ADDRESS 
ON 
0 B S T E TRIG S, 
DELIVERED BEFORE THE 
INTERNATIONAL MEDICAL CONGRESS, 
AT 
P H1LADELPH1A, 
September 7, 1876. 
BY 
THEOPHILUS PARVIN, M.D., 
PROFESSOR OF OBSTETRICS AND THE MEDICAL AND SURGICAL DISEASES OF WOMEN, COLLEGE 
OF PHYSICIANS AND SURGEONS OF INDIANA. 
[Extracted from the Transactions. | 
P HILADELPI1IA: 
1876. ADDRESS 
ON 
OBSTETRICS, 
DELIVERED BEFORE THE 
INTERNATIONAL MEDICAL CONGRESS, 
AT 
PHILADELPHIA, 
September 7, 1876, 
by 
THEOPHILUS PARVIN, M.D., 
PROFESSOR OF OBSTETRICS AND THE MEDICAL AND SURGICAL DISEASES OF WOMEN, COLLEGE 
OF PHYSICIANS AND SURGEONS OF INDIANA. 
[Extracted from the Transactions.] 
PHILADELPHIA: 
1876. PHILADELPHIA: 
COLLINS, PRINTER, 
705 Jayne Street. ADDRESS. 
" There is no department of medicine or surgery, superior to'midwifery in 
dignity and utility."-J/auriceau. 
Of American Obstetrics, with its associate branches, Gynaecology and 
Paediatrics, we commemorate the centennial. 
What have Americans done, in the century just closed, to advance 
these great departments of Medicine ? How easy the question and how 
difficult the answer! Contemporaneous discoveries and successes are 
found in these as well as in other fields of human effort, and who, then, 
shall be primus inter pares ! Sometimes, too, that which is supposed to 
be new1 is really old, and the discoverer has unconsciously trodden in 
the footsteps of another. 
Beside this, much of medical knowledge is merely provisional, the 
best expression of the truth for the time being, and serves only a present 
utility-a mere ladder by which we ascend to higher platforms and larger 
planes, and which is then cast aside. Nor does everything claimed as 
valuable by him who first pointsit out,prove to be such when thoroughly 
tested. Alas, for the many Ixions who mistake a cloud for a goddess! 
Alas, for the fool's gold that so often delights, so surely disappoints! 
Change is not synonymous with improvement; so far from change always 
being progress, it may be retrogression.2 
Nor are these the only difficulties. Add to them the limitation of 
individual knowledge, and the infirmities of human judgment, so liable 
to error in estimating the value of things present, no matter how deter- 
mined and desirous one maybe suum cuique tribuere. And surmounting 
all these, there stands in bold relief the fact that the very work of this 
occasion has been largely anticipated by an able paper in the American 
Journal of the Medical Sciences,3 from the pen of one who has himself 
contributed so much to the glory of American Medicine. Confronted by 
such difficulties, and addressing such auditors, one even of ample qualifi- 
cations might well shrink from attempting the duty assigned me. 
However, strengthened by your recognition of these impediments, and 
1 Professor Blackie, Horce Hellenicce, observes : " Even in the free exercise of poetical 
talent in the case of individual poets of highly potentiated imagination, we constantly 
stumble on comparisons which have been made independently by other poets at other times 
or in distant countries, and which superficial critics are sometimes eager to fasten on as 
plagiarism." Quite similar facts are observed in the history of medicine. 
2 Baudelocque, Vol. II, pp. 34, of L' Art des Accouchemens, Paris, 1781, in referring to 
the obstetrical forceps remarks : " . . car si plusieurs ont travaillt d sa perfection, 
les autres ne Von rendu que plus imparfait." 
' July, 1876. A Century of American Medicine. Ill-Obstetrics and Gynaecology. 
By T. Gaillard Thomas, M.D. 4 
PARVIN, 
confiding in your earnest sympathies with this work, I address myself 
to it with zealous desire to honor justly both the dead and the living of 
our country, who have added useful knowledge in obstetrics, and in 
diseases of women or of children, and to help exalt their fame in all 
they have thus done to lift or lighten the cross of human suffering. 
In this proposed exposition, the subject of Obstetrics will, for obvious 
reasons, be presented first. After some brief allusions to the condition 
of obstetric art and science in the last century, and the sources from which 
the first American practitioners of this art derived their knowledge, 
suitable topics will be found in works on Obstetrics, and in special con- 
tributions to obstetric pathology and therapeutics. 
The eighteenth century was marked by great advances in obstetric 
knowledge. and improvements in practice, though history has shown 
the mistake of a distinguished physician of South Carolina, Dr. David 
Ramsey, who, in an address before the Medical Society of his State, on 
the first day of the present century, asserted "that the art of obstetrics 
had been brought to such perfection, further improvements were scarcely 
to be expected." 
Standing at the commencement of the eighteenth century is the famous 
Hollander, Deventer, who declared theory as essential to practice as body 
to shadow-surely a very doubtful compliment to practice-who asserted 
that those1 ignorant of the obliquities of the uterus were equally blind 
with him that saw trees as men walking, but who, despite these and similar 
exaggerations, despite plain, palpable errors, advocated cephalic version, 
and taught the genu-pectoral position as part of the treatment in one 
variety of prolapse2 of the cord, and in some cases of transverse3 presen- 
tation. 
Near its close we have the illustrious Baudelocque, to whom so many 
of our obstetric authors acknowledge their obligations, and whose fame, 
notwithstanding his twenty-three presentationsand ninety-four positions, 
has suffered only partial eclipse in the revolutions of more than four- 
score years. And interposed we have Chapman coming from the country 
to London once a year to give lectures on obstetrics, the first,4 and the 
first ever given in that city, being in 1730, and revealing the beneficent 
instrument which the Chamberlens had kept secret with cruel cupidity, 
the obstetric forceps; we have Sir Fielding Guide, the wit's " Lord deliver 
1 . . quicunque obliqui situs uteri sunt ignari, in artibus obstetricantium asque cecu- 
tiant, ac ille, qui homines instar arborum videbat ambulantes. Henrici a Deventer, Medi- 
cinse Doctoris, Operationes Chirurgicae Novum Lumen exhibentes Obstetricantibus, etc., 
Leyden, 1701. 
2 Similiter accidit sed rarius, nt funiculus & capite retrorsum vertebris vel ossi sacro 
apprimatur: tunc caput alterutra manu removendum, prout scilicet plus minus in alterutrum 
latus vergit; parturient! (si vires suppetant) in genua provolutce A tergo manum sospitam 
admoveat obstetrix : aut, si infirmior fuerit, in alterutrum latus declinetur, uno pede ad 
ventrem attracto, ut plus spatii suppetat, etc., Ibid., cap. xxxviii. De partu difficili, ab 
infante praevia vena umbilicali prodeunte. 
3 ... ideoque parturientem, tali situ disponat, quo uteri spatium suppetat, nec 
ille cum infante in manum obstetricis delabatur; nimirum utero propendulo convenit 
parturientem procumbere genibus, aut in dextrum latus inclinare, posteriore corpore 
aliquatenus elevato, et ut plurimum prono, etc., Ibid., cap. xl. De infantibus transversim 
positis. 
4 My authority is Dr. Thyme. Vide MSS. Lectures, 1794, Surgeon-General's Library, 
Washington. Dr. T. remarks, " Chapman had no machines, nor were his students allowed 
to attend midwifery cases. To Smellie we owe those improvements." Denman, however, 
credits Dr. Maubray, 1724, with the first lectures. ADDRESS ON OBSTETRICS. 
5 
us," giving a glimpse at the mechanism of labor, that mechanism soon to 
be much more fully and clearly expounded by Smellie and Solayres; we 
have Smellie and William Hunter, representing opposite but concordant 
elements of obstetrics, mechanism and physiology, the one writing a work 
upon obstetrics, the fruit of forty years' study, which for nearly three- 
quarters of a century was the best English text-book, and enduring the 
harmless criticism of Dr. Burton, who probably had his reward in being 
made the Dr. Slop of Tristram Shandy ; the other preparing those plates 
of the human gravid uterus, which can never become obsolete ; we have 
Levret, the geometric obstetrician, explaining the mechanism of labor 
before the Paris Academy of Surgery, using in his demonstrations the 
egg of an ostrich and a " mattrice mechanique," and dividing with 
Smellie1 the honor of an important improvement in the forceps. With 
these two men, using the words of Baudelocque, commenced the most 
brilliant epoch of obstetric art. 
But it is not my purpose to mention further the famous obstetricians 
of the eighteenth century, and allude to any of their special contribu- 
tions. Enough to add that the two first American obstetric practitioners 
had been instructed by two of the most eminent of London teachers, for 
Lloyd,2 in Boston, and Shippen,3 in Philadelphia, were pupils of Smellie 
and Wm. Hunter. Thus we see that the germ of American Obstetrics 
was British rather than French, in so far giving probable contradiction 
to the assertion of Dr. Tyler Smith when he states, " notwithstanding 
the blood relation between the United States and this country, American 
Midwifery is far more the child of France than of England." So, too, 
probable contradiction is given by these other facts, that Dr. Samuel Bard, 
the author of the first American work on obstetrics, had received his pro- 
fessional training largely in Edinburgh ; and that there, too, after having 
previously been a house-pupil in London under Drs. Osborne and John 
Clarke, was instructed Dr. T. C. James, the first professor of obstetrics in 
the University of Pennsylvania. And the famous Dewees, who bears 
the same paternal relation to American Obstetrics that Physick does to 
American Surgery, or Kush to American Practice, and who " has the 
high honor of first attempting a full course of lectures on obstetrics in 
America,"4 was too independent a thinker and original investigator to 
be unduly swayed by the teachings of any man or of any school.5 And 
finally, the obstetric books of the American profession have been British 
or American much more than French. 
Seventy or eighty years ago, the practice of obstetrics was almost 
exclusively in the hands of women, even in the long settled parts of the 
United States, and, as the tide of population passed westward, the female 
midwife was still the trust of the matrons among the early settlers who 
1 Possibly, according to the recent researches of Dr. McClintock, each of them was anti- 
cipated by Dr. Pugh (see Dublin Journal, June, 1876), so that there is an end to the con- 
test in this matter between France and England. 
2 Dr. Bartlett, of Massachusetts, states that Dr. James Lloyd, of Boston, was the first 
systematic practitioner of midwifery in that section of the country, 1754. 
3 In 1756 Dr. William Shippen engaged in the same practice at Philadelphia, and sub- 
sequently was Professor of Anatomy, Surgery, and Midwifery in the University of Penn- 
sylvania. 
4 Eulogium upon William P. Dewees, by Prof. Hugh L. Hodge. These lectures were 
first delivered in 1797. 
5 " Drs. James and Dewees should be regarded as the fathers of obstetric science in 
America: the former, erudite and polished, gave currency to the teachings of the British 
schools ; the latter, more vigorous and energetic, exemplifying theoretically and practically 
the doctrines of the French obstetricians."-Preface to Hodge's Obstetrics. 6 
PARVIN, 
swept away the forests and founded an empire beyond the Alleghanies. 
Dr. J. G. F. Holston1 has given a most graphic description of early mid- 
wifery in Ohio; but the compensation of these practitioners, as stated 
by him, seems so meagre that none could have had a lucrative practice, 
no matter how large it was-one dollar, and in cities not more than 
three dollars, and in the country the midwife was also nurse the first 
week or until the ninth day. 
Nor had the American midwife any of the posthumous honors which 
were once the fortune of her sisters in France. That famous sage-femme, 
Louise Bourgeois-whose picture2 Dr. Goodell has with such perfect 
art recently exhibited to the profession-in her Instructions to her 
daughtre, Paris, 1617, states, " There are now very few women who have 
such an affectionate regard for their midwives as prevailed formerly, 
when it was the custom, if a midwife died, for her friends to put on deep 
mourning for her, and they prayed God not to send them any more 
children,"3 etc. 
However the fact remains that the general practice of obstetrics in 
this country has been but for little more than half a century chiefly 
devolved upon medical men, and even to this day, in most of our large 
cities, a considerable portion of this practice, more especially among the 
foreign population, is attended to by females. 
The first American work on obstetrics was the Compendium of Mid- 
wifery, by Dr. Samuel Bard, of New York, the first edition being issued 
in 1808, the fourth and last in 1817. Using the phrase of the present 
day, this book is remarkable for its amount of padding, page after page 
being filled with extracts from Smellie, Perfect, Clarke, and various 
writers in the Medical and Physical Journal. But it also contains 
many judicious thoughts and directions wTell expressed by Dr. Bard, and 
from the very number and variety of important cases quoted, is really 
an excellent compend of clinical obstetrics. In meeting that nodus obste- 
tricus-why labor occurs at nine months, Dr. Bard does not shelter him- 
self with Avicenna behind the grace of God, but assails the question 
with a brace of questions, Why do strawberries ripen in June and 
peaches in August? 
In reference to the delivery of the placenta, he certainly was greatly 
in advance of many obstetric authors of recent days, advising almost 
essentially Credo's method before Credo was born, as the following passage 
clearly shows. " While this is about," i. e. attention to the new-born 
child, "let an assistant or the woman herself, place her hand on the ab- 
domen, a little above the fundus uteri, so as in some measure to grasp it 
in the palm, and make a moderate pressure upon it. This can possibly 
do no harm; it has been my general practice; and I think I have found 
a manifest advantage from it in promoting the contraction of the uterus 
and in disengaging the placenta." 
And in the management of women after parturition the following 
instructions seem wise, though even at this day they are too generally 
neglected. "After one or two days, women should rise from their beds, 
and sit up for a longer or shorter time every day, according to their 
1 Transactions of the Ohio State Medical Society, 1857. 
2 A Sketch of the Life and Writings of Louyse Bourgeois-The Annual Address of the 
Retiring President before the Philadelphia County Medical Society, by William Goodell, 
A.M., M.D. Delivered June 5th, 1876. 
3 Dr. John Moultrie, for forty years at the head of the profession in Charleston, died 
about 1773; and several of the ladies of the city bedewed his grave with their tears, and 
went into mourning for him.-Thacher's Medical Biography. ADDRESS ON OBSTETRICS. 
7 
strength and inclination." " The lochia require no other attention than 
sitting up a short time every day to promote their evacuation." 
Of wider scope, of more originality, and destined to a much larger 
fame, was the Compendious System of Midwifery, by Dr. Dewees, first 
issued in 1826, of which no less than twelve1 editions have been pub- 
lished. Dewees himself had some years before, 1807, published an 
abridgment of Heath's translation of Baudelocque, with annotations, 
and it passed through at least three editions. Burns's Principles of Mid- 
wifery was republished in 1810, with notes by Dr. Chapman, and several 
subsequent editions edited by Dr. James ; in 1821, Denman's Introduction 
to the Practice of Midwifery, with very valuable notes by Dr. John W. 
Francis, was issued in New York. But not Baudelocque, nor Burns, nor 
Denman was to be the first great obstetric teacher of the American pro- 
fession. He who was to have this honor was no favored child of fortune, 
but one early in youth left fatherless and poor, with no heritage but a 
good name, with few facilities for acquiring a complete literary education 
amid the desolations of the Revolution, yet bravely struggling up against 
rude adversities. His first professional labors were those of a country 
practitioner in one of the pleasantest2 of villages-once hidden away, 
surrounded by farms or forests-now almost lying within reach of the 
outstretched arms of this great city. There he acquired those habits of 
close observation and reflection which were the foundation of his future 
greatness and fame. Then, after four years' experience casting his lot in 
Philadelphia, and without fortune, without family influence, without 
professional friends save as they were attracted to him by the recognition 
of his abilities-no adventitious aids-he succeeded by his own inherent 
power and perseverance. The name of William Potts Dewees should 
live forever in the memory of the American profession. 
Dr. Hodge, in speaking of Dr. Dewees in 1842, observed: " He isour 
representative to other nations on the science of obstetrics, and as such 
is continually quoted by European authorities, as if he constituted one 
of their own number.3" As to the merits of Dewees's Midwifery, let me 
again quote the opinions of Dr. Hodge. He considered it, twenty years 
after its publication, as "probably the best practical book in our pro- 
fession." "It takes a stand decidedly in advance of Denman, Osborne, 
Burns, and other English authorities in general use in our country at 
that period, and even of Baudelocque himself," etc. Without acceding 
to the truth of Pope's couplet- 
"Authors, like coins, grow dear as they grow old ; 
It is the rust we value, not the gold," 
1 "An honor rarely, if ever, bestowed on any similar work."-History of American Medi- 
cal Literature. By Professor S. D. Gross. 
2 Abington, Penna. 
3 " Dr. John Ramsbotham, of London, dedicated the second part of his * Practical Obser- 
vations on Midwifery' to Dr. Dewees, in connection with Sir C. Mansfield Clark. Dr. Edward 
Rigby, of London, and author of a most excellent work on Obstetrics, which has lately 
been republished in this country, writes to Dr. Dewees in August, 1834, in the following 
manner:-'I trust you will pardon the liberty I have taken in writing to you, as well as 
the motives which have induced me to do so. I have been accustomed, for some years, to 
hold such frequent intercourse with you in reading your admirable system of Midwifery, 
and work on children, that I cannot refrain from requesting a more direct intercourse 
between us,' etc. The July number of the British and Foreign Medical Review, for 1839, 
contains the following handsome compliment:-* The Philadelphia school of Midwifery has 
for many years been looked upon with great respect by the obstetricians on this side of the 
Atlantic. The high name and professional standing of Dr. Dewees, his great experience, 
and, above all, his inestimable, compendious system of Midwifery and other valuable pub- 
lications, have mainly contributed to this result.' " 8 
PARVIN, 
let me predict that as with pious care and grateful appreciation one of 
the most celebrated of the Dublin school is bringing the " Treatise" of 
Smellie before this generation, so this or a succeeding generation will 
see the avatar of the " Compendium" of Dewees in like modern form. 
To Dr. Dewees, probably, we are more indebted than to any one else, 
for the general preference on the part of the American profession for the 
long forceps.1 Dr. Dewees2 accomplished great good in exposing the 
errors of Denman in his aphorisms as to the use of this instrument, and 
the practice of the former is much more in accordance with that of 
to-day, than is that of the latter: an apparent timidity and conservatism 
ruled Denman's teachings in this regard, which conduced to the interests 
of neither mother nor child-he was a representative of that physiological 
school of obstetrics, originating with William Hunter, in opposition to 
what Tyler Smith has termed the mechanical school of Smellie-but our 
American obstetrician represented both in harmonious union. 
To Dr. Dewees belongs the honor of pointing out the value of 
venesection not only in overcoming rigidity of the os uteri, but also 
in diminishing the resistance of vaginal cicatrices-the utility of his 
teaching and practice in this regard being recognized by foreign obste- 
tricians. 
It is sad to recall the fact that this famous man, with whom the history 
of American obstetrics really begins, should ever have been an unsuc- 
cessful candidate for the chair of midwifery in the University of Penn- 
sylvania ;3 sadder still to know that when, twenty-four years later, the 
honor came by unanimous voice of the trustees, failing health permitted 
him to hold it but a year-the infirmities of age are upon him, almost 
the shadow of the grave is in his path before he reaches the noble goal of 
his life, and grasps the coveted prize. How true it is that his 
-" laurel crown 
Rustled most when the leaves turned brown." 
The next American work on Obstetrics was "The Philadelphia Prac- 
tice of Midwifery," by Dr. Charles D. Meigs,4 published in 1838 ; it was 
brief and elementary; a second edition was issued in 1842. Three 
years subsequently Dr. Meigs was elected a professor in Jefferson Medi- 
cal College, and became famous as one of the best of teachers and one 
of the most brilliant of lecturers, while his genial manners in social life 
won all hearts. Almost equally fascinating with his uttered are his 
printed words, so that one can now read page after page until hours 
pass away without weariness. Fluency and force, strength and beauty, 
characterized his literary composition in a remarkable degree; not only 
1 It is stated by Hutchinson (Biographia Medina, London, 1799), that Smellie for a time 
endeavored to substitute wooden for steel forceps. 
2 In referring to Dr. Denman, Dr. Dewees remarks : . . "there was a time in my life 
when I looked upon Dr. Denman to be the highest authority in midwifery." 
9 The election of Dr. James seems really to have been effected by a combination between 
him and Dr. Chapman-there were only three candidates-the latter to have half the emolu 
inents, and to succeed to the next vacant chair in the University (see Hodge's eulogium 
upon Dewees)-a sort of bargain and sale which at this distance does not seem quite im- 
maculate. 
4 A very interesting memoir of Dr. Charles D. Meigs, by his son, Dr. J. Forsyth Meigs, 
has been published, but unfortunately did not come into the writer's possession until he 
was correcting the proof-sheets of this Address. In the memoir the author states that his 
father wished to call his home in the country " Paraclete," the Comforter. Was not this 
in imitation of Abelard, who, when his admiring students, following him to his desert 
retreat, built him a new oratory, called it the Paraclete? ADDRESS ON OBSTETRICS. 
9 
the treasures of his favorite department were his, but he was at home 
in general literature and familiar with classic storv, while a Gallic 
vivacity, if not a poetic genius, flashed out as he moved on his brilliant 
path, like the phosphorescent spray from a ship's prow as she ploughs 
the tropic seas. 
In 1849, Dr. Meigs re-issued his work on obstetrics in a much en- 
larged and improved form ; since that date four editions have been 
published, this fact indicating the great favor with which the Ame- 
rican profession regarded it. The most valuable discovery in obstetric 
pathology made by Dr. Meigs is the usual cause of sudden death after 
delivery, which he announced in 1849. Before and since, various other 
explanations of this terrible accident have been given, such as the entrance 
of air by the uterine veins, nervous exhaustion, shock, puerperal poison- 
ing, etc., but to-day the theory of Meigs has general professional accept- 
ance, even if the heart clot, or pulmonary thrombosis, the immediate 
cause of fatality, should be proved to be itself a result of myo-cardiac1 
degeneration. 
As we read how earnestly Dr. Meigs declares against Csesarean section, 
save in the interests of the mother, we shall find additional reasons for 
questioning Dr. Smith's allegation as to American obstetrics being so 
much more nearly a product of French than of English teaching-the 
chief alleged characteristic of the French school being the proneness to 
sacrifice the mother's rather than the infant's life whenever the rights of 
the two are brought in conflict. 
Dr. Meigs's views as. to puerperal fever were boldly expressed, and no 
concealment of them is now required. The painter in the Sacrifice of 
Iphigenia simply drew a veil over the face of Agamemnon: Would that 
a veil had forever hidden, not the views of Dr. Meigs only, but of other 
teachers of the Philadelphia school, and many sacrifices, blinder, more 
terrible, might have been averted 1 lie who held the non-contagiousness 
of measles, of scarlet fever, even, might also hold to the non-communica- 
bility of puerperal fever under all circumstances. To-day, at least, the 
American profession are generally agreed that while the disease is fre- 
quently auto-genetic, it sometimes at least, and in its most terrible forms, 
is hetero-genetic, and it is the merest petitio principii to allege, as Dr. 
Meigs did, that, because he did not know of his having communicated it, 
either by conveyance of the poison from one patient to another, or from 
autopsies, therefore this never happened to others. 
In 1849, "A Theoretical and Practical Treatise on Human Parturition," 
by Professor Henry Miller, of the University of Louisville, was published. 
In 1858, a republication of this work, much enlarged and improved, was 
made. From Dubois, Dr. Miller took his anatomy, and from his 
classification of presentations and positions, while his principles of practice 
were essentially the same as those of Burns and Hamilton. Dr. Miller's 
views in reference to the importance of inflammation of the lining mem- 
brane of the uterus as a frequent cause of abortion, were certainly in 
advance of obstetric writers of his day. So, too, the higher honor must 
be given of being the first American obstetric author who advocated 
amesthesia in labor. 
Dr. Miller was a man of vigorous mind ; he was clear and original in 
thought, concise in expression, severe almost to bitterness in controversy. 
1 De la Myocardite Puerperale, comine cause la plus des Morts Subites apres 
1'Accouchement. Par Maurice Coste. Paris, 1876. 
2 10 
PARVIN, 
Like Dr. Dewees, he had few early advantages in education, but he 
learned to use his pen with more ease and force than the latter, and pro- 
bably was a man of better original endowments. His work on obstet- 
rics was declared by the late Dr. Condie1 to be a most able one, confer- 
ring the utmost credit upon the author. 
The Principles and Practice of Obstetrics, by Gunning S. Bedford, 
M.D., Professor of Obstetrics in the University of New York, was pub- 
lished in 1861 ; and five subsequent editions have been issued. Dr. 
Bedford's volume, which is probably the most learned of American 
works on obstetrics, is in the form of lectures, and with here and there 
some extravagances in rhetoric, is written clearly, plainly, indeed some- 
times assuming a colloquial style. It is evidently " the result of much 
labor and research."2 From its long list of authors quoted, and from its 
full and carefully prepared index, it is admirable as a book of reference. 
We find this author arraying himself on the side of the contagionists 
as to puerperal fever, but a rejector of anaesthesia in normal labor. His 
teaching as to the choice between craniotomy and the Caesarean section 
is almost directly the opposite of that of Dr. Meigs and most other 
American obstetricians, and while he protests against craniotomy, he 
does not fully recognize that podalic version may be the true alternative, 
and not the Caesarean operation. 
In 1864, the most original and elaborate of American Obstetrical 
works was issued in Philadelphia, the admirable treatise of the late Dr. 
Hugh L. Hodge, the honored successor of Dewees in the University of 
Pennsylvania. After thirty-one years of obstetric teaching, he prepared 
this rich legacy for the profession.3 
Dr. Hodge was the first to illustrate the peculiarities of the female 
pelvis, its axes and its planes, by taking a plaster cast of it, and making 
sections of the cast. He was the first to use photography,4 to exhibit 
with perfect accuracy the relations of the foetal head to the mother's 
pelvis, in the various presentations and positions, and in the different 
stages of simple and of complicated labor, and also the applications of 
the forceps in different positions. He contributed materially to restore 
the vectis to use in the remedying of malpositions. The application 
of the obstetrical forceps to steady and isolate the head, in craniotomy, 
then after the operation the use of the instrument for compression 
and extraction, must be regarded as a most valuable improvement, for 
which the profession is indebted to Dr. Hodge. He also improved the 
operation of cephalotripsy by devising a simple and efficient instrument 
-his compressor cranii. lie taught the doctrine of synclitism, or 
parallelism of the plane of the child's head, in cases of natural presenta- 
tion, to the planes of the pelvis and vagina, as early as the year 1832, 
and from that time until his death presented this doctrine with more 
precision and detail than has any other author. He was among the first 
to recommend the induction of premature labor, in cases where labor had 
previously terminated fatally to the child in consequence of its great size 
and the complete ossification of its head. His obstetric forceps is the one 
1 American Journal of the Medical Sciences, Jan. 1857. 
2 British and Foreign Medico-Chirurgical Review, July, 1862. 
3 " Dr. Hodge's treatise is, nevertheless, full of much valuable information, and although 
its price alone will prevent its ever becoming popular amongst students in this country, 
still we strongly recommend that it should have a place in the library of every obstetric 
physician."-British and Foreign Medico-Ohirurgical Review, October, 1865. 
4 This was done at the suggestion of his son, Dr. H. Lenox Hodge. ADDRESS ON OBSTETRICS. 
11 
held in most favor by the American profession. Few men have studied 
the mechanism of labor more thoroughly, none have expounded it more 
clearly. Generations may come and depart, until another century pours 
its treasures upon the race, but it is doubtful if among these will be found 
another work on obstetrics of greater relative merit and of more enduring 
value than the treatise of Dr. Hodge. 
In the year 1870, a Treatise on the Theory and Practice of Obstetrics, 
by Dr. W. II. By ford, was published, a second edition appearing in 
1873. The design of Dr. Byford was to furnish the student and busy 
practitioner with a more concise work than any in general use, and 
yet embodying all the necessary practical information. No one can 
question how well its able and industrious author has succeeded in this 
design. 
A work entitled Elements of the Principlesand Practice of Midwifery,, 
by Dr. David II. Tucker, was issued in 1848. The Obstetric Catechism 
of Dr. Warrington was, in Philadelphia, held in high esteem twenty or 
more years ago, especially by those who were fortunate enough to avail 
themselves of the practical instructions of this excellent teacher. Dr. 
Cock's Manual of Obstetrics, 1853, was held in like favor in New York. 
Having devoted so much space to the consideration of treatises upon 
obstetrics, the topics of obstetric pathology1 and therapeutics must neces- 
sarily be briefly considered. 
The present century has been marked by some of the most important 
advances in obstetrics ; and " it is not going too far to assert that, not- 
withstanding the brilliant improvements in surgery, and the solid and 
wise modifications in medicine, the changes in our art have preserved 
more lives, and relieved more human suffering and misery."2 In pro- 
moting these advances, and in effecting these changes, our country has 
borne her part. Few obstetricians of the present day would accept the 
statement of William Hunter, that upon the whole the forceps had " done 
more harm than good," or participate in the "doubt" of Denman 
" whether it would not have been happy for the world if no instrument 
of any kind had ever been contrived for, or recommended in, the practice 
of midwifery," or believe-and we quote again from Denman3-that 
" the doctrine of applying forceps before the bulk of the head has passed 
the superior aperture of the pelvis, carries great danger and insurmount- 
able difficulties with itnor again, does the obstetrician now wait until 
he can " feel an ear," or until " the head has rested six hours upon the 
perineum," before resorting to an instrument that is at once for the good 
of both child and mother. 
Anaesthesia in obstetricy must be counted one of the greatest glories 
of the century-nay, the brightest, broadest beam of perennial light that 
has ever fallen upon woman's pathway, darkened by the primeval curse. 
In 1846, the great discovery of anaesthesia by inhalation of ether vaporr 
with which the names of Wells and Morton are so inextricably inter- 
1 The topics of obstetric anatomy and physiology would be appropriate could their history 
be made really complete. Under the former head would be mentioned in detail Dr. II edge's- 
studies as to the female pelvis, already referred to; Dr. John Neill's, as to the shape of the- 
thyroid foramen, and numerous similar investigations; and under the latter, studies such 
as Dr. Dalton's, of the corpus luteum; Dr. Geo. J. Englemann's recent, patient, thorough,, 
and interesting researches as to the mucous membrane of the uterus ; Dr. Isaac E. Taylor's 
demonstration of the non-shortening of the cervix in the latter months of pregnancy; and 
Dr. J. R. Beck's observations upon the entrance of the spermatozoa into the uterus. 
2 Dr. Thomas Edward Beatty's address before the Dublin Obstetrical Society, 1862. 
3 Criticism of Leake. 12 
PARVIN, 
woven, was macle; in January, 1847, the illustrious Simpson, of Edin- 
burgh, proved the value of ether in child-birth. The discovery found 
Walter Channing, the first professor of obstetrics1 in Harvard, past his 
three-score years ; but he entered heartily into the study of this question, 
and the next year he presented a volume upon Etherization in Child-bed, 
in which the records of nearly six hundred cases were given, and which 
greatly contributed to the frequent-I wish at this day one could say 
general-use of anaesthetics in labor. Other names deserving of recogni- 
tion in this connection are those of Drs. F. Barker, of New York ; IL R. 
Storer, of Boston ; J. C. Reeve, of Dayton, Ohio ; and II. Miller and L. 
P. Yandell, of Louisville, Kentucky. 
The administration of chloral is another of the beneficent means of 
recent times for the relief of the sufferings of parturition, which has had 
many advocates in this country. 
The opium treatment of peritonitis is one of the most important ad 
vances in therapeutics. It may be now true, as asserted by Dr. Spender,2 
that " the bare mention of that terrible disease, peritonitis, is suggestive 
of the siren lullabies of opium." But this treatment was the suggestion 
and practice of Dr. Alonzo Clark, as early as 1841,3 though it was not 
until 1848 that he had an opportunity of demonstrating its value in the 
puerperal form of peritoneal inflammation. Opium alone, is the treat- 
ment of phlegmasia dolens advocated by Dr. Clark,4 of Oswego, and he 
claims that the remedy is as efficient as quinia in ague. 
A marked advance lias been made in the more liberal diet and rational 
hygiene of women after labor. That former horror of the lying-in room, 
1 This position Dr. Channing held for nearly forty years, and only a few weeks since 
passed away from earth, having lived to be upwards of ninety years of age. 
2 Therapeutic Means for the Relief of Pain. London, 1874. 
3 The following recent note from Dr. Clark will be read with interest:- 
Dear Doctor : I continue to use opium in the treatment of simple peritonitis and puer- 
peral peritonitis, and peritonitis after perforation, with the fullest confidence that it will 
cure a much larger proportion of cases than any other treatment yet proposed. It is ac- 
cepted by all the physicians of this city and State, I think ; at least I hear of no other, not 
only for peritonitis in its different forms, but in all operations, injuries, and wounds that 
are likely to be followed by this inflammation. 1 do not know how far it is approved 
abroad, but infer that it has received little attention in England, from the fact that Dr. 
Barker, of this city, made it the topic of an address at a meeting of English physicians a 
year or so ago. 
Dr. Graves, it is said, used opium in large doses for the cure of peritonitis after perfora- 
tion of the intestine. When he began that treatment I do not know; but I do not find 
any reference to it in his lectures published in 1843. Watson's Lectures, one of the later 
editions, refers to a Mr. Bates, who treated peritonitis with opium; but when he began, 
does not appear. Still the English physicians generally seem to know little of the power 
of opium in the different forms of peritonitis. In the Am. Journ. of Med. Sci., July, 1876, 
p. 144, you may find a statement of the origin of this treatment in my own mind, in 1841; 
and before 1843 cases of intestinal perforation had been successfully treated on this plan. 
Regarding the rules, I begin with two grains of opium, or its equivalent opiate, and in 
two hours give the same, or more, or less, according to the effects produced. Patients re- 
sist or yield to the narcotic effects of the drug very differently. In some cases, twenty-four 
grains of opium a day is all that is required ; in a few. twelve or sixteen grains is sufficient. 
In most, two to four grains at a dose are needed ; in a few, more than this. The aim is to 
get and maintain the symptoms of safe narcotism, or, as I sometimes call it, semi-narcot- 
ism, indicated by subsidence of the pain; contracted pupils; itching of nose and skin; a 
continuous sleep, from which, however, the patient is easily aroused; reduced frequency of 
respiration, followed by reduced frequency of pulse ; and absolute quiet of the bowels. 
Regarding the respiration, the aim is to reduce its frequency to twelve in the minute, 
and in the attempt to do this it is often found to fall as low as seven, without danger, if 
the opium is then withheld for a few hours, till it rises to ten, when a smaller dose is given, 
to be increased or not afterwards. Yours truly, A. Clark. 
4 New York Medical Record, June, 1870. 13 
ADDRESS ON OBSTETRICS. 
the very existence of which is cast in doubt-milk fever-which was to 
be averted by a liberal use of the canonical caudles of Smellie's day, and 
the prophylactic panadas of more modern times, and by poisoned air, no 
longer governs practice; and the recent parturient is given cold water 
as she desires, inhales pure air, and is fed with wholesome food, that is, 
such as will best repair her exhausted powers and furnish suitable mate- 
rial for making good milk. How early any publications were made 
advocating this course, I cannot ascertain, but certainly it has been pur- 
sued for some years, and possibly it may not have been at the instance 
of any professional leader, but simply a general tendency of physicians 
themselves. The names of Drs. F. Barker, William Goodell, and Wil- 
liam B Atkinson, are among the more prominent of those who have ad- 
vocated it. 
During the present year a most able volume on Extra-uterine Preg- 
nancy, by the late Dr. John S. Parry, has been published. In it the 
talented author, removed too early for the honors that surely awaited 
him, and for a career of great usefulness not half accomplished, has col- 
lected five hundred cases of this accident, and from a careful study of 
them has deduced most important practical rules. Such works are at 
once permanent contributions to medicine, and indices of its higher de- 
velopment and more scientific character. 
Some of the most remarkable cases of operation for extra-uterine preg- 
nancy are those by Dr. William Baynham,1 of Virginia, who operated 
twice, 1791 and 1799, successfully by abdominal incision; one by Dr. 
John King, of South Carolina, 1813, who incised the vagina at full term, 
saving both mother and child, and one by Dr. T. G. Thomas, the preg- 
nancy having advanced to three months, who also incised the vagina, 
but with the galvano-caustic knife. So, too, the case reported by Clarke, 
in 1806, where he passed his hand into the bowel, and with his finger in 
the child's mouth exerted such traction that he withdrew the bead per 
anum, should not be forgotten among the extraordinary cases, especially 
as he thus showed the feasibility of the method of abdominal explora- 
tion recently proposed by Simon. Dr. Easley,2 of Little Rock, Ark., has 
quite recently reported an interesting and successful case of abdominal 
section for the removal of a dead foetus. 
The Induction of Premature Labor was first resorted to in this coun- 
try, in 1810, by Dr. Thomas C. James3-the cause, contracted pelvis, and 
the result fortunate to both mother and child. Since that time a much 
larger range has been given this operation. We have already stated Dr. 
Hodge's views as to its being indicated in cases where the head is large 
and completely ossified at full term. Dr. Thomas4 has enumerated ten 
other conditions indicating it, the most important being placenta prsevia 
and aggravated urtemia. The teaching and experience of Dr. Thomas have 
contributed much towards the recognition of the propriety of inducing 
premature labor, in the interest of both the mother and the child, in 
cases where the placenta is preevia. A distinguished British obstetrician5 
observes: "We have arrived at a very generally admitted conclusion as to 
' Dr. William Baynham was long considered the most eminent surgeon in the Southern 
States, and was particularly distinguished for his accurate knowledge of anatomy.- 
Thacker's Medical Biography. 
2 American Practitioner, September, 1876. 
3 Memoir of Dr. Thomas 0. James. By Professor Hugh L. Hodge, Philadelphia, 1853. 
4 New York Medical Journal. February, 1870. 
5 Dr. Playfair. British Medical Journal, May 4th, 1872. 14 
PARVIN, 
the danger of temporizing, and as to the advisability of artificially in- 
ducing labor as soon as the existence of placenta prsevia has been fully 
determined." It is true Dr. Thomas's publication was in some measure 
anticipated some six years by a paper from Dr. Greenhalgh,1 advocating 
this practice; but he himself was partially anticipated by Dr. A. S. 
Donkin,2 who proposed to expedite labor and check the flooding in pla- 
centa prsevia by inserting into the os uteri a sponge-tent prepared for tbe 
purpose. Dr. S. C. Busey,3 of Washington, has presented an able argu- 
ment for the induction of labor in uraemia. 
Placenta Praevia has been the subject of special study by Dr. J. D. 
Trask,4 and by Dr. Wm. Read.6 Dr. Read was regarded by the highest6 
critical authority in Great Britain as having rendered valuable service 
to his profession, and considerably enlarged and strengthened tbe founda- 
tions of obstetric science; and it is declared that the impartial and philo- 
sophic manner in which he has used statistics for the purpose of deciding 
grave practical problems is worthy of all praise and imitation. 
Dr. Trask, whose prize essay on placenta praevia has been alluded to, 
has also laid tbe profession under obligations by quite a thorough study 
of rupture7 of the uterus; four hundred and seventeen cases of this 
accident are tabulated, and important lessons deduced. This mono- 
graph ranks by the side of the one by Crosse on uterine inversion. 
Dr. John Stearns,8 of New York, in a letter to Dr. Akerly, published 
in the Medical Repository, 1807, announced that ergot9 was capable of 
exerting a specific action upon the uterus; that it greatly augmented 
the power of that organ during the efforts of parturition ; and that, in 
lingering and protracted cases, it speedily induced forcible pains, and 
greatly expedited delivery. And in June, 1813, Dr. Oliver Prescott, in a 
communication made to the Massachusetts Medical Society, pointed out 
the value of this agent inhemorrhage. Thus the two most 
important obstetric uses of ergot were first made known by American 
physicians. An able paper, by Dr. William Goodell, on Concealed Acci- 
dental Hemorrhage,10 was published in 1869. This paper contained an 
analysis of one hundred and six cases, and presented the symptomatology 
more clearly and definitely than had been done before. Diphtheria of 
Puerperal Wounds has been made the subject of important contributions 
by Drs. Lusk and Parry. 
We now make some brief references to operative obstetrics, including 
both manual and instrumental. 
One of the most valuable contributions to obstetric art ever made was 
1 Transactions of the London Obstetrical Society, vol. vi. 
2 Edinburgh Medical Journal, 1859. 
3 American Journal of Obstetrics. 
4 Prize Essay. Transactions American Medical Association, vol. viii. 
5 Library of Practical Medicine. Published by order of the Massachusetts Medical So- 
ciety. Vol. xxii. Philadelphia, 1861. 
6 British and Foreign Medico-Chirurgical Review, 1862. 
7 American Journal of the Medical Sciences, 1848 and 1856. 
8 The American Dispensatory. By Dr. James Thacher. Boston, 1817. 
9 PuZm's arf was the name soon appropriated to the powdered ergot. Hosack, 
however, shortly substituted for it, Pulvis ad mortem. This is suggestive of Guy Patin's 
remark in regard to an antimonial preparation which was in great favor in his day, known 
as the Vinum vitce. In one of those letters, first published at Geneva, 1683, of which 
Voltaire has observed, "they were read with eagerness, because they contained anecdotes 
of such things as every body loves, and satires, which are liked still more," Patin writes 
that the Vinum vitce should be called Vinum mortis. 
10 American Journal of Obstetrics, August 1869. ADDRESS ON OBSTETRICS. 
15 
that of Dr. M. B. Wright,1 of Cincinnati, in the year 1854. To him is 
justly due the credit of originality in the method of such bimanual 
operation as will in shoulder-presentation succeed in converting it into 
a presentation of the head. Even if the method of Wright were pre- 
cisely the same as that of Hicks,2 still it was published six years before. 
But the essential of each is in the use of both hands-the external hand, 
not as by former operators merely to steady the uterus, but to assist the 
action of the other. True, Dr. Wright applied the method only to what 
is called cephalic version; Dr. Hicks gave greater prominence to the 
accomplishment of podalic version. 
Next among important manual operations must be placed the postural 
treatment of prolapsed cord and of shoulder presentations, known in its 
first application as the method of Thomas, in its second as that of Maxon. 
In foot-notes I have given extracts from the original work of Deventer, 
conclusively showing that this treatment was advised by him, though it 
was pressed with no urgency, and seems to have been theoretical rather 
than supported by clinical facts. Dr. Bard, in considering podalic ver- 
sion in presentations of the breast, belly, and back, says expressly: "And 
in all cases of particular difficulty, we may facilitate the operation by a 
judicious choice of the posture of the woman ; or by changing it from the 
side to the back, or from the back to the knees and elbows. Deventer par- 
ticularly recommends this position." No one in the face of these testi- 
monies can doubt the priority of the Hollander in the suggestion of 
postural treatment in these labor-complications. So, too, in Dr. Wright's 
essay, already referred to, the suggestion of the knee-elbow position is 
made. Nevertheless, to Dr. Thomas, of New York, and to Dr. Maxon, 
of Syracuse, is due the credit of having demonstrated by abundant 
clinical facts the great value of this method in prolapse3 of the cord, 
and in transverse presentation, and of establishing it in professional 
confidence. 
A passing notice is due Dr. Goodell's " Management of Head-Last 
Labors,"4 in which constant supra-pubic pressure conjoined with con- 
tinuous traction may so expedite delivery as to greatly diminish foetal 
mortality; and Dr. Parry's5 method of correcting with the hand faulty 
presentations and positions. 
In obstetric surgery no country can claim more brilliant operations 
than those of the late Dr. William Gibson, Csesarean section twice suc- 
cessfully performed upon the same subject, the children also saved, and 
the gastro-elytrotomies of Thomas and Skene. 
Of course it is impossible to refer to even a tithe of all the valuable 
American contributions to obstetrics and puerperal diseases in the limits 
of this Address-a simple bibliography would consume more than the 
time allotted it; and a dictionary of dates, with a catalogue of cases, 
would illy meet the requirements of the occasion. Nevertheless, three 
contributions in this department demand special notice. 
In the year 1843, Dr. Oliver W. Holmes published, in the New England 
1 Prize Essay. Ohio State Medical Society. " Difficult Labors and their Treatment." 
2 Dr. Hicks published his method in the Lancet in 1860, giving five cases of placenta 
praevia in which he had resorted to bimanual version, and in 1863 (London Obstetrical 
Society's Transactions, vol. v.), presented a fuller account of it. 
3 Prolapse of the cord has been made the subject of an elaborate monograph by Dr. 
George J. Englemann, American Journal of Obstetrics, 1873-4. 
4 Philadelphia Medical Times, March 20, 1875. 
5 American Journal of Obstetrics, vol. viii. p. 138. 16 
PARVIN, 
Quarterly Journal of Medicine and Surgery, a paper afterwards issued in 
book form, in reference to the contagiousness of puerperal fever. Emped- 
ocles combined in one, poet, priest, politician, and physician ; and history 
records that he rescued a city from desolation by blocking up a mountain 
gorge through which pestilential winds were sweeping. In like manner 
an American, whom the world so knows as poet, essayist, and philosopher, 
that, arrayed in these glories, crowned with these honors, we almost for- 
get that he is a physician and medical teacher, once by his bold, decisive 
utterances, his startling array of facts, his invincible logic, greatly con- 
tributed to destroy a pernicious doctrine taught by some of our leading 
obstetric authors-a doctrine which was more certainly laden with death 
than the foul wind that was destroying the citizens of Agrigentum. 
In 1868, the Obstetric Clinic, a Practical Contribution to the Study of 
Obstetrics and the Diseases of Women, by Dr. George T. Elliot, was pub- 
lished. Its author, whose talents and culture were admirable, and who, 
alas, was taken away in the prime of life and power, utters these noble 
and just words explaining his motives in writing this book, words which 
ought to be well pondered by all who have similar opportunities. "The 
work is presented as a partial discharge of the debt due to the profession 
by all who enjoy hospital advantages; and in grateful recognition of the 
benefits which the author has derived from the experience of others." 
Elliot's Obstetric Clinic has taken its place among the classics of our 
profession, and cannot fail to be of value to any one who consults its 
pages. 
In 1874, the first edition of Dr. F. Barker's Lectures on the Puerperal 
Diseases was issued, and the second edition the present year. This, too, 
is a clinical work, and eminently practical. It filled a gap in medical 
literature, met an urgent need of the practitioner, and was received 
with great favor, both at home and abroad. 
In considering the second division of the subject, an order similar to 
that observed in the first will be pursued, and accordingly American 
treatises on Diseases of Women will first be referred to. These works 
have had the following authors: Dewees, Meigs, Hodge, Byford, Chap- 
man, and Thomas. The first edition of Dewees's work was issued in 
1826, the ninth and last in 1847; this contains the revisions and addi- 
tions made by the author a short time before his death, and may be 
regarded, therefore, as embracing Dr. Dewees's best utterances upon the 
subjects discussed in it. To say that the book is badly written, would 
be a mild way of stating that there are therein frequent instances of 
violations of the simplest rules of grammar and the plainest laws of 
rhetoric. But what of the matter? More than one-third of the five 
hundred and odd pages are occupied with the disorders of pregnancy, 
puerperal fever, phlegmasia dolens, milk abscess, and hysteria; diseases 
of the ovaries are discussed in a little more than a page, and the moder- 
ately well-behaved irritable uterus of Gooch, becomes a monster of 
inflammation for the conquering of which general depletion is some- 
times, and local depletion is always, necessary. On pages 256 and 257, 
there is given the history of one of the most strangely managed cases, as 
seen by the light of to-day, that ever was recorded. In brief, nature 
tried to extrude from the vagina a uterine fibrous polypus as large as a 
child's head, and the doctor with might and main resisted, but vainly, 
the extrusion; and then, instead of dividing the short, thick pedicle, he 
tried to push the tumor back because the womb was inverted; but the 17 
ADDRESS ON OBSTETRICS. 
tenderness of the parts prevented, tlie tumor became black and offensive, 
and the next day the patient died. 
However, Dr. Dewees did advance the knowledge of the profession in 
regard to the symptoms of uterine displacements, and the means for 
relieving them ; he taught when and how to use tincture of cantharides 
in amenorrhoea, and his name will not be forgotten as long as dysmenor- 
rhoea ever suggests tbe ammoniated tincture of guaiacum. But Dr. 
Dewees's great fame is that of an obstetrician, not a gynaecologist. 
Woman, Iler Diseases and Remedies-the work of Dr. Charles D. 
Meigs-was issued in 1847, and tbe fourth edition in 1859. The volume 
is in the form of letters, and, of course, less dignity of style and greater 
freedom of expression are permitted than in a purely didactic treatise. 
Here are not only sketches of disease, but also lessons of high morality, 
of professional honor, and of tender sympathy; here are odd words and 
odd forms of expression ; sometimes ludicrous dialogues, in which refine- 
ment and dignity are thrust in the background by realism; a fluent 
stream, apparently wandering at its own sweet will-now rippling with 
music and sparkling with sunshine, here narrow and strong, there diffuse 
and almost wearisome in its slow progress-but still always advancing, 
and strengthening in the advance; or a picture-gallery (and the (esthetic 
element in his nature was so strong that, possibly, Dr. Meigs might have 
been a great poet, or a great painter, had he not been a great physician), 
in which various representations, persons and scenes are collected, some 
altogether mean, and given with painful minuteness of sketch and color, 
others noble in conception and expression, but each filling a destined 
place, all real, vivid, and combining in a common design and purpose- 
such are these Letters that never lose their charm. Dr. Condie, who 
had no patience with anything but the plainest English, severely criti- 
cized in the American Journal of the Medical Sciences the style of these 
letters. But the style was the man; the letters are not less his teach- 
ings than they are Dr. Meigs himself. 
Undoubtedly the instructions of Meigs were very much in advance of 
those of Dewees. Was he not, too, the first American at least to describe 
vaginismus under his horrible designation of sphincterismus ? He hated 
abdominal surgery, and so rejected ovariotomy ; cervical surgery, too, 
and so in stenosis adhered to Mackintosh rather than to Simpson ; he 
clung with devout faith to Gooch's canula in the removal of uterine 
polypi, and regarded compflete perineal ruptures as incurable. 
Clinical Lectures on the Diseases of Women and Children, by Dr. 
Gunning S. Bedford, were published in 1855, the seventh edition in 1862. 
To this work was paid the high compliment of translation into French 
and German. With much that is valuable even to-day, and impressively 
given, there are some things that would be utterly rejected as rules of 
practice. For example, who would now think of salivating a patient 
because she had ovarian dropsy, or expect such dropsy to disappear under 
the magnetic influence of "patting the tumour with the ends of the 
fingers several times during the day, together with pressure, and the in- 
ternal administration of muriate of lime." The author's utterances, too, 
as far as manner is concerned, are at times either simply grandiloquent, 
or degenerate into tedious and undignified dialogues, or trite common- 
places. 
A far better book than any of those yet referred to is the Practice of 
Medicine and Surgery applied to the Diseases and Accidents incident to 
Women, by Dr. William II. By ford, published in 1865. Its great merit 18 
PARVIN, 
is its evidence of faithful observation and reflection ; it was the work of 
a painstaking, conscientious man with large experience, and it has con- 
tributed much to the promotion of a knowledge of diseases of women 
among the American profession. Dr. Byford (p. 348) has proposed and 
practised an original method of treating uterine fibroids, which is pro- 
bably deserving of more professional attention than it has received, and 
he also first made use of tents of slippery elm. Dr. Byford speaks of the 
" philosophy" of uterine displacements, and in the misuse of this term1 
has been imitated by some others: would it not be quite as correct to speak 
of the philosophy of boot-blacking or of coat-cutting? 
Diseases Peculiar to Women, by Dr. Hugh L. Hodge, the first edition 
in 1860, the second edition revised and enlarged in 1868, and Hysterology, 
by Dr. E. N. Chapman, New York, 1872, are two works diametrically 
opposed to each other, or at least presenting entirely different theories of 
uterine disease. Dr. Chapman's pathology is congestion, and his local 
therapeutics are chiefly scarification and nitrate of silver; where pessa- 
ries are required, preference is given for those that are globular, and appro- 
priate constitutional treatment is directed. His work is largely clinical, 
though unfortunately most of his reports of cases are too brief to be of 
great utility. Dr. Hodge, on the other hand, taught that the condition 
of uterus characterized by tenderness, congestion, increase of secretion and 
of size, was not inflammation, and should not be so treated. Here was 
the irritable uterus rescued from the inflammation of Dewees which was 
devouring it, and restored to the position which Gooch and Addison meant 
to assign it; nay, given an importance and extent in uterine pathology 
which they could hardly have anticipated. According to Dr. Hodge, 
" displacements of the uterus are the most frequent cause, original or 
secondary, of irritable uterus;" and "the mechanical treatment of ute- 
rine displacements by intra-vaginal supports is essential, a sine qua non 
for their perfect relief." 
Whether accepting in full, or only in part, the views of Dr. Hodge upon 
uterine pathology, no one can deny the great service that he rendered 
uterine therapeutics in the device of his lever pessary, an instrument in 
such common use in all lands where diseases of women are studied. Ilis 
pessary was no happy accident, but the result of much thought and of 
many experiments; as he himself once expressed it, he had hundreds of 
abortions before producing it. "Great poetry, great philosophy, great 
scientific discovery, every intellectual production which has genius, work, 
and permanence in it, is the fruit of long thought, and patient and pain- 
ful elaboration."2 Not only with the form of the pessary, but with the 
material, is Dr. Hodge to be credited. No man ever accomplished as much 
with these instruments, or explained their modes of application and their 
utilities more clearly and completely. He showed their value not only in 
relieving the ordinary results of uterine displacement, but also in curing 
sterility, and in the prevention of abortions when these, too, were conse- 
quences of such mal-positions. So, too, he demonstrated their value as 
repositors, gradually replacing the uterus when in mal-position. He 
1 Sir William Hamilton, Discussions on Philosophy and Literature, remarks upon the 
vague universality which is given to the terms philosophy and philosophical in common 
English-an " indefinitude" limited especially to Great Britain : " Mathematics and physics 
may here be called philosophical sciences; whereas, on the Continent, they are excluded 
from philosophy, philosophy being there applied emphatically to those sciences which are 
immediately or mediately mental." 
2 Froude's Address to the Students of St. Andrews, March 19, 1869. ADDRESS ON OBSTETRICS. 
19 
showed how useful they were, too, in relieving some of the urgent 
symptoms of uterine fibroids. 
But the American work on diseases of women most widely known is 
the Practical Treatise of Dr. T. G. Thomas, published in 1868, and pass- 
ing to its fourth edition in 1874. As a clear, concise, and practical expo- 
sition of gynaecology, it has no superior. At home, its merits have been 
so fully appreciated by the profession that nearly twenty-iive thousand 
copies are now in their hands, helping them in their daily work-a suc- 
cess which, when we compare it with that of even popular1 literary pro- 
ductions, is simply astonishing. Abroad, its great, merits have been fully 
acknowledged by the leading journals of the profession, and it has been 
translated into French, German, Spanish, and Italian. Some of Dr. 
Thomas's views as to uterine diseases, and some of his special contribu- 
tions to gynaecology, will be referred to in the next topics presented. 
Laying aside the briefer mongraphs, whether appearing in the form of 
reports in the Transactions of Medical Societies, lectures, addresses, etc., 
the libelli of our literature, and contributions to our medical journals-all 
these numbering not merely hundreds but thousands, and of course an 
analysis of which, even if it might be instructive, would be impossible 
-four works relating to diseases of women, demand especial attention. 
These are Clinical Notes on Uterine Surgery, by Dr. Sims (New York, 
1869); Vesico-Vaginal Fistula, by Dr. Emmet (New York. 1868); Gene- 
ral and Differential Diagnosis of Ovarian Tumors, by Dr. Washington 
L. Atlee (Philadelphia, 1873); and Ovarian Tumors, their Pathology, 
Diagnosis and Treatment, especially by Ovariotomy, by Dr. E. Randolph 
Peaslee (New York, 1872). 
The Uterine Surgery was published not only in New York, but also 
in London, and a French translation appeared in Paris. It met, as it 
deserved, with much favor at the hands of the profession, although some 
parts of it did not escape2 severe criticism. One of the leading British 
journals3 spoke in these terms of the book: " It is a collection of bedside 
studies of the uterine diseases of which it treats, notable for their accu- 
racy, and continually challenging our admiration for the sagacity and 
originality of their author, the fertility of resource, the unfailing patience, 
the successful adaptation to new purposes of simple means, the exact 
perception and clear statement of the vital points of every case." "For 
the first time in the history of medicine, the sterile condition is here 
subjected to a full and philosophical analysis, complete as far as the 
advanced knowledge of our time permits." 
Dr. Emmet's work on Vesico-Vaginal Fistula was essentially clinical 
in character, the history and treatment of the seventy-five cases given, 
representing the author's own invaluable experience. "The results of 
the numerous cases related are in the highest degree honorable to Dr. 
Emmet's skill as an operator, and also to American surgery."4 
Of the two admirable volumes upon Ovarian Tumors referred to, one 
embodies the thirty years' experience of a surgeon who ranks as one of 
the world's most celebrated ovariotomists, and is a treatise upon the 
general and differential diagnosis of these tumors. The other is more 
ambitious in design, and wider in scope. More largely a work of com- 
1 Mark Twain's Innocents Abroad, for example, has reached a sale of two hundred 
thousand. 
2 London Medical Times and Gazette, 1866. British and Foreign Medico-Chirurgical 
Review, January, 1867. 
3 Lancet, February 3, 1866. 4 Lancet, February 20,1869. 20 
PARVIN, 
pilation and of analysis, than a record of personal experience, it exhibits 
the indefatigable research, the patient investigation, and the accurate 
judgment of its scholarly and erudite author. Without being encum- 
bered, or possibly for some enriched, with so many details, it has much 
of the encyclopedic character of Gallez's volume,1 and not only is a most 
useful guide in the diagnosis and treatment of ovarian tumors, but is 
valuable for reference. 
Special contributions to gynaecology, other than those just referred to, 
can be better considered under the heads of particular disorders. But 
before entering upon this division of our subject, two or three prelimi- 
nary observations may be permitted. 
The first is, that while in this country specialism in other departments 
of medicine has made rapid progress, in gynaecology few, and until quite 
recently only two, specialties are found. And this arises from the 'fact 
that the diseases of women must, in the nature of things, be chiefly 
under the charge of the general practitioner. What is the numerical 
relation between those diseases that are constitutional in their origin 
and amenable to general treatment, and those that are local and re- 
quire local treatment, is a question that would have different answers, 
according as addressed to the general or the special practitioners. That 
there were extreme surgical tendencies of uterine pathologists, was the 
complaint a few years since of one2 of the most eminent of British 
gynaecologists; and that this is true to-day, in this country, will be very 
generally admitted. There is something so fascinating in surgery, so 
demonstrative and demonstrable-that which the eye can see and the 
fingers touch-as to inspire the operator with ambition and the patient 
with hope. 
Undoubtedly the danger of specialism is an undue exaltation of local 
disease and of local therapeutics. The general practitioner, on the other 
hand, is liable to depreciate the former, and then of course the latter. He 
does not extend himself, as Mill said of Jeremy Bentham, infinitely in 
one direction, but must be many-sided, undergoing a more general and 
complete development. Thus, other things being equal, he will be better 
able to detect the relations between local and general disorder, what in a 
given case is the antecedent and what the consequent, what may be cause 
or effect, unless indeed the specialist, as I believe is true of all who are 
devoted to gynaecology in this country, has chosen his department after 
large experience in general practice. The pine in our Southern forests 
grows stately and tail, lifting its tufted head far up to the clouds, but it 
is almost bare of boughs, and barren of foliage and fruit. "The un- 
wedgeable and gnarled oak" is knit together with a stronger fibre. 
More firmly rooted, it spreads broadly on every side great branches, with 
dense foliage, ample shade, and abounding fruit. 
The American development of gynaecology has been largely due to the 
labors of men engaged in general practice. Considering now that devel- 
opment, brief reference will be made first to the treatment of some of the 
positional disorders of the uterus. 
The pessary of Hodge has already been spoken of; an instrument 
which, both as to form and material, has received the general and grate- 
ful acceptance of the profession everywhere. Modifications or additions, 
more or less valuable, of the lever pessary have been made by Drs. Albert 
1 Histoire des Kystes de 1'Ovaire, etc. Brussels, 1872. 
2 Dr. E. J. Tilt. Transactions of the London Obstetrical Society. ADDRESS ON OBSTETRICS. 
21 
II. Smith, Cutter, Thomas, and others. Nor must we omit, in this con- 
nection, a passing reference to the very interesting observations of Dr. II. 
F. Campbell, of Georgia, upon pneumatic pressure in the treatment of 
uterine displacement. 
Turning to the greatest of all the positional disorders of the uterus-■ 
inversion-we will find that American operators may challenge com- 
parison with those of any country in regard to ingenuity, skill, and 
success in its cure. 
Inversion of the uterus,1 an accident first noticed by Celsus,2 was, until 
quite recently, an opprobrium of the profession, since replacement of 
the organ, unless efforts were made almost immediately after the acci- 
dent, was regarded as impossible. The few instances where a chronic in- 
version was reduced, were regarded as happy accidents rather than as 
indicating a rule of practice. On April 13, 1858, Dr. Tyler Smith ob- 
served, in reporting to the Medico-Chirurgical Society3 a case of uterine 
inversion of nearly twelve years, which he had reduced: "Hitherto 
inversion of the uterus has been treated either with styptics and astrin- 
gents, or the inverted organ has been removed by ligature or excision. 
The instances in which reinversion has been accomplished have been few 
in number, and chiefly limited to cases of recent origin." On the 12th 
of March of the same year, Dr. J. P. White,4 of Buffalo, reduced an in- 
version of nearly six months' duration. The one used elastic pressure 
and taxis ; the other taxis and pressure5 with a bougie. These success- 
ful cases were the heralds and guides of numerous similar successes at 
home6 and abroad. 
In this country the most important new methods of accomplishing 
reduction were that of Noeggerath, indenting one or other or both of the 
cornua, and thus starting the movement of restoration ; that of Emmet, 
using silver sutures to hold in place a partial reduction; and those of 
Thomas, consisting, the one of mediate dilatation with a boxwood cone 
pressed down from the abdomen into the constriction, the other of abdo- 
minal section, and then immediate dilatation ; and the repositor of Dr. 
White. Abdominal section, with immediate dilatation, has been twice 
performed-once with complete success, and once with a fatal result- 
but fails of professional endorsement. The repositor of Dr. White is 
an admirable instrument, as any one who has ever used it faithfully will 
testify: no one comparing it with the "drum-stick" repositor of Depaul 
1 Dr. Isaac E. Taylor has proposed and ably sustained the view that spontaneous inver- 
sion of the uterus sometimes commences at the os; a view which is strengthened by the 
cases of spontaneous reduction, the most extraordinary of which has recently been reported 
(American Practitioner) by Dr. Chesnut, of Lafayette, Ind. In Dr. Chesnut's case the 
restoration was twelve years after the accident. 
2 I am indebted to Dr. J. S. Billings for the following reference: Celsus, A. Cor., Medi- 
cinae Libri Octo; Ed. by A. Lee, London, 1831. Lib. I. Praefatio, p. 15. "Cum aetate 
nostra quaedam, ex naturalibus partibus carne prolapsa et arente, intra paucas horas exspi- 
raverit; sic ut nobilissimi medici neque genus rnali, neque remedium invenerint. Quos ego 
nihil tentasse judico, quia nemo in splendida persona periclitari conjectura sua voluerit; ne 
occidisse, nisi servasset, videretur," etc. I find that several have commented on this pass- 
age, and especially Morgagni, who decides it to be a case of inversion of the uterus. Re- 
spectfully and truly yours, J. S. Billings. 
3 Medico-Chirurgical Transactions, vol. xli. 
4 American Journal of the Medical Sciences, July, 1858. 
5 Dr. Thomas is in error when he states (Diseases of Women) that taxis alone was used 
by Dr. White, as can be seen by reference to the original account of the operation. 
6 Dr. White has been successful in twelve cases, and in one of the twelve the inversion 
had existed for twenty-two years. 22 
PARVIN, 
would hesitate to give a decided preference to the former. Its value 
will become more and more appreciated as its use becomes more general. 
Two of the most useful therapeutic agents in uterine disease, the one 
suggested by Dr. Sims, the other by Dr. Emmet, are among the simplest, 
viz.: glycerine1 and hot water.2 Dr. Emmet began the use of hot water 
injections in 1859, and observes, "I have been so thoroughly identified 
with this mode of practice, that it seems scarcely necessary to claim the 
priority. Certainly, no one in this country is on record as an advocate 
for the practice previous to myself; and so far as I have been able to 
ascertain, the same is true in regard to the practice of gynaecologists 
abroad." Confirmatory of Dr. Emmet's views as to the action of hot 
water injections in producing contraction of bloodvessels, and therefore 
useful not only in uterine, but also in pelvic, congestion, and in threatened 
cellulitis, was the practice of Trousseau3 in menorrhagia-frequently 
directing two or three very hot injections daily. If Dr. Emmet had done 
nothing beside this, his name would deserve to be one of the most hon- 
ored of the century in medicine. 
Since the invention of the hysterotome by the illustrious Sir James 
Y. Simpson, and of its many modifications or substitutes by others, the 
cervix uteri, relieved from the potash-persecutions which, carried on by 
the ultra followers of Dr. Henry Bennet, a few years ago, threatened its 
integrity, has been made the subject of numerous cutting operations for 
the relief of dysmenorrhcea, or of sterility. Those who have contributed 
most to the practical study of these operations are Drs. Sims, Emmet, 
Fallen, Peaslee, and Worster, of New York, and Reamy of Cincinnati. 
There is something wonderfully fascinating both for surgeon and patient, 
when the former can carry salvation from dysmenorrhcea, and also a 
baby, upon the sharp edge of a bistoury, or between the blades of scis- 
sors 1 Unfortunately a conflict exists, both in theories and in experi- 
ences, as to the utility, the modes of, and the cases for, operation. It is 
to be hoped that since the recent publication of Dr. 1'easlee, so conserva- 
tive in its character, there will be elicited such discussion as will fully 
present the truth in this matter, and firmly establish practical rules for 
general professional guidance. 
In amputation of the cervix uteri the flap method of Dr. Sims, and 
the use of the galvano-cautery of Dr. Byrne, are worthy of remembrance. 
Fluid applications to the lining membrane of the uterus are regarded by 
the profession everywhere as of great utility; and the safest and most 
common way of making such applications is simply one in close imita- 
tion of that originally devised and practised by the late Dr. Henry Mil- 
ler,4 of Louisville, Ky., more than a score of years ago. 
Uterine fibroids in their frequency, in their exacting symptoms, in 
their sometimes apparently capricious history, and in the utter uncer- 
tainty of therapeutic means pursued for their relief, have long presented 
to the gymecologist a field at once inviting and repellant. Electrolysis, 
studied in this relation by Neftel, Sims, Cutter, Kimball, and some others, 
cannot yet be said to have been admitted to professional confidence. Dr. 
Byford has ably collected most of the experience of the profession of this 
1 Sims's Uterine Surgery, pp. 21, 72. 
2 New York Medical Journal, June, 1874. 
3 Nouveau Dictionnaire de MGdecine et de Chirurgie Pratiques, vol. xxii. p. 452. 
4 Others whose names might be mentioned in connection with the study of means for 
making such applications are Emmet, Lente, Nott, and Reamy. 23 
ADDRESS ON OBSTETRICS. 
country in the hypodermic use of ergot of Hildebrandt. But this treat- 
ment frequently fails, and the knife is occasionally required. 
Those whose names in this country are especially identified with ope- 
rations for the removal of these tumors, are Dr. Atlee,1 Dr. Sims, and 
Dr. Emmet. The most valuable original observation belonging to the 
last is the pedunculization of a fibroid which can be effected by traction. 
The important operations performed by the others, and the ingenious in- 
struments devised for this by Dr. Sims, almost as prolific of instruments 
as Hudibras2 of tropes, we pass by with this brief reference. 
Removal of the uterus by abdominal section has been performed seve- 
ral times in this country, but most of these operations have not been suc- 
cessful. Probably the first case in this country, certainly one of the first, 
was that of Dr. Thomas G. Prioleau,3 of Charleston, S. C., in the year 
1819. The tumor, prior to the operation regarded as malignant, was 
very large, its removal with the uterus attended with much hemorrhage, 
and the patient died in twenty-four hours. On the 16th of April, 1850, 
Dr. Paul F. Eve removed the uterus for malignant disease, and the pa- 
tient lived for between three and four months. The operation has, how- 
ever, been done on account of fibroid disease, with permanent recovery, 
by the Atlees, Burnham, Kimball, II. R. Storer, Thomas Wood,4 and 
some others. 
Removal of the prolapsed uterus-the vaginal operation-has several 
times been successfully performed. Cue of the most interesting of these 
cases is that of Dr. S. Choppin, of New Orleans. The doctor, in 1861, 
removed not only the uterus, but with it the left ovary and Fallopian 
tube, which were also prolapsed, and the patient rapidly recovered. 
Many other topics in this division are suggested, but only two can be 
considered as the greatest glories of American gynaecology, the operation 
for genito-urinary fistula, and that for the removal of ovarian tumors. 
Holding up these to the world, she may, with just pride, exclaim: These 
are my offerings to Humanity and to Medicine 1 Yea, these are my 
offerings 1 
But is not the operation for genito-urinary fistula a triumph of Ameri- 
can surgery ? Up to less than a quarter of a century ago, how deplorable 
the condition of the unfortunate woman suffering from such a lesion ! 
She had entered upon all the remaining sad and weary years of her life, 
through a portal over which surgeon and obstetrician alike had, time 
and again, witten: Let her who enters here dismiss hope. If here and 
there, now and then, a case was cured, the result was the exception, 
failure the rule. If Jobert, for example, cured some, his operation always 
failed in the hands of others. Now, how changed I An operation, known 
abroad as the American method, rescues these unfortunates from their 
infirmity, and restores them to society. Failure is now as rare as success 
was formerly. 
Of course surgeons had come to apprehend the principles, before they 
had attained the method of cure. 
1 Transactions of the American Medical Association, 1853. 
2 " For rhetoric, he could not ope 
His mouth, but out there flew a trope." 
3 Dr. Prioleau graduated in Philadelphia in 1808. Drs. Samuel Jackson and W. P. C. 
Barton were classmates. At the organization of the Medical College of the State of South 
Carolina, in 1824, he became Professor of Obstetrics, and filled the chair for many years. 
I am indebted to Prof. J. Ford Prioleau, the present occupant of the chair, for the state- 
ments given. 
4 Dr. Wood's cases are seven, with three recoveries. 24 
PARVIN, 
For the closure of these fistulous openings two things were necessary. 
First, their margins must be thoroughly and uniformly freshened. 
Second, this vivification accomplished, the freshened surfaces must be 
brought and retained in accurate apposition until union took place. But 
how should these edges be pared so completely and accurately? The 
first step for the accomplishment of this end was their thorough expo- 
sure. This step was taken in the position and speculum of Marion Sims. 
Here we have the very foundation of the operation. This fixed, knives 
of various angles, forms, and sizes, or curiously curved scissors, became 
mere minor matters, resting with the individual operator, or determined 
by the exigencies of each individual case. 
But how are the prepared fistulous margins to be brought and kept in 
contact until nature binds them fast? Here again we hear, in 1852, the 
voice of Marion Sims crying, and crying aloud and on, until the whole 
world has heard Silver Sutures. Am I told that a British surgeon, in 
1834, using silver gilt sutures, cured a case of vesico-vaginal fistula? He 
did not follow up this one success, and confirm it by others. He estab- 
lished no rules of practice, he instituted no method, and his report was 
unnoticed, it was as the voice of one crying in the wilderness. That 
one success, too, was it any more than an American, Mettauer, of 
Virginia, had gained in 1830, with lead sutures? Was it as much as 
Hayward, of Boston, accomplished with silk sutures? But are the 
brilliant results which Simon obtains, adduced to disparage the Ameri- 
can method? Simon's operation has become the property and the prac- 
tice of the profession scarcely more than Jobert's. We gratefully record 
the statement of one of the most eminent of French gynaecologists, 
Courty,1 that the American school has no higher claims to future cele- 
brity than the operation for vesico-vaginal fistula. 
It is needless to mention the various modifications made by Dr. Sims 
in his original operation, or the valuable improvements introduced by 
Dr. Emmet, or the peculiarities of the method of Dr. Bozeman, who has 
labored with such signal zeal and ability, both at home and abroad, in 
this department of surgery, or the additions made by Dr. Mastin, of 
Alabama; or by Dr. Schuppert, of New Orleans; or by Dr. Battey, of 
Georgia; for the American method remains essentially that of Dr. Sims. 
Nor is it necessary to speak of Dr. Sims's early trials, patient persever- 
ance, and triumphant success in working out the great problem to which, 
more than thirty years ago, he devoted himself with all that he had. 
The world knows them, and he has received honors such as have been 
accorded to few representatives of American Medicine. 
A beautiful fable of the old Greeks made Apollo, the god of healing, 
give to the laurel tree its evergreen leaves, and consecrate them as crowns 
for the brows of victors. And surely who so worthy of the present of 
these crowns as a son of Apollo, who, after years of bitter struggles, has 
gained a victory which has brought blessings to thousands, and will 
bring them to tens of thousands more ? 
Is not ovariotomy one of the rightful glories of American gynaecology ? 
What are the facts ? In the year 1809 a village doctor of Kentucky suc- 
cessfully removed an ovarian tumor, and from that time until his death in 
1830, operated in all thirteen times with eight recoveries2-a success, by 
1 TraitS Pratique des Maladies de 1'Uterus. 
2 For the collection of Dr. McDowell's cases, the profession is indebted to Prof. S. D. 
Gross. ADDRESS ON OBSTETRICS. 
25 
the way, which, compared with the first thirteen cases of Baker Brown, 
or Spencer Wells, is most extraordinary. Spencer Wells, whose opera- 
tions began in 1857, lost four out of the first thirteen, and Baker Brown 
lost eight out of his first thirteen. 
Is the priority of Ephraim McDowell as the first surgeon to remove 
the diseased ovary invalidated by the case of Houston, of Glasgow, in 
1701 ? All other claims to priority have been swept away as blunders or 
shams, and this, too, would need no notice, had not Dr. Washington L. 
Atlee republished it as a proof that ovariotomy " originated with Eng- 
lish surgery," and had not Spencer Wells asserted that it " undoubtedly 
strengthens the claims of British surgery to the honor of originally prac- 
tising ovariotomy."1 It is strange that this case, rejected by Boinet and 
Clay,2 should be now adduced. The operator simply incised a cyst and 
evacuated its contents. He no more performed ovariotomy than he who 
lances a suppurating parotid has extirpated the gland. The claim of 
British surgery to the honor of originating ovariotomy is weak beyond 
expression if it rests upon this case. 
Again we are told, "But the operation was suggested by William 
Hunter ; its practicability and the mode of performing it were taught by 
John Bell." William Hunter said: " I am of opinion that excision can 
hardly be attempted." He adds, however: " If we could beforehand know 
that the circumstances would admit of such treatment, the incision should 
admit of only two or three fingers, and the cyst be tapped and drawn 
out, that the surgeon may cut the pedicle without introducing his hand." 
But Tozzetti,3 in 1752, Vanderhaar and Delaporte, in 1752, and Morgagni, 
in 1761, gave more encouragement to ovariotomy than did William Hun- 
ter; some of them as much, indeed, as John Hunter did, in 1786. The sug- 
gestions of Hunter and the instructions of Bell doubtless had an import- 
ant influence upon McDowell's mind, but this detracts nothing from the 
glory of his achievement. The fame of Columbus is not dimmed by the 
fact that others before him, others in his time, believed with him that by 
sailing westward a sea-way to the Indies would be found. No matter 
what surgeons may have believed and suggested as to removal of diseased 
ovaries, no matter though John Bell taught the mode of operating, their 
faith without works was utterly dead, and the new Columbus started 
upon his exploration without pilot or chart. 
But then, declares Nelaton, McDowell's first patients were negresses, 
and Gallez follows him, adding that his effort was to save the lives of 
slaves, who at that time commanded a high price, so that surgery owes 
this brilliant conquest to the cupidity of planters. How strange that 
historical facts of the present century can be so misrepresented. The 
truth is, that Dr. McDowell's first patient4 was not a colored woman, but 
one of his own race and social position. 
1 Diseases of the Ovaries. 
2 Comme le fait judicieusement remarquer Boinet, aprfes J. Clay, il y a eu simple incision 
du kyste, qui n'a et6 li6, ni excisS: on ne pent done voir la une operation d'ovariotomie 
proprement dite. Gallez, op. cit. 
3 Gallez, op. cit. p. 404. 
4 This was Mrs. Crawford, who, after the operation, resided for a time at Madison, Ind. 
From the late Dr. Speer, of Hanover, Ind., who, when a young man, was for a time a 
member of her family, I received some years since a statement as to the efforts made by Dr. 
Ephraim McDowell's nephew to wrest the honors of the operation from the uncle. A law- 
yer from Lexington, Ky., visited Mrs. C., urging her to sign a paper stating that the 
nephew was the operator. Her reply was that she was blindfolded, and could not posi- 
tively assert that Dr. Ephraim McDowell was the operator, but that she never would have 
consented to the young man's operating. 
3 26 
PARVIN, 
Surely British surgery has glory enough in the splendid successes of 
Spencer Wells and Keith, and the French in those of P6an, without either 
abating one jot or tittle of the fame of Ephraim McDowell. 
Only sixty-five years since the performance of his first ovariotomy, 
only fifty-eight since its publication, and then many years before general 
professional recognition of the operation as legitimate, and probably it is 
not extravagant to assert that more than two thousand women have been 
by it rescued from impending death! Dr. Peaslee, writing in 1872, 
concluded, from a careful calculation, that ovariotomy had, in the 
United States and Great Britain, within the last thirty years, added 
more than thirty thousand years to the active life of woman. We may, 
indeed, assert most unequivocally that the name of the father of ovari- 
otomy is worthy of being recorded with those of the best benefactors of 
the race. 
Dr. McDowell's third ovariotomy was in 1816. In that year, or in the 
one preceding, Dr. Thomas G. Prioleau, whose extirpation of the uterus 
has already been referred to, assisted by his nephew, Dr. Philip Prioleau, 
and Dr. Frost, attempted ovariotomy, but was compelled by extensive 
adhesions to abandon the attempt; he therefore simply evacuated the 
cyst, and excised a portion of it. The patient died. Dr. Nathan Smith, of 
Connecticut, Dr. Alban G. Smith, of Kentucky, Dr. David L. Kogers, of 
New York, and Dr. Billinger, of South Carolina, are among the early 
American ovariotomists. To give a list of those who have operated 
since, including as it would numbers of the profession in almost every 
State in the Union, and in some more than a score of them, is impossible. 
Those who have operated most frequently are Atlee, Kimball, Dunlap, 
Burnham, Peaslee,Thomas, White, Sims, and Bradford. The last named, 
the late Dr. J. T. Bradford, of Augusta, Ky., had a higher percentage, no 
less than ninety per cent., of recoveries than any other operator in the 
world. Those who have contributed most, by the publication of statistics 
of the operation, or arguments in its behalf, to its proper appreciation, are 
the late Dr. Pope, of St. Louis, Dr. Lyman, of Boston, Dr. Atlee, the late 
Dr. Miller, of Louisville, Ky.,Dr. Peaslee, and Drs. Hamilton and Keeve, 
of Ohio. In regard to the diagnosis of cystic diseases of the ovary, no 
more important addition has been made than the examination with the 
microscope of the contained fluid by Dr. Drysdale.1 Dr. Atlee has estab- 
lished important rules of diagnosis from the coagulability of the fluids 
obtained from uterine or ovarian cysts, or from the abdominal cavity.2 
1 Dear Sir : Since reading the paper at St. Louis, in 1873, " On the Granular Cell 
found in Ovarian Fluid," I have continued the investigation of these and other dropsical 
fluids, and have now examined over a thousand specimens of them. These examinations 
enable me to emphasize the opinion which I then expressed, that the ovarian granular cell 
is pathognomonic of cystic disease of the ovary. Yours, very truly, T. M. Drysdale. 
1 (1) Fluids, drawn from the peritoneal cavity, or from ovarian or broad ligament cysts, 
do not coagulate on mere exposure to air. (2) Fluids, drawn from non-inflammatory accu- 
mulations in the peritoneal cavity, will'coagulate more or less under the influence of heat 
and nitric acid. (3) Fluids, drawn from inflammatory accumulations, will coagulate by 
heat and nitric acid; and will also, by standing, produce a fibrinoid deposit in small quan- 
tities without heat and nitric acid. (4) Fluids of ovarian cysts proper, will coagulate to a 
greater or less extent by heat and nitric acid. Certain fluids, however, may collect in the 
parenchymatous structure of an ovarian tumor, which will neither coagulate by heat or 
nitric acid, nor on mere exposure to air. (5) Fluids of cysts of the broad ligament will not 
coagulate by any means. (6) Fluids, drawn from fibro-cystic tumors of the uterus, are dis- 
tinguishable from all others taken from the abdominal cavity by coagulating rapidly on ex- 
posure to air, and, after standing, by separating into clot and serum. This fluid, when not 
stained with red blood, is very transparent and of a yellowish color, and is really blood, or 
liquor sanguinis minus the red corpuscles. Washington L. Atlee. ADDRESS ON OBSTETRICS. 
27 
In the operation itself the most important advance is the enucleation 
of the cyst according to the method of Dr. Miner, of Buffalo. This 
method is not of general, but of particular, application, and permits the safe 
removal of tumors that otherwise could not be dealt with in consequence 
of adhesions. Clamps, instruments used probably by only a minority of 
American operators, have been devised by Atlee, Storer, Dawson of New 
York, and Mears of Philadelphia. Peritoneal drainage after operation 
has been practically studied by Kimball, Atlee, Sims, and Thomas. Dr. 
Peaslee has shown the utility of intra-peritoneal injections in septi- 
caemia, regarding them as more valuable than any other and all other 
means. 
Vaginal ovariotomy originated with Dr. Thomas, in 1870. The same 
operation has since also been successfully performed by Dr. Davis, of 
Pennsylvania, Dr. Gilmore, of Alabama, and Dr. Battey, of Georgia. 
Ovariocentesis Vaginalis has been greatly improved by Noeggerath,. 
and the results he has had are remarkably favorable. 
Removal of the ovaries in order to determine the menopause in certain 
cases where menstruation is attended with great suffering, and otherwise 
incurable disease, was the proposition of Dr. Battey. The operation has 
been performed sixteen times,1 with three deaths, the operators being Dr. 
Battey, Dr. Sims, and Dr, Thomas. Its propriety is hardly established 
in the face of such statistics. 
Did time permit, many other contributions to operative gynaecology 
might be alluded to, such as that of Nott,2 extirpation of the coccyx for 
coccygeal neuralgia, in 1844; Schuppert's3 operation for obliteration of 
the vagina, in 1858, " the first case of vulvar occlusion by elytro- 
episiorraphy without ulterior accidents;"4 and Emmet's method of securing 
the restoration of the anal sphincter in operation for ruptured perineum,, 
a method which has recently been successfully followed by a surgeon of 
Rouen.5 So, too, we might mention the peculiarities of Dr. Bozeman's 
operation for vesico-vaginal fistula - his knee-chest support, his self- 
retaining speculum, his button sutures, his method of auto-plasty by 
gradual approaches,6 and, above all, liis past successes at home, his present 
abroad, might be mentioned. The merit of a method will be at once 
conceded when it has won the approval of such men as Simon, Braun,, 
and Doi beau. 
One of the minor, but by no means insignificant advantages of the 
establishment of a method of cure for vesico-vaginal fistula, that must 
not be omitted, is that in consequence thereof the operation of vaginal 
lithotomy is relieved of its most serious objection-the resulting fistula. 
Now surgeons, following the example of Dr. Sims, in 1850, remove the 
calculus by vagi no-vesical incision, and immediately close the opening; 
with silver sutures. This operation is growing in favor; in this country 
forty-one cases have been collected by Dr. Mastin: "the operation,"7 says- 
Dr. Warren, "seems to have been done more frequently in this country 
1 Dr. Trenholme, of Montreal, and Dr. Peaslee, have reported cases of the operation since- 
the delivery of this address. 
2 American Journal of the Medical Sciences, October, 1844. 
3 A Treatise on Vesico-Vaginal Fistula, New Orleans, 1866. 
4 Le Double, Du Kleisis Genital, et principalement de 1'Occlusion Vaginale et Vulvaire- 
dans les Fistules Uro-G6nitales. Paris, 1876. 
5 Annales de Gynecologic, July, 1876. 
6 New York Medical Record, August 26, 1876. 
7 Boston Medical and Surgical Journal, July 20, 1876. 28 
PARVIN, 
than in any other." Hybord,1 in considering the relative advantages of 
lithotrity, dilatation and lithotomy, observes that the latter, especially 
vesico-vaginal, with immediate suture, is preferable if the calculus is hard, 
large, or encysted. 
But turning from these and many other topics, and concluding this 
division of the subject, we cannot refrain from a remark or two concern- 
ing the surgical development of American Gynaecology. Of course in 
this country, as in others, the advance has been much greater in the 
surgical than in the medical department of so-called uterine therapeutics. 
In explanation of this fact, as it is observed here, two peculiar causes 
have been in operation, in addition to those which are common. One of 
these is in the characteristics of the American mind-its tendency is to 
action rather than to reflection ; quick and fertile in expedients, it seeks 
immediate results, rather than exercises the patience for recondite inves- 
tigation. And again, most of those who have made themselves espe- 
cially famous, and therefore have become leaders of sentiment and of 
action, have acquired their celebrity and influence by brilliant operations. 
An inspiration conies from the graves of the dead and from the deeds of 
the living, kindling hope and ambition, to emulate their fame, and to do 
their works, or even greater works. American Gynaecology has proved 
its power, and recorded triumphs that cannot perish. The past is secure. 
The future is the child of the past, and its glories may be more numerous 
and grander. 
"Men, my brothers, men the workers, ever reaping something new; 
That which they have done but earnest of the things that they shall do." 
Let us hope that, as Uterine Surgery has in this country made such 
great progress, and accomplished so much, the future historian will 
record similar progress and a corresponding development of Uterine 
Medicine. 
The first American work on Diseases of Children, entitled, "A Treatise 
on the Physical and Medical Management of Children," was by Dr. 
Dewees, and published in 1825. Up to 1842 no less than seven editions 
had been issued. "To Dr. Dewees we are greatly indebted," said Dr. 
Hodge, "simply for fixing attention on the physical management of 
children, independently of the high value of his directions; for, prior to 
this period, the profession in this country left the details almost exclu- 
sively in the hands of nurses and midwives, with all their tormenting 
ignorance and officiousness." Dr. John Eberle, one of the first professors 
in Jefferson Medical College, then a professor in the Medical College of 
Ohio, and finally in the Transylvania School at Lexington, Ky., where 
he died in 1838, was author of a Treatise on the Diseases and Physical 
Management of Children, which was published in 1837. A third edition 
appeared in 1845. Dr. Eberle was a compiler, but was always judicious 
in his compilations. 
In 1841, the Practical Treatise on Diseases of Children of Dr. James 
Stewart was published. This was, according to Dr. Condie, "certainly 
superior, in many points of view, to those heretofore accessible to the 
great body of our profession in this country." The author refers to the 
fact that opium is of admirable benefit in many of the inflammatory com- 
plaints of children, especially after bleeding, and was much in use by the 
•older American practitioners. The practitioner of to-day would use the 
' Des Calcules de la Vessie chez la Femme et les Petites Filles. Paris, 1872. ADDRESS ON OBSTETRICS. 
29 
opium much oftener than he would the bleeding. The year 1844 brought 
another Practical Treatise on Diseases of Children, the well-known vol- 
ume of Dr. D. Francis Condie. The sixth edition of it was issued in 
1868. 
Dr. Condie was, according to Prof. StilR, by long and extensive ex- 
perience, accurate observation and diligent study, not only of English 
writers, but also of the Continental, and especially of the German, well 
qualified to prepare such a work. The volume grew with each new edi- 
tion, especially in accretions from foreign sources, and one who reads it 
now will, without the greatest care, occasionally get lost in conflicting 
pathological opinions and theories. But no one can mistake the two 
important characteristics of the therapeutics-great caution in the use of 
opium, great faith in the power of mercurials. Few American physicians 
have equalled Condie in medical learning, and the hundreds, possibly I 
might say thousands, of pages of criticism he has contributed to the 
American Journal of the Medical Sciences, constitute an important feature 
of our national medical literature. He was remarkably fluent in compo- 
sition, yet no one could say- 
" His talk was like a stream which runs 
With rapid course from rocks to roses." 
Rocks, big, solid rocks, enough there were in his writing, but roses 
fared as ill at his hands, as the poppy-heads that fell before Tarquin's 
angry cane. 
In 1848, A Practical Treatise on Diseases of Children, by Dr. J. Forsyth 
Meigs, was issued by Lindsay and Blakiston. This was the third of the 
series of manuals which this well-known firm engaged in publishing, the 
first being the work on Obstetrics, by Dr. Tucker, to which reference 
was made in a former part of this address. Meigs on Diseases of Child- 
ren has been and still is held in much esteem by the American profession. 
It has passed to the fifth edition, and in the preparation of the two last 
editions Dr. Wm. Pepper has been associated with Dr. Meigs. 
A Treatise on the Diseases of Infancy and Childhood, by Dr. J. Lewis 
Smith, was issued in 1869; the third and latest edition appeared in 1876. 
"Smith" is a book of fewer pages than "Meigs and Pepper," but clearly 
and concisely written. As a guide for the practitioner, and as a text- 
book for students, it hardly has a superior. 
In 1849, Dr. John B. Beck, one of the first professors in the College of 
Physicians and Surgeons, New York, published his work on Infant 
Therapeutics, which Dr. Gross1 recently pronounced "a perfect gem in its 
way." The late Dr. C. R. Gilman2 states that "it was received with the 
greatest favor, both at home and abroad. Few medical books of its size 
contain an equal amount of sound learning and practical good sense." 
Observations on certain of the Diseases of Young Children, by Dr. 
Charles D. Meigs, was issued in 1850. Here we have, in the midst of 
excellent and most useful instruction as to the management of several of 
the diseases of children, some of the author's peculiar pathological views, 
views which were always ingenious, and, if not always true, never failed 
of the semblance of truth. Here we are taught the efficacy of a wool- 
len cap in coryza, the " right-side treatment" of cyanosis, and are brought 
face to face with that "endangium" which played so important a part in 
his theories of disease. 
1 History of American Medical Literature. 
2 American Medical Biography. 30 
PARVIN, 
In Dr. Bedford's valuable Clinical Lectures, already referred to, some 
of the diseases of children are treated of plainly, practically, and wisely, 
but there is by no means a complete course given. Indeed, in reading 
this volume, and finding here and there these diseases considered, while 
the great body of the work is occupied with diseases of women, one is 
reminded of a street-car or omnibus crowded with adults, and then here 
and there a child interposed or superposed. 
Having thus briefly noticed these different volumes, we shall next refer 
to a few special American contributions to Paediatrics. Among the 
earlier, must be placed the letters on Angina Trachealis, by Dr. Richard 
Bayley, of New York, 1781, to Dr. William Hunter. Dr. John W. 
Francis1 speaks highly of these letters, and states, "we are justified in 
giving to Dr. Bayley the merit of being the first writer who understood 
the nature and treatment of croup." In a letter written to Dr. Fother- 
gill by Cadwallader Coklen, New York, October 1, 1753, the writer 
describes diphtheria and its treatment, chiefly as observed by Dr. Doug- 
lass, of Boston. In 1736, Dr. Douglass published a pamphlet2 entitled, 
The Practical History of a new Epidemical Eruptive Miliary Fever, with 
an Angina Ulcusculosa which prevailed in New England in the years 
1735 and 1736. "The first full description of this affection published in 
this country," says Dr. J. F. Meigs, " was by Dr. Bard, and based on an 
epidemic which occurred in 1771. The views advanced in his paper have 
been universally recognized, even to the present day, as most clear and 
just." Dr. Bard's account of the disease has been recently very favorably 
referred to and quoted by Loraine & Lepine.3 
Shall we mention one of the first applications of electricity as a thera- 
peutic agent, in this country; its successful use in 1752 by the illustrious 
Franklin in a case of convulsions, in a patient of Dr. Cadwallader Evans, 
of Philadelphia, a girl of fourteen, who bad been afflicted for ten years? 
In regard to the treatment of croup, four important therapeutic agents 
have been introduced by American physicians. The mercurial treatment 
is attributed to Dr. George Monroe, of Delaware, who graduated at the 
University of Edinburgh in 1786. Dr. Hubbard, of Maine, is to be credited 
with first using and advising the yellow sulphate of mercury, a remedy 
which has received from Dr. Fordyce Barker, after using it twenty-eight 
years, the highest possible praise. The late Dr. Charles D. Meigs was 
the first to advise the common alum as an emetic, while more recently 
the treatment by cold has been ably advocated by Dr. Jacobi. 
The most valuable contributions to the subject of umbilical hemorrhage 
have been by three American physicians, Drs. Minot, Stephen Smith, and 
J. Foster Jenkins. 
The subjects of masturbation and hysteria in young children have been 
elaborately presented by Jacobi, whose many and valuable contributions 
to Paediatrics are so well known to the profession, not only at home but 
abroad 
Dr. R. W. Taylor4 has produced a monograph upon Syphilitic Lesions 
of the Osseous System in Infants and Young Children, which has at- 
tracted much attention, both in this country and in Europe. 
Dr. Busey5 has given a faithful study of the action of certain drugs in 
1 Anniversary Discourse before the New York Academy of Medicine, 1847. 
2 An abstract of this paper will be found in the Medical Recorder, Philadelphia, 1825. 
3 Nouveau Dictionnaire de Medecine et de Chirurgie Pratiques, vol. xi. 
4 American Journal of Obstetrics. 
5 Columbia Hospital Report. ADDRESS on obstetrics. 
31 
bronchitis. And thus, name after name might be mentioned, paper after 
paper referred to, showing how active the American profession has been 
in the department of diseases of children. But this address has already 
transcended the time assigned it, and I must conclude. 
Did time permit, I might mention the organization of societies devoted 
to the especial study of obstetrics, and of diseases of women and of child- 
ren, in Louisville, Boston, New York, and Philadelphia, as at once the 
signs and means of advance. So too, the American Gynaecological So- 
ciety, born this Centennial year, gives promise of high honor and great 
usefulness. The establishment of hospitals devoted to diseases of women, 
is another evidence of progress. The Woman's Hospital of New York, 
founded and built chiefly by the labors of Sims and Emmet, and which 
has been of such incalculable benefit to thousands of suffering women, 
and to the profession, has been the noble pioneer. May the day speedily 
come when every State shall have a similar institution ! 
The American Journal of Obstetrics, founded by Dr. Dawson, and 
conducted with such signal ability, the demand for the reprint of the 
Obstetrical Journal of Great Britain and Ireland, and the valuable addi- 
tions made to it by American writers, are evidences of progress. 
And now, in conclusion, have we brought the names of those who, in 
this country, have been prominent in advancing the knowledge of Obstet- 
rics, Gynaecology, and Paediatrics, for apotheosis in some new Olympus? 
Nay, rather, for inscription in our memorial window of the Temple of 
Medicine. There let them be written, Samuel Bard, William P. Dewees, 
Thomas C. James, Ephraim McDowell, Charles D. Meigs, Gunning S. 
Bedford, Hugh L. Hodge, D. Francis Condie, Henry Miller, Walter 
Channing-but I cannot repeat the long list.1 There let them all be 
recorded, and there forever abide. It is done. Lo! the Orient sun of 
the Republic's second century is pouring its light upon them, is kin- 
dling in our hearts gratitude and joy, and evoking more than Memnonian 
music, Te Deems and Jubilates, from a multitude whom no man can 
number, who lived because they lived, who suffered and who were saved 
from their sufferings and from the sorrows of death by the interposition 
of their Divine Art. When that sun is sinking behind the flood of years, 
may its. departing rays gild those names witli a new glory, shining too 
on others still more illustrious. 
1 Is it presumptive to interpret the presence with us to-day of two eminent obstetric 
teachers from abroad, as a cheerful tribute to the value of American work in this depart- 
ment of Medicine ? To those teachers, one of them the honored occupant of a chair made 
illustrious by the names of the Hamiltons and of Sir James Y. Simpson, and the other 
whose fame has gone out into all the earth, and whose imperial authority the professional 
world acknowledges, every American physician gives hearty thanks.