© The article was published in The Bureau Of Homoeopathics, in 1924.
The first allusion of which I am informed by a medical author to the power of Pulsatilla to correct mal-presentation of the foetus, is the statement of Dr. Bethmann in the Homoeopathic Gazette. A woman in labor sent for him. The membranes were not yet ruptured, and the orifice of the womb but slightly opened, notwithstanding the presence of severe and protracted pains, and by an examination, he recognized a shoulder presentation. “Not willing to precipitate anything” (the foetus, I suppose), he gave a dose of Pulsatilla; some minutes after, the woman experienced a violent pain, with such a sensation of overturning in the abdomen that she was frightened; then, after some time of quiet, the pains recommenced regularly, and on the second examination Bethmann was greatly surprised to find the head presenting; the delivery terminated naturally. “I, myself,” continues a Dr. Creserio, “obtained five years ago upon a lady in the rue St. Denis, a similar result, by the use of the same means, under the same circumstances”.
CASE I : In the American Homoeopathic Review, May 1864, Dr. Mercy B. Jackson of Boston, reports the case of Mrs. T., in her eighth pregnancy, who had puerperal convulsions in her last two confinements, and suffered since with severe congestion of the head and neuralgia. The doctor listened to the beating of the foetal heart, and found it not in the right or left iliac region, but beating strongly about two inches above and to the left of the umbilicus. On further examination, she found the back of the foetus to the mother’s back, the small parts in front could scarcely reach the foetus per vagina, but from the little that could be touched, believed it to be one of the nates. Pulsatilla, 30th, five pellets in half a glass of water.
Dr. Jackson returned home and made arrangements on account of the tendency to convulsions, should it by necessary to take the child with forceps. Being called five days later, found the patient with severe periodical pains, the os uteri undilated and the foetal heart beating in the same place; gave Pulsatilla as before; pains left and all slept till morning. She could then mark the points of the nates and assure herself of the presentation. In the meantime, she had searched for light on means to avert convulsions, and finding the record of Dr. Bethmann’s case, gave Pulsatilla 30 in solution, a teaspoonful every three hours when awake. On the third day of its regular use, the patient felt a great commotion in the abdomen with pain and necessity to go to stool, and soon felt better and more natural than for a long time previous. At 11 A.M. the next day she was far advanced in labor, the head coming down rapidly; in thirty minutes, a boy, weighing eight pounds, was born. Both mother and child did remarkably well.
CASE II : Mrs. P., September, 1862, who had four children all born by the breech; was on this occasion, also of breech presentation, treated in the same way, with similar result.
CASE III : May, 1863. Another case of breech presentation was treated in the same way, with similar result.
CASE IV : August, 1863. Another breech case, primipara, was treated by Dr. Jackson with Pulsatilla 30 with similar result. The patient had passed the expected time by ten days, when the malposition was discovered and Pulsatilla given. Twenty-four hours later, the head was found presenting.
CASE V : October 20th, 1863. The fifth case in which a breech presentation had been ascertained in the some manner as before, and Pulsatilla administered, had the happiness to attain a few days later the same result. The child was born, after three hours labor, with vertex presentation, second position, all the other mentioned cases in the first position. These five were all in which she had, at that time, used Pulsatilla, and all successfully.
CASE VI : August 19th, 1866, A case of labor begun, yet delayed; foetus lying across the abdomen head to the left, back upwards, only the knee within reach, the breech being high up on the right side, heart beating on a line with or a little above the umbilicus. Gave Pulsatilla 30 in half a tumbler of water, a teaspoonful at 2:30 P.M., continued every hour. At 6 P.M., the head had come down on the left side, so that it could, with great exertion, be touched; the knee had receded, and the pelvis on the right side was empty. At 12 P.M. examination showed the head fully down; at 4 A.M. a girl was born, after only 2 1/2 hours of much pain. When asked if she had suffered much, the mother replied, “No! but a tremendous commotion.” This was the seventh case, six breech and one transverse, in which Pulsatilla 30 had changed the presentation to the vertex before the membranes had been ruptured.
CASE VII : May, 1870. A woman, eight months pregnant, with breech presentation, took Pulsatilla 30, as always prescribed by Dr. Jackson, every three hours: evolution was accomplished in a week, the child born at full term by the head.
CASE VIII : March 2d, 1871. Mrs. H. expecting confinement in a week, trunk presentation, back in front, head to the right. Pulsatilla 30, in solution, every six hours. At the end of five days evolution nearly accomplished. Five days later she was delivered by the vertex, after short labor.
CASE IX : March 15, 1871. Mrs. McL. expecting confinement daily. Breech presentation. Pulsatilla 30. In three days examined, found the vertex presenting; delivered on the 23d with rapid labor, child born by the head. Fourteenth trial by Pulsatilla, states Dr. Jackson, resulting with perfect success but one, in which Pulsatilla had been omitted some time before delivery, after a trunk presentation had been converted into a foot.
CASE X : Dr. A.W. Woodward, of Chicago, Medical Investigation Vol. VI, p. 139. Mrs r. with fourth child, large, muscular woman, two weeks previous overtaxed herself in lifting, and subsequently felt no motion; was taken in labor at 12 M., with severe pain until 7 P.M., when seen. Examination : Os so high the hand had to be introduced to reach it; it was closed though soft and dilatable; unchanged during pain. By external examination, foetus found nearly transverse, head at the right upper side, pelvis and feet in the left. During pain the doctor could feel the contraction to be transverse, longitudinally with the foetus. Pulsatilla 2nd, in solution in water, after every pain for an hour. At 8 P.M. a gradual correction of the shape and position of the foetus; medicine continued another hour; position fully corrected; long axis of the foetus in the median line, os descending, dilation one inch. The head presenting, pains much less frequent and less severe, patient sleepy. At 6 A.M., found the woman delivered, having been awakened from a five hours sleep by pains which did not leave her till the child was born in about five minutes.
CASE XI : Dr. W. H. Burt in the Medical Investigation, gives the case of a woman who two years before had borne a child with presentation of the feet. She had now, february 21st, a cross presentation with the head in the left iliac fossa. The form of the child could be traced with eye and hand. The mother said the child had lain in that position during the whole period of gestation. I quieted her mind as much as possible and said I would give her something that would turn the child, and gave Pulsatilla 30, about thirty small pellets dry on the tongue, and left the case, never believing that Pulsatilla would change the child’s position.
February 27th I was called, and to my great astonishment found the breech in the epigastric region, the head in the first position and labor progressing naturally. I asked the lady if she could tell when the child turned to the natural position? She replied, “Oh yes, in less than half an hour after taking the dose of medicine, there was a great commotion in the womb, and the child turned with his feet to my stomach”.
CASE XII : Dr. W. F. Dodge detailed the following case in the Medical Investigation Vol. VIII, p. 80; Mrs. B. of bilious lymphatic temperament. Melancholy, a Nux patient, has four children; always troubled with labor for two or three days; had lost two children with hydrocephalus. She was found sitting in a chair. She said: “The child is not right; it is across, the head is here, putting her hand on her left side; the os was found undilated. There was without doubt mal-presentation; I gave Pulsatilla 2nd and awaited results, expecting a tedious time. In about half an hour she gave a scream, drew a long breath and exclaimed: “the child is turned,” went to bed and in four hours was delivered of a healthy, living child.
CASE XIII : Dr. H. W. Martin, in 1866, had a case of labor in which he thought he detected a shoulder presentation; gave a dose of Pulsatilla 200, and went after Dr. M.L. Kenyon. On returning, the woman said that the medicine had produced a great commotion in the abdomen. Dr. Kenyon found the vertex presenting, and the child was born in fifteen minutes.
CASE XIV : Dr. Kenyon stated that having a case of breech presentation (it was a boy, as he could feel the genitals) he gave Pulsatilla and went home. Returning in a short time the woman complained that a great commotion had occurred in her abdomen. He quickly made examination, the pains being urgent, and received the head of the child in his hands, it being, as predicted, a boy.
CASE XV : Dr. Baylies’ case: I was called September 6, 1873, at 11:30 P.M., to Mrs. S., a black-haired brunette who had suffered severely with pains, attended by great anxiety and apprehension since 6 A.M. The wall of the uterus acquired no tonicity or firmness during the pains, which were without expulsive effort. On digital examination, the os uteri could not be distinctly felt, but a tuber ischii just within the brim of the pelvis, near the left acetabulum. By palpation though the abdominal wall, I traced the child from above the brim of the pelvis, on the left, to a point above the crest of the mother’s right ilium, where I unmistakably grasped its head, the back of the child presenting toward the anterior uterine wall. I prescribed Pulsatilla 200 in half a glass of water, a teaspoonful every two hours. Was called in haste the following morning at half-past four o’clock, and found the patient in active labor, the pains regular and efficient, the child’s head occipito anterior in the upper strait. The birth was completed and placenta delivered at 5:30 a.M. The mother stated that she felt a turning movement of the child after the second dose of Pulsatilla. She had formerly required Sulphur, though not recently, for head symptoms and hemorrhoids; at the time of labor and for some days had been troubled with a cough which seemed to come from the upper sternum, and caused soreness in the abdomen. Without regard to the malposition and the inefficient pain, her temperament, fretful and worried state of mind and the cough from the upper sternum, might have suggested Pulsatilla.
Cases of Dr. Jackson : presenting details of the action of Pulsatilla are seven of the nine here reported. The duration of the use of Pulsatilla 30th in these cases up to complete evolution is as follows:.
Breech case, evolution in eight days; birth on the ninth day.
Breech case, evolution in twenty-four hours; time of birth not stated.
Breech case, evolution in seven days; birth three weeks later.
Breech case, evolution in “a few days.”.
Trunk case, evolution in five days; birth five days later.
Breech case, evolution in three days; birth five days later.
Trunk case (in labor), evolution in nine and one-half hours; birth four hours later.
Dr. Dode’s trunk case: Pulsatilla 30, 1 dose dry; evolution in one-half hour; birth four hours later.
Dr. Woodward, Trunk case: Pulsatilla 2d; evolution in two hours; birth nine hours later.
Dr. H. N. Martin, shoulder case; Pulsatilla 200; evolution in one hour; birth five hours later.
Dr. L. M. Kenyon, Breech case, probably membranes broken; Pulsatilla; evolution in a “short time”.
[Dr. Butler’s case, see transactions of I. H. A. 1889.] Dr. C.W. Butler, 1 trunk case; Pulsatilla mm. (Tafel) ; one and one-half hours for evolution and birth.
Dr. Kent, 1 Breech case (oral report), Pulsatilla 2m. (2,000; evolution and birth in a few hours.
Dr. Baylies, 1 Trunk case; Pulsatilla 200; evolution in two hours; birth three and one-half hours later.
These cases show that when Pulsatilla 30 was given before the end of gestation, several days were required to complete evolution (cephalic version); when given during labor, a short period, ranging from half an hour to several hours.
All the cases of Dr. Jackson which I have narrated, except one treated during labor, were treated before the termination of gestation, and with the 30th. In these the version was accomplished in from twenty-four hours to eight days. In the case where labor was daily expected, it was complete in twenty four hours; during labor, one case in nine and a half hours. In two of the eight other labor cases the second potency was given to one, with version in half an hour, to the other, in two hours.
In Dr. Butler’s case of the millionth potency, version and birth were complete in about one and one-half hours. In the one dose 30th potency case, two hours. In the 200th cases, one in one hour, the other in two hours.
In Dr. Kenyon’s case the potency is not mentioned. As he determined the sex at the first examination, the membranes must then have been ruptured; it thus making with Dr. Butler’s the only two of these nine cases of cephalic version, which followed the administration of Pulsatilla in dry labor.
Malposition of the foetus implies a non-conformity of the containing to the contained, an abnormality akin to disease. Considering the muscular structure of the uterus, it seems evident that a relaxation of the oblique or transverse fibers, will permit a proportionate gravitation of the foetus into an oblique or transverse position. When in that position it may be conceived that contractions of other fibers may raise or depress the corresponding extremity of the trunk and vary the malposition, or correct it.
The homoeopathic relation of Pulsatilla to these cases is, with hardly a single exception, not stated. Empirical experience that Pulsatilla corrects inefficient pain, and promotes normal labor, having been the apparent guide to its selection. The abnormal innervation and action of the uterine muscles causing malposition of the foetus, should be treated homoeopathically according to the totality of the symptoms, and certainly other remedies may be required, but the following symptoms of Pulsatilla show its powers to induce, and therefore to cure, nervous and muscular derangement of the uterus:.
Pain in the small of the back like labor-pain, and as if a band had passed
through the small of the back and everything were constricted.
Pressive pain, as from fatigue in the sacrum in the evening.
Drawing pressive pain extending toward the uterus, with qualmishness.
Cutting pain in the orifice of the uterus.
Contractive pain in the left side of the uterus obliging her to bend double.
Anxiety and fretfulness, not knowing what to do, is a mental symptom of
Pulsatilla, common in inefficient labor.
Dr. Campbell had no paper written, but said:
Everything should be done in the name of humanity to relieve the pangs of women in labor, and I should like to know if a homoeopathic physician can consistently use an anaesthetic in normal labor. It is either right or wrong to use it; if it is not wrong to use it, then it is wrong not to use it. It is on this question that I should like to get the sense of this meeting.
Dr. Wesselhoeft : I believe that in a great majority of cases of normal labor we get along better without any anaesthetic whatever. We all know, also, that in many abnormalities we can aid labor very materially with a well-selected homoeopathic remedy. Still, there are certain occasional cases, especially in primiparae, where after the second stage of labor is nearly ended, the head presents at the vulva with the most agonizing suffering, and either we fail in our selection of the remedy or it fails to act from mechanical reasons, where, I say, it is only merciful to give a few whiffs of Ether or Chloroform while the head is passing in order to alleviate this most agonizing and terrific suffering. A very few whiffs of Ether or Chloroform will be sufficient, and I do not believe in giving any more than enough to just lessen keen pain, without approaching complete anaesthesia.
I believe too that it is perfectly justifiable for us to use an anaesthetic in obstetrical operations. I do not think I will ever apply the forceps again without at least partial etherization. Many women now seem to expect Ether from the beginning of the pains to the end of the labor; such procedure is wrong. The majority of cases get along better without a drop of anaesthetic, but in many others it is, if not necessary, at least merciful to the limited extent that I have just indicated.
Dr. Stow: I wish to call attention to a probable effect of the administration of Ether at the last stage of labor. We all know that there is often extreme distension and tension of the perineal muscles during the last throes of labor and a little prior to the last. Is it not highly probable that an anaesthetic administered at that point would relax those muscles and do much to prevent rupture and laceration? If I had a case of dislocation or fracture, I would not attempt to use my own slight muscular strength against the contracted and rigid muscles of a stronger patient. I should administer an anaesthetic and then proceed to the easy and safe reduction of the dislocation or fracture, aided by the relaxation of the muscles produced by the anaesthetic. The same applies to the management of difficult cases of labor, and I think we should be left to our own judgment and to the exigencies of the case.
Dr. Kent: In these painful and extraordinary cases, as in all others, the first duty of the physician is to act for the best interest of his patient’s future. He cannot always do this by being merely merciful. If, with the idea of saving pain, you use Chloroform early in a labor case, the symptoms which call for a remedy will be entirely obliterated. I sit by the side of the bed, watching and waiting for a symptom to arise upon which I can base a prescription which will relieve the suffering. It seems merciful to relieve this great suffering promptly with Chloroform, but it is more merciful to relieve it in the only right way, by the homoeopathic remedy when this is possible — because the relief is a real one and beneficial in its effect on the whole future of the mother and offspring, instead of merely palliating the pain. I appreciate what Dr. Wesselhoeft has said, but I do not think with Dr. Stow that we are justified in producing so deep a narcosis as to relax the muscles of the perineum. It would take a great deal of Ether to do that.
Dr. Dever: As I look at it, labor is a natural physiological process, and in a healthy woman should be gone through without drugs or medicine at all. If the process is in any way abnormal, then the woman is sick and needs the homoeopathic remedy which will relieve, as we all know, more quickly and more permanently than any anaesthetic. It is very seldom, if ever, necessary to use anything else.
Dr. Bell: If enough Ether is given to relax the perineum, then the labor is going to stop, and so deep an anaesthesia is very apt, if prolonged, to injure the child.
Dr. J. V. Allen: I would like to ask Dr. Bell if Ether or Chloroform have any effect upon nerves supplying involuntary muscles?.
Dr. Bell: Yes sir I think they do.
Dr. Stow: I do not wish to go on record as recommending Chloroform or Ether indiscriminately. I am not in the habit of so using them. But I know that I have without deep necrosis, produced sufficient relaxation of the muscular tissue to very materially aid the passage of the head and to prevent laceration of the perineal structures. I must differ with Dr. Bell when he says that anaesthetics affect the involuntary muscles. Ordinarily, the heart continues to beat, the lungs to move, and the expelling power of the uterus is scarcely impaired under an anaesthetic. If you should carry the effect so deep as to effect the involuntary muscles, you would kill the patient.
Dr. Fincke: This discussion is not necessary and does not answer the question that Dr. Campbell asked, She asked; whether it was, in the opinion of this Society, legitimate for a homoeopath to give anaesthetics in normal labor in a sentimental way, to stop pain. I say that if everything goes well, she should bear some pain, for the woman will be loved better and will love her children better, if she suffers some pain. Pain is a part of labor, and if everything is normal, we should allow nature to do her own work.
I have seen many cases go wrong because the doctor had no time to properly attend the case, so hurried matters to the harm both of the mother and child. Many women that have a quite natural childbirth will cry out with pain and say that they are going to die. If you give them a tiny pellet of Aconite, it all passes off, and the child will be born all right.
Dr. Carr: When I first began practice, I administered Chloroform in every case. But I did not know as much about homoeopathy at that time as I do now. It was not until I had some very untoward results that I turned my attention to the remedies. Aconite, Kali Carb, and Chamomilla have served me well in such cases.
Dr. H. C. Allen: One point has been overlooked in this discussion. One reason why we should not give anaesthetics in labor, is because the old school do. The farther we keep away from their methods the better for all concerned. A woman is more susceptible during labor and pregnancy to the action of remedies than at any other time. Moreover, the symptoms of the mother corrected during gestation and just prior to confinement, tend to make the labor normal. An anaesthetic masks symptoms, prolongs suffering, increases the liability to haemorrhage, to mastitis and other troubles of the mammary glands.
Dr. Wesselhoeft: I do not want to be understood, nor do I wish it to go on record, as advocating the use of anaesthetics, except in certain rare cases, such as I have mentioned. As for our allopathic friends using or not using anaesthetics, I do not think that has anything to do with it.
I think we should use an anaesthetic whenever the forceps have to be applied; also in some cases, especially in primiparae, during the last moments when the child’s head is bursting through the vulva and the woman is enduring the most excruciating torture. Just a few whiffs are enough, and it is all over. I have never seen bad results from it and I have had women thank me for those few whiffs. Mind, that in the great majority of cases I say we do not need it and are better off without, but in the cases I speak of, I am glad to give relief by its use.
Dr. Alice B. Campbell: Those few whiffs are going to lower Dr. Wesselhoeft a little in my estimation. I am very jealous of the reputation of this society, and my gratification is great to have Dr. H.C. Allen, Kent and others stand up for true Homoeopathy. I believe Dr. Wesselhoeft thinks he is right, but I do not; whether it is Dr. Stow with his complete narcosis or Dr. Wesselhoeft with his few whiffs, the principle is the same. If you do the same as the allopaths, wherein lies the difference? Can we not stand alone? Must we depend upon their miserable expedients? I have followed where it has been used, and have always found more or less trouble, generally in connection with lactation.
Dr. Kimball: I was called to a case in which a girl about seventeen, in labor, was in the most horrible convulsions. The immediate use of Ether relieved the pains, and I do not think five minutes elapsed before the child was born.
Dr. Bell: We must concede a little here, I think. If things were just as we should like them to be we would have plainless labor and we would have no surgery. I think that Ether may be safely and comfortably used toward the close of labor, when, according to the judgment of the physician, it is best.
Dr. Wesselhoeft: Do not understand that I advise the use of Ether right from the moment the woman begins to cry out. Many of the women are abnormal nowadays, and can hardly have a normal labor. When we have a mechanical tumor pressing against and distending to the point of rupture, the vulva, with that horrible agony depicted on the face, I have used a little Ether, and I am glad I did.
Dr. Hoyne: I have found that women nowadays are educated about Chloroform and will not have a doctor attend them in confinement unless he will consent to give it to them. Very little is necessary, and only towards the close of labor. I have never heard of its doing any damage when used in that way.
Dr. Fincke: I wish Dr. Wesselhoeft had tried the remedy just at that point (perhaps Aconite would have done it), because we would have learned something. Suppose, in cases similar to this, we try the remedies and then we will know. How do we know that the anaesthetic does not have an after effect? There must be some reaction I think, but I do not know enough about it.
Laughing gas, administered to have a tooth drawn, produced very serious effects, changing a woman‘s disposition of cheerfulness to one of sadness; also of a widow who, during an operation, was under the action of anaesthesia for many hours. In the course of time she began to weep, and wept herself to death. I do not know whether this case be due to the anaesthetic or not. it is only possible, and would have to be proved.
Dr. Dever: These desperate cases are the very ones that need homoeopathic treatment, and those in which our remedies will do good.
Dr. Thomson: I have never used an anaesthetic in parturition. The more excruciating the pain, the quicker will the indicated remedy cease it. Pain is nature’s danger signal. It is just as criminal to take away that pain with an anaesthetic as it would be to cut down the red flag, the danger signal, and let two trains come together. The pains are a part of, and coincident with, the contractions of the uterus, and we should not interfere with them.
Dr. H. C. Allen: Let us settle this question by observing, for the next years, all the obstetrical cases in which Chloroform or Ether has been given, and see how they get on. Observe especially the progress of lactation. My personal experience is, that troubles in lactation are very common when an anaesthetic has been used, either mastitis, suppression of milk, or some similar trouble. Many mothers appear to be perfectly healthy, yet are unable to nurse their children…they have no milk. Has the use of anaesthetics anything to do with it?
Dr. Guernsey: What is normal labor? Is such a case as Dr. Wesselhoeft mentions normal? I think not. Such intense, agonizing pain is not natural.
Dr. Wesselhoeft: As I said before, we have abnormal women to deal with. A normal woman, who uses her muscles, who has strength and ability, who has never injured herself by wrong dressing, will have a normal baby, by means of normal labor. Such a woman will not present a head twelve inches long, bursting though the vulva with such horrible pains. I am not talking about painful contractions of the uterus at all; these are the normal pains of labor. I am speaking of the last pains, due to the mechanical bursting, tearing of the vulva, by an abnormal head. No remedy could correct that; it is not a dynamic condition, and a few whiffs of an anaesthetic will do the whole business. it can do no more harm than a few whiffs of amyl nitrite.
Dr. J. V. Allen: I have just one case in which I used Ether. After the patient had been in labor twenty-four hours, I wished to use forceps, but was refused. At the end of the third day I procured Ether and administered it; applied the forceps and in three minutes delivered the child.
Dr. Custis: The best argument against the anaesthetic yet advanced is Dr. Kent’s, that we thereby cover up symptoms and cannot make a prescription. The drift of the discussion amounts to this; never give an anaesthetic in normal labor. In abnormal labor correct the condition with the indicated remedy, if you can, and if you cannot, help the woman with the anaesthetic and the forceps.
Dr. Alice B. Campbell: What Dr. Wesselhoeft says is true. We have abnormal women to treat; and they are likely to remain abnormal so long as their ignorance is ministered to after the manner of Dr. Wesselhoeft and Dr. Hoyne.
Dr. Hitchcock: If the women themselves are abnormal, are we justified in using abnormal measures in treating them?
Dr. Kent: Suppose your woman is under the influence of an anaesthetic, and an active haemorrhage comes on. What are you going to do for her with her symptoms masked by that be numbing influence?.
Dr. Wesselhoeft: I have had just such a case. The woman was under an anaesthetic, the child was delivered, when a sudden post-partum haemorrhage came on, such as I had never seen before. The doctor who was connected with me in the case, ran for his instruments. I ran for my Ipecac, and gave it. It stopped immediately. It was one straight, hot gush of bright red blood, as thick as a man’s arm. I knew I would have to work quickly: I have Ipecac always near me in labor cases.
Dr. Brownell: It seems to me that the Ipecac does not deserve any credit for stopping that haemorrhage. Was it not the sudden contraction of the uterus forcing out the sudden gush of blood that stopped it, and the danger was over when the gush of blood that stopped it and the danger was over when the gush of blood was first seen?
Dr. Rushmore: I recall at this moment three cases of labor in which I was called in consultation. They were all instrumental cases, and in each case Chloroform was used. In two of the three the child was past resuscitation, and in the third resuscitation was very difficult. But I think it proper to consider that the deaths may have been due to other causes than the use of Chloroform.