« SebelumnyaLanjutkan »
wise a science. He who was to elevate it to this high sphere was found in the person of the great Englishman, William Hunter, whose admirable work upon the gravid uterus did for this department of medicine what the eminent labors of Euclid did for mathematics, existing to-day as a valuable part of the library of every intelligent practitioner of midwifery.
From that time to the present, a steady advance has been made; and in our day we see the reproach which, once upon a time, and that not so very long ago, attached to the "man-midwife," entirely wiped away. But all this has often been written of. Let me now pass over the wide chasm which divides two centuries from each other and speak of those improvements in this hundred-year-old science to which the past decade has given birth.
With how little pomp and parade are the greatest discoveries of science usually heralded! Who could have pictured to himself the wonderful results which were to follow the crude experiments of Count Rumford with steam; the watching of the swaying of a set of church-lamps by Galileo; Newton's study under the apple-tree; or the flying of a Yankee printer's kite upon Boston Common? Yet the world has trembled and swayed under the results of these things, and mankind has felt their influence in every fiber and atom. In my judgment, one of the greatest achievements of modern pathology has been the discovery of the agency of certain lowly-organized monads, micrococci and microzymes, classed under the head of bacteria, in the production of septicemia, pyæmia, and the long list of diseases which are their outcome. These atomic bodies, floating in the atmosphere, clinging to sponges and towels, and adhering to instruments and fingers, enter the blood through abraded surfaces. The prevention of the evil consequences of such entrance by the plans of Lister has accomplished a great deal for general surgery. Applied to obstetrics and gynecological surgery, the same methods are found to be fully as successful.
Progressive obstetricians are now pretty well agreed that the diseases which follow child-birth are due, for the most part, to the introduction of some contagium or poisonous element
from without through the open mouths of exposed blood-vessels laid bare by the parturient process, somewhere between the fundus uteri and the vulva. This theory being once accepted, it follows as a natural deduction that every means in the power of the obstetrician should be adopted for the prevention of the introduction of the morbific agents.
Even though the obstetricians of to-day are not prepared to make aseptic midwifery a rule wherever that art is practiced, it is highly probable that, in the very near future, this position will be accepted. Even now, this method, in a modified form, is exerting a beneficial influence and is steadily working its way to adoption, in spite of the fact that it entails a great deal of trouble on the practitioner. That it can do no harm is quite evident. Does any man, can any conscientious obstetrician, maintain that strict cleanliness and the most scrupulous avoidance, so far as it lies in his power, of all things which can possibly admit of the entrance of the agents which in all probability produce puerperal septicemia will do any harm in the lying-in chamber? Supposing that only one life be saved out of a hundred deliveries; will any one assert that the saving of this one life would not repay him for the trouble which his preventive precautions have cost? If the whole theory of the bacterial origin of puerperal fever be false, then, in a quarter of a century from now, all precautionary measures will disappear and the old régime will triumph. But if, perchance, this theory be valid and true, then no human power will prevent the realization of the prophecy that aseptic midwifery will be a rule as strict, as inviolable, and as obligatory, as the aseptic surgery of amputations and of laparotomy is to-day. Look at the surgery of London, of Paris, of Vienna, and of New York of twenty years ago, with its unclean hands, its fatally dirty instruments, its death-laden sponges, and its foul air, with its terrible mortality, and then look at the surgery of those same cities to-day; and he will be a bold man who dares gainsay the statement that, in another quarter of a century, no one will venture to rise in a scientific body and declare that any efforts at perfect cleanliness in the lying-in room are superfluous or absurd.
To free the parturient act from the dangers of septic poisoning, to prevent that scourge, the so-called puerperal fever, and suppurative arthritis, pyæmia, embolism, and septic inflammation of the lungs, liver, and other organs, would be to save millions of lives in every generation, and to raise the science of obstetrics to an enviable height.
The germ-theory has done more for obstetric medicine than what I have here alluded to. It has revolutionized the treatment of that variety of septicemia which has been called puerperal fever. No longer do we depend in the treatment of this affection upon quinine, opium, and the application of emollients over the abdomen. By intra-uterine injections, the cavity of the uterus is thoroughly and repeatedly washed out with solutions of the bichloride of mercury 1 to 2,000, or with a 21-percent. solution of carbolic acid. Surely no one who has experience in the new and the old methods will cavil at my statement that a great improvement has been effected by the former.
Were I called upon to sum up the treatment of a declared and undoubted case of puerperal septicemia, marked by the usual symptoms of a pulse of 120, a temperature of 105° or 106°, which would meet the requirements of our time, I should give it categorically thus:
1. Quiet all pain by morphine hypodermically.
2. Wash out the uterine cavity with antiseptics.
3. Lower the temperature at once below a hundred, not by the barbarous method of the cold bath, but by the far better one of the coil of running water.
4. Feed the patient upon milk and nothing else, unless some good reason exist for changing this diet.
5. Exclude from her room all except the nurse and the physician, keeping her as quiet as possible.
Although the subject of extra-uterine pregnancy has attracted attention from the earliest days of medicine, it is only of late years that it has been carefully studied, its diagnosis put upon a firm basis, and its treatment systematized. Laparotomy, with its wonderfully beneficent results, has been brought to bear upon these cases, before and even after rupture of the vica
rious foetal nest. By this procedure, Jessup, of England, has succeeded in delivering at full term a child developed in the peritoneal cavity, and in saving at the same time the mother; and by it, Tait, of the same country, has saved four women after the foetal sac had ruptured. But it is to the fœticide powers of the electric current, first used by Allen, of Philadelphia, and then by Landis and Reeve, that the safety of such cases can best be trusted. This method is harmless to the mother, even if an incorrect diagnosis be made, and it is effectual in producing fœtal death if the diagnosis be correct. The number of lives which have already been thus saved is quite large and is daily increasing; and these are lives which, in former times, would have been sacrificed to inattention, want of skill in diagnosis, or to a lack of reliable remedial measures, even if the diagnosis were rendered pretty certain.
It must not be supposed that, in the olden time, no cases of extra-uterine pregnancy were saved. In making my statement, I allude only to the systematic management of cases in their early periods, as regards both diagnosis and treatment. In this country, even as early as 1759, Dr. John Bard successfully performed gastrotomy for the removal of a full-grown child from the peritoneal cavity. Dr. Baynham did so twice, once in 1791 and again in 1799; and Dr. John King, of Edisto Island, South Carolina, in 1816, cut through the vagina at full term, applied the forceps through the opening, and safely delivered a slavewoman of a child which was developed in an abdominal pregnancy. But at that time and long afterward-until our own times, I may say-the early diagnosis and early treatment of tubal pregnancy were found to be impossible. To-day, given a woman whose symptoms of pregnancy are irregular, who suffers pain in one iliac fossa, who has sudden gushes of blood, and who is subject to occasional attacks of faintness, and every intelligent practitioner would at once examine with reference to the existence of ectopic gestation, and, discovering it, would promptly proceed to destroy the foetus in its false uterus.
Some one has very pithily said of late that the medicine of a hundred years hence will consist chiefly of prophylaxis and
surgery. It appears to me that this statement, which has more than one grain of truth in it, applies with great force to our subject of to-day. The day is, I feel sure, not far distant, when preventive measures will be applied with most triumphant results to placenta prævia, puerperal nephritis, placental apnoea, contracted pelvis, the obstinate and often fatal vomiting of pregnancy, and to that extreme hydræmia which so often results in thrombosis.
Obstetricians are beginning to question themselves as to whether it be wise, in the interests of both child and mother, to wait and watch during the last two months of pregnancy until a sudden and furious hæmorrhage makes an issue unavoidable in placenta prævia, or until a convulsion announces the limit of tolerance in puerperal uræmia, or the cessation of fœtal movement tells the tale that the crippled intra-uterine lung has ceased to have power enough to prolong foetal life. The methods of inducing premature labor are now so simple, so certain, and so void of danger, that they now, more than at any previous time, present themselves as a sovereign resource in such cases. And this is more especially true since Tarnier, by his glass-house with heated air regulated so as to meet the feeble heat-making process of the premature infant, renders the perpetuation of the lives of these beings so much more certain than when they were exposed to the chilling draughts of the chamber, and perhaps were at once dipped in water and exhausted by washing and dressing.
How often has every man in this room watched with intense interest and anxiety the following picture! A mother of several children, a beloved wife, and the center of a large circle dependent upon her for love, for care, and for counsel, about the end of the seventh month, develops the symptoms of placenta prævia or severe puerperal nephritis. The physician can not conceal from those who surround her the fact that a violent hæmorrhage or a sudden convulsive seizure may at any moment destroy life. Should one of these occurrences take place, the patient's friends know full well that it may be hours before medical aid can be obtained in their dire necessity. Day after