is your next duty. Draw her chemise down her back and legs until it is straight, then with safety pins, pin the chemise on inner side of thighs so that the chemise will go around both thighs separately. Now you have the shirt fast to keep it from sliding upwards, and you are ready to make a band of the chemise to support the womb and abdomen. Bring the chemise tightly together for two or three inches above the pelvis to form a band. Previous to pinning, draw the lump (womb) you feel above symphesis, up, then pin, and the belt you have made of the chemise will support the womb. All is safe now, but you must not leave for two hours. You may have delivered a feeble woman, who may flood to death after delivery of the child, if you do not leave her safe. I have in mind one case who flooded all of two quarts at a single dash. The first symptom was a pain in the head.
I know of only two causes that would produce hemorrhage or bleeding after the child is delivered. One is when the afterbirth (placenta), is separated from its attachment to the womb and stillretained in the womb or vagina, or when a part is separated and still lies in the womb, that retention of placenta prevents the natural circular contraction of the womb, to close on itself and retain it, with force enough to prevent the further discharge of blood, would give a chance for a continued stream. Then should the patient bleed profusely after the placenta has been removed, another cause would be in pulling away the afterbirth, as part of the upper portion of the womb may be pulled to an inverted position, which would be like a hat if you press the top down with the hand. Then there is a chance for leakage because of this unnatural fold made in the womb.
My method of relief is to insert the hand, and with back of fingers smooth out all folds. Before you draw the right hand from the womb place left hand on abdomen, catch the womb between the thumb and finger and withdraw hand. With the left hand pull the hair above symphesis or scratch the flesh just above across the region of the symphesis, just enough to make an irritation. After the hand is out of vagina pass a small bundle of cloths as far under the symphesis as would be necessary to hold everything up, then fasten chemise; beginning at symphesis draw it tightfor about two inches above symphesis and with strong pins fasten it. Be sure you keep garment tight by pulling down between limbs. The coarser the chemise the better, as you want to make a strong bandage at that point so as not to push the womb down into the pelvis. If the patient's general health is fairly good let her tell you what she wants to eat, and go and get it. Let her diet be after her usual custom. You must remember she has just left the condition of a full abdomen. Lace her up, fill her up and make her comfortable for six hours; then change her bedding.
Remember this, if you stop digestion on her for some hours with teas, soups and shadows to eat, you carry her to the condition where it would be dangerous to give her a hearty meal. My experience and custom for forty years has been crowned with good success. I never lost a case in confinement. I have universally told the cook to give her plenty to eat.
If she begins to have fever followed by chilly sensations, with swelling of one or both breasts, I relieve that by laying her arm ranging with her body. Let some one hold the arm down to the bed, then I place both of my hands under the arm,pull it up with considerable force till I get it as high or higher than normal position of the shoulder. Then pull her shoulder straight out from the body a fairly good pull, then pull the arm up on a straight line with the face, and be sure that you have let loose the axillary and mammary veins, nerve and artery, which have been cramped by pulling the arm down during delivery. No breast should become caked in the hands of an Osteopath. Do not bother about the bowels for two or three days. It may be necessary to use the catheter if the water should fail to pass off after inhibiting the pubic system. This is straight mid-wifery and will guide you through at least in ninety per cent of the cases you will meet in normally formed women.
Right here I wish to say one word: I think it is very wrong to teach, talk and spend so much time with pictures, cuts, talks and lectures, and hold up constantly to the view of the student, births coming from the worst imaginable deformities and call that a knowledge of mid-wifery. It is normal mid-wifery you want to know and be well-skilled in. The abnormal formations are few and far between, and when a case of that kind does appear, it is your knowledge of the normal that guides you through the variations. You will very likely never find two abnormals presenting the same form ofbone. As this is intended to only present to the student natural delivery I will let the subject drop with one word about the sore tongue of the mother. Adjust her neck, relieve constrictor and all other muscles that would impede any blood vessel that should drain the mouth and tongue. Remember this, that a horse that is always hunting bugars never finds a smooth road.