Obstetrics Among American Indians

Emil Krulish
1912 Journal of the American Medical Association  
6, 1912) recalled to my mind some similar cases which I observed during my service as physician among the Navajoes on the Navajo Indian Reservation, 95 miles from the railroad town of Flagstaff, Ariz. Many of these Indians have never seen a white man and naturally their customs and mode of living are most primitive. Until recently the native medicine\x=req-\ man prospered among this tribe by practicing his art of casting the evil spirits from his ignorant and unfortunate patients. In the last
more » ... ents. In the last few years, however, the government through the agent and the physician has been discouraging this practice. One afternoon an Indian policeman called at the agency and requested me to go with him and see his wife, who was in labor. As we approached his hut I heard the chant of the Indian medicine-man. On entering I could not see on account of the smoke from a lire on the ground in the middle of the hut, which filled the hut and irritated my eyes. About twenty Indians, men, women and several children, were sealed on the ground on sheepskins in a circle about the lire, chanting, Within the circle, close to the fire was a woman smoking a cigarette and the medicine-man alongside of tier was leading the chant. This woman was my patient. She was sitting with her buttocks in the ground and I noticed a rope hanging by her side which was fastened to some of the timber overhead. This rope was used for the woman to pull on during the severe pains. I noticed that she had nn occasional light pain, during which she would stop smoking, frown and bend forward and remain in this posture until the pain had ceased; then she would straighten up again and resume her smoking. After about a half an hour I decided that then? would be no delivery for some time and therefore I left the camp, instructing the Indians to call me if necessary. The following morning 1 was informed that the child was born some time during the night amid the chant of the audience and as everything progressed favorably 1 was not called. Under the circumstances I did not regret it. Three days later 1 was asked by the husband to treat the woman for severe headache from which she had been suffering since the lime of labor. When I saw ber she had a temperature of 108 with a correspondingly rapid pulse, coated longue and constipation. I informed Die husband of the serious condition of his wife and told him that unless she was taken lo the agency hospital immediately where I could treat, her without any interference I would have nothing to do with the ease, lie reluctantly consented. On examination lit the hospital, 1 discovered thai a portion Of the placenta had remained in the uterus. After curettage and the usual care that these cases require, she recovered. The next case is thai of an adherent placenta with an hour-glass contraction of the uterus in a llopi Indian woman, aged about 30. This was her fourth child, as I learned later, and on all three former occasions the white physician had to be called to remove the afterbirth, One evening about, !):,'(() a llopi asked me to see his wife, who had given birth to a child that morning. I found my patient lying on a pallet on the floor in one of the native adobe houses. I found that the cord was hanging out of the vagina, the uterus was enlarged and above (he syniphysis pubis; no fever. The end of the cord outside of the vagina was fastened around a portion, about six inches in length, of a branch of a tree. On Inquiry I was told that this was for the purpose of preventing the cord from slipping back into the uterus. After assuring them that there was no danger of that occurrence, and discarding the stick, I gave her one dram id' the lluid extract' of ergot by mouth and practiced the Credê method of expression for some ten min-I utes, hut without any success. 1 left one dram of the ergot with instruction to give it in four hours and notify in« in the morning If the membranes had not been discharged by that time. The following morning my Indian friend came to tell nie that no change had Occurred in his wife's condition during the night. Taking with me what 1 thought would be required, I rode down to the village again. I found that no change had occurred. I spread a clean towel on the Moor in a convenient spot within reach of.my right hand, as I had no assistant to call on to hand me any article. On this towel I laid some sterile gauze, a hypodermic syringe loaded with ergotin, a long dressing forceps and a vaginal spéculum, f anticipated hemorrhage and wished to be prepared for it. Then 1 cleansed the vulva as best 1 could under the circumstances and gave a vaginal irrigation of mercuric bichlorid 1-6000. I washed my hands with soap and water and (hell soaked them in a bichlorid solution for a few minutes, passed my left hand into the vagina and I lien gradually worked my way into the uterus; my right hand was placed on the abdomen over the fuiidus to steady the organ during my manipulations, the os was rather contracted and I experienced some difficulty in dilating il. My linger encountered another constriction and I then discovered that I had to deal with an hourglass contraction of the uterus. After passing this second constriction I worked my finger? very carefully between the mucous membrane of the uterus and the placenta, separating the two as 1 progressed. I finally succeeded in breaking the adhesions and freeing the afterbirth. By traction on the cord with my free hand I pulled the placenta out and as I was about to withdraw my hand from the uterus I noticed that quite a profuse hemorrhage from the organ had occurred. With my left hand still in the uterus, 1 injected ergot and began massage of the fundil* through the abdomen, at the saine time keeping up a rotatory movement of my closed hand within the uterus. Feeling the organ contracting, 1 gradually withdrew my hand hut still continued the external massage. The uterus contracted down to the size of a billiard hall and the hemorrhage ceased-After applying a binder in the usual manner 1 waited a" hour before 1 left to ascertain that there would be no recurrence of the hemorrhage. The patient developed a slight septic condition with headache, some fever and a foul discharge. These symptoms cleared up after rest in bed. irrigations and quinin internally, and finally terminated in complete recovery. These two eases show that the Indian woman, like hc-r white sister, at times has difficulty and complications during labor and requires the assistance of the medical man.
doi:10.1001/jama.1912.04260020188026 fatcat:4iwromk6rrb5vli54g247zagoy