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Gabbe’s
Obstetrics
Essentials
Normal and Problem
Pregnancies

Mark B. Landon, MD
Richard L. Meiling Professor and Chair, Department of Obstetrics and
Gynecology, Ohio State University College of Medicine, Columbus, Ohio

Henry L. Galan, MD
Professor, Department of Obstetrics and Gynecology, University of
Colorado School of Medicine
Co-Director, Colorado Fetal Health Center, Aurora, Colorado

2
Eric R.M. Jauniaux, MD,PhD,
FRCOG
Professor of Obstetrics and Fetal Medicine, EGA Institute for Women’s
Health, Faculty of Population Health Sciences, University College
London, London, United Kingdom

Deborah A. Driscoll, MD
Luigi Mastroianni Professor and Chair, Department of Obstetrics and
Gynecology, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, Pennsylvania

Vincenzo Berghella, MD, FACOG

Professor, Department of Obstetrics and Gynecology, Director, Division of
Maternal-Fetal Medicine, Thomas Jefferson University, Philadelphia,
Pennsylvania

William A. Grobman, MD, MBA

Arthur Hale Curtis Professor of Obstetrics and Gynecology, Department
of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois

Steven G. Gabbe, MD
Emeritus Chief Executive Officer, Ohio State University Wexner Medical
Center, Professor of Obstetrics and Gynecology, Ohio State University
College of Medicine, Columbus, Ohio

3
Jennifer R. Niebyl, MD
Professor, Department of Obstetrics and Gynecology, University of Iowa
Hospitals and Clinics, Iowa City, Iowa

Joe Leigh Simpson, MD

Senior Vice President for Research and Global Programs, March of Dimes
Foundation, White Plains, New York
Professor of Obstetrics and Gynecology, Professor of Human and
Molecular Genetics, Herbert Wertheim College of Medicine, Florida
International University, Miami, Florida

4
Table of Contents
Cover image

Title page

Copyright

Contributors
PART I. Physiology

Chapter 1. Placental Anatomy and Physiology

Placental Anatomy

Placental Histology

Placental Physiology

Chapter 2. Fetal Development and Physiology

Umbilical Blood Flow

Amniotic Fluid Volume

Fetal Growth and Metabolism

Fetal Cardiovascular System

5
 Fetal Kidney

Fetal Gastrointestinal System

Fetal Adrenal and Thyroid Glands

Fetal Central Nervous System

Chapter 3. Maternal Physiology

Overview

Cardiovascular System

Hematologic Changes

Respiratory System

Urinary System

Body Water Metabolism

Alimentary Tract

Endocrine Changes

Pancreas and Fuel Metabolism

Skeleton

Skin

Central Nervous System

Lower Reproductive Tract

Microbiome

Chapter 4. Maternal-Fetal Immunology

Introduction

Immune System Overview: Innate and Adaptive Immunity

Innate Immunity: First Line of Host Defense

6
 Adaptive Immunity

Regulatory T Cells

Fetal Immune System

Maternal Tolerance of the Fetus

Solid Organ Transplantation in Pregnancy

Amelioration of Rheumatoid Arthritis in Pregnancy

Chapter 5. Developmental Origins of Adult Health and Disease

Introduction

Epigenetics and Programming

Fetal Nutrition and Growth

Energy-Balance Programming

Maternal Stress and Anxiety

Glucocorticoids and Prematurity

Immune Function

Other Programming

PART II. Prenatal Care

Chapter 6. Preconception and Prenatal Care

Definition and Goals of Prenatal Care

Components of Preconception Care and Well-Woman Visits

Preconception Health Counseling

Screening for Chronic Disease, Optimizing Care, and Managing

Medication Exposure

Prenatal Care

7
 Components of the Postpartum Visit

Chapter 7. Nutrition During Pregnancy

Overview

Integrating Nutrition Into the Obstetric History

Maternal Weight Gain Recommendations

Maternal Weight Gain Recommendations for Special Populations

Maternal Nutrient Needs: Current Recommendations

Vitamin and Mineral Supplementation Guidelines

Nutrition-Related Problems During Pregnancy

Special Nutritional Considerations During Pregnancy

Chapter 8. Drugs and Environmental Agents in Pregnancy and

Lactation: Teratology and Epidemiology
Overview

Basic Principles of Teratology

Medical Drug Use

Drugs of Abuse

Drugs in Breast Milk

Occupational and Environmental Hazards

Chapter 9. Obstetric Ultrasound: Imaging, Dating, Growth, and

Anomaly
Biophysics of Ultrasound

Optimizing the Ultrasound Image

Special Ultrasound Modalities

8
 Scanning Technique

First-Trimester Ultrasound

Second- and Third-Trimester Ultrasound

Components of the Examination

Ultrasound for Determining Gestational Age

Safety of Ultrasound

Ultrasound Diagnosis of Malformations

“Entertainment” Ultrasound Examinations

Chapter 10. Genetic Screening and Prenatal Genetic Diagnosis

Genetic History

Genetic Counseling

Chromosome Abnormalities

Single-Gene or Mendelian Disorders

Multifactorial and Polygenic Disorders

Procedures for Prenatal Genetic Diagnosis

Preimplantation Genetic Diagnosis

Chapter 11. Antepartum Fetal Evaluation

Defining the Problem of Perinatal Mortality

Potential Utility of Antepartum Fetal Testing

What Do These Tests Tell Us About the Fetus?

Biophysical Techniques of Fetal Evaluation

Clinical Application of Tests of Fetal Well-Being

PART III. Intrapartum Care

9
Chapter 12. Normal Labor and Delivery
Labor: Definition and Physiology

Mechanics of Labor

Cardinal Movements in Labor

Normal Progress of Labor

Spontaneous Vaginal Delivery

Delivery of the Placenta and Fetal Membranes

Episiotomy and Perineal Injury and Repair

Ultrasound in Labor and Delivery

Chapter 13. Abnormal Labor and Induction of Labor

Diagnosis

Induction of Labor

Techniques for Cervical Ripening and Labor Induction

Chapter 14. Operative Vaginal Delivery

Operative Vaginal Delivery

Operative Vaginal Delivery Instruments

Risks of Operative Vaginal Delivery

Chapter 15. Intrapartum Fetal Evaluation

Direct Fetal Heart Rate and Uterine Activity Monitoring

Indirect Fetal Heart Rate and Uterine Activity Monitoring

Physiologic Basis for Electronic Fetal Heart Rate Monitoring

Summary of Placental Causes of Interrupted Oxygenation

10
 Fetal Response to Interrupted Oxygen Transfer

Pattern Recognition and Interpretation

2008 National Institute of Child Health and Human Development

Consensus Report

Benefits of Electronic Fetal Monitoring

Limitations of Electronic Fetal Monitoring

Chapter 16. Obstetric Anesthesia

Personnel

Pain Pathways

Effects of Pain and Stress

Analgesia for Labor

Anesthesia for Instrumented Vaginal Delivery or Perineal Repair

Anesthesia for Cesarean Delivery

Chapter 17. Malpresentations

Overview

Clinical Circumstances Associated With Malpresentation

Abnormal Axial Lie

Management of a Singleton Gestation

Face Presentation

Brow Presentation

Compound Presentation

Breech Presentation

Term Breech Trial

11
 Shoulder Dystocia

Chapter 18. Antepartum and Postpartum Hemorrhage

Pregnancy-Related Hemodynamic Changes

Physiologic Adaptation to Hemorrhage

Classification of Hemorrhage

Antepartum Hemorrhage

Chapter 19. Cesarean Delivery

Incidence

Indications for Cesarean Delivery

Technique of Cesarean Delivery

Complications of Cesarean Delivery

Tubal Sterilization

Chapter 20. Vaginal Birth After Cesarean Delivery

Trends

Risks Associated With a Trial of Labor After Cesarean

Chapter 21. Placenta Accreta

Overview

Pathogenesis

Epidemiology

Management

PART IV. Postpartum Care

12
Chapter 22. The Neonate
Cardiopulmonary Transition

Abnormalities of Cardiopulmonary Transition

Birth Injuries

Neonatal Thermal Regulation

Clinical Applications

Infant Feeding

Neonatal Hematology

Perinatal Infection

Respiratory Distress

Nursery Care

Outcome of Neonatal Intensive Care and Threshold of Viability

Late Preterm Infant

Chapter 23. Postpartum Care and Long-Term Health

Considerations
Physiologic Changes

Management of the Puerperium

Health Maintenance

Pregnancy Prevention

Postpartum Psychological Reactions

Chapter 24. Lactation and Breastfeeding

Breast Anatomy and Development

Physiology of Lactation

13
 Breast Milk: The Gold Standard

Role of the Obstetrician and Gynecologist

Focused Issues in the Successful Management of Breastfeeding

Anatomic Abnormalities of the Breast

Labor and Delivery Management

Maternal Nutrition During Lactation

Breast and Nipple Pain

Mastitis and Breast Abscess

Milk Transfer and Infant Growth

Jaundice in the Newborn

Galactogogues: Drugs to Improve Milk Production

Maternal Disease

Breast Masses During Lactation

Back-to-Work Issues

Contraception

PART V. Complicated Pregnancy

Chapter 25. Surgery During Pregnancy

Maternal Physiology

Diagnostic Imaging

Nonobstetric Surgery and Pregnancy Outcome

Fetal Monitoring

Laparoscopy in Pregnancy

Adnexal Masses in Pregnancy

14
 Obesity, Bariatric Surgery, and Pregnancy

Chapter 26. Trauma and Related Surgery in Pregnancy

Incidence of Trauma in Pregnancy

Anatomic and Physiologic Changes of Pregnancy

Blunt Trauma

Specific Injuries

Management Considerations

Diagnostic Imaging

Exploratory Surgery for Traumatic Injuries During Pregnancy

Chapter 27. Early Pregnancy Loss and Stillbirth

Introduction

Frequency and Timing of Pregnancy Loss

Placental Anatomic Characteristics of Successful and Unsuccessful

Pregnancies

Numerical Chromosomal Abnormalities: Most Frequent Cause of Early

Pregnancy Loss

Chromosomal Rearrangements

Mosaics

Nonchromosomal Causes of Early Pregnancy Loss

Thrombophilias

Exogenous Agents

Management of Recurrent Early Pregnancy Loss

Late Pregnancy Loss (Stillbirth)

Obstetric Outcome After Early Pregnancy Complications

15
Chapter 28. Cervical Insufficiency
Overview

Short Cervix

Risk Factors for Cervical Insufficiency

Tests for Cervical Insufficiency

Clinical Diagnosis of Cervical Insufficiency

Sonographic Diagnosis of Cervical Insufficiency

Diagnosis of Cervical Insufficiency on Physical Examination

Treatment

Chapter 29. Preterm Labor and Birth

Overview

Definitions

Frequency of Preterm and Low-Birthweight Delivery

Clinical Care for Women in Preterm Labor

Diagnosis of Preterm Labor

Treatment for Women in Preterm Labor

Conduct of Labor and Delivery for the Preterm Infant

Prevention of Preterm Birth

Chapter 30. Premature Rupture of the Membranes

Overview

Fetal Membrane Anatomy and Physiology

Etiology of Premature Rupture of the Membranes

Clinical Course After Premature Rupture of the Membranes

16
 Risks of Premature Rupture of the Membranes

Management of Premature Rupture of the Membranes

Chapter 31. Preeclampsia and Hypertensive Disorders

Definitions

Preeclampsia

Eclampsia

Chrionic Hypertension

Chapter 32. Multiple Gestations

Zygosity and Chorionicity

Diagnosis of Multiple Gestations

Maternal and Fetal Risks of Multiple Gestation

Perinatal Morbidity and Mortality

Issues and Complications Unique to Multiple Gestations

Selective Intrauterine Growth Restriction in Monochorionic Twin

Pregnancies

Twin Anemia-Polycythemia Sequence

Antepartum Management of Multifetal Pregnancy

Timing of Delivery in Multiple Gestations

Mode of Delivery in Multiple Gestations

Intrapartum Management of Twin Vaginal Delivery

Chapter 33. Intrauterine Growth Restriction

Perinatal Mortality

Regulation of Fetal Growth

17
 Definition and Patterns of Fetal Growth Restriction

Etiologies of Intrauterine Growth Restriction

Maternal and Fetal Manifestations of Intrauterine Growth Restriction

Diagnostic Tools in Fetal Growth Restriction

Screening and Prevention of Fetal Growth Restriction

Management in Clinical Practice

Assessment of Fetal Well-Being

Timing of Delivery

Delivery

Chapter 34. Red Cell Alloimmunization

Nomenclature

Historic Perspectives

Incidence

Pathophysiology

Rhesus Alloimmunization and Fetal/Neonatal Hemolytic Disease of the

Newborn

Prevention of RhD Hemolytic Disease in the Fetus and Newborn

Clinical Management

Intrauterine Transfusion

Hemolytic Disease of the Fetus and Newborn Due to Non-RhD

Antibodies

Chapter 35. Amniotic Fluid Disorders

Overview

Amniotic Fluid Volume

18
 Amniotic Fluid Formation

Amniotic Fluid Removal

Oligohydramnios

Polyhydramnios

PART VI. Pregnancy and Coexisting Disease

Chapter 36. Prolonged and Postterm Pregnancy

Definition

Incidence

Etiology

Diagnosis

Perinatal Morbidity and Mortality

Maternal Complications

Management

Long-Term Neonatal Outcomes

Multiple Gestation

Chapter 37. Heart Disease in Pregnancy

Maternal Hemodynamics

Diagnosis and Evaluation of Heart Disease

General Care

Congenital Heart Disease

Summary

Cardiomyopathy

Myocardial Infarction

19
 Marfan Syndrome

Pulmonary Hypertension

Other Conditions

Critical Care: Hemodynamic Monitoring and Management

Chapter 38. Respiratory Disease in Pregnancy

Pneumonia in Pregnancy

Bacteriology

Bacterial Pneumonia

Viral Pneumonia

Tuberculosis in Pregnancy

Asthma in Pregnancy

Restrictive Lung Disease

Chapter 39. Renal Disease in Pregnancy

Altered Renal Physiology in Pregnancy

Asymptomatic Bacteriuria

Pyelonephritis

Acute Renal Disease in Pregnancy

Chronic Renal Disease in Pregnancy

Chapter 40. Diabetes Mellitus Complicating Pregnancy

Perinatal Morbidity and Mortality

Maternal Classification and Risk Assessment

Early Screening for Overt Diabetes and Detection of Gestational

Diabetes Mellitus

20
 Treatment of the Patient With Type 1 or Type 2 Diabetes Mellitus

Antepartum Fetal Evaluation

Timing and Mode of Delivery

Glucoregulation During Labor and Delivery

Management of Gestational Diabetes

Postpartum Follow-up in Gestational Diabetes Mellitus

Prepregnancy Counseling in Preexisting Diabetes Mellitus

Contraception

Chapter 41. Obesity in Pregnancy

Prevalence of Obesity in Women of Reproductive Age

Pregnancy Complications in Obese Women

Postpartum Considerations

Neonate/Child

Other Considerations

Chapter 42. Thyroid and Parathyroid Diseases in Pregnancy

Parathyroid Disorders

Thyroid Diseases

Chapter 43. Pituitary and Adrenal Disorders in Pregnancy

Anterior Pituitary

Posterior Pituitary

Adrenals

21
Chapter 44. Hematologic Complications of Pregnancy
Pregnancy-Associated Thrombocytopenia

Evaluation of Thrombocytopenia During Pregnancy and the

Puerperium

Therapy of Thrombocytopenia During Pregnancy

Management of Thrombotic Thrombocytopenic Purpura and Hemolytic-

Uremic Syndrome

Fetal/Neonatal Alloimmune Thrombocytopenia

Iron Deficiency Anemia

Megaloblastic Anemia

Hemoglobinopathies

von Willebrand Disease

Chapter 45. Thromboembolic Disorders in Pregnancy

Epidemiology and Incidence

Genetics

Pathophysiology of Thrombosis in Pregnancy

Chapter 46. Collagen Vascular Diseases in Pregnancy

Systemic Lupus Erythematosus

Antiphospholipid Syndrome

Rheumatoid Arthritis

Systemic Sclerosis

Sjögren Syndrome

Chapter 47. Hepatic Disorders During Pregnancy

22
 Overview

Differential Diagnosis of Hepatobiliary Symptoms and Conditions

During Pregnancy

Abdominal Imaging During Pregnancy

Pancreatobiliary Disease

Common Liver Diseases Incidental to Pregnancy

Chapter 48. Gastrointestinal Disorders During Pregnancy

Differential Diagnosis and Evaluation of Gastrointestinal Symptoms
During Pregnancy

Diagnostic Testing During Pregnancy

Chapter 49. Neurologic Disorders in Pregnancy

Epilepsy and Seizures

Multiple Sclerosis

Stroke

Carpal Tunnel Syndrome

Chapter 50. Malignant Diseases and Pregnancy

Introduction

Cancer Therapy During Pregnancy

Radiation Therapy

Surgery and Anesthesia

Pregnancy Following Cancer Treatment

Cancer During Pregnancy

Postoperative Adjuvant Therapy

23
 Central Nervous System Tumors

Neonatal Outcomes

Fetal-Placental Metastasis

Fertility Preservation

Gestational Trophoblastic Disease and Pregnancy-Related Issues

Chapter 51. Skin Disease and Pregnancy

Physiologic Skin Changes Induced by Pregnancy

Preexisting Skin Diseases and Tumors Affected by Pregnancy

Cutaneous Manifestations of Autoimmune Disorders

Pruritus in Pregnancy

Specific Dermatoses of Pregnancy

Chapter 52. Maternal and Perinatal Infection: Chlamydia,

Gonorrhea, and Syphilis in Pregnancy
Chlamydia

Gonorrhea

Syphilis

Congenital Syphilis

Chapter 53. Maternal and Perinatal Infection in Pregnancy: Viral

Viral Infections

Human Immunodeficiency Virus

Influenza

Parvovirus

Measles

24
 Cytomegalovirus Infection

Herpesvirus

Varicella

Hepatitis

Human Papillomavirus

Ebola

Chapter 54. Maternal and Perinatal Infection in Pregnancy: Bacterial

Group B Streptococcal Infection

Urinary Tract Infections

Upper Genital Tract Infections

Chapter 55. Mental Health and Behavioral Disorders in Pregnancy

Mood Disorders

Anxiety Disorders

Eating Disorders

Schizophrenia

Substance-Related Disorders

PART VII. Legal and Ethical Issues in

Perinatology

Chapter 56. Patient Safety and Quality Measurement in Obstetric

Care
Patient Safety

Approaches to Improve Obstetric Safety

25
 Measurement of Obstetric Quality of Care

Chapter 57. Ethical and Legal Issues in Perinatology

Reproductive Liberty

Abortion Politics and “Obamacare”

Human Embryonic Stem Cell Research Funding

Genetic Counseling, Screening, and Prenatal Diagnosis

Forced Cesarean Delivery

Chapter 58. Improving Global Maternal Health: Challenges and

Opportunities
Maternal and Reproductive Health

Sexual and Reproductive Health

Major Obstetric Complications: Prevention and Management in

Resource-Poor Countries

Practical Advice on Volunteering to Work Overseas

Appendix

Appendix A. Normal Values in Pregnancy and Ultrasound

Measurements

Appendix B. Anatomy of the Pelvis

Appendix C. Glossary of Key Abbreviations

Index

26
Copyright

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Philadelphia, PA 19103-2899

GABBE’S OBSTETRICS ESSENTIALS: NORMAL AND PROBLEM

PREGNANCIES ISBN: 978-0-323-60974-6

Copyright © 2019 by Elsevier, Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in

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Notices

Knowledge and best practice in this field are constantly changing.

27
As new research and experience broaden our understanding,
changes in research methods, professional practices, or medical
treatment may become necessary.

Practitioners and researchers must always rely on their own

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Library of Congress Cataloging-in-Publication Data

Names: Landon, Mark B., editor.

Title: Gabbe’s obstetrics essentials : normal and problem
pregnancies /
[edited by] Mark B. Landon [and 5 others].
Other titles: Obstetrics essentials | Abridgement of (work):
Obstetrics
(Gabbe) 7th edition
Description: Philadelphia, PA : Elsevier, [2019] | Abridgement of
Obstetrics

28
 / [edited by] Steven G. Gabbe [and 8 others]. Seventh edition.
2017. |
Includes bibliographical references and index.
Identifiers: LCCN 2018007618 | ISBN 9780323609746 (pbk. : alk.
paper)
Subjects: | MESH: Pregnancy Complications | Pregnancy | Prenatal
Care
Classification: LCC RG524 | NLM WQ 240 | DDC 618.2--dc23 LC
record available at
https://lccn.loc.gov/2018007618

Senior Content Strategist: Sarah Barth

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Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

29
Contributors
Kjersti Aagaard, MD, PhD, MSCI, Associate Professor,
Department of Obstetrics and Gynecology, Baylor College of
Medicine, Houston, Texas

Kristina M. Adams Waldorf, MD, Associate Professor,

Department of Obstetrics and Gynecology, University of
Washington, Seattle, Washington

Margaret Altemus, MD, Associate Professor, Department of

Psychiatry, Yale University School of Medicine, New Haven,
Connecticut

George J. Annas, JD, MPH, Professor and Chair, Department of

Health Law, Bioethics & Human Rights, Boston University School
of Public Health, Boston, Massachusetts

Kathleen M. Antony, MD, MSCI, Department of Obstetrics and

Gynecology, University of Wisconsin School of Medicine and
Public Health, Madison, Wisconsin

Jennifer L. Bailit, MD, MPH, Clinical Director, Family Care

Service Line, Metrohealth Medical Center, Cleveland, Ohio

Ahmet Alexander Baschat, MD, Director, Johns Hopkins Center

for Fetal Therapy, Department of Gynecology and Obstetrics, Johns
Hopkins Hospital, Baltimore, Maryland

Vincenzo Berghella, MD, Professor, Department of Obstetrics

30
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 “Is that so? I understood the Japanese wanted them to build
barracks for their soldiers on the land.”
“I have not heard anything about the Japanese wanting them; it
was that Frenchman who said he wanted them, to build a store
there.”
The benevolent spirit of this enterprising foreign friend is
revealed more intimately when we learn that he threatened to
shoot on the spot, if he could only find out who he was, the man
that had thwarted his plan for this bit of real-estate speculation.
The same intention was avowed by the American miner against
the foreign official of the Korean Government whom he regarded
as standing in the way of the success of the “Poong Poo”
Company (see p. 361 f.).
[92] Korea and Her Neighbors, by Isabella Bird Bishop, p. 64.
[93] Quoted from an anonymous letter, signed “Foreigner,” and
published in the Seoul Press, date of August 6, 1907. The spirit of
this passage is characteristic of the entire letter, which was nearly
a column long, and which was, alas! written by a missionary.
[94] Editorial in the Seoul Press, August 8, 1907.
[95] In this connection it should be remembered that the Young
Men’s Christian Association in Seoul is heavily subsidized by the
Residency-General in recognition of its services for the good of
the Koreans; that Marquis Ito sent a message of welcome,
accompanied by a gift of 10,000 yen, to the “World’s Christian
Student Federation” at its meeting in April, 1907, in Tokyo; and
that His Excellency has taken all possible pains to assure the
Christian missionaries in Korea of his desire for their active co-
operation, by use of the moral and spiritual forces which they
wield, with his plan to use the allied economic and educational
forces, for the betterment of the Korean nation.
[96] Letter to the Japan Times, published, Tokyo, May 9, 1907.
[97] See Problems of the Far East, by the Hon. George N.
Curzon, M.P. (1894), pp. 192-197.
[98] Compare the narratives of Part I, pp. 37-64; 90-111.
[99] “Abnormal,” i. e., from the point of view of what would be
expected from minds of a higher degree of culture and of self-
control.
 [100] With regard to the personnel of the Korean members of
this commission, the head was Yi Sung-sol, who had formerly
been a Cabinet Councillor. With him were associated Yi Chun-
yong, a Judge of the Supreme Court, and Yi Wi-chong, who was
at one time secretary to the Foreign Legation at Russia. The two
former seem to have taken the Siberian route to St. Petersburg,
where they arrived about April 20th, and were met there by Yi Wi-
chong. The Russian Government, being at that time negotiating a
treaty with Japan which was to recognize in most explicit terms
the Japanese Protectorate over Korea, and give to it a “free hand”
in the management of Korean affairs, naturally enough, gave no
encouragement to the Koreans or to their “foreign friend.”
In view of the large sum of money which, according to rumor at
the time, the Emperor contributed to this purpose, it seems
scarcely credible that the Korean delegates should feel compelled
at The Hague “to stay at a low-class hotel where the meals cost
about 50 sen” (or 25 cents in gold), as the cable despatch reports.
No less a sum than 240,000 yen was subsequently traced to
expenditure upon this futile scheme; and 100,000 yen additional
was suspected on good grounds. In addition to this, as the event
proved, it cost the Emperor his crown.
[101] It should be understood that the proposal of Count Inouye
did not contemplate taking the Korean Emperor prisoner and
carrying him off by force to Japan. It expressed simply the belief
on the Count’s part that the shortest way of making Korea accept
Japan’s guidance was to cause the Emperor to become
acquainted with Japan by personal observation.
[102] The mixture of ignorance and craft of which the ex-
Emperor is capable was illustrated in a humorous way by his
inquiry of Marquis Ito whether the Japanese Government would
not undertake the arrest and punishment of his own emissaries at
The Hague! The reply was, of course, that Japan could no more
do such a thing in Holland than Korea in Japan.
[103] This double policy of soliciting advice and help from
Marquis Ito, as his most true and powerful friend, while acting
contrary to the advice when given and rendering the help difficult
or impossible, has characterized the Emperor throughout in his
relations with the Marquis.
[104] It was subsequently reported that the number of Koreans
injured during the disturbances of this Friday was 210; since the
majority of these had bullet wounds and the Japanese police
were not armed with rifles, the conclusion is inevitable that most
of these casualties were occasioned by the firing upon the crowd
of the mutinous Korean soldiers.
[105] These quotations are from the article, the publication of
which was followed by the incident already narrated (p. 355,
note). This example is typical of the temper and methods of the
anti-Japanese leaders and their foreign friends.
[106] This is perhaps the place to deny, authoritatively and
finally, that Marquis Ito procured, counselled, or even gave
consent to, the act of abdication. Indeed, the members of the
Residency-General, and the Japanese in Seoul generally, who
approved of the more strenuous measures to be taken against
Korea, regretted to have the abdication take place. To use the
expression of one of them: “It dulled the edge of the Japanese
sword.”
[107] It should be understood that this office is the most
important and influential of all the Korean offices, so far as private
transactions with the Emperor are concerned. Now Pak Yong-hio,
after a life of idleness and debauchery in Japan, whither he had
fled some years before, and where he had been supported by the
kindness of Japanese and Korean friends, had recently been
pardoned and allowed to return to Korea. In petitioning for
permission to return, Pak dwelt in pathetic terms on his “home-
sickness,” and expressly promised in the future to refrain from
political intrigue. But he had scarcely set foot on the soil of Korea
before he began a most dishonest and disgraceful course of
political intrigue. A little more than twenty-four hours after his
pseudo-appointment as Minister of the Imperial Household, the
Cabinet Ministers ordered his arrest, and he was subsequently
condemned to be punished with eighty lashes and banished for
life to the Island of Quelpart. Such are the vicissitudes of Korean
political careers when most free from foreign influence!
[108] For the text of this new Convention, which is remarkable
at once for its brevity and its comprehensive indefiniteness, the
reader is referred to Appendix C. In view of the claims that the
Convention of 1905 could not have been consented to by the
Emperor because it does not bear his signature, or that it did not
have the consent of the Ministers, because they did not all sign it,
attention is called to the fact that the new Convention is signed
only by Marquis Ito and the Korean Prime Minister.
 [109] One of the leaders of the riot of July 19th confessed that
he was betrayed into his action by the false report of the Taihan
Mai-il Shimpo (or Korean edition of the Korean Daily News—Mr.
Bethell’s paper), that the Emperor would be forced to go to Japan
to apologize for The Hague incident. On reading the Japanese-
Korean Convention, however, he was surprised at the moderation
of Japan, and considered himself a fool for being deceived by the
paper. This is only one of innumerable instances illustrating the
truth that the English editor of this paper, and his American
coadjutor have, of late, probably done more mischief to the
Korean nation than any other persons except the Emperor and
his small coterie of corrupt Court officials.
[110] The word thus translated, however, means “paid” troops
rather than volunteers.
[111] How dangerous is prophecy touching the future of the Far
East is well illustrated by the following passage quoted from Mr.
Whigham’s generally calm and fair book on Manchuria and Korea,
p. 49. Speaking of the mistake which Japan made in not
preventing Russia from building the Manchurian Railway, Mr.
Whigham says: “On the other hand, one is more and more
convinced that what used to be talked about a short time ago as
the inevitable war between Russia and Japan is destined to end
in smoke, since the Japanese have already lost their great
opportunity.” This was written as of July, 1901. Less than three
years later “the inevitable war” began in the “smoke” of battle, and
ended with Japan in possession of this same Manchurian
Railway.
 INDEX

Agriculture, state of, 92 f., 122 f., 127 f., 301 f., 303, 304 f.;
founding Station and School of, 122 f., 126, 302
Alexeieff, M. Kir, doings of, in Korea, 224 f.
Allen, H. N. (Acting Minister), on education in Korea, 327
An Chung-ho, 107

Bell, the Great, at Seoul, 26, 31 f., 179 f.

Bethell, Mr., Editor Korean Daily News, 158
Bingham, Minister, 197 f.
Bishop, Mrs., quoted, 390
Brinkley, quoted, 184, 192, 193
Brown, Mr. J. McLeavy, Director of Customs, 224 f., 360
Buddha, “The Great White,” 137 f.
Buddhism, condition of, in Korea, 133 f., 137
Bunki, nature of, 342 f.

Chemulpo, visit to, 113 f.;

population of, 114;
appearance of, 114 f.;
harbor of, 115
China, influence of, on Korea, 181 f., 190, 194, 202 f., 253, 296;
its claims of suzerainty, 189 f., 191 f., 194, 196 f., 199, 203,
211 f., 216 f.;
soldiers of, in Korea, 203 f., 205 f., 214;
 war with, 214 f.;
present condition of, 444 f.
Cockburn, Mr., British Consul-General, 131 f., 134 f.
Confucianism, of Korea, characterized, 181 f., 296
Conventions (see also Treaties), with China, 210 f.;
Yamagata-Lobanoff, 224 f.;
of Nov., 1904, with Korea, 252-279, 414;
of July, 1907, 419, 431 f., 433;
disorder following, 434 f.
Councillor, in Privy Council, new office created, 82
Court, the Korean, corruptions of, 151 f., 297, 452;
cowardice of, 182 f.;
“Purification” of, 297, 452 f.
Crown Prince (now Emperor), 298 note
Curzon, Hon. George N., quoted, 402

Daily News, the Korean, 42, 52, 62 f.;

announces commission to The Hague, 83 f.;
attacks Dr. Jones, 355

Education, condition of, in Korea, 325-339;

earlier efforts at reform of, 327 f.;
modern organization of, 330 f., 335 f.;
missionary work in, 332 f.;
attitude of Koreans toward, 334;
interest of Japan in, 336
Ellis, Mr. Wm. T., 367
Emperor, of Korea (now ex-Emperor), audience with, 44 f., 147
f.;
personal appearance of, 44 f.;
message to, 148 f.;
character of, 151 f., 154 f., 158, 175 f., 235 f., 282 f., 286 f.;
 renounces suzerainty of China, 216 f.;
flees to Russian Legation, 220;
subsequent behavior, 233 f.;
treachery of, 242, 244, 246, 298, 361, 415, 428 f.;
receives letter from Emperor of Japan, 254;
his part in Convention of 1904, 256 f., 259 f., 268 f., 274 f.,
415 f.;
abdication of, 423, 428
Epworth League, fate of, in Korea, 38
Eui Wha, Prince, 17, 75 f.

Foulk, Ensign George C., report of, to United States, 200 f., 203,
204 f.;
quoted, 376
Fusan, town of, 15 f., 140 f., 142;
public park in, 15, 142;
reception at, 16 f., 140 f., 143;
lectures at, 142;
schools of, 142;
revolt of settlers in, 185

Gale, Dr., quoted, 378

General Sherman, the visit of the, to Korea, 191

Hague, Peace Conference of, Korean Commissioners to, 83 f.,

298, 414, 416;
Japanese press concerning, 418 f.;
action of Tokyo Government, 419
Hai-tai, the, 28
Hall, of “Audience,” 29;
of “Congratulations,” 30
Hamilton, Angus, quoted, 377
Han, Korean Prime Minister in 1904, 263 f., 266 note, 267
Hanyang, town of, predecessor to Seoul, 22, 32
Harris, Bishop M. C., quoted, 397
Hay, Secretary, efforts of, 236 f.
Hayashi, Minister in Korea, 260, 263, 269;
special Ambassador to Korea, 419 f., 421 f.
Hershey, quoted, 219 f., 223 f.
Hideyoshi, the invasion of, 15 f., 25, 90 f., 183 f., 187 f.;
war with Prince Mori, 145
Hiro-Mura, trip to, 6 f.
Hulbert, Mr. Homer B., leaves Seoul, 83 f.;
on Korean history, 182;
quoted, 183, 236, 289, 290, 291, 293, 295, 336;
charges of, examined, 375

Ichihara, Mr., President of “Economies Club,” 55 f.

Il Chin-hoi (Society), memorial of, to Ministers, 76 f.;
to Residency-General, 430 f.
Independence Arch, 43, 132
Independence Hall, 43;
lecture at, 52
Industrial Training School, founded at Seoul, 128 f.
Inouye, Count, negotiates treaty with Korea, 107 f.;
later visit of, as ambassador, 205 f.;
administration in Korea, 218 f.;
views on Commission to The Hague, 417 f.
Ito, Prince Hirobumi, invitation of, 3 f., 8 f., 14, 37 f., 40 f., 56;
attitude of, toward Korea, 8 f., 55 f., 64, 139, 157, 164 f.,
169 f., 226, 395 f.;
 work of, in Korea, 86 f., 168 f., 173 f., 253 f., 287 f., 298,
301 f., 330 f., 341 f., 355 f., 412;
negotiates treaty with China, 194 f., 210 f.;
speech of (1898), 226 f.;
visits Peking, 231;
and St. Petersburg, 232;
negotiates Conventions with Korea, 252 f., 256, 260 f.;
in Convention of 1907, 421, 424, 432 f.;
enlarged plans of, 441;
visits Tokyo, Aug., 1907, 442
Iyeyasu, treatment of Korea by, 189 f.

Japanese, characteristics of, 1 f., 55, 121 f., 183, 431 f., 454,
457;
invasion by, 15 f., 25, 183 f.;
settlements of, in Korea, 15 f., 19, 114, 143 f., 450 f.;
as an audience, 55, 97;
relations of, to Koreans, 55 f., 59 f., 91, 109 f., 119 f., 150 f.,
171 f., 202 f., 368 f., 393 f., 458;
ladies in Seoul, 57 f.
Japan Times, quoted, 418 f.
Jones, Dr. G. Heber, quoted, 22, 23, 27, 89, 168 f., 179, 425;
assistance by, in work, 48, 49, 52 f., 59, 113 f.;
interview of, with Marquis Ito, 63 f.;
attack upon, 355 note
Justice, the Public, previous condition of, 340 f., 343, 345, 347
f., 369;
use of torture, 340 f., 375 f.;
attempts at reform of, 341 f., 343 f., 349 f.;
police system, 345 f.;
courts of, 347 f.

Kabayama, Admiral, visits Korea, 205 f.

Kang, chief Eunuch, 154
Kenochi, Mr., Resident at Chemulpo, 117
Kikuchi, Mr., Resident at Pyeng-yang, 100
Kimmei, Korean envoy to, 186
Kim Ok-kiun, 31;
murder of, 213
Kim Tuk-nyung, Korean general, 183
Korea, country of, 19 f., 92 f., 113 f., 301;
hunting tigers in, 120 f.;
historical relations of, to Japan, 179-251;
reasons for its degradation, 180 f.;
treaty of 1876 with, 182;
trade relations with Japan, 185 f., 356;
control of, by Japan, 242 f., 452 f.;
resources of, 300 f., 303 f., 310 f., 322 f.;
reforestation of, 306 f., 308 f.;
mines of, 309 f., 361 f.;
customs of, 313 f., 324 f.;
finances of, 315 f., 318 f., 320 f., 356 f.;
debt of, 324;
foreign trade of, 356 f.
Koreans, the condition of, 8 f., 60, 158 f., 160 f., 180 f.;
characteristics of, 86 f., 105 f., 120, 129, 162 f., 180 f., 289
f., 295 f., 428 f.;
independence of, 8 f., 169, 174 f., 216 f., 296 f., 336 note;
intrigues of, 8, 10 f., 66, 68 f., 85 f., 105, 171 f., 201 f., 218
f., 371 f.;
appearance of, 18, 47 f., 292, 294;
superstitions of, 23 f., 131, 293 f., 391;
burial places of, 23 f., 132 f.;
as an audience, 47 f., 51 f.;
women, 57 f., 86 f., 294;
murder Japanese, 202, 206 f., 399, 425;
as workmen, 292 f.;
 emigration of, 364 f.;
religious condition of, 390 f., 392 f.
Korean Review, quoted, 315, 327, 328 f.
Kublai Khan, Embassy of, 187
Kuroda, General, makes treaty with Korea, 182, 197 f.
Kuruda, Mr., villa of, 141 f.
Kwon, Minister of War, attempted assassination of, 66 f., 70 f.;
address of, at Suwon, 127

Lady Om, address at school of, 54 f., 155

Lawrence, Prof., on Convention of Feb., 1904, 247 f.
Laws, absence of code of, 341 f.;
affecting real estate, 342 f.;
and mines, 362 f.
Li Hung Chang, 13;
negotiates treaty with Japan, 209

Manchurian Question, the, 229-233, 236

Megata, Mr., appointed “Financial Adviser,” 246 f., 315;
work of, 246 f., 301, 308, 315 f., 318 f., 320 f., 355
Min, the Family, 200, 201 f., 203 f.
Min Hyung-sik, Vice-Minister of Education, 51, 72, 74
Min Yung-whong, commits suicide, 278 f.
Ministry, the Korean, change in personnel, 76 f.;
and character of office, 80 f., 246, 252;
position of, in Russian Legation, 222 f.;
behavior of, in 1907, 420, 421
Missions, success of, in Korea, 61, 93 f., 404 f., 408 f., 441;
founding of, 116, 401, 403, 404 f.;
schools of, 332 f.;
 differing views as to, 388 f., 400;
need of civil support, 394 f., 412;
work of woman in, 400 f.;
persecution of, by Koreans, 401, 402;
the Roman Catholic, 403 f.;
the Protestant, 404 f.;
“Great Revival” among the, 408 f., 410 f.
Missionaries, attitude of, 58 f., 60, 166 f., 396 f., 398;
complaints of, 62 f., 368;
educational work of, 332 f.;
difficulties of, 392 f., 401 f.;
martyrs among, 401 f.
Mollendorff, M. von, action of, in Korea, 207 f.
Mongols, invasions of, 184 f.
Moore, Digest of International Law, quoted, 211 f.

Nagasaki, visit to, 12 f.

Nam-san, view from, 23, 40;
wild-cats on, 39 f.
Noble, Dr., 93, 102, 106, 110
Norman, Henry, quoted, 377

Pagoda, the Marble, 32 f.;

the “Pagoda Incident,” 384
Pak, Acting Prime Minister, attempted assassination of, 66;
resigns, 77;
action as Minister of Foreign Affairs, 264, 268 f.
Pak Yong-hio, conduct of, 428 f.
Pak Yong-hwa, assassination of, 68
Palaces, the “Special South,” 27;
the “Mulberry,” 27 f., 287;
 the “Palace of Beautiful Blessing,” 28 f.;
East Palace, 30 f.;
the present residence, described, 44 f., 153 f.
Pavloff, M., Minister to Korea, 227 f., 237 f.
“Peony Point,” visit to, 100 f.
Po-an, Secret Society, suppressed, 244
Prince, the “little” (Son of Lady Om), appearance of, 44 f.;
made Crown Prince, 441
Protectorate, the Japanese, effect of, on business, 118 f., 352 f.;
Protocols establishing, 245 f., 248, 253, 433;
Prof. Lawrence on, 247 f.;
as arranged in Nov., 1904, 253 f., 264 f., 272 f.;
false reports concerning, 253 note f., 378 f.;
as affecting foreign relations, 352 f., 354 f.;
extended to home affairs, 433 f.;
prospects of, 446 f.
Protocols, with Russia (1896), 224;
Nishi-Rosen (1898), 225;
with Korea (Feb., 1904), 245 f., 255, 273;
and (Aug., 1904), 245 f., 248, 255, 273
Puk Han, as mountain fortress, 22, 133;
excursion to, 131 f.;
walls of, 133, 135 f.;
flora of, 134
Pyeng-yang, invitation to, 43 f.;
history of, 90 f., 100 f.;
Japanese in, 91, 97 f., 383 f.;
visit to, 90 f., 110;
missions in, 63 f., 107 f., 110;
audiences in, 93 f., 96 f., 107;
improvements in, 98 f., 101;
theological students of, 102 f., 104, 107 f.;
Governor of, 103 f.;
stud-farm at, 383 f.
Queen, the late, her assassination, 30, 219 f.;
character of, 283 f.

Railways, Fusan-Seoul, 16 f., 139 f.;

Seoul-Pyeng-yang, 92;
Seoul-Electric, 230 f.;
the Sanyo, 246;
construction of, in Korea, 373 f., 379 f.
Resident-General (see also Ito), interests of, 8 f., 122 f., 129 f.,
169 f., 175 f.;
social influence of, 86 f.;
creation of office of, 270 f.;
scope of present power of, 452 f.
Reynolds, Rev. Mr., skill as linguist, 48 f.
Rockhill, Minister, on China’s suzerainty over Korea, 198 f.;
on the Manchurian Question, 236
Root, Secretary, recognizes Japanese Protectorate, 249
Russia, Treaty of, with Japan, 9 f.;
domination of, in Korea, 221 f., 227 f., 230 f., 236 f.;
negotiations with, 239 f.

Saga Party, the, 193 f.

Saionji, Marquis, Ambassador to Korea, 216
Schools, in Korea, 17 f., 142, 325, 330, 332, 335
Scranton, Dr. W. B., 63, 404
Seoul, arrived at, 19 f.;
aspects of, 20 f., 23, 34 f., 130;
meaning of word, 22;
walls of, 24 f.;
gates of, 25 f.;
palaces of, 27 f.;
lectures at, 43 f., 54 f.;
 foreigners in, 85 f.;
influence as capital city, 88 f.;
departure from, 139 f.
Seoul Press, the, quoted, 66 f., 70 f., 99 f., 122 f., 160 f., 301 f.,
415
Shimonoseki, Treaty of, 13
Sill, American Minister, report of, 214 f.
Son-o-gong, 26
Sontag, Miss, 20
Speyer, M. de, policy of, 225
Stevens, Hon. D. W., 140, 205 f.;
on Korean complaints, 171 f.;
his account of Count Inouye’s Embassy, 205-209;
on outbreak of war, 243;
appointed “Adviser” on Foreign Affairs, 246;
quoted, 269, 315, 342, 353, 370, 376
Suwon, Agricultural Station and School at, 122 f., 126 f.;
excursion to, 126 f.

Tablet, the Tortoise, 33

Tai Won Kun, the quarrels of, with Queen, 26, 201 f., 218, 219 f.,
284;
builds palace, 28, 306;
character of, 282 f., 401, 402;
persecutes Christians, 400, 401 f.
Takezoye, Minister at Korea, 405 f.
Tokugawa, Prince, his visit to Korea, 75 f., 88
Tokugawas, the, their treatment of Korea, 189 f.
Tong Hak, rebellion of, 213 f., 216 f.
Townsend, Mr. W. D., 116, 118 f.
Treaties (see also Conventions), with Japan, in 1876, 182, 197
f.;
the Shufeldt, 192;
Japan and China, 210 f.
Tsushima, relations of, to Korea, 15, 185

United States, relations of, to Korea, 191 f., 197 f., 199, 211 f.,
216, 236, 249;
Foreign Relations (Reports), quoted, 216, 249;
recognizes Japanese Protectorate, 249 f.

Waeber, M., Russian Minister in Korea, 223

Wakayama, visit to, 8 f.
Walls, of Seoul, 24 f.;
of Puk Han, 133, 135
Whigham, quoted, 245, 296, 445 note
Wilkinson, The Government of Korea, quoted, 212 f.

Yagi, Capt., 1 f.
Yang-ban, the Korean, 39, 74, 156;
baleful influence of, 112 f., 156 f., 287 f.;
character of certain, described, 288 f., 291
Yi, Korean admiral, 183, 189
Yi Hy-eung (see Emperor, now ex-Emperor)
Yi Wan-yong, appointed Prime Minister, 77 f.;
action of, in Nov., 1904, 264 f.;
signs Convention of 1907, 432
Yi Yong-ik, Emperor’s favorite, 235, 243, 286
Yi Yong-tai, 70, 73, 74
Yomiuri, Japanese paper, extract from, 167 f.
Young Men’s Christian Association, invitation from, 38 f., 42;
assistance of, 42 f., 53, 407;
lectures at, 43 f., 47 f., 54 f.;
Korean helpers of, 50 f., 83 f.;
subsidy to, 396;
success of, 407
Yuan Shi Kai, doings in Korea, 31, 210 f., 212
Yun Chi-ho, Mr., 39

Zumoto, Mr., 13, 92, 113

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