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THE BETTER WAY …e.: eace-resºrº -: * **, & - ...) º *, *- º tº" vº tº--> **.* ...sºss-cº-º" BY GEORGE WILLIAM WINTERBURN, PHAR. D., M. D. President of the American Obstetrical Society, Editor of the Homeopathic Journal of Obstetrics, Gynecology, and Pedology, Hon. Mem. Med. Soc. of Mich., Fellow American Akadémé, Mem. Amer. Folk-Lore Soc., Amer. Acad. Political and Social Science, M. Y. Pedological Society, etc., etc. NEW YORK A. L. CHATTERTON & COMPANY 78 MAIDEN LANE 1892 BY THE SAME AUTHOR. THE VALUE OF VACCINATION. A. Non-Partisan Review of Its . History and Results. I82 pages, I2mo, cloth, 75 cents ; paper, 50 cents. PURPURA. Its Origin, and its Treatment, with a Repertory, 240 pages, I2mo, cloth, $1.50. A REPERTORY OF THE MOST CHARACTERISTIC SYMP- TOMS OF THE MATERIA MEDICA. 182 pages, 16mo, flex- ible calf, $2.50. & COMMONPLACE MIDWIFERY. 67 pages, 8vo, paper, 75 cents. ON THE RELATION OF THERAPEUTICS TO MIDWIFERY. I5 pages, 8vo, paper, 25 cents. THE FIRST HOURS OF LIFE. 24 pages, 8vo, paper, 25 cents. THE PERINEUM IN ITS RELATION TO NORMAL LABOR. I6 pages, 8vo, paper, 25 cents. ON THE RELATION OF HOMEOPATHY TO ANTISEPTIC MIDWIFERY. I6 pages, 8vo, paper, 25 cents. THE BETTER WAY. THE history of obstetrics shows that our art has been an evolution from crude methods toward more exact ones. This we know is true of all arts, but in one which deals so directly with life as does ours, the manner of its develop- ment, and the probability of the still further refinement in its methods, interests not alone its practitioners as in other arts, but every woman who hopes to be a mother. The art of midwifery is indeed the one universal art upon which all others depend. The warrior, the statesman, and the scholar have all to be born ; this is the indispensable prelude to all their achievements; and upon the skill of the obstetrician, to a larger extent than is usually recognized, depends the whole outcome of the life now just being essayed. I have called attention elsewhere + to the fact that, from a biological point of view, the art of obstetrics is the art of bringing into the world a race of sturdy children who shall have better control of their physical forces than their fathers and mothers had. It is not enough that the * Read before the American Institute of Homeopathy, at Washington, D. C., June 14, 1892. + “On the Relation of Therapeutics to Midwifery’ (New York: A. L. Chatterton & Co., 1891). 6 THE BETTER WAY. child be born alive, and that the woman arise from her bed after the period of lying-in, and resume her daily routine. The accoucheur who has that conception of his duties, who merely separates mother and child, and who is satisfied if they only both live, is just a mechanic, and nothing more. To a man of such low ideals it is useless to speak of art; he will not understand. The art of obstetrics had its crude beginnings among the most primitive races. In fact, it had its origin doubtless among the simianoid ancestry of the human race, as even the more intelligent anthropoid apes give an aimless sort of help to the parturient female. In the rude beginnings of primitive races, when man was just emerging from a state of simple animality, it was the female who gave aid to her suffering fellow, and this continued to be the rule until about two centuries ago, as indeed it still is among a vast majority of mankind. It was looked upon as woman's work, and, being a mere manual function, as beneath the dignity of man. It was not only derogatory to man, except as priest he was called in to give advice and lend the sanctity of his presence in a case of peculiar difficulty, but it was actually indecent for a man to be present at the birth of a child. Dr. Wertt, of Hamburg, in I 522, assumed the dress of a woman to attend a case of labor, in order to study the proc- ess, and was burned alive in consequence. This somewhat discouraged would-be investigators, and it was not until a century and a half later that certain men came to be known as man-midwives. The modern art of midwifery is the growth of the two past centuries. Not that there is anything really new in the world of obstetrics, for all our discoveries, even anti- THE BETTER WAY. 7. sepsis, are only recoveries of lost arts. It is somewhat startling to find that even such apparently modern ideas as: the Créde method of expressing the placenta was in its. essentials known to the ancient priesthood and practiced by them. With the decay of the priestly influence the practice became less intelligent, and indeed sank again into barbaric rudeness. The men who are advocating the popular obstetrical practices of the day are walking side by side with those grim priests of the Nile who thought all our thoughts, and lived an intellectual life to which we can only aspire, five thousand years ago. If the high priest of Karnac, he who was high priest when Thuban (Alpha Draconis) was pole star to our earth,” could stand in this hall to-day, there would be little of practical value in the obstetrical art that we could tell him—little, that is, save the application of homeopathy to midwifery. And it is to homeopathic midwifery that I would apply the designation, “The Better Way,” which forms the title of this thesis. I believe there is no department of medicine in which homeopathy is so useful as in midwifery. It is more useful here than anywhere else, because we have through it the power to control the physical and moral destiny of the unborn child. Medicine will do more for an unborn child than for a sensate one. This large field of therapeutics has. remained almost unexplored. Neither the laity nor the medical profession, except here and there some solitary “crank,” realizes the importance of prenatal medication, and the immense advance the human race will make toward mens sana in corpore samo when homeopathy is properly applied to the child yet in the mother's womb. Every * B. C. 28OO. $ THE BETTER WAY. characteristic of the child is prefigured in the mother's con- dition. In this formative stage it appeals to us through its mother's mind and heart. These appeals are vague, elusive, transitory. It speaks to us in faint whispers which only strained attention can hear. It requires keen insight into the hidden springs of motive and desire, on the part of the physician, in order for him to discern these subjective, chameleon-like appeals, and broad knowledge in general pathology to read their meaning. But it can be done. If to this problem was brought the intellectual enthusiasm and patient heroism which has been applied to many fields of knowledge, as for instance to the development of spectrum analysis, the human race would be elevated by it to a plateau of living as superior to what it now knows as its present existence is higher than that of the anthropoid ape. This is the true field of the homeopathic obstetrician; but it is a somewhat narrower one that we are called upon to dis- cuss to-day. The question before us ignores this larger duty of the obstetrician, and confines our attention to the par- turient chamber and its occupants. I do not wish to be understood as belittling the importance of this subject, to which attention has been directed by the chairman of this Bureau. It is a very important one, and I am glad to be privileged to take part in its discussion. Broadly speaking it is this: Shall we adopt the expedients of the allopathist who, without any certain guide to his feet, seeks here and there, in honest but misguided endeavors, to find the better way ? Or have we in homeopathy the better way ? Can homeopathy do as much for the parturient woman as it can for the man with pneumonia or the child with diphtheria P This is a very proper question to be discussed before the American Institute. THE BETTER WAY. 9 The great trouble about homeopathic obstetrics is that it is a strait and narrow path which each must walk alone. It admits of no generalities. It is suited to neither the lame nor the lazy. It is impossible of reduction to routine. The author, or the professor, cannot say to the student, “When you are called to a case of labor, do so and so.” He can only say, if he himself is a true disciple of the Master, which, alas, is not always nor frequently the case, “Treat the case as you would any other, with the remedy home- opathic to the symptoms then present.” To which the neophyte will probably answer, “But supposing I have a severe hemorrhage to treat, shall I give the homeopathic remedy, and let the woman bleed to death while the medi- cine is having time to act?” We have heard that query re- peated and again repeated, until it has become a very musty chestnut indeed. If the homeopathic remedy is given at the proper time and in the proper dose, it will do its proper work. In instant emergencies the homeopathic remedy acts instantly. The trouble is that some remedy is given, in potency which is not the true similimum. It fails to act in- stantly. The doctor blames the medicine, and not his own ignorance. Of course, if he does not know how to practice homeopathically, he must resort to allopathic expedients. Life is short and art is long. If he spends his energies in ac- quiring facility in the use of allopathic expedients, he will have neither time nor strength to learn how to apply homeo- pathy. Homeopathy is a stern mistress, who imparts nother secrets to him who coquettes with other 'pathies. There is a class of men, and their faith in medicine is usually in- versely to its remoteness from the tincture form, who are never tired of saying that they care nothing for homeopathy, *e e? • *e e < * © Q © to © tº O e IO THE BETTER WAY. that they want to cure their patients, and are willing to use anything that will do this. The lack of confidence is mutual. The homeopathic muse cares nothing for such men. This spurious eclecticism is based partly on natural incapacity to apprehend spiritual truth, partly on laziness, which makes a man take the road that seems easiest, notwithstanding it leads down rather than up, and partly on the necessities of a large practice. Only a man of phenomenal brain-power, thoroughly trained, can do a large practice along homeo- pathic lines. The ordinary practitioner cannot make a score of calls in the course of an afternoon, and make a score of homeopathic prescriptions, unless he has had years of care- ful study in the materia medica: by which time he will have ceased to be an ordinary practitioner. On the other hand, the allopathic road is broad and easy. It does not require much brains to learn to keep clean ; even the gilded youths who breakfast at noon at Delmonico's do that. To one who has spent so much of his life on tene- ment-house stairs; who has attended women in every degree of poverty and degradation ; who has passed from the home of opulence, where a day-nurse and a night-nurse and a nurse for the baby was considered ordinary comfort, directly to the dark closet into which sunlight and pure air had never penetrated since the roof went on, in which lay a parturient woman, who probably had never had on a really clean chemise during her whole pregnancy, and who now lay on a bed which could only be accurately described as a mass of filthy rags spread on a dirty floor, and has seen the power of the homeopathic remedy to remove or prevent complications disastrous to the health of mother or babe, with equal celerity in these extremes of the social scale, ; : : : : : THE BETTER WAY. I I and in all the several degrees between this drear poverty and that enveloping luxury, the assertion of a prominent allopathic authority,” that “the efforts of the obstetric teacher must now be directed to the introduction of anti- septic methods into private practice, as they have been into the maternity hospitals,” seems particularly ludicrous. In the latest authoritative work on obstetrics, in which is set forth in two royal volumes the opinions and practice of the day from an allopathic standpoint, it is calmly asserted “that the terrors of childbed have been but little mitigated for the young mother confined in her own home, even when under the most fortunate circumstances "t—provided she employs an allopathic doctor. So completely hypnotized has the medical profession become under the influences in the air that one of the most prominent obstetricians in this fair city of Washington f gravely remarks that the “neglect or inefficient administration of obstetrical antisepsis must, in view of its admitted value, be regarded as criminal.” Men must have fads, and this antiseptic business is per- haps no worse than another. It is a very much easier prac- tice than homeopathy; but homeopathy will do all that is claimed for antisepsis and something more. The overdone, meddlesome, and dangerous antiseptic practice has no attractions for one who thoroughly understands home- opathy, and is able to apply it to midwifery emergencies. There are cycles in therapeutics. We are at present passing through the antiseptic cycle in midwifery. Notwithstand- ing that the application of antiseptics has been fraught with * George J. Engleman, M. D., in Hirst's “System of Obstetrics,” p. 65. + Hirst's “System of Obstetrics,” p. 65. † Samuel G. Busey, M. D., ibid., p. 497. I 2 THE BETTER WAY. misfortune, and that thousands of women have been in- jured through the misapplication of carbolic acid, the bichloride of mercury, and numberless other poisons which have been so freely administered by persons who have but the most vague and unsettled opinions as to their direct value, but who are always willing to experiment on some- body else's wife, we yet find men who consider them- selves homeopathists, and who have access to all the splendid achievements of scientific therapeutics, who will stand up here and ask us to embark with them on this treacherous sea of antisepsis. Our attention has been challenged to witness the glories of this sublimated folly. Glorious accounts of its wonders and its triumphs appear in our journals, in hospital reports, and in the transactions of our societies. Tables of cases are ingeniously arranged, wherein is shown the awful mortal- ity in childbed before antisepsis was introduced, and the almost complete reduction to zero of the death-rate after- ward. Men are found willing to stand up and say that they were formerly so ignorant as to how to properly care for the paturient that many died, but that now, having accepted this universal panacea, death has been banished from the lying-in room wherein they perform this mystic rite. But those whose memories are not too fatally defect- ive may, without very strenuous effort, recall Lister and Listerism, the carbolic spray, and the rest of that parapher- nalia. Where are these things now P And yet it is not so many years ago. Well may it be said, “in memoriam ” of these, and of antipyrin, and of Koch's lymph, et al., there be fads in medicine ! The disciples of antisepsis appeal to the post hoc argu- THE BETTER WAY. I3 ment. The woman lived through it, ergo it was good for the woman. If the argument is good, let those who be- lieve that there is a better way than antisepsis record their experiences also. If the argument is good sauce for the antiseptic goose, it is good sauce for the homeopathic gander. Therefore I record one case as an example, and I select this one because it is recent, and because, if there ever was a case where the antiseptic procedure was de- manded by the surrounding conditions under which labor took place, this was that case. The environment was all that could be undesired ; and the case itself one which, under any circumstances, the accoucheur would approach with apprehension as to the outcome to both mother and babe. On the first day of December, last year, I was asked to take charge of a young woman, then about five months pregnant with her first child. The expectant mother was about twenty-three years of age, and I had known her from girlhood. She had gone out of the State to live, upon marriage, but had returned to New York in order to be under my care during her approaching confinement. She was the granddaughter of a physician, who, in his day, had been a prominent figure in New York life; but the family had gone down in the world, as so often happens when fathers are prosperous and sons brought up to luxury, and the doc- tor's son was now the janitor in a twenty-family apartment house of no social pretensions, and lived in an underground set of rooms; and it was to this basement that the daughter came home. The girl herself had been gently nurtured and well educated, being college-bred ; but she was brought into the world at a time when her father and I4. THE BETTER WAY. {} mother were deep in financial anxieties, and was conse- quently of a delicate organization, beautiful, but fragile. Her health, on the whole, had been very good, but she was a slight, Dresden-china-like sort of a girl, as sensitive as a flower. She passed through her pregnancy in fair comfort. Dur- ing the four months which preceded her confinement, which occurred March 26–27, I visited her nearly every day, and prescribed for such symptoms as arose. By this means, ap- parently, she was saved from those minor ills which are usually concomitant to pregnancy, and to which, from tem- perament and surroundings, she seemed, peculiarly liable. When a person has taken cold, and has pains in the chest, fever, thirst, restlessness, apprehensiveness, etc., and is given aconitum, if the pathological condition dissolves away, and the person returns to usual health, we may well claim that an incipient pneumonia has been aborted. And so, when the mental and physical symptoms during pregnancy are carefully met by the similimum, and disappear under treat- ment, we can reasonably hope we have saved our patient unnecessary suffering, and prepared her, in the best possible way, to sustain the shock of her coming ordeal. I have said that the janitor and his family lived in a set of underground rooms. This is hardly a correct designation, as they were not rooms in the ordinary acceptation of the word ; but wooden partitions, or Screens, had been run up, separating parts of this otherwise open cellar into box-like receptacles, in which the family disposed themselves at night. There were open doorways, but these had no doors. The floor was concrete. Through what the family called their sitting room, and also through the kitchen, passed the THE BETTER WAY. I 5 grocer, the butcher, and the baker, with the supplies for the families overhead. All the coal and wood passed in, and the ashes and garbage of twenty families passed out, the same way. And in the midst of these heterogeneous and neces- sarily odorous surroundings, from almost actual contact with which it was impossible to isolate her, she gave birth to her child. During the two weeks of lying-in, and the two subsequent weeks before she went to her husband, she was constantly exposed to any evil influence which the milkman from his stables, the butcher from the shambles, the grocer from his not over-fresh stock of vegetables, the peddler who had just come out of some reeking tenement, and the other one hun- dred and one persons who, from one motive or another, had business with the tenants upstairs, might bring. Scarlet fever, diphtheria, and whooping cough were epidemic upon the block, and if microbes ever had an opportunity at a de- fenseless woman, now was their time. I will admit to hav- ing suffered considerable anxiety on her account. Her parents did not expect her to live through parturition ; but she did. Our good friends, to whom antisepsis seems such a transcendental blessing, would have expected her to have septic fever; but she didn't. What happened was this: She was brought to bed in the best possible condition of health, both mental and physical. q Perfect mutual confidence had been established between doc- tor and patient. She believed he knew exactly what to do and what was for the best, and he knew that he could depend upon her to do exactly as she was told. The labor came on naturally and gradually, and lasted about eight hours. The child in O. D. P. position was born without so much as nick- I6 THE BETTER WAY. ing the fourchette. It is claimed that this cannot be done. But some things can be done as well as others, if we go about them in the right manner. The child weighed eight and a half pounds; the mother's normal weight is one hun- dred and five pounds. Immediately after the birth of the placenta, the mother received a dose of arnica ; this was re- peated in the course of the night twice. She had no other medicine during the entire period of lying-in, as she had no symptoms upon which to hang a prescription. The lochia was normal and without a particle of odor at any time; she had no fever, not even on the proverbial third day; the milk came naturally and without any soreness or discomfort in the breasts; she had no pain of any kind during the entire period, not even a headache; her appetite was good, and her bowels moved naturally and easily on the fifth day. I kept her in bed sixteen days, and fed her an abundance of food, in fact, carrying it almost to the proportion of enforced feeding toward the end of the period, in the man- ner of Dr. Weir Mitchell in cases of neurasthenia, the result being that on the day after getting up, she went out and walked a mile, and came home with the appetite of a schoolboy. This is an extreme case, and would be hard to duplicate in its entirety. It illustrates the power of ante-parturient medication to put the woman in such a healthy condition that she resists the influences about her, no matter how malign these may be ; and furnishes, as it seems to me, an unanswerable rejoinder to those who claim that the physician is recreant to his duty who omits to enforce, in the ordinary lying-in room, the paraphernalia of antisepsis. This case exemplifies what homeopathy will do, properly applied, and THE BETTER WAY. 17- is my answer to antisepsis. There is no doubt but that this allopathic expedient is useful in the hands of those who, know no better way of treating their parturient cases; but the man who practices homeopathy has no use for it. The following editorial notes also appeared in the September, 1892, number of the Homeopathic /ournal of Obstetrics, Gyne– cology and Pedology. As these contain even more distinctly than the thesis, “The Better Way,” the views of the author on the whole subject of antisepsis in midwifery practice, they are appended. HE discussion of antisepsis in midwifery practice is presented with the fullness which it deserves in this number of the Journ AL. Antiseptic midwifery is one of the live medical ques- tions of the day, and if the prominence here given to the discussion of this subject will help our readers to a truer under- standing of its merits we shall be glad to have aided in so, desirable a consummation. Whatever personal predilection we may each have, we ought to be willing to listen with open-- mindedness to arguments advanced by the other side. As we said in the initial number of this volume, the Journ AL OF OBSTETRICS is the arena for the expression of the views of its subscribers. The editor has his own opinions, and proposes to express them at all proper opportunities; but he is equally glad to . give currency to the opinions of others, even when diametrically - opposed to his own. It is only thus, by free discussion tempered by earnestness of purpose and charity in judgment, that we can hope to attain to the best possible practice of our art. >k >k THE able articles by Prof. Danforth and Dr. Mills present,. with fullness and perspicuity, the argument for antisepsis in midwifery, and the means by which this may be attained. Dr. Millsop, though pledging herself to a faith in antisepsis, admits. that it is impracticable of application in the ordinary cases that come to the country practitioner, and quaintly suggests that a special Providence watches over the poor and ignorant, while- the rich and cultured are left to the antiseptic care of the accom— I8 THE BETTER WAY. plished obstetrist. Prof. Pauly believes in the golden rule of cleanliness, and states that no antiseptic is satisfactory, for one after another is taken up to be put aside for a successor, and as our idea of the subject becomes broader, the use of chemicals lessens, while attention to cleanliness increases. Prof. Cogswell affirms that if the use of injections was discontinued there would be fewer lives sacrificed and less work for the gynecologists. Dr. Winterburn says a few words for homeopathy, not doubting that antisepsis is a useful expedient in the hands of those who know no better way of treating their parturient cases, but assert- ing that the man who practices homeopathy has no use for it. In the lively discussion which followed the reading of these papers, and which lasted for three hours, a number of well-known prac- titioners expressed their views. These will be found reported in full in this number, beginning at page 486. It will be seen that the opinions expressed were overwhelming in favor of antisepsis. * * * º HAT, then, is antisepsis 2 This is a somewhat hard question to answer, for the devotees of antisepsis are by no means agreed as to what constitutes a proper procedure. What one de- clares to be the only safe and scientific manner of conducting a case, another denounces as meddlesome and dangerous ; and yet both claim to be orthodox antisepsists. The carbolic spray, once thought the very essence of good practice, has doubtless every- where been abandoned. It fortunately never had great vogue in American midwifery, but in Europe, and more particularly in Germany, it was practiced upon thousands of women, to the per- manent detriment of many ; until at last even the most obtuse were convinced that however good it might be in theory, in practice it was costly in human life. The moisture-laden air which its use involved caused complications so serious in nature that they could not be ignored, and amid the outcries of the younger men, who openly rebelled against this death-deal- ing procedure, it went into innocuous desuetude. The same may be said of every other antiseptic expedient which has been in vogue long enough to reveal to unwilling eyes its power for mis- Achief. We do not intend here to go through the long list of ways THE BETTER WAY. I9 and means which have been devised, exploited, and abandoned, because, with the possible exception of the spray, each has still its adherents. One instance will suffice to illustrate our meaning ; manifold others might be given if space permitted. Less than two years ago the following remarkable procedure was in vogue in Paris hospitals, and may be yet for all we know to the con- trary : * Beginning four weeks before the expected labor, the patient receives twice daily a vaginal injection of a 1–1 ooo sub- limate solution, and in the intervening period between these in- jections wears an iodoform gauze tampon in the vagina. When the labor pains begin the tampon is removed, and an examination made. If everything proves normal, a new tampon is placed in the vagina and is allowed to remain there until pushed out by the advancing head. On the completion of labor the vagina is washed out with sublimate solution, and a tampon again inserted. This is changed daily, and in addition an iodoform or a subli- mated compress kept over the vulva. Green of Boston, himself an ardent antisepsist, according to, his own acceptation of the term, denounces this procedure as “antisepsis run mad,” f while Englemann of St. Louis speaks of the prophylactic douche, even when used but at the beginning of the case, and without all this rigamarole of iodoform tampons and sublimated pads, as meddle- some and dangerous, and gives special credit to Max Runge, assistant to Prof. Gusserow, who in the face of opposition and ridicule (1880—mark the date) abandoned it and outlined a more reasonable practice.f *** T is a somewhat interesting, but by no means exhilarating oc- cupation to watch the progress of a medical idea. Somebody proposes it. Then somebody in authority takes it up. It gradu- ally gets whispered about that so-and-so says so-and-so. The more wide-awake portion of the profession stumble over them- selves in the mad rush for something new, as witness the proces- sion to Berlin two years ago. Gradually that large number of the * Verchère, L’Abeille Médicin, 1890, No. 9. + Boston Medical and Surgical Journal, January 22, 1891. f George J. Engleman, “History of Obstetrics,” in “Hirst's American Sys- tem of Obstetrics,” vol. i. p. 67, IS90. 2O THE BETTER WAY. profession who never read a medical journal, except an occasional sample copy, learn that something is going on. But meanwhile those on Olympus who were so fascinated with the new toy have come to the time when it makes them tired, and they cast it aside for the next novelty. The bulk of the profession do not read, and, consequently, the now worn-out sensation finds an ever widening field as it descends from the heights of Olympus to the darker valleys below. This is well illustrated by the history of the rise and progress of Liebig's preparation of beef. The older men in the profession can well remember when his extractum carnis was heralded as the ideal food for the sick. A few years passed, and Baron von Liebig himself repudiated as untenable the views which he had previously advanced with no little firmness and pertinacity. It was admitted that the extract was no better than urine as an article of diet, a statement which can be extended to include or- dinary beef-tea. But has this put an end to the sale of the ex- tract? By no means. The better men in the profession have discarded it, but it is still prescribed by a vast majority of that class known as “the busy practitioner.” This is an ensample of what has always constituted therapeutic progress from an allo- pathic standpoint. It is as true to-day as it was in any past age, heightened by a frantic attempt to find something which shall ob- struct the triumphant march of the doctrine of similia. It is characteristic of this restless desire for novelty that every new thing is hailed as the acme of knowledge, and the pervading spirit is still the same as when, in the early part of the century, Boyer wrote: “Surgery, in our day, has made the greatest progress, and appears to have attained, or nearly so, the highest perfection of which it is capable.” Boyer spoke as one having authority. There were those who spoke for antisepsis, at Washington, who were filled with the same flatus. *** HE antisepsists are not a bashful crowd. They claim the earth and the fullness thereof. Anything which seems good in their eyes, each man according to his own point of view, is— antisepsis. In fact “antisepsis" is a sort of trade-mark, like “malaria” or “heart failure,” and is as elastic of application as THE BETTER WAY. 2 I these. The chemical agents are all antiseptic—until they are found out to be otherwise. Phenic acid has been given for nearly a score of years in typhoid fever because of its microbi- cidic power, though now it is only too well known that phenic acid is an excellent culture medium in which the typhoid bacilli thrive. But it is not alone chemical forces which they invoke. Von Bergmann has said that a ligature is one of the most im- portant antiseptic agents. Blood—simple blood, which von Bergmann considers a most potent cause of sepsis, and it is to get rid of blood in the wound spaces that he lauds the ligature as an antiseptic by exclusion, on the same principle as the iodo- form tampon is used by Verchère—is, according to a recent writer, one of the best antiseptic agents. Another writer goes so far as to class “gentle handling of the parts " among antiseptic agencies. Welch, of Johns Hopkins, inveighs against those who differentiate asepsis from antisepsis, and claims that ordinary cleanliness is antisepsis. When, in connection with all this, we take the statement of Geppert, corroborated by others, and during the past three months acknowledged by leading bacteriologists to be correct, that, in the presence of fatty matters, or albumi- nous substances, corrosive sublimate is no better as a disinfectant than an ordinary salt solution, and that in such a situation as the vagina, while corrosive sublimate has powerful inhibitory power it does not actually destroy the pathogenetic bacteria, we may well ask: What is antisepsis *** HE dogma of antisepsis is older than Karnac or the Pyramids. In its nineteenth century revival it has assumed as kaleido- scopic a character as ever befell an attempt to improve on nature. In so far as antisepsis stands for that cleanliness which is akin to godliness, it is in accord with nature and deserves universal appli- cation to both the healthy and the sick ; but chemical agents have not established themselves, either in reason or experience, as the necessary basis of cleanliness. Dirt has been wittily de- scribed as matter out of place. In the attempt to make living tissue clean it should not be forgotten that it has some power of its own in this direction ; that nature kept things pretty tidy long before the obstetrician was evolved in the progress of civiliza- 22 THE BETTER WAY. tion, and that a vagina is not to be cleaned by the same methods as a dishpan. We reach here the key to the whole situation. The ideas advanced by the antisepsists are baldly material and mechanical. Because a bistoury can be made clean by scrubbing and polishing, they imagine the same ends may be accomplished by the same means in a vagina. They take it as a matter of course that be- cause a bistoury would get dirty if left to itself, a vagina is equally incapable of self-protection. But a vagina is not inert. It is composed of a multitude of so-called cells, each of which is a living creature, and with a power of self-protection which seems little understood. The healthy vagina can and does keep itself clean. If it is not healthy it is within the province of the physician to make it so ; and this not by means of chemical douches, which can act only in a mechanical and perfunctory manner, but through the forces which lie latent in his medicine case. The homeopathist who has to fall back on mechanical treatment is no homeopathist at all. And the man who essays to practice any specialty in medicine without homeopathy ignores the only law of cure which has as yet been discovered and formu- lated. Sk :: :: OEDERLEIN of Leipsic has made a very thorough study of the vaginal secretion. We commend his observations thereon to the attention of those who imagine antiseptic mid- wifery to be the culminating glory of the fin de X/X siecle. Those who can not read the original can find an excellent résumé there- of, by Dr. Whitridge Williams, in the American Gynecologica/ Journal, May, 1892. Therein is shown that the vaginal secre- tion in healthy women, virgin or pregnant, is largely composed of a bacillus, which can be cultivated upon sugar bouillon and ager- ager. It produces an acid, thought to be lactic acid, with great rapidity, and to this the normal acidity of the vaginal secretion is due. The products of the life of this bacillus are fatal to most of the pathogenetic organisms. Pus introduced in large quantities had entirely disappeared in four days. In young girls, virgins, as a rule, the vaginal secretion is more intensely acid than in married women. Of the latter, Doederlein examined the vaginal secre- THE BETTER WAY. 23 tion from 195 pregnant women, of whom somewhat more than one-half had normal and the others abnormal secretion. The normal secretion contains no bacilli save the large vaginal one spoken of, thus disproving Garrigues' assertion that pathogenetic germs exist normally in the vagina.” The pathological secretion, however, possesses marked pathogenetic properties, as proved by inoculating rabbits ; microsopically, it consisted of epithelial cells, many pus cells, and a mixture of all kinds of micro-organisms, in- cluding the streptococcus which bacteriologists consider the cause of puerperal fever. In cases where pathological secretion is found, a one per cent. Solution of lactic acid favors the growth of vaginal bacillus, and a consequent destruction of the pus cells and micro-organisms. This is corroborative of what has been long known that an injection of simple syrup (i. e., sugar dissolved in water to the point of saturation) would change an abnormal vaginal secretion to a normal one ; or, as Prof. John C. Morgan says, “sweeten the parts " by making the secretion acid, so that it gives an intense reaction to litmus paper. To those who know how to cure leucorrhoea homeopathically the proper course of procedure in Doederlein's 44.6 per cent. pathological cases need not be pointed out. If the vaginal secretion is abnormal the pregnant woman is a sick woman, she is a woman needing treatment, and if she fails to receive the appropriate treatment trouble may be expected during the puerperium. Few doctors realize the importance of watching with utmost solicitude their preghant patients, and providing against puerperal accidents by strictly homeopathic treatment during gravidarum. When this becomes the rule of the profession, there will no longer be even the semblance of an excuse for chemical antisepsis. >k >k >k HERE is, however, a still stronger argument against the validity of the claims put forward for chemical antisepsis. It is becoming every day clearer that the most valuable agent which the surgeon has, in his efforts to secure asepsis, is the capacity of the fluids and cells of the animal body to overcome in- * H. J. Garrigues, “Antiseptic Midwifery,” in Hirst’s “American System of Obstetrics,” vol. ii. p. 305. Tº 4 THE BETTER WAY. vading micro-organisms. In the light of the knowledge which has dawned upon the bacteriological mind during the past twelve months, it seems plain that hitherto the efforts of the antiseptic 'surgeon have been directed too exclusively toward the attempt to keep bacteria out of wounds, and destroy micro-organisms which have found entrance into wounds, and not enough toward preserving the germicidal power of the tissues and fluids. The experiments of Nutall, * and of Buchner, f and of Nissen prove the germicidal action of fresh-blood serum, a power which it does not lose even by freezing and thawing. These conclusions have been re-enforced by the experiments of Prudden Š on non-inflam- matory transudations of the body. This germicidal power is as- sociated with the albuminoid constituents of the fluids of the body, both those contained within the body and those excreted upon its surface. These discoveries will not be welcomed very warmly by some of these who have committed themselves to antisepsis as it is usually understood. Even the medical jour- nals are silent in the presence of these significant evidences of the marvelous power of the body to preserve its own integrity. And yet all this is only in the line of what was already known. The very occurrence of self-limiting diseases, such as typhoid £ever, lobar pneumonia, etc., indicates that there is within the body some sort of adjustment of forces by which, under ordinary conditions, the deleterious effects of pathogenetic micro-organ- isms are neutralized. We would not have it understood that these experiments amount to absolute demonstration ; the crust over chaos is not yet very solid; but these facts are in accord with the general trend of evolution, and not contrary to it as the chemical theories of asepsis are. We, therefore, commend them to the closest scrutiny of the antisepsists. As Prudden naïvely * “Experimente über die bacterienfeindlichen Einflüsse des thierischen Körpers.” Zeitschrift fºr Hygiene, bd. iv, p. 353. + “Úber die bakterientôdtende Wilkung des zellenfieien Blutsetums. Centralblatt /zir Bacteriologie, etc., bd. v., No. 25, and ba. vi., No. I. f “Zur Kentniss der bacterienvernichtenden Eigenschaft des Blutes.” Zeitschrift für Hygiene, bd. vi., p. 487. § T. Mitchell Prudden. “On the Germicidal Action of Blood Serum and other Body Fluids.” Medical Record, vol. xxxvii, No. 4. THE BETTER WAY. 25 says : “The significance of these new discoveries would seem to be very great and far-reaching in calling back the attention of therapeutical adventurers from germicidal warfare to what ap- pears to be the natural defense of the organism against bacterial invaders, namely, a healthy condition of the blood.” >{< Sk sk ISER words were never uttered. The natural defense of the organism is a healthy condition of the blood. This is not to be secured by the obstetrician spending forty minutes washing his hands and making his toilet while the woman is lying in the throes of childbirth awaiting his attentions. This is not to be secured by precipitating the albumin in the normal vaginal secretion with mercuric chloride, and so destroying the natural protection elabo- rated by the system itself. This is not to be secured by occlud- ing a natural opening of the body which in a state of health pro- tects itself, and in a state of disease contains already the germs which the occlusion is intended to exclude ; and the bacteriologist knows that the micro-organisms grow most prolifically, in the culture medium, when the opening to the test-tube is occluded by some impervious material. This is not to be secured by any amount of douching, or scrubbing, nor by any sort of chemical or mechanical treatment, Leave all those things to those who know no better way of treating their parturient cases. A healthy condition of the blood can be secured by the proper application of the homeopathic remedy at the proper time. The proper time to treat these cases is during the progress of pregnancy. The man who permits the women in his regular clientèle to come to bed, without having had all the advantages which homeopathy can give them during the previous nine months, is shamefully negligent of his duty, and is responsible before God for every unnecessary pain they may suffer. There is no time in the life of woman when homeopathy can do so much for her as during pregnancy. We hope to show this in a forthcoming thesis on “The Mother in Pregnancy.” During the gravid period, and especially during the earlier part of it, the woman's system is in a state of flux, which furnishes the physician an opportunity of which he but rarely avails himself. The true line of progress in midwifery is not to be found in antisepsis, but in securing for the woman that : . 26 THE BETTER WAY. natural defense of the organism, a healthy condition of the blood- Women do not know this. They look upon the obstetrician as a mere mechanic. And how should they know any better when the obstetrician himself considers midwifery practice as a mere separat- ing of mother and babe, and ignores all its higher functions It is alleged that the obstetrician does not and cannot know his cases thus early, that most frequently he only sees the case after the woman is taken with pains. Personal observation and ex- perience lead us to affirm that he can have his cases, as a rule, from the earliest weeks of pregnancy, if he so desires. All he has to do is to educate his public, and he will do this just as soon as he realizes the advantages to be derived from so doing—advan- tages which his patient, himself, and medicine in general alike share. * >k >k O far in this discussion we have seemed to coincide with those who look upon obstetrics as a department of surgery. We have done so because the surgeons practically assumed control of the discussion at the Institute meeting, and we have chosen to meet them on their own ground. Man after man got up and stated that he did little obstetrical work, and then proceeded to talk about antiseptic midwifery. We were very glad to have them express their opinions. We have already expressed our opinion that the man who does midwifery practice should be an obstetri- cian. The more he is an obstetrician, and the less he is a sur- geon, the better for his patients. One surgeon who took part in the discussion said : “My experience in obstetrics is limited , nine-tenths of the cases of childbirth are surgical cases . . . a doctor's hands, unless he is thoroughly alive to the matter, are the most dangerous thing on the face of the earth.” This may be the experience of his unfortunate patients, he is certainly in a position to know, but no competent obstetri- cian would subscribe to such a statement as representing his own practice. On the contrary, labor is a physiological process, and never becomes a surgical one unless (1) the mother or child is markedly deformed or disproportioned, or (2) the case has failed to receive the medicinal treatment which the symptoms indicated. Doubtless, in the hands of an incompetent attendant, many cases º o wº e"e te O : : © THE BETTER WAY. 27 become surgical which only required ordinary skill to have been conducted to a more satisfactory conclusion. This is no reflec- tion on the surgeon in question, who is of excellent repute in his own specialty and a “jolly good fellow beside ’’; but a man may be a good orthopedic or aural surgeon, and be either by nature or inexperience an incompetent obstetrician. It seems to be con- sidered that any graduate in medicine can do midwifery work, but it requires as much special natural aptitude to be a good obstetrician as it does to be a good surgeon, and the two are rarely united in the same person. The reason for this is that the tendency of surgery is more and more toward purely me- chanical treatment, to the use of the bistoury rather than the medicine case, while obstetrics, properly studied, insists upon therapeutic measures as replacing mechanical ones. The crudest obstetrics is purely mechanical. As methods become more refined, it is seen that it is wise to refrain from unneces- sary interference. What formerly was thought proper is now con- sidered officious and meddlesome. The highest ideal of normal labor is one in which extraneous assistance is not required, and this results from perfect health on the part of the mother and normal development on the part of the child. The methods by which this may be secured are known and will engage our attention in a subsequent issue of the JOURNAL. *** EFORE closing the discussion we wish to make a prediction. And this we do with a full knowledge that a prophet is with- out honor in his own country, or, nowadays, anywhere else. Nobody will remember the prediction when it comes true, and meanwhile it will form a subject of jest for the scornful. The wise man never prophesies, at least never except to affirm that what the popular opinion declares to-day to be true will always remain true forevermore. We were not born wise, but otherwise, and, therefore do not fear to rush in, etc. No one need be told that chemical antisepsis is the popular theory of the day in the medical world. The courteous professor of obstetrics in a college not a thousand miles from New York, who told the writer on the conclusion of the reading of “The Better Way,” that he 28 THE BETTER WAY. was “not in it,” that he “had better go home and read, and learn something,” and that he “didn’t know what he was talking about,” was only voicing the sentiments of the bulk of the profession. Nevertheless, we venture to record our dissent, and to repeat that homeopathy can do all that is claimed for antisepsis, and more. Beyond this we further venture to put on record the assertion that, before the bells ring in the twentieth century, the leaders in chemical antisepsis in midwifery will have abandoned its use ; that the men who make public opinion in medicine will have ceased to use on or within the person of the parturient woman, or in the room in which she is confined, any form of chem- ical disinfectant, and will rely exclusively upon—boiled water, used at such temperatures as may seem expedient. The use of boiled water before it has returned to its normal temperature, pro re nata ; the careful avoidance of unnecessary interference with the natural course of mechanism in labor ; and securing to the woman that natural defense of the organism, a healthy con- dition of the blood, seem to us the tripartite components of an ideal midwifery practice. We can hardly hope to see this ac- cepted as the universal practice in our own day, but it will be, we hope, the ideal to which men's minds will be turning with the opening decade of the new century. So mote it be No. 230 WEST I32.D STREET, NEw York. CHIG *** < . | | f Y of | | \!șĒ •; *r3 •~~~~ ș，***~~~~*****…）, `ſ，******） -* \,ș ſae* ** «; , ，-* * “... :’）, º * ~:：s' * --- ~~ * . . . ... * * * * ·,·， ș- -*- » .* … *x* »----#*-• ×.*••• •- --<！---。、:: -** --'... :-）--~~~~）; …..！ ！ : „ ” （” , ， ， … --~~ ~~~~）; *****A.-^^ ^--.---**** **„ș” •-- ~~~~ . }.*~~~* * ， *、š ： » ¿ț¢ tº ！“, „ ș °-ºſ. *|× Ā → ¿