t Ca I POLLARD AND MINKLER'S OBSTETRICAL SUPPORTER: A DESCRIPTION OF ITS APPLICATION, USE, & BENEFICIAL EFFECTS, AS CONNECTED WITH THE NATURAL PARTS AND ORGANS, IN THE mmmm m vmmmmm EMBRACING ALSO A DESCRIPTION OF THE MUSCLES CONCERNED IN THE MECHANISM OF LABOR. BY A. POLLARD, M. D. KEESEVILLE, N. Y. PRINTED BY JON. F.MORGAN: 1849. f& By transfer frotn Pat. Office Ldfc. April i*l4. wtisjmwfflsm mrnmm I presume that under no circumstances what- ever could 1 have produced a work that would have carried the world along with it, nolens vo- lens ; that would require a depth of thought, a fund of knowledge, and a sparkling genius to which I make not the least pretension. Nor did I ever claim in my wildest boyish flights of day-dreams, amid the enchantments of a roman- tic scenery, or when lured on by the 'will-o'-the- wisp' to build castles in the air, that I possessed that peculiar kind of captivating or meteoric ge- nius that shoots athwart the literary and scien- tific horizon and leaves a splendid and luminous path behind it, to attract the astonished and ad- miring gaze of all our fellow-mortals, and, by sirenization, hold them fast against their judg- ment and their will, and by lighting up their foot-steps in a halo of enchanting effulgence, IV serve as a beacon to draw the world of mankind in my wake through weal or woe. However agreeable those charmed powers might be to him who could sway the universe thereby, and mould the minds, hearts and actions of his fel- low-men into a subserviency to his own views, and at all times control the turbulence of human passions and emotions, as the winds of heaven are held by the Power that created them, still I never could work myself into a belief that I pos- sessed them. I do think, however, that under a different state of things I might have told the simple facts and truths which I have endeavored to lay before the public, in a more pleasing if not in a more forcible manner. At least, I think I might have clothed them in a more graceful exterior ; but after all, truth is the real gem which we are all in pursuit of. While composing this little work, I have la- bored under almost every disadvantage that a man could and not be entirely deprived of his intellect. It is known to all who have made the experiment, that our mental faculties may almost as well be absent as to be divided among a thousand conflicting calls at one and the same time. In the first place, it is a kind of labor that I . have never been accustomed to perform. True, I have been in the habit of thinking to some ex- tent ; but I have not been in the habit of arran- ging my thoughts in a systematic form for the in- spection of my professional friends, or the com- munity at large. I have been somewhat distur- bed and embarrassed under the pressure of pe- cuniary matters, which has afflicted the business community of all this region of country more or less. My professional business, for the most part of the time, has been pressing and some- what urgent, and for a part of the time very much so ; and no hour in the twenty-four have 1 been able to call my own. I have been com- pelled to write in my office of business, and nearly one-third part of the time some one has been talking to me ; and I was compelled to hear and answer, compose and write, in the best manner that I could under all these perplexing drawbacks, which were sometimes enough to discourage a person with a much firmer nerve than I possess. Now, that this pamphlet will contain errors, I have not the least doubt in the world. It would be passing strange if it did not That they will be numerous, I very much fear. — That many of these errors may be attributed to a2 VI the causes above enumerated, I think will be acceded to by all ; but that this will satisfacto- rily account for all these errors, is a matter yet to be tried. Those who are disposed to criticise harshly (I shall not say those gentlemen in this supposi- tion) which is sometimes done without under- standing the embarrassments under which a work is got up, and sometimes without under- standing even the w r ork itself, will probably be that class of persons with whom no excuse, whether reasonable or unreasonable, will be available. With this class I have nothing to do : I leave them to plume themselves in all the glo- ry that they may acquire by an abuse or a de- traction of the merits (if merits it has) of this little pamphlet. But, I hope, at least, that the disadvantages under which I labored will be ta- ken into the account by my friends, when they pass upon the style, or give judgment on the ex- ecution of this seemingly small, but to me real- ly great undertaking. If there appears to be a lack of research to gather together the proper and fit materials for a public exhibition like this, or a want of perception to lay hold of, and ap- propriate to my use materials that are already in my reach ; or, if there is a lack of judgment VII to apply, or put together these materials, then, of course, these deficiencies must be attributed to other causes than those which I have men- tioned, and a part of them, at least, to a cause over which I have no control, and of course can • not be accountable for the errors that grow out of those deficiencies. The only excuse that I can offer of any ap- parent weight for my audacity in stepping out of my appropriate sphere of action, and for attempt- ing a thing of this kind, for which I was but poor- ly qualified, and which had ought to have been the work of more able hands, is simply this : — the apparent urgency in the matter seemed to impel me irresistibly along until I was fairly committed, and then 1 went on from mere des- peration. In this little pamphlet I have laid an instru- ment before the profession and the world that is new to them both. I have attempted to de- scribe it, together with the natural parts and or- gans which it is' designed to aid and assist — al- so its true mode of application, use and benefits, or beneficial effects on that portion of our race who are worthy of our sympathies, and who have long stood in need of more substantial aid from those who hold the reins and have the di- VIII rection of that science which pertains to the healing art. This instrument, being new to the profession, will probably, like all other new things, have its warm friends and strong advocates, and also its opposers and detracters. It has already some very ardent, able and talented friends in the lit- tle circle where it is known, who are willing to go all lengths to secure its introduction and to promote its use — believing, as they do, that it is a heaven-sent messenger to mitigate the suffer- ings ot the female portion of our race. Some of the brightest stars that radiate the honor of our profession, have given a decided and most un- equivocal judgment in its favor. On the other hand, it has met with its oppo- sers ; but they are comparatively very few, and always theoretical instead of practical men ; and, 1 say it in all truth and candor, they are al- most universally those who hold a far less ex- alted station in the profession and in the eyes of the world at large, than those who have given it a voluntary and hearty approval. And finally, the opposers are usually those whose opposition, to say the least of it, is not very alarming, and whose influence would be but triflingly flat- tering. Some, without even seeing the inst-ru- IX ment, or having its application or utility explain- ed to them, have cried out, "Humbug — hum- bug ! away with this impostor ! we wash our hands of all participation in this abominable counterfeit, that is about to be palmed off on community!" and, in this way, these guardians of the common weal rid their garments of all the sins that are incident to the introduction and use of this instrument. Pious souls ! what a relief it must be to them ! However, most of this kind of opposition ap- pears to arise from no real wickedness of heart, but more from a want of capacity or discrimina- ting powers to distinguish between a humbug and a reality : consequently, they put down ev- erything that their grandfathers and fathers have not used, to be a 'humbug,' as a matter of course. Others have apparently been actuated by a kind of selfish jealousy — a dislike to everything which they have not had a hand in producing ; and al- though they do not violently oppose, still they will turn a cold shoulder — put on a most tremen- dous wise look, and then remark that "It may be popular among the women, but that it prob- ably don't amount to much, after all." Strange as it may appear, an alarm has been taken at the srreat success of the instrument, and some have expressed a fear that it would be purchased by families, and by its aid they would be enabled to dispense with the assist- ance of the accoucheur, and in this way a great injury was about to be perpetrated on the pro- fession ; which is probably without the least foundation, unless the profession drive them in- to it. While others have no objections in par- ticular, but say that the labor of child-birth is a natural process, and that nature neither requires nor will she admit of any successful or real as- sistance, and that we have only to fold our arms and let the work go on. Of this objection I have only to remark in this place, that it is a doctrine that has been too long preached for the good of suffering humanity. I had supposed that none of these objections would have been raised ; and I am happy to say that, with a ve- ry large majority of the profession, and those de- cidedly the most eminent in the science and art of Obstetrics, have made no such objections. — So, in regard to numbers, the instrument has a very large preponderance in its favor; and in re- gard to weight of character, you might as well compare infinity with finite things. From the very earliest time when I had weigh- ed this matter in my own mind with care — from XI the conclusions which I then arrived at, even be- fore an instrument was constructed, I had al- most made up my mind that no such objections would be urged against it. The principle on which it would act beneficially, appeared to me to be so perfectly obvious, that 1 verily believed no one at all conversant with the science could fail for one moment to comprehend its whole utility. But my disappointment in these expec- tations convinced me of the real necessity for me to expose myself in this public manner, in order to explain away those objections, accor- ding to the best of my abilities under the cir- cumstances as well as to show the actual or positive benefits which must necessarily result from a right application and use of the instru- ment. And in making these explanations, and in showing these benefits, I have struck off into a path hitherto, as far as my knowledge ex- tends, untrodden by man. The philosophical views which I have advan- ced to sustain the positions I have taken in this matter, and the explanations given (as I believe in accordance with both science and philoso- phy) are sustained, if I have not misapprehend- ed my whole subject, by actual demonstrations w 7 hich cannot be controverted, together with the XII reasons why it is that the calls of nature or the instinct of the female demand the various parts of this instrument to support and to aid and as- sist the natural efforts which are put forth by the muscular system, both voluntary and organ- ic or involuntary. All these explanations are ori- ginal with me. I have always understood that these things were called for by the patient, so and so ; but the reason why she calls for them I have searched for in vain through all the med- ical lore from the days of Hippocrates down to the present time ; — o'er all this ocean of learn- ing and science my efforts have been attended with the same ill success as was the first adven- ture of Noah's dove. If those principles w r hich I have advanced to prove the efficacy and the certainty with which it will most efficiently aid the parturient female have ever been previously advanced by any one in or out of the profession, they certainly have not come to my knowledge, and of course I have derived no advantage from them. Some have objected to the instrument be- cause a patent is obtained for it. I am well aware that there is a strong objection generally to patent anything in the profession ; and as far as medicines are concerned, my prejudice is as XIII strong as any other man's. But with regard to the surgical or to the mechanical department of the profession, I think the case is somewhat dif- ferent. As respects this instrument, the idea ori- ginated with my partner, and he is not a mem- ber of the profession. 1 am sorry to deprive the profession of the honor, but duty compels me to do so; and it was only by an express a- greement that the instrument should be patent- ed that I obtained a right to participate in the matter at all. I do not say that I have been entirely idle in the master. After having the original idea sug- gested to me, I have used all the powers of mind and knowledge that I could command to adapt the instrument exactly to the wants of nature in those cases in which it is designed to assist. If I am correct, I have no doubt but I shall receive the cordial support, and be sustain- ed by all the profession whose good opinions are worth aspiring for. If I am in an error, of course it will be detected, and it will then share the fate of all other known errors, in the condemna- tion of all wise and good men. With these remarks I submit this whole mat- ter to the decision of that tribunal before whom it must be adjudged ; and most cheerfully do I XVI await the result, with a firm expectation that the verdict will be in favor of all I have claimed. I now ask a careful perusal of this little pamphlet : it will be a loss of but little time, at most ; and if I am all wrong, I think it due to me from my professional brethren to make a sacrifice of thi£ very small amount of time to set me right again. POLLARD AND MINKLER'S ©oDsinsirBasMi gropssirisiB* In order to describe this Instrument in such a manner that the description may pay the reader for a perusal, and interest those most directly concerned in its operation, and also to give a clear and philosophical account of its benefi- cial effects, the natural parts which it aids and assists, the manner in which, and the reason why it does it — it appears to be be necessary to give a concise and somewhat minute description of the anatomy of the parts more imme- diately concerned in the mechanism of labor. This may appear superfluous, and with apart of the pro- fession it may be so, to some extent ; still I think it will be better understood by most if not all the profession, to have the anatomy of the parts most directly concerned in labor, given in a connected form and in the order in which they are brought into operation in the great and important work of child-birth. A descripticn of the Instrument in the abstract, or a su- perficial glance at the natural organs concerned in parturh 16 OBSTETRICAL tion, would probably lead to more or less confusion in the mind of the reader, and most likely to an endless controver- sy, without any fixed or determinate principles by which the controversy might be brought to a close and the points of dispute settled, beyond a peradventure. Whereas, a description of the Instrument, its operation and effects, in connection with a full, fair and plain description of the muscles and organs with which it co-operates to benefit the female, will lay the principles of action of both the na- tural and artificial parts before the reader in so simple and comprehensive a manner, and mark out the way in so plain and straight-forward a direction, that it would seem to be unnecessary for a fool to err therein. And although I may take up a little time in the description of those muscles which are directly and indirectly concerned in the delivery of the female, so as to give their rise, insertion and ordina- ry use, I hope I shall be excused, from the fact that mos£ of the principles which I propose to advance on this part of the subject are original with me, and of course I wish to sustain them with all the strength and force of argument which I can bring to bear in their favor. An explanation of the parts, as well as the facts involved in this work, appears to be the more important from the fact, that in many instances where I have been conversing with my professional brethren about the Obstetrical Sup- porter, it has been with much difficulty that I could make them understand how the supporter could facilitate labor, although they could readily understand that it would miti- gate the sufferings very much. This, with many other cir- cumstances, led me to believe that a short explanation of all the various operations, together with the means by which they are produced, might not at all times be amiss, even among the sons of Esculapius. Another reason why I sub- SUPPORTER. 17 mit my scribblings to the inspection and criticisraof m j superiors is, that those most directly benefited in all these operations of which we treat, and consequently those most deeply interested, do not belong to the profession ; and al- though they may not comprehend all the force of my rea- soning on the anatomical structure of the various parts concerned in the process of parturition, from the fact that they will be unacquainted with many of the terms which I am compelled to use, still the most of what I have to say they will understand perfectly well, and very much of it they will comprehend fiom sad experience. And I have no doubt but to many of the arguments which 1 shall make use of, they would add their unqualified testimony to the truth of the same ; and fhey may very naturally and very laudably have a curiosity, (not an idle one,) to know some- thing about the o aeration of an instrument that affords them so much he'p at a time when, of all others, they most need it. I shall endeavor to make myself understood by almost every person with an ordinary intellect, with the exception of my anatomical descriptions ; they, of course, must be given in anatomical language, and this will be familiar on- ly to those who are acquainted with that branch of our profession. I will first proceed to describe the rise, insertion, use and operation of the muscles concerned in the process of partuii ion. Those muscles most directly concerned in labor, are the abdominal and the real respiratory muscles ; but in order for these muscles to act with any effective force, or to ren- der anything like the aid which it was intended by the Al- mighty that they should do, there must be a fixed or firm foundation and a reliable starting-point for them to act up- on. Then, having laid our foundation on the primeval • b2 18 OBSTETRICAL rocks, against whose mural fronts the winds and the waves may dash their furious blasts and surges in vain, a systematic description of all these operations would naturally commence with this foundation. When the abdominal muscles con- trast with sufficient force to make any essential expulsive stTort, they must necessarily pull hard upon the points to which the two extremities of the muscles are attached, and the tendency to move those points will be in proportion to the contractile power of the muscles. The amount of la- bor accomplished by these muscles will be in proportion to the contractile power of the muscles, and the firmness with which the points of attachment are fixed and mace immo- vable, It cannot but be obvious to any person, on a moment's reflection, that if the points of attachment or insertion of these muscles are allowed to move when the muscles con- tract on themselves and consequently pull upcn these points, that all the effective or expulsive power, or at least the greatest poition of it, that belongs to these muscles, is counteracted at once. The various parts and processes of the pelvis being the points in which these muscles have their rise or insertion, it becomes all-impoitant that the pelvis should be made stationary — that it should be safely anchored, and held so, with a cable of sufficient strength to resist the contractile power of the abdominal muscles, which are called into ac- tion to expel the contents of the prim& vies, or uterus. — This might be done by commencing at the feet, making them a basis of action for this part of our wcrk, and then ascend from point to point until we arrive at the one con- cerned directly in parturition ; but this would be a round- about way of coming at the real object of the whole opera- tion. If we commence at the feet, we must first plant the SUPPORTER* 19 feet upon some firm or not easily movable platform, and they must be fixed in such a manner that they can be retained in that position, without inconvenience, for a length of time which they are required to serve that purpose. The feet then act as a basis for the work which is now undertaken : the leg, i. e., the tibia and the fibula, must be fixed on the foot by the co-operative contraction of the appropriate but usually antagcnistical muscles — then the thigh must be fix- ed on the leg in the same manner — then the pelvis on the thigh in the same way ; but as I before remarked, this mode complicates the operation, and at the same time renders it far less effective. As brevity combined with efficiency I believe is always desirable, I therefore propose to do this business in a shorter way ; and I have other, and I think more weighty reasons, aside from brevity and simplicity. The first is, I think I can do it altogether better, and in a more workmanlike manner : the next is, I wish to connect with it a helping hand, which I cannct do with any proba- bility of success if I commence with the feet as the basis of my operations. In the construction of our Obstetrical Supporter, I had two grand objects' in view : the first was, to facilitate the operation of parturition by every means that could be em- ployed with perfect safety to the mother and child ; and while weio-hins; this matter, and with a most intense study endeavoring to bring something out of chaos to aid me in my effort, the idea darted through my mind of the great im- portance of firmly fixing the two points of attachment of the abdominal muscles ; and from this time commenced the first favorable impression I entertained for the Supporter; and to this end, and fcr this purpose, I have endeavored to adapt one portion of it. The next object was to mitigate directly the sufferings of 20 OBSTETRICAL parturient females, by every means that human invention could devise, or that God has placed within our reach. To accomplish the first of these designs, I found it to be indis- pensably necessary that the pel /is should be fixed with great firmness, for reasons that I have heretofore given ; and for the above named reasons, and others to be given more in detail hereafter, I have fixed my basis of opera- tions at the knees. In order to prove the correctness of my position, and also to demonstrate- beyond cavil of the skeptical that by commencing at this point all can be accomplished that could be done in any other way, (how much soever you might complicate the machinery,) I shall proceed to give the origin and insertion of the muscles belonging to this department of our machinery, (viz: ) those belonging to the thigh and the pelvis. The muscles on the outside of the pelvis, called muscles of the thigh, are composed of one layer before and three layers behind. The layer before consists of five muscles, two of which are usually described with another set. The Pectinalis — Arises, broad and fleshy, from the upper and anterior portion of the os pubis, immediately a- bove the foramen thyroideum. Inserted into the anteri- or and superior part of the linea aspera of the os femoris, a little below the trochanter minor, by a flat and short ten- don. Us^, to bring the thigh upwards and inwards, and to give it a degree of rotation outwards. The Triceps Adductor Femoris. — I believe, according to the best modern anatomists, that under this appellation are comprehended three distinct (or nearly so) muscles : 1st. Adductor Longus Femoris — Arises, by a strong roundish tendon, from the upper and anterior part of the pubis and from the symphysis pubis on the inner side of SUPPORTER. 21 the pectinalis. Inserted, tendinous, near the middle of the posterior portion of the linea aspera, being continued for some way down. 2d. Adductor Brevis Femoris — -Arises, tendinous, from the os pubismear its joining with the opposite os pubis, be- low and behind the former. Inserted, tendinous and fleshy, into the inner and upper part of the linea aspera from a lit- tle below the trochanter minor to the beginning of the in- sertion of the adductor longus. 3d. Adductor Magnus Femoris — Arises a little lower down than the former, near the symphysis pubis, tendinous and fleshy, from the tuberosity of the os ischium — the fi- bres there run outwards and downwards. Inserted into al- most the whole length of the linea aspera and into a ridge above the internal condyle. Use of these three muscles or triceps to bring the thigh inwards and upwards according to the different directions of their fibres, and to some extent to roll the thigh outwards. The Obturator Externus — Arises, fleshy, from the low- er part of the os pubis and fore part of the inner crus of the ischium, surrounds the foramen thyroideum — a number of its fibres arising from the membranes that fill up that for- amen, and are collected like rays towards a centre and pass outwards around the root of the back part of the cervix of the os femoris. Inserted by a strong tendon into the cavity of the inner and back part of the root of the trochanter major, adhering in its course more or less to the capsular ligament of the thigh bone. Use, to roll the thigh bone obliquely outwards, and to prevent the capsular ligament from being pinched in the joint. Behind are, 1st. The Gluteus Maximus — Arises, fleshy, from the posterior part of the spine of the os illium, a little higher up than the joining of the ilium with the os sa- 22 OBSTETRICAL erum, from the whole external side of the os sacrum below the posterior spinous process of the os ilium, from the pos- terior sacD-isciatic ligament and from the os coccygis. — All the fleshy fibres run obliquely forwards and a little downwards to form a very thick broad muscle, which is di- vided into a number of strong fasciculi. Inserted, by a strong thick and broad tendon, into the upper and outer part of the linea aspera, which is continued from the tro- chanter major for some way downwards as far as the ori- gin of the short head of the biceps flexor cruris, and also in- to the fascia femoris. Use, to extend the thigh by pulling it directly backwards and a little outwards. 2d. Gluteus Medius — Arises, fleshy, from the ante- rior superior spinous process of the os ilium, and from the outer edge of the spine of the ilium, except its posterior part, where it arises from the dorsum of that bone. In- serted, by a broad tendon, into the outer and upper margin of the trochanter major. Use, to draw the thigh bone out- wards and a little backwards, to roll the thigh bone out- wards, especially when it is bended. The third layer consists of four muscles : 1st. The Gluteus Minimus — Arises, fleshy, from a ridge that is continued from the superior anterior spinous process of the os ilium, and from the middle of the dorsum of that bone as far back as its great niche. Inserted, by a strong tendon, into the anterior and superior part of the trochanter major. Use, to assist the former in pulling the thigh out- wards and backwards and rolling it. 2d. Pyriformis— Arises v,ithin the pelvis by three ten- dincus and fleshy origins from the second, third and fourth pieces of the os sacrum, from thence growing gradually narrower, it passes out of the pelvis below the niche in the posterior part of the os ilium, where it receives a few r fleshy SUPPORTER, .23 fibres. Inserted, by a roundish tendon,intothe upper part of the cavity of the inner side of the root of the trochanter major. Use, to move the thigh a little upwards and roll it outwards. 3d. Gemelli — Arise by two distinct origins, the superior from the spinous process, and the inferior from the tuber- osity of the os ischium, also from the posterior sacro-isci- atic ligament. Inserted into the cavity of the inner side of the root of the trochanter major, on each side of the tendon of the obturator internus, to which they firmly adhere. — Use, to roll the thigh outwards and to preserve the tendon of the obturator internus from being injured by the hardness of that part of the os ischium over which it passes ; also, to hinder it from starting out of its place while the muscle is in action. 4yhen the superior extremity is fixed, to raise the pelvis. SUPPORTER. 11 The structure and divisions of this muscle show the won- derful adaptation w r ith which nature has fitted organs or parts to the functions which they are to perform. The differ- ent parts of this muscle will contract separately and inde- pendently of the others, and it is said to do it with equal power and efficacy as if the whole muscle was called into action at the same time ; and when any particular part of the muscle contracts, it acts directly upon that part of the abdomen with which it is connected ; and, of course, when they all contract together, all the parts connected with it are affected at the same time. But another advantage is gained by the structure of this muscle, aside from the fact that it will act upon a local puint and no other. When the whole of this muscle acts together, it only produces a slight undulation on the surface of the abdomen — whereas, if a muscle of that size and length should contract from one end to the other by a continuous set of fibres, it would produce so large a tumor that it would not only be inconvenient, but in that situation would very much disfigure a person. The short central muscle is called Fyeamidalis- — Ari- ses along with the rectus, runs upward, enclosed in the same sheath, and is inserted by an acute termioa'.ion mere than half-way between the os pubis and the umbilicus, into the linea alba and inner edge of the rectus muscle* Its Use is probably to assist the inferior part of the rectus. I say probably, because it is sometimes wanting, without any great inconvenience. This closes my description of the abdominal muscles, or those on the external parte of it. Of their use, power and benefit in parturition it is not easy to mistake ; but I shall say more of that hereafter, and probably in a more connect- ed form ; or, at least, I shall endeavor to put all of this ma- 4Q OBSTETRICAL chine together, both the natural and the artificial, and show the manner in which they co-operate and the assistance that one renders to the other, in such a manner that the mind's eye can take them in at a glance. So vastly impor- tant are they to the parturient female, when a fair opportu- tunity for them to exert themselves exists, that they must not be passed over lightly. There is one other muscle, though usually considered to be almost entirely appropriated to respiration, and in fact is a very important agent and performs a very large share of that life-sustaining act which we call breathing, still so great is the assistance which it gives when acting in con. junction with the abdominal muscles in the act of parturi. tion, that it certainly deserves a few passing remarks by w r ay of description ; and so immediately commingled and intimately connected are the actions of all these muscles, that it seems fully to warrant a description of this. It is call- ed the Diaphragm. It is a Greek word, and literally trans- lated it means inter septum,. It is the transverse partition between the abdomen and the thorax. It is not merely a transverse partition betwixt these two cavities, but it is a vaulted division betwixt the thorax and abdomen ; and not only is the middle raised into a vaulted form, but its obliquity is such that though its forepart is as high as the sternum, its lower and back part comes from near the pelvis, from the lowest vertebrae of the lcins. It is a thin muscle, and very broad in the middle of it reaching as high on each side, in the thorax of the skeleton as the fourth rib. It is commonly divided into two portions. The superior or great muscle ol the diaphragm, which arises by distinct fleshy fibres from the cartilago ensiformis, from the cartilages of the seventh and all the superior rib* of both sides. The fibres from the ensiform cartilage, and SUPPORTER. 49 from the seventh and eighth ribs, run obliquely upwards and outwards — from the ninth and tenth, transversely inwards and upw r ards, and iiom the eleventh and twelvth oblique* ly upwards. From these different origins tire fibres run like radii from a circumference to a centre. Inserted into a cordaform ten- don of considerable breadth, w r hich is situated in the mid- dle of the diaphragm, and in which therefore fibres from op- posite sides are interlaced. There is a perforation towards the right side which trans- mits the venacava inferior, and the mediastinum and the pe- ricardium are connected to the upper convex part of it. The inferior or lesser muscle, or the appendix of the di- aphragm, arises from the second, third and fourth lumber vertebrae, by eight fleshy tongues, or heads, of which two in the middle are longest : they are called crura 9 and are usually tendinous. The aorta and thoracic duct pass between these, and the great sympathetic nerve and vena azygas pass on the outside and perforate the shorter heads. Those muscular fibres which run obliquely upwards and forwards from the two middle fleshy columns, decussate and leave an open space which transmits the cesaphagus and eighth pair of nerves, On either side of the lower portion of this muscle ar« formed two bow-shaped ligaments, inserted, by strong iieshy fibres, into the posterior portion of the middle tendon. The diaphragm is the principal agent in respiration, and more particularly that of inspiration, For where these dif- ferent fibres act to biing themselves into a plain, by their simultaneous action on the middle tendon, by which the cavity of the thorax is enlarged, particularly near the sides where the lungs are mostly situated, (it is a well-known fact that the lungs are always contiguous to the inside of E OBSTETRICAL the thorax and upper side of the diaphragm,) the air rustl- es into them to fill a vacuum or increased space. This mus~ cle is assisted by the two rows of intercostals which elevate the ribs and the cavity of the thorax is still more enlar- ged. During violent exercise, or whatever other cause drives the blood to the lungs with increased celerity, the pectoral muscles, the sarati, antici majoris, sarati posteri superioris and scaleni muscles affect the lateral dilatation of the tho- rax, when brought into action ; and the muscles which arise from the upper part of the thorax also assist by fixing the scapula, and then move the ribs on the scapula in laborious breathing. The diaphragm is pushed up, in rather a relax- ed state, during expiration, by the action of the abdominal muscles contracting on the viscera of the abdomen, and they press it upwards at the same time that their combined ac- tion with the sterno cos'alis, ssrrati, and postici inferioris pull down the ribs, and by the elasticity of the cartilages that join the ribs to the sternum they derive a powerful assistance ; hence it can readily be seen how the cavity of the thorax is diminished and the air expelled from the lungs with much ease. The diaphragm is however the principal agent in the dilatation of the chest in the act of inspiration. The quadrati lumborum, the sacro lumtalis, and the longissimus dorsi, all assist laborious expiration from dispnea, in asthmatic affections, etc., when the scapula is fixed, by pulling down the ribs. The diaphragm is arch- ed when relaxed, the top of which is very nearly on a level with the anterior portion of the fourth rib. This arch is flattened when the dipahragm is contracted, though the cor- diform tendon is siid to be very little depressed, and of course in proportion as the abdominal viscera are pressed downward, the cavity of the thorax will be increased : this SUPPORTER. 51 downward pressure of the viscera causes that swelling or protrusion of the abdomen which we observe during inspi- ration. The diaphragm and the abdominal muscles usually an- tagonise each other, from the fact that they contract alter- nately. Occasionally, however, they contract in perfect unison, and this is the fact when they are called upon to act in that great and important work for which we have brought them into notice at this time — that is, to assist the womb in the expulsion of the foetus, at that momentous period when a fellow- being is about being brought into ex- istence ; or rather to be made conscious of its existence. — When they do act in unison, they compress the viscera and their contents between the two plains which they form with each other, with such a tremendous force as some- times to cause hernial protrusions. This is not the case, however, in labor, as the womb lays anterior to the other viscera, and consequently occupies the region where her- nial protrusions take place. This fact obviates the dan- ger at such times. Finally, the diaphragm is a noble muscle, and might "well call forth from Hallar that flattering cognomen, s< Noblissi- mus post cor musculus," We may smile at Buffon, who was a much better geologist than anatomist ; and after all, it is no £reat wonder that he should mistake its central ten- don for a nervous centre, the place from which originate all our emotions, and the seat of the soul. This closes what we have to say on the muscles by way of description, and we believe that the description embra- ces nearly all that are directly concerned in the process of parturition. We have mentioned, or briefly referred to, most of those lhat are indirectly called into action in the performance of this great work. It is nothing less than 52 OBSTETRICAL. the fulfilment of that edict which has gone abroad on all the- face of the earth, from pole to pole, embracing latitudes and longitudes to their utmost extent, and it comes from no less a personage than Him who made heaven and earth and sea — who has said, " multiply and replenish the earth, and add to the numbsr of those who shall add to the glory of my creative power." As guardians of the common weal of mankind, it is not too mush to expect of us that we should emplo} 7 - our minds and inventive powers to soothe and alleviate the sufferings of that portion of our race on whom the great burthen of the fulfilment of that command seems to fall with an al- most crushing power ; and if we can accomplish anything in this way, let us not doit w 7 ith a grudging hand, but free- ly exert ourselves to the last extent of our abilities. Who, then, among the wise men w r ho have an oriental abode at this day, shall dive into the unfathomable depths of futuri- ty, and bring to our view the importance that may be at- tached tolhe safe delivery of one single case of child-birth. The w r or.h of the mother may, to some extent, be appre- ciated by us ; but the value of the one to whom she is about to give birth, either to its friends or to the world at large, can only be known to an Omniscient God Himself ! Who but Him can tell whether the unborn will n,ot be one who shall sway sceptres, kingdoms, kings and empires,, as the gamester moves his miniature great ones across the pfa:e of the chess-board? or whether, in science and phi- losophy, he shall not be a Franklin or a Newton, a.Gali- leo or a Harvey ; or in war a Washington, a Napoleon, a Caesar or an Alexander ? The fact that this, offspring may be equal to any of these, shows the great importance at- tached to the safe delivery of the same; and it also shows another important fact in connection w T ith the above, that SUPPORTER. 53 it never should be entrusted in the hands of quacks and ig- norami, who stalk abroad on the earth like a destructive mildew that blights the hyacinth and the rose ere their ver- dure and their sweet perfumes gladden the senses of an ex- pectant world. And he who shall facilitate this work, and at the same time add to its safety, shall not only assist in the obedience of God's command, but be doing a service to his country of more importance and of greater value than all the gold contained in the vast regions of California, or all the diamonds that ever sparkled on the diadems of mon- archs. Then it is certainly worth our time, our exertions, our highest aims and most untiring efforts, mental and bo- dily, aided by all the inventive genius that we have power to cultivate or otherwise command, and concentrate them all on the one great object to project, and bring forth some instrument that shall render safe and easy this great work; and then most humbly and devoutly invoke the aid and the blessings of God that we may succeed in these our lauda- ble and praiseworthy objects. This is the work assigned, and, as far as we are concerned, with all confidence of suc- cess, to the Obstetrical Supporter. I have previously remarked that I had tw r o principal de- signs in the application of the Supporter to obstetrical pur- poses; and in presenting it to the consideration of my pro- fessional brethren for their approval or disapproval, as its benefits or inutility may strike their judgments, I might add a third, which, perhaps, had ought to have been the first one named- — that is, the increased safety which it af- fords to the parturient patient in those critical, and, in most cases, dreadful moments of her life. In those terror-fraught moments, big with important events which are about to transpire with the patient, she certainly requires all the aid and support that can by any means be afforded her to e2 5 i OBSTETRICAL inspire and sustain all the fortitude, hop3 and courage' which lies in the power of temporal things to impart to her ; and let us never tire or £ar of doing too much in the right way to enable the poor suffering female to pass thro' this soul-trying ordeal. These important results we also most confidently claim for the Supporter, and only ask, by way of confirmation, a fair trial by those who are blind in unbelief. As the description of th's Instrument has heretofore been but partial* and quite imperfect, I shall now proceed to a more minute account of it ; and however imperfect it may be, I hope to render myself intelligible to those most direct- ly interested in its operation. It has, 1st, a back pad, which is composed of a central metallic plate to give and maintain its form : this is cover- ed on one side with leather of some kind, such as strikes the fancy of the maker as being the best — on the other side it is nicely cushioned, so that it will press upon the back with all of its inner surface and with perfect ease, even when the pressure is very great. The pad is oi somewhat conical or cordiform shape, with the base of the cone up- wards : it is convex externally, and concave internally : it fits very nicely to the back, which holds it firmly and with ease, and may be put on or moved so as to apply the pres- sure directly over the seat of the pain, or the part that re- quires to be held. The manner in which this pad fits the back, and the amount of pressure which this instrment en- ables the patient to apply to it, holds the back most deci- dedly better than any other mode that I have ever seen tri- ed j nor can I now conceive of a better plan to accomplish the important object allotted to this division of the Support- er. I never could conceive why this method should be ob- jected to by any person who had the least idea that that SUPPORTER. 55 support was ever required for the back in any case ; and certainly it is a general rule, and it is well known to all who have any knowledge on the subject, that females require the back to be supported, and usually they require the sup- port to be very strongly applied during child-birth, The exceptions to this statement are barely sufficient to make it a general rule. Then, since this support is almost univer- sally required, it seems to me to be the height of folly to re- ject the very best mode that has ever been devised to make and apply that support. And it is equally w r ell known to all that this support, or counter-pressure upon the back, when judiciously and properly applied, mitigates the pain and the suffering consequent therefrom to a very great extent, and many times relieves it entirely. Then I repeat, that no philanthropist will reject or oppose the best means to re- lieve the sufferings of our fellow-beings ; and particularly to that portion of them to whom our best gratitude is due. 2d. The main strap, which may be made of leather or other material of sufficient strength to hold the. amount of pressure that is necessary to apply to it. The force- appli- ed to these straps varies very much, and this variation de- pends upon the expulsive efforts of the voluntary system and the contractile power of the muscles which are enga- ged. In healthy and muscular females, this power is very great, and sometimes almost supernatural. This strap pas- ses through two loops on the back pad, then comes for- ward and passes over the hips, then along the thigh and around the knees. It holds and supports the hips as it pas- ses over them. In some cases, and in particular stages of labor, the pain in the hips is quite severe, and sometimes excruciatingly so : in these cases, this strap affords a very great relief. Aftjr passing round the knees, the ends of this strap are made to approximate the back pad to a dis- 66 OBSTETRICAL tance of a little more than half-way up the thigh, where they are fastened to the strap as it passes down the thigh. — This must be done in a workmanlike manner, so that the strap will set perfectly smooth on the thigh. This forms two loops, into which the knees may be planted and held with great firmness and stability, which gives a sensation of support and increased strength that is felt through the whole muscular system. This seemingly increased strength in- spires hope and confidence : this mental buoyancy does away fear, despondency and all the other depressing pas- sions, and the labor proceeds with regularity and dispatch ; which is exceedingly agreeable to both patient and friends. On this main strap and near the back pad on either side are two strong leather straps with buckles fitted to each, so that the length of the strap may be readily adjusted to the length of the thigh of any person. 3d. To those loops which hold the knees are attached two sliding pads, held by two narrow loops that slide on the loops of the main straps, so that these pads maybe mo- ved as the length of the main strap is altered, so as always to bring the pads directly over the knees. The use of these pads is to prevent the pressure of the straps from becoming painful to the knees in protracted labor, and the benefits which they afford are not to be neglected, for the trouble of moving them is nothing, nor does it take up a moment's time. 4th. There is a narrow strap that is made fast to one side of the loop that passes over the knee : this narrow strap then passes directly under the foot of the patient, and to its other extremity is attached a buckle which buckles on to a short strap of the same width, which is attached to the loop that passes over the knee on the oppnsite side from the attachment of the long strap. The use of this strap is to SUPPORTER. 57 prevent the possibility of the main strap slipping oft" from the knee when the patient pulls hard by the handles, or in case she should pull on the handles before the extension is made of the thighs on the pelvis ; and wh^n the patient lays on the side it gives additional support to the whole lower extremities. But when the patient is in a sitting po- sition, or lies on her back, the feet rest upon some other substance, and do not require that support. The extension should be made by the knees in the loops of the main strap in all cases. 5th. There are two handles — they are constructed 'as follows : there is a strap to each knee, which passes thro 7 the loops of the movable knee-pads — the ends of these straps come up on each side of the thigh, and are then attached to each end of a handle that lies transversely across the thigh, approximating near enough to the pelvis to make it conve- nient for the patient to grasp them with her hands. The shape of these handles is so well adapted to the grasp of the hands that no cramping or any other difficulty whatev- er attends this action : they are covered w T ith soft velvet, so that they can cause no uneasiness to the hand when the pa- tient pulls hard upon them, and the patient may pull on them as hard or as lightly as she chooses, and in prcportion as she pulls on the handles, the pressure and support of ths knees will be augmented. It will be found in practice that the patient always wants to grasp something with the hands, and either pull or push on whatever they lay hold of: the reason of this will be explained hereafter, in connection with a condens- ed description of the natural and artificial parts together. 1 think it better for the patient to pull than to push, from the fact that both the abdominal muscles and the diaphragm act with greater force and efficiency when they pull : still, 58 OBSTETRICAL they will many times grasp the main straps as they pass down the thigh, and push to very good advantage : but I have almost universally found, where the patient was in- clined to push, that, with a little timely and well-directed advice, they can be persuaded to pull on the handles ; and after they have made the experiment two or three times they will do it with all the ardor and zeal of those who commence it with their own freewill and accord. I have never yet had a case that, with a little tact and manage- ment, did no!; terminate in this way. I have now given descriptions of those parts concerned in parturition, which were formed by the God of Nature for that end some of these havebeen quite brief, others more at length and detail. I have also given you a descrip- tion of that Instrument which we have intended, and which we design to be a co-worker with the former — extending an auxiliary hand to those natural parts to assist them to bring to a speedy, safe, and, in every other way, successful termi- nation, the painful labor in this department of the great work of re-production. I will now proceed to give in a more connected form the manner in which I propose to accomplish the two great de- signs which we had in view in the invention and introduc- tion of this Instrument, viz., to facilitate the process of la- bor, and at the same time to mitigate the sufferings and the agonizing pains of that portion of God's creation on whom the curse of the fall seemed to light with a heavy and a withering hand. The process of parturition is of a very complex nature, from the fact that there are a very great number of parts- involved in the operation, and these of a very heterogeneous nature ; and great care and some little skill is required to give the separate functions of them all in a clear and com- StOTORTEft. b& prehensive manner. But, poor a mariner as I am, I must launch away upon this stormy ocean with the best chart and compass which I have at hand, and put my hand to the oar and show my good will if not my success in this great attempt. With regard to the individual members that are connect- ed in this work I have given most of them in detail ; thai is, the great number of the voluntary muscles, their names, their insertion, and also their use, in the ordinary operations for which nature designed them to act; and, yery imper- fectly, the part w^hich they perform in the great drama which has caused them to appear before my readers at this time. The other cause of complexity arises from the differ- ence in the nature of those servants or agents who are call- ed upon to labor in this all-important field of operations. Those of the first class which we have mentioned we have already said were voluntary ; that is, they are under the power and control of the will or volition. The idll, as it were, issues its imperative commands to those voluntary agents, and the mandate is implicitly obeyed, if in the pow- er of the agent so to do. It is the exercise of the will over the abdominal and other muscles that constitutes the volun- tary part of labor, and it is to this part that we are able to render the most immediate and efficient assistance by art ; and here it is that the Supporter steps in, not as an intru- der, but as an important co-worker and an invaluable assis- tant in the labor that is before them. The other part of this work is done in a different manner and by another set of hands altogether: the operation is different — different causes are in operation to produce the same result, and these causes obey a different set of laws en- tirely. The actions which take place in this department, are called, in common parlance, organic, or involuntary : 00 OBSTETRICAL they commence independently of any effoit of the patient, and proceed in the same manner. These actions are like an ancient description of the wind — we hear the sound thereof, but know not whence they come nor whither they go : they are not under the control of the will, nor do they obey its laws or its mandates ; but, like the Yankee soldier, they fight on their own hook. The organ of which I am speaking at this time, is called uterus matrix, or womb. — This is undoubtedly a muscle, as all its structure and func- tions show, and one of exceedingly great power, (as sad experience has sometimes taught me to my cost) ; but this organ, as I have before observed, is not, like those which I have described, under the power of the will. It acts entirely independent of all the exercises of volition : it is controlled by, excited to, and continued in action, by a cause or causes the nature of which it would be worse than useless for me to attempt to explain. Why it is that the uterus, after the lapse of a certain time from impregnation, should commence the process of partu- lition by a continued series of efforts to throw off its burthen or relieve itself of its contents, is more than I can tell ; and I shall spare myself the committal of one folly by declining to make the attempt. Long and many, tortuous and per- plexing, fine-spun but slack-twisted, are the theories and explanations that have been attempted to account for this wonderful performance of the uterus. Many a great man with a little mind has written lengthy and rlowery disser- tations on this subject, and embellished them with a kind of tea-bell eloquence that is more tongue than brains ; but they have probably been edified to a much greater extent, and far more agreeably entertained by their own research and eloquence than has fallen to the lot of any of their readers. SUPPORTER. This class of productions, as far as I have had the mis- fortune to examine them, have usually been the wild-fire productions or vagaries of some hair-brained fanatic, or pu- erile monomaniac. It is one of those unfortunate cases where philosophy has yielded the ground entirely, or con^ sented to amalgamate herself with a train of ill-conceived chimeras, and badly chosen hypotheses ; and the effect has been a darkening of the atmosphere of true science all around us, as with a fog of pestilential exhalation of poi- sonous effluvia and baleful ch oak-damps, thrown off from the quagmires and stagnant pools of fancy, without reason and imagination — without judgment. These writers, or will-o'-the-wisps, as they might be called, are those that we read of when it was said by the patunt one of old, u Yo darken counsel by multiplying words without knowledge.'' All that I shall attempt to say with regard to the efficient and final cause of the contractions of the womb al the end of a particular period of gestation to expel the foetus, is, that it is some inherent, instinctive, organic principle that God has implanted there, and it is subservient to certain calls of nature which she makes upon it whenever she stands in need of its assistance. We ail know the fact that after fecundation has taken plac6 3 and the ovum through the medium of the fallopian tubes has passed from the ovarium to the uterus, and about forty weeks or two hundred and twenty-eight days hare passed by, that the uterus then commences a most vigorous effort to expel its contents, which had laid there with per- fect quietude, and the uterus had carried it without a show of resistance for the space of ten lunar months. These ef- forts of the uterus to relieve itself of its contents, consist of a series of contractions and relaxations , which occur at greater or less intervals, attended with considerable pain { Yi OBSTETRICAL and restlessness, usually accompanied with a desire \o move often from place to place ; and not very unfrequent- 3y it is accompanied with a feeling of fretfulness and imp-a- lienee. This may occur however with any disposition, no matter what the natural affability or good- nature of the person may be : it is merely the effect of these contractile efforts of the uterus produced on the whole nervous sys- system, and takes place on the principle that effects follow causes. These symptoms, in connection with others not necessary to mention here, we take as the commencement of labor ; and these alternate contractions of the uterus are usually called by the patient and the attendants, ''grinding pains," from the fact that they give a kind of a grinding; and disagreeable sensation, without any particular expulsive efforts; and at this stage of the labor very little can be done by the way of art. This action being organic, and without the scope of volition — the organ to which these ef- forts belong, must do the work. The Supporter can do little or nothing at this time, ex- cept in those cases where there is great pain in the back from the commencement of labor; in these cases much re- lief may be afforded to the back. I have used it under those circumstances with most decided relief ; but when used at this time it should always be explained to the pa- tient that the relief to the back is all that she is to expect of the Supporter at this stage of labor. With this under- standing I have used it with the most perfect satisfaction to the patient, and to those who witnessed the effects; and I have thought sometimes that the expulsive efforts came on sooner and that the labor was terminated in less time than it otherwise would have been. But if the Supporter was injudiciously applied at this stage of the labor, with an en- couragement that it was going to enable her to be delivered SUPPORTER. 63 at once, an inevitable and most injurious disappointment must be the result ; for it is not in the nature of things, without the direct interference of miraculous results, for the woman to be delivered before th«e mouth of the womb is di- lated. Consequently it would be most reprehensible in any person to hold out such hope to the patient, no matter what the power of the assistant was, if it was anything short of an omnipotent hand, I make these remarks from tlie fact that wicked and designing men might make use of this method to bring the Supporter into disrepute among fe- males, who, of course, cannot be supposed competent to judge of the philosophical operation of the instrument when -separated from that of her own experience. These dilating pains are not under the control of the will, they are made by the uterus alone ; and in making them the uterus obeys certain inherent and determinate laws, which I have already declined an attempt to explain. This part of the labor that is performed by the uterus is not on- ly different from the other or voluntary part of it, but it is also somewhat complex in itself. The uterus is a muscular structure of a peculiar kind, and is composed of two sets of fibres, with a power of contrac- ling on themselves; and this power is complicated in such a manner that these fibres act antagonistically, or in con- trary directions. One of these set of fibres are called cir- cular or transverse fibres, and when they contract they les- sen the transverse diameter of the uterus by approximating the parietes in that direction ; and it is these fibres, and par- ticularly those situated about the servix and 03 uteri, that enables the uterus to carry and sustain the weight of the foe- tiis during the time of gestation ; and when the fibres act in conjunction with the others, they oppose the dilatation ot the os uteri, and the expulsion of the head of the child S4 OBSTETRICAL through the mouth of the womb, just in pioportion to their contractile power. And even after the exit of the child's head through the mouth of the womb, a strong contraction of these fibres would firmly embrace whatever portion o^ the child remained within their reach, and consequently they would retard the expulsion of the foetus in the same ratio that these fibres are called into action. Hence g reat care should be taken that nothing be done to excite an un- due action in these fibres, otherwise the labor will be pro- longed, and the sufferings of the female will be augmented by such useless and injudicious management. It was for this reason that I declined the attachment or use of a fiont pad, (which I once had in contemplation,) to be applied to our Supporters, believing from the facts which I have here mentioned that its effects and operations would be to retard the work rather than help it, and that it would most certainly, inmost cases, prove a hindrance rather than a help. All the parts of our instrument, as it is constructed and used at the present time, are indicated by nature, and in- stinctively called for by the parturient female ; and I added ihem one by one in the various trials which I made, by watching the effects of those which I had, and the indica- tions or calls for those which I had not. But I never in all my practice heard a female call for pressure over the womb, or any part of the abdomen, during the time of child birth. And from the fact that this never seemed to be indi- cated by nature or called for by the patient, (if it was wanted it would be called for the same as other things they demand,) I have, as I believe very judiciously, and as a matter of safety, rejected it as worse than useless. In instruments, as in medicine, I consider that the indi- cations of nature ought in all cases to be the rule by which SUPPORTER. 65 the bounds of safety are marked out; and they should also be considered the true landmarks by which all the con- struction and use of both instruments and medicines should be regulated. What are the great and primary objects of medicines and instruments as they are used to aid us in the healing art? It is not to create new principles by which we may lord it over nature, and compel her to bend herself in conformity to this or that arbitrary rule ; that would certainly lookjike being wise above what is written. Now to me it would look rather more becoming a poor short- sighted mortal to endeavor to assist nature to perform her own work in her own way ; and when she calls for aid, it becomes us, in all humility as her servants, to tender such things as we, after a careful examination and close and well directed obervation 5 find best adapted to satisfy those calls. And what she does not call for, let no one presume to force upon her in order to drive her from the path which God has marked out for her ; or what is still worse, make forced and gratuitous applications for the sake of filching from another what jusily and of right belongs to him. If any thing can ever be done by pressure on the ab- domen of the female during her accouchment, or if any thing- is ever required to be done in this way, it can be much better done by the hand of the accoucheur than by any other means under heavens; for by using the hand, the pressure may be made directly upon the fundus of the uterus, which might assist the longitudinal fibres to approx- imate the fundus towards the mouth, and thereby assist them in making the expulsive efforts to accomplish the delivery of the child. But nothing can be more clear to a mind of sufficient capacity to comprehend the mechanism of labor, than the simple fact that pressure made by a pad over the region of the lower circular fibres would stim- f2 OBSTETRICAL uliite them to contract ; and just in proportion to that con* traclibility, as I have before shown conclusively, they will retard the delivery of (he child. I shall say no more on this branch of the subject, and to those who are not total and entire strangers to all the functions and operations of the different parts concerned in labor, I have already said more than was necessary. A wise man will be convinced with less than what has been said, and a fool will not be convinced though I had said a thousand times mere. And even if they were, it is a thriftless work to make such proselytes ; it is a kind of game that never pays for your powder and shot. The ether set cf fibres which enter into and belong to the structure and formation of the uterus, run in nearly an opposite direction from those that have been described, and consequently encircle the long diameter of the uterus ; and from this fact they are called longitudinal fibres. — When these fibres contract they approximate the fundus or top of the womb towards its mouth, which lessens the long diameter of the womb, and, at the same time, it increases the transverse diameter. The circular fibres resist this efeo.t of the longitudinal ones ; but, by a eontin- ed action of the superior power of the longitudinal ones, this resistence is overcome, and the os uteri becomes dila- ted — ready to give egress to the child's head as it commen- ces its first jour ne} T of life, I have spoken of the superior power of the longiiudinal fibres. I am aware that this is a controverted point, as regards the power of the two sets of uterine fibres ; but, from the simple fact that these two sets of fibres oppose each other at the commencement of labor, and that, in the end, the longitudinal ones prevail, it is ve- ry natural for us to conclude that thcs3 whose works pre- ponderate are the most powerful. SUPPORTER, 67 Thus far the lator has progressed almost entirely by an involuntary action, or a series of them , which will have occupied a greater or less amount of time, just in proportion as the longitudinal fibres have been strong and active, or as the circular fibres have resisted their efforts. This is a very tedious part of the labor, and it is rendered much more so from the fact that these dilating pains are generally con- sidered by the patient and the attendants as being entirely useless ; because they do not u bear down," as they ex- press it, they think they are having all that suffering without any beneficial effects to repay them, and hence it' is that w r e so often see an impatience and fretfulness manifes- ted by the patient. The idea of suffering without any compensatory bliss to follow r , produces a depression of spirits and a despondency of mind, and this causes great irritability and excitability of the nervous system ; and from this state of the nervous system follmvs impatience and fretfulness, to a greater or less degree, with as much certainty as the needle follows the pole in the chambers ol the north. With this impression on the mind, the patient, and not unfreqaently the attendants, will importune the physician to give something to relieve them ; or in other words to produce better pains. But in this stage of the neither Supporter nor medicine can be made available, if the dilatation is proceeding properly. t is however a mistaken idea that these dilating pains are useless or unnecessary ; and this error should be cor- rected by the best means that may, under all the circum- stances, be suggested to the mind of the accoucheur. The fact is ; that these dilating or grinding pains are a prepara- tory process, and must, in ihe nature of things and of laws out of our control precede the real effective and efficient causes to produce the Lirth of a human being; and they 68 OBSTETRICAL are as important as any other stage orpoition of the labor. When the longitudinal fibres have prevailed ov r er the resistance of the circular ones, and the mouth of the womb has become properly dilated, then a change comes over the face of things ; the labor is no longer conducted by the involuntary efforts of the uterus alone, but the vol- untary powers now offer their aid and assistance, and the pains seem to pass rather imperceptably from what the pa- tient and the assistants call grinding or useless pains to those which are accompanied with forcible bearing down efforts, which give the patient an impression that they are doing some good and are destined soon to relieve her from her sufferings. At this time she begins to have a strong desire to help herself, and, as the result of these desires, she wishes to make bearing down efforts simultaneously with the invol- untary contractions of the womb ; and now all the various parts and machinery of labor are brought into requisition, and so strong are the desires of the patient for what she thinks she wants, that it seems exceedingly hard that she should be denied . The mcst of these desires are instinctive- ly suggested to the female ; she cannot tell you why it is that she wants them, but she can tell you with a great deal of emphasis of the fact that she does want them. And now let us see what these calls of nature are which are suggested and required by the suffering female in this her hour of peril and tribulation. Usually the first thing called for by the parturient female after the efforts of the expulsive pains have fairly commenced, is to have her knees held firmly, so as to allow her to press on the point of resistance by extending the thighs on the pelvis ; at leas! the tendency of the effort is made in that direction and ii that manner. It is very seldom, however, that by tl SUPPORTER. 69 means heretofore used the knees could be held with suffi- cient firmness to satisfy the wishes of the female, and it is more effectually done with the Obstetrical Supporter than it could be done by a combination of every other means that I have ever known. Next is a desire to grasp something with their hands and pull upon it with more or less force ; and the fact that they cannot give a philosophical or sciantific reason for these desires does not in the least degree diminish the desires themselves, nor does it satisfy the patient when she cannot be gratified. Next in order is the pain in the back ; this is not always very severe, sometimes it is slight and does not cause a great uneasiness to the patient. At other times it is most excruciatingly severe, so much so that it requires all the powers of endurance that human nature is gifted with, in order to bear it with any degree of composure. With all those powers of endurance for which females are so much celebrated, these sufferings will many times extort from the sufferers such cries and groans as will pierce to the heart even of the most careless spectator, and they are certainly any thing but pleasant to the ear of the humane physician, particularly when he is appealed to in the most earnest and supplicating manner to do something that will give them a few moment's relief from their anguish. How often would I have given any thing, or all things that I could have commanded of this world's goods to have been able to comply with and satisfy those pitiful appeals. But never did I realise the gratification of these laudable desires un- til I had the pleasure of using the Obstetrical Supporter ; and up to this time I never saw those pains mitigated or at all relieved, save in a very slight degree, and that in a very bungling and troublesome manner. How often have I 70 OBSTETRICAL turned away in disgust from these unavailing efforts with the mental exclamation of ' c Oh ! my God ! are these suffer- ings never to be palliated by human skill ?" and a negative answer made our boasted science appear smaller than Hahnemann's 30th dilution of common coffee. But the long looked for and mach desired agent has come at last, with healing in his wings. I do not hesitate to say, and I say it without fear of contradiction by those who have made the experiment, that nineteen twentieths of all this pain in the back may be done away with by a judicious use of the Supporter. And if this was all that it effected, and its entire benefits were summed up in this one thing, it would well deserve and probably receive the patronage of the profession. I have now given a brief description of the organs and parts most directly concerned in the mechanism of labor, comprehending both the voluntary and the involuntary systems, and the manner in which each fulfil their sepa- rate appointments. I have set forth, according to the best of my ability, w r hat are the calls of nature in this great work, and how they are instinctively made known to the fe- male,who is the principal laborer to perform this great work; &nd also what are the materials which nature has put into the hand of the female to enable her to perform this work; and the manner in which the various parts of this machin- ery act when in performance of the task assigned to it.— Now, the question arises, can nature be aided in the per- formance of this work by the hand of art ? I answer that it can : others may say that it cannot. It d has already been said by some, (who are probably more conscientious than wise,) that any attempt to relieve the sufferings of the female in her agonizing struggles to give birth to her offspring, i$ striving against the edict of Supporter. i Jehovah. They say-that the pains incident to childbirth are the effects of the curse that was pronounced on woman in the garden of Eden for her disobedience in picking and eating and giving to the man that he might eat, the inter- dicted fruit, whereof it was said " thou shalt not eat," etc. Allowing this to be the case, for which, taking together all that was said at that time, there is some little plausibility; still it does not say that this penalty should remain eter- nally in force without any mitigation or palliation. If we take what was said against the woman by way of penalty inflicted on her in certain situations as the fruits of her disobedience, we will also receive what was said in her favor in connection with the former, eminating from tha same high power. After the pronunciation of the curse a word of comfort was spoken to th^ poor dejected female, by him on whose words are based the pillars of heaven and earth. He gave her to understand that though for a time she must be afflicted, nevertheless that the old wiley ser- pent, the devil, should not always hold dominion over her nor her posterity. But on the contrary it was said that the seed of the woman was to bruise this serpent's head ; by which she was undoubtedly to understand that the unlim- ited sway of the devil should be broken — that his domin- ion on earth should be scattered like chaff before the winds of heaven — and that with the cessation of this dominion should end his power to inflict pain and misery on the sons of men. Hence it is that the immortal Milton has not sung his paradise regained without good authority for so doing. And if the pain of childbirth is the penalty of the first transgression, judging from what little I have seen of those sufferings, it would seem to be placed beyond a doubt that the sin in question was most amply atoned for, so far as suffering could do it ; and that it is high time something 7£ OBSTETRICAL was done to round off the sharp angles of these almost life destroying agonies, if it is in the power of man to accom- plish so great a work. And as respects the sin and iniqui- ty that rests upon oar endeavors to ameliorate these suffer- ings, I can only say that when I come to close up my career here on earth, and am called to render up to the bar of God an account, I do most devoutly pray that, no other sin may be found resting on my soul or standing between me and the celestial paradise, than my endeavors to render more safe and easy the entrance of posterity into this wicked world. Others have objected to our endeavors to give aid and comfort in this matter, because, say they, you have no right to do so ; and as evidence of this allegation they adduce the fact that labor is a natural process, and say that it is mere presumption to attempt an interference by the puny arm of art. I really think that the force of this argument will not knock a man down. As well might we say that tiaveling was a natural process and that the use of the lower extremities are all the means we have any right to make use of to perform that work ; and that steam bcati and rail road cars and all other locomotive engines are mere innovations and trespassers upon rature, and ought to be annihilated at once. By the same rale of logic, all our ordinary manual labor must be performed without any ar- tificial aid ; we must forever lay by, (not as useless, but unusable,) the advantage of the lever, the screw,the pally the wheel and axle, and all other artificial and mechanical powers which in the wisdom of man he has made subser- vient to his use and comfort. The same objection would* apply with equal force and pertinancy to all the obstetrical instruments that have been invented from the days of A- ristotle down to the present time. Finally, it is a sufficient SUPPORTER. 73 answer to all these childish objections, to say that nature is not always competent to do her own work in her own way. There are accidents, deficiencies, and malforma- tions, all of which it is the business of art to remedy, as far as in it lies. In these, either the de&th of the child or the mother or both must ensue, or artificial aid must be given to the unavailing efforts of nature to finish her task. Then if life may be saved by our efforts, when scientifically and judiciously applied, in some cases, it follows with equal certainty that nature may be assisted under other circum- stances ; and that much pain and suffering may be saved by a timely exercise of the same kind of skill and efforts. And now, on taking a retrospective view of these things. I can lay my hand on my heart and say, the only thing that I have to regret in all this matter, whether it be in the sinfulness and impiety, or the impropriety of our endeavors to afford this aid, is, that I did not sooner bestir myself in the work, to invent or devise some means by which we might sooth, soften down, and heal those dreadful wounds inflicted by the barbed dart of sin on poor suffering rru - inanity. I know it was said to the woman in the garden of Eden, "In sorrow dhalt thou bring forth," alluding to the offspring ; and never has there been a more literal truth spoken from the whole volume of inspiration, and never was there a sentence executed more fully to the letter. We all know that it was said to man that the earth should be cursed on his account, including that hallowed spot on which he stood when he came from the hand of his maker in his primeval purity. The sentence passed upon man was no less explicit than that passed upon woman ; and from that oracle whose word can roll the everlastino* hills from their resting places, and cause mountains to spring up in the mighty deep ? the edict came forth, and poor fallen 74 OBsTEfRfC^t man was informed that thorns, briars and thistles should spring up in the land whither he goeth ; and that with such a luxurious growth should they shoot forth as to take the place of those spontaneous and edible fruits which the ve- getable kingdom had heretofore yielded them in great a- bundance ; and as a necessary consequence of all this, it was said that man should gain his bread by the sweat of his face. There can be no mistake about the meaning of this language. Well, has man laid down under this sen- tence, and said, it is the edict of Jehovah and I must per- form all this work with my hands or natural limbs, and never exert myself at all to ameliorate my condition under this state of things ; or has he employed all the powers of his soul, mind and strength to render bearable and easy the work which was at that time allotted him to do ? I let the ten thousand times ten thousand different kinds of machin- ery propelled by water, wind and steam, aided by all the advantages of the whole series of combinations of mechan- ical powers, from old Archimedes down to the wiley Yan- kee, calculated to save the labor and sweat of man, an- swer this question. And sorry am I to say, although I be- lieve the assertion to be perfectly just and founded in truth, that so perfectly selfish has been the heart of man, that he has allowed his whole mind to be occupied with the desire to better his own condition, and with this desire has bent the whole force of his efforts and Ins energies to accomplish that end. In the mean time he has allowed the poor wo- man to welter unaided in her agonizing pains to bring forth an offspring that should prevent this earth from becoming a solitary waste. Up to the time of the application of our Supporter, and its adaptation to aid parturient females, very little has been done to assist her ; and that little has been in an inefficient, incomplete, bungling, perfectly un- SUPPORTER. ?5 scientific and unsatisfactory manner. . And I appeal to the sorrowful experience of every female who has gone through with this ordeal, the terror and torments of which are lit- tle less than the rack and the wheel of inquisitorial memo- ry, to verify the truth of the assertions I have made on this occasion. What has been the occasion of all this deficien- cy in the obstetrical art. It has not been for the want ot inventive genius; enough of that has been abroad in the world to supply this and every olher call that might be made upon it, and enough of it a thousand times over has been wasted on the desert air, which if turned into the pro- per channel might have devised some means for the relief of poor neglected females centuries ago. The solution of the cause, then, why this deficiency has been so general and so wide spread all over the earth, must have been a want of attention, an inexcusable care- lessness on that point of obstetrical practice. Aud why this carelessness ? Probably not from a want of respect to females, nor from an indifference or want of sympathy for their sufferings. I think there are two causes to which maybe referred these laches in our profession. One of these I have already adverted to, that is, the selfish occu- pation of our minds for our own special benefit ; the other, it is to be feared, has grown out of an error promulgated from high places, and from the mouths of those who ought to have spoken better things in the name of their profess- ion to those poor mortals who are obnoxious to the penal- ties of sin — pain, sufferings and death. None of these are charged as growing out of a wicked or perverse heart or a depraved mind ; nor is it believed or intended to be con- veyed by the writer, that these errors have grown out of any malevolent feelings harbored by those w r ho made these erroneous statements. They seem rather to have grown • O OBSTETRICAL out of an unfortunate amalgamation of the first and second stages of labor, and from the very obvious fact that no effi- cient artificial aid could be given to the former, that of ne- cessity it would follow that nothing could be done for the latter. We are all well aware that the edict has gone forth, that nothing can or ought to be done to aid or relieve a natural labor ; that there is a certain natural routine of operations to go through with, and it is only the reckless, the pre- sumptuous, and the igaorant, who will attempt to do any thing. This error has been copied from author to author, and handed down from the wise of one generation to the wiser of another, till finally this antedeluvian shade has become venerable from its great antiquity, if not from its philosoph- ical veracity ; and so long has this been kept before the stu- dent and the practitioner, that it is now received as a self evident fact that nothing can be done. Hence, if the mind has glanced upon the subject for a moment, it has not been allowed to dwell there long enough to reflect whether this assertion is founded in truth or error, but has been in- stantly thrown off from the subject by the very sage reflec- tion that great men have said that nothing can be done, ergo, nothing must be attempted, not even so much as to weigh the probabilities of the success or failure of a trial. It wculdseem that the idea of affording relief to a case of natural labor was clothed v/ith a most awful majesty, and arrayed in some fearful garb that struck instantaneous ter- ror to the s'outest heart ; and no sooner is the idea reveal- ed to the perception than the beholder is struck dumb with affright, then turns and flees as if a thousand demons were leagued in the pursuit.. Now I am not one of those who are fond of making u> SUPPORTER. 77 discriminate and uncalled for innovations upcn old, long- established, and well tried principles and usages ; partic- ularly when the new idea strikes at theroct of the tree that was planted and nourished by my superiors. But it so hap- pens that I have lived long enough to learn that great men are only human, after all that may be said or sung of them, and that they are liable in common with their fellow mortals to commit an error. Unfortunately for them, and for us all, in this plain republican country, where each one thinks and acts for himself, none are infallible. In this generation of wisdom, wonders and intelligence, I presume the idea will not be controverted that a great, wise, learned and good man, in saying a great many things, may at some time in his life say something wiong ; and having come from a great man, it may be copied, circula- lated and acted upon, by men great and small, for a suc- cession of years or generations, and at last some blockhead like myself may detect the error. If so, I have an un- doubted right to correct it, and none has a right to resist me ; and the correction of the error may be as important and as beneficial to mankind as if it had been made by one of the great ones of the earth. A correction of this kind does not make me the greater man, nor the one who com- mitted the error the lesser one ; while the great man may de- tect and correct a thousand errors of mine, I have an equal right to correct one of his, if it comes under my cogni- zance, and within the scope of my perception. We are not to say, because a man is learned and wise, that his fallibil- ity is not to be questioned, or his known errors corrected. This would be striking at the foundation of truth and all good principles, by which we may distinguish right frcm wrong ; the destruction of which would level mankind al- most to the brute creation. g2 /b OBSTETRICAL I have had the hardihood to attempt a correction of these errors by the introduction and recommendation of our Ob- stetrical Supporter, and have taken a position that it is a real and substantial benefit to those it was designed to help; and have assumed the responsibility to aver that it will give aid and comfort to parturient females in all na- tural labors. If on trial, however, it proves to be of no service, a mere dead weight on the practice of the obstet- rical art, of course it will fall into deserved neglect and disuse ; and the id 3a will remain in the ascendant, that nothing can be done. On the contrary, if it does all we claim for it, then the instrument will continue to be used, (and with greatful hearts by the females at least,) until child-bearing shall have gone out of fashion, and there is no more call or necessity for re-production of the species. If 1 may be allowed to judge from the past, I think it safe to predict that the destination of this instrument is onward, onward , until its beneficial effects shall encircle the earth — until the rays of the bright luminary of heaven shall not shed his beams on a portion of our globe where its utility is not known and appreciated. And it will probably be found by those who make the experiment, that a sneer or a vain and shallow attempt at ridicule, by weak, barren and gro- velling minds, will never retard its progress. As well might these puerile efforts be put foith to suspend the di- urnal motion of this earth, and thereby shut the vivifying rays of heaven's sparkling fountain forever away from us ; or in the simplicity of their juvenile minds, make the ab- ortive attempt to extinguish the flames of Vesuvius with sulphuric ether. The honest fact is this, and it is the summing up of the whole matter as far as opposition is concerned, the instru- ment is of real and substantial benefit ; and those interest- SUPPORTER. 79 ed in its operation will so find it, and they will not be de- nied the privilege of availing themselves of its benefits. Hence arise my confident assertions that no opposition that may be offered by trifling or fault-finding individuals will ever be effectual in retarding its onward course, to merit and receive a universal approbation. Why it is that an opposition should be offered or at- tempted against the Obstetrical Supporter, is more than I can tell, or have any conception of. It carries out the principles that we have been acting upon from time imme- morial, with this difference, that the means formerly used were inconvenient, inefficient and unsatisfactory to the pa- tient, and harassing and fatiguing to the attendants. The Supporter does all that has heretofore been attempted, and does it in a neat, safe, efficient and satisfactory manner to the patient ; and relieves the attendants entirely. If these are objectionable parts or properties loan instrument, then let us have them ; if they are not, then reserve the objec- tions for an occasion where they will be more useful. The soi desant, great man in her Majesty's dominions, one who is intrusted with the perservation ot the life and the continuance of the health of his fel'ow beings, to some extent ; who has also the high responsibility resting on his shoulders of moulding the principles, storing the minds, and otherwise equipping those young men with the proper armor who are holding themselves as candidates for that high, humane and honorable station of guardians of heahh — he should have been the last one to reject the benefits of the Supporter to those who look up to him for aid in time of trouble and distress ; and also to refuse to impart a knowledge of its benefits to those who are dependant upon him for that knowledge which is to regulate their future conduct and lav a foundation for their usefulness in 80 OBSTETRICAL ail time to come. Such men should not be so puffed up with a fallacious idea of their own far seeing wisdom and clairvoyant foresight of futurity as to think themselves capable to predict with certainty the future destiny and ability of our instrument, without an ordinary examina- tion or a moment's reflection ; nor should he, when ad- dressed in a gentlemanly manner, put on such an air of pomposity and assume such a commanding position that it would be perfectly withering to a man in the common walks of life ; then under a garb of all this dignity and dignified ostentation undertake to cover up an unpardonable ignor- ance of the operation and utility of a thing, by coolly and sneeringly calling it a u yankee notion," closely allied to wooden nutmegs, etc ; and under the same transparent veil of would-te-greatness undertake to excuse himself from approbating the thing by saying that it was improper for ladies to exert themselves with such an instrument, and that he should have to take his servant with him to carry it around — (the " instrument weighs about 18oz.) — this aigumert weighs about as heavy as the instrument of which it complains ; and they are neither of thf m very alarming, except to weak minds. Nor do I believe that the public mind when rightly informed will allow h'm to reject an instrument of so much worth with impunity; and instead of taking the trouble of carrying the weight of one pound, or employing his servant to do so, he could indulge himself in the more pleasing employment, and claim it as a right due to his great dignity, to recline himself wi(h all ease and much complacency on a highly finished sofa, or other' convenient place for lounging, and allow the poor suffering female to waste her strength and prostrate all her vital energies with her unaided and almost unavailing efforts to relieve herself from the agonizing and terror-fraught SUPPORTER. SI sufferings incident upon childbirth. These things may pass on for a while until a knowledge of their afflicting and life destroying principles are made known to the community at large, then they will recoil with a deadly effect on the heads of those who have palmed them off on an unsuspect- ing and confiding people. Then these men who are wise above what is or ever ought to have been written will find that their assumed omniscience is the rock on which they split and made shipwreck of their terriffic prophesies, and that the stone which the builders have refused has become the chief of the corner, and on whomsoever it falls it shall grind him to powder. Now in taking leave of this subject, (on which I have probably digressed too far, for which I ought to ask pardon,) allow me to say to my friend, that in all human probability the popularity of this instrument will live and be cherished in the hearts and memories of those poor sufferers who have been aided by its beneficial and salutary influences, when all that shall remain of him will be his hie jacet on the cold marble, and his emphemeral fame shall be quietly reposing in the shades of oblivion. The question has been asked me, and probably will be again, that if it was necessary to call all those muscles which I have described into action to fix the points of at- tachment for the abdominal muscles, why they were not made fixed points from the beginning, and thus save all this trouble of using so many muscles, supporters and other apparatus to do the work that might have been done once for all. To these interogatories we may reply, that in nearly if not every other situation and condition in life in which these points of attachment or the bones to which they belong are employed for our benefit, it is most decided- ly necessary that they should be movable instead of fixed 82 OBSTETRICAL bodies. I cannot now call to mind an other instance in which it is imperatively necessary that they should be firmly stationary in order to perform the function to which God had assigned them. It is indispensible that the move- ments of the trunk on the pelvis should be perfectly freo and unrestrained, in order to allow us to perform those well balanced movements by which we maintain the centre o£ gravity in an erect position, and all other positions which our various occupations render necessaiy for us to assume. Without this the sloth of South America would be a better locomotive than we should. It is of equal moment that the connection of the pelvis with the lower extremeties should allow a perfectly free and easy motion, in order for us to perform that almost constantly required act of locomotion, as well as to use the lower extremeties for a great number of other and nearly equally important functions, which could not be done were it otherwise. The motion of the ribs and sternum could not be dis- pensed with and sustain the life-preserving act of respira- tion ; or at least without these motions respiration would never fulfil the designs for which it was intended by our beneficient creator. The absolute necessity of the multi- form and unrestrained movements of the scapula, or shoulder blade, are too obvious to require a passing re- mark ; particularly when we take in connection the move- ment, between the scapula and humorous, or bone of the arm. Then commentaries cannot but be gratuitous, in as much as it is so clearly indicated that all those innumera- ble useful and indispensible movements of the upper ex- tremities depend upon the freedom of these motions. It is to be hoped that the answers here given will show sat- isfactorily why these points should not naturally be fixed, and it would seem that the wisdom in design and the SUPPORTER, S3 munificence in execution in the adaptation of these parts so perfectly and fully to supply all our wants and necesities, should call forth our most unbounded admiration for the goodness and mercy of the divine architect and our bene- ficient creator, instead of the stupid question why they were not made otherwise. But in the process of parturition, the necessity becomes as great, and is quite as indispensible, that these points should be fixed with a reliable firmness, as it is that their motions should be untrammeled to serve the other purposes of life for which nature has fitted them. The materials with which to fix these centres ofc motion, nature has fur- nished in great abundance. She has even been lavish, to some extent, both as to numbers and power. It then only remains for us to furnish a few simple mechanical supports by which these natural powers can be brought into an ef- fective action ; then all is done that we can do. And why it is that we should have slumbered so long over the fre- quent calls for this instrument, can only be accounted for by the soporific effects which carelessness and bad advi- sors have produced upon our mental faculties. So com- pletely had our senses become steeped in the fumes of these narcotics, that the mind had become all but caotic on this subject. It seems to be cue of those unfortunate omis- sions that has passed on unheeded from era to era, and from generation to generation, until it would seem to require a voice sufficient to awake the antedeluvian dead in order to fix the mind upon it again. But once the iiea is broached, and has stirred up the mind with sufficient activity to dwell upon it for a few moments, it would seem that the most verdant tyro in the land might have invented it long ago ; and that too, with so slight a mental effort that it would hardly be sufficient to disturb the slumbers of a mid- summer's day-dream. S4 OBSTETRICAL To supply these few natural deficiencies, and to enable the appropriate sets of muscles with great ease and prompt- itude to fix and hold those naturally movable points with an unwavering stability, we again offer our Obstetrical Supporter. It is a very simple instrument. Its simplici- ty, combined with its efficiency, should recommend it at first sight. It is easily made, easily applied, and most ex- ceedingly easing in all its effects and operations. It even surpasses the most sanguine expectations of those who laid it before the public. You who have not seen this in- strument, do not imagine that it looks any like the cholera, the nightmare, or any other frightful or terrific object that is calculated to fill us with awe and astonishment. It is perfectly mild and inoffensive in its appearance, and a child might pick it up without exciting the least degree of fear. It never required any superhuman powers of intellect, nor a depth of thought that would be likely to rattle dirt into their bread and milk on the other side of the earth to in- vent, construct, and apply it. After the idea once crept through the head, and was backed up with the conclusion that it was not fighting a- gainst the decrees of Jehovah, or an attempt to counter- mand his express ordinations, it then only required a mod- erate effort of common sense to do the remainder of the work. I have no notion that a man ought to be deified for this discovery, and have a place set apart in heathen mythology for his special benefit and occupancy ; nor do I set myself up as a stump candidate for that honor. After having ascertained, as we believe, the philosophical rea- sons, as well as the fact, why a female requires her knees and back to be held and supported, and also the reason why she desires to grasp something firmly with her hands and pull so as to make them a fixed and stationary point, then SUPPORTED. 85 the suggestions were easy and rather naturally made as to what would be the best mode of supplying those wants ; and the grand and primary object has been, from the com- mencement to the termination, to go just as far as the re^ quirements of nature demanded and there stop short, without making one gratuitous addition, the effect of which would probably be to perplex and encumber the accou- cheur, and annoy if not injure the patient. This would bo reprehensible in a tyro, and especially so in one who pre- tends to be' an adept in his business. I could have added to our instrument, if I had been regardless of the utility of its parts, and of every part of it, a spinal supporter, a cru- ral suppoiter, a shoulder brace, and night- cap ; also a flag- staff and the colors of the United States, and unfurled my colors and set them waving on the staff. But after ail this show of great things, I should have displayed a much greater amount of patriotism than obstetrical know led-: The spinal supporter in cur humble opinion would not on- ly be entirely useless, but decidedly detrimental; from the fact that it would confine, if not entirely destroy or pre- vent the motions of the trunk on the pelvis forwards and backwards ; consequently we would lose the great advan- tage we claim for our Supporter in regard to the ease and facility, as well as .the certainty, with which we adapt the line of direction" to the axis of the pelvis, so that nododg- menc or unnecessary pressure of the head on either side shall retard its progress through the superior strait. This we claim, and I believe justly so, to be a very important part of the beneficial effects of our Supporter, and it must be perfectly obvious to every one that a spinal supporter would annihilate these benefits zt once. A spinal supporter and shoulder brace, (why not a D collar and tugs) would inevitably curtail, confine and en- H OBSTETRICAL iwely suppress a great many motions cf the trunk on I pelvis, and of the upper extremities, which would be very convenient and useful for the patient to make during the time of parturition ; being not only useless to the patient, perplexing to the accoucheur, but directly detrimental and injurious in more ways than one. For these reasons I re- jected them without the least hesitation, when suggested to me before a patent was procured for our Supporter. The determination to attach these things to our Supporter, and to use them in that combination, must have been fostered and matured b} 7 one of two errors : Either the projectors of this fallacy must have been perfectly reckless in regard to the utility of their attachment, or its adaptation to the v/ants or "calls of nature, and have gone on prompted by one single desire, that is, to get up something, no matter what, to evade our patent — or else they must have been actuated by a most shameful and unpardonable ignorance of all the process and mechanism of that labor incident to child-birth. Fov no mind of man, in the possession of a capacity that would enable the possessor to shun the ordin- ary destructive elements, such as fire and water, or with a sufficient instinctive knowledge to seek a shelter when it rained, would fail for one moment to see the glaring fallacy and worse than useless effect of these far-fetched and un- scientific attachments, if he had ever accumulated a suffi- cient knowledge of obstetrical science to enable him to distinguish the pelvis from the cranium. What has been said heretofore of our Supporter and the natural parts with which it is intended to be connected, and to which it is designed to give aid and support, has been . J in detached or somewhat remote situations one from now proposed to collect the various par^s SUPPORTER. 87 connected form, as they are designed to act in concert with each other. Then I shall cease to afflict my friends with any further remarks on that subject. It was stated in the early part of my remarks, that I had two reasons for fixing my extreme point of muscular ac- tion at the knees. One of those reasons I explained at the time, and dwelt upon it at considerable length ; endeavor- ing to sustain the correctness of my preference for the knee as the basis of muscular action for the lower extrem- ities. The other reason, as was stated at the time, was, that I wished to mitigate the sufferings of the female, as well as to increase the power of the muscular action, there- by shortening the duration of the labor. For this pur- pose, that is, to mitigate the sufferings, we have the back pad, which is made to fit nicely and sit easy on the back ; and I never have known it to cause any trouble or uneasi- ness, however great the pressure that was applied to it. On a former occas'on it was also remarked that this pres- sure was to be applied by the main strap that passes through the loops of the back pad ; from thence each extremity of the strap takes a forward direction io form two large loop;; which pass over the knees ; then the thighs are extended on the pelvis until they are stopped and held fast by the loops of the main straps. When this motion is brought to a stand by the resistance of these loops, into which the knees are firmly planted, then all the efforts at ex- tension made by the thighs on the pelvis bear directly upon the loops that hold the knees, and through the medium of the main strap the same amount of pressure is made to bear upon the back pad, and holds and supports the back just in proportion to the force that is applied by the knees to the loops that hold them. We may as well remark in this place, what is well known by all who have had any OBSTETRICAL considerable amount of experience in these matters, with a slight degree of observation, that when the head of the child is passing the superior strait, and while it is moving along the inner and concave surface of the os sacrum, unless it is counteracted by an external pressure of an equal or a greater amount of force, made from behind in a direction forward so as exactly to oppose the internal pressure, that this last named force will frequently produce a most ex- cruciating, and in many cases an almost insufferable pain and torment. Many times there is great pain in the back before the head has entered the superior strait, when the fundus of the womb is thrown forwards and the mouth backwards, and the longitudinal fibres contract powerfully to impel the head onward, it is driven against the back with great power, amounting to all the contractile force exerted by the longitudinal fibres, causing great pain, fatigue and suffering, without making the least progress in labor. In this case the line of direction must be changed so as to car- ry the head from the back and allow it to enter the strait* This will relieve the patient, and give an opportunity to terminate the labor successfully. It must readily be perceived that by carrying these straps over the knees, the pressure is made to bear upon the back in nearly a horizontal direction ; whereas if these straps were carried downward and passed under the feet, so that the pressure must be made by the feet instead of the knees, so great would be the obliquity of this direction, that the unavoidable tendency w^ould be to draw the back pad al- most directly downwards ; consequently the force applied in this direction would draw the pad away from the back, in a line directly towards the feet, so that all the benefits we claim for our Supporter by our mode of application must inevitably be lost, To prevent the back pad from, 4 - SUPPORTER. oy being pulled entirely from the back, a spinal supporter has been attached to that, and a shoulder brace is made fast to the upper end of the spinal supporter. This I suppose serves as a kind of top-mast to be used only in a light breeze. This shoulder brace of course must be lashed fast to the shoulders, and these appendages may serve to hold the back pad ,per force, from being drawn down to the feet. But I do not see how the difficulty is remedied, as far as the utility of the pad is concerned ; it certainly could not cause the pad to press against the back, and hold and sup- port it in a direction to oppose the pressure of the head of the child. The remedy proposed for the wrong direction which this mode of extension gives to the back pad, I con- sider to be worse than the malady itself ; for no mind can fail to comprehend what the effect would be. The spinal supporter being attached to the back, of course when the back pad is drawn forcibly downwards it must carry the spinal supporter along with.it, unless that is held by some superior counteracting or controlling power. Now let us see what the curative process consists of, for this grand dif- ficulty ; it seems to be more easily applied than rendered effectual, it is this : The shoulder brace is attached to the top of the spinal attachment, and the brace is made fast to the shoulders, so that # the back pad musi keep its place un- less the patient pulls her shoulders down below her hips. This remedy however is unfortunately rendered entirely inefficient, from the fact that it is not the mere presence of the pad in a certain situation that produces its beneficial effects, but it must be made, by some force applied to it, to press hard on the back in a particular direction ; and this pressure and this direction cannot be given or applied by the combination and application of the apparatus as above described. Of course this puts an end to all that is neces- h2 90 OBSTETRICAL * sary to say on this part of the subject. One thing more, however, I had intended to have remarked upon ; the whole force applied by the feet to the main strap comes e- ventually on the shoulders of the patient, and when a great amount of force is applied, the effect on the shoulders, the chest, and all the upper portion of the body, must be ex- ceedingly annoying ; and after they have been repeated a few times, accompanied with great exertions, these excess- ive inconveniencies must become entirely unbearable to the patient. And what is worst of all, these sore afflictions are not relieved by a single ray of hope that a beneficial effect may be produced thereby. I must say, in conclusion, that the only thing that allays my utmost astonishment that such a thing should ever be attempted, by those who style themselves medical men, is, that the attempt itself presupposes an entire ignorance of the mechanism of labor. These things might do ad captandum valgus, but they will never take among the Doctors. The manner in which the back pad of our Supporter will hold and support the back, from its shape, and the circum- stances connected with its application, the direction in which the pressure is made, and the amount of pressure be- in * regulated by the will of the patient, renders the utility of it perfectly obvious to everyone. It needs only to be seen by Physicians, (meaning those who deserve the name,) to have its real worth estimated by a clear sighted and well-founded appreciation of nearly all its beneficial tendencies. Those females who have borne children will require no rhetorical charm to be mingled with its des- cription, or to embellish its commendation, nor any trum- pet-tongued eulogiums to convince them of its utility or the practicability of its powers to relieve them. Sad ex- perience has taught them its true value, and in their judg- SUPPORTER. 91 merits, based upon experience, they will prize it far above the gold of the modern El dorado, or the oriental gems of the first water. Another important part of our Supporter is the main strap, which passes from the back pad in a forward direc- tion, exactly over the hips ; and they also receive a firm and very grateful support from the strap. The ends of the strap again approximate the back pad and are united to the strap as it passes down the thigh, in such a way that they sit perfectly smooth and easy on the thigh ; this un- ion forms two loops of sufficient capacity to receive the knees and fit nicely to them. The knees then being the distal extremity for the insertion of those muscles which have their origin from the different points of the pelvis, and are des'gned to fix and hold it while the abdominal muscles contract and pull upon the superior points of the pelvis in the act of paturition. It seems almost a w^aste of time to remark in this place, the idea is so naturally suggested, that it is worse than use- less to fix the point to which we apply our support below the knees; it would certainly complicate the machinery to an unwarranted degree, by bringing into action a great num- ber of muscles which have no direct connexion with the work to be accomplished. The most obvious and natural result of this commingling together of those parts dissimi- lar in f unctions and operations, forming a kind of hetoroge- nious complexity of the useful with the useless and una- vailing exertions, will be to w r eaken if not destroy the ef- fective efforts of those agents on which, if allowed to act by themselves, we might confidently and safely rely to ac- complish the objects for which w x e employ both the natur- al and artiacial parts. I believe that simplicity, combined with utility, is so far desirable that it is almost universally 92 OBSTETRICAL sought for, and is a commendable quality in all instruments and mechanical structures ; and with this principle in view we should always simplify to the full extent that we can go, without a positive redaction of power in the essential parts, or curtailing the utility of the instrument or ma- chinery. The knees then are firmly planted in the loops of the main straps, followed by an extension of the thighs on the pelvis until the loops of the strap prevent the efforts at extension from going any further. Then the loops re- ceive the effect of all the extensor muscles of the thigh, and they serve {he double purpose of giving an easy and ample support to the knees, and at the same time the pow- er applied to them is conveyed to the back through the straps, and is all that can be asked for or given in the way of a most grateful and all -sufficient support to that part. In all this operation it will be seen that the patient is the sole actor in the w T hole drama ; if she is sitting she is not drawn off from her seat ; if she is lying she is not disturb- ed in her position. She supplies the powder by which the knees are held and the back supported ; and this too is done by a simple effort that is peremptorily demanded to hold the pelvis in its proper position ; and the pressure on the knees and back may be greater or less at the volition of the patient. Now all this work that was once complica- ted, mysterious, crude and uncertain, is carried on with an ease and simplicity, a quietude and neatness, that cannot fail to call forth the approbation and lead captive the good taste of every well-balanced mind that is based upon sound judgment. And the systematic co-operation of all its parts, combined with its regularity and reliable certainty, can on- ly be excelled by the harmonious revolutions and equi-dis- tant motions of the heavenly bodies, whose equalibrii ar3 sustained by an Almighty power. SUPPORTER. 93 The muscles which perform this part of the work, and fire connected with the lower extremities, and the applica- tion of the back pad and main strap of the Supporter, having their rise from some points of the pelvis, and their insertion into the cervix, trochanters and staff of the thigh bone and into the head of tibia and fibula, are the pectinalis, the triceps adductor femoris, the adductor lon- gus femoris, the adductor brevis femoris, the adductor mag- nus femoris, the obturator externus, the gluteus maximus, the gluteus medius, the gluteus minimus, the pyriformis, thegemelli, the quadratus femoris, the sartorius, the graci- lis, the rectus femoris, the semitendinosus, the semimem- branosus, the triceps flexor cruris, the iliacus internus, the obturator internus, the psoas magnus. When the efforts of the extensor portion of these muscles are brought to a stand by the loops of the Supporter in which the knees are planted, which prevents the action of the extensors pro- ceeding any further, then these muscles all contract on themselves — they become very hard and rigid, and by their inherent and contractile force they pull very hard upon each pcint of their attachment, which by a reference to the description I have given of them in a former part of this work, will be found to be on some inferior or depending portion of the pelvis on the one hand, and some point of the thigh bone down to the knee, and into the heads of the two bones forming and being near the knee joint on the other. Now nothing can be more certain or less obnox- ious to contradiction, than the fact that when these mus- cles contract in their muscular centres, and pull hard upon these points of attachment, that they will fix. firmly and almost immovably the pelvis on the thigh bone ; and this js one of the principal or grand designs of our Supporter. To antagonise these muscles, and to act nearly in an op- 94 OBSTETRICAL poslte direction, and apparently to balance the action of the abdominal muscles, and to act in the same direction with them, we have the quadiatus lumborum and the psoas parvus ; these are attached by one extremity to the spine, and the other tc) the posterior half of the pelvis. While the abdominal muscles act in an anterior and supe- rior direction, these muscles act in a posterior and superior direction. These two sets of muscles hold a balance of power to some extent, and by their co-opeialive contrac- tion the superior portion of the pelvis is held in a more steady, firm and well balanced position, The abdominal muscles have somewhat the proponderence in respect to power, and this is necessary to overcome the natural ob- liquity of the pelvis forwards and downwards. It is impor- tant for the abdominal muscles to act in a direction to raise the anterior part of the pelvis, and to bring the trunk for- ward so that the line of direction indicated by the child's head from above downwards, shall cut a horizontal line on the brim of the pelvis or superior strait, at right angles. When these regulations are systematically arranged, and all the parts brought into and maintained in their proper and relative situations, then the head will enter and pass through the superior strait without crowding so hard on the bones of either side as to prolong the duration of labor twice or thrice the length of time that would be required if every thing wr.s properly conducted. In this day of light and knowledge, a failure by a physician to make the required observations, or a neglect to apply the proper means and give the necessary direction to secure such a position and relative situation of all the parts as will tend most directly and systematically to facilitate the great work of a safe and expeditious delivery, shows an amount of ignorance in his profession that may seek in vain for a valid STJPFOKTES. excuse, and ought to paint his cheek in a crimson dye that no bleaching agent can remove. Or, on the other hand, it shows a recklessness and desperation that is regardless of the lives and well-being of their fellow creatures, and betrays a breach of confidence and good faith reposed in them by a confiding community, that ought to be deemed a good cause to expel them from the pale of the profession, and effectually cut them off from all privileges and com- munion with the medical word. We will now proceed to fix the superior extremities of those great voluntary agents which nature employs in the work of parturition. The artificial parts, or those which we propose to supply from the Supporter, to aid in this de- partment of the work, are the handles of that instrument. It will be recollected that these are attached to the knees by straps passing through loops of the movable knee pads. The handles are made fast to each end of these straps and lay transversely across the thighs, a little above the knees. The patient grasps these handles firmly with the hands, then the flexors and extensors of the hand and forearm con- tract and fix the forearm on the hand, and in the same manner with another set of muscles the arm is fixed on the forearm. Then those muscles which have their origin from the different prominences and projections of the sca- pula, and their insertion into the bone of the arm or 03 numerous, contract and fix the scapula on the arm. A description of these muscles may also be found by referring back to the description of muscles. They are the supra- spinatus, the infra- spinatus, the teres minor, the teres ma- jor, the deltoides, the coraco brachialis, the sub-scapularis, the biceps flexor cubiti, the triceps extensor cubiti. When thes3 muscles contract to fix the scapula on the arm, they 1 ~:ve a tendency to draw the scapula downwards and for- 96 OBSTETRICAL wards ; and this calls into action another set of muscled which exert their contractile power to prevent the scapula from being pulled out of its place. They are situated on the posterior and superior portion of the thorax. These muscles have also been fully described in rotation, as they occurred in the description of muscles. They are the tra- pesius or cucularis, the latisimus dorsi, the rhomboideus, the levater scapula. These muscles do not directly antag- onise the former set in the direction of all their fibres, but they do it sufficiently to make a fixed point of the scapu- la, which usually moves with great ease. The contractile efforts of one part of these muscles are directly opposed to the former set, and the remaining part of them act in a line of direction which forms an angle with the others, more or less approximating a right angle according as their several lines of direction decussate each other. This brings us to the points of attachment for the su- perior portion of the abdominal muscles, which are the ribs and sternum and the cartilages that belong to them both. When the abdominal muscles contract, they must of course pull upon the ribs and sternum with a tendency to draw them downwards, or downwards and backwards ; this will stimulate another seL ul muscles, and cause them to con- tract and resist the effort to draw the ribs and sternum downwards. This set of muscles are those situated be- tween the ribs and sternum and the scapula, and between the ribs, sternum and cartilages and clavicle or collar bone. The scapula, it will be recollected, when these previous sets of muscles are in a contracted state, is a fixed point ; and consequently when those muscles contract firmly, they will fix the ribs and sternum to the scapula and clavicle. These muscles will be found among those we have described in the former part of this work. They are the pectoralis ma- SUPPORTER. 97 jor, the sub clavius, the pectoralis minor, the serratus mag- nus, the triangularis or sterno-costalis. These muscles are -also very much assisted by the action of the intercostalis externi and the inlercostalis interni. When these muscles -all act, as they will when any force is exerted which has a tendency to pull one rib from the other, they bind ail the ribs firmly together, so that when the other muscles act only upon a part of the ribs, by the aid of the intercostal muscles all the ribs are held with equal firmness and se- curity. This completes a series of fixed points from the hands to the ribs and sternum. It forms a grand chain cable, stretch- ing from one of.these points to the other, and no pains has been spared to describe every link in this chain with that perspicuity, simplicity and truthfulness^ that will enable every person to comprehend, by this view of the component parts, the real utility of the whole connexion. When this is understood, the philosophical principles on which the Supporter must inevilably contribute largely to the comfort and relief of the female, are as clear as the cause of that effect which is so often made manifest to us, and with which our visual organs have become so familiar, (i. e-.) the effulgent rays of heaven's bright luminr ich dispels the darkness and gloom that had previously hung over ue. As I leave this part of my subject, permit me to say, if my arguments have been clothed with an ambiguity that cannot be penetrated by common minds, or if I have un- fortunately blundered upon wrong premises, so that my inferences and conclusions must fall to the ground, it all be attributed to a want of skill or a lack of argumenta- tive power; for I have labored long and hard to be both correct and comprehensive, beyond the power of the logi- cian to set aside. j. OBSTETRICAL The two paints of attachment for the abdominal muscles being now fixed with a sufficient firmness and strength of material to hold them against the powerful efforts of those muscles to move them, It now only remains for the abdom- inal and respiratory muscles to exert their inherent pow- er, given them by the Almighty and Omniscient Architect of all things, to finish the work that now only awaits their exertions for that purpose. At the commencement of the voluntary efforts of labor, and aftsr the os uteri has been fully dilated, the Supporter may be applied with a full expectation of receiving great benefit from its operation. The Supporter is applied ex- ternally to the clothes, so that no exposure or any other inconvenient or objectionable operation arises from its use. The back pad is applied over the region of, or opposite to the pressure of the child's head. This very much re- lieves or entirely suspends this very troublesome and many times excruciating pain. The loops of the main strap are then carried forward and passed over the knees, always re- membering to adjust the sliding pads to the knees — this, in connexion with the muscles, fixes and holds fast the in- ferior or depending portion of the pelvis. Then the pa- tient grasps the handles, (and would do so instinctively if she was not told,) and through a continued chain of con- tractions fastens the ribs and the sternum. Simultaneous- ly, or a little preceding the last named efforts, the patient takes a full inspiration, which presses down the superior arch of the diaphragm, which converts this vaulted mus- cle into an inclined plane, commencing at the ziphoid car- tilage and passing obliquely backwards and downwards, the lower portion descending as far as the inferior dorsal or superior lumber vertebra. From this powerful and entire inflation of the lungs, by this long and full inspiration, and SUPPORTER. 9S the consequent firm pressure of the lungs up©n the dia- phragm, the plain thus formed is rendered quite firm and unyielding to the pressure that is made upon it. Then the abdominal muscles contract, (as may well be supposed from their size and power,) with a force that will overcome al- most any opposition ; and, as heretofore shown, both the points of attachment for these muscles are now fixed with firmness and stability, and these muscles can exert all their contractile power to the very best advantage that nature and art can afford them. The great ani invaluable advan- tage to be gained by the stationary and stable position of these points, grows out of the fact that the power of these muscles is greatly increased, and their action is guarded and sustained by the greatest economy, so that nothing is lost of all the effective power that they are capable of ex- erting. When this contraction takes place in a proper manner, by the abdominal muscles, another plain is formed, though not exactly parallel with that formed by the diaphragm, yet from the manner in which the space between the two plains is occupied, they are sufficiently parallel for all practical purposes. The obtuse angle formed by the spine and the junction of the diaphragm with it, is, during the time of child-birth, occupied and filled with the abdominal viscera ; so that the uterus comes directly in contact with, and under the influence of, the abdominal muscles. The womb is then pressed with great force, and by ma- terials every way calculated to bring about the desirable end, between the plains formed by the abdominal muscles and the superior portion of the diaphragm. The uterus is compressed with a firmness, a power, and an adaptation of material, that was planned and executed by a higher pow- er and a more far-seeing wisdom than was lately displayed ■TOO OBSTETRICAL in the application of a pad to these parts. Who can now* fail to discern that from the manner in which the recti muscles will contract, (i.e.) bj seperate or independent sections,they will almost embrace the fundus of the womb ; find that this voluntary contractile action must necessarily afford great assistance to the efforts of the longitudinal fibres of the womb to overcome the resistance made by the circular fibres- to retard the passage of the child. These contractile efforts put forth by the recti muscles, in con- junction with the same powers exerted by the longitudi- nal fibres of the womb, enable them to approximate the fun- dus towards the mouth, and consequently the contents of the womb must be expelled. These are all plain, easy, straight forward, arid natural operations ; there are no con- tortions nor circumlocutions to mislead the unwary, or to .hide an error, however small it may be. Thus it may be seen that in proportion as the power or effective operation of these muscles are brought to bear on the womb, in the same ratio the labor must be facilitated. Perhaps I may as well remark in this connexion, that if any person is disposed to doubt the truth or validity of my arguments, and the assertions which I have ma are with re- gard to the functions and the labor performedVas connect- ed with the work of parturition, by the various sets of muscles which I have described, they have only to exam- ine the condition of these muscles while in that situation, ia which I have represented them as performing certain actions by virtue of their inherent contractile powers, and if they do not find them hard and unyieldingly rigid, and under the influence of a very powerful contract ibilitj, then I yield the point. But if they find them in this condition, then I claim that they perform every thing that I have as- signed them in the voluntary depaitment of parturition, SUPPORTER. 101 and take it for granted that my arguments stand upon a firm basis, and are sustained by a fair and unequivocal de- monstration. My candid opinion is, although it may not be of much value, that the time of any one would be far more advantageously spent by endeavoring to improve on the rules and principles here laid down, than by a fruitless and unavailing attempt to controvert or disprove them. Then if I have proved to the satisfaction of my readers, and I think it can hardly be otherwise, that by the aid of our Supporter we increase the effect of the contractile power of the abdominal muscles, then so far we claim, and even demand, credit for the beneficial effects of the Sup- porter. We now ask, as an equitable claim for the Sup- porter in the nature of benefits entire, or as beneficial aid afforded to the natural parts concerned in the process of child-birth, the following specifications : 1st. That it mitigates the sufferings of parturient fe- males, from the manner in which it holds and supports the back, and thereby counteracts the pains and sufferings which are produced by the pressure of the head upon the internal surface of the back. And I wish it to be recol- lected that this pad may be used in all cases, no matter how great the tenderness and irritability which has previ- ously existed. So nicely is the cushion of the pad adapt- ed to the back that it yields a most ample support, unat- tended with the most remote probability of doing an in- jury. I never have known a solitary instance where any inconvenience has been experienced from the use of it. I have known a number of cases where the patient would object to its application under the impression that it would increase the irritability then existing, but directly on the application of the Supporter, the pain in the back would be o;reatlv relieved or entirely cease. i2 102 OBSTETRICAL 2d. That the entire ease with which we can adapt the ;ngle of direction to the axis of th3 pelvis in a right and roper manner, enables us to proceed without the loss of :ny pains ; and so perfectly simple and easy is the method )f doing it, that no accoucheur is at all excusable if he leglects to avail himself of this important benefit. He las only to direct the patient to grasp the handles of the nipporter^ and if the head is thrown forwards and strikes n the os pubis, as is most commonly the case from the natural obliquity of the pelvis forwards and downwards, as I have before described, then direct her to pull herself for- wards by the handles — this will carry the fundus of the ■ vvomb forward, and give the head a backward direciion, and if skill and care be used, the line of direction on which the head descends may be made to intersect the horizon of the pelvis at right angles, ceteris paribus } the head will enter the superior strait and pass on. If, on the contrary, as sometimes happens, the head is thrown backwards and strikes the prominence of the os sacrum, then direct the pa- tient to extend her arms and move herself backwards, which of course will carry the fundus of the womb in the same direction, and give a forward movement to the head ; this will dis'odge it from the sacrum, and with the same precautions, it will move on as before. If the head does not become firmly fixed on either of ihese points, it is quite frequently the case that such is the )'oliquity of the pelvis, or the direction in which the head lescends, that it presses so hard on one or the other of those •oints that it will very much retard the advancement and •rolong indefinitely the duration of labor. It is not ne- essary for me to repeat the manner and the ease with vhich the head may be made to enter the superior strait at 'ght angles, with the brim of the pelvis. When these SUPPORTER. 103 liings are properly attended to, no pains are lost, and much suffering is prevented. Experience has taught those fe- males that something must be done to overcome the natur- al obliquity of the pelvis ; hence it is that old ladies who have borne children and been frequently with others, will direct the patient to draw down or curl under her chin when the pain comes on ; and by this motion of drawing dow r n the chin she carries herself forward, and very imper- fectly performs that which the Supporter does in great per- fection. Although the good old lady has no definite notion why she gives her advice, except that she has found relief from it, nevertheless the idea is a good one, and based on sound philosophy, and I have no hesitation to quote it as good authority for many of the directions which I have previously given ; and I have as good authority for the correctness of the principle as Prof. Meigs, of Philadelphia. I heard him advance the same remark in one of his lec- tures. 3d. That by the aid of the Supporter, we positively shorten the duration of labor, by enabling the proper sets of muscles to fix the two points of attachment for the ab- dominal muscles, thereby enabling them to exert the whole force of their contractile power, without loss or hindrance of any kind, for the expulsion of the foetus from the womb. The operation of the Supporter in this respect is to en- able the voluntary muscles to perform that part of the la- bor which the God of Nature designed them to do, instead of leaving the whole of these almost superhuman exertions to be performed alone by the organic or involuntary mus- cles. N'ow if there ever was a case under the broad cano- py of heaven that called loudly for the utmost exertion of every agent endowed with a capacity to lend a helping 104 OBSTETRICAL hand, it is that of child-birth ; and as far as my knowl- edge extends, there is no labor required of human nature to perform so directly calculated to prostrate the whole en- ergies of the system. I shall not dwell upon the branch of our subject now under consideration, in this place, for the reason that I have discoursed upon it at great length elsewhere ; and if one will not be convinced after all I have said and demon- strated on this part of the subject, they would not believe though Moses and the Prophets should appear and verify my sayings. 4th. That we may entirely dispense with the aid of any assistants, as the Supporter will do all that can be done by the greatest number of them that could be gathered a- roundthe patient ; and what is of still greater importance, do it a thousand times better. A nurse to take care of the mother and child after delivery, is all the help we need, and all that is required to be in attendance ; unless the pa- tient should require the presence of some near and dear friend to sooth her in this hour of tribulation, which some- times tries the fortitude of both patient and physician.— This however is the true province of the attending phy- sician, and if he is a gentleman, and has his heart in the place that every member of the profession should have, he will never neglect or allow an opportunity to pass unim- proved to sooth and comfort the poor sufferer by the most kind, sympathising and encouraging language that he is master of ; and he may rest assured that such conduct will never be forgotten by the recipient, and it will revive and restore her crushed and drooping spirits, like the kindly dews that are distilled from the benign heavens above us on the parched and withered plant — so that the patient is not only relieved to a very great extent from her pains and SLTPORTER. 105 sufferings, but a very considerable amount of toil, patience and trouble is saved to the assistants ; and this to many feeble and delicate females has proved the cause of a severe and sometimes a protracted case of illness. Even this latter benefit, isolated from all the others, would materi- ally interest nearly the whole female portion of any com- munity, and should enlist their influence for the adoption and general use of the Supporter ; and when its whole op- erations are known, it never can fail to produce that re- sult. 5th. That the Supporter is not only entirely safe to the mother and child, but it adds to the safety of the mother to an extent that has never yet been fully appreciated ; and this, to my mind, and to every mind duly impressed with a just sense of the weighty responsibility due to its fellows and to its God, is no trifling recommendation, but one that should favorably impress the mind and judgment of every person who justly appreciates the value of human life. In my opinion, it ought to be*the watchword of every plvysi- cian in the land, that we should always, without excep- tion, use those means that are known to be safe, and such as will increase the safety and lessen the danger of those who confide with an unwavering hope in our skill and phi- lanthropy. From the earliest time in which I was iniatiated as a no- v-iate in that noble, philanthropic and almost God-like art of healing the sick, down to the time of penning thes e thoughts, the idea was irrevocably and most solemnly im- pressed on my mind, that the true science of medicine, when faithfully studied, perfectly understood, and wisely, judiciously and carefully administered in its application to practice, was one of the great and prominent mercies of God to man, and through His, unbounded goodness it was 106 OBSTETRICAL bestowed on us to lessen the dangers naturally incident to human life — to alleviate our pains and afflictions — to eke out the span of human existence ; and, from its source, as well as from the principles it inculcates, I have ever look- ed upon it as one of the noblest sciences that ever the ca- pacious mind of man was enabled to embrace or compre- hend. With these exalted ideas of this pre-eminent science, I also imbibed another, to me very natural impression, which was engraved on my innermost soul with indelible materi- al, viz., that the great, grand and fundamental principles of this science were embraced in these few words : 6i Visit and administer with care, skill and prudence to the sick and afflicted — cure and prevent disease by every laudable and safe means that sound reason or true philosophy has sug- gested to your mind — endeavor, at all times, when called upon, to aid the agonizing struggles of nature to free her- • self from the fangs of disease, by every safe and expeditious remedy that the munificent hand of God has so abundantly strewed in your pathway." These principles, according to the views of your humble servant, are a kind of multum inparvofiT cornucopia, from whichmaterials may be drawn to rear the whole grand superstructure of that proud science of medicine which has descended from our ancient and dei- fied worthies. So strongly have these principles entwined themselves about my memory, that I shall probably never be able to rid my mind of the impression that the safety of the patient, (or those who intrust their lives and health in our hands,) should stand in the frontrank of all our endea- vors for the restoration of health, or the mitigation of pain and suffering ; and that safety is the key-stone in the sub- lime arch of the healing art. Being of that school of politicians that are not frightened SUPPORTER. 107 at responsibilities, I take it upon myself to say, that no man has a right, that may be inferred either from religion, mo- rality or humanity, which are taught from the word or in- spiration of God, or from the principles, rules or philoso- phy which are taught in the science of medicine, to use dangerous and destructive articles in the curative process within the province of the physician ; or to use doubtful remedies, the operations and effects of which are not per- fectly well known and scientifically established on the most reliable basis ; or to use those remedies, the effects of which are not to be depended upon, being erratic, eccentric and dangerous, from the fact that they are governed by no fix- ed laws or established principles on which a safe and phi- losophical calculation might be based : hence, every endea- vor to effect a specific object with these things, would be like the efforts of the blind man to comprehend light. Whoever so far forgets the dignity of his station as to make use of these unsafe, uncertain and uncontrollable re- medies, fraught with treachery and danger, degrades his calling, and descends to a level with the empirical ignora- mi : he is out of the pale of his profession, and has over- stepped the farthest landmark that gives bounds to the most liberal construction which ma} 7 be put upon the most favorable rule or principle inculcated or put forwards in the whole science of medicine. The station in life held by the man who indulges in the use of these forbidden fruits of the profession, does not alter the case at all : if I take a club, gilded and ornamented in the most splendid manner, and beat a man's brains out with it, I am equally amenable to an outraged law as if my club had been simply 'rough and ready. 5 It matters not whether a man is wise or simple, noble or ignoble : ' the Ethiopian cannot change his skin' — he is battering down the pillars that uphold the venerable 1 08 OBSTETRICAL temple reared with so much care by the wisest and best men of the profession in all ages of the world. Safety, I repeat, is the polar star, and of the first magnitude in that heaven- guarded constellation composed of the brightest spirits that ever shed light and glory upon the medical world ; and the eye of the good physician will ever be fixed upon it, and if his compass is made of the right materials it will direct him to that star with the same unerring certainty that the magnetic needle, though far away on-the ocean-wave, will point to the mysterious chambers of the north. When called upon by an afflictive dispensation of a wise through inscrutable Providence, to administer to the sick or to perform an operation on the afflicted, that star should be in the ascendant, and our conduct be regulated thereby. Hence the first enquiry that will present itself for our con- sideration will be, what is the safest course to be pursued for the benefit and restoration of this patient? And when settled by a scientific knowledge of the disease and the proper remedy, the next thing presented for our considera- tion and determination will be, what is the most expedi- tious mode to accomplish the same end ? And when this is settled upon, we should prayerfully invoke the blessings of heaven to aid the efforts we may put forth for the recovery or the comfort of a fellow being. When this is done with that faith which will ever make works effective, we may commence our labors with every human probability of suc- cess. Would to heaven that this was a universal law by which every member of the profession was governed throughout the wide universe or God! These rules and principles have been laid down as landmarks and beacons for our guidance, as pilots while steering the ship of practice through that ocean of science that has for its object the perfection of the healing art, by SUPPORTED. 109 fevefy work on therapeutics that has ever emanated froth the light-giving bodies of our profession since the setting of that star that presided oyer the life of the venerable and deified Hippocrates. The same wholesome laws and righteous principles have been promulgated from the desk of every Professor where your humble servant has been so fortunate as to be a lis- tener ; and he has treasured them up in the archives of his memory as things never to be forgotten, with the same veneration as did the'worshippers of Apollo the predictions of the great Oracle at Delphi, And they have been hand- ed down to us for imitation, clothed with a garb made sa- cred by the experience of ages on ages. These ancient and time-honored maxims have been distilled from the lips of the hoary-headed sages in our profession, who have grown gray in a long and honorable life, spent at the bed side of their patients, who have been gathered to their fathers as a harvest fully ripe, and have bequeathed us these heaven- approved principles, which, if heeded, will fall upon us like Elijah's mantle, and shield us from a thou- sand sins and follies. They should ever be to us like the oracles of ages speaking from the tombs that hold the dust of greatness and wisdom. I appeal to the sober second thought, to the cool and deliberate reason, io the calm, profound and philosophical judgment of every noble, w r ell balanced and philanthropic mind, the whole wide w T orld over, if the side of safety is not the shore on which every son of good old iEsculapius should arrange himself if he desires the approbation of Heaven and the good will of his fellow- men. The minds and souls of those great and good men, the source from which these principles have emanated, are as high above the novel but gilded butterfly toys of the shallow-brained, barren-minded empirics, whose highest 110 OBSTETRICAL aspirations of ambition are to captivate the vulgar by seme little wonder-working incantation, or temporary insensibil- ity, as those soul-cheering beams from heaven's grand lu- minary are superior to the insignificant glow of the solar phosphori that excites the nocturnal wonder of the poor nervous school-boy. Some have wove themselves a kind of arachnoid mantle to shield themselves from the frowns of an incensed com- munity, if their folly should prove fatal to its recipients, by saying that the patient had called for the suspender of vi- tality; but that covering is too thin altogether. Suppose they did call for it — they are not the proper judges, at such- times, of the danger or safety of a remedy. I have been appealed to, often and again, in the height of the most ago- nizing torment, to give them something to put them to rest or kill them at onee. Suppose the patient should tell you 7 while in a slate of misery amounting to a degree of suffer- ing to which death seems, for the time being, by far the most preferable, to take a razor and cut her throat. Would that shield you from the retributive justice of the broken and outraged laws of your country ? Would it dry up the tears, and hush to slumber the cries and groans of the near friends and dec*r relatives of the deceased ? Would it be a valid excuse or a reliable shield to allay the ire or turn aside the unerring shaft of offended justice, or the devour- ing judgments of that all-powerful but seemingly disregar- ded God, who has devoted an entire commandment in his decalogue to the great law-giver, to say unto man, " Thou shalt not kill" ? Better for the man who should commit this, or a similar wickedness, that a mill-stone had been ti- ed to his neck, and he cast into the midst of the great deep. A physician has no license to be a gambler, and human life is not a proper material to stake on a game of chance- SUPPORTER. Ill for the reason that, if it is lost, it can never be made up or restored. If we must indulge in a kind of professional gam- bling, let us do it theoretically instead of practically : theii 5 we may lose our reputations, but not the lives of our pa- tients. In this case we shall use our own funds instead of borrowing that which we have no means under the heav- ens of paying. Let us never presume to experiment with, or foolishly employ those agents, the tendency and effects of which are known from past experience to be dangerous. And when I speak of damgerous remedies, I do not mean those that are known to be fatal at all times ; but if former trials, either of our own or tbose of others, that have come to our knowledge, have demonstrated to our satisfaction that from the administration and baleful effect of an article a few have died and a great many have escaped from its fatal consequences, this ought to be sufficient, for phy- sicians at least, to let it alone. It is certainly not very be- coming in us, who are the guardians of the lives and health of those who confide in our skilly and trust implicitly in our friendship, and have set us in the watch-towers of that sci- ence whose ostensible purpose is io give warning when dan- ger approaches, to make the experiment and see who are the unfortunate ones that are to die^ or the fortunate ones that are to escape death, under the use of a remedy, the ef- fects of which are, to suspend, for the time being, the whole vital energies of the nervous system. Because a person may be in danger and escape immediate death, does not ren- der it desirable to„those who have an ordinary degree of pru- dence, to rush, heedless of consequences, into those places fraught with danger and with death. Bonaparte crossed the bridge of Lodi under a most tre- mendous and galling cross-fire of his enemies, which dark- ened the noon-day sun, and made the atmosphere rife with 1L3 OBSTETRICA-! balls and grape-shot ; — yet he escaped with his life.—* But does that render it a suitable place of resort for a physi- cian to recommend to his patients for their health ? Gene- ral Taylor escaped from a. number of well and hard -fought battles on the plains of Mexico, where many a brave sol - dier fell by his side to rise no more till aroused by the sound of that angelic trump that shall awake the slumbers of the grave. On these sanguinary fields, where death finds his harvest amid the clash and clang of mingled armor, sounding in mortal combat, where the missiles of death flew swiftly and thickly around him like the silent messengers of fate to invite the spirits of heroic men to the fields of another world , the old hero stood erect among the ruins they had made around him, with his undaunted eye beaming confidence of success. Some of these death-dealing messengers, howev- er, had the audacity to carry away the breast-work of the old brown coat, but there was no surrender. And yet Gen- eral Taylor escaped unharmed from all these impending clouds of desolation, whose portentious frosts seemed to threaten immediate death and annihilation. But few of us, I think, would.be particularly anxious to make the experi- ment in order to ascertain whether we would be alike for- tunate with the general. Perhaps I have taken up too much time on this branch of my subject ; but I consider it of vast importance that the community should know where danger is concealed, and that they should also understand that an escape from danger is not a destruction of it, but the dan- ger may remain to take deadly effect on them at another time. I have said that our Supporter adds to the safety of the patient, and now I will endeavor to show wherein. We shall take it for granted (certainly till the contrary -is shown) that it has been proved beyond controversy that our Instru- SUPPORTER. 113 ment increases the power and efficacy of the voluntary mus- cles that enter directly into the labor of child-birth. In connection with this, another fact presents itself, of equal importance and perspicuity : it will not be disputed, if the former is admitted, that the Instrument will lessen the la- bor for the involuntary, in the same degree that it increases the operative power of the voluntary muscles, which, with- out this, or something similar to support them, are almost a dead-letter in the whole operation. It follows, then, as effect follows cause, that if a good proportion of the labor is thrown upon the voluntary department, it will relieve the uterus from the same amount of toil, and instead of throwing the whole upon the womb to be performed by that organ alone, which must necessarily waste its strength and exhaust the vitality and contractibility of its fibres, and there- by render it incapable of contraction after the expulsion of the child. It is greatly assisted by the voluntary muscles, both as to the amount of labor it has to perform, and in re- spect to the time it is compelled to keep up those powerful- ly contractile efforts. The result of all these contractile ef- forts from the voluntary system, rendered salutary and ef- fective by the aid of the Suppoiter, enables the womb to come out from the work active, vigorous and strong, hav- ing the power of a ready and voluntary contraction, or very easily excited to the same after delivery. Now I presume it is well known to every accoucheur in the land, that one of the great, if not the greatest causes of danger and death attendant on child-birth, is a uterine he- morrhage after the separation of the placenta from the womb, or a partial separation accompanied by a flaccidity of that organ, -and an inability to contract upon itself with sufficient firmness to compress the bleeding surface so as at once to prevent the hemorrhage. In speaking of hemor- j2 114 OBSTETRICAL rhage in this place, reference is not had to the unavoidable hemorrhage that takes place more or less when the placen- ta is attached to the cervix and os uteri : this takes place prior to the delivery of the child, and depends upon other causes than those I refer to above. It is more than probable that the whole number of deaths from hemorrhage after delivery, has never been known to the profession at large. Doubtless many deaths have oc- curred from concealed hemorrhage, w T ith the young and in- experienced practitioner, who has failed to detect the cause himself, or has neglected to make it known for fear of cen- sure for his want of observation in not detecting it in time to apply the proper remedies. This would be a most rep- rehensible conduct, and, when detected, should be met with no measured terms of disapprobation by every right-mind- ed and truly philanthropic member of the profession : nev- er allow one error to be covered up by the committal of another, and thereby deprive those who are- alike inex- perienced from the practical benefits which they might de- rive from a knowledge of the. misfortunes of the other. When the powers of the womb are not prostrated by long continued and unaided efforts for the expulsion of the child, and strong, healthy and vigorous action takes place, accom- panied with an immediate and equal contraction of all its parts, then all danger is happily at an end, and we may re- joice in the entire safety of our patient. I have never known a case of troublesome hemorrhage where the Supporter was used, either in my own practice, or that of any other phy- sician ; and I have taken pains to inquire particularly in re- ference to this matter, of those who have made the most extensive use of it. The beneficial effects of the Supporter in these respects are so nearly self-evident, that it seems almost like an in> SUPPORTER. 125 position on the good sense of one who has been fairly ini- tiated into the science and art of obstetrics to undrtake to prove it by other means than the plain principles upon which the Instrument operates. From the very nature of the op- eration of the Supporter, taking into consideration the in- creased power which it affords to the voluntary muscles, it must be obvious to every person who has the slightest ac- quaintance with the mechanism and organs by which the birih of a child is effected, that in proportion as you increase the efficient power of that division of labor which is under the power of volition, that in the same proportion you re- lieve from labor the organic or involuntary agents that have a-share in this work. The fact is, there is a certain amount of labor, (and most woful hard labor too,) to be done by the two sets of agents appointed by the Almighty to per- form the work : if it is all thrown upon one set, of course they must perform it ; but, being contrary to the original design, it becomes unnatural labor for those parts, — the con- sequence is, an undue exhaustion and prostration of those parts. Whereas, if the labor is equally divided, agreeably to the design of Omnipotent Wisdom, each part will be competent to the task, and able to perform it without pro- ducing that degree of prostration that amounts to a tempora- ry suspension of the vitality of the part, and consequently an incapacity to promote any further action. This equality in the division of the labor for the two systems to perform, which is attributable to the use and effects of the Suppor- ter, enables the whole to go through its own portion of the labor with very little prostration of strength, and of course leaves it more vitality and contractile power, w r hich soon enables it to recover the natural size of the organ in an un- impregnated state, and the danger is less and the recovery, more rapid in the same ratio exactly. 116 OBSTETRICAL There is another clanger, though not so frequent, but more disastrous in its consequences, which the Supporter would have a tendency to remove, if not entirely, to a very great extent : I allude to a rupture of the womb during la- bor, which is usually a most fatal accident. Happily, how- . ever, for the condition of poor suffering females, this is an accident of rather rare occurrence ; but when it does hap- pen, it is awful in the extreme, and every precaution ha- ving the most remote probability of preventing the accident, should be seized upon with avidity, and applied in a man- ner best calculated to give it full force and effect to accom- plish that object. If the rapture is a consequence of a dis- ease of the uterus, or from any cause the tendency of which is to destroy the strength or elasticity of the muscular fibre, or the fibre itself, probably no precaution v i bin the reach of a human arm could prevent it. But when he accident hap- pens in consequence of an undue exertion o tie womb to ex- pel its contents, having all or nearly all the labor thrown upon it for the want of proper means to bring in As aid the con- tractile power of the abdominal and resj itory muscles, then the Supporter is exactly the thine; it is wanted to supply the deficiency, and to prevent the o currence of this ter.ible and fatal disaster. The effect of the Supporter in these cases would be, to equalize the labor among all the natural pa s concerned in it, and, by so doing, relieve the womb from its almost un- earthty struggles, which are sometimes enough to break through bars of brass and tripple steel, and through the restoration of this equilibrium of action, save the lives of both mother and child. Not only this, but the manner in which the direction of the head may be controlled by the Supporter, as I have heretofore describ; d 3 which enables the accoucheur to prevent a lodgement of the head on the SUPPORTER. 117 pubis or the sacuum ; or if the obliquity in the lineof di- rection is not sufficient to effect an entire lodgement on ei- ther of these points, the head may be prevented from pres- sing hard upon them — thereby requiring a much greater amount of contractile force from the womb to propel it for- ward.. Either of these accidents might very much endan- ger a rupture of the womb, which would probably be the death of both mother and child, and may with great ease be prevented , with a little tact in the use of the Obstetrical Supporter. Probably one great cause of a rupture of the womb ari- ses from its being pressed with great violence while in a dis- tended and attenuated state, and every fibre strained to its utmost extent of endurance by a powerful contraction be- tween the head of the child and the sharp angle of the linea clio-peitinea which is sometimes unusually sharp. All this danger may be prevented by a careful and skillful adapta- tion cf the head' of the child to the axis of the pelvis ; and should the calamity happen through a want of these pre- cautions by the one who had the charge of the female in this situation, he should be put where the disaster would not be repeated through his ignorance and want of skill. I have a word to say in this place, which ought to have been said in another place while speaking of a front pad, which has been proposed to be attached to the Obstetrical Supporter, to press directly over the region of the womb. Now there can be no doubt in the mind of anyone capable of comprehending the subject, that a pressure made in this manner on the womb, while in a state of violent contraction, would be one of the most fruitful causes of rupture that has ever had an agency in the production of that most dreadful casualty. There is still another benefit to be derived from the Sup,- 118 OBSTETRICAL porter : it will have a direct and most decided tendency to prevent that frequent, troublesome, and sometimes even fa-, tal difficulty, called prolapsus uteri. So far as my own ob- servation goes, in reference to the cause of this difficulty, I think I can say that by far the greatest number of cases that I have treated might have been referred back, direct- ly or indirectly, for its cause, to a long, tedious and protrac- ted labor, where the whole burthen of that most terrible and fatiguing process has been thrown upon the uterus to perform almost entirely alone. The same thing happens here as in the case previously treated upon : there is no balance of power maintained, and no equality in the distri- bution of the labor among those parts which were designed by nature to co-operate in harmony together, in order to ac- complish with safety to all the parts concerned, that great work to which we have so frequently referred. Probably no one who has ever witnessed the progress and comple- tion of this labor would hesitate to declare without fear of contradiction, that when the labor was divided among the different parts designed to bear a portion of its burthen, with the most scrupulous care in regard to the equality of the distribution, that there was still enough in all conscience for each one to perform. It is in those cases where there is a great inequality in the distribution of the labor, that the womb becomes so much fatigued and worn out by an almost preternatural ex- ertion, and the ligaments of the womb are kept so long and so violently on the stretch, that their contractile power is not only prostrated, but almost entirely destroyed — so much so, that they remain in a flaccid and debilitated state for a great length of time. The same difficulty operates upon the foundation on which the womb rests that has already de- stroyed its suspensory power, so that the support is lost SIJTPORiEn. 119 from above and beneath, and, of course, its gravity must carry it downwards : this is a prolapsus uteri, in some one of the stages in which authors describe it, which depends upon the extent it has fallen. After the female has waited as she believes a sufficient time from her accouchment for a recovery from its effects, she makes the attempt to walk about, and with a great pain in her back and side, a gene- ral feeling of lassitude and low spirits, accompanied with a seeming inability to raise her limbs from the floor, she drags herself around, an object of pity to all w r ho can ap- preciate the misery she endures. As soon as the female places herself in an erect position, under these circumstan- ces, and the gravity of the uterus is brought to bear on the enfeebled and debilitated ligaments, instead of holding it by a healthy and tonic contraction, they relax at once, and al- low the whole superincumbent weight to press upon the vagina, which in a healthy state affords a very great sup- port ; but from the general relaxation of all these parts, that now gives way, and a complete prolapsus uteri is the result of all these failures. I am aware that many writers on this subject refer the great majority of cases of prolapsus to leucorrhwa as a cause ; but I must beg leave to dissent from tbat opinion. That lucorrhcea accompanies a large majority of the cases of pro- lapsus, I have no doubt ; and that it accompanies it more frequently as an effect than a cause, I am equally certain. If I am correct in my views in regard to the cause of this difficulty, that is, throwing too great a proportion of the labor on the uterus, to perform alone, it will then fol- low as a necessary result, that if the cause be removed, the effects will cease to trouble us. It certainly cannot be thought unreasonable to say, that it is by far the most com- mendable course to use all proper means to prevent this ISO OBSTETRICAL disease, than to pursue a practice well calculated to produce it, and, when produced, use a remedy worse than useless for its cute. We now offer our Supporter to the profession, and thro' them to the poor sufferers, as an instrument that is exceed- ingly well calculated to remove this cause. The manner in which it will equalize the labor among the voluntary and involuntary parts, and thestrong L vigorous and healthy state in which it leaves the uterus, I have already com- mented upon, and shall not enlarge ur.cn again here. 6th. That the mental effect produced by the Instrument is worth everything to the patient: and in speaking on this subject I can say as did Paul when he appeared before Agrippa. Hhe said, " I am thankful, O king, that I am permitted to speak before thee this day, touching those things whereof I am accused ; for I know thee to be ex- pert in all the laws, customs and usages of the Jews"': that is to say, he was thankful that the Judge, before whom he was to deliver his plea of justification, was one that could comprehend the depth and force of the arguments w T hich he was about to put forth in his own behalf. So it is with my- self when I address my professional friends on the effects of mental emotions. I. too, feel thankful that they can under- stand the force and appreciate the truth of my arguments. It is rather a popular notion that these mental emotions, op- erations and influences are trifles light as air, and are not worth the serious attention of any person to remedy, or prevent them when they spring from a wrong source, and follow a wrong channel. But the physician who is also a metaphysician, or, at least, sufficiently so to comprehend the phenomena which result from the connection of mind with matter, will from daily observation, become very competent and expert to judge of the wonderful influence SUPPORTER. 121 which the mental exerts, and frequently for a long time maintains, over the corporeal system. I presume there is no experienced or practical accouch- eur that has not had frequent occasions, and many times too frequent for his own comfort, of witnessing the bad effects of the depressing passions, such as fear, despondency, and the like, which operate to clog the various wheels in hu- man machinery; and especially those females of delicate con- stitutions and finely attuned nervous systems. They cannot control their feelings; nor will anyone qualified to judge of the mutual effects of mind and matter, or sufficiently ac- quainted with to be capable of discriminating between the various constitutions and temperaments with which they will so frequently meet, expect them to do so. God has not furnished them, with materials to fortify against the ra- vages and inroads of injurious mental excitements, howev- er strong the desire may be. They cannot rise above the depressing and injurious effects of these mental emotions on the contractile power of the whole muscular system. — - These effects follow the operation of the cause, when it is allowed to exist, as necessarily and as certainly as a sick- ness of the stomach follows the administration of an emet- ic. Hence, our pity and commiseration may and ought to be excited in their behalf; but we never should allow our patience to be thrown from its equilibrium in conse- quence of our plans being thwarted by these causes* Who, among us all, have not witnessed more times than one, the total suspension of all operations, almost as com- pletely as if the patient had been visited With a shock of total paralysis,from the seemingly small cause of disappoint- ment in not being able to procure the attendance of her ' own favorite physician ? Then, hour after hour may elaps* before the inroads of these mental innovations can De re* k OBSTETRICAL paired, though met in the face and eyes by the exercise of all the tact and skill that the most expert manager can call to his aid. For this reason, I have alwa}^s been averse to attending cases in obstetrical practice where another * phy- sician was sent for before myself; not fFom any chagrin or jealousy because another one was preferred before me, but because I feared that some unpleasant consequence might be the result of the disappointment to the patient ; espe- cially if I know her to be one of those temperaments that will break over the restraints of the judgment, and run wild w T ith the imagination over the extended prairie of thought, gathering flowers only from those plants of a noisome and narcotic odor, the effects of which will bring up the gloomy shades of death before the mind's eye, and spread out the landscape of despair to gaze upon. In these cases, the rose and the lily may be tendered to them in vain — the medium through which they view things is smoked and bleared — the consequence is, the better appears the worse, and the worse the better. The time that has been lost, both to patient and physi- cian, the sufferings and tortures endured by poor unfortu- nate females who are constitutionally feeble, both in mus- cle and in nerve, and consequently full of fears, doubts and desponding feelings that arise in dismal clouds before her, from the fact that she knows her own inability through the delinquency of those physical powers to perform that im- portant work that lies before her and must be done, and the number of infant lives that have been lost by the un- reasonable procrastination of that much-desired moment to every poor, worn and disconsolate parturient female, i e., the end of their labor, never can be computed or compre- hended by any living man. Nothing short of the all-seeing eye that views the past as the present, can realize its mag- SUPPORTER. 123 aitude. But the experience of eaeh individual will teach. him that if the experience of evenj individuahxlio has prac- ticed the art of midwifery were consolidated together, or spread out on one great chart before them, that the result would be most shocking to every philanthropic heart, and perfectly astounding to the most careless beholder. Now, over all this arid and desolate landscape, where sorrow and misery sit brooding like the boding owl over the devoted city of the plain, and while standing aghast in the midst of this Golgotha, where pyramids of human bones might be scraped together, must we sit down in despair and say, there is no remedy ! Is there no gleam of light ema- nating from the soul-cheering lamp of hope, to shed its bright beams on these cheerless regions where the sombre cloud of despair has cast its gloomy shadow o'er all the land ? Is there no balm left in Gilead, and is there no phy- sician there ? I say there is, and have tendered its services to the world. If fear and its attendant depressing passions are the cause of all these woes and ills of life, then if we remove the fear we abstract the cause : if we annihilate the cause, I need not add that we effect the cure ; and allow me to add, in all humility, it is a cure that the Genius of remedies might have been proud of. There is something peculiar and al- most wonderful about our Supporter to dispel fear and in- spire hope. It is like the coat of mail to the stout-hearted soldier, whose implicit confidence is reposed in it for the preservation of his life. I have never known or heard of a female, while using the Supporter, to be fearful, despond- ing, or doubtful of her ability to go through with the labor before her with certainty and success. The fact is, they feel themselves held and supported, in every place where support \B required ? in such a manner that they cannot mis- 124 OBSTETRICAL take the great and certain utilityof the agent which imparts this support ; and it unavoidably inspires them with a soul- cheering certainty that they will be able to outride the storm of suffering and danger, and land triumphantly in the haven of safety and rest. And you may well suppose that the person who has passed through, on former occasions, a long, lingering, cheerless and desponding labor, can, in a most intelligible manner, appreciate these great and life- giving benefits. These are the effects and the legitimate results ^vowing out of a fair and well-timed use of our Supporter, and those who are disposed to doubt it I hope will remember the fate of unbelievers, and ponder well on the course they mark out for themselves, and beware how they incur the penalty annexed to their gratuitous folly and unbelief. And I would inquire, is there one among all the nume- rous intelligences of God's creation, who has ever experi- enced the transition from a gloomy, fearful and foreboding despair, to a firm, rational and well-grounded hope of suc- cess, that would not range this wide world over, from the icy regions of the north to the eternal snows of the south, to procure an agent which could impart this heaven-sent fruition ? A sudden passage from one of these conditions to the other is a fullness that we cannot comprehend how it can be improved even by the bliss of heaven itself. These are not the ephemeral and evanescent seribblings of an excited moment, or an over-heated brain, to accom- plish a selfish purpose, or eulogize an offspring ; but they are truths, and truths of momentous consequence. They must and will shine out to illuminate this earth, and cheer the heart of many a sorrow- stricken female. It is in vain to raise the puny arm of mortality to prevent them : as well might you interpose the gossamer to shut out the rays of SUPPORTER. 125 heaven's bright luminary, and eclipse this earth in total darkness. Let us then vie with each other in our exertions to send broad-cast, all over the earth, an agent that will cast out fear and inspire hope among that division of our lace to whom, under God, we are most directly indebted for our own existence ; and ere we pause from our labors, let us feel sure that none are in want of this blessing from a lack of our exertions. Then may we rest our head on our pil- low, and say and believe that we have not lived in vain. The stimulus of hope is one of the safest, the most de- lightful, the most soul-exhilarating remedies that ever was administered to mortal man. It is probably not of terres- trial origin, buUhas its source from that Fountain that sup- plies " every good and perfect gift." It is a lamp that lights up the pathway of the poor suffering pilgrim whose journey is onward through the shoals and quicksands of this wicked world. This stimulus of hope is always safe, but does not intoxicate : herein lies one very desirable property of the remedy — it is perfectly safe at all times 1 and under all circumstances, whether w r eak or strong. The beggar may obtain it — the rich man may not be able to buy it. This potent charm may always be administered with an entire certainty that no bad effects will result from its administration ; and when it is tendered by a soothing and friendly hand, accompanied by the good wishes of those who administer it, how the languishing soul will drink it down ! Nothing can be more grateful to the care-worn spirit that is seeking for a resting-place or green spot where- on it may repos3 and be shielded from the ills of this life. The use of our Supporter affords all these benefi's of hope and confidence, and by every pain through which the suffering fema!e passes, she is satisfied that something has k2 126 OBSTETRICAL been accomplished. From the success of every effort she is inspired with confidence to make another ; and now so great is the progress of the labor that the patient becomes satisfied, beyond a lingering doubt, that her exertions are being attended with the most complete and satisfactory suc- cess ; and soon she begins to indulge a hope that every ef- fort which she makes will be the last that w T ill be necessa- ry to free her from her sufferings and allow her to repose under the watchful and soothing care of her friends ; and mast happy am 1 to say, that it is very seldom the case that it proves to be a hope deferred. This closes what I have to say on the beneficial effects of the Supporter. Much more might be said : in fact, it is difficult to say too much in its favor, or to praise it high- er than it deserves ; but enough has probably been said to induce my readers to make a trial of it, and a full and fair trial is all that I ask to insure its unbounded success. I now leave it in the hands of my professional friends : they are competent to judge of its power to do good in the world, and to relieve those who most of all have stood in need of it for a great length of time ; and I feel confident that no true philanthropist, who is in possession of a knowledge of the great benefits that may be derived from its introduction and use, will ever* lay a straw in the way of its onward course, until it is within the reach of all who may require its aid. A fair trial is all we ask of any one ; and when this is done under circumstances to make it a fair one, and it does rot meet the expectation or come up to the recommenda- tion I have given it, then throw it aside in the waste places and let it moulder away with the useless and unused things of this world. But I can most solemnly assure the world at large, that it is no humbug ; nor is it anything originating SUPPORTER. 127 in that direction. It is well known to all the world who know me, that I am not a vender of humbugs. 1 have uni- formly opposed all the leading impositions of the day that crossed my path, and those that have moored themselves within range of my guns, with all the energy and ability that God has given me ; and what little I have been able to add to it, has been freely thrown into the same side of the balance. This has been done, many times, w r ith a bold- ness and determination of purpose that has injured my bu- siness, and sometimes to a considerable extent ; but I have taken what I believed to be duty for my guide, and made my opposition to humbugs and impositions without reference to loss or gain. I have neither fellowship nor partnership with the hordes of that genus of spirits that escaped from the disaster when the swine ran furiously into the sea and were drowned — who have since been made tangible bodies and are now strolling the country under the names of 4 Quacks' and ' Impostors' — who are cheating the gallows out of that on which it has a fair and undoubted claim — who are trespassing on the legal rights of the people every step they take that is not toward the state prison — and who are flooding the land from the arctic to the antarctic regions with their nostrums, panaceas, and all other aerial wonder- working curatives, and their pigmies on elephants' legs, boasting of their semi-almighty power to trample diseases of all kinds under their feet with the same ease that the jack- ass did the chickens, and it is usually done with about the same amount of skill and intelligence. All their patent rem- edies are usually put a little ahead of the fruit from the ori- ginal tree of life, and of course must act by charms, incan- tations and legerdemain ; for, according to their own show- ing, they can act on no known or natural principles. The venders, boasting at the same time of their supernatural 128 OBSTETRICAL powers and inspirations in the healing art, having received their pretended skill by imbibition, substituting impu- dence for knowledge, they shrink not at telling the most barefaced and outrageous falsehood that their great tutor and schoolmaster, the Devil, has ever instructed them in. True, their remedies are generally effectual ; for they usu- ally kill disease and patient with the same stroke of their wand. No doubt but these perambulating siroccos destroy more lives than the cholera, the plague, and all the other sweeping epidemics that have gone abroad among us appa- rently to make desolate the face of the earth. Epidemics are usually periodical, and occur only at long intervals ; but these scoundrels, like the virus of some unseen cyptogamia, are always at their work of destruction. Sometimes, when I look abroad upon their works and the workers, I think as the old bachelor did when the school-boys gathered around him, tangled his legs, and threw him down. He then arose in his w T rath and frowned most portentously on the boys, and exclaimed, " We are in great want of a pes- tilence \P I do not wish to be understood as boasting of my know- ledge, or scientific attainments. I never pretended to know but little ; and, in what I have said, I only mean to be un- derstood that I do not make, unfounded pretensions to a knowledge of things, of the nature of which I am entirely ignorant. I know very well that I have said some large things of our Supporter ; and I also believe that I have ex- plained them upon natural and philosophical principles. — We have made no pretensions to a special revelation, nor have we called to our aid the operation of supernatural causes. I again repeat, that we have got up this Instru- ment with care and deliberation. Commencing with a small and somewhat rude beginning, I made trial of its effects, SUPPORTER. 129 watching with all the acuteness that I was master of the benefits it produced — endeavoring, at the same time, to as- certain all the wants of nature that were not supplied. As I from time to time discovered these wants, I endeavored to supply them, with the best means that the ingenuity of us both could invent ; and when, as I believe, from repeat- ed trials and close and unwearied observation, I had sup- plied all the calls of nature, 1 stopped — believing that any- thing further would have a tendency to complicate the In* strument, and injure its effects, thereby defeating the ends I had so ardently desired to accomplish. And I believe that it may be said without boasting, that I am not exactly a novice in that department of our pro- fession which pertains to the art of obstetrics. I hope my friends will excuse a relation I am about to give, which might, under some circumstances, appear like a pedantic boast ; but I believe my design is laudable, for I make the statement not so much in pride as in thankfulness to God for his blessings on the feeble means which I have been enabled to put forth for the preservation of the liyes of my fellow-beings. In almost seventeen years 1 practice, I have never lost a solitary patient in child-birth that has been under my care, nor of any disease immediately connected with it. To those who are acquainted with me, I need not say that it is not because I have done nothing in this branch of my profession. To those who are not acquainted with me, I will only say, that I have probably done as much as any other country practitioner of my age. If any doubts are entertained of the veracity of these statements, they may be easily satisfied on all these matters by a correspondence with those who know me well. All my field of operations in my professional career has been in Essex and Clinton counties, in the state of New York. 130 OF .riTRICAL I now leave this subject to be enlarged upon by wiser heads, and embellished by more able pens than mine. If this Instrument shall prove as beneficial as I have anticipa- ted it will, to that portion of my fellow-beings to whom I am more immediately indebted for my existence, and to whose fostering care I owe the preservation and sustenance of my helpless, and infantile years, then I shall consider all my toil and labor, both mental and corporeal, most amply rewarded; and the good wishes and fervent prayers of those kind-hearted females for my future success in all laudable designs, is all the monument of fame that I aspire to. Explanation of the Plates. Plate 1. Figure 1 is a perspective view ; [A] Is a pad to hold and support the back and apply a counter pressure to that made by the head of the child ; [BB] Is a strap passing through two loops on the back pad, having- a buckle [b] on each end, buckling back into the strap towards the back pad, enabling the accoucheur to adapt it to the length of the thigh of any person w T ith great facility ; it also forms two large loops for the knees, with two straps passing un- der the feet to prevent the possibility of the loops of the main strap slipping from the knee. Fig. 2 Is a back pad. [A] Shows the back of the pad, also its true shape ; [B] Shows the main strap as it passes through the loops on the back pad. Fig. 3 Is a moveable knee pad; [C] Is the pad itself; [B] Is the main strap passing through two loops on which guPPORTEtl. 131 the knee pad slides ; [E] Is a narrow strap, going up the thigh, to which the handles are attached. Fig. 4 Is one of the handles. [D] Is the part of the handle to he grasped with the hand ; [E] The strap that passes through the loops of the knee pad, then passes up the thigh on each side, to which the handle is attached ; [C] Is the knee pad, 132 SUPPORTER, Fig. Plate 2. 5 Shows the Instrument in use. [A] Shows thfe place of the back pad ; [BBB] shows the different situa- tions of the main strap when the Instrument is applied ; [D D] shows the two handles as they lay transversely across the thighs ; [E E] are two straps to which the handles are attached ;. [C CJ shows the situation of the knee pads ; [F F] shows the two straps that pass under the feet to prevent the main strap from slipping over, the knee. Tiai S LIBRARY OF CONGRESS 021 062 538