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habits of the race during reproduction. So dubious one. In Illinois it would be sufficient long as these longings were of trifling char- to make the claim that the mental condition acter their morbid nature would not be disput- of the puerperal woman was unsound, and the ed, nor considered worthy of thought; but let burden of the proof would immediately fall on a pregnant woman kill and eat her husband, the State, in obedience to that old legal preor newly-delivered woman, in that peculiar sumption of innocence in every man. In Infrenzy for blood that arises from perturbed diana and New Hampshire the same just sexual states, kill her child, and these ludicrous doctrine is held. Mental states are matters of longings furnish a psychological key to such fact, not ideal creations of law. It is sad to actions of great forensic importance. Every say that in the majority of our States the burwoman during the pregnant state is, it will be den of proof falls on the prisoner in all cases obvious, subject to influences that weaken in which insanity is a defense, and what insanher will, engender emotional mobility, render ity is, is determined by legal tests set up deapathetic natural affection, and give rise to cades ago under pressure from English ideas of suspicion as well as to perverted precedents. Barbarous as these legal doctrines sensations and propensities.
are, they are held in California, Delaware, Legally these mental states predispose to Kansas, Georgia, Maine, Massachusetts, Mismurder, infanticide, nymphomania, arson, souri, Minnesota, New York, Ohio, Pennsylsanguinary cruelty, dipsomania and klepto- via, Texas, Michigan, Mississippi, Nebraska, mania, either pure or resulting from a desire New Jersey, North Carolina, Tennessee, Kenfor possession dominating a weak will. The tucky, and the Federal Courts. literature is full of illustrative instances. These cruel absurdities have their natural When a well-to-do puerperal woman steals the results. Judges unable to rid themselves of public authorities willingly admit the plea of legal superstitions, resort to subterfuges to kleptomania; but when the poor, hunted, avoid enforcing the alleged law in cases in seduced woman steals she is too often treated which crime was the offspring of insanity not as a criminal. If a married woman kill her covered by the legal definitions. In the innew-born child, no jury will convict her. Let fanticide case of “The People vs. Kate Harvey" a seduced and abandoned girl do the same, (Alienist and Neurologist, 1885,) expert tesand a public example is demanded (pour en- timony was not introduced until after the jury courager les autres.) Yet in this last case the had convicted the prisoner; but the judge alpower of self-control is much more weakened, lowed the mental condition produced by the not only from the puerperal state but from puerperal state to mitigate the sentence. The other moral effects engendered by seduction, absurdity of such procedures is well summed desertion and dread of exposure. This is ar- up by Judge Doe, of New Hampshire. “If rant injustice, that can only be defended on tests of insanity are matters of law, the practhe tyrant's plea of necessity for the protec- tice of allowing experts to testify what they tion of society, a plea, as history shows, based are should be discontinued. If they are maton ignorant prejudice. Severe penalties never ters of fact the judge should no longer testify decreased infanticide, since the seduced infant without being sworn as a witness and showing icide never could apppreciate the bearing of himself qualified to testify as an expert." these penalties. This was well illustrated by
In dealing with any forensic question the Goethe, who never drew a truer or more physician's first duty is to determine whether pathetic picture than that of Margaret, about such a thing is a fact, not whether it might to be executed for an infanticide springing under certain supposable conditions have a from the perturbed mental state clearly evi- bad effect in society. Once ascertained to be dent from her last interview with Faust.
a fact, it is his duty to declare it such. In In conditions of doubt, justice leans to the this spirit I have striven to prove that in presumption of innocence. From what has crimes committed during the puerperal state already been said it must be evident that the the burden of the proof lies on the State, mental state of the puerperal woman is a since the alleged criminal suffers from a path
ological state predisposing to violations of by means of the close relation of the capsule major and minor morality. The law, in its to the outer fibers a considerable relaxation assumption that every one is innocent, regards may be obtained, while the muscle is not alcrime as an unusual state, and this presump- lowed to fall back as in operations for strabistion of innocence is strengthened if the state The relative position of the muscle to of the alleged criminal predisposes to unwill the eye is very little if any changed, in reality ing violations of morality.-The Alienist and the muscle is only weakened. Relaxation to Neurologist.
the desired extent is always obtained, but the
relief to the insufficiency is not always per Remarks on Steven's Operation. manent, for the healing process is sometimes
attended with a degree of contraction nearly Read before the Topeka Academy of Medicine equal to the advantage gained by the operaand Surgery, April 1, 1890.
tion, in which cases a renewal of the operation
upon the same or opposite sides may be made. BY G. A. WALL, M. D.
The operation is nothing more nor less than a
partial tenotomy, but instead of commencing Mr. President and Gentlemen :-The subject at the border of the tendon, we commence at of this paper is one which is creating consid- its center. It might be well to say here, that erable favorable and much unsavorable com- should any high or even moderate error of rement from the profession, especially in the fraction be found it should first be corrected east.
before concluding to operate. The object of It will probably not be amiss to give the this operation is to reduce the slight tendency details of his operation. It is one which de- to deviation of the visual lines which is not mands careful judgment and delicacy of ma- visible but which can easily be found, should nipulation on the part of the surgeon, for it is it exist, by producing diplopia by means of an easy matter to produce diplopia, and our prisms. It is in those tendencies that this opcure would certainly be much worse than the eration seeks its results. disease. The operation is performed in the We all know that these slight deviating tenfollowing manner: Having placed the eye dencies would cause more trouble than the under the effect of cocaine, the conjunctiva is greater ones, because then our patient soon divided immediately over the insertion of the learns to suppress the image of the squinting tendon, and at its center, about 4 inch in ex- eye, and therefore has no desire for binocular tent. The tendon is then picked up with a vision; but in these slight tendencies, there is small, fine-toothed forceps and small opening a constant desire to retain binocular vision, and made in it, the point of a small, blunt hook, since the muscles do not act in harmony, there similar to a strabismus hook, only much must be a constant strain on some muscle, smaller, is then introduced into the opening and sooner or later it will begin to feel that in the tendon, and with a fine, blunt pointed strain, and as a result headaches, pain in the scissors the tendon is divided towards each eyes and various nervous phenomena will border between the hook and sclera, preserv- arise. By this operation he claims to be able ing the capsular attachment at the borders of to relieve headaches, spinal pains, neuralgia, the tendon.
and even chorea and epilepsy when not due to The insertion of the tendon is somewhat organic lesions. That there are beneficial refan-shaped, and by dividing all but the ex- sults to be obtained by this operation in some treme fibers at the borders of the tendon, it of those nervous phenomena I have no doubt, lengthens slightly, while division of the ex- but before we operate we should carefully ternal fibers leaving a central band, results in weigh every statement made by our patient, very little if any extension of the tendon. not at one examination but at several. I have The advantage of this operation is, that by seen many cases benefitted by it, and call to means of the extreme outer fibers of the ten- memory the following case which, I think, ildon, or where greater relaxation is required, lustrates its effect. A lady from Wisconsin
was brought to the Woman's Hospital in Chi- eyes for which in the past were assigned to the cago for some supposed ovarian trouble, I records as "cause unknown." Perhaps many know not what. A double ovariotomy was poor unfortunates who, without this operation, recommended, I think. She complained of would end their days as inmates of insane and occipital headache, pain down the spine at imbecile asylums, will be cured ! the angles of the scapula, and vertigo when
Especially does this apply to cases of chronic compelled to sit or stand long. She said she chorea and epilepsy in which no organic lesion had not been able to sleep on her back for six of the brain or spinal cord exists. In Steven's months, and in any position was much troub-work he cites many cases of chorea and epiled with insomnia. In the meantime she was lepsy which were permanently cured, and sent to Dr. Hotz for some eye trouble, and many which were only improved or not benupon examination only a slight error of re
efitted at all. fraction was found, but he found a tendency
That some assertions contained in this artiof the eyes to upward deviation, and suggest-cle are true, I hope to be able to demonstrate ed an operation to the patient, stating that to this society at some future day. some of her symptoms might be relieved by it. Accordingly a Steven's tenotomy of the
Preparation for Motherhood. superior rectus of the right eye was made and within two weeks the patient commenced im- Read before the Eastern Kansas District Medproving, and three weeks after a second ope
ical Society, at Topeka, K's., April 8, 1890. ration was made on the inferior rectus of left eye, the deviation not being fully corrected by
BY DR. M. R. MITCHELL, OF TOPEKA, KS. the first one. In probably one month from date of last operation all pain and other symp
The most important epoch of womanhood is toms had subsided, the patient grew more the incipiency of motherhood. Much of its fleshy, and pinched appearance of her face importance is the attending suffering it brings. had gonc. She returned home, without any
Glancing over the field of our subject the operation except those done by Dr. Hotz, and following question arises, viz.: What can be it is needless to say she was a happy and grate-done to prevent, or at least to help bear these ful patient. Now can there be a shadow of a sufferings? doubt but what that muscular difficulty was
Such questions should concern us as physicausing allthose nervous phenomena? There cians, and awaken the deepest sympathies of a exists not the slightest doubt in my mind but common humanity. that the terrible strain upon the muscles of The question as to causes suggests a wrong her eyes, in her efforts to retain binocular somewhere that may be righted. vision, caused all the troubles which kept that
During the whole process of gestation and woman in a state of perfect misery. If I did parturition, we observe Nature's admirable not wish to become a bore, I could cite many adaptation of means to end. The formation like cases of nervous troubles which were of the enveloping membranes, the uterus cured by a slight tenotomy. Of course, like gradually enlarging to accommodate the conall new things, people are slow to believe in tinuously growing contents. The generative their efficacy.
passage has been increasing in size, and beNo doubt but what Dr. Stevens in his ambi- coming soft and distensible, so that the partution overreaches the bounds of benefit de rient process, which was seemingly impossible, rived from this operation. There is, of course, can be accomplished without physical harm. great antagonism to it among the physicians Yet possibly not without some suffering. of New York city, but one can plainly see Lusk says, “The pains of labor are mainly why that is. Notwithstanding that opposition, through the compression of the uterine nerves it is progressing, and will surely succeed in by the contraction of the muscular fibers." saving many sufferers from the torments of The severity of the pains may be regarded as headaches, neuralgia, and constantly aching in proportion to the resistance to be overcome. The agony becomes greatest, in the mechan- themselves at the menstrual period is truly ical distension of the cervix by the presenting appalling.
uncommon thing for part, and the passage of the same along the young ladies at the menstrual period, to so exvaginal canal and through the vulva.
pose themselves at balls, skating rinks, and This pain can be scientifically explained as like places, in such manner as is most calcuthe result of a physiological action.
lated to do them the most harm. Such reckIt is, however, a gratifying fact that the lessness is really criminal, and the sad consepractice of certain modes of life, and medical quences are sooner or later realized. science may do much to mitigate even the There is no want of obstetrical literature physiologically contingent pains of childbirth. giving instructions as to the best procedures
It is undeniably the case, that the larger and appliances to be used in assisting and amount of suffering attendant upon the preg- carrying the woman through the trying ordeal nant state, and childbirth, is owing to prevent immediately incidental to the parturient effort. able causes and pathological conditions.
Gynecological teaching is abreast with the Although in consequence of Mother Eve's demands for methods of treatment and repair first and great transgression, the sentence, "In of diseased conditions as we find them incisorrow thou shalt bring forth children,” was dental to childbearing. But it may be that pronounced upon herself and her feminine more detailed and specific teaching in referdescendants, yet it must be conceded that ence to prevention of woman's sufferings much the greater amount of sorrow and suffer- would be in line with a progressive civilizaing, attending the childbearing process among tion, and the genius of practical christianity. the daughters of Eve, are attributable to the Preventive medicine does hold a prominent perverting and degenerating influences of place on the programme of duties of the incustoms indulged in, and especially under the dustrious and conscientious general practirule of modern civilization.
tioner. No less possible and imperative is It would, therefore, be decidedly unjust, the use of proper preparatory means in the unscientific and, we think, untheological for prevention of many of the long list of ills the becoming mothers of this age to still far- connected with childbearing. ther tarnish the memory of their maternal an- When we look down the vista of many macestor by attributing more than at least a ternal lives, we see a series of periodical torsmall part of their woes to her original sin. tures, each covering almost the whole time
Evidence of this fact is sustained by history from gestation to months after confinement. of barbarian nations, where it is said the Is it any wonder that some such in their deswomen are generally less perverted physically peration will resort to criminal methods to than civilized women. Childbirth is regarded gain relief? with very little apprehension, since it occa- Look at the home training of girls as we sions little pain or inconvenience. The same find it, in the so-called fashionable and higher is true with many women among the lower la- grades of civilized and christianized countries. boring classes.
Many of the ills referred to are clearly trace“The ease with which the Indian women able to physical defects in early development. perform the parturient act is proverbial. They How many of these girls pass into womansuffer scarcely at all with the pains of child- hood mere dwarfs, chlorotic, pale, sickly, birth, and, without doubt, one reason is, the nervous, hysterical, stooped, hollow-chested, preservation of their sexual health by rest imperfectly developed bone and muscle, imduring the menstrual period.” It is said, at paired digestion, headache, backache, imperthose seasons they invariably absent them- fect menstrual function ; in a word, ere they selves from the lodge and enjoy absolute rest. arrive at the threshold of the connubial state, If the hardy women of the forest are benefit they are miserable physical wrecks. All the ted by rest, certainly our more delicate fe- result of causes, such as a want of proper males may be thus benefitted. The reckless nutrition, proper clothing, proper physical exmanner in which some young women treat ercise, proper primary instruction and guidance as to physical functions. A mother's The profoundest learning, the most charmcare, influence and teaching can accomplish ing talents and the best accomplishments are much. In fact, a woman who is a true mother, of little value to success in any great underpossesses a prowess unequalled. She is af- taking without physical vitality. Too many forded a sphere of good to the race scarcely of the so-called educated and cultured ladies, surpassed by any other human agency. Es- when they enter the domain of pregnancy and pecially is it so in regard to the physical de- parturition, appear as intellectual fizzles. velopment of her daughters. The application
A worthy enthusiasm is now abroad in this of dietary rules should be her constant care, age, striving to afford the young woman at also proper and timely exercise, at work, or least equal advantages with the young man, play, which will develop strong muscular to mental culture and accomplishments in the power. Clothing should be provided such as fine arts. will secure comfort, protection, ease and free- But abreast with these should be physical dom of muscular action. Thus, the girl's feet culture, which is absolutely essential to the should not be crowded into little shoes, hands proper enjoyment of the intellectual and æspinched by little kids, the body as tightly thetical attainments. So, also, should the bound as a whipstock, or as thinly clad as a training and education of females include the Fegee Islander.
development of strong, vigorous muscular and No person has a better opportunity, nor is nervous systems, because these qualities are more capable than the mother of instructing the sine qua non to the physiological process the girl as to a practical knowledge of her of childbearing. own peculiar functions. This should be given It the judicious use of air, sunshine and early and timely, that she may grow into muscular exercise, should occupy prominent womanhood intelligent as to the importance places in the curriculum of schools and colof her mission as a possible mother. False leges for the education of girls, childbearing modesty, and an equally false fear of degiad- would be shorn of many of its terrors, and a ing or corrupting the young mind, should healthier, longer lived race would ere long never deter from this important duty. On inhabit our globe. Some little attention has the other hand, neglected early teaching and been given, of late years, to the introduction ignorance in these matters often record the of gymnastics into our schools, though in a story of suffering in connection with the crude and unsystematic mode, yet we have pregnant state and parturition.
reason to feel that this indicates the dawning " Youth is the time to serve the Lord,
of better days for the physical culture of The line to secure the great reward."
women. Not only in the home, under the tutelage of
A more thorough'development and practical the mother, has the essential physical culture execution of this idea afford a fine field for of the girl been neglected or perverted, but laudable effort on the part of philanthropic also has our system of education in this re- societies, and the race-loving medical profesgard been a failure.
sion. The spirit of the ages in relation to educa
The immediate preparatory attention of the tion, from the time of the Christian Era, has been to despise and neglect the body, as if the physician is important in carrying the woman body were a clog or an impediment to the ac- He should be consulted early in every preg
safely through pregnancy and confinement. quisition of knowledge. The Manichæans put the climax to this idea by teaching that nancy. He should use all proper and availa
ble means to acquaint himself with the genGod was the author of the soul, but the devil
eral state of health, the predisposition of the was the maker of the body."
woman, the formation, structure and condition As well might we expect a house to stand
of the pelvic organs, and to correct, as far as when the foundation is taken from under it, as to demand intellectual vigor from one whose possible, any abnormal condition. Perhaps the physical strength has been dwarfed or most important therapeutic data in a case, is wrecked.
the condition of the blood. A capital fact in