A REVIEW OF MODERN ANTISEPTIC MIDWIFERY,

BY EUGENE FOSTER, M. D., Augusta, Ga.

In no department of medicine can we find a more striking illustration of the fickleness of medical opinions, nor a more valuable and instructive lesson to the seeker after truth, than is presented to the mind of him who patiently, laboriously, and intelligently investigates the literature of puerperal febrile diseases. The literature of the subject reaches thousands and tens of thousands of pages, and after spending months upon months in close and intelligent study of these diverse and voluminous papers, the student rises from his task fully satisfied that writers who have attempted to solve the problem have but rendered "confusion worse confounded."

It may be humiliating to our pride, but the fact remains, that we know to-day absolutely nothing more of the essence of these diseases than was so imperfectly conjectured fifty

years ago.

The physician asking himself, as any conscientious man must do, what shall be his rule of conduct in the practice of midwifery, finds himself in a truly embarrassing position. In the whole service of his life he is called upon to minister to disease except in the lying-in room. Here he is called upon, not to treat disease, but to supervise a purely physiological process. His duty is solely to ward off hidden dangers and to assist incompetent nature. Do what he will, bad cases will come upon him, which neither forethought, care nor skill can avert-cases in which, although every

possible caution and due skill be exercised, disastrous results follow, and, by the innuendoes or misrepresentations of the mean and vicious, the physician is made to suffer in mind, reputation, and if a jack-legged lawyer be handy, in pocket, if he has anything therein. The responsibility of the accoucher is greater at the present day than ever before in the history of medicine. A latter-day gospel is being preached by eminent text-writers in our profession, who, in the language of Dr. T. G. Thomas, of New York, say, "The woman who is to bring forth should be treated as though she is to go through a capital operation in surgery." Dr. Thomas further said that "in private practice, even among the wealthy, there is a laxity of system and a carelessness with regard to preventive measures which borders closely on criminality." He then insists upon the necessity of executing a system of prophylactic measures, with a dogmatism which is lamentable indeed. These will be reviewed in the course of this paper.

Dr. Thomas in this paper said, in regard to the pathology of the disease, he believed that "puerperal fever, in whatever form it might show itself, was puerperal septicæmia; the cause of the affection being the absorption of a poison by solution of continuity in the genital tract, and that there were only two methods by which it could be introduced into the system. These were, first, through the atmosphere, and, secondly, by the contact of the hands of the physician or nurse, sponges, instruments, cloths, clothing, or bed-covering with the genital tract."

Dr. William T. Lusk, in his "Science and Art of Midwifery," the authoritative text-book in America, plants himself squarely upon the identity of surgical septicemia and puerperal fever, and highly endorses the same antiseptic precautions in midwifery as are used by Lister in his surgi

cal practice. He says: "The great improvement in maternity patients in recent years has been due to the application of Lister's principles to obstetric practice."

The great and learned medical school of Harvard impresses upon its students the absolute necessity of antiseptics in all obstetric cases, both normal and abnormal. Other teachers impress their students with these views, and as these young men graduate and go into practice they become preachers of this system, and are ready to criticize as an old fogy the physician who holds on to the good old way.

The journals are literally full of papers advocating Listerism in midwifery, and scarcely a writer is to be found who dares to attempt to stem this current of professional opinion. The position of the accoucher is quite disagreeable if he cannot fall into line with this latest medical fashion. If he fails to follow the fashion of using antiseptic precautions in all cases of accouchment, and his patient unfortunately has fever, he is charged with "carelessness which borders closely on criminality."

Dr. Thomas in his paper properly said, "Every scientific paper ought to be challenged for its raison d'etre." This I propose to do in the following remarks. I shall attempt to demonstrate that the antiseptic system is founded upon speculation pure and simple; and, furthermore, that this antiseptic system, as a routine practice, is, in its essential features, unscientific, unsuccessful, unnecessary and frequently directly harmful to the lying-in woman. The facts upon which my argument is based shall be taken almost exclusively from writers who are, or have been, advocates of the antiseptic system.

Permit me now, as briefly as possible to an intelligent presentation of the subject, to call your attention to the theories of the most prominent writers as to the essential nature of

puerperal fever. Mark you, theories! for each one is a matter of unadulterated guess-work. I shall not attempt to state every theory which has found advocates in our profession in the past. I shall content myself with reviewing the four prominent theories of the present day. An examination of the literature of the subject will convince the student that there is greater diversity of opinion among writers as to the nature of puerperal fever than exists in regard to any other disease in the whole catalogue.

Let us now examine these theories and ascertain if or not my statement be true or false, that the antiseptic system of midwifery (Listerism, in other words) is in its essential features unscientific, unsuccessful, unnecessary and frequently harmful to the lying-in woman in normal labor. I propose, gentlemen, to discuss this question from the standpoint of accouchment in the homes of the people-not in hospitals, which are but too often only elegant mausoleums to the mistaken philanthropy of the donors There is no analogy whatever between puerperal fever in private practice and hospital experience as to the modes of infection and the necessity for prophylaxis.

1st. Is the antiseptic system unscientific under the theories discussed? Let us see:

Take the theory of Dr. Barker, that "the disease is an essential fever, not dependent on local lesions nor local inflammations, nor absorption of dead matter, either autogenetically nor heterogenetically, nor specific poisons of the exanthemata." Dr. Barker himself says antiseptic, vaginal and intra-uterine injections cannot be recommended with safety as a routine practice in normal labor. He says distinctly that not two per cent. of cases of puerperal fever are caused by absorption of putrescent matter from the genital tract. Indeed, he is one of the few men in America who has