Gregg Custis J B
There is no office filled by the physician that is so sacred as that of obstetrician, and none in which he has so great opportunity for good or evil.
When he is acting in that capacity he comes into closer relation with his patient, and nearer the very heart of the family than is possible in any other; and to him is committed, confidingly and almost absolutely, the welfare of his patient and her offspring, in whom are centered the hopes and happiness of the family, not for the time being only, but for the years of the future as well, for according to the judgment and skill with which he guides her through her hour of peril, will be her capacity for filing, in its fullness, the office of mother, the duties and responsibilities of which end only with her life, and the benign influences of which mould the life of her offspring, and reach to the generations beyond.
Again; there has been no such boon to the human race, none that has done so much to advance civilization, since the establishment of the Christian religion, as the recognition of the law of similia and its adoption as a fundamental principle in the practice of medicine, and he who receives it fully, and applies it faithfully, is a fountain of blessing wherever employed; and pre-eminently so when called to advise and direct and help in the case of the women who in her own body is bearing the life of another, and who, in the fullness of time, under the guidance of his wisdom and skill shall bring it forth to grow up into the perfection of development of manhood or womanhood.
To thus receive fully, and apply faithfully, the law which is constant and never fails us, we must know and receive and practice; making them a part of our very life, the teachings of the great master who grasped the law as none before him did, and who received, developed, proclaimed and practiced it with a capacity, faith, zeal and perseverance unequaled by any example we have in the annals of medicine.
My paper is to deal with elementary obstetrics, and my excuse for writing it is my earnest conviction of the necessity that this Association should be heard on the subject, for the honor of the medical profession, and the protection of the mothers and children.
When a professor of a leading Homoeopathic College tells his students never to leave the lying-in chamber until they have given the woman an antiseptic injection; when the larger part of the discussion of a medical society meeting is given up to a consideration of the question whether we shall use Carbolic Acid, Corrosive Sublimate, Cresoline, Soda, Listerine or Sanitas, for washing out the vagina; and when the only Homoeopathic Journal of Obstetrics republishes, with approval, methods long since discarded by the allopathic school-for instance, that we should give a considerable dose of quinine every fifteen minutes during labor.
Again, when we consider that more than three-fourths of the work of the gynecologist is to repair the injuries sustained in childbirth, we are more than justified, indeed it becomes our duty as Hahnemannians, to talk over our methods, even the elementary, and to determine whether we do not attain to better results than the allopathic obstetricians, or than the spurious homoeopaths, many of whom are boastful of their independence of the law that they invoke, and adherence to which, alone, gives light to the title of homoeopath.
We all agree that it is the duty every pregnant woman to consult her physician as soon as she thinks herself to be enciente, confiding to him her hopes and fears in connection with child bearing.
When she does apply, examine first into her personal history from childhood, and into the child-bearing history of her mother . Examine her as to all the functions of her body, and as to the minute history of her pregnancy up to the time of consultation.
If any antipsoric remedy is indicated, prescribe it, no matter what remedy minor functional symptoms may suggest. Under the action of the antipsoric, symptoms will often disappear though they are not all found in the Materia Medica. If the functional symptoms do not disappear under its action, a good foundation will have been laid. I have seen the most obstinate cases of vomiting yield like magic, after the indicated antipsoric had been given, to remedies which had failed previous to its administration.
After the fourth mouth examine the urine, and continue to examine it every mouth, and oftener if there is much headache or oedema. If albumen is found, and no other remedy is specially indicated, Merc. cor. will generally reduce it.
Now as to diet, about which we are frequently asked. In the case of a primipara, let her cat liberally of a mixed diet, insisting that she shall eat some fruit; and, within reasonable bounds, let her follow any idiosyncrasy of diet, avoiding only those things which all know to be indigestible, and especially those which experience has taught her disagree with her.
In case the history of other confinements shows a long, difficult labor, increase fruit and vegetables, and decrease meat. The same should be required when albumen is found in the urine.
Have her avoid the use of lime water, especially if she is a Calcarea patient, because such assimilate the lime more easily during pregnancy, and if they use the “hard water” you will at least have a “hard-headed” baby. But the restriction of the diet to vegetables, fruits or meats exclusively is not favorable, because of its effects on the foetus. We must remember that the child which we seek to bring into the world has to be prepared for the various demands of a complex life. We do not want a child deficient in bone any more than one deficient in nervous development or flesh.
The tokological methods are very fashionable in our part of the country. I have seen all tried, and only lately, when called to see a weekly specimen of its work, the very bright nurse said, “Doctor, here is a case in which the teachings of tokology have been followed to the letter. Look at that”.
The mother indeed looked well, and from appearances should have had a perfect child. She had no pain; the child was born before the physician could be reached, but the issue was a thin, nervous, whining baby that lived about two months.
No right-minded woman wants an “easy time” at the expense of her child. I can see no reason for giving remedies to “make an easy labor.” If they accomplish the purpose it must be through their power to relax the organs involved, while we know that the greater the tone of the system the more rapid and complete is the recovery of the patient.
I give occasional dose of Pulsatilla during the last mouth, because the evidence seems to show that it has changed the position of the foetus, bringing about a natural and not an unnatural one.
Having reached full term, insist that you be sent for at the first appearance of labor, for then if the position is not favorable it can be corrected.
Make the diagnosis of position at that time, and see that the os points towards the axis of the vagina. In the early stage this can be readily corrected, if necessary, by the influence of gravity, and pressure upon the abdomen while you have a finger in the os.
I have known slight deviations in the position of the uterus to cause, during the last week of pregnancy, severe headache; and, in fact, it may cause reflex neuralgia in almost any part of the body. To give the patient comfort in these cases it may be necessary for her to lie in bed with hips elevated for a considerable time. When the mal-position is due to a large and pendulous abdomen, it is better to wait for the second stage of labor before making compensation for it.
Headache is a threatening sign and must be watched. Never get beyond call of a lying-in woman with a headache, or fever, or one who has albumen in her urine. Either may have convulsions without any other warning. The remedies most likely to be called for in cases of headache are Bell., Acon., Gels., Glon., Hyos., Cim., Nux., and spig. Their indications here are the same as everywhere else.
If along with the headache there is any important of vision, convulsions are imminent, and in the case of primipara hasten delivery by any means possible.
Note the condition of the vulva and vagina. If the patient is intolerant of examination, Plat. or Arm. will remove the sensitiveness, if local, and Bell. or China if caused by the condition of the nervous system.
As to the state of the os, if it exhibits a tendency to spasm, or is too rigid, careful and firm pressure of the finger in addition to Bell., Gels, or Cim. will relieve it. This condition is always accompanied by nervous symptoms which will help us to differentiate between the remedies.
After the second stage begins, stay by year patient to encourage, direct and help. if the anterior lip is large, you can hasten delivery by holding it out of the way, and your management of the last pains and of the head during the last moments, will determine whether or not you have helped the woman, and whether the midwife would not have done as well.
Too rapid delivery of the head is to be avoided. If it does not fall into the sacrum, firm and steady pressure will help it. If it presses too far back, raise it up by putting the second finger in the rectum while you hold the head back with the palm of the hand until the soft parts are sufficiently dilated for its safe passage. Following these precautions, you will have few cases of lacerated perineum.
During the last few minutes the free use of cosmoline or lanoline will materially help, as also the application of cloths wrung out of hot water, in cases of special difficulty or danger to the perineum.
It is not my purpose at this time to take up the conduct of labor in cases in which the presentation is abnormal, but rather to show what must not be done. You will notice that I have said nothing about the preparation of the bed or the patient’s clothing, not because I am not mindful of its importance, but because of the limited time, and because I know that every one of us has the best method. My only rule is, do every thing possible to avoid unnecessary movement or excitement of the patient after delivery. Beyond that adapt yourself to circumstances.
Now in regard to the use of forceps. In skilful hands they are a great boon to the woman, and often the salvation of the child. If in your judgment their use is, or will be, necessary, do not wait until the patient is exhausted, either physically or nervously. use them while she is strong and reasonable. When convulsions threaten or are present, use them as soon as they can be introduced within the os. They will be required in seven out of ten occipito-posterior presentations; also in face and brow presentations.
We find some cases in which the head advance and recedes, in which, generally, the cord is around the neck, and in which forceps are indicated for the safety of the child. In short, use forceps when any danger threatens either mother or child, which will have passed or been lessened by delivery, but when nature seems competent to finish labor safety, give her a chance.
In regard to anaesthetics, the fact that a woman is in labor is no indication for their use. I have just heard a prominent practitioner say that he used Chloroform in every case. There is no such thing as an absolutely safe anaesthetic, or an absolutely safe method of administration; but I believe that under their influence the operator has better control of his patient and there is less danger from shock in cases where forceps are required, through I never give the anaesthetic until they are applied. Convulsions are an indication for its use, as also a condition of nervous excitement in which the pains seem to be cut short. a necessary caution is to stop the administration as son as delivery is complete, and not renew it in repairing damage to the perineum, when that occurs. The only case in which I have observed evidence of shock was one in which the anaesthetic was renewed for that purpose.
As to the particular anaesthetic to be used, I say Chloroform, without hesitation. Either, with its vomiting and consequent depression, is not safe. With the antidotes, amyl Nitrite, either and brandy at hand, you have complete control of the patient under the use of the former.
As to remedies to be used, I can add nothing to what has been left us by henry MN. Guernsey, M.D., in the 3rd edition of his work on Obstetrics. The indications there are pure gold. I would call special attention to Bell, when we have head pains; Caust. or Puls. when back pains are excessive; Gels. when pains go up instead of down; Cham. for the cross patient, and Arn. for the patient who complains more than the pains warrant.
Now that the child is delivered, what about the cord/ Wait until its pulsations stop, no matter how long it may be. I have waited for a half hour. As long as it beats there is no danger from haemorrhage, as the placenta is not detached from the womb, and you give the child a full chance for life. Watch the child’s color change from blue to white, and then to pink, and we will see one reason for waiting.
By following this method we will have no blue babies, and I do not believe we will have any trouble from retained placenta, or hour glass contractions of the uterus. I would like to hear the experience of those present on this point.
After you have laid the baby aside, you will find the placenta lying either in the month of the uterus or in the vagina.
As to tying the cord, each can follow his own method. I see no great difference in the results from the varied practice.
My practice is to tie on the foetal side for the sake of cleanliness, and because bleeding does sometimes occur with some danger to the child, and much to the nerves of the mother. I also tie on the placental side for the sake of cleanliness, and because it leaves more bulk to the placenta and gives more stimulus to the uterus.
As to the dressing for the cord, there is nothing equal to absorbent cotton, unless it be the latest absorbent, wood wool, when we can get it free from corrosive sublimate.
Leaving the child, the first rule in regard to the management of the placenta is, do not be in a hurry, unless there is haemorrhage, in which case, deliver immediately; otherwise, wait until it can be reached with one finger, which you can hook into the side of it, and by pressure on the uterus excite sufficient pain for its expulsion. I can see no advantage in forcible expulsion.
Puls., Bell., or Caul, are the only remedies I have had to use to aid expulsion.
After the placenta is expelled examine it to see that it is complete, and that you have the membrane as well.
If you have attended to the third stage of labor thoroughly there is no cause for septicemia, and there need be no fear on account of the state of the uterus.
If there is haemorrhage, keep cool. It is no reason for following any allopathic method. It is a case in which you can prescribe on one symptom, when such a master as Guernsey has laid down the signs.
As for myself, I have not needed to go outside of Sab., Croc., Ipec., China, or Bell., with the addition of brandy and Valentine’s beef juice; but her you can use compression of the uterus with advantage, as also in some cases the injection of hot water. If you do use it, do it thoroughly. Have the water hot; apply it yourself, and inject until it returns clear.
Now, the child having been delivered, the placenta removed, the perineum examined, either by daylight or candle light, and repaired if necessary, and the wet clothing removed, what next? Let your patient rest. There is no condition more intolerant of handling, or of unnecessary exertion, then the lying-in-state, and none in which a patient is more deserving of rest and careful watching than the woman who has just given birth to a living soul.
One professor says: “Never leave her until you have given an antiseptic injection.” And why? Surely not because of anything that has come from her? A human soul represents the best blood of the mother, and all that is best of the father. Then it must be on account of the accoucheur. he must have introduced something unclean; perhaps so, if he has used Carbolized Vaseline, Eucalyptus or Corrosive Sublimate, without which I have been told, you should not enter the lying-in-room.
But, why should we use any of these foul-smelling, life- destroying mixtures? is this the one physiological act in which nature show weakness? the one normal physiological act that needs the physician’s interference/ One says, “suppose you have a foul- smelling discharge? Well, suppose you have. what does it mean? I grant that it means that something is wrong; and it is an indication for remedies, and Carbo an., Carbo veg., or Carbolic Acid 200, or higher, will generally remove the cause.
Now, as to laceration of the cervix uteri, I have no doubt that in the majority of cases of child-birth the cervix is torn, and that in nearly every one of them it will heal if let alone, to be bathed only by the natural discharges; but to be bathed in the foul-smelling decoctions of the later-day scientists will interfere with the healing of anything. The very originators of antiseptic treatment are now advocating dry dressing after operations, while the obstetricians advise daily or hourly interference with liquid, so-called, antiseptic injections. The gynecologist has to follow this unnatural treatment, and you can judge of the obstetrician’s usefulness by the amount of work he leaves for the gynecologist to do.
Let your patient lie quietly in bed; if weak give beef juice and gruel; if not weak, the old style tea and toast until the flow of milk is established and then feed her liberally, and she will need little treatment. if she does, prescribe for her as you would for any other patient, forgetting as far as possible that she has given birth to a child, and you will have but few complaints.
Gentlemen, time will not admit of my going more into detail, but I promise that in the future you shall have the entire treatment of complications, constitutional and special, on a Hahnemannian basis, and that it may be complete I want your help.
Let this organization be outspoken on all subjects. it requires courage on the part of the struggling physician to practice Hahnemannian homoeopathy in the face of popular prejudice, and more to face the pseudo scientists in his own school.
We can, by giving such men a guide in their work, give them courage and strength, such as is inspired by conformity with the teachings of a recognized and respected authority. Through observation and experience I know that there is no body of men in this country who individually exert such influence as the working members of the I.H.A.
Dr. J.B. Bell: I wish to enter a strong protest against either Cosmoline or vaseline coming in contact with a human being. They produce symptoms, and are, therefore, not entirely innocuous; and I want to protest still more strongly against Chloroform requires the entire attention of a skilful man. It is not much less dangerous to a lying-in woman than to others, and, therefore, the obstetrician should not trust himself to give it while his attention is taken up with other matters. Either, on the other hand, given in the small quantities required does not call for the services of another, does not produce vomiting, and does not prostrate.
Dr. Hawley: What is the use of Cosmoline or of Vaseline, or of anything of that kind? Oils and fats are always heating to a mucous surface. I once took about four ounces of lard out of the vagina of a woman in labor. it had been put there by the doctor to lubricate the parts. twenty-four hours had passed without any progress being made, and beneath that lard I found the vagina just as dry as a bone. The lard remove, the natural moisture was soon restored and the baby was born within fifteen minutes afterwards.
Dr. H.C. Allen: I should like to know why Dr. Custis always gives Pulsatilla in the last few weeks of gestation, without any indications?.
Dr. Custis: Because since I have been doing if I have never had a case of abnormal presentation, and because I have never seen any trouble arising from it.
Dr. Reed: I am opposed to the administration of any remedy as a preparation for labor, unless it is indicated. If gestation is normal, then any remedy will do harm. There is no more excuse for giving Pulsatilla than there is for giving Chamomilla or Gelsemium or any other remedy at such a time.
Dr. Carleton: A protest to a protest! Anything in this world but Either in the lying-in room. it is too sickening. There may have been more deaths, oil told, from Chloroform than from Ether since their discoveries, but there have been deaths from Ether at the hands of the best men. Some of you may recollect the narrow escapes reported by me to this Association, where all the common methods of resuscitation failed, and only the bastinado was able to restore the patients after they had been given up for dead. And Ether was the only anaesthetic which had been used. I never entrust the administration of any anaesthetic to the nurse. The responsibility is too great.
Dr. Farley: In the paper read, Mercurius cor. is advised if there should be albumen in the urine. I do not think that advice should go unchallenged.
Dr. Reed: I entirely disagree with Dr. Custis on the Mercurius cor. question. never give any medicine unless it is indicated, and I do not think albumen in the urine without any subjective symptom is an indication for Mercurius cor. In regard to an assistant in labor, you should remember that many babies are born in the country, ten miles from any help, so that an assistant is not so easy to get. I suppose I have performed instrumental deliveries twenty-five times without help.
Dr. Hichcock: A gentleman of large experience told me that he had never had to use forceps. Are forceps a necessity?.
Dr. Wesselhoeft: Dr. Bell once left a young man in charge of his practice during a short absence. The young man had two cases of placenta previa before Dr. Bell returned. Dr. Bell had never, up to that time, seen a case of placenta previa. I left the same young man in charge of my practice, and before I got back he had a placenta previa. I have never seen a case of that kind. That young man must have been unlucky.
Now, when a man says he has gone through a long life of medical practice without using the forceps, he must have been awfully lucky, that’s all. I have been obliged to use the instruments after the most careful and thoughtful administration of remedies which helped nothing.
My father, who practiced medicine for forty years, had very remarkable mechanical skill. He was a whitesmith by trade, and made many of his own instruments. In forty years he had used instruments in labor only three times. I have used them much oftener than that in thirty-five years.
Dr. Carr: The forceps are certainly necessary at times, but in the majority of abnormal cases, we can get a natural delivery by the use of remedies, and hence I object to a too early or thoughtless use of instruments. They may save life, however, and should always be on hand. I have had two cases of placenta previa; I have used chloroform, but never either. I think also that there is too much haste in cutting the cord, and the rule given by Dr. Custis is correct, but I do not think any remedy should be given during gestation unless indicated.
Dr. Kent: All through the history of obstetrics, we find women have died during childbirth, and I have no doubt but that many more women would die in the present time, were it not for the forceps. The indicated remedy may not be easily found at the time, and not everybody is expert enough to find a remedy to correct the wrong in advance. I have had to deliver with forceps on that account; yet I have known men with many times my obstetrical practice, who have never used the forceps.
It is a difficult question to solve, concerning anaesthetics. I remember one case in which I expected to deliver with forceps, without an anaesthetic, as I had done before, and have done since. It was a case in which thickening and infiltration of tissue had followed a pelvic cellulitis. The cervix was undilatable. Dilatation had to be performed mechanically, and forceps had to be introduced high.
The intense agony, the extreme suffering, it seemed to me, would destroy the woman’s life. It was rare case and I had to give chloroform. At the same time I do not want to be understood as endorsing or advising the use of chloroform except in some case of horrible suffering.
Dr. Custis: I do not see how the remedies can possibly do away with the forceps, where we have non-conformity between the axes of the head and of the pelvis. If the head is too large it is beyond the province of remedies to decrease its size; the forceps will do so. i have used chloroform only in obstetrical practice. The stimulus to the heart of child-bearing seems to counteract the depressing effect of the chloroform, and I have never had any bad results. It is, of course, best to have another physician present, but not absolutely necessary. I have elsewhere, in a paper on albuminuria, given the effect of Mercurius cor., getting a positive action from it in the sixtieth decimal trituration. Following this experience I have given Mercurius cor. on a pathological basis on this symptom alone.
Dr. Hoyne: did Dr. Custis ever hear of a death from the administration of chloroform during labor?.
Dr. Custis; No, sir; I never did.