1138 MIDWIFERY, ANCIENT AND MODERN.

led him to form a faulty conclusion, he sets aside asirrelevant all the current loose talk of second attacks.Chicken-pox and mumps he has never observed twice,and he doubts if he has ever seen a second attack ofwhooping-cough. _____

MIDWIFERY, ANCIENT AND MODERN.THE issue by THE LANCET of a Special Supplement

on Modern Methods in Abnormal and Difficult Labourhas moved an archaeological contributor to send usnotes upon eighteenth century midwifery for contrast.The notes consist mainly of comments on the advicegiven in the well-known work of Hugh Chamberlen,which was itself a translation of the text-book ofFrançois Mauriceau, " sworn master Chirurgen ofParis." From the period of the later Stuarts onwardto that of George II. and George III., this was thestandard text-book on midwifery and the diseases ofwomen in England, and in its English form appearsas the " Diseases of Women with Child, and in Child-bed." It was first published in 1683, and the thirdedition is of date 1697. The translation is interestingnot only because it was the source whence the earlymen-midwives such as Smellie and William Hunterderived their knowledge in their student days, butalso as showing how rational on the whole had beenthe craft or practice of midwifery from remote timesto a period when surgery and medicine may be saidto have become modern. " The work shows," writesour correspondent,

" how an ancient form of knowledgeevolved and gradually became free from mediaevalabsurdities. Chamberlen’s translation ran throughseveral editions, but in all the preface remainsunchanged. It contains the notable passage in whichhe refers darkly to the secret method employed by hisfamily in cases of difficult labour. This was quoted atlarge by Dr. Aveling in his work on the Chamberlens,published in 1882. I will now take leave to offer anapology,’ says Hugh Chamberlen in a closing passageof his preface, ’for not publishing the Secret 1 mention :we have to extract children without Hooks, whereother Artists use them---viz., there being my Fatherand two" Brothers living, that practise this Art, Icannot esteem it my own to dispose of, nor publishit without injury to them. Still,’ (he continues), ’wefour are the people who can serve the public in theirextremities with greater safety than the persons whoextract the child from the womb with the help ofhooks fixed in the neck.’ The Chamberlens kepttheir secret, the use of the midwifery forceps, till wellon in the eighteenth century, when poverty compelledHugh, the elder, to sell it to a Dutch obstetrician namedRoonuysen. Thus, the preface to a work in the mainrational refers to a trade secret, and in so far as it doesthat belongs to a vanished period of medical pro-cedure." " Here and there throughout Mauriceau’swork," continues our correspondent,

" medievalcuriosities survive and are sometimes allowed to passwithout protest by the translator, whose marginal notesare at other times full of common sense. Thus.* we’ll nowpass to convenient remedies for the belly of a new-lay’dwoman,’ says Mauriceau. ’All authors do appoint,immediately after delivery, the skin of a black sheepflaid alive, for this purpose, to be laid all over her belly,and to lie on four or five hours ; others will have ahare-skin. Truly, I believe that by reason of thenatural heat of such skins, the remedy is not bad.’But it is of too much trouble,’ for a butcher must beat hand in the lying-in room, or at least in the house,that so they may have the skin very hot according todirections.’ The same work likewise directs ’a smallplaister of galbanum, with a little civet in the middle,’to be applied to the woman’s navel, which as theyimagine is very proper to keep the womb in its place,because being delighted with that smell, it draws nearto it of itself." ... " But this remedy is a little super-stitious," adds Mauriceau, yet’ practice and successcommend it’ (comments Chamberlen). ’’Nor is there i

reason wanting to defend it; wherefore notwith-standing the author’s sense, it may be successfullycontinued." ]

The use of the colour red as a cure or prophylactictakes us back to the medicine of savages. Thus apregnant woman injured by a fall was often advisedby the midwives and by some authors of Mauriceau’speriod " to take some crimson silk, small minced inthe yolk of an egg, or the grains of scarlet [kermes,derived from " the grains of the scarlet oak," Bailey’sDiet., Edit. 8, 1737], and treddles of several eggs putinto the yolk of one, as if that entring the stomachwere able to fortify the womb and the child in it, andto keep it there." Mauriceau is of opinion thatreason and truth are against this, but Chamberlen asks,if this be so, " how then do inward medicines eitherprevent miscarriage or forward travail ? " To prevent" headmouldshot," a condition referred to in old billsof mortality, which has puzzled the moderns; a French-woman often applied a piece of scarlet cloth to thechild’s head and kept it there for some time. Mauriceaudevotes a chapter with two illustrations to headmould-shot, and entitles it " Of the mould of the head, and ofthe sutures being too open," the first explanationwe have seen of the phrase. " Shot " is written" shotten " by Chamberlen, and " shotten " is explainedby Bailey in his dictionary as " curdled," or, better still,as overlapping. Red curtains, Mauriceau notes, arehung by some round the bed of a child ill of small-pox," because this colour doth ordinarily move the humoursfrom the centre outwards... many antient as wellas modern physicians attribute the cause of the diseaseto the residue of the menstrous blood, wherewiththe infant was nourished in the mother’s womb."Chamberlen, tending towards rationality, prefersgreen to red as being more soothing to the eyes. Henotes on several occasions that French methods differfrom English in such matters as swaddling and thebandaging of the baby head. Mauriceau’s longdescription of his sister’s tragic death from flooding,when before the age of 21 she was brought to bed ofher fifth child, does not surprise his commentator, whoimagines similar cases in England to be caused by thevanity and ignorance of midwives and physicians.

ON THE MUSCULATURE OF THE LUNGS.

EXCEPT in the case of asthma the pathologist andclinician are both alike inclined to overlook theimportance of the musculature of the lung, and acareful piece of work by Dr. Joseph Harkavy in theJournal of Pathology and Bacteriology (October, 1924)is a timely contribution to this subject. Startingfrom the histological work of Husten, Miller, andothers, the writer points out that the entire lung isextraordinarily well supplied with musculature, andgoes on to ask the pertinent question what is thefunction of this musculature and what alterationtakes place in disease ? With these questions in viewhe investigated 176 lungs obtained from cases ofcardiac disease, pneumonia, broncho-pneumonia,and pulmonary tuberculosis. Excluding the cases inwhich no changes in the musculature were found, thewriter divided his positive’findings into four groups.The first group contained lungs from cases of cardiacdisease. Here was found marked increase in themusculature of the alveolar passages and of themuscle ring of the bronchiolus respiratorius, occurringmost commonly in pure mitral stenosis. Elastictissue was also found to be increased. In the secondgroup were lungs from cardiac cases in which pul-monary induration and pleural obliteration were

present, and these showed a more general increaseof musculature affecting the indurated lung paren-chyma, vessels and septa, and especially marked inareas of scars and indurated pleura. The third groupcontained cases of total pleural obliteration withevidences of old tuberculosis, in which the increasedmusculature was chiefly evident in the interstitiumand in the quantity of the muscle sheets in thethickened pleura, with new-formed blood-vessels.multiplication of pleural elastic tissue fibres, andhypertrophy of the muscle round about the areas ofcompensatory emphysema. The fourth group com-prised cases of emphysema, pulmonary cirrhosis

1139NICE NOISE.-EPIDEMIC DIAPHRAGMATIC PLEURISY.

following pneumonia, anthracosis and pulmonaryoedema of nephritic origin, and were characterisedby the irregular nature of the muscle hypertrophy,some areas showing marked hypertrophy and othersnone. The changes seen were chiefly thickening ofthe muscle of the alveolar pillars, of the alveolarpassages, especially in the vicinity of pleura andsepta, wherever chronic obstruction to expirationhad taken place. After discussing various possibletheories of causation of hypertrophy of this systemof musculature the writer points out that two forcesare concerned-viz., movement of the chest wall andrespiratory action of the lung proper. When theformer is restrained by disease, compensatory hyper-trophy of the musculature of the lung results. Thatthis musculature takes an active part in respirationis clear, and its response to disease by increasedaction on the arterial side of the alveolar passages,on the large vessels of the interstitium, and thelymphatics of the septa, therefore, seems likely.Many years ago S. West suggested that we might" compare the lungs with the arteries and speak ofpulmonary tone ’ just as we do of ’ arterial tone,’and connect the tone in the lungs as we do in thearteries, with the condition of the muscles, andpossibly of the nerves." In an article containingsome beautiful illustrations of the musculature ofthe lung, W. S. Miller has further shown that thebronchial musculature is arranged very much in theform of a network made up of geodesic bands whichprevent any tangenial motion, thus permitting thegreatest amount of extension and contraction of thebronchioles and their subdivisions., Muscle bands,indeed, penetrate much further along the ramificationsof the bronchial tree than physiological text-bookswould lead us to suppose ; they extend as sphinctersto the openings of the alveoli into the bronchiolesrespiratorii, but there is no muscle in the walls ofthe air spaces. The implications of these researchesmay be considerable ; vital capacity and the pheno-mena of dyspnoea as applied to emphysema and otherchronic pulmonary diseases must all depend, amongstother factors, upon the bronchial musculature-ananatomical mechanism hitherto only very imperfectlyunderstood.

_____

NICE NOISE.

THE dreadful noise of towns becomes worse andworse. Complaints reach us from various sources ofthe loss of sleep occasioned thereby in hospitals andnursing homes. Some physicians and surgeons regardthis noise as a serious impediment to their patients’chance of recovery, and at the least it tends to retardconvalescence. Mr. E. V. Lucas has described themotor-bicycle with internal trouble as the secondnoisiest thing he knows ; and the editor of Psycheincludes it in a leading article with the new form ofpavement breaker and alludes to the gratuitous andever-increasing hubbub of newsboys, street organs,bells and the like in residential areas. Time was whensuch noises were more or less confined to businessareas, but they are now ubiquitous. The remedy ishard to seek. It is impossible to fit bedrooms innursing homes and wards in hospitals with double-paned sound-proof windows without interfering with Ithe necessary ventilation. The patient may plug hisears and so obtain a quiet night, but it is not everyonewho can tolerate the presence of a meatal tampon.It seems too much to hope that the motorist can beinduced altogether to abandon the use of his hooterafter dark, although, as Sir Lenthal Cheatle haspointed out, with careful driving most of the motor-horn emissions are quite unnecessary. Persons inrude health are able to focus unpleasant noise ontheir deaf spot and find it hard to realise, until theyare ailing themselves, how noise may rack the nervesof others.A temporary solution is probably to be found in

Ithe substitution of nice noise for horrible noise. Sir I1 Samuel West: Diseases of Respiratory System, ii., 628.

2 Amer. Rev. of Tuber., 1921-22, 5, 689.

Henry Hadow’s address on Wednesday at the RoyalHospital, Chelsea, was devoted to the healing influenceof music, and Sir Bruce Bruce-Porter has attributedthe high turnover of a hundred beds per month at theThird London General Hospital during the war tothe distraction provided by gramophones and con-certs. The distinguished pianist, Mr. Moissye Bogus-lawski, invited to the wards, at the instance of thestaff of the Chicago State Hospital, never found anindividual who did not respond in some way torhythm, and Dr. Michael Grabham writes thisweek in our columns on personal experienceof the therapeutic value of music. Folk-songsseemed to have special value. The ChicagoCommissioner of Health remarks that the nurse

or hospital attendant who hums or sings softlywhile near the patients seems to inspire con-

fidence and contentment. That may have its risks,and all these means are only available to some on afew occasions. But the advent of wireless transmis-sion has brought the temporary bedrid into touchwith beautiful sounds by the mere turning of abutton. In another column we set out some of the

I facilities as they exist at present for convalescentpatients to obtain wireless sets. No doubt the supplywill increase as the need for them is realised. Thedemand is sure to come.

EPIDEMIC DIAPHRAGMATIC PLEURISY.

IN the October number of the American Journalof the Medical Sciences Dr. Robert G. Torrey, of thePhiladelphia General Hospital, states that during thesummer of 1923 an epidemic occurrence of an acutefebrile condition characterised by severe pain in theepigastrium or chest was reported to the State Boardof Health of Virginia by Maude M. Kelly as observedby her in two counties of the State. A subsequentreport was made under the heading of " epidemic,transient, diaphragmatic spasm," by Payne andArmstrong,! who regarded their series of cases as

representative of a fairly widespread epidemic, andconsidered the condition to be a definite clinicalentity. The disease was prevalent in the latter partof the summer of 1923 in the Middle Atlantic States,particularly Virginia and New Jersey, where it waspopularly known by the name of " Devil’s grip."Dr. Torrey, who records four illustrative cases inadults, states that the onset is sudden and oftenaccompanied by a distinct chill, the temperaturerising to 102°-104°F., and the pulse usually followingthe temperature. Pain is the main symptom, occurringin the epigastrium or back or in the lower part of thechest. It is aggravated by breathing or by movement.It is increased during the febrile attacks and decreasedas the temperature drops. With the pain there maybe marked tenderness which may persist after thepain has disappeared. There may be only one attack,but there are usually recrudescences of pain andfever occurring at intervals of 24 or 48 hours.Headache is a usual symptom and is generally frontal.Profuse sweating is characteristic and occurs late.Prostration is not marked as in influenza. There isan absence of lung involvement and pleural frictionhas not been heard. The knee-jerks may be diminishedor lost, but promptly return to the normal. Theprognosis is good. No deaths have been reported.As a rule recovery is prompt and complete. The

pain is probably due to involvement of the diaphragmor diaphragmatic pleura. The headache and’reflex

nervous disturbances indicate some degree of nervetissue involvement by the toxin. In the same numberof the journal as Dr. Torrey’s article Dr. James C.Small describes under the name of PIas7aodiuszzpleurodyniae a protozoan organism which he hasfound within the red cells of patients suffering fromthe disease, different stages in the cycle of its develop-ment being observed. The organism is differentiatedfrom those of the malarial group in its staining

1 THE LANCET, 1923, ii., 1097.