IN one of our Medical Journals I read that a doctor should have thirty-three instruments and fourteen remedies in his trunk; then he is prepared to attend an obstetric case. In the four thousand hours of instruction given to medical students in Philadelphia during the winter, fifty per cent. of the time is devoted to surgery. Thus it would seem that the colleges deem it much more important to know how to "cut up" a patient than to know how to cure them. How much time is given to teaching students how to prepare a pregnant woman for her "hour of trial"? None at all. To-day great stress is laid upon the "operative" treatment of midwifery. As a result of such teaching the average doctor goes to an obstetrical case with visions of turning, abnormal presentations, convulsions, flooding, instrumental delivery, etc. He expects trouble and he generally gets it. One thing he always seems to forget is that child birth is a natural process of Nature, and that meddlesome midwifery is bad and in most cases entirely uncalled for. That in nine cases out of ten Nature will do the work if we let her alone and don't "butt in." The young doctor is impatient; he is in a hurry, he likes to make a "play to the grand stand" by the use of instruments, and collect an additional fee for applying the forceps. He tells the husband all kinds of ghost stories of what will happen to the woman if he does not deliver her with instruments. He is prone to inject some kind of "dope" into her or apply chloroform to kill the pain. This kind of treatment makes business for him later. If the pains are not strong enough to suit him he gives ergot. That remedy causes powerful contractions of the uterus and has killed thousands of babies in this world. The use of instruments to deliver a woman at confinement is the cause of 60,000 women in the United States being affected with cancer of the uterus. The use of chloroform or some kind of dope to kill pain makes invalids and business for the gynecologists. In my student days I attended lectures on obstetrics under four different teachers of that branch of medical study. Two of them were practical men and their teaching was along practical lines. They had the largest obstetrical practice in their respective cities and in their thirty years' practice had never used the forceps to deliver a woman at confinement. In my own practice of forty years I have never used the forceps or had a pair in my possession. During that time I have attended three hundred cases of confinement and have never lost a woman during or after her confinement. I have never had a case of laceration of the perineum or puerperal convulsions in my own practice although I have seen them in the practice of other physicians. Why did I not meet with such cases in my practice? Because I always put the woman under the proper course of preparatory treatment, before the expected labor.
The Indian women never have a doctor in confinement. They know how to treat themselves. They drink squaw wine—partridge berry tea before the confinment and thus have a quiet and easy labor. The Eclectics have used the mitchella repens (partridge berry) for the past seventy-five years as a preparatory treatment for child birth and it has given them splendid success in obstetrics. When I have a case of confinement to attend, I always give the woman, about two months before the expected time, the following remedy:
Rx. Spec. Med. Mitchella, ℥iv.
Fl. Ext. Cimicifuga, ℨiv.
Syr. Sarsaparilla, q. s. ℥viii.
Mix. Sig. Teaspoonful after each meal and at bedtime.
When this remedy is used beforehand as directed, I have had no postpartum hemorrhage or convulsions. The labor is generally quick and easier than it would be without this preparatory medicine. If albumen appears in the urine previous to full term you should give Fl. Ext. Eupatorium purpurium. Dose, fifteen drops three times a day. This will speedily clear it up. I would urge upon my brother physicians to lay aside their prejudice and give these remedies a fair trial in their cases of expectant labor. If they will it will prove a Godsend to thousands of expectant mothers. If there are symptoms of abortion—pain and flowing—give half a teaspoonful of Hayden's Viburnum Compound once in two hours in a little cold water. In threatened placenta previa this remedy has helped me delay the accident. In a case of false conception where it seemed as if the woman would flow to death Hayden's Viburnum Comp. gradually checked the flooding.
Some women have a weak heart in pregnancy. These should be given three drops tincture digitalis three times a day to strengthen the heart's action. Many cases of sudden deaths during child birth could have been avoided if the heart had been stronger and no powerful arterial sedative had been given to weaken its action.
Pregnant women are frequently troubled with constipation. Cascara cordial will prove very beneficial in such cases. Dose, one to two teaspoonfuls at bedtime. For hemorrhoids you should give tincture aesculus (horse chestnut) five drops night and morning. Apply black molasses to the little tumors, push them back into the rectum and apply a small pledget of absorbent cotton against the anus to keep the molasses from soiling the clothes. If this is done a few times after each movement of the bowels it will cure the hemorrhoids. Pregnant women will often crave chalk and suffer from the toothache. It is the demand of the system for lime. Let her nibble a piece of chalk several times a day, or give her five grains phosphate lime three times a day. It is the best way to cure the toothache in a pregnant woman and when the child is born there will be more probability of a healthy child, and you will have less trouble during dentition. To harden the nipples the yolk of an egg and glycerine, equal parts, is a good remedy. Apply once or twice a day, a month before the expected confinement. The "morning sickness" is a great cause of distress to the pregnant woman. Inserting the index finger three quarters of an inch inside the neck of the uterus to dilate the external os has cured many cases. In my practice oxalate cerium five grains three times a day has proved effectual, or ten grains of ingluvin after each spell of vomiting. Plethoric women are often troubled with nervousness, are "figity," have horrible dreams, are frequently wakeful, in such instances bromide soda is the needed remedy. Dose, five to ten grains once in six hours. In cerebral congestion, flushed face, cold hands and feet, throbbing carotids, veratrum viride is the needed remedy. Dose, five drops of the first decimal tincture veratrum, once an hour for three hours, afterwards once in three hours. For the hysteria and hysterical spasms sometimes present you should give bromide camphor. Dose, five grains first decimal, every fifteen minutes until relieved. Sometimes there will be trouble with the bladder and your pregnant woman complain of being obliged to urinate very often. In such instances tincture staphisagria is the indicated remedy. Dose, five drops of the sixth decimal every two hours. Cramps in the calves of the legs during the latter months of pregnancy can be helped by five drop doses of tincture viburnum opulus, once an hour. For pain and soreness of the abdomen in the last month I like bathing the part with one ounce warm sweet oil to which has been added one fluid drachm tincture arnica. The abdomen should be bathed each night during the last month of pregnancy. Some women are very cross when pregnant, nothing pleases them. For such cases we have our chamomilla. Dose, add twenty drops tincture chamomilla to a glass of water; mix and give a teaspoonful every two hours. Pain under the left breast is often met with in pregnant women. Give these cases two grains first decimal macrotin once in three hours. If the urine is scanty, sometimes dark, at other times profuse and watery with edema of the face and feet, digitalis is the remedy. Dose, two grains second decimal digitalin once in three hours. If there is anemia ferrum first decimal should be given.
Dose, three tablets after each meal. The adminstration of this remedy will often prevent hemorrhage after labor in women who are predisposed to it. If a woman in the last stages of pregnancy becomes enfeebled, pale, anemic, dyspeptic, urine excessive or deficient in quantity—sometimes albuminous, great depression of spirits, helonias is the remedy, especially when simulating Bright's disease. Dose, three tablets of second decimal helonias once in two hours. The "mitchella comp." as mentioned in the early part of this chapter to be given before confinement will help those "cramplike" pains of women in the latter months of pregnancy. In some women you will get excessive salivation during some part of their pregnancy. For this condition jaborandi is the remedy. Dose, three tablets of the second decimal three times a day. A dropsical condition is one of the distressing complications sometimes met with in pregnancy. The best remedy to remove the dropsy is Ext. elaterium. Dose, one-tenth grain every four hours. It will produce profuse diuresis and fluid discharges from the bowels; it has prevented coma and convulsions in the uremia of pregnancy. For the heart burn which frequently presents itself you can give a teaspoonful of elixir Lactopeptine or peptenzyme after each meal. Do not tell the woman (as some doctors do) when called to prescribe for the ailments of a pregnant woman, "Oh, it's your condition; you must expect all these things until after you are confined." Such a doctor should be discharged and one engaged who knows how to care for a woman during pregnancy. A physician who is not capable of carrying a woman safely through the disorders of pregnancy should not be trusted to attend her at the time of her confinement.
You may be called to a case of severe flooding during confinement and such cases are "something one never forgets." If ever a doctor needs to have the right remedy it is then. I have used a remedy which has never failed me even in the worst cases. Every doctor should keep it in his satchel and have no fear of the "bleeders." It is the following:
Rx Sulphuric Acid (by weight), ℨv.
Oil Turpentine, fl. ℨii.
Mix. Place the acid in a wedge wood mortar, slowly add the turpentine to it, stirring the mixture constantly with the pestle. Then add alcohol 503 minims in the same manner, constantly stirring until all the fumes arise. Place it in a well secured glass stoppled bottle. If properly made the mixture will be dark red color like dark blood, but if it is a pale dirty red color it is not fit to use. After a few days a pellicle forms on the surface which must be broken and the fluid below it used when needed. Dose, into an ordinary tea cup place a teaspoonful of brown sugar, add forty drops of the above mixture, mix them thoroughly together; slowly stir in water until the cup is nearly full. This should be immediately swallowed by the patient. Repeat the dose in an hour if it is needed. This is called "Warren's Styptic Balsam," and was used by him for hemorrhages from the uterus, stomach, lungs and nose. It is one of the remedies handed down to us by the fathers of the Eclectic School of Medicine.
It is well to instruct your patients when they feel the first labor pains to take an enema of warm water to clear out the bowels; it also helps to relax the rigid os. If the pains are not regular and as strong as they might be, place twenty drops of tincture cimicifuga in a glass of water. Mix and give a teaspoonful every half hour. It will produce natural pains and hasten delivery. It will not hurt either mother or child. When the patient is nervous, restless, and the os is rigid, the quickest way to overcome the rigidity is to give ten drops of Lloyd's Spec. Med. jaborandi every half hour. One or two doses will produce profuse diaphoresis; it soothes the patient, she bears her pains better, the rigid os relaxes, it dilates more rapidly and in a short time the labor is terminated satisfactorily. This takes the place of the forceps and "dope" or chloroform.
When the pains are pressing down upon the bladder or rectum and the patient imagines she must urinate or have a stool, nux vomica is the remedy. Dose, five drops tincture nux vomica in a glass of water; mix and give a teaspoonful once an hour. You will have patients that are cross and peevish. They are very sensitive to the least pain and exclaim continually, "Oh, I can't bear this pain!" Give them tincture chamomilla. Dose, add twenty drops to four ounces of water; mix and give a teaspoonful every hour.
When the vitality of the patient is low, she is worn out with worry and trouble of some kind, patient restless, tearful and nervous, she should be given kali phos. Dose, add five grains third decimal, kali phos. to a half cup of warm water and give the patient a teaspoonful every fifteen minutes. It will put new life and energy into her, strengthen her nerves and bring on strong vigorous pains which will soon terminate the labor. Your patient expects you to help her in her hour of trial and wants you to do something for her. Study her symptoms carefully and give the remedy indicated. If the afterbirth does not come away with the child, wait a few moments for the woman to get her breath, then grasp the hand firmly over the uterus, tell the woman to bear down and one or two pains will expel the placenta. For the after pains put twenty drops tincture gelsemium in a glass of water; mix and give a teaspoonful every half hour. If your patient seems to be flowing more than she ought put a teaspoonful of pulverized cinnamon in a cup of hot water and give a teaspoonful every few minutes. It will check the flow to about the natural quantity.
When the shoulder presents, fold up quilts two feet square, and pile them in the middle of the bed, about eight inches high. Let the woman kneel on this pile of quilts, bringing her face down forwards upon the bed. Pass your hand into the vagina, well oiled and if the shoulder, uterus, child and all have not already passed back, press very gently and they will by gravity pass down and back. Follow with the hand extended, when the fingers will readily grasp the head; and by the aid of a pain, it will approach and engage in the superior strait. Retaining the grasp with the fingers, lay the woman on her left side or back and you will have a natural presentation. My object in relating this method is, that it is far better than the old rule—to turn and deliver—and can be easily accomplished in less than two minutes, besides being altogether free from danger both to mother and child. I trust, before long to see the method brought more prominently before the profession; and I am certain that all who try it will be delighted with the results.
During the years that I practiced obstetrics in a town of 10,000 inhabitants, I had more cases of obstretics than any of the other physicians. The women liked my method of treating such cases. They got up nicely after their confinement and there were no bad after effects. All I tried to do was to assist "Nature."
Definite Medication, 1911, was written by Eli G. Jones, M.D.