By B. Fincke, M. D., Brooklyn, N. Y.

“Multa experiando confieri, quae seqnibus ardua videantur.” - Tacitus

It is known, that sometimes children are born “with a veil,” or “within the caul,” which means with a membrane covering the head and face, more or less, and considered to be a remnant of the broken amnion.

Popular superstition, more than the medical profession, attaches to circumstances of this kind peculiar importance. The medical profession, so far, does not seem to appreciate it, for it is not particularly treated in the text-books. Common people think that children born with a veil are gifted with a foreknowledge of coming events. They have this membrane carefully dried and pulverized, and then at a certain age give it to the child born with it. The time for this administration is, I believe, when the child is fourteen years old, but for what purpose they give it, I have not ascertained as yet. Others will have the caul destroyed, and say, if it be not destroyed, the disposition of the child will be so affected as to render it cross, unhappy and fretful. Frequently the caul is handed down from father to son, especially among sea-captains, because, as I understand, it is believed that whosoever possess it is safe from drowning. It is even said, that the caul protects the crew and the vessel of the captain who possesses it. The high value set upon this membrane by seafaring men, causes the nurses sometimes to save it against the wish of the mother, who desires to secure to her offspring a pleasant disposition.

A case has come to my knowledge where a mother, residing in Philadelphia, preserved carefully in a box the caul in which her daughter was born. Whenever the membrane, which is generally smooth, shows wrinkles, she takes it as a sign of illness of her daughter who resides in Brooklyn. The latter, an accomplished lady, assures me that the indication never fails.

It is reported of Denmark Vesey, Atlantic Monthly, June, 1861, p. 733. “he was a preacher, was said to have been born with a caul on his head, and so claimed the gift of second sight.”

Such superstition, though unjustifiable in the light of reason, yet frequently points to hidden relations, which requires patient investigation.

Some old physicians and nurses, also, call it “born within the caul” when in the course of natural labor the child is enveloped in its unbroken membranes as a whole ovum.

Such expulsion of the human ovum at full term is acknowledged to be very rare and is very seldom, if at all, taken cognizance of in tocological literature. And since it always presents a remarkable occurrence, I propose to discuss a few cases of the kind which partly fell under my own observation, and partly came otherwise to my knowledge.

CASES.

1. Mrs. N., an American lady, about 38 years of age, of medium height, charming disposition, excellent constitution, and form, though not robust, dark hair, blue eyes, fair skin, inclined to embonpoint, was pregnant with her tenth child.

During the first three months she experienced various little ailments which were attributed to the painting of the house about the same time. No medical aid, however, was required until the latter part of June, 1860, in the eighth month of her pregnancy, when she complained of very sharp pain in the socket of her right hip-joint, as if a knife were stuck in, on rising from sitting, and of excruciating sharp pains deep in both sides of the abdomen, in two corresponding lines below the umbilicus about four to five inches in length on either side, as if a knife were cutting downwards, on turning in bed. She had a similar pain in a former pregnancy, but only in the left side, and she had it the first time, five years ago, when, hearing the croupy sound of one of her children, she suddenly jumped out of bed. The child's position is very low.

June 27th, 1860. Rhus tox. 3/10 m. 3/0 in Sacch. lact., six powders, one to be taken every forenoon.

July 5th, nine, p.m. Patient only took two powders because she then felt better. Yesterday slight pain came on again as before described. Severe pressure at the symphysis pubis. Rhus tox. 2/30.

July 9th, m. The pain in the abdomen is very much lessened, sometimes altogether gone. That pain about the hip has disappeared. The pressure upon the symphysis pubis continues and is mostly felt on rising from sitting. Nux vom. 2/5 m.

July 12th, nine, p.m. This afternoon, either when asleep or awake, she cannot tell, patient felt a movement, as if a child was born. Since then, pains in the back and symphysis pubis. If she had not had similar pains in former pregnancies, she would think to be at full term now. Puls. 3/30 2/0.

July 16th. At about eleven, p.m., I found the patient in labor. The pains had commenced at seven, p.m., and continued coming on about every five minutes. The os uteri was dilated to the size of a dollar, the head was presenting in the left occipito iliac position. The fetal circulation was distinctly perceived in the left iliac fossa, not so very low down however as usually is the case at that time. She complains of a pain at the fundus uteri; as if the child would rise up, and the sharp pain along the sides of the uterus would come on now and then. There is less pain about the symphysis pubis, and the patient is very hot and dry. I directed her to lie on the left side and gave her Rhus t. 1/16 m, after which the pains in the sides of the abdomen disappeared. The same dose was repeated twice about 1.35, a.m., when irregular sharp pains in the right and left sides of the abdomen came on. Until this time the labor pains were confined to the fundus, yet no waters were broken. It was evidently a dry labor. Patient was comparatively quiet and comfortable.

At about 1.40, a.m., all at once she began to moan and press, and after four or five pains without interruption, quietly looking at me, she said,“ the child is there.” And surely there it was, and a great sight it was.

There was the whole ovum intact and the child still within the folds. It was motionless, doubled up in the structureless parchment-like membrane which was so transparent that every part, and especially the cord, wound round the back of the neck as a blue string was clearly discernable. This membrane formed a complete sac of oval shape, the caudal end being fuller than the capital one; and it was closed smoothly and without any folds where it naturally gives the outer coat to the umbilical cord. The maternal part of the cord was beating vigorously. I tried to rupture the sac with my fingers, but the membrane was very slippery and so firm that I did not succeed in thus lacerating it. A slit with the scissors was made on its abdominal side; and the partition of the membrane easily effected by carrying the forefinger along towards the capital extremity. Then the membrane was turned back, the cord removed from the neck, and the child taken out and placed between the lower extremities of the mother. The child was alive and well, though the face was blue. Some friction was applied and the cord divided about fifteen minutes later, when the child had become more active, respiration regular and the strong pulsation of the cord had subsided. The whole scalp was full of hair and covered with vernix caseosa, which also was accumulated on the back and in all the folds which the body presents. But there was no amniotic fluid to be found, not the least amount of it, neither on opening of the sac nor after the child was taken out of it. The inner coat of the membrane presented no marked difference from the outer one, except, perhaps, that of being a little more glossy and slippery.

The mother lost very little blood. About fifteen minutes after the detachment of the child, the placenta was delivered. It presented on its fetal side, under the chlorotic coat, strong suffusion of blood; and on the uterine side it was very much torn.

After delivery the uterus appeared to be unusually large, so much so, that the patient thought another child might be present. This, however, was not the case. Sometimes the sharp pains in the sides of the abdomen returned. When I left, at half-past two, a. m., the patient had no after-pains as she used to have in two of her previous confinements; she felt every way comfortable. No binder was applied, as also none were put on in her two last confinements.

Early application of the babe to the breast was recommended. The next day some after-pains came on, when the child would draw vigorously; otherwise she was comfortable and got well in due time. The babe (female) weighed nearly eight pounds, and was in every respect well formed. All the former children of Mrs. N. had been delivered in the usual manner.

In her two pregnancies preceding her last one, she was under homoeopathic treatment with high potencies. The first time, in 1856, she had a somewhat difficult labor which terminated favorably, but was followed by a puerperal fever of the highest grade. The second time, in 1858, she was delivered of a child in a very short time. Two years later, in 1862, she was confined again and gave birth to a healthy child, the labor being natural.

2. Dr. Minton, of Brooklyn, related to me a case he attended several years ago in which the child was enclosed in a sac, filled with two quarts of amniotic fluid. The membrane was so firm that it could not be opened with the fingers alone. It presented no folds at the insertion of the navel-string.

3. Dr. E. W. Woodson, of Woodville, Ky., in the October number of The American Journal of Medical Sciences, reports a case of twins, one of which was enveloped in the membranes. The patient in this case was a negro woman. The midwife, supposing the child to be dead, deposited it in a vessel without rupturing the membranes and set it away until the doctor arrived, which was at least fifteen minutes after delivery. The rest I give in Dr. W.'s own language: “As soon as I entered the room, she (the nurse) related what had happened, and presented the vessel for me to inspect. I at once ruptured the membranes, and found the cord still pulsating. I removed the child, and succeeded in resuscitating it by using friction, artificial respiration, etc. I allowed the cord untouched as long as it pulsated. The child was perfectly livid, and apparently dead when I commenced to work with it. The breathing was at first gasping and at long intervals, but finally became regular and quiet. The child lived and did well.”

4. Dr. Atlee, of Philadelphia, in The Medical and Surgical Reporter, reports another case of expulsion of the child with the membranes entire. This child was the fourth product of a quadruple birth in a healthy woman, after three other children had been born. The first one was born before the doctor came in. The second one was enveloped by strong membranes which were with the greatest difficulty ruptured. An immense gush of liquor amnii followed. The membrane of the third one had to be opened with the scissors, and furnished again a copious discharge of water.

“While I was engaged in placing a binder around the patient,” Dr. Atlee continues, “she was seized with severe and rapid pains, and soon she cried out that something was coming from her. Upon examination I discovered that another child, with the membranes entire, had been expelled. I immediately tried to tear the membranes, but they were too strong and I slit them open with the scissors, and exposed a living female child. The placenta came away without difficulty, and the uterus contracted well. The loss of blood was trifling. All the children were living and large, and active for the period of gestation (seven months). With proper care, I think all these children could have been raised. But the day and room being cold, and the parents poor and no provision having been made for more than one child, they were all greatly exposed and died within the next two days. The mother bore the parturition well and had an excellent recovery. Two years afterwards she became pregnant again, and was delivered at full time of a single healthy child.”

5. The Medical and Surgical Reporter, of January 5th, 1861, has a similar case of a woman in labor with her third child. The woman was of medium size, healthy, and had come to her full term. After a protracted labor, though not unnatural, she gave birth to a son of large frame and very lean in appearance, but apparently perfectly healthy. There was not a drop of liquor amnii present, about one pint of yellow unctuous fluid being substituted for it. The membranes were so tough that the ordinary means would not rupture them, and rather suddenly the foetus was expelled with the membranes entire.

6. The two following cases were related by an intelligent American lady, who deserves credit for her statements.

Mrs. N., an American lady, twenty-five years ago, was delivered of a child enclosed in the membranes entire. The accouchur drew a fold of it asunder with his fingers, and the interior of it lying open looked like a honeycomb. The child looked very purple and the string was wound around the neck several times. The child was well and has always been healthy since, and is said to be a very smart man, intellectually.

7. In a case of delivery of another American lady, the expulsion of the foetus was delayed for several hours by the interposition of a sac, which was then artificially ruptured and discharged clear, clean water. On examination it was round that it formed a separate sac, having no communication with the membranes which inclosed the child. This was delivered without further delay and proved to be a healthy female child, which is now (1861) twelve years of age and was always in good health.

Dr. Darcy, an old physician, is reported to have had several cases of delivery with the membranes entire, in Newark, but the particulars of these I do not know.

9. Mr. Sherk, of Brooklyn, tells me, that in the open market place of a town in East Prussia, he saw a mare bending low down and observed a large bladder coming out of its hind body; while the bladder was lying on the ground, it suddenly broke and a young colt made his appearance, standing upon his legs.

Dr. Barker, of Brooklyn, confirms that this mode of delivery is quite common with mares.

10. Dr. W. Wright, of Brooklyn, E. D., on discussing the above cases in the Kings County Homoeopathic Society, stated, he had four cases which passed off pleasantly. He thought it was owing to the wideness of the parts.

11. Dr. P. P. Wells, of Brooklyn, at the same time remarked, that within twenty-five years he bad two cases which were premature. He never had a case of entire want of liquor amnii.

12. Dr. A. Wright, of Brooklyn, E. D., had a case which terminated favorably. The report is promised for publication, but has not come to hand as yet.

Observations. - In connection with this subject I beg to submit the following observations:

1. In the case number one, the sac, in which the child was enclosed was a firm and very slippery membrane, but readily separated when once a breach was made into it. It was a uniform transparent parchment-like structure without interlacing fibres and without vascular arrangement. It resembled isinglass very much, with the exception of a bluish-white shade which, however, interfered but little with its transparency. The sac was closely drawn round the foetus which had just room enough to lay in it doubled up. The membrane was not folded on the abdominal side as it is usually represented in the text books, but smooth and uniform, and in no way different from the dorsal side. The umbilical cord was inserted into it, midway between the two extremities of the sac, at right angles with the circumference. That part, coiled round the neck of the foetus, was quite blue; that part lying outside of the sac; was white as usual.

The fetal portion of the placenta was much torn and suffused with blood, but not the slightest trace of blood or injury could be detected upon the sac which enclosed the child.

2. Considering this state of things, there cannot be the slightest doubt that the sac described was the amnion, and now the question arises, what relation, in this case, did the ovular membranes bear to each other?

In the common mode of normal childbirth (Eutokia) the three membranes of the ovum, the decidua refiexa, the chorion and the amnion, form one single sac, which is ruptured during labor. The foetus, then, passes through into the world. The placenta follows the same path, and is either expelled or extracted, with the membranes turned inside out. For the reason of the simility of the process this discharge of the placenta has been appropriately styled “Afterbirth” (Hysteron).

In order to examine the relation of the membranes, we have to draw the sac of the afterbirth back from the placenta. We, then, find, going from without inwards, 1, the rough and bloody decidua reflexa, adhering closely to the chorion; 2, the chorion, and, 3, the amnion. The amnion then is the inner lining or the sac, glistening and slippery, covering at the same time the placenta and the umbilical cord in one continuous envelope. The amnion and chorion sometimes can be distinctly seen to consist of an exterior and an interior lamina, with a shining transparent jelly between. A blow-pipe may, with a little dexterity, be brought in and the membrane infiltrated, to prove the existence of the two laminae. The interior is quite glossy, smooth and slippery, and the exterior somewhat rough.

As we proceed in our examination, after drawing off the amnion from the chorion underneath, all along its connection with it, which in some instances we are able to do, we find the chorion likewise covering the fetal surface of the placenta and the cord. If we now consider the attachment of the chorion to the placenta, we find that between its two coats, extending all over the placenta, it contains the terminations of the placentar vessels which, from all sides, increasing in size, are directed toward the insertion of the navel-string, where they enter into the arrangement of the umbilical circulation. In this same direction the chorion increases in thickness until it forms the insertion of the cord, sometimes visible as a firm fibrous ring, and helps to build up the umbilical cord itself by giving it its internal sheath, the outer covering being furnished by the amnion.

On the placentar side, the exterior coat of the chorion, as far as it contains the large collective placentar vessels, meets the interior coat at the rim of the placenta and forms a firm fibrous margin of considerable thickness all around. Looking towards the placenta, then, the outer part of the exterior coat of the chorion, is continued into the fibrous structure which in combination with the outgrowth from the allantois and from the decidua vera constitutes the substance of the placenta itself.

Along the fetal circumference, the decidua reflex a, being the membrane lying to the outside, adheres, more or less, to the exterior coat of the chorion.

The question about the relation of the ovular membranes, in the case of intra-amniotic childbirth, can now be answered to this effect: that there the difference is only in the circumstance that the amnion, instead of distending immediately from or within a few inches of its placentar reflection upon the cord, is attached to the cord for a considerable length and then distends into the sac enclosing the foetus, entirely independent of the surrounding chorion and adhering deciduas reflexa. One part of the cord, therefore, is located outside of the amnion in the open space between amnion and chorion during gestation.

The higher insertion of the amnion into the cord for a few inches is of no unfrequent occurrence, and is seen sometimes to follow the spinal direction of the cord.

3. Labor, accordingly, may proceed in a two fold manner, depending upon the attachment of the amnion into the navel-string; the one where the amnion is departing from the point where the cord leaves the placenta or within a few inches near it, the other where it is inserted high enough to admit of an intra-amniotic childbirth.

4. In the first instance, delivery would proceed as usually observed, by rupture of the amnion, though it would not be impossible that, even then, child, amnion and afterbirth, might be expelled simultaneously in its natural order. In that respect it would be interesting to know the specialities of childbirth of Indian squaws and other savages, who are reported to bring forth their offspring without seriously interrupting ordinary duties, or even causing much delay, when participating in long marches.

5. In the other instance, it appears that, in a case like number one, the most favorable chance for natural delivery is presented, inasmuch, as the firmness of the amnion enables the foetus to form a tough, slippery, elastic and elliptic body which is capable of adapting itself to the maternal passage without obstacles intervening, such as prolapse of the extremities. And, in such a case, prolapse of the funis would not be a very formidable sign, if ever it should occur.

6. The contractions of the womb can only tend to present either one or the other of its two smaller and rounded extremities to the one centre of the os tinsae, and any false presentation is utterly impossible. The presentation, then, would be simplified, being either a vertical or a horizontal presentation. If the latter take place, it will immediately be acted upon and corrected by the womb itself. For the body represents only one larger and one smaller end of the elipse. If the womb contract equally on all sides upon the body in horizontal position, it will necessarily find more resistance at the larger end than at the smaller one, and the result will be the conversion of the vicious horizontal into the correct vertical presentation. And thus capital or caudal turning would be natural and necessary consequence of the uterine contraction.

7. Montgomery reports very thick membranes, which at first he took for hydrocephalus. He thinks the assumption of thick and rigid membranes is often erroneous, and that the phenomenon rather depends upon the weakness of the uterine contractions. The cases herein above reported, and all of them, show the firmness of the membranes, but by no means any inefficiency of uterine contractions, since they terminated favorably.

Therefore, and conformably to the preceding observations, it seems altogether advisable, in case of delay, to abstain from artificially rupturing the membranes, because it might deprive us of the very beat mode of delivery.

On the contrary, the main indication seems to be, that the uterus in its contractive power should be supported by proper medication.

8. When, after the expulsion, the sack of the amnion remains closed, there seems to be no danger for the child, so long as the cord is pulsating vigorously. For the child must then be regarded as being in utero still. The membrane forms a hermetically closed envelope which excludes atmospheric respiration and consequently precludes the necessity of a direct supply of atmospheric air. And the circulation being unimpaired, the child is nourished as before by the foeto-maternal circulation.

9. Here arises a nice physiological question. Is not this, after the expulsion of the child, the natural indication: not to have the cord cut sooner than when it ceases to beat, and then to leave it untied on the maternal side? Possibly, if so, the separation of the placenta from the womb would be facilitated, because the pressure of the placentar circulation on the fetal side is taken away by the oozing out or the placentar blood through the placentar extremity of the separated cord.

We do not know, whether in the reported cases of adherent placenta, the placenta was out or not, before the cord ceased to pulsate, and whether the cord on the external side was left untied. At all events correct observations in this respect are highly desirable.

10. The entire absence of liquor amnii, in case number one, bears testimony to the complete and perfect development of the foetus. E converso. Hydramnios takes place only in hydropic females, and a large amount of amniotic fluid is observed, together with poorly developed children, in weak females.

11. It is true that some of the other cases show a large amount of liquor amnii together with an entire membrane on delivery. In one case (3) the interior of the membrane looked like a honeycomb; in another (5) the liquor consisted of a yellow unctuous fluid. And there seems to be a certain incongruity between the firmness of the amnion as indicating vigor and the copiousness of liquor as indicating weakness on the part of the mother.

But, if weak and hydropic subjects produce hydropic amnions which soon give way to the pressure, it does not follow that, under certain circumstances, vigorous subjects do not present the two opposite states of firmness of the texture and copiousness of the contents of the amnion. For, then, the seeming incongruity is reconciled by that law of compensation which holds good in organic life as well as in the organic world.

12. If the moderate amount of amniotic fluid which generally does not exceed one to two pounds, is favorable for the development and expulsion of the foetus; then any larger amount of it must be considered as unfavorable and the more so the more it exceeds the average.

13. Relating to the development of the foetus, experience proves that weakly and hydropic subjects produce a great quantity of liquor amnii, and at the same time a poor foetus. The connection between the two facts is obvious. The increased secretion of the liquor amnii indicates, invariably, an impoverished condition of the blood of the mother. This allows a more copious and watery transudation into the fetal membranes, and lessens the plastic properties required for the development of the foetus.

14. As to the expulsion of the foetus. A large amount of liquor amnii, though it implies a thin and leas resistant amnion, compensating the uterine contractions (since it does not require so much force to break it, as it would if having a greater resistance), yet, it appears to be unfavorable for the expulsion. For, if the amount is large, the foetus is separated from the walls of the uterus by a greater quantity of intervening fluid, consequently liable to movements not immediately guarded and not regulated by the walls of the uterus. This may cause misplacements of the cord and malpresentations of the foetus. And the same accidents may be occasioned by the circumstance, that on sudden breaking of the waters a draught ensues towards the os tinsae, carrying the nearest part of the foetus, such as the cord or extremities with it, independently of and contrary to uterine action.

15. With the views here entertained, an excess of amniotic fluid is to be considered as a result of an abnormal course of pregnancy, and as such it calls for early and persevering homoeopathic treatment.

The presence of such excess is to be ascertained from the size of the abdomen being excessive in proportion to the size of the woman. In order to select the proper homoeopathic remedy, this and concomitant symptoms and circumstances have to be examined.

16. It has been stated, very correctly, that pregnancy per se is not a pathological state, but a physiological development of the organism. As soon however as it deviates and ceases to be a mere physiological condition, which unfortunately is only too often the case in our present stage of civilization; then it is necessary to obviate and meet the difference on pathological and therapeutical grounds. Homoeopathic treatment, judiciously applied, will always be conducive to the best of the organism; and it is a matter of actual experience that when the homoeopathic treatment of a case of pregnancy and labor did not seem to prevent evil consequences at that time, it did exert its beneficial influences the next time.

Much will always be gained in any case of pregnancy by a prophylactic dose of Pulsatilla, repeated at intervals of a fortnight.

17. The entire want of liquor amnii, as reported in case number one is of rare occurrence as Rokitansky states ( Lehrbuch der pathol. Anat., Wien, 1861, third edition, Vol. III, page 545), “The amniotic fluid sometimes is present in extraordinary large quantity (Hydramnios); more remarkable, however, are the rare cases, where its quantity is so little, that the facts appears to be enclosed tightly by the amnios.”

In our case there was no fluid whatever.

18. The established fact of normal expulsion of the child with the amnion entire, invites farther investigation in several departments of Embryology and Tocology, bearing upon the subject.

Among such is the operation of Version, by which we do not mean turning by external manipulation or by position of the mother, that being a kind of nursing rather than surgical interference.

19. Turning is generally recommended as a safe means of delivery in malpresentations either as long as the membranes are entire, or soon after the escape of the waters; and it is warned against, decidedly, and by the best authorities, when the walls of the uterus have already firmly contracted upon the foetus. “It is indispensable,” says Scanzoni, “ that the foetus have such a mobility in the uterine cavity, that its position can be changed without much exertion of power and without danger of injuring the maternal organs. This mobility, however, may be safely assumed to exist then, when either the water is not broken at all yet or, at least, is not evacuated completely, and a long time ago; when the palpation of the abdomen not not show any firm general or partial contraction of the uterus; and when the presenting part of the foetus has not yet entered the superior strait.”

As a general rule, then, turning is recommended at a time when either the membranes are entire, or the water is on the point of escaping or has just escaped. The success of the operation is lessened in the ratio as the time from the escape of the water increases.

20. Now, from what has been already said about the entirety of the amnion, facilitating and securing the proper movements of the foetus, it follows, that turning would be preposterous at a time when the ovum is unbroken and the uterus in good working order. For no ability on the part of the accoucheur is equal to the subtle force - douce violence - by which nature accomplishes the end in such case.

21. The supposition of the turners is, that even during the time when the ovum is yet entire, it might be necessary, to correct the malpresentation of the foetus. But this supposition is untenable, because at that time the final presentation has not yet taken place. And hasty effort to prevent a supposed possible malpresentation may just as well prevent the normal presentation. It, on the contrary, tends to disturb and confound the work and effort of nature, and is likely to superinduce the very condition it is intended to avoid.

22. The subject of spontaneous version and evolution was brought before the profession by Denman, who tried to explain its mechanism.

Antony Everard described a case of spontaneous version in the person of his own wife.

Riecke observed spontaneous evolution ten times in 220,000 labors, and Johnson and Sinclair twice in 13,748 cases.

Velpeau describes one case of spontaneous cephalic version in his own practice.

Scanzoni confessed his surprise, when he saw, that the foetus which in the eighth or ninth month, nay a few days prior to its expulsion, had been found in distinct trunk presentations, had assumed the one or the other head presentation.

Esterle observed in twenty-two cases of trunk presentation, nine cases of spontaneous version in the seventh and eighth months.

Doig saw one case of changing the shoulder presentation in to a footling case.

Wist noted frequent changes of position during labor, among others of a shoulder presentation into a cephalic presentation.

Spaeth marked one case of spontaneous turning in trunk presentation in 12,523 cases.

To these allopathic authorities must be added the famous case of Bethmann, cited by Croserio in his celebrated treatise on “Obstetrics” (1852), and which is reported (translation by Cote, p. 51,) as follows: “The membranes were not yet ruptured, and the orifice but slightly opened, notwithstanding the pressure of severe and frequent pains. On examination he recognized a shoulder presentation. Not wishing to precipitate the labor, he gave a dose of Pulsatilla; some minutes after the woman experienced a violent pain with such a sensation of overturning in, the abdomen, that she was frightened at it; then, after some time of quiet, the pains recommenced regularly, and on a second examination, Bethmann was very agreeably surprised to find the head presenting; the delivery terminated naturally.”

Croserio also relates having gained a similar result by the use of the same homoeopathic means, and under the same circumstances.

Dr. Jackson, of Boston, furnished lately some other beautiful cases of version by the use of Pulsatilla³⁰ in watery solution (American Homoeopathic Review, Vol. IV, p. 505).

Professor Walker, of the Medical College of Missouri gives a case of spontaneous cephalic version under aggravated circumstances, in the Western Homoeopathic Observer, Vol. II, p. 2.

Dr. Baruch, in a case of trunk presentation, found the head in the right side, no progress made in five hours. The pains ceased, the woman was in despair. Guided by the symptoms of a chronic inflammation of the eyes with which the patient was afflicted, Hepar sulph. calc¹⁶⁰⁰ was administered, and in fifteen minutes a healthy child was born.

Another case of the kind occurred (1861) in our own practice. It was that of a woman whose early pregnancy was marked with such difficulties as eventually lead to a trunk presentation. Under homoeopathic treatment with high potencies, the malpresentation (trunk) was deranged into a head presentation during a labor protracted for three days, which terminated favorably for mother and child, a result which, under the circumstances of the case, growing out of a bad constitution and former allopathic maltreatment, almost surpassed fair expectation.

These facts and observations would, no doubt, be multiplied, if the experience of homoeopathic accoucheurs were more generally known, and they all verify beyond controversy, that correction of malpresentation, consisting in spontaneous version and evolution, is accomplished by nature alone, and by proper medication respectively.

23. The therapeutical treatment in the allopathic school is mostly limited to some heroic remedies, such as Opium, Ergot, Tartar emetic, etc., all of which are used in doses so large as to exert, at best, only palliative effects. Such treatment, too, often leads to unpleasant and disastrous after effects, such as dislocation of the symphysis pubis, resulting from the effect of “appreciable doses” of decoction of Ergot in “half-saucerful” quantities which produced an abscess beneath the tissues of the mons veneris, opening just above the clitoris, and indicating disintegration of the cartilaginous substance interconnecting the pubic bone, as reported in the Western Homoeopathic Observer, Vol. III., p. 81. This occurrence coincides with Rokitansky's remark (Pathological Anatomy, third edition, Vol. II., p. 187), where he says, “Next the ruptures of the synchondroses induced by considerable external violence, there is observed a softening (Lockerung) of the same during pregnancy; during labor they can suffer a considerable extension, even a partial separation of connexion; after delivery they sometimes slough (verjauchen) in the course of malignant puerperal processes.” The case in the Observer makes us suspect, that the sloughing may be the result of overdosing by the Ergot, attended with “malignant puerperal processes,” for Secale cor. is known by its pathogenesis to produce gangrene.

The allopathic practice adds also chloroform and venesection to the list of remedies; but both are such means as no conscientious Homoeopathician can recommend, if he knows his potencies well and understands how to use them.

24. It is with too much emphasis, we think, that the tocological world dwells upon the character of pregnancy and parturition as being chirurgical, and we must admit, in this respect, that not much progress has been made since the time of Hippocrates.

The wonderful discoveries made in the science of Tocology, would seem to admonish us, not to increase the dreadful armamentarium which is still in use, but which resembles the instruments of torture of the middle ages more than anything else. Those discoveries prove, that the generative process, considered by itself, is not necessarily a pathological process requiring medical or surgical treatment, but is a physiological process taking place normally, according to certain fixed laws, to which the human organism is subject, and that it ranges like any other physiological process of greater or minor importance. Undoubtedly utero-gestation, and parturition, have to be regarded in the same light. We never think of chirurgical interference, generally, when we may attain the desired end by proper attention to the natural cause of things and try proper medication. Just so we may safely discard chirurgical interference in tocological cases, which require nothing but proper attention to the natural course of generation and proper homoeopathic medication. “If ours were the period of honest admissions,” truly observes Champion, “what honorable practitioner, and particularly what accoucheur, is there who would not have some revelation of this kind to make?” (Bedford's Chailly.}

25. According to a table compiled by Churchill, the proportions of cases of presentation of the superior extremities amounting to trunk-presentation, are on an average, as follows: in England and France 0,38, that is, little more than 1.3 percent. In Germany a larger percentage. Spaeth having had in 12,523 cases, 93 trunk-presentations; Schwoerer in 39,917 cases, 259, which gives for Spaeth 0,74 or 3.4 percent., for Schwoerer 0,64 about 3.5 percent. Scanzoni observed in 8,514 cases 48, which gives 0,57, that is about 3.5 percent.

Now, it is agreed, that vertical presentations never necessitate, or cause, dystocia, because they are always regarded as normal physiological conditions (Scanzoni). And all authorities concur, that the horizontal presentations only, on account of the difficulty of converting them into vertical ones on the part of the mother, are to be considered as vicious presentations requiring the physician's interference. And it is only in 1.3 to 3.4 percent. of all cases of parturition under allopathic treatment, that this chirurgical interference is believed to be called for, on the plea of danger to mother and child.

26. In all such cases, the common rule adopted by the profession is, to perform the operation by turning (version) as the comparatively safest means of delivery under the circumstances. And, in order to justify this operation, some reasoning is indulged in, running somewhat in this fashion, viz.:

“There is danger for mother and child in n horizontal presentation, if it is not converted into a vertical one. If the mother herself is unable to do this by the natural mechanism required for the expulsion of the child, then it must be done by the midwife; the midwife should turn, as long as there is a chance offered by the mother to do it; this chance offered is, that the ovum be entire, so that the foetus can easily be turned in the waters. However, version is not safe, when the uterus has contracted firmly upon the foetus after the escape of the water; in such a case the contractions of the uterus have to be overcome by bloodletting, Opium, Tartar emetic; after that, further spontaneous action on the part of the mother is precluded, and the only chance now for mother and child exists in terminating the labor by extraction at once; extraction is only a secondary indication resulting from untoward circumstances if the first chance, turning in the membranes, should fail.”

But such reasoning invites criticism. It is unsound all over.

If the profession recommends turning in every case of horizontal presentation as long as the foetus is enveloped in its membranes, because the chance of natural conversion into the vertical presentation might fail, then it arbitrarily cuts off, beforehand, the very chance of natural delivery, which is generally better and preferable, as we, have seen, since natural delivery, even under difficulties, occurs oftener than is generally supposed. Bedford (Chailly) says: “Spontaneous version almost always takes place without the knowledge of the accoucheur,” and he confesses, that “we but imperfectly understand its mechanism and causes.” The prognosis he considers“ extremely favorable to both mother and child.” Hence it is very probable, that the frequency of the occurrence of spontaneous version is generally underrated and that it would be rather safe, as a rule, to trust more to the effects of nature while supporting the organs by proper attention, than forcible operations which often are likely to be premature or unnecessary.

27. The recommendation of turning while the water is yet unbroken, strikes us, as being in the same vein with the notorious indication of Tracheotomy in Croup, which is, by the highest authorities, only then considered safe and justifiable, when there is power of reaction enough left in the system to overcome the operation beside the disease, and only as long as the children are merely anxious to get breath without really becoming asphyxiated (Roser). Yet, it is well known, that in such cases the pure homoeopathic treatment offers far better chances. Many physicians, with Boenninghausen at the head, will bear us out in this. Even if Tracheotomy should succeed in hopeless cases where asphyxia has already begun, still, Homoeopathy claims as an offset many equally hopeless cases, treated homoeopathically with success, without Tracheotomy.

The same applies to our present question concerning the pretended indication of version while the membranes are entire. The conditions for delivery depend, naturally, not upon the operation, but upon the conditions present, predeterminating whether the operation should be made or not. Homoeopathy may obviate the necessity of version.

28. Horizontal presentations are owing to the relaxation of the parenchyma of the uterus with consecutive dilatation of the uterine cavity (Scanzoni), such as is found in multiparae and in those whose genital organs have been weakened by disease. In such cases we would not expect to find the thick and firm amniotic sac, as in our case number one; we would rather look for a large amount of amniotic fluid, favoring an easy rupture of the membranes.

From these circumstances it is clear, that in a case of horizontal presentation a poor chance would offer for version, because the water will have been broken when the os tincae is dilated sufficiently for admitting the hand of the operator, consequently the condition of entirety of membranes fails, and therewith the indication of version, while the membranes are entire, falls simply to the ground.

29. But, suppose, together with horizontal presentation there should be a firm amnion? Then, again, the indication would fail, because every condition for correcting the malpresentation would be already fulfilled, and it would be not the version but only the uterine contraction which is wanted for effecting the condition.

However, they say, that this indication failing only the first chance is lost, but the second indication is induced, viz.: the extraction of the child. And here they rigorously enjoin us, not to enter the womb if the walls are firmly contracted upon the foetus, and that in such a case the uterine contractibility must be reduced and the labor terminated at once by extraction.

But here, again, they put the indication in the wrong place.

For, if the walls of the uterus contract firmly, then the uterus exerts power to expel the foetus, which is the very thing desirable and ought to be aided. That powerful contraction, in a trunk-case, is, on the maternal part, the only means to expel the child; to support it, therefore, is the proper indication, and artificial paralysis is only the mistaken professional allopathic indication.

Now there are cases on record, where, even then, when the uterus Contracted firmly upon the foetus, spontaneous version took place as those quoted. We, undoubtedly, would know more cases of this kind, if the general practice of the profession did not by unwarrantable interference prevent the more frequent occurrence of such happy terminations of labor.

But clear it is, that the proper homoeopathic administration of such potencies as Aconite, Apis mel., Belladonna, Chamomilla, Nux vomica, Opium, Pulsatilla, Sabina, Sepia and others, would favor the result of spontaneous version more than anything else would do.

30. Time is another great element in the tocological process.

The allopathic school, with its inadequate means, lays down the loss of time as being equally dangerous for the safety of mother and child. Yet just the contrary is defensible. For it wants time for the uterus to gather strength, and it wants time for the foetus to shift its untoward position. This precious opportunity offered by time is lost if the accoucher takes hold of the foetus to extract it.

“Sapientissma res tempus.”-Bacon.

The customary indications change entirely with the homoeopathic treatment of the case. It is ascribable to a want of better information, when even homoeopathic manuals on Obstetrics, [The action implied by the word “Obstetrics” is so unhomoeopathical, that “Homoeopathic Obstetrics” would seem to be a contradictio in adjecto, and the use of the term “Obstetrics” for that department of our art and science which relates to childbirth should be discarded, as being inadequate, prejudicial and improper.] in the event of difficulties arising, recommend all the surgical operations described in the text-book of the allopathic school. Possibly, the precarious position which the Homoeopathician occupies under the pressure of allopathic traditions may have something to do with the deficiency alluded to. For they, on the other, side constantly ignore Homoeopathy altogether. But this should not be an excuse for Homoeopathicians for stopping where the so-called old school left it.

It is probable, that after the exhibition of the potency, homoeopathic to the case, the uterus will relax and cease to contract upon the child. When so, the allopathic obstetrician would find it indicated, as well as convenient, to perform version and extraction under the usual cautelae. But the homoeopathic tocologian would not so understand it. He would, after medicating, patiently wait for contraction after contraction, and ultimately, I doubt not, find that the malpresentation under the action of the potency by degrees, or suddenly, yields to the resumed and well directed and well supported efforts of the uterus, and that, thus, labor takes its natural course to natural termination.

Unfortunately, but unmistakably, the indication in cases of protracted labor is time. But time is not what the practitioner has to spend, especially if he is much sought after.

There are sometimes delays of hours, when no progress is made. The woman feels with all protraction comparatively comfortable, takes food and sleeps. All this requires time; and time, we repeat it, is the great element for successfully treating such cases.

It was a very good rule given in the old play: “Festina lente - let the time have its time!”

31. That the result of such treatment, as here proposed, can be successful in the end we are satisfied. But you ask, in how many cases was it so? The answer is, so far it was only in one; but that, a unicum, is a case closely observed. Such a case, although single, is worth more than thousands of cases less closely observed. One case shows that it can be done, and that is enough. One case is sufficient to prove that a child can be born naturally enveloped in its membranes unbroken, with comparative comfort to mother and child, and that is enough to prove that this is one of the modes of childbirth nature has prescribed.

You refer to statistics. But with them it is as Goethe says, “Thousand grey horses don't make a white one.” The white one here is the case, carefully individualized, as Hahnemann taught us to do. The average of a large number of cases does not teach how a given case should be treated, for that is always a case sui generis. On the whole, statistics must be considered and used like auxiliary sciences of medicine, cum grano salis. The practitioner must certainly be acquainted with them, but he must take heed and not conclude from what does not correctly follow them.

To illustrate: the one single symptom 145 of Spongia tost., well observed by Lehmann and recognized by Hahnemann as the true pathognomonic symptom of croup, has saved thousands of children, while all the many prescriptions of the allopathic school and all imperfect domestic medicine could not do it. So here. Thousands of your statistical cases of forcible interference, with corresponding proportion of mortality, do not disprove this one case of natural delivery and corresponding proportion of life. Your thousands of cases only show what you could do. Our case proves what nature did, and that it can be done otherwise, than you did. What has been done, can be done again. Weighing your frightful mortality and failings on one side, and our success, and chance of success, on the other side, why would it not be better and more rational to try our new way, which happens to be the old way laid out by nature herself.

32. But, suppose, the malpresentation could not have been corrected in the one or the other case of the 1.3 to 3.4 percent. of all cases, what then?

When coming to this point, the Alloeopathician at once looks for his armamentarium, and revolves in his mind all the many bloody operations which have been devised and invented, to destroy the child, for the purpose of saving the mother, if there is no other chance left.

We are aware, that here arises a formidable responsibility. The danger from presentation of the superior extremities for mother and child is obvious, and especially so, when com PARED with the limited and inadequate means at the command of the allopathic school.

It must be admitted, that there is some courage, strength, and boldness in the allopathic treatment which, by general custom, and under the sanction of the school, shrinks not from endangering the mother and the child, nor from destroying the child, under the pretext, that there is no other means of saving the mother, nor, alas, from sacrificing them both, lege artis.

But would it not be well, if this boldness, strength, and courage would raise the brain rather than the arm? Would it not be better if, instead of relying on brute force and cunning, we should trust to the powers of nature combined with a judicious support of the same, as was done and indoctrinated by Hahnemann and his true followers?

If we could but know the untold psychological processes going on in the mind of many an experienced obstetrician, foil of desire to render helpful assistance in such trying circumstances, how deeply should we sympathize with him, and how earnestly desire to help him out of his perplexities, growing out of the inefficiency of allopathic treatment. He, if a kind-hearted man, will, in such straits, trust to the never-failing forces of nature more than to the drugs and manipulations of his school, and if doing so, he will find relief in his mind by the probability of the greatest success possible.

The following cases prove conclusively, at the same time the insufficiency of allopathic treatment and the sufficiency and competency of nature for arduous tocological processes:

a. Case of Spontaneous Cephalic Version, by Velpeau. “A young woman, pregnant for the second time, came into the hospital at ten o'clock in the morning. The os uteri was little dilated; nevertheless, I could recognize a second position of the left shoulder. The waters did not escape until three, p.m. At eight, p.m., the shoulder had sensibly moved towards the left iliac fossa, and I could then readily detect the ear at the right. At eleven, p.m., the temple had almost gained the centre of the orifice; the contractions were augmented in energy; and the cervix was entirely effaced. At midnight the vertex had become lower; the head engaged, and in the course of an hour the vertex was delivered.”

b. Case of spontaneous cephalic version, by Richardson. Medical and Surgical Reporter, Vol. XII., p. 39: “Mary Ann Burke, born in Ireland, aged 23 years, was admitted to the hospital, October 25th, 1858. On Friday preceding her admission, while at work, she received an accidental blow over the uterus, which ruptured the membranes and produced the entire discharge of the liquor amnii. The patient was not at term by several weeks. During Friday, Saturday and Sunday, her sufferings were very great. On Monday, as above stated, she was admitted into the hospital, having been conveyed there in a carriage. She was taken to the obstetrical ward without delay and placed in bed. Making an examination per vaginam, I found an elbow presenting; but owing to the rigid contraction of the os uteri about the arm, made no attempt to correct the presentation. The uterine contractions soon became rapid and vigorous. On making a second examination, I discovered the right hand protruding through the external organs. The position being the first of the right shoulder.

“About two hours subsequent to the first examination, the os was patulous and the vagina relaxed and moist. Deeming this an appropriate time to interpose, I endeavored to make version by the feet, but finding the uterus so sensitive as to contract energetically upon the slightest touch, was obliged to desist. In the hope of obviating the malpresentation, I exhorted the woman not to bear down, and she endeavored to obey the injunction, but without avail. The uterus continued to contract rapidly. Fearing laceration, I introduced my hand, determined to make the most eligible change in the position of which the case would admit. Much to my relief and gratification, I found the child's arm had receded into the uterus, the vertex having engaged. In the course of an hour and a half the child was ushered into the world, the head being first born, making evidently a case of spontaneous version by the vertex.

“The foetus weighed five pounds was still-born, having been dead apparently several days. The patient convalesced happily, being able to resume her usual vocations in about ten days. This was her second accouchment, the first child having also been born dead. It may not be uninteresting to state, that the whole time occupied in the above process, from the putting to bed of the patient until the delivery, was about five hours.”

c. Case of spontaneous cephalic version, by Walker,. Western Homoeopathic Observer, Vol. II., p. 3.

“Mrs. H., married and the mother of two children, was seized with labor-pains at full term on the morning of Saturday, October 22,1864, and was attended by a midwife. The case progressed without any untoward symptom until three, p.m., when the waters broke, and the midwife discovering the hand drew it down, and with all her. 'might and main' endeavored to deliver by traction upon the arm. At six o'clock, three hours after the rupture of the membranes, Dr. Vastine, an experienced practitioner of thirty-five years standing, was summoned. The hand and wrist were outside of the vulva, and at least twelve inches of the cord prolapsed. For three hours he made every effort to turn and deliver by the feet. The contractions of the uterus were most powerful, so that rupture of the womb seemed eminent. A mixture of chloroform and ether was administered, and under its influence repeated efforts to turn signally failed.

“He now deemed it best to eviscerate and force delivery, and for that purpose came to request my assistance. During his absence the midwife again essayed to deliver by drawing down the arm, which had been pushed up and pulling upon it. At ten o'clock, p.m., I arrived, and after a careful exploration, found the right shoulder and arm presenting, with the head in the right iliac fossa, the back of the child pressing the spine of the mother, and the head so rotated that its chin was in close proximity to the left shoulder. The occiput could be felt upon the extreme right. The cord was still prolapsed to the extent of a foot or more.

“As there was still pulsation in the cord, and the doctor deeming it altogether impracticable to turn at that stage, and the pains being exceedingly strong, I advised that we return the arm as far as possible, and wait to see if any change would occur. The necessary instruments being at hand to eviscerate, we resolved to delay the operation to the last practicable moment. The patient, who had been lying upon her back, was requested to take the position upon her left side. Pressure was then made against the shoulder and arm in a downward direction - that is, towards the left side - hoping, that, as the breech could not be made to enter the superior strait, the head might be induced, to take that position. After a few pains, which were most violent, and between which the patient insisted upon getting on her feet - which was allowed her - we thought we could feel a larger surface of the occiput. Being encouraged, we continued to wait. In half an hour after my arrival, the head had fairly engaged, and at eleven, p.m., the child was born by a vertex presentation - the right arm and cord prolapsing. The child was asphyxiated, and our utmost endeavors failed to excite breathing, although twenty minutes before its birth, there was pulsation in the cord. The weight of the child was not ascertained, but could not have been less, according to the judgment of both of us, than seven pounds and a half.

“In this case the prolapse of the cord, and the consequent pressure upon it, could have been the only cause of the death of the child. The pelvis of the patient, although well formed and sufficiently capacious, was not extraordinarily so. At the present writing, the woman is doing well, and recovering as rapidly as in a case of ordinary labor.”

There are various causes in this case to which the death of the child may be ascribed. Among them the previous administration of a mixture of chloroform and ether, and the repeated efforts of turning, should not be lost sight of altogether.

33. All these cases, which could be multiplied if space would permit, are of the cephalic variety; they are cases of spontaneous cephalic version in utero and of cephalic evolution, accomplished by the force of nature. Though inviting to a multitude of suggestions, we must leave them to the reader's own consideration, who will not fail to mark, that in all these cases the membranes had been ruptured long before the version took place.

These dreadful presentations of superior extremities, which are commonly taken for a justification of so very superior extremities in obstetric handicraft, show, indeed, a fearful mortality. According to Churchill, one-half of the children. and one mother in nine, have been lost under the benefit of alloeopathic operations. It is, of course, too late, and perhaps impossible, to ascertain, what result would have followed spontaneous evolution, if it had been allowed to take its natural course. But it is reasonable to suppose, that not so many of the cases would terminate so unfavorably, if spontaneous evolution were allowed to proceed according to its own laws.

Denman was the first who observed that nature frequently corrects malpresentations by spontaneous version as he calls it, and, thus confiding in nature, he had no cause to complain of the result. Now, constantly, there are cases being recorded which have terminated successfully for the mother and sometimes the child by self-evolution without manual interference by version or otherwise.

34. But we may do better yet. If by nature, being left alone, so much is affected, how much more may be accomplished when we aid and augment her forces by the judicious, careful and circumspect appliance of homoeopathic potencies!

Already one splendid case is on record, by Croserio. This case shows, that more than ever before can be done by homoeopathic treatment. Here it is.

a. Case of delivery with an antero-posterio diameter of the brim of the pelvis of two and a half inches, by Croserio, Homoeopathic Manual of Obstetric, from the French of Dr. C. Croserio, by M. Cote, M.D. Cincinnati: Moore, Anderson, Wilstach and Keys, 1853, p. 69.

“In the case of a woman, 26 years of age, in her first labor, in whom the sacra-pubic diameter of the superior strait did not offer more than two inches and a half, I had the patience, to wait for seventy-two hours the natural efforts of labor. The head being in the first position at the end of the second day, it began to engage in the superior strait; at the end of the third day, the pains slackened very much; the woman became very feeble, was pale, exhausted and had lost all hope. I put Secale cor.³⁰ in a glass of water, and gave her a teaspoonful at eleven o'clock in the evening; some minutes after she fell asleep and slept very quietly for three quarters of an hour; when awakened by a violent pain, she made a courageous effort, and two hours after gave birth to a child, pale and in a state of asphyxia, but which was recalled to life by proper care. The recovering of the mother proceeded in a regular manner.”

On the whole this case is a much more serious one, than the much descanted case of a presentation of superior extremities with the ordinary dimensions or the pelvis. No Alloeopathician, being backed by his whole profession, would in this case have hesitated, one moment, to perform the bloody operation described in all the text-books, which inevitably victimizes the child, and always imperils the mother. But in this case the result proves, only, again, and conclusively, what we already know, viz., that where alloeopathic wit is at an end, true medicine begins. Ubi desinit philosophia, ibi incipit medicina.

Here we insert another good case, instructive about correct administration of the homoeopathic remedy.

b. Case of adherent placenta, by Bethmann, Archiv fur hom. Heilkunde, Ed. by Stapf, Vol. VII., 1, p. 65.

“Dr. Bethmann was called to a country woman of 85 years of age, of large, stout frame and violent temper, being in labor since two days, with the most violent contractions of the uterus. He found her with dark red face which was much distended, and her eyes protruding far from their sockets. On examination he found that the uncommonly large size of the head of the foetus was the only obstacle to delivery. He then delivered with forceps by some vigorous traction at once. But, shortly after, it was found that the placenta was adhering. At six, p.m., he ordered a simple emulsion of sweet almonds against the increasing thirst, and recommended perfect rest. Next morning, at eight o'clock, he found the patient with highly red face, brilliant eyes, dry skin, small hard pulse, 90. Since midnight, the vagina was dry, the placenta was found to adhere firmly to the uterus. The abdomen was much distended, and painful to touch in the right side of it. Short dry hacking cough, licking her lips without wanting to drink; great anxiety and inner unrest.

“He now administered a small part of a drop of the sixth attenuation of Belladonna. Already after half an hour, thorough-going pains came on, and the placenta, with a considerable coagulum, passed away without evil consequences. After two hours bland perspiration set in, the tension of the abdomen, and the hacking cough was gone, and in four hours the threatening disease had wholly disappeared. The patient was well towards evening and remained so ever since.”

In this case, the Belladonna was indicated at the first instance when delivery of the foetus was delayed. If it had then been given, the foetus would have been born without; forceps, and the adherence of the placenta would not have taken place. As it was, however, it proved its potency, when it was given at the delay of the delivery of the placenta, being again indicated by the simility of the symptoms, the state of the organism after delivery of the child being similar to the preceding state. The obstacle to the child-birth was the head sticking fast in the pelvic canal, and the obstacle to the afterbirth was the placenta adhering to the uterus. But the fact is, that the uterus was equally unable to expel the foetus and placenta. Belladonna, by virtue of its homoeopathicity, enabled the uterus to resume its natural function, consequently to separate and expel the placenta, as it would have enabled it to expel the foetus.

However, we here only propose to discuss those cases, where the difficulty of presentation of superior extremities and no other, has been removed by homoeopathic treatment. To illustrate this point we refer to the celebrated

c. Case of spontaneous version., by Dr. Bethmann, Croserio's Manual, n. s., p. 5l.

“A woman in labor sent for him, the membranes were not yet ruptured and the orifice was but slightly opened, notwithstanding the presence of severe and frequent pains, and by an examination he recognized a shoulder-presentation; not wishing to precipitate anything, he gave a dose of Pulsatilla. Some minutes after, the woman experienced a violent pain with such a sensation of overturning in the abdomen, that she was frightened at it; then after some time of quiet, the pains recommenced regularly, and on a second examination, Bethmann was very agreeably surprised to find the head presenting; the delivery terminated naturally.”

To which Dr. Croserio adds: “I believe, I myself obtained a similar result by the use of the same means and under the same circumstances.”

35. Considering the different modes of expulsion of the foetus with regard to malpresentation of the trunk, or superior extremities, after the membranes have been broken, and the liquor amnii has been discharged, the term self-evolution appears to be singularly felicitous, as graphically describing the passage of the foetus from the womb through the pelvic canal. Evolution is an expulsion connected with a spiral motion. In this regard, there is no difference in the passage of the foetus through the pelvic canal between the common prompt expulsion in ordinary labor, and the less common, tedious expulsion in difficult labor, designated by the name of self-evolution, excepting only the difference of time, by reason of the obstacles offered by the maternal parts and the foetus.

The criterion between normal child-birth and self-evolution lies in the different mode of evolution, being, in the latter case, effected by spontaneous version. Hitherto by spontaneous version has been understood the spontaneous turning of the child within the membranes in utero, whilst by self-evolution is meant the turning of the foetus without the membranes in the pelvic canal, breech foremost. So, spontaneous version in the womb within the membranes is one thing, whether upon the vertex or upon the feet (if such a thing occurs) or upon the breech; and spontaneous version in the pelvic cavity without the membranes is another thing, also, whether upon the vertex, or the feet, or the breech.

Here we have, therefore,

1. Spontaneous uterine version, vertical and podical.

2. Spontaneous pelvic version, vertical and podical.

Consequently, what has been termed self-evolution par excellence, is in fact spontaneous pelvic version on the breech, or feet, and what has been termed spontaneous cephalic version is in fact spontaneous pelvic version on the head.

Expulsion is all the same here and there, and all cases of childbirth where the deliverance of the child is being developed by the mother herself, are, strictly speaking, cases of self-evolution, as contradistinguished from those cases where the child is forced out or taken away by the instrumentality of the operating surgeon, which might be styled surgical evolution.

36. The mechanism of the spontaneous pelvic version of the vertical variety is in no way different from the evolution in vertical presentation.

The mechanism of the spontaneous pelvic version of the podical variety is also precisely the same as that in all other breech or podical presentations (Douglas, Dubois).

The difference of these two mechanisms is in this only, that the pelvic version requires more energy on the part of the mother, to convert the horizontal or oblique presentation into the perpendicular one, and that it wants more time than in ordinary labor.

In this difficult undertaking the Alloeopathician is utterly destitute of means to help the mother. He does not acknowledge the laws of nature or the power of the homoeopathic potencies under them. And this is the only ground on which he can be excused for resorting to all kinds of reckless operations, desperately to take the child, alive or dead, out of the the grasp of the motherly organ. Let us see, now, whether we, too, have reason to be so desperate.

37. It is an undisputed fact, that the head of the foetus offers the largest diameter towards the pelvis of the mother, and, therefore, it presents the greatest obstacle in labor, because it requires the main strength of the maternal organs to squeeze it through the passage.

According to Radford the circumference of the portion of head presenting in labor, varies from twelve to thirteen inches and a half; that of breech with thighs flexed up, twelve to thirteen inches and a half; that of breech with one thigh turned up, eleven to twelve inches and a half; and that of hips with legs extended, eleven to twelve inches and a half.

Now, the foetus is ”une masse spongieuse” (Capuron) the only inflexible part of which is the base of the skull, amounting in all to two inches and a half to three inches in diameter. All other parts yield to pressure, especially in horizontal presentations which, as a general rule, occur in poor subjects producing a poor foetus. We may, therefore, as it were, twist and bend the foetus as we please; its diameter will never surpass the diameter of its head. And this very head is, in the language of Dr. Slop, “naturally as soft as the pap of an apple” (Sterne).

38. If this is so, and it must be admitted, as there can be no reasonable doubt about it, why, then, is the danger so great? It is, because there is in the body of the foetus not resistance enough in the direction of expulsion. The head is turned aside and contributes nothing to the mechanical process going on. Hence the uterus has to supply the want of resistance on the part of the foetus by compression of the fetal mass into a denser body. Thus the uterus works to disadvantage, because its fundus, which is the originator of the most efficient labor-pains, is too much dilated and the longitudinal fibres are less active than the circular and oblique ones. Hence the foetus can make not so much progress, as it would in a cephalic presentation.

39. A similar difficulty arises in breech-presentation. But there, the breech being in position, it does not require as much power for the descension.

The difference is, that in shoulder-presentation the flexion first of the abdomen upon the thorax, and secondly of the feet upon the abdomen, during expulsion, must be considered as the preparation to a breech-presentation which could not be accomplished any sooner than at the inferior strait, while an original breech-presentation takes place at the superior strait. Consequently, there is in favor of the shoulder-presentation this one point, that there the inferior strait is passed as soon as the presentation of the breech is gained, while in the breech-presentation the breech has to pass yet the pelvic canal.

The rest of the difficulty, the actual expulsion of the foetus is equal in either case of shoulder or breech-presentation.

40. We observe another fact, proving that the delivery by self-evolution is only a modified and difficult case of breech-presentation. This fact is, that, according to Dubois, at the moment, when the breech appears over the perineum, the trunk suffers a revolution around its longitudinal axis, as is precisely the case in some breech-presentations.

The proper indication, in such a case, would be not to diminish the power of the uterus, as is done by large doses of Tartar emet., Opium and by bloodletting, and not to proceed at once to the artificial extraction of the child; but to support the contractive power of the uterus, that is, to moderate its action, if it become spasmodic (by Aconite, Belladonna, Chamomilla, Pulsatilla, etc.) and to increase its action, if the strength begin to fail (by Pulsatilla, Secale cor., etc.); always provided, that these remedies be selected with due regard to the general condition of the parturient, carefully individualized, and, above all, that they be given in such refined doses as to produce no aggravation, either homoeopathic or alloeopathic. Here, too, the main rule will prevail, the higher the susceptibility, the finer the dose.

At the same time it must not be omitted to use proper means, in order to support the nutrition of the mother, to inspire her with hope, to give her rest, when nature seems to invite it, and, in one word, to use all the advantages which careful individualization of the case and confidence in his art, give to the physician. In such manner to attend to the case, no doubt, requires much time, care, judgment and resolution on the part of the tocologian, but he is amply rewarded if crowned with success, as the probability is that he will be.

41. Directing our attention to the child, a very grave objection to trusting a delivery to spontaneous pelvic version as recommended above, may be raised on account of the danger of asphyxia. Such danger, certainly, exists. It may, however, be overrated. Even in regular cephalic presentation children are born nearly asphyxiated, blue and without signs of life; and still by the application of the proper means they come to life. There are numerous cases known where the child was with the head wedged in the pelvis for six or more hours, and yet born alive and healthy.

Dr. Baruch, in a case of long continuing false pains which pressed the child's head against the symphysis pubis, without making any progress, and accompanied with violent tenesmus in ano, terminated labor, at once, by a single dose of Cinnabaris in high potency. The child showed on the head a large bruise and was well.

This circumstance of threatened asphyxia of the child, I think, is to be risked any way, since, as a general rule, the life of the child is always sacrificed, when the safety of the mother requires it. “The mother is more than the child.” We have not yet sufficient experience of homoeopathic treatment in such cases; still, from what we know already, we may safely conclude, that the chances of such treatment, for the preservation of the child, are better, than those of alloeopathic treatment

42. In this connection much stress has been laid on the compression of the cord. But before an argument from that could be made available, another question would have first to be decided, .viz.: how far such compression is allowed by the construction of this organ of the cord? It being formed of the structureless membranes of the chorion and amnion, and of the Whartonian gelatine, in which the arteries and the vein lie imbedded, besides the lymphatics and nerves, we are inclined to believe that, on close examination, the cord will turn out, to be not quite as compressible, as is generally imagined.

Nay, considering the harsh and rough measures, in such cases of unfavorable labor, employed under the common alloeopathic treatment, asphyxia of the foetus is often owing, not so much to the compression of the cord, as to the medicinal overaction of such drugs as Chloroform, Ether, Secale corn. in large doses, or to the effect of surgical manipulations on mother and child.

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