INTRODUCTORY LECTURE, COURSE ON OBSTETRICS DISEASES OF WOMEN AND CHILDREN. DELIVERED IN THE UNIVERSITY OF PENNSYLVANIA. NOVEMBER 5, 184(5. HUGH L. HODGE, M. D. Enflafoelpfifa: WILLIAM S. YOUNG, PRINTER,—50 N. SIXTH STREET. 1846. * * AN INTRODUCTORY LECTURE, COURSE ON OBSTETRICS DISEASES OE WOMEN AND CHILDREN. DELIVERED I.N THE UNIVERSITY OF PENNSYLVANIA, NOVEMBER 5, 1&4C. BY , HUGH L. HODGE, M. D. UhanUrlphfa: WILLIAM S. YOUNG, PRINTER,—50 N. SIXTH STREET. 1S46. Philadelphia, Nov. 12th, 1346. Dear Sir,—At a meeting held last evening in the Amphitheatre, by the Medical (Mass, it was " Resolved, That a committee be appointed to wait upon Dk. Hugh L. Hodgi:. and to express to him the thanks of the Class for his able and eloquent Introductory Address, and that a copy be requested for publica- tion."1 Allow us, sir, in communicating the above resolution, to add our personal solicitations to that of the class, and hope that you will comply with the request. Yours, very respectfully, John Howlett, Va., Chairman. George L. Potter, Penn., Secretary. committee, J? John L- Williamson, N. C. Uriah Q. Davis, Penn'a. Simon Turner, Tenn. John F. Allen, Mo. William II. Holcombe, la. *James ,—I appear before you as the representative of the Obstetric department of this University. In this capacity, I must teach you the jcience and the practice of Obstetrics, or, as it has been well named, Tokology. It constitutes that division of the medical profession which takes cognizance of those wonderful phenomena which occur in the female system from the moment of con- ception to the full period of utero-gestation; which examine?, with sci- entific accuracy, the minute and varied changes which occur during labour, ascertains what are the fundamental laws which regulate this important process, and studies every deviation from the natural course of parturition. From these sources are deduced those principles which render our science so eminently useful—so important to the welfare of the community. That I may teach, and that you may learn this science, the first and the greatest desideratum is to form right conceptions of the nature and importance of the Obstetric art; that, being fully persuaded of its great—I had almost said its inestimable value—we may devote to its culture every talent we possess, with a zeal and a perseverance, which will overcome every obstacle and defy every opposition. On former occasions, when I had the honour of introducing this sub- ject to a medical class, I felt so deeply the importance of forming cor- rect and elevated notions of our science, that I cheerfully embraced the opportunity to explain the true character of Tpkology, and, by various considerations, to urge its claims on the time and thoughts of a medi- cal student. It was then demonstrated that this branch of medicine truly deserved the name of a science; that it was not merely an art— a fortuitous collection of facts, to be learned merely by observation and experience; but that it was founded on the peculiar structure and functions of the female system : of course demanding, as a preliminary study, a knowledge of anatomy and physiology. Moreover, it was shown that it was involved so intimately with the other branches of medicine, that no man can be a good obstetrician who is not a good physician. All the sciences, a knowledge of which .( « ) ready immediately to provide a dinner for her lord, or to follow him through the prairie or the forest. . . Such, it is reported, is parturition in savage life. And even in civil- ized communities, how few females, it is contended, receive more than the simplest attentions; and how few accidents ensue. Why, then, it is triumphantly asked, should we not leave this process to unassisted nature? Why spend time, and labour, and money in the acquisition of knowledge of so little value; which places its possessor on no supe- rior eminence—which renders the scientific accoucheur no more useful than an ignorant midwife? Language, somewhat similar, is occasionally heard even from physi- cians of some reputation. They acknowledge, it is true, that some information is requisite; that a midwife should have some idea of ana- tomy, and physiology; should know that there is some difference be- tween" a male and female pelvis; that the fcctus ought to present its head in favourable labours, and that occasionally difficulties do occur. But they maintain that no very peculiar attention is demanded,—that any physician is sufficiently prepared,—that the employment of medi- cal means,—bleeding, cathartics, opiates, &c, &c,—are usually suffi- cient, especially when conjoined with patience,—the sovereign pa- nacea with them for the pains, anxieties, and dangers of parturient fe- males. Wait patiently and all will be right: nature is powerful,— every difficulty will vanish,—and, in time, the child will be born. They say. too much midwifery is taught—too much is done for the parturient female; that more evil than good results from manual and instrumental assistance, and, that it is a question whether the obstetric art has not slain more than it has preserved. They appeal, in confir- mation of these vague assertions, to the truly horrible cases of mal- practice in midwifery, and detail, triumphantly, the injuries sustained by the unhappy mother, and the fatality which has often ensued to the child, and frequently even to its parent. Such are the most important objections which have been urged by the popular or professional voice against the science of obstetrics. They have been presented from time immemorial, and have always had, and perhaps always will have, an influence. As, however, civili- zation advances,—as the darkness of ignorance, prejudice, and supersti- tion yield before the rising lights of literature, science, and religion,— these objections become easily understood, and are easily overthrown. Experience, the true teacher, the accurate discriminator between the true and the false, bears universal testimony to the value of our art. Wherever civilization appears,—wherever female sufferings excite sympathy, and the life of woman is deemed important,—more or less attention is paid to her during the progress of gestation and parturition. Nevertheless, it must be confessed that, notwithstanding all that has lately been accomplished, the scientific study and practice of obstetrics is lamentably deficient, even in civilized countries. The assertions which we have recited, so derogatory to midwifery, still have too much* influence. It is imagined, too generally, that the practice is easy, that few attentions are demanded, and that these can be usually paid by ig- norant females; that, in cases of emergency, physicians may be con- ( 7 ) suited, hut even then no great knowledge is demanded, or any peculiar art or experience required. Hence we find that few, very few physi- * cians, even in our populous cities, have become skilled in the science of obstetrics: many practise it simply as an art, and are miserably pre- pared for the difficulties which must be encountered—difficulties which always involve much suffering, and often the life of the child and its parent,—the responsibility of which must then bear very heavily on , the feelings and conscience of the ignorant practitioner of the art. If such be the case in populous cities, where there is every facility for study, and every opportunity for practical improvement; where the prejudice which is so natural, and, it may be added, so honourable to females, respecting the employment of the male sex in their accouch- ments, has been fully overcome; you may easily imagine how la- mentably defective must be the condition of our science among the villages, towns, and districts of our extended country. How much suffering exists among the parturient females of our country which might be alleviated; how many dangers are they exposed to which might be avoided; how many actual, unavoidable, difficulties—many of them having a fatal issue, which might be removed, did but the bright light of obstetric science illuminate the mind, and direct the hand of the practising obstetrician. Facts, too well substantiated, demonstrate that this is no vain sup- position. I have little doubt, that young as you are in the profession, you have heard, and perhaps have been witnesses, of scenes of distress, and even of death, arising from ignorance or quackery, suffi- cient to convince you of the necessity of improving the practice of obstetrics in these United States, of wresting this branch of the pro- fession from the hands of ignorance and empiricism, and of commit- ting it, (and of course, with it, the best interests of women and society.) to the hands of well-instructed accoucheurs. On this subject, gentlemen, I am mUch interested. Fully sensible, I would hope, of the importance of the station 1 here occupy, I feel deeply that there are duties involved with it much more extensive and enduring, than simply to teach you the principles of obstetrics. Any information which you may here gain, and any influence which I may exert over your opinions and conduct, should be exercised for the be- nefit of the whole community with which we are connected; yea of generations yet unborn, which are rapidly succeeding each other, and whose interests, as already shown, are intimately involved in the prac- tice of midwifery. A great object, therefore, of my ambition is, not only to indoctrinate you with true scientific principles, on this subject, but to assist, through your instrumentality, in revolutionizing the opinions and prac- tice of the inhabitants of our country—to open their eyes to the im- portance of our art; to convince them that, in all cases of labour, even the most natural and favourable, pain and anxiety can be alleviated; that dangers and difficulties can be avoided; and that, when unavoidable accidents or difficulties occur, they can always be ameliorated, and very often overcome; and frequently, in cases of labour, absolutely imprac- ticable, by all the efforts and resources of nature, that our science appears ( 8 ) as an angel of mercy from the heavens—as the favoured instrument in her hands of a benevolent and beneficent Providence, to accomplish this otherwise impracticable work—to preserve the life of a wife and a mother, and, in many instances, to save even the innocent cause of all these anxieties and sufferings. ' In prosecution of this design, permit me during the remainder of this address, to demonstrate that the various objections which we have pre- sented as derogatory to our science, arc without foundation ; that grant- ing, as we fully do, that parturition is a natural process, and that in a majoritv of cases, nature unassisted can effect a safe and often an ensy delivery ; yet, that ihere are peculiarities in the human female which render parturition necessarily more difficult, painful and dan- gerous than among the lower order of animals ; that as civilization and re- finement advance this important'proccss becomes more complicated and dangerous; that these complications occur frequently, always aggravating the suffering of our patients, often increasing the difficulties, and in many instances appearing so unexpectedly and suddenly, that the life or death of two interesting individuals hang on the decisions of a moment: that there are labours so difficult, so impracticable, that both mother and child will unavoidably perish without the resources which our art can alone furnish. It has been already granted that parturition is a natural process, and that, in a majority of cases, it is accomplished, without assistance, in safety to the mother and her infant. In one respect, it differs, however, from other natural and healthy processes of the economy—it is always attended with feelings of distress and anxiety, and almost universally with pain of a most trying and severe character. While other func- tions, in their exercise, are agreeable, and afford a pleasant excitement, that of the uterus and its assistants, during the process of parturition, depresses the moral and mental energies of the female, excites the most intense suffering, and interferes with the healthful play of other organs, sometimes to a dangerous and fatal extent The inferior order of ani- mals apparently suffer in a similar manner, but certainly not to the same extent Woman suffers, and no doubt, always will suffer under the pri- meval curse, which, while it doomed man to eat his bread in the sweat of his brow, solemnly declared, as regards his frail companion, that" in sor- row thou shalt bring forth children." Although it is not for us, as phi- losophers, to consider the moral bearings of the distinction thus drawn between the human and the brute female, so much to the disadvantage of the former.—yet we can point out certain anatomical arrangements and certain physiological stat.es, which prove, that parturition must necessa- rily be more laborious and more painful in the human female. In quadrupeds, it is found that the axis of the pelvis corresponds, in most cases, nearly or exactly, to the axis of the body : that during de- livery, therefore, of the pregnant female, the fcetus passes in a straight line from the cavity of the uterus, through the apertures of the pelvis, meet- ins; with little resistance from impinging against the bones of the sacrum and coccyx. These apertures, also, are usually larger in proportion, owing to the moveable condition of the caudal extremity of the spine, and perhaps to the greater proportional separation of the rami of the (.9 ) pubes. The erect portion of the human female, " vultus ad sidera."' deprives her of these advantages. If with her, the axis of the pelvis corresponded to that of the body, and of course, if the apertures or openings of the pelvis were directly opposed, parallel to those of the abdomen, great uneasiness and distress would necessarily result from the pressure of the superincumbent viscera on those of the pelvis: the bladder, the uterus and the rectum, would receive the direct weight of the abdominal contents, and be necessarily disturbed in their functions. and no doubt constantly displaced. Prolapsus uteri would be a universal disease, with all its distressing symptoms. To prevent these evils. the pelvis in the human race is oblique, its apertures and axis do not correspond to those of the "body—and hence only an indirect or lateral pressure is made on its contents by the viscera of the abdomen. so that few inconveniences comparatively ensue. Nevertheless, human females are liable, from this cause, to displacements of the uterus and other organs, and to many symptoms of a severe character to which the lower order of animals, from their prone condition, are not exposed. It is, however, during the parturient process, that this obliquity of the pelvis produces the most serious difficulties. The foetus, in its de- scent, continually impinges on the walls of the pelvis; its direct course is impeded; it is obliged to describe a curved line in its passage, and of course, the uterine powers arc partially exhausted on the sides of the cavity in foijcing the foetus in this tortuous direction. Hence more power comparatively is demanded : and as this power is resident chiefly in the muscular fibres of the uterus, and as the contractions of these fibres excite painful sensations, we perceive at once, why there is not only more mechanical difficulty, but more suffering in the human female, than in the brute during the parturient efforts. There is another fact, which augments this difficulty and suflenng in the human species; it is the comparatively large size of the foetal head. When you shall hereafter examine the head and body of a new-born infant, you will be surprised that they could possibly descend through the openings of the pelvis and vagina: and your surprise will not be dis- sipated until you study the mechanism of labour and learn how won- derfully Providence has adapted the means to the end. Still from this cause, the comparative difficulty, suffering and danger in the human species is materially enhanced. These facts are strengthened by another physiological phenomenon of great importance which has been strangely overlooked in all the assertions and arguments which have been employed on this subject. I allude to the comparative irritability and sensibility of the superior and lower order of animals. It is not true, that the reptile when crushed by the foot of the traveller, " Feels a pang as great as when a giant dies. It reouires no laboured argument and no great array of facts, to show that a« we ascend in the scale of animated nature, irritability and sen- sibility are more and more developed. Plants have irritability, but no sensibility. The molluscae and vermes manifest very faint signs oi sensibilitV. This property is more evident in the superior classes of the cold-blooded animal*, but is