Thanks to Dr. Hayes profitable article (March Recorder), attention has been called to that very valuable book, Yinglings Accouchers Emergency Manual, and I want to add a few remarks on my use of the same volume in prescribing here in the Congo. Circumstances here are different from that of my colleague but the human race is the same, and response to medicine is the same and this book has been a repeated help to me in quickly and accurately finding the right remedy.
I remember a breathless runner arriving one Friday, as I finished Dispensary hour of some 200 patients and was on the point of resting, to call me for a patient who had been in labor “since yesterday.” Making sure I had a pair of sterile gloves and Yinglings manual in the car, a short run of fifteen miles and a walk of a few hundred yards in to the forest brought me to the village of the Babila tribe.
A crowd gathered around one of the huts at once showed where the interest was. Stooping to enter the low door, I got the usual sting of smoke in my eyes and, adjusting my vision to the half dark interior, I looked around to see which was my patient, whom I located sitting, knees up, on a thin mat with some fresh banana leaves on the floor, leaning against another woman behind her who, sitting legs spread apart, her bare belly became a reclining back for the case in labor whom she thus supported. This is the classical position for delivery. Several older women are always present to officiate. And woe be to the patient who wants to change her position or stand up or rest herself, for she would be greeted by a chorus of urgent shouts and threats, and if, the case should not turn out well, this would be attributed to the fact she had changed her position.
I sat down on the low stool which they offered me, and the lower one gets the better one can stand the smoke, which is impossible standing up, and observed my patient, and asked, “How long have you been in labor? Is this your first labor? Why didnt you come to Mission for examination during your pregnancy instead of waiting until you are in trouble?” No intelligent answer could be expected from the last question and it is purely for propaganda reasons and for its effect and result upon the by-standers. At first all labor cases look alike and one may say there is nothing unusual here and nothing special to go by; but always with a little patience and observation something can be found which makes the present case personal, and UNLIKE all others.
In my work I must get this usually objectively, for these people are neither intelligent nor expressive, so I rubbed my smarting eyes and observed. Presently my patient went outside the door to urinate, in spite of the annoyed protests of the old women. “Why?” I asked. “With every pain I must urinate” she said, apparently relieved to find me sympathetic in contrast to the old women who felt this was all simply to annoy them! I moved my stool nearer the door for light on Yinglings Manual and on page 229 under Labor found “urinate, with urging to, Lil. t., Nux v.”
How definite and concise and accurate! Not having Lil. t. in my case decided me for Nux and I gave a powder of the 30th on her tongue. With the next pain the whole picture changed and the uterine muscles got right down to work in a spectacular exhibition of Nature doing her part, and gave me no time to put on my gloves; but, after hurriedly rinsing my hands in Lysol water and putting a clean banana leaf under the field of delivery, the case was completed amid exclamations of “only one powder!” and “medicine of the white man!” to which I replied” “Give thanks to God who made the powder!”.
Caulophyllum is our most frequently used remedy in labor here and is a sure shot for stopping pains, if false, or increasing them, if it is true labor, and has saved us from many unnecessary trips to attend normal cases, for we do not like to see normal cases if we can avoid it. Many times we send Caul. 3x to a case we have not seen, with instructions to bring word again within a few hours if the baby has not been born.
Chamomilla is second on our list; for these cases often become very irritable after a few hours of pain after pain, especially if without progress. Some patients fly to pieces and show their disposition to all within reach, while others, though feeling just as irritable within, control themselves to a certain extent. In both of these, Cham. is the remedy and the labor will soon be completed if she receives it.
A case of labor for three days was carried to our hospital in a blanket tied by each end to a pole. A quick examination showed the head well down, uterus tried out, the foetal heart still going and I thought the humane thing to do would be to put on forceps. Our native staff sprang into activity of preparations; and while waiting for the steriliser I noticed the angry way the patient pulled her shoulder away from her friend sitting behind her on the floor, who was showing her every kindness but received only a vicious response.
I thought of Cham. but I had never, at that time, used Cham. in a labor case and it did not seem to me “reasonable,” and not having much confidence I “tried” it while urging the staff to hurry with the instruments. Cham. 3x and presto! what a change! and we barely had time to lift that woman onto the operating table for a painless delivery.
And, Dr. Elizabeth Wright Hubbards surprise to the contrary notwithstanding, I too have not used any anaesthetic in these cases for the last ten years.
We have also had six Caesareans, all with classical indications; and of these, six mothers and seven infants survived, including, obviously, a case of twins which I did not suspect before.
Twice I have had the unpleasant job of removing a dead foetus piecemeal.
So among these natives of the Congo the remedies we most often use are Caul., Cham., Puls., and Gels., and the volume most often consulted is Yinglings Manual, which should not be allowed to be out of print.