Care and Management of the Preg- nant Woman-B. M. Hypes, M D. 1 Case of Tetanus Following Vaccina- Contribution to the Therapeutics of Conservative Yet Effectual Treat- ment of Hypertrophied Prostate by Electro-Incision, Done Through Prostate; Demonstration of the Bottini-Freudenberg Electro-In- cisor-Bransford Lewis, M.D... 101 81 ...... ..... 338 276 296 Cystoscopy in the Male-T. C. With- Diagnosis of Cerebro-Spinal Fever -Elsworth Smith. Jr., A.M, MD 403 Epidemic of Dysentery and Diarrhea 463 236 135 398 117 237 Mr. F. A. Henry 378 Mr. Matthews Exonerated by the Federal Courts Needle in the Heart Small-Pox in the South and West... 238: Soap Known to the Ancients. 297 Society of German Physicians of Some Health Statistics. Southern Illinois Medical Associa- Spelling Reform Movement.. Fair Play for the Doctor That Re- commends the Specialist; A Hint Faith-Cure Fakirs-W. M. Reedy... 399 Importance of Early Operation in 139 242 298 Texas State Medical Association 338 317 126 Nitrate of Silver Stains 134 nessee. 126 Reminiscences of the Early Days in Report of a Case of Suppurative Report of a Case of Removal of the Gasserian Ganglion-H. H. Mudd, Report of Two Cases of Prostatec- tomy Following Electrical Inci- sion of the Vesical Outlet After the Bottini-Freudenberg Method, with Remarks-J. P. Bryson, M D 426 Report on the Progress of Gynecol- Results of Treatment in One Thou- nine Cases of Acute Alcoholism; Cesarian Section Through the Va- Open-Air Treatment of Phthisis Peritoneopexy of the Uterus Per- the Treatment of Retroflexions.... 294 377 Pillow-Case Method of Administer- 501 Points in the Arsenical Caustic 271 262 Credé's Silver Salts and Soluble Sil- Prevention of Cinchonism 396 419 Prophylaxis of Retroflexion of the 150 Uterus 256 Digitalin in Heart Failure 396 152 Cerebral Hemorrhage With Tempo- Treatment of Lupus by Thyroid 39 Remarks of the President....... Report of a Case of Irritable Urin- Report of a Case of Prostatectomy, With Remarks on a Novel Proce- dure for Facilitating the Opera- Report of Two Cases of Prostatec- tomy Following Electrical Inci- sion of the Vesical Outlet After the Bottini-Freudenberg Method, Sanitary Inspection of Schools and Municipal Medical School Inspec- Upon an Ear and Throat Infection, 411, 413 191 187 358 Cicatricial Contraction of the Hand 187 ORIGINAL ARTICLES The Care and Management of the BY B. M. HYPES, M.D., ST. LOUIS. Those of you who take interest in obstetrics are aware that great advances have and are constantly being made in its practice. As a branch of medical science it is moving forward, hand in hand, with medicine and surgery. But that degree of success has not yet been attained, which we, as conscientious and progressive physicians, should strive and hope for. There is still too great a mortality connected with the physiological act of child-bearing. A sad feature of these deaths, too, is that many of them are preventable. When we are told by various statistics, that 7 per cent of women, who die during the child-bearing period (from 20 to 50 years), succumb to puerperal septicemia, and when we note the number of mothers and children annually lost from lack of proper care and attention during pregnancy, it demands that we pause and reflect; that our methods of practice should be revised; that, if need be, laws should be enacted to restrain this slaughter of the innocents. NO. 1. occur during the development of the girl into woman. hood, we observe her not only suffering pain, but especially liable to many and severe diseases. Again, at the climacteric, do we find woman disturbed in her func. tions and prone to all sorts of affections. How much more then must she be liable to suffering and disease, when undergoing the cyclonic changes of pregnancy? And yet, she is ridiculed for complaining; and too often a deaf ear is turned to her entreaties for help to bear this most uncomfortable burden. Asking for bread, she is given a stone. Yearning for help and sympathy, she is turned coldly aside, by both friend and physician, with the remark, "Oh, this is only the result of pregnancy; nothing can be done for you." In this disturbed and hypersensitive condition of mind and body, how readily the overworked organs pass the boundary line from exaggerated physiological function to a pathological condition? and how often do we find the latent or mild forms of disease, especially of kidneys, heart and nervous system, slowly and insidiously develop most dangerous and uncontrollable symptoms? But proper care and management will lessen, if not entirely relieve, the many discomforts of pregnancy; and timely medical advice will generally ward off disease and prevent it assuming a dangerous character. By skilled attention during pregnancy, not only will gestation be more successfully accomplished, but woman will be so strengthened and fortified for the demands of labor, that its difficulties and fatalities will be markedly lessened. Now, gentlemen, if skilled management during preg. nancy will lessen disease, and frequently prevent death; Pregnancy is a natural physiological function. In a if this same attention better fits the woman to go through state of perfect health it should be accomplished with. labor, and assures a safer result to both mother and out disease or suffering. But, as a matter of fact, how child, I beg to solemnly ask you, is the pregnant woman rarely do we meet such fortunate cases? So generally to day receiving the care and attention from her physiis pregnancy associated with discomfort and illness, cian that the importance of her case demands? I fear that a celcbrated French obstetrician has called it, "a not. nine months' disease." Nor is it to be wondered at that My observation and experience leads me to infer that women should suffer in this condition. Greater the this is a field in obstetrical practice that needs cultiva. astonishment, considering the rapid developments of tion by us, as physicians. The laity, too, need educaher physical nature, that she does not suffer more. Un- tion on the importance of caring for women throughout der no other circumstances do such extensive changes pregnancy, not only for her own sake, but as Plato has in organs and functions take place in so short a time. expresse i it, "That she may successfully bear children In the comparatively slow and few modifications, which to the State." We may very properly go still further back and de1Read before the Medical Society of City Hospital Alumni, Thurs-mand that the girls, who are to be the future mothers day Evening, December 1, 1898. of the country, should receive such care, training and education, as will properly fit them for this noble and At the seventh month he should make a careful physiresponsible duty. They should be taught the simpler cal examination, both external and vaginal, to determine laws of hygiene-how to eat, to exercise, to care for presentation and position of child, and to note any abtheir bodies and minds, in order that they may develop normalities which might seriously complicate both labor into healthy women. The hygienic surroundings of and pregnancy. Pelvimetry must be regarded as a most every school, factory, store, and workshop, should be necessary part of this physical examination. supervised, to protect them from injury and abuse. Who can more appropriately and successfully work out this much needed reformation than the doctor, as family physician, as member of the board of health, as advisor to the board of education, and as public legislator? The time limit of this paper will not allow the tempting consideration of these vastly important subjects, but the mere suggestion of them, at this time, will, I hope, cause the members of this influential Society to think, to write, and to propose practical reforms along these lines. Now, in viewing this subject from a practical standpaint, the inquiry naturally arises, "In what does the care of pregnant women consist?" and, "Can such a practical course of management be adopted that it will meet with the approbation of the profession, and become a feature of our routine practice?" The care of the pregnant woman should begin with conception. The laity ought to be taught, that whenever a woman finds herself pregnant, she should at once select an attendant physician and place herself under his management and direction. This she does, not that she may be "dosed" with medicine, but that she may receive advice and instruction as to the duties and dangers of pregnancy, and that her physician may gain such knowledge of her as will enable him to successfully manage both her pregnancy and labor. The physician upon being consulted and engaged to attend her, should thoroughly familiarize himself with the patient's personal and family history, with all diseases suffered, with all difficulties in previous labors, with all personal and family peculiarities and idiosyn crasies, so that he may fit his instructions and medica. tion to her individual case. He should then advise her in regard to her food, its character, and when and how it should be taken; as to bathing, and how performed; as to proper clothing, and mode of wearing it; as to danger of constipation, and means of prevention; as to bad effects of coitus, and the necessity of its control; as to the care of breasts, so as to fit them for the new function of lactation; and of the necessity, especially after the sixth month, of frequent examinations of her urine. Included in the care of the pregnant woman, is the timely attention to the disorders of pregnancy. In this way not only may her condition be made more comfort. able, but many serious consequences averted. To this management of pregnancy I apprehend two objections, i. e., firstly, it it unnecessary, as seldom does a pregnant woman need medical attention; and secondly, that it is impracticable. As to the first-that it is unnecessary-let me reply that the same may be said of labor. In a large per cent of confinements, the physician need merely stand by, and Nature will do the work. But his presence is nevertheless demanded to attend the natural as well as the difficult cases, for what? To watch for dangerous delay to mother and child; to pro. tect the perineum; to see that the secundines are all ex. pelled; to prevent post partum hemorrhage; to assist when Nature fails; in short, to prevent all evil consequences to both mother and child. Likewise, as a preventive measure, should his care of pregnancy be to instruct the woman in hygienic laws; to watch for the first signs of disease, and to check it in its incipiency; to correct abnormalities when possible; to obtain valuable knowledge of condition of mother and child. Thus forearmed, with prior knowledge of the condition of the pregnant woman, he will anticipate and be prepared to treat most successfully emergencies that may arise during labor, and to lessen the unduly large mortality of childbirth. Thorough acquaintance with the woman, and properly directed treatment, both before and during pregnancy, will check this great stream of abortions to which we are almost daily called upon to administer. Puerperal eclampsia, that dire calamity of child bearing, is a preventable disease, and will almost disappear from the records when women are properly cared for during pregnancy. The brilliant obstetrical and surgical records of the maternities are greatly due to the fact that the women are under ob. servation and the abnormalities diagnosticated during pregnancy, and because the most favorable time for op. eration is taken advantage of. For the above, and many other valid reasons, it seems to me there is a necessity for such a care and manage. ment of pregnancy as is suggested in this paper. I As to the second question-is it practicable? To this desire to answer most positively-yes. For several years past this has been my practice, and rarely do I attend labor cases, except in consultation, without having had the patient under previous observation and man She should be given certain danger signals, and should be thoroughly impressed with the necessity of iuforming him at once, of any abdominal pains, of any flow of blood from the vagina, of persistent headache or dizziness, of any epigastric pain, of nausea and vomiting late in pregnancy, and of the first appearance of edema. She should be informed of the danger of lifting heavy agement. I make it a practice to visit expectant cases weights, of reaching, of overexertion and of fatigue, of riding over rough roads, and taking long railroad journeys. of labor; to make frequent examinations of the urine; to measure the pelvis of all new customers; to note presentation and other conditions of child in utero; to gain |