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their professional labors will yield them, and they are not ready to give without compensation the benefits of a knowledge which they have acquired at considerable cost. If women are not successful as physicians-and for social and physiological reasons they are not-they are certainly well calculated to act as midwives. From time immemorial, they delivered their sex, long before obstetrics was recognized or known as an art; and even in this city, in the early part of the present century, there was only one physician who attended cases of labor.

It is hardly necessary to dwell on the need of providing the public with a corps of well-trained midwives. Thousands are annually brought to bed by their own sex; many through choice, more through necessity. Among the German peasantry, comparatively few are delivered by physicians. It has generally been the custom to deride and revile the "old midwife” if she has met with bad luck. This is not argument, however, and in spite of it she has survived, deserving rather the physician's respect than his contempt. Many are hostile to the education of women as midwives. Some assert that a person should be thoroughly well informed in the science and art of medicine before beginning this line of practice. Others fear that it will cripple the young physician, and that it will reduce his income by interfering with his resources. Others apprehend that midwives will be meddlesome.

A normal labor is not a surgical operation, there not being any deviation from health in its natural progress; medicine or medical aid is not called for to terminate it; and it is a purely physiological act. Many look upon its advent with horror and dismay, and these unfortunate women, the victims of the vicious and demoralizing tendencies of our times, view it as a calamity rather than a blessing. If it were not for some overt act on the part of the mother or meddlesome interference of the attendant, it would rarely be accompanied with danger. To demonstrate the accuracy of this statement, I have only to refer you to the general simplicity and safety of the parturient process among uncivilized races. The objection to the attendance of midwives, that it will reduce the physicians' revenue, is more imaginary

than real. The classes which will depend on midwives are not generally such as are able to fairly remunerate a physician for his services. A physician, however, will always be indispensable in the management of serious cases.

This question under consideration is of immense interest to other than medical men; and its solution lies in that which will do the greatest good to the greatest number. The selfish disposition which sometimes asserts itself in the medical profession has done much harm; and hence medical legislation is looked upon with suspicion in popular assemblies. I need only to remind you of the fate of the bill lately before the English Parliament, and the manner in which a medical bill was crushed a few years ago in Massachusetts.

The last objection is that midwives will interfere with the medical attendants. This is an objection entertained against many trained nurses: that they know just enough to make themselves mischievous. However, this does not disprove the fact that trained nurses are useful and indispensable in the sick-room. We should not condemn pharmacists, because a large number of them are daily prescribing over the counter for every phase of disease; we need women to attend confinements; and any one who denies this is either biased by prejudice or ignorant of facts.

Admitting that the small fee generally paid does not properly remunerate the medical attendant, that the injudicious resort to the use of ergot or to the application of the forceps to hasten and terminate labor is often attributable to his desire to shorten labor, and that a majority of child-bearing women are among the poor, many of whom are absolutely unable to pay anything whatever-what is the proper remedy? Midwives are urgently needed to-day. Midwifery is an occupation in which women may earn a fair compensation for their attendance, and it is an entirely legitimate pursuit.

How shall women be trained in the art of midwifery so that they may do justice to themselves and to those whom they attend? What shall be the kind and the extent of such training? It is, perhaps, quite needless to remind many of you that a place was


opened in this city two years ago in which women were taught the rudiments of obstetrics. It had an auspicious opening, and was conducted by medical gentlemen well known to the public and profession as men of character and ability. Its aims were encouraged and it was favorably noticed by the medical press of the city. But those in control committed a fatal blunder by resorting to disreputable methods, with a view of securing pupils, and brought down on it the unanimous condemnation of the medical profession. As a natural consequence, this violent and uncompromising hostility has had the effect of destroying that which, if honorably conducted, might have been of immense value.

No one, knowing the demand for educated midwives, should allow his prejudices to warp his judgment or influence his actions. The question really at issue in the matter is not, Do the people need them?-that has been answered by the health-authorities of our largest cities-but, as physicians guided rather by humane intentions than selfish motives, How shall we devise means by which a sufficient number of trained midwives may be properly educated, both theoretically and practically?

Is it feasible to make provision for giving women a practical training in a city maternity? There is nothing difficult or impossible in the way of securing this end, although, like every new undertaking in medicine, this will encounter opposition which will, however, be readily overcome, for, if worthy of public support and professional recognition, the effort will be sustained. No city possesses greater facilities than New York to supply the necessary material, and no city is more convenient of access for those living in other States.



By AUSTIN FLINT, M. D., of New York County.
November 20, 1884.

In order that the scope of my remarks may be apprehended at the outset, it is necessary to define the terms embraced in the title of this address.

The term therapeutics may denote only the employment of medicines; that is, drugs. This is a limited sense of the term. In a broader sense, it comprehends the treatment of diseases, not by medicines alone, but any means or appliances. The latter is the more correct definition according to the etymology of the term (@epâπeuw), and in this sense I shall now use it.

The term medicinal, as I shall use it, is restricted to the employment of drugs.

The title which I have chosen might be otherwise expressed as, remarks on the treatment of diseases with and without drugs. From time immemorial it has been considered to be the chief office of the physician to prescribe drugs and to regulate their employment. Not entering at all into the past history of medicine, let me ask, What is the prevailing popular sentiment at the present time, in all countries, respecting the part which medicinal therapeutics play in medical practice? Is it not that the practice of medicine without the use of drugs would be like the play of "Hamlet" with the part of Hamlet omitted? How many patients at this day would be satisfied to be treated for an illness, without drugs?

Several years ago, my friend, Professor Alfred Stillé, visited with me my wards at Bellevue Hospital. I pointed out a patient who had recovered from pneumonia, the disease having passed through its course in the most favorable manner. As we were leaving the patient he exclaimed, in a tone of much irritation, "No thanks for my getting well; I have not had a particle of medicine since I came into the hospital." The case had been left to nature, and nature had effected the recovery as quickly and as completely as possible; yet the patient was much aggrieved and felt that he had been neglected. Now, had he been treated with perturbatory medicinal agents, which might have induced ailments in addition to those incident to the disease, perhaps prolonging the duration of his illness and rendering his convalescence tedious, doubtless he would have been satisfied, and possibly would have felt grateful to his physician. Have not many of those whom I now address met with analogous instances in which patients, having been subjected to little or no medication, have manifested after recovery no sense of obligation for medical services? Some may even have reproached themselves for having incurred the unnecessary expense of medical attendance and may perhaps have declined to make an adequate pecuniary compensation. Professional visits not supplemented by requisitions on the apothecary are deemed by many to be valueless. The worth of medical attendance is measured, in the minds of not a few, by the number of drugs prescribed. How generally, after a consultation, is it asked, "What new remedies are to be given?" and how often a feeling of disappointment, if the consulting physician have simply concurred in the propriety of the remedies already in use, leads to the reflection that a consultation might just as well have not taken place.

The twofold sense of the term medicine is significant. In one sense of the term, medicine denotes "a science, the object of which is the cure of diseases and the promotion of health." In another and the more popular sense, the term denotes a medicinal agent or a drug. The same is true of the term physic. Up to a late period, this term was used in a sense synonymous

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