THE Medical Bulletin. JOHN V. SHOEMAKER, A.M., M.D., Editor. A. L. HUMMEL, M.D., Business Manager. Philadelphia, August, 1886. THE NEW YORK MEDICAL JOUR- withdrawn from the Congress because they do not approve of the way in which it is managed.' With but few exceptions,' he adds, 'I found very little inclination to incur the trouble and expense of a trip across under such discouraging auspices. My replies only corroborated previous impressions." PNEUMATIC DIFFERENTIATION. WHEN 7HEN the pneumatic cabinet was introduced a few months ago as a panacea for all lung diseases, THE MEDICAL BULLETIN pointed out that its chief value consisted in the fact that by its use the patient was compelled HE following extract from the New York to expand his lungs more fully than ordinarily, sample of the disreputable methods adopted by the New York and Philadelphia specialists in their attempt to prevent the success of the International Medical Congress. We do not know who this patriotic correspondent of the New York Medical Journal is, but he is evidently a combination of Sir Oracle and Baron Munchausen, and would command a high salary as a writer and narrator of border romances: "THE INTERNATIONAL MEDICAL CONGRESS. and no pay two hundred and fifty dollars a year rental for the cabinet, when the same and even better results can be obtained by simply directing the patient to habituate himself to breathe deeply and slowly while pursuing his usual avocations. This view has since been confirmed by so eminent an authority as Dr. William Porter, of St. Louis, Mo. In a recent number of the Weekly Medical Review, Dr. Porter says: "Many inquiries have been received during the past few months regarding the pneumatic The writer cannot indorse all that has been cabinet and its practical value and application. said in its favor, although some good has probsaid in its favor, although some good has probably been accomplished already. So far it seems to have been little more than aid to deep the hands of a careless or unskilful practitioner breathing, which could be done without it. In least in cases where there was a tendency to it would possibly be a dangerous agent, at hemorrhage. -A well-known American physician writes to us from Berlin, under date of June 30th, that he has lately come in contact with prominent members of the profession in that city,-Bremen, Hamburg, Dresden, Munich, Vienna, and Breslau, and that everywhere the leading questions were: What about the Congress of 1887? Will it be held? Will it be a success? Will you be there? How much reduction will there be in the passage rates? Is it to be managed by homoeopaths? Have the dissen-thought to have been obtained a few years ago "Our readers will remember the great results sions which threatened to wreck the Congress by the use of Waldenburg's apparatus for conbeen adjusted? Whom shall we meet whom densed and rarified air. If there is one now we know?' etc. To these queries he felt it his duty to answer : The Congress will surely be held. Whether it will be a success, cannot now be foretold. I SHALL NOT BE THERE. So far as I know, there will be no reduction in fares to America. The homoeopaths have nothing whatever to do with the Congress. The dissensions have not been adjusted in any sense whatever. You will be likely to meet chiefly men whom you do not know by name or fame, since the majority of the best known men in the United States have used in St. Louis the writer does not know of it. His has been idle for several years. We will be very patient with the cabinet till we know more of its actual value in inducing permanent improvement." A MERITED HONOR.-The Trustees of the Rush Medical College have conferred the honorary degree of M.D. upon Dr. Grant Bey, of Cairo, one of the most esteemed correspondents of THE MEDICAL BULLETIN. very than midwives' Every year greater I use the forceps more frequently than before;' and the pleased expression of the audience assured the speaker that his sentiments were theirs. There, too, I was amazed to learn-from the experience of these speakers, how numerous were the cases of laceration of the cervix, of the uterus, and of the perineum-so numerous, indeed, that, when coupled with the fact that they were numerous in a positive ratio with the increased frequency of instrumental delivery, and with the other fact that the advocates of frequent delivery with the forceps, in this convention, were teachers of midwifery and also eminent surgeons, skilful to 'repair' these lacerations, so painful, so distressing to women, and that these repairs brought large remunerations to the surgeons from the ofttimes slender means of their patients, I was dazed; I knew not what to say. I could not believe it possible that the earnest gentlemen before me could have con livery (without allowing the patient a chance for natural delivery), in order that lacerations should be produced, so that the business of repairing should be brisk and profitable. No, I could not believe it, and yet the wicked thought dashed through my brain, and left an unpleasant sensation there. 6 "In my secluded country home, with little intercourse with my kind Philadelphia friends, who are so industriously looking into every department of our profession, I was not, until a very few years ago, aware that women in labor were subjected to new modes of manage-spired to teach this rushing, forceps plan of dement, 'safer to the child, safer to the mother, and in point of time distancing nature so speedily,' that women cried for the new measures, as children are said to cry after some quack medicines. On inquiry, I learned that the forceps were used often-many, many times oftener, in proportion to the number of cases, than twenty years ago, and that this was done in the early part of the labor, not because nature was inadequate to the work, but because the physician had never hurt himself by using the instruments, and wished to get away speedily, as he had other patients who needed attention; and, though the condition of the lying-in woman would well have permitted him to visit his other patients and return to her in time to aid her if she needed it, still he would not do it, through fear that the child might be born in his absence, or some other doctor be called in his place. Soon after being thus awakened to what was going on, and after learning that the graduate of a month could use the forceps and all the other swift-sure means of speedy delivery, without hurting his hands or spraining his back-of course, the suffering and fate of the woman were of secondary importance—I was anxious to learn all about these advances in the art of midwifery. With this desire I attended the meeting of the American Gynecological Society, in Philadelphia, a few years ago. There, I heard from the mouth of more than one eminent gynæcologist-men "In October, 1880, The Boston Medical and Surgical Journal came to me containing an article by J. W. Elliott, M.D., of Boston, on Antiseptics in Gynecology.' I had heard something about their use by accoucheurs, and when I saw this publication, and from a Boston doctor, too, I was quick to acquaint myself with it, supposing that he would give me the advanced views on the subject; and I was not disappointed. From him was learned the fact, as he believed, that puerperal fever was sometimes produced by the noxious material within the woman-sometimes, indeed generally, by poisonous matter or germs from without, and that these latter were introduced by the finger of the doctor or the nurse. Then came directions to prevent their introduction, as follows: "At the beginning of labor the patient should have a hip-bath; the hair should be cut from the genitals, the vagina and vulva should be washed with soap and disinfected with carbolic acid; next the hands of the doctor and nurse should be absolutely clean. "During labor every examination should be preceded by a vaginal injection of a three per | such stuff, when I learned that my Philadelphia cent. carbolic acid solution, to prevent the examining finger from carrying germs lodged at the vulva, or in the vagina, up to the uterus, which is about to be more or less lacerated. "After a normal delivery the vagina should be immediately washed out with a three per cent. carbolic solution, and these injections should be continued twice or three times a day, according to the foulness of the lochia, for nine or ten days. "After delivery the uterus and genitals should be considered as a deep and important wound which may heal by first intention, or in which the secretions may stagnate, become putrid, and be absorbed.' friends engaged in obstetrical practice were, to some considerable extent, following the lead of the Germans, and, above all, when I received from my good friend, Dr. Albert H. Smith, whose too early death we deeply regret, a copy of his Clinical Lecture on the Relation of Cleanliness to the Prevention of Puerperal Septicemia,' the necessity to carefully examine the subject presented itself to me. This is an interesting lecture, taking the view of the necessity of vigilant antiseptic measures during all the course of labor, and differing very little from Dr. Elliott's article as to the means to be used. It would scarcely be just toward Dr. Smith to make brief extracts from his lecture, which, from beginning to end, is crowded with opinions and directions, all of which to him were deemed important. "In view of this wide-spread belief of the eminent teachers and practitioners of obstetrics, that there is absolute necessity to practise the rigid rules looking to a speedy termination of every stage of labor by forcible means, and to the use of constant antiseptic precautions, I am inclined to ask, Is labor a natural process? In other words, can a child be born without the aid of the forceps, and is it necessary, when labor has commenced, that, after a bath, antiseptics should be injected into the vagina—yea, into the uterus-as directed by teachers, and that the physician should at once begin to force open the mouth of the womb by hooking one or two fingers in it and pulling and stretching it, and if this fails, using cunningly devised forceps-dilating forceps and, when it has been forced open, so that one blade can be introduced, employing that as a lever to stretch it open so that the other blade may be introduced, and the head of the child, though still at the upper strait, be grasped and drawn down, disregarding in this heroic undertaking, rupture "From Dr. Elliott's paper I also learned that 'Winckel's Hospital, in Dresden, is one grand experiment to perfect this theory. There no one is allowed to examine a patient without first scrubbing his hands with soap and a nailbrush, then disinfecting with a five per cent. carbolic acid solution, and this procedure must be repeated before and after each examination.' "When I had read all this, it occurred to me that possibly German women were unlike the women of America. How else could I account for the fact that the thousands whom I had attended without antiseptics, and without observing the precautions spoken of, did not all die. As I had never before heard of Dr. Elliott, I concluded that he was a very young practitioner, who, perhaps, had never had many cases to attend, and so I went on in my usual way, taking no razor with me to shave the parts as directed by him, no syringe, no carbolic acid, but let nature go on with her work, pleased to see how steadily and perfectly she accomplished it, as in the days of fifty years ago. Though I plodded on in my accustomed way, all around me, in the cities, from Boston to New Orleans, the air was filled with carbolic acid in lying-in rooms, and the medical jour-of the cervix and the perineum? And, if the nals teemed with directions how to keep the child is born alive, must it immediately have poisonous germs from getting access to the its body, and even its eyes, washed with some body of the puerperal woman. One writer antiseptic by the nurse, while the doctor withcautioned against allowing them to enter by out a moment's delay, presses his one heavy the anus while the patient was at stool. How hand on the sore belly of the mother and thrusts amazing all this seemed to me after having the other into the vagina, so that, by pressing seen three thousand women, subjected to no strongly with the one and pulling with the precautions at all, pass safely through their other, the after-birth-I declare, it is hard for labors, and in a brief time rise from their beds me to get away from these old, now obsolete, well, I need not say here. I was about to dis- words, after-birth and midwife-may be got miss the subject, to forget that I had ever read | away, 'so as to prevent flooding?' Numerous as are these questions, is it necessary that the | and thirty-six cases in which scarcely half a physician now that the after-birth is away, dozen women suffered from puerperal fever, should stay by the bedside, pressing down on peritonitis, and pelvic abscess taken together. the tender womb for two hours, as directed by That answer might excuse me from anything teachers? And when the labor is progressing more, but, as I regard the measures now urged naturally and well, is it necessary that the -one and all, save cleanliness, in the old doctor have at the side of the bed, during all sense of that term as unnecessary, and very the time of his manipulations a dilute Labarraque dangerous to the lying-in woman and her offsolution, and dip the finger in it every time spring, the responsibility rests upon me to avert, before a touch be made, and from time to time as best I can, the danger forced on these helpbathe the genitalia with a cloth wrung out of less patients at the very moment when life is the liquid, and, as the head passes keep the trembling in the balance. Dr. Albert Smith cloth in continuous contact with the tissues?'-good, conscientious man-felt compelled to And, after the labor is accomplished, is it important to the safety of the mother to wash out the uterus with a carbolic solution or with hot water at 115 or 120° Fahr., either chlorinated or acidulated with vinegar about twentyfive per cent.' as recommended by Dr. Albert H. Smith in his recent work? The answer to these questions will be found scattered here and there through the following pages. It appears to me that many persons who report the doings in foreign hospitals and urge their adoption here, when they themselves really have never tested such practice, and know little of its danger, assume a great responsibility, indeed, sometimes imperil the health, if not the lives, of those on whom such measures are practised. In the Philadelphia Medical and Surgical Reporter, of March 28, 1885, Dr. W. O. Stillman, of Albany, N. Y., has an article in which he describes the precautions taken by Professor Carl Braun, of Vienna, to prevent infection to the lying-in woman. After urging every possible care to disinfect everything needed to be near to the woman prior to examination, he thus speaks: As soon as the after birth is removed the vagina is washed out high up with a two per cent. solution of carbolic acid at the temperature of the room. About one gallon of the solution is used, and the injection is given by means of a huge glass fountain syringe. Almost as soon as the child is born, and often before the cord is cut, its eyes are syringed out with a two per cent. solution of nitrate of silver.' Dr. Stillman doubtless believes he has given valuable information to the thousands of American practitioners. He has us on trial. Dare we refuse to follow Carl Braun? This brings me to the inquiry: "Are antiseptic solutions, when thrown into the vagina and uterus, safe? I do not know. I have never used them in my three thousand bear testimony against the carbolic acid solution, because he saw two patients partially poisoned by it. Afterward he recommended water, 110 to 115° Fahr. But Dr. Thomas, of New York, in a paper read before the New York Academy, said: As labor sets in, the nurse should administer a warm vaginal injection of antiseptic character.' Referring to this utterance of Dr. Thomas, Dr. George T. Harrison, of New York, in a paper on Puerperal Septicæmia, published in the Transactions of the Medical Society of Virginia,' thus writes: Against this advice I must enter an earnest protest, as such injections are unnecessary and fraught with danger.' In the same 'Transactions,' Dr. Dickinson, in a report on 'Advances in Obstetrics,' quotes from a letter from Berlin, written by Dr. Cushing, in which he says: Vaginal injections are now abandoned, in all institutions of repute, after normal labor.' Poor Carl Braun's hospital seems not in good repute! Could we take in the whole field in which this carbolic antiseptic practice has prevailed, how many thousands of women must have suffered from this (at that time) highly lauded practice of using carbolic acid injections! Dr. Smith refers to the experience of Fritsch, as confirming his belief in the danger of carbolic acid solution as thus used. Now, when I reflect how many thousands of physicians are there in the United States who are using carbolic solutions as they were at first recommended, and who are not aware of their poisonous effects when thus used, I feel that it is proper here to state what Fritsch has said on the subject. Do you ask, 'How can it be that they are not aware of these poisonous results if they have ever occurred in their practice?' My answer is that, although these effects may have been produced many times, they would almost certainly have attributed them to the intro |