THE RATIONAL TREATMENT OF CERTAIN PUERPERAL DISORDERS



R. LUDLAM, M.D.: I think it is important to be specific in what we are talking about. Two or three have the same opinion, but they haven’t specified. My good friend, Dr. Boothby, thinks that such a weak solution as one to ten thousand of the bichloride would be of no great service in the vagina. My good friend, Dr. Foster, speaks inferentially, of the bichloride upon the perinaeum. The bichloride in contact with the perinaeum is very poisonous in a very weak solution, but it is not so in the vagina, unless it chances to get through into the perinaeum. So I submit that these two very clever fellows are talking about two things.

C.H. COGSWELL, M.D.: I don’t know that I dare tackle this subject. I had occasion to prepare a paper for the American Institute last year, but it is very seldom that I do. I stated in my paper then-I can only reiterate the statement to-day-that I have no use for antiseptics in obstetrical practice. I have never seen a time when they were needed. I know of a great many cases that have been injured by the use of them. I reported twenty cases last year from the use of the bichloride (one to three thousand) in labor. I try to be clean and keep my patients clean and when I have done that I believe i have done all that the good Lord asks me to do.

H.W. ROBEY, M.D.: One point, I think, would profit all of us to ponder. It seems to me that the Homoeopathic profession is gradually and surely taking ground against the germ-theory of the origin of disease, and we, I believe the majority of us, are coming more and more clearly to the conclusion that it is merely one of the passing fancies of the age-that diseases are not, as a rule, produced by these germs, but they are simply the accompaniments of disease; they act as scavengers of the system to throw out the morbid product of disease and that they are blessings in disguise and not our great enemies. We find connected with all the products of decomposition, both in the animal and vegetable kingdom, certain kinds of scavengers which nature seems to have provided in her great law of conservation.

DR. SHELDON LEAVITT: I have been slow to put myself on record with regard to this matter of antisepsis. I have been undecided in my own mind just what course it is best to pursue. I spent some six weeks with Tate in Birmingham, England, and I saw there the utter disregard for these things which he manifested, and at the same time the excellent results which he obtained in a surgical way. In regard to practice of an obstetrician I may say that this is an important matter.

I make no allusion now to the puerperal state wherein we may have indications of pathological conditions, but I allude to parturition. I always wash my hands thoroughly before in operation, and I usually employ no antiseptics. If the nurse asked me if I wished to use in antiseptic solution, I would say: “Yes, with thanks.” If nothing is said, I do not use it. In am particular to wash my hands very clean. I carry in my case the bichloride and Carbolic acid, but in three cases cut of four I make no use of them. I have in my private practice for a number of years seen no evidence of septic infection.

My practice in the hospital is difficult. The conditions and circumstances and surroundings are different, and I feel called upon to exercise still greater precaution. Now, I believe that we ought to exercise unusual care in the hospital, but what I have been alluding to, in my remarks just made, is to practice of a private nature, and you have my modus operandi in these cases.

DR. HARVARD: I would like to ask one question of Dr. Leavitt. If we, as physicians, are not responsible for our example, and if we have positive opinion upon subject we should say “yes” when we mean it, and if we think it is not necessary say “no”, with thanks”.

DR. LEAVITT: As I said, my opinions on this subject are not very positive, but I am giving my practice.

J.W. HINGSTON, M.D., North Platte, Neb.: All who have yet spoken have been from the cities, and their practice is mostly among the better classes. They have a privilege, to a certain extent, of choosing their patients. Now, it has been my experience to be called into places from which I would gladly have staid out-called there was neither fame nor name. When we look around for a nurse, we find one of the same class. When we wish to give instructions as to the work, we find that, no matter how particular we are, our words are entirely neglected. If we ask for a syringe, it is black with fifth; if we ask for a basin to wash our hands in, it is one used in the kitchen. So that it is often a question in my mind whether we should do anything at all in the way of antisepsis.

PHOEBE J. B. WAITE, M.D.: We must remember that there are many things to be learned form experience, and from the experience of those who have gone before. The fact remains that notwithstanding all the antisepsis that we are talking about to- day, our grandmothers and our mothers had families of six to ten and even up into the teens, and they lived and that children lived, and the doctors who attended them had never seen a fountain syringe, had never heard of the bichloride, and the disgusting smell of Carbolic acid was unknown in the world.

I suppose there is not a gentleman in this room who does not believe that cleanliness is next to godliness. When I began the practice of medicine I understood that. I have had no case of septic poisoning and have used an Carbolic acid or bichloride. Among the “well-to-do” I can have things more comfortable, but I dare not say I have had any better success than among the lower classes.

F.B. RIGHTER, M.D.: I am very desirous of hearing the end of Dr. Hingston’s story, and I have just asked him if he was troubled in his cases with peritonitis and other septic diseases, and he says no. Now this is enough to shatter the rankest bacteriologist. I was in hopes, when I came here, that I would gain some knowledge as to whether this World’s Congress believes in the germ-theory as the cause of disease. The discussion of the subject by the essayist wandered over a large territory. I may be doing him an injustice, but he seemed to me to treat this subject with something like levity. I don’t catch the drift of his paper; however, what I did get of it reminded me of that great American humorist who, when he announced his subject, never referred to it again during the whole lecture.

In regard asepsis, I, with Dr. Hingston, have seen many cases which occurred where the conditions were as bad as they could be, and no bad results occurred. Now that may be due to our atmosphere and our climate. I never in my practice of obstetrics use the vaginal douche unless there is some special call for it.

F.J. BECKER, M.D.: I must apologize for speaking here, but I cannot refrain from saying something in the face of these remarks, which seem to leave the impression that we, as physicians, are allowing ourselves to stand in the face of the facts which are taught us by bacteriologists. If these men who have spoken to-day knew what has been accomplished in German hospitals in the way of antisepsis, they would be friends of antisepsis. I am a friend of asepsis, but there are cases in which antisepsis must be practiced in order to obtain asepsis. Take the germ of cholera and put it in gelatine, and the germ can be produced and reproduced. The fact that many persons escape septic disease is no argument whatever against antisepsis.

MARTHA G. RIPLEY, M.D.: I should say that the practitioner who comes from a case of erysipelas has no business in the obstetrical room.

The younger men and women may learn something from the practical experience of those who talk to them. There is something to be said for the country practitioner in the way of good air, which in crowded cities we don’t get. If I could choose my patients, I would have their surroundings pleasant and the best of nursing, the best of care. But in general practice we must do the best we can. I think we forget that an obstetrical case is not necessarily a pathological case; that it is physiological. I live in a city where I presume that two-thirds of the women are attended by midwives. We have a large Scandinavian element, and they rarely call in a physician. They take no antiseptic precautions, and often the doctor’s business is to stand by and watch, and merely help when it is needed.

Now, in the maternity hospital of which I have charge there are hundreds of woman, and almost up into the thousands, who have been confined within a few years. We have not had a single case of sepsis. I treat these cases according to common-sense-my idea of common-sense. My hands are cleaned, the nurse’s hands are cleaned-not necessarily with bichloride, although we have it. No antiseptic treatment is used at all unless there is a bad uterus. Then we cleanse it. Fifty years ago it was better for a woman to be confined in a gutter than in a hospital. In our days things have changed. It is better for a woman to be confined in a hospital than at her own home. Why is that? Because we have found out the close relationship between the puerperal state and septic disease.

George B Peck